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Although we share the committee's views that treatment and prevention are critical components in the war against drugs, we disagree with several major conclusions and recommendations set forth in this report. They include: (1) that the National Drug Control Strategy's treatment and prevention programs ignore the poor and people of color, and instead directs law enforcement activities at these populations; (2) that the national strategy should include "treatment on demand," and; (3) that cities should have direct access to treatment and prevention funds.

The Federal strategy does not ignore poor and people of color

The report accuses the National Drug Control Strategy of having objectives that "virtually ignore the poor, urban and communities of color." (p. 71). This is not a fair indictment. We have held hearings in which this specific question has been raised. The committee heard testimony indicating that those agencies who are part of the treatment and prevention team of the national strategy are continuously making efforts to meet the needs of the poor and people of color. As recently as October 18, 1990, the Secretary of the Department of Health and Human Services, Louis Sullivan announced grants totaling $24.2 million to 80 programs in 35 states and territories to improve individual drug abuse treatment programs specifically serving adolescents, minorities and public housing residents. Other high risk populations that will benefit from these grants include the homeless, the mentally ill, those afflicted with AIDS, and populations in rural areas.

The report also states that less educated poor people, many of whom are minority, are more likely to be targeted by law enforcement rather than treatment and prevention efforts, and as a result, a disproportionate number of people of color spend time in prison and jail. We reject the report's inference that law enforcement efforts are somehow inappropriate or counterproductive to drug abuse prevention. The real victims of the drug war are the innocent and upstanding residents in our communities whose lives are continually threatened and often lost in the violence and criminal activity that now abound on our streets. The citizens of communities have a right to walk their streets; our children have a right to play out in the open; and our neighborhoods, have a right to be neighborhoods, not drug bazaars. Thus we support responsible law enforcement efforts in drug-infested areas, wherever they may be,

to try and provide protection and safety to the innocent people whose communities are being destroyed by drugs.

There are notable law enforcement programs that are successful in cleaning up drug-infested areas in the inner cities. In Charleston, South Carolina, for example, Police Chief Ruben Greenberg implemented innovative law enforcement methods directed at what had been the worst area in the inner city, the public housing projects. When Greenberg became Chief in 1982, the projects were beginning to be dominated by drug dealers and their violence. The police force by this time had given up trying to make a difference. The attitude was "let'em have it, as long as we stay out of there." Greenberg thought public-housing residents deserved better protection. He also thought good police work, founded on respect for law-abiding citizens without regard to income or race, could overcome the mistrust between ghetto neighborhoods and the cops. "We went in on a rescue mission," he says. The projects were "the easiest place to start, because that's where the victims are." 1

Using foot patrols and "flying squads" and working closely and regularly with the tenants, Greenberg's law enforcement efforts drove the drug dealers out of this area. At the time Greenberg was interviewed for his story, crime has been cut by 35 percent and no one had been murdered in the Charleston projects in five years.2 Treatment on demand is a laudable goal, but is it realistic

The report recommends that "treatment on demand," making treatment programs available to all who want it, should be a goal of the national strategy. The question is not whether this is a laudable goal, but whether it is a realistic goal. Throughout the report, statements are made that treatment works. But this "fact" is qualified: "Decades of research tell us that treatment works, but primarily for individuals who have more to lose-those with jobs, families, and friends, the majority of whom come from the middle and educated upper classes." (p. 88). Unfortunately, this tells us more about those for whom treatment programs work best, than about the types of programs that are successful for those without jobs, families, and friends. In fact, the report documents well how very little we know about what types of treatment work best for different individuals: the success and effectiveness of self help groups is not known (p. 62); there are problems in keeping hard-core drug users in drug-free outpatient treatments (p. 62); there are limitations, and questions as to the effectiveness of methadone maintenance programs (pp. 62-65); the rate of recidivism is high at private rehabilitation centers and worse at inner city programs (pp. 68-69); and the results of the Treatment Outcome Prospective Study (TOPS) reveal that only half of those who go through treatment are drug-free or have significantly reduced their drug use three to five years later (p. 69). Šimilar results were documented in a June 1990 Government Accounting Office report on how other drug-consuming nations fight the war on drugs.

