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short a time, with a recommendation as to the degree of control to be exercised over marihuana use. This special treatment is certainly justified by the social climate of our times and the idea has much to commend it.
One of the features in existing legislation which needs change is the penalty structure particularly as it applies to simple use and possession of controlled drugs. In this respect the bill recently passed by the Senate (S. 3246) is a marked improvement in specifying relatively mild penalties for first offenses of simple use and possession of controlled substances and for trival transfers of marihuana. The bill is also commendable in providing judicial discretion to grant probation for first offenses of possession and possible expungement of the record if the probation is successfully completed. The bill also provides appropriately severe penalties for the illicit trafficker and hibitual criminal. The chief improvement to be suggested for the penalty structure as given in S. 3246 is that in the case of offenders 21 years or less in age probation for a first offense of simple use or possession ought to be mandatory, the second offense ought still to be a misdemeanor, and only on subsequent offenses should the more severe penalties be invoked.
One way of viewing the problem of assigning penalties is that they should be assessed in relation to the harm which a particular offense does to society. Simple use and possession may be harmful to the individual, but is not necessarily harmful to society. Subsequent acts which the individual may commit as a result of his use of a drug may, of course, be harmful to others. But it is for this subsequent act that the individual should be punished and not for the use of drug per se. It may, perhaps, be appropriate to increase the penalty for an act committed under the influence of a drug in a manner analogous to our treatment of acts committed under the influence of alcohol.
Another aspect of the penalty problem lies in the manner of dealing with the addict. Such an individual may commit criminal acts but he does so because of his illness. Adequate legislation should contain provision for such an individual's rehabilitation. Mr. Dodd's earlier bill in the Senate (S. 1895) contained provisions permitting the release on probation into the custody of the Surgeon General of individuals adjudged to be addicts if they would agree to commit themselves for treatment. I was disappointed not to find these provisions in S. 3246.
Our law enforcement officers have difficult roles to play and there may be merit in the contention that their role has become more and more difficult in recent years. It is not my attention nor within my competence to comment on the many enforcement details in existing or proposed legislation. Nevertheless, and in spite of a strong desire to see law enforcement generally increase in effectiveness, I am one of those who believes that the so-called "no knock" provision in currently pending legislation is most unwise. If it should be finally passed it is to be hoped that those who contend that it is unconstitutional will prove to be correct.
Detailed references to the two pending bills (S. 3246 and H.R. 13743) which seem to be most in the forfront designed to adapt them to conform to the above general principles could be supplied if the Committee desires.
Dr. BAIN. I would be glad to go through the bill in detail and point out some detailed changes and submit them to you.
Mr. ROGERS. We would like to have you submit them for the use of the committee, and we will appreciate that very much. We appreciate your testimony very much.
(The information requested was not available to the committee at the time of printing.)
Mr. ROGERS. I might say it was this committee that pioneered the different approach in penalties when we passed the LSD bill because it was there that we changed possession to a misdemeanor and provided that the first offender could have the record wiped clean if in
the judge's decision he thought it was warranted, and they have picked us up now in the bill over in the Senate and I think the provision is to give it a try.
Dr. BAIN. Mr Hunt pointed out the provision for expunging from the record could lead to multiple first offenses.
Mr. ROGERS. This record can only be used once.
Thank you very much, sir. We appreciate your testimony. I am sorry to have kept you waiting so long.
Dr. BAIN. Thank you.
Mr. ROGERS. Our next witness is a man of great patience, Dr. John D. Griffith, assistant professor of psychiatry and instructor of pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn. We apologize for holding you so long. I remember your previous testimony before this subcommittee. We are glad to see you back. STATEMENT OF DR. JOHN D. GRIFFITH, ASSISTANT PROFESSOR OF PSYCHIATRY AND PHARMACOLOGY, VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
Dr. GRIFFITH. Thank you Mr. Chairman, members of the committee. Allow me to introduce myself further as only one of a number of investigators at Vanderbilt Universitly that study problems of drug abuse. Our activities are quite broad and include surveys into the sales and distribution of illicit drugs, the treatment of drug addiction, the effects of drugs on human behavior, and the basic pharmacology of these compounds in animals. All of these activities would be affected by the bill you are now considering.
We have been told by the Bureau of Narcotics and Dangerous Drugs that the controlled dangerous substances bill is quite broad, but that we can trust them not to enforce it in such a way that treatment and research is impeded. I would like to dispute this on the basis of a personal experience.
