We have been doing that for a long time and have not achieved anything. In fact, all we have seen is an increase in the number of people who are abusing drugs.

People take drugs because they have received some benefit from the drugs they are taking, and what we have to do is give them some alternative, some alternative way of dealing with their problems, of dealing with the crisis situations which they have to meet and not make that alternative drugs.

So, I definitely would recommend that if they do move this drug into controlled substance schedule II category, that the people who are in possession of the drug should not be placed in jail for possessing but should be put in therapy programs, rehabilitation programs. And that is also an important factor, because at the present time there are very few programs available for people who are not dependent on opiates.

We do not seem to be very concerned about these other problems, and it is quite obvious from what is happening in the Government that funds are being cut back in this area. I think this is a tragic mistake, to cut back on appropriations dealing with the problems of individuals who take drugs.

I think we should develop programs for people involved with amphetamines, people involved with the sedative-hypnotic-type drugs, and not just limit it to heroin. And I think we should remove criminal penalties for possession. It is no solution to the problem.

Senator BAYH. I think there is a great deal of merit in what you say as to our inability, almost total inability if not total inability, to date, to provide clinics that will treat adequately the amphetamine abusers the speed freaks-the barb addicts, the Sopor, and the Quaalude addict or whatever. The entire emphasis, unfortunately, has been almost exclusively on treating heroin addiction.

In fact, you can force someone to go cold-turkey by locking them up, but that does not deal with the problem that spawned addicts and what happens when you release them.

Let me ask you this: I am speaking not about the person who may purchase a handful of 10 to 25 tablets to sustain his individual habit, but the individual who has in his possession the pickle jar of 2,500, or the drugstore or the druggist who does not keep this particular kind of substance under lock and key. Other provisions of schedule II require the production control; require the careful policing and securing of the drug at all levels; require that prescriptions are more carefully monitored, so you can't call them in. So, it is more difficult to secure the drug in the first place. And there are additional controls under schedule II. What about these? Should they be applied to methagualone?

Dr. SCHNOLL. In those areas, I think there should be some form of punishment for the drug companies which overmanufacture. I think that they are as much a pusher as the man on the corner who is selling a few bags of heroin.

Senator BAYI. If I might interrupt? Before dealing with punishment, would you support the application of the stricter criteria? In other words, as far as production, would you be in favor of produc

tion control. As far as prescriptions, would you require a short-term prescription which could not be given orally over the telephone?

Dr. SCHNOLL. Yes.

Senator BAYH. Would you require it to be kept under lock and key in each State and not be treated cavalierly as it is now?

Dr. SCHNOLL. Most definitely. As I mentioned, I feel it should be placed in schedule II; however, with removal of the provision that the person in possession of a few tablets or capsules not be punished criminally for possession. However, I think that the individuals who are manufacturing, selling, distributing this substance should be punished in accordance with the act at the present time.

Senator BAYH. When this committee started the ball rolling on amphetamines, we were told by, I assume well-intending, officials of this Government at high levels from BNDD and FDA and some members of the medical profession that this was a poor way to proceed because amphetamines, barbiturates, methaqualone all have a legally recognized medical use, and they said: "Senator, if you dare to limit production, you are going to limit the accessibility of this drug to the doctor who is careful and has a patient who really needs it." Now, of course, with amphetamines, we found this last year we were able to cut production by 80 percent. I do not know whether you, as a doctor, have heard of a lot of people who needed amphetamines who have not been able to get them because production was cut, but if you have I would like to know. If you have not, I would like to know your opinion as to whether we might run into this problem if we place methaqualone into this category and cut production?

Dr. SCHNOLL. I do not believe we will limit the availability to those individuals who need the drugs therapeutically by limiting production. Certainly, I think that at the present time all sedativehypnotic drugs are used by the medical community as well as by people on the street by overprescription, and I think the people should be made aware of this.

The cutback in amphetamines certainly did not limit its availability to those who legitmately need the drugs, and I do not think we are going to limit the availability of methaqualone or any of the short-acting sedative-hypnotic drugs simply by limiting production to a reasonable quantity.

I think, at the present time, if the figures that BNDD is publishing are correct, there are 147 million dosage units being produced in the United States, which is a rather extensive quantity of just one sedative-hypnotic drug, and there are many other sedative-hypnotic drugs produced in this country. I think the drug companies have led us to believe a lot of things that are erroneous, making us believe we all need drugs to sleep properly.

There is an ad on television that used to say that if you do not fall asleep in about 15 minutes, there is something wrong with you, that maybe you need a drug to help you fall asleep. And, yet, scientific studies have shown that the average sleep-induction time was between 20 and 25 minutes. So, most people are not going to be asleep in 10 or 15 minutes.

So, they are giving us erroneous concepts of how we have to live. And this kind of advertising is also sent to the physicians in beautifully photographed pamphlets. Individuals come to the physicians' doors and drop off samples. The average physician is learning about drugs, not from pharmacologists, but he is learning about drugs from that book that is on your desk there, the "Physician's Desk Reference," which is put out by the pharmaceutical industry.

The information in there comes from the pharmaceutical manufacturer of each substance, and it is not an independent evaluation of each substance. I think this leads to a great deal of overprescription and overuse of drugs.

