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

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:::22recogrnize vre professional people are reluctant to change from a habitor course that we have been foUowinir. But would it te desirable to putin perspective the necessity of balancin
:::::.—23American Society of Pharmacology and Experimental Therapeutics, 1930-Council, 1937; membership committee, 1942, 1943, 1944 (chairman);president, 1946, 1947; nominating committee, 1949, 1950American Physiological Society, 1933-(chairman)Federation of American Societies of Experimental Biology ExecutiveCommittee, 1946, 1947 (chairman), 1948Society for Experimental Biology and Medicine Council,American Medical Association1950-1953Vice-chairman, Section of Experimental Medicine and Therapeutics1951-1052Chairman, 1952-1953Member, Council on Drugs (formerly Council on Pharmacy and Chemistry)1952-1962* Member—Committee on Alcoholism and Drug Dei>endence—Council onMental Health, 1964-Chairman—Committee on Research on Tobacco and Health AMA-ERF1964-Honorary membershipsAmerican Society of Anesthesiology.Japanese Pharmacological Society.Committees and consultantshipsMember—Board of Scientific Counselors, National Heart Institute, NationalInstitutes of Health, 1957-1960.Member—Drug Abuse Panel, President's Advisory Committee—WhiteHouse Conference on Narcotic and Drug Abuse, 1962-1963.Member—Surgeon General's Committee on Smoking and Health, Departmentof Health, Education, and Welfare, 1962-1963.Chairman—Committee on Behavioral Pharmacology—PsychopharmacologyService Center-National Institutes of Health, 1964-1968.American coordinator—U.S. Japan Cooperative Program on Drug AbuseNational Science Foundation and Japan Society Promotion of Science,since 1964.Member—President's Commission on Marihuana and Drug Abuse, 1971-72(established by Public Law 91-513)EditorialBoard of publication trustees, American Society for Pharmacology and ExperimentalTherapeutics, 1948, chairman, 1949-1961.Editorial board. Physiological Reviews, 1943-1951.Editorial board. Proceedings Society for Experimental Biology and Medicine,1944-1959.Editorial committee. Annual Review of Pharmacology, 1959-1962.InternationalWHO (United Nations) Expert Advisory Panel on Drugs Liable to ProduceAddiction, 1951-Second Medical Mission to Japan, May-June, 1951 Unitarian Service Committeeand Department of the Army.U.S. National Committee for International Union of Physiological Science,Chairman American team—Conference on Physiologic and PharmacologicBasis of Anesthesiology—Japan, April-May 1956.Consultant—Minister of Public Health of Thailand—Bangkok, May 2-17,1959Consultant, Minister of Health and Welfare of Japan, Tokyo, 1963-.AwardsThird Class of the Order of the Rising Sun 6f Japan, 1963.Distinguished Service Award Washburn University Alumni Association,1964. ^^ .„„_Second Class—Order of the Sacred Treasure of Japan, 1967.^Henrv Russell Lecturer—The University of Michigan, 196 (.J Y. Dent Memorial Lecturer—Kings College-University of London, 1968.Certificate of Commendation from Minister of State Director-Geneial,Prime Ministers Office, Japanese Government, October 1969.•Current appointments.
Page 5: NARCOTICS RESEARCH, REHABILITATION,
Page 9 and 10: ::VEXHIBIT NO. 4 (a) AND (b)Eddy, D
Page 13: NARCOTICS RESEARCH, REHABILITATION,
Page 17 and 18: urden that such addiction imposes u
Page 19 and 20: 1 (lata; (->) the sliariiis" oF iii
Page 21 and 22: 9Chairman Pepper. The committee is
Page 23 and 24: ::11quota production from unrecogni
Page 25 and 26: 13in this country. This raises the
Page 27 and 28: 15from other clinical projects of w
Page 29 and 30: :17practice, experience has indicat
Page 31 and 32: ;19.I think a quota would be better
Page 33: 21When methadone was first introduc
Page 37: _'—25.I'BOCUREMENT AND ISSUE DATA
Page 40 and 41: '.28Fiscal years-1967 1968 1969 197
Page 42 and 43: 30rally in opium. By indirect, the
Page 44 and 45: 32We can, I think, most helpfully g
Page 46 and 47: 34so intense that we haven't done v
Page 48 and 49: Dr. Eddy. Well, physicians, usually
Page 50 and 51: 38Dr. Eddy. No.Chairman Pepper. Now
Page 52 and 53: :40get away with it as Dr. Keats su
Page 54 and 55: :—:42public health hazard was jud
Page 56 and 57: :44Bibliography(1 Nathan B. Eddy. "
Page 58 and 59: 46(52) Nathan B. Eddy. "Dilaudid."
