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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.

  1. 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.)
  2. 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 problem.
  3. Stop focusing on the tip of the iceberg, i.e. “good” patients, and develop strategies to get more of the vast sea of heroin addicts who are not interested in becoming good patients, or even in becoming bad ones, into treatment. Streamlined new patient processing is but the first thing we must implement.  Turning Point will have its “Open Access” proposal on the new Governor’s desk by January 22, 2015.
  4. Community churches, with congregations truly open to taking in heroin addicts as members, will be an important part of any successful Reformation. My church and clinic are sister organizations.  I desperately want to see this model replicated, elsewhere in Baltimore, and around the country.  Last month, I appointed my first Manager of Faith-Based Programs.  The State ought to consider pilot grant funding for such programs.  Let’s watch, carefully, how well they work.
  5. The community needs to be educated, and then re-educated again, as to the enormous unseen benefits methadone programs provide. Politicians need to take the lead in this.  They also must try, difficult though it surely will be, to resist the temptation to inhibit the development of new clinics as constituents cry “not in my backyard!  One way to do this is the model Turning Point is using.  We will develop other clinics in Baltimore, with mental health, and primary and urgent care components.  They will constitute meaningful redevelopment projects in blighted areas, providing construction and then permanent jobs to many.  This is what we are doing presently.  That is, if the City approves our site proposal.  These will require some funding, but the savings to Medicaid will pay for such many times over.
  6. Pass legislation and adopt policies that will make “Directed Care” practical, and develop other methadone clinics so that Directed Care can become the norm when it comes to inner city primary and urgent care. Of course, these clinics will not only serve addicts, but all in the community.  These Directed Care clinics will have to be large in order to make the numbers work by achieving meaningful economies of scale.  In Baltimore, there has been talk of going in the opposite direction, toward many, but smaller, methadone clinics.  Although now is not the time to make the case, such talk is pure madness.  These patients need MORE and not LESS resources.  Moreover, large, Directed Care clinics will SAVE vast amounts of Medicaid dollars.  A bunch of inefficient, little clinics is only going to cost more taxpayer money, which governments surely do not have, and they could never provide the resources needed by addicts.
  7. There is NOTHING policy makers and legislators can better do to get more people into treatment, and keep them there, than this: Welfare reform!  Many states are trying to implement or have proposals regarding the lucid and courageous idea of linking welfare to drug testing:  If you want your welfare and food stamps, then cease drug use.  With methadone being a near perfect substitute for heroin, such a policy of welfare reform is hard to criticize.  This could bring multiple times as many people into treatment.  I am requesting a meeting with Maryland Governor-elect Hogan to discuss this matter.  If we are going to force people into Directed Care, then we are going to have to first force them into methadone treatment.

Conclusion:  Governors need to appoint someone, not to study, but to bring about a Substance Abuse Treatment Reformation.  Forgive me for this, but I cannot ignore the parallel to the real Reformation, which some historians attribute compellingly to the preceding “black death” that killed 30 percent to, some say, 60 percent of ALL of Europe’s population.  I have spent 30 years of my life fighting black death in East Baltimore.  I want to start winning.  I am asking the new Maryland governor to help me. A quarter century ago, an African-American columnist, Dorothy Gaiter, wrote in The Miami Herald that “Being poor is no crime and should not result in a sentence to live among the lawless.” Maybe our Reformation can make her aspiration a reality, finally.   Rev. Milton E. Williams President, Turning Point Clinic Sr. Pastor, New Life Evangelical Baptist Church

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 all agree that $80 is cheap.  Very cheap.  It not only gives patients a chance at ceasing drug use, but reduces crime, avoids police/justice/incarceration costs, reduces domestic violence, and reduces emergency room visits and the associated costs.  In other words, it pays for itself many times over.

But there is more, much more, that can be achieved in terms of saving taxpayer money.  Although completion of a research project that is underway at Turning Point will require the installation of different leadership in the Maryland State House and at the Department of Health and Mental Hygiene, the data collected so far indicates that our patients needlessly waste $20 million each year in emergency room visits.  It may well be more!

