gather information together, and I would hope that you could give us something in this line. Dr. JAFFE. We will try to give you what you want, sir. MEANS OF GETTING THE PROGRAM INTO ACTION Must of our effort is being directed toward steps which must be taken if we are going to develop a truly national strategy for attacking the drug abuse problem. They are identification and definition of the scope of the total problem and its more important parts, the definition of our immediate and longer range objectives, and determination of the range and variety of programs needed—including an objective assessment of existing programs. Important tools will include a national data bank on drug abuse information and a set of social indicators which will show the nature, extent and trends in the drug abuse problem as well as the kinds of workload measures which will tell us the kind of progress we are making. We recognize that two types of actions must be pursued simultaneously. On the one hand, we must know more about the specific needs for drug abuse prevention, treatment, rehabilitation, education, training and research, and each of these will require a more effective assessment of the situation than we have now. On the other hand, each will also require a carefully conceived strategy to determine what capabilities must be developed to meet these needs. In the area of treatment, for example, current treatment capabilities exist through locally supported drug treatment centers, VA facilities, hospitals, community mental health centers and even private organizations. The matching of capability to need must take all of the potentially useful resources into account. In this context, we must decide how federal funds can best be distributed to supplement, support and encourage local initiative, and we must carefully avoid encouraging a reduction of available local funds because of an increase in available federal funds. Rather, we should seek to develop a thorough capability in each of the areas of our endeavor. Mr. SYMINGTON. Mr. Chairman, I have a word of additional caution because my mind runs back to your mention earlier of the friends you had in these other agencies and reliance you would place on them. My experience in bureaucracy tempts me to believe that working for different agencies of Government can place a great strain on friendships, especially when they are competing for the same tax dollar. Some people you will be looking toward to help you, people with respect to whom you would wish to have leverage because of your relationship. Others who actually supervise their work will be looking to them to use their leverage on you for the same reason. Little by little you will find that a friend is pretty much like anybody else, and you are going to have to treat everybody with great respect and know a little bit more about their job than they do, and then you will be successful. Mr. ROGERS. I do want for the record, too, if you would, please let us know the moneys to be spent on research, and in what areas and whether this will be done in-house or by contract. Also, if you could let us have the best thinking of our people now involved on the various drugs that are being developed to fight heroin and other addiction, particularly haldol and any other that you think offer some promise, and whether methadone should be considered as an investigational new drug, or should we move beyond that if we are at that stage, and whether your office would have any jurisdiction in that, I think if we could have some of this for the record, it would be helpful. (The following information was received for the record:) THOUGHTS ON DRUGS TO FIGHT ADDICTION In general, drugs are used in the treatment of addiction for detoxification and for a program of chronic maintenance which is utilized to intervene in the cycle of chronic relapsing behavior. In general, detoxification is best treated utilizing a drug from the same class of substances that is being abused. For example, methadone in decreasing dosages is used in the treatment of heroin addiction and pentobarbital in decreasing dosages is used in the treatment of barbiturate dependence. There have been occasional reports regarding the efficacy of major tranquilizers in the treatment of heroin withdrawal. Such drugs as chloropromizine and haloperidol have been recommended for treatment of opiate withdrawal states. In general, these drugs reduce the anxiety and emotional discomfort of the withdrawal state, but are not specifically treatments of withdrawal. The patient still suffers the symptoms of opiate withdrawal which are best treated with methadone substitution in gradually decreasing dosages over a period of 7 to 14 days. Articles appearing in the press recently relative to the research work of Dr. Lal of Brown University utilizing haloparidol in the treatment of opiate withdrawal offer no evidence that this drug is more efficacious than cholopromizine in the treatment of withdrawal states, therefore less effective than opiate substitution. There is no indication that haloperidol would be effective in the alteration of chronic relapsing behavior. Drugs which have been used in the treatment of chronic relapsing behavior have generally been of two types: opiate substitutes and narcotic blocking drugs. Methadone has been most extensively used for treatment of chronic relapsing behavior and appears to be reasonably efficacious in reducing the use of opiate drugs. It may also be effective in altering some of the other aspects of the addiction cycle including criminal behavior. More recently Jaffe and Blachley have been studying the use of alpha-acetyl methadol which is a methadone-like substance with a 48 to 72 hour duration of action. This drug, still classified in Schedule I, may be a useful substitute for methadone and significantly reduce the cost of clinical program use which utilized this treatment modality. Maintenance with narcotic blocking drugs has been studied in relatively few cases. The drugs which have been available have a relatively short duration of action. There is a need to develop a long-acting narcotic antagonist with a duration of action of 14 to 30 days. These drugs have the advantage of treating the addict while removing his addiction to an opiate substance. At this time two narcotic blocking drugs have been studied: cyclazocine and naloxone. Cyclazocine has some unpleasant side effects but has a duration of action of 18 to 24 hours; naloxone has relatively few side effects but in reasonable dosage it is effective for