In addition, the arrest liability for these behaviors is very low. I don't want to antagonize the enforcement people of the country, but if you want to understand criminal involvement go to the addict himself and forget arrest statistics. We have gone to the addict and interviewed him while he is still active and our data would suggest that he is committing in excess of 120 crimes for each one that he is arrested. For each one that he is arrested, less than half of them are ever brought to the point where he is found guilty and either serves times or is put on probation for that offense. The arrest liability for committing crimes is relatively low.

Speaking to the issue of the new patient being a younger person, we know that he is. In 1965 the average age of patients seen at the Lexington facility was around 30. The average age of all people seen in the New York State narcotics program last year was only around 23, and it was a much larger population that the one we had in Lexington. The age of the addict has gone down considerably. We are not dealing with a 30-year-old adult. We are dealing with a 19-, 20-, 21-, and 22-year-old beginning adult.

During the same period of time when the ages were high, we did not see the individual in treatment until he had been addicted some 7 to 10 years. Now we get him into treatment during his first and second year. We are not only getting a younger addict but a novice addict.

I point these out not to give you numbers or facts because I am not sure what they mean. I rather ask you to ponder something. If we have generated all of our treatment modalities on the basis of the addict we were seeing in 1965 or so but the essential nature of the addict has changed, should we not consider what changes and new modalities ought to be pursued?

I would also hope that those who shape our national strategy would consider that probably more of our population have become dysfunctional from the abuse of nonnarcotic drugs, the so-called soft drugs, than from the abuse of narcotics.

Let me share the results of a study we recently did in Miami. It involved going to the emergency room and finding out what kind of OD's showed up.

Jackson Memorial Hospital is our county hospital and our teaching hospital. It has the fourth most active emergency room in the country. We get some five OD's a day in our emergency room. We followed those OD's for an 8-month period. Of those who survived, we found less than 30 percent-28.3 percent-had overdosed from using one of the illicit drugs. The remainder had overdosed from the legally prescribed and distributed drugs. We were very surprised to learn that because these OD's were overdoses from the legally prescribed and dispensed drugs were not from narcotics. Some 28 percent were for sedative overdose, and the sedative overwhelmingly was Doriden, at that time being marketed as a nonbarbiturate nonaddicting sedative-hypnotic. As a result of exposing the misuse of Doriden in our community we believe the incidence of its use has declined.

We found more of our people, for example, showing up in the emergency with OD's from Darvon that we did from heroin, and yet this is a drug which is essentially noncontrolled. I guess what we are saying is that we would hope that the national strategists would not overlook a couple of items we believe. One, there are people who have drug

problems which methadone will not address and there are people wanting in programs other than methadone. For example there are waiting lists for the Therapeutic Communities in my county. We would also choose that they not lose sight of the fact that in numbers we have a bigger problem with the nonnarcotic users.

Senator HUGHES. Thank you very much, Doctor. You have covered a lot of territory in your statement. You have raised a lot of questions. How does it happen that addicts in maintenance programs have enough left over to sell?

Dr. CHAMBERS. Possibly Mr. Ellis has better insight into that issue than I do. It has been my experience that many addict-patients, once they get onto a take-home regimen often begin to manipulate their own medication. An individual cuts his own dose. If he is on 120 I believe he can cut that to 60 with no problem. Then he has 60 milligrams a day that he can sell. He then uses the money to buy stimulants or sedatives. He buys amphetamines, cocaine or some of the sedatives which he can inject to get high. In this way, he never has to worry about being sick but he can also have his high.

The question is how much diversion occurs from this process as compared to how much private physicians are prescribing and diverting, how much staff within methadone programs themselves are selling and diverting, et cetera.

Quite frankly, none of us know.

Senator HUGHES. Do you have any idea from your research, how many methadone addicts there are in the country?

Dr. CHAMBERS. No; we could hazard a computation. Primary methadone addicts are showing up in the Federal program. Roughly some 8 to 10 percent of all admissions may be methadone addicts. We are getting about the same figure in our community based programs. It is a difficult thing to assess. An individual might be a heroin addict the first 6 months of this year and his supply could dry up, his pusher might get busted, and he could switch to illicit methadone for 6 months and then move to get another drug.

