The clinic represents a shift in the country's approach to stemming overdose deaths.
Advocates say it acknowledges the importance of keeping people alive, first and foremost, while they confront the sometimes insurmountable challenges associated with recovery. Critics argue it enables illegal activity.
Though efforts to address the problem have fallen short of achieving large-scale change, Baltimore has long been ahead of the curve. The city launched a needle exchange program in 1994, and in recent years, officials have focused on expanding access to naloxone while reducing low-level narcotics and drug paraphernalia arrests. A local organization runs another mobile treatment program that parks outside the city’s jail and offers buprenorphine prescriptions to people getting released.
Research shows the drug significantly reduces a person’s risk of overdose and death. Despite its effectiveness, a relatively small percentage of people experiencing opioid addiction are prescribed the medication. In contrast to methadone treatment, which is highly regulated and often requires patients to visit a clinic every day, buprenorphine prescriptions can last weeks or months.
Culver’s four children are living with relatives in West Virginia, but she thinks about them constantly and hopes to be reunited soon. She said this isn’t her first time seeking treatment: She previously spent 12 years participating in a methadone program, which had stricter rules. Even though she ultimately was kicked out after relapsing, she found the added accountability measures helpful.
Sometime after the marriage dissolved, mother and son moved to Florida while Kelly stayed put. He was living in his grandmother’s southwest Baltimore rowhouse, which he later inherited. The three-story brick rowhouse is sturdy and well-maintained. For Kelly, it’s filled with family memories spanning generations. But the interior has seen better days, with sparse furniture and cluttered surfaces. Kelly rents out rooms, sometimes to people experiencing addiction and desperate for somewhere to stay, which he said can create a volatile environment.
Kelly said he wants more people to understand the realities of substance use disorder, how it gradually consumes your life until you almost don’t recognize yourself anymore. He compared the process to a “road full of IEDs” — you’re so focused on sidestepping immediate danger that you don’t realize you’re headed deeper into hostile territory.
Baltimore police cruisers routinely patrol the area, part of the city’s crime-fighting strategy to increase law enforcement presence in communities plagued by gun violence. “The population we’re serving, many of these people are profoundly underserved and mistrustful of the health system,” said Dr. Kathleen Page, a Johns Hopkins medical school professor who helped launch the program. “Building trust is a big part of it.”
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