from the main subject of what you have testified to, about the question of methadone, which is a highly controversial one right now. I understand a new drug application for methadone is pending before your department.

Dr. EDWARDS. That is correct.

Mr. PREYER. Would you have anything to say about the status of that at this time or could we look forward to any date on which there might be some ruling on it?

Dr. EDWARDS. Yes, Mr. Congressman. We do have a new drug application for methadone that has been submitted by Eli Lilly & Co., and this is being considered by the Division of Neuropharmacological Drug Products. Information relating to the new drug application is being sent to a special advisory committee we have on the particular subject.

This committee will be meeting on September 14, and they will be providing us with their recommendations as to whether or not methadone should be approved for this new use.

Mr. PREYER. We have been reading in the local papers recently of some of the dangers of methadone when prescribed without proper safeguards by physicians and I am sure your group will be considering that. Dr. Roy, I am sure, would know far more about that than I would. Now, the only other question I wanted to raise at this time, concerns the community mental health facilities. You indicated, Mr. Secretary, that you object to the bill because it would force community health centers to duplicate existing services in areas where such services already exist. I have thought about the bill, and if it is carried out in the language of the bill properly, I think it would not force any duplication of existing programs, but that it would be a method of complementing these programs. The testimony we have heard is that the approach on drug abuse must be a multifaceted program, and that there is a place for the store front treatment centers, the therapeutic communities, the methadone programs-the whole bit.

In the bill, H.R. 9059, in subsection 1 of section (c), it says:

The center will provide in such fiscal year a treatment and rehabilitation program for drug addicts and other persons with drug abuse and other drug dependency problems, who are in the area served by the center, for the need for such a program in the area served by the center is not of such magnitude to warrant the provision of such a program by the center.

Don't you believe that the "savings" clause would draw your objection?

Secretary RICHARDSON. If it were clarified just a little to make clear that the determination of need is not a determination of the total need for treatment facilities and service in the area, but rather the residual need, taking into account the degree to which some other facility or center is already dealing with the problem.

If that clarification were made or understood, then I think the requirement would be unobjectionable.

Mr. PREYER. I think we do seek to reach the same end, and I don't believe it is our intention at all; that is, the sponsors of this bill, to duplicate any service.

Mr. Chairman, I had one other question I wanted to ask Dr. Edwards which I failed to ask him.

On page 7 of the Secretary's statement, he states:

In addition, FDA has authority to reclassify drugs from over-the-counter status to prescription-only status, because of drug abuse potential.

Dr. Edwards, have you had occasion to use that authority or do you anticipate that there are some drugs which will be changed to "prescription only" status because of the drug abuse potential?

Dr. EDWARDS. Mr. Preyer, we have not used that authority since I have been Commissioner. We are, as you may know, developing a plan to look at the over-the-counter drug market and one of the first classes of drugs we will look at are "mood" drugs, psychotropic drugs, over-the-counter drugs. I would suspect, either using outside expertise or our own, there might be some drugs now classified as "mood" drugs that may go from over-the-counter status to prescription status. But I can't give specific examples at this particular point in time.

Mr. PREYER. I am glad to see you are moving in that direction, and I certainly would like to encourage you in it. We will be interested in the results.

Thank you very much.

Mr. ROGERS. Mr. Symington.

Mr. SYMINGTON. Thank you, Mr. Chairman.

Mr. Secretary, on page 3, you indicated that the Office will be established for 3 years and not permanently, with the provision for an extension. Is it your thought that coordination will have reached the takeoff point then, and we no longer will need a coordinator, or that the problem will be sufficiently under control not to require coordination?

Secretary RICHARDSON. I think the judgment to seek legislation to create this office on an emergency basis rests on a combination of two hopes.

One is, as you just mentioned, the hope that a concerted attack will have reduced significantly the dimension of the emergency itself.

The second is that the development of a total strategy will have brought into being a comprehensive network of service and facilities that can carry forward from there without the same kind of governmentwide powers. First of all, to develop the strategy and then get it into action.

Mr. SYMINGTON. Secondly, you stated that you believe that the first order of business is coordination between the relevant departments, and the second order of business is to coordinate within each department.

