Maryland opioid-related overdose deaths have fallen sharply since the pandemic peak, dropping 57% from more than 2,500 deaths in 2020 to just over 1,000 last year. The decline marks a 10-year low, though the crisis is far from over.
State officials point to naloxone, fentanyl test strips, treatment access, and local outreach as major reasons behind the progress. Gov. Wes Moore said Maryland’s partnerships with local communities are “invaluable,” while adding that there is still more work to do.
Maryland tracks overdose deaths across several categories, including opioid-related deaths, fentanyl, heroin, and prescription opioids. The broad opioid-related category shows the clearest pattern: a steep pandemic-era rise, followed by a return to levels closer to what the state saw a decade ago.
Fentanyl remains central to the numbers, even with the improvement. Since 2020, fentanyl deaths have dropped by about 60%, while overall opioid-related deaths fell 57%. That means the state is improving, but fentanyl still drives much of the risk.
The decline is uneven across counties. Baltimore City still has the highest overdose death rate among major U.S. cities, while Prince George’s and Baltimore counties remain high in total deaths. Anne Arundel County, however, saw a major drop from 2020 levels.
Maryland officials point first to wider access to naloxone and fentanyl test strips. Since 2020, naloxone distribution rose 199%, while fentanyl test strip distribution increased 239%, giving more people tools to respond faster when overdoses happen.
Last year, Maryland distributed more than 440,000 naloxone doses and 260,000 drug test strips, the highest totals on record for the state. Health officials say that reach matters because prevention only works when supplies actually reach people at risk.
Keller also credited local outreach and treatment access, especially medications for opioid use disorder. She said reaching that population helped improve health outcomes, while smaller community groups continue doing daily frontline work that often does not get public attention.
Maryland’s Opioid Restitution Fund is another piece of the response. The fund sends 70% of settlement money to local efforts and keeps 30% for grants and state programs. This year, the fund has received $245 million, with $34 million spent.
The state also secured more than $90 million from the Purdue Pharma and Sackler family settlement. Keller was blunt about it, saying, “It’s about time that they pay,” referring to the harm tied to the opioid crisis.
A wider supply shift may also be helping. Researchers found fentanyl purity fell from about 25% in early 2023 to roughly 11% by late 2024, after disruptions to precursor chemicals and online marketplaces linked to illicit fentanyl production.
Maryland’s decline has opened a real debate over what deserves the most credit: naloxone, treatment, local outreach, settlement funding, or changes in the fentanyl supply. The answer is likely a mix, which makes continued investment harder to ignore.
What comes next should focus on county gaps, especially Baltimore City’s still-high overdose rate, even as statewide numbers improve. Keeping naloxone, test strips, treatment access, and community support available will matter if Maryland wants the decline to hold.