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

517were any significant differences between subjects maintained on a partial systemof naloxone blockage; a group receiving a placebo; and a group attending theexperimental clinic, but receiving neither naloxone nor a placebo. The results ofthis study will probably not be known for another 18 to 24 months.Out of these endeavors there has begun to emerge yet another perspective asto the more effective use of naloxone. As had been indicated earlier, the previousstudy focused on the results of the parsimonious reduced dosage of naloxoneproducing a continuing partial narcotic blockade. It would appear that thissystem entails substantial amounts of naloxone usage as the drug is administeredover extended periods of time. The plan suggested itself that it might be moremeaningful to alter the therapeutic strategy by administering naloxone in high(24-hour) blockage dosage only at those times when narcotic usage occurs, andquickly terminating the administration of the narcotic antagonist when thesubject once more reverts to abstinence. Such a total blockade extending over a24-hour period in which the high producing effects of the illicit opiate administrationis sought would be completely neutralized. This system of naloxoneadministration would be maintained until the stress-])roducing urge for the narcoticexperience has been ameliorated and the individual once more resuming hisabstinent course.Obviously, a variety of responses to this form of therapeutic management maybe anticipated. These would range from the individual who deliberately absentshimself from the clinic in order to resort to his surreptitious administration of anarcotic drug, to the individual who responds dramatically to the protectionprovided by the narcotic antagonist as it carries him through a period of stressbringing about his urge for the narcotic experience. There is no reason to believethat the former consideration, namely the attempt to resort to unauthorizedabsences, cannot be dealt with promptly and effectively, particularly in programsentailing mandatory supervision. It can be anticipated on the l)asis of previousexperience that the great majoritj' of the subject population, despite their occasionalrelapses from abstinence, will be cooperative toward taking the naloxonemedication. This cooperation in turn will be promptly rewarded by a promptdiscontinuation of the naloxone as the individual displaj^s his capacity to maintainabstinence.With this possibility in view, a number of recommendations are being made toallow for a more vigorous exploration of the possibilities of employing this systemof treatment. One is that a vigorous effort be instituted to make larger suppliesof naloxone available to qualified clinical investigators in order that the explorationof its therapeutic application may be more actively pursued. In order tobring this about, it is recommended that a high priority be established for investigatingways and means for increasing the supplies of thebaine, from which naloxoneis synthesized. With adequate supplies of naloxone it may be possible to managelarge numbers of patients whose only alternative to an abstinence program at thepresent time is their maintenance on a narcotic drug such as methadone. With theability to manage patient populations on programs maintaining a high level ofabstinence, it may be that there will be opportunities for bringing about a rehabilitationof the narcotic abuser by minimizing the need for maintenance on amethadone program or the resort to illicit drugs. Moreover, it will also help toameliorate a hazardous state of affairs of the sociopathic individual whose nefariousactivities as a participant on a methadone program maj' only be enhanced withtheir resultant deleterious consequences to the social structure.In conclusion, it is my impression that the narcotic antagonists, particularlynaloxone, which may be a forerunner of even more potent com]3ounds of thisnature, hold a great deal of promise as a treatment modality, particularly in theindividual against whom society has had to deal punitively because of the criminalactivity associated with the procurement of drugs for his illicit use. The potentialof these compounds, the antagonists, should be actively investigated by an increasingcommitment of research activities in this area, with emphasis on theirpriority. Hopefully, as more ample supplies of these drugs are made available, anexpansion of their clinical investigation can be carried out.Attachment 1Name.—Albert A. Kurland, place and date of birth: Wilkes-Barre, Pa., June 29,1914.Marital status.— Married, 1941.Education.—Baltimore City College, 1932; Universitv of Maryland, B.S., 1936;M.D., 1949.