Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
Narcotics research, rehabilitation, and treatment. Hearings, Ninety ... Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
644narcotic antagonist, and the other is the final testing of a long actingform of methadone.It is also time, I believe, for the Federal Government to bring an endto a fiction, a useful fiction, but nevertheless a fiction, nainely thatmethadone maintenance is an experimental procedure. This fiction isnecessary in order to, in effect, license m.etliadone maintenance programs.Continued close control over such programs is uncjuestionablynecessary. It should, however, be done through licensing rather thanthrough its retention as an investigational procedure.Spending lots of money will not alone assure a good result. Lots ofmoney may be necessary, but good planning must go with it.Mr. Perito. Doctor, I take it from your statement that you havesevere reservations about the present concept of the IND number aspresently structured through FDA.Dr. Kramer. I have reservations about it only in that it is a fictionand that certain disadvantages in the use of this treatment are causedby this fiction. I have tried to emphasize that control is necessary,but it should be done through a legitimate procedure rather than, asI say, through a subterfuge.Mr. Perito. In other words, you do not believe that since there are30,000 addicts being treated under a methadone maintenance approachthat the FDA is seriouslv making a determination as to whether thedrug is in fact, safe and efficacious.Dr. Kramer. I know that thev are making such statements. I readone such statement in the press. The American Medical News publisheda letter from the public information director of the FDA in which heinsisted that it was, in fact, an experimental procedure. jMost of usinvolved in the study of methadone maintenance would disagree, Ibelieve.Mr. Pertto. Do you think substantial disadvantages flow to thephysician as a result of the present system of allowing methadonemaintenance only under the investigational new drug permits?Dr. KRA]vrER. I think that it increases the difficulty in initiating andexpanding legitimate pi-ograms.Mr. Perito. Doctor, based upon your experience, would you saythat antagonists have a j^lace in civil commitment programs?Dr. Kraimer. x\ntagonists ?Mr. Perito. Eight ; do you believe that antagonist drugs, like cyclazocine,naloxone, have a place in the treatment armamentaria ofphysicians ?Dr. Kramer. I believe any useful technique to control addiction hasa place in civil commitment programs; yes, including the use of narcoticantagonists.Mr. Perito. Do you know, based upon your experience, whethernarcotic antagonists are being used in civil commitment programs inCalifornia?Dr. KRA:\rER. I am reasonably certain that they are not being soused. They may be used for detection, the so-called Nalline test is used,I believe, in Los Angeles County. But in terms of a treatment procedure,to the best of mv knowledge, they are not being used in civilcommitment programs in California.^Ir. Perito. Doctor, you have a substantial ex]:)erience Avith the civilccnnmitment piT)gram in California. Based upon your experiences, do
645you think that it is possible to structure an involuntary civil commitmentprogram which will produce results, results in the sense thatyou will increase the number of people being substantially helped?Dr. Kramer. Yes, I believe that civil commitment programs canbe structured so that the success rate will be substantially increased.I think this can be done through reasonable and extensive use of allthe modalities that we currently have available, including methadonemaintenance, potentially including narcotic antagonists, potentiallyincluding Synanon-type programs.One of the problems in the civil commitment program in Californiais that in the so-called group therapy meetings, the man's likelihood ofdepaiting from the institution depended on what he said in the groupmeeting. This encouraged a certain amount of deception on the part ofthe patients.Mr. Perito. Have the treatment approaches changed with the passageof time since the inception of civil commitment programs inCalifornia ?Dr. Kr.\mer. Yes ; there have been some changes. I think a genuineeffort is being made on the part of the people who are running theprogram. I have never denied their desire to make their programsuccessful.The changes for the most part have been procedural rather thansubstantial. The one most promising aspect of this is that the CaliforniaDepartment of Corrections, which has the authority over the civilcommitment program, has on its own initiated a methadone maintenanceprogram, both for civilly committed addicts, and for feloneouslycommitted addicts, and has in the last year or so allowed their paroleesto be admitted to methadone maintenance programs.I might point out that about a year ago, we had to go to court to askto have a patient of ours admitted to a methadone maintenance programand I must say that though we lost in the courts, the pressure ofthe publicity probably forced the change on the part of the paroleboard.Mr. Perito. The committee has heard some limited testimony onthe NARA program, Narcotic Addict Rehabilitation Act, which Iknow you are familiar with. By and large, I think it is fair to capsulizeit that the implementation of the act has not been particularly successful,has not spanned a broad range of treatment approaches, nor hasit been able to help that may people. Based upon your experiences, whydo you think that NARA has not done so well ?Dr. Kramer. I pointed out in my statement that from the informationthat I had, which is now about 6 months old—I have not gottenmore recent information—they seemed at least at the beginning tobe doing a little bit better than the California or New York programs.One reason that they have not done even better, perhaps, is becausethose running the program seem, frankly, rather antagonistic to themethadone maintenance approach. When I spoke with one worker inthe NARA program, he almost apologized for the fact that they hadseveral patients on outpatient status who were receiving methadoneand he did not in fact include them in his list of successes.Mr. Perito. Do you think the States on their own can structureprograms in the civil commitment area vrithout substantial help fromthe Federal Government ? Based upon your experiences ?
- Page 614 and 615: 594of value in the testimony you ha
- Page 616 and 617: 596gone ahead with several. We have
- Page 618 and 619: 598force within our State Police De
- Page 620 and 621: 60PRased on the proposed goal of 2.