Page 60 and 61: 48(98) "The New Narcotics, Post-gra
Page 62 and 63: ^.50
Page 64 and 65: 52entails the consideration of addi
Page 66 and 67: 54Chairman Pepper. Have you found t
Page 68 and 69: 56^.I wonder would you care to comm
Page 70 and 71: 58Chairman Pepper. Without objectio
Page 72 and 73: —1958-681959-«419691962-64196219
Page 74 and 75: —62abuse and has brought about th
Page 76 and 77: 64bank robbery or an assault. You d
Page 78 and 79: 66Mr. Wiggins. Would the stopping o
Page 80 and 81: 68—Chairman Pepper. Can you give
Page 82 and 83: :70The problem then would be the wi
Page 84 and 85:
;72taking exceptional measures in t
Page 86 and 87:
)—74pay serious attention to this
Page 88 and 89:
;76From 1958 to 1961, he served as
Page 90 and 91:
78deine in painkilling drugs. So if
Page 92 and 93:
;80ning capabilities, responsibilit
Page 94 and 95:
;:;82terials. If they could introdu
Page 96 and 97:
84Figure 1infrared Ektachrome film
Page 98 and 99:
;86Figure 3.—Tones of wheat (W) a
Page 100 and 101:
88ers at the poppyfields or at any
Page 102 and 103:
:90;:tional situations has handicap
Page 104 and 105:
;;92Locating illicit opium cropsDet
Page 106 and 107:
94Jaffe. Well, there would be some
Page 108 and 109:
96Mr. Jaffe. Primarily on the fact
Page 110 and 111:
98in the same ball park about what
Page 112 and 113:
100Chairman Pepper. Mr, Waldie, do
Page 114 and 115:
::102agencies and input data would
Page 116 and 117:
104most facilities are barely able
Page 118 and 119:
;106We have also studied a ^roup of
Page 120 and 121:
108Dr. Gearing. Yes, sir; I would n
Page 122 and 123:
110somethino: in the nei
Page 124 and 125:
112program is put into the machiner
Page 126 and 127:
I114you have some data there that s
Page 128 and 129:
116Dr. Gearing. It depends on what
Page 130 and 131:
118Chairman Pepper. Would you have
Page 132 and 133:
120it not be so that we could proje
Page 134 and 135:
.122admission rate was approximatel
Page 136 and 137:
124BESULTS(1) Although many of the
Page 138 and 139:
1262. All the members of the methad
Page 140 and 141:
128HETHADOHE MAINTENANCE TREATMENT
Page 142 and 143:
11 1 1 1 1 11130Methadone Halnten?n
Page 144 and 145:
132TABLE 2.-METHAD0NE MAINTENANCE T
Page 146 and 147:
134Figure 9 Methadone tlaintenance
Page 148 and 149:
136Methadone Ka'ntanance Treatmf:nt
Page 150 and 151:
:::.::.138Appendix A^—Methadone M
Page 152 and 153:
140nance treatment patients showing
Page 154 and 155:
142Figure 3 •lethadone Kaintenanc
Page 156 and 157:
144Dr. DuPoNT. 1,760 on methadone m
Page 158 and 159:
:146there are dramatic reductions i
Page 160 and 161:
148Health insurance coverage for me
Page 162 and 163:
150Dr. DtjPont. Well, there are no
Page 164 and 165:
152Mr. Blommer. You would agree the
Page 166 and 167:
154done. Where is the evidence ? No
Page 168 and 169:
156There are several reasons a pers
Page 170 and 171:
158It would seem to me a very busy
Page 172 and 173:
160we had before. I don't think it
Page 174 and 175:
162heroin addiction and support all
Page 176 and 177:
164Dr. DuPoNT. I am reluctant to ge
Page 178 and 179:
166Using this figure as rule of thu
Page 180 and 181:
)168ment facilities for heroin addi
Page 182 and 183:
.170parole departments. None were c
Page 184 and 185:
::172Table 2.— Selected character
Page 186 and 187:
174TABLE 3.—HEROIN ADDICTION RATE
Page 188 and 189:
176W.a^^cc-V.c Cffv..AdF-ro ftcoKjL
Page 190 and 191:
178.^06V f\QrK-'SEt G^ouP/AJ6SIS're
Page 192 and 193:
I180*i coo)u->CM>—'CMUJCOO O COa>
Page 194 and 195:
I(/I182esiMmin0)^> oo.00 =E|c O.2 o
Page 196 and 197:
184encouraged to return to methadon
Page 198 and 199:
186or other side effects. This incr
Page 200 and 201:
:188number as that on the bottle. W
