To this end, we are working with the Department of Defense to utilize and coordinate existing trained manpower in both the civilian and military population in a massive training effort so that sufficient manpower will exist on site in Vietnam and that facilities in the United States and Europe will be better able to provide adequate treatment for servicemen with drug dependence problems. I have discussed our plans with Secretary Laird, and my staff has been working with Assistant Secretary Kelley, who has DOD responsibility in this area.

I should like to emphasize again that many caveats must be observed in interpreting the information we are now obtaining from Vietnam. First, these figures continue to change as we test men coming from different units and as the proportions of men in the various services shift. In addition, we have recently increased the sensitivity of the detection system so as to increase the time over which drug use can be detected. Furthermore, we have no way of knowing at this time how many of these men are occasional users and how many are markedly dependent. We are constantly increasing our efforts to motivate men to enter treatment. Enforcement procedures to decrease the availability are also in effect.

There are still other complex factors that we believe may cause variability in our estimates over time, and I would be happy to elaborate on these later. In summary, we feel that the urine tests are providing better estimates of the size of the problem than we had previously, but we believe that it will be several more weeks before we can obtain a fairly reliable estimate.

Our relationship with the Department of Defense has been positive. Since last week one of my colleagues has been in Vietnam providing technical assistance to the laboratory personnel there so that fair and accurate procedures could be maintained. We are receiving on a reg ular basis from the command in Vietnam through the Department of Defense the data we have requested on treatment, detoxification, and identification facilities. The same information is being developed for other U.S. military commands around the world. In my discussions with the Secretary of Defense he has repeatedly affirmed his support of these efforts and his willingness to take whatever measures are necessary to see that the programs we are developing together move forward as rapidly as possible. We are determined to do more than merely treat the military as an isolated problem. In large measure the present military drug problem is a reflection of the problem in society at large-albeit compounded by the specific circumstances in Vietnam. I have concentrated on the situation in South Vietnam, Mr. Chairman, because I believe that events there can have serious impact on our domestic scene, and also because I think we can learn much of broader use by studying the somewhat more controlled military drug situation.

One of the great advantages of the Special Action Office will be its ability to transfer knowledge between previously insulated agencies. The President commented to me in San Clemente that there are many previous instances where the knowledge gained from military medicine has been beneficial to society as a whole. He is committed to the proposition that we can gain knowledge from the treatment of the military drug problem which will enable us to better deal with drug

abuse in society as a whole. To this end our systems analysts are working with the systems analysis staff of DOD to develop a scientific analysis of the military drug abuse problem and an evaluation of the effectiveness of DOD drug programs.

Certainly drug abuse in the military and in society as a whole represents a serious danger to this Nation. Yet, by candidly addressing this problem and by using the unique characteristics of the military as a sample population, we have an opportunity to gain valuable insights which will make us better able to deal with the problem in civilian society. Again, the military have been extremely cooperative in this matter and the day may not be too distant when I will be able to recommend to my civilian colleagues that they examine DOD drug programs and learn from them.

In my previous testimony I was asked whether the authority for SAO should include direct budget control over DOD drug abuse activities. I believe that my recent DOD relationships have tended to confirm my judgment that such a move would not be useful. The policy authority I would exercise would permit me to come to grips with the essential problems of the military drug abuse scene and its relationship to the domestic situation. I have seen how the military apparatus to combat drug addiction is an integral part of the regular combat and support establishment, not easily separable from its more purely military role, especially in the combat zone. It is difficult to identify the statutory authority for drug abuse work except the basic authority of the Military Establishment itself. There is no alternative to the use of this military capability. I cannot and would not attempt to assume any operational responsibility for those activities. I believe that the key people in DOD recognize the need for central policy guidance both on how best to develop the drug response systems within DOD, and its crucial relationships to our domestic environment. As of now, Mr. Chairman, I believe that the policy authority which H.R. 9264 would give me and the authority of the President, as Commander in Chief, are fully adequate for the task.

Thus, in our relations with other agencies, we are finding that the concepts of H.R. 9264 are viable and effective.

