[Senate Hearing 106-982]
[From the U.S. Government Publishing Office]
S. Hrg. 106-982
THE RESURGENCE OF HEROIN USE AND ITS EFFECT ON YOUTH
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HEARING
before the
SUBCOMMITTEE ON YOUTH VIOLENCE
of the
COMMITTEE ON THE JUDICIARY
UNITED STATES SENATE
ONE HUNDRED SIXTH CONGRESS
FIRST SESSION
on
EXAMINING THE PROBLEM OF HEROIN ABUSE AND IMPLEMENTING TREATMENT
PROGRAMS
__________
NEW CASTLE, DE
__________
NOVEMBER 15, 1999
__________
Serial No. J-106-61
__________
Printed for the use of the Committee on the Judiciary
U.S. GOVERNMENT PRINTING OFFICE
71-969 DTP WASHINGTON : 2001
COMMITTEE ON THE JUDICIARY
ORRIN G. HATCH, Utah, Chairman
STROM THURMOND, South Carolina PATRICK J. LEAHY, Vermont
CHARLES E. GRASSLEY, Iowa EDWARD M. KENNEDY, Massachusetts
ARLEN SPECTER, Pennsylvania JOSEPH R. BIDEN, Jr., Delaware
JON KYL, Arizona HERBERT KOHL, Wisconsin
MIKE DeWINE, Ohio DIANNE FEINSTEIN, California
JOHN ASHCROFT, Missouri RUSSELL D. FEINGOLD, Wisconsin
SPENCER ABRAHAM, Michigan ROBERT G. TORRICELLI, New Jersey
JEFF SESSIONS, Alabama CHARLES E. SCHUMER, New York
BOB SMITH, New Hampshire
Manus Cooney, Chief Counsel and Staff Director
Bruce A. Cohen, Minority Chief Counsel
______
Subcommittee on Youth Violence
JEFF SESSIONS, Alabama, Chairman
BOB SMITH, New Hampshire JOSEPH R. BIDEN, Jr., Delaware
JON KYL, Arizona DIANNE FEINSTEIN, California
JOHN ASHCROFT, Missouri HERBERT KOHL, Wisconsin
Kristi Lee, Chief Counsel
Sheryl Walter, Minority Chief Counsel
(ii)
C O N T E N T S
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STATEMENTS OF COMMITTEE MEMBERS
Page
Biden, Hon. Joseph R., Jr., U.S. Senator from the State of
Delaware....................................................... 1
Specter, Hon. Arlen, U.S. Senator from the State of Pennsylvania. 3
CHRONOLOGICAL LIST OF WITNESSES
Panel consisting of Alan I. Leshner, Ph.D., Director, National
Institute on Drug Abuse, National Institutes of Health; Charles
O'Brien, M.D., Ph.D., chief of psychiatry, Philadelphia
Veterans Medical Center, and professor of psychiatry,
University of Pennsylvania School of Medicine; William R.
Nelson, acting special agent in charge, Philadelphia Field
Division, Drug Enforcement Administration, and Thomas C.
Maloney, president and executive director, SODAT Drug Treatment
Center......................................................... 6
Panel consisting of Sgt. Tony Hernandez, New Castle County police
officer, Heroin Alert Unit; Lt. Karl Hitchens, New Castle
County paramedics supervisor; Marie Allen, Heroin H.U.R.T.S;
Maria Matos, executive director, Latin American Community
Center; and Sally Allshouse, Brandywine Counseling and
Treatment...................................................... 41
ALPHABETICAL LIST AND MATERIAL SUBMITTED
Allen, Marie: Testimony.......................................... 43
Allshouse, Sally: Testimony...................................... 46
Hernandez, Sgt. Tony: Testimony.................................. 41
Hitchens, Lt. Karl: Testimony.................................... 42
Leshner, Alan I.:
Testimony.................................................... 6
Prepared statement........................................... 7
Maloney, Thomas C.: Testimony.................................... 24
Matos, Maria: Testimony.......................................... 44
Nelson, William R.:
Testimony.................................................... 16
Prepared statement........................................... 20
O'Brien, Charles, M.D., Ph.D.:
Testimony.................................................... 12
Prepared statement........................................... 14
THE RESURGENCE OF HEROIN USE AND ITS EFFECT ON YOUTH
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MONDAY, NOVEMBER 15, 1999
U.S. Senate,
Subcommittee on Youth Violence,
Committee on the Judiciary,
New Castle, DE.
The committee met, pursuant to notice, at 10:18 a.m., at
the New Castle Police Headquarters, New Castle, DE, Hon. Arlen
Specter presiding.
Also present: Senator Biden.
OPENING STATEMENT OF HON. JOSEPH R. BIDEN, JR., A U.S. SENATOR
FROM THE STATE OF DELAWARE
Senator Biden [presiding]. Good morning, everyone. Thank
you all very much for being here. I apologize for being late. I
told Senator Specter that it is twice as far from route 141 as
it is from Philadelphia, is the reason why.
I particularly want to thank Senator Specter on two
accounts. One, for coming down to hold this hearing, and
second, and technically, he should be opening this hearing. In
case no one has noticed--I know former Mayor Maloney has
noticed--I am in the minority. That means that I am the ranking
member of a committee and it means that the majority always
runs the hearing. So Senator Specter is really chairing this
hearing, but he has been kind enough to allow me in my home
State to do what I used to do in the bad old days when my team
was in charge.
When it comes to Senator Specter and me, those who know us,
and the news media know us because they are always reluctant
that we never criticize one another, when it comes to us, we
are a team. We are friends. I can only think of a couple things
we have disagreed upon, and this is not one of them. So I want
to thank Senator Specter for making the effort and being so
courteous to me.
Second, I am going to make a relatively brief opening
statement here and then I will turn it over to Senator Specter
and then we will introduce the witnesses, and I thank them all
for being here. We have two very distinguished panels this
morning, and as you can tell by the turnout, there is keen
interest and concern about the subject matter of our hearing
today.
This is a hearing of the Senate Judiciary Youth Violence
Subcommittee, a field hearing on heroin abuse, and I
especially, as I said, appreciate Senator Specter being here. I
also appreciate the chairman of the subcommittee, Senator
Sessions of Alabama, for authorizing us being able to have this
hearing.
We are here today to focus on the resurgence of heroin and
to discuss steps that we can take now to prevent it from
wreaking havoc on our communities like crack cocaine did in the
mid-1980's and up into the mid-1990's.
There is always a drug of the moment. In the mid-1980's, it
was crack. In the mid-1990's, it was methamphetamine. Today, in
my view, it is heroin. Senator Specter and I join together
today to hold this hearing to highlight the Delaware-
Pennsylvania, more particularly the Delaware-Philadelphia
deadly heroin connection.
The drug trade does not recognize State boundaries, and all
of us in Delaware and Pennsylvania, and Delaware and the
Wilmington-Philadelphia area, need to work together to address
the problem. I would like to say publicly today that the ball
is rolling to include Delaware in the Philadelphia-Camden, what
we call high-intensity drug trafficking area, known as HIDTA,
which allows particular resources to be able to be used, extra
resources to be able to deal with the drug problem. I expect we
will hear testimony today from our law enforcement folks about
why this should happen.
In a 20-minute drive, teens and young people from
Delaware--and, by the way, they do not have to drive 20 minutes
to get heroin when they can get it right here in our own
streets, but in a 20-minute drive, teens and young adults from
Delaware, many of them from hard working middle-class families
in the suburbs, go to the badlands and the streets in the
Kensington section of Philadelphia, and for $10 a bag buy
heroin that is as much as 90 percent pure. It is a death drive.
It is killing our young people. It is destroying our families.
We are here today to try to figure out how we can stop it.
There are an estimated two million heroin users in the
United States today, and that number is growing. As our
witnesses today will attest, heroin use is on the rise,
especially among young people. Long-term national data showed
that in 1997, we had the highest level of heroin use among high
school seniors since 1975. Here in New Castle County, in the
first half of this year, there were 71 heroin-related
overdoses, ten of which resulted in death. Fifteen of those
overdoses involved teenagers, including one 14 years of age.
It is no coincidence that the rise in heroin use among
youth is happening as heroin purity levels are skyrocketing.
When heroin was less potent, users had to inject it to get the
same high. Now that heroin is up to 90 percent pure in some
cities, including Philadelphia, users can get high by smoking,
snorting, or inhaling the drug, making it much more attractive
to teens and to young adults.
No matter how heroin is taken, it is addictive and it is
deadly. We are going to hear some tough testimony today, the
toughest from Marie Allen, whose daughter, Erin, became
addicted to heroin after snorting the drug, and after three
years' struggle with the addition, it finally killed her at the
young age of 21.
There is no other disease that affects so many directly and
indirectly as does addiction. We have 14 million drug users in
this country, four million of whom are hardcore addicts. We all
have family members, neighbors, colleagues, or friends who
found themselves or their children addicted to drugs, and we
are all affected by the clear connection between drug use and
crime.
An overwhelming 80 percent of the 1.8 million men and women
behind bars today in the United States have a history of drug
and alcohol abuse or addiction or were arrested in a drug-
related crime. If we decrease drug use, we decrease crime. It
is simple arithmetic.
As a nation, our primary response to the drug epidemic has
been punishment. Clearly, simply locking up people has not
solved the problem of drug-related crime, and Senator Specter
and I have been authors, and I make no apologies for it, of
some of those very tough drug laws that we passed.
In the 1994 Biden crime law, we created drug courts as a
cost-effective innovative way to deal with nonviolent offenders
who need drug treatment to keep them from getting into the drug
stream fully. Delaware's adult drug court judges Richard
Gebelein and Carl Goldstein are with us today, as well as our
juvenile drug court judge, Peggy Ableman, as well as Wilmington
and New Castle County and Delaware State Police, all of whom
are here today, and they can tell you the effectiveness of
these courts.
Senator Specter and I are fighting in Congress to continue
funding for drug courts. Quite frankly, as a member of the
Appropriations Committee, Senator Specter has played an
incredibly important role, not only in this, I might add, but
in our Violence Against Women Act. He is the guy who has made
sure when some in my party and his party decided not to fund
fully that Act, and not to fund fully the shelters, he is the
guy that bucked everyone, put it in, and forced them to vote,
and after the first vote of us getting beat, we went back at it
again and we won, and the very person who took the money out
asked to cosponsor it when you put it back in. So I just want
you to know, this is an effective advocate right here and has
been a major player in making sure that these programs work,
particularly fighting for the drug courts now.
As our first witness, Dr. Alan Leshner, has taught us,
addiction is a chronic, relapsing disease. Ten years ago, I
asked the question, if drug addiction is an epidemic, are we
doing enough to deal with the medical cure? That led to the
creation of the Medications Development Division at the
National Institute of Drug Abuse, dedicated to unleashing the
tremendous power of medical science to find medical cures for
this social and human ill. I commend them for the great
progress they have made thus far, and I understand there is a
promising new treatment for heroin addiction that Dr. Alan
Leshner, who is here today, and his team at the National
Institute of Drug Abuse helped to develop. I look forward to
hearing their testimony.
But before I introduce the first panel of witnesses, let me
turn now to my colleague on the Senate Judiciary Committee and
my friend for an opening statement.
OPENING STATEMENT OF HON. ARLEN SPECTER, A U.S. SENATOR FROM
THE STATE OF PENNSYLVANIA
Senator Specter. Thank you very much, Senator Biden. Thank
you for inviting me to this important hearing today. Senator
Biden and I have collaborated on many matters in the course of
the past 19 years. We ride the train from Washington to
Wilmington, and there is a tremendous amount we can accomplish
in that kind of a ride.
I have been very much impressed with what Senator Biden's
publications have been. I have received not too long ago this
elegant treatise on the successes of the Violence Against Women
Act by Senator Biden. Somehow, he left my name off as a co-
author. [Laughter.]
This is in September, and on November 15, heroin. I said to
Senator Biden before we began here, what happened to October? I
want to make sure I have the full edition of the current
treatises.
Senator Biden. That is on the Nuclear Test Ban Treaty. It
is coming.
Senator Specter. Speaking of the Nuclear Test Ban Treaty,
we worked on that together last month, as well, and while we
have not yet been successful on that, just stay tuned. We will
be.
The issue of heroin, the broader issue of drugs, the
broader yet issue of violent crime, is one where we have not
had an adequate societal response. I became an assistant DA
many years ago. I hesitate to think of the year--1959. I was a
younger lawyer then. I am still a young lawyer. I have watched
our failure to respond to the drug problems and to the issue of
rehabilitation generally, because there are answers.
We need to divide the criminal element into two groups, the
career criminals, where we need to throw away the key, life
sentences. Senator Biden and I collaborated many years ago on
the armed career criminal bill, which provides for a life
sentence. That is 15 years to life in the Federal courts for
anyone with three or more violent offenses, including sale of
drugs, anyone found in possession of a firearm.
There is another class of criminal, one who will be
released, and what we need to do is to provide realistic
rehabilitation. That means drug treatment, that means alcohol
treatment, that means literacy training, and that means job
training. We are not going to solve the problem of drugs unless
we work hard on the so-called demand side, that is, to try to
eliminate the demand.
For many years, I served as district attorney in
Philadelphia and I think you have to have tough law
enforcement. But tough law enforcement is not going to solve
the problem as long as there is so much money in selling drugs,
and there is a tremendous amount of money. It is long past due
that we devoted at least 50 percent of the resources to the
demand side.
Senator Biden refers to some of the work that I have done
on the Appropriations Committee, and there, we are really
placing tremendous resources into the so-called demand side.
The National Institutes of Health had an increase in its budget
of almost $1 billion 2 years ago. Last year, Senator Tom Harkin
and I--he is the ranking Democrat, and I learned a long time
ago that if you want to get anything done in Washington, you
have to cross party lines, as Senator Biden and I are again
today--Senator Harkin and I took the lead in adding $2 billion
to the National Institutes of Health. This year, we are still
working on the budget. It is $2.3 billion, and candidly, our
colleagues are aghast at the kind of funds we are adding, but
nobody has the audacity to try to remove them, that is, not
publicly.
But speaking of the NIH Institute on Drug Abuse, that
funding is up now to $690 million, an increase of $81 million
from last year. The Substance Abuse and Mental Health Services
Administration has a block grant to the States of $1.6 billion.
That is a lot of money. And treatment programs, $214 million
this year, which is an increase of $43 million over last year.
So those are some of the avenues which we need to approach,
and I am delighted to look forward to the very distinguished
testimony we will hear today from our very impressive panel of
witnesses.
Thank you again, Senator Biden, for including me.
Senator Biden. Thank you, Senator, and the only reason I
did not put your name on the Violence Against Women report is
the reason I put that report out was I was getting criticism--
questions from within my own party as to how effective was it,
how was it working. So I did not want to put you in any more
jeopardy than you already are about being associated with me as
much as you are in your party.
Senator Specter. Well, goodness knows, I never get any
questions from my party. [Laughter.]
Senator Biden. We have a truly, for the local press here, a
truly distinguished panel. I want to briefly explain why we
decided to ask this panel to be put together in the way it has
been.
One of the things that we have found is there is an
emerging consensus among law enforcement, the DEA, the
treatment folks, like Tom Maloney at SODAT, and Dr. O'Brien,
the University of Pennsylvania School of Medicine, as well as
at the National Institute of Drug Abuse. There was a report,
and poor Dr. Leshner, I am a broken record on this since the
mid-1980's, another report that I wrote back in 1989 calling
for spending over $1 billion on beginning the process of
dealing with pharmacotherapy treatment of the drug abuse
problem. There always have been promising drugs. There always
have been promising alternatives.
But what has happened is, in fairness to the drug
companies, it is not very much in their interest to promote
them. It is not very much in their interest. If we have 1.7
million addicts, you come up with a cure for those addicts,
then you have 1.7 million people to market it to, and of those
folks, none of them want to buy it. So it gets difficult.
But we have with us today a genuine leader in this area,
the Director of the National Institute on Drug Abuse, Dr. Alan
Leshner, who we will hear from. Then on the same panel, we will
also hear from one of the country's foremost experts on heroin,
Dr. Charles O'Brien, who is at the University of Pennsylvania
Medical Center and a professor and vice chair of psychiatry at
the University of Pennsylvania, as well as the senior Drug
Enforcement Administration agent from the Philadelphia-Delaware
region, Bill Nelson with the DEA. He knows the territory very,
very well.
Locally here, a man who runs one of the most successful
programs in the country of its size and scope, Mr. Tom Maloney,
the former mayor of the City of Wilmington who runs SODAT Drug
Treatment Center in Wilmington and who will talk about the
effectiveness from his perspective of the juvenile drug court,
as well as SODAT's use of naltrexone to treat heroin addiction.
Dr. Leshner, the floor is yours. I keep saying ``Lesher''
because there used to be a great high school basketball player
who Tom and I played with, went off to West Virginia, and his
name was Lesher, from my home city of Claymont, and I
apologize. But you can easily administrate as well as he could
shoot, and he could shoot the lights out.
PANEL CONSISTING OF ALAN I. LESHNER, PH.D., DIRECTOR, NATIONAL
INSTITUTE ON DRUG ABUSE, NATIONAL INSTITUTES OF HEALTH; CHARLES
O'BRIEN, M.D., PH.D., CHIEF OF PSYCHIATRY, PHILADELPHIA
VETERANS MEDICAL CENTER, AND PROFESSOR OF PSYCHIATRY,
UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE; WILLIAM R.
