Baltimore pastor to open on-demand methadone clinic
By Meredith Cohn, The Baltimore Sun
Tired of the heroin and crime surrounding his Northeast Baltimore church and treatment center, the Rev. Milton Williams said Thursday that he plans to open the city’s first “open access” clinic, which will hand out methadone within 15 minutes to any addict who walks through the door.
Williams said defiantly that he will open the doors of his Turning Point clinic on North Avenue on July 5 to possibly 100-150 addicts a night — though he still lacks approval from state and federal regulators.
“The waiting game is over,” Williams said in announcing the program in front of a crowd that included city police officers and representatives of city and federal lawmakers. “It means one less desperate criminal will be walking our streets at night.”
Williams acknowledged that this is not a traditional treatment program, like the one he runs during the day. A shortage of openings in programs statewide can mean delays of days to months, and this is an interim measure aiming to give addicts a fix and a line to treatment.
But state officials say he hasn’t received permission from the Department of Health and Mental Hygiene to bypass federal regulations that require a physician’s and counselor’s evaluation, drug testing and a treatment plan before a dose of methadone is prescribed.
Williams has only made a proposal to the state medical director, said Thomas Cargiulo, director of the Maryland Alcohol and Drug Abuse Administration, which oversees clinics in the state. He said Williams needs a variance and has not applied for one. Further, 15 minutes may not be sufficient to properly evaluate an addict.
Cargiulo did say Williams’ idea was appealing, and he agreed that the federal red tape is a barrier to treatment that ought to be cut. “But from what I know now, it sounds like what he wants to do is outside of what the regulations allow,” he said. “You can’t have someone walk off the street and get a Schedule 2 narcotic.”
He also said Williams’ clinic currently can’t take any more patients into its traditional treatment program because he lacked the proper number of counselors per clients, among other issues. Williams said the problems are resolved, and Cargiulo said he would have the clinic re-inspected soon. That could mean a boost of traditional slots from more than 600 to 1,000 at Turning Point.
Cargiulo said the state has been ramping up treatment slots across the state even though funding has been cut over the years. The budget for substance abuse prevention and treatment for fiscal 2012 is nearly $156 million, mostly from federal and state sources.
Though there were not even 15,000 state-funded slots available, more than 50,000 individuals received treatment in fiscal 2010 — though Cargiulo said tens of thousands more need help. Lack of available slots has long been cited as a problem, particularly in Baltimore.
Williams charged that state and city officials just don’t want to see his faith-based treatment program take the lead on a new way of treating addicts.
“We intend to do this with or without the blessing of our mayor, our governor or our elected officials in Annapolis,” he said.
Representatives of the mayor and governor didn’t respond to requests for comment.
Williams said he wasn’t concerned with offending elected officials. This is personal.
Though he lives in Owings Mills, his daughter found her way into the city’s drug scene, he said. Lisa Renee Brown was shot in the head and killed in 2002 in the Park Heights area in what Williams said was part of a drug deal gone bad. She was sitting in a car owned by former heavyweight boxing champion Hasim Rahman with one of the boxer’s employees, though the boxer was not implicated in a crime. She left behind three children.
Baltimore police officers at Williams’ press event said they support the program because locking up addicts hasn’t solved the drug problem.
Detective Donny Moses, now a spokesman for the department, said he spent five years in the narcotics division and during that time “had a change of heart” about arresting addicts.
“I must have arrested a million and one people addicted to heroin, and I thought there had to be a better way,” he said. “I was thinking this was someone’s daughter or son and someone was praying for you. … The Police Department is no longer interested in locking up all the addicts.”
Lt. Col. Ross Buzzuro from the police commissioner’s office, added, “We can’t arrest ourselves out of this problem. We’re seeking those wreaking the most havoc on the city. Our mission has changed somewhat.”
And while some addicts at the event said they had committed their share of crimes, they were just trying to get high.
Romaine Vance said she grew up in the suburbs and got a college degree before succumbing to drugs. She said she stayed on heroin for 20 years before getting into treatment at Turning Point and becoming a regular five years ago at Williams’ New Life Evangelical Baptist Church, which houses the clinic.
She said nighttime is the worst for addicts because there’s nothing around but cravings. If someone had offered her methadone on any given night, she would have taken it. The alternative was stealing or prostituting. And prison.
“As addicts, we don’t want to be sick,” she said. “If you could get us meds, we’d open our ears. The whole focus is getting meds.”
She believes many addicts would seek a traditional treatment program if they’d had methadone once.
Dr. Hendree Jones, an adjunct professor at Johns Hopkins and an addictions specialist, said that may be true. She wasn’t familiar with the Turning Point program but said a 2006 study by other Hopkins researchers found that in Baltimore those who got interim methadone treatment were more likely to end up in traditional treatment than those put on a waiting list.
Those participants, however, were given up to 120 days of methadone and emergency counseling. They also took longer than 15 minutes to get started, Jones said. That time may not be sufficient to properly assess if someone is an addict through a urine test and observance of track marks and mild to moderate withdrawal symptoms.
She estimated that two to three hours would be needed, and then three weeks to years for treatment.
A non-addict who slips in to the program could begin seeking drugs or could overdose, she said. Addicts would have to be monitored the first time they take methadone to ensure they don’t become too heavily sedated or their heart rate is not too depressed, and the craving is actually suppressed. They also can’t be high at the time, or they could overdose.
And under law, only those addicts who test negative for a certain length of time for opioids — including heroin, morphine, codeine, oxycodone — can leave a clinic with a dose in hand.
Still, Jones said she supports efforts to expand treatment with methadone. It can have a huge impact in terms of quality of life and reducing crime when ancillary services also are offered including drug, employment and HIV counseling.
“Methadone lasts in a person’s body for 24 hours, so it might prevent someone from going out and shooting up heroin, which would be a good thing. But one time is not treatment,” she said. “We do need more treatment. People are desperate for treatment. There are waiting lists.”
That’s the problem, Williams says.
He said his walk-ins would get instant approval for five days of methadone from a state-approved medical care organization, Maryland Physicians Care, which would bill Medicaid. A representative of Maryland Physicians Care reiterated support for the program at the press event Thursday. Other insurers could not be reached or said they’d not yet heard about the program.
Williams could not estimate the cost to Medicaid, the federal-state program for the poor, though he said a week’s worth of methadone costs $90-$150.
“Poor people can’t afford that,” he said. “And they can’t wait.”