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140nance treatment patients showing a constant and accelerated decline in criminalbehavior and the contrast group showing a pattern very similar to the earlierperiod of observation.4. SUPPORTIVE SERVICESPatients on methadone maintenance have available to them on demand oneor more members of the program staff who are ready, willing, and able to respondto their needs whether these needs be medical, psychiatric, vocational,social, or legal.5. PROGRAM PHILOSOPHYTreatment programs for heroin addiction using methadone maintenance haveaccepted the fact that the "hard-core" addicts have a chronic disease, and, therefore,need medication and support over a long period of time, if not for life.This philosophy has resulted in a more permissive attitude toward patientswho show evidence of recurrent abuse of other drugs such as barbiturates andamphetamines or continued chronic alcohol abuse, and every effort is made toassist the patients in handling these problems. Only when this support fails arepatients dropped from the program.CONCLUSIONMethadone maintenance is a valid treatment for those hard-core addicts whoare 18 years or older with a history of at least 2 years of addiction and whohave had difficulties in adjusting to the stringencies of abstinence programs.Among patients selected in this manner methadone maintenance has provedsuccessful in 80 percent of more than 4,000 patients in the New York City methadonemaintenance treatment program. A majority of the patients have completedtheir schooling or increased their skills and have become self-supporting.Their pattern of arrests has decreased substantially. This is in sharp contrastto their own previous experience, as well as their current experience when comparedwith a matched group from the detoxification unit, or when compared withthose patients who have left the program. Less than 1 percent of the patientswho have remained in the program have reverted to regular heroin use. No othertreatment 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 addiction.For this reason, we believe that any treatment program using methadonemaintenance must be prepared to provide a variety of supportive services to dealwith such problems as mixed drug abuse, chronic alcoholism, as well as psychiatricor behavioral problems and a variety of other social and medical problems.Therefore, methadone maintenance should not be considered as a method oftreatment suitable for use by the private medical practitioner in his office practice,because of the requirements for other program components including socialrehabilitation and vocational guidance.
141Figure Methadone Maintenance Treatment ProgramIEmploynent Status and School Attendance for 15-:6 i-ien in Methadone MaintenanceThree Months or Lcnqer as of March 31. 1*^70(In-Patient Induction)100—20-v\-80-fow_0-
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NARCOTICS RESEARCH, REHABILITATION,
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::VEXHIBIT NO. 4 (a) AND (b)Eddy, D
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urden that such addiction imposes u
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1 (lata; (->) the sliariiis" oF iii
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9Chairman Pepper. The committee is
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::11quota production from unrecogni
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13in this country. This raises the
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15from other clinical projects of w
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:17practice, experience has indicat
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;19.I think a quota would be better
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21When methadone was first introduc
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:::::.—23American Society of Phar
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_'—25.I'BOCUREMENT AND ISSUE DATA
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'.28Fiscal years-1967 1968 1969 197
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30rally in opium. By indirect, the
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32We can, I think, most helpfully g
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34so intense that we haven't done v
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Dr. Eddy. Well, physicians, usually
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38Dr. Eddy. No.Chairman Pepper. Now
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:40get away with it as Dr. Keats su
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:—:42public health hazard was jud
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:44Bibliography(1 Nathan B. Eddy. "
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46(52) Nathan B. Eddy. "Dilaudid."
