Tonight from Boston, coast-to-coast and in color, "The Advocates." Lisle Baker; guest advocate, William Bailey; the moderator, Victor Palmieri, and the man faced with a choice, the Honorable Kevin White, mayor of Boston.

Good evening. Every Sunday at this time, "The Advocates" looks at an important public problem in terms of a practical choice. And tonight the problem is drug addiction. The practical choice is this: "Should your city pro-vice methadone to heroin addicts upon their request?" Advocate Lisle Baker says, yes.

Mayor White, the issue tonight is whether our general fear of narcotic drugs will keep us from distinguishing the illegitimate, dangerous abuse of one drug from the use of another drug to help fight the problem. Now, our cities and your city have it within your power to do something about the terrible scourge of heroin addiction, and what you can do is support methadone maintenance treatment centers. The question is whether our fear of the word drug will keep you and will keep other cities from seizing that opportunity.

With me tonight to convince you that a properly run program of methadone maintenance can restore many addicts to useful lives in the community is Dr. Jerome Jaffe. Dr. Jaffe is associate professor of psychiatry at the University of Chicago in Illinois and head of the drug abuse division of the Illinois department of mental health. Dr. Jaffe is one of the country's leading experts on the treatment of heroin addiction.

Also with me is Mr. Pleasant Harris, administrative assistant in the methadone maintenance program at Bronx State- Hospital in New York. Mr. Harris will tell you how methadone maintenance helped him deal successfully with 17 years of heroin addiction.

Our guest advocate, William Bailey says, no.

Mayor White, I'm glad that Mr., Baker said "a properly run program" because I want you to focus your attention on the specific proposal before us tonight. You see, this proposal would let all addicts of all ages and all temperaments go on an indefinite methadone maintenance program. Not at all tied to this program is any rehabilitative program whatsoever. And also they're not required to demonstrate before they get into this methadone maintenance that they've tried something else, that they've tried to become drug-free and failed.

Now, with me tonight, Mayor White, I have Dr. Karl Deissler. Dr. Deissler is a private physician from Oakland, California and has long personal experience in working with drug addiction and for the past four years; Dr. Deissler has been the national medical director of the Synanon Foundation. Dr. Deissler will tell you, Mayor White, why he feels that drug-free existence is a goal that's within reach of every drug addict.

My second witness will be Mr. Gene Haislip. Mr. Haislip is the special assistant to the deputy director of the Federal Bureau of Narcotics and Dangerous Drugs. Later on Mr. Haislip is going to tell us what the federal government's position is on methadone maintenance.

Thank you, gentlemen. Now, let's take a look at the record about heroin.

Heroin. One of the most addictive narcotics on the books and for our country an increasingly deadly problem. For an addict it's a precious, expensive drug — precious because he lives from one fix to the next; expensive because he has to buy it illegally at ever increasing prices and in larger and larger doses, often $100 worth a day. To raise that money the addict turns to robbery, theft, prostitution and/or drug peddling. For his $100 the addict must steal and pawn about $500 worth of goods and the longer he uses heroin, the more he needs every day. And each day the odds against him increase.

Hepatitis from dirty needles or a heroin overdose may kill him or he may end up in jail. Deprived of his drugs, the addict cannot escape the torture of withdrawal. (Sounds of a person in withdrawal) When his body has finally adjusted to the lack of the drug, he's free technically of his addiction. But the odds are better than 9-1 that soon he'll be right back under the needle. Almost any addict will swear he wants to kick his habit. Most have tried to do it. Most of them don't make it.

There are an estimated 2-300,000 addicts in this country and their number grows each day, particularly among teenagers. Heroin addiction is a major source of crime, now costing all of us over one billion dollars per year. Police admit they've been unable to solve the problem or even stop its growth. But the addicts themselves can be reached.

Traditional attempts to end addiction through withdrawal and psychotherapy have been successful but for only a tiny percentage of the addict population. Now attention is focusing on methadone, a synthetic narcotic. Given to the addict every day in orange juice, this inexpensive drug blocks the hunger for heroin as well as its effects allowing the addict to return to a more normal life. Methadone, however, is just as addictive as heroin. Little is known about its long-term effects or about the possibility of freeing addicts from their dependence on methadone itself.

Well, gentlemen, before we begin I'm going to ask Mr. Baker to clarify his proposal.

Mayor White, what we propose tonight is a program of methadone maintenance. That means — like you saw on the statement of facts — giving hard-core heroin addicts a dose of methadone in a glass of orange juice or tang or some other similar drink every day. That dose will help them fight their drug problem. We advocate that if necessary you give them a dose every day for an indefinite term of time. We also advocate that you make it available to all addicts who request it.

Well, Mr. Bailey, tell us now exactly where you disagree.

Mayor White, we’re opposed to this program for two specific reasons. Number one, we say methadone maintenance alone is not enough. Unless you tie it to some rehabilitative social program you are not going to accomplish curing the drug addict's problem. Therefore, we say that must be a necessary goal written into any program. Now, secondly, you're going to hear the federal government position is, methadone is still classed as an experimental drug. Therefore, we say if you use it, use it with great caution and only as a last resort.

Well, our guest tonight is the Honorable Kevin White, the mayor of Boston. Mayor, I know like all big city mayors that you must be very concerned about drug abuse problems and I think our audience would like to know what you're doing about it in Boston.

