Taking addicts out of ER and into treatment

Our view: With its first-ever “stabilization center,” Baltimore tries a new approach to steering drug and alcohol users toward the help they need

Late at night, a 45-year-old man arrives in the hospital emergency room in Baltimore. He is intoxicated, and he is high on heroin, his addiction the end result of a downward spiral that began with a taste for alcohol and prescription opiates that cost him a job, a family and his health. Doctors take his vital signs, recognize that he has no acute medical need and sit him in a corner until he sobers up and can speak to a social worker. Hours later, he is back on the streets, homeless and looking for his next high. His half-day in the ER has accomplished little but make an already crowded waiting room that much more crowded.

Anyone who has spent any amount of time in an emergency room recognizes that scenario. It happens many times each day, often late at night or early in the morning. ERs are designed for medical emergencies — a broken bone, an open wound or perhaps an active psychosis. Drug addicts end up there for many reasons, from chronic medical issues and depression to nausea or other symptoms of withdrawal. But one thing most hospital emergency rooms aren’t especially good at is what such individuals often need most, a path forward, a referral to detox or addiction counseling or a job or maybe a hot meal.

Next week, for the first time in history, there will be an alternative available for Baltimore’s addicts. The city health department is trying something that’s never been done before. It’s opening a “stabilization center” that will take individuals headed to a hospital ER and divert them to a place where a social worker and case manager aren’t an add-on, they are a central part of the interaction. Open 24/7, the center will focus on wraparound services for drug addicts, one-stop shopping for one of Maryland’s most vulnerable populations.

If anything, the concept is overdue. At least two cities, San Antonio, Texas and San Francisco, Calif. have experimented with versions of “sober centers” to help people who might otherwise be headed to jail or homeless shelters. Baltimore’s approach is more in the continuum of medical care. And the goals are pretty obvious — to help reduce the epidemic of overdose deaths, to get more people into treatment and perhaps even to help reduce the chaos and wait times in hospital emergency rooms.

Baltimore Health Commissioner Dr. Leana Wen is the project’s chief advocate, but she credits many others for helping make it possible from former Del. Peter Hammen (now a top aide to Mayor Catherine Pugh) who secured the necessary tax dollars to renovate West Baltimore’s Hebrew Orphan Asylum on Rayner Avenue to General Assembly leaders who helped secure two years of operational funding and Behavioral Health System Baltimore, the contractor that will run the facility. Next week, the stabilization center will open at the nearby Tuerk House residential drug treatment center. One year from now, Dr. Wen expects the Asylum renovations to be completed and the center to begin operations there.

When all is said and done, the stabilization center should be able to assist 30-35 people each day at a cost of between $2 million and $3 million annually. But by 2020, Dr. Wen and others involved will have to determine if their experiment proved a success and should be expanded or duplicated elsewhere in the city. Did it save lives? Did it get more drug addicts into treatment? Is it allowing more people to walk away from the horrors of substance abuse?

Still, the question people should be asking right now is why did it take so long to devise such a common sense approach to reaching people under the influence of drugs and alcohol? Politicians are quick to speak of a drug crisis but seem to be reluctant to tap the resources needed to do something about it. More than 700 people died from overdoses last year in Baltimore. Seven hundred! That is the equivalent of about four airline crashes or 41 Florida school shootings. Training every addict in how to use Naloxone to reverse an opioid overdose would seem the least we should be able to accomplish — and that’s on the agenda at the stabilization center.

That bedraggled middle-aged man who showed up in the ER surely deserves the same level of attention we would give anyone suffering from a potentially fatal disease — and make no mistake, the public health crisis of addiction is all that and worse. This isn’t just about Baltimore, it’s about combating a costly epidemic that cuts across race, class and and political boundaries. Should the stabilization center prove a particularly useful weapon, it could become a model — a second chance appropriate to its orphanage roots — for the rest of the country.

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