Hoping to curb the spread of HIV, Baltimore officials want to hand out thousands more needles to drug addicts than Maryland law now allows.
Since 1994, city Health Department vans that work with addicts have traded clean syringes for used ones in a one-for-one exchange, currently distributing 500,000 needles a year. City officials say that system hasn't stopped enough heroin addicts from sharing or reusing needles and spreading disease.
So the Rawlings-Blake administration is asking the General Assembly to pass legislation allowing the city to distribute as many syringes as an addict needs — no strings attached — as is done in New York, Chicago, San Francisco and Vancouver. That means 500,000 to 1 million more needles a year would be given out.
"Baltimore continues to have a problem with HIV infection," said Baltimore's health commissioner, Dr. Oxiris Barbot. "We're concerned about hepatitis C infections. This is an opportunity to decrease those rates."
There are about 14,000 people in Baltimore with a diagnosis of HIV or AIDS, about 2 percent of the population. The city's Needle Exchange Program, now in its 20th year, provides syringes to about 2,500 people annually.
City officials say the program has been successful. In 1992, 53 percent of Baltimore's HIV-positive population contracted the virus through intravenous drug use, according to the Health Department. That dropped to 17 percent by 2009 and 12 percent by 2012.
Barbot said Baltimore's one-for-one needle exchange program results in addicts using clean syringes about 42 percent of the time. But she said programs in cities that distribute needles "as needed" get them to use clean syringes about 61 percent of the time.
Mayor Stephanie Rawlings-Blake calls the requested legislation "common sense" and says it's one of the most important bills she's pushing in Annapolis this year.
"There will be less exposure to dirty needles," the mayor said. "Cities that have gone to a needs-based exchange have seen AIDS reduced."
If the legislation is approved, the budget for distributing needles would need to be increased from about $35,000 to $55,000, officials said.
Not everyone sees the move as a good idea. Mike Gimbel, an independent consultant who formerly headed Baltimore County's Office of Substance Abuse, said he believes that having more clean needles would encourage addicts to keep using drugs. He said used syringes could be sold or proliferate as litter on city streets.
"I don't want to see more needles on the street," Gimbel said. "The needle to a heroin addict is gold, especially a new needle that's sharp. They'll sell them to other addicts."
Gimbel said he contracted hepatitis C from injecting heroin as a teenager 40 years ago and is undergoing treatment for the infection.
"I've never been a fan of needle exchange," he said. "I don't believe that harm-reduction programs convince addicts to get help. Addicts don't usually stop until they reach a level of pain. The reason I stopped is I was afraid I was going to die."
State Sen. Verna Jones, who heads the city's Senate delegation, said she won't support the bill without changes. She says the number of needles distributed should be capped.
"It shouldn't be a syringe on demand," she said. "There should be a ceiling on it."
But Del. Curt Anderson, chairman of the city's House delegation, supports the mayor's proposal, pointing to evidence that the city's needle-exchange program has been successful.
"One of the reasons why it was initially set at one-to-one is we wanted to get the bill passed, and we were going to face conservative opposition if we were just giving out a ton of free needles," he said. "We won't face as much opposition now because the program works."
Anderson recalled how Dr. Maxie T. Collier, a former city health commissioner and early supporter of needle exchanges, "predicted an epidemic of the AIDS virus hitting Baltimore, like a Third World country."
"That never happened," Anderson said. "The fact that it didn't makes me think we've done well."
Barbot said addicts in Baltimore say they now use needles two to four times before turning them in to the Health Department. She said city officials would still require addicts to turn in the old needles in their possession and that it's highly unlikely that offering more clean needles would create drug users.
"The reality is, we don't get clients who come in starting to look at using drugs," she said. "While Baltimore was one of the first cities to institute a syringe exchange, it's one of the last major cities to change to a needs-based exchange."
The mayor's legislative initiatives for the 2014 General Assembly include several bills she says will help fight crime and encourage development.
She wants the Assembly to prevent individuals with outstanding criminal arrest warrants — there are 38,000 such outstanding warrants in Baltimore — from receiving a state income tax refund. Rawlings-Blake wants legislation empowering judges to track "gang-related" crimes in hopes of helping prosecutors gain tougher sentences for repeat, violent criminals.
She is also asking that the state consider increased penalties for illegal dumping and for assaults on traffic enforcement officers — there were 19 such assaults last year — and extend tax credits that she believes help attract and retain city residents.
"We've got a good track record of getting bills passed, and we're pretty judicious in deciding what bills we put forward," Rawlings-Blake said.