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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;240South Bronx, Bedford-Stuyvesant, and it was different from anyaddiction problem we had had before. Formerly addiction was somethingamong doctors, nurses, people of some means.In the early 1950's a demand arose that the city do something aboutit because they had practically no facilities for the treatment of drugaddiction.In response to this demand, the city did several things. It openeda hospital for drug users called Riverside Hospital and in its earlyyears an earnest attempt was made with psychologists, psychiatrists,social workers, et cetera. The board of education opened a school andsupplied an interested faculty. irOM*^Riverside Hospital was opened in 1953. :In 1958, the health commissioner of the State of New York wantedto see what the State was getting for its money, and he had the ColumbiaUniversity School of Public Health do a survey of the patientswho had been in Riverside Hospital, and they took a certain timeperiod and then tracked down the cases treated in that period, 1955,What this study found was an unusually high death ra-te ; but ofthose who survived, none were off heroin. It was obvious RiversideHospital was a failure as far as getting anybody free of heroin. Itdid give some social first {lid, a chance to reduce dope and stay awayfrom the police. It is obvious there was no single treatment allowed forhard-core heroin addiction,, , r 'l, 'iroll-yt Si ^r /^•ji-pilU •- > .iiiIn 1963, the health research council of New York City got Dr,Vincent Dole, later joined by Dr, Nyswander, to do research in thetreatment of drug addiction; Dr. Dole went on the assumption thatwhatever the psychological or sociological reasons that a person becameaddicted, once he was thoroughly addicted there was a physiologicalchange and unless he did something about this he would not b^able to rehabilitate the patient, the hard-core heroin addict, ..(Dr. Dole's goal was rehabilitation. By that he meant the addictcould function in our society as well as he was capable.Dr. Dole tried several things. He tried to see if he could stabilizea patient on morphine, some other narcotics. It didn't work. Thenhe used methadone in a new way. It is a synthetic narcotic that wasused in World War II by the Germans, when their supply of opiumwas cut off.After the war methadone was used mostly for the detoxificationof patients—to get them drug free in a humane way instead of sufferingthrouerh "cold turkey." In a week you can get any heroin addict offheroin. The point is the addict won't stay off heroin. Dr. Dole wantedto see what would happen if instead of reducing the dose of methadoneas in detoxification, he gradually increased the dose. He foimd twothings : Wlien a certain level was reached the addict lost his drug hunger.He no longer had any craving for heroin, and if you went to astill higher dose it blocked the effect of heroin.Dr. Dole got pure heroin and .eventually injected Inr.o-e quantitiesof heroin into patients on blocking doses of methadone. Xothiiig happened.This is called the blocking effect.When we speak of the methadone maintenance treatment programwe mean the Dole-Nyswander technique of givmg blocking doses ofmethadone—not just giving methadone in any haphazard sort of way.

MSMethadone has properties that make it very useful for this woik. Itis fully effective by mouth, it is long acting; once you get a patientstabilized, a single dose by mouth will last him 24-36 hours. It is asafe drug. .a^j'-r ;->,>..We haven't had any serious harmfill' effects either medically, surgically,or obstetrically in 7 years. The body develops great tolerancefor methadone in a relatively short tima It no longer acts as a narcotic.By that I mean it does not make the patient high and it doesn'tmake him sleepy. It is, however, addictive. If taken away from thepatient he would have withdrawal symptoms. '• 'Dr. Dole did this work with six cases at Rockefeller Institute andthen came to Dr. Ray Trussell, who was then commissioner of hospitalsin New York City, and asked for facilities to expand his work.Through Dr. Trussell 's efforts, Dr. Dole got the beds in what is nowthe Beth Israel Medical Unit for Drug Addiction. We inauguratedthis program in 1965.When Dr. Trussell set this program up, he insisted that a separatecontract be given to the Columbia University School of Public Healthto do an independent evaluation of what happened to every patient inthe methadone program. This is important. We now have records ofevery single patient who has ever come into our program, and theseresults have been independently evaluated by the Columbia UniversitySchool of Public Health. .i^i"bji bsmiiiuor) a >.i nn-nU]If we are going to get ahywh'er^'in treafm'g driig addiction we mustknow what works and what doesn't work. T think this independentevaluation is an important part of this program.,»it/.)!^'- Originally the patient was taken into the hospital for 6 weeks. Afterhe was stabilized, he was sent to a clinic with a number of supportingservices : counselors, research assistants, social workers. The goal is rehabilitation,not just to satisfy the drug hunger..ip/iwrr:,J Many of our patients started- very young. You now have help forthem with all their problems, help them with welfare, with the courts,with their wives, get a job, all of these things. -You must help to getthe patient intothe square f'society if^^"' '^fut.'/ '.v^jiyrf o1 ojJIi [tWe do this. We believe that a methadone hlaiTitenarice programshould be done in a structured program. You must know whtit happensto your patient, and you work intimately with him.As a matter of fact, we don't let an individual clinic exceed 150_patients.We want the staff to know the patient well and what is happeningto him. At the present time we have almost 40 clinics scatteredthroughout the New York City area. ; . ".iWhen we reach a census of 150, we open a new' clinic. Wedobkatthe addict as an individual with a chronic illness. He is a m.edical patient.We base our program on a hospital. IMost all our clinics are out inthe community. They are considered an extension of the hospital. Wethink this philosophy of medical en re is important.Addicts have other problems besides their addiction. They havemedical problems. The medical profession has shunned treatment ofdrug addiction for a number of generations now. In the past it wastoo dangerous for a doctor to deal with drug addicts. He risked prosecutionand possible jail.We now have a medically based program with a hospital to take

