Use of ORF Funds

DISCLAIMER: Maryland’s Office of Overdose Response is developing an interactive dashboard to share information about prescription opioid settlement funds in Maryland. The content here will be removed once the dashboard is live. This information may also be updated on a regular basis. 

Expenditure Summary

Note: This page references information from our Settlement Overview Page. Visit this page to see an overview of Maryland’s prescription opioid settlement framework and a summary of funds received. 

A cumulative total of $192,260,874.59 in prescription opioid-related legal settlement funds has been deposited into the Opioid Restitution Fund as of the 2025 fiscal year. Of this, $12,519,234.61 has been spent by local subdivisions through Targeted Abatement Grants (TAG) funding, $1,331,260.67 has been spent by the state through State Discretionary Abatement Fund grants, with an additional $22,539,785 in future allocations, and $14,418,335.56 has been spent by the state through the state allocation, with an additional $34,507,990.00 allocated for future spending. Outside of the state fund, local subdivisions have spent $5,893,230.67 of the prescription opioid settlement funds they receive directly from the settlement administrator. 

Local Subdivisions Funds

Local Direct Funds

Local Direct funds are distributed directly from the settlement administrator to local subdivisions. The payments occur on a calendar-year basis, and the schedule for payments can be found here. As of the end of fiscal year 2025 (FY25), $53,580,085.23 of Local Direct funds have been received by participating subdivisions. Based on amounts from settlements that are currently finalized, an additional $106,513,331.77 will be distributed by 2038, totaling $160,093,417 in local direct funds. 

According to local subdivision reporting submitted to Maryland’s Office of Overdose Response (MOOR), $5,893,230.67 of local direct funds have been expended as of the end of fiscal year 2025. 

Targeted Abatement Funds

Targeted Abatement Grant Funds are distributed to subdivisions by MOOR after a Local Abatement Plan has been submitted and approved. MOOR reviews Local Abatement Plans to ensure spending aligns with allowable uses. As of the end of the 2025 fiscal year, 30 of the 58 participating subdivisions did not have an approved Local Abatement Plan. 

Funding through the Targeted Abatement Fund is formula-based as specified by the State-Subdivision Agreement. The allocation percentages are the same for all settlements governed by the State-Subdivision Agreement, with the exception of the Walmart settlement, which includes Baltimore City in its calculations.

As of the end of the 2025 fiscal year, $97,015,609.83 was deposited into the Opioid Restitution Fund for use as Targeted Abatement Fund grants. Based on amounts from settlements that are currently finalized, $187,365,610.12 in additional payments will be made through 2038, totaling $284,763,252.13.

Of the amount received by the end of fiscal year 2025, $85,313,969 was distributed to subdivisions with a Local Abatement Plan and Qualifying Charter Counties. As of the end of the 2025 fiscal year, a total of $11,701,640.83 in unaccessed TAG funds remain in the Opioid Restitution Fund due to the number of subdivisions that have yet to submit a Local Abatement Plan.

Local subdivisions have reported spending $12,519,234.61 in TAG funds. To see a summary of spending by subdivision, please reference our most recent Annual ORF Expenditure Report.

State Discretionary Abatement Fund

As of the 2025 fiscal year, Maryland received $37,960,873 through the Opioid Restitution Fund designated for use as State Discretionary Abatement Funds, which is intended to be distributed through a competitive grant process. Based on currently finalized settlements, Maryland expects to receive an additional $62,529,527.78 to this fund through 2038. In total, this fund will receive $100,490,400.97. 

In the 2025 fiscal year, $1,331,260 in State Discretionary Abatement Funds were spent, with an additional $12,239,78 to be spent in future years on currently issued grant awards. For fiscal year 2026, MOOR has made a budget request of $10 million for future grant processes, and an additional $300,000 was allocated through Maryland House Bill (HB) 1131 of 2025 for grants for training paramedics on administering buprenorphine. 

Maryland Department of Health Request for Applications (FY 2025-2027: $13,571,045)

On June 26, 2024, the Maryland Department of Health issued a Request for Applications for funding using available funds through the State Discretionary Abatement Fund. Through this competitive funding opportunity, applicants were eligible to receive up to $1 million to support programs and initiatives that meet the funding requirements of Exhibit E, the Opioid Restitution Fund, and the 2023 recommendations from the Opioid Restitution Fund Advisory Council (more information regarding the 2023 recommendations is provided below). 

Through this opportunity, Maryland’s Office of Overdose Response awarded a total of $13,571,045 to 28 organizations. As of this report, $1,331,260 has been expended through two quarters of active grant awards. The remaining $12,239,785 is allocated for use through fiscal year 2027. 

