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

212sists of a network of 21 geographically distinct facilities across theState serving more than 1,600 narcotics users.Our present primary goal is to eliminate the waiting list so thatevery patient who seeks treatment can get it immediately. We haveenjoyed the full support of the Governor, the legislature, and thedepartment of mental health. We should reach our primary goal withinthe next 6 months.11.Almost from the beginning of the work with methadone, it wasobvious that if we expected patients maintained on methadone to leadnormal, productive lives it would be impossible to demand that theycome to a clinic every day in order to ingest their medication undersupervision. Eventually patients would have to be permitted to taketheir medication home, and although we might hope that 95 percentof the patients would not abuse this privilege, it would be naive tohope that there would not be a small minority who would give awayor sell their prescribed medication. Among the potential solutionsto 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 theUniversity of Chicago.After a 3-year delay we resurrected the project and last year mycolleagues and I reported that acetylmethadol seemed to be as effectiveas methadone in facilitating the rehabilitation of heroin addicts.Advantages includes its longer duration of action and its lower abusepotential. Its longer duration should also mean reduced program operatingcosts since, obviously, you don't have to give out the medicationevery day, but need only give it three times a week. Several monthsafter our first report, one of my collaborators. Dr. Paul Blachly atthe University of Oregon, sent us a confidential report in which heobserved some advei-se side effects with 1-acetvl-methadol.By that time our group, including Drs. Charles Schuster, EdwardSenav, and Pierre RenauU had alreadv repeated our controlled double-blindstudies and had found no such side effects ; since that timewe have carried out still additional studies—so that our total experienceincludes well over 75 patients studied for at least 4 months. Thusfar our conclusions are the same—acetyl-methadol is as effective asmethadone.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 becertain at this point that at such higher doses we would not see unwantedeffects.III.From the bejiinning of our program one of the criteria by whichwe measured effectiveness was the extent to wliich treatment reducedantisocial behavior. We have done at least four separate studies inwhich we have compared the &t;lf- reported arrest rates of patientsprior to treatment and their arrest rates during treatment. In everyone of these studies we have observed a very substantial drop in thearrest rates. In some instances the rates were reduced to one-half ofthe pretreatment rate. In others, the rates were reduced to one-third