NELSON, ACTING SPECIAL AGENT IN CHARGE, PHILADELPHIA FIELD
DIVISION, DRUG ENFORCEMENT ADMINISTRATION; AND THOMAS C.
MALONEY, PRESIDENT AND EXECUTIVE DIRECTOR, SODAT DRUG TREATMENT
CENTER
STATEMENT OF ALAN I. LESHNER
Mr. Leshner. Thank you, sir. I am only sorry my basketball
game is terrible.
Senator Biden. So is mine.
Mr. Leshner. Good morning. I am very pleased to be here and
I will discuss only briefly how science is helping us to combat
the major public health problem of increased heroin use,
particularly among our use.
Heroin is, of course, sold in many different forms, and it
can be injected, sniffed, snorted, or smoked. Taken by any of
these routes, heroin very rapidly enters the brain, where it
attaches to the brain's natural opiate receptors. It is
important that heroin also acts on the brain's natural rewards
circuitry, where it produces pleasurable sensations.
Now, as street heroin has become cheaper and purer in the
last few years, it is being used more and more by the
noninjecting routes, like sniffing or smoking. This appears to
have made heroin more attractive to young people, who
historically have been adverse to injecting drugs, but who seem
now to think that by snorting heroin, they are protected from
its addictive and other harmful properties. This, of course, is
simply wrong. Heroin is extremely addicting no matter how it is
taken, and we know that many heroin smokers and snorters
rapidly progress to injecting, as well.
A critical problem with heroin use is that, over time,
prolonged use actually changes the brain's structure and
function. These brain changes, then, lead to the compulsion to
use drugs. That compulsion is the state that we call addiction.
And this brain change-induced state of compulsion is actually
the essence of addiction and is what causes family and
community disruption.
The fact that addiction has this biological basis rooted in
brain changes is why people cannot simply stop using heroin.
The brain change is why they require treatment to get their
compulsion or addiction under control. Fortunately, our strong
science base has provided a number of effective treatments to
help combat heroin addiction.
For example, thanks in part to Senator Biden's interest in
developing antiaddiction medications and Senator Specter's
strong support of NIDA's overall budget through his role as
chair of NIH's Appropriations Committee, the biomedical
research community has been developing new medicines to help
treat addiction. Two of the most successful treatments for
heroin addiction, methadone and LAMM, are helping many addicts
who previously were a drain on society now to lead productive
lives.
I am pleased to say that we are now very near to bringing
the Nation another medication to help treat heroin addiction,
this one called buprenorphine or buprenorphine naloxone.
Because of this particular medicine's pharmacological
properties, we expect buprenorphine will be administered in a
more traditional medical environment, such as in physicians'
offices, thus expanding treatment options tremendously.
In spite of this progress, less than half the Nation's four
million drug addicts have received any drug addiction
treatment. Thus, there is a tremendous need to make state-of-
the-art science-based treatments more widely available and more
widely used.
I am pleased to mention here that last month, NIDA launched
its much anticipated national drug abuse treatment clinical
trials network. This network will serve not only as a mechanism
for testing science-based treatments in real life settings, but
also as a mechanism for promoting the rapid translation of new
treatments into actual community use.
I am especially pleased that one of the first nodes of this
network is located in the Delaware Valley. The network is
centered at the University of Pennsylvania, but it also
includes ten treatment organizations as partners in
Pennsylvania, New Jersey, and here in Delaware. Clinical trial
network nodes have also been established in four other regions
of the country, and we hope to expand this network by at least
five new nodes each year.
I am going to conclude here, but I would like to state
emphatically that although the data on heroin use is alarming,
science does provide us with much hope for getting a better
handle on this serious public health problem. I thank you for
the opportunity to testify and I will be happy to respond to
your questions.
Senator Biden. Thank you, Doctor.
[The prepared statement of Mr. Leshner follows:]
Prepared Statement of Alan I. Leshner
Thank you for inviting me to participate in this important hearing.
I am Dr. Alan I. Leshner, the Director of the National Institute on
Drug Abuse (NIDA), one of the research institutes that comprise the
National Institutes of Health. As the world's largest supporter of
research on the health aspects of drug abuse and addiction, I would
like to share with you today what NIDA-supported research has come to
teach us about heroin abuse and addiction.
In the United States, there are over 810,000 people addicted to
this illegal drug. Heroin is both the most frequently abused and the
most rapidly acting of the opiates. It is processed from morphine, the
naturally occurring substance extracted from the seed pod of certain
varieties of poppy plants. It is usually sold as a white or brownish
powder, or in some regions of the country (particularly in the
Southwest) as a black sticky substance known on the street as ``black
tar heroin.'' Heroin can be injected, sniffed/snorted or smoked. It is
important to point out at the outset that regardless of how heroin is
taken it is extremely addictive and can lead to other detrimental
consequences as well.
Heroin abuse is not a new problem. In fact opiate use dates back
long in history. What is new and particularly alarming, however, is the
high purity of today's heroin, its inexpensive price, and the way it is
being taken, all of which appear to be recruiting new users. Heroin is
now cheaper and purer than ever, making it more accessible to young
people who can smoke or snort the drug rather than inject it
intravenously. Until recently, the most common route for administering
heroin was through intravenous injection. Today, given the purity of
the drug, in many regions of the country, including the Philadelphia
metropolitan area, where street-level heroin purity remains one of the
highest in the Nation, people can snort heroin and achieve a high that
is similar to what they can obtain from injection. Our research is
showing that many of the new initiates to heroin are in fact trying the
drug because they can snort it and think they would be protected by not
injecting. In addition to that last fact being clearly wrong, studies
also show that noninjecting heroin users are at considerable risk of
becoming injection drug users (IDUs). In fact, more than 15 percent of
participants in a recent study transitioned from other routes of
administration to drug injection during an average period of little
more than a year.
The health risks associated with both injecting and noninjecting
heroin use are also substantial. For example, because of the behavioral
factors (high risk sexual activity, sharing of drug paraphernalia)
associated with heroin use, the chances of the individual contracting
an infectious disease such as HIV, hepatitis B, and in rare cases
hepatitis C, are greatly increased regardless of route of
administration.
The misperceptions about the addictive properties of heroin, may
account for why in 1997, an estimated 81,000 persons used heroin for
the first time. We are also seeing increases in the annual number of
heroin-related emergency room visits. From 1991 to 1997, the annual
number of emergency room visits in major metropolitan areas increased
from 36,000 to 72,000. Similar trends are being seen in the Delaware
Valley. The number of emergency room visits involving heroin in
Philadelphia has increased from 2,653 in 1990 to 3,817 in 1997.
We are also seeing increases in the number of individuals who are
seeking treatment for heroin addiction caused by snorting or
inhalation. Nationally, admissions, for heroin use by injection have
dropped from 77 percent of all heroin admissions in 1992 to 68 percent
in 1997, while the percentage of heroin admissions for inhalation has
increased from 19 percent in 1992 to 28 percent in 1997 (National
Admissions to Substance Abuse Treatment Services: The Treatment Episode
Data Set (TEDS) 1992-1997). This is also a trend we are seeing at the
local level. For example, last year in Philadelphia, 39 percent of the
heroin treatment admissions were for snorting heroin.
Now let me explain in a bit more detail, why these data are so
alarming. Because of its chemical structure heroin is able to very
rapidly enter the brain where it is actually converted into morphine.
In this form, the drug rapidly crosses the blood brain barrier and
attaches to the natural opioid receptors. By binding to these receptors
the drug initiates its multiple physiological effects, including pain
reduction, depression of heart rate, and the slowing of respiration. It
is heroin's effects on respiration, in particular, that can be lethal
in the case of heroin overdose. Heroin also acts on the brain's natural
reward circuitry to produce a surge of pleasurable sensations.
It is of course these pleasurable effects that cause people to take
drugs basically, people like what drugs do to their brains. Research is
showing that prolonged drug use can actually change, brains. These
changes are thought to play an integral role in the development of
addiction. Powerful new technologies are giving us even greater insight
into these dramatic brain changes.
This poster (POSTER 1) allows you to see morphine's effects on the
brain. The bottom images demonstrate the fact that when heroin addicts
are given 30 mg of morphine the brain's ability to metabolize glucose
is significantly reduced. Glucose is what actually fuels the brain
cells. In other words, heroin reduces brain activity in some regions of
the brain.
Understanding the neurobiology of addiction has led us to develop a
number of effective tools to treat heroin addiction and to help manage
the sometimes-severe physical withdrawal syndrome that accompanies
sudden cessation of drug use. Of course we now know that withdrawal and
physical dependence are only a minor part of the problem that must he
addressed when treating heroin addicts. In fact, withdrawal symptoms
can now be effectively managed through the use of modern medicines.
But it is the compulsive drug seeking behaviors that we have
defined as the essence of addiction, which must be addressed in a
comprehensive treatment program. And many behavioral and
pharmacological treatments are available, although not always widely
used.
For example, pharmacotherapies can be an important component of
treatment for many addicts. Twenty-five years of NIDA-supported
research have given us quite a number of effective medications to
combat heroin addiction. For example, LAAM (levo-alpha-acetyl-
methadol), a newer drug for the treatment of heroin addiction was
developed and is now available as a supplement to methadone. Both
methadone and LAAM block the effects of heroin and eliminate withdrawal
symptoms. Treatment with methadone requires daily dosing. LAAM blocks
the effects of injected heroin for up to three days. Research has
demonstrated that, when methadone or LAAM are given appropriately, they
have the ability to block the euphoria caused by heroin, if the
individual does in fact try to take heroin. Both methadone and LAAM,
especially when coupled with a behavioral treatment component, have
allowed many heroin addicts to lead productive lives.
By the way, it is important to emphasize here that contrary to
popular myth, methadone is not actually a substitute for heroin.
Although it does bind to the same brain receptors, it acts dynamically
in the brain quite differently from heroin. While heroin de-stabilizes
the brain of the addict, methadone actually stabilizes the heroin
addicts brain and behavior.
In an effort to give treatment providers another effective tool to
combat heroin addiction. NIDA is working with the Food and Drug
Administration and the pharmaceutical industry to bring to market a new
medication called buprenorphine-naxloxone. This medication has the
potential for administration in less traditional environments, such as
in physician's offices, thus expanding treatment to populations who
either do not have access to methadone programs or are unsuited to
them, such as adolescents. Buprenorphine would not be a replacement for
methadone or LAAM, but yet another treatment option for both physicians
and patients.
Although we have some quite effective behavioral and
pharmacological treatments in the clinical toolbox, many of the most
recently developed science-based treatments have not found their way
into normal practice settings, and we see that as a tremendous national
need. This idea of bringing science-based treatments to those who are
in need of treatment is fast becoming a reality, however. Recent
advances in treatment research, coupled with the generous
appropriations that NIDA received last fiscal year, have allowed the
Institute to accelerate the launch of its much-anticipated and needed
National Drug Abuse Treatment Clinical Trials Network. This Network
will serve as both the infrastructure for testing science-based
treatments in diverse patient populations and treatment settings, and
the mechanism for promoting the rapid translation of new treatment
components, into actual clinical practice in community settings
throughout the nation.
I am especially pleased to announce that one of the first five
research nodes we have awarded resources to is the Delaware Valley
Node, which will be centered at the University of Pennsylvania. This
Node is affiliated with ten community treatment programs in the region
including providers in the Thomas Jefferson Health System, The Belmont
Center, Fresh Start, the Northeast Treatment Centers, the Robert Wood
Jobnson Medical School-Mercer Trenton Addiction Sciences Center, the
Philadelphia Health Management Corporation, the University of
Pennsylvania Health System, the Rehab After Work Program, the Mercy
Health System, Achievement Through Counseling and Development, and the
Caron Foundation. The community treatment programs are in Pennsylvania,
New Jersey and Delaware. It is in these patient populations that we
will be testing some of the world's most promising behavioral and
pharmacological treatments. In addition to being treated, these
patients will also be helping researchers determine what works best for
whom and under what circumstances. We have also established Research
nodes in four other regions of the country to feed into the Network.
We hope to expand this Network each year. When complete, the
network will consist of 20 to 30 regional research treatment centers or
nodes.
Developing and bringing new medications and behavioral therapies to
populations that are in need is just one aspect of a comprehensive
solution we must continue to take to solve this Nation's drug problem.
Because addiction is such a complex and pervasive health issue, we must
include in our overall strategies a comprehensive public health
approach, one that includes extensive education and prevention efforts,
adequate treatment and aftercare services, and research. Twenty-five
years of research has provided us with effective prevention and
treatment strategies that can be used to combat heroin addiction, as
well as other drug problems. Research has shown that these strategies
are effective in reducing not only drug use but also in reducing the
spread of infectious diseases such as HIV/AIDS, hepatitis, and in
decreasing criminal behavior.
Thank you once again for the opportunity to testify at this
hearing. I will be happy to answer any questions you may have.
[GRAPHIC] [TIFF OMITTED] T1969.001
[GRAPHIC] [TIFF OMITTED] T1969.002
Senator Biden. Dr. O'Brien, would you, before you begin
your testimony, tell the panel a little bit about your
operation up there. I was incredibly impressed, if you would be
willing to speak just a moment about what you are doing.
STATEMENT OF CHARLES O'BRIEN, M.D., PH.D.
Dr. O'Brien. Thank you, Senator Biden and Senator Specter.
I appreciate the opportunity to be able to tell you about our
program because we actually began at the Philadelphia VA
Medical Center in 1971, during the height of the Vietnam War.
Actually, I was still in my Navy uniform when I went around the
country visiting treatment programs to try to find out what was
known then about addiction treatment, and then we started our
program as a research program and we have done basic research
on all of the major drugs of abuse, including heroin, cocaine,
amphetamines, alcohol, nicotine, marijuana, and the
hallucinogens.
We now treat about 10,000 veterans a year, different
veterans in the Philadelphia area, including linkages with the
Wilmington VA Medical Center, and we also treat nonveterans
through our University of Pennsylvania Clinic, and all of this
is with the idea toward building better treatments. So we come
up with ideas, we test them in controlled trials, and those
things that work, then we write about them and try to get other
people to use them. Now with the clinical trials network that
Dr. Leshner just talked about, we will be testing these new
treatments in more and more programs throughout the Delaware
Valley.
Senator Biden. I was incredibly impressed when you took me
through. I advised, you probably had it done, but the press who
has an interest in whether or not there is any real serious
work going on in terms of treatment in the region, I do not
know what your policy is, and I may be inviting chaos for you,
but I really would invite you to take a look at this program at
the Veterans Hospital up there and the nonveteran portion at
the University of Pennsylvania. It is really impressive, truly
impressive, I think. Anyway, thanks for coming down and I look
forward to hearing your testimony.
Dr. O'Brien. Thank you for the nice words. I will try to be
brief, because, as I mentioned, our work includes all of the
drugs of abuse, and in order to put it in its proper
perspective, I have to emphasize that the legal drugs, namely
nicotine and alcohol, actually produce more problems, more
deaths, and more addiction among our young people and older
people than the illegal drugs. I could tell you a lot about
cocaine, but there is some good news, as you implied in your
opening statement, because cocaine problems have improved a
great deal. But let me focus on heroin.
There is good news to report about the availability of new
and effective treatments for heroin addiction, but there is
also much grim news to report. Philadelphia, and presumably the
surrounding areas in Delaware, has the sad distinction of
having the most potent heroin in the country, according to DEA
figures over the past several years, and I think that Mr.
Nelson will show you some slides that support what I am telling
you.
When we founded our program in 1971, and continuing until
the 1990's, the average purity of a bag of heroin was around
four percent, and actually, we have research on testing for
physical dependence. Some of the bags were zero, they were cut
so much. But 4 percent was the average. Lately, it has
increased to as much, as you said, as much as 85 to 90 percent,
with most bags falling in the 70 percent range. In other parts
of the East, the figures are only slightly lower. Thus, heroin
per milligram is cheaper than ever in modern history. This
increased purity is reflected in overdoses and in high levels
of physical dependence in patients presenting for treatment.
Moreover, we are seeing increasing numbers of young people
starting on heroin that is snorted or smoked, as Dr. Leshner
said. It is so potent that they are able to get effects by
smoking it or placing it in their noses rather than being
obliged to inject it. This is exactly what I found in my work
as a U.S. Navy physician during the Vietnam War. Our current
heroin purity and use patterns are similar to the tragic
situation in Vietnam.
More middle class and suburban youths are being introduced
to heroin. We have been studying the Philadelphia needle
exchange program, which, incidentally, has shown efficacy in
reducing the spread of infection, and we were shocked to find
on the first day of our study a group of students from our own
university who came to get needles for their heroin injections.
These were outstanding students who were hooked on heroin.
In spite of this increased severity and spread of heroin
addiction, we have long waiting lists for methadone treatment
and some politicians calling for reduced methadone treatment.
Fortunately, we have a very effective spokesperson in General
Barry McCaffrey, who has eloquently made the case for more
methadone availability. He has also spearheaded the drive for
making buprenorphine and other effective medication available
with fewer restrictions than are now imposed on methadone.
The current situation is ironic. We have more effective
treatments than ever before. In the area of medications, thanks
to NIDA-supported research and introduced by this committee, as
Senator Biden indicated, we have methadone, LAMM,
buprenorphine, buprenorphine naloxone in combination, and
naltrexone, including a long-acting depot preparation now in
clinical trials. In other words----
Senator Biden. Explain what that means, because that is
fascinating.
