MAVERICKS IN THE WAR ON DRUGS

Baltimore attempts to treat addiction as illness, not crime

Ed Myers celebrated his six drugfree months with Ruth Daiken, executive
director of the Jones Falls Counseling Center in Baltimore.

BALTIMORE There is a war on drugs going on in Ronnie Webster's brain,
but the heroin always seems to get its way. She dreams at night of
getting clean, getting a job, getting back her kids. Then she spends her
days begging, stealing, living to score dope. Quitting is the hardest
thing she's never done.

''I know I could be productive in society, but it's like the drugs take
over my mind,'' said Webster, 34, a former welder who has been using
for 15 years. ''They tell me what to do.''

The nation's war on drugs has been just as futile on the streets of
Baltimore, where 85 percent of all felonies are now drugrelated. The
city is now home to an estimated 45,000 addicts, who must raise about $1
billion a year to feed their habits. AIDS is now the city's leading
cause of death for young adults, with 75 percent of all cases related to
intravenous drug use.

So in July, Baltimore launched its own war on drugs, a war with little
in common with Washington's. Its major departure is to treat addiction
more as a medical problem than a criminal problem, pouring money into
treatment and prevention rather than enforcement and incarceration. And
it has already attracted the eye of maverick philanthropist George
Soros, who has pledged to pump another $25 million into urban programs
here.

Baltimore's new plan includes the nation's most aggressive drug
treatment initiative, officials say, approaching though not achieving
treatment on demand, as well as its largest publicly funded needle
exchange, which has already reduced HIV transmission among addicts by 40
percent. It also offers job training, housing aid and other social
programs for recovering addicts. Finally, the plan will steer criminals
into treatment, through a ''drug court'' and a new ''community court.''

These programs will all stretch city coffers, and researchers disagree
about the effectiveness of treatment programs. But local officials say
the outlays will be pocket change compared with a war that has cost
Americans an estimated $300 billion since 1980, the vast majority of it
on law enforcement and interdiction.

''The war on drugs has been a total failure,'' said Peter Beilenson, the
city's health commissioner ''The problem is, most politicians are
terrified of looking soft on drugs if they do anything different. Maybe
we'll be able to change that.''

The key politician here, Mayor Kurt Schmoke, has never been afraid of
looking soft. He has even suggested that drugs should be legalized to
eliminate the profit motive. Soros, a billionaire currency speculator
who bankrolled the successful movement to decriminalize medical
marijuana in California, is even more controversial in antidrug circles.
The new branch of his Open Society Institute here is already raising
suspicions that this bluecollar city is sneaking toward legalization.

Thomas Frazier, Baltimore's police commissioner, firmly opposes
legalization, and he insists his department will keep making drug
arrests until the problem goes away. But he also says the city cannot
''arrest its way out of the drug dilemma.'' Maryland's prisons are full.
Its prosecutors dismiss twothirds of all misdemeanor cases. Its felony
docket has a backlog of 3,600 cases. Still, in some Baltimore census
tracts, more than 40 percent of the adults identify themselves as
substance abusers.

''We have two choices,'' Frazier said. ''We can have more jails, more
courts, more cops, more prosecutors, more parole officers, more
probation officers, and more corrections officers. Or we can change what
we're doing. It's not a tough call.''

It is graduation night at the Jones Falls Counseling Center, a time for
58 clients in outpatient therapy to celebrate six drugfree months. A
recovering addict named Ramelo reads a poem: ''I had ears, but I did not
hear/My eyes have seen, but nothing was clear.'' There is a moment of
silence for drugaddicted babies. Then the choir, made up of addicts,
muddles its way through ''I Believe I Can Fly.''

This is the promise of drug treatment, the idea that broken people can
be fixed. It is the hope that social parasites who neglect their
children and commit crimes so they can get high can become good parents
and good citizens.

Kevin Hodges, a 33yearold heroin addict on probation for drug
offenses, is doing odd jobs, learning to read, and visiting his son for
the first time in years.

''I was so sick and lazy all I wanted to do was shoot dope,'' Hodges
said. ''Now I feel like a person again.''

Last year, Baltimore spent $14.7 million on drug treatment, nearly all
of it state and federal money. This year, Schmoke will spend $27
million, much of it city money. The result will be more than 3,000
additional treatment slots, including more intensive outpatient programs
and three times as many residential beds. Waiting lists as long as four
months should be cut to weeks.

The residential programs here can cost as much as $11,000 a year, but
officials point out that jail cells can cost $25,000 a year, and that
AIDS treatment can cost $100,000 a year. Not to mention the costs to
society for addicts' disability payments, welfare checks, law
enforcement, child protection, and crime.

The problem is, drug treatment is no cureall. Studies suggest that only
one in every five cocaine addicts remains clean five years after
treatment. At the Jones Falls graduation ceremony, fewer than half of
the 58 graduates even showed up.

''I'm all for treatment, but it's unbelievably hard to shake an
addiction,'' says Joseph Califano, president of the National Center on
Addiction and Substance Abuse. ''You've got to use the stick with this
population, not just the carrot.''

Still, advocates say that treatment can be worthwhile even if patients
do relapse; a California study found that every dollar invested in
treatment saved $7 in other expenditures. The addicts commit fewer
crimes while they are clean. And they are more likely to seek treatment
again if they begin using. Addiction, the advocates say, is a chronic
disease, and it is folly to expect treatment to perform instant
miracles.

''The philosophy in America is once you treat it, it should go away,''
said Nancy Aiken, clinical director at Harbel Substance Abuse Services
and a recovering addict. ''But the revolving door is not a failure
it's how the disease works.''

Michelle Brown runs the needle exchange van, distributing clean syringes
to addicts who bring brown paper bags full of used ones. She tells them
how to shoot up at a 45degree angle, to protect their veins. She tells
them how to prepare their speedballs in a sterile environment, so they
don't contract HIV from their cookers. If there is space, she tries to
direct them into treatment programs. But she does not judge them.

''Look at them,'' she said, pointing to Ronnie Webster and a dozen
addicts lined up outside her van. Their eyes are drawn, their arms
blotchy. They look tired. ''They're sick. Do you think they'd keep
coming if we told them they were evil?''

The addicts behave around the van, which visits only communities that
welcome it. Brown has never kicked a user out of the program, and the
police have only been called once. And contrary to initial fears, the
van has not attracted addicts from out of town; 98 percent of its
clients are local.

But the needle exchange does have its detractors, and their criticisms
hint at larger concerns about ''medicalization.'' To some citizens, the
white van parked near Dunbar Middle School looks like a white flag, and
so does the whole idea of treating addicts like patients instead of
criminals.

''Whatever happened to `Just Say No?''' asked Arthur Johnson, a janitor
and father from East Baltimore who is about to leave his lifelong
neighborhood. ''The kids shouldn't see junkies getting new needles. They
should see junkies getting thrown in jail.''

The trend in the drug war has been toward jail. But if the Baltimore
experiment is successful, along with a similar effort to create
treatment on demand in San Francisco, that trend could be turned around.

''We're losing a generation of children,'' said Andrea Evans, who
oversees Baltimore's 39 substance abuse programs. ''I see communities
where drugs are just a way of life. Come on. We've tried the war on
drugs their way. It's time for a new way.''

Copyright 1997 Globe Newspaper Company.