In July, the president of a clinic proposed for the town of Columbia's Oakland Mills village, notified the state that he would not open a facility. His decision came after a very public four-week battle by local politicians and residents.

This week, plans to open a clinic in a business park near the Scarlet Oaks neighborhood of Elkridge was also dropped, the Baltimore Sun reported August 22.

"We can't fight misconceptions," said Neal Berch, who operates three other treatment centers in Maryland and proposed the clinic in Scarlet Oaks. "I just don't have the stomach to fight these people."

In response, County Councilman David A. Rakes said, "The struggle is over." Rakes, whose district covers east Columbia and parts of Elkridge, was a key player in the fight against the Oakland Mills clinic, too.

Berch is now trying to relocate the clinic in an industrial area. He regrets that this plan is necessary. "It's kind of bad for people who need the help" if they live in residential areas, he said. "They shouldn't be forced to travel because of NIMBY (not in my back yard)."

Despite the community concern, Howard County still has a need for treatment services, said Dr. Cargiulo. Addiction to prescription painkillers such as OxyContin and Percocet are rising and can be treated with methadone as well as counseling.

Cargiulo, the county's first "drug czar," was hired in May and thrown immediately into the NIMBY debates. In both cases, he was forced to defend methadone to residents who despised the idea of having clinics near their homes and schools.

"I got exposed to a lot over the past couple of months," Cargiulo said in an August 21 article in the Laurel Leader. "I was in the position of having to give a very unpopular point of view; telling people that methadone was an effective treatment was not what they wanted to hear. But I had to do it. There were a lot of misconceptions out there."

The position of drug czar in Howard County has long been recommended. A year-long study released in 2002 by the Columbia-based Horizon Foundation concluded that drug abuse is a growing problem in the county. Among the report's 70 recommendations for improving the county's fight against drugs was hiring someone to coordinate it.

Cargiulo, who has a doctorate in pharmacy and is a certified drug and alcohol counselor, was working as a clinical pharmacist at the University of Maryland and serving on Howard County's Alcohol and Drug Abuse Advisory Board when he was hired to be the first director of substance abuse services.

Cargiulo's top priority is developing a continuum of care for people who need treatment, including a halfway house, drug court, and eventually, an intensive outpatient program. He also wants to get more physicians licensed to dispense buprenorphine.

"There definitely is a drug problem here and we need to increase the level of knowledge about addiction in general," he said.

Cargiulo estimates that 7,000 county residents have drug or alcohol problems. "And 60 percent of those people work," he said. "They're not just skid-row addicts we're talking about."

The methadone clinic controversies have had a positive side, Cargiulo said. The debates proved to him that public officials in Howard County are willing to support additional drug treatment centers in the right location.

"Time will tell if that's the case; you have to walk the walk," Cargiulo said. "But they're saying they are in favor of more treatment centers. And that's a tremendous help."