DIVERSION-FROM THE CRIMINAL JUSTICE SYSTEM Diversion of drug violators from the criminal justice system is being advocated by several disciplines. We have noted that there are at least four contemplated diversion programs being considered, in both the public and the private sector, that merit consideration and study. We do not oppose diversion, but we do have some concern about the method in which individuals will be diverted from the criminal justice system. We cannot ignore the citizens we serve and their right to protection from criminal activity. Diversion must be carefully considered. There is merit in the diversion of certain first-time offenders not involved in the sale of narcotics or in crimes of a violent nature. We, too, are concerned with the criminal records being attached to some of our young people, but let us also recognize the millions who do not get involved in crime. We recognize that diversion requires the cooperation of many people including law enforcement, the prosecutor, parole and probation, and the judiciary. Some courts have been extremely lenient toward the criminal population in this County and the sentencing practices of some of the judiciary has been, in our view, a significant factor in the rate of recidivism. Law enforcement has borne the brunt of criticism, but others in the criminal justice system must assume their rightful share. For example, we have long supported, and many judges have opposed, the concept of special narcotics courts where judges, thoroughly trained, experienced, and aware of the total drug picture can render objective decisions. Where the total resources of the community can be utilized in the administration of justice, because the judge knows what is available, court decisions would probably run the gamut from education to incarceration, but they would be consistent with the facts at hand and the welfare of the total community. In 1971 there were 2,681 convictions in this state for selling either opiates or dangerous drugs, and only 16% of this group was sentenced to state prison. The remaining were diverted into treatment programs and/or minimal county jail and probation terms. In a number of these cases, the decisions were not consistent with the facts. Do not interpret our comments as being a condemnation of the total judiciary because we firmly believe that citizens in our community enjoy the efforts of some of the most knowledgeable and competent judges in the nation. A diversion plan that we have reviewed with great interest is a federal plan, "Treatment Alternatives to Street Crimes" (T.A.S.C.), which is intended to deal with the persons arrested who are opiate dependents. Such persons may be offered a treatment program in lieu of incarceration. We caution, however, that diversion from the criminal justice system must be started out carefully and there must be adequate selectivity of those who are to be diverted. We do not believe that diversion presents an insurmountable problem, and we remain open minded to any and all valid programs that will relieve this nation of its number one social, health, and law enforcement problem-drug addiction. CONCLUSION In the final analysis, we are firmly convinced that enforcement and treatment, no matter how massive the programs, will be ineffective without a realistic education program. Drug education must begin when youngsters are exposed to learning things as basic as their ABC's and parents must be educated at the same time. All efforts initiated after involvement in drug abuse, are capable of only minimal success. We must climb out of the rut of initiating adequate programs and committing adequate resources only after crisis develop. Senator BAYII. Our next witness is John Randell, chairman of the Southern California Methadone Conference of Los Angeles, and appearing with him will be Dr. Lawrence Hart, acting director of the drug treatment program, Community Health Services for Los Angeles. TESTIMONY OF JOHN H. RANDELL, M.S.W. CHAIRMAN, SOUTHERN CALIFORNIA METHADONE COUNCIL, ACCOMPANIED BY DR. LAWRENCE HART, DIRECTOR, DRUG TREATMENT PROGRAM, COMMUNITY HEALTH SERVICES, LOS ANGELES, CALIF., AND JAMES D. MITCHELL, PROGRAM MANAGER Dr. RANDELL. Mr. Chairman, as chairman of the Southern California Methadone Council, I am pleased to testify here today. I would like to also present Mr. James Mitchell, program manager, for the Health Services Methadone program, who is also here. I submitted a statement to the subcommittee which I will not read from. First, a comment about that statement and several things that have been mentioned this morning. There are 1,395 patients on the methadone program in Los Angeles County. In all of southern California-from Santa Barbara to San Diego-there are 2,565 methadone patients in treatment. The planned expansion of the Los Angeles County programs in the next 6 months to a year will be approximately 3,000 patients. The planned expansion for all of southern California will be about 4,500 patients. I should probably also comment that the waiting list in Los Angeles County of all programs is close to 6,000 patients. There is no program, as of today, that is taking new applicants except for the three veterans' hospital facilities. Before we hear from the other members, I would like to comment on four things that were mentioned earlier today. One was the impact on crime. The sheriff commented, that perhaps 112 percent of all addicts in Los Angeles County are receiving methadone maintenance treatment. We do not feel that we can make an impact on crime with that small number of participants. The second statement which was made earlier was questioning the desire of the addicts to receive treatment at UCLA. The committee should know that the UCLA methadone maintenance program has been in existence for about 212 years. They have never had over 30 patients and have had 22 patients for most of those 3 years. The other program which UCLA offers is an inpatient detoxification program which consists of two beds at present, and has had a total of four beds. When heroin dependent people