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NARCOTICS RESEARCH, REHABILITATION, 

AND TREATMENT 



HEARINGS 

BEFORE THE 

SELECT COMMITTEE ON CRIME 
HOUSE OF REPRESENTATIVES 

NINETY-SECOND CONGEESS 

FIRST SESSION '" '" 

PUESUANT TO 

H. RES. 115, A RESOLUTION CREATING A SELECT COMMITTEE 
TO CONDUCT STUDIES AND INVESTIGATIONS OF 
CRIME IN THE UNITED STATES 



PART 1 OF 2 PARTS 



APRIL 2Q, 27, 28, 1971 ; WASHINGTON, D.C. 



Serial No. 92-1 



Printed for the use of the Select Committee on Crime 




U.S. GOVERNMENT PRINTING OFFICE 



60-296 WASHINGTON : 1971 



For sale by the Superintendent of Documents, U.S. Government Printing Office 
Washington, D.C, 20402 - Price .$1.50 

NORTHEASTERN UNiVERSin SCHOQL of LAW IMM 



SELECT COMMITTEE ON CRIME 

CLAUDE PEPPER, Florida, Ghairman 

JEROME R. WALDIE, California CHARLES E. WIGGINS, California 

FRANK J. BRASCO, New York SAM STEIGER, Arizona 

JAMES R. MANN, South Carolina LARRY WINN, Je., Kansas 

MORGAN F. MURPHY, Illinois CHARLES W. SANDMAN, Jr., New Jersey- 

CHARLES B. RANGEL, New York WILLIAM J. KEATING, Ohio 

Paul L. Perito, Chief Counsel 
Michael W. Blommer, Associate Chief Counsel 

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CONTENTS 



April 26 1 

April 27 77 

April 28 209 

June 2 341 

June 3 _^____^ 391 

June 4 .-. 481 

June 23 553 

Oral Statements by Government Witnesses 

Health, Education, and Welfare, Department of: 
Food and Drug Administration: 

Edwards, Dr. Charles C, Commissioner : 393 

Gardner, Dr. Elmer A., Consultant to the Director, Bureau of 

Drugs ___ 393 

Jennings, Dr. John, Associate Commissioner for Medical Affairs. 393 
Health Services and Mental Health Administration: 
National Institute of Mental Health: 

Besteman, Dr. Karst, Acting Director, Division of Narcotics 

and Drug Abuse 430. 439 

Brown, Dr. Bertram, Director 430, 439 

Martin, Dr. William, Chief, Addiction Research Center, 

Lexington, Kj' 435,439 

van Hoek, Dr. Robert, Associate Administrator for Operations. 430,439 
Narcotics and Dangerous Drugs, Bureau of: 

IngersoU, Hon. John E., Director 344, 439 

Lewis, Dr. Edward, Chief Medical Officer 344, 439 

Miller, Donald E., Chief Council 344, 439 

Treasury, Department of, Hon. Eugene T. Rossides, Assistant Secretary, 

Enforcement and Operations 61 

Oral Statements by Public Witnesses 

AREBA (Accelerated Reeducation of Emotions, Behavior, and Attitudes), 
Dr. Daniel H. Casriel, director; accompanied by Rev. Raymond Massev 
and Dr. Walter Rosen '_ 273 

Brickley, Hon. James H., Lieutenant Governor, State of Michigan (on 

behalf of Gov. William G. Milliken) 614 

Brill, Dr. Henry, director, Pillgrim State (N.Y.) Hospital 51 

Carter, Hon. James, Governor, State of Georgia 608 

Casriel, Dr. Daniel H., director, AREBA (Accelerated Reeducation of 

Emotions, Behavior, and Attitudes) 273 

Chambers, Dr. Carl, director, division of research, New York State 

Narcotic Addiction Control Commission 558 

Davidson, Dr. Gerald E., a.ssociate director, Drug Dependency Clinic, 

Boston City Hospital 322 

Drug Dependency Clinic, Boston City Hospital, Dr. Gerald E. Davidson, 

associate director ^^ ^ 322 

DuPont, Dr. Robert L., Director, District of Columbia Narcotics Treat- 
ment Administration 143 

Eddy, Dr. Nathan B., Chairman, Committee on Problems of Dnig Depend- 
ence, Division of ]\Iedical Sciences, National Academy of Sciences- 
National Research Council 29 

Gearing, Dr. R. Frances, associate professor, division of epidemiology, 
Columbia University School of Public Health and Administrative 
Medicine 105 

Georgia, State of, Gov. James Carter ^ 608 

(ra) 



IV 

Page 

Gollance, Dr. Harvey, associate director, Beth Israel Medical Center 239 

Hesse, Rayburn F., special assistant to the chairman, Federal-State rela- 
tions, New York State Narcotic Addiction Control Commission 5.58 

Holden, William, department head, MITRE Corp 80 

Holton, Hon. Linwood, Governor, Commonwealth of Virginia .594 

Horan, Robert F., Jr., Commonwealth attorney, Fairfax County, Va 255 

Illinois Drug Abuse Program, Dr. Jerome H. Jaffe, director 210 

Institute of Applied Biology, Rev. Raymond ^Nlassey 273 

Jaflfe, David, department staff, MITRE Corp 80 

Jaflfe, Dr. Jerome H., director, Illinois Drug Abuse Program 210 

Jones, Howard A., commissioner, New York State Narcotic Addiction 

Control Commission 558 

Kramer, Dr. John C, assistant professor, department of psychiatry and 
human behavior, department of medical pharmacology, University of 

California (Irvine) 642 

Kurkmd, Dr. Albert A., director, Maryland State Psychiatric Research 

Center 505 

McCoy, William O., Maryland State Psychiatric Pi,esearch Center 506 

Maryland State Psychiatric Research Center; 

Kurland, Dr. Albert A., director 505 

McCoj^, William ,506 

Taylor, Robert 507 

Masse}', Rev. Raymond, Institute of Applied Biology 273 

Michigan, State of, Lt. Gov. James H. Brickley (on behalf of Gov. WiUiara 

G. Milliken) 614 

MITRE Corp 80 

Holden, William, department head. 
Jaffe, David, department staff. 

Yondorf, Dr. Walter, associate director, national command and con- 
trol division. 
Narcotics Treatment Administration, District of Columbia, Dr. Robert L. 

DuPont, Director 143 

New York State Narcotic Addiction Control Commission: 

Chambers, Dr. Carl, director, division of research 558 

Hesse, Rayburn F., special assistant to the chairman, Federal-State 

relations 558 

Jones, Howard A., commissioner 558 

Pennsylvania, Commonwealth of. Gov. Milton Shapp 602 

Resnick, Dr. Richard B., associate professor, department of psychiatry, 

New York Medical College 1 .539 

Rosen, Dr. Walter, New York, N.Y 273 

Seevers, Dr. Maurice H., chairman, department of pharmacology, University 

of Michigan Medical School 9 

Shapp, Hon. Milton, Governor, Commonwealth of Pennsylvania 602 

Taylor, Robert, Maryland State Psychiatric Research Center 507 

Villarreal, Dr. Julian E., associate professor of pharmacology, University 

of Michigan Medical School 1 483 

Virginia, Commonwealth of, Gov. Linwood Holton 594 

Yondorf, Dr. Walter, associate director, national command and control 

division, MITRE Corp 80 

Exhibits Received for the Record 

exhibit no. 1 

American Medical Association, Dr. Richard S. Wilbur, deputy executive 
vice president, letter dated July 9, 1971, to Paul L. Perito, chief counsel. 
Select Committee on Crime 16 

EXHIBIT NO. 2 

Seevers, Dr. Maurice H., chairman, department of pharmacology, Univer- 
sity of Michigan INIedical School, curriculum vitae 1 22 

EXHIBIT NO. 3 

Defense, U.S. Department of, Dr. Louis M. Rousselot, Assistant Secre- 
tary, Health and Environment, letter dated June 28, 1971, to Chairman 
Pepper, with attachments _ 24 



V 

EXHIBIT NO. 4 (a) AND (b) 

Eddy, Dr. Nathan B., Chairman, Committee on Problems of Drug De- 
pendence, Division of Medical Sciences, National Academj^ of Sciences- 
National Research Council: P»Ke 

(a) Prepared statement 40 

(b) Curriculum vitae 42 

EXHIBIT NO. 5 (a) AND (b) 

Brill, Dr. Henry, director, Pilgrim State Hospital, New York, N.Y.: 

(a) Prepared statement 58 

(b) Curriculum vitae 59 

EXHIBIT NO. 6 

State, Department of, David M. Abshire, Assistant Secretary for Congres- 
sional Relations, letter dated July 2, 1971, to Chairman Pepper, with 
attachments 70 

EXHIBIT NO. 7 

Treasur}^ Department of, Eugene T. Rossides, Assistant Secretary for 

Enforcement and Operations, curriculum vitae 75 

EXHIBIT NO. 8 (a) AND (b) 

Jaffe, David, department staff, MITRE Corp.: 

(a) Supplemental statement 101 

(b) Curriculum vitae 102 

EXHIBIT NO. 9 

Ulrich, William F., manager, applications research, scientific instruments 
division, Beckman Instruments, Inc., prepared statement (dated 
June 27, 1970) 103 

EXHIBIT NO. 10 (a) AND (b) 

Gearing, Dr. Francis R., associate professor, division of epidemiology^, 
Columbia University School of Public Health and Administrative 
Medicine : 

(a) Paper entitled "Successes and Failures in Methadone Mainte- 
nance Treatment of Heroin Addiction in New York City" 121 

(b) Position paper entitled "Methadone — A Valid Treatment Tech- 
nique" 138 

EXHIBIT NO. 11 (a) THROUGH (e) 

DuPont, Dr. Robert L., director. District of Columbia Narcotics Treat- 
ment Administration : 

(a) Article entitled "Profile of a Heroin Addict" 166 

(b) Study entitled "Summary of 6-Month Followup Study" 178 

(c) Brief collection of statistical information entitled "Dr. DuPont's 
Numbers 183 

(d) An administrative order setting forth guidelines for methadone 
treatment 183 

(e) Article entitled "A Study of Narcotics Addicted Offenders at the 

D.C. Jail" '_ 195 

EXHIBIT NO. 12 

Jaffe, Dr. Jerome H., director, Illinois Drug Abuse Program, curriculum 

vitae 236 



VI 

EXHIBIT NO. 13 (a) THROUGH (C)' 

Page 
GoUance, Dr. Harvey, associate director, Beth Israel Medical Center: 

(a) Article entitled "Methadone Maintenance Treatment Program". _ 249 

(b) Letter dated May 7, 1971, to Chris Nolde, associate counsel, 
Select Committee on Crime 253 

(c) Letter dated Nov. 11, 1970, to Dr. Vincent P. Dole, Rockefeller 
University from Carlos Y. Benavides, Jr., assistant district 
attorney, Laredo, Tex 254 

EXHIBIT NO. 14 (a) THROUGH (g) 

Casriel Dr. Daniel H., director, AREBA (Accelerated Reeducation of 
Emotions, Behavior, and Attitudes) : 

(a) Article entitled "The Case Against Methadone" 296 

(h) Article entitled "Casriel Institute of Group Dynamics, New 

York, N.Y." (discussion of Dr. Revici paper on Perse) 302 

(c) Submission entitled "Significant Therapeutic Benefits Based on 

Peer Treatment in the Casriel Institute and AREBA" 311 

(d) Introduction and explanation of the AREBA program 314 

(e) Reprint of article from the Medical Tribune-World Wide Report 

entitled "Therapy of Narcotic Addicts Sparks Psychiatric Theory". 315 

(f) Article reprinted from the Sandoz Panorama entitled "The Family 
Physician and the Narcotics Addict" 317 

(g) Curriculum vitae 320 

EXHIBIT NO. 15 

Davidson, Dr. Gerald E., associate director, drug dependency clinic, 
Boston Citv Hospital, study entitled "Results of Preliminary Perse 
Study"....: 331 

EXHIBIT NO. 16 

Beaver, Dr. William T., associate professor, department of pharmacology, 
Georgetown University School of Medicine and Dentistry, prepared 
statement 334 

EXHIBIT NO. 17 (a) THROUGH (e) 

Health, Education, and Welfare, Department of: 

(a) Jennings, Dr. John, Associate Commissioner for Medical Affairs, 

Food and Drug Administration, prepared statement 420 

(b) Edwards, Dr. Charles C, Commissioner, Food and Drug Admin- 

istration, memorandum dated May 14, 1971, with attachments. 422 

(c) van Hoek, Dr. Robert, Associate Administrator for Operations, 

Health Services and Mental Health Administration, prepared 
statement 430 

(d) Brown, Dr. Bertram S., Director, National Insititue of Mental 

Health, Health Services and Mental Health Administration, 
prepared statement 469 

(e) Steinfeld, Dr. Jesse L., Surgeon General, letter dated June 21, 

1971, to Chairman Pepper 480 

EXHIBIT NO. 18 

Villarreal, Dr. Julian E., associate professor of pharmacology. University 

of Michigan Medical School, prepared statement 502 

EXHIBIT NO. 19 

Agriculture, Department Of, N. D. Bayley, Director of Science and Educa- 
tion, Office of the Secretary, letter dated July 23, 1971, to Chairman 
Pepper, re thebaine 510 

EXHIBIT NO. 20 

Kurland, Dr. Albert A., director, Maryland State Psychiatric Research 

Center, prepared statement 520 



vn 

EXHIBIT NO. 21 (a) and (b) 

Page 

New York State Narcotic Addiction Control Commission, Howard A. Jones, 
Chairman-designate : 

(a) Letter dated June 22, 1971, to the committee, re summary of 

New York State drug report 578 

(b) Prepared statement 580 

EXHIBIT NO. 22 

Holton, Hon. Linwood, Governor, Commonwealth of Virginia, prepared 

statement 597 

EXHIBIT NO. 23 

Shapp, Hon. Milton, overnor, Commonwealth of Pennsylvania, pre- 
pared statement 606 

EXHIBIT NO. 24 

Carter, Hon. James, Governor, State of Georgia, prepared statement 612 

EXHIBIT NO. 25 

Brickley, Hon. James H., Lieutenant Governor, State of Michigan, pre- 
pared statement 617 

EXHIBIT NO. 26 (a) THROUGH (f) 

Letters and statements of officials of various cities regarding problems 
of drug abuse: 

(a) Boston, Mass., Mayor Kevin A. White 628 

(b) Detroit, Mich., Mayor Roman S. Gribbs 630 

(c) Hartford, Conn., Mayor George A. Athanson 631 

(d) New Haven, Conn., Mayor Bartholomev.' A. Guida 634 

(e) Philadelphia, Pa.: 

O'Neill, Joseph F., police commissioner 637 

Sofer, Dr. Leon, deputy health commissioner, office of 

mental health/mental retardation 638 

(f) Washington, D.C., Mayor Walter E. Washington 640 

EXHIBIT NO. 27 

Kramer, Dr. John C, assistant professor, department of psychiatry and 
human behavior, department of medical pharmacology, L^niversity 
of California (Irvine), prepared statement 662 

EXHIBIT NO. 28 

Statement submitted on behalf of S. B. Penick & Co., Merck & Co., Inc., 

and Mallinckrodt Chemical Works 670 

EXHIBIT NO. 29 

Becker, Arnold, public defender, Rockland County, N.Y., statement .__ 677 

EXHIBIT NO. 30 

Andrews, Rev. Stanley M., Libert}' Lobby, prepared statement 679 

EXHIBIT NO. 31 

Benson, Dr. Richard S., letter dated August 4, 1971, to Chairman Pepper, 

re transcendental meditation (with enclosures) 681 

EXHIBIT NO. 32 

'Copy of letter sent to drug companies by Chairman Pepper re research 

concerning narcotic blockage and atagonistic drugs 690 



NARCOTICS RESEARCH, REHABILITATION, 
AND TREATMENT 



monday, april 26, 1971 

House of Representatives, 
Select Committee on Crime, 

Washington^ B.C. 

The committee met, pursuant to notice, at 10 :05 a.m., in room 2359, 
Rayburn House Office Building, Hon. Claude Pepper (chairman) 
presiding. 

Present: Representatives Pepper, Mann, Wiggins, Steiger, Winn, 
and Keating. 

Also present : Paul Perito, chief counsel ; and Michael W. Blommer, 
associate chief counsel. 

Chairman Pepper. The committee will come to order, please. 

The House Select Committee on Crime today begins 7 days of 
public hearings which will cover four separate but related areas of 
narcotic addiction. We have been examining the complex problems of 
drug abuse and drug dependence since our inception as a committee 
on crime in May 1969. The heroin addiction crisis has reached threat- 
ening proportions. Our cities are beseiged. Our suburban areas have 
become infected. Even our rural areas are now feeling the shocking 
effect of this malady. Drug abuse and drug dependence have become 
so unmanageable that they are now responsible, both directly and 
indirectly, for contributing to 50 percent of the street crime in our 
Nation. While our population has increased 13 percent from 1960 to 
1969, crimes against property increased 151 percent, and violent 
predatory crimes increased 130 percent. 

In the face of this mounting evidence of spiraling street crime, our 
citizens are properly asking whether their Government is helpless, 
or corrupt, or even worse, totally incapable or unwilling to deal with a 
public health epidemic. 

The national heroin addiction epidemic places an impossible burden 
upon an overburdened criminal justice system. This heroin epidemic 
forces our police to allocate their resources unequally in attempting to 
stem the illicit drug traffic. Testimony taken by our committee in New 
York, Washington, San Francisco, Boston, and Miami vividly dem- 
onstrated the fact that prosecutors must devote an inordinate amount 
of their time and staff to the investigation and prosecution of cases 
which are heroin connected. Our Crime Committee investigators have 
revealed that in New York, as in most of our major cities, the adminis- 
tration of criminal justice has been brought to a virtual standstill be- 
cause of the volume of heroin related cases. Probation officers through- 
out the country have advised our investigators that they cannot begin 

(1) 



to cope witli the burdens imposed on their officers b}' heroin addiction 
probationers. For the same reason, our prisons also are overloaded and 
our detention facilities arc strained beyond imagination. How can these 
institutions be expected to perform the pi-oper function of confinement, 
which is rehabilitation ? Correction and rehabilitation are not only hin- 
dered by the heroin epidemic, they are made virtually impossible. As a 
direct result, our alleged correction process has become a myth, and 
recidivism flourishes in every major city in our Nation. 

The cost in terms of dollars is staggering. The cost in terms of lives 
lost is appalling. Truly, the heroin addiction epidemic has become a 
national tragedy. 

If we attempt to compute the monetnry loss resulting from this 
heroin epidemic, we must include the involuntary social costs; that 
is, the cost for law enforcement and the administration of criminal 
justice, the cost of production losses. Our statistical computation of the 
national dollar loss due to the heroin epidemic ranges from $1.5 to $2 
billion aniuially. But this staggering amount of lost dollars pales into 
insignificance when we consider the loss of human life related to heroin 
addiction. Dr. Milton HelpeT-n, chief medical examiner of New York 
City, told our committee in June that in 1960 there were 199 narcotic- 
related deaths in New York, but this figure soared to 1.006 deaths in 
1969. Sadly, of the 1,006 narcotic-related deaths in 1969, 255 were teen- 
agers. Heroin addiction is the leading cause of death in New York 
among adolescents and young adults between the ages of 15 and 35. 
The heroin death rate in New York is not typical for densely popu- 
lated metropolitan areas. 

In Dade County, Fla., my congressional district, 41 young people 
died from heroin last year, and nine deaths have already been re- 
ported as of this year. 

The death rate for narcotism in Washington and Miami have at- 
tested to similar growth patterns. 

You may wonder why our witness list today includes three out- 
standing scientists and medical clinicians but only one law enforce- 
ment official. You may wonder why a committee on crime is soliciting 
the views of the scientific and medical communities and not concen- 
trating exclusively upon local police officials and narcotics agents. 
You may wonder why this committee is vitally concerned about the 
insignificant amount of Federal and State dollars devoted to research 
into the development of more eflFective blockage and antagonistic 
drugs, and synthetic substitutes for heroin and morphine. 

It is precisely because we have taken a comprehensive view of the 
national and international drug abuse and drug addiction problem 
that we are today examining the capabilities of our scientific and 
medical communities to deal with this national heroin epidemic. 

We have for too long relied solely upon law enforcement to control 
this public health menace. This is not to suggest that law enforcement 
should not play a vital role in what should be a national commitment 



to stem the tide of narcotic addiction arid interdict the flow of illicit 
heroin into our country. However, we can no longer delude ourselves 
with the thought that law enforcement alone is capable of controlling 
or even substantially reducing the flow of illicit heroin into the 
United States or of reducing the number of addicts daily threatening 
our cities. Heroin addiction is clearly crimogenic. Information gath- 
ered by our investigators leads us to conclude that a svibstantial por- 
tion of our addict population must not only steal, but also deal^ 
in order to pay for their voracious habits. Every addict dealer is a. 
walking health menace. 

Dr. Robert DuPont, of the District of Columbia Narcotics Treat- 
ment Administration, estimates that the average addict in the District- 
gets illegal possession of $50,000 worth of goods a year to sustain his 
addiction. 

The mounting evidence of the growing illicit flow of heroin into 
the United States compels the conclusion that we must search for new 
and imaginative answers. Our scientific and technological capabilities 
must be enlisted in the fight. No longer will the prosaic law enforce- 
ment approaches of the past serve as guides for future congressional 
conduct. 

It is with this prospective that we open 7 days of heai'ings in which 
we plan to explore some brave new worlds in our struggle against the 
menace of a national heroin epidemic. 

In January, our committee filed a heroin report with the Congress 
in which we recommended that our Government advocate and nego- 
tiate toward the total eradication of worldwide opium cultivation. We 
are convinced of the futility of relying solely upon overburdened and 
devoted customs and narcotics agents whom we have assigned tlu' im- 
l)0ssible burden of policing our borders and ferreting out heroin traf- 
fickers. Responsible law enforcement officials have told our committee 
that the combined efforts of our dedicated Federal and State narcotic 
agents result in seizures of less than 20 percent of the heroin smuggled 
into our country. Even if we were to double the size of our narcotic 
enforcement agencies and provide them with unlimited spending au- 
thorization, we might be able to increase our seizures 100 percent and 
thereby seize 40 percent of the heroin destined for the addicts' eager 
veins. But what about the remaining 60 percent ? How can we possibly 
expect customs agents to search the 250 million people who pass 
through our borders each year ? How can we possibly and reasonably 
expect the customs agents and narcotic officials to inspect the 65.310.- 
807 cars and trucks, the 306,476 planes, and the 156,994 ships wiiich 
entered our country last year ? 

We have been told by the customs and narcotic officials that on the 
ordinary size ship arriving at the Port of New York there are 30,000 
places where heroin can be concealed. 

On a local level, a recently concluded study by the New York State 
Investigations Commission revealed that in 1970, officers of the under- 



cover unit of the narcotic division of the New York City police made 
7,266 buys of narcotics, and made 4,007 arrests in connection therewith. 
In all of these citywide arrests made in a year's time, a total of 4.97 
pounds of highly adulterated heroin was seized. The cash used by the 
New York police to make these purchases totaled $91,197.50 — that is 
over $1,100 an ounce for highly diluted heroin. Surely it cannot be 
argued that these arrests and seizures, at a tremendous cost of man- 
power and actual cash outlay, are having a significant impact in stem- 
ming the tide of organized narcotic trafficking in the city of New 
York. 

It seems highly unlikely that the continued diligent efforts of dedi- 
cated narcotics agents, on all levels, will result in a significant increase 
in the rate of heroin seizures. It seems clear that if the opium poppy 
continues to be cultivated legally there will inevitably be illegal traffick- 
ing in the heroin derived from this poppy. 

Consequently, our committee is today examining the question of 
whether we really need the opium poppy. If we can supply the pain- 
killing and cough-suppressing needs of our Nation by reliance upon 
domestically manufactured synthetic substitutes, then this Congress 
should take the lead today in banning the importation of all crude 
opium. It is to this end that we will devote a portion of this hearing. 

We will then hear from law enforcement experts and scientific re- 
searchers about the possibility of policing such a worldwide ban. We 
also want to know whether our Federal law enforcement officials 
believe that this bold step would be helpful to them, not only in stem- 
ming the illicit flow of heroin into the United States, but also as a 
lever in bargaining with officials from opium-producing countries. 

We then plan to look at the state of development of narcotic block- 
age and antagonistic drugs. Our interest is not confined to methadone, 
which looks promising but is also fraught with problems. Our inter- 
est is also in assessing the potential of developing longer lasting block- 
age drugs such as acetylmethadol, which is being used experimentally 
by Dr. Jerome H. Jaffe, in Chicago. We also want to know whether the 
so-called heroin antagonists are, as Dr. Stanley Yolles (former Direc- 
tor of the National Institute of Mental Health) commented, the most 
promising area in narcotics research. If this is true, our committee 
wants to know why more adidcts are not now being treated in rehabili- 
tation centers throughout the country with nonaddicting cyclazocine 
and naloxone. What are the results of experiments with antagonist 
drugs? Do scientists really believe that these drugs offer a viable 
alternative to methadone maintenance and drug-free treatment 
modalities? 

Additionally, as a committee on crime, we must not only be con- 
cerned with the humanitarian aspect of opiate addiction, but also the 



burden that such addiction imposes upon a society threatened and 
ravaged by crime directly rebated to tliis addiction. Is methadone 
maintenance an efficacious method of reducing crime perpetrated by 
addicts under treatment? Does methadone maintenance reduce the 
illegal activity of addicts and provide a vehicle to move these addicts 
back into our society ? Is methadone maintenance safe if properly 
administered in a comprehensive rehabilitation program ? 

Do the deaths recently attributed to methadone — we have had six 
reported deaths in the last few weeks here in the District of Colimi- 
bia — do the_ deaths recently attributed to methadone mean that we 
must reconsider the present posture of methadone maintenance or are 
these deaths a natural incident and to be expected with the rise of 
methadone treatment programs? These are just some of the ques- 
tions which this committee wants answered during the course of these 
hearings. 

"VYe also want to know whether the guidelines recently promulgated 
by the Food and Drug Administration will serve as a barrier against 
wrongful, negligent, and unlawful practices by some physicians who 
have dispensed methadone. We want to examine the critical question 
of how can methadone, an admittedly dangerous synthetic drug, best 
be dispensed. "We want to know whether methadone maintenance 
can truly be an effective therapeutic approach with the proper and 
costly support services. 

Finally, this committee intends to survey and evaluate our present 
Federal and State expenditures relating to opiate research. We want 
to know if new drugs are on the horizon. Certainly the scientific genius 
of this country should be implored and employed to help solve this 
national calamity. 

It might well be that at the conclusion of these 7 days we have 
raised more questions than we have answered. However, we can no 
longer afford to avoid the unpleasant evidence of the geometric 
growth in narcotic addiction. This tragedy, however, might well push 
us into a needed national mobilization of our medical and scientific 
resources to destroy the awful heroin traffic and to deal humanely 
with those who suffer from it. I know I sjDeak for all the members of 
this committee when I conclude by stating that this committee is 
ready to make the sacrifice, financial and otherwise, which is neces- 
sary to wipe out this national health epidemic. 

At this time, let us place in the record a copy of House Resolution 
115, introduced January 3, 1971, and approved March 9, 1971, which 
created the Select Committee on Crime in the House of Representa- 
tives, described its purposes, set its goals, laid its jurisdictions, and 
delineated its functions. 

(H. Res. 115 follows:) 



6 



92D CONGKES.S 
1st J>kssion 



H. RES. 1 1 5 



IN TIIK IIOISK OF llKriiKSFXTATLVKS 

.I.\.\i m;v -J-I. 1!)71 

.Me. I'l rrii; ( I'of liiiiist'lf iind .Mr. A\'i(;(:in>) siil)inittc(l tin- r()ll()\vin<r I'esohition ; 
wliii-li wiis ivIVri'i'd to tin' ("oiumittfe on Knlcs 

Fi:ni!r\i;v l*.">. I'.'T! 

]>r|)()ilc(l uilli ;iiii(Mi(liiiciits, ivI'eiTi'd to tlic House Ciilciidar, ami ofdorcd to 

1)0 i)rir>t('d 

.Mmmii !). 11)71 
( 'oiisidiTi'il, ;nii(Midi'd, and ajifced lo 



RESOLUTION 

;i liesolred, That, effective Jamiarv o, 1971, there is 

2 hereby created a select coiimiittee to he composed of eleven 

3 Memher.s of the House of Kcpreseiitative.s to ))e appointed 

4 \>\ \\\(' S])eaker, one of \\ii(nii he shall desijiiiate as chainnaii. 

5 Any vacancy occnrrinji' in the niciuliersliip of the select 
G coiiiniitlee shall he liHed in the same manner in wjiich the 

7 oriuinal ai)pointment was. made. 

8 )Six\ 2. The select connnittee is authorized and directed to 
conduct a full and complete investigation ;uid study of all 

10 aspects of crime affecting- the United States, including, but 

11 not limited to, (1) its elements, causes, and extent ; (2) the 

12 preparation, collection, and dissemination of statistics and 



1 (lata; (->) the sliariiis" oF iiiloniiatioii. staiti^itics, and data 

2 amoiio' law enforcement awncies, Federal. State, and local. 

3 inchuling' the excliange of infoi-niation. .statistics, and data, 

4 with foreign nations; (4) the adeqna(-y i»l' law enforcement 
^ and the administration of justice, inchuling' constitutional is- 
^ sues and prohlems pertaining thereto: (.")) the effect of crime 
'^ and distnrhanccs in the metro]iolifan nrhan areas: ((>) the 
^ effect, directly or indirectly, of crime on the connnerce of 
^ the Nation: (7) the treatment and rchahilitation of ])ersons 

^^ conxicted of crimes; (8) mcasni-es relating to the reduction.. 

^^ control, or prevention of crime: (11) measures relating to the 

^- injpi'oxement of (A) investigation and detection of crime, 

^'^ (B) law enforcement techniques, including, hut not limited 

•^ to. increased cooperation among the law enforcement agen- 

-^■^' cies, and (C) the efTcctive adnnnistration of justice: and 

^^ (10) ineasures and progi'ams h>r increased respect for the 

' ]n\y and constituted authoi'ity. 

•"^ Si'.C. .'5. I'or till', pui'posc of making such in\estigations 
and studies, the. conmiillee or any suhcoimnittee thereof is 

a,uthori/ed to sit and act. suljject to clause 31 of rule XI of 

21 • • • 

the Rules of tlie House of Kepresentativcs. during the pres- 

00 . ... 

ent Congress at such times and places within the United 

23 1 • • 

States, includmg any Commonwealth or possession thereof, 

24 

wliether the House is meeting, has recessed, or has ad- 

95 

journed, and to hold such hearings and reipure, h\' suhpena 



8 

3 

1 or odierwise, tlu' aUciKljiiicc and tcstiiiioii}- of ^iicli \vitiicsscs 

12 and tlio ])r()dut'ti()n of such Ixxtks. records, correspondence, 

3 menioiaiidiims, })ai)('rs, and documents, as it deems iieces- 

4 'ijary. Snbpenas may l)c issued over the signature of the chair- 

5 man of the connnittee or any member designated b\' him and 
^ may be served liy any person designated by such chainnan 

7 or member. 

8 Sec. 4. The select connnittee shall report to the House as 

9 .sooii as lU'acticable during the present Congress the results 

10 of its investigations, hearings, and studies, together with such 

11 recommendations as it deems advisable. Any such report or 

12 reports which are made when the House is not in session 

13 shall be filed \\ith the Clerk of the House. 



9 

Chairman Pepper. The committee is very much pleased to call at 
this time Dr. Maurice H. Seevers, one of the Nation's most respected 
researchers in the held of driio- abuse and drug addiction. 

Dr. Seevers holds both a Ph. D. in pharmacology and an M.D. from 
the University of Chicago. 

In the course of his distinguished career, Dr. Seevers has served as a 
research fellow in pharmacology at the Universit}- of Chicago ; an 
instructor in pharmacology at Loyola of Chicago ; associate professor 
of pharmacology at the University of Wisconsin; and as associate 
dean of the University of Michigan Medical School. Since 1042, he 
has served as professor of pharmacology and chairman of the depart- 
ment of pharmacology at the University of Michigan IMedical School. 

Dr. Seevers is a past president of the American Society of Pharma- 
cology and Experimental Therapeutics, and has served as chairman 
of the executive committee of the Federation of American Societies 
of Experimental Biology. 

He is a consultant to the National Research Council's Committee 
on Problems of Drug Dependence ; a member of the American Medical 
Association's Committee on Alcoholism and Drug Dependence: and 
chairman of the American Medical Association's Committee on Re- 
search on Tobacco and Health. 

Dr. Seevers has served as a member of the board of scientific coun- 
selors of the National Heart Institute ; the Drug Abuse Panel of the 
President's Advisory Committee, "Wliite House Conference on Nar- 
cotics and Drug AlDuse; and the Surgeon General's Committee on 
Smoking and Health. 

Dr. Seevers presently serves as the American coordinator of the 
United States- Japan Cooperative Program on Drug Abuse; he is a 
member of the Expert Advisory Panel on Drugs Liable To Produce 
Addiction of the U.N.'s World Health Organization; and is a con- 
sultant to the Minister of Health and Welfare of Japan. Dr. Seevers 
was recently appointed by President Nixon to the President's Com- 
mission on Marihuana and Drug Abuse. 

He has served on the editorial boards of numerous scientific journals 
and has received honors befitting a man of his wisdom and dedication, 
including three honors from the Government of Japan. 

Dr. Seevers, we are indeed honored to have you here today, and very 
grateful to you for coming here. 

Mr. Perito, our chief coimsel. You may inquire. 

Mr. PERrro. Thank you, Mr. Chairman. Dr. Seevers, I understand 
that you have a prepared statement. 

STATEMENT OF DE. MAURICE H. SEEVERS, CHAIRMAN, DEPART- 
MENT OF PHARMACOLOGY, UNIVERSITY OF MICHIGAN MEDICAL 
SCHOOL 

Dr. Seevers. I do. 

Mr. Perito. Would you care to read that statement ? 

Dr. Seevers. Thank you, sir. 

I will address myself primarily to the question of whether it is pos- 
sible to substitute synthetic drugs for horticulturally derived 
substances. 

60-296— 71— pt. 1 2 



10 

The question currently before your committee, the substitution of 
synthetic narcotic analgesics for narcotic analgesics or their semisyn- 
thetic derivatives derived from opium is not a new one. Nor has it re- 
mained unanswered by competent authorities in the past. In 1951, the 
Committee on Drug Addiction and Narcotics — now the Committee on 
Problems of Drug Dependence — National Academy of Sciences-Na- 
tional Research Council, was confronted by the following questions 
by the Munitions Board (Minutes of the seventh meeting, January 15, 
1951, "Bulletin of the Committee on Drug Addiction and Narcotics") : 

1. What percentage of national requirements for opium derivatives could 
safely be replaced by synthetics ? 

2. If at some stage during a national emergency our stocks of opium should 
become exhausted and irreplenishable, how serious would be the consequences 
on <he public health in view of the availability of synthetic substitutes? 

The Committee answered thus — this was in 1951, 20 years ago: 

All uses of morphine, codeine, and other products and compounds derived from 
opium for systematic relief may be replaced adequately with substitutes now 
known. The only question for which a complete answer cannot be given at pres- 
ent is whether or not replacement of codeine for self-medication for cough re- 
lief with synthetic agents would be as safe as the use of codeine itself? An im- 
mediate and intensive effort should be directed toward the answer to this ques- 
tion of safety. 

For several years prior to this response the Committee was be- 
sieged with requests to test new synthetic analgesics for their depend- 
ence liability on voluntary ex-addicts at the USPHS Hospital at Lex- 
ington. This facility was then, and still is, the only place in the world 
where such studies can be conducted on man. 

The industrial output has always been far in excess of the capacity 
of tliis clinical unit. 

Having utilized the rhesus monkey as a laboratory model of mor- 
phine dependence since my graduate student days in 1925, and found 
this species remarkably similar to man in its response to this class of 
drugs, I suggested to the committee that this animal might be utilized 
as a preliminary screen to reduce the number of drugs to be tested in 
man. After 3 years of development during which the results on mon- 
keys were compared carefully with those obtained on humans at the 
Lexington facility, satisfactory testing procedures were available. 
Since that time, this monkey colony at the University of Michigan has 
become a world facility. Over 800 drugs of this class have been evalu- 
ated, representing the world output, including all of these Avhich have 
reached the market. Some possess properties superior to those of mor- 
phine. Dozens of those tested, although not profitable for marketing 
at the present stage, could be used safely and effectively in man. 

Tlius 20 years after the limited affirmative of the NRC Committee 
the scientific answer today is an unqualified affirmative. 

But other questions which relate to the practical a]:)plication of this 
scientific affirmative cannot be answered with such precision and as- 
surance. Whereas I make no claim to expertise in all of these areas, I 
have been involved on the scene over the last 30 3'ears, and sor.ie com- 
ments may be pertinent. The elementary question, of course, is two- 
pronged. ,.,j(,, 

One aspect is, would the total elimination of quota production by 
U.N.-recognizcd producing countries prevent the smuggling of non- 



11 

quota production from unrecognized countries? The second aspect, 
would it be possible to control illicit production or snuiggling of syn- 
thetics when it is currently impossible to control heroin ? 

The answer to these two questions is clearly in thenegative without 
international cooperation, a most uncertain probability in view of the 
strong economic factors involved. May I remind you that the 10th 
:session of the Economic and Social Council of the United Nations in 
1956 came within one vote of adopting a resolution which would have 
prohibited the production of synthetic narcotics. This action was of 
such great concern to Commissioner Anslinger that he asked me to 
write a paper on the subject. This paper was entitled "Medical Per- 
spectives on International Control of Synthetic Narcotics." This arti- 
cle raised the ire of representatives of the producing and manufactur- 
ing nations, especially France, Turkey, Yugoslavia, and India. They 
objected to many of the statements made in this article and for many 
reasons but especially the following : 

On the contrary, the scientific and medical advances in the synthetic and nar- 
cotic field have been so rapid that even today very few natural products are in- 
dispensable to the public health. The evidence in favor of the "synthetics" is so 
impressive when subjected to comparative analysis that the author is tempted 
to predict that the day is not far distant when the Commission will be confronted 
with resolutions which would propose to abolish forever the cultivation and 
production of all "horticulturally derived" narcotics. 

Probably you have heard the following statistics but to refresh your 
minds: 163 tons of morphine were manufactured legally in 1969. Ap- 
proximately 90 percent of this was converted into codeine. Codeine, 
although present naturally in opium, is present in such small amounts 
that it is not commercially practical to obtain codeine without convert- 
ing it from morphine. 

This quantity of morphine was produced from 1,219 tons of opium 
production and 28.274 tons of poppy straw. This was the licit produc- 
tion of opium. It is controlled by the International Control Board 
of the United Nations. Almost three-fourths of the total, 864 tons, was 
produced by India. The second largest producer was the U.S.S.R., 217 
tons ; the third largest, Turkey, with a production of 117 tons, less than 
one-tenth of the total. The combined production of Iran, Pakistan, 
Japan, and Yugoslavia was only 16.7 tons. If the assumption is correct, 
that most of the smuggled heroin which comes into the United States 
is derived from licit opium production, then it is clear that licit pro- 
duction greatly exceeds legitimate medical needs. 

The 1970 report of the International Narcotics Control Board of the 
United Nations which furnished the above figures also contained the 
following statement : 

Yet if leakages from licit production could be virtually extinguished, smugglers 
would still be able to have recourse to opium which is produced illegally or be- 
yond Government control. There are now extensive areas of such production 
and it is essential that, side by side with reinforcing monopoly controls over 
licit production, major efforts should be made to eliminate poppy cultivation in 
these areas. The regions chiefly involved are situated in Afghanistan, Burma, 
Laos, and Thailand ; and there is also some production in parts of Latin 
America. 

Other questions must be dealt with. In my opinion, placing restric- 
tions on natural narcotic analgesics would inspire massive resistance 
by organized medicine and the allied professions. Having served on 



12 

a variety of committees of the American Medical Association dealing 
with druss for over 20 vears, I am fully aware that physicians are 
extremely conservative about drug therapy. Codeine, for example, 
ranks high on the list of "most prescribed" drugs for the relief ot 
cough and minor pains. It is a constituent of many mixtures which 
are "prescribed for a varietv of sedative and antispasmodic effects. 

Whereas we do have effective substitutes for codeine which are 
known to be safe, they have made relatively little inroads in the pre- 
scribing of codine. Furthermore, they do not substitute for codeine in 
all respects, particularly since they lack its analgesic and mild sedative 
properties. Relative costs, although not a compelling factor, must be 
considered. Tax-free morphine is now one of the cheapest compounds 
available to medicine today. 

The paramount question then which confronts you, in my opinion. 
is not whether synthetics will substitute for "horticulturally derived" 
narcotics but rather whether outlawing the latter in favor of synthetics 
will accomplish the objectives of significantly diminishing abuse of 
all narcotic analgesics or, in fact, of even heroin itself. 

I say this because of several international situations. I just returned 
from Japan last week where I consulted with the Minister of Health. 
They know exactly how most of the heroin and opium arrive in Japan, 
largely down the Mekong River from the countries which I mentioned 
earlier, transshipped through Macao in Hong Kong. From there it 
is smuggled into their many ports, some by air, but mostly by sea to 
Kobe and Yokohama, et cetera. 

The Japanese have done a good job of heroin control. In 1964, the 
Japanese had a sharp rise in heroin abuse. They make an all-out effort 
to control this. They have available to them the facilities which I 
doubt are available in the United States. In the first place, when they 
say an all-out Government effort they really mean it. This goes from 
the Prime Minister on down. In the last 4 or 5 years they have helcl 
several thousand public meetings all over Japan in which governors, 
states, mayors, even the Prime Minister participate. These are usually 
held in theaters or a public auditorium and may be attended by as 
many as 3,000 or 4,000 people. The hazards of drug addiction are 
graphically portrayed. 

Furthermore, radio, television, newspapers, and other communica- 
tion media have made an all-out campaign against heroin. 

One of the things which I believe contributes significantly to their 
success is the fact that Japan has attacked one drug at a time rather 
than to try to hit the whole area of drug abuse. This goes back to 1955 
when they had the world's largest epidemic of stimulant drug abuse. 
In that year there were 55,000 arrests of methamphetamine abusers. 
Two years later they had reduced this by strong countermeasures to a 
level of about a thousand arrests. This is the only extensive epidemic 
of drug abuse, with which I am familiar, in the world that has been 
controlled in such a short time. They later did a similar job of con- 
trolling heroin. 

One of the situations involves different attitudes toward authority. 
In Japan, when an expert goes on television, such as a professor in 'a 
major university, people listen to him. I am certain this rarely occurs 



13 

in this country. This raises the question whether we really have the 
capabilities of adopting successfully this type of approach. 

But the Japanese have their problems as well. I bring this in inci- 
dentally because it doesn't bear on your major thrust but it is a drug 
abuse problem which must be dealt with. 

Last year, Japan had 40,000 arrests for glue sniffing, with 200 deaths. 
That is one kind of substance which is almost impossible to control. 
To do so, we would have to control all sales from paint stores and pur- 
veyors of more than 50 related solvents. Lacquer thinner is used exten- 
sively in Japan by teenagers 16, 18 years old. So Japan is not without 
her problems, but they have done a remarkably good job in controlling 
amphetamines and heroin addiction. I was told by the Ministry that it 
liacl been reduced to a level where they though it was probably impossi- 
ble to reduce it further. I think this is important — to recognize that 
control will never be absolute. 

Chairman Pepper. Mr. Perito, any questions ? 

Mr. Perito, Dr. See vers, I had the opportunity to look at your lab- 
orator3^ The committee has not had that unique opportunity. 

I wonder if you could kindly explain to the committee exactly what 
is being done in your primate laboratory and how that laboratory is 
financed ? 

Dr. Seevers. This laboratory has been in operation for 20 years. As 
I indicated — we have tested during this time some 800 drugs. This test- 
ing procedure started about 1953. We set it up originally on an entirely 
objective basis and it has always remained so. Dr. Nathan Eddy, who 
is here in the room, has been a long time collaborator on the project. He 
received these drugs on a confidential basis from industry. This facil- 
ity has been available to those who wish to submit for testing. Dr. Eddy 
sent them to our laboratory by code number so that we do not know 
the identity of the supplier. 

Once the tests have been made the information is channeled back 
to Dr. Eddy and he informs the manufacturer. 

Until about 5 years ago, our testing procedure involved primarily 
drugs which would substitute for morphine or for heroin. In other 
words, we were looking for a drug which was superior to morphine 
in the sense it reduced respiratory depression, less side effects, less tol- 
erance development, and less what we call, in general terms, addiction 
liability, the capacity to produce physical dependence. 

We tested many compounds for 15 years and didn't find any that 
would fulfill most of these qualifications. Wlien it was discovered that 
some of the antagonists, which I understand you are going to consider 
later, also possessed pain-relieving properties, somewhat like mor- 
phine, and yet did not produce physical dependence or lead to addic- 
tion, then a new concept was born. Since that time we have tested a 
hundred or more antagonists. We have done this with the objective of 
finding a substance which would still be useful as a pain reliever but 
did not have a capacity to produce physical dependence. I understand 
that is a class of drug that you intend to explore. 

We maintain a colony of around a hundred monkeys. They receive 
an injection of morphine every 6 hours, day and night, right around 
the clock, 7 days a week. When we want to test a new drug we simply 
substitute for the morphine which they ordinarily receive. If this drug 



14 

suppresses signs of abstinence we then can qiiantitate this in a rough 
way and say this drug has morphine-like properties. This has been a 
A^^ery useful test. 

The number of drugs that have gone to Lexington during this 
period for test — and they were sent only to Lexington if they possessed 
some special propeities that were superior to morphine — I would 
guess, maybe, is in the order of 40. I am not certain about the exact 
number. The facility at Lexington has never had the capacity to test 
more than six or eight drugs in a year. 

The ultimate test, of course, is whether the effect in man is desirable 
or undesirable. Monkeys are not men, but close enough to it that it has 
been a very useful screen. We hope to continue it. 

I feel certain that the direction which the research is taking today, 
moving to find a compound of antagonist type, ultimately will be suc- 
cessful. We have some good compounds now. Unfortunately, they are 
too short acting and have to be administered too often to fulfill the 
practical requirements as substitutes. 

This class of drugs, incidentally, acts entirely opposite to metha- 
done. ]\Iethadone simply suppresses and acts like heroin. These new 
drugs antagonize heroin and create a situation so that an individual 
taking the antagonist can take the heroin without anv effect on him. 
In fact, in proper amounts, it completely wipes out any effects of 
heroin. In the long run, this is an area where money could be well 
spent. I think it is possible to find techniques to make available for 
practical use, substances that we currently have available. 

Many other antagonists have been screened in our laborator}^ which 
are potential candidates for this type of action. But they have been 
of no particular interest to the manufacturers, so they were just 
dropped after testing. But a careful review of all antagonists that have 
been studied in the laboratory might uncover some longer acting com- 
pounds that might be useful. 

Dr. Eddy, I run sure, will speak to this point, because he has been 
the one that has channeled the compounds to our department and can 
look at the problem with perspective. 

Chairman Pepper. Doctor, you do think it is within the realm of 
feasibility to develop an antagonistic drug which for all practical 
purposes immunizes the addict against the euphoria th.at he ordinarily 
gets from taking heroin ? 

Dr. Seevers. I think so. Of course, one problem that you must recog- 
nize—a practical problem — is whether it is possible to take heroin 
addicts and force them to take this drug. This is analogous to the 
methadone situation. I don't believe you will ever get beyond the 
vohmteer situation where the addict says "I want to get rehabilitated 
and will take the drug voluntarily." I suppose theoretically it would be 
possible to force any addict to take the drug. I have doubts whether 
it could be done from the enforcement point of view. 

Mr. Perito. Dr. Seevers, could you explain how your laboratory is 
financed ? 

Dr. Seevers. W^ll, up until recently the National Research Council 
Committee of the Problems of Drug Dependence had collected money 
from a wide variety of industrial groups. This is, I believe, the only 
granting agency in the National Eesearch Council. They have col- 
lected this money and have used it to support our laboratory and also- 



15 

from other clinical projects of which Dr. Eddy has been largely re- 
sponsible. He can outline this better than I. 

What is going to happen in the future I am not certain. I believe 
the Bureau of Narcotics and Dangerous Drugs is going to support 
the laboratory because they need this kind of information. But this 
has not been completely clarified as yet. 

I will retire this year. A^^iether my successor, not yet appointed, 
is amenable to carrying on this program at Michigan is not yet known. 
But I am assuming that he is, because it is a well established and 
on-going program. Dr. Julian Villarreal, currently in charge of the 
program, I understand, will testify before your group. He is fully 
capable of taking over this program and has done a beautiful job in 
the last several years. 

Mr. Pekito. Doctor, would it be possible for your laboratory to 
develop an eflecti^'e synthetic analgesic which does not have addiction 
liability ^ 

Dr. Seevers. Well, none of these antagonists have significant ad- 
diction liability. This is their advantage, of course. They do not evoke 
the cellular changes in the brain which is responsible for the phenom- 
ena of physical dependence. We have compounds at the present time 
that can be administered chronically and they do not produce physi- 
cal dependence. 

I am not quite sanguine enough to say that we could develop a eom- 
pound that, if it has any subjective effects, would not be abused by 
some persons. We have on the market a substance of this type now 
which does not produce significant physical dependence: pentazocine. 
I'his compound has shown some small abuse. The number of people who 
will abuse this drug which does not produce subjective effects is very 
small. I think if we can reduce abuse to a minimal level, it is probably 
the best we can ever expect to do. 

Chairman Pepper. Have you had any deaths from the use of pen- 
tazocine ? 

Dr. Seevers. Not to my knowledge. There have been a few re- 
ported cases of drug dependence. 

Mr. Perito. Directing attention to your statement about synthetic 
substitutes for codeines; do we now have a single drug which will 
effectively substitute for codeine or do we have to use a combination 
of drugs ? 

Dr. Seevers. Well, we have a compound which is a little more 
]3otent: dihydrocodeinong. This has been used but since it is more 
potent, it is more subject to abuse. But it is not entirely synthetic. 

The search for a codeine substitute has been one of the primary 
aims of industry in the last decade. It is easy enough to find substi- 
tutes for morphine because we have got a Avhole list of them. But 
those, that hPvVe sufficiently low potency, that they could be used as 
codeine is used, with minimal addiction potential, is something we 
have not quite achieved. 

Chairman Pepper. Just one question. Doctor, how do you think we 
can best induce organized medicine to accept a synthetic substitute 
for morphine and codeine ? 

Dr. Seevers. I don't think we will have any trouble with morphine. 
The problem would be with codeine because it is so widely used. In 
fact, the amount of morphine used in this country is very small com- 
pared to the use of Demerol or other synthetics. The vast bulk of 



16 

strong narcotic use is ^Yith drugs other than morphine at the present 
time. 

Chairman Pepper. Well, we expect to contact and elicit a response 
from the American Medical Association on this matter. 

(The correspondence referred to above follows :) 

[Exhibit No. 1] 

American Medical Association, 

Chicago, III., July 9, 1911. 
Mr. Pattl L. Pekito, 

Chief Counsel, Select Committee on Crime, House of Representatives, 
Congress of the United States, Washington, B.C. 

Dear Mr. Perito: This is in response to your letter requesting our opinion 
concerning the substitutability of synthetic drugs for codeine and morphine. At- 
tached to this letter is a brief review of various available synthetic drugs. As you 
will note from the conclusions stated therein, it is our opinion that at the present 
time no drug is fully satisfactory as a substitute for morphine or codeine. 

We indeed appreciate the concern of the committee in its efforts to find a 
means of curtailing the drug abiise problem prevalent today, and I want to assure 
you that the medical profession is also desirous of attaining this goal. We do 
not believe, however, that removing moTphine and codeine from the physicians' 
drug armamentarium is an appropriate remedy. We strongly recommend that 
these drugs should remain available to physicians so that their patients will not 
be deprived of the valuable benefits of these drugs. 

Thank you for the opportunity of providing our views, and we would appreciate 
this letter and memorandum being included in the record of your hearings. If we 
can be of further assistance to the committee, we shall be pleased to do so. 
Sincerely, 

Richard S. Wilbur, M.D. 
[Attachment] 

MORPHINE substitutes 

Thousands of compounds have been synthesized and tested in the search for 
a substitute for morphine. In addition to analgesic potency, this search has 
focused on lack of addiction liability as a primary objective. To date, these efforts 
have not been completely successful, although some advances have been made. 

At the present time, nine strong analgesics, that are prepared synthetically (i.e., 
not derived from opium) are available on the market. These are : 

1. Levorphanol Tartrate (Levo-Dromoran), 

2. Methadone Hydrochloride (Dolophine). 

3. Meperidine Hydrochloride (Demerol). 

4. Pentazocine (Talwin). 

5. Alphoprodine Hydrochloride (Nisentil). 

6. Anileridine Phosphate (Leritine). 

7. PiminO'dine Esylate (Alvodine). 

8. Fentanyl (Sublimaze). 

9. Methotrimeprazine (Levoprome). 

Meperidine was the first of this group to be introduced and although earlier 
it was thought to be nonaddicting. later it was found to have an addiction 
liability approaching that of morphine. Nevertheless, it is the most widely used 
of the strong analgesics. This may suggest that it is capable of substituting for 
morphine in many cases ; however, it is recognized that meperidine Is not an 
adequate sub.stitute in certain ca.ses, e.g., acute myocardial infarction. 

Several of the available compounds are chemically related to meperidine, drug 
numbers 5-8 in the above list. These were prepared in the attempt to improve 
on the properties of meperidine. The actions of these drugs are generally similar 
to those of meperidine, and although each has individual characteristics, which 
limits its use in certain conditions, none is superior to meperidine, and like it 
none of these would be an adequate substitute for morphine in all cases. 

Both levorphanol tartrate (Levo-Dromoran) No. 1 and methadone hydro- 
chloride (Dolophine) No. 2, are effective strong analgesics and have other 
properties in common with morphine, including addiction liability ; however, in 



17 

practice, experience has indicated that neither would meet the requirepients in 
all cases of an adequate morphine substitute. 

The newest member of this group is No. 4 pentazocine (Talwin). It is the 
only one with a low addiction potential, being less than that of codeine ; thus, 
it is not subject to the controls of the narcotic laws. Although pentazocine is an 
effective strong analgesic, as with all other drugs in this group, in certain cases, 
morphine would be preferable. Additional compai-ative studies are necessary to 
fully evaluate the potential use of this new drug, particularly in relation to 
the older drugs. 

Compound 9, methotrimeprazine (Levoprome), differs chemically from all 
others of this group, being a phenothiazine derivative and related to the anti- 
psychotic group of drugs. Although it does have strong analgesic properties, 
its side effects of marked sedation and hypotension greatly limit its uses and 
would prevent it from being an daequate substitute for morphine. 

Most controlled studies with these drugs have been conducted to determine 
equivalent analgesic potencies (i.e., milligram dosage), and have been carried 
out in only a few types of pain, e.g., postoperative, cancer. Their broader use- 
fulness in a variety of painful conditions has been determined by clinical 
experience. 

On the basis of this evidence it is concluded that, taken as a whole, the 
group of available strong analgesics could be substituted for morphine in some 
cases ; however, no single agent of this group is capable of substituting alone 
for morphine. At present, evidence from experimental studies are not available 
to define the preferred drug in each case. Many additional comparative studies 
and further experience are necessary, particularly with newer agents like 
pentazocine, to determine their ultimate efiicacy in various conditions. Further- 
more, there are certain situations, e.g., acute myocardial infarction, adjunct 
to anesthesia in cardiac surgery, pulmonary edema of heart failure, certain 
cancer patients, in which none of the synthetic analgesics are capable of satis- 
factorily replacing morphine. 

CODEINE SUBSTITUTES 

To act as a satisfactory substitute for codeine, a drug would need to have 
the following properties : 

1. Analgesic activity. 

2. Antitussive activity. 

3. Oral effectiveness. 

4. Low addiction potential. 

Of the presently available drugs none possesses all of these properties; how- 
ever, it is not necessary for a comiwund to have both analgesic and antitussive 
properties to be useful. Those drugs that have one or more of these properties 
are considered individually below from the standpoint of a potential codeine 
substitute. 

Propoxyphene (Darvon) is an orally effective analgesic but it is less potent 
than codeine and would not provide pain relief comparable to codeine in many 
cases. Propoxyphene has low addictive liability but no antitussive activity. 

Pentazocine (Talwin) lacks antitussive activity but possesses the other three 
properties necessary to substitute for codeine. However, insuflBcient compara- 
tive data are presently available to fully evaluate its potential as a substitute 
for codeine as an oral analgesic. 

Several agents are marketed as antitussive agents : these are orally effective 
and have no or low addiction potential. The most widely used of this group is 
dextromethorphan. Although it and the others of this group may be adequate 
for relief of the milder types of cough, i.e.. associated with the common upper 
respiratory infections, they would be inadequate for severe cough. For use 
in this situation, a strong analgesic with antitussive activity such as methadone 
may be required, but this drug has a greater addiction liability than codeine. 

In conclusion, no other single drug has all the properties of codeine : thus, 
none would be a satisfactory substitute. That other drugs have some of the 
properties of codeine is recognized, but an adequate substitute for codeine's 
use either as an analgesic or antitussive is not available at present. 

NARCOTIC ANTAGONISTS 

The use of the narcotic antagonists in addition to morphine and codeine 
would be affected by a ban on opium and opium derivatives. Two of the three 



18 

available narcotic antagonists are prepared from opium derivatives. These 
are nalorphine (Nalline) and naloxone (Narcan), the other, levallorphan (Lor- 
phan) is prepared synthetically. The properties and uses of nalophine and leval- 
lorphan are similar and the latter could substitute for the former. However, 
the actions of naloxone differ from those of the other two agents and is con- 
sidered the drug of choice in treatment of overdosage of a narcotic. Even more 
significant are the studies showing that naloxone has promise in the treatment 
of heroin addiction : thus, to ban the source of this drug would deprive the 
medical profession of a useful drug. 

Cliairman Pepper. Mr. Mann, have you a question ? 

Mr. Maxx. I am very much interested in tlie action of the Economic 
and Social Council of the United Nations in almost outlawino- syn- 
thetic narcotics. You imply here that the economic factor was the main 
factor involved. What other motivating factors do you see in that 
almost-action? 

Dr. Seevers. Well, I don't really know. This got doAvn to a l^attle 
between the producing and manufacturing nations and those that were 
most interested in the synthetics. I don't know of any other, except 
traditional. Many of these changes have been in this business for a long 
time. Change would be resented in countries where producing has been 
going on for a long time. There is a manpower problem as well as 
substitution — finding some crop that would substitute for opium. 

Mr. Mann. Do you think the medical community is prepared for 
the legislative outlawing of morphine ? 

Dr. Sefa'ers. I don't believe so. Although morphine, itself, isn't used 
so much, I think the biggest rebellion is codeine. The reason I say that, 
is because we have had a somewhat analogous situation with amphet- 
amines. Amphetamines as a chass of drugs are, in my opinion, the most 
dangerous drugs of all available for abuse. We know from a practical 
point of view that the production of amphetamines greatly exceeds any 
legitimate medical need. But if you pose this question to orgnnized 
medicine, which w^e have had occasion to do, even in our committee — 
I attended a meeting of the AMA committee in Chicago on Saturday 
of last week — even among the committee there are questions as to 
whether we could get along without these. I personally think we could. 

But you will not find a consensus on these matters. 

Chairman Pepper. Excuse me. Will the gentleman yield right at that 
point ? 

]Mr. Mann. Yes, sir. 

Chairman Pepper. Doctor, this committee last year offered an amend- 
ment in the House, which was later adopted by the Senate, proposing 
that there be a production quota system for amphetamines imposed 
by the Department of Justice on the recommendation of tlie Depart- 
nient of Health, Education, and Welfare. Do you think that was a 
l^roDer nroposal ? 

Dr. Seevers. Well, it is in the right direction. I am not sure whether 
it would accomplish the objective you seek. 

The only country that has really been successful in controlling am- 
phetamines, as I mentioned earlier, is Japan. Sweden has also adopted 
a complete ban in the sense that even a medical use is restricted to a 
few speci-^lists. Three of the Australian states have done this recently. 
These nations have all done it in response to a rising and hazardous 
abtise problem with amphetamines. 



19. 

I think a quota would be better than nothing, but I am not sure this 
would really solve the problem. 

Chairman Pepper. Mr. Mami, I interrupted you. 

Mr. IVLvNN. No further question. 

Chairman Pepper. Mr. Wiggins ? 

Mr. Wiggins. Doctor, if Congress should ban the importation of 
morphine, should that law have an immediate effective date or should 
it have a delayed application ? 

Dr. Seevters. Well, off the top of my head, I would say that time is 
not very important. It might be delayed long enough to work out some 
alternative, but I don't see that much would be gained by delay, except 
possibly the codeine problem. 

]\Ir. WiGGixs. Yes. You indicated that substitutes for morphine are 
available. Are they available in sufficient commercial quantities to 
meet the necessary commercial need or should the industry be per- 
mitted a period of time to get into that kind of production? 

Dr. Seevers. I think that would probably be wise, but we have 
enough variety of these compounds of synthetic origin at the present 
time that I don't think we would have any significant shortage, if 
there was a reasonable time. 

Mr. Wiggins. Are those synthetic substitutes typically manufac- 
tured in the United States ? 

Dr. Seevers. They are. The principal one is sold under the commer- 
cial name of Demerol. I don't know what the current total consump- 
tion or total use of this substance is in the United States, but at one 
time about 50 percent of the strong analgesic was done with this drug. 
It is comparatively simple to produce. I don't think there would be a 
serious problem. 

Mr. Wiggins. If Congress should enact a statute prohibiting the 
importation of morphine could you suggest any exce]:)tion we should 
make to that statute ? 

Dr. Seevers. Not really. 

Mr. Wiggins. Oft'hand, it occurs to me that you would like to con- 
tinue your scientific studies and others doubtless would too. 

Dr. Seevers. I think this could be done and it would be necessary. 
Morphine is still used as a standard by which we compare all other 
drugs. I think a certain amount of research should be carried on. But 
as far as general medical use is concerned, I can't think, offhand, of 
exceptions for medical use. 

Mr. Wiggins. Is it your feeling that if we excepted necessary sci- 
entific research we could impose an absolute ban on the importation 
of morphine ? 

Dr. Seevers. It would be possible. I am not sure it will solve your 
problem. 

Mr. Wiggins. Are the medical consequences tolerable ? 

Dr. Seevers. From a medical point of view, I think the answer is 
yes. _ ; ' 

Mr. Wiggins. That is all, Mr. Chairman. 

Chairman Pepper. Mr. Steiger ? 

Mr. Steiger. Thank you, Mr. Chairman. 

Doctor, did Japan treat a marihuana problem? I guess first, do 
they have a marihuana problem, and if they did, did they treat it? 



20 

Dr. Seevers. They have a rising marihuana problem. They have 
never had much abuse of marihuana in Japan, although it grows wild 
all over Japan. But they have become concerned about it now to the 
point where one of the people in the Ministry said they are thinking 
about cutting it off at the root right now, which implied there would 
be stricter penalties rather than lesser penalties. 

A good bit of this problem has been brought back into Japan by 
returning American servicemen who are there for recreation. The 
Ministry is frank enough to say this, but abuse of marihuana is also 
spreading now to the younger people, and there have been a consider- 
able number of seizures of smuggled hashish. Some of it is smuggled 
in from Korea and other areas, and also from Vietnam. So they have 
had an increasing number of users in the last couple of years. 

Mr. Steiger. It is illegal ? 

Dr. Seevers. It is illegal. 

Mr. Steiger. Have we developed, or is there any research which 
points to the potential development of any oral antagonists at this 
point? They are all injected ? 

Dr. Seevers. Practically all of them are injected. We have some that 
can be used. The trouble with these antagonists, and this has been the 
real problem, is that they produce unpleasant subjective responses, 
much like the hallucinogens. Individuals have weird dreams, and 
weird thoughts, and the like. This has been one of the principal ob- 
jections to the use of the antagonist class of drugs. 

Mr. Steiger. I should think that would help sell them. 

Dr. Seevers. These effects are not sufficiently pleasant. Most of 
them are the type of perceptive distortions that they leally don't want. 

Mr. Steiger. Doctor, to your knowledge, how long have ampheta- 
mines been in use medically, not the illegal use or the abusive use, 
but how long have amphetamines been in use ? 

Dr. Seevers. It is back to the early 1930's as I recall. 

Mr. Steiger. That long? 

Dr. Seevers. Yes. 

Mr. Steiger. Do you know if our military still issues the morj^hine 
ampules they used to issue to people in the field, or do we use Dem- 
erol, or one of these others ? 

Dr. Seevers. I don't know what the present state of the military 
is in this respect. 

Mr. Steiger. Thank you, Doctor. 

Chairman Pepper. Mr. Winn ? 

Mr. Winn. Thank you, Mr. Chairman. 

Doctor, on page 6 you say : "Whereas we do have effective substitutes 
for codeine which are safe, they have made relatively little inroads 
in the prescribing of codeine." 

yiy question is why ? 

Dr. Seevers. I suppose it is natural conservatism of medicine. 
Codeine has always been known traditionally as the weak analgesic. 
It has become, by general use, to be a constituent of many mixture? 
in small amounts, and medicine is one of the most conservative 
professions. 

If a drug gets off on the wrong foot, medicine just looses interest 
in it. I refer to a compound we are all familiar with today, methadone. 



21 

When methadone was first introduced into the field by Lilly & Co. 
it was introduced under the trade name of Dolophine. They thouojht 
the drug was much more potent than it actually is. Dolophine was 
introduced on a 3 -milligram dose basis whereas we know the drug 
has about the same potency as morphine, and the average dose is 10 mil- 
ligrams. Dolophine fell flat. If Lilly had introduced it at a 10-milli- 
gram dose we might have had methadone substituting for morphme. 

Methadone is one of the drugs that can satisfactorily substitute 
for morphine. 

Mr. Winn. How many years ago did Lilly come out with that, sir? 

Dr. Seevers. That was the midfifties, as I recall, just around the 
midfifties. 

Mr. Winn. Would you encourage the pharmaceutical houses to get 
a press campaign or campaign put together so that they can use the 
substitutes for codeine ? 

Dr. Seevers. That is a $64 question. I don't know whether I could 
give an answer to that. 

Mr. Winn. Well, I am saying do you think it would be wise to do 
that. 

Dr. Seevers. For them to initiate a campaign ? 

Mr. Winn. Yes. 

Dr. See\^rs. I don't know who would do the initiating, whether the 
competitors would initiate or whether producers would do the initiat- 
ing. I doubt the practicality. 

Mr. Winn. Thank you, Mr. Chairman. 

Chairman Pepper. ^Ir. Keating? 

Mr. Keating. No questions, Mr. Chairman. 

Chairman Pepper. Doctor, two questions. One, this committee has 
had testimony from many sources that there are some 8 billion amphet- 
amines produced and distributed in this country every year, and we 
have been advised, as has the Committee on Interstate and Foreign 
Commerce, Subcommittee on Health, that about half of those go into 
the black market. Would you tell us what, in your opinion, is the 
medical need, if any, for amphetamines in this country ? 

Dr. Seevers. In my opinion the need is relatively small. I think this 
is a concensus of most people who reviewed the problem. The biggest 
use is in the treatment of obesity. At best, this use can be said to only 
temporarily be effective. The reason for this is that tolerance develops 
to its continued exposure. Bigger and bigger doses are necessary. With 
susceptible individuals, but not in all cases, they are likely to become 
dependent upon it. 

Chairman Pepper. Would you put the need in hundreds, or thou- 
sands, or millions ? 

Dr. Seevers. Compared to 8 billion ? 

Chairman Pepper. Yes. 

Dr. Seevers. Well, that is pretty difficult. The only thing I can say 
is that as far as I can determine, in Japan, Sweden, and the three 
Australian States, medicine hasn't been hurt very badly. 

Chairman Pepper. You would say the medical need is small ? 
'' Dr. Seevers. Comparatively small. 

Chairman Pepper. One other question. You have spoken about the 
probable reluctance or probable tardiness of the medical profession in 
accepting these synthetic substitutes for morphine and codeine. We all 



22 

recogrnize vre professional people are reluctant to change from a habit 
or course that we have been foUowinir. But would it te desirable to put 
in perspective the necessity of balancin<r the harm that this country 
derives from the abuse of these drusrs, the heroin that is smugorled into 
this comitry, the terrible cost in lives and other expenditures as distin- 
guished from the inconvenience or perhaps some of the imperfection 
in the use of these substitutes? Would it be desirable for the medical 
profession to balance those two interests in making this decision? 

Dr. Seevers. I think the answer to that question is a tangential one. 
You would have to sell the profession on the notion that doing this 
would accomplish the objectives that you seek. In other words, when we 
have so many synthetic drugs available, if there is a market, for ex- 
ample, suppose you abolish illegal heroin or illegal niorphine or wipe 
out all morphine, we know that there are many places in the world that 
have no respect for patents, they can make these synthetic compounds 
with relative simplicity and they are equally subject to abuse. I think 
the real question is whether you'^simply replace one bad situation with 
another one. 

I think it would be necessary to convince the profession as a whole 
that the objectives that you seek would be accomplished. 

Chairman Pepper. Doctor, we are profoundly grateful to you for 
bringing your knowledge and experience to the benefit of this com- 
mittee and helping our Congress and country try to find some solution 
to this terrible narcotics problem. 

I think counsel wants to put in the record your original finding 
here. 

Mr. Perito. Mr. Chairman, may we include in the record the cur- 
riculum vitae of Dr. Seevers ? 

Chairman Pepper. Without objection, it will be so received. 

(Dr. Seever's curriculum vitae follows:) 

[Exhibit No. 2] 

Curriculum Vitae of Dr. Maurice H. Seevers, Chairman, Department of 
Pharmacology, University op Michigan Medical School 

Date of birth, October 3, 1901, Topeka, Kans. 
Education : 

Washburn College (Topeka. Kans.), 1920-1924 (A.B.) 
University of Chicago, 1924-1928 (Ph. D., pharmacology) 
University of Chicago (Rush Medical), (4 year certificate) 19.30; (M.D.) 
1932 
Internship, University of Wisconsin General Hospital, 1930-1932 
Appointments : 

Research fellow, pharmacology, Chicago, 1926-1928 
Instructor, pharmacology, Loyola (Chicago), 1929 
Assistant professor, pharmacology, Wisconsin, 1930-1934 
Associate professor, pharmacology, Wisconsin. 1934-1942 
Visiting associate professor, pharmacology (summer 1941), Chicago 
♦Professor of pharmacology and chairman of the department of pharmacol- 
ogy, the University of Michigan Medical School. 1942- 
Associate dean, the University of Michigan Medical School, 1947-1950. 
Memberships and committees : 
♦National Research Council 

Committee on Problems of Drug Dependence (formerly Committee on 

Drug Addiction and Narcotics) 1946-1968: Consultant— 196&- 
Subcommittee Anesthesiology (Committee on Surgery), 194»-1957 



23 

♦American Society of Pharmacology and Experimental Therapeutics, 1930- 
Council, 1937; membership committee, 1942, 1943, 1944 (chairman); 
president, 1946, 1947; nominating committee, 1949, 1950 (chairman) 
♦American Physiological Society, 1933- 

Federation of American Societies of Experimental Biology Executive 

Committee, 1946, 1947 (chairman), 1948 
Society for Experimental Biology and Medicine Council, 1950-1953 
♦American Medical Association 

Vice-chairman, Section of Experimental Medicine and Therapeutics 

1951-1052 
Chairman, 1952-1953 

Member, Council on Drugs (formerly Council on Pharmacy and Chem- 
istry) 1952-1962 
* Member — Committee on Alcoholism and Drug Dei>endence — Council on 

Mental Health, 1964- 
♦Chairman — Committee on Research on Tobacco and Health AMA-ERF 
1964- 

Honorary memberships : 

♦American Society of Anesthesiology. 
♦Japanese Pharmacological Society. 

Committees and consultantships : 

Member — Board of Scientific Counselors, National Heart Institute, Na- 
tional Institutes of Health, 1957-1960. 

Member — Drug Abuse Panel, President's Advisory Committee — White 
House Conference on Narcotic and Drug Abuse, 1962-1963. 

Member — Surgeon General's Committee on Smoking and Health, Depart- 
ment of Health, Education, and Welfare, 1962-1963. 

Chairman — Committee on Behavioral Pharmacology — Psychopharmacology 
Service Center-National Institutes of Health, 1964-1968. 

♦American coordinator — U.S. Japan Cooperative Program on Drug Abuse — 
National Science Foundation and Japan Society Promotion of Science, 
since 1964. 

♦Member — President's Commission on Marihuana and Drug Abuse, 1971-72 
(established by Public Law 91-513) . 

Editorial : 

Board of publication trustees, American Society for Pharmacology and Ex- 
perimental Therapeutics, 1948, chairman, 1949-1961. 

Editorial board. Physiological Reviews, 1943-1951. 

Editorial board. Proceedings Society for Experimental Biology and Medi- 
cine, 1944-1959. 

Editorial committee. Annual Review of Pharmacology, 1959-1962. 

International : 

♦WHO (United Nations) Expert Advisory Panel on Drugs Liable to Pro- 
duce Addiction, 1951- 

Second Medical Mission to Japan, May-June, 1951 Unitarian Service Com- 
mittee and Department of the Army. 

U.S. National Committee for International Union of Physiological Science, 

Chairman American team— Conference on Physiologic and Pharmacologic 

Basis of Anesthesiology— Japan, April-May 1956. 
Consultant— Minister of Public Health of Thailand— Bangkok, May 2-17, 

1959 
♦Consultant, Minister of Health and Welfare of Japan, Tokyo, 1963-. 

Awards : 

Third Class of the Order of the Rising Sun 6f Japan, 1963. 

Distinguished Service Award Washburn University Alumni Association, 

1964. ^^ .„„_ 

Second Class— Order of the Sacred Treasure of Japan, 1967.^ 
Henrv Russell Lecturer— The University of Michigan, 196 (. 
J Y. Dent Memorial Lecturer— Kings College-University of London, 1968. 
Certificate of Commendation from Minister of State Director-Geneial, 

Prime Ministers Office, Japanese Government, October 1969. 



•Current appointments. 



24 

(The following letter was received for the record.) 

[Exhibit No. 3] 

Assistant Secretary of Defense, 

Washington, D.C., June 28, 1971. 
Hon. Claude Pepper, 
House of Representatives, 
Washington, B.C. 

Dear Mr. Pepper : This is in reply to your letter of June 7 in which you re- 
quested our views on the use of opium derivative drugs in the military medical 
services and statistical data representing procurement and issues of these drug 
items, as well as synthetic pharmaceuticals with similar effects. 

"A consensus of military medical opinion on the need for opium derivative 
drugs to treat casualties in the field and in hospitals." It is the consensus of 
the Military Medical Departments that opiate drugs have an established place 
in medical practice and cannot adequately be replaced by any other substances. 
The need for opiate drugs is predicated on the pi-inciple that the highest pos- 
sible quality of medical care should be rendered to military personnel and their 
dependents. While it is true that there are many occasions when the synthetic 
analgesic drugs would suffice, there is also a substantial number of indications 
where the opiate drugs are clearly superior. For example, it has not been 
demonstrated that the synthetic drugs are equal in efficacy to the opiates in 
myocardial infarction, acute pulmonary edema, and in relief of pain in the 
severely wounded. 

"A consensus of military medical opinion on (a) the use of, and (b) the ef- 
fectiveness of synthetic analgesic substitutes to treat casualties in the field and 
in hospitals." The synthetic analgesics have a significant and increasing use- 
fulness in treating casualties in the field and in hospitals. However, there re- 
mains a substantial proportion of casualties in whom the opiate drugs are clear- 
ly preferable. In addition, many of the synthetic analgesics have only a very 
short period of experience with their use and it would be unwise to restrict 
medical practice by relying solely on these newer compounds. 

"A consensus of military medical opinion on the advisability of eliminating 
opium derivative drugs and the substitution of synthetic analgesics." It would 
be inadvisable to eliminate opiate drugs from medical and surgical practice. It 
Is evident that the amount of opiate drugs used could be greatly curtailed by 
substitution of the synthetic drugs. However, the total removal of opiates from 
medical practice would result in less than optimum treatment of countless in- 
dividuals having life-threatening diseases and injuries. 

Statistical data representing procurements and issues of centrally managed 
opium derivative drugs, as well as synthetic pharmaceuticals with similar ef- 
fects, is attached as enclosure 1. This data represents the latest 4 complete fiscal 
years. Data prior to fiscal year 1967 is not available. Miss Hastings of your 
staff agreed to the submission reflecting this period of time. 

Although most of the opium derivative drugs are procured and issued to the 
military medical services by the Defense Supply Agency, larger medical facilities 
locally procure nonstandard, slow moving opium derivative drugs. These facil- 
ities are all registered with the Bureau of Narcotics and Dangerous Drugs. 

Attached as enclosure 2 is a copy of the regulation "Safeguarding of Sensi 
tive. Drug Abuse Control, and Pilferable Items of Supply" as per your request. 

The Veterans' Administration does not procure these items from the Depart- 
ment of Defense. The Veterans' Administration has its own procurement system 
and buys these items directly from vendors. 

There are no separate regulations or security precautions applicable to syn- 
thetic analgesics versus opium derivatives. The governing factor in this instance 
is whether the Bureau of Narcotics and Dangerous Drugs has classified the item 
in one of five schedules for controlled substances. If so. security measures are 
required ; however, these items are dispensed by prescription only. 

I trust this information will be of assistance to you and the committee. 
Sincerely, 

Louis M. Roussei.ot, M.D., F.A.C.S. 



25. 

I'BOCUREMENT AND ISSUE DATA FOB CENTRALLY STOCKED OpIUM DERIVATIVE 

Drugs and Synthetic Analgesics With Similar Effects 

The information in tliis enclosure is qualified as follows : 

1. Procurement quantities are indicated by the fiscal year in which contracts 
w^ere awarded (or delivery orders processed). Actual delivery to DSA depots 
and subsequent issue to DSA customers does not normally correspond to these 
fiscal years. In addition tlo Army, Navy and Air Force units, the DSA has in- 
teragency agreements to supply medical materiel directly to the following 
Federal agencies : NASA, USAID, D.C. Government, U.S. Coast Guard, FAA and 
GSA. Certain Army, Navy and Air Force units also supply directly to other Fed- 
eral and foreign agencies. For example, the Republic of Vietnam Armed Forces 
and USAID in Vietnam are supplied with medical materiel from the U.S. Army 
Medical Depot in Okinawa. 

2. In some cases, procurement and issue data do not appear to be related. This 
can occur when items are being phased out of the distribution system or new 
items are added to the armamentarium. Further, changing mobilization reserve 
materiel objectives may be responsible. 

3. Only those forms of propoxyphene containing at least 65mg are included. 

4. Methadon is n(jt managed centrally as yet. 



1967 



Fiscal years — 



1968 



1969 



1970 



6505-114-8950— Codeine sulfate tablets, NF, 32 mg., 20's: 

Procured by DPSC ^ 24,700 

Issued to: 

Army _ _ ._ 4,797 

Navy 1,678 

Air Force 640 

IVIAP 20 

Other = _.. 3 

6505-114-8975— Codeine sulfate tablets, NF, 32 mg., lOO's: 

Procured by DPSC 92,016 

Issued to: 

Army ^fek 9,525 

Navy 9,420 

Air Force. 9,088 

MAP 9.803 

Others 14,987 

6505-615-8979— Codeine phosphate, USP, 1 oz. (28.35 gm.): 

Procured by DPSC 2,502 

Issued to: 

Army 5,306 

Navy - _. 1,752 

Air Force 576 

MAP...,. 144 

Oth^ir 19 

6505-864-8092— Codeine phosphate injection, USP, 30 mg. 
cartridge-needle unit 1 cc, 20's: 

Procured by DPSC i 

Issued to: 

Army.... 2,610 

Navy.. 1,367 

Air Force 1,071 

MAP. L-. 

Other 2 

6505-864-8091— Codeine phosphate injection, USP, 60 mg., 
cartridge-needle unit 1 cc, 20's: 

Procured by DPSC .^^..^ ic..: 4,230 

Issued to: ^ ' = 

Army 1,181 

Navy 1,293 

Air Force. 732 

IVIAP . 

Other 

6505-929-8986— Hydromorphine, HOI injection, NF, 2 mg. 
cartridge-needle unit 1 cc, 20's: 

Procured by DPSC 10,200 

Issued to: 

Army _' 

Navy 

Air Force 19 

MAP 

Other 

See footnotes at end of article. 



3,638 


1,818 


1,454 


297 


203 


22 


366 


126 


52 


4 


7 


474 


1 


7 


3 15, 593 


75,816 


96,336 .. 




47, 481 


55, 344 


14,811 


8,980 


9,405 


8,470 


9,514 


10, 581 


9,759 


9,508 


5,407 


22,012 


236 


2,614 


2,221 


11,808 


2,304 .. 




5,016 


2,043 


4,111 


1,126 


1,312 


664 


1,753 


2,106 


1,433 


21 


25 


85 


76 


109 


27 


9,600 


11,430 .. 




3,278 


5,366 


1,260 


994 


1,532 


418 


1,166 


2,057 


1,085 


19 


63 


86 


9 


56 


171 


2,040 


11,100... 




1,542 


1,410 


840 


1,482 


2,009 


771 


882 


1,211 


889 


14 


40 


25 


14 



56 


59 
2,520 


1,483 


1,160 


927 


586 


1,274 


800 


750 


1,196 


1,440 





1 





9 


24 


15 



60-296 — 71— pt. 1- 



26 







Fiscal year; 


i— 






1967 


1968 


1969 


1970 


6505-132-3030-Paregorlc, USP, 1 pt. (473 cc): 

Procured by DPSC ' - 


69,792 -. 




39, 936 

92, 776 

3,715 

5,706 

3,556 

424 


64, 368 


Issued to: 

Army. - - 

Navy 

Air Force 


25, 773 
2,691 
7,497 

18,813 
496 


23, 598 

4,499 

6,484 

4,017 

339 


3,960 
2,618 
4,658 


MAP 

Other 2 - 

6505-129-5000— Morphine sulfate tablets, USP, 8 mg., 20's: 

Procured by DPSC 


7,658 
168 


Issued to: 

Army --- 

Navy - 

Air Force - 

MAP 

Other -..- ------ 

6505-129-5500— Morphine sulfate tablets, USP, 16 mg., 20's: 

Procured by DPSC --- 


4,428 

852 

110 

50 

73 


235 

323 

34 

5 

920 


65 ... 
21 ... 
78 ... 

4 ... 
32 ... 




Army - 

Air Force - -- 


3,924 
996 
1,265 
3,460 
4,432 

226,250 .. 


663 

233 

793 

1,772 

20 


3,181 ... 

1,411 ... 

318 ... 

... 

4 ... 




Other 

6505-129-5517— Morphine injection, USP, 16 mg., 1.5 cc: 

Prnnirori bv DPSC 1 .. 




Army. _ - - 

Navy - - - 

Air Force -. 


2,096 

2,974 

36, 206 



2,500 

258,500 .. 

22, 782 
11,601 

6,019 
12,921 

1,483 


25, 387 

3,744 

4,599 

50 



24, 805 
4,057 

604 
6,023 

949 


39, 892 

2,132 

11,549 

370 



25, 193 

12, 897 

1,162 

8,719 

4,112 


11.160 

12,203 

9,132 


MAP.--. 

Other' -- 


105 
18, 000 


6505-129-5518— Morphine injection, USP, 16 mg., 1.5 cc, 5's: 
Procured bv DPSC 




Army - 


5,259 
6,363 


Air Force 


292 


MAP--- 

Other - 

Procured bv DPSC 


15,603 
1,840 


Army. - - - 

Navy --- 

Air Force 


597 

594 

537 

20 



4,500 

1,606 

741 

588 



1 

5,820 

3,626 

2,053 

2,559 

5 

267 

3,660 

2,623 

1,750 

1,753 



1 


201 

530 

310 





4,380 

1,757 

1,391 

614 

28 

9 

28, 335 

11,737 

3,592 

3,257 

4 

185 

9,420 

3,734 

2.300 

2,139 

20 

92 


178 ... 
152 ... 
191 ... 

... 

... 

3,360 

1,672 

973 

695 

5 

53 

5,640 ... 








Other. - 

6505-864-7617— Morphine injection, USP, 8 mg., cartridge-needle 
unit, 1 cc, 20's: 


2,500 


Issued to: 

Navy -- 


905 
618 
784 


MAP - 


1 




146 


6505-864-7618— Morphine injection, USP, 15 mg., cartridge-needle 
Procured bv DPSC - .. 




Issued to: 

Army - 

Air Force 


6,133 

2,138 

2,978 

33 

217 

10,590 

4,247 

2,473 

2,652 

2 

59 


3,299 
2,549 
3,265 


MAP 

Other - 


9 

141 


unit, 1 cc, 20's: 


4,328 


Issued to: 

Navy 


2,816 
2,515 
3,020 


MAP 


8 


6505-435-8477— Pentazocine lactate injection. Equivalent of 30 
mg. of pentazocine, 1 cc, syringe-needle unit lO's: 
I Procured bv DPSC ' . 


50 
5,184 


Army 








3 










13 


k\T Torce _ 








2 










2 


other 2 - - 








7 



See footnotes at end of article. 



27 



Fiscal years— 



1967 1968 1969 1970^ 



678 


19, 789 


179 


18, 432 


669 


13,281 


20 


154 


276 


799 



6505-689-5513— Pentazocine lactate injection. Equivalent to 30 
mg. of pentazocine per cc, 10 cc: 

Procured by DPSC... - - - 43,200 46,656 

Issued to: 

Army _ .-. 

Navy._ - - 

Air Force - -- 

MAP _ ..- - -- 

Other 

6505-477-4655— Fentanyl citrate injection. Equivalent to 0.05 
mg. of fentanyl per cc, 2 cc, 12's: 

Procured by DPSC _ 1,296 

Issued to: 

Army _ 

Navy - - - _ 

Air Force - 

MAP. - _ 

Other - 

6505-477-4667— Fentanyl citrate and droperidol injection, 5 cc, 
12's: 

Procured by DPSC i 1,728 

Issued to: 

Army.. _ 

Navy ___ 

Air Force 14 

MAP 

Others _ _.. _ ' 

6505^84-6183— Fentanyl citrate and droperidol injection, 2 cc, 
12's: 

Procured by DPSC _ _ _ 1,728 

Issued to: 

Army _ _ ___ 

Navy _ _ 

Air Force _ _._ § 

MAP 

Other 

6505-958-2364— Propoxyphene HCI capsules, USP, 65 mg., 500's: 

Procured by DPSC 35,520 28,080 18,336 17,664 

Issued to: 

Army 9,741 13,841 12,629 11,865 

Navy 3,303 4,953 5,758 8,304 

Air Force 5,255 5,719 6,821 7,248 

MAP 44 57 92 

Other.... 98 161 348 165 

6505-913-7907— Propoxyphene HCI, aspirin, caffeine, and 
phenacetin capsules, lOO's: 

Procured by DPSC 1 10,224 3,660 500 

Issued to: 

Army 2,994 49 904 2 749 

Navy 129 213 30 188 

Air Force 33 41 116 307 

MAP 34 60 24 

Others..-. 524 793 2,465 

6505-784-4976— Propoxyphene HCI, aspirin, caffeine, and phen- 
acetin capsules, 500's: 

Procured by DPSC 78,048 158,208 131,688 27,792 

Issued to: 

Army 31,782 68,946 71,995 29,776 

Navy... 14,392 23,853 31,896 28,162 

Air Force 20,399 25,837 31,928 32,927 

MAP 441 962 985 

Other... _ 653 562 2,318 840 

6505-082-2651— Meperidine HCI injection, NF, 75 mg., cartridge- 
needle unit, 1 cc, 20's: 

Procured by DPSC 4,680 7,380 2 640 

Issued to: 

Army 1,313 3,178 2,298 1,938 

Navy 936 716 1,587 528 

Air Force. 1,195 2,045 1,694 1,354 

MAP- 11 36 15 

Other...- _ 1 181 84 

6505-082-2652— Meperidine HCI injection, NF, 75 mg.,cartridge- 
.needle unit, 1 cc.,20's: 

- Procured by DPSC 1 13,200 8,730 19,200 8,820 

Issued to: ■,. , ,- 

Army ..AQ..'il>.:'.'iil.:: - 2,401 4,986 7,151 6,346 

Navy 1,505 2,362 2,900 3,355 

AirForce. ■ 2,455 2,809 3,658 4,749 

MAP 18 6 6 

Others 225 167 102 133 



See footnotes at end of article. 



28 



Fiscal years- 



1967 1968 1969 1970 



6505-126-9375— Meperidine HCI tablets NF, 50 mg., lOO's: 

Procured by DPSC 13,536 5,904 6,480 7,920 

Issued to: 

Army --- - 4,052 

Navy..-. 2,295 

Air Force ---- 2,048 

MAP 1,788 

Other.. - ---- ---- 631 

6505-126-9360— Meperidine HCI injection NF, 50 mg., per cc, cc: 

Procured by DPSC .- 93,744 

Issued to: 

Army -...:. 20,298 

|\|avy 24,448 

Air Force 17,907 

MAP - 4,392 

Other 3,455 

6505-864-8093— Meperidine HCI injection, NF, 100 mg., car- 
tridge-needle unit, 1 cc. 20's: 

Procured by DPSCi 3,830 

Issued to: 

Army... ---. 1.920 

Navy.. 1.926 

Air Force 1.558 

MAP 

Other 2 2 

6505-854-8094— Meperidine HCI injection, NF, 50 mg., cartridge- 
needle unit, 1 cc, 20's: 

Procured by DPSC ..-- 21,270 

Issued to: 

Army --- 4,616 

Navy - 2,715 

Air Force --- 3,410 

MAP 

Other 157 

6505-864-8095— Meperidine NCI injection, NF, 100 mg., cartridge- 
needle unit, 1 cc, 20's: 

Procured by DPSC. ^p '. .- 4,200 

Issued to: 

Army.-.. .--- 4,243 

Navy .-- .--- 3,177 

Air Force 2,825 

MAP .-- 30 

Other - 148 

6505-864-8095— Meperidine HCI injection, NF, 50 mg., cartridge- 
needle unit. 1 cc, 20's: 

Procured by DPSC 11,340 

Issued to: 

Army 765 

Navy.. 615 

Air Force 855 

MAP 

Other 2 2 



1,311 
1,460 
1,919 
1,456 
38 


2,862 

1.573 

1,956 

140 

39 


1,222 

1,095 

1,586 

1,458 

352 


63,720 


59,184 ... 




34,803 

16,144 

12,305 

5,378 

128 


24, 870 

13,709 

8,681 

48 

165 


6,892 
8,977 
5,228 
3,696 
89 


3,300 


12,720 


4,740 


2,792 
754 

2,152 

625 

98 


2,830 
1,338 
2,339 
1,106 
224 


2,060 
1,011 
1,657 
2,555 
386 


13, 860 


27, 840 


18,180 


8,846 

2,825 

3,963 

100 

150 


10,873 

3,167 

5,146 

64 

175 


9,835 

3,295 

6,228 

51 

190 


9,300 


18, 540 


8,888 


7,654 

3,399 

2,830 

119 

138 


5,305 

2,980 

3,714 

8 

60 


5,817 
3,244 
4,066 

1 
44 


4,260 


10,020 


4,140 


3,651 

1,269 

2,383 

339 

136 


4,481 

1,289 

2,240 

7 

132 


1,139 

1,396 

1,977 

65 

147 



» The difference between quantities procured and total issued is caused by the exclusion in this tabulation of the in- 
ventory on hnnd (beginning FY 1957) and the inventory required to be retained as depot stocks at the end of FY 1970. 

2 Other type customers are non-DoD. In order of user magnitude: AID and Public Health about the same. Coast Guard, 
State Departnient. etc. 

3 Item deleted May 1, 1970, This quantity transferred to property disposal. 

(Enclosure 2 was retained in the committee files.) 

Chairman Pepper. Our next Tvntness is a man so eminently qnalified 
to spealv on the subject of drug abuse that I could spend a good i>art 
of the rest of this hearing just listing his qualifications. 

The committee is pleased and honored to welcome Dr. Nathan B. 
Eddy. 

Dr. Eddy holds a doctor of medicine degree from the Cornell Uni- 
versity Medical School and an honorary doctor of science degree 
from the University of Michigan. 



29 

Dr. Eddy began his career with the practice of medicine in New 
Yoi-k City in 1911. Since then, he has been an instructor of physiology 
;it McGili University; an assistant professor of physiology and phar- 
macology at the University of Alberta; visiting investigator at the 
department of pharmacology, Cornell University Medical School; 
visiting investigator and lecturer, department of physiology, the Uni- 
versity of Michigan: consultant biologist in alkaloids to the U.S. 
Public Health Service; principal pharmacologist. National Institutes 
of Health; chief of the Section of Anal<resics, Laboratory of Chemis- 
try. National Institute of Arthritis and IMetabolic Diseases of the Na- 
tional Institutes of Health. The last position he held before he sup- 
posedly retired in 1960. Since his retirement, he has served as a con- 
sultant on narcotics to the National Institutes of Health ; the Executive 
Secretary and currently Chairman of the Committee on Drug Addic- 
tion and Narcotics of the Medical Division of the National Research 
Council ; consultant to the Bureau of Narcotics and Dangerous Drugs; 
consultant to the New York State Narcotic Addiction Control Com- 
mission, and consultant to the Le Dain Commission on Nonmedical 
Uses of Drugs. 

Dr. Eddy is a member of numerous honorific and professional asso- 
ciations and has served on countless committees concerned with drug 
addition, lioth in this country and for the United Nations. 

Dr. Eddy's awards, all well deserved, are legion. Some of the groups 
which have honored him are the U.S. Public Plealth Service, the 
World Health Organization, the Eastern Psychiatric Research Asso- 
ciation, and the American Social Health Association. 

Dr. Eddy has authored and coauthored more than 150 books and 
articles on a variety of subjects. 

'^ Dr. Eddy, with his considerable experience in pharmacology and 
physiology, will testify today on the present availability of synthetic 
drugs to replace morphine and codeine. 

It is indeed a great honor to have you with us today, Dr. Eddy, 

Mr. Perito, our chief counsel, will inquire. 

Mr. Perito. Dr. Eddy, I understand you have a prepared statement. 

STATEMENT OF DS. NATHAN B. EDDY, CHAIRMAN. COMMITTEE 
ON PROBLEMS OF DRUG DEPENDENCE, DIVISION OF MEDICAL 
SCIENCES, NATIONAL ACADEMY OF SCIENCES-NATIONAL RE- 
SEARCH COUNCIL 

Dr. Eddy. Mr. Chairman, I prepared a statement for the committee 
which might be called a series of thumbnail sketches of potential 
alternatives to morphine and codeine. 

I think it would take considerable time and be repetitious of a good 
deal of technical detail to read that statement. With your permission, 
I would prefer to make some pertinent statements of pertinent facts 
and principles and afterward elaborate, if you wish, and answer ques- 
tions so far as I can on points which have not been covered. 

Chairman Pepper. Proceed as you will, Dr. Eddy. 

Dr. Eddy. It is a privilege indeed to be here today and speak on the 
question of the replaceability of the natural opiates direct and indirect. 
By direct I mean, of course, morphine and codeine which occur natu- 



30 

rally in opium. By indirect, the substances which are derived from 
morphine and codeine by modification of one sort or another, such 
as hydrocodone, hydromorphone, oxymorphone, oxycodone, and 
heroin, which, of course, is paramount in the problems of drug 
dependence. 

Let me start off by saying unequivocally that the natural opiates, 
direct and indirect, can be replaced by synthetic substances presently 
available. I am not alone in this belief. Dr. Seevers has already so 
stated and I believe Dr. Brill will concur in this opinion. Also, as 
Dr. Seevers indicated, the Committee on Drug Addiction and Narcot- 
ics, now the Committee on Problems of Drug Dependence of the 
National Research Council, has on at least four occasions adopted 
resolutions, the sense of which is the same. 

Referring to the descriptions which were in the statement prepared 
for the committee on specific alternates, these cover a wide range, not 
so wide strictij speaking from the chemical standpoint, but a wide 
range in potency when we think in terms of dosage only. There are also 
some variations in the surrounding j)roperties of the various com- 
pounds. We have compounds which are several times — I am talking 
about compounds which are presently available on the market — we 
have compounds several times more potent than morphine; levor- 
phanol, for example, which is like morphine in all essential 
respects and equally dependence-producing. We have phenazo- 
cine, somewhat different chemically, which is also several times more 
potent than morphine and shows a slightly reduced dependence poten- 
tial. It has not become very popular because the difference is not as 
great quantitatively as hoped in the beginning. 

We also have potential substitutes which are less effective dose wise 
than morphine. The most popular of these is Demerol, or meperidine, 
or pethidine. It has 40 or 50 different names around the world. It is 
only about one-sixth to one-eighth as potent as morphine, thinking only 
of dosage. It is equally dependence-producing. As a matter of fact, it is 
my personal opinion relative to its pain-relieving properties it has a 
greater dependence potential than does morphine itself. 

Then we have pentazocine, which is quite different from Demerol 
in its chemistry and belongs to a new class of compounds to be referred 
to in somewhat more detail in a moment. It is about one-fourth as 
potent as morphine. It has essentially no physical dependence potential 
or such physical dependence potential as it possesses is of a different 
type from that of morphine. It does have subjective effects which a 
few people have found to their liking, especially if they have been 
abusing other drugs and there are a small number of cases of abuse of 
pentazocine reported. Pentazocine is being accepted to a verj^ consider- 
able extent by the medical profession: its sale is increasing and it is 
proving to be a quite effective compound. 

There is a difference in these compounds with respect to their rela- 
tive oral and parenteral use, oral and subcutaneous or intramuscular 
use. The first I mentioned, levorphanol, is equally effective by mouth 
as by injection. Practically all of the others are less effective by mouth 
than by injection. Ppntazocine perhaps is another exception, the range 
between its oral and parenteral dose is narrower than for most of the 
other compounds. 



31 

I have been involved in this problem of trying to find, or trying to 
disassociate, the dependence properties and the useful pain-relieving 
properties of compounds which we could use in place of morphine for 
some 40 years. It has been a most frustrating effort for most of that 
time until we discovered, partly by accident, as the result of a sugges- 
tion I made in another connection, that certain chemical modifications 
of morphine-like substances produced at the same time the ability to 
relieve pain or possessed at the same time the ability to relieve pain 
and the ability under some circumstances to antagonize the effects of 
morphine itself. The first of them was nalorphine. Many like com- 
pounds, or many compounds in this class, have been made since then, 
as Dr. Seevers pointed out. These antagonists, the compounds with 
antagonistic potentiality, have little or no i^hysical dependence capac- 
ity. Such physical dependence capacity as they possess is of a different 
type from that produced by morphine. Their subjective effects are 
different and in most people are exceedingly unattractive. We call these 
compounds agonist-antagonists and pentazocine is an important 
example. 

To reiterate, I believe that it is possible to replace the natural opiates 
with synthetic substances. The question is: Is it practical? At the 
present time I think the answer has to be "no," because we have to 
take so many other things into account other than the mere ability 
to replace one compound with another without interfering with medi- 
cal practice or without damage to the patient. As a matter of fact, 
we might even, with some of these substitutes, improve the conditions 
with respect to the patient. 

Again, the answer is "no," if we are thinking simply in terms of 
saying you cannot have the natural opiates, but must use the synthetics. 
We banned heroin in this country from medical practice, but that did 
not ban it from the illicit market. The illicit market in heroin is still 
increasing. 

As I said, I have been working in this held for 40 years, hoping that 
some day we could say we can get along without opium. Today we 
can say that, medically, we can get along without opium, but I am 
not at all sure that we should say it in just that way, without qualifi- 
cation. If I may make a suggestion, I think we can say to the world 
at large, the time has come wlien we should be putting every effort into 
economic and technical assistance to the opium farmer so that he can 
live by the production of other crops and without the production of 
opium. Meanwhile, we are going to continue to study the agonist- 
antagonists because I think pentazocine can be further improved upon 
and we are going to continue to pursue other lines of chemical investi- 
gation, which in some instances already promise compoimds which are 
not antagonists but which have reduced the dependence potential. 

Some people like practically every drug, or for practically every 
drug there are some people who like it, no matter how adverse it 
seems to most of us. We call this craving or liking a psychic depend- 
ence. I am very pessimistic about our ever eliminating completely 
psychic dependence. We can and we have eliminated the ability — or 
produced compounds which have eliminated the ability — to produce 
physical dependence. We can do something about the individuals lik- 
ing for other things, like his abuse of other things, and we can improve 
the situations so far as drug abuse in medical practice is concerned. 



32 

We can, I think, most helpfully go back to the source, the opium 
source, and try to do more than we have done about the overproduc- 
tion, especially the illicit production, of opium to reduce the availa- 
bility of compounds for abuse. 

Chairman Pepper. Doctor, did I understand you to say tliat you 
thought we could now scientifically develop an antagonistic drug to 
heroin which would give, as Dr. Seevers indicated, a relative immunity 
of sensation to tlie addict in the taking of heroin ? 

Dr. Eddy. We already have such compounds. 

Chairman Pepper. If that could be put into mass use, then that would 
to a large degree remove the desire for the taking of heroin, I ])resume, 
from the addict ? 

Dr. Eddy. Well, the answer isn't quite as simple as that. We can 
antagonize the effects of heroin. We can prevent the individual from 
getting a response to his taking of heroin. We don't necessarily, by 
the same token, remove his desire to take heroin. We can prevent the 
heroin from having any effect upon him, but we don't necessarily, at 
the same time, prevent him from wanting to have that effect. 

Chairman Pepper. ]SIr. Wiggins wishes to ask a question. 

Mr, Wiggins. Doctor, I am confused. Why would a person take two 
drugs that would have the net effect of taking none? I gather that 
there are antnironists that neutralize heroin? 

Dr. Eddy. That is right. 

Mr. WiGGixs. Which has the effect of not taking heroin. 

Dr. Eddy. That is right. 

IVIr. WiGGixs. So why not, just in terms of the logic of it, avoid tak- 
ing heroin in the first instance? 

Dr. Eddy. Well, they generally do. If you can persuade them to take 
the antagonist even though they want the subjective effects of the 
hei^oin or another opiate. The problem is to s:ei: them to take something 
v/hich they know is going to prevent them from getting the kick they 
want. The people who have been put on the antagonists, they don't 
necessarily take your word for it that they are not going to get any 
kick out of their heroin, and they may go back and try heroin until 
they find that this is futile. If they have got any sense they are going 
to say, "Well, I am throwing mj^ money away." And as long as you can 
keep them on the antagonist they cannot get an effect out of heroin and 
hence have no reason to abuse heroin or to go out on the street and 
steal televisions and cars and the rest of it to buy heroin. 

So you have improved the situation from that standpoint for them 
and yourself. But you have to persuade them to take the antagonist. 

Chairman Pepper. Excuse me. Could you add something to that 
antag'onistic drug to cause the patient to get an unfavorable reaction 
if, after taking the antagonistic dnig, he took heroin ? 

Dr. Eddy. Well, you can do it the other way around. If he is taking 
heroin and you give him the antagonist you certainly give him an mi- 
pleasant reaction. I don't know any instance wheie he necessarily gets 
an unpleasant i-eaction from the heroin he attempts to take after he 
has taken the antagonist. He may get an unpleasant reaction from the 
antagonist itself until you stabilize him on it. 

Mr. Wiggins. Does the antagonist have any effect ? 

Dr. Eddy. For a person dependent on an opiate, the antagonist pve- 
cipitates withdrawal symptoms, very markedly so. It is the same as if 



33 

you had taken all of the heroin or opiate away from the addict, just' 
like that. He goes into withdrawal when you give him an antagonist if 
he is taking an opiate. 

Mr. WiGGixs. How much success are you having in getting people to 
do this voluntarily ? 

Dr. Eddy. Well, it hasn't been tried too widely. There are two diffi- 
culties, at least. One is that the most potent antagonist we have, which 
has been tried, cyclazocine, is likely to produce unpleasant reactions 
when you start to administer it. Dr. Seevers referred to these. They 
are quite disagreeable. You have to proceed rather cautiously with 
most people to stabilize them on the cyclazocine. They, too, become tol- 
erant, accustomed to the drug so that these unpleasant reactions disap- 
pear and you can stabilize them, keep them in a state where they can 
take cyclazocine day by day and be free from any adverse symptoms. 
You have got to completeh' withdraAv them from their heroin, dis- 
continue their hei'oin administration completely for several days before 
you start the antagonist. 

That is one drawback for that particular antagonist. The other one 
which has ]:)een used to the greatest extent is naloxone, which does not 
produce any unpleasant reactions at all. It is as nearly as we know, a 
pure antagonist. It has no morphine-like eifects whatsoever. Cyclazo- 
cine does have morphine-like effects under certain circumstances. It is a 
powerful analgesic. It is on the order of 40 times more potent as an 
analgesic than morphine itself. But to attain its analgesia you are liable 
to produce, with a great many people, these unpleasant side reactions. 
So it is not a practicable analgesic. 

Xaloxone is not an analgesic at all. It only produces antagonism. 
It is quite effective when injected, but it is very poorly effective by 
mouth and the doses required to stabilize the individual to a state 
where he would not get a reaction from taking heroin requires very 
large oral doses, and the duration of action is short. 

But we have other antagonists in the offering, which we ho[)e to be 
able to develop, of longer duration and hopefully as effective as cycla- 
zocine, without the unpleasant reactions. This is the field in which a 
great deal of effort is being put at the present time. Ideally, it would 
seem to me the way to go about it. Practically, as I say, the difficulty is 
to 2:)ersuade the patient to begin and to continue the administration of 
the antagonist; but he must, initially, give up his opiate entirely and he 
must take a compound which he knows is going to prevent him from 
getting any of the reactions that he has been wanting. So far as this 
can be done, the program is successful. 

Chairman Pepper. Doctor, Mr. Perito has a question. 

Mr. Perito. Dr. Eddy, do these antagonists have an opiate base? 

Dr. Eddy. No. 

Mr. Perito. They do not ? 

Dr. Eddy. No; not necessarily. 

The original, tlie first antagonist that we are familiar with, nal- 
orphine, is a modified morphine. You can make similar modifications 
in various of the synthetic bases which are used as analgesics, in levor- 
phanol, for example. You can make a similar substitution in levor- 
phanol and get a more potent antagonist than nalorphine. You can 
similarly substitute in the synthetic phenazocine the same group and 
get a very powerful antagonist with very intense subjective reactions, 



34 

so intense that we haven't done very much with it. Or you can modify 
either of these bases in other ways and get lesser degrees of antagonism 
with lesser subjective effects. Pentazocine is such a compound. It is, 
at the same time, an agonist; that is, a morphine-like substance which 
produces the morphine-like relief from pam and so on, as well as 
being a mild antagonist. So that it can prevent the development of 
morphine-like dependence or precipitate withdrawal phenomena if 
given to a person dependent on morphine. 

Mr. Perito. I assume the same would be true with cyclazocine and 
naloxone. 

Dr. Eddy. Cyclazocine is a modification of one of the synthetics. 
Naloxone, on the other hand, is derived by modification of a morphine 
derivative. Therefore, theoretically, we would require the availability 
of opium in order to produce naloxone. Actually there is another 
variety of poppy which produces one of the opium alkaloids in its 
natural life history without producing morphine, and work is under- 
way to develop this particular variety of poppy to get the starting 
material to make naloxone without having, at the same time, an over- 
supply of morphine. 

Even though naloxone is morphine based, if I may put it that way, 
it is theoretically possible to come to it without having to go through 
morphine production. 

Chairman Pepper. Doctor, if we could eliminate the legitimate need 
for the growing of the opium poppy, and, if, as you suggested, we could 
provide a comparable income to the grower of the opium poppy by 
substituting some other crop that would not have these injurious 
effects, do you think that would be in the public interest of this Nation 
and the nations of the world ? 

Dr. Eddy. Very definitely so. If you reduce the overall production 
you must increase the trend toward the use of the substitutes. 

If I might refer to the question that was asked of Dr. Seevers with 
respect to the international situation when we came so close to ban- 
ning the synthetics some years ago, it was largely an economic ques- 
tion. The opium producing countries were afraid of the loss of their 
income, of course, and they put forth the claim, or made the assertion, 
that if we permitted the synthetics, we would develop a greater prob- 
lem than we had in controlling opium, since we would develop the 
opportunity for illicit production of the synthetics. Well, that prob- 
lem has not developed and the manufacturing countries argued that 
thev did not expect that it would develop. 

Chemistry is not all that simple. If we were to cut off the supply 
of opium completely we might be faced with some prol)lems along 
those lines, because we know now that there are illicit manufacturers 
of barbiturates and amphetamines in addition to the licit manufac- 
ture. So we can't eliminate completely the possibility of illicit manu- 
facture of synthetics if we turn to the synthetics in place of natural 
alkaloids. 

Chairman Pepper. Doctor, from your knowledge of the general field 
and of the sums available for carrying on the very commendable re- 
search in finding a synthetic substitute for morphine and codeine, and 
also for the finding of an antagonistic drug to heroin, are the funds 
presently available adequate to carry on the research programs that 
vou think are desirable ? 



