Alcohol and Drug Abuse in Baltimore

Alcohol and illicit drug abuse are among the most serious problems confronting Baltimore.2  At least 60,000 city residents need alcohol and drug treatment.[11]  Even on the basis of conservative estimates, the proportion of Baltimore residents needing treatment is at least double the national rate.[12]  Alcohol and drug abuse reaches deep into taxpayers’ pockets, increasing the costs of health care, criminal justice and other services.  Based on national calculations by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), Drug Strategies estimates that the economic costs of alcohol and drug abuse in Baltimore exceed $2.5 billion a year.[13]

Extent of the Problem
For more than two decades, Baltimore has had an entrenched subculture of heroin addiction.[14]  Two-thirds of Baltimore residents with addictions are injection drug users.[15]  Crack cocaine’s arrival in the early 1990s compounded the city’s longstanding problems with heroin; crack drew a younger crowd of users and dealers, and violent crime associated with drug sales escalated.  Many heroin addicts also began using crack.  According to a July 2000 assessment by the U.S. Drug Enforcement Administration (DEA), Baltimore is the “most heroin-plagued area” in the nation and faces one of the most severe crack problems as well.[16]

Heroin is Baltimore’s primary drug of abuse.[17]  The proportion of city residents needing treatment for heroin abuse is 15 times the national rate.[18]

Alcohol and Drug Use Among Youth
During the past decade, crack cocaine, heroin and marijuana use among Baltimore 8th and 10th grade students has been consistently higher than the national averages.[19]  Drinking is much more prevalent among Baltimore students than illicit drug use, as is true nationwide.[20]  Student drinkers in Baltimore outnumber marijuana, crack and heroin users by a wide margin.  Based on student self-reports as part of the 1998 Maryland Department of Education’s Maryland Adolescent Survey, 5,300 Baltimore 8th and 10th graders had at least one drink in the month prior to the survey, compared to 3,030 who used marijuana, 375 who used crack, and 275 who used heroin.[21]

Underage Drinking and Maryland’s Low Alcohol Tax Rates
Underage drinking in Baltimore, however, is less prevalent than among youth in the rest of Maryland.  Indeed, rates of youth drinking in Maryland are higher than among youth nationwide.[22]  According to NIAAA, youth who begin drinking early (before age 15) are four times more likely to develop alcohol dependence than those who begin at age 21.[23]  Each year’s delay in initiation of drinking greatly reduces the likelihood of later alcohol problems.[24]

Research has shown that increasing the price of alcohol reduces drinking and alcohol-related problems, including accidents, violence and disease.[25]  Youth and young adults are especially sensitive to alcohol price increases.[26]  However, Maryland’s alcohol excise taxes (based on alcohol content) are among the lowest in the nation.  Maryland’s beer excise tax rate ranks eighth lowest, while only a dozen states have a lower wine excise tax rate, and no state has a lower liquor excise tax rate.[27]  Because Maryland’s excise taxes are not indexed for inflation, their value erodes over time.  The current excise tax on liquor is worth only 16 percent of its value in 1955, when the tax rate was last raised, and the beer and wine taxes are worth only 25 percent of their value in 1972, when they were last raised.[28]

Drug-Related Hospital Emergencies
The U.S. Department of Health and Human Services’ Drug Abuse Warning Network (DAWN) tracks hospital emergency room (ER) episodes related to drugs in metropolitan areas across the country.  From 1994 to 1998, the rate in the Baltimore area was nearly triple the national rate.3/[29]  The Baltimore area consistently reports the highest rates of cocaine- and heroin-related ER episodes in the nation.  In 1998, half of Baltimore-area ER drug episodes involved heroin, compared to only 14 percent nationwide. Every year since 1992, the rate of ER cocaine mentions in the Baltimore area has been at least quadruple the national rate.

Alcohol-Related Deaths
Alcohol poisoning and alcohol-related diseases and accidents claim the lives of nearly 350 Baltimore residents each year, according to mortality data maintained by the National Center for Health Statistics.[30]  From 1993 through 1997 (the most recent five-year period for which data are available), Baltimore’s alcohol-related mortality rate of 50 deaths per 100,000 residents was 60 percent higher than the rate in the rest of Maryland and 40 percent higher than the national rate.[31]  Deaths from cirrhosis and other chronic liver diseases related to heavy and prolonged use of alcohol occur in Baltimore at three times the rate in the rest of the state and at twice the national rate.[32]

Illicit Drug Overdose Deaths
In 1999, Maryland’s Chief Medical Examiner recorded 324 drug overdose deaths[33] in Baltimore (excluding alcohol)—63 percent of all such deaths in Maryland.[34]  The city’s 1999 overdose death rate (51 per 100,000 residents) was triple the 1990 rate, driven by a skyrocketing number of heroin deaths.[35]  This steep increase may reflect widespread experimentation by a new generation of younger users as well as a surge in low-cost, high-purity heroin.[36]  Heroin’s price in the Baltimore metropolitan area—already 40 percent cheaper than the national average in 1998—fell by a third in 1999, to 33¢ per pure milligram.[37]  According to the DEA, heroin purity in Baltimore is 13 percent higher than the national average.[38]

In 1999, for the first time ever, more Baltimore residents died of drug overdose (324) than by homicide (309).[39]

Increasing drug overdose deaths in Baltimore may also be related to rising incarceration rates of city residents addicted to drugs.[40]  On average nationwide, prisoners serve about 2½ years behind bars before release.[41]  Injecting drug users (IDUs) who serve time in prison are especially vulnerable to overdose in the weeks immediately following their release.[42]  Enforced abstinence or greatly reduced drug use while incarcerated lowers physical tolerance for drugs, heightening susceptibility to overdose if drug use is resumed at the same level as prior to confinement.  A possible link between release from incarceration and the rising rate of drug overdose deaths in Baltimore warrants close examination, especially given that at least 40 percent of the 10,200 Maryland state prison inmates sentenced from Baltimore had engaged in injection drug use prior to their incarceration.[43]

Infectious Diseases
Injection drug use (IDU) creates multiple health risks, including transmission of infectious diseases such as AIDS and hepatitis.  Since 1979, more than half of the 11,250 AIDS deaths in Maryland have been in Baltimore,[44] where AIDS is the leading killer of young adults (aged 25 to 44).[45]  IDU is the leading cause of AIDS in Baltimore, accounting for 60 percent of new AIDS cases in the city in 1999, compared to 33 percent in the rest of Maryland and 26 percent nationally.[46]

AIDS and hepatitis B and C spread quickly among injection drug users who share needles.  Like AIDS, hepatitis B has no cure.[47]  The U.S. Centers for Disease Control and Prevention (CDC) and NIDA report that AIDS and hepatitis B are twice as common among young injection drug users (aged 15 to 30) in Baltimore than among those in New York City, Los Angeles, Chicago and New Orleans.[48]  Moreover, ninety percent of the Baltimore drug users studied who share needles are infected with hepatitis C, which leads to chronic liver disease for 70 percent of those infected.[49]

Baltimore experienced a syphilis epidemic during the 1990s.[50]  Although syphilis is easily treated with penicillin, it can be caught again and again, and those with syphilitic lesions are more likely to contract HIV.  By 1999, Baltimore’s rate of new syphilis cases (38 per 100,000 residents) had fallen 63 percent since its 1997 peak, but remained 15 times higher than the national average.[51]  City health officials report that the practice of selling sex for drugs—especially crack cocaine—contributes to the spread of syphilis.[52]

Impact on Crime
Baltimore is troubled by a persistently high crime rate, which in 1998 was double the national average.[53]  In 1998, Baltimore’s overall crime rate was two-thirds higher than in other big U.S. cities;[54] violent crimes occurred twice as frequently[55] and Baltimore’s murder rate was 3.5 times higher.[56]  Among the 26 largest U.S. cities, only Detroit recorded higher rates of overall and violent crime in 1998.  Only Washington, D.C. had a higher murder rate.[57]

