Gov. William Donald Schaefer, who previously has opposed Baltimore's efforts to launch a needle exchange program, said yesterday he would support emergency legislation allowing the city to dispense clean syringes to drug users.
His announcement, which was quickly embraced by Mayor Kurt L. Schmoke, came a day after the mayor and city Health Commissioner Peter Beilenson said they intended to soon start an exchange program for about 1,000 drug users.
In seeking to prevent intravenous drug users from spreading the AIDS virus through shared syringes, the city has lined up a prospective clinic in an impoverished neighborhood with heavy drug traffic.
Baltimore has been frustrated in offering an exchange program because the General Assembly refused earlier this year to exempt the city from a state law prohibiting the distribution of syringes and other drug paraphernalia. Mayor Schmoke said Wednesday that the city was exploring ways to surmount that legal barrier.
Worried that the city would circumvent the legislature, Mr. Schaefer said he would go along with a strictly regulated program on a pilot basis. He added that he still personally opposes needle exchanges.
Mr. Schaefer's willingness to go along with the city's plans avoids a prickly legal complication. Dr. Beilenson approached Attorney General J. Joseph Curran Jr. about a month ago to discuss the legal consequences of opening the center.
The attorney general said he advised Dr. Beilenson that the only way to bypass the 1976 drug paraphernalia law would be to go to court and declare a medical emergency in Baltimore.
That move, Mr. Schaefer said yesterday, would have been "a terrible mistake."
"There is no medical emergency that wasn't there some time ago," he said.
Instead, he proposed that top state officials, including Public Safety Secretary Bishop L. Robinson, Juvenile Services Secretary Mary Ann Saar, Health Secretary Nelson J. Sabatini, and possibly School Superintendent Nancy S. Grasmick, work with city officials to develop a test program that all could support. The governor said he would endorse a strict program to which they all agreed.
Mayor Schmoke, who has maintained that a needle exchange is critical to making inroads in the AIDS epidemic among Baltimore's drug users, said he was happy to wait a few more months for state approval.
"The reason I continue to talk about it is that AIDS has become the No. 1 cause of death among people between the ages of 25 and 44," he said. A needle exchange "is vitally important if we are to combat the spread of AIDS."
The Johns Hopkins University School of Hygiene and Public Health estimates that about one-quarter of the city's 40,000 drug addicts carry the human immunodeficiency virus. Four to five more are infected each day, Dr. Beilenson said.
While the deadly disease used to be found predominantly among homosexual men, about 70 percent of the cases in Baltimore today are among intravenous drug users. Studies have shown that the virus that causes AIDS is spread rapidly among shared needles, and bleach has done little to stop it, Dr. Beilenson said.
Mr. Schmoke said the task ahead is to convince state lawmakers that "everybody's at risk," from infants born to drug-using mothers to young men or women dating someone who experimented with heroin. During the last General Assembly session, the House Judiciary Committee rejected a bill that would have allowed the pilot program by a 13-11 vote. Opponents said they feared it was tantamount to a state sanction of drug use.
"The biggest problem that we've had to overcome is that people think that it is someone else's disease," said Mr. Schmoke. He emphasized that the entire pilot program would cost only about $160,000, as compared with the $120,000 cost for treating each new AIDS case.
Baltimore's clinic would be staffed by health educators and nurses to offer counseling and medical services, including testing for tuberculosis and AIDS.
While 16 other cities exchange clean needles for dirty ones, only New Haven, Conn., provides treatment to get addicts off drugs.
Mr. Schaefer said if the pilot program is tightly regulated to prevent making needles more widely available, an emergency measure could be introduced in January and enacted within the first 30 days of the session.
The measure could go into effect immediately.
Del. R. Clayton Mitchell Jr., speaker of the House of Delegates, said, "I think the right approach is to bring it back to the legislature and let us take a look at it."
But the Kent Democrat would not speculate on whether the legislature would go along with such a plan.
Del. Howard P. Rawlings, a Baltimore Democrat and chairman of the Appropriations Committee, said he supports the concept and thinks the legislature will, too.
"I think the legislature would support a well-crafted bill with a very thoughtfully designed needle exchange program as a pilot," he said.