Senator BAYH. We know you have to catch this plane, but let me ask you one more question.

We will put your entire statement in the record.

Senator BAYH. I note on page 6 you mention that many physicians feel the drug is completely safe because it is not included under the Controlled Substances Act.

Now, in your experience, what other standards does a typical physician rely upon the assess the dangerousness or abuse potential of a given drug?

Dr. SCHNOLL. He relies upon the information received in a book such as PDR and the information he gets from a detail man.

The mere fact that a drug is placed under control by the Bureau of Narcotics and Dangerous Drugs is an important factor to a physician, letting him know that that drug is abused and that he should be concerned about how he gives it out.

Senator BAYH. I suppose that would be true of the great bulk of physicians and pharmacists?

Dr. SCHNOLL. Yes.

Senator BAYH. Men and women who want to do the right thing. And if they get that red flag, they are more apt to be careful.

Dr. SCHNOLL. Absolutely. That is an important factor in letting people know of the possbility for abuse of the substance.

Senator BAYH. Do you have any suggestions as to how we can provide better information to the doctors who make these assessments?

You are critical of this digest

Dr. SCHNOLL. The PDR, yes. I said there should be an independent assessment of all drugs which should be funded probably by some independent council and distributed free of charge to physicians just as the PDR is, so the physician does not have to pay for it. Whatever he gets free, of course-whatever any individual gets freeis obtained more readily than that for which he has to pay.

And I notice the AMA Council on Drugs has stopped publishing their booklet on the evaluation of drugs, and I think this is a terrible error. I think we need such independent sources of information, and information obtained from these councils' books should be distributed freely to physicians, just as the PDR is.

Senator BAYH. Well, for the second time, let me ask you one last question:

As a practicing physician, can you see any reasons, any red tape, any inconvenience which might make it more difficult for you to do your job if this type of substance was scheduled under schedule II?

Dr. SCHNOLL. The major difference, if that were put into schedule II, would be to place my BNDD number on any prescription, which takes about 3 or 4 seconds more in terms of what I have to write.

It may require a little red tape in sending away for my BNDD number which costs a minimum amount of $5. I do not think that is a great burden on anyone. I think the $5 is also tax deductible, so that physicians should not mind sending away for that.

But also the only other limitation is it would not allow the person to get unlimited refills. In schedule II, refills would not be allowed. I think this is important, because it makes the physician reevaluate the case more often.

Senator BAYH. I am going to be the devil's advocate. I am a retiree, and I have difficulty making ends meet, and I have to scrimp, but I also have trouble sleeping, and you have prescribed methaqualone. Do you prescribe methaqualone in one form or another?

Dr. SCHNOLL. Yes.

Senator BAYH. Now, if this substance is in the II category you are limited to one prescription. This man might have to come back to you. I have to go back to you to make certain that everything is as I say it is?

I can't call in on the phone after 30 days, can I?

Now, looking at it from the standpoint of that indigent or semiindigent elderly person, or any other patient, is that kind of hardship insurmountable?

Dr. SCHNOLL. I do not think so. I am considered somewhat as a radical in the medical profession, because I do not believe that people should have to pay to receive medical care, and that is why I run a free clinic. And I do not think, if we did give free medical care to those individuals, it would be much of a hardship, and I think the programs such as Medicare and Medicaid which are now being cut back should, certainly, be reinstituted and allow these people to go frequently to a physician when they need to without having to worry about the costs involved.

Senator BAYH. I know some people would think it is a hardship. But there is nothing like having a doctor observe and review the case. I know senators discuss an issue and when it comes up again 6 months later, you have to force yourself to refresh your memory. With physicians, it seems to me, the benefit to be derived from that would be the increased quality of medical care that the person receives and that the increased quality in medical care would offset the hardship. But I want to get your impression as a physician.

Dr. SCHNOLL. I definitely agree with that. I think all too often, especially in hospitals, physicians very frequently, whether the patient needs it or not, write a prescription for a sleeping medication and quite often for several other medications and are not aware of whether the patient even gets the medication or not. They just write PRN-which means as needed-after the order. This is standardly

done. The physician after his general order will write for some sleeping medication for the patient. So, the physician is not aware if the patient has some sleeping problem, which he probably should be made aware of if it is present. And in this way the patient gets the sleeping pill and the only person who knows is the nurse.

In medical school, I was taught at the end of each order for patients coming into the hospital I should write for a painkiller, laxative, and a sleeping pill so I would not have to be awakened in the night if someone had a pain problem or was constipated or had problems sleeping. I think this is a terrible way to practice medicine.

Senator BAYH. For all of the above?

Dr. SCHNOLL. Yes.

Senator BAYH. Thank you, Doctor.

Dr. SCHNOLL. I would like to demonstrate the extent to which the drugs have come into the subculture or the youth culture. And these shirts, Senator, are available all over the country at the present time. And there are others that have AS on them-for Arnar-Stone -with a pill on it also.

Senator BAYH. Could I have it?

Dr. SCHNOLL. Certainly. Where do you want to wear it? It is yours. I hope it fits.

[The photograph was marked "Exhibit No. 5" and is as follows:]