Baltimore County needs to change zoning laws to allow more drug treatment and recovery facilities and should provide low-level drug users with assistance finding jobs or housing instead of sending them through the criminal justice system, according to recommendations from public health experts.
The guidance is part of a 27-page draft report from the county’s Opioid Response Working Group created by County Executive Johnny Olszewski Jr. to recommend ways to reduce addiction and overdose deaths in the county. The group includes medical executives, doctors and drug treatment providers from Johns Hopkins University, the University of Maryland Medical System and Shepard Pratt Health System. Olszewski can direct county agencies to make many of the 11 recommended changes, but some will require county council approval.
Baltimore County consistently sees the second-highest number of overdose deaths in Maryland, with county police recording 202 deaths and 858 overdoses as of Sept. 19. Additionally, county officials say it’s difficult to accurately monitor nonfatal overdoses because hospitals may not always report every overdose to law enforcement. From January through June 2019 Baltimore County fatal opioid overdoses declined by nearly 14% from the same period the year before, state data show.
“We need solutions that are evidence-based and have support from the community,” Olszewski, a Democrat, said in a statement, “and that’s what the work group has provided us with.”
Republican Baltimore County Councilman David Marks of Perry Hall said he thinks there’s going to be “broad consensus” on a lot of the proposals, but the zoning issue will be the toughest thing to implement.
The opioid group report recommends the county revise its zoning laws to allow more recovery housing and drug treatment facilities. The county currently has seven treatment programs, and a new residential treatment program is in the works.
Recovery houses are communal living settings that offer peer support to people seeking sobriety. The county’s lack of certified recovery housing was deemed a “crucial gap” in the report. Treatment programs give people addiction medication such as methadone or buprenorphine in places such as hospitals. Recovery housing and treatment programs can operate independently of each other, but treatment programs can also exist within recovery housing.
Neighbors may get upset by new facilities proposed in their neighborhood. Given the stigma against people who use drugs, according to the report’s summary of public comments, the county needs to address the “not in my backyard” mentality that actively resists placement of recovery housing in certain neighborhoods.
“There’s a definite need, but on the other hand there are many people who will see this and be afraid of the unknown,” Marks said.
A major obstacle regarding zoning will be the county’s “two unrelated rule,” Marks said.
The two unrelated rule is a housing law that states no more than two unrelated persons can live together in a single family home. The law is designed for places like Towson, where there’s a problem with over-renting to students, Marks said.
Prospective recovery homes could overcome this obstacle by getting a boarding house permit, but these permits are rarely issued, Marks said.
Marks said it would be “wise” for the council to seek public feedback on how to craft a law regarding recovery housing. These programs shouldn’t be clustered in certain communities, Marks said, but “the simple fact” is recovery houses need to be close to the populations they’re going to serve.
Dr. John Chessare,president and CEO of GBMC HealthCare and chair of the Opioid Response Working Group, said the housing and treatment program proposals might raise concern among residents. Both can be a “very successful tool” in reducing addiction if they meet high-quality standards, Chessare said.
The working group thinks the county should enact every recommendation listed, but it’s ultimately up to county officials to accept the proposals. Chessare said the county will be better off if they enact as many as possible.
“We were not brought together to make comments about politics. We were brought together to vet the evidence and to make recommendations to the public," Chessare said.
Beyond addressing treatment, the report also advises the county not to place low-level drug offenders in jail, and to instead provide a wide range of support services to offenders — emulating the Baltimore City Police Department’s Law Enforcement Assisted Diversion program, or LEAD.
LEAD is based on a treatment and support services model used in Seattle and other cities. Baltimore’s program began in 2017 after more than a year of planning with health organizations. The Bel Air Police Department in Harford County is also planning to implement LEAD this year.
Usually low-level drug offenders go through the normal cycle of booking, detention, prosecution, conviction and potential jail time. Through LEAD, police agencies refer offenders to case managers who provide legal aid, housing, employment services, and health care. LEAD programs can also help with food and drug abuse treatment.
Baltimore County Police Chief Melissa R. Hyatt, a former city police colonel, said her department is looking forward to working with other county agencies and organizations to address the opioid problem. She stressed her department “will have a strong role” in the fight against drug addiction. Likewise, County Fire Chief Joanne R. Rund said her department is training personnel to identify when it’s appropriate to leave the opioid overdose antidote naloxone with families who would be trained on how to administer it.
The opioid report recommends the county work with hospitals and health programs to expand access to medication-based treatment for opioid addiction. And the draft urges the county to make methadone, buprenorphine, and naltrexone available to all individuals with opioid addiction in the county correctional system.
The county should also distribute clean needles to drug users, the report said. Baltimore City has a similar needle exchange program designed to reduce HIV, hepatitis C and other infections spread by reusing syringes. The city’s program also helps drug users overcome addiction by linking them to drug treatment services.
Chessare said needle exchanges help people accept treatment while avoiding the "scourge and huge public health problem of infections from contaminated needles.”
Opioid working group members said their proposals are in line with “the best evidence” for treating drug addiction and based on public input from an online survey and two public meetings.
“Our plan speaks to the needs of the community, but also what we know from public health practice and public health research,” said Michelle Spencer, associate director of the Bloomberg American Health Initiative at Johns Hopkins University.