Friday, October 28, 2016

In Preparation for the 2017 Legislative Session:

Hospitals Can Help Solve Drug Problem
 Editorial from The Baltimore Sun      Originally published on May 5 2000

By Dan Morhaim

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. 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.

Tuesday, October 4, 2016

On Behalf of the 129 Who Died Today --A Thought for Avery Road

Today I testified at the Montgomery County Hearing in opposition to the 30 year lease with Avery Road Treatment Center.  I was the only one.  

Two others testified in favor --a parent testified, as well as a peer in recovery.  Avery Road had brought a van of peers holding signs about how ARTC had saved their lives. Following the testimonies of those in favor, the Avery Road crowd clapped and cheered.  

The testimony from the peer in recovery told his story about recovering at Avery Road after being a given a 2nd chance in lieu of jail --he was recently married with his first child and a good job.  Inspirational.  Compelling.  If he could do it --then those who went back out and used and died, made a poor choice.  Avery Road cannot be held responsible.  George Leventhal and other Council members smiled and nodded.  

Afterward, I spoke with a girl outside.  I thought about a young man whose girlfriend had called me just yesterday --who had been on the waiting list for two weeks, but had missed calling at 11:00 for just one day and had been bounced to the back of the waiting list.  I asked the girl about him.  She said that Avery Road only lets in "those who really want it --who are really serious."  She should know, she says --she has been to ARTC nine times.  "If you are really serious --you will not miss an 11:00 call."  

I looked at all the hopeful freshly recovered faces around me, signs in support of ARTC under their arms.  I asked them about the success rate of Avery Road.  "Only 10%" offered one.  When I pointed out that those who get into a halfway house and stay for 3 months have a success rate of 30% to 50%, and asked him why Avery Road discharges to homeless shelters instead of halfway houses, he told me that "people who really work at finding halfway houses get help".

These were the strong swimmers.  The ones who had made it through the myriad of barriers and swam the gauntlet.  The ones to be cheered and patted.  The ones to receive the prize of recovery.  

I spoke today for the weaker swimmers.  The ones to be shunned and forgotten by their peers because they were not strong enough swimmers to make it.  The one who was passed out at 11:00.  The one that was too depressed to try again.  The one who was lost to the streets of Baltimore --all family contacts severed and bridges burned.  The one who shoots dope to stop the voices in their head --the voices they are too scared to talk about.  The one who can't go back to rehab for the ninth time and instead buys a gun.  

I spoke for the 129 across our nation who died today.  The weak ones.  

The ones that might have survived had Avery Road simply called them.  The ones that might have survived had they been discharged to a halfway house, rather than a homeless shelter.  The ones that might have survived had they received family counseling.  The ones who might have survived had they not been kicked out prematurely.  The ones who might have survived had their mental health issues been addressed.  The ones who might have survived had they not been too disorganized, or too immature, or too depressed, or too sick, or too confused, or too battered, or too hopeless.  

I spoke for them today and I was alone.