Where do these monies live?

The Opioid Restitution Fund (Fund) holds 75% of Maryland’s opioid settlement funds,[1] including the 45% of funds allocated for Targeted Abatement Grants.[2]

What can this share be spent on?

Monies from this share must be spent on the forward-looking abatement uses specified in state law and in a manner that’s consistent with the national settlement agreements’ (non-exhaustive) Exhibit E.[3] The permitted uses specified in Maryland state law include:

• Eleven (11) evidence-based programs, services, supports, and resources for substance use disorder (SUD) prevention, harm reduction, treatment, or recovery.[4]

• “[S]upporting community-based nonprofit recovery organizations that provide nonclinical substance use recovery support services.”[5]

• Evidence-informed SUD prevention, harm reduction, treatment, or recovery pilot programs or demonstration studies that are not evidence-based, if approved by the Maryland Opioid Restitution Fund Advisory Council.[6]

• Evaluations of the effectiveness and impact of Fund expenditures.[7]

Who ultimately decides how to spend this share (and how)?

Qualifying charter counties decide autonomously; other localities decide with Maryland Department of Health approval. Targeted Abatement Grants (45% of Maryland’s total opioid settlement funds) are non-competitive grants made to two types of local governments:

• Qualifying Charter Counties — Baltimore City and Anne Arundel, Baltimore, Frederick, Harford, Howard, Montgomery, and Prince George — receive their monies automatically.[8] Importantly, Baltimore City receives funds only from the statewide settlement with Walmart, as it declined to participate in the other statewide settlement agreements.[9]

• The remaining 51 subdivisions each receive their monies through a Maryland Department of Health (MDOH) grant program after approval of their Local Abatement Plans.[10] Approval of Local Abatement Plans is limited to MDOH ensuring funds are used for permitted uses that constitute future opioid remediation and that the subdivision “has the capability of carrying out the specific program for which the grant is to be made.”[11] Subdivisions that do not participate in this process will have their funds reabsorbed by their respective county.[12]

Are supplantation uses prohibited for this share?

Yes, supplantation is prohibited. State law provides that monies expended from Opioid Restitution Fund — which houses this share — are “supplemental to and not intended to take the place of funding that otherwise would be appropriated for programs and services.”[13] This means that this share must only be used in ways that supplement — rather than replace (or “supplant”) — existing resources.

Can I see how this share has been spent?

Yes (public reporting required). View annual public reports here. Maryland state law requires the governor to annually report to the Maryland General Assembly all expenditures from the Opioid Remediation Fund, including Targeted Abatement Grants.[14]

Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.

What else should I know?

Not applicable.

Citations

1. Md. State Finance and Procurement Code Ann. Secs. 7-331(b) (establishing the Opioid Restitution Fund), (e) (providing that the fund includes all opioid settlement revenues received by the state); State-Subdivision Agreement Between the State of Maryland and Local Governments on Proceeds Relating to the Settlement of Opioids Litigation (“2022 Maryland State-Subdivision Agreement”), Secs. II(h) (requiring the state to maintain a Targeted Abatement Subfund in the Opioids Restitution Fund), IV(a)(1) (directing 15% state share to the Opioid Restitution Fund), IV(a)(2) (directing 60% of the state’s annual settlement payments to the Targeted Abatement Subfund). See also State-Subdivision Agreement Between the State of Maryland and Participating Local Governments on Proceeds from Settlement of Opioids Litigation Against Teva, Allergan, Walmart, and Walgreens (“2023 Maryland State-Subdivision Agreement”), Sec. I (providing that except as otherwise specified, the terms of the 2022 Maryland State-Subdivision Agreement apply to the settlements with Teva, Allergan, Walmart, and Walgreens). ↑

2. 2022 Maryland State-Subdivision Agreement, Secs. IV(a)(2), IV(a)(2)(B); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

3. Md. State Finance and Procurement Code Ann. Secs. 7-331(f) (listing permitted uses of monies in the Opioid Restitution Fund), (i)(2) (prohibiting use of Fund monies for administrative expenses except as specified in subsection (f)); 2022 Maryland State-Subdivision Agreement, Secs. I(h) (defining “Permitted Use” to “mean any use permitted by the National Settlement Agreement and Section 7-331(f) of the State Finance and Procurement Article, as amended from time to time. Except as specifically provided otherwise by this Agreement, Permitted Uses shall be limited to Future Opioid Remediation”) (emphasis added), III(a) (requiring all settlement funds be used for “Permitted Uses that serve the purpose of Future Opioid Remediation” unless otherwise authorized), III(b) (authorizing reimbursement uses for only a portion of the 25% local share); IV(a)(2)(B) (requiring Targeted Abatement Grants be used for “Permitted Uses”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). See also Distributor Settlement Agreement, Sec. I.SS (“Exhibit E provides a non-exhaustive list of expenditures that qualify as being paid for Opioid Remediation. Qualifying expenditures may include reasonable related administrative expenses”). See also Emily Keller. “Re: State Finance and Procurement Article § 7–331 (Chapter 537 of the Acts of 2019)—Opioid Restitution Fund Expenditure Report (MSAR # 14240).” Maryland Opioid Operational Command Center. November 1, 2023. Accessed August 27, 2024 (“to determine whether expenditures are approved and to identify the procedural and allocation requirements that apply to particular funds deposited in the ORF, the Maryland Department of Health must examine the requirements of Section 7-331, of the particular settlement agreement or judgment from which funds were derived, and of any applicable state-subdivision agreement entered by the Attorney General with one or more of the State’s subdivisions”). ↑

4. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(1). Note that administrative expenses are specifically authorized for four of the eleven enumerated uses: (1) “expanding the Heroin Coordinator Program”; (2) “organizing primary and secondary school education campaigns to prevent opioid use”; (3) “enforcing the laws regarding opioid prescriptions and sales”; and (4) “research regarding and training for substance use treatment and overdose prevention.” Md. State Finance and Procurement Code Ann. Secs. 7-331(f)(1)(iv), (f)(1)(vii)-(x). ↑

5. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(2). ↑

6. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(3) (providing that the Opioid Restitution Fund Advisory Council must both “determine[] that emerging evidence supports the distribution of money for the pilot program or that there is a reasonable basis for funding the demonstration study with the expectation of creating an evidence-based program” and “approve[] the use of money for the pilot program or demonstration study”). ↑

7. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(4) (“evaluations of the effectiveness and outcomes reporting for substance use disorder abatement infrastructure, programs, services, supports, and resources for which money from the Fund was used, including evaluations of the impact on access to harm reduction services or treatment for substance use disorders and the reduction in drug-related mortality”). ↑

8. 2022 Maryland State-Subdivision Agreement, Secs. I(k) (defining “Qualifying Charter Counties”), IV(a)(2)(B) (“These non-competitive grants shall be made … to the Local Abatement Funds of participating Qualifying Charter Counties within 30 days of the later of the deposit of Annual Payments in the Targeted Abatement Subfund or a Qualifying Charter County’s establishment of a Local Abatement Fund pursuant to this Agreement”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