applied for treatment they were told that the waiting list for treatment was between 2 and 6 years. Neither the methadone maintenance or detoxification program has been one that could readily accept people who apply for their program. I think these factors account for the small number of addicts who applied for treatment at UCLA. The third thing I would like to comment on, speaking for the methadone programs from Santa Barbara to San Diego, is that we are against involuntary participation in methadone maintenance programs. We insist that the participation be voluntary. Mr. BAYH. May I make an apology to the witnesses; we have gotten ourselves significantly behind and we want to hear everyone; and so that the members of the committee do not run out of gas before the day is over, you will permit us, I hope, without seeming to be discourteous, to have a little intake of nutrients so we can continue with your testi mony, and then make an on-the-scene visit to the drug-treatment clinic here in Los Angeles County, and then come back to more witnesses. So, I just wanted to explain that this is not the normal way we would treat you gentlemen. Dr. RANDELL. The present programs in California, including my particular program, the Suicide Prevention Center, is now subject to the regulations of six governmental agencies. These agencies are: BNDD, FDA, NIMH, SAODAP, the Research Advisory Panel at the State level, and now, presently, the Department of Mental Hygiene. These six governmental agencies have regulatory powers and inspection powers with the various methadone maintenance programs. In addition to those regulatory powers, the Southern California Methadone Council, because of a review of each program, has instituted many controls among the programs in southern California. Among those have been the problem of diversion. The second control has been a peer pressure among program leaders to lower the methadone dosages the programs are using for treatment. I think that you will see in the State of California within the next 6 months that the average dose of methadone will be dropped to between 40 and 70 milligrams of methadone a day, as compared to 180 milligrams that is the upward limit allowed by law. I think these are the only things I can address myself to, and I will give Dr. Hart a chance to talk. (Dr. Randell's prepared statement is as follows:) SUICIDE PREVENTION CENTER, INSTITUTE FOR STUDIES OF SELF-DESTRUCTIVE BEHAVIORS, BIRCH BAYH, Hon. SENATOR BAYH: Enclosed please find our initial outlines for our testimony before your Sub-Committee to Investigate Juvenile Delinquency on November 14, 1972, regarding the issues of methadone diversion and the proposed legislation, S.B. 3846. The problems your Sub-Committee are investigating are of great concern to the Southern California Methadone Council and we want to thank you for the opportunity to testify before you. If we may assist you in exploring other pertinent areas, we would welcome the opportunity to explore these areas further. Sincerely, JOHN H. RANDELL, M.S.W., Chairman, Southern California Methadone Council. STATEMENT TO THE UNITED STATES COMMITTEE ON THE JUDICIARY CONCERNING METHADONE TREATMENT OF HEROIN-DEPENDENT PERSONS IN SOUTHERN CALIFORNIA John H. Randell, M.S.W. Chairman, Southern California Methadone Council The current and proposed capacity of methadone maintenance treatment programs in Los Angeles County is as follows: (1) UCLA-NPI: Present patient population is 30, with an anticipated increase to 225 patients within the next 6 months. (2) Suicide Prevention Center Methadone Maintenance Program: Present population 30, with an anticipated increase to 200 patients within 6 months. (3) Rosemead Lodge: Present patient population 90, with anticipated increase to 200 patients within the next 6 months. (4) Veterans Administration facilities: Brentwood: Present patient population of 161, of whom 128 are methadone maintenance patients. The goal is to have 250 patients in treatment with 200 of those patients on methadone maintenance. Sepulveda Present patient population of 292 with expansion to 300 planned for the near future. Hill Street sate-lite office: Present patient population of 55, anticipated expansion to 250 within the next 6 months. (5) Department of Corrections, Central Testing Center: Present patient population of 200; anticipated expansion to 350 within 6 months. (6) Los Angeles County Department of Health Services: Present patient population of 570, anticipated expansion to 1025 within 6 months. Two private organizations are now in the process of submitting application to the State of California Research Advisory Panel for approval of methadone maintenance programs. Compton Foundation Hospital plans to treat 100 patients on a private basis. Ingleside Mental Health seeks to treat 40 patients on a private basis. In summary, there are 1395 patients currently receiving methadone maintenance treatment in Los Angeles County. Anticipated program expansions would raise the total of patients being treated to 2750. There are six methadone maintenance treatment programs outside of Los Angeles County in Southern California. These programs are as follows: Orange County has a patient population of 300, with anticipation expansion to 450 within the next 6 months. Riverside methadone treatment program has 100 patients at present and anticipates expanding to 150 within the next six months. San Diego County is presently treating 540 heroin-dependent persons with methadone. Expansion to 800 patients is contemplated, together with an additional 100 patients to be treated under contract with the Veterans' Administration. The Santa Barbara methadone maintenance treatment program is presently caring to 54 patients in its own program and 55 patients in a satellite program in Santa Maria. There are no immediate plans for expansion of this program cluster. The San Bernardino methadone maintenance treatment program is currently caring for 100 patients, and the goal for expansion to 150 within the next 6 months. Project SPAN in Pomona is currently treating 