would have been cured. But she would never have been hurt all during those years from taking that amount of drug.

To return-I want to say—

Chairman KEFAUVER. Before you return, we were talking about tranquilizing drugs.

Dr. KOLB. Tranquilizing drugs; yes.

Chairman KEFAUVER. What is the makeup of any of the so-called tranquilizing chemicals or ingredients in various types of barbiturates, sleeping pill tablets?

Dr. KOLB. Well, a barbiturate is the salts of barbituric acid. I can't give you the chemical formula for all of them; I have it in the book. But there is a very large group of barbiturates that people take for sleeping, and, of course, sometimes you hear of people taking those things for suicide.

Chairman KEFAUVER. Are they made of the same kind of ingredients as tranquilizing drugs?

Dr. KOLB. No; they are different. The tranquilizing drugs are a different chemical composition. I don't know enough about chemistry and pharmacology to give you that.

Of course, I have it in books and things. But they are entirely different in chemical composition from the barbiturates, and entirely different from the opiates in chemical composition.

Chairman KEFAUVER. All right. Thank you.

Mr. CHUMBRIS. Doctor, you mentioned if you could discover a formula, it would be a saving to mankind. Let me ask you this: How much money is going into research along that line?

Dr. KOLB. Well, I will tell you about this program. This program of finding out, trying to discover a different opiate drug that wouldn't have the physical properties, was started as a joint project between the Public Health Service and the University of Michigan and the University of Virginia.

That program came to an end in, well, I think 1937 or so, when the Public Health Service took it over because the other people ran out of money; and they were working on it on a grant.

The Public Health Service took that over, and took some of the personnel over, the pharmacologists and the chemists, who were trying to develop that drug, and they have since been pursuing that.

But I understand from a chemist who is in that thing that they are not supporting it quite as much as they did before, perhaps because they think maybe this thing is not going to pan out to anything. Now, they have actually made numerous, perhaps 50, different opiate derivatives, but every one of them has had the physical-addiction properties; and that is something that the addiction research center at the Lexington Hospital finds out; they try these drugs out to see whether they do have the physical-addiction properties. If they do, they tell them, and they are not released to the public.

I think there are only about two of the drugs that have been discovered in this thing that are in use now, than can be prescribed. I don't know what they are, but they are physically addictive, so it doesn't amount to anything.

Senator KEFAUVER. All right.

Mr. MITLER. Do you have some affirmative recommendations about what a good treatment program would be in the United States?

Dr. KOLB. Yes. We, of course, should have more hospitals for treatment of drug addicts. But it should be treated entirely as a medical problem.

Now, I don't believe in forcibly arresting people as has been so much done now and then, forcing them into treatment like is done under this new law that was passed in the District of Columbia. I don't agree with that law, and Dr. Chapman, I believe, will tell you later on how many States have commitment laws that are not on that basis; but we should have hospitals to which patients should go, either voluntarily or by commitment, depending on where the hospital is and whether it is by a State or a city.

Chairman KEFAUVER. How are you going to commit them unless you have compulsion?

Dr. KOLB. I would only commit people who are found violating a law, and who come to the attention of the police that they are addicts. I wouldn't go out hunting for them. And the reason I wouldn't do it is because I have found by studies in Europe that it is not done there, anyway. They know that this opium addict out in the public is not hurting anybody and is not going to commit any crime because of his addiction, so they don't go after him to commit him to a hospital. I don't say we shouldn't do it here. If we come across this addict, and he comes to the attention of the police because of some violation, or if his family will make a complaint against him as they do when he becomes mentally ill, they say, "He is an addict; we would like to have him treated," then I would go in for the commitment.

I would have hospitals for treatment, and I would repeal these, what I consider more or less extreme laws, whereby an addict cannot be put on probation.

The thing I think we should have or what the original narcotics law had when Lexington and Fort Worth were established-judges could' put addicts, violators, on probation and send them to Lexington or Fort Worth, on the condition that they go there and stay until they are cured.

Now, the probation feature at Lexington has fallen down because we have got these extreme laws, partly because of that, whereby the judge is forced to give a prison sentence, and prison sentences which are, to my mind, excessive.

