IN BALTIMORE TOO – IT’S THE NARCAN
Drops in opioid overdose deaths are consistent with the timeline of effective community naloxone distribution, not with fentanyl supply or other desperate, distracting cover stories for expert treatment lethal failure
by Clark Miller
Published February 13, 2026
Key Takeaways
In Baltimore over most recent years –
Effectively targeted, community-based naloxone campaigns increasingly placed overdose reversal units where they are most effective, in the hands of laypersons and peers.
Those peer and layperson reversals, as elsewhere, increasingly constitute gross undercounts of opioid nonfatal overdoses = high-risk use.
Direct service estimates of numbers of potentially fatal opioid overdoses reversed more than account for all year-by-year decreases in opioid overdose deaths.
Attributing decreases in opioid deaths to any other factors requires evidence establishing that there were not year-by-year increases of at least 250 or more unique opioid user instances of naloxone reversals for each of the years 2024 and 2025.
Patterns of increasing high-risk opioid use and overdose, necessitating intensive emergency naloxone campaigns, constitute gold standard treatment failure.
The news from Baltimore of large reductions over 2024 and 2025 in fatal opioid overdoses was predictable and welcomed, a huge relief for America’s opioid overdose “capital” city, where last year’s headlines included mass opioid overdose events. But no deaths associated with those two events – fatalities avoided by the quick responses of those nearby armed with opioid OD death-reversing naloxone (Narcan).
Maryland saw about a 25% decrease in fatal drug overdoses in 2025, when more than 1,300 people died from overdosing, according to data released by the Maryland Department of Health Thursday.
It’s the second year in a row the state has seen a significant drop in drug deaths. Since 2023, the number has decreased by nearly half, according to the state’s overdose dashboard. A similar drop has been recorded for Baltimore, which has had the worst overdose crisis of any major American city. …
The city of Baltimore saw more than 560 overdose deaths last year, compared to more than 1,000 three years ago, according to state data.
[emphasis added]
From another local report –
After a decade defined by a swelling overdose death toll, Baltimore saw a historic drop last year. The numbers have provided a new wave of optimism among officials, though they’ve emphasized the battle is far from over.
There were 774 overdose deaths in Baltimore last year, a 28.5% decrease from the year prior [2023], which marks the largest single-year drop in at least a decade, according to data from the Maryland Department of Health. The last time the city saw fewer than 800 overdose deaths was in 2017, when 761 deaths were reported.
The lower death rate has seemingly continued into 2025, with 679 deaths in the 12-month period ending in March. While the decline is part of a national trend, public health experts have said harm reduction initiatives have undoubtedly played a role in driving down overdose deaths.
So, over the years 2024 and 2025, drug overdose deaths (primarily due to opioids) decreased by about half, from more than 1000 in 2023 to 560 over 2025.
It turns out that the trends and evidence point clearly to year-by-year increases in naloxone effective, targeted, trained provision to laypersons that more than account for all of those approximately 250 fewer opioid OD deaths for 2024 and then again in 2025. Importantly, the reported characteristics of the distribution programs as we’ll see predicted more effective distribution and use of naloxone to account for those drops.
And as we’ll see, the evidence from trends and on-the-ground programs and services in Baltimore is direct evidence of deaths prevented by naloxone saves being linked to the past two years’ death reductions, leaving no prevented opioid OD deaths to be accounted for by other factors.
Let’s take a look at the evidence.
In Maryland, there have been clear increases over the past decade in distribution of Narcan units to Baltimore residents.
And most of those receiving a naloxone unit identified their reason as either being a “Family Member” or “Social Experience”, defined as “people who use drugs and their associates”.
That information is for Maryland, not specifically Baltimore, where the trend was similar: naloxone distribution trending upwards through 2023, maintaining into 2024, dropping at the end of the year, then with increases again early in 2025 and spiking at record values July through September of 2025, beginning over the period of the two mass overdose events.
For Baltimore, the proportion of those receiving a naloxone unit identifying their reason as either being a “Family Member” or “Social Experience” (defined as “people who use drugs and their associates”), that is, as being proximate for fast response to high-risk opioid users, was significantly greater – close to 90 percent.
There’s more to the picture, and it’s important.
From an August 2025 report,
Baltimore will soon launch a coordinated naloxone outreach program that’s expected to vastly expand access to the life-saving overdose reversal medication as officials look to curb in-home overdose deaths.
Standing before a sea of nonprofits, city agencies, and residents directly impacted by the overdose crisis, Mayor Brandon Scott announced the “Naloxone Neighbors” initiative at the city’s annual International Overdose Awareness Day event on August 28 at ABC Park in West Baltimore. Nearly two-thirds of all overdoses in the city occur in people’s homes, and through the program, the Mayor’s Office of Overdose Response will work directly with neighborhood and community associations to distribute naloxone and train residents how to use it. It is slated to begin by early October. …
They will provide widespread naloxone distribution and training at community events like block parties in neighborhoods most impacted by the crisis. Those neighborhoods include Sandtown-Winchester, Greater Mondawmin, Johnston Square, and Clifton-Berea, city officials said.
In addition, they will conduct door-to-door outreach, directly providing harm reduction resources and naloxone training for residents. Public health experts have said that naloxone was an important factor in the city’s historic drop in overdose deaths last year — a trend seen nationwide — and officials said on Thursday their goal is to get it into the hands of as many people as possible.