9. See City of Baltimore Joins Settlement in Walmart Opioid Suits. Baltimore City Mayor press release. February 29, 2024. Accessed August 27, 2024; Baltimore City Executive Order – Administration of Baltimore City Opioid Restitution Funds. August 29, 2024. Accessed September 4, 2024. See also Settlement Overview. Maryland’s Office of Overdose Response website. Accessed August 27, 2024 (“Baltimore City is pursuing independent litigation against Johnson & Johnson and is not eligible to receive funding through Maryland’s settlement agreement. However, non-government organizations that operate in Baltimore City will be eligible to receive discretionary abatement funds for eligible uses through the Janssen settlement, which will be distributed through a competitive process”). ↑

10. 2022 Maryland State-Subdivision Agreement, Secs. I(j) (defining “Qualifying Exhibit G Subdivision” to mean “a subdivision listed on Exhibit G of the National Settlement Agreement that is not a Special District”), IV(a)(2)(B) (“These non-competitive grants shall be made … to other participating Qualifying Exhibit G Subdivisions upon the Secretary’s approval of a grant application demonstrating that a Local Abatement Fund for deposit of Settlement Proceeds has been established, that the Settlement Proceeds will be used under a Local Abatement Plan that ensures the use of funds for Future Opioids Remediation through a Permitted Use, and that the Qualifying Exhibit G Subdivision has the capability of carrying out the specific program for which the grant is to be made. … A Subdivision receiving a grant under this subparagraph … must renew it every five years”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). See also Settlement Overview. Maryland’s Office of Overdose Response website. Accessed August 27, 2024 (“The remaining 51 subdivisions must submit “Local Abatement Plans” and participate in a block grant program administered by the Maryland Department of Health to receive their portion of these funds”). ↑

11. 2022 Maryland State-Subdivision Agreement, Sec. IV(a)(2)(B) (“A grant application under this subparagraph (ii) that meets these requirements must be approved by the Secretary”) (emphasis added); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

12. 2022 Maryland State-Subdivision Agreement, Sec. IV(a)(2)(B) (“The Settlement Proceeds of any Qualifying Exhibit G Municipal Subdivision that does not apply for a grant shall revert to the County in which the Subdivision is located”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

13. Md. State Finance and Procurement Code Ann. Sec. 7-331(i)(1). Vital Strategies and OpioidSettlementTracker.com have confirmed with the Maryland Office of Overdose Response that this provision operates as a substantive prohibition on supplantation uses rather than a mere expression of intent. ↑

14. Md. State Finance and Procurement Code Ann. Sec. 7-331(j)(3). ↑

Where do these monies live?

The Opioid Restitution Fund (Fund) holds 75% of Maryland’s opioid settlement funds,[1] including the 15% state share.[2]

What can this share be spent on?

Monies from this share must be spent on the forward-looking abatement uses specified in state law and consistently with the national settlement agreements’ (non-exhaustive) Exhibit E.[3] Permitted uses are specified by state law to include:

• Eleven (11) evidence-based programs, services, supports, and resources for substance use disorder (SUD) prevention, harm reduction, treatment, or recovery[4]

• “[S]upporting community-based nonprofit recovery organizations that provide nonclinical substance use recovery support services”[5]

• Evidence-informed SUD prevention, harm reduction, treatment, or recovery pilot programs or demonstration studies that are not evidence-based, if approved by the Maryland Opioid Restitution Fund Advisory Council[6]

• Evaluations of the effectiveness and impact of Fund expenditures[7]

Up to 15% of funds from the Walmart, Teva, and Allergan settlements and up to 5% from the Walgreens settlement may be used to reimburse past abatement expenditures, and remaining monies must be spent only on forward-looking opioid remediation uses.[8]

Who ultimately decides how to spend this share (and how)?

Opioid Restitution Fund Advisory Council recommends, the “State” (likely the Maryland Department of Health) decides. This share must be spent on permitted uses in accordance with the state budget.[9] The Opioid Restitution Fund Advisory Council, which is supported by Maryland’s Office of Overdose Response,[10] is responsible for annually recommending expenditures of Fund monies to the Governor and Secretary of Health.[11] The Maryland Department of Health then distributes these funds.[12]

Are supplantation uses prohibited for this share?

Yes, supplantation is prohibited. State law provides that monies expended from Opioid Restitution Fund — which houses this share — are “supplemental to and not intended to take the place of funding that otherwise would be appropriated for programs and services.”[13] This means that this share must only be used in ways that supplement — rather than replace (or “supplant”) — existing resources.[14]

Can I see how this share has been spent?

Yes (public reporting required). View annual public reports here. Maryland state law requires the Department of Health to post on its website decisions regarding the allocation of money from the Opioid Restitution Fund, including the 15% state share.[15] The governor is also required to annually report to the Maryland General Assembly all expenditures from the Fund.[16]

Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.

What else should I know?

Not applicable.

Citations

1. Md. State Finance and Procurement Code Ann. Secs. 7-331(b) (establishing the Opioid Restitution Fund), (e) (providing that the fund includes all opioid settlement revenues received by the state); State-Subdivision Agreement Between the State of Maryland and Local Governments on Proceeds Relating to the Settlement of Opioids Litigation (“2022 Maryland State-Subdivision Agreement”), Secs. II(h) (requiring the state to maintain a Targeted Abatement Subfund in the Opioids Restitution Fund), IV(a)(1) (directing 15% state share to the Opioid Restitution Fund), IV(a)(2) (directing 60% of the state’s annual settlement payments to the Targeted Abatement Subfund). See also State-Subdivision Agreement Between the State of Maryland and Participating Local Governments on Proceeds from Settlement of Opioids Litigation Against Teva, Allergan, Walmart, and Walgreens (“2023 Maryland State-Subdivision Agreement”), Sec. I (providing that except as otherwise specified, the terms of the 2022 Maryland State-Subdivision Agreement apply to the settlements with Teva, Allergan, Walmart, and Walgreens). ↑

2. 2022 Maryland State-Subdivision Agreement, Sec. IV(a)(1); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). It also contains “all Additional Restitution Payments.” Id. ↑

3. Md. State Finance and Procurement Code Ann. Secs. 7-331(f) (listing permitted uses of monies in the Opioid Restitution Fund), (i)(2) (prohibiting use of Fund monies for administrative expenses except as specified in subsection (f)); 2022 Maryland State-Subdivision Agreement, Secs. I(h) (defining “Permitted Use” to “mean any use permitted by the National Settlement Agreement and Section 7-331(f) of the State Finance and Procurement Article, as amended from time to time. Except as specifically provided otherwise by this Agreement, Permitted Uses shall be limited to Future Opioid Remediation”) (emphasis added), III(a) (requiring all settlement funds be used for “Permitted Uses”); IV(a)(1) (requiring the state share be used for “Permitted Uses”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). See also Distributor Settlement Agreement, Sec. I.SS (“Exhibit E provides a non-exhaustive list of expenditures that qualify as being paid for Opioid Remediation. Qualifying expenditures may include reasonable related administrative expenses”). See also Emily Keller. “Re: State Finance and Procurement Article § 7–331 (Chapter 537 of the Acts of 2019)—Opioid Restitution Fund Expenditure Report (MSAR # 14240).” Maryland Opioid Operational Command Center. November 1, 2023. Accessed August 27, 2024 (“to determine whether expenditures are approved and to identify the procedural and allocation requirements that apply to particular funds deposited in the ORF, the Maryland Department of Health must examine the requirements of Section 7-331, of the particular settlement agreement or judgment from which funds were derived, and of any applicable state-subdivision agreement entered by the Attorney General with one or more of the State’s subdivisions”). ↑

4. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(1). Note that administrative expenses are specifically authorized for four of the eleven enumerated uses: (1) “expanding the Heroin Coordinator Program”; (2) “organizing primary and secondary school education campaigns to prevent opioid use”; (3) “enforcing the laws regarding opioid prescriptions and sales”; and (4) “research regarding and training for substance use treatment and overdose prevention.” Md. State Finance and Procurement Code Ann. Secs. 7-331(f)(1)(iv), (f)(1)(vii)-(x). ↑

5. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(2). Note that this permitted use was added by legislation in 2024. See 2024 MD HB 980, Sec. 1. ↑

6. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(3) (providing that the Opioid Restitution Fund Advisory Council must both “determine[] that emerging evidence supports the distribution of money for the pilot program or that there is a reasonable basis for funding the demonstration study with the expectation of creating an evidence-based program” and “approve[] the use of money for the pilot program or demonstration study”). ↑

7. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(4) (“evaluations of the effectiveness and outcomes reporting for substance use disorder abatement infrastructure, programs, services, supports, and resources for which money from the Fund was used, including evaluations of the impact on access to harm reduction services or treatment for substance use disorders and the reduction in drug-related mortality”). ↑

8. 2022 Maryland State-Subdivision Agreement, Secs. III(a) (requiring all settlement funds be used for “Permitted Uses that serve the purpose of Future Opioid Remediation” unless otherwise authorized), III(b) (authorizing reimbursement uses only for a portion of funds from the 25% local share); 2023 Maryland State-Subdivision Agreement, Secs. I (generally applying terms to later settlements), II(d) (but replacing Sec. III(b) of the 2022 State-Subdivision Agreement to specify that “[t]he State … may use up to 15 percent received from the Walmart Agreement, the Teva Agreement, and/or the Allergan Agreement to pay for opioids-related measures (including past Opioid Remediation” and “up to 5 percent received from the Walgreens Agreement to pay for opioids-related measures (including past Opioid Remediation)”). ↑

9. Md. State Finance and Procurement Code Ann. Sec. 7-331(h)(1) (“Expenditures from the Fund may be made only in accordance with the State budget”); 2022 Maryland State-Subdivision Agreement, Secs. IV(a)(1) (“The Settlement Fund Administrator shall allocate all Additional Restitution Payments, and 15 percent of all Annual Payments, to the State Fund for distribution to the State. Such payments shall be deposited in the Opioid Restitution Fund and expended on Permitted Uses as determined by the State”), I(u) (defining “State” to mean “the government of the State of Maryland, without inclusion of Subdivision governments”). ↑

10. Md. Health-General Code Ann. Sec. 7.5-904(b). ↑

11. Md. Health-General Code Ann. Sec. 7.5-905(a) (“On or before November 1 each year, the Council shall provide specific findings and recommendations in writing to the Governor and the Secretary regarding the allocations of money from the Fund for expenditures consistent with uses of the Fund and considering (1) [t]he number of people per capita with a substance use disorder in a jurisdiction; (2) [d]isparities in access to care in a jurisdiction that may preclude persons; (3) [t]he number of overdose deaths per capita in a jurisdiction; (4) [t]he programs, services, supports, or other resources currently available to individuals with substance use disorders in a jurisdiction; and (5) [d]isparities in access to care and health outcomes in a jurisdiction”), (b)(1) (requiring the Secretary of Health to present decisions on allocations of Fund monies to the Council within 6 months of receiving the Council’s findings and recommendations”); Md. State Finance and Procurement Code Ann. Sec. 7-331(j)(2) (requiring the Governor to consult with the Council on recommended appropriations from the Fund at least twice annually), (j)(3)(iii) (requiring the Governor’s annual report to the Maryland General Assembly to include “recommended appropriations from the Fund identified in accordance with” the governor’s responsibility to consult with the Council). See also Settlement Overview. Maryland’s Office of Overdose Response website. Accessed August 27, 2024 (describing the state share as “[f]unds that may be used at the discretion of the state for opioid abatement purposes. Subject to ORF Advisory Council recommendations”). See, e.g., Memorandum from the Opioid Restitution Fund Advisory Council to Governor Wes Moore and Secretary Laura Herrera Scott. Opioid Restitution Fund Advisory Council. October 3, 2023. Accessed August 27, 2024 (2023 Council funding recommendations). ↑

12. See, e.g., Opioid Restitution Fund Announcement Request for Applications, Sec. 1.1.1. Maryland Department of Health. June 26, 2024. Accessed August 28, 2024. ↑

13. Md. State Finance and Procurement Code Ann. Sec. 7-331(i)(1). Vital Strategies and OpioidSettlementTracker.com have confirmed with the Maryland Office of Overdose Response that this provision operates as a substantive prohibition on supplantation uses rather than a mere expression of intent. ↑

14. The 2024 Opioid Restitution Fund Announcement’s standard grant agreement also prohibits supplantation uses of granted funds. Opioid Restitution Fund Request for Applications, Sec. 3.2.2.6 (download “MDH BHA Opioid Restitution Fund Announcement.pdf” under “Attachments”). Maryland Department of Health. June 26, 2024 (“The Grantee will … not [be] permitted to use funds under this program … [t]o supplant existing local, state, or federal funding” and “[a]pplicants may not use grant funds to supplant or supplement Medicaid funding for billable services”) . See also Opioid Restitution Fund Request for Applications, Sec. 3.1. Maryland Department of Health. June 26, 2024 (“The focus of this RFA is to fund Opioid Remediation activities via the State Allocation and the State Discretionary Abatement Sub Fund under the National Settlement Agreement”). ↑

15. Md. Health-General Code Ann. Sec. 7.5-905(b)(2). ↑

16. Md. State Finance and Procurement Code Ann. Sec. 7-331(j)(3). ↑

Where do these monies live?

The Opioid Restitution Fund (Fund) holds 75% of Maryland’s opioid settlement funds,[1] including the 15% of funds designated as State Discretionary Abatement Funds.[2]

What can this share be spent on?

Monies from this share must be spent on the forward-looking abatement uses specified in state law and consistently with the national settlement agreements’ (non-exhaustive) Exhibit E.[3] Permitted uses are specified by state law to include:

• Eleven (11) evidence-based programs, services, supports, and resources for substance use disorder (SUD) prevention, harm reduction, treatment, or recovery[4]

• “[S]upporting community-based nonprofit recovery organizations that provide nonclinical substance use recovery support services”[5]

• Evidence-informed SUD prevention, harm reduction, treatment, or recovery pilot programs or demonstration studies that are not evidence-based, if approved by the Maryland Opioid Restitution Fund Advisory Council[6]

• Evaluations of the effectiveness and impact of Fund expenditures[7]

Who ultimately decides how to spend this share (and how)?

