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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658support some of the inethadone proo-rams and some other proirramsto a ratlier modest degree throncrh a matcliin*;- plan in wliicli tlie Statepays for 90 percent of mental liealth care. I am sorry, I don't knowhow much is beino; s]>ent. T would certainly guess that the total sumis far, far less than that being s]>ent by the State of Xew York.Chairman Pepper. Do you regard the treatment and rehal)ilitationprograms for narcotics in California today as adequate to theneeds ?Dr. Kramer. Absolutely not. 1 do not know of any place in theTTnited States, Avhether city or State, with maybe one or tAvo rareexceptions — possibly the State of Oregon—in which there is anywherenear adequate treatment for narcotics addiction.Chairman Pepper. You ha\e coveied ]xirt of the question I wantedto ask in your comment to ISir. Wiggins. But I would like to haveyou state again, what kind of treatment and reliabilitation facilitiesdo you regard as the most desirable? And how widely should theybe spread ?Dr. Kramer. Tlie most desirable in terms of cost etf'ecti\eness?Chairman Pepper. Yes; in terms of eifectiveness in dealing withthe problems.Dr. KiLVMER. In terms of eifectiveness in dealing with the problems.Mr. WiNX. Excuse me, Mr. Chairman, could we have both, effecti^'enessand cost effectiveness ?Chairman Pepper. Yes ; give us both.Dr. Kp^vmer. I think both can be still put under the same rubiic,which at this time, is methadone maintenance.Chairman Pepper. Should that be administered by a clinic or somesort of institution or should the methadone bo prescribed by physiciansor both ?Dr. Krais[er. At this momeiit in time, I think individual }

659if properly operated iiiider ])roper supervision of public iuithorities.Would you agree ?Dr. Kramer. Yes, sir; I would indeed. We have one such programin California. There are several similiar programs in other Stateswhich are privately run, I believe generally on a noni:)rotit basis, thoughI believe there may be one or two which are even prolitmaking institutions,supported by outside contributions and the patient's fee ; yes, sir.Chairman Pepper. Now, Dr. Smith also stated, as I recall it, thatthese facilities should be a\ailable in almost every community wherethere was a narcotics problem. When one of the Governors testified herethis morning, I believe Governor Carter of Georgia, he said addictsdid not Avant to go across town where they had to get in a bus or a taxi,you get more im'olved where they are more or less connnunity facilities.Do vou agree ?Dr. Kramer. I certaijily agree. Some of our patients have to travelthree-quarters of an hour each way to come to our ju-ogram. Whenthey must come very, very frequently, it is certainly an imposition ontheir time, particularly the ones who linally do get a job.Chairman Pepper. Xow, just two more questions. One is, what canAve do to get most of the addicts into the treatment program? Dr.Jaft'e told me j^ersonally that we would get al)0ut 50 percent, maybe,of the addicts into a voluntary program. Would you agree? Has thatbeen your experience? ITow can we get a larger number of addicts intoan effective program ?Dr. Kramer. At this moment in time, I think that were I to guessabout what proportion of all long-term addicts, again over a year ortwo, would come, for example, into methadone or other programs, I donot care which, the overwhelming majority Avould go into methadoneprograms. One thing we do not kno^^•, we do not know A^hat AA'Ouldhappen Avhen Ave finally get those 50 percent into treatment.What I find, for example, is that a man aa'Iio has been uiiAvilling tocome into a treatment program sees seA'eral of his friends in a treatment])rogram. He has denigrated tlie vnhm of the program. He sees hisfriends Avho are noAv not going to jail, aaIio are leading decent liA^es.He then comes and asks for help. I suspect that Ave might findthat larger and larger numbers of addicts Avill present themselves ifAve proA^ide effective programs.One situation may shed some light on this. Because of the supportof the Governor of Oregon, extensiA^e methadone facilities Avere madeavailable in that State. It Avas estimated that Oregon had l)etAA-een250 and 300 addicts. They noAv have roughly oOO patients on methadone.I am not saying that they have all the addicts in the State, butI think this might be a testing grouiid, a community in Avhich thereare a relatively limited number of addicts which might lie a microcosmfor all other programs. We iniglit be able to learn something frompeople in Oregon as to hoAv completely people are Avilling to comeinto a program Avhen the doors are open and anybody avIio needs itand is appro])riate for this can get treatment.have not been able to take care of the addicts that AveSo far, AvehaA^e.Chairman Pepper. Would you recoimnend any kind of hiAv thatwould refjuire anyone involuntarily to be brought into treatment in aprogram if he Avere found to be a heroin addict?

658support some of the inethadone proo-rams <strong>and</strong> some other proirramsto a ratlier modest degree throncrh a matcliin*;- plan in wliicli tlie Statepays for 90 percent of mental liealth care. I am sorry, I don't knowhow much is beino; s]>ent. T would certainly guess that the total sumis far, far less than that being s]>ent by the State of Xew York.Chairman Pepper. Do you regard the <strong>treatment</strong> <strong>and</strong> rehal)ilitationprograms for narcotics in California today as adequate to theneeds ?Dr. Kramer. Absolutely not. 1 do not know of any place in theTTnited States, Avhether city or State, with maybe one or tAvo rareexceptions — possibly the State of Oregon—in which there is anywherenear adequate <strong>treatment</strong> for narcotics addiction.Chairman Pepper. You ha\e coveied ]xirt of the question I wantedto ask in your comment to ISir. Wiggins. But I would like to haveyou state again, what kind of <strong>treatment</strong> <strong>and</strong> reliabilitation facilitiesdo you regard as the most desirable? And how widely should theybe spread ?Dr. Kramer. Tlie most desirable in terms of cost etf'ecti\eness?Chairman Pepper. Yes; in terms of eifectiveness in dealing withthe problems.Dr. KiLVMER. In terms of eifectiveness in dealing with the problems.Mr. WiNX. Excuse me, Mr. Chairman, could we have both, effecti^'eness<strong>and</strong> cost effectiveness ?Chairman Pepper. Yes ; give us both.Dr. Kp^vmer. I think both can be still put under the same rubiic,which at this time, is methadone maintenance.Chairman Pepper. Should that be administered by a clinic or somesort of institution or should the methadone bo prescribed by physiciansor both ?Dr. Krais[er. At this momeiit in time, I think individual }

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