Dr. O'Brien. Naltrexone is a nonaddicting medication that
sits on opiate receptors and blocks them. So a person who has
been detoxified from heroin can be given this medication and
they cannot get readdicted. They are absolutely blocked. It
works great for motivated people. I have had some physicians
who were using opiates illegally and I treated them and I put
them on naltrexone and they have taken it for as long as 15 or
20 years on a daily basis, feeling normally, but they cannot
relapse, even though they have to work with opiates every day
in the hospital. It would be great for heroin addicts, but they
tend not to take it regularly, because you have to take it
every day or two.
With this new preparation, you give an injection with a
needle and it lasts for 30 to 60 days. We now have, and this is
perhaps news to you, Senator, we have three pharmaceutical
companies who are competing with one another to develop this
depot naltrexone, and we have all three preparations in various
stages of production right now. I am sure that one of them is
going to win, and that will be terrific for us. That means that
people who are motivated after they are detoxified, we give
them this injection, and then they cannot change their mind, at
least for a month or two, and during that month or two, we can
work with them. So this will be a big event.
Senator Biden. In this report back in 1989, I suggested
that maybe a way to deal with people on probation, a condition
of probation is to return once a month and have this depot. The
DuPont Company was developing at that time kind of like a tiny
little time capsule, as they talk about on the TV. At any rate,
it has phenomenal potential.
Dr. O'Brien. We actually did a study in probationers in
Philadelphia, in the Philadelphia Federal Probation Office,
randomly assigning them, one group to naltrexone orally,
another group to treatment as usual. We had twice the
reincarceration rate in the control group as in the group
getting naltrexone. In other words, we more than cut it in
half, going back into prison, because these were people who
have heroin-related crimes before.
Let me just conclude. I know you are short on time. So we
have strong evidence, also, for the efficacy of counseling and
psychotherapy in combination with medications that can produce
impressive rehabilitation of heroin users. But in the treatment
area, we have an inadequate number of slots and an inadequate
funding of the slots that do exist. Methadone has only minimal
benefits, compared to the much greater effects of counseling
and psychotherapy when given with methadone or other medical
treatment.
So, in other words, we cannot get away cheaply by just
giving the drug. These people have a lot of problems besides
the medical ones, and so they need the counseling, as well.
Unfortunately, despite the rhetoric, we really do not have
enough funding for treatment.
I would like to thank you very much for giving me this
opportunity to speak on these things and I would be delighted
to respond to your questions.
Senator Biden. Thank you.
[The prepared statement of Dr. O'Brien follows:]
Prepared Statement of Charles O'Brien, MD, PhD
1. orientation
Our clinical program treats about 10,000 veterans each year with
mental disorders, about a fourth have primary substance use disorders,
and another third have combined substance abuse with other mental
disorders. The treatment program, one of the largest and oldest in the
VA has received the Award of Excellence from VA Headquarters and is a
National Center of Excellence for Substance Abuse Training. We were
also recently awarded a Mental Illness Research, Education and Clinical
Center (MIRECC) with a substance abuse theme. We teach medical
students, residents and fellows and we host a national training program
for minority medical students in treatment of substance use disorders.
2. research
Our research program is funded by National Institute on Drug Abuse
(NIDA), Dept. Veterans Affairs(DVA) and National Institute on Alcohol
Abuse and Alcoholism (NIAAA). In studies dating back to the early
1970s, our group has been credited with the development of several new
treatments for addiction, new understanding of the brain mechanisms
underlying addiction and for inventing the standard measuring
instrument for measuring the severity of addiction used throughout the
world. Our research deals with the four main addicting drugs: nicotine,
alcohol, heroin and cocaine. While addiction to the two legal drugs,
nicotine and alcohol, is responsible for many more deaths and economic
loss than heroin and cocaine, my remarks will emphasize the current
facts concerning the two illicit drugs, cocaine and heroin.
3. cocaine
There is good news to report. New cases of cocaine abuse and
dependence have fallen off dramatically. Crack cocaine dealers have
been quoted as saying that they can no longer make a living selling
this drug. Cocaine in both crack and powdered forms is still widely
available and cheap in our area, but fewer people are buying it. This
development is not surprising since previous stimulant epidemics have
been self-terminated in the past, both in this country and abroad. We
would like to give credit to drug prevention programs, but there are
important other factors. We believe that decline of new users is
related to the fact that cocaine produces destruction of lives fairly
quickly and thus prospective new users can see the deterioration in
their older friends and relatives and decide not to take up the drug
themselves. Heroin, in contrast, is less toxic. It simply mimics the
effects of normal hormones that all of us have and produces social
destruction more gradually. The medical consequences of heroin use are
mainly indirect based on infections such as AIDS and hepatitis.
Unfortunately, those already dependent on cocaine have generally
not been able to stop permanently. Thus we see many chronic cocaine
users who continue to relapse after treatment is stopped. They also
have developed chronic psychiatric and medical disorders such as heart
disease. We are heavily engaged in NIDA supported research to develop
new medications and behavioral treatments for cocaine addiction.
Currently we are testing several promising new medications including a
cocaine vaccine and we have already published studies of effective
psychotherapy for cocaine dependent people. Our research group has
recently been awarded a special center grant for conducting clinical
trials in community treatment programs. Our network involves ten
treatment programs in the Delaware Valley including the Northeast
Treatment Center which has clinics in the Wilmington area.
I would also like to point out that the legislation for the NIDA
medications development program was introduced by Senator Biden and it
resulted in funding for one of the most successful drug research
programs in our history. The report on development of medications for
addictive disorders by the Institute of Medicine of the National
Academy of Sciences cited the remarkable benefits of this legislation.
4. heroin
While there is good news to report about the availability of new
and effective treatments for heroin addiction, there is also much grim
news to report. Philadelphia and presumably the surrounding areas in
Delaware has the sad distinction of having the most potent heroin in
the country according to DEA figures over the past two years. When we
founded our treatment program in 1971 and continuing until the 1990s,
the average purity of a bag of heroin was 4 percent. Lately it has
increased to as much as 85 percent with most bags tested falling into
the 70 percent range. In other parts of the East, the figures are only
slightly lower. Thus heroin per mg. is cheaper than ever in modern
history. This increased purity is reflected in overdoses and in high
levels of physical dependence in patients presenting for treatment.
Moreover, we are seeing increasing numbers of young people starting on
heroin as smokers or snorters. It is so potent that they are able to
get effects by smoking it or placing it in their noses rather than
being obliged to inject it. This is exactly what I found in my work as
a navy physician during the Vietnam war. Our current heroin purity and
use patterns are similar to the tragic situation in Vietnam.
More middle class and suburban youths are being introduced to
heroin. We have been studying the Philadelphia needle exchange program,
which incidentally has shown efficacy in reducing the spread of
infections, we were shocked to find on the first day a group of
students from our own university who were coming to get needles for
their heroin injections.
In spite of this increased severity and spread of heroin addiction,
we have long waiting lists for methadone treatment and some politicians
calling for reduced methadone treatment. Fortunately, we have a very
effective spokesperson in General Barry McCaffery who has eloquently
made the case for more methadone availability. He has also spearheaded
the drive for making buprenorphine, another effective medication,
available with fewer restrictions than are now imposed on methadone.
The current situation is ironic. We have more effective treatments
than ever before. In the area of medications, thanks to NIDA-supported
research, we have methadone, LAAM, buprenorphine, buprenorphine/
naloxone combination and naltrexone including a long acting depot
preparation now in clinical trials. We have strong evidence for the
efficacy of counseling and psychotherapy in combination with
medications that can produce impressive rehabilitation of heroin users.
But in the treatment area, we have inadequate number of slots and
inadequate funding of the slots that do exist. Methadone alone has only
minimal benefits compared to the much greater effects of counseling and
psychotherapy for patients in methadone or other medical treatment.
5. other drugs
There are, of course, other drug problems that I don't have time to
discuss. Marijuana is a problem for some young people although research
shows that compared to the drugs cited earlier, the rate of dependence
is low. Ecstasy or MDMA is a problem, less so in this country than in
Europe, but still worthy of attention. Solvent abuse receives little
publicity in this part of the country, but those of us in the Delaware
Valley were saddened last spring to read of five young girls from the
same high school killed in an auto accident attributed to solvent use.
Benzodiazepines, sleeping pills and other prescription drugs can be
associated with abuse and we also have some patients with such
problems. In terms of national policy, however, it would appear that
our prevention and treatment efforts should be directed to the four
major drugs that I cited earlier: nicotine, alcohol, cocaine and
heroin. Among high school and college students, I must remind you one
more time, that the overall negative impact of nicotine and alcohol
from binge drinking far outweighs the impacts of the illegal drugs.
Senator Biden. Mr. Nelson, welcome.
STATEMENT OF WILLIAM R. NELSON
Mr. Nelson. Thank you, sir. Good morning. Good morning,
Senator Specter. Thank you for the opportunity to participate
in this important hearing and to speak to you today about the
heroin situation in Pennsylvania and Delaware and particularly
DEA's efforts to combat the influx of heroin in this area.
DEA's Philadelphia Field Division is responsible for
enforcing the Federal laws in the States of Pennsylvania and
Delaware. DEA staffs seven offices in Pennsylvania and
Delaware, with more than 250 special agents, task force
officers, intelligence analysts, and support personnel. This
morning, we would like to outline production trends and the
international trafficking routes of heroin to the United States
and specifically to this region; and to also discuss the
national, local, and regional trends in the heroin situation in
terms of heroin trafficking, availability, use of heroin,
prices and purities of heroin that have been observed to this
date; also to describe DEA's current efforts to combat heroin
traffic and abuse in this region, which are often conducted in
cooperation with Federal, State, and local law enforcement
agencies.
The supply of heroin to the United States originates from
four distinct production areas around the world. The United
States may be the only country in the world that is supplied by
each of these four source areas, Southeast and Southwest Asia,
Mexico, and most importantly in this region, South America, and
in particular, Colombia.
Most, if not all, of the heroin seized in Pennsylvania and
Delaware originates in South America. I have a chart that will
display the highlights of the typical routes used to transport
heroin from Colombia to the Caribbean and Mexico to the East
Coast of the United States. The next figure highlights the
regional trafficking routes from what we believe to be a source
city for Delaware, which would be Philadelphia.
Colombian heroin is typically transported to the United
States via couriers who smuggle one or two kilograms at a time
aboard commercial aircraft flights directly to cities such as
Miami and New York. Couriers employ a variety of means to
smuggle heroin into the United States, which include the use of
false-sided suitcases, body packs, and internal body carries.
Due to the increased law enforcement efforts at Eastern
ports of entry, South American heroin traffickers are smuggling
heroin across the U.S. Southwest border into Texas. New York,
Miami, New Jersey, and Puerto Rico have been identified as
primary source areas for the South American heroin found in the
Pennsylvania-Delaware region.
New York-based Colombian groups are primarily responsible
for wholesale distribution of heroin to the Philadelphia and
Delaware area. The Colombians saturated the market with high-
purity heroin, using strategic marketing techniques such as
providing free samples of heroin with shipments of cocaine,
allowing customers to take heroin on consignment, and lowering
prices. Regional investigations have shown that distributors
purchase retail quantities of heroin in Philadelphia and then
sell them on the streets of smaller cities and towns throughout
Pennsylvania and Delaware. Philadelphia-based Hispanic,
primarily Dominican, led organizations are active in this
particular type of distribution.
There are two distinct heroin markets in the United States,
one on the Eastern side of the Mississippi. In the East, high-
purity white heroin from South America is predominately
available, while in the West, lower-purity Mexican black tar
and brown heroin are predominately available.
Heroin users, both in this region and throughout the
Northeastern United States generally represent all socio-
economic classes and age groups. The combination of heroin's
readily available low prices and high purity has made it
attractive to many new, nontraditional users. For example, many
young middle-class users are now able to snort and smoke heroin
because of the high purity instead of injecting it. Many of
these users are lulled into a false sense of security,
believing that because they inhale heroin, they are less likely
to become addicted.
According to the DAWN information, the annual number of
heroin-related emergency room visits was slightly over 10,000
in 1978, as we see on the chart. In 1990, the number of heroin-
related emergency room visits was roughly in the 33,000 range.
By 1997, that number had more than doubled, to approximately
70,000.
Nationally, the number of heroin-related emergency room
visits by young people aged 12 to 17 increased significantly
since 1989. As we see in this particular chart, it is up
significantly from 1989 to 1997 with the age group of 12- to
17-year-olds.
During 1998, the price of heroin emanating from South
America ranged from $50,000 to $200,000 per kilogram. In this
region, gram quantities of high purity South American heroin
sells for up to $100 in Philadelphia and between $100 and $300
in Delaware and other regions of Pennsylvania.
Studies indicate that heroin purity has increased tenfold
since 1979. In the 1980's, heroin purity levels averaged
between 1 and 10 percent. Today, in some cities, average purity
levels exceed 70 percent. This significant rise in purity
corresponds to the increased availability of higher-purity
South American heroin, especially in the Northeastern part of
the United States.
In this particular figure, Figure 5 on the easel shows a
20-year trend to where heroin prices have decreased while
purities have increased. Inexpensive and highly pure South
American heroin has flooded the Pennsylvania and Delaware
market. In 1999, retail heroin purities ranged from 54 percent
in Boston to 60 percent in Newark and 63 percent in New York
City. Yet, in Philadelphia, the average retail heroin purity
was 71.7 percent. The chart on the easel will reflect the
national average compared to the Philadelphia-Delaware area. In
fact, Philadelphia has reported higher heroin purities than
anywhere else in the nation in 4 of the last 5 years.
Heroin brand names are used by dealers as a marketing tool
to increase their share of the market. Brand names change
frequently, and the popular ones are sometimes imitated by
competing trafficking organizations. Brand names help identify
the product of a particular organization and are sought after
by users to ensure they are buying high purity, high quality
heroin.
Senator Biden. Mr. Nelson.
Mr. Nelson. Yes, sir.
Senator Biden. Is the heroin I have on this table here,
``Bad Boy,'' ``Boss,'' ``Pac Man,'' ``White Bear''----
Mr. Nelson. ``Turbo Dead Com''?
Senator Biden. ``Murder One,'' yes.
Mr. Nelson. They are brand names.
Senator Biden. And they are brand named particularly to
target to teenagers and younger people, is that the reason?
Mr. Nelson. In my opinion, yes, sir. The brand name is a
trademark, as I stated, and that is a typical example of a
trademark. I cannot see it from here, but----
Senator Biden. Let me pick one up and read. ``Land Rover.''
Mr. Nelson. Yes.
Senator Biden. Now, this is actually heroin?
Mr. Nelson. I would suspect it is, sir. I think one of the
officers had it there.
Senator Biden. What would the consumption of what is in
this bag, what would the consumption of this amount of heroin
do in terms of giving a person the affected high that they
want, or however you characterize it?
Mr. Nelson. The injection method, with that particular
brand name, if it is the high-purity heroin we have in
Philadelphia, the injection method is the fastest, intravenous
method. If it is snorted, the effects take 15 to 20 minutes and
will last for 4 to 5 hours.
Senator Biden. Four to five hours?
Mr. Nelson. Yes.
Senator Biden. Thank you. And how much did this cost?
Mr. Nelson. Ten dollars. As I was saying, typically, stamp
bags of user amounts of heroin sell from between $10 and $20.
DEA Philadelphia intelligence and the Philadelphia Police
Department maintain databases containing thousands of brand
names, such as ``Turbo,'' ``Dead Com,'' ``Ready to Die,'' and
``One Half Dead.''
It is not just adults who are selling heroin. In August of
1999, a Delaware newspaper reported that a 14-year-old young
man from Wilmington was arrested after he was found with 35
packets of heroin.
Senator Biden. By packets, you mean something this size?
Mr. Nelson. Yes, sir, individual packets, and, of course,
the larger amounts are bundles or bindles.
Over the last decade, DEA has arrested numerous heroin
distributors and immobilized scores of large trafficking
organizations. In fiscal year 1998, the last full year in which
statistics are available, DEA arrested 32 percent more
individuals nationwide in heroin investigations than in 1995.
To address the threat posed by Colombian and Dominican
trafficking groups, the DEA and the Philadelphia Field Division
has focused its resources against the communication networks of
the Colombian sell managers. Simultaneously, DEA has targeted
surrogate groups from the Dominican Republic and Puerto Rico
who comprise the ever-growing conglomerate of distribution
networks in our area. Hopefully, these areas will help us with
an increased ability to build prosecutable cases against the
leadership of the Colombian and Dominican syndicates.
A cornerstone of DEA's mission has been working closely
with other Federal, State, and local enforcement agencies. We
believe it is a win-win situation to pool our resources,
expertise, and intelligence to attack a common enemy. We
benefit from local investigators' knowledge of the methods of
known drug dealers within their communities.
One way DEA and other law enforcement agencies work
together is through our DEA State and local task force program.
Another way in which DEA assists State and local enforcement is
through its newly formed mobile enforcement teams. DEA field
divisions deploy mobile enforcement teams at the request of
local enforcement officials who are confronting serious drug-
related crime and violence in their areas. Since the program's
inception within our division in 1995, we have worked with the
cities of Wilmington, DE, as well as in Philadelphia as part of
Operating Sunrise, Reading, Allentown, Clairton, Easton,
Norriston, and Bristol, PA. Our MET Program has posted
impressive results both in terms of drug seizures and the
arrests of violent drug traffickers.
