The nation's failure to tame the drug epidemic ravaging cities such as Baltimore has brought Mayor Kurt L. Schmoke's advisers to a stark admission: Many people are going to remain addicts, so society ought to reduce the harm they cause themselves and others.
In the wake of the sweeping proposal made Wednesday by a mayoral panel, Health Commissioner Peter Beilenson said the goal of any new drug policy will be to get people off drugs for good.
But he admits that the proposal places heavy emphasis on programs aimed at reducing crime, disease, joblessness and alienation even as people continue to abuse illicit drugs.
"It's valid that some of this is harm reduction," Dr. Beilenson said. "We realize that for time immemorial, societies have had problems with addictive substances. You have to realize that some people are not going to get off drugs, and you have to reduce the harm -- crime as well as HIV.
"Not just harm to the individual but harm to society."
The recommendations made by the Mayor's Working Group on Drug Policy Reform would, as Dr. Beilenson puts it, "put treatment into the mainstream" by relying more on primary care doctors and clinics to take on a role now performed almost exclusively by drug treatment programs.
Money to train doctors about drug addiction, to run a needle exchange, to expand methadone in clinics and to start a "methadone bus," as the panel has also suggested, would probably have to come from private sources such as foundations. The policy recommendations come at a time when the slots in treatment programs have been cut back to the lowest point in years.
"There are some addicts who can stop being addicts, and we want to encourage that," said Kevin B. Zeese, a panel member who is vice president of the Drug Policy Foundation. "But there are also addicts who are unable to do that for whatever reason. We want to find a way to get these addicts out of the cold and put our arms around them and help them as well."
'Interested in life'
Doubling or tripling the number of addicts taking methadone, as the panel has suggested, might get many people off heroin. But they may have to be given methadone, a more benign narcotic, for years.
"By allowing a maintenance alternative you get a person in the door, functioning, out of the routine of having to acquire illegal drugs," Mr. Zeese said. "The goal is to get them interested in life."
