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

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65GDr. KT?A:\rEij. 1 suspect tliat tlie snrcess rate would be modest. Iwould suspect that certain individuals would not o])t to txo into a ^'Ahospital for any one of a variety of reasons.I would also take this opportunity to su
'•657ill Southeast Asia tliat heroin is as addictive when inhaled as wlieninjected,Îr. Wixx. I do not understand.Dr. KijAMER. TJuit heroin inhaled, sniti'ed, in powder form, is asaddictive as it is wlien injected.Mr. "Wixx. Is that the waj' they arc taking- it ?Dr. Ki;.\:\nn;. They are inhaling- it in powder form.Mr. "Wixx. Is this done because they"cannot trace the!'inhalingas Avell ^-^Dr. Kii.urKii. Xo; inhaling because perhaps they do not have theinjection apparatus, and because the heroin is so i)otent that they caneasily get the desii'ed elfect by iidialing or smoking the heroin.Mr. Wixx. And they do not lia ve the needle marks iDr. Kramer. And they do not have the needle marks. It is just theway that the drug culture has unfortunately develo]ied in SoutheastAsia; this is the technique of ingestion that the culture has developed.One of the reasons that it has develo])ed this way is that there is theassumption that when snitfed or smoked, heroin is not addicting. Infact, it is highly addicting, almost as highly addicting if not as highlyaddicting, througli that route as through being injected.Mv. "Wix-x". "Well, now, they are getting a more perfect type of herointhat part of the world, and when they get back to the United Statesilland if they are still addicted and they get some of the junk that isi)eing sold on the sti-eets, they are not going to realize tii(> high thatthey have had over there. Is that true ?Dr. Kramer. That is correct; unless they do inject it directlyand perha])s not e^'en then.INIr. Wixx. Because it is ]iot as good a tj' pe.Dr. Kram]:r. Because of lower potency.Mr. Wixx. That is what I Avas trying to grapple for but I couldnot come np with the words. Well, Dr. Kramer, I appreciate yourcoming from California, to api)ear befoi'e this committee and I thinkyou have given lis some new thoughts and some ditferent ideas thatthe committee lias not heard before. I thank yon.Tliank you, l^lv. C^hairman.Chairman Peeper. Thank you. Îr. Winn. Dr. Kramer, this morning,representatives from the State of Xew York testified that the Stateof Xew York Avas sjjending in fiscal year 1972 for treatment and rehiibilitationof addicts of heroin and major drugs $180 milliou. Couldyou give us a conrparable figure for the iState of California ^Dr. Kramer. I cannot oifhand. I do not know what was includedunder this umbrella in the statement of the gentleman from NewYork.Chairuiau Peiter. The ligure that I gave you excluded law enforcement.Dr. IvRAzyiER. Did it include, for example, the Dole-XySAvander programs.Daytop Villag(\ and so forth ?Mr. Peuito. Yes, sir.Dr. Kraaier. I will liaAe to think Avhen I talk because I was not|)rei)ared for this; I do not have the figures. I will try to get as manyojf the top of my head as I can think of.The civil cfjiniiiitment jn-ogram in the State of California costsiiltout II luillioii ;i year. Tlie State of California may, to some extent,
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NARCOTICS RESEARCH, REHABILITATION,
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::VEXHIBIT NO. 4 (a) AND (b)Eddy, D
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urden that such addiction imposes u
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1 (lata; (->) the sliariiis" oF iii
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9Chairman Pepper. The committee is
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::11quota production from unrecogni
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13in this country. This raises the
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15from other clinical projects of w
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:17practice, experience has indicat
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;19.I think a quota would be better
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21When methadone was first introduc
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:::::.—23American Society of Phar
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_'—25.I'BOCUREMENT AND ISSUE DATA
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'.28Fiscal years-1967 1968 1969 197
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30rally in opium. By indirect, the
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32We can, I think, most helpfully g
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34so intense that we haven't done v
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Dr. Eddy. Well, physicians, usually
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38Dr. Eddy. No.Chairman Pepper. Now
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:40get away with it as Dr. Keats su
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:—:42public health hazard was jud
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:44Bibliography(1 Nathan B. Eddy. "
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46(52) Nathan B. Eddy. "Dilaudid."
