A doctor in the House Prescribes Drug Rehab

 Article from The Sun

Sinai ER physician carries experiences into Md. legislature
Dr. Dan Morhaim
By Todd Richissin, Sun Staff

The junkies have been to the hospital emergency room on this morning, have been stitched and fixed and sent away, but the doctor in the blue scrubs knows there are more addicts on the way.

There always are.

And that is why the man in blue, Dan K. Morhaim, treats his patients not only as a physician in the emergency room of Sinai Hospital but also as a delegate on the floor of the Maryland General Assembly.

Not every problem facing the state can be traced to drug abuse, he knows. But a lot of them can be.

"Let's say that tomorrow you take 20,000 people in Baltimore who are addicted and put them in treatment," he explains. "Immediately, you ease the pressure on the police, on the courts, on hospital emergency rooms. Then, maybe, you can really start dealing with the problem."

Conscious of his habit of talking a marathon a minute, of jumping from point to point on the same topic, he adds: "Am I being clear?"

In Annapolis, he apparently is being not only clear but persuasive.

The junkies nobody wanted to deal with are getting attention outside the police stations and courthouses, in no small part because Morhaim, a Baltimore County Democrat, has managed to help shape public policy with his experience in emergency room medicine.

After decades of pleas to make treatment a priority, the dollars are finally beginning to make that happen. Largely as a result of legislation he ushered through the General Assembly, Maryland will put aside more money this year than ever before to treat drug addicts.

Nobody knows for certain how many addicts there are in Baltimore, but the most common estimates by those who deal with them are 40,000 to 60,000, a sellout-plus at an Orioles home game.

Add 40,000 or so addicts in the metropolitan area outside the city, and the region is faced with a problem that ordinarily - if it were an illness without stigma - would have been recognized as an epidemic worthy of attack a long time ago.

With Morhaim, the issue is nothing new.

"He's been terrific in pounding away at this," says Lt. Gov. Kathleen Kennedy Townsend, who has worked with Morhaim on addiction issues.

She recalls Morhaim's sway on a state task force on addiction, which she co-chaired with him, when he related experiences from the emergency room. The report the task force issued last month calls for $300 million in increased funding for addiction treatment over 10 years.

Time and again, Morhaim says, his patients swear to him that they'd like to change, would like help in getting off heroin or crack. He knows many of them say what the doctor wants to hear, some wouldn't go to rehab if they were chauffeured to it in a limousine, and others will try and fail.

But he also knows that one day off the streets and in a program is one day that a heroin addict won't have to commit petty crimes to generate the $30 or $50 for his drugs.

Long waiting lists

Morhaim also knows, though, that getting some of these people into a program right away - as in right after the emergency room visit, when they're most likely to follow the doctor's orders - is difficult, often impossible. There are months-long waiting lists for such programs, especially in Baltimore, where the state's addiction problems are most severe.

"In a very graphic way it illustrated the challenge," Townsend says of Morhaim's experiences with addicts. "Here was somebody under a doctor's care, here was somebody in trouble who was willing to get help. And even a patient of somebody as well connected as Dan Morhaim was having difficulty getting any help."

In the emergency room, Morhaim is a blur when the bodies are rolling in, a controlled spasm of energy at 52 years old.

The number of people addicted to drugs can be reduced, he insists, through education and rehabilitation.

Indirect results

A woman with skin abscesses, who has taken to shooting heroin into her muscles because her veins are collapsed, has obviously been addicted for a long time.

Would a slot at a methadone clinic - $10 a day - have helped her?

A gunshot victim one hour, two the next, all because of the drug trade. Would their numbers decrease if there were less demand?

"We're not going to save everybody," Morhaim says. "The realistic goal is to help as many as possible."

And that means more than people caught up in drugs.

In the emergency room, the child with the respiratory infections, Morhaim sees, has been damaged by the smoking of his parents. The man with the liver problem, he recognizes, has alcohol to thank.

Which is precisely why, he says, he ran for office.

"If there's a social cause that's at the root of a medical problem," he says, "I figured I may as well start working on the social cause side of it."

Morhaim was raised in Los Angeles, attended the University of California, Santa Cruz and Berkeley, graduated with honors from New York Medical College in Valhalla and then returned to California. When he and his wife, Shelley Cole Morhaim, had their first child in 1981, they moved to Pikesville to be closer to her family. They have had two more children since.

Morhaim's challenge when he arrived in Annapolis in 1994 was to temper wishful idealism with practical politics. At the State House, an all-or-nothing approach more often leads to nothing, and coming off as the smartest guy in the room can actually be a hindrance.

"He's very intense, certainly, about things that he cares about," says Sen. Paula C. Hollinger, another Baltimore County Democrat. "I guess that can annoy some people who are less into public policy.

"You have to care enough about what you're doing that you don't care if you annoy somebody now and then, and I think that's Dan's approach."

When the task force he led with Townsend recommended spending an additional $300 million over the next decade, Morhaim wanted more. "I think there was a very strong case that we could use more, but, hey," he says, "the fact is, we are moving by leaps and bounds in the right direction."

Part of Morhaim's success can be attributed to timing.

Increased government funding of treatment programs has become politically palatable in the past few years as the lock-'em-up approach to addiction has proved enormously expensive and not particularly effective.

But that evolution has come about largely because of people like Morhaim, who have tailored their message to get law-and-order conservatives to see the financial benefits of treatment.

"You now have a significant number of Republicans who argue that you can no longer pursue to the nth degree a policy of locking drug offenders up," says Sen. Andrew P. Harris, a Baltimore County Republican and also a physician.

"I think what you see is a convergence of a lot of things. We're running out of prison space in this state. Now, if we have the choice between locking up a drug user or locking up a violent person, well, lock up the violent person -but we better do something with the drug users."

Morhaim, for his part, takes pains to stress that he is not a wacko liberal who thinks all drug addicts can be treated effectively. "Jail," he says, "is a perfectly appropriate response for some of these people."

But, he argues, just because treatments for asthma, for example, are not always successful doesn't mean treatments don't work for some asthmatics. So failures by some addicts to recover should not be used to rationalize a lack of drug treatment for all who want it.

One of his primary goals in the coming years is to make sure the money recommended by the task force becomes a reality. That won't take care of every addicted person in Maryland, he knows, but it's a real start.

"We're getting there," he says. "It's been a big change in thinking. People now recognize that it's not a matter of whether treatment works but a matter of how we get the best treatment system running in this state."

Originally published March 2, 2001