35 

Dr. Eddy. No. 

Chairman Pepper. Therefore, Avoiild you think additional Federal 
fluids would be in the public interest for these research programs ? 

Dr. Eddy. Yes. 

Chairman Pepper. Mr. Mann ? 

Mr. Mann. Thank you. 

Pursuing this economic problem just one step further, would there 
be any allegation on the part of the opium-producing countries at this 
point, or any justifiable allegation that the United States would have 
any monopoly on the production of the synthetic drugs, or that the 
cost of producing these synthetic drugs on a legitimate basis would 
make the outlawing of opium economically bad for all other countries ? 

Dr. Eddy. I don't think so, because the know-how is present in 
other countries besides the United States. We do have a group of 
manufacturing countries on the one hand and presently a group of 
producing countries, if you want to call them that, the opium pro- 
ducers, on the other hand. But my suggestion was that we put our 
effort into giving the opium producers and producing countries, eco- 
nomic and technical assistance so they can live without opium. We 
can't expect to do this at their cost solely. We have got to do some- 
thing about getting them to grow alternative crops. But once you have 
done that I don't see that they have any allegation that we are taking 
the bread out of their mouth. 

Mr. Mann. Nothing further. 

Chairman Pepper. Mr. Wiggins ? 

My. Wiggins. Doctor, do you generally concur in the observations 
made by Dr. Seevers that if the Congress were inclined to prohibit the 
importation of morphine that such a statute should have immediate 
effect? i- ■ }\ >'' 

Dr. Eddy. Well, I don't know — I am not sure that I know what 
you mean by immediate. As of now, no. You couldn't do it quite that 
quickly. 

There is reluctance on the part of the physicians to use the syn- 
thetics, justifiably so. They have been fooled more than once. Heroin 
was introduced as a nonaddicting substance 75 years ago. It was 
promptly proved to be — that was promptly proved to be — erroneous. 
Demerol was introduced 30 years ago as a nonaddicting substance, even 
though at the time that it went on the market we had evidence that it 
was as dependence-producing as morphine itself. The producer dis- 
agreed and claimed for a number of years, 6 or 8 years, that we were 
wrong, that it did not produce morphine-like dependence. Later, they 
did admit that we were right, that it did produce physical dependence, 
and the}' have changed their advertising. It is now under narcotic 
control — they advertise it now as a morphine-like substance. 

Mr. Wiggins. Doctor, we both understand that if Congress were to 
await a medical concensus that we would not act at all, just because the 
doctors are, as has previously been testified to, an independent lot. 
Nothwithstanding that, if Congress should make a determination that 
it is in the public interest to prohibit the importation of morphine do 
you know of any reason why that statute should not be made operative 
as of its effective date, or would it be in the public interest to delay it 
a month, 6 months, a year, 2 years, something on that order ? 



Dr. Eddy. Well, physicians, usually physicians are not all that 
familiar with new products. I think there should be some reasonable 
delay in order to familiarize them with the substitutes. As I said 
earlier, we banned heroin from the medical practice without too much 
resistance, partly because we kept morphine, which in many instances 
was advantafjeous over heroin and heroin was not all that popular in 
the United States. When the attempt was made to ban heroin in Great 
Britain there was a tremendous furor and the Home Office eventually 
withdrew the ban and heroin is still permissible in Great Britain. 

If we were to attempt to ban, by congressional action, the use of 
morphine in clinical medicine I think there would very justifiably be 
a fjood deal of resistance on the part of physicians. The natural opiates 
are what they are accustomed to and you would have to give them an 
opDortunity to become accustomed to things to be used alternatively. 

Mr. WkvOtxs. I have difficulty in reconciling your statement that 
medical resistance would be iustified in view of your earlier statement, 
there are adequate substitutes for morphine now existing. 

Dr. Eddy. Well, those substitutes are there, but not all of the physi- 
cians in the country are aware of them and familiar with their use. 
They would say: "Well, what am I going to do for John Jones for 
whom I must have morphine in order to get him through this opera- 
tion or to handle his broken leg or something else. I don't know any- 
thing about this compound. I have never heard of it." You have got to 
give him an opportunity to familiarize himself, carry on some sort of 
campaign to get them to accept the alternative. 

I was very active, took a very great interest in the introduction of 
pentazocine. It was quite slow m coming on the market for reasons I 
don't need to go into. I was particularly interested because it appeared 
to be completely free of physical dependence factors, and it is reason- 
ably so. We did not expect any abuse of it at all. There has been a 
very small amount of abuse because a few people who have abused 
other drugs have found the reactions of it pleasant to them and have 
gone on to use excessive amounts, but the number is very small. It 
does have antagonistic properties if given to a person already depend- 
ent on morphine. It was likely the withdrawal phenomena would be 
precipitated and would probably make him sick and probably very 
angry with his doctor if the doctor w^as not aware of what was going 
on. But the reaction to it has been exceedingly good. It is an agonist- 
antagonist and physicians are accepting it, and I think we can get 
them to accept it and other compounds of this sort to a sufficient ex- 
tent so that medical practice would not suffer for lack of the opiates. 
But this takes a little time. 

Mr. Wtootns. I would like to ask two additional questions. Doctor. 
How would you describe the ease of manufacturing the existing sub- 
stitutes for morphine? That question is really aimed at whether or not 
we can expect a lot of backyard or backroom clandestine laboratories 
turninir out the substitutes if the United States were to prohibit the 
use of morphine. 

Dr. Eddy. Well, none of the synthetics are all that easy to produce. 
It would require a very skilled, very well-equipped technical chemical 
laboratory to produce them. It isn't anything like the ease with which 
heroin is obtained from morphine. You can cook up hei-oin in your 



37 

kitchen from morpliine if you have a morphine supply. You can ex- 
tract morphine from opium without very much difficulty. 

Mr. Wiggins. Is it as easy as manufacturing LSD or more difficult? 

Dr. Eddy. Well, given a supply of lysergic acid for the production 
of LSD, the development of the synthetics in place of the natural opi- 
ates would be much more difficult. 

Mr. Wiggins. What would be the price for synthetics versus price of 
morphine? 

Dr. Eddy. Presently the price to the patient is practically the same 
per dose for all the compounds we have been considering. We have al- 
ready looked into that. 

Mr. Wiggins. Thank you, Doctor. 

Chairman Pepper. Mr. Steiger ? 

Mr. Steiger. I have no questions. 

Chaii-man Pepper. Mr. Winn ? 

Mr. Winn. Thank you, Mr. Chairman. 

Doctor, you have a statement here which says you believe drug de- 
toxification has no effect on a person's craving for drugs. You spoke to 
that a minute ago, and this same statement says that is what you re- 
ferred to as the lesson of Lexington. Could you speak to that a little 
bit more? 

Dr. Eddy. Well, perhaps I can answer your question this way : So 
far as we know, putting a patient through cold turkey, which means 
withdrawing from opiate without any treatment at all, does not deter 
him from relapse, relapse to the use of opiate once he is free of the 
treatment as against treating him as humanely as possible. So there is 
no point — there is no justification — for cold turkey treatment of a 
drug-dependent person. 

]\Ir. Winn. What you are saying, which you referred to a little while 
ago, is that there would be no difference in the psychic craving ? 

Dr. Eddy. That is right. 

Mr. Winn. And not a physiological craving ? 

Dr. Eddy. We can handle the physical dependence side of it without 
difficulty, because we know how to take the person through withdrawal 
so he does not suffer, to all intents and purposes, take him through 
withdrawal with reasonable comfort. 

But that doesn't necessarily affect his remembrance of the effects 
that he got from the heroin he took or the oj^iate that he took previ- 
ously or his desire to reexperience those effects. That is psychic 
dependence. 

Mr. Winn. Are you doing anything, or is anything being clone, to 
offset this psychic dependency. 

Dr. Eddy. Yes; of course. Any treatment program should include 
psychotherapy to try to help the man to understand and meet his prob- 
lems Avithout resort to drugs to convince him that the subjective effects 
which he obtained were not essential to him, that life without drugs is 
possible and reasonable and more productive, more rewarding. 

Mr, Winn. Thank you very much, sir. 

Thank you, Mr. Chairman. 

Chairman Pepper. Doctor. I understand that in Britain, one way of 
handling heroin addiction is to authorize the prescription of heroin 
to addicts. Would you recommend that course in this country ? 



38 

Dr. Eddy. No. 

Chairman Pepper. Now, would you care to comment about the use of 
methadone as a drug in the treatment of heroin addiction? 

Dr. Eddy. In the use of methadone you use, or you accustom, the 
individual, you stabilize the individual on a dosage level which, 
through the mechanism of cross-tolerance, prevents him from getting 
anj' acute reaction to the methadone which he is taking or a dose of 
heroin which he might take. Therefore, you stabilize him in a state 
where he is in a stable mood so far as drug use is concerned and is of a 
mind to turn his attention to other things rather than simply to his 
previously drug-seeking behavior. Therefore, he no longer needs to go 
out in the street and steal cars and televisions and so on to buy his 
heroin. Ke has an opportunity to concern himself with getting a job 
,and supporting his family. 

Mr. Pepper. How do you think methadone should be furnished to 
the addict? 

Dr. Eddy. Through a team effort to help handle all of his problems, 
not just simply to supply him with drugs, because you must have the 
psychotherapy, the vocational assistance, the job help and housing 
help, perhaps, and all this while he is stabilized on methadone. Other- 
wise he has other reasons for trying to go back to other drugs, even 
though he is not getting any satisfaction out of his heroin. 

Chairman Pepper. In other words, a prescription of methadone by a 
physician is not the answer to the problem alone ? 

Dr. Eddy. Very definitely not. Theoretically, in a very rare instance, 
it would be possible for a private physician with very close rapport 
with his patient to put that patient on methadone and keep close con- 
tact with him and treat him satisfactorily. But practically, writing pre- 
scriptions for drug-dependent people for methadone, letting them go 
to tlie drugstore and buy it without doing anything else for him, is 
not the answer at all. You just give him the opportunity to use exces- 
sive amounts of methadone or to sell some of it to somebody else, go to 
another doctor and get some more. You have no control over the prop- 
osition at all. You have not accomplished what you have set out to do. 

Chairman Pepper. Doctor, one other question. 

What is your opinion as to the medical need for amphetamines^ 

Dr. Eddy. The legitimate need is very small indeed. 

Mr. Wiggins. Doctor, what is the difference between methadone 
maintenance or stabilization and heroin maintenance or stabilization, 
assuming the heroin was made available at no cost or minimum cost 
to the patient ? 

Dr. Eddy. Theoretically, none when you supply the heroin. If you 
are going to be successful you have got to supply him \yith enough 
heroin to maintain him in a reasonably stable state. Practically, there 
are differences because at the present time they are still^ sujiplying 
heroin in England to be taken by injection, which maintains the 
ritual of heroin abuse which the individual has been subject to pre- 
viously. In the methadone maintenance program the drug is given by 
mouth and therefore you upset the ritual, which goes along with his 
dependence, and probably is a very significant factor in the mainte- 
nance of dependence. 

Put more than that, you can build up to a dose of methadone which 
will maintain the individual in the stable state throughout the 24- 



39 

hour period. It is exceedingly difficult to do that with heroin because 
heroin is so short acting and particularly ineffective by mouth. Meth- 
adone is nearly as effective by mouth as it is by injection. Heroin is 
much less effective by mouth. That is why they stick to the injection 
route, and it would be exceedingly difficult to stabilize a person on 
heroin given by mouth, almost impossible. 

But theoretically in both instances you are simply maintaining the 
individual's dependence by giving him another opiate. 

Chairman Pepper. Any more questions ? 

Mr. Steiger. Just one. 

Dr. Eddy, in your work with Dr. Seevers in his primate laboratory 
did you see any symptoms of the psychic dependence, or is there any 
method of observing that ? 

Dr. Eddy. There are programs going on in a number of laboratories 
directed toward that very thing. As a matter of fact, we are very 
hopeful that in the not too distant future we will have techniques for 
measuring drug seeking behavior through offering the drugs to the 
primates for self-administration. This is a very promising line of re- 
search that is going on in Dr. Seevers' laboratories and other labora- 
tories as well. It is a different approach from what he described where 
we were attempting to assess the dependence liability of compounds 
sent to him under code designation. 

Mr. Steiger. Is there any investigation in which we are attempting 
to support psychic independence by chemical means? Has that been 
explored? Is it not conceivable? Is that a part of what you just 
described ? 

Dr. Eddy. I am not sure what you mean. 

Mr. Steiger. In which we can reach the psychic dependence chemi- 
cally or by 

Dr. Eddy. Well, you do. In methadone maintenance or heroin main- 
tenance you are administering the same type of drug upon which the 
individual is dependent psychically and physically, so you satisfj'^ his 
psychic as well as physical craving. 

]Mr. Steiger. I understand that. Is there any attempt to find a chem- 
ical which will allow the patient to overcome the psychic dependence 
without the need for all of the social requirements that we now have ? 
Is that not achievable, in your opinion ? 

Dr. Eddy. Perhaps. Dr. Keats once said when he first began study- 
ing the antagonists — Dr. Keats is a very skilled person in clinical 
medicine and very much involved with some of the new compounds — 
he once said that perhaps the solution to our problem was to develop 
a compound which made the individual uncomfortable and yet re- 
lieved his pain. If he could be persuaded to take cyclazocine as an 
analgesic in the ordinary clinical situation he would probably at some 
times, at least, be pretty uncomfortable. He wouldn't like it very 
much. But if he got sufficient relief of pain he might be able to tolerate 
the unpleasantness until tolerance to it developed. The pharmaceutical 
houses have not been willing to take that gamble. 

There is a related compound, one of the synthetic groups, actually 
as potent as cyclazocine. I discussed with the manufacturer the possi- 
bility of pursuing it as a drug for clinical medicine, hopefully that 
there would be enough difference between the dose level for the dis- 
agreeable side effects and for the pain-relieving effect so that we could 



40 

get away with it as Dr. Keats suggested. The company did make a 
brief trial but the results were even worse than with cyclazocine and 
they would have nothing further to do with it. 

But something along those lines may be possible. Pentazocine in 
some circumstances, and in some individuals, has had disagreeable 
side effects though to a lesser degree then cyclazocine, but it is being- 
accepted by physicians and patients at the present time. So in a sense 
we have accomplished w4iat we are striving for. 

Mr. Steigek. Thank you, sir. 

Chairman Pepper. ]\Ir. Keating ? 

jMr. Keating. No questions. 

Chairman Pepper. Mr. Perito, do you have anything to put in the 
record or any other questions ? 

Mr. Perito. Yes, Mr. Chairman, I would like to offer for the recoi-d 
the prepared statement and curriculum vitae of Dr. Eddy. 

Chairman Pepper. Without objection they will be received. 

Dr. Eddy, we wish to than you very much for coming here and giv- 
ing us from your vast knowledge and experience the encouraging testi- 
mony you have given us this morning. 

Thank you very much. 

Dr. Eddy. It has been a privilege and a pleasure to talk with you. 

(The material referred to follows : 

[Exhibit No. 4(a)] 

Prepared Statement of Dr. Nathan B. Eddy, Chairman, Committee on Prob- 
lems OF Drug Dependence, Division of Medicax Sciences, National Academy 
OF Sciences-National Research Council 

The Select Committee on Crime has seen the resolutions of the Committee on 
Drug Addiction and Narcotics, Division of Medical Sciences, National Research 
Council, the earliest of which has been quoted by Dr. Seevers today. These resolu- 
tions maintain that medical practice, and the patient, would suffer no loss if the 
natural alkaloids of opium, and substances derived from them, were not available. 
All medical indications for morphine and/or codeine, as well as for substances 
semisynthetically derived from them, can be met by substances of wholly synthetic 
origin. Adequate substitution is possible. Is it practical or advantageous? Many 
considerations must enter into the answer to this question. Dr. Seevers and Dr. 
Brill have, or will, discuss some of them. Obviou^^ly the advantages and disad- 
vantages of potential substitutes are important, so I offer for the record brief 
summaries of some replacements already on the market. The presentation is in 
approximate chronological order. 

Pethidine (meperidine, Demerol®) was the first wholly synthetic morphine- 
like analgesic, the characteristics of which were discovered only incidentally. 
Close scrutiny, however, revealed that its structure corresponded ro an internal 
part of the morphine molecule, hence, presumably, its morphine-like properties. 
As with heroin 40 years earlier, pethidine was introduced as not dependence- 
producing, a claim which undoubtedly was of great importance in building the 
drug's popularity and is in vogue among many physicians even today. Fortunately 
we liavc not again been so far off the mark. The optimal analgesic dose of pethi- 
dine, effective against many types of pain, is 100 nig. approximately equivalent 
to 10 mg. of morphine when each is given intramusculary. Pethidine is available 
for oral administration, usually in combination with aspirin, but its effective- 
ness by this route is not as great as the small dose in the cominerical preparation 
seems to indicate. The use of pethidine is accompanied by the same sort of side 
effects as are associated with the use of morpliine witli only minor quantitative 
differences. Sleepiness and constipation may be less frequent, a feeling of well- 
being more frequent. It produces respiratory depression, relative to its analgesic 
action, at least as great as that following morphine, and is probably more likely 
to cause a fall in blood pressure. Pethidine has been used widely in obstetrics 



41 

and may facilitate dilation of the cervix, but it may also decrease uterine con- 
tractions and it does not necessarily shorten labor. Pethidine has a significant 
effect on the infant, increasing the frequency of delay in first breath and cry. 
This depression is less than when the barbiturates are used and i)rol)abIy less 
than with administration of morphine, but it is definite and should not be re- 
garded lightly. From the very first tests for determination of the possibility, 
pethidine has been shown to be dependence-producing and many cases of de- 
pendence on it, of morphine type, have been reported, especially among medical 
and ancillary personnel. The euphorigenic and dependence-producing dose of 
pethidine is close to its optimal analgesic dose, so that its dependence liability 
relative to its analgesic action is much like that of morphine. 

Methadmie (Dolophine®), though apparently dissimilar to morphine in struc- 
ture, can produce qualitatively essentially all of moi-phine's actions and in many 
respects is quantitatively equivalent. It is more effective than morphine when 
taken by mouth and its euphorigenic action persists longer vphether the oral or 
parenteral route is employed. Tolerance, cross-tolerance, and dependence develop 
as with morphine and the side effects of methadone and morphine are similar. 
The withdrawal syndrome after chronic administration of methadone develops 
more slowly, is less intense, and is longer in duration than the morphine absti- 
nence syndrome. Methadone is a good enough suppressant. There should be no 
difficulty in using methadone wherever morphine is indicated but its abuse 
liability is as great as with morphine. 

Normethadonc is closely similar to methadone in structure and action, but 
has been used only in a mixture as a cough suppressant. The addition of the 
other active constituent in the marketed mixture, Ticarda : namely Suprifen, 
does not reduce abuse liability and may indeed increase it because of its am- 
phetamine-like stimulant subjective effects. Cases of dependence in clinical prac- 
tice have been described. While at least as effective as codeine, according to the 
usual therapeutic doses, for cough relief, the abuse liability or normethadone 
is greater. 

Levorphanol (Dromoran®) is a result of attempts to synthesize morphine in 
the laboratory and has the structure minus three chemical features. It is 
morphine-like in its action in all respects and dosewise is several times more 
powerful. It is particularly effective when taken by mouth. Again it could be 
used for all morphine indications, but there would be no reduction in dependence 
liability. 

Dea:ftrometh orphan (Romilan®) is structurally related to codeine as levorpha- 
nol is related to morphine, but it is qualitatively different in some respects. It 
does not have pain-relieving potency, but is as effective as codeine for the relief 
of cough. It will not support an established dependence of morphine-type but 
the sul)jective effects of large doses, mainly psychotomimetic rather than mor- 
phine-like, are appreciated by some subjects and a few cases of abuse have 
been encountered. Preparations of dextromethorphan are available over the 
counter. 

Phenazocine (Prinadol®, Narphen®) is a result of further simplification of the 
morphine molecvile, or of less-advanced synthesis toward the morphine molecule. 
It is a basic structure present in morphine and levorphanol and represents fur- 
ther deletion of certain chemical features. It is qualitatively similar to morphine 
in its action but shows some quantitative differences. Analgesic potency is pres- 
ent in phenazocine about on a par with that of levorphanol, that is, several times 
greater than with morphine. Side effects are similar with all three drugs. De- 
pendence capacity is reduced definitely, as measured by animal experiments, 
but little as judged by quantitative comparisons in man. Phenazocine is effective 
orally, often nearly as effective as after parenteral injection, and therein may lie 
its greatest u.sefulness. Oral phenazocine has been well received in England' and 
other countries : it has not been marketed for oral use in the United States. 

Propoxyphene (Darvon®) is structurally related to methadone and has en- 
joyed wide popularity as a mild oral analgesic, especially ia combination with 
APC (aspirin, phenacetin, and caffeine). An intensive review of manv studies, 
comparing the drug w^ith codeine, or with aspirin, or APC, concluded that even 
the mixture with APC hardly equaled the oral effectiveness of codeine and 
certainly did not surpass it. Propoxyphine can produce morphine-like subjective 
effects, supports an established morphine dependence poorly, but has measurable 
dependence-producing capacity. Cases of abuse have been reported. However, 
after 5 years of marketing experience, the abuse liability of propoxyphene as a 

60-296— 71— pt. 1 i 



42 

public health hazard was judged not to warrant narcotics control, nationally or 
internationally. 

Caramiphen (Parpanit®) is not related chemically to any of the compounds 
which have been described. It was introduced as a relaxant and later shown 
to have cough-suppressant action, but there have been few controlled studies 
comparing it with codeine. Few side effects have been reported and no case of 
dependence or abuse. 

Benzonatate (Tessalon®) is also unrelated to the morphine structure, but is 
claimed to have a suppressant effect on cough reflexes both at the site of irrita- 
tion peripherally and at the responding center in the nervous .system. Again 
there have been few carefully controlled .studies. The recommended therapeutic 
dose is at least three times larger than for codeine and tolerance to the cough- 
relieving action may occur. 

Pentazocine (Talwin®) is a member of the benzomorphan series of which 
phenazocine was the first marketed example, and illustrates our most promising 
leads for opiate substitution. These constitute two underlying basic principles : 
(1) Animal experiments have shown consistently greater dissociation of pain 
relief and dependence capacity among the benzomorphans, which represent only 
partial synthesis toward morphine, than in any other chemical group. This 
ti'end has been partially confirmed in studies in man; (2) Whether the basic 
structure is morphine, morphinan, or benzomorphan, certain modifications have 
led to the appearance of specific antagonistic properties simultaneously with 
the retention of some morphine-like action. Compounds displaying such a com- 
bination of effects are classified as agonist-antagonists and pentazocine is in 
this group. It relieves pain satisfactorily, given orally or parenteral] y at a dose 
about four times greater than for morphine. Side effects with therapeutic doses 
are morphine-like. Pentazocine is also a weak morphine antagonist and will not 
support an established morphine dependence. Chronic administration of pentazo- 
cine causes the appearance of some dependence and a mild abstinence syndrome 
when the drug is abruptly withdrawn. Both the dependence and the abstinence 
syndrome are partly like, partly unlike, these phenomena with morphine. There 
is less drug-seeking behavior. The clinical effectiveness of pentazocine is being 
well received by physicians and patients. A few cases of abuse have been re- 
ported, very few in relation to the total doses prescribed. The drug has not 
been subjected to narcotics control. 

The foregoing descriptions confirm, I think, that we can do without morphine 
and codeine but the book on opiate substitution is not closed. Not only is the 
agonist-antagonist group undergoing and worthy of much further study, but 
there are other compounds of diverse structure in development, following fur- 
ther dissociation of dependence capacity and therapeutic action. 

[Exhibit No. 4(b)] 

Curriculum Vitae of Dr. Nathan Browne Eddy, Chairman, Committee of 
Problems of Drug Dependence, Division of Medical Sciences, National 
Academy of Sciences-National Research Council 

Date and place of birth : Glens Falls, N.Y, August 4, 1890. 

Family: Wilhelmina Marie Aherns (wife); Charles Ernest Edjdy (son), de- 
ceased. 
Education and degrees : 1911 — Cornell University Medical School — M.D. : 1963 — 

University of Michigan — D. Sc. (honorary). 
Special training or experience : 

1911-16 — Practice of medicine. New York City. 

1916-20 — Instructor of physiology, McGill University ; teaching and research. 

1926-28 — Assistant professor, physiology and pharmacology, T^niversity 

of Alberta — teaching and research. 
1928-30 — Associate professor of pharmacology, University of Alberta, teach- 
ing and Research. 

1927 (May-September) Visiting investigator. Department of Pharmacology, 
Cornell University Medical School. 

1928 (May-September) Visiting investigator and lecturer. Department of 
Physiology, University of Michigan Medical School. 

1929 (May-September.) Visiting investigator and lecturer, Department of 
Physiology, University of Michigan Medical School. 



43 

1930-39 — Research professor in pharmacology, University of Michigan — 
rGSGcircli. 

1980-39 — Consultant Biologist in Alkaloids, U.S. Public Health Service. 

1939-49 — Princii)al Pharmacologist, National Institutes of Health. 

1949-60 — Medical Officer, General, National Institutes of Health. 

1951-60 — Chief, Section on Analgesics, Laboratory of Chemistry. National 
Institute of Arthritis and Metabolic Diseases, National Institutes of Health 
—retired August 31, 1960. 

1960 — Consultant on Narcotics, National Institutes of Health. 

1961-67 — Professional Associate, designated Executive Secretary, Com- 
mittee on Drug Addiction and narcotics, Medical Division, National Re- 
search council. 

1968 Consultant, Bureau of Narcotics and Dangerous Drugs. 

1969 Consultant New York State Narcotic Addiction Control Commission. 

1970 Consultant Le Dain Commission on Nonmedical Use of Drugs. 

Membership in professional organizations : 

Society of Pharmacology and Experimental Therapeutics. 

American Association for the Advancement of Science. 

Society for Experimental Biologyand Medicine. 

Sigma Xi. 

Editorial board, Excerpta Medica ; editorial advisory board "Voice of 
America". 

Society for the study of addiction to alcohol and other drugs. 

Washington Academy of Sciences. 

American College of Clinical Pharmacology and Chemotherapy. 

Institute for the Study of Addiction. 

College of Neuropsychopharmacology. 

Eastern Psychiatric Research Association. 
Committee appointments, etc. : 

Committee on Drug Addiction and Narcotics (Problems of Drug Depend- 
ence), National Research Council, Secretary 1947-61; chairman 1970. 

U.S. Public Health Service Drug Addiction Committee (resigned). 

U.S. Public Health Service Post Office Advisory Committee, (resigned). 

Bureau of Narcotics Advisory Committee on Oral Prescription bill. Ad hoc. 

Advisory Committee under Narcotics Manufacturing Act of 1960. 
Chairman, 1961. 

Expert Panel on Addiction-Producing Drugs, World Health Organization ; 
member of each expert committee chosen from this panel ; chairman of 
Committee on first, second, eighth, ninth, 12th, 13th, and 16th sessions. 

Technical Adviser, U.S. Delegation to United Nations Commission on Nar- 
cotic Drugs. 1947, 1948, 1957, and 1958. 

Technical Committee, United Nations Plenipotentiary Conference on Single 
Convention on Narcotics Control, 1961. 

Special Consultant to Addiction-Producing Drugs Section, World Health 
Organization, 1954, 1955, 1956, 1959, and 1961. 

Consultant to Army Chemical Center. 

American Social Health Association Advisory Committee on Narcotic Addic- 
tion. 

Delegate and Panelist, Wliite House Conference on Narcotic and Drug Abuse, 
September 27-28, 1962. 

Alternate delegate for ASHA National Coordinating Council on Drug 
Abuse Information and Education. 
Honors and Awards : 

Corecipient, First Annual Scientific Award, American Pharmaceutical 
Manufacturers Association, 1939. 

Guest speaker, Royal Canadian Institute, Toronto Ontario, Canada, March 
28, 1953. 

Lister Memorial Lecture, October 1, 1959, Edinburgh, Scotland. 

Public Health Service Superior Performance Award for Sustained Outstand- 
ing Service, August 31, 1960. 

Delegate and gue.st speaker, Los Angeles Conference on Narcotic and Drug 
Abuse, April 27-28, 1963. 

Guest speaker, Hawaiian Pharmaceutical Association, Honolulu, May 4, 1963. 

D. Sc (honorary) University of Michigan, 1963. 

Dent Lecturer, Society for the Study of Addiction, London, 1967. 

WHO Medal for Distinguished Service, 1969. 

Snow Medal of American Social Health Association, 1969. 

Gold Medal of Eastern Psychiatric Research Association, 1970. 



44 



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"Secretin and the change in the corpuscle content of the blood dur- 



ing digestion." J. Fla. Med. Assn., 5 : 101-106, 1916. 

Nathan B. Eddy. The role of the thymus gland in exophthalmic goitre." 
Canadian Med. Assn. J., 9 : 203-213, 1919. 

Audrey W. Downs and Nathan B. Eddy. "The influence of internal secre- 
tions on the formation of bile." Am. J. Physiol., 48 : 192-198, 1919. 

"The influence of spenic extract on the number of corpu.s'cles in 

the circulating blood." Am. J. Physiol., 51 : 279-288, 1920. 

"Effect of subcutaneous injections of thymus substance in young 



rabbits." Endocriu., 4 : 420-428, 1920. 

"Extensibility of muscle : The effect of stretching upon the develop- 



ment of fatigue in a muscle." Am. J. Physiol., 56 : 182-187, 1921. 

"Extensibility of muscle: The production of carbon dioxide by a 



muscle when it is made to support a weight." Am. J. Physiol.. 56 : 188- 

195, 1921. 
Nathan B. Eddy. "The internal secretion of the spleen." Endocrinologv. 

5 : 461-475, 1921. 
"A simple device for the demonstration of heart block in the 

student laboratory." J. Lab. and Clin. Med., 6 : 635-638, 1921. 
Ardrey W. Downs and Nathan B. Eddy. "Secretin. V. Its effect in anae- 
mia with a note on the supposed similarity between secretin and vitamin 

B." Am. J. Physiol., 58 : 296-300, 1921. 
"Further observations on the effect of the subcutaneous injection 

of spenic extract." Am. J. Physiol., 62 : 242-247, 1922. 

"Some unusual appearances of nucleated erythrocytes in the cir- 



culation following repeated injection of splenic extract." Am. J. Phvsiol.. 
63 : 479-483, 1923. 

"Secretin and a suggestion as to its therapeutic value." Endocrin- 



ology, 7 : 713-719, 1923. 
Nathan B. Eddy. "The action of preparations of the endocrine glands 

upon the work done by skeletal muscle." Am. J. Phvsiol., 69 : 430-440, 

1924. 
Ardrey W. Downs and Nathan B. Eddy. "Secretin : VI. Its influence on 

the antibodies of the blood." Agglutinin. Am. J. Physiol., 77 : 40-43, 1924. 
Ardrey W. Downs, Nathan B. Eddy, and Robert M. Shaw. "Secretin : 

VII. Its inflence on the antibodies of the blood." Complement. Am. J. 

Physiol., 71 : 44-45, 1924. 
"Secretin: VIII. Its influence on antibodies of the blood: Haemolv- 



tic amboceptor." Am. J. Physiol., 71 : 46-48. 1924. 
Nathan B. Eddy and Ardrey' W. Downs. "Blood regeneration." Canadian 

Med. Assn. J., 16 : 391-396, 1926. 
"Secretin : IX. Its relation to the activity of skeletal muscle." Am. 

J. Physiol., 7.^ : 489-490, 1925. 
Nathan B. Eddy. Studies on hypnotics of the barbituric acid series." 

J. Pharmacol, and Exper. Therap.. 33 : 43-68. 1928. 
Nathan B. Eddy and Ardrey W. Downs. "Tolerance and cross-tolerance 

in the human subject to the diuretic effect of carreiue. theobromine. 

and theophylline." J. Pharmacol. & Exper. Therap., 33: 167-174. T92S. 



45 

(28) Nathan B. Eddy and Robert A. Hatcher. "The seat of the emetic action 

of the digitalis bodies." J. Pharmacol, and Exper. therap., 33 : 295-300, 
1928. 

(29) Ardrey W. Downs and Nathan B. Eddy. "Morphine tolerance: I. The 
acquirement, existence and loss of tolerance in dogs." J. Lab. and Clin. 

Med., 13 : 739-745. 1928. 

(30) "Morphine tolerance: II. The susceptability of morphine tolerant 

dogs to codeine, heroin and scopolamine." J. Lab and Clin. Med., 13 : 
745-749, 1928. 

(31) Ardrey W. Downs, Nathan B. Eddy, and John P. Quigley. "Morphine 

tolerance : III. The effect of cocaine upon dogs before, during and after 
habituation to morphine." J. Lab. and Clin. Med.. 13 : 839-842, 1928. 

(32) Nathan B. Eddy. "The regulation of respiration: XXVII. Tlie effect upon 

salivary secretion of varying the carbon dioxide and oxygen content of 
of the inspired air." Am. J. Physiol., 88: 534-545, 1929. 

(33) "The effect of the repeated administration or diethyl barbituric 

acid and of cyclohexenylethyl barbituric acid." J. Pharmacol. & Exper. 
Therap., 37: 261-271, 1929. 

(34) "The excretion of diethyl barbituric acid during its continued ad- 
ministration." J. Pharmacol. & Exper. Therap. 37; 273-282, 1929. 

(35) Ardrey W. Downs and Nathan B. Eddy. "The influence of Tyramine on 

the number of red corpuscles in the circulating blood." Proc. Soc. Exper. 
Biol. & Med., 27: 405-407, 1930. 

(36) Nathan B. Eddy. "Antagonism between methylene blue and sodium cya- 

nide." J. Pharmacol. & Exper. Therap., 39: 271, 1930. (Proc.) 

(37) "Regulation of respiration. The effect upon salivary secretion of 

the intravenous administration of sodium bicarbonate, sodium carbon- 
ate, sodium hydroxide, sodium chloride, and sodium sulphate." Quart. 
J. Exper. Physiol., 20: 313-320, 1930 (8 plates). 

(38) "Regulation of respiration. The effect upon salivary secretion of 

the intravenous administration of lactic acid, sodium lactate, and hydro- 
chloric acid." Quart. J. Exper. Physiol., 20: 321-326. 1930 (5 plates). 

(39) —"Regulation of respiration. The effect upon salivary secretion of 

the intravenous administration of ammonium chloride and ammonium 
carbonate." Quart. J. Exper. Physiol., 20: 327-332, 1930 (5 plates). 

(40) "Regulation of respiration. The effect upon salivary secretion of 

an increased oxygen content of the inspired air and of forced venti- 
lation." J. Pharmacol. & Exper. Therap., 4I: 42.3-433, 1931. 

(41) "Regulation of respiration. The effect upon salivary secretion of 

the intravenous administration of sodium sulphide, sodium cyanide and 
methylene blue." J. Pharmacol. & Exper. Therap.. 4I: 435-447, 1931. 

(42) "Regulation of respiration. The antagonism between methylene 

blue an dsodium cyanide." J. Pharmacol. & Exper. Therap., 4i-' 449-464, 
1931. 

(43) "The action of the codine isomers and some of their derivatives." 

J. Pharmacol. & Exper. Therap., 45: 236, 1932. (Proc.) 

(44) "A comparison of phenanthrene and some 2-, 3-, and 9-monosubsti- 

tution products." J. Pharmacol. & Exper. Therap., 45: 257, 1932. (Proc.) 

(45) Nathan B. Eddy and A. Kenneth Simon. "The measurement of the de- 

pressant action of the codeine isomers and related substances by the 
use of mazetrained rats." J. Pharmacol. & Exper. Therap., 45: — , 1932. 
(Proc.) 

(46) Hugo M. Kreugar and Nathan B. Eddy. "A study of the effects of codeine 

and isomers on the movements of the small intestine." J. Pharmacol. & 
Exper. Therap., 45: 266, 1932. (Proc.) 

(47) Nathan B. Eddy. "Studies of morphine, codeine, and their derivatives: 

I. General Methods." J. Pharmacol. & Exper. Therap., 45: 339-359, 1932. 

(48) "Studies of morphine, codeine, and their derivatives: II. Isomers 

of codine." J. Pharmacol. & Exper. Therap., 45: 361-381, 1932. 

(49) Ardrey W. Downs and Nathan B. Eddy. "Influence of barbital upon 

cocaine poisoning in the rat." J. Pharmacol. & Exper. Therap., 45: 383- 
387, 1932. 

(50) "Effect of repeated doses of cocaine on the dog." J. Pharmacol. & 

Exper. Therap., 46: 195-198, 1932. 

(51) "Effect of repeated doses of cocaine on the rat." J Pharmacol. & 

Exper. Therap., 46: 299-200, 1932. 



46 

(52) Nathan B. Eddy. "Dilaudid." J. Am. Med. Assn., 100: 1031-1035, 1933. 

(53) Gerald G. Woods and Nathan B. Eddy. "Some new alkamines of the 

tetrahydronapthalene series." J. Pharmacol. & Exper. Therap., 48: 175- 
181, 1933. 

(54) Nathan B. Eddy. "Studies of phenanthrene derivatives : I. A comparison 

of phenanthrene and some 2-, 3-, and 9-monosubstitution products." J. 
Pharmacol. & Exper. Therap., 48: 183-198, 1933. 

(55) "Studies of the relation of the hydroxyl groups of morphine to its? 

pharmacological action." J. Pharmacol. & Exper. Therap., 48 : 271, 1983. 
(Proc.) 

(56) "Studies of morphine, codeine, and their derivatives : III. Morphine 

methochloride and codeine methocloride." J. Pharmacol. & Exper. 
Therap,. 49: 319-327, 1933. 

(57) "Studies of morphine, codeine, and their derivatives: IV. Hydro- 

genated codine isomers." J. Pharmacol. & Exper. Therap., 51: 35-4:4, 
1934. 

(58) "Studies of phenanthrene derivatives: II. Monosubstitution prod- 
ucts, first variations. The effect of muzzling the hydroxyl group of 2- or 
3-hydroxyphenanthrene." J. Pharmacol. & Exper. Therap., 51: 75-84, 
1934. 

(59) Charles W. Edmunds and Nathan B. Eddy. "Some studies on the drug 

addiction problem." Michigan Alumnus Quarterly Review, 4^: 250-257, 
1934. 

(60) Charles W. Edmunds, Nathan B. Eddy, and Lyndon P. Small. "Studies 

on morphine addition problem." J. Am. Med. Assn.. 103: 1417, 1934. 

(61) Nathan B. Eddy. "Studies of phenanthrene derivatives: III. Di-subst. 
'f>= products." J. Pharmacol. & Exper. Therap., 52 : 275-289, 1934. 

(62) Nathan B. Eddy and John G. Reid. "Studies of morphine, codeine, and 

their derivatives: VII, Dihydromorpliine (paramorphan), dihydro- 
morphinene, (Dilaudid), and dihydrocodeinone (Dicodide)." J. 
Pharmacol. & Exper. 52 : 468-493, 1934. 

(63) Nathan B. Eddy and Homer A. Howes. "Studies of morphine, codeine, 

and their derivatives : VIII. Monoacetyl- and diacetylmorphine and 
their hydr. derivatives." J. Pharmacol. & Exper. Therap., 53: 430-439, 
1935. 

(64) Nathan B. Eddy. "Phenanthrene studies. The effect of different nitric- 

taining side-chains." J. Pharmacol. & Exper. Therap., 54 : 149, 1935. 

(65) A. Kenneth Simon and Nathan B. Eddy. "Studies of morphine, codeine, 

and their derivatives : V. The use of maze-trained rats to study the effect 
on central nervous system of morphine and related substances." Am. J. 
^7 : 597-613, 1935. 

(66) Nathan B. Eddy and Bertha Aheens. "Studies of morphine, codeine, and 

their derivatives : VI. The measurement of the central effect of codeine, 
hydrocodeine, and their isomers bv the use of maze-trained rats." Psy- 
chol., ^7 : 614-623, 1935. 

(67) Nathan B. Eddy. "Studies of morphine, codeine, and their derivatives: 

Methyl ethers of the morphine and codeine series." J. Pharmacol. & 
Therap., 55 : 127-135. 1935. 

(68) Nathan B. Eddy and Homer A. Howes. "Studies of morphine, codeine, 

and their derivatives : X. Desoxymorphine-C, desoxycodeine-C and their 
hydro derivatives." J. Pharmacol. & Exper. Therap., 55 : 257-267, 1935. 

(69) Natpian B. Eddy. "Studies of phenanthrene derivatives: V. Homologous 

and aldehvdes and some of their derivatives." J. Pharmacol. & Exper. 
Therap., 55 : 354-364, 1935. 

(70) "Studies of phenanthrene derivatives : VI. Amino alee of the ethan- 

olamine and propanolamine type." J. Pharmacol. & Exper. 55 : 419-429, 
1935. 

(71) "Studies of morphine, codeine, and their derivatives: The isomers 

of morphine and dihydromorphine." J. Pharmacol. «& Exper. 56' : 429-431, 
1936. 

(72) "Studies of phenanthrene derivatives: 'SMI. A comparing analogous 

phenanthrene and dibenzofurau derivatives." J. Pharmacol. Exper. 
Therap., 58 : 159-170, 1936. 

(73) ^"Drug Addiction. Pharmacological Studies." Hosp. New 34, 1936. 



47 

(74) Nathan B. Eduy and C. K. Himmelsbach. "Experiments on the tolerance- 

and addiction potentialities of dihydrodesoxymorphiue-D ("Desomor- 
phine")." Suppl. No. 118 to the U.S. Public Health Reports. 33 pp.. 1936. 

(75) Nathan B. Eddy. "Analgesic and other effects of some carbazoles." J. 

Pharmacol. & Exper. Therap., 60: 105, 1937 (Proc.) 

(76) "The search for more effective morphine-like substitutes." Am. J. 

Med. Sc, J97 : 464^79, 1939. 

(77) Lyndon F. Small, Nathan B. Eddy, Erich Mosettig, and C. K. Himmels- 

bach. "Studies on drug addiction. With special reference to chemical 
structure of opium derivatives and allied synthetic substances and their 
physiological action." Suppl. No. 138 to U.S. Public Health Reports, 143 
pp., 1939. 

(78) Nathan B. Eddy. "Studies of carbazole derivatives: I. Amino-carbazoles." 

J. Pharmacol. & Exper. Therap., 65 : 294-307, 1939. 
(79) "Studies of carbazole derivatives: II. Amino alcohols and deriva- 
tives of tetrahydrocarbazole." J. Phai-macol. & Exper. Therap., 65 : 308- 
317, 1939. 

(80) "Studies of morphine, codeine, and their derivatives: XIV. The 

variation with age in the toxic effects of morphine, codeine, and some 
of their derivatives." J. Pharmacol. & Exper. Therap.. 66 : 182-201, 1939. 

(81) Nathan B. Eddy and Margaret Sumwalt. "Studies of morphine, codiene, 

and their derivatives : XV 2,4-Dinitrophenylmorphine." J. Pharmacol, 
& Exper. Therap., 67 : 127-141, 1939. 

(82) Nathan B. Eddy. "Pharmaceutical education and the public health." Am. 

J. Pharmaceut. Ed., 181-186, 1942. 

(83) Hugo Krueger, Nathan B. Eddy, and Margaret Sumw^alt. "The Pharma- 

cology of the Opium Alkaloids." Suppl. No. 165 to the Public Health 
Reports, 1448 CXL pp., 1943. 

(84) Nathan B. Eddy. "4,4-Diphenyl-6-dimethylamino-heptanone-3 : A new syn- 

thetic morphine-like analgesic." Soc. for Exper. Biol. & Med., Washing- 
ton Section, April 1947. 

(85) "Metopon hydrochloride." J. Am. Med. Assn., 134: 219-292, 1947. 

(86) Harris Isbell, Abraham Wikler, Nathan B. Eddy, John L. Wilson, and 

Clifford F. Moran. "Tolerance and addiction liability of 4,4-diphenyl- 
6-dimethylamino-heptanone-3 (Methadone)." J. Am. Med. Assn., 135: 
883-894, 1947. 

(87) Nathan B. Eddy. "Metopon." J. Am. Pharmaceut. Assn., Pract. Pharmac. 

Education, 8 : 430-433, 1947. 

(88) "A new morphine-like analgesic." J. Am. Pharm. Assn., Pract. 

Pharm. Ed.. 8 : 536-540, 1947. 

(89) "Analgesic drugs in cancer therapy." Fourth International Cancer 

Research Congress, St. Louis, Sept. 5, 1947. Acta L'Union luteruat. 
Cong. Cancer, 6 : 1379-1385, 1950. 

(90) "Metopon." Am. Soc. Anesthesiologists — Symposium on New Drugs, 

New York, Dec. 5, 1947. 

(91) "Progress in Drug Therapy of Pain." Am. Pharmaceut. Monuf. 

Assn., Annual Award Meeting, New York, Dec. 16, 1947. Am. Prof. 
Pharmacist, 14 : 252-253, 1948. 

(92) "Metopon hydrochloride." Canad. Med. Assn. J. January 1947. 

(93) "Metopon hydrochloride (Methyldihydromorphinone hydrochlo- 
ride)." Report to the Council on Pharmacy and Chemistry of the AMA 
by the Committee on Drug Addiction and Narcotics of the National Re- 
search Council. J. Am. Med. Assn., 137 : 365-367, 1948. 

(94) "Newer analgesics in the control of pain in cancer patients." Post- 
graduate symposium on Cancer, Medical College of Virginia, Rich- 
mond, Va. Mar. 25, 1948. Unpublished. 

(95) "Newer preparations for pain relief." Read Apr. 16, 1948. George 

Washington University Medical School. Postgraduate course. Unpub- 
lished. 

(96) "Progress in drug therapy of pain." Adapted from No. 91. Read 

at Staff Meeting of Arlington Hospital, Arlington, Va. May 6. 1948. 
Unpublished. 

(97) "Pharmacology of Metopon and other new analgesic opium deriva- 
tives." New York Academy of Science. May 14-15, 1948. Ann. N.Y. 
Acad. Science, 51 : 51-58, 1949. 



48 

(98) "The New Narcotics, Post-graduate Course in Internal Medicine 

of tlie American College of Physicians, May 22, 1948." Am. Practitioner, 
3 : 37^2, 1948. 

(99) "Cooperation on Narcotics." Drug & Allied Indust., 5: 8-11, 1949. 

(100) . "Metopon hydrochloride. An Experiment in Clinical evaluation." 

U.S. Public Health Reports, 64 : 93-103, 1949. 

(101) - — —"Progress in drug therapy of pain." Am. Professional Pharmacists, 

14 : 2.52, 1948. 

(102) "The relation of chemical structure to analgesic action." J. Am. 

Pharmaceut. Assn., Sc. Ed., 39 : 24.5-251, 1950. 

(103) Nathan B. Eddy, Caroline Fuhrmeister Touchberrt, and Jacob E. 

LiEBERMAN. "Synthetic analgesics. I. Methadone isomers and deriva- 
tives." J. Pharmacol. & Exper. Therap., 98 : 121-137, 19.50. 

(104) Nathan B. Eddy. "Methadols and acetylmethadols." Read Lilly Research 

Laboratories, May 24, 1951 : Pharmacological Institute, Basle, Switzer- 
land, Nov. 15, 1951. Unpubli.shed. 

(105) Nathan B. Eddy, Evekette L. May, and Erich Mosettig. "Chemistry and 

pharmacologv of the methadols and acetylmethadols : XII." Interna- 
tional Cong. Chem., New York, Sept. 7, 1951 : J. Org. Chem., 17 : 321-326. 
1952. 

(106) Nathan B. Eddy. "N-Allylnormorphine." Comm. Drug Addiction & Nar- 

cotics. Jan. 21, 1952. Unpublished. 

(107) "Drugs liable to produce addiction (The work of the World Health 

Organization Expert Committees)." Public Health Reports, 61: 362, 
1952. 

(108) Nathan B. Eddy and Everette L. May. "The isomethadols and their acetyl 

derivatives." J. Org. Chem., 17 : 210-215, 1952. 

(109) Nathan B. Eddy, G. Robert Coatney, W. Clark Cooper and Joseph 

Greenberg. "Survey of antimalarial agents." Public Health Monograph, 
No. 9 : .323 pp. U.S. Govt. Print. Off., Washington. D.C. 1953. 

(110) Nathan B. Eddy and Dorothy Leimbach. "Synthetic Analgesics: II. Di- 

thienvlbutenyl- and dithienylbutylamines." J. Pharmacol. & Exper. 
Therap. 107 : 385-393, 19.53. 

(111) Nathan B. Eddy. "Heroin (diacetylmorphine). Laboratory & clinical 

evaluations of its effectiveness and addiction liability." Bull. Narcotics, 
5:39-44,1953. 

(112) "Symposium on drug addiction: Foreword." Am. J. Med. 14'- 537, 

1953. 

(113) — "The hot plate method for measuring analgesic effect in mice." Na- 
tional Research Council Bull. Drug Addiction & Narcotics, 603-612, 
19.53. Unpublished. 

(114) "Drug Addiction: Fact and Fancy." Royal Canadian Institute, 

Toronto. Canada, Mar. 28, 19.53. Pro. Roval Canad. Inst., 18: 44, 19.53: 
Health Ed. J., 17 : 1, 11 ; 17 : 2. 14-19, 19.53. 

(115) Dorothy Leimbach and Nathan B. Eddy. "Synthetic analgesics: III. 

Methadols, Isomethadols and their acvl derivatives." J. Pharmacol. & 
Exper. Therap., 110 : 135-147, 19.54. 

(116) Nathan B. Eddy. "The Phenomena of tolerance." Symposium on Drug 

Resistance, Washington, D.C, Mar. 26, 1954. Published by Academic 
Press — "Origins of Resistance to Toxic Agents." pp. 22.3-243* 1955. 

(117) "The Committee on Drug Addiction and Narcotics." News Report, 

National Academy of Sciences ; ^ : 93, 1954. 

(118) Olav J. Braenden, Nathan B. Eddy, and H. Halbach. "Synthetic sub- 

stances with morphine-like effect. Relationship between chemical struc- 
ture and analgesic action." Bull. World Health Organization, 13: 937, 
19.55. 

(119) Nathan B. Eddy. "Addiction liability of nlagesics: tests and results." 

Read, Symposium on alagesics, American Theraueptic Society, June 3, 
19.55, Atlantic City, N.J. J. Am. Geriatrics Society, 4: 177, 19-56. 

(120) "The search for new analgesics. Part of Symposium, Pain and its 

relief." J. Chronic Dis., //.- 59, 1956. 

(121) Nathan B. Eddy, II. Haibach, and Olav J. Brafndex. "Synthetic sub- 

stances with morphine-like effect. Relationship between analgesic action 
and addiction liability, with a discussion of the chemical structure of 
addiction producing substances." Bull. World Health Organization, 14: 
.353. 1956. 



49 

(122) Nathan B. Eddy. "Synthetic narcotic drugs." Union Signal, 82: 7, 19r.5. 

(123) Theodore D. Perrine and Nathan B. Eddy. '"The preparation and anal- 

gesic activity of 4-carbethoxy-4-pheuyl-l-(2-phenyIetliyl) -piper idine and 
related compounds." J. Org. Cheni., 21: 12.j, ID.jH. 

(124) Nathan B. Eddy. "Habit-forming drugs." Bull. Drug Addiction & Nar- 

cotics, p. 1494. 195«;. 

(125) "The history of the development of narcotics." Law and Contempo- 
rary Problems, 22: 3, 1907. 

(12G) "Addiction-producing versus habit-forming." Guest editorial J. Am. 

Med. Assn., 163: 1G22, 1957. 

(127) "New developments in analgesics." Read, Bahamas Medical Con- 
ference, Nassau, Apr. 25, 1957. Unpublished. 

(128) "Addiction — ^the present situation." Read, Bahamas Medical Con- 
ference, Nassau, Apr. 25, 1957. Unpublished. 

(129) Nathan B. Eddt, H. Halbach, and Olav J. Braenden. "Synthetic sub- 

stances with morphine-like effect. Clinical experience : Potency, side 
effects and addiction liability." Bull. World Health Orgn., 27; 569, 1957. 

(130) Nathan B. Eddy, James G. Murphy, and Everette L. May. "Structures 

related to morphine : IX. Extension of the Grewe morphinan synthesis 
in the benzomorphan series and pharmacology of some benzomorphans." 
J. Org. Chem., 22: 1070, 1957. 

(131) Nathan B. Eddy, Red wig Besendorf, and Bela Pellmont. "Synthetic 

Analgesics : IV. Aralkyl substitution on nitrogen of morphinan. "U.N. 
Bull. Narc. 10: (No. 4) , 23, 1958. 
(131a) Lyndon F. Small. Nathan B. Eddy, J. Harrison Ageu. and Everette L. 
May. "An improved synthesis of N-phenethylnormorphine and analogs." 
J. Org. Chem., 23: 1387, 1958. 
1 132) Nathan B. Eddy and Lyndon E. Lee, Jr. "The analgesic equivolence to 
morphine and relative side reaction liability of oxymorphone (14-hy- 
droxy-dihydromorphinoue)." J. Pharmacol. & Exper. Therap., 125: No. 2, 
February 1959. 

(133) Nathan B. Eddy, Lyndon E. Lee, Jr., and Cari. A. Harris. "The rate of de- 

velopment of physical dependence and tolerance to analgesic drugs in 
patients with chronic pain : I. Comparison to morphine, oxymorphone 
and anileridine." Bull. Narc, 11: Nos. 1, 3, 1959. 

(134) Nathan B. Eddy and Harris Isbell. "Addiction liability and narcotics 

control." Public Health Reports, 7.J; 755, September 1959. 

(135) Nathan B. Eddy. "Chemical structure and action of morphine-like anal- 

gesics and related substances." Sixth Lister Memorial Lecture. Chem. & 
Indust., 47.- 14H2 November 1959. 

(136) Nathan B. Eddy, Lyndon E. Lee, Jr., and Carl A. Harris. "Dependence 

physique et tolerance vis-a-vis de certains analgesiques chez des malades 
souffrant de douleurs chroniques. Comparison entre la morphine, I'oxy- 
morphoneet I'anileridine." Bull. Org. Sante, 20: 1245, 1959. 

(137) Nathan B. Eddy, Modeste Piller, Leo A. Pirk, Otto Schrappe, and 

SiGUARD Wende. "The effect of the addition of a narcotic antagonist on 
the rate of development of tolerance and physical dependence to mor- 
phine." Bull. Narc, 12: No. 4, 1959. 

(138) Everette L. May and Nathan B. Eddy. "A new potent synthetic anal- 

gesic" J. Org. Chem., 2J,: 294, 1959. 

(139) Everette L. May, and Nathan B. Eddy. "Structures related to morphine: 

XII. ( ± ) -2'-Hydroxy-5,9-dimethyl-2-phenethyl-6,7-benbomorphan ( NIH- 
7519) and its optical forms." J. Org. Chem., 24: 1435-1437, 19.59. 

(140) Paul A. J. Janssen and Nathan B. Eddy. "Comiwunds related to pethi- 

dine : IV. New general chemical methods of increasing the analgesic 
activity of pethidine." J. Med. Pharmaceut. Chem., 2: 31. I»i0. 

(141) J. R. Nicholls and Nathan B. Eddy. "The assay, characteristics, compo- 

sition and origin of opium. No. 97. Analysis of samples of opium of 
unknown origin." United Nations, ST/SOA/Ser. K/97, February 19, 
1960. 

(142) BENJAJfiN J. CiLiBEKTi AND Nathan B. Eddy. "Preanesthetic medication: 

morphine, anileridine, oxymorphone, and placebo." Bull. Narc, 13 : Nos. 
3, 1, 1961. 

(143) Everette L. May and Nathan B. Eddy. "The assay, characteristics, com- 

position, and origin of opium. No. 111. The analysis of authenticated 
opium samples bv means of direct absorption spectrophotometry." United 
Nations, ST/SOA/Ser. K/Hl, October 6, 1961. 



50 

<144) Nathan B. Eddy, H. M. Fales, E. Haahti, P. F. Highet, E. C. Horning, 
E, L. May, and W. C. Wildman. "The assay, characteristics, composi- 
tion, and origin of opium. No. 114. Identification and analysis of opium 
samples by linear-programed gas chromatography." United Nations, 
ST/SOA/Ser.K/114, Oct. 6, 1961. 

(145) Maxwell Gordon, John J. Laffebty, David H. Tedeschi, Nathan B. 

Eddy, and Everette L. May. "A new potent analgetic antagonist." Na- 
ture, 192 : 1089. 1961 . 

(146) Maxwell Gordon, John J. Lafferty, Blaine M. Sutton, David H. 

Tedeschi, Nathan B. Eddy and Everette L. May. "New benzomorphan 
analgetics." J. Med. Pharmaceut. Chem., 1962. In press. 

(147) Nathan B. Eddy and Hans Halbach. "Synthetic substances with mor- 

phine-like effect: V. Tests for addiction." Bull. World Health Organi- 
zation, 1962. In press. 

(148) Nathan B. Eddy and Everette L. May. "Synthetic Analgesics, Part 2, B. 

Benzomorphans" Pergamon Press, 1962. In press. 

(149) H. Halbach and Nathan B. Eddy. "Tests for addiction (chronic intoxi- 

cation) or morphine type." Bull. World Health Organization, 1963, 
28 : 139 

<150) Nathan B. Eddy. "Statement on Relative Safety of Codeine Prepara- 
tions." Read, Senate Committee on Judiciary, California Senate, Sacra- 
mento, Calif., Mar. 8, 1963. 

(151) — ^ "The role of the National Academy of Sciences and the National 

Research Council." Proceedings White House Conference on Narcotic and 
Drug Abuse, Washington, D.C., Sept. 27-28, 1962, p. 136. 

(152) "The chemo-pharmacological approach to the problem of drug ad- 
dition." Read, Conference on Drug Addiction, University of California 
at Los Angeles, Apr. 27-28, 1963. U.S. Public Health Report (1963) 78: 
673. Proceedings of the conference. McGraw-Hill (1964). In press. 

(153) Nathan B. Eddy, B. Ciliberti, and Phyllis F. Shroff. "Preanaesthetic 
medication." Bull. Narcotics (1964) 16 : No. 2, 41. 

<154) Nathan B. Eddy. "Drug addiction and the law." Britannica Book of the 
Year (1964), 291. 

(155) "The search for a nonaddicting analgesic." Proc. of symposium on 

history of narcotic drug addiction problems. Mar. 27-28, 1958. Public 
Health Service publication No. 1050, U.S. Gov. Print. Off. (1963). 

Chairman Peppp:e. We will now take a 5-minute recess. 

(A brief recess was taken.) 

Chairman Peppee. The committee will come to order, please. 

Dr. Brill, would you please come forward. 

Our next witness today is Dr. Henry Brill, ca distinguished psychia- 
trist and hospital administrator. 

Dr. Brill, a graduate of Yale College and Yale Medical School, 
served his internship at Pilgrim State Hospital in New York, the 
same facility that he now serves as director. 

Dr. Brill is a diplomate of the American Board of Neurology and 
Psychiatry, a fellow of the American Psychiatric Association, and a 
certified mental hospital administrator. 

He has served as assistant commissioner for research and medical 
services of the New York Department of Mental Plygiene : and vice 
chairman of the New York State Narcotic Addiction Control 
Commission. 

PTe has been director of Pilgrim State Plospital, with time out for 
some of his other appointments, since 1958. 

Dr. Brill has served as clinical professor of psychiatry at Albany 
Medical College and as professional lecturer at Upstate Medical Cen- 
ter in Syracuse, N. Y. 

He is presently a lecturer in psychiatry at Columbia Uiiiversity-s 
College of Physicians and Surgeons, and clinical professor of psychia- 
try at the New York School of Psychiatry. 



51 

In the past, Dr. Brill has served as president of both the American 
College of Neuropsychopharmacology and the Eastern Psychiatric 
Research Association. He is currently president-elect of the American 
Psychopathological Association. 

In addition to serving on the editorial boards of four scientific jour- 
nals, Dr. Brill is a member and past chairman of the American Medi- 
cal Association's Committee on Drug Dependence and Alcoholism; a 
member and past chairman of the National Research CounciFs Com- 
mittee on Drug Dependence, and was recently appointed to the Presi- 
dent's Commission on Marihuana and Drug Abuse. 

In 1965, Dr. Brill was chairman of the methadone maintenance 
evaluation advisory committee of the Columbia School of Public 
Health. 

I have taken the time to list but a few of Dr. Brill's many profes- 
sional appointments and accomplishments. I will not detail the over 
100 papers in the field of psychiatry, administration, somatic theory, 
and drug dependence he has authored. 

Dr. Brill, we are greatly honored that you have taken time from 
your busy schedule to share your immense knowledge with us. 

Mr. Perito, would you make the inquiries ? 

Mr. Perito. Thank you, Mr. Chairman. 

Dr. Bril], I understand you have a prepared statement ? 

STATEMENT OE DE. HENEY BRILL, DIRECTOR, PILGRIM 
STATE HOSPITAL, NEW YORK, N.Y. 

Dr. Brill. I have. 

Mr. Perito. Would you care to read that statement or just sum- 
marize it? 

Dr. Brill. I would like to skip through it because much of it re- 
peals what you have already heard this morning. 

Chairman Pepper. Doctor, without objection, your full statement 
will appear in the record, and you may give such summary of it as you 
will. 

Dr. Brill. Thank you, sir. 

I think what I would like to stress here is that the question before 
your committee, as has been mentioned, was already brought up in 
1051, but it is different in one important respect. In 1951, the question 
was asked what would happen in a state of national emergency when 
stocks of opiuni derivatives were exhausted and not to be replenished. 
Now, today this Nation is in a secure position with respect to such an 
emergency, and I think that you already have heard that we haA-e good 
substitutes under such circumstances so there would be no emergency 
in the medical practice if the supplies were cut off. 

I would also like to point out that this is, to a significant degree, the 
direct result of a major coordinated research in which the iSTational 
Academy of Medicine-National Research Council Committee played 
an important role under the leadership of Dr. Nathan Eddy, who was 
its chairnian for most of the time, since 1951, and I might also add that 
another important element was the work of Dr. Maurice Seevers, whom 
you have heard this morning. 

You now, as I understand it, are interested in the situation with re- 
spect to a complete substitution in a nonemergency situation, and this 



52 

entails the consideration of additional important factors, factors in 
jiddition to those coiisidered in response to the first question: That is 
the established patterns of medical and pharmaceutical practice, and 
I might add. it also relates to the habits of the public with respect to 
the medication they take, because one of these medications- codeine, 
is extensively self-administered for the treatment of cou^h. 

From all ])ersonal experience, I am led to believe that tlie synthetics 
are playing a large and growing role in the practice of medicine, yet 
it appears the natural opium products and their derivatives are still 
extensively used in spite of the availability of heavily advertised syn- 
thetic rei)lacements, and these synthetics are being heavily advertised 
in the medical press at least. The TT.N. publication "Statistics on Nar- 
cotic Drugs for lOGO." table o, indicates that the amou.nt of morphine 
converted into '^odeine actually rose worldwide from 112.350 kilo- 
grams in 1905 to 146,000 kilograms in 1969, and the corresponding 
U.S. figures rose from 20,000 kilograms to 28,000 kilograms, v.-hir>h 
points to a marked public acceptance of the use of codeine in current 
practice. 

The increases were irregular, but the figures seemed to show that 
the natural products, and especially codeine, continue to play a very 
large role in world medicine and in the United States, and that the 
U.S. share is significant but by no means decisive in the overall figures. 

It would thus seem that in a plan to influence the dru<i' dependence 
field by terminating the use of natural products would call for re- 
orientation of this aspect of medical practice within the Ignited States 
and in other countries as well. Quantitativelv the story relates to co- 
deine. The issue which would have to be considered includes the relative 
costs of the natural and synthetic products and the relative familiarity 
of public and the health professions with the many characteristics of 
each of the various drugs because in practice few drugs are entirely 07- 
essentially identical. They tend to vary among themselves as to speed 
and duration of their primary action and the relative intensity and 
timing of their many other properties. From all available information, 
it would seem that a replacement is technically feasible Init it would 
also appear that this would call for full considtation with organized 
medicine and pharmacy. In order to be fully accepted, such a transition 
would require further research to explore the many pharmacological 
characteristics of the substitute drugs — and this includes the question 
of teratogenicity, which is a thorny question at the present moment, 
the capacity to create deformities in unborn children — in the multi- 
plicity of clinical situations and the many conditions under which the 
drugs are used and this would call for extensive laboratory studies 
and clinical investigations. Because when a drug comes out of a labora- 
tory and comes into clinical practice there is a large empirical element 
that must enter into it, because no laboratory can ever go into all the 
various complex situations that are liable to be faced in actual mcMlical 
practice. They can approximate it, but they can't totally reproduce it. 

I appreciate the opportunity to appear before this body and realize 
that there is room for nnich clifference of opinion on all these matters 
but have sought to identify the prol)loms which would seem to require 
solution in connection with the proposal which is before you. Under 
emergency conditions the synthetic drugs which we now have would 
fully replace the natural products in control of i^ain and for other 



53 

indications but under nonemergency conditions it would seem that 
the immediate reorientation of medical and pharmaceutical procedures, 
on the scale implied in the U.S. figures, would require a major effort, 
although there are strong indications that the long-term trend lies in 
this direction, that is, in the direction of the gradual substitution of 
he natural products by the introduction of synthetics. 

Thank you, sir. 

Chairnian Pepper. Doctor, what needs to be done, in addition to what 
has already been done, to justify Congress in prohibiting the impor- 
tation of any deri^'ati\'GS of opium so as to lead to the stoppage of the 
growing of the opium poppy ? Do you think additional research is nec^ 
essary, and if so, are additional funds required ? What more needs to 
be done^ 

Dr. Brill. I would say yes to both counts. For example, a synthetic 
way of producing codeine which hasn't yet been achieved or a synthetic 
which will substitute completely for codeine — and we do not have a 
drug which is exactly like codeine — both of these would be well worth- 
while in connection with the proposal, and they call for research. 

In addition, if I may, there is a large amount of investigation that 
needs to be done and has not been done in connection with many, many 
interesting products that have been tested and are available for fol- 
lowup but have not been thoroughly investigated because of a lack of 
funds. 

Chairman Pepper. Doctor, what do you consider the state of develop- 
ment of antagonistic drugs to heroin addiction? 

Dr. Brill. I think we are at the beginning, sir. Naloxone is one drug 
which is quite acceptable to those patients who are willing to take the 
antagonist and the supply is as yet not extensive. I think that this is 
now being developed, but we need a substance which will have a longer 
action tlian naloxone has. But I must also point out that many pa- 
tients will refuse to take, many addicts will refuse to take, antago- 
nists. This is from my personal experience. 

Chairman Pepper. Are you informed about the methadone experi- 
ment in New York '? 

Dr. Brill. , Yes. 

Chairman Pepper. "Would you comment on the use of methadone in 
the treatment of heroin addiction? 

Dr. Brill. When methadone is used along the lines that Dr. Eddy 
outlined, when it is properly used in a program of treatment, it can 
produce results which I think are better than any other techniques 
that I know for a certain number of addicts whose condition is intrac- 
table to any other procedure. But when methadone is used by other 
methods, by other techniques and in other ways, it can become a pub- 
lic health hazard and the essential difference between the medical use 
of methadone and the abuse of methadone is that the medical use of 
methadone provides physical saturation, saturation of the physical 
need but it produces no mental effect. "Whereas, if the drug is used in 
such a way as to produce mental effects it produces all the harm of ad- 
diction as we know it. It produces mental effect when it is injected in- 
travenously and when it is taken orally by beginners on an irregular 
basis. 



54 

Chairman Pepper. Have you found tliat the use of methadone in the 
New York experiment with which you are familiar has reduced the 
amount of crime committed by the heroin addict treated ? 

Dr. Brill. In the cases that are under treatment, the statistics are 
quite spectacular. The amount of crime was reduced by over 85 per- 
cent. But I cannot say that there was an impact on the overall crime 
statistics, althou<ili I knoAv how difficult it is to eA^aluate overall 
crime statistics. But among the population that followed the metha- 
done treatment, the reduction in crime is spectacular. 

Chairman Pepper. Mr. Perito, do you have any questions of Dr. 
Brill? 

Mr. Pertto. a couple of brief ones, Mr. Chairman. 

Dr. Brill, how would it be best to coordinate the eflForts of or- 
ganized medicine to move toward the use of synthetic analgesics ? 

Dr. Brill. You mean to advance the use of existing synthetics or 
new synthetics ? 

Mr. Perito. Existing synthetics. 

Dr. Brill I think an educational program would be useful. I think 
there is relatively little problem, as Dr. Eddy pointed out, in connec- 
tion with the use of synthetics for the control of pain in connection 
with operations and major surgery or major accidents and this kind 
of thing. 

The real problem is in the use of codeine as an analgesic and an 
antidepressant for the control of cough. Hero the drug has a combi- 
nation of qualities that are not easily mimicked. 

Mr. Perito. Would you acquiesce in the judgment of Dr. Eddy that 
methadone should not be distributed by private physicians but should 
only be distributed in a coordinated clinical atmosphere with proper 
support services? 

Dr. Brh^l. Most certainly. 

Chairman Pepper. Mr. Mann. 

Mr. Mann. No questions, Mr. Chairman. 

Chairman Pepper. Mr. Wiggins? 

Mr. Wiggins. Doctor, your testimony indicated that one of the 
problems with the synthetics is that they have not been thoroughly 
tested to know fully their impact in general clinical use. But isn't 
it so. Doctor, that many of these substitutes are now in clinical use ? 

Dr. Brill. Yes, sir ; they are. Unfortunately, it takes years of clinical 
use before all the ramifications of a drug can be identified. For exani- 
ple, we take one of the commonest drugs in clinical use, and that is 
tobacco. It was in clinical use for hundreds of years before anyone 
suspected that it might possibly lead to pathologies in the lungs and 
so on. So the same has happened over and over again with ncAvly 
introduced drugs. After they have been on the market for a while, 
questions have been raised. 

Antidiabetic drugs recently had questions raised about them which 
are not fully answered as yet. It is a controversial subject, as you know. 

So the fact that a drug is in clinical use is reassuring, but not totally 
reassuring. 

Mr. Wiggins. Doctor, simply because questions exist and probably 
will always exist, are you satisfied that those questions standing alone 
are sufficient reason not to warrant a statute which would outlaw 
morphine and thereby force the general clinical use of the substitute ? 



55 

Dr. Brill. I think there would be less difficulty with a statute out- 
lawino: morphine than with a statute outlawing all opium products. 
I think it would be relatively simple to outlaw morphine, although 
there would be, as has been brought out here, professional questions 
raised both on the grounds of familiarity with the morphine and on 
the grounds that there is a reluctance to have such things legislated. 
But this is not, as I see it, the major problem. 

Mr. Wiggins. The point was made by Dr. Eddy that the medical 
profession would require a period of orientation and education. How 
long do you suppose would be appropriate for that purpose? 

Dr. Brill. If I might add to that question, it might be well to allow 
organized medicine to come in and make its comments. 

Mr. Wiggins. They will be invited to do so. 

(See Exhibit 1.) 

Dr. Brill. Yes. 

Chairman Pepper. Yes. 

Dr. Brill. I hesitate to speak for organized medicine, but it cer- 
tainly couldn't be done in less than several years to the satisfaction of 
most people. 

Mr. Wiggins. That is all the questions I have. 

Chairman Pepper. Mr. Steiger? 

Mr. Steiger. Thank you, Mr. Chairman. 

Doctor, the summation of your testimony and that of Dr. Eddy and 
Dr. Seevers is that there is no medical reason for retaining the natural 
analgesic, whatever the medical term is. Now, Doctor, as a layman, it 
occurs to me that we have had painted here this morning a rather un- 
flattering picture of the medical profession, because we say we arrive 
on a conclusion based on a question posed in 1951, the conclusion being 
that in a physical emergency in which opium was not available the 
medical profession could readily adjust. Now, we understand, and 
rather thoroughly, from the testimony that it would be, one, inconven- 
ient and it would be what is termed justifiable for natural resistance 
to any change, it would be difficult to stop cough. 

Now, I think, it seems to me unfair to the medical profession — I 
wouldn't want to just leave it lying there — that the inconvenience, the 
comfortable familiarity with the existing natural opiates, all of these 
things of themselves are so important that the evils that the opiate 
now represents are going to be somehow set aside. It would be easy for 
those of us in the political arena — and I am sure some of us will — to 
call this an emergency situation. We truly have an emergency. There 
are many areas in which the emergency is very genuine. The chairman, 
I think, defined it pretty well at the outset. 

I would hope that possibly — obviously the most comfortable thing 
for us, and we are interested in our comfort, too — would be for the 
medical profession to come forth and say now is the time and for the 
medical profession to declare this an emergency and for the medical 
profession to say these synthetics work, they will use them, those who 
have coughs will perhaps have to cough a little. 

I don't honestl}'^ know what the clinical situation is. But I know 
that, again, just having heard this and having considered myself a 
friend of medicine, I think we are painting medicine accurately, per- 
haps, but unfairly nevertheless. 



56^. 

I wonder would you care to comment, and I suspect it is rather un- 
fair, but on the likelihood of the medical profession feeling the need 
to come forward and say let's do this thing. 

Dr. Brill. I think that the real issue is the feeling of the public. The 
medical pi-ofession can only represent the patient in this area, because 
the doctor deals with a patient, and the indications for the use of 
codeine, for example, are not indications of life and death. They are 
relatively minor indications. 

But I think all any technical person can do is to venture an opinion 
as to whether a drug can be fully substituted to the satisfaction of the 
patient or whether the substitution will not be equally satisfactoiy to 
the patient. I think it would be misleading, from my point of view, if 
I were to say that in my opinion drugs wdiich would replace codeine 
would be just as satisfactory to the patient as codeine now is, particu- 
larly keeping in mind that much of the codeine is over the counter 
where the physician doesn't enter into it at all. 

But the bar is not an absolute bar. It is a question of cost-benefit 
ratios, and T am not in a position to judge the benefits. I think these 
benefits have to do with traffic and so on, which I don't know anything 
about. 

Mr. Steiger. I understand. All right. 

Medically, Doctor, on a scale of 1 to 10, how effective — and putting 
codeine at 10 — how effective are the known codeine substitutes for 
cough suppressants on this scale of 1 to 10, and would that be sufficient 
to make the abolishment of opium and Avhatever benefits would derive 
on a national basis? Really, I guess that is what we are faced with. 
Obviously we don't want to impose a genuine hardship on the public. 
By the same token I have great faith in the medical profession being 
able to convince the public that what we are prescribing for them is 
good for them, even though that may not always be the case. 

On that 1 to 10 ratio, what would you say ? 

Dr. Brill. Well, as a rough guess I would say two or three. 

Mr. Steiger. So in your opinion that is where the gap lies, then ? 

Dr. Brill. There is a possible difference, and there also is a possible 
difference between the usefulness of codeine as an analgesic in many 
cases and the usefulness of the competing analgesics. I think it is 
less clear cut. These are matters of judgment and opinion and not 
easily measured. But I think there is that difference. 

But I must again say that much of this codeine, I don't know what 
proportion — you easily can find out — much of the codeine used has 
no medical intervention at all. This is a matter of public habit. 

Mr. Steiger. I must say is not used medically ? 

Dr. Brill. There is abuse of the cough mixtures. That is true. There 
also is abuse of synthetic cough mixtures. So that is an even tossup. 

Mr. Steiger. I thank you. 

Chairman Pepper. ^Ir. Blommer, any questions? 

Mr. Blommer. No, Mr. Chairman. 

Chairman Pepper. Mr. Winn? 

Mr. WixN. None, Mr. Chairman. 

Chairman Pepper. INIr. Keating? 

Mr. Keating. None, Mr. Chairman. 



57 

Chairman Pepper. Dr. Brill, I think you have given us extremely 
valuable testimony this morning. You know, sometimes we can be 
pushed a little bit to get to the conclusions that we want to reach. 

I very much sympathize with what was suggested by Mr. Steiger. 

Is codeine used largely in the suppression of cough? 

Dr. Brill. Suppression of cough and for the control of minor pains 
and minor discomforts. It is an analgesic. 

Chairman Pepper. Yv e hope to iiear later from the medical associa- 
tion and the whole medical profession on this subject. We w^ould cer- 
tainly hope that they would take the lead in trying to move as rapidly 
as possible, because Congress is faced with such a terrible problem in 
heroin addiction. I believe we all agree that it is growing worse; 
isn't it i (See Exhibit No. 1 for AMA views.) 

Dr. Brill. Yes, sir ; it is. 

Chairman Pepper, ilie problem is so serious, and it seems impossible 
to stop it by law enforcement, which catches only 20 percent of the 
heroin being smuggled into this country. That method seems so im- 
probable of success that we have to turn to alternatives to see what 
else we can do. 

Dr. Brill. I agree. 

Chairman Pepper. That is the reason we are trying to get teclmical 
information, scientific knowledge that would guide the Congress in 
seeing whether or not we may safely and properly move in this direc- 
tion of stopping importation of opium. If we could stop the legal 
growing of the opium poppy it would be easier to police a ban. We 
could catch it, then. 

Dr. Brill. Thank you. 

Chairman Pepper. Mr. Perito has one more question? 

Mr. Perito. Dr. Brill, have you had an opportunity, in your pro- 
fessional practice, to treat and evaluate addicts who have been given 
antagonists ? 

Dr. Brill. Yes. 

Mr. Perito. What is your professional opinion about the possibili- 
ties of developing antagonists to the point w^here they will become an 
effective weapon o^ the clinician in the treatment of drug-dependent 
persons ? 

Dr. Brill. I think it is a very good possibility and a very excellent 
lead to follow. I wouldn't want to leave the impression that this is a 
panacea, but the antagonists certainly are one of the best leads that 
I know of. 

Chairman Pepper. Are more funds necessary, in your opinion, to 
carry on the developmental work in the finding of these solutions for 
opium derivatives and finding antagonistic drugs to heroin addiction ? 

Dr. Brill, Yes, sir; to my personal knowledge many of the most 
important research activities in the country today in this field are 
feeling the pressure of shortage of funds, and I think that this is 
something that I have to call to your attention. 

Chairman Pepper. The Federal Government might well interest 
itself in providing more funds ? 

Dr. Brill. I think so. 

Chairman Pepper. Anything else ? 

Mr. Perito. Mr. Chairman, may we have incorporated in the record 
Dr. Brill's prepared statement; also, Dr. Brill's curriculum vitae. 

60-296 O — 71— pt. 1 5 



58 

Chairman Pepper. Without objection, they will be admitted. 
Thank you very much Doctor, for coming today. 
(The material referred to follows :) 

[Exhibit No. 5(a)] 

Prepared Statement of Dr. Henry Brill, Director of Pilgram State 

Hospital, New York, N.Y. 

On the feasibility of replacing natural opium products with totally 
synthetic substances in medical practice. 
Mr. Chairman and Members of the Committee: I am Dr. Henry Brill of 
Brentwood, N.Y., and a member of the committee on alcoholism and drug de- 
pendence of the American Medical Association and the Committee on Problems 
of Drug Dependence of the National Research Council. I am also immediate past 
chairman of both committees and a member of the World Health Organization 
Expert Committee on Drug Dependence. However, my statement here today is 
made in a purely personal capacity and I am not here as a representative of any 
group or organization. 

I believe you already have testimony to the effect that as long ago as 19ol, the 
Committee on Drug Addiction and Narcotics (now the Committee on Problems 
of Drug Dependence), National Academy of Science-National Research Council 
was questioned about the possibility of completely replacing natural opium 
products with synthetic substances in the practice of medicine. The answer at 
that time was a qualified affirmative and, as you know, the answer today has 
become an unqualified aflSrmative. With this I fully concur and agree that from 
the scientific and pharmacological point of view, such a substitution is entirely 
practicable. 

The question now before your group is different from that which was posed 
in 1951. That question related to a state of national emergency in which it was 
assumed that stocks of opium were exhausted and irreplenishable. Today this 
Nation is, I believe, in a secure position with respect to such an emergency and 
this improvement is to a significant degree the direct result of a major coordi- 
nated research effort in which the National Academy of Medicine-National Re- 
search Council Committee played a prominent role under the leadership of Dr. 
Nathan Eddy who was its chairman for most of that time. 

You are now interested in the situation with respect to a complete substitu- 
tion in a nonemergency situation and this entails consideration of an important 
factor in addition to those considered in response to your first question and I 
refer to the established patterns of medical and pharmacological practice. 

From all personal exi^erience, I am led to believe that the synthetics are play- 
ing a large and growing role but yet it appears that the natural opium products 
and their derivatives are still extensively used in spite of the availability of 
heavily advertised synthetic replacements. The U.N. publication "Statistics on 
Narcotic Drugs for 1969," table 5, indicates that the amount of morphine con- 
verted into codeine actually rose worldwide from 112,350 kilograms in 1965 to 
146,084 kilograms in 1969 and the corresponding U.S. figures rose from 20,089 
to 23,084 kilograms. The increases were irregular but the figures seem to show 
that the natural products continue to play a very large role in world medicine 
and in the United States and that the U.S. share is significant but by no means 
decisive in the overall figures. 

It would thus seem that any plan to influence the drug dependence field by 
terminating the use of natural products would call for reorientation of this 
aspect of medical practice within the United States and in other countries as 
well. The issue which would have to be considered includes the relative costs 
of the natural and synthetic products and the relative familiarity of public and 
the health professions with the many characteristics of each of the various 
drugs because in practice few drugs are entirely or e.'^sentially identical. They 
tend to vary among themselves as to speed and duration of their primary action 
and the relative intensity and timing of their many other properties. From all 
available information, it would seem that a replacement is technically feasible 
but it would also appear that this would call for full consultation with organized 
medicine and pharmacy. In order to be fully acceptable, such a transition 
would require further research to explore the many pharmacological character- 
istics of the substitute drugs in the multiplicity of clinical situations and the 



59 

many conditions undef which the drugs are used and this would call for ex- 
tensive laboratory studies and clinical investigations. 

I appreciate the opportunity to appear before this body and realize that there 
is room for much difference of opinion on all these matters but have ;;ought 
to identify the problems which would seem to require solution in connection 
with the proposal which is before you. Under emergency conditions the synthetic 
drugs which we now have would fully replace the natural products in control 
of pain and for other indications but under nonemergency conditions it would 
seem that the immediate reorientation of medical and pharmaceutical procedures, 
on the scale implied in the U.N. figures, would require a major effort although 
there are strong indications that the long-term trend lies in this direction. 

[Exhibit No. 5(b)] 

Curriculum Vitae of Dr. Henry Brill, Director, Pilgrim State 

(N.Y.) Hospital 

1906 Born Bridgeport, Conn. 

1928 Graduate Yale College. 

1932 Graduate Yale Medical School. 

1932-34 Medical intern Pilgrim State Hospital (recognized as basis 

for Nat. Board Part III). 

1934 Licensed New York State (28727) . 

1938 Diplomateof National Board (by exam) (6160). 

1938 Qualified psychiatrist, New York State. 

1940 Diplomate of American Board of Neurology and Psychiatry. 

1951 Fellow American Psychiatric Association. 

1957 Certified Mental Hospital Administrator (412) . 

1934-50 Resident, Senior Psychiatrist, Clinical Director and Associate 

Director, Pilgrim State Hospital. 

1950-52 Director, Craig Colony and Hospital (epilepsy) . 

1952-59 Assistant Commissioner for Reserach and Medical Services, 

Department of Mental Hygiene, New York. 

1958-64 (Director, Pilgrim State Hospital — on leave). 

1959-64 Deputy and First Deputy Commissioner, N.Y. State Depart- 

ment of Mental Hygiene (Special reference to Research 
Training and Medical Services). 

1964-66 Director Pilgrim State Hospital. 

1966-68 Vice Chairman NY State Narcotic Addiction Control Com- 

mission (Director — on leave — P.S.H.). 

1968 to date Director Pilgrim State Hospital. 

teaching 

1955-64 Associate Clinical Professor and Clinical Professor — Psychia- 

try — Albany Medical College. 
1958-64 Professional lecturer — Upstate Medical Center, Syracuse. 

1958 to date Lecturer — Psychiatry — College of Physicians and Surgeons, 

Columbia University. 

1959 to date Clinical Professor of Psychiatry, New York School of Psy- 

chiatry. 



1964-68 



ORGANIZATIONAL 

Past President of American College of Neuropsychophar- 

macology and of Eastern Psychiatric Research Association. 
Currently President-Elect American Psychopathological 

Association. 
Elected to Council of American Psychiatric Association; 

Council Representative to Committee on Mental Hospital 

Standards and Practices. 



EDITORIAL BOARD 



1948 to date Psychiatry Quarterly. 

1968 to date International Journal of Addictions. 

1969 to date Psychopharmacologia. 
1971 to date Comprehensive Psychiatry. 



60 



1958-68 

1959-«4 

1969 

1962-64 

1962 



1969 
1965 

1970 

1971 



COMMITTEES 

Member and Chairman of Advisory Committee Clinical Psy- 
chopharmocolgy NIMH. 

Member and Chairman A.P.A. Committee on Nomenclature 
and Statistics (DSM II). 

Chairman of American Psychiatric Association Task Force 
on Nomenclature and Statistics. 

Member of Subcommittee on Classification to U.S. Surgeon 
General. 

Consultant to World Health Organization — Statistics and No- 
menclature (Psychiatry). 

Member and past chairman of A.M.A, Committee on Drug De- 
pendence and Alcoholism. 

Member and past chairman of National Research Council — 
Committee on Drug Dependence. 

Member W.H.O. Expert Committee on Drug Dependence. 

Chairman — Methadone Maintenance Evaluation Advisory 
Committee Columbia School of Public Health. 

Member of NY State Regents Committee on Continuing Edu- 
cation 

Member of Presidential Commission on Marihuana and Drug 
Dependence 

On various Advisory Committees — Department of Justice, 
FDA, and NIMH. 



1970 
1970 



PUBLICATIONS AND HONORS 

Author of over 100 papers in the field of Psychiatry, Admin- 
istration, Somatic Therapy and Drug Dependence. 
Member of Sigma XI and Phi Beta Kappa. 
Recipient Hutchings Award. 
Listed in current "Who's Who in America." 



Chairman Pepper. Secretary Rossides, please. 

The committee is pleased to call now the Honorable Eugene T. Ros- 
sides, Assistant Secretary of the Treasury for Enforcement and 
Operations. 

Mr. Rossides serves as the principal law enforcement policy advisor 
to the Secretary of the Treasury. His responsibilities include provid- 
ing policy guidance for all Treasury law enforcement activities, as 
well as direct supervision of the Bureau of Customs, the U.S. Secret 
Service, the Bureau of the Mint, the Bureau of Engraving and Print- 
ing, the Consolidated Federal Law Enforcement Training Center, the 
Office of Operations, the Office of Tariff and Trade Affairs, and the 
Office of Law Enforcement. 

Mr. Rossides also serves as U.S. Representative to Interpol, the in- 
ternational criminal police organization, and was elected one of three 
vice presidents of Interpol in October 1969. 

From 1958 to 1961, he served as Assistant to Treasury I'nder Secre- 
tary Fred C. Scribner, Jr. Early in his law career, Mr. Rossides served 
as a criminal law investigator in the rackets bureau on the staff of Xew 
York County District Attorney Frank S. Hogan. For 2 years, he was 
an assistant attorney general for the State of XeAv York, assigned to 
the bureau of securities to investigate and prosecute stock frauds. A 
former legal officer for the Air Materiel Command, Mr. Rossides holds 
the reserve rank of Air Force captain. 

A native of New York, Mr. Rossides received his A.B. degree from 
Columbia College and his law degree from Columbia Law School. 



61 

Mr. Rossides is a vice president of the New York Metropolitan 
Chapter of the National Football Foundation and Hall of Fame and 
a director of the Touchdown Club of New York. 

Mr. Rossides, it is indeed a pleasure to have you with us today. Al- 
though your responsibilities are widespread, I understand that you 
are going to limit your testimony today to the role of the Bureau of 
Customs in controlling the illicit flow of heroin into the United States 
and your support for this committee's proposal for an international 
ban on opium cultivation. 

Mr. Perito, will you inquire ? 

Mr. Perito. Secretary Rossides, I understand you have a prepared 
statement ? 

STATEMENT OF EUGENE T. KOSSIDES, ASSISTANT SECRETARY OF 
THE TREASURY, ENFORCEMENT AND OPERATIONS 

Mr. Rossides. Yes ; I do. 

Mr. Perito. Would you care to present that to the committee ? 

Mr. Rossides. Mr. Chairman, members of the committee, it is a great 
pleasure to appear again before this committee. 

I think this committee has done some of the most significant work 
that has been done in Congress in this area of narcotics — in the total 
area of the narcotics problem. 

I am pleased to be here today. I will summarize my statement and 
read the key paragraph regarding the committee's inquiry. 

Mr. Chairman and members of the committee, I am pleased to be 
here at the request of the committee to give my views on a narrow but 
significant question ; namely, what would be the enforcement effect if 
there were an adequate supply of synthetic substitutes for opium and 
substances derived from opium. Put another way, would it be helpful 
in preventing the illegal growth and diversion of opium and the prod- 
ucts of heroin and its smuggling into the United States. As back- 
ground, let me say that there are at least five critical points in the ille- 
gal narcotics traffic: 

( 1 ) The growth of opium poppies ; 

(2) Illegal diversion of opium; 

(3) Illegal production of morphine and heroin ; 

(4) Smuggling into the United States ; and 

(5) Distribution within the United States. 

I have testified before this committee regarding the President's six- 
point action program. I think the President has by his personal inter- 
vention and initiatives elevated the drug problem to a foreign policy 
level. His White House conferences and other efforts devoted to this 
problem have alerted not just the international community but the 
national community as well. His efforts have stimulated debate, re- 
search, education, and enforcement and have recognized the role of the 
States and the role of the private community in dealing with the nar- 
cotics problem. The private community under discussion here today, 
and the medical profession particularly, have an enormous role to play 
in this whole problem. 

This doesn't mean more should not be done. But I do feel, and it is 
my own personal judgment, that the President's action program has 
alerted the international community to the global problem of drug 



62 

abuse and has brought about the action needed to combat it; and on 
the national scene, has arrested our incredible downward slide into 
drug abuse. 

As I have testified before, however, let there be no false optimism. 
This simply means we have stopped the downward trend, turned it 
around, and have a long way to go to come back to the level at which 
we would like to be. 

I am confident we Avill meet that challenge, because it has become a 
national bipartisan effort. The Congress has an essential role as does 
the executive in this entire area. The private community has a role. 
The States have the central role in law enforcement, in the distribu- 
tion of needed information, in education, and indeed they might do 
more in research. 

With this background, Mr. Chairman and members of the commit- 
tee, I would answer the committee's inquiry by stating that in enforce- 
ment terms the ban on opium production as a legal item would be a 
definite plus. When there is no legal growth of poppies permitted, the 
enforcement officials will clearly have a much easier time in locating 
illegal acreage. 

Secondly, when there is no legal acreage, the grower does not have 
a legal supply of opium from which to withhold and divert to the 
illegal market. It is as simple as that, Mr. Chairman. 
It would be a definite plus, a definite step forward. 
Thank you. 

Chairman Pepper. Mr. Perito, will you inquire ? 
Mr. Perito. Secretary Rossides, in 1969 the General Assembly of 
Interpol took a position in reference to this. What was your position 
at that time representing the U.S. Government ? 

i\Ir. Rossides. We were for a complete ban on legal production of 
opium worldwide. 

Mr. Perito. Is that still the position of the U.S. Government ? 
Mr. Rossides. Let me qualify that to this extent : Yes ; from the en- 
forcement point of view we were stating that obviously and clearly it 
would be of substantial help to the enforcement community — the var- 
ious police forces, the various customs forces throughout the world — 
if no legal production of opium poppy was allowed. That is still the 
position of the Government. 

That is not to say, though, that there may not be other factors in- 
volved in the timing and phasing of this proposal. This is the push 
that we would want. There would be no reason not to still have that 
position. 

Mr. Perito. There seems to me to be some reluctance expressed inso- 
far as the codeine aspect of the ban was concerned. Do you have at 
your disposal any more additional facts medically which would dis- 
abuse some of the people who felt that we could not move on it insofar 
as the synthetics for codeine were concerned ? 

Mr. Rossides. Well, it would be the testimony— and this has to be 
up to the medical profession— it Avould be the testimony that this 
committee has heard today. I want to be very clear in the fact that as 
a lawyer and as a person with responsibilities of enforcement at the 
Department of the Treasury, and within the administration's enforce- 
ment community, we do not try to intrude \ipon the medical judg- 
ment. I recall, while working on the task force of Operation Inter- 



63 

cept, thereafter called Operation Cooperation, we pinned down 
the doctors and said all right, what is the harm? Obviously, harm 
you compare with the harm regarding heroin, because an estimated 
15 percent of heroin is grown illegally and produced— from the 
poppies — in Mexico and converted to morphine and heroin and smug- 
gled in. But the other operation of Intercept was regarding mari- 
huana. 

What is the medical testimony? The medical evidence? We cross- 
examined them and pushed them as this committee is pushing, and 
rightly so, and they came back with the comment that there is no 
known good for marihuana, it can lead to serious mental health prob- 
lems, and taken in conjunction with other drugs it can have a more 
serious effect. So we had to base it on the medical evidence and went 
accordingly. Research since then has tended to confirm the problem 
of marihuana. 

Getting back to the specific point, that has to be up to the doctors, 
but I concur, in listening to the testimony and the chairman's ques- 
tions and Mr. Steiger's questions,; that the medical profession has 
clearly ^ot to move ahead and rapidly. There is no simple answer to 
the heroin problem. It requires a multidimensional approach. 

I think the President has recognized this from the outset. This 
committee has, and it is moving ahead on many fronts in education 
and enforcement, for example. If I had a dollar to spend— well, I 
would have spent, before these recent hearings, 90 percent on educa- 
tion, maybe a little less on education, a little more on research, but 
enforcement is just one of the elements in the effort. 

I am convinced that the youth have acquired great concern about 
heroin and some of the other dangerous drugs. They are not nearly 
as convinced about marihuana yet, but every little bit helps and 
every little bit of pressure helps, and particularly from the Congress. 

Chairman Pepper. Mr. Secretarv, you heard the testimony of Dr. 
Eddy, and I believe Dr. Brill. Both said that heroin addiction in this 
country is growing. We have had testimony from the Bureau of 
Customs and the Bureau of Narcotics and Dangerous Drugs that with 
all of the splendid efforts they are putting forth and the millions of 
dollars of money that Congress has made available to you, the 
hundreds of new agents that you have been able to put on the job, yet 
the problem is so colossal that you are able to seize only about 20 
percent of the heroin coming into this country. 

Now, here at home we have thousands of dedicated law enforce- 
ment officers trying to stop the distribution of heroin in this country. 
There is no foreseeable date, it seems to me, when by law enforcement 
alone we are going to be able to stop heroin from getting into the 
hands and the veins of the addicts of this country. 

Do you generally agree to that ? 

Mr. RossmES. The last statement I agree to — the last part of your 
statement, Mr. Chairman — that law enforcement alone cannot do the 
job. That is an absolute principle as far as I am concerned. I cannot 
agree with certain of the other comments regarding statistics. No one 
fully knows. Statistics in this crime area are not quite that reliable 
because we don't have a scientific way of gathering them. 

The heroin area and crime is one of the most unusual, because you 
do not have a victim in the criminal sense as you do when there is a 



64 

bank robbery or an assault. You do not have the heroin addict coming 
forward and complaining. He is trying to find where he can get 
some more heroin. 

I do feel the total effort which has been made in the last 2 years 
has stemmed the tide. You can feel it when you are talking to some 
of the college students and others. That doesn't mean we are still not 
in a crisis situation. 

Chairman Pepper. You mean, sir; we are not in a crisis situation 
with respect to heroin use in this country ? 

Mr. RossiDEs. I said that we are. We have done an enormous amount, 
in my judgment, in the combined Federal and State establishment in 
the last 2 years, and we have arrested a downward slide, in my own 
personal judgment. I get this from many different people — from en- 
forcement people, from students, and others. 

But that doesn't mean we are not still in a crisis. We are; obviously 
we are. But it took 10 years to get to this stage and the trip back may 
take a long time. 

Chairman Pepper. What we are trying to do is supplement the 
splendid effort you law enforcement people are making by seeing if 
it wouldn't be possible to stop the growing of opium. But you have 
to stop the legitimate demand. In order to do that you have to have 
effective substitutes, 

Mr. RossiDES. From the enforcement point of view, this is essential. 

Chairman Pepper. That is why I feel, and I hope this belief is 
shared by the committee, that more money spent in research to find 
these synthetic substitutes, and more money spent in trying to find 
antagonistic drugs so that the pusher's market would be diminished, 
would help law enforcement in the country. 

Mr. RossiDES. No question whatsoever, Mr. Chairman. 

I used to stress that out of the dollar I would want most of it going 
for education. I have changed in the last year to now add the need 
for research. I do want to point out the President has substantially 
increased funds for research and education. But that doesn't mean more 
may not be needed. That is up to the Congress and the executive to 
work out. 

Chairman Pepper. Mr. Blommer ? 

Mr. Blommer. No ouestions, Mr. Chairman. 

Chairman Pepper. Mr. Mann ? 

Mr. Mann. Recognizing that the abolition of legal growing of the 
opium poppy would necessarily be pursuant to an international agree- 
ment, almost worldwide, what good would it do for the United States, 
through the Congress, to take unilateral action to abolish the importa- 
tion of opium ? What good would it then do you in trying to negotiate 
an international agreement with other countries? 

Mr. RossiDES. I would say, without commenting fully on the pre- 
mise — because it can be done unilaterally by each country 

Mr. Mann. Yes. 

Mr. RossiDES. (continuing). The will of the Congress spoken after 
hearings, after testimony, after review and analysis — that this is the 
judgement of the Congress of the United States, would have, in my 
judgment, a very salutary effect throughout the world, throughout the 
nations that are members of the TTnited Nations, and it would be a 
plus. 



65 

Mr. Manist. But without other sanctions we have merely cut off our 
trading point as far as the control of the market is concerned if you 
say, "Well, we don't need your poppy any more." Why should this 
cause them to stop growing it ? 

Mr. RossiDES. When you say sanctions, you are talking about nego- 
tiation and added factors are involved ; this is another step in the ne- 
gotiation process. I think, for the first time, the United Nations has 
been galvanized to do something following the President's speech last 
October, and our own contribution of $1 million out of a $2 million 
pledge. I think other nations are coming forward. A conference on 
the revisions of the 1961 Single Convention on the Control of Drugs 
is planned, hopefully, for early next year with proposals for construc- 
tive amendments bemg considered. 

Now, all of this is helpful. I happen to feel that the publicity value 
of public opinion, hearings, and of statements and of positions are 
helpful. It is no panacea, but it is a step and it is a helpful step. 

Mr. Mann. Thank you 

No further questions. 

Chairman Pepper. Mr. Wiggins ? 

Mr. Wiggins. Yes, sir ; I would like to continue with the questions 
started by my colleague, Mr. Mann. 

The United States constitutes a major portion of the world demand 
for the lawful manufacture of morphine, and accordingly, if we were 
to stop our importation of it, it would have more than publicity impact 
on those supplying countries ; wouldn't it ? 

Mr. RossiDES. Yes, Mr. Wiggins ; I should have added that. It cer- 
tainly would. The countries that are selling to us would not have the 
market. So that they would then be possibly more inclined to look for 
other crops. 

Mr. Wiggins. We have observed in Turkey, for example, the elimi- 
nation of provinces where the growing of poppy was permitted law- 
fully. I think we are down to about six or seven now, as against a high 
of more than 20 not too long ago. 

Can you comment on the enforcement within the nation of Turkey 
as to the illicit growing of poppy in those provinces where it has been 
discontinued ? 

Mr. RossiDES. Yes. Our reports are that it has been quite successful 
in the provinces where it has been discontinued. It was up to 21 prov- 
inces and is now down to seven. Reports that we receive are that in 
those provinces in which growth has been lawfully discontinued, en- 
forcement has been quite successful. 

The. main growing areas are still in the seven provinces. But at least 
the enforcement effort has been successful in the provinces. 

I might conimend the Turkish Government for these efforts, and 
they are devoting more manpower to this problem, and I might quote 
the new Turkish Government's public comment recently made by the 
Prime Minister, Mr. Erim : 

Our Government believes that opium smuggling, which has become a terrible 
disaster for the youth of the vporld, is hurting above all our humanistic senti- 
ments : therefore due importance will be attached to this problem. Opium pro- 
ducers will be provided with a better way to make a living. 

That is a step forward. Everybody, including the United States, 
has to do more, as this committee is pointing out. 



66 

Mr. Wiggins. Would the stopping of the importation of lawful 
morphine into the United States, in your opinion, tend to stimulate 
the Government of Turkey to accelerate its program of cutting down 
these provinces where the opium poppy is lawfully grown ? 

Mr. RossiDEs. I would have to pass on that. Congressman. I would 
have to check with the State Department and get back to the commit- 
tee. I just don't know. I am not m a position to know. (See exhibit 6.) 

Mr. Wiggins. Well, let us suppose that there is no more lawful opium 
poppy grown in Turkey. What impact would that have on organized 
criminal activities in the United States ? 

Mr. RossiDEs. Well, the impact would be significant, in my judg- 
ment, and they would look to other sources, Southeast Asia, other 
possibilities in the Near and Middle East. But clearly you have made 
a major advance because you have disrupted a known pattern of 
trade, of illegal activity. 

One of the things that we are doing, we are making strenuous 
efforts to analyze, review and do something about the situation in 
Southeast Asia, even though the percentage, we estimate that the per- 
centage of opium coming from there is quite small. There is an enor- 
mous amount grown in Burma and Thailand, and most of it is used 
in the area, but we are trying now for the first time to be ahead of 
the game instead of our just reacting. In fact, the organized criminals 
are not going to stop when they see a profit. We have to have a total 
fight. It has to include enforcement, education, research; every possi- 
ble way. 

As I say, I think we have done a good job. I really do. But more 

["» Q o "t c\ hf* ri on (^ 

Mr. Wiggins. It is generally known that the largest opium pro- 
ducers in the world are India and the Soviet Union with Turkey 
third. It is usually stated, however, that there is minimal diversion 
from India and from the Soviet Union. 

Do you think if we were to ban the lawful importation of morphine 
that we run the risk of development of an illicit market in these two 
areas ? 

Mr. RossiDES. I do not. 

Mr. Wiggins. Well, now let's turn to Mexico. Usually the figure is 
5 to 15 percent, something of that range, is attributed to Mexico as a 
source of heroin. It is not grown lawfully in Mexico at all. Mexico is 
not one of the — what is it, seven — countries that may lawfully grow 
poppies ? 

Mr. RossiDES. Correct. 

Mr. Wiggins. What impact do you think it would have, if any, in 
Mexico ? 

Mr. RossiDES. None — no real impact in Mexico — because it is already 
illegal there as is the growing of hemp. The problem in IVIexico is that 
the growth is in the mountains — very difficult areas to detect — and in- 
accessible areas where it is quite difficult to prevent the growth. The 
Mexican Government, however, has made many strenuous efforts and 
has had some success. But a great deal more needs to be done and is 
being done. 

We have just concluded the fourth or fifth meeting with our col- 
leagues from Mexico, and I commend the efforfs of the Mexican Gov- 
ernment and the public condemnation by the Mexican Government of 



67 

the traffickin<2: in heroin and marihuana. They are doinji: better. Again, 
it is an intei-national problem. We cannot be satisfied. We cannot say 
that anyone is doing adequately, except maybe Japan, which took care 
of the lieroin problem by tlie strictest kind of enforcement, moral and 
cultural, and public effort. Every one of the policemen in Tokyo is a 
narcotics expert, and with their tough customs efforts, Japan has done 
the job. What I am saying is that I don't want to point a finger at any 
one country, because we are all guilty. But no matter how much more 
we are doing, we are not nearly at the point Avhere we can even think 
of seeing the end of the road, and we are just going to have to redouble 
our efforts. 

Mr. WiGGixs. I would like to conclude, Mr. Chairman, with just a 
brief comment. 

I don't think any of us have ever felt that the prohibition against 
the importation of morphine in this country would be in and of itself 
a panacea. But there are many incidental fallout benefits for doing so. 
One of them is the disruption of the organized criminal infrastructure 
involved in the importation of heroin in this country. It took many, 
many years to develop the chain from Turkey into the Port of New 
York. That in and of itself is a substantial achievement. 

Chairman Pepper. If you Avill excuse me just a minute, while you 
are on that subject, there are two things I want to ask the Secretary. 

One is, can you tell us what is the extent of the involvement as you 
have found it of what we call organized crime in the importation of 
heroin into the United States ? How deeply is organized crime involved 
in the importation of heroin ? 

Mr. RossroES. Mr. Chairman, practically every bit of heroin brought 
into the United States is brought into the United States by organized 
crime. The heroin traffic is a highly organized criminal conspiracy. 

Now, what is the definition of organized crime ? That is where peo- 
ple may disagree. My first law enforcement came while working under 
Mr. Hogan, probably the greatest district attorney that the Nation has 
had. He would never allow his assistants to use the word "Mafia," be- 
cause it gave the false impression that the Mafia was the only part of 
organized crime. 

Organized crime is a criminal conspiracy of a continuing nature, I 
would say this, that there have been more members of certain of the 
IVIafia families involved before — probably less now — but the groups 
that are involved now in the heroin traffic are of all ethnic groups, all 
religious groups, and all racial groups. The key groups outside the 
country are the French Corsicans. Certain of the families — the Mafia 
families — are still involved at the importation level. They take their 
cut on getting it in. They do not have, as they do in their other enter- 
prises, the distribution system up and down the line. In gambling, for 
instance, they will take care of someone that is pulled in, provide him 
with counsel and take care of the family. That is not necessarily the 
problem here. 

You have a different distribution system. It is in the ghetto. The 
blacks are profiting from it, the Puerto Ricans, ethnic, Irish, Italian, 
Greek, every group. 

My only point is that organized crime is involved, but we cloud the 
issue when we try to equate organized crime with the Mafia. 

My point is that organized crime is far broader. 



68 

Chairman Pepper. Can you give us an estimate as to the number of 
people who make up that organized crime group responsible for the 
importation of heroin into this country ? 

Mr. EossroES. I would not have that at my fingertips, nor would we 
have a firm figure of the number of persons involved. 

Let me review that with my staff, Mr. Chairman, and try to supply 
the committee with an estimate of the number of persons that you 
are talking about. 

Chairman Pepper. We would appreciate it if you would get us 
that information. 

The reason I ask particularly is because Mr. William Tendy, for- 
merly of the U.S. attorney's office in Xew York, told our committee 
that, as I recall it, 10 to 15 organized crime figures were responsible 
for most of the heroin smuggled into the United States. 

Mr. Rossides. I believe they meant syndicates. I would agree with 
that figure. I would agree you are talking about probably up to 15 
at a maximum of significant criminal conspiracies, of organized crime, 
of all types, natures, and backgrounds. 

Chairman Pepper. One other question. Do you have any estimate or 
could you get us one as to how much all the growers of the opium 
poppy in the world — I mean, growing it in any appreciable quantity — 
are making from that production. 

Mr. Rossides. I don't have it now. I will try and supply it, Mr. 
Chairman. 

(The information requested was not available at time of printing.) 

Chairman Pepper. If we and others working with us were to give 
every opium poppy grower in the world the same amount of income 
that he is now deriving from the growth of the opium poppy, how much 
would it cost the participating nations in such a program ? 

Mr. Rossides. I will try and find out, Mr. Chairman, but I would 
like to go on record as strongly opposed to any concept of preemptive 
buying. It would simply stimulate production and it would take away 
the responsiblity of each nation to handle the problem as part oP the 
international community. I just want to make sure of that. 

Chairman Pepper. I don't think anybody on this committee would 
follow that will-o-the-wisp of wanting to start the United States in 
buying all the opium production in the world. I am not talking about 
that. 

I am talking about if you got them to grow soybeans, wheat, or 
something else, if they had the guarantee of the same income from the 
growing of legitimate products, how much would the financial burden 
be upon the nations including the nation where the growing occurs ? 

Mr. Rossides. I would answer that. I will find out the figure, if it 
is available. There would be no financial burden because what you 
would be doing is substituting a crop. So really you would be making 
an investment, a capital investment for the group. 

Chairman Pepper. Yes. 

(The information requested was not available at time of printing.) 

Chairman Pepper. Mr. Steiger? 

Mr. Steiger? 

Mr. Steiger. I yield to Mr. Wiggins. 

Mr. Wiggins. I have just one more question, Mr. Rossides. There is 
the possibility that if effective synthetics are mandatory in this coun- 
try that they in turn would be widely abused and diverted. Let's sup- 
pose that happens. Has your experience indicated that the organized 



69 

criminal groups within this country have been in the business of di- 
verting amphetamines, for example? 

Mr. RossiDES. Oh, yes. 

Mr. Wiggins. Do we change the nature of the enemy in any way ? 
I would like you to comment on the ease or difficulty of controlling 
diversion from lawful manufacturers in the United States as dis- 
tinguished from lawful producers of natural poppy elsewhere. 

Mr. RossiDES. I would refer the diversion problem to the Bureau of 
Narcotics and Dangerous Drugs, which has the responsibility for pre- 
venting illegal distribution of dangerous drugs. (See testimony of 
John Ingersoll, Director, BNDD, on Jmie 2, 1971.) 

