Community-Guided Opioid Settlement Administration
A Community-Informed Model for Administering Opioid Settlement Funds Across an Urban, Suburban, and Rural County of One Million People
Montgomery County, Maryland, administers its opioid settlement funds through a layered, data-driven process that pairs a broad community Overdose Prevention Team with a smaller steering committee and final county council approval, builds the staffing infrastructure needed to actually deploy the money, and directs awards to evidence-based community programs, youth residential treatment, naloxone saturation, and prevention curricula across a county that contains urban, suburban, and rural communities.
The Challenge They Were Addressing
When opioid settlement dollars began flowing to Montgomery County, the county already had two decades of overdose response work behind it, including naloxone training and distribution dating back to 2014, a syringe services program, and a network of community coalitions. What it lacked was the internal staffing infrastructure to absorb a new, sustained funding stream and turn it into community impact. For much of the past decade, the prevention and overdose response function had been understaffed for the scale of a county of more than one million people. That mismatch between mandate and capacity was the first gap to address.
The clinical and community picture was also shifting. Where opioid use disorder once began for most people with a prescription medication from a doctor, the team was now seeing widespread use of fake pharmaceutical pills purchased on the street, polysubstance use, and cocaine adulterated with fentanyl. Trends were moving faster than any single program could respond to, and the county needed a way to make funding decisions that kept pace. The previous model, in which individual program staff tracked individual grants in isolation, was not built to scale.
Adding to the complexity, Montgomery County is not one place. Down-county communities such as Silver Spring are densely urban; the suburban core includes Rockville, Gaithersburg, and Takoma Park; and up-county communities are rural. A naloxone kiosk strategy that works at a Silver Spring gas station does not automatically work in a rural part of the county where residents may live thirty minutes from the nearest pharmacy. The administrative model had to be capable of routing funds to the right strategy in the right place, based on data rather than on which community spoke up loudest.
What They Built
Montgomery County built an administrative model for deploying opioid settlement funds with three connected parts: a community-informed decision-making process, an internal staffing structure adequate to the work, and a portfolio of evidence-based programs and saturation strategies funded through the settlement. The model is housed in the Division of Behavioral Health and Crisis Services within the Department of Health and Human Services, in the Prevention and Harm Reduction Services section, and is overseen by a manager who reports up through the division and out to the county council and state.
The decision process is deliberately layered. A broad Overdose Prevention Team, which evolved from the state's earlier Opioid Intervention Team model when Governor Moore took office, meets regularly to review data, identify priorities, and gather community input. In-person listening sessions and virtual feedback channels gather direct input from residents, including people with lived experience and family members. A smaller steering committee then synthesizes that input and makes final funding recommendations, which go to the county council for approval before being built into the upcoming fiscal year's budget. The point is that no single staff member, including the funds' administrator, is positioned to make decisions in isolation.
The county strategically invested a portion of its opioid settlement funding to build the internal capacity needed to effectively administer and deploy the funds. This included supporting a Program Manager II for Harm Reduction, a Program Manager I for Grants and Contracts, an Administrative Specialist who provides administrative support across prevention programs, and a therapist within Specialty Behavioral Health Services. By intentionally combining operational, clinical, and community-facing roles, the county created the infrastructure needed to administer and monitor grants and contracts with community-based organizations while also strengthening the delivery of direct services.
Externally, the county deploys settlement funds through several channels. The county Office of Grants Management administers a competitive Fentanyl Use and Overdose Death Reduction grant cycle, now in its third round, which has funded multiple community-based organizations. Settlement dollars also funded a Substance Use Disorder Prevention and Intervention Program that case-manages people under age twenty-five and supports the family alongside the young person, including transportation to Mountain Manor youth residential treatment in Baltimore. Settlement dollars funded the launch of naloxone kiosks (including two inside the county Department of Corrections facilities), a Sunoco gas station kiosk in Silver Spring, wellness vending machines planned for both urban and rural parts of the county and added peer recovery specialist positions at community-based organizations. Future funds are earmarked to fund the launch of a primary prevention curriculum for upper elementary and lower middle school.
Key Program Components
Who You Need at the Table
What made a willing partner essential vs. optional?
The required partners are the ones whose participation makes the administrative model possible at all. The Department of Health and Human Services must be the designated lead. The county council is required because every funding recommendation has to pass through it before any dollar is appropriated. The Overdose Prevention Team and the smaller steering committee are required because they are the engine of community input and decision-making; without them, the model collapses into a single staff member making allocations alone. The county Office of Grants Management is required because it is the legal and operational mechanism for routing settlement dollars to community-based organizations. The Maryland Office of Overdose Response is required because it sets state guidance and routes additional funding to county partners. The Department of Corrections, community-based grantees, and the Overdose Fatality Review Team are required because they are where the work actually happens and where the data actually come from.
Helpful partners extend the model rather than enabling it. Municipalities with their own direct allocations strengthen coordination, but the county process runs regardless. Advisory bodies, law enforcement, the school system, the community college, and industry partners all sharpen the work; none of them is the reason a dollar moves. The Opioid Response Network adds national peer connections but is not on the critical path of any single decision.
Budget Breakdown
What is the minimum viable budget to replicate this?
