In October 2017, the U.S. Department of Health and Human Services for the first time declared the opioid overdose epidemic a “public health emergency.” Since then, it has renewed this declaration 30 times, while nearly 500,000 lives have been lost to opioid overdoses.

Although national data suggests that opioid overdose deaths began to decline in 2023, the epidemic is far from over. Provisional data from the federal Centers for Disease Control and Prevention show that 80,000 people died from opioid overdoses in 2023. More than 900 of those deaths occurred in Baltimore and were linked to fentanyl.

Baltimore has been among the cities hardest hit by the opioid overdose epidemic, with a per capita overdose death rate significantly higher than the national average.

Something must change — particularly in cities like Baltimore — and that something is how we approach prevention, treatment, harm reduction and recovery from opioid misuse. It’s time to abandon siloed efforts and embrace a unified, systems-based approach — one that saves lives across all racial and socioeconomic groups and helps rebuild communities hit hardest by opioid use disorder (OUD).

Unlike the cocaine and other drug crises of past decades, the opioid overdose epidemic is a uniquely modern crisis born from misleading and aggressive marketing of highly addictive prescription drugs. What began with overprescribed painkillers in the 1990s has evolved into an epidemic driven by synthetic opioids like fentanyl, which accounted for an estimated 75% of U.S. overdose deaths in 2022.

According to the U.S. Joint Economic Committee, costs related to OUD and fatal opioid overdose climbed from $1.07 trillion in 2017 to $1.5 trillion in 2020.

These staggering costs stem from a web of factors, including a lack of access to substance abuse treatment during the pandemic that worsened addiction, the complexity of treatment and the incarceration of individuals for drug-related offenses.

Efforts like Narcan distribution, drug court programs and limiting opioid prescriptions are essential — but they’re not enough on their own. These strategies are often siloed and lack the coordination needed to address OUD at scale. While opioid prescriptions have decreased due to their addictive properties, and overdose reversals have risen with increased Narcan awareness and training, many people with OUD have turned to — or continue using — heroin or synthetic fentanyl, fueling increases in untreated OUD, homelessness and crime.

Leaders should ask, “Are we reducing overdoses and saving lives across the entire system — from prevention to sustainable recovery?”

Baltimore’s overdose crisis is compounded by deep gaps in treatment services, housing and behavioral health care. For example, when people return home from incarceration, they often have no place to live, no path to treatment and no support to rebuild.

As a subject matter expert for a regional reentry initiative funded by the U.S. Department of Housing and Urban Development and the Department of Justice, I’ve seen what works when systems collaborate.

In Maryland’s Prince George’s and Montgomery Counties, the Capital Region Pay for Success project helped expand permanent supportive housing for individuals with a history of justice involvement who also experienced chronic homelessness and had unmet behavioral health needs. We treated housing as health infrastructure. With the right support, individuals stabilized, reoffended less and reconnected with their communities.

Baltimore faces similar challenges — and should consider similar solutions. Without stable, affordable homes and supportive services, our efforts to combat OUD will always fall short.

Shifting from isolated efforts to a systems approach helps address these complex social challenges and clears pathways for collaboration. Local governments, health care systems, schools, the criminal justice system, insurance providers, housing organizations, workforce development organizations and community organizations must coordinate their efforts, share data — to see where overdoses are happening, how drugs are making their way in, and which demographics are most affected — and allocate resources where they’re needed most. The first step is building a coalition of multifaceted partners, including people with lived experience of OUD and their families.

Centering the voices of community members is crucial. Through a nationwide bus tour, Mobilize Recovery amplifies lived experience while offering advocacy training, digital tools and education on addiction — connecting communities across the country.

In the Nicholtown neighborhood in Greenville, South Carolina, I lead the VOICES project (Voices of Informed Community Engagement for Safety), which unites residents and leaders to address substance use disorder and safety issues. This kind of systems-level collaboration helps those closest to the challenges shape sustainable solutions.

But community coalitions can’t move the needle while stigma remains an obstacle to OUD recovery. Suffering from OUD is not a moral failing — it’s a treatable medical condition. Grassroots efforts led by schools, churches, hospitals and youth organizations can help shift this misconception and encourage treatment and recovery programs.

Policy reform is another critical piece of the puzzle. Communities need to work with legislators to push for changes that focus on treatment instead of incarceration and make effective care, like medically assisted treatment, more accessible.

Through my work, including in Maryland, I’ve seen both the scale of this epidemic and the strength of communities fighting to overcome it. The building blocks for change already exist. What’s needed now is sustained collaboration and bold leadership to scale what works.

Jennifer Loeffler-Cobia is the Justice and Public Health Policy and Practice director at WestEd and an adjunct associate professor at the University of Southern California. She leads research and evaluation studies and technical assistance projects for WestEd’s Justice and Prevention Research Center. In Maryland, Loeffler-Cobia supported Prince George’s and Montgomery counties through a federal housing initiative focused on individuals experiencing homelessness.