HB 1131 EMS Buprenorphine Grants: (FY 2026–2031: $300,000)

HB 1131 of 2025 establishes a grant program to assist counties with offsetting the cost of training paramedics to administer buprenorphine after an overdose, with funding provided by the ORF. The bill also requires MOOR to convene and staff a workgroup to study access and utilization of buprenorphine in Maryland. The workgroup is required to produce a report by December 31, 2025.

State Allocation (Including McKinsey, Publicis, and Mallinckrodt)

As of the 2025 fiscal year, Maryland received $57,284,391.70 through the Opioid Restitution Fund designated for use as State Allocation funds, which are to be spent at the discretion of the state. Based on currently finalized settlements, Maryland expects to receive an additional $64,730,470.89 to this fund through 2038, totaling $122,014,862.59.

Past spending occurred with funds from the McKinsey settlement for a total of $8,007,084.39. These funds were used to support the Examination and Treatment Act Grant Program, the Access to Recovery Emergency Gap Funds Grant Program, and the Data Informed Risk Mitigation Project. Please see our reporting for previous years for more information on past expenditures.

A total of $8,074,100.00 was allocated for spending from the state allocation in fiscal year 2025, and $6,411,251.17 was spent. Funds that were allocated but unspent will be returned to the state allocation fund. This brings total state allocation spending through fiscal year 2025 to $14,418,335.56. 

Additionally, Maryland enacted three new pieces of legislation during the 2025 session that resulted in appropriations from the State Allocation in fiscal year 2025. 

SB 1099 Fiscal Summary for Naloxone Co-Located in AEDs (Allocated for FY25: $74,100.00 | Spent as of FY25: $0) 

SB 1099 expanded the Public Access Automated External Defibrillator (AED) Program to require that naloxone be co-located with each AED placed in a public building. The bill requires the EMS Board to develop and implement the program in collaboration with MDH, with funds from the ORF. Naloxone must be in place at required locations by October 10, 2027.

At the time of this writing, MOOR is working to establish memoranda of understanding with state agencies to implement the requirements of SB 1099, and no funds were expended in the 2025 fiscal year. MDH will purchase naloxone for this program in the 2026 fiscal year, and the associated expenditure will be included in next year’s update to this report.

Budget Reconciliations and Financing Act – BHA Buprenorphine Initiative (Allocated for FY25: $3,000,000.00 | Spent as of FY25: $2,482,821.40) 

Maryland’s Buprenorphine Initiative, which is overseen by the Behavioral Health Administration (BHA), is working to expand and maintain access to buprenorphine across the state for individuals ages 16 and older with opioid use disorder. Activities and services funded through this program include: targeted prescriber outreach, education, and technical assistance; anti-stigma campaigns; low-threshold buprenorphine access sites and buprenorphine provision through outpatient community providers; substance use treatment programs in behavioral health settings; training for medical staff in hospitals and detention centers; and training for EMT personnel along with their respective support staff. 

Budget Reconciliations and Financing Act – Department of Public Safety and Correctional Services MOUD Support (Allocated for FY25: $5,000,000.00 | Spent as of FY25: $3,928,429.77) 

This funding provides support for medications for opioid use disorder (MOUD) to those who enter the Baltimore City Pre-Trial facility and those continuing MOUD upon entry into the Division of Correction facilities. Additionally, it supports the staffing needed to expand access to substance use disorder treatment and counseling services.

State Allocations for Future Fiscal Years

In addition to the expenditures outlined above, a total of $34,507,990.00 has been allocated from the State Allocation for spending in future years for the programs below. Some of this spending was allocated through legislation, and some was made at the state’s discretion. 

SB 1099 Fiscal Summary for Naloxone Co-Located in AEDs (FY 2026–2029: $490,189)

SB 1099 expanded the Public Access Automated External Defibrillator Program to require that naloxone be co-located with each AED placed in a public building. The bill requires the EMS Board to develop and implement the program in collaboration with MDH, with funds from the ORF. Naloxone must be in place at required locations by October 10, 2027. The funds support a program manager’s salary and the purchase of naloxone and other supplies. 

