Chairman KEFAUVER. Thank you very much, Lieutenant Driscoll, Inspector Driscoll, for your appearance.

Lieutenant DRISCOLL. Thank you.

Chairman KEFAUVER. We also want to express our appreciation to the prosecutor, Mr. Victor Blanc for his cooperation. He was in Newark with us.

Lieutenant DRISCOLL. I might say the success of the mass raids is also due to the fine cooperation of Mr. Blanc's office and the cooperation of the courts.

Mr. Blanc has saw fit that immediately after these mass raids that all the persons arrested have been held under high bail. That they are brought to trial quickly and in the cases of the drug pusher who is not a user, that long prison sentences are meted out and we have received splendid cooperation from his office and from the courts in enforcing the laws.

Chairman KEFAUVER. All right, thank you very much.

Mr. MITLER. Dr. Lowry?

Chairman KEFAUVER. We will have a 10-minute recess at this time. (Short recess.)

Senator LANGER (presiding). Call your next witness.

Mr. MITLER. Dr. Lowry, please.

TESTIMONY OF DR. JAMES LOWRY, MEDICAL OFFICER IN CHARGE, UNITED STATES PUBLIC HEALTH SERVICE HOSPITAL, LEXINGTON, KY.

Senator LANGER. Doctor, we are very happy to have you here. Dr. LowRY. Thank you, Senator Langer.

Mr. MITLER. Your name is James Lowry?

Dr. LowRY. That is correct.

Mr. MITLER. What is your present position, Doctor?

Dr. LowRY. I am medical officer in charge of the United States Public Health Service Hospital at Lexington, Ky.

Mr. MITLER. Can you briefly tell us your background prior to that? Dr. LowRY. I am a physician and I began work with narcotic addicts in 1938 when United States Public Health Service Hospital was opened in Fort Worth, Tex. I was chief of the psychiatric service at that hospital in 1943, clinical director of the United States Public Health Service Hospital in Lexington from 1943 to 1947 and I have been medical officer in charge since July 1954. From 1947 to 1954 I was chief of the community services branch of the National Institute of Mental Health. As such I initiated one part of the activities under the Mental Health Act which stand as a continuing tribute to Mr. Percy Priest. My medical specialty is psychiatry and I have been a diplomate of the American Board of Psychiatry since 1946.

Mr. MITLER. Your responsibility is that you are in charge of the medical staff at the United States Public Health Hospital at Lexington?

Dr. LowRY. That's right.

Mr. MITLER. Would you tell us something about the hospital, what the program is and what the approaches of the hospital are toward the drug addict?

Dr. LowRY. Yes, I will be glad to do that. I want to say that what I do say today will be based on my experience with addicts at the hospitals at Lexington and Fort Worth and I think it should be remembered that the addicts admitted to the hospital there are not necessarily representative of the addicts in the United States, even though we admit about 3,000 a year. When I use the term addict I mean a person who is physically and psychologically dependent on an opiate drug or a synthetic drug with opiatelike properties.

I might say that in my presentation I am going to use tables and read from a paper which I have written and will be published shortly. I ran across a quotation recently that explains why I do this. The quotation says:

In the excitement of the moment I am sure to say something which I will be sorry for when I see it in print,

so I have it here in black and white and there are no mistakes made. People attach too much importance to what I say anyhow.

This was said by Mr. Lincoln.

I will tell you a little bit about our hospital at Lexington. It was opened in 1935. And it is located about 5 miles from the city of Lexington and has a functional capacity of about 1,200 patients. There are about 350 beds in the infirmary wards, medical surgical and psychiatric withdrawal, TB, and the rest of the beds are in dormitories.

The buildings are located on a 1,050-acre reservation and I might say that they are less prisonlike in appearance than most prisons and more prisonlike in appearance than most hospitals.

It is a minimum custody institution and about four Federal prisoners leave without authorization each year. The valid judgments of the patients who are there vary widely. Some of them regard it as very distasteful place to be living and others regard it as above what they have been used to.

I have for you a paper that contains most of this information.

However, I think I will go through some of the highlights of it. It has already been mentioned that we have voluntary patients who are admitted at their own request and we have authority to admit them if there are beds available after the Federal prisoners and probationers are accommodated.

