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

244hospitals in the city, came into our program. In answer to your question,two marines I know personally came back addicted. The reasonthe marines snort heroin and don't inject it is so they won't leavetrackmarks. But when they come back here they will start injectingheroin. This one Marine had gotten $6,000 from an automobile accidentand wanted to return to the Orient for drugs. I got him into themethadone program and he is doing very well, u; ruoiu iChairman Pepper. Mr. Perito, please proceed.Mr. Perito. Thank you, Mr. Chairman.First, Doctor, do you believe that private physicians should be permittedto maintain addicts on a maintenance program ?Dr. GoLLAxcE. At this time I would say no. Our feeling is that thisshould be done in a structured program. We have given a lot ofthought to how to use private practitioners. For example, if we had awell-stabilized patient he might be referred to a private practitioner.If this were done, it would furnish a means of having the patientchecked, because there is possibility of abuse.There is the program in New York City that disbursesMr. Pertto. You mean dispensing of methadone by a private physician; is that what you are talking about ?Dr. Gollance. That is right.Mr. Perito. What steps can be taken in order to avoid problems"'of this nature ? ^'''^ ^'^^^-'^ ^^''^ ' ,' '^ f^'^ ^ ' '•! o^i JDr. Gollance. Well, the thing is if you can set up enough programsso the patient can come in and get it from established programs verycheaply and receive good care. We g&t many patients from this privatedoctor when we can reach him on our list.'^-^ ''^- ' "'''^ o.iPj.i,:>. i .^i/:Unfortunately, we have quite a long waiting list. The last time T wasbefore this committee, we were asked how can we expand the program.I might say, since that time last year, we have taken as many patientsin 1 year as were taken in all of the previous 5 years. We have themechanism for expanding this widely if' we get the necessary fundsMr. Perito. Do you believe addiction is a metabolic situation ?Dr. Gollance. I think you have to make that assumption. At leastit has worked here. The psychological and sociological apiproacheshave not worked for this type of patient. We have tried all thesethings without methadone and they haven't worked. Under methadoneyou can use a number of successful aLppjcoac.hes, but without it we have'c. ..,. ^.i. _ii;been very unsuccessful.Mr. Perito. What steps have you taken in your program to controldiversion?Dr. Gollance. First of all, we limit the size of the clinic so weknow the patient. We constantly watch the patient, besides the urinechecks, to know that he is not using Other drugs, and if we have anysuspicion at all we will put him on a daily regime.One of the interesting tilings is the patient develops a loyalty to tlieprogram. I know addicts are not supposed to squeal, biit tliey willcome to us and toll us. look out for this f'^How. and avo will. Thoy willgive us information about our patients. We have a patient-phvsicianrelationship. We don't take a punitive approach. We don't look at theaddict as a dope fiend or outcast. We encourage him to tell us whenhe is abusinc:. In the first few weeks he will.