million supplemental funds in this area. Although it is customary to support a request of this magnitude with detailed justification on the need for additional staffing, I am purposefully avoiding this bureaucratic approach and will make every attempt to accomplish the goals I have outlined here today by fully utilizing our present staff.

Let me close by saying we cannot let the long-range goal prevent us from taking effective action right now. I think that is the spirit and intent of the law as passed by Congress; I know it is the philosophy of the Special Action Office under my direction; and with your approval of these supplemental funds, I pledge to you that it will continue to be the reality of our operation.

I will be happy to answer your questions, and thank you for listening.

ACCOMPLISHMENTS OF THE SPECIAL ACTION OFFICE

Mr. STEED. First, Dr. Jaffe, turning to the funds that have already been made available to you, could you give us a little detail on what you have been able to accomplish.

Dr. JAFFE. The funds primarily were requested prior to the passage of the Drug Abuse Office and Treatment Act of 1972. It created new authorities and new responsibilities so that the amounts requested were primarily for the coordinating and staffing of an office, which at that time was operating under Executive Order 11599 and whose main purpose was to set priorities and to rebudget.

Therefore, the primary functions of the Office continue to be carried out and they were to attempt to coordinate 14 Federal agencies, set priorities, and to see that wherever we could make progress we were moving along. The major thrusts of the Office prior to and even after the passage of the act were to make certain that all of the agencies of the Federal Government were moving with maximum speed. To tell you what the funds were used for would be in effect to detail for you all of the accomplishments of all 14 Federal agencies.

For example, many of the resources of our particular Office budget here were used to permit a technical assistance and evaluation function to go on in most of VA and the Department of Defense treatment units where we could take treatment experts from civilian groups and meet with all of the newly developed Department of Defense and VA treatment units. In addition, we have visited the programs that upon analysis were found to be those least productive from a financial point of view. We now have funded more than 350 programs for the treatment and rehabilitation of drug users. They show a wide range of efficiency. Some programs are performing beyond their expectations. On the other hand, some programs are on another extreme of treating very few people for a great deal of money. We have visited those and made suggestions and we have an ongoing system of trying to increase the output for Federal dollars that we have invested.

In addition, our staff is. as I said, working with the private industry. to develop pharmacological agents. I suppose that a considerable amount of our resources have literally gone into an FDA survey of all the methadone programs, and we are working on new regulations to

tighten up the distribution of methadone. I am trying to think of some other highlights that we have undertaken.

Mr. STEED. If you decide to add some when you correct the record, do so.

(The information follows:)

Although the Special Action Office is one of the youngest White House agencies, it has already made an impressive start in dealing with drug abuse problems. Increased Federal funds have been approved to fight drug abuse. Since 1969, Federal support has increased fourfold for research, sixfold for treatment and rehabilitation, and thirtyfold for education and training.

The Special Action Office has scrutinized the budgets and evaluated the policies of all civilian Federal agencies engaged in drug abuse prevention, excepting those offices involving law enforcement. It has worked with each agency to establish specific goals and shape budgets to achieve them. A system to monitor and evaluate these efforts has been organized.

Programs were developed to reduce drug abuse among GI's in Vietnam, and at other bases overseas and at home. Military policy has shifted to treat drug abuse as a medical problem-not simply as a disciplinary problem. A massive screening program has been set up to detect drug abusers who are then provided treatment and rehabilitation services.

The number of federally funded treatment programs has been sharply expanded toward the goal of providing care to all those who need it. The Veterans' Administration which runs the largest hospital system in the world, has substantially increased its drug abuse services; 32 units have been developed since the Special Action Office began operations, and another 12 are now being organized. More drug abusers are under treatment today than ever before; more and better forms of treatment are becoming increasingly available.

Large numbers of narcotics users are voluntarily seeking treatment from programs using methadone. The Spceial Action Office in cooperation with the Food and Drug Administration helped conduct a nationwide review of all the methadone maintenance programs in the United States, and the status of the drug has been changed from a research tool to that of a recognized form of medical treatment, under strict Government controls. The capacity to treat those who want treatment is being expanded.

