First of all, I would like to make it clear that I support properly run and properly controlled methadone treatment programs. Basically 1 support the original concepts of the program of Dr. Vincent Dole in New York City. I firmly believe that with a certain class of addict, there is no where to go but up. On the other hand, I believe that many of the original Dole concepts have been prostituted upon the altar of the quick and simple solution. There is too much of an attitude in some quarters to consign anyone and everyone who has used heroin to methadone maintenance, regardless of his state of addiction. Even Vincent Dole admits that this method of treatment may consign its participants to a lifetime of methadone addiction, since this compound is a physically addictive one. I oppose such an easy consignment. In fact Dole testified before this very committee in April of 1969 that a lifetime of addiction was the probable result.

The methadone problem is of particular significance in my jurisdiction for two reasons: (1) because of the nature of hard narcotic use and the hard narcotic users that we find in suburban Virginia, and I suspect that the same would be true in most of suburban America; and (2) the increasing availability of this compound as an abuse drug in the streets of suburban Virginia.

In connection with the first reason, it is important to remember Dole's original guidelines. When he commenced the program in 1964 and continuing until at least April 1967 he insisted on at least three minimum standards: (1) the addict should be at least 20 years of age; (2) he should have at least 4 years main-line hard narcotic addiction; and (3) that some other methods of treatment must have been tried and failed before he would be committed to maintenance.

I would suggest to you, Mr. Chairman, that very few addicts in suburban Virginia would meet just those three guidelines. In my jurisdiction, 77 percent of all our drug abuse cases, regardless of drug, involves those aged 20 and below. The phenomena of drug abuse has been upon us since late 1966, and heroin abuse was practically nonexistent in my jurisdiction until the spring of 1969. The net effect of this is that today virtually all of our heroin users have less than 2 years main-line addiction. Most, if not all, of them are below age 20; and when they first come to our attention, no other method of treatment has been tried in an attempt to cure them. It is easy to see they don't meet, by and large, the three minimum guidelines that Dole had at least as late as 1967.

My concern is that in the search for the panacea for hard narcotic abusers we might consign to a lifetime of methadone maintenance some very young kids without ever attempting another route of cure. In my opinion, very few kids in my jurisdiction should be so consigned. An analogy to "throwing out the baby with the bath water" might fit our situation.

I would not for 1 minute contest the right of the District of Columbia or New York City to commit themselves fully to massive methadone maintenance programs. But please, for Heaven's sake, let's not commit the rest of this metropolitan area, unless we fully understand the type of addict with which we are dealing.

I guess I have read most of what DuPont and Dole say about their programs, and their writings certainly substantiate their commitment-but their special jurisdictional circumstances appear to require

it-my jurisdiction does not, and I suspect that most of suburbia around Washington is in my situation and not in theirs.

We presently have in Fairfax County a drug treatment program based upon the therapeutic community concept. We have in operation a residential treatment center. We don't use the wonder drug methadone, except for withdrawal, and I still don't believe that with our type of addict, methadone makes sense at this point in time, except for a limited few patients.

The second area of significant difficulty with methadone involves the availability in suburban Virginia of methadone as an abuse drug. Hopefully, our difficulty will be alleviated by recent FDA regulations which may control the dispensing of methadone by the private practitioner. Prior to this action the situation was atrocious. The Fairfax Police Department and myself began complaining of the availability of methadone after our second methadone death in December 1969. Unfortunately four more deaths were necessary before anything was done to tighten up the dispensing guidelines in the District and two of these deaths involved youngsters 16 years of age.

The evaluation by the police, my office, and our treatment center over the past year indicates certain serious problems in suburban Virginia with methadone.

(1) Large supplies of this drug have been coming from the offices of private practitioners in the District of Columbia, apparently purchased legally. Much of this methadone has been diverted into abuse circles, and in some cases it has become the drug of choice. Some of it is being sold right in the syringe for $1.50 per cc. This makes it an excellent profit drug inasmuch as at least one physician distributes 50 cc.'s at a cost of $15 per container. Upon reseale at $1.50 per cc. the profit is apparent.

