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Mr. HELBERG. Yes, I think there are; and I think Dr. Lewis probably would be able to speak to this better because he and Dr. Kaufman work with these patients in their rap groups and get to know them. I think at the service and treatment level they can speak to that directly.
Senator IIRUSKA. Mr. Rector, have you any questions?
Mr. RECTOR. No, Senator.
Senator HRUSKA. Miss Falco, do you have any questions?
Miss FALCO. No, Senator.
Senator HRUSKA. Mr. Lazarus?
Mr. LAZARUS. No.
Senator HRUSKA. Mr. Meredith?
Mr. MEREDITH. NO.
Senator HRUSKA. Mr. Malec, do you have anything you would like to contribute to the record? We know of your record and the record of your associates in this program.
Mr. MALEC. Thank you, Senator.
I am very delighted to be here. Thank you for inviting me.
We believe we have Omaha awareness and action off and running as long as we can stay funded. It has been a traumatic year and a half or two getting Omaha awareness and action going. As Gordon said, it is being accepted as a whole by the city fathers and law enforcement. This was one of our biggest problems at the first. Now we have rapport with all of the power structure while still maintaining rapport with the street people. I think we have a good program going. We hope to get into the education field much heavier as soon as we are running smoothly so that we can make the entire community more aware of the problem.
Senator HRUSKA. Of course, the legislative program can take care of only a small part of the drug education or rehabilitation program. That is recognized. Uncle Sam is big, he is strong, he is rich, but he is not that strong and that rich, nor is he possessed of the ability to get into the neighborhoods and out on the streets and among the homes of those who are victims, or potential victims. Therefore, we are glad to see this type of development here. That is part of the reason for part of the funds being furnished by LEAA. Education and information, for example, is one of the big concerns for the State. Far too many people in the public conceive the drug abuse program as being a law enforcement program. While that is a necessary feature, by no means is it the most important or the most extensive.
I thank you very much for coming. If there are additional question that can be developed by the staff, they will be in touch with you by mail to get additional information.
Mr. HELBERG. Thank you, Senator.
Mr. MALEC. Thank you.
[Mr. Helberg's prepared statement is as follows:]
PREPARED STATEMENT OF GORDON HELBERG, EXECUTIVE DIRECTOR,
Mr. Chairman and distinguished members of the subcommittee; thank you for the opportunity of appearing before you with regards to S.3846.
As Executive Director, I am here representing Omaha Awareness and Action, Inc., a private, non-profit program designed to coordinate, plan, and
program drug services in the Omaha community. Omaha Awareness and Action has been in operation about 18 months and during that time has worked to develop a relationship with the local government entities as well as the State of Nebraska Commission on Drugs.
Our funding to date has included an L.E.A.A. Discretionary grant through the City of Omaha, and Establishment Grant through the Nebraska Division of Rehabilitation Services and Douglas County, United Community Services (the local Red Feather Agency) and private donations. At the present time we are working with the National Institute of Mental Health on an Eight Year Comprehensive Grant, with local match coming from the Nebraska Commission on Drugs and the City of Omaha. A Third Party Agreement is being negotiated for funding through the Nebraska Division of Rehabilitation Services, with local match coming from Douglas County.
Omaha Awareness and Action works with the three medical units in our community that now use methadone as a treatment for narcotic addicts. You will be hearing from staff representatives today from each unit. Equilibria Medical Center, Inc. is the free medical clinic for our coordinated program and is funded through Omaha Awareness and Action for all drug related services.
Dr. Jack Lewis, giving testimony before you today, now directs the methadone program there and has been fully accountable for the use of methadone at the clinic.
Two primary concerns at Omaha Awareness and Action are the 1) Methadone be used as a last resort for the hard core addict only. The quality of heroin in Omaha is sufficiently weak that a minimum number of persons would need to be under this treatment. To use methadone as a withdrawal treatment under strict control is acceptable, but maintenance programs for addicts should be entered into with extreme caution. 2) Strict controls as outlined in S3846 be administered with no exceptions for drug abuse treatment services.
Omaha Awareness and Action pledges itself to work with your committee in anyway we can to assure strict controls of methadone. Our goal is to work toward the alleviation of drug abuse in our community and it includes abuse of any treatment substance.
