Two years ago, Maryland was in the grip of an overdose crisis that felt insurmountable. Fatal overdoses were climbing year after year, devastating families in Baltimore City, along the Eastern Shore, and in the rural Appalachian communities of Western Maryland. Today, the numbers tell a dramatically different story — one of measurable, sustained progress that state officials say proves evidence-based strategies are working, even as they warn the fight is far from over.
At the second annual Overdose Prevention Advocacy Day on February 10 in Annapolis, Lt. Governor Aruna Miller led a rally alongside community partners, healthcare providers, faith leaders, lawmakers, and Marylanders with lived experience of addiction and recovery. The event served as both a progress report and a call to action, as the state confronts the tension between encouraging results and the work that remains.
"Behind every number is a life, a family, a community, and a future that we must fight for," said Lt. Governor Miller. "Maryland is proving that when we engage with those closest to the problem, we find solutions that work. We are turning the tide, but our work is not done until every Marylander has an accessible road to recovery."
The Numbers Behind the Progress
According toa recent report from the Maryland Overdose Response Advisory Council, which the Lt. Governor chairs, fatal overdoses dropped nearly 26 percent from 2024 to 2025. That followed a 37 percent decline the year before.
Taken together, the number of fatal overdoses in 2025 is now less than half of the state's peak in 2021 — a sustained multi-year decline that stands out nationally at a time when many states are still struggling to bend the curve. The state has attributed that progress to a strategy built on several pillars: expanding access to naloxone, the overdose reversal medication; investing in treatment and recovery services; meeting people where they are through low-barrier outreach; and ensuring that people with lived experience have a seat at the policy table.
In 2025 alone, more than 440,000 doses of naloxone were distributed at the community level across Maryland — a number that reflects both the scale of the crisis and the scale of the response. Each of those doses represents an opportunity to reverse an overdose that might otherwise have been fatal.
A Structure Built for the Long Fight
Maryland's approach has been distinct in its emphasis on centralized coordination. In 2023, Governor Wes Moore signed an executive order establishing the state's Office of Overdose Response, which operates under the Lt. Governor's leadership and works to align efforts across 18 state offices and agencies. It's a structure designed to prevent the kind of fragmented, siloed response that has undercut overdose prevention efforts in other states.
Since taking office, the Moore-Miller administration has allocated more than $56 million in opioid settlement funds toward initiatives that include expanding access to medications for opioid use disorder, strengthening the behavioral health workforce in rural areas, supporting youth prevention programs, and building recovery support services. The administration is also developing a public dashboard to provide transparency in how opioid settlement funds are spent at both the state and local level.
"Whether you're from Baltimore City, the Appalachian Mountains in Western Maryland, or our beautiful Eastern Shore, everyone knows someone who has been touched by the overdose crisis," said Special Secretary of Overdose Response Emily Keller. "And that means it's going to take all of us working together, regardless of our party or politics, to keep making an impact. We owe it to our communities to keep fighting."
Centering Lived Experience
One of the more notable elements of Maryland's strategy has been its emphasis on including people with lived experience of addiction and recovery in shaping state policy. The administration established a Citizen Advisory Workgroup specifically designed to ensure that individuals who have navigated the system — and their families — have direct input on how resources are deployed and programs are designed.
It's an acknowledgment that policymakers and clinicians don't always see what people on the ground see. The barriers to treatment, the gaps in recovery support, the moments when someone falls through the cracks — those are realities that are most clearly understood by the people who have lived them. Giving those voices a formal role in governance isn't just symbolic; it produces better policy.
Overdose Prevention Advocacy Day brought those voices to the forefront, with Marylanders sharing personal stories of loss, survival, and recovery alongside professionals working in healthcare, law enforcement, and community organizations. The event was designed not as a victory lap but as a reminder that behind every percentage point of decline are real people whose lives depend on the state's continued commitment.
The Work That Remains
While the numbers are encouraging, officials were careful to note that cutting fatal overdoses in half from a crisis peak still means thousands of Marylanders are dying. Fentanyl remains the dominant driver of overdose deaths, and the emergence of adulterants like xylazine — an animal tranquilizer increasingly found in the drug supply — has introduced new medical complications that naloxone alone cannot reverse.
Rural communities continue to face acute challenges in accessing treatment, and workforce shortages in behavioral health persist across the state. The $56 million in opioid settlement funds, while significant, represents a fraction of the long-term investment needed to sustain progress and close remaining gaps.
Maryland's trajectory offers a case study in what sustained, coordinated, evidence-based investment can accomplish. But it also serves as a reminder that progress is fragile — and that the communities most affected by the crisis cannot afford for that investment to waver.