There is no question that there are efforts by organized crime to 
steal the pills, and one of the reasons for the Drug Abuse Act of 1970 
was that before there were not the proper controls on the manufacture 
and distribution in following production down the line so that you had 
a controlled system. It was a simple thing to sell a million pills to a 
post office box number in Tijuana and then smuggle them back into 
the United States. It was really very simple. 

My own feeling is if we are able to be more successful in stopping 
heroin from coming in, organized crime would naturally try to divert 
to dealing in pills. But again it is a manageable problem. It is some- 
thing we are trying to do in the area of cargo theft. It is not that 
difficult to develop a system at the ports of entry. 

Mr. Wiggins. Is it more manageable than the difficulty you are 
experiencing in preventing the importation of heroin ? 

Mr. RossiDES. I haven't looked at it enough. In my judgment it 
would be. But you have got to remember that a lot of pills are pro- 
duced. I hadn't thought of the comparison of the problem, but it is 
not — let me put it a different way. I would rather face the problem 
of increased effort to divert the pills that would come from a sucess- 
ful effort to prevent the heroin being smuggled into the United States, 
I think that is far more manageable and we can move in that area by 
careful controls by the manufacturers themselves in many ways. 

Chairman Pepper. Mr. Steiger ? 

Mr. Steiger. Yes, Mr. Chairman. 

Mr. Secretary, you have been very candid, and I appreciate it. In 
your relations with Interpol and with other enforcement people from 
these other countries, as a cold, practical matter if there were to be — 
somehow we could achieve international agreement that would ban 
the poppy, how rigid do you think the internal enforcement would be, 
say, in Turkey, and I might add that the seven privinces which now 
produce, which Turkey has reduced the legality of the poppy, it is 
my understanding and you indicated the same thing, that still had 
about 90 percent of the existing poppy production. So it really sounds 
good to go from 20 to seven, but we haven't reduced the production 
by 30 percent. 

In those areas of five or 10 poppy producers, as a practical, political 
matter, how tough would their enforcement be ? 

Mr. RossiDES. Well, even on the question — if it were made illegal ? 

Mr. Steiger. Yes ; how tough would the Turkish police be on their 
people ? 

Mr. RossiDES. I think we have to commend the new Turkish Gov- 
ernment for its forthright statement. The first time that a public 
statement has been made, and I do commend them for that. 



70 

The problem then would be the will of the Government of Tur- 
key, and I am convinced that they would be able to handle it. 

Mr, Steiger. Well, of course, you know, we talk about preempted 
buying. One area this country has expertise in is in paying people not 
to grow things. We have a great, long history of that. I am con- 
vinced, as apparently the chairman is, that we could produce a viable 
plan in which we could augment the poppy growers' income to the 
point where he wouldn't have to grow poppies at a fraction 

Mr. KossiDES. Crop substitution is the answer. I don't consider that 
to be preemptive buying. 

Mr. Steiger. But we are dealing with a very real problem as we un- 
derstand it, the guy wants to grow poppies, he has grown poppies 
forever, and his folks before him, and that is something a little tough 
for us to understand. I am asking you how valid is this desire to grow 
poppies on the part of the seven Turkish provinces and how emo- 
tional an issue is it within those provinces. 

Mr. RossiDES. I would pass and let the State Department come up 
with the analysis of the psychology of the Turkish farmer. 

(The analysis referred to above follows :) 

[Exhibit No. 6] 

Department of State. 
Washington, B.C., July 2, 1971. 
Hon. Claude Peppeb, 
Chairman, Select Committee on Crime, 
House of Representatives. 

Dexar Mr. Chairman : I refer to your letter of May 27, requesting informa- 
tion about Turkey and opium. 

As you may know, on June 30 that country's government showed a strong 
sense of international responsibility in taking the diflBcult decision to ban further 
opium cultivation to be effective approximately 1 year from now. Under Turkish 
law farmers must be given 1 year's notice before opium poppy planting can 
be prohibited in areas where cultivation has been permitted. Nonetheless, in 
his statement explaining the opium ban, the Prime Minister has said that he 
wU take every measure to eliminate smuggling and he will undertake a program 
to induce farmers, who are legally permitted to plant in the fall of 1971. to 
voluntarily abstain from planting. Beginning in the fall of 1972 opium poppy 
will be banned throughout Turkey. 

We have also been encouraged by other recent evidence of the Turkish 
Government's intention to prevent Turkish opium from entering illicit channels. 
On June 18, a strict opium licensing and control bill was reported out of com- 
mittee; it was passed by the National Assembly of the Parliament on June 21. 
The bill is now under consideration in the Turkish Senate. We anticipate that 
the legislation will pass before the end of the session, now scheduled for July 30. 

In addition, measures which the Turkish Government has taken to insure 
collection of the total production from this year's harvest will result, we 
believe, in a much improved performance. Among these new measures are : 
training of additional agents ; an increase in the purchase price of the opiiuu 
gum ; provision for advance cash payments to the farmers ; collection of the 
gum at the farm immediately after harvest; and improved coordination of 
tlie elements involved in the collection. Moreover, enforcement efforts arc also 
showing improved results. 

The amount of opiates seized during tlie first 4 montlis of 1971 (equivalent 
to 574 pounds of pure heroin, which would have been worth about $00 million 
in the IJ.S. market) is more than double that seized during the entire year of 
1970. It is also more than the total amount seized by U.S. enforcement agencies 
within the United States and at our borders during these same 4 months. 

With regard to substitute crops, none have been identified tliat can replace 
opmm pQppy in all the provinces where it is grown. Tlie Turkish Ministry of 
Agriculture is conducting research into this problem witli assistance provided 
under an AID loan. However, agricultural research by its very nature is a 



71 

slow prcx?ess. Some possible alternative crops have been identified and further 
investigations are being conducted. The Turkish Agricultural Extension Service 
is working with farmers in those areas where production has been banned teach- 
ing the farmers ways of increasing their yields of such crops as sunflower seeds, 
vetch, various fruits and vegetables and new varieties of wheat. 

Prime Minister Erim recognized that the cost and diflBculties of controlling 
opium cultivation were greater than the economic importance it has for the 
Anatolian farmer, great as that is. His courageous and statemanlike action 
will greatly help to reduce and to disrupt the existing pattern of illicit inter- 
national traflBcking, and it will provide an example for other countries. I en- 
close a translaton of Prime Minister Erim's statement explaining his Govern- 
ment's reasons for terminating opium production and a copy of the Turkish 
Government's decree. 

I hope this information will be helpful. Please do not hesitate to call on us 
when ever you feel we might be of assistance. 
Sincerely yours, 

David M. Abshire, 
Assistant Secretary for 
Congressional Relations. 
(Enclosure 1) 

Statement of Prime Minister Erim. — June 30, 1971 

In recent years the abuse of narcotics in the world has assumed a very seri- 
ous and dangerous condition. This situation has been described by the United 
Nations as almost an "exp'osion." Several times more production is made of 
narcotic drugs than is needed for legitimate and medical needs. For this reason, 
the lives of millions of persons who use narcotics end. In some countries, this 
deadly disaster is spreading rapidly, particularly among youth. It is noted that 
even 12-year-old children are drawn to drugs. Countries which never used drugs 
10 years ago are now its victim. The tragedy has spread even as far as the 
African countries. Furthermore, addiction has begun to threaten all the mem- 
bers of the community. Youth in particular must be protected from this addiction 
as a great duty for the sake of mankind. 

We have seen what a great danger the world is facing. We touched on this in 
the Govenment program which our Parliament passed : "And indicated that 
the problem of opium smuggling, which has become a destructive tragedy for 
all young people in the world, will be seriously undertaken by the Government, 
which believes before all else that this harms sentiments of humane considera- 
tion. Opium growers will be given support by showing them a better field for 
earning their living." 

Indeed. Turkey has not remained a stranger to the development of the prob- 
lem of narcotic drugs, to the international agreements made in this matter since 
the beginning of the 20th century, and to the work of the United Nations. On 
the contrary, she has joined in the agreements and has taken decisions to end 
this disaster. 

Turkey has participated in all the international agreements made on the sub- 
ject of narcotics beginning with the Hague Agreement of 1912 ; those concluded 
agreements in 1925, 1931, 1936, 1946. 1948, 1953 and 1961. 

An important provision of the 1961 Narcotics Single Convention, signed by 78 
nations, is the article which binds the production of opium to the permission 
of the Government. 

Governments coming before us have fulfilled their commitments to interna- 
tional agreements and furnished all types of statistical information to the 
authorized organs of the U.N. However, the need law establishing a licensing sys- 
tem for planting in Turkey, which is the key point of this agreement, for some 
reason was not passed until this year. Our state was continuously asked by inter- 
nationally authorized organs to fulfill this commitment. This shortcoming was 
criticized in the parliaments of many countries and by their public opinion. The 
U.N. Secretary General in the report he presented on this subject in 1970, based 
on these criticisms, said that an extensive amount of smuggling was being made 
from Turkey. 

After this, matters took a rapid turn. In the summer of last year the matter 
was first taken up at the U.N. Economic and Social Committee. The Committee 
on Narcotic Drugs was called to an extraordinary meeting. There, the critical 
situation in the world was taken up and it was decided to start a struggle by 



72 

taking exceptional measures in the three stages of the problem : Production, 
supply and demand, and smuggling. It was stipulated that a fund was to be 
established to assure the financial means for this purpose. The subject was agreed 
upon at the General Council meeting of the U.N. too. 

In a law passed by the Turkish Grand National Assembly in 1966, Turkey 
ratified the international agreement signed in 1961. In this way, international 
commitments became a part of our national law. Accordingly, "In the event 
one of the parties fails to implement the provisions of the agreement and through 
this, the object of the agreement is seriously harmed, the control body will ask 
that the situatiotrbe corrected and can go so far as to set up an embargo against 
this country. 

Smuggling made from our country in recent years has become very distressing 
for us. Governments, whicli were unable to prevent smuggling, decreased the 
number of provinces where poppies were planted from 1960 on and gradually 
moved to the planting of opium from regions close to the border to the center 
of Anatolia. Now planting has been decreased to four provinces. In this way it was 
hoped to prevent smuggling. 

However, imfortunately, this system did not give results. During 1970 many 
things developed in favor of the smugglers. Although the soil products oflSce 
obtained 116 tons of opium from the poppies planted in 11 provinces in 1969, 
in 1970 the opium which reached the oflSce from nine pro\ances was only 60 tons. 

The whole world is asking where the difference is going. The contraband opium 
seized by our security forces, which we learn about in radio and newspaper 
reports, shows everyone the extent of the problem. 

It is certain that a smugglers' gang organized on an international scale, consti- 
tutes a political and economic problem for Turkey. They will not be i^ermitted to 
play around with the prestige of our country any further. 

This horrible network of smugglers fools our villagers either with the wish 
to make extra money or by force and it tries to use them for their own ends. 
Of the tremendous sums which revolve around these transactions, the poor 
hard-working Turkish villager actually does not get much. The smugglers pay 
400 or 500 liras for an illegal kilo of opium to the villagers whom they force to 
break the law. By the time this opium reaches Turkey's borders, the smugglers 
have made a profit many times multiplied. After it leaves our country and 
throughout its route, the value of the drug becomes augmented more and more ; 
in the end it reaches an unbelievable price. International smugglers are earning 
millions from the raw opium produced by the villagers, but the Turkish farmer 
gets only a paltry sum. In countries where health is endangered through this 
opium, because smuggling cannot be prevented in Turkey, anti-Turkish opinions 
are created. 

The Turkish villager also naturally feels bitter against this problem created 
by the smugglers who make millions from the back of our farmers. All I'urkish 
citizens also feel a moral pain that our country is blamed for smuggling which 
is poisoning world youth. 

The measures to be applied to control smuggling are extremely expensive. In 
general, poppies are planted in one corner of the field. For this reason, it is 
necessary to establish an organization which can control an area 10 times that 
of a total poppy farming area of 13,000 donums which may actually be planted. 
Vehicles, gasoline, personnel and their salaries must not be forgotten. Smugglers 
on the other hand, it must be remembered, will resort to any means. Until now, 
foreign assistance was obtained for control purposes; even an airplane was 
obtained for our organization. But, unfortunately, the matter was imiK>ssible to 
control by these means, in spite of all the efforts which were made. Our nation, 
which is known for its honesty and integrity, is now under a grave accusation. 
The time when we must end the placing of blame for deaths in other countries 
on T'nri.-aT- is lori"' ovptIik^. 

We cannot allow Turkey's supreme interests and the prestige of our nation 
to be further shaken. Our government has decided to apply a clear and firm 
solutioii. ii forbids completely the planting of poppies; they have already been 
reduced to four provinces. The agreement ratified in 1966 also stipulates this 
arrangement. 

Poppies will not be planted in Turkey beginning next year. However, we have 
given careful consideration to the fact that the farmers have until now obtained 
a legitimate and additional source of income from the phinting of ix>ppies. For 
this reason, in order that the poppy growers will not incur a loss in any way, the 
necessary formula has been developed. This formula is: in order to make up 



73 

for the income farmers who are planting in provinces at present will lose, they 
will be given compensation beginning from the coming year. This compensation 
will work this way : the basis will be the value on the international market 
of the whole produce, such as opium, seeds, stems, etc., that the planters will sell 
to the soil products office this year. 

Furthermore, in order to replace the income lost by farmers by other means, 
and to provide them other means or earning a living, long-term investments will 
be made in the region. Until these investments give fruit, villagers will continue 
to be given comi>ensation. From among those who would normally plant this 
year, those who voluntarily give up planting in the coming Autumn will be given 
compensation on the same basis. 

I am now addressing my villager citizens, in order that this plan may be 
successful and that it will be possible to establish real values for future year 
compensations and the criteria for investment, please turn over all your produce 
to the Soil Products Office. You will receive the necessary assistance in this 
respect We have also raised our purchasing price. The larger the amount turned 
over to the office by all the poppy producers, the larger the compensation they 
will receive in the coming years without planting. Bes(ide.s, by selling all his 
produce to the TMO, the producer will prove he is not the tool of the smuggler, 
that the Turkish farmer at no time had the object of poisoning the whole world, 
nor that he encouraged this knowingly. Dear Farmer Citizens, you will be the 
ones to save the prestige of our nation. The Government will also henceforth 
give special importance to your problems. Our Government has taken precau- 
tions in order that, in the end. not a siingle farmer family will incur a loss. Your 
income will be met without allowing any room for doubts; at the same time, 
it is planned to establish necessary installations to open new sources of income 
in the region. I ask you to carry out this plan and to .sell all your opium products 
for this year to the Office at the high price established last month, thereby you 
will give this program a good start. 

(Enclosure 2) 

Turkish Opitjm Decree, June 30, 1971 

On the basis of the letter of the Ministry of Agriculture dated June 26, 1971, 
No. 02-16/1-01/342 ; per law 3491 as amended by law 7368, article 18 ; and per 
article 22 of appendix agreement dated December 27, 1966, to law 812, the 
Council of Ministers has decided on June 30, 1971 : Definitely to forbid the 
planting and production of poppies within the borders of Turkey beginning 
from the autimm of 1972. This Will be done by specifying the provinces shown 
on the lists attached hereto. 

1. To forbid poppy planting and opium producing in provinces where warning 
is given as of the autumn of 1972 — Afyon, Burdur, Isparta, Kutahya. 

2. To forbid popipy planting and opium producing in the provinces where a 
warning has been g*iven from the autumn of 1971 — Denizli, Konya, Usak. 

3. To give a suitable compensation as proposed by the Ministry of Agriculture 
and by decision of the Council of Ministers to the planters in these seven prov- 
inces where poppy planting and production have been forbidden. This Will be 
on the basis of the opium they deliver this year to the Soil Products Office and 
on the ba.sis of other poppy byproducts so that the farmers will not incur any 
loss of income. 

4. To grant to the planters in the areas indicated in paragraph 1, who volun- 
tar'ily give up planting in the autumn of 1971, the right to benefit from the 
compensation set forth in paragraph 3. 

C. SUNAY, 

President of the Republic. 

Mr. RossiDES. But I only IPass in a sense. I don't want to duck any 
question, because I keep coming back to what I think was a tremendous 
statement by the new Government of Turkey, which I think they 
should be commended for. The Prime Minister's statement, Mr. Erim's 
statement, to the effect that the contraband trade in opium, which has 
assumed the aspect of ovei- whelming blight for the youth of the whole 
world, is offensive on humanitarian grounds. The Government will 

60-206 O— 71— pt. 1 6 



74 

pay serious attention to this problem. Turkey's opium growers "will 
be shown a way to earn a better living. 

We should commend the Turkish Government for this statement. 
I know what you are saying. The tradition of hundreds of years 
and 

Mr. SteiCxER. My only point in this whole line of questioning. Mr. 
Secretary, and you obviously realize it, but I think it is important that 
we understand it, as I think we do, is that it is obviously a positive 
step, it is obviously appropriate, but we mustn't be deluded into think- 
ing it is any kind of panacea and actually the difficulties that you are 
now experiencing will not be alleviated completely. There will still be 
attempts made by this organized crime organization if they have to go 
somewhere else. It took them a long time to work up their Turkish- 
American lines, but they now know how to do it and there are lots of 
places they can go, as you indicated, and as Mr. Wiggins replied, there 
is a question about Mexico. 

I think it might be worthwhile if you could help the committee in 
finding out what the Japanese customs did, for example, that enabled — 
aside from the educational program they went through as described — 
what actual 

Mr. RossiDES. Correct. I will be happy to submit a statement that 
the committee would hopefully consider whether it wanted to include 
it as part of the record. I was not aware of the enormous success of the 
Japanese until last year. It was a total effort by the Government and 
was effective as a result of their cultural heritage, which provides 
other avenues for relief of tensions. But their national police and their 
customs police did a tremendous job, and they don't have a heroin 
problem. In fact, they get upset when there is a seizure of marihuana, 
as being a very dangerous thine, and thev are concerned about this 
Nation's efforts to ease the penalties in marihuana. 

We have a difficult problem. I think the easing of penalties was good 
on the first offenders. 

Chairman Pepper. Excuse me. You say you have that report? 

Mr. RossroES. I will submit a statement regarding it. 

Chairman Pepper. We will incorporate it with your testimony. 

Mr. RossiDES. I will commend the Washinirton Post on this, because 
it was their article last fall which was practically a full page article. 

( The statement referred to above follows : ) 

Japanese Customs' Successful Curbing of Heroin Traffic 

According to reports in the past few months, Japanese Customs have success- 
fully curbed the importation of heroin into Japan. Much of this success was based 
on tightened surveillance of incoming traffic — especially ships. 

The customs officials were supported in their effort by strict enforcement of 
narcotic laws by police who were well trained in narcotic enforcement, a hard 
hitting press-TV campaign, and the cooperation of the Japanese people. 

Chairman Pepper. Any other questions ? 
Mr. Steiger. No. 
Chairman Pkppfj?. Mr. Winn ? 
Mr. Winn. Thank you, Mr. Chairman. 

Mr. Secretary, two questions. Do you consider the college students 
who bring heroin into the United States a part of organized crime ? 



75 

Mr. RossiDEs. I do not consider it a part of organized crime when a 
college student goes overseas and purchases some heroin, or into Mexico 
and brings it back and sells it to some of his fellow students. The 
amount of this that goes on, in my judgment, is minimal, a very small 
percentage. I don't even know if it is 1 percent. There are far more who 
bring marihuana and hashish into the country, and they are quite 
organized. In the New England area 600 pounds was seized. That 
effort was highly organized and the marihuana and hashish were going 
to be sold to fellow students. 

Mr. Winn. My next question Avas what percentage and I think you 
answered that. That may be 1 percent. 

Mr. RossiDES. Yes ; a very small amount regarding heroin. 

Mr. Winn. Do college students work with organized crime? They 
may not be considered a part of it, but they are working with the 
criminals to make 

Mr. RossiDES. Sometimes, they are used as ducks or couriers. But do 
not assume anyone who is bringing in heroin is an unsophisticated, 
naive college student. I think very few are involved in heroin smug- 
gling. Marihuana and hashish, moreso — and they are making a lot of 
money on their fellow students. 

Mr. Winn. Thank you. 

Chairman Pepper. Mr. Keating ? 

Mr. Keating. No questions. 

Chairman Pepper. Any other questions ? 

Mr. Mann ,• No ; thank you. 

Chairman Pepper. Mi-. Secretary, we thank you very much for your 
valuable contribution this morning. 

We want to keep in touch with you and cooperate Avith you in any 
way we can. 
■ Mr. RossiDES. Thank you, Mr. Chairman. 

Mr. Perito. Mr. Chairman, may the curriculum vitae of Secretary 
Rossides be incorporated in the record. 

Chairman Pepper. Without objection, it is so ordered. 

(The curriculum vitae of Mr. Rossides follows:) 

[Exhibit No. 7] 

Curriculum Vitae of Eugene T. Rossides, Assistant Secretary of the 
Trbiasury for Enforcement and Operations 

As Assistant Secretary of the Treasury for Enforcement and Operations, Mr. 
Rossides' responsibilities include direct supervision of the Bureau of Customs, 
the U.S. Secret Service, the Bureau of the Mint, the Bureau of Engraving and 
Printing, the Consolidated Federal Law Enforcement Training Center the Office 
of Operations, the Office of Tariff and Trade Affairs, and the Office of Law 
Enforcement. 

Mr. Rossides serves as the principal law enforcement policy advisor to the 
Secretary of the Treasury. His responsibilities include providing policy guid- 
ance for all Treasury law^ enforcement activities, including those of the Internal 
Revenue Service. 

Mr. Rossides is responsible for the administration of the antidumping and 
countervailing duty laws. 

Mr^ Rossides serves as U.S. Repre.sentative to Interpol (International Crimi- 
nal Police Organization) and was elected as one of three vice presidents of 
Interpol in October 1969. 

^ ^^,>'- I^ossides, 43, had been a partner in the law firm of Royalls, Koegel, Rogers 
& ^\ells (now Royall, Koegel & Wells) of New York City and Washington, D.C. 



76 

From 1958 to 1961, he served as Assistant to Treasury Under Secretary Fred C. 
Scribner, Jr., before returning to the practice of law in New York City. 

Early in his law career, Mr. Rossides served as a criminal law investigator in 
the rackets bureau on the staff of New York County District Attorney Frank S. 
Hogan. 

For 2 years, Mr. Rossides was an assistant attorney general for the State of 
New York, having been appointed by the then Attorney General Jacob K. Javits, 
who assigned him to the bureau of securities to investigate and prosecute stock 
frauds. 

A former legal officer for the Air Materiel Command, U.S. Air Force, Mr. Ros- 
sides holds the reserve rank of Air Force captain. 

A native of New York, Mr. Rossides graduated from Erasmus Hall High School, 
Brooklyn, and received hi'* A.B. decree from Columbia College in 1949. He re- 
ceived his LL.B. degree from Columbia Law School in 1952. He is a member of 
the Columbia Co lere Coun'^-il, n director of the Co umt>ia College Alumni Associ- 
ation, and a member of the Columbia College Varsity "C" football club. 

A member of the Greek Orthodox Church, he serves on the church's highest rul- 
ing body, the Archdiocesan Council of the Greek Orthodox Church of North and 
South America, both as treasurer and member of the coimcil's policy committee. 

He is a vice president of the New York Metropolitan Chapter of the National 
Football Foundation and Hall of Fame, and a director of the Touchdown Club 
of New York. 

He is a member of the American, Federal, and New York State bar associations, 
and New York State District Attorneys Association, the American Political Sci- 
ence Association, and the Academy of Political Science. 

He is married to the former Aphrouite Macotsin of Washington, D.C. They 
have three children Michael Telemachus. 8; Alexander Demetrius, 6; and Eleni 
Ariadne, 3. Mr. Ros.sides has another daughter. Gale Daphne, by a previous 
marriage. 

Chairman Pepper. I would just like to announce before we break 
up that these are the witnesses for tomorrow: the MITRE Corp. 
representatives: Mr. David Jaffe, department staff; William E. 
Holden, department head, resources planning department; Dr. Walter 
F. Yondorf , associate technical director. 

Then next is Dr. Frances R. Gearing, associate professor, Division of 
Epidemiology, Columbia University School of Public Health and Ad- 
ministrative Medicine. 

Next is Dr. Jerome H. Jaffe, director, Illinois Drug Abuse Program ; 
Wayne Kerstetter, University of Chicago Law School Research Center. 

Next is Dr. Robert L. DuPont, director, Narcotics Treatment Ad- 
ministration for the District of Columbia. 

If there is nothing further, we will recess until 10 o'clock tomorrow 
morning in this room. 

Thank you. 

(Whereupon, at 1 :1T p.m., the committee adjourned, to reconvene 
on Tuesday, April 27, 1971, at 10 a.m.) 



NARCOTICS RESEARCH, REHABILITATION, 
AND TREATMENT 



TUESDAY, APRIL 27, 1971 

House or Representatives, 
Select Committee on Crime, 

Washington^ D.C. 

The committee met, pursuant to notice, at 10 :05 a.m., in room 2359, 
Rayburn House Office Building, Hon. Claude Pepper (chairman) 
presiding. 

Present: Representatives Pepper, Eangel, Mann, Brasco, Waldie, 
Wiggins, Steiger, Winn, and Keating. 

Also pr(;sent : Paul Perito, chief counsel ; and Michael W. Blommer, 
associate chief counsel. 

Chairman Pepper. The committee will come to order, please. We are 
very pleased to see in the audience this morning a large niunber of 
young ladies and gentlemen. We hope you will find something of 
interest in the hearings we are holding today. 

Yesterday, the Crime Committee heard testimony from three 
uniquely qualified and eminently distinguished scientists and medical 
researchers. Doctors Seevers, Eddy, and Brill all agreed that we now 
have sufficient synthetic substitutes for morphine and codeine ca- 
pable of satisfying the painkilling and cough suppressing needs of our 
Nation. 

For those who were not here yesterday, let me say that the Select 
Committee on Crime is trying to find some way to diminish the menace 
of heroin addiction in this country. We have already heard evidence to 
show that in spite of all the efforts of the Federal Government and 
all those agencies cooperating with the Federal Government, we seize 
only about 20 percent of the heroin that is smuggled into this country. 
The other 80 percent comes into this country to be the largest single 
cause of death of young adults in some of our largest cities. 

Last year, in Dade County, Fla., my congressional district, we had 
41 deaths from heroin. We have already had nine this year. The num- 
ber is in the several hundreds in the United States each year. 

So in view of the difficulty of stopping heroin from coming in, we 
are looking at some options, or some alternatives, as it were. If we 
could just stop the worldwide cultivation of the opium poppy alto- 
gether, that would, of course, eliminate that problem. It would make 
it unnecessary to spend so much money trying to intercept the opium 
smuggled into this country in the form of heroin. 

But in order to do that, we have to eliminate a very large legitimate 
need for derivatives of opium, because doctors use morphine and co- 

(77) 



78 

deine in painkilling drugs. So if we cannot eliminate that legitimate 
need for the growing of the opium poppy, it will continue to be grown 
and the farmer, at least according to the pattern of the past, will con- 
tinue to divert a part of his crop into the black market maintained by 
the international organized crime syndicate. 

In order to eliminate the necessity for importing certain derivatives 
of opium for medicinal purposes, we are asking the scientific com- 
munity of our country if there caimot be developed synthetic substi- 
tutes for morphine and codeine so there wouldn't be a legitimate need 
for the growing of the opium poppy anywhere in the world. 

The other aspect of this hearing is to find blockage drugs which 
will prevent the addict taking heroin from experiencing any sensa- 
tion from it. So if you take that blockage drug, you might as well not 
take the heroin, because you don't derive any sense of satisfaction from 
the taking of it. That is the reason we are engaged in this scientific 
inquiry into these areas. 

We have received testimony from Assistant Secretary of the Treas- 
ury Eugene T. Rossides, who told us that the total eradication of opium 
cultivation, accompanied by domestic reliance upon synthetic sub- 
stitutes, would be a definite plus to the law enforcement community 
charged with the responsibility of policing our borders. Mr. Rossides 
further told us that the switch from the natural opiates to the syn- 
thetics might well cause a disruption in the organized criminal con- 
spiracies which are responsible for bringing most of the heroin into 
the United States. 

Today, we will hear testimony from scientific researchers concern- 
ing the possibilities of policing a worldwide opium cultivation ban. 
The first three witnesses, from MITRE Corp., will tell us about the 
possibility of using our satellite capabilities to police an international 
treaty banning opium cultivation. We will also hear testmony about 
the role which the scientific and engineering community can play in 
the international addiction crisis. 

We then will move into the second phase of our hearing. In this 
segment we will attempt to determine whether methadone mainte- 
nance is efficacious in reducing the number of arrests and illegal activ- 
ities of addicts under such treatment. 

It is generally said that it costs between $50 and $75 a day to main- 
tain heroin addiction once a person becomes thoroughly addicted to 
that drug. Well, not many people can afford $50 or $75 a day. Those 
who cannot afford it have to go out and illegally get possession of 
goods, which, when sold to a fence, will yield the amount of money 
they must have to sustain their addiction. 

It is estimated bv Dr. DuPont, who is in charge of the Narcotics 
Treatment Administration here in the District of Columbia, that 
each addict in the District of Columbia gets illegal possession of about 
$50,000 worth of goods a year in order to sustain his addiction. With 
some 16,000 addicts in the District, it is no wonder we have so many 
robbery, burglaries, and muggings on the street. 

Our next witness. Dr. Frances R. Gearing, is eminently qualified to 
give us an analytical and statistical survey of Dr. Vincent Dole's meth- 
adone maintenance program that will help us in determining the ef- 
ficacv of the methadone maintenance approach. 



79 

We then will hear from Dr. Robert L. DuPont, Director of the Nar- 
cotics Treatment Administi-ation, who has compiled some fascinating 
statistical studies on crime reduction and methadone maintenance in 
Washington, 

Our final witness today is Dr. Jerome H. Jaffe, director of the Illi- 
nois Drug Abuse Program. This multimodality treatment program is 
the largest in the Midwest. Currently Dr. Jaffe and his able staff are 
treating 1,590 addicts. Dr. Jaffe will explain his approach to metha- 
done maintenance and the multimodality treatment method. He will 
also share with us his thinking about the possibilities of developing 
longer lasting and effective antagonist drugs. Finally, Dr. Jaffe will 
advise us how we can best accelerate and coordinate scientific research 
into the multiple problems of opiate addiction. 

Our first witnesses this morning are three gentlemen who represent 
what America's advanced technology can contribute to the fight against 
social ills. David Jaffe, William E. Holden, and Dr. Walter F. Yon- 
dorf are employees of the MITRE Corp., a research and development 
think-tank with heavy experience in space and defense. 

These gentlemen are now applying their technology to the possibil- 
ity of detecting the illegal cultivation of opium. 

Mr. Jaffe is a memlier of the department staff of MITRE, and is 
primarily concerned with the application of technology to criminal 
justice systems. 

Before joining MITRE last September, he was deputy head of the 
public safety department of the Research Analysis Corlp., where he de- 
veloped program concepts for research in law enforcement and the 
administration of justice. Studies he directed included the relationship 
between the physical environment and the crime rate, logistic support 
to police and fire departments in combating civil disorders, and the role 
of police in a ghetto community. 

Mr. Jaffe holds a master of science degree in physics and mathemat- 
ics from the University of Connecticut. 

Mr. Holden, a MITRE department head, is an electrical engineer 
with a bachelor of science degree from the Massachusetts Institute of 
Technology, and a former naval aviator. During the last 15 years at 
Lincoln Laiboratory, MIT, and with MITRE, Mr. Holden has been 
responsible for many mission analyses and other planning activities 
in the fields of air defense, command and control at senior military 
levels, foreign satellite identification, airborne command posts, air- 
borne launch facilities, missile test ranges, and Air Force test centers. 
He served as a foreign service officer assigned to the NATO interna- 
tional staff for 2 years to assist in planning NATO-wide air defenses. 

Dr. Yondorf is associate technical director of MITRE Corp's na- 
tional command and control division in McLean, Va. The division 
provides systems engineering and other scientific and technical assist- 
ance to defense agencies, primarily in the areas of communications, 
data processing, and sensor development. Sponsors include the De- 
fense Communications Agency, the Defense Special Projects Group, 
Safeguard Systems Command, Air Force Systems Command and the 
Advance Research Project Agency. Dr. Yondorf's earlier MITRE as- 
signments have included the development and implementation of a 
5-year project to improve and automate JCS strategic mobility plan- 



80 

ning capabilities, responsibility for requirements analysis of the Na- 
tional Military Command System, the study of attack assessment sys- 
tems, and research in crisis management. 

Before joining MITRE in 1962, Dr. Yondorf was a senior staff mem- 
ber at the Laboratories for Applied Sciences, University of Chicago, 
where he was engaged in strategic studies and the political and eco- 
nomic analysis of limited conflict. Earlier, he was an instructor at 
the University of Chicago teaching courses in the committee on com- 
munication. 

As a fellow of the Social Science Research Council, 1959-60, Dr. 
Yondorf undertook a study of the dynamics of political and economic 
integration in the European Common Market. 

Dr. Yondorf was educated in Germany, Switzerland, and the United 
States, and holds M.A. and Ph. D. degrees in political science from the 
University of Chicago. 

Gentlemen, we are pleased to have you with us today. 

Mr. Perito, our chief counsel, will you please inquire of the witness. 

Mr. Perito. Mr. Jaffe, I understand that you have a prepared 
statement ? 

STATEMENT OF DAVID JAFFE, DEPARTMENT STAFF, MITRE CORP. ; 
ACCOMPANIED BY : WILLIAM HOLDEN, DEPARTMENT HEAD; AND 
DR. WALTER YONDORF, ASSOCIATE TECHNICAL DIRECTOR, 
NATIONAL COMMAND AND CONTROL DIVISION 

Mr. Jaffe. Yes ; I do. 

Mr. Perito. Would you care to read that statement for the 
committee ? 

Mr. Jaffe. Yes. 

Mr. Perito. Thank you, please proceed. 

Mr. Jaffe. Thank you very much. I am pleased to contribute to 
the work of this committee at your kind invitation, and am grateful 
for the opportunity to discuss with you the role that the technical 
community should be playing in the control of narcotic and dangerous 
drugs. I will suggest how the application of technology could make 
some significant contribution to the solution of the pressing and criti- 
cal problems of drug abuse and to the control thereof : I will describe 
some typical benefits that may be derived from the adaptation of ad- 
vanced techniques; and I will suggest a program for realizing such 
benefits. 

A little less than a year ago this committee heard a presentation by 
Dr. William F. Ulrich of Beckman Instruments in which he outlined 
the ways in which scientific and engineering capabilities could con- 
tribute to drug control. He touched on the subjects of technology 
transfer and systems analysis, and I would like to expand on those 
topics to show how some specific programs might assist those conduct- 
ing the fight against illicit drug production and distribution. 

Suggestions on how to solve the drug problem differ as to approach. 
There are those who argue for an attack on the sources: Foreign 
growers of opium and local manufacturers of psychotropic substances. 



$1 

There are others who would have us concentrate on interrupting the 
distribution channels. Still others believe the attack should be focused 
on rehabilitating the users. I submit that we need a coordinated effort 
in all these directions. 

To say that the problem is complex is not to argue that solutions are 
impossible, or slow to be realized. My thesis is rather that, if we are 
to achieve effective controls in reasonable time, we must begin by 
accepting the complexity, understanding it fully, and devising rea- 
soned rather than intuitive or emotional responses. 

Techniques which were developed for analysis of highly complex 
systems, if properly understood and managed, can be powerful weap- 
ons in revealing subtle relationships and vulnerabilities. The methods 
of systems analysis and systems engineering are not cure-alls. As 
with any highly structured method, the results cannot be more precise 
than the information used. 

BACKGROUND 

What then are the particular problems which should be addressed 
by the scientific and engineering community ? 

Source Detection 

The sources of opium, the fields of the Middle East, Southern Asia, 
and of Southeast Asia, present an interesting challenge because of the 
combination of difficulties encountered. To begin with there is the 
problem of detecting the presence of small, out-of-the-way, illicit 
crops, primarily an operational and technological problem. Then there 
is the consideration that opium is often the principal or only cash 
crop for the local farmer, an economic problem. In Southeast Asia, 
some tribes have built a nomadic lifestyle based on opium poppy culti- 
vation, a sociological problem. And we hear frequently about the polit- 
ical barriers to opium control. 

The necessity to solve each kind of problem, and all of them on an 
integrated basis, is apparent. The detection of illicit crops is a key 
factor in the entire process because it should provide the detailed 
facts on which can be based the economic, social, and political solu- 
tions. Other parts of an integrated program rely, to some degree, on 
being able to specify the location and extent of illicit opium cultiva- 
tion with precision and confidence. 

Laboratory Detection 

A second major problem area which may be amenable to techno- 
logical attack is the location of the laboratories where the opium and 
morphine bases are transformed into heroin. 

In the past, these laboratories have escaped detection from the air. 
They remain prime targets partly because of their strategic function 
in the heroin supply process, and partly because much raw material 
and important personnel can be captured at these places. 

Tracers 

It would be helpful to law enforcement officers if they could reliably 
trace the movement and chemical transformation of narcotic ma- 



82 

terials. If they could introduce an identifiable tag at the poppyfield 
and intercept some of that material at several points in the distribu- 
tion network, a much clearer description of that network would result. 
The operational possibilities for such tracer materials are numerous. 
The problem is in finding suitable tags which are, among other things, 
reliable and safe. 

Sensors 

Another problem susceptible to technological solution is the detec- 
tion of concealed drugs at short distances. It would be of immeasur- 
able value to be able to reveal the presence of drugs hidden in suit- 
cases, automobiles, packages, on the person, and in many other places. 
Devices are needed which can detect extremely small amounts of opi- 
ates w^ith response times of seconds and reliability in the upper 90 
percentile. The requirements of sensitivity, speed, and reliability tend 
to be mutually exclusive and difficult to achieve. Development of such 
devices requires extensive research and design and some amount of 
tradeoffs in design. 

Data Bank 

The complexity of the international drug enterprise is reflected in 
the great amount of information needed to describe the production, 
distribution, and consumption of the products. The effectiveness of 
drug control is dependent on access to that information. And the ef- 
fectiveness will also be a function of how timely the retrieval is and of 
how complete is the data produced. 

It follows that a comprehensive data bank is required as a reposi- 
tory of worldwide information on all aspects of the drug problem. 
Narcotics agents at all levels should be able to request rapid retrieval 
of information. The high mobility of dealers in drugs and the world- 
wide nature of their operations suggest the need for a similarly ex- 
tensive data bank. 

O'perations Analysis 

Referring again to the intricate nature of the illicit drug business, 
it is often difficult to predict the ultimate consequences of any control 
activity. Squeezing the balloon at one place may simply cause it to 
expand some place else. A comprehensive, systematic, analytic method 
is needed which can help to identify how other parts of the system 
will be affected if one part is changed. 

A corollary problem is the allocation of drug control resources. 
Like managers in all other situations, drug control administrators 
must decide how to assign their personnel, equipment, dollars, and 
management attention so as to realize the most beneficial results. It 
would help these people to have a technique for anticipating the 
effects of their allocation decisions. No such technique will replace a 
good manager, but it can provide him with information he would 
otherwise not have. 

BENEFITS 

Some of the benefits which should be derived from such efforts 
by the scientific and engineering community are : 
Worldwide location of opium crops ; 
Information on potential yield of opium crops ; 



83 

Determination of harvesting time ; 

Selective destruction of crops ; 

Tracing of distribution networks ; 

Sensing of concealed material at ports of entry ; 

Detection of clandestine laboratories ; 

Kapid retrieval of pertinent data ; 

Identification of network sensitivities and vulnerabilities ; 

Assessment of alternative control measures : 

Mechanism for training exercises ; and 

Good resource management. 

I must urge you to keep in mind that these benefits, as I have been 
calling them, are not going to solve the full range of narcotic and 
drug problems. In fact, we cannot be entirely certain that all of these 
benefits, and others which could be added to the list, can be achieved 
in a reasonable time or at acceptable costs. And the changing opera- 
tional requirements may make some of them obsolete before long. 

But for the present, we should not overlook any tool which answers 
a real need, and these benefits can be vital elements to the integrated, 
coordinated attack which, in my opinion, is the only reasonable route 
to effective control. 

PROPOSED PROGRAM 

Before identifying how the scientific and engineering community 
might participate in the control of drugs, I wish to acknowledge that 
there are already in progress some efforts along the lines to be de- 
scribed. The Bureau of Narcotics and Dangerous Drugs and the Bu- 
reau of Customs have active research and development programs which 
address many of the points contained in this statement. In addition 
to their own projects, these Bureaus are being assisted by other Fed- 
eral agencies which have specialized capabilities. I have met with a 
number of people involved in these efforts and can attest to their 
competence and dedication. But the scope of the ongoing efforts, and 
the adequacy of available resources, remain as appropriate questions 
before this committee. I will return to this issue presently. 

Having established some of the benefits which research and develop- 
ment should pi'oduce, let us examine how such a program might be 
structured. We can conveniently view the woi'k that needs to be done 
as a five-part program. 

Surveillance of Opiy/m Poppy Crops 

The remote sensing — that is, from aircraft and satellites — of agri- 
cultural crops dates from the early 1930's when aerial photographs 
were used to locate and measure fields. Since then, observational and 
interpretive techniques have progressed a great deal, although much 
experimentation and development remains to be accomplished. I have 
several photographs to illustrate what can be accomplished with ad- 
vanced techniques. 

Mr. Perito. Mr. Chairman, may the record reflect the lights are noAv 
being turned out and the photographs about to be shown will be made 
available for the committee to incorporate in its record. 

Chairman Pepper. So ordered. 

Mr. Jafte. The first figure is a well-known photo made from Apollo 
9 at 131 nautical miles over Imperial Valley, Calif. It was taken with 



84 




Figure 1 



infrared Ektachrome film with a spectral response between 0.510 and 
0.890 microns. The dark dotted patches are crops. Across the bottom is 
seen a section in which the amount of dotted area, and consequently the 
vigor of the vegetation, is markedly lower. That sharp line of demarka- 
tion is close to the Mexican border. A single color photograph like this 
one contains limited useful information. 

The next figure (fig. 2) shows the same scene in three photos made at 
the same time. The one on the upi^er left was taken with Pan X film 
with a green filter; the upjx^r right on Pan X with a red filter; and the 
lower photo on black and white film "sensitive to infrared radiation. It 
is apparent that each photo produces different relative contrasts and 
enhances the images of some features over others. 

The next photos (fig. 3) demonstrate the different resi^nses that 
similar crops will provide in relatively narrow spectral bands. The left 
photo, made with a blue filter, shows little difference between oats and 



85 




Figure 2 



wheat. But the ones made with red and infrared filters show the dis- 
tinction quite clearly. So, in a simple case at least, we see that it is 
ix)ssible to isolate crops in this way. 

In fact, it is possible to do a lot better than that. The next photos 
(fig. 4) show how two varieties of corn which can hardly be differenti- 
ated at visible wavelengths (on the left) look quite different at infrared 
wavelengths. 

Mr. Perito. May the record reflect the lights being turned back on 
and we are continuing with Mr. Jaffe's statement. 

Chairman Peppek. Without objection, so ordered. 

You may proceed. 

Mr. Jaffe. What I have illustrated here are the mere fundamentals 
of remote sensing of agriculture. These techniques have been advanced 



86 




Figure 3. — Tones of wheat (W) and oats (O) differ when recorded by an airborne 
multilens camera filtered to three spectral regions (0.38 to 0.44 micron, at left ; 
0.62 to 0.68, center; and 0.58 to 0.89, at right). 

[Data Collected by Purdue University Agronomy Farm.] 

to include simultaneous observation in many spectral bands and com- 
puter analysis of the data. 

I am not aware of opium poppies having been observed by these 
methods, but it is reasonable to expect that they would be readily dis- 
cernible; perhaps even by single band, rather than multispectral, sens- 
ing. "VVliat is needed is a set of experiments to establish which ap- 
proach produces the desired information with reference to opium 
poppy cultivation. It should be possible to use either an established 
poppyfield or a specially prepared one and to overfly it with equip- 
ment designed for spectral analysis. The signatures of poppies could 
thus be obtained and examined for uniqueness. Once unique, charac- 
teristic images are obtained from the test bed, the appropriate appa- 
ratus would be used in an operational test to determine what, if any, 
real-life difficulties might be encountered. Further refinement of the 
technique would follow. 

Remote sensing from aircraft is very likely to be successful in locat- 
ing opium fields. Similar observations from satellites, particularly 
from NASA's Earth Resources Technology Satellite (ERTS), are 
somewhat less certain to produce useful results. The multispectral 
sensing devices on the initial ERTS spacecraft will provide resolution 
of objects down to about 300 or 400 feet. The smallest opium fields 
are said to be about i/^ acre or typically about 150 feet in linear di- 
mension. It is possible, but not at all certain, that a distinctive signa- 
ture of that size will be discernible by an instrument with the resolu- 
tion available on ERTS. Needed is experimental determination of the 
poppy signatures and some experience with the real capabilities of the 
ERTS instruments. We must also consider future instruments that 
may provide finer resolution and other favorable characteristics. 

Trace?' Technology 

Tracers, or tag identifiers, can be used to identify captured samples 
as coming from the same sources. It may be possible to introduce trac- 



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88 

ers at the poppyfields or at any point thereafter. For manufactured 
drugs, methods of tracing are not nearly as difficult because of distinc- 
tive characteristics of tablets and capsules. 

Four primary handicaps exist in the use of trace materials ; insert- 
ing the tracers into the drugs and the tagged drugs into the illicit 
traffic ; the tracer must be safe for use internally or intravenously ; the 
tracer must be highly reliable ; and a tracer, to remain a unique identi- 
fier, cannot be reused until the tagged material has been cleared from 
the marketplace — a condition which can require several years. 

The advantages to be derived from being able to correlate the origin 
of captured samples, and therefore being able to correlate the network 
links and nodes, should compensate for the difficulties involved in over- 
coming the handicaps. Captured shipments can be tagged and rein- 
serted in the network ; radioactive tracers may not be totally safe, but 
chemically idenifiable tag materials are possible; the reliability of 
unique identification can be very high; and large numbers of trace 
materials can be found in time. To introduce tracer materials into the 
poppy plant, and consequently into the opium, requires trace materials 
that can survive the processing that transform the opium into heroin. 
Analysis of the morphine alkaloid, the heroin, and the impurities that 
remain after processing could suggest ways of altering the chemical 
composition. Alterations would presumably be distinguishable and 
hence would serve to identify a particular batch of material. 

Trace materials can also be inserted into the distribution network 
at points other than the source. For this purpose, it is necessary to 
have tag materials which replace those used at later stages in the proc- 
ess. For example, it could be possible to use traceable acetic anhydride 
in converting morphine base into heroin (diacetylmorphine). 

It should also be feasible to introduce trace materials still later in 
the network ; as for example, during the cutting phases. Either chem- 
ically distinguishable but similar substances could be used, or inert 
and distinctive things, perhaps plastics, could be added. But all of this 
will take intensive investigation and development before operational 
utility is achieved. 

Sensor Technology 

Sensors for the detection of concealed narcotics and drugs, and for 
the detection of effluents at heroin laboratories, will also require dedi- 
cated research and development. The first task will be to identify 
technioues which can sense very small amounts of drugs or related 
materials. The second task will be the adaptation of those techniqu'°s 
to operationally useful forms. 

More so than for other technological weapons, sensors are highly 
susceptable to countermeasures. It should be fairly easy, once the sens- 
ing technique is recognized, for the narcotic distributors to devise eva- 
sive procedures or devices. The need is therefore for an arsenal of sen- 
sors and a variety of ways for utilizing them in order to keep the other 
side off balance. 

There are a number of analytic technioues which are useful in 
identifying narcotic and dangerous drugs. These methods include gas 
chromatography, infrared spectroscopy, mass spectroscopy. X-ray 
spectroscopy, free radical electron resonance, and a number of chemi- 
cal analyses. But the apparatus which is most attractive for the opera- 



89 




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90 

tional situations has handicaps. These devices require preconcentration 
of the sample material, are too heavy to be portable, or may react too 
slowly for expedient analysis. 

However, mass spectrometers have been made with reduced size and 
weight, and trade-offs are possible in design requirements. The recent 
intensive effort in developing air pollution monitoring equipment has 
resulted in promising devices and technology which might be applied 
to the near real-time detection of gas or particulate contaminants as- 
sociated with the production of controlled drugs. ^lerging the fields 
of qualitative instrumental analysis with particulate detection, the 
possibility arises of highly special and sensitive mechanical sensors. 
Dr. Lou Rabben of the MITRE Corp. suggested a scheme developed 
for another purpose. He proposes to use an infrared spectrometer with 
a sample chamber constructed in such a manner that the infrared beam 
passes through the gas sample many more times than is usually the 
case for this type of analysis. Hopefully, this would result in greatly 
enhanced sensitivity. I must emphasize that the applicability of this 
or other techniques to drug detection is unknown. I merely wish to 
suggest examples of how the application of sensor technology might 
be pursued in the solution of these problems. Similar developments 
may be possible with other techniques. Adaptation of existing tech- 
nology would seem to be a sensible approach to the initial acquisition 
of suitable equipment. 

Data handling 

I spoke isarlier of the need for a comprehensive data bank covering 
all facets of the drug enterprise. A data bank will serve both the re- 
search community in its efforts to analyze the system and find its weak- 
nesses, and the enforcement agencies in their operational activities. I 
doubt the need to elaborate on this item except to mention that a modest 
start has been made in this direction. 

Network modeling 

The established technique of network modeling could be applied to 
describe the entire procedure whereby narcotic and dangerous drugs 
proceed from source to user. Such a model would include : 

(1) Location of illicit poppy fields; (2) growing seasons of illicit 
poppyfields; (3) economic analysis of poppy cultivation ; (4) packag- 
ing and transport of raw opium; (5) ports of exit and entry, plus 
procedures followed to avoid detection; (6) chemical processing: 
(a) plant locations, 
( h ) methods of shipment to and from, 

(c) possible signatures of processing effluents, and 

[d) chemical and supplies used ; where obtained ; 

(7) finished product handling and shipping; (8) distribution 
systems : 

{a) economic analysis, 

(6) organizational structure; and 

(9) covert intelligence ; its cost versus its value. 

At each point of the network, alternative routings, sources or pro- 
cedures should be identified to reveal how the network Avould be dis- 
rupted by elimination or modification of that point. 

The economic as well as physical networks should be simulated and 
these models should be operated to determine alternative control meas- 



91 

ures; to assess likelihoods of success of those control measures; to 
evaluate sensitivities of the systems to variations of the elements; and 
to identify the links and modes which may be most susceptible to at- 
tack. A corollary use of the models should be the training of super- 
visory level personnel in the Federal and local enforcement agencies. 

APPROACH 

A few words on how to proceed with a research and development 
program. 

The various aspects of applicable technology- — surveillance, trac- 
ers, sensors, a data bank, and network modeling — must be structured 
into an integrated and focused research and development program. 
In a systems approach of this kind, the benefits are not only those re- 
sulting from each specialized technique or procedure, but also from 
the coordinated use of all methods available. 

As mentioned earlier, there is some work underway in the areas 
cited, so any program should begin by assessing the scope and direc- 
tion of those efforts, I have made a limited survey which indicated that 
current efforts are minimal. 

In addition to a status survey, an intensive feasibility analysis 
should be undertaken to reveal what may be technologically, eco- 
nomically, and operationally possible both in the short term and the 
far term. This feasibility study would, using a complete systems ap- 
proach, show just which of the areas I have mentioned are most fruit- 
ful to pursue at the present time. The efforts in this area which are 
underway at BNDI) and the Bureau of Customs, and through them by 
other agencies, need to be enlarged and unified by this coordinated 
across-the-board attack on the drug problem. Important consideration 
should be the operational needs — the real-life situations faced by en- 
forcement agents — and potential countermeasures. 

The feasibility analysis should be followed by a detailed research 
and development plan providing for the elements of the program sug- 
gested above and including cost estimates and multiyear projections. 
The plan must be produced from the point of view of an attack on the 
entire drug problem ; from the producers to the chemical processors 
to the street level distributors and users. The drug problem is not 
static; the planning and implementation of its control cannot be static 
either. Every plan must be part of a logical long-term effort, but the 
plan will change as the problem changes. The plan should include 
provision for evaluation of results achieved and for readjustments in 
scope and direction. 

SUMMARY 

I have tried to indicate some of the problems faced by drug con- 
trol agencies, to show what benefits could be derived from increased 
employment of technology, and to indicate an approach to increased 
involvement by the research and development community. 

Programs of the kind suggested are not inexpensive and often re- 
quire more time than one would like. But in the context of the overall 
drug problem and its direct and indirect social and economic drain 
on our society, the costs of an intense research and development pro- 
gram would be small indeed in view of the potential benefits, such 
as — 



92 

Locating illicit opium crops ; 
Detecting illegal material at ports of entry ; 
Developing drug network vulnerability data ; and 
Improving resource management. 

The important aspects are (1) the need for a total systems ap- 
proach; (2) the need for an accelerated research and development 
effort ; and (3) the need to get started now. 

Thank you very much. 

Chairman Pepper. Mr. Jaffe, I want to commend you on your mag- 
nificent and comprehensive statement, that you have given as to how 
this whole problem should be coordinated in an effective and compre- 
hensive program. 

Mr. Perito, do you have any questions ? 

Mr. Perito. Mr. Jaffe, you have had some contact both with the 
Federal Bureau of Narcotics and Dangerous Drugs, and U.S. Customs 
regarding your presentation ; is that correct ? 

Mr. Jafft:. Yes. 

Mr. Pertto. Could you estimate what it would cost the Government 
at this point to put together the type of research and development 
program which you have suggested ? 

Mr. Jaffe. It is very difficult to answer that on a short-term basis. 
On a longer term basis, and comparing it to the existing budgets as 
I have been able to reconstruct them, which is difficult, I would guess 
it runs something on the order of $10 million over a 5-year period; 
something like that. 

Chairman Pepper. Excuse me. 

You mean $10 million for 5 years ? 

Mr. Jaffe. Distributed over a 5-year period. 

Mr. Perito. Mr. Jaffe, do you know how much is now being spent on 
such efforts by the Federal Government ? 

Mr. Jaffe. No ; I do not know precisely. I have some bits and pieces 
of information about what particular subagencies are spending, but 
that is all. 

Mr. Perito. I assume then, based upon your contacts, vou would 
conclude that the Federal Government is spending something mini- 
mal, at best ? 

Mr. Jaffe. Oh. very minimal. 

Mr. Perito. If you were assigned the responsibility of policing an 
international narcotics treaty, wherein all the signatories would agree 
not to Arrow poppies, do vou believe this technological approach could 
be used by the International Narcotics Control Board, for example, 
to police throuflfh satellite surveillance the cultivation of poppies? 

Mr. Jaffe. The use of satellite surveillance may not be available to 
us in the immediate future. But high-flying aircraft, and ultimately 
the use of satellites, will provide that kind of capability. It would sig- 
nificantlv contribute — in fact, it is difficult to imagine how such a 
treaty would be enforceable without such surveillance or something 
equivalent. 

Mr. Perito. At the present time, do you know of any accelerated re- 
search concerning an international data bank? 

Mr. Jaffe. I don't have anv specific knowledge about that; no. 

Mr. Perito. Do you envision that a data bank could be set up so 
that you could have input from several countries and protect the dis- 
closure from those people who should not get disclosure ? 



93 

In other words, can you envision a data bank which would suffi- 
ciently service an organization like Interpol, yet at the same time not 
be available to the individuals who could wrongfully profit by this 
information ? 

Mr. Jaffe. The question of security in data banks has received a lot 
of attention of late, and I would suspect that the probability is it could 
be done as well as it coud be done in any other area. I think that could 
be effected. 

Chairman Pepper. Just one question before the other Congressmen 
inquire. 

Mr. Jaffe, would it be possible to develop any sort of technical 
method by which you could detect the conversion of morphine base 
into heroin as it takes place in the laboratories of southern France by 
flying over the area where the laboratories are located? 

Mr. Jaffe. Yes ; I think there is at least a sufficiently good chance 
of that being done so that it deserves more attention than it seems to 
be getting. 

Yes; as Dr. Yondorf is saying, that would be susceptible to counter- 
measures, and one gets into this problem which the military faces, of 
countermeasures and counter-countermeasures. But I don't think that 
is a sufficient argument not to take the first step ; that is, for us to take 
the initiative in trying to locate those laboratories, especially from the 
air. 

Chairman Pepper. Mr. Brasco, do you have any questions ? 

Mr. Brasco. Yes. 

I am sorry I am late, Dr. Jaffe. This is rather interesting. 

I didn't get a chance to go through the beginning — that we do have 
at this time such devices or are you suggesting the $10 million go into 
the research and developinent of such devices ? 

Mr. Jaffe. I am saying that there is a very limited effort under 
way on the development of such methods. 

Mr. Brasco. But we don't have the devices that you are speaking 
about ? 

Mr. Jaffe. Generally not of the various things I have spoken about. 
Generally they are not available in an operational sense. They are not 
being used on the street by enforcement agencies. 

Mr. Brasco. This $10 million that you were speaking about is the 
cost of the entire project? Is that the cost for the entire project, as 
you set forth in your summary ; that is, locating, detecting, developing 
the dragnet work and improving the resource management? 

Mr. Jaffe. Yes; provided that you understand that that does not 
mean it includes the operational costs, the cost of using it. That figure 
is the cost of a research and development program that should produce 
such results. 

Mr. Brasco. I understand. Now, what would then be the cost after 
it is produced, if you have any idea, of putting it 

Mr. Jaffe. That is really a little bit out of my realm, and I don't 
know. For example, if we developed a technique for overflying, what 
it costs to run an aircraft for an hour I really don't know. But it 
would be that sort of thing. 

Mr. Brasco. How long, if you had the $10 million, do you think it 
might take to develop such a program ? 



94 

Jaffe. Well, there would be some immediate results or very early 
results, and they would be distributed. 

Mr. Brasco. I know you said 5 years, but are you saying it is 5 years 
before any of the equipment could be used ? 

Mr. Jaffe. I use tlie 5 years only as a way of averaging cost. 
There is no significance in the 5 years, in terms of when results 
would be available. I would expect there to be a stream of results 
over a longer period of time, too. Just as a way of averaging the cost 
I say I think that the program might run something like $10 million 
over a 5-year period. If you like, say an average of $2 million a year 
or something like that. 

Mr. Brasco. I wasn't inquiring so much about the money. I was con- 
cerned about when it might be operational. 

I am trying to find out when you would have a system that you are 
talking about? I am not trying to pin you down, just trying to get 
an idea. 

Mr. Jaffe. I think it might be as early as a year before we can spot 
poppyfields from the air, or a fraction of a year, within a year. 

Some of the other techniques, the establishment of a model for 
example, and the operation of that, generally takes longer because 
there are long periods .of validation necessary while you test the thing 
out and make sure you got the right model. 

So there are differences. I think that sensors, for example, might 
run 1 to 2 years, something in that period, or even less. 

Chairman Pepper. Dr. Yondorf ? 

Dr. YoNDORF. Thank you, Mr. Chairman. 

I would suggest that sensing from satellites would require much 
more development. It is easier with our pjresent technology to identify 
poppyfiields with airborne sensing equipment; that is, with minor 
adaptations of sensor equipment now existing on aircraft. On the 
political problems of flying over foreign territory with aircraft, you 
are more expert than I am, but technically this is where one should 
start. Sensors aren't sufficiently discriminating now to identify crops 
from very great altitudes. Research and development money initially 
should be spent to develop more sensitive sensors and test them out. 

Mr. Brasco. Thank you. 

Chairman Pepper. Mr. Wigsins. 

Mr. Wiggins. I have no ouestions, Mr. Chairman. 

Chairman Pepper. Mr. Mann. 

Mr. Maxn. You imply that the governmental efforts beins: made 
now in these areas are minimal. Are they doing anything with refer- 
ence to opium crop detection capabilities, sensor devices? 

Mr. Jaffe. Yes; they are. In fact, with the exception of the data 
bank on which I was not able to uncover anything, something is being 
done in each of the other areas. There is something being done on the 
question of surveillance from the air, and some of the others — the 
sensors and tracers, too. There is some very limited modeling going on. 

Mr. Mann. Dr. Yondorf, you sujrgested that aircraft surveillance 
to develon the techniques is a preliminary step to developing a satel- 
lite capability. 

Do you think a satellite capability is possible ? 

Dr. Yondorf. We do think it is possible. It is just a matter of refin- 
ing existing techniques. Of course, one can ai-gue Ihon from which 



d5 

altitude the satellites should operate. We have satellites that go up 
to 22,000 miles— synchronic altitude— and it probably is extremely 
difficult to see poppies from that altitude. 

But low altitude satellites might well attain the discrimination one 
would need for this purpose. 

Mr. Mann. Mr. Jaffe, are you aware of any aerial surveillance, aerial 
efforts made by the United States of poppyfields? 

Mr. Jafte. No ; and those who are in a lot better position to have 
heard of any such things tell me that they are 99 percent sure that 
there is no such thing in existence. To date, no aerial surveillance has 
been made of poppyfields. 

Mr. Mann. Well, is my information correct that there are poppy- 
fields in areas of this world. Southeast Asia, for example, where we 
have a lot of aircraft operating ? 

Mr. Jaffe. That is true. 

Mr. Mann. No further questions. 

Chairman Pepper. Mr. Steiger. 

Mr. Steiger. Thank you, Mr. Chairman. 

Just a couple of questions, Mr. Jaffe. 

Incidentally, I for one find your presentation very interesting as 
opposed to my colleagues' rather casual interest. I wonder if you have 
heard of the work of Joe Zabitzi — and I can't tell you how to spell it, 
He works for the USGS and has developed infrared photography pri- 
marily in the search of water resources and has developed 

Mr. Jaffe. I have heard of the work they are doing, but the name is 
not familiar. 

Mr. Steiger. I think it might be of interest for you gentlemen to 
coordinate with him because he has done some very dramatic things 
I have seen, and obviously, it coincides completely with the type of 
thing you are doing here. I know you are aware of this, but I think 
the record should reflect your awareness, since your statement does not. 

In all your research and development I would assume you would 
suggest the need for security, even in the research and development 
phase, so as to at least minimize the opportunity for the countermeas- 
ures you referred to ? 

Mr. Jaffe. Absolutely ; yes. I certainly agree with that. 

Mr. Steiger. I say this because, interestingly enough, Mr. Zabitzi 
recited to me a proposal by a gentleman from the private sector, I 
believe would be a friendly way of saying it, who asked him if he 
could find poppyfields for him. He was on a United Nations mission 
in North Africa, and he was asked if his technique would show up 
poppyfields. 

This fellow, who said he was a horticulturist, which I thought was 
interesting, indicated that he would be willing to pay for the informa- 
tion as to the location of the poppyfield. 

So there is an awareness among the group. 

Mr. Wiggins. Horticulturists ? 

Mr. Steiger. Among the horticulturists. 

That is all, Mr. Chairman. 

Chairman Pepper. Mr. Rangel. 

Mr. Rangel. Mr. Jaffe, in the course of your studies, upon what do 
you base the assumption that the United States does not know where 
these opium crops are located or where the laboratories are ? 



96 

Mr. Jaffe. Primarily on the fact that there seems to be more than 
casual interest among the enforcement agencies in techniques of this 
sort when we do talk to them about these things. From the fact that 
they have some ongoing programs in these areas, one would assume 
that they don't know precisely where the fields are or where the labora- 
tories are. And it is just information of which I don't have firsthand 
knowledge, but I think pretty good secondhand knowledge. 

Mr. Rangel. Well, in view of the fact that we have — at least I think 
we can admit we have — U-2 surveillance aircraft, we have been, able 
to detect missiles in Cuba, we have been able to determine areas of 
vegetation in Vietnam and Korea before this, and in view of the fact 
rhat we have a very close economic relationship with the countries that 
we are mentioning that are considered to be friendly to us, and so 
therefore there is an assumption that Government is cooperating with 
us, it seems to me that all of the information would lead us to believe 
that we know exactly where the crops are located and where the labora- 
tories are. 

Mr. Jaffe. I think there is a difference between knowing generally 
where they are and knowing specifically where they are. It strikes 
me that that really is the difference that we would be getting at with 
technology. 

Mr. Rangel. Well, have you studied any of the reports of the sophis- 
tication of our U-2 aircraft ? 

Mr. Jaffe. Well, I know generally about what they can do, about 
their operational capabilities. 

Mr. Rangel. And the information has been rather specific ? 

Mr. Jaffe. Yes. 

Mr. Rangel. And if we can send these aircraft over unfriendly na- 
tions, I just presume we can send them over friendly nations. 

Mr. Jaffe. I would agree. 

Mr. Rangel. And if we can do all of this I presume that we have 
the knowledge that we want already. 

Mr. Jaffe. I can't disagree with your presumption. The informa- 
tion I have is that the locations are not precisely known over a period 
of time. Obviously if they detect one, if they find it, they know where 
that one is, but 

Mr. Rangel. If my presumptions are correct, we don't need any more 
research and development? 

Mr. Jaffe. The location of a laboratory, for example, from the air, 
does require additional research and development. There is no suitable 
way at the moment of overflying or finding a laboratory. 

Mr. Rangel. We can find missile bases but we can't find laboratories ? 

Mr. Jaffe. Correct; because the laboratory, from the air, looks like 
nothing more or less than an ordinary house, somebody's private home. 

Mr. Rangel. Even with information given to us by so-called 
friendly nations ? 

Mr. Jaffe. Well, I don't know about that part of it. 

Mr. Rangel. Well, let me ask you one last question, Mr. Jaffe. As- 
suming that we did get the refined sophisticated type of research and 
development that you are suggesting; after we got it, what would you 
suggest we do with it ? 

Mr. Jaffe. AVell, all through my remarks I stressed the need to have 
the research and development program aimed at the operational needs 



97 

of the enforcement agencies. So presumably, the output would be some- 
thing which is immediately operationally useful to an enforcement 
officer. 

The next step, then, would be to turn it over to him and let 
him use it. 

Mr. Rangel. Have any of the law enforcement agencies in the United 
States ever requested this type of support that you know of ? 

Mr. Jaffe. Yes. They have ongoing programs, and I have discussed 
with them the magnitude of those programs. I think I can say that 
there is a need and they would agree to a need — not everyone, you 
know, of course. If you talk to the guy about his little laboratory he 
says this is fine, this is my kingdom. 

Mr. Rangel. Is there any agency that has a mandate to eradicate the 
international trafficking of drugs, that has gone on record in asking 
for more Federal assistance in the area you have testified to ? 

Mr. Jaffe. I don't know. I really don't know. 

Mr. Rangel. Thank you. 

Chairman Pepper. Excuse me just 1 minute. 

Mr. Jaffe, as I understood the import of your testimony, you were 
assuming that if we had an international treaty or agreement that 
would ban the growing of the opium poppy then if somebody were 
to plant a field of opium poppies it could be detected by surveillance 
methods so that the policing could be effective ? 

Mr. Jaffe. That is exactly right. 

Chairman Pepper. Is your information the same as mine, that these 
laboratories in southern France are moved around from place to place, 
from time to time, so there is no fixed location? 

Mr. Jaffe. That is true. They do move quite a bit. Some of them are 
easily knocked down and set up again somewhere else. 

Mr. Mann. To that may I make a statement ? 

Chairman Pepper. Go right ahead. 

Mr. Mann. I was in Paris last week where I conferred with the 
director of the National Police Force, a representative of the BXDD 
in Paris, and I came away persuaded that France is making every 
effort in cooperating with us and the law enforcement arena to un- 
cover the laboratories, that there is no reluctance on their part or no 
economic considerations on their part that are interfering with their 
cooperation in attempting to uncover these laboratories. 

Chairman Pepper. Mr. Winn. 

Mr. Winn. Thank you, Mr. Chairman. 

Mr. Jaffe, your statement intrigues me, partly because I am on the 
Science and Astronautics Committee and I am aware of the work that 
has been done in the satellites and sensors by ERTS. How much work 
have you actually done on the feasibility of the total systems 
approach ? 

In other words, have you taken each of the suggested — like the 
laboratory detection tracers, sensors — have you actually tried to co- 
ordinate all that and put a package together ? 

Mr. Jaffe. No ; we haven't really done that in this particular case. 
Our organization and others like it specialize in doing that sort of 
thing, but in this particular application we haven't yet done that. 

Mr. Winn. Well, I don't mean to be rude about that, but I gather 
that from your guess of $10 million, because I don't think you are 



98 

in the same ball park about what it would cost. But that is ray own 
opinion. 

I do think you are on the right track, and I wish possibly some- 
where m your realm you would try to coordinate more closely these 
potentials. 

I don't really care whether any law enforcement agencies in this 
country or the world have asked you to do it. 

I would hope someone with your capabilities would do it, and there 
is a tremendous need for it. 

Now, on the satellite capabilities, I have no doubt that within a 
very short period of time— and I agree with your time schedule that 
within a year, we can view from the air, from satellite, the poppy- 
fields. Of course, some one might get up on the floor of the House and 
say that their poppyfield had been bugged, but I think we are going 
to have to use those approaches, and go at it from that direction. 

Because here is a program that is already available to us, here is a 
program where we have spent millions of dollars trying to use the 
science and technology research capabilities of these men. These are 
the same men whom we are now putting out of jobs because some of 
our programs are being phased out, and we could use their ability to 
help solve some of the drug problems in the country. 

I think you are on the right track. I commend you for your state- 
ment and I hope that possibly you can put some additional informa- 
tion in the record as far as coordination is concerned. 

Thank you very much. 

Chairman Pepper. Mr. Keating ? 

Mr. Keating. No questions, Mr. Chairman. 

Chairman Pepper. Mr. Brasco, any questions ? 

Mr. Brasoo. Yes, I wanted to ask one question and make an 
observation. 

I heard several times about an agreement being necessary, but it 
would appear to me if we are talking about satellite surveillance I 
don't know if we need any agreement to use that kind of technique, 
and I think it makes it more attractive because of that because you 
are apt to get an arrangement where you can perfect the equipment 
before you get an agreement. But the one question I would like to 
ask in connection with the sensors that you spoke about, which ap- 
parently would detect the drug, you mentioned that they were not 
of sufficient capability at this time to be possibly used in satellites. 

Could you use whatever equipment you have now, and are they 
using it, anyone, if you know, at points of entry in the United States 
just to detect it, if someone has it, you know, in a bag or on their 
person, or somewhere in the vicinity of the airport or the seaport? 

Mr. Jaffe. First of all, there are really two different classes of 
things that we mean when we talk about surveillance from the air and 
sensing at a point of entry. The techniques for detecting opium fields 
from the air are generally available. They just haven't been applied in 
this direction and haven't been adapted to this application. 

Mr. Brasco. How about the latter one that I was talking about ? 

Mr. Jaffe. On the latter one. the Bureau of Customs does have a pro- 
gram underway in that area. I don't know of anything being used now. 
I don't think anything has progressed to the point where it is being 
used now. 



99 

ISIr. Brasco. Is that a possibility, in your opinion, to develop that 
kind of thing:? 

Mr. Jaffe. Very much so. 

Mr. Brasco, That obviously is not included in the program you are 
talkinof about now ; or is it ? 

Mr. Jaffe. Yes ; it is included in the program suggested. 

Mr. Brasco. How far might we be away from getting something like 
that effected? I am talking about — let's take away the satellites and 
the other kinds of survellances that we could develop something that 
customs agents could use for detecting on peojjle, in bags, what have 
you, on ships coming into the United States. 

Mr. Jaffe. I think with the right kind of program, on the order of a 
year. 

Mr. Brasoo. Do you have any idea as to what that specific item would 
cost, just that item. 

Mr. Jaffe. That is so hard to do without sitting down and working 
it out for that particular application. 

Anybody want to guess ? 

Mr. Brasco. Xo idea ? 

Mr. Jaffe. It is very easy to say on the order of a half a million 
dollars to a million dollars, something like that. 

Mr. Brasco. Thank you. Dr. Yondorf , do you have anything to add 
to what Mr, Jaffe has said ? 

Dr. YoxDORF. I generally agree, but not with his numbers. I, person- 
ally, guess — I haven't made a survey — that this research could be very 
much more expensive, as Mr. Winn has said. How much more is diffi- 
cult to say. The sort of thing one would try to permit detection at entry 
gates would be some simple thing first, perhaps several techniques in 
the area of spectrum analysis. If it doesn't work one would have to try 
many other techniques. I don't think we have done enough research, 
certainly not any of us here, to have a very good feeling of what mag- 
nitude of effort would be required if at first simple things don't work. 

First feasibility tests — this is indeed what we suggest here — can 
be undertaken and some results gotten within a year. But before one 
can make a solid estimate as to how^ much more work is required one 
has to have that feasibility study under one's belt. We haven't done 
that. 

Mr. Brasco. Notwithstanding disagreement with respect to the num- 
bers, but you do agree with Mr. Jalfe's position that it can be done? 

Dr. Yondorf. That can be done ; yes. 

(For more detailed statement concerning proposed research and de- 
velopment program see exhibit Xo. 8(a) page 101.) 

Chairman Pepper. Mr. Holden, would you add anything? 

Mr. Holden. Perhaps just a statement in regard to Mr. Rangel's 
point that the militaiy has been flying IJ-2's all over the world and 
satellites surveying, apparently, anything of interest. So why haven't 
we done this — located illicit poppyfields? It is a question of where 
we, as a government, point our cameras find which budget pays for 
what type of surveillance coverage. 

It is obvious the military has done a lot of work in this area of 
aerial and spatial surveillance. The point here is that this activity 
ought to receive its fair share of the budget to apply survellance tech- 
niques to the fight on drug abuse. 



100 

Chairman Pepper. Mr, Waldie, do you have a question? 

Mr. Waldie. Well, Mr. Chairman, I am intruding in a conversation 
that has already occurred, but it seems to me that to invest any great 
sums of money in surveying that area of the globe where opiimi is 
being grown is moving to the problem in the wrong way. We know 
where opium is being grown. It is being grown in Laos. It is being 
grown in Burma. It is being grown in Turkey. 

It has not been a problem of identifying where the fields are. It is 
getting those who grow the opium to curtail production of it. Their 
failure to curtail production has not been a failure on their part to 
identify where it is being grown. 

It would seem to me that money ought to be spent, first, to get 
willingness on the part of the governments that own the land on 
which the opium is being grown to embark upon a program of eradica- 
tion and then, perhaps, to a system in identifying the areas in which 
eradication is necessary. 

I don't think there is any problem of identifying Laotian opium. 
It is participated in by the Laotian Government. They are profiting 
from it. Burma opium crops are not any secret ; neither are the Turkey 
opium crops. I just am not quite certain why we would invest any 
money in aerial surveillance to determine where the fields are that are 
growing opium at this point. 

Chairman Pepper. I think, perhaps, you didn't get the assumption. 

Mr. Jaffe would you state what the assumption was upon which you 
recommend the use of these detection devices for growing poppyfields ? 

Mr. Jaffe. First of all, the idea that there is no one route, there is 
not lust one thing that needs to be done and that the aerial surveillance 
of the opium fits into a total scheme of things which would include 
such things as international agreements, which would then have to be 
enforced, and violations of that treaty would have to be detected. 
From there we get to the aerial surveillance. That is one route, to get 
to the aerial surveillance. 

But it is within the total scheme of things, we think, that aerial sur- 
veillance plays a part. I would agree that in the case of Laos there may 
be no, or very little reason to want to know where each field is 
precisely. 

But I think the reasons in Turkey and other countries that are 
closer and friendly, the reasons become somewhat more compelling. 
It is one thing to have an agreement from them to limit the growth of 
opium. It is another thing to be sure that it is actually happening and 
to know where it is and isn't happening. 

It is in that context that we propose to use it. 

Chairman Pepper. Gentlemen, if I understand it, you surmise, as did 
Assistant Secretary of the Treasury Rossides. that the bringing in of 
heroin to this country is effectuated largely by an international con- 
spiracy of people who are perpetrating that crime in order to make 
hundreds of millions, if not billions of dollars, a year. They are ruth- 
less, they are well organized, they are ably directed. 

In other words, it is a criminal conspiracy of great magnitude. 

You are suggesting that if we are to be effective against that kind 
of an international conspiracy to bring opium into this country and 
distribute it we must employ or we should, to be most effective, employ 
the most modwn techniques and the most comprehensive program for 
dealing with it ; is that the theme of your statement ? 



101 

Mr. Jaffe. I think it is a very precise statement of the case. 

Chairman Pepper. Thank you very much. 

Have you anything for the record, Mr. Perito ? 

Mr. Perito. Yes, Mr. Chairman. 

May we place in the record the supplemental statement and curric- 
ulum vitae of Mr. Jaffe; also, the prepared statement of Mr. William 
S. Ulrich, which was unfortunately omitted from our New York hear- 
ings, but relates to the statements made by Mr. Jaffe, Dr. Yondorf, 
and Mr. Hoi den. 

Chairman Pepper. Without objection, they will be received. 

(The material referred to follows:) 

[Exhibit No. 8(a)] 

Supplemental Statement of David Jatfe, Department Staff, MITRE Corp. 

The suggested research and development program consists of five major parts. 
In what follows, each part is further defined in terms of tasks, products, and 
probable cost. The cost estimates are related to performance periods, as 
appropriate. 

The structure of these efforts is highly variable, and the corresponding per- 
formance period and cost will be sensitive functions of the approach selected. 
A conservative approach can be taken in which ideas are investigated one at a 
time, or a redundant program can involve several simultaneous efforts with the 
same objective. The cost estimates given below are for conservative approaches. 
They are subject to considerable flexibility and interpretation and should be 
taken as gross values appropriate only for initial planning. 

(1) Surveillance of Opium Poppy Crops 

An initial experiment would establish the basis for assembly of test apparatus. 
After evaluation of the test gear, designs would be finalized and prototype equip- 
ment, suitable for aircraft-bome operation, would be constructed and tested. 
Culminating in delivery of the prototype instrument with operating procedures, 
this effort might cost about $2.5 million and take 1 to 2 years. The prototype 
instrument would be suitable for use by operational agencies in verifying func- 
tional utility and in specifying future procurements. 

Satellite observations would at first make use of data from available instru- 
ments. Only then could the possible need for special hardware be determined. 
Depending on the results of initial experimentation, this project could cost 
between $500,000 and $2 million. The lower figure presumes ability to use avail- 
able data ; the higher one would be the cost of a special instrument package 
suitable for flight on a satellite. 

(2) Tracer Technology 

This effort would consist of identifying tracer materials which could be used 
in a variety of operational situations. Contracts would be let to chemical research 
firms to develop specific tracers which would be subjected to tests for suscepti- 
bility to detection and countermeasures. The product of this effort would be 
recommendations to the enforcement agencies for use of a variety of tracers. 
Costs are estimated at $1.5 million over a 2- to 3-year period. 

(3) Sensor Technology 

Techniques known to be capable of identifying heroin would be rated as to 
their potential for meeting the constraints of the operational situations. Con- 
tracts would be let for redesign of the two best possibilities and for tests of 
techniques which might prove to be applicable. Prototypes of the most promising 
designs would be constructed, tested, and made available to enforcement agencies. 
A continuing effort would be devoted to finding additional useful concepts and 
designs. In a 5-year period, it is expected that three or four prototypes would 
be completed at a total cost of about $4 million. 

(4) Data Handling 

A computerized data bank would be designed using information on all facets 
of illicit drug production, distribution, use, and control. Information to be in- 
cluded would be determined by the operational requirements of the enforcement 



102 

agencies and input data would be supplied by those agencies. The agency charged 
with maintaining the data bank would be provided with a complete system 
design, including performance specifications for hardware and software. They 
would also receive technical assistance during the implementation and testing 
phases. Total cost of this effort is estimated at about $1 million. 

(5) Netivork Modeling 

Drug production and distribution networks, and their economic systems, will 
be simulated by mathematical relationships and other representations. The 
models will be operated to reveal sensitivities and vulnerabilities of the illicit 
trade. This project is viewed as a joint effort by the model developers and a 
user agency for 5 years, after which the model will be run entirely by the agency. 
The 5-year cost above the normal agency costs will total about $1 million. 



[Exhibit Xo. 8(b)] 
Curriculum Vitab of David Jaffe, Department Staff, MITRE Corp. 

EDUCATION 

Brooklyn College, B.S., 1951, physics and math. 
University of Connecticut, M.S., 1952, physics and math. 

Additional graduate courses in solid state physics, mathematical statistics, and 
magnetic resonance. 

EXPERIENCE 

The MITRE Corp., September 1970 to present : 

Department staff. Concerned with the application of technology to criminal 
justice systems. Communications, information systems, sensors and alarms, and 
specialized technology are the subjects of these efforts. Methods of approach 
include operations analysis and systems engineering. 

Research Analysis Corp., October 1965 to September 1970 : 

Deputy head, public safety department. Developed program concepts for 
research in law enforcement and the administration of justice. Directed studies 
including the relationship between the physical environment and crime rates, 
logistic support to police and fire departments in combating civil disorders, the 
development of specifications for techniques and devices in the prevention of 
burglary, the role of the police in a ghetto community, and others. 

As deputy department head of RAC's unconventional warfare department, 
conducted studies of dissident and insurgent grouns. their modes of operation, 
and their vulnerabilities. Assessed national threats from internal and external 
population segments. Investigated the feasibility of techniques designed to 
measure magnitudes of insurgent activities. 

American Machine d Foundry Co., Alexandria Division, 1959 to 1965: 

Assistant manager, space instrumentations department. Directed the re- 
research and development activities of about 30 men. This group, consisting of 
physicists, electronic engineers, and mechanical designers as well as support per- 
sonnel, specialized in the conception, design, development, fabrication, and test- 
ing of scientific instrumentation, primarily for use on satellites and rockets. 
Areas of primary competence include X-ray. optical, and microwave instrumen- 
tion and measurements. A major nroject was the design and constrnrtion of soft 
X-ray solar spectrometers for flight on Aerobee rockets and the OSO series of 
satellites. 

As head of physics section, directed experimental and development programs 
in general phvsics. iuf'luding classical and quantum disciplines. Tvnimi pro- 
grams were the investigation of gaseous microwave spectroscopy involving ex- 
tremely sensitive receivers ; visible signals in space, their sources, and their 
interactions: develonment of specialized ontical and electro-ontiral sy--tenis and 
instrumentation: ion and atomic beams for space communication: parametric 
amplifiers: the generation of submillimeter waves: standardization measure- 
ments on microwave components: microwave attenuation in dielectric materials. 

Diamond Ordnance Fuze Lahnrntoric^. iri"> to 1959. 

Conducted theoretical and experimental studies of the behavior of ferromag- 
netic materials at microwave frequencies. Investigated ferromagnetic resonance 
in ferrite and garnet materials to develop a microwave detector. Measured the 



103 

magnetostrictive behavior of ferrites. Made infrared measurements of ferrite 
materials. 

Ballistic Research laboratories, 1953 to 1955 : 

Employed high resolution radioactive tracer techniques in the investigation of 
internal ballistic effects. Designed and constructed scintillation and photomulti- 
plier systems for detection and location of radioactive sources. 

Naval Ordnance Laboratory, 1952 to 1935 : 

Designed tests and associated equipment for the evaluation of electronic and 
magnetic underwater ordnance components. Included were opertaional, life, and 
environmental tests. Designed an automatic and fast-operating open-circuit tester 
for a complex cable harness. 

HOXORS 

Sigma Pi Sigma (physics) . 

PUBLICATIONS 

D. Jaffe, J. C. Cacheris, and N. Karayianis, "Ferrite Microwave Detector," 
Proc. IRE, 46 (3) : 594-601, March 1958. 

D. Jaffe, Cacheris, and Karayianis, "Detection of High-Power Microwaves by 
Ferrites and Garnets," Diamond Ordnance Fuze Laboratories, TR-867, Wash- 
ington, D.C. 

D. Jaffe et al., "Some Aspects of Indicator Analysis," Research Analysis Corp., 
RAC-S-1900, McLean, Va., 1966. 

Other reports classified or proprietary. 



[Exhibit No. 9] 

Prepared Statement of William F. Ulrich, Ph. D., Manager, Applications 
Research, Scientific Instruments Division, Beckman Instruments, Inc., 
Dated June 27, 1970 

Scientific methods have numerous applications in law enforcement programs 
including the detection and determination of narcotics and dangerous drugs. Yet, 
utilization of modern technology still falls short of its potential in this field. I 
appreciate the opportunity to comment on this point and to discuss areas in which 
positive action might be taken. 

To a large extent my remarks are based upon discussions with individuals 
from various law enforcement agencies throughout the country. Almost without 
exception, these people have been cordial and most helpful in describing the 
needs and practices in their diverse operations. From their comments it is obvious 
that narcotics and dangerous drugs, which only a few years ago were encoun- 
tered rather infrequently, now represent a major factor in their daily workloads. 
Furthermore, the problem is not restricted to major population centers but can 
be found in virtually all sections of the country. To combat this, mre effective 
methods are needed for handling the large number of samples processed each 
day. Even more desirable is the development of new technology which will pro- 
vide an effective means for halting production and preventing distribution of 
illicit materials. 

In evaluating technology in this regard, several distinct areas merit consider- 
ation. The first and perhaps simplest of these is to improve the utilization of 
techniques and methods which have already been developed within this field. 
In an age when communications permit instant transmittal of information and 
computers can be used for storage and retrieval, much of the technical informa- 
tion within the law enforcement field still follows a relatively slow and haphaz- 
ard path. Several publications are devoted to this purpose but even with these 
information is often delayed. Even worse is the fact that much of the infor- 
mation either is not published at all or is published in journals or internal publi- 
cations which are not readily available to other workers. Certainly this is not 
an insurmountable problem but it does require an organized program which 
w^ould encompass all efforts in this field. 

A related area to be considered is the utilization of technology developed in 
other disciplines. Many of the techniques and metbod^ applied for the life 
sciences, space research, environmental control, and other areas can serve 
equally well in the law enforcement field. In fact, this has been the basis for 
much of the technology now in use. However, for this to be truly effective, 
greater contact with these disciplines must be fostered. 

In both of these areas, there should be greater opportunity for law enforce- 
ment scientists to devote time to development efforts. With present workloads. 



104 

most facilities are barely able to handle daily problems let alone give thought 
and attention to new and improved methodology. Only a relatively few lab- 
oratories are able to do this type of work and even in these much of the effort 
is performed on an ott-huurs basis. Until this situation is improved, technical 
advancements will be slow and inefficient. 

In assessing opium products, more specific objectives can be considered. Es- 
sentially, this market can be described on the basis of classical supply and de- 
mand principles. Greater control can be achieved either by restricting the 
supply or by decreasing the demand. The latter involves a host of social, en- 
vironmental, medical, and other factors. Technology participates in these but is 
not a dominant factor. 

On the other hand, scientific methods can and do play an active role in com- 
bating the production and distribution of illicit narcotics. Current technology 
provides simple and reliable procedures for identifying and quantitatively 
determining these substances even when they are heavily diluted with excip- 
ients or present in minute quantities. Unfortunately these methods are applicable 
mainly to seized materials and are relatively ineffective for interception pur- 
poses. Thus, they are more useful for prosecution than for prevention whereas 
ideally the latter would be preferred. Therefore, more consideration should be 
given to the development of remote sensing and tracer techniques. 

In terms of opium products, at least six discrete points can be identified where 
technology can be applied : 

(1) The point of origin; namely, the naturally occurring or cultivated crop. 
This represents an ideal point at which specific tracers could be added. 

(2) The facilities where the raw material is refined and processed to yield 
high-grade morphine and heroin. Surveillance here might be facilitated by de- 
tection of the chemical reagents utilized or emitted during processing. 

(3) The port of entry where the illicit material is brought into the United 
States. 

(4) The secondary processing facility where bulk samples are diluted and 
repackaged. 

(5) Transportation to the ultimate user. 

(6) The user, his dwelling or property. 

Each of these represents a unique set of circumstances and levels of difficulty. 
For example, chemical detection of material in sealed containers is far more 
difficult than when it is being processed or otherwise exposed to the atmosphere. 
In the first case, it may be necessary to open the container for detection whereas 
in the latter even remote sensing is conceivable. In terms of need, interception 
near the source is more desirable than at the ultimate user because of the 
quantities involved. The point to be made is that interception is not a simple, 
single concept but rather a set of individual opportunities each of which 
should be examined on its own merit. Therefore, an approach similar to that 
used by systems-oriented technologists can be visualized. A simplified outline 
of such a program might involve the following steps : 

(1) Clearly define primary and secondary goals. 

(2) Research and evaluate existing state-of-the-art or level of knowledge 
of the known and presumed technology which may be involved. 

(3) Outline all approaches conceivable for achieving the specified goals. 

(4) Evaluate current feasibility of each approach, the manner in which these 
interrelate, and the potential for their practical application. 

(5) Select the approach or approaches which should be pursued as based on 
social and economic factors and the probability of technical achievement. 

(6) Design, develop, and test the new technology, systems, and procedures 
and apply to the problem. 

(7) Continually evaluate the effectiveness of each approach to insure it con- 
tinues to move toward the specified goals and to detect new approaches which 
might evolve from the advancing technology. , , i , 

Depending upon manpower and other resources, parallel efforts should be 
considered as a means of providing answers in the shortest period. At the out- 
set a program should be undertaken to evaluate current capabilities and knowl- 
edge which exist within the various agencies of the Federal establishment, inter- 
national organizations, academic institutions, and private iiulustry It may well 
be that technology already exists for this purpose and only needs to be directed 
to the proper aL^encies for exploitation. At the very least, such information would 
be of considerable value to law enforcement programs at all levels and even to 
external groups such as those engaged in medical research. 



105 

I would do this committee a serious injustice to suggest that a simple, fool- 
proof detection device is just around tlie corner. Ratlier, it seems likely that 
progress will be made in orderly steps which ultimately will provide effective 
deterrents to the illicit traffic. I urge this committee to provide support and en- 
couragement to such a program. 

Chairman Pepper. Will Dr. Frances Gearing please come forward? 

The committee is pleased to welcome now Dr. Frances Gearing. In 
addition to her medical degree. Dr. Gearing holds a master of pnblic 
health degree from the Columbia University School of Pnblic Health 
and Administrative Medicine. 

Since 1957, Dr. Gearing has been associated with the Columbia Uni- 
versit}' School of Pnblic Health and Administrative Medicine, where 
she now holds the rank of associate professor of epidemiology. 

Since 1967, Dr. Gearing has served on the Xew York State Narcotics 
Commission's advisory committee on criteria for funding narcotics 
treatment pi-ograms. This year, she was appointed a member of the 
professional advisory committee on heroin addiction of the District of 
Columbia Department of Human Resources. 

Since 1965, Dr. Gearing has been director of the evaluation unit 
for methadone maintenance treatment program for heroin addic- 
tion, in which position she has supervised a comprehensive study of the 
efficacy of methadone maintenance and its relationship to crime control. 

Dr. Gearing, we w^elcome your testimony on this matter of critical 
importance. 

Mr. Perito, will you inquire ? 

Mr. Perito. Dr. Gearing, we understand that you have conducted 
several studies on the relationship between the use of the methadone 
modality treatment approach and the decrease in crime by addicts 
under such treatment ; is that correct ? 

STATEMENT OE DR. FRANCES R. GEARING, ASSOCIATE PROFESSOR, 
DIVISION OF EPIDEMIOLOGY, COLUMBIA UNIVERSITY SCHOOL 
OF PUBLIC HEALTH AND ADMINISTRATIVE MEDICINE 

Dr. Gearing. Yes. 

Mr. Perito. I wonder if you could review for the committee the 
approach that you took and the type of studies that have been final- 
ized by you or under your direction. 

Dr. Gearing. Well, for the record, it is all one study. It is a con- 
tinuing ongoing evaluation. 

We have looked at it in several ways. First of all, we did before- 
and-after pictures of what has happened to the patients who have been 
admitted to the program, looking at their previous criminal records 
and comparing this with what has happened to them since they have 
been in the program. 

Our latest review would say that you could almost look at metha- 
done as some kind of a vaccine against crime and look at it in a vaccine 
efficacy-type model and in that light we would say that methadone 
maintenance patients have a decrease in their criminality in the first 
year of 81.5 percent ; in the second it is about 92 percent; in the third 
year, 96 percent ; and for those who stay in the fourth year, it comes 
close to 99 percent. That is using the same patients' previous crim- 
inality records as a basis for comparison. 

60-296 0—71 — pt. 1 S 



106 

We have also studied a ^roup of addicts who have been admitted to 
the detoxification unit at Morris Burns Institute in New York City. 
This is a short-term drym^ out process where they remain in the facil- 
ity for approximately 2 weeks, .qfettintr decreasing: doses of methadone. 

We matched these people with patients in the studv populaHon and 
looked at their criminal records pr'or to time of admission in detoxifi- 
cation and what has happened to them subsequentlv. 

The contrast is rather strikinsj. The detoxification does not prevent 
crime. Their records, since under our observation, are no different than 
thev were prior to admission for detoxification. 

Mr. Pertto. Dr. Gearina:. how large a samplinq; did vou use? Did 
you use the entire group when you did this profile analysis that you 
gave us from 81.5 to 99 percent? 

Dr. Gearing. The figures I gave you of the 4 years would be the first 
1,000 patients admitted to the pro.qrram. I have another figure for the 
first 600 patients who were admitted on an ambulatory basis. The 
figures are roughly similar. 

Mr. Pertto. The first 1,000 patients, I take it, those were not all 
ambulatory patients ? 

Dr. Gearing. None of them were. 

Mr. Perito. How long were the addicts confined for treatment ? 

Dr. Gearing. Six weeks. 

Mr. Perito. Then released and come back on a periodic basis ? 

Dr. Gearing. No ; they are released, then, to an ambulatory or out- 
patient clinic unit where they come in initially every day for their 
medication and gradually twice a week. 

Mr. Perito. Did you personally secure the raw data or was it pre- 
sented to you by people working in the program ? 

Dr. Gearing. No, sir ; the majoritv of the data we secure ourselves. 
Our prime source is from the New York City narcotics register, as re- 
ported from the police. 

However, the data that we get from the program would tend to show 
that it is very useful, too, because the patients do report to the program 
when they are arrested because legal counsel is available to them. 

Mr. Perito. Did you take a sampling or did you do some personal 
interviews with each of these addicts to make a determination as to 
their rate, for example, of illegal activity which did not result in some 
type of criminal charges being lodged against them ? 

Dr. Gearing. No, sir. 

Mr. Perito. Do you know of any study such as this in the United 
States where the addicts were interviewed as to their criminal activity 
as opposed to a pure evaluation of the process ? 

Dr. Gearing. No, sir. I think there is a group at Harvard that may 
be undertaking such a study in a patient population in New York. 

Our charge was to obtain objective criteria for evaluation, and we 
tried to make it as obiective as possible and find things that we could 
measure, and the things we could measure were arrests and incar- 
cerations. 

Mr. Perito. And your study of the New York program is ongoing ; 
is that correct? 

Dr. Gearing. Yes, sir. 

Mr. Perito. I understand that you are also about to do an analysis 
and efficacy study of the Narcotics Treatment Administration in Wash- 
ington ; is that correct ? 



107 

Dr. Gearixg. I have been asked to consult with them and assist them 
and to set up some kind of ongoing evahiation for their program. 

Mr. Perito. Now, going back to your New York program, the 
statistics, the 81.5 to 99 percent, did those statistics only include the 
1,000, or did the amount of patients in that study increase ? 

Dr. Gearixg. No; they decreased because I started with 1,000 
patients, the first 1,000 patients admitted. Not all of them have been 
in the program for 4 years because of the way the patients were 
admitted. 

Mr. Perito. What was, to the best of your knowledge, the dropout 
rate of the first 1,000 patients ? 

Dr. Gearixg. The dropout rate is approximately 15 percent during 
the first year, about 5 percent in the second year, and about 2 percent 
a year for the ensuing years. 

Mr. Perito. Did your analysis also include an evaluation of their 
return to work or to school ? 

Dr. Gearix^g. Yes, sir. 

Mr. Perito. Could you tell us what those statistics show ? 

Dr. Gearixg. The average employment percentage for patients en- 
tering the program during the early phases was approximately 25 
percent. 

Those who stayed in the program for 6 months, approximately 45 
percent of them were employed. 

Those who stayed in the program over a year, the percentage goes 
up to 55, and for those who have been in the program 5 years or longer, 
it is approximately 90 percent. 

Of those who were admitted initially on an ambulatory basis be- 
cause of the selective process by which they tested the ambulatory 
procedure, a higher percentage of them were employed or in school 
at the time of admission. 

So that their rate of increase of employment is not as great. 

However, it levels off to approximately the same figure at 18 months. 

Mr. Perito. Dr. Gearing, did you ever have occasion to do a com- 
parative study of the drug- free approach in New York ? 

Dr. Gearixg. Did I ever have occasion to ? 

Mr. Perito. Yes. 

Dr. Gearixg. I offered my services. They were not accepted. 

Mr. Perito. Do you know of any studies done similar to the studies 
which you did on the methadone programs in New York of drug-free 
programs anywhere in the United States ? 

Dr. Gearixg. I wish I did. 

Mr. Perito. To the best of your knowledge, those studies do not 
exist ? 

Dr. Gearixg. That is correct. 

Mr. Perito. Dr. Gearing, you have presented us, kindly, with a paper 
which you presented to the Third National Conference on Methadone 
Treatment on Saturday, November 14, 1970 ? 

Dr. Gearixg. Yes, sir. 

Mr. Perito. And also a paper which you gave at Pontiac, Mich., 
on December 2, 1970, and these relate to your studies of the evaluation 
of the methadone maintenance approach ; is that correct ? 

Dr. Gearix'g. Correct, 

Mr. Perito. Are these the two latest studies which you have done ? 



108 

Dr. Gearing. Yes, sir; I would not consider the position paper a 
study. That was a lawyer's confrontation for which I wrote a position 
paper. 

Mr. Perito. Mr. Chairman, I would at this point ask that these two 
papers be incorporated in the record. 

Chairman Pepper. Without objection, they will be admitted for the 
record. 

(The documents referred to above appear at the end of Dr. Gearing's 
testimony.) 

Chairman Pepper. Just one question before we proceed. 

Is it your conclusion, therefore. Dr. Gearing, from the studies that 
you have made over a period of time that methadone is the best treat- 
ment now known and now available for heroin addiction? 

Dr. Geartxg. I wouldn't make quite that strong a statement, ISIr. 
Pepper. I would say that for those patients who volunteered for the 
methadone maintenance treatment program who have a history of 
long-term heroin addiction, this is the best treatment we have at the 
moment ; yes. 

Chairman Pepper. And you did find a striking diminution in the 
amount of crime committed by the people who took methadone who 
previously had a heroin addiction ? 

Dr. Gearing. Yes, sir. These were patients who by definition, to get 
into the program, have had to be known as "criminal addicts." They 
had to have had previous infractions of the law. 

Chairman Pepper. Have you had long enough experience with these 
people who took methadone to determine Avhether it became addictive 
with them. 

Dr. Gearing. I am not sure the patients who have been on the pro- 
gram a long time consider themselves addicted. They consider them- 
selves dependent, and happily dependent because it has freed them 
from the problems they had when they were chasing heroin. 

Chairman Pepper. Did you find the people who took methadone over 
a period of time have suffered any apparent trouble or physical injury ? 

Dr. Gearing. As far as we can determine, from serial medication 
examinations, and the patients in the program 5 years or longer have 
been monitored carefully, there seems to be no physical or physiologi- 
cal problems. 

Chairman Pepper. Yesterday, we had some distinguished witnesses 
here who said that they did not think that private physicians should be 
authorized to prescribe methadone. 

What is your recommendation on that ? 

Dr. Gearing. If you will look at the recommendations that the ad- 
visory committee and I put together at the end of that last rei)ort, we 
make the same recommendation, that it is not for use of the ])hysician 
in his private office, because methadone, in and of itself, is only really 
a brid.o-e which allows the patients time to get involved in their own 
rehabilitation. 

The big need, for manv of them, is to gain extra skills, to find a job, 
and many other social services. 

Chairman Pepper. Mr. Blommer, do you have any questions? 

Mr. Blommer. Yes. 



109 

Doctor, on page 3 of the paper that you have kindly given us, you 
show the reasons for discharge from the program as being alcohol 
abuse and abuse of other drugs. Now, these figures are relatively 
small. 

What standards are applied to the people in the program that 
could lead to their being discharged ? 

Dr. Gearing. Every effort is made in the program to help them 
with their problems. It is continual abuse, and inability to handle 
their other problems, that may lead to discharge. 

But there are supportive services. In fact, particularly in the Har- 
lem area, working on the alcohol problem they have one full-time 
person. And many of the patients do very well. 

Mr. Blommer. Doctor, would it be a fair statement to say that 
merely because someone is abusing the program, and by that I mean 
not just taking methadone, but also taking alcohol, taking ampheta- 
mines, that this abuse would not be grounds enough to drop them from 
your program? 

Dr. Gearing. That is correct. I think initially they were dropped 
from the program for two reasons : 

One was the program was not equipped to handle these problems; 
and second, there was such a long list of patients waiting to get into 
the program; the waiting time had become so long that the decision 
on the part of the program people was, "How to do the best job for 
the greatest number," and if some patients Averen't making it then it 
was better to substitute somebody else. I think that was the philosophv 
as I understood it, 

Mr. Blommer. In any case. Doctor, if someone has a job, would you 
say they Avould most likely be retained in the program, that job being 
an indication they were adjusting? 

Dr. Gearing. Someone has a job, even though he may be abusing 
drugs or alcohol ; definitely. 

Mr. Blommer. So that your statistics of people having a job bene- 
fits your program? 

Dr. Gearing. It is not my program, sir. 

Mr. Blommer. Excuse me. The program that you evaluate. The 
chart seems to go up, showing that more and more people have jobs, 
and the sampling goes down. 

Dr. Gearing. It is not the sampling. Remember, patients are being- 
admitted all the time. So that at any point in time you have so many 
patients in the program only 2 weeks or 3 months. For instance, when 
I started evaluating the program there were 66 patients in the pro- 
gram. Forty-five of those patients are still in the program, but those 
are the only ones on whom I can say I have a 5-year followup, because 
that is all the patients who had been admitted at that time. 

Mr. Blomer. In other words, there are fewer and fewer patients 
that meet the criteria ; is that correct? 

Dr. Gearing. No ; the program started 5 years ago with 66 patients. 
That is all the 5-year followup patients I could possiblv have, ever: 
right? 

Mr. Blommer. I see. 

Dr. Gearing. Now, in the 4-year followup we have a smaller num- 
ber and right now, if I were doing a 3-month followup, I would have 



110 

somethino: in the nei<rhborhood of 6,000 patients. That is the rate at 
■which admissions are being taken on now. 
Mr. Blommer. Let me switch topics. Doctor. 

Is anyone in the Dole-Nyswander program receiving methadone 
maintenance but no therapeutic services? 
Dr. Gearing. There is a small group that was started last July. 
Mr. Blommer. Have you any statistics on whether they are able to 
stay out of trouble and keep jobs? 

Dr. Gearing. I have a very short followup on them. 
Mr. Bi,0MMER. Is there any trend emerging? 

Dr. Gearing. Yes; the dropout rate is somewhat higher. Their ar- 
rest record is about the same, and their rate of obtaining new employ- 
ment is slightly lower. 

Mr. Blommer. The same as the ones who are receiving therapy ? 

Dr. Gearing. That is on the first 100 patients. 

Mr. Blommer. Would it be a fair statement to say that the trend, 
then, is away from therapy as opposed to more therapy ? 

Dr. Gearing. No; I would say the trend is an attempt to select out 
of a group of patients who need the additional supportive services and 
concentrate the supportive services on those who need them the most, 
or start with supportive services for patients who seem to need it and 
gradually put them into a less-structured program. 

Mr. Blommer. I have no further questions, Mr. Chairman. 

Chairman Pepper. Mr. Waldie ? 

Mr. Waldie. No questions. 

Chairman Pepper. Mr. Wiggins ? 

Mr. Wiggins. Yes, Mr. Chairman. 

Doctor, what is the proper name for this program to which we have 
referred in general terms ? 

Dr. Gearing. It was ori.qinollv known as the Dole-Nvswander pro- 
gram ; later on known as the Beth Israel procrram ; now the Methadone 
Treatment Program in New York City and Westchester County, be- 
cause it now encompasses, in addition to those units I have mentioned, 
another unit in the Bronx and the New York City program which 
started the first of November. 

Mr. Wiggins. Who is the dire<"tor of the program ? 

Dr. Gearing. Dr. Harvey Gollance would be the director of those 
portions that come under what is now called the Beth Israel program. 

Mr. Wiggins. How do you spell his name ? 

Dr. Gearing. G-o-l-l-a-n-c-e, and Dr. Robert Newman is the direc- 
tor of the New York City program and Dr. Edward Gordon is the 
director of the Westchester program. 

Mr. Wiggins. Is this a private program or a Government program ? 

Dr. Gearing. Beg pardon ? 

Mr. Wiggins. Is this a private program or a Government program ? 

Dr. Gearing. It is a projrram, with one small minor exception, 
supported by the State of New York Narcotics Addiction Control 
Commission. 

Mr. Wiggins. So far as you know, are there any direct Federal 
grants involved in the program ? 

Dr. Gearing. As far as I know, except for perhaps some laboratory 
research at Rockefeller University, there is no Federal money in this 
program. 



11(1 

Mr. "VViGGixs. How does a patient qualify for the program, Doctor? 

Dr. Gearing. Well, that is a little bit out of my field, but a patient 
applies for admission. He is screened and he has to meet certain 
criteria. 

Mr. Wiggins. Would it be accurate to say that all of the patients 
are voluntary? 

Dr. Gearing. Absolutely. In fact, they have to sign a voluntary 
commitment to take the medication. 

Mr. Wiggins. Is there a method, so far as you know, of course in 
the State of New York, whereby courts may compel attendance to 
methadone programs as a condition to probation, for example? 

Dr. Gearing. Compel ? 

Mr. Wiggins. Yes, ma'am. 

Dr. Gearing. No; I think they can give the patient the option of 
taking methadone or going into one of the other nonmedication pro- 
grams. 

Mr. Wiggins. Have you had any experience in evaluating other pro- 
grams in which you might give us some guidance concerning the 
wisdom of compulsory methadone programs. 

Dr. Gearing. No ; I sort of shudder at the thought of compulsory 
treatment programs. I would think that voluntary treatment programs 
in prisons might be useful. 

I think to legislate medication goes against my physician's blood. 

Mr. Wiggins. Yes, ma'am. 

You describe in your prepared statement certain security techniques 
that are employed to insure that your patients are not using the pro- 
gram to satisfy their own drug needs. How is this information au- 
thenticated ? 

More specifically, let us suppose that a patient qualified, how do you 
know that he is not also continuing to feed his heroin addiction on the 
street ? 

Dr. Gearing. Well, he is periodically tested with urine samples. 

Initially, he has a urine sample taken every time he comes in. While 
the patients are being built up to their tolerance dose, many of them 
do shoot heroin, there is no question about it. 

Mr. Wiggins. Will a urine sample detect the presence of heroin ? 

Dr. Gearing. No : it will detect the breakdown products, morphine, 
and also since we in New York still cut it with quinine, it also detects 
quinine. 

Mr. Wiggins. In that event you can still tell whether a patient is 
continuing to feed his heroin addiction by shooting heroin from th" 
street ? 

Dr. Gearing. Yes. 

Mr. Wiggins. How about the other drugs ? 

Dr. Gearing. This is really a program-type question. I happen to 
know something about it, but this is not really my field. 

The other drugs, amphetamines, barbiturates, methadone, and co- 
caine, can be detected in urine. Marihuana and alcohol ; no. 

Mr. Wiggins. Let's suppose a patient signs up for and qualifies for 
a program in New York City and he also tries to sign up and qualify 
for another program to get a double dosage. How is that prevented 2 

Dr. Gearing. We are attempting to prevent this in that we have 
what is known as a data bank where each patient that applies for a 



112 

program is put into the machinery and matched by his first name, 
last name, and his mother's maiden name, which seems to be more 
useful than the birth date, to prevent this kind of duplication. 
So far, I think two have been picked up. 

Mr. Wiggins. If a person just simply used a different name, would 
he be detected ? 

Dr. Gearing. No. What purpose would be served by a patient going 
to more than one program 'i 

Mr. Wiggins. Well, 1 don't know, Doctor. Maybe you can help me. 
Dr. Gearing. Because he takes his medication daily. He takes his 
medication at the clinic. He is giving no medication to take home. 

Mr. Wiggins. I understand that. Would a person who is dependent 
upon methadone and had a prior history of heroin addiction, get a 
greater euphoric effect, or whatever the impact may be, from a second 
dose of methadone than he would from just one ? 
Dr. Gearing. You will have to ask the patients. I don't know. 
I know the experience with the majority of the patients who have 
been in the program for some months, many of them ask to have their 
dosages cut down. They do not develop a tolerance like with heroin 
where they have to get increasing dosage. At the stabilizing dose, some- 
where between 80 and 120 milligrams a day, they don't appear to crave 
more. 

Mr. Wiggins. Is that conclusion generally held in the medical com- 
munity ; namely, that a stabilizing tolerance is achieved with metha- 
done programs, unlike other analgesic substances ? 