- Page 622 and 623: 602STATEMENT OF HON. MILTON SIIAPP,
- Page 624 and 625: (51)4and apprehend the wholesalers
- Page 626 and 627: J'606[Exhibit No. 23Prepared Statem
- Page 628 and 629: 608Under our 1071-72 budget proposa
- Page 630 and 631: GIOcenters for the treatment of her
- Page 632 and 633: . Dr.612Bourne informs me that we h
- Page 634 and 635: 614Governors in Atlanta to which re
- Page 636 and 637: 616pretty bad news, because it indi
- Page 638 and 639: 618Scientific statistical ioformati
- Page 640 and 641: 620((')) Finally, I believe that al
- Page 642 and 643: 622Governor Carter. I certainly rec
- Page 644 and 645: 624programs that are now available,
- Page 646 and 647: 626all of the top officials in the
- Page 648 and 649: 628perhaps greater than some of the
- Page 650 and 651: )630tion and many others attempting
- Page 652 and 653: 632(3) Long term residential self-h
- Page 654 and 655: 634for the support of drug service
- Page 656 and 657: :636D. NARCO, Inc.Narcotics Addicti
- Page 658 and 659: 638crimes to obtain the necessary m
- Page 660 and 661: 640million to $25 milliou per year.
- Page 662 and 663: 642Mr. Perito. Thank yoii. Mr. Chai
- Page 666 and 667: 646. Dr. Kramer. From what I have s
- Page 668 and 669: —(348your money on, but methadone
- Page 670 and 671: —650I know of no techinque in pri
- Page 672 and 673: 652Dr. Kramer. Yes, sir. As a matte
- Page 674 and 675: :'654prison and who liave no—wlio
- Page 676 and 677: 65GDr. KT?A:\rEij. 1 suspect tliat
- Page 678 and 679: 658support some of the inethadone p
- Page 680 and 681: '6660Dr. IvKAisrKK. 1 believe that
- Page 682 and 683: 662jrest that the Veterans' Adminis
- Page 684 and 685: 664opiates may be ingested in sever
- Page 686 and 687: 666(5) It suppresses the desire for
- Page 688 and 689: 668Many people have benefited from
- Page 690 and 691: —G70Other researches which may di
- Page 692 and 693: 672synthetic painkillers, our commi
- Page 694 and 695: 074IV. A universal ban on legitimat
- Page 696 and 697: ..676iTlius we must look to educati
- Page 698 and 699: 678states, from Arnold Becker, publ
- Page 700 and 701: 680However, we must look at rehabil
- Page 702 and 703: :682(a) The natural history of narc
- Page 704 and 705: 684was a heavy user. The decrease i
- Page 706 and 707: 686(13) Wallace. R. K. : Physiologi
- Page 708 and 709: 688TABLE 9.-USE OF "HARD LIQUOR" BE
- Page 710: UFRAL BOOKBINDING CO. Q /-^ /-» .1
644narcotic antagonist, <strong>and</strong> the other is the final testing of a long actingform of methadone.It is also time, I believe, for the Federal Government to bring an endto a fiction, a useful fiction, but nevertheless a fiction, nainely thatmethadone maintenance is an experimental procedure. This fiction isnecessary in order to, in effect, license m.etliadone maintenance programs.Continued close control over such programs is uncjuestionablynecessary. It should, however, be done through licensing rather thanthrough its retention as an investigational procedure.Spending lots of money will not alone assure a good result. Lots ofmoney may be necessary, but good planning must go with it.Mr. Perito. Doctor, I take it from your statement that you havesevere reservations about the present concept of the IND number aspresently structured through FDA.Dr. Kramer. I have reservations about it only in that it is a fiction<strong>and</strong> that certain disadvantages in the use of this <strong>treatment</strong> are causedby this fiction. I have tried to emphasize that control is necessary,but it should be done through a legitimate procedure rather than, asI say, through a subterfuge.Mr. Perito. In other words, you do not believe that since there are30,000 addicts being treated under a methadone maintenance approachthat the FDA is seriouslv making a determination as to whether thedrug is in fact, safe <strong>and</strong> efficacious.Dr. Kramer. I know that thev are making such statements. I readone such statement in the press. The American Medical News publisheda letter from the public information director of the FDA in which heinsisted that it was, in fact, an experimental procedure. jMost of usinvolved in the study of methadone maintenance would disagree, Ibelieve.Mr. Pertto. Do you think substantial disadvantages flow to thephysician as a result of the present system of allowing methadonemaintenance only under the investigational new drug permits?Dr. KRA]vrER. I think that it increases the difficulty in initiating <strong>and</strong>exp<strong>and</strong>ing legitimate pi-ograms.Mr. Perito. Doctor, based upon your experience, would you saythat antagonists have a j^lace in civil commitment programs?Dr. Kraimer. x\ntagonists ?Mr. Perito. Eight ; do you believe that antagonist drugs, like cyclazocine,naloxone, have a place in the <strong>treatment</strong> armamentaria ofphysicians ?Dr. Kramer. I believe any useful technique to control addiction hasa place in civil commitment programs; yes, including the use of narcoticantagonists.Mr. Perito. Do you know, based upon your experience, whethernarcotic antagonists are being used in civil commitment programs inCalifornia?Dr. KRA:\rER. I am reasonably certain that they are not being soused. They may be used for detection, the so-called Nalline test is used,I believe, in Los Angeles County. But in terms of a <strong>treatment</strong> procedure,to the best of mv knowledge, they are not being used in civilcommitment programs in California.^Ir. Perito. Doctor, you have a substantial ex]:)erience Avith the civilccnnmitment piT)gram in California. Based upon your experiences, do
Change language