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Mr. REESE. Any questions that this body might have of us, if they would give us the questions we would be glad to answer the questions in writing at any time.
Mr. BAYH. All right.
I would appreciate it, lieutenant, if you would provide that for the record so that we can move on. I do not want to lessen the significance of your contribution, but that is one that I think would come more accurately in writing and it will permit us to go ahead.
Thank you, gentlemen.
(Chief Collins' prepared statement is as follows:)
A POSITION Paper on Methadone Relative to Senate BILL S. 3846 PRESENTED BY ASSISTANT CHIEF JACK G. COLLINS, LOS ANGELES POLICE DEPARTMENT The Los Angeles Police Department shares the concern of Senator Cook and the Committee regarding the lack of regulation of narcotic treatment programs. We welcome legislation designed to regulate treatment programs and to safeguard against diversion of methadone for illicit use and sale. We agree with the need for registration requirements; however, we contend that the requirements set forth in the bill are not restrictive enough to prevent misuse. First, we oppose any attempt to permit general practitioners to dispense this narcotic because we feel that such licensing will lead to methadone diversion to street use. And second, we contend that stringent control of public methadone maintenance programs is needed because of the many possibilities for abuse in these programs. The Los Angeles Police Department recognizes methadone maintenance treatment as one of many proposed programs to alleviate the nation's heroin addiction problem. We also recognize that methadone is an addictive narcotic and is not a cure, but is instead a replacement for another addicting narcotic.
Methadone maintenance treatment is still in the experimental stage and, as such, appears to be in need of tight control in areas of methodology, distribution participant selection, and evaluation. The need for distribution control is especially evident in light of the increasing number of deaths due to methadone. A Los Angeles Times newspaper article dated October 5, 1972, reported that deaths caused by methadone overdose equaled or exceeded deaths caused by heroin in Washington, D.C., Buffalo, and Minneapolis. The Times also indicated that in New York City methadone is the second leading cause of death among narcotic users. It is the opinion of reporting medical authorities that the rapidly increasing methadone-related death rate is a direct result of methadone misuse caused by improperly controlled treatment programs.
At present the problem of methadone control experienced in the East is not prevalent in California; however, proposed expansion of treatment programs without corresponding controls would foster an increase in methadone-related deaths in California and would increase the likelihood of local misuse.
Inquiry and observation have shown us that the possibilities for problems and for abuse in these programs are many.
Reports indicate that in some cases the heroin addict uses the outpatient treatment center as a gathering place and a potential market for narcotics traffic.
It is possible, too, that some addicted persons who enroll in methadone programs have no intention of giving up the heroin habit. Such persons may use clinics to their own advantage, taking methadone to keep their tolerance low, then skipping their methadone dosage and injecting heroin for enjoyment. When this is done over a weekend, for example, the take-home supply of methadone can be sold or traded for heroin.
A further problem with dispensing a narcotic and maintaining an addiction without requirements for adjunctive treatment is that the program may treat only the physiological symptoms, not the possible underlying psychological problems. We propose that the standards set for registration include a requirement that registrants be a part of a therapeutic team with the wide range of medical, psychiatric, and counseling skills necessary to deal with all aspects of rehabilitation.
A severe limitation on the effectiveness of the programs appears in that they deal only with a small percentage of users. Addicts have stated that only the older addicts, those who are tired of "running," tired of jail time, and who are actively seeking aid, are taken into the methadone treatment programs.
Moreover, it must be understood that methadone maintenance is a voluntary treatment program. Addicts do not have to become involved in the program and are free to drop out when pressures of regulation or loss of initial zeal overcomes their dedication to the program.
Methadone abuse also stems from lack of control over the dosage given to the addicts. Daily doses of 80 to 100 milligrams are dispensed. Clinical studies indicate that 40 to 50 milligram doses are sufficient to prevent withdrawals In reality, an addict can prevent withdrawals with less than the prescribed dosage, having a remainder which he may divert into the illicit market.
It is the opinion of many medical experts, as well as police administrators, that compulsory institutionalization of most addicts is a necessary first step in any successful treatment program. Once the addict has been identified by arrest, he can be directed into programs offering opportunities for rehabilitation.
This kind of supervision provides a stronger base for rehabilitation, through methadone maintenance or any other program, because of the more exact control provided over the addict. This concept has the added advantages of eliminating methadone misuse and preventing addicts from infecting others with their habit. The legislature has seen fit to establish sentences of imprisonment for the violators of narcotics laws designed to restrain addicts from contaminating the community and afford them the opportunity for rehabilitation.
There is much more to be learned about methadone and the addiction process. To use the limited experiments and published reports as a basis for opening large-scale treatment centers without restriction or control could prove to be a tragic mistake. The trend toward large-scale methadone treatment programs is obvious. Realistic restrictions would represent the important first step in maintaining control over these programs.
