AN EDITORIAL: HOW THE SAFETY NET FAILS ADDICTS AND CITY

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

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 81percent 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 handpicked 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 30member 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.

The BSAS board is revising the organization's governance and operation. But
the board, following an outside consultant's advice, is in danger of making
matters worse. The consultant has recommended that the overly large board
be expanded to 36 members to add representatives from such agencies as the
United Way and the school system. Though this suggestion is tempered with a
structure of working committees, it is a misguided idea.

Should BSAS be abolished? We think not. If run properly, it could
outdistance any city government agency in efficiency and freedom to
experiment. BSAS, though, is not maximizing that potential.

Recommendations

The following steps should be taken:

At its July 8 meeting, the BSAS board should reject the ill advised
reorganization proposal. A more workable alternative would be a smaller
executive board of 10 to 12 members, supplemented by an advisory board. A
compact governing body would make BSAS's success more likely.

The effectiveness of all BSAS programs should be evaluated.

The BSAS board must move quickly to establish uniform standards for
contractors, including requirements for regular drug testing.

To reduce the possibility of conflicts of interest, no representatives of
groups that receive BSAS funding should be on the board.

A central intake system must be established. The absence of one has made it
difficult to track patients and compile reliable information about waiting
times for treatment. It also complicates shifting patients from one program
to another, leading to patients dropping out and relapsing.

BSAS is a creation of Mayor Schmoke and Dr. Beilenson; the next mayor could
alter the way Baltimore manages its treatment slots. With the city
projected to face large budget deficits, the direction of Baltimore's drug
treatment plan should be a major issue in this year's mayoral campaign. All
candidates should address it in detail.

Unless the drug scourge is curbed, Baltimore has little hope of permanently
decreasing gun violence and the high number of homicides, which are serious
deterrents to the city's well being and economic growth.