Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
Narcotics research, rehabilitation, and treatment. Hearings, Ninety ... Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
156There are several reasons a person might continue occasional use ofheroin. Many persons are fearful about withdrawal symptoms andfeel 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 hispractice 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 privatedoctor." 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 gettingenough.The treatment was to counsel the patient, to help him see that hewas getting enough methadone, and he stopped taking two doses.Mr. Wiggins. Dr. DuPont, we are running out of time, and I wouldlike to get into the record the technique you employed to prevent peoplefrom abusing your program by obtaining methadone from a secondsource, and the way that you insure that those who take it homedo not misuse it. Would you describe your security procedure?Dr. DuPoNT. The NTA patient takes his methadone on the premisesfor the first 3 months of the program, and then he gets take-homeprivileges of gradually increasing duration until the minimum frequencyallowed, which is two clinic visits per week. The patient mustbe 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 allhard drug use, but, of course, we can't separate a second dose methadone.But we know that a person is not going to more than one of ourcenters, because all patients come in and have their pictures taken andget an I.D. card. It is, however, possible to take methadone from anothersource, 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 ColonelHassan's program and register for that program and receive methadoneand 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 inour central registry.Mr. WiGGixs. What is the solution to that problem ?Dr. DuPoxT. The solution is a regional registry for everybody whogets methadone. Everybody who takes a dose of methadone anywherein 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 asthe suburban counties in Maryland and Virginia.Mr. Steiger. I wonder if we could have the witness, if he could remain?I hate to impose on him, but I think all of us would like to explorethis.Chairman Pepper. Doctor, could you wait a few minutes more?Dr. DuPoxT. Sure.Chairman Pepper. Doctor, let me make this announcement beforewe recess. We will come back.Dr. Jaffe is here, another distinguished witness, and he has kindlyconsented to stay over until tomorrow morning. Without objection on
157the part of the committee, when we do recess today we will recess until9 :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 today,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 byyour testimony and others, that physicians are a source of the illegalmethadone. 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 greatreluctance to admit the complacency of the medical profession. I say"complacent" advisedly. I don't mean there is any kind of conspiracyby the medical profession itself, as a major source of opiates.I wonder if in your experience, Xo. 1, if you agree that it couldbe a problem not only in methadone, but in the dispensing of otheropiates, and if the equation that the reason for many of the peopleinvolved in your program and the New York City program are theunderprivileged as an economic matter that the privileged are ableto buy through pseudolegitimate source the wherewithal to feed theirhabits : is this a valid position ?Dr. DtPoxT. There are so-called medical addicts or people whohave become addicted through medical treatment. This does not necessarilyinvolve any dereliction on the part of the physician, althoughoftentimes there is less vigilance than probably was appropriate.On the other hand, I don't think it Avould be fair to say that opiateaddiction is uniformly distributed throughout the population by socialclass and that the lower classes don't have the wherewithal to getit and the upper classes do. Opiate addiction is concentrated in theloAver social classes, even adding in people going to private physicians.On the other hand, those who do go to private physicians are obviouslyfrom the upper classes. One thing we have noticed in the Districtis that whereas about 8 peicent of the overdose deaths in the cityare white, only about 4 percent of our patients are white, which meansthat there is an underrepresentation of whites in our patient group.I am sure that this is accounted for by more white addicts going toprivate physicians.Mr. Steiger. That is a very interesting statistic and I can draw alot of conclusions from it, which I don't want to do superficially, butI am glad to have these statistics.Now, we have had some specific instances in the Phoenix, Ariz., areain which physicians were actually dispensing narcotics in a mannerthat could hardly be determined medically responsible. I don't thinkit serves any purpose to identify it as a racket, but just as irresponsibility.My question is : In your experience, how widespread—I will phraseit a different way.
- 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 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 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
- Page 210 and 211: 198CONCLUSIONSCertain patterns emer
- Page 212 and 213: 200TABLE 5.— PROFILE OF BARBITUAR
- Page 214 and 215: 202TABLE ll.-SUPPORT OF HEROIN HABI
- Page 216 and 217: 204TABLE 17.-AGE OF ADDICTS AND NON
156There are several reasons a person might continue occasional use ofheroin. Many persons are fearful about withdrawal symptoms <strong>and</strong>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 hispractice 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 privatedoctor." 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 underst<strong>and</strong>, was treating his anxiety about not gettingenough.The <strong>treatment</strong> was to counsel the patient, to help him see that hewas getting enough methadone, <strong>and</strong> he stopped taking two doses.Mr. Wiggins. Dr. DuPont, we are running out of time, <strong>and</strong> I wouldlike to get into the record the technique you employed to prevent peoplefrom abusing your program by obtaining methadone from a secondsource, <strong>and</strong> the way that you insure that those who take it homedo not misuse it. Would you describe your security procedure?Dr. DuPoNT. The NTA patient takes his methadone on the premisesfor the first 3 months of the program, <strong>and</strong> then he gets take-homeprivileges of gradually increasing duration until the minimum frequencyallowed, which is two clinic visits per week. The patient mustbe 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 allhard drug use, but, of course, we can't separate a second dose methadone.But we know that a person is not going to more than one of ourcenters, because all patients come in <strong>and</strong> have their pictures taken <strong>and</strong>get an I.D. card. It is, however, possible to take methadone from anothersource, 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 ColonelHassan's program <strong>and</strong> register for that program <strong>and</strong> receive methadone<strong>and</strong> not be in our central register.Mr. Steiger. Is he still conducting his program ?Dr. DuPoxT. Yes ; <strong>and</strong> only those patients for whom we pay him inour central registry.Mr. WiGGixs. What is the solution to that problem ?Dr. DuPoxT. The solution is a regional registry for everybody whogets methadone. Everybody who takes a dose of methadone anywherein 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 asthe suburban counties in Maryl<strong>and</strong> <strong>and</strong> Virginia.Mr. Steiger. I wonder if we could have the witness, if he could remain?I hate to impose on him, but I think all of us would like to explorethis.Chairman Pepper. Doctor, could you wait a few minutes more?Dr. DuPoxT. Sure.Chairman Pepper. Doctor, let me make this announcement beforewe recess. We will come back.Dr. Jaffe is here, another distinguished witness, <strong>and</strong> he has kindlyconsented to stay over until tomorrow morning. Without objection on
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