I would think that is the reverse of what would be necessary to have effective coordination between the departments. That you would want intragency relationships to be worked out first so the coordinator would know what he was coordinating. That is on page 2, of your statement on the bottom.

Secretary RICHARDSON. I don't think that the thrust of this was intended to imply that action under the second heading would wait for action on the first, but rather that there are two different kinds of things that need to be done. As it says here:

“. . . . First, ordering the relationships between Federal departments and the relationships within each department.

In HEW, NIMH is the lead agency in problems of drug abuse. A year or almost a year after I came into HEW, and well before the pro

posal to establish the Special Action Office had emerged, we have been seeking to make the lead agency function more effectively. I think this subcommittee is well aware that nothing is more difficult in Government than to weld the rows of separate agencies into a cohesive whole. To assure, in other words, that the whole is greater than the sum of the parts. I think the Government needs to learn how to do this. We have felt that the development of the lead agency role on the part of NIMH in the drug abuse field had important implications for the way in which HEW performs in a great many other areas that cannot be confined within any single operating agency.

Mr. SYMINGTON. I think you are charting, really, a new bureaucratic course in attempting to achieve this kind of coordination between agencies which have many departments within themselves. I have asked previous witnesses if they could give me an example of the suc cess of such an effort previously, and the only, I think, suggestion was the moon race which I think was probably a simpler problem.

Secretary RICHARDSON. Well, I appreciate your use of the phrase "charting a new bureaucratic course." I don't think there is a serious problem confronting HEW today-whether it is drug abuse, alcoholism, or mental retardation, or the many manifestations of the problem of poverty itself that can be considered the exclusive province or concern of any single one of our line agencies. It follows, therefore, that if we are to make effective use of available resources in attacking these problems, we have to learn how to integrate our resources and deploy them in a way that makes optimum use of them.

Mr. SYMINGTON. Thank you, and thank you, Mr. Chairman.
Mr. ROGERS. Mr. Hastings.

Mr. HASTINGS. Thank you, Mr. Chairman.

Mr. Secretary, I personally strongly support the President's proposal. I have some questions that go beyond this proposal and the main one that is of special concern to me is a question of involuntary rehabilitation and civil commitment. When I speak of involuntary commitment I speak of it in the terminology that says:

We are not just obligated to identify addicts, and then, under some form of civil commitment, get them off the street, but get them off the street into rehabiliation facilities offering every program that may be available, both under the proposal before us and others that may be forthcoming.

Do you have any comment or feeling on civil commitment and involuntary rehabilitation?

Secretary RICHARDSON. My only concern, Congressman Hastings, has to do with the effectiveness of it. I think it is probably axiomatic that the potential success of any program in treatment and rehabilitation of an addict depends upon the motivation of the addict himself. It tends to follow, therefore, that when commitment is involuntary, that you have on your hands an individual who does not have the requisite motivation to make the rehabilitation program likely to be successful. We should at least be using the limited resource of skilled manpower for treatment and rehabilitation of addicts who are preferably motivated to seek recovery. This seems to suggest, therefore, that we ought to emphasize programs that are directed toward those who voluntarily commit themselves.

Mr. HASTINGS. The only objection I have to it is, every place this subcommittee has gone and every State and city that has spent huge

sums of money, and New York is one having spent some several hundred million dollars over the past years, we find we are not reaching the addicts and they are not walking off the street into the voluntary rehabilitation facilities.

In New Orleans, they identified 6,000 addicts and treated 400. I believe that heroin addiction is in fact, an infectious disease in our society.

I am not talking about incarceration in a penal institution, but I think we have a difficult problem, with no solution in the short-range future that I see. And we are going to have to take some difficult steps if in fact, we are going to make correction of the problem at all or we are going to wind up with just a great number more of heroin addicts over the next 5 or 10 years.

Most of the proposals I see on education, rehabilitation and research are in terms of a time span of 5, 10, or 15 years. Frankly, I don't think this country can afford to wait that long. I don't know that civil commitment is the answer, but I am most anxious to take a look at it and see if it might be helpful in a shorter range solution to this horrible problem.

Secretary RICHARDSON. I certainly don't think we should close any doors.

