Few things would be more audacious than for everyone in Baltimore City to have quality, affordable health care, including full access to prevention and treatment for addictions. This would surely help the tens of thousands of Baltimore residents who have no health care coverage and suffer physically, emotionally, and financially as a result. It would also help all of us because everyone’s health insurance premiums now have to pay for the hospitalization of the uninsured, and we all also pay in many ways for the tragic and high social costs of drug and alcohol addiction.

Luckily, we are making progress toward this audacious goal. Thanks to the Governor’s Working Families and Small Business Health Care Coverage Act of 2007, we expanded health care coverage to over 100,000  low and middle income Maryland families. Concurrently, the state raised the tobacco tax by $1.00 to help finance the health care expansion and deter young people from buying tobacco products. Since the enactment of these laws in 2008, over 100,000 Baltimore City residents became newly insured and 73.9 million fewer packets of cigarettes were sold.

But, there is much more to do. We are all working to achieve health care for all at the national level, and we must also make sure that here in Maryland we meet that goal no matter what happens in Washington. We have a plan for Maryland that makes sure health care is affordable for everyone in our state and that addiction prevention and treatment is fully funded. We are proposing to fund this partly by increasing taxes on tobacco and alcohol, which by themselves will substantially reduce smoking and alcohol abuse and save thousands of lives. Join our Health Care for All! coalition today and help us turn this audacious idea into reality for Baltimore and Maryland!

When talking about insurance coverage for substance abuse and mental illnesses, people often assume that the problem is limited to the poor. That assumption is way off the mark. Even for those families with “good” health insurance, coverage is far from easy to obtain.

In my own experience, when trying to obtain coverage for residential treatment, you are often told the treatment can be obtained on an outpatient basis. In our community, that treatment could be offered at a community hospital, could be available only a few days a week, and is hardly suitable for an adolescent who needs detox, medication, therapy, group therapy, education and stabilization which takes months and years not days and weeks.

In my experience, even when our child was hospitalized for mania, the insurance company said that three days was adequate, the hospital disagreed and put us in touch with the insurance commissioner who obtained 10 days of coverage. At that critical time, when our child was very sick, it gave us the opportunity to have a diagnosis, begin a form of treatment and begin to look for long term residential care to begin to deal with the substance abuse issues.

Families who are looking for treatment for substance abuse and mental illnesses are often at their wits’ end. Not only is the loved one ill, the entire family is traumatized. It’s exactly the time when insurances are most needed and making families fight for coverage at their most vulnerable time is unconscionable.

Editor’s note: Following National Alcohol and Drug Addiction Recovery Month, we’ve asked several individuals to share their ideas about addiction issues and the war on drugs. This week, Kimá Joy Taylor, Director of OSI-Baltimore’s Tackling Drug Addiction Initiative, closes the Recovery Month series with her thoughts.

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The recession and other health care changes have created a critical time when addiction treatment funding will change tremendously. As the state and nation seek to address health care and increase access to care, it is disturbing to see how much of the conversation is focused on the money and not on the people, not on people getting better and engaging in a full life. Not on people with a chronic disease who need ongoing access to a whole variety of care—addiction treatment or mental health, but also prevention services, vaccines, cancer screenings and the total health care package. 

I realize that cuts are a reality and that the budget crisis means we have to save money. But, part of saving money is looking at what patients need to improve and then looking at the current structure to see if the funding fits with these needs. It means spending money early so that one can reap savings later—i.e. early diagnosis in an effort to decrease long term health care costs, plus, improving someone’s life earlier. The state and city need a map of how to fund addiction as a chronic disease. The state recently held a convening to talk about recovery-oriented systems of care, and ideal treatment systems, but many of these documents and ideas are missing from current discussions. Addiction treatment is more than acute episodic care, in fact, health care for someone with addiction is more than addiction treatment—it is taking care of a whole person to take care of a whole person, the whole person has to enter into budget conversations.

Editor’s note: Following National Alcohol and Drug Addiction Recovery Month, we’ve asked several individuals to share their ideas about addiction issues and the war on drugs.

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“The definition of insanity is doing the same thing over and over again and expecting different results.” — Albert Einstein

I have worked for over 30 years in emergency medicine. We have measured that between 60%-80% of our patients who lack insurance are there due to addiction. Coding systems categorize by final diagnosis, e.g. “forearm laceration,” but when the record is closely examined, it turns out that the laceration occurred because the patient broke a window during a burglary to get money for drugs.

