Opioid Treatment: Research shows saturation of treatment centers increases crime - Baltimore Post-ExaminerBaltimore Post-Examiner

Opioid Treatment: Research shows saturation of treatment centers increases crime

In 2014, the Central Baltimore Partnership put together a task force of neighborhood representatives to study the high concentration of drug treatment centers and other social services providers in the north central area of the city of Baltimore.  The group was convened as a result of the high number of drug arrests in proximity to drug treatment centers.
As Baltimore continues to build its economic base, we worried areas such as ours would be skipped over due to a saturation of treatment services.  More than that, we worried over the life of our streets: for the addict and non addict alike.  The result of our efforts is  MD State Legislature page for SB199, which seeks an assessment for the location of new Opioid Treatment Centers.
On February 18, 2015, I testified before the Maryland Senate Finance Committee in support of SB199. Here is my written testimony:

I, Robert Mara, representative of the Harwood Community Association, would like thank the Senate Finance Committee for allowing me to submit testimony in support of SB199.

My testimony will focus on data surrounding the issue of saturation, drug treatment and market forces driving the industry.  The Saturation of Metropolitan Services Agencies (SMSA) Task Force defines saturation as a condition where the number of patients treated for opioid addiction in a given neighborhood or area far exceeds the number of opioid addicts needing treatment in that area.

SATURATION DATA

Dr. Debra Furr-Holden of Johns Hopkins University, Bloomberg School of Public Health authored a study titled, “Not In My Backyard:  A Comparative Analysis of Crime around Publicly-funded Drug Treatment Centers, Liquor Stores, Convenience Stores and Corner Stores.”  Her study compared violent crime only and concluded that less violent crime occurs around drug treatment centers than around liquor stores and corner stores.

While we applaud any study that demonstrates a lessening of violent crime in areas around drug treatment centers, we find her conclusion, that ‘drug treatment centers get an unfairly poor reputation that is not backed by data’ to be simply untrue.

Police patrol Greenmount Avenue where a homicide recently happened. (Justus Heger) -

Police patrol Greenmount Avenue where a homicide happened last year. (Justus Heger) –

For her conclusion to be an honest assessment, her study should have been more exhaustive and looked at all crime, as we (SMSA) did.

Our research covers all arrests in lower Charles Village from 2009 to 2014 and may be furnished to the committee upon request.

In the the Old Goucher section of the Charles Village area, we have two methadone clinics and one suboxone clinic.  A fourth clinic, to dispense methadone just blocks away, has recently (December 2014) received it’s opioid dispensing license.  According to statistics from the Maryland Department of Health and Mental Hygiene, less than 18 percent of patients seeking treatment within the 21218 catchment area live within 21218.  The remaining 82 percent of patients seeking treatment within 21218 come from other catchment areas.

Greater Charles Village is broken into four patrol sectors by the Baltimore Police Department (BPT).  Post 516, the smallest of the four sectors, comprises only two by five city blocks and contains all three of the existing Opioid Treatment Programs (OTP’s). According to the Baltimore Police Department, Post 516 had 49 drug arrests (CDS) in the first half of 2014.  Forty  of those arrests were in near proximity (within 1 block) to one of the three OTP’s.  Of those arrests, 38 arrests were made during hours of treatment center operation (6am-5pm).  Only 11 arrests were made during non business hours (5pm-6am).

In comparison, Posts 511, 512 and 513, more than three times the size of Post 516, have had 31 total arrests in the first half of 2014. With the arrest rate in Post 516 being almost five times the rate of each of the other sectors, the correlation is conclusively high between high treatment density and an after-treatment open air drug market surrounding the clinics OTP’s.

The Charles Village Community Benefits District (CVCBD) is comprised of a 100 block area of north central Baltimore.  For the first ten months of 2014, the 48 drug arrests (CDS) forwarded to district court were submitted to the CVCBD monthly crime and safety meeting.  Of those arrests, 44 were made within two blocks or less of either of the three existing OTP’s.  In other words, over 90 percent of the drugs arrests in the CVCBD area originated near the OTP’s.  What’s more, only 20 percent of those arrestees lived within the 21218 zip code.  This is further proof that individuals are coming to an area of OTP saturation to buy and sell drugs.