Opioid Restitution Fund Advisory Council recommends, Maryland Secretary of Health decides. The State Discretionary Abatement Fund is spent on permitted uses that the Maryland Secretary of Health determines “best serve the purpose of Future Opioid Remediation in the State.”[8] Specifically,

• The Maryland Secretary of Health is required to establish a program that allows Qualifying Non-Litigating Subdivisions (i.e., small local governments) to apply for grants from this share.[9] The Maryland State-Subdivision Agreement outlines factors that the Secretary may consider in making such grants,[10] but whether any grants are made is left to the Secretary’s discretion.[11]

• This share is also distributed to state and local government agencies, public colleges or state universities, and other organizations through a competitive grants process administered by Maryland’s Department of Health.[12]

State Discretionary Abatement Fund amounts are subject to the recommendations of the Opioid Restitution Fund Advisory Council.[13] The Council, which is supported by Maryland’s Office of Overdose Response,[14] is responsible for annually recommending expenditures of the Fund to the Governor and Secretary of Health.[15]

Are supplantation uses prohibited for this share?

Yes, supplantation is prohibited. State law provides that monies expended from Opioid Restitution Fund — which houses this share — are “supplemental to and not intended to take the place of funding that otherwise would be appropriated for programs and services.”[16] This means that this share must only be used in ways that supplement — rather than replace (or “supplant”) — existing resources.[17]

Can I see how this share has been spent?

Yes (public reporting required). You can review the annual public reports published here. Maryland state law requires the Department of Health to post on its website decisions regarding the allocation of money from the Opioid Restitution Fund, including the 15% State Discretionary Abatement Fund.[18] The governor is also required to annually report to the Maryland General Assembly all expenditures from the Fund.[19]

Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.

What else should I know?

Not applicable.

Citations

1. Md. State Finance and Procurement Code Ann. Secs. 7-331(b) (establishing the Opioid Restitution Fund), (e) (providing that the fund includes all opioid settlement revenues received by the state); State-Subdivision Agreement Between the State of Maryland and Local Governments on Proceeds Relating to the Settlement of Opioids Litigation (“2022 Maryland State-Subdivision Agreement”), Secs. II(h) (requiring the state to maintain a Targeted Abatement Subfund in the Opioids Restitution Fund), IV(a)(1) (directing 15% state share to the Opioid Restitution Fund), IV(a)(2) (directing 60% of the state’s annual settlement payments to the Targeted Abatement Subfund). See also State-Subdivision Agreement Between the State of Maryland and Participating Local Governments on Proceeds from Settlement of Opioids Litigation Against Teva, Allergan, Walmart, and Walgreens (“2023 Maryland State-Subdivision Agreement”), Sec. I (providing that except as otherwise specified, the terms of the 2022 Maryland State-Subdivision Agreement apply to the settlements with Teva, Allergan, Walmart, and Walgreens). ↑

2. 2022 Maryland State-Subdivision Agreement, Secs. IV(a)(2), IV(a)(2)(A); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

3. Md. State Finance and Procurement Code Ann. Secs. 7-331(f) (listing permitted uses of monies in the Opioid Restitution Fund), (i)(2) (prohibiting use of Fund monies for administrative expenses except as specified in subsection (f)); 2022 Maryland State-Subdivision Agreement, Secs. I(h) (defining “Permitted Use” to “mean any use permitted by the National Settlement Agreement and Section 7-331(f) of the State Finance and Procurement Article, as amended from time to time. Except as specifically provided otherwise by this Agreement, Permitted Uses shall be limited to Future Opioid Remediation”) (emphasis added), III(a) (requiring all settlement funds be used for “Permitted Uses that serve the purpose of Future Opioid Remediation” unless otherwise authorized), III(b) (authorizing reimbursement uses for only a portion of the 25% local share); IV(a)(2)(A) (requiring State Discretionary Abatement Fund monies be used for “Permitted Uses as determined by the Secretary to best serve the purpose of Future Opioid Remediation in the State”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). See also Distributor Settlement Agreement, Sec. I.SS (“Exhibit E provides a non-exhaustive list of expenditures that qualify as being paid for Opioid Remediation. Qualifying expenditures may include reasonable related administrative expenses”). See also Emily Keller. “Re: State Finance and Procurement Article § 7–331 (Chapter 537 of the Acts of 2019)—Opioid Restitution Fund Expenditure Report (MSAR # 14240).” Maryland Opioid Operational Command Center. November 1, 2023. Accessed August 27, 2024 (“to determine whether expenditures are approved and to identify the procedural and allocation requirements that apply to particular funds deposited in the ORF, the Maryland Department of Health must examine the requirements of Section 7-331, of the particular settlement agreement or judgment from which funds were derived, and of any applicable state-subdivision agreement entered by the Attorney General with one or more of the State’s subdivisions”). ↑

4. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(1). Note that administrative expenses are specifically authorized for four of the eleven enumerated uses: (1) “expanding the Heroin Coordinator Program”; (2) “organizing primary and secondary school education campaigns to prevent opioid use”; (3) “enforcing the laws regarding opioid prescriptions and sales”; and (4) “research regarding and training for substance use treatment and overdose prevention.” Md. State Finance and Procurement Code Ann. Secs. 7-331(f)(1)(iv), (f)(1)(vii)-(x). ↑

5. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(2). Note that this permitted use was added by legislation in 2024. See 2024 MD HB 980, Sec. 1. ↑

6. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(3) (providing that the Opioid Restitution Fund Advisory Council must both “determine[] that emerging evidence supports the distribution of money for the pilot program or that there is a reasonable basis for funding the demonstration study with the expectation of creating an evidence-based program” and “approve[] the use of money for the pilot program or demonstration study”). ↑

7. Md. State Finance and Procurement Code Ann. Sec. 7-331(f)(4) (“evaluations of the effectiveness and outcomes reporting for substance use disorder abatement infrastructure, programs, services, supports, and resources for which money from the Fund was used, including evaluations of the impact on access to harm reduction services or treatment for substance use disorders and the reduction in drug-related mortality”). ↑

8. 2022 Maryland State-Subdivision Agreement, Secs. I(r) (defining “Secretary” to mean the Secretary of Health), III(c) (providing discretionary authority to the Secretary “to supplement grants to Qualifying Exhibit G Subdivisions for Permitted Uses with additional funding derived from Settlement Proceeds whose expenditure is committed to the discretion of the Secretary”), IV(a)(2)(A) (requiring State Discretionary Abatement Fund monies be used for “Permitted Uses as determined by the Secretary to best serve the purpose of Future Opioid Remediation in the State” and specifying that “nothing in this subsection shall require the Secretary to make any grant or restrict the Secretary’s discretion in utilizing funds deposited under this Subsection IV(a)(2)(A) as the Secretary believes will best serve the needs of Maryland residents and communities for opioids remediation”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). See also 2022 Maryland State-Subdivision Agreement, Secs. II(d) (“Any power conferred by this Agreement upon the Secretary may be delegated by the Governor to the Executive Director or a similar official created by future executive order”), I(g) (defining “Executive Director” to mean “Executive Director of the Opioid Operational Command Center”); 2023 Maryland State-Subdivision Agreement, Secs. I (generally applying terms to later settlements), II(a) (but replacing the 2022 State-Subdivision Agreement’s definition of “Executive Director” with “Special Secretary for Opioids Response or her designee or such other person designated by the Governor or by law to direct the Opioid Operational Command Center or any successor agency having substantially similar responsibilities and duties”); Maryland Executive Order 01.01.2023.21. December 14, 2023 (establishing the Office of Overdose Response within the Maryland Department of Health as the successor to the Opioid Operational Command Center). ↑