1 Vern E. Smith, "A Frontal Assault on Drugs", Newsweek, April 30, 1990. p. 26. 2 Ibid.

We found no overall statistics on treatment effectiveness, but limited studies in the United States and West Germany indicate that long-term individual treatment programs have shown that 30 to 50 percent are able to abstain from drugs following such treatment.3

In light of these obvious indications that we do not know which treatments work, the emphasis the report gives to finding out the costs of treatment is troublesome. Instead, determining the types of treatment programs that have been successful and are effective for those who seek it, should be of prime consideration.

In the end, we have no way of accurately measuring the number of people who seek treatment. To blindly expand treatment programs to a point where there is no more demand for treatment slots would severely bankrupt the federal anti-drug budget.

Direct funding to mayors of large cities questionable

The report recommends that anti-drug funds be given directly to larger cities. The U.S. Conference of Mayors is cited as demanding this change because of funding delays and the wish to play a more active role in the state planning process (p. 50). We understand the concerns of the Conference. It is important to eliminate funding delays and inefficiencies that detrimentally impact efforts of mayors across the country to address the drug problem in their cities. However, we think that it may be counterproductive to assign mayors sole responsibility for the use and distribution of federal anti-drug funds.

The federal strategy's goal is to make states accountable for their anti-drug efforts. Legislation now under consideration, that has received the Administration's support, would encourage coordination at the local level between a city's major service organizations (social, health, correctional and vocational), and drug treatment facilities. Through the system, the city, or mayor, would have direct input into the state planning process. Under this coordinated process, each state could be better held accountable for its efforts, weak links could be more easily identified, and effectiveness could be measured more efficiently.

While we can appreciate and understand the goals reflected in the recommendation to give anti-drug funds directly to the mayors of large cities, we are not convinced that it would be the most efficient or cost-effective way to implement successful anti-drug activities. Direct funding could result in fragmentation among neighboring communities and make the coordination of state and federal anti-drug efforts even more difficult.

3 U.S. General Accounting Office, "Drug Control: How Drug-Consuming Nations Are Organized for the War on Drugs," GAO/NSIAD-90-133, June 1990.

The national strategy is correct in its request for a cooperative working relationship between mayors, city officials, and program directors in the smallest community and in the largest city. Their input at the state level and ultimately to the federal level will give unity and purpose to the fight against drugs.










I commend the committee for its excellent report on the role of demand reduction in the National Drug Control Strategy. The report goes a long way toward outlining the goals that the Federal Government should adopt for the reduction of demand for abused drugs of all kinds.

There are several issues that I consider of great importance that should be addressed to make the report more complete. These issues were the subject of a hearing held by the Subcommittee on Human Resources and Intergovernmenal Relations in September of this year on strategies to prevent HIV infection among intravenous drug users.

There is a well documented connection between intravenous drug use and the AIDS epidemic. The AIDS virus is transmitted through the sharing of needles and other works used in injecting drugs. Of the cases of AIDS reported to the Centers for Disease Control through September, 47,500, or 31 percent were associated with IV drug use, directly or indirectly, and this percentage is increasing. In several Northeastern states including New York and New Jersey, and in Puerto Rico, the number of adult AIDS cases among IV drug users exceeds those among homosexual men. Among all cases of AIDS in women through May 1990, about 70 percent are associated with IV drug use or an IV drug-using sexual partner. In addition, about 70 percent of the perinatally infected children with AIDS had mothers who were either IV drug users themselves or had sexual partners who were.

Conservative estimates of IV drug users not in treatment place the numbers at from 1.1 to 1.8 million. Needle sharing is practiced among virtually all groups of IV drug users. One reason for this is that in most States there are laws that prevent the purchase of needles and syringes without a prescription, and that make possession of them a crime.

In order to reach those persons who are injecting drugs with information about preventing HIV transmission, research results tell us that the best means is through trained outreach workers, who actually go into the communities where drugs are sold and used, to teach IV drug users how to prevent HIV transmission.

The National Institute of Drug Abuse (NIDA) has funded threeyear demonstration programs that studied and changed the highrisk behaviors of IV drug users in community-based programs in 18 cities. Preliminary data from five cities was impressive. From 34 percent to 59 percent of IV drug users reported decreased sharing of drug injection equipment and from 22 percent to 37 percent reported decreased borrowing of drug injection equipment. Of those who continued to inject drugs, 20 to 39 percent reported using bleach to clean their needles consistently. And 14 to 35 percent of

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