;240South Bronx, Bedford-Stuyvesant, <strong>and</strong> it was different from anyaddiction problem we had had before. Formerly addiction was somethingamong doctors, nurses, people of some means.In the early 1950's a dem<strong>and</strong> arose that the city do something aboutit because they had practically no facilities for the <strong>treatment</strong> of drugaddiction.In response to this dem<strong>and</strong>, the city did several things. It openeda hospital for drug users called Riverside Hospital <strong>and</strong> in its earlyyears an earnest attempt was made with psychologists, psychiatrists,social workers, et cetera. The board of education opened a school <strong>and</strong>supplied an interested faculty. irOM*^Riverside Hospital was opened in 1953. :In 1958, the health commissioner of the State of New York wantedto see what the State was getting for its money, <strong>and</strong> he had the ColumbiaUniversity School of Public Health do a survey of the patientswho had been in Riverside Hospital, <strong>and</strong> they took a certain timeperiod <strong>and</strong> then tracked down the cases treated in that period, 1955,What this study found was an unusually high death ra-te ; but ofthose who survived, none were off heroin. It was obvious RiversideHospital was a failure as far as getting anybody free of heroin. Itdid give some social first {lid, a chance to reduce dope <strong>and</strong> stay awayfrom the police. It is obvious there was no single <strong>treatment</strong> allowed forhard-core heroin addiction,, , r 'l, 'iroll-yt Si ^r /^•ji-pilU •- > .iiiIn 1963, the health <strong>research</strong> council of New York City got Dr,Vincent Dole, later joined by Dr, Nysw<strong>and</strong>er, to do <strong>research</strong> in the<strong>treatment</strong> of drug addiction; Dr. Dole went on the assumption thatwhatever the psychological or sociological reasons that a person becameaddicted, once he was thoroughly addicted there was a physiologicalchange <strong>and</strong> unless he did something about this he would not b^able to rehabilitate the patient, the hard-core heroin addict, ..(Dr. Dole's goal was <strong>rehabilitation</strong>. By that he meant the addictcould function in our society as well as he was capable.Dr. Dole tried several things. He tried to see if he could stabilizea patient on morphine, some other narcotics. It didn't work. Thenhe used methadone in a new way. It is a synthetic narcotic that wasused in World War II by the Germans, when their supply of opiumwas cut off.After the war methadone was used mostly for the detoxificationof patients—to get them drug free in a humane way instead of sufferingthrouerh "cold turkey." In a week you can get any heroin addict offheroin. The point is the addict won't stay off heroin. Dr. Dole wantedto see what would happen if instead of reducing the dose of methadoneas in detoxification, he gradually increased the dose. He foimd twothings : Wlien a certain level was reached the addict lost his drug hunger.He no longer had any craving for heroin, <strong>and</strong> if you went to astill higher dose it blocked the effect of heroin.Dr. Dole got pure heroin <strong>and</strong> .eventually injected Inr.o-e quantitiesof heroin into patients on blocking doses of methadone. Xothiiig happened.This is called the blocking effect.When we speak of the methadone maintenance <strong>treatment</strong> programwe mean the Dole-Nysw<strong>and</strong>er technique of givmg blocking doses ofmethadone—not just giving methadone in any haphazard sort of way.

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