SPECIAL ACTION OFFICE FOR DRUG ABUSE PREVENTION FRIDAY, JULY 9, 1971 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON PUBLIC HEALTH AND ENVIRONMENT, St. Louis, Mo. The subcommittee met at 9 a.m., pursuant to notice, in Stienberg Auditorium, Washington University, St. Louis, Mo., Hon. Paul G. Rogers (chairman) presiding. Mr. ROGERS. The Subcommittee on Public Health and Environment will come to order. We are here today in St. Louis to conduct hearings on a subject of extreme national importance and one that is growing more urgent each day: drug abuse and drug addiction among hundreds of thousands of Americans. The disease of drug addiction, as I am sure all of you are aware, affects every segment of our society. It is our expectation that this hearing will help us to formulate needed legislation and, also, to evaluate the efficacy of legislation which has already been enacted. We are particularly emphasizing three legislative measures and conducting hearings all over this Nation and inspection trips: H.R. 9059, which most members of the subcommittee have introduced, to set up treatment centers in community mental health hospitals and in the public health hospitals and clinics; also, H.R. 6731, introduced by Congressman Scheuer, of New York, and, of course, the President's proposal, the administration's proposal, H.R. 9264. We have had an interesting visit to a number of the treatment centers and programs here in St. Louis last night, and the committee is particularly pleased to be in St. Louis, because one of your own distinguished Congressmen, as you know, serves on this committee. He has brought great expertise to the committee, and it really is at his request that the committee changed its schedule to come to St. Louis as one of the first parts of our program throughout the United States. We have as our first witness today Dr. Raymond R. Knowles, accompanied by Mr. Alvin Muse. Dr. Knowles is the program director of the narcotic addiction treatment program, chief of alcoholic and drug abuse program of Missouri Division of Mental Health. The committee welcomes both of you gentleman. You are very kind to show us through some of your operations last night, which were very impressive, and we are delighted to have you with us and we will be pleased to receive your testimony at this time. STATEMENT OF DR. RAYMOND R. KNOWLES, PROGRAM DIRECTOR, NARCOTIC ADDICTION TREATMENT PROGRAM, AND CHIEF, ALCOHOLIC AND DRUG ABUSE PROGRAM, MISSOURI DIVISION OF MENTAL HEALTH; ACCOMPANIED BY ALVIN MUSE Dr. KNOWLES. Mr. Chairman and distinguished members, I appreciate the opportunity of appearing before this committee to testify on H.R. 9264 and H.R. 9059. As in all other States, we in Missouri are alarmed at the mounting evidence that drug abuse-including alcohol dependency-has become the single most significant index of social pathology in the United States today. It is both a cause and a consequence of hopelessness and helplessness in those it afflicts and in their families. St. Louis is led by only one other city in the Nation in numbers of homicides by firearms. St. Louis was recently featured in a national TV program because of the extent of its urban blight; sections of the city were shown derelict and vacant. Such conditions typify an environment in which drug addiction flourishes. The distinguished St. Louis researchers, Dr. George Murphy and Dr. Lee Robins, in a classic study of 230 normal young Negro men found that 13 percent admitted to having tried heroin and 10 percent to having become addicted to it; 17 percent admitted to amphetamine use, 8 percent to having used it regularly; 14 percent admitted to the abuse of barbiturates; 50 percent admitted to the abuse of marihuana. In their study they found that being a high school dropout significantly increased the probability of drug experimentation, while identification as a juvenile delinquent by age 17 and absence of a father in the home were significantly associated with heroin addiction. And now there is evidence that the contagion has spread to the suburbs. An estimate was made in 1967 of 30,000 drug abusers among our country youth. In 1970 this was revised upward to 60,000. Rates of arrest have doubled each year in both the city and county. But I wish to bring to the attention of this committee that St. Louis has been one of very few cities in the country which achieved a reduction in its crime rate during 1970. A high school survey revealed marihuana use by 24 percent of students surveyed, hashish by 16 percent, LSD by 9 percent, amphetamines 9 percent, barbiturates 8 percent, heroin and other opiates by 4 percent. Of those denying any drug abuse, 14 percent indicated their intention to try some kind of drug in the future. St. Louis has a serious drug problem. Comparable statistics could be obtained for Kansas City, other large urban areas, and the rural section of the State. Missouri has developed a program of prevention and rehabilitation but lacks the funds it urgently needs for a major coordinated attack on this social problem. Mr. Chairman, I wish to express my gratification at the bold and innovative approach taken by the administration at this time of national crisis. H.R. 9264 proposes the establishment of an office having unprecedented authority in the health field. While it laudably seeks to focus the comprehensive resources of the Federal Government, now located in several agencies, within one office, surprisingly, it does not provide for coordination of certain law enforcement activities which are directly drug related. For example, the interface between our youth culture and government is a critical one and programs of prevention may be handicapped if they neglect to provide for a coordinating relationship between the proposed Special Action Office and the law enforcement activities. The centralizing of authority and of functions now distributed