(Chief Collins subsequently supplied additional material for the record. It was marked "Exhibit No. 7" and is as follows:)
EXHIBIT No. 7
LOS ANGELES POLICE DEPARTMENT,
Hon. BIRCH BAYH,
DEAR SENATOR BAYH: This letter is in response to your request made at the recent Los Angeles hearings of the United States Senate Committee on the Judiciary, Subcommittee to Investigate Juvenile Delinquency.
First, thank you again for the opportunity to testify concerning the Los Angeles Police Department's position on Senate Bill S. 3846. As I stated at the hearing, we welcome any legislation designed to properly regulate methadone maintenance programs. However, we do not believe Senate Bill S. 3846 provides adequate controls for methadone maintenance treatment.
In California methadone maintenance is used in closely controlled experimental treatment of narcotic addiction; consequently, we experience less diversion and abuse than other states. We believe that permitting every general practitioner to administer a methadone maintenance program will lead to increased diversion and street use. There is little doubt that many of the incidents of increased methadone abuse experienced by other states are attributable to improperly controlled treatment programs.
Allowing inadequately informed persons, as most individual practitioners are concerning methadone, to manage a methadone program would build weakness into the system for the insincere patient to exploit. Also, the general addict population requires rehabilitation services from a wide range of psychiatric and medical skills. We seriously doubt the ability of most individual practitioners to successfully integrate a methadone maintenance program into a practice estab
lished in another discipline. Methadone maintenance is a specialized course of treatment requiring specialized skills. Furthermore, a heroin addict is a unique type of patient whose treatment requires special precautions and controls.
Another problem with the general licensing of doctors to administer methadone is the increased possibility of a person with ulterior profit motives maintaining such a program. This is not to imply the venality of the medical profession is greater than other professions. However, just one unethical doctor over-prescribing methadone could have tragic, far-reaching effects on a community. An example of such over-prescribing is the case of Doctor Charles E. Baker of Long Beach, California. For several years Dr. Baker unnecessarily prescribed and over-prescribed dangerous drugs to young adults. Representatives of St. Mary's Hospital in Long Beach, California, estimated that 60 percent of the barbiturate overdose cases treated by them in the past four years resulted from Doctor Baker's prescriptions. Although Dr. Baker was known as “Dr. Feelgood” to his youthful patients, the Long Beach Police Department reports numerous overdose deaths attributable to his prescriptions. Although not common, the case of Dr. Baker is by no means unique. Our Department is currently investigating a doctor who will, for a $5 charge, perform a cursory physical examination and prescribe a drug of the patient's choice. Because this physician writes up to 160 prescriptions a day, his detrimental effect on the community is widespread.
It is nearly impossible to monitor such activities. The Los Angeles doctor mentioned above has been known to law enforcement for several years and has been investigated by local, county, state and federal authorities. Because it is difficult to establish the elements necessary to prove a crime has been committed, no one has yet constructed a prosecutable case against this doctor.
At the Senate Subcommittee hearing, Senator Hruska stated the premise that strong disciplinary action against doctors violating the proposed law would serve as a deterrent to other physicians. Our experience and study of past violations indicate this is not the case.
In spite of existing regulations concerning the prescription of narcotics and restricted drugs in California, many deliberate violations continue to occur. During 1968 and 1969 the State Board of Medical Examiners brought charges against 92 doctors for improperly prescribing narcotics or dangerous drugs. An additional 77 doctors were charged with improper self-administration of narcotics or dangerous drugs. Although some physicians had their licenses revoked, there has been no apparent reduction in the rate of similar new charges brought by the Board of Medical Examiners. One investigator for the Medical Examiners Board stated that disciplinary actions taken against doctors for improper or illegal prescription or sales of drugs definitely have not served as a deterrent to similar crimes by other physicians.
I am sure you understand our concern regarding the general licensing of individual practitioners to dispense methadone as treatment for narcotic addiction. We seriously doubt that governments, both local and federal, will be able to monitor and control such a widespread methadone system. The opportunity for abuse is too great. We believe increased street use and overdose deaths will result if Senate Bill S. 3846 is enacted.
We reiterate our proposal that the standards set for registration include a requirement that the registrant be part of a therapeutic team with the wide range of medical, psychiatric, and counselling skills necessary to deal with all aspects of rehabilitation. We suggest strict controls over methadone and methadone patients to prevent misuse and the contagion of narcotic addiction.
There is much more to be learned about methadone and the addiction process. To use the limited experience and published reports as a basis for opening largescale treatment centers without restriction or control could prove to be a tragic mistake. The trend toward large-scale methadone treatment programs is obvious. Realistic restrictions would represent the important first step in maintaining control over these programs.
Very truly yours,
JACK G. COLLINS, Assistant Chief, Acting Chief of Police.
