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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440Dr. Brown. Our current estimate is 250,000. We in truth have thesame estimate as you have heard. Several hundred thousand, perhapssomewhere between 150,000 and 400,000. Our best guess is a quarterof a milUon.Chairman Pepper. Now, Dr. Edwards told us today that about30,000 people are being maintained; that is, are being treated constantlyby the use of methadone. Do you generally agree with thatfigure?Dr. Brown. Yes; I think it is a little on the high side, and if I wereasked to give a number, I would have guessed closer to 20,000 than30,000.Chairman Pepper. So, to use a maximum figure, of your estimateof possibly 250,000 heroin addicts in the country, about less than50,000 of them are being treated by any kinds of drugs?Dr. Brown. Yes; there is an additional small number that are onother drugs, mostly experimental ones that you have spoken of.These include cyclazocine and naloxone, but that additional thousandsthat you can count on one hand, so it still falls under 50,000.Chairman Pepper. So, the maximum number in your opinion, ofheroin addicts in the United States being treated by some kinds ofdrugs would be under 50,000?Dr. Brown. Yes, sir.Chau-man Pepper. That would leave approximately 200,000heroin addicts that are to be treated by some other method.What are the other methods currently used in the treatment ofheroin addiction other than the use of drugs?Dr. Brown. There are several methods. One is the therapeuticcommunity, particularly Synanon and other similar models. One isthe comprehensive approach that combines counseling, jobs, vocationalreferral, and training. This is often called multimodality.Dr. Jaffe has popularized this phrase.There is individual treatment that a physician might take on withan individual patient to see what he can do. There are specific subtreatmentssuch as being a member of a halfway house or some othersemi-institutional setting.This is the range of treatments that I am aware of. Mr. Bestemanmight want to expand on a few others.Mr. Besteman. I think essentially most have been covered. Thereare still some treatment programs that go on in the traditional institution,care away from the home community, and we do know ofcrisis treatment centeris that are more related to drug abuse than theyare, say, to addiction.Chairman Pepper. Those are clinical or institutional approaches;are they not?Dr. Brown. Yes.Chairman Pepper. They require personnel, require trying to putthe person in a proper frame of mind, trying to get him a job, givehim therapeutic treatment that may be necessary and the like. It issort of an institutional approach. And also sort of a multiple approach.Dr. Brown. That is correct.Chairman Pepper. A psychological as well as physical approachto the individual.

441Dr. Brown, what would you say is the state of the art at the presenttime in the development of drugs for the treatment of heroin addicts?Would you give us vour own summary?Dr. Brown. The state of the art is primitive and promising if I canput together two words. It is primitive only in the sense that imtilwe understand some of the most basic mechanisms of what the natureof addiction is, what the nature of dependence is, it will be difficultto develop drugs tailored specifically to actions you do not fullyunderstand.On the other hand, we have promising leads in several areas thatyour committee is exploring. These include blocking agents, antagonists,and perhaps even other drugs that relieve the secondary effectssuch as anxiety, tension, and depression.These are some of the promising leatls.Dr. Martin may want to give you an even more thoughtful orknowledgeable response to that question. I think I would like verymuch for him to answer that question.Chairman Pepper. That is what we would like to get. The doctorcovered it pretty well in his statement, but I want to get in the recordabout the present state of the art, as it were, on the development ofblocking or immunizing or antagonistic drugs in respect to the treatmentsof heroin addicts.Dr. Martin. I am not the diplomat that Dr. Brown is. I wouldsay the state of the art is primitive.I think we have several leads that may in the end prove helpful.We have the use of the "hair of the dog" ; namely, the methadone-typeof approach, or acetyl-methadol, that may help perhaps 25 percent,perhaps more of the addict population.We have the possibility of using, developingChairman Pepper. Excuse me. You mean being used for the treatmentof that large a percentage or maybe as adapted for use withrespect to that large a percentage of the heroin adtlicted population?'Dr. Martin. I think that percentage of the total addict populationmay very well be amenable to this type of treatment.I think a smaller percentage, but nevertheless a significant percentage,of the addict population would be amenable to the use ofthe narcotic antagonists, and I think by eventually finding a way ofadministering both the methadone-type of drug and the narcoticantagonist on an infrequent basis, using a depot, so that the patientis protected throughout the intervening time, may facilitate verydefinitely both treatment modalities or both types of treatment.I think that our efforts to develop a depth form are somethingthat should be encouraged and helped and I think it is an effort thatshows great promise. It would, I think, for example, have one verypractical consequence, that it would eliminate diversion.Chairman Pepper. Eliminate diversion?Dr. Martin. Diversion, because the patient would carry the drugwith him inside of his body in a way that it could not be easilyextracted.At the present moment, I think that these are the most promisingleads in the area of chemotherapy, but I do believe that we shouldvery definitely attempt to set our sights a good deal higher than this.

441Dr. Brown, what would you say is the state of the art at the presenttime in the development of drugs for the <strong>treatment</strong> of heroin addicts?Would you give us vour own summary?Dr. Brown. The state of the art is primitive <strong>and</strong> promising if I canput together two words. It is primitive only in the sense that imtilwe underst<strong>and</strong> some of the most basic mechanisms of what the natureof addiction is, what the nature of dependence is, it will be difficultto develop drugs tailored specifically to actions you do not fullyunderst<strong>and</strong>.On the other h<strong>and</strong>, we have promising leads in several areas thatyour committee is exploring. These include blocking agents, antagonists,<strong>and</strong> perhaps even other drugs that relieve the secondary effectssuch as anxiety, tension, <strong>and</strong> depression.These are some of the promising leatls.Dr. Martin may want to give you an even more thoughtful orknowledgeable response to that question. I think I would like verymuch for him to answer that question.Chairman Pepper. That is what we would like to get. The doctorcovered it pretty well in his statement, but I want to get in the recordabout the present state of the art, as it were, on the development ofblocking or immunizing or antagonistic drugs in respect to the <strong>treatment</strong>sof heroin addicts.Dr. Martin. I am not the diplomat that Dr. Brown is. I wouldsay the state of the art is primitive.I think we have several leads that may in the end prove helpful.We have the use of the "hair of the dog" ; namely, the methadone-typeof approach, or acetyl-methadol, that may help perhaps 25 percent,perhaps more of the addict population.We have the possibility of using, developingChairman Pepper. Excuse me. You mean being used for the <strong>treatment</strong>of that large a percentage or maybe as adapted for use withrespect to that large a percentage of the heroin adtlicted population?'Dr. Martin. I think that percentage of the total addict populationmay very well be amenable to this type of <strong>treatment</strong>.I think a smaller percentage, but nevertheless a significant percentage,of the addict population would be amenable to the use ofthe narcotic antagonists, <strong>and</strong> I think by eventually finding a way ofadministering both the methadone-type of drug <strong>and</strong> the narcoticantagonist on an infrequent basis, using a depot, so that the patientis protected throughout the intervening time, may facilitate verydefinitely both <strong>treatment</strong> modalities or both types of <strong>treatment</strong>.I think that our efforts to develop a depth form are somethingthat should be encouraged <strong>and</strong> helped <strong>and</strong> I think it is an effort thatshows great promise. It would, I think, for example, have one verypractical consequence, that it would eliminate diversion.Chairman Pepper. Eliminate diversion?Dr. Martin. Diversion, because the patient would carry the drugwith him inside of his body in a way that it could not be easilyextracted.At the present moment, I think that these are the most promisingleads in the area of chemotherapy, but I do believe that we shouldvery definitely attempt to set our sights a good deal higher than this.

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