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Mr. JAVITS. Again I refer the chairman to some of these indexes. Let us just take one which catches my eye.

In 1951 the prison authorities in the city listed 2,501 inmates who had been users of drugs.

In 1954 there were 2,906 in the city's prison population, an increase of 16 percent.

In 1951 the New York City Department of Correction reported the sentencing of 1,463 persons on charges of selling or possessing drugs; and that figure was about 45 percent over 1950, showing that 1951 was a very serious year.

In 1952 that figure went down to 1,140; in 1953 it went ahead to 1,589; and in 1954 it was 2,004 or 35 percent higher than 1951.

Now again I repeat we can only give you the indicia. Our figures from the General Sessions Court in New York County, which Judge Goldstein referred to yesterday, show that about 30 percent of all those sentenced for major crimes are narcotic addicts.

All of these indices, as well as others which are dealt with in that report, lead toward our conclusion that the curve is up and up so markedly that it is a serious matter, and that is all that we contend.

Senator DANIEL. One sentence catches my eye here on page 17: Narcotic addicts sentenced for crime in this latest tally are 35 percent greater than in the epidemic year of 1951.

Mr. JAVITS. That is the figure I just gave.

Senator DANIEL. Yes.

Mr. JAVITS. So I do not think anybody could make any pretense of making an absolute dictum that this is a new emergency, new record, or anything else.

All you can do is draw your conclusions from the indices which are available.

There is no census of narcotic addicts that we know of.

Senator DANIEL. There is no doubt but that you do have a problem. It would appear from what has been put before the committee thus far, that it is different here and in California from the other States. We have had some decreases reported, I believe, decreases in most of the States except California and New York.

Mr. JAVITS. Well, this is endemic in the problem. You have these enormous ports of entry, and the very great problems which they involve.

In addition, as this committee so well knows, if you chase these addicts, ultimately they will find their way to seaboard where they have the best chance to get the drugs.

The seaboard in the big metropolitan areas, with enormous shipping traffic, where everybody knows, and Mr. Anslinger has testified time and time again, as he said, would take all the armed services, including the FBI, to draw a cordon sanitaire around any great port like New York or Los Angeles.

Senator DANIEL. Anything further? Thank you very much, Gen

eral.

In order that our public health witnesses might go on as a groun we are going to hear from the American Medical Association repre sentatives at this time, Dr. Bartemeier and Dr. Plunkett.

If both of you will stand I will swear you together.

Do you, and each of you, solemnly swear the testimony you are about to give to this subcommittee of the Senate Judiciary Committee will

be the truth, the whole truth, and nothing but the truth, so help you God?

Dr. PLUNKETT. I do.

Dr. BARTEMEIER. I do.

TESTIMONY OF DR. RICHARD J. PLUNKETT, SECRETARY, COUNCIL ON MENTAL HEALTH, AMERICAN MEDICAL ASSOCIATION

Senator DANIEL. I will ask Senator Butler to preside.

Senator BUTLER. Dr. Plunkett, I believe you have a prepared statement?

Dr. PLUNKETT. I have.

Senator BUTLER. Would you like to proceed?

Dr. PLUNKETT. Mr. Chairman, to identify myself for the record, I am Dr. Richard J. Plunkett, of Chicago, Ill., where I serve as secretary of the council on mental health of the American Medical Association. I am appearing here today with our council chairman, Dr. Leo H. Bartemeier, of Baltimore, Md.

With the thought that it may be helpful to the committee, I should like to outline briefly the functions of the council on mental health, and the history of the association's interest and activities in the medical aspects of the narcotic problem.

Following my short statement, Dr. Bartemeier will discuss our present views and activities in this field.

The council on mental health is relatively new, having been established as a permanent entity only 4 years ago. Prior to that time, a special committee in this field, appointed by the board of trustees in 1930, had continued for several years and had referred a number of recommendations to other bureaus and council of the association for

action.

With our increasing awareness of the extent of the mental health problem, and our growing recognition of the desirability for closer liaison between psychiatry and general medicine, it became evident that a permanent special committee devoting its entire effort to the problem was necessary. This led to the creation, in June 1951, of the committee on nervous and mental diseases, now known as the council on mental health.