Mr. BAYH. Will Chief Block of the sheriff's department come forward, please?
TESTIMONY OF CHIEF SHERMAN BLOCK, LOS ANGELES COUNTY SHERIFF'S DEPARTMENT, ACCOMPANIED BY CAPT. NORMAN HAMILTON, COMMANDER OF THE NARCOTICS BUREAU, AND SGT. EUGENE RUDOLPH
Mr. BLOCK. I am Chief Sherman Block of the Los Angeles County Sheriff's Department. To my immediate right is Capt. Norman Hamilton, commander of our narcotics bureau, and Sgt. Eugene Rudolph, who is one of our qualified experts in the area of narcotics enforcement. Sheriff Pitchess has asked me to extend his regret for not being able to personally appear, but he has been troubled with a lingering ear infection and is undergoing some treatment at the present time. Now, in the interest of brevity, I would like to excerpt some of the points that were made in the statement of Sheriff Pitchess that was presented to the committee.
First of all, we welcome, Mr. Chairman and Senator Hruska, the opportunity to appear and discuss the abuse and illegal use of narcotics and dangerous drugs because as you have indicated and all of the witnesses have indicated, we are in total agreement that we view this as one of the greatest threats to the survival of our Nation that has probably ever existed.
For too long a time drug abuse and problems related to drug abuse have been considered as purely a local problem. There seemed to be a general assumption that local authorities were responsible for the enforcement effort as well as the treatment efforts and so forth related to drug traffic. We were pleased that the Federal Government has expanded their role in the area of narcotics and dangerous drugs, that there has been a great deal more activity not only in the enforcement directed against drug importation, but there has been an increase in the number of cooperative coordinated programs that the Federal agencies have undertaken, along with the local authorities.
Heroin addiction as such is unquestionably a national disaster. There is no other way to equate it. But, we feel that there is some hope and we state this primarily because of the fact that there has never been this level of coordination and cooperation among agencies attempting to deal with this particular problem.
We in law enforcement have been somewhat effective in disrupting the distribution process, the distribution system of heroin in this country, and in Los Angeles we have been engaged in a multiagency cooperative effort for several years, including Federal, State, county, and city agencies which have enabled us to act as a single force against a drug trafficker and our activities regarding major traffickers have been very significant in terms of the arrests and size of seizures and so forth.
Now, we have estimates that range anywhere from 30,000 to 100,000 hard narcotics addicts in the county of Los Angeles. The number of addicts, the estimate, depends on, probably, on the person supplying the estimate.
There is no way, of course, to effect an accurate account but we do know that the addiction that does exist results in the loss not only of millions of dollars for the community, but untold human suffering.
These addicts engage in a complete spectrum of criminal activity ranging all the way from petty theft and prostitution to robbery and murder, with crimes against property, particularly burglary being the most common type of addict crime.
In Los Angeles County, we have knowledgeable experts in both the public and private sectors who concern themselves with treatment programs for drug abusers.
We believe that proper treatment can, to some degree, reduce the demand for drugs. In this county, included in this comprehensive plan, are almost 200 different organizations and agencies, both public and private.
Some are voluntary in nature, completely self-supporting financially, and others operating under public funds. The important thing is that a system and program has been developed in Los Angeles County where there are agencies responsible for reviewing grant monies that are being supplied by the Federal Government through the State, and to see that these things are used to their best advantage. Currently there are two treatment dimensions available to the heroin addict in Los Angeles County. One is through our publically administered methadone maintenance program, and the other is through a private program which requires total abstinence from all drugs. Both of these programs have had a measure of success and both of these programs have had a degree of failure.
Methadone maintenance is expensive, it requires staffing by experts, close adherence to guidelines and regulations, bed space and other clinical resources for the optimum treatment.
The nature of the program demands extensive follow-up patient care, including family, vocation and social counseling. We in the sheriff's department have cooperated fully with those who are administering these programs by allowing them to continue methadone maintenance programs for some of the inmates in our county jail facilities who are in for brief periods of time and have a pending release in the offing.
We believe very strongly that the treatment responsibilities belong with those who have the expertise in this field and we reject proposals that the sheriff should assume responsibility for total treatment of addiction in the county jail system.
The reason that we make this statement is that there are people who have advocated that the county jail become an institution conducting the methadone maintenance program, and that the sheriff's medical staff facility, correctional facilities and so forth become a part of the system. We do not feel that we are qualified or able to handle such a program.
Now, it is unfortunate that with all of the safeguards that have been established some illegal methadone is appearing on our streets.
Some of this is the result of diversion from the take-home weekend dosages and some we believe to originate in other States.
Illegal methadone is not yet a significant problem in this community, and I think that Chief Collins echoed that same feeling.
In fact, if I quote a statistic, during the year 1972 our Narcotic Bureau has processed 34 persons known to be in the methadone
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