Maryland Reports Over $34 Million in Opioid Restitution Fund Expenditures for Fiscal Year 2025

Per a press release from Maryland’s Office of Overdose Response (MOOR), the state has allocated over $34 million from its Opioid Restitution Fund (ORF) for the fiscal year 2025. These funds are designated for state and local initiatives aimed at addressing the opioid crisis. Additionally, the state has set aside over $56 million for future spending from this fund, which was established in 2019 to receive monies awarded to Maryland through legal actions related to prescription opioids. The annual report detailing these expenditures is a requirement mandated by state law, ensuring transparency in the utilization of these funds.

The Opioid Restitution Fund was created to consolidate all monetary awards obtained by Maryland through litigation against opioid manufacturers, distributors, and related entities. As per state statutes, an annual report must be submitted to the General Assembly by November 1st, outlining all deposits into the ORF and how those funds have been spent. This report specifically details expenditures by category of use, jurisdiction, and budget program, alongside progress toward stated goals and objectives.

Maryland has received payments from a variety of settlements, including agreements with Mallinckrodt, McKinsey & Company, Janssen, Walmart, Walgreens, Allergan, Teva, and Publicis Health. Five of these are part of the National Opioid Settlement, while Mallinckrodt, McKinsey, and Publicis have separate allocation formulas. The state has also reached settlements with Purdue Pharma and several distributors like Alvogen, Amneal, Apotex, Hikma, Mylan, Sun, and Zydus, with payments expected to continue until fiscal year 2038. In total, as of the end of fiscal year 2025, Maryland and its subdivisions have received over $245 million and expended more than $34 million, with over $56 million allocated for future use.

A significant portion of the recovered funds, 70%, is distributed at the local level through State-Subdivision Agreements. These agreements specify how funds are shared between the state and participating subdivisions and outline allowable uses for the money, consistent with the National Opioid Settlement guidelines. Fifty-eight subdivisions across Maryland have agreed to forgo individual lawsuits and join the state’s settlement agreements, encompassing numerous counties and municipalities.

Funding streams from the National Opioid Settlement are divided into four categories: Local Allocations (25%) and Targeted Abatement Grants (TAG) (45%) for local subdivisions, and State Allocation (15%) and a State Discretionary Abatement Fund (15%) for state-level initiatives. Local Allocation payments are sent directly to participating subdivisions, while TAG funds are channeled through the state’s ORF. Local subdivisions must submit an approved Local Abatement Plan (LAP) to receive TAG funds, detailing how the money will be spent in compliance with settlement terms and state law. However, eight qualifying charter counties are exempt from this LAP requirement due to prior agreements.

At the state level, the State Allocation can be used for expenditures at the state’s discretion, while the State Discretionary Abatement Fund is intended for competitive grants. Payments from settlements outside the national framework, such as those from McKinsey, Mallinckrodt, and Publicis, are generally directed to the State Allocation fund. Notably, the McKinsey settlement also involves local distributions that are managed independently of the state.

As of the close of fiscal year 2025, Maryland has received over $192 million into the Opioid Restitution Fund. Of this, a substantial amount has been designated for TAG funds, State Discretionary Abatement Fund grants, and the State Allocation. Additionally, over $53 million has been directly transferred from settlement administrators to local subdivisions. MOOR is currently developing a public dashboard, in collaboration with the Maryland Department of Health, to provide accessible reporting on ORF expenditures, as mandated by recent legislation. Local subdivisions are also required to report their ORF expenditures annually, detailing funded programs and their alignment with allowable uses.

Regarding specific expenditures within Washington County and Hagerstown, the provided report lists the following: Washington County received $1,734,992.24 in Local Direct funds and spent $0. The City of Hagerstown received $184,296.50 in Local Direct funds and spent $0. Neither Washington County nor the City of Hagerstown had any TAG funds reported as received or spent in this fiscal year.

Reported expenditures by local subdivisions from Local Direct and Targeted Abatement Funds reveal significant allocations across various categories. These include improving access to overdose reversal medications, supporting peer specialists, increasing access to medication-assisted treatment, expanding crisis residential services, establishing crisis stabilization centers, funding education campaigns for opioid prevention, and supporting research and training for substance use treatment and overdose prevention.

The State Discretionary Abatement Fund has received nearly $38 million, with plans to distribute it through a competitive grant process. In fiscal year 2025, over $1.3 million was spent from this fund, and future grant awards total over $12 million. A significant grant initiative through the Maryland Department of Health awarded over $13.5 million to 28 organizations to support programs aligned with Exhibit E of the National Opioid Settlement. Additionally, a grant program funded by House Bill 1131 of 2025 aims to support paramedics in administering buprenorphine.

Funds from the State Allocation, totaling over $57 million received by the end of fiscal year 2025, are to be spent at the state’s discretion. Past spending from this allocation has supported programs like the Examination and Treatment Act Grant Program and the Data Informed Risk Mitigation Project. For fiscal year 2025, over $8 million was allocated, with over $6.4 million spent. Several new legislative initiatives also resulted in appropriations from the State Allocation in FY25, including a program to co-locate naloxone with Automated External Defibrillators (AEDs) and initiatives to expand access to buprenorphine and medications for opioid use disorder within correctional facilities.

The Opioid Restitution Fund Advisory Council (ORFAC), established to provide recommendations on fund usage, has delivered its third set of recommendations for state spending. These recommendations consider factors such as the prevalence of substance use disorders, disparities in access to care, overdose death rates, and existing resources within different jurisdictions. The council’s input guides discretionary spending from funds like those originating from the McKinsey and Publicis settlements, as well as the State Discretionary Fund and State Allocation.

Future spending plans for the State Allocation include significant amounts for the BHA Buprenorphine Initiative, support for medications for opioid use disorder in correctional settings, and the Opioids Enforcement Unit within the Attorney General’s Office. Further allocations are designated for a Medicaid 1115 waiver for pre-release MOUD services, administrative support for MOOR, a policy advisor in the Lieutenant Governor’s Office, and grant programs for rural peer recovery specialists.

Performance indicators reported for local direct and targeted abatement funds show that over 1,400 individuals in detention settings received medications for opioid use disorder, and over 4,200 peer engagements occurred. Additionally, over 700 individuals received transportation support for treatment, and nearly 14,000 doses of naloxone were dispensed. Over 7,500 youth engaged in prevention programs. Performance metrics for state-level initiatives are still being collected as many of these programs are in their early stages.

The full report is available on the State website.

Article by Ken Buckler, based upon information from the Maryland’s Office of Overdose Response.

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