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48(98) "The New Narcotics, Post-gra
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^.50
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52entails the consideration of addi
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54Chairman Pepper. Have you found t
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56^.I wonder would you care to comm
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58Chairman Pepper. Without objectio
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—1958-681959-«419691962-64196219
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—62abuse and has brought about th
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64bank robbery or an assault. You d
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66Mr. Wiggins. Would the stopping o
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68—Chairman Pepper. Can you give
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:70The problem then would be the wi
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;72taking exceptional measures in t
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)—74pay serious attention to this
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;76From 1958 to 1961, he served as
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78deine in painkilling drugs. So if
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;80ning capabilities, responsibilit
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;:;82terials. If they could introdu
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84Figure 1infrared Ektachrome film
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;86Figure 3.—Tones of wheat (W) a
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88ers at the poppyfields or at any
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:90;:tional situations has handicap
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;;92Locating illicit opium cropsDet
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94Jaffe. Well, there would be some
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96Mr. Jaffe. Primarily on the fact
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98in the same ball park about what
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100Chairman Pepper. Mr, Waldie, do
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::102agencies and input data would
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104most facilities are barely able
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;106We have also studied a ^roup of
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108Dr. Gearing. Yes, sir; I would n
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110somethino: in the nei
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112program is put into the machiner
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I114you have some data there that s
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116Dr. Gearing. It depends on what
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118Chairman Pepper. Would you have
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120it not be so that we could proje
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.122admission rate was approximatel
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124BESULTS(1) Although many of the
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1262. All the members of the methad
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128HETHADOHE MAINTENANCE TREATMENT
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11 1 1 1 1 11130Methadone Halnten?n
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132TABLE 2.-METHAD0NE MAINTENANCE T
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134Figure 9 Methadone tlaintenance
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136Methadone Ka'ntanance Treatmf:nt
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:::.::.138Appendix A^—Methadone M
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140nance treatment patients showing
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142Figure 3 •lethadone Kaintenanc
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144Dr. DuPoNT. 1,760 on methadone m
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:146there are dramatic reductions i
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148Health insurance coverage for me
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150Dr. DtjPont. Well, there are no
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152Mr. Blommer. You would agree the
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154done. Where is the evidence ? No
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156There are several reasons a pers
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158It would seem to me a very busy
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160we had before. I don't think it
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162heroin addiction and support all
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164Dr. DuPoNT. I am reluctant to ge
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166Using this figure as rule of thu
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)168ment facilities for heroin addi
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.170parole departments. None were c
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::172Table 2.— Selected character
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174TABLE 3.—HEROIN ADDICTION RATE
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176W.a^^cc-V.c Cffv..AdF-ro ftcoKjL
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178.^06V f\QrK-'SEt GôuP/AJ6SIS're
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I180*i coo)u->CM>—'CMUJCOO O COa>
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I(/I182esiMmin0)^> oo.00 =E|c O.2 o
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184encouraged to return to methadon
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186or other side effects. This incr
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:188number as that on the bottle. W
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190Attachment ThreeTo all medical s
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-jI IALLI192ATTACHMENT- FIVE,J: IPA
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194ATTACHMENT NINEGOVERNMENT OF THE
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......—196half of the addicts sta
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198CONCLUSIONSCertain patterns emer
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200TABLE 5.— PROFILE OF BARBITUAR
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202TABLE ll.-SUPPORT OF HEROIN HABI
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204TABLE 17.-AGE OF ADDICTS AND NON
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206TABLE 23.—PRESENT MARITAL STAT
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208TABLE 28.-MILITARY SERVICEAddict
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:210The committee is pleased to cal
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212sists of a network of 21 geograp
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214(6) Basic studies on the nature
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216in fact, constitute autonomous o
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Chairman Pepper. Mr. Perito?218;; M
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^'220is not a very forgiving drug.
