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

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412Dr. Edwards. All 1 know, I can look at their budget, and they havea budget, but I don't know how much they have earmarked specificallyfor this particular purpose.Mr. Mann. That is all, Mr. Chairman.Chairman Pepper. Mr. Rangel?Mr. Rangel. Yes, doctor, is it safe to say that over the 7-3êarperiod methadone has been before your agency, that you have notbeen able to determine its safety ^^^.th any degree of accuracy?Dr. Edwards. No. Its long-term safety has not been established.Mr. R.ANGEL. Now, v^hy would you continue to give IND numbersfor a drug which you cannot over this period of time determine itssafety?Dr. Edwards. Well, again, you have got to remember the way it isbeing used now, the kind of data and information that we need todetermine safety. We are just beginning to accumulate this right noAV.Mr. Rangel. You are accumulating. Does your agency have anyjurisdiction to sanction a phj^sician that wants to prescribe methadonefor whatever purpose he wants to prescribe it?Dr. Edwards. No. If the physician has a narcotics license, he canfortunately or unfortunately use it any way he wants.Mr. Rangel. You have no control over this?Dr. Edwards. We have no control over the individual physicianspracticing medicine; no.Mr. Rangel. But you have control as to whether or not this drugcan be used by this physician.Dr. Edwards. Can be marketed; yes.Mr. Rangel. So, in fact, even though there has been no completionof the study as far as safety is concerned, any physician can dispensea narcoticDr. Edwards. We are satisfied as to the safety of the drug, accordingto its labeling. In other words, as an analgesic, as an antitussive.Mr. Rangel. But you can't control how it is actually being used onthe streets.Dr. Edwards. If the doctor wants to misuse or abuse the drug,there isn't much we can do about it.Mr. Rangel. Now, you mentioned in your testimony the bias thatexists in selecting patients who are using methadone, and I assumeyou are talking abovit the institutions. Is it safe to say that the civilrights statutes don't apply as relates to treating drug addicts?Dr. Edwards. Again, what was that? I didn't get the exact question.Mr. Rangel. Well, on page 4 of your statement, jôu indicate thatit is impossible for your agency to determine with any degree ofaccuracy the rehabilitative value of the drug because the institutionsare selecting in the main, older people, and in the main, the majorityof the patients are white.Dr. Edwards. What I said is that the several studies that have beenbrought to our attention, and which we reviewed in some depth, havetended to have a select group of patients in the study. They havetended to be perhaps better educated, white, and so forth.Mr. Rangel. Well, my question was, do the civil rights statutesapply in connection with dispensing methadone to drug addicts?Dr. Edwards. I would hope so.
413Mr. R ANGEL. But from the studies that you received, it doesn't.Dr. Edwards. Well, again, I couldn't make a comment on thatspecifically. I would hope that it did. In other words, there are reasonswhy patients are selected for a study. I am not being necessarilycritical of the investigators per se, but it may be that for the firstgroup, they wanted a better educated group to try this on. I don'tknow all of the background.Mr. Rangel. Now, your testimony reveals 257 IND numbers, 277programs, 185 of these programs are in institutions. How many investigatorsdo you have to police these IND numbers?Dr. Edwards. Well, theoretically, we have some 700 inspectors inthe field for general use. At the moment, we are probably using, oh, Isuspect 50 of our inspection al staff for this particular purpose.Mr. Rangel. Now the92 that are other, how many of those arelocated in New York State?Dr. Gardner. There are approximately 60 in the New York Cityarea and about another 20 or so throughout the rest of the State.Mr. Rangel. How many investigators would be assigned to thosethat are located in New York City?Dr. Gardner. There is a staff of at least 100 in the New York Cityregional office but at the moment only a small portion of those peopleare assigned to this particular kind of investigation.Dr. Edwards. At the moment it is a combmed effort between ourheadquarters staff and the particular regional staff, wherever theprogram might be. Again, as I mentioned earlier, it does take somespecialized traming to be able to properly evaluate some of theseprograms, some of the technical aspects of it. I suspect that we haveused off and on in the last several weeks in the New York area probably25 or 30 different people.Mr. Rangel. Are you satisfied with the clinical work of the methadoneclinics that operate on 95th and 97th Streets in the city of NewYork, Manhattan?Dr. Edwards. No; we absolutely are not.Mr. Rangel. Well, why is it that they are still allowed to, in thecommunity's opinion, dispense without regulatory sanctions?Dr. Edwards. We have inspected their operation. If the deficienciesthat were pointed out to them very clearly are not corrected in just amatter of days, the program will be terminated.Mr. Rangel. Now, I have contacted your office I think severalmonths ago. Are we saying that we are now within a couple of days ofreaching a conclusion?Dr. Edwards. I think that is a fair statement; yes.Mr. Rangel. Is it true that your Agency has authorized or givenIND numbers to physicians that have been convicted of violating theHarrison Act?Dr. Jennings. I don't believe that to be so, sir. I would hope not.Mr. Rangel. Well, specifically, a doctor from the District ofColumbia. Did he have a con^dction of violating the Federal narcoticlaws when he was issued his IND, after your investigation?Dr. Jennings. I don't know that, sir. We can check that out for you.I hate to keep going back to history but only very recently, the requu'ementof prior approval by both the Bureau of Narcotics andDangerous Drugs and ourselves was put into effect. It would be pos-60-296—71^pt. 2 6
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NARCOTICS RESEARCH, REHABILITATION,
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::VEXHIBIT NO. 4 (a) AND (b)Eddy, D
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urden that such addiction imposes u
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1 (lata; (->) the sliariiis" oF iii
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9Chairman Pepper. The committee is
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::11quota production from unrecogni
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13in this country. This raises the
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15from other clinical projects of w
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:17practice, experience has indicat