One of the things I would reinforce with you, Senator, is that we don't have, at least in my data and surveys, the primary narcotic addict that we had in the past. We have a polydrug user. Methadone will address only the narcotic portion of this polydrug habit. If he is using eight different drugs from say, six different classes such as sleeping pills, minor tranquilizers, stimulants, psychedelics, and so forth, on top of his heroin, any programing we do with methadone addresses only the narcotic portion of his drug taking problem.

We have labored under a relatively naive assumption for a long time that if we addressed what drugs did to the individual we had hedge on him. I think that is probably incorrect. If we don't begin to address what the drugs are doing for him, then we are going to continue to have, basically, the same kind of success we have had in the past 35 years which hasn't been all that great.

Senator HUGHES. Mr. Ellis, as I understand it, you are a counselor with Dr. Chambers.

Mr. ELLIS. Yes.

Senator HUGHES. If I heard correctly, you have been 8 years on methadone maintenance.

Mr. ELLIS. Not quite 7. I came to Florida several months ago and I was with the Beth Israel program for over 6 years.

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Senator HUGHES. You and your wife are both on methadone maintenance?

Mr. ELLIS. Yes.

Senator HUGHES. How many years did you use heroin?

Mr. ELLIS. 19 years.

Senator HUGHES. Then you would be the typical heroin user Dr. Chambers was talking about?

Mr. ELLIS. Yes, sir.

Senator HUGHES. Why do you want to stay on maintenance?
Mr. ELLIS. I use the phrase that I was tired of being tired of that

life.

Senator HUGHES. How old are you?

Mr. ELLIS. Forty-five.

Senator HUGHES. And you have been on methadone maintenance for 7 years. How many times were you in prison?

Mr. ELLIS. Four times.

Senator HUGHES. Each time you came out you went back on heroin! Mr. ELLIS. Right away.

Senator HUGHES. During the first day or two?

Mr. ELLIS. Well, not quite.

Senator HUGHES. As soon as you could make enough money or steal enough?

Mr. ELLIS. Absolutely.

Senator HUGHES. Were you in Lexington?

Mr. ELLIS. Yes, sir.

Senator HUGHES. Did that give you enough contacts to take you all over the country?

Mr. ELLIS. Pretty near; yes.

Senator HUGHES. That is what I have heard. When you go to Lexington, you can make contacts to buy heroin all over the country. Then you don't have much trouble going to any city and finding out where to make a buy.

Mr. ELLIS. Yes.

Senator HUGHES. What do you, as a counselor, find with these young men and women coming in? Give me your concept of what is happening, if you can.

Mr. ELLIS. AS Dr. Chambers mentioned, it is an absolutely new breed of drug user today. I don't consider them "junkies." I call them drug abusers. The oldtimers, if you will, either are on the methadone program or they have passed on. After being with this program all these years I found that being lax, as the doctor mentioned, does give you a chance to chippy with the medication.

I will give you an illustration. If you are getting 100 milligrams from the clinic you begin to feel that maybe 80 will hold you. Now you have an extra 20. Then you try 60, and so forth. Unless you have the proper facilities and laboratory workers and staff, methadone can't work properly. As they do down in Florida, they screen the urines out pretty near every day, which ultimately makes it impossible for one of these people that are abusing drugs to get away with it even of someone doesn't deserve the use personally. It shows up in

the urine.

These junkies, so-called, today are altogether different than my era, for some reason. They think they are a lot smarter. It is just an asbolute new breed. It is altogether different games.

Senator HUGHES. What success do you have in counseling them? Mr. ELLIS. Fortunately, there are some that look to me as a former loser that came back, thanks to methadone, which only helped partly. I needed a lot of confidence that was placed in me by people. I went to school. I graduated from college since I have been on the program. I needed all types of work. It wasn't the methadone alone that did it. I needed a lot of insight into myself. My wife helped me quite a bit, strangely enough, and vise versa, I helped her.

The basic thing is, Senator, that if you are not honest with yourself, it is just a waste. You can get all the methadone in the world and that is only the surface of this cure.

As the doctor mentioned, you have to get jobs, schooling, and you have to be game for anything to want to help yourself. Of course, you have to do the work.

Senator HUGHES. There also has to be an opportunity for hope and dignity.

Mr. ELLIS. Absolutely. Trust-you have to place trust. There is a lot of success in these programs that I have seen. But by and large, unless you have a properly oriented staff, it seems that just “maintaining" isn't the answer, though I do approve of methadone. Senator HUGHES. Tell me how methadone affects you.

