The Crisis in Baltimore | How heroin and opioids have turned “Charm City” into the heroin capital of America
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The Crisis in Baltimore How heroin and opioids have turned “Charm City” into the heroin capital of America

, Political Reporter
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Though nicknamed “Charm City,” Baltimore has become infamous as the muse for the gritty HBO series “The Wire,” which explored the grim reality of a city plagued by drugs, violence and poverty. In a city of 621,000 people, Baltimore health officials estimate there are 60,000 drug or alcohol addicts — 48,000 of them addicted to heroin.

Dubbed the “heroin capital of the United States,” Baltimore’s battle with heroin is not new.

“We’ve had a heroin problem in Baltimore since the end of World War II,” said Kurt Schmoke, who served as mayor of Baltimore from December 1987 to December 1999.

“What’s happened in Baltimore is just that we have this incredible concentration of poverty,” Schmoke told Rare. “Half of the state’s welfare recipients live in our city. It’s just a tremendous concentration of poverty here that makes Baltimore a tale of two cities.”

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Half of the state's welfare recipients live in our city. It's just a tremendous concentration of poverty here that makes Baltimore a tale of two cities.

Starting with his first term in office, Schmoke led the charge to change the way the city’s criminal justice system addressed heroin and drug dealers generally. As mayor, he pushed for the decriminalization of drugs and placed an emphasis on creating opportunities through investing in education, housing and public health programs. The approach gained traction in Baltimore but did not seem to reverberate to the rest of the country’s inner cities grappling with drug use.

“The consensus of the electorate back in the 1980s and ’90s was that this problem of heroin and drug abuse was primarily an inner-city people of color problem. And because the electorate generally could say it’s a problem of those people, it was easy then to say, ‘Let’s have approaches that deal with those people. Put them away, incarcerate them,’ ” Schmoke said.

RELATED: As the heroin crisis grows, doctors prescribe enough painkillers for every person to have a bottle

However, now that the heroin epidemic has taken hold of suburban neighborhoods, the calculation seems to have changed. The current vernacular of “compassionate care” for those dealing with drug addiction and treating the crisis as a public health concern is a far cry from the approach in the 1980s and 1990s. The Anti-Drug Abuse Act of 1986, for example, enacted mandatory minimum sentences for drugs, with strict sentences such as five years without parole for possession of five grams of crack cocaine.

That approach had devastating effects on inner cities that found themselves arresting low-level dealers or users.

“It does pain me to think about the lives that have been lost and ruined because we didn’t take an approach 30 years ago that I believe could have saved a lot of families and a lot of communities,” Schmoke said of the push to decriminalize drugs.

“What happened in the 1980s was that most people really did think that we could arrest and prosecute our way out of the problem. So when I said that we ought to consider decriminalization or making the war on drugs a public health war,” the former mayor said, “that seemed so strange” to most lawmakers.

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It does pain me to think about the lives that have been lost and ruined because we didn't take an approach 30 years ago that I believe could have saved a lot of families and a lot of communities.

Over the past 40 years, the United States has spent over $1 trillion on the so-called War on Drugs, going after and jailing drug users and offenders. Now the narrative is changing, as President Barack Obama this year has pushed to reform the criminal justice system in ways that focus on community building, education and opportunity.

“Part of what has made it previously difficult to emphasize treatment over the criminal justice system has to do with the fact that the populations affected in the past were viewed as — or stereotypically identified as — poor, minority, and as a consequence, the thinking was it is often a character flaw in those individuals who live in those communities, and it’s not our problem they’re just being locked up,” President Obama said in March 2016 at the National Prescription Rx Abuse and Heroin Summit.

The tragedy of Baltimore’s decades-long history with heroin has afforded the city the time to find and implement innovative approaches to tackling the problem. The failed needle exchange initiative that then-Mayor Schmoke proposed in the 1980s and 1990s has now become key to Baltimore’s public health approach to the epidemic.

RELATED: New Hampshire’s crisis becomes a waiting game of life or death

The percentage of people with HIV from IV drug use in 2000 was 64 percent. In 2014, because of needle exchange, it's now 8 percent.

In 2004, Baltimore implemented a plan aimed at curbing deaths related to opioid and heroin overdoses. The approach urges users to turn in dirty needles for clean ones in an effort to avoid HIV and Hepatitis C. Baltimore City Health Commissioner Leana Wen has issued a blanket prescription for every resident of the city to be able to access Narcan — the drug that can reverse an overdose if administered immediately — as well as free trainings for the use of Narcan.

“Heroin affects every aspect of our communities. It ties into the fabric of our city,” Wen told Rare. “We know that there are over 20,000 people in our city who use heroin and many tens of thousands more who could be addicted to other substances, including alcohol and other opioids,” Wen added.

RELATED: There are two types of families crippled by the heroin epidemic: those coping with addicted children, and those who have buried children because of it

Addressing the impact of the needle exchange program, Wen said that Baltimore has helped reduce its HIV infection rate from IV drug use dramatically.

“The percentage of people with HIV from IV drug use in 2000 was 64 percent. In 2014, because of needle exchange, it’s now eight percent,” Wen told Rare.

“We believe in saving lives, we believe in preventing disease, we fight any stigma that comes our way with science and that’s the work that we do to lead to addiction recovery in our city as well,” Wen said. She hopes Baltimore can be transformed from a city known for its sky-high addiction rates to a “model of recovery instead.”


Rare politics reporter Yasmeen Alamiri and videographers Tolleah Price and Dan Yar spent months researching and reporting this series — traveling to Maryland, New Hampshire and other heroin-torn places while talking and listening to users, police officers, public figures and devastated families all affected by the epidemic. See the full series at on.rare.us/HeroinInAmerica.


Everyone’s Addiction | Heroin in America, Part 1

The Crisis in New HampshireHeroin in America, Part 2

Behind the Badge | Heroin in America, Part 3

A Mother’s Love | Heroin in America, Part 4

The Crisis in Baltimore | Heroin in America, Part 5

Success in Needle Programs  | Heroin in America, Part 6

Seeking Solutions | Heroin in America, Part 7

Yasmeen Alamiri is a political reporter for Rare. Follow her on Twitter @Yalamiri
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