Before addressing the problem of drug addiction and how and where to treat it, two facts must be acknowledged.
First, substance abuse is a chronic health condition, not unlike high blood pressure or diabetes. As with these conditions, addiction requires compliance with a treatment plan to keep it under control.
Second, addiction knows no bounds. The prevalence of this disease is similar across gender, race and socioeconomic class. Though the drugs of choice may vary, adults in Ruxton abuse substances at a comparable rate to adults in East Baltimore. And teens in Carroll County use illicit drugs at equal rates to teens in Arbutus.
Once these truths are accepted, we can move on to a discussion of how to attack the problem, which clearly can’t be solved by sending addicted citizens out of the country. Nor can we deal with non-violent substance abusers by sending them to jail. Indeed, every one of the six police commissioners I served with in 13 years as Baltimore’s health commissioner told me there was no way the city could incarcerate its way out of its drug epidemic.
So, how best to offer drug treatment? For decades, substance abusers in Baltimore have primarily been treated at neighborhood-based drug treatment centers, with fairly good results. Many of the centers have strong programs, excellent staff and great outcomes; others, less so. Well-conducted studies have shown that Baltimore’s treatment centers have reduced the frequency of drug use, and, in turn, lowered the unemployment rate and homelessness among patients. Despite that, critics claim that these centers serve as magnets for crime. Similar assertions were made about the needle exchange program that was initiated when I was health commissioner. Multiple studies conclusively show that this is not true.
Admittedly, Baltimore City does have a disproportionate share of treatment centers in the region. Since many patients in city-based treatment centers actually live in the adjacent counties, it would only be fair to have treatment programs located in all areas. But, attempts to do exactly that in the past have been met with strong opposition and cries of NIMBY (not in my back yard).
Notwithstanding the success of neighborhood treatment centers, it’s time to look at the problem of addiction and how to address it through a different lens. If we as a society accept that substance abuse is a health condition, then we need to treat it as such. Instead of treating addiction in isolated facilities, as if addicted individuals are pariahs, we need to bring treatment into the primary care office and onto the therapist’s couch.
In fact, this philosophy of holistic addiction treatment has started to take hold. Buprenorphine (a drug that treats opioid addiction) is widely prescribed in Baltimore internists’ offices. And, as a result of the Affordable Care Act (ACA), increased coverage of mental health and drug treatment has allowed many people to get treated by therapists and physicians.
Unfortunately, with the current Republican-sponsored health care bill, we may be heading rapidly in the wrong direction. One of the under-reported potential consequences of the GOP plan to repeal and replace the ACA, is the provision in the proposal that would allow states to stop requiring coverage of mental health and substance abuse treatment. This, combined with the Republican plan to slash Medicaid (which currently provides substance abuse treatment to a sizable percentage of substance users), will eliminate treatment for millions of Americans and thousands of Baltimoreans.
At a time when violent crime — 90 percent of which is related to the drug trade — is out of control in Baltimore, and drug overdose deaths are rampant throughout the region, the last thing we should be doing is decreasing access to high quality drug treatment. We should be making it easier, not more difficult, for people in need to get help. Even more importantly, we shouldn’t retreat on the effort to integrate drug treatment into the overall provision of health care. By bringing addicted individuals into the mainstream of care, we will take a big step toward the goal of exhibiting compassion to those suffering from addiction rather than demonizing them.
Dr. Peter Beilenson (email@example.com) was Baltimore City health commissioner from 1992 to 2005 and Howard County health officer from 2007 to 2012.