9. 2022 Maryland State-Subdivision Agreement, Secs. I(j) (defining “Qualifying Non-Litigating Subdivision” to mean “a Subdivision other than a Qualifying Exhibit G Subdivision or Special District that has established a Local Abatement Fund in accordance with the requirements of this Agreement”), IV(a)(2)(A) (“the Secretary shall establish a program that enables Qualifying Non-Litigating Subdivisions to apply for grants and may, in the Secretary’s discretion, make grants from this amount to participating Qualifying Non-Litigating Subdivisions … nothing in this subsection shall require the Secretary to make any grant or restrict the Secretary’s discretion in utilizing funds deposited under this Subsection IV(a)(2)(A) as the Secretary believes will best serve the needs of Maryland residents and communities for opioids remediation”) (emphasis added); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). See also Settlement Overview. Maryland’s Office of Overdose Response website. Accessed August 27, 2024 (describing State Discretionary Abatement Fund as “[f]unds that may be used at the discretion of the state for opioid abatement purposes after considering grant applications from local subdivisions with a population of less than 10,000 people”). ↑

10. 2022 Maryland State-Subdivision Agreement, Sec. IV(a)(2)(A) (“In determining whether to make a grant under this subsection, the Secretary may consider: (i) whether a grant is consistent with the overall needs for abatement in the community and in Maryland; (ii) the experience of the Subdivision in providing programs for opioids remediation and for the public health generally; (iii) the feasibility of the program to be funded by the grant; (iv) the consistency of the program with State policy and its level of integration with State and County programs for abatement and the discussions required by Section IV(b) of this Agreement; and (v) other needs for Future Opioids Remediation across the State”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

11. 2022 Maryland State-Subdivision Agreement, Sec. IV(a)(2)(A) (“the Secretary shall establish a program that enables Qualifying Non-Litigating Subdivisions to apply for grants and may, in the Secretary’s discretion, make grants from this amount to participating Qualifying Non-Litigating Subdivisions … nothing in this subsection shall require the Secretary to make any grant or restrict the Secretary’s discretion in utilizing funds deposited under this Subsection IV(a)(2)(A) as the Secretary believes will best serve the needs of Maryland residents and communities for opioids remediation”) (emphasis added); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

12. Opioid Restitution Fund Announcement Request for Applications, Sec. 1.1.1. Maryland Department of Health. June 26, 2024. Accessed August 28, 2024; Opioid Restitution Fund Announcement Request for Applications, Sec. 2.1.1. Maryland Department of Health. June 26, 2024. Accessed August 28, 2024 (“The Applicant shall be a Social organization as defined per Section 7-402 of the State Finance and Procurement Article of the Annotated Code of Maryland or a Maryland local or state government agency, or public college or state university in Maryland”); Md. Code Ann., State Fin. & Proc. Sec. 7-402(a)(2) (defining “Social organization” to mean “an association or corporation that is operated for a charitable, cultural, educational, historical, humane, industrial, medical, or military purpose”). See Opioid Restitution Fund Announcement Request for Applications, Sec. 3.2.2.6. Maryland Department of Health. June 26, 2024. Accessed August 28, 2024 (describing allowable and unallowable costs). ↑

13. Md. Health-General Code Ann. Sec. 7.5-905. See also About [the Opioid Restitution Fund Advisory Council]. Maryland’s Office of Overdose Response website. Accessed August 28, 2024 (“Maryland’s Opioid Restitution Fund (ORF) was created in 2019 to receive all funds awarded to the State of Maryland through legal settlements with prescription opioid manufacturers and distributors. In 2022, Maryland established the Council to provide recommendations regarding the use of those funds”). ↑

14. Md. Health-General Code Ann. Sec. 7.5-904(b). ↑

15. Md. Health-General Code Ann. Sec. 7.5-905(a) (“On or before November 1 each year, the Council shall provide specific findings and recommendations in writing to the Governor and the Secretary regarding the allocations of money from the Fund for expenditures consistent with uses of the Fund and considering (1) [t]he number of people per capita with a substance use disorder in a jurisdiction; (2) [d]isparities in access to care in a jurisdiction that may preclude persons; (3) [t]he number of overdose deaths per capita in a jurisdiction; (4) [t]he programs, services, supports, or other resources currently available to individuals with substance use disorders in a jurisdiction; and (5) [d]isparities in access to care and health outcomes in a jurisdiction”), (b)(1) (requiring the Secretary of Health to present decisions on allocations of Fund monies to the Council within 6 months of receiving the Council’s findings and recommendations”); Md. State Finance and Procurement Code Ann. Sec. 7-331(j)(2) (requiring the Governor to consult with the Council on recommended appropriations from the Fund at least twice annually), (j)(3)(iii) (requiring the Governor’s annual report to the Maryland General Assembly to include “recommended appropriations from the Fund identified in accordance with” the governor’s responsibility to consult with the Council). See also Settlement Overview. Maryland’s Office of Overdose Response website. Accessed August 27, 2024 (describing the State Discretionary Abatement Fund as “[f]unds that may be used at the discretion of the state for opioid abatement purposes after considering grant applications from local subdivisions with a population of less than 10,000 people. Subject to ORF Advisory Council recommendations”). See, e.g., Memorandum from the Opioid Restitution Fund Advisory Council to Governor Wes Moore and Secretary Laura Herrera Scott. Opioid Restitution Fund Advisory Council. October 3, 2023. Accessed August 27, 2024 (2023 Council funding recommendations). ↑

16. Md. State Finance and Procurement Code Ann. Sec. 7-331(i)(1). Vital Strategies and OpioidSettlementTracker.com have confirmed with the Maryland Office of Overdose Response that this provision operates as a substantive prohibition on supplantation uses rather than a mere expression of intent. ↑

17. The 2024 Opioid Restitution Fund Announcement’s standard grant agreement reiterates this prohibition on supplantation uses of granted funds. Opioid Restitution Fund Request for Applications, Secs. 3.1 (“The focus of this RFA is to fund Opioid Remediation activities via the State Allocation and the State Discretionary Abatement Sub Fund under the National Settlement Agreement”), 3.2.2.6 (“The Grantee will … not [be] permitted to use funds under this program … [t]o supplant existing local, state, or federal funding” and “[a]pplicants may not use grant funds to supplant or supplement Medicaid funding for billable services”). Maryland Department of Health. June 26, 2024 (download “MDH BHA Opioid Restitution Fund Announcement.pdf” under “Attachments”). The call for proposals for FY2025 competitive grants also reiterates this prohibition, though it is unclear whether these grants are funded with opioid settlement monies. FY2025 Call for Proposals: Competitive Grant Program (“Funding Specifications”). Maryland’s Office of Overdose Response. January 9, 2023 (“Grantees are not permitted to use funds under this program … to supplant existing local, state, or federal funding”). See also FY2025 Call for Proposals: Competitive Grant Program, Exhibit 1 Grant Agreement, Sec. 5.C (“Grantees shall not use funds for the … [s]upplanting of existing local or federal funds activities described in this program. Supplanting is the use of MOOR grant funds to replace local or federal funds which were previously appropriated/budgeted for, or otherwise would have been spent on, the specific purpose(s) for which this award has been awarded. Any salaries, positions, personnel expenses, contractual expenses, equipment, travel, and other expenses paid for with MOOR grant funds must be used to supplement your organization's existing budget, and may not replace any funds that were already included in your entity's existing or projected budget“). ↑

18. Md. Health-General Code Ann. Sec. 7.5-905(b)(2). ↑

19. Md. State Finance and Procurement Code Ann. Sec. 7-331(j)(3). ↑

Where do these monies live?

