Drug Problems as Health Issue: Schmoke Task Force Shows Way

September 12, 1993|By SANDY BANISKY

For years, Baltimore Mayor Kurt L. Schmoke had been talkingabout drugs: about "medicalizing" the problem, about treating drugs as a public health issue and not just a problem for police.

The trouble was: Most people had no idea what he was talking about.

And so last spring, he appointed the Mayor's Working Group on Drug Policy reform and told its members -- including specialists in addiction, experts in law enforcement, public-health researchers, political allies -- to find ways to reduce his theory to reality. Give City Hall some ideas, he told them, on what to do now, in the ruins left by failed war on drugs.

Wednesday, after 20 hours of debate over four meetings since May, the group drafted a series of recommendations that will be printed in a report due in the mayor's office within two months.

Among the ideas: Support needle exchange programs; expand the number of methadone programs; encourage arrest and prosecution of big drug traffickers but push non-violent users into treatment instead of jail; train doctors, nurses and pharmacists to recognize and treat addiction, instead of ghettoizing drug users in drug clinics.

"In some circles, what we came up with might be regarded as middle of the road," said David M. Altschuler, a research scientist at the Johns Hopkins Institute for Policy Studies and the moderator of the group. "And yet, when you take a look at it and measure it up against what's happening in the rest of the country, it's really very bold.

"In its entirety, if we were to push that agenda forward in Baltimore, it would put Baltimore in the forefront of drug policy."

"I think the mayor was probably relieved to see we were so self-controlled," Kevin B. Zeese, vice president of the Drug Policy Foundation, said with a laugh.

Many of the people named to the working group had never met before the first session. They were assembled in large part by Mr. Altschuler and Dr. Peter Beilenson, Baltimore's health commissioner, who each knew a variety of experts. The Abell Foundation picked up expenses.

But they had one thing in common: They each believed that the country's drug strategies have failed. They believed in "harm reduction," lowering the damage that addiction does to the addict and to society.

Advocates of stricter drug policies were not invited. This was a session about reform, not about perpetuating current policies.

"Otherwise, we would have wasted our time arguing over basic issues," Mr. Zeese said. "We've heard that debate already. Instead of arguing over whether the drug war is working or not, we were able to get on to other issues."

Mr. Schmoke opened the first session, back in May, in a conference room at the World Trade Center. Don't limit yourselves, he told them. Take it wherever it goes.

And then the mayor walked out of the room. At the outset, there was a chance, a small one, that this panel could become a rogue group producing a report so radical that Mr. Schmoke would bTC have to reject it.

But in the end, they proved to be practical visionaries -- mindful of the fact that only reasonable recommendations had any likelihood of being implemented. But first, they ran through all the possibilities in drug reform.

"This is the time for bold action," Arnold Trebach, president of the Drug Policy Foundation, said that day.

So, on the first morning, the ideas abounded: Legalize marijuana? Stop arresting people for just possession of drugs? Offer methadone injections to users who don't like the oral dose? Start giving away needles to addicts immediately, though state law doesn't allow it? Try offering amphetamines to cocaine abusers? Change federal regulations on prescription drugs?

All ideas were considered respectfully. Mr. Altschuler, working at an easel, listed them in marker on large sheets of newsprint, then taped the pages to the wall to allow the group to survey the scope of its interests.

He gave them a structure: For every suggestion, discuss the risks involved. Consider what legal problems the new policy might encounter. Discuss any impact on the medical system and the courts. And weigh the political issues, the odds that Baltimoreans would embrace the idea or reject it.

That system discouraged grandstanding. No one could toss out a radical notion without immediately acknowledging any negative implications -- such as, simply: It's too controversial to ever be accepted.

"We weren't playing to an audience," said Dr. Solomon Snyder, professor of neuroscience, pharmacology, molecular sciences and psychiatry at the Johns Hopkins School of Medicine. "We were talking to each other."

Hour after hour, they talked. The conversation was spirited, but there were no shouting matches. Everyone listened and everyone was willing to accommodate one another's views.

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