Well, Vic, I don't think anyone in a public or private capacity can afford to be complaisant about the issue. I mean drug abuse is without question one of the most important problems in our society today, and it affects not only the big city but the small town as well. In Boston, we've tried to respond to it with a program called Operation Turn-Off, and Turn-Off has four major components. What we've tried to provide is comprehensive treatment centers, new educational programs, intensifying law enforcement and what we call neighborhood coordinated councils between parents and teenagers.

I think tonight's question is a fundamental one and I look forward to hearing the respective arguments of counsel. I think only by understanding the degree of this problem and the proper response to it are we going to be able to at least curb what is adequately described as a cancer in our society today.

And methadone clinics are part of your plan, isn't that right?

Part of the program that we're putting forth is concerned with methadone treatment.

Okay, let's start now to go to the cases. Mr. Baker, let's begin.

Mayor White, heroin addiction is a national scourge. It wrecks the lives of the users and it destroys individuals who are average citizens who are set upon by addicts who commit crime to support their habit. Now, cities have within their power a means to deal with this problem and help many of the addicts who prey upon you who watch this program. That's methadone maintenance treatment centers and to show you how one of these centers works...

...call him Dave. He lives in Elbaria, Spanish Harlem. Dave started using heroin when he was 13. He was addicted for 7 years. It cost him $80 a day to support his habit. He got the money by pimping, mugging and stealing and he himself has been stabbed and shot. But now Dave is clean. He's been clean for a year. The reason is a drug called methadone.

This is a methadone clinic. Every day Dave comes here to get his medication as do about 100 other former heroin addicts. The procedure is simple. He leaves a urine sample which is tested for the presence of other drugs in his system. Then he gets his medication — a prescribed dose which he drinks in a glass of orangeade. That's all there is to it. The busiest hour at the clinic is lunch hour because most of these former addicts are now working or like Dave, in school again. What has methadone meant to Dave? These are his words.

Methadone is what helped me out, what really got me together again. Don't get me wrong. I’m not trying to say that methadone is the answer for all your problems. That's not true. Methadone just takes care of your drug problem. The other problems you have to take care of yourself. I don't think it's the best thing they have to cure an addict but at the present time it is.

Mayor White, despite what critics of the program will say, it's important to recognize there is a distinction between heroin addiction and methadone maintenance. Heroin addicts alternate between a sick feeling or drug hunger and a high or euphoria which he gets after he gets a fix. And these fixes only last from 4 to 6 hours so he's got to go out and get another fix three or four times a day. So he swings up and down and up and down and he spends almost no time in this zone of normal feeling.

Now, methadone maintenance given to him in stabilizing doses in a glass of orange juice or tang, do away with this sick feeling or drug hunger. It's medicine to solve this problem and in large doses it can black any high or euphoria if an addict decides he wants to go ahead and shoot it up, some heroin. And so in effect you've made it impossible for him to move outside this zone of normal feeling and he can begin to act and feel and be just like you and me through methadone maintenance.

Now, I'd like to call one of the country's leading experts on this program, Dr. Jerome Jaffe, to the stand. Dr. Jaffe is associate professor of psychiatry at the University of Chicago and head of the drug abuse program for the state of Illinois.

Welcome, Dr. Jaffe.

Dr. Jaffe, many of the people are afraid of using one drug to fight another drug. Can you help us out on that?

Well, I think that the problem is in the way it's expressed. Medicine has for a long time used drugs to fight problems. In this instance, we're using a drug to fight a human feeling, a compulsion to seek out heroin. We have for a long time accepted the idea of using medication to fight anxiety, to fight depression and if we could, I think most of us would be willing to find a medicine that would be used to fight the compulsion to smoke cigarettes. We don't have such a medicine right now, but I would have no hesitation in using it if it were a safe medication for people who wanted to discontinue smoking.

And methadone is safe for ...

We can find no long-term toxic effects of orally administered methadone as it's used in well regulated clinics.

How well does methadone work compared to other forms of treatment like abstinence or therapy?

Without question for the overwhelming majority of long term, chronic heroin users in urban areas methadone maintenance is the most acceptable form of treatment and for those people who stay in it — and most of them do — the rate of gainful employment more than doubles and the arrest rate drops from anywhere from 1/5 to 1/10 to what it was prior to their entering treatment. So I would say that it's quite successful as compared to other treatment programs.

Mr. Bailey advocates for instance that you require an addict to have failed in some other program before you give him methadone. What do you think of that?

Well, we've explored that in a very specific, controlled way and what we've found is that we can give methadone to people even if they haven't been long term users and at some point transfer them into programs in which absence is the goal. So we have found it is not necessary to insist that somebody die of an overdose or spend time going in and out of jails or treatment programs that they're not ready for before we're ready to provide them with methadone.

Thank you.

Dr. Jaffe, if I might ask a few questions here. You use the words "safe" and "long range" and Mr. Baker in his opening presentation said on that chart that there was a distinction between heroin and methadone. Aren't there some frightening similarities, and by that I mean, isn't there at least some evidence that there can be physical damage to the use or withdrawal of methadone? And secondly, doesn't methadone have at least a chance of leading to the use of other drugs in the course of providing it?

Well, I think first of all we have to recognize that we're dealing with a potentially lethal disease call it addiction. The death rate is high; the complication rate is high. I think compared to that, methadone has few complications.