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48(98) "The New Narcotics, Post-gra
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^.50
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52entails the consideration of addi
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54Chairman Pepper. Have you found t
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56^.I wonder would you care to comm
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58Chairman Pepper. Without objectio
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—1958-681959-«419691962-64196219
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—62abuse and has brought about th
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64bank robbery or an assault. You d
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66Mr. Wiggins. Would the stopping o
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68—Chairman Pepper. Can you give
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:70The problem then would be the wi
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;72taking exceptional measures in t
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)—74pay serious attention to this
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;76From 1958 to 1961, he served as
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78deine in painkilling drugs. So if
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;80ning capabilities, responsibilit
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;:;82terials. If they could introdu
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84Figure 1infrared Ektachrome film
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;86Figure 3.—Tones of wheat (W) a
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88ers at the poppyfields or at any
Page 102 and 103: :90;:tional situations has handicap
Page 104 and 105: ;;92Locating illicit opium cropsDet
Page 106 and 107: 94Jaffe. Well, there would be some
Page 108 and 109: 96Mr. Jaffe. Primarily on the fact
Page 110 and 111: 98in the same ball park about what
Page 112 and 113: 100Chairman Pepper. Mr, Waldie, do
Page 114 and 115: ::102agencies and input data would
Page 116 and 117: 104most facilities are barely able
Page 118 and 119: ;106We have also studied a ^roup of
Page 120 and 121: 108Dr. Gearing. Yes, sir; I would n
Page 122 and 123: 110somethino: in the nei
Page 124 and 125: 112program is put into the machiner
Page 126 and 127: I114you have some data there that s
Page 128 and 129: 116Dr. Gearing. It depends on what
Page 130 and 131: 118Chairman Pepper. Would you have
Page 132 and 133: 120it not be so that we could proje
Page 134 and 135: .122admission rate was approximatel
Page 136 and 137: 124BESULTS(1) Although many of the
Page 138 and 139: 1262. All the members of the methad
Page 140 and 141: 128HETHADOHE MAINTENANCE TREATMENT
Page 142 and 143: 11 1 1 1 1 11130Methadone Halnten?n
Page 144 and 145: 132TABLE 2.-METHAD0NE MAINTENANCE T
Page 146 and 147: 134Figure 9 Methadone tlaintenance
Page 148 and 149: 136Methadone Ka'ntanance Treatmf:nt
Page 150 and 151: :::.::.138Appendix A^—Methadone M
Page 154 and 155: 142Figure 3 •lethadone Kaintenanc
Page 156 and 157: 144Dr. DuPoNT. 1,760 on methadone m
Page 158 and 159: :146there are dramatic reductions i
Page 160 and 161: 148Health insurance coverage for me
Page 162 and 163: 150Dr. DtjPont. Well, there are no
Page 164 and 165: 152Mr. Blommer. You would agree the
Page 166 and 167: 154done. Where is the evidence ? No
Page 168 and 169: 156There are several reasons a pers
Page 170 and 171: 158It would seem to me a very busy
Page 172 and 173: 160we had before. I don't think it
Page 174 and 175: 162heroin addiction and support all
Page 176 and 177: 164Dr. DuPoNT. I am reluctant to ge
Page 178 and 179: 166Using this figure as rule of thu
Page 180 and 181: )168ment facilities for heroin addi
Page 182 and 183: .170parole departments. None were c
Page 184 and 185: ::172Table 2.— Selected character
Page 186 and 187: 174TABLE 3.—HEROIN ADDICTION RATE
Page 188 and 189: 176W.a^^cc-V.c Cffv..AdF-ro ftcoKjL
Page 190 and 191: 178.^06V f\QrK-'SEt G^ouP/AJ6SIS're
Page 192 and 193: I180*i coo)u->CM>—'CMUJCOO O COa>
Page 194 and 195: I(/I182esiMmin0)^> oo.00 =E|c O.2 o
Page 196 and 197: 184encouraged to return to methadon
Page 198 and 199: 186or other side effects. This incr
Page 200 and 201: :188number as that on the bottle. W
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190Attachment ThreeTo all medical s
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-jI IALLI192ATTACHMENT- FIVE,J: IPA
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194ATTACHMENT NINEGOVERNMENT OF THE
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......—196half of the addicts sta
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198CONCLUSIONSCertain patterns emer
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200TABLE 5.— PROFILE OF BARBITUAR
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202TABLE ll.-SUPPORT OF HEROIN HABI
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204TABLE 17.-AGE OF ADDICTS AND NON
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206TABLE 23.—PRESENT MARITAL STAT
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208TABLE 28.-MILITARY SERVICEAddict
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:210The committee is pleased to cal
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212sists of a network of 21 geograp
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214(6) Basic studies on the nature
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216in fact, constitute autonomous o
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Chairman Pepper. Mr. Perito?218;; M
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^'220is not a very forgiving drug.
