Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
Narcotics research, rehabilitation, and treatment. Hearings, Ninety ... Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
148Health insurance coverage for methadone maintenance is importantonce the person is stabilized. The private doctor then has the option,if that person breaks down, of returnino; him to the public clinic fromwhich he came for more extensive work.The private physician doesn't have the capability of control ofmethadone that is needed in the induction phases of methadone treatment.This involves more than just ancillary services. Private doctorshave made their greatest errors by p:iving unstabilized patients 1 or 2weeks' supply of methadone right at the beginnino; so that a patienttakes out a bottle or prescription of methadone which he takes in anunsupervised way.I think the dangers to the public from such practices are very greatand ought to be avoided.Mr. Pertto. Chairman Peoper mentioned tlie situation relating torecent deaths. Do you anticipate, with tlie expansion of methadoneprograms, that death is a natural incident, that there will be three orfour deaths as a result of the inevitable distribution process of yourprogram, either because of misuse or wrongful distribution or a situationwhere a nontolerant person accidentally ingests methadone intendedfor an NTA addift ?Dr. DuPoNT. "Well, I think that there will be deaths, and there havebeen.On the other hand, I would certainly not take a fatalistic view thatthese are unpreventable and we just pass them off and go to the nextpatient.I think we need to take these methadone-related deaths very seriouslyand to do everything in our power to try to reduce the likelihoodof that kind of event occurring. For this reason NTA issues take-homemethadone in locked boxes and child-proof bottles. We have ratherelaborate forms that the patient signs.On the other hand, I think it is a very serious public relations problem.All of the methadone deaths that are occurring are being chargedeither explicitly or implicitly to the NTA programs, and this is farfrom being true.In the last 9 months in the District we have been able to uncover23 deaths that involved methadone, either alone or with other drugs.In only five of those deaths was there any relationship to the NTAprogram. Thus, 18 of them had nothing to do with the program.But there were five deaths related to NTA and we do everythingwe can to prevent the likelihood of that occurring again. But in asituation where only about 20 percent of the deaths are associated withthe NTA program, we suffer the criticism for all.Chairman Pepper. Dr. DuPont, we have had a quorum call on thefloor 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 answerthe 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 cyclazocineor naloxone to any of the addicts in your program ?
149Dr. DuPoNT. No ; we haven't. The only drug we have used is methadone.Mr. Perito. You are probably aware of certain testimony that hasbeen given previously to congressional committees by Dr. Yolles whohas stated that cyclazocine and naloxone and antagonistic drugs areone of the most promising areas of narcotic research. Do you have anopinion, based on your experience, with antagonistic drugs?Dr. DuPoNT. I think you are going to hear from Dr. Jaffe, whois one of the foremost experts on the subject.As a clinician and an administrator, there are problems with theantagonistic drugs. Put simply, they are not acceptable to patients.Nowhere in the country, to my knowledge, has there been any largescale use of these drugs. The real issue—at least one of the initial problems—isthat the heroin addicts don't find the antagonists helpful tothem. Most patients don't, although there are a few who do.The other problem is that the antagonists are presented to the publicas 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 weknow of so far are like methadone in that they are only useful so longas they are taken regularly and remain in the body ; that is, they don'timmunize the person against anything, patients have to go right ontaking cyclazocine or naloxone and we know far less about the longtermeffects 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 statedthat to the best of your knowledge the addict population in AVashingtonwas 10,400. Subsequently you reevaluated your estimate and youhave stated, to the best of my knowledge, that the addict populationis, 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 preparedto change that estimate yet, although it may be that the addictpopulation is not growing any more, as it was in previous years. Wedon't have good enough measures, really, of changes in the addictpopulation.But the death rate has not been going up in the District over thecourse of the last 9 months. If anything, it has fallen slightly duringthis period of time.So I use 16,800 as a ballpark estimate. The only fact that is reallyrelevant is that there are still very many untreated heroin addicts inthe Washington community who are suitable for and interested intreatment.We had occasion 5 weeks ago to open up a new clinic. It was thefirst new clinic NTA had opened in many months. This clinic wasswamped with patients, going from zero to 200 patients in the courseof 6 weeks.Even though we are providing treatment for 3,000 patients we canrecruit 200 new addicts by opening a clinic for just 6 weeks. This is avery startling demonstration that when clinics are opened they attractpatients. I think the only relevant fact is that there are thousands ofuntreated heroin addicts in the District of Columbia today.Mr. Perito. How many addicts are presently being treated in theDistrict either under the auspices of NTA or some other program operatingand funded within the District?