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;19.I think a quota would be better
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21When methadone was first introduc
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:::::.—23American Society of Phar
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_'—25.I'BOCUREMENT AND ISSUE DATA
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'.28Fiscal years-1967 1968 1969 197
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30rally in opium. By indirect, the
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32We can, I think, most helpfully g
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34so intense that we haven't done v
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Dr. Eddy. Well, physicians, usually
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38Dr. Eddy. No.Chairman Pepper. Now
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:40get away with it as Dr. Keats su
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:—:42public health hazard was jud
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:44Bibliography(1 Nathan B. Eddy. "
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46(52) Nathan B. Eddy. "Dilaudid."
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48(98) "The New Narcotics, Post-gra
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^.50
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52entails the consideration of addi
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54Chairman Pepper. Have you found t
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56^.I wonder would you care to comm
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58Chairman Pepper. Without objectio
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—1958-681959-«419691962-64196219
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—62abuse and has brought about th
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64bank robbery or an assault. You d
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66Mr. Wiggins. Would the stopping o
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68—Chairman Pepper. Can you give
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:70The problem then would be the wi
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;72taking exceptional measures in t
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)—74pay serious attention to this
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;76From 1958 to 1961, he served as
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78deine in painkilling drugs. So if
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;80ning capabilities, responsibilit
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;:;82terials. If they could introdu
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84Figure 1infrared Ektachrome film
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;86Figure 3.—Tones of wheat (W) a
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88ers at the poppyfields or at any
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:90;:tional situations has handicap
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;;92Locating illicit opium cropsDet
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94Jaffe. Well, there would be some
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96Mr. Jaffe. Primarily on the fact
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98in the same ball park about what
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100Chairman Pepper. Mr, Waldie, do
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::102agencies and input data would
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104most facilities are barely able
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;106We have also studied a ^roup of
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108Dr. Gearing. Yes, sir; I would n
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110somethino: in the nei
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112program is put into the machiner
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I114you have some data there that s
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116Dr. Gearing. It depends on what
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118Chairman Pepper. Would you have
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120it not be so that we could proje
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.122admission rate was approximatel
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124BESULTS(1) Although many of the
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1262. All the members of the methad
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128HETHADOHE MAINTENANCE TREATMENT
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11 1 1 1 1 11130Methadone Halnten?n
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132TABLE 2.-METHAD0NE MAINTENANCE T
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134Figure 9 Methadone tlaintenance
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136Methadone Ka'ntanance Treatmf:nt
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:::.::.138Appendix A^—Methadone M
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140nance treatment patients showing
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142Figure 3 •lethadone Kaintenanc
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144Dr. DuPoNT. 1,760 on methadone m
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:146there are dramatic reductions i
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148Health insurance coverage for me
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150Dr. DtjPont. Well, there are no
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152Mr. Blommer. You would agree the
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154done. Where is the evidence ? No
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156There are several reasons a pers
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158It would seem to me a very busy
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160we had before. I don't think it
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162heroin addiction and support all
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164Dr. DuPoNT. I am reluctant to ge
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166Using this figure as rule of thu
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)168ment facilities for heroin addi
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.170parole departments. None were c
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::172Table 2.— Selected character
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174TABLE 3.—HEROIN ADDICTION RATE