A county that wants to adopt this administrative model does not need a million-dollar division to start. The non-negotiables are: at least one dedicated staff position to coordinate settlement administration so the work is not added on top of an existing full-time role; a small flexible fund for community listening sessions and basic data analysis; a clear mechanism for routing approved awards out to community-based organizations (the county uses its existing Office of Grants Management, but a small county can contract this function); and the explicit authority to convene a committee with real decision-making influence rather than a purely advisory body. Counties without internal epidemiology capacity can partner with a local university research department or a graduate student to conduct a community needs assessment at low or no cost. A modest set-aside for evaluation, even five to ten percent of the annual allocation, preserves the ability to learn from the work.
What Worked and Why
Specific decisions or design features that drove success
Building the staffing infrastructure first was the most consequential decision. Before the county added the manager position, the program manager roles, the community health nurse, the administrative specialist, and the grants and contracts position, the prevention and overdose response function was a small team trying to do the work of a county of more than a million people. Once those positions were in place, the county was able to absorb new funding, manage grants and contracts rigorously, and move settlement dollars out to the community on a predictable cycle. The lesson is clear: settlement dollars cannot be deployed at scale without staff.
Layering decision-making across a broad committee, a smaller steering committee, and the county council reduced the risk that any single person would be seen as the gatekeeper of opioid abatement funds. Listening sessions and virtual community input channels ran alongside the formal committees, and lived experience was treated as essential rather than optional. The result is a process that the community can see and a set of politically durable decisions.
Anchoring every decision in data made the work defensible and self-correcting. The team reviews overdose mortality, ER visits, demographics, polysubstance trends, and census-tract-level incidence rates on a monthly or bi-monthly basis. A suicide prevention coalition example sharpened the point: the coalition came in convinced the most affected group was youth and discovered through data analysis that the most affected group was male veterans, which redirected their strategy. The same discipline keeps the opioid abatement portfolio aligned with the county's actual epidemiology.
Investing in evidence-based and evidence-informed strategies, guided by Johns Hopkins principles, kept the portfolio from chasing one-off pilot ideas. Where evidence is still emerging, the county prioritizes promising practices and builds evaluation into the contract. This discipline also gives community-based grantees a clear standard to design against when they apply for funding.
Routing settlement dollars to staff infrastructure and community programs has been a political balancing act, but the right call. Community pressure often pushes for all dollars to go out the door to programs. The county's position, supported by data and made transparent through the committee process, is that staff capacity is what makes program dollars effective. The county has found that clearly explaining this and demonstrating program results builds support for the approach over time.
Early outcomes and data
Three competitive Fentanyl Use and Overdose Death Reduction grant cycles have been administered to date, funding multiple community-based organizations in each cycle.
Naloxone kiosks were deployed in the lobbies of two county Department of Corrections facilities, a Sunoco gas station in Silver Spring, and the lobby of the county MAT program in Rockville.
Wellness vending machines on track to be fully operational by the end of 2026, with placements planned in both urban down-county and rural up-county communities.
Two added peer recovery specialist positions were placed at community-based organizations through settlement funding, plus a settlement-funded therapist position focused on opioid use disorder.
Mountain Manor youth residential treatment access sustained through a multi-year settlement contract, with a county case management bridge supporting young people and their families through admission, treatment, and reentry.
A primary prevention curriculum for upper elementary and lower middle school students was launched through settlement funding, addressing a longstanding gap in the county's prevention portfolio.
Outreach materials were translated into seven to eight languages to meet the needs of a multilingual county population.
Internal staffing capacity built from a near-solo function to a team of eight to nine people on the way to ten to twelve, enabling the county to administer and monitor grants and contracts at scale.
Peer-county consultation requests are received regularly through the Maryland Office of Overdose Response, with Montgomery County serving as a model for other Maryland counties seeking to establish similar processes.
Lessons Learned
Build the team before you build the portfolio. Settlement dollars cannot be deployed at scale without staff doing so. The single highest-value early investment is internal capacity: a manager, program coordinators, grants and contracts support, and access to data analysis. Programs land harder and stretch further when the administrative function is staffed for the work.
Decisions do not happen in a vacuum. No single staff member, including the funds administrator, should be in a position to make allocation decisions alone. Form a committee, layer in a smaller steering body, and route every recommendation through the elected council. The process is slower in the moment and stronger over time.
Follow the data, not the anecdote. Anecdotal pressure is constant. Data-driven priority-setting protects the portfolio from chasing the loudest concern and lets the team redirect when the picture shifts, as it did from prescription opioids to street-purchased pills to polysubstance use.
Lived experience is essential, not optional. Programs designed without the involvement of people who have used substances, and their families, miss the practical realities that determine whether a service is usable. Build their voices into the committee and the listening sessions from the start.
Plan for sustainability while the funding is still flowing. Opioid settlement funding is substantiated in Maryland for at least the next eighteen years, but no funding stream is permanent. Design programs so they can be sustained through Medicaid billing, braided federal and state grants, or county general funds when the settlement winds down.
Meet a multilingual county in its own languages. Translating outreach materials into seven to eight languages, partnering with community-specific outreach workers, and addressing the needs of African American, Latino, and immigrant communities alongside the broader population is not an add-on. It is the work.