Mr. ELLIS. How it affects me now?

Senator HUGHES. Did you feel any high from it?

Mr. ELLIS. Never. I can appreciate what euphoria is, Senator. I, for some reason, never got that so-called high. I wasn't looking for a high, as I did with heroin. I was just concerned about being normal, just going about my business day by day. One of the toughest jobs I had after I got on the program, and I told the doctor this many times, was that I stopped lying approximately 90-some-odd percent. Senator HUGHES. That is a fair percentage.

Mr. ELLIS. Well, you have to sell some people.

Dr. CHAMBERS. It has to be normal.

Senator HUGHES. It is probably better than average.

Mr. ELLIS. That was the toughest job I had, Senator, to try to be truthful. The whole life was an out and out farce.

When I first got on the program, I knew I was going to succeed for one big reason, because I couldn't turn around in those years with heroin without getting busted, doing time for forging prescriptions, etc. I did 12 years out of my life in the penitentiary. It seemed that that wasn't the answer by any means. Sometimes they had no facilities, and they would send me to a State hospital even though I knew I wasn't insane. But when I heard about methadone, I latched onto it and I just, so to speak "went along" with the program. I was a little more fortunate than the average. I went to work for the program right away. I just figured I am going to make a success out of it and I have.

I have been helping many of my constituents. I try to show them the rights and wrongs of this game, and so forth.

Senator HUGHES. Do you want to get off of methadone?

Mr. ELLIS. Absolutely, yes, sir.

Senator HUGHES. After 7 years, when do you start?

Dr. CHAMBERS. I might interrupt here. Charles and his wife both want detoxification and have approached me both in New York and

in Miami. We have not detoxified them in Miami because we don't think it is a suitable time. A suitable time is a very nebulous kind of thing, but we want the best pluses going that we can have. They only recently relocated to Miami, they have bought a home for the first time, they are living in a nice suburban community for the first time, as opposed to New York City and I wanted them to get settled first. He will start his detoxification in another 30, 60 or 90 days in a very programed, clinical research manner. I have great faith it will hold.

Senator HUGHES. Clinically not only is this important but if I read Mr. Ellis properly, he is more interested in facing himself for what he is and gaining an identity. If he has a difficulty, I think he will be the first man to tell us so.

Dr. CHAMBERS. I am constantly amazed that we don't listen to our patients very well. I think they can come to us and tell us when they are ready for detoxification. If we tell them they are not ready, essentially what we are saying is that we are not ready yet.

Senator HUGHES. Mr. Ellis, I found, a lot of heroin addicts being maintained on methadone who are consuming alcohol by the gallon. I look at them as chronic alcoholics while being maintained on methadone. Do you find this in your constituency also?

Mr. ELLIS. I worked with the Beth Israel program for 6 years. Unfortunately, it was a problem there. The fellows who started drinking started for the same reason they started using junk. It is what they call today peer pressure and years ago it was that they didn't want to be chicken.

For the life of me, I could never get it across to quite a few of them that our livers are already damaged just from using narcotics, and yet they drink that good 45 cents a pint Gypsy Rose or Thunderbird, that has been chemically aged for 2 hours and it gets to them. It is really pathetic.

I understand they are starting an alcoholics program in New York. I hope they will be successful with it. The only way these fellows will stop drinking is for them to use the same reason they had wanted to get off of junk.

Senator HUGHES. Once they get off heroin, addicts need a job if they are going to stay off!

There are two or three things that can stop a person from getting a job. One is rape and another is a narcotics bust.

If you have one of those two things on your record, you have had it for the rest of your days. How do we begin? In addition, we need clinics in the neighborhoods throughout the Nation to maintain the addict.

Dr. CHAMBERS. Where we failed, Senator, is we have addressed only a very small piece of the problem. As a result addressing only that small piece, we have lost sight of what the problems are. It is true that all of us experience some difficulty in putting clinics in neighborhoods. It is no different than the trouble we have in placing low cost housing in neighborhoods as well. It is no different than if I went to build any kind of an institution or any kind of facility to address social casualties in a neighborhood. It is essentially the same problem, not unique to the addict. What we have forgotten is that these people are multiple casualties and we have addressed only one. For example, in several thousand standardized tests we are able to show now that roughly a third of the addicts that we see, and we can't