Rodricks: Time to turn some prisons into hospitals

On Eager Street Tuesday morning, Larry Dawkins parked a large white van about 100 feet from the release door of the Baltimore Central Booking and Intake Center. The van is a clinic on wheels. The idea is to give people coming out of pretrial detention the counseling and drug treatment they can’t get behind the walls.

When released defendants walk through the door onto Eager Street, they should easily see the van. For many, it could be a lifesaver from the opioid crisis. Ask anyone in the field: The first hours and days after incarceration are terrible for drug addicts, the time when they are particularly vulnerable to trouble, including overdose.

So that’s why the van, once used as a mobile clinic on the Eastern Shore, was open for business on Eager Street, in Our City of Perpetual Recovery, Tuesday morning.

It was Dawkins’ first day as the van driver, and the first day of PCARE — for Project Connections At Re-Entry — the latest effort of a Baltimore nonprofit to fill gaps in services for the city’s poor, in this case with an approach the state does not sanction behind the walls. That means treating people with mental health problems or addiction to opioids, and getting those who use heroin started on suboxone, a combination of buprenorphine and naloxone that treats addiction while curbing abuse and reducing the risk of overdose.

The doctors and researchers of the Behavioral Health Leadership Institute believe, accurately, that most people who get arrested probably need drug treatment. So the organization wants to do on the outside what’s not being done on the inside.

So the van will be there three hours a day, four days a week, with Dawkins at the wheel, one of four nurses from Johns Hopkins Hospital — yesterday, it was Kevin McAndrew — and, at varying times, one of two doctors from Hopkins Bayview. There will also be a case manager.

And Deborah Agus should be there a lot.

She’s executive director of the BHLI and an adjunct faculty member at the Johns Hopkins Bloomberg School of Public Health. Her group already supports treatment programs in East Baltimore and West Baltimore. The PCARE van is a pilot project.

“We are focusing on the jail because so few services are offered there and often it is people who have not even been found guilty yet remain incarcerated,” she told me. “Many of the people BHLI treats in the community unfortunately cycle in and out of detention, and the experience is quite devastating.”

I shook hands with Agus, Dawkins and McAndrew, wished them luck, and told them I’d be back for the coffee and donuts when the PCARE van has its grand opening. (Tuesday was the project’s soft opening.)

I appreciate the effort. But why not provide the service inside the walls?

There are thousands of drug addicts in the city, many of them born into poverty and still stuck there, many destitute because of their long experiences with heroin. And many of them, no doubt, were arrested at some point, either for drug possession or, in the age of the user-dealer, for selling drugs. Many were arrested for crimes related to their habits — theft, robbery, breaking and entering.

What I really want to say is what I’ve said before, and then some: Declare victory in the war on drugs, put the money we spend on law enforcement into drug treatment. And, while doing that, we should turn the prison system inside out: Keep violent criminals in maximum security, but give just about everyone else a room in a rehabilitation hospital.

We are in the midst of a horrific opioid crisis that killed more than 64,000 people last year. And while there is a new population of users dying from overdoses, the base has been there a long time — heroin addicts who have been in and out of prisons and who return to their old neighborhoods still vulnerable to addiction. We miss an opportunity to help them while they’re behind the walls.

A decade ago, when the combined population of American prisons and jails stood at 2.3 million, the National Center on Addiction and Substance Abuse found that 1.5 million of those inmates met the medical criteria for substance abuse or addiction. Another 458,000 had histories of drugs or alcohol, were under the influence of one or the other at the time of their crimes, or committed crimes to get money for drugs.

But only about 11 percent of all inmates with addictions received any treatment during incarceration.

In the organization’s most recent report, published last month, only about 10 percent of inmates received addictions treatment.

In Maryland, efforts are underway to reform criminal justice, with more emphasis on drug treatment. Fine. But, given the history, given the present epidemic, given what’s at stake, it just looks like earnest tinkering to me. We should scrap what we’ve been doing for decades and start over.

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