A proposal for a research trial in which doctors would provide heroin to some Baltimore addicts came under fierce attack yesterday from elected officials as a symbolic step in the wrong direction.
"It doesn't make any sense," said Gov. Parris N. Glendening. "It sends totally the wrong signal."
"Do we go from 'Baltimore, the city that reads,' to 'Baltimore, the city that nods'?" asked City Council President Lawrence A. Bell III, using the slang term for the sleepy euphoria of the heroin user.
Mayor Kurt L. Schmoke reined in his health commissioner, who had expressed strong support for a trial of heroin maintenance, saying he wanted "to make it real clear that this administration has no intention of initiating a heroin maintenance program."
Dr. Peter L. Beilenson, the health commissioner, had not proposed distributing heroin from city Health Department clinics or with city money, but he had urged John Hopkins University drug abuse experts to pursue an academic study. Schmoke said he does not want Beilenson to be "spokesman" for the idea.
"Any further discussion about heroin maintenance and how it relates to the city of Baltimore will come out of the university community and not the local government," Schmoke said.
The mayor received national attention about 10 years ago for advocating "decriminalization" of drug use, and he told The Sun in April he would consider having Baltimore participate in a multicity heroin maintenance experiment. But in that interview he also expressed concern that such a program could prove so controversial as to be counterproductive, and yesterday he appeared to reach that conclusion.
"We've gotten such good support from the public [for a health care approach to drug abuse] that I don't want to lose that support because they feel we've gone in a direction they are not comfortable with," he said.
But Dr. Alfred Sommer, dean of the Johns Hopkins School of Public Health, said the criticism should not be permitted to stifle scientific inquiry.
"It's discouraging to hear people say they're absolutely against this before they know anything about it," said Sommer. "That's not the way to advance public policy or to find ways to protect public health."
Sommer cited data from a Swiss study that tracked more than 1,000 addicts over three years. "What we've learned so far is that such programs can dramatically improve the health of those addicted to heroin," as well as reducing crime, increasing employment and moving some people into treatment or off drugs altogether, he said.
Sommer said he wants Hopkins to help organize a conference to bring local and state public health officials together with drug treatment specialists and community leaders to discuss heroin maintenance.
"Does it make sense in Baltimore? I have no idea," Sommer said. "It's going to take a lot of debate and discussion."
Drug abuse experts, including some from Baltimore, gathered in New York over the weekend to hear about the Swiss experience with heroin maintenance and plans for similar experiments in Spain and the Netherlands. Several Hopkins drug abuse experts and Beilenson recently discussed joining with other cities to try offering heroin to a limited number of the hardest-core drug addicts who have not responded to treatment.
Advocates of the concept say the war on drugs has failed and new approaches should be tried. Several hundred public figures, including Schmoke and Beilenson, signed a letter in the New York Times Monday declaring that "the global war on drugs is now causing more harm than drug abuse itself."
Drug policy reform advocates say heroin addicts now steal to support their habits and spread AIDS by sharing needles. Administering injections of heroin in clinics to people already addicted would at least reduce theft and curb HIV transmission; it might lure otherwise unreachable drug abusers into counseling that eventually could get them off drugs, the advocates say.
Baltimore City Councilman Norman A. Handy Sr., a minister from the southwest 6th District, was one of the few public officials to express such a view yesterday.
"If we don't do [heroin maintenance], some other city will do it," Handy said. "And even if we don't do it, it should be discussed. Obviously, this war on drugs is a failure, and we need to fire all the generals."
But many addiction experts say funding for traditional drug treatment falls far short of the demand, and heroin maintenance is a dubious distraction from proven remedies for drug abuse.
"Even as a research proposal, I think it's a bad idea," said Dr. Georges C. Benjamin, the deputy state health secretary who oversees drug and alcohol treatment. "I think to translate the Swiss data to this very different culture is a very big jump."