I ask addicts three questions. What is the daily price tag of your addiction? Answer: $20-$100/day. What do you do to get the money? Answer: sell drugs, steal, prostitution, work if available. Would you go into a drug treatment program now? Answer: Yes, but none is immediately available.

Quick and conservative estimate: $50/day x 60,000 addicts in Baltimore metro area x 365 days/year = $1.1 billion. 

Analyzed from an economic view, the drug business is amazing. Product (poppy, coca) is grown, refined, and shipped into every city in the U.S. A vast distribution network ensures that product is readily available down to the street corner level. Financial systems turn the cash of the “dime bag” into multi-billion dollar operations, complete with money laundering, banking, and investment, not to mention the expensive security enforcement required by an illegal industry.

When constituents ask me about their rising health insurance premiums or fear of crime, I respond that addiction is at the source. But after 40+ years of the “War on Drugs,” our society is no better off and probably worse. Jammed prisons, AIDS, destroyed families, crime victims, terrorist funding: the toll is immense. Addiction treatment is a critical step but just a beginning. Isn’t it time our society had a full, open, honest, and intense discussion about drugs? Shouldn’t we admit that the War on Drugs has failed and that other policies deserve exploration? Prohibition didn’t cure alcoholism in the 1920s; it only fueled organized crime. Like that well-intentioned but failed experiment, is it now time to end drug prohibition? Is it time to consider a system of regulation, taxation, treatment, and real control?

Editor’s note: Audacious Ideas is featuring a special month-long series in conjunction with National Alcohol and Drug Addiction Recovery Month. We’ve asked several individuals to share their ideas about addiction issues and the failed war on drugs.

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When we sent our son to an in-patient addiction treatment program, we were spinning with doubt about the choice we had made, whether he would get better, and how would we deal with him when he came home. The program encouraged parents/spouses to attend educational sessions, so we went with the hope that we would learn how to care for our post-rehab son. We were surprised to learn that our priority while our son was away was to start the process of getting ourselves well.

So, we wondered, if we are not addicts, why did we need to be in recovery, too? Quickly we learned that we needed to heal the insanity that had taken hold of our lives. We needed to stop trying to manage our son’s addiction. We learned that many addicts feel tremendous guilt, shame and regret that are hurting people they love and that sometimes the reactions of family members adds to that burden and prevents them from getting well. Our first steps in the path to our own recovery entailed radical changes in our interactions with our son and our understanding that he has a serious illness.  It is called a path because recovery does not happen overnight—either for us or for our son. It takes time and requires a lifetime commitment to ending our own enabling and judgmental behaviors.

One of the best recommendations we received was to attend Al-Anon, a 12 –step program that is comparable to Alcoholics Anonymous and Narcotics Anonymous, but helps the loved ones who are dealing with addiction in their families or friends take charge of their own recovery. We started, stopped, started again, and went off and on to Al-Anon. Finally after a few months, we realized that we needed to be a regular part of a fellowship of people who want to repair the damage to their lives and the relationships with people they love who are addicted. We are much better, he is much better, and we know that our son appreciates the changes we have made. Now, when we meet people whose lives are in crisis like ours was, we try to share what others shared with us and hope it helps them too.

Editor’s note: This September, Audacious Ideas features a special month-long series in conjunction with National Alcohol and Drug Addiction Recovery Month. We’ve asked several individuals to share their ideas about addiction issues and the failed war on drugs.

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Being addicted when you are a teenager does not seem believable. You think people who tell you that you are an alcoholic or an addict are lying. You see other people use drugs and drink and they do not get sick enough to have to go to a rehab program. You just want to be able to be like everyone else and have fun. But soon you realize that you are not really like everyone else if you need to drink or use drugs just to get through the day. And when you are using all the time, your days are awful because you end up thinking so much about getting high or drunk and you lose connections with other things and people in your life that really matter.

Even when you know you are addicted, and you need help, you do not want to go to treatment and you definitely do not want your parents to send you to rehab. It is weird, but rehab is both scary and safe at the same time. If you cannot stop drinking or using very addictive drugs like cocaine, then you need rehab. But you are so scared because you have no idea how you will function without your drugs or alcohol. After a while in rehab, it feels safe there because everyone there is like you–they are trying to stop using.

You learn in rehab that stopping your abuse of drugs and alcohol is just the first thing you need to do. You also learn that what lies ahead is the rest of your recovery. So when formal rehab ends you have to go to outpatient treatment, have a therapist, and go to Alcoholics Anonymous or Narcotics Anonymous meetings. One Day at a Time is a lot easier to handle than thinking about recovery as something that you’ll be doing for the rest of your life.