Well, we should have hospitals to treat these people, and there should be commitment procedures to hospitals like the Riverside Hospital in New York; they have it in New York. Being a State institution, they can commit to them or put them there with some little police pressure. That is all right. And they should stay until they are cured.

Now, it is very important that when they come out, that there should be some followup, but not by police. That is a destructive thing, and the thing where we have gone so far wrong.

I would like to digress a little bit here, just to say what this has done. I have seen a fellow come back to Lexington in tears. We cured him, got him a job, and the police came around and said to his employer, "You know, that fellow is an addict."

What happened? The employer gets distressed. He thinks, "Well, there is a terrible criminal here," and he isn't anything of the kind, "and besides, I might be violating some law."

And so the fellow, he discharged him. The fellow couldn't get a job, and he got into a distressful situation without any employment, and he relapsed to drugs, and he comes back again.

This has happened over and over again. That is why the police should never follow these people.

Now, the followup that I would recommend for people coming from Lexington and Fort Worth would be, in the big cities, for the Public Health Service, big cities like Washington or Chicago or New York, Detroit, Los Angeles, where they have most of the addicts, to have a clinic there to which these people would be asked to go and report from time to time, and the clinic would be run by trained psychiatric social workers, perhaps, with a psychologist, where we could get one, and with some psychiatric consultants where these people could go from time to time to get their emotional problems straightened out, and some assistance from the social workers in getting them into jobs and, when necessary, to refer these people to psychiatrists to get them to help to unravel their emotional disturbances so that they could stand stresses more than they ordinarily can, and would not relapse too much.

I doubt whether it would be feasible to have a program to follow every addict who might go to rural regions and to all the small cities in the United States. It would be more expensive, and the results wouldn't justify it.

Chairman KEFAUVER. Then in that followup program, you said that you don't know about the smaller cities; but most cities, and also counties, have some kind of public health service, and cities the size of Knoxville and Chattanooga certainly have psychiatric physicians to be of service.

Dr. KOLB. Yes, sir, but I don't think from Knoxville and Chattanooga you will get very many addicts going to Lexington and Fort Worth. I don't know just what the figures are. They are getting the biggest numbers from New York, Chicago, Philadelphia, Washington, Detroit, Los Angeles.

Chairman KEFAUVER. Would it not also be helpful if the employment service, for instance, could help in making a special problem of employment for these people?

Dr. KOLB. It would be very helpful if they did that, because that is one thing that causes addicts to relapse, to go out, and they are more or less shunned; and if they are known about, people avoid them. They are afraid they are criminals, and they are not necessarily criminals at all. They are just weak people.

And there are thousands of them around here working, of the same type of person except they haven't been unfortunate enough to become drug addicts.

Now, the thing that Mr. Rosenblum said here today, I believe that was his name, who has that followup thing in New York, I think that is very good, sort of a AA type of followup where they go to those people

Chairman KEFAUVER. His name is Rosenfeld.

Dr. KOLB. The program he had there was a very good program for those people, and it has been a very good program, like Alcoholics Anonymous for alcoholics.

Of course, he said a lot of things about the nature of curing them with which I don't agree, but that is not important.

Chairman KEFAUVER. He is a layman.

Dr. KOLB. But he is doing a splendid job there, I can see very well. That type of followup is a very good thing for drug addicts. Mr. MITLER. Could I clarify just one thing, Doctor. In your speaking about these laws, you are not making reference to the nonaddict pusher, the man who just goes out coldbloodedly and sells? Dr. KOLB. I don't care what they do with a fellow who is not an addict.

Mr. MITLER. In other words, the law should be severe for that? Dr. KOLB. I think about 95 percent of the fellows who are selling them and are arrested for selling are addicts who are selling a little in order to get more money to support their own habit, and those are the kind of people I would treat as addicts, and not as a pusher like people such as Lucky Luciano and other people. They are the terrible criminals who ought to be dealt with in a severe way, and it doesn't make any difference.

But for the ordinary addict-pusher, he should be treated usually in a probationary way in a hospital like Lexington and Fort Worth, and stay there until the doctors think he is all right.

