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

227Dr. Jaffe. I think that more work has to be done in delineating- theconditions under which these drugs can be used for the treatment ofaddiction. ,. . p xxtt^ • -•I am not satisfied with our current apphcation ot a l^D, nivestigationaldrug.. ,On the other hand, I have no pat solution for the best way in wnichour health care delivery system can become involved in deliveringthe services to the advantage of the patient and the community.I mean, we have to protect both, and we have to serve both. I thinkmore work has to be done on it. I am not satisfied with our presentcontrols, nor would I want to see us return to a purely repressionarypolice state during which no physician would ever let an addict intahis office for fear he might be some kind of local police informant,and that if he treated him in any way he might be prosecuted.That was an era of sheer terror for physicians, and the mere factsomebody might be an addict was sufficient reason for them to pick upthe phone and call the police and say get this whatever-it-is out of myoffice.Mr. WiGGixs. As I recall it, when they operated under a systemof private dispensing of heroin the abuses were so widespread that theonly way to control it was to confuie it to a clinical setting.Dr. Jaffe. Well, I have no personal knowledge of what went on. Iread the reports. I know the details. I am not sure that you w^U geta consensus on what really went on.It is obvious that there is no way of dispensing or prescribing shortactingdrugs without lisking significant illicit diversion. We have saidthe best clinics under the best controls, trying to dispense heroin,would open themselves up to illicit diversion, that you need a longactingdrug that you can supervise and preferably one that can onlybe used orally. We have such pharmacological substances available. Ithas to be realized that methadone wasn't even known to be an effectivenarcotic drug until the late 1940's, in this country.I mean, some of the pharmacological knowledge that we are talkingabout never existed in the 1920's when they tried these clinics. So tliatone couldn't even experiment with the possibility of a carefully regulatedcontrolled system of treating those people who are willing to betreated in this way. I think that we are now in a different technologicalball park. We have to stop harking back to old days, when we usedold technology and look at what we can do now, what our potentialsare and what is the best way to strike the best balance in treatmentand still, at the same time, protect the community from widespreadillicit diversion of the drugs we are using for treatment.Chairman Pepper. Mr. Brasco, do you have any questions ?Mr. Brasco. Yes; I wanted to ask Dr. Jaffe: In connection withthe methadone program, would there be any great difficulty, given thefact that there is agreement over the danger of abusing the use ofmethadone in the street, why is it not possible, at least from the pointof view of stopping those who are in treatment from proliferatinguse in the street, having users report once a day to take the methadoneat the clinic so we know we can stop that kind of abuse ?Dr. Jaffe. I think it is a fine question. It has been raised a numberof times.