Carl C. Pfeiffer, M.D., Ph. D., Deputy Director, Bureau of Research in Neurology, and Psychiatry, State of New Jersey.

Dr. Henry K. Oliver, Professor of Hygiene, Harvard University.

Herbert A. Raskin, M.D., Adjunct Associate Professor of Psychiatry, Wayne State University, Detroit.

F. C. Redlich, M.D., Dean, Yale Medical School.

Howard P. Rome, M.D., Professor, Mayo Graduate School of Medicine, Mayo Clinic.

Michael Rosenthal, Professor of Law, University of Texas and Former Consultant, President's Commission of Law Enforcement and the Administration of Justice.

Parkhurst A. Shore, Ph. D., Professor of Pharmacology, University of Texas, Dallas.

Louis Jolyon West, M.D., Chairman, Department of Psychiatry, UCLA.

Harry L. Williams, M.D., Professor of Pharmacology, Emory University, Atlanta, Georgia.

Stewart Wolf, M.D., Regents Professor of Medicine, University of Oklahoma. Lauren A. Woods, M.D., Ph. D., Professor of Pharmacology, University of Iowa.

Arnold Ludwig, M.D., Member, Wisconsin Dept. of Justice Advisory Committee on Drug Abuse.

Mr. ROGERS. Dr. West, I share your concern and that is why this committee is going into great detail into this problem.

Did you testify before the Dodd committee?

Dr. WEST. I did not.

Mr. ROGERS. Did anyone representing your association testify?
Dr. WEST. No, sir.

Mr. ROGERS. Was a request made at all?

Dr. FREEDMAN. I believe so, sir. I know for a certainty that the American College made a request for a Dr. Jonathan Cole to appear. He received a letter but no invitation.

Mr. ROGERS. He could only file a written statement?

Dr. FREEDMAN. Yes.

Mr. ROGERS. I think that is unfortunate.

Before we go into questions, I understand, Dr. Freedman, you would like to make your statement.

STATEMENT OF DR. DANIEL X. FREEDMAN

Dr. FREEDMAN. I do want to thank this committee. Mr. Chairman, I want to see effective law enforcement, effective reg ulation of illicit drug traffic, effective preventive measures to combat the epidemics of drug abuse, and useful treatment for its victims. In the process, the rights of privacy of the great majority of the lawabiding public need not be abrogated; the advancement of our attempts to conquer ignorance and disease through research and education need not be retarded. Indeed, we can have effective enforcement without intruding the threat of police between patient and doctor, without subsidizing propaganda from a powerful enforcement bureau to replace credible education. We can do this if we really want to.

But the BNDD has written a different scenario in which the bathroom medicine cabinet and the physician's consultation room are open to the intrusion of Federal agents. This is not because Congress has found such powers to be necessary. Rather, we all have been promised that since the BNDD are nice people, they will not use the extraordinary powers they ask from Congress. If such powers hit the mark,

one would not be opposed; but they splatter aimlessly over a wide area rather than targeting on the real problem.

This country is facing two epidemics. Across the land there are epidemics of specific or multiple drug experimentation, epidemics which rise and fall. They may begin with college-age youth, or with veterans, and they eventually can pass through the age groups down to the grade school level. These are epidemics of drug experimentation, misuse, and abuse.

There is a second and quite significant and larger epidemic. I call this an epidemic of drug interest. It is fed by a number of sources which, at this moment of legislative emergency, we need not elaborate. This epidemic is reflected in the various drug cultures, in an overly morbid fascination in turning on, up, down, or off with drugs, or in debating this. It is this spread of drug interest which has upset our entire society. This is reflected in anguished discussions of parents and children, schools, churches, as well as the local police and press, with respect to drug problems. Parents-no matter how misguided or misinformed-are rightly concerned that the use of these drugs and the focus on drug experiences can have the potential for disrupting the development of sound skills, sound habits of self-regulation. So, we all are confronted with an excess of excitement about drugs and understandably-this evokes latent panic. This makes it difficult to toughly calibrate exactly what the scope and range of dangers are. Before we lose our heads and our rights and our health resources as well, we ought to come to our senses and inspect the issues.

They clearly call for action. Yet, even if the entire medical profession and the entire group of scientific teachers and investigators who employ a medicine were abolished, this would not touch the real epidemics of drug interest and misuse, their nature, their causes, sources, or their cures.