Editor’s note: This September, Audacious Ideas features a special month-long series in conjunction with National Alcohol and Drug Addiction Recovery Month. We’ve asked several individuals to share their ideas about addiction issues and the failed war on drugs. Franklin Dyson is the second in our series.

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“The crisis that’s killing our city” is how Governor Martin O’Malley, former Baltimore Mayor, refers to drug addiction. Beyond the devastating consequences for the individuals who abuse alcohol and drugs, addiction contributes to the spread of infectious diseases and fuels crime. Research conducted by Copersino, Comberbatch, Jones, and Sitzer (2004) states that in Baltimore, injection drug use is the primary cause of AIDS, which is the leading killer of city residents between the ages of 25 and 44.¹ Baltimore’s crime rate is double the national average, and as many as three-quarters of the city’s thefts, robberies and murders are associated with alcohol and illicit drugs. During the 1990s, the city’s drug overdose death rate tripled. The economic costs of drug abuse and addiction in Baltimore alone exceed $2.5 billion a year. Many of Maryland’s leaders are coming to the conclusion already reached in Baltimore: Treatment deserves more support. Elected officials have become increasingly concerned about drug abuse throughout the state, especially over heroin’s resurgence during the 1990s.

Let’s face facts, in Baltimore, as well as across the United States, we are fighting a losing battle. The war on drugs is really a war on people who use drugs. Locking up people who use drugs is a waste of time, energy and resources. Jails become a revolving door for many addicts who could benefit more from residential drug treatment programs than being exposed to hardened career criminals and inhumane conditions which exist in prisons. Offering drug offenders an opportunity to go to treatment as opposed to going to jail would help reduce the stress on an already over-burdened penal system and reduce the recidivism rate among drug addicts. Of course not all drug offenders will benefit from treatment, however, those who do benefit integrate back into society as responsible productive members of their communities. The reciprocal effect of those addicts who make a commitment to change their lives is greatly multiplied when they return to their families and communities as changed people.

Unfortunately, this country’s approach to drug treatment is more reactive than responsive. This is due mostly to the fact that much of our country’s economy is built on drug use as opposed to drug treatment. Decriminalize drugs and you step on a whole lot of toes. The need for prisons and police are greatly reduced, as well as the infrastructures which support those systems.

In order to change the seemingly insatiable demand Americans have acquired for drugs we must change our way of thinking about drugs. This whole notion we have about “better living through chemistry” must be re-analyzed and remarketed. Treatment teaches people about the effects of drugs, it gives people without hope a reason to live. It helps people examine and re-evaluate their lives and the direction they are headed. Treatment brings families together and helps them examine their roles and relationships it teaches them how to interact in more wholesome and healthier ways. Treatment affords addicts a time out from being caught up in the getting and using and finding ways and means of getting and using drugs, without exposing them to the hardened life of prison. Treatment works, treatment saves lives.

¹ Copersino, M., Cumberbach, Z., Jones, H., Stitzer, M. (2004). Comparative Drug use and psychosocial profiles of opiate dependents applying for medication versus medication-free treatment.  American Journal of Drug and Alcohol Abuse 30(2), 237.

Editor’s note: This September, Audacious Ideas features a special month-long series in conjunction with National Alcohol and Drug Addiction Recovery Month. We’ve asked four individuals to share their ideas about addiction issues and the failed war on drugs. Pat Taylor is the first in our series.

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On Saturday September 12, over 70,000 Americans Rallied for Recovery! at walks, rallies, picnics and other events in 90 communities across the country. People in or seeking long-term recovery from addiction, their families and friends came together as part of a growing movement that is calling for new public attitudes and policies that will expand opportunities for recovery.

Rally for Recovery! and other public events are taking on a new meaning with the growth of an organized recovery community. For too long a great majority of the over 20 million Americans in long-term recovery and their allies have been silent about their experiences and successes.

Times are changing. In addition to the wonderful music, food and festivities that are the hallmark of recovery celebrations, growing numbers feature elected and public officials, celebrities, law enforcement officers, educators and other supporters. There are opportunities to participate in our nation’s civic life through voter registration; contact Congress about pending health reform legislation; and take action on critical local issues. Speakers represent the many pathways to recovery and join with family members to stand up for the elimination of policies that discriminate against people seeking or in recovery.