Last March, just before I was scheduled to attend a scientific meeting a narcotic addict asked if I would hospitalize him and withdraw him from drugs. Since we have a program at the Nashville VA Hospital for addicts and since the patient was a veteran with an honorable discharge he developed his addiction while serving the armed services in Japan-I agreed to admit him when I returned from the meeting.
So that this man would not have to seek narcotics from illegal peddlers, I arranged for him to obtain a small amount of morphine every 2 days from a reputable druggist. This procedure is recommended by the AMA for addicts who cannot be immediately hospitalized. It is not recommended as a treatment in itself.
With the patient's permission, I then telephoned the local Federal narcotics officer and told him what I was doing. This was to prevent any misunderstanding as to the nature of the prescription, the purpose behind furnishing the patient drugs, and the legitimacy of the procedure. The officer said the procedure was illegal. When I disputed this he said he would hate to have to arrest me. I suggested that he contact his district office and the local attorneys general before presuming that what I was doing was illegal.
The officer was advised by his district supervisor that he should proceed. This was not supported, however, by the Federal and State attorneys. The agent later telephoned and told me that they rarely arrested doctors, "just took their licenses away." This was not reassuring.
This prompted me to contact the head of the Bureau of Narcotics and Dangerous Drugs and their chief counsel.
Mr. ROGERS. Was this Mr. Ingersoll?
Dr. GRIFFITH. Mr. Ingersoll and Mr. Miller. Both these gentlemen assured me that I could expect the cooperation of the agent in our program. Mr. Miller added that I ought to prescribe methadone instead of morphine to the patient "in this one instance." He was genuinely surprised to learn that the acute and cumulative effects of methadone are not predictable, especially on an outpatient basis.
By this time the agent had pretty much given up on me and, accompanied by the State narcotics officer, visited the druggist to tell him that what he was doing was illegal. This was not true, as the agent later admitted, but the possibility of an arrest, however invalid, was far too great a risk to pay for an act of charity. I was finally forced to find an emergency bed for the patient and place him in the hands of a physician who really had no time to treat the patient. Therefore, it was no surprise to me when the patient later relapsed and further hospitalization became necessary.
This experience points out several problems. First, it is not the threat of a conviction that prevents a doctor from treating a patient. It is the fear of an arrest. Being innocent does not free one from the possibility of arrest, perhaps a night in jail, and very stiff legal fees. A broad law will only increase such incidents.
Second, the committee should realize that even if the Bureau of Narcotics does administer its program rationally-and I for one do not doubt that this is Mr. Ingersoll's objective-the Federal law would be widely imitated on a State level. Indeed, Bureau lawyers are now visiting State capitals attempting to get such laws passed. Can the Federal Bureau of Narcotics guarantee that the State laws will be wisely enforced?
Finally, I would ask that the committee view the victims of addiction with compassion. Many addicts, for example, were teenagers when inducted into the armed services, only to become addicts while serving overseas. These men deserve better than the jail sentences they get. One such patient has a renal disease and perhaps 7 more years to live. He has served his country. Shall we deny him treatment during the last years of his life?
Mr. ROGERS. Thank you for your testimony, Dr. Griffith. Your experience is very disconcerting to the committee, having gone through what you did. This committee is very much concerned about the problem, as I think you probably know, and transferring so much authority to the Attorney General, the enforcement agency of Government, rather than keeping it in HEW, a scientifically oriented organization. I hope we can make the necessary changes.
You said that this man who had 7 years to live was a veteran. Is there no place to treat him now? Is there no treatment being given this man?
Dr. GRIFFITH. We have only five beds at the Nashville VA hospital to treat addicts and almost no money for staff. We have treated this man as best we can, but he needs something more-methadone maintenance, for example. As least he would then be able to tolerate the last few years of his life without being constantly preoccupied with drugs.
Mr. ROGERS. I just stated we have just increased funds for narcotic addiction centers as well as alcoholic centers. We hope we can begin to meet this problem and can begin to treat them in a medical way rather than just as criminals, as you say.
You have done research in illegal traffic. Where is it all coming from?
Dr. GRIFFITH. Before your committee changed the laws pertaining to amphetamine and barbiturate distribution, these drugs leaked from every point in the chain from manufacturer to the family medicine chest. Since the 1965 legislation, however, druggists are very much more careful about dispensing the drug and doctors are reminded that amphetamine and barbiturates are dangerous because these prescriptions have to be rewritten every 6 months. Many physicians will no longer prescribe amphetamines.
