Dundalk Clinic Tries to Meet Addicts' Needs
On a stretch of Old North Point Road in Dundalk, not far from the North Point Village neighborhood, a couple of unlikely neighbors share a parking lot: Methadone clinic BD Health Services and a strip club called Dreamers. The arrangement works well for them, as Dreamers closes from 2 a.m. to noon and BD is only open from 5:30 a.m. to 10 a.m. On his way into the clinic in the morning, BD Health's clinical director, Moshe Markowitz, sometimes passes Dreamers employees getting off work.
BD Health Services operates in a small converted two-family home on a quiet street a few blocks from the Beltway. From the outside, you'd never know the room that used be the kitchen is now a nurse's station and that bedrooms have been turned into tiny counseling offices. Inside, thick, worn carpeting and homey wallpaper serve as a reminder of the structure's former use and seem a far cry from the cold, sterile hospital hallways of most methadone clinics.
On a recent morning, a stream of patients files up the creaky wooden stairs to get some help dealing with their addictions. Inside one of the rooms, patients watch Barack Obama on an oversized flat-screen TV. Behind a plexiglass window, nurses push small cups of red liquid methadone through sliding doors to waiting patients. A woman with long, blond hair and pink flip-flops takes a dose and downs it like a shot.
BD Health is one of only three methadone clinics operating in Baltimore County. It was opened in December 2006 when a group of private investors hired Markowitz to run it because they felt the county's other existing clinics (in Pikesville and Timonium) were too far away to serve communities in the eastern part of the county. Before BD opened its doors, recovering addicts in eastern Baltimore County often went for treatment to clinics in the city, but those clinics didn't always meet the needs of the county-based clientele. For example, BD Health tries to accommodate a working clientele by offering early-morning hours so people can get treatment before going to work or after they are through with an overnight shift.
In addition to methadone, a synthetic opioid medication used to treat addiction to heroin and other opiates by reducing cravings and withdrawal symptoms, BD offers patient counseling. Each client meets with a counselor as part of treatment, and some patients are even allowed to take home and self-administer methadone, as long as they drop by to check in with a counselor on a regular basis.
Methadone, though helpful for many addicts, is also addictive, and its use has always been controversial. When asked how long his patients typically remain on methadone, Markowitz shrugs. "It's different for every person," he says. Some stay on it for years, he says, and compares an addict taking methadone to a diabetes patient taking daily insulin. A relapse to drug use could cause a recovering addict to harm himself or others, Markowitz says, so if methadone keeps a patient from using heroin, BD's staff will keep that person on methadone for as long as he or she needs it.
Before BD opened its doors, addicts living in the eastern part of the county who wanted to try a methadone program had limited options. The closest clinics were in the city, and it was difficult for those who needed treatment to get transportation. In addition, Markowitz says, some found it difficult for people to remain drug free in an urban environment. "As soon as you walk out of the door of a city program, they're out there selling," says a BD Health patient named Eileen, who says she's been using drugs for 20 years.
Another problem for county addicts seeking treatment, Markowitz says, is that the window for intervention in drug addiction can be very brief and city clinics often have long waiting lists. Addicts sometimes have sudden inspirations to sober up, Markowitz says, "but if you don't get them into treatment that day, they change their minds."
BD Health Services is a for-profit company, and it receives no public funding and is backed solely by its investors. This frees the clinic from sponsor-imposed restrictions on things like patient fees and structured-treatment plans, Markowitz says, allowing staff to adapt to patients' needs. That's particularly important in Baltimore County, he says, because opiate addiction in the counties often has a different face than that of the city.
Communities like Dundalk are home to many blue-collar laborers who have a higher risk of job-related injuries than office workers. A typical county heroin addict may start out as a construction worker who hurts himself at work, and then undergoes a painful surgery and recovery powered by potent painkillers.
The most commonly prescribed painkillers, like oxycodone and hydrocodone, are opiates that produce the same high heroin does, albeit in weaker intensities. A patient can become physically addicted to opiates in pill form and start buying more on the street when his prescription runs out. Black-market painkillers are expensive, however, so some pill addicts make the jump to a cheaper alternative also readily available on the streets: heroin.
According to the Maryland Department of Health and Mental Hygiene, 1,830 people in Baltimore County were treated for opiate addiction in 2006, the latest year for which data is available. In Maryland, Baltimore County was second only to Baltimore City in documented opiate-addiction rates, and all other counties in the state except one, Anne Arundel, recorded less than half that number of addicts.
Baltimore County Depart-ment of Health spokeswoman Monique Lyle says that the county's Bureau of Substance Abuse funds 400 methadone-maintenance slots in Timonium's privately operated Awakenings Counseling Center. She says that other private treatment centers, like BD, provide an additional 1,000 spaces in their own clinics. These facilities "allow for more treatment slots in different locations in the county," she says.
It can be tough, though, for methadone facilities to find places that welcome them in the suburbs. The privately operated methadone clinic in Pikesville, A Helping Hand Health Services, has been inundated with legal troubles since 2002, when the county passed a zoning ordinance that prohibits the clinic from operating in its current location. Another clinic, proposed for Fullerton in northeast Baltimore County, was told in April that it would have to find a new location for its facility due to zoning rules that state that medical clinics must be at least 750 feet from residences.
Before BD Health Services opened, several community associations, including the Wells-McComas Citizens Community Association, protested its presence. Markowitz says that now, a year and a half after the clinic opened, complaints have died down. BD's location complies with zoning regulations, though one of the initial complaints was that the clinic would be in close proximity to a business: Dreamers strip club.
Despite initial adversities, the clinic now seems well-established. Patients who take advantage of its services are referred by physicians or find out about the clinic through advertisements in local newspapers, though Markowitz says most patients seem to hear about BD by word of mouth. The clinic would not disclose the number of patients it treats, citing patient confidentiality concerns; however, Markowitz says its client base has grown. He estimates that roughly 80 percent of patients live in Baltimore County and that 90 percent of them are employed.
Standing in the parking lot as BD Health closes and Dreamers gets ready to open, recovering addicts trickle out of the clinic as customers of the strip club begin to arrive. Watching the clients leave, it's clear that Markowitz is not off the mark in saying that most of the people BD serves appear to be regular working folks. In fact, as the clientele of the two businesses mix in the parking lot, it's tough to tell the difference between the recovering addicts and the customers arriving for their first lap dance of the day.
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812 Park Ave.
Baltimore, MD 21201