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'222Furthermore, in our present con
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—224the Federal Government decide
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-—I have presented one generic ki
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,clinic;?,>•
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230I realize we are running late.Do
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''232'']Vir. Winn. Tiien you mentio
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234So having put it in the area, ha
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,Memberships'—i236privilege of co
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;238A central hypothermic response
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;240South Bronx, Bedford-Stuyvesant
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242€are of patient addicts. We ha
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244hospitals in the city, came into
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246that came into my office, and I
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'Mr.;>•/nmo'.i,,;248deputy commis
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:250two Rockefeller Institute physi
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:252during pliase II that serious e
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254well-structured methadone mainte
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;:256nonsense and serves only to ad
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:258you best complete your statemen
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260Mr. Pertto. Based upon your expe
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262A a'reat case in point was a con
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«264Mr. Steiger. Did you discuss w
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—:266Mr. HoRAN. We don't support
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268Mr. Horan, let's back up a littl
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270It is not up to heroin or morphi
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272nesses yesterday who brought out
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274;Mr. Perito. It is my understand
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276So that at the end of the week t
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278steroid he lias in him we might
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280Mr. Perito. You are referriii"'
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282not drug free. I can say approxi
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28 A$2-a-day habit these individual
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•As286I got to the point once in
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288Mr. Steiger. You mentioned anoxi
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290Mr. Eangel. I could see then tha
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292Dr. Casriel. Mr. Keating, I have
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j294What period of time are ^ve tal
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296was March of 1970—he was admit
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298"The paper by Dole and Nyswander
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:300vent them from coming to New Yo
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302[Exhibit No.14(b)]Casriel Instit
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304to result from the insuflScient
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306It is this role of the intervent
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308EESULTSStudies concerning tlie p
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310The method derives from a specia
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312Why is this happening? What need
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m)effective with uncured alcoholics
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I316Casriel, who is medical-psychia
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318resort to heroin. One must not f
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.320in Permanent Cure of Narcotic A
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322!(4) '-Modification of Adaptatio
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324sections of the country, all sor
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;Mr.Pertto.niuch,I?,Mr. Peritq. Tha
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328Chairman Pepper. Mr. Steiger.Mr.
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, Mr., In''wMr, WiNx.nltiiink tlie
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:332"Stomach cramps" were found to
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'i.We334'""^li'anTOanl^ETPPEiL That
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:))))336would be deprived of any cl
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338less abuse liability than agents
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CONTENTSApril 26 1April 27 77April
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:•vEXHIBIT NO. 4 (a) AND (b)Eddy,
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:lovernor,vnEXHIBIT NO. 21 (a) and
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342have no desire to preempt the au
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344We hope these hearings will prov
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346tons in 1962 and to 155 tons in
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348SOUTHEAST ASIAAs you know also,
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350I would also point out as I did
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352their farmers who have been grow
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354told that much of the insurgency
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356Mr. IxGERSOLL. Well, again, Mr.
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358jority of the heroin problem in
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360years, but I have been frustrate
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362Mr, Steiger. If you were goin^ t
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364report marihuana among junior gr
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366And it seems to me tliat we Avou
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?368effectively, then maybe we will
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370improvement as far as the abilit
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372was there. Your visits probably
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374the purchase of Avitnesses—I s
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:376administrations to publicly say
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378Chairman Pepper. We will take a
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380Mr. Ingersoll. No. I don't recal
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:382can fulfill the vow made by the
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384have to give you the same answer
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386Mr. Brasco. But that is another
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388Mr. Ingeksoll. Well, that is the
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-39,3,Dr. Edwards held a surgical f
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395of Narcotics and Dangerous Drugs
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397Naloxone, recently approved for
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399for example, who might be abusin
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401Now, because of our attention ha
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403and this is only for the investi
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405effects this drug will produce i
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407Now, if it is not used intravene
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409Mr. Wiggins. Dr. Jennings, does
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411Penicillin is good for pneumonia
Page 433 and 434:
413Mr. R ANGEL. But from the studie
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415Dr. Gardner. Again, we don't hav
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417Dr. Edwards. I suspect it at lea
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419On the other hand, if serious si
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421of the best known programs. Alth
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423Medical Association, American Ps
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425of the United States Pharmacopei
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4275. Repeated examinations. Physic
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429agement and rehabilitation of se
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—431As the agenc.v within HEW whi
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433and complex acts such as driving
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435(Inig induces physical and psych
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437Chiiirmtin Pepper. Doctor, I thi
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439A large proportion of youngsters
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441Dr. Brown, what would you say is
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443Chairmiui Pepper. Wliat is tlie
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446The state of the art is promisin
Page 467 and 468:
447Lot nie ask you first, is tlic d
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449Chairman Pepper. Do you happen t
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451want you to take a look at. We w
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453In addition to that, there seems
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455the Mfldict is having a program
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457—on drugs? By that I mean, vei
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459\\ e are basically saying, in or
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—;461that this is the extent to w
Page 483 and 484:
463We could go into the drug area a
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.465program that was i)ut into Jack
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467Mr. Brasco. Possibly. However, w
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469him, arrange to get somebody els
Page 491 and 492:
471ainpheta.mines, or barbiturates.