Of the 44 cases forwarded to district court, 31 were for the sale or possession of Benzodiazepines (Clonazepam, Alprazolam, Valium, Xanax, etc).

Benzodiazepines are class IV controlled substances because they have significant utility in treating anxiety disorders and are also well known to be highly addictive.

In connection with Methadone maintenance, these drugs are highly sought after by patients in search of narcotic effect that is available with the interaction of Methadone and Benzodiazepines.  In fact, it is widely believed that many patients seen “nodding” in the area of the clinics have used other drugs in addition to Methadone, most frequently Benzodiazepines.  Benzodiazepine use in conjunction with Methadone can result in respiratory failure, a common finding in overdose deaths.  Given the 88 percent increase in overdose deaths in Maryland between 2011 and 2014, this is a critical public health concern.

Since the passage of a Prescription Drug Monitoring Program (HB-1296, 2014), the State of Maryland has cracked down on “pain clinics” that have provided a large volume of non-medically justified opiate prescriptions.   It is believed that some of these “pain clinics” also provide prescriptions for Benzodiazepines in addition to opiates.   Unfortunately, the state’s efforts to stem the flow of opiate prescriptions do not appear to have shut off the ample supply of Benzodiazepines available on the streets near the Maryland Avenue clinics.

51XCV6KWB2L._SY344_BO1,204,203,200_Author Rachel Greene Baldino, MSW, in her 2001 book “Welcome to Methadonia:  A Social Worker’s Candid Account of Life In A Methadone Clinic,” gives an insiders perspective on what occurs beyond the clinic walls:

“Methadone advocates argue that methadone cuts down on heroin related crime, and this may be true.  From what I observed in my year at a methadone clinic, however, a whole crime culture blossoms around methadone clinics, a culture founded upon the illegal sale of take home doses, urine samples, pills, cocaine, marijuana and or course, heroin.  But it should come as no surprise that drug dealers flock to the areas around methadone clinics; they understand only too well that they have a built in customer base in these neighborhoods.

She further states:

“Methadone clinics often serve as centralized locations for addicts to get together to deal drugs, get high, turn tricks, buy and sell take home doses and clean urine samples, and the like.  As I already pointed out, methadone clients are nothing if not entrepreneurial.  Clearly, not all methadone patients stop engaging in addictive and criminal behavior just because they are in treatment, in part because they trigger one another to continue abusing drugs.  In addition, some clients pick up more drug habits at methadone clinics than they had before entering treatment.  I have often wondered what the policymakers who created methadone clinics could have been thinking when they decided to assemble hundreds of addicts in a central location.”

Author Rachel Greene Baldino offers us additional perspective on the arrest records we have compiled.  The records show an extraordinary level of drug dealing in the vicinity of OTP saturation that we, and many treatment professionals believe causes an increased likelihood of treatment failure.

Footnotes:

The study authored by Dr. Furr Holden was co-authored by Gregory Warren, who is now operator of the newest OTP (Concerted Care Group) in our neighborhood.  As well, the study itself all but confirms that saturation exists as an issue by stating, ‘Our analyses controlled for the number of drug treatment centers on the same block or within the same building as the density of treatment may increase crime’.

MARKETPLACE DATA

The recently licensed Opioid Treatment Program (OTP) in lower Charles Village is located just blocks away from the existing saturation cluster of OTP’s.  This for-profit OTP is owned by a developer rather than industry professionals for the benefit of his shareholders, who seek to use new revenue streams with the reform of health care.  Where previously, treatment providers were made to compete for grant funding to cover running costs, the expansion of insurance coverage through Medicaid and state and federal insurance exchanges has made funding more fluid and absolute.  If the public wants to know if addiction treatment is mainstream, we need only follow the money.

The National Institute of Drug Abuse (NIDA) estimates cost of drug addiction at $600 billion  annually.  The NIDA estimate includes the cost of damages caused by crime, health care, law enforcement, the courts, incarceration and subsidized treatment and prevention.  In backing up the overwhelming cost to the nation, a 2004 study from the President’s Office of National Drug Control Policy stated the cost of addiction had an annual growth rate of 5.3 percent  between 1992 and 2002.  The President’s study also noted GDP during those years (1992-2002) was 5.1 percent annually.

