Pubdate: Thu, 23 Jun 2011
Source: Baltimore Sun (MD)
Copyright: 2011 The Baltimore Sun Company
Author: Meredith Cohn, The Baltimore Sun


Center Plans to Give Addicts a Dose Within 15 Minutes

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

"Poor people can't afford that," he said. "And they can't wait."
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MAP posted-by: Richard R Smith Jr.