Senator HUGHES. Was that the original request, or after OMB reviewed it?

Dr. JAFFE. I don't recall precisely what the original request was. My recollection is that there were no substantial changes except for some shifting of requested amounts to other budget categories.

Senator HUGHES. It is late, and we have a number of witnesses left, and at the rate we have been going, I have 7 hours questioning left for you. I think the best thing I can do is submit some questions to you which I hope we can get written responses to a little better than we have on some other things we have asked your office for.

Dr. JAFFE. If you find that they are not coming through, Senator, I would appreciate your letting me know.

Senator HUGHES. All right, I will let you know right now on one, then. At your confirmation hearing, you promised the committee a letter on the need for the drug abuse education legislation.

Dr. JAFFE. That response was sent out, sir. This was on review of the Drug Abuse Education Act.

Senator HUGHES. None of us have seen it on either side of the aisle here. If it was sent out, who did you mail it to?

Dr. JAFFE. I saw the letter go to Senator Javits.

Senator HUGHES. His legislative assistant, Jay Cutler, has not received it.

Dr. JAFFE. I sent it, I signed it. I will get you a copy of it.

Senator HUGHES. Would you mind getting me one, too, and copies for the rest of the committee?

Dr. JAFFE. We will be happy to.

(The information subsequently supplied follows:)

EXECUTIVE OFFICE OF THE PRESIDENT,

SPECIAL ACTION OFFICE FOR DRUG ABUSE PREVENTION,

Hon. JACOB K. JAVITS,
U.S. Senate, Washington, D.C.

Washington, D.C., May 23, 1972.

DEAR SENATOR JAVITS: This is in response to your request at the Senate Labor and Public Welfare hearings on April 11, 1972, for a letter presenting my views on the Drug Abuse Education Act and my recommendations for its future role in the federal effort to combat drug abuse. Drug abuse education has always been an important segment of the overall efforts to prevent the abuse of drugs. The federal government in the past year alone has substantially increased the amount of funds available for education and training, and I am certain that, as time goes on, larger commitments to this aspect of our overall program will be made.

The Drug Abuse Education Act is due to expire in Fiscal Year 1973. The programs under it have been in operation for only 2 years, and I have just learned that little evaluation of the kind I believe is necessary rational judgment has been undertaken. Accordingly, I have instructed my staff to accelerate our plans for meaningful evaluation of those programs so that I will be in a position to provide you and the Congress with a realistic appraisal of what has been accomplished. Since we have over a year until the present Act expires, I feel there is sufficient time for this to be done. I am hopeful that we will have some answers in the not too distant future at which time, I will be glad to again discuss the matter with you.

Sincerely,

JEROME W. JAFFE, M.D., Director.

Senator HUGHES. It will eliminate some of the doubt we have about getting responses to other questions. Could I ask you just a couple of questions, and I will be brief, if you will. Don't give me a speech with each response. If you don't know this answer, tell me, or if it is in doubt, just tell me that.

A

First, I want to go back to one subject. Is there just one company manufacturing methadone!

Dr. JAFFE. No, there is one other.

Senator HUGHES, I have been told the Lilly Co. does not make a profit on the sale of methadone. Do you know whether that is true! Dr. JAFFE. It is very hard to tell.

Mr. PERITO. Senator, just for clarification, on that, dolophine hydrochloride which they marketed for other indications, we assume that they must have made a profit on that. Whether they made a profit on the medication they have marketed for detoxification and maintenance is another question, but it is used as an analgesic in hospitals, and I assume they make a profit on that.

Senator HUGHES. I would like to clarify something on page 10 of your statement which worried me when you gave it. The first paragraph says "as a result, we have concluded that methadone maintenance should be made available for all addicts who consent to use it under approved treatment programs."

What do you mean by that word "consent"?

Dr. JAFFE. As you know there is great concern that the Government will force people to take methadone.

Senator HUGHES. That is the reason I am asking the question.

Dr. JAFFE. We feel that it would be inappropriate to require that people take medication, even though it is no longer considered investigational in that sense. Some people will raise the issue they don't have very much alternative if the court says, "Get into treatment," and methadone is the only treatment they want.

I am not sure that is coercion. People do have alternatives. I don't think it appropriate that the court order someone to take methadone, or that people be involuntarily committed to a methadone program. I think that is what the intent of that statement is; it is a philosophical view.

Sonator Hranes. Let me get an example. Do you think men ought to be offered parole, for example, subject to the use of methadone!

Dr. Jares, Subject to treatment. Treatment can take a variety of forms If someone relapses to heroin use, then the treating agency might say that he is not successful in an abstinence program, offer hum methadone, and if he refuses it and says he elects to continue using heroin, he is obviously failing in the treatment, and one can say he has the option of having his parole removed, or moving into a methadone program.

Sonator Niches. That is not what I am saying. Should a parole board say to the prisoner who is being reviewed for parole, "Will you go on a mothadone maintenance program if we grant you a parole?" Dr. Jaree. I think that is much too specific, and I would be unhappy with that kind of alternative offered a man who is in prison who is not currently using a narcotic, and to say that he leaves prison and that they start to give him methadone. I think this vitiates the very possibility of recovery here.

Some data was presented yesterday to indicate that people who have, in fact, served a prison term have the best possibility of achieving long term abstinence, I am not advocating prison terms. I am saying there is a possibility that if this one has been off narcotics long enough I am not sure it is appropriate to require that he take methadone to get a parole.

