CITY SUCCESSES ON DRUG TREATMENT ARE OVERLOOKED

ALTHOUGH The Sun's two-part editorial on drug treatment earlier this week
was fraught with errors and serious misrepresentations, I was pleased to
see two of the conclusions: Baltimore is on the right track in its efforts
to get treatment to all who need it, and the organization created to
oversee the publicly funded treatment system, Baltimore Substance Abuse
Systems Inc. (BSAS), should remain.

No doubt, Baltimore has a serious substance abuse problem. Mayor Kurt L.
Schmoke and I realize that we cannot arrest our way out of the drug
problem. Although about 85 percent of all crimes committed in the city are
drug-related, the vast majority are nonviolent offenses commited by
individuals needing money to feed their habits. Continuing to stick these
addicted individuals in prison without addressing their underlying health
problems before they get into serious trouble makes no sense. Thus, we have
long supported a philosophy of "medicalizing" the drug problem, which
consists of three prongs:

- - Implementing a system of treatment on request, which we define as intake
into a treatment program within 24 hours of request by an addict.

- - Redirecting current resources from agencies whose work is seriously
impacted by substance abuse to increase funding for treatment and prevention.

- - Initiating harm reduction programs, such as our very successful needle
exchange program, to curb damage caused by individuals who can't or won't
stop using at this time, to themselves, their partners, their babies and
society.

Leading Role Downplayed

Although it was only given one sentence in the two editorials, Baltimore is
leading the country in its approach to drug addiction. At a time when many
other cities have cut treatment dollars, Mayor Schmoke and his
administration have more than doubled treatment dollars in each of the past
two years. Only San Francisco has made a similar effort. And Baltimore has
achieved this increase, from $16 million to $33 million, almost solely with
redirected city funds and funds from local foundations.

Because of the mayor's initiative, although we are not yet at "treatment on
request," we have made tremendous strides. Two years ago, Baltimore only
had 4,100 treatment slots which treated approximately 11,330 uninsured
substance abusers. This year, with the infusion of redirected dollars from
the city housing, social service, police and health departments, along with
grants from the Open Society Institute, the Abell Foundation and the
Weinberg Foundation, we have 8,100 treatment slots for between 22,000 and
24,000 uninsured individuals.

As the editorials noted, we estimate that we need an additional $30 million
to $35 million to achieve our goal of true treatment on request. We will
continue to work hard to increase the amount of resources available to
provide treatment to all Baltimoreans in need of it.

Accentuate The Negative

It is interesting to note how little attention was paid to the uniqueness
of the entity we have created to manage and oversee Baltimore's treatment
system. The Sun often criticizes the city for lacking creativity, yet here
is an excellent example of governmental innovation that gets little credit.
Instead of being stuck in bureaucracy, with slow movement of resources and
personnel, the mayor and I thought that by using a quasi-public corporation
to manage the treatment system, we would be able to respond much more
quickly to the needs of Baltimore's addicted citizens.

In fact, that's what has happened for the past few years. Strong programs,
which show good results, have been able to receive increased funding much
more quickly through BSAS compared with the city system. Just as important,
programs which have not performed appropriately have quickly lost funding.

The editorials have three main criticisms of BSAS and the treatment system
it oversees:

The BSAS board structure.

The need for a central intake system.

The need to establish better performance standards.

I find it ironic that The Sun, which so favors inclusivity, criticizes
BSAS's so-called "hand-picked" board. The members of the board were chosen
to be broadly representative of the community and city and state
decision-makers.

This means the board is large, with approximately 30 members. To cut the
board by more than half would necessitate removing important voices from
the decision-making process, making cooperation between criminal justice
and health officials less likely.

On Central Intake

The question of a central intake for the city is controversial. Many feel
that a central intake site for addicts creates a larger access problem than
currently exists. Why? Because addicts will have to get to one central site
or a few sites, often quite distant from their neighborhood. It makes much
more sense to continue to increase treatment availability throughout the
current system of 39 neighborhood-based programs.

Regarding the need for improved performance standards across all the
programs, The Sun has a point.

That's not to say Baltimore's programs don't have performance standards.
They do. In fact, our programs operate with basically the same performance
standards as programs throughout the state and the country.

Finally, let me address what The Sun terms the "rift" between city and
state on the drug issue and how it could cost the city needed drug
treatment dollars.

There is no evidence to suggest that a perceived "feud" is hampering our
efforts to increase treatment funding in Baltimore.

On the contrary, our efforts to increase neighborhood-based treatment using
city resources complement the lieutenant governor's efforts to increase
state resources for several corrections-based treatment programs, both in
Baltimore and around the state.

But, more important, The Sun is simply wrong in trying to characterize our
round-table discussions on substance abuse treatment as a "feud."

Are there differences over what proportion of the drug treatment pie
different folks feel should be spent on voluntary vs. coerced treatment? Of
course.

The truly remarkable thing about our situation in Baltimore is that, unlike
almost any other city, the vast majority of law enforcement officials,
health officials, the community and elected officials agree that rather
than continuing to build more prisons and lock up more individuals for
nonviolent drug-related crimes, it is more productive and cost-effective to
try to create a system that provides the appropriate treatment for all who
need it.

Peter L. Beilenson is Baltimore health commissioner.