Drug abuse, especially among our young people, has reached crisis proportions in this country. As chairman of the Senate Subcommittee to Investigate Juvenile Delinquency, I have heard countless witnesses in Washington, and throughout the country-some in California— tell of the grave peril we face, as a Nation, from the rapid spread of heroin addiction, and the abuse of nonopiate drugs such as amphetamines, barbiturates, and tranquilizers.

I am deeply concerned, not only as a U.S. Senator, but as the father of a 16-year-old boy, that we must find new and better ways to deal with this drug epidemic. We must find ways to extricate 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 use.

This is what we want to find out from the California experience; Are we opening the door, or perhaps how can we keep from opening the door to wide numbers of additional users of a different type of drug?

We are all too familiar with the devastating consequences of heroin addiction for the individual addict, the addict's family, and society as a whole. In order to support his habit, the addict is driven to engage in criminal activities, often threatening the personal safety of our citizens.

The cost-in human and economic terms-is 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 panaceasno magic wands! But, there are a number of treatment modalities which have had a degree of success in rehabilitating certain addicts.

Our hearings today will focus on a drug which has received a great deal of attention in the past several years-methadone. It has been utilized extensively in the treatment of heroin addicts.

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, met hadone addiction is substituted 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 a community.

It is important to emphasize that methadone 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, in my judgment, ill-conceived and will lead to a "turnstyle or breadline" type of treatment. Pressure for hastily developed, large-scale, underfinanced, understaffed programs must be resisted. Methadone maintenance may open the door to rehabilitation for some addicts, but an addict must desperately want to change his lifestyle, and must have extraordinary motivation in order to benefit from the program.

However successful methadone maintenance has been in treating certain addicts, we must not use methadone to "smoke-screen" the effect of drug addiction on our society, and the social conditions that spawn drug addiction. We must make certain that our society continues to give adequate attention to the causes of the original heroin addiction. Methadone maintenance should not provide a "fix" for a complex social, political, medical, and psychological problem. Equally important, we must deal with the escalating numbers of multiple nonopiate drug abusers for which methadone is not even a partial

answer.

In 1968, there were fewer than 400 patients enrolled in methadone treatment programs nationwide; today there are more than 60,0000 patients in more than 400 programs. Proposed Federal regulations contemplate an even broader proliferation of methadone distribution. This rapid expansion of methadone programs, and the quantity of methadone dispensed, has simultaneously provided increased opportunity for diversion of methadone into the illicit market.

In many cities, methadone is already widely available in the illicit market. A recent survey of heroin addicts in New York City found that 92 percent had been offered illicit methadone; that 56 percent had purchased illicit methadone; and that 13 percent had sold methadone. Illegal methadone has several primary origins: carelessness or unscrupulous physicians; thefts and diversion from methadone programs; and patients enrolled in methadone programs. In some communities, one or more physicians have contributed substantially to the illicit traffic. A physician in the District of Columbia was recently convicted on 22 counts of illicit methadone distribution. It was alleged that he sold 11,000 prescriptions-815,000 10 mg. doses-and accumulated more than a quarter million dollars for his efforts. We went to make certain that no physician or no citizen of this country has a chance of making a quarter million dollar profit out of program which is originally designed to treat heroin addicts. This is one of the purposes for our being here. This is one of the reasons that the legislation before us has been introduced. Here in California, State agents recently arrested a pair of methadone runners carrying 2,000 methadone pills destined for southern California. Several Arizona physicians were allegedly the sources for these pills.

Employees and volunteers associated with methadone programs have been implicated as sources of illegal methadone. It appears, however, that such diversion is usually unwittingly permitted, and can be attributed to poor organization and loose controls. A recent development has been armed robberies of methadone clinics in Baltimore and New York City. In these instances, substantial amounts of methadone were stolen.