We do not-at least we hope not intend to become just another layer of bureaucracy. We are getting involved not only in the setting of policy but also in the budgetary process the key to effective control. We intend to use our budgetary authority to require performance standards and to motivate the separate agencies to work together in coherent and efficient manner. And through the agencies we hope to improve the standards of the programs that are delivering services to the citizens. We intend to develop a unified response to a national problem.

Yet at present we are constrained by the lack of the full authority that would be provided by the bill before you. We will soon reach a plateau of effectiveness beyond which we cannot legally proceed. For this reason I urge that you act at the earliest possible date to set up the Special Action Office for Drug Abuse Prevention, as provided in H.R. 9264.

Mr. ROGERS. Thank you very much, Dr. Jaffe. We appreciate your testimony.

Mr. Preyer?

66-841-72-pt. 3- 6

Mr. PREYER. Thank you, Dr. Jaffe. You have given us a lot of testimony on your ideas as to how to manage the problem and how to organize it. I will leave those questions to the gentleman on the subcommittee, Mr. Symington, who has had much more experience on that than I have.

I was interested in your South Vietnam trip. First I commend you on your plan for thickening the testing procedure. When I first read of the 2-day provision, it did seem to me that that wasn't enough where you have a strong incentive-in 2 days you go home if you pass, and if you flunk you stay in Vietnam. That is pretty powerful, and I could see how a lot of people could dry themselves out temporarily. As I see it now, you will test 2 days before you go home and then you would test-what is the earliest date, a month before?

Dr. JAFFE. The logistics of this are rather difficult. Ideally, we would like to test 7 days, 10 days, 30 days. That is the period during which men are shifting rapidly from unit to unit in preparation for returning home, so we have to talk to the command about how we can be certain to get the men who are going to go home 30 days before. The issues have to do with the fact that no matter how much we attempt to persuade men that punitive action will not be taken, they are convinced that it is always better not to come up with a positive urine unless you are absolutely forced to, and that means we have to ascertain at which locations we can obtain a specimen that really belongs to the man.

So we can say that it is going to be thickened, and we can say that it will be perhaps 30 days before, but the precise days, and precisely where, are still trying to be developed.

Mr. PREYER. But do you think you would be able to guarantee in every instance at least two tests?

Dr. JAFFE. Two or more. That doesn't end it. The plan envisions continually testing. So we will be testing 6 months before. Once we get those people into treatment, we will then follow the users every week for almost the next 2 months.

Now, the logistical problems of getting the urine specimens, obtaining them and delivering them, are formidable. These are things that really require a lot. It is almost like a campaign. You have to send out helicopters, literally, to fire bases to get them. You have to have officers involved who supervise them. Enlisted men are reluctant to obtain a urine specimen from a buddy if they think that in any way will be detrimental to him. Problems of communications and trust are involved here.

I say we can lay out the plan ideally and then say what is feasible under the conditions that exist.

Mr. PREYER. You would still continue your random samples obtained?

Dr. JAFFE. Random samples are primarily to give us a handle on what is the size of the problem rather than identifying specific individuals. It is almost a separate statistical operation.

Yes, we would continue those.

Mr. PREYER. You mentioned the logistical problem of trying to identify these people where you have shifting troops. Since we are tempting to bring combat to an end and bring our troops home, estion occurred to me in connection with two other statements

you made. One, when you say you don't want any sort of operational control over DOD, you put it pretty heavily on the basis that we should not meddle in a combat operation, which I would agree with; but if we are rapidly bringing the combat part of it to a close, do you think the same reasoning applies to it?

Dr. JAFFE. To a large extent; yes. Let me give you an example. If there is a unit 200 miles away from where we are collecting urine, at the present time simply by saying, "Get those specimens and get them here 30 days before. We need that," somehow the commanders make it happen.

I would have to review the budget and say I don't know how much a helicopter costs or what it takes to man it and how to get it in there and how to make sure it gets in there safely. Right now that is handled by command and I am not sure it is cost accounted.

It is an issue of transporting specimens that have been adequately supervised back to a laboratory so we can identify people.

These are rather complex issues which get into almost a total understanding of a military operation. I would wonder whether or not we would have our own drug abuse helicopters, or do we borrow them from the command. If we borrow them from command, don't we have to know whether they would be needed for other preparedness?