The prospect you project is a horrible prospect, and I think I would be less than honest to try to convince this subcommittee that the sum total of all of the recommendations that we, or anybody else have developed, do not offer any assurance of success.

Mr. HASTINGS. Well, I share that feeling with you. Frankly, I think it is time that both Members of Congress and the administrative agencies of the Government tell the American people that with the passage of any piece of legislation pending here, we are not going to solve the problem of drug addiction. I think the easier answer concept that so many people offer is something that we should stop right at this moment and let the public know we are dealing with a horrible problem that has no easy solution. Too many people have suggested it, and that is why I go to these extreme measures perhaps.

Secretary RICHARDSON. I would only say that I would wholly concur. We have to tell the American people that the aggregate impact of these proposals, or any proposals and programs that I have seen or heard of, do not offer the assurance of success, but I wouldn't go so far as to say they don't contain the potential of success.

One of the more hopeful areas certainly is that of research and the prospect of discovering a heroin antagonist that is truly effective.

Going back for a moment to just the problem of involuntary commitment, New York State has had, of course, a program of involuntary commitment which they are in the process of deemphasizing because of the considerations I touched on earlier.

Mr. HASTINGS. Mostly because of lack of dollars, Mr. Secretary? Secretary RICHARDSON. It may be. Let me ask Dr. Brown if he would like to add or subtract from what I have said.

Dr. BROWN. The addition I wou'd make is twofold.

One is, we have not fully explored how far one can go with the reaching-out process. For example, right here in the District, Dr. DuPont, whose program I am familiar with, has been knocking on the door and the real issue is shortage of funds and manpower with ability

to have the system grow to take on those who will volunteer and you have a sort of rolling momentum that is good and does help. And even in the most hard-core addict a mixed-up person, there is some element of wanting to save his life and health. If the program is available, and there is momentum, we will reach out, but we have not fully explored in any place yet how far we can go with good outreach programs.

This is analogous to the history of dealing with other problems of mental health, where the only answer was involuntary commitment for centuries. We now find hardly any patients, even those who are grossly psychotic, who will not respond to this type of a sensitive program. Mr. HASTINGS. The only statement I want to make is mental illness is not addictive to other people.

Dr. BROWN. Yes, but let me say the outreach program has not reached out.

Secondly, we have not yet had the knowledge of how yet to fully treat those who ask for help and are fully addicted, and here I make a plea you are probably familiar with, that perhaps research on the biology and personality of such people would pay handsome dividends.

Mr. HASTINGS. I have many, many more questions, but with the limitation of time, I thank you very much and thank you, Mr. Chairman.

Mr. ROGERS. Dr. Roy.

Mr. Roy. Thank you, Mr. Chairman, and thank you, Mr. Secretary, for an excellent statement.

I have been impressed with the fact that the legislation does not reach into the Department of Defense, as well as to the Department of Justice. We had the VA folks before us yesterday, and they tell us that since July 7 three individuals have been referred to them from the Department of Defense for further treatment of drug addiction. As an experienced and excellent administrator, can you tell me how, under the present proposed legislation, Dr. Jaffe could correct this whereby he could be sure that the Department of Defense does not discharge drug addicts into our society without definite arrangements for them to go either to the VA hospitals or community facilities?

Secretary RICHARDSON. I would insist that there be developed a plan for doing this. In fact, to the best of my knowledge and belief, a considerable amount of time and thought has been devoted to the development of just such a plan. I think that an effective way of dealing with the problem could and should be evolved without necessarily vesting in Dr. Jaffe the same kind of authority over the military, for example, that he would have over treatment, research, and rehabilitation programs. But there is certainly no question this has to be done.

As I said earlier in response to Mr. Kyros, there needs to be such a clearly defined interface between the responsibility of the military, responsibility of the VA, and responsibility of community-based facilities, so that no addicted individual is lost in the process of transfer from one to the next. At some point along the line, it may be that there is nothing that can be done to force addicts to maintain treatment. This takes us back to the problem that Mr. Hastings was touching on a moment ago. But in any event, a failure to continue his treatment should, under no circumstances, result from the fact that the VA facility in a given area does not know that a discharged veteran, who is addicted, has come into their area.