With the 2025 Legislative Session approaching, MACo is profiling major issues, including the opioid crisis, that stand to gather significant attention.
The Maryland Department of Legislative Services is forecasting additional legislative measures to address the opioid crisis across the state. The opioid epidemic remains one of Maryland’s most urgent public health crises, making it a key issue for the 2025 legislative session. Although overdose deaths have decreased slightly—by 2.4% in Maryland from April 2023 to April 2024—the crisis remains severe, with fatality rates in 2024 more than double those in 2015.
With millions in opioid settlement dollars to combat the epidemic’s devastating effects, counties are navigating complex funding streams, rigorous reporting requirements, and shifting state policies. Their efforts are not just about meeting standards but ensuring these resources make a real difference in their communities.
Maryland’s Opioid Restitution balance is around $75.4 million, as recently published in the agency’s report. In the last session, the Maryland General Assembly passed HB 980/SB 751, which added another layer of accountability. This bill initially tasked the Maryland Department of Health (MDH) with developing a plan to make all opioid settlement expenditures accessible to the public. Maryland’s Office of Opioid Response recommended the best way to consolidate and share information about how state, county, and municipal levels use opioid settlement funds.
According to the 2025 Issue Papers:
While overdose fatalities have decreased over the last year in Maryland and the United States, the number of fatalities in Maryland in 2024 is more than twice those in 2015. Overdose deaths overwhelmingly involve opioids, primarily fentanyl. Maryland has received, and will continue to receive, hundreds of millions of dollars from opioid settlement awards. The State has established an Opioid Restitution Fund and several governance mechanisms to determine how best to invest resources to prevent overdose deaths and treat substance use disorder.
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MDH distributes this funding to local health departments, correctional facilities, and community organizations through block grants and competitive grants, and annually reports its spending to the General Assembly. The Opioid Restitution Fund Advisory Council meets throughout the year to discuss the best uses of funding and submit recommendations on spending priorities. Per the various settlement agreements, most ORF funding will be expended through competitive grants, and some will be distributed to local governments as block grants through a formula. Some ORF funding is expended at the discretion of the Secretary of Health who, in 2024, committed to distributing all discretionary funds through grants to local governments and organizations.
Ensuring these funds are used effectively and equitably will be a central legislative challenge.
As covered previously on the Conduit Street blog, MACo anticipates upcoming legislation that would require increased reporting requirements for local jurisdictions receiving money from opioid settlements. While intending to show transparency and a comprehensive view of how settlement funds are allocated and used across the state, counties already comply with copious reporting requirements. Continuously adding layers of reporting could ultimately result in a system that unintentionally prioritizes paperwork over meaningful remediation efforts. As such, it is important to balance accountability with effective solutions to address the opioid crisis at the local level.