One might note that I just described above how methadone treatment reduces emergency room visits.  If so, then how is there still $20 million in potential savings?  The reason is because the ER visits that methadone treatment avoids (by reducing overdoses), which is well known by policy makers, is just the very tip of this iceberg.  As one might easily imagine, lifelong, inner-city heroin addicts do not take their health (or most anything else) very seriously.  They have every chronic disease imaginable, but are notoriously disinterested in reliably seeing their doctors and taking their medication.  But, because most must come to the methadone clinic each day for medication, we have a magnificent opportunity to oversee (and force, if needed) compliance with their doctor’s orders.  How?  We make participation in the methadone program contingent on doing so:  You want your methadone, then we will watch you take your blood pressure medicine, for example.

Turning Point is intending to build a primary care and urgent care facility on property recently acquired just across the street from its methadone clinic.  This will make “Directed Care” as I call it relatively convenient for patients.  But there are issues, of course.  What if a patient tells us he or she has already taken, say, his or her blood pressure medicine that day?  How do we know?  One answer is that active methadone patients, unless and until demonstrated to be unnecessary, will be given such medication by Turning Point along with their methadone.  There are other issues as well, such as how to get paid for the added cost of doing these things.  This may require changes to Medicaid rules, but, given the vast savings that would be available to Medicaid, such should not be much of an issue.  Well, let’s hope.

This truly is “Street Smart Medicine.” Who would have thought that heroin addicts in treatment (and even those not in treatment, because they are a vast potential opportunity) are an asset!  Well, at least from the perspective of potential taxpayer savings.  Of course, like most assets, they aren’t worth anything unless they are developed.  So, I have made making Directed Care a reality, and a model for others, my highest priority.  And, rather than begging the State of Maryland and City of Baltimore for money to help THEIR addicts, I’ll be asking simply to help me save them money.

Conclusion:  Heroin addicts are kind of an asset to be developed, with dividends to be earned by the community and taxpayers.  That might sound like a dehumanizing way to look at it, but it is time that drug treatment be designed and implemented for the benefit of the community and the taxpayer.  For the most part, society has already done all it can for the addict.

Tomorrow, in my final Report, I will detail specific things policy makers, political leaders and legislators must do.  Perhaps most important of all, they must change welfare rules.

 

Rev. Milton E. Williams

President, Turning Point Clinic

Sr. Pastor, New Life Evangelical Baptist Church

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 good friend likes to tell me, “You don’t know what you don’t know.” How true!  And so it is with the community and the usually invisible benefits of methadone treatment.

Unfortunately, what IS visible is that addicts tend to line-up early for treatment, and/or hang around the community afterwards, due largely to the fact that they simply have nothing else to do.  This is not something that city officials, policy makers, or those who run methadone clinics can ignore.  It is more than just a little disconcerting to come out your front door and find a heroin addict sitting on your steps.  He or she is probably just sitting there, causing no particular trouble, but that hardly mitigates the issue.

There is no obvious or easy solution to the loitering problem, which is the genesis of community opposition to such programs.  Neither the police nor clinic managers can simply (and effectively) demand that patients get on the bus and leave.  But each has a proper role in addressing this issue:  Clinic managers must threaten (and institute) disciplinary measures, and the police must maintain a continuous presence.  At Turning Point, we try diligently to address these issues, but there is no perfect solution.  It is vital, nonetheless, that communities, as much as possible, learn to accept the presence of current and new methadone clinics.  Communities need to be educated, and often I think, as to the invisible benefits these programs surely produce.