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'222Furthermore, in our present con
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—224the Federal Government decide
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-—I have presented one generic ki
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,clinic;?,>•
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230I realize we are running late.Do
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''232'']Vir. Winn. Tiien you mentio
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234So having put it in the area, ha
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,Memberships'—i236privilege of co
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;238A central hypothermic response
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;240South Bronx, Bedford-Stuyvesant
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242€are of patient addicts. We ha
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244hospitals in the city, came into
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246that came into my office, and I
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'Mr.;>•/nmo'.i,,;248deputy commis
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:250two Rockefeller Institute physi
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:252during pliase II that serious e
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254well-structured methadone mainte
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;:256nonsense and serves only to ad
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:258you best complete your statemen
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260Mr. Pertto. Based upon your expe
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262A a'reat case in point was a con
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«264Mr. Steiger. Did you discuss w
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—:266Mr. HoRAN. We don't support
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268Mr. Horan, let's back up a littl
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270It is not up to heroin or morphi
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272nesses yesterday who brought out
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274;Mr. Perito. It is my understand
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276So that at the end of the week t
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278steroid he lias in him we might
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280Mr. Perito. You are referriii"'
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282not drug free. I can say approxi
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28 A$2-a-day habit these individual
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•As286I got to the point once in
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288Mr. Steiger. You mentioned anoxi
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290Mr. Eangel. I could see then tha
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292Dr. Casriel. Mr. Keating, I have
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j294What period of time are ^ve tal
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296was March of 1970—he was admit
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298"The paper by Dole and Nyswander
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:300vent them from coming to New Yo
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302[Exhibit No.14(b)]Casriel Instit
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304to result from the insuflScient
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306It is this role of the intervent
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308EESULTSStudies concerning tlie p
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310The method derives from a specia
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312Why is this happening? What need
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m)effective with uncured alcoholics
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I316Casriel, who is medical-psychia
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318resort to heroin. One must not f
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.320in Permanent Cure of Narcotic A
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322!(4) '-Modification of Adaptatio
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324sections of the country, all sor
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;Mr.Pertto.niuch,I?,Mr. Peritq. Tha
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328Chairman Pepper. Mr. Steiger.Mr.
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, Mr., In''wMr, WiNx.nltiiink tlie
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:332"Stomach cramps" were found to
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'i.We334'""^li'anTOanlÊTPPEiL That
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:))))336would be deprived of any cl
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338less abuse liability than agents
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CONTENTSApril 26 1April 27 77April
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:•vEXHIBIT NO. 4 (a) AND (b)Eddy,
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:lovernor,vnEXHIBIT NO. 21 (a) and
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342have no desire to preempt the au
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344We hope these hearings will prov
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346tons in 1962 and to 155 tons in
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348SOUTHEAST ASIAAs you know also,
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350I would also point out as I did
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352their farmers who have been grow
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354told that much of the insurgency
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356Mr. IxGERSOLL. Well, again, Mr.
