Maryland Panel Urges Paraphernalia Decriminalization, Safe-Use Sites

A Maryland work group made up of people with lived experience of substance use has recommended that the state decriminalize drug paraphernalia and open overdose prevention centers where people can use drugs under the supervision of trained staff, according to recommendations reported Thursday by WYPR.

The group also called for anti-stigma training in hospitals and social service agencies, wider distribution of naloxone, and changes to how Medicaid reimburses treatment providers and how the state oversees them. The paraphernalia recommendation was among those formally adopted, the station reported.

The proposal lands in a state that has spent years expanding harm reduction infrastructure while leaving the legal status of the equipment that infrastructure depends on largely untouched. Maryland operates syringe service programs and funds drug checking through the Rapid Analysis of Drugs program at the state health department, work that runs partly on samples participants volunteer.

What the panel put on the table

The group's reasoning on paraphernalia is administrative as much as moral. Criminal penalties for pipes and syringes discourage people from carrying them and from handing them over for testing, which limits what laboratories can learn about the supply. The panel argued that removing the penalties would move the state away from prosecuting people who need medical care and would give researchers clearer legal footing to handle the equipment they analyze.

That argument has particular weight in Maryland because two of its flagship monitoring efforts depend on voluntary surrender of drug material. Johns Hopkins University's Check It program and the health department's Rapid Analysis of Drugs both test what people bring in, looking for adulterants and shifts in the supply before those shifts show up in death certificates. Advocates have argued that staff at such programs can technically run afoul of paraphernalia law when they handle items obtained outside sanctioned exchange channels.

Lawmakers have attempted the change before. WYPR reported in December 2025 that supporters planned another push during the 2026 session, after earlier efforts stalled.

The harder sell: supervised consumption

The recommendation to open overdose prevention centers is the more contested half of the package. The panel described them as places where trained staff can reverse overdoses, hand out hygiene supplies and connect people to medical care and treatment, and it pointed to the international record in its written recommendations.

"Bringing users out of the shadows into a caring environment inspires healthier choices including substance use disorder treatment," the panel wrote. "They also provide public service, preventing infections, reducing crime, and keeping drug use indoors. Economic evaluations report favorable cost-benefit ratios with benefits far outweighing expenses. Over 150 overdose prevention centers operate elsewhere in the world, some for 40 years, and none with an overdose fatality."

Whether that record travels is the question state officials will have to answer. Supervised consumption sites remain rare in the United States, and proposals have repeatedly run into federal law, local zoning fights and opposition from officials who argue the sites condone drug use. The panel's own framing — public order, infection control, cost — is an attempt to move the debate away from that objection.

The recommendations on Medicaid reimbursement and oversight are the least visible part of the package and, for patients already in care, the most consequential. How a state pays for treatment and what it measures when it inspects a program determine which services survive.

Where the recommendations go next

The recommendations now sit with state government, which must decide whether to translate them into legislation, budget language or agency policy. Decriminalizing paraphernalia would require action by the General Assembly; overdose prevention centers would need both statutory authorization and, in practice, a decision by local governments about whether to host one.

The panel's recommendations amount to a request to treat the legal framework around harm reduction as infrastructure rather than as an afterthought — the same argument other states have made, with uneven results.

People looking for treatment in Maryland can find medication-assisted treatment through a mix of opioid treatment programs, office-based prescribers and community health centers, though availability varies by county. For readers tracking how states have handled similar votes, this blog has covered Delaware's harm reduction law and Oklahoma's decision to let its syringe law expire.