I’m a newcomer here, and certainly not an expert about Baltimore and the incidence of addiction to drugs and alcohol among its residents. I’m working on a national project to make drug treatment available to all who seek help.
Baltimore’s drug treatment system actually serves as model for this project based on its progress made over the past seven years, doubling the resources available and increasing the numbers of people who are receiving treatment for their addiction.
Baltimore should be proud of that accomplishment. But I know that many more city residents need help with their addiction and still have problems finding the right help.
So what might a city that has worked to improve the health of its residents by increasing the amount of treatment do next?
Here are two related ideas that not only use existing resources, but could result in better quality and more treatment.
First: Most people who need detoxification from alcohol and/or drugs don’t need to be in a full-service, acute care hospital to become medically stable. More than 85% of patients who require detoxification can safely achieve medical stability in a community-based, medically monitored, non-hospital setting. In Baltimore most patients who are uninsured and whose treatment is paid for by public grant and contract funds, receive detoxification in such community-based programs. But, there are also Baltimore residents who need detoxification service and who are covered by Medicaid insurance, that receive this service in an acute hospital setting. If the number of Medicaid covered patients is significant–as my informal inquiry indicates–there is great potential for saving and using those resources for expanded treatment. In Massachusetts, for example, 90% percent of Medicaid detoxification cases in a two-year period were shifted from acute care hospitals to medically monitored community settings. This resulted in per enrollee savings of 40% and an increase in access from 38 to 43 patients per 1000 Medicaid members. The annual savings of many millions of dollars was invested by the state into intensive day treatment and related post detoxification services. Let acute hospitals provide detoxification for patients whose addiction is actively interacting with and compromising another serious condition—such as major ulcerations or trauma—and less expensive and high-quality community-based medically monitored settings provide detoxification for all others.
Second: A little understood fact is that detoxification per se is not treatment. It provides medical stability required for a person to engage in medication-based or rehabilitative therapies. Less widely known is the fact that between 50%-70% of people who are detoxified never continue on to a treatment program and are at high risk of quick relapse. So perhaps we should consider a higher rate of reimbursement to community treatment providers that not only provide detox to patients but then successfully discharged them to an active treatment, on-going treatment program. Detoxification without follow up treatment is essentially a ‘vacation from alcohol and drugs’, and without active follow up, it’s not the best use of scarce resources.
These are broad ideas that need more detail to implement. Each has been done in other communities. What do you think Baltimore should do to make treatment more available?