METHADONE USE AND ABUSE-1973

FEBRUARY 13, 1973

U.S. SENATE,

SUBCOMMITTEE TO INVESTIGATE JUVENILE DELINQUENCY, COMMITTEE ON THE JUDICIARY, Louisville, Ky.

The subcommittee (composed of Senators Bayh, Hart, Kennedy, Burdick, Cook, Hruska, Fong and Mathias), met, pursuant to notice at 9 a.m., in the courtroom No. 2, United States Federal Courthouse, second floor, sixth and Broadway, Louisville, Jefferson County, Ky., the Honorable Birch Bayh, chairman, presiding.

Present: Senator Birch Bayh and Senator Marlow W. Cook.

Also present: Mathea Falco, Staff Director and Chief Counsel; John M. Rector, Deputy Chief Counsel; Billy M. Wise, Professional Staff Member; B. Elizabeth Marten, personal secretary to the staff director and chief counsel; Betty A. Webb, Minority Clerk; and Ronald Meredith, Esq., Legislative Assistant to Senator Marlow W. Cook.

Mr. BAYH. We will convene our hearing, if you please. A special word of gratitude to Judge Gordon and the members of his staff, and other officials here in this court for making it possible to enjoy their hospitality this morning.

Senator Cook and I both appreciate all of you being here. Perhaps it is disillusioning, but perhaps it is best to start on one housekeeping note.

I understand that there has been a recent department expenditure of several thousand dollars to provide a new rug for the courtroom, and I would hate for activities of the legislative branch to, in any way, damage the fine carpet that has been provided for the judicial branch.

I was asked if I had any objection to people smoking, and I don't. If you want to smoke, fine, but I understand there are some ashtrays on the aisles, and if we could make certain we use them, so that the carpets aren't damaged, I would appreciate that.

Now, Senator Cook and I are here wearing official hats as the chairman and ranking member of the Senate Juvenile Delinquency Subcommittee. This committee has heard countless witnesses tell of the drug addition involving young people, which is a problem more important than any other. I am glad to have the opportunity to be in Kentucky, because it is the home State of Senator Cook, who has cooperated in every way with the committee on a number of our endeavors, to try to deal with the problems of young people, whether it is to try to control amphetamines, barbiturates, or as we are here

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this morning, to learn a way with which we can more effectively deal with the problem of methadone diversion and abuse.

I have prepared a brief statement I would like to have the reporter put in the record; for the sake of time, I will not read it. [Senator Bayh's prepared statement is as follows:]

PREPARED STATEMENT OF SENATOR BIRCH BAYH

Drug abuse, especially among our young people, has reached crisis propor tions in this country. As Chairman of the Senate Subcommittee to Investigate Juvenile Delinquency, I have heard countless witnesses tell of the grave peril we face as a nation from the rapid spread of heroin addiction and the abuse of non-opiate drugs, such as amphetamines, barbiturates, and tranquilizers. The facts are alarming: A national survey conducted in 1971 found that six percent of the nation's high school age youth have used heroin at least once. This means that 1.5 million young Americans between the ages of 12 and 18 have tried heroin. We must find ways to help those already involved in the tragic cycle of drug dependency and addiction and to prevent even greater numbers of our young people from establishing destructive patterns of drug abuse.

We are all too familiar with the devastating effects of heroin on the individ ual addict, his family, and society as a whole. We know that heroin has destructive physiological consequences, debilitating the health of the user and impairing his ability to lead a normal, productive life. The social consequences are equally devastating. In order to support his habit, the addict is driven to engage in criminal activities which threaten the safety and well-being of all our citizens. The costs in human and economic terms are enormous.

Billions of dollars are expended each year to protect our citizens from drug related crime.

Billions of dollars of merchandise are stolen each year.

Many innocent people have been killed and physically assaulted.

Hundreds of thousands of otherwise productive lives have been lost to the destructive, endless cycle of heroin addiction.

As we have learned from bitter experience, there are no simple solutions to the epidemic of narcotic addiction. There are no panaceas—no magic wands! But there are a number of treatment modalities that have been developed during recent years which have had some degree of success in rehabilitating certain addicts. Therapeutic communities which provide intensive therapy, counseling, and peer group interaction have helped some addicts free them selves from heroin addiction. Other programs include the use of the drug methadone as part of the treatment approach, both for detoxification and for maintenance.

