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

—431As the agenc.v within HEW which carries the primary respoiLsibiUty for liowhealth services are organized and delivered to the American people, the HealthServices and Mental Health Administration performs a wide variety of functions.These range from supporting basic and applied research—including that in thearea of drug abuse which is our primary focus today, collecting and disseminatingdata on health services delivery, to stimulating innovative approaches to thedelivery of health services.Drug abuse has been a long-term concern of the medical profession and ofpublic health officials. Opiates were a frequent basic ingredient of widely availablepatent medicines prior to the passage in 1914 of the Harrison Narcotic Act.Attempts to deal with widespread noncriminal addiction through public clinicsduring the 1920's were fraught with problems—mostly of inadequate controlover the continued use of drugs. While truly accurate statistics have never beenavailable, it is generally conceded that the percentage of the American populationaddicted to narcotics reached its height in the United States prior to the passageof the Harrison Narcotic Act, and gradually decreased after 1914. During WorldWar II traditional sources of supply were cut off, greatly diminishing the e.xtentof the problem.By the 1950's, use again increased over prewar levels, mostly concentratedamong minority group members living in ghettos of the large urban centers.The last decade has witnessed an increase, with some youthful middle classinvolvement beginning in the late 1960's. Our best current estimate is that approximately250,000 persons are addicted to narcotics. It must be rememberedthat no current estimates on the extent of drug abuse are wholly satisfactor\\Clearly, drug addiction, in addition to being a social, legal, and moral problemis a major medical and health problem. At the physiological-clinical level notonly does overdosage often lead to tragic deaths—especially among very youngusers—but narcotics also pose significant dangers because of the associatedmedical problems of serious liver involvement (hepatitis) and other types ofinfections deriving from the use of nonsterile needles.Drug abuse must also be viewed from the standpoint of the mental healthand health services system. How can both the acute and the chronic needs ofthese physically and psychologically ill persons be met? The nature, the growthand the geographical distribution of drug addiction present unusual challengesto the American health care system.Physicians— pediatricians, internists, family physicians, and others—need torapidly acquire the skills and information needed for them to work effectivelywith addicts and other drug abusers. Unless physicians are knowledgeable aboutthe early signs of drug addiction, about the management of acute crisesespecially withdrawal—and about various treatment methods, there is little hopethat they can provide the leadership which is expected of them.A wide variety of health and medical comjoonents need to be involved incommunity drug abuse activities. These include emergency services, inpatientunits of general hospitals, neighborhood health centers, community mentalhealth centers. State mental hospitals, and health services in special settingssuch as prisons. The necessarj^ arrangements must be developed to insure continuityof care for patients and the proper coordination of various health services.We expect that health maintenance organizations, in collaboration with specializeddrug addiction services and with community mental health centers, can takesignificant steps to provide emergency and continuing medical treatment fornarcotic addicts. I also anticipate that several of the experimental health servicesplanning and delivery projects being developed by the Health Services andMental Health Administration will include a major drug addiction component.As you will shortly hear from Dr. Brown and Dr. Martin, Federal researchefforts in the area of drug abuse have grown considerably in recent years. However,it is also obvious that we are only a small wa.v down the road toward anycomplete understanding of the cause, treatment, and prevention of drug abuse.The Health Services and Mental Health Administration is pleased that one ofits major components, NIMH, is now taking a lead role within the Department,as well as within the total Federal Government, in inci'easing our knowledge ofthe complex problem of drug abuse.Thank you for providing me with this opportunity to express my enthusiasticinterest in our common endeavor.