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Mr. ROGERS. The pharmacist will have a record of that prescription and who filled it. Does he put the date it has been refilled and who filled it on the prescription that the person hands him?
Mr. Woods. On the refill. He has a file, a little box in which he keeps all of the prescriptions and he would put that information on the prescription and then file it.
Mr. ROGERS. If I wanted my prescription back, I can get four more refills?
Mr. Woods. You can't get it back.
Mr. ROGERS. It goes to the druggist and he will keep it?
Mr. Woods. Yes, sir.
Mr. ROGERS. The patient can never get it back?
Mr. Woods. That's right.
Mr. ROGERS. Suppose the person says "I want to go to Florida." Mr. Woods. It is against the law for the pharmacist to give it back. Mr. ROGERS. Once you go to one pharmacist, you have to continue going to that pharmacist until that prescription is used up?
Mr. Woods. To get any refill he would have to get it from that same store.
Mr. ROGERS. From the same pharmacist?
Mr. Woods. Yes, sir.
Going back to the matter of diversion, I would like to mention the point that the attorney general for California mentioned that they had found transportation of large quantities of dangerous drugs that have been shipped from a, midwestern manufacturer-I don't know what type of manufacturer it was to Mexico, consigned to Mexico, but really delivered to a warehouse in California.
This seems to me is the type of thing where you have the masses or the big bulk of the illicit drugs.
Mr. ROGERS. I would think so and I want to know why more of this is not tracked down, because obviously it must be going on.
Thank you very much. Your testimony has been most helpful. Our next witness will be Dr. Louis Jolyon West, chairman of the department of psychiatry and medical director, Neuropsychiatric Institute, University of California School of Medicine.
Dr. West, we are delighted to have you here and again we will be glad to receive your testimony.
STATEMENTS OF DR. LOUIS JOLYON WEST, TRUSTEE OF THE AMERICAN PSYCHIATRIC ASSOCIATION; DR. DANIEL X. FREEDMAN, PROFESSOR AND CHAIRMAN, DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF CHICAGO; AND SANFORD MOSS, CHICAGO, ILL.
Dr. WEST. I wonder if I could request that the next witness, Dr. Daniel X. Freedman, be allowed to join me here and follow his testimony after mine and then we would both respond to questions.
Mr. ROGERS. That would be very satisfactory to the committee. Dr. Daniel Freedman is professor and chairman of the department of psychiatry, University of Chicago; also the president elect of the American College of Neuropsychopharmacology.
We welcome both of you gentlemen and we will be pleased to receive your testimony.
Dr. WEST. Thank you, Mr. Chairman.
I am honored to appear before you today as spokesman for the American Psychiatric Association to discuss principles that we believe should underly any Federal legislation for drug abuse control. Our association comprises 17,000 members most of the practicing psychiatrists in our country. The oldest national medical society in the United States, it was founded in 1844 and it has been in operation ever since. American psychiatry is deeply concerned about the outcome of the debate, now taking place in Congress, about how best to approach the drug abuse problem through comprehensive legislation. The treatment of addicts and drug dependent individuals has always been a responsibility of ours. Many of the drugs that lend themselves to abuse are also drugs that have significantly contributed to treatment and care of the mentally ill. Psychiatry is continually involved in research and on a wide variety of chemicals, hoping always to find more substances that will enhance the effectiveness of the treatments.
We are alarmed as anyone about the drug abuse problem in modern society and most particularly among young people, perhaps because we see so many of the casualties.
I might add here Dr. Freedman in addition to his other titles and distinctions is the chairman of the American Psychiatric Association's Task Force on Drug Abuse in Youth.
You have undoubtedly heard many times that the prospects for our society are grim if we as a people cannot stem the rising tide of drug abuse and addiction. The use of drugs for other than sound medical reasons should be discouraged altogether. Psychiatrists applaud the efforts of the Congress to come to grips with the problem through comprehensive legislation. However, at the same time we hope that when such legislation is passed it will not harbor provisions which vitiate its very intent.
The bill (S. 3246) that recently was passed by the Senate has many good features, but it also suffers from some grave defects. It is my understanding that H.R. 13743 now before you is virtually identical. In our view, the major defects of this bill stem from erroneous assumptions about where the priority of emphasis should be placed in the development of a truly effective national attack on the drug abuse problem and where certain responsibilities should lie.