Now, in the case of probationers, people who have been sentenced, when they go out and they are followed by the probation officers, that is all right. But for the voluntary addict, he should never be followed by any police at all, because it will inevitably happen they will be, with perfectly good intentions, the police will make raids on them and arrest them, and they will get into the criminal class, and we will have these headlines about 300 or 400 people being brought in, and you find out that two-thirds of them are nothing, they are just raiding people, and it adds to the excitement.

I did intend to say something about the British system as I found out about it when I was over there, and as I have later on studied about it.

Now, in England especially-I will refer to England because I especially studied it there, and since I have studied it, and it applies also to countries like Germany, Italy, and Denmark. In England, the doctor is never disturbed in his prescribing for narcotics. Dr. Lindesmith yesterday gave you a very good example of what is going on in England.

I don't think any doctor in England ever has been sent to jail because he prescribed for an addict. But they do prosecute a doctor in England if he prescribes for himself.

What happens there, and I will go over it again, is this: that there are people on the panel in England, doctors; they write prescriptions for an addict if they think he should be carried on a maintenance dose, and they noted it on the panel. And a regional medical officer will go around and see the doctor about it, and consult with him and suggest to him, "Now, maybe you should cut this fellow down" or "maybe you should have a consultation with another physician before you continue to carry on with him."

Mr. MITLER. That was the system Dr. Lindesmith described.
Dr. KOLB. That was the same system he described in England.

Mr. MITLER. In other words, your observations are the same as his.
Dr. KOLB. My observations are the same as his.

Mr. MITLER. Do you have an account there?

Dr. KOLB. I have here

Mr. MITLER. We will put that in the record.
Chairman KEFAUVER. Let him explain what it is.

Mr. MITLER. I am sorry.

Dr. KOLB. The reason why I brought this down here is that people in this country, in perfect good faith, say that the English don't do the thing any different from what we do. And I have heard it said over and over again-it is surprising what intelligent people will allow their their emotions to carry them on to say, or how they can get blinded to facts. I will just read the 2 lines in this thing that they go by, in this 15-page thing. This line is:

The continued supply of dangerous drugs to a patient solely for the gratification of addiction is not regarded as medical need.

Now, that is in there, and the English don't indiscriminately give opiates to addicts, and this shows it.

In 1924, a committee that was called the Ralston committee in England was appointed to advise the Government what to do about this, and they made a report which has been English law ever since; and in these instructions to doctors and dentists under the Dangerous Drugs Act and Regulations, revised by the Home Office in 1956, it very definitely tells you how the doctor can go about these things and what he should do, and I would like to read perhaps just what is the law, and with the various modifications which Lindesmith and I told you about, They carry an addict, when they find out that he is an addict and they can't cure him, they carry him on drugs indefinitely with the minimum dose. Here is what they do, I would like to read this:

In the preceding section, the conclusion has been stated that morphine or heroin may properly be administered to addicts in the following circumstances, namely, (a) where patients are under treatment by the gradual withdrawal method with a view to cure

that is not allowed in the United States. Doctors have gone to jail for trying to do that here—

(b) where it has been demonstrated, after a prolonged attempt at cure, that the use of the drug cannot be safely discontinued entirely, on account of the severity of the withdrawal symptoms produced, (c) where it has been similarly demonstrated that the patient, while capable of leading a useful and relatively normal life when a certain minimum dose is regularly administered, becomes incapable of this when the drug is entirely discontinued.

Now, these people are carried in England on maintenance doses as long as they live. They continue with their work, they never disturb anybody because of addiction.

But in their regulations, if one of these men getting narcotics from one doctor goes to another doctor and gets one, then they punish him and they give him a short jail sentence and put him back on the thing. Mr. MITLER. That is the gist of Dr. Lindesmith's statement.

Dr. KOLB. That is the gist of the whole thing, and that thing put in regulation here would wipe out 90 percent of our crime overnight because of drug addiction.

The thing I would do here, I wouldn't be quite as liberal with it as the English are, because we are a little bit different culture; I would have this thing policed by doctors, not by policemen, not by narcotics enforcement people. I would have the law so changed that people could be sent to penitentiaries up to 10 years, that is what they can do in England, but always within the discretion of the judge.