At the Clinic Doorstep: Why Addicts Congregate at Baltimore’s Drug Treatment Centers

Part One of a Three-Part Investigative Series

Morning on Monument Street

At 6:30 a.m., the line has already formed outside the methadone clinic on Monument Street. Dozens of men and women shuffle quietly, hoodies pulled tight against the early chill, coffee cups in hand. The hum of city buses mixes with the murmur of small talk: “You going in today?” “Who’s got a ride out west?”

Around the corner, a man leans against a lamppost. He’s not here for treatment. Residents say he’s here every morning, selling small wax baggies of heroin and fentanyl to anyone wavering between recovery and relapse.

By 8 a.m., sidewalks are crowded with patients who’ve dosed but haven’t gone home. Some linger to smoke cigarettes, others wait on friends, and a few, visibly high, slump against the brick wall of the clinic itself. To the neighbors who live in rowhouses across the street, it looks less like a place of healing and more like a drug market with a front door.

“It’s like two worlds colliding,” says Denise Thompson, who has lived in East Baltimore for more than twenty years. “Inside, they’re trying to save lives. Outside, it feels like chaos. We see people nodding out on the stoop every day.”

A Magnet for Hope—and Temptation

Why do so many people remain outside these clinics instead of returning home? Addiction experts say the answer is complicated, rooted in the realities of poverty, trauma, and the structure of treatment itself.

“Treatment centers are anchor points,” explains Dr. Marlon Edwards, an addiction medicine physician interviewed by WYPR Baltimore. “People know if they need methadone, Suboxone, or a referral, this is where they can come. But they’re also magnets because drug dealers know the same thing. It’s a vulnerable population, and that makes them targets.”

Methadone programs require patients to show up almost every day—sometimes for months—before earning the privilege of take-home doses, according to federal guidelines cited by the National Institute on Drug Abuse. For someone who’s unhoused or unemployed, the clinic becomes one of the only places they’re expected. “When you don’t have stable housing, you don’t have anywhere else to go,” Edwards says. “The clinic becomes your routine, your social circle, your lifeline.”

For many, it’s also about ambivalence. Recovery is rarely linear. Someone may be committed to treatment but still craving heroin. Hanging around the clinic keeps them close to both worlds—the possibility of getting better and the temptation to relapse.

The View from the Neighborhood

For longtime residents, though, the clustering has become unbearable. Complaints to the city often mention trash, loitering, public drug use, and, in some cases, overdoses just steps from clinic doors.

“Every time I walk my kids to school, we pass folks slumped over,” says Marcus Hill, who lives near a West Baltimore treatment center. “I want people to get help. But do they have to turn our block into the waiting room?”

Neighborhood associations have pushed city officials to take stronger action. Some have even petitioned for clinics to relocate. But public health leaders argue that moving them doesn’t solve the underlying issue—it just shifts it to another block.

A Legacy of Need

Baltimore has one of the highest rates of opioid addiction in the country. The city has been on the front lines of the overdose crisis for decades, from heroin in the 1990s to fentanyl today. In 2023 alone, nearly 1,000 residents died of overdoses in Baltimore City, according to the Maryland Opioid Operational Command Center. Fentanyl was responsible for the vast majority of those deaths.

Methadone treatment, first introduced in Baltimore in the 1970s, has saved countless lives, researchers at the National Institute on Drug Abuse report. Patients who remain in treatment are significantly less likely to overdose or contract HIV and hepatitis C. Clinics are, by most measures, a public health necessity.

Yet the sidewalks tell another story: visible addiction, open-air dealing, and a community caught between compassion and fear.

Dealers at the Door

The presence of dealers outside clinics is one of the most corrosive dynamics. In interviews with current and former patients conducted by The Baltimore Sun and the Washington Post, several admitted they’d relapsed immediately after dosing—sometimes buying drugs within minutes of leaving the building.

“You get your methadone, but if you’re still sick or the cravings are too much, the dope man is right there,” says Andre, a 42-year-old patient who asked that his last name not be used. “It’s like trying to quit smoking when someone’s blowing cigarettes in your face.”

Law enforcement has tried periodic crackdowns, but officers acknowledge it’s a revolving door. Arrest one dealer, and another takes his place the next day. “You can’t police your way out of this,” says one Baltimore Police sergeant, who asked not to be named because he was not authorized to speak publicly. “As long as the demand is there, supply finds its way.”

A Symptom of Bigger Gaps

Behavioral health advocates argue that the sidewalk scenes outside clinics are not a failure of treatment but a reflection of larger systemic gaps.

“These aren’t people loitering because they enjoy it,” says Adrienne Breckenridge, a peer recovery coach who works in West Baltimore. “They’re there because they don’t have housing, they don’t have jobs, they don’t have safe spaces to go. If you don’t fix those gaps, you’ll keep seeing people outside the clinic.”

According to data from Behavioral Health System Baltimore, one in three people entering treatment in the city is also experiencing homelessness. For them, the clinic is not just medical care—it’s the only reliable stop in their day.

The Question Ahead

As Baltimore expands its treatment system—with new stabilization centers, crisis teams, and mobile methadone vans—residents and providers alike wonder if these changes will finally ease the clustering outside clinics.

Part Two of this series will examine the city’s evolving strategies to balance public health with neighborhood quality of life: from peer navigators and crisis diversion to redesigned treatment models.

For now, the sidewalks remain crowded each morning. Hope and despair stand side by side, just a few steps from the clinic doors.