TPC Series-One

IT’S HIGH TIME WE RETHINK THE ROLE OF SUBSTANCE ABUSE CLINICS AS BALTIMORE AND AMERICA FIGHT TO ESCAPE THE HELL OF HEROIN ADDICTION (This is the first in a series of seven reports from the front line in the on-going battle against heroin addiction, written by Rev. Milton E. Williams, founder of East Baltimore’s Turning Point Clinic and a 30-Year veteran in this widening war.) More and more of us are reading more about it, hearing more about it, and becoming more concerned about it every day:  There is a cruel, life wrecking, death dealing substance abuse wave now sweeping out of control across the dazed face (and faces) of Baltimore and all America.  It is truly a relentless epidemic that is spreading so rapidly that alarmed governors in state after state are finally sounding the call to battle stations. Maryland’s Governor-elect Larry Hogan did just that two weeks ago when he announced his intention to declare a “state of emergency” due to the rapidly increasing number of heroin users, overdose deaths and related crime across Maryland.  This could be the beginning of the beginning as we rethink the proven ineffective policies that have been in place for decades. Too often politicians have focused only on their wrongheaded policies, precisely in order to ignore the problem itself, policies which they still persist in implementing with little, if any, positive results. Just promoting the familiar apparently has been more politically expedient than admitting we need a new battle plan altogether.  But there could be hope on the horizon, with the changes in leadership coming to the State House in Annapolis... read more

TPC Series-Two

Baltimore Really Does Have AT LEAST 60,000 Heroin Addicts (Second in a series of reports from the front line of the battle against heroin.) In yesterday’s Report, I said we need a Substance Abuse Treatment Reformation if we are to intelligently respond to drug addiction.  To start the Reformation, we must have some reasonable and honest estimate of how many heroin addicts there actually are.  And Baltimore is a good case to consider.  This is one of the four areas the Baltimore Mayor’s drug task force is supposed to investigate over the next nine months.  But after only two weeks, her taskforce has concluded somehow that there are only 19,000 heroin users, instead of her prior estimate of 11,000 heroin addicts.  The National Institute of Drug Abuse estimates that 23% of heroin users will become addicts.  This might roughly imply that the Mayor’s estimate of 19,000 users means Baltimore has less than 5,000 addicts.  Of course, if that were true, then we would really have no visible heroin problem at all in the City.  That number would also suggest that Turning Point has already treated more heroin addicts than exist, and that almost all (or even more than all) heroin addicts are already in treatment!  If only. Two weeks ago, Governor-elect Larry Hogan announced that, immediately upon taking office next month, he would declare a “state of emergency” due to the ever-worsening heroin problem in Maryland.  How can the Mayor, who, in effect, just declared that the City has no significant heroin problem, and the governor-elect both be right?  Well, they aren’t.  Let’s derive our own estimate of the... read more

TPC Series-Three

Substance Abuse Treatment Is The Art Of The Possible (Third in a series of reports from the front line of the battle against heroin.) Yesterday, I developed a reasonable estimate of the MINIMUM number of heroin addicts in Baltimore City, 60,000.  Now, I’d like to delve into what a methadone clinic is and what it is not; and which heroin addicts participate in such programs, and which do not and why. Turning Point is rather unique among methadone clinics, because it has grown so big, so fast, having tripled in size in three years.  Other clinics have mostly patients who have been in the program for years.  Our average patient has been with us only about a year and a half.  What this means is that we see every day the stark contrast between patients who want to cease drug use (those who have been in the program many years) and those who simply present themselves for medication because they do not at that moment have money to buy drugs. In other words, there are essentially two clinics operating under the same roof.  To underscore that the patient clientele served by each is so very different, let’s call one “good” clinic and the other “bad” clinic. The good clinic is what everyone hopes a methadone clinic will be, a place full of people anxious for and working diligently towards total recovery.  Sometimes failing and sometimes not, they are nonetheless serious about their recovery.  We try to give these folks every service we can afford to give.  We provide counseling, social work, daycare for children while patients are in the... read more

TPC Series-Four

The Calculus Of Substance Abuse Recovery (Fourth in a series of reports from the front line of the battle against heroin.) Yesterday, I introduced the concept that any inner-city methadone clinic, like Turning Point, is really two clinics:  A good clinic, for those who truly seek recovery, and a bad clinic for those who simply did not have money to buy drugs on a particular day.  Of course, we probably all know that such a dichotomy is an exaggeration, and that patients in treatment constitute a continuum of “seriousness” toward their recovery. Now, why should the bad clinic predominate?  Why should those unrepented addicts so outnumber those who are serious about their recovery?  After counseling and ministering to addicts for 30 years, I have come to believe that many policy makers do not fully understand the answer.  Which is really quite simple:  The calculus of recovery for most addicts simply does not produce the kind of perceived net benefit that would make all the hard work associated with changing their entire lives worthwhile.  The “economics” are just not there. I recently returned from visiting friends in China.  Like most of us, I had (still do) little to no facility with using chopsticks.  Having used a knife and fork for, lo, these 60 years, that should come as no surprise.  A knife and fork is all I have known, and it’s worked OK for me.  Accordingly, not only do I have no facility with chopsticks, I have very little motivation to develop such.  It’s the same for lifelong heroin addicts:  They require a compelling reason to change.  The most compelling... read more

