We feel we could duplicate that at center after center around the city. The problem is a lack of facilities which is directly traceable to a limitation of funds. Senator BUCKLEY. There are those who feel that methadone treatment will not be considered the universal cure-all for this. Dr. DUPONT. I am one of those. Senator BUCKLEY. What about other efforts being made in the District with narcotics addiction? Dr. DUPONT. There are three therapeutic communities in operation in the District which have no formal relationship with the District Government: Second Renaissance at St. Elizabeth's Hospital, RAP Inc., at 19th and T, and Second Genesis in Alexandria. I know they are all excellent. There are also two therapeutic communities within the Narcotics Treatment Administration and we at NTA do a great deal with counseling, vocational training, and other kinds of treatment techniques in addition to using methadone. It is very, very unfortunate that I have been presented to the public as Mr. Methadone and that NTA is thought of as the methadone program. We lack in our community some other voices talking clearly and loudly about the proper role of methadone. If we only had a vociferous supporter of methadone, I could arise as the soul of reason and say that what we want is different strokes for different folks. We want opportunities for people to do whatever they can to turn themselves off heroin. This is what really goes on in NTA. We have, however, found that methadone is very useful to many heroin addicts. It is not necessary or useful to all. Senator BUCKLEY. How do you sift out? Do you have a procedure when someone presents himself at your door to determine whether he ought to be ushered towards methadone or one of these other techniques? Dr. DUPONT. Unfortunately there is not enough of any kind of treatment. So we run into a problem of the limitation of facilities entering into this kind of decisionmaking. It is my understanding that the committee is going to visit the center at 59 M Street NE., tomorrow. You can watch an orientation where these options are discussed with the patients. Each patient has an opportunity for detoxification or for maintenance-they only have an option for maintenance if they have been using heroin for more than 2 years, and are at least 18 years old, and they make this choice. Perhaps our distinction between detoxification and maintenance has obscured a practical fact and that is, each patient taking methadone says he finds it helpful to him and, he often says things like "it saved my life and helped me get my life back together again." Secondly, most patients want to be off methadone. William Raspberry had a recent column in the Washington Post about this in which he talked about a person who had been on methadone for a year and tried to come off and is interested in coming off again. Methadone is not, in any sense, a final solution to the heroin problem. It represents the best there is right now for many people. With it they will be alive and out of jail and ready to take advantage of a better technique when it comes along. I, for one, am quite optimistic that we will develop such new techniques. In New York Dole and Nyswander developed methadone maintenance with a very tiny budget. It is my hope that as more money is put into research we will develop better pharmacological and other techniques to deal with this critical problem. Senator BUCKLEY. Doctor, a discrepancy has been pointed out to me, or at least a different focus, between the guidelines in the District applied to the methadone approach and those recommended by Dr. Dole. I believe Dr. Dole has a bottom age limit of 20 years and a history of 4 years of mainlining and I believe the District uses 18 years and 2 years. Would you care to comment? Dr. DUPONT. Dr. Dole has changed his criteria. Senator BUCKLEY. Good. There is another question I want to ask you, Doctor, having to do with this difficult problem of research and the focusing of the proper funding in the proper area. I heard it stated by someone I won't name, but a person who has reason to have studied the problems with some care, and his feeling is that at this stage it is not necessarily so much a question of how much money is being spent, in fact, he suggested an awful lot of money is being spent, but the coordination of that spending and also a cross fertilization of ideas. He feels, in short, a tremendous amount of money is being wasted in terms of developing new techniques and so on. Would you care to comment? Dr. DUPONT. Yes. I think a lot more money has to be spent on developing new techniques and I would be in favor of some diversion from treatment into promising research areas. I think that makes a lot of sense. On the other hand, I think we have got an essentially untreated epidemic in our country where the untreated individuals contribute to the spread of heroin addiction. We have a very difficult kind of trade off going on. In terms of NTA's use of funds, we did have a professional advisory committee looking into this that had very broad representation from our community and, although their studies were not as exhaustive as some would like, they were generally supportive of the uses we were making of our funds. They also pointed out the need for large amounts of additional funds for treatment and research. I am sympathetic with the argument that NTA has not solved the problem and our approach is not going to solve the problem. It is a far bigger problem than any of us realized. I am convinced that the most important problem in the spread of the epidemic is the availability of heroin. Whatever we can do to decrease the availability of heroin should have the top priority. (The report of the Professional Advisory Committee on Heroin Addiction in the District of Columbia follows:) Professional Advisory Committee On Heroin Addiction Erman W. Edgecombe, M.D. (Co-chairman) Thomas E. Piemme, M.D. (Co-chairman) Professor of Medicine Director, Division of General Medicine The George Washington University School of Medicine Theresa Abbott, Executive Director Washington Area Council on Alcoholism and Drug Abuse, Inc. The Honorable Stanley Anderson, Member District of Columbia City Council Marion Barry, Director Pride, Incorporated Roderic Boggs, Esquire Executive Director, Washington Lawyers' Committee for Civil Rights Under Law Barbara Bowman, Director Public Defender Service Linwood Chatman Capitol East Community Organization William Dinsmore, Management Analyst Executive Office of the President Office of Management and Budget Vincent P. Dole, M.D., Professor of Medicine Charles T. Duncan, Esquire Frances Rowe Gearing, M.D., Director Methadone Maintenance Evaluation Unit Columbia University School of Public Health and Donald H. Glew, Jr., M.D., Chairman Drug Dependency Committee Medical Society of the District of Columbia The George Washington University School of Medicine The Honorable Harold H. Greene, Chief Judge Kenneth Hardy, Director District of Columbia Department of Corrections Peter Barton Hutt, Esquire Ann Macrory, Esquire Coordinator, Criminal Law Assistance Lawyers' Committee Narcotic Addicts Sally McConnell, Pharmacologist Division of Experimental Therapeutics Frank H. Rich, President Metropolitan Washington Urban Coalition Hugh J. Scott, Ed.D. District of Columbia Father William Wendt, Rector St. Stephen and the Incarnation Church Jerry V. Wilson, Chief of Police ii |