We do not want our justified anxiety converted into panic which will blind us to the really effective measures that can be used. I am sympathetic with the difficulties enforcement may have, and wish they had asked for what they needed rather than what they do not need. To be brief, we do not want our panic used as an excuse for politicizing the entire area of medicine, health research, and their proper regulation.

Strict constructionism, if not commonsense, would indicate that where each Government agency does its job well and collaborates, the public can begin to expect some realistic answers to drug abuse. Or do we have a series of private governments in the executive branch? Where any Government agency either ducks its responsibilities or arrogates power for which it has neither competence nor mandate, we should at least be suspicious and require thorough inquiry, and we probably should expect the worst.

To be blunt, there is absolutely no question that the Government's health scientists have been muzzled, while their spokesmen mumble confused reassurances. I cannot see, in an area as serious as this, why anyone should fear the truth, and I think it could be severely damaging to our health enterprise not to speak the truth. Personal whim cannot be the basis of sound drug control policy. Congress, I would hope, does not give power to an agency simply because a particular

man wants it; would it hesitate to thrust obligations upon an agency simply because some particular man does not want it? Specifically, either Dr. Egeberg does not know what he is talking about or he won't talk about what he knows. In every step of this bill, it should be the primary responsibility of the Department of Health, Education, and Welfare, and not the Attorney General, to arrive at decisions which require primary competence in scientific or medical matters.

I want to say at the outset that I see only one ultimate answer to these epidemics of drug interest and drug misuse. A general habit of constraint in our use of recreational drugs-nicotine, alcohol, as well as the medically useful drugs which the Bureau of Narcotics now wishes to control-is required. We will have to temper our beliefs that drugs are magic bullets to answer life's problems. We will have to continue to develop a variety of regulations-some arrived at by consent and some by law. So, no informed persons is against effective regulation.

I must say if we really examine medical practice, we would find there are many internal constraints from hospitals, local societies, and

on up.

But the bill before you misses the mark. After all, illicit supplies of drugs have been diverted by many groups: narcotics agents (if you recall the arrests of over 20 last year), by a few physicians, and perhaps researchers. None of these diversions represent the real target. While many were mesmerized by a reduction in penalties, the bill inserted broad, intrusive powers, largely irrelevant to the control of illicit traffic in drugs.

But worse than this, it is an overwritten, imprecise, and confusing bill which will be enormously costly in the area of health care. Even members of the BNDD's advistory committee cannot tell us what it contains or how individual teachers or doctors can proceed. Some of these did not ever know that their advice was at the whim of the Attorney General-unlike the councils of NIH. Others thought research was not reviewed by Justice, when, in fact, the language and intent to review purely scientific protocols or procedures is indeed in the bill, and has survived every re-write since draft No. 1. If it is a seriously enforced bill, it will require an entire new health establishment built into the Department of Justice. We might as well move into the BNDD the Bureau of Standards, the assessment of pollutants and any other action based on technical data that the Department of Justice has to take.

Congress should not be led to believe that there is not already within Government a mechanism for conducting research and education or for regulating the introduction of new compounds (e.g., the investigational new drug regulations of FDA)-agencies lodged within the Department of Health, Education, and Welfare.

The Bureau of Narcotics and Dangerous Drugs cannot produce succinct evidence to demonstrate to you how it is that they could have stopped epidemics which have occurred with the powers for which they ask. This bill would have been credible if, instead of directing the Attorney General to duplicate research (or subsidize congenial results), it had asked for what it already has the tools to identify the contents of street drugs. One might want this done by another agency if developmental research is entailed but-just as fingerprints

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are useful in enforcement-so, too, would be the identification of drugs. But if this is so, why not be explicit? This kind of vague bill writing convinces us that BNDD wants more than effective police forces need. The bill also asks to educate but-if I were a proponent of the bill-I would specify education of agents and police. Why were these legitimate specific requests not made?

