Senator HUGHES. You use a better choice of words than I do, Doctor. It seemed rather ridiculous to me. It can seem remote to you. Professional respect, I guess, and all that.

Well, Senator Schweiker?

Senator SCHWEIKER. Thank you, Mr. Chairman. You used, Doctor, the figure based on your experience in the Tombs there are 4 out of 5 people that you treated are people that came into the Tombs and were drug related in terms of their crime. Is that right?

Dr. DOLE. No, Senator. The figure of 4 out of 5 refers to the proportion of addicts that wanted treatment after release. If you consider all admissions to the Tombs for all causes, you find that about half of them are addicts. When I said 4 out of 5, I meant 4 out of 5 of these inmates were addicts seeking treatment.

Senator SCHWEIKER. I am sorry. I misunderstood it. But to get back to the figure, you are talking about 50 percent?

Dr. DOLE. Yes.

Senator SCHWEIKER. This is of the whole New York City average. about 50 percent of the criminals going into the jail system there are related to drug addiction in some form, is that accurate?

Dr. DOLE. Yes. In fact, the percentage of addicts in the Adolescent Remand Shelter, which takes boys between the ages of 16 and 20, is even higher. And also in the women's prison, the percentage of addicts is higher.

Senator SCHWEIKER. Following up Senator Hughes' line of questioning, in terms of your work and the need that you see from the viewpoint of your operations, what use would you put of the money, if Federal money were to be made available to you, what would be your priorities of use in terms of what purpose and what accomplishments! Dr. DOLE. First, what is needed in the corrections system is a clearinghouse facility, which they do not now have. With the present system a man is thrown into a crowded, noisy jail. He stays there until he is picked out for trial. Some sort of plea-bargaining is done; he may be given a reduced sentence, put in prison for a time, and thrown again back to the streets. Nothing has happened.

What is needed in this system is a clearinghouse providing space for medical services, opportunities for interviews with representatives of various agencies, and social evaluation.

If you could have an efficient process for placement in suitable treatment programs, the corrections system could begin to put together a plan for aftercare. The courts would be given alternatives to prison.

This would be my first priority. I met yesterday with Governor Rockefeller, asking him to transfer to the New York City Department of Corrections a facility which had been fitted up by the State narcotics commission, but is now abandoned by them. If this facility were made available, it would be possible within a matter of a few weeks to set up a first rate classification and placement center. We could evaluate the addict's potential and needs. He would have a chance to find an alternative to prison.

I would want to associate this facility with a first rate medical center, I would also attempt to interest the courts in installation of a courtroom in the facility to reduce delay times, and I would provide interview space for all reputable treatment programs interested in helping the accused addicts.

A similar clearinghouse and placement facility is urgently needed for the adolescents in detention.

Senator SCHWEIKER. Following up what you just described as a rough estimate, how much money could you effectively and properly use, say, of course, in the next year to do this without, in other words, the way that you are set up to operate now and the time and resources, et cetera? How much Federal money could you properly spend for the program to spend what you describe?

Dr. DOLE. I cannot give you a reliable estimate of the expense of setting up and operating a new institution in the department of corrections. This would involve maintenance and custodial expenses that would have to be calculated by experts in the department. However, limiting my own concern to the provision of aftercare services for addicts released from jails, and adding to this budget the funds that could be effectively used to expand adolescent services, I would say $2 million. This amount, if used effectively, would yield a lot of results. Senator SCHWEIKER. Wouldn't it be true that with all this difference of opinion about what way do we go in treatment of drug addiction and what is the problem in terms of the questions raised this morning, wouldn't we be able to learn an awful lot of the answers under the kind of a program you have described?

Dr. DOLE. We obviously would. Indeed much important data is buried in the unanalyzed questionnaires. For example, the question came up a couple of weeks ago as to how many of the Vietnam veterans are getting into crime in New York City. The answer is sitting on shelves. One of the questions we asked was, "What was the source of your addiction, where, and how long?" It is just a question of tabulating the answers.

To get preliminary information, we asked a group of people to tabulate a couple of thousand questionnaires to get a sample. That was not really a proper statistical analysis, but the best we could do. Almost any question you might have that relates to crime and addiction has an answer buried in the questionnaires.

Senator SCHWEIKER. Doctor, you heard previous testimony indicating-well, I specifically asked about the funding on some of these projects, and yet as you know, there are waiting lists for people who want to get methadone maintenance and can't.

How do you account for this discrepancy? This is a matter of local organization and resources, at the local level, or just how do you explain it?

Why the gap here that we have just heard?

Dr. DOLE. It is partly an impediment to the flow of funds from Federal sources to treatment programs, and partly the tremendous demand. The other consideration is the efficiency with which programs can convert money into effective treatment. When this is done properly, the results are impressive. In New York City the health department has a dynamic methadone program run by Dr. Robert Newman. He has expanded his services with extraordinary rapidity, and yet has maintained control over quality of medical care. He told me the other day that his limiting factor in rate of expansion is the inability to find acceptable space and to recruit trained staff. He has approximately 10,000 addicts waiting for admission, and he said to me with amazement "No matter how many we admit, the waiting list is even getting bigger."

As you bring treatment facilities into view, more and more addicts came forward wanting treatment.

The gel that we must take as a minimum in New York City » 3.00. Fven with maximum financial support it will take 2 years to reach thus hgure, and it is very likely that after this we will find anather: 26,900 That want to be treated.

Sensiar Ses WE.KER. What is your specific reaction to some of the new 24 proposed regulations on methadone?

