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

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

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—224the Federal Government decides it -svill not support welfare or sometliin^else, the State must do that, and therefore it can only trim optionalkinds of things, mental health, treatment of addiction, andeducation.So that the Federal Government has to realize that as it shifts itspriorities, the States are in a reciprocal relationship. Communitiesalso set priorities and traditionally these treatment programs havebeen viewed as optional; that is, it is optional rather than legallyrequired that there will be narcotic treatment programs.Mr. Waldie. One final question. Doctor.Do we have enough experience yet to knoAv whether it is moredifficult, at first, to an indi^ndual in setting off of methadone addictionthn n heroin addiction, for example ?Dr. Jaffe. The withdrawal syndrome from heroin, given the dosesthat most people use in the street, is pretty much a thing that is over ina matter of a few days. The difference is that the relapse rate is phenomenallyhigh. Certainly people who withdraw from methadone arecomplaininir mildly, but somewhat longer. It is dragged out. ovqi: a?fj', .;:i(f,v. // .'ijaperiod of weeks or so.Howei^er. our experience has been when you stabilize someone onmethadone and he has gotten to the point where he has a job and isback with his family, and thei-e are a number of social supports, andhe has been accepted by the community as a responsible citizen hemay have a tougher time when he withdraws from methadone in thesense that it is sort of a dragged-out situation, but the probabiltiesof being; able to remain stable may be slightly higher.I don't think enough work has been done as yet with trying to takepeople off methadone to try to answer that question in any definitivewav; It is one of the research areas tliat will deserve attention.Mr. Waldie. Thank you.'Chairman Pepper. Mr. Wiggins.Mr. WiGGT^rs. Doctor, I want to commence vHth a hypotheticalquestion. Let us suppose, hypothetically, that methadone were totallysubstitued in our drug culture foi' heroin, but that it was used in exactlythe same way, the shooting of it, using dirty needles, cutting of it.using impurities ond other things, let's suppose it happened that therewas a total substitution in, that war for heroin: would we be betteroff or worse off? ^f^^^V- '''' ''^'''"'' '" '' '' '/^"'- ''''^[^ '['"'.^Dr. JAffe. '"N'o; the advantages of methadone are not nearly aspharmacologibally—Mr. Wiggins. Just respond to that question, better off or worse off?Dr. Jaf*t.. We %oiild be no better off. T don't think we would be anyworse off. It is hard to picture a situatioh niuch woi'se off.The advantage of the present situation is as mnch in the system bywhich the methadone is controlled—its supervision—as in its "pharmacologicaldifferences.^ ^^ .oifohKO loi.t !. oi,i v- -; ^."INIr. Wiggins. I tliink it is an important question, because conceivablywe could end up in that position. T would think there is a ])ossibilitywe might be better oft'. At least the narcotic would be producedby local manufacturers who would be subject to somewhat more controlthan Turkish farmers. Perhaps the Mafia or some other organizedcriminal activity would not be so intimately involved in its distribution.These may not be insignificant advantages.

. .>99; zoDr. Jaffe. I would say that I can't conceive of a situation, in knowingwhat we laiow, where we would permit the situation to deteriorateto the point that methadone would be that readily available forintravenous use. M'^-rr^ n >•.Mr. WiGGixs. Many of us have harbored the suspicions, at least,that metliadone programs proceeded from the assumption that theonly way to take crime out of a drug business is to make the drugavailable to addicts at a reasonable cost and to maintain their habits.For many reasons, however, some of which Avere political, we justcouldn't bear to provide them heroin as did the British, so we came upwith a substitute called methadone; is there any truth in thatsuspicion? .4^ Y^nr\y . f/ri')Dr. Jaffe. I thnik that is an oversimplification that misses manyof the critical distinctions between methadone and heroin.First of all, the pharmacology of this drug is such, as I pointed outbefore, that you can get somebody psychologically stabilized and thecontrast between a fairly stabilized individual taking an oral medicinewhich has very few peaks or valleys, and somebody taking a drug,short-acting or intravenous, going up and down several times a day,is dramatic. People on this smooth-acting drug can function iai termsof devoting their energies to productive activity.;People going up and down, taking intravenous doses, really do notfunction Avell.

. .>99; zoDr. Jaffe. I would say that I can't conceive of a situation, in knowingwhat we laiow, where we would permit the situation to deteriorateto the point that methadone would be that readily available forintravenous use. M'^-rr^ n >•.Mr. WiGGixs. Many of us have harbored the suspicions, at least,that metliadone programs proceeded from the assumption that theonly way to take crime out of a drug business is to make the drugavailable to addicts at a reasonable cost <strong>and</strong> to maintain their habits.For many reasons, however, some of which Avere political, we justcouldn't bear to provide them heroin as did the British, so we came upwith a substitute called methadone; is there any truth in thatsuspicion? .4^ Y^nr\y . f/ri')Dr. Jaffe. I thnik that is an oversimplification that misses manyof the critical distinctions between methadone <strong>and</strong> heroin.First of all, the pharmacology of this drug is such, as I pointed outbefore, that you can get somebody psychologically stabilized <strong>and</strong> thecontrast between a fairly stabilized individual taking an oral medicinewhich has very few peaks or valleys, <strong>and</strong> somebody taking a drug,short-acting or intravenous, going up <strong>and</strong> down several times a day,is dramatic. People on this smooth-acting drug can function iai termsof devoting their energies to productive activity.;People going up <strong>and</strong> down, taking intravenous doses, really do notfunction Avell.

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