Page 202 and 203:
190Attachment ThreeTo all medical s
Page 204 and 205:
-jI IALLI192ATTACHMENT- FIVE,J: IPA
Page 206 and 207:
194ATTACHMENT NINEGOVERNMENT OF THE
Page 208 and 209:
......—196half of the addicts sta
Page 210 and 211:
198CONCLUSIONSCertain patterns emer
Page 212 and 213:
200TABLE 5.— PROFILE OF BARBITUAR
Page 214 and 215:
202TABLE ll.-SUPPORT OF HEROIN HABI
Page 216 and 217:
204TABLE 17.-AGE OF ADDICTS AND NON
Page 218 and 219:
206TABLE 23.—PRESENT MARITAL STAT
Page 220 and 221:
208TABLE 28.-MILITARY SERVICEAddict
Page 222 and 223:
:210The committee is pleased to cal
Page 224 and 225:
212sists of a network of 21 geograp
Page 226 and 227:
214(6) Basic studies on the nature
Page 228 and 229:
216in fact, constitute autonomous o
Page 230 and 231:
Chairman Pepper. Mr. Perito?218;; M
Page 232 and 233:
^'220is not a very forgiving drug.
Page 234 and 235:
'222Furthermore, in our present con
Page 236 and 237:
—224the Federal Government decide
Page 238 and 239:
-—I have presented one generic ki
Page 240 and 241:
,clinic;?,>•
Page 242 and 243:
230I realize we are running late.Do
Page 244 and 245:
''232'']Vir. Winn. Tiien you mentio
Page 246 and 247:
234So having put it in the area, ha
Page 248 and 249:
,Memberships'—i236privilege of co
Page 250 and 251:
;238A central hypothermic response
Page 252 and 253:
;240South Bronx, Bedford-Stuyvesant
Page 254 and 255:
242€are of patient addicts. We ha
Page 256 and 257:
244hospitals in the city, came into
Page 258 and 259:
246that came into my office, and I
Page 260 and 261:
'Mr.;>•/nmo'.i,,;248deputy commis
Page 262 and 263:
:250two Rockefeller Institute physi
Page 264 and 265:
:252during pliase II that serious e
Page 266 and 267:
254well-structured methadone mainte
Page 268 and 269:
;:256nonsense and serves only to ad
Page 270 and 271:
:258you best complete your statemen
Page 272 and 273:
260Mr. Pertto. Based upon your expe
Page 274 and 275:
262A a'reat case in point was a con
Page 276 and 277:
«264Mr. Steiger. Did you discuss w
Page 278 and 279:
—:266Mr. HoRAN. We don't support
Page 280 and 281:
268Mr. Horan, let's back up a littl
Page 282 and 283:
270It is not up to heroin or morphi
Page 284 and 285:
272nesses yesterday who brought out
Page 286 and 287:
274;Mr. Perito. It is my understand
Page 288 and 289:
276So that at the end of the week t
Page 290 and 291:
278steroid he lias in him we might
Page 292 and 293:
280Mr. Perito. You are referriii"'
Page 294 and 295:
282not drug free. I can say approxi
Page 296 and 297:
28 A$2-a-day habit these individual
Page 298 and 299:
•As286I got to the point once in
Page 300 and 301:
288Mr. Steiger. You mentioned anoxi
Page 302 and 303:
290Mr. Eangel. I could see then tha
Page 304 and 305:
292Dr. Casriel. Mr. Keating, I have
Page 306 and 307:
j294What period of time are ^ve tal
Page 308 and 309:
296was March of 1970—he was admit
Page 310 and 311:
298"The paper by Dole and Nyswander
Page 312 and 313:
:300vent them from coming to New Yo
Page 314 and 315:
302[Exhibit No.14(b)]Casriel Instit
Page 316 and 317:
304to result from the insuflScient
Page 318 and 319:
306It is this role of the intervent
Page 320 and 321:
308EESULTSStudies concerning tlie p
Page 322 and 323:
310The method derives from a specia
Page 324 and 325:
312Why is this happening? What need
Page 326 and 327:
m)effective with uncured alcoholics
Page 328 and 329:
I316Casriel, who is medical-psychia
Page 330 and 331:
318resort to heroin. One must not f
Page 332 and 333:
.320in Permanent Cure of Narcotic A
Page 334 and 335:
322!(4) '-Modification of Adaptatio
Page 336 and 337:
324sections of the country, all sor
Page 338 and 339:
;Mr.Pertto.niuch,I?,Mr. Peritq. Tha
Page 340 and 341:
328Chairman Pepper. Mr. Steiger.Mr.