- 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 152 and 153: 140nance treatment patients showing
- 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 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
- Page 202 and 203: 190Attachment ThreeTo all medical s
- Page 204 and 205: -jI IALLI192ATTACHMENT- FIVE,J: IPA
- Page 206 and 207: 194ATTACHMENT NINEGOVERNMENT OF THE
- Page 208 and 209: ......—196half of the addicts sta
148Health insurance coverage for methadone maintenance is importantonce the person is stabilized. The private doctor then has the option,if that person breaks down, of returnino; him to the public clinic fromwhich he came for more extensive work.The private physician doesn't have the capability of control ofmethadone that is needed in the induction phases of methadone <strong>treatment</strong>.This involves more than just ancillary services. Private doctorshave made their greatest errors by p:iving unstabilized patients 1 or 2weeks' supply of methadone right at the beginnino; so that a patienttakes out a bottle or prescription of methadone which he takes in anunsupervised way.I think the dangers to the public from such practices are very great<strong>and</strong> ought to be avoided.Mr. Pertto. Chairman Peoper mentioned tlie situation relating torecent deaths. Do you anticipate, with tlie expansion of methadoneprograms, that death is a natural incident, that there will be three orfour deaths as a result of the inevitable distribution process of yourprogram, either because of misuse or wrongful distribution or a situationwhere a nontolerant person accidentally ingests methadone intendedfor an NTA addift ?Dr. DuPoNT. "Well, I think that there will be deaths, <strong>and</strong> there havebeen.On the other h<strong>and</strong>, I would certainly not take a fatalistic view thatthese are unpreventable <strong>and</strong> we just pass them off <strong>and</strong> go to the nextpatient.I think we need to take these methadone-related deaths very seriously<strong>and</strong> to do everything in our power to try to reduce the likelihoodof that kind of event occurring. For this reason NTA issues take-homemethadone in locked boxes <strong>and</strong> child-proof bottles. We have ratherelaborate forms that the patient signs.On the other h<strong>and</strong>, I think it is a very serious public relations problem.All of the methadone deaths that are occurring are being chargedeither explicitly or implicitly to the NTA programs, <strong>and</strong> this is farfrom being true.In the last 9 months in the District we have been able to uncover23 deaths that involved methadone, either alone or with other drugs.In only five of those deaths was there any relationship to the NTAprogram. Thus, 18 of them had nothing to do with the program.But there were five deaths related to NTA <strong>and</strong> we do everythingwe can to prevent the likelihood of that occurring again. But in asituation where only about 20 percent of the deaths are associated withthe NTA program, we suffer the criticism for all.Chairman Pepper. Dr. DuPont, we have had a quorum call on thefloor of the House. If you will please suspend <strong>and</strong> await our return,we will go over <strong>and</strong> answer the quorum <strong>and</strong> be right back.We will take a temporary recess until we can get back, to answerthe call on the floor.(A brief recess was taken.)Chairman Pepper. The commitee will resume session, please.Dr. DuPont is on the st<strong>and</strong>.Mr. Perito was inquiring of Dr. DuPont.Mr. Perito. Dr. DuPont, have had occasion to administer cyclazocineor naloxone to any of the addicts in your program ?
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