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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:252during pliase II that serious efforts are made in the rehabilitation of theIt ispatient A wide spectrum of services is offered to the patient in the areas ofmedical care counseling on problems of everyday life, social services m regardto family living and community resources, vocational rehabilitation, and legal defenseadvice. The older patients on the staff are especially helpful in this phase,and are constantly available to help with problems peculiar to addictive patients.After a year when the staff is convinced that the patient is doing well, at ajob, at school, 'or at keeping house, and the patient seems to have no problemwith alcohol or drugs, he is assigned to a phase III clinic. The treatment is essentiallythe same, but the frequency of visits is much shorter and there is littleneed for the counseling staff. These services, however, are available if needed.EVALUATIONFrom the start, in 1964, this program has had independent evaluation of allthe patients who have ever entered it. Originally, when the city financed thisprogram, money was allocated to the Columbia School of Public Health to performthis evaluation. When financing of the methadone maintenance treatmentprogram was assumed by the State narcotic addiction control commission in1967, a separate contract was given by the State to the Columbia UniversitySchool of Public Health and Administrative Medicine to continue this evaluation.A highlevel committee was appointed. The charge to this committee was toevaluate the results of this program in an objective manner, and to make recommendationsbased on this evaluation. Frances Rowe Gearing, M.D., was appointedthe director of the evaluation unit.In their report of March 31, 1968, the committee reached these conclusions"The results of this program continue to be most encouraging in this group ofheroin addicts, who were admitted to the program on the basis of precise criteria.For those patients selected and treated as described, this program can be considereda success. It does appear that those who remain in the program have,on the whole, become productive members of society, in contrast to their previousexperience and have, to a large extent, become self-supporting and demonstrateless and less antisocial behavior. It should be emphasized that these are volunteers,who are older than the average street addict and may be more highlymotivated. Consequently, generalizations of the results of this program in thispopulation to the general addict population probably are not justified. Thereremains a number of related research questions which need further investigation."A report as of March 31, 1969, showed there were 153 women and 861 men whohad been under observation 3 months or longer."Among the women, 10 percent were employed on admission. After 12 months,33 percent were employed. Fourteen percent were homemakers, and 3 percentwere in school. After 18 months, 65 percent were employed, in school, or homemakersand, after 2 years, this percentage had increased to 73 percent."Among the men, tlie percent of those employed or in school increases from26 percent on admission to 56 percent at 12 mouths, 70 percent at 24 months, andS3 percent at 3 years. The percent of men on welfare or supported by others decreasesproportionately from 54 percent at 6 months to 44 percent at 12 months,30 percent at 24 months, and 17 percent at 36 months."The arrest records of those who enter the methadone program and those whoenter our detoxification program are similar. Patients who are accepted have towait a long period. Acceptance into the program does not have a marked effecton their pattern of arrest in the 12 months prior to admission. Following admission,there is a marked decrease in arrests while the pattern of arrest amongthe contrast (detoxification) group is very similar to earlier patterns."None of the patients who remained in the program have become readdictedto heroin. Problems with drug abuse (amphetamines and barbiturates) variedfrom 4 percent to 12 percent.The methadone maintenance treatment program is an effective, economical wayof treating hard-core heroin addicts who cannot be treated successfully with anyexisting programs. It can now be done on an entirely ambulatory basis for mostpatients. This makes the program feasible for those areas where inpatient bedsare difficult to obtain. We feel it is very important that this program be a structuredone so that it i-emains carefully controlled.Methadone maintenance treatment for heroin addiction is a public health program.It should be accomplished under the direction of a public health deijartment,a hospital, or an organized uiodical facility. Since rehabilitation and socialproductivity of the patient is the prime objective of this program, it is important