Methadone is a narcotic similar to heroin and morphine. Although it is dangerously addictive, methadone has been used successfully to detoxify or maintain heroin addicts. In maintenance programs methadone addiction is substi tuted for heroin addiction. But the methadone acts to suppress the craving for heroin. The chronic addict can be stabilized and permitted to concentrate on rehabilitative efforts. For some addicts methadone can lead to a productive life in the community.

It is important to emphasize that methadone alone is not a "cure" for heroin addiction. Any effort to use the drug itself as a simple, inexpensive, large-scale answer to heroin addiction is ill-conceived and will lead to "turnstyle or breadline" treatment. Pressure for hastily developed, large-scale, under financed, under staffed programs must be resisted. The emphasis would be on the quality of services not merely the number of persons processed.

However successful methadone maintenance has been in treating certain addicts, we must not use methadone to "smoke-screen" the effects of drug addiction on our society and the social conditions that spawn drug addiction. Methadone maintenance should not provide a "fix" for a complex social, political, medical and psychological problem. Reduction of the incidence of criminal activity associated with heroin addiction is a high priority but it should not be our sole priority. If there is no hope but dope, an addict on methadone will turn to other so-called "chemical solutions," most often barbiturates and alcohol. The programs should assist addicts in working towards freedom from

Therefore, I am pleased to be able to join with Senator Bayh today, to conduct a Hearing on Senate bill 778, a bill which recently was introduced in the Senate. This bill, called the Narcotic Addict Treatment of 1973, will simultaneously secure the legal basis for present and new treatment programs while serving to eliminate diversions of narcotic drugs into street traffic.

The principal concern of this legislation is the use of the drug, methadone, a controversial drug which can be abused like heroin, or employed by medical experts in such a way as to help the addict back into society.

In the last several years, the use of methadone for narcotic addicts. had rapidly expanded. For example, in 1968, there were fewer than 400 patients enrolled in methadone treatment in programs nationwide. Today there are over 60,000.

It is true that many sincere and innovative programs have been established across the country, and thousands of patients are receiving new and valuable help; but because of the absence of a sound law qualifying and regulating these programs, some unscrupulous people have taken advantage of this situation to sell the drug in an indiscriminate manner for profit.

Many people fail to understand that a drug such as methadone, which can be valuable when used properly, can do the same damage as heroin when abused in the street. The tragic results of these lack of controls are now piling up in the death statistics of major cities across the Nation.

In 1971, methadone accounted for 14 percent of all of the narcotic deaths in the District of Columbia, in Washington. Last year, the figure rose to almost 40 percent, of all deaths, on drugs. A similar dramatic increase has occurred in New York City, and to a lesser extent in communities in Miami, Buffalo, Boston, and New Orleans. The legislation which we are considering today will provide for the regulation of all drug treatment programs, and for the fixing of standards to insure that they are operated for the best interests of the communities. Those who have no intention of providing sincere treatment, but are seeking merely to profiteer on sales of the drug, will be unable to meet these standards, and thus will be driven out of business. If they persist in their operations, they will be apprehended and convicted on the same basis as any other illegal drug trafficker.

This new authority is particularly needed at this time, in view of the fact that the use of methadone is now of accepted value and its utilization in treatment programs continue to rapidly expand and although there are some 60,000 addicts receiving treatment with the drug, the situation is nevertheless a novel one in our medical history for which the Bureau of Narcotics and Dangerous Drugs in the Department of Justice, lacks the necessary authority to protect the community from diversion.

It would indeed be a great shame if our recent success in curbing the availability of heroin from Southeast Asia and France were to be negated by leakage of narcotic drugs produced in our own country, and I hope that this bill would prevent it.

We have been traversing the country in search of a solution to this problem. One of the proposed solutions that is being used is Methadone. We are trying to pursue this intelligentlly.

Senator Cook, last year, in July, introduced a bill which became S. 3846. We re-introduced it again this year as the S. 778. This legislation is necessary in order to provide a more stringent control of the use of methadone.

Unfortunately, our society succumbs to the temptations to try to deal with very complicated and critical problems with simple solutions. I am hopeful that the use of methadone as a treatment for heroin wil not be in that category, because in my judgment, there can be no simple solution for the treatment of heroin. It's a very complicated sociological and psychological problem.