only 3 to 4 hours. Laboratory studies utilizing several new substances are currently underway. These substances include EN-1639, M-5050, and on other substance that has recently come to the attention of the Addiction Research Center at Lexington. The problem with narcotic blocking drugs is that they must be derived from thebaine which is in relatively short supply. Were all of the presently available thebaine converted to naloxone we would only have sufficient quantity of this drug to treat 750 patients per year. Furthermore, the cost of the naloxone so produced would be $10 for a one day supply. The DuPont Co. is currently working on a synthetic process to inexpensively synthesize thebaine. The substance is currently only available from natural sources (the opium poppy). A major priority of the Special Action Office for Drug Abuse Prevention is the development of a major research and development program which will lead to the development of a long-acting narcotic antagonist which can be studied in clinical research programs. If clinical trials prove promising, large scale use of these drugs will be indicated. There has recently been some testimony on the utilization of a drug Perse. The substance is being administered by several physicians in New York but has not been tested in animals nor systematically studied in man so that it is impossible to assess the efficacy of this approach. Moreover, a number of health officials have expressed a great deal of uncertainty about the exact position of this particular substance under Federal Drug Laws. RESEARCH PROGRAM OF THE SPECIAL ACTION OFFICE The Special Action Office for Drug Abuse Prevention will not place its primary emphasis on pursuing research projects independently. Rather, it will evaluate the efficacy of such programs in the agencies under our purview. Our emphasis will be to make the best use of the research expertise of other agencies, and we will shift resources between programs and/or agencies when necessary to bring about a more substantial result. One of the focal points of research will be the development of preventive treatment, for example, a vaccine which might someday become as routine an immunization as a smallpox, tetanus, or polio shot. Another major effort will be the development of a better selection of drugs for use in treatment. The Special Action Office will support research in the development of both narcotics substitutes (like methadone) and narcotics antagonists. The latter are drugs which block the effects of heroin and other morphine-like drugs. METHADONE Methadone is not considered a new drug at this time. It is a "fixed" part of the drug scene, but should not be thought of as the only or necessarily the best drug for combatting heroin addiction. Not all addicts respond well to methadone. It is an important drug, however, for its use often enables a person undergoing treatment to function as a regular member of society and most of those on methadone look forward to the day when they can be completely free of reliance on drugs. It is our hope that given time and adequate resources, we will be able to utilize a broad range of drugs to combat addiction and that every patient will respond well to at least one of these. We are continuing to observe methadone treatment carefully and study its impact. We recognize that we do not yet know all there is to know about its long-term effects, and cannot, therefore, pass final judgment until considerable time has elapsed. Mr. ROGERS. Are there any other questions? Doctor? Mr. Roy. I want to thank you, Dr. Jaffe and Mr. Weber, and I appreciate your testimony; and I fear unless a great number of things are done other than this program, that we will have more addicts 2 or 3 years from now than we do have presently. You have a considerable amount of competence in your professional field, and I wish you well. Dr. JAFFE. Thank you. Mr. ROGERS. May I say that we appreciate the patience of you gentlemen today before the committee. I think we have spread on the record a great number of questions that have helped us to make proper judgment. You have been very patient with us; and as your first appearance here, I think you have done a very excellent job with Mr. Weber and your associates. The committee is grateful to you for your indulgence of all of our questions. Dr. JAFFE. I would like to thank you, Mr. Chairman, and members of the committee for your attention. Mr. ROGERS. Thank you. The committee stands adjourned until 10 o'clock tomorrow morning. (Whereupon, at 5:20 p.m., the subcommittee adjourned, to reconvene at 10 a.m., Tuesday, June 29, 1971.) SPECIAL ACTION OFFICE FOR DRUG ABUSE PREVENTION TUESDAY, JUNE 29, 1971 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON PUBLIC HEALTH AND ENVIRONMENT, Washington, D.C. The subcommittee met at 10 a.m., pursuant to notice, in room 2123, Rayburn House Office Building, Hon. Paul G. Rogers (chairman) presiding. Mr. ROGERS. The subcommittee will come to order, please. In continuing hearings on the Special Action Office for Drug Abuse Prevention bills, there are a number of approaches here that we are going into. We are pleased to have as our witness today the Honorable John E. Ingersoll, Director of the Bureau of Narcotics and Dangerous Drugs, Department of Justice. The committee welcomes you. We are pleased to have you and your associates. Would you introduce them for the record. We will be pleased to receive your testimony. STATEMENT OF JOHN E. INGERSOLL, DIRECTOR, BUREAU OF NARCOTICS AND DANGEROUS DRUGS, DEPARTMENT OF JUSTICE; ACCOMPANIED BY DONALD MILLER, CHIEF COUNSEL, AND FREDERICK GARFIELD, ASSISTANT DIRECTOR FOR SCIENTIFIC SUPPORT Mr. INGERSOLL. Thank you for your welcome, Mr. Chairman. I have with me the Bureau's chief counsel, Donald Miller, who is on my left, and the Bureau's Assistant Director for Scientific Support, Frederick Garfield, who is on my right. Mr. ROGERS. We welcome you. Mr. INGERSOLL. Mr. Chairman, this morning my statement will give you a brief outline of the current situation with regard to narcotic drugs in the United States and around the world, particularly focusing on heroin, which is the drug that is of primary concern to all of us at this time. I would like to summarize what we have done in the past few years and then make a couple of brief suggestions on the directions we can take in the future. The shortness of time between when I was requested to appear and now prevented me from preparing a more complete discussion, but I will try to be responsive to your questions. |