MORE HELP IS ON THE WAY FOR DRUG ADDICTS IN D.C.

On a gray Palm Sunday, not long after dawn, the morning ritual inside
the government building on First Street in Northeast Washington
resembles a form of communion.

Men and women in work clothes, church clothes and just regular clothes
step up to a bulletproof window. They call out a five-digit number and
flash a photo ID. A nurse spins a turntable and serves up a paper cup
of deliverance.

This is the D.C. methadone clinic where Melvin Martin goes every day
for the synthetic narcotic that helps keep his 25-year heroin habit at
bay. Without it, says Martin, 50, "I'd probably be running wild."

Today, there are 1,062 D.C. addicts on a waiting list for methadone
treatment. Scores more are lined up for slots in residential drug
treatment. Neither number includes addicts who don't bother to
register when they hear of the long wait.

After years of tolerating deep inadequacies in treatment, however, the
District plans to overhaul the way it serves the city's estimated
65,000 substance abusers. Mayor Anthony A. Williams will testify today
about his health policy before the D.C. Council. His goal is a
dramatic increase in access to treatment and, in the process, an
improvement in the quality and variety of programs.

If all goes well, more than 100,000 low-income D.C. residents will
become eligible in October for substance abuse treatment under
Medicaid. Three inpatient programs now run by the city will be
contracted out to private companies as part of a shift in the
government's role.

The new city hall theory holds that, as the treatment network grows,
the city will be able to reduce its direct part in treating addicts.
While continuing to operate certain programs, the District's drug and
alcohol agency would shift its focus to regulation, planning and the
crucial role of monitoring private programs.

"It doesn't change overnight. There is a whole host of deficiencies,"
one of the mayor's policy advisers said. In the beginning, he said,
there may not be enough programs, but "the goal is to make the money
available so the private sector will respond and build the capacity."

Addiction policy specialists caution that such changes are not only
ambitious but fraught with complexity. While welcoming the city's
fresh energy, these experts said the city must design a plan flexible
enough to meet the unpredictable needs and quirks of addicts and also
rigorous enough to ensure quality services.

"Today, someone with a building and a certificate of occupancy could
offer what we call 'three hots and a cot' and call it residential
treatment. No license, no standards, no oversight," Gale Saler, deputy
executive director of Second Genesis Inc., a Bethesda-based treatment
provider, told a D.C. Council committee last week.

Linda Plitt Donaldson, advocacy director of So Others Might Eat, spoke
of her "grave concerns" about the mayor's proposal to rely more on
health maintenance organizations, which would provide treatment for
Medicaid patients. She said many primary-care doctors in HMOs, who
would be responsible for deciding whether patients need treatment,
have limited experience in the field.

"I am skeptical that the managed-care model could provide a quick
response to addiction needs," said Donaldson, whose organization runs
20 social programs in the District.

Recognizing Challenges

D.C. officials say they recognize the challenges and are at work
designing strategies and safeguards alike.

"One of the things we have ahead of us is to write standards for these
services," said Paul Offner, the D.C. Medicaid director. "We can't
just simply open the door and not control this at all."

For years, according to outside critics and government workers, the
District has fallen short on drug treatment. In a city that is home,
by its own count, to 65,000 substance abusers, the treatment budget
dropped from $31.3 million to $19.7 million from fiscal 1993 to fiscal
1998. That meant a loss of 2,000 treatment slots for addicts.

Last year, fewer than 9 percent of D.C. substance abusers received
treatment, said Deidra Y. Roach, administrator of the city's Addiction
Prevention and Recovery Administration. In remarks to the D.C. Council
last week, she said budget cuts have had a "devastating impact."

The list of D.C. addicts awaiting a spot in a methadone program stands
at 1,062, with 98 others seeking a slot in a residential treatment
program. Yet even these numbers do not tell the entire story.

An additional 27 D.C. parolees and 47 men and women on probation are
waiting for residential treatment, according to the federal agency
that oversees District criminal offenders. Because of the lack of
space in D.C. programs -- which sometimes caused paroled prisoners to
remain behind bars for months while waiting for treatment -- the
agency is spending $1.2 million for drug and alcohol treatment services.

