Baltimore Health Commissioner Leana Wen is struggling to provide addiction treatment on demand, NPR reports. An estimated 20,000 people in the city use heroin, and 65,000 have some kind of addiction to drug or alcohol or both.

The city has been focusing on providing addiction treatment for decades, the article notes. In the 1990s, then-Mayor Kurt Schmoke promoted the idea that drug addiction was a public health problem, not just a criminal justice one. That view was highly controversial at the time.

Billionaire George Soros gave the city $25 million in 1997 to create innovative solutions for addressing problems including drug addiction.

Wen, who has been in her current job for a little over a year, says she is not certain it is possible to provide treatment on demand. “We can progress, because we’re so far off from it,” she said. “We’re so far off.”

Last year the city launched a 24-7 phone line for addiction and mental health resources, which is receiving about 1,000 calls weekly. “It’s not getting them treatment on demand, but it’s getting them treatment at some point soon and resources right now,” she said.

Wen’s team is working on a database that would show how many treatment slots are available at any given moment in Baltimore. “What I worry about is, maybe there are spots that are available, but we’re not able to fill them,” she said.

Wen is concerned that medication-assisted treatment still carries a stigma. “There is the misguided belief out there that methadone, buprenorphine treatment is replacing one addiction with another,” she said. “That is not true. Methadone and buprenorphine are proven, evidenced-based treatments endorsed by every medical organization.”

She wants to promote peer-recovery specialists and case managers, who follow people through the process. Wen is also urging Medicaid and insurers to cover these services. Currently they are largely funded by grants.