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

231arrangement with tlie physician who would handle this problem on anindividual basis in a carefully regulated way.^Without that possibility this man is limited to any area that hasa clinic and largely these clinics arc limited to the large urban areasthat can sustain a clinic of a hundred or so people.Mr. Stetger. But isn't it conceivable that we could extent the authorityto permit the clinic to approve the physician for that specificpatient '?Dr. Jaffe. That becomes another issue. In other words, what you aresaying is that no physican unaffiliated with an approved programwould be permitted to prescribe methadone for addicts.Mr. Steiger. Based on your experience, in terms of volume of illicitmethadone, isn't there a far greater propensity for the privatephysican to be the source of the illicit methadone than there is forthe clinic, the approved clinic ?Dr. Jaffe. Well, I think in terms of the ratio of patients treated andthe amount they let leak on the street. I would say that may be true.Obviously, in terms of absolute numbers, a program treating 1,600people will be responsible for more leakage than any one physiciantreating a few patients.In other words, if he is only treating five or six people,a single physician probably will not have as much leakage as aj)rogram treating 2,000.Mr. Steiger. If those five or six people are dealers, themselves ?Dr. Jaffe. Well, the physician would have to be rather naive.Mr. Steiger. How about dishonest? How about the dishonestphysician?Dr. Jaffe. Dishonest physicians should be treated like any otherdishonest individual?Mr. Steiger. But right now he is not violating anything?Dr. Jaffe. As I said before, I think we have to think through ourregulatory procedures so that the dishonest physician is treated forwhat he is. He is a pusher, operating under cover of his medicallicense.Mr. Steiger. Eight now, except for whatever State regulation mayexist, he would not be in violation, as Mr. Wiggins pointed out, hecould appeal to his medical judgment and say this, in my best judgment,was what this particular patient needed, even if it obviouslywasn't ?Dr. Jaffe. Well, I certainly think we have to think through how wewill control the dishonest physician, there is no (question about that.Mr. Steiger. Would you agree there is a question of the dishonestphysician who could be a source of methadone ?Dr. Jaffe. How could one deny it ?Chairman Pepper. Mr. Mann.Mr. Mann. No questions.Chairman Pepper. Mr. Winn.Mr. Winn. Two quick questions, Mr. Chairman.Doctor, I missed the first part of your testimony. Are any of yourcases ambulatory when they come to you ?Dr. Jaffe. All of our cases are ambulatory when they come to us.