And that is the way that the law reads.

These voluntary patients come into the hospital at their own request and they are free to leave the hospital when they make the decision. Of course we make every effort to point out to them the consequences of leaving if it appears to us that it is an inopportune time and they have not completed treatment.

I think some of the things that affect a hospital are the characteristics of the addict patients, and the addicts that we see at our hospital have changed over the years and I think one of the important items that I might bring to your attention is a comparison between the addict as he was seen at the hospital 20 years ago and as we see him today.

Mr. MILTER. Would you make a special focus of your attention on those who are under 21 years old?

Dr. LOWRY. I certainly will. In 1936 Dr. Pescor published an article in which he spoke about a statistical addict and I compared this with a study of addicts we made in 1955. In 1936 the average addict was a white male prisoner 38 years of age who had a 2-year sentence. Today we find an average addict is a Negro male, voluntary patient who is in his twenties.

Chairman KEFAUVER. What would be the average age today?

Dr. LowRY. He would be a Negro male in his twenties. His average was 38 20 years ago. Dr. Pescor found that his addict patients had intact homes up to 18. The patients we see today don't come from intact homes. Most of them can't remember seeing their father and their mother was usually working as a domestic.

Mr. CHUMBRIS. You said the age of 38?

Dr. Lowry. That's right.

Mr. CHUMBRIS. Then you say in the twenties. Can you be more specific as to where in the twenties?

Dr. LowRY. I will cover that point more thoroughly in a minute. The addict today becomes addicted to heroin usually in his early twenties, 20 years ago he became addicted to morphine late in his twenties. They used to prefer morphine and now they prefer heroin. Twenty years ago the patients had a number of chronic illnesses. Now we find they are an essentially healthy adult, young male population.

I think one of the changes that I have remarked on and I touched on briefly a moment ago was the change that is reflected in the increase in the number of young Negro addicts. I think I should bring out here that at the hospital we receive male addicts from east of the Mississippi River and women addicts from anywhere in the United States. What we have seen in the recent past, and by that I mean the last 6 or 7 years, is an increase in the young Negro addict. Whereas in 1935 the Negroes constituted 9 percent of the population at the hospital, now they account for over 50 percent. Now the age distribution of the white males at the hospital is similar to what it was 20 years ago. If you divide the white patients by decades, you will find that there are as many in the 20, 30, 40, and 50 as there were 20 years ago and the distribution is about equal. However, if you look at the Negro males you will find that 70 percent of the Negroes that we had in the hospital last year were under the age of 30. This same thing holds true for both men and women addicts at the hospital.

In Pescor's study fortunately he inquired as to the age of onset of the use of drugs. And I might point out that in 1936 he found that 162 percent of the addicts said they began to use narcotic drugs at age of 18 or younger. In a study of a similar group which was prisoner addict patients at Lexington, in 1955 and 1956 we found out that 45 percent said they began using narcotic drugs at age 19 and under.

So you see there has been a shift there in the 20-to-29-age group in 1936, about half of the patients started and in 1955-56, 45 percent. So that you see by the age of 29 then there are 89.6 percent of the patients have started using drugs these present days.

I brought some figures for you so I could tell you what our experience has been with young addicts in the last 5 years. We have information covering this period. If you look at the addicts who were

18 years or under who were admitted to the hospital in the past 5 years, you will find that the first admission run like this: 1952, 46; 1953, 49; 1954, 60; 1955, 25; and 1956, 25. In other words we have 199 young, age 18, 17, 16, addicts at the hospital in the past 5 years. Of these 199, 15 were readmitted during that period.

When I looked at the race distribution of these 199, I found out that 112 were Negro and 87 were white. You will recall I said that the males come from east of the Mississippi and the women from the entire country. If you look at the State of origin of these addicts 18 years of age and younger, you find that they come from New York, Illinois, and the District of Columbia. There were 59 from New York, 59 from Illinois, and 18 from the District of Columbia, and then there is a scatter from a fairly good number of large States each contributing 2, 3, 4, or 5. I can pinpoint this a little further for you. They not only come from New York but they come from New York City. There are studies that show they come from specific neighborhoods in New York City and these studies further show that they come from broken homes in these particular cases. I am sure you have had that testimony in New York. Chairman KEFAUVER. Very few come from farming districts, is that right?

