Beyond the iron gate, the fence and the razor wire, 10 inmates in maroon uniforms sit in stillness, listening to the serene sounds of sitar music. Eyes closed, hands folded, they await the tiny pricks of acupuncture needles being inserted delicately in their ears.
Ancient Chinese medicine came to Baltimore's jail 16 years ago with the promise of curbing the cravings of drug addiction. Since then, acupuncture has been the centerpiece of a treatment program that serves nearly 700 inmates each year.
Modern science has not found solid evidence that it works. Still, the inmates claim that with acupuncture, all they crave are the meditative moments it brings. They say it soothes them and helps clear their cluttered minds to find the strength to confront their addiction.
"I've done buprenorphine and methadone, but neither one of them could compare to those needles," says Derrick Brooks, 42, who's battled heroin his entire adult life. "Those needles put you in touch with stuff that's within you that no pill or nothing else could do."
District Judge Jamey H. Hueston thinks every addict should try it. "I am a huge fan of acupuncture," says Hueston, who presides over the city's drug court. "I have sent people in there kicking and screaming, resentful and scowling at me. And later they say, 'Judge, thank you.' "
Acupuncture is the key element of the Addicts Changing Together Substance Abuse Program administered by the city's drug court. Beginning for women in 1993 and for men three years later, the program steers nonviolent offenders to a rigorous 45-day behind-bars regimen in lieu of a longer prison sentence.
In addition to 25 acupuncture sessions, inmates get group and individual counseling, GED training and life-skills classes. Recently, the program added a family mediation option for addicts who long ago burned family bridges but want to mend them.
Participants reside in a separate dorm at the Baltimore City Detention Center, away from the general population, and are encouraged to rely on each other for support.
The theory behind the acupuncture treatment is that it releases naturally occurring chemicals in the body that ease the symptoms of drug withdrawal and help users fight their addiction.
An acupuncturist places superfine stainless-steel needles in five points in the outer ear, each one designed to evoke a particular feeling, from calming the spirit to acceptance to reminding a person of his own willpower. The recipient then sits quietly for 30 to 40 minutes. Lights are dimmed, and soft music plays to promote meditation.
Eastern medicine experts say what is at work is not just New Age wishful thinking.
The treatment causes the body to release feel-good chemicals called endorphins, which go to the same receptors in the brain that are turned on when someone takes drugs, says Dr. Lixing Lao, director of the traditional Chinese medicine program at the University of Maryland's Center for Integrative Medicine.
The technique works to treat pain in the same way, says Lao, who works closely with Maryland Shock Trauma Center, treating patients who have been critically injured.
"The concept is very obvious," he says. "If acupuncture works for pain, it should work for heroin addiction."
In the 1970s, doctors in a New York hospital began trying the ancient technique to treat heroin addiction. Since then, acupuncture centers have popped up around the world.
At a cost of $40,000 a year for all 688 inmates, the acupuncture portion of the city jail program is cheap by most treatment standards. But its supporters stress that it must be used with counseling and other services to be effective.
The state Division of Correction does not track inmates after they complete the program and does not keep data on whether addicts stay clean. But Mohammad Riaz Ahmad, the program's director, points to studies elsewhere that suggest acupuncture's effectiveness. A Yale University study found that 55 percent of participants tested free of cocaine during the last week of acupuncture treatment, compared with 24 percent and 9 percent in two groups that did not have acupuncture. But a follow-up study contradicted the earlier findings, and researchers said the topic needs more research.
A 2001 study of an acupuncture program at Baltimore's Penn North Neighborhood Center found that nearly a third of patients stayed in the program for at least 30 sessions, or about three months, and that their rate of being arrested and charged decreased.
"We are not saying it's curing addiction - there is no cure for addiction," says Dave Wurzel, a certified acupuncturist whose firm does the jail's treatments. "Just like there is no cure for heart disease or diabetes. All we are doing in addiction treatment is lowering the risk factor that this person will die today of his or her addiction."
Officials with the jail program say the big problem comes when it's time for participants to be released.
About 80 percent of inmates who complete the program need the structured support of a residential treatment facility for as long as a year afterward, officials say. But demand for such treatment is so great that the facilities don't bother to keep a waiting list, says Gregory C. Warren, who heads Baltimore Substance Abuses Systems, the quasi-governmental agency that oversees drug treatment in the city.
So graduates of the acupuncture program are often referred to outpatient programs instead of residential centers. And if even those slots are full, the inmates sometimes must be held in the general prison population for up to several weeks until a treatment space opens up.
"If it's one day, it's bad," says Danny McCoy, the detention center's assistant warden. "Back inside the institution, they are encountering all the things and people that would defeat the purpose of all they have learned in the treatment process."
The lure of the street is even worse, says Brooks, who took part in the jail's acupuncture program a decade ago. He stayed clean for six years.
He had started selling drugs at age 12, the same year his mother moved in with her boyfriend and left him to largely fend for himself. At 17, he snorted heroin for the first time.
But after his first stint in the acupuncture program, he felt transformed. He fell in love, got married and had a baby boy. Brooks worked two jobs and the family lived in a house they rented but hoped to buy.
Eventually, though, he started hanging out with old friends in the drug game, and stopped going to church and to Narcotics Anonymous meetings. One day, he tried a "tester" of heroin being hawked on a corner. Just one hit, he thought. By the time he was arrested last year, he was doing $200 a day worth of dope.
"I gave back six years in three seconds," he says, wiping away tears. "Why? Please don't ask me that. That's why I'm here now, trying to figure out why."
Brooks graduates this week, complete with a cap, gown and celebration. But he doesn't want any accolades. He knows his biggest accomplishment lies ahead.
"When I get back in society, that's when the real test comes," he says. "This is nothing compared to what I got to do."