Senator HRUSKA. The next witness will be Mr. Kushner, executive director of the Nebraska Commission on Drugs.
Mr. Kushner, you have someone accompanying you. Will you identify him for the record?
Mr. KUSHNER. Rev. Rex Bevins, a member of the commission.
Senator HRUSKA. You have submitted a statement. Mr. Kushner. It will be placed in the record in full. You can proceed in your own. way with your testimony.
STATEMENT OF JEFFREY KUSHNER, EXECUTIVE DIRECTOR, NEBRASKA COMMISSION ON DRUGS, OMAHA, NEBR.
Mr. KUSHNER. First of all, I would like to thank you, Senator, on behalf of the Nebraska Commission on Drugs for the opportunity to appear before you with regard to Senate bill 3846, a bill to aid in regulating the use of narcotic drugs in the treatment of narcotic addiction.
Along with Reverend Bevins, we have another member of the commission, Sister Gabriel, who is the chairman of our treatment and rehabilitation committee. Reverend Bevins is chairman of our legislative committee.
Senator HRUSKA. How many are on the commission?
Mr. KUSHNER. Twenty members appointed by the Governor. Senator HRUSKA. Are they geographically representative of the State?
Mr. KUSHNER. Yes, they are.
Senator HRUSKA. How often do you meet?
Mr. KUSHNER. Once every month. The commission meets as a whole once a month, and every commission member is on a subcommittee which also meets usually once a month.
Senator HRUSKA. Do you render reports from time to time?
Mr. KUSHNER. Yes, we do.
Senator HRUSKA. To whom? To the Governor?
Mr. KUSHNER. Yes.
Senator HRUSKA. Once a year?
Mr. KUSHNER. Once a year by statute, and of course with the new Public Law 92-255 we will be preparing the first real comprehensive plan for the State of Nebraska which will be submitted, of course, to NIMH and the special action office.
Senator HRUSKA. With whom do you maintain contact in Washington on the Federal level?
Mr. KUSHNER. The State representative from NIMH is an individual by the name of Glenn Petty, who has of late gotten into communication concerning applications that have been submitted. We are also in contact with Miles Matthews of the special action office.
Sol Silverman of NIMH.
We now have a Nebraska representative from the special action office that covers the central region. Her name is Miss Angelari. Senator HRUSKA. How many do you have on your staff?
Mr. KUSHNER. Myself, a planner, and a secretary. Three of us. Senator HRUSKA. With that background, concerning the structure upon which you work, will you now proceed with your statement.
Mr. KUSHNER. The State of Nebraska is not much different than other States in regard to the expansion of the drug abuse problem in recent years. Perhaps the problem has not peaked yet in Nebraska as hopefully it has in many coastal states, and perhaps the drugs abused in Nebraska differ than many other States, but the problem here is just as real. I do not wish to bore you with statistics, but from the 1971 activity summary of the Nebraska State patrol the following information is available: In 1967, there were 52 drug arrests; in 1968, 232 arrests; in 1969, 510 arrests; in 1970, 911 arrests; and in 1971, 1806 arrests.
In the year between 1970 and 1971 there was almost a 100-percent increase in arrests made. The 1972 rate looks like it will not quite double the 1971 figure.
This also jibes very closely with the uniform crime statistics being compiled by the State planning agency of LEAA. These figures indicate that no peaking effect has yet come to Nebraska.
The report goes on to say:
It is estimated that the total illicit value of drugs seized by law enforcement in Nebraska in 1971 amounts to over $3.5 million. The seizures reflect only a small percentage of illegal transactions involving controlled substances; but even with this minimal data, it is apparent that illicit drugs are an important area of criminality.
The Federal Government must not take States like Nebraska lightly. Although the number of arrests and hard core addict popu
lation may be less than other more heavily populated States, the drug abuse problem is here, it is bad, and it is getting worse.
Concerning Senate bill 3846, the Nebraska Commission on Drugs is certainly in favor of any legislation that will aid in stopping the diversion of methadone or other drugs used in chemotherapy, provided it does not hamper treatment programs. We are not sure that there is not a duplication of effort concerning this bill and the new FDA regulations dated December 15, 1972. I have talked with Senator Bayh's office and still have no clear answer on this. The separate registration of practitioners who distribute drugs for treatment should not hamper rehabilitation efforts as long as the confidence of the patient is maintained.
