Baltimore is in the grip of a severe drug crisis, with overdose deaths driven by fentanyl and other synthetic opioids creating a public health emergency that affects every neighborhood. The city’s opioid-related death rate far exceeds that of most others, nearly doubling fatalities in similarly sized urban areas. Systemic issues like entrenched poverty, unemployment and inadequate mental health resources fuel the epidemic, while stigma, limited resources and a rapidly evolving drug landscape hinder effective responses. In 2023 alone, over 1,000 lives were lost to overdoses, with fentanyl implicated in most cases — underscoring the urgent need for bold, compassionate solutions to save lives and rebuild communities.

The Baltimore City Health Department has implemented several strategies to combat the opioid crisis, focusing on prevention, treatment access and harm reduction. Programs like Kids Off Drugs aim to educate youth about substance misuse and address some of the systemic factors that contribute to addiction. However, these initiatives, while beneficial, do not adequately address the specific and urgent challenges posed by the opioid epidemic. As a result, overdose fatalities continue to persist, underscoring the need for a more targeted and cohesive approach.

Critics argue that the city’s efforts lack coordination, with programs often operating in isolation rather than as part of a unified strategy. While lawsuits against pharmaceutical companies are necessary for accountability, they have diverted resources away from immediate needs such as expanding treatment facilities and mental health services. Delayed public hearings, persistent stigma surrounding addiction and limited funding further hinder progress. Even critical programs like needle exchanges, essential for disease prevention, struggle to connect individuals to long-term recovery. Without addressing these systemic gaps, Baltimore’s death toll will stay high.

Baltimore’s crisis demands urgent action and a willingness to explore innovative approaches. We can look to the Netherlands for inspiration. After years of advocacy, the Dutch adopted state-sponsored supervised injection sites as a cornerstone of their opioid treatment strategy. These sites, which provide a safe environment for drug use under medical supervision, significantly reduce overdose deaths and prevent the spread of diseases like HIV and hepatitis C.

What makes this approach compelling is its dual focus on immediate harm reduction and long-term recovery. Supervised injection sites not only save lives by preventing factual overdoses but also serve as gateways to critical support services, including addiction treatment and mental health care. By creating a stigma- free space, they help build trust with marginalized populations, encouraging them to seek help and transition toward recovery. Emulating this evidence-based model in Baltimore could offer a transformative path forward, addressing the crisis with compassion and measurable impact.

It’s time for Baltimore to embrace similarly bold measures. This includes expanding on- demand access to evidence-based treatments like medication- assisted therapy and piloting supervised injection sites to save lives and foster recovery. Finally, Baltimore must adopt a data-driven approach from these facilities to ensure resources are allocated where they are needed most. Real-time data can identify overdose hot spots and measure the effectiveness of programs, enabling continuous improvement.

Critics of harm reduction argue that these strategies, such as supervised use sites and good Samaritan laws, may inadvertently enable continued drug use by reducing its immediate risks without addressing addiction itself. They believe harm reduction signals implicit government acceptance of drug use, potentially leading to higher rates of substance abuse in the future. Proponents, however, counter that drug use persists regardless of legality and that evidence-based measures like overdose prevention centers save lives, reduce overdose deaths and provide a critical pathway to treatment for those who cannot or are not ready to stop using drugs.

There is hope. Baltimore’s greatest strength lies in its people — grassroots organizations, health care providers and community leaders tirelessly working to save lives and drive change. We should push for compassionate, life-saving solutions that can rebuild our city. Baltimore can lead the way in tackling urban drug crises by addressing addiction’s systemic roots and scaling proven interventions. Join the movement — voice your support, advocate for change and help ensure every Baltimorean has the opportunity to heal, recover and thrive. Together, we can turn the tide.

Pradeep Thomas lives in Ellicott City and is a doctoral student in public health at Tulane University.