Treatment here, not Timbuktu

Our view: The mayor needs to champion efforts to create more neighborhood-friendly drug treatment, not undermine the premise

Mayor Catherine Pugh’s recent musings that drug addicts should be put “on a plane to Timbuktu or somewhere” rather than receive treatment where they live misunderstands the nature of addiction and recovery, and, whether intentionally or not, it connotes an attitude that addicts should be put out of sight and out of mind rather than cared for as members of our community. We sincerely hope it does not become policy in a city where we need to be doing everything possible to make treatment more available and accessible, not less.

The mayor’s theory makes a certain amount of sense if you don’t think it through too carefully. One might imagine it would be hard for drug abusers to get clean in the environment where they first became addicted and where the pressures and temptations that led to their problems remain. Why not ship them away to an environment where it might be easier to kick the habit?

But checking in to Betty Ford is simply not an option for most of those struggling to get help. And even if it were, what happens when the month of treatment is up and the now recovering addict is back in the community? Addiction, particularly to opioids, is not typically the kind of thing that can be “cured” with a stint in rehab; it is a chronic condition that must be managed over a period of years, often involving treatment with methadone or buprenorphine, the former of which requires regular access to a clinic. Even if the mayor means that drug treatment should be concentrated around hospitals rather than literally in Mali, moving such clinics away from the homes of those who need them means adding to what is often already a struggle to get from home to work to child care on a daily basis.

What seems more likely to be driving Ms. Pugh’s view is the frequent complaint that drug treatment centers (and particularly methadone clinics) are magnets for crime. She has suggested that they are attractive places for drug dealers to hang out, hoping to snare people prone to relapse. We don’t dispute that some poorly run treatment centers have had problems, but the data overall contradict the theory that they attract crime. A 2016 paper in the Journal of Studies on Alcohol and Drugs written by researchers at the Johns Hopkins University Bloomberg School of Public Health, the Hopkins School of Medicine and Wayne State University in Detroit found that their effect on crime was much smaller than that of liquor stores or corner stores and about equivalent to that of a 7-Eleven or Royal Farms.

The researchers plotted the locations of drug treatment centers in Baltimore as well as those of corner stores, convenience stores and liquor stores with seven-day, on-premises/off premises licenses. (Of note, there are more than eight times as many of that kind of liquor store as there are drug treatment centers.) They then used statistical methods to control for the socio-economics of the neighborhoods in which the business are located and to calculate the incidence of violent crime in proximity to each type of establishment, and the degree to which such crime tapered off as the distance from them decreased. The results: Violent crime was about one and a half times more prevalent around liquor stores and corner stores than it was around drug treatment centers or convenience stores. Furthermore, violence dropped more sharply the farther one traveled from liquor or corner stores than it did in the case of drug treatment centers, suggesting they aren’t magnets for crime at all but merely tend to be located in places where crime is already high. Indeed, the researchers found that the majority of drug treatment centers were in the most disadvantaged areas of the city, whereas only a fifth of liquor stores were.

To the extent that communities still have trepidation about drug treatment centers, it is Mayor Pugh’s responsibility to make the case for their life-and-death necessity and to take concrete steps to ameliorate any genuine problems they cause. Treatment centers don’t move around; it would be easy enough to ensure they get extra attention from police patrols, to fix broken streetlights around them and to otherwise ensure they aren’t nuisances. In fact, a city task force co-chaired by Greater Baltimore Committee President and CEO Don Fry, Catholic Charities of Baltimore Executive Director Bill McCarthy and Health Commissioner Dr. Leana Wen is now working to identify best practices for locating and managing neighborhood-friendly drug treatment centers. We hope the mayor will throw her support behind implementing the conclusions of that effort, not undermining its premise.

To her credit, Ms. Pugh recently supported a lease for a new West Baltimore drug treatment center in a Board of Estimates vote. But her rhetoric is nonetheless concerning. Ms. Pugh says she believes treatment centers “tear neighborhoods and communities apart." In fact, it is addiction that tears neighborhoods and communities apart, and we need to address the problem where it exists.

 

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