OSI Conference: Cities on the Right Track—Building Public Drug Treatment Systems

Opening Plenary

Leading the Way with Treatment—A View from City Hall
George Soros, along with mayors Martin O’Malley of Baltimore, David N. Cicilline of Providence, John W. Hickenlooper of Denver, and Byron W. Brown of Buffalo discussed the impact of addiction and the successes and challenges of providing drug treatment in cities today. Michel Martin, NPR host and ABC news correspondent, moderated this plenary session. Listen to the audio.

Welcoming Remarks
Michael Klag, Dean of the Johns Hopkins Bloomberg School of Public Health, Diana Morris, Director of OSI-Baltimore, and Dr. Robert Schwartz, OSI-Baltimore Director of Drug Addiction Treatment and Medical Director of Friends Research Institute. Watch the video.

George Soros’s $10 Million Pledge
George Soros, OSI Chairman, announced the $10 million initiative to help U.S. cities build comprehensive public drug treatment systems. Watch the video.

The Public Health Impact of an Effective City-Wide Drug Addiction Treatment System
David Vlahov, PhD, Director, Center for Urban Epidemiologic Studies, New York Academy of Medicine and Professor of Clinical Epidemiology, School of Public Health at Columbia University, New York, New York.

Although research indicates that drug addiction treatment reduces drug use, crime, and the spread of HIV infection, most treatment systems cannot provide care to a significant portion of needy residents because they are not built to scale. Vlahov presented evidence of the significant and persistent treatment gap in the United States and explained what can happen when a city successfully takes steps to meet the demand for treatment. Watch the video. View the PowerPoint presentation (pdf).

Increasing Access to Addiction Treatment in Baltimore
Joshua Sharfstein, MD, Commissioner of Health, Baltimore, Maryland.

Baltimore launched its effort to provide ready access to effective drug addiction treatment to all of its residents in 1997. Although the program has not met its ultimate goal of treatment for all, funding has tripled and capacity has more than doubled. Sharfstein describes the ongoing campaign for funding and capacity building; the impact treatment has made towards reducing drug use and crime, and improving the health of the city; and next steps to meet the needs of those not yet treated. Watch the video. View the PowerPoint presentation (pdf).

Treatment on Demand in San Francisco
Alice Gleghorn, PhD, Deputy Director, Community Behavioral Health Services, Department of Public Health, San Francisco, California.

Eight years ago when the city was experiencing budget surpluses, San Francisco’s Health Department launched its treatment expansion efforts to address increased use of cocaine and methamphetamine. The city has made considerable progress and continues to expand access to drug addiction treatment. Gleghorn describes San Francisco’s approach and successes as well as its plans to expand treatment capacity even further to meet the demand. View the presentation (pdf).

Improving Performance

Improving the Quality of Treatment: A National Perspective
David L. Rosenbloom, PhD, Professor, Boston University School of Public Health, and Director, Join Together.

Although treatment resources are still not adequate to meet the great need, Join Together has convened panels of experts to urge state and local treatment providers to develop systems which measure outcomes, promote accountability, and reward results. Rosenbloom discussed recent recommendations developed by Join Together to help state governments improve drug and alcohol treatment systems and adopt policies to improve local treatment systems. Watch the video. View the presentation (pdf).

Baltimore’s DrugStat Performance Improvement System
Adam Brickner, Director, Baltimore Substance Abuse Systems, Baltimore, Maryland.

With the assistance of its Scientific Advisory Committee, Baltimore has set benchmarks for utilization, treatment retention, and drug testing for each of its treatment modalities. It has implemented a system of reviewing these data with program directors in a group setting. This process facilitates accountability and provides a forum to share best practices, improve individual programs, and plan system-wide interventions. Brickner reviewed data showing improvement in outcomes over the past five years. Watch the video. View the PowerPoint presentation (pdf).

Service Linkage

Linking Primary Care and Addiction Treatment in San Francisco: Office-Based Opioid Treatment
Alice Gleghorn, PhD, Deputy Director, Community Behavioral Health Services, Department of Public Health, San Francisco, California.

In order to increase access to effective opioid agonist therapy, San Francisco embarked on an ambitious plan to expand office-based treatment using primary care physicians. Gleghorn described the planning, implementation, and results of this demonstrably effective program. Watch the video. View the presentation (pdf).

New York City’s Buprenorphine Expansion Program
Lloyd Sederer, MD, Director, Office of Mental Health, Substance Abuse and Developmental Disability, New York, New York.

In order to expand access to treatment for New York City’s estimated 200,000 heroin-addicted residents, the city is implementing a plan to address the considerable regulatory, educational, and funding barriers so that buprenorphine treatment for heroin addiction can become widely available. Sederer described the plan and its success to date. Watch the video. View the PowerPoint presentation (pdf).

Innovative and Effective Use of Case Management in Philadelphia
Marvin Levine, MSW, Executive Director, Coordinating Office for Drug and Alcohol Abuse Programs, Philadelphia, Pennsylvania.

Inpatient detoxification is an expensive but necessary component to a treatment system. Its effectiveness, however, is compromised if patients do not continue in counseling after discharge. In order to improve its treatment system outcomes, Philadelphia implemented and evaluated a successful case management system to increase aftercare adherence for this high-risk, high-cost group of patients. Levine presented Philadelphia’s approach to case management and the resulting benefits. Watch the video. Read Levine’s article “Improving Continuity of Care in a Public Addiction Treatment System with Clinical Case Management” (pdf).

Outreach to Out-of-Treatment Individuals

Recovery Outreach in Detroit
Calvin R. Trent, PhD, Director, Bureau of Substance Abuse Prevention, Treatment and Recovery, Department of Health and Wellness Promotion, City of Detroit, Michigan.

One goal of Detroit’s Substance Abuse Bureau is for patients to learn to live as recovering citizens in the community. Trent and his staff, in partnership with recovering individuals, have created a self-help “clubhouse” to serve as an entry point for treatment and as a community support during and after treatment. Trent spoke about this important community-based approach to recovery and wellness. Watch the video. View the presentation (pdf).

Needle Exchange as a Linkage to Treatment in Seattle
Michael Hanrahan, Manager, Education & Prevention Services, Public Health, Seattle and King County, Washington.

Needle exchange programs have been proven to be highly effective at reducing the spread of HIV infection among injecting drug users who are not yet ready or able to discontinue drug use. Hanrahan described Seattle’s needle exchange program, including its ability to attract intravenous drug addicted individuals into drug treatment and recovery. Watch the video. View the presentation (pdf).

Site Visit

Mobile Methadone Treatment

The Institutes for Behavior Resources has been operating a mobile methadone treatment program in Baltimore for the past fifteen years. It has provided links to drug-free outpatient programs and successfully navigates the NIMBY syndrome through partnerships with community and faith-based organizations. A tour of this novel program was led by Carol Butler, Director of Services Programs, and program founder Dr. Joseph Brady, Professor of Behavioral Biology and Neurosciences at the Johns Hopkins School of Medicine. View the PowerPoint presentation (pdf).

Closing Plenary

What Do Cities Need to Build Effective Drug Addiction Treatment Systems?
Carlos Hardy, Director of Drug Treatment, Citizens Planning and Housing Association, Baltimore; Jerome H. Jaffe, MD, Professor of Psychiatry, University of Maryland School of Medicine, Baltimore, and the nation’s first drug czar; and David Rosenbloom, MD, Director of Join Together.

Hardy, Jaffe, and Rosenbloom, as well as the conference participants and panelists talked about the crucial components that need to be present in order to create effective drug addiction treatment systems in cities. Watch the video.

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