DEA Philadelphia has recently placed more emphasis and
attention to heroin cases and trafficking organizations and has
recently formed an enforcement group specifically designed and
dedicated to investigate drug trafficking organizations whose
members are of Caribbean nationals. As a result, there has been
more than a four-fold increase in arrests in heroin cases since
1994 through 1999. We have also removed more heroin for that
fiscal year period of 1994 through 1999, and the number of new
heroin investigations has also increased almost 300 percent.
One recent investigation stands as a prime example of DEA's
emphasis on heroin trafficking organizations. On November 3,
1999, a Federal grand jury in the Eastern District of
Pennsylvania returned a 61-count indictment charging 29
individuals with participating in a heroin, cocaine, and crack
cocaine distribution organization.
This indictment and the recent arrest of several of the
indicted individuals were results of more than a 2-year-long
investigation into the Darien Street organization, as it is
known in the parlance in Philadelphia, that organization, which
allegedly used an entire Philadelphia city block to conduct
illicit operations for more than 15 years. This organization
operated around the clock, selling multikilogram quantities of
heroin, cocaine, and crack cocaine on a weekly basis,
generating over that particularly period of time more than $20
million in proceeds. The street on which this organization
operated was also within 1,000 feet of a Philadelphia middle
school.
DEA stresses the need for all segments of the community,
law enforcement, schools, government, churches, the media,
business, and industry, to work together in mounting a well-
orchestrated response to local drug-related issues. The
Philadelphia Field Division has a very active demand reduction
program, reaching out to schools, civic groups, and community
coalitions in cities and towns throughout our area of
responsibility.
Senator Biden. Mr. Nelson.
Mr. Nelson. Yes, sir.
Senator Biden. I want to hear everything you have to say.
Senator Specter is going to have to leave to go to Washington
shortly because his appropriations bill is part of this final
negotiation which we are going to figure out by Wednesday,
hopefully, and I want to give him a chance to ask questions
first. So if you could summarize the remainder of your
statement, then I will pick up on, when he leaves, on some of
the detail of it, if I may.
Mr. Nelson. I think we could conclude. Thank you.
Senator Biden. Thank you.
[The prepared statement of Mr. Nelson follows:]
Prepared Statement of William R. Nelson
Senators Biden and Specter: I thank you for the opportunity to
participate in this important hearing and speak to you today about the
heroin situation in Pennsylvania and Delaware and DEA's efforts to
combat the influx of heroin to this area. I am accompanied today by
Resident Agent-in-Charge Paul Maloney of our Wilmington office.
DEA's Philadelphia Field Division is responsible for enforcing the
federal narcotics laws in the states of Pennsylvania and Delaware. In
Delaware, we have offices in Wilmington and Dover, while in
Pennsylvania, the cities of Philadelphia, Harrisburg, Pittsburgh,
Allentown, and Scranton house DEA offices. DEA staffs these offices
with more than 100 special agents and another hundred support
personnel. Additionally, we have 69 Task Force Officers working in
various cooperative enforcement efforts and a number of contracted
personnel assisting with computer support and administrative functions.
Besides using our own resources, I believe that it is vital to
DEA's mission to work in concert with other federal, state and local
law enforcement agencies. I will describe our cooperative efforts in
greater detail when I outline our response to the growing heroin
threat.
This morning I would like to:
Outline production trends and the international trafficking
routes of heroin to the United States and, specifically, to
this region,
Discuss the national and local (or regional) heroin
situations in terms of heroin trafficking, availability and
abuse of heroin, and prices and purities of heroin observed to
date, and
Describe current DEA efforts to combat heroin trafficking
and abuse in this region, which are often conducted in
cooperation with other federal, state, and local law
enforcement agencies.
trafficking trends
The supply of heroin to the United States originates from four
distinct production areas around the world. The United States may be
the only country in the world that is supplied by each of these four
source areas: Southeast Asia (principally Burma), South America
(Colombia), Mexico, and Southwest Asia-Middle East (Afghanistan,
Turkey, Pakistan, and Lebanon).
Most, if not all, of the heroin seized in Pennsylvania and Delaware
originated in South America. Figure one (1) highlights typical routes
used to transport heroin from Colombia, through the Caribbean and
Mexico, to the East Coast of the United States. Figure two (2)
highlights regional trafficking routes.
The most common method of transporting Colombian heroine to the
United States is via couriers, who typically carry one to two kilograms
aboard commercial air flights directly to cities such as Miami and New
York. Couriers employ a variety of means to smuggle heroin into the
U.S., which include the use of false-sided suitcases, body packs, and
internal body carriers. However, increased law enforcement efforts at
eastern ports-of-entry forced South American heroin traffickers to find
alternative routes. Recent investigations have shown that Colombian and
other Latin American couriers are smuggling heroin across the US
southwest border into Texas.
DEA uses what is known as the Heroin Signature Program to combine
scientific, chemical profiting of heroin samples with investigative
data and intelligence to determine what amounts of heroin are entering
the U.S. from what source areas. In the early 1990s, the Heroin
Signature Program reported that Southeast Asian heroin dominated the
national heroin market. Since 1993, South American heroin has been
increasingly reported, to the point where, in 1998, 65 percent of the
heroin seized nationally originated in South America.
Cheaper, higher purity, South American heroin is mainly available
in the east. It is for this reason that the DEA Philadelphia Field
Division consistently reports the availability of inexpensive, high-
purity heroin.
New York and Miami, along with New Jersey and Puerto Rico, have
been identified as primary source areas for the South American heroin
found in the Pennsylvania/Delaware region. New York-based Colombian
groups are primarily responsible for wholesale distribution of heroin
to the Philadelphia area.
Colombians saturate the market with new, high-purity heroin. using
strategic marketing techniques. For example, to increase their market
share, Colombians allowed heroin customers to take whole quantities on
consignment and also forced cocaine wholesale customers to accept
quantities of heroin along with their shipments as a condition of doing
business. Also, they build clientele by dropping the price so low, that
the heroin can be purchased for less.
Regional investigations have shown that distributors purchase
retail quantities of heroin in Philadelphia and then sell it in on the
streets of smaller cities and towns throughout Pennsylvania and
Delaware. Philadelphia-based Hispanic, primarily Dominican-led,
organizations are active in this type of distribution activity. In
fact, the Philadelphia Field Division recently created a dedicated
enforcement group to address the trafficking activities of these
organizations.
The high availability of heroin in Philadelphia allow traffickers
to supply users in the urban areas of Harrisburg, Lancaster, Lebanon,
and York, as well as the Scranton/Wilkes Barre metropolitan region.
Northern Delaware, including the cities of Wilmington and Newark, is
the primary region of heroin abuse and distribution in Delaware.
availability/abuse
There are two distinct heroin markets in the U.S., demarcated along
the Mississippi River. In the east, high-purity white powdered heroin
from South America is predominantly available, while in the west, lower
purity Mexican ``black tar'' and brown heroin are predominantly
available.\1\
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\1\ Source: National Narcotics Intelligence Consumers Committee.
The NNICC Report 1997 page 63.
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As previously mentioned, national trends indicate that smaller
urban and rural areas are no longer isolated from the heroin problem.
These areas are supplied by traffickers who travel to larger
metropolitan areas to purchase retail quantities of heroin for street
sales.
Pennsylvania and Delaware are not exempt from this trend. Heroin
has been and remains readily available in metropolitan, suburban, and
rural areas of Pennsylvania and Delaware. Local distributors from
northern Delaware, and the Pittsburgh, Harrisburg, Allentown, and
Scranton areas of Pennsylvania purchase heroin in Philadelphia and
transport it back to their own areas to be sold on the street.
Heroin users, both in this region and throughout the northeastern
U.S., generally represent all socioeconomic classes and age groups. The
combination of heroin's ready availability, low prices and high purity
has made it attractive to many new non-traditional users. For example,
many young middle-class users are now able to snort and smoke heroin
because of the high purity instead of injecting it, which is the
traditional, yet higher-risk method of administration. Reports indicate
that 50 percent of users inject, while the other 50 percent snort
heroin.
According to the Drug Abuse Warning Network (DAWN) and as shown on
figure three (3), the annual number of heroin-related emergency room
visits was slightly over 10,000 in 1978. In 1990, the number of heroin-
related emergency room visits was roughly 33,000. By 1997, that number
had more than doubled, to about 70,000. Nationally, the number of
heroin-related emergency room visits by young people (age 12 to 17)
also increased significantly since 1989. Figure four (4) shows this
dramatic increase.
The ability to snort or smoke, rather than inject, undoubtedly
played a role in the increase of heroin abuse by teenagers. Many of
these users are lulled into a false sense of security believing that
because they inhale heroin, they are less likely to become addicted to
it. The teenagers also believe that they are safe from, acquiring
diseases, such as AIDS or hepatitis, which are associated with the use
of needles. As a result we are seeing a rise in first-time heroin
users.
prices and purities
During 1998, the price for a kilogram of South American heroin
ranged from $50,000 to $200,000 nationally. In this region, gram
quantities of high-purity, South American heroin sold for a price up to
$100 in Philadelphia and between $100 and $300 in Delaware and other
regions in Pennsylvania. This pricing reflects the trend where retail
quantities of heroin are purchased in Philadelphia for sale in smaller
urban and rural areas throughout Delaware and Pennsylvania.
The DEA's Domestic Monitor Program (DMP), a program where retail
quantities of heroin are regularly purchased in major U.S. cities to
collect data on the price, purity, and origin of the heroin, indicated
that heroin purity has increased tenfold since the program was
initiated in New York City in 1979. In the 1980s, heroin purity levels
averaged between one and ten percent; today, in some cities, average
purity levels exceed 70 percent. This significant rise in purity
corresponds to the increased availability of higher-purity South
American heroin, especially in the northeastern United States.
Figure five (5) shows a 20-year trend where heroin prices have
decreased while purities have increased.
Inexpensive and highly pure South American heroin has flooded the
Pennsylvania/Delaware market. In 1999, the DMP found that retail heroin
purities ranged from 58.4 in Boston to 60.6 percent in Newark and 63.1
percent in New York City. Yet, in Philadelphia, the average retail
heroin purity was 71.7 percent, the highest of all DMP markets.
Philadelphia has reported higher heroin purities than anywhere else in
the nation in four of the last five years (see figure six). Again, the
trends indicate that the high-purity heroin used in Delaware and
Pennsylvania comes from Philadelphia.
Heroin brand names are used by dealers as a marketing tool to
increase their share of the market. Brand names change frequently and
the popular ones are sometimes imitated by competing trafficking
organizations. Brand names help identify the product of a particular
organization and are sought after by users to ensure they are buying
high purity, high quality heroin. Typically, stamped bags of user
amounts of heroin sell for between $10 and $20. DEA Philadelphia
intelligence and the Philadelphia Police Department maintain databases
containing thousands of heroin brand names, such as ``TURBO'', ``DEAD
CALM'', ``READY TO DIE'', and ``\1/2\ DEAD.''
It is not just hardened criminals who are selling heroin with brand
names. In August 1999, a Delaware newspaper reported that a 14-year old
young man from Wilmington was arrested after he was found with 35
packets of heroin, marked with the brand name ``LANDROVER.'' The young
man was charged with distribution, among other charges.
enforcement/impact
Over the last decade, DEA has arrested numerous heroin distributors
and immobilized scores of large trafficking organizations. In fiscal
year 1998, the last full year in which statistics are available, DEA
arrested 32 percent more individuals nationwide in heroin cases than
fiscal year 1995.
To address the threat posed by Colombian and Dominican trafficker
groups, the DEA and the Philadelphia Field Division has focused its
resources against the communications network of the Colombian cell
managers. Simultaneously, DEA has targeted Surrogate groups from the
Dominican Republic and Puerto Rico who comprise the ever-growing
labyrinth of distribution network in our area. Hopefully, these efforts
will provide us with an increased ability to build prosecutable cases
against the leadership of the Colombian and Dominican, syndicates.
A cornerstone of DEA's mission has been to work closely with other
federal, state and local enforcement agencies. We believe it is a win-
win situation to pool our resources expertise, and intelligence to
attack a common enemy. We benefit from local investigators' knowledge
of the methods of known drug dealers within their communities.
One way DEA and other law enforcement agencies work together is
through state and local task forces. Within our division we have
formalized joint task forces in Philadelphia and Pittsburgh. Also, a
provisional task force operates both in Wilmington and Dover, Delaware.
Another way in which DEA assists state and local law enforcement is
through its Mobile Enforcement Team (MET) program. DEA field divisions
deploy Mobile Enforcement Teams at the request of local law enforcement
officials who are confronting serious drug-related crime and violence
in their areas. Since the program's inception within our division in
1995, we have worked with the cities of Wilmington, Delaware as well as
Philadelphia (as part of Operation Sunrise), Reading, Allentown,
Clairton, Easton, Norristown, and Bristol, Pennsylvania. Our MET
program has posted impressive results, both in terms of drug seizures
and in arrests of violent drug criminals.
DEA Philadelphia has recently placed more emphasis on and attention
to heroin cases and trafficking organizations. As a result, there has
been more than a four-fold increase in arrests in heroin cases between
fiscal year-1994 and fiscal year-1999. We also have removed nearly
double the amount of heroin from the street in fiscal year-1999 than in
fiscal year-1994. The emphasis on heroin investigations is also shown
in the number of heroin cases opened. The number of new heroin
investigations has increased more than 300 percent from 1995-1999.
One recent investigation stands as a prime example of DEA
Philadelphia's emphasis on heroin trafficking organizations. On
November 3, 1999, a federal grand jury returned a sixty-one count
indictment, charging twenty-nine individuals with participating in a
heroin, cocaine, and crack cocaine distribution organization. This
indictment and the recent arrest of several of the indicted individuals
were the result of a more than two-year long investigation into the
Darien Street Drug Organization, which allegedly used an entire
Philadelphia city block to conduct illicit operations for more than
fifteen years. This organization operated around the clock, selling
multi-kilogram quantities of heroin, cocaine, and crack cocaine on a
weekly basis, generating more than twenty million dollars in proceeds.
The street on which this organization operated was also within 1000
feet of a Philadelphia middle school.
DEA stresses the need for all segments of the community--law
enforcement, schools, government, churches, the media, business, and
industry--to work together in mounting a well-orchestrated response to
local drug-related issues. The Philadelphia Field Division has a very
active demand reduction program, reaching out to schools, civic groups,
and community coalitions in cities and towns throughout the region.
It should be noted that other local agencies have taken proactive
steps to counter the growing heroin abuse problems in their areas. The
``Heroin Alert Program,'' sponsored by the New Castle County Community
Services Unit is regionally, if not already nationally, recognized for
its effective program to educate teenagers and the community at large.
closing
In conclusion, heroin dependence is a chronic, relapsing disorder
that exacts an enormous cost on individuals, families, businesses,
communities, and nations. Along with prevention, education, and
treatment, law enforcement is essential to reducing drug use in the
United States.
Law enforcement is our first line of defense. I believe that law
enforcement efforts alone are not the only answers to the heroin
problem. There is no magic formula for success and the problem will not
disappear overnight. However, DEA, with our other federal, state and
local partners, are prepared to fight this problem aggressively. With
the concerted, cooperative efforts of the law enforcement community
working together with our prevention, education and treatment
professionals, we can take tremendous strides toward limiting the
destructive effects of this scourge.
I thank you again for the opportunity to speak to you today and
have prepared copies of my prepared statement for you and for the
record. I will be happy to answer any questions you may have.
______
Biography of William R. Nelson Acting Special Agent-in-Charge
Philadelphia Field Division Drug Enforcement Administration
William R. Nelson began his career in 1968 as a criminal
investigator with the Drug Enforcement Administration's (DEA)
predecessor agency, the Bureau of Narcotics and Dangerous Drugs (BNDD),
in Baltimore, Maryland. Special Agent Nelson participated in the first
federal drug telephone wiretap investigation in the country in 1968,
authorized under the 1968 Omnibus Crime Bill. Special Agent Nelson was
then assigned as the Regional Training Officer responsible for the
training of over three thousand state and local police officers.
In 1972, Special Agent Nelson was assigned to the Dallas Office of
Internal Security, conducting internal security investigations in the
southwest and south central regions of the US.
In 1977, Special Agent Nelson was assigned to DEA Headquarters in
Washington, DC where he coordinated all internal security
investigations and office inspections.
In 1979, Special Agent Nelson was appointed as chief of the DEA
Headquarters State and Local Section's Office of Compliance, directing
criminal investigators who investigated the illegal distribution of
legally produced drugs. This program involved the administration of
twenty-six programs in twenty-five states.
From 1981 to 1988, Special Agent Nelson was assigned to the DEA
Baltimore District Office as a supervisory special agent for a number
of different enforcement groups, including state and local task forces.
In 1988, Special Agent Nelson returned to DEA Headquarters as chief
of the Contracting and Transportation Section, managing the procurement
and transportation needs of DEA.
In 1990, Special Agent Nelson was appointed chief of the State and
Local Section at DEA Headquarters, where he supervised the
administration of the DEA Organized Crime Drug Enforcement Task Force
(OCDETF) program, the DEA task force program, the High Intensity Drug
Trafficking Area (HIDTA) program, and the Weed and Seed Task Force
program.