Drinking, drug addiction and drug trafficking fuel both property crime and violent crime in Baltimore.  Three-quarters of nonviolent property offenses in Baltimore are linked to alcohol and drug abuse,[58] with unrecovered property losses totaling $46 million a year—more than $885,000 per week.[59]  Baltimore law enforcement officials estimate that 50 to 60 percent of the city’s homicides are related to drug dealing, including violent clashes among competing dealers and buyers and sellers.[60]

Data on the number of alcohol-related homicides in Baltimore are not available, but 45 percent of imprisoned murderers nationwide report having been drinking heavily at the time of their offense.4/[61]  Although significant overlap occurs between alcohol-related homicides and those linked to illicit drugs, as many as three-quarters of Baltimore’s murders are associated with alcohol and illicit drugs.[62]

Drug Arrests
Drug arrests climbed steadily in Baltimore from 1990 to 1995, peaking at 23,092, before falling to 15,706 in 1996 due to a shift in police priorities toward gun enforcement.[63]  Drug arrests have recently climbed again, reaching 18,052 in 1998 (10,334 for possession; 7,718 for sales).[64]  Juvenile arrests for drug distribution increased 40 percent from 1994 to 1998.[65]  Although still below the 1995 peak, Baltimore’s 1998 drug arrest rate was nearly triple the rate for U.S. cities with populations of 250,000 or more, and nearly five times the national average.[66]  Heroin and cocaine arrests, which make up 80 percent of the city’s drug arrests, occur at ten times the national rate.[67]  On average, Baltimore police made 49 drug arrests per day in 1998, including 19 for heroin and cocaine sales and 21 for heroin and cocaine possession.

Drug Offenders in Prison, on Parole and Probation, and in the Juvenile Justice System
Drug offenses are the leading reason for incarceration of state prisoners convicted of crimes committed in Baltimore.  As of September 2000, half of the 10,200 prisoners who had been sentenced in Baltimore committed drug offenses.[68]  Drug crimes were the most serious offense for 29 percent of Baltimore offenders sentenced to more than a year in state prison,[69] compared to 11 percent of prisoners nationwide.[70]  Most of those imprisoned by the state for drug crimes committed in Baltimore are not violent offenders.[71]  Indeed, the vast majority (84 percent) of all non-violent Baltimore offenders in prison are drug offenders.[72]

Drug crimes are also the most common offense among those on parole and probation in Baltimore.  As of September 2000, nearly half of Baltimore’s 30,150 parolees and probationers were under court supervision for drug offenses.[73]  Drug crimes are the most serious offense for almost half of Baltimore probationers,[74] compared to one-quarter of probationers nationwide.[75]  Drug offenders comprise the majority (62 percent) of all non-violent offenders on parole or probation in Baltimore.[76]

One in every 40 Baltimore adults is on probation for a drug offense,[77] seven times the national rate.[78]

Drug offenses are also the leading reason for which Baltimore youth enter the state’s juvenile justice system.  In 1998, nearly one-quarter of the 12,800 juvenile justice intake cases involving Baltimore youth were due to alcohol (128) and other drug offenses (1,128 for possession and 1,770 for distribution).[79]  Baltimore’s rate of juvenile intake cases involving drug distribution offenses rose nearly 50 percent between 1994 and 1998,[80] and the city accounted for more than two-thirds of all such cases statewide in 1998.[81]  As of March 2000, Baltimore accounted for one-third of the 10,100 youths statewide assigned to probation, detention and residential programs within Maryland’s juvenile justice system.[82]

Drug Use and Treatment Need Among Offenders
Drug use is widespread among adults arrested in Baltimore.  A 1995 study (the most recent data available) conducted by the Center for Substance Abuse Research (CESAR) at the University of Maryland found that two-thirds of men and three-quarters of women arrested by the Baltimore Police Department tested positive for at least one drug, not including alcohol.[83]  Baltimore arrestees recorded the highest rates of heroin use ever found in any U.S. city—37 percent of men and 48 percent of women tested positive for opiates in 1995.[84]  These rates were five times higher than the averages found in 23 cities participating in the federal Arrestee Drug Abuse Monitoring (ADAM) program.[85]  (Baltimore has never been an ADAM program site, but CESAR’s 1995 study was based on ADAM’s methodology.)

The CESAR study concluded that almost half of those arrested over the course of the year needed treatment, and that nearly three-quarters of those who needed treatment were heroin users.[86]  In 1998 (the latest year for which comprehensive data are available), the Baltimore Police Department made 17 percent more total arrests than in 1995, suggesting that some 22,000 adult arrestees were in need of treatment.[87]  However, only 18,738 people (from all referral sources) actually received treatment in Baltimore in 1998, according to Maryland’s Alcohol and Drug Abuse Administration (ADAA).[88]  The need for treatment among adult arrestees alone outstripped the city’s overall treatment capacity by 17 percent in 1998.[89]

According to state criminal justice officials, four out of five convicted offenders in Baltimore need treatment.  As of September 2000, at least 80 percent of the state prison inmates who were sentenced in Baltimore (8,160 out of 10,200) had substantial alcohol and drug abuse problems when they entered prison, regardless of offense; half of this group (more than 4,000 inmates) had engaged in injection drug use prior to their incarceration.[90]  In addition, at least 80 percent of Baltimore’s 30,150 parolees and probationers also needed treatment, regardless of offense.[91]

According to the Maryland Department of Juvenile Justice (DJJ), data from nearly a decade of drug testing show that the more involved a youth is in the juvenile justice system, the greater the likelihood of a drug problem.  Both in Baltimore and statewide, DJJ estimates the prevalence of drug abuse at 30 percent for youth on probation, 40 percent for youth in detention, and 50 to 60 percent for youth in residential programs.[92]  One-third of the 3,400 Baltimore youth involved in the juvenile justice system in early 2000 had drug problems.[93]

Many people addicted to drugs come into frequent contact with the criminal justice system, which can be a key venue for treatment.  Research has shown that treatment imposed through the coercion of the criminal justice system can effectively reduce drug use and crime.[94]  Too often, however, this opportunity is missed.  Chapter IV describes the important role of court-mandated treatment in Baltimore, especially given the extensive need for treatment among offenders.

Impact on Greater Baltimore and the State of Maryland as a Whole
Drug abuse and trafficking harm Baltimore’s quality of life,[95] but the damage is not confined to Baltimore.  Indeed, 70 percent of Maryland residents who need alcohol and drug treatment live outside Baltimore.[96]  Many of them come to Baltimore to buy drugs, helping to fuel the open-air drug markets that afflict numerous neighborhoods.[97]  Because Baltimore’s problems are intertwined with those of the rest of the state, progress in reducing drug addiction in Baltimore—where the problem is most severe—will benefit all Maryland residents.

In recent years, many of Maryland’s other counties have seen rapid increases in their own drug problems, particularly with regard to heroin, whose resurgence nationwide appears related to falling retail prices (down 60 percent nationwide from 1990 to 1998) and increasing purity (up 128 percent).[98]

Problems with drug abuse elsewhere in the state still do not approach the magnitude of the problems in Baltimore.   But because today’s more potent heroin means that users can get high by snorting the drug—thereby removing the risk of exposure to HIV that might have deterred many new users[99]—more people appear to be experimenting with and becoming addicted to heroin.  This trend has compelled the state’s other counties to look more closely at their own drug problems.