Is it similar to pharmacological agents classified as narcotics?

It's classified as narcotic drug, and it produces a form of physical dependence. This is inconsequential in comparison to the disease under treatment. So that most of us look at this and weigh it and find no difficulty in accepting this as effective treatment.

Do you mean the words dependence and damage to be synonymous?

Not at all.

Let's hear from Mr. Bailey on cross-examination.

Dr. Jaffe, before I begin I just want to state that I think everyone who's concerned with the heroin addiction problem has great admiration for the work that you've been doing in Chicago and even previously. In fact, in preparation for this evening I did my research, and I found quite a number of informative articles written by you, so I'd like to refer to some of your previous statements and ask you about your present opinions. Doctor, for example, is it your position today that given the wide differences between drug addicts and their personalities, do you believe that it would be irrational to establish large scale programs using only one specific kind of treatment approach?

Yes, I do think that would be irrational. The issue is not — as I understand it ~ whether or not there should be only methadone but whether there should be well-regulated methadone clinics. Obviously, I advocate a wide range of opportunities so that methadone is not the only treatment available. However, I think it's essential at least in large urban areas it be one element in the spectrum of services made available to heroin.

which would include therapeutic communities situations…

Yes…

. . . Confrontations…

. . . and a possibility for withdrawal and after care . . .

. . . even Synanon-type situations?

We support them in Chicago.

In fact you expressed admiration for the Synanon and considered it a most advantageous development in America at one point.

I haven't changed that.

All right. All right. I'm just trying to understand your position, Doctor, because maybe v/e are apart on the proposition tonight. The proposition is to give a person methadone — he may submit a urine, he may have to be above a certain age but that's all he has to do — come in, submit a urine, get his methadone and leave. No tie-in of any kind of program whatsoever. No requirement that ultimately he would put into a therapeutic type situation.

It wasn't my understanding that that was the proposition. To me, at least, a good methadone clinic provides opportunities for rehabilitation, staff for rehabilitation and it's usually tied in to programs which permit the drug user at some point to elect to move into abstinence programs if he feels ready for that.

But isn't it true, Doctor Jaffe, isn't it true that in Chicago the results were tested against a methadone program where no rehabilitation was included and that the control group showed just about as good results as the group where rehabilitative programs were part of it?

I don't think that would be accurate. We have tested a number of possibilities including pure methadone with no other rehabilitation, methadone with much rehabilitation. Methadone with rehabilitative efforts is better than no rehabilitative efforts but without question providing methadone to people as they come in from the street is better than denying them access to any treatment whatsoever.

. . . one thing I'd like to say . . .

... and right now we don't have enough facilities available for people who elect treatment.

One thing I learned from you, Dr. Jaffe, in one of your articles that it is a problem of drug addicts that they constantly seek out the company of their own kind, other drug addicts. And I found a statement that simply issuing methadone will not stop a person from associating with other drug users, halt his anti-social behavior or give him vocational skills or hope for a better life. And that to be effective methadone must be a part of a broad program of social rehabilitation. Now that's what I'm contending. Do you disagree with that statement now?

I think it has to be modified in this way. That you can get a certain degree, a certain amoung of amelioration of the syndrome with nothing but the medication but you can do much, much more by tying it in with major rehabilitative programs. It's my understanding that when we talk about a well-regulated methadone clinic that it almost by definition includes efforts at rehabilitation.

So you would recommend to Mayor White of Boston that he include some kind of rehabilitation program when he starts issuing methadone. Is that correct?

If he can afford it.

Suppose you had to choose though? Suppose you have to choose where you put your dollars?

If that is the case, then I'm afraid you get into a kind of a triage in medicine, you know, who you're going to save if someone must die. Methadone treatments turn out to be less expensive than other rehabilitative efforts and if you must choose I think you'd get more rehabilitation, more decrease in crime and more increase in vocational adaptation with methadone programs than others. I ...

Dr. Jaffe, excuse me, did you have a point? Go ahead.

I merely meant to say I hope that we won't find ourselves in the position of having to choose in that way.

I hope so, too. Thank you very much for being on "The Advocates."

Thank you.

Mayor White, lest we seem to be sliding together here, I think it's important to recognize that we don't say that you shouldn't have available, if addicts want them other services. Mr. Bailey's arguing that you should make those services a prerequisite for use of methadone. We say it's important to get out and help these people now, and if you can build the other services, that's fine. But you don't force people to walk through a program they don't want, to get into methadone which they do.

Now, I'd like to call on a man whose had personal experience with both methadone treatment and heroin addiction. He is Mr. Pleasant Harris who is assistant director, I'm sorry, he's administrative assistant of the methadone treatment program at the Bronx State Hospital in New York City.

Mr. Harris, we're glad to see you.

Mr. Harris, you're taking methadone now. Do you feel any euphoria or do you feel sedated at all?

No, there is no high, no euphoria involved with the taking of methadone. Possibly in the beginning with some addicts there might be some sedate-ness, you might say, but this very quickly wears off. Usually once the man's stabilized there is no feeling whatsoever from his drinking his methadone.

That's right. You bring him up to a certain level and you hold him there for a period of time.

That's right.

Now, has methadone helped the drug hunger that you used to feel?

Well, that's its main function, really, there are two things that it does. It eliminates the urge to use drugs and if one does use heroin — and it's just the opiate based drugs that methadone works for, or works on you might say — if one does use heroin, you will not feel any effect from it, you see. It blocks the high of the heroin.