In 1995, Special Agent Nelson was assigned as an assistant special
agent-in-charge of the Philadelphia Field Division, where he supervises
the administration of the division and a number of enforcement group
operations.
Since July 1999, Special Agent Nelson has served as the Acting
Special Agent-in-Charge of the Philadelphia Field Division, pending the
arrival of the newly appointed Special Agent-in-Charge in December
1999.
Special Agent Nelson is a graduate of the University of Baltimore
and holds a Bachelor of Science degree in psychology.
Senator Biden. Mr. Maloney.
STATEMENT OF THOMAS C. MALONEY
Mr. Maloney. Senator Biden and Senator Specter, I am happy
to be here and I am present here before you today representing
SODAT-Delaware, Inc. Incorporated in 1971, SODAT is the oldest
continuously operating outpatient substance abuse treatment
center in the State of Delaware.
During our most recent years of operation, SODAT has
piloted several innovative approaches for working with
substance abuse problems in our State. In anticipation of the
increase in heroin abuse, resulting addictions in our
community, SODAT launched a program in October 1993 that
utilized opiate antagonist medication naltrexone. In fact, the
person who headed that program, Lisa D'Angelo, is here today
and is now working for Doctor O'Brien.
During this program, we had many people attempt to
stabilize in the program, but of the 12 clients that did, they
were placed in an intensive outpatient treatment setting,
monitored in their naltrexone dosage, and remain completely off
all illicit substances, as evidenced by urine screen results
and clinical consultations. Had these continued to use heroin
at an average cost of $1,800 per month for heroin for each
client, these clients would have consumed $21,600 worth of
heroin, or a total of $259,200 in illegal drug purchases for
any 12-month period.
Criminal justice statistics indicate that fencing of stolen
goods yields approximately 10 percent on the dollar. In other
words, these 12 clients would have had to steal or deal over
$2.5 million in property or drugs to support their addiction.
In Delaware, the approximate annual cost for incarceration
of an adult is $25,000. These figures stand in stark contrast
to the $23.20 per diem per client costs for SODAT to operate
the intensive treatment program. The annual per client cost is
$8,468.
Eighty-two percent of these clients completed the program
with no new criminal charges. The program clearly demonstrates
that the combination of intensive substance abuse treatment and
case management services with the use of effective medications
produces good outcomes.
We at SODAT are very hopeful that the depot long-term
naltrexone caplet or caplet implant or injection can be
approved in the near future. This will allow for greater
concentration on direct treatment services. Groups who can
immediately benefit from this innovation include offenders
released from incarceration by significantly reducing the
likelihood of recidivism that results from drug use.
In 1995, SODAT partnered with Delaware's family court under
a grant through the City of Wilmington to implement a diversion
and treatment program for illegal drug offending juveniles with
no or minor prior criminal records. We expanded this program's
geographic reach under a grant from the Department of Justice
and funding from the State of Delaware to become Statewide. I
believe we are the only Statewide juvenile drug program in the
country.
There are currently 188 clients in this program. Each
client is provided with the option of participating in
counseling and case management services or taking his or her
case to trial. If the client succeeds in the program, the
referring charges are dropped and there is no loss of the
privilege to hold a driver's license.
We have studied the participants in this program and their
progress for over 3 years. Our most recent evaluation
demonstrates a 21 percent less likelihood of recidivism among
program graduates as compared to a control group. Those that do
commit new crimes are far less likely to commit serious
misdemeanors and felony offenses to the degree that we see in
the control group.
Program expenses range from $3,600 to $4,800 per year, as
compared to the $70,000 to $77,000 it costs to incarcerate a
juvenile in Delaware for a year. The hallmark is that
prevention and early intervention works and works well.
In conclusion, I cannot emphasize enough the innovation of
directly partnering treatment and case management agencies with
a judge to improve outcomes and reduce recidivism. This concept
of therapeutic jurisprudence is mirrored in Attorney General
Janet Reno's recent call for reentry courts for the recently
released offenders.
Senator Biden. Thank you very much.
One brief introduction before you begin your questioning,
Senator. I want you to know that this audience that is
assembled here are the activists and the leaders in our
community, including some of the mothers.
I looked over here and I showed you a bag that was empty
and I wondered, I said, oh, my Lord, I hope the bag wasn't full
when it was here. My staff pointed out that some of the empty
bags were provided by the mothers in the audience who found
them in such places as washing machines and around the home.
We have the Speaker of the Delaware House, Terry Spence,
here, and I appreciate his presence here.
We have Senator Margaret Rose Henry, one of the leaders in
this community. Stand up, Margaret Rose, so everybody can see
you.
We also have former State Representative Herman Holloway,
who, unlike many when we decide to leave office or we are
defeated, fade away, he did not fade away. He was active in the
community before and since. Herman, stand up and welcome. I
want people to know you are here.
We also have leaders here from the schools who run programs
within the schools, like Mrs. Aiken, who is here and has been
very involved with school counselors across the State and,
actually, from my alma mater.
And we have community leaders in the union movement here,
like the president of the GM local, which is a very large
local, Joe Brennan, who is here, along with others I will
introduce later.
I just want you to know that this is an audience of
concerned and informed people here and I thank you all for
coming.
Senator.
Senator Specter. Thank you very much, Senator Biden. That
is a very impressive group, both on the podium and in the
audience.
Mr. Maloney, beginning with you, the statistics you cite
are very impressive in terms of the costs of incarceration and
the costs of prosecution compared to the costs of
rehabilitation. We have never been able to put together a
really comprehensive statistical set on how the rehabilitation
works. I think it would be very useful if you could put all
those figures together for us to show the economy on therapy
and treatment contrasted with the prosecution and
incarceration. You are well on your way there. But I think if
you could put those together, I know I would be interested and
I think our full Judiciary Committee would be interested.
Mr. Nelson, you have gone through the sources of supply,
Latin America being the principal for this area, and there have
been massive efforts made to try to substitute crops in
Colombia, Bolivia, all over Latin America, for more than a
decade since we have authorized the use of military
intervention, and we are still struggling in the Judiciary
Committee and in the full Senate and the Congress for a 50/50
split for so-called supply side, to try to eliminate sources
and prosecute dealers, contrasted with 50 percent for the
demand side.
What is your view as to what the spilt ought to be? Do you
think a 50/50 split would give enough emphasis to law
enforcement on supply, to bring more emphasis to the demand
side?
Mr. Nelson. Senator, that is a difficult question for me to
answer. Certainly, I advocate that the law enforcement
component of the three-legged stool, if you will, is the first
line of defense. The demand side certainly, I think by the
testimony you have heard here today, needs support. We often
said that if you have a three-legged stool, the enforcement
portion of it is one leg, the educational leg, and, of course,
the rehabilitation leg. Take one leg away and the stool will
fall over.
But to answer your question directly, I would not be in a
position to----
Senator Specter. Well, if you have a three-legged stool and
education and rehabilitation are two legs, I think I just upped
the percentage to two-thirds.
Mr. Nelson. That is a good way to look at it.
Senator Specter. Dr. Leshner, on the research, we have been
very expansive and expensive in what we have allocated to the
National Institutes of Health, mental health, drug abuse. Are
you adequately funded? Would it be useful--the statement goes
that there are ten doors and we open three or four of them to
look behind on the grants. With a budget of $1.8 trillion, when
we are allocating this year $15.6 billion and next year, if our
allocation goes through, $17.9 billion, it is still a
relatively small amount. My view is that the NIH is the crown
jewel of the Federal Government, perhaps the only jewel. Could
additional funding open some more of those doors and perhaps
give us greater insight into drug abuse?
Mr. Leshner. Absolutely, Senator, and we do very much
appreciate the gracious largess that the Congress has given us.
I should point out that the National Institute on Drug Abuse
supports 85 percent of the world's research on drug abuse and
addiction, and although the increase that is now proposed will
be extremely useful, it still will only allow us to open some
2.8 out of 10 of those doors and only allow us to expand our
clinical trial network by four or five nodes.
Senator Specter. Only 2.8 out of 10 doors?
Mr. Leshner. That is right, Senator.
Senator Specter. One of the reasons the closed doors remain
so numerous, I understand that the more the grants go up, the
more doors there are to open, more applications.
Mr. Leshner. Well, actually, the number of applications----
Senator Specter. Can we get ahead of this curve, or more
funding will just produce more applications, which is fine in
and of itself?
Mr. Leshner. We are in a situation where the science of
drug abuse and addiction has really expanded exponentially in
the course of the last decade. When I came to NIDA 5 years ago,
at the Society for Neuroscience meeting, there might be four
posters on the neurobiology of addiction, and now there are 40
posters, so that the opportunities are expanding at a
tremendous rate. I would argue the accomplishments have also
expanded.
Senator Specter. The Genome Project is supposed to reach 90
percent completion by next spring, that is, to identify the
genes and have a road map of the human body. Does NIH's work on
drug abuse or mental health offer any realistic likelihood that
the gene can be identified for drug addiction to deal directly
and target that specific cause of drug addiction?
Mr. Leshner. There is no question that the individual
differences to the vulnerability to becoming addicted has a
very large genetic component to it, and in response to that,
last year, actually, my institute mounted a major initiative
focused on determining precisely what genes. It is unlikely it
will be one gene, more likely to be an interaction among
multiple genes, but we have mounted a major effort to go after
that genetic determinant of vulnerability to being addicted.
Senator Specter. We had the scientists in on Parkinson's,
Alzheimer's, other diseases. The Parkinson's expert said that
they were within 5 years of a cure, 10 years at the outside. If
you scientists can give us something very tangible, Senator
Biden and I have a better chance of working on our colleagues
to appropriate. What would a realistic estimate be of
identifying the genome for drug addiction in terms of a target
date for solving that problem? We listened to Mayor Maloney on
the costs. If we have a cost efficient target, perhaps we can
get you some more money. Can you give me an encouraging time
table?
Mr. Leshner. One of the problems with addiction, of course,
is that it is a multigenetic determinant and it is not going to
be a single gene and, therefore, it will be more difficult to
find. I am reluctant to give you a specific date, but I can
tell you that in another domain, we have made tremendous
advances in developing new medicines for the treatment of
addiction and we are about to bring one out for opiate
addiction, hopefully within the next 2 months, assuming it is
approved by FDA, and then we are well on our way to the
development of anticocaine medications.
Senator Specter. I understand the success that you are
finding with treatment modalities. I would urge you to take a
look at the genome prospect. If you can realistically work on
the issue of cure, it is a little different than the therapy or
the medicine.
Dr. O'Brien, your statement, many of your statements were
profound. Many statements have been profound. But when you say
that there are more problems from nicotine and alcohol than
from all of the illegal drugs, we have been tackling the
tobacco issue and trying to put the tobacco companies on a
penalty line for teenage addiction. What suggestions would you
have if you want to focus on nicotine and alcohol, contrasted
with illegal drugs, as to what ought to be done by the medical
profession, or more specifically, by the Congress?
Dr. O'Brien. Of course, I do not want to diminish the
importance of the illegal drugs, and we spend a lot of our
effort, including genetics, which I could tell you about
another time----
Senator Specter. You have not diminished their importance.
You have just elevated nicotine and alcohol.
Dr. O'Brien. But I have to tell you that if you just look
at the gross numbers, there are far more young people engaged
in binge drinking and getting into serious problems with that,
and also getting hooked on nicotine, and when you get hooked on
nicotine at age 14 or 15, it is very, very hard to get off, and
as we know, about 450,000 Americans die prematurely each year,
which is, you know, about 10 or 20 times the amount of people
who die from illegal drugs. So it is a huge disparity.
I think the answer is prevention, and in prevention--for
example, I just saw what they are doing in Florida, which I
think is wonderful, because they are taking some of the tobacco
money, the tobacco settlement money, and they are putting it in
the hands of teenagers who are designing programs to get to
teenagers on smoking directly themselves. I think that kids are
really terrific at figuring out what works with kids.
Senator Specter. Prevention education?
Dr. O'Brien. Yes, sir.
Senator Specter. Thank you very much. As Senator Biden
stated, we are in the final stages of trying to conclude the
budget in Washington and my bill on Labor, Health, Human
Services, and Education is at its final stage and I am due
there in the early afternoon, and perhaps I can do more good
there on trying to get increased funding for some of these
programs than I can do here by the next round of questions. And
besides that, you have a very good questioner on tap. Thank
you, Senator Biden.
Senator Biden. Thank you very much, Senator Specter. I
appreciate it. [Applause.]
Gentlemen, I am going to ask you some questions that are
pretty basic for professionals like yourselves and those who
have been advocates, like myself, for the last 27 years, and
some of the questions I clearly know the answer to, but I think
it is very important that the folks understand what we are
talking about here.
Dr. Leshner, would you explain to the committee the
difference between an antagonist and an antigen? What are we
talking about here? What do we mean? What do we know about how
the brain functions relative to the stimulation it receives
from these various drugs? In this case, we are talking about
opiates.
I might make it clear. The reason I focused on heroin is
not because heroin is the worst thing that is happening to
America. If God came down and sat here and said, I promise you
I can eliminate one form of addiction and only one, just
eliminate one, I would pick alcoholism as the thing that
affects the most malformed babies, affects the most accidents,
affects the most cost, affects the most everything.
But the difference here is that on the controlled
substances like heroin, unlike alcohol and others, which cause
more deaths, it spawns a culture of crime. It spawns a
subculture that has the wave of infecting much more than the
users. It affects, with the accumulation of billions of
dollars, it affects our economy. It affects our workplace. It
affects us in ways that are malignant, not that the others are
not, not that the others are not, but it literally spawns,
which is, I might add, one of the reasons why some folks like
Kurt Schmoke and Mr. Buckley and others have called for the
legalization of these drugs, which I think is a very bad idea,
but I will not bore you with that now.
So I do not mean to imply by the reports that I have
written and keep pounding at this, is that one of the reasons--
I am the guy that wrote the legislation, as you know, to set up
the drug director's office. I fought 7 years to get that done.
Nobody wanted it done, and particularly Presidents, Democratic
and Republican, because it requires accountability. And one of
the reasons was to try to be able to get ahead of the curve on
the drug of choice at the moment and to spare some of our
children and spare our society if we could get ahead.
Right now, we are finally just beginning to deal with what
I talked to you and your colleagues about over a decade ago,
pharmacotherapy. There is nothing new today that we did not
know then except we did not have the money then to spend the
time--there is maybe some new, but not much. All these drugs, I
listed the drugs, LAMM, buprenorphine, all the drugs that are
used, I listed them in this report in 1989. They were out
there. The scientific community, you guys told us about them
and we just did not spend any money on dealing with it.
So what I want to focus on here for the people of my State
to understand is, one, and let me explain my prejudice and then
I will ask my question. I believe if mothers and fathers of
this State understand how readily available this stuff is, how
appealing it is to young kids, how I view it very much like the
crack epidemic. Remember, that started in the Bahamas. You had
guys like Moynihan waving a flag, saying, it is coming, it is
coming, it is coming, and no one would pay attention.
If I am not mistaken, it used to be for every one female
cocaine addict back in the early 1980's, we had four men. The
ultimate equalizer was crack cocaine. Now, it is one to one,
because women could smoke it instead of snort it and distort
their nostrils or do things that they thought at the front end
would, in fact, affect them cosmetically. You could just smoke
it, no problem.
That is what I am worried about with heroin. I am worried
about, and the New Castle County Police here can tell you, I
had a little seminar with all of them 4 years ago saying, this
is what you are going to see. This is what is coming.
So I want to establish how dangerous it is and available,
so people know. There used to be a commercial on television--
they have taken it off--for a long time, 6 or 8 years ago, a
man on a wintry day standing in a graveyard looking at a
tombstone, and all you saw was his topcoat and his pants and
his shoes and you heard his voice and he would say, ``Johnny, I
am sorry. I did not know. I knew drugs killed, but I did not
know. I did not know it happened. I did not know when you were
12 this could happen.''
We are talking about 12-, 13-, 14-, 15-year-olds. Granted,
the average age is down to 17 from 18, thereabouts. But I want
parents to understand this is real. It can happen anywhere.
The other reason for this is that if we do some smart
things, we can affect, we can affect those who are out there,
because I get calls from mothers and fathers saying, my child
is addicted to heroin. There is nothing I can do. They truly
view that once that occurs, life is over. It is not over, if we
make the right investment, if we do the right things.
So they are, very selfishly, the two purposes, the reason
why I wrote the report and the reason I asked you all here. But
in order for the very people that are paying the taxes to
understand why I want to spend more of their money on this
effort, it is important to me, I think, to be able to explain
to them what we are talking about here. So explain how some of
these drugs work, some of these medicines work on the brain.
Mr. Leshner. OK; I will try to be brief on this subject. I
have been known to go on for hours.
Senator Biden. I could listen to you for hours.
Mr. Leshner. Let me start out by saying the essence of
addiction is the changes that drug use produces in brain
function, and one needs to understand that, at its core, both
drug abuse and addiction are about brains. That is to say,
people like drugs because they like what drugs do to their
brains. The problem is that, over time, prolonged drug use
changes the brain in fundamental and long-lasting ways that
produce the compulsion that is the essence of addiction.
Having said that, that tells us that an addicted individual
is actually in a different brain state than a nonaddicted
individual, and that is why they cannot just cut that out, why
they cannot just stop it and why you have to have treatment.