Cutting Treatment

"For several years, we cut, we cut, we cut," D.C. Council member Jim
Graham (D-Ward 1) said at last week's council session. "Fifty percent
of these cuts came directly out of treatment services
themselves."

Local spending on treatment grew $3.1 million to $22.8 million in the
current budget year. The city's delivery of services has long been
plagued by procurement snarls, high turnover and poor coordination. It
took nearly two years after bids were sought for the project, for
example, for the city to open 77 much-needed residential treatment
beds this month.

The ripple effects of substance abuse stretch from hospital emergency
rooms and maternity wards to holding cells at D.C. Superior Court and
prison cells at the Lorton Correctional Complex.

An estimated 80 percent to 85 percent of the birth parents of the
District's 3,253 foster children are substance abusers, reports the
Child and Family Services Agency. In the past 22 months, 61 babies
have been abandoned in D.C. hospitals, the great majority by
drug-using mothers.

Forty-nine percent of 1,084 adults arrested and screened for drugs in
the District in February tested positive for cocaine, opiates or PCP.
Among juveniles, 65 percent had drugs in their system, primarily
marijuana, including one 10-year-old and five 13-year-olds.

"We pay a huge price for addiction. People are going to support their
habits, no matter what," said D.C. Police Chief Charles H. Ramsey, who
spent 9 1/2 years on the Chicago narcotics squad. "There are just not
enough beds sometimes to keep pace with addicts and people who need
treatment."

Ramsey participated in drug stings in Chicago in which newly arrested
users were introduced to counselors and offered immediate treatment --
without a promise that the charge would be dropped.

"It worked well," he said. "Maybe out of 50, you got eight who
accepted. Maybe that's eight fewer people you've got to lock up the
next time. To me, it's chipping away at the problem. Chip away, chip
away, chip away.

"A person can come to you today and say they want treatment, but if
you tell them they have to wait six months, forget about it," Ramsey
said. "You've got to get them right at that moment. If you don't,
you're going to lose them."

A recent University of Maryland study of 1,216 lawbreakers in the
Washington-Baltimore area appears to support Ramsey's argument. The
research, sponsored by a grant from the federal Office of National
Drug Control Policy, shows that a system that includes extended
treatment, drug testing and sanctions can reduce crime.

The average drug user in the study was unemployed and 34 years old.
Three in four were men. Two in five used drugs at least every day. On
average, they had 10 arrests and five convictions. After using prior
records to estimate the likelihood of each person's arrest in the
absence of treatment, researchers studied arrest patterns six months
after treatment and found a 50 percent decline.

Through the program that did the study, the District receives $1.3
million in federal funds for treatment. Advocates, who say the money
fills gaps in the city's treatment spectrum, are worried that the
funds will evaporate this year. Joseph Peters, an official with the
Office of National Drug Control Policy, said that the choice lies with
National Drug Policy Director Barry McCaffrey and that no decision has
been made.

Supply and Demand

Treatment proponents believe that to improve results in the District,
the substance abuse network must be expanded and access to quality
long-term residential care must be significantly improved. Money and
slots remain scarce, but the mayor's lieutenants believe that supply
will grow to meet the need.

"There's obviously a somewhat limited array of providers now," said
Offner, the D.C. Medicaid director. "But by putting these HMOs in a
situation where they're going to go out and look for these services,
you'll find private providers springing up to meet that demand."

The mayor's proposed 2000 budget for the Addiction Prevention and
Recovery Administration will be smaller than this year's, as $4.1
million is shifted to help pay for the Medicaid expansion. But because
a larger number of addicts will be able to obtain Medicaid-funded
treatment, more APRA money will be available for residential treatment
beds, the mayor's office predicts.

At the D.C. methadone clinic at 1300 First St. NE, James O'Brien is
describing how his life has changed since he entered treatment. After
using heroin and cocaine on and off for 30 years, he is down to one
dose of methadone and a few rounds of APRA counseling sessions each
week.

"It brings your sanity back. It makes you feel you want to do more for
yourself," O'Brien, 50, said. "We need more services, for more people
to get in."