Ø                  Based on interviews with 132 drug treatment, prevention, enforcement and medical personnel statewide, Maryland’s summer 2000 Drug Scan reported heroin as a primary drug of abuse in Baltimore and seven counties (Baltimore, Calvert, Carroll, Cecil, Frederick, Prince George’s and Wicomico) and as an emerging drug of abuse in eight of the state’s other 16 counties.[100]

Ø                  In 1998, 34 percent of Baltimore County residents believed that heroin was being sold in their neighborhoods, up from 21 percent in 1992.  Also in 1998, 35 percent of Anne Arundel and Howard County residents believed that heroin was being sold in their neighborhoods, up from 15 percent in 1992.[101]

Ø                  During the 1990s, heroin use was higher among 8th and 10th graders statewide than in Baltimore.  In 1998, Baltimore 10th graders reported past month heroin use at more than double the national rate, while 10th graders statewide reported past month heroin use at more than triple the national rate (2.2 percent vs. 0.7 percent).[102]

Ø                  From 1990 to 1999, the number of heroin overdose deaths nearly tripled in Baltimore, and more than tripled in the rest of the state, led by a nearly five-fold increase—from 24 to 112 deaths—in Baltimore’s five neighboring suburban counties (Baltimore County and Anne Arundel, Carroll, Harford and Howard counties).[103]

Heroin’s spread beyond Baltimore is not Maryland’s only concern regarding substance abuse.  For example:

Ø                  Binge drinking (defined as five or more drinks at a time) was more prevalent among 10th graders statewide than in Baltimore throughout the 1990s.  In 1998, 26 percent of 10th graders statewide reported binge drinking in the past month, compared to 17 percent in the city.[104]

Ø                  The drug arrest rate in the rest of Maryland rose 19 percent from 1994 to 1998, led by a 41 percent increase in suburban Baltimore (from 368 to 520 arrests per 100,000 residents).[105]

Ø                  Baltimore’s rate of juvenile drug arrests rose 17 percent from 1994 to 1998, compared to a 63 percent increase in the rest of Maryland.  Suburban Baltimore had an 86 percent increase (from 316 to 587 arrests per 100,000 youth).[106]

FOOTNOTES:

2           This report discusses alcohol as well as illicit drugs because alcohol, though legal for those 21 and older, is an intoxicant with high potential for abuse and addiction.  Most drinkers are not problem drinkers, but the sheer prevalence of drinking—given alcohol’s legal status and social acceptability—results in adverse consequences for health and safety exceeding the damage caused by illicit drugs.  In Baltimore, 36 percent of those who enter treatment have a drinking problem.   

3           A high level of awareness of drug problems by health officials and hospital personnel in the greater Baltimore region arguably results in a fuller, more accurate accounting of drug-related emergencies than in many other metropolitan areas.  DAWN statisticians acknowledge that uneven reporting practices make site-by-site comparisons problematic.  But even if the true level of ER drug episodes nationwide from 1994-1998 were double the rate of 222 episodes per 100,000 residents reported to DAWN, the Baltimore-area rate (656 per 100,000) would still have been nearly 50 percent higher.

4           Research has shown that neighborhoods with a high density of liquor stores suffer increased health and social problems, including violent crime.  In Baltimore, neighborhoods that are both low income and predominantly African American have substantially more liquor stores per capita than do other neighborhoods in the city.

ENDNOTES:

[11]      Maryland Department of Health and Mental Hygiene, Alcohol and Drug Abuse Administration (ADAA).  Based on treatment admissions data for fiscal year (FY) 1998, ADAA estimated 60,375 Baltimore residents to be in need of treatment for alcohol or other drug abuse—amounting to 12.8 percent of the city’s 471,147 adults in 1999, or one in eight adults.  ADAA acknowledges that this estimate is conservative, particularly in accounting for alcohol treatment need and for the number of drug abusers among the city’s criminal offenders.  The true number of Baltimore residents needing treatment may be in the range of 75,000 to 80,000.

[12]      J. Epstein & J. Gfroerer.  “Changes Affecting NHSDA Estimates of Treatment Need for 1994-1996.”  Analysis of Substance Abuse and Treatment Need Issues.  Substance Abuse and Mental Health Services Administration (SAMHSA), May 1998.  In 1996, an estimated 9.383 million Americans 12 years of age and older were in need of drug treatment (not including alcohol), amounting to 4.27 percent of the U.S. population aged 12 and older in 1996 (219.866 million).

Maryland Department of Health and Mental Hygiene, Alcohol and Drug Abuse Administration (ADAA).  In 1997, an estimated 58,126 Baltimore residents were in need of drug treatment (not including alcohol), amounting to 10.75 percent of the city’s population aged 12 and over in 1997 (540,830)—2.5 times the national rate.

B. Grant.  “The Influence of Comorbid Major Depression and Substance Use Disorders on Alcohol and Drug Treatment: Results of a National Survey.” Paper presented at the September 1994 NIDA Technical Review Meeting on Comorbid Mental and Addictive Disorders—Treatment and HIV-Related Issues.  Based on the NIAAA-sponsored National Longitudinal Alcohol Epidemiologic Survey (NLAES), in 1992 an estimated 13,759,846 Americans aged 18 and over abused or were dependent on alcohol, amounting to 6.60 percent of the 1992 U.S. population aged 18 and over (208.357 million).

P. Reuter et al.  Estimating the Need for Substance Abuse Treatment in Maryland.  College Park, MD: Center for Substance Abuse Research (CESAR), January 1998.  In 1995, an estimated 34,153 Baltimore residents aged 18 and over were in need of treatment for alcohol abuse or dependence, amounting to 6.69 percent of the city’s 1995 population aged 18 and over (510,797), or 1.3 percent higher than the national rate.

[13]      National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA).  The Economic Costs of Drug and Alcohol Abuse in the United States, 1992.  September 1998.  NIDA and NIAAA estimate that alcohol and drug abuse cost the nation $276 billion in 1995; adjusting for population growth and inflation increases this estimate to $328 billion in 1999.  Based strictly on Baltimore’s share of the U.S. population, the annual economic burden on the city would be about $785 million.  However, Baltimore’s alcohol and drug abuse problems are considerably more severe than in the nation as a whole.  Given the indicators below, the annual economic toll is at least triple the $785 million population-based figure—in the range of $2.5 billion.  This figure is offered not as a precise calculation but as a plausible estimate of the magnitude of the economic impact of alcohol and drug abuse in Baltimore.

The $2.5 billion figure represents 30 percent of estimated costs in Maryland.   Maryland’s share of the $328 billion national drug-related economic burden, based on its portion of alcohol and drug treatment clients nationwide, is approximately $8.5 billion per year (see Note 149).  Although Baltimore constitutes 12.6 percent of Maryland’s population, it accounts for a much larger share of the state’s alcohol- and drug-related problems:

63 percent of Maryland’s drug overdose deaths;
24 percent of Maryland’s deaths due to alcohol poisoning and alcohol-related diseases and accidents;
61 percent of Maryland’s newly-diagnosed AIDS cases related to injection drug use;
26 percent of state residents in need of alcohol and drug treatment;
29 percent of state admissions to treatment;
64 percent of state arrests for heroin and cocaine offenses (sales and possession);
60 percent of state prisoners sentenced to more than a year for drug sales;
51 percent of state residents on probation for drug offenses; and
55 percent of state residents on parole for drug offenses.

[14]       Baltimore Substance Abuse Systems, Inc. (BSAS).  Scientific Advisory Committee Report and Recommendations.  October 1999.

[15]       Associated Press.  “Baltimore leads in ER cases tied to drugs.” The Baltimore Sun, March 22, 1998.  According to Baltimore Health Commissioner Peter L. Beilenson, about 40,000 of the city’s estimated 60,000 residents addicted to drugs are injection drug users.

Baltimore Substance Abuse Systems, Inc. (BSAS).  Fiscal Year 1999 Data Update.  December 1999.  In FY 1999, 34.8 percent of the 16,812 clients admitted to treatment at BSAS-funded programs acknowledged having injected either heroin (33.6 percent) or cocaine (1.2 percent), suggesting that Health Commissioner Beilenson’s two-thirds figure may be an overestimate.  But behavior patterns of those who enter treatment cannot be assumed to prevail among drug users who do not enter treatment, and research suggests (see below) that most injection heroin users have never entered treatment of any kind. 

J. Inciardi et al.  “The Heroin Street Addict:  Profiling a National Population,” in J. Inciardi & L. Harrison (eds.), Heroin in the Age of Crack-Cocaine.  Thousand Oaks, CA: Sage Publications, 1998.  A 1998 study based on a nationwide sample of more than 38,561 injection heroin users (obtained through the National AIDS Demonstration Research Program) found very low levels of involvement with treatment: 58 percent reported never having been in detoxification, more than 70 percent were never in methadone maintenance, and more than 80 percent were never in any form of outpatient treatment.  Even among the minority who reported some form of treatment experience, most had been in treatment only one or two times.

