Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

)168ment facilities for heroin addicts. However, it seems unlikely that the suburbscontributed more than 10 to 20 percent of BDC registrants. Thus, even when theBDC registration list is discounted for suburban residents, nonheroin users andmultiple registrations for the same person, the 20,000 figure suggests that thereare many more thousands of addicts in Washington than the 1968 list of theBureau of Narcotics and Dangerous Drugs indicated.There are other figures which indicate that the addiction problem is greaterthan had previously been estimated. The Washington, D.C., Metropolitan PoliceDepartment reported 4,730 narcotics arrests during 1970. Ninety percent of thesearrests related to heroin use or sale. The numbers of narcotic arrests for eachyear from 1967 through 1969 were 818, 1,077 and 1,716 respectively. Thus, therewas a 462 percent increase in narcotics arrests from 1967 to 1970. Undoubtedly,part of this increase reflects improved and increased police activity. However, italso reflects the spreading epidemic of heroin addiction.Evidence for increasing the estimate of the total number of heroin addicts inWashington comes from several relatively independent sources. These includethe rate of commitment of narcotics offenders to the jail, the rate of opioid overdosedeaths, and the rate of narcotics arrests. More direct evidence comes fromthe universal experience of Washington heroin addiction treatment programswhich report large numbers of registrants.No one piece of evidence is conclusive. However, taken together, the data forma pattern which clearly indicates that the number of heroin addicts in Washingtonis far higher than earlier estimates. Tlie evidence also suggests that therehas been a major increase in the prevalence of heroin addiction in the last severalyears.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 2,793heroin addicts in treatment in the NTA programs.Study of the 77 onioid overdose deaths in 1969 and 1970 revealed demographiccharacteristics of the group on the four basic variables of age, sex, race, andplace of residence in the city. This population was then compared to the NTApatient population using these same four variables. The results are shown infigures 1 and 2.There was a close correspondence betAveen these two populations. This supportedthe assumption that NTA was reaching typical addicts and, unlike virtuallyall other drug programs in the country, the treatment population wasgenerally 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 Districtof Columbia addict population, it is possible to determine when the heroinaddiction began for Washington addicts. (See fig. 3.)Fifty^two percent of the Washington addicts began heroin use after 1965 and65 percent began after 1963. This data indicates that the epidemic began between1964 and 1966 and became increasingly widespread at least through 1968.The individual who has become addicted only recently is often less motivatedto seek treatment for his addiction since he is still enjoying the "high" of thedrug and has experienced relatively little of the pain and danger of addiction.Thus, most treatment programs have an overrepresentation of older, more chronicaddicts. This reluctance of the newer user to seek help probably explains thesharp drop in the number of addict patients who began use during 1969 and1970. However, it seems certain that the rise in addiction between 1964 and 1968reflects a serious epidemic of heroin addiction in Washington. This is corroboratedby a recent study of the rate of commitment of known addicts to theDistrict of Columbia jail between 1958 and 1968 which shows a sharp increaseoccurred in 1967 (4). (See fig. 4.) This increase also corresponds to a sharp risein reported serious crimes in Washington in 1966. ( See fig. 5.A recent St. Louis study (5) suggests that the list of the Bureau of Narcoticsand Dangerous Drugs of known heroin addicts, which is derived primarily frompolice data, generally offers a good estimate of. total number of addicts in acommunity when the total is stable. The data may not be reliable, however, ina community which is experiencing a sudden epidemic of heroin addiction. TheDistrict of Columbia jail study showed that there is a substantial time lag betweenbeginning addiction and coming to the jail. For example, the average