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

415Dr. Gardner. Again, we don't have all of the figures but I wouldsay from what we have, "No."Mr. Rangel. Let's talk about the cities where you have your majorclinics. Are they not located to service the inner cities?Dr. Gardner. Many of the progTams are located in the majorcities, but by no means all. At least half of the programs are locatedoutside of the cities or inner cities.Mr. Rangel. I am not talking numerically in terms of number ofclinics; I am talking about in terms of the number of patients thatare being treated by methadone. Isn't it a clear fact that the overwhelmingnumber of the patients that are being treated by methadonefall into a very low economic bracket?Dr. Gardner. No; this is not a clear fact, as yet, in many programs,even those in the inner city, we see large numbers of patients frommiddle-income groups and from the suburbs. This is one of thethings that we wanted more, better figures about, you know, whythis is going on and how this can occur. But by no means in thefigures that we have are the bulk of the patients from lower economicgroups, at least to begin with. Of course, if they have been on heroinfor a while that may occur, but by no meansMr. Rangel. How far away can the American public expect theFDA to give a professional decision as to whether or not methadoneis safe for use on human beings.Dr. Edwards. I can't give you a specific answer on that. I think itdepends on how our new regulations work, how rapidly we are ableto accumulate meaningful data.Dr. Jennings. I might add one thing to that, sir, in response toyour question, and in partial response to one Mr. Wiggins raisedearlier. The Dole and Nyswander study, which was the pioneer study,was published in the open medical literature but it is onh^ within amatter of the past several months that at our behest, and funded bythe drug companj^, an effort has been made to collect their data in aform that would permit us to make the kind of decision you are speakingabout. I think we could say now, that by the usual measurementsof safety, that methadone in these dosages would be safe for a definitiveperiod of time, for perhaps a matter of a year or two or three.We have no data on the extended range beyond that, and Dr.Dole, of course, insists that patients who start on methadone willpersist on it for the rest of their lives.We need to go very far to find examples of drugs that seem to besafe for even an extended period of time, but when studies were donethat encompassed, say, perhaps 10 years, adverse effects that werecompletely unsuspected began to develop, and we are currentlywrestling with just such a problem in a drug that must be administeredchronically.Chairman Pepper. Mr. Sandman?Mr. Sandman. I only have two questions. Dr. Casriel was here andtestified about a drug that he called Perse. Are you familiar with thatdrug?Dr. Edwards. Yes; we are.Mr. Sandman. I came here late and if you have already discussedthis, I will withdraw the question.