THE NUMBERS are appalling: An estimated 60,000 Baltimore residents -- one of eight adults -- are addicted to drugs, many simultaneously abusing heroin, cocaine and marijuana. The surrounding counties are believed to have 60,000 more addicts.
Out of these numbers flows a river of misery: Last year, police say, drugs were involved in more than 75 percent of the 314 slayings that made Baltimore one of America's most murderous cities. Drug dependence spawns other criminal activity, from break-ins and holdups to prostitution and panhandling. About 85 percent of suspects in pretrial incarceration have a drug habit.
"This is the biggest problem in the city," says Health Commissioner Peter Beilenson. "If we really want to address the economy and crime, we have to address treatment."
Some progress has been made. Drug courts, which sentence offenders to treatment rather than to prison, have become common. On June 1, city probation officers were given unprecedented rights to monitor judges' treatment orders. Without having to go back to court, they can apply an escalating scale of sanctions, culminating with jail time, against an offender who fails drug tests.
Under Mayor Kurt L. Schmoke, drug treatment spending has doubled to $33 million a year from $16.5 million in 1996. Yet leaders cannot agree on the most effective use of these funds.
Lt. Gov. Kathleen Kennedy Townsend, who heads a statewide task force on drug treatment and has emphasized criminal justice in discussing a run for governor in 2002, thinks most available funds should be used to wean lawbreakers from addiction. "You've got the stick of prison time to get people into treatment," she explains.
Mr. Schmoke prefers a voluntary approach. "I view the addicts more as patients to be treated than persons to be incarcerated. I want to get to them before they get into the criminal justice system."
This dispute has impaired state-city cooperation. While government grants have so far been unaffected, such a visible rift about philosophy and spending priorities could cost the city needed drug-treatment dollars.
It is already hampering efforts to raise private matching funds for foundation grants to increase drug treatment in the city.
The dispute between Ms. Townsend and Mr. Schmoke is perplexing because the two officials agree on so many other things. Both see treatment as preferable to locking up addicts; both share a liberal Democratic outlook on social policy. Yet strong convictions, ambition and turf protection, combined with a shifting national drug policy, have prevented them from harmoniously pursuing a goal they share -- combating drug victimization.
Mr. Schmoke, who will end his 12-year tenure as mayor in December, established his credentials as a drug reformer soon after arriving at City Hall. In 1988, he proposed a national debate on drug decriminalization. In 1993, when that effort failed to materialize, he asked President Clinton, a longtime personal friend, for $30 million to launch a national pilot program in Baltimore to treat all addicted people wanting help. The city did not get the money.
The idea of using the city as a model cropped up again three years later. It was recommended to Lieutenant Governor Townsend by a task force financed by the White House's drug policy office. That panel, the Washington/Baltimore High Intensity Drug Trafficking Area (HIDTA), strongly criticized the city and recommended that it give treatment priority to criminal offenders. "Reducing recidivism of chronic hard-core offenders means less criminal activity," the report said, referring to the prevalence of addiction among lawbreakers. "It also means safer streets and higher quality of life for Baltimore City residents."
HIDTA is one of 21 regional anti-drug task forces overseen by retired Gen. Barry R. McCaffrey, the White House drug czar. Its territory spans Northern Virginia to Baltimore and its suburbs.
While all other task forces have concentrated on providing law enforcement the tools to fight a more effective drug war, the Beltsville-based Washington/Baltimore HIDTA has taken advantage of the Clinton administration's recent interest in medical alternatives and advocates mandatory treatment for criminals.
The group's studies trumpet the success of its approach. A recent survey tracking 1,216 offenders contends "quality treatment with supervision" reduced the probability of rearrest by 50 percent.
One of the authors of the study -- and of many previous ones -- is Faye Taxman, a top HIDTA official who is also Ms. Townsend's chief scientific adviser on drug addiction. Her overlapping roles have established the University of Maryland research professor as a powerful behind-the-scenes figure. Ms. Taxman, who has a Ph.D. in criminology, is controversial, not least because of her readiness to render opinions on medical issues.