Hospitals can help solve drug problem

May 05, 2000|By Dan Morhaim

The 100,000 addicts in Baltimore City and surrounding counties cost us in many ways.

Addicts are responsible for 80 percent of our region's crime. Their injuries -- inflicted on themselves and their victims -- drive up health care costs, jam the courts and criminal justice system and disrupt the lives of their families and our communities. Estimates of the cost of their criminal behavior alone exceed $2.3 billion a year.

Yet it has been proved that addiction treatment programs are effective in promptly reducing these fiscal and social costs. What will it take to get the job done? Can local hospitals help?

First, we must acknowledge that addiction treatment is often not a cure, just as treatments for cancer or asthma may not result in a cure. A 28-year habit will not be solved in a 28-day drug program. For treatment to work, we need a community commitment to tackle this problem head-on, with compassion but without illusions that it will be easy or quick. And as we pursue treatment, we should intensify our efforts at interdiction and prevention education.

Second, we need a substantial and sustained funding mechanism. Addiction treatment costs money, and counselors are woefully underpaid. Because each dollar spent on addiction treatment saves $7 in taxpayers' costs, this expenditure is a sound investment and deserves protection from political whims and economic fluctuations.

If one-third of the total number of addicts in the Baltimore area enter programs, about $200 million a year will be needed. And we can anticipate spending this annually for at least a decade. Several funding plans have been proposed. One suggestion is an across-the-board fee on all insurance carriers; another is an independent funding mechanism similar to that used for Maryland Shock Trauma Center. But whatever method is used, it must be sufficient and ongoing.

Third, such a vast expenditure demands tight fiscal accountability. Different types of programs work for different addicts. Some respond to methadone, others need a faith-based approach; some need in-patient care, some out-patient; some need job skills and others child care. Whatever programs we fund must be held accountable and must have results. Studies have shown that the key element for success is treatment on demand. The addict must be able to immediately enter a program when the opportunity -- whether voluntary or coerced -- presents itself.

Lastly, we need to use one resource that has been overlooked in our treatment approach: our community hospitals. These hospitals already take care of every problem an addict might have except the addiction itself.

Community hospitals could provide treatment on demand. They are open 24 hours a day, are secure, safe -- often with a police presence -- and are near public transportation. They have the range of personnel -- from physicians and nurses to social workers -- to deal with the myriad physical and mental challenges addicts present.

Fiscal systems of accountability are already in place at hospitals, as are regulatory systems and quality-of-care review. Most hospitals have space available, and putting addiction programs there would avoid the "not-in-my-backyard" problems often faced by new drug treatment centers.

So why don't hospitals already treat addiction?

Very simply, because they are not reimbursed to do so, regardless of whether the patient is insured. Therefore, let's add these hospitals to the addiction care system and have them work in concert with the other programs and community efforts that are available.

We've been paying the price of drug addiction for a long time: in wasted lives, shattered families, the spread of AIDS and other diseases and the constant impact of crime and violence on our streets.

It's time to get serious and step up to the plate with the required money and commitment to reduce the crisis that addiction in Maryland causes. Let's spell out the costs and demand results. We know how to get the job done. The only question is whether we have the will to do so.

Del. Dan Morhaim is an emergency physician at Sinai and University Hospitals and has represented the 11th District in the Maryland House of Delegates.

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