[16]       U.S. Drug Enforcement Administration.  Baltimore District Report.  Washington, D.C.: DEA, July 2000.

[17]     Center for Substance Abuse Research (CESAR), Maryland Drug Scan: Current Trends in Drug Use, Summer 1999.  College Park, MD: CESAR, January 1999.

[18]       P. Reuter et al.  Estimating the Need for Substance Abuse Treatment in Maryland.  College Park, MD: Center for Substance Abuse Research (CESAR), January 1998.  As cited by CESAR, Maryland’s Alcohol and Drug Abuse Administration (ADAA) estimated that 34,276 Baltimore residents needed treatment for heroin use in 1995, amounting to 56.4 percent of the 60,816 total estimated to be in need of treatment for alcohol or drug abuse that year.  ADAA’s 1998 total estimate of treatment need for Baltimore (60,375) was less than 1 percent lower than the 1995 estimate.  Lowering the 1995 heroin estimate by the same proportion provides an estimate of 33,933 city residents in need of treatment for heroin use, which amounts to 5.36 percent of Baltimore’s total population in 1999 (632,681).  This proportion is 14.9 times higher than the proportion of the U.S. population considered in need of treatment for heroin use (see below).

Office of National Drug Control Policy (ONDCP).  National Drug Control Strategy, 2000 Annual Report.  February 2000.  Based on estimates derived from the National Household Survey on Drug Abuse (NHSDA) and the Arrestee Drug Abuse Monitoring (ADAM) Program, there were some 977,000 “hardcore” heroin users in the United States, with “hardcore” denoting users whose severity of symptoms make them prime candidates for treatment.  These 977,000 hardcore heroin users in need of treatment amounts to 0.36 percent of the total U.S. population in 1999 (272,878,000).

[19]       Maryland State Department of Education.  1998 Maryland Adolescent Survey.  March 2000.

National Institute on Drug Abuse (NIDA).  National Survey Results from the Monitoring the Future Study, 1975-1998.  September 1999.

The proportion of Baltimore 8th graders reporting crack cocaine use within the past month rose from 0.7 percent in 1992 to 2.4 percent in 1998—nearly triple the national rate.  Over the same period, the rate of past month heroin use among Baltimore 8th graders rose from 0.6 percent to 1.6 percent, also nearly triple the national rate.  Similar trends prevailed among 10th graders.  The proportion of Baltimore 8th graders reporting past month marijuana use dropped sharply between 1996 (21.5 percent) and 1998 (10.6 percent), but remained slightly higher than the 1998 national rate (9.7 percent).  One in four Baltimore 10th graders reported past month marijuana use in 1998, up from 13 percent in 1992, and one-third higher than the national average of 18.7 percent.

[20]       Maryland State Department of Education.  1998 Maryland Adolescent Survey.  March 2000.

National Institute on Drug Abuse (NIDA).  National Survey Results from the Monitoring the Future Study, 1975-1998.  September 1999.

In 1998, 36.2 percent of Baltimore 10th graders reported drinking within the past month, up from 32.5 percent in 1994, and comparable to the 38.8 percent figure for 10th graders nationwide.  In 1998, 18.1 times more Baltimore 10th graders reported past month alcohol use (36.2 percent) than reported past month crack cocaine use (2.0 percent).  The gap between alcohol and crack cocaine use was even greater at the national level; in 1998, 35.3 times more U.S. 10th graders reported past month alcohol use (38.8 percent) than reported past month crack cocaine use (1.1 percent). 

[21]       Maryland State Department of Education.  1998 Maryland Adolescent Survey.  March 2000.  The estimates of 5,300 past-month drinkers, 375 past-month crack users, 275  past-month heroin users and 3,030 past-month marijuana users among 17,000 Baltimore 8th and 10th graders in 1998 are derived by applying the past-month drug use percentages provided by the 1998 Maryland Adolescent Survey to U.S. Census Bureau population estimates of Baltimore 13-year olds (8th graders) and 15-years olds (10th graders) as follows:

8,440 13-year olds (8th graders): 26 percent alcohol (2,194); 10.6 percent marijuana (895); 2.4 percent crack (203); 1.6 percent heroin (135).
8,519 15-year olds (10th graders): 36.2 percent alcohol (3,083); 25.0 percent marijuana (2,130); 2.0 percent crack (170); 1.6 heroin (136).
Totals equal 16,959 8th and 10th graders; 5,277 past-month alcohol users; 3,025 past-month marijuana users; 373 past-month crack users; and 271 past month heroin users.  Rounding yields 17,000 8th and 10th graders; 5,300 past month alcohol users; 3,030 past month marijuana users; 375 past month crack users; and 275 past month heroin users.

[22]       Maryland State Department of Education.  1998 Maryland Adolescent Survey.  March 2000.

National Institute on Drug Abuse (NIDA).  National Survey Results from the Monitoring the Future Study, 1975-1998.  September 1999.

In 1998, 27 percent of Maryland 8th graders reported drinking at least once in the past month, compared to 26 percent of Baltimore 8th graders and 23 percent of 8th graders nationwide.  Also in 1998, 43 percent of Maryland 10th graders reported drinking at least once in the past month, compared to 36 percent of Baltimore 10th graders and 39 percent of 10th graders nationwide.

[23]      B. Grant & D. Dawson.  “Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey.”  Journal of Substance Abuse, 9:103-110, 1997.

[24]       B. Grant & D. Dawson.  “Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey.”  Journal of Substance Abuse, 9:103-110, 1997.

[25]       F. Chaloupka.  “Effects of price on alcohol-related problems.” Alcohol Health and Research World, 17(2):46-53, 1993.

P. Cook.  “The effect of liquor taxes on drinking, cirrhosis, and auto accidents” in M. Moore & D. Gerstein (eds.), Alcohol and Public Policy: Beyond the Shadow of Prohibition.  Washington, D.C.: National Academy Press, 1981.

[26]      General Accounting Office (GAO).  District of Columbia:  Taxes and Other Strategies to Reduce Alcohol Abuse.  Washington, D.C.: GAO, 1998.

M. Grossman et al.  “Effects of alcohol price policy on youth: A summary of economic research.”  Journal of Research on Adolescence, 4(2):347-364, 1994. 

[27]       General Accounting Office (GAO).  District of Columbia:  Taxes and Other Strategies to Reduce Alcohol Abuse.  Washington, D.C.: GAO, 1998.  Maryland’s low excise tax rates combine with the state’s moderate 5 percent sales tax make alcoholic beverages less expensive in Maryland than in any other jurisdiction in the region except Delaware (which imposes higher excise taxes than Maryland but has no sales tax).  For example, Maryland adds 30¢ in combined excise and sales taxes to the price of a $5 six-pack of beer, whereas Virginia adds 38¢ and the District of Columbia adds 45¢.

[28]       In 1955, Maryland raised its liquor excise tax rate from $1.25 to $1.50 per gallon.  In 1972, Maryland raised its beer excise tax rate from 3¢ to 9¢ per gallon and raised its wine excise tax rate from 20¢ to 40¢ per gallon.  If the 1955 liquor excise tax rate had been indexed to inflation, it would have risen to $9.44 per gallon as of January 2000.  If the 1972 beer and wine excise tax rates had been indexed for inflation, they would risen to 36¢ per gallon and $1.61 per gallon, respectively, as of January 2000.              

[29]       U.S. Department of Health and Mental Services, Substance Abuse and Mental Health Services Administration (SAMHSA).  Year-End 1998 Emergency Department Data from the Drug Abuse Warning Network (DAWN). December 1999.  Over the 5-year period 1994-1998, the Baltimore metropolitan area averaged a rate of 656 drug-related ER episodes per 100,000 residents, 2.9 times higher than the U.S. average of 222 per 100,000.  Among the 20 other metropolitan areas over-sampled by DAWN, only San Francisco ever surpassed Baltimore’s rate during the 1994-1998 period, including in 1994 (771 to 715 per 100,000) and in 1997 (598 to 556 per 100,000).