:253that the means to do this must be an integral part of the program. It is not sufficientto prescribe methadone alone.Under these circumstances, the addict is given a chance in a program which heis capable of handling, and which offers him a realistic path to living as a responsiblemember of his community and of society without the crutch of heroin.Mr. Lichtman, whose statements follow, is a research assistant at the BethIsrael Medical Center. Before becoming an assistant there, he was a drug addict.In conjunction with Dr. Gollance's article on the methadone maintenance program,Mr. Lichtman tells how the program has helped him.I am 29 years old. I started using heroin at the age of 15. I used it for a periodof approximately 10 years. Approximately 4 of those years were served as aguest of the city. State, and Federal governments in any number of institutions.After a period of 10 years, I found that a strange thing happened to me. I developeda certain motivation which I had not had during that time. I decided thatI wanted something more than I had had for those 10 years. I came to the BethIsrael Medical Center in April 1966, at which time I applied for the methadonemaintenance program. The reason that I had originally applied for that programis that I had unsuccessfully tried other methods of treatment when coming outof institutions in other programs. I found that the same drug craving which Iliad in going into a program would return upon my release from an institution.I had heard many stories about methadone. I heard that while taking methadoneyou are still addicted, and you would not be able to function in the cuiiim unity.But I decided that since I had not been able to function in the other prograni.s,that I wonld try methadone.As I said, I went into the hospital, and stayed there for a period of 6 weeks,during which time the metl'adone level was increased.After leaving the hospital, I returned to my family, who were skeptical. Myfather owns his own business in Manhattan. He is a furrier and does make agood living. During the 19 years I was using drugs, he did not allovs- me intohis place of business. When I returned there from the methadone program, asI ?aii\. he was skeptical, but was willing to take a chance with me.I lived at home for 4 months, at which time I met a young lady who wasalso willing to take a chance with me and who knew my background. Afterabout 6 months, we were married.I now have a lovely home in Riverdale, and a new car. I work for the programin helping other addicts attain that which I have attained.I find there is no real "hang-up" in using methadone. I leave a urine specimenwhen I come into the clinic weekly and pick up six bottles of medication totake hnme with me, which I take at my leisure. Methadone is a long-acting drug.I take the drug at any time during the day, and sometimes forget to take itand then overlap hours. The drug lasts anywhere from 24 to 30 hours. I havenever experienced any withdrawal symptoms.As I say, there is no drug craving, and no outw^ard appearance of euphoria.^Methadone does not produce these symptoms as other opiate drugs do.In the time I have been on the methadone program, I find that there are manypeople who are willing to take a chance on the addict population once they(the addicts) are stable on it, that is, the maintenance drug. In New York Cityalone we have many large organizations, such as the telephone company andlarge construction firms, who are willing to employ some of our people in theprogram.It is difficult for me to tell you all of the things that have happened to mein the past. I have a new life today and it is something that T was never able tohave before.[Exhibit No. 13(b)]Beth Israel Medical Center,Methadone Maintenance Treatment Program,New York, N.Y., May 7, 1971.Mr. Chris Nolde.Associate Covnsel, House Select Committee on Crime,Washington, B.C.Dear Mr. Nolde : Following are my comments concerning the statements ofMr. Horan1. We agree that private physicians should be regulated in their use of methadonefor maintenance ; but we should be careful not to impede the development of

:253that the means to do this must be an integral part of the program. It is not sufficientto prescribe methadone alone.Under these circumstances, the addict is given a chance in a program which heis capable of h<strong>and</strong>ling, <strong>and</strong> which offers him a realistic path to living as a responsiblemember of his community <strong>and</strong> of society without the crutch of heroin.Mr. Lichtman, whose statements follow, is a <strong>research</strong> assistant at the BethIsrael Medical Center. Before becoming an assistant there, he was a drug addict.In conjunction with Dr. Gollance's article on the methadone maintenance program,Mr. Lichtman tells how the program has helped him.I am 29 years old. I started using heroin at the age of 15. I used it for a periodof approximately 10 years. Approximately 4 of those years were served as aguest of the city. State, <strong>and</strong> Federal governments in any number of institutions.After a period of 10 years, I found that a strange thing happened to me. I developeda certain motivation which I had not had during that time. I decided thatI wanted something more than I had had for those 10 years. I came to the BethIsrael Medical Center in April 1966, at which time I applied for the methadonemaintenance program. The reason that I had originally applied for that programis that I had unsuccessfully tried other methods of <strong>treatment</strong> when coming outof institutions in other programs. I found that the same drug craving which Iliad in going into a program would return upon my release from an institution.I had heard many stories about methadone. I heard that while taking methadoneyou are still addicted, <strong>and</strong> you would not be able to function in the cuiiim unity.But I decided that since I had not been able to function in the other prograni.s,that I wonld try methadone.As I said, I went into the hospital, <strong>and</strong> stayed there for a period of 6 weeks,during which time the metl'adone level was increased.After leaving the hospital, I returned to my family, who were skeptical. Myfather owns his own business in Manhattan. He is a furrier <strong>and</strong> does make agood living. During the 19 years I was using drugs, he did not allovs- me intohis place of business. When I returned there from the methadone program, asI ?aii\. he was skeptical, but was willing to take a chance with me.I lived at home for 4 months, at which time I met a young lady who wasalso willing to take a chance with me <strong>and</strong> who knew my background. Afterabout 6 months, we were married.I now have a lovely home in Riverdale, <strong>and</strong> a new car. I work for the programin helping other addicts attain that which I have attained.I find there is no real "hang-up" in using methadone. I leave a urine specimenwhen I come into the clinic weekly <strong>and</strong> pick up six bottles of medication totake hnme with me, which I take at my leisure. Methadone is a long-acting drug.I take the drug at any time during the day, <strong>and</strong> sometimes forget to take it<strong>and</strong> then overlap hours. The drug lasts anywhere from 24 to 30 hours. I havenever experienced any withdrawal symptoms.As I say, there is no drug craving, <strong>and</strong> no outw^ard appearance of euphoria.^Methadone does not produce these symptoms as other opiate drugs do.In the time I have been on the methadone program, I find that there are manypeople who are willing to take a chance on the addict population once they(the addicts) are stable on it, that is, the maintenance drug. In New York Cityalone we have many large organizations, such as the telephone company <strong>and</strong>large construction firms, who are willing to employ some of our people in theprogram.It is difficult for me to tell you all of the things that have happened to mein the past. I have a new life today <strong>and</strong> it is something that T was never able tohave before.[Exhibit No. 13(b)]Beth Israel Medical Center,Methadone Maintenance Treatment Program,New York, N.Y., May 7, 1971.Mr. Chris Nolde.Associate Covnsel, House Select Committee on Crime,Washington, B.C.Dear Mr. Nolde : Following are my comments concerning the statements ofMr. Horan1. We agree that private physicians should be regulated in their use of methadonefor maintenance ; but we should be careful not to impede the development of

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