Page 342 and 343:
, Mr., In''wMr, WiNx.nltiiink tlie
Page 344 and 345:
:332"Stomach cramps" were found to
Page 346 and 347:
'i.We334'""^li'anTOanl^ETPPEiL That
Page 348 and 349:
:))))336would be deprived of any cl
Page 350 and 351:
338less abuse liability than agents
Page 353 and 354:
NARCOTICS RESEARCH, REHABILITATION,
Page 355 and 356:
CONTENTSApril 26 1April 27 77April
Page 357 and 358:
:•vEXHIBIT NO. 4 (a) AND (b)Eddy,
Page 359:
:lovernor,vnEXHIBIT NO. 21 (a) and
Page 362 and 363:
342have no desire to preempt the au
Page 364 and 365:
344We hope these hearings will prov
Page 366 and 367:
346tons in 1962 and to 155 tons in
Page 368 and 369:
348SOUTHEAST ASIAAs you know also,
Page 370 and 371:
350I would also point out as I did
Page 372 and 373:
352their farmers who have been grow
Page 374 and 375:
354told that much of the insurgency
Page 376 and 377:
356Mr. IxGERSOLL. Well, again, Mr.
Page 378 and 379:
358jority of the heroin problem in
Page 380 and 381:
360years, but I have been frustrate
Page 382 and 383:
362Mr, Steiger. If you were goin^ t
Page 384 and 385:
364report marihuana among junior gr
Page 386 and 387:
366And it seems to me tliat we Avou
Page 388 and 389:
?368effectively, then maybe we will
Page 390 and 391:
370improvement as far as the abilit
Page 392 and 393:
372was there. Your visits probably
Page 394 and 395:
374the purchase of Avitnesses—I s
Page 396 and 397:
:376administrations to publicly say
Page 398 and 399:
378Chairman Pepper. We will take a
Page 400 and 401:
380Mr. Ingersoll. No. I don't recal
Page 402 and 403:
:382can fulfill the vow made by the
Page 404 and 405:
384have to give you the same answer
Page 406 and 407:
386Mr. Brasco. But that is another
Page 408 and 409:
388Mr. Ingeksoll. Well, that is the
Page 411 and 412:
Page 413 and 414:
-39,3,Dr. Edwards held a surgical f
Page 415 and 416:
395of Narcotics and Dangerous Drugs
Page 417 and 418:
397Naloxone, recently approved for
Page 419 and 420:
399for example, who might be abusin
Page 421 and 422:
401Now, because of our attention ha
Page 423 and 424:
403and this is only for the investi
Page 425 and 426:
405effects this drug will produce i
Page 427 and 428:
407Now, if it is not used intravene
Page 429 and 430:
409Mr. Wiggins. Dr. Jennings, does
Page 431 and 432:
411Penicillin is good for pneumonia
Page 433 and 434:
413Mr. R ANGEL. But from the studie
Page 435 and 436:
415Dr. Gardner. Again, we don't hav
Page 437 and 438:
417Dr. Edwards. I suspect it at lea
Page 439 and 440:
419On the other hand, if serious si
Page 441 and 442:
421of the best known programs. Alth
Page 443 and 444:
423Medical Association, American Ps
Page 445 and 446:
425of the United States Pharmacopei
Page 447 and 448:
4275. Repeated examinations. Physic
Page 449 and 450:
429agement and rehabilitation of se
Page 451 and 452:
—431As the agenc.v within HEW whi
Page 453 and 454:
433and complex acts such as driving
Page 455 and 456:
435(Inig induces physical and psych
Page 457 and 458:
437Chiiirmtin Pepper. Doctor, I thi
Page 459 and 460:
439A large proportion of youngsters
Page 461 and 462:
441Dr. Brown, what would you say is
Page 463 and 464:
443Chairmiui Pepper. Wliat is tlie
Page 465 and 466:
446The state of the art is promisin
Page 467 and 468:
447Lot nie ask you first, is tlic d
Page 469 and 470:
449Chairman Pepper. Do you happen t
Page 471 and 472:
451want you to take a look at. We w
Page 473 and 474:
453In addition to that, there seems
Page 475 and 476:
455the Mfldict is having a program
Page 477 and 478:
457—on drugs? By that I mean, vei
Page 479 and 480:
459\\ e are basically saying, in or
Page 481 and 482:
—;461that this is the extent to w
Page 483 and 484:
463We could go into the drug area a
Page 485 and 486:
.465program that was i)ut into Jack
Page 487 and 488:
467Mr. Brasco. Possibly. However, w
Page 489 and 490:
469him, arrange to get somebody els
Page 491 and 492:
471ainpheta.mines, or barbiturates.
