With the 2026 Legislative Session on the horizon, MACo is profiling some of the major issues likely to gain significant attention amongst the General Assembly. Among them, the opioid crisis remains one of the most significant public health crises facing Maryland communities. 
Although overdose deaths have declined in recent years, they remain higher than 2015 levels. Funding from the Opioid Restitution Fund (ORF), derived from opioid settlement payments to the State, has helped support local health departments, correctional institutions, and community-based organizations in their efforts to respond to the crisis. Yet, best practices for local governments to balance reporting requirements and accountability with effective solutions continues to be debated.
As Maryland counties continue to receive and deploy millions of dollars in opioid settlement funds, local leaders are tasked with translating these historic investments into meaningful impact. Beyond administrative obligations, counties must make strategic decisions about where to invest these funds in response to changing local needs and emerging best practices.
As for the current state of the ORF and its funding, according to the 2026 issue papers,
“As of the close of fiscal 2025, the ORF had a balance of $100.6 million. Maryland is projected to receive approximately $282.0 million more in settlement revenue through calendar 2038. The ORF Advisory Council meets throughout the year to develop spending recommendations and publishes an annual report each December. MOOR distributes ORF revenue to local health departments, correctional facilities, and community organizations through block grants and competitive grants, in alignment with settlement agreements and ORF Advisory Council recommendations and annually reports its spending to the General Assembly. The fiscal 2026 budget includes $67.6 million in ORF expenditures. As of October 2025, MOOR has awarded $10.3 million in fiscal 2026 competitive grants and block grants. In addition, through fiscal 2031, MOOR will distribute $50,000 annually to local governments through the Buprenorphine Training Program, established by Chapter 759 of 2025. The program will award up to $5,000 per county to train paramedics to administer buprenorphine.”
In 2025, legislation passed that addressed the allowable uses of ORF spending and increased public transparency through additional reporting requirements. HB 798/SB 589 requires the Maryland Office of Overdose Response (MOOR) and the Maryland Department of Health (MDH) to develop and maintain an interactive dashboard detailing ORF spending.
In November 2025, MOOR released its new Opioid Restitution Fund Primer, which comprehensively details Maryland’s opioid restitution structure and offers the public a better understanding of how settlement dollars are being managed and distributed across the state.
Additionally, MOOR released an updated one-pager highlighting areas of focus and recommended strategies for effective ORF spending.
As state policies and oversight structures continue to evolve, the effective management and administration of these funds will remain a critical issue in the 2026 legislative session, shaping how Maryland ensures accountability and meaningful outcomes in addressing the opioid crisis.
