Baltimore Fights Drug War Step by Small Step : Addiction: Mayor once called for decriminalization of drugs. Now he tries less radical methods to battle problem.

Two years after Mayor Kurt L. Schmoke surprised the nation by suggesting that it consider decriminalizing drug use and treating it as a public health problem, his city is starting down the path of what Schmoke aides call drug medicalization.

The first few steps have been small and halting: an experimental acupuncture treatment program, a proposed needle exchange to help protect addicts from AIDS, a conference to sensitize doctors to addicts’ needs, a scramble for new federal treatment money in this cash-strapped city.

“Progress is slow,” Schmoke said, in the search for new and sometimes unorthodox solutions. “Existing laws prevent us from moving ahead quickly.”

And by itself there is little Baltimore can do, he said, to address the other side of the treatment coin: decriminalization of drugs.

“If we repealed our drug laws and no one else in the country did, we would be inundated by addicts and our health system would be overwhelmed,” the mayor said.

His now famous decriminalization speech, which rocked the U.S. Conference of Mayors in Washington in April, 1988, was “geared to changes in national policy” and did not signal an intention to gut Baltimore’s drug laws, he said.

Thus, there has been no shift from cops to clinics in Baltimore in what Schmoke aides call the city’s medicalization of drug abuse. Drug arrests continue to increase. Police narcotics units are at full strength. The city, with Schmoke’s express blessing, designated 39 controversial “drug-free zones” where police have additional power to oust suspected drug dealers, a practice challenged as unconstitutional by the Maryland Public Defender’s Office.

“There’s been no de-emphasis in enforcement,” said Police Capt. Michael J. Fannon, chief of anti-narcotics operations. . . . “If anything, it’s been heightened.”

Drug arrests, he said, jumped from 15,985 in 1988 to 18,291 in 1989 and are expected to exceed 20,000 this year.

Schmoke’s medical initiatives are dwarfed by the city’s drug problems. There are an estimated 55,000 cocaine and heroin addicts in Baltimore--more than 7% of the city’s population--but only 3,400 are enrolled in treatment, according to the city health department. Most traditional programs here, like those in Washington, involve short-term counseling or methadone treatment for heroin addicts and have had only limited success.

“By ourselves, using our own resources,” he said, “we are not going to solve all these problems.”

Schmoke’s 1988 decriminalization speech triggered criticism from members of Congress, the Bush Administration and law enforcement organizations. But the mayor continued to push his ideas, contending that the national and international war on drugs has been largely ineffective. The war should be moved from the “attorney general’s office to the surgeon general’s office,” he is fond of saying.

Gradually, Schmoke’s position has moved from calling for national debate to outright advocacy of decriminalization. He is the only big city mayor taking that position.

Schmoke cites the Netherlands, where he said major drugs are closely controlled by the government: Marijuana is sold by licensed stores, and heroin and cocaine are distributed by health officials in a treatment setting.

Drug addiction there also is fought by education and public service ads, just as cigarette smoking is in this country. Under Schmoke’s concept, some synthetic drugs such as PCP would not be decriminalized, and private importation of heroin and cocaine still would be banned.

To keep his ideas alive, Schmoke convened a meeting of national drug-abuse experts in late 1988 to explore alternative ways of coping with the spread of illegal drugs. After that, there were several smaller brainstorming sessions among Baltimore public health planners, city Health Commissioner Maxie T. Collier said.

The planners examined several unorthodox treatment concepts--nutrition therapy, biofeedback, hypnosis--but settled for the time being on other approaches, including acupuncture, special prenatal care for pregnant addicts, a mobile van for cruising neighborhoods to distribute methadone and “transitional housing” for addicts coming out of treatment and needing to stay away from the environment where they acquired their drug problem.

The only proposal that has gotten off the ground so far is a pilot acupuncture clinic in west Baltimore where about 60 cocaine and heroin addicts undergo 90-day classic Asian needle therapy to relieve stress and, ultimately, the craving for drugs.

Modeled on a similar program at Lincoln Hospital in the Bronx, N.Y., that has been treating hundreds of addicts at a time since 1977, the Baltimore clinic has drawn praise from many of its patients and now has a waiting list.

“After my first session, I had my first good night’s sleep in a month,” said Harold Whitaker, 42, a financial planner and heroin addict. He has been in the program three weeks, he said, and already, “the physical craving (for heroin) is not there. But the psychological desire is still there.”

Every evening, acupuncturist Bruce Marshall meets with about 20 addicts at the clinic, counseling them and inserting stainless steel needles into their ears, brows and heads as they sit quietly in a circle of high-backed chairs. Sessions last about 45 minutes.

Since the program began in January with $66,000 in city and state money, Marshall said, about 75% of the addicts have remained enrolled, an unusually high rate. It is too early to say how many will stay off drugs permanently, he said, but at Lincoln Hospital and the few other acupuncture clinics around the country, the success rate is about 80% among those who complete such programs.

The Baltimore clinic has drawn a wide range of addicts: male, female black, white, college-educated professionals, street drifters. “You’ll have a housewife sitting next to some guy that just mugged somebody yesterday,” Marshall said.

Barbara N. Squires, the city’s policy coordinator for substance-abuse programs, said acupuncture is relatively cheap and unlike methadone--an addictive chemical that blocks an addict’s craving for heroin--is a “drug-free therapy.” She said the city is considering extending acupuncture to a prenatal care clinic and possibly the city jail, if money can be found.

“There’s a lot of new federal grant money for drug treatment,” Squires said. “The State of Maryland expects about $9 million in fiscal 1991 . . . and we’re seeking a big piece of that.” The city gets $13 million in substance-abuse money and wants to add another $5 million to $6 million.

Expectations are modest in the face of Baltimore’s 55,000 addicts. Squires points to a grant proposal she is preparing, for example, that would provide two city row houses for a total of four pregnant women and their children as a haven from drug-infested homes.

On another front, Health Commissioner Collier said the Schmoke Administration is coordinating programs with the city’s private medical associations for an addict treatment reimbursement plan, as well as a conference in October to help doctors identify and treat addicts.

“We’re trying to get them to deal with addicts as patients,” Collier said. “Addiction has to be viewed as a primary care problem . . . like hypertension or diabetes.”

Schmoke’s most controversial proposal--the needle exchange for addicts--is not, strictly speaking, a drug treatment concept. But it “fits in with the broader philosophy of viewing the drug epidemic as a health issue rather than a law enforcement issue,” said Ann Walker, executive assistant to Collier.

Opposed by police officials, the exchange program would permit 100 registered addicts in a pilot project to bring in their used needles to a public clinic and trade them for clean needles, plus bleach, condoms and “safe sex” literature. The project, which has not been funded, would be monitored by the Johns Hopkins University School of Public Health to see whether it reduces needle-sharing and the spread of AIDS among addicts.

A similar needle-exchange program recently was abandoned in New York, one of the few U.S. cities to try it. Schmoke said Baltimore’s proposal is modeled on one in the Netherlands that has been “tested successfully.”