Dr. Gearing. I don't think there is anything about the drug addiction 
field that is universally held in the medical profession. 

Mr. Wiggins. Do you have any comment about that? Have your col- 
leagues, so far as you know, come to a contrary conclusion? 
Dr. Gearing. None who work for the program; no. 
Mr. Wiggins. Doctor, I gather that there is some diversion in 
methadone and that it can be obtained occasionally on the street. What 
do you believe is the source of that diversion? 

Dr. Gearing. In New York City the source of that diversion is al- 
most exclusively the private-practice physician who, in being kind to 
his patient, gives him not one dose but several doses, such as a pre- 
scription for several doses or a week's supply. 

Mr. Wiggins. Do you have any recommendations to this committee 
on how that problem might be curtailed ? 

Dr. Gearing. I think my recommendation is that I wish that physi- 
cians were not giving it in their private offices, but apparently that is 
being done. 

Mr. Wiggins. Will it be your recommendation that the private dis- 
pensing of methadone outside of a control clinic be banned entirely ? 

Dr. Gearing. No; the recommendation is that those physicians wlio 
are interested in working with drug addicts in methadone maintenance 
affiliate themselves wnth some kind of an ongoing progi-am and that as 
the patients become stabilized and no longer need the supportive serv- 
ices of a total program that the private sector could then take on the 
patient. 

Mr. Wiggins. Doctor, so far the witnesses agree that methadone is a 
dangerous addicting narcotic, and 1 am sure you agice with that 
statement. 

Dr. Gearing. Yes. 



113 

Mr. WiGGixs. Is it more difficult to withdraAv a patient addicted to 
methadone than it is a patient addicted to heroin ? 

Dr. Gearing. No; I think it takes a little bit longer, because the 
methadone that they are getting when they are on methadone mainte- 
nance is pr-etty good stuff. The heroin that they are getting on the street 
is not such good stuff. 

Mr. Wiggins. I am going to use a term that may not be appropriate. 
I am going to use the term "euphoria." That may not be truly descrip- 
tive of the effect on the human body, but you use the appropriate tenn. 

What is the difference in the euphoric effect between the use of heroin 
and the use of methadone ? 

Dr. Gearing. The difference is primarily in the mode in which it is 
given. If methadone is injected euphoria is obtained. Methadone given 
by mouth, the euphoria, as I understand, it does not occur. 

Heroin given by mouth doesn't do anything. 

Mr. Wiggins. Methadone is an antagonistic drug; isn't it? 

Dr. Gearing. No ; it is known as a block. 

Mr. Wiggins. Yes ; but it is not antagonistic. 

TVhat satisfies the psychic craving for the euphoric effect if they 
don't get it on the methodone maintenance program ? 

Dr. Gearing. My judgment Avould be that the heroin addict has two 
phases. He has a euphoric phase. He also has a fear of withdrawal 
phase. I think that this stabilization seems to block that craving. I can't 
answer that any further because I don't know. 

Mr. AViGGiNS. Have you observed that there is abuse by shooting 
methadone on the streets of New York, for example ? 

Dr. Gearing. Very little. 

Mr. Wiggins. Is it more dangerous if applied intravenously? 

Dr. Gearing. The methadone that is used in the methadone main- 
tenance program is theoretically noninjective. 

Mr. Wiggins. That i=i all I have, Mr. Chairman. 

Chairman Pepper. Mr. Waldie ? 

Mr. Waldie. No questions. 

Chairman Pepper. Mr. Brasco ? 

Mr. Brasco. Yes. 

Dr. Gearing, I understood you to say before — correct me if I am 
wrong — that the methadone detoxification program as measured in 
relationship to criminality was not as successful 

Dr. Gearing. I didn't talk about the methadone detoxification pro- 
gram. I talked to about 100 patients that we selected out of the detoxifi- 
cation program by virtue of the fact that they matched by age and by 
ethnic group and time of admission to detoxification unit the patients 
in the methadone maintenance program, and we followed this. 

Mr. Brasco. May I ask you this. Doctor? In connection with the 
methadone maintenance program ; is there anything within the con- 
fines of the program itself that leads toward the eventual withdrawal 
of all drugs ? 

Dr. Gearing. There is no plan in the program for a time when a 
patient shall be withdrawn from methadone ; is that what you mean ? 

Mr. Brasco. Yes. 

Dr. Gearing. Many of the patients ask to be withdrawn with the 
notion that they think they can make it on their own, and they are 
withdrawn and then they are given the privilege of returning. I think 



114 

you have some data there that shows that a goodly portion of them do 
return. 

Mr. Brasco. They do return ? 

Dr. Gearing. Although a small proportion of them go into absti- 
nence programs. 

Mr. Brasco. In connection with dispensing of methadone, I under- 
stood you to say that initially the patients took their dosage at the insti- 
tution where they entered the program and later on they come twice a 
week. 

Dr. Gearing. Some of them come twice a week. Some of them never 
get beyond the every day. This depends upon a good many things, in- 
cluding their own rehabilitation. 

Mr. Brasco. I take it those who come twice a week 

Dr. Gearing. Yes ; in a locked box. 

Mr. Brasco. No ; I wasn't trying to be — I personally agree with your 
first statement. Maybe I should have said that first, that this is proba- 
bly the best we have to offer. 

Dr. Gearing. At the present time. 

Mr. Brasco. What 1 was trying to do was to get some answers from 
you. The program has been from time to time, as you know, criticized. 
One of the things is the incidence of death. I heard some statistics — I 
am not saying it is true, I am just saying 

Dr. Gearing. That is from what, bv whom ? 

Mr. Brasco. Where did we get the statistic, Paul, with respect to 
the deaths ? 

Mr. Steiger. In children. 

Dr. Gearing. Death in children, three. 

Mr. Steiger. Six. 

Dr. Gearing. Is it six now ? In New York City ? 

Mr. Steiger. Here, in Washington, D.C. 

Mr. Brasco. In any event, is there any reason why we couldn't have 
all of the people in the program report every day for their dose? 

Dr. Gearing. It impairs the rehabilitation of the patient. In trying 
to be fair to a patient you would like to give him some freedom as he 
stabilizes and becomes a productive citizen. 

Therefore, this is actually the one punitive measure that is used in 
a program, and that is if a patient begins getting into trouble or act- 
ing up or abusing other drugs they are put back to having to come in 
every day. 

At the moment, they are all given weekend medication to take 

home. 

Mr. Brasco. Just one last question in connection with Mr. Wiggins 
line of questioning concerning the fact that some of the methadone 
was getting into the streets of New York. That must be measured with 
the severe limitations that there are in connection with the program. 

I had a young man come to my office several weeks ago, and it took 
me a day and a half, calling all oVer the place, trying to find a spot 
for him. , 

In any event, I kind of suspect that if the program was developed 
i n large cities in the way that you described 

Dr. Gearing. The program is expanding astronomically. 

Mr. Brasco (continuing). There would never been any need tor it 
being dispensed by anyone else. 



115 

Dr. Gearing. The New York City program, which started on No- 
vember 1, was wondering where they were going to get their patients. 
They now have a waiting list of over 1,000 patients. They have 3,000 
who may be accepted, and money for 2,000, and the other 1,000 will 
be waiting. 

Mr. Brasco. The question really is : In New York there are mone- 
tary limitations? 

Dr. Gearing. It is monetary limitations and staffing. 

Mr. Brasco. And staffing ? 

Dr. Gearing. Yes; and also finding locations which will accept a 
narcotic treatment program in the area. Not every area of New York 
City, as you may know, enjoys the idea of having a methadone main- 
tenance treatment program on their block. 

Mr. Brasco. Unfortunately, I do know something about that. 

Might we integrate that with a hospital service? Might that help 
cut down on that problem ? In other words, use a portion of a hospital ? 

Dr. Gearing. This has been done at Delafield and the Washington 
Heights Center. There are two units in the Washington Heights 
Health Center and one in the Delafield Hospital. 

Mr. Brasco. Thank you. 

Chairman Pepper. Mr. Steiger. 

Mr. Steiger. Thank you. I was very interested, Doctor, in Mr. Wig- 
gins' approach on the possibility of the patient continuing his heroin 
habit undetected. The urine analysis is the only method that this 
program uses to detect the heroin ? 

Dr. Gearing. It is the only method there is, as far as I know, and 
it only detects heroin taken within the last 24 hours. 

Mr. Steiger. I assume they use interviews also; I mean, they ask 
them? 

Dr. Gearing. The patients squeal on each other. 

Mr. Steiger. ^Yhat is the incentive to squeal ? 

Dr. Gearing. Pride in the program. 

Mr. Steiger. Is there any method you know of, of beating the test, 
beating the urine analysis ? 

Dr. Gearing. Oh, I am sure there is. The urine analysis is not used 
in the punitive sense. It is used primarily for counseling. They don't 
shake their finger and say "You have been a bad boy." 

Mr. Steiger. An addict who was continuing a heroin habit and had 
the desire, he could conceivabl}^ continue it and stay in the program 
undetected ? 

Dr. Gearing. I wouldn't say undetected; no. There have been, I 
think, something like 1 percent of the patients who have been dropped 
from the program for continual shooting of heroin after they were 
reaching — supposedly — a stabilizinsr dose. The theory here is that in 
these patients this treatment doesn't work, obviously. 

Mr. Steiger. The ingenuity of the addict is fairly well known. He 
will do a great many things to achieve — to acquire — the drug and 
use it. It occurs to me that maybe we, as an interested coneressional 
committee, might want to explore possibly a more efficacious test. 
This would be my only concern, because we have had reports of urine 
analysis, the methods of beating urine analysis itself, some very in- 
genious methods. It occurs to me it might be worth while to explore a 
better test. 



116 

Dr. Gearing. It depends on what you are concentrating on. Are you 
concerned about the urine or the patient ? I really don't know what 
difference the urine makes if he has become a productive citizen and 
is able to function and is staying out of jail, because I suspect that in 
certain groups of the population, we could test for a variety of drugs 
and find habitual users, even among such illustrious people as among 
our Congress. 

Mr. Wiggins. Users of what ? 

Dr. Gearing. Drugs, amphetamines, barbiturates, tranquilizers, pep- 
up pills, et cetera. 

Mr. Wiggins. I just didn't want you to be misunderstood as accusing 
Members of Congress shooting heroin. 

Dr. Gearing. No. I think in a rehabilitation program of this kind 
one can get overly hung up on urine testing, which is a very expen- 
sive and time-consuming part of the operation. I think it is very good 
from a counseling standpoint to let the patient know that big brother 
is watching him, but as far as handling the patient and his problem, 
it is not his urine you are concerned about. 

Mr. Steiger. The whole problem, it seems to me, the basic objec- 
tion to the problem in terms of laymen is we are substituting one 
dependence for another, and in this instance we may not even be doing 
that. We may simply be mitigating the original dependence. 

I would like to ask one question : On urine analysis, have you been 
able to get a statistically representative group of people who have been 
through the program for a given period, whatever that may be, and 
now no longer take methadone and are no longer addictive and are 
productive ? Are' there any fisrures like that ? 

Dr. Gearing. We are in the process of trying to find those people. 
They can find those who haven't made it. That is the easiest thing, 
because we can find them through our other reporter services. 

We have a group of some 20 percent of the patients who have left 
the program that we haven't been able to find through these sources. 
We are now in the process of trying to find out what proportion of 
these people are, in fact, drug free. 

Mr. Steiger. My question is: In your opinion is it possible for 
somebody, through the methadone maintenance program, to achieve 
independence from methadone and anything else, or do we have to an- 
ticipate that he will be a methadone addict for the rest of his life '? 

Dr. Gearing. From the information I have at the present time I 
would equate methadone maintenance with insulin for diabetics, as 
probably a lifelong commitment for many of the patients. 

Chairman Pepper. Mr. Mann. 

Mr. Mann. Doctor, in your evaluation, what employment problems 
or patterns do you find these people having and is the community prej- 
udiced or reluctant to employ these neonle ? 

Dr. Gearing. The answer to the last question is yes. in some areas. 
The experience that has come about in the pro.Qfram is that it is like 
getting the first olive out of the bottle. Gettin.q; the first man on meth- 
adone maintenance employed in a particular industry or jxroiin is the 
tough one. Once they have accepted the first one and thev find out 
that he is a useful citizen, then getting other people into that is a 
simnler iob. That is one point. 

The main point, I think, is that many of them have to be given 



117 

some kind of skill training in order to be employable above the wel- 
fare level, and this has taken some doing and is an active part of 
the program. 

Does that answer your question ? 

Mr. Mann. Yes ; thank you. 

Can a person be on methadone and take a periodic heroin shot 
for the euphoric effect and incur no increased physical danger be- 
cause of the combination of the two ? 

Dr. Gearing. I can't answer the question on physical danger. The 
answer from the standpoint of the patient is that many of them in 
the first few months that they are on methadone maintenance do 
shoot heroin and come back very angry because they spent their money 
on nothing, because they get no euphoria. That is supposedly the block 
of methadone, is that it blocks the effects of heroin. 

Chairman Pepper. We will take a short recess at this point. 

(A brief recess was taken.) 

Chairman Pepper. The meeting will come to order, please. 

Dr. Gearing, if I may interrupt before the other members return, 
I Avould iust like to ask you three things : 

One : We have had reports that about six people have died fn the 
District of Columbia in the last few months from taking methadone. 
Have you any comment to make on that ? 

Dr. Gearing. I would defer that to Dr. DuPont in his testimony, 
because he has the knowledge. I have only read it in the newspapers. 

Chairman Pepper. Have you experienced deals from methadone in 
New York? 

Dr. Gearing. Yes. 

Chairman Pepper. Roughly how many ? ^ 

Dr. Gearing. Aside from the ones in children, which were acci- 
dentally taken thinking it was orange juice, I think that there may be 
two or three in the young teenagers. 

Chairman Pepper. In your experience, are the deaths generally in 
cases where they were not previously addicted to heroin and they just 
started right off taking methadone ? 

Dr. Gearing. They were not tolerant to the dose of methadone they 
were taking. Whether they were on other drugs or not, I don't know. 

Chairman Pepper. Does the taking of heroin give you a tolerance for 
methadone ? 

Dr. Gearing. I don't know. 

Chairman Pepper. Well, the deaths, you would say, are people who 
have not developed tolerance for methadone ? 

Dr. Gearing. That is correct. 

Chairman Pepper. Who are beginning to take it for the first time ? 

Dr. Gearing. Who just took it accidentally or just for kicks, just like 
many of the heroin deaths we have in New York City are not in 
addicted kids. They are. in kids that are shooting for the first or second 
time and get either an allergic or some other kind of reaction, or a real 
overdose. 

Chairman Pepper. Do you agree with the testimony before this 
committee of Dr. Halpern of the city of New York, that any given 
dose of heroin, even to an addict, may be a fatal one ? 

Dr. Gearing. I certainly wouldn't contradict Dr. Halpern in a field 
in which he is an expert and I am not. 



118 

Chairman Pepper. Would you have any comment to make about the 
District of Columbia methadone maintenance program ? 

Dr. Gearing. Very few comments at the present time, because I 
have just recently started working with them. I think my first com- 
ment is on how rapidly it has ^rown and how well they were handling 
the problem of large numbers in any single unit. 

On my first visit to D.C. Hospital I was overwhelmed with the size 
of their population, that they were handling with the staff that they 
had and their unit at that point was, I think, something in he neighbor- 
hood of 600 patients. In T^ew York City, most of the outpatient units 
handle between 125 and 150 patients each. 

Chairman Pepper. Do you have enough money and personnel and 
facilities for the treatment of all of the heroin addicts in the city of 
New York? 

Dr. Gearing. Do I, sir ? 

Chairman Pepper. Yes. Are there available enough facilities and 
personnel ? 

Dr. Gearing. I am sure the answer to that is an unqualified no. I 
don't know if there is enough money in the world. 

Chairman Pepper. Same situation all over the country ? 

Dr. Gearing. Yes. 

Chairman Pepper. One other thing. Would you state what are the 
goals of the methadone maintenance program ? 

Dr. Gearing. Freedom from "heroin hunger," decrease in antisocial 
behavior, increase in social productivity, and recognition and willing- 
ness to accept help for other problems, such as alcohol abuse, other 
drugs, psychiatric and medical problems. 

Chairman Pepper. Mr. Winn. 

Mr. Winn. Thank you, Mr. Chairman. 

Dr. Gearing, just a quick question. We heard yesterday in the testi- 
mony the difference between psychotic craving and physiological crav- 
ing. What is the methadone reaction to these two cravings ? 

Dr. Gearing. The two psychiatrists who will follow me will probably 
be able to answer that question much better than I. 

It would appear from the patients who are admitted to the metha- 
done maintenance program in New York City that gross psychiatric 
problems are not a major portion of their problems. They have be- 
havioral problems very similar to the behavior problems that some of 
the rest of us have, and need sometimes more help with those and 
psychiatric help is available both on an individual basis and group 
psychotherapy. 

But it is not universally required. 

Mr. Winn. The testimony yesterday was that they could go through 
all of these treatments, cold turkey and all of that, and still have a 
psychiatric craving, that even though they were supposedly cured, the 
psychiatric craving would drive them back to hef oin. 

Dr. Gearing. I am sorry, but I don't know what a psychiatric crav- 
ing is, so I can't answer your question. 

Mr. Winn. But you have heard the term ? 

Dr. Gearing. Yes. 

Mr. Winn. Thank you very much. 

Chairman Pepper. Sorry, Mr. Mann, had you finished your ques- 
tioning? 



119 

Mr. Manx. I have one or two more, and I think perhaps I am in the 
psychiatric field, too, but not in the evaluation field. 

Would a nonaddict enjoy the methadone program ? 

Dr. Gearing. Would a nonaddict ? I wouldn't think so. 

Mr. Mann. Well, it offers a lot of other benefits, other than mere 

Dr. Gearing. Not really; you have to take an awful lot of medica- 
tion every day. 

Mr. Mann. Could a nonaddict get into the program ? 

Dr. Gearing. It would be difficult. 

Mr. Mann. This again is a question I perhaps shouldn't ask. 

Does the existence of a methadone program perhaps lessen the stigma 
or lessen the resistance to one becoming involved in heroin in the 
first place ? 

Dr. Gearing. I have no idea but I would think not ; no. 

Mr. Mann. You would hope not ? 

Dr. Gearing. Yes. 

Mr. Mann. You obviously have great faith in this program, and I 
am curious as to your major reaction, based on your evaluation as to the 
disadvantages, not in detail, but your major reaction to the disad- 
vantages. 

Dr. Gearing. The disadvantages have been well stated by many 
people. The first one is that it is an addictive drug that you are sub- 
stituting for another one. This is not my major objection. 

The second is it is a drug that has to be taken every day. It is our 
hope that at some point there will be developed a longer acting metha- 
done kind of treatment. 

I think the major objection to the program in New York City is 
the waiting time it takes to get into it, once the patient makes the de- 
cision that he wants to try it. 

Mr. Mann. Thank you. 

Thank you, Mr. Chairman. 

Chairman Pepper. Mr. Keating? 

Mr. Keating. No questions. 

Chairman Pepper. Mr. Rangel ? 

Mr. Rangel. Yes ; Mr. Chairman. 

Doctor, a lot of support is received by the methadone proponents 
because of the drastic decrease in crime. You presented, this morning, 
some rather dramatic statistics, and if I understand them correctly, 
you took a sampling of drug addicts and compared their records after 
having gone through the methadone treatment. 

Dr. Gearing. Yes; using the same sources of information we use 
on patients in the program. 

Mr. Rangel. And using their past criminal records as an indication 
of how drastic the criminal activities were reduced. 

Now, as a part of your program, I understand that you offer medical- 
psychiatric-social services, educational, job training, and all of this as 
a part of the methadone training program or methadone treatment 
program ; is that correct ? 

Dr. Gearing. Those services are all available to the patient ; yes, sir. 

Mr. Rangel. Assuming that all crimes are not comitted by addicts, 
that you had a group of people in central Harlem that have the same 
type of criminal record, and they were offered the same type of sup- 
portive services, of course, without the assistance of methadone, would 



120 

it not be so that we could project a drastic decrease in their criminal 
activity, especially in view of the fact that many of these addicts are 
former addicts employed by the programs on which they are treated? 

Dr. Gearing. I would hope that that were true, and I would like 
some data to show that it is true. The problem that we have had, is we 
have no comparative data, that is the reason we have to force a com- 
parison group. We have no data from any group that has such a 
facility. 

The only data we do have is in the detoxification unit. They do 
have a group where they have offered the services and they have not 
been terribly successful. 

Mr. Rangel. Notwithstanding all of this dramatic data and de- 
crease in crime, you could not really determine whether or not the 
decrease was due to job training, consultant services, opportunities 
for employment, or methadone? 

Dr. Gearing. That is correct. What we are saying is that this pro- 
gram offering this package in this way is doing this. That is all we 
can say. 

Mr. Rangel. Right. 

Now, in answer to a previous question you were saying that it is pos- 
sible for one to get a high, say, from methadone if not given orally. 

Dr. Gearing. It is my understanding that methadone intravenously 
gives a very nice high. 

Mr. Rangel. Well, the drug which is presently being adminis- 
tered in New York, could that be reduced to liquid so that it could be 
given intravenously ? 

Dr. Gearing. As I understand it, it is very difficult. I was goin^ to 
say it can't be done, but I was told today that it can, and knowing 
addicts who can shoot milk and a few things that some of the rest of 
us wouldn't dream of, they probably could shoot it ; yes. 

Mr. Rangel. Well, being raised in that community and still li\dng 
there, there is some thought we have now developed a type of metha- 
done addict, and my real question was in view of the earlier question 
of dual registration or using different names, if you now believe, as I 
believe, that it is possible to be produced as to what is dispensed to a 
drug that can be injected into the body intravenously, then what is to 
prevent a community from becoming addicted to methadone as a first 
experience in view of the fact that the patient could give any name 
and give a different name and receive free drugs? 

Dr. Gearing. I think this goes back to my suggestion that the dis- 
pensing of the drug is the key issue in this whole problem. 

Mr. Rangel. My question was one of registration. As I understood 
earlier 

Dr. Gearing. The patients do not get a week's supply of medication 
to sell on the street. The patient gets one dose that he takes on the 
premises. 

Mr. Rangel. What about the patients that you were saying come 
in twice a week? 

Dr. Gearing. Well, those patients are not the source of the drugs 
on the street. Those are the patients who have been in the program for 
a good long time. They are not selling it. 

Mr. Rangel. What I am asking is : Is it possible for this patient to 



121 

go to two or three different clinics and use two or three different names 
and receive two or three weekly dosages ? 

Dr. Gearing. If he went to a different place he would have to start 
all over again, because he would have to register as a new patient. 

Mr. Brasco. Would you yield for one moment? 

Mr. Rangel. Yes. 

Mr. Brasco. Dr. Gearing, I have heard, as Congressman Rangel has 
been trying to point out, that there is some traffic in the street with 
methadone, but what would be the value ? This is something that es- 
capes me. Why take the methadone if you don't get the euphoric effect 
that you want ? Is there some other valiie ? 

Dr. Gearing. These are questions that I cannot answer. This is not 
my field. I know that there is methadone on the street, and I think I 
told you where we believe the major source of it comes from. In fact, it 
was highlighted in the Xew York Times the other day. I do not think 
that the majority of methadone on the street comes from the patients 
who are on methadone maintenance. This is a very valuable piece of 
equipment to the patients. 

Mr. Brasco. But you don't know, then, I take it, the answer to my 
question. "Whether or not the use of methadone is the initial attraction 
as the use of heroin would be to an individual ? 

Dr. Gearing. I wish you would save those questions for Dr. Jaffe. 

Mr. Brasco. Thank you. 

Mr. Rangel. My last question is do you know of any reason why the 
Food and Drug Administration has not certified this drug? 

Dr. Gearing. I think they are overly cautious, to put it mildly. 

Chairman Pepper. Any other questions ? 

Thank you very much, Dr. Gearing. We appreciate your valuable 
testimony this morning. 

(The following material, previously referred to, was received for 
the record:) 

[Exhibit No. 10(a)] 

Successes and Failures in Methadone Maintenance Treatment of Heroin 

Addiction in New York City 

(By Frances Rowe Gearing, M.D., M.P.H. (Supported under Contract No. C- 
35806 from New York State Narcotic Addiction Control Commission), Associ- 
ate Professor, Division of Epidemiology Columbia University School for Public 
Health and Administrative Medicine, and Director, Methadone Maintenance 
Evaluation Unit) 

For Presentation at Third National Conference on Methadone Treatment, Satur- 
day, November 14, 1970, Park Sheraton Hotel, New York, N.Y. 

introduction 

October 1 marks the fifth anniversary of the establishment of the methadone 
maintenance evaluation unit and the first meeting of the evaluation committee. 
When our unit began operations there were 66 men and eight women in the pro- 
gram and there were facilities available to admit approximately seven new 
patients each month. As time has marched on, the progress reports from our 
Evaluation Unit have attempted to monitor the progress of the program with 
cautious optimism, with the result that we have been quoted and misquoted by 
legislators at all levels of government and by all the mass media. 

Our recommendation for continued expansion of the program has resulted in 
a veritable population explosion in the past year. As of October 31, 1969, the 
methadone maintenance treatment programs under our surveillance included 
six inpatient induction units, and ambulatory induction was just beginning. The 

60-296 O— 71— pt. 1 9 



122 

admission rate was approximately 50 patients each month, equally divided be- 
tween ambulatory and inpatient induction with rather cautious selection of those 
admitted for ambulatory induction. 

This year has seen an almost complete reversal in this procedure. The vast 
majority of patients are currently being stabilized on an ambulatory basis, and 
inpatient services are used only for those patients who present unusual problems. 

As of October 31, 1970, we have under surveillance 13 inpatient induction units 
and 46 active outpatient and ambulatory units. These units cover the four largest 
New York City boroughs and lower Westchester County. How many patients 
are involved? Table 1 shows the October 31, 1970, census. There have been 4,376 
admissions to date, and 3,485 patients are under treatment. This is contrasted 
with the census as of October 31, 1969, when there were 2,325 admissions and 
1,886 patients in treatment. This highlights the rapid expansion from approxi- 
mately 50 patients per month to a level of 50 new patients each week. The loca- 
tions of the inpatient and outpatient units are listed in appendixes A and B for 
those who are interested. The rapid induction group is a relatively new unit, 
opened in late July 1970, to which a group of approximately 100 patients from 
the waiting list have been offered ambulatory induction to methadone main- 
tenance with medication only and little or no supportive services at the outset. 
The success rate in this group is being followed with great interest because Its 
initial objective is to delineate that portion of the accepted patients which can 
be maintained with only minimal supportive services. 

DESCRIPTION OF SAMPLE 

The age distribution of patients in the methadone maintenance treatment pro- 
gram has not changed substantially over the past 5 years despite the change in 
age criteria for admission. This appears to be the result of two balancing forces. 
These are (1) the inclusion of a few 18-year-old patients, and (2) the admission 
of a small number of oriental patients who are in their late 50's. Therefore, the 
median age of all patients remains at about 33.3 years with the average age of 
the black patients somewhat older (35.6) . 

The ethnic distribution remains approximately 40 percent white, 40 percent 
black, 19 percent Spanish and 1 percent oriental. 

We will discuss the "failures" first. 

RATE OF DISCHARGE 

The rate of discharge by month of observation has demained amazingly stable 
despite the changes in admission criteria and the change of emphasis from in- 
patient induction to ambulatory induction. This is illustrated in figure 1 where 
the rates of discharge for the two groups are contrasted. The two curves are 
identical. The Van Etten group, which active tuberculosis as an additional prob- 
lem to heroin addiction, demonstrate a somewhat accelerated discharge rate as 
might be expected. 

In figure 2 we contrast three cohorts of 500 patients by date of admission, and 
once again we find no difference in rates of discharge among these three cohorts 
representing the first 1,500 patients admitted to the program. 

Figure 3 contrasts the discharge rate for men and women. The slight difference 
shown is not significant due to the much smaller number of women. The rate of 
discharge for men by age at time of admission is shown in figure 4 and once 
again shows no difference between younger and older patients. A small difference 
appears in figure 5 between the rate of discharge in the third year between 
black and white patients. This difference is not statistically significant at this 
point but bears monitoring in the future. 

SEASONS FOR DISCHARGE 

As shown in figure 6 problems with alcohol abuse as a reason for discharge 
increases with age at time of admission for both men and women, drug abuse 
(primarily amphetamines and barbiturates) as a reason for discharge decreases 
with age and is more common among the women than among the men. Voluntary 
withdrawal from the program increases with age particularly among the men. 

Discharge for behavior or psychiatric reasons is more common among the 
younger patients of both sexes. Deaths follow the pattern in the general 
population. 



123 

When we look at reasons for discharge by ethnic group as shown in figure 7, 
we note that alcohol problems are more common among the black patients and 
drug abuse is more commonly a factor among the white and Spanish patients. 

Voluntary withdrawals and discharge for behavioral reasons account for the 
majority of dropouts in the first year. Chronic problems with alcohol abuse, and 
continued drug abuse were the major causes of discharge in the second and third 
year. 

FOLLOWUP OF DISCHARGED PATIENTS 

With the assistance of two medical students, (Michael Lane, Downstate Medi- 
cal School, and Mary Hartshorn, Medical College of Pennsylvania) during this 
past summer, we completed an intensive foUowup on a sample of patients who 
had left the program. We selected all patients who were discharged alive by 
December 31, 1969, and who had been in the program 3 months or longer at the 
time of discharge. This gave us a pool of 562 persons. We divided this group into 
two segments: (1) those who had left the program voluntarily, and (2) those 
who had been discharged from the program for cause. 

Our primary source of followup was the New City Narcotics Register which 
receives reports from the police and correction agencies, hospitals, and treat- 
ment programs, and from private practitioners. Another very useful source was 
a series of interviews with patients who left the program and have subsequently 
been readmitted. This was a major contribution by the medical students. 

For the sample of 281 patients on whom we could obtain 6 months of follow- 
up the results are shown in table 2. 

Those patients who left the program voluntarily had a lower arrest and de- 
toxification record, than the rest. They also had a larger proportion admitted 
to other treatment programs an one-third had been readmitted to the program, 
contrasted with only 6 percent of those discharged for cause. If one considers 
that no record found is roughly equivalent to remaining "clean," one-third of 
this group were still "clean" 6 months after leaving the program. 

The same sampling procedure was followed for the 396 patients on whom we 
could obtain 12 months to followup. These results are shown in table 3. In this 
group only 21 percent would be considered still "clean." The readmission rate 
was somewhat lower (13 percent). Except for arrests and deaths those who left 
the program voluntarily are very similar to the other group. 

Table 4 shows the results of the followup on our sample of 181 patients on 
which we had a followup of 1 year or more. Here the readmission rate is 22 
percent and the proportion who appear to have remained "clean" is only 18 
percent and the death rate reaches 5 percent. 

These data would tend to indicate that, among those patients who withdraw 
from methadone maintenance treatment, only a small portion have been able to 
"make it" on their own. 

Because of the tremendous current interest in "criminality" associated with 
addicition, we looked into the previous arrest records of those patients who 
have remained in the program, contrasted with those who left the program 
voluntarily, and those who were discharged for cause. We contrasted this, in a 
"before and after" picture, as shown in figure 3. It is interesting to note that 
the past history of those who were discharged for cause with reference to arrests 
is worse than either of the other two groups — and that their behavior following 
discharge is as poor or worse than before admission. Those who left voluntarily, 
demonstrate a short preiod of improvement but also tend to return to their 
previous arrest pattern. Those who remained in the program show a constant 
and accelei'ated decline in criminal behavior as measured by arrests. 
Enough of failures. Now let's discuss successes. 

CRITERIA FOR SUCCESS 

The criteria established by our evaluation unit with the approval of the evalua- 
tion committee for measuring success of the program has resolved around four 
basic measures : 

(1) Freedom from heroin "hunger" as measured by repeated, periodic "clean" 
urine specimens. 

(2) Decrease in antisocial behavior as measured by arrest and/or incarcera- 
tion (jail). 

(3) Increase in social productivity as measured by employment and/or school- 
ing or vocational training. 

(4) Recognition of, and willingness to accept help for excessive use of alcohol, 
other drugs, or for psychiatric problems. 



124 

BESULTS 

(1) Although many of the patients test the methadone "blockade" of heroin 
one or more times in the first few months, less than 1 percent have returned 
to regular heroin usage while under methadone maintenance treatment. 

(2) Antisocial behavior as measured by arrests and incarcerations (jail) have 
been looked at in several ways. First, the percentage of arrests among patients 
in the program during the 3 years prior to admission was compared with the per- 
centage of arrests of these same persons following admission. This "before and 
after" picture is also contrasted with the proportion of arrests in a contrast group 
of 100 men selected from the detoxification unit at Morris Bernstein Institute 
matched by age and ethnic group and followed in the same manner. The results 
are illustrated in figure 9. The arrest records of these two groups are quite simi- 
lar for each year of observation prior to admission. Following admission to the 
program, the contrast is striking for each period of observation with the metha- 
done maintenance patients showing a marked decrease in the percentage of 
patients arrested, and the contrast group showing a pattern very similar to the 
earlier period of observation. 

We have also calculated the arrests per 100 patient-years of observation for the 
3 years prior to admission in contrast to the arrests per 100 patient-years of 
observation after admission. We have compared these data using the same com- 
putations for the contrast group. The results are shown in table 5. These results 
would appear to indicate that remaining in the methadone maintenance program 
does indeed decrease antisocial behavior as measured by arrests or incarcerations. 

(3) Increased social productivity can best be illustrated by the employment 
profiles shown in figures 10 and 11. There is a steady and rather marked increase 
ii the employment rate with a corresponding decrease in the percentage of 
patients on welfare as time in the program increases. This is true both for the 
men and the women. These data include both ambulatory and inpatient induc- 
tion groups. This accounts for the increased percentage of men employed at time 
of admission since this was one of the early criteria for admission to an ambula- 
tory unit. 

(4) Figure 12^ is an attempt to illustrate stability of employment among 
patients remaining in the program as contrasted with their previous employment 
experience. The shaded area might be considered as a measure of their increased 
social productivity since admission to the program. 

(5) Although chronic alcohol abuse continues to be a problem for approxi- 
mately 8 percent of the patients (both men and women), and for some becomes 
the principal reason for discharge, a majority of these patients show continued 
improvement in their ability to handle their alcohol problem with the support 
and assistance of members of the program staff who recognize the problem, and, 
are willing and able to cope with it. 

(6) Problems with chronic abuse of drugs such as barbiturates, amphetamines, 
and more recently cocaine are evident in approximately 10 percent of the patients. 
There again, for some, it has resulted in discharge from the program. For many 
othets, the patients are able to function satisfactorily, with the assistance and 
support of members of the program staff. 

CONCLUSIONS 

On balance, the successes in the methadone maintenance treatment program 
far outweigh the failures. The rapid expansion of the program during the past 
year, and the change in emphasis to include primarily ambulatory induction 
under the expanded admission criteria does not appear to have made any notice- 
able change in the effectiveness of this treatment for those heroin addicts who 
have been accepted into the program. A majority of the patients have completed 
their schooling or increased their skills and have become self-supporting. Their 
pattern of arrests has decreased substantially. This is in sharp contrast to their 
own previous experience, as well as their current experience when compared with 
a matched group from the Detoxification unit, or when compared with those 
patients who have left the program. Less than 1 percent of the patients who 
have remained in the program have reverted to regular heroin use. 

A small proportion of the patients (10 percent) persent continued evidence of 
drug abuse involving use of amphetamines, barbituarates, and cocaine, and 
another 8 percent demonstrate continued problems from chronic alcohol abuse. 
These two problems account for the majority of failures in rehabilitatin after the 
first 6 months. 



125 

Methadone maintenance as a treatment modality was never conceived as a 
"magic bullet" that would resolve all the problems of patients addicted to heroin. 
For this reason, we believe that any treatment program using methadone mainte- 
nance must be prepared to provide a broad variety of supportive services to 
deal with problems including mixed drug abuse, chronic alcoholism, psychiatric 
or behavioral problems, and a variety of social and medical problems. 

Many questions continue to remain unanswered with reference to the role of 
methadone maintenance in the attack on the total problem of heroin addiction ; 
nevertheless the data presented on the group of patients who have been ad- 
mitted to this methadone maintenance treatment program continues to demon- 
strate that this program has been successful in the vast majority of its patients. 

After a careful review of the data related to successes and failures over the 
past 5 years, the methadone maintenance evaluation conmiittee has submitted 
the following recommendations as of Friday, November 6, 1970 : 

KECOMMENDATIONS 

As a result of the continued encouraging results in the methadone maintenance 
treatment program through October 31, 1970, the methadone maintenance evalu- 
ation committee recommends : 

(1) That there be continued financial support for the methadone mainten- 
ance treatment program to allow continued intake of new patients using ad- 
mission criteria including a minimum age of 18 years and a history of a mini- 
mum of 2 years of addiction with care in selection of patients to prevent the 
possibility of addicting an individual to methadone who is not physiologically 
addicted to heroin. 

(2) That there be continued evaluation of the long-term effectiveness of the 
methadone maintenance treatment program for the group stabilized on art in- 
patient basis, the group being stabilized on an ambulatory basis, and the group 
undergoing rapid induction. 

(3) That new programs which plan to use methadone maintenance should in- 
clude all eleemnts of the program including : 

(c) Availability of adequate facilities for the collection of urine and labor- 
atory facilities for frequent and accurate urine testing. 

(&) Medical and phychiatric supervision. 

(c) Backup hospitalization facilities. 

id) Adequate staff including vocational, social, and educational support 
and counseling. 

(e) Rigid control of methods of dispensing methadone and number and 
size of aoses given for self -administration in order to prevent diversion to 
illicit sale or possible intravenous use. 

(/) Staff members of potential new programs planning to use methadone 
maintenance be trained in this technique in a medical center which has 
been shown to use methadone maintenance effectively. 
4. That continued research is essential particularly with reference to : 

(c) The role of methadone maintenance in the treatment of young heroin 
addicts ( under 18 ) . 

(&) Developing programs using methadone maintenance in combination 
with other approaches to the treatment of heroin addiction. 
Projects in these areas should be supported and encouraged, but must be con- 
sidered new research studies, and should be subjected to the same surveillance, 
and independent evaluation as the current programs. 

(5) That methadone maintenance not be considered at this time as a method 
of treatment suitable for use by the private medical practitioner in his office 
practice, because of the requirements for other program components including 
social rehabilitation and vocational guidance. 

(6) That a pilot or demonstration project be developed involving the use of 
properly trained practicing phy.sicians as an extension of an organized methadone 
maintenance treatment program to treat those patients whose needs for ancillary 
services are minimal. These patients should be continued under the supervision 
of the methadone maintenance treatment program for periodic evaluation and 
urine testing. 

ACKNOWLEDGMENTS 

1. The members of the methadone maintenance evaluation committee, both past 
and present with particular reference to Dr. Henry Brill, who has so aptly 
chaired that committee since its inception. 



126 

2. All the members of the methadone maintenance treatment program staff for 
their devotion to their job and for their cooperation whenever needed. 

3. The staff of the Rockefeller Data Bank especially Dr. Alan Warner and 
Mrs. Ellen Smith for their willingness to make available to us, whenever re- 
quested, data which has been a crucial starting point of our evaluation. 

4. Those medical students who have made substantial contributions to our 
efforts over the past 4 years. 

5. The directors of the New York City Narcotics Register who have allowed 
us to use their data for validation and for followup. These listed in chronological 
order over the past 5 years are : Dr. Florence Kavaler, Mrs. Zili Amsel, Miss Joy 
Fishman, Mr. Sherman Patrick. 

6. The diligence and devotion of my staff including : Mrs. Dina D'Amico, Mrs. 
Angela del Campo. Mrs. Frieda Karen, Miss Elaine Keane, Mrs. Dorothy Mad- 
den, Mrs. Ingel Mayer. 

7. And last but not least to the New York State Narcotic Addiction Control 
Commission for funding our efforts. 



127 



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20- 



10- 



11/10/70 



128 



HETHADOHE MAINTENANCE TREATMENT PROGRAM 

Rate of Discharge by Month for Patients Inducted on an Ambulatory Basis 

Versus In-Patient Induction and Van Etten 

as of June 50, 1170 




n= 1921 

n= 130'i o- 
n= 11)7 X- 



— - In-Patlent Induction 
-O = Ambulatory 
-X» Van Etten 



—r 

12 



— r 

15 



21 



2k 



— r 

27 



30 



— r 
33 



36 



Months 



— r 
39 



U2 



Figure 2 



Methadone Maintenance Treatment Program 

Rate of Discharge by Month for Three Successive Cohorts of 500 Patients 
By Dote of Admission 




kO 



Cohort #1 = • ' 

Cohort #2 - 

Cohort #3 = X X 



2e 



10 



n/K/70 



—r 



-r~ 



"T" 



12 15 18 



21 2k 27 30 33 36 39 1(2 1*5 

Months 



kS 



129 



Figure 3 



METHADONE MAINTENANCE TREATHEIIT PROGRAM 

Rate of Discharge by Month for Men versus Vtonen 
as of June 30, 1970 



100- 
90 i 
SO 
70 

60 

50- 

llO- 
30- 



20- 



16 



n/ic/70 



~~o~r 



~o^r- 



^=r- 



--o^^r^ 



-o— 



-o~- 



12 



— r- 
15 



— 1- 
18 



2i 21' 27 30 33 36 



Months 



O o- 



Men n= 2835 

Women n= 537 



Figure ^i 



60-1 



so- 
li 0- 

30- 

20- 



10- 



Methadone Maintenance Treatment Program 

Rate of Discharge by Hcnth for 2835 Men by Ag? at Time of Admission 
as of June 30, 1970 




— r- 
12 



. .= -^30Yrs. n= 709 

•= 30-39 Yrs.n= 1802 

> v= I10+ Yrs. n= 32'i 



— I 1 1 

15 18 21 

Months 



zif 27 



— r- 
30 



33 



— I 
36 



11/18/70 



Figure 5 

100- 
SO- 
SO- 

70- 
60- 

50 • 
o 

C 

o 

i- 

« 

a. 

20 



130 



Methadone Halnten?nce Treatment Program 

Rate of Discharge by Month for ?306 Men by Ethnic Group 
as of June JO, 1970 



10 




11/' 0/70 



. ■= White n=l IJO 

X v= Spanish n= SS^ 

= Black n=I122 



3 6 9 



"1 1 1 1 1 1 1 1 1 1 

12 15 18 21 2i) 27 30 33 36 

Months 



Figure 6 METHADOflE MAIMTEMANCE TREATMENT PROGRAM . 

Percentage Distribution of Principal Reason for Discharge of 718 Patients by Age at Time of Admission 



<lO 



c 20 



-Ti 



f 
i 



Alcohol 



40 



20 - 



I 



i 



i 



A) Women n=l 19 



I 



^ 



■ 



Arrests Drugs Voluntary ''ehavior 



I 



i 



Death 

[;f: :JAge 20-29 

B) Men n=599 |_l*9e 30-39 

K/ylAge 110+ 



JZZZL 



E^m 



Alcohol Arrests 



Drugs Voluntary Tehavior 



Death 



11/10/70 



131 

Figure 7 METHADONE HAINTEHAHCE TREATMENT PROGRAM 

Percentacje Distribution of Principal "eason for discharge of 710 Patients by Ethnic Group 



"lO- 



c 20- 






i 



r-^ 



A) Women n= 1 19 



i 



m 



Alcohol Arrests Drugs Voluntary "ehavior Death 



Jia 



20- 



1 



i 



B) Men n= 599 



D 



Black 



V/hite 



Spanish 



n^ 



Alcohol Arrests Drugs Voluntary Behavior 



Death 



11/10/70 



132 



TABLE 2.-METHAD0NE MAINTENANCE TREATMENT PROGRAM 
IFollowup of 281 patients 6 months following discharge from M.M.T.P.; in percent] 





Left 

volun- 
tarily 


Dis- 
charged 
for cause 


Total 
dis- 
charge 




Left 

volun- 
tarily 


Dis- 
charged 
for cause 


Total 
dis- 
charge 


Arrest or jail 

Dead 

Detoxification 

Other Rx program 

Medical or psychiatric 
facility . 


10 

2 

13 

11 

2 


26 
2 

20 
4 

3 
2 


23 

2 

19 

7 

2 
2 


Moved 

Readmitted 

No reports found 

Total sample 

Total N.. 


7 

33 
22 


1 

6 

36 


1 

11 
33 


. 45/100 
. 90 


236/100 
472 


281/100 
562 


Private medical doctor. . 







TABLE 3.— METHADONE MAINTENANCE TREATMENT PROGRAM 
IFollowup of 198 patients up to 1 year after discharge from M.M.T.P.; in percent] 





Left 
volun- 
tarily 


Dis- 
charged 
for cause 


Total 
dis- 
charge 




Left 
volun- 
tarily 


Dis- 
charged 
for cause 


Total 
dis- 
charge 


Arrester jail 

Dead 

Detoxification 

Other Rx program 

Medical or psychiatric 

facility 

Private M D 


13 

34" 

6 

3 
3 


28 
2 

23 
6 

4 

1 


25 
2 

25 
6 

4 
2 


Moved 

Readmitted 

No reports found 

Total sample 

Total N 


25 


2 
13 
21 


2 
13 
21 


. 32/100 
. 64 


166/100 
232 


198/100 
396 







TABLE 4.-METHAD0NE MAINTENANCE TREATMENT PROGRAM 
[Followup of 181 patients 1 year or more after discharge from M.M.T.P.; in percent] 



Arrest or jail. 

Dead 

Detoxification 

Other Rx program 

Medical or psychiatric 

facility.. 

Private M.D.. 



Left Dis- 

volun- charged 

tarily for cause 



18 



37 
11 

6 
6 



30 
5 

27 
11 

7 
3 



Total 

dis- 
charge 



28 
5 

28 
22 

7 
3 



Left Dis- 

volun- charged 

tarily for cause 



No reports found. 
Readmitted' 



21 
129 



17 
121 



Total sample 28/100 153/100 

Total N 56 306 



Total 
dis- 
charge 



18 
122 



181/100 
362 



> Readmitted patients each had 1 or more reports of arrest or detoxification. 



Figure 8 



133 



HETHAOOIIE MArMTCMArXE JREMIW.'T PROGRAM 



Comparison of Arrest Records Amonn Persons 
Continuing and Oischarcerl from Methadone Maintenance Treatment Program 



Prior to Admission 



a - Since Admission 
■^ b £ c - Since Discharge* 




years 



' years ^ 



n ".MP , (2560) (2560) 
n Vol.Dis. CtS) CtS) 
n lnvol.Dis.(23f>) (23&) 



(2560) (2560) OSA'.) (788) iiBt*) 
('•5) (AS) (32) (20 
(236) (236) (166) (153) 



*AI1 discharges had participated in HMTP for at least 90 days prior to discharge. 
10/26/70 



Figure 9 



134 



Methadone tlaintenance Treatment Progran 



Percentage Distribution of Arrests for 2G'»1 Men In Methadone Maintenance Program 

Three Months or Longer as of Harch 31, K-?") and Contrast Group 

5y Months of Observation 



DEFORE <- 



START 



^ AFTER 



Percentage 
30-1 



20- 



10- 




Year Prior to Admission 
to Program 



Year After Admission 
to Program 



n MMP (28'il) 


(23'il) 


(28'»J) 


(281)1) 


(15'*'.) 


(788) 


OSM 


n Contrast (100) 


(100) 


(100) 


(100) 


(98) 


(95) 


(92) 


11/10/7^ 















135 

TABLE 5.— METHADONE MAINTENANCE TREATMENT PROGRAM 

iThe Number of Arrests and Incarcerations per 100 Person-Years for Methadone Maintenance Patients Before and After 
Admission Contrasted With Patients From Detoxiflcation Unit] 

Methadone Detoxification 
group group 

Before admission: 

Arrestsper 100 person-years 115 131 

Jail per 100 person-years... 49 52 

N=person-years 17,500 600 

Following admission: 

Arrestsper 100 person-years 4.3 135 

Jail per 100 person-years 1.0 63 

N=person-years 10,800 1,040 



136 



Figure 10 



Methadone Ka'ntanance Treatmf:nt Program 

EfTipIoyment Status and School Attendance for Men in Metiadone Maintenance 

Three Months or Longer as of March 3'. '970 

(In-Patient and Ambulatory Induction 



00- ^ 


^ 


^ 


^ 


:^ 


^ 


^ 


^ 


-_ 






1 




— 1 

— 1 

— 1 






80- 


/ 


^32 




' 


= 


— 


^ — 




— 






/ y 




[ ' 




60 - / 


• y/^ 














// 
















/ / 
















/ / 
















"tO -11 
















20 _ 
- 










• 







School 
Welfare 



Supported by 
Others 



Employed 



6 Months 12 Months 18 Months Ih Months 30 Months 36 Months 'i2 Months A8 Months 
Months Following Admission to Program 
n- (I97lt) (1807) (1330) (891) (650) (468) (330) (203) (R1) 



11/9/70 



Figure II 



Methadone Haintensnce Treatmant Program 

Employment Status and School Attendance for '(66 Women in Methadone Maintenance 
Three Months or Longer as of 'l.-.rch ?1, WT^ 
(In-Patlent and Ambulatory Induction) 



100 




11/10/70 



n= (1)66) 



VsM School 



Welfare 



Homemsker 



Employed 



6 Months 12 Months 18 Months 2't Months 30 Months 36 Months 
Months Following Admission to Program 
(JitS) (2i.5) (161) (109) (71) (A5) 



137 



Figure 12 Methadone Maintenance Treatment Program 

Percent of Pcrson-fonths of Observation During Which Mon in Program l/ere Employed 
Defore and After Admission by Duration of Employment 
as of July 31, '963 



Increase of Observed 
Over Expected 



* F 1 A Person-Months of Employment 

* Einployed = Person-Months of Observation 



Sli Months 
'/] 51 Months 




% Employed 
Prior to Admission 



% Employed 
Following Admission 



ADMISSION TO PROGRAM 



11/10/70 



60-296 O - 71 - pt. 1 - 10 



138 



Appendix A^ — Methadone Maintenance Treatment Program 
Inpatient Induction Units by County as of October 31, 1970 

Manhattan : 

Grade Square Hospital (men and women). 

Harlem Hospital (men). 

Morris J. Bernstein Institute (men ad women). 

Riker's Island (men). 

Rockefeller University Hospital (men and women). 

Roosevelt Hospital (men and women). 

St. Luke's Hospital (men and women). 
Bronx : 

Albert Einstein Medical Center ( men and women ) . 

Bronx State Hospital (men and women) . 
Brooklyn : Brookdale Hospital (men and women). 
Westchester County : 

St. Joseph's Hospital (men and women). 

White Plains Hospital (men and women). 

Yonker General Hospital (men and women). 



Appendix B — Methadone Maintenance Treatment Program 
Outpatient and ambulatory induction units by county as of October 31, 1970 



Number 
of units 
Manhattan : 

City Probation 2 

Gracie Square Hospital 1 

Greenwich House 1 

Harlem Hospital 5 

Jewish Memorial Hospital 1 

Morris J. Bernstein Institute 1 

Lower East Side 10 

Lower West Side 2 

Rapid Induction 1 

Mount Sinai Hospital 1 

Rockefeller University 

Hospital 2 

Roosevelt Hospital 1 



St. Luke's Hospital- 
St. Vincent's Hospital. 
Bronx : 

Bronx State HospitaL. 

Lincoln Hospital 

Van Etten Hospital— 



1 
1 

1 
1 
1 



Number 
of units 
Brooklyn : 

Brookdale Medical Center 1 

Coney Island Hospital 2 

Cumberland Hospital 2 

Lutheran Hospital 1 

Methodist Hospital 1 

Queens : 

Long Beach Memorial 

Hospital 

Triboro Hospital 

Westchester : 

St. Joseph's Hospital 1 

White Plains Hospital 

Yonkers General Hospital 

Yonkers Public Health Build- 
ing (WCCMHB) 



1 
2 



1 
1 



[Exhibit No. 10(b)] 
Position Papek : Methadone: — A Valid Treatment Technique 

(By Frances Rowe Gearing, M.D., M.P.H. (Supported under Contract No. C-35806 
from New York State Narcotic Addiction Control Commission), Associate 
Professor, Division of Epidemiology, Columbia University School of Public 
Health and Administrative Medicine, and Director, Methadone Maintenance 
Evaluation Unit) 

For Presentation at State Conference on "Drugs — The Issues on Trial," 
Pontiac, Mich., December 2, 1970 

Position Paper — Methadone Maintenance : a Valid Treatment for 

Heroin Addiction? 

My answer to this question is yes when properly administered in an organized 
methadone maintenance treatment program. 
There are at least five basic reasons for my positive response which I list: 



139 

1. DRUG PKOPEKTIES 

Methadone has several properties which make it useful as a treatment for 
heroin addicts. These properties includes the following : 

(a) It is a longer acting drug than heroin. Patients on methadone mainten- 
ance, after a relatively short induction period, require only one dose a day. This 
contrasts with four to six fixes a day for the patient "hooked" on heroin. 

(&) Methadone is given by mouth in noninjectable form. This alone makes it 
most attractive from a medical standpoint, because it is well-known that many 
of the medical problems of heroin addicts are related to intravenous injection 
without proper sterilization techniques. These problems include, hepatitis, endo- 
carditis, tetanus, and a plethora of other medical problems. 

(o) Patients on methadone can be gradually built up to a stabilizing dose of 
between 80-120 mgs. daily, and can be maintained at this level over periods of 
time up to 5 years without having to alter the dosage level. This is in sharp 
contrast to the addict's experience with heroin. Patients on heroin rapidly de- 
velop a tolerance to the ordinary street "bag" to the point where they have 
eitlier to increase the number of bags for each "fix" and increase their hustling 
in order to get more "bags" more often to support their needs, or to apply at a 
detoxification unit for a drying-out period which will bring them back on the 
street within 2 weeks with a less-expensive habit. 

(d) Methadone maintenance when used at high dosage levels produces a 
"blockade" against the effect of heroin which might be referred to as heroin 
"euphoria." Under carefully controlled circumstances, patients stabilized on 
methadone maintenance given by mouth have demonstrated that this blockage 
is effective even with high doses of pure heroin. 

(e) The long-term medical effects of methadone maintenance are minimal. 
This statement is based on a careful medical followup of a series of 80 patients 
who have been on 80-120 mgs. of methadone daily for a period of over 5 years. 

These properties make methadone a very useful tool in the treatment and 
rehabilitation of patients addicted to heroin for the basic reason that it gives 
former heroin users a chance to use their time in a more productive way. Under 
methadone maintenance they are relieved of the problem of spending most of 
their waking hours in hustling for means to get their next "fix." This difference 
might be equated with the difference between the old insulin treatment for di- 
abetes patients which involved three to four injections per day based on urnie 
samples. The new look in diabetes treatment is more apt to be one injection a day 
of long acting insulin or control by medication which can be administered orally. 

2. REHABILITATION — EMPLOYMENT AND SCHOOLING 

Patients on methadone maintenance can remain in their local community with 
their family or peer groups throughout their treatment. They are encouraged 
and offered considerable assistance by members of the program staff to complete 
their basic education at least through high school, to acquire a skill through 
additional vocational training, to becoming a wage earner and hopefully become 
self-supporting. 

These objectives have been achieved in a majority of the patients in the metha- 
done maintenance treatment program in New York City as illustrated by the 
employment profiles by men and women in figures 1 and 2. There is a steady and 
rather marked increase in the employment rate with a corresponding decrease 
in the percentage of patients on welfare as time in the program increases. This 
is true both for the men and the women. 

3. CRIMINALITY 

Patients on methadone maintenance have demonstrated a rather striking 
change in their antisocial behavior as measured by arrests as shown in figure 3, 
where the percentage of arrests among patients in the methadone maintenance 
treatment program is contrasted with their arrest experience for the 3 years 
prior to adminission and this "before and after" picture is contrasted with the 
proportion of arrests in a contrast group of men selected from the detoxification 
unit at Morris Bernstein Institute matched by age and ethnic group and followed 
over the same period. The arrest records of the two groups are quite similar for 
each year of observation prior to admission. FoUwing admission to the program 
the contrast is vivid for each period of observation with the methadone mainte- 



140 

nance treatment patients showing a constant and accelerated decline in criminal 
behavior and the contrast group showing a pattern very similar to the earlier 
period of observation. 

4. SUPPORTIVE SERVICES 

Patients on methadone maintenance have available to them on demand one 
or more members of the program staff who are ready, willing, and able to re- 
spond to their needs whether these needs be medical, psychiatric, vocational, 
social, or legal. 

5. PROGRAM PHILOSOPHY 

Treatment programs for heroin addiction using methadone maintenance have 
accepted the fact that the "hard-core" addicts have a chronic disease, and, there- 
fore, need medication and support over a long period of time, if not for life. 

This philosophy has resulted in a more permissive attitude toward patients 
who show evidence of recurrent abuse of other drugs such as barbiturates and 
amphetamines or continued chronic alcohol abuse, and every effort is made to 
assist the patients in handling these problems. Only when this support fails are 
patients dropped from the program. 

CONCLUSION 

Methadone maintenance is a valid treatment for those hard-core addicts who 
are 18 years or older with a history of at least 2 years of addiction and who 
have had difficulties in adjusting to the stringencies of abstinence programs. 
Among patients selected in this manner methadone maintenance has proved 
successful in 80 percent of more than 4,000 patients in the New York City metha- 
done maintenance treatment program. A majority of the patients have com- 
pleted their schooling or increased their skills and have become self-supporting. 
Their pattern of arrests has decreased substantially. This is in sharp contrast 
to their own previous experience, as well as their current experience when com- 
pared with a matched group from the detoxification unit, or when compared with 
those patients who have left the program. Less than 1 percent of the patients 
who have remained in the program have reverted to regular heroin use. No other 
treatment program can demonstrate a better rate of success. 

Methadone maintenance as a treatment modality was never conceived as a 
"magic bullet" that would resolve all the problems involved in heroin addic- 
tion. For this reason, we believe that any treatment program using methadone 
maintenance must be prepared to provide a variety of supportive services to deal 
with such problems as mixed drug abuse, chronic alcoholism, as well as psychia- 
tric or behavioral problems and a variety of other social and medical problems. 
Therefore, methadone maintenance should not be considered as a method of 
treatment suitable for use by the private medical practitioner in his office prac- 
tice, because of the requirements for other program components including social 
rehabilitation and vocational guidance. 



141 



Figure I 



Methadone Maintenance Treatment Program 

Employnent Status and School Attendance for 15-:6 i-ien in Methadone Maintenance 
Three Months or Lcnqer as of March 31. 1*^70 
(In-Patient Induction) 



100— 



80- 



fo- 



w_ 



20- 



0- 



v\- 


, ^ 


s^^ 


>^:;l ^ 


ii^ 


;nV 


\v 










^ 








/ 









Welfare 



Employed 



n= (13i6) 



C .or.ths 12 Monfis 18 Months i'4 Mcr.ths 30 Months 35 Months hi Months U% Months 
Month: Fcllowing Adrnission to Program 
.-23) (•.;7J) (77M (606) (IjSA) (330) (203) (31) 



\'in(>na 



Figure 2 



Methadone Maintenance Treatment Program 

Employment Status and School Attendance for ^S6 Vtomen in Methadone Maintenance 
Three Months or Longer as of ''arch '1, l-'?" 
(In-Patient and Ambulatory Induction) 



100— 




11/10/70 



(':!i£) 



'vTs i School 



V/el fare 



Homemaker 



Employed 



6 Months 12 Months 18 Month; Ik Months 30 Months 36 Months 
Months Following Admission to Program 
(3^5) (2^5) (161) (10?) (71) Ct?) 



142 



Figure 3 



•lethadone Kaintenance Treatment Program 



Percentage Distribution of Arrests for 2u'»I '';en in Methadone f'aintenance Program 

Three Months or Longer as of 'jrch 31, ''7"^ arid Contrast Group 

^y Mor.ths of Observation 



CEFORE <- 



START 



-^ AFTER 



Percentage 

3r-i 



20- 




10- 



Year Prior to Admission 
to Program 



Year After Admission 
to Program 



n (IMP (ZSkl) 


(2341) 


(2841) 


(2841) 


(1544) 


(780) 


(384) 


n Contrast (100) 


(100) 


(100) 


(100) 


(98) 


(95) 


(92) 


11/10/70 















143 

Chairman Pepper. Our next witness is Dr. Robert L. DuPont, Di- 
rector of the District of Columbia Narcotics Treatment Administra- 
tion since its creation in February 1970. 

Dr. DuPont, a young man with impressive credentials in medicine 
and phychiatry, has been changed with implementing Mayor Wash- 
ington's pledge to have treatment available to every heroin addict in 
the District of Columbia within 3 years. 

Prior to assuming his present position, Dr. DuPont was Associate 
Director for Community Services in the D.C. Department of 
Corrections. 

In that capacity, Dr. DuPont participated in the preparation of a 
report that revealed that some 45 percent of all men brought to the 
District of Columbia jail in August 1969, were heroin addicts. 

Since then. Dr. DuPont has used the word "epidemic" to describe 
heroin addiction in the District. 

Dr. DuPont is a graduate of Emory College in Atlanta and the 
Harvard University Medical School. He served his medical internship 
at the Cleveland Metropolitan General Hospital and his residency in 
psychiatry at the Massachusetts Mental Health Center, Harvard 
University. 

For 2 years, Dr. DuPont served in research and clinical psychiatry 
at the National Institute of Mental Health. 

Dr. DuPont, we are glad to have you again before this committee. 

STATEMENT OF DR. ROBERT L. DUPONT, DIRECTOR, DISTRICT OF 
COLUMBIA NARCOTICS TREATMENT ADMINISTRATION 

Dr. DuPont. Thank you, Mr. Chairman. 

Chairman Pepper. Mr. Perito, would you inquire? 

Mr. Perito. Dr. DuPont, as you know, this committee is particularly 
interested in an evaluation of methadone and related drug abuse pro- 
grams. One of the matters of particular interest to the committee is 
the question of the efficacy of methadone maintenance and its relation- 
ship to the decrease in crime rate or illegal activity of those addicts 
under such treatment. Have you any statistical studies which reflect 
findings similar to those which Dr. Gearing presented to the commit- 
tee this morning ? 

Dr. DuPoNT. Yes, Mr. Perito. First of all, the District's program 
is not simply a methadone program. It is a multimodality program in 
which some people are taking methadone and some are not. Some 
patients receive methadone maintenance ; others are taking it for de- 
toxification. 

I will answer your question, but I want to begin with that qualifica- 
tion because it relates to some of the statistics that I want to bring up. 

Mr. Perito. Can you tell us how many addicts are presently being 
treated in your program ? 

Dr. DuPoNT. The current number is 3,106 as of last Friday, and of 
that number 1,760 are on methadone maintenance, 633 methadone de- 
toxification, 631 are in abstinence programs. An additional 82 are re- 
ceiving methadone on what we call "methadone hold" which means 
emerqfency treatment prior to complete evaluation. 

Chairman Pepper. How many on methadone ? 



144 

Dr. DuPoNT. 1,760 on methadone maintenance, 633 on methadone 
detoxification, 82 on methadone hold, which is an emergency short- 
term treatment, and 631 are in abstinence programs, that is, receiving 
no methadone. 

Mr. Perito. Do you have a waiting list, Doctor ? 

Dr. DuPoNT. We don't have a waiting list right now. We have in 
the past, and we are moving in the direction of having a waiting list 
again. We found that a waiting list discourages many people from 
coming into the program. Only about 30 percent of the people who 
sign up on a waiting list actually show up, at least in our experience. 

Whenever procedures are set up as hurdles for people to get over 
before treatment, act to discourage the use of the treatment, and ac- 
cordingly limits the kind of people who will go over these hurdles 
to get in. It is a grave step to take to build up barriers of any kind to 
get into narcotics treatment. 

Narcotics treatment of a continuing nature, regardless of whether 
it is methadone or abstinence, is efficacious in reducing not onlv heroin 
use but arrest rates. The critical question that needs to be addressed is 
the issue of retention in program. Some programs exaggerate their 
fiarures by counting patients who come into the program but who. for 
all practical purposes, dropped out and have no continuing relation- 
ship. Those patients that do have a continuing relationship and are 
participating actively, whether methadone or not, do quite well. I 
don't think one needs to feel he has to use methadone. 

On the other hand, our experience is that for most criminal heroin 
addicts the treatment of their choice and the one that seems to make 
the most sense from their point of view does involve methadone. I 
think heroin addicts need to have choices for themselves about what 
kinds of treatment they are going to get. Our program at NT A offers 
considerable choice. 

Mr. Perito. Is it fair to say that your programs jjoals are similar to 
the goals articulated by Dr. Gearing for the New York urograms? 

Dr. DuPoNT. Absolutely. Manv of the best features of our program 
have been taken from New York, including our basic goals. 

Mr. Perito. Directing your attention now back to my first question, 
you have compiled some recent statistics pursuant to the committee's 
request. 

Dr. DtjPont. Riffht. Last May 1^ we drew a sample. NTA then had 
1,060 patients in treatment. We did a random sample of 450 of those 
patients. Six months later, 56 percent of them were retained in the 
program. 

At 11 months, the figure retained had fallen to 40 percent. So that 
40 percent of the people in the program last May 15 were still in the 
program at the end of last week. 

Now, the retention rate in the program is highly related to the use 
of methadone. I don't have the followup data to 11 months on the 
basis of treatment modality, but at 6 months the results were quite 
striking. We found that patients who were on 60 milligrams or more 
of methadone had an 86-percent retention rate at 6 months. Of the 
patients who elected abstinence, only 15 percent remained in the pro- 
gram for 6 months. 

There is a very high dropout rate associated with abstinence pro- 



145 

grams, at least in our experience. Those who did stay in the abstinence 
program did well. That needs to be emphasized. 

Now, about the arrest rate : Of the 450 in the program on May 15, 
1970, 22.5 percent were arrested in the course of the following 11 
months. 

Of the 186 who stayed in the program the entire 11 months, or until 
arrested, a total of 25, or 13 percent were arrested. 

Of the 264 who dropped out of the program, 75, or 28 percent were 
arrested. 

Now, further to clarify this and to attempt to get at some of the 
harder data on this, Ave found that not all of the 450 people in the study 
had identifiable records of detention in District of Columbia jail. 
That is, we couldn't identify District of Columbia Department of 
Corrections numbers on all the patients. 

Mr. Perito. You had access to the criminal reference reports and 
rap sheets, I assume ? 

Dr. DuPoxT. We had access to the rap sheets in the Department of 
Corrections so that if a person is detained in a correctional institution 
we have that information. 

However, if he is arrested and released before going on to incarcer- 
ation we do not have the data. This has happened in minor offenses, 
such as traffic cases and first offenses, but it is not common with addicts. 
However, when it happens, we don't have the information. 

There is a law in the District of Columbia that prohibits the police 
department from releasing information to non-law-enforcement agen- 
cies on arrests. We are looking into this and are seeing if we can't get 
that information. It won't change any of the results, because we use 
the same criteria to apply to those who are in the program and those 
who drop out, and also to comparison groups. 

So although the total number would change, the relative percentages 
would stay the same, at least that is our assumption. 

But we asked this question another way : Of those people who have 
identifiable rap sheets, how many were arrested over 11 months. 

We found that 19 percent of those who had identifiable rap sheets 
and who stayed in the program were arrested, whereas, 99 percent of 
the 145 who dropped out and w^ho had rap sheets were arrested. The 
relative relationships were the same ; that is, the people who dropped 
out of the ])rogram had an arrest rate over the period of 11 months 
of about 214 times the arrest rate of those who stayed in the program. 

Another way to look at this data is to ask, for example, about the 
arrest rate for a comparison group or similar group. The most simi- 
lar group we have found was the Department of Corrections narcotics- 
involved releases prior to the existence of the Narcotics Treatment 
Administration, and of that group 36 percent were arrested in 6 
months. 

We don't have the figure for 11 months, but it would be over 50 
percent. 

Thus for those who stay in the program there is a considerable 
reduction in the arrest rate and methadone treatment is associated 
with higher retention rates. 

On the other hand, I am not here to say that a simple matter of 
giving a person methadone is a panacea. It is not a magic method, 
as some have thought, to absolutely eliminate criminal activity. But 



146 

there are dramatic reductions in arrest. There are some other studies 
of a more impressionistic nature and certainly those of us who have 
clinical experience could corroborate this, that show that heroin ad- 
dicts who are in the treatment programs do in a dramatic way reduce 
their heroin use and that much of their criminal behavior was driven 
by their need to get heroin. 

On the other hand, let's be clear that we are talking about a very 
disadvantaged segment of the population, by and large, a group for 
which there are often few employment opportunities, a group with 
very inadequate education and a group which has developed rather 
considerable skills in hustling and illegal activities. 

It is therefore, hardly surprising to find that this simple matter of 
putting a person in a treatment program does not in itself eliminate 
criminal activity, although it clearly reduces it. 

Mr. Perito. I asked Dr. Gearing about her knowledge of efficacy 
studies of drug-free programs, the value of detached analytical studies, 
and similar questions about the crime reduction. Do you know of any 
such studies in the drug-free programs across the Nation so that this 
committee can compare those results with the results of methadone 
and related drug programs? 

Dr. DuPoNT. I think drug-free programs have tended to get in- 
volved unnecessarily in rhetoric and politics. 

They tend to get more involved in this and have a hard time deal- 
ing with failures. So they are quite resistant in general to doing the 
kind of studies that Dr. Gearing has done and the kind of study that 
T reported here which, after all, reports something less than complete 
success. 

Abstinence programs have a hard time dealing with their very high 
dropout rates. 

I don't know of any published evidence of the efficacy of any drug- 
free programs that is comparable in any way with the kind of data 
that Dr. Gearing has presented. 

On the other hand, it is my impression from visiting drug-free 
programs that they have considerable merit. The problem is that they 
are not acceptable to many heroin addicts. And many people who do 
start there, do drop out. So I think that any city which is thinking 
about programing for heroin addiction treatment, needs to include 
abstinence or drug-free programs, but it needs some perspective in 
terms of their efficaciousness and their acceptability to the heroin 
addicts. 

I guess I could have answered that question by simply saying "No." 

Mr. Perito. Doctor, at the present time, what is vour appropriation? 

Dr. DuPoNT. The current appropriation for the Narcotics Treat- 
ment Administration is $2.2 million with an additional $2.9 million 
available to us through Federal grants. 

Mr. Perito. In addition to NTA's treatment programs, are you pres- 
ently carrying on any independent research in the opiate area ? 

Dr. DuPoNT. Well, our research is primarily related to two ques- 
tions, really : 

One is trying to do some monitoring of the epidemic of addiction in 
the District of Columbia, and the other is evaluating the performance 
of our programs. We don't do any basic research into chemical alter- 
natives to methadone, for example, or many other kinds of research. 



147 

Mr. Perito. Doctor, under the IND concept, as I understand it, 
your program is not specifically designated as a methadone mainte- 
nance program ^ 

Dr. DuPoNT. Well, the IND procedure does not specify what main- 
tenance is, and this has been a very serious handicap in the District 
of Columbia in terms of trying to come to grips with the private phy- 
sicians and others who are using methadone in ways that many of us 
feel are not responsible. There are regulations associated with the 
Food and Drug Administration that deal with methadone mainte- 
nance, but since they don't define "maintenance," it is quite possible 
for people to talk about long-term or even endless detoxification pro- 
grams. 

They talk about 20-year detoxification programs. In other words, 
there is no point at which detoxification becomes a maintenance. It 
is a matter of anyone's semantics. 

NTA does have an application with the Food and Drug Adminis- 
tration and we have the distinction of being one of the few programs 
to be audited by the Bureau of Narcotics and Dangerous Drugs. Five 
agents went over our procedures about 2 weeks ago, and this was 
very helpful. 

But in general the Food and Drug Administration and the Bureau 
of Narcotics and Dangerous Drugs make no attempt in assessing com- 
pliance, either with their regulations or IND protocol that was filed 
with them. 

Mr. Perito. Doctor, we have heard testimony from several wit- 
nesses that it was their considered judgment that a private physician 
could not properly dispense methadone within an ordinary office be- 
cause such physician is not able to offer the proper and necessary an- 
cillary and supportive services. Do you maintain a similar opinion? 

Dr. DuPoNT. Well, I asrain find myself really following in the 
footsteps, to some extent, of the work that has been done in New York 
City and what Dr. Gearing said today. 

lit is obvious in dealing with a widespread epidemic that has clear 
medical dimensions and where medical skills are valuable, that it 
doesn't make sense to entirely write off the private health care sector 
and trv to create an entirelv Government-run clinic system to deal 
with all the problems of all the people who are currently heroin 
addicts. 

So I think the challensre is to find ways to make use of the private 
sector in a constructive way. 

I think probably a good way to start is to have private phvsicians 
associate themselves with ongoing structured programs and then to 
pick up stabilized to successfully adjusted maintenance patients to 
follow privately. 

Therefore, after a person has been in a methadone program and 
demonstrated his stabilitv for 6 months or a vear, then he would be 
transferred to a private physician who would handle no more than 
10 or 20 heroin addict patients as part of his regular practice. 

In this way we get away from part of the financial gain of private 
phvsicians merelv selling prescriptions. 

We don't build Government clinics to treat all diabetics. Most dia- 
betics get private care. Stabilized heroin addicts can also move to the 
private sector. 



148 

Health insurance coverage for methadone maintenance is important 
once the person is stabilized. The private doctor then has the option, 
if that person breaks down, of returnino; him to the public clinic from 
which he came for more extensive work. 

The private physician doesn't have the capability of control of 
methadone that is needed in the induction phases of methadone treat- 
ment. This involves more than just ancillary services. Private doctors 
have made their greatest errors by p:iving unstabilized patients 1 or 2 
weeks' supply of methadone right at the beginnino; so that a patient 
takes out a bottle or prescription of methadone which he takes in an 
unsupervised way. 

I think the dangers to the public from such practices are very great 
and ought to be avoided. 

Mr. Pertto. Chairman Peoper mentioned tlie situation relating to 
recent deaths. Do you anticipate, with tlie expansion of methadone 
programs, that death is a natural incident, that there will be three or 
four deaths as a result of the inevitable distribution process of your 
program, either because of misuse or wrongful distribution or a situa- 
tion where a nontolerant person accidentally ingests methadone in- 
tended for an NT A addift ? 

Dr. DuPoNT. "Well, I think that there will be deaths, and there have 
been. 

On the other hand, I would certainly not take a fatalistic view that 
these are unpreventable and we just pass them off and go to the next 
patient. 

I think we need to take these methadone-related deaths very seri- 
ously and to do everything in our power to try to reduce the likelihood 
of that kind of event occurring. For this reason NTA issues take-home 
methadone in locked boxes and child-proof bottles. We have rather 
elaborate forms that the patient signs. 

On the other hand, I think it is a very serious public relations prob- 
lem. All of the methadone deaths that are occurring are being charged 
either explicitly or implicitly to the NTA programs, and this is far 
from being true. 

In the last 9 months in the District we have been able to uncover 
23 deaths that involved methadone, either alone or with other drugs. 

In only five of those deaths was there any relationship to the NTA 
program. Thus, 18 of them had nothing to do with the program. 

But there were five deaths related to NTA and we do everything 
we can to prevent the likelihood of that occurring again. But in a 
situation where only about 20 percent of the deaths are associated with 
the NTA program, we suffer the criticism for all. 

Chairman Pepper. Dr. DuPont, we have had a quorum call on the 
floor of the House. If you will please suspend and await our return, 
we will go over and answer the quorum and be right back. 

We will take a temporary recess until we can get back, to answer 
the call on the floor. 

(A brief recess was taken.) 

Chairman Pepper. The commitee will resume session, please. 

Dr. DuPont is on the stand. 

Mr. Perito was inquiring of Dr. DuPont. 

Mr. Perito. Dr. DuPont, have had occasion to administer cycla- 
zocine or naloxone to any of the addicts in your program ? 



149 

Dr. DuPoNT. No ; we haven't. The only drug we have used is metha- 
done. 

Mr. Perito. You are probably aware of certain testimony that has 
been given previously to congressional committees by Dr. Yolles who 
has stated that cyclazocine and naloxone and antagonistic drugs are 
one of the most promising areas of narcotic research. Do you have an 
opinion, based on your experience, with antagonistic drugs? 

Dr. DuPoNT. I think you are going to hear from Dr. Jaffe, who 
is one of the foremost experts on the subject. 

As a clinician and an administrator, there are problems with the 
antagonistic drugs. Put simply, they are not acceptable to patients. 
Nowhere in the country, to my knowledge, has there been any large 
scale use of these drugs. The real issue — at least one of the initial prob- 
lems — is that the heroin addicts don't find the antagonists helpful to 
them. Most patients don't, although there are a few who do. 

The other problem is that the antagonists are presented to the pub- 
lic as if they were somehow more benign than methadone, for example, 
or were somehow to be treated more casually. 

I think this is a mistake, and I think that the antagonists that we 
know of so far are like methadone in that they are only useful so long 
as they are taken regularly and remain in the body ; that is, they don't 
immunize the person against anything, patients have to go right on 
taking cyclazocine or naloxone and we know far less about the long- 
term effects of these drugs than we know about methadone. 

Mr. Petiro. Two final questions, Dr. DuPont. 

When you testified before our committee in October 1970 you stated 
that to the best of your knowledge the addict population in AVashing- 
ton was 10,400. Subsequently you reevaluated your estimate and you 
have stated, to the best of my knowledge, that the addict population 
is, in fact, 18,000. Would that be your estimate today, 18,000 ? 

Dr. DuPoNT. Well, our current best estimate is 16,800. 1 am not pre- 
pared to change that estimate yet, although it may be that the addict 
population is not growing any more, as it was in previous years. We 
don't have good enough measures, really, of changes in the addict 
population. 

But the death rate has not been going up in the District over the 
course of the last 9 months. If anything, it has fallen slightly during 
this period of time. 

So I use 16,800 as a ballpark estimate. The only fact that is really 
relevant is that there are still very many untreated heroin addicts in 
the Washington community who are suitable for and interested in 
treatment. 

We had occasion 5 weeks ago to open up a new clinic. It was the 
first new clinic NTA had opened in many months. This clinic was 
swamped with patients, going from zero to 200 patients in the course 
of 6 weeks. 

Even though we are providing treatment for 3,000 patients we can 
recruit 200 new addicts by opening a clinic for just 6 weeks. This is a 
very startling demonstration that when clinics are opened they attract 
patients. I think the only relevant fact is that there are thousands of 
untreated heroin addicts in the District of Columbia today. 

Mr. Perito. How many addicts are presently being treated in the 
District either under the auspices of NTA or some other program op- 
erating and funded within the District? 



150 

Dr. DtjPont. Well, there are no other proarrams that have anything; 
like comparable numbers. I would pav that usingr our definition there 
are no more than 500 other heroin addicts who are beinff treated in all 
the Drop-rams in the citv. inclndina: the abstinence programs. 

Including the detoxification programs and the private physicians, 
it mav be that there are as manv as a thousand more patients in all. 
I can't imaarine the total beino- hisfher. 

Chairman Pepper. Dr. DnPont, you told u« that approximatelv half 
of the peonle who were in jail here in the District were found to be 
heroin addicts. 

Have those figures been carried forward by the police department at 
the present time? 

Dr. DuPoNT. Yes: we repeated this study in January 1971, and 
have not finished analvzinof it. I don't have the full breakdown yet. 
But it was very sicrnificant that there wasn't an obvious reduction in 
the percent. The figure is still about 50 percent. 

One thing: that was quite dramatic, however, was that the percent 
of druff arrests had increased dramatically. Whereas when the initial 
study was done in August 1969, 10 percent of the total of all people 
coming into the jail were on druq- charges. By January 1971, the 
figure had risen to 22 percent of all jail intake. 

This reflected the fact that far more purely drug charges were being 
made by the police. 

Chairman Pepper. Has there been any studv made of heroin addic- 
tion among people arrested for burglary, offenses against property, 
and muggings on the streets? 

Dr. DuPoNT. Yes. We found that the addicts were slightly less 
likely to commit crimes aarainst people than the nonaddicts coming 
into the jail, but that the differences were not statistically significant. 

For instance, more than half of the criminal homicides were com- 
mitted by addicts. 

Chairman Pepper. More than half of the homicides were committed 
by heroin addicts? 

Dr. DuPoNT. Right. So anybody who is reassured by thinking that 
heroin-addiction-related crime is confined to shoplifting, prostitution, 
and drug sales is sadly mistaken. 

Chairman Pepper. I am glad to get that clarified. I thought it was 
generallv assumed that heroin addicts were not very dangerous. They 
were satisfied, had a sensation of feeling good, but you said half of 
the criminal homicides are committed by addicts ? 

Dr. DuPoNT. That is right. But this must be put in perspective. 

Most serious crimes, the FBI index crimes, are property crimes. The 
last time I looked at the list, 86 percent of all the serious crimes in 
America were so-called nonperson or property crimes. So that addicts 
are like other criminals, other criminal behavior of other people in 
that the primary crimes addicts commit are property crimes. 

On the other hand, if you turn the question around and you ask of 
the person crimes, of the robberies, of the muggings, of the homicides, 
itself, what percentage of those crimes are committed by addicts sup- 
porting their habits, the answer is about one-half. This is a very 
serious and very important finding. 

Chairman Pepper. Half of the crimes against property and against 
person ? 



151 

Dr. DuPoNT. It is about equal. In other words, addicts commit 
about one-half of the person crimes and about one-half of the property 
crimes. 

Chairman Pepper. So that the heroin addiction, then, has a very 
direct relationship to crime ? 

Dr. DuPoNT. Absolutely, including crimes against people. 

Now, again this is not a drug effect. The heroin addict who is high 
is not a person inclined to commit crimes because the drug tranquilizes 
the person. But he commits crimes to secure money to buy heroin, and 
this need leads to desperation on the part of many addicts and they 
act in ways that are extremely dangerous to themselves and others. 

Chairman Pepper. Well, now, you gave us evidence, as I recall, last 
year, when you appeared before our committee, that in your opinion 
the average addict in the street, in the District of Columbia stole — or 
had to get illegal possession by offenses against the person or other- 
Avise — about $50,000 worth of property a year in order to sustain his 
heroin addiction. Is that still your general opinion ? 

Dr. DuPoNT. Yes. That kind of evidence comes from asking addicts 
about the size of their habits and then making some assumptions 
about the ways they get their money. For example, if a person says he 
needs $40 a day to buy his heroin, you would figure, if he is involved in 
stealing property, that he has to steal it at some discount so the total 
value of the property stolen is some figure in excess of the $40. 

On the other hand, there have been some studies, since I testified 
before you last, that would suggest that the total amount of property 
crimes in the District of Columbia, at least as reported and estimated, 
is not large enough to support that assumption. So that this technique 
may overstate the actual criminal activity related to heroin addiction. 

On the other hand, we don't really know how much unreported 
crime there is. We are also in a swampy area when we estimate how 
many addicts there are. The only thing we need to know however is 
that there is a tremendous amount of criminal activity associated with 
drug addicts. In the District of Columbia alone, $200 million a year 
is probably a low estimate. 

Chairman Pepper. What do you estimate to be the average cost of 
heroin addiction a day ? 

Dr. DuPoNT. Well, $40 is the figure found. 

Chairman Pepper. In other words, he has to get enough property 
in one way or another to net $40 a day ? 

Dr. DuPoxT. $40 a day. But the addict will put into his arm as 
much as he can get. The limit is not the physiology having to do with 
the drug, but his ability to get the money. Some days he is not as able 
as others so his habit fluctuates. 

Chairman Pepper. Mr. Blommer. 

Mr. Blommer. Thank you, Mr. Chairman. 

Doctor, we are going to have Mr. Horan, the commonwealth attor- 
ney from Fairfax County, testify here tomorrow, and he believes there 
is a methadone epidemic. 

Dr. DuPoNT. I believe there is a serious problem with methadone 
in illegal channels in this city. 

Mr. Blommer. Do you accept methadone addicts in your program ? 

Dr. DuPoNT. You mean people who come to us and say they have a 
methadone habit from somewhere else and say they want to come into 
the program ; sure. 



152 

Mr. Blommer. You would agree there is a black market in meth- 
adone ? 
Mr. DuPoNT. Yes. 

Mr. Blommer. And there will come a time — I assume you are al- 
ready thinking of it — when you have hard-core methadone addicts 
that may have become addicts from unscrupulous doctors, from the 
black market, or whatever, but now we have hard-core methadone 
addicts. 

Dr. DuPoNT. Most of those people are using heroin, also. It will 
depend on the availability. I don't think you are going to find people 
who are shooting methadone, for example, who are not also shooting 
heroin. Usually they will go back and forth, and use whatever is 
more available. 

Mr. Blommer. Would you believe it would be efficacious to take 
those people in your program ? 

Dr. DuPoNT. Yes. They are j ust like heroin addicts. 
Mr. Blommer. Doctor, I know we have a disagreement on statistics 
and what they mean. I do have a sheet here that I believe we got 
from your office that shows in the last 6 months in 1970, 60 people 
that were autopsied by the D.C. coroner had narcotics in their bodies. 
As I read it, 10 of the 60 died of gunshot wounds, 13 of the dead 
people had only methadone in their body, one had cocaine, and one 
had Talwin. Therefore, 15 of the 50 remaining after we take away 
the gunshot deaths had no heroin in their bodies. That leaves us 
with 35 heroin-related deaths. Could you, using whatever analysis 
or formula you want, make a judgment on how many heroin addicts 
there are in the District of Columbia ^ 

Dr. DuPoNT. I am having a little trouble following your assump- 
tions. You are making the assumption that the methadone addict is 
different from the heroin addict when he is pursuing addiction on 
the street. In other words, methadone will compete with heroin and 
produce the same effects when injected. 

Injected methadone produces a high like herom. It strikes me as 
sortof a question of semantics. 

You could call them opiate addicts and lump them together and 
talk about the frequency. . i j i -i j 

For example, if it were more available, morphnie would be the drug 
of choice. Today heroin is the main drug in the black market, but 
other opiates would work just fine. , 

Mr. Blommer. Doctor, what I am suggesting is that it and wtien 
we clear up the heroin problem that we might then be dealing with 
a methadone problem. . , 

Dr DuPoNT. I don't call that "clear." We now have an opiate 
addiction problem that is very serious, and if we switch from one 
drug to the other, and have all the same consequences, we have gained 

''''Mr!'BL0MMER. But the point is, though, Doctor, no matter who is 
giving the drugs out, there will be people who will be methadone 
addicts and people who are heroin addicts. 

Mv question is: Don't you feel that there is a great danger that 
the people becoming metliadone addicts will then ] ust come to vou 
instead of to the street pusher that they used to go to for herom? 

Dr. DuPoNT. Well, come to me for what ? 

Mr. Blommer. For their drugs, for their methadone. 



153 

Dr. DuPoNT. To do what ? 

Mr. Blommee. To satisfy their craving, assuming they are metha- 
done addicts, to satisfy their craving for methadone. 

Dr. DuPoxT. And then stay in the program and pursue the course 
we are interested in in the program. So what is the problem? 

Mr. Blommer. The problem is you are aiding them in being addicts. 

Dr. DuPoNT. I don't see how we are aiding them in being addicts. 
They were addicts before they ever got there. 

Mr. Blommer. Doctor, is all the methadone dispensed by your clinic 
to the 1,700 people you are maintaining, is all that consumed in front 
of you ? 

Dr. DuPoNT. No; the patients who are stabilized in the program 
have take-home privileges and they take the methadone out with them. 

Mr. Blommer. Don't you see a problem ? Couldn't those people sell 
to the black market and then take heroin, for instance ? 

Dr. DuPoxT. Sure ; but I think you are looking at a little thing and 
overlooking a big thing. Where do you think the methadone is coming 
from that is causing Mr. Koran's and other people's problems in Fair- 
fax County ? It is not coming from our program. He knows that. 

He has said as much. Are you saying there should be no take-home 
medication? What we need is widespread availability of good treat- 
ment programs, whether they are in Virginia or the District. If you 
did that you would undercut tremendously the black market in heroin. 
You would undercut tremendously the death rates that we are seeing, 
and there would be a tremendous social gain associated with that. The 
need for good treatment is the big thing. Our take-home procedures 
are the little thing. We also need to do something about the uncon- 
trolled, unsupervised dispensing of methadone in the metropolitan 
area. Do you agree with my statement ? 

Mr. Blommer. Well, to some degree; but you seem to premise that 
on the fact that the black market now comes from unscrupulous doc- 
tors. 

Dr. DuPoNT. And perhaps other sources that I don't know about, 
but I am quite sure that it is not coming from our NTA program. 

Mr. Blommer. Do you have an opinion on how easy it is to manu- 
facture methadone ? 

Dr. DuPoxT. I talked to Mr. Ingersoll, Director of the Bureau of 
Narcotics and Dangerous Drugs, and he said as far as he knew there 
was no illegal manufacture of methadone. 

Mr. Blommer. My question is : Do you know how easy it is to manu- 
facture it illicitly ? 

Dr. DuPox'^T. I don't know how easy it is. 

Mr. Blommer. Did Mr. Ingersoll tell you about the laboratory? 

Mr. DuPoxT. In Tupelo, Miss. They broke that one 2 years ago. 

Mr. Blommer. And that man had made 50 kilos of methadone. 

Dr. DuPoxT. Yes ; maybe it will be happening again. If your argu- 
ment is methadone is not a panacea and needs to be thought of as hav- 
ing a serious abuse potential, I agree with you. 

Mr. Blommer. My argument is you should have far stricter controls 
than apparently you have. 

Dr. DuPoxT. There is no evidence of our methadone being a prob- 
lem in terms of control. We have questioned the police to find if they 
find it in illicit channels. Our methadone is clearly labeled. The police 
haven't brought even one bottle that they have found of our metha- 

60-296 O— 71— pt. 1—^11 



154 

done. Where is the evidence ? Nobody in Fairfax County has died be- 
cause of our methadone. What is the problem we are addressing? 

Mr. Blommer. Mr. Horan, I think, will address himself to that 
problem. I don't feel I should speak for him. 

That is all the questions I have. 

Chairman Pepper. Mr. Mann. 

Mr. Mann. Your methadone in the program is administered in a 
wav to bring about stabilization, which means they don't get high off 
of it? 

Dr. DuPoNT. Eight. 

Mr. Mann. That w^ould make it different from the street addict of 
even methadone ? 

Dr. DuPoNT. Right. 

Mr. Mann. You mentioned there were a wide variety of choices of 
programs under yours. I don't see but two, the methadone maintenance 
and abstinence programs. What else is there ? 

Dr. DuPoNT. To give you an example of the diversity of the pro- 
grams, we have halfway houses in which people can live in where they 
can in some cases take methadone and others remain abstinent. 

We have 65 beds in a hospital unit for detoxification, primarily for 
young people. They have programs entirely abstinent and these are 
used a good deal. We have people taking it in decreased dosages, lead- 
ing to abstinence and others maintained on it. 

For example, in the city we cooperate with Colonel Hassan and the 
Black Man's Development Center. In the Black Man's Development 
Center patients go through a different experience entirely and are 
educated in citizenship training, residential treatment, and decreasing 
doses of methadone. That is a very different kind of treatment experi- 
ence than goes on in most of the rest of our programs. 

Another program, Step-One, run by ex-offenders known as Bona- 
bond. Inc., is a halfway house and outpatient clinic that uses no 
methadone. 

A person can move freely between any of these options. 

Another program. Guide, D.C., uses psychologists and social work- 
ers, in family and individual therapy of patients, and for those who 
find that useful, they can go to the program. 

So there is quite a variety of treatment programs, perhaps not com- 
plete, but quite a variety. 

Mr. Mann. Getting back to the chairman's reaction to your state- 
ment of crimes of personal violence. I was interested in your state- 
ment that these crimes of personal violence were not motivated by the 
drug effect, but were still motivated by the acquisition of property, 
of funds to sustain their habits. 

Dr. DuPont. Right. 

Mr. Mann. Have you made any effort to distinguish those property- 
related crimes, even though they result in personal violence, from 
crimes of passion resulting in personal violence ? 

If you were to take homicides and divide them in half you would 
find that half passion and half property ? 

Dr. DuPoNT. Right. I haven't looked at that, but that is a good 
question. I will look into that and maybe I can supply something for 
the record on those crimes committed in our previous study. 

Mr. Mann. Very good. 

Thank you, Mr. Chairman. 

(The information referred to above follows:) 



155 





100 addicts 




125 nonaddicts 


Offense with which charged 


Profit Passion 


Profit 


Passion 


Larceny 

Robbery 

Burglary 


21 

10 

6 




11 ... 
15 .... 

8 ... 

3 ... 

1 ... 




Stolen property 


3 




Housebreaking 






Offense/family 






1 


Assault 




5 .... 
3 .... 




9 


Homocide 




1 


Assault/deadly wea pon 




3 


A rmed robbery 


1 




2 ... 

1 .... 

3 ... 

2 .... 




Bank robbery 

Forgery 

Fraud 

Manslaughter 


2 

3 

2 


2 


Private orooertv 








4 












Total 

Total (percent) 


48 

48 


8 
8 


46 
37 


20 
16 









Note.— Table Is a result of study conducted by the Narcotics Treatment Administration at D.C. Jail between Aug. 11 and 
Sept. 29, 1969, on an accidental sampling of 225 Inmates. 

Chairman Pepper. Mr. Wiggins. 

Mr. Wiggins. Dr. DuPont, I am still a little bit confused on the 
effect of methadone on the human body. When it is taken by a patient 
in your program, what effect does it have on that patient ? 

Dr. DuPoNT. Well, the regular effect is that the person comes into 
the program and he has an opiate habit which is in almost all cases, 
at least as far as I have ever seen any data, a heroin habit. 

When he comes he wants some help with that, and he will take an 
initial dose of methadone of around 30 to 50 milligrams. Now, when 
he takes that he has a suppression of the withdrawal of symptoms 
that he usually experiences and he feels relatively normal. 

Now, the patient has choices at that point, and he can either go on 
decreasing doses leading to abstinence, taking anywhere from a few 
days to a few months ; or he can choose a maintenance schedule in which 
his dose goes up to about 100 milligrams and he stabilizes at that point 
until he feels it makes sense to try detoxification and comes down 
again. 

Depending on the amount of the drug, and if there is a little bit 
more given than is needed just to suppress withdrawal symptoms, the 
person might feel a little drowsy, a little euphoria. 

He would also, in many cases, experience constipation. Some people 
will also experience excessive sweating. Those are the primary effects. 

In addition, while the person is on increasing doses or beginning 
treatment, some men have a transient impotence, probably associated 
with the anesthetic effect of the drug. The mechanism is not clear. 

Once he is stabilized, the only effect that most patients experience 
is the constipation and excessive sweating. In other words, there is 
tolerance to the other effects, except suppression of the opiate drug 
craving and the blocking of the euphoric effects of heroin. 

Mr. Wiggins. Is there any benefit of feeling good by going out and 
getting more methadone if you are on a diet of 100 milligrams ? 

Dr. DuPoNT. No. Once on 100 milligrams there is no effect either 
orally or injected. Now, many patients do go out and shoot methadone 
or heroin to test their blockade. He will not have any euphoric or other 
effect. 



156 

There are several reasons a person might continue occasional use of 
heroin. Many persons are fearful about withdrawal symptoms and 
feel they must take increasing doses to prevent withdrawal symptoms, 
even though they can't feel the drug effects. But they feel very anxious. 
We had one patient who, when a private doctor recently stopped his 
practice of giving methadone, said, "Oh, I didn't want to tell you this, 
but I was getting a second dose of methadone by going to a private 
doctor." Since there is no central registry now we didn't know that. 
He was taking two doses of methadone each day. "V^Tiat he was doing, 
as far as we can understand, was treating his anxiety about not getting 
enough. 

The treatment was to counsel the patient, to help him see that he 
was getting enough methadone, and he stopped taking two doses. 

Mr. Wiggins. Dr. DuPont, we are running out of time, and I would 
like to get into the record the technique you employed to prevent peo- 
ple from abusing your program by obtaining methadone from a sec- 
ond source, and the way that you insure that those who take it home 
do not misuse it. Would you describe your security procedure? 

Dr. DuPoNT. The NTA patient takes his methadone on the premises 
for the first 3 months of the program, and then he gets take-home 
privileges of gradually increasing duration until the minimum fre- 
quency allowed, which is two clinic visits per week. The patient must 
be on the program at least 6 months to a year for that to happen. 

The patient's urine is tested twice weekly. Urine tests identify all 
hard drug use, but, of course, we can't separate a second dose metha- 
done. But we know that a person is not going to more than one of our 
centers, because all patients come in and have their pictures taken and 
get an I.D. card. It is, however, possible to take methadone from an- 
other source, either inside the city or out, which is a serious problem. 

Mr. WiGGixs. What w^ould be an in-city source ? 

Dr. DuPoNT. A private physician. A person could also go to Colo- 
nel Hassan's program and register for that program and receive meth- 
adone and not be in our central register. 

Mr. Steiger. Is he still conducting his program ? 

Dr. DuPoxT. Yes ; and only those patients for whom we pay him in 
our central registry. 

Mr. WiGGixs. What is the solution to that problem ? 

Dr. DuPoxT. The solution is a regional registry for everybody who 
gets methadone. Everybody who takes a dose of methadone anywhere 
in this area ought to be required to be in a central register. 

Mr. WiGGGixs. How central ? IMultistate ? 

Dr. DuPoxT. We should ultimately involve Baltimore as well as 
the suburban counties in Maryland and Virginia. 

Mr. Steiger. I wonder if we could have the witness, if he could re- 
main? I hate to impose on him, but I think all of us would like to ex- 
plore this. 

Chairman Pepper. Doctor, could you wait a few minutes more? 

Dr. DuPoxT. Sure. 

Chairman Pepper. Doctor, let me make this announcement before 
we recess. We will come back. 

Dr. Jaffe is here, another distinguished witness, and he has kindly 
consented to stay over until tomorrow morning. Without objection on 



157 

the part of the committee, when we do recess today we will recess un- 
til 9 :45 tomorrow morning. 

AVe will take a temporary recess so we can go over and vote again, 
Doctoi'. We are sorry to put you to so much trouble today. 

(A brief recess Avas taken.) 

Chairman Pepper. The committee will come to order, please. 

Dr. DuPont, I understand you have some problems with time to- 
day, also. 

Dr. DuPoNT. Yes ; I do. 

Chairman Pepper. We will try to expedite our examination of you. 

Mr. Steiger. 

Mr. Stei«er. Thank you, Mr. Chairman. 

Doctor, I wanted to get into one thing about half opened up by 
your testimony and others, that physicians are a source of the illegal 
methadone. I notice that in almost all the drug hearings we have had, 
and the committee has held before, even in other areas, there is a great 
reluctance to admit the complacency of the medical profession. I say 
"complacent" advisedly. I don't mean there is any kind of conspiracy 
by the medical profession itself, as a major source of opiates. 

I wonder if in your experience, Xo. 1, if you agree that it could 
be a problem not only in methadone, but in the dispensing of other 
opiates, and if the equation that the reason for many of the people 
involved in your program and the New York City program are the 
underprivileged as an economic matter that the privileged are able 
to buy through pseudolegitimate source the wherewithal to feed their 
habits : is this a valid position ? 

Dr. DtPoxT. There are so-called medical addicts or people who 
have become addicted through medical treatment. This does not neces- 
sarily involve any dereliction on the part of the physician, although 
oftentimes there is less vigilance than probably was appropriate. 

On the other hand, I don't think it Avould be fair to say that opiate 
addiction is uniformly distributed throughout the population by so- 
cial class and that the lower classes don't have the wherewithal to get 
it and the upper classes do. Opiate addiction is concentrated in the 
loAver social classes, even adding in people going to private physicians. 

On the other hand, those who do go to private physicians are ob- 
viously from the upper classes. One thing we have noticed in the Dis- 
trict is that whereas about 8 peicent of the overdose deaths in the city 
are white, only about 4 percent of our patients are white, which means 
that there is an underrepresentation of whites in our patient group. 
I am sure that this is accounted for by more white addicts going to 
private physicians. 

Mr. Steiger. That is a very interesting statistic and I can draw a 
lot of conclusions from it, which I don't want to do superficially, but 
I am glad to have these statistics. 

Now, we have had some specific instances in the Phoenix, Ariz., area 
in which physicians were actually dispensing narcotics in a manner 
that could hardly be determined medically responsible. I don't think 
it serves any purpose to identify it as a racket, but just as irrespon- 
sibility. 

My question is : In your experience, how widespread — I will phrase 
it a different way. 



158 

It would seem to me a very busy physician who finds it reasonably 
profitable and could justify perhaps in his own mind the regular pre- 
scription of opiate prescription for persons who didn't require much 
attention, and to which he was going to get paid for each prescription. 

Dr. DuPoNT. In advance. 

Mr. Steiger. In advance. Is that the way it works ? 

We have now taken public official notice of the private physician in 
regard to dispensing of methadone, and your recommendation there 
is that he not be permitted to do this without other qualification, 
which I think is very valid, but really we are still skirting the prob- 
lem. 

Dr. DuPoNT. It is still going on. , 

Mr. Steiger. Well, Ko. 1, of course, there is no way to control it, we 
understand that. We all know we are talking theory here. Short of 
having the AMA speak to its own, what do you recommend ? 

Dr. DuPoNT. Well, the AMA has spoken to its own. They had a 
release about a month ago in which they strongly discouraged private 
doctors. 

I think it is going to take something more than this. I am not an 
attorney, but what I understand is that once a drug, any drug, is avail- 
able in the pharmacy, any pharmacy, that any doctor can prescribe 
it for anything he wants to. There are certain recommendations that 
are made by the medical profession and by the Food and Drug Ad- 
ministration, but these do not have the force of law and the doctor can 
pretty much do what he wants. 

Methadone is an established drug available in every pharmacy. I 
wonder if it wouldn't require some sort of legislative action to make 
methadone an exception and to bring it under control. 

You might pursue this with subsequent witnesses who can speak 
more authoritatively, because I think it is a very serious problem when 
Federal agencies and other groups pretend to have the power to curb 
certain kinds of behavior that are considered to be undesirable but 
really don't have that power. The question is whether thev do have 
the power; if they do have the power, then why has nothing been 
done? 

I think many people are misled and believe that power exists when 
it doesn't. 

Mr. Steiger. Good. 

Thank you. Doctor, I have no further questions. 

Chairman Pepper. Is that all ? 

Mr. Steiger. Yes. 

Chairman Peppek. Mr. Kangel, have you inquired of Dr. DuPont? 

Mr. Rangel. Doctor, in your medical experience, have you ever 
found a national health problem such as drug addiction being treated 
as you are treating it with — and multimethods of service and com- 
munity controls? Is this a usual way to treat a problem of such 
enormity ? 

Dr. DuPont. I don't think there is anything usual about heroin 
addiction. I don't know what the analogy would be. I think it is very 
exceptional. 

Mr. Rangel. This is a very exceptional method of treatment of any 
problem, any medical problem of this sort, isn't it ? 

Dr. DuPoxT. I think so. I am not sure where I am being led to, but 
I will say, "Yes," and put an asterisk after it. 



159 

Mr. Rangel. Well, I wasn't goin^ to lead you any further, but I 
wonder if we were talking about a different economic class of people, 
whether or not those in the medical profession would be more prone 
to have this type of community control over dispensation of drugs. 

Dr. DuPoxT. That is a good point. If it were a different social class 
I don't think the problem would have gone on in Harlem as long as it 
did without any treatment at all. It wasn't until the majority of the 
country, the more affluent part of the country, in any event, became 
very frightened about crime rates in their cities, and until they got 
concerned about their own junior and senior high school children using 
drugs that we got a national commitment. 

But it is coming and I think it is to everybody's benefit. 

Mr. Rangel. This national commitment, as far as I can see in the 
area of rehabilitation, it has settled down to the question of expand- 
ing methadone treatment ; has it not ? 

Dr. DuPoxT. No ; I don't think that is true. 

Mr. Raxgel. How much time does your institution spend on devel- 
oping scientific methods of curing this, other than methadone ? 

Dr. DuPoxT. Well, about 25 percent of our patients are not on 
methadone, for example. 

Mr. Raxgel. But are you looking for other scientific cures ? 

Dr. DuPoxT. No; we don't do any basic research. That would be 
more properly done elsewhere. We are a city treatment agency. 

Mr. Raxgel. But you have no national institution that you can go to 
in order to increase your ability to deal with the drug addiction prob- 
lem ; do you ? 

Dr. DuPoxT. Well, the National Institute of Mental Health is prob- 
ably one of the logical sources for this kind of activity. In fairness to 
them, some activity is going on there, but very little. 

Mr. Raxgel. Have they been of any assistance to you to reach a 
program Avhere you could professionally feel that you are doing the 
best you can with what is available ? Have they assisted you in devel- 
oping your program ? 

Dr. DuPoxT. Yes; they have given us $800,000 a year for one major 
component of our program. 

Mr. Raxgel. I am not making myself clear. I am not talking about 
the money. I am talking about you, as a doctor, with your background. 

Dr. DuPoxT. I see. 

Mr. Raxgel. Have you got a national institution that can give you 
scientific data as a result of their research that you can depend on so 
that perhaps you could expand and develop other methods of treating 
drug addicts, other than methods of Colonel Hassan ? 

Dr. DuPoxT. No. 

Mr. Raxgel. So that as far as you are concerned, all you have is what 
New York City has done as a basis of where you are going ? 

Dr. DuPoxT. Well, I think Chicago and Dr. Jaffe added something 
very important to the New York experience, and that was the concept 
of a multimodality program. So I think there are other additions, and 
I think all over the country there are a lot of very resourceful and 
energetic people who are involved from a variety of sources. 

For instance, in Stanford University, Professor Goldstein, who is a 
pharmacologist, made a very important contribution, for example, with 
a urine testing technique which promises a lot of advantages over what 



160 

we had before. I don't think it is quite fair to say there is no where 
to turn. 

Mr. Kangel. I am talking about on a national level. 

Dr. DuPoNT. I think the national agencies have provided very little, 
approaching nothing. 

Mr. Kangel. You said earlier that there was no difference between 
a heroin addict and a methadone addict, and I agree with what you 
and I have seen in central Harlem. 

On the other hand, other people have testified there is no difference 
between a methadone addict and a diabetic. I see a large medical 
credibility gap between those two statements. 

Dr. DuPoNT. Well, I think Mr. Blommer and I were talking about 
the "addict" as different from the "dependent." Dr. Gearing made 
this distinctioii. We are going to have to make a distinction between 
the person who is taking methadone and is dependent upon it as part 
of a structural program and the so-called addict. Both are technically 
addicted, although the behavior one observes is quite different. 

Mr. Kangel. Let me just use your terminology. Is there any dif- 
ference between a person dependent on heroin and a person dependent 
on methadone ? 

Dr. DuPoNT. Yes; I think there is a dramatic difference. It is as- 
sociated with the drug and also with where it comes from. 

Mr. Kangel. Didn't you say earlier there was no difference between 
a heroin addict and a methadone addict ? 

Dr. DuPoNT. When it is out on the street and people are shooting 
it and are pursuing an addict life style, there is no difference. 

Mr. Kangel. To put it another way, if we were to dispense heroin 
or have a heroin maintenance program, then would there be any dif- 
ference, taking out the life style of the street and heroin maintenance 
program and your methadone maintenance program? 

Dr. DuPoNT. Yes ; there would be. I think there are pharmacological 
advantages to methadone, which is very important. One is that metha- 
done needs to be taken once a day instead of three or four times a day 
as with heroin. That is a very important distinction. 

Another difference is that methadone can be taken orally rather than 
injected. Many of the problems associated with heroin addiction have 
to do with its being injected. 

Perhaps even more important, methadone allows the person to be 
stabilized at a dose and he doesn't continue to crave for increasing 
amounts. 

The fact is that most people "maintained" on heroin — for exam- 
ple, in the British clinics — are dropouts from society. This is not the 
typical experience with the methadone-dependent patient in a pro- 
gram. He is a person who is able to call on his own inner strength and 
pursue a life course that makes sense, including productive prosocial 
work. 

I think the personal experience of seeing the persons in a methadone 
program is dramatic. 

I was with the Department of Corrections a little oyer 2 years ago 
and had no interest in or special knowledge about this field. I went 
through a very personally moving experience when I first visited a 
methadone program and talked to the patients. This experience meant 
more to me than all of Dr. Gearing's charts. But I was impressed by 



161 

the sincerity of many of these people as they described the difference 
of their lives and their families after methadone treatment. You talk, 
for example, to the wives of men who are in the program, and they 
are appreciative of the changes that have come about in their 
husbands. 

Mr. Eangel. You can't attribute all of this to methadone. 

Dr. DuPoNT. No, I don't. I think a lot of it has to do with the pro- 
gram, but I think the programs could not function without methadone. 
If you put a head-to-head kind of test with just the ancillary services 
in one and the other you had the ancillary services plus methadone, 
you would get 10 percent effect in the one with ancillary services and 
90 percent in the other. 

I don't think you should underestimate the effect of methadone in 
dealing with chronic heroin addiction. 

Mr. Rangel. But you don't know if you were able to give all of 
these services to youngsters not addicted to anything whether or not 
you would still feel great that you were helping youngsters ? 

Dr. DuPoNT. I think youngsters need all of the services, regard- 
less of whether they are taking heroin, especially employment oppor- 
tunities. There are great segments of our society who don't have 
enough opportunities now, whether they are on a program or not. 

