Crystal Parker first learned about the plan to open a new drug addiction treatment program in her West Baltimore neighborhood when she saw a zoning notice posted on the front of a former carryout restaurant.

For years, she and her neighbors have worked toward revitalizing this long-neglected stretch of West North Avenue, where drugs are openly sold and used, into something more vibrant. What they didn’t need, Parker said, was one more treatment program in an area that already had at least six in close proximity.

But despite a petition signed by more than 300 people opposing the new program, the zoning board voted last year to allow the changes required for it to open.

“It feels like the neighborhood has no say in this,” Parker said.

Parker, president of the North Avenue and Hilton Street Business and Community Task Force, said she recognizes the necessity of treatment, but heard complaints about the quality of some nearby programs that caused her and others to question whether providers were there to help — or to profit.

Some city leaders have started to raise similar concerns. State health officials struggled to keep providers in check in recent years, leading to an influx of treatment programs, many of which use unscrupulous practices.

As of last year, there were more than 670 Medicaid-funded addiction treatment locations in Baltimore, state data shows, up 50% from 2021. That’s equivalent to more than eight treatment locations per square mile on average. Home to one-third of the state’s publicly funded treatment programs, the city attracts patients from across Maryland.

During a City Council hearing Wednesday, Councilwoman Phylicia Porter cited an investigation by The Banner and The New York Times last year that revealed at least 13 people, including a toddler, died in connection to a Baltimore drug treatment program that received millions of dollars from the state each year.

The city should work “to get these bad actors out of our community” and have a more hands-on role in overseeing providers, Porter said during her committee’s latest hearing on the city’s fatal overdose crisis. Porter has previously expressed concern about the concentration of programs in predominantly Black neighborhoods, in particular.

Regulators and advocates alike have raised the alarm about programs that take advantage of patients by illegally seizing government benefits or placing them in squalid apartments.

For example, programs recruit patients from tent encampments and house them in residences with bedbugs and mold, according to Christina Flowers, an advocate for people experiencing homelessness who spoke at Wednesday’s hearing.

Providing medication, counseling and supportive services, such as case management and housing, can help people recover from drug addiction. But a major challenge is that the regulation of treatment programs — from vetting applications to investigating complaints — is largely the responsibility of a complicated patchwork of state agencies, which in recent years had weathered considerable dysfunction.

Behavioral Health System Baltimore, a nonprofit tasked with helping the state oversee treatment in the city, asked the Maryland Department of Health for more power to hold providers accountable. So far their efforts have not been successful, according to the organization’s spokeswoman Adrienne Breidenstine.

Councilman Paris Gray, who represents parts of Southwest Baltimore, said he hears complaints about exploitative programs constantly and he’s “sick and tired” of having to tell constituents to take the issue to state or federal agencies because there’s little the city can do to help them.

Gray pleaded for coordination between local and state leaders. “Help us rein this in,” he said.

In an interview Monday, Maryland Health Secretary Meena Seshamani said the state is also working to improve access and care across behavioral health services, and that it’s important for state and local leaders to work together.

Wednesday’s council meeting offered few concrete solutions, but officials promised more conversations to explore solutions. Councilman James Torrence, whose district recently saw a mass drug overdose that hospitalized at least 27 people, said he plans to introduce a bill to convene a task force to issue recommendations. Separately, Councilman Mark Conway said he is meeting with providers to determine how to measure treatment quality.

Porter said she plans to reintroduce a bill to the Maryland General Assembly that would require new programs to seek community input as part of their licensing process.

Back on West North Avenue, the new facility, known as Vert Treatment Center, has not yet opened. The listed owner, Isiaka Ibraheem, did not return messages seeking comment. Court documents show Ibraheem has struggled with past businesses, including a Towson treatment program that was evicted for nonpayment of rent and other companies that he operated without proper licenses.

Doren Davis, a 64-year-old longtime resident who was in treatment for heroin addiction decades ago, was one of several people who wrote letters to the zoning board opposing Vert Treatment. In an interview, Davis said he worries that treatment centers aren’t inspected with enough regularity.

The battle over the treatment center may not be over. The neighborhood, along with the West North Avenue Development Authority, are exploring other ways to block it.

Instead of more treatment centers, community leaders are now pushing for a new commercial stretch of small businesses and retail, where people can walk to get something to eat or visit a cafe without encountering drug dealing or vacant store fronts.

Already, a few blocks down, the neighborhood has a food hall at The Mill on North, which sits on the border of Coppin State’s campus. Davis, who manages the community garden with the help of YouthWorks employees at Parker’s nonprofit, said he can already envision a better future.

“I want to come out in my motorized chair with my paper, or my dog, with my coffee, and see kids playing,” he said.