TPC Series-Five

Methadone Clinics Are A Vast Benefit To The Community (Fifth in a series of reports from the front line of the battle against heroin.) Yesterday, I discussed why so few heroin addicts have any interest in sustained treatment.  Getting them into treatment is the key to rescuing the community from their crime.  Clinics like Turning Point, and the “bad” clinic in particular, can be an enormous benefit to the community, but only if we get MORE bad patients into treatment. We know that every time we see a patient drink his or her methadone, that that patient is not abusing his or her family, or robbing or burglarizing those in the community.  Many of our patients at Turning Point do not show up for treatment around the first of the month.  That’s when welfare checks come out.  One way or the other, directly or indirectly, we must all understand that the government “buys” much of the illegal drugs in the inner-city.  What is the famous quote, “We have seen the enemy, and he is us!” How true!  Whether a patient, having run out of government money, seeks medication a few times a month out of a desire not to rob or burglarize, or whether simply to avoid withdrawals, the point is the same.  The benefit to the community due entirely to the presence of a conveniently located methadone clinic is vast! But that benefit is also invisible.  No one in the community knows that he/she did NOT get robbed that day because patient John Smith was medicated at the local methadone clinic a few hours earlier.  As a very... read more

TPC Series-Six

“Street Smart Medicine” (Sixth in a series of reports from the front line of the battle against heroin.) Yesterday, I focused on how methadone clinics such as Turning Point benefit the community, in spite of the unfortunate and somewhat intractable problem that patient loitering presents.  This week, I would like to explore a concept I call “Directed Care,” aka “Street Smart Medicine.” Previously, I introduced the concept of “bad” patients and “bad” clinics.  These are the patients who really have no interest in ceasing drug use.  Bad clinics is a construct.  They are the resources of each ordinary methadone clinic that are geared toward bad patients.  Good patients require a specific amount and type of resources and practices, and bad patients require something very different. But sometimes “bad” is actually good.  First, many of our good patients started out as bad patients.  By which I mean that they first came to the clinic with no intention whatsoever of even considering giving up drug use.  Today, a third of our “new” patients are actually prior patients who have decided to give treatment another chance.  In other words, they are becoming good patients.  So, the more bad patients you admit, the more good patients you will end up with.  This is surely good news for the community, not to mention the patients! But there is more to the story.  Methadone treatment costs Medicaid $80 per week per patient.  Some people, who don’t want any money spent on drug addicts, think that is $80 too much.  For the rest of us, those who actually live here on planet earth, we would probably... read more

TPC Series-Seven

Welfare Reform Will Force Addicts Into Treatment and Directed Care (Last in a series of reports from the front line of the battle against heroin.) Yesterday, I suggested how much money could be saved by managing, or “directing,” all the medical care of heroin addicts through their participation in a methadone program.  Now, it’s time to wrap things up by making some suggestions to the incoming leadership in the Maryland State House. For simplicity, I will follow the chronology of this series, but add a final recommendation, welfare reform, to which all the others are linked, one way or another. We need to think in terms of a Substance Abuse Treatment Reformation. If drug treatment is what we all seek (recovery for addicts, but most notably relief for the community), then we must first admit that methadone clinics are not very effective in bringing that about, even among “good” patients.  Incentives to get new patients into treatment, and to stay there, will help.  Providing breakfast and lunch for patients will help more.  Turning Point runs the largest food pantry in Maryland.  We expect to begin such free, hot meal service for patients in 2015.  This may require limited grant funding.  (The $80 a week that Medicaid pays for methadone treatment is hardly adequate even for minimal services.) Rearranging the deck chairs (or, more aptly, recounting the lifeboats) is not going to change things. Baltimore has a staggeringly huge number of heroin addicts—at least 60,000—and probably far more.  We need to recognize this as state budgets are prepared, and policies (hopefully new ones) are developed that deal with the addiction... read more

Hogan to declare state of emergency on heroin addiction 12/14 WMAR-Channel 2, Baltimore’s ABC affiliate, in a report on Gov.-elect Larry Hogan’s plans to declare a heroin “state of emergency” once he takes office the following month, interviews Rev. Williams where he praises the renewed attention on the... read more

Md. pharmacies to stock heroin antidote 12/14 The Baltimore Sun, in an article about the rise in heroin use in the State of Maryland, quotes Rev. Williams, “The governor-elect is going to bring a whole new strategy, a whole new philosophy to fighting this war on heroin addiction,” Rev. Williams, said. “The current administration has become entrenched in talking about it as opposed to bringing action and resources to the table that’s going to make a change in stopping this thing here and... read more

Making a Difference


A Recovering Addict’s Journey