TEST OF `HEROIN MAINTENANCE' MAY BE LAUNCHED IN BALTIMORE

Health Commissioner, Experts Back Plan To Give Drug To Addicts; `Will Be
Politically Difficult'

Johns Hopkins University drug abuse experts and Baltimore's health
commissioner are discussing the possibility of a research study in which
heroin would be distributed to hard-core addicts in an effort to reduce
crime, AIDS and other fallout from drug addiction.

The plan for a trial of "heroin maintenance" for some Baltimore addicts who
have refused or failed in traditional drug treatment is still at a
preliminary stage. Conscious that the issue could be politically explosive,
the doctors involved are treading carefully and trying to persuade
colleagues in other cities to launch such studies simultaneously.

In a sign of the growing willingness to consider controversial strategies
against illegal drugs, experts on drug abuse from around the world met
Saturday at the New York Academy of Medicine to discuss heroin maintenance.
Public health specialists from a half-dozen cities in the United States and
Canada then met Sunday at the Lindesmith Center, a drug policy institute
supported by financier George Soros, to discuss the logistics and politics
of a multi-city heroin maintenance study.

"It will be politically difficult, but I think it's going to happen," said
Baltimore Health Commissioner Dr. Peter L. Beilenson. "It's not going out
on the streets and handing out heroin. It would be carefully controlled by
health care providers under a research protocol."

Beilenson, a physician who has an academic affiliation with the Hopkins
School of PublicHealth, said he strongly supports a heroin maintenance
study but believes it should be carried out by Hopkins researchers and not
by Baltimore personnel.

"We would not use city money, and it would not be in city Health Department
clinics," he said.

David Vlahov, a professor of epidemiology at the Hopkins School of Public
Health who attended the weekend meetings, said the discussions are "pretty
preliminary," but that data from a three-year study of heroin maintenance
in Switzerland are encouraging.

Vlahov, who has tracked 3,000 Baltimore drug addicts for 11 years, said
only 15 percent of intravenous drug users are in treatment and only 50
percent have ever been in treatment. Offering controlled doses of heroin
might lure some addicts off the street and into a setting where they can
get health care and counseling and eventually kick the habit, he said.

"Heroin maintenance is an outreach strategy to bring people into the
system," Vlahov said.

Other Hopkins researchers who have discussed a possible heroin maintenance
trial are Dr. George E. Bigelow, who runs the Behavioral Pharmacology
Research Unit, and Dr. Robert K. Brooner, director of addiction treatment
services at Hopkins' Bayview campus. Both expressed interest in the
proposal but said Hopkins has not made any decision about participating.

Brooner noted that heroin maintenance is "not revolutionary," since doctors
routinely give methadone and other substitute drugs to addicts in
treatment. Methadone can be given in once-a-day oral doses, while heroin
would probably have to given by injection three times a day, he said.

"My guess is we could reach some patients who are not being reached," said
Bigelow, who has studied drug abuse at Hopkins for 27 years.

In addition to Baltimore, the researchers who met Sunday came from Chicago,
New Haven, Conn., San Antonio and Sacramento, Calif., as well as the
Canadian cities of Toronto, Montreal and Vancouver. Participants said
details of funding, scientific research design and numbers of participants
have yet to be worked out.

Heroin maintenance trials would require approval from the Food and Drug
Administration and probably from the Drug Enforcement Administration as
well, researchers said.

The debate brewing over heroin maintenance echoes the 10-year-old
controversy over the distribution of clean needles to drug addicts to
reduce the spread of acquired immune deficiency syndrome.

Needle exchange programs have faced bitter political opposition and
President Clinton decided not to provide federal funding this year for such
programs, despite a finding by Health and Human Services officials that
they curtail transmission of the human immunodeficiency virus that causes
AIDS.

On one side of the drug debate are those who, like Beilenson and Mayor Kurt
L. Schmoke, consider the U.S. war on drugs to be a costly disaster that has
filled the prisons without reducing the devastation inflicted by narcotics.
These drug policy reformers advocate treating drugs chiefly as a health
problem, not a law enforcement problem. They have embraced a philosophy of
"harm reduction," which seeks strategies to reduce the death, disease and
crime resulting from drug abuse.

Such advocates have received funding in recent years from Soros and
philosophical encouragement from Ethan A. Nadelmann, the lawyer and drug
policy expert who heads the Lindesmith Center.

On the other side are those, including political conservatives but also
many drug abuse experts, who believe that prosecution of drug users does
discourage drug use.

They say any step that appears, however indirectly, to condone the use of
drugs sends a mixed message to impressionable young people. Some oppose
needle exchange programs and a few have begun to publish pre-emptive
attacks against heroin maintenance.

Dr. Sally L. Satel, a psychiatrist at a Washington methadone clinic,
blasted the weekend heroin maintenance conference in the Wall Street
Journal on Monday, asserting that the notion of giving heroin to addicts is
"wrong" and "scientifically groundless."

"We're being presented with false choices," Satel said yesterday. She
questioned the claimed success of the Swiss experiment and said other
strategies should be tried first, including the use of drug courts to
coerce addicts into treatment; expansion of residential treatment; and drug
testing for people who receive welfare or other aid.

Some scientists who favor trials for heroin maintenance say they resent
what they see as an unwarranted fear of even raising the topic for study,
saying science should not be intimidated by political unpopularity.

"In many ways, the biggest prohibition in the United States is not on
drugs, but on the discussion of new solutions to drug abuse," said Dr.
David C. Lewis, director of the Center for Alcohol and Addiction Studies at
Brown University, who led Sunday's discussion on heroin maintenance.

Lewis said heroin maintenance was widely discussed in the United States in
the 1970s, and a proposal to try it in New York City in 1971 was approved
by local and state officials before being rejected by federal authorities.
In 1976, he said, the National League of Cities considered launching a
heroin maintenance program, but nothing came of it.

The Swiss study followed 1,146 addicts on heroin maintenance for three
years, ending in 1996. It found a 60 percent decrease in crime committed by
those on the program and an increase in health and employment, according to
the study's authors.

Similar programs are planned in Spain and the Netherlands, and about 300
people receive heroin by prescription in the United Kingdom, according to
Nadelmann.

Checked-by: Richard Lake