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Not-So-Tricky FIX Just say no? Not for a Poly grad and a Hopkins professor, who say the answer for drug addiction is yes--to a treatment plan that worked during the Nixon years and can do so again.

THE BALTIMORE SUN

Journalist Michael Massing has devoted a decade to investigating America's war on drugs. He has talked with peasants in remote coca-growing regions of Colombia. He has combed through dusty boxes of federal archives. He has documented the heroic struggle of treatment workers at a drop-in center in Spanish Harlem. He has watched a heroin addict shoot up in a New York City tenement.

And this is his conclusion:

Richard Nixon was right.

Now there's a sentence you don't see every day. But Massing argues in "The Fix," his fascinating and unforgiving account of U.S. drug policy, that the Nixon administration's approach in the early 1970s resulted in less crime, fewer overdose deaths and fewer drug-related visits to hospital emergency rooms.

Not only would the Nixon plan work today, Massing believes, but it also would cost less.

Interested? Here's the catch: Nixon's drug-fighting strategy included treatment for every hard-core drug addict who wanted it. Massing believes the country could -- and should -- offer the same today.

Still interested?

"I've learned that the c-word -- compassion -- is a real red flag for people," Massing says. "I'm stressing that this is a much more effective and promising approach.

"When you lay out the research and how affordable and generally successful treatment is compared to other approaches, that rings in people's ears."

With "The Fix," recently published by Simon and Schuster, Massing presents a meticulously researched, fact-filled account of U.S. drug policy since the Nixon years. Although the country now spends more than $17 billion a year to fight drugs, and prison populations and costs are soaring, there still remain an estimated 4 million hard-core abusers of cocaine and heroin.

Something's not working.

"It would be hard to think of an area of U.S. social policy that has failed more completely than the war on drugs," Massing writes in the book's opening sentence. The answer, he writes later, is a "new public-health approach to the nation's drug problem, one based not on the punitive powers of the law but on the healing powers of medicine."

Massing, 46, is a 1970 graduate of Polytechnic Institute in Baltimore. Although he now lives in New York, he didn't have to look far from his former home to find the person most responsible for crafting the Nixon administration's successful drug-fighting strategy.

Jerome Jaffe, who lives in Towson, was the nation's first drug czar. A psychopharmacologist, Jaffe had created a network of treatment programs in Illinois when he was picked by Nixon in 1971 to run the newly created Special Action Office for Drug Abuse Prevention.

"I wanted treatment to be so available that people could not say they committed crimes because they couldn't get treatment," Jaffe says. "If somebody becomes dependent, and there's no option for them, and they steal something, society faces a moral dilemma. They didn't provide an alternative, but they're holding them accountable."

Well-founded worries

As Massing's book indicates, it certainly wasn't sympathy for drug addicts that led Nixon's advisers to Jaffe. A heroin epidemic at home, combined with press reports of increasing drug addiction among American GIs in Vietnam, produced well-founded White House worries of a political problem before the 1972 election. Nixon hoped Jaffe would help solve it.

To Massing, this is yet another example of the Nixon paradox. The anti-Communist president who went to China also was the law-and-order champion who did more to help addicts than any president since.

To Jaffe, "Nixon was the ultimate pragmatist. He certainly had strong feelings about drugs. He felt that they corroded the fabric of society. How do you deal with that? One way is to get supply under control. I think he came to realize that you have to deal with the demand side as well."

"The Fix" is much more than a public policy analysis. Massing also tells the gripping stories of Raphael Flores, the obsessively dedicated worker at Hot Line Cares, a walk-in center in Spanish Harlem where addicts could walk in off the street and get help, and Yvonne Hamilton, a cocaine and crack addict.

While visiting a "shooting gallery," Massing says, he was talking to some addicts when a man casually rolled up a sleeve, wrapped a belt around his arm to make a vein appear and plunged a needle into his skin.

"At that moment, looking at him, I fainted," Massing says. "I've always had a thing about needles. I felt totally chagrined. Here I was, the tough reporter, going in and fainting."

