SPECIAL ACTION OFFICE FOR DRUG ABUSE PREVENTION FRIDAY, OCTOBER 22, 1971 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON PUBLIC HEALTH AND ENVIRONMENT, Richmond, Va. The subcommittee met at 9:30 a.m., pursuant to notice, in the auditorium of Virginia Commonwealth University's Medical College of Virginia campus, Hon. Paul G. Rogers (chairman) presiding. Mr. ROGERS. The Subcommittee on Public Health and Environment of the U.S. House of Representatives will come to order, please. First of all, I want to say how pleased and delighted we are to be here in Richmond and at the university to have the benefit of the advice of witnesses that we will hear this morning. We are conducting hearings over the country and in Washington on what I think it is one of the Nation's most serious problems, drug abuse. We have 35 pieces of legislation that the committee must con-ider, including the President's proposal to set up a Special Action Office for Drug Abuse headed by Dr. Jaffe, and this committee hopes to write this legislation within the next few weeks. These hearings will be most helpful to us in doing that. We have come to Richmond at the invitation of your distinguished Congressman, and our good colleague who is the ranking member on this subcommittee, the Honorable David E. Satterfield. It is a real pleasure to be here in his district, and the contribution he has made to this committee's work has been outstanding, so we are honored to be here today in your district. We are pleased that the members of our subcommittee, not all of them could come, but I think we have a good representation in addition to Congressman Satterfield, Congressman Kyros of Maine to my left, Congressman Preyer of North Carolina, and Congressman Symington of Missouri. Mr. Steve Lawton is the counsel to the subcommittee. I think we will proceed, if you would like to say anything first. Mr. President, we are honored to be here on your campus, and we would be pleased to have any statement by you that you wish. STATEMENT OF DR. WARREN W. BRANDT, PRESIDENT, VIRGINIA COMMONWEALTH UNIVERSITY, RICHMOND, VA. Dr. BRANDT. Thank you, Congressman Rogers, it is my privilege to welcome you and the members of the subcommittee this morning, particularly to Richmond. particularly the middle class and upper middle class teenage group in the city of Richmond. They have come to him in the programs that he has developed. Some of the experimental programs he has been carrying out we think are quite distinctive, and we are pleased to have you hear him. In addition to Dr. Bright, we have Dr. James Mathis, who is chairman of our department of psychiatry, for Congressman Symington's information, educated at the University of Missouri, and has his M.D. from St. Louis University. Dr. Matthews came to us a year ago. He has an extensive experience in the psychiatric field, and a great deal of experience working with young people and working with the drug problem in particular. Following him will be Mr. Harrison, who is director of the pharmacy services in the Virginia Commonwealth University Hospital. Educated at the University of Michigan and the University of Florida, he has been working very closely in a leadership role with the methadone program. I think he will have many significant comments to add to the other two gentlemen. Let me again welcome all of you, and we hope you have a delightful visit to Richmond and to the Virginia Commonwealth University. We are honored and pleased to have you here. Thank you, Mr. Chairman. Mr. ROGERS. Thank you very much, Dr. Brandt, for your very generous remarks, and the background of your university. I think it might be well just to mention this committee has just completed legislation in a conference with the Senate, which is not lways easy, to try to work things out, but we have been successful in completing the health manpower legislation and the Nurse Training Act, which probably will be, I think, the most significant supporting legislation for medical education in the history of this Nation, and I am sure that this university can benefit from it. We hope we can fund it properly. Dr. BRANDT. Mr. Chairman, we are certainly very cognizant of your efforts in that area, as well as the cancer area, and because of the close relevancy these have for the total programs as well as the specific programs in cancer, we are watching developments practically daily, and at any time we can be of assistance, please do not hesitate to call on us. Mr. ROGERS. Thank you. Our first witness is Dr. George M. Bright, director of adolescent medicine at the Medical College of Virginia. STATEMENT OF DR. GEORGE M. BRIGHT, DIRECTOR, ADOLESCENT MEDICINE, MEDICAL COLLEGE OF VIRGINIA, RICHMOND, VA. Dr. BRIGHT. Thank you very much. The Adolescent Clinic at the Medical College of Virginia is, at present, an outpatient facility, offering comprehensive medical-social services to young people between the ages of 12 and 21. The usual problems frequently encountered in the adolescent years are those of growth and development, drug abuse, school achievement, and interpersonal relations. Since the Adolescent Clinic became an established teaching and service area 112 years ago, approximately 1,000 families have been seen for a variety of chief complaints. Recent statistics of this total number reveal 51 percent have drug or drug-related problems. Of this total number, 135 are adolescent opiate (heroin) addicts under the age of 21. With this basis, it became mandatory to develop a comprehensive program not previously available to this age group. The permanent staff consists of a medical director and associate, a registered nurse and a nurse aide, a medical-psychiatric social worker, an occupational therapist and job developer, a medical librarian, a psychiatric consultant, a receptionist, four secretaries, and five resident physicians in pediatrics. Two