The campaign is part of a years-long effort to expand naloxone access. Data from the Maryland Department of Health shows that distribution of the medication has trended upward in Baltimore as the overdose crisis has progressed and the drug supply has become increasingly dangerous over the past decade.
Since late 2014, roughly 425,000 people in Baltimore have received naloxone from overdose response programs in the city, according to the data. More than 76,000 people received the life-saving medication last year alone, and 47,000 people received it as of July this year.
[emphasis added]
And from this January 2026 report –
Maryland’s Special Secretary of Overdose Response Emily Keller … credited collaborative efforts between state and local agencies and community organizations to tackle the crisis, including the widespread distribution of naloxone, a medication that reverses opioid overdoses.
Over the past decade, community programs and government agencies have given out increasing amounts of naloxone across the state, according to the state health department. There was a notable spike in naloxone distribution last summer, coinciding with mass overdoses in Baltimore’s Penn North neighborhood that hospitalized dozens of people, but resulted in no deaths.
So, targeted, intensive, community distribution of life-saving naloxone to place it in the hands of laypersons – dramatically increasing its effectiveness (e.g., here and here, following links) – has been increasing over recent years in Baltimore, as fatal overdoses have declined. And if those dramatic increases have not been associated with increases over those same years in numbers of reversals of otherwise fatal opioid ODs, then Baltimore would be an anomaly, a stark outlier compared to the many locales where, consistently, that’s been found to be true.
But let’s look at more of the data and evidence
From information provided by the Baltimore City Health Department (BCHD) –
The Staying Alive Program was launched in 2004 by the Baltimore City Health Department to reduce opioid-related deaths in Baltimore by providing overdose prevention education and dispensing naloxone to residents free of charge. Staff train people to recognize opioid and heroin overdose signs and respond effectively to save lives. Training sessions, which include access to naloxone (Narcan), are held at various SSP sites, partner locations, and online. In 2015, the program became an Overdose Response Program (ORP) and received state certification to train third parties and individuals with substance use disorders on Narcan administration.
Since 2015, BCHD has trained 43,591 people. From 2015 to 2024, BCHD and its partners trained over 163,464 Baltimore residents, contributing to more than 18,000 overdose reversals.
[emphasis added]
We’ll come back to that figure of more than 18,000 reversals (potentially fatal opioid overdoses prevented). For now, it is important to note that (as described in detail in this recent post and prior posts linked to therein) from widespread reports from diverse locales, consistently, where intensive, targeted, successful community naloxone campaigns have placed reversal units in the hands of laypersons, as in Baltimore, evidence points to the prevalence of naloxone reversals increasingly underestimated over recent years, predictably because layperson and peer reversals go unreported.
To emphasize the point, “increasingly underestimated,” describes year-by-year increases in numbers of fatal overdoses prevented by naloxone use that are missed, unreported, and increasing each year as desperately required naloxone campaigns shift reversals from EMT responses to peer, family, and layperson reversals. Those increasingly frequent, “invisible” opioid overdoses, of course, each represent instances of high-risk opioid use, that is, are a valid measure of the lethal failure of expert, gold standard treatments.
Here’s more, in this April 2025 report, from additional harm reduction organizations in Baltimore, these funded by NIH.
Peer educators working for the OASIS project identify settings where people use drugs, and in those settings place overdose prevention materials, including Naloxone—a medicine that rapidly reverses opioid overdoses in a matter of seconds or minutes—wound care kits, and cards and visuals that demonstrate how to reduce overdose risk. The places are often abandoned buildings, the homes of known friends and acquaintances who use drugs, and other locations where materials for overdose prevention can be reached specifically by people who use drugs. Thus far, OASIS has trained 148 community members to provide overdose prevention training and place overdose prevention and care materials in places where people who use drugs can easily access them.
“These programs are designed to meet individuals where they are, offering overdose prevention strategies, naloxone, and drug treatment referrals. Through peer education training, we empower people who use drugs to spread crucial information and resources within their communities, ensuring that more individuals have the skills to prevent and respond to overdoses while also gaining access to treatment,” says Dayton.
Let’s get to the point
That figure of 18,000 reversals of potentially fatal opioid ODs (of fatal opioid deaths reversed) in Baltimore over 2015 to 2024 gives us some idea of the magnitude of death reductions due to emergency Narcan use. That would be about 1,800 for each of those years if there had been no upward trend, which we are essentially certain there has been.
But very roughly.
For the reasons discussed, they are a gross underestimate, the magnitude of the underestimate increasing over recent years.
Those figures are for just one source in Baltimore (“BDHD and its partners”), among all organizations engaged in naloxone campaigns.
But there’s a bottom line.
There were about 250 fewer opioid fatal ODs in Baltimore in 2024 compared to 2023, and then another 250 fewer in 2025.
For any factor other than emergency naloxone saves to have been significant in those recent year opioid OD death reductions, it is required to account for the data and evidence outlined in this post, and supported by additional evidence, to show that there were not year-by-year increases of at least 250 or more naloxone reversals for each of those years.
Lacking evidence to rule out those increases in reversals over 2023 to 2025, we are compelled to accept what seems to be almost certain – that emergency saves accounted for all of the fatality reductions, not other factors (and here).
That is, we are compelled to again acknowledge what has been apparent for years, that emergency naloxone saves have functioned as harm reduction against and have hidden the lethal failure of America’s expert gold standard treatment systems.
