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Time for methadone on demand

There is a desperate and obvious need to re-create what methadone treatment for heroin addicts is: its purpose, practice and availability. Simply put, since the time methadone programs were created many decades ago, the nature of the beast — heroin addiction — has changed.

One might ask, "Surely it means the same thing to be addicted to heroin today as it did, say, 50 years ago?" True, the nature of addiction itself has not changed; but almost every other aspect of the problem has. Crime, social consequences, prevalence in Baltimore, cost of the drug, social acceptance in ghetto areas: All these things are very different today than when methadone treatment programs, and the policies and practices surrounding them, were inaugurated long ago.

If we are going to address this city's problems caused by heroin addiction, then it is going to require something qualitatively different than mere evolutionary changes in methadone treatment. A few more treatment slots, more counseling, more creative types of interventions — these are all good things promoted by experts of high quality and good intention. However, these kinds of changes alone will never get the job done and slay the beast.

Let's not kid ourselves. Although Baltimore, mercifully, has seen crime rates decline over the past 10 years, this trend is nationwide and has been attributed by experts to a variety of factors, including putting more people in jail, the aging of the population, better policing — even more abortions.

But I have not read anywhere that any experts in criminology have attributed, even minimally, the nationwide decrease in crime to better and/or more substance abuse treatment.

I have counseled thousands of heroin addicts over the past 25 years. Needless to say, I have learned a lot. I know that no addict becomes drug free unless or until he wants to. The problem is not that methadone treatment is ineffective. I would actually call methadone a miracle drug. The problem is that, overwhelmingly, heroin addicts lack sufficient desire to cease using heroin. Accordingly, we cannot use methadone treatment to bring about significant reductions in crime by continuing to follow only the current treatment approaches.

It is time to go back and rethink what we wish to accomplish, as a society, with methadone treatment. Such treatment has always been, and continues to be, focused on the recovery of the addict. Although we reflexively refer to such people as "victims," the family, friends, employers, neighbors and innocent bystanders who are preyed upon by addicts in desperate need of money to buy drugs are more justly to be called victims. And these victims are far more numerous, because they include all of us.

Traditional programs that aim at bringing addicts into long-term treatment (usually after waiting weeks or months), counseling them and implementing various other interventional strategies, address only the addict as a victim. Although current counseling programs seek to involve families and others in the "recovery" process, it is only incidentally that all the other victims may benefit from these programs. This must change.

Overwhelmingly, the heroin addicts who commit so much of the total crime in Baltimore (a) have little interest in ongoing treatment and the cessation of drug use; and (b) have no interest in waiting weeks (or even days) for methadone medication. Society is desperately trying to slay the beast, but has chosen the wrong weapon!

We must focus our efforts on the addict who has no money to buy drugs — who cannot and will not wait for treatment. So far, "on-demand" treatment has been a fiction. On-demand does not mean next week or next month. On-demand, for a heroin addict about to rob or burglarize someone (or far worse), means now.

My organization, Turning Point, intends to begin next month a true "on-demand" methadone program. We have committed to getting addicts in, evaluated, medicated safely, and out the door in 15 minutes. Turning Point operates the largest methadone program in Baltimore and Maryland. This traditional program serves the needs of addicts who are trying to become drug free. I have dedicated my life to helping such people.

It is also time that we, as a society, focus on helping ourselves enjoy better lives by avoiding drug-related crime. We will do this by medicating precisely the heroin addicts who are about to commit crimes that very night. I am not embarrassed by focusing on the "other" victims of heroin addiction; rather, I am delighted to say that now, finally, substance abuse treatment in Baltimore has real — and not merely indirect — benefits for the rest of us.

This new program is game changing. Turning Point had to go back and re-create what is meant by "substance abuse treatment" in order to learn what is really needed — needed for a future increasingly free of drug-related crime.

The Rev. Milton E. Williams, senior pastor of New Life Evangelical Baptist Church, is president of Turning Point Clinic. His email is revwilliams@turningpointclinic.org.

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