fourth-year medical students serve a 1-month or 2-month elective on a rotational basis. Students from the departments of social work, pharmacy, and occupational therapy within the Virginia Commonwealth University complex, attend teaching sessions held on Monday, Wednesday, and Friday mornings. A large percentage of the patients population came from referrals through agencies, physicians, schools, or by word of mouth. Although 51 percent of these young people have drug or drug-related problems, the majority have significant medical chief complaints warranting consultation with a group of pediatric subspecialties within the Department of Pediatrics at the Medical College of Virginia, including cardiology, hematology, neurology, endocrinology, nephrology, allergy and infectious disease, gastroenterology, and obstetrics and gynecology. A more detailed description of the clinic function is included in this adolescent medicine manual (see attachment-Adolescent Outpatient). An equally important part of any medical program is an inpatient section for medical and social problems. At the present time, construction is underway to develop a 10-bed section which will be available for referrals throughout the State. This unit is being designed to care for adolescents with the comprehensive approach to those medical or social problems requiring hospitalization. The most frequent medical problems are local and systemic infections, secondary to the communal use of nonsterile needles and syringes. The more complicated medical problems are those of growth failure, psychosomatic symptoms, and diagnostic problems referred from outlying communities where laboratory facilities and our subspecialties are not available. This area is to be used for adolescents who need medical services to withdraw from opiates and/or a controlled environment from adverse effects of hallucinogens (see attachment-Adolescent Inpatient Service). This is the only adolesent diagnostic and treatment center for drug abuse in the State of Virginia. An important aspect of the drug treatment program is in methadone maintenance and detoxification programs whose objectives are outlined under the methadone maintenance and substitution program (see attachment). The rules and regulations followed in establishing this program are in compliance with Federal and State regulations regarding methadone hydrochloride. The enclosed protocol will give you an in-depth interpretation of the entire adolescent program. It includes copies of the social history, physical examinations, social intake form, consent forms, samples of laboratory urine screening sheets used in maintaining up-to-date accurate records, and followup data. Of the 13 area hospitals in the city of Richmond, the Department of Pediatrics of the Medical College of Virginia has the only training-treatment program for drug abuse with special services for heroin addicts. Guidelines have been developed for methadone use in the emergency room setting that would give the physician a moderate amount of background and accurate information for an acute detoxification schedule. Recommendations for referral and consultation with the adolescent or adult programs are mandatory (see attachment-Methadone Emergency Room Gudelines. Richmond is very fortunate to have a multimodality approach to drug abuse. Methadone maintenance and detoxification is only one part of the medical support. Psychological support services are also available as outlined in the protocol. The adult methadone service and pharmacy dispensing area works very closely with the adolescent program, as well as the therapeutic community, Rubicon, in providing job counseling, social guidance, therapy sessions, and educational programs-(see attachmentMethadone Adult Services and Methadone Pharmacy). Since drug abuse is a community affair, proposals were presented to civil clubs in an effort to assist with an educational program, as well as to involve them in rehabilitation for young people who have already been evaluated and were ready for reentry into an entirely different life style than they had been accustomed to. Proposals were presented to an inner-club council with a positive response in terms of a commitment for sponsorship programs, donations, and assistance with a job bank. The adolescent clinic is very fortunate to have a job developer who serves as the director of the hotline, or the Richmond Crisis Intervention Center, and serves as coordinator for the adolescent medical ward with young people who have physical handicaps and problems with their self-image. As a result of this service, hotline and the clinic receive approximately 100 phone calls per day for drug or drug-related information. In 1970, it became obvious that many of the parents did not understand the terminology used by young people involved in experimentation, use, and abuse of drugs. A training manual was developed to include a vocabulary and medical information concerning a variety of prescribed and illicit drugs. This manual is now used throughout the State by teachers, law-enforcement agencies, and the medical profession (see attachment-Hotline Manual). Another important service of the adolescent service is a medical librarian who collects the educational materials with complete reprint files on drug abuse and an up-to-date collection of journals, periodicals, books, and films relating to the medical-social problems of adolescents (see attachment-Bibliography). The city of Richmond is indeed fortunate to have a Council on Drug Abuse Control-CODAC-serving as an umbrella for a variety of other agencies available to young people and adults. Brief descriptions of the services provided by our therapeutic community, the Rubicon, the Fan Free Clinic, included (see attachments). All of these agencies communicate and cooperate in helping expand programs for our adolescents. |