The advent of new revenue streams and for profit Opioid Treatment Centers (OTP’s) began with passage of health care reform in Massachusetts in 2006.  In the same year (2006),  a venture capital group bought CRC Health, then the largest treatment provider in the nation with the most for-profit locations in Massachusetts, for $723 million.  In the fall of last year (2014), the venture capital group sold CRC Health to what is now the nations largest treatment provider, Acadia Healthcare for $1.175 billion.  Their venture groups’ profit over seven years:  $442 million, or more than 50% growth in value.

To understand why the treatment industry has become so profitable, we looked at market research.

In 2011, GBI Research estimated the value of the treatment industry at 8.8 billion with an annual growth rate of 5.8 percent through 2018.

Their reasons to invest:

  • a low compliance with therapy due to the nature of addiction, a lack of innovative products in the pipeline and an increased use of generics.

GBI Research notes the markets are ‘poised for strong growth’ and advises its investors to strengthen their market position by ‘identifying key companies for mergers, acquisitions and strategic partnerships’.

Another market research group, IBIS WorldInc., estimates the value of the substance abuse and mental health industry at $12-16 billion as of 2015.  IBIS sees behavioral health services (drug treatment and mental health) as resistant to recession due to changes in healthcare coverage, increased awareness and funding to further encourage revenue growth.

IBIS states that further funding has allowed the a ‘growth of outpatient services that are less costly to underwrite’, noting a lower level of capital investment is required for outpatient services.  For example, IBIS notes that every dollar in wages requires only $0.04 cents of investment and, wages account for only 48 percent of total industry revenues.

On January 1, 2014, the Affordable Care Act (ACA) began coverage for alcohol and drug treatment.  Since then, the drug treatment industry market has blossomed.  The value of shares in Acadia Health almost doubled ($38.76-$66.88) between April 2014 and October 2014 on NASDAQ.  According to ‘the street.com’,  on February 3, 2015, shares in Acadia shot up another 14.7 percent with word that Soroban Capital had taken a 10 percent share of the company.

SUMMARY

Last week, several of us from the SMSA Task Force held a conference call with individuals from the treatment community in Maryland who, I expect, will give testimony in opposition to this bill.  Both Alan Minarchik and I explained that conditions of saturation, of open air drug markets and repeated arrests were a hindrance to patients seeking treatment.  The response from Ellen Weber, of the University of Maryland Law School Drug Policy Clinic, was telling.  She stated the problems surrounding the clinics were a ‘police issue’.  Our response to her was more plain:  the horrid conditions surrounding clinics and saturation are exactly what this bill seeks to ameliorate, for the benefit of the patient and the community as one.

SB-199 uses guidelines (TIP 1, 1993) from the U.S. Department of Health and Human Services  to address the issue of saturation of Opioid Treatment Programs (OTP’s).  The Maryland Attorney General’s opinion states SB-199 is not ‘facially violative’ of the ADA.  By creating a greater assessment for the location of new OTP’s, we believe SB-199 is an enhancement to the ADA, to providers, patients and the community as a whole.

The passage of the Affordable Care Act (2009) has created an expanding capital market for treatment industry.  There is now more money than ever before to treat our fellow Americans who suffer from addiction where previously treatment was underfunded.  This is proof that treatment for addiction has mainstreamed since the passage of the ADA in 1990.

The treatment industry seems poised to oppose any and all regulation.  What is needed is assessments to make OTP’s act interdependently with the communities they purport to serve rather than independently.  SB-199 does this.


About the author

Robert Emmet Mara

Robert Emmet Mara has been in Baltimore since 2006. A native New Yorker, Robert came to Baltimore to do three things: work with kids, renovate houses and write a second book of fiction. Since his arrival, he has managed to do all three and more. He has sought better oversight for his still blighted Harwood neighborhood from the city and has been asked to speak to various community association leaders on the subject of city agency relations. Contact the author.
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