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

223answer is that its oral to parental ratio is not as high, meaning thatit takes a lot of heroin orally to give you a blood level so that youget an effect. That is also true of morphine. It is also true of manyof tlie standard narcotics tliat we use in medicine.If somebody really has pain, you would have to give them a shotof a drug like morphine. Methadone is one of the few drugs in thenarcotic analgesic group that has a good oral potency, meaning thatyou don't have to give a tremendous amount of it by mouth to havean effect.Mr. Brasco. As a practical matter, what would one take heroinorally for?Dr. Jaffe. The same way you take codeine, you give a littleMr. Brasco. We are talking about people addicted to drugs.Dr. Jaffe. Nobody would ever take lieroin orally if they were addicted.It is too inefficient. People sniff it, some people smoke it, butprobably nobody would swallow it, simply because it is not efficient.The body metabolizes it before it gets a chance to be active.Chairman Pepper. Mr. Waldie, have you any questions?Mr. Waldie. Just one question. Dr. Jaffe. If the Federal Governmentwere to participate in some way in this whole problem with whichyou have been involved, would you discuss, No. 1, the areas in whichyou think our participation would be most beneficial ; and No. 2, wouldyou believe in terms of priorities of expenditure, which would be thenature of our participation, that there is one portion of this programthat is more deserving of expenditure than other portions? Couldyou comment on those two areas ?, . Dr. Jaffe. WTiich program are you referring to ?Mr. Waldie. I don't know. I want you to tell me. I want to to tellme what the Federal Government, in your view, should interest themselvesin most in terms of priority or expenditures.Dr. Jaffe. Well, in the entire area you could divide it into thingslike direct support of treatment, development of research directedtoward the development of treatment and control systems, direct controlof drug availability and training ; training both for research andtreatment.Now, obviously there are some areas that you could say need priority.Our experience has been that patients who are chronic heroin userswho want treatment with methadone should be given that treatment,because it is better for them and everybody in the community, andtherefore that should be a high priority for the Federal Governmentto see that the funds are there to provide sensible, rational treatment.Now, if there are other treatment areas that can be demonstrated tobe effective for those people for whom we will say methadone is noteffective, such as young polydrug users who have not been on drugsvery long, people who just don't want to be on methadone, peoplewho want to come off methadone. In our experience many, many peoplefeel they have had their lives stabilized, they would like to comeoff. Such treatments should be provided or developed if they do notnow exist. That should be done and the Federal Government shouldsee that they provide that.There are some problems in communities. I cannot speak officiallyfor any State or community, but I do know there are certain obligatoryexpenditures they cannot get out of. I read in the paper that wlien