Now, some people charge that because you are dependent, on methadone to take every day on methadone medication, that you're a second class- citizen. How do you feel?

Well, I guess you have to include many people who are diabetics, and those who are heart patients also as second class citizens. There are many people who find it necessary to take a medication, you see, and this is no different. The addict, he has been ill. And he is receiving medication from a doctor. If anything it releases him from being a second class citizen, you might say, as far as being a heroin addict and allows him to function in a normal way as anyone else may be able to.

What about the emphasis on being drug free. This is a great sort of pie in the sky idea that somehow if you're drug free you're different or a better human being than you are, for instance, who take methadone every day.

Well, that's the so-called Utopia, you might say, that so many of us are looking for, but it's rather unrealistic when you consider that his man has been addicted for quite a few years and it might be possible that he might need a drug to function correctly for the rest of his life but there would be many who would not need the drug for the rest of their lives. But the main thing is this, that the man is able to function and function correctly, you see, and we can't get away from that fact.

Let's hear from Mr. Bailey.

I want to correct one misconception first, Mr. Baker made a point. I don't want to force people under any program even on methadone maintenance but I do want to make sure that they can't succeed at going clean before I'll give them methadone for live.

Mr. Harris, I do want to say that I think you're a very dramatic testimony to a successful methadone maintenance program at least for some addicts. And you're one of those I'd like to if I may, just ask you a few questions about your own background to establish the parameters of that proposition. Mr. Harris, would you mind telling us how long you took heroin before you went on methadone maintenance?

Over a period of 17 years.

How about how regularly?

Every day.

Every single day?

Yes.

Were you arrested during this time?

Yes, I was.

How often?

Not too often fortunately.

Five, six times?

No, two or three times.

Only about two or three times in 15 years.

Seventeen years.

Seventeen years? And did you ever come off heroin for a period of time?

Many times.

Many times you came off?

Many times.

You were clean for a period of time?

For about a day or two.

Only a day or so.

Right.

Did you ever go to a hospital and detoxify?

Yes, I did.

And for how long would you be off heroin after that?

The same day I left the hospital, sir.

You'd go right back to it.

Right back.

So you tried to get off. Now, would you say it's fair to say about your background that there were times during that seventeen year experience when you had tremendous motivation, you told yourself I'm going to be free of drugs. Did that happen to you?

Of course it did. It happened every time I wanted to stop using drugs.

But it didn't succeed. You went right back.

There's more to it than that.

But you went back, isn't that right?

Right. But this is towards the individual now who might have the so-called will power or the motivation to stop using drugs does not necessarily mean that he is going to stop, you see. And this is where methadone plays a very important part.

I only want to ask you about that one point.

Yes.

You did have, make an effort to get off and didn't succeed.

Right.

Incidentally, Mr. Harris, did you ever go to a therapeutic community or any kind of psychiatric ...

... no, because I felt that the therapeutic community was to some extent an affront to my dignity.

So you never tried that.

I didn't think it would work for me and I had never known it to work for any of my friends.

All right. So that you've never gone to a therapeutic community and you've not succeeded at coming off heroin after 17 years. And during that 17 years period, Mr. Harris, did you get married?

Yes, I did.

Do you have a family?

Yes, I do.

Do you have a son?

I have a son.

How old is he?

He's nine years old now.

Nine years old. So you had very substantial motivation to at least get away from heroin, didn't you, when you went onto methadone? You had to take care of a family...

Well, I was married for eight years when I was addicted.

But when you finally did come off, was that one of your principal motivations?

Definitely, yes.

So you had that working for you also?

Well, I was seeking help. I was seeking help, and I found it through methadone maintenance...

To get back to your son, Mr. Harris, I'm sorry for interrupting...

... that's quite all right.

With regard to your son, if your son came to you in the future and said,

"I'm getting caught up in heroin, I think I may even be an addict," before you let him go on methadone maintenance, wouldn't you want him to at least try one other program to go back and be completely clean?

Let's put it this way, sir. If it were possible for him to remain drug free going through a therapeutic community program, fine.

You'd let him try it anyway?

I would let him definitely try it.

Wouldn't you want him to try it, though?

Here's the thing, though. I have seen so many youngsters who have tried it this way especially when they've gone through a detoxification program. And the same day they came out of the hospital, they've taken overdoses and died. Possibly if this person had been placed on methadone, he would not have died, you see. And I would be more concerned about my son's life rather than the means in which he would attempt to come off the drugs.

Mr. Harris, let's let the mayor wrap this one up.

Well, I just wanted to ask one question. Now that you're on methadone, has it aborted or has it stopped your own personal desire for therapeutic help?

Myself?

Yes.

Well, I was one of the fortunate ones you might say due to the extent that once I came on methadone — and I happened to have a job and when I did come onto methadone — I was able to more or less continue, you see, without any need of group therapy or psychiatric help or what have you.

Okay, Mr. Baker you wrap it up for yourself.