Now, the fact that addiction is a brain disease, actually,
that has embedded behavioral and social context pieces to it,
is why you have to use medicines as a part of the total
treatment modality that you will use to deal with the problem,
and what we have been trying to do, stimulated, I must say, by
your tremendous leadership, why we have been putting so much
focused effort into the development of new and improved
medicines and why we are taking advantage of what we have
learned about the brain and how it interacts with drug abuse
interdiction to develop new biology-based approaches to dealing
with the problem.
Senator Biden. Are the same parts of the brain--I know the
answer to this, but it is important to say--are the same parts
of the brain affected by the consumption of heroin, an opiate,
as they are by the consumption of coca, cocaine, which is a
stimulant?
Mr. Leshner. Every drug of abuse has its own individual or
idiosyncratic way of affecting the brain, but what we have
learned in the last 5 years, I would say, is that there also
are common effects on the brain that are common to all drugs of
abuse. For example, they all modify the functioning of the
brain's reward system of pleasure centers in a particular way,
and we believe that those common effects are actually a part of
the common essence of addiction, that is, the common essence of
what produces that compulsion to use drugs. So our efforts are
directed not only at specific drugs, but at addiction per se,
addiction itself.
Senator Biden. With regard to heroin, it was explained to
me by one of your colleagues at Yale years ago that there are
several receptors in the base of the brain, and indicated to me
that if we could find a way to effectively block those
receptors, like, and the analogy used was, like when you have
an infant child, you put those little plastic things in each of
the receptacles on the floor. You stick them in so that the kid
cannot stick his fingers in it. If the kid cannot stick his
fingers in a receptacle, he does not get electrocuted.
The way it was suggested to me was, there is a possibility,
then, based on adhering to molecules--well, without going into
all that, either, that you could literally block the receptor,
theoretically, block the receptor in the brain that makes you
get the good feeling from the consumption of an opiate, in this
case, heroin. Is that essentially true?
Mr. Leshner. That is what, if I may speak for him, that is
what Dr. O'Brien was speaking about with naltrexone. That is,
naltrexone is what is called an antagonist. It blocks the
action of heroin or other opiates at the opiate receptors in
the brain and, therefore, when a heroin addict who has been
detoxified is put on naltrexone, if they were to use heroin,
they would not get the high from it. So it is actually doing
exactly what you suggest.
Senator Biden. Doctor?
Dr. O'Brien. There is a risk here, though, that we have to
tell you about, and that is that the drugs actually hijack
normal brain functions. So the same pathways that Dr. Leshner
talks about are also called into play during pleasure, watching
a good movie, having sex, eating a good meal, or whatever, and
so we do not want to block all pleasures, but we would really
like to block the linkage, the abnormal memories, really, that
link the drug use stimuli and the pleasure, and that is tricky,
but that is what we are working on.
Naltrexone, fortunately, does block the very, very specific
effects of heroin and other opiates, but most of our patients--
not all, some of them actually cannot take it because they get
unhappiness, really, with it, but that is a relatively small
number, but most of them can still have normal pleasures even
though we block the opiate-rewarding pleasures.
Senator Biden. What are some of the other drugs, medicines,
that you are looking at, or are there others that have the
potential to block only the pleasure that comes from opiates
but would not block other pathways of pleasure, in other words,
would not block the pleasure of tasting, I guess, good food,
sex, whatever else? Are there any other vehicles you are
looking at?
Dr. O'Brien. In the antagonist category, the best one that
we have available right now is naltrexone. There is another
drug called nalmethine that is being studied. Buprenorphine
that Dr. Leshner talked about is another special category of
drug. We call it a partial agonist, because----
Senator Biden. Spell agonist.
Dr. O'Brien. A-g-o-n-i-s-t--a partial agonist, whereas
heroin, morphine, methadone, these are full agonists, and
buprenorphine is a partial agonist, so it gives some opiate
effect, but it has a ceiling. It has a limit on it and it
cannot give a full opiate effect. So it is almost impossible to
overdose on it and it prevents the excessive effects from other
opiates. It also, unlike naltrexone, which you have to have
good motivation to take it every day, you need a lot of
support, because you do not get any good feeling from it.
Methadone, you get good feeling from, but you can still use it
excessively. It has mostly benefits, but you have to know how
to use each one of these.
Buprenorphine has other benefits in that it is something
like naltrexone in its blocking ability, but it is also
something like methadone in that you feel a little bit better.
So there are more addicts who are willing to take buprenorphine
on a regular basis than they are willing to take naltrexone.
Senator Biden. I have one last question in this area. The
way it has been explained to me by you gentlemen and others in
your field is that the antagonist, the things that block any
impact of the drug, like naltrexone, that they are thought of
as most useful in the context of a holistic treatment of the
person. Once they are off, it keeps them off for a time in
order for you to be able to--it is not thought of as the
vehicle to keep them on the rest of their lives, although some,
I guess, it is possible. That in order to be able to live a
normal life and have normal pleasures that do not relate to
opiate consumption, in this case, that it is part of a
psychotherapy regime that it goes on with and other initiatives
that are nonprescriptive, nonpharmacotherapy in nature. Is that
right? Is that how you think of the best use of these
antagonists, as opposed to agonists?
Dr. O'Brien. Right. Exactly. I think all of the
medications, whether we are talking about agonists, partial
agonists, or antagonists, they all require counseling,
psychotherapy, something to help people with the transition
from heroin use to a drug-free state.
If I could just add one point that I think is responsible
for a lot of trouble in this field, there is a lot more than
just taking people off the heroin, which is what is generally
paid for in our public assistance programs for Medicare and
Medicaid and in our insurance and HMO programs. They are
willing to pay for detoxification, but in most programs, they
do not pay for the long-term treatment.
So what happens is you have a revolving door. You get
people to stop the heroin, they are clean for a while, and then
they relapse. It is because there is a change in the brain that
Dr. Leshner talked about that you need the chronic treatment,
and I, personally--I am in charge of a large treatment program.
I have a budget. I have to spend my money in the most efficient
way. I think it is much more efficient to pay for long-term
outpatient care, like the SODAT Program, rather than investing
a lot in inpatient care without paying for the chronic long
term to prevent the relapse, with medication and psychotherapy.
Senator Biden. Now, one or both of you, and I would like to
hear what you have to say about that, Dr. Leshner, we are going
to add another piece to it and you can speak to both, if you
would. One or both of you referenced that methadone, for
example, has become a bit of a political football. There have
always been its critics in terms of the way it is distributed,
gets to readdiction to a ``less dangerous'' drug, et cetera.
One of the things we have worked with you on, my office
has, Dr. Leshner, is this notion. I introduced a piece of
legislation called the Drug Addiction Treatment Act which would
establish a new way for drugs like buprenorphine to get to
patients, not in the clinic system like methadone, but in
doctors' offices. It is also very controversial. One of my
colleagues in the Florida Senate made a very tough speech
saying this is just the liberals gone astray again. I had to
remind him, every * * * criminal law written since 1978, I have
authored, literally, not figuratively, but literally, that is
the new battleground.
The new battleground is when it is appropriate to prescribe
buprenorphine or methadone or what may come along. What is the
best way to do that to diminish the possibility of abuse and,
nonetheless, help make it safer for my mother to walk out of
the PathMark at dusk and not get mugged in the parking lot
putting her groceries in by somebody who needs another $500 to
maintain a habit for the remainder of the next 2 weeks. Can you
talk to both those issues for a moment?
Mr. Leshner. Sure.
Senator Biden. Then I will yield and I will let you
respond.
Mr. Leshner. Just quickly, to reiterate, addiction is a
bio-behavioral disorder, and just like any other brain disease,
Parkinson's, Huntington's, whatever, having a stroke, not only
do you have to deal with the biological consequences but the
fact that it takes over your life, as a stroke does. You need
rehabilitation. You need rehabilitation from addiction.
Having said that, let me turn to methadone. One of the
problems with methadone is there is tremendous ideology out
there that is rooted in a fundamental misunderstanding about
methadone.
Senator Biden. Yes.
Mr. Leshner. It is not true in the technical sense that
methadone is literally a substitute for heroin. Whoever said
that many years ago did a terrible disservice to drug treatment
in this country. Methadone does, in fact, bind to the same
receptors. However, it has a slow onset, a slow offset, and it
actually stabilizes the brain of the heroin addict rather than
destabilizing the brain.
Having said that, the Institute of Medicine and the
National Academy of Sciences and a specially convened consensus
panel of the National Institutes of Health both advocated that
methadone, and now buprenorphine, buprenorphine naloxone, be
brought into the mainstream of medical care in this country.
There is no question that, over time, we are going to need to
see these medicines, better understood, and then well delivered
in clinical practice by physicians.
Senator Biden. Explain what you mean by the mainstream of
medical practice. Give me an example of what you mean. Do you
mean, John Doe is a heroin addict. John Doe has gone through
the process where he or she has been detoxified, if that is the
phrase--I know, in alcohol, it is detoxified. Now, they are
looking for a maintenance, an ability to stay off the stuff,
whether they choose the naltrexone route or not, and they go to
the local doctor. Do you mean the local doctor should be able
to write a prescription?
Mr. Leshner. I do not anticipate that just any GP is going
to be giving any addiction medications. Addiction medicine is a
specialty and you need some substantial training to understand
how to do it, to understand when you have to refer to
treatment, to understand when you have to do clinical practice.
But having said that, there is no reason why an
appropriately trained physician could not prescribe methadone,
or particularly buprenorphine combined with naloxone, this new
medication, that actually will be virtually nonabusable by a
heroin addict on the street.
So what we are hoping for is that appropriately trained
physicians will be able to, through hospital clinics, through
private practices with a limited number of patients, will, in
fact, be able to prescribe these medicines in an appropriate
way to those people who so desperately need it.
Senator Biden. The last question I have on this, because
the press, understandably, will want to ask more about this,
about what are you proposing, Biden? Is there within the
medical community, the governing boards, the accreditation
community, is there discussion about the accreditation--assume
we go this route, because that is what medical science and the
practice is saying, we should move that direction--is there
discussion about what credentials would be required,
particularly requiring a particular, not just having an M.D.
behind your name? Is there any discussion of narrowing the
circumstance under which medical doctors could prescribe these
kinds of agonists or partial agonists?
Mr. Leshner. Absolutely, and Dr. O'Brien has been involved
in some of these activities. Let me just quickly say that the
American Society of Addiction Medicine certifies physicians to
be addiction physicians. The American Academy of Addiction
Psychiatry also certifies physicians in addiction psychiatry,
and both of those organizations have agreed to be working on
guidelines for the administration. So this will not be a
haphazard activity.
Dr. O'Brien. If I could just add, there are two opposing
issues here because nowhere else in medicine do we have people
required to get special accreditation. I am a physician----
Senator Biden. I agree. That is why I am raising the
question.
Dr. O'Brien. I could prescribe all sorts--legally prescribe
all sorts of very dangerous immunotherapies and hormones and
cardiac drugs and things that I know very little about, but I
could legally do it. I could not ethically do it, but I could
legally do it. And, actually, buprenorphine is a very safe drug
and there are probably a lot of physicians who could benefit
from some information about it so that they could prescribe it.
But if we put legal restrictions, I think that that is going to
really limit it more, and if you compare it to other drugs, it
is actually a lot easier to use.
Senator Biden. That is why I raised the question, because I
think there is going to be a political dynamic here, that if we
move in this direction with the ability to so easily demagogue
this issue from the right, I mean, it is a great thing. I can
make a speech. It is an easy one to make. I think, absent some
way in which to do something that I think is probably not from
a professional standpoint particularly enlightened or wise, but
nonetheless may be politically necessary in order to get the
kind of support that is going to be needed to deal with this
pharmacotherapy aspect of treatment. We are just beginning that
fight.
I apologize to the other folks in here. One of the senses
of relief my colleagues got when I gave up the Judiciary
Committee and we lost control of it is, I find this so
interesting and so fascinating, I hold hearings for hours on
this subject. It makes me, as my mother would say, a little bit
of knowledge is a dangerous thing. I have a hell of a lot more
knowledge than anybody in the Congress, but only a little bit
of knowledge, which is worrisome, I guess, to people. I could
keep you here all day, but you both have incredibly busy
schedules, as does the second panel.
So I have no more questions for you two. You are welcome to
stay. I do have questions for the remaining two members of the
panel, but I know, Doctor, you have got to get back to
Philadelphia, and I know you have to get down to Washington,
and I appreciate it very, very much and look forward to being
able to call on you again, as well, privately, to pursue some
of these specific issues.
Mr. Leshner. Thank you, Senator.
Dr. O'Brien. Thank you.
Senator Biden. Thank you so much for coming. I appreciate
it.
Mr. Nelson, I want to focus on two items. One is, as I
understand it, to cut to the chase here, one of the reasons why
I started 6 years ago saying heroin is coming and it is coming
from South America, it is not going to come from Turkey, it is
not going to come from the Golden Triangle in Southeast Asia,
it is going to come from the South, is because our boys in the
South had basically saturated the market on cocaine and it was
predictable there was going to be a new deal coming.
It does not take a whole lot of hectares to provide enough
poppy for opium. These guys already had the network set up and
they already were in business and they, * * *, they could bring
in oil by their pipeline that they have, almost, although that
is more cumbersome and bulky. But they are very, very efficient
distributors.
So as I understand it, there has been a shift not away from
cocaine, but an added product, a new service offered by our
friends from Colombia and the Wahila Valley and other areas
between Peru, Bolivia, Colombia. But now, the route is either
through Mexico or up through the Caribbean, the traditional
route that used to be the way until we got relatively effective
and it found its way through Mexico.
The interesting thing to me is, though, the Colombians and
Dominicans seem to be in control, whereas cocaine, the Mexicans
have taken over a major chunk of the distribution because they
have seized not only--they not only have the old tollbooth
method, if you are going to come through my country, you give
me a piece of the action, they have essentially taken over
networks and cocaine.
Mr. Nelson. Right.
Senator Biden. Can you explain to me why the Colombians
still seem to be the wholesalers and the Dominicans on the East
Coast are the retailers?
Mr. Nelson. Senator, I believe that, as you put it, the
Colombians have the network. They utilize the transportation
routes for airports into Miami and New York. They had the
retailers right at their beck and call. They were giving the
product of cocaine to the Dominicans for distribution and they
simply told them, we have a new product, and for you to
continue to have access to this cocaine and the lucrative money
making, you must take the heroin. That is one of the rationales
that we believe that the Dominicans have control of the cocaine
and most of, if not all of, the heroin distribution in
Philadelphia, which impacts, obviously, here into Wilmington.
Senator Biden. One other question about the distribution
piece. When cocaine was introduced, crack cocaine was
introduced, it was essentially given away like candy to get
people addicted. I mean, these guys could sell soap well. They
go out into a market, they saturate the market, they have a low
price, they have given it away in the past to teenagers, they
have given it away at a very low price, not unlike, and I am
going to get in real trouble for saying this, the tobacco
companies promoting, early on, at least, additional addictive
nicotine content in cigarettes, based on the records that are
being made available, in order to get people hooked early. You
get them early, you have got them for life. You get them early,
you have got them to the average life expectancy of heroin
users, 29, or 28 it used to be. It may be a little lower on
average. I do not know, Tommy, what it is now, today.
But is there a relationship between the purity and the
introduction? When I say introduction, I mean this new wave of
heroin is relatively new in terms of purity and price. What do
you anticipate happening? I mean, as the market expands, as the
clientele expands, if it does, do you expect the purity and
price to stay where it is?
Mr. Nelson. Yes; years ago, when heroin was being used in
Washington, DC, where I first began, it was at a 4 and 5
percent usage level, and as you can see now, we are talking
about 80, 90, and even higher. Ninety-five percent, I think, is
our highest. That is a quicker introduction to the product. The
addiction process begins quickly. It is not a short-term event.
So we believe that, yes, that the purity is going to stay
there, currently at the percentage we show in Philadelphia, and
the price is going to possibly go up. Of course, in the
business end of this, if you have something that someone
desperately needs and you have it sold to them for $10
yesterday and they desperately need it and you can up the ante,
the profitability certainly is there.
Senator Biden. The irony of all of this to me is, as a
student of this subject, we are well into our second drug
epidemic. The first one, particularly with opiates, began in
the 1870's, culminated with the passage of the Harrison Act in
the late teens and early 1920's, and our first drug czar was
actually a guy named Anslinger, like gunslinger, back in the
1920's.
It used to be, by the way, that we had mandatory drug
education in about 32 States, K through 12, back then to break
the drug addiction, and we do not have that anywhere today. I
mean, I do not know why the heck we do not learn from the past,
but apparently, it is not a route we want to go, but it leads
me to this question.
This idea of dealing with the ability to interdict drugs,
which we all support, the question is not--I am not going to
ask you the percentage, but the irony is, you are seizing
incredibly larger amounts of controlled substances, cocaine and
heroin, and yet we are still maintaining usage and/or the total
amount being consumed is higher, which would lead one to
believe that, notwithstanding how, and this is no criticism, I
mean, the effectiveness is amazing. You are picking up
incredible amounts of seizures, but there are also incredible
amounts getting through. What does that tell you? I guess in
your business, it is seize more.