Senator HUGHES. Would you recommend against that?

Dr. JAFFE. I think I would; yes.

A lot of these will be under State jurisdictions, and the issue is whether or not we can, in fact, prohibit it. But I would recommend against this position.

Senator HUGHES. I understand, but your voice does have influence in State programs.

Dr. JAFFE. Yes.

Senator HUGHES. On programs that have Federal grants you can certainly set up guidelines, or at least I am under the impression you

can.

Dr. JAFFE. We are working on those guidelines.

Senator HUGHES. I have one question that I don't want to pass up, because of its importance in the overall consideration of methadone. You mentioned it somewhat in your opening statement, and you have been aware of it all the years you have been working in the drug programs, and I have been, too.

There were stories in the press about 10 days ago about a conference in Baltimore, in which there were heated accusations that methadone was a tool of racial and political repression. When I have held hearings in black sections of cities in America, the statement has been made, that it was a vehicle of people to keep black males repressed. I would like you to speak to that for a moment.

Dr. JAFFE. I find the statement somewhat mysterious. The people I have seen treated with methadone are not suppressed. They are liberated. They don't have to buy heroin at high prices from pushers. They are able to work, they are able to participate in the mainstream of society, some of them for the first time in their lives.

Now I have never viewed it as anything but something which frees somebody from pressure that otherwise seems inescapable, and I am referring primarily to people from minority groups. It is very hard for me to respond to something which seems illogical.

I have not seen the basis, or really perceived the basis then for the accusations, and if someone will enlighten me further on the logic of it, I will try to respond to it in whatever way seems appropriate.

I have heard the same things that you have. I have also seen thousands of patients treated.

Senator HUGHES. How many years did you work in the clinic in Chicago?

Dr. JAFFE. It began in 1966. We were using methadone in New York prior to that time.

Senator HUGHES. You found no evidence of this at all?

Dr. JAFFE. I think that to a certain extent if one feels that it is one's legitimate right to rob and steal from other people of the community, regardless of what ethnic groups they belong to, then you could raise an objection to methadone in some programs.

The programs operated in some areas do expect that the patients participating will, in fact, begin to be law abiding. To the extent that that is repressive and controlling, then one begins to have some basis for that kind of an accusation.

I don't happen to feel that expecting them not to commit major felonies is in any way repressive. So from my point of view it is not a legitimate objection, and we have taken the position that we will continue to offer this treatment to those who want to participate in it.

I have already taken the position we should not want to coerce people into it. We are really addressing the issue of whether the people should be volunteers for this kind of treatment.

Senator HUGHES. Thank you very much, Dr. Jaffe. I won't pursue the questions any further, because the hour is growing late. We will submit to you a written series of questions which we will get responses to as soon as you are able to give them to us.

(The information, subsequently supplied, appears on p. 187.) The Chair calls Dr. DuVal.

STATEMENT OF DR. MERVIN K. DuVAL, ASSISTANT SECRETARY, HEALTH AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY DR. CHARLES C. EDWARDS, COMMISSIONER OF FOOD AND DRUGS; DR. BERTRAM S. BROWN, DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH; AND DR. JOHN S. ZAPP, DDS, DEPUTY ASSISTANT SECRETARY FOR LEGISLATION, HEW

Senator HUGHES. You may proceed, Dr. DuVal.

Dr. DUVAL. It is a pleasure to appear before you again, Mr. Chairman, to discuss new Federal initiatives on the use of methadone in narcotic addiction treatment, and also S. 2840, a bill to authorize emergency assistance in the establishment of narcotic addict maintenance, treatment, and rehabilitation programs.

The chairman and members of this subcommittee are already well informed on the problems of drug abuse and there is no need for a general discussion of the nature and the extent of this situation. More pertinent, I think, is a discussion of the steps now being taken to combat this serious problem which has generated widespread public

concern.

HEW DRUG ABUSE ACTIVITIES

As you know, several agencies within the Department of Health, Education, and Welfare have programs concerned with drug abuse.

The National Institute of Mental Health supports treatment and rehabilitation programs, primarily through grants to public and private nonprofit organizations.

NIMH also supports research to provide knowledge as to the causes, prevention, and treatment of narcotic addiction and other forms of drug abuse. NIMH funds a wide range of drug abuse information and education activities, and coordinates the health education aspects of all Federal drug abuse education projects.

The Office of Education is active in the development of new drug abuse curriculum material and makes grants for the training of school personnel in the fundamentals of drug abuse education.

The Social and Rehabilitation Service supports vocational rehabilitation services, often an essential part of treatment programs for drug abusers.

The Food and Drug Administration has the important responsibility for a continuing evaluation of the safety and efficacy of methadone and other drugs used in drug abuse treatment programs. FDA is also responsible for assuring that the labeling of all drugs and the advertising of prescription drugs accurately reflect their drug dependence potential. In addition, FDA has authority to reclassify drugs from nonprescription status to prescription status because of drug abuse potential. Paregoric has recently been reclassified for this reason.

Mr. Chairman, in view of the fact that this remainder of the testimony is a recitation of the testimony Dr. Jaffe has given you, and in view of the fact that you have a large number of such witnesses, I would suggest that you authorize me to submit this for the record instead of taking your time to read it this morning.

Senator HUGHES. Thank you very much, Dr. DuVal, we will incorporate the statement in the record as though delivered. (The prepared statement of Dr. DuVal follows:)