CITY OF BALTIMORE, MARYLAND
Mayor Kurt L. Schmoke

Needle Exchange Programs Benefit Everyone

Drug abuse is at the root of a host of problems that threaten the well being of our city, including crime, child neglect, and neighborhood blight. Because 80 percent of new AIDS cases in Baltimore are linked to injection drug use, drug abuse is also the City's biggest public health threat.

Health Department officials estimate that there are approximately 43,000 heroin and cocaine addicts in Baltimore. Despite this staggering problem, Baltimore City currently has only 5,700 drug treatment slots. This means that we are only able to help about 16,000 addicts a year. What's more, there is up to a four-month wait for drug treatment. And drug addicts are not patient people. When they finally take the step to get help, they need that help now. Clearly, we must do more to meet this pressing need.

The case for drug treatment is strong. Respected research studies have found that treatment is cost-effective and that those who are in treatment or who complete treatment are much less likely to commit crimes or engage in high-risk behavior. Such individuals also are much more likely to become productive members of society than their drug using counterparts.

In addition, we know that it is impractical to jail every person who has a drug habit. Maryland's prisons are already overcrowded with people charged with various drug offenses, and we know that young black men are disproportionately represented in this population. After serving their sentences, these young men not only must forever bear the label "ex-con," they also are likely to leave prison with the yearning for drugs still intact, and the downward spiral of addiction and addiction-related crime begins anew.

Given these harsh realities, Baltimore has been seeking additional drug treatment funds from the federal government for the last three years -- to no avail. The problem is too grave for us to wait any longer for outside funding. That's why I recently moved to create a $5 million pool of funds, drawn from existing City resources, to enable us to expand drug treatment programs.

These reallocated funds will allow us to provide treatment slots for an additional 5,000 addicts. Most importantly, we plan to use these funds to leverage additional money from local and national foundations, as well as through federal grants, to enable us to treat thousands more. I'm pleased that the Greater Baltimore Committee already has expressed an interest in lending its support to this initiative, and I hope we will be successful in receiving support from other sources as well.

Alongside moving to expand drug treatment, Health Commissioner Dr. Peter Beilenson and I have been working vigorously to win approval from the Maryland General Assembly to extend the City's Needle Exchange Program. The program has been a key weapon in the City's battle against AIDS, the number one killer of Baltimoreans between the ages of 25 and 44. Drug users who share needles account for the vast majority of these cases.

We launched needle exchange as a demonstration project in 1994, after three years of lobbying the state legislature. The program's authorization runs out this summer, and we are now asking the legislature to make the program permanent. There is no mystery behind this request: needle exchange has ben a success.

In launching the program, we wanted to see if giving addicts the opportunity to exchange used needles for clean ones would reduce the transmission of HIV among injection drug users, their sexual partners, and their children. Our experience is showing that it is. Johns Hopkins researchers who recently evaluated the program found that enrolled addicts lower the risk of contracting AIDS by almost 40 percent.

The Needle Exchange Program has also been valuable from a drug treatment standpoint. It provides addicts with counseling and information on drug treatment options and, upon request, places them in drug treatment programs. Some participants who were drawn to the program initially because of the promise of free needles, later used the program as a stepping stone to drug treatment. This is particularly significant because many in the program are what the Health Department calls "harder core addicts," those with long-term addictions and less likelihood of having previously been in drug treatment.

Even those in the program who continue to use drugs have benefited through their participation. Studies show there is a 20 percent reduction in needle sharing and other drug behaviors that put addicts at high risk for AIDS as well. In many ways, then, the program is helping to save lives.

Our most earnest hope is that ultimately all the participants in the program -- and every drug addict in Baltimore -- will seek treatment. They won't be able to do that if the treatment slots aren't there. My recent plan to almost double the number of drug treatment slots in Baltimore will certainly help. But the City can't meet this pressing need on its own. That is why we are intensifying our efforts to seek more outside support for drug treatment. In seeking that support, our basic message is simple: Drug treatment doesn't just benefit addicts. Helping people break the bondage of drug addiction and become productive, law abiding citizens benefits everyone.

In November of 1993, our task force, known as the Mayors Working Group on Drug Policy Reform, came up with several recommendations:

Support a needle exchange program

• Support pilot programs in your communities
• Support State legislation exempting needles from paraphernalia laws
• Recommend to the Surgeon General that the federal ban on use of federal funds for needle exchange can be overturned

Expand treatment and linkage of drug treatment to primary care/training requirements

• Seek additional funding for expansion of treatment slots
• Seek funds for health clinics to provide methadone maintenance and withdrawal services to those who are opioid dependent
• Enable primary care providers to give substance abuse treatment in their own health care settings
• Support the training of primary health care personnel in the diagnosis and treatment of substance abuse problems

Expand Drug Maintenance Options

• Seek a broader distribution of Oral Methadone
• Seek changes in state regulation to raise the upper limit on the magnitude of oral methadone doses
• Seek changes in federal law, allowing for "low threshold" programs of oral maintenance

Review Police, Prosecutorial and Judicial Practices

• Review police practices and arrest policies
• Support the creation of a drug court as a mechanism for promoting prosecutorial discretion and court diversion which is consistent with a public health approach to handling drug offenders

Establish a Public Information Campaign

• Conduct a public education campaign designed to inform the public about the failures of current drug control policies

For more information contact Dr. Peter Beilenson, Baltimore Health Commissioner at (410) 396-4387.

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