We are distresesed to find that the bill is written primarily from the viewpoint of law enforcement, rather than from a medical and public health point of view. Wise laws, and their enforcement undoubtedly comprise an esential ingredient of a national program to combat drug abuse.
Penalties for the illicit production and distribution of certain drugs must be imposed, and furthermore, if those who develop dependency on drugs become involved in criminal activity, they must be subject to the laws concerned with the particular crimes committed. Beyond that, however, and without excusing any criminal behavior, the drug dependent person must be considered a sick person just as an alcoholic must be considered a sick person. The real hope of our society for coping with the growing problem of unhealthy misuse of chemicals must lie in a massive program of research, public and professional education, and provision of adequate treatment and rehabilitation facilities.
There are many merits in the bill before the subcommittee. Its approach to first offenders, for example, is a move in the right direction. It has long seemed paradoxically tragic to me that the very laws presumably enacted to protect our youth have, in fact, ruined the lives of so many of them. However, while the proposed bill recognizes the rule for the Department of Health, Education, and Welfare in the national effort against drug abuse, it is merely an advisory role in relation to the Attorney General who is empowered to make the final decisions on all issues of substance. Here is a serious defect in the present bill (as contrasted with H.R. 11701). The business of the Attorney General and the business of the Secretary of Health, Education, and Welfare are ambiguously intertwined in this legislation, to the inappropriate diminution of the latter's role.
Perhaps the most telling reflection of the spirit of the bill is the "no-knock" provision, which would allow a police officer to enter a private dwelling, laboratory, or office, without notice or warning, in the search for evidence of illicit possession of drugs. Experts in constitutional law, rather than physicians, should be heard on this provision, but it seems, nevertheless, to symbolize an oversimplified "policeman's" approach to a problem having immense medical, scientific, and social implications.
As I was reading the copy I got of this bill on the plane, I thought of a recent incident in my own family that made me tremble a little bit. The last time I was out of town my wife went to the dentist. He did some painful work and she got a drug called Darvon for pain. She came home and was telling my teenage daughter about this, an 18-year-old girl who attends UCLA. A friend of the family was present. She said, "You know, I get Darvon from my doctor for menstrual cramps."
My daughter was just beginning to have menstrual cramps. She said, "Maybe I could try those for my cramps this month instead of the stuff I got."
So, my wife gave her three or four of her Darvon tablets. My daughter put them in her purse and drove back to the university.
At that point, under this law, if, let's say, my daughter had been in a traffic accident and the contents of her purse had been searched, both my daughter and my wife would be liable to imprisonment for between 2 and 10 years and a fine up to $20,000 or both. Maybe that would not have happened to them but it could.
There are several other provisions of the bill which are of more specific medical concern. I shall mention some of these. But I would not like to pass this point without reminding you that the way the bill is actually worded, half the households in the country have enough in their own medicine cabinets to send the families to prison and they would not have a valid prescription on their person or anything like that, but would have been lost or they would have brought it when they moved from another town and so forth.
For example, certain drugs widely used in medical practice and already regulated as "controlled substances", are included in the classification schedules in the bill; these include some common tranquilizers, chloralhydrate, and paraldehyde. Of course, the drugs can be and no doubt are abused; but not nearly so much as nicotine, alcohol, or even aspirin. For years aspirin has been widely used, especially by
young people, to commit suicide, not to mention the large number of accidental deaths it causes among children.
Generally speaking, the above-noted tranquilizers and sedatives are as "safe" as many drugs not included in the schedules. In short, the criteria used in classifying the drugs in many cases appear to confuse the issue of how medically useful they are, with the question of their actual potential for social abuse.
In other respects the scheduling of drugs appears to reflect a certain lack of expertise and professional judgment. For example, we doubt that bufotenine poses much menace as a dangerous drug, but it is nevertheless classed together with LSD. Meanwhile, the amphetamines, which are placed in schedule III, are among the most dangerous of all currently abused drugs. On the whole, there has been a lack of sufficient medical and psychopharmacological expertise in the formulation of these schedules. They need reworking. Logically, this should be the continuing responsibility of appropriate agencies in health components of the Department of Health, Education, and Welfare. But instead we find that the Attorney General is given final authority to do the classifying. To be sure, the bill specifies that he should seek the advice of the Secretary of Health, Education, and Welfare and a Scientific Advisory Committee in doing so. But it is not stipulated that he is bound by the advice he receives.
