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

471ainpheta.mines, or barbiturates. Of the patients in the civil commitment programwho had been in aftercare for 3 months or more, 60 percent were not abusing anydrugs. The same is true of patients who had been in the community treatmentprogram for 3 months or more. Of the patients who are in the civil comtmitmentaftercare phase, we know that 60 percent do not become readdicted during theirfirst year in aftercare. Of the remaining, 25 percent do abuse some drugs or becomereaddicted and require further hospital treatment. The remaining 15 percentdrop out of the program.There is a great deal of public interest currently in methadone maintenancetreatment for narcotic addiction. Many claims and counterclaims are beingmade regarding its effectiveness. How effective is methadone maintenancetreatment? The answer I am about to give you is a cautious one, but I believerepresents the state of our knowledge at this time. The Food and Drug Administration,which has responsibility for determining the degi-ee of safety and efficacyof drugs, has determined that the exact degree of safety and efficacy of methadonemaintenance treatment in unknown at this time. Many groups, including groupsin New York City, Illinois, and here in Washington, D.C., are evaluating methadonemaintenance. The National Institute of Mental Health is currentlj' sponsoringthe use of methadone in both its civil commitment treatment program andits community-based treatment in-ograms under carefully controlled conditionsso that we can generate data to help determine methadone's safety and efficacy.With regard to comparing methadone and other treatment modalities, I mustagain point out that the patients who are being treated with methadone differin many characteristics from the patients who are being treated with othermodalities. For example, they differ in age, sex, race, length of addiction, historyof criminal behavior, and so on. Lastly, I might again say that comparisons ofefficacy depend on which measures or benefits one looks at—employment,arrest records, drug abuse, or pursuit of education. At the present time I do notknow of any conclusive studies which demonstrate significant differences betweenthe benefits achieved by methadone patients compared with the benefits achievedby patients treated in other waj's.It might be good to mention here that we are studying other narcotic substituteswhich ma}^ be longer acting than methadone. One drug we are testing isL-alpha-acetyl-methadol, whose effects last for 48 to 72 hours, and if successful,wall mean that patients could come in from treatment only two to three timesa week rather than every day. This would greatly decrease the cost of a maintenanceprogram and allow the patient to live a more normal life. We are also supportingresearch into tiie development of a nontoxic removable implant which candeliver an antagonist drug slowly into the patient's system over a period of timeso that the need for repeated medication would be markedly reduced. A fullysafe and effective antagonist, however, has not yet been developed.Mr. Chairman, my overview of the Intsitute's research program would not becomplete unless I mentioned three additional activities. First, the Institute'sprogram of supplying standardized pure preparations of drugs of abuse to qualifiedresearchers. Originally this program focused on distributing LSD to researchersthrough the joint FDA-NIMH Psychotomimetric Agents Advisory Committee.With the increased use of marihuana and related drugs, the program has expandedto include a wider spectrum of drugs, including psilocybin, radioactively taggedand untagged tetrahydrocannabinol (Delta-8 and Delta-9 THC), a uniformstandard grade of marihuana leaf, and most recentlj- heroin for research purposes.At present the Institute is not only supplying requests from the U.S. investigatorsbut has estabhshed procedures with the Canadian Food and DrugDirectorate and the United Nations Narcotics Laboratory for supplying anddistributing these drugs for research in Canada and Western Europe. Informationgenerated by research performed in foreign countries should help the U.S. researchprogram. The number of requests for research drugs has doubled in the past year.Since this program's inception, 650 requests for research drugs have been filled,250 of them for marihuana or its derivatives.Second, the Institute is currently pretesting a number of educational materialsincluding pamphlets, posters, workbooks, and films to determine their usefulnessin reaching different groups within the population. Materials which pass thispretesting phase will be ready for release in the fall of this year. Some of thematerials and educational materials which have previously been developed throughthe National Clearinghouse for Drug Abuse Information have been used in theInstitute's training program, which in fiscal j^ear 1970 provided 1- and 2-weekcourses on drug abuse for over 1,500 professionals, allied health workers, Governmentofficials, and members of the public.