How the safety net fails addicts - and city

Drugs, crime: Linked ills fester as Baltimore spends millions on inefficient treatment.

June 28, 1999

THE SCHMOKE administration's goal remains to provide drug treatment for all Baltimoreans who want it. To do so would require the city to add at least 4,000 taxpayer-paid treatment slots to the existing 8,000. Estimated price tag: $35 million -- in addition to the $33 million currently being spent.

Officials say the cost is high because Baltimore would have to add expensive new treatment methods, including residential centers. That may be a bargain, though, considering the scope of the city's drug curse and the awesome cost of incarceration. One of eight adults is addicted, and drugs were a factor in more than 75 percent of the city's 314 homicides last year.

Yet the money is well spent only if the city's treatment programs produce results. Currently, there is no way to tell.

The city's quasi-governmental treatment management organization, Baltimore Substance Abuse Systems Inc., is unable to show the effectiveness of voluntary treatment, the philosophy favored by Mayor Kurt L. Schmoke.

This has given plenty of ammunition to critics, including Lt. Gov. Kathleen Kennedy Townsend. They cite statistics that show the completion rates in the city's voluntary treatment programs are often the worst in the state. Meanwhile, they point to the success of targeting criminal offenders for treatment. They say that approach, used in a new probation program, has resulted in an 81-percent drop in positive drug tests in three months.

BSAS is unusual in that most big cities let their health departments run treatment programs. Here, Mayor Schmoke and Health Commissioner Peter Beilenson created BSAS to oversee separate contractors' programs, chiefly because as a nonprofit agency, BSAS can solicit charitable donations and foundation funding.

Despite their independence, the health department and BSAS are intertwined. Dr. Beilenson is BSAS's board chairman and has hand-picked all the board members; BSAS President Andrea Evans, a treatment professional with a master's degree in social work, has the equivalent rank of an assistant health commissioner.

Since 1995, BSAS has managed treatment programs that serve mainly addicts who have no health insurance or insufficient coverage; insured addicts tend to rely on private treatment programs. Its clients are overwhelmingly poor; 72 percent are unemployed; 79 percent are between the ages of 26 and 50; 50 percent are black males; 33 percent white men; 10 percent are black women; 7 percent white women. Most have multiple addictions: 65 percent heroin; 56 percent crack or powdered cocaine; 40 percent alcohol and 25 percent marijuana or hashish.

Not all BSAS clients are city residents, though. More Baltimore countians are treated for heroin addiction in the city than in the county because the county has only one methadone program.

Over the years, BSAS has come under sharp criticism from outside evaluators. Little has been done, however, to improve performance monitoring of the various groups that provide treatment. One reason is that BSAS has been too busy expanding programs since Mr. Schmoke doubled the drug treatment budget in 1996 by redirecting funds from other city agencies.

The result is a system under which BSAS's 44 treatment contractors run their programs largely as they choose. No uniform admission and performance criteria exist. Even drug testing, a crucial measurement of success, is left to the contractors to administer at their discretion.

The lack of central intake forces addicts to search among various programs for treatment. That can be a daunting and futile exercise; most programs have long waiting lists.

The contractors' freedom has led to occasional cherry picking, with providers opting to enroll "easy" clients and rejecting addicts whose behavior is disruptive. And because many providers are paid in advance by the city, they have little incentive to make sure slots are occupied by addicts likely to continue treatment.

Dr. Beilenson acknowledges the problem, saying more performance monitoring is needed.

Many of BSAS's failings are traceable to its board, a 30-member behemoth that includes heads of city and state agencies -- including Lieutenant Governor Townsend; representatives of medical institutions, foundations, businesses, treatment providers, and recovering addicts. Those board members display varying degrees of understanding of complex treatment issues. Their commitment also varies. At two consecutive monthly meetings this winter, board minutes could not be approved because of the lack of a quorum.

In the absence of clear board policies, most BSAS practices and priorities are set by its staff.

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