(2) We have found a number of cases where nonheroin addicts were obtaining methadone from private practitioners without any real determination being made as to whether they were in fact an addict. I guess the classic case from northern Virginia is the man who had never had a hard narcotic in his life, who was absolutely clean of narcotics, who walked into a physicians office in the District of Columbia and got 50 cc.'s to take out in the handy carry-out dose. From my point of view I defy any physician, unless he is dealing with a man 25-26 years old who has been in the vein for many years, on a 5 minute office visit to tell me whether or not a man is an addict. He may have used the drug. He may have it in the vein but that does not make him an addict.

(3) Methadone addiction appears to be growing at a faster rate than heroin addiction. Our drug treatment program over the past year found it necessary to engage in medical detoxification of 39 patients, 13 of these were detoxified for a heroin habit and 26 were detoxified for a methadone habit. A large majority of those detoxified were below age 20.

(4) Some of the users were obtaining methadone by going to one physician on one day and a different physician a couple of days later. This resulted in their being able to obtain a weekly supply from each physician in the same week.

(5) Dr. Vincent Dole originally felt that one of the main reasons for dispensing methadone diluted in fruit juice was that it would only be taken by mouth. We find many provable cases of injection directly

into the vein of methadone mixed with juice or Tang. As a matter of fact in our most recent 16-year-old fatality when the pathologist took apart his lungs at the time of his autopsy the interior linings of those lungs was coated with a substance found only in Tang. There is only one way to get it in the lung and that is through the vein.

(6) Many cases of nonfatal overdose began to show up simply because methadone was too much drug for the drug abusers in our area, particularly when it was being injected rather than taken orally.

(7) A great number of our citizens were not even aware that their youngsters were involved in a so-called methadone treatment program in the District. A number of other parents, while aware of the program, were not aware that the treatment involved the daily dispensing of a physically addictive narcotic.

I question the right of a 17- or 18-year-old without parental consent to get methadone. I know you couldn't do it in Virginia and I seriously doubt whether under the law of the District it can be done. I can only reiterate, in conclusion, that methadone maintenance probably does have a proper place and is the only mode of treatment in some cases; however, I strongly endorse the caveat of the House Select Committee on Crime at page 82 of its report of January 2, 1971, wherein that committee said:

Every precaution against diversion must be observed. While we believe the drug should be reclassified, we do not believe that individual private practitioners should be allowed to prescribe methadone for prolonged maintenance of individual heroin addicts.

The footnote to that caveat gets to the heart of the issue, in my opinion, where the committee states, "Methadone must be accompanied by proper psychiatric, social, and vocational services." I would only add to that the suggestion that maintenance should not be the original mode of treatment except in an isolated class of cases and second, that in the case of many young suburban abusers proper psychiatric, social, and vocational services will obviate the necessity of maintenance.

Thank you, Mr. Chairman.

Senator TUNNEY. Thank you very much, Mr. Horan.

I would like to explore a few areas contained in your statement and also to branch out a little bit from your statement.

You indicated in your statement that large supplies of this methadone drug were coming into Virginia in illicit drug traffic as a result of physicians in the District of Columbia dispensing it in a way that was uncontrolled and which allowed a person who so desired, to then resell substantial amounts of the drug for profit. Are you saying that, in the last 6 months, this illicit drug traffic has been sponsored by physicians in the District of Columbia?

Mr. HORAN. Certainly, for the last 2 years it has been.
Senator TUNNEY. Including the last 6 months?

Mr. HORAN. Including the last 6 months. As a matter of fact the most recent death we had, which was a week ago Sunday, there is no question the methadone involved in that death originally came from a private physician in the District.

Senator TUNNEY. What would you suggest be done in the way of amending existing laws to prevent physicians from dispensing large amounts of this drug?

Mr. HORAN. I am opposed to a private practitioner being in the business basically. I am opposed to that. To my knowledge we have never seen any methadone in northern Virginia that comes out of the NTA program here. To the best of my knowledge we have seen no diversion from the program run by DuPont.

It seems to happen, I think basically, because those private practitioners are essentially in the business of distribution more so than treatment. They are merely substituting the addiction of methadone for the addiction of heroin.

Senator TUNNEY. How many physicians do you think are involved? Mr. HORAN. I personally know of at least four.

Senator TUNNEY. Have you had the opportunity to talk to them? Mr. HORAN. I have discussed it with one of them.

Senator TUNNEY. What was the answer that you got?