With the help of the National Bureau of Standards, the Special Action Office has developed a technique to prevent the diversion of methadone to illicit channels, yet protect the anonymity of those under treatment. To reduce the possibility of diversion, a longer-lasting methadone is under development.

Through new grant programs operated by the National Institute for Mental Health, the Special Action Office is assisting medical schools to expand their course work in drug abuse problems. Physicians and other medical professionals are being trained in the latest techniques for drug abuse diagnosis and treatment. New treatment assistance in combating drug abuse is being offered to the States. The Special Action Office has assembled teams of professionals to help communities with special drug abuse problems, and to set up demonstration programs. The National Clearinghouse for Drug Abuse Information is being expanded to offer the latest information in the drug abuse field to professionals and others. On request, the clearinghouse furnishes information on medical and educational techniques and offers sugestions on how to establish local drug abuse programs.

A master reporting system to collect data on all kinds of drug abuse is being organized. New programs have been started to gather information on the amount and patterns of drug abuse, and to note shifts in trends of usage.

Because nearly half of all street crimes committed in the United States are thought to be drug-related, the Special Action Office has developed a new concept to provide treatment alternatives to drug abusers who are arrested. They are offered a wide range of treatments designed to break the drug addiction-street crime cycle. In cooperation with the Law Enforcement Assistance Administration, the concept is being tested in a number of metropolitan areas.

Research has been stepped up in a variety of drug abuse areas. New and more effective narcotic antagonists are being tested; simpler ways of screening for drug abuse are under development; studies are under way to determine the implications of long-term use of marihuana. Morphine and heroin are being restudied for possible physical dangers that may not have been recognized. New studies are being conducted to find out what moves some people to voluntarily give up drugs, and on educational techniques to prevent them from starting at all. Dr. JAFFE. We discussed the National Drug Abuse Training Center last time and that is now operational.

STAFFING PATTERN

Mr. STEED. How many people do you have on your staff now? Dr. JAFFE. We now have 113 on board full time and as of now we are authorized 174.

Mr. STEED. What are some of the skills that you utilize?

Dr. JAFFE. They vary tremendously. We need people who range from program analysts, for long-range planning and health care delivery systems, to pharmacological experts, and people who have spent years in drug abuse education. We have people who are experts in pharmacological analysis, and we have some people who have spent time developing programs in urban areas. We have lawyers, doctors. psychiatrists, experts in evaluation, experts in systems and computer programs, people who have worked with State and local governments. We obviously have people who know all of the Federal regulations so that we can operate the Office and handle our personnel problems and usual civil service regulations that have to be met. We have auditors and contract specialists. It is a very varied group because the wide range of things that we cover. Our purview is research, treatment, rehabilitation, education, training, and evaluation. We have experts in all of those fields.

Mr. STEED. Do you anticipate hiring any more?

Dr. JAFFE. We intend to, up to our full ceiling, and to begin to reduce our dependence on consultants. To a large degree we have had a large number of outside consultants. We have had consultants for intermittent kinds of employment. They help with our technical assistance. Some of them have been persuaded to give a year or two of service to the Federal Government and come on full time so that we can continue to increase the output of those 350-odd programs that are now being funded. It is not enough to fund the program but we want to make sure when they are in full operation they do what they are intended to do.

SUPPLEMENTAL REQUEST FOR RESEARCH

Mr. STEED. The first item in your request is $20 million for salaries and expenses. Will it take that much for you to come up to your full complement?

Dr. JAFFE. Salaries and expenses?

Mr. STEED. That is what the justifications refer to.

Mr. HOWARD. The request for $20 million is for section 224 of Public Law 92-255, pharmacological research.

Dr. JAFFE. Virtually none of that is for salaries and expenses. Mr. HOWARD. We are not requesting additional funds for salaries and expenses.

Dr. JAFFE. No additional staffing.

Mr. STEED. What do you mean by pharmacological research?

Dr. JAFFE. In the evolution from the administration's original bill creating the Special Action Office to the bill finally passed by Congress, there was a great deal of sentiment within Congerss, primarily in the House, that the Government make a special effort to develop narcotic antagonists and other drugs that would be useful in treating drug abuse, particularly heroin addiction. This particular section was put in by both Houses of Congress, and it was clearly their intent that we accelerate research in this field. There are groups of substances that are useful in helping drug users from relapsing to heroin use particularly. Methodone is helpful but is in itself a narcotic substance. There are drugs that are nonnarcotics. These are antagonists. Mr. STEED. What I am trying to do is get a reading on how you arrive at $20 million.

