Five years after addiction treatment officially became "medical treatment" under federal policy, more Marylanders are dying from heroin overdoses than ever, and the state still does not track treatment outcomes adequately.
This according to the "interim" report from the "Heroin and Opioid Emergency Task Force" released yesterday by Lt. Gov. Boyd Rutherford. It made the news all over the state, but the stories tended to focus on the $800,000 going to the one state-operated residential treatment center on the Eastern Shore, and on the fact that Rutherford spoke approvingly of the "Just Say No" type drug-awareness campaigns of the 1980s.
The interesting stuff was elsewhere.
In the report, under subheads "Access to Treatment" and "Quality of Care," are separate proposals to develop "specific metrics to track progress." This has long been the dog that did not bark in the discussion of drug treatment: How do we track the progress of individual patients, and how do we determine the most effective courses of treatment for the greatest number of addicts? Until recently, this has not been done, because policy has been driven by advocacy groups and the treatment industry itself. Indeed, part of the promise of opiate addiction treatment has been the creation of jobs—addiction counselors, for example—for people in recovery. It has perpetuated a parochial, insular faith-based culture ("faith" in the small-f sense) that has, at times, directly opposed the evidence-based work of medical professionals. City Paper covered this ground extensively in a 2010 series.
Back then it was hard to get a frank acknowledgment that the lack of medically proven outcomes research was a problem. But the National Association of State Alcohol and Drug Abuse Directors were—fitfully—working on a uniform system to track drug abuse and recovery statistics across counties and states. And the state itself promised it was integrating its data so that better standards of care and outcomes tracking would be accomplished by 2015.
It is unclear whether such a system is yet operational. But the report suggests not:
"Established standards of care for addiction medicine and practice are not applied at all treatment facilities, resulting in inconsistent quality of care across providers in the State. Currently, notions of quality of care are often based on diagnoses, availability of services, and provider comfort rather than an evidence-based, outcome-driven approach."
"Finally, there was great dissatisfaction regarding standards of care generally, gaps in communication and collaboration between health care services and law enforcement, and lack of accountability for outcomes."
That the report promises attention to these matters is very hopeful. What is less so is Rutherford's contention, widely reported, that the state may not be able to afford the drug treatment resources its citizens require. The interim report details the dissemination of $2 million for additional resources.
That is not very much money, and the $1.2 million remaining after funding 14 additional beds at the A.F. Whitsitt Center has been divided among many programs and for more cops—without apparent regard for what actually works—just as has always been done.
"Generally, funds will be spent on naloxone training and distribution to local health departments and local detention centers, overdose survivor outreach programs in hospital emergency departments, prescriber education to improve quality of care, recovery housing for women with children, detoxification services for women with children," the report states. "It also details how $189,000 in Governor's Office of Crime Control and Prevention grant funding to local law enforcement will be spent for overtime pay, gang and heroin disruption efforts, and license plate reader technology."
The report says $100,000 is targeted toward "recovery housing, prioritizing those jurisdictions that currently do not have recovery housing for women with children and those with a significant waiting list."
To get an idea of how paltry this is, consider: Typical recovery-house rent for a single bed in a bunk room is $300-$400 per month. Because you need to at least double that (1 mom + 1 kid = 2 beds), the housing cost for an addicted mother is at least $600 per month. So, assuming this lowest possible price and maximum efficiency, $100,000 might house as many as 13 single mothers for a year. The reality is likely much less.
The $2 million described in the interim report is less than the money stolen by a single Baltimore drug treatment operator. William Hathaway, former CEO and founder of Baltimore Behavioral Health, a Southwest treatment center that, in the mid-2000s, collected nearly $20 million per year from government payers, pleaded guilty in federal court in March to taking $2.5 million that he should have remitted in federal payroll taxes for his staff. The state itself claimed a loss of nearly $1 million, and Hathaway also took another $53,000 from an employee retirement plan, according to his plea agreement. He is scheduled to be sentenced Nov. 13.
City residents continue to struggle with addiction and access to treatment, but the interim report says that Baltimore City is the only jurisdiction that does not have "significant gaps in services."