When talking about fighting drug addiction, Baltimore Mayor Catherine Pugh likes to pose a question: "If you had a child who was on drugs, would you treat them in the neighborhood in which they were drug addicted?"
Then she answers, as she did at a news conference last week: "I would think that your answer would be 'no,' you'd put them on a plane to Timbuktu or somewhere."
Pugh has publicly used the formulation twice in recent weeks as she calls for the city to rethink how it works to treat the estimated 7,000 of its 24,000 opioid users who are not currently getting help. She says she agrees with the growing consensus that addiction should be viewed as a health problem rather than a criminal one. But she argues treatment needs to be shifted away from neighborhoods — where, she says, patients have a worse chance of getting better, and where clinics become magnets for drug dealers.
"I believe that this whole philosophy around 'people need to be treated in their neighborhoods and communities' is just not working," Pugh said at an event in Florida last month. "I think that what you do is tear neighborhoods and communities apart."
Many in Baltimore share the mayor's concern about how methadone clinics and other drug treatment facilities could affect communities in the city, which has battled high rates of addiction among its residents for years. But it's a concern that advocates and treatment providers say is misguided and based more on the stigma surrounding drug addiction than science.
Adrienne Breidenstine, a spokeswoman for Behavioral Health System Baltimore, said many patients addicted to drugs prefer to get treatment close to home, where they have the support of friends and family. She said it's rare for people to travel long distances to get care.
"If people want it, helping them access treatment in the community is the goal,'" said Breidenstine, whose organization oversees drug treatment in the city.
Advocates say that sending someone away for treatment can cause problems because when they turn to their old environment, they're at greater risk of relapsing. And they say even a long bus trip across the city to get a daily dose of methadone can greatly deter people from sticking with treatment.
Although Pugh says she thinks a different approach is needed, she has not laid out a clear plan for what that might be. At a City Hall news conference last week she suggested mobile treatment units or house calls could work; at the Florida event she mentioned concentrating treatment around hospitals.
In the meantime, Pugh's administration has taken steps that would seem to contradict her stated position. Last month, the mayor voted in favor of signing a lease for space in a West Baltimore neighborhood to house a stabilization center to help people who overdose or have other serious problems caused by drug use. The center at 2700 Rayner Ave. in Mosher would serve about 30 patients at a time, helping them sober up and then connecting them with long-term drug treatment and other social services.
A spokesman for the mayor did not respond to questions about the center. Dr. Leana Wen, the city's health commissioner, declined to comment on Pugh's statements about neighborhood treatment centers. Last week, Wen said the stabilization center would be a step toward "treating individuals that have a substance use disorder with the same urgency and compassion as we would any other disease."
The mayor, however, says there is a link between drug treatment and crime — a complaint echoed by leaders in some communities that are home to methadone clinics. She says it makes sense for a drug dealer to stand near a treatment center, where patients might be tempted to relapse.
Debra Furr-Holden, a researcher at the Johns Hopkins University, conducted an in-depth study of links between drug treatment centers and crime in Baltimore. She concluded they caused no more problems than other commercial establishments.
"People say things that aren't true because what they won't admit is their bias and bigotry against people with behavioral health problems," she said.
One treatment center in the city does receive criticism from health officials. Turning Point at North Avenue and Belair Road is singled out for attracting large crowds, and in 2015 it entered into a settlement with state health authorities after investigators concluded it was violating regulations.
Del. Cory McCray, a Democrat who represents the area, said the clinic has become too large and difficult for the state to keep under control.
"When you get a bad methadone clinic, that's not like having a bad neighbor," he said. "That's like having the end of the world coming down on a neighborhood."
But state investigators found that Turning Point quickly fixed the rule violations after the 2015 settlement went into force. A spokesman for the state health department said the settlement period was successfully completed and that the clinic is reviewed quarterly.
The Rev. Milton Williams, a pastor who runs Turning Point, said the clinic provides a valuable service, helping some 3,000 people get methadone and other treatment each day.
"Clearly we're saving lives by being the largest treatment center here in Baltimore," he said. "I don't think that for the most part we understand the horrors of addiction. If we understood the absolute destructive nature of addiction, we would look at methadone clinics differently."
Alan Mlinarchik, a neighborhood activist trying to figure out how communities and treatment centers can coexist, looked at data on where treatment slots were available and where people who used them lived.
He found that some areas in the center of the city had an oversupply, while other neighborhoods faced a dearth of options.
The answer, he said, would be to have smaller clinics spread more widely throughout Baltimore. They'd be more accessible to those in need, but less likely to attract drug dealers and worry their neighbors, he reasoned.
Treatment at hospitals, as the mayor suggested, could also make sense, Mlinarchik said — especially for patients needing other health services.
"We need treatment beyond what we have now in the city of Baltimore," he said. "Our point is just be strategic and put treatment where it's needed."