Page 493 and 494:
473In the meantime, the Institute d
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475treated in the community centers
Page 497 and 498:
477research on narcotics in the sam
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479c 53 03E
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Page 503 and 504:
483spending for research through NI
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485There has been no concerted seri
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487it is left in one of their veins
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489I do not think I should explain
Page 511 and 512:
491Dr. ViLLARREAL. Until the reflex
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493evidence strongly shows is that
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495Chairman Pepper. One other quest
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497Dr. ViLLARREAL. So, it is a biol
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'.499could result in a laboratory s
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5qifinds it in normal exploration.
Page 523 and 524:
503synthesized a large number of na
Page 525 and 526:
505STATEMENT OE DR. ALBERT KURLAND,
Page 527 and 528:
507discovered if we iiad taken the
Page 529 and 530:
509Mr. Perito. Dr. Kurland, do you
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511Chairman Pepper. Has the Food an
Page 533 and 534:
513]Mr. Steiger. Do you feel from y
Page 535 and 536:
515In this second study there was a
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517were any significant differences
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519The Deceptive Communication and
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.522than a State psychiatric hospit
Page 544 and 545:
524Department of Mental Hygiene), R
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TABLE 3—COMPARISON OF THE 1ST POS
Page 548 and 549:
528TABLE 10—RELATIONSHIP OF AGE T
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530tution and his involvement in th
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Attachment No. 5;r\ N-CH,-CH=CHo ,
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'-534Chart No. U (case No. 672)Disp
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536Chart No. 4 (case No. 694)Illust
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538Chart No. 35 {case No. 697)Excep
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540This amount of heroin is roughly
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5msuccessful or not in that short a
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544Chairman Pepper. Would you repea
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54^creased amount of licit as well
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—54Sand the bureaucracy and the a
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,,Mr.550you have used some of the s
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552so many areas is also a pitiful
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55,4nitiide of heroin addiction in
Page 576 and 577:
556reached $976.5 billion, we can w
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558Mr. Jones was appointed to the c
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560cant when you consider that Out
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562criminal act in his lifetime. Ye
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—564Mr. Perito. Would it be fair
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566Now, Dr. Cliambers, can yon resp
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—568Mr. Raxgel. Our distinguished
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;-570Mr. Jones. That is correct. Ou
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572the commissioner, $186 million i
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574there should be something in the
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576and the way in which the funds a
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57SDr. Chambers. I think wliat you
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580Education is the best way of pre
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58-2Certain essential facts must re
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584done through determined action,
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586druffs, has the Nation's largest
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:588To repeat, methadone maintenanc
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:590I believe the Federal Governmen
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:take no such satisfaction. We have
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594of value in the testimony you ha
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596gone ahead with several. We have
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598force within our State Police De
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60PRased on the proposed goal of 2.
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602STATEMENT OF HON. MILTON SIIAPP,
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(51)4and apprehend the wholesalers
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J'606[Exhibit No. 23Prepared Statem
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608Under our 1071-72 budget proposa
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GIOcenters for the treatment of her
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. Dr.612Bourne informs me that we h
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614Governors in Atlanta to which re
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616pretty bad news, because it indi
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618Scientific statistical ioformati
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620((')) Finally, I believe that al
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622Governor Carter. I certainly rec
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624programs that are now available,
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626all of the top officials in the
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628perhaps greater than some of the
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)630tion and many others attempting
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632(3) Long term residential self-h
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634for the support of drug service
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:636D. NARCO, Inc.Narcotics Addicti
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638crimes to obtain the necessary m
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640million to $25 milliou per year.
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642Mr. Perito. Thank yoii. Mr. Chai
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644narcotic antagonist, and the oth
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646. Dr. Kramer. From what I have s
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—(348your money on, but methadone
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—650I know of no techinque in pri
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652Dr. Kramer. Yes, sir. As a matte
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:'654prison and who liave no—wlio
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65GDr. KT?A:\rEij. 1 suspect tliat
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658support some of the inethadone p
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'6660Dr. IvKAisrKK. 1 believe that
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662jrest that the Veterans' Adminis
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664opiates may be ingested in sever
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666(5) It suppresses the desire for
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668Many people have benefited from
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—G70Other researches which may di
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672synthetic painkillers, our commi
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074IV. A universal ban on legitimat
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..676iTlius we must look to educati
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678states, from Arnold Becker, publ
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680However, we must look at rehabil
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:682(a) The natural history of narc
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684was a heavy user. The decrease i
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686(13) Wallace. R. K. : Physiologi
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688TABLE 9.-USE OF "HARD LIQUOR" BE
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