Thousands of people go to Baltimore methadone clinics for a daily dose of the addiction treatment drug. Often doors are locked and there are guards and cameras, though there are few government or industry security requirements.
Opioid treatment programs across the city are reviewing security measures since a shooting last month at the Man Alive clinic on Maryland Avenue left two dead and two injured.
But officials and observers believe, and records show, clinics have little risk for such violence — little more than other sites of mass or workplace shootings where there are fewer security expectations, such as the Walmart in El Paso, Texas, or the nightlife district in Dayton, Ohio.
“My view is that this is symptomatic of the culture we live in, the prevalence of guns, and not an issue of it being in a clinic per se,” said Kelly Cross, president of the Old Goucher Community Association, where Man Alive and other treatment centers are located.
Man Alive, the state’s oldest clinic, had no history of safety problems. No issues were noted when it was last inspected in June by the state Department of Health. None of the other 30 or so similar Baltimore programs has reported a shooting inside.
Clinics are required to report “critical incidents,” including those that involve deaths. In the past three years there have been 133 reports, and two-thirds were deaths from overdoses or a chronic health condition and the remainder were dosing errors, medication diversion and nonfatal “health and safety” related events, state health figures show.
Officials say that doesn’t mean all clinics are good neighbors or neighborhoods want them. Primary community concerns relate to property values, quality of life and crime.
But a 2012 study by University of Maryland researchers suggested crime concerns were misplaced. The study relied on two years of FBI Uniform Crime reports around 13 methadone clinics, and researchers found convenience stores to be more of a crime magnet.
A review of police service calls to clinic addresses in Baltimore show Man Alive’s address logged the fewest calls in the past year and most of those calls involved something outside the clinic, such as a car stop or a community interaction. A handful of clinic addresses were linked to far more calls, but most of those were for incidents outside the clinics. Police couldn’t say how many of the calls involved the clinics themselves without reviewing each case.
Adrienne Breidenstine, spokeswoman for Behavioral Health System Baltimore, the nonprofit that oversees city programs, acknowledged not all clinics were “created equal.” Some have high foot traffic and don’t prevent loitering or littering or respond to complaints. Drug dealers sometimes target the vulnerable clientele.
Clinics emphasize they are health care providers and don’t want security that puts off people who need treatment and may have court records.
But the staff, community and clients deserve to feel safe, Breidenstine said, especially since the shooting.
“Violence like this is rare, but it doesn’t mean something can’t happen,” she said. “One thing we’re going to do at the authority after the investigation is completed is determine things we can do systemwide to make the clinics more safe.”
Police continue to investigate the July 15 shooting, but have reported that a man, who they believe was formerly a Man Alive client, fatally shot a technician and wounded another worker and a police officer before being killed.
Breidenstine said treatment is still vitally needed. Thousands of Marylanders have died of opioid-related overdoses in recent years, and methadone is widely considered an effective treatment. It alters the brain’s response to pain, reducing opioid withdrawl symptoms and blocking the euphoria associated with opioids. Clinics dispense it as a liquid daily. Some clinics also offer prescriptions for buprenorphine pills or film.
The state has no security requirements for treatment centers. A primary accreditation agency, Commission on Accreditation of Rehabilitation Facilities, promotes staff training to handle potentially unsafe client behavior. It requires proper methadone storage and tracking and responses to workplace violence and emergencies.
Baltimore police, who are often called to handle situations involving those with substance use and mental health issues, recently have been required to undergo crisis intervention training. A pilot program that began in 2017 paired an officer and social worker to answer some calls, and an analysis since the launch found that led to a more than 37% reduction in use of force in the Central District compared to other police districts.
The Johns Hopkins Broadway Center for Addiction, on the hospital’s medical campus in East Baltimore, uses unarmed guards with special training to greet and interact with clients, who may be homeless, suffer mental health conditions or just hungry.
The clinic serves lunch so clients can get a healthy meal and feel cared for, said Dr. Kenneth Stoller, the center’s director. That also keeps them from loitering as they wait for services, he said. Clinicians undergo training to de-escalate situations, and if a problem becomes significant, Hopkins has armed security guards stationed nearby.
Because of the Man Alive shooting, Stoller said, the Broadway clinic plans to conduct drills so staff all know how to handle an active shooter — though he doesn’t believe the threat of severe violence has increased.
“The population can be challenging to work with,” he said. "Drills are something we can do if something were to happen in the future to give the staff a greater sense of security.”
Cross, from the Old Goucher neighborhood, said he recognizes the need for treatment and appreciates the clinics’ security efforts. Man Alive and others are good neighbors and have not stymied commercial investment in the small area between Station North and Charles Village.
But he counts seven service providers nearby, and some aren’t as conscientious. And some problems, like predatory drug dealing, can happen beyond clinic security’s watchful eye.
He said Maryland officials should locate more clinics closer to where users live, making treatment more accessible and lessen burdensome for Baltimore communities. He cited a 2016 state Behavioral Health Administration report that found counties surrounding Baltimore had insufficient treatment capacity.
Dr. Aliya Jones, who oversees methadone clinics as the chairwoman of the Bon Secours Department of Behavioral Health, knows there are a lot of city programs, but said there is also great need. She wants clinics to be “havens” from the street drug culture and stigma.
Part of that means providing security for clients, as well as the staff and community, she said. The doors to Bon Secours’ clinic near the West Baltimore hospital are locked and there are security guards, cameras and panic buttons.
Jones said officials already were updating the health system’s emergency plan and conducting active shooting training. Since the Man Alive shooting, they are considering arming clinic guards and adding metal detectors. She suggested accreditation could include more security requirements.
Jones also said the clinics aren’t alone in needed to evaluate security.
"Yes, there are things we can do better,” Jones said. “But in terms of security, everyone has to do these kinds of things in the day we’re living in now. I’m sitting in front of a library. Someone can walk in anywhere with a gun.”