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

:—297What will the other 50,000 addicts in this country do when they hear the boysin New York are getting their stuff free and legal? New York will have 50,000new citizens to add to our welfare rolls. "What will we do with the deluge V Willthey have to be a citizen of New York to obtain free or low-cost methadone?They will not have to be a citizen of New York to steal from the citizens of NewYork. What will prevent the have-nots from buying and stealing some methadonefrom the haves? Do the proponents of maintenance really believe that a newunderworld market in methadone will not be established?The millions of addictive prone—how many of these people will become addictsbecause another narcotic is legal or at least easy to obtain? Have we forgottenthe reasons for the original narcotic laws? Are we prepared to treat 6-8 millionaddicts?Proponents of methadone maintenance therapy say the glamour will be takenout of addiction when the addict drinks his opiate rather than injects it into hisarm. First, addiction to the addict is as glamourous as terminal cancer. Thosethat need to inject something into their vein (very few for a symbolic needthey use a vein because it gives them the quickest and strongest kick) and willcontinue to inject something, and many would-be addicts who have fear ofinjection now would have a new source of oral narcotic to start them on theroad to heroin.In this country there are three groups—three philosophies—one might callthem three armies, fighting the common enemy of drug addiction.The first army, of course, are the traditionalists. I myself was once an adherentof this group. In 1962, the New York Tribune contained a quote relativeto the treatment of the drug addict. It was :"Put him away either in a hopsital or jails for the rest of his life—or givehim all the heroin he wants."I was the author of that statement. I had all but thrown up my hands in helplessness.After using the traditional approach in a great number of cases, Iknew I had cured no one and that any help I had given was transitory, ineffectual,and not worth the time and the effort. The schools, the courts, and thehospitals had no better results. Doctors in private practice refused to treat adrug addict. No force, intimidation, jail term.s—even the threat of death—badany impact on the addict. The traditionalists admitted failure, and just did allthey could to keep the problem under control. But it does not stay under control.It became worse all the time in terms of numbers of addicts and the degree ofchronicity and tenacity of their habit. The traditionalists were and are losingthe battle.Recently a second army has arisen. A new philosophy has re-emerged—on thebasis of, "If we can't lick them, let's join them," we now have, "If we we can't curethem, let's try to control them. We'll stop them from stealing to get money fordrugs. We'll give them all the drugs they need." These are the adherents of themethadone system. This was basically the philosophy of the "British System."I personally feel that this approach is absolutely wrong not only philosophically,but also medically. As a scientist I can accept any program which ha« a researchdesign and is limited in its scope, but I am utterly and completely opposedto the indiscriminate use of methadone as a treatment for drug addictionin the city. I feel we are opening Pandora's box. We shall develop not only aheroin underworld traffic, but a methadone underworld trafllc. The Britishfound they had a problem of illicit heroin trafl3c developed from supplies givento the addict legally, and the British have had, until now, only a very minorproblem with what I call secondary addicts. Our problem in this country isentirely different, as a majority of our addicts are what I call primary addicts—thatis, drug addiction is a way of life for them. They withdraw from allof life's constructive functionings and their entire lives are centered around theobtaining of narcotics—raising the "bread" (cash) and finding the "connection."They live to shoot dope.Dole and Nyswander reported in 1965 ^ on the results of their preliminarystudies in the use of methadone to block heroin addiction. At that time muchhope was placed in this method as a result of their findings. However, Dr. VictorH. Vogel, chairman of the Narcotic Addict Evaluation Authority of the State ofCalifornia, wrote on September 3, 1965 to the Journal of the American MedicalAssociation.j'i'K't'Vf'l^y1 Journal of the American Medical Association.60-296—71—pt. 1 20