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176W.a^^cc-V.c Cffv..AdF-ro ftcoKjL
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178.^06V f\QrK-'SEt GôuP/AJ6SIS're
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I180*i coo)u->CM>—'CMUJCOO O COa>
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I(/I182esiMmin0)^> oo.00 =E|c O.2 o
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184encouraged to return to methadon
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186or other side effects. This incr
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:188number as that on the bottle. W
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190Attachment ThreeTo all medical s
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-jI IALLI192ATTACHMENT- FIVE,J: IPA
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194ATTACHMENT NINEGOVERNMENT OF THE
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......—196half of the addicts sta
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198CONCLUSIONSCertain patterns emer
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200TABLE 5.— PROFILE OF BARBITUAR
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202TABLE ll.-SUPPORT OF HEROIN HABI
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204TABLE 17.-AGE OF ADDICTS AND NON
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206TABLE 23.—PRESENT MARITAL STAT
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208TABLE 28.-MILITARY SERVICEAddict
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:210The committee is pleased to cal
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212sists of a network of 21 geograp
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214(6) Basic studies on the nature
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216in fact, constitute autonomous o
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Chairman Pepper. Mr. Perito?218;; M
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^'220is not a very forgiving drug.
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'222Furthermore, in our present con
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—224the Federal Government decide
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-—I have presented one generic ki
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,clinic;?,>•
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230I realize we are running late.Do
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''232'']Vir. Winn. Tiien you mentio
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234So having put it in the area, ha
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,Memberships'—i236privilege of co
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;238A central hypothermic response
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;240South Bronx, Bedford-Stuyvesant
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242€are of patient addicts. We ha
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244hospitals in the city, came into
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246that came into my office, and I
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'Mr.;>•/nmo'.i,,;248deputy commis
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:250two Rockefeller Institute physi
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:252during pliase II that serious e
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254well-structured methadone mainte
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;:256nonsense and serves only to ad
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:258you best complete your statemen
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260Mr. Pertto. Based upon your expe
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262A a'reat case in point was a con
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«264Mr. Steiger. Did you discuss w
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—:266Mr. HoRAN. We don't support
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268Mr. Horan, let's back up a littl
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270It is not up to heroin or morphi
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272nesses yesterday who brought out
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274;Mr. Perito. It is my understand
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276So that at the end of the week t
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278steroid he lias in him we might
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280Mr. Perito. You are referriii"'
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282not drug free. I can say approxi
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28 A$2-a-day habit these individual
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•As286I got to the point once in
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288Mr. Steiger. You mentioned anoxi
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290Mr. Eangel. I could see then tha
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292Dr. Casriel. Mr. Keating, I have
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j294What period of time are ^ve tal
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296was March of 1970—he was admit
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298"The paper by Dole and Nyswander
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:300vent them from coming to New Yo
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302[Exhibit No.14(b)]Casriel Instit
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304to result from the insuflScient
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306It is this role of the intervent
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308EESULTSStudies concerning tlie p
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310The method derives from a specia
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312Why is this happening? What need
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m)effective with uncured alcoholics
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I316Casriel, who is medical-psychia
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318resort to heroin. One must not f
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.320in Permanent Cure of Narcotic A
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322!(4) '-Modification of Adaptatio
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324sections of the country, all sor
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;Mr.Pertto.niuch,I?,Mr. Peritq. Tha
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328Chairman Pepper. Mr. Steiger.Mr.
