Can Heroin Maintenance Help Baltimore?

February 2009 / Abell Reports / Criminal Justice and Addiction, Health and Human Services

What Baltimore can learn from the experience of other countries.

Baltimore City in particular has been adversely affected by the problem of heroin addiction. Whether measured by the number of heroin-related deaths per capita, heroin treatment admissions, or HIV related to heroin injecting, Baltimore City has for decades been the leading or close to the leading city in the United States. Even the massive expansion of Baltimore City’s treatment programs that has occurred since 1995 has failed to rid the city of the problem.

Given that tougher enforcement and greater treatment provisions have not managed to make a large dent in the harm that heroin causes Baltimore City, there is a continuing desire to consider more radical  solutions. In November 2007, the Baltimore City Council once again considered a bill proposing the legalization of drugs, hardly a realistic option given the federal government’s views on, and role in, drug policy.

There is, however, a less radical, though still bold, innovation that has received attention from time to time in Baltimore City: heroin maintenance. Under this option, heroin users who have tried and failed in other kinds of treatment, including methadone maintenance, are provided heroin in the context of a medically supervised facility. The assumption is that if an addict has cheap access to heroin
in safe conditions, many of the harms of the drug will disappear; the risk of overdose will become minimal, and the addict will no longer have to commit numerous property crimes, or sell to other users, in order to finance an extremely expensive habit.

There are many arguments against this assumption, involving both principle and pragmatic considerations. For example, in the heroin maintenance program, the government appears simply to be providing addicts with what they want rather than curing them of a dependence that prevents them from leading productive and socially engaged lives. Others assert that these programs lead to an increase in heroin initiation because they make the consequences less harmful. Nonetheless, a small but growing number of Western nations are experimenting with heroin maintenance. In two European countries, the Netherlands and Switzerland, heroin maintenance is now a routine treatment option, available to most heroin addicts, though taken up by few. Germany, the United Kingdom, and Spain are seriously considering the option. Canada has experimented with heroin maintenance in two cities, Vancouver and Montreal. The treatment evaluations, which are of varying quality, generally show positive results; none show negative results.

The purpose of this study is to provide interested citizens, specifically in Baltimore City but elsewhere in the U.S. as well, with a summary of what is known about heroin maintenance as of early 2008. The study does not make recommendations as to whether Baltimore should adopt this option, which would require a great deal of legal change, because the issue involves important and controversial value judgments. However, the study does aim to allow citizens to develop an informed position by presenting an examination of the concerns that have been raised about the option.