That is another thing that happens to you when you work with these 
people, vou learn that. 

Mr. Rangel. Would you consider your patients normal? Some- 
one said earlier, a witness testified that they believed that the metha- 
done patient would always be dependent on drugs. Now, you have 
different programs, but you do have one that does not try to diminish 
the amount of methadone, and is it fair to say that the person included 
in this program will always be dependent on methadone ? 

Dr. DuPoNT. No ; it isn't fair to say that, because some will try at 
later points to come off and some of those people will make it. 

Mr. Rangel. During this period of time, how do you as a doctor 
distinguish between them and so-called normal people who are 

Dr. DuPoNT. You can't tell any difference. The only way is the 
urine test. 

Mr. Rangel. But how do they function ? 

Dr. DuPoNT. Methadone maintained patients function perfectly 
normally. To add to this a little bit, I have never seen this in writing 
and I hope it is not denied, but it is, I understand, the case that the 
District of Columbia Motor Vehicles Bureau has been very interested 
in how our methadone people have been faring in terms of accidents. 
Although they have a list of quite a number of our patients asking 
for permits about whom we have written saying they are rehabilitated. 
So far, these patients haven't had the first accident. The Motor Ve- 
hicles Bureau said facetiously, that methadone maintenance may not 
only reduce crhne but also reduce auto accidents. 

But I think the point is very important. These people do perform 
normally. 

The same thing goes on with employers. As Dr. Gearing said, em- 
ployers are quite skeptical about methadone. Many have learned from 
experience that methadone maintenance patients make good employees. 

But again I want to emphasize what I think you are saying, which 
is that there are vast unmet needs in the community which spawn 



162 

heroin addiction and support all kinds of destructive behavior. Meth- 
adone does nothing about those problems. 

Mr. Rangel. Thank you. 

Chairman Pepper. Mr. Keating. 

Mr. Keating. Doctor, did I understand you earlier to indicate that 
there were 26 deaths attributed to the methadone, or did I hear you 
incorrectly ? 

Dr. DuPoNT. Twenty-three that involved methadone. Not all you 
could say could be attributed to methadone, because many of them 
also had heroin as well. There were a total of 14 of the 23 that did not 
involve heroin also. 

Mr. Keating. Breaking that down, did you indicate that five were 
associated in some way or another with your group ? 

Dr. DuPoNT. Five out of the 23 and three out of the 14. 

Mr. Keating. How were you able to determine if these were asso- 
ciated with a drug dispensed by your organization ? 

Dr. DuPont. Well, two of them were patients who were in our pro- 
gram 2 days, one of whom took heroin and alcohol along with the 
methadone and died of a multiple overdose. 

The second was a young woman who was in the second day of the 
program and felt sick in the evening after taking her dose at 8 o'clock. 
She went to bed, vomited in her sleep, inhaled the vomit into her 
lungs, and died. Those were the only two patients to die of overdoses. 

A third death was a person who was put into a cab and who was 
about to die of an overdose. The cab raced to the hospital but the 
driver noticed that the person who put him in the cab threw some- 
thing into the street that was not identifiable. The policeman was told 
about this. When he came back and looked in the street he found a 
bottle with an NTA label. But we count that as a death that may have 
had something to do with our methadone. Two other cases occurred 
when people not in the treatment program were given bottles of NTA 
methadone and died of overdoses. Both included heroin as well as 
methadone ; that is, they participated in an addict drug-taking experi- 
ence which involved methadone. 

That is the total : Five. 

Mr. Keating. Have you had any deaths that were attributed to 
people who took the methadone from the clinic to take at home or as 
a result of that procedure ? You know, you have some people that only 
come in twice a week. 

Dr. DuPoNT. No patient who has been on the program longer than 
2 days has died from an overdose of anything. 

Mr. Keating. I think that helps clear up a number of questions I 
had. How do you ascertain the previous experience of the patient in 
terms of heroin or methadone or some other drug? 

Dr. DuPoNT. We ask them and record the information about when 
they say they first begun to use each of the numerous illegal drugs, 
including methadone and heroin. 

We also take a urine test at the beginning of the treatment. It re- 
mains possible for a person who is not an opiate addict to get into our 
program and to continue to participate in the program without ever 
having been an opiate addict. 

For example, if a person would drink a bottle of tonic water, such 
as gin and tonic, it would produce quinine in the urine, which is a com- 



163 

mon finding with people iisino; heroin. We would tabulate that as 
heroin "positive." But such an impostor would have to drink the meth- 
adone on the NTA premises for 3 consecutive months and give us a 
urine sample twice a week. We haven't had any investigators or re- 
porters that pursue that course. Whether there are people, children or 
otherwise, who have gone through this process and are not bona fide 
addicts in the first place, we don't know. 

Mr. Keating. How do you know what level to start them ? 

Dr. DuPoNT. On the basis of what they tell us. A person who is 
young would get a smaller dose and a person without a lot of track 
marks would get a smaller dose, and an older person with a lot of track 
marks would get a larger dose. In all cases, the dose is from 20 to 50 
milligrams to start. 

Mr. Keating. Do you have any information of somebody coming in 
and getting started in your program ? I think this question was asked 
earlier. Is that a constant concern of yours ? 

Dr. DuPoNT. I am concerned about it from a theoretical point of 
view. I don't have any evidence of that happening. My impression is 
it is unlikely because the methadone treatment in my experience is not 
a positive one in terms of pleasure. It is certainly disruptive to a per- 
son's life to come in every day for 3 months and fill out all the forms, 
get an I.D. card, and to give us urine specimens twice a week. This 
would deter, I think, a casual fake from coming in. 

On the other hand, I am concerned about it and if there was some 
evidence to the contrary I would like to know about it. We are really 
quite concerned. There isn't any obvious way to find that out, though. 

Mr. Keating. You indicated a patient needs a choice of modality. 
How many different choices do you provide? 

Dr. DuPoNT. There are 15 centers in the city right now, not that 
everybody can choose each one of them. For example, some of them are 
restricted to geographic areas. So if a patient doesn't live in that geo- 
graphic area he can't go there. But every person can choose at least 
detoxification on methadone with dex^reasing dosages, or methadone 
maintenance, unless he is under 18 years of age or reports a history of 
addiction less than 1 year, in which case he cannot choose methadone 
maintenance. Each patient can choose an abstinence program and come 
in and give a urine sample and participate in counseling programs. 

Mr. Keating. Do you check any police records as part of your 
procedure, before you put them on your program? 

Dr. DuPoNT. No. This is certainly a good thought. We are now con- 
sidering trying to identify arrest records earlier, and if we can't, to 
make extra efforts to make sure we have the correct identification. 

Our initial attempts to make positive identification were not as 
strict as they are now. Our current procedure is to find a driver's 
license or something else to confirm identification. 

In other words, we just don't take the person's word for his name, 
the way we did earlier in the program. Everybody who now has his 
identification renewed is expected to go through' this same process 
of proving who he is. 

Mr. Keating. Is there any procedure during the course of your 
treatment that would lead to a counseling that would try to persuade 
the person to abstain ? 

Is there any effort in this direction ? 



164 

Dr. DuPoNT. I am reluctant to get involved in encouraging that 
unless there is some reason to believe it is likely to succeed. It is very 
hurtful to people to talk them off methadone when they really need to 
be on it. We have had some very bad experiences with people who 
have discontinued methadone under some overt or covert staff pres- 
sures and then who go back to heroin and leave the program. 

Mr. Steiger. Excuse me. 

Mr. Keating. Yes. 

Mr. Steiger. A person who is addicted or dependent on methadone 
in the oral form, and he abstains, are his withdrawal symptoms phys- 
ically as stringent as the heroin addict ? 

Dr. DtrPoNT. They tend to be, dose-for-dose, less intense and of 
longer duration, but, of course, the dose-for-dose qualification is im- 
portant because the street heroin addict is likely to have a smaller 
total dose. The peo]:)le who are on methadone maintenance have very 
painful withdrawal symptoms if they stop abruptly. If they detoxify 
over weeks or months the common experience is easy until the patient 
is down to about 20 or 30 milligrams a day, at which time he will start 
developing hunger for the drug again and he may start shooting heroin 
again. 

When he takes his last dose of methadone, if he doesn't go back to 
heroin, he will have insomnia, aching of his joints and muscles, which 
will last for several days to several weeks. 

Chairman Pepper. Mr. Brasco ? 

Mr. Brasco. Thank you. 

There are several observations that have been made, Doctor, and it 
is sort of puzzling me. I share the concern of my colleagues about the 
problem of methadone traffic in the street. It would appear to me that 
if there is no euphoria attached to drinking meliadone, then there 
would be no need or no reason for an addict to be taking it in the street, 
unless 

Dr. DuPoxT. He shoots it, they inject it. 

Mr. Brasco. All right. Now, the next thing is if he does that and 
based on my own experience in the area, having practiced criminal law 
for some 10 years, addicts are not stupid when it comes to their own 
needs. 

Are the problems that you talk about concerning greater withdrawal 
effects in usmg methadone, and obviously if they are obtaining it 
illicitly they are paying for it anyway. Wliat would be the advantage 
of using methadone when an addict can get heroin in the streets easily. 

Dr. DuPoNT. Well, if the methadone is cheaper he would take the 
methadone, and I think with the widespread availability of methadone 
on the street it is cheaper, dose for dose. 

Mr. Brasco. So what you are basically saying is that the people that 
are trafficking in the street are using it to shoot it up because of the 
availability and the fact that it is cheaper ? 

Dr. DuPoxT. Oh, yes. 

Mr. Brasco. One other thing. 

I agree with my colleague, Mr. Rangel, that the support programs 
surrounding the methadone program that Dr. Gearing talked about, if 
they were given to underprivileged people without the problem of 
addiction they would be very effective in doing a job to lessen crime 
rates in deprived areas. But in your program I am wondering whether 



165 

or not there is great resistance in the job opportunity areas, based on 
two reasons : 

One, the fact that the individual is an addict in your program ; and 
two, this question of the previous record of an individual, which seems 
to me probably to be the most destructive force that we have in our 
area of rehabilitation. I am wondering if we were able to devise some 
kind of system where we could do away with a criminal record follow- 
ing you around for the rest of your life, whether or not that would be 
helpful in terms of the effectiveness of your program, at least the 
followup portion, the job aspects? 

Dr. DuPoNT. Well, it might be. It certainly wouldn't hurt. But I 
think you have to keep in mind that the average educational level of 
the patients in our program is 10th grade. That is, half the people have 
dropped out by the time the 10th grade has come around. So we have 
some serious handicaps here of an educational nature that are not 
going to be dealt with simply by eliminating the arrest record. 

I think in some respects I would like to put in a qualification on the 
ancillary services and dealing with the patients' problems. I don't 
know where the evidence is about job training, for example, or psycho- 
logical counseling in terms of reducing unemployment, or many other 
things. 

I think that the whole manpower question really needs a very hard 
look at what is going: on. I am taking the position that it is not just 
training that is needed, but opportunities for work. You can have a 
lot of training go on and put an awful lot of money into training pro- 
grams that don't really go anywhere. 

Mr. Brasco. Let nie just rephrase the last question another way: 

Getting away from the program that you are talking about and in 
the area that you are expert in, do you think that cari-ying a prior 
record around for the rest of your life serves any purpose other than 
to deprive people of job opportunities ? 

Dr. DuPoNT. I think it does deprive people of job opportunities, 
but, perhaps, not as many as you may be thinking. It is possible in many 
circumstances to establish an identity as a rehabilitated former offender 
that is quite positive and constructive. 

I don't think it is necessarily a bar forever. There is some evidence 
of social change about this. Businesses, I think, now are more con- 
cerned about social responsibilities in terms of reducing criminal be- 
havior by providing job opportunities, more so than they were 5 years 
ago. 

Mr. Brasco. Thank you. 

Chairman Pepper. Dr. DuPont, I just want to ask you one question : 

You estimated there were 16,800 addicts of heroin in the District of 
Columbia. You testified you had 3,160 in your treatment program and 
most of the rest of them are not being treated. 

Now, how much money would it take, according to your best esti- 
mate, to provide the best known treatment to all the addicts of the 
District of Columbia? 

Dr. DuPoNT. Mr. Chairman, our best estimates are that it costs 
about $2,000 a patient-year to provide comprehensive multimodality 
treatment. 

That amount of money in no way meets all the needs of these people, 
including health and training, et cetera. But it meets many of them. 



166 

Using this figure as rule of thumb, it would take about $34 million 
to treat 16,800 heroin addicts. 

Chairman Pepper. You are now getting a total of about $5,100,000 
for the program from the District and Federal Governments ? 

Dr. Du Pont. Yes sir. 

Chairman Pepper. Well, thank you very much. Doctor. We appreci- 
ate your coming. 

I am sorry to have kept you so long. 

We want publicly to thank Dr. Jaffe again for his willingness to 
stay over and let us hear him tomorrow morning. 

We will recess until 9 :45 tomorrow morning, in room 2253, and we 
win be back in this room at 10 o'clock Thursday. 

Without objection, the insertions will be included in the record. 

Mr. Perito. For the record, Mr. Chairman, exhibit No. 11(a) is en- 
titled "Profile of the Heroin Addiction Epidemic." 

Exhibit No. 11(b) is dated January 12, 1971, and entitled "Summary 
of 6 Months Follow Up Study." 

Exhibit No. 11(c) is in the handwriting of Dr. DuPont and is en- 
titled 'JDr DuPont's Numbers." 

Exhibit No. 11(d) is dated January 1971 and entitled "Administra- 
tive Order." 

Exhibit No. 11(e) is entitled "A Study of Narcotics Addicted Of- 
fenders at the D. C. Jail." 

(The exhibits referred to above follow :) 

[Exhibit No. 11(a)] 

Profile of a Heroin Addiction Epidemic 

(By Robert L. DuPont, M.D., D'rector, Narcotics Treatment Administration, 

Washington, D.C.) 

Abstract 

Washington, D.C, is experiencing an alarming epidemic of heroin addiction. 
According to current estimates there are now about 17,000 heroin addicts in the 
city. 

Two-thirds of the addicts are under 26 years of age, 91 percent are black, 74 
percent are male, and 52 percent began heroin use within the last 4 years. In one 
large part of the central city it is estimated that 20 percent of the boys agei 15 
to 19 and 38 percent of the young men 20 to 24 are heroin addicts. 

A major treatment program has been implemented in Washington which is now 
treating 3,000 heroin addicts of whom about 75 percent receive methadone. 

An initial performance study found that 55 percent of all patients remained in 
the program after 6 months and that 86 percent of those on methadone main- 
tenance were retained in the program during the 6-month study. Among the 
patients treated, heroin use decreased, arrest rates fell, and employment rates 
rose. 

Introduction 

Washington, D.C, Is engulfed by an alarming epidemic of heroin addiction. 
Increasingly sophisticated research information accumulated over the course of 
the last year demonstrates this without a doubt. It is now estimated that there 
are 16,800 heroin addicts in the city, or 2.2 percent of the total population of 
756,510. The social and personal losses are tremendous. The related crime rate is 
appalling. 

But the figures do not stop with the tragic consequences of heroin addiction in 
the Nation's Capital. Limited data available from metropolitan areas around the 
country suggests that these cities are also experiencing the epidemic. 

Upon recognizing that heroin addiction was such a disastrous problem in 
Washington, D.C, the largest and fastest growing municipal treatment program 



167 

in the Nation, the Narcotics Treatment Administration, was begun in February 
1970. Nevertheless, it is obvious that even this effort is grossly inadequate for 
the needs of the Washington community. 

What is known of the epidemic in Washington? How many heroin addicts 
are there? Where do heroin addicts live in the city? What are the basic char- 
acteristics of the addict population? When did the epidemic begin? Is it getting 
worse? What is the relationship between the distribution of addiction in the city 
and other social factors including crime and poverty? How much does the 
epidemic cost the community ? What can be done about it? 

This paper attempts to answer these vital questions and should be useful to 
the Washington, D.C., community and to other cities and States which know far 
less about their problems with heroin addiction. 

How many heroin addicts are there? 

In the summer of 1969 the only basis for estimating the Washington addict 
population was the Bureau of Narcotics and Dangerous Drugs (Justice Depart- 
ment) 1968 list of 1,162 addicts in Washington. However, in August 1969 a study 
at the District of Columbia jail showed that 45 percent of all new admissions 
were heroin addicts. Only 27 percent of the men identified as addicts by inter- 
view and urine testing were previously known to the BNDD (1). 

On the basis of this new information, the estimate of the total number of 
addicts was raised to 3.7 times 1,162 or 4,300 addicts. Next, in cooperation with 
the District of Columbia coroner, an analysis was made of the total number of 
known opioid overdose deaths in Washington. An opioid overdose death is a sud- 
den death, without other cause, of an individual whose urine or other tissues 
contain an opioid drug such as heroin, morphine, or methadone (3). In 1967 the 
number was 21. Using the Baden formula (2) that one of every 200 heroin addicts 
dies of an overdose reaction each year, the total number of District of Columbia 
heroin addicts appeared to be 4,200 for 1969. However, there were 13 overdose 
deaths in the first 3 months of 1970. This was equivalent to 52 per year and indi- 
cated a total addict population of 10,400 using the Baden formula. During the 
first 6 months of 1970 a total of 21 people died of overdoses. Thus, in the first 6 
months of 1970, the same number died of overdose reactions as died in all of 1969. 

In July 1970, again in cooperation with the District of Columbia coroner, a 
new more systematic procedure was developed. Complete narcotics drug screens 
(using gas liquid chromatography) were performed on all autopsied deaths of 
individuals between the ages of 10 and 40 as well as individuals younger or 
older who showed evidence of drug use. During the next 6 months, 42 people were 
identified as dying of opioid overdose reactions. The annual rate was 84. The 
estimate of total heroin addicts was accordingly raised to 16,800. 

During the calendar year 1968 a total of 875 narcotic addict information forms 
were received by the Biostatistics Division of the District of Columbia Health 
Services Administration. In 1969 one of these individuals died of an opioid over- 
dose. During 1970 three died of opioid overdose reactions. Thus the rate of death 
was one per 438 man-years. This data was not used to compute a '^Washington 
formula" because the numbers are small, but it suggests that the multiplier used 
by Baden in New York may be low for Washington. If this is true, then the cur- 
rent estimate of 16,800 heroin addicts in Washington may also be low. 

It should be noted that the increase in the rate of overdose deaths in the last 
2 years did not reflect only increased heroin use. In part, the increase was due to 
greater awareness of the problem of overdose deaths and to improved and more 
frequently used laboratory procedures. For example, during the 18 months prior 
to July 1970 drug screens were performed on only 6.3 percent of all autopsied 
deaths. During the last 6 months of 1970, the period of the systematic study, 
narcotic drug screens were performed on 51 percent of all autopsied deaths. ( See 
table 1. ) 

There was no evidence of increasing death rates over the 6 months of the study. 
Twenty-three people died from July through September, and 19 died from October 
through December 1970. Thus, although the time span was short, and the numbers 
were small, the Washington heroin addiction epidemic may have stabilized during 
the last 6 months of 1970. Data collection is continuing and in the next year more 
definitive conclusions should be possible. 

By January 1971, a private drug treatment program located in the District of 
Columbia, the Blackman's Development Center (BDC) which made small doses 
of methadone available to addicts as part of a voluntary outpatient withdrawal 
program, had registered over 20,000 "drug dependents" — almost all heroin addicts. 
Some BDC clients lived in the Washington suburbs, which have almost no treat- 



168 

ment facilities for heroin addicts. However, it seems unlikely that the suburbs 
contributed more than 10 to 20 percent of BDC registrants. Thus, even when the 
BDC registration list is discounted for suburban residents, nonheroin users and 
multiple registrations for the same person, the 20,000 figure suggests that there 
are many more thousands of addicts in Washington than the 1968 list of the 
Bureau of Narcotics and Dangerous Drugs indicated. 

There are other figures which indicate that the addiction problem is greater 
than had previously been estimated. The Washington, D.C., Metropolitan Police 
Department reported 4,730 narcotics arrests during 1970. Ninety percent of these 
arrests related to heroin use or sale. The numbers of narcotic arrests for each 
year from 1967 through 1969 were 818, 1,077 and 1,716 respectively. Thus, there 
was a 462 percent increase in narcotics arrests from 1967 to 1970. Undoubtedly, 
part of this increase reflects improved and increased police activity. However, it 
also reflects the spreading epidemic of heroin addiction. 

Evidence for increasing the estimate of the total number of heroin addicts in 
Washington comes from several relatively independent sources. These include 
the rate of commitment of narcotics offenders to the jail, the rate of opioid over- 
dose deaths, and the rate of narcotics arrests. More direct evidence comes from 
the universal experience of Washington heroin addiction treatment programs 
which report large numbers of registrants. 

No one piece of evidence is conclusive. However, taken together, the data form 
a pattern which clearly indicates that the number of heroin addicts in Washing- 
ton is far higher than earlier estimates. Tlie evidence also suggests that there 
has been a major increase in the prevalence of heroin addiction in the last several 
years. 

What are the characteristics of the addict population? 

In February 1970, Washington began a large multimodality treatment program, 
the Narcotics Treatment Administration. By January 14, 1971, there were 2,793 
heroin addicts in treatment in the NTA programs. 

Study of the 77 onioid overdose deaths in 1969 and 1970 revealed demographic 
characteristics of the group on the four basic variables of age, sex, race, and 
place of residence in the city. This population was then compared to the NTA 
patient population using these same four variables. The results are shown in 
figures 1 and 2. 

There was a close correspondence betAveen these two populations. This sup- 
ported the assumption that NTA was reaching typical addicts and, unlike vir- 
tually all other drug programs in the country, the treatment population was 
generally representative of the total Washington addict population. 

Some of the basic characteristics of this population are shown in table 2. 

When did the epidemic of heroin addiction tegin? 

Assuming that the NTA patient population is representative of the total Dis- 
trict of Columbia addict population, it is possible to determine when the heroin 
addiction began for Washington addicts. (See fig. 3.) 

Fifty^two percent of the Washington addicts began heroin use after 1965 and 
65 percent began after 1963. This data indicates that the epidemic began between 
1964 and 1966 and became increasingly widespread at least through 1968. 

The individual who has become addicted only recently is often less motivated 
to seek treatment for his addiction since he is still enjoying the "high" of the 
drug and has experienced relatively little of the pain and danger of addiction. 
Thus, most treatment programs have an overrepresentation of older, more chronic 
addicts. This reluctance of the newer user to seek help probably explains the 
sharp drop in the number of addict patients who began use during 1969 and 
1970. However, it seems certain that the rise in addiction between 1964 and 1968 
reflects a serious epidemic of heroin addiction in Washington. This is corro- 
borated by a recent study of the rate of commitment of known addicts to the 
District of Columbia jail between 1958 and 1968 which shows a sharp increase 
occurred in 1967 (4). (See fig. 4.) This increase also corresponds to a sharp rise 
in reported serious crimes in Washington in 1966. ( See fig. 5. ) 

A recent St. Louis study (5) suggests that the list of the Bureau of Narcotics 
and Dangerous Drugs of known heroin addicts, which is derived primarily from 
police data, generally offers a good estimate of. total number of addicts in a 
community when the total is stable. The data may not be reliable, however, in 
a community which is experiencing a sudden epidemic of heroin addiction. The 
District of Columbia jail study showed that there is a substantial time lag be- 
tween beginning addiction and coming to the jail. For example, the average 



169 

period of addiction prior to the current incarceration was 7 years (1). Ttiere- 
fore, the discrepancy between the St. Louis data and the District of Columbia 
data may reflect the acute epidemic in Washington in recent years. This hypo- 
thesis gains some support from the fact that the BNDD list for Washington rose 
sharply from about 1,100 each year from 1965 through 1968 to 1,743 by December 
31, 1970. The earlier BNDD figures for Washington for 1965 through 1969 were: 
1,116, 1,164, 1,106, 1,162, and 1,636. 

Where do heroin addicts live in the city? 

Based on the opioid overdose deaths and NTA patients, and assuming that 
there are a total of 16,800 heroin addicts in the city, it is possible to describe a 
geographic profile of addiction in the city. 

( See table 3 and fig. 6. ) 

The rates of heroin addiction range from less than 0.1 percent for the rela- 
tively affluent northwest section of the city west of Rock Creek Park, to the rate 
of 4 percent in the model cities area, area 6. These rates of addiction closely 
parallel reported crime rates and other indicators of poverty and social 
disorganization. 

(See table 4.) 

Using this same data it is possible to estimate the number of addicts per 
thousand people in various sex and age groups in the Washington, D.C., 
population. 

From statistics based on opioid deaths, several conclusions can be drawn. 
Addiction is concentrated almost exclusively between the ages of 15 and 45. 
Sixty^five percent of the addicts are under 26 and 31 percent are younger than 
21 years of age. For the age range 15 through 19, the citywide rate for boys is 
10.7 percent and for girls 2.2 percent. The next older age bracket, 20 through 24, 
has rates of 19.8 percent and 3.2 percent respectively for boys and girls. From 
25 through 29, the rates are 6.2 and 5.0. 

( See fig. 7 and table 5. ) 

Relating this data to the geographic distribution data and using the distribu- 
tion of NTA patients indicates that in service area 6 (the model cities area) 20 
percent of the boys between the ages of 15 and 19, and an astonishing 38 percent 
of the young men between the ages of 20 and 24 are heroin addicts. The District 
of Columbia model cities area begins six blocks north of the White House, and 
extends east above Massachusetts Avenue to four blocks north of the U-S. 
Capitol. 

How much does the heroin addiction epidemic cost the community? 

The most certain and tragic cost of heroin addition in 1970 was the 63 people 
who died of opioid overdoses. In addition, almost all heroin addicts commit 
crimes to support their expensive habits. Based on an estimate of 15,0(X) heroin 
addicts, and assuming an average habit of $40 per day, a recent study estimated 
that the annual value of proijerty and services transferred because of addiction 
through robbery, theft, prostitution, drug sales, et cetera, was $328,100,000 (6). 
One of the common ways to support a habit is to sell heroin. This spreads the 
epidemic. The indirect costs of heroin addiction to the community from urban 
disorganization and fear of crime are equally staggering. 

What can be done about the epidemic? 

Heroin addiction is a treatable disease for most addicts. There is excellent 
evidence that methadone maintenance is safe and effective (7). Therapeutic com- 
munities (such as Synanon, Day top, and Phoenix House) and community self- 
help organizations (such as Blackman's Development Center in Washington) 
offer promise of success with many addicts. 

A recent study of the narcotics treatment administration program perform- 
ance with 475 randomly selected patients for the 6-month period from May 15 
through November 15, 1970, showed that 55 percent of all patients in the program 
on May 15 were still in the program 6 months later. The retention rate for high 
dose methadone maintenance was 86 percent after 6 months. Arrest rates were 
down and employment was up for the patient population. Only 7 percent of the 
patient population was still regularly using illegal drugs and 55 percent showed 
no evidence of illegal drug use during the sixth month of treatment (S). 

Seventy -six percent of NTA patients were voluntary, self -referred walk-ins 
to one of the 10 NTA centers located throughout the city. Twenty-four percent 
were referred by agencies of the criminal justice system, such as probation and 

60-296 O— 71— pt. 1 12 



170 

parole departments. None were civilly committed. About 100 lived in three NTA 
halfway houses. Seventy were residents almost always for less than 3 weeks, on 
two NTA detoxification wards at District of Columbia General Hospital. The 
remainder, about 2,600, were outpatients. Fifty-four percent were receiving 
methadone maintenance, 26 percent were in abstinence programs, and 20 percent 
were receiving decreasing doses of methadone leading to abstinence. 

The unprecedented, sharp dip in the rate of serious crimes in Washington 
during 1970 (see fig. 5) was widely attributed to increased police presence and 
particularly to the effectiveness of the NTA treatment programs (9) . 

How much do treatment progrwms cost? 

An economic study of drug addiction demonstrates that if NTA can suc- 
cessfully treat only 40 percent of 1,000 patients (a low estimate on the basis of 
performance studies) the cost of treatment for 1 year will be $1,400,000. The 
benefits in terms of reduced criminal activity will be $5,750,770. This shows a 
benefit-cost ratio of 4.1 to 1 (6). 

On January 14, 1971, when NTA had 2,793 patients, the total cost »f the pro- 
gram was less than $4 million a year. 

References 

(1) Kozel, N., Brown, B., DuPont, R. : "Narcotics and crime: a study of narcotics 

involvement in an offender population." Narcotics Treatment Administra- 
tion, 1971. 

(2) Glendinning, S. : "District of Columbia coroner's office study." Narcotics 

Treatment Administration, 1970. 

(3) Johnston, E. H., Goldbaum, R., Welton, R. L. : "Investigation of sudden 

deaths in addicts." Medical Annals of the District of Columbia, 38: 375- 
380, 1969. 

(4) Adams, S., Meadows, D. F., Reynolds, C. W. : "Narcotic-involved inmates in 

the Department of Corrections." District of Columbia Department of Cor- 
rections Research Report No. 12, 1969. 

(5) Robins, L. N., Murphy, G. E. : "Drug use in a normal population of young 

Negro men." Am. J. Publ. Hlth., 57 : 1580-1596, 1967. 

(6) Holahan, J. : "The economics of drug addiction and control in Washington, 

D.C. : a model for estimation and costs and benefits of rehabilitation." 
Special Report by the Office of Planning and Research of the District of 
Columbia Department of Corrections, 1970. 

(7) Gearing, F. R. : "Successes and failures in methadone maintenance treatment 

of heroin addition in New York City." Presented at the Third National 
Conference on Methadone Treatment, Nov. 14, 1970. 

(8) Brown, B. S., DuPont, R. L. : "6-month followup of heroin addicts in a large 

multimodality treatment program." Narcotics Treatment Administration, 
1971. 

(9) DuPont, R. L. : "Urban crime and the rapid development of a large heroin 

addition treatment program." Presented at the Third National Conference 
on Methadone Treatment, Nov. 16, 1970, accepted for publication in J. Am. 
Med. Assoc, 1971. 

Table 1. — The number of opioid overdose deaths each month from, July through 

December 1970 

July 9 

August 5 

September 9 

October 8 

November 7 

December 4 

Total 42 

Average per month 7 



171 



i<\urd CncL. Ch&r&ckris-l-ics Crf' fheCfiCcl OOc'i^JoSd Ocaih GrcLi^p 



27% 



13% 


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Caucasian NeQro 





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SBHUiCk pif^ea OF REbiPkNCE 



172 

Table 2. — Selected characteristics of the NT A patient population (N=2T59) 

Percent 

Reporting regular heroin use prior to treatment 99 

Average number of arrests reported prior to treatment 4. 7 

Average number of convictions reported prior to treatment 1. 7 

First drug used : 

Heroin 9 

Marihuana 49 

Heroin and marihuana in same year 7 

Other 35 

Average age at first heroin use 19 

"Voluntary admissions 76 

Referred from agencies of the criminal justice system 24 

Civilly committed 

Reporting prior treatment for heroin addiction 41 

Martial status : 

Single 58 

Married 23 

Separated 13 

Divorced 4 

Widowed or deserted 2 

Last year of school completed, average 10. 4 

Receiving welfare at start of treatment 7 



173 



Fi'aard To-c. 0.h:irac-hirjs4/ct> of -Hie MT/} Pafi'ttif fc pal ail on 



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174 



TABLE 3.— HEROIN ADDICTION RATES BY SERVICE AREA 



Heroin overdos 


e deaths 










from April through 


NTA clients (random 


Estimated 


Number 


November, 


1970 


sample 


of 500) 


total 
number 


of addicts 
per 1,000 










Number 


Percent 


Number 


Percent 


of addicts 1 


population 2 


3 


6.5 


33 


6.6 


1,109 


13.3 








17 


3.4 


571 


10.9 


6 


13.0 
19.6 


55 
62 


11.0 
12.4 


1,848 
2,083 


19.9 


9 


18.0 


4 


8.7 


71 


14.2 


2,385 


27.7 


13 


28.3 


121 


24.2 


4,066 


40.2 


10 


21.7 


121 


24.2 


4,066 


30.8 








2 


0.4 


67 


0.8 


1 


2.2 


18 


3.6 


605 


14.6 



Service area 

1 

2 

3 

4 

5 

6 

7 

8. 

9. 

Total 



46 



100 



500 



100 



16,800 



21.2 



1 Based on 16,800 estimate of total number of addicts distributed according to percent of NTA patients or service area. 

2 Based on 16,800 estimate of total heroin addicts and distributed according to percent of NTA patients by service area. 



Note.— Service area population used were 1967 estimates. 



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TABLE 5.— CITYWIDE HEROIN ADDICTION RATES BY AGE-SEX GROUPINGS i 

(In percent] 



Males 



Females 



Total 



15tol9 12.9 2.0 7.1 

20to24.... 18.9 3.0 10.5 

25to29 _ 6.3 4.7 5.5 

30to34 5.4 3.4 4.4 

35to39 4.3 .9 2.5 

40to44 2.5 .7 1.5 

45 to 49 

50 to 54 _.. .7 .4 



' Based on 1968 population statistics, age-sex distributions of 91 overdose deaths (August 1968 through November 1970), 
and total estimated addict population of 16,800. 



177 



Number In 
Thousands 

40 

38 
36 
34 
32 

30 
28 
26 
24 
22 
20 
18 
16 
14 
12 
10 

8 

6 

4 

2 





FIGURE FIVE 



CRIME INDEX OFFENSES 
1959 THRU 1970 

SIX MOKTH TOTALS 



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Agg. Assault 
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DEC JUN DEC JUN DEC JUN DEC JUN DEC JUN DEC JUN DEC JUN DEC JUN DEC JUN DEC JUN DEC JUN DEC JUN DEC 

58 59 60 61 62 63 64 65 66 67 68 69 




D. C. SERVICE AREAS 

AND 

ns7o 

CENSUS TRACTS 

PREPARED BY THE D C GOVERNMENT 
AND 
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PLANNING COMMISSION 



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[Exhibit No. 11(b)] 

GOVEBNMENT OF THE DiSTBICT OF COLUMBIA, NABCOTICS TbEATMENT 

Administbation, Office of the Dieectob, Washington, D.C. 

Januaby 12, 1971. 

SUMMAEY of 6-MONTH FOLLOWTJP STUDY 

There were 1,060 heroin addict patients in treatment with the Narcotics Treat- 
ment Administration on May 15, 1970. iSix hundred and twenty-five (625) of these 
were randomly selected and followed for 6 months by the Research and Develop- 
ment Division of the NTA. 

The Youth Division of NTA differed significantly from the adult programs and 
is therefore considered separately. 

There were 475 patients in the adult program sample on May 15, 1970. Six 
months later, on November 15, 1970, 217 (46 percent) of these people were still 
active and reportable* with their original NTA program. In addition, 43 (9 per- 
cent) were active and reportable in other NTA programs into which they had 
transferred. Thus, a total of 55 percent of the clients reportable to NTA as of 
May 15 remained reportable to NTA 6 months later (table 1). Eighty -nine (19 
percent) of these 475 had been arrested for a new charge during the 6 months 
followup period. 

The highlights of this followup study are reported in tables 1 through 4. 

It is noteworthy that there is a much higher retention-in-program rate in high 
dose methadone treatment than in other treatment classifications (table 1). 

The high dose methadone group not only achieves this high retention rate (86 
percent) , but also has the lowest arrest rate (12 percent) (table 2) . 

The arrest data was also examined comparing the arrest rate of individuals in 
the NTA programs with the arrest rate of those who left the program. The former 



♦A patient Is "reportable" If he has been seen at least four times In the 14 consecutive 
calendar days preceding the weekly NTA census. 



179 

had an arrest rate of 2.8 percent per patient-month of treatment while the latter 
(the dropouts) had an arrest rate of 5.7 percent per month after leaving the 
program. 

Table 3 reports arrest rates after 6 months in the community for heroin addicts 
released from the Department of Corrections before the start of NTA in 1970. 
This table is included for comparison purposes. 

Tables 4 and 5 contain data on employment rates and dirty urine rates. Both 
are encouraging but suggest the need for increased counseling and job placement. 

The 150 patients in the youth program fared less well (see client's functioning 
in the Youth Division programs — ^May 15, 1970 — Nov. 15, 1970). Only 1 percent 
of these youths received methadone maintenance treatment while an additional 
10 percent received either methadone detoxification or emergency short-term 
methadone treatment (methadone hold). Thus 89 percent of the sample never 
received methadone. Forty-two percent of the youth clients were arrested during 
the course of the 6-month followup. Sixty of the 150 youths remained in the pro- 
gram after 6 months (40 percent retention rate) but only 18 of these were still 
giving regular urine samples (12 percent of 150). 

The results of the Youth Division program were generally similar to the 
results of the abstinence programs for adults. The results of the abstinence pro- 
grams are not as encouraging as the results from high dose methadone mainte- 
nance treatment. However, it must be emphasized that while there were many 
failures in the abstinence programs there were at least a few apparent suc- 
cesses — for example while 42 percent of the youths were arrested during the 6 
months followup, 58 percent were not arrested. 

This summary relates to NTA's performance with patients who were in the 
program from May 15 through November 15, 1970. 'Since May 15, there have been 
some improvements in our programs and a great enlargement. On January 8, 1971, 
NTA had 2,670 reportable patients. Of this total 1,402 receiving methadone main- 
tenance treatment, 526 were on methadone detoxification, and 35 were on emer- 
gency doses of methadone (methadone hold). Thus 1,963 (74 percent) were 
receiving methadone and 707 (26 percent) were abstinent. 



180 



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183 

[Exhibit No. 11(c)] 
Dr. DuPont's Numbers 

Of 1,060 patients in NTA on May 15, 1970, 450 were randomly selected for 
foUowup. 

Of these 450, 56 percent remained in the program for 6 months, and 40 per- 
cent remained for 11 months. 

Of those on methadone maintenance, 86 percent remained 6 months as com- 
pared to 15 percent who received no methadone (or were abstinent). 

After 11 months, 22 percent of the 450 were rearrested. Of the people who re- 
mained in the program, 13 percent were rearrested. Of those who dropped out, 
28 percent were rearrested in 11 months. 

In the last 8 months, 23 people have died of overdoses with methadone. Only 
five of these got their methadone from NTA. 



[Exhibit No. 11(d)] 
Administration Order 

1. purpose 

The purpose of this administration order is to provide medical and program 
guidelines for methadone treatment in Narcotics Treatment Administration pro- 
grams and cooperating programs. 

2. DEFINITIONS 

New admissions are persons who have no previous record in Information 
Central. 

Readmissions have l)een previously known by NTA central information but 
their cases have been deactivated. 

Reportable patients are defined as patients who have been seen at least four 
times in the preceeding 14 consecutive calendar days. 

Reportable patients will be considered to be in one of the following four 
categories : 

1. Abstinence 

2. Methadone maintenance 

3. Methadone detoxification. 

4. Methadone hold. 

Nonreportahle patients are seen at least once in the preceding 28 days but do 
not qualify as reportable. 

Transfers are any patients known to Information Central who undergo an 
approved change in treatment centers. 

Inactive patients are defined as those who have no face-to-face contact during 
the preceding 28 days. 

Abstinence is defined as any continuing treatment contact with the Narcotics 
Treatment Administration program or cooperating program in which the indi- 
vidual patient does not receive methadone. 

Methadone maintenance is a treatment classification to be used for all pa- 
tients who receive regular doses of methadone when the dose of methadone is 
not consistently reduced. That is, any patient who receives a regular dose of 
methadone at the same dose level or increasing dose level is to be considered 
a methadone maintenance patient.* All patients in the methadone maintenance 
category should be urged to stay on methadone maintenance until their life 
situations have been stabilized for a period of 6 months to 1 year or longer. Any 
patient who comes off methadone maintenance should be strongly urged to stay 
in the treatment program while he is being detoxified and after he is abstinent 
for a period of not less than 2 months. During this time, urine testing and coun- 
seling should continue while the patient is considered an "abstinence patient." 
If there are signs of renewed drug hunger and the patient feels he cannot con- 
trol this urge, or if there are signs of renewed drug use, the patient should be 



* The only exceptions to this definition are the special youth detoxification schedules 
which have a period of Increasing doses, a plateau, and a programed detoxification within 
6 months of the first dose. 



184 

encouraged to return to methadone maintenance treatment for another pro- 
longed period of time. Experience has shown that patients who stop meihadone 
mamteuance have a high relapse rate, especially it ihey have been on the metha- 
done maintenance program less than a year. Therefore, every effort shuula be 
made on the part of program staff to retain patients in continuing treatment for 
a period of weeks or months after the patient begins a detoxification program. 
Patients in methadone maintenance should be treated with regular doses of 
methadone between SO and 120 milligrams a day. Dose levels less than SO mini- 
grams are discouraged because of the likelihood of continued drug abuse. Doses 
above 120 milligrams are to be discouraged because it is unlikely that they will 
produce additional benefits to the patient. Under no circumstances are patients 
to be given more than 150 milligrams of methadone a day. 

Methadone detoxification should in no circumstances be prolonged for more 
than 3 months. A patient on detoxification should not receive more than 50 milli- 
grams a day unless he is being detoxified from methadone maintenance. The 
physician in charge of the patient's treatment should establish a schedule for 
gradually decreasing doses with abstinence to be achieved between 2 weeks and 
3 months after the start of methadone detoxification. Urine results must be 
monitored carefully in this group because of a strong likelihood that they will 
experience renewed drug hunger and return to illegal drug use, particularly at 
dose levels below 40 milligrams a day. Evidence of renewed illegal drug use or 
drug craving beyond the individual patient's ability to control it are indications 
for the patient's going on methadone maintenance. Under no circumstances 
should a person be classified as methadone detoxification for more than 3 months. 
Methadone hold patients are classified in this group if they are given doses of 
methadone on an emergency basis prior to appropriate examination, diagnosis 
and disposition. Under no circumstances should a patient be retained in the 
methadone hold category for more than 2 weeks. 

Authorized medical representatives. Only physicians can sign prescriptions. 
Others, including nurses, medical assistants etc., may dispense methadone and 
sign NTA Form 6 (attachment 5). 

3. POLICY 

Because people who are addicted to heroin often have many psychological and 
vocational problems requiring vigorous and effective treatment, IsTA's goal for 
each patient is social rehabilitation. Methadone treatment must be considered 
within this context as only one part of the total treatment program. 

The heroin addict patient may suffer from a number of medically treatable 
illnesses and for each of these, of course, the appropriate medical treatment is 
indicated. For example the heroin addict may have clinical schizophrenia with 
the common symptoms of that illness. In this case, the most appropriate medical 
treatment includes a phenothiazine. 

Nevertheless, the only drug that has been shown to be useful in the treatment 
of heroin addiction itself is methadone. Therefore, no other drug should be 
prescribed for treatment of heroin addiction. For example, there is no evidence 
that tranquilizers or hypnotics are useful in the treatment of heroin addiction 
or heroin withdrawal. Furthermore, these drugs are specifically contraindicated 
in the treatment of heroin addicts since they are likely to become drugs of 
abuse in their own right. This is particularly true of the hypnotics (such as 
Seconal and doriden) but it is also true of the antianxiety tranquilizers (such 
as librium and meprobamate). The heroin addict has, in part, gotten himself 
in serious trouble because of his tendency to medicate himself and to treat 
his unpleasant feelings with a variety of drugs, especially heroin. Therefore, 
the physician dealing with heroin addicts can anticipate requests from the addict 
for medications of all kinds. The doctor should be armed with the knowledge 
that no tranquilizer or hypnotic has been shown to be useful in the treatment 
of heroin addiction. He should share this information with the patient. How- 
ever, the physician should avoid routine use of either type of drug. The physician 
should never prescribe these drugs for more than a few days because of the 
likelihood of producing dependence on, or even addiction to, these drugs. 

Meth<idone maintenance, on the other hand, has been demonstrated to be 
effective in achieving specific results. The primary drug result is blocking the 
"drug craving" which usually occurs at a dosage of about 40 to 50 milligrams 
a day. When maintenance levels reach about 100 milligrams a day, there is 
an additional important drug effect : the suppression of euphoria from intra- 



185 

venously administering heroin. These are the two effects that are most desirable 
in the use of methadone maintenance for chronic heroin addiction. Methadone 
maintenance does not produce the suppression of all anxiety, depression, or 
other uncomfortable bodily feelings. Neither the addict nor the doctor should 
expect these results. 

Methadone in adequate doses, blocks the drug hunger for heroin and the 
high of heroin. It does not alter other forms of drug abuse. Therefore, the 
clinician should be watchful for signs of other drug abuse such as amphetamine, 
barbiturate, and most especially alcohol abuse. Each of these conditions is serious 
and requires prompt, appropriate, and vigorous treatment. 

4 PR0CE3)URES 

Methadone may be used in three treatment categories : methadone mainte- 
nance, methadone detoxification, and methadone hold. The following are in- 
dividual discussions of each : 

I. Methadone Maintenance 

A. Indications for methadone maintenance 

The indications for methadone maintenance are : 

1. The patient volunteers for methadone maintenance; 

2. The patient has used heroin continuously for at least one (1) year ; 

3. The patient is at least eighteen (18) years old. (Exceptions to this 
ruling are discussed in section I, I. Methadone Maintenance Treatment for 
Youth.) 

B. Preparing the patient for methadone maintenance treatment 
Methadone maintenance treatment is entirely voluntary for all patients. No 

one should be forced or coerced into methadone maintenance. If the patient ex- 
presses the desire to go on methadone maintenance, the implications of treat- 
ment must be carefully and completely explained to him. 

Prospective methadone maintenance patients should be encouraged to think 
of it as, at least, a 6-month commitment to continue the treatment. For most 
patients it makes sense to continue methadone maintenance for years until 
their social, psychological, and biological life has been satisfactorily stabilized. 
The preliminary results of our investigations into program performance indi- 
cate that the premature discontinuance of methadone maintenance and dose 
levels under 80 milligrams per day are often associated with the patient's re- 
turn to heroin addiction and criminal behavior. 

C. Consent to take methadone maintenance treatment 

Before beginning methadone maintenance treatment, each patient must sign 
NTA Form 19 "Informed Consent to Take Methadone Treatment" (see attach- 
ment 1). If a patient is under 21, every effort should be made to get either a 
parent or guardian signature on the consent form, although this may not be 
possible or practical in every case. In addition, NTA Form 7 (see attachment 
2) must be completed on each patient and registered with Information Central 
before any medication or treatment services are provided. 

D. Dose level 

For all NTA treated patient's receiving methadone maintenance treatment, 
the physician should attempt to give a "blocking" dose of 80 to 120 milligrams a 
day. There is good reason to be'ieve that lower doses are associated with signifi- 
cantly hisher failure rates and that lower doses do not produce any advantage 
to the patient. 

Methadone maintenance programs have been shown to be effective only when 
methadone is used in a specific manner. The drug is given to the patient once 
a day, and the patient's dose is modified on the basis of his response to the medi- 
cation. The initial dose level should be moderate, in the range of 20 to 50 
milligrams. 

NTA medication schedules (see attachment 3) provide all necessary informa- 
tion for raising or lowering doses, depending on the treatment indicated, by age, 
size and duration of habit, et cetera. Since the duration of action of methadone is 
24 to 48 hours, the drug lends itself to daily administration. 

The dose level should be increased to a level of about 100 milligrams a day 
in those patients who can tolerate this dose level without excessive drowsiness 

60-296 0-^71— pt. 1 13 



186 

or other side effects. This increase should occur gradually over a 3- to 6-week 
period. 

Patients are not to be told their dose level since this leads to an unhealthy 
'"competition" among the patients for the highest doses. Dose level is a medical 
issue and it should be managed by the medical staff. 

E. Side effects of methadone 

Side effects of methadone include excessive sweating, constipation, edema, 
drowsiness, dermatitis, and relative impotence in men. None of these symptoms 
are serious, and, with the exception of excessive sweating, they usually disappear 
as treatment is continued and tolerance is attained. However, some patients con- 
tinue to suffer from constipation. This can be treated symptomatically with a 
laxative, but even this is usually not needed once a tolerance develops. 

F. Take-home medication 

Methadone is to be administered to the patient daily (6 or 7 days per week 
depending on the number of days the center is opened) on the premises of an 
NTA facility for the first 3 months of his treatment. Once the patient's drug 
use has ceased for at Idast 1 month and he has demonstrated stability in his life 
patterns, he may take home his weekend medication at the discretion of the 
appointed person in charge and after signing NTA Form 22 "Statement of Re- 
sponsibility for Take-Home Medication" (see attachment 4). 

Individual doses to take off NTA premises must be properly labeled with the 
patient's name, the date the dose is to be taken, and the specific program name 
and telephone number. The label must also state that the bottle contains metha- 
done and that it is dangerous and may be fatal if taken by anyone other than the 
patient. 

Patients are to return all empty bottles before new bottles are given. If the 
patient fails to return his bottle, loses or breaks it, or reverts to drug use, he will 
be required to report in daily again for at least 4 weeks. 

Because methadone may be fatal when taken by a nonaddicted person in doses 
conventionally given to methadone maintenance patients, patients taking medi- 
cation home must keep it in the locked container provided by the center. The 
fact that methadone is packaged in a liquid form makes it particularly attractive 
to children. The patient must be impressed with the danger involved in taking 
medication home and be strongly encouraged not only to lock up his methadone, 
but to place it out of children's reach. 

In addition, the patient should be reminded that methadone should not be 
refrigerated. 

G. Urine testing 

Every methadone maintenance patient must submit a monitored urine speci- 
men a minimum of once a week. 

These urine collections must be monitored by an NTA staff member or a staff 
member of a cooperating program under the general direction of the program 
chief. Unmonitored specimens are worthless for our purposes and should be 
discarded. 

All staff who are monitoring urine should sign the urine specimen label found 
on the back of NTA form 6 (see attachment 5). These staff members should be 
trained so they recognize an adequate quantity of urine. No urines should be 
reported back from the laboratory as quantity not sufficient (QNS) : the staff 
should discard urines of inadequate quantity. 

In unusual cases, or where there is special concern about the possibility of 
patients continuing to use illicit drugs, three or more samples a week may be 
sent to the laboratory for analysis. 

H. Suspension from methadone maintenance program 

Patients failing to report for treatment for 30 consecutive days will auto- 
matically be suspended from treatment. The suspended patient will have to 
wait 30 days before he is eligible for treatment or the waiting list again. 

If the center physician and/or the center administrator suspends a patient 
before 30 consecutive days without treatment have elapsed, the physician or 
administrator must complete NTA form "Report of Pntirvt Chnnor of Status" 
(see attachment 6) 'and send it to Information Central. Tr^ this case, the patient 
will not be accepted back into treatment or placed on the waiting list for 30 days 
after the suspension date. 



187 

I. Methadone maintenance treatment for youth 

For purposes of treatment planning (as opposed to legal considerations re- 
garding consent) patients are considered adults if they are 18 or over. 

Individuals who are less than 18 may receive methadone on short or long 
detoxification schedules (none longer than 6 months) after notifying the director 
of NTA. 

In the future, NTA may try an experimental maintenance program for youth 
under 18 but our experience is too limited to make a final decision on that issue 
at this time. 

II. Outpatient Methadone Detoxification 

A. Eligibility 

Outpatient methadone detoxification should be attempted with the following : 

1. Any patient who has a history of less than 1 year addiction to heroin ; or 

2. Any patient who is under 18 years of age ; or 

3. Any patient who requests this treatment. 

B. Dose level 

Methadone detoxification should begin by "catching" the addict's habit, usual- 
ly with doses in the range of 20 to 50 milligrams per day. ( See medication sched- 
ules, attachment 3.) 

Initially, this may require doses more than once a day until the proper dose 
level is achieved so that the patient does not experience vdthdrawal symptoms 
(too little methadone) or excessive drowsiness (too much methadone). This 
holding dose should then be reduced very gradually over a 2 to 12-week period. 
Drug hunger should be anticipated at dosages of less than 40 milligrams per day. 

C. Urine testing 

Regular urine testing and monitoring should be followed as in the methadone 
maintenance program. ( See section I, A for details. ) 

Reemergence of regular heroin use is a sign of withdrawal treatment failure. 
If this occurs, the patient should be encouraged to switch to a methadone main- 
tenance program (if he is eligible) at blockading doses of about 100 milligrams 
per day. 

D. Exceptions 

If a patient fails at outpatient withdrawal even if he has used heroin for 
less than 1 year or if he is less than 18 years, he may be considered for 
methadone maintenance if he volunteers for this treatment. However, under 
these circumstances, the director of the NTA must be notified of each such ex- 
ceptional patient. 

III. Physical Examinations 

Every patient receiving methadone must have a physical examination per- 
formed by a physician within 30 days after the first dose of methadone. Physical 
exams should occur as soon as possible. 

IV. Records 

A. Medical records 

Patients who take methadone must have physical examinations and medical 
histories performed by a licensed physician or medical student working under 
the supervision of a physician. The results of these examinations must be in- 
cluded in the patient's clinical record and the date of physical examination must 
also be noted on NTA Form 10 (see attachment 7. ) 

Form 10 "Record of Patient Prescription" must also be used by the physician 
to record all new NTA patients' medical treatment, or major changes in treat- 
ment of an existing NTA patient. 

B. Accountability of methadone 

Each bottle of methadone liquid (1,000 cc. ) disbursed to the centers for pa- 
tient treatment will contain an envelope showing the same registered number as 
that appearing on the label affixed to the bottle. 

Everytime a patient has received a dose of methadone, a copy of NTA form 6, 
"Record of Patient Activity," (see attachment 5) used to record the amount of 
methadone disbursed, will be filed in the envelope containing the same registered 



188 

number as that on the bottle. When the large bottle is emptied, the envelope 
containing the NTA forms 6, showing total disbursements (1,000 cc. ) will be 
sealed and returned to Information Central via messenger. The forms in the 
envelope will tell the pharmacist the date, the dosage level, and names of the 
patients who were served out of that particular bottle. All doses of methadone 
dispensed must be strictly accounted for at all times. 

C Discrepancies 

NTA form 14, "Director's Discrepancy Notice" (see attachment 8) will be 
used to notify the physician of any discrepancies in recordkeeping or NTA pro- 
cedures as noted by the computer. 

The following are some items which may be noted : 

1. Dosage level higher than that prescribed by the physician. 

2. Irregular dosage level. 

3. Consistently dirty urine. 

4. No physical examinations within 30 days of initial intake. 

5. Discrepancy in methadone medication disbursement. 

6. Lack of proper patient evaluation. 

7. Apparent lack of patient progress. 

8. Exception to take-home medicine policy. 

D. Confidentiality of records 

The Narcotics Treatment Administration respects the basic right of patients 
to have all information and treatment records maintained with strict confiden- 
tiality. NTA regards this effort as vital to the establishment of an effective treat- 
ment relationship with its patients. 

For this reason, only Information Central is authorized to release information 
on patients to vertified requestors. With the exception of criminal justice and 
civil commitment patients and patient-employees, no information on any patient 
will be released unless : 

1. The patient has signed and Information Central has received NTA 
form 28 "Patient Consent for Release of Treatment Information" (see 
attachment 9) specifically authorizing the requestor access to information: 

2. Information Central has received the request for information in writ- 
ing ; and 

3. Information Central has verified the current status of the patient vis- 
a-vis the requestor. 

Criminal justice system patients are those who have been formally referred 
to NTA by the police, courts. Department of Corrections, or parole board as a 
condition of release to the community. Requests for information on these patients 
by the agency must be honored immediately by the program chief or his designee. 
The request and the response should preferably be made in writing and the 
current status of the patient vis-a-vis the requestor verified before the informa- 
tion is released. Information should be released in the form of treatment sum- 
maries whenever possible. 

Civil commitment patients are those brought to an NTA facility under signed 
pickup orders by the Narcotics Squad of the Metropolitan Police Department. 
The results of their diagnostic evaluation and determination of their treatment 
status is automatically forwarded to the referring agency — the Metropolitan 
Police Department. 

Patient-employees are staff members of NTA who also remain in a treatment 
status with NTA. They will be required, as a condition of employment, to remain 
free of illegal drugs, and must agree to release information on their urine 
surveillance reports and pertinent medical summaries to their immediate super- 
visors, program unit chiefs, and the coordinator of counselors. Such information 
will not be shared with other staff members but can be used as a basis for 
disciplinary action or suspension of employment if confrontation does not result 
in termination of illegal drug use. 

Minors under 21 years of age should be encouraged to authorize a parent or 
guardian to receive at least a summary statement of their treatment status. 

Emerfjcneirs arising when an NTA patient is confined because of arrest, ill- 
nes.s, or accident will receive immediate attention. Every effort will be made to 
assure the patient immediate medical assistance to maintain his medication 
level for the duration of the emergency upon request from the medical authori- 
ties attending the patient. 



189 

Attachment One 

Informed Consent to Take Methadone Treatment in the Narcotics 

Treatment Administration 

I, , understand that methadone treatment for chronic heroin 

addiction and its consequences is a new use of an established drug. I further 
understand that methadone is a powerful and addictive narcotic drug and that 
if I stop taking it I will experience serious withdrawal symptoms. Although 
methadone treatment has been used successfully by thousands of people through- 
out the country, I also understand that the long-term effect of this drug on 
humans is not entirely known at this time. 

I willingly give my informed consent to take methadone under the careful 
supervision and control of the NTA staff or NTA cooperating agency staff. I 
have tried to stop using illegal drugs and I now think that methadone is neces- 
sary for me to avoid further use of illegal drugs. 

I have not been forced or pressured into this dec' '■ion. I understand that I 
can stop methadone treatment at my own discretion and that the staff may 
terminate me at their discretion. If I do stop methadone treatment for any 
reason, I understand that for my own safety I should withdraw from methadone 
by using gradually reduced doses of the medication under the control of the 
medical staff. 



Signature and date 



Printed or typed name 



NTA patient number 



Program name 



"Witness 

Signature and date 
NTA FORM 19(10-70). 



ATTACHMENT TWO , 







1.0. NO. 


PATIEfJM!) NAM ■ " - 


^OCRGE NC Y . ADDRESS iMoTJiERyRtLAIiyEO " .. 


CENTER ASSIGNED 


TRANSFERRED TO (Cente,^ Date) 


SOCIAL SECURITY NO. 


BIRTHOATE 


DATE NO. ASSIGNED 


PHONt NO. 


WgiKING NOW? 
□ YES □ N8 


EXMRATION DATE 


EMPLOYER'S NAf€ 4 ADDRESS (If WORKING) ' 


DATE PICTURE SCHEOUlfO 






DATE PICTURE TAKEN 



NTA FORM 7 (8.70) RECORD OF PATIEKT 1.0. NUFfiER ASSIGNED 



190 

Attachment Three 
To all medical staff 

On schedules 10, 11, and 12, the value of X (the initial dose) must be speci- 
fied on the initial prescription along with which schedule is being used. 

On schedule 12, it must be specified at what does the schedule stops. 



Day 



1 . 

2 . 

3 . 
4 

5 . 

6 . 

7 . 

8 . 

9 . 
10 



Detoxification schedule 1 
Milligrams Day : 



20 


11 


20 


12 


20 


13 


15 


14 


15 


15 


15 


16 


15 


17 


15 


18 


10 


19 


10 


20 



1 Detoxification completed. 



Day 



1 . 

2 . 

3 - 

4 . 

5 - 

6 - 

7 . 

8 - 

9 . 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 



Detoxification schedule 2 
Milligrama Day : 



50 


27 


50 


28 


50 


29 


50 


30 


50 


31 


45 


32 


45 


33 


45 


34 


45 


35 


45 


36 


40 


37 


40 


38 


40 


39 


40 


40 


40 


41 


35 


42 


35 


43 


35 


44 


35 


45 


30 


46 


30 


47 


30 


48 


30 


49 


30 


50 


30 


51 


25 





Milligrams 

10 

10 

10 








Milligrams 

25 

25 

25 

25 

20 

20 

20 

20 

20 

15 

15 

15 

15 

15 

10 

10 

10 

10 

10 

5 

5 

5 

5 

5 

(') 



1 Detoxification completed. 



Detoxification Schedule S 

Day : Milligrams Day : 

1 20 43 

15 15 50 

29 10 



Milligrams 

5 




Detoxification Schedule 4 



Day: 
1 _ 
15 
29 
43 



Milligrams 
30 
25 
20 
15 



Day: 
57 
71 

85, 



Milligrams 

10 
5 




Day; 



191 



Maintenance Schedule 10 
Day: 



1 X mgs. 10. 

2 X mgs. 11. 

3 X+5 mgs. 12. 

4 X+5 mgs. 13. 

5 X+10 " 14. 

6 X+10 " 15. 

7 X+15 " 16. 

8 X+15 " 17. 

9 X+20 " 18_ 



X+20 mgs. 
X+25 " 
X+25 " 
X+30 " 
X+30 " 
X+35 " 
X+35 " 
X+40 " 
X+40 " 



To 100 mgs. total or until otherwise stopped by adding 5 mgs. to dose every 
other day. 



Maintenance Schedule 11 



Day: 
1. 
2. 
3- 
4. 
5- 
6. 



Day: 



-.X mgs. 
..X mgs. 
-X mgs. 

-.X+5 mgs. 
- X-i-5 mgs. 
-.X+5 mgs. 



7- 
8__ 
9_- 
10- 
11_ 
12. 



. X+10 mgs. 
-X+IO mgs. 
-X+IO mgs. 
-X+15 mgs. 
-.X+15 mgs. 
.X+15 mgs. 



To 100 mgs. total by increasing by 5 mgs. every third day or until stopped by 
prescription. 

Maintenance Schedule 12 



Day: 

1 X mgs. 

8 X+5 mgs. 

15 X+10 mgs. 



Day: 

22 X+15 mgs. 

29 X+20 mgs. 



Attachment Four 

Statement of Responsibility for Take Home Medication 

I, , understand that methadone is a powerful drug which 

can seriously harm or even kill a person who is not on methadone maintenance. 
For this reason, I agree to put my methadone bottle in a locked container, out 
of children's reach. I also agree to tell my family how dangerous methadone can 
be and take all necessary precautions to prevent its accidental use. 

In addition, I understand that I must not lose, break or fail to return my 
methadone bottle to the clinic or revert to drug u.se. If I do, I will not be able 
to take methadone home but will have to I'eport into the clinic daily for at least 
30 days. 



Patient signature and date 



Printed or typed name 



ID number 



Program name 



NTAForm 22 (11-70). 



Clinic administrator, piiysician 
or nurse signature and date 



192 

ATTACHMENT- FIVE, 



•■ I HI 
E - < 

ofo 



Oo 



PATIENT'S IDENTIFICATION 



J: I 



NARCOTICS TREATMENT ADMINISTRATION 



CENTER ADDRESS 



PATIENT'S SIGNATURE 



ADMIN. BY (Sign Below) 



METHADONE 



COUNSELING 



DOSAGE LEVEL 



NARCOTICS TREATMENT 
ADMINISTRATION 



STATUS 
□ hold □detox. □ MAINT. □abstinence □ SURV. ONLY 



TESTS REQUESTED 



COCAINE 



AMPHETAMINE 



BARBiTURATES 



TEST RESULTS 







^^^^y^,Lj.U^ 



''<M/////MyMmy/yM:/,ymA''/Z 



OTHERS (Specify) 



I I ALL TESTS NEC. 



I I REPEAT 



CHECK APPROPRIATE BOX 

E SURVEILLANCE 



-j I URINE 



D' 



lETHADONE 



n 



COUNSELING 



z 

UJ 

< 



Z 

UJ 

U 



ATTACHMENT SIX 



^ 5 

UJ D 

J 

1 o 
3 U 

u. 

•" o 

UJ L> 

a I- 

zy 

15 

1 o 

u. UJ 
O I 

°^ 



< ° 



PATIENT'S IDENTIFICATION 


1. PATIENT TRANSFERRED 




I 


1 


FROM(Pf*>:irnt Cfnlot) 


TO(New Ccntci) 




2. PATIENT'S CLASSIFICATION (Check approptiale blocks) j 




Participating }n Pvogram 1 ;' 




Voluntarily withdrew from program a/rer completrng treatment 


i 
i 


CENTER ADDRESS 


DATE 










1 




involuntarily withdrew from program- incarcerated 




o 


Involuntarily withdrew from program-/josp/fa//>edor other medical reason 


1 


t 

ST 
5 
cr 


Disniisied from program -alcoholism oi drinking problem 




COUNSELOR'S 
SIGNATURE 


Dismissed from program— bad conduct or disciplinary problem 


1 




L. 


Deceased 


1 


J ADMINISTRATOR'S SIGNATURE 


Other (specify) i 



t/J 



(D O 
•fi ^ ^ 

3 4- uj 



< E 

SI:: 



193 

ATTACHMENT SEVEN 



PATIENT'S IDENTIFICATION 




DOSAGE LEVEL 


NARCOTICS TREATMENT 
ADMINISTRATION 




PATIENT'S PROGRAM SPECIFICATIONS 




1 I DETOXIFICATION SCHEDULE 

1 ' ' 


CENTER ADDRESS ,, 


DATE , , 


n MAINTENANCE SCHEDULE 




R. 


o 


n~]HOLD ' j 

1 


o 

5 
cr 
, 


DATE OF PHYSICAL 


r] OTHER MEDICATION 


"■ DOCTOR'S SIGNATURE 

Z 


QfHANGEOF MEDICATIONS 1 



o 



ATTACH>ffi:NT EIGHT 



DIRECTOR'S DISCREPANCY NOTICE 



PATIENT'S NArt 



DATt 



TO: The Center Administrator 

FROM: Director, Narcotics 

Treatment Administration 



CE.^ER 



1.0. NO. 



PLEASE ADVISE WITHIN 24 HOURS, THE REASON(S) 
FOR THE DISCREPAN CIES LHL CXED BELOW. 



1. MEDICATION 



PERIOD COVERED 



□ record not R£CEIVEO(nt» form 6) r]"0 RECORD CF PATIENT'S PHYSICAL EXAM. QoTHER (explain) 

(lITA FORM 10) 

QrECORD REC'D LATE(nt« form 6) QoOES NOT t€CT ftDICAL GUIDELINES 

n NO RECORD CF OR'S PRESCRIPTION Q I (CONSISTENT WITH OR'S PRESCRIPTION 

" — ' (nTA form 10) INTA FORM 10) 



PERIOD COVERED 



URINE ANALYSIS 



PI HOST RECENT RECORD NOT REC'D (Submit nta form 6) jZI QUANTITY NOT SIFFIC lENTdjNs) 

Q RECORD RECEIVED LATEInta form 6) LH CONSISTENTLY DIRTY (Th8 or i«re Tii*s) 



3. CHANGE OF STATUS 



PERIOD COVERED 



n 



NO ACTIONS INDICATED IN PAST TW0(2) WEEKS 
(rJTA FORM 9) 



QnO /CTIONS INDICATED IN PAST FOlf) WEEKSd.) (nta form 9) 



PERIOD COVERED 



COUNSELING 



n NO CONTACT INDICATED IN PAST WEEK(mt« form 6) NO CONTACT INDICATED IN THE PAST 

(nta form 6) 

□counselor's REPORT OVERDUE (Counselor's NA^c , ) 



{ 



I I TWO WEEKS 
I I MONTH 



5. SERVICE AT OTHER CENTER 



NAf€ CF OTHER CENTER 



DATE 



PERIOD COVERED 



Q NO REFERRAL INDICATED (nta form 9) 



^ETHADONE DISBURSEMENT 



TomniuFBEr 



PERIOD COVERED 



n 



TOTAL A:iOUrn REPORTED DOES NOT AGREE WITH Tt£ 
AMOUHT DISBURSED IN TfC BOTTLE 



AMOUNT OF DISCREPANCY (-HJR .) 



SIGNATJiE OF THE DIRECTOR 



DATE 



TO: DIRECTOR, NARCOTICS TREATMENT ADMINISTRATION 



CENTER AOnl'IISTRATOR'S REPLY(USE REVERSE SIDE IF NECESSARY) 



SICNATlFE OF THE CENTER AOMI')ISTRAT0R 



DATE 



194 

ATTACHMENT NINE 



GOVERNMENT OF THE DISTRICT OF COLUMBIA 
Narcotics Treatment Administration 



PATIENT CONSENT FORM FOR RELEASE 
OF TREATMENT INFORMATION 



I hereby authorize the following person/agency: 



Name 



Address 



Telephone 

I vmderstancT'tEair'ohlyTnformation Central is authorized 
to release this information. This consent form is void after 



PATIENT SIGNATURE, 
DATE 



WITNESS 



195 

A.O. 202.1 
Addendum 
April 7, 1971 
OD 
Administration Order 

1. Purpose 

The purpose of this administration order is to provide additional clarification 
for the medical and program guidelines as originally issued for the Narcotics 
Treatment Administration programs and cooperating agencies. 

2. Procedures 

Anyone missing 3 days medication at any center is to have his medication dis- 
continued until he sees the doctor at the center, at which time he will need a new 
prescription signed by the physician. If a physician is not immediately available, 
the patient may be given an emergency dose not to exceed 25 mgs. to hold him 
until he can see the physician. 

No new patient can be given a dose in excess of 50 mgs. on the first day of his 
program, whether it is maintenance or detoxification, unless it can be verified 
that he is being transferred from a maintenance program and is currently on a 
higher dose. 

[Exhibit No. 11(e)] 

A Study of Narcotics Addicted Offenders at the District of Columbia Jail 

(By Nicholas J. Kozel, Barry S. Brown, and Robert L. DuPont, Narcotics Treat- 
ment Administration, Washington, D.C.) 

(An acknowledgement of appreciation is made to Charles Rodgers, Superintendent of the 
District of Columbia Jail, for his cooperation and assistance in this study and to the 
research assistants for their unremitting effort to collect data under extraordinary 
conditions. ) 

A study was conducted at the District of Columbia Jail between August 11 and 
September 22, 1969, in an effort to determine the parameters of heroin use in the 
District of Columbia. Findings of the study are based on responses to interview 
schedules personally administered by a team of research assistants and the re- 
sults of urinalysis conducted separately by the research assistants. 

METHOD 

Interview schedules were completed on an accidental sample of 225 of the resi- 
dents present at the District of Columbia Jail during the time the study was con- 
ducted. In addition, urine specimens were collected from 129 of those interviewed. 
Urine specimens were collected from as many new offenders as possible at the 
time of their admission. The research team subsequently attempted to intersnew 
as many of these new admissions as they could reach — usually within the first 
few days of incarceration. 

To determine whether the sample interviewed was representative of the larger 
offender population from which it had been drawn, comparisons were made on se- 
lected personal and .social characteristics. Comparisons made on age, race, number 
of prior commitments, and offense for which presently incarcerated indicated that, 
in terms of the.se characteristics, the sample was representative of the District of 
Columbia Jail population. 

RESULTS 

Drug use 

Among the 225 offenders interviewed, 45 percent were identified as addicted to 
heroin. Forty-three percent admitted using heroin and having been addicted to it. 
An additional 2 percent of the total sample — 3 percent of the sample of urinal- 
yses — reported never haviD<r used heroin or refused to answer the question con- 
cerning lieroin use, but had positive urinalysis results for morphine and/or 
quinine — the components of heroin (table 1).' Thus, 45 percent of all per.sons ad- 
mitted to the District of Columbia Jail can be described as addicted to heroin. 

Among nonaddicts, 22 percent stated they had u.sed drugs at some time in the 
pa.st (table 2). Of these, most started out on marihuana. At the same time, almost 



^ This veracity among narcotics addicts supports Ball's findings in his study of addict 
interview responses. Ball, John C. "The Reliability and Validity of Interview Data Obtained 
from 59 Narcotic Drug Addicts." The American Journal of Sociology, 1967, 72(6), 650-654. 



196 

half of the addicts stated that marihuana was the first drug they had ever used. 
About a quarter of the addicts, however, started out directly on heroin (table 2a). 

Cocaine. — The great majority of self-reported addicts — 85 percent — have used 
cocaine, usually trying it for the first time after they had turned 20 years of age. 
More than half of those who have used cocaine in the past admit to still using it. 
At the same time, 29 jiercent of the nonaddicts who admitted using drugs liave 
tried cocaine (tables 3, 3a, and 3b). 

Marihuana. — Marihuana has been used by far more nonaddict drug users — 
68 percent. — than any other drug. Similarly, 75 percent of the self-reported addicts 
have used marihuana. Among addicts, around a third had used marihuana for 
the first time before age 17. but when both groups are combined, 50 percent report 
having used marihuana for the first time when they were older than IS years. 
About half of the nonaddicts and a third of the addicts who had tried marihuana 
in the past are still using it ( tables 4, 4a, and 4b ) . 

Barbiturates. — Eighteen percent of self-reported addicts admit having used 
barbiturates. Like marihuana, barbiturates were, for the most part, "first tried 
after the user had reached 18 years of age. Five of the 17 addicts who have used 
barbiturates state they are using them at present (tables 5, 5a, and 5b). 

Methadone. — Street methadone has been used by 16 percent of self-reported 
addicts. None of the nonaddict drug users report ever having used street 
methadone. 

Amphetamines. — Among self-reported addicts and nonaddict drug users, 18 
percent mention having used amphetamines. Use of amphetamines begins at 
about 18 and half of those who have used them in the past continue to use 
them at present (tables 7. 7a, and 71)). 

Heroin. — Though not addicted, four of the 28 nonaddict drug users have 
used heroin. By definition, all of the addicts have used heroin. In terms of age, 
half of the addicts had used heroin for the first time before they were 20 years 
old. Indeed, 26 percent had used heroin by 17 ( tables 8 and 8a ) . 

Heroin addiction 

Withdrawal. — The overwhelming majority of self-reported heroin addicts — 
88 percent — stated that they had experienced withdrawal symptoms (table 9). 
At the same time, only 38 percent recall ever receiving treatment for their 
addiction problem (table 9a ) . 

Off drugs during past 5 years. — Eighty -five percent of addicts report having 
been off the drugs for some period of time during the past 5 years (table 10). 
The number of times drugs have been voluntarily or involuntarily given up 
ranges from one to more than 10, with over half of the addicts claiming to have 
been off drugs three times or less during the past 5 years ( table 10a ) . 

Support of habit. — The average reported cost of a heroin habit is .$44 a day. 
Not surprisingly, the majority of heroin addicts have resorted to crime as a 
means of supporting their habit (table 11). Crime, hustling, and pushing drugs, 
alone or in combination with legitimate employment are the usual ways in which 
habits are supiwrted (table 11a ) . 

Stop own drug use. — Eighty-eight i>ercent of addicts believe that they can 
stop using drugs (table 12). A variety of ways of stopping drug use were men- 
tioned including changing environments, methadone or other treatment, work, 
and jail. However, 26 percent of those who believe they can stop feel they could 
just stop without outside assistance, while an additional 11 percent either could 
not answer or did not know how to stop their own drug use (table 12a). 

Drug use among family. — There is reportedly little drug use among members 
of the addicts' families — ranging from 5 percent among si>ouses to 10 percent 
among siblings. At the same time, there is a relatively high incidence of don't 
know/no answer responses to questions about family drug use (tables 18. 13a, 
and 13b). This suggests that, while inclined to l>e candid about their own history 
of drug use, addicts may be less than willing to revenl information about their 
family which they feel would, in some way, place their family in jeopardy. 

Drug use among friends. — The preponderance of addicts report that at least 
some of their fHpnds usp drugs. Indeed, a third state that all of their friends 
are drug u.sers, while 2 T)ercent deny having any friends who u.se drugs (table 14). 

Age of drug users. — Slightly more than a third of the addicts reiwrt that most 
heroin iisers today are between 16 and 25 years of age. At the same time, an- 
other third either don't know or didn't respond lo the nuestion (table 15). Drug 
use, according to a majority of the addicts, presently begins among youtlis between 
15 and 17 years old ( table 1 5a ) . 

Methadone treatment. — Eighty-six percent of self-reported heroin addicts have 



197 

heard of methadone treatment as a way of overcoming illegal drug use (table 16). 
Of these, almost three-quarters believe methadone treatment is good without 
qualification, while an additional 7 percent feel that, on the whole, it is good, 
but still have some reservations about it (table 16a) . 

Personal and social characteristics 

Age and education. — About a third of addicts and nonaddicts are 21 years 
old or younger and two-thirds are under 30 (table 17). More than 75 percent 
of the two groups have had some high school education, and 25 percenit report 
graduating from high school (table 18). 

Parents. — Approximately 80 percent of addicts and nonaddicts claim to have 
been reared by their biological parents (table 19). At the same time, a greater 
number of addicts as compared to nonaddicts report that both of their parents 
are stSll living (table 20). 

Among those whose parent (s) are deceased, about 50 percent of the addicts 
were less than 16 when one or both parents died, while about half of the non- 
addicts were between 16 and 21 when death of parent (s) occurred (tables 20a 
and 20b). 

Siblings. — Compared to addicts, nonaddicts tend to have more brothers and 
sisters. Thirty percent of nonaddicts have four or more brothers and 20 percent 
have four or more sisters compared to 15 and 11 percent respectively for 
addicts (tables 21 and 21a). 

Religion. — Both addicts and nonaddicts are more likely to be members of 
Protestant seots than other religious groups. At the same time, a significantly 
greater number of nonaddicts compared to addicts report religious aflBliation 
(table 22). Furthermore, while there was noticeably more frequent attendance 
at religious ser\iees during childhood among both groups, significantly more 
nonaddiots compared to addicts claim to attend services at present (tables 22a 
and 22b). 

Martial status. — The majority of both addicts and nonaddicts are single (table 
23). Among those who are married, slightly more addicts report having been 
married for 2 years or less (table 23a). Both groups have experienced a high 
incidence of separation from their spouses — 60 percent on the average (table 23b). 

Employment status. — Significantly more nonaddicts than addicts were employed 
at time of arrest (table 24). The majority of both groups were employed by tht* 
time they reached 18 years of age (table 24a) and the usual type of employment 
for both groups is unskilled labor (table 24b) . More than half of both groups have 
been employed at three or le.ss places during the past 5 years (table 24c). 

Residence. — Neither group is very mobile. Twenty-three percent of the non- 
addicts and 33 percent of the addicts have resided at the same home for the 
past 5 years. Over 70 percent of the two groups have changed their residences 
less than three times during the past 5 years (table 25). Further, about half 
of both groups resided for more than 1 year at the home in which they were 
living at the time of their arrest ( table 25a ) . 

Income. — Almost two-thirds of addicts and nonaddicts supported themselves 
financially at time of arrest. Twenty percent were dependent on their parents 
(table 26). About half of both groups reported that the weekly income of the 
home in which they were living when arrested was between $51 and $150 (table 
26a). 

City of Birth. — Significantly more addicits were born and spent most of their 
childhood in large cities as compared to nonaddicts (tables 27 and 27a). 

Military service. — Between 25 and 29 percent of the two groups served in the 
military (table 28). Nonaddicts had slightly more years of service (table 28a) 
and 70 percent of both groups, on the average, reported having had honorable 
discharges (table 28b) . 

Criminal offenses. — In terms of pre.sent offenses, addicts are charged with 
more offenses against property and drug violations — 37 and 15 percent respec- 
tively as comapred with 30 and 6 percent respectively for nonaddicts. Non-addicts 
are charged are larceny and theft, while nonaddicts are not charged with any 
addicts (21 percent). However, three of the four criminal homicides reported 
were charged against addicts. The most frequent crimes with which addicts 
are charge are larceny and theft, while nonaddicts are not charged with any 
single offense with outstanding frequency ( table 29 ) . 



198 



CONCLUSIONS 

Certain patterns emerge from the results of this study. One of the most 
relevant is the alarmingly widespread use of heroin in the District of Columbia. 
Forty-five percent of offenders entering the District of Columbia jail are heroin 
addicts. Further, there is reason to believe that hard narcotics are l>pginning 
to reach a younger population. Although addicts at the District of Columbia 
jail started using drugs in their late teens or early twenties, drug use today is 
starting at about 15 or 16 years of age. The profound implications of this problem 
for society are apparent. Addicts must turn to antisocial behavior, at least in 
part, to support their habit. And this deviant behavior will continue to increase 
as a function of addiction. 

Another important finding is the lack of difference between addicts and non- 
addicts in the criminal justice system. It appears to be a widely held belief that 
addicts belong to a subculture with its own unique membership characteristics 
quite distinct from the nonaddict criminal subculture. However, the similarity 
between addicts and nonaddicts in terms of personal and social characteristics 
and, to some extent, drug use (marihuana) suggests that both addict and non- 
addict offenders may. in fact, belong to a single subculture characterized by a 
variety of illegal activties, one of which is use of hard narcotics. 

Although, for the most part, addicts and nonaddicts share common character- 
istics, there are a few areas in which they differ. For example, nonaddicts tend 
to have more ties to the community — come from larger families and attend 
religious services with much greater frequency — than addicts. These indica- 
tions of a closer relationship with the community may, in effect, provide addi- 
tional support which the addict finds lacking. 

Addicts, on the other hand, appear to be more urban, having been born and 
reared in large cities to a much greater extent than nonaddicts. 

The results a' so point out a difference between addicts and nonaddicts in terms 
of the offenses with which they are charged. This provides some support for the 
idea that addicts do not commit crimes against people with the same frequency 
as nonaddict offenders. 

Contrary to the stereotype of an unstable, highly mobile personality, the nar- 
cotics addict appears to be able to retain employment. A surprisingly high per- 
centage of addicts were employed at the time of arrest and. indeed, almost half 
of the addicts claim to have supported their heroin habit in part through work. 
Further, adicts showed a certain stability of behavior — at least to thf extent of 
not differing from nonaddicts — in maintaining themselves in the military. 

One further point that deserves mention is the apparent interest that most 
addicts have in stopping their own drug use. The great majority have been off 
drugs at some time during the past several years. Most addicts al.so l)elieve. 
realistically or not. that they can give up drugs on their own. In addition, even 
before the city wide narcotics treatment program was imniemented in which 
methadone was used as one technique of treating heroin addiction, most addicts 
had heard about methaone. and a majority of these believe it was a good form 
of treatment. This favorability toward methadone may provide a treatment 
climate which could facilitate rehabilitation. 

In conclusion, it should he mentioned that intensive research in narcotics addic- 
tion and treatment has, in a sense, very recently begun. Very little seems to be 
known about the addict. This study provides some basic descriptions of a specific 
addict population. Hopefully, those findings will suggest new areas of research 
aimed at combating the problem of heroin addiction in the community. 

TABLE 1.— POSITIVE URINALYSES FOR MORPHINE AND OR QUININE AND SELF-REPORTED HEROIN DEPENDENCE 



Urinalyses and self-reoorts: 

Interview positive; urine oositive 

Interview/ positive; urine negative 

Interview positive; no urine 

Interview negative; urine positive 

Interview negative; urine negative... 

Interview negative; no urine 

Total 100 100 



Addict 


Non- 


addict 


Total 




Number 


Percent 


Number 


Percent 


Number 


Percent 


42 


42 . 






42 


19 


10 


10 . 






10 


4 


44 


44 . 






44 


20 


4 


4 . 






4 


2 






73 
52 


58 

42 


73 
52 


32 






23 









125 



100 



225 



100 



199 



TABLE 2.— SELF-REPORTED USE OF DRUGS 



Addict 



Non-addict 



Total 



Number Percent Number Percent Number Percent 



Ever used drugs: 

Yes 

No 

No answer 

Total. 

First drug of abuse: 

Marijuana 

Heroin 

Cocaine __- 

Other 

No answer; don't know 

Total 



96 
2 


96 
2 
2 ... 


28 
97 


22 
78 


124 

99 

2 


55 
44 


2 


1 






100 


100 

45 
23 
13 
3 
16 


125 

17 

4 
2 

1 
4 


100 

61 
14 

7 

4 

14 


225 

60 
26 
14 
4 
20 


100 


43 


49 


22 


21 


12 


U 


3 

16 


3 

16 



96 



100 



28 



100 



124 



100 



TABLE 3.— PROFILE OF COCAINE USE 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number Percent 



Ever used cocaine: 

Yes 

No 

Total 

(a) Age at 1st use of cocaine: 

14 years 

15years 

16 years _ 

17 years _ 

18 years..- 

19 years... 

20 years 

21 years or older 

No answer; don't know 

Total 

(b) Presently using cocaine: 

Yes 

No... 

No answer 

Total 



82 


85 

15 


8 

20 


29 

71 


90 
34 


73 


14 


27 






96 


100 


28 


100 


124 


100 







1 

2 
4 
7 
6 
7 
12 
35 
8 



82 



1 _ 

2 

5 

9 2 

7 

9 

15 1 

42 3 

10 2 

8 

4 
4 

100 8 



1 
2 
4 
9 
6 
7 

13 
38 
10 



I 
2 

5 
10 
7 
8 
14 
42 
11 



82 


100 


8 --- 


90 


100 






46 


56 
23 
21 .... 


4 

4 _ 


50 
23 
17 


56 


19 


25 


17 


19 







90 



100 



TABLE 4.— PROFILE OF MARIHUANA USE 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number Ferceil 



Ever used marihuana: 

Yes -.- 72 

No 23 

No answer.. 1 

Total ___. 96 

(a) Age at 1st use of marihuana: 

13 years Of younger... 2 

14 years 5 

15 years 8 

16 years... 8 

17 years 6 

18 years or older 34 

No answer; don't know 9 

Total.... 

(b) Presently using marihuana: 

Yes 

No 

No answer... _ 

Total 72 



100 



75 19 68 91 73 

24 9 32 32 26 

1 1 1 

100 28 100 124 

2 2 2 

7 5 5 

11 I 5 9 10 

11 1 5 9 10 

9 2 11 8 9 

47 11 58 45 50 

13 4 21 13 14 



72 


100 


19 


100 


91 


100 






22 


31 
47 
22 


9 
7 
3 


47 
37 
16 


31 
41 
19 


34 


34 


45 


16 


21 







100 



19 



100 



91 



100 



200 



TABLE 5.— PROFILE OF BARBITUARATE USE 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number Percent 



Ever used barbituarates: 

Yes - 

No... 



Total. 



(a) Age at first use of barbituarates: 

14 years or younger 

ISyears... 

16 years.. 

17 years 

18 years or older 

No answer; don't know 



Total. 



(b) Presently using barbiturates: 

Yes 

No. __ 

No answer.. 



Total. 



17 


18 

82 


1 
27 


4 
96 


18 

106 


15 


79 


85 






96 


100 


28 


100 


124 


100 



1 
1 
1 
1 

12 
1 



17 



5 

10 
2 



17 



1 
1 
1 
1 

12 
2 



18 



5 

10 

3 



18 



TABLE6.— PROFILE OF STREET METHADONE USE 



Addict 



Nonaddict 



Total 



Number Percent Number Percent umber Percent 



Ever used street methadone: 

Yes _ 

No - 



Total. 



(a) Age at first use of street methadone: 

18 years _ 

19 years 

20 years 

21 years or older 

No answer ; don't know 



Total. 



(b) Presently using street methadone: 

Yes... 

No 

No answer 



Total. 



15 
81 


16 ... 
84 


......... 


""""ioo" 


15 
109 


12 
88 


96 


100 


28 


100 


124 


100 



15 



15 



15 



15 



TABLE 7.-PR0FILE OF AMPHETAMINE USE 



Ever used amphetamines: 

Yes 

No 



Total. 



(a) Age at 1st use of amphetamine: 

16 years 

17 years... 

ISyears 

19 years or older 

No answer; don't know 



Total. 



(b) Presently using amphetamine: 

Yes... 

No 

No answer 



Total. 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number Percent 



12 
84 


13 
87 


4 
24 


14 
86 


16 
108 


13 
87 


96 


100 


28 


100 


124 


100 



12 



5 
5 
2 

12 



1 
2 
9 
2 
2 



16 



8 . 
6 . 
2 . 



201 

TABLE 8.-PR0FILE OF HEROIN USE 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number Percent 



Ever used heroin: 

Yes - 

No..._ 

Total... 

(a) Age 1st use of heroin: 

14 years or younger 1 1 

ISyears 5 5 

16years 8 8 

17years 11 12 

ISyears 12 13 

19years 11 12 

20years 8 8 

21 years 6 6 

Over21 years 34 35 

Total. 96 100 



96 


100 


4 
24 


14 
86 


100 
24 


81 
19 








96 


100 


28 


100 


124 


100 



1 
1 
1 

i' 

4 



1 


1 


5 


5 


8 


8 


11 


11 


13 


13 


12 


12 


9 


9 


6 


6 


35 


36 



100 



100 



TABLE 9.-HER0IN WITHDRAWAL 



Addicts 



Number 



Percent 



Ever withdrew: 

Yes 

No 

No answer; don't know 

Total.. 

(a) Treatment for heroin addiction: 
Yes.. 

No 

No answer; don't know 

Total 



84 


88 


11 


11 


1 


1 


96 


100 


36 


38 


55 


57 


5 


5 



96 



100 



TABLE lO.-OFF DRUGS DURING PAST 5 YEARS 



Addicts 



Number 



Percent 



Off drugs: 

Yes 

No 

No answer; don't know 

Total 

(a) Number of times off drugs during past 5 years: 

4to5 

6 to 10 

More than 10... 

No answer; don't know 

Total 



82 


85 


13 


14 


1 


1 


96 


100 


19 


23 


26 


32 


10 


12 


7 


9 


1 


1 


19 


23 



82 



100 



60-296 O — 71 — pt. 1- 



-14 



202 



TABLE ll.-SUPPORT OF HEROIN HABIT 







Addicts 








Number 


Percent 


Ever commit a crime to support habit: 
Yes 




57 
27 
12 


59 


No 




28 


No answer 




13 








Total 




96 


100 








(a) Usual way habit was supported: 

Hustling (N =96) 




55 
45 
42 
27 


57 


Work (N =96) 




47 


Crime (N =96) 




44 


Pushing (N =96) .. 




28 








TABLE 12.- 


-BELIEVE OWN USE OF DRUGS CAN BE STOPPED 










Addicts 








Number 


Percent 


Can stop: 
Yes 




84 

1 
8 
3 


88 


No 




1 






8 


No answer 




3 








Total 




96 


100 








(a) Way in which own use of drugs can 
Just stop 


be stopped: 


22 

16 

15 

12 

6 

4 

9 


26 


Change environment 

Treatment; therapy.. 

Methadone 




19 
18 
14 


Work 




7 


Jail . . 




5 


No answer' don't know 




11 








Total 




84 


100 














Addicts 








Number 


Percent 


TABLE 13.-DRUG USE BY SPOUSE 






Addicts 








Number 


Percent 


Drug use: 

Yes . 




2 

29 

9 


5 


No 




73 


No answer' don't know 




22 








Total 




40 


100 


(a) Drug use among siblings: 
Yes 




9 
62 

16 


1 


No .... 




71 


No answer; don't know 




19 








Total 




87 


100 


(b) Drug use among other members of the family: 
Yes: 

Father - -- -.- 


3 
3 
3 

65 
26 


3 


Mother 




3 


Other 




3 


No ... 




65 


No answer; don't know 




26 








Total 




100 


100 









203 

TABLE 14— DRUG USE AMONG FRIENDS 



Addicts 



Number 



Percent 



Drug use: 
Yes: 

All 

Most 

Some _ 

No 

No answer; don't know. 



32 


32 


7 


7 


49 


49 


2 


2 


10 


10 



Total 


_ 100 


100 








TABLE 15.- 


-AGE OF MOST HEROIN USERS TODAY AS REPORTED BY ADDICTS 






Addicts 






Number 


Percent 



Age: 

Less than 10 years. 

11 to 15 _ 

16 to 20 _ 

21 to 25... ._ 

26 to 30.. 

31 to 35 

36 to 40 

More than 40 years 

No answer; don't know __ 

Total . 

(a) Age at which most drug use presently begins as reported by addicts 

12 years or younger.. 

13 _ 

14 

15. 

16 - 

17.. _ 

18 years or older.. 

No answer; don't know 

Total _ 



3 


3 


6 


6 


20 


20 


16 


16 


8 


8 


5 


5 


3 


3 


7 


7 


32 


32 



100 



100 



2 


2 


5 


5 


11 


11 


17 


17 


28 


28 


12 


12 


13 


13 


12 


12 



100 



100 



TABLE 16.-FAMILIARITY WITH METHADONE TREATMENT 



Addicts 



Number 



Percent 



Heard of methadone: 

Yes 

No 

No answer 

Total 

(a) Favorability concerning methadone treatment 
Believe methadone treatment is good: 

Yes (unqualified) 

Yes (with reservations)... 

No 

Don't know.. 

No answer 

Total.... _ 



86 
9 
5 



100 



100 



63 


73 


6 


7 


4 


5 


11 


13 


2 


2 



86 



100 



204 



TABLE 17.-AGE OF ADDICTS AND NONADDICTS 



Addict 



16 to 17 _ 

18tol9 _ 16 16 

20to21 14 14 

22to23 7 7 

24to25 _ 9 9 

26to27 9 9 

28to29. 9 9 

30to31... _. 9 9 

32to33 _ 4 4 

34to35.. 4 4 

36to37. _ .55 

38to39 _... 2 2 

40orolder 12 12 

Total.. 100 100 



Nonaddlct 




Total 




Number 


Percent 


Number 


Percent 


2 




1 


2 


1 


25 




20 


41 


18 


18 




14 


32 


14 


11 




9 


18 


8 


11 




9 


20 


9 


11 




9 


20 


9 


5 




4 


14 


6 


4 




3 


13 


6 


6 




5 


10 


4 


6 




5 


10 


4 


1 




1 


6 


3 


7 




6 


9 


4 


18 




14 


30 


14 



125 



100 



225 



100 



TABLE 18— HIGHEST GRADE COMPLETED 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number Percent 



LessthanS 10 10 19 15 29 13 

8 __._ __ 8 8 7 5 15 7 

9 - 13 13 22 18 35 16 

10 22 22 16 13 38 17 

11 21 21 25 20 46 20 

12 19 19 19 15 38 17 

Some higher education 6 6 12 10 18 8 

No answer 115 4 6 2 

Total 100 100 125 100 225 100 



TABLE 19.— REARED BY NATURAL PARENTS 



Addict 



Nonaddict 



Total 



Number 


Percent 


Nui 


Tiber 


Percent 


Number 


Percent 




79 


79 




102 


82 


181 


81 




20 


20 




17 


13 


37 


16 




1 


1 




6 


5 


7 


3 



Yes 

No 

No answer. 

Total 



100 



100 



125 



100 



225 



100 



TABLE 20.-PARENTS LIVING OR DECEASED 



Addict 



Nonaddict 



Total 



Number 


Percent 


Number 


Percent 


Number 


Percent 


49 


49 


45 


36 


94 


42 


25 


25 


37 


30 


62 


28 


11 


11 


16 


13 


27 


12 


11 


11 


18 


14 


29 


13 


4 


4 


9 


7 


13 


5 



Living or deceased: 

Both parents living 

Father deceased _ 

Mother deceased 

Both parents deceased 

No answer, don't know 

Total 

(a) Age at time of mother's death 

5 years or younger. 

etc 15 

16to21.... 

Over 21 

No answer; don't know.. 

Total 

(b) Age at time of father's death: 

5 years or younger 

6tol5_ 

16 to 21 ^... 

Over 21. 

No answer; don't know.. 

Total ._ 



100 



36 



100 



100 



125 



55 



100 



100 



225 



91 



100 



4 


18 


3 


9 


7 


13 


7 


32 


8 


24 


15 


27 


2 


9 


8 


24 


10 


18 


7 


32 


13 


38 


20 


35 


2 


9 


2 


5 


4 


7 


22 


100 


34 


100 


56 


100 


7 


19 


4 


7 


11 


12 


12 


34 


20 


37 


32 


35 


6 


17 


7 


13 


13 


14 


7 


19 


21 


38 


28 


31 


4 


11 


3 


5 


7 


8 



100 



205 



TABLE 21.— NUMBER OF BROTHERS 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number Percent 



Number: 

18 18 

1 21 21 

? - 24 24 

3. _._. 14 14 

4.. _.- 9 9 

5 3 3 

6 _.__ 

7 _ 2 2 

More than 7 _._ 1 I 

No answer; don't know 8 8 

Total ._ 100 100 

(a) Number of sisters: 

16 16 

1--- - -- _.__ 28 28 

2 22 22 

3 14 14 

4.. __ 5 5 

5 3 3 

6... 

7 1 i 

Morethan7 2 2 

No answer; don't know 9 9 

Total 100 100 



21 


17 


39 


17 


22 


18 


43 


19 


25 


20 


49 


22 


11 


9 


25 


11 


17 


14 


26 


11 


8 


6 


11 


5 


6 


5 


6 


3 


3 


2 


5 


2 


5 


3 


6 


3 


7 


6 


15 


7 



125 



125 



TABLE 22.— RELIGIOUS AFFILIATION 



100 



100 



Addict 



Nonaddict 



225 



225 



Total 



100 



12 


10 


28 


13 


31 


25 


59 


26 


35 


28 


57 


25 


13 


10 


27 


12 


9 


7 


14 


6 


7 


5 


10 


4 


1 


1 


1 


1 


7 


6 


8 


4 


1 


1 


3 


1 


9 


7 


18 


8 



100 



Number Percent Number Percent Number Percent 



Affiliation: 

Protestant 43 43 

Catholic... 24 24 

Other 10 10 

None _ 23 23 

No answer; don't knowi 

Total 100 100 

(a) Childhood attendance at religious services: 

At least once a week 82 82 

Less than once a week 5 5 

Notatall 12 12 

No answer; don't know _ 1 1 

Total 100 100 

(b) Present attendance at religious services: 

At least once a week 26 26 

Less than once a week 10 10 

Notatall 63 63 

No answer _ 1 l 

Total __.. 100 100 



63 


50 


106 


47 


32 


26 


56 


25 


17 


14 


27 


12 


11 


9 


34 


15 


2 


1 


2 


1 



125 



125 



125 



100 



100 



100 



225 



225 



225 



100 



99 


79 


181 


80 


11 


9 


16 


7 


9 


7 


21 


10 


6 


5 


7 


3 



100 



58 


46 


84 


37 


17 


14 


27 


12 


47 


38 


110 


49 


3 


2 


4 


2 



100 



206 



TABLE 23.— PRESENT MARITAL STATUS 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number Percent 



Status: 

Married 

Single 

Separated or divorced 

No answer... 

Total... 

(a) Length of time married: 

1 year or less... 

2 years 

3 to 4 years 

5 to 6 years 

7 toSyears 

9 to 10 years. 

More than 10 years 

No answer 

Total J 

(b) Ever separated from spouse 

Yes 

No. - 

No answer 

Total 



21 


21 


24 


19 


45 


20 


57 


57 


68 


54 


125 


56 


15 


15 


32 


26 


47 


21 


7 


7 


1 


1 


8 


3 



100 



100 



125 



100 



225 



100 



6 


15 


5 


9 


11 


12 


6 


15 


4 


8 


10 


11 


4 


10 


9 


17 


13 


14 


5 


13 


9 


17 


14 


15 


7 


18 


3 


5 


10 


11 


3 


7 


4 


8 


7 


7 


8 


20 


12 


23 


20 


22 


1 


2 


7 


13 


8 


8 



40 


100 


53 


100 


93 


100 






25 


62 

33 

5 


31 

20 

2 


58 

38 

4 


56 

33 

4 


60 


13 


36 


2 


4 







40 



100 



53 



100 



93 



100 



TABLE 24.— EMPLOYMENT STATUS 



Addict 



Nonaddict 



Total 





Number 


Percent 


Number 


Percent 


Number 


Percent 


Status: 














Employed 


41 


41 


76 


61 


117 


52 


Unemployed _. 


55 


55 


48 


38 


103 


46 


No answer 


4 


4 


1 


1 


5 


2 






Total _ 


100 


100 


125 


100 


225 


100 


(a) Age at which first started working: 














15 years or younger 


15 


15 


13 


11 


28 


12 


16 years 


19 


19 


33 


26 


52 


23 


17 years 


20 


20 


22 


18 


42 


19 


18 yea rs 


21 


21 


18 


14 


39 


17 


19 years 


4 


4 


8 


6 


12 


5 


20 years. . _ 


6 


6 


8 


6 


14 


6 


21 years or older 


8 


8 


11 


9 


19 


9 


No answer; don't know 


7 


7 


12 


10 


19 


9 






Total 


100 


100 


125 


100 


225 


100 


(b) Usual level of employment: 














Unskilled... 


45 

24 

22 

4 


45 

24 

22 

4 


65 
25 
22 

7 


52 

20 

18 

5 


110 
49 
44 
11 


49 


Semi-skilled.. 


22 


Skilled 


19 


Other 


5 


No answer; don't know. . . . 


5 


5 


6 


5 


11 


5 






Total :. 


100 


100 


125 


100 


225 


100 


(c) Number of places employed during past 5 years: 














. 


7 


7 


3 


2 


10 


4 


1 


17 


17 


16 


15 


33 


15 


2 


19 


19 


28 


23 


47 


21 


3 


23 


23 


24 


19 


47 


21 


4 


9 


9 


17 


14 


26 


11 


5 


6 


6 


9 


7 


15 


7 


More than 5 


17 


17 


26 


20 


43 


19 


No answer; don't know 


2 


2 


2 


2 


4 


2 






Total _ 


100 


100 


125 


100 


225 


100 



207 



TABLE 25.— NUMBER OF PLACES RESIDED DURING PAST 5 YEARS 



Addict 



Nonaddict 



Total 



Number 


Percent 


Number 


Percent 


Number 


Percent 


33 


33 


29 


23 


62 


27 


46 


46 


60 


48 


106 


47 


8 


8 


12 


10 


20 


9 


2 


2 


5 


4 


7 


3 


1 


1 


3 


2 


4 


2 


5 


5 


1 


1 


6 


3 


5 


5 


15 


12 


20 


9 



Number: 

1 

2 to 3 

4 to 5 - 

6 to 7 -..- 

8 to 9 - 

10 or more 

No answer; don't know 

Total 

(a) Lengtti of time resided at home in which living 
at time of arrest: 

Less than 1 month _ _. 

1 to 3 months 

3 to 6 months 

6 to 12 months 

1 to 3 years 

3 to 5 years 

More than 5 years _ 

No answer, don't know.. 

Total _ 



100 



100 



100 



100 



125 



100 



125 



100 



225 



225 



100 



17 


17 


20 


16 


37 


16 


10 


10 


13 


10 


23 


10 


8 


8 


7 


6 


15 


7 


11 


11 


17 


14 


28 


13 


17 


17 


24 


19 


41 


18 


8 


8 


7 


6 


15 


7 


27 


27 


28 


22 


55 


24 


2 


2 


9 


7 


11 


5 



100 



TABLE 26— MAIN FINANCIAL SUPPORT OF PEOPLE IN HOME IN WHICH LIVING AT TIME OF ARREST 



Addict 



Nonaddict 



Total 







Number 


Percent 


Number 


Percent 


Number 


Percent 


Financial support: 

Self 

Parent(s) 

Friends 

Relatives . 




63 
21 
6 
4 
2 
1 
3 


63 
21 

6 

4 

2 

1 . 

3 


81 

25 

2 

5 

4 

8" 


65 

20 

2 

4 

3 

6 


144 
46 
8 
9 
6 
1 
11 


64 

20 

3 

4 


Spouse 

Other 

No answer.. 


of home in which living 


3 

1 
5 


Total 


100 


100 


125 


100 


225 


100 


(a) Total weekly income 
at time of arrest: 

$50 or less 

$51 to $100 


3 

21 

27 

10 

5 

6 

4 

5 

19 


3 

21 

27 

10 

5 

6 

4 

5 

19 


7 
35 
31 
12 

7 
7 
1 
2 
23 


5 

28 

24 

10 

6 

6 

1 

2 

18 


10 
56 
58 
22 
12 
13 
5 
7 
42 


4 
25 


$101 to $150 




26 


$151 to $200 . 




10 


$201 to $250 




5 


$251 to $300 




6 


$301 to $400 




2 


More than $400 

No answer; don't know 


3 
19 








Total 


100 


100 


125 


100 


225 


100 



TABLE 27.-SIZE OF CITY IN WHICH BORN 



Addict 



Nonaddict 



Total 





Number 


Percent 


Number 


Percent 


Number Percent 


Size: 

Large city (over 500,000) 


72 
6 
7 
4 
1 
1 
9 


72 
6 
7 
4 
1 
1 
9 


62 
6 

19 

15 
5 
4 

14 


49 
5 

15 

12 
4 
3 

12 


134 


Medium city (100,000 to 500,000) . 


12 


Small city (10,000 to 100,000) 


26 


Town (1,000 to 10,000) 


19 


Village _._ _ 

Farm _ 

No answer; don't know... 


6 

5 

23 


Total 


100 


100 


125 


100 


225 


(a) Size of city in which most of childhood was spent : 
Large city (over 500,000) _ 


74 
5 
5 
2 

1 

1 
12 


74 
5 
5 
2 

1 

1 

12 


67 
2 

18 

10 
2 
5 

21 


54 
2 

14 
8 

1 

4 

17 


141 


Medium city (100,000 to 500,000) 


7 


Small city (10,000 to 100,000)... 


23 


Town (1,000 to 10,000) 


12 


Village 

Farm... _. 


3 

6 


No answer; don't know 


33 






Total... 


100 


100 


125 


100 


225 



208 



TABLE 28.-MILITARY SERVICE 



Service: 

Yes 

No 

No answer 

Total 

(a) Years in military service: 

1 year 

2years 

3 years 

4 years 

More thaa4 years 

No answer _ 

Total 

( b) Type of military discharge: 

Honorable 

Dishonorable 

Medical 

General.. ..- 

Other. 

No answer; don't know 

Total _. 



Addict 




Nonaddict 




Total 




Number Percent 


Number 


Percent 


Number 


Percent 


25 


25 


36 




29 


61 


27 


73 


73 


88 




70 


161 


72 


2 


2 


1 




1 


3 


1 


100 


100 


125 




100 


225 


100 


5 


20 


6 




17 


11 


18 


8 


32 


9 




25 


17 


28 


6 


24 


7 




19 


13 


21 


1 


4 


5 




U 


6 


10 


4 


16 


7 




19 


11 


18 


I 


4 


2 




6 


3 


5 


25 


100 


36 




100 


61 


100 


18 


72 


25 




70 


43 


70 


2 


8 


3 




8 


5 


8 


1 


4 


3 




8 


4 


6 


1 


4 . 

8 

4 


"l" 

3 




..... 
8 


1 
4 
4 


2 


2 


7 


1 


7 



25 



100 



36 



100 



61 



100 



TABLE 29.-OFFENSE FOR WHICH PRESENTLY CHARGED 



Addict 



Nonaddict 



Total 



Number Percent Number Percent Number 



Percent 



Offense: 

Larceny; theft 21 21 

Drug law violation 15 15 

Robbery 10 10 

Possession of implements of crime 5 5 

Burglary 6 6 

Receiving stolen property _ 3 3 

Carry/possess weapon 5 5 

Housebreaking 

Assault (other than aggravated) 5 5 

Soliciting (for lewd and immoral purposes) 4 4 

Criminal homicide 3 3 

Forgery; counterfeiting... 3 3 

Fraud; embezzlement 2 2 

Autotheft 2 2 

Armed robbery 1 1 

Bank robbery 2 2 

Disorderly conduct; drunkenness 1 1 

Escape 2 2 

Destroying private properly 

Assault (with a deadly weapon) _. 

Offense against family. . _ 

Traffic violation. 1 1 

Obstructing justice 

Parole/probation violation 1 1 

Unlawful entry.... 2 2 

Resisting arrest 

Sex offense 

Manslaughter 

Gambling 

Contempt 

Civil action 

Ball Act 

No answer; don't know 6 6 

Total _ 100 100 



11 


8 


32 


8 


6 


23 


15 


12 


25 
5 


8 


6 


14 


3 


2 


6 


12 


9 


14 


1 


1 


1 


11 


9 


16 


1 


1 


5 


1 


1 


4 


3 


2 


6 


2 


2 


4 


6 


5 


8 


2 


2 


3 


1 


1 


3 


6 


5 


7 
2 


5 


4 


5 


4 


3 


4 


1 


1 


1 


4 


3 


5 


3 


2 


3 

1 






2 


1 


1 


1 


1 


1 


1 


2 


2 


2 


1 


I 


1 


1 


1 


1 


1 


1 


1 


1 


I 


1 


9 


7 


15 



14 
10 
11 
2 
6 
2 
6 



125 



100 



225 



100 



(Thereupon, at 2:45 p.m. the hearing adjourned, to reconvene to- 
morrow, April 28, 1971, in room 2253, at 9 :45 a.m.) 



NARCOTICS RESEARCH, REHABILITATION, 
AND TREATMENT 



WEDNESDAY, APRIL 28, 1971 

House of Representatives, 
Select Committee on Crime, 

Washington^ D.C. 

The committee met, pursuant to notice, at 10 :00 a.m., in room 2253, 
Ray burn House Office Building, the Honorable Claude Pepper (chair- 
man) presiding. 

Present : Representatives Pepper, Waldie, Brasco, Mann, Murphy, 
Rangel, Wiggins, Steiger, Winn, Sandman, and Keating. 

Also present: Paul Perito, chief counsel; and Michael W. Blom- 
mer, associate chief counsel. 

Chairman Pepper. The committee will come to order please. 

The Select Committee on Crime today continues its hearings into 
what science and medicine can do to help us fight heroin addiction in 
the United States. 

Yesterday, we heard impressive testimony from Dr. Frances Gear- 
ing of New York and Dr. Robert DuPont of the District of Columbia 
on the effectiveness of methadone programs. 