Thank you, Mr. Harris, we appreciate your being here. Mayor White, heroin addiction and crime are highly intertwined. Heroin addiction accounts for half of the major crimes in New York City and Washington, D.C. and almost 40 percent of the major crime in your own city of Boston. This year heroin addiction will cost citizens of New York City one half a billion dollars in stolen goods. New York has already treated 2,000 addicts on the methadone maintenance program. Columbia University made an evaluation of that program, and it found that it saved the city 45,000,000 dollars in thefts for 2,000 addicts, not to mention all the hospital costs, the welfare costs, the jail costs, the taxes that these people pay cause they're not employed and it cost $250,000 for the city and many methadone maintenance programs are self-supporting because the ex-addicts pay for it themselves. A properly run methadone maintenance program can do more for law and order than almost any similar expenditure of public funds today. Now not all addicts support themselves by crime and theft...

The Mayor has a question, so I'm going to-interrupt.

I think this is an important point because you said that the program could do more for law and order. It seems it's very difficult for me to distinguish the course that you advocate I think from one that was advocated recently in our injection into Cambodia. One is on military grounds. Yours seems to be on economic grounds. They both seem to dismiss the moral grounds to the individual involved.

Well, Mayor, if I may...

Can you draw the distinction for me?

Yes, I can. I think that Mr. Harris has told you that it's immoral to let addicts go out on the streets and die from overdoses. It's immoral to have them set upon citizens in your town and beat them over the head and steal their money. That the morality is helping these people solve their problem and not in saying, let's make them go through something else. Just one other point about crime. Many heroin addicts sell dope to make their enough money to handle their own addiction. Now, if you use methadone maintenance program, you will reduce the number of addicts who have to push dope to maintain their habit. This moans there're less people out there selling dope to your kids. Now methadone is a cure it's not a prevention…

...I can't let you take the rest of the program for this closing speech. Very well done, but I want to hear from Mr. Bailey with his side of the case.

Incidentally, I read that same study of the Columbia University and I'd just like to point out a couple of things on the other side, if I may, Your Honor. For example, the average median age of the person enrolled in the program was a little over 33 years. And it v/as also stated in the study that it was emphasized the need for careful selection of addicts for a methadone program. Dr. Henry Brill, Mayor White, just came to Boston at your request on a seminar that was run in Samuel Hall and I was there when he said, by no means the majority of drug addicts would find an answer in long-term methadone maintenance. I want to focus on the specific issue before you, Mayor White. We aren't against methadone. We are against it's issuance before other efforts have failed and we're also against not at least tying in at least some social rehabilitative program if you give it out. Now as my first witness I'd like to call to the stand Dr. Karl Deissler, the national medical director of the Synanon Foundation.

Welcome, Dr. Deissler.

Dr. Deissler, is a drug free existence a reasonable alternative for drug addicts?

Indeed it is. 1,600 people live drug free in Synanon today.

Well, now, Doctor, are you therefore saying that Synanon or any one kind of program is the only approach?

Of course not.

Well, Doctor, coming back as I have constantly to this proposal tonight, this would permit a heroin addict to go on an indefinite methadone maintenance program without tying in any kind of social, rehabilitation program. What is your opinion of that proposal?

That's the way I understood the proposal and if it were accepted in this form it would produce a personal disaster for the recipient and a social disaster for the community.

Would you explain that please?

Contrary to Mr. Baker's statement, every addict you put on methadone liberates X units of heroin, of course. And the heroin which the methadone man no longer needs will go into community. I assure you. It will change the situation from a seller's market into a buyer's market and if the Mafia finds competition through methadone, they really will push.

What about the individual that gets into this program?

In my opinion it deprives the majority of human beings who get on methadone of any motivation to do anything else, and they carry on the same social inhuman problems with them they had before. They're just as lonely, just as alienated, just as miserable, just as sick in some way as they were before. And the statement that the methadone program solves crime is fallacious. 20 percent of those on methadone use other drugs which in their effect are escalated beyond what they would do without the methadone basis. Alcohol is twice as bad for a methadone man as it is otherwise.

Mr. Bailey, let's get into that first film of yours now.

Yes. Mayor White and Dr. Deissler, recently we went to New York City, and we interviewed 24 ex-addicts. And we asked them specifically, "what do you think of the proposal in terms of this methadone maintenance?" I'd now like you to see what they had to say.

I don't think anybody that's using methadone is any more of a well-adjusted or well-functioning human being than a person who is using heroin.

It's really just a substitute, just another dependency.

I wouldn't want to do it because I'd be the same person. I'd have the same problems that I had when I used drugs. I'd only be covering them up. I'd still be the same unhappy person, only on methadone instead of on heroin.

It's the dependency that's created by methadone. A person has to have it. It's just feeling of having to have methadone that puts me against it.

I wouldn't want it for myself, and I wouldn't want it for nobody else.

To me it was like using another form of narcotic.

To me it's just like being in a shell just as if I was putting heroin in my arm.

While I was being maintained on methadone, as I say I had the old similar interests that of the general drug world, the mystique surrounding drug addiction and the whole scene.

Methadone didn't work for me because even though it helped me clean up, get off my habit, the main thing that it didn't do was it didn't take away any of the problems of why I started to use heroin and try and block out the world to begin with.

I think this is a great shortcoming of a methadone maintenance program is that again they're just treating the symptom. The public is ready to seize upon it as a panacea that is going to sort of cure all the ills of drug addiction.

Dr. Deissler, I'd like to ask you just one final question. What do you see as the potential impact on young people — young people like in those films — if tonight's proposal were put into effect?