Let’s remind ourselves once again of the clear and compelling benefits that two clinics, but especially the bad clinic, produces:  These patients show up for treatment PRECISELY when and because they would otherwise be robbing or burglarizing that day.  There are not very many of them who would choose instead to endure withdrawals.  It is imperative that sufficiently many clinics exist, and with convenient access and long hours of operation to accommodate these “bad” patients.  One could surely and better describe them as well-intentioned patients, because, although they are not interested in ceasing drug use, by seeking medication they are demonstrating that they do not want to victimize someone.  “Bad,” then, is hardly the best word to use, especially since their willingness to seek treatment instead of committing crimes is the community’s ONLY hope!

The key element in having treatment available “on demand” for these “bad” patients is streamlining the new intake process.  I suspect Turning Point gets these people in and out as fast as anyone else, and without an appointment, but it still takes hours.  Well, “hours” is an eternity to a suffering addict.  We tried three years ago to persuade an uninterested State of Maryland and Health Secretary to permit some such streamlining.  Their response was to the effect that if we did as we proposed, they would close the clinic!  (Sometimes, when people wonder why Baltimore is labeled the “Heroin Capital of the World,” I don’t know whether to laugh or cry, because the answer is simultaneously laughably obvious, and yet pitifully depressing.)  I am hoping that the housecleaning in Annapolis that the voters initiated in November might make possible a more receptive attitude on this matter when we raise it again with the State.

Conclusoin:  The community must begin to recognize the true benefits methadone clinics provide, warts and all.  Ending such ignorance must be part of the Substance Abuse Treatment Reformation, which I will ask Governor-elect Hogan to diligently pursue.

 

Tomorrow, I want to describe another “benefit” that the bad clinic offers, potentially at least.  It represents an opportunity to get these patients, not only into drug treatment, but into primary and urgent care as well.  I am going to guess that doing this, for Turning Point’s present patient population alone, can save Medicaid $20MM a year, by avoiding emergency room visits by our patients.  This strategy is something I call “Directed Care.” A better name might be “Street Smart Medicine.”

 

Rev. Milton E. Williams

President, Turning Point Clinic

Sr. Pastor, New Life Evangelical Baptist Church

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 reason would be provided by withholding welfare money for failed drug tests.  That concept will be explored in the seventh article in this series.

For now, let’s think about who are lifelong, inner-city drug addicts and their mentality toward treatment.

 

  1. Almost all of those in treatment, and who will remain so for any time sufficient for recovery, are over about 40 years of age. It simply takes that long for most addicts to get tired of their lives of addiction.  So, this is the age group that we will discuss here.
  2. These folks have typically known nothing but a life of drugs and getting high since they were maybe 10, 12 or 15 years old. Generally, most or all their family and friends are drug addicts, and they have no jobs or education or other interests or any realistic, near term prospects for such.  Recovery, obviously, requires a total transformation of every aspect of their lives.  This is a lot to expect from anyone!
  3. But, you wonder, don’t the addicts see and want the great benefits that are available to them if they give up heroin? Well, the answer is usually “no.” The same as me not giving up my knife and fork.
  4. Ok, can’t they make new friends and find other things to do? Not readily.  There are probably not many non-addicts who want former addicts as friends, and the list of worthwhile recreational or other pursuits (such as jobs) potentially open to former addicts in the inner city is not a long one.
  5. Don’t they at least want to live longer lives, avoiding the hassle and hazards of having continually to find money to buy heroin, injecting it, etc.? The answer here, as well, is usually “no.” Most lifelong addicts have every chronic, and life-threatening disease imaginable—HIV, Hepatitis C, cirrhosis, diabetes, heart disease, COPD, kidney disease.  The list goes on and on.  Statistically, heroin or not, they are not likely to live beyond their 50s.  And, after finding money to buy drugs and injecting heroin for perhaps 20 plus years, they’ve probably gotten pretty good at doing so.  Or at least so they think.

