Baltimore could receive another $100 million in its opioid lawsuit, but only if the city agrees to accept a significant cut to the money it won at a trial against a pair of opioid distributors last year, a judge ruled late Friday.

The city could walk away with about $152 million if it takes the deal. That’s only a fraction of the $5 billion that Baltimore sought for “abatement,” or money aimed at resolving the ongoing harms of opioid addiction in the city.

Baltimore City Circuit Judge Lawrence Fletcher-Hill wrote that the city should build on existing opioid treatment infrastructure rather than relying on billions of dollars in abatement money from McKesson and AmerisourceBergen, the two drug distributors who faced the city at a seven-week trial late last year. The companies lost, with a jury of city residents awarding a massive $266 million verdict in favor of the city.

Fletcher-Hill rejected the jury’s decision in June, finding that the amount awarded was “grossly excessive.” He ordered the city to accept a reduced verdict of about $52 million — an 80% cut — or have another trial to determine damages.

The jury’s verdict is the first of two pots of money at play in the lawsuit, which accused the drug distributors of contributing to Baltimore’s opioid crisis by failing to monitor and stop suspiciously large orders of opioid painkillers to Baltimore pharmacies. The money awarded by the jury, known as damages, was intended to cover money the city has spent on the opioid crisis, such as emergency services and policing.

The second pot is abatement money, which is intended to rectify the ongoing harm the city argued was caused by millions of prescription opioids that drug distributors shipped to pharmacies in Baltimore. The city requested $5 billion for a sweeping wish list of services, including harm reduction, addiction treatment and wraparound services such as housing, nutrition and other essential needs.

Abatement decisions are made by a judge, rather than a jury.

“We have received the court’s abatement ruling and are considering all options at this time,” Mayor Brandon Scott’s office said in an emailed statement. “We remain committed to securing justice for all Baltimore residents disproportionately impacted by the opioids crisis. We will respond in due time in the appropriate judicial forum.”

A McKesson spokesperson said they plan to appeal.

The city’s experts estimated that the abatement plan, if fully implemented, would avert more than 6,000 fatal overdoses over the next 15 years and more than triple the rate at which Baltimore residents receive medical treatment for opioid use disorder.

But, in his decision in June, Fletcher-Hill signaled he disagreed with the city’s methodology and would award far less in abatement money than the city wanted.

“Rather than the City’s ground-up approach, the Court is more likely to provide an abatement plan that builds on existing programs and resources,” Fletcher-Hill wrote in June. ”The Court most likely will focus on much narrower measures to increase harm reduction steps and to reach more individuals suffering from opioid use disorder to connect them with existing treatment resources.”

Baltimore has experienced the highest rate of overdose deaths of any major city in America, according to a series of articles in The Baltimore Banner and The New York Times last year.

McKesson and AmerisourceBergen supplied about 60% of the half a billion opioids that flooded Baltimore and Baltimore County from 2006 to 2019, according to federal drug dispensing data. At the trial last year, jurors determined the drug distributors were responsible for 97% of the city’s opioid epidemic.

Fletcher-Hill rejected the jury’s conclusion, noting that the city originally sued a much longer list of companies and individuals, including drug manufacturers and pharmacy chains, that likely also shared responsibility. Before trial, the city won more than $400 million in settlements with drug companies and pharmacy chains.

Fletcher-Hill also found that two of the city’s expert witnesses offered testimony that inappropriately inflated the number of suspicious orders of opioids that the drug companies should have halted. The judge wrote that his “mistake” in allowing the testimony warranted a new trial to determine damages.

The judge proposed a lower verdict award of about $52 million, which the city could accept or reject. If Baltimore rejected the lower award, there would be a new trial to decide damages, Fletcher-Hill wrote. Following a request from the city, Fletcher-Hill agreed to rule on the abatement money before requiring the city to make a decision.

In Friday’s opinion, Fletcher-Hill accepted some of the city’s proposed abatement fixes and rejected others.

“The city advances a theory that defendants must be made to pay for every aspect of every measure, even if the measure already exists,” the judge wrote. “The city also seems to suggest that the court should include any measure that has any conceivably beneficial effect, without considering any assessment of whether the measure will have an effect that warrants its cost. The court takes what it thinks is a more practical approach of building on existing resources and trying to target effective measures without excessive cost.”

Fletcher-Hill declined to order funding for services that he deemed too far removed from the opioid crisis, such as HIV treatment and mental health services.

He rejected any funding for overdose prevention sites, where people who use drugs would be allowed to do so in a safer, medically controlled environment to prevent overdoses. These centers do not exist in Baltimore, and the drug distributors argued they are not legal under state law.

“Without making any determination whether this strategy is valuable from a public health perspective, the court will not require this feature in the abatement plan,” Fletcher-Hill wrote. “If the city believes this approach is valuable, it is up to city leaders both to resolve the legal issues with this type of site and to convince the community that these sites are valuable and appropriate.”

Fletcher-Hill approved funding for drop-in and stabilization centers, which are places where people who use drugs can easily get access to a variety of services in their community. The judge declined to award funding for opioid treatment services more broadly, however, because “extensive treatment programs” already exist in Baltimore and are largely funded through Medicaid.

In all, Fletcher-Hill said the city could receive $100.5 million in abatement money if it accepts the reduced verdict and the abatement ruling. That breaks down to about $72.5 million from McKesson and nearly $28 million from AmerisourceBergen.

McKesson, in a statement, said the company has programs to detect and prevent opioids getting out of the pharmaceutical supply chain.

“We appreciate the court’s previous ruling that the jury’s verdict was contrary to the evidence and grossly excessive,” the company’s wrote.  “In light of that ruling, we disagree with the court’s decision to approve even part of the City’s abatement plan.  The remedies put forth in the plan bear no relation to McKesson’s alleged conduct or business practices.”

AmerisourceBergen, now known as Cencora, said in an email that it is “reviewing today’s decision and evaluating next steps.” McKesson did not immediately provide a comment on the decision.