A 13-YEAR-OLD GIRL IS killed by a stray bullet during a dispute over drugs on a Baltimore street. A mugger, presumed to be a drug addict, robs and kills a minister for $15. The venereal disease rate soars, as prostitutes sell themselves for drug money. The city records more than 300 homicides per year -- 75 percent drug-related.
For the drug addict locked into the madness, salvation is fleeting. Pleas go unheeded, because a lack of available treatment leaves junkies returning to the heroin needle or crack pipe.
As the city's Sept. 14 mayoral primary election nears, Baltimore's growing legion of recovering addicts say drugs will continue destroying city neighborhoods unless the next mayor makes treatment within 24 hours -- "treatment on demand" -- a reality.
City addicts wanting to kick their habits must wait at least 11 days for outpatient help or close to a month for more successful residential treatment. Although the city has made great strides during the past 18 months, doubling treatment capacity, Baltimore health officials concede that they are only halfway to their goal.
"I feel helpless," said a recovering addict who is active in Narcotics Anonymous and often hears the pleas of addicts in need of treatment. "Outside of sending them to a Narcotic Anonymous meeting, I'm helpless. And coming to ask for help and experiencing rejection makes their plight that much more hopeless."
All of the city's leading mayoral candidates have promised to implement treatment on demand. Yet finding the money will be difficult for the city's 47th mayor, who also will face a $153 million projected budget deficit over the next four years.
Narcotics Anonymous members say the estimated $30 million necessary to ensure citywide drug treatment is no longer an option but a necessity much like police protection, trash pickup and fire service.
"Treatment does work, it makes a difference," said Doug Anglin of the UCLA Drug Abuse Research Center. "If you have a million dollars, put it into drug treatment if you want an effect. If you put it into police enforcement, you might not see it."
Since 1996, city funding for drug treatment has more than doubled, from $16 million to $33 million. The number of treatment slots has nearly doubled, from 4,100 to 8,000, giving the city the ability to reach 24,000 uninsured addicts annually. An estimated 60,000 addicts live in the city.
Two of the leading mayoral candidates, City Council President Lawrence A. Bell III and Councilman Martin O'Malley of the Third District, have emphasized turning off the city drug supply by shutting down open-air drug markets. Both favor "zero tolerance," a strategy based on aggressive policing that has reduced violent crime in cities such as New York and Cleveland.
Yet drug abuse experts say the enforcement aspect is only half of the answer.
"Unless you do something about demand, new suppliers will swoop right in," said City Health Commissioner Peter L. Beilenson.
Both Bell and O'Malley say they support extending more funding for treatment but not until the city's current programs are studied for efficiency.
Mayor Kurt L. Schmoke set up Baltimore Substance Abuse Systems Inc. to monitor 44 drug treatment contractors in the city. Critics maintain that the agency's 30-member board is too large to be efficient. They also point to program completion rates that are among the worst in the state and question whether the city is holding treatment operators accountable -- accusations that Beilenson and other city health officials dispute.
Treatment operators in the city commend the agency, saying that they are able to offer more efficient services and obtain money to conduct studies on the success of patients. The best course for the next mayor, they say, is to continue Schmoke's dream of treatment on demand.
"We have not given the city folks the credit due to them," said Ruth Daiker, director of the Counseling Center, with offices in Govans and Hampden. "In the past, we never had extra dollars, and although you can never get enough treatment, it has improved 100 percent."
Debate has also risen over whether treatment should be offered to addicts voluntarily or forced on them after they have brushes with the law.
O'Malley leans toward forcing addicts to get clean. He is skeptical about spending another $30 million without knowing if current funding is providing a proper return.
"I have prosecuted drug addicts, and I've defended drug addicts, and I can say that government's response is woefully inadequate," O'Malley said. "I have represented a number of people who are addicted to drugs, and it took an arrest or maybe a subsequent arrest to coerce them to get help."
O'Malley proposes increasing the charge for court costs to raise $17 million statewide to help pay for more drug treatment. He favors an increase in in-patient programs to get addicts off the streets, and he wants out-patient centers to remain open 24 hours so recovering addicts with jobs can be accommodated.
Bell proposals
Bell, too, has ideas on how to pay for treatment. The 12-year council veteran said he would try to obtain up to $10 million a year in state proceeds from the tobacco settlement. Bell would also seek to use unbudgeted city revenues to help pay for treatment.
Bell also favors increasing the number of residential drug-treatment slots.
"If we can get another substantial increase in beds over a year or the next two, we should be able to get people off drugs," Bell said.
Former City Councilman Carl Stokes endorses treatment on demand, saying that he would increase city funding to strengthen the program. But he has not explained how he would fund it. Stokes maintains that he could find up to $100 million in wasted dollars in the city budget.
Including after-care
In his campaign stops, Stokes has mentioned studies showing that treatment was seven times more effective than investing in law enforcement. Like Schmoke, Stokes leans toward community policing and voluntary drug treatment.
"Long-term treatment must include after-care," Stokes said. "Sending the recovering addict back into the life that made drugs appealing in the first place won't work."
The one mayoral candidate who has made drugs a chief plank of his platform is A. Robert Kaufman. The founder of the City Wide Coalition citizens groups has urged the government to create clinics that would sell drugs to addicts at cost and track them for rehabilitation.
Johns Hopkins University has discussed creating a heroin maintenance program, which has been denounced by leaders ranging from Gov. Parris N. Glendening to Schmoke. They say the public is not going to support such treatment. Kaufman believes that the quickest way to cut off the demand is to take the profits out of drugs, which also would reduce the bloodshed.
"Talk to guys on the street, and just ask them what would happen if the drug markets are closed," Kaufman said.
Recovering addicts maintain that treatment is the solution.
Consider this 53-year-old former heroin addict, who asked that his name not be used. He has been clean for three years and works in a city job. He lives in the southwest Baltimore neighborhood of Poppleton, where he helps addicts seeking help. Most recently, he has been busy ripping campaign signs from vacant buildings in his community.
Like many recovering addicts, he is touched by the pleas of addicts who desperately want to kick addiction. He often burrows through the red tape, trying to find an open bed for an addict. But he worries that the slightest delay will lead the hopeful back to drugs and crime.
"You have to be ready with treatment that instant, because the feeling may only come over them once," he said. "When you go back to find them, they could be dead."
, Gerard Shields is covering the mayor's race for The Sun.