This share is distributed directly to towns, cities, and counties according to Exhibit G of Maryland’s State-Subdivision Agreement, and each locality must establish a separate fund to hold its opioid settlement proceeds separate from other local government monies.[1]

What can this share be spent on?

With limited exceptions,[2] Maryland’s local share must be spent on the permitted uses described in the national settlement agreement’s (non-exhaustive) Exhibit E,[3] which includes prevention, harm reduction, treatment, recovery, and other strategies.

Excepting proceeds from Maryland’s Walgreens settlement, which limits reimbursement uses to 5%,[4] up to 60% of the local share (15% of statewide funds overall) may be used to reimburse past abatement expenditures.[5] The remaining must be spent only on forward-looking opioid remediation uses.[6]

Who ultimately decides how to spend this share (and how)?

State guides, localities decide. Decisionmakers for the towns, cities, and counties will ultimately decide for themselves how to spend their monies on permitted uses using non-binding recommendations from the state.[7] Counties must confer with their municipalities and the state on their planned uses of settlement monies,[8] but each locality has final say on its expenditures.[9]

Are supplantation uses prohibited for this share?

No, supplantation is not prohibited. Maryland does not explicitly prohibit supplantation uses of opioid settlement funds from its local share. This means that cities, counties, and towns may spend their monies from this share in ways that replace (or “supplant”) — rather than supplement — existing resources.

Can I see how this share has been spent?

Up to each locality (neither public nor intrastate reporting required). Though opioid settlement expenditures are not officially published in a centralized location for this share, legislation approved by the Governor in May 2024 requires the Maryland Department of Health to “examine and report … on the best process for making all of the expenditures of all opioid settlement agreements entered into by the State, counties, and municipal governments accessible to the public.”[10] The Department of Health must submit this report to the Maryland General Assembly by December 1, 2024.[11]

Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.

What else should I know?

Excepting Walmart,[12] Baltimore City is not participating in most of Maryland’s statewide settlements and has opted to instead to pursue its own litigation against certain opioid corporations.[13] However, the state provides that “non-government organizations that operate in Baltimore City [are] eligible to receive State Discretionary Abatement Funds and funds from the State Allocation for eligible uses.”[14]

Citations

1. State-Subdivision Agreement Between the State of Maryland and Local Governments on Proceeds Relating to the Settlement of Opioids Litigation (“2022 Maryland State-Subdivision Agreement”), Secs. IV(a)(3) (“The Settlement Fund Administrator shall allocate 25 percent of all Annual Payments to the Subdivision Fund for distribution directly to the Local Abatement Funds established by participating Qualifying Exhibit G Subdivisions”), I(l) (defining “Qualifying Exhibit G Subdivision to mean “a subdivision listed on Exhibit G of the National Settlement Agreement that is not a Special District”). See also State-Subdivision Agreement Between the State of Maryland and Participating Local Governments on Proceeds from Settlement of Opioids Litigation Against Teva, Allergan, Walmart, and Walgreens (“2023 Maryland State-Subdivision Agreement”), Sec. I (providing that except as otherwise specified, the terms of the 2022 Maryland State-Subdivision Agreement apply to the settlements with Teva, Allergan, Walmart, and Walgreens). ↑

2. See, e.g., Distributor Settlement Agreement I.SS (“Exhibit E provides a non-exhaustive list of expenditures that qualify as being paid for Opioid Remediation. Qualifying expenditures may include reasonable related administrative expenses”). ↑

3. 2022 Maryland State-Subdivision Agreement, Secs. I(h) (defining “Permitted Use” to “mean any use permitted by the National Settlement Agreement and Section 7-331(f) of the State Finance and Procurement Article, as amended from time to time. Except as specifically provided otherwise by this Agreement, Permitted Uses shall be limited to Future Opioid Remediation”), III(a) (requiring all settlement funds be used for “Permitted Uses”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). See also Settlement Overview. Maryland’s Office of Overdose Response website. Accessed August 27, 2024 (“Funding under this agreement must comport with Exhibit E of the national settlement”). ↑

4. 2023 Maryland State-Subdivision Agreement, Sec. II(d). ↑

5. 2022 Maryland State-Subdivision Agreement, Secs. III(a) (requiring all settlement funds be used for “Permitted Uses that serve the purpose of Future Opioid Remediation” unless otherwise authorized), III(b) (providing that subdivisions receiving funds from the 25% local share “may use up to 15 percent [of total funds] to pay for past Opioid Remediation consistent with Permitted Uses”), IV(a)(3) (providing that localities may use up to 60% of their local share, which is “15 percent of all Base Payments and Incentive Payments overall[,] … for purposes other than Future Opioid Remediation”); 2023 Maryland State-Subdivision Agreement, Sec. II(d) (replacing Sec. III(b) of the 2022 State-Subdivision Agreement to specify that “[t]he State, and any Subdivision receiving settlement proceeds [from the local share], may use up to 15 percent received from the Walmart Agreement, the Teva Agreement, and/or the Allergan Agreement to pay for opioids-related measures (including past Opioid Remediation” and “up to 5 percent received from the Walgreens Agreement to pay for opioids-related measures (including past Opioid Remediation)”). ↑

6. 2022 Maryland State-Subdivision Agreement, Sec. III(a) (requiring all settlement funds be used for “Permitted Uses that serve the purpose of Future Opioid Remediation” unless otherwise authorized); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

7. 2022 Maryland State-Subdivision Agreement, Secs. IV(b) (“each year, no later than 180 days before an Annual Payment is due, the Secretary shall provide nonbinding recommendations for County and Municipal Subdivision expenditure of Settlement Proceeds that, in the Secretary’s judgment, will serve an efficient and effective program of Future Opioid Remediation across Maryland”), I(r) (defining “Secretary” to mean the Secretary of Health), II(d) (“Any power conferred by this Agreement upon the Secretary may be delegated by the Governor to the Executive Director or a similar official created by future executive order”), I(g) (defining “Executive Director” to mean “Executive Director of the Opioid Operational Command Center”); 2023 Maryland State-Subdivision Agreement, Secs. I (generally applying terms to later settlements), II(a) (but replacing the 2022 State-Subdivision Agreement’s definition of “Executive Director” with “Special Secretary for Opioids Response or her designee or such other person designated by the Governor or by law to direct the Opioid Operational Command Center or any successor agency having substantially similar responsibilities and duties”); Maryland Executive Order 01.01.2023.21. December 14, 2023 (establishing the Office of Overdose Response within the Maryland Department of Health as the successor to the Opioid Operational Command Center). ↑

