their going out to get heroin. But when they are in jail they do not even have the heroin urge. Mr. WIGGINS. Physiologically speaking? They do not have a heroin urge in prison physiologically? Mr. KOCH. Physiologically. Mr. WIGGINS. But the real problem is all psychological, or at least it is difficult to treat; that is, the psychological problem? Detoxifying a heroin addict is the easiest thing in the world? Mr. KOCH. That is right. But once he is back on that one bag he is back on heroin. Thank God I have never been a drug addict. Just for the record, let me make that clear. So that what happens at the end of his prison program and he has been in there 6 months or a year and his time is up, people that are involved in this program-Mr. Gordon Chase, health administrator in New York, this is his program, it is not in effect but it is a very good idea-you make a decision, is this someone who is going to need drugs the rest of his life. Is this someone who by psychiatric assistance and therapy you can get off drugs totally, then you do not put him on methadone. You make that decision. Obviously many times it is going to be erroneous. Then that guy who is going to need drugs for the rest of his life you put him on methadone before he leaves prison. Mr. EDWARDS. One last question. How much money are we talking about? Mr. KоCH. I honestly do not know. To give you some idea of the costs involved, the Daily News, in reporting the $475,000 Federal grant for a methadone withdrawal program used the figure of 40,000 prisoners to be treated under this program. That is simply detoxification. To provide drug therapy treatment, psychiatric and all that is required, this will cost millions. Mr. WIGGINS. Even the figure which you mentioned is incredible for the detoxification program. We already have these people incarcerated. It is just a matter of administering methadone and methadone is relatively inexpensive substantially when purchased by the Government? Mr. KOCH. I would agree. It does not cost anything, 15 cents a week per prisoner. Well, when you are on detoxification, it is a very dangerous state, and you have to be under nurse surveillance for 24-hour periods; consequently, for the 15 beds that I was able to get in back in July, the nursing services were $50,000. So that is why these moneys add up. Mr. SANDMAN. Do you believe in segregating the narcotic users from other prisoners? Mr. KOCH. I certainly do. It seems to me anybody that is in jail has got a problem. Mr. SANDMAN. A fellow who has never used the stuff is hopeless when he is in the same environment with them; isn't he? Mr. KOCH. I would agree with that. Mr. EDWARDS. Thank you very much, Mr. Koch. The committee is very grateful. We will adjourn now until next Wednesday. (Whereupon, at 12:20 the Subcommittee No. 4 of the House of Representatives Committee on the Judiciary adjourned, to reconvene the following Wednesday, June 30, 1970.) TREATMENT AND REHABILITATION OF NARCOTICS ADDICTS WEDNESDAY, JUNE 30, 1971 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE No. 4 OF THE The subcommittee met at 10:05 a.m., pursuant to notice, in room. 2141, Rayburn House Office Building, Hon. Don Edwards of California (chairman of subcommittee No. 4) presiding. Present: Representatives Edwards (presiding), Waldie, Sarbanes, Wiggins, Sandman, Keating, and McClory. Also present: Jerome M. Zeifman, counsel; Samuel A. Garrison III, associate counsel. Mr. EDWARDS. The subcommittee will come to order. Today, subcommittee No. 4 will continue its hearings on various proposals to provide for treatment and rehabilitation of narcotics addicts. As I mentioned at our last hearing, all of the proposals before us, including the administration's proposal relating to methadone maintenance, involve amendments to laws that originated here in the Committee on the Judiciary. These laws included the Narcotic Addict. Rehabilitation Act of 1966-a landmark measure which clearly recognized addiction as a medical problem and established legal procedures for the commitment of narcotics addicts for treatment, and the Omnibus Crime Control and Safe Streets Act of 1968, which included provisions for assistance to the States in the rehabilitation of addicts. In my view, the evidence presented at the hearings held by this subcommittee last week, as well as at a series of hearings held by the subcommittee last year, indicate that in administering the Narcotic. Addict Rehabilitation Act of 1966, the Government would seem to be guilty of almost criminal neglect. We have heard testimony to the effect that each year only some 800 narcotic addicts in the entire United States are admitted for treatment under the Civil Commitment Procedures of the 1966 act. When one considers the enormity of the heroin problem this pathetically low number of treated addicts would seem unconscionable. Yet unconscionable as is this low number, the evidence indicates that we have all been barbarous in our insensitivity to the need for treatment. For me one of the most appalling facts that I have learned from my study of the narcotics problem is that each year approximately 50 percent of the addicts who are sent to Lexington or Fort Worth under Civil Commitment Procedures, usually on a volunteer basis, are denied treatment on the grounds that they are "not likely to be rehabilitated." One of the questions which I, for one, want to explore at these hearings is how any physician-whether federally employed or in private practice can conclude that a person addicted to heroin ought