Dr. LowRY. I could run through this: Georgia 2 in 5 years, Indiana, 4 in 5 years; Iowa, 2; Kentucky, 2; I don't see any from the Dakotas at all.

Mr. MITLER. While I was in Lexington, you told me something about the difference in the makeup of addicts who come from large cities and those who come from less densely populated areas. I think that would be interesting.

Dr. LowRY. I probably mentioned to you that we see our Negroes coming from the large northern cities and a great many of the whites coming from smaller towns and rural areas in the South.

Mr. MITLER. Are there some professional men that come from the smaller communities? I think you mentioned something of that

nature.

Dr. LowRY. We admit about 40 physicians a year and I do not have a study showing where they come from; I don't know whether they come from the city or the country.

You may be interested in knowing that of these 199, 18 years old and younger, that 116 of them were voluntary patients and 83 came as prisoners or probationers.

Mr. MITLER. Dr. Lowry, could I ask you a few questions about the volunteers? I think it is significant to know whether the volunteers stay as long as they should or whether they leave prematurely to get the full benefit of your program.

Dr. LowRY. I can give you some figures on that and there will be a chart in this material that I will submit and I can tell you what our experience has been because we have studied it each year for the last several years.

Mr. MITLER. Surely.

Dr. LowRY. Let us take the male addict voluntary patients. For instance, a study of 765 who left the hospital between January and June 1955 showed that 25 percent of these voluntary patients left the hospitals within 7 days of the time of their admission. This is

almost the same as saying that they were still in the withdrawal period and receiving narcotic drugs when they left. In addition a number left, so by the end of 2 weeks 40 percent of the voluntary patients had left the hospital and by the end of 30 days 55 percent had left the hospital. By this time, by the end of 30 days the patient is no longer receiving institution treatment. That is completed ordinarily in 7, 10, 14 days. He is beginning to get his appetite back and sleep better, but you cannot say that he has no clinical signs of abstinence remaining.

Mr. MITLER. How long do you require the volunteer to stay at the hospital to get some benefit from the program?

Dr. LowRY. I think if we are discussing only the physiological program from addiction, I would say a period of 3 to 4 months is a minimum time to obtain physical return to normal. In the same period, the vocational rehabilitation and psychological rehabilitation can occur, but this will have to be carried on after the patient has left the hospital. We have learned to not use the word "cure" when we refer to narcotic addict patients who are leaving the hospital. If they stay until such a time as we feel they are ready to return to their home community, we group them in a class called hospital treatment completed, so that no one will get the idea that this is the end of the treatment process, what happens to those that are there at the end of 30 days, if an addict, voluntary addict is in the hospital at the end of 30 days, the chances are very good he will stay until the physician says he is ready to go home.

Mr. MITLER. Now, the word "blue grass law" has been mentioned. Could you explain what that is, and how that used to affect the volunteers?

Dr. LowRY. The blue grass law is a Kentucky statute which says it is a crime to be an addict in Kentucky and if an individual goes to a police officer and says he is an addict, he can be taken into court and given a sentence. I believe the sentence is limited to 1 year and the courts can probate this sentence on condition, well, they can put any conditions they want to but they frequently make it a condition that the patients be treated for an addiction and remain in treatment until he is discharged. In the past we have had a number of addict patients admitted to the hospital under this procedure. However, we were informed, I think it was about two and a half years ago, that it was improper to require a person to go through with that, what amounts to a criminal procedure to be admitted to the hospital as voluntary patient.

Actually the blue grass law, there is something akin to it in many States, where a State court can probate a sentence on certain conditions and the patients could come to the hospital.

We find a number of addict patients who have been in the hospital and who have found that they can't stay once they come in, who have of their own accord come into the city of Lexington and gone to the court, got a sentence and come to the hospital because then the decision is out of their hands as to whether they will stay or not.

Those persons are decreasing in number in the past several years. Mr. MITLER. Dr. Lowry, what is the program with respect to psychotherapy in the hospital? What services are offered there?

Dr. LowRY. Well, I will start with the newly admitted patient. When he comes into the hospital, he is on the withdrawal ward for a