The somewhat related problems of alcoholism and narcotic addiction are within the scope of the council's interest. Subcommittees have been created to function in each of these fields. The subcommittee on narcotic addiction held its first meeting in Chicago only 10 days ago, on September 10.

Dr. Bartemeier will discuss at greater length the plans and programs of this subcommittee, but I should like to touch on its relation to the narcotics policy of the American Medical Association, in order that there may be no confusion on that point.

Policies of the association are established by actions of the house of delegates, its duly elected representative governing body. Since the house of delegates normally meets only twice a year, interim policies are sometimes established by the board of trustees, within the framework of general policy laid down by the house.

Consequently, should the ultimate recommendation of the Subcommittee on Narcotic Addiction involve modification of any estab

lished association policy, it would be necessary that such a recommendation be approved by the council on mental health, the board of trustees, and the house of delegates before becoming effective.

There is little likelihood that this process could be completed before June 1956, at the earliest, assuming there is to be any modification of present policy.

I should like to mention one other activity of the association in the study of the narcotic problem. We have joined with the American Bar Association in the formation of a joint committee to conduct a cooperative study of the legal as well as the medical aspects of narcotic addiction.

This committee has not yet commenced its task, the approval of the project by the bar association having been given only a month ago at the last meeting of its house of delegates.

We have high hopes, however, that through such a group each profession can make its specialized knowledge available to the other and that the joint effort will be productive of a sound approach to the solution of the common problem.

I believe that it is fair to state that the problem of narcotic addiction became an item of major concern to the medical profession at about the same time that public awareness of the problem culminated in enactment of the Harrison Act in 1914.

During the decade from 1914 to 1924, the narcotic problem, encompassing not only the treatment of addicts but the interpretation and enforcement of the Harrison Act and numerous State narcotic laws, received considerable attention from the association.

Comprehensive reports of special committees which had worked diligently on the subject were submitted to the house of delegates at its meetings at New Orleans in June 1920 and again at Boston in June 1921. It is my understanding that the committee is in possession of published copies of these reports, so there is no need for me to elaborate on the record in that respect.

It may be well to note, however, as Mr. Rufus King has suggested in his excellent article in the April 1953 Yale Law Review, that the ambulatory treatment so roundly condemned in the reports involved furnishing the addict with a rather large supply of the drug for unsupervised self-administration.

Whether the same strong condemnation would have been forthcoming in a case where the drug was administered by a physician in the course of withdrawal treatment of an addict not institutionalized, I do not know, but the Supreme Court apparently was concerned with the evils of the addict's possession of large amounts of the drug in the Behrman case, and comparatively unconcerned over the small maintenance dose prescribed in the Linder case. I leave the question

open.

At the June 1924 meeting in Chicago, however, the house of delegates established the position of the association, and in the following 30 years, no comprehensive review of that position has been undertaken. Briefly, the current views and policy of the American Medical Association, established in 1924, cover the following points:

1. We oppose the ambulatory treatment of narcotic addictswhether by a private physician or in a so-called clinic.

2. We have strongly urged that State and Federal authorities put an end to this type of treatment.

3. We recommend the strict enforcement of State and Federal narcotic laws to eliminate the supply of illicit drugs.

4. We advocate the establishment of both States and the Federal Government of special institutions for the treatment of addicts.

5. We deplore and condemn "scrip doctors"-that is, physicians who provide addicts with prescriptions for drugs under the guise of

treatment.

6. We strongly recommend followup and supervision of addicts following their discharge from a hospital.

These six points have been our policy for over 30 years, although I remind the committee that an extensive review of the situation is now underway. It is entirely possible that, as a result of this review, the views of the association may be modified.

As the committee is well aware, at least 3 of our 6 points have been fully or partially implemented. Strict enforcement of the Federal narcotic laws along the lines of our recommendation is a fact. There are Public Health Service narcotic hospitals at Lexington and Fort Worth, a municipal hospital here in New York City, and followup clinics in Detroit and Chicago.

Of course, the type of maintenance clinics which were in vogue in the late teens and early twenties have vanished. Our recommendation regarding followup of addicts discharged from hospitals has not been followed to any degree, insofar as we now know, with the exception of the localities which I mentioned.

With this background, Mr. Chairman, Mr. Bartemeier will outline our present thinking and activities.

