The Opioid Restitution Fund (Fund) holds 75% of Maryland’s opioid settlement funds,[1] including the 15% state share.[2]
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]
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]
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]
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.
Not applicable.
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). ↑
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”). ↑
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). ↑
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. ↑
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”). ↑
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”). ↑
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)”). ↑
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”). ↑
Md. Health-General Code Ann. Sec. 7.5-904(b). ↑
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). ↑
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. ↑
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. ↑
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”). ↑
Md. Health-General Code Ann. Sec. 7.5-905(b)(2). ↑
Md. State Finance and Procurement Code Ann. Sec. 7-331(j)(3). ↑