[30]       National Institute on Alcohol Abuse and Alcoholism (NIAAA).  State Trends in Alcohol-Related Mortality, 1979-1992.  September 1996.  NIAAA calculates alcohol-related mortality based on mortality data maintained by the National Center for Health Statistics (NCHS) and on the proportion of different categories of death that research has demonstrated to be alcohol-related.  For example, deaths grouped in the category “causes of death with explicit mention of alcohol” (such as alcoholic cirrhosis of the liver) are considered 100 percent alcohol-related and are assigned an “alcohol-attributable fraction” of 1.0.  The two other categories—“other alcohol-related diseases” and “other alcohol-related injuries or adverse effects”—include causes of death which are only sometimes attributable to alcohol.  These causes of death are assigned alcohol-attributable fractions less than 1.0; for example, 60 percent of deaths of persons 35 and older due to chronic pancreatitis are considered to be alcohol-related.  Drug Strategies used this method to calculate alcohol-related mortality for Baltimore, Maryland and the United States from 1993-1997, the most recent 5-year period for which NCHS mortality data was available (on the web at http://wonder.cdc.gov.).

[31]     For 1993-1997, Baltimore’s death rate due to alcohol poisoning and alcohol-related diseases and accidents was 50.5 deaths per 100,000 residents, 60.3 percent higher than the rate of 31.5 deaths per 100,000 residents in the rest of Maryland, and 39.5 percent higher than the national rate of 36.2 deaths per 100,000 residents.

[32]       For 1993-1997, Baltimore’s death rate due to cirrhosis and other alcohol-related liver diseases 13.6 deaths per 100,000 residents, triple the rate of 4.6 deaths per 100,000 residents in the rest of Maryland, and double the national rate of 6.9 deaths per 100,000 residents.

[33]      L. Li & J. Smialek.  “Observations on Drug Abuse Deaths in the State of Maryland.”  Journal of Forensic Sciences, 41(1):106-109, January 1996.  A “drug-caused death” is defined as “any death in which a toxic level of drug is found with no other cause of death present.  In other words, a drug-caused death is a death that can be directly attributable to or is caused by drug intoxication.  A drug abuse death is a death that is caused by illicit drug intoxication.”

[34]       County-by-county illicit drug abuse death data for 1990-1999 were compiled for Drug Strategies by the Maryland Office of the Chief Medical Examiner.  Baltimore’s 324 illicit drug abuse deaths in 1999 comprised 62.9 percent of the Maryland total of 515 such deaths.  From 1990-1999, Baltimore accounted for 66.9 percent of all such deaths in Maryland.

[35]       During the 1990s, 90 percent of Baltimore’s 2,312 drug abuse deaths involved heroin, while 29 percent involved cocaine.

[36]       The surge in low-cost, high-purity heroin is the result of  the expansion of Colombian cocaine traffickers into the heroin trade in the early 1990s.  In 1998, 65 percent of the heroin seized and purchased in the United States by Drug Enforcement Administration (DEA) agents originated in Colombia, up from 15 percent in 1993.

[37]       U.S. Drug Enforcement Administration (DEA).

L. Henderson.  “Drug Use in the Baltimore Metropolitan Area:  Epidemiology and Trends,” Draft for inclusion in the June 2000 report of NIDA’s Community Epidemiology Work Group (CEWG).

[38]       U.S. Drug Enforcement Administration (DEA).  Baltimore District Report.  July 2000.

[39]       S. Shane.  “Overdose deaths exceed slayings.”  The Baltimore Sun, September 15, 2000.

[40]       E. Drucker.  “Drug Prohibition and Public Health: 25 Years of Evidence.”  Public Health Reports, 114:14-29, January/February 1999.

[41]       P. Ditton & D. Wilson.  Bureau of Justice Statistics Special Report: Truth in Sentencing in State Prisons.  January 1999.

[42]       D. Harding-Pink, “Mortality Following Release from Prison.”  Medicine, Science and the Law, 30(1):12-16, January 1990.

S. Seaman et al.  “Mortality from overdose among injecting drug users recently released from prison: database linkage study.”  BMJ, 316(7129):426-428, February 7, 1998.

A. Seymour et al.  “Drug-related deaths among recently released prisoners in the Strathclyde Region of Scotland.”  Journal of Forensic Sciences, 45(3):649-654, May 2000.

[43]       See Note 90.

[44]      Maryland Department of Health and Mental Hygiene, AIDS Administration.  Maryland HIV/AIDS Epidemiological Profile, Second Quarter 2000.  June 2000.  Baltimore residents accounted for 6,024 (53.6 percent) of the 11,249 AIDS deaths recorded in Maryland between January 1979 and June 2000.

[45]       Maryland Department of Health and Mental Hygiene, Vital Statistics Administration.

[46]       Maryland Department of Health and Mental Hygiene, AIDS Administration, Center for Epidemiology and Health Services Research.  As modes of exposure, injection drug use (IDU) and men who have sex with men and engage in injection drug use (MSM/IDU) accounted for 319 (60.8 percent) of the 532 AIDS cases diagnosed among Baltimore residents in 1999.  In the rest of Maryland, IDU and MSM/IDU accounted for 201 (33.0 percent of the 609 AIDS cases diagnosed in 1999.

Centers for Disease Control and Prevention (CDC).  HIV/AIDS Surveillance Report, 1999 Year-End Edition.  May 2000.  Nationwide, IDU and MSM/IDU accounted for 9,042 (25.5 percent) of the 35,482 AIDS cases diagnosed in 1999.

[47]       Centers for Disease Control and Prevention (CDC), National Center for Infectious Diseases.  Viral Hepatitis B—Frequently Asked Questions.  On the web at www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm

Centers for Disease Control and Prevention (CDC), National Center for Infectious Diseases.  Viral Hepatitis C—Frequently Asked Questions.  On the web at www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm

[48]       C. Fuller et al.  “Correlates of HIV infection among newly initiated adolescent and young injection drug users.”  Paper presented at the 32nd Annual Meeting of the Society for Epidemiological Research, Baltimore, June 1999.  Ten percent of Baltimore injection drug users from 15 to 30 years old are infected with HIV, compared to 5 percent of young IDUs in New York City, Los Angeles, Chicago and New Orleans.  Fifty-one percent of Baltimore injection drug users from 15 to 30 years old are infected with hepatitis B, compared to 21 percent of young IDUs in New York City, Los Angeles, Chicago and New Orleans.

[49]       C. Fuller et al.  “Correlates of HIV infection among newly initiated adolescent and young injection drug users.”  Paper presented at the 32nd Annual Meeting of the Society for Epidemiological Research, Baltimore, June 1999.

Centers for Disease Control and Prevention (CDC), National Center for Infectious Diseases.  Viral Hepatitis C—Frequently Asked Questions.  On the web at www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm

[50]       D. Sugg, “City working to curb rise in syphilis.”  The Baltimore Sun, February 6, 1996.

[51]       Centers for Disease Control and Prevention (CDC).  Sexually Transmitted Disease  Surveillance, 1999.  September 2000.  Baltimore’s rate of new syphilis cases in 1999 (38.1 per 100,000 residents) was 15.2 times higher than the national rate (2.5 per 100,000 residents).  At its peak in 1997, Baltimore’s rate of new syphilis cases (101.8 per 100,000 residents) was 31.8 times higher than the national rate (3.2 per 100,000 residents).

[52]       J. Bor & D. Sugg.  “Syphilis epidemic beginning to wane.” The Baltimore Sun, December 7, 1998.

[53]       Federal Bureau of Investigation (FBI).  Crime in the United States: Uniform Crime Reports, 1998.  October 1999.  Baltimore’s 1998 Crime Index total (10,947 crimes per 100,000 residents) was more than double the U.S. rate (4,615.5 crimes per 100,000 residents).