8. 2022 Maryland State-Subdivision Agreement, Sec. IV(b) (providing that a county “shall meet with representatives from the Municipal Subdivisions that are located within the County and that receive Settlement Proceeds under this Agreement, plus any other Municipal Subdivisions that [are not receiving settlement funds but] express interest in a meeting and are located within the County, together with the Secretary or the Secretary’s designee”) (emphasis added); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

9. 2022 Maryland State-Subdivision Agreement, Sec. IV(b) (“In the event of disagreement, the ultimate use of specific Settlement Proceeds shall be determined by the Subdivision that has been granted them in a manner consistent with the other provisions of this Agreement and applicable law”); 2023 Maryland State-Subdivision Agreement, Sec. I (applying terms to later settlements). ↑

10. 2024 MD Laws Ch. 852, Sec. 2. ↑

11. 2024 MD Laws Ch. 852, Sec. 2. ↑

12. See City of Baltimore Joins Settlement in Walmart Opioid Suits. Baltimore City Mayor press release. February 29, 2024. Accessed August 27, 2024; Baltimore City Executive Order – Administration of Baltimore City Opioid Restitution Funds. August 29, 2024. Accessed September 4, 2024. ↑

13. See OpioidSettlementTracker.com’s Global Settlement Tracker. ↑

14. See also Emily Keller. “Re: State Finance and Procurement Article § 7–331 (Chapter 537 of the Acts of 2019)—Opioid Restitution Fund Expenditure Report (MSAR # 14240).” Maryland Opioid Operational Command Center. November 1, 2023. Accessed August 27, 2024 (“Baltimore City is pursuing independent litigation against Johnson & Johnson and is not eligible to receive funding through Maryland’s settlement agreement”). ↑

Can I provide input on spending?

• 15% state share and 15% State Discretionary Abatement Fund share: Depends on future programming (not required). Though the state is not required to seek public input on its uses of settlement funds, the Opioid Restitution Fund Advisory Council (Council), which recommends expenditures from these shares,[1] has in the past included dedicated time in some of its past meetings for questions and comments from the public,[2] convened public listening sessions, and circulated public surveys to gather input on settlement spending. However, the Council does not regularly include dedicated public comment periods at all its meetings,[3] which are required to take place at least four times a year but typically occur monthly.[4]

• 25% local share and 45% Targeted Abatement Grants share: Up to each locality (not required).[5] Local governments are not required to seek public input on uses of their shares. However, each may choose to seek such input. For example, Harford County hosted several listening sessions to receive public recommendations to “help determine a framework and next steps” for uses of its funds.[6] Watch for other opportunities to weigh in on spending decisions for Maryland’s cities, counties, and towns, such as council meetings and town halls.

Can I apply for grants?

Yes. Maryland’s Office of Overdose Response has established settlement-funded grant opportunities for which community organizations are eligible to apply. Visit the MOOR Grant Programs page to view current funding opportunities. Local governments also may create grant programs to distribute their share of funds. The existence, parameters, and processes for local settlement grant programs will vary by locality, so stay alert for new opportunities. Visit the Opioid Settlement Community Grants Portals (OpioidSettlementTracker.com and Legal Action Center) for the most up-to-date information on settlement grant opportunities for community organizations.

Where do I go for updates?

• For updates on the Targeted Abatement Grants share,[7] a good starting point is to check the websites for your county council, city council, or local health department. You can also refer to the Maryland Association of Counties’ various opioid settlement-related articles on its Opioids page. See also Opioid Restitution Fund Advisory Council (Maryland’s Office of Overdose Response).

• For updates on the local share,[8] a good starting point is to check the websites for your county council, city council, or local health department. You can also refer to the Maryland Association of Counties’ various opioid settlement-related articles on its Opioids page.

• For updates on the state share, visit the Opioid Restitution Fund Advisory Council’s website and join Maryland’s Office of Overdose Response mailing list.

• For updates on the State Discretionary Abatement Fund share, visit the Opioid Restitution Fund Advisory Council’s website and join Maryland’s Office of Overdose Response mailing list.

• You can also sign up for updates from Community Education Group’s Appalachian Opioid Remediation (AOR) Database, which tracks information about the 13 states of Appalachia.

What else should I know?

Not applicable.

Citations

1. These shares are “subject to ORF Advisory Council recommendations.” Opioid Restitution Fund Advisory Council (“Settlement Overview”). Maryland’s Office of Overdose Response website. Accessed September 1, 2024. ↑

2. Emily Keller. “Re: State Finance and Procurement Article § 7–331 (Chapter 537 of the Acts of 2019)—Opioid Restitution Fund Expenditure Report (MSAR # 14240)”. Maryland Opioid Operational Command Center. November 1, 2023. Accessed September 1, 2024 (“Between November 2022 and August 2023, the ORF Advisory Council met twelve times and held two public listening sessions. Members of the public were able to submit written comments at any time to the help.oocc@maryland.gov inbox to be shared with the council in addition to the opportunity to share comments and ask questions at the end of each advisory council meeting. Throughout the meetings and listening sessions, the council heard from state officials regarding data and gaps in service, community organizations, and individuals directly impacted by the overdose crisis”). ↑

3. Compare 8/14/2023 Opioid Restitution Fund Advisory Council Meeting Agenda (Agenda item VII: “Questions/Comments from the Public”) with 4/30/2024 Opioid Restitution Fund Advisory Council Meeting Agenda (no such agenda item). ↑

4. Md. Health-General Code Ann. Sec. 7.5-904(a)(3). See agendas and minutes from prior meetings of the Council here. ↑

5. Excepting monies that are automatically distributed to Qualifying Charter Counties, funds from the Targeted Abatement Grants are awarded through a non-competitive program to cities, counties, and towns. Qualifying Charter Counties include Baltimore City and Anne Arundel, Baltimore, Frederick, Harford, Howard, Montgomery, and Prince George’s counties. State-Subdivision Agreement Between the State of Maryland and Local Governments on Proceeds Relating to the Settlement of Opioids Litigation (“2022 Maryland State-Subdivision Agreement”), Sec. I(k) (applying to Distributors and Janssen). See also State-Subdivision Agreement Between the State of Maryland and Participating Local Governments on Proceeds from Settlement of Opioids Litigation Against Teva, Allergan, Walmart, and Walgreens (“2023 Maryland State-Subdivision Agreement”), Sec. I (providing that except as otherwise specified, the terms of the 2022 Maryland State-Subdivision Agreement apply to the settlements with Teva, Allergan, Walmart, and Walgreens). ↑

6. Harford County Seeks Public Input on Use of Opioid Restitution Funds. Hartford County Executive press release. April 2, 2024. Accessed September 1, 2024. Harford County also launched a survey to determine respondents’ opioid settlement planning-related focus group interests. ↑

7. These shares are “[n]ot subject to ORF Advisory Council recommendations.” Opioid Restitution Fund Advisory Council (“Settlement Overview”). Maryland’s Office of Overdose Response website. Accessed September 1, 2024. ↑

8. Opioid Restitution Fund Advisory Council (“Settlement Overview”). Maryland’s Office of Overdose Response website. Accessed September 1, 2024. ↑

This Community Guide will describe how Maryland is spending its opioid settlements and whether Maryland is working to ensure community access to opioid settlement funds. Last revised September 1, 2024.