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358jority of the heroin problem in
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360years, but I have been frustrate
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362Mr, Steiger. If you were goin^ t
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364report marihuana among junior gr
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366And it seems to me tliat we Avou
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?368effectively, then maybe we will
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370improvement as far as the abilit
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372was there. Your visits probably
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374the purchase of Avitnesses—I s
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:376administrations to publicly say
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378Chairman Pepper. We will take a
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380Mr. Ingersoll. No. I don't recal
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:382can fulfill the vow made by the
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384have to give you the same answer
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386Mr. Brasco. But that is another
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388Mr. Ingeksoll. Well, that is the
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-39,3,Dr. Edwards held a surgical f
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395of Narcotics and Dangerous Drugs
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397Naloxone, recently approved for
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399for example, who might be abusin
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401Now, because of our attention ha
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403and this is only for the investi
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405effects this drug will produce i
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407Now, if it is not used intravene
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409Mr. Wiggins. Dr. Jennings, does
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411Penicillin is good for pneumonia
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413Mr. R ANGEL. But from the studie
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415Dr. Gardner. Again, we don't hav
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417Dr. Edwards. I suspect it at lea
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419On the other hand, if serious si
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421of the best known programs. Alth
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423Medical Association, American Ps
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425of the United States Pharmacopei
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4275. Repeated examinations. Physic
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429agement and rehabilitation of se
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—431As the agenc.v within HEW whi
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433and complex acts such as driving
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435(Inig induces physical and psych
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437Chiiirmtin Pepper. Doctor, I thi
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439A large proportion of youngsters
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441Dr. Brown, what would you say is
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443Chairmiui Pepper. Wliat is tlie
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446The state of the art is promisin
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447Lot nie ask you first, is tlic d
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449Chairman Pepper. Do you happen t
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451want you to take a look at. We w
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453In addition to that, there seems
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455the Mfldict is having a program
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457—on drugs? By that I mean, vei
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459\\ e are basically saying, in or
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—;461that this is the extent to w
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463We could go into the drug area a
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.465program that was i)ut into Jack
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467Mr. Brasco. Possibly. However, w
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469him, arrange to get somebody els
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471ainpheta.mines, or barbiturates.
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473In the meantime, the Institute d
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475treated in the community centers
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477research on narcotics in the sam
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479c 53 03E
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483spending for research through NI
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485There has been no concerted seri
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487it is left in one of their veins
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489I do not think I should explain
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491Dr. ViLLARREAL. Until the reflex
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493evidence strongly shows is that
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495Chairman Pepper. One other quest
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497Dr. ViLLARREAL. So, it is a biol
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'.499could result in a laboratory s
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5qifinds it in normal exploration.
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503synthesized a large number of na
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505STATEMENT OE DR. ALBERT KURLAND,
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507discovered if we iiad taken the
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509Mr. Perito. Dr. Kurland, do you
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511Chairman Pepper. Has the Food an
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513]Mr. Steiger. Do you feel from y
Page 535 and 536:
515In this second study there was a
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517were any significant differences
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519The Deceptive Communication and
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.522than a State psychiatric hospit
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524Department of Mental Hygiene), R
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TABLE 3—COMPARISON OF THE 1ST POS
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528TABLE 10—RELATIONSHIP OF AGE T
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530tution and his involvement in th
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Attachment No. 5;r\ N-CH,-CH=CHo ,
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'-534Chart No. U (case No. 672)Disp
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536Chart No. 4 (case No. 694)Illust
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538Chart No. 35 {case No. 697)Excep
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540This amount of heroin is roughly
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5msuccessful or not in that short a
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544Chairman Pepper. Would you repea
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54^creased amount of licit as well
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—54Sand the bureaucracy and the a
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,,Mr.550you have used some of the s
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552so many areas is also a pitiful
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55,4nitiide of heroin addiction in
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556reached $976.5 billion, we can w
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558Mr. Jones was appointed to the c
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560cant when you consider that Out
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562criminal act in his lifetime. Ye
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—564Mr. Perito. Would it be fair
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566Now, Dr. Cliambers, can yon resp
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—568Mr. Raxgel. Our distinguished
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;-570Mr. Jones. That is correct. Ou
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572the commissioner, $186 million i
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574there should be something in the
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576and the way in which the funds a
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57SDr. Chambers. I think wliat you
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580Education is the best way of pre
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58-2Certain essential facts must re
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584done through determined action,
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586druffs, has the Nation's largest
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:588To repeat, methadone maintenanc
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:590I believe the Federal Governmen
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:take no such satisfaction. We have
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594of value in the testimony you ha
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596gone ahead with several. We have
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598force within our State Police De
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60PRased on the proposed goal of 2.
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602STATEMENT OF HON. MILTON SIIAPP,
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(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 664 and 665: 644narcotic antagonist, and the oth
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 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
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