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, Mr., In''wMr, WiNx.nltiiink tlie
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:332"Stomach cramps" were found to
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'i.We334'""^li'anTOanlÊTPPEiL That
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:))))336would be deprived of any cl
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338less abuse liability than agents
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CONTENTSApril 26 1April 27 77April
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:•vEXHIBIT NO. 4 (a) AND (b)Eddy,
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:lovernor,vnEXHIBIT NO. 21 (a) and
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342have no desire to preempt the au
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344We hope these hearings will prov
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346tons in 1962 and to 155 tons in
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348SOUTHEAST ASIAAs you know also,
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350I would also point out as I did
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352their farmers who have been grow
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354told that much of the insurgency
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356Mr. IxGERSOLL. Well, again, Mr.
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358jority of the heroin problem in
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360years, but I have been frustrate
Page 382 and 383: 362Mr, Steiger. If you were goin^ t
Page 384 and 385: 364report marihuana among junior gr
Page 386 and 387: 366And it seems to me tliat we Avou
Page 388 and 389: ?368effectively, then maybe we will
Page 390 and 391: 370improvement as far as the abilit
Page 392 and 393: 372was there. Your visits probably
Page 394 and 395: 374the purchase of Avitnesses—I s
Page 396 and 397: :376administrations to publicly say
Page 398 and 399: 378Chairman Pepper. We will take a
Page 400 and 401: 380Mr. Ingersoll. No. I don't recal
Page 402 and 403: :382can fulfill the vow made by the
Page 404 and 405: 384have to give you the same answer
Page 406 and 407: 386Mr. Brasco. But that is another
Page 408 and 409: 388Mr. Ingeksoll. Well, that is the
Page 411 and 412: NARCOTICS RESEARCH, REHABILITATION,
Page 413 and 414: -39,3,Dr. Edwards held a surgical f
Page 415 and 416: 395of Narcotics and Dangerous Drugs
Page 417 and 418: 397Naloxone, recently approved for
Page 419 and 420: 399for example, who might be abusin
Page 421 and 422: 401Now, because of our attention ha
Page 423 and 424: 403and this is only for the investi
Page 425 and 426: 405effects this drug will produce i
Page 427 and 428: 407Now, if it is not used intravene
Page 429 and 430: 409Mr. Wiggins. Dr. Jennings, does
Page 431: 411Penicillin is good for pneumonia
Page 435 and 436: 415Dr. Gardner. Again, we don't hav
Page 437 and 438: 417Dr. Edwards. I suspect it at lea
Page 439 and 440: 419On the other hand, if serious si
Page 441 and 442: 421of the best known programs. Alth
Page 443 and 444: 423Medical Association, American Ps
Page 445 and 446: 425of the United States Pharmacopei
Page 447 and 448: 4275. Repeated examinations. Physic
Page 449 and 450: 429agement and rehabilitation of se
Page 451 and 452: —431As the agenc.v within HEW whi
Page 453 and 454: 433and complex acts such as driving
Page 455 and 456: 435(Inig induces physical and psych
Page 457 and 458: 437Chiiirmtin Pepper. Doctor, I thi
Page 459 and 460: 439A large proportion of youngsters
Page 461 and 462: 441Dr. Brown, what would you say is
Page 463 and 464: 443Chairmiui Pepper. Wliat is tlie
Page 465 and 466: 446The state of the art is promisin
Page 467 and 468: 447Lot nie ask you first, is tlic d
Page 469 and 470: 449Chairman Pepper. Do you happen t
Page 471 and 472: 451want you to take a look at. We w
Page 473 and 474: 453In addition to that, there seems
Page 475 and 476: 455the Mfldict is having a program
Page 477 and 478: 457—on drugs? By that I mean, vei
Page 479 and 480: 459\\ e are basically saying, in or
Page 481 and 482: —;461that this is the extent to w
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463We could go into the drug area a
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.465program that was i)ut into Jack
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467Mr. Brasco. Possibly. However, w
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469him, arrange to get somebody els
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471ainpheta.mines, or barbiturates.