 

The point of all this is straightforward.  Although I am not suggesting, of course, that prospective methadone patients actually think the matter through in such an analytical way as I have described, it is unquestionable that the costs versus benefits perceived by the addict do not make the prospect of fighting the battle to cease drug use all that compelling.  And, if they have welfare money to pay for drugs, that makes the calculus of giving up drugs vastly less compelling still.  What other explanation could there be for the wholesale unwillingness of inner-city addicts not to want to cease drug use?  For heroin, at least, there is a cheap, fairly safe, drug that is a near-perfect substitute, which will eliminate withdrawal symptoms, cravings and even block the effect of heroin.  Among all drug addicts, heroin addicts, therefore, are the MOST treatable!  Or at least would be, if we had suitable policies in place.

To say this a better way, you can’t remove something so central to the life of an addict as that on which his or her whole life has been focused for decades and not replace it with something else.  That would be like taking away my knife and fork and not even giving me chopsticks!  Surprisingly, what the Alcoholics Anonymous folks taught us 80 years ago is just as true today with drug addicts.  Whether one is religiously-minded or not, even the most devout atheist, if he’s honest, can perhaps appreciate that a person having lived for decades a life of total self-absorption and drug use is going to have to learn to focus on something else.  And for us at Turning Point, that means the Church.  I try to be as ecumenical as anyone else in my thinking.  Our faith-based program is optional.  But, quite legitimately, for most lifelong inner-city heroin addicts, who probably have no family or anything else of substance in their lives (or the near term prospect for such), the one thing that might make recovery compelling is the Church.  New Life Evangelical Baptist Church, of which I am Sr. Pastor, has been described as the only church ever, anywhere, to truly open its doors to heroin addicts.

Conclusion:  The Church is an integral part of any realistic, inner-city approach to initiate and sustain recovery from drug addiction.

Yesterday, I argued that the bad clinic is of huge benefit to the community.  Tomorrow, I will explore that in more detail, and address why it is, then, that communities (quite understandably) are not exactly overjoyed when a new methadone clinic opens its doors.

 

Rev. Milton E. Williams

President, Turning Point Clinic

Sr. Pastor, New Life Evangelical Baptist Church

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 clinic, onsite mental health therapy, free food, and, perhaps most notably, an optional faith-based program.  We are actually the only faith-based methadone program in the world.  It is in the good clinic where the so-called “medical model” of treatment for addiction is most relevant.  Although the good clinic benefits the community by helping addicts become drug free, it is primarily oriented toward benefiting the individual patient.

The bad clinic is frequented by patients who simply do not have money to buy drugs on the particular day of his or her visit.  Of course, we hope that these patients will eventually end up in the good clinic, genuinely seeking recovery.  Although many do, most often that is not going to happen.  But that is not all bad.  In fact, it’s not bad at all.  Because, going without the medication that the bad clinic provides to these patients, they would be otherwise involved in domestic violence, due to withdrawals, robbing/burglarizing people, and often selling their children for sex.  For the $80 Medicaid pays for a week’s worth of methadone treatment, I think most anyone would agree that the bang for the 80 bucks is very good indeed!  Patients in the bad clinic are not usually very interested in other services that we make available.  In total contrast with the good clinic, the bad clinic exists overwhelmingly for the benefit of the COMMUNITY.

Although there is no disagreement on the good things the good clinic does for people, policy makers and regulators are loath to acknowledge the existence and benefit of the bad clinic.  They simply can’t comprehend that, overwhelmingly, most inner-city heroin addicts have no interest whatsoever in seeking recovery.  And, strangely, they simply cannot grasp the indisputable and obvious fact that medicating “bad” patients precisely when they do not have money to buy drugs is an unimpeachably “good” thing to do.  In their own way, these patients are trying to avoid committing drug-related crimes, whether policy makers want to accept that fact or not.

This is the key point I want to make in this series on addiction treatment:  Most of those in the good clinic might well have ceased drug use regardless of treatment.  Accordingly, that implies that the bad clinic is not only relevant, because some of those folks will find methadone worthwhile and end up in the good clinic, but that the bad clinic is actually of FAR greater real benefit to the addicts, their families and the community.  If policy makers would only accept this fact, then the population of addicts in treatment would explode.  Although no miracle in terms of expected recovery rates, this would still be a true miracle for the community and the taxpayer!

