Baltimore's Opioid Crisis Response: Balancing Legal Strategy and Public Health

For years, Baltimore’s leadership largely overlooked the escalating overdose crisis, despite a sharp rise in the death rate. This summer, however, it appeared that the city was finally prepared to address the drug epidemic with renewed urgency.

The City Council had scheduled four hearings after reports from The New York Times and The Baltimore Banner revealed that Baltimore’s overdose rate was higher than any other major American city. Additionally, Mayor Brandon Scott announced a $45 million legal settlement with a drug manufacturer, raising hopes for substantial new public health initiatives to combat the epidemic, which had claimed nearly 6,000 lives over the past six years.

However, just before the first hearing, and as demonstrators gathered outside City Hall, the council president abruptly canceled the session at the request of Mayor Scott’s administration. The administration argued that holding public meetings could jeopardize a lawsuit the city had filed against several opioid manufacturers and distributors, which Baltimore leaders believe could result in a much larger financial settlement than the $45 million already secured.

This decision to cancel the hearings was consistent with the city’s recent reluctance to disclose details of its overdose prevention efforts, citing the ongoing lawsuit, which is set for trial in September. Most City Council members have been unwilling to comment on the hearings or the overdose crisis, a stark contrast to their earlier discussions on the issue.

While it is not unusual for governments to limit public statements during litigation, some public health experts and residents have expressed concern about the lack of transparency in Baltimore’s response to the epidemic. The decision to cancel the hearings has left many in the dark about the city's plans.

“It sets a really dangerous precedent,” said Robin Pollini, a public health professor at West Virginia University, who began studying overdoses in Baltimore. “You’re saying, ‘We’re not going to talk about a public health problem that’s killing our neighbors.’”

Mayor Scott, when asked about his approach, said it was influenced by his personal experiences of seeing overdoses in his neighborhood and his desire to protect the potential financial outcome of the lawsuit.

“My responsibility is to do what’s best for the city,” he stated.

The overdose death rate in Baltimore has quadrupled since fentanyl, a synthetic opioid, became prevalent in the illegal drug market a decade ago. Earlier this year, reports indicated that much of Baltimore’s previous aggressive overdose prevention strategy had stalled, as city leaders focused on other issues.

The situation became more complicated last week when the city’s health commissioner, Dr. Ihuoma Emenuga, was fired amid an investigation into her work with a nonprofit healthcare group. Dr. Letitia Dzirasa, a deputy mayor and former health commissioner, also left her position in June.

Baltimore filed its lawsuit against opioid manufacturers in 2018 as part of a larger wave of litigation by local and state governments. Unlike other Maryland jurisdictions, which agreed to a $400 million settlement, Mayor Scott’s administration chose to pursue its case independently, hoping for a larger payout.

Since the release of the Times/Banner series, Mayor Scott and his aides have suggested, without evidence, that the articles were somehow connected to the defense strategies of opioid companies. City administrator Faith Leach hinted at this during a budget hearing, one of the few times the administration publicly addressed the overdose crisis.

When pressed at a recent news conference, Mayor Scott said, “I think the residents of Baltimore know when there’s smoke, there’s fire.”

As the legal case nears its conclusion, the tension between transparency and legal strategy remains. Councilman Mark Conway, who had planned to hold the first public hearing on overdoses, has been one of the most vocal advocates for increased focus on the crisis. Despite negotiating with the city’s top lawyer for weeks, Conway’s hearing was ultimately canceled due to legal concerns.

In the aftermath, Conway expressed disappointment, stating, “The health and lives of Baltimoreans ought to transcend politics, and I regret that did not happen today.” Mayor Scott publicly criticized Conway, accusing him of prioritizing his personal profile over the city’s best interests.

As it stands, the future of Baltimore’s response to the overdose crisis remains unclear. The city’s Overdose Prevention Team met in June but did not finalize any new goals for addressing addiction. The current plan, drafted in 2020, expired this year, with a new draft expected this fall.

Public health and legal experts remain divided on the mayor’s decision to limit discussions about the crisis. Some, like retired federal judge Andre Davis, believe the strategy, though costly in terms of transparency, is necessary. Others argue that cutting off all conversation is too high a price to pay, especially as the city continues to grapple with a worsening public health emergency.

Source: NY Times