An Old City Seeks a New Model

In early December 1984, an undercover police officer named Marcellus Ward met with a pair of heroin dealers above a candy store in southwest Baltimore. Ward had planned to make a buy, then an arrest. But when Drug Enforcement Administration agents stormed into the building, one of the dealers panicked and shot Ward to death. The next day, Kurt Schmoke listened to the recording from Ward's body wire. A friend of the slain detective, Schmoke was then Baltimore's 35-year-old chief prosecutor. The incident, he would say later, prompted him to rethink the drug laws he had spent six years enforcing: Setups and stings and jail terms hadn't curbed the violence associated with the drug trade, let alone reduced drug use.

In 1988, soon after his election as Baltimore's mayor, Schmoke proposed easing many drug laws and repealing others--in part to undercut the black market, in part to focus resources on reducing demand. It was startling talk from a big-city mayor, and Schmoke's call for decriminalization got him on Nightline and on the front page of the New York Times. But of course no mayor can decriminalize drugs. Schmoke was soon overshadowed by national drug czar William Bennett, who preferred escalation of the drug war, not reform.

In 1992 Schmoke returned to the drug issue--this time with a strategy that went beyond rhetoric. That year he appointed Peter Beilenson, then 32, a young and relatively inexperienced doctor, as health commissioner. The two officials then set about increasing capacity for drug treatment, pledging to continue until they reached "treatment on demand." In the past three years, the city's treatment slots have doubled, making Baltimore a case study for the promise--and problems--of universal drug treatment.

Aside from Baltimore, San Francisco is the only locality to even set a goal of guaranteed, immediate treatment for any drug user who wants it. But San Francisco has the luxury of booming tax rolls, while Baltimore is characteristic of declining cities with the most pressing drug problems, the most need for change and the least resources. With an estimated 60,000 addicts, the city regularly ranks first on lists of drug-related emergency-room visits and per capita violent crime. The city has lost at least 200,000 people since 1970, and its population drops by another 1,000 each month. Boarded up or burned-out homes scar most blocks--in total, 40,000 are abandoned. When I accompanied police Lieut. Michael Kundrat on his evening shift through the Western District, he pointed out each of the area's fifteen active streetcorner drug markets, which he largely blames for forty-five murders (out of 314 citywide) last year. "If you ask what is one of this city's biggest problems," he says, "there's no question that it's drugs."

When Beilenson went over the budget in 1995, he found that the city was missing its best opportunity to ameliorate that problem. Of $15 million spent annually on treatment, only $350,000 was coming from the city. And the city's 4,000 slots could serve only 12,000 people a year--a pittance compared with the total addict population. Last year Schmoke ordered city departments--including police, housing, social services and health--to come up with budget cuts totaling $10 million over three years. That, plus new state money and grants from the local Abell Foundation ($1 million a year for three years) and George Soros's Open Society Institute ($2 million), pushed the total drug-treatment budget to $32 million and the number of slots to 7,500. At the end of this year, the slots are expected to number 8,100.

Critics note that it's taken Schmoke more than a decade to reach these goals. Others say that if he deserves credit for the drug-treatment plan, it is for hiring Beilenson and giving him wide latitude. Beilenson grew up in West Los Angeles the son of a state legislator (later congressman). His interest in drug policy--as with his other focus, universal healthcare--is that of the pragmatic liberal, not an experienced user. (Beilenson says he's never tried illegal drugs. When he notes, "I know what a speedball is. I know what a cooker is. I know what ice is," he sounds like a proud student.)

The soft-spoken Beilenson quickly shook up a system that had grown lethargic. Two years ago he spent an afternoon calling the city's public treatment centers, telling them he was "Todd Jackson," a three-times-a-day heroin user for four years, and asking "When can I start treatment?" Only one of the twenty-three programs he called would even put him on the waiting list; the others insisted he call later or come in person. He visited three other treatment centers but none would let him through the doors--telling him, via intercom, to come back when they were open for intake. So Beilenson ordered the programs to coordinate their intake, and he created a citywide referral line.

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