I think from what we have seen in Los Angeles, in San Francisco. and more recently in Omaha, and what is going to be heard here today and Indianapolis tomorrow, and later in Washington, methadone is a tool that can be used to treat heroin addiction, but let's not overlook the fact that it is a drug. Methadone maintenance is a habit. I would hope that we would not confine our efforts to use of this drug; that we would not be content to substitute one habit for another, even though the one habit might assist some communities to deal with problems such as increased crime.

I am hopeful that we can share the Kentucky experience, and later on tomorrow, the Indiana experience, and I am hopeful that we can find a way in which we can use methadone or a related methadone substance or drug to move from a heroin environment through the methadone phase, detoxification, and ultimately find the user in a drug free environment.

Now, this is going to take some ancillary services. It's not going to come just by taking methadone. I am familiar with the efforts of the CASA program in Indianapolis and I am anxious to see what is being done in Kentucky. I am familiar with the high degree of success where methadone is used in a comprehensive treatment program to move from heroin addiction to a drug free environment, so that the onetime heroin addict can live a normal life, be able to provide for himself and his family, stand on his feet, and be self reliant, and get this monkey off his back.

It's not going to be a simple task. We are here to ask you what you were doing in Kentucky, and Senator Cook and I appreciate your hospitality.

Senator Cook. I want to thank you. As you well know, we have two detoxification centers in the State; one here, and one in the Federal facilities in Lexington.

I have a short statement, and I will just go ahead and read it, because I think it expresses my feelings, and expresses my feelings relevant to S. 778, because one of the great problems which confronts us today is the epidemic of narcotic addiction which has gripped the Nation.

Any effort which will successfully combat this predicament must include both treatment for addicts and the apprehension of illicit drug traffickers.

Therefore, I am pleased to be able to join with Senator Bayh today, to conduct a Hearing on Senate bill 778, a bill which recently was introduced in the Senate. This bill, called the Narcotic Addict Treatment of 1973, will simultaneously secure the legal basis for present and new treatment programs while serving to eliminate diversions of narcotic drugs into street traffic.

The principal concern of this legislation is the use of the drug, methadone, a controversial drug which can be abused like heroin, or employed by medical experts in such a way as to help the addict back into society.

In the last several years, the use of methadone for narcotic addicts had rapidly expanded. For example, in 1968, there were fewer than 400 patients enrolled in methadone treatment in programs nationwide. Today there are over 60,000.

It is true that many sincere and innovative programs have been established across the country, and thousands of patients are receiving new and valuable help; but because of the absence of a sound law qualifying and regulating these programs, some unscrupulous people have taken advantage of this situation to sell the drug in an indiscriminate manner for profit.

Many people fail to understand that a drug such as methadone, which can be valuable when used properly, can do the same damage as heroin when abused in the street. The tragic results of these lack of controls are now piling up in the death statistics of major cities across the Nation.

In 1971, methadone accounted for 14 percent of all of the narcotic deaths in the District of Columbia, in Washington. Last year, the figure rose to almost 40 percent, of all deaths, on drugs. A similar dramatic increase has occurred in New York City, and to a lesser extent in communities in Miami, Buffalo, Boston, and New Orleans. The legislation which we are considering today will provide for the regulation of all drug treatment programs, and for the fixing of standards to insure that they are operated for the best interests of the communities. Those who have no intention of providing sincere treatment, but are seeking merely to profiteer on sales of the drug, will be unable to meet these standards, and thus will be driven out of business. If they persist in their operations, they will be apprehended and convicted on the same basis as any other illegal drug trafficker.

This new authority is particularly needed at this time, in view of the fact that the use of methadone is now of accepted value and its utilization in treatment programs continue to rapidly expand and although there are some 60,000 addicts receiving treatment with the drug, the situation is nevertheless a novel one in our medical history for which the Bureau of Narcotics and Dangerous Drugs in the Department of Justice, lacks the necessary authority to protect the community from diversion.

It would indeed be a great shame if our recent success in curbing the availability of heroin from Southeast Asia and France were to be negated by leakage of narcotic drugs produced in our own country, and I hope that this bill would prevent it.