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The last public residential drug treatment program for Maryland youths has closed, ending access to a variety of long-term treatment that has been used less frequently in recent years.

People of all ages with substance use disorders are now more often steered to clinic-based programs near home. And while many treatment experts support the move, shuttering the Catoctin Summit Adolescent Program has raised concerns.

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There were just seven youths housed at the facility in Frederick County when it closed at the end of September. But the program has treated hundreds if not thousands of kids since opening in the late 1980s, according to the Washington County Health Department, which ran the center for the state.

Catoctin largely accepted youths from the juvenile justice system. Other privately run facilities that offered more intensive, inpatient treatment to youths in and out of the justice system have recently switched to treating only adults with opioid addictions.

Some in the treatment and legal arenas say this eliminates something of a treatment middle ground for youths that was needed less but still needed. These facilities offered a campus-like setting, where kids could go to school and other activities.

They said the choices now are at the ends of the spectrum: outpatient programs that treat youth able to live at home or inpatient facilities, potentially out of state, that emphasize security for those who are a risk to themselves or others.

“Maryland urgently needs more drug treatment options for youth, a need that will be even more heightened with Catoctin closing,” said Melissa Rothstein, spokeswoman for the state’s Office of the Public Defender. “The opioid crisis has hit Marylanders of all ages, and while there has been increased funding and resources for adults, we have fewer and fewer options for children.”

Overdose deaths among those 25 and younger represented about 5.5 percent of the state’s 2,400 deaths in 2018, according to figures from the Maryland Department of Health. The fatalities have been declining this year after more than doubling from 2007 to 2017.

Experts say youths tend to favor marijuana and alcohol, which are linked to far fewer deaths.

Declining need at Catoctin was a major factor in the decision to close, said Rod MacRae, a spokesman for the Washington County Health Department. State records show Catoctin had 17 placements from the justice system in fiscal 2018, down from 85 in 2016.

“The landscape of addiction treatment has changed,” MacRae said. “It’s much more widely available, potentially in the communities where a lot of these residents live.”

A memo about the program’s closure circulated in the state also said Catoctin had “ongoing difficulties recruiting and maintaining the skilled staff needed to operate and maintain a round the clock residential facility.”

Scott Beal, executive director for community services at the state Department of Juvenile Services, said community-based services will be considered first for those entering the justice system with a substance use disorder.

Youths who pose a threat or have heightened needs will go to a more secure facility. There are no such options for girls in Maryland and they likely would be sent to Pennsylvania.

That is not ideal, said Dr. Marc Fishman, the medical director of Mountain Manor Treatment Center in Baltimore. That is one of the facilities that switched its residential services to adults only. It still offers outpatient services to youths in and out of the justice system.

He said older adolescents still could benefit from the beds, particularly if they have unstable home lives or other behavioral health issues, but not as much as young adults who use more opioids.

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Fishman said threats from marijuana and alcohol use among youths remain serious, though they are downplayed in American culture. Marijuana is now sold as “medicine” while research shows it can be harmful to developing brains, he said.

Further, he said young marijuana and alcohol users are often “future opioid users.” That includes prescription painkillers and illicit heroin and the more powerful fentanyl, which has fueled the national overdose crisis.

The total need for care is unknown, Fishman said, because youth cases tend to remain “hidden” because no one recognizes the need for treatment.

“All things being equal, it would be preferable to have the resource,” he said of residential care. “I don’t think the need is huge, but it’s not zero. In a perfect world we’d have it.”

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