[2] The 70% to local governments includes the 45% Targeted Abatement Grants share and 25% Local Share.

Has the state established an advisory body for settlement funds?

Yes. The (Council) was created by state law,[1] and the 15% State Discretionary Abatement Fund and 15% state shares are subject to its recommendations.[2] The Council’s primary function is to annually submit written “findings and recommendations . . . regarding the allocations of money from the [Opioid Restitution] Fund” to the Governor and the Secretary of Health by November 1 each year.[3] In doing so, the Council must consider these criteria across jurisdictions:

• Number of people per capita with a substance use disorder (SUD)[4]

• Number of overdose deaths per capita[5]

• Currently available programs, services, and supports to individuals with SUD[6]

• Disparities in access to care and health outcomes[7]

The Governor is required by state law to consult with the Council at least twice annually to “identify recommended appropriations from the [Opioid Restitution] Fund.”[8] The Council may consult with state agencies and create committees to carry out its duties.[9]

Effective October 1, 2024:[10]

• The Secretary of Health must present decisions on allocations from the Opioid Restitution Fund to the Council within 6 months of receiving its written recommendations, and the Department of Health must publish both the Council’s recommendations and ultimate allocation decisions on the Department’s website.[11]

• The Council’s staffing and administrative support will be provided by (instead of the Opioid Operational Command Center).[12]

The Council is required to meet at least four times per year but in practice has met more frequently.[13]

Is the state advisory body required to include member(s) with lived and/or living experience?

Yes. The must include “an individual in recovery from a substance use disorder,”[14] as well as an “individual disproportionately impacted by substance use disorders and disparities in access to care.”[15] The Council is also required to include “a family member of an individual who has experienced an overdose.”[16]

What is the overall membership of the state advisory body?

The composition of the 14-member is defined by state law:[17]

• Member of the Maryland Senate, appointed by the Senate President[18]

• Member of the Maryland House of Delegates, appointed by the House Speaker[19]

• Deputy Secretary for Behavioral Health or their designee[20]

• Deputy Secretary for Health Care Financing or their designee[21]

• Maryland Attorney General or their designee[22]

• The Special Secretary of Overdose Response or their designee (previously Executive Director of the Opioid Operational Command Center or their designee)[23]

• Three appointments by the Governor:*

  • Person representing a “community-based opioid treatment program”[24]

  • Person representing a “community-based substance use disorder and mental health treatment program[]”[25]

  • Public health expert “engaged in harm reduction services”[26]

• Three appointments by the Secretary of Health:*

  • Person in recovery from a substance use disorder[27]

  • Person who is a family member of an individual who has experienced an overdose[28]

  • Person who is “disproportionately impacted by substance use disorders and disparities in access to care”[29]

*The six (6) members appointed by the Governor and Secretary of Health must additionally seek to reflect Maryland’s geographic regions, represent “at- risk populations,” and reflect the “ethnic, gender, and cultural diversity of the state.”[32] Members appointed by the Governor and Secretary of Health serve two-year terms and may serve a maximum of two (2) consecutive terms.[33]

Are local governments required to establish a settlement advisory body? If so, are local advisory bodies required to include member(s) with lived and/or living experience?

What else should I know?

Citations

1. Md. Health-General Code Ann. Sec. 7.5–902 ("There is an Opioid Restitution Fund Advisory Council in the Department [of Health]”). See also Md. Health-General Code Ann. Secs. 7.5-901 through 7.5-905. ↑

3. Md. Health-General Code Ann. Sec. 7.5-905(a). ↑

4. Md. Health-General Code Ann. Sec. 7.5-905(a)(1). ↑

5. Md. Health-General Code Ann. Sec. 7.5-905(a)(3). ↑

6. Md. Health-General Code Ann. Sec. 7.5-905(a)(4). ↑

7. Md. Health-General Code Ann. Secs. 7.5-905(a)(2), (5). ↑

8. Md. State Finance and Procurement Code Ann. Sec. 7-331(j)(2). ↑

9. Md. Health-General Code Ann. Secs. 7.5-904(a)(1)-(2). ↑

11. Md. Health-General Code Ann. Sec. 7.5-905(b). ↑

12. Md. Health-General Code Ann. Sec. 7.5-904(b). ↑

14. Md. Health-General Code Ann. Sec. 7.5-903(a)(8)(i). ↑

15. Md. Health-General Code Ann. Sec. 7.5-903(a)(8)(iii). ↑

16. Md. Health-General Code Ann. Sec. 7.5-903(a)(8)(ii). ↑

17. Md. Health-General Code Ann. Sec. 7.5-903(a)(1)-(10). ↑

18. Md. Health-General Code Ann. Sec. 7.5-903(a)(1). ↑

19. Md. Health-General Code Ann. Sec. 7.5-903(a)(2). ↑

20. Md. Health-General Code Ann. Sec. 7.5-903(a)(3). ↑

21. Md. Health-General Code Ann. Sec. 7.5-903(a)(4). ↑

22. Md. Health-General Code Ann. Sec. 7.5-903(a)(5). ↑

24. Md. Health-General Code Ann. Sec. 7.5-903(a)(7)(i). ↑

25. Md. Health-General Code Ann. Sec. 7.5-903(a)(7)(ii). ↑

26. Md. Health-General Code Ann. Sec. 7.5-903(a)(7)(iii). ↑

27. Md. Health-General Code Ann. Sec. 7.5-903(a)(8)(i). ↑

28. Md. Health-General Code Ann. Sec. 7.5-903(a)(8)(ii). ↑

29. Md. Health-General Code Ann. Sec. 7.5-903(a)(8)(iii). ↑

30. Md. Health-General Code Ann. Sec. 7.5-903(a)(9). ↑

31. Md. Health-General Code Ann. Sec. 7.5-903(a)(10). ↑

32. Md. Health-General Code Ann. Secs. 7.5-903(b)(1)-(3). ↑

33. Md. Health-General Code Ann. Secs. 7.5-903(d)(1)(i), (d)(2). ↑

34. Md. Health-General Code Ann. Sec. 7.5-903(c). ↑

35. Md. Health-General Code Ann. Sec. 7.5-903(f). ↑

36. Md. Health-General Code Ann. Sec. 7.5-904(a)(4). ↑

37. Md. Health-General Code Ann. Sec. 7.5-903(d)(3). ↑

Here are the entities that ultimately decide how each of Maryland’s opioid settlement shares are spent:

• 45% Targeted Abatement Grants share: local officials for counties, cities, and towns

• 25% local share: local officials for counties, cities, and towns

• 15% state share: the “State” (likely the )

• 15% State Discretionary Abatement Fund share:

Opioid Restitution Fund Advisory Council

• Settlement Overview

• ORF Advisory Council Funding Recommendations (October 3, 2023)

Maryland Association of Counties (MACo)

• Conduit Street: “Opioids”

Community Education Group

• Appalachian Opioid Remediation (AOR) Database

• Maryland: Allocation of Funds