The most frequently cited source of illegal methadone is the patients themselves. Some addict-patients who have "take home" privileges for ambulatory maintenance programs sell part of their supply. Recent studies have found that nearly two-thirds-and I think this is extremely important-that nearly two-thirds of the addicts who purchased illegal methadone obtained it from individuals enrolled in methadone programs designed to treat the heroin habit. This can be very profitable. Average daily dosages range from 40 to 180 milli

grams. The street price for 10 milligrams of methadone ranges from 2 to 10 dollars. Here in Los Angeles the street price for 40 milligrams of illegal methadone is reportedly $10. I understand that as part of an effort to determine the sources of diverted methadone, programs in southern California have decided to place a flavortracer in their methadone. We want to determine if this is an effective tool.

Addicts use methadone in a variety of ways. Many prefer methadone to heroin because it is readily available, it is cheaper, and they find that the euphoria is of longer duration and higher quality, particularly if injected intravenously. Others buy illegal methadone to insure against withdrawal from heroin when heroin is unavailable; to boost the effects of cocaine and amphetamine and enhance their euphoric effects; to reduce the size of their heroin habits. Thus, there are numerous uses for methadone besides the prescribed use in the treatment of heroin addiction.

Doctor Jaffe of the White House Special Action Office for Drug Abusc Prevention reports that there has been a steady rise in the last 3 years in the number of persons addicted primarily to methadone. We want to assess the extent of methadone addiction in California. Are we merely substituting one habit for another? Are we making it possible for young people to be hooked on methadone who normally would not have acquired the heroin habit?

A survey of recent applicants for Miami methadone programs found that 40 percent were using illegal methadone along with other drugs, and 7 percent were using solely illegal methadone. In relative terms, the extent of methadone abuse does not presently rival heroin abuse, but the trend is alarming.

Illicit sales lead to the addiction of others. Polydrug abusers and experimenters are among the regular purchasers of illegal methadone. Methadone programs may create a demand as well as a supply for the demand. A recent study of 55 heroin addicts terminated from methadone maintenance programs found that 35 percent were abusing illicit methadone along with other drugs, and 8 percent were abusing solely methadone.

Now, many of these new addicts are younger and less experienced with drug use than the typical heroin addict. This alarms me. Some doctors express concern that unless we rigidly control the distribution of methadone, we may be creating a new generation of methadone addicts. Instead of a generation of heroin addicts destroying our society, destroying the lives of countless people throughout the country, we may replace it with a generation of methadone addicts. We want to see whether the legislation before us and suggestions that you may make to enhance it will prohibit this from happening.

The impact of illicit methadone traffic is vividly documented by the staggering numbers of methadone overdoses and deaths. In New York City, 100 deaths directly attributed to methadone have been reported in the first 9 months of this year, or 15 percent of all narcotic deaths as compared with 10 percent last year. In Washington, D.C., methadone has been more lethal than heroin. In the first 6 months of this year, methadone deaths numbered 26 and heroin deaths 19. Methadone accounted for 14 percent of the narcotic-related deaths in 1971, and 40 percent of the recorded deaths to date this year. Most of the dead are

younger people, primarily teenagers who took methadone orally, although some injected it. The trend is alarming.

A related problem is the increased numbers of accidental methadone poisonings. Within 9 months of opening Detroit's methadone maintenance clinic, 19 children were treated for methadone poisoning. Within the next 7 months, 27 others were treated. Several young children died as a result of these poisonings.

It is abundantly clear that adequate safeguards must be developed to insure the effective operation of methadone programs and protect our communities from the introduction of yet another potent drug of abuse and addiction. The need for such safeguards should not be interpreted as an indictment of methadone programs, but rather as a realization that methadone can be harmful when diverted and improperly used. To point out that the way it is being used today is not the perfect way in all too many examples.

In closing, I will say that on April 6 of this year, the Food and Drug Administration published a notice of its intention to permit the use of methadone for the maintenance treatment of narcotic addiction for all adults for whom it is medically justified. In response to this development and the growing incidence of methadone diversion under current regulations, on July 26, 1972, my colleague and ranking minority member of this subcommittee, Senator Marlow Cook, introduced Senate bill 3846. The Department of Justice believes this legislation is necessary in order to strengthen its legal authority to protect against methadone diversion. The bill requires separate registration of practitioners who utilize narcotic drugs in the treatment of addiction and provides for special drug security requirements.

