Baltimore's promising experiment in combating the opioid epidemic

It wasn’t an easy sell at first — opening a stabilization center in West Baltimore where doctors could send those who showed up to emergency rooms inebriated or high on drugs to sober up. Residents didn’t want a drug clinic in their neighborhood, and securing funding for a new approach to addressing the opioid epidemic took some convincing. Only a handful of cities around the country have such centers, so there was no long-term evidence about their success.

But a year after the center opened on a pilot basis, the agencies behind the idea, the Baltimore Health Department and Behavioral Health System Baltimore, a non-profit that oversees mental health and substance use treatment in the city, have convincing early evidence that such a set up works in getting people off the street and on the path to recovery.

The pilot center, which has been operating at Tuerk House in the Greater Rosemount community, has served 343 people, with 391 visits. Key to the model is that peer counselors try to connect clients to treatment and other wrap-around services, and it seems to be effective. Most of those who have gone to the center, about 62 percent, have entered treatment for addiction. Even better, nearly 40 percent remained in that treatment after 30 days.

Now the city has begun renovations next door on the Hebrew Orphan Asylum building so they can expand the center, with plans for completion next spring, and potentially reach even more people. Emergency rooms in Baltimore get more than 16,000 visits a year resulting in a diagnosis related to alcohol or drug abuse. The expanded facility, which will operate 24 hours a day, will be able to serve 35 people at a time, more than double the capacity of the pilot program.

The early success shows what can happen when state and local officials work together on an seemingly intractable issue, such as opioid and alcohol addiction, which killed 1,848 people in the first nine months of last year, the latest figures available.

The center is being renovated with $3.6 million in capital funding allocated in the state budget. The Maryland Department of Health also provided $2.6 million for operating expenses.

Rather than a clinic that nobody wants, the project is now being celebrated as an economic development engine for the neighborhood, which city officials hope can be the home to a full-service health care center. The Coppin Heights Community Development Corp. and Cross Street Partners are undertaking the $17 million renovation of the building, which has been vacant for 30 years. It is a fitting use for a building that was last the home to Baltimore General Hospital.

Doctors at the University of Maryland Medical Center Midtown Campus said they have noticed the impact of the pilot program in the short time they have referred patients to the stabilization center. They now have a place to send intoxicated patients who don’t have a true medical emergency. This frees up doctors for life-saving cases while getting substance users needed treatment, rather than discharging them without meeting their behavioral health needs.

The majority of intoxicated patients do not need all of the diagnostic and treatment support provided in the emergency room, said Dr. Zachary D.W. Dezman, attending physician at the hospital. They need social supports like those provided at the stabilization center.

This doesn’t mean emergency rooms are shutting their doors to those with addictions. A small number of intoxicated patients do indeed have serious conditions, such as intracranial bleeding and seizures, and they still need critical care that emergency room doctors will continue to offer.

The Maryland Hospital Association said the center has great potential for quickly getting people to the right care. One of the barriers had been transportation. The city has partnered with the Maryland Institute for Emergency Medical Services Systems to expand protocols so that basic life support teams can take people to the center. They also have started to set up a system so that individual hospitals can make direct transports from their emergency departments.

The stabilization center is no miracle cure for the opioid crisis, and the staff knows they won’t reach everybody. The approach is not to pressure people into treatment because those addicted to drugs and alcohol have to be ready for such a major change in their lives. Pushing too hard can have the opposite effect. But sometimes folks just need that nudge to seek help or to have the idea put into their head for when they are ready to take that step. Some will start treatment and not finish. That’s still progress because it may move them a step closer to trying again.

Those working on the ground trying to solve the opioid crisis should use this promising start as a catalyst to try other unconventional ways to stop the unrelenting surge in overdose deaths. Some in the state are also pushing for safe consumption sites, where people can go and openly use opioids under the supervision of a doctor or other medical professional, in hopes that addicts will at least stay alive long enough to give treatment a chance. It’s another idea that is worth trying.

It is an unorthodox epidemic that calls for unorthodox solutions.

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