Office of the Mayor of Baltimore.  The Mayor’s Plan to Dramatically Reduce Crime in Baltimore: A Plan of Action for Transforming the Baltimore Police Department into a High Performance Organization.  April 2000.  An FBI-endorsed audit of Baltimore Police Department crime reports for 1999 found that serious crime was under-reported by 15 percent, suggesting that Baltimore’s crime rates reported to the FBI for 1998 and prior years may have also understated the occurrence of serious crime in the city.

[54]   Federal Bureau of Investigation (FBI).  Crime in the United States: Uniform Crime Reports, 1998.  October 1999.  Among the other 25 U.S. cities with populations of 500,000 or more in 1998, the overall crime rate was 6,570.5 per 100,000 residents.  At 10,947 per 100,000 residents, Baltimore’s overall crime rate was 66.6 percent higher than the average among other big U.S. cities.

D. Andrulis & N. Goodman.  The Social and Health Landscpae of Urban and Suburban America.  Chicago, IL: American Hospital Association Press, 1999.  Even when compared to other big cities facing similar social and economic problems, Baltimore’s crime rate is high.  In addition to Baltimore, eight other big cities rank in the bottom half of both the Deprivation Index and the Child Welfare Index, which are published by the American Hospital Association.

Baltimore ranks 88th on the Deprivation Index (based on poverty rate, educational attainment, unemployment rate, percent of population that are non-English speakers, per capita income, and crime rate) and 95th on the Child Welfare Index (based on child poverty rate, births to teenage mothers, low birth weight babies, female headed households, and infant mortality rates).

The eight other cities that rank in the bottom half of both indices are Boston, Dallas, Detroit, Memphis, Milwaukee, New York City, Philadelphia, and San Antonio. Compared to the average crime rate among these eight cities in 1998, Baltimore’s overall crime rate was 44 percent higher and Baltimore’s violent crime rate was 73 percent higher.

[55]       Federal Bureau of Investigation (FBI).  Crime in the United States: Uniform Crime Reports, 1998.  October 1999.  Among the other 25 U.S. cities with populations of 500,000 or more in 1998, the violent crime rate was 1,206.8 per 100,000 residents.  At 2,419.6 per 100,000 residents, Baltimore’s murder rate was double the average among other big U.S. cities.

[56]       Federal Bureau of Investigation (FBI).  Crime in the United States: Uniform Crime Reports, 1998.  October 1999.  Among the other 25 U.S. cities with populations of 500,000 or more in 1998, the murder rate was 13.5 per 100,000 residents.  At 47.1 per 100,000 residents, Baltimore’s murder rate was 3.5 times higher than the average among other big U.S. cities.

[57]       Federal Bureau of Investigation (FBI).  Crime in the United States: Uniform Crime Reports, 1998.  October 1999.  Among the nation’s 26 largest cities in 1998, only Detroit recorded a higher overall crime rate than Baltimore (11,791.4 compared to 10,947.0 per 100,000); only Detroit recorded a higher violent crime rate than Baltimore (2,442.8 compared to 2,419.6 per 100,000); and only Washington, D.C. recorded a higher murder rate than Baltimore (49.7 vs. 47.1 per 100,000).

[58]       National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA).  The Economic Costs of Drug and Alcohol Abuse in the United States, 1992.  September 1998.  NIDA and NIAAA estimate that drug abuse contributes to 25 to 30 percent of income-generating crime nationwide and that alcohol abuse contributes to 5 percent of income-generating crime.  Given that Baltimore’s rates of drug and alcohol abuse are 2.5 and 1.3 times higher than the national rates, respectively (see Note 12), then it can be estimated that alcohol and drug abuse contributes to nearly 75 percent (between two-thirds and four-fifths) of income-generating crime in Baltimore.

[59]       Maryland State Police.  Crime in Maryland: 1998 Uniform Crime Report.  October 1999.  The value of unrecovered stolen property in Maryland averaged $229 million per year from 1994-1998, ranging from a high of $256 million in 1995 to a low of $182 million in 1998 (figures include losses due to robbery, breaking or entering, larceny-theft, and motor vehicle theft).  Based on the Baltimore’s proportion of all such crimes committed each year in Maryland, the value of unrecovered stolen property in Baltimore averaged $67 million per year from 1994-1998, ranging from a high of $79 million in 1995 to a low of $48 million in 1998.  Alcohol and drug abuse contributes to an estimated 74 percent of nonviolent property offenses in Baltimore (see Note 58), accounting for $46 million per year in unrecovered stolen property losses from 1994-1998 ($885,000 per week).

[60]       Bar Association of Baltimore City.  The Drug Crisis and Underfunding of the Justice System in Baltimore City: Report of the Russell Committee.  1990.  The Russell Committee reported that 55 percent of the city’s homicides were drug-related.

Office of the State’s Attorney for Baltimore City.  Based on analysis of 237 of Baltimore’s 303 homicides in 1997 and information from police homicide detectives, the Assistant State’s Attorney for Baltimore estimates that at least 50 percent and more likely 60 percent of the city’s homicides are drug-related.

[61]    Bureau of Justice Statistics (BJS).  Substance Abuse and Treatment, State and Federal Prisoners, 1997.  January 1999.  In 1997, of 55,104 state and federal prisoners convicted of murder, 44.5 percent reported having been under the influence of alcohol at the time of their offense.

Bureau of Justice Statistics (BJS).  Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol Involvement in Crime.  April 1998.  Among state prisoners convicted of murder who report having been having been drinking at the time of their offense, the estimated average blood alcohol concentration (BAC) was 0.28 grams of alcohol per deciliter of blood, nearly triple a BAC of 0.10, the most commonly used definition of intoxication.

[62]       Bureau of Justice Statistics (BJS).  Substance Abuse and Treatment, State and Federal Prisoners, 1997.  January 1999.  In 1997, 44.5 percent of state and federal prisoners convicted of murder reported having been under the influence of alcohol at the time of their offense and 26.8 percent of state and federal prisoners convicted of murder reported having been under the influence of drugs other than alcohol.  Some of these offenders reported having been under the influence of both alcohol and drugs, so the total proportion of alcohol- and drug-involved offenders was 52.4 percent, not the 71.3 percent that would result from simply adding 44.5 and 26.8.  The 18.9 percentage point overlap represents a 26.5 percent difference between the figure arrived at simply through addition (71.3) and the true figure (52.4).  Adding the Baltimore estimates for alcohol-related (44.5 percent) and other drug-related (50 to 60 percent) homicides gives a range of 94.5 to 104.5 percent.  Subtracting 26.5 percent from each end of the range leaves a range of 69.5 percent to 76.8 percent.  Alcohol and drugs can therefore be considered linked to between two-thirds and three-quarters of Baltimore’s homicides (from 215 to 238 of the city’s 309 murders in 1999).  

[63]      P. Hermann. “Commissioner shifts priority to handguns: Baltimore police directed to focus less on small drug arrests.”  The Baltimore Sun, January 25, 1996.

[64]      Maryland State Police.  Crime in Maryland: 1998 Uniform Crime Report.  October 1999.

[65]       Maryland Department of Juvenile Justice.  Statistical Report, Fiscal Year 1998.  October 1999.  Intake cases for Baltimore juveniles for alleged drug distribution rose from 1,263 in 1994 to 1,770 in 1998, a 40.1 percent increase.  Since only 2 to 3 percent of intake cases are not the result of an arrest, the drug distribution intake figures provided by the Department of Juvenile Justice provide a close approximation of the number of drug distribution arrests.

[66]       Federal Bureau of Investigation (FBI).  Crime in the United States: Uniform Crime Reports, 1998.  October 1999.

Maryland State Police.  Crime in Maryland: 1998 Uniform Crime Report.  October 1999.

