The Hogan administration is considering turning part of the closed Baltimore City Detention Center into a mental health and substance abuse treatment center for inmates as part of its efforts to combat the state’s opioid addiction epidemic.
The idea, included in the governor’s broader opioid initiative announced Tuesday, was questioned by some health officials and substance abuse experts who think the state should act now to address this underserved population.
The administration said it would order a feasibility study on repurposing the Civil War-era jail, which Hogan closed in 2015 because of its decrepit condition. The study would be conducted by a consultant chosen by three state agencies.
The plan comes as those in the treatment community have been pushing for more care in the corrections system, arguing that jailing opioid users without treatment doesn’t address the underlying problem of addiction.
“We don’t need a study to show why this is so urgent,” she said. “If this was a priority of this administration, they could implement something right now.”
Wen said addicts in jail could be treated within the current system. Given the urgency of the epidemic, she said, a cumbersome process involving a study and eventually repurposing the old jail seems unnecessary. She said the administration should look at ways to offer medication-assisted treatment, or the use of drugs such as methadone and buprenorphine that stop an addict’s craving and prevent them from going into withdrawal.
The Baltimore jail complex offers limited methadone treatment to those who can prove they are already in treatment, but Wen and others think it can and should be offered to more inmates. About 60 percent of the population in the corrections system is estimated to have a substance use disorder.
A Johns Hopkins professor who has advocated for more treatment in jails and prisons said she thinks there are better ways to spend the money, but applauded the governor for looking at the issue.
Deborah Agus, an adjunct professor at the Johns Hopkins Bloomberg School of Public Health, also believes that resources should be focused on medication-assisted treatment that can be implemented in and outside of the correctional system now. Agus is also executive director of the Behavioral Health Leadership Institute, which recently parked a van outside the city jail complex to offer treatment to those with opioid use disorders.
“It is imperative that significant investment be made to support evidence-based treatment within a public health approach,” she said in an email. “That means reducing the reliance on the criminal justice system. We must treat the disease and improve access to [medication-assisted treatment] within a continuum of increased community treatment.”
The governor's 2018 capital budget included funding for planning demolition of the older buildings within the city jail complex, including the men's detention center, said Amelia Chasse, a spokeswoman for the governor. The governor included $4 million for demolition in his recent 2019 budget proposal. The administration will continue to provide funding as this process moves forward, she said.
The feasibility study will help determine, among other things, the level of security needed for this type of therapeutic facility and recommended programming for mental health, substance abuse and medical treatment, Chasse said.
“This type of therapeutic facility would be a cutting-edge, long-term strategy to treat this vulnerable population,” she said.
Adrienne Breidenstine of Behavioral Health System Baltimore said she is glad the Hogan Administration is addressing a gap in treatment. She said she hoped the study would address a wide range of treatment needs and not just focus on low-level drug offenders.
“We know we need treatment in jails and certainly a study to figure out how we would go about how that would be implemented is good,” Breidenstine said. “I hope this is done with the sense of urgency that is needed.”
The governor’s initiative also authorized Attorney General Brian E. Frosh to sue opioid manufacturers and distributors for creating the epidemic by not being forthcoming about the addictiveness of opioids.
Frosh said he already had asked the governor for approval to sue and that his office was investigating and taking action against drug manufacturers and distributors. He also said the governor’s office has not provided enough funding for his office to do more.
“We have multiple attorneys working tirelessly to advance these efforts,” Frosh said in a statement. “Our criminal division has prioritized combating the heroin epidemic by focusing on dismantling the most dangerous drug organizations across the state. … We simply do not have sufficient resources, however, given the enormity and urgency of this effort.”
The governor also plans to introduce legislation that will add fentanyl to the list of drugs that carry tougher penalties if sold in high volumes. Fentanyl is a potent opioid sometimes added to heroin that has caused most of the overdose deaths in the state.
Other proposed legislation would create a statewide database that would allow first responders to track opioid overdoses so they can send resources to specific areas that are being hit hard.