Mr. HORAN. Well, he indicated that he is very careful, but I doubt that, because I don't think that Northern Virginia Sun reporter could have gotten methadone had that physician been careful and I think that there are provable cases of District of Columbia policemen in the course of their duties going in and making purchases, nonaddicts making purchases from District physicians.

Senator TUNNEY. I would suggest that you contact the other three physicians that you know are dispensing large amounts of this drug to nonaddicts and tell them of your very deep concern particulerly inasmuch as you have had six deaths recently in northern Virginia.

Mr. HORAN. Our first death was in September of 1969. The second was in December 1969 and one of the physicians who continues to distribute in the District was fully aware of the situation as to that death in December 1969.

Senator TUNNEY. I think it is most appropriate then that you contact him and tell him, and the others that you know, of your very deep concern while we review the bill. Maybe testimony today, tomorrow, and future days will indicate a change in the law must be the result of these hearings. In the meantime you should certainly contact physicians that you know are dispensing large amounts of medical addictives to nonaddicts.

In your statement you seem to indicate that there is a difference between an urban addict and the suburban addict. Can you tell me what the difference is?

Mr. HORAN. I don't think there is any question of that. Essentially it is a question of time more than anything else. In the District of Columbia for at least two decades heroin addiction has been a major problem. Heroin in my jurisdiction was absolutely nonexistent in 1966. It just wasn't there. So essentially we don't have the backlog of long term addicts that exist in the District of Columbia.

Secondly, most of our kids at the mental health center are called garbage collectors. They will take any kind of drug. If heroin is available they will do that and if marihuana is available, they will do that.

In the District you have a more prolonged experience with heroin. You have defined channels of distribution of that substance and therefore you have an awful lot more youngsters getting into heroin addiction at younger ages than we do.

Senator TUNNEY. Is there any part of Virginia that has a methadone treatment program?

Mr. HORAN. Yes. The city of Richmond and the city of Roanoke just began one.

Senator TUNNEY. I would assume you would not recommend that Fairfax County initiate such a program.

Mr. HORAN. I am opposed to it at this time.

Senator TUNNEY. Do you have any idea of the number of drug addicts in Fairfax County?

Mr. HORAN. Of course I go back to the questioning of the imprecise term addict. If you are talking in terms of those who are fairly chronic users of heroin-I would well imagine it numbers in the hundreds. If you are talking about a confirmed daily heroin user, I would suspect it is probably somewhere around 100.

Senator TUNNEY. How many crimes do you think are committed in a week as a result of heroin addicts in Fairfax County? Robbing their neighbors in order to maintain their habit?

Mr. HORAN. I don't know how I could really answer that question. Again we have a little different situation from the District. My jurisdiction is, as you may know, quite affluent. In fact it is in the upper 2 percent of the country in median income. Many of the kids there can sustain a $10-$20 habit, whereas in the District that wouldn't be possible. So I think it is taking them a longer time before they have to steal to support their habit as happens in the District.

Secondly, an awful lot of the type crime that drug addiction breeds. in northern Virginia grows out of the whole narcotics traffic itself. It is like the addict who goes to the District to get his 50 cc's of methadone. There will be some who go get it just to get enough to sell to support their habit. If he can get a $15 jar and sell it for $60 he has $45 left free to purchase heroin.

Senator TUNNEY. Is it legal to take methadone from the District of Columbia to Fairfax County?

Mr. HORAN. No. It isn't. I think if he has a prescription from a District of Columbia physician he is probably within the Virginia Criminal Act.

Senator TUNNEY. How many addicts are being treated at the Fairfax Residential Treatment Center?

Mr. HORAN. We have 25 in residential treatment at this time.
Senator TUNNEY. Do you have enough beds?

Mr. HORAN. I don't think we ever have enough beds, Senator. Of course we have available to us a second Genesis House which is in Alexandria and we have some from the county who are presently in treatment at Lexington.

Senator TUNNEY. If an individual is accused of drug possession with no other offense-what is the normal course of action your office takes?

Mr. HORAN. We have many cases that come to our attention simply because the parent calls in, or friend calls in, and says that some youngster is a drug user. Any case that comes by that route we try to put into a rehabilitation program without any prosecution. If, on the other hand, he is arrested for another crime and is a drug user we make an individual judgment in each case as to whether he is going to be susceptible to rehabilitation.

The crime question we all can ask is: Was he a thief before he was a drug user? I think one of the fallacies in connection with heroin