Today we are continuing our examination of methadone with testi- 
mony from Dr. Jerome Jaffe, director of the Illinois Drug Abuse 
Program. 

Dr. Jaffe was originally scheduled to testify yesterday, but was 
kind enough to stay over until today as we ran behind schedule be- 
cause of several votes on the floor. 

We will also hear testimony today from Dr. Harvey Gollance, as- 
sistant medical director of Beth Israel Medical Center in New York. 

Both Dr. Jaffe and Dr. Gollance have had wide experience in the 
administration of methadone maintenance programs. 

We also have with us today Robert F. Horan, Commonwealth at- 
torney for Fairfax County, Va., who will tell us about the special 
drug-abuse problems of his suburban county. 

We will also hear from Dr. Daniel Casriel about a new treatment 
program for heroin addicts that employs a rapid-acting detoxification 
drug. 

And, finally. Dr. Gerald Davidson, of Boston City Hospital, will 
explain the workings of his program. 

We hope that the information we receive from these witnesses and 
others yet to appear will help us formulate recommendations to the 
Congress on what the Federal Government can do to fight addiction, in 
addition to what we are now doing. 

(209) 



210 

The committee is pleased to call now Dr. Jerome H. Jaffe, a dis- 
tinguished doctor and the director of one of the Nation's largest drug- 
abuse programs. 

Dr. Jaffe is associate professor of psychiatry at the University of 
Chicago, and director of the drug abuse program of the Illinois De- 
partment of Mental Health. 

Dr. Jaffe holds both a bachelor's and master's degree in psychology 
from Temple University and an M.D. from the Temple University 
School of Medicine. 

He has been the holder of a U.S. Public Health Service Post Doc- 
toral Fellowship in Pharmacology and has twice received the U.S. Pub- 
lic Health Service Career Development Award. 

Dr. Jaffe is a member of numerous scientific and honorary organi- 
zations. He is a member of the editorial board of the International 
Journal of the Addictions; a member of the Review Committee of 
NIMH's Center for Studies of Narcotics and Dangerous Drugs; a 
consultant to the Illinois Narcotic Advisory Council and the New 
York State Narcotic Addiction Control Commission. He also serves 
as secretary of the section on drug abuse of the World Psychiatric As- 
sociation; a consultant to the Department of Health, Education, and 
Welfare; and special consultant to the World Health Organization's 
Expert Committee on Drug Dependence. 

He is also the author of numerous articles on drug addiction. 

Dr. Jaffe, we are indeed pleased to receive your testimony today. 

Mr. Perito, will you inquire ? 

Mr. Perito. Thank you, Mr. Chairman. 

Dr. Jaffe, I understand that you have a prepared statement; is 
that correct ? 

STATEMENT OF DR. JEROME H. JAITE, DIRECTOR, ILLINOIS 

DRUG ABUSE PROGRAM ^ 

Dr. Jaffe. That is correct. 

Mr. Perito. Would you care to present that to the committee ? 

Dr. Jaffe. Yes. I would like to comment briefly on four areas re- 
lated to the problem of narcotics addiction and drug abuse : 

First. The spectrum of treatment services required to treat narcotics 
users, and our experiences in the State of Illinois in developing a 
multimodality program for delivering such services. 

Second. A progress report on acetyl-methadol, a drug that we be- 
lieve may have significant advantages over methadone in the treatment 
of heroin users. 

Third. Our current estimates on the effect of treatment in reducing 
antisocial activity. 

Fourth. My own views on the kinds of research that will be re- 
quired if we are to avoid another pandemic of drug use similar to the 
one we are now experiencing. 

1 Subsequent to Dr. Jaffa's appearance before the committee. President Nixon, on June 12, 
1971, named Dr. Jaffe as his chief consultant on drucr abuse and drnp dependence and 
proposed his name for consideration by the Senate as Director of the President's proposed 
Special Action OflSce on Drug Abuse Prevention. 



211 



In the State of Illinois our efforts to develop treatment programs 
began in 1966. Our approach to treatment was based on a very clear 
set of premises and principles : 

(1) Narcotic users are a heterogeneous group requiring different 
treatments. 

(2) To determine which treatments were most appropriate for a 
given community required a community diagnosis. 

(3) Treatment programs should be located in the communities 
where patients lived. 

(4) No program, no matter how sound it might appear to be theo- 
retically or how appealing it was emotionally, would be continued 
unless objective evaluation revealed it to be effective and to justify 
the expenditure of public funds. 

Initially, our program could be called a controlled comparison of 
several different approaches, somewhat competitive, but friendly. We 
developed a therapeutic community — Gateway Houses — modeled after 
Daytop Village. We explored the use of narcotic antagonists such as 
cyclazocine ; we developed halfway houses, a specialized hospital unit ; 
and we used methadone for maintenance at both high doses and low- 
doses. 

Later we began to wonder why it was necessary to have a separate 
unit for each approach. It became obvious that such separatism was a 
relic of old rivalries and philosophical disputes that had no place in 
a scientifically run and evaluated program. With some effort we were 
able to get most of our units to offer all of the available approaches in 
a more or less eclectic fashion. 

In other words, at a single facility a patient could participate in a 
methadone maintenance program, later withdraw, live in a residential 
self-regulating community, reenter the community at large on an 
abstinent basis, or elect to take cyclazocine and in the event of a 
relapse, move back into a residential facility, or if he was holding a 
job merely start again on methadone on an ambulatory basis. He 
rnight then wait for a number of months — until it was his vacation 
time — move into the facilities and then withdraw from methodone. 

Not every unit is able to sustain specialized treatment services. For 
example, we have one unit under the leadership of Dr. John Chappie 
that specializes in the care of addicts with serious medical problems, 
alcoholism, psychosis, and pregnancy. Yet this unit serves the entire 
network and a patient who needs such treatment is merely transferred 
without any interruption of treatment. 

We believe that to reach the majority of addicts it requires more 
than one approach or modality. We also believe that we have dem- 
onstrated that all of the modalities can be accommodated within a 
single administrative structure. The advantage to this approach is 
that program planning and expansion can then be based on the results 
of a fair and uniform evaluation system imposed by the administra- 
tive structure rather than by emotion, rhetoric, and a political trial 
at arms in the lists of the mass media. This kind of eclectic program 
has come to be called the multimodality approach. 

Currently lodged in the department of mental health and operated 
with the cooperation of the University of Chicago, the program con- 



212 

sists of a network of 21 geographically distinct facilities across the 
State serving more than 1,600 narcotics users. 

Our present primary goal is to eliminate the waiting list so that 
every patient who seeks treatment can get it immediately. We have 
enjoyed the full support of the Governor, the legislature, and the 
department of mental health. We should reach our primary goal with- 
in the next 6 months. 

11. 

Almost from the beginning of the work with methadone, it was 
obvious that if we expected patients maintained on methadone to lead 
normal, productive lives it would be impossible to demand that they 
come to a clinic every day in order to ingest their medication under 
supervision. Eventually patients would have to be permitted to take 
their medication home, and although we might hope that 95 percent 
of the patients would not abuse this privilege, it would be naive to 
hope that there would not be a small minority who would give away 
or sell their prescribed medication. Among the potential solutions 
to this problem would be a longer acting methadone-like drug. 

In 1966, I proposed to study one such substance, acetyl-methadol, 
but the project was shelved when I moved from New York to the 
University of Chicago. 

After a 3-year delay we resurrected the project and last year my 
colleagues and I reported that acetylmethadol seemed to be as effec- 
tive as methadone in facilitating the rehabilitation of heroin addicts. 
Advantages includes its longer duration of action and its lower abuse 
potential. Its longer duration should also mean reduced program oper- 
ating costs since, obviously, you don't have to give out the medication 
every day, but need only give it three times a week. Several months 
after our first report, one of my collaborators. Dr. Paul Blachly at 
the University of Oregon, sent us a confidential report in which he 
observed some advei-se side effects with 1-acetvl-methadol. 

By that time our group, including Drs. Charles Schuster, Edward 
Senav, and Pierre RenauU had alreadv repeated our controlled dou- 
ble-blind studies and had found no such side effects ; since that time 
we have carried out still additional studies — so that our total experi- 
ence includes well over 75 patients studied for at least 4 months. Thus 
far our conclusions are the same — acetyl-methadol is as effective as 
methadone. 

I want to caution, however, tliat we have not used very high doses. 
We have used it primarily and solely in males and we cannot be 
certain at this point that at such higher doses we would not see un- 
wanted effects. 

III. 

From the bejiinning of our program one of the criteria by which 
we measured effectiveness was the extent to wliich treatment reduced 
antisocial behavior. We have done at least four separate studies in 
which we have compared the &t;lf- reported arrest rates of patients 
prior to treatment and their arrest rates during treatment. In every 
one of these studies we have observed a very substantial drop in the 
arrest rates. In some instances the rates were reduced to one-half of 
the pretreatment rate. In others, the rates were reduced to one-third 



213 

of the pretreatment rate. Until recently, we were unclear about how 
to evaluate these results. 

First, they are considerably less dramatic than those reported by 
other workers. However, this could be due to our policy of taking 
all applicants regardless of our estimate of how well they will do. 

But second, for technical reasons, we were unable to examine the 
actual arrest records of our patients, but were forced to rely on their 
own reports to our legal unit. The only penalty for a failure to report 
an arrest was that if it was later reported the legal unit would offer 
no assistance with respect to that arrest. 

More recently our program wrote a contract with the University of 
Chicago Law School to conduct an independent assessment of the 
impact of treatment on crime. 

Mr. H. Joo Shin and Mr. Wayne Kerstetter were able to obtain 
the arrest records of a sample of a little over 200 of our patients. 
We then gave them access to all of our data. Their findings are still 
being analyzed, but thus far they have found that official arrest rec- 
ords do not record all of the arrests that our patients have had. 

The study conducted by the University of Chicago Law School re- 
vealed that prior to treatment this sample of patients had recorded on 
their arrest records approximately 84 arrests per 100 man-years ; dur- 
ing treatment, they accumulated only 31 arrests per 100 man-years. 
Depending on how you want to calculate the percentage, this would 
be viewed as a 61-percent reduction in arrest rate. Self-reported data 
indicated that prior to treatment our patients had 148 arrests per 100 
man-years. After treatment the arrest rate was 76 arrests per 100 
man-years. 

Thus, it appears that whether we use arrest records or patients self- 
reports, arrest rates decrease dramatically. We do not have at present 
a more detailed qualitative analysis of the change, but we suspect that 
the crimes committed by patients in treatment are less impulsive and 
more benign. 

IV. 

Lastly, we come to research : 

It may be that I am too close to the issue to see it in perspective. To 
a certain extent I consider myself a displaced person. 

I left my laboratory and my research in order to develop a much 
needed program in the State of Illinois and I look forward to returning 
to full-time research. 

The projects that I personally think deserve high priorities are : 

(1) Further studies on the use of antagonists in facilitating the 
withdrawal from methadone and in treating young people who have 
begun to use heroin but have not become physically dependent. We 
need to develop long-acting forms of nontoxic antagonists. 

(2) An expanded investigation into the safety and utility of acetyl- 
methadol and similar agents. 

(3) The development of a system under the aegis of a health-care 
authority for monitoring trends in drug use and addiction so that we 
can mobilize earlier and more rationally to abort epidemics. 

(4) Experiments to determine whether early intervention can abort 
a microepidemic. 

(5) Further studies on the natural history of the drug-using syn- 
dromes; for example, we still do not know how many individuals stop 
using various drugs spontaneously. 



214 

(6) Basic studies on the nature of the biochemical events involved 
in tolerance and physical dependence. 

Research requires people. It is simply inadequate to make money 
available and expect that trained and competent researchers -will ma- 
terialize from the ether. These individuals require support before they 
are ready to conduct their own research and not all of those who re- 
ceive such support will develop into able researchers. Thus, some sup- 
port for training of new researchers or the retraining of researchers 
from other fields is a prerequisite to a long-run attempt to conduct the 
research I have described. 

Thank you. 

Chairman Pepper. That was a very able and comprehensive state- 
ment. Dr. Jaffe. 

Mr. Perito, do you have any questions ? 

Mr. Perito. Thank you, Mr. Chairman. 

Dr. JafFe, you started the program in Illinois in 1967 ? 

Dr. Jaffe. Well, the legislature passed the appropriations bill and 
it was signed in August of 1967. It took us a number of months to find 
out how to use that appropriation because we were an entirely new 
agency in a sense. 

We took the first patient, under the aegis of the Department of 
Psychiatry of the University of Chicago in January 1968, and that 
began in my own office at the university. We sort of got started in an 
unusual way. 

Mr. Perito. You have gone from one patient to 1,590 patients from 
January 1, 1968, up until the present time ? 

Dr. Jaffe. We have at least doubled our patient load every year, and 
intend to double it again this year. It is, we think, a very orderly rate 
of growth. 

Mr. Perito. Does your program or programs, rather, have a waiting 
list at the present time? 

Dr. Jaffe. Yes ; it has had a waiting list from the first day that we 
took in the first patient. No matter how fast we expand, we have al- 
ways had people waiting for treatment. 

Mr. Perito. Your program is the largest in Chicago ; is that correct ? 

Dr. Jaffe. Yes. 

Mr. Pepito. Are there other large programs working in conjunction 
with yours ? 

Dr. Jaffe. Well, we have no mechanism for monitoring the size of 
other programs. Unofficially, I think the largest program that does 
not come under our aegis has 50 or 60 people. 

Mr. Perito. Do you receive any Federal moneys for your program ? 

Dr. Jaffe. There is one grant from the National Institute of Mental 
Health to the University of Chicago. 

Mr. Perito. Is this a research or a service grant ? 

Dr. Jaffe. There is a service grant. 

Chairman Pepper. How much Federal assistance do you receive? 

Dr. Jaffe. The first year it was about $450,000 to $500,000. It was 
a matching grant. It has decreased by 10 percent each year thereafter. 

Mr. Perito. What do you figure the cost is, per patient-year, to iim 
your program at the present time ? 

Dr. Jaffe. Well, I can give you some exact figui-es, but I would 
like to give you some context in which to put them. 



215 

About 20 percent of our patients are living in a residential setting. 
At present, we use no traditional hospitals at $80 per day, but we 
have developed more efficient — and we think more rational — ways of 
handling patients who are drug abusers, since for the most part, cor- 
rectly handled they are not acutely ill. Our residential settings still 
cost us about $10 to $12 per patient per day, or $3,500 per year. 

Our outpatient methadone program costs between $800 and $1,500 
per patient per year. 

Again, I give you this range because the longer somebody is in 
treatment, if they remain continuously in treatment, the less costly it 
is to treat them. Once they become stabilized they get a job and they 
are functioning reasonably well. 

At that stage, it does not take as much personnel or staffing to main- 
tain that person in a functioning state. So that for a patient in the 
early stages of treatment, you have to have more input. As our pro- 
gram has matured, our outpatient cost per patient have actually gone 
down in spite of inflation. 

Now, if you want an overall cost for treating 1,600 people with the 
research we have conducted, with our evaluation with our equipment 
costs, the cost is a little over $2.4 million to treat 1,600 people. 

Again, I caution you that we only reached 1,600 January 1, so you 
are going to look at a mean patient load of about 1,400 over an entire 
year. 

In a program that is expanding it is more rational to look at the 
projected cost when it stabilizes. At that point we expect that resi- 
dential costs will be in the neighborhood of $3,000 to $3,500 per patient 
per year, and outpatient costs will be about $1,200. 

Mr. Perito. Do most of your funds emanate from the State of 
Illinois? 

Dr. Jaffe. The State of Illinois. 

Mr, Perito. Do you receive any money for your program from the 
University of Chicago ? 

Dr. Jaffe. Only to the extent that the University of Chicago makes 
commitments to faculty people and provides fringe benefits to those 
faculty people, and these benefits that are very difficult to charge to 
grants. In that sense we are supported primarily by the Federal 
grant and the State of Illinois. 

On the other hand, we sort of cannibalize a lot of the brainpower 
at the University of Chicago and have no way of compensating them 
for the unofficial consultation time and the time that we take up in 
trying to plan strategy. 

Mr. Perito. Doctor, how large is your staff at the present time, 
that is your full-time staff ? 

Dr. Jaffe. Well, there are approximately 135 total State positions 
at this time. At the university there are perhaps 40 positions. Our 
program was designed to maximize where possible community par- 
ticipation and the co-opting of whatever community resources could 
be brought to bear on this problem. Since there is a great reluctance 
of community people to donate their time to the State, we arrange to 
contract with specifically developed not-for-profit corporations to op- 
erate certain components of this program. Although we evaluate them 
and although we consider them operating arms of the program, they, 



216 

in fact, constitute autonomous or semiautonomous not-for-profit 
corporations. 

For example, Gateway Houses Foundation, which now runs three 
residential facilities for young polydrug users and heroin users, oper- 
ates on a contract with us and Gateway, I believe, employs 18 staff 
people. 

We have several other small organizations that are contracting with 
those. 

I would guess, in the aggregate, their staff may come to a total of 
perhaps 30 people. So that if you want to total it all- up it is perhaps 
about 220 people, give or take a few, to take care of this patient load. 

Mr. Perito. Doctor, in your prepared statement you mentioned the 
use of acetyl-methadol. Do you foresee that this long-lasting drug will 
someday be a replacement for methadone? 

Dr. Jaffe. Not entirely as a replacement for methadone. Any new 
drug has its advantages and disadvantages. 

First, I would like to emphasize that acetyl-methadol requires fur- 
ther study. It may very well be that an attempt to use it at much 
higher doses would cause some side effects. Furthermore, it is a drug 
whose primary advantage is its long duration of action. This means 
that it is a drug that can be given three times a week. No drug need 
be taken home and therefore no drug can be illicitly diverted. It has 
its advantages. 

Mr. WiGGixs. Doctor, who developed this drug ? 

Dr. Jaffe. This drug has been around since the 1950's. It was origi- 
nally developed by Merck, tested at Lexington, but because it was so 
long acting there was no further use for it in medicine. I was about 
to say its advantage turns out to be its disadvantage. Many people are 
not familiar with a drug that should not be given every 24 hours. 
If you give it every 24 hours you get cumulative toxicity, the drug 
lasts for several days, so that you have some overlap. Before this drug 
can be widely used it will take an educational program. 

Mr. Wiggins. You make an interesting point, and that is drugs that 
are really effective sort of price themselves right out of the market, 
don't they, because there is no longer a need for them if they solve 
the problem that they are created to solve? Is that really what you 
are saying here about this, that it was so effective that there was no 
market for it ? 

Dr. Jaffe. No; I am saying it was tested as an analgesic agent, a 
painkiller, and in some instances people were unaware that this was 
a drug that should not be given every day. When they gave it every 
day some patients developed cumulative toxicity. In effect, by taking 
it every day they received overdoses. This made it virtually useless 
as an analgesic. It was just too tough to use. 

Mr. Wiggins. This drug was developed by a private pharmaceu- 
tical house ? 

Dr. Jaffe. That is correct. 

Mr. Wiggins. For sale for profit, I take it ? 

Dr. Jaffe. It never reached the market in any meaningful way. 

Mr. Wiggins. Are you satisfied that we can or should rely i:)rimarily 
on the private researchers and pharmaceutical houses to develop a 
drug that you may need ? 

Dr. Jaffe. No. 



217 

Mr. Wiggins. "\Yliere else is it being done or should it be done ? 

Dr. Jaffe. Well, my experience has been that we do not have an 
effective mechanism for developing drugs which don't have a poten- 
tially significant commercial market. Drug houses do not want — and 
at least in my own experience — to develop drugs which have no 
market, utilizing their own resource and their own personnel and their 
own laboratory facilities. 

On the other hand. I think we have precious little in the way of that 
kind of resource within the public sector. Generally, universities are 
not in the business of developing drugs. 

Mr. WiGGixs. What suggestions might you make to the committee 
if we are interested in encouraging the development of such drugs? 

Dr. Jaffe. Well, I am not sure that I know enough about the devel- 
opment of pharmaceutical preparations to make really meaningful 
suggestions on it. I suspect there is some difficulty with respect to 
patent problems. As soon as you give subsidies to a commercial or- 
ganization, it then loses the possibility of distributing and marketing 
that product for profit. 

Mr. Wiggins. Well, could it be done alternatively or together at the 
National Institutes of Health or at universities operating under 
grants ? 

Dr. Jaffe. I think it could be, but traditionally universities have 
not been in the drug development business and it would mean think- 
ing about what would be necessary to develop that capacity within 
a university. J 

The difficulty with many universities, at least until recently, is 
that Govermnent encourages universities to apply for grants that 
run for 3 or 4 years. The university recruits people and brings them 
from wherever they were to the university. Their families are there. 
And then the grants run out. The Government just says, well, we have 
other priorities now. The university is left with the problem of staff 
people who nobody wants any more. They are surplus. This is a hu- 
man problem. 

If the university doesn't teach the development of pharmaceutical 
products, then, you know, it is very difficult to get it involved in de- 
veloping this kind of thing. 

There are, you know, schools of pharmacy, but whether or not they 
are in the business of developing drugs, I can't say. The development 
of new pharmaceuticals is npt^^y area^of expertise. 

Mr. Wiggins. All right. ' -v ...^ ., ^ r ( ^ ■• r^^ ^ 

Chairman Pepper. Excuse me;"^,, ^. 

Apropos to what Mr. Wiggins was asking you, the suggestion was 
made the other day that it might be possible for the U.S. Government 
to give grants to drug houses to carry on approved research in areas 
where the Government desired such research be carried on, with the 
understanding that if the company ever profited from the distribu- 
tion of that drug, the United States would get its money back, and in 
that way you would allow the company to retain the ownership of 
the patent while reimbursing the Government should the research 
produce a drug that is economically profitable. , 

Dr. Jaffe. That sounds like a very creative approach to me. I won- 
der whether or not it can be accomplished. Certainly it is the first 
time I have heard that suggestion. I know it has been a stumbling 
block for most pharmaceutical houses. 

60-296— 71— pt. 1 15 



218 

Chairman Pepper. Mr. Perito? 
;; Mr. Perito. Thank you. Mr. Chairman. I have a couple of more 
questions along that line for Dr. Jaft'e's consideration. 

You had mentioned earlier during staff interviews that one of the 
problems was in developing new research techniques involving possi- 
ble development of antagonists that researchers become terribly spe- 
cialized, but then when the problem is solved there is no need for them 
any longer. 

I wonder, could you expand upon this for the committee's benefit? 

Dr. Jaffe. Yes; my point was simply that I think the situation is 
somewhat analogous to the space program. If Government decides it 
has a priority and wants to have a crash program, we can give out a 
great deal of money and get people to drop a secure position where they 
are teaching something or doing research on something which has 
long-range value. Those people come into the field and they get in- 
volved in the crash progi'am. As soon as the problem is solved, they are 
out of business, and it is a human problem. I think it causes some re- 
luctance for the best people to drop their work and get involved in it. 

What you often get with this kind of crash interest is that you move 
marginal people who haven't done well in more traditional fields than 
this, which is precisely what won't get the job done. I have no specific 
suggestions as to how to get the job done. I think it remains a problem 
for Government to examine what it does about its human excess bag- 
gage, particularly when that excess baggage turns out to be its best 
brainpower that it recruits into solving public problems and then 
abandons. 

I can say for myself that at this point I would have to stop for a 
number of months to review the literature, to prepare a grant applica- 
tion, to get caught up with a research field in order to get a grant. 
Since I moved into the public service sector in order to develop a 
delivery system that made use of known research which existed in 
1967 and 1968 I, at least, have a university base. Other researchers 
may not have such an affluent base — I am not sure our university is 
affluent — but at least universities are willing to make that commit- 
ment of saying, "You may now sit back and get caught up with your 
own field in order to compete for a grant." 

This is the difficulty. You move people into one thing, then you want 
them to switch. Nobody supports them during that interval while 
they are trying to reacquire the tools and get caught up with the tech- 
nology in order to compete for other grants. 

We certainly have gutted the universities in many respects with 
respect to their capacity to support people. They are very dependent 
on research grants. When these things are cut back they have no way 
of supporting those people who then are looking to find out what are 
the new areas that are of interest to the public. 

Mr. Perito. Have you found an appreciable difference on your crime 
studies and the efficacy of your program in reducing crime or anti- 
social behavior? Have you found a principal difference betAveen the 
arrest records that you have checked, and the actual instances of crimi- 
nal behavior that you have found out through interviews with addicts? 

Dr. Jaffe. Well, I can say that our interviews with addicts indicate 
that a great deal of crime occurs that is not reflected in an arrest. It is 
a very interesting kind of thing. 'V^Tien we establish rapport with 



219 

somebody who, almost as a professional, engages in antisocial activity, 
they will be very honest with you. 

We have seen that when we get people into treatment, even A\-hen 
they don't give up their antisocial activity entirely in the early months 
of treatment — and get a legitimate paying job — their antisocial activity 
still drops dramatically. They may not be arrested at all, yet we know 
they are committing crimes. Nevertheless they are committing them 
at half the rate they were committing thom. So that sometimes you 
can get a great deal by talking to people that the arrest records will 
not reveal. 

The arrest records are only a very approximate index of what is 
actually happening. There are discrepancies and they go in both direc- 
tions. Sometimes people who commit virtually no ciime manage to 
get arrested for some charge anj^way, and somebody else who is more 
skilled continues to engage in antisocial activities for long periods and 
is not arrested at all. We have seen both of these kinds of things go on. 

Mr. Perito. Do you regard the coiicept of narcotic antagonists like 
cyclazocine and naloxone as a hopeful aiea in multimodalit}' approach '{ 

Dr. Japfe. Do I regard the concept of narcotic antagonists as a hope- 
ful area ? The answer is that I do. 

HoAvever, as I said several 3'ears ago, it is quite clear that in order 
to be effective in treating narcotics users a more appropriate form of 
narcotic-antagonist will be required. We will require an antagonist 
with minimal side effects that can be given in a way that will produce 
a blockade of narcotic effects for at least several days. Unlike metha- 
done, patients don't want to come back to a clinic every day just to 
take a drug that blocks narcotic effects. 

Some will. Some will for a number of months, but for the most 
part, after a few months they are convinced they don't need the an- 
tagonist any more, so they stop. 

Chairman Pepper. Excuse me a moment. 

The effect of this antagonist drug is to prevent them from getting 
any sensation of satisfaction or euphoria from the taking of heroin? 

Dr. Jaffe. That is correct. 

Chairman Pepper. Now then, could you add to that drug the quality 
of making the taking of heroin, again within a reasonable time, repul- 
sive to the system; that is, causing a reaction of an unfavorable 
character? 

Dr. Jaffe. I am not sure that we have such a drug, nor am I really 
certain that it would be useful. It would be interestmg if we had one, 
but you see, they do have something comparable to that in alcoholism 
with Antibus. and the results have not been overly dramatic. If the 
revulsion reaction is severe enough it may be endangering somebody's 
life and you have an ethical question. 

The antagonists have the advantage that you can perhaps persuade 
somebody to become involved with the antagonists, because it will not 
hurt him if he takes a narcotic. It merely blocks the effect. 

Obviously, what it does not do is in any way allay this kind of 
narcotic hunger, this craving that some addicts seem to feol when 
they are not actively using or during the first year or so after they 
stop taking narcotics. 

I want to get back to your question about naloxone and cvclazocine. 
Cyclazocine I think we have explored. It is a difficult drug to use. It 



220 

is not a very forgiving drug. Its side effects require that the treaters 
have a considerable degree of skill. It still lasts only 24 hours. Given 
the effort required and given the level of patient acceptance, I don't 
think cyclazocine is a drug that in its present form we can hope to 
see widely employed. 

Naloxone is a very promising substance, theoretically, in that it has 
no side effects at all. For most people it is entirely inert. The problem 
is that it is not very effective orally and it is short acting. Its cost is 
such that even if you wanted to take it every day in huge quantities, it 
would probably cost as much as the heroin habit that you are trying 
to treat. Therefore, naloxone in its present dosage form, to me, is not 
a very useful or a hopeful approach. ■ r ■ 

I might say that our hope lies with the entire family of narcotics 
antagonists, and there are literally dozens that could be investigated, 
one of which I am sure will be extremely potent, orally effective, and 
have minimal side effects. 

If that then proves to be promising it could be converted into some 
kind of dosage form that might be effective for at least several days 
or weeks. 

This is a matter of product development. I am sure it can be done if 
people are willing to put the effort into it. 

Chairman Pepper. And the money. 

Do you think it would be in the public interest for the Federal Gov- 
ernment to expand its research funds to encourage the appropriate 
people to develop those leads that you are talking about ? 
o Dr. Jaite. I think if we do not look into them we will be remiss. 

Chairman Pepper. Mr. Blommer, do you have any questions ? 

Mr. Blommer. Thank you, Mr. Chairman. 

Doctor, I believe Dr. Dole of New York has said he believes that 
about 25 percent of the heroin addicts in New York would benefit from 
methadone maintenance. I wonder if you could comment on that state- 
ment and tell the committee what type of heroin addict you believe 
should be put into a methadone-maintenance-type of program ? 

Dr. Jaffe. Well, I will comment first on the 25 percent. I don't know 
how Dr. Dole obtained his figure, but we came out with almost the 
same figure, based on a very empirical 2-year study of heroin users in 
the Chicago area. ^ 

In other words, we admitted everybody who came. If you came to 
the door, you were admitted. We thought, based on epidemicologic 
studies in the commounity, that about half of known active narcotics 
users would seek treatment, and, of those, over tlie long run about lialf 
would obtain substantial benefits. So half of half is 25 percent. This 
is based on or data of several years and several thousand patients. 

What kind of patient would benefit is much more difficult to answer:, 
because it is very hard to predict. ^ - ' 

Mr. Wiggins. I^et me interrupt, because I want to get somethilig^^^ 
my mind. > i ■ m 

Dr. Jaffe. Yes, sir. 

Mr. Wiggins. Would you say that any person who is inclined to 
take heroin would be better off taking methadone instead of heroin ? 

Dr. Jaffe. I am not sure what you have in mind when j-ou say any 
person inclined to take heroin. 



22l 

"''Mr. Wiggins. A lot of people are inclined to take heroin for very 
poor reasons, but they do it, nevertheless. Is methadone better than 
heroin t 

Dr. Jaffe. Well, oral methadone is a lot safer than heroin bought 
from a pusher on the street without any question. If I had someone 
absolutely committed to finding out how a narcotic drug felt and 
you presented me only two alternatives, either they wanted to buy 
some heroin on the street, cook it, or take a swallow of oral methadone, 
I think the answer would be obvious. They would be a lot better off 
and safer taking methadone. But I don't know if that is what you 
are driving at. . 

Mr. Raxgel. Let me ask this : Would your answer be the same it 
the heroin was being taken orally, notwithstanding the difference m 
reaction? 

Dr. Jaffe. No; if these were known dosages of heroin and metha- 
done, both taken orally, I don't think that it really makes much ciiffer- 
ence at all. 

Mr. RaXgel. Would it make much of a difference if the methadone 

were injected? 

Dr. Jaffe. Oh, yes. Injectable narcotics produce some very rein- 
forcing effects in the sense that you can do research on animals and 
you can show that animals, given an opportunity to inject _ intra- 
venously any one of the narcotics, learn very quickly to keep injecting 
those drugs. 

Mr. Waldie. Doctor, may I interrupt you at this moment ? 

In response to Mr. Wiggins and Mr. Rangel's question, I under- 
stood you to say that if you had the same control over heroin in terms 
of quantity and the manner in which it is administered as you have 
over methadone, the man taking heroin would be ill no better or worse 
position than the man taking methadone ? 

Dr. Jaffe. No. The question was in response to a single dose. 

Further, j'ou are talking about chronic administration. 

Mr. Waldie. Let me phrase the question this way, then : There is a 
concern among some people, and I share it, that we are substituting 
one addictive drug for another. Is there some advantage to that sub- 
stitution, to substitute methadone for heroin, other than the advan- 
tages that you have stated, that there might be an infection because of 
the intravenous injection and there might be adverse effects because 
of the impurity of the heroin ? 

Dr. Jaffe. Oh, yes. . 
):Mr. Waldie. Are there other results that are beneficial for use of 
methadone rather than heroin ? 

Dr. Jaffe. In our present context, without a,nj question. There are 
two; ■'' ■ ' 

First of all, the oral absorption of heroin is somewhat erratic. Fur- 
thermore, the drug— and I am not sure this has been studied in de- 
tail — is probably not even in significant quantity going to have smooth 
duration of action if you were to give it once a day under observation. 
: 1 mean, if you were still in the position of looki'^o- for something 
which lasts 24 hours, of letting peonle take it home for their own use. 
As soon as you begin letting people take it home to]H,have trouble 
with illicit diversion and accidental ingestion. ■■' 

"ff ! y rfCMJoefiii Y< •: ;o ii.Mcj v.-'I'. 



222 

Furthermore, in our present context we are deeply concerned about 
tlie intravenous use of illicit heroin. The use of methadone provides 
one very pragmatic possibility of knowing when patients continue to 
use illicit heroin. In our program, patients on methadone have their 
urine tested. We know a patient is taking heroin in addition to metha- 
done. If we weren't giving them methadone — but were giving them 
oral heroin — we would have no way of knowing whether they continue 
to take intravenous illicit heroin. 

Mr. Waldie. Let me ask one question. Are the results on the indi- 
vidual of taking methadone less debilitating than the results on the 
individual of taking heroin ? 

Dr. Jaffe. Let me try to state this as precisely as I can. 

Mr. Wiggins. That is a clinical setting, right ? 

Mr. Waldie. Eight. 

Dr. Jaffe. No one. to my knowledge, has done adequate, careful, 
controlled studies of large doses of oral heroin. So we are always 
forced to compare the British experience with self -administered in- 
travenous heroin with our own experience of regular administration 
of oral methadone. 

So the two situations are not comparable. 

To the best of our knowledge, intravenous heroin is not a good drug 
sociologically or psychologically, because the ups and downs of a 
short-acting drug get people going from a "high" to a little bit "sick" 
and then they want to be high again. It is not a drug permitting easy 
stabilization and functioning — the stabilization of the kind that lets 
citi7:ens take care of business. 

Methadone does permit that when used orally. 

Mr. Brasco. May I ask one question ? You sort of confused me as to 
what was said, at least as I understood it, by Dr. Gearing yesterday 
when we spoke about taking heroin orally. 

If I understand correctly. Dr. Gearing said there would be no effect. 
Exactly what is the effect of taking heroin orally ? 

Dr. Jaffe. Taking heroin orally ? 

Mr. Brasco. Yes ; has it the same effect that you get when you use 
it intravenously ? 

Dr. Jatte. No. 
' Mr. Brasco. What effect does it have ? 

Dr. Jaffe. Well, the effect you get when you take a drug intraven- 
ously, a very short onset of action. 

Mr. Brasco. No ; I am talking about taking heroin orally. 

Dr. Jaffe. Heroin was given orally. It was used in this country until 
about 5 or 10 years ago when we ran out of old stocks for cough 
medicine. 

Mr. Brasco. I understood her to say — and maybe I am laboring 
under a misapprehension — that if you take it orally there was basically 
no effect. 

Dr. Jaffe. From oral heroin ? 

INIr. Brasco. Right ; as opposed to taking the methadone orally, you 
would have the stabilizing effect and it would prevent the cra\nng for 
the heroin. "When you take the heroin orally, I got the impression that 
you were sort of in the same position as not having taken it. 

Dr. Jaffe. Well, I think you are asking two different questions. One 
is: Is heroin as effective a drug taken orally as by injection? The 



223 

answer is that its oral to parental ratio is not as high, meaning that 
it takes a lot of heroin orally to give you a blood level so that you 
get an effect. That is also true of morphine. It is also true of many 
of tlie standard narcotics tliat we use in medicine. 

If somebody really has pain, you would have to give them a shot 
of a drug like morphine. Methadone is one of the few drugs in the 
narcotic analgesic group that has a good oral potency, meaning that 
you don't have to give a tremendous amount of it by mouth to have 
an effect. 

Mr. Brasco. As a practical matter, what would one take heroin 
orally for? 

Dr. Jaffe. The same way you take codeine, you give a little 

Mr. Brasco. We are talking about people addicted to drugs. 

Dr. Jaffe. Nobody would ever take lieroin orally if they were ad- 
dicted. It is too inefficient. People sniff it, some people smoke it, but 
probably nobody would swallow it, simply because it is not efficient. 
The body metabolizes it before it gets a chance to be active. 

Chairman Pepper. Mr. Waldie, have you any questions? 

Mr. Waldie. Just one question. Dr. Jaffe. If the Federal Government 
were to participate in some way in this whole problem with which 
you have been involved, would you discuss, No. 1, the areas in which 
you think our participation would be most beneficial ; and No. 2, would 
you believe in terms of priorities of expenditure, which would be the 
nature of our participation, that there is one portion of this program 
that is more deserving of expenditure than other portions? Could 
you comment on those two areas ? 
, . Dr. Jaffe. WTiich program are you referring to ? 

Mr. Waldie. I don't know. I want you to tell me. I want to to tell 
me what the Federal Government, in your view, should interest them- 
selves in most in terms of priority or expenditures. 

Dr. Jaffe. Well, in the entire area you could divide it into things 
like direct support of treatment, development of research directed 
toward the development of treatment and control systems, direct con- 
trol of drug availability and training ; training both for research and 
treatment. 

Now, obviously there are some areas that you could say need priority. 
Our experience has been that patients who are chronic heroin users 
who want treatment with methadone should be given that treatment, 
because it is better for them and everybody in the community, and 
therefore that should be a high priority for the Federal Government 
to see that the funds are there to provide sensible, rational treatment. 

Now, if there are other treatment areas that can be demonstrated to 
be effective for those people for whom we will say methadone is not 
effective, such as young polydrug users who have not been on drugs 
very long, people who just don't want to be on methadone, people 
who want to come off methadone. In our experience many, many peo- 
ple feel they have had their lives stabilized, they would like to come 
off. Such treatments should be provided or developed if they do not 
now exist. That should be done and the Federal Government should 
see that they provide that. 

There are some problems in communities. I cannot speak officially 
for any State or community, but I do know there are certain obliga- 
tory expenditures they cannot get out of. I read in the paper that wlien 



224 

the Federal Government decides it -svill not support welfare or some- 
tliin^ else, the State must do that, and therefore it can only trim op- 
tional kinds of things, mental health, treatment of addiction, and 
education. 

So that the Federal Government has to realize that as it shifts its 
priorities, the States are in a reciprocal relationship. Communities 
also set priorities and traditionally these treatment programs have 
been viewed as optional; that is, it is optional rather than legally 
required that there will be narcotic treatment programs. 

Mr. Waldie. One final question. Doctor. 

Do we have enough experience yet to knoAv whether it is more 
difficult, at first, to an indi^ndual in setting off of methadone addiction 
thn n heroin addiction, for example ? 

Dr. Jaffe. The withdrawal syndrome from heroin, given the doses 
that most people use in the street, is pretty much a thing that is over in 
a matter of a few days. The difference is that the relapse rate is phe- 
nomenally high. Certainly people who withdraw from methadone are 
complaininir mildly, but somewhat longer. It is dragged out. ovqi: a 
period of weeks or so. ?fj', .;:i(f,v. // .'ija 

Howei^er. our experience has been when you stabilize someone on 
methadone and he has gotten to the point where he has a job and is 
back with his family, and thei-e are a number of social supports, and 
he has been accepted by the community as a responsible citizen he 
may have a tougher time when he withdraws from methadone in the 
sense that it is sort of a dragged-out situation, but the probabilties 
of being; able to remain stable may be slightly higher. 

I don't think enough work has been done as yet with trying to take 
people off methadone to try to answer that question in any definitive 
wav; It is one of the research areas tliat will deserve attention. 

Mr. Waldie. Thank you. 
'Chairman Pepper. Mr. Wiggins. 

Mr. WiGGT^rs. Doctor, I want to commence vHth a hypothetical 
question. Let us suppose, hypothetically, that methadone were totally 
substitued in our drug culture foi' heroin, but that it was used in exactly 
the same way, the shooting of it, using dirty needles, cutting of it. 
using impurities ond other things, let's suppose it happened that there 
was a total substitution in, that war for heroin: would we be better 
off or worse off? ^f^^^V- '''' ''^'''"■'' '" '' '■' '/^"'- ''■''^[^ '[■■■'"'. 

^ Dr. JAffe. '"N'o; the advantages of methadone are not nearly as 
pharmacologibally — — 

Mr. Wiggins. Just respond to that question, better off or worse off? 

Dr. Jaf*t.. We %oiild be no better off. T don't think we would be any 
worse off. It is hard to picture a situatioh niuch woi'se off. 

The advantage of the present situation is as mnch in the system by 
which the methadone is controlled — its supervision — as in its "pharma- 
cological differences. ^ ^^ .oifohKO loi.t !.■ oi,i v- -; ^." 

INIr. Wiggins. I tliink it is an important question, because conceiv- 
ably we could end up in that position. T would think there is a ])ossi- 
bility we might be better oft'. At least the narcotic would be produced 
by local manufacturers who would be subject to somewhat more con- 
trol than Turkish farmers. Perhaps the Mafia or some other organized 
criminal activity would not be so intimately involved in its distribu- 
tion. These may not be insignificant advantages. 



99; 



zo 



Dr. Jaffe. I would say that I can't conceive of a situation, in know- 
ing what we laiow, where we would permit the situation to deterior- 
ate to the point that methadone would be that readily available for 

intravenous use. M'^-rr^ n >■•■■. 

Mr. WiGGixs. Many of us have harbored the suspicions, at least, 
that metliadone programs proceeded from the assumption that the 
only way to take crime out of a drug business is to make the drug 
available to addicts at a reasonable cost and to maintain their habits. 
For many reasons, however, some of which Avere political, we just 
couldn't bear to provide them heroin as did the British, so we came up 
with a substitute called methadone; is there any truth in that 

suspicion? .4^ Y^nr\y . f/ri') 

Dr. Jaffe. I thnik that is an oversimplification that misses many 
of the critical distinctions between methadone and heroin. 

First of all, the pharmacology of this drug is such, as I pointed out 
before, that you can get somebody psychologically stabilized and the 
contrast between a fairly stabilized individual taking an oral medicine 
which has very few peaks or valleys, and somebody taking a drug, 
short-acting or intravenous, going up and down several times a day, 
is dramatic. People on this smooth-acting drug can function iai terms 
of devoting their energies to productive activity. ; . . > 

People going up and down, taking intravenous doses, really do not 
function Avell. ■<{ -t\':-> 

J Second, we can supervise a long-acting eilective oral drug, meaning 
that if we want tQ, and if we feel it absolutely necessary, we can pre- 
vent methadone from being on the street. Very often, frankly, at much 
too ^reat a cost to the rehabilitated patient. 

Mr. Wiggins. I would like to know your views on how we can pre- 
vent methadone from being easily available on the stree^; subject to 
being shotup, cut, sold at a profit just like heroin. ^ 

Dr. Jaffe. Well, No. 1, the dosage form of methadone could be so 
uniform you can dissolve it in fruit juice and it is very hard to extract 
,and to in any way dilute it and shoot it. 

Mr. Wiggins. Say that again. Is it difficult to shoot it ? 5 

Dr. Jaffe. H you dissolve methadone in 4 ounces of orange juice 
and then try to concentrate it so that you can get it into a syringe, you 
get a gummy, sticky mass. There is nothing you can do with it. That is 
the original way it was developed, and many of the original programs 
went to great pains to see that this was done. 

Second — and I must say that as the volume of patient j.oad increases 
it is becoming difficult to do this, and it may be a matter of funding 
and other things — initially every new patient came to a clinic once a 
day. He drank the methadone under supervision. The only medicine 
on the street was in his belly. There was no medicine to sell or illicitly 
distribute. Theoretically, only the most stabilized patients are given 
the privilege of taking methadone home with them. 

Mr. Wiggins. But the fact is that methadone is on the street. 

Dr. Jaffe. I can't conceive of a situation where you get uniform 
adherence to a set of regulations, no matter how sensible they may be. 
You always have practitioners who won't adhere even to a very sensi- 
ble, rational set of regulations; and you always have a very, small 
minority of patients who are mavericks^ who don't have a sense of 
responsibility. 



I have presented one generic kind of solution to this problem. The 
generic solution is a longer acting substance. If you had a methadone 
that only had to be given three times a week, people for a while will 
come three times a week, and there is no drug on the street — none, 
zero. 

Now, we have one such drug 

Mr. Wiggins. Excuse me. 

I take it that a private physician could nevertheless order from a 
pharmaceutical house a case of methadone and dispense it subject only 
to his personal medical judgment on the need for it; is that risrht? 

Dr. Jaffe. No ; I would say there is some vagueness under the Fed- 
eral regulations. Most States are able to delineate the difference be- 
tween treating a temporary syndrome — such as somebody waiting to 
go into treatment, or treating someone with a chronic painful illness — 
and maintaining a narcotics user on methadone with greater precision. 
Therefore, a physician would be in violation of State laws in most 
States. 

Mr. Wiggins. What controls operate on a private physician other 
than his own judgment in dispensing of methadone ? 

Dr. Jaffe. Well, in our State we have defined the chronic treatment 
of addiction with narcotic drugs as not yet an established routine medi- 
cal procedure. So that in a sense it is acceptable as medical treatment 
only in programs approved by the department of mental health. If 
that physician does not seek such approval and adhere to a protocol, 
he may be subject to prosecution under our uniform drug law. 

Now, it may be that he could fight that successfully. We don't know. 
But — - 

Mr. Wiggins. First of all, is this a matter of State regulation? 
Dr. Jaffe. Yes. 

IVIr. Wiggins. And, therefore, there may be 50 different sets of regu- 
lations in the country ? 

Dr. Jaffe. That might be the case. That is for 50 or so. 
ISIr. Wiggins. Is there any legal prohibition against a doctor who is 
so inclined from purchasing great quantities of methadone? 
Dr. Jaffe. Not to the best of my knowledge. 

Mr. Wiggins. If that doctor were so inclined, what legal prohibitions 
preventing him from dispensing it at his front door or back door ? 

Dr. Jaffe. I suppose the only prohibition would be his concern that 
a promising medical career at which he earns a reasonable living could 
be permanently terminated by successful prosecution under a felony 
charge of illicitly selling narcotics. 

Mr. AViggins. Is it a defense, so far as you know, to that charge that 
the doctor believes in the exercise of his professional judgment that 
the person before him was an addict and who would profit from the use 
of methadone ? 

Dr. Jaffe. It would be a defense, I suppose, onlj'^ if a substantial 
number of his professional colleagues in that community stood up 
and said this is the good i)ractice of the community and it is in the best 
interests of tlie patient aiid comnumity. Tlie cluinces might be he 
would be convicted of a felony. 

Mr. Wiggins. Given the situation as you described it, are you satis- 
fied that is an adequate control ? 



227 

Dr. Jaffe. I think that more work has to be done in delineating- the 
conditions under which these drugs can be used for the treatment of 

addiction. ,. . p xxtt^ • -• 

I am not satisfied with our current apphcation ot a l^D, nivesti- 

gational drug. . , 

On the other hand, I have no pat solution for the best way in wnich 
our health care delivery system can become involved in delivering 
the services to the advantage of the patient and the community. 

I mean, we have to protect both, and we have to serve both. I think 
more work has to be done on it. I am not satisfied with our present 
controls, nor would I want to see us return to a purely repressionary 
police state during which no physician would ever let an addict inta 
his office for fear he might be some kind of local police informant, 
and that if he treated him in any way he might be prosecuted. 

That was an era of sheer terror for physicians, and the mere fact 
somebody might be an addict was sufficient reason for them to pick up 
the phone and call the police and say get this whatever-it-is out of my 
office. 

Mr. WiGGixs. As I recall it, when they operated under a system 
of private dispensing of heroin the abuses were so widespread that the 
only way to control it was to confuie it to a clinical setting. 

Dr. Jaffe. Well, I have no personal knowledge of what went on. I 
read the reports. I know the details. I am not sure that you w^U get 
a consensus on what really went on. 

It is obvious that there is no way of dispensing or prescribing short- 
acting drugs without lisking significant illicit diversion. We have said 
the best clinics under the best controls, trying to dispense heroin, 
would open themselves up to illicit diversion, that you need a long- 
acting drug that you can supervise and preferably one that can only 
be used orally. We have such pharmacological substances available. It 
has to be realized that methadone wasn't even known to be an effec- 
tive narcotic drug until the late 1940's, in this country. 

I mean, some of the pharmacological knowledge that we are talking 
about never existed in the 1920's when they tried these clinics. So tliat 
one couldn't even experiment with the possibility of a carefully regu- 
lated controlled system of treating those people who are willing to be 
treated in this way. I think that we are now in a different technologi- 
cal ball park. We have to stop harking back to old days, when we used 
old technology and look at what we can do now, what our potentials 
are and what is the best way to strike the best balance in treatment 
and still, at the same time, protect the community from widespread 
illicit diversion of the drugs we are using for treatment. 

Chairman Pepper. Mr. Brasco, do you have any questions ? 

Mr. Brasco. Yes; I wanted to ask Dr. Jaffe: In connection with 
the methadone program, would there be any great difficulty, given the 
fact that there is agreement over the danger of abusing the use of 
methadone in the street, why is it not possible, at least from the point 
of view of stopping those who are in treatment from proliferating 
use in the street, having users report once a day to take the methadone 
at the clinic so we know we can stop that kind of abuse ? 

Dr. Jaffe. I think it is a fine question. It has been raised a number 
of times. 



228 

The answer tends to be a very practical one, which is that for the 
first 3 or 4 months you do insist that somebody come every day. 
But if you are successful, if he begins to view himself as a produc- 
tive citizen, if he now has a job and he has to get to that job on time 
and come back, and your clinic doesn't happen to be either near his 
horne or near his job, you are asking him to somehow get to your 
clinic once each day. It may be very difficult for you to keep the clinic 
open long enough for him to get there every day. It may be, for ex- 
ample, impossible to get nurses to work in certain communities after 
sundown. 

Mr. Brasco. It becomes a problem of logistics ? 

Dr. Jaffe. Primarily a problem of logistics. It also becomes a prob- 
lem of self-image. We have had people in treatment for 3 years, work- 
ing every day, earning retirement benefits. They haven't used any 
drugs and they are still wondering why everybody else is trusted with 
phenobarbital for epilepsy, and other people are trusted with all kinds 
of drugs. ■,.,.,,, 

Mr. Brasco. Then j^ou are saying it has a definite effect in the re- 
habilitation program if the program doesn't give that basic show of 
trust? 

Dr. Jaffe. I think for many people that is the case. But I am nqt 
willing to push the logistics aside, because logistics happen to be para- 
mouiit in a place lilje-I^os Angeles, which has virtually no public 
transportation system. You are, in effect, saying, "We want you to get 
rehabilitated, but so rehabilitated you can have a .(?ar to get to the 
, clinic every day." 

Chicago has its own transportation problems, as every urban area 
does. They just can't afl^ord to come to the clinic every day. 

Mr. Brasco. Doctor, one other thing now. ajio tjoy 1riIi s/nb snil- n 

In connection with that, then, and I don't knowTf you have .aaiy 
statistical information on it, but wliat is your experience for the po- 
ten<:iality of abuse of allowing the methadone to get out on the street 
illicitly, coming through those in treatment ? 
; ,. , Dr. Jaffe. It is minimal, butifc.is'riot zero. 

Mr. Brasco. Right. : (^ :• < ,■ , 

Dr. Jaffe. I want to emphasize that anybody who is riealistic knows 
that we are not treating a group of Boy Scouts. 

Mr. Brasco. So what you are saying is it is a tolerable risk ? 

Dr. Jaffe. Let's ask what we are trading that risk in for. Tliet's'say 
5 percent of people leak their methadone. Primarily 85 to 90 percent 
of that leaked methadone is going into the people who are currently 
using heroin. l 

So, frnidamentally, the methadone will remain in competition with 
the illicit heroin market for the time being, and that really doesn't 
represent a major social catastrophe at this points' yiv^.r ■?.':( »,7 

Mr. Brasco. You said something before that was interesting to me. 
You said that when they dispense or when you dispense methadone 
you use it in — or mixed with — orange juice. r -^iii ^ 

Dr. Jaffe. Fruit juice. ''rnui m '■y<\> 

Mr. Brasco. And that it is most difficult to conctotrate,-tilaiat yoit get 
a gummy substance ? > ■•■<,j. ■■>' 

Dr. Jaffe. That is true. ■ ^ o 



229 

Mr. Brasco. Then for those who are shooting, what are they doing, 
using the mixture of the juice with that or some other form of metha- 
done which is dispensed, such as pills ? 

;Dr. Jaffe. That is a fundamental point. Not everybody is as con- 
cerned about this issue as we are, and therefore some people are using 
different forms of methadone tablets, methadone diskets, which may, 
in fact, at least in their presently constituted form, be so constructed 
that it is possible to create an injectable form from jt. We knoM' that 
when once dissolved in fruit juice of various kinds, it becomes impos- 
sible to extract methadone with ordinary techniques. 

Mr. Brasco. So then as a starter, if we got to the point where metha- 
done was only dispensed with fruit juice, as you were talking about, 
and I assume both are equally effective, then we would be taking a long 
step in the right direction in terras of having abuse of it reduced? 

Dr. Jaffe. May I make one comment? Let us avoid rigidity. It is 
always the exception that makes life difficult. We have a patient who, 
after Avorking for 2 years, wanted to visit his wife's family in 
Europe. I would trust him with my life. I know him very well and his. 
family and his wife. '^' ' ' ' 

If we gave him 21 bottles of juice — he is going for 3 weeks — No. 1, 
it would spoil ; and No. 2, what do you think customs would say about 
these 21 bottles of juice ? You tether him to a clinic. There has to be 
some form used for the exceptional case, and 21 little tablets that would 
handle the situation, make it possible for him to function as a human 
being in the exceptional situation. 

Mr. Brasco. Assuming that all of them are not going to Europe, and 
I take thatto be a fact oini nni m 

Dr. Jaffe. That is true for the overwhelmiilg majority. 

Mr. Brasco (continuing). So that we still would be taking a long 
step in the right direction wdth this little aside that you have in terms 
of possible exceptions cropping up ? ^^''t^ -f '* ' ^■■' ' ' 

Dr. Jaffe. Eight. I am not unaware this is a legislative group. So I 
am saying I want to avoid seeing thmgs couched in such language 
that an exception automatically becomes a crime, because as soon as 
you do that you really reduce the possibility of effective treatment. 

Mr. Brasco. No ; I wasn't talking about that. I was trying to define 
an area where we might recommend something. 

Dr. Jaffe. With strong recommendation for the exceptional cases 
it would be very helpful and would certainly reduce some of the 
present problems. 

Mr. Brasco. Just one last question. 

"VVTien you use methadone intravenously, do you have the same expe- 
rience in terms of it becoming a short-lasting kind of effect as with 
heroin ? 

By that I mean if you start to shoot it, would you have to use it 
several times a day ? 

Dr. Jaffe. To the best of our knowledge. It is a little longer acting, 
but you certainly would have to use it several times a day. In practice, 
people who use methadone could use it several times a day. 

Mr. Brasco. Thank you. I have nothing else. 

Chairman Pepper. Mr. Steiger. 

Mr. Steiger. Thank you, Mr. Chairman. 



230 

I realize we are running late. 

Doctor, I assume you have personally interviewed a good many of 
these l.noo patients. 

Dr. Jaffjl In the beginning I had enough time to see a lot of them 
personally. I must say as the program grows I become progressively 
more insulated from the direct patient care. 

Mr. Steiger. Do you have any experience with a methadone addict 
^ho reported into the program 

Dr. J.\FFE. Using methadone? 

Mr. Steiger. Yes. sir ; a man addicted to methadone? 

Dr. Jaffe. Yes, certainly. 

Mr. Steiger. "Were you able to ascertain how he became involved 
with methadone or how he acquired it ? 

Dr. Jaffe. Well, some of them buy it illicitly on the street. Where 
they get it is not clear, but obviously some people have, as they have 
for many years, come to doctors with stories of chronic pain, with 
things that would justify the prescription of oral methadone'. 

Furthermore, once in a while, before we had a program, there were 
physicians who, I think in all good conscience, knew somebody who 
was working and functioning and the alternatives were lieroin or 
methadone. The physician would say, "I understand you are trying 
to get into a program,'' and for a few months he would prescribe this 
medication. He would call us up and say that this man was on metha- 
done for several months, and say, "I have been prescribing for him, 
this is the dose, and the sooner you take him into the program' the 
better off we will all feel." 

Mr. Steiger. Did you run into any heroin addicts who had beeir 
acquiring a regular source of methadone from a licensed physician, 
and because of either the death of a physician or his stopping, re- 
ported into the program ? 

Dr. Jaffe. Oh, that is not uncommon. 

Mr. Steiger. I am not as concerned as my colleagues are that the 
responsible clinics are going to leak a sufficient volume of methadone 
to create a new hazard. I am very concerned that there are physicians, 
regardless of their motives, who are continuing to prescribe methadone 
and/or heroin. I wonder from your experience, again on the basis 
of interviews, if you feel there would be any merit in legislatively 
limiting the dispensing of methadone and heroin to licensed clinics 
and thereby making an absolute prohibition against the private physi- 
cian dispensing it ? 

Dr. Jaffe. Well, first of all, there isn't any hei'oin ever dispensed 
or prescribed. There is none in this country. It has been outlawed. 
There was a little bit of stock in Philadelphia for a few years after it 
was outlawed, but there is none at the present time. 

I am generally opposed to any absolute legal prescription of some- 
thing, because then you I'un into a situation where you ha^•e done 
what you set out to do, you have rehabilitated former heroin users and 
they are offered a job in some community where there is no clinic. 
He can't accept that job, and he can't in effect, change his life style 
and start all over again.. Under appropriate conditions, if there were 
no absolute medical prescriptions, he might be able to make a private 



231 

arrangement with tlie physician who would handle this problem on an 
individual basis in a carefully regulated way.^ 

Without that possibility this man is limited to any area that has 
a clinic and largely these clinics arc limited to the large urban areas 
that can sustain a clinic of a hundred or so people. 

Mr. Stetger. But isn't it conceivable that we could extent the au- 
thority to permit the clinic to approve the physician for that specific 
patient '? 

Dr. Jaffe. That becomes another issue. In other words, what you are 
saying is that no physican unaffiliated with an approved program 
would be permitted to prescribe methadone for addicts. 

Mr. Steiger. Based on your experience, in terms of volume of il- 
licit methadone, isn't there a far greater propensity for the private 
physican to be the source of the illicit methadone than there is for 
the clinic, the approved clinic ? 

Dr. Jaffe. Well, I think in terms of the ratio of patients treated and 
the amount they let leak on the street. I would say that may be true. 
Obviously, in terms of absolute numbers, a program treating 1,600 
people will be responsible for more leakage than any one physician 
treating a few patients. 

In other words, if he is only treating five or six people, 
a single physician probably will not have as much leakage as a 
j)rogram treating 2,000. 

Mr. Steiger. If those five or six people are dealers, themselves ? 

Dr. Jaffe. Well, the physician would have to be rather naive. 

Mr. Steiger. How about dishonest? How about the dishonest 
physician? 

Dr. Jaffe. Dishonest physicians should be treated like any other 
dishonest individual? 

Mr. Steiger. But right now he is not violating anything? 

Dr. Jaffe. As I said before, I think we have to think through our 
regulatory procedures so that the dishonest physician is treated for 
what he is. He is a pusher, operating under cover of his medical 
license. 

Mr. Steiger. Eight now, except for whatever State regulation may 
exist, he would not be in violation, as Mr. Wiggins pointed out, he 
could appeal to his medical judgment and say this, in my best judg- 
ment, was what this particular patient needed, even if it obviously 
wasn't ? 

Dr. Jaffe. Well, I certainly think we have to think through how we 
will control the dishonest physician, there is no (question about that. 

Mr. Steiger. Would you agree there is a question of the dishonest 
physician who could be a source of methadone ? 

Dr. Jaffe. How could one deny it ? 

Chairman Pepper. Mr. Mann. 

Mr. Mann. No questions. 

Chairman Pepper. Mr. Winn. 

Mr. Winn. Two quick questions, Mr. Chairman. 

Doctor, I missed the first part of your testimony. Are any of your 
cases ambulatory when they come to you ? 

Dr. Jaffe. All of our cases are ambulatory when they come to us. 



232 

' ']Vir. Winn. Tiien you mentioned, I gatiiered, tlios'e that are now on 
methadone? 

Dr. Jaffe. People who are in a residential setting can be on metha- 
done or withdraw from methadone in the same facility. We have no 
difficulty with that. 

Mr. WINN. I missed the point. I thought you said these were not 
people under hospital care. 

Dr. Jaffe. No ; because it is not a hospital. It is a residential setting, 
staffed, but we don't have round-thc-cloclt nurses or elaborate medical 
equipment. This is one way of reducing the cost. We don't have, in a 
residential setting of relatively healthy people, a little buzzer you press 
and have three people running with an emergency cart. 

Mr. Winn. After 3 days they can go home ? 

Dr. Jaffe. In an emergency setting ? 

Mr. Winn. Yes. 

Dr. Jaffe. No ; they might live there about 3 or 4 or 5 weeks, trying 
to straighten their lives out. 

Mr. Winn. They come fropi all over the country, outside the com- 
munity you serve ?' '"'''^ ®«^' ■^'"' ' .... 'T''^ 

Dr. Jaffe. Yes. We only have four or five residential facilities in 
the State. 

Mr. Winn. All right. Are these black or white, or both ? 

Dr. Jaffe. We have all integrated facilities. 

Mr. Winn. Thank youJ ''■ ■^' ' 

Chairman Pepper. Mr. Murphy. 

Mr. Murphy. Doctor, I just returned from an around-the-world trip 
with Congressman Steele from Connecticut, and the purpose of the 
trip was to impress upon these countries that are engaged in opium 
growing to curtail their production, and in fact eliminate it. 

One distressing point we came across in Southeast Asia is that the 
type of heroin that our troops are becoming addicted to is of a puritj^ 
of 94-97 percent. In fact, they don't even have to mainline it, they are 
snorting it and thev are smoking it. 

My question to you. Doctor, is : If this is compared to a 6 or 7 per- 
cent purity injection of the United States, what is the outlook or the 
prognosis for those fellows when they come back to the States. Would 
you just have to increase your intensity using the methadone treatment ? 

Dr. Jaffe. No; eventually you can stabilize people on moderate 
doses. The doses of methadone that are normally used for the heroin 
users that we now have, Avill be adequate to handle people who start 
off using even pure quantities of heroin. Their habits aren't that great 
and they can be brought down to a stabilization level with very little 
difficulty. 

I don't anticipate the need for modifying dosages in any way, if one 
decides that is the best way to treat a young Vietnam veteran who has 
never had any other treatment. I don't mean to imply that would be 
the routine or immediate response to finding out that a veteran has 
used heroin in Vietnam. It may be that you use this approach only 
when other things have failed. This is still to be determined. 

Mr. Murphy. Tliank you. 

Cliairman Pepper. Mr. Sandman. 



233 

Mr. SANDMAxlTf ari'AcTcIi'ct had the choice'b'efween herein aii'dmetha- 
'done — I gather there isn't any choice — he would choose heroin ? 

Dr. Jaffe. Intra venbus heroin versus oral methadone ? I think most 
addicts TTOuld do so : yelsi''^'" v,oii -. 

Mr. Saxdmax. From whfft you say, methadone is used on some one 
ah-eady addicted to heroin? ' 

Dr. Jaffe. That is how we lise it ;' yes. 

Mr. Saxdiiax. Have you had any experience where you have liad 
some people come in who are addicted only to methadone? 

Dr. Jaffe. People' wlio ha,ve neyer used any other drug ? Yes ; a few 
such cases. ia.3.^3 li^noij^y 

Mr. Sa^'dmax. But they are rare ? ^^ •'; ^-^;- \/''', , 

. Dr. JxVFFE. In this country. They are not so rare in' EnglkiYd' where 
people are beginning to prescribe, methadone tliat can be used 
mtravenously. fe^v, ^h.oc. odi .n i 

Mr. Wixx. Is it accurate for me to assume from your testimony that 
in the absence of some other way or some other drug you feel metha- 
done is serving its purpose in allowing the heroin addict to at least be 
able to ciirry but his responsibilities of life: is tlikt j'bur position? 
, I)r.„jAFFE. That .is (Sur primary position. It allows many of them 
to function, but' we are hot prefeentilig' it as a panacea. Once you get 
everybody who can be effectively treatfed with methadone, treated and 
functioning, you will still need other programs for' those people who 
have not "made it" with metha;dbne oi- whb are still not interested in 
methadone. , , rf . j • . , '"".',] 

. Mr. Wixx'tou 'm hot' Hlaimlhg'W is^^^ehd^ :^6s^t,:I understand, 
^ut'in the absence bf somethiiig better you feel it'isf- '^" :""''*" ^I'' ^'^■' 
"' Dr. Jaffe. I have made the pohit and I thiiik it 'should be available 
to all those people who woi;ld like to.give it a try and who qualify 
for it.' ' ' ''■ '' ■' ' ' "'■ ■ ■■ ■/' ■; ,,' " 

'' Chairman Pepper, Mr. Rangel. ■Pif/Oi'- 

f . Mr. Raxgel. Yes. ^ .,l,fr. ■ r. a ^ \ 

Doctor, about the 1,G0() hafcotics users, you[py "ifneT ai^e- integrated, 
or were vou talking about staff' ? , ■ ■ •; 

;., Dr. Jaffe. Staff , too. 

^ Mr. Raxgel. Well, with the users, what would you consider the 
ethnic breakdown of your State's program, in the patients? 

Dr. Jaffe. Well, I haven't looked at it for several weeks. It was, for 
the first couple of years, about 72 percent black. A small percentage are 
Puerto Ricans, Mexican Americans, and the rest white. 

Mr. Raxgel. Considering this ethnic breakdown and considering 
the population of your State, this sampling reveals an overwhelmingly 
high minority breakdown. Using minority as it is generally used, 
this is an extremely high minority figure ; is it not ? 

Dr. Jaffe, I think that might be misleading. Our program, as I said, 
be^gan as a pilot program. We were going to diagnose the community. 
We were not going to start treating the entire community or State, 
The question was: AVhere shall we put our initial facilities"? The deci- 
sion was made to locate this around the University of Chicago, where 
the University of Chicago could lend its iDrainpower to the 
development. 



60-296 — 71 — pt. 1 16 



234 

So having put it in the area, having made our facilities immediately 
available in a geographic area where 85 percent of the population is 
black, it is not surprising that we had an overrepresentation for the 
program as a whole. They had the most immediate access. They were 
given first priority because they were there. 

It wasn't until a year and a half later that we had the first treatment 
facility on the northside of Chicago where Caucasians, Puerto Kicans, 
and Mexican Americans could find it equally accessible. 

Mr. Raxgel. But if you were to project not only your State's but the 
Nation's methadone treatment programs, would not that same ethnic 
breakdown be bound to exist on a national basis ? 

Dr. Jaffe. It would be very hard for me to really project it nation- 
ally. I would guess that in most of the large urban areas of the East 
and perhaps the Midwest there would be an overrepresentation of 
black patients. However, in the Southwest it would be Mexican 
Americans. 

Mr. Ranoel. But they would be people in the lower economic level 
of American life ; wouldn't they ? 

Dr. Jaffe. I think until very recently heroin addiction was primar- 
ily a problem of the lower socioeconomic groups. 

Mr. Rangel. Now, with all of your priorities in terms of where Fed- 
eral money should be spent, I think you listed research and training. 
Do you not think that perhaps the causes and the reasons why a partic- 
ular economic group is prone to become addicted to drugs should not 
be one of the priorities ? 

Dr. Jaffe. That was assumed under research. I talked about research 
into epidemiology, into what is responsible for the epidemics, what is 
the natural history of these things, and how to respond to these to 
epidemics. 

Under the research I listed those questions and I recall saying the 
first priority should be to make treatment available to everybody who 
wants it. 

Next we are to find out about why this happens m the neighborhood 
it happens in and what the trends are. 

Mr. Rangel. I am wondering. Doctor, if a different economic group, 
that is, a more affluent economic group, were afflicted by a similar tyj^e 
disease, whether or not we would be talking about ma king methadone 
so available as a possible cure to disease or whether or not there would 
be a concentration on research rather than just expansi< n. 

Dr. Jaffe. Well, I can only tell you that everyone I h ave talked with, 
given the option of waiting for more research with the possibility that 
in the meantime their children or relatives might die of overdoses or 
go to jail, opts for "Let's take what we think is most eff< ctive and make 
it available." 

Mr. Rangel. I don't see where you have too many choices, because 
you have the problem that you have to deal with and the best thing 
American research has come up with has been methador e ; that is vour 
professional opinion ? 

Dr. Jaffe. Well, for large-scale operation ; yes. 

Mr. Rangel. But in terms of national research, are you satisfied that 
this Nation is doing all it can to research a solution to the drug prob- 
lem that we are having at the present time ? 



235 

Dr. Jaffe. Well, we have pointed out areas where more could be 
done. I think that lookintr at it from the point of view of somebody 
who has reviewed research grants and applications and looked at the 
funding, all the good brainpower that wants to get into the field, you 
know, is able to get involved. 

The issue is getting more brainpower to bear on the subject. 

Mr. Rangel. My last question is: Are you satisiied that the fact 
that the victim of this epidemic happens to be in the low economic 
strata of our society has not affected the determination of our Ameri- 
ca's research in doing as much as it can ? You don't believe it would be 
any different if we were dealing with a more affluent group ? 

Dr. Jaffe. Well, I suppose that it is already dealing with a more 
affluent group. There are a number of very wealthy suburbanites who 
are extremely concerned. But I think if you escalate it into a crash 
program, a tremendous amount of money into research per se, hoping 
that the competent researcher will materialize, you may be disap- 
pointed. You need to gear up for these things and support people. I 
think all you would do with crash programs is bring in a lot of mar- 
ginal people. 

If you nave a phased planning and say, "Yes, we are concerned and 
at this stage we will have to bring more people into it." Then, in fact, 
you have a program that will bring more people into it. 

I don't think that research in this area is being underfunded, to 
answer your question more directly, because the problem of heroin 
addiction affects primarily lower socioeconomic groups. 

Mr. Ranget.. Thank you. 

Chairman Pepper. We are running considerably behind here. 

Do you have any questions? Mr. Brasco? 

Mr. Brasco. I just wanted to ask Dr. Jaffe — and if he answered it 
before I will get the information from someone else. 

We were sort of interrupted when we were talking about the possi- 
bility of developing a longer lasting drug, other than methadone, and 
you said you didn't want to promise anything, and at that point you 
went to something else. 

Did you get to that, because I was a few minutes late and I am 
wondering what the prognosis is for developing it. 

Dr. Jaffe. I think the prognosis is excellent. I think it is only a 
matter of time before we will be able to discuss which specific drugs 
might be able to be used, and which would have significant advantage. 

Mr. Brasco. Are you saying we have them now ? 

Dr. Jaffe. Yes; we are working on them. We named one that is 
under study, that has been under study for a year. There are still some 
questions to be resolved that ; yes, this is a drug that can be used on a 
Avide scale. 

Mr. Brasco. And longer lasting? 

Dr. Jaffe. Longer lasting than methadone. 

Mr. BPtASCo. "Wliat is the dosage ? 

Dr. Jaffe. Three times a week instead of seven times a week. 

Chairman Pepper. Dr. Jaffe, you see from the questioning by this 
committee how enormously interested we are in your vast knowledge in 
this field.; We are very grateful for you coming today and giving us 
your testimony. I am sure our committee would like to have the 



236 

privilege of continuing to keep in contact with you when we come 
to the formulation of our recommendations as to what more the Fed- 
eral Government can do to combat heroin addiction. 
(The curriculum vitae of Dr. JafFe follows:) 

[Exhibit No. 12] 

CuRRicruLUiii; Vitae of De. Jerome Herbert Jaffe, Dieector, Illinois Drug 

Abuse Program i 

Formal education : Temple University; A.B., psychology, 1954 ; M.A., experi- 
mental psychology, 1956 ; Temple University School of Medicine ; M.D., 1958. 

Awards and honors : Temple University, College of Liberal Arts ; magna cum 
laiide ; distinction in psychology ; alumni prize : highest academic average ; Psi 
Chi Award (scholarship and achievement in psychology); Psi Chi, Honorary 
Society. 

Temple University School of Medicine : Summer Research Fellowship in Phar- 
macology, 19i57; Babcock Honorary Surgical Society: Alpha Omega Alpha: 
Merck Award : outstanding achievement in medicine during senior year ; Mosby 
Scholarship Award : highest 4-year average in medicine. 

Fellowships: USPHS Post Doctoral Fellowship in Pharmacology, 1961-1964. 
USPHS Research Career Development Award, 1964 to 1966, 1967-70. ' ' 

^lajor interests : Psychopharmacology — use and abuse of psychoactive drugs — 
biological and sociological aspects. 

Experience and training : Rotating internship — ^U.S. Public Health Service 
Hospital, Staten Island, N.Y., 1958-59. Residency in psychiatry— U.S. Public 
Health Service Hospital, Lexington, Ky., 1959-60. Psychiatric staff— U.S. Pub- 
lie Health Service Hospital, Lexington, Ky., 1960-61. Post doctoral fellow, inter- 
disciplinary program — Albert Einstein College of Medicine, 1961-62. Post doc- 
toral fellow and resident in psychiatry: Albert Einstein College of Medicine 
and Bronx Municipal Hospital Center, 1962-64. Assistant professor, Departpient 
of Pharmacology and Instructor, Department of Psychiatry, Albert Einstein 
College of Medicine, 1964-66. Assistant professor. Department of Psychiatry, 
University of Chicago, 1966-69. 

.: Present positions : associate professor, Department of Psychiatry, University 
of Chicago, 1969 to present. Director, drug abuse program, Department of 
Mental Health, State of Illinois, 1967 to present. 

, Memberships in organizations: Alpha Omega Alpha, Sigma XI, American 
Medical Association. American Psychiatric Association, American Society of 
Pharmacology and Experimental Therapeutics, American College of Neuro- 
Psychopharmacology, New York Academy of Science, American Association for 
the Advancement of Science, Illinois Medical Society, Chicago Medical Associa- 
tion, Illinois Psychiatric Society, and World Psychiatric Association. 

CONSULTANTSHIPS. ADVISORY PANELS AND EDITORSHIPS 

Member, Editorial Board, International Journal of the Addictions, 196&-. 

Member. Review Committee, Center for Studies of Narcotics and Dangerous 
Drugs, NIMH, 1966-. 

Visiting Assistant Professor of Pharmacology and Psychiatry, Albert Einstein 
College of Medicine, 1966-. 

Visiting Lecturer, University of Texas, Medical Branch, 1966-, 

Consultant, Illinois Narcotic Advisory Council, 1966-68. 

Consultant, New York State Narcotic Addiction Control Commission. 1967-. 

Member, Committee on Narcotics and Dangerous Drugs, Illinois State Medical 
Society, 1968-. 

Member, Technical Advisory Board, National Coordinating Council on Drug 
Abuse Education and Information, 1969-. 

Secretary, Section on Drug Dependence, World Psychiatric Association, 1969-. 

Member, Advisory Board, Psychopharmacologia. 

Member, Committee of the Division of Clinical Pharmacology, American Soci- 
ety for Pharmacology and Experimental Therapeutics, 1970-. 

Member, Advisory Committee. Drug Abuse Training Center, California State 
College, Hayward, California, 1970. 

Consultant, Bureau of Drugs Advisory Panel Systems, Department of Health, 
Education and Welfare, 1970-. 



237 

Special Consultant (Technical Adviser), Expert Committee on Drug Depend- 
ence. World Health Organization, Geneva, Switzerland, 1970- 

Member, American Psychiatric Association Task Force on Alcoholism, 1970-. 

Consultant, Joint Information Service, American Psychiatric Association and 
the National Association for Mental Health (Project on Current Methods for the 
Treatment of Addiction), 1970-. 

In addition to these on going advisory and consulting activities, Dr. Jaffe 
has been, over the past three years, an invited participant in more than fifty 
national and international conferences and symposia. He has also served as 
special consultant to a number of State and Local Governments interested in 
developing drug abuse treatment or educational programs and has been the 
keynote speaker at three Governor's Conferences. Dr. Jaffe has also served as a 
consultant to a number of temporary State and Federal advisory panels, as well 
as school systems, not-for-profit corporations, and private industry. 

PUBLICATIONS OF JEROME HERBERT JAFFE, M.D. 

The electrical activity of neuronally isolated cortex during barbiturate with- 
drawal. The Pharmacologist, 5:250, 1963 (Abs.) (with S. K. Sharpless). 

The rapid development of physical dependence on barbiturates and its relation 
to denervation supersensitivity. The Pharmacologist 5:249, 1963 (Abs.) (with 
-S. K. Shariiless). ;•.•'•' 

Drug^ addiction and drug' 'abuse. In, "The Pharmacological Basis of Thera- 
peutics," 3rd edition, Goodman, L. and Gilman, A. (eds.), The MacMillan Co., 
-New York, 1965. 

' Narcotic analgestics. In "The Pharmacological Basis of Therapeutics," 3rd 
edition, Goodman, L. and Gilman, A. (eds.). The MacMillan Co., New York, 1965. 

The rapid development of physical dependence on barbiturates, (with S. K. 
Sharpless) /. Pharmacol, and Exper. Ther., 150 :140-145, 1965. 

Changes in CNS sensitivity to cholinergic (muscarinic) agonists following 
withdrawal of chronically administered scopolamine. The Pharmacologist 8 :199, 
1966 (Abs.) (with M. J. Friedman). 

The electrical excitability of isolated cortex during barbiturate withdrawal, 
(with S. K. Sharpless) J. Pharmacol, and Uxper. Ther. 151 :321-329, 1966. 

Research on newer methods of treatment of drug dependent individuals in 
the U.S.A. Proceedings of the Fifth International Congress of the Collegium 
International Neuropsychopharmacologicum, Washington, D.C., Excerpta Medica 
Intern ational Congress Series, 129 :271-276, 1966. 

Cyclazocine, a long acting narcotic antagonist : its voluntary acceptance as a 
treatment modality by ambulatory narcotics users. Xwith L. Brill) Internat. J. 
Addictions, 1 :99-123, 1966. o-'-'^i' 

The use of ion-exchange resin impregnated paper in the detection of opiate 
alkaloids, amphetamines, phenothiazines and barbiturates is urine, (with Dahlia 
Kirkpatrick) Psychopharm. Bull., S :, No. 4, 49-52, 1966. ■ 

The relevancy of some newer American treatment approaches for England, 
Brit. J. Addict., 62 :375-386, 1967 (with L. Brill). . . 

Cyclazocine in the treatment of narcotics addiction. In. "Current Psychiatric 
Therapies," Masserman, J. (ed.), Grune and Stratton, New York, 1967. 

Pharmalogical denervation supersensitivity in the CNS : A theory of physical 
dependence, (with S. K. Sharpless) In, "The Addictive States", Wikler, A. (ed.), 
The V\'illiams and Wilkins Co., Baltimore, 1968. 

Narcotics in the treatment of pain, Med. OUn. North Am,., 52 :33-45, 1968. 

Drug addiction : New approaches to an old problem. Postgrad. Med., 45 :73-81, 
1968 (with J. Skom and J. Hastings). 

Opiate dependence and the use of narcotics for the relief of pain. In, "Modern 
Treatment", Wang, R. (ed.), 5 :1121-1135, 1968. ^ 

Psychopharmacology and opiate dependence. In, " Psych opharmacology : A re- 
view of Progress, 1957-1967," Efron, D. H., Cole, J. O., Levine, J., Wittenborn, 
J. R. (eds.). Proceedings of the Sixth Annual Meeting of the American College 
of Neurophyschopharmacology, San Juan, Puerto Rico, December, 1967. 

Cannabis (marihuana). In "Encyclopedia Americana," Grolier, N.Y., 1969. 

Drug addiction and drug abuse. In, "Encyclopedia Americana," Grolier, N.Y.. 
1969. 

A review of the approaches to the problem of compulsive narcotics use. In, 
"Drugs and Youth", Wittenborn, J. R. ; Brill, H. ; Smith, J. P. ; and Wittenborn, S, 
(eds.), Charles C. Thomas, Springfield, 1969. 



238 

A central hypothermic response to pilocarpine in the mouse. J. Pharmacol, exp. 
T/ier., 167:34-44, 1969 (with M.J. Friedman (1)). 

Central nervous system supersensitivity to pilocarpine after withdrawal of 
chronically administered scopolamine. J. Pharmacol, exp. ther., 167:45-55, 1969 
(with M. J. Friedman (1) and S. K. Sharpless). . 

Pharmacological approaches to the treatment of compulsive opiate use : iheir 
rationale and current status. In, "Drugs and the Brain," Black, P. (ed), Balti- 
more, 1969. ^ ,.^ ^ ^u 

Experience with the use of methadone in a multi-modality program for the 
treatment of narcotics users. Internat. J. Addictions, 4 (3), 481-i90, 1969 (with 
M. Zaks and E. Washington). 

Problems in Drug Abuse Education : Two Hypotheses. In, "Communication and 
Drug Abuse: (with D. Deitch)." Proceedings of the Second Rutgers Symposium 
on Drug Abuse, Rutgers University, New Brunswick, New Jersey, 1969. 

Tetrahydrocannabinol: neurochemical and behavioral effects in the mouse. 
Science, 163, 1464-1467, New York, 1969. (with Holtzman, D. (1) Lovell, R. A., 
and Freedman, D. X.). 

The treatment of drug abusers. In, "Principles of Psychipharmacology", Clark, 
W., and del Guidice, J. (eds. ) , Academic Press, New York, 1970. 

Whatever Turns You Off. Psychology Today, 3, (12), 42^4, 1970. 

A comparison of dl-alpha-acetylmethadol and methadone in the treatment of 
chronic heroin users: a pilot study. JAMA, 211 (11), 1834-1836, 1970 (with C. R. 
Schuster, B. Smith, and P. Blachly). 

The implementation and evaluation of new treatments for compulsive drug 
users. In, "Advances in Mental Science II — Drug Dependence" Harris, R. T. ; 
Mclsaac. W. M. ; and Schuster, Jr., C. R. (eds.). University of Texas Press, 
Austin, 1970. 

Narcotic Analgesics. In, "The Pharmacological Basis of Therapeutics", 4th 
Edition, Chapter 15, Goodman, L. and Gilman, A. (eds.). The MacMillan Com- 
pany, New York, 1970. 

Drug Addiction and Drug Abuse. In, "The Pharmacological Basis of Thera- 
peutics", 4th Edition, Chapter 16, Goodman, L., and Gilman, A. (eds.). The Mac- 
Millan Company, New York, 1970. 

Further experience with the use of methadone. International Journal of the 
Addictions, September 1970. 

Development of a successful treatment program for narcotics addicts in Illinois. 
Chapter 3, In, "Proceedings of the Second Western Institute on Problems of Drug 
Dependence", Blachly, P. (ed.). 

Drug maintenance and antagonists : limits and possibilities. Proceedings of the 
November 24, 1969 Conference of the New York State Narcotic Addiction Control 
Commission. 

An identification of techniques for the large scale detection of Narcotics, bar- 
biturates, and central nervous system stimulants in a urine monitoring program. 
In Abstracts of the Academy of Pharmaceutical Sciences, (117) with K. K. 
Kaistha. 

An overview of the conference. Proceedings of a Conference on Methodology on 
the Prediction of Drug Abuse Potential, Washington, D.C., September 8-10, 1969. 
U.S. Government Printing OflBce. 

In press 

The heroin copping area : a location for epidemiological study and interven- 
tion activity. Archives of General Psychiatry , (with Pat Hughes). 

Developing in-patient services for community based treatment of narcotic 
addiction. Archives of General Psychiatry, (with Hughes, P., Chappel, J., 
Senay, E.). 

Methadone and 1-Methadyl Acetate in the management of narcotics addicts. 
JAMA, (with E. C. Senay). 

Effects of variation of methadone dose on the outcome of treatment of heroin 
tisers, Proceedings of the Annual Scientific meeting of the Committee on the 
Problems of Drug Dependence. February 16. 1071. (with S. DiMonza). 

Experience with eyolnzocine in a nuilti-modality treatment prosram for nnr- 
cotics addicts. International Journal of the Addictions, (with J. N. CbappeU 
E. C. Senay). 



239 

Submitted or accepted for publication 

Role of hospitalization in tlie treatment of drug addiction, (with J. N. 
Chappel). 

A double-blind controlled study of cyclazocine in the treatment of heroin 
users, (with J. N. Chappel). 

Extraction and identification techniques for drugs of abuse in a urine screen- 
ing program. Presented to the Annual Scientific Meeting of the Committee on 
Problems of Drug Dependence, Toronto, February 16, 1971, (with K. K. Kaistha). 

In preparation 

Successful withdrawal from methadone : a 1-year follow-up. 

Minimal methadone support for narcotics addicts awaiting entry into a com- 
prehensive addiction rehabilitation program. 

(A brief recess was taken. ) 

Chainnan Pepper. The committee will come to order, please. 

Our next witness is Dr. Harvey Gollance, assistant director, Beth 
Israel Medical Center in New York City, with specific responsibility 
for the center's narcotic programs. 

Before assuming his present position, Dr. Gollance was deputy 
commissioner for operations of the New York City Department of 
Hospitals, in which post he was in charge of operations at 19 munici- 
pal hospitals. 

He has also served as supervising medical superintendent of Kings 
County Hospital Center. 

Dr. Gollance is a fellow of the American College of Hospital Admin- 
istrators and the American Public Health Association. 

Dr. Gollance has had extensive experience in narcotics treatment 
programs, and is a member of the narcotics register advisory commit- 
tee of the New York City Department of Health and the methadone 
evaluation committee of the Columbia University School of Public 
Health and Administrative Medicine. 

Dr. Gollance, we are grateful for your appearance here today. 

Mr. Perito, will you inquire ? 

Mr. Perito. Dr. Gollance, I understand you have a statement which 
you are going to offer for the record and briefly summarize. 

STATEMENT OF DR. HARVEY GOLLANCE, ASSOCIATE DIRECTOR, 
BETH ISRAEL MEDICAL CENTER, NEW YORK, N.Y. 

Dr. Gollance. I would like to make a brief statement. 

I know you have heard a lot about methadone. We run the largest 
methadone program in the world. We are pioneers in this. The Beth 
Israel Medical Center is the largest voluntary hospital for the treat- 
ment of narcotics addiction in the world. We have 350 beds for nar- 
cotic addiction treatment. We admit over 9,000 patients to our detoxi- 
fication service, and over 3.200 patients are under active treatment in 
our methadone maintenance program. 

We sponsor this program in 12 other hospitals in New York City, 
some of the most outstanding hospitals in the world. 

I would like to start with a brief statement of how the methadone 
treatment program came into being, because I think this is important. 

We have had very serious heroin addiction in New York City for 
over 20 years. It struck in the low-income areas of the city, Harlem, 



240 

South Bronx, Bedford-Stuyvesant, and it was different from any 
addiction problem we had had before. Formerly addiction was some- 
thing among doctors, nurses, people of some means. 

In the early 1950's a demand arose that the city do something about 
it because they had practically no facilities for the treatment of drug 
addiction. 

In response to this demand, the city did several things. It opened 
a hospital for drug users called Riverside Hospital and in its early 
years an earnest attempt was made with psychologists, psychiatrists, 
social workers, et cetera. The board of education opened a school and 
supplied an interested faculty. irOM*^ 

Riverside Hospital was opened in 1953. : 

In 1958, the health commissioner of the State of New York wanted 
to see what the State was getting for its money, and he had the Colum- 
bia University School of Public Health do a survey of the patients 
who had been in Riverside Hospital, and they took a certain time 
period and then tracked down the cases treated in that period, 1955, 

What this study found was an unusually high death ra-te ; but of 
those who survived, none were off heroin. It was obvious Riverside 
Hospital was a failure as far as getting anybody free of heroin. It 
did give some social first {lid, a chance to reduce dope and stay away 
from the police. It is obvious there was no single treatment allowed for 
hard-core heroin addiction, , , r 'l, 'iroll-yt Si ^r /^•ji-pilU •- > .iii 

In 1963, the health research council of New York City got Dr, 
Vincent Dole, later joined by Dr, Nyswander, to do research in the 
treatment of drug addiction; Dr. Dole went on the assumption that 
whatever the psychological or sociological reasons that a person be- 
came addicted, once he was thoroughly addicted there was a physio- 
logical change and unless he did something about this he would not b^ 
able to rehabilitate the patient, the hard-core heroin addict, . .( ; 

Dr. Dole's goal was rehabilitation. By that he meant the addict 
could function in our society as well as he was capable. 

Dr. Dole tried several things. He tried to see if he could stabilize 
a patient on morphine, some other narcotics. It didn't work. Then 
he used methadone in a new way. It is a synthetic narcotic that was 
used in World War II by the Germans, when their supply of opium 
was cut off. 

After the war methadone was used mostly for the detoxification 
of patients — to get them drug free in a humane way instead of suffer- 
ing throuerh "cold turkey." In a week you can get any heroin addict off 
heroin. The point is the addict won't stay off heroin. Dr. Dole wanted 
to see what would happen if instead of reducing the dose of methadone 
as in detoxification, he gradually increased the dose. He foimd two 
things : Wlien a certain level was reached the addict lost his drug hun- 
ger. He no longer had any craving for heroin, and if you went to a 
still higher dose it blocked the effect of heroin. 

Dr. Dole got pure heroin and .eventually injected Inr.o-e quantities 
of heroin into patients on blocking doses of methadone. Xothiiig hap- 
pened. This is called the blocking effect. 

When we speak of the methadone maintenance treatment program 
we mean the Dole-Nyswander technique of givmg blocking doses of 
methadone — not just giving methadone in any haphazard sort of way. 



MS 

■ Methadone has properties that make it very useful for this woik. It 
is fully effective by mouth, it is long acting; once you get a patient 
stabilized, a single dose by mouth will last him 24-36 hours. It is a 
safe drug. .a^j'-r ;->,>■. . 

We haven't had any serious harmf ill' effects either medically, sur- 
gically, or obstetrically in 7 years. The body develops great tolerance 
for methadone in a relatively short tima It no longer acts as a nar- 
cotic. By that I mean it does not make the patient high and it doesn't 
make him sleepy. It is, however, addictive. If taken away from the 
patient he would have withdrawal symptoms. '• ' ■ 

Dr. Dole did this work with six cases at Rockefeller Institute and 
then came to Dr. Ray Trussell, who was then commissioner of hospitals 
in New York City, and asked for facilities to expand his work. 

Through Dr. Trussell 's efforts, Dr. Dole got the beds in what is now 
the Beth Israel Medical Unit for Drug Addiction. We inaugurated 
this program in 1965. 

When Dr. Trussell set this program up, he insisted that a separate 
contract be given to the Columbia University School of Public Health 
to do an independent evaluation of what happened to every patient in 
the methadone program. This is important. We now have records of 
every single patient who has ever come into our program, and these 
results have been independently evaluated by the Columbia University 
School of Public Health. .i^i"bji bsmiiiuor) a >.i nn-nU] 

If we are going to get ahywh'er^'in treafm'g driig addiction we must 
know what works and what doesn't work. T think this independent 
evaluation is an important part of this program. ,»it/.)!^' 

- Originally the patient was taken into the hospital for 6 weeks. After 
he was stabilized, he was sent to a clinic with a number of supporting 
services : counselors, research assistants, social workers. The goal is re- 
habilitation, not just to satisfy the drug hunger. .ip/iwrr:, 
J Many of our patients started- very young. You now have help for 
them with all their problems, help them with welfare, with the courts, 
with their wives, get a job, all of these things. -You must help to get 
the patient intothe square society f' if^^"' '^fut.'/ '.v^jiyrf o1 ojJIi [t 

We do this. We believe that a methadone hlaiTitenarice program 
should be done in a structured program. You must know whtit hap- 
pens to your patient, and you work intimately with him. ■ 
_ As a matter of fact, we don't let an individual clinic exceed 150 pa- 
tients. We want the staff to know the patient well and what is happen- 
ing to him. At the present time we have almost 40 clinics scattered 
throughout the New York City area. ; . ".i 

When we reach a census of 150, we open a new' clinic. Wedobkat 
the addict as an individual with a chronic illness. He is a m.edical pa- 
tient. We base our program on a hospital. IMost all our clinics are out in 
the community. They are considered an extension of the hospital. We 
think this philosophy of medical en re is important. 

Addicts have other problems besides their addiction. They have 
medical problems. The medical profession has shunned treatment of 
drug addiction for a number of generations now. In the past it was 
too dangerous for a doctor to deal with drug addicts. He risked prose- 
cution and possible jail. 

We now have a medically based program with a hospital to take 



242 

€are of patient addicts. We have seen some very interesting byprod- 
ucts of this other than the direct treatment of addiction. We find out 
that when we set up a clinic associated with a hospital, the medical 
staffs become interested in treatment of drug addiction. If we are go- 
ing to get anywhere in this field we need to bring the best brains we 
have into solving this difficult problem. Methadone maintenance has 
set up a climate favorable for this. 

Methadone is not the final answer. It happens to be the best answer 
we have at this time for treatment of the hard-core heroin addict. 

Dr. Dole's original criteria were that the patients had to be 21 years 
of age and under 40, because there is a theory around that drug addic- 
tion burns itself out as the patient gets older. 

They had to have a history of mainlining heroin. They were hard- 
core addicts. They all had criminal records and had tried other pro- 
grams without success, to further confirm their serious addiction. 

The original program, because it was new, excluded certain condi- 
tions: alcoholism, pregnancy, mixed drug use. However, as we have 
gained much experience we have broadened the criteria for admission. 
We admit now a patient over the age of 18, there is no longer an upper 
age limit. We have one man 87, one 82, and a number collecting social 
security. 

We now require 2 years of heroin addiction. We are very careful to 
see that the applicant is a confirmed addict. 

This is a voluntary program. In our experience it takes about 2 
years before a heroin addict is first willing to do something about his 
addiction. At the beginning the drug addict rather enjoys the high 
he gets. He is a very busy individual supporting his habit by stealing. 
He rather enjoys that culture at the beginning. We feel it takes 2 years 
before he is willing to do something constructive by entering this 
program. 

For this group of cases, this program has proved very successful. I 
believe you heard Dr. Gearing. She does our evaluation. She is a very 
competent individual. 

I would like to review what our experience has been. Basically we 
liave an 80-percent retention rate in the program. We have a 20-per- 
cent dropout rate. Very few of the patients drop out of their own voli- 
tion. They are usually dropped out by us for administrative reasons. 
These turn out to be severe alcoholics, a few get arrested early in the 
program or use other drugs. 

The work records are very interesting. I don't have the most recent 
figures. I don't know what ejffect the present recession will have. Up to 
about a year or two ago our patients were about 25 percent legit- 
imately employed when they started. At the end of 6 months, about 50 
percent are working and after 2 years 80 percent. For those in the 
jDrogram 3 years or longer, 92 percent were either working, keeping 
house, or going to school, and only 6 percent were left on welfare. 

Tlie arrest records in our program have been phenomenal. Dr. Gear- 
ing did a study of arrest patterns. She took a group before they came 
into the methadone program and studied their arrest records. It showed 
115 arrests per 100 patients in the course of a year, 48 convictions per 
100 patients in the course of a year. She then followed the course of 
these patients for 4 years after they started on methadone. 



2fi3 

The 115 arrests per 100 per year dropped to 4.5. The 48 convictions 
dropped to 1 per 100 per year. The arrests practically disappear and 
the longer in the program, the fewer the arrests. 

Here was a program that took hard-core heroin addicts whose treat- 
ment had been very unsuccessful before. I, myself, when I was deputy 
commissioner of hospitals, tried setting up programs, pleading with 
doctors to set up programs. I was not successful. The few programs in 
existence were very unsuccessful and most physicians I knew were 
very discouraged. 

Now, we take a large number of severe heroin addicts and you have 
them working, you keep them out of jail, you put tlieir families to- 
gether. 

That doesn't mean we have all angels in our programs. "We have 
some who have problems. Some will do things they shouldn't, but on 
the whole this has been a very successful program. 
With that introduction, I would like to answer some questions. 
Chairman Pepper. That is a very good summary. 
Dr. GoLLANCE. Could I answer the previous question about dispens- 
ing it ? 

I would be against dispensing it just in pills. We have changed over 
to what we call a disket. It is a large tablet that leaves a sludge, and 
the patients can't inject it. We use diskets to prevent careless handling 
so that children can't get them. 

For this reason we have a tendency to use diskets dispensed in vials 

with locking caps where they can be kept in the medicine chest away 

from children. 

Mr. Brasco. That is the question I asked. Doctor. 

Do you agree with Dr. Jaffe, then, of the impracticality in New 

York of having a patient come once a day for his dosage rather 

than 

Dr. GoLLANCE. Yes; when you are on a very large scale program. 
Mr. Brasco. So you agree ? 

Dr. Gollance. Yes ; and for the reason Dr. Jaffe said, we are trying^ 
to rehabilitate patients. 

Mr. Brasco. The disket is something that cannot be injected; is 
that correct ? 

Dr. Gollance. That is correct. 

Mr. Brasco. I was concerned about working with substances that 
would be practical for carrying and used just as long as they could 
not be used intravenously. 
Dr. Gollance. That is right. 

Mr. Brasco. But that disket is not something capable of being used 
intravenously ? 

Dr. Gollance. That is correct. I would like to answer Congressman 
R angel on the ethnic distribution of patients in New York. We have 
a narcotic registry run by the health department and the ethnic dis- 
tribution of their list is 50 percent black, 25 percent white, 25 percent 
Puerto Rican. 

The patients in our programs approximate that ethnic distribution. 
I would also like to say that this is no longer a situation of the low- 
income group. Last week the daughter of a prominent professor and 
the son-in-law of a prominent head of surgery in one of the leading 



244 

hospitals in the city, came into our program. In answer to your ques- 
tion, two marines I know personally came back addicted. The reason 
the marines snort heroin and don't inject it is so they won't leave 
trackmarks. But when they come back here they will start injecting 
heroin. This one Marine had gotten $6,000 from an automobile acci- 
dent and wanted to return to the Orient for drugs. I got him into the 
methadone program and he is doing very well, u; ruoiu i 

Chairman Pepper. Mr. Perito, please proceed. 

Mr. Perito. Thank you, Mr. Chairman. 

First, Doctor, do you believe that private physicians should be per- 
mitted to maintain addicts on a maintenance program ? 

Dr. GoLLAxcE. At this time I would say no. Our feeling is that this 
should be done in a structured program. We have given a lot of 
thought to how to use private practitioners. For example, if we had a 
well-stabilized patient he might be referred to a private practitioner. 
If this were done, it would furnish a means of having the patient 
checked, because there is possibility of abuse. 

There is the program in New York City that disburses 

Mr. Pertto. You mean dispensing of methadone by a private physi- 
cian ; is that what you are talking about ? 

Dr. Gollance. That is right. 

Mr. Perito. What steps can be taken in order to avoid problems 
of this nature ? , "' ' ^'''^ ^'^^^-'^ ^^''^ ■' '^ ' f^'^ ^ '•! i J o^ 

Dr. Gollance. Well, the thing is if you can set up enough programs 
so the patient can come in and get it from established programs very 
cheaply and receive good care. We g&t many patients from this private 
doctor when we can reach him on our list. '^-^ ''^- ' "''' ^ ■o.iPj.i,:>. i .^i/: 

Unfortunately, we have quite a long waiting list. The last time T was 
before this committee, we were asked how can we expand the program. 
I might say, since that time last year, we have taken as many patients 
in 1 year as were taken in all of the previous 5 years. We have the 
mechanism for expanding this widely if' we get the necessary funds 

Mr. Perito. Do you believe addiction is a metabolic situation ? 

Dr. Gollance. I think you have to make that assumption. At least 
it has worked here. The psychological and sociological apiproaches 
have not worked for this type of patient. We have tried all these 
things without methadone and they haven't worked. Under methadone 
you can use a number of successful aLppjcoac.hes, but without it we have 
been very unsuccessful. 'c. ..,. ^.i. _ii; 

Mr. Perito. What steps have you taken in your program to control 
diversion? 

Dr. Gollance. First of all, we limit the size of the clinic so we 
know the patient. We constantly watch the patient, besides the urine 
checks, to know that he is not using Other drugs, and if we have any 
suspicion at all we will put him on a daily regime. 

One of the interesting tilings is the patient develops a loyalty to tlie 
program. I know addicts are not supposed to squeal, biit tliey will 
come to us and toll us. look out for this f'^How. and avo will. Thoy will 
give us information about our patients. We have a patient-phvsician 
relationship. We don't take a punitive approach. We don't look at the 
addict as a dope fiend or outcast. We encourage him to tell us when 
he is abusinc:. In the first few weeks he will. 



245 

If he is using other drugs we will ask him to tell us so we can work 
with him. 

Mr. Perito. Finally, Doctor, to the best of your knowledge, is there 
a black market for and in methadone in New York City? 

Dr. GoLLANCE. I am sorry to say there is. We have asked the police 
repeatedly, ever since we have had the program, do they thuik our 
program is a problem for them. 

Tliey have told us our program is not. But we do know it is getting 
on the*^ streets from some very unstructured, unsupervised programs. 

I appeared before a group of probation officers and a police officer, 
and he said, "I know it gets on the street." I said, "I would like to see 
it. I don't think it is any of ours." He pulled out a vial and there was 
a label of this unsupervised program in New York City. 

Chairman Pepper. Mr. Blommer. 

Mr. Blommer. I have no questions, Mr. Chairman. 

Chairman Pepper. Mr, Waldie. 

Mr. Waldie. No questions. 

Chairman Pepper. Mr. Wiggins. 

Mr. Wiggins. Would you describe the workings of the central regis- 
try for us ? 

' ! Dr. GoLLANCE. The health department gets all the information. 
Physicians are supposed to report to them and it is strictly confiden- 
tial. I would say most of their records are gotten through arrest 
records. When arrested, that is reported to the central registry. Also, 
physicians and others with knowledge are required to report this to 
the health department. 

Incidentally, Dr. Dole has been working on detoxifying prisoners 
in the New York City prison and at nights I have personally observed 
that at least two-thirds of the prisoners are addicts under the influence 
of heroin. 

Mr. Wiggins. Can you describe the methadone registry for the 
record? 

Dr. GoLLANCE. That is a special methadone registry under the di- 
rection of Eockefeller University. This registry for the methadone 
patients is available to Dr. Gearing and Dr. Dole at Rockefeller. Any 
patient we treat, or any hospital connected with us must report every 
patient into this central computer. We finance and train hospitals. 

One thing that we will not yield on in any way is that they must 
report in their results in exactly the same manner as we do. There is 
standardized reporting in our program. 

However, there are programs that do not report to this central 
registry. 

Mr. Wiggins. That is all. 

Chairman Pepper. Mr. Brasco. 

Mr. Brasco. Yes. Could you tell us, Doctor, how long is the waiting 
list for the program ? -.iuAj-"ji\r nfi : .■ 

Dr. GoLLANCE. It varies. It used to be very long. It has gotten much 
shorter. We have set up a number of programs, including what we call 
rapid induction. We are working now on what we call a holding pro- 
gram. That will cut down waiting time. It varies from weeks "to 
months, depending on the area in which the patient lives. 
;;Mr. Brasco. That is another thing. I know it is localized. Coming 
Irom- New. York, I had an opportunity to try to place a young man 



246 

that came into my office, and I was sort of distressed to find out that 
the program he was talking about had longer than a 5-month waiting 
period and over and above and beyond that there was this geographic 
thino- where they said we don't service that particular area. 

Apparently what had happened is one program that had some open- 
ings said we don't service that area and the other program said we 
don't service that program. 

I thought it was all your program. ^ 

Dr. GoLLAXCE. No ; there are a number of programs m New York 
City. We are in four boroughs. We have others besides ours. The city 
has opened up several, the Bronx has a separate program. 

In our own network we have 14 hospitals, 30 clinics, and 3,200 pa- 
tients. If we get the funds, we will go to 6,000 patients. We have the 
means now to expand. We have trained staff to act as a nucleus for 
expansion. It is not only a matter of money. It is to get space, to train 
stall's, to get people willing to do this work. I think we are over most 
of that hurdle. 

Mr. Brasco. You say you have the means. You say you have 3,200 
patients. What does that mean ? How many patients can you convert 
if you have the money and you have the staff ? 

Dr. GoLLANCE. They have been making funds available now and 
more and more are getting into 

Mr. Brasco. How many additional patients would that be ? 

Dr. GoLLANCE. If we get what we ask for from the State — for ex- 
ample, we are financed entirely by the New York State Narcotics Ad- 
diction Control Commission — if they give us the funds we will jump 
from 3,200 to 6,000 this year. That is just our program. 

Mr. Brasco. One last question. 

The diversion of methadone, when it is diverted in the streets, it is 
used, I take it, as a substitute for heroin, mainly because it is cheaper ; 
is that the reason ? 

Dr. GoLLANCE. From what I gather from all the addicts I have 
spoken to, they do not take methadone as a drug of choice. After he has 
become addicted, after a while, the addict is not looking for the highs. 
He is looking to be comfortable. He doesn't want to be sick. Methadone 
will prevent him from getting sick. 

Mr. Brasco. So that what you are saying^ then, is that the addict 
that is using this in the street, when methadone is diverted, is using it 
in the same way that he would use it in your program, other than the 
fact that it is 

Dr. GoLL.\NCE. He is trying to do it that way by and large. There 
are a number of psychotic individuals around. For example, our ex- 
perience has been that anybody who takes heroin after 8 weeks in our 
program, usually turns out to have a serious psychiatric problem. He 
doesn't get any high from it. He is a needle addict. 

Mr. Brasco. I have no further questions. 

Chairman Pepper. Mr. Steiger. 

Mr. Steiger. No questions. 

Chairman Pepper. Mr. Mann. 

Mr. Mann. Qualified personnel is a problem in the expanding medi- 
cal field. How about your problems ? 

Dr. Gollance. Well, there has been a great improvement in our 
program. For example, we are getting young doctors now who are 



247 

interested, and I have applications from doctors to join the program. 
I don't have spots for them right now. The nurses enjoy doing this 
work. We are one of the few programs that doesn't have difficulty 
recruiting nurses. 

The counselors are flooded with requests from bright young people 
now because of the job situation and we can get a good calibre of 
counseling. We are not having problems getting personnel that we 
had, maybe, 2 years ago, 3 years ago. 

Our problem now is boiling down to money. 

Mr. Maxn. To what extent do you use ex-addicts in your program ? 

Dr. GoLLANCE. We use ex-addicts. We call them research assistants. 
They are a very valuable part of the program. We have a very limited 
number. In our requirement we will not take an addict right from 
our program and hire him as a research assistant. He must get a job 
and show he can hold a job on the outside. When he does, we can hire 
him. They are very useful, they are useful as a model to the new patient 
in explaining the program to the new patient, useful in explaining the 
addict to the "square" staff that we hire. So they are very, very useful. 

Mr. Mann. Thank you. 

No further questions, Mr. Chairman. 

Chairman Pepper. Mr. Winn. 

Mr. Winn. Along that same line, what difficulties have you en- 
countered in obtaining physical facilities for treatment of the addicts ? 

Dr. GoLLANCE. We have had many problems in that area, and we 
use any physical facilities we can get. We use stores, brick them up. 
We don't call them storefronts because our addicts have had bad ex- 
periences with storefronts. We use health buildings, office buildings. 
We even set up a program in a church and are looking at another 
church to get space. So we will use available space. 

Now, there is a problem in getting space. We go into a community 
and try to see if the community is going to back this program. They 
are very much in favor of it but don't want it on their block. 

So we have worked that out. 

In the Harlem cormnunity, fortunately, we don't have that problem. 
We have been able to open up a great many clinics and we are expand- 
ing there. 

But in certain other areas, it is a problem. 

Mr. Winn. Do you use the residential system Dr. Jaffe referred to ? 

Mr. GoLLANCE. No ; we haven't done that. Practically all our patients 
are treated on an ambulatory basis. We have a certain number of beds 
for those who have difficult problems and we will take them into the 
hospital for 6 weeks. 

We also have a medical service and obstetrical service to take care of 
the patients. 

I would also like to touch on that because this comes up. We think 
it is important for the pregnant addict to be stabilized on methadone. 
Our experience is that the pregnant woman stays on the street as long 
as she can. She is a prostitute, gets no prenatal care, takes a shot of 
heroin and tries ta smuggle some heroin in with her when she enters 
the hospital for delivery. At least on methadone maintenance they 
get prenatal care, we can follow them carefully, and I might say that 
methadone has brought about a great change in climate. When I was 



248 

deputy commissioner of hospitals, it was recognized that pregnancy 
in addicts was a problem. , i 

We approached the chiefs of the obstetrical services and almost to 
a man they said this is not their problem. Now, our obstetricians see 
these cases. They are much interested in them and there is a much 
better climate for the. pregnant addict than what existed 5 or 10 years 

Mr. WioGiNS. Incidentally, does 'the child manifest withdrawal 
symptoms? 

Dr. GoLLANCE. We have watched them very carefully. We are going 
to follow those infants for a long time. But the alternative would be 
they would have heroin withdra,wal symptoms. ■ '. i 

Chairman Pepper. Doctor, I have to go to the floor for a little while. 

I will ai^k Mr. Walrlie if he will be good enough to take. the Chair. 