Budget Reconciliations and Financing Act – BHA Buprenorphine Initiative (FY 2026: $2,430,383.00)

Maryland’s Buprenorphine Initiative, which is overseen by the Behavioral Health Administration (BHA), is working to expand and maintain access to buprenorphine across the state for individuals ages 16 and older with opioid use disorder. Activities and services funded through this program include: targeted prescriber outreach, education, and technical assistance; anti-stigma campaigns; low-threshold buprenorphine access sites and buprenorphine provision through outpatient community providers; substance use treatment programs in behavioral health settings; training for medical staff in hospitals and detention centers; and training for EMT personnel along with their respective support staff. 

Budget Reconciliations and Financing Act – Department of Public Safety and Correctional Services MOUD Support (FY 2026: $5,000,000)

This funding provides support for medications for opioid use disorder (MOUD) to those who enter the Baltimore City Pre-Trial facility and those continuing MOUD upon entry into the Division of Correction facilities. Additionally, it supports the staffing needed to expand access to substance use disorder treatment and counseling services.

SB 495 – Office of the Attorney General Opioids Enforcement Unit (FY 2026–2029: $6,000,000)

SB 495 of 2025 altered the allowable uses of Maryland’s Opioid Restitution Fund to include the provision of funds for the operating expenses and personnel costs for investigations, enforcement actions, and other activities conducted by the Opioids Enforcement Unit within the Office of the Attorney General (OAG). OAG is also required to report annually, beginning October 1, 2025, on the status of activities of the Opioids Enforcement Unit.

Medicaid 1115 CMS Waiver for MOUD Pre-Release (FY 2026–2027: $9,442,432.00)

In January of 2025, CMS approved a Reentry Demonstration as a part of Maryland’s HealthChoice Demonstration 1115 waiver. The demonstration provides a set of targeted Medical Assistance services up to 90 days prior to release for individuals with substance use disorder (SUD) and/or severe mental illness (SMI) in a Department of Public Safety and Correctional Services (DPSCS) operated facility. The targeted services are comprehensive case management for individuals with SUD and/or SMI, MOUD for SUD as clinically appropriate, with accompanying counseling, and the provision of all prescribed medications for 30 days upon release. 

MOOR Staff Salaries – ORF Administration Support Positions (FY 2026–2038: $7,116,286.00)

As the Maryland state entity tasked with administratively managing the Opioid Restitution Fund, MOOR is tasked with offering grant opportunities, processing TAG payments, coordinating and reviewing local subdivision reporting, providing technical assistance to local subdivisions, supporting the Opioid Restitution Fund Advisory Council, and advising the state on best uses of the state allocation fund. In order to do this work effectively, 1.06% of the projected ORF funds to be paid to Maryland have been allocated to MOOR to hire two grants staff and a program manager to manage day-to-day ORF inquiries and support. This total comes to $7,116,286.00.

Lt. Governor’s Office Opioid Policy Advisor (FY 2026–2038: $1,844,900.00)

The Lt. Governor’s Office is the primary entity in the Executive Office of the Governor that oversees the Opioid Restitution Fund and issues related to substance use and overdose. As such, MOOR reports directly to the Lt. Governor, who also serves as chair of the Maryland Overdose Response Advisory Council. To support these functions, $1,844,900.00 was allocated to support a policy advisor position within the Lt. Governor’s Office focused on substance use and overdose through the 2038 fiscal year. 

Maryland Department of Labor RAMP Grant Program (FY 2026–2028: $2,000,000)

The Rural Advancement for Maryland Peers (RAMP) program seeks to alleviate the shortage of certified peers by competitively awarding grant funds to organizations that will offer the necessary training for peer recovery specialists to become certified in the State of Maryland. Priority will be given to applicants who serve residents in areas with significant behavioral health workforce shortages and those with a high prevalence of opioid-related overdose deaths. The target population for this grant is unemployed or underemployed individuals in rural parts of the state. 

Opioid Settlement Dashboard SB 589 (FY 2026–2038: $96,000)

SB 589 of 2025 requires MOOR to develop and maintain an interactive dashboard on ORF spending and prescription opioid-related settlement information with the public, with funding provided by the ORF. The dashboard is also required to include links to relevant state, county, or municipal websites that provide access to additional information on the use of settlement funds. MOOR is currently partnering with MDH to develop this dashboard, which is tentatively scheduled to be completed in December 2025. $96,000 in ORF funds will be used to maintain this dashboard through the 2038 fiscal year. 

Fiscal Mapping Contract (FY 2026: $87,800)

The funding landscape related to programs and services related to substance use and overdose in Maryland is complex, with multiple agencies receiving and administering funds from various federal and state sources. The purpose of this fiscal mapping project is to provide an assessment of the current funding landscape for Maryland and recommendations for improving coordination in funding to maximize all available resources, including opioid settlement funds.