20 patients and has no present concrete plans for future expansion. In summary, there are 1170 patients receiving methadone maintenance treatment in Southern California outside of Los Angeles County. Presently proposed expansion on these programs would raise that total to 1780 within six months. In view of the above, totals for all of Southern California are: Present number of patients, 2565. Future total under planned expansion, 4530. The Southern California Methadone Council was established in October, 1971. At present there are 13 member programs. The major concerns of the Council in the past year have been: (1) Developing more effective treatment modes for heroin-dependent persons. (2) Minimizing diversion of methadone to non-patients. (3) Facilitating patient transfers among programs. (4) Developing central files to prevent duplication of patients. (5) Establishing of an evaluation team to assess functioning of programs. (1) The Council has continually stressed the importance of improving the ways in which heroin-dependent persons may be helped. Screening techniques, therapeutic approaches, and the development of controls within programs have been studied and discussed at the Council's monthly meetings. The activities of the Council have been of significant assistance to its members. (2) Diversion of methadone has been a major concern of the Council, and all member programs have exerted efforts to minimize diversion. These efforts have included elimination, for a period, of all take-home medication. This method, however, is felt to be punitive with respect to the successful patient, and an inappropriate way of dealing with the problem of diversion. The problems of diversion are now being dealt with in a slightly different manner. Programs are colorcoding take-home doses of methadone: Orange County is using a red-colored, easily distinguishable medication, Riverside uses lime Tang; VA Sepulveda uses lemon-color, and so on. The Council has been in contact with the manufacturers of Tang-type substances in the effort to make possible the use of a different color for each program in Southern California. (3) Arrangements have been made by the Council to make possible the transfer of patients from one program to another within Southern California. Acceptance of patients from outside the Southern California area is possible only when all identifying information, together with complete medical information, is received at least two weeks prior to desired intake. Emergencies are handled on an individual basis with the procedure varying from program to program. (4) As of the date of this statement, there exists no State or Federal system for the identification of patients so that there will be no duplication of patients in the various treatment programs in Southern California. However, during the past six months the members of the Southern California Methadone Council have submitted data on each of their patients as a means of prevention and duplication. This data includes: name, social security number, date of birth, and mother's maiden name. Each program checks the applicant's name against this central file before admission. The central file has in addition been of important assistance to law enforcement authorities when they have sought to verify the status of certain individuals as patients in methadone maintenance programs. It is anticipated that in the near future this central file will be upgraded to include an identification card with a photograph and a thumbprint of the patient and other identifying information. It is hoped that this centralized identification system will eventually facilitate the dispensing of methadone to patients when they may be incarcerated in a prison or jail. (5) The Council is also in the process of setting up an evaluation team. When a member requests permission from the Research Advisory Panel and the Food and Drug Administration to expand their program, a recommendation could be made by the Council, providing the evaluation team had evaluated the program. When a non-member applied for permission to operate a methadone maintenance program, the evaluation team could review the protocol, evaluate the site, the program and the staff and then make a recommendation. No member of a team would inspect his own facility. (6) Los Angeles County and Orange County programs are the sub-committee for methadone maintenance for the Inter Agency Task Force on Drug Abuse for Los Angeles County. This is the sanctioning body for all methadone programs in Los Angeles County. Mr. Witherill of the Department of Health Services (the new governmental department combining health, mental health, hospitals and veterinary services) is designated as the Drug Abuse Coordinator for Los Angeles County. The Inter Agency Task Force on Drug Abuse and the County Narcotics Commission are advisors to Mr. Witherill. When a request for approval goes to Mr. Witherill, he in turn seeks the advise of the IATFDA. If it were concerning methadone, the advice would be requested eventually from the Council. (7) When state legislation A.B. 400 and S.B. 714 were under consideration, it became obvious to the methadone programs that a state organization was necessary. In April of 1972, representatives from all methadone programs in the state met to discuss the formation of the California Association of Methadone Programs (CAMP). At that time, it was apparent the best direction to go was a regional one, North and South, joining together to form the state organization. However, the formulation of CAMP was delayed because the Southern region was organized and the Northern was not. In early December of 1972 the Northern California section of CAMP will be formalized and in early 1973, CAMP will be a viable professional association. (8) In reviewing S. 3846 it is the general feeling of the Council that it duplicates provisions of the FDA, BNDD, and RAP requirements. It is felt that S. 3846 should have provisions to waive registration and recordkeeping requirements if the protections are safeguarded by state regulations. |