Now, the reason the bad clinic is held in such contempt by shortsighted policy makers and researchers is rather simple.  They have a white, suburban, idealist mentality, believing that more can be accomplished with lifelong, destitute, inner-city heroin addicts than is actually realistic.  With respect to white, suburban, middle class addicts, their views and policies might be quite correct.  Recovery is much more likely among such a clientele.  But we need policies and clinics to address the reality of inner-city addiction.  And that means we desperately need the bad clinic.

I am reminded of the famous quote attributed to Otto von Bismarck, who said “politics is the art of the possible.” We must learn that substance abuse treatment in the inner-city must be the art of the possible, and not simply some policymaker’s fantasy.  And, no matter what new drugs we develop to replace methadone (which, by the way, is as perfect a substitute for heroin as anyone could want); no matter what researchers find in terms of new approaches to counseling and therapy; no matter what additional services we provide; we will still be left with the immutable fact that most inner-city addicts do not have any interest in ceasing drug use.

 

Conclusion:  Substance abuse treatment must be the art of the possible.

 

Tomorrow, I will discuss why the inner-city addiction problem is so intractable.

 

Rev. Milton E. Williams

President, Turning Point Clinic

Sr. Pastor, New Life Evangelical Baptist Church

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 minimum number of addicts in Baltimore.

It is important to have an idea of the correct number so that we might understand how well the substance abuse treatment industry is doing in getting people into treatment.  We also need to know what the potential demand for treatment is so that more clinics can be built, if warranted.

We don’t really need to do nine months of research (of whatever sort that might be, I don’t know) to estimate the minimum number of heroin addicts in Baltimore.

Consider the following back-of-the-envelope estimate, if you will:

 

  1. Turning Point Clinic has taken in roughly 6,000 heroin addicts in the past 10 years. Yes, of course, new addicts are created every day, and old addicts die (and some recover), but the total number has probably remained roughly consistent.
  2. Overwhelmingly, Turning Point’s patients live within two miles of the Clinic; have Medicaid; and are over age 40.
  3. Let’s make some simple, but reasonable assumptions. Let’s say that half the City’s heroin addicts have Medicaid.  This would imply that, if all had insurance, then, instead of admitting 6,000 patients over the past 10 years, that number would have been 12,000.  We turn away prospective patients daily, because they do not have Medicaid.
  4. Now, let’s assume that no more than one of every two and a half of the City’s heroin addicts live within two miles of Turning Point. If all lived within that radius, i.e. if Turning Point were equally convenient for all of the City’s heroin addicts, then the 12,000 minimum estimate from above becomes 12,000 X 2.5 = 30,000 total heroin addicts in the City.
  5. Further, if half of the addicts are under age 40 (but probably MORE), and these folks were as likely to seek treatment as their older peers, then the 30,000 estimate becomes 60,000.

 

We now have what seems like a very rough, but reasonable, MINIMUM estimate.  Note that the analysis above ignores altogether the fact that some heroin addicts with the demographics of our patients as just described have NOT sought treatment at Turning Point.  If they had, instead of implying 60,000 total heroin addicts in Baltimore City, that estimate would be much higher.  Also, all patients with the demographics mentioned who sought treatment did NOT necessarily seek it at Turning Point.  We are but one of two dozen methadone clinics in the City.  This, too, implies a far higher estimate than 60,000 addicts.

True, Turning Point does not have the capacity to have taken in, say 60,000 addicts instead of “only” 6,000.  But that is hardly relevant for the purpose of making this estimate.

So, lo and behold, the 60,000 estimate, which was reported in this summer’s National Geographic special called “Drugs, Inc.; The High Wire,” appears altogether reasonable, but it is still only the MINIMUM.

Now we have a basis from which to begin understanding the effectiveness, or lack thereof, of current substance abuse treatment policies and clinics in Baltimore.  Although we cannot here consider all jurisdictions and clinics, the point is clearly applicable elsewhere.