These are the kinds of things you get into. Somebody could say, "If we leave those go, how do you respond if there is a crisis if they are out collecting urine?" These are command decisions, as I understand them and as I saw them there. I would not want to take the responsibility at this point to do either; to detach military personnel from their assigned duties to get involved in drug abuse.

On the other hand, I think the costs of replicating that system and getting your own staff and your own special vehicles to do this would be absolutely exhorbitant and would deplete the kinds of resources that I would like to see best deployed in the civilian end of things.

Mr. PREYER. To shift just for a moment, you say that your latest screening tests, which were July 30, showed 5.44 percent had drugpositive urines on a most sensitive test. Do you have a benchmark that you could measure that against? For example, what was the percentage figure a year ago? Was it 2 percent or was it 3 percent? Dr. JAFFE. Unfortunately, there was no benchmark figure. There were no figures on urine tests prior to this initiative on June 18. What we did have were some questionnaires carried out theoretically anonymously. Hopefully, they gave us some honest answers. They were carried out by the Army in April and May on a random sample of men both in replacement battalions and even field units and carried out on men below the rank of E-5, or E-5 or below. That was the group thought to be most susceptible.

Mr. PREYER. Assuming that was not as scientifically valid as this, what sort of percentage figure did that show?

Dr. JAFFE. It indicated with respect to opiates-and again based on this rank group about 5 percent were estimated to be using opiates on a regular basis.

Now, I might point out that was Army and of a particular rank. To get an estimate of what percentage of the entire command, which

would be comparable to the data we are getting, since we are getting on everybody now, you would have to dilute the Army figures by adding in a percentage of the officer corps, as we know officers use these close to zero. Then you would have to dilute the Army figure by the Air Force and Navy, which are data which are now considerably lower. So one would say in April and May our best estimates would be in the, perhaps, 3 percent mark of regular use.

The estimates of people who have used it one time or higher, 10 or 12 percent, is not surprising. In fact availability in some neighborhoods of the United States, sociological studies have indicated that in many neighborhoods the number of young men who had tried heroin on an occasion was considerably higher than 10 percent.

So, again looking at an occasional user versus somebody who is more of a regular user, these are reasonable figures.

Our figures on urine testing, of course, don't make that distinction. It will only tell whether somebody has opiate in his urine at the point where he is about to leave.

Mr. PREYER. On your urine tests, on July 30, it was 5.44 percent. Do you have the figures as to what it was on June 30 and May 30 and April 30?

Dr. JAFFE. Yes. What happened-and it is an interesting phenomenon we had predicted-is that with the advent of urine testing the first few days we had two factors working simultaneously, and a third factor which is unfortunate, which is that you don't suddenly develop 20 supremely trained lab technicians in the middle of Vietnam. So there was a technological problem with people learning their equip

ment.

But what we suspected was that the number of people we saw the first day or so-and this could affect those people for 4 or 5 dayswent from about 7 percent quickly over a period of 10 days down to 5 percent. This was on June 18, because most people were suspectedMr. PREYER. On June 18 it was 3 percent?

Mr. JAFFE. No, closer to 7 or 8 for a day or 2 days and then it slid down.

Mr. PREYER. When did you begin this testing?

Mr. JAFFE. June 18 at Long Binh and June 19 at Camranh Bay.

Mr. PREYER. It begin at 7 percent and quickly went down to what think was a realistic figure of 3 percent?

you

Mr. JAFFE. Down to 3.2 percent, and then it flucuated. Then it began to creep back up again as people realized we meant business. We weren't out to cut off any heads and we are going to treat them like human beings. The panic of cold turkey or hiding urines or bribing people perhaps decreased.

We think the figures we have been getting from, say, July 1 are, perhaps, going to be representative of what we can achieve before we institute further treatment, screening, and so forth, until we get the entire range of incentives and options functioning. We do think that what has been happening from about the beginning of July to present is a reasonable estimate of the size of our problem.

Mr. PREYER. We have heard wide-ranging estimates on it, and it seems to me what you are saying is that we really haven't had any solid testing procedures up until June. Only recently are we really

inning to find out. Even from your explanation of those figures