FROM OPIOID CRISIS CAPITAL BALTIMORE, MORE MEDICAL MISINFORMATION TO HIDE CAUSES OF RECORD DEATHS AND A WORSENING CRISIS
The city that topped all others for record deaths now plans to use $hundreds of millions in settlement funds for the same lethal treatments
by Clark Miller
Published August 1, 2025
A long road to recovery would be understandable, a remarkable reassurance, as would be even some signs of coming relief. But not, driven by reckless disregard, a long painful drive on a dead end, on an avoidable, predictable course of continuously increasing high-risk opioid and opioid combination drug use and deaths with emergency, harm-reducing, dependence on a single factor moderating deaths, Narcan, whose days are numbered. Certainly not when that predictable course, fueled by America’s expert, gold standard medical and other treatments for an entirely non-medical condition have been established for years as lethal failures, as fueling the epidemic, have never been evidenced as effective.
From the FRANCE 24 news piece –
“We’ve had tremendous efforts throughout the city to get people into treatment, and then we’ve also had tremendous efforts in getting Naloxone out there,” said Michael Fingerhood, head of addiction medicine at Johns Hopkins Bayview Medical Center.
Distributed broadly for about a decade, Narcan has worked like a “fire extinguisher,” Fingerhood said.
Right on! So, a big push “to get people into treatment” has been the reason deaths are dropping, says a top expert, a head of addiction medicine at the renowned Johns Hopkins Medical Center. Those treatments referred to, set to be supported even more with $hundreds of millions in settlement dollars on the way, are American Medicine’s opioid substitution treatment (OST) also known as opioid agonist therapy (OAT), medication for opioid use disorder (MOUD), aka medication assisted treatment (MAT), by the dispensing of opioids buprenorphine (Subutex, Suboxone, Sublocade) and methadone.
And Baltimore, on the word of a top expert, has seen a remarkable turnaround in opioid-related deaths with surges in provision of those medical cures to diseased brains, as well as in traditional addiction treatment services (“rebab” and outpatient addiction treatment).
Let’s think a bit more about just what is being said here, in the run-up to $hundreds of millions in settlement funds being allocated, being spent to expose vulnerable Baltimore residents to some chosen array of services, “treatments”, that will potentially save lives or … have some other outcome. That’s in the context of record deaths and of the sudden downturn in opioid related deaths being, as in many other locales, dramatic, for some surprising, remarkable, in Baltimore fatal overdoses dropping by 35 percent over 2024 compared to 2023.
A dramatic welcome change, and the experts whose guidance will shape use of funds for treatment have messaged first of all, tied to that drop, the “tremendous efforts to get people into treatment” just as if there is a cause-and-effect relationship, as if we can expect that with even more doses of those substitute opioids dispensed, the crisis will abate even more, more lives will be saved. And? Then, there’s the Narcan, “Distributed broadly for about a decade”, around and out there for a decade, so it’s hard to imagine that being the factor that is tied to the sudden shift away from persistently increasing deaths, just occurring suddenly last year, 2024, when Narcan has been around, “distributed broadly”, for a decade.
It’s well worth taking a look at that, at the veracity based on the evidence of that provided picture, because it turns out that just as in other locales consistently, the lethal truth is just the opposite of what is being conveyed – opioid deaths have been rising persistently over decades, with few, transient exceptions, while provision of expert gold-standard medication assisted and other treatments have expanded over those same years and decades, as in the states and locales listed here, and in dramatic examples like this.
But what about Narcan, distributed broadly for a decade in Baltimore, does that even fit with the delayed, then sudden, dramatic drop in deaths? It turns out, just as in other locales consistently, that the timeline of an effective, targeted, intensive naloxone campaign in Baltimore corresponds to the dramatic drop in opioid deaths, and unlike for gold standard treatments, with direct evidence of a causal relationship – each report of naloxone used to reverse and prevent an otherwise fatal overdose is a directly-observed reduction in fatal ODs by 1.
Let’s consider the evidence.
In Baltimore and in Maryland generally, the availabiity and provision of substitute opioids buprenorphine and methadone were rising dramatically as early as 2013 and 2014 for buprenorphine, with provision of methadone rising to 3rd highest in the nation by 2021 measured by per capita number of outpatient clinics, 4th highest in the nation for average daily dose to recipients by 2020. Those trends and timelines are covered in detail with supporting evidence and links to research and reports in past posts for Baltimore, here, and for Maryland, here.
Maryland then joined with other states to significantly relax prescribing safety standards for methadone and buprenorphine. From the previous post –
But bupe isn’t the only form of expert-assured, proven, “medication support” for problem opioid use.
There’s methadone.
And that’s where Maryland’s efforts based on guidance from the consensus of America’s top experts really stand out.
Here’s a graphic generated by the DEA and presented in this research paper, showing Maryland 3rd highest in the nation through 2021 in number of methadone outpatient programs per 1 million population.
And magnifying that effect, also from the DEA, average daily dose of methadone for those it is dispensed to was in 2020 4th highest for Maryland among all states.
The graphic is annotated by the author of the piece it appeared in, here.
That’s a high level of dispensing of methadone to individuals with history of high-risk use, completely in line with emerging expert consensus of “the more the better”, reflecting the push beginning around 2020 for relaxation of methadone safety standards, notably “take-home” rules.
And Maryland, among the top states for dispensing methadone, again complied with calls to loosen standards.
How has that worked out, relaxing safety standards for dispensing of methadone, like buprenorphine commonly abused with additional substances?
Consistently, locales that adopted relaxed standards and/or significant expansion in provision of methadone have experienced increased methadone-related deaths, described here for:
Ohio
Arizona
Colorado
Washington DC, and
Ontario, Canada
And in a post soon to appear, for Vermont.
That’s no surprise, based on what a longstanding body of evidence tells us about methadone.
Back to our current post –
And what about that naloxone campaign in Baltimore? In detail, in this post, and this, the course of a dramatic shift to more intensive, targeted, community based, successful efforts – resulting in distribution, use, and reversal of many times more potentially fatal overdoses than are needed to fully account for all reductions in opioid deaths – corresponds exactly in a time line as antecedent and cause of the dramatic drop in fatal opioid overdoses seen in late 2023 and 2024. Timing, known prevention of deaths, and mortality data fitting in a causal relationship.
While in Maryland, despite Narcan moderation of fatal overdose by reducing harms of gold standard treatments, high-risk opioid use, measured by nonfatal overdoses, continued to mount, incontrovertably pointing to gold standard treatment failure. As high-risk use continues to mount daily in Baltimore, exposed by breaking news.
And despite celebrated “tremendous efforts throughout the city to get people into treatment”.
The evidence is clear and it points the way to a dead end. To the extent that $hundreds of millions are used to enable additional expansion of provision of expert gold standard treatments as proposed in Baltimore’s 2025 Opioid Response Strategic Plan, more illness, suffering, and deaths are to follow, predicted by the established failure and lethal fueling of a worsening crisis in Baltimore and Maryland
It’s how America’s experts took Baltimore to 1st Place.