When one asks the Bureau precisely why they must have these extensive powers, why they must have the initial and final authority to classify the dangerousness of drugs, why they must adjudicate research, and why they must carry out programs of education, the answer is always simply, "We must-don't worry." I find it inconceivable that a Congress would rest with such an answer. To tell the public the truth, this education has been going on for the past 40 years-although under what line item on the budget I do not know. The Bureau of Narcotics has been "educating" its own officers and enforcement officers at every level in this country, and doing so even under the enlightened leadership of Mr. Ingersoll. The misinformation in many of these documents is well worth scrutinizing. What I am saying bluntly is that the Bueau has lobbied for years and has continued to do so. It has drafted so-called model legislation for the States, recommending similar omnibus powers which could apply to a vast array of local, county, and State officers. I believe that this is not good practice for the Bureau, nor for the public, nor for the good cause of combating drug abuse. Nor would I at all mind scrutinizing the method by which contracts have been let or scientific projects funded. If the National Institutes of Health followed the practices of this Bureau, Congress would have reacted strongly, and I see no reason for exemption here.

It clearly is equally important to ask the Bureau for proof as to why major diversions of drugs are not controlled. If international agreements are needed, let us have them. If there are not enough agents, then let us have more agents. But the problem of ineffective control cannot be because Federal agents need more time to do research or to go into the classroom.

If I were a proponent of this bill, I would not be able to explain to any colleague who happened to be teaching physiology or basic medical sciences what he is or is not liable to under this act. The legalistic twists and turns-the giving with the left hand and taking with the right hand-have been followed by many of us since the bill began to be drafted over 14 months ago. All we do know for a certainty is that there are not sufficient funds to get the various jobs that need to be done in drug abuse done. Why is that not the center of our attention? But, if one indeed were looking for the economical way out, he would not fund what this bill entitles the Bureau of Narcotics to do. You have already heard testimony on the costs of hospital and clinic recordkeeping; I would also advise you of the costs of preventive recordkeeping-namely, in view of the vague and implicit powers scattered throughout the bill, no sane researcher or cautious physician, or clinic, will expose itself to sanctions for even innocent oversights, sanctions that neither tax evaders nor polluters have to face.

Again, if those upon whom the costs of this bill would fall were major offenders, one might not be disturbed-but the costs of this bill go directly to the legal practices of the bulk of the law-abiding

public. In this bill, approximately one-third of the prescriptions written by general practitioners would come under the control of the Attorney General. If any physician has to administer a "starter dose" of these commonly used medicines, he had better have his file cabinet and secretary near at hand.

Not only is the bill impractical, not only does it make unnecessary work, it still is scientifically inaccurate. Of course the BNDD will tell you that this bill has been written with the greatest of collaboration of the Department of Health, Education, and Welfare a fact that all of us know is not true. The evidence is that the wealth of pharmacological talent in the National Institutes of Health could not have made the mistakes and misspellings and misclassifications that appeared in every version of this bill. Some are still present. A veterinary anesthetic is classified as an opiate; a psychopharmacologically inert substance is classified with LSD-possibly because it is a precursor; but in that case, a number of conceivable precursors of hallucinogens are not on the list. The Bureau wishes to codify every conceivable drug that might conceivably be used and to list these prior to the first warnings of an epidemic-it scientifically cannot be done.

I could-but, in the interest of public health, will not-cite some common compounds easily available in every supermarket which have been involved in epidemics. Where are those potential public health dangers classified in the comprehensive bill? I do not understand why administrative devices so costly to the confidence and progress of our public health and so far from the target of illicit supplies are proposed when many substances inconvenient to control in this way-are not even mentioned. Is the Bureau limited?

I can only conclude that this bill represents an arrogation of power, pure and simple.

The BNDD should not become a medical treatment agency. Many of us know that draft guidelines for regulating how methadone should be given exist, but neither we nor most of the advisory groups have seen these documents from Mr. Ingersoll's group. Is this the collaboration promised? You will hear testimony that responsible clinics, working with research in the use of methadone for narcotics addicts, have in the past been harassed by narcotic agents. Experts in the health field who have tried in the last 10 years to deal with drug casualtiescasualties one Bureau of Narcotics official called garbage-have been on the front lines and have known, often before police agents, what epidemics were beginning. Two such scientists in New York were called into court for their legitimate program.

I brought with me, Mr. Chairman, a colleague in our narcotics program in Chicago, Mr. Moss; when we have concluded, I hope you will hear from him for a few minutes to help you get a personal picture of what happens when physicians retreat from treating addicts. I think it would be useful.

Now, in view of all of this history, I would like to announce to you that the first drug which appears in the Attorney General's list as having no medical usefulness-acetylalphamethadol-will shortly be reported in the journal of the American Medical Association to indeed have great promise. Because it acts for 48 hours, it could diminish the portable methadone which might to a small degree provide a minimal diversion of supplies.