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473In the meantime, the Institute d
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475treated in the community centers
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477research on narcotics in the sam
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479c 53 03E
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483spending for research through NI
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485There has been no concerted seri
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487it is left in one of their veins
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489I do not think I should explain
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491Dr. ViLLARREAL. Until the reflex
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493evidence strongly shows is that
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495Chairman Pepper. One other quest
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497Dr. ViLLARREAL. So, it is a biol
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'.499could result in a laboratory s
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5qifinds it in normal exploration.
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503synthesized a large number of na
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505STATEMENT OE DR. ALBERT KURLAND,
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507discovered if we iiad taken the
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509Mr. Perito. Dr. Kurland, do you
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511Chairman Pepper. Has the Food an
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513]Mr. Steiger. Do you feel from y
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515In this second study there was a
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517were any significant differences
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519The Deceptive Communication and
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.522than a State psychiatric hospit
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524Department of Mental Hygiene), R
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TABLE 3—COMPARISON OF THE 1ST POS
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528TABLE 10—RELATIONSHIP OF AGE T
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530tution and his involvement in th
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Attachment No. 5;r\ N-CH,-CH=CHo ,
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'-534Chart No. U (case No. 672)Disp
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536Chart No. 4 (case No. 694)Illust
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538Chart No. 35 {case No. 697)Excep
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540This amount of heroin is roughly
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5msuccessful or not in that short a
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544Chairman Pepper. Would you repea
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54^creased amount of licit as well
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—54Sand the bureaucracy and the a
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,,Mr.550you have used some of the s
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552so many areas is also a pitiful
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55,4nitiide of heroin addiction in
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556reached $976.5 billion, we can w
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558Mr. Jones was appointed to the c
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560cant when you consider that Out
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562criminal act in his lifetime. Ye
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—564Mr. Perito. Would it be fair
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566Now, Dr. Cliambers, can yon resp
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—568Mr. Raxgel. Our distinguished
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;-570Mr. Jones. That is correct. Ou
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572the commissioner, $186 million i
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574there should be something in the
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576and the way in which the funds a
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57SDr. Chambers. I think wliat you
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580Education is the best way of pre
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58-2Certain essential facts must re
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584done through determined action,
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586druffs, has the Nation's largest
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:588To repeat, methadone maintenanc
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:590I believe the Federal Governmen
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:take no such satisfaction. We have
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594of value in the testimony you ha
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596gone ahead with several. We have
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598force within our State Police De
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60PRased on the proposed goal of 2.
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602STATEMENT OF HON. MILTON SIIAPP,
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(51)4and apprehend the wholesalers
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J'606[Exhibit No. 23Prepared Statem
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608Under our 1071-72 budget proposa
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GIOcenters for the treatment of her
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. Dr.612Bourne informs me that we h
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614Governors in Atlanta to which re
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616pretty bad news, because it indi
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618Scientific statistical ioformati
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620((')) Finally, I believe that al
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622Governor Carter. I certainly rec
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624programs that are now available,
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626all of the top officials in the
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628perhaps greater than some of the
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)630tion and many others attempting
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632(3) Long term residential self-h
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634for the support of drug service
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:636D. NARCO, Inc.Narcotics Addicti
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638crimes to obtain the necessary m
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640million to $25 milliou per year.
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642Mr. Perito. Thank yoii. Mr. Chai
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644narcotic antagonist, and the oth
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646. Dr. Kramer. From what I have s
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—(348your money on, but methadone
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—650I know of no techinque in pri
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652Dr. Kramer. Yes, sir. As a matte
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:'654prison and who liave no—wlio
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65GDr. KT?A:\rEij. 1 suspect tliat
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658support some of the inethadone p
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'6660Dr. IvKAisrKK. 1 believe that
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662jrest that the Veterans' Adminis
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664opiates may be ingested in sever
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666(5) It suppresses the desire for
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668Many people have benefited from
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—G70Other researches which may di
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672synthetic painkillers, our commi
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074IV. A universal ban on legitimat
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..676iTlius we must look to educati
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678states, from Arnold Becker, publ
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680However, we must look at rehabil
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:682(a) The natural history of narc
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684was a heavy user. The decrease i
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686(13) Wallace. R. K. : Physiologi
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688TABLE 9.-USE OF "HARD LIQUOR" BE
Page 710:
UFRAL BOOKBINDING CO. Q /-^ /-» .1
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