As I said, I think it would be disastrous. It will lead to the notion they'd it is safe to experiment with heroin because if you get into trouble you always can go on methadone. Number two, you really willing to contemplate the possibility that the Vietnam returned veterans who are addicted — some of whom are addicted—will be offered methadone as the only solution for their problems which is what this proposition poses? Are you willing to put 14, 15, 16, 17 year old youngsters on methadone for life? Are you prepared to abandon a whole generation of youngsters who get caught up in the drug scene by putting them on methadone despite the fact that they are well known to be multiple drug abusers? That proposition to me seems to be preposterous and as the Mayor so beautifully said, it is immoral in it's consequences and implications.

Let's hear from Mr. Baker now on cross-examination.

Dr. Deissler, you said so many outrageous things, I just don't know where to begin. Let's take one of them right at the top.

Oh, wait a minute now.

In the first place you said that if we dried up the heroin market, the Mafia would go out and push. Assuming that Synanon...

...dried up the heroin market...

...yes...

I-said nothing of the kind.

You said that if methadone were introduced that the Mafia deprived of the methadone users as a source of buying power, would go and really push.

Doesn't that seem logical?

That same thing is exactly true. If Synanon were any good. If Synanon were really good, you would see send those addicts into the program, they would come out clean, they wouldn't buy any heroin and the Mafia would push. Isn't that patently absurd?

Is it much more so because the ones who are in Synanon are permanently taken out of the drug scene.

They stay in Synanon, however, don't they? They don't go into the outside world any more...

...oh really?...

...like normal people...

...oh, really?

…don’t they?

That's your fantasy.

No, sir...

No it's not true.

Let me ask you another question. You said, for instance, that young — people the people who come back from Vietnam —- we're not advocating, for instance that you exclude any other form of treatment.

That isn't what your proposition tells us.

No, our proposition is make methadone available to all addicts who request it for an indefinite period. That does not say that you cannot take any other program and use it, does it? That you're just saying addicts are locked in a cage of addiction.

That's right.

And there are many doors out and one of these is methadone maintenance. And we're saying, let's open that door. Now what's wrong with that?

I say do not do it because it is an experimental approach; It isn’t proven. We do not know what the social consequences will be. It is immoral in the concept of the Mayor, and I think it should be the last thing to try. It should be the product of the council of desperation. It should be the last resort. Everything else should be tried first.

Doctor, isn’t it true, though, that the other program that they had in the past before methadone were not very good in terms of returning these addicts to society at least socially acceptable. And before we methadone, isn't that true?

May I ask you what programs you refer to?

Well, Synanon, one in terms of significant numbers.

The numbers are what they are and far below what they should be because this most worthwhile experiment has not found the public support which we are apparently trying to waste on methadone.

But isn't it true that methadone has turned large numbers of addicts back into society at least as being socially acceptable for a start?

I doubt that the total number is substantially larger than what Synanon has done, sir.

Go on, Mr. Baker.

Doctor, you know that there are at least two theories of heroin addiction. There's a theory that part of heroin addiction is psychological in origin, that there are individuals who have hang ups and they take heroin to escape from those hang ups. Now, Drs. Nole and Neiswander who have done a considerable amount of research with methadone posit that heroin addiction is in effect a metabolic change in the human chemistry and that you have to do something about the change in metabolism. Now, assuming their theory is right, doesn't methadone maintenance offer a chemical means of solving a chemical problem?

There is no reason whatsoever to assume that their assumption is right. The very simple refutation is that apparently Synanon has 1,600 people who are distinguished by the fact that they do not share this metabolic disorder. Isn't that strange?

Isn't it strange . . .

Doctor, Mr. Baker. Mr. Bailey has a second film which he's going to show. Dr. Deissler, I thank you very much for being on "The Advocates."

Mayor White, Dr. Deissler told you that he does feel that at least some effort towards a drug-free existence should be made and that it is a realistic goal for most addicts. While we were in New York, we asked the same people you saw before what it felt like to lead a drug-free existence and I'd like you to hear what they had to say on that question.

I always thought it was a mystery to stay clean but it's not. It's just a matter of facing reality, facing the realities of life and yourself.

I think there is no choice. If you are going to clean up from drugs, you've got to do it entirely.

Yes, I believe for the majority of drug addicts, yes, that they can make it; they can live without using drugs.

Since I've been clean now for seven years, I can definitely say that there is no comparison between being maintained on methadone and being clean from the use of drugs.

How does it feel to be clean. That's a question that I find very difficult to answer. I feel good. I feel great. It's wonderful to wake up in the morning and not have to worry about hustling money for drugs. It's wonderful to wake up in the morning and not have to worry about getting a hit. It's wonderful to be happy again.

I can just be myself, be accepted as myself and get good feelings from myself without any outside chemical or alcohol or anything.

I'm beginning to like myself now which is a new experience.

Emotionally, I'm a human being again. I can feel the changes around me. The whole world is out there for everybody. I'm meeting people that — people, people that have nothing to do with drugs; people that are sort of like, you know, people that have some interests in life that are pretty interesting that are groovy and I'm looking forward to this.

There's no comparison whatsoever between somebody being maintained on some kind of drug and somebody that's leading a drug-free, learning kind of life.

At this time I'd like to call to the stand Mr. Gene Haislip, special assistant to the deputy director of the Federal Bureau of Narcotics.

Welcome, Mr. Haislip.

Thank you.