Mr. Nelson. Yes, sir. That would be--like I said, the more
we do in law enforcement, it seems like we end up having more
to do. This is one of the issues that has faced us in the law
enforcement business over the years.
To answer your question, I do not have the figures of the
production of the heroin and the cocaine throughout the world.
Yes, our statistics show that we are making seizures every day
and increasing those seizures, yet the problem still exists.
Senator Biden. I have one last question for you. Given the
fact that people in both my State and the State of Pennsylvania
are getting heroin--and New Jersey, I might add, the Camden
area--are getting heroin from the same place, downtown
Philadelphia----
Mr. Nelson. Correct.
Senator Biden [continuing]. Are local, State, and Federal
law enforcement agencies in all three jurisdictions working
together to deal with this, along with the Feds?
Mr. Nelson. Yes, sir. That is one of the classic efforts
that DEA prides itself in, working with States and locals and
their Federal counterparts. We have a major task force
operation in Philadelphia, well over 30 years old. As you know,
we instituted an office in Dover with your help as a part of
our program to establish the communication between the State
and local folks and our efforts. We are a national agency. We
work worldwide, so our communications are good.
But to answer your question, the communication is there.
The support is there between the agencies, and it is one of
DEA's primary missions, is to work with our State and local
counterparts.
Senator Biden. I do not want to get you in trouble, and I
am occasionally accused, because of my having, in a sense,
founded the office and my relationship with General McCaffrey,
but do you have an opinion on whether or not Delaware should be
included in the Philadelphia-Camden HIDTA efforts?
Mr. Nelson. Yes, sir, I think that Delaware could certainly
benefit from the resources of the Drug Czar's office. The
coordination aspect of that certainly can be handled between
the DEA offices, as well as the committees that are formed to
oversee the HIDTA's, which are basically the State and local
entities, the Federal entities. Inclusion into the Camden-
Philadelphia HIDTA is one method. Creating its own HIDTA here
may serve better. But the resources that could be applied here,
an approach could be to identify the needs of that three-legged
stool, law enforcement, treatment, and education, and have that
as the backbone for requests for support from ONDCP in terms of
funding and other resources.
Senator Biden. I am, as should come as no surprise to you,
I am working on that and I am hopeful that we can get that
done.
Tom, I have a couple questions for you, because the three
people who have spoken are national and regional in their scope
and they have worked in this issue for a long time. But to use
that old expression, you are right where the rubber meets the
road. I mean, you have Delawareans walking in off the street,
being sent by the courts. You work with the courts, the drug
courts, closely.
You have cited the success you have had with naltrexone and
why and the relative savings versus enforcement. If--if--a
depot is developed, and as I said, as long ago as 10 years ago,
11 years ago, we wrote about that as a possibility, then it was
talked about literally injecting, in effect, a capsule into
your arm so that you would be in a position that for up to 30
days, and I heard today they may be able to go up to 60 days,
that you would have this blocker in place. And, I might add,
there is very promising research on cocaine, carzomezapine and
other medicines, and there is a particularly promising one that
I will not bore you with that you know about, but this is about
heroin.
Assume, for a moment, that there is developed a depot--by
depot, again, you and I know what I mean, that is whether it is
through injection or insertion into the bloodstream an ability
to have one injection or one orally-taken pill that would block
the receptors, the opiate receptors in the brain, for up to 30
to 60 days--what is the practical impact on the person who
receives that blocker, heroin addict who receives that blocker?
Does it enable them--assume, for a moment, based on your
experience, they were in that state for 30 to 60 days at a
shot. Can you extrapolate from your experience how that affects
their motivation, how that affects their ability to hold a job,
how that affects their life?
I know with lithium, with those who are bipolar and
alcoholic, the consumption of lithium tends to work, but they
do not take it because they lose the ability to have that manic
high and they miss it and so they do not take it.
What is the practical effect, if you can talk about it, how
someone would be able to function?
Mr. Maloney. Well, Senator, the problem we had with the
naltrexone with those who we administered it was that it was in
50 milligrams, which meant we would have to give it to them
every 2 days. Obviously, if someone did not show up on a
Friday, you had a pretty clear indication we probably would not
see them on Monday.
So part of the treatment side of it was administering the
medication, and if you could have something that would have a
30- to 60-day lasting effect, then full concentration could be
given to treatment as well as some of the horizontal
integration of getting jobs for people, job skills training so
they could get decent jobs. And so you could focus on those
kinds of alternative things in their life that would make----
Senator Biden. If you had a long enough period for them to
be off of it?
Mr. Maloney. Yes. And in addition, if you stop in Delaware
and look at the largest increased population in our prisons, it
is for people who are violating probation. Now, we all know
that many people come out of prison and no one wants to hire
them. They cannot get a job, so they obviously do not feel very
good about themselves. They usually revert back to drugs, if
that is what their background was, and they end up that they
want to get more drugs and the only way they are going to get
them is to commit a crime. So, eventually, this cycle goes
back.
So the enormous cost to us by having a population coming
out of prison that is going to get rearrested in a 2-month
period, that is an enormous cost to us. Therefore, if we could
have medications that would last for 30 or 60 days and
incorporate them into a probation program, I think we would see
a radical change in the crime rates in our State.
Senator Biden. When I suggested that 10 years ago, I was
met with the following, and I think legitimate, criticism. They
said that the moral component of this is not there. To force
someone on probation, which I proposed, into a circumstance
where the condition of probation was that they take, assuming
it were developed and we are on the eve of that happening, a
medicine that, by injection or otherwise, would block the
effects of the addiction that they had, in this case, opiates,
for 30 to 60 days, was immoral, that the State had no right to
do that.
I realize you are not an ethicist, although you are one of
the most ethical people I have ever known in my life, and I
have known you since high school. Do you have an opinion as a
treatment provider what the social/ethical dynamic, if that
were written into the law, assuming we arrive at this
capability, to deal with probation or parole as a condition to
have to show up with you or whomever once every 30 days or 120
days?
Mr. Maloney. Well, I would think the easiest example to use
would be those who we think we might be able to release earlier
than we normally would under the condition that they would
accept taking the medication, and there, it would be a
voluntary choice on the part of the participant that, yes, I
would like to be released earlier.
If it is someone who has completed the sentence, whether or
not the court could impose after they have fulfilled the
sentence a condition of probation that they take the
medication, I suspect there may be legal issues of due process
on that.
Senator Biden. I think there----
Mr. Maloney. But I certainly would think that it would be
something that many people would opt to do, because I do not
think that the people that I have dealt with want to do drugs.
They would like not to have to do drugs. And many of them would
love to have an opportunity to find something that would work
for them.
Senator Biden. The way, I think, from a constitutional
standpoint, the way to do it, and I will raise this with my
next panel and my staff is telling me to move on here, is that
it could be a condition of the sentencing at the front end. If
the sentencing was, you are sentenced to x-number of months or
years and then, I assume that could be met constitutionally.
I thank you both for being here. I may submit a couple
questions in writing for you, if I could, for the record.
It has been extremely helpful and I thank you very, very
much.
Mr. Maloney. Thank you, Senator.
Mr. Nelson. Thank you.
Senator Biden. Now I am going to call our next panel. Our
next panel is made up of Sergeant Tony Hernandez, New Castle
County police officer assigned to the heroin alert unit.
Next is Lt. Karl Hitchens, New Castle County paramedics
supervisor. He has the unfortunate job far too frequently of
responding to heroin overdose calls and help coordinate the New
Castle County Police heroin alert video slide presentation.
We also have Marie Allen of Heroin H.U.R.T.S., H-U-R-T-S.
Heroin H.U.R.T.S. is a support group of parents whose children
are either heroin addicts or have died from overdoses. Her
daughter, Erin, died earlier this year of a heroin overdose.
Next is Maria Matos, executive director of the Latin
America Community Center.
And we have Sally Allshouse, Brandywine Counseling and
Treatment, which is a methadone treatment facility in Delaware
with some 600 clients.
Why do we not start with you, Sergeant Hernandez, and tell
us a little--if you can keep your statements to about 5
minutes, I would appreciate it, because I do have questions for
you. Tell us a little bit about the heroin alert unit, please.
PANEL CONSISTING OF SGT. TONY HERNANDEZ, NEW CASTLE COUNTY
POLICE OFFICER, HEROIN ALERT UNIT; LT. KARL HITCHENS, NEW
CASTLE COUNTY PARAMEDICS SUPERVISOR; MARIE ALLEN, HEROIN
H.U.R.T.S; MARIA MATOS, EXECUTIVE DIRECTOR, LATIN AMERICA
COMMUNITY CENTER; AND SALLY ALLSHOUSE, BRANDYWINE COUNSELING
AND TREATMENT
STATEMENT OF SGT. TONY HERNANDEZ
Sergeant Hernandez. Good afternoon, Senator. The Heroin
Alert Team was developed last year, April. It came into
existence at the direction of our colonel. He saw a national
trend with heroin and decided, let us look to see what is going
on at home. A team was formed to research the extent of the
problem. We did that, determined that we had a serious problem
that was really sneaking up on us, and then developed a
program, initially directed to parents to heighten their level
of awareness. Once they started to see the program, they asked
us to take it into the schools, communities, churches, youth
groups.
We have had some successes that we would never have guessed
we would have experienced, successes such as a student who
approached us at a local high school after seeing the program
and was very, very gracious and kind and thanked us for having
the presentation. His school, we thought it was no big deal. He
later indicated that it was a big deal because he had plans of
using heroin, trying it for the first time that weekend, and he
was so moved by the program that he decided that is not where
he wanted to go, and he was being misled. He was being deceived
by those around him that were using. So that is just one
example, and we have had other successes.
Senator Biden. What do the kids say in high school these
days? I can remember back early on, if you said to kids, you
know, you can inject this heroin in your arm and they go, oh,
man, that is bad stuff. But then, on the other hand, if you
said, by the way, you can smoke a joint here and it is not
addictive, it is no big deal, in what end of the spectrum is--I
mean, how does this get sold, figuratively speaking? How do
high school kids talk to each other, because a lot of ``good
kids'' are trying this stuff. How is it sold? I do not mean
physically sold, I mean, what is the deal? What do people say
to one another?
Sergeant Hernandez. A lot of people, I think, consider
peer pressure as one of the main factors, and it is true. Peer
pressure does contribute to the problem. However, curiosity
plays just as big a factor, and a lot of the young people we
talk to try it because they are curious, because they want to--
--
Senator Biden. Do they think it is addictive? I mean, what
do they think? What are you hearing in the high schools? Do
kids say, well, I can try this and it is no big deal, I mean,
or they think it is a big deal.
Sergeant Hernandez. Sure. We have had cases or incidences
where young people have been drinking alcohol, smoking
marijuana, thinking, well, I beat those addictions. I could try
heroin and it is not going to affect me. Again, they are being
misled, though, by their own friends, or so-called friends, and
persuaded into doing something that is obviously deadly.
Senator Biden. Lieutenant Hitchens.
STATEMENT OF LT. KARL HITCHENS
Lt. Hitchens. Yes.
Senator Biden. Do you have an opening statement you would
like to make? Can you tell us a little bit about the work you
are doing?
Lt. Hitchens. With the Heroin Alert Team, I was put on it
because the paramedics are dealing with these addicts on a day-
to-day basis. I can tell you, we have a slide presentation, if
you would like to start that, to give you an idea what is going
on with this drug.
Senator Biden. OK.
Lt. Hitchens. You hear a lot of statistics and figures and
numbers, and a lot of people do not realize that these are our
kids that are dying in our homes and the streets. When I
started in EMS 12 years ago, responding to a heroin overdose
was an event and they were few and far between. Most of them
tend to occur in the city, and your victims were your older,
hardcore addicts.
But over the past few years, with heroin becoming popular,
cheap, pure, heroin overdoses are commonplace. They are common
occurrences in our county. I can tell you that, last year, in
New Castle County, we had 136 heroin overdoses that the New
Castle County paramedics canceled, and that shows you where
they are at all over the county. It does not matter where you
live. We also had 24 deaths. They occurred all over the county.
Right now, in 1999, we respond to an average of 12 heroin
incidents a month, and those numbers are rising.
The victims of the overdoses are getting younger and
younger and they come from the very communities that we all
live in. They do not come from somewhere else. Heroin has
become the drug choice of mainstream America. It has moved from
the opium den into the family den. And, yes, Senator, I can
tell you, heroin is in your community just as well as it is in
mine. It is in everyone in this room's community.
No walk of life is immune to this epidemic. During my
tenure with the Heroin Alert Team, I have met police officers,
nurses, doctors, lawyers, elected officials, you name it. We
have met a profession who is living through the * * * of having
a loved one addicted to heroin. Something has got to be done.
We need more funding for treatment, prevention programs,
before another little brother has got to find his big brother
like this, or a mother finds her son like this, or another
boyfriend is found like this, or a single mom finds her only
son like this.
Now, words alone cannot express the frustration of families
that are dealing with this heroin problem. As a paramedic
handling heroin overdoses, I not only have to deal with the
sights of another dead young person, I have to deal with the
family emotions. Each and every scene is the same, the young
victim, the paraphernalia, the family wondering out loud, why?
Where did we go wrong?
One, in particular, heroin death sticks out. It was a 19-
year-old young man dead from heroin. As the paramedics were
declaring him dead, his family was downstairs asking out loud
what went wrong. His sister was screaming, ``I only left him
for a little while.'' She had been keeping an eye on him on a
24-hour watch after he asked her for help for his heroin
addiction because there were no beds in detox for him to go to.
His healthcare insurance would not cover the treatment he
needed. So his sister tried to watch him and tried to
accomplish the near impossible. She tried to keep him away from
the heroin. She did her best. She was with him day and night as
he fought the cravings. But she took some time to take care of
herself, and when she came home, she found him like this, dead
from a heroin overdose. From his bedroom, he went here, to the
cold, hard slab.
I could go on and on with story after story, but they are
all the same, about families fighting to get help for their
loved ones' addictions.
In particular, the State of Delaware needs to wake up. I
cannot put it any plainer. I will give you an example. Delaware
has no juvenile detox center. They detox on the cell floors. A
14-year-old in the State of Delaware can sign themselves out of
treatment without their parents' consent. That is State law.
There are no long-term residential treatment centers in the
State of Delaware, and we have a serious heroin problem. We
need to wake up before another mother has to identify her
daughter in the morgue like this. Thank you.
Senator Biden. Thank you. [Applause.]
Ms. Allen, are you OK?
Ms. Allen. Yes.
Senator Biden. I must say to you that I have, having lost a
child by other circumstances, not addiction, a young baby,
almost 2 years old, I am not sure I could sit through that--it
happened to be an automobile accident, the statistics about
automobiles--and still testify. You are a better person than I
am. We truly appreciate you being here and we welcome your
testimony. Take whatever time you need. If you want to stop and
we will come back, we will do it any way you want.
Ms. Allen. I am all right.
Senator Biden. OK.
STATEMENT OF MARIE ALLEN
Ms. Allen. Thank you for letting me be here. When I found
out that Erin was addicted to heroin, I really did not have a
clue. I was uneducated about heroin and its deadly grip. I
thought that she could kick this addiction. Little did I know
that she had been lured into a deadly trap that would
eventually take her life.
Erin was becoming someone I did not recognize. Her arms and
legs were scarred with needle marks. Her eyes were sunken and
dark. She was dying before our eyes and we did not know how to
help her. Our entire family was being controlled by Erin's
heroin addiction. Getting heroin had become Erin's full-time
job. She traveled to Kensington and to Philadelphia every day
to feed her addiction, going in the places that you and I would
never dream of going. Erin did not want to be a junkie, a slave
to heroin. She tried many times to detox and rehab. She would
stay clean for maybe a week or so, then she would give in to
her cravings for heroin.
After being clean for 9 months and residing at the CREST
Program in Wilmington because of a felony charge directly
related to Erin's heroin addiction, she had gotten out on work
release. A simple blood test had made Erin's cravings for
heroin return stronger than ever. She left work that day and
went to Kensington. I did not see Erin again until we were
called to the coroner's office in Philadelphia. Erin had died
and heroin was her killer, and it is still loose in our
neighborhood.
Since April of last year, I have been working with the New
Castle County Police Heroin Alert Team in an effort to raise
the level of awareness about this problem. I have been telling
Erin's story because I know how she suffered and I know that
she would want me to warn other people about heroin. She would
want me to tell them how this drug took her life and changed
our family's life forever.
A little over a year ago, after seeing a Heroin Alert
program, three moms who all have children who are addicted to
heroin formed the Heroin H.U.R.T.S. support group. I joined
that group, and we now have over 150 families in Delaware and
Maryland who come to share their pain, their horror stories,
their hope that their children will someday be able to live a
life without heroin.
Heroin H.U.R.T.S.'s mission is to provide support,
education, and advocacy to parents, family members, and friends
of persons with addictions, and to promote research and
development for more and better treatment programs and
facilities specifically for heroin addiction. Heroin H.U.R.T.S.
is in the process of getting transitional housing so that when
a person is released from detox, they will have a safe haven
while waiting to be placed in treatment, instead of being sent
back into the streets to use again.
Over the past 1\1/2\ years, I have met too many young
people addicted to heroin and fighting to get their lives back.
Some of those young people have come here today with their
parents. They are involved with each other's lives through a
peer counseling group that was started by Heroin H.U.R.T.S.
This group is giving these young people a chance that my
daughter, Erin, did not have.