As we work to make Recovery Voices Count in our communities during the 20th annual Recovery Month observances, it’s time to raise the national profile of the solution. We have a new federal administration that is committed to improving our country’s drug policies. In one of his first statements as Director of the Office of National Drug Control Policy, Gil Kerlikowske made a welcome call for abandoning the divisive “war on drugs” rhetoric.  

What will take its place? It’s time for a high-profile Presidential Commission on Addiction Recovery and a fully-funded Office of Recovery at the Office of National Drug Control Policy that will chart a new direction in public and private attitudes and policies. It’s time to demonstrate our commitment to ensure that all Americans have the right to recover from addiction.

Over the last 11 years, the Open Society Institute-Baltimore has worked hand-in-hand with the city to build a comprehensive public drug addiction treatment system.  Since opening our doors in 1998, we knew that addiction treatment had to be one of our chief concerns if we were to help revitalize Baltimore and improve the health and stability of our most vulnerable families.  We have invested over $10 million in the Baltimore treatment system and launched a national project to Close the Addiction Treatment Gap based on Baltimore’s successful efforts to make treatment more accessible.

Imagine our frustration and consternation at the current situation—following five years of patient discussions and public education—in which the Baltimore City Council has not yet approved a zoning change to remove illegal barriers to sitting licensed residential facilities for people recovering from drug addiction, among others.  Federal law is clear that the current Baltimore zoning regulations violate the Fair Housing Act and the Americans with Disabilities Act—so clear, in fact, that the U.S. Department of Justice has officially notified Baltimore that it will sue the city if it does not amend zoning laws that illegally allow community residents, through their City Council representatives, to veto licensed residential facilities.

City Council members have a choice to make.  It is clear that the Department of Justice will win the litigation it plans to bring against the city.  If they act quickly, City Council members still have time to step up, change the illegal zoning provision, and save the city from squandering valuable public resources in unnecessary litigation costs.  Moreover, by removing barriers to the availability of licensed residential facilities, the City Council will directly help people in recovery to stay in recovery, thereby protecting the city’s investment in their treatment and opening up treatment slots to new Baltimore patients.

In providing this leadership, City Council members should also provide community members with clear information that  the zoning change would be limited to state licensed residential programs as well as about existing procedures to address problematic non-licensed housing, which fall outside the scope of the proposed zoning regulation.  Council members should also point out that helping drug-dependent people to access residential treatment and recovery facilities is key to their economic and social stability, which will help the entire city move toward economic recovery. 

In a city ostensibly dedicated to treating its huge addiction problem—and the health, workforce, foster care, crime and negative reputation it engenders—the City Council’s capitulation to misinformation and discrimination is hard to understand.  And, unfortunately, it makes us wonder about the City’s commitment to a public-private partnership to build a strong addiction treatment and recovery system.

Why is the Baltimore City Council more willing to spend taxpayer dollars to defend illegal laws that keep its citizens out of drug treatment than to invest in their recovery? They should stop defending a fifty-year old zoning law that shuts out the very health care services that so many citizens want and need. 

The City knows its restrictions on the opening or expansion of residential drug treatment programs violate the Americans with Disabilities Act (ADA) and the Fair Housing Act. The U.S. Department of Justice knows it too, and has been working with the City Solicitor and treatment providers for almost two years to find a remedy. Last year, Mayor Dixon introduced a bill that would amend Baltimore’s zoning code so that it no longer discriminates against citizens seeking treatment for drug addiction. 

Mayor Dixon’s bill is fair and fiscally prudent. It would bring the City in line with the zoning standards of surrounding counties. It applies to only those treatment programs that meet state licensure standards, many of which also meet national accreditation standards for health care facilities. It adopts the same zoning standard for licensed drug treatment programs that the City has enforced for over ten years for residential services for persons with mental illness. It also creates a point person in the Mayor’s office to address community concerns and provide linkages to state officials and local enforcement officials.

Why does the City Council refuse to act on the bill? It should do the math. State data show that among patients who received residential treatment in 2006, the percentage who gained employment tripled between admission and discharge. These individuals pay taxes. They regain their health. They contribute to safer neighborhoods. We can’t afford to pass up these remarkable results.

Because the City Council continues to drag its feet, the Department of Justice is now ready to bring a federal civil right lawsuit against the City. The City’s own attorney has advised the City Council that it won’t win this fight. The City Council won’t use its own funds to defend this lawsuit, so why should it be permitted to squander taxpayer dollars? The Council’s action even puts Baltimore’s federal treatment dollars at risk because it’s perpetuating discrimination even as it spends those funds. 

The City Council has time to adopt a fair zoning law before a court orders it to do so.