Baltimore’s 1998 drug arrest rate (2,796.2 per 100,000 residents) was 16.8 percent below the city’s peak rate during the 1990s, recorded in 1995.  Even so, Baltimore’s 1998 drug arrest rate was 2.7 times higher than the rate among the nation’s 54 cities with populations of 250,000 or more (1,036.1 per 100,000) and 4.7 times higher than the national average (596.2 per 100,000).  Baltimore also accounts for a disproportionately large share of Maryland’s drug arrests—43 percent of the state’s total in 1998, including 63 percent of all heroin and cocaine arrests.

[67]       Federal Bureau of Investigation (FBI).  Crime in the United States: Uniform Crime Reports, 1998.  October 1999.

Maryland State Police.  Crime in Maryland: 1998 Uniform Crime Report.  October 1999.

In 1998, heroin and cocaine arrests (for both sales and possession offenses) were made in Baltimore at the rate of 2,237.8 per 100,000 population, 10.3 times higher than the U.S. rate of 218.2 per 100,000.  Over the 5-year period 1994-1998, Baltimore made heroin and cocaine arrests at the rate of 2,144.9 per 100,000, 9.2 times higher than the U.S. rate of 234.2 per 100,000.

[68]       Maryland Department of Public Safety and Correctional Services, Division of Research and Statistics.  As of September 2000, 5,115 (50.0 percent) of the 10,229 offenders sentenced from Baltimore to more than a year in Maryland state prison were charged with drug offenses.  (Baltimore and each of Maryland’s 23 other counties are separate sentencing jurisdictions. With rare exceptions, an offender is sentenced in the jurisdiction in which he or she committed the offense.  The sentencing jurisdiction, therefore, is not necessarily an offender’s jurisdiction of residence.  For example, a Howard County resident who is convicted of a crime committed in Baltimore would be sentenced by the Baltimore jurisdiction; by the same token, a Baltimore resident convicted of committing a crime in Howard County would be sentenced by the Howard County jurisdiction.)   

[69]       Maryland Department of Public Safety and Correctional Services, Division of Research and Statistics.  As of September 2000, drug sales were the most serious offense for 3,021 (29.5 percent) of the 10,229 offenders sentenced from Baltimore to more than a year in Maryland state prison.

[70]     Bureau of Justice Statistics (BJS).  Substance Abuse and Treatment, State and Federal Prisoners, 1997.  January 1999.  In 1997, inmates sentenced for drug offenses accounted for 11.3 percent of all state prisoners nationwide sentenced to more than one year.

[71]       Maryland Department of Public Safety and Correctional Services, Division of Research and Statistics.  As of September 2000, 1,234 (24.1 percent) of the 5,112 state inmates imprisoned for drug offenses committed in Baltimore were charged with violent crimes. By comparison, 85.7 percent of those imprisoned for non-drug offenses committed in Baltimore were charged with violence.

[72]       Maryland Department of Public Safety and Correctional Services, Division of Research and Statistics.  As of September 2000, 3,881 (84.2 percent) of the 4,611 non-violent Baltimore offenders serving more than a year in Maryland state prison were drug offenders.

[73]       Maryland Department of Public Safety and Correctional Services, Division of Research and Statistics.  As of September 2000, 13,045 (43.3 percent) of the 30,148 Baltimore residents on parole or probation were under court supervision for drug offenses.

[74]       Maryland Department of Public Safety and Correctional Services, Division of Research and Statistics.  As of September 2000, drug crimes were the most serious offense for 11,405 Baltimore probationers, 49.5 percent the Baltimore’s total probation population of 23,048.

[75]       Bureau of Justice Statistics (BJS).  Probation and Parole in the United States, 1998.  August 1999.  According to BJS, 24 percent of probationers nationwide in 1998 had a drug law violation as their most serious offense.  

[76]       Maryland Department of Public Safety and Correctional Services, Division of Research and Statistics.  As of April 2000, the 15,519 non-violent drug offenders on probation and parole in Baltimore comprised 62.5 percent all the total of 24,837 non-violent Baltimore probationers and parolees.

[77]     Maryland Department of Public Safety and Correctional Services, Division of Research and Statistics.  As of April 2000, drug crimes were the most serious offense for 11,869 Baltimore probationers, amounting to 2.519 percent of the city’s adult population in 1999 (471,147), or 1 in every 40 Baltimore adults.

[78]       Bureau of Justice Statistics (BJS).  Probation and Parole in the United States, 1998.  August 1999.  In 1998, 820,227 probationers nationwide had a drug law violation (24 percent of the total probation population), amounting to 0.374 percent of the U.S. adult population in 1998 (219,393,000), or 1 in every 276 U.S. adults.  Baltimore’s rate (1 in 40 adults) is therefore 6.7 times higher than the U.S. rate.

[79]       Maryland Department of Juvenile Justice (DJJ).  Statistical Report, Fiscal Year 1998.  October 1999.  Of the 12,800 juvenile justice intake cases involving Baltimore youth, 3,026 were due to alcohol violations and other drug offenses, 23.6 percent of the total.  

[80]       Maryland Department of Juvenile Justice (DJJ).  Statistical Report, Fiscal Year 1998.  October 1999.  Baltimore’s 1,263 juvenile intake cases involving drug distribution offenses in 1994 translated to a rate of 934.7 such cases per 100,000 Baltimore residents ages 5-18 years.  The city’s 1,770 juvenile drug distribution intake cases in 1998 translated to 1,382.2 such cases per 100,000 Baltimore residents ages 5-18 years, 47.9 percent higher than the 1994 rate.

[81]       Maryland Department of Juvenile Justice (DJJ).  Statistical Report, Fiscal Year 1998.  October 1999.  Baltimore’s 1,770 juvenile drug distribution intake cases in 1998 amounted to 67.5 percent of the 2,622 such cases statewide.

[82]       Maryland Department of Juvenile Justice (DJJ).

[83]       T. Gray & E. Wish.  Substance Abuse Need for Treatment among Arrestees (SANTA) in Maryland.  College Park, MD:  Center for Substance Abuse Research (CESAR), May 1998.

[84]     T. Gray & E. Wish.  Substance Abuse Need for Treatment among Arrestees (SANTA) in Maryland.  College Park, MD:  Center for Substance Abuse Research (CESAR), May  1998.

[85]       Formerly known as the Drug Use Forecasting (DUF) program, a total of 36 sites have participated in the National Institute of Justice’s Arrestee Drug Abuse Monitoring (ADAM) Program during the 12-year period 1988-1999.  Most ADAM sites are known by the name of the largest city in the area, but the catchment area for each site extends beyond the urban center and in most cases covers the entire county.  For example, the catchment area for the Detroit ADAM site is all of Wayne County.

ADAM’s Miami site, an 11-year participant, has never tested female arrestees.  The number of sites has increased from 20 in 1988 (14 of which tested female arrestees) to 34 in 1999 (32 of which tested females).  Seven of the 36 ADAM sites (19.4 percent) include central cities that are less than half the size of Baltimore (Anchorage, Birmingham, Des Moines, Ft. Lauderdale, Laredo, Salt Lake City, and Spokane).  But 12 of the ADAM sites (33.3 percent) include central cities that are larger than Baltimore (Chicago, Dallas, Detroit, Houston, Indianapolis, Los Angeles, New York City, Philadelphia, Phoenix, San Antonio, San Diego, and San Jose).

[86]       T. Gray & E. Wish.  Substance Abuse Need for Treatment among Arrestees (SANTA) in Maryland.  College Park, MD:  Center for Substance Abuse Research (CESAR), May  1998.  From October 1994 through September 1995, the Baltimore Police Department made 61,331 arrests of adults.  Because a number of individuals were arrested more than once, the total number of individuals arrested by BPD during this period was 41,124.  CESAR estimated that 45.8 percent (18,844) of these adult arrestees needed treatment for alcohol or drug abuse, including 13,600 (72.2 percent) needing treatment for heroin, 11,000 for cocaine, 6,000 for alcohol and 1,200 for marijuana.