It would be far better to remove this responsibility from his jurisdiction altogether. These classifications are medical and scientific matters, not law enforcement matters. An example of a more expert approach to this very issue of drug classification can be found in the new 17th report of the WHO Committee on Drug Dependence, World Health Organization Technical Report Series No. 437, Geneva, 1970. It is much more scientifically rational than the classification in the bill before you today.
Mr. ROGERS. The committee would be pleased to receive that and it will be placed in the committee files pertaining to this hearing. Dr. WEST. It is much more rational
Mr. ROGERS. Perhaps you could go down the list as they appear in the Senate bill and give us your opinion as to whether or not they are proper schedules.
Dr. WEST. That would not be too difficult and I will see to it that such an analysis is put into the hands of the committee.
(The information requested was not available to the committee at the time of printing.)
Dr. WEST. To the best of my knowledge, the Justice Department does not possess a medical staff sufficient to carry out such responsibilities. The necessary expertise already is available in the Department of Health, Education, and Welfare. We see no advantage-and many disadvantages-in directing authority over health matters to an agency that has no traditional roots in medicine and public health, nor any special understanding of the methodology of medical science, nor any particular link with medicine's concerns, its culture, and its purposes. The emphasis in this legislation should be just the other way around. Such matters as what drugs fit into what schedules, which medicaments are to be considered to have relative potential for abuse and to what degree, the assessment of psychopharmacologic effects of various substances, and the evaluation of the current state of knowledge
in the field: these and related questions are the proper business of the Department of Health, Education, and Welfare.
The legislation should specify that decisions in these matters shall be made by the Secretary of Health, Education, and Welfare after consultation with his staff and scientific advisers, perhaps with the stipulation that he should consult with the Attorney General when special problems in law enforcement present themselves.
As physicians, we of the American Psychiatric Association are also dismayed with the power given to the Attorney General in this bill to license medical practitioners dispensing and using various drugs. We do not quarrel with the desirability of special registration for the use of certain drugs but we reject the idea that the Attorney General should be the one to run the registry. Furthermore, we are disturbed to find that he may refuse or revoke a registration "on the ground that the applicant's past practice or proposed procedures furnish ground for belief that the applicant will abuse or unlawfully transfer such substances or fail to safeguard his supply of such substances against diversion from legitimate medical or scientific use." Such language is altogether too broad and lose. This provision essentially empowers the Attorney General to determine which research workers are qualified to carry out investigations with schedule I substances, and to pass upon their research protocols. We think it will discourage research and research investigators.
As Dr. Kline pointed out this morning, it would have discouraged him. I think Dr. Freedman can give us an even more current example. An example of the self-defeating character of such an orientation. can be seen in the marihuana problem. Not the least of the bases for the fact that we don't know enough about the effects of marihuana, derives from the severe difficulties imposed for years by the Government on prospective investigators. Even those, like myself, who are deeply concerned about possible subtle psychological changes in the personalities of chronic marihuana smokers, cannot point to solid research findings to use in persuading young people to avoid the drug or give it up.
I have some very persuasive arguments I use.
Mr. ROGERS. What are those arguments mainly, doctor?
Dr. WEST. I think Mr. Kyros pointed his finger at some of them when he was questioning Dr. Kline this morning. I think it is better to be sober than intoxicated. I think there are possible dangers in the use of marihuana that may not have come to light yet.
Meanwhile, why take a chance with your brain? I feel certain that without being able to define yet all of the cause and effect relationships that a great many young people that I have seen who have used large amounts of marihuana over a long period of time have suffered personality changes in relationship to that use. That certainly has not been helpful to them and I think it has been harmful to them and I try to persuade them not to use it. I also try to persuade them to use tobacco and alcohol only in moderation. How successful these efforts are, I can't tell you.
This situation is in sharp contrast with the vast amounts of data that have been collected in support of the anticigarette smoking campaign which is now beginning to pay off. It may also be contrasted with the striking success of the venereal disease control campaign of the