We believe a program of methadone maintenance for the treatment of opiate dependents is favorable and the advantages of such a program outweigh the disadvantages. However, every effort should be made to correct the disadvantages, one of which is methadone diversion. We believe that methadone administered in a liquid form provided in a setting which truly encourages a crime-free, normal social existence, is a definite benefit to society. We do, however, favor programs where the ultimate objective is total abstinence.
The Nebraska Commission on Drugs encourages the efforts of the FDA, SEODAP, BNDD, NIMH, the Office of Drug Abuse Law Enforcement and LEAA in their efforts to provide new regulations to minimize methadone diversion without affecting the development of treatment programs.
In summary, I would like to say that we support S. 3846 to closely monitor and regulate the dispensing of methadone and similar drugs. I would urge that the Federal Government make a more careful analysis of the multimodality programs in our country and not stress the methadone maintenance programs in their funding efforts. And lastly, we need more guidance in the coordination of Federal agencies in order to continue to seek a coordinated effort at the State level.
I thank you on behalf of the Nebraska Commission on Drugs.
Senator HRUSKA. Mr. Kushner, in your statement you raise the question of the effect of the new regulations on the necessity or the desirability or the mission of any new legislation.
It is my understanding that the new regulations, those of 1972, have two principal effects:
1. They set forth minimal standards for supportive services in a methadone program.
2. They represent an attempt to close up the so-called filling stations which irresponsibly distribute methadone, or inefficiently, as the case may be.
One problem, among others, which still remains for our law enforcement community is the validity of statutory foundation for enforcing the regulations. We have regulations, and, of course, they can be promulgated and they can exist, but there are limitations on those who issue those regulations insofar as prescribing sanctions. For example, punishment, penalty and other enforcement factors. This problem is premised on the classification of methadone as an experimental drug relying, of course, on Public Law 90-255, section
408 of that law. The pending bill. S. 788, which last year was 3846, would add additional support to this current and rather tenuous enforcement authority and not be rooted in the classification of methadone as experimental.
In the light of that background, and also in the statements of Senator Cook in introducing the bill last year and repeated again yesterday, would you care to discuss further the ultimate policy question that we will face, which is the problem of trying to strike a balance between the positive aspects of the methadone programs and the problem of diversion, which in some quarters is becoming quite serious?
Mr. KUSHNER. The only thing I would say to that is that the advantages of methadone are quite evident, and especially in the bigger States where the addiction population is so much greater than it is here, it is almost a necessity for those States to catch up with the problem. I think the only route that can be taken is a stricter enforcement of the regulations. There is no doubt in my mind, or in the minds of the Commission members, that this is the right route to take.
Senator HRUSKA. The thrust of the proposed bill is to get at this problem of diversion.
Mr. KUSHNER. Right.
Senator HRUSKA. There are very serious symptoms in evidence that lead us to believe that the problem is fairly bad in places. Before we get to a point where it becomes uncontrollable, however, we hope to get it under control by way of enforcement. This is what we are especially concerned with. If you have any ideas as to standards that we might utilize, or any methods, we surely would be very happy to hear from you on that subject.
Mr. KUSHNER. I think that the new legislation, 92-255, which places much of the responsiblity of coordinating treatment programs and the licensing of those programs at the State level and designating that State drug authority as the responsible party who may also designate another agency to handle the licensing and rehabilitation is another very important means of helping to regulate the diversion problem. In the State of Nebraska, we will be working very closely with the State health department office, and I think a representative is here today to address you.
Our treatment and rehabilitation committee is currently working on regulations for all treatment facilities, and I am sure they will include some regulations concerning diversion of methadone and its safekeeping and the recordkeeping.
I guess what I am saying is that I think that by adding this responsibility to a State level office that can help coordinate it with the Health Department, and any other areas in mental hygiene, or whatever, that there is another step that I think will prove very beneficial.
Senator HRUSKA. Of course, we have to get down to that level, and in that activity, if the program will be at all effective and also devoid of such harmful side effects or consequences that might result.