Mr. Haislip, has the federal government found it necessary to undertake a study of methadone and methadone maintenance programs?

Yes, we have. We've been concerned over this for several reasons. First, there is a growing illicit traffic in methadone itself, and secondly methadone programs have been increasing and we are interested to see that these are operated in a fashion which will not injure the community and create additional problems.

Now, Mr. Haislip, referring once again to tonight's specific proposal. What do you see are the dangers, first in terms of the individual who's put into that kind of a program?

Well, as the proposal is stated there are several dangers we have to consider. First of all, of course, methadone, itself is a highly addicting drug. In fact, when you consider that most of the heroin available in cities has been greatly diluted through the cutting process, the addiction to methadone may be well in excess of that which is customary on the street. One of the dangers that we run is making methadone addicts out of people -- particularly young people — who may be only peripherally involved with experimentation with narcotic drugs. Second danger, we cut off all possibilities of an early cure in return of individuals to a drug-free existence unless we assure ourselves that far less radical and presently accepted techniques have been first used to see if this can be accomplished.

Something you touched on just a second ago. What do you see are the potential dangers in terms of the illicit drug traffic in this country?

Well, there are several. Unless such programs are accompanied by strong therapeutic efforts to change the addict's entire life pattern, several things can happen. First, we may only succeed in driving up the cost of the heroin habit that he currently has because we know that if he can acquire sufficiently large doses of heroin in the illicit traffic he can still obtain his euphoria. Secondly, we may drive him into other forms of drug abuse which are completely unaffected by the methadone — the abuse of cocaine, meth amphetamine, barbiturates. All of these drugs are completely without effect. So these are two important reasons.

Finally, Mr. Haislip . . .

Let's go to Mr. Baker now. Mr. Bailey, I want to interrupt and see what Mr. Baker has waiting on cross-examination.

If I can get untangled from this snake cord over here, I'll ask you a few questions. Now, Mr. Haislip, you pointed out several dangers and .one of the dangers of being on this program is microphone cord. But anyway, you said that methadone itself is highly addictive. We don't dispute that, but let's make a distinction, shall vie? You said there's a danger of people becoming methadone addicts on the street. Now you can shoot methadone up, but we're advocating a program where you give methadone to people orally in orange juice which can't be shot up in a stabilizing basis. Now there's no danger of these people experiencing a euphoria or high from the use of that methadone in that manner, is there?

No, I would dispute that. I think that has not been proven. I think there is a question as to just how much euphoria is experienced by these people but certainly we have people who have worked in this field to tell us that a good percentage of their patients do manifest the typical euphoria symptoms and frequently will not. Now the extent of which this is true is questionable. It's clearly not as true in the case of heroin. But this is the point you must remember. The addict's primary motivation frequently, particularly those who have not been through the mill, so to speak, is to obtain this high to the extent that you do succeed in blocking it by giving his methadone without any other therapeutic advantages or programs, he will merely seek that same high in other drugs* or perhaps in acquiring additional doses of your illicit methadone in the traffic.

Mr. Haislip, you studied Dr. Jaffe's program in Chicago; you know it well and you know the Dolan-Neiswander program. Isn't it in fact true that there were very few cases of drug abuse outside methadone, in fact you have urinalysis as a means of testing whether an addict is using any other form of drug.

Well, we did look at Dr. Jaffe's program, and I think he has an excellent program from what we were able to see. And I certainly want to make that clear. But I wouldn't concede your point. The indications are that there is a good deal of abuse of other drugs accompanied with many of these programs. Perhaps, not Dr. Jaffe's but certainly many of them. In fact if urine surveillance is not done on a very regular basis and on a surprise basis, you will not be able to pick this up.

Mr. Haislip, could I ask a question because I think it is the issue here. I don't think that film shows there's any dispute between being clean and being on methadone, that's not in dispute. What's in dispute here it seems to me is fundamentally this. If we make therapeutic treatment a mandatory part of a program will that decrease the number of those who will seek rehabilitative help?

Will it decrease the number of those who will seek rehabilitative help? Well, I find that difficult, if not impossible, to answer. I don't know of data on that particular thing, but to the extent that it does, of course, it selects out the most promising candidates and one way of looking at the matter is that if you have X number of dollars to spend, you should probably spend it on those who represent the most promising candidates if you want to make a definite improvement. That's the way I would analyze your question. I don't have data on the specifics that you ask.

All right, Mr. Haislip, thank you very much for being on "The Advocates." Mr. Bailey, you now have one minute to summarize.

Mayor White, I think it's important to understand that I'm not against methadone. I'm especially not giving methadone to that person for whom it is the last resort — the person who might die from an overdose of heroin, the person for whom any other program is a complete failure. But I do urge you, sir, please, if you're going to establish a program which does issue methadone in the city of Boston, consider, consider what you've heard from Dr. Deissler and Mr. Haislip about the necessity of tying in some kind of rehabilitative program that gives that young addict a chance, at least a chance, to be drug-free and not maintained for life. And also bear in mind the serious dangers that both ray witnesses point out to you about the potential illicit drug traffic, about encouraging all kinds of new experimentation and about letting people who could go clean live on methadone for the rest of their life.

Thank you, Mr. Bailey, and now Mr. Baker you also have one minute.

