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the IV drug users entered a drug treatment program following the intervention.

There is no question that outreach programs such as the NIDA model should be continued and expanded, for not only do they teach substantial numbers of drug users how to protect themselves from HIV, but they also lead to treatment programs for many of them. They are essential companions to the programs described in this report.

A second issue that needs discussion is the lack of medications that can treat cocaine addiction. At the present time there is no treatment for cocaine addiction similar to methadone as a treatment for heroin addiction. Much work must be done to test and approve treatments for cocaine addiction in all its forms. The length of time before we have an effective treatment for cocaine addiction is estimated to be as much as ten years at the current rate of research. Undoubtedly, more must be accomplished at a faster rate to meet this urgent need.

And finally, the Office of Technology Assessment conducted a study at the subcommittee's request on "The Effectiveness of Drug Abuse Treatment: Implications for Controlling AIDS/HIV Infection." This report found that there is substantial evidence that methadone programs are effective not only in reducing the use of heroin but also in reducing HIV transmission.

However, even a treatment that works, if it is improperly implemented, can be ineffective. In the case of methadone, an adequate dosage is essential to stop the craving and withdrawal symptoms that drive heroin users to inject the drug. An appropriate dose level for methadone has been demonstrated as an effective drug treatment, leading to greater retention of clients in treatment and to a reduction in HIV transmission.



Mr. Chairman, I want to lend my support to this report. As a member from New York City I can assure that we are losing the war on the demand side. Many years ago I managed a drug rehabilitation clinic. At that time, our resources for reaching the minority addicted population were somewhat limited. That was before the arrival of crack-cocaine. I can assure that the limitations that I faced were minor in comparison to the crisis facing drug treatment practitioners today. The city currently has waiting lists for drug treatment that require people to wait not a few days or weeks but actually months in order to receive treatment. The report addresses the child health problem which is also associated with the demand for drugs in our inner cities. New York's crack babies are now schoolage children. Given the side effects of drug addiction, the educational future is already tarnished.

It is quite clear that much more must be done to address the demand side of the equation. It is not enough to say no; we must provide real alternatives and programs to assist those people who have become addicted. It is time that we recognize that treatment, for all drug abusers, is important.



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