In response to the drug crisis, Baltimore’s leaders have embarked on an aggressive strategy to make high-quality treatment available “on request.”  Research across the country demonstrates that treatment more than pays for itself by averting the much steeper health care and crime-related costs that addiction imposes when left unchecked.  A 1994 California study, for example, found that state taxpayers saved $7 in future costs for every $1 invested in treatment.[8]  For policymakers ultimately concerned about the bottom line, the evidence is unambiguous: It costs less to treat addiction than it costs not to treat it.

In pursuing an ambitious treatment strategy, Baltimore’s leaders are bolstered by strong political support from diverse constituencies across the city who favor a treatment approach—from religious congregations; neighborhood organizations; the legal, medical, business and philanthropic communities; as well as the media.  Indeed, treatment on request has become a major item on the city’s agenda for renewal.

At least 60,000 residents need treatment for alcohol and drug abuse—one in eight Baltimore adults.[9]

Beginning in the mid-1990s, the city government launched a major treatment expansion, shifting funds into treatment services and transferring responsibility for treatment from the city health department to the quasi-governmental Baltimore Substance Abuse Systems, Inc. (BSAS). Even so, Baltimore's leaders have no illusions that the city can shoulder the burden on its own. Given the sharp limits on Baltimore's own budget—city revenues are essentially flat—outside help is crucial. The Maryland state government, drawing on federal funds, has historically contributed the bulk of Baltimore's treatment budget. Implementing the city's aggressive new plans will require unprecedented levels of funding from—and cooperation with—Annapolis.

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.  In 1998, the Maryland General Assembly created a Task Force to Study Increasing the Availability of Substance Abuse Programs statewide.  In its December 1999 interim report, the Task Force concluded that insufficient treatment capacity throughout Maryland was primarily due to “insufficient funding for treatment by the State.”[10]  The Task Force recommended providing treatment on request for Maryland’s uninsured and underinsured, 24 hours a day, seven days a week.  

Baltimore and Maryland are in the early stages of a promising partnership to reduce drug addiction and its related harms by investing more in treatment. Their success in doing so could provide a powerful model for other cities and states across the country.

FOOTNOTES:

1        As used in this report, the word “Baltimore” appearing alone always signifies just the City of Baltimore, not the Baltimore metropolitan area or Baltimore County.

ENDNOTES:

[1]       S. Shane.  “City seeks $25 million for ‘crisis.’”  The Baltimore Sun, February 15, 2000.

[2]       Maryland Department of Health and Mental Hygiene, AIDS Administration, Center for Epidemiology and Health Services Research.  Injection drug use (IDU) accounted for 6,010 of the 9,503 AIDS cases diagnosed among Baltimore residents during the 1990s (63.2 percent).

[3]       Maryland Department of Health and Mental Hygiene, Vital Statistics Administration.

[4]       Federal Bureau of Investigation (FBI).  Crime in the United States: Uniform Crime Reports, 1998.  October 1999.  Baltimore’s 1998 Crime Index total (10,947 crimes per 100,000 residents) was more than double the U.S. rate (4,615.5 crimes per 100,000 residents).

[5]       See Notes 58-62.

[6]       Maryland Office of the Chief Medical Examiner.  Between 1990 and 1999, Baltimore’s drug overdose death rate increased from 17.0 to 51.2 deaths per 100,000 residents.

[7]       See Note 13.

[8]       California Department of Alcohol and Drug Programs.  Evaluating Recovery Services: The California Drug and Alcohol Treatment Assessment (CALDATA).  Sacramento, CA: State of California Department of Alcohol and Drug Programs, 1994.

[9]       See Note 11

[10]      Maryland Task Force to Study Increasing the Availability of Substance Abuse Programs. Interim Report by the Committee on Availability and the Committee on Effectiveness.  December 1999.