Conclusion:  Do not count on “official” estimates of the problem. (Recounting the lifeboats on the Titanic would not have addressed the issue at hand!)  It’s high time we move forward with the Substance Abuse Treatment Reformation.

Tomorrow, I would like to talk about treatment effectiveness, and the fact that any methadone clinic is really two clinics:  One for those genuinely interested in ceasing drug use, and the other for those who only ran out of welfare (or other) money with which to buy drugs.

Rev. Milton E. Williams

President, Turning Point Clinic

Sr. Pastor, New Life Evangelical Baptist Church

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 in January.  Who knows?  Someone down there finally might start listening with an open mind.  And maybe we can make and implement changes in Maryland that make real sense—for the community and the taxpayer!

Over the next seven days I want to begin a real discussion, challenging every aspect of present drug treatment policies and practices in Maryland and America. I hope you will accompany me on this journey to substance abuse reality.

Let’s start by looking at the numbers.  The next article in this series will demonstrate that the Mayor of Baltimore’s recent estimate of 19,000 heroin “users” is utterly defenseless.  For now, let’s use the 60,000 number frequently accepted by disinterested persons when the subject of Baltimore’s heroin problem comes up in the national media, as it has recently in a National Geographic Special.

Now, let’s say there are 6,000 heroin addicts presently in treatment in Baltimore. That is only one out of every ten heroin addicts.  Turning Point, now arguably the largest drug abuse treatment center in the world, has the most widely “open door” policy for new patients among the City’s methadone clinics.  (Methadone is the drug of choice for the treatment of heroin addiction.)  We take in new patients on a walk-in basis almost 12 hours a day, six days a week.  No appointment needed.  Just show up.  We even give new patients twenty dollars to enter the program, which covers bus fare both ways and lunch at McDonald’s.

But the City’s remaining 54,000 addicts not in treatment are not exactly breaking down our doors.  We receive about five new patients each day.  Why so few?  The answer is obvious:  THEY DON’T WANT TO CEASE USING HEROIN.

Overwhelmingly, they show up for admission to the program around the end of the month, because they have no more welfare money left with which to buy drugs.

Now, what about the patients who are in an inner-city methadone program?  Studies show that 15 to 20 percent of the 10 percent (assumed above) who are in treatment will become drug free one day.  Which is to say that only one and a half to two percent of the total heroin addicts in the City will ever become drug free.  That is a 98 to 98.5 percent failure rate!  But wait!  As the TV pitchmen say.  There’s more (less, actually).

On any given day, hundreds of thousands of addicted people worldwide give up using forever that substance to which, yesterday, they were addicted.  And the VAST majority of them do so OUTSIDE of a “program.” So, what, then, is the actual success rate honestly attributable to a patient’s participation in a methadone program?  It would appear to be negligible.

The message is clear. 

Conclusion:  Do not expect miracle recovery rates from substance abuse treatment.  What we need is a Substance Abuse Treatment Reformation in our thinking, practices and goals.

Tomorrow, I will examine how many heroin addicts Baltimore City really has.  It’s actually quite important to know, at least roughly, what the true number is.  And, we must not leave that up to the imagination of people who, for political reasons, can’t (or just won’t) see the proverbial elephant in the room.  In Baltimore, and elsewhere, we can be certain that politicians have deliberately underestimated the problem, and overestimated the supposed successes of their favorite treatment policies.

 

Rev. Milton E. Williams

President, Turning Point Clinic

Sr. Pastor, New Life Evangelical Baptist Church

Hogan to declare state of emergency on heroin addiction 12/14

https://www.abc2news.com/news/state/hogan-to-declare-state-of-emergency-on-heroin-addiction

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 problem.

CBS Baltimore – Hogan Declare State Of Emergency


Md. pharmacies to stock heroin antidote 12/14

https://www.baltimoresun.com/business/bs-bz-naloxone-20141209-story.html

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 now.”