If the devil is out to destroy lives, then I would have to
say that the devil is heroin. I have never seen anything so
destructive, and I do not know how, but it must be stopped.
Senator Biden. Thank you very much, Ms. Allen. Let me ask
you one question. What did you mean by a simple blood test
caused her to relapse?
Ms. Allen. She went to get a blood test, and when the nurse
put the needle in her arm, she came out of the office like she
was going through withdrawal. She told me it made her start
craving it.
Senator Biden. That is what I thought you meant.
Maria, welcome. Thank you for being here.
STATEMENT OF MARIA MATOS
Ms. Matos. Thank you.
Senator Biden. You seem to be involved in every good thing
we try to do.
Ms. Matos. We try to be there. We have to all get involved.
I thank you for having me.
This very second, there is a teenager in our community
trying heroin for the first time, not knowing where in the long
run he is going to end. Here in Delaware, heroin use is
skyrocketing. Heroin in our community is not only affecting the
older generation, but now, more than ever, it is affecting our
youth. The number of adolescents and young adults using heroin
is growing rapidly every day. Heroin affects the whole
community. It is not just a problem in the inner city. Heroin
has found its way into suburban families all around Delaware.
Today, heroin users range from the homeless to the
straight-A honor students. One important factor that we have
learned is that heroin does not discriminate. One of the main
reasons heroin is so appealing to our youth is because of the
way it is packaged. The majority of youth use heroin in powder
form, which is much more attractive than the dirty old syringe.
The sad part is that whether they inhale or inject, it still
pulls them into the dark, horrible world of addiction.
In an informal survey conducted at the LACC----
Senator Biden. Explain what you mean by the LACC.
Ms. Matos. The Latin American Community Center. Young
people, ages 11 to 22, were asked three questions. One was, do
you know what heroin is? If so, have you ever seen anyone doing
heroin, and how difficult or easy is it to get or to buy? We
talked to 56 kids. Out of those, 16 did not know what heroin
was. Forty knew exactly what it was. And out of the 40, 45
percent, or 18, had actually witnessed someone using. Pretty
disturbing.
When asked about the assessability, the answers were very
alarming. Answers were, like buying candy from the store,
extremely easy to get. They come up to you and ask you. You do
not have to ask.
This is where the question of treatment comes in, Senator.
Delaware at this moment cannot meet the demands for the
treatment programs, especially treatment for our young people.
Many of the drug treatment programs that we have in Delaware
requires a person to be at least 18 years or older. We are
dealing with a drug addiction which is a very, very cunning
disease and requires long-term intensive treatment, 24 hours a
day.
We need longer-term care programs, programs like Hogar
Crea. Hogar Crea is a nonprofit, 2\1/2\- to 3-year drug and
alcohol treatment program with a 5-year followup. Maybe you are
asking yourself, what makes Hogar Crea different from all other
types of treatment programs? What makes Hogar Crea different
from all the other treatments in the world is Crea believes in
reeducating rather than rehabilitating. Any addict can go away
to a program and get healthy and rehabilitated, and
rehabilitate his body and leave. But when he leaves, he will
still have all those negative behaviors and characteristics of
an addict, which will soon head them back to addiction, whereas
in Crea, we focus on breaking down everything about a negative
character and rebuilding a healthy, positive character and
instilling moral values into their lives. The theme of Hogar
Crea is responsibility, because our main focus is to
restructure the lives of addicts so they become responsible,
respectful, mature, and productive members of society.
This State and the country need to fund programs that work.
Programs like Hogar Crea that has a success rate like no other
drug and alcohol treatment in the world. Ninety-two percent of
all residents who finish the entire program, including the 5-
year followup, have not returned to drug addiction. Hogar
Crea's success rate speaks for itself. Many will agree that
Hogar Crea is the most effective drug treatment in the world.
At this moment, Hogar Crea only has one facility in the
entire State of Delaware that is opening and functioning. We
also own another property, which will be developed into a
women's center, and we have plans to go as far away as
Georgetown. Of course, the only obstacle Hogar Crea has is the
funding to open up the centers, which are desperately needed in
the State.
In our community, we have seen the trend locally go from
crack cocaine to heroin, and this is obvious based on bags that
area residents are finding and police have identified as heroin
paraphernalia. There is a large number of young people that
have been introduced to heroin and now need help. We find that
the resources are not in place to meet the growing need, very
few detoxification beds and no long-term treatment programs.
Heroin is very addictive and in order to break that addiction,
one needs long-term care and intensive aftercare.
Parents who have addicted youth are told either by the
courts, the parole officers, or others that they have to watch
their youths 24 hours a day. How is this possible if they have
to work to support their families?
Non-English-speaking inmates with heroin addiction are left
out in the cold because programs like CREST and KEY are not
accessible to them.
I thank you for allowing me to speak on behalf of the many
families that have lost their children to this dreadful
disease, including myself--I lost a stepson to heroin--and many
that are still looking for help and their children but cannot
find it. Thank you.
Senator Biden. Thank you very much.
Ms. Allshouse.
STATEMENT OF SALLY ALLSHOUSE
Ms. Allshouse. Yes. My name is Sally Taylor Allshouse and I
would like to thank you for the opportunity to speak before
this public hearing. I have worked in the drug and alcohol
field for over 26 years in the State of Delaware. We are at a
crisis point and all resources, both State and Federal, must
respond to the heroin epidemic in Delaware.
I have brought a chart for you today that I think shows the
problem that treatment programs are experiencing in Delaware.
This chart presents the increasing census that Brandywine
Counseling has experienced over just the past several years.
These numbers just reflect our heroin missions. We have over
1,000 people in treatment, and these are just our heroin.
As you can see, Brandywine Counseling has shown an increase
of over 300 percent in our heroin admissions, and for the first
time in several years, waiting lists will now occur for both
methadone programs in Delaware. This will occur since dollars
are no longer available to meet the demand. The Division of
Alcoholism, Drug Abuse, and Mental Health funds the majority of
treatment programs in Delaware, and even though the State
continues to experience surplus in revenues, the alcohol and
drug treatment dollars have actually decreased over the past
several years, thus not allowing providers inflationary
increases or addicts increased access to treatment.
This chart also shows you the breakdown of people who are
actually in treatment at this point, 66 percent male, the race,
47 African-American, 46 percent Caucasian, seven percent
Hispanic, and as you see, over 39 percent of our clients are
really between the ages of 18 and 34, and again, that is for
just our heroin admissions.
Senator Biden. Are you able to treat legally someone under
18?
Ms. Allshouse. With parental consent, yes.
Senator Biden. But you do not have any?
Ms. Allshouse. None. These numbers just reflect individuals
being admitted to Brandywine Counseling methadone maintenance
program. Heroin addiction hurts not only the addict, but also
hurts the parents, the children, other family members, and our
communities. These numbers do not show the crimes committed,
the neglected children, and the medical complications
associated with this drug.
Delaware ranked seventh in the nation for AIDS cases, up
from 13th in 1992. Intravenous drug use is the number one
reason for that ranking. This alone should be a reason to fund
programs that fund heroin addiction.
These charts are people who are waiting outside at midnight
to be admitted into my program. Since they know that there is a
demand for slots, if they show up and sleep outside, they might
get a number to get in early into treatment.
Brandywine Counseling is not the only alcohol and drug
treatment program in Delaware being stretched to its limit.
Programs Statewide are seeing admissions soar. In fact, New
Castle County detox, for the first time since records have been
kept, saw heroin become the primary drug of admission,
outranking alcohol for the first time.
Delaware has hit a crisis point, and if increased dollars
for treatment and law enforcement are not provided, then still
another generation will be lost. The changing face of heroin
addiction has brought younger addicts to our programs,
overwhelming our resources.
What can be done? One, provide additional dollars to
treatment programs so that waiting lists are eliminated. This
will allow treatment for heroin addiction on demand. It costs
less than $3,500 a year to keep one heroin addict in treatment
at Brandywine Counseling, a small price to pay for the hurt
heroin afflicts both financially and emotionally in our
community.
Two, investigate adding to the drug courts in Delaware
crimes of shoplifting and prostitution. These crimes are not
included at this time and are associated with heroin use. This
will allow earlier intervention into the addiction process, and
other drug courts have found this very successful. Delaware has
a very successful drug court and adding these crimes would
further enhance the program.
Establish a needle exchange program in New Castle County.
All revenues for prevention of HIV and AIDS must be brought to
the table. The City of Wilmington and many legislators do
support this effort, and with dollars and a commitment by the
legislature in Delaware, this could occur.
Four, increase law enforcement efforts between Delaware and
Pennsylvania. Delaware needs their cooperation, since the
majority of users buy their drugs in Pennsylvania. Both States
have to have a mutual commitment if law enforcement can begin
to combat this problem.
I would like to thank you and also say that Renatta Henry,
the Division Director of Alcohol, Drug Use, and Mental Health,
is here today, and I would be glad to answer any questions and
I know she would, also. Thank you, Senator.
Senator Biden. Thank you very much.
Let me begin with you. What does it take for a treatment
center to be qualified to distribute methadone?
Ms. Allshouse. They have to be approved by the single State
agency, which is Renatta, Ms. Henry's division, at this point.
We have to be approved by the FDA and the DEA to also provide
the drug, since it needs to be stored and distributed
appropriately.
Senator Biden. And how many such distribution sites are
there in Delaware?
Ms. Allshouse. There are only two in Delaware, Brandywine
Counseling in New Castle County, and as you can see, we have
over 700 addicts in treatment just in that particular program,
and also there is one in Kent County run by Peg McMullen, Kent
County Counseling, which I know has over 60 individuals.
Senator Biden. Have you noticed any change in the profile
of those seeking help from you, not court assigned, but just
spontaneously seeking help?
Ms. Allshouse. Yes, sir. Most of the people who come for
admission are younger now. Methadone programs, they used to say
they were aging out. People were 35, 40, 50 years old. Now, we
are getting people younger, a lot of younger white young
ladies, which brings another whole problem into drug treatment,
which is pregnancy. We also have a pregnancy program, and that
is being stretched to its limits, also, because when you deal
with a younger population, you are also dealing with other
problems associated with that.
Senator Biden. In the report that I have updated here, this
heroin report, and it is the second one, I mean, I did this 6
years ago and I think you are familiar with that----
Ms. Allshouse. I am.
Senator Biden [continuing]. One of the things that I call
for is for drug addiction, generally, for adults, is that there
either be treatment or prison, and then treatment in prison if
there is prison. What I hear from my critics is that--I mean,
personally, my critics, those who criticize that position, is
the following. Without enforcement, without the threat of a
sentence over the head of an individual, no one seeks
treatment. Is that true in your experience?
Ms. Allshouse. No. That is why I brought these slides.
Those people waiting outside, camping outside our doors, are
not sent by the law. In fact, that is a real misconception
about heroin addiction. Most of the people in my program,
heroin addicts, do not really have long criminal records. Most
of the crimes they commit early on in their addiction have to
do with against their families, stealing checks, taking credit
cards, also shoplifting, also prostitution, and those crimes
really do not end you up in jail, and a lot of times, heroin
addicts have to go way down in their addiction in order to end
up in the prison setting.
I think there should be treatment in prison, but we need to
intervene early in these lives, and so by including things like
shoplifting and prostitution in the drug courts, we would be
able to intervene earlier on in the addiction process. Those
people had no courts over them to get admitted. They were
waiting. They want to come to the programs.
Senator Biden. Now, my experience nationally has been,
regardless of which jurisdiction I am in, that there are always
a heck of a lot fewer treatment slots than people who literally
are raising their hand and saying, I am not arrested yet, I am
not being sent anywhere, I need help, and literally knocking on
somebody's door. I thought it was a pretty graphic slide, two
young kids, they look like they were high school, college-age
kids, sleeping outside the door to get inside.
What we have to do across the Nation is we turn these folks
out, and I do not know what the hell we expect them to do. I
mean, we are going to turn them away and they are going to say,
oh, well, no problem. I am going to just say no today. I am not
going to rob anybody. I am not going to burglarize anything. I
am not going to steal Dad's credit card. I am not going to hock
the family jewels. I am not going to do any of that. It is
beyond me. I do not quite get it, except I think I really do
get it.
Ms. Allshouse. Senator, if you had a disease and you had to
sit outside your doctor's office at 5:30 in the morning in
order to get an appointment, you would think something is
wrong, and that is just what we are doing.
Senator Biden. Well, the difference here is, that I have
found, since I have worked in this not as intensely as you, but
for 2 years longer than you have been doing it, is that I, and
I get in trouble--I get in trouble a lot, but I get in trouble
for saying this, as well. As part of our sort of puritan ethic,
which is not a bad thing, this idea that if you are ill, if you
get cancer, you did not do anything to get the cancer, so
society rallies around and says, we will try, we will try to
help, although we are not doing a very good job of that in
terms of access to medical care and insured medical care.
But my experience has been, and I would like you to comment
on this, that there is this piece that this is a self-inflicted
wound. Somebody by their own volition at some point picked up
the first bag of this and used it. Therefore, there is this
reaction, I find, across the social spectrum, white, black,
Hispanic, Asian, rich, poor, men, women, liberal, conservative.
It is, hey, look, do not make me pay to get them well when they
did this to themselves. I have no obligation to deal with that.
What is your response to that?
Ms. Allshouse. Well, you know, we pour a lot of money into
cancer research and a lot of people pick up cigarettes and we
still pay for that. We treat people for cancer and they might
relapse. We continue treating them. We have heart disease in
this country and people do not do the exercise, they do not eat
correctly, but we still treat them. Relapse in all other
diseases is acceptable.
For some reason, we have chosen this disease to have some
sort of stigma associated and it needs to stop because we are
losing too many children.
Senator Biden. One last question I have for you. I believe
that people would be more inclined to support my initiatives in
the Congress and other places if they believed that ``treatment
works.'' In other words, we hear the phrase, ``treatment
works,'' but I think the average person, based on some
experience, some observation--Ms. Allen, your daughter was in
treatment a number of times, and----
Ms. Allen. But she was never there long enough.
Senator Biden. Right. Well, that is what I want to get at.
There is the notion abroad that treatment does not work and the
most often criticized aspect of my--I mean, the good and bad
news is that I am most associated with the drug problem and
drug strategies of anyone in the Congress because I have been
doing it so long. It does not make me right, I have just been
doing it so long.
The letters, the comments, whether it is from the
community, from the press, from anyone, is that, Biden, you
keep pushing this notion of treatment, but it does not work.
How do you define a success at Brandywine Counseling and
Treatment? What constitutes a success?
Ms. Allshouse. I would say the majority of my staff that
works for me are recovering staff and they are a success. But
every day an addict is not out committing a crime, hurting
themselves, hurting their family, is a success.
I would say again to you that we would not, because someone
relapsed from another disease, deny them access to treatment,
and this, again, is a chronic relapsing disease. Every research
has shown, the longer you stay in treatment, the more
successful you are going to be in staying off drugs. So the
longer we keep addicts into treatment by any means, whether it
is residential, outpatient, drug-free, drug detox, whatever,
the longer we can hold onto them, the more they are going to be
successful, and yes, they are going to relapse.
Senator Biden. That is the key. I think one of the things
that sometimes I also get criticized for is I say that we have
to redefine what we mean by success.
Ms. Allshouse. Right.
Senator Biden. For example, if we shut down every high
school in America that had a graduation rate less than 100
percent, we would shut down almost every high school in
America, literally. If we shut down every high school in
certain minority communities in major cities that had a
graduation rate less than 60 percent, we would shut down a
majority of the high schools in all of those areas, in minority
areas. We would shut them all down.
We do not have the same standard of what constitutes
success for baseball teams, football teams, high schools,
military spending, about anything you can think of, as we do on
the treatment side. But I think part of the reason is, we
tend--not you--we tend to oversell treatment as what we mean by
success.
If my numbers are correct, and I have been doing more
foreign policy these days in my responsibility than I have been
the author of these initiatives, but if my recollection is
correct, the average addict in America addicted to whatever
substance, it could be cocaine, it could be heroin, it could be
any number of hallucinogenics, any number of drugs, they
commit, on average, 171 felonies a year, because most are not
born millionaires. Most are not born owning a bank. Yet if you
have that same person in treatment for 6 months, what you have
done is you have cut the number of crimes they have committed
in half.
Ms. Allshouse. Right.
Senator Biden. So there is a social value, and it is
cheaper. It is cheaper.
Ms. Allshouse. Much cheaper.
Senator Biden. I think we have got to--or I have got to
figure out a way to be more articulate in terms of
communicating to people what the genuine benefit, the immediate
benefit of treating someone who they believe it is their fault
that the reason they got there, and more explicitly,
immediately and clearly their fault in the minds of the vast
majority of Americans, and I think they think that with good
reason.
Maria, you and I have known each other a long time. I am a
big fan of yours, as you well know. One of the things I like
about what, as you pointed out so nicely in an occasion not so
long ago, although I am not a co-founder, I am basically a co-
founder of the Latin American Community Center. We go back a
long way. I can remember when you only had a little row house
and not much else. You have expanded greatly.
I think one of the reasons for your success is, you are
also street smart. You understand what people mean and what
they are saying. What are kids saying? This is what I was
trying to get at, and maybe Sergeant Hernandez can get into
this again. What is the deal in the school yard, in the parked
car at 11:30 at night, in the locker, in the places where kids
congregate? What do they talk about when