De Dak Tin.nk the intent is very good. Clearly we need quality caviras. To throw methadone maintenance treatment open for unGULIZA, 92, use would lead to chaos.

However, there are some points in the proposed guidelines that are adused. The stapuistion that everyone come to a clinic twice a week forever is a musike. The diversion of methadone which concerns all of us is my going to untreated addicts. Impediments on the delive w... increase the black market by widening the gap between demand and legitimate treatment.

Frequent, even as..y, clinic visits are needed for the first few weeks or months of treatment, but a man who is rehabilitated must be able to live a more norma. fa. The proposed guidelines seemed to be directed only to the control of new patients.

There are other details of a technical sort such as frequency of laboratory tests that 1 have discussed with FDA. Thus, although I do not accept all the details of the proposed guidelines, I do endorse the general principis

Senator SchwEKER. All right, Dr. Dole. The chairman had to go to another meeting, and he asked me to thank you very much for appearing. We certainly appreciate it. I am sure the committee will weigh very carefully some of your advice as well as your past working efforts.

Thank you very much for being with us.

Dr. DoLE. Thank you, Senator Schweiker.

(Whereupon, at 12:40 p.m. the subcommittee recessed, to reconvene at 9 a.m., Wednesday, May 24, 1972.)

DRUG ADDICT TREATMENT AND REHABILITATION

ACT OF 1972

WEDNESDAY, MAY 24, 1972

U.S. SENATE,

SUBCOMMITTEE ON ALCOHOLISM AND NARCOTICS,

OF THE COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D.C.

The subcommittee met at 9 a.m., pursuant to recess, in room 6226, New Senate Office Building, Senator Harold E. Hughes (chairman of the subcommittee) presiding.

Present: Senators Hughes (presiding) and Javits.

Subcommittee staff members present: Mary Ellen Miller, staff director; Jay Cutler, minority counsel.

Senator HUGHES. The Senate Subcommittee on Alcoholism and Narcotics will come to order.

The Chair calls Dr. Robert Newman, director, methadone maintenance treatment program, City Health Services Administration, New York, N.Y.

Thank you for your willingness to come here and testify on this very important subject matter, Doctor.

STATEMENT OF DR. ROBERT NEWMAN, DIRECTOR, METHADONE MAINTENANCE TREATMENT PROGRAM, CITY HEALTH SERVICES ADMINISTRATION, NEW YORK, N.Y.

Dr. NEWMAN. I am very pleased to be here at this particular time because, as you know, there are a number of decisions being made here in Washington, and also at the State and local level, which will have a very profound effect on methadone maintenance programs throughout the country and the increasing number of patients who are dependent upon this treatment for their medical and social well-being. So I am especially appreciative of being here today.

I would like to first of all explain what my program is. This is the New York City Health Services Administration methadone maintenance treatment program. We have been in existence for just under 18 months, and in these 18 months we have developed an active patient census of over 5,500.

Senator HUGHES. How many was that?

Dr. NEWMAN. Over 5,500 in 18 months.

I think the independent evaluation that is now going on will show that this is not only a numbers game but also that we are providing very effective treatment to these patients.

(87)

This is very encouraging, especially being able to do this within the governmental structure. On the other hand, there certainly is no reason for complacency. In these same 18 months we have received over 23,000 applications for treatment. We have right now on our active waiting list (and this is a real number of people who have not been admitted, who are not being treated elsewhere, who are not in jail) over 8,200 persons.

These are people who are eligible, who have applied, who want treatment and who essentially have to wait on the streets because we don't have the capacity to accept them.

There is also no reason to think that we are even close to the end of this demand. We have been consistently getting between 300 and 500 new applications every single week, and there has been absolutely no change in this volume over the last 6 months.

Rather than dwell on the success, or the effectiveness, of the program at this stage, what I would rather do is discuss some of the main problems with the methadone maintenance program.

This is in keeping with the current trend-which is regrettable-of focusing only on the alleged problems and not paying any attention at all to the very definite benefits to patients and society.

I think it might be helpful, however, to discuss these problems from the perspective of somebody running one of the largest methadone programs in the country.

Senator HUGHES. Is it the largest?

Dr. NEWMAN. It depends on whom you ask. It is either the largest or second largest. Beth Israel may have a couple more hundred patients. One of the most serious problems that has gotten a tremendous amount of publicity recently is the problem of illicit diversion of methadone. This seems to be the focus from beginning to end of the newly proposed Federal regulations governing the use of methadone. It is also very much in the news and very much the concern of lay and professional people alike.

I think the perspective from which the problem of diversion has been viewed has been very one-sided, and this is very inappropriate. Any illicit market, any market at all, whether it be legal or illegal, has to be viewed not only from the supply end but also from the demand end; we must decide not only how we can deal with limiting supply, but also why there is the demand.

In the case of methadone, there is no secret why people can be induced to sell methadone. It is simply the incentive to earn money.

The critical factor is why people want to buy methadone on the street. It is my very, very firm conviction that people want to buy methadone on the street, the overwhelming percentage, because this is known to be an effective alternative to continued heroin use and all that goes with such use.

Recognizing that we have 8,000 people on our waiting list, and that in New York City there are probably 20,000 people on various waiting lists for public programs, it would be naive to be surprised that some of these people buy methadone illegally when they are forced to wait as long as a year to get into a legitimate program.

Furthermore, the efforts to control the supply end, as far as I am concerned, have always failed with any kind of illicit market. This is true of, for instance, alcohol during prohibition. It has been true of the