Page 493 and 494:
473In the meantime, the Institute d
Page 495 and 496:
475treated in the community centers
Page 497 and 498:
477research on narcotics in the sam
Page 499 and 500:
479c 53 03E
Page 501 and 502:
Page 503 and 504:
483spending for research through NI
Page 505 and 506:
485There has been no concerted seri
Page 507 and 508:
487it is left in one of their veins
Page 509 and 510:
489I do not think I should explain
Page 511 and 512:
491Dr. ViLLARREAL. Until the reflex
Page 513 and 514:
493evidence strongly shows is that
Page 515 and 516:
495Chairman Pepper. One other quest
Page 517 and 518:
497Dr. ViLLARREAL. So, it is a biol
Page 519 and 520:
'.499could result in a laboratory s
Page 521 and 522:
5qifinds it in normal exploration.
Page 523 and 524:
503synthesized a large number of na
Page 525 and 526:
505STATEMENT OE DR. ALBERT KURLAND,
Page 527 and 528:
507discovered if we iiad taken the
Page 529 and 530:
509Mr. Perito. Dr. Kurland, do you
Page 531 and 532:
511Chairman Pepper. Has the Food an
Page 533 and 534:
513]Mr. Steiger. Do you feel from y
Page 535 and 536:
515In this second study there was a
Page 537 and 538:
517were any significant differences
Page 539:
519The Deceptive Communication and
Page 542 and 543:
.522than a State psychiatric hospit
Page 544 and 545:
524Department of Mental Hygiene), R
Page 546 and 547:
TABLE 3—COMPARISON OF THE 1ST POS
Page 548 and 549:
528TABLE 10—RELATIONSHIP OF AGE T
Page 550 and 551:
530tution and his involvement in th
Page 552 and 553:
Attachment No. 5;r\ N-CH,-CH=CHo ,
Page 554 and 555:
'-534Chart No. U (case No. 672)Disp
Page 556 and 557:
536Chart No. 4 (case No. 694)Illust
Page 558 and 559:
538Chart No. 35 {case No. 697)Excep
Page 560 and 561:
540This amount of heroin is roughly
Page 562 and 563:
5msuccessful or not in that short a
Page 564 and 565:
544Chairman Pepper. Would you repea
Page 566 and 567:
54^creased amount of licit as well
Page 568 and 569:
—54Sand the bureaucracy and the a
Page 570 and 571:
,,Mr.550you have used some of the s
Page 572 and 573:
552so many areas is also a pitiful
Page 574 and 575:
55,4nitiide of heroin addiction in
Page 576 and 577:
556reached $976.5 billion, we can w
Page 578 and 579:
558Mr. Jones was appointed to the c
Page 580 and 581:
560cant when you consider that Out
Page 582 and 583:
562criminal act in his lifetime. Ye
Page 584 and 585:
—564Mr. Perito. Would it be fair
Page 586 and 587:
566Now, Dr. Cliambers, can yon resp
Page 588 and 589:
—568Mr. Raxgel. Our distinguished
Page 590 and 591:
;-570Mr. Jones. That is correct. Ou
Page 592 and 593:
572the commissioner, $186 million i
Page 594 and 595:
574there should be something in the
Page 596 and 597:
576and the way in which the funds a
Page 598 and 599:
57SDr. Chambers. I think wliat you
Page 600 and 601:
580Education is the best way of pre
Page 602 and 603:
58-2Certain essential facts must re
Page 604 and 605:
584done through determined action,
Page 606 and 607:
586druffs, has the Nation's largest
Page 608 and 609:
:588To repeat, methadone maintenanc
Page 610 and 611:
:590I believe the Federal Governmen
Page 612 and 613:
:take no such satisfaction. We have
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 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 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:
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