to be denied medical treatment for that addiction. As chairman of this subcommittee, I do not want to prejudge the kind of legislation Congress ought to enact. However, there is one principle which I am convinced must be accepted if our Nation is to survive the ravages of heroin. That principle is the simple humane notion that any person who is addicted to hard narcotics who volunteers for treatment ought to have treatment available to him. I would hope that out of our hearings will come some form of legislation to implement that principle. This morning the subcommittee is honored to have as our first witness Dr. Jerome Jaffe, who is now the special consultant to the President for Narcotics and Dangerous Drugs. Dr. Jaffe is the former director of the Illinois drug abuse program, professor of psychiatry at the University of Chicago. Dr. Jaffe has degrees, awards, memberships too numerous to describe, which I shall insert in the record, certainly one of the world's most outstanding experts in this area and a brilliant selection by the President. He was only appointed to this job a few weeks ago, and he probably has one of the most difficult specific jobs in modern history. Many people, Dr. Jaffe, are going to ask you to find answers to problems which nobody in history has been able to solve. I assure you that you are going to have in your important work the full cooperation of this subcommittee. We also recognize that there are a lot of questions that you are not going to be prepared to answer today because of the perfectly reasonable necessity for you and your people to thoroughly evaluate all the Federal programs for which you will be responsible. We really do not expect you to have instant solutions. Dr. Jaffe is accompanied by a number of experts from the Department of HEW and the Department of Justice, and you gentlemen who are accompanying Dr. Jaffe, we expect that you will be able to answer some of our questions as to how the Federal programs have been administered today. However, I think it is important to note that Dr. Jaffe should not be considered as a spokesman for any past policies with which he might disagree. So we welcome you, Dr. Jaffe, and before I go any further I would like to yield to our distinguished colleague from Illinois, Mr. McClory. Mr. McClory. Mr. McCLORY. Thank vou, Mr. Chairman. As a Representative from Illinois, on this subcommittee, I certainly want to extend a warm welcome to Dr. Jaffe, and also to express to the members of the subcommittee the excellent representation which preceeded his appointment, here in Washington, as head of the Illinois. drug abuse program. I also want merely to commend him on the courage that he has in coming to this post at a most critical time in our Nation's history with regard to the overall problem of drug abuse. I am confident that he is going to have good support from the members of this committee and Congress in behalf of forward-looking and constructive measures which can and should be carried out in order to help resolve this critical problem we have facing us. Thank you, Mr. Chairman. Mr. EDWARDS. We also have with us today as a guest of the subcommittee the most distinguished Congressman from New Jersey, who is the author of a number of important bills that have relationship to the committee's responsibilities and one of whose bills we have under consideration at this time, H.R. 1540, the gentleman from New Jersey, Mr. Rodino. Dr. Jaffe, you may proceed, and before proceeding would you please identify the other gentlemen with you? STATEMENT OF DR. JEROME H. JAFFE, SPECIAL CONSULTANT TO THE PRESIDENT FOR NARCOTICS AND DANGEROUS DRUGS, ACCOMPANIED BY RICHARD HEANEY, DEPUTY DIRECTOR, BUREAU OF PRISONS; FREDERICK GARFIELD, ASSISTANT DIRECTOR FOR SCIENTIFIC SUPPORT, BUREAU OF NARCOTICS AND DANGEROUS DRUGS; WILLIAM RYAN, CHIEF, NARCOTICS AND DANGEROUS DRUGS SECTION, CRIMINAL DIVISION, DEPARTMENT OF JUSTICE; DR. VERNON WILSON, ADMINISTRATOR, HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION; DR. BERTRAND BROWN, DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH; AND KARST BESTEMAN, ACTING DIRECTOR, DIVISION OF NARCOTIC ADDICTION AND DRUG ABUSE Dr. JAFFE. I am accompanied on my right by Richard Heaney, Deputy Director, Bureau of Prisons; Frederick Garfield, Assistant Director for Scientific Support, Bureau of Narcotics and Dangerous Drugs: William Ryan, Chief, Narcotic and Dangerous Drugs Section, Criminal Division, Department of Justice. On my left, Dr. Vernon Wilson, Administrator, Health Services and Mental Health Administration; Dr. Bertrand Brown, Director, National Institute of Mental Health, and Karst Besteman, Acting Director, Division of Narcotic Addiction and Drug Abuse, the National Institute of Mental Health. Mr. Chairman and members of the subcommittee. I wish to thank you for granting me the opportunity to appear today. I know that this. subcommittee shares with the administration and with the American people a determination to search out the best possible solution to the problem posed by narcotic addiction. I welcome the invitation to share with you my views, both in my official capacity as the Special Consultant to the President for Narcotics and Dangerous Drugs and as one who has for the past 12 years been intimately involved in efforts to develop treatment programs for heroin users. I would like to outline for you the administration's views concerning rehabilitation of drug abusers and then relate these views to the various bills pending before this subcommittee. |