Reasons for hope in nation's 'heroin capital'

Baltimore City has long held the unfortunate title of "U.S. heroin capital." Over the years, many people inside and outside of Baltimore have chosen to promulgate this unofficial designation when reporting on or portraying Baltimore's challenges with drugs, addiction and the residual effects of high crime, violence and other social ills. Baltimore, like many urban jurisdictions across the country, has suffered and continues to suffer tremendously from the consequences of illegal drugs flowing into our city. What may not be as widely known is the progress Baltimore has made to counteract its undeserved title.

In 1999, Baltimore's overdose death rate exceeded that of its homicide rate; then-Health Commissioner Peter Beilenson called drug addiction "the biggest problem in the city"; and Baltimore Sun editorials called for more drug treatment. Within five years, grant funding for drug treatment doubled to support an increase in treatment from 18,000 admissions in 1999 to 30,000 in 2004. An overdose prevention program was introduced, and drug courts were expanded. In 2006, Baltimore's treatment system started the innovative Baltimore Buprenorphine Initiative, offering clients access to Suboxone, a medication that effectively treats opiate addiction.

Despite all of these efforts, the demand for treatment continued to significantly outpace availability, with waiting lists at methadone programs stretching for weeks to months. Clear to many was the limit of grant funding to support the large number of uninsured seeking services, particularly single, low-income men. In 2009, Del. Pete Hammen championed a bill that revolutionized access to treatment in Baltimore City; Maryland Medicaid's Primary Adult Care Program was now to pay for outpatient substance abuse treatment, including comprehensive medication-assisted services, for anyone with an income of 116 percent of federal poverty (around $12,600) or less.

Since enactment of the legislation in January 2010, Baltimore City methadone and buprenorphine treatment providers have seen more people walk through their doors and watched their waiting lists dwindle to virtually nothing. An internal poll of 12 methadone treatment providers in Baltimore City earlier this month demonstrated that eight of 11 respondents (73 percent) had no waiting list at all. Outpatient treatment on demand is now a reality for many. All of which might lead one to ask: What impact have all these efforts had on the problem of heroin addiction in Baltimore?

While cause and effect is often difficult to establish, there is no denying that Baltimore City has seen progress. Heroin-associated overdose deaths have significantly decreased, from a high of 283 in 1999 to a low of 87 in 2009. From a public safety perspective, violent crime and homicides have declined from more than 300 in the 1990s to 223 in 2010. Prevention programs targeting at-risk youth are working to help kids stay — and do better — in school.

One inspiring, concrete result of the expanded treatment efforts over the last 20 years is the resilient and strong recovery community in our city. Just as science has led to the understanding of addiction as a chronic sometimes relapsing disease, emerging research has started to confirm a long-held belief that people in recovery play a key role in helping others seeking the same. For example, a positive connection to others in recovery is cited as a key factor to sustaining that recovery. Structured telephone calls from peers can help strengthen recovery or identify and intervene with early signs of relapse.

Baltimore City will soon benefit even more from the strength of its recovery community. The Recovery Corps, in partnership with the mayor's stepUP! Baltimore volunteer initiative, will recruit, train and place 100 people in recovery in community settings to serve as peer advocates, gain valuable experience, and eventually, possible employment. Baltimore Substance Abuse Systems Inc. will begin accepting applications for volunteers today.

The progress Baltimore has made has led to its recognition as a national leader in innovative approaches to addressing drug addiction. Delegations from countries such as Peru, Colombia and Russia, and visitors from England and Australia, have come to Baltimore to learn about these methods for possible application back home.

Clearly, though, there is more work to be done, and those who care about Baltimore City should not rest until much more progress has been made. There's good reason Mayor Stephanie Rawlings-Blake in 2010 declared drugs and addiction as the biggest problem facing Baltimore City. Too many people, too many families and too many communities are ravaged by drugs. But amid the anguish, there is real hope.

Dr. Yngvild Olsen is medical director of Baltimore Substance Abuse Systems Inc. Her email is

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