Baltimore officials are seeking another $25 million a year in state funds for drug treatment, saying the crime and social breakdown caused by the thousands of addicts who can't get help is costing far more.
"This is the crisis that's killing our city," Mayor Martin O'Malley said Friday. "Eighty percent of our homicides are drug-related. Too many people are wasting their lives on drugs."
The $26 million to be spent this year on 42 city treatment programs is about twice the treatment budget of four years ago. But addicts without health insurance find they must wait weeks or months for a slot, particularly if they are seeking residential or methadone programs.
"I called every program I could find, and they said I'd have to wait three months, four months," said Nathan Pullifrone, 25, a heroin addict who entered the Glenwood Life methadone program in Govans on Feb. 1 after a frustrating three-month search. "If I hadn't gotten in? I'd still be out there boosting [shoplifting]."
Pullifrone said most long-term drug users he knows talk frequently about getting into treatment, but their frantic quest for the next fix gets in the way.
"You don't ask for help until you're completely down and out," Pullifrone said. "When you hear three months, it's like forget it."
Baltimore's treatment expansion was launched by former Mayor Kurt L. Schmoke, using money from the departments of housing, social services and health, as well as donations from the Abell Foundation and the Open Society Institute-Baltimore. State funding has also increased, but more slowly.
Gov. Parris N. Glendening's proposed budget sets aside $10 million statewide from the state's tobacco settlement for additional drug treatment next year, with less than $3 million of that slated for Baltimore. O'Malley says that is not nearly enough.
"The governor's budget allocated $30 million for smoking cessation," O'Malley said. "I don't know what it's like in Prince George's County [Glendening's home] but people here aren't killing each other over the high price of cigarettes."
Raquel Guillory, a spokeswoman for the governor, said more drug treatment money may be added to the budget later. "The governor is well aware of the city's problems, and he doesn't object to putting more money into viable programs," she said.
The rising spending in recent years has resulted from a political consensus that drug addiction is the cause of the city's most serious social problems, from theft and murder to child neglect and family disintegration.
"The very day someone goes into treatment, they're not out there robbing for that $50 or $100 for drugs," says Del. Dan K. Morhaim, a Baltimore County Democrat and physician who is vice chairman of Lt. Gov. Kathleen Kennedy Townsend's drug treatment task force. "People see there's a real return on investment in terms of crime reduction."
Several major anti-crime initiatives depend on ready access to treatment, from Townsend's "Break the Cycle" program to get criminals off drugs to O'Malley's pledge to close 10 Baltimore street drug markets. Police drug sweeps routinely pick up dozens of addicts who need treatment.
The increased funding to date has increased the city's treatment slots from 4,100 to 6,600 and the people served each year from 11,000 to 18,000, according to Baltimore Substance Abuse Systems (BSAS), a quasi-public agency that oversees publicly funded treatment.
But that falls far short of the need. The state Department of Health and Mental Hygiene estimates that about 230,000 Marylanders need treatment for drug or alcohol addiction. Baltimore accounts for the largest number, 60,000, followed by Baltimore County with 30,000 and Anne Arundel County with nearly 25,000.
Apart from the numbers, Baltimore's drug problem is especially formidable. The counties' largest treatment category is alcohol. In Baltimore, the most abused drug is heroin.
"Baltimore has a hard-core, older-adult heroin problem that is very hard to deal with," says Michael M. Gimbel, who oversees treatment in Baltimore County.
Gimbel says drug abuse officials in other jurisdictions know the severity of the city's problem and applaud the city's treatment expansion. "We all need more money, but there's no envy here," he said.
Baltimore Health Commissioner Dr. Peter L. Beilenson, who is chairman of the BSAS board, says the city's goal is to place every addict who seeks treatment voluntarily or by court order in a program within 48 hours. He estimates that to achieve that goal, the city's programs would have to serve about 40,000 people per year, more than double the current number served.
Frank Satterfield, director of Glenwood Life, says his treatment program has been a beneficiary of the funding boost so far, growing from 230 slots in 1996 to about 500 today. But he says Glenwood nonetheless has 450 people awaiting treatment, all of whom must call in weekly to stay on the waiting list.
"It's very disheartening for my staff to tell people to wait for treatment, 'Maybe 10 weeks, maybe 12 weeks,' " Satterfield said. "They know they'll lose some of those people."
Despite the demand for additional slots, Satterfield said, it would be wise to put at least some new money into strengthening existing programs. He said his 10 counselors are paid between $22,000 and $29,000 a year. He has three vacancies, and the jobs are hard to fill.
Many addicts today have severe, multiple problems beyond their addiction, he says: HIV infection, sparse or nonexistent work histories, homelessness, serious medical problems or mental illness. To get such people off drugs often requires much more than counseling or methadone, he says.
"It's very clear there's a desperate need for more intensive services," said Faye S. Taxman, a University of Maryland criminologist who studies addiction. "Before I'd ever expand slots, I'd train counselors, pay them more money and increase the intensity of services."
With that in mind, BSAS is studying how to make additional services available through treatment programs -- for instance, adding job counselors or housing specialists.
To do that, while abolishing the wait for treatment, might cost as much as $70 million a year in Baltimore, Beilenson says. He adds a pledge.
"If we got $70 million, I'd say that in three years, we'd cut crime in half," he says. "And if we didn't, I'd quit."