But Massing's work in Spanish Harlem -- he spent four years there -- showed him the similarity between what Jaffe was doing in Chicago 30 years ago and what workers such as Raphael Flores were trying to do today.

Both believed help needed to be available as soon as addicts requested it. Otherwise they may never be seen again. And both discovered that different addicts require different methods of treatment. Some require structure. Heroin addicts might require methadone, a synthetic narcotic that allows some to lead productive lives. Some addicts reject formal programs. And some don't get better the first time. Or the second. Or the third.

Today, Jaffe says, "it's clear that there's a certain sense that treatment doesn't work, and I think it's more an issue of values than it is an issue of facts."

In fact, Massing says the research is clear: Treatment is the most cost-effective method of reducing drug addiction. He cites a 1994 RAND study that showed treatment is seven times more cost effective than arresting people, 10 times more effective than keeping drugs from entering the country and 23 times more effective than attacking drugs at their source.

The effects of treatment

"It's amazing to think that even while somebody's just in treatment, it pays for itself, dollar for dollar, in reduced crime, reduced medical problems, reduced havoc in the country," Massing says. "It pays for itself. Everything else is a bonus."

With Jaffe as drug czar, thousands of addicts sought treatment in 1972. The amount of time they were forced to wait for a bed decreased dramatically. And so did crime. FBI figures in 1972 showed that crime rates dropped in 94 of 154 U.S. cities with a population of more than 100,000. Nationally, the crime rate decreased for the first time in 17 years.

Although Jaffe says other factors likely contributed to the lower crime rate, he notes that 90,000 people entered treatment programs when he was in charge. "An awful lot of people stopped behaving the way they did."

Despite the successes, the Jaffe method was an easy target. Methadone treatment always has been controversial, and no politician has ever won an election by advocating more treatment for addicts. Mandatory prison sentences for drug offenders have proven more popular among voters than reducing the wait for a hospital bed. The Reagan administration eventually cut the treatment budget by 25 percent.

"If you have a population that's tougher to treat at the same time you cut the resources in half, you make it very tough to get good results," Jaffe says.

Massing says an estimated 1.7 million people, nearly half of the nation's hard-core addicts, couldn't get help today even if they wanted it because of a lack of treatment beds. If Congress did nothing more than balance the money spent on supply and demand (law enforcement vs. treatment), those addicts could get treatment, he says. "It's not radical," he says. "It's do-able."

But Massing says it will take another president with strong law-and-order credentials -- "I hate to say it, a Nixon-like figure" -- who can shift the emphasis from law enforcement to treatment. He says governors complain privately about the high cost of imprisoning drug offenders.

"Money is going from education into prisons," he says. "I think people are going to start saying this is not a good development. They're going to see that drug abuse continues to plague us. My hope is that there will be a new openness."

The answer, he says, is neither drug legalization nor HTC throw-away-the-key sentencing.

"This policy has been a disaster in political and human terms," he says. "We're seeing hundreds of thousands of people locked away. I would like to see a more humane policy."

Jaffe left the White House in 1973. He later served as director of the Addiction Research Center in Baltimore and as acting director and senior science adviser at the National Institute on Drug Abuse. Now 65, he's a visiting professor at Johns Hopkins University and a professor of psychiatry at the University of Maryland School of Medicine in Baltimore.

He helped create a drug policy that worked in every respect except politically. It must be frustrating for him.

"Not frustrating," he says. "That's not the right word. It's sad. I guess you get used to the way that public policy doesn't always follow a logical path, at least as I saw that logical path."

Science and public policy rarely move in lockstep, he says. He refers to a research paper that says even though it was known in 1601 that three teaspoons of lemon juice would reduce scurvy deaths, it took the British Navy almost 200 more years to give citrus juice to sailors on a regular basis. Change takes time.

"I don't take it personally," Jaffe says of U.S. drug policy. "I did the best I could as God gave me the ability to see the light. When it's your turn, you step down and let others take it from there."

Reading

Michael Massing will read selections from "The Fix" at 7 p.m. Jan. 7 at Barnes and Noble in Towson, 1 E. Joppa Road. Dr. Jerome Jaffe will introduce Massing.

Pub Date: 12/29/98

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