Mayor White, talking about encouraging illicit drug traffic and talking about encouraging youngsters to go into dope is like saying, you're not going to help a man who's going to get run over by a car because you want to discourage people from jay walking. We're dealing with a moral crisis in our community that people are dying from heroin overdoses; they're living wretched lives; they're preying on citizens in our community, and you have it in your power to do something about it. Dr. Jaffe has told you how; Mr. Harris has told you how. It strikes me that the critics of the methadone program remind me of the fellow who wouldn't throw a life line to a drowning man because he was depriving him of such a beautiful chance to learn to swim. Thank you.

Thank you, Mr. Baker. Well, recently "The Advocates" conducted a national public opinion poll on the question of providing methadone to heroin addicts on their request. I'm going to show you the results of that national public opinion poll in just a moment. First let's get a reaction from our studio audience here in Boston. Just before the broadcast started, we asked them to vote on this issue. Now no group of one hundred people can give us a scientific sample of the country but in selecting this group in our studio, we did try to approximate a broad cross-section of our population. Before we reveal the results of that first vote, I'm going to ask our studio audience to vote a second time. Ladies and gentlemen, you've heard both sides of the argument. You all know the voting procedure. You know the question. Remember to hold the lever down for a full five seconds. Are you ready? Please vote now. Five, four, three, two, one. Thank you.

Let's see now the results of the first vote that was taken before the broadcast started and there it is. In our studio audience 51 said, yes, they favor methadone programs; 20 said no, 29 were still undecided. Now those 51 people who originally favored the proposal, let's see what happened. How many left that position; where did they go? May we see that please? Ten left. Six of them went to no; 4 went to not voting. Now the 20 people who opposed the proposal, how many changed their minds? Nine -- almost half. Seven to yes, and 2 to not voting. And finally of those 29 who were originally undecided, who went which way? There it is. Sixteen left — 4 to no and 12 to yes. And here's the final count in the studio. We have 60 saying, yes, they favor methadone programs despite the dangers; 21 say, no, 19 still undecided.

Well let's compare that with the results of the national poll that "The Advocates" took on this same question. On our national poll we had 46 percent saying yes, provide methadone. 30 percent said, no, don't provide it and 24 percent registered no opinion. Not a big gap but somewhat less nationally favoring the program than those who heard Mr. Baker's arguments.

Well, ladies and gentlemen, now's the time for you at home to act. You've heard the cases. You know how the people in our studio audience feel about this problem. The question is how you feel about it and what you're going to do about it. Wherever you stand on the question of providing methadone, to heroin addicts on their request, you as a citizen can make your position felt and you do it by writing "The Advocates", Box 1970, Boston 02134. We tabulate your views and make them known to Mayor White here, make them known to every other big city mayor throughout the country. If you want to work with organizations dealing with this problem, let us know and we'll do our very best to put you in touch with them; and tell us, will you, the station on which you heard this broadcast? Incidentally while we welcome your comments at any time, as you know, if you want your vote to count, let us have it within, two weeks of our broadcast, because that's when our tally is made up. Will you remember that address? "The Advocates", Box 1970, Boston, 02134. Rolls off the tongue, doesn't it?

Two weeks ago "The Advocates" brought you a special program on the Cambodia crisis from our nation's capitol. Our question was this: "Should Congress resolve that the President immediately withdraw all troops aid and advisors from Cambodia and commit no further forces outside Vietnam?" And the largest response to any Advocates question so far as of Friday, May 22, nearly 16,000 people from throughout the entire country had mailed us their vote. 57.8 percent said, yes, withdraw from Cambodia; 41.6 percent said, no. Only 6/10th of one percent expressed other views.

On March 15th "The Advocates" argued the proposal: "Should the government pressure people to use doctors who work in groups on salary?" Our guest that evening was Paul McCloskey, a Republican congressman from California. He's considered the question, and he's prepared with his statement.

The public response to this question has been overwhelmingly favorable, but I'm not yet personally convinced that the government should require medicare and medicaid patients to go to group clinics. Encourage, yes. But require, not yet. I hate to see the government require anything of people until we have exhausted our attempts to reach the same result through encouragement. I think that the development in use of group practice is something to be encouraged. The group practice have proven their merit and the Nixon administration has recently introduced proposals to put an incentive system of institutional reimbursement and to cause payments to be perspective rather than retroactive. I think that these legislative considerations now before the Congress merit your concern, and I hope that everyone watching this program will take the opportunity to write your views and your experiences to the Senate Finance Committee and the House Ways and Means Committee that are now considering this legislation.

Thank you very much, Congressman McCloskey, for your thoughtful comment. Now let's look ahead to next week.

There are over one half million inmates in the nation's prisons. When they are released, more than half of them will commit another crime. Would retraining outside of prison work better and cost less? Next week, "The Advocates" argue: "Should automatic probation replace prison sentences for all those convicted of non-violent crime?"

Thanks very much, Mayor White. Thanks very much to our guest advocate William Bailey, to all our witnesses. Ladies and gentlemen, this is Lisle Baker's last appearance as a regular advocate. Lisle, from all the staff of "The Advocates" our thanks for a job very well done. Ladies and gentlemen, I'm Victor Palmieri. Until next Sunday night, good night.

"The Advocates" as a program takes no position on the issues debated tonight. We ask each advocate to present responsible arguments, not necessarily his personal views. Our job is to help you understand both sides more clearly.

This program was made possible by grants from the Ford Foundation and the Corporation for Public Broadcasting.