Dr. JAFFE. There are a number of ways to approach it. It is not enough to discover an agent and to say this agent might be useful. I might point out that I was probably the first investigator in this country at least, and perhaps in the world, to have reported on the clinical use of narcotic antagonists in the treatment of heroin addiction. That was in December of 1965. My report was published in early 1966. It has been 6 years during which time no major thrust was given to this area. I can understand why there were other priorities at the governmental level. The facts are that we can develop agents but they won't do us any good unless we get the people running treatment programs to understand them and to begin to use them. The intent of this particular approach is not merely to develop them but to see at the same time that the knowledge of how to use them and how useful they are is made available to the people providing the treatment. This is not simply research; it is clinical research. That means that what we hope to do with this is to treat people with these newer agents because heroin addiction is potentially a lethal syndrome. Many people that come in for treatment are not suitable for methadone. They don't want long-term treatment in residential facilities. We need something more effective than simply withdrawing them from drugs.

Mr. STEED. I understand that, but how do you come to $20 million? Dr. JAFFE. We think sometime between now and June we should be able to launch a number of clinical programs treating a reasonable number of people. One way of calculating this is as follows:

Right now to treat somebody on an outpatient basis with a narcotic antagonist or methadone costs roughly $1,500 on a per year basis merely on the basis of an established program. But in an innovative program that does very careful evaluation, that has to be started up when you need to train researchers and might cost somewhat more. We calculated if we found only 50 to 100 programs and each of which treated only 100 people, maybe 150, this might give us a range of somewhere between 8,000 to 9,000 people-perhaps even 10,000-who would be involved in treatment with these new substances by the end of

June. In other words, a commitment to support treatment for another year, at our estimated cost this would be approximately $20 million, even if we don't allow additional resources for the clinical testing, toxological testing, and the evaluation of these agents. It is our hope to be able to offer a wider range of treatment options than we now have. Right now it is usually methadone or drug-free. If drug-free does not work, you are forced to put people on methadone.

Mr. STEED. How long do you use a person as a guinea pig in a test situation such as this?

Dr. JAFFE. We expect that these drugs thus far have proved to be so nontoxic that we would expect that people might be treated from 3 to 6 months and taken off, continued to be followed with rehabilitation services; if they began to relapse they could be put back on the antagonists.

WAITING LISTS

Mr. STEED. Is this a one-time type of thing or do you anticipate this as a proliferating activity?

Dr. JAFFE. We would expect that once these agents are developed, this particular fund would shrink. But we would begin to simply incorporate these resources into the funds for treatment. I think you have to evaluate this request in the context of the fact that we have a number of people waiting for treatment. Our estimates were that as of last June we had 30,000 people waiting for treatment with methadone.

Mr. ROBISON. Would you yield?

I am intrigued by that figure, and also concerned about it. I would like to know, because this fits into the context of what we are talking about here, where are they waiting and why are they waiting?

Dr. JAFFE. They are waiting for a number of reasons. I can give you a breakdown. What we did last April was to launch a major survey of all of the methadone programs.

Mr. ROBISON. State, local, Federal.

Dr. JAFFE. Private, Federal, everyone that the FDA could say was known to be using methadone with their approval. It turned out to be 450 programs. We did an on-site direct analysis with FDA, HSMHA teams. Among the questions they asked were: "How many people are you now treating? How many people were you treating with methadone?"

Many programs that use methadone don't use it exclusively. They have drug-free patients and some on antagonists and some on methadone. We said, "How many people are waiting for treatment?" We got a list of those and then added it all; some didn't keep exact figures and others were unwilling to admit people were waiting.

Our best figures were around the 30,000-person mark. I have a list of all of the programs. As I said, there are 450 of them. We could submit that for the record if you would like. You must understand that this was last June. They are being verified. That is how we got that figure.

Mr. STEED. If you will do that we will make it a part of the record. (The information follows:)