through a variety of agencies but principally within the National Institute of Mental Health (Division of Narcotic Addiction and Drug Abuse) optimizes program control. However, it might be asked whether consideration has been given to the feasibility and merit of acting uniformly with the recently passed Staggers-Hughes alcohol legislation which created a National Institute on Alcohol Abuse and Alcoholism. A National Institute on Narcotic Addiction and Drug Abuse could provide a strong coordinating and planning authority. Conceivably its coordinating responsibility could extend to the Department of Defense, the Veterans Administration, and community resources recognizing that will be in this latter sphere that the major responsibility for rehabilitating our returning servicemen will ultimately reside. Such a National Institute might well build on appropriate drug prevention and treatment programs to existing community mental health centers. It is perhaps understandable that the daring innovations proposed in H.R. 9264 might arouse some concern about continuing effectiveness of existing programs. Would the agency currently charged with the prime responsibility in this field simply house personnel while policy and decisions were made elsewhere? Would its viability be threatened if its highly trained professional personnel saw their status reduced as authority and responsibility were transferred? It is not clear to me how grants and contracts would be awarded were this bill adopted. The established procedure of review committees composed of one's scientific peers making recommendations to the National Advisory Mental Health Council would surely be retained? In summary, Mr. Chairman, while one cannot but admire the efficiency such centralization of control confers, H.R. 9264 deals primarily with organizational issues in a general sense-it does not allude in any detail to what existing operational mechanism shall be used in its implementation. The distinguished Special Consultant to the President for Narcotics and Dangerous Drugs enjoys the respect and admiration of all workers in this field. There are few experts so well qualified to assume the immense responsibility H.R. 9264 would confer upon him and his office. Mr. Chairman, that completes my testimony. Mr. ROGERS. Thank you very much, Dr. Knowles. I think some of the points you made here also concern the committee as we consider the specific proposal. Mr. Satterfield? Mr. SATTERPIELD. Thank you, Mr. Chairman. Dr. Knowles, I have just a couple of questions I would like to ask you. I think you raised some very pertinent questions when you spoke. We talk about the possibility of a National Institute on Narcotic Addiction and Drug Abuse coordinating with the Defense Department and Veterans' Administration. Do you know of any similar situation now where that kind of coordination is presently being pursued? Dr. KNOWLES. No, Mr. Congressman, I do not. Mr. SATTERFIELD. You know, the one thing that has bothered me about this bill is that we are not just talking about treatment, but we are talking about treatment, rehabilitation, research and, as a matter of fact, the question of prescribed treatments. This committee last year in the Drug Abuse Control Prevention Act wrote into law something new which for the first time would give to somebody other than the Attorney General the authority to determine what is a validly prescribed treatment for addiction. That authority is now vested in the Secretary of HEW, who makes the determination and then would advise Congress that he has done so. I would like your reaction to the suggestion that this kind of authority be transferred to the Special Office in the White House and whether or not you think that is where it ought to be or should it stay with the Secretary of HEW. Dr. KNOWLES. Well, we are dealing with an unusual disease, and for unusual diseases you have unusual cures. But I think the issue of cure in this case is still moot. I have to respectfully point out that the treatment programs that you gentlemen saw last night, which are substantially representative of similar programs in various parts of the country, are regarded by most specialists in the field as experimental. The problem that we face in dealing with a major and concerted attack on the drug problem in this country might be compared-although analogy is always dangerous-to the situation that existed in this country at the time of the successful launching of the sputnik. We were confronted with what amounted to a major national crisis, in this case in the scientific and technological area, and we did not have at that point the means with which to meet that challenge. We established a national priority No. 1 to bridge the gap which apparently existed. We were fortunate that we could rather tool up with the needed technologists and engineers and scientists. The situation is not that dissimilar in the drug field. We are talking about mounting major programs of treatment and prevention. Gentlemen, what are those programs? Those programs will have to be mounted by people who are skilled in their administration. Gentlemen, where are those specialists? We have the responsibility for training to develop a cadre, an army of specialists, before we could begin to implement even experimental programs on a nationwide basis. Our experience here in St. Louis, I think, is illuminating, because we were initially very inexpert in the matter of dealing with addicts. Their life style is so different to our own we tend to initially react to them as we react to all of our other patients, and we found out this is inappropriate, and we bought our experience in St. Louis dearly. In our early years of experimentation, the dropout rate of our program approached 50 percent. In the most recent year, I think it was about half that. A dropout rate of 25 percent is still not impressive, |