Senator BUTLER. Thank you ever so much, Dr. Plunkett.

Senator Daniel?

Senator DANIEL. I have no questions.

Senator BUTLER. Thank you ever so much. We appreciate your

statement.

May I welcome my fellow Marylander, Dr. Bartemeier.

TESTIMONY OF DR. LEO H. BARTEMEIER, CHAIRMAN, COUNCIL ON MENTAL HEALTH, AMERICAN MEDICAL ASSOCIATION

Dr. BARTEMEIER. Thank you, Mr. Chairman.

Mr. Chairman, I am Dr. Leo Bartemeier of Baltimore, Md., chairman of the council on mental health of the American Medical Association, and medical director of the Seton Institute in Baltimore.

Dr. Plunkett has presented the past history of actions of the American Medical Association with relation to its position on narcotics and narcotic addiction and what is now the present official position of the American Medical Association.

This whole matter has been brought up again recently by presentation of a resolution concerning a possible change in the association's viewpoint on use of clinics for narcotic addicts. The resolution was presented by Dr. Andrew A. Eggston of New York at the annual meeting of the American Medical Association in San Francisco in June 1954.

I believe your committee has already heard Dr. Eggston's views on this subject. The substance of the resolution is as follows:

Whereas the medical profession, in its traditional role as guardian of the public health, has been distressed by the narcotic problem and its apparent increase; and

Whereas the average user of narcotics must spend from $15 to $100 per day to keep himself supplied with drugs; and

Whereas the crime in drug addiction stems from the inability of persons of moderate means to purchase drugs at present illegal prices; and

Whereas the most serious of these crimes is the conversion of each addict into a salesman, with consequent formation of new addicts; and

Whereas the use of morphine and heroin in themselves do not incite these unfortunate persons to crime, since both drugs are depressants; and

Whereas the illicit narcotic trade exists only because of the huge financial profits, such as are obtained by purchasing 2 pounds of heroin in China for $10 and selling it after adulteration and packaging for $80,000: Therefore be it, Resolved, That the American Medical Association favor the legalization of distribution of narcotics at cost or free under the following safeguards:

(1) Establishing narcotic clinics in cities where needed under the aegis of the Federal Bureau of Narcotics;

(2) Registration and fingerprinting of narcotic addicts;

(3) Keeping of accurate records;

(4) Administering the optimal doses at regular intervals to addicts at cost or free;

(5) Prevention of self-administration;

(6) Attempt cures through voluntary hospitalization, if possible; and (7) Avoidance of forceable confinement.

This resolution was considered by a reference committee of the American Medical Association's house of delegates which felt that additional information was necessary, and, therefore, referred it to the council on pharmacy and chemistry.

The council on pharmacy and chemistry subsequently, in December of 1954, reported that their examination of information available showed that there seemed to be evidence that the narcotic problem has been increasing in seriousness since the close of World War II, but that the method of alleviating the problem suggested in the resolution had been extensively tried during the period following the end of the First World War, and experience at that time with clinics had clearly indicated that they were an absolute failure.

Also that they tended to increase rather than diminish the problem. However, the Council on Pharmacy and Chemistry felt that the present situation was far from satisfactory and that it was being handled too exclusively as a police problem without sufficient emphasis on its most important medical aspects.

Senator DANIEL. May I interrupt to ask, Have you got a copy of the Council on Pharmacy and Chemistry Report?

Dr. BARTEMEIER. I can furnish it to you, Mr. Chairman, and will be pleased to do so, and will ask

Senator BUTLER. It will be made a part of the record and included in the appendix of the record.

Senator DANIEL. Thank you.

(Report entitled "Council on Pharmacy and Chemistry, Report to the Council," from the Journal of the American Medical Association, July 26, 1952, vol. 149, may be found in the appendix at p. 1924.)

Dr. BARTEMEIER. On the basis of this report and additional pertinent material received from the National Research Council and the Federal Bureau of Narcoties the board of trustees of the American Medical Association recommended that the resolution presented by Dr. Eggston not be adopted.

The board felt, however, that further exploration on the matter should be made and, therefore, referred the problem to a recently formed subcommittee on narcotic addiction of the Council on Mental Health for further study.

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