I will ask you one question and make one comment..! iiL-o oi \ 

How is your program financed ? > ot/j ^oiijj'rt'p.rr vth e-ij; i : 

Dr. GoLLANCE. Entirely by New York State Addiction Control 
Commission, and we are worried very much about future financing. 

Chairman Pepper. Secondly, on behn.lf of the committee I want to 
express our very deep appreciation for your coming here and giving us 
the benefit of j^our knowledge and experience. 

Dr. GoiXANCE. Thank you. It is a privilege to. be here. 

Mr. Waldie ( presiding) . IMt. ISIurphy. q 'jn'r 
' Mr. Murphy. Yes. ii biifi 'jvorf 

What experience do you know of that the Army has had with 
methadone? 

Dr. Gollance. I don't' know the Army's experience. I know the 
veterans hospitals in our area have been very interested. I have spoken 
to two of them. One of them is setting up a program. I would think 
that this is a very serious problem. I am not an expert on the Army's 
situation. q aiiH :;loj;J ot Bfiioi>. • /nmo'. sdi i vij i> v 

I had one nian tell me the main reason for reenlistment in a certain 
group was to stay in the Orient where they could get heroin. 
" Mr. Murphy. That is all. - ,, ; ; 

Mr. Waldie. Mr. Eangel. iiii /• qir k 

Mr. Rangel. Do you know of any feasible way to dispense methadone 
in such a form that it cannot be reduced to another substance so that 
it can be used intravenously ? . ;> - 

Dr. GoLLANCE. Well, if it is given dissolved in Tang, as we do, or 
in disket form it can't be injected. - . > .j^i. . vi;. 

Mr. Rangel. But we discussed tMte earlier 'aiid determined that it 
was not practical to do this. Is there any other form, concrete form, 
that you can create a methadone treatment or dosage so that it would 
be impossible for the patient to later reduce it for injection? 

Dr. Gollance. Well, I don't think they can reduce either of these 
two forms we use. The type they inject are the pills usually gotten 
from physicians. They are the usual* medical tablets and they are in-t 
jectable. Perhaps do away with the injectable pills might be one way. 

Mr. Rangel. Are you saying that in your treatment program you 
don't give methadone in any solid form at all? if^b 7o'1 [■>;<!-»;[ ^(Fi 

Dr. GoLLANCE. Only in this disket which is a sj^ccial form, certain 
substances are put there so it leaved a sludge so it won't go through a 
needle. 



249 

Mr. Hangel. That is a solid form ? 

Dr. GoLLANCE. It is a solid tablet. It is dissolved in water. It is like 
a large Alka-Seltzer and it fizzes up and it leaves a sludge and they 
drink it when dissolved. 

Mr. Eangel. If all of methadone was required by law to be dis- 
pensed only in the form in which you dispense it, would that not 
eliminate the possibility of injections ? 

Dr. GoLLANCE. Yes ; and I might point out that methadone is a diffi- 
cult drug to synthesize. There is only one manufacturer that I know 
of in thi^ country, so it is not the type of drug that you can bootleg 
and make it surreptitiously. 

]\Ir. Rangel. Thank you. 

Mr. Waldie. Thank you. 

Are there any other questions ? 

Doctor, we appreciate very much your appearance before the 
committee. 

(The following material was received for the record from Dr. 
Gollance:) 

[Exhibit No. 13(a)] 

Methadone Maintenance Treatment Program 

(Reprinted from Maryland State Medical Journal, November, 1970, Vol. 19, pages 
74-77. © 1970 by the Medical and Chirurgical Faculty of the State of Maryland, Baltimore, 
Maryland. Printed in U.S.A.) 

By Harvey Gollance, M.D., Associate Director, Beth Israel Medical Center, 
Administrator, Methadone Maintenance Treatment Program, New York, N.T. 

Drug afldiction has reached epidemic proportions in Isfeio York City and in 
other sections of the United States as well. An effective treatment for severe heroin 
addicts known as the methadone maintenance treatment program has ieen 
developed at Rockefeller University and has continued in a greatly expanded 
program at the Beth Israel Medical Center in New York. 

Facilities for the treatment of narcotic addiction were almost nonexistent in 
New York until the 1950's. It was then that the increase in the number of addicts 
in the low-income areas was recognized, as was the increase in the use of nar- 
cotics by the young. Concerned city authorities prompted the department of 
hospitals to establish facilities for adolescent drug users. As a result, a 140-bed 
hospital. Riverside Hospital, was opened in 19.52. Psychiatrists and strong re- 
habilitative and supportive services were provided. In addition, beds were ob- 
tained in a proprietary hospital. Manhattan General Hospital, to detoxify nar- 
cotic patients. With one exception, the chiefs of service of the municipal general 
care hospitals resisted the treatment of drug addicts in their service. Few physi- 
cians were interested, and almost all refused to treat the addicts. 

A study was done by Columbia University in the late 1950's of 248 patients 
discharged from Riverside Hospital. It showed that almost 100 percent of the 
patients still alive became readdicted shortly after discharge. Ray E. Trussell, 
M.D., director of the School of Public Health and Administrative Medicine of 
Columbia University, during a sabbatical leave, had been appointed commis- 
sioner of hospitals of New York City in 1961. Dr. Trussell, as a result of the 
Riverside Hospital study, and because of additional serious administrative 
problems, decided that Riverside Hospital should be closed, and that we should 
seek new approaches to treat drug addicts. Riverside Hospital was closed in 
196.3. Although it had given its patients some social assistance, it failed both in 
preventing readdiction and in rehabilitating its patients. It seemed clear that 
the answer to the treatment of narcotic addiction lay in new directions to be 
determined by future research. 

research encouraged 

The Health Research Council of New York City was interested in encouraging 
research in the area of drug addiction, and in 1963 they initiated a grant to 

60-296—71 — pt. 1 17 



250 

two Rockefeller Institute physicians: Vincent Dole, M.D., a specialist in meta- 
bolic research ; and Marie PI Nyswander, M.D., a psychiatrist with long experi- 
ence in drug addiction. 

Dr. Dole and Dr. Nyswander attempted to find a means of treating a patient 
which would enable the patient to function productively in society. The research- 
ers considered drug addiction as a psychological disorder and thought it reason- 
able to ask whether some medication might control the drug hunger. At first 
they attempted to maintain patients with morphine. While this did away with 
much of the patient's antisocial behavior, it did not make him productive. Next, 
they used methadone in an unusual way, giving their patients gradually increas- 
ing doses until the tolerance level was reached, usually between 80 to lliO 
milligrams daily. When patients reached this maintenance level, usually after 
6 weeks of treatment, the physicians found that several things happened : 

(1) The patient showed no harmful effects from methadone. He was neither 
sleepy nor high. Medical examination and all types of medical, physiological, 
and psychological testing showed no harmful effects from methadone. 

(2) The patient lo:>t his drug hungei*. 

(3) The effect of heroin was blocked. Even when given an injection of heroin, 
the patient experienced no effects from it. 

(4) The dosage of methadone, once established, remained stable. It did not 
have to be increased, and was long acting (24 to 3G hours). 

GROWTH OF THE METHADC>fE PROBLEM 

After intensive study and experience with six patients. Dr. Dole went to Dr. 
Trussell, showed him the histories of his six patients, and asked for facilities to 
expand his work. In 19G5, through Commissioner Trusseli's efforts, beds were 
obtained at the Manhattan General Hospital. This hospital of 386 beds later was 
acquired and became an integral part of the Beth Israel Medical Center. This 
was done through the help and cooperation of the president of the Board of 
Trustees of the Beth Israel Medical Center, Mr. Charles H. Silver. In 19GG, the 
center was renamed the Bernstein Institute of the Beth Israel Medici^.l Center. 
It is the largest center for drug addiction under voluntary auspices. Methadone 
maintenance is one of several narcotic programs of the Bernstein Institute. 

In 5 years, the Methadone program has expanded to the point where over 1,300 
patients are currently being treated in four hospitals and 15 clinics under the 
sponsorship of the Beth Israel Medical Center. Several additional voluntary and 
municipal hospitals and clinics are now almost ready to join the Beth Israel 
Methadone Maintenance Treatment Program. The inpatient phases of the vrork 
are done either at Beth Israel or at Harlem Hospital. Clinics have been estab- 
lished at Beth Israel Medical Center, Harlem, St. Luke's, and Cumberland Hos- 
pitals. In addition, a number of hospitals in New York City have established 
their own methadone programs based on the work done previously at the Beth 
Israel Medical Center. 

This program considers the addict a patient with a chronic disease. The in- 
dividual whom it treats is the hard-core addict who suffers from euphoria and 
drug hunger, is unable to function socially or economically, and must take drugs 
to relieve his physical misery. 

Naturally, we realize that it would be best if the cause could be removed and 
the patient made drug-free. But all programs which have attempted this in a 
community setting have failed. This program deals with the symptoms. The 
Methadone blockade against opiates frees the addict from his drug hunger so 
that he becomes receptive to rehabilitation. It should be stressed that this 
program deals with the long-term, usually ci'iminal addict, who has been unable 
to make it in any other way. Our goal is social rehabilitation for those who have 
been unable to achieve abstinence. 

TREATMENT APPROACH 

The Methadone program is not based on a psychiatric approach. While psy- 
chiatric consultation is needed for a number of patients, it is not the primary 
modality. Our experience has shown that the program is equally effective in a 
department of psychiatry, medicine, or community medicine. The important fac- 
tor is competent direction by an interested physician. Our experience has also 
shown that there should be available good medical and obstetrical services by 



251 

pliysicians who are familiar with methadone patients and who are available for 
back-up in program. 

INTAKE OF PATIENTS 

A central intake of patients for all the clinics and h-^spitals associated with 
this program has been established under the direction of a skilled staff. This 
staff has had experience working with addicts, and their backgrounds are essen- 
tially in social service. They screen the applicants for acceptability in the pro- 
gram. A research assistant (an addict in the program who has proven himself) is 
of great assistance in this procedure. 

Originally, because this was an experimental program, very rigid qualifications 
for admission were established. These subsequent qualifications and their modi- 
fications are : 

1. Af7e.— Originally, age was set at 21 to 39 years. The patient had to be able 
to sign a consent form but could not be over 39 because of the theory that drug 
addiction decreases with age. The age requirement has now been changed ro 18 
years with proper consent. No maximum age limit now exists. We even treat 
patients collecting Social Security, and those registered with medicare. 

2. Residence. — ^New York City residency is required because of reimbursement 
aspects. 

3. Addiction. — Only opiate addicts are accepted. Severe barbiturate an<l am- 
phetamine users are rejected, as well as are those with multiple addiction (i.e., 
combination of opiates with barbiturates). Hov/ever, the final decision for accept- 
ance may be modified by the clinician in charge. 

4. Length of drug use. — Originally, a minimum of 5 years of mainlining heroin 
was set. This has been gradually reduced and is now 2 years. 

5. Psychiatry. — Any history of psychoses or severe mental disturbance is 
usually cause for rejection. This may be modified by the clinician. 

6. Addiction in family unit. — If the patient's spouse is addicted, both must be 
eligible and admitted together. The same is true of any family members living 
in the same household. 

7. Alcoholism. — Severe chronic alcoholics are rejected. 

8. Mental deficiency. — Addicts are rejected if intelligence quotient is so low 
that they cannot handle the responsibilities of the program. 

9. Medical. — Cirrhosis of the liver, diabetes, epilepsy, and terminal conditions 
were originally reasons for rejection. We now have no medical exclusions. 

10. History of previous unsuccessful treatment. — This has now l)een modified, 
and a determination is made according to the judgment of intake personnel. 

11. Acceptance of patients. — Finally, the physician in charge must approve the 
selection of the patient. 

PROCEDURE 

When it has been determined that the patient meets the criteria and a vacancy 
for treatment occurs, he is admitted into a phase I program. Originally, this was 
a 6-week period of hospitalization on an open ward. This phase has been modi- 
fied and now, in a high percentage of cases, it is done on a strictly ambulatory 
basis. The patient is given divided doses at first. As the dosage is increased, and 
there are no undesirable side effects, the dosage schedule is changed to a single 
daily dose. The methadone is dissolved in an orange juice substitute and taken 
orally. 

After reaching maintenance level, the patient is next assigned to a phase II 
clinic. At first, the patient reports daily. He leaves a urine specimen which is 
tested for opiates (heroin and morphine), amphetamines, quinine, barbiturates, 
and methadone. He drinks his dose of methadone in front of the nurse, and 
periodically reports on his activities (for example, school, work), or problems. As 
the staff is convinced of the patient's progress, he is required to report less often — 
three times a week, twice a week, then once a week. However, when he does rei»ort, 
he drinks that day's dose of methadone in front of the nurse (to be sure that he 
is still taking it), leaves a urine specimen, and is given his daily supply of 
methadone for those days when he does not report to the clinic. 

We try to limit the size of our phase II clinic to less than 100 patients. Each 
clinic has a part-time physician, a nurse, or nurses (depending on the hours of 
the clinic), a supervisor, counselors, a research assistant (ex-addict), and clerical 
personnel. Backup medical, psychiatric, pharmaceutical, social, legal, and other 
services are provided when needed. 



252 

It is during pliase II that serious efforts are made in the rehabilitation of the 
patient A wide spectrum of services is offered to the patient in the areas of 
medical care counseling on problems of everyday life, social services m regard 
to family living and ■community resources, vocational rehabilitation, and legal de- 
fense advice. The older patients on the staff are especially helpful in this phase, 
and are constantly available to help with problems peculiar to addictive patients. 

After a year when the staff is convinced that the patient is doing well, at a 
job, at school, 'or at keeping house, and the patient seems to have no problem 
with alcohol or drugs, he is assigned to a phase III clinic. The treatment is essen- 
tially the same, but the frequency of visits is much shorter and there is little 
need for the counseling staff. These services, however, are available if needed. 

EVALUATION 

From the start, in 1964, this program has had independent evaluation of all 
the patients who have ever entered it. Originally, when the city financed this 
program, money was allocated to the Columbia School of Public Health to per- 
form this evaluation. When financing of the methadone maintenance treatment 
program was assumed by the State narcotic addiction control commission in 
1967, a separate contract was given by the State to the Columbia University 
School of Public Health and Administrative Medicine to continue this evaluation. 
A highlevel committee was appointed. The charge to this committee was to 
evaluate the results of this program in an objective manner, and to make recom- 
mendations based on this evaluation. Frances Rowe Gearing, M.D., was appointed 
the director of the evaluation unit. 

In their report of March 31, 1968, the committee reached these conclusions : 
"The results of this program continue to be most encouraging in this group of 
heroin addicts, who were admitted to the program on the basis of precise criteria. 
For those patients selected and treated as described, this program can be con- 
sidered a success. It does appear that those who remain in the program have, 
on the whole, become productive members of society, in contrast to their previous 
experience and have, to a large extent, become self-supporting and demonstrate 
less and less antisocial behavior. It should be emphasized that these are volun- 
teers, who are older than the average street addict and may be more highly 
motivated. Consequently, generalizations of the results of this program in this 
population to the general addict population probably are not justified. There 
remains a number of related research questions which need further investigation." 

A report as of March 31, 1969, showed there were 153 women and 861 men who 
had been under observation 3 months or longer. 

"Among the women, 10 percent were employed on admission. After 12 months, 
33 percent were employed. Fourteen percent were homemakers, and 3 percent 
were in school. After 18 months, 65 percent were employed, in school, or home- 
makers and, after 2 years, this percentage had increased to 73 percent. 

"Among the men, tlie percent of those employed or in school increases from 
26 percent on admission to 56 percent at 12 mouths, 70 percent at 24 months, and 
S3 percent at 3 years. The percent of men on welfare or supported by others de- 
creases proportionately from 54 percent at 6 months to 44 percent at 12 months, 
30 percent at 24 months, and 17 percent at 36 months. 

"The arrest records of those who enter the methadone program and those who 
enter our detoxification program are similar. Patients who are accepted have to 
wait a long period. Acceptance into the program does not have a marked effect 
on their pattern of arrest in the 12 months prior to admission. Following admis- 
sion, there is a marked decrease in arrests while the pattern of arrest among 
the contrast (detoxification) group is very similar to earlier patterns." 

None of the patients who remained in the program have become readdicted 
to heroin. Problems with drug abuse (amphetamines and barbiturates) varied 
from 4 percent to 12 percent. 

The methadone maintenance treatment program is an effective, economical way 
of treating hard-core heroin addicts who cannot be treated successfully with any 
existing programs. It can now be done on an entirely ambulatory basis for most 
patients. This makes the program feasible for those areas where inpatient beds 
are difficult to obtain. We feel it is very important that this program be a struc- 
tured one so that it i-emains carefully controlled. 

Methadone maintenance treatment for heroin addiction is a public health pro- 
gram. It should be accomplished under the direction of a public health deijart- 
ment, a hospital, or an organized uiodical facility. Since rehabilitation and social 
productivity of the patient is the prime objective of this program, it is important 



253 

that the means to do this must be an integral part of the program. It is not suffi- 
cient to prescribe methadone alone. 

Under these circumstances, the addict is given a chance in a program which he 
is capable of handling, and which offers him a realistic path to living as a respon- 
sible member of his community and of society without the crutch of heroin. 

Mr. Lichtman, whose statements follow, is a research assistant at the Beth 
Israel Medical Center. Before becoming an assistant there, he was a drug addict. 
In conjunction with Dr. Gollance's article on the methadone maintenance pro- 
gram, Mr. Lichtman tells how the program has helped him. 

I am 29 years old. I started using heroin at the age of 15. I used it for a period 
of approximately 10 years. Approximately 4 of those years were served as a 
guest of the city. State, and Federal governments in any number of institutions. 

After a period of 10 years, I found that a strange thing happened to me. I devel- 
oped a certain motivation which I had not had during that time. I decided that 
I wanted something more than I had had for those 10 years. I came to the Beth 
Israel Medical Center in April 1966, at which time I applied for the methadone 
maintenance program. The reason that I had originally applied for that program 
is that I had unsuccessfully tried other methods of treatment when coming out 
of institutions in other programs. I found that the same drug craving which I 
liad in going into a program would return upon my release from an institution. 

I had heard many stories about methadone. I heard that while taking methadone 
you are still addicted, and you would not be able to function in the cuiiim unity. 
But I decided that since I had not been able to function in the other prograni.s, 
that I wonld try methadone. 

As I said, I went into the hospital, and stayed there for a period of 6 weeks, 
during which time the metl'adone level was increased. 

After leaving the hospital, I returned to my family, who were skeptical. My 
father owns his own business in Manhattan. He is a furrier and does make a 
good living. During the 19 years I was using drugs, he did not allovs- me into 
his place of business. When I returned there from the methadone program, as 
I ?aii\. he was skeptical, but was willing to take a chance with me. 

I lived at home for 4 months, at which time I met a young lady who was 
also willing to take a chance with me and who knew my background. After 
about 6 months, we were married. 

I now have a lovely home in Riverdale, and a new car. I work for the pro- 
gram in helping other addicts attain that which I have attained. 

I find there is no real "hang-up" in using methadone. I leave a urine specimen 
when I come into the clinic weekly and pick up six bottles of medication to 
take hnme with me, which I take at my leisure. Methadone is a long-acting drug. 
I take the drug at any time during the day, and sometimes forget to take it 
and then overlap hours. The drug lasts anywhere from 24 to 30 hours. I have 
never experienced any withdrawal symptoms. 

As I say, there is no drug craving, and no outw^ard appearance of euphoria. 
^Methadone does not produce these symptoms as other opiate drugs do. 

In the time I have been on the methadone program, I find that there are many 
people who are willing to take a chance on the addict population once they 
(the addicts) are stable on it, that is, the maintenance drug. In New York City 
alone we have many large organizations, such as the telephone company and 
large construction firms, who are willing to employ some of our people in the 
program. 

It is difficult for me to tell you all of the things that have happened to me 
in the past. I have a new life today and it is something that T was never able to 
have before. 



[Exhibit No. 13(b)] 

Beth Israel Medical Center, 
Methadone Maintenance Treatment Program, 

New York, N.Y., May 7, 1971. 
Mr. Chris Nolde. 

Associate Covnsel, House Select Committee on Crime, 
Washington, B.C. 

Dear Mr. Nolde : Following are my comments concerning the statements of 
Mr. Horan : 

1. We agree that private physicians should be regulated in their use of metha- 
done for maintenance ; but we should be careful not to impede the development of 



254 

well-structured methadone maintenance programs because of the improper use 
of methadone by private physicians. 

2. Methadone in injectable form (Dolophine) has been available in the legal 
and illicit markets for a long time. It is inaccurate and misleading to ascribe 
methadone overdoes in any community to the existence of methadone programs 
alone since Dolophine has been available for many years and is still available 
in the illicit market. Most structured programs do not use Dolophine in pill 
form. 

3. Although methadone maintenance is not the treatment of choice for all ad- 
dicts, it should be available for those for whom it is the treatment of choice. 

(a) We have changed our admission criteria as follows : 

(1) Minimum age requirement has been reduced from 20 to 18 years. 

(2) Number of years of verified addiction has been reduced from 4 to 2 
years. 

We made these changes in order to make this treatment available to the 
younger patient who is already thoroughly addicted to heroin ; in this v\-ay we 
can treat the younger patients who need the program without addicting persons 
to methadone who are not already clearly addicted to heroin. 

(b) We find that most, if not all of our patients, have been treatment failures 
in other programs; but this is not an absolute prerequisite for admission. 

4. We agree that every effort must be made to screen out any applicant v.'ho 
is not already addicted to heroin. 

5. Therapeutic communities and residential treatment mentors are modalities 
of choice for young and nonaddicted users of heroin. Communities containing 
a significant number of addicted persons should provide programs designed to 
meet their specific problem, including heroin addiction. 

6. Part 5 of the statement reads in part : "We find many provable cases of 
injection directly into the vein of methadone mixed with juice or Tang." I have 
checked with our clinical staff to make sure that my impression is correct and 
it is their opinion that the following is correct : Methadone mixed with juice or 
Tang is nouinjectable for several reasons which I think are too technical to go 
into here, but the fact is that the drug in this form is not injectable and any 
patient who succeeded in injecting it would become fatally ill. 

I would emphasize that there is a large group of chronic heroin users for whom 
all existing treatment programs except methadone maintenance have been a 
failure. 

The goal should be to set up structured, controlled programs and not to deny 
the seriously heroin addicted this proven program which is literally lifesaving. 
both for the patient and the community. 
Sincerely yours, 

HaPwVey Gollance, M.D. 

Asfnciatc Director, 
(In charge of narcotic trcatmcitt proyranis). 



[Exhiliit Xo. 13(c)] 

FoRTY-NiNTii .Judicial Distuict, 
Counties of Dimmit, Wekb, Zapata, 

Laredo, Tex., November 11, 1070. 

Vincent P. Dole. M.D., 

Rockefeller I 'nirer.sity, 

New York, N.Y. 

Dear Sir: This is to notify you that a complete check of our district court 
records reveal tiie following in connection with cases involving burglary and 
theft, theft, aggravated assault, forgery, under the infiuence, and other' pettv 
theft cases. 

Our records reflect that since the inception of the methadone maintenance pro- 
gram in Laredo. Webb County. Tex., the reduction in this type of crime has 
dropped approximately 05 percent. 
Very truly yours, 

Carlos V. P.EXAvinES, Jr., 
A.'iS'Stant District Attorney. 



Chairman PEPPEr.. The next witness is Mr. Robert F. Iloran. 

Mi\ Horan is the Commonwealth attorney for Fairfax County, Va, 

Mr. Iloran is a native of New Brunswick, N.J. He attended Mount 
St. Mary's College, Emmitsburg, Md., where he received liis B.S. 
degree in 1954. Following graduation, he was commissioned a second 
lieutenant in the U.S. IMarine Corps and served as a Marine officer 
until 1958. Upon leaving active service, he entered Georgetown Univer- 
sity Law School and earned his LL.B. degree. He served as an assistant 
Commonwealth's attorne_v during 1964 and 1965. In September 1965 
he resigned as assistant Commonwealth's attorney to become a partner 
in a Fairfax law firm. His law partnership terminated in March 1967, 
when the circuit court appointed him Commonwealth's attorney to fill 
an unexpired term, and in November 1967 he was elected to that office 
for a term of 4 years. 

Mr. Horan is a member of the Virginia State Bar, National District 
Attorney's Association, Northern Virginia Trial Lawyers Association, 
Delta Theta Phi Legal Fraternity, the Marine Reserve Officers As- 
sociation, and the Young Democratic Club of Fairfax County. He is 
a member and former secretary of the Fairfax County Bar Associa- 
tion. Mr. Horan is first vice president of the Virginia Commonwealth's 
Attorney's Association, and in March of 1970 he becam.e the first 
elected chairman of the Northern Virginia Criminal Justice Advisory 
Council. 

Mr. Horan, we welcome your testimony. 

STATEMENT OF EOBEET F. HOEAH, JE„, COMMOITWEAITI! ATTOE- 
NEY FOE THE COTJI^ITY OF FAIRFAX, C0MM0IW7EALTH OF VIE- 
GINIA 

Mr. Horan. Thank you, Mr. Chairman. 

I am the chief criminal prosecutor for a jurisdiction containing 
upward of one-half million people. Prior to the year 1967, drug abuse 
as a problem in what is essentially a suburban jurisdiction was prac- 
tically nonexistent. 

Commencing in the fall of 1966 and early 1967, we had our first 
onset of drug abuse, as did most of suburban America. One of the 
significant things that has happened to us and is pertinent for this 
comniittee is that in the last 18 months in that jurisdiction we have 
had five provable methadone overdose deaths. We have had tv/o others 
that are probably methadone deaths. In the same period of time we 
only had one heroin overdose death. 

r am here today because of my increasing concern about the direc- 
tion in which we are being pushed in the area of methadone main- 
tenance. It seems that everyone articulates the position that metha- 
done is not the panacea for heroin addiction, and yet in some quarters 
it seems that that is exactly how we are treating it. 

In my opinion, the news media has added massively to the con- 
fusion concerning this drug. I sometimes get the feeling, and that 
feeling was amplified by the WTOP editorial last week, that some 
feel that methadone equals rehabilitation, and if a jurisdiction does 
not have a methadone maintenance program they are simply not in 
the rehabilitation business. WTOP's view, in my opinion, is patently 



256 

nonsense and serves only to add confusion to an already confused 
situation. 

The confusion is not alleviated when a physician can stand before 
this committee, as one did in October of 1970, and state that the use 
of methadone in treatment is "paralleled in importance only by the 
discovery of penicillin during this century." I don't know what the 
founder of the polio vaccine feels about that statement, but it strikes 
me as grossly misleading. 

First of all, I would like to make clear that I support a properly 
run and properly controlled methadone treatment pi'ogram. Basically 
I support the original concepts of the program of Dr. Vincent Dole, 
in New York City. I firmly believe that with a certain class of addict, 
there is nowhere to go but up. On the other hand, I believe that many 
of the original Dole concepts have been prostituted on the altar of the 
simple solution. Tliei'e is too much of an attitude in some quarters to 
consign anyone and everyone who has used heroin to methadone main- 
tenance, regardless of his state of addiction. Even Vincent Dole admits 
that this method of treatment may consign its participants to a lifetime 
of methadone addiction, since this compound is a physically addictive 
one. I oppose such an easy consignment for two basic reasons : 

One, because of the nature of hard narcotic use and the hard nar- 
cotic users that we find in suburban Virginia — and I suspect that the 
same would be true in most of suburban America — and two, the in- 
creasing availability of this compound as a prime abuse drug. 

In connection with the first reason, it is important to remember some 
of Dr. Dole's original guidelines. 

(1) The addict should be at least 20 years of age ; 

(2) He should have at least 4 years mainline hard-narcotic addic- 
tion; and 

(3) Other methods of treatment must have been tried and failed 
before he would be committed to maintenance. 

I would suggest, members of the committee, that very, very few 
addicts in sulmrban America would meet just those three guidelines. 
In my jurisdiction. 77 percent of all our drug abuse cases, regardless 
of drug, involves those aged 20 and below. The phenomena of drug 
abuse hit us in 1966, while heroin abuse did not hit us until 1969, in 
the spring. The net effect of this is that today virtually all of our 
heroin users have less than 2 years' mainline addiction. Most, if not all 
of them are below age 20 ; and when they first come to our attention, 
no other method of treatment has been tried in an attempt to cure them. 
Thus we can see that most of our addicts, and I use the term loosely, do 
not meet Vincent Dole's original guidelines. 

My concern is that in the search for the panacea for hard-narcotic 
abusers we might consign to a lifetime of methadone maintenance 
some very young kids without ever attempting another route of cure. 
In my opinion, very few kids in my jurisdiction should be so consigned. 
An analogy to "throwing out the baby with the bath water" might fit 
our situation. 

I would not for 1 minute contest the right of the District of Columbia 
or New York City to commit themselves fully to massive methadone 
maintenance programs. But please, for Heaven's sake, let's not commit 
the rest of the country. 



257 

I guess I have read most of what Drs. DiiPont and Dole say about 
their programs, and their writings certainly substantiate their commit- 
ment — but their special jurisdictional needs appear to require it — my 
jurisdiction does not, and I suspect that the rest of suburban America 
is in my situation and not in theirs. 

We presently have in Fairfax County a drug treatment program 
based upon the therapeutic community concept. 

We have been in the business for quite some time now. We are satis- 
fied with our methods of treatment, and if there comes a time when we 
have a large scale number of hard-narcotic abusers, then we are prob- 
ably going to take a much harder look at methadone. But that is not 
our situation today. 

The second problem in northern Virginia involves the use of metha- 
done as a prime abuse drug. Supposedly, the situation will be alleviated 
by FDA regulations which may control the dispensing. I hope those 
guidelines do that, because prior to any guidelines our situation was 
atrocious. In the spring of 1970 the Fairfax Police Department and I, 
after our second methadone overdose death, began to complain about 
the availability of this drug in the marketplace. Unfortunately, three 
more deaths were necessary before anything was done to tighten up 
dispensing guidelines in the District, and two of those deaths involved 
kids 16 years of age. 

We have tried, through the treatment program, the police depart- 
ment and my office, to evaluate our situation with regard to the avail- 
ability of methadone. I would like to share with you some of the find- 
ings that we made, based on a cold, hard look at it in the past year. 

First. Large supplies of this drug have been coming out of the Dis- 
trict of Columbia, primarily from private practitioners' offices. Much 
of this methadone has been diverted into abuse circles and in some 
cases it has become the drug of choice. Some of it is being sold right 
in the syringe at $1.,50 a cubic centimeter. This makes it an excellent 
profit drug and as much as in the case of at least one physician, he 
distributes 50 cubic centimeters at a time at $15 a throw. 

Upon resale of that at a $1.50 a cubic centimeter the profit is 
apparent. 

Mr. Peeito. Mr. Horan, has this doctor been prosecuted? 

Mr. HoRAN. To my Imowledge he has not. We have no jurisdictional 
control over him. 

In the District of Columbia he can do exactly what he is doing. 

Mr. Perito. Have you recommended to the District authorities that 
he be prosecuted? 

Mr. Horan. I have had a great deal of contact with the narcotics 
squad over the year, and the district attorney's office, and they feel 
their hands are somewhat tied. That is the impression I get. 

Mr. Sandman. Why are they tied ? 

Mr. HoRAN. Because, evidently, under the existing regulations he 
can maintain an addict on methadone because he is making: a purely 
medical iudgment, and. therefore, it is not criminal under District law. 

Mr. Waldie. Mr. Horan, may I interrupt you ? 

We are in the middle of a quorum call. I would like to have you 
complete your statement before the end of the second bell. Perhaps 



258 

you best complete your statement and then we will come back for 
inquiries. 

Mr. HoRAX. The second thing we find is a number of cases of non- 
heroin addicts being dispensed methadone in the District of Colum- 
bia from private practitioners. These are kids that weren't addicts 
to begin with, and they are getting methadone without being a true 
addict. 

You may have read about the reporter from the Northern Virginia 
Sun who had never had a narcotic in his life, came over here, plunked 
down $15 and he got methadone in a hand}' carryout dose. 

Third. Methadone addiction appears to be growing at a faster rate 
than heroin addiction. Our drug treatment program over the past 
year found it necessary to engage in medical detoxification of 39 pa- 
tients. Thirteen of these were detoxified for a heroin habit and 26 
were detoxified for a methadone habit. A large majority of those de- 
toxified were below age 20. 

Fourth. Some of the users were obtaining methadone by going to 
one physician on one da^?- and a different physician a couple of days 
later. This resulted in their being able to obtain a weekly supply from 
each physician in the same week. 

Fifth. Dr. Vincent Dole originally felt that one of the main reasons 
for dispersing methadone diluted in fruit juice was that nobody would 
shoot it. We find many, many provable cases of injection directly into 
the vein of methadone mixed with juice or Tang. 

As a matter of fact, the interior of the lungs of one of the recent 
death cases was coated with a material that was consistent with 
methadone abuse. There is only one way to get that on the interior 
lining of the lungs, and that is through a vein. 

Many cases of nonfatal overdose began to show^ up simply because 
methadone was entirely too much drug for the drug abusers in our 
area, particularly when it was being injected rather than taken orally. 
An addict may have been getting 2- or 3-percent heroin in his vein 
and all of a sudden he is getting a relatively pure drug in methadone 
and his central mervous system can't stand it. His respiratory system 
fails, he stops breathing. 

Sixth. A great number of our citizens were not even aware that 
their youngsters were involved in a so-called methadone treatment 
program in the District. Their kids were in treatment programs. They 
didn't know the treatment involved the daily dispensing of phj-sically 
addicting narcotics. 

In conclusion I want to say that methadone maintenance probably 
does have a proper place and is the only mode of treatment in sonic 
cases. However, I strongly endorse the caveat of this committee, at 
page 82 of its report of January 2, 1971, entitled "Heroin and Heroin 
Paraphernalia," where in this committee said : 

Every precaution against diversion mnst be olxserved. While we believe tliat 
drug should be reclassified, we do not believe that individual private practitioners 
should be allowed to prescribe methadone for prolonged maintenance of indi- 
vidual heroin addicts. 

The footnote to that caveat gets to the heart of tlie issue, in my opin- 
ion, where tliis committee states: "Methadone maintenance must be 
accompanied b}' proper psychiatric, social, and vocational services.'' 



259 

- I would only add to that the suggestion that maintenance should not 
be the original mode of treatment except in an isolated class of cases ; 
and secondly, that in the case of many young suburban abusers proper 
psychiatric, social, and rocational services will obviate/ tjiie necessity 
of maintenance to begin with. \ ■, .,. 

Mr. Waldie. Thank you, Mr. Ploran. 

There will be, I am sure, a number of questions to be asked of you. 
Hopefully we v^^ill reconvene at 1 o'clock. 

The committee will remain in recess until that time. 

(Thereupon the committee recessed to reconvene at 1 p.m.) 

Afternoon Session 

Mr. Mann (presiding). The committee will come to order. 

Prior to the recess, Mr. Horan was testifying and we will resume 
his testimony. 

Mr. Horan, you had completed your statement in chief ? 

Mr. Horan. Yes ; I have, sir. 

Mr. Mann. All right ; Mr. Perito, will you inquire ? 

Mr. Perito. Thank you, Mr. !Mann. 

Mr. Horan, I assume from your testimony that you are not opposed 
to properh^ run methadone programs ; is that correct ? 

Mr. HoKAN. Tliat is correct. 

j\Ir. Perito. It is the thrust of your testimony then, if I underst.md 
it, that you consider that your problem is different from the problem 
in the District of Columbia or in New York City; would that be 
correct ? 

Mr. HoRAN. I certainly think that is so, predominantly because I 
think we have a different breed of addict than New York City has, 
sir. 

]Mr. Perito. Would NTA be the type of program that you point to as 
an example that you could support ? 

Mr. HoRAN. That may be a little far. 

From the point of view of the one issue of the ability to di\'ert 
methadone into drug abuse circles, I have no evidence that we have 
ever seen any methadone in our area that has come out of NTA. 

From that point of view I am satisfied with the NTA controls at this 
point in time. 

On the second issue, my difficulty with NTA is that they appefir to 
be, on the surface, entirely too methadone prone. That seems to be 
the big thing with them as opposed to what I think is a growing tend- 
ency in research programs to indicate that different modes of treat- 
ment are necessary. 

Mr. Perito. And you believe that the propensity toward methadone 
distribution in a clinical setting causes you, as a prosecutor, problems? 

Mr. Horan. Yes ; I think so. 

Mr. Perito. And those problems come from diversion ? 

Mr. Horan. They come from diversion. They also come from '^he 
psychological attitude, if you will, that methadone is the cure, and vou 
find an awful lot of addicts, who discover it really isn't the cure, it is 
just another drug for those addicts. It just continues to be a difficult 
criminal problem. 



260 

Mr. Pertto. Based upon your experience, have you found diver- 
sion on a manufacturing level in Fairfax County ? 

Mr. HoRAN. No ; we have not. 

Mr. Perito. I assume that based upon your experience your diver- 
sion is found on the low levels of dispensing, say from private 
physicians? 

Mr. HoRAN. Almost entirely private practitioners. 

Mr. Perito. Have you found any evidence of diversion on the drug- 
store level? 

Mr. HoRAx. There is a recent report by the Virginia Board of Phar- 
macy. An investigator who did a report for the Virginia Board of 
Pharmacy found virtually no diversion anywhere in the State. 

Mr. Perito. So it is fair to say that ordinarily, and based on your 
experience, the diversion which causes you problems, as a prosecutor, 
comes from private physicians ? 

Mr. HoRAN. Yes ; it does. 

Mr. Perito. Based upon your experience, how do you think that 
diversion problem can best be handled ? 

Mr. HoRAN. I feel at this point in time a private practitioner simply 
should not be in the business. He should not be in the business of 
methadone maintenance. My feeling is that I have never seen a prac- 
tioner in the metropolitan area of Washington who I feel has the 
pi'opcr supportive services to go along with his program so that he 
is an effective rehabilitation mode. I think that with the average physi- 
cian we have run into in the metropolitan area of Washington, all he 
is is another drug seller. I would hate to think that organized crime 
ever wants to move in under the guise of a medical license. Organized 
crime might move into the dispensing of methadone, because it is a 
high-profit drug as it is being dispensed privately. 

Mr. Perito. You presently have operating in Fairfax County thera- 
peutic communities ? 

Mr. HoRAN. Yes ; we do. 

Mr. Perito. I assume by that you mean a drug-free community ? 

Mr. HoRAX. Yes. 

Mr. Perito. And they only use methadone as a detoxification drug? 

Mr. HoRAN. Actually the treatment center, itself, does not use metha- 
done at all in treatment. We use methadone in the jail facilities as a 
withdrawal drug to detoxify an addict. 

Mr. Perito. How long has the therapeutic facility been in operation 
in Fairfax County ? 

Mr. HoRAiSr. Since September of 1969. 

Mr. Perito. Do you have any statistics from that facility as to the 
efficacy of their approach insofar as the reduction of crime or incidence 
of antisocial behavior is concerned ? 

Mr. HoRAN. I don't have any specific statistics that could prove it 
one way or the other. I do know that of those in the treatment pro- 
gram wc have had very few that we later see in the court scene as a 
criminal statistic. 

Ml-. Perito. Do you know, as a genei-al matter, whether therapeutic 
communities have been successful in reducing the crime rate of addicts 
under treatment ? 
Mr. Horan. I think probably they have been. 



261 

Mr. Perito. Is your thinking based upon studies that you have 
seen? 

Mr. HoRAN. Mostly the reading that I have done in the area, from 
other parts of the country. 

Mr. Perito. If you have any of those studies, I would appreciate 
you making them available to the chairman of the committee. 
Mr. IIORAX. I certainly will. 

(As of the time of printing of this record, the committee had not 
received the studies or statistical evaluations from Mr. Horan of the 
efRcacy of drug-free clinics insofar as the reduction of crime or anti- 
social behavior is concerned. ) 
Mr. Pepper. Mr. Blommer. 

Mr. Blommer. Mr. Horan, would you say that in Fairfax County 
(here are very many drug takers that you would call addicts, as op- 
posed to drug experimenters or drug users ? 

Mr. Horan. The head of ou]- Fairfax-Falls Church Mental Health 
Center, a psychiatrist, refers to our population of drug abusers as 
1)eing garbage collectors. By that he means they will take anything, 
regardless of what it is, or what form it is in. 

I would suspect an overwhelming percentage of our kids are in 
that boat. They will use anything. They aren't committed strongly 
to any one drug, by and large. 

We tried to figure out the other day, sitting down, tried to put 
together a list of those we thought were anyv>^here near 4 years in 
the vein, and we couldn't come up with 10, and most of them were 
addicts that we had dealt with, 7, 8 years ago, coming out of the city 
of Alexandria, mostly. They are the only ones we could come up with. 
Most of our kids are diversified drug users. They have tried heroin 
a few times here and there, along with a number of other things, and 
they aren't in the vein that heavily. 

As a matter of fact, I can recall no case of a jail prisoner who 
took much longer than 20 hours to be completely detoxified. Most 
show absolutely no withdrawal symptoms after the 20-hour mark. 

As a matter of fact, we have had kids come in, who supposedly 
had big drug habits, who never show any withdrawal symptoms the 
whole time they were in the jail. 

Mr. Blommer. Mr. Horan, do you have what you would call a black 
market in drugs in Fairfax County and if so, what drugs are available. 
Mr. Horan. I think they are all available, unfortunately. I think 
our drugs essentially come from about three major sources. 

First, I would be in the hard narcotics field, heroin and maybe some 
morpliine on rare occasions. That almost invariably is coming out of 
the wholesalers in the District of Columbia. I know of only one whole- 
saler that we have ever dealt with in Fairfax County in the heroin 
area. That is one source. 

The second source is the methadone source which appears to be 
private practitioners in the District. 

The third source is the ximerican free enterprise system at its best, 
and that has to do with marihauna, LSD, and hashish, and there it is 
a very amateur, nonprofessional, somewhat noncommercial market 
where kids are using a tremendous amount of ingenuity to come up 
with drugs. 



262 

A a'reat case in point was a conple of years airo I had a phone call 
from th<? ]>r;)secutor in Lincoln County, >7ebr., Foit PJafte, Kebr. Pie 
wanted to know if we had a kid in our coinmunit}', for want of a better 
name, Joe Blow, and I said yes, we did. As a matter of fact, we were 
prc^eciitinir him for a drn^ oifense at that time. They had just picked 
him up in ISTebraska with liis trusty sickle in hand, he was cuttinj^ 
down a field of marilmuna in Lincoln County, Xebr., and had 17- 
pouuds in the trunk of his car when the Lincoln County, Nebr., police 
arr-psted him. 

H? is th.e free enterpri'-e type who would come back with a tremen- 
dou'^ amount of marihauna for sale. 

Ml-. Blommer. You liave said tliat you find that methadone in your 
black market comes from physicians in the District of Columbia that 
are jirescribinjT; it. Are there any physicians in Fairfax County that 
are prescribing methadone that you feel is entering in that black 
ma rket ? 

Ml". HoRAisr. No; we can't show any physician in northern Virginia 
add'ug to the black market. We have a couple of cases that involve 
aboi!^ eiirht persons who are receivino; metliadone maintenance from 
Virginia physicians, but we find no indication of diversion. 

Mr. Blommer. If you found a doctor in your county that you felt 
was more of a peddler than a healer, is there any statute in the State 
of V' rcinia that you could use to prosecute that doctor ? 

Ml-. IToRAN. Yes; I think we could prosecute him under our Drug 
Coutrol Act. 

Mr. Bf o^FMER. You have heard Dr. JafTe refer to his law. Then the 
Stat.'^ of Virginia has a comparable law? 

M:-. HoRAN. It is comparable law. In my opinion as a prosecutor it 
would be very, very difficult to get a conviction because I think you 
run into the basic ]>i-oblem that tlie physician sitting there before a 
jury, he can lay it all off on the medical considerations, I made a medi- 
cal judgment and this w^as my mode of treatment. 

I think you would have trouble convicting him imder the statute. 

I think, in Virginia, a far better vehicle would be to go through 
the State board of medical examiners to revoke his license, or in the 
case of pharmacists, the State board of pharmacy to revoke his license. 
I think that would be a far better method of getting at the corrupt 
practitioners than would be a criminal prosecution under the Drug 
Control Act. 

Mr. Blommer. Would you favor Federal legislation in this area? 

Mr. HoRAN. I am totally in favor of Federal legislation that sets 
up strict controls on methadone availability. One of the reasons I feel 
so strongly about it is that I know that for a year we banged our 
heads against a brick wall to try to cut down the availability of this 
drug that was coming out of the District of Columbia. 

We have been totally unsuccessful. We have got three deaths to 
prove it. It seems to me only Federal legislation is going to control 
that situation, at least as far as Virginia is concerned. 

Mr. Blommer. Thank you, JVIr. Horan, 

That is all the questions I have, Mr. Chairman. 

Chairman I^epper. Mr. Mann ? 

Mr. ]Mann. No questions. 



263 

Chairman Pepper. Mr. Steiger ? 

Mr. Steiger. Thank you, jMr. Chairman. 

Mr. Horan, to your knowledge, has any physician ever been charged 
in the State of Virginia under the statute to which you just referred? 

Mr. HoRAx. Yes ; I think there have been charges under that statute. 

Mr. Steiger. To what degree of success ? 

IMr. HoRAX. The net effect was that the physician just turned in his 
license and the prosecution ended there. They didn't pursue it. 

IMr. Steiger. He didn't continue the practice of medicine? 

Mr. HoRAx. He lost his right to practice medicine. 

Mr. Steiger. You mentioned in several instances of private physi- 
cians in the District of Columbia who are the source of diverted 
methadone. How many are we talking about ? 

Mr. HoRAX. At least four. 

Mr. Steiger. At least four. 

And you know who they are ? 

Mr. HoRAX. Yes ; I think we have a good idea. 

Mr. Steiger. What kind of volume are we talking about. I ^uess the 
thing that would really interest us would be not only that which finds 
its way into Fairfax, but that which is being diverted in the District, 
also. 

Mr. HoRAx. One example that I can give you is in the case of one 
specific physician. We have had him under surveillance a number 
of times over in the District because we feel that at least two of the 
drug deaths we have are related to his supply. 

In the course of surveillance of this physician there was never a 
time when the physician had less than 10 patients an hour in his office 
at $15 a throw. If you give him a six-hour day and a 5-day week, he 
has about $325,000 gross minimum in just his dispensing habits. 

Mr. Steiger. Excuse me. All of these patients, based on your observ- 
ance, were receiving methadone ? 

Mr. HoKAX. Yes ; everybody that was in there. That is what he is 
there for. 

Mr. Steiger. He didn't do much else ? 

Mr. HoRAX. He is supposedly a general practitioner, but I think 
his main business is methadone. In his case, he is dispensing in a form 
that is probably costing him $0.25. In my opinion, the whole treatment, 
at least as we know it, has to do with dispensing methadone and 
nothing more. 

Mr. Steiger. Right. 

Mr. HoRAx. There are no rehabilitative or vocational services. 

Mr. Steiger. Do you know the form, the physical form ? 

Mr. HoRAx. Methadone mixed in Tang. 

Mr. Steiger. It was the same form in which it is given at the clinic 
as you described ? 

Mr. HoRAX. That is right. 

Mr. Sreiger. It has been your experience, which you stated in your 
statement, that contrary to some of the medical opinion we had that at 
least one victim apparently did shoot the mixture in the Tang ? 
Mr. HoRAX. Every one of our dead ones was in the vein with metha- 
done; in one case it was the methadone mixed in Tang. Every one 
of them was shooting but only one of them, to my knowledge, had 
Tang. 



264 

Mr. Steiger. Did you discuss with the District of Columbia author- 
ities this particular physician ? 

Mr. HoRAN. Yes ; I did. 

Mr. Steiger. Did they corroborate your observance? 

Mr. HoRAx. As a matter of fact, the District of Columbia Police 
indicated to me that on four occasions they had detectives who went 
to this doctor's office and got methadone. 

Mr. Steiger. Do you know what action they took against him ? 

Mr. IIoran. There was a grand jury proceeding, and the grand jury 
did not indict. I am only basing this on hearsay, as to what the grand 
jury proceeding was. There has never been a prosecution for illegal 
dispensing against that physician. 

Mr. Steiger. Is there an AMA organization in the District? 

Mr. HoRAN. I believe there is. 

Mr. Steiger. Do you know if anybody has called this matter to their 
attention ? 

Mr. IIoiLVx. I think it has been. I think it has been brought to the 
attention of the D.C. Medical Society. 

Mr. Steiger. As far as you know — this fellow — there was no action 
taken to limit this activity ? 

Mr. HoRAN. No ; there was not. 

Mr. Steiger. Now, these other three that you are aware of, are they 
conducting as extensive an operation as this gentleman? 

Mr. HoRAN. One of them may be bigger. 

Mr. Steiger. Is it possible that there are other physicians that you 
aren't aware of? 

Mr. HoRAN. Oh, yes; I am sure of that. "What happens to you. I 
think, is that certain physicians develop a name in drug circles, that 
name is mentioned, and it is kind of a public relations program to be- 
come known and then you become the source. 

I think that is what happens. Maybe the kids in ^Montgomery 
County are going to someone else; I don't know. 

]Mr. Steiger. Have you ever checked with the FDA to find out if 
any of these four have a so-called IND number issued by the FDA ? 

Mr. HoRAN. I have checked with them on two of them and they do. 

Mr. Steiger. They do ? 

Mr. HoRAN. Two of them do. 

Mr. Steiger. What was the response of the FDA when you advised 
them of your observance ? 

Mr. HoRAN. We never had an awful lot of success with FDA. I 
guess we had about as much success as the Bureau of Narcotics and 
Dangerous Drugs. There seem to be some loggerheads between the two 
of them as to what the policy should be. I final Iv brought it to the 
attention of Virginia's two U.S. Senators and "at least, based on 
the speech that Senator Byrd gave on the floor of the Senate, he didn't 
have an awful lot of success with FDA, either. 

Mr. Steiger. I think loggerheads is a very general philosophy. 

I take it, then, as recited both bv the chairman and INTr. ^Nlann.'and T 
guess everybody else, that you do favor very specific Fodornl statutes 
which obviously would be applicable in the District of Columbia « 

Mr. HoRAN. Yes, sir ; I do. 



265 

Mr. Steiger. Limiting the dispensing of methadone ? 

Mr. HoRAN. At this time I don't think private practitioners should 
be in the business. 

Mr. Steiger. Based on your testimony, at an estimated cost of 25 
cents, this man is making a profit of $14.75 a patient, less the overhead 
for rent and lights and heat, and at the rate of 10 patients an hour, 
he is there for somewhere in the neighborhood of $150 an hour ? 

Mr. HoRAN. At least. 

Mr. Steiger. Mr. Chairman, I won't pursue this any further, but I 
would like to compliment the staff and Mr. Horan for spelling this out 
so specifically. I think one of our basic problems has always been the 
tendency to accept the medical profession as being incapable of the 
kind of action you described, and I, for one, have never subscribed to 
that, the sanctity of any profession. They are just people, and I would 
hope that we would be able to do something, Mr. Chairman. 

Chairman Pepper. I am sure the committee will give very serious 
consideration to that problem. 

Mr. Horan. I would suggest, Mr. Chairman, if I might, I think one 
of the difficulties that you run into is that by and large medicine as a 
group has never paid much attention to this subject because it was just 
beyond normal medical needs. I think what has happened is that you 
do have a very small percentage in the clinical end, and of course they 
are some of the great minds on the subject, Jaffe, Wyland. and Dole. 
Those are the people who have the most experience with it. Medicine 
generally has never dealt with it. 

It is not taught in medical schools. When the private practitioner 
gets into this business he is dealing with a very difficult situation be- 
cause he is not really in a knowledgeable position. 

Chairman Pepper. If I may corroborate what you said, my wife and 
I have been identified for a long time with the Parkinson Foundation 
and Institute, and we have come in contact with some of the outstand- 
ing authorities who have developed and discovered methods for the 
practical application of L-Dopa in the treatment of Parkinson's dis- 
ease, and these authorities say very strongly that the average practi- 
tioners should not be permitted to give L-Dopa because they don't 
know that much about it. 

I know a Senator here in the Congress right now who was being 
given, by certain medical authorities, large quantities of L-Dopa. One 
of the outstanding authorities in the country visited the Senator and 
reduced his dosage very much and he improved, because it is a spe- 
cialized subject and you have to know a lot about it before you can 
wisely dispense it. 

JNIr. HoRAN. Yes, sir. 

Chairman Pepper. Have you finished ? 

Mr. Steiger. Yes, sir. 

Chairman Pepper. Mr. Rangel. 

Mr. Rangel. Yes. 

Mr. Horan, you support the efforts being made b}^ the District of 
Columbia and New York City in the area of treating addicts with the 
use of methadone ? 

Mr. Horan. Yes ; in a certain class of cases. 

]Mr, Rangel. And you also support its use in the jails of Fairfax 
County ? 

60-296— 71— pt. 1 18 



266 

Mr. HoRAN. We don't support it as a matter of maintenance, only as 
a matter of withdrawal. 
Mr. Kangel. For detoxification ? 

Mr. HoRAN. Right ; bring them down, and we bring them down in- 
side of 48 hours. 

Mr. Rangel. What is the ethnic composition of the drug addicts in 
Fairfax County? 

Mr. HoRAN. That is a good question. INIy county is about 5 percent 
black. Using the normal phrase "minority group," I don't think there 
is a high percentage of any other minority group in my county. Yet 
in the year 1970, of 322 prosecutions only 10 of the 322 were blacks. 
In our black community, by and large, we never really had a drug 
problem until the fall of last year when one major dealer — and this is 
the only real wholesaler I have ever dealt with in the heroin field — 
moved into our black community, began a selling operation, and un- 
fortunately about the time we got into the act there were a number of 
15- and 16-year-old blacks in the vein, pretty serious heroin habits. 

Of course, Ave never would have cracked it, except for a District of 
Columbia policeman. He is really the one who cracked it for us. 

Mr. Raxgel. So your overwhelming population in Fairfax County 
is white ? 

Mr. HoRAN. That is right. 

Mr. Rangel. If you had to give a general classification, what would 
they be, middle income ? 

Mr. HoRA>r. High-middle income. In median income we are about 
the third or fourth county in the count r3% I think. 

Mr. Rangel. Were you here earlier when I asked Dr. Jaffe whether 
he thought that the medical profession had established a different 
standard in taking care of the problems, medical problems of poor peo- 
ple as opposed to the medical problems of middle income people ? 
Mr. HoRAN. Yes; I heard that question, and I thought about that. 
Mr. Rangel. Aren't you really supporting that type of thing in 
your testimony today ? 

Mr. HoRAN. No. I feel this wa^-, and I feel pretty strongly about it : 
You look at the statistics, the statistics still indicate that one-half of 
all heroin addicts in the country live in the city of New York. Of those 
in the city of New York, let's face it, most of tliem come from Harlem 
or Spanish Harlem. As long as there Avas a problem in the city of New 
York in those communities, nobody really cared, who cared outside the 
city authorities ? 

The rest of the countrs^ didn't worry about it, it wasn't their prob- 
lem. I think, by and large, because it was the low-income groups in the 
city of New York, no one cared. 

That is a tragedy. I think we should have been learning something 
from New York's 30 years of experience and we didn't. 

On the other hand, I think that medicine by and large now sees it 
on a large scale, all over the country. ]\Iedicine is looking at it, and 
I think medicine, like everybody else, is scrambling for an answer. I 
would not impute to medicine the motive that they are willing to take 
the easy way out and just consign these low-income groups to 
addiction. 

Mr. Rangel. Let's look at it in view of your testimony. What you 
are basically saying is that you would like 'to see medical science pro- 



267 

vide otlier ways to take care of your addict population rather than 
relying on methadone 'i 

Mr. HoRAN. Yes ; I would. 

Mr. Raj^-gel. And you also say if the situation gets so bad in your 
community that there is no way out except methadone, then, and 
only then, will you consider this ? 

Mr. HoRAx. Absolutely. 

Mr. Rangel. I am asking you, would you not give the sam.e con- 
sideration to the District of Columbia and the population of New 
York City, that is, until you can evaluate that our addict population 
has reached that point then you would have this same reservation about 
the distribution of methadone for any community ? 

Mr. HoRAx. I sure would. 

Mr. Rangel. I am only hoping that the medical profession will 
share your ideas. 

Mr. H0R.VX. Of course, Mr, Rangel, my difficulty is in evaluating 
New York. I, necessarily, have to rely on what Dr. Dole is saying, 
Dr. Gollance is saying, what New Yorli's experts are saying about their 
population, and they tell me in their writings that what they are 
essentially aiming at is the guy who has been in the vein for many, 
many years, the guy who is just fully, totally, and completely hooked 
on heroin. 

They are saying to me the only way we can treat them is with meth- 
adone. My answer is, I don't know. 

But I do know this, that I don't think methadone is the answer 
if you have got a guy only 2 years in the vein and if they are com- 
mitting New York addicts with 2 years in the vein to methadone, 
I think they are wrong. 

I think they should be going some other route of treatment, 

]\Ir. Raxgel. So if my breed of addict, or a part of my breed of 
addict, is similar to what you described as similar to Fairfax County's 
breed of addict, we would share the same ideas ? 

Mr. lioRAx. Yes ; I don't think the addict, the IT-, 18-, 19-year old, 
I don't think he should be committed to a methadone mamtenance 
program at that age or with that short a term of addiction. When I 
ttilk of breed of addict, really what I am talking about is in New 
York where you have a lot of people who have been in the vein 10 
years, I don't have any of those. But I think that those that are in 
the same position as mine, the 18-year old who has been in the vein 
for a year, I don't agree with New York putting him on methadone 
any more than I agree with Fairfax County putting him on 
methadone. 

Mr. Raxgel. Mr. Chairman, I want to join in with my colleagues 
and thank the staff for bringing Mr. Horan before us. I think it sub- 
stantiates the fact that not everyone has just accepted methadone as 
a solution to our present problem. 

Thank you, Mr. Horan. 

Chairman Pepper. We all will profit very much from your testi- 
mony. 

We have some more questions. 

Mr. Winn. 

Mr. Wixx. Thank you, Mr. Chairman. 



268 

Mr. Horan, let's back up a little bit. Over in Fairfax County, those 
that are on drugs, the kids that are on drugs, a high percentage of 
the users are on marihuana ; right ? 

Mr. HoRAx. Well, a less high percentage all the time. In 1967 one 
case out of every 10 would be a stronger drug than marihuana. By 
last year it was one case out of every four. I think there has been a 
real graduation of marihuana users. 

Mr. Winn. The percentage of those who were on marihuana have 
switched and gone to the harder drugs in the percentage of one out 
of four now ; right ? 

Mr. HoRAN. Yes. 

Mr. Winn. All right. Physicians prescribe all kinds of drugs for 
different things, which is within their realm. It is a little hard for 
me to comprehend that all the bad guys are in the District of Columbia, 
physicianwise, and all the good guys are in Fairfax County. 

Mr. Horan. I wouldn't want to create that impression although, 
you know 

Mr. Winn. I think maybe we have. 

Mr. Horan. In fairness to our medical society, I would say abso- 
lutely that one of our real sources of help out there has been the medi- 
cal profession. I think they police themselves. 

Mr. Winn. That leads me into the next question : Do you think it 
is because of the strength of the Fairfax County medical society that 
they are keeping a stronger and tighter rein on the doctors and physi- 
cians over there that might be prescribing, say free lancing, methadone 
compared to the District of Columbia ? 

Mr. HoRAN. Yes, sir. I think that is probably part of it. I think 
another ])art of it is the fact that when the drug phenomena hit us in 
1966, medicine got in the act early, and medicine began taking a look 
at this subject that they knew nothing about. 

Let's face it, the average physician, if he is below age 25, he never 
had a course in medical school that involved the three main abuse 
drugs in society today, LSD, marihauna, and heroin. They aren't 
taught in medical school because they have no therapeutic value. 

Mr. Winn. They are still not being taught now ? 

Mr. Horan. Well, Georgetown 

Mr. Winn. But not nationwide ? 

Mr. Horan. No ; it is not. 

So medicine, first of all, in a community such as mine, has got to 
get into the act to understand it to begin with, because they are in a 
foreiirii field, just like every layman out on the street. 

Our medical society did that. Our medical society took a good hard 
look at prescribing practices, which I think is really the key. 

I think medicine has got to look at themselves and say what are we 
doing. 

Mr. Winn. Right. That clarifies that, because I don't think you 
really made that clear, at least I didn't get it that way in the earlier 
testimony. 

Now, the Drug Control Act is basically controlled again by each 
State. That would go right along with the same vein of thinking, 
depending on which State is really going to clamp down and wliich 
ones are going to close their eyes to some of the acts ; right ? 



269 

Mr. HoRAN. That is right. 

Mr. Winn. Which would come into effect possibly again because 
of the control and the District of Columbia control might be lighter 
than in Virginia. 

Mr. HoRAN. I think that is right. 

Mr. Winn. Okay. 

Well, I don't know about Baltimore — how about Baltimore? 

Mr. HoiLVN. I never had all that much experience with Baltimore. 

Mr. _ Winn. All right. You mentioned several times the history of 
the jail cases, and I understood you to say that you have a system, I 
believe you referred to some hours and you said 24 hours as an aver- 
age for getting them detoxified ? 

Mr. HoRAN. Most of the time, they are detoxified in 24 hours. 

Mr. Winn. Twenty-four hours ? 

Mr. HoRAN. That is without any 

Mr. Winn. Yes ; right. 

Mr. HoRAN. "\^^ierever it is felt that they need help to come down, 
it is all over in 48 hours. 

Mr. WixN. Then you use methadone ; right? 

Mr. HoRAN. Jail physicians prescribe Dolophine in a certain amount 
and that is what the prisoner gets and it never goes over 48 hours. 

Mr. Winn. What is their reaction to the methadone within that 
48-hour period ? 

Mr. HoRAN. It all depends on what kind of addict they are. 

Mr. Winn. Give us the worst example and give us — and the lightest 
one obviously would have no reaction, probably. The heaviest 

Mr. HoRAN. One of the things you constantly have to watch for is 
the kid who comes in there and the first thing he is saying when that 
jail door closes is, get me the methadone, because the word is out 
among that breed that you can get this stuff if you qualify and you 
may have a rruy coming in there that isn't really any addict at all, and 
he wants methadone because he is going to get high. 

Two davs in jail high beats 2 days in jail any other way. So he wants 
it. ■ ^ _ 

Mr. Winn. How does he get hisfh on oral methadone that is taken 
with Tang? 

Mr. HoRAN. Anybody who says you don't get a high on methadone 
is dreaming. I am talking about you and I. The problem is — and I see 
the newspapers constantly use this term — a "noneuphoric substitute 
for heroin" — it is not a noneuphoric substitute. 

If you are talking about a guy who has been in the vein 5 years, 
yes; but you know, you could do anything to that guy and it is going 
to be noneuphoric compared to heroin. With most other people we 
get a high. 

Many women today in hospitals after a very difficult delivery, the 
prime druff used the following day after the delivery, if the woman 
is in pain and having problems, is what they call in the hospital Dolo- 
phine, and that is methadone, same drug. They give her Dolophine. 

You talk to anv woman who has ever hpd Dolophine and ask her if 
it is euphoric. She says, "You bet your life. That is the reason they 
gave it to me. it lifted my spirits and killed the pain. That is why 
they gave it to me." It does have a definite euphoria on the scale. 



270 

It is not up to heroin or morphine, but it is probably on the level 
with Demerol ; anybody who has ever had Demerol will agree it has 
a good euphoria. 

li a guy comes into jail and is really not an addict, he is going to 
get a high. 

Mr. Winn. Wait just a minute. I want to point out strongly, Mr. 
Chairman, that this is in direct conflict with testimony we have heard 
in the past from several of these other experts. I want to point it out 
because it is completely different. 

Chairman Pepper. Apropos of what my colleague said, the way I 
believe it was stated by Dr. Jaife this morning was that with the first 
little bit of taking of methadone you do get a high, but then if the doc- 
tor giving it keeps on experimenting with the individual and gets to a 
point where that person is stabilized and he doesn't get a high, 

Wasn'tthat the gist? 

Mr. Winn. I believe that was Dr. Jaffe's ptatem.ent, Mr. Chairman, 
but I believe one of the other experts said that there was no euphoric 
sensation from orally taken methadone. 

Mr. HoRAN. I say that is flat out untrue. 

I think the problem is that they are constantly asking a true addict 
is there any euphoria, and he is telling the truth, for him there is 
none, but he is comparing it to heroin. It is like the Irishman and the 
Englishman seeing the guy la3'ing in the ditch. The Englishman said, 
"Look, that guy is drunk." The Irishman said, "No, he isn't, he 
moved." 

It is about the same ball park, really. 

There is medical research that will substantiate the fact tliat if 
you get to a certain level of heroin use, say the guy who is maybe a 
hundred dollars a day in the vein, he gets to a certain level where the 
heroin itself is noneuphoric because he has gotten too high on the 
scale, there is no euphoria left in the drug for him. 

In fact, there are some in research who sav you could create the 
same blockage M-ith high doses of heroin as you do with high doses 
of methadone, because you reach the point where the drug itself 
reaches the block. 

Mr. Winn, Let me ask you one more question. 

Of the drug deaths that you referred to, could the drug deaths be 
from an overdose of oral methadone ? 

Mr, HoRAN. That is a very good question. In two of the cases it 
appears that the dead boy was taking it both orally and intravenously. 
It could have been the combination, although our pathologist 
suspects that because of the massive infusion when you go in through 
the vein, that is what causes the quick respiratory system depression. 

Mr. Winn. We have had some statements made here and the facts 
presented to us, that some of the deaths not in Fairfax County, but 
some of the deaths from methadone really proved out to be not deaths 
from methadone at all, but a combination of lots of other things; is 
that possible ? 

jNIr. HoRAN. Sure it is. 

Chairman Pepper. The committee has to go to the floor to vote. 

We will take a brief recess. We will be back in a few minutes. 

(A brief recess was taken.) 



271 

Chairman Pepper. The committee will come to order, please. 

Mr. Keatinsr, ttouIcI you like to examine ? 

]Mr. IvEATixG. ^Ir. Horan, I was not here for your entire testimony. 
However, the portions that I heard in the question and answer por- 
tion of vour statement I found to be excellent. 

I think ]Mr. Ranp:el had indicated, and I agfree, that the goal we want 
to achieve is rehabilitation and not total maintenance for the life- 
time of the addict. So I don't have any specific question, but I wanted 
to make those comments. 

Chairman Pepper. Thank you. 

]Mr. Horan, your testimony about the drug problem in Fairfax 
County is of particular interest to those of us who are on this com- 
mittee now who were members of the committee in the last Congress, 
because either in the latter part of 1969 or the early part of 1970 we 
held a hearing in Fairfax Countv, vou recall, in the courthouse? 

]Mr. HoRAxrYes, sir : the fall of 1969. 

Chairman Pepper. What interested us was that here was a very fine 
county, composed of very fine citizens, high level of income, primarily 
residential in character, that had a heroin problem. 

I recall very well that we had some students from one of your high 
schools who testified at our hearing and told about the prevalence of 
drugs in the schools, the high schools. 

So, you, as the Commonwealth's attorney of Fairfax, are telling us 
that in 1969 the drug problem in Fairfax County became serious and 
continues to be, I imagine, a very serious problem. 

Mr. HoRAx. Yes, sir ; is it. 

Chairman Pepper. Do you find that drugs, either in one way or an- 
other, are related to the crime problem in your county ? 

Mr. Horan. Mr. Chairman, we have seen in the last 2 years, anyway, 
a veiy high percentage of drug-related crime. They aren't actually 
coming into the court as a drug case, a drug prosecution, but in the 
area of burglary or robbery. We had two murders last year where the 
defense to the murder was that it was committed under the influence 
of LSD. So we have seen a very high percentage of drug- related crime. 

Chairman Pepper. So you are concerned about the drug problem in 
relationship to crime primarily as the Commonwealth's attorney. 

You have observed, as a prosecuting attorney, certain reactions to 
the use of methadone which have also concerned you and which you 
have been very ably telling us about here today. You are speaking, of 
course, out of your experience as a prosecuting attorney, not as a medi- 
cal doctor, I assume ? 

Mr. HoRAN. That is right. 

Chairman Pepper. I suppose we all agree that somehow or another 
we must find a way of dealing adequately with the drug problem, par- 
ticularly heroin problem, and we don't want to create another problem 
in tryinsf to get rid of the first, 

Mr. HoRAX. Exactly. 

Chairman Pepper. You have raised a very serious question as to 
whether or not a private physician, unskilled in respect to this sub- 
stance of methadone and others of similar character, should have au- 
tliority to distribute it. dispense it. There is always a possibility of 
abuse. We are very much concerned about that very thinp-. We had "wit- 



272 

nesses yesterday who brought out the very question you talked about 
here today, the danger of allowing private physicians to prescribe 
methadone at will. 

If it were to be distributed by a private doctor, would you consider 
it desirable, if not imperative, that there be a registry so that every 
doctor who did prescribe methadone would have to report it to a cen- 
tral force or data bank so that any other doctor who wanted to protect 
the public interest would have easy access to that information to know 
what other doctors were prescribing, maybe in the same day for the 
same patient, and also it would give an opportunity for somebody 
looking at that data bank to see how much methadone, for example, 
was being prescribed by any one doctor, whether he was making a pri- 
mary business of that ; would you favor such a data bank ? 

Mr. HoT^Ax. I would feel that, if the private practitioner is going 
to be in the business, the data bank is absolutely imperative. I think 
that is part of our problem here. 

Second, I think ovce. a data bank was established, it should be moni- 
tored by someone outside those who are in the business. 

Chairman Pepper. Well, the last question is: Would you think it 
desirable for the Federal Government to give very serious considera- 
tion to trying to find something better and less objectionable than meth- 
adone in dealing with this matter of breaking heroin addiction ? 

Mr. HoRAN. Yes, I do, Mr. Chairman. INIy concern is with the ques- 
tion of leaving a drug personality when you are finished with your 
methadone program. 

It would seem to me Federal money would be well spent in th_e 
area of trying to come up with a different tool, a different ]>harma- 
cological tool. 

As a criminal prosecutor I sit there and when somebodv shows me 
reduced crime rates I have got to be impressed ; that means something 
to me. Maybe I am selfish. Maybe I don't like as much business as 
I have. 

1 would like to see a reduced crime rate. But I always have in mv 
mind — what is the price? You know, we could reduf^e the rate of rnnp 
by providing every rapist with a wom.an, for example, and you could 
go to your handy service clinic and get a woman and then we cut rape 
in half, or worse, and what is the price? I feel the snme wav about 
methadone. What is going to be the price of having this many drug 
personalities, and that's what we have when the drug is out in socie^v. 

I think the Federal dollar would be well spent, coming up with a 
deto-^ifi^ntion nnd ab'-tinence notential in another drnier. 

T think the chairman mentioned before the possibility of coming up 
with a drug that would make it revolting to have one narcotic. 

With the American pharmaceutical mind we ought to be able to 
come up with something like that. 

Chairman Pept^er. We have discovered from onr A^arious hearings 
that about half of the crime is related to drug use, and, therefore, if 
we could cnt down drug use we would reduce crime. 

That is the reason the House of Pepresentatives is concei^ned about 
drugs. So we are dealing with something directly related to crime, are 
we not ? T ask you as a prosecuting attorney. 

Mr. HoRAN^. There is no question about that. 

Chairman Pepper. Thank you very much. 



273 

Any other questions, gentlemen ? 

Thank you, Mr. Horan. We appreciate your coming here today. 

The committee's next witness is Dr. Daniel H. Casriel, a New York 
psychiatrist who has long been interested in drug addict rehabilitation 
programs. 

Dr. Casriel received his medical training at the University of Cin- 
cinnati, and served as a captain in the U.S. Army Medical Corps. 

Dr. Casriel has served as court psychiatrist in the New York City 
Court of Special Sessions; psychiatric consultant to the S^'nanon 
Foundation ; clinical assistant professor of psychiatry at Temple Uni- 
versity Medical School, and cofounder and medical-psychiatric direc- 
tor of Daytop Village, a therapeutic community for addicts. 

Dr. Casriel, in addition to the private practice of psychiatry, is the 
director of AKEBA, an addict treatment program in New York. 

He is the author of "So Fair A House," the story of Synanon, as 
well as the author of several articles. 

Out of your wide experience. Doctor, we are very much pleased to 
have you here today. I am advised that you are accompanied by Dr. 
Walter Rosen and Rev. Raymond Massy, who will supplement your 
statement and respond to questions. 

Mr. Perito, would you inquire ? 

Mr. Perito. Thank you, Mr. Chairman. 

Dr. Casriel, as you have been kind enough to provide us with some 
written material and a statement by Dr. Revici ; is that correct ? 

STATEMENT OF DE. DANIEL H. CASEIEL, DIEECTOE, ACCELEEATED 
EEEDUCATION OF EMOTIONS. BEHAVIOE, AND ATTITUDES 
( AEEBA) ; ACCOMPANIED BY EEV. EAYMOND MASSE Y. INSTITUTE 
OF APPLIED BIOLOGY, INC. ; AND DE. WALTEE EOSEN 

Dr. Casreel. Yes; I have given you some of the written material 
and my remarks after Dr. Revici's initial lecture on his new drug called 
Perse. I didn't give you the article that Dr. Revici has written, but I 
assume you have that. 

Mr. Perito. Yes ; we do. 

Mr. Chairman, at this point I respectfully request that the materials 
which have been furnished to us by Dr. Casriel be incorporated into 
the record. 

Chairman Pepper. Without objection, they will be received and will 
appear following Dr. Casriel's testimony. 

Mr. Perito. Dr. Casriel, you have worked with the addiction prob- 
lem in a substantial portion of your professional life; is that correct? 

Dr. Casriel. That is correct. Almost 20 years. 

Mr. Perito. Is it fair to say that your therapeutic approach is an 
amalgamation of your learning from Synanon and Daytop, plus 
some innovative thinking of your own ? 

Dr. Casriel. Also my training in Columbia Psychoanalytic Insti- 
tute, my experience in Synanon, my establishment of Daytop, my ex- 
perience in Daytop and my own private practice. 

I have a new amalgam of treatment now which is different from all 
of these and I find it clinically very effective. 



274 

;Mr. Perito. It is my understanding, Doctor, that in your treat- 
ment ajiproach you have been using- a new experimental drug; is that 
correct ? 

Dr. Casrtel. Yes ; it is, Mr. Perito. 

Mr. Perito. And that experimental drug can be properly referred 
to as a rapid-acting detoxification drug? 

Dr. Casriel. Yes ; it can. 

Mr. Perito. That drug is nonaddictive ? 

Dr. Casriel. It is nonaddictive. 

Mr. Perito. Could you kindly explain to the chairman and members 
of this committee what your experience has been with the use of this 
drug ? 

Dr. Casriel. Yes. 

Chairman Pepper. You are talking about the drug Perse, P-e-r-s-e? 

Dr. Casriel. Right. 

I met Dr. Revici, the developer of this drug, a year ago last Febru- 
ary, and I guess like most of you who might have seen it for the first 
time, I didn't believe my clinical eyes, but in the past 14 months I am 
convinced that this is a major breakthrough, on a chemical basis, of 
the addictive phenomena of addiction. 

I personally have given it to about a 100 addicts, about 30 of 
whom have remained in my therapeutic community, called AREBA, 
which stands for the Accelerated Reeducation of Emotions, Be- 
havior, and Attitude. 

I have never found any hai'mful side effects from Perse per se. It 
has removed not only the addicting quality, but it gives the individual 
a sense of well-being, the type of well-being he had before he was 
addicted. 

However, I would like to make sure that the committee realizes 
there is a difference between an addict who is addicted, and an addict 
who is not addicted. 

After you remove the addiction you still have to treat the individual. 

My work in the past 20 years has been with people. I have rehabil- 
itated tlie addicted and it really doesn't make mucli difference what 
they are addicted to, whether it is heroin, or morphine, or alcohol, or 
homosexuality, or delinquency, or whatever. 

The basic underlying personality structure has to be changed. 

Perse has made my job much easier with those character disorders 
called the addict. 

Chairman Pepper. With what? 

Dr. C ASPJEL. With those people, the psychiatrists call the addicted 
personality. 

Chairman Pepper. I see. 

Mr. Pfrito. Doctor, is it fair to sav that you are drawinij a distinc- 
tion between physical addiction and ps3^chic addiction ? 

Dr. Casrtel. Yes ; there is a tremendous distinction. Perse removes 
the physical addiction, the phA'siological addiction. It takes the type of 
psychotherapy that I am doing, whicli is much different than classical 
psychotherapy, to restructure the addict. 

'■I think in terms of the physiological addiction, the physical ad- 
diction, it is interesting that the several people I heard before me 



Avho spoke about methadone and methadone blockade really have not 
mentioned what do they mean by blockade, where does the location of 
the blockading effect, what is the j^hysiological cause of addiction, 
how does addiction work, what is addiction, how does it Vvork, v\'hy 
does m.ethadone blockade, what does it blockade, et cetera, et cetera, et 
cetera. 

These answers have never been mentioned. I am aghast, really, that 
this whole concept of methadone maintenance started with the re- 
search, clinical research of six highly addicted heroin addicts by Dr. 
Dole, who then transferred them to methadone and maintained them 
on methadone. 

Tliere is no theory, no pharmacological theory to substantiate meth- 
adone addiction or methadone maintenance. 

I met Dr. Eevici. He is a fine old gentleman. He speaks in such a 
quiet voice and he is so esoteric it took me about a year to really un- 
derstand his understanding of the nature of addiction, and if I may, 
in the next few minutes, I would like to give this committee my inter- 
pretation of his understanding of the nature of addiction. 

He developed Perse with a pencil and paper. He theorized the 
nature of addiction from his knowledge of intercellular physiology, 
biochemistry, and pharmacology. With this theoretical approach he 
then theorized the type of pharmacological type of drug that was 
needed to solve it. 

Chairman Pepper. That is the way Dr. Einstein developed the 
Einstein tlieory, with a pencil and paper. 

Dr. Casriel. On a piece of paper, a pencil and piece of paper, and 
you might have said he never had enough money to do it any other 
way. 

He took this chemical and applied it successfully to thousands of 
laboratory animals and then finally applied it to several thousand 
patients that he has detoxicized from heroin without any harmful 
effects. 

I have detoxicized about 100 without any harmful effects whatso- 
ever. I have personally taken some Perse, myself, to see the effect that 
it would have in preventing — it also prevents alcohol addiction, alco- 
hol intoxication — to see what it would do to me in preventing alcoholic 
intoxication. Normally 2 ounces of alcohol taken by me will give me a 
drunk and I fall asleep. One big cocktail will get me sleepy on an 
empty stomach. 

I took two of his capsules of Perse and proceeded to drink 8 ounces 
of scotch without any side effects of dysarthria or intoxication. It is 
true my belly felt a little bloated and my wife told me I smelled like 
a kangaroo, but I was not drunk. I had no harmful effects. 

I have no hesitation, if necessary, to inject this whole bottle of Perse 
into me. I am that sure of its safety. 

This is_a 100 cubic centimeter bottle. The addict only takes 5-10 
cubic centimeters. 

("hairman Pepper. Orally? 

Dr. Casriel. Injectable, because we know how much is going in that 
way. The first day about four times, the second about three times, the 
third day twice and the_ fourth day one injection, and this is supple- 
mented with the pills which are continued for the week. 



276 

So that at the end of the week this person is detoxicized from his 
addiction. 

Chairman Pepped. You mean if anybody had been taking heroin for 
a protracted period of time and had that course of injections which 
you just described, all in 1 week, that at the end of that week that 
person would not have any further craving for heroin ? 

Dr. Casriel. Wliile he is on Perse, no further physiological craving, 
but if he stops taking Perse and takes heroin, he will get his old habit 
back, his old euphoria. 

The first injection of Perse immediately cuts down the amount of 
heroin they need to sustain their addiction. I have seen people go from 
iiO bags a day to one bag until they came to me the next clay and got 
another shot of Perse. 

Now, how does Perse work? Dr. Revici stated that heroin is an 
alkaloid. iVn alkaloid is a building block of protein. Those chemicals 
which are addictive are basically alkaloids building blocks of proteins. 
Now, if you put a specific protein into your body like milk, you will 
get a specific reaction to that milk, you will get a marked inflammed 
area and you will develop certain antibodies to counteract the proteins 
in the milk. 

But an alkaloid is only a small portion of a protein and it doesn't 
develop a specific antibody when it is injected. Instead, the body devel- 
lops a generalized defensive substance which is a steroid, which com- 
bines with the alkaloid, be it heroin, or methadone, or morphine. But 
because it is not specific there is an overproduction of this steroid. 

For instance, if one unit of heroin got into the body, the body miglit 
manufacture in an analogous two units of steroids, one which combines 
with the heroin and neutralizes the effect of the heroin. 

The other one is free in the body. It is this free steroid which is not 
attached to the heroin which causes the addictive phenomena, it causes 
the craving phenomenon. 

Now, when a person who has never used a narcotic injects a small 
portion of narcotics into his body or takes it orally, the body's defense 
system is activated. The injectable route is the quickest route. If you 
digest it, it take a little longer to get into the bloodstream. The eftects 
of the narcotics will be felt by the body, it goes to the brain centers. 
It diminished the body's awareness of pain and it is a basic depressant. 
One dies of an overdose because one's respiration stops and then the 
individual stops breathing. That is how one dies of an overdose. 

One of the lifesaving measures is to give artificial respiration imtil 
the effect of the narcotic is passed out of the body. 

Now, the body removes heroin in about 4 to 6 hours. It takes the body 
about 36 hours to remove methadone. That is why one injection or 
one pill of methadone can last at least 24 hours, Avhereas one injection 
or one pill of heroin would only last 4 to 6 hours. 

But when this heroin is detoxicized it is removed by the body, the 
steroid whicli the body has developed previously to defend itself 
against the hei-oin is free and it gradually develops an attraction to the 
body tissue, sotting up a type of ])ulling or craving sensation. It sets up 
in tile body what Dr. Eevici calls an anoxicbiosis, which when ti-ans- 
lated into English means a negative oxygen metabolism. It is ver}' 
similar to the type of pain and feelings you would get if a tourniquet 



277 

were tied around your hand. You get a negative oxygen metabolism 
Avith an increase of lactic acid. The oxygen isn't present to break down 
the carbohydrates in the body. 

"Wliat we have then, after the injection of heroin after 4 hours, the 
heroin goes through the body, we have this steroid which turns upon 
the body which produced it, causing an anoxicbiosis. This is perceived 
by the addict as a craving, as a yearning. As this anoxicbiosis builds 
up greatei- and greater, depending on the amount of steroids, there is 
localized acidosis that develops in the body and the body attempts to 
compensate for this localized acidosis by a generalized alkaline reac- 
tion. This is manifest clinically as the so-called cold turkey phenom- 
enon. It is very uncomfortable for the addict to experience. It is seen 
with high amounts of steroid — not high amounts of heroin — but a 
high amount of steroid developed over a long period of addiction or 
due to methadone maintenance. The blockading effect of methadone, 
by the way, is just the overwhelming of the body's ability to produce 
more steroids and the body then develops a tolerance for methadone, 
just as some people who start to become heavy alcoholic drinkers can 
show heavy tolerance for alcohol before they become drunk. I have 
seen people drink 10 ounces of alcohol and look like they are sober. 

But tlie steroid which has been produced in response to this foreign 
alkaloid, remains in the body about 7 days. It takes about 7 days for 
this steroid to break down. This is why it takes 7 days to detoxify some- 
body from addiction. It takes 7 days to maintain a state of oxygena- 
tion in the body while the steroid is being broken down. 

Dr. Revici has developed other pharmacological tools to go along 
with this basic tool called Perse. For instance, when a person has been 
on methadone maintenance, for instance, he has so much steroid in him 
that all the Perse that you give him still causes some side effects, you 
just can't get enough of this oxygenizing substance into the tissue and 
that is all that Perse is. 

Mr. Perito. Doctor, excuse me. 

Are you saying it is more difficult to detoxify a methadone addict 
than a heroin addict ? 

Dr. Casriel. Yes, because a person on methadone maintenance, has 
tremendous quantities of defensive substance built up in them. Dr. 
Revici has developed a substance which will temporarily combine and 
neutralize the steroid in the blood and this is called trichlorbutinol. 
It is an alcohol, but the interesting thing about this alcohol, it doesn't 
develop more steroid. 

For instance, if I have given a person who is really under tremen- 
dous craving, and you know he has a large steroid component because 
he has been on, say, methadone maintenance, I would give him, to- 
gether with the Perse, some trichlorbutinol. Within 7 to 15 seconds he 
feels better because that alcohol combines with the steroids in the 
bloodstream. It takes about 7 to 15 minutes for the Perse to get into 
the tissue to counteract the anoxiobiosis. If the person is already in 
secondary stages of withdrawal, the cold turkey phenomenon, you can 
give him a little hydrochloric acid to counteract the generalized alka- 
line condition that he has. 

If we know the degree of his steroid developed, we can detoxify a 
person without any side effects. If we don't know the amount of 



278 

steroid he lias in him we might get some ^vithd^a\Tal effects after using 
Perse because we havn't given him enough Perse or we don't give it 
often enough. It is true we do get some side effects, residual side effects 
of their detoxifying process. 

Mr. Perito. Doctor, are you concerned about the possible toxic effects 
of the selenium in that solution ? 

Dr. Casriel. Not at all. I never knew what selenium was. Dr. Revici 
told me there are four types of selenium. Three are highly fatal in 
minute dosages. One is completely inert. Of course, he uses the one 
that is completely inert. It has no effect on the body. It acts apparently 
as a catalytic agent to the peroxide in Perse, and hydrogen peroxide is 
an ox3^genizing agent. Perse has a fatty acid base. Dr. Revici's research 
for the last 50 years concerned itself with these fatty acids. This allows 
this material to get within the cell. ' 

For instance, water doesn't permeate the skin. Fats don't permeate 
the skin, but he has developed substances that can permeate the skin 
and get right into the tissue so that other things such as muscular 
aches and cramps and arthritis can be relieved directly because he can 
add an oxygenizing substance directly to the tissue, wherever he wants 
to apply it. 

So what happens is that when the Perse gets into the cell, the bind- 
ing of the selenium to the peroxide is free. The peroxide that was 
bound to the selenium is free. The peroxide is then used as an oxy- 
genizing agent, removing the negative oxygen balance and giving the 
person a sense of well-being and very frequently the addict will say, 
"My God, what did you give me? I feel as if I got a fix, my stomach 
feels warm and good, my head feels clear, my head feels clear.'* 

"What kind of drug are you giving me because suddenly I feel as 
if I got a fix, except my head stays clear and I didn't get any high 
and I didn't go on the high, but my stomach feels good and I feel 
as if I had a iix, except I don't have any side effects of having a fix." 

Mr. Perito. It is a feeling of normality ? 

Dr. Casriel. Yes ; Feeling of normality ; saying, "I haven't felt like 
this since before I shot dope," is normal. 

Now, the interesting thing with the physicological addiction is that 
the body responds in a nonspecific way to several things, so that not 
only will the body develop a steroid in defense of the" alkaloid that 
you inject, but frequently a hot bath or hot shower will cause a steroid 
development. 

I remember when I was medical superintendent of Daytop, on Satur- 
day night the residents would take a hot bath or hot shower, get 
dressed, and would split out the door, I never could figure out why 
they used to leave on Saturday night after they were all cleaned and 
dressed up. I figured some of them were afraid of the visitors, or since 
they are dressed up, they might as well leave, or it is Saturday night 
and they remember how it used to be on Saturday night. I ani begin- 
ning to realize one of the reasons they would split is because that is 
when they took their hot baths or hot showers. A person who has been 
physiologically clean by cold turkey procedures can, under certain 
circumstances such as a hot bath, develop a craving again as if he had 
need of addiction. 

Mr. Perito. Doctor, I would like you to clarify something: The 
committee has heard some testimony in the past that there are primary 



279 

and secondary withdrawal syndromes. Would you care to comment 
on this phenomena, if such syndromes are, in fact, recognized by 
clinicians treating: addicts ? 

Dr. Casriel. That is probably 99 percent psychological. However, 
it is theoretically possible that he might have had a hot bath, or it 
is theoretically joossible he is under tension. When I get tense my 
"fix" is to go to the Caribbean for a week. Other people's fix is to have 
a scotch and soda. Other people play a good game of golf or tennis. 

The addict, with his psychological memory, says, "'V\nien I feel 
like this I want a good shot of dope." Perse is not going to cure the 
addict, it is going to resolve his addiction and keep it, certainly, 
within manageable results, because on a psychological theoretical level, 
every addict w^ould rather get high on a $5 bag than remain addicted, 
spending $100 a day. He would not have to be addicted, therefore the 
amount of crime that he has to commit will be tremendously reduced 
because he worit need $100 to get a reaction to his heroin. 

So certainly this can remove the crime tremendously. However, I 
Avish to go on record as very strongly suggesting to the committee 
that the person who had been addicted is in tremendous need of psycho- 
logical retraining and retreatment. 

I also want to tell you as a psychiatrist that our classical means of 
treating are completely ineffectual when it comes to the treatment of 
a psychological addict, or as a matter of fact, the psychological delin- 
quent, the criminal, and so forth and so on. 

In the past 10 years we have developed a new process which has 
gotten tremendously favorable results. In AEEBA nine out of 10 
people that come in stay. I expect that those that stay will be well, 
psychologically well; emotionally, behaviorally, and attitudinally re- 
educated, and if necessary reeducated morally, educationally, and 
socially. 

The treatment process is a reeducation of that human being in af- 
fairs of his thinking, feeling, and behavior. This takes time, and the 
medical profession is not yet geared to this type of treatment. But 
v\'e can buy the time with Perse to train and retrain the professional 
army of psychologists and psychiatrists and social workers to truly 
rehabilitate the human being, because heroin or methadone is only 
one chemical. These kids that are on methadone maintenance, I have 
seen them on cocaine maintenance, barbituate maintenance, and delin- 
quency maintenance. 

If you think giving them methadone is going to remove the prob- 
lem, it is going to give you an additional problem. 

One of the big problems you are going to get is amphetamine and 
cocaine. Cocaine especially because methadone doesn't stop them from 
enjoying cocaine, and cocaine is a much more dangerous drug than 
heroin is. So are amphetamines and, of course, so is LSD. 

But at least we now have a chemical that is nonaddicting, that is 
nontoxic in any way, that will remove the addictive phenomena. Also, 
by the way, work for barbiturate addiction and alcoholic addiction. 
It can sober up the alcoholic as it does the narcotics addict and also 
sober up the barbiturate or a person in a barbiturate coma the same 
wav. 

I, for the life of me, can't understand why they have been dragging 
their feet on this chemical. 



280 

Mr. Perito. You are referriii"' to the FDA now? 

Dr. Casriel. Yes. Over 2,000 people have taken it. I would be will- 
ing to take this whole bottle by injection or orally. I am not a hero — it 
is a perfectly safe drug. It is a perfectly safe drug. 

Chairman Pepper. How long has it Ijeen now since Perse was sub- 
mitted to the Food and Drug Administration? 

Keverend Massey. About two and a half months. 

Mr. R angel. That is the second time? 

Reverend Massey. That is the second time. 

Dr. Casriel. To me this is lifesaving. 

Cliairman Pepper. You personally treated how many patients when 
you first started ? 

Dr. Casriel. Approximately 100. 

Chairman Pepper. And you personally observed those patients? 

Dr. Casriel. I personally observed those patients and I have per- 
sonally observed my reaction with Perse in me with alcohol. 

Chairman Pepper. And you have had no injurious effects in your 
patients ? 

Dr. Casriel. No. 

Chairman Pepper. That has achieved the effect you have described, 
to detoxify ? 

Dr. Casriel. Yes. I have been able to detoxify three people who were 
on methadone maintenance with this, who have come to me. One was 
on 140 milligrams of methadone maintenance, one was on 160 milli- 
grams of methadone maintenance, and one was on 240 milligrams of 
methadone maintenance. 

In addition, the person on 140-milligram methadone maintenance 
was also taking about 60-100 milligrams of barbiturates a day and was 
also taking anything he could take, anything he could get, which in- 
cluded cocaine, and so forth. 

Chairman Pepper. Doctor, how would that interesting, and certainly 
challenging, drug be properly adapted for general use into a drug ad- 
diction treatment program ? 

Dr. Casriel. Under methadone — and I agree with the previous 
speaker that methadone should not be in the hands of the general physi- 
cian — it shouldn't be used, but if it has got to be used, don't put it in 
the hands of general physicians. I think it is chaos under clinical con- 
ditions. 

But Perse can be given to every physician in the country. This is 
not addictive. You only need to use this at most for a week. 

Chairman Pepper. You mean Perse could safely be used and pre- 
scribed by a private physician. 

Dr. Casriel. Every physician in the country. It is not a narcotic. 
He doesn't need a special narcotic control, it is not dangerous, it is not 
addictive. 

It will also detoxify alcoholism and barbiturate addiction. It is a 
lifesaving drug. It is a major breakthrough in treatment. It has given 
me the opportunity to treat the addict as I would treat the aA'erage 
character disorder, because we don't have to treat them against their 
physiological craving. We remove that right away. They are imme- 
diately able to get into treatment. I don't have to wait for a period 
of detoxification of a month or 2 weeks, or whatever. 



281 

They are immediately psychologically capable of being engaged 
psychologically. . 

i wouldn't think of trying to psychologically treat a person on meth-' 
adone any more than I wonld try to wash a person who has a raincoat 
around them. You just can't get through that protective rubberized 
skin. 

Mr. Pekito. Knowing what you do, Doctor, about Perse, would you 
use methadone to detoxify an addict, rather than rely on Perse ? 

Dr. Casriel. No ; this is much easier, much simpler, much cheaper, 
much quicker, much everything. 

Chairman Pepper. By the way, what is the cost of Perse ? 

Dr. Casriel. Reverend ISIassey, you are the administrator to Dr. 
Eevici. 

Reverend Massey. I can't recall the exact cost, but I understand it 
should be less than $1, or less than $1.25 or something like this. 

Chairman Pepper. Less than $1 a bottle ? 

Dr. Casriel. About 5 cents a shot. 

Chairman Pepper. How long would that bottle that you said cost 
less than a $1, how long would that treat a heroin addict? 

Dr. Casriel. An average addict needs about 6 shots, that is about 
20-40 cubic centimeters. You could treat two-and-a-half or three ad- 
dicts with this. 

Chairma]! Pepper. Treat two-and-a-half addicts. That is phenom- 
enal. Doctor. 

Dr. Casriel. Yes, it is, Mr. Pepper. It is a major brealdhrough. I 
didn't believe it when I fir^^t saw it because I have been treating drug 
addicts for a long time. But I have been with this now for 14-15 
months, and it works. "\'\niat can I tell you ? 

Mr. Perito. Do you think your AREBA approach would work with-r 
out Perse ? 

Dr. Casriel. Yes ; but not as well. We don't have any problem hold- 
ing them. These kids stay. We suck them in psychologically. We don't 
have to work against the physiological craving. 

Mr. Perito. If that precludes the physiological craving it is pos- 
sible for a person to detoxify on Perse but relapse soon after the effects 
of Perse wear off ? 

Dr. Casriel. Yes. You are not going to cure the psychological prob- 
lem with this. You will cure the physiological addiction with it. Those 
people still need to be treated. 

Mr. Steiger. Would counsel yield on that point ? 

I wondered. Doctor, the person who repeats the process several times, 
does he require additional Perse each time ? 

Dr. Casriel. No. 

Mr. Steiger. In other words, there is no cumulative resistance to 
Perse ? 

Dr. Casriel. Not at all. 

Mr. Steiger. Thank you, Mr. Perito. 

Mr. Perito. As far as you know, the 1,900 patients that have been 
treated by Dr. Revici are drug free ? 

Dr. Casriel. I don't know. I haven't followed Dr. Revici's patients. 
I have enough trouble following my own. 

Reverend Massey. May I answer that question for you? Approxi- 
mately 1,900 patients treated with Perse, I can say that these 1,900 are 

60-296— 71— pt. 1 19 



282 

not drug free. I can say approximately 7.5-8 percent, that I know of 
and follow up, are drug free. 

What does that give us? Approximately 143-145 individuals that 
I know of that are free of drugs. 

The other remaining amount are either individuals whom I could 
not keep up with because of no addi-ess, or moved, no contact, out of 
town, because we get them from Boston, we get them from California, 
as well, coming for this treatment. So, therefore, I can say I can put 
my hand on approximately 145 individuals who are drug free from 
this medication here. 

Dr. Casriel. I would like to say one other thing, and I think it is 
imporatnt in passing. 

Dr. Revici does not charge anyone an3^thing for his treatment. I have 
gotten medication now for 15 months without cost to me, and I pass 
that on to my patients. In other words, I don't charge them for this 
drug. 

Dr. Revici is the head of the Institute of Applied Biology which 
which is a nonprofit corporation, and I have seen him treat literally 
scores while I have visited him, scores of indigents. There has never 
been a question of fee. I have seen him treat people who come in who 
are extremely wealthy, and there has never been a question of a fee. 
This is a man who is one of the true humanitarians that I have met, 
one of the very, very few. 

Chairman Pepper. Doctor, in a treatment program, in the use of 
Perse, would there need to be clinics set up over the country to get it, in 
addition to the doctors? 

Dr. Casriel. No ; the Perse, itself, could be given through medical 
channels because it is not addicting, it is not habit-forming. You 
just take it for a week. It is like penicillin. If you got pneumonia 
you take penicillin for a week and it cures pneumonia. If you are ad- 
dicted and 3^ou take this for a week it cures your physiological 
addiction. 

As Reverend Massey said, a certain small percentage, once they got 
free of the monkey on their back, will stay clean. A much larger per- 
centage, because they are psychologically mixed up, will revert back 
to addiction. 

However, they don't like a larce habit. They get no fun out of a large 
habit. Once they found out this can at least remove the habit, thev 
won't need $100 a day to maintain their habit. One shot of heroin will 
give them a much better high than $100 worth before. 

However, these people now can bo engaged in psvchological treat- 
ment. You have to treat the individual psychologically. It really does 
not make any difference if they are addicted to morphine or bar- 
biturates, or liSD, or anything else, you have to treat them 
psychologically. 

I also again wish to reiterate that the current classical psycholoiricnl 
treatment is not effective, but we have developed an effective process. 
This will give us time to tool up. Currently, right now, Phoenix 
ITonse, which is the largest rehabilitation center in the country, 
which is over 1,000 people, have sent to my institute 15 of their top 
clinical people who are actively involved in the rehabilitation of th^ir 
addicts, and I am retooling them in my current knowledge, the psy- 
chological knowledge of what I have learned. 



283 

Drug addiction can be cured. This doesn't mean just a remova\ of 
drugs. It means changing the underlying structure of the personahty. 
We have to do this. We cannot settle for anything less because there 
are just too many people who are addictive prone, certainly over half 
the country. 

Chairman Pepper. Doctor, I hate to interrupt you. 

Members of the committee, we will take a short recess. 

( A brief recess was taken. ) 

Chairman Pepper. The committee will come to order. We will con- 
tinue with the questioning of Drs. Casriel and Rosen and Reverend 
Massey. 

Mr. Mann, any questions. 

Mr. Mann. Doctor, you have been using Perse and the followup for 
about 14 months ? 

Dr. Casriel. Yes. 

IMr. Mann. What dropout rate have you had in your experience? 

Dr. Casriel. Well, I am a psychiatrist and I treat the total spectrum 
of problems. I have developed a private therapeutic community called 
AREBA, which certainly about 00 percent are there because of the 
use of heroin and similar destructive drugs, a couple LSD. We have 
only lost five. About 95 percent have stayed. We are now graduating 
our first members. 

The program is geared for 9-month rehabilitation courses. We 
sent our first member back to your home State, Miami, Fla., about 2 
weeks ago. He is a beautiful boy. I helped establish Self -Help and the 
Concept House in the Miami area. He is now in Self-Help, helping 
scores of others. 

Chairman Pepper. Have vou fijiished, Mr. Mann? 

Mr. Mann. Yes. 

Chairman Pepper. Mr. Rangel. w^ho has been very much interested 
in Per?e. has asked to speak to a question out of order because he wants 
to clear up some possible confusion. 

Mr. Rangel. Yes. 

Reverend Massey, you gave a very small percentage of Dr. Revici's 
that are drug free. 

Reverend Massey. Yes, sir ; correct. 

Mr. Rangel. But these are persons you can identify as beins: druar 
free? i ^ j b 6 

Reverend Massey. Correct. 

]\Ir. Rangel. This does not imply that the other patients with the 
doctors are not drug free? 

Reverend Massey. True. 

Let me state here that I know of individuals going through this 
ti-eatment, and I want you to understand that I have been with Dr. 
Revici right from the beginning when he started the use of Perse. 
Every day, 7 days a week for the past 17 months. Individuals moti- 
vated somehow, self-motivation or through motivation of the court, 
have come to Dr. Revici for treatment for the detoxification from the 
use ot hepom, alcoholism, or some type of drug, have been treated and 
detoxified. But once they have left, some go immediately back to the 
use of drugs. 

Now, why? Because probably their habits were very high 40 50 
bags a day, which totals about $100 a day. To get it back down to a 



28 



A 



$2-a-day habit these individuals who return directly to the use of 
druo:s after detoxification have no real intent of really staying drug 
free. 

Then we have those who are really motivated within themselves to 
really leave the drug scene. These individuals, some that I can account 
for, like I stated, still others who are still drug free, I am sure, but 
cannot be reached. 

]\Ir. Raxgel. Reverend INIassey, this drug only brings the addict back 
to where he was before he became an addict ; is that correct ? 

Reverend Massey. True. 

]Mr. Raxgel. And the patients that you have been dealing with 
mainly have come from the Central Harlem community; is that 
coi-rect ? 

Reverend Massey. Correct. 

!Mr. Raxgee. So no matter what this drug does, it sends them back 
to the same addict environment from which they became addictive in 
the first place ? 

Reverend Massey. Correct. 

^Lr. Rax^gel. So I believe that Dr. Casriel was sayinof this does not 
take care of the psychological problem which may exist before the 
person became an addict ? 

Reverend ISIassey. It on! v takes care of the physical. 

Dr. RosEX. The concept has to be, in anything such as this, that there 
is a totality of treatment. You can't deal with drug addiction, with 
alcoholism, with any of those problems, unelss you have a totality of 
treatment. That totality' must encompass both psychological and 
physiological. It must encompass rehabilitation, vocational rehabilita- 
tion, counseling, changing the patterns of their economic existence, 
changing the patterns of where they live and how they live. 

If you are going to have any kind of program that is worth a darn 
you will have to have a program that encompasses all of that. 

What Dr. Casriel was saying, Perse is great, you can give it and have 
an addict withdrawn without any problems and then you must ap- 
proach the other aspects of the situation that need attention. It ran be 
done immediately with the totalitv being added as you go along. 

But it is never going to work without funds because Dr. Revici just 
started with this 14 months ago. Of course, he has many addicts com- 
ing in and goino; out the old revolving doors, but no money to do the 
total program. It is not going to work to that effect until you have a 
totality of program in anything, either the drug addiction or the 
alcoholism. 

]Mr. Raxgee. I would like to state for the record that it was this 
drug and Dr. Revici I was speaking about when I first had tlie oppor- 
tunity to join this committee and liavinff been born and raised and still 
live in this community, I don't suppose anybody was more cynical 
when it came to drug rehabilitation than mvself. 

I just want the record to state that my first impressions. I felt the 
need to bring with me the administrator of the Harlem hospitals drug 
rehabilitation program. That is how cynical I was before I had the 
opportunity to meet Reverend IMassey and talk with Di-. Re\nci. The 
results and what we witnessed with patients was so unbelievable that 
the doctor from Municipal Hospital has now gone back on a daily 



285 

basis in order to continue with this chance to see the miraculous re- 
sults that have taken place. I personally have gone back on several 
occasions to the clinic. I have talked with patients, talked with young- 
sters that have given up on being decent human beings, given up and 
have talked with their parents and grandparents, many times in the 
presence of responsible State officials that have subscribed publicly 
to the methadone program and yet vigorously support the efforts 
that have been made by Dr. Revici. 

I just want that stated for the record. I only regret that the illness 
of Dr. Revici prevented him from more eloguently being present. 
But I hope that in the near future, whether we have further hearings 
or not, that each one of you will have the opportunity to really meet 
this very decent human being who I believe has made an outstanding 
contribution in this area. 

Chairman Pefpek. I want to say for the record that Mr. Rangel has 
been impressing upon the consideration of the committee this remarka- 
ble work and Dr. Eevici's remarkable work and your splendid coop- 
eration for some time. He has entertained, as he has expressed here to- 
day, high hopes for it. That is one of the bases on which we initiated 
these hearings, to see if we can't get the Federal Government to have 
a part in the development of some of the brilliant leads that we have 
alread}" learned about. This is one of them. 

Now, anything that offers a hope, even the hope that you have 
testified about here today, should receive the strongest approbation 
of the Government of the United States as soon as the Government 
is satisfied that it is safe and will do substantially what you claim 
for it. Because this would, to a large degree, enable us to combat the 
drug problems in this comitry. 

Seventy percent of the people in prisons in this country are there 
for alcohol abuse. We have got to spend billions of dollars if we are 
going to use the current methods of dealing with drug addiction. If 
we could develop something like this it would make the whole prob- 
lem immeasurably more easy and cheaper and effective. 

Dr. Casriel. I asked Dr. Rosen to come with me. He is a general 
practitioner in Harlem. He has been spending a considerable amount 
of his time with alcoholism and the problems of that. 

Chairman Pepper. You find it effective with respect to alcoholism ? 

Dr. RosEX. Let me give you a little bit of background that might be 
of interest. 

I started practice in Harlem 21 years ago, and I agree with what 
Mr. Horan said about the training that a doctor gets in terms of drug 
addiction and alcoholism. It is practically nil. 

I had an excellent residency in internal medicine and I came into 
practice and thought I was pretty well equipped to handle anything 
that came along. All of a sudden I am operating a practice in Harlem, 
I see alcoholics, drug abuse, and I don't know what to do about it. 
The only thing to do when a drug addict came into my office would 
be to suggest Lexington, Ky. It has a facility and that is about where 
3'OU can go, and they would laugh in my face. 

This was a period of frustration for many, many j^ears and at pe- 
riods of time I would knock my brains out, calling social workers, try- 
ing to find something to do for them, somehow to handle the situation. 



286 

I got to the point once in terms of the methadone we are talking about 
in the private practitioner's hands, there were a number of houses at 
one point, about 4 or 5 years ago, who were dealing with drug addic- 
tion : Exodus House, Phoenix House. These drug addicts are pretty 
shrewd. They come in with, "Doc, I am drug addict, I want to kick the 
habit and if you give me something to help it. I swear I am going to 
kick it. I have a job, a family, I can't go into a program." 

Most of the time, of course, this was something I wouldn't accept 
from them. I thought at this point maybe if you get a drug addict or 
any kind of addict who has some motivation, maybe you can use that 
motivation and direct it. 

So I contacted Exodus House and we got together on a program 
where as somebody came to my office under those circumstances I 
would say, "Look, if you are really sincere and you want to do some- 
thing I will give you enough Dolophine, methadone, to withdraw but 
not yet, you first have to go to Exodus House, you have to get involved 
with a meeting there, get a letter from them and come back here. 

"I will give you enough for 2 days, until the next meeting, and 2 days 
more, and 1 day more, until you are withdrawn." 

• As Mr. Horan said, public relations in the drug addict community 
is so great that they were falling all over themselves in my office wait- 
ing for prescriptions for methadone. 

Sure, they hit the first meeting, the second meeting, but I think out 
of the whole group, maybe I did about 30 in a month's period of time, 
there wasn't one that really made it. 

Eeally what they were doing, if the habit is getting to be so high 
that they can't afford that kind of habit, the methadone cuts it so that 
they can go and start back down again on one bag instead of five or 
three instead of 10, or if things are tight on the street and they can't 
get it, methadone is a good thing. 

I don't know their names, but there are a lot of practitioners I know 
of who will give you a prescription any time you walk in. They are 
not involved in drug-addiction programs. They are selling methadone 
prescriptions. 

Chairman Pepper. Mr. Steiger, any questions? 

Mr. Steiger. Yes, Mr. Chairman. 

Let me understand. Dr. Casriel, this Perse will detoxify an5^body 
who is addicted chemically, I use that advisedly, recognizmg that an 
opiate is a natural derivative, including alcohol ; is that correct ? 

Dr. Casriel. That is correct. 

Mr. Steiger. When you say detoxify an alcoholic, are you saying 
that works when a gaiy is hungover, v.ill this cure the hangover feel- 
ing, because this is something I understand ? 

Dr. Rosen. No; hungover is not a criteria of alcoholism. Wliat we 
are dealing Avith is somebody who has passed over the line from social 
drinking to compulsive. 

"What the Perse will do, and it is very interesting, because of this 
stuff Dr. Casriel came up with, because I didn't know some of these 
concepts — some of the concepts up at Columbia about the development 
of alkaloids — what happens in anybody's body when they take a drink, 
what is the physiological mechanism. They have come up with some 
studies that have shown there are actually alkaloids produced in the 
brain that are similar to the alkaloids of hallucino<renic substances. 



