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

219somebody who, almost as a professional, engages in antisocial activity,they will be very honest with you.We have seen that when we get people into treatment, even A\-henthey don't give up their antisocial activity entirely in the early monthsof treatment—and get a legitimate paying job—their antisocial activitystill drops dramatically. They may not be arrested at all, yet we knowthey are committing crimes. Nevertheless they are committing themat half the rate they were committing thom. So that sometimes youcan get a great deal by talking to people that the arrest records willnot reveal.The arrest records are only a very approximate index of what isactually happening. There are discrepancies and they go in both directions.Sometimes people who commit virtually no ciime manage toget arrested for some charge anj^way, and somebody else who is moreskilled continues to engage in antisocial activities for long periods andis not arrested at all. We have seen both of these kinds of things go on.Mr. Perito. Do you regard the coiicept of narcotic antagonists like'{cyclazocine and naloxone as a hopeful aiea in multimodalit}' approachDr. Japfe. Do I regard the concept of narcotic antagonists as a hopefularea ? The answer is that I do.HoAvever, as I said several 3'ears ago, it is quite clear that in orderto be effective in treating narcotics users a more appropriate form ofnarcotic-antagonist will be required. We will require an antagonistwith minimal side effects that can be given in a way that will producea blockade of narcotic effects for at least several days. Unlike methadone,patients don't want to come back to a clinic every day just totake a drug that blocks narcotic effects.Some will. Some will for a number of months, but for the mostpart, after a few months they are convinced they don't need the antagonistany more, so they stop.Chairman Pepper. Excuse me a moment.The effect of this antagonist drug is to prevent them from gettingany sensation of satisfaction or euphoria from the taking of heroin?Dr. Jaffe. That is correct.Chairman Pepper. Now then, could you add to that drug the qualityof making the taking of heroin, again within a reasonable time, repulsiveto the system; that is, causing a reaction of an unfavorablecharacter?Dr. Jaffe. I am not sure that we have such a drug, nor am I reallycertain that it would be useful. It would be interestmg if we had one,but you see, they do have something comparable to that in alcoholismwith Antibus. and the results have not been overly dramatic. If therevulsion reaction is severe enough it may be endangering somebody'slife and you have an ethical question.The antagonists have the advantage that you can perhaps persuadesomebody to become involved with the antagonists, because it will nothurt him if he takes a narcotic. It merely blocks the effect.Obviously, what it does not do is in any way allay this kind ofnarcotic hunger, this craving that some addicts seem to feol whenthey are not actively using or during the first year or so after theystop taking narcotics.I want to get back to your question about naloxone and cvclazocine.Cyclazocine I think we have explored. It is a difficult drug to use. It