From Sidewalks to Solutions: Can Baltimore Build a New Recovery Model?

Part Three of a Three-Part Investigative Series

The Street-Level Reality

On a chilly morning in East Baltimore, Andre—the man who lingered outside a methadone clinic in Part One—says he’s been “trying to get clean for real this time.” He points to the peer navigator who helped him last week. “She’s the only one who didn’t treat me like trash,” he says.

His story reflects the tension across Baltimore: a city wrestling with the visible chaos of addiction, while quietly building new systems that could one day make the street crowds obsolete.

Beyond the Clinic Walls

City officials and health leaders agree that the future of recovery cannot hinge on daily clinic visits alone.

“We need comprehensive recovery hubs that address housing, employment, mental health, and addiction in one place,” says Adrienne Trustman, chief medical officer at Behavioral Health System Baltimore (BHSB), in a 2024 WYPR interview.

Such models already exist in other cities. In Rhode Island, “recovery campuses” integrate medical detox, long-term housing, and job training. Studies published in the American Journal of Public Health show these hubs reduce relapse rates and stabilize communities.

Baltimore leaders are now considering similar models, according to BHSB planning documents.

Housing First

One of the clearest lessons from decades of addiction research is the link between recovery and housing. A 2022 National Institute on Drug Abuse (NIDA) report found that people without stable housing are up to five times more likely to relapse after entering treatment.

Baltimore has piloted “housing-first” programs that provide shelter before requiring sobriety. “If someone is sleeping in an abandoned rowhouse, they’re never going to stabilize on methadone,” says Kevin Lindamood, president of Healthcare for the Homeless, in an interview with Maryland Matters.

Yet demand far outstrips supply. The city estimates more than 2,000 people are homeless on any given night, and many overlap with the behavioral health system.

Peer Power

If there’s one area where Baltimore is already ahead, it’s the use of peer recovery specialists.

The city employs dozens through the Stabilization Center, mobile vans, hospitals, and community programs. According to BHSB data, peers engage over 20,000 residents each year, often serving as the bridge between the clinic sidewalk and the treatment plan inside.

“It’s not just about handing out a flyer,” says peer coach Adrienne Breckenridge. “We can walk with them—literally—into detox, into housing intake, into their first job interview. That’s the difference.”

Funding Uncertainty

Despite progress, Baltimore’s plans face a familiar challenge: money.

Federal COVID-19 relief dollars helped fund many recent initiatives, including GBRICS and peer programs. But those funds are expiring. In late 2024, Maryland lawmakers warned the state faces a shortfall of over $3 billion in the coming years, putting health and social services on the chopping block (Maryland Matters, Dec. 2024).

“Without sustained funding, these innovations risk becoming temporary pilot projects,” warns Dr. Dzirasa, Baltimore’s health commissioner.

Community Tensions

For residents like Denise Thompson, featured in Part One, the future feels uncertain. She supports treatment—but she still wants her block back. “It’s hard to hear about all these programs when I still see people nodding off in my alley,” she says.

Community groups are pushing for more transparency. “We need to know not just how many people got methadone, but how many got housing, how many got jobs, how many are still clean a year later,” says James Carter, leader of a West Baltimore neighborhood association.

A Fragile but Real Shift

Experts say Baltimore’s trajectory is fragile, but real. Overdose deaths remain devastatingly high—1,000 city residents died of overdoses in 2023, according to the Maryland Opioid Operational Command Center—but the numbers have finally begun to plateau after years of sharp increases.

“This crisis won’t disappear overnight,” says Dr. Trustman. “But if we keep scaling housing-first programs, recovery hubs, and peer support, we can change what the streets outside treatment centers look like in 10 years.”

The Final Question

For now, the sidewalks outside Baltimore’s treatment centers remain crowded—a mix of hope, hustle, and heartbreak. But beneath the surface, the city is building something new: a system that might one day make those crowded sidewalks obsolete.

The question is whether Baltimore—and its funders—will stay the course long enough to see the transformation through.