287 

Just to get back to your question of what Perse does, in the same 
sense it wiU detoxify a drug addict, in the disease of an alcoholic there 
is a physiological mechanism that creates the compulsion and Perse 
will destroy the physical compulsion of that disease. So that they will 
go through withdrawal like a dream. 

Alcohol is more frightening than narcotics. They die from alcohol 
withdrawal, but not from narcotics. 

Mr. Steiger. Assume they have a man in a state of alcoholic in- 
toxication. Have you had any experience — or you. Dr. Kosen, or you — 
or perhaps Reverend ISIassey has observed this — we give Perse to the 
man in the state of alcoholic intoxication or under the influence of al- 
cohol or LSD ; what is the result? 

Dr. Casriel. With alcohol he is sober. With LSD, it doesn't help. 

Mr. Steiger. He gets sober with one shot ? 

Dr. Casriel. Weil, I have only had about half a dozen acute alco- 
holics come into my institute, but with one shot they get sober ; yes. 

Dr. Rosen. It varies, and just how darned drunk they are. I have 
had them falling down drunk and it doesn't always sober them up, 
but where a second shot 

Mr. Steiger. In what period of time would it sober up a person 
reasonably drunk? 

Dr. Rosen. About 5 or 10 minutes; 5 or 10 minutes after the injec- 
tion you will have someone just weaving a bit, sober. 

Mr. Steiger. A^Hiat would happen if an addict, whether it is in 
speed, freak or whatever, if he were to take Perse, or Per-se, which 
pronunciation do you prefer? 

Dr. Casriel. You name it. Perse. 

Reverend ISIassey. I think Dr. Revici's pronunciation is Per-se, being 
French, it is Per-se. 

Mr. Steiger. "Wliat would occur, or have you considered the possi- 
bility of the individual who, anticipating a breakdown of his char- 
acter, would take Perse in advance of either amphetamines or alcohol? 

Dr. Casriel. I already mentioned this. I did this to myself. 

Mr. Steiger. You took that prior to your 

Dr. Casriel. Prior to the 8 ounces, and I didn't get drunk, and 2 
ounces will get me drunk. 

Reverend ISIasset. May I state here, also, with the addict himself, if 
he takes this prior to an injection of heroin he will get high. 

Mr. Steiger. He will get high ? 

Reverend Massey. He will get high. 

Mr. Steiger. How about amphetamines ? 

Dr. Carsiel. Not amphetamines. It works on barbiturates, alcohol, 
and narcotics. These are all alkaloids. 

Mr. Steiger. All right. In the production of this substance obviously 
it is inexpensive to produce. Is Dr. Revici producing it himself? 

Dr. Casriel. Yes. 

Reverend Massey. In his laboratories. 

Mr. Steiger. Has he approached a pharmaceutical house or have 
they approached him ? 

Reverend Massey. They have approached him. 

Mr. Steiger. And he is not interested ? 

Reverend ]Massey. Yes, he is; but he wants to get Federal Drug 
Administration approval. 



288 

Mr. Steiger. You mentioned anoxicbiosis. Is that a characteristic 
symptom of all of the withdrawals, of either alcoholism or narcotic 
withdrawal ? 

Eeverend JMassey. I can't answer that with authority, because I 
am not, you know, I am not Dr. Kevici. I think the anoxia, the negative 
oxygen metabolism is the criteria. 

^ii-. Steiger. All right. Again using the same anticipatory vision, 
do you know if Dr. Revici has measured the oxygen deficit effect ? 

Reverend Massey. Yes ; he has. 

Mr. Steiger. Giving this prior to say just exertion because, you 
know, we develop anoxia if we climb the stairs. 

Reverend Massey. I saw his book that was sent to the Food and 
Drug Administration with all the tests with the oxygen differentia- 
tion, with Perse, without Perse, and so forth and so on. He has all 
that documented. 

Mr. Steiger. That is a measurable situation ? 

Reverend Massey. Yes ; he has that measured. 

Chairman Pepper. Would you let me interrupt you just a minute? 

We have this as a matter of committee business. I have had a note 
passed to me by Mr. Wiggins, the ranking Republican, advising me 
that five members of our committee have other commitments and can- 
not be here tomorrow, and since all of us would like to hear the testi- 
mony for tomorrow, we will defer tomorrow's hearing until a later 
date. 

Mr. Steiger, you may continue. 

Mr. Steiger. Doctor, both of you are, I assume, aware of no con- 
sistent ill effects in the use of this. On the other hand, you don't know 
of any prolonged use. By prolonged — is there anybody. Reverend 
Massey, perhaps you could help us — is there anything in the 7 months' 
period of your exposure to Dr. Revici's treatment, do you know of 
anybody who has been treated, say at least twice a month, or once a 
month ? 

Reverend Massey. No, Mr. Steiger, no ; in reference to that I know 
Dr. Revici has given this over a long period, to laboratory animals, 
without any harmful side effects. 

He has also told me the amount he has given mice and rats that is if 
similar amounts were given to human beings in terms of weight, about 
6 liters have to be injected before a toxic response. That is less fatal 
than the water. I couldn't inject 6 liters into the body. 

Mr. Steiger. All right. All the substances that make up this mate- 
rial are available? 

Dr. Casriel. Inexpensive and available. 

Mr. Steiger. Inexpensive and available, and you say you can give it 
orally but it simply takes longer to achieve the same effect, in a larger 
dosage ? 

Dr. Casriel. Right, a little larger dosage ; yes. 

Mr. Steiger. In your experience with your community with 
APEBA, do vou find yourself oombatiTiir the ol-)vions ro^^nonso of the 
dedicated addict who says, "You found this wonderful thinir and I 
am now able to get high for little or nothing and there is really no 
reason for me to stay straight because I can s^ei: " 



289 

Dr. Casriel. No; that hasn't been my experience. AREBA is for 
an upper-middle-class youngster and we seek them in psychologically 
and they don't even think about drugs after a few days of AREBA. 

Dr. Rosen. Most of them in my group, which is entirely different 
from the AREBA group, come and eventually agree to go through this 
treatment because they have some motivation, so they go and have it. 
But what happens to many of them is that they get thrown back into 
the same environment and same friends and it is not a question of 
using this and Imowing they are going to go back to it. The motive 
is there originally, but the same life pressures cause them to relapse. 

Mr. Steiger. The guy goes back to his own group and who started 
in the first place, he is still better off because he can conceivably hold 
a job and do all of these things ? 

Dr. Casriel. He doesn't have to be addicted any more. 

IMr. Stetger. I understand that, but there is no blockage effect — 
yes : there is a blockage effect as far as the narcotic 

Reverend Masset. Let's put it this way : This also reduces the mental 
desire for the use of the drug, as well. 

Mr. Steiger. That is prett}^ hard to measure, isn't it. Reverend? 

Reverend Masset. I am telling you. 

Let me tell you from what I know, not from what I am guessing at : 
I see 75 percent of our patients being treated. "\Anien I say 75 percent, 
that is a large percentage, in and out of a hospital. 

Now, we have seven male beds and three female beds. Those who go 
into the hospital and stay the length for treatment, I see them all. 
I am tliere every dav. 

Mr. STEiGER.That is 1 week ? 

Mr. Perito. Is this Trafalgar Hospital that you are referring to ? 

R e veren d Ma sse y. Th at is right . 

Mr. SiT^iGER. This is in the hospital for 1 week ? 

Reverend Massey. Correct ; for the 1-week period. 

There is something amazing about this medication. The individual 
who is in the hospital for the 1 week, when he is discharged and comes 
back to the office where the doctor talks to him, I talk to'him, he states 
he has no desire whatsoever, no desire whatsoever for the use of heroin 
or what have you that addicted him previously. 

Now, how does he take on this desire after treatment? He returns 
to the environmental surroundings. He is first offered by the pusher 
in the neighborhood a bag of heroin free. Why? Because he has 
detoxified himself, he is not addicted any more, he has no desire. I 
get this constantly from most individuals who stay through the period 
of treatment. But he falls back into that old environment again, no 
job and society constantly turns him away. 

When they see he has a record or has been addicted to drugs he is 
turned back to his environment because society rejects him, because 
he was a previous addict. 

Mr. Raxgel. I would lilce to state that while Dr. Casriel and 
Reverend Massey have stated that the addict treated says he felt 
normal, I think the tragic thing is that after treatment at the clinic 
they have merely said they want a job. 

Dr. Casriel. Right. 



290 

Mr. Eangel. I could see then that if I was unable to fill that need 
for a job, how easy it would be for them to go right back into the 
same population. So I think we are both saying the same thing. 
Reverend Massey, in addition to working very closely with Dr. Revici, 
has a long reputation of working very closely in the community, so 
that he really wears two hats when he is working in the laboratory, 
because the other is his very close identification with the addict popu- 
lation in my district. 

Mr. Stetger. I just have one question. I am about through. 

You know, we heard Dr. DuPont previously, and I don't remember 
who else, that the "I feel normal" reaction is one that they have heard 
from people who are on methadone maintenance. I don't want to make 
an equation here, but obviously they feel an improvement, and there is 
clearly a chemical improvement because the physiological craving is 
answered and there is no high and so they feel relatively iiormal. 

Are they getting any kind of a comparable situation out of Perse 
and if not, why not ? 

Dr. Rosen. Simply because of the fact that they are being normal 
on a drug. They are taking the drug to be normal. With Perse, you 
give them the drug and detoxify them and the noncravings and the 
normal feelings they have are while they are not on medication. You 
do that with an alcoholic where the craving lasts 3 months with this 
up and down sensation that he needs a drink. I will take them through 
withdrawal and they will tell you they have been through drying-out 
places before and they know they have got this constant hassle with 
needing a drink on Perse without tranquilizers, without any sedative 
drug, they will say, I feel normal. But they are not on addictive drugs 
while they are saying it. ■,■<.■< 

Reverend J^Iassey. Gentlemen, may I say here that with methaaone 
—and I was for methadone at one time because I had no other source 
of referral. I figured that if methadone was available, shoot, why not, 
if it is going to reduce the crime rate in the communities, if it is going 
to allow an individual to become employed, why not. But then when 
I approached Dr. Revici in coming up with a medication that is not 
addictive, whereas an individual does not have to depend on a drug to 
survive, to work every day and to lead a normal life, then I felt that if 
Dr. Revici can fulfill these desires of coming out with a medication 
that will detoxify an individual 100 percent, that is, taking the drug 
out of the body and leaving it normal like myself, I am under no addic- 
tion at all — then I feel that an individual who speaks normal from the 
use of detoxification with Perse, then he actually speaks the truth. 

Now, how can an individual who is taking methadone in place of 
heroin, even if he is maintained, say he feels normal ? The body has 
drugs in it. If he has used — if methadone is used as a treatment for a 
number of days, he still has drugs in the blood cell. He is not normal. 
He will have reactions. He will have a desire, because the body is 
calling for more drugs at certain times. 

It is impossible for an individual who is on methadone. I have taken 
methadone, myself, and I think I heard a gentleman ask whether or 
not an individual can get a high off of methadone orallj\ I was never 
on any dr-ugs at the time, and I have experimented with drugs for 
the main reason I wanted to be able to converse with the addict, and 



291 

I am out in the street at 3 and 4 o'clock in the morning with the addict 
trying to help him, and to be able to communicate with the addict I 
have to understand him. 

I have tried — not LSD, I am sorry — I have tried heroin, cocaine; 
marihuana is out of the picture because that is not a drug. I have tried 
some barbituates, Seconol, you name it, I have tried it, except LSD 
and speed. I know what I am talking about. 

INIr. Steiger. AVliat happened when you took methadone ? 

Reverend Massey. I got high off of 10 milligrams — I got high. 

Chairman Pepper. Is that all ? 

Mr. Steiger. Yes, sir. 

Chairman Pepper. Mr. Winn, would you yield ? 

Mr. Wixx. I will be glad to yield. 

Chairman Pepper. Thank you very much. ]SIr. Keating, you may 
inquire. 

Mr. Keatixg. I am interested in a couple of points. Maybe you said 
and maybe I didn't hear it, but I assume that you implied there are 
no withdrawal sjmiptoms with the use of Perse. 

Dr. Casriel. If it is used correctly there is absolutely no withdrawal 
symptoms. 

Mr. Keating. They don't go through the suffering that is associated 
with withdrawal ? 

Reverend Massey. May I answer that question ? 

I don't like to, like I say — I noticed with the addict who is going 
through treatment in the hospital — and let me say Dr. Casriel is in 
one location and I am in another — there may be some symptoms as 
far as where I am. There may be some symptoms of withdrawal, and 
when I say "symptoms" they are very mild, running eyes, running 
nose, yawning, some crampiness of the stomach. 

With the use of Perse they may have some aches, but they are 
so minor they are variable. 

Dr. Casriel. I agree. When I say no symptoms I mean ■ 

Mr. Keating. No comparison. Everj^thing is relative ? 

Dr. Casriel. Veiy moderate. 

Mr. Keating. The gentleman mentioned something before about the 
high numbers confined in jail because of public intoxication. I used 
to sit on the bench for a number of years. We have had them in court 
and the idea was to put them in jail for a few days and send them 
home or else keep them a night in jail. 

Would Perse be, or could it be used in this situation where they 
are arrested and it is not safe to leave them on the street because they 
can be physically harmed and they have to be brought in ? They could 
be treated with Perse and then go home ? 

Dr. Casriel. In 15 minutes they are sober. 

Mr. Steiger. Winos, too ? 

Dr. Casriel. In 15 minutes they are sober. 

If a wino has no brains left because he has drenched his brain, that 
is something else. 

Mr. Keating. The population of our city jails — and I can speak 
from experience — are occupied mostly by people who have been ar- 
rested for public intoxication. 



292 

Dr. Casriel. Mr. Keating, I have been thinking about this for 
many months now. I can see the use of Perse like peanuts in a bar and 
before you leave to drive home take one or two peanuts called Perse 
and drive home sober. 

Mr. Keatino. We have been through Antibuse. The governments are 
spending thousands and hundreds of thousands of dollars on alco- 
holism. 

We have councils all across the country. If this works as effectively 
as you say, in my area where we arc fighting for a new workhouse 
facility or correctional institute for misdemeanants, we could reduce 
the size of the facility substantially by simply having this form of 
medication to treat the alcoholics. 

Dr. Rosen. There is no comparable medication. Antibuse doesn't 

]Mr. Keatixg. I understand that. I am speaking generally of all 
these programs and all this money being spent in all these areas. 
If this is as effective as you say 

Dr. Casriel. Mr. Keating, I think this is revolutionary. I can say 
you are going to have a lot of inquiries because I am going to get busy 
on that letter and a lot of councils I have worked with through so 
manv years, contacting you, that people on probational — I am getting 
off the field of druofs, but not really 

IMr. Keatixg. That is the point, it is the same thing, alcohol and 
barbiturates and Seconals and heroin and LSD. You have got the 
problem of the person. This will resolve the physiological problem 
of alcoholism, narcotics, and barbiturates. 

]Mr. SA>:r>:\rAx. Is this addictive ? 

Dr. Casrtel. No: not at all. It is not nn alkaloid. 

Mr. Keating. How long does it take for an alcoholic, the man who 
has been drinking for years and there is no way for you to reach him. 
he still, I understand, has psychlogical problems, but how long does 
it take him to phvsiologically recover ? 

Dr. Casriel. From acute — 5 minutes. 

IMr. Keating. So that vou are talking about, in the case of metha- 
doTie or heroin, it takes about a week or mavbe I misunderstood. 

Dr. Rosen. Withdrawal from alco^^ol is about the same time, about 
5 dn vs in the chronic alcoholic to withdraw him. 

Dr. Casriel. But the acute symptoms- 



IMr. Keating. But he needs about a week to destroy 

Dr. Casriel. The steroids. 

Dr. Rosen. Let's not go cutting down moneys for alcoholism. The 
thing is it is not a panacea that we cnn have peanuts on the bar and 
there will be no alcoholism, because the alcoholism is going to be there. 
You can have somebody withdraw and take this and go back to drink- 
mp- for the same emotional reasons as bof orehnnd. 

Mr. Keating. If this is as successful as indicated, you eliminate 
one of the obstncles of treatment. 

ATr. Rosen. Tha<- is the main impact. 

Mr. Keating. '\"^niich is the mnior thrnst of what we are all talkinfir 
abont and driving at, which makes the psychological problem easier 
to cope with. 

Dr. Rosen. Right. 

Mr. Keating. Mr. Chairmnn, I find this extremelv remarkable and 
verv fascinating, and obviously it has a number of other possibilities. 



293 

You have been kind to take me out of order and Congressman Wiim 
has allowed me to go out of order. 

Mr. WixN. I have no questions. Go right ahead. 

Chairman Pepper. Go I'iglit ahead. Mr. Keating. 

Mr. Keating. I can just see at the misdemeanor level, as I indicated^ 
that this destroys the whole concept under which we have been operat- 
ing. We talk about putting in a whole detoxification center. Well, you 
wouldn't even need it at all. really. 

Dr. Casriel. As I think I have mentioned in my paper that followed 
Dr. Revici's paper on this, it is going to revolutionize the problem of 
addiction : alcohol, narcotics, and barbiturates. 

Mr. Keating. How long has it been before the Food and Drug 
Administration ? 

ISTr. Rangel. About 21/4 months. It was there before and rejected for 
additional tests. We had scheduled a meeting with Dr. Revici before 
the FDA. The FDA has not really rejected it in terms of saying tliat 
it doesn't do everything Dr. Revici claims it does, but in their opinion 
there are certain clinical tests that ha,ve not been made, and Dr. Revici 
was supposed to have come down. 

Tills committee has had doctors available to go with him. We thought 
we would be able to come back with some lav knowledge of what the 
FDA was reallv demandinsf. Unfortunatelv, because of the sudden ill- 
ness of Dr. Revici, this meeting has been postponed. 

But T have talked with people in the l^Hiito House that have been 
in touch with the FDA, as well as the FDA itself, and they have made 
it abundantly clear that we are not rejecting any of the testimony that 
we have heard today, but merely indicated that we have certain 
standards that have to be met. T think Mr. Perito will be able to report 
back soon. 

Mr. Keating. "Wliat limitations are there, at this sta^e, from the use 
of Perse by hospitals, physicians, and the fact that it has not been 
approved by the FDA ? 

Dr. Casrtee. Well, right now it is only a research drug usable in the 
State of New York by experts. 

:Mr. Keating. Could, for example, a physician in my district use it? 

Dr. Casriel. What is your district ? 

Mr. Keating. Cincinnati, Ohio. 

Dr. Casrtel. That is where I went to medical school. 

Reverend Masset. Only in New York State may it be used. 

Mr. Rangel. Transportation could be arranged for him to come to 
New York. 

Dr. Casriel. xis soon as we get FDA approval you will be able to 
use this on a research basis throughout the country. That is what we 
have been waiting for and waiting for, and every time there is an 
automobile death, every time there^is a death from addiction I feel 
there is something wrong with bureaucracy. 

^ Mr. Keating. We all know 50 percent of the deaths, as someone men- 
tioned, automobiles, come from drivers under the influence. I am talk- 
ing in terms of 20,000, 30,000 people a year. We are not going to have 
100 percent. We are talking about a lot of people whose lives may very 
well have been saved. ' 

Mr. Steiger. Bill, would you yield on that? 



j 294 

What period of time are ^ve talking about for the oral 

Dr. Casriel. About 15 minutes, 20 minutes; depends upon a person's 
capacity to absorb. 

Mr. fciTEiGER. I can see just before closing time everybody have a 
Perse. 

Dr. Casriel. Right, everybody sober up, party's over, sober up. 

Mr. IvJEATiNG. I have no more questions. 

Chairman Pepper. Mr. Winn. 

Mr. Winn. No questions, Mr. Chairman. 

Chairman Pepper. Mr. Blommer. 

Mr. Blommer. One question, Dr. Casriel. 

You said that you treated three people who had been maintained 
on methadone, and 1 am sure that you talked to them about their 
experiences on methadone. 

Now, when they said, as I assume they said to the doctor that was 
maintaining them on methadone, *'I feel normal," were they speaking 
the truth? 

Dr. Casriel. They are lying out of their heads, for God's sake. They 
weren't just on methadone, they were taking everything they could 
o-et their hands on. They told the doctor this is good. They were tak- 
ing cocaine, barbiturates, getting drunk, taking anything. It is ridicu- 
lous. They don't know the psychology of an addict. He will lie through 
his teeth. He will steal his mother's teeth, and you expect him to tell 
the person who gives him methadone, or if he is taking anything 
else, of course, he won't say that. He will say. This is a wonder- 
ful drug and I have been looking for a job, et cetera, et cetera, et 
cetera. You are dealing with a pathological infantile character dis- 
order. 

How can you treat them as if they are adult people, adult, respon- 
sible people ? They are all liars, all liars. 

Mr. Blommer. My next question was what you think the people on 
methadone maintenance think of the program. I think you have an- 
swered that. 

Chairman Pepper. Doctor, just one or two questions. 

We had testimony before our committee from the commissioner of 
corrections of New York City. He testified that thousands of people 
who come into the correctional system with heroin addiction simply 
have to go through agonies of withdrawal, without any treatment at 
all, because they don't have any treatment. 

Dr. Casriel. Mr. Pepper, let me answer that. 

I was a court psychiatrist and I saw them kicking the Tombs, and 
I was a ward psychiatrist at Metropolitan Hospital and I saw them 
kick at Metropolitan Hospital, and I have also, of course, been in 
Synanon, Daytop, and I have seen them kick this. The same kid, with 
the same habit, with the same length of time, reacts completely differ- 
ent in the Tombs, in Metropolitan Hospital, and in Daytop. 

In the Tombs he will figure the least he will get is to be known as a 
junky with a large habit. He gets status. The more he complains and 
climbs the walls, he figures maybe if he screams enough they will send 
Jiim to the hospital and he will get some methadone. 

.In the methadone unit they yelled bloody murder and climbed the 
wa2lB because they got methadone. The same kid, and I saw them, the 



295 

same kid literally, the same kid in the jail with methadone and Day- 
top, the same kid would finally tell me what he was doing. He figured 
the more he screamed, the more drugs he would get, or at least have the 
reputation of a junky with a big habit. 

In Daytop they have a cold, runny nose, upset, sick, in a day or two, 
and then get over it. It is not a physiological thing. 

Now, methadone maintenance is another thing. That is a lot of dope 
and the kid you have to withdraw from the methadone maintenance 
can really get pretty damned sick. 

Chairman Pepper. This would be a simple and relatively inexpensive 
way of treating those with withdrawal symptoms ? 

Dr. Casriel. Yes ; you just give them a shot or a pill. 

Chairman Pepper. Well, Doctor, I think all of us are excited about 
this testimony you have given today. We have heard about Dr. Revici's 
work and we certainly do hope, and I know my colleagues hope, it can 
be a satisfactory drug and come into general use. 

It has been my belief for a long time that that is one of the reasons 
this committee committed itself to hold these hearings. 

Dr. Casriel. If you can speed up this drug to public use you will 
save lives. Every day that is wasted is killing people, and costing bil- 
lions of dollars. 

I think, if I may suggest, if you can use your influence to speed up 
the investigational use of this drug so that it can get out on the market, 
I know it is going to work. I know it works. 

Chairman Pepper. Mr. Sandman, would you like to inquire? 

Mr. Sandman. How many cases have you tried this on ? 

Dr. Casriel. About 100. 

Mr. Sandman. I wasn't here when you apparently testified. 

What were your results ? 

Dr. Casriel. They were detoxified. 

Mr. Sandman. Detoxified. Does this satisfy their desire ? 

Dr. Casriel. Satisfies their desire. 

Mr. Sandman. You can take a hardened heroin addict 

Dr. Casriel. I can take a person on methadone maintenance — to 
me that is the hardest — and get them off. 

Mr. Sandman. Now, he has to continue taking this, he never really 
is cured ? 

Dr. Casriel. Oh, no ; a week and you are finished. This isn't a main- 
tenance drug. 

Mr. Sandman. Oh, you only do this for 1 week ? 

Dr. Casriel. One week at the most. 

Eeverend Massey. May I also say here that some can take it for a 
week, some for just 2 to 3 days. If an individual is shooting 50 bags 
a day he may take it for 3 days only with approximately three or four 
injections per day. 

Mr. Sandman. But he is going to go right back to heroin ? 

Reverend Mabsey. No ; I beg your pardon. 

Mr. Sandman. He is not ? 

Reverend Massey. Also, he takes oral medication in between the 
injections. He is given oral medication. 

Mr. Sandman. This is injected ? 

Reverend Massey. This is injectable. I have a brother who was on 
heroin, shooting approximately 50, 60 bags a day. A year ago — no, it 



296 

was March of 1970 — he was admitted into Trafalgar Hospital, de- 
toxified, received this injection for 3 days. The remainder of his stay 
in the hospital — he stayed 8 days — he received oral medication, and 
I must say he is back to the use of drugs but it is not because he 
stopped. 

Mr. Sandman. This doesn't cure the habit ? 

Reverend Massey. This detoxifies him physically. 

Mr. Sandman. It just detoxifies him ? 

Reverend Massey. Correct. 

Mr. Sandman. I got it. 

I have no more questions. 

Chairman Pepper. Well, thank you very much, Dr. Casriel, Dr. 
Rosen, and Reverend Massey. We have very much appreciated your 
testimony and we are obliged to you for coming here today and giving 
us this very exciting testimony. We appreciate it. 

For the record. Dr. Rosen, please give us your name and address. 

Dr. Rosen. Walter Rosen, 102 Eastll6th Street, New York City. 

Chairman Pepper. And you are a medical doctor ? 

Dr. Rosen. Yes, sir. 

Chairman Pepper. Under the laws of New York ? 

Dr. Rosen. Yes, sir. 

Mr. Pepper. How long in practice ? 

Dr. Rosen. Since 1949. 

Chairman Pepper. Since 1949. 

Reverend Massey, your full name ? 

Reverend Massey. Rev. Raymond Massev ; my address is 144 East 
90th Street, Institute of Applied Biology, In New York City 10026. 

Chairman Pepper. You are a member of the clergy ? 

Reverend Massey. Yes ; I am. 

Chairman Pepper. What is your church ? 

Reverend Massey. Bethel Baptist Church, Jamaica, Long Island. 

Chairman Pepper. You have been associated with Dr. Revici for 
about IT months ? 

Reverend JNIassey. Correct. 

Chairman Pepper. Thank you very much. 

(The material received for the record follows:) 

[Exhibit No. 14(a)] 
The Case Against Methadone 

Daniel Casriel, M.D., past president, American Society of Psychoanalytic 
Physicians, and medical psychiatric superintendent, Day top Village, Inc. 

The current proposition before the city council to supply drug addicts with 
methadone is, in my opinion, malpractice. To substitute one narcotic for another 
is not the answer nor the solution to drug addiction. When a narcotic is made 
free and available by Government agencies, it can only increase and encourage 
the further use of drugs. 

Is it planned to make methadone legal and keep heroin illegal? Is a person 
using heroin a criminal and an addict using methadone a patient? Is a person 
selling heroin a criminal pusher — a person selling methadone a businessman? 
Is a man selling scotch a criminal but a man selling bourbon a law-abiding 
citizen? 

How about the pot (marihuana) smoker — should he continue to go to jail for 
possession while his cousin the junkie goes to work — as the proponents of metha- 
done maintenance propose? The fact is that a large proportion of pot smokers 
are law abiding and functioning citizens. 



297 

What will the other 50,000 addicts in this country do when they hear the boys 
in New York are getting their stuff free and legal? New York will have 50,000 
new citizens to add to our welfare rolls. "What will we do with the deluge V Will 
they have to be a citizen of New York to obtain free or low-cost methadone? 
They will not have to be a citizen of New York to steal from the citizens of New 
York. What will prevent the have-nots from buying and stealing some methadone 
from the haves? Do the proponents of maintenance really believe that a new 
underworld market in methadone will not be established? 

The millions of addictive prone — how many of these people will become addicts 
because another narcotic is legal or at least easy to obtain? Have we forgotten 
the reasons for the original narcotic laws? Are we prepared to treat 6-8 million 
addicts? 

Proponents of methadone maintenance therapy say the glamour will be taken 
out of addiction when the addict drinks his opiate rather than injects it into his 
arm. First, addiction to the addict is as glamourous as terminal cancer. Those 
that need to inject something into their vein (very few for a symbolic need — 
they use a vein because it gives them the quickest and strongest kick) and will 
continue to inject something, and many would-be addicts who have fear of 
injection now would have a new source of oral narcotic to start them on the 
road to heroin. 

In this country there are three groups — three philosophies — one might call 
them three armies, fighting the common enemy of drug addiction. 

The first army, of course, are the traditionalists. I myself was once an ad- 
herent of this group. In 1962, the New York Tribune contained a quote relative 
to the treatment of the drug addict. It was : 

"Put him away either in a hopsital or jails for the rest of his life — or give 
him all the heroin he wants." 

I was the author of that statement. I had all but thrown up my hands in help- 
lessness. After using the traditional approach in a great number of cases, I 
knew I had cured no one and that any help I had given was transitory, inef- 
fectual, and not worth the time and the effort. The schools, the courts, and the 
hospitals had no better results. Doctors in private practice refused to treat a 
drug addict. No force, intimidation, jail term.s — even the threat of death — bad 
any impact on the addict. The traditionalists admitted failure, and just did all 
they could to keep the problem under control. But it does not stay under control. 
It became worse all the time in terms of numbers of addicts and the degree of 
chronicity and tenacity of their habit. The traditionalists were and are losing 
the battle. 

Recently a second army has arisen. A new philosophy has re-emerged — on the 
basis of, "If we can't lick them, let's join them," we now have, "If we we can't cure 
them, let's try to control them. We'll stop them from stealing to get money for 
drugs. We'll give them all the drugs they need." These are the adherents of the 
methadone system. This was basically the philosophy of the "British System." 

I personally feel that this approach is absolutely wrong not only philosophically, 
but also medically. As a scientist I can accept any program which ha« a re- 
search design and is limited in its scope, but I am utterly and completely op- 
posed to the indiscriminate use of methadone as a treatment for drug addiction 
in the city. I feel we are opening Pandora's box. We shall develop not only a 
heroin underworld traffic, but a methadone underworld trafllc. The British 
found they had a problem of illicit heroin trafl3c developed from supplies given 
to the addict legally, and the British have had, until now, only a very minor 
problem with what I call secondary addicts. Our problem in this country is 
entirely different, as a majority of our addicts are what I call primary ad- 
dicts — that is, drug addiction is a way of life for them. They withdraw from all 
of life's constructive functionings and their entire lives are centered around the 
obtaining of narcotics — raising the "bread" (cash) and finding the "connection." 
They live to shoot dope. 

Dole and Nyswander reported in 1965 ^ on the results of their preliminary 
studies in the use of methadone to block heroin addiction. At that time much 
hope was placed in this method as a result of their findings. However, Dr. Victor 
H. Vogel, chairman of the Narcotic Addict Evaluation Authority of the State of 
California, wrote on September 3, 1965 to the Journal of the American Medical 
Association : 

.j'i'K't'Vf 'l^y 

1 Journal of the American Medical Association. 
60-296— 71— pt. 1 20 



298 

"The paper by Dole and Nyswander on the treatment of heroin afldiction by 
methadone does not come np to expectations pjenerated by prior publicity in the 
public press and two feature articles in the New Yorker. 

"The authors seem to be unaware of the tragic consequences of the introduc- 
tion of heroin as a cure for morphine addiction at the turn of the century and 
the later introduction of Demerol as a harmless narcotic. Although the authors 
state at the beginning of the paper that it is only a progress report, an unwar- 
ranted conclusion is made, 'Maintenance of patients with methadone is no more 
difficult than maintaining diabetics with oral hypoglycemic agents, and in most 
cases the patient should be able to live a normal life' : The authors are silent on 
the problem of treating methadone addiction. 

"Although 22 cases are presented as evidence of success of the treatment, two 
had been followed less than 1 month and 10 cases for less than 2 months : Perusal 
of the paper shows that four of the cases were still in the hospital, four others 
had used 'Unscheduled' narcotics, two others had been discharged after toler- 
ance tests only, and one left the program against advice. 

"A common pitfall for investigators studying new cures for narcotic addiction 
is the difficulty of determining the degree of addiction at the beginning of the 
experiment. liimmelsbach and others have shown that narcotic dependence 
can be determined only by objective observations during withdrawal, after 
which the subject may be restabilized and experimental testing with the new 
drug begin. 

"The evidence presented in this paper that the substitution of the narcotic 
methadone for the narcotic heroin is superior to withdrawal from all narcotics, 
is not impressive. In spite of what the authors say. successful treatment by 
withdrawal is not rare, particularly over a period of less than 2 months which 
is the time reported by Dole and Nyswander in 10 of the 22 cases." 

The following statements might be useful in counteracting some of the mis- 
leading reports that are becoming more numerous daily. 

Victor H. Vogel, Harris Isbell and Kenneth W. Chapman, wrote in the Journal 
of the American Medical Association. December 4, 1948, in an article called The 
Present Status of Narcotic Addiction: "The total addiction liability to metha- 
done is almost equal to that of morphine, although its physical liability is less. 
The euphoric effect of methadone on the addict (and undoubtedly in the addic- 
tion prone person) is equal to that of morphine, so that its habituation liability 
is high." 

Harris Isbell wrote in his article "Methods and Results of Studying Experi- 
mental Human Addiction to the Newer Synthetic Analgesics," published in the 
annals of the New York Academy of Science, October 1, 1948: "The behavior 
of men addicted to methadone was similar to the behavior seen during morphine 
addiction. The patients ceased all productive activity, neglected their persons 
and their quarters, and spent most of their time in bed in a semi-somnolent 
state which they regarded as very pleasurable. Psychological changes seen dur- 
ing addiction to methadone were similar to those seen during morphine addiction. 
During addiction to methadone patients continually requested increases in 
dosage." 

Harris Isbell, Abraham "Wikler, Anna J. Eiseman, Mary Daingerfield and Karl 
Frank, in their article "Liability of Addiction to 6-dimethylamino-4-diphenyl-?.- 
heptanone (methadone amidone or 10820) in Man: Experimental Addiction to 
methadone" published in the Archives of Internal Medicine, October 1948: 
"When the dosage was increased to 40-60 mg. daily in the second week of addic- 
tion, definite evidence of sedation appeared after the third or fourth iniection, 
and the men began to express satisfatcion with the effects of the drug. Their be- 
havior became strikingly similar to that seen during addiction to morphine. . . . 
The degree of somnolence and lack of activity was greater than that seen dur- 
ing morphine addiction. The men complained about this, and said that while 
addicted to methadone they could do little but stay in bed. They stated that 
methadone lacked a peculiar quality possessed by morphine, which was termed 
'drive' and which they described as a sense of ambition to work and play games. 
When it was pointed out that their behavior while addicted to moriihine was 
inconsistent with these observations, the patients were puzzled and stated that 
when they were receiving morphine at least they thought they were ambitious, 
but when they were taking methadone they knew that they were lazy." 

Last December Dole and Nyswander wirh Alan Warner reported on further, 
and more extensive, studies (750 cases) in the Journal of the American Medical 



299 

Association, December 16, 1968, Vol. 206, No. 12, and it is presumably on the 
basis of these studies that New York City has established a pilot program 
for the treatment of addicts by this method. 

However, Dole and Nyswander themselves state in their report : 

"We have not, however, considered it desirable to withdraw medication from 
patients who are to remain in the program, since those who have been dis- 
charged have experienced a return of narcotic drug hunger after removal of the 
blockade, and most of them have promptly reverted to the use of heroin. It is 
possible that a very gradual removal of methadone from patients with several 
years of stable living in phase 3 might succeed, but this procedure has not yet 
been adequately tested." 

In the same report, Dole and Nyswander also write : 

"Since blockade with methadone makes heroin relatively ineffective, a pa- 
tient cannot use heroin for the usual euphoria. * * * He can, however, remain 
drug-oriented in his thinking, and be tempted to return to heroin." 



"The greatest surprise has been the high rate of social productivity, as de- 
fined by stable employment and responsible behavior. This, of course, cannot 
be attributed to the medication, which merely blocks drug hunger and narcotic 
drug effects. The fact that the majority of patients have become productive 
citizens testified to the devotion of the staff of the methadone program — phy- 
sicians, nurses, older patients, counselors and social workers." 

In the Progress Report of Evaluation of Methadone Maintenance Treatment 
Program as of March 31, 1968 by the Methadone Maintenance Evaluation Com- 
mittee, Chairman Henry Brill, published in the same issue of the Journal of the 
American Medical Association the authors mention : "None of the patients 
who have continued under care has become readdicted to heroin, although 11 
percent demonstrate repeated use of amphetamines or barbiturates, and about 
a percent have chronic problems with alcohol." 

Now I come to another point I should like to make against methadone main- 
teuance therapy, which is an ethical, or perhaps I should say philosophical one. 
Can we, as physicians, in all good co^iscience, prescribe medication which is not 
curative, which may prove to be very destructive, when there is a growing 
school of thought, backed by ever-increasing proof, that there is a cure for the 
disease? Do we not, as physicians, owe the patient the opportunity of at least 
having a chance of being cured, before we condemn the individual to a fate, 
at best, of a zombied state of existence, and at worst to a reinforced highway 
to destruction and death? Should a physician prescribe aspirin for pneumonia 
and avoid the use of iJenicillin? Methadone at best treats only the symptom and 
not the disease. At worst, methodone reinforces the disease. Methadone also 
does something else. It reduces the motivation to get well. "Why try and get 
well," says the addict. "Why suffer the stresses and strains of what amounts 
to psychological rebirth in a therapeutic community such as Daytop? Why learn 
to function and grow up when I can get all the methadone I need to avoid all 
the pain of addiction, and I can spend my time raising money for a little 
heroin that will give me pleasure. Why pay for dinner when I can get a free 
lunch?" 

Methadone does something else too. It re-inforces the addict's sense of futility 
and hopelessness. He is now able to say to himself "you see? There is no cure * * * 
so why try? Even the medical profession has admitted there is no cure. My friends 
in the street, my fellow junkies are right. Once a junkie always a junkie." 

It is planned to make methadone legal and keep heroin illegal. Is a person 
using heroin a criminal and an addict using methadone a patient? Is a junkie 
selling some of his heroin a criminal pusher — a junkie selling (or trading) some 
of his methadone a businessman? Is a person drinking or selling scotch a criminal 
but a person drinking or selling bourbon a law abiding citizen? Even during the 
illogical years of prohibition we did not become that illogical. 

And how about the "pot" (marijuana) smoker — should he continue to go to 
jail for possession while his cousin the junkie goes to a hospital — or (more 
ridiculously) as the proponents of methadone maintenance suggest — goes to 
work? A large proportion of "pot" smokers are otherwise law abiding and 
functioning. 

Also, what will the other 50,000 addicts in this country do when they hear 
the "boys" in New York are getting their "stuff" free and legal? What will pre- 



300 

vent them from coming to New York to get their "free lunch?'' What will we do 
with the deluge? Will they have to be a citizen of New York to obtain free or low 
cost methadone? They will not have to be a citizen of New York to steal from 
the citizens of New York. What will prevent the have nots from buying and 
stealing some methadone from the haves? Do the proponents of maintenance 
really believe that a new underworld market in methadone will not be estab- 
lished? 

How about the millions of addictive prone — how many of these people will 
become addicts because it is legal or at least so much easier to obtain? Have we 
forgotten the reasons for the original narcotic laws? Are we prepared to treat 
6-8 million addicts in addition to the 6-8 million alcoholics we already have? 

Some proponents of methadone maintenance therapy state the glamour will be 
taken out of addiction when the addict drinks his opiate rather than injects it 
into his arm. First, addiction to the addict is about as glamorous as terminal 
cancer. Secondly, those that need to inject something into their vein (very few 
have a symbolic need * * * they use a vein because it gives them the quickest- 
strongest kick) will continue to inject something. And thirdly, many would-be 
addicts who have a fear of injection, now could have an additional large steady 
source of oral supply to start them on their road to heroin. 

FINANCIAL 

The proponents of methadone maintenance introduce a point that appeals to 
the taxpayer, i.e., methadone is the cheapest treatment, about 13 cents a day. 
A closer look at the figures yields these facts : 

$85 a day for early phase inpatient care (6 weeks approximately). 
$5 a day for outpatient service. 

Against the normal term of 18 months for rehabilitation in the therapeutic 
communities, such as Daytop Village, the comparison cost of methadone care is 
higher : 

Methadone (18 months inpatient (6 weeks) and outpatient) (16% months). 
$5,887. 
Therapeutic community (e.g., Daytop) (18 months), $5,748. 

And when you consider the fact that after the 18 months, the therapeutic 
community (Daytop) produces a drug-free, resiwnsive recovered individual 
while methadone maintenance produces a dependent addicted individual, the 
comparison becomes clearer. Over a period of 10 years the Daytop graduate 
will have 8Vi years of autonomous, productive (tax-paying) performance with 
additional cost to Government while methadone maintenance will produced a 
full 10 years of drug dependence at a total 10 years of $25,470 per individual. 

And the final point against methadone. Diseases, like this are unethical and 
immoral. They do not play the game according to the conditions set forth. When 
will we learn that you cannot do business with disease? If we do not destroy 
disease, disease will destroy us. There is no compromise. There can be no main- 
tenance. 

And now for the third army in the field fighting the enemy addictive disease, 
a growing army in which I am proud to be among the leaders. An army com- 
posed not only of professionals, but of doctors, psychologists, sociologists, social 
workers, clerical workers, enforcement oflScers, judges, officials from the Depart- 
ment of the Treasury, customs oflicials, but now we have in our ranks the re- 
habilitated victims that were in the enemy organization. We have a new breed 
of men, the ex-addict, who by his training has been a paraprofessional, ready, 
willing, and able to assist us and one other in depleting the enemy's forces: 
addicts, * * * bound in slavery to their addiction, and in destroying once and 
for all the enemy * * * sometimes called addiction, sometimes called criminality, 
sometimes called pothead, sometimes called alcoholism, sometimes called homo- 
sexuality, sometimes called school dropouts, sometimes called the inadequate 
personality, * * * always called the character disorder. 

For over 7 years I have observed and taken part in the fight against addic- 
tion by a new tactic, a new philosophy, which on one hand is very difficult, yet 
on the other hand whose tactics are so obvious as to sometimes be oversimpli- 
fied and called common sense. After working intensively learning the process of 
treatment of the drug addict specifically and the character disorder in general, 
I was finally able to trace it back and evolve a psychodynamic theory which to 



301 

me adequately explains why the process works. This theory is now being put into 
practice by Daytop and some other therapeutic communities where ex-arldicts 
work together to help themselves and each other grow into mature, responsible 
human beings. It is a process which involves 18 months of intense confronta- 
tion and challenge to growth within the addict/ex-addict peer group. Hard work 
is the name of this game of recovery. There is no magic in winning back human 
lives. To attest to its success, we have an ever-increasing army of Daytop resi- 
dents and graduates who today bear witness to the fact that the addict can 
recover his life — that man is not fragile and need not be sedated — that he can 
be challenged to grow ! 

To effectuate treatment one must first remove the shell of heroin and prevent 
the individual from acquiring or running into any other kind of shell. And then, 
once exposed to the light of reality, without his fortress of the shell of with- 
drawal, he is in a position to be taught how to grow up emotionally, socially, 
culturally, morally, ethicall.v, vocationally, and educationally. This is no small 
undertaking, but nothing less will suffice * * *and this is what is done at Daytop. 

Which brings me to the treatment techniques. Empirical observation and re- 
search at Daytop has found that there are only two prescriptions and two pre- 
scriptions needed for complete treatment. They are simple. The prescriptions 
are: 1) No physical violence, 2) No narcotics or other chemicals, and by infer- 
ence no other shells under which to hide. By these two simple prohibitions we 
have successfull.v eliminated two of the three ways an individual copes with 
pain or danger. There is only one reaction open to him. only one method which 
he can utilize, and that is by reacting to real and imagined stresses and strains, 
real and imagined pains and dangers ... by fear. Motivated by fear he can 
do one of two things. He can stay and attempt to cope with his fears, or he can 
run out of the door, sometimes never to return, frequently to return again at 
some later date. We have found that at least 80 percent of those who enter Day- 
top will sooner or later remain to get well. We do not know what happens to the 
other 20 percent who will never return. Perhaps they are dead, perhaps they 
are in jails, perhaps they are in hospitals, perhaps they are still attempting to be 
drug addicts, perhaps they have stopped taking drugs, perhaps they are on 
methadone. 

Daytop now has three facilities housing approximately 300 members, and a 
rehabilitation rate of 92 percent C103 graduates). If allowed to grow it could 
make a real impact not only on the drug addiction problem in the city, but also 
on crime, delinquency, and, not least, on our tax dollars. If given support, it 
could save the people of New York hundreds of millions of dollars now stolen by 
addicts or wasted by ineffectual treatment processes. 

Efren Ramirez, in his article, "City and Community Resources for Drug Addic- 
tion." published in New York Medicine, Col. XXIV. No. 9. Sept. 19GS. writes: 

"Addicts . . . almost without exception, show clear and definite manifesta- 
tions of a wide variety of character malformation." 

"They are poorly motivated toward long-range treatment and rehabilita- 
tion . . . There are few professionals who can motivate addicts . . . By and 
large the way to break through the apathy and lack of committment in the addict 
is to use the simple expedient of employing a trained, rehabilitated ex-addict, 
who can show by his own example, the feasibility of rehabilitation." 

"For the serious addict rehabilitation requires a stay of some length in a 
therapeutic community . . ." 

"Addiction is one of the outstanding problems of the city of New York. And, 
as such. It must be dealth with in an unusual, imited, really coordinated way." 

And I think I can do not better to close these remarks by ouoting from the 
article Medical Aspects of Drug Abuse by Michael M. Baden, in the same issue of 
New York IMedicine : 

"There is professional sterility when a physician marvels at a cirrhotic liver 
and does not apnreciate or concern himself with the severe psychiatric and social 
factors that led to it. Even if the alcohol consumption were stopped, as with 
Antabuse, the underlying primary p.sychiatric pathology must still be treated 
if we are to cure the person and not merely the symptom. So it is with drug 
addiction: removing the needle does not in itself even begin to deal with the 
causes that lead to the use of the needle . . . drug abuse is not a physical disease 
but a psychiatric one and must be treated as such if it is to be cured." 



302 

[Exhibit No. 14(b)] 
Casriel Institute of Group Dynamics, New York, N.Y. 

I am honored to be the first discussant of this historic paper presented by 
Dr. Revici. His paper has opened a new dawn on the treatment of addiction. Be- 
cause of the great contribution of his knowledge of cellular physiology and 
pathology and his resultant pharacological treatment of disease, I aim sure medi- 
cal history will honor him as one of the greatest physicians of this century. I 
am proud to be able to sit at his side today. 

When I was first introduced to Dr. Kevici. some 15 months ago, to observe 
the clinical reaction of several obvious drug addict patients to an injection of 
his drug, I felt highly suspicious as to the nature of the drug. The individuals 
reacted as if they had just received a "Fix." In 15 months I have given this 
drug to over 100 drug addicts. Though their clinical reaction remained the 
same as I first observed, after a week's utilization of Perse, the individual is 
totally free of all narcotic needs and of Perse too. 

Except for four cases early in my use of Perse, there have been no side effects 
These four early cases reacted with a toxic "Grippe Like" fever which lasted 
about 24 hours. Dr. Revici stated that it was the sulfur in the particular 
preparation that caused this effect. After he lowered the sulfur concentration, 
no other generalized side effects attributed to this drug was ever observed! 
Clinically it seems to be perfectly safe. On one occasion, I personally took two 
pills, to evaluate its effectiveness in preventing drunkeness due to alcohol. 
Two tablets allowed me to drink 8 ounces of 86 percent T & B Scotch without 
any side effects as to dysarthria, dizzyness. drowsiness, sleepiness, euphoria, 
or any of the side effects T usually obtain from more than 2 ounces of alcohol 
The clinical reaction of Perse is exactly as Dr. Revici describes. 

I have had the occasion to detoxifize three people who were on methadone 
maintenance ; one using 140 mg., one using 150 mg., and one using 240 mg. daily. 
In all cases, the people were detoxified successfully and effectively. All of 
the residents given Perse in my therapeutic community, called AREBA, were 
able to maintain themselves and remain in the community, needing only addi- 
tional rest. The clinical effectiveness I have observed from Perse is exactly 
that which Dr. Revici described in his 1,000 cases. Rather than to review the 
clinical reactions which Dr. Revici has already adequately reviewed, and for 
which he has much more documentation than I. I shall formidate some of the 
chnnges that I anticipate will take effect in the wake of the utilization of Perse. 
The use of Perse will force a total review of the entire abuse and treatment 
not only of narcotics, but also of alcohol and barbituate addiction. Perse will 
eliminate the addictive probabilities of all these drugs, as well as remove the 
effect of the drug if Perse is taken. However it will not remove the psychological 
dependence, only the physiological addiction. 

1. Methadone is contra-indicated and will stop being given for both mainte- 
nance and withdrawal. 

2. The simple, inexpensive (fraction of a centi diagnostic test for immediate 
detection of Alkaloids in the urine also developed by Dr. Revici means that 
though individuals may still take drugs, they will not become addicted. At 
the first sign (i.e.: positive urine test) of the use of any alcohol, narcotic, or 
barbituate: Perse could be given, eliminating the addictive cycle. 

.^. The restructuring of most 24-hour therapeutic communities into large day 
centers. This will reduce the cost by almost half. The average cost of the 
therapeutic community like Daytop Village is ,$11 a day. Methadone mainte- 
nance in the Dole Set-up costs S.'i..50 a day. A day center such as was structured 
by myself in Hialeah. Fa., in Operation Self Help, operating 10 a.m. to 10 p.m.. 
7 days a week should cost closer to the $5..50 a day per person level. Unlike 
methadone maintenance which could last forever, the average length of a time 
of treatment in day renter will probably be in the area of a year. With the new 
advances in the psycholoa:ical treatment of the addict, the actual time in a day 
center conld be shortened. 

4. Since the person is not addicted, he will be much more readily treatable, 
psychologically. 

5. Since hospitalization is not necessary (i.e.: the period of time normally 
needed for detoxification of addiction) pyschological treatment can be prescribed 
and instituted immediately at the clinic where the test takes place. There will 



303 

be no loss of applicants due to the need to wait for the end of the detoxification 
period. 

6. Since people need not become addicted, they are not necessarily weak or 
need additional hospitalization for complication due to addiction. 

7. Since they do not become addicted, crimes committed to obtain money for 
drugs will be markedly reduced. Insurance costs will come down, courts and 
police will have a markedly lesser business. Jails will not be as crowded. The 
savings could be passed on to the taxpayer. 

8. Because of no addiction, many more addicts can be treated on an outpatient 
basis, with a great reduction of costs. Hospital beds for addiction can be phased 
out. 

9. Perse is not only antiaddictive, it tends to remove the psychological effects 
of nonspecific "tissue memory"— spontaneous physiological readdiction will be 
greatly reduced. 

10. Perse will remove acute intoxication. One or two pills and 15 minutes 
will remove drivers from "driving under the iufiuence of" — preventing half of 
the auto fatalities, lowering insurance costs, etc. 

11. Perse is life saving if given in time, no one need die of an overdose of 
narcotics or barbituates. 

12. Perse cost is extremely low. It can be reproduced relatively easily and 
distributed quickly. Perhaps the current addiction programs already set up 
can be the institutions which will distribute the Perse, take the urine tests, 
and institute the specialized psycotherapy. 

13. Money saved could be used to retool the psycotherapy used for the treat- 
ment of severe character disorders. This is essential. 

The criticism I have heard from professionals in discussing Dr. Revici's paper, 
is that he has no scientific reference to the literature in his paper. I refer them 
to Dr. Revici's erudite, professional textbook. Christopher Columbus could not 
have given a cross-reference on previous work of the New World he discovered. 
Dr. Revici has opened the way for the period of new results in the field of 
addiction as well as other fields. Dr. Revici should not and cannot be judged 
as one may with classical schools of researchers. Perse is revolutionary. It is 
but one of many chemicals to spring from the "Pen" of a revolutionary researcher. 
Dr. Revici, relying on his own knowledge of biochemistry, physiology, histology, 
pharmacology, as well as clinical medicine theoi'ized the problem of addiction. 
The cause of addiction. From his theory of cause and effect, he formulated his 
chemical treatment, all on pencil and paper. He took his theories to his animal 
laboratories and then finally to his human clinical laboratory, his hospital. 
Trafalga Hospital. What more is there to question? Thousands of animals and 
over a thousand patients have taken Perse without ill effects. So have I. Treat- 
ment is not chronic, only for a week or less, therefore, no serious problem of 
chronic accumulation of drugs, being build up in the body or other pathological 
interreaction being built up in the body. The fact that Dr. Revici could the- 
orize by pen, a treatment approach which he could successfully then apply 
clinically, awes me. 

On the contrary the headlong fatal social plunge into methedone maintenance 
is based on a nonvalidated hypothesis, not biochemically validated, not physio- 
logically validated, not pharmacologically validated and without even a scientific 
theory of how methodone "blockades the effect of Heroin" only a clinical hy- 
pothesis. Dr. Revici's theory, of course does explain this phenomenon. It is 
not at all a "blockading effect" of methedone on heroin — but rather an exhaus- 
tion of the bodies defensive reaction to the overwhelming dosages of methedone. 

As an expert in the clinical treatment of addiction, I am totally convinced as 
to the merit of Perse. Dr. Revici you are a blessing to all of humanity, I salute 
you. 

Research in Drug Addiction 

(By Em. Revici, M.D.) 

In the past years the tremendous growth in the number of people addicted to 
drugs, has made of addiction a main national problem. The limited ability to 
cope with the first basic aspect of the problem, the medical one, has conse- 
quently limited the eflBciency of the psychological and social approaches. This 
explains why the problem of addiction is still practically uncontrolled. The fact 
that no real progress has been made in the medical control of addiction appears 



304 

to result from the insuflScient understanding of basic processes involved in addic- 
tion and especially in the withdrawal syndrome. 

The study of the pathogenic aspect of addiction and of the withdrawal sjti- 
drome from a new angle has led us to certain conclusions concerning the nature 
of the processes involved. As corrolary, a new approach aimed at controlling 
addiction itself, without subjecting the person to the distressing withdrawal 
syndrome, has been developed. It has resulted in an effective short-term therapy, 
simple to administer, nontoxic, and inexpensive. 

THEORETICAL CONSIDEBATION 

In the study of addiction and of the withdrawal syndrome we have applied 
our previous research concerning the mechanism involved in the pathogenesis 
of abnormal conditions in general, and of the intrinsic role played by lipids in 
these apthogeneses. In this research we have shown that symptoms, clinical and 
analytical signs of any abnormal condition can be integrated into one of three 
basic biological offbalances. Each one is characterized by its proper pathogenic 
metabolic processes, clinical manisfestations and analytical changes. In one 
of these offbalances we found that the metabolic processes have a prevalent 
anoxybiotic character. The metabolism of glucose, limited to the fermentative 
phase, leads to the appearance of acid substances, mainly lactir acid. The re- 
sulting local acidosis is one of the main characters of this offbalance. It is the 
further utilization of excess hydrogen liberated in these processes that gives 
the occurring metabolism an anabolic character. In the second offbalance the 
abnormal processes concern mainly the sodium chloride metabolism. The chloride 
ions of sodium chloride are irreversibly fixed, while sodium ions which remain 
free, bind carbonic ions. This results in the appearance of alkaline substances. 
A local alkalosis characterizes this offbalance. The occurring dyschlorohiotic off- 
balance has a catabolic character. In the third offbalance, the dy.soxybiotic. the 
abnormal metabolism lends to an intensive fixation of oxygen, with the appear- 
ance of peroxides. 

The study of these three offbalances has also furnished characteristic Hinical 
and analytical data. This permits not only to define but also to recognize the 
offl^alanfe present. The study of the relationship between these offlialances has 
shown fundamental antagonistic characters between them: that is, between the 
biological processes involved, and the resulting clinical manifestations and 
analytical changes. 

Further study of these offbalances has shown the importance of the level of 
the organization where the abnormal processes are taking place. Clinical mani- 
festations and analytical data were seen to differ widely if a subnuclear. cellu- 
lar, tissue, organic or systemic level of the body organization is affected. When 
a condition is studied, this organizational aspect has to be considered. 

Moreover, these offbalances were connected with the pathogenic intervention 
of lipids. In the anoxybiotic offbalance, a predominance of lipids with positive 
polar groups, mainly sterols, was found. 

The dyschlorohiotic offbalance was seen to result from the intervention of a 
spocific grouo of lipids with negative polar groups. These are separated as 
"abnormal" fatty acids: namely, those having trienic conjugated double bond 
formations in their molecules. The irreversible fixation of chloride ions, which 
charactprizes this offbalance takes place at the conjugated double bonds of 
these fatty adds. 

In the dysoxybiotic offhnlanr-e. free unsaturated fatty acids with nonconju- 
gated double bonds were seen to intervene. The physicochemiral antagonism was 
seen to exist between the respective linids which intervene in the pathogenesis 
of the offlialances. It could be related to the clinical and pathogenic antagonisms 
seen between the offbalances. as well as between the processes involved and the 
resu^fins: mnnifest'itions 

Stn^'ting from tb's point, the i-.li.irmacologirnl a.sin'"t of ''T^ids aiid otbi^r agent's 
was inve.stigated. losing each one of these three groups of lipids, it was nossiWe 
to induoe the respectivo offbalan<^e. Various other agents were studied for their 
relationship to thp lipids and their capacity to induce an offlialance. Their 
spenfic as well as their nonspecific actions could be integrated in the defined 
offlifilnnnes. This extilains many of the pharmacodynamic properties of these 
agents. FJnsed on the offlmlnnces thes« agents induce they can be separated into 
three groups which manifest the antagonism between the offbalances. Their 



305 

general character to induce an anoxybiotic, dysoxybiotic or dyschlorobiotic off- 
balance, is associated to a specific capacity to act mainly at a certain level of the 
organization. 

The therapeutic approach was thus developed by relating these basic concepts 
of offbaiances with the pathogenesis of the different conditions and the phar- 
macopdynamy of different agents. In this guided therapy the nature of the agents 
and their doses are determined by the ofEbalance present in the condition to be 
treated. This is revealed by the clinical and analytical data obtained. 

In practice, analysis of a condition under this specific aspect permits to rec- 
ognize which offbalance is present and which level is affected. Consequently, 
it suggests which agent has to be used in order to corret the condition. The clin- 
ical and analytical changes induced by these agents are indicative of the neces- 
sary changes in dosage. 

ADDICTION AND WITHDRAWAL SYNDROMES 

It is from this specific point of view that v>'e have approached the problem of 
drug addiction and withdrawal syndrome. From the interpretation of the ana- 
lytical data and clinical manifestations it appears that the addiction itself cor- 
responds to an anoxybiotic type of offbalance. This offbalance was seen to be 
induced in part directly by addicting drugs. 

When administered experimentally in animals, addicting drugs were seen to 
induce an anoxybiotic offbalance. For instance, rats with standai'd wound made 
on their back, were given drugs of the narcotic group. They induced changes 
toward more acid values in the pH of the crust of the wound measured on the 
second day. This corresponds to an anoxybiotic off"balance. 

A similar anoxybiotic offbalance was seen to result also from another mecha- 
nism. When an addicting drug is introduced in the body it acts as an antigen 
and the body tries to defend itself against it, as it does against any antigen. 
However, in the specific case of the addicting drugs, the body appears unable 
to produce the entire progressive series of defense substances, up to the spe- 
cific globulins which would fully neutralize the antigen. Consequently the body's 
I'esponse remains at a lower step of this defense mechanism, with a low degree 
of specificity. This corresponds to release of lipids with a positive polar group. 
As this defense is qualitatively insufficient the body produces an excess of these 
defense substances. Their lipid nature with positive polar groups induces an 
anoxybiotic offbalance. Addiction, therefore, corresponds to nn anabolic aroxy- 
biotic offbalance which is induced directly by the addicting drug, and mainly by 
the excessive production of these low specific defense lipidic substances. 

In general the organism attempts to correct the abnormal situation created 
by the presence of an offbalance. This is attempted by the intervention of nroc- 
e««es corresponding to an opposite offbalance. For the anoxybiotic offbalance 
these "correcting" processes are mainly brought about by the appearance of 
dyschlorobiotic processes, through the intervention of conjugated fatty acids. 
This dyschlorobiosis, whir-h in the case of drug addiction occurs mainly at the 
systemic level of the body, is recognized through the appearance of a systemic 
alkalosis. We have shown that the main analytical change which corresponds 
to the withdrawal syndrome is the appearance of alkaline urines, resulting from 
the systemic alkalosis. Manifestations such as abdominal cramps, di'-rrhea. 
vomiting, lacrimation and muscular pains appear to result mostly directly from 
the intensive dyschlorobiotic offbalance with systemic alkalosis. The addict may 
control this noxious dyschlorobiotic offbalance. by intake of an addictinar drug. 
By inducing anoxybiotic changes the addicting drug acts directly upon the 
antagonistic dyschlorobiotic offbalance present in the withdrawal condition. 
When a systemic acidosis replaces the previous alkalosis, the dyschlorobiotic 
offbalance is temporarily controlled. Urines then change from alkaline to acid. 
However, as a consequence of the repeated intake of drus:s. the amount of defense 
anoxybiotic substances, as well as the intensity of correcting dyschlorobiotic 
processes, is progressively increased. This results in an increasing need, an urge, 
for more addicting drugs. Withdrawal of the addicting dru;? leaves the bodv of 
the addict under the full infiuence of the progressively more intensive noxious 
correctins: processes. The dyschlorobiotic offbalance which results, with it« in- 
tensive alkalosis and the withdrawal symptoms which it induces, is thus progres- 
sively increased. 



306 

It is this role of the intervention of "correcting" process in the withdrawal 
•condition which explains why all withdrawal syndromes are more intensive for 
the first 3 to 4 days after the discontinuance of the drug, and why they decrease 
in intensity in the following days. This is due to the fact that although noxious, 
the correcting processes acting upon the anoxybiotic offbalance of the addiction 
itself, succeeds to reduce its intensity with time. As a corrolary, the correcting 
processes also decrease. 

THEEAPETJTIO ATTEMPTS 

These considerations concerning the pathogenesis of addiction and of the with- 
drawal syndrome led us to a therapeutic approach. As mentioned nbove, an off- 
balance can be induced by administration of the lipids respon.sible for the off- 
balance. This is also obtained with synthetic agents which have the same ba.sie 
lipoidic-physico-chemical characters. 

Our studies have shown that each offbalance is opposite to the two other off- 
balances. Likewi.se, when one offbalonce is induced it will control any one of two 
others. An induced dysoxybiosis may thus act against an anoxybiosis as well as 
upon a dyschlorobiosis. These basic considerations were used in the search for 
a guided therapy for drug addiction, .since the addiction itself is an anoxybiosis 
and the withdrawal pyndronie corresponds to a dyschlorobiosis. Theoretically, 
both should be controlled by agents able to induce a dysoxybiosis. Consequently 
in the therapeutic attempts we u.sed agents which we knew from previous studies 
to be able of inducing a dysoxybiotic offbalance. 

We have found these properties in the members of the sixth series of the 
periodic elements : that is, for oxygen, sulfur, selenium and tellurium. Adminis- 
tration of agents able to furnish oxygen in a highly reactive form temporarily 
influenced the withdrawal symptom.s. but were unable to control addiction 
itself. This led us to use the second member of the series : sulfur. Inorganic 
bivalent sulfur compounds as well as magnesium and ammonium thiosulfates 
were \ised. We discontinued their use, for, despite effectiveness, we could not 
administer sufficient amounts to fully control the condition. However the clinical 
results obtained with these agents showed that we were on the right path. Con- 
f^eqnently, we used bivalent negative sulfur but as organic lipidic compounds. 
They were mainly hydropersulfides and persulfides of unsaturated fatty acids. 
These compoiuids. although active, were however seen still not suffif^iently 
effective to control withdrawal symntoms such as muscular cramps and vomiting. 
This led us to consider selenium, the third member of the series. In view of the 
high toxicity of most of the selenium compounds this became the main problem 
in therapeutic use. Previous experience with selenium preparations has shown 
that active selenium preparations with a very low toxicity could be obtained. 
These are compounds of bivalent negative selenium, with lipidic properties. We 
selef'ted an organic lipidic compound of bivalent negative selenium, with the 
selenium bound as perselenides to unsaturated fatty acids. 

In experimental studies in animals this preparation induced a dysoxybiotic 
offbalance. It Is this strong activity which seems to indu<^e debydrogenation 
whif^h in turn changes sterols into inactive substances siich as Diet's hydro- 
carbon, (the ^ methyl, 1, 2 cyclopentanophenanthrene). By inactivating the ster- 
ols they intervene in the pathogenesis of the anoxybiotic offbalance. 

The same processes act upon the abnormal fatty acids with conjugated double 
bonds, leading to their inactivation. This influences the dyschlorobiotic off- 
balance. We have been using these preparations in order to act unon the two 
offbnlances present In drug addiction and in withdrawal symntoms. These 
nrena rations are used as oily iniectables and orally. The clinical results obtained 
have confirmed their tbei-aneutical value. 

The important role nlaved by the svstemic alkalosis in withdrawal symptoms 
has led us to the use as adjuvants which have a strongly acidifving and oxidising 
action. Hydrochloric acid and to a lesser extent its ammonium salt, effectively 
net upon the svndrome. A preparation containing acidifying and oxidizing acrents 
is used f's "adiiivant." This preparaiion for control of the withdrawal syndrome 
is administered orally. 

TOXTCITT 

Toxicity studies in animals have shown that the orcranic lipidic selenium prep- 
arations we use have an extremely low toxicity. In order to detprmine in acute 
toxicity the LD50 in mioe and rats, we used couf^entrated solutions of the pr<^para- 
tion having more than 10 times the content in selenium than the preparations 



307 

used in humans. In intraperitoneal and subcutaneous injections, doses up to 2 mg. 
selenium per 100 g. of animal were tolerated without ill effects. The LD50 for 
mice for intraperitoneal injection was 40 mg. Se/Kg, and for rats, 53 mg. Se/Kg. 
The LD50 for subcutaneous injections are GO mg. Se/Kg in mice, and 72 mg. Se/Kg 
in rats. In a 60 Kg man this would correspond to 1,000 ml. injected all at once. The 
usual therapeutic dose for humans is a maximum of 50 ml./day for 2 days and 20 
ml. for the 3d day— This is a total of 120 ml. for 3 days of treatment. Therefore, 
the safety index for the drug is sufficiently high. There is a very low toxicity for 
subacute administrations. The only limitation is the amount of oily material to be 
injected. Infections of 0.05 mg. Se per 100 g. mice and rats daily, 5 days a week, for 
6 \Yeeks, was seen to be without ill effects. Similar doses injected in dogs for 6 
weeks were also seen to be well tolerated. 

In chronic toxicity studies, doses for mice of 0.1 mg. Se per 100 g. body weight, 
were injected for 3 months, without ill effects. The animals were not losing weight 
and behaved normally. Pathological studies showed no lesions in any of the 
organs. Administered to pregnant mice in doses of 10 mg. Se/per mouse, for 3 
consecutive days, the preparation did not interfere with continuation of the 
pregnancy, nor with the condition of the offsprings. Administered to mating 
female and male mice, no teratogenic effects were seen. 

The same lack of toxic effects was observed when preparations containing 35 
mg. Se per ml. were administered to mice and rats through a catheter introduced 
directly into the stomach. Administered orally to weanlings, it did not interfere 
with normal development. 

There were no changes in blood (CBC, hematocrit, electrolytes, enzymes — GOT, 
GPT, LDH — albumin, globulin, CO- combining power, thymol turbidity, choleste- 
rol) and urine analyses (glucose, albumin, acetone, blood, pH, surface tension, 
chlorides, sediments) of experimental animals (mice, rats, guinea pigs, dogs, and 
rabbits) kept on selenium preparations. There ^pve no ahnarmaiitjps e^thpr in 
the gross and microscopic examination of the organs of animals sacrificed in 
acute, subacute, and chronic toxicity studies. 

In humans preparations containing up to 10 mg of selenium per ml have been 
well tolerated without any local or systemic reactions in repeated I.M. injections 
of 10 ml. In some subjects in concentrations at or above 10 mg of selenium per 
ml the compound tended to induce a local reaction at the site of the injection, 
which was still stronger with repetition of the injections. We are using in pref- 
erence preparfitions having up to 10 mg selenium per mil. They were well toler- 
ated locally. Capsules for oral administration containing up to 35 mg of selenium 
each were also seen to be well tolerated in doses up to 10 a day. 

We have used the same preparations in humans for other conditions and have 
administered them continuously for several months, without producing any 
toxic effects. Blood and urine analyses (the same as those mentioned for animal 
studies) as well as clinical data have shown no toxic changes. 

From these studies we have concluded that the selenium preparations we are 
using are safe in doses much higher than those necessary to induce therapeutic 
effects. 

Acidifying and oxidizing adjuvants, pharmaceutically accepted, which act 
upon withdrawal manifestations were added to the treatment with selenium. 
Their concomitant administration with selenium preparations did not influence 
the very low toxicity of both preparations. 

TREATMENT 

The selenium preparation containing 0.35 mg Se per ml is administered in in- 
tramuscular injections in doses from 5-10 ml. These injections are repeated four 
times in the first 24 hours, two or three times for the 2d day, and one or two times 
for the 3rl day. Additional injections are given if withdrawal symptoms are still 
present. Not more than six injections in 24 hours are given. From the adjuvant 
acidifying solution, doses of one ounce are added as often as any withdrawal 
symptoms appear without other limitation. After the 3d day of treatment 
with selenium the subject continues only on the adjuvant solution. He may re- 
ceive however, additional injections of the selenium preparation, only if the 
withdrawal symptoms appear and are not fully controlled by the adjuvant 
solution. 



308 

EESULTS 

Studies concerning tlie pathogenesis of addiction and withdrawal syndrome 
and of the ditl'erent therapeutic attempts were made in over 1,000 patients. They 
were young and old addicts, ranging from 14 to 48 years of age. Most were ad- 
dicted to heroin and cocaine, a few to morphine and barbiturates. Some were 
newly started on the habit, while others were using the drug for years, some 
even for more than 20 years. 

Almost all patients wlien submitted to adequate treatment responded with the 
same promptness. Administration of selenium preparations by injection to an 
addict is generally followed within minutes by a favorable subjective change. 
Most of the subjects use the same terms to describe the sensation they feel. They 
say: "I am normal" to indicate that the effect is fundamentally different from 
that obtained with the addicting drug. And this sensation persists usually from 
2 to 12 hours. Their manifestation of an immediate loss of the urge, namely the 
need for the addicting drug is a very important effect. Concoraitant]y, the pa- 
tient Is started on the adjuvant acidifying solution, which is repeated as often as 
any symptom of withdrawal appears. With these medications (the selenium 
preparation and the adjuvant) addiction and withdrawal symptoms are eon- 
trolled without being replaced by euplioria. There is no sensation of being ''high" 
like that induced by the addicting drug, but rather an old sensation of feeling 
"normal." 

With the treatment used as indicated above, most of the patients remain free 
of symptoms during and after the treatment. 

Against insomnia we give barbiturates only if the usual doses of chloral hy- 
drate appear insufficient : and this only for the first days of treatment. 

Although there is no pain or any local or general reaction after the injections, 
many patients even after first few injections indicate the desire to discontinue 
these injections. They say : "I do not need any injections anymore, I have no 
urge or any trouble, I am normal now." We then continue the treatment with the 
adjuvant solution orally, recurring to injections only if the withdrawal symp- 
toms are not fully controlled by this oral medication. 

In a variant of the treatment, the injections of selenium are replaced by the 
oral administration of the oily concentrated solution of the same px'eparations 
with capsules containing up to 3-5 mg. Se. They are administered together with 
the adjuvant solution, and in some cases the clinical results are similar to those 
obtained with the injections. 

In order to evaluate objectively the effects of the different medications upon 
withdrawal symptonv'^- we have used a ouantitation of the syndrome according 
to the method of Hi-^'melsliaeh, which we have expanded by adding other symp- 
toms and signs. Each of the withdrawal symptoms or signs such as vomiting, 
diarrhea, lacrimation etc. are given a numerical value. This eva^i^ation of the 
condition is made either once or sevei-al times a day, and at the end of each ob- 
servation the points obtained are added up. The curves drawn represent the 
cour.se of withdrawal. For untreated siibjects the curves have a steep rising 
abruptly and remaining elevated for a number of days. For patients receiving the 
treatment, the curves barely rise and remain very low. for duration of the treat- 
ment and thereafter. 

CONTROT,R 

In order to assess the real effectiveness of this treatment, we have carried out 
control .studies. Some patients were given only a very small amount of the sele- 
nium preparation to calm the withdrawal symptoms for a short time. When the 
patient felt a return of the symptoms or an urge for the addicting drug, he was 
given an injection of sterile sesame oil or of a preparation known as being inef- 
fici^'nt. In every instance the incipient withdrawal symi^foms became mngnified 
and the patient often became uncontrollable. A number of these patients became 
so agitated that they signed themselves out of the program. An adequate treat- 
ment with injections of the selenium rtreparation find adjuvant solution cnlmed 
the wltlidrn-^'nl pviiiptoms within minntos. Ti.is! pi-T^eduro wns '•r'nen**':! on n 
number of diffei-ent pntients, as v,-ell ns cm the same patient at different times, 
and was alwavs followed bv the same effect. 

Double blind studies will have to be carried out next in an institution better 
equipped to Implement such an aspect of the program. 



309 

COMPAKISOX 

The subjects who had undergone previous detoxification treatments, remarked 
on the difference between this and other earlier treatments. They particularly- 
pointed out that with our treatment they no longer felt the need for the addicting 
drug. With methadone, for example, they claimed to have remained with pains 
in the legs and e.specially with the urge for the addicting rlrug during, and even 
after, treatment. In contrast, the urge for the drug disapiieared practically with 
the first injection of our treatment, and then did not recur. 

FOLLOWUP 

After the first injection with the selenium preparation almost no patient has 
voiced the desire the drug. UpoH leaving the hospital after 5 to 8 days, they 
all manifest emphatically this lack of need for the drug. On followup visits 
many subjects were seen to have remained free of narcotics weeks and even 
months after treatment. 

Others, however, resumed taking drugs. It is nevertheless important to point 
out that not a single patient who has resumed taking the drugs and who has come 
back for help, has said that he did it because of a return of the "urge." A few 
resumed using drugs because of unresolved psychological problems. Many be- 
cause they were "forced" by friends, and have been using addicting drugs without 
any need or desire for the drug. Most of the patients after treatment return to 
their old problems and their unchanged environment. They do not receive psycho- 
logical or social help. Yet, inspite of this, of about 1.50 patients referred to us 
by Rev. Raymond Massey of the Neighborhood Board No. 5, Inc., 22 percent 
have returned to steady jobs without additional medication, and without the 
help of psychological or social services. Of those receiving outside help, another 
17 percent have returned to steady jobs. 

VArXJE OF THIS APPROACH 

In this important problem of addiction, we must evaluate as objectively as 
possible the contribution which every new approach may bring to the solution of 
the problem. Based on the the results we obtained, our treatment seems to repre- 
sent a working solution of the medical problem of addiction. In a few days the 
addict becomes free from the craving for the drug, without having to undergo 
the torture of the withdrawal syndrome. This then opens the door for the second 
and third approaches, namely the psychological and social ones. 

Without the physical need for the drug, many of the patients become aware 
of the important part played by their psychological condition and ask for psy- 
chiatric and social help. 

The efficacy of the treatment gives back to the patient the hope he had lost, 
namely the possibility of a total recovery. By no longer facing the medical prob- 
lem, the psychiatrist can treat a subject who is no longer hopeless or even hostile, 
but one who is looking for help, like a nonaddict in his situation would do. And 
this is the important contribution of our treatment to the psychological problem 
of addiction. The experience of psychiatrists — in particular that of Dr. D. Casriel, 
New York City — in the field of addiction has confirmed the importance of the 
relationship between our medical approach and the indispensable psychological 
treatment of addiction. 

While the treatment contributes to the solution of the medical problem of 
addiction, we must emphasize the need to integrate it into the more general 
problem with its psychological and economical aspects. The medical treatment 
will show its full value as part of such a complete program. 

(Based on a lecture given at the Trafalgar Hospital medical staff meeting. 

May 23, 1970) 

Emanuel Revici, M.D., Scientific Director, Institute of Applied Biology, Inc. 

TREATMENT OF DRUG ADDICTION 

It is unnecessary to emphasize the importance of a simple, safe, efficient, and 
inexpensive method for the control of the medical a.spect of drug addiction. This 
represents the key for the completion of the treatment through an efiicient 
psychological approach — and further social adjustments. 



310 

The method derives from a special concept concerning the pathogenesis of the 
drug addiction itself. The addiction corresponds thus to a peculiar abnormality 
of the defense mechanism of the body toward the influence exerted by external 
agents, when introduced into the organism. In this special case of an addictive 
drug the progressive series of defense substances evaluated is stopped at a rela- 
tively low level. The incapacity of the body to manufacture higher more specific 
defense substances against the addicting drug results in a quantitatively exag- 
gerated aspect of less specific lower means. The excess itself of these defense 
substances constitutes an abnormal condition. The apport of the drug, with the 
capacity to neutralize the defense substances in excess, suppresses temporarily 
the existing anomaly. At the same time it enhances however the production of 
more defense substances, increasing thus the addiction itself. The low specificity 
of the intervening defense substances explains the possibility to substitute one 
addicting drug by another, in order to temporarily neutralize them. 

If the addicting drug is not taken, the organism tries by itself to resolve the 
existing abnormal condition of the excess of low defense substances. This is done 
through the intervention especially of the parasympathic system. It is this inter- 
vention which constitutes the withdrawal manifestations. The apport of the 
drug, with the consequent neutralization of the defense substances, stops the 
intervention of the nervous system and of the withdrawal symptoms. 

It is the concept of the pathogenesis of the addiction and of the withdrawal 
manifestations which has led to the therapeutic intervention. The agents of the 
preparation Perse were chosen to act upon the processes involved in addiction. 

The preparation Perse is in a sterile injectable form, readily absorbable. 

Toxicity studies have shown practically the absence of toxicity. Doses of 6 or. 
of Perse per 100 g. of animal in mice and rats were seen to be well supported. 
Reported to human beings they would correspond to an injection of 6,000 ml. 
The same, the preparntion introdu'-ed by catheter into the stomach of mice. 
were seen to be without toxicity. Similar values were obtained in subacute tox- 
icity studies, followed over 10 days with 1 ml. by injection or orally. No gross 
or microscopic pathology was found in the animals sacrificed after this period. 
No toxicity was seen in the study of chronic toxicity followed over .3 months. 

No toxic effects were seen in humans treated with these preparations, as re- 
vealed by clinical and analytical studies. 

SCHEME OF TREATMENT 

The treatment aims to control drug addictions, preventing at the same time 
the withdrawal syndrome. 

Afjents Used. — Preparation Perse. An organic compound of negative bivalent 
selenium, sterile for injections. 

To.r/mf?/.— Doses of 2 ml. injected I.P. or S.C. to 28-30 g. mice or of 20 ml. 
injected I.P. or S.C. to 150 g. rats were not toxic. 

Similarly no toxicity was seen in subacute and chronic toxicity. No local or 
systemic side effects were seen in humans with repeated 10 ml. doses injected 
I.M. 

Conduct of Treatments.— ThQ first day doses of 10 ml. of Perse are injected to 
the subject three times a day— that is at S hours interval and at least as fre- 
quently as he would usually take his drug. If the subject was taking high doses 
of narcotics, this interval is reduced to 6. 4 or even 3 hours. It is the same if 
any withdrawal symptoms appear before the schedule time for the next injec- 
tion. An injection is then given immediately and the time between the next in- 
jections is reduced to a value below the interval. 

This form of treatment is followed for the first 24 to 48 hours, after which 
the .'subject receives only one injection every 12 hours the next day and one 
infection the following 24 hours. 

With this form of treatment the patient remains free of his addiction within 
2 to 3 days without having had any symptoms of withdrawal. 

If necessary, especially for psychological reasons, the treatment mav be pro- 
longed for a few more days at the rate of one injection a dav or repeated as often 
as desired, without any inconvenience. 



311 

[Exhibit No. 14(c)] 

Significant Therapeutic Benefits Based on Peer Treatment in the Casriel 

Institute ^ and AREBA ^ 

(Daniel Casriel, M.D., New York, N.Y.) 

Historically, tlie treatment of emotional and behavior disorders has been the 
province of authority figures. We have called these authority figures witch doc- 
tors, priests, holy men, faith healers, doctors, alienists — psychiatrists. Society 
in general, and the individual in particular have delegated to these men not only 
the rational authoriiy due them, but also an irrational authority premised upon 
the possession by them of magical omnipotence in one form or another. 

Two hundred years ago the mainstream of western society ceased ascribing 
magical curative pov.ers to its doctors and priests. But the sick or incapacitated, 
individual, in his state of helplessness, frequently — at times unconsciously — 
attributes magical power to his doctor or other healer. 

Occasionally, the doctor or doctor-surrogate can utilize the role of magical 
omnipotence, given him by his patient to help him. But the doctor can also use 
this role has a cloak to hide his own feelings of therapeutic inadequacy and help- 
lessness However, once the contract is made, neither patient nor doctor can, each 
for his own reason, admit to the healer's lack of magic. 

Therapeutic improvement, limited by the nonverbalized contract of delega- 
tion and acceptance of magic on the part of patient-doctor, comes to a halt Treat- 
ment, by the very nature of the relationship, cannot be reconstructive, but at best 
reparative, more often, just supportive. Very frequently after an initial improve- 
ment, the patient becomes worse when doctor-father-God cannot or will not 
continue to live up to the role mutually agreed upon. The doctor's magical role 
that he accepted, encouraged, or seduced from the patient has now backfired. Th* 
patient feels betrayeii and angry. The doctor feels annoyed and would like to rid 
himself of the problem patient 

Modern psychiatry, stemming from the basic concept of Freudian theory, 
attempted via psychoanalysis to use rational authority to reeducate the irra- 
tional authority the patient delegates to the doctor. Unfortunately, psychoanalysis 
is not only a very long and costly process, but it is also effectively useful only 
witii those personality structures that are both basically adult (versus child- 
like) and neurotic (versus character disordered) to begin with all the other 
categories are, to a greater or lesser extent, unable to utilize psychoanalysis, as 
can be seen in the following chart. 

BASIC PERSCNALITY TYPES « 

Level of 

personality 

integration Psychotic Neurotic Character disordered 

Adult Psychotherapy with Reconstructive analytic Classical forms of treatment 

psychcpharmacology. therapy. relatively ineffective. 

Adolescent.. Perhaps reconstructive 

analytic therapy. 

Childlike Reparative therapy 

Infantile _ Supportive therapy 

• The major difference between character disorder and neurotic has been published by the author in "Physician's 
Panorama," October 1966. 

Currently, an ever-growing list of self-help groups are being established. 
Starting with Alcoholics Anonymous in 1936, we have seen the rise of Gamblers 
Anonymous, Weight Watchers, Addicts Anonymous, Neurotics Anonymous and 
groups for wives, parents and friends of the afflicted. Self-help therapeutic com- 
munities such as Daytop and Synanon, and more recently, scores of lesser known 
smaller self-help communities and storefront operations such as Encounter and 
SPAN are sprouting and growing. 



'^ The Casriel Institute : the treatment and training facility for the new identity group 
process and theory. This new theory and process will be published by Coward-McCann in a 
booli called A Scream Away From Happiness to be written by the author. 

- AREBA : A private therapeutic community for the rehabilitation of middle and upper 
class drug addicts and other behavioral bankrupts. AREBA (accelerated reeducation of 
emotions, behavior and attitudes). 



312 

Why is this happening? What need are these organizations fulfilling that tradi- 
tional therapies (medical, paramedical, or religious) failed to fulfill? Who are 
the people helping and being helped that found no help by professional workers? 
How are the incurable and unhelpable being helped by each other? Who are they 
able to help, and why are they able to help each other? What is the new "magic" 
ingredient? What can trained professionals learn from all this? 

Simply stated, we must examine the process involved with words such as peer 
relationship, responsibility, concern, involvement, absence of magic, confronta- 
tion.^ 

First and foremost is the concept of equality — peer relationship. Both in 
AREBA and at the Casriel Institute the member entering in the groups or into 
AREBA is treated as a potential equal, a peer by the group, the group leader 
and the AREBA staff. By inference, it is assumed by all the members of the 
group and the staff that the new member's potential for healthy functioning is 
basically equal to any other in the group, including the group leader or AREBA 
staff who make no secret of once having been in the new member spot). The 
entering member is quickly told there is no magic, only hard work. We can 
teach, but the member must learn ; no one can do the work for him or learn the 
lesson of feeling, thinking, and behaving for him. Each must learn for himself. 
Each learns that the more he attempts to involve himself in teaching his peers, 
the more he learns for himself. To paraphrase Dr. Cressey, if criminal A at- 
tempts to help rehabilitate criminal B. criminal B may not be rehabilitated by 
A's activity, but A will almost certainly benefit. 

The new member soon learns that others around him have no magical gifts. 
Some have inherent special attributes that make them better in some areas than 
in others — but all have the potential for happiness. He learns that he can be 
as mature, secure, adequate, lovable, and affective as all those around him. 

Not only is there no "we — they" situation such as we the patients, they the 
therapists, but neither is false therapeutic contract able to be established. The 
nonverbal, unconscious transfer of magical curative powers cannot be consum- 
mated. The patient-member soon learns that he is not only responsible for. but 
capable of his own growth and development. The whole concept of who is re- 
sponsible for "getting well" or growing up, is clearly defined. 

If a patient delegates magic to the therapist or the therapist accepts the 
responsibilit.v of getting the individual well, reconstructive treatment of all 
but the adult personality (where little if any magic is delegated or accepted) 
is doomed to failure. A therapist has no real magic power. All he has. and this 
is in no way an underestimation of his role, is empathy, a desire to help another 
humnn being, and knowledge which, if learned and applied by the patient, can be 
curative. The leader's knowledge to some degree was gained from his own 
academic work, but mostly, and most importantly, from his own experience 
working first on himself, and then on others. 

The peer group process as practiced in both AREBA and the Casriel Institute 
by the author, is so constituted that it does not allow the patient to delegate 
magic powers to the therapist (s) and prevents anyone, out of concern, from 
assuming responsibilities that in realty, he cannot fulfill. One can be responsible 
only to the degree one has control of one's thinking, feeling and behavior. 

Therapy is frequently misused because of the conflict and confusion of the re- 
lationship between patient and therapist described by the words "responsibility" 
and "concern." However, human relationships in general are frequently mangled 
by the same confusion. Healthy parents are not only fully concerned for their 
newborn child but are also fully responsible for his well-being. As the child grows 
older, he must accept a greater and greater share in the responsibility for his own 
life. By the time he is adult, he has total responsibility. His parents no longer 
have any responsibility though their loving concern may be just as great or even 
greater than the day he was born. 

A good therapeutic process, whether in AREBA or in the Casriel Institute. Is 
to assume only the responsibility of teaching the member what he is doing, think- 
ing, and feeling; and what he has to do and feel to be mature. Learning is up to 
the member's doing, thinking, and feeling. 



3 Df'flnitions (a) Troatment — Any nipnsiiro desitriiod to ariK^liorate or euro an aluiorninl or 
undesirable condition: (&) Rational authority is based on g-eniiine ability and comi"'tpnfy 
and is exemplified by tb.e teacher imparting: knowledge to a pupil ; (c) Peer — It is sittniflcant 
to note that this word Is not defined in the psychiatric dictionary ; {cD Therapy — Treatment 
of disease: therapeutic; (c) Therapeutic — PertainlnK to or consisting of medical treat- 
ment ; healing, curative. 



313 

The concomitant is the assumption upon the part of other members that the 
new member is potentially equal to them and is equally capable of doing for him- 
self and growing up. 

In AREBA, it is assumed that the new entering member knows nothing, has 
learned nothing but self-destructive, maladaptive behavior, thinking, and feel- 
ing. The members and staff of AREBA have in their own growth learned to be 
truly concerned for the entering member. They enjoy the challenge and will in- 
volve themselves with the new member. They know that the more they teach, 
the more they learn. They desire to give. They are given the time and knowledge 
to teach the newer members everything they need to know to be mature, loving, 
adult human beings. An entering member's potential for being a mature individ- 
ual is assumed when he arrives. 

There is also the assumption that the emotionally and socially bankrupt mem- 
ber has learned nothing constructive for himself. The staff and senior residents 
of AREBA painstakingly teach the new member minute by minute, hour by hour, 
day by day, week by week, and month by month how to do for himself ; how, in 
effect, to act like a mature human being. After a few months, the member starts 
to learn how to feel like an adult human being — and feels what an adult human 
feels. 

In the Casriel Institute, the patient is confronted at the stage of his emotional, 
vocational, educational, and social maturation at which he enters the group ther- 
apy process and is taught from that level upward. 

There is a general avoidance of constructive confrontation throughout our 
society's social fabric, because most people fear the consequences of challenging 
and being challenged. If a child disagrees with his parents, he is scolded, pun- 
ished, rejected. If he disagrees with teachers, he is reprimanded, expelled, or 
failed. If one disagrees with the boss, he may be fired for insubordina- 
tion, recalcitrance or personality incompatibility. If one disagrees with 
the social power structure, he may be considered a traitor, criminal, rabble 
rouser, coward, anarchist or fascist. Disagreement with any authority within 
our culture gives one a stamp of social disapproval. We have grown up with the 
attitude that even if we're right, to disapprove of authority will result in pain 
or loss of love. 

Translated into a peer relationship, the attitude becomes, "I'll mind my 
own business." 1. If I try to help, I'll only get hurt (i.e., the murders that in 
the sound and sight of others were not interdicted). 2. If I reach out and show 
my concern by expressing constructive criticism, I leave myself open and vul- 
nerable to other criticism * * * people in glass houses shouldn't throw stones. 

This peer indifference and isolation is endemic throughout our social fabric! 
human — including therapeutic — relationship if personal growth is to ensue. The 
Yet constructive challenge between equals is precisely what is needed in any 
therapist, be it friend, doctor, or group member, will, in this open bilateral 
interaction, change and grow too. The therapist must not only be willing and 
able to change, but to show by example — by his role model position — that the 
enjoyed and benefited from the experience, though he too was once frightened 
and lost. He was not delivered into adulthood magically well but had to undergo 
his own painful therapeutic re-education, which was hard work, and only later 
became training for what he is now doing. 

The humanistic-peer attitude on the part of the therapeutic teacher-leader 
is essential. Peer relationship on the part of the therapist demands a more 
personal kind of involvement. It leads to a quicker, more resonant, and fuller 
human growth for the patient. It is diametrically opposite to the formal, de- 
tached, impersonal, nonfeeling therapeutic relationship demanded in our train- 
ing and experience in psychoanalysis. 

The effectiveness of humanistic-peer involvement as a therapeutic treatment 
process has several significant implications. 

First and foremost is a total change of attitude that professionals have to 
develop in order to effectively engage in this type of process. 

Second, the obvious empirical observation that a feeling human being, who 
has learned for himself as a patient-student the process, and has the capacity, 
ability, and desire to engage others, can be an extremely effective therapeutic 
change agent. Previous academic training is of relatively little use, though pre- 
vious life experiences are of great value as are one's own former neuroses 
or character-logical problems which have been resolved. In line with this, cured 
hysterics are most effective with uncured hysterics; cured alcoholics are most 

60-296 — 71 — pt. 1 — — 21 



m 

effective with uncured alcoholics; cured drug addicts are most effective with 
uncured drug addicts; and cured homosexuals are most effective with uncured 
homosexuals. However, this does not mean to say or imply that one has to 
be an ex-hysteric, alcoholic, drug addict, homosexual, to do effective intervention. 
The peer symptoms identification early in treatment is extremely helpful and 
in some cases necessary, but within a few weeks all patients, no matter what 
the variation of symptoms, realize they have the same problems,* that below 
the symptoms, they are all human beings with the same basic needs and desires 
and the same basic fears. 

Third, psychoanalysis must be returned to the areas where it belongs : as a 
highly specialized, very limited fine tool, in the tool chest of psychotherapy. 

Fourth, because of the relative ease of treating and training, large numbers 
of individuals can be treated and trained at little cost and relatively little time. 
This means that large numbers of skilled group leaders can become available to 
meet a tidal wave of need. Costs are within realistic ranges." 

Fifth, it is logical to see the role of the professionally experientially trained 
psychiatrist, psychologist and S.W. as consultant and trainer of the trainers, 
as well as being used as the agent of initial interviews, medication, testing or 
using traditional ancillary roles. 

The significance for society is that the large number of untreatables could 
now be treated ; the large numbers who could not afford treatment could now 
afford it ; the large numbers who wanted treatment but had no available thera- 
pist in the area could now find therapists ; a large number who were unwilling or 
unable to commit themselves to many years of therapy could now look forward 
to major reparative psychotherapy and reconstructive (major personality change) 
therapy being done in a matter of months for most, or 1 to 2 years for some. 

Indeed, this process, if fully applied, could make a significant impact relatively 
quickly on major portions of our sick society. 



[Exhibit Xo. 14 (d)] 

AREBA, Inc., A Humanizing Process foe the Family of Man 

Introducing AREBA, A New Concept in Rehabilitating Drug Addicts 
AND Other Emotionally Disturbed People 

A new psychotherapeutic treatment program for middle-class and upper- 
class adolescents and adults — designed for severely character dis- 
ordered personalities who do not need a sustained 3-year program 
to get well 

In 9 months — the time it takes to conceive and give birth to a 
baby — AREBA can reprogram a person toward in-the-world behav- 
ioral and emotional health. 

At highly successful Day top Village, 3 years used to be required to rehabilitate 
an addict. But, today, new techniques have reduced the time to a year and a 
half. Now, Psychiatrist Dan Casriel and Ron Brancato, former director of pro- 
gram at Daytop, have utilized their experience to establish a new kind of program 
for middle-class emotionally disturbed people. 

Frankly, AREBA is a hard-nosed program that isn't easy. (At least, at the 
beginning. When people have been in AREBA a few weeks, they usually start to 
like it * ♦ ♦ and to develop an esprit de corps about AREBA. ) 

The program starts by telling newcomers to stop acting out their symptoms. 
Immediately. Then, it goes to work on the distorted feelings and defeatistic 
attitudes which have caused the symptoms to exist in the first place. 

AREBA makes people face the truth about themselves, find out who they are, 
and grapple with how they feel inside. At the same time, it trains people to 
function in the world in which they must live. 

The AREBA program is designed to treat people whose emotional problems pre- 
vent them from functioning effectively and responsibly within the boiuuhiries 
of normal society. There are no rigid age restrictions. AHERA i.s strui'tiired 



* Inability to accept love or express Identity anger. This Is the subject of another paper 
submitted for publication by the author. 

* "The Use ajid Abuse of Paraprofesslonals" — unpublished paper by the author. 



315 

fo focus on the problems of both adolescents and adults. AKEBA is based <m 
the principle that psychiatric treatment alone is not enough to rehabilitate an 
infantile neurotic or character-disordered personality — who, invariably, does 
not know how to function. The program is designed to help an individual in two 
ways : (1) to provide psychotherapeutic treatment to help him express and under- 
stand distorted feelings and self-defeating attitudes ; and ( 2 ) to provide fetep- 
by-step guidance about how to function more effectively in the world. 

The program has been founded and structured by Psychiatrist Daniel Casriel 
and Ron Brancato, former director of po-ogram of Day top Village. It is realistic, 
tough minded, and extraordinarily effectively. Study the schedule following and 
see for yourself why AREBA is different from other approaches you may have 
read about. 

The AREBA program lasts 9 months, and consists of three distinctly diffeient 
phases of i)ersonal growth. 

PlutHO I — First Jf months, 2Jf hours a day, 7 days a week 

At the start, a young person is immersed in a 24-hour-a-day structured disci- 
pline. For example, he arises at 7 :30 a.m., immediately begins to clean his i-oom. 
and eats breakfast. Then, his day continues with meetings, seminars, group 
thereapy sessions (held every day), and specific work responsibilities. Eveiy 
hour of the individual's time is programed. He ineracts with others during free 
time, and is accountable for everything he says and does. Special "probes" ( last- 
ing 8 to 12 hours) explore self-defeating attitude patterns. "Marathons" (30-hour 
extended group-therapy sessions) are aimed at breaking down emotional de- 
fenses, and getting members of AREBA in contact with gut-level feelings. 

Phase II — Fifth mmith through seventh month 

In the next phase of treatment, a young person starts to attend school a?ain. 
Or, if he is through with school, he goes to work outside of the AREBA com- 
munity. He is encouraged to apply what he has been learning in phase I train- 
ing. Hut he continues to live in the AREBA community, and continues to be 
involved in Dr. Casriel's new identity groups, probes, marathons, etc. In thera- 
peutic sessions, the emphasis is on helping the individual express his fears and 
anxieties, and helping him learn how to function more effectively in the ex- 
panded world to which he is now relating. 

Phase III — Eighth and ninth months 

In the final phase of treatment, an individual both works and lives outside of 
the AREBA community. His involvement with AREBA is to attend encounter and 
new identity groups three times a week. During these groups, he works on feel- 
ings and attitudes which may be preventing him from adjusting healthily to the 
nontherapeutic "outside world." He also spends time serving as a role model 
for people entering AREBA for the first time. 

Parents get training, too 

Throughout the 9-month period, special groups and special counseling are 
provided for parents of young people who are in the AREBA program. With 
parents, the emphasis is on establishing a permanently better relationship Iie- 
tween themselves and their offspring. 



[Exhibit No. 14(e)] 

Therapy of Narcotic Addicts Sparks Psychiatric Theory 
[From the Medical Tribune — World Wide Report] 

New York. — A psychoanalyst said here that he has evolved a psychodynamic 
theory to explain character disorders by observing and working in the successful 
rehabilitation of narcotic addicts. The theory is based on the concept that per- 
sons whose primary method of defense is withdrawal, not "flight oar fight," "fit 
into the pyschiatric classification of character disorder." 

Dr. Daniel H. Casriel explained both his theory and the rehabilitation process, 
which he called "the Daytop phenomenon," at a meeting of the American Society 
of Psychoanalytic Physicians, of which he is president-elect. The term refers to 
Daytop Village and Daytop Lodge, addict-reform communities in Staten Island, 
N.Y., patterned after the Synanon centers, with some modifications of technique. 

"Daytop is the breakthrough in the treatment of the drug addict," said Dr. 



316 

Casriel, who is medical-psychiatric superintendent of Daytop Village. "For the 
first time, an addict upon entering Daytop sees 100 people who were also 
addicted but who are living happily and functioning without drugs or the pre- 
occupation with the thought of drugs." 

Daytop A'illage has been in existence for 6 months. It is an outgrowth of Day- 
top Lodge, established under a 5-year National Institutes of Mental Health proj- 
ect to compare the results of several alternative probation arrangements for 
felons of the Second Judicial District, New York Supreme Court, and initially 
limited to 25 probationers. , 

"People live in Daytop in a pleasant, paternalistic, tribelike, family environ- 
ment," Dr. Casriel said, paraphrasing his book on Synanon, "So Fair A House." 
The members think of Daytop neither as a hospital, a prison, nor a halfway house, 
but as a family-type club or home — a fraternity of people living together and 
helping each other to get well * * *. The members are neither patients nor in- 
mates ; they are free to leave any time they wish." 

OXCE BELIEVED THEKE WAS NO HOPE 

He said that he himself had once believed there was virtually no hope for 
drug addicts : "Ten years of contact through community psychiatry with the 
problem of drug addiction had left me deeply pessimistic * * *. My observations 
had almost brought me to the conclusion that, once addiction was established in 
certain predisposed but undefined personalitie.s. a basic metabolic change or 
deficiency was produced in the a,ddict, manifesting itself in" a craving that only 
the opiate could relieve." .'n.:-. .■ 

"That was my position imtil I discovered Synanon 3 years ago," he said, call- 
ing Daytop "the amalgamation of the best that was Synanon and the best of the 
professional understanding and knowhow." 

Citing the relative lack of success of psychiatry in the treatment of character 
disorders, he said that "the question I kept asking myself was, 'Why were non- 
professionals able to stumble upon a rehabilitation and cure of the drug addict, 
whereas professionals, as a general rule, were completely unsuccessful?' At last 
I feel I've discovered why. 

"After working intensively learning the process of treatment of the drug ad- 
dict specifically and the character disorder in general, I was finally able to trace 
it back and evolve a psychodynamic theory which to me explains why the proc- 
ess works." 

The theory, he said, was a modification of the psychocultural views developed 
by the Columbia School of Adaptational Psychodynamics. 

"A major defect in the adaptational psychodynamic theory," as.serted Dr. 
Casriel, "was its lack of awareness that there are three major methods of coping 
with pain or stress. * * * They accounted for two of these ways by the mecha- 
nisms of defense called flight or fight, using the emotions of fear or rage. What 
they failed to bring into focus is that there is a majoi:, perhaps more primary 
mechanism in which one avoids danger or pain. * * * it uses neither the emo- 
tions of fear nor rage and may be called isolation or encapsulation. * * * Some 
people withdraw from the pain of awareness, the pain of reality, what they 
experience as the pain of everyday functioning, by withdrawing unto themselves." 

It was bis observation, he said, "that those people whose primary mechanism 
of defense is withdrawal are those who fit into the psychiatric classification of 
character disorder." 

Once this "intrapsychic world without tension" has been evolved, he con- 
tinued, "the individual will overtly or covertly fight anyone who attempts to 
remove him from his prison-fortress. * * * Once the adaptational mechanism of 
isolation is evolved and becomes a primary mechanism, the standard psycho- 
analytic techniques using introspections and observation are useless. The indi- 
vidual patient, though he hears, cannot be reached." 

shbh:,!. must be removed 

To treat such patients, Dr. Casriel said, "One must first remove the shell and 
prevent the individual from acquiring or running into any other kind of shell." 
Then he must be taught how to grow uj) emotionally, socially, culturally, sex- 
ually, vocationally, and educationally. '•!/,!•.< I 

On this basis, addicts entering Daytop are given two simple prescriptions: no 
physical violence and no narcotics or other chemicals — "and bv inference no 



317 

other shells under which to hide." Only one reaction to his stress is left open to 
the Daytop member — fear. He can leave Daytop if unable to cope with his fears. 
However, said Dr. Casriel, "We anticipate that at least 80 percent of those who 
enter Daytop will sooner or later remain to get well." 

If he stays, the member is given two prescriptions — go through the motions 
and act as if. The first means to abide by the rules and follow instructions, like it 
or not. If a member complains that he doesn't linow exactly how to do as he is 
told, he is instructed to act as if * * * you knew what to do * * * you had the 
experience * * * you are mature * * * it is going to be successful * * * you are 
going to grow up and get well * * * you are already well and adult. 

"When people go through the motions of acting as if," Dr. Casriel said, "they 
start thinking as if and finally feeling as if." At the beginning of this process, 
there is a crucial 90-day hump during which painful underlying feelings come to 
the surface, he said, but the support of others at Daytop helps the new member. 

COMMUNICATION IS TREATMENT 

Treatment through communication then helps the member to understand that 
the undifferentiated somatic painful feelings that he has experienced on a vis- 
ceral and emotional level * * * are nothing more than fear, anger, guilt, and de- 
pression, emotions experienced by all humanity * * * are not exclusive to what he 
felt was the mystical parahuman called the drug addict. 

Tools of communications used at Daytop are a form of group therapy called 
the encounter, seminars, public speaking, psychodynamic interviews, lectures, 
and community relations. There are also rituals and rites of passage, including 
the intake and indoctrination processes, entrance into regular membership after 
a month's probation, a birthday after a year, and primitive rituals to maintain 
discipline, called the haircut and the general assembly. 



[Exhilnt Xo. 14ff)] 

The Family Physician and the Narcotics Addict 

(By Daniel H. Casriel, M.D.^) 

(From the Sandoz Panorama, February 1970) 

Because of my work in rehabilitation of drug addicts, I am often called upon 
for help by family doctors faced with this problem in their practices. The fol- 
lowing is basically a summary of the answers I have given to their questions. 

People seeking relief from their emotional problems have always been among 
us. Drugs are not a specific maladaptive resolution of an emotional need, but 
our present culture is drug oriented. Most of us have not the slightest hesitation 
in taking aspirin at the first twinge of a headache or a sleeping pill for a restless 
night or two. The underpinnings of this drug orientation are widespread and 
culturally accepted. One has only to turn on the nearest radio or television set 
to be cajoled, pleaded with, even intimidated into buying any of the medicinal 
remedies for a wide variety of common conditions. The easj' availability of 
medicines through comercial production, widespread distribution, and multiple 
sources of supply, makes the awarweness, acquisition, and use of all kinds of 
drugs so easy as hardly to be given a second thought. In this way the ground is 
prepared for the specific use of narcotic drugs, and the resulting addiction to 
them by the emotionally troubled. 

Availability is a prime factor; it is, indeed, a fact that those sections of the 
country which are closest to sources of supply have the greatest problem in this 
field. One obviously cannot be a heroin addict without access to heroin. A house- 
wife in the black ghetto of Harlem, might be (one could even dare to say, would 
probably be) addicted to heroin and in close contact with her pusher : whereas a 
housewife in Iowa might be habituated, if not addicted to some barbiturate, tran- 
quilizer, or stimulant, while maintaining a very close relationship with her 
doctor-supplier. 

Anyone who is not functioning, or who is under achieving in a responsible task, 
is potentially susceptible to drugs, and a certain percentage of these people will 



1 Dr. Casriel Is well known for his snccessfiil rehabilitation of narcotics addicts. He has 
been medical director of the Daytop therapeutic community, and its affiliates, for many vears. 
He also has a private psychiatric practice in New Yorls City. 



318 

resort to heroin. One must not forget that before the narcotics laws were passed 
in the early part of this century, we had anywhere from 2 to 5 million people 
addicted to various nostrums containing opium. 

DIAGNOSING ADDICTION 

The family physician dealing with a great variety of patients can — indeed 
should — make a differential diagnosis specifically excluding drug addiction of any 
one who is not functioning near his capacity, or of anyone suffering from a great 
deal of anxiety or depression (often masked as fatigue). Look for unexplainable 
needle marks or scars on the arms. Test the urine for morphine or its variants. 

The psysician should be cautioned in two ways. First, prescril)e no narcotics 
unless absolutely necessary, and even then only to patients known to you. Second, 
anyone coming in for chronic refills of barbiturates, tranquilizers, or ampheta- 
mines, should be referred for psychiatric help l)efore they become addicted to 
stronger drugs. 

There is also a third aspect which should be borne in mind. This is that the 
patient who demands a narcotic for continued or intermittent pain (which may 
or may not be somatically induced) is addicted. This addiction may have been 
iatrogenically induced for valid medical reasons, but it is the responsibility of 
the physician who so addicted his patient to ensure safe weaning and detoxifica- 
tion as soon as possible. Those physicians who are asked to mantain someone 
on narcotics whose history they do not know, may be perpetuating an illegal ad- 
diction, and are guility of malpractice, not only in a legal, but also in the 
medical sense. 

CUBE IS AVAILABLE 

A severe conflict faces a family physician in determining what to do witli a 
known drug addict who happens to be a friend, closely related to a friend, or any 
well-respected member of his community. Many physicians in such circumstances 
have perpetuated the individual's addiction, feeling that there is no real help, 
or that help is not available. Let me nov*- state quite emphatically that a cure is 
available. 

For the past 6 years we have been curing drug addicts at Daytop Village. Day- 
top is a therapeutic community. At the moment it con.sists of almost 300 ex- 
addict«, men and women, with and without their children or their mates, plus a 
staff of about 40 (about a third of whom are ex-residents) living together and 
helping each other to recover. Physically Daytop at present consists of three 
facilities : the original one in Staten Island, a second at Swan Lake, and a third 
recently opened on 14th Street, Manhattan. 

There is no magic in rehabilitating a drus addict. There is only an understand- 
ing of how to do it. a lot of hard work in doing it, and responsible love and con- 
cern by all involved. The program consists of : intake procedures ; intensive group 
encounters several times a week ; seminar sessions to improve the member's 
ability to communicate verbally, to enlarge his interest and knowledge, and to 
enal)le him to comprehend ab.stract concepts beyond his daily life experiences; 
and then, of course, there is work, all kinds of work and plenty of it. because 
the members of Daytop are taught to be self-sufficient. 

Da.vtop has a record of 02 percent recovery. That is to say, not only are 92 
percent of those who have graduated now free from drugs, but they are living 
mature, productive and responsible lives. !\rany have returned to us and now 
work with ns in staff positions, supervisintr and participating in all the internal 
v,ork. The staff ratio to resident population, incidentally, is 1 to 22, thereby 
making Daytop probably the least expen.sive, and certainly the most effective, 
of any kind of program so far tried. 

DAYTOP HISTORY 

T wrote an article for this magazine about 3 years ago (in the vol. 4. No. S, 
October 10(>() issue) in which T detailed the manner in which, having found 
standard techniques useless, we developed our methods, and I described the 
stages we worked throueh with our members in helping them to achieve new. 
mature, .secure personalities. Tn the meantime Daytop has srrown and chansjed 
and. indeed, is still ijrowinc: and chanjzinc:. Originally the stav that a resident 
could expect when he first came in was about 3 years. Today the expectation is 



319 

down to 20 uioiiths, and w