Mr. ROGERS. Has the American Medical Association done anything to tighten up the prescribing of these drugs?
Dr. GRIFFITH. NO.
Mr. ROGERS. Should they?
Dr. GRIFFITH. Yes; they certainly should. Amphetamines have few essential medical uses and we may be forced to follow the lead of other countries and eliminate prescription sales of drugs of the amphetamine class. Japan did this, for example, and brought amphetamine addiction under control within a few years. Indeed, they were so successful they were able to close their Amphetamine Commission.
Mr. ROGERS. Should the same be done in this country?
Mr. ROGERS. Should the Department of HEW have the authority to set the quota that can be manufactured in this country?
Dr. GRIFFITH. Someone should have the authority and I think a doctor education program is in order, too.
Mr. ROGERS. I want to get to the problem of setting the quota. The bill allows the Attorney General to set quotas. Should that be left in the hands of the Attorney General or put in the hands of the Department of HEW for setting quotas for the amount of drugs that may be produced?
Dr. GRIFFITH. In the special case of amphetamines, I am quite certain both HEW and the Attorney General would squeeze it down to
Mr. ROGERS. I understand that. But should HEW do it, which is medically and scientifically oriented, or should the law enforcement agency be the one to set the quota?
Dr. GRIFFITH. I would pick HEW.
Mr. ROGERS. I would presume it would have to be based on medical advice, what use the doctors found for it and how many patients that have to be treated, and I would presume HEW would have better knowledge for getting the sources of that information than Justice. Would you agree?
Dr. GRIFFITH. Yes. However, as much as I distrust the ability of a policeman to decide what is good research and what is bad research, he does have certain data available to him that needs to be made available to HEW on which to make such decisions.
Mr. ROGERS. I can understand that from the number of cases they are finding of abuse and so on, but I am talking about the decision that should be produced in the country.
Should the determination be made by the Attorney General or
Dr. GRIFFITH. HEW.
Mr. ROGERS. I thought so, and I thought you would feel that way. Where is this illegal traffic coming from?
Dr. GRIFFITH. I think that the illegal manufacture of amphetamine right now represents only a very small amount, but it could be expanded very easily.
Mr. ROGERS. Do they use the normal manufacturers?
Dr. GRIFFITH. No, these are the basement laboratories.
Mr. ROGERS. Where do they get the basic materials?
Dr. GRIFFITH. The basic materials are common industrial chemicals. Mr. ROGERS. Should any of those basic materials be restricted or controlled, or have an accounting of them?
Dr. GRIFFITH. Dr. Michum E. Warren, Jr., assistant professor of chemistry at George Peabody College, has made a special study of this and is of the opinion that it would be very difficult to control the illegal manufacture of amphetamines by control of precursors.
Mr. ROGERS. So you see no chance of closing that off?
Dr. GRIFFITH. No, and I don't think this is essential. A more effective approach would be to restrict prescription sales to treatment of narcolepsy and hyperkinetic impulse disorder-two rare diseases.
Mr. ROGERS. Do you think this is where most of the drugs are coming from, diversion from prescription sales?
Dr. GRIFFITH. There is no doubt of that.
Mr. ROGERS. You have no doubt that is true.
Dr. GRIFFITH. Yes. Many doctors will not prescribe amphetamines; others prescribe amphetamines in good faith but are fooled by patients who want the drugs for other than medical purposes. A very few doctors sell prescriptions quite openly. For example, we investigated one doctor in Nashville who gives students prescriptions for almost any reason. One man operating in this fashion can make quite a few tablets available for illicit use. If the indications for amphetamines were restricted to the treatment of narcolepsy and hyperkinetic impulse disorder then doctors would not prescribe amphetamines as freely-for fear of being sued, among other reasons.
Mr. ROGERS. You are telling me there are not really very many medical uses for amphetamines?
Dr. GRIFFITH. A few thousand tablets would supply the whole medical needs of this country. In fact, it would be possible for the Government to make and distribute the tablets at very little cost. This way there would be no outside commercial interests involved.
Mr. ROGERS. The barbiturates do not quite create that problem, or do they?
Dr. GRIFFITH. Barbiturates are a big problem. They are not as easily controlled, however, because these drugs have wider legitimate medical use than amphetamines.