Today, we will hear testimony from law enforcement officials, representatives of methadone programs, and others in the Los Angeles area, knowledgeable in the treatment and control of heroin addiction, We hope that the session will be a productive one and will help us develop an understanding of the type of controls which are consistent with program objectives and the protection of the community at large. Suffice it to say, that at least as one member of this committee, I come to the hearing with no preconceived notion of the role that methadone should ultimately play in our efforts to assist people to kick the heroin habit. I am hopeful that if we devote as much time and attention, if we devote as many of our national resources to kicking the heroin habit, as we have to accomplishing certain other goals over the past 10 or 20 years that we can do more than substitute one undesirable habit for another. But, certainly, the goal of hearings and of each of us as human beings in this country, as we look at the heroin problem, is to find a cure, not just a substitute, the lesser of two evils. Senator Hruska?

Mr. HRUSKA. Thank you, Mr. Chairman.

Your summary and description of the background and foundation for these hearings is a very excellent one. It tipifies the thoroughness with which you and your staff have prepared for this series of hearings. I want to commend you for arranging them and planning them so carefully and I want to complement your staff for the fine fashion in which they have assembled these witnesses and made available to

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us the other resources in California. All of this will be helpful to us in considering and processing further legislation on this subject.

The chairman is right when he says this is a complicated area. It is a complicated problem. It is an area and a problem which is constantly changing and we need to review the facts and the programs from time to time. Our knowledge needs updating if we are to legislate in a constructive way.

The basic legislation in this field was passed just 4 years ago, in 1968. That was the first systematized departure from the Harrison Narcotic Act passed over a half century before that. In 1970 there was an updating necessitated even within those short 2 years by the development of procedures which had been singularly outstanding in dealing with this very grave national crisis.

Under the 1970 act we have that system of scheduling of drugs. We have the system of moving from one schedule to another with the concurrence of the Secretary of HEW but the thrust of that bill is really in the field of enforcement under the Department of Justice and, of course, under the Bureau of Narcotics and Dangerous Drugs from which our first witness comes.

Now, there are many features of the bill that we have here which will tie right into the law of 1970. This bill is designated to meet a situation we did not anticipate just 2 years ago. Hopefully, we can in some way anticipate similar situations. Only recently, within the past 12 months, for example, there has been the development and upsurge and virtual explosion of the Qualudes (phonetic) and the Methalqualone (phonetic) which is a nonbarbiturate and which is described as "safe" and "nonaddictive" and yet there are many indications that it is not safe and nonaddictive.

These substances have been in use in England for as much as 15 to 18 years, from time to time, and in use in Japan for a long time, but within the last 9 to 10 months there has been a sudden explosion of the use of these Qualudes (phonetic) and these Methalqualones. Certainly a bill such as we have here that will deal specifically with comparable situations will help greatly to anticipate and prevent many situations before they overwhelm us. That is very desirable.

This chairman and this Senator, together with Senator Griffin of Michigan, cosponsored and there enacted into law S. 2140, which is known as Public Law 92-420, having been signed only about 60 days ago by President Nixon. Of course, it had for its subject the authority of the courts to place addicts in methadone maintenance programs when the medical testimony, the medical know how judges it well that it be done. That is within the framework of the alternative of rehabilitation and perhaps either that or prosecution under the criminal statutes. So, it is a constantly changing scene, but never does it lose its tragic proportions and its very somber outlook for the future unless we continue to probe into its many intracacies to try and devise better and more effective statutory basis for our procedures.

So, I thank you again, Mr. Chairman, for having these hearings. They will be very, very helpful and I look forward to processing further this bill with the hope that it will soon evolve into a signed public

law.

Mr. BAYH. Thank you, Senator Hruska.