[87]   Maryland State Police.  Crime in Maryland: 1998 Uniform Crime Report.  October 1999.  In 1998, the Baltimore Police Department made 71,693 arrests of adults, 16.9 percent more than the 61,331 adult arrests made by BPD over the 12-month period from October 1994 through September 1995.  Adjusting BPD’s 1998 adult arrest to account for repeat arrestees by using the same percentage as in the CESAR study (that is, multiplying the total arrests by 67.05 percent) provides a total of 48,070 individual adults arrested by BPD in 1998.  If 45.8 percent of them needed of treatment, as CESAR found to be the case for arrestees in 1995, then 22,016 adult arrestees needed treatment in 1998. 

[88]       Maryland Department of Health and Mental Hygiene, Alcohol and Drug Abuse Administration (ADAA).  ADAA’s administrative database (Substance Abuse Management Information System, or SAMIS) generated an unduplicated count of 18,738 individuals in treatment at state-certified clinics in Baltimore in FY 1999 (July 1, 1998-June 30, 1999). 

[89]       Applying CESAR’s 1995 estimate that 45.8 percent of adult arrestees need treatment for alcohol or drug abuse to the number of adults arrested by the Baltimore Police Department in 1998 yields a 22,016 adult arrestees in need of treatment, 17.5 percent greater than the number of individuals who actually received treatment in Baltimore in FY 1999 (18,738).   

[90]       Maryland Department of Public Safety and Correctional Services (DPSCS).  Based on intake assessment of prisoners, DPSCS officials estimate that 80 percent of Maryland prisoners have substantial substance abuse problems and 40 percent are injection drug users (IDUs).  Accordingly, Drug Strategies estimates that at least 80 percent of the 10,200 prisoners sentenced in Baltimore had substantial substance abuse problems upon entering prison, and at least 40 percent (4,080) engaged in injection drug use prior to their incarceration.

Bureau of Justice Statistics (BJS).  Substance Abuse and Treatment, State and Federal Prisoners, 1997.  January 1999; and Substance Abuse and Treatment of Adults on Probation, 1995.  March 1999.  According to BJS, three-quarters of all prisoners and two-thirds of all probationers nationwide can be characterized as “alcohol- or drug-involved offenders.”

[91]       Maryland Department of Public Safety and Correctional Services, Division of Parole and Probation.

[92]       Maryland Department of Juvenile Justice (DJJ).  In Maryland, an estimated 30 percent of all youth on juvenile probation, 40 percent of all youth in juvenile detention, and 50 percent of all youth in juvenile residential programs have drug problems.  The Department of Juvenile Justice noted that “there appears to be a relationship between substance abuse and delinquency.  The deeper a juvenile is in the Juvenile Justice system, the more likely it is that the youth will have a substance abuse problem.”

[93]       Maryland Department of Juvenile Justice (DJJ).  As of March 2000, Baltimore accounted for 2,662 (one-third) of the state’s juvenile probation population (8,061), and an estimated 800 (30 percent) of Baltimore youth on juvenile probation had drug problems.  Based on assignments from prior years, as of March 2000, Baltimore accounted for 165 (37 percent) of the state’s juvenile detention population (447), and an estimated 66 (40 percent) of Baltimore youth on juvenile detention had drug problems.  As of March 2000, Baltimore accounted for 583 (37 percent) of the state’s juvenile residential population (1,580), and an estimated 292 (50 percent) of Baltimore youth in juvenile residential programs had drug problems.  Therefore, 1,157 (34.2 percent) of the Baltimore youth in the state’s juvenile justice system as of March 2000 had problems with alcohol or other drugs.

[94]       D. Farabee et al.  “The effectiveness of coerced treatment for drug-abusing offenders.” Federal Probation, 62(1):3-10, June 1998.

[95]       U.S. Census Bureau.  Among the nation’s major cities from 1990-1999, only Washington, D.C. lost a greater proportion of its population (minus 14.5 percent) than Baltimore (minus 14.0 percent).

[96]       Maryland Department of Health and Mental Hygiene, Alcohol and Drug Abuse Administration (ADAA).  Based on FY 1997 treatment admissions, ADAA estimates that 223,190 Maryland resident need alcohol or drug treatment, 158,005 of whom (70.8 percent) live outside Baltimore.

[97]       J. Apperson & T. Richissin.  “A ‘monster’ drug unleashed in Maryland.”  The Baltimore Sun, April 5, 1998.

P. Hermann.  “Drugs: The city-suburban connection.”  The Baltimore Sun, June 21, 1998.

[98]       U.S. Drug Enforcement Administration (DEA).  According to the DEA’s Domestic Monitor Program, heroin’s average price per pure milligram fell from $2.15 in 1990 to $0.87 in 1998, a 60 percent decline.  At the same time, heroin’s average purity more than doubled, rising from 18.0 percent to 41.1 percent.

[99]       U.S. Department of Health and Mental Services, Substance Abuse and Mental Health Services Administration (SAMHSA).  Summary of Findings from the 1998 National Household Survey on Drug Abuse.  August 1999.  Among recent heroin initiates in 1997 and 1998, 87 percent were under age 26, and 72 percent had never injected heroin.  Among recent heroin initiates in 1991 and 1992, only 61 percent were younger than age 26 and only 46 percent had never injected.

[100]     Center for Substance Abuse Research (CESAR).  Maryland Drug Early Warning System (DEWS) Drug Scan Summer 2000 Report.  September 2000.

[101]     Center for Substance Abuse Research (CESAR).  “Baltimore City Residents Most Likely to Perceive Drug Problem.” CESAR Fax, 1(20), June 29, 1992; and “Residents of Baltimore City and Surrounding Counties Most Likely to Report Heroin Being Sold in Their Neighborhood.” CESAR Fax, 7(20), May 18, 1998.

[102]     Maryland State Department of Education.  1998 Maryland Adolescent Survey.  March 2000.

National Institute on Drug Abuse (NIDA).  National Survey Results from the Monitoring the Future Study, 1975-1998.  September 1999. 

[103]     County-by-county illicit drug abuse death data for 1990-1999 were compiled for Drug Strategies by the Maryland Office of the Chief Medical Examiner.  The number of Maryland overdose deaths involving heroin rose from 160 in 1990 to 471 in 1999, a 194 percent increase.  Baltimore heroin overdose dearth rose from 112 in 1990 to 302 in 1999, a 170 percent increase.  The number of heroin overdose deaths in Baltimore’s five surrounding suburban counties (Anne Arundel, Baltimore, Carroll, Harford and Howard) rose from 24 in 1990 to 112 in 1999, a 367 percent increase.

[104]     Maryland State Department of Education.  1998 Maryland Adolescent Survey.  March 2000.  In 1992, 10 percent of Baltimore 10th graders reported having had five or more drinks on the same occasion (binge drinking) within the past month; in 1998, the proportion reporting binge drinking within the past month rose to 17.3 percent, a 73 percent increase over 1992.  Statewide, 19.9 percent of 10th graders reported past month binge drinking in 1992, with the statewide proportion rising to 26.4 percent in 1998, a 32.7 percent increase.  The 1998 statewide rate of 26.4 percent was 52.6 percent higher than the Baltimore rate of 17.3 percent. 

[105]     Maryland State Police.  Crime in Maryland: 1998 Uniform Crime Report.  October 1999. Drug possession arrests fueled the increase in the drug arrest rate in suburban Baltimore, particularly in Anne Arundel County, where the rate of heroin and cocaine possession arrests rose 67 percent and the rate of marijuana possession arrests nearly tripled between 1994 and 1998.

[106]     Maryland Department of Juvenile Justice (DJJ).  Statistical Report, Fiscal Year 1998.  October 1999.  Baltimore’s rate of juvenile drug arrests rose by 16.8 percent from 1994-1998 (1,936.8 to 2,263.1 arrests per 100,000 youth aged 5-18).  In the rest of Maryland, the juvenile drug arrest rate rose by 63.3 percent from 1994-1998 (300.8 to 491.2 arrests per 100,000 youth aged 5-18).  In the five suburban Baltimore counties, the juvenile drug arrest rate rose by 86 percent from 1994-1998 (315.7 to 586.6 arrests per 100,000 youth aged 5-18)