Conference Highlights Drug Treatment Successes (web article)

A decade ago Baltimore was a city nearly crippled by drugs. Now it’s being held up by public health experts as a model in attacking urban drug woes.

Baltimore City Health Commissioner, Joshua Sharfstein, MD, who spoke at a drug treatment conference at the Johns Hopkins Bloomberg School of Public Health, credits substantial private and public investment in substance abuse treatment and innovative treatment programs with helping to reduce Baltimore’s drug overdose deaths by 33 percent. Fatalities decreased from a peak of 328 in 1999 to 218 deaths last year, the lowest number of drug deaths in a decade.  

In 1997 financier George Soros’ Open Society Institute gave the city $25 million to expand drug treatment in Baltimore. The cash infusion, along with elected officials who made drug treatment a priority and strong support from advocacy groups, led to significant increases in public funding for treatment programs. 

In the past ten years Baltimore’s drug treatment budget more than doubled to $52 million, treatment slots increased by 60 percent and heroin and cocaine-related emergency room visits decreased 39 percent.

The successes of Baltimore and other cities in addressing the problems of illegal drugs were highlighted at a June 8 conference at the Bloomberg School that drew researchers, treatment advocates and service providers from cities across the country. Dean Michael J. Klag, MD, MPH ’87, opened the conference with praise for “cities like Baltimore that have taken on the problem of drug addiction and started to solve it.”

The conference? Cities on the Right Track: Building Public Addiction Treatment Systems? featured public health officials from Detroit, San Francisco, New York and Seattle who shared their achievements in combating substance abuse as well as future challenges. 

“We see this as a way to share some of the things we’ve been able to learn in Baltimore, and what’s going on in cities across the country that share our commitment to building a system of drug care for people who aren’t able to get the treatment they need,” said Diana Morris, JD, director of the Open Society Institute-Baltimore, a conference sponsor along with the Bloomberg School and the City of Baltimore. 

David Vlahov, PhD ’88, director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine, said that many drug-related deaths and illnesses are preventable with proven treatments. But most treatment systems aren’t built to scale to accommodate the large numbers of people without insurance who require care.

In 2004, Vlahov said, only 10 percent of the 23.5 million people in the U.S. who needed alcohol and drug treatment received services. 

“Treatment is in short supply, and untreated addiction results in avoidable public health problems,” he said.

Needle exchange programs-pioneered in Baltimore to reduce HIV infection among intravenous drug users-have been found to be an effective “bridge” into drug treatment programs, Vlahov said.

“We’ve learned that needle exchange does not encourage drug use,” he said, adding that New York is exploring a needle exchange program through pharmacies.

Studies have shown that HIV-positive, substance abusers who receive appropriate drug treatment are more likely to have access to antiretroviral therapy.  

“Drug treatment is HIV prevention,” Vlahov said.

In the past two years the medication buprenorphine has emerged as an effective treatment for heroin addiction with a lower risk of some of the side effects associated with methadone, including withdrawal and respiratory depression. Vlahov said clinical trials have shown the medication to be as effective as moderate doses of methadone.

He noted that in France a program that treated heroin users with buprenorphine led to a 78 percent reduction in deaths.

Alice Gleghorn, PhD, deputy director with San Francisco’s Department of Public Health, related her city’s efforts over the past decade to improve the quality and availability of drug treatment. In 1996 the situation at San Francisco General Hospital reflected the city’s severe drug problems, with the majority of patients being treated for drug-related conditions. 

City budget surpluses in the mid-1990s funded more drug treatment services, including a soft tissue infection clinic to treat cellulitis, a common skin infection related to intravenous drug use. The clinic saved San Francisco General $8.8 million from 1996 to 2002, Gleghorn said.

Although the drug conference focused on cities’ advances in treating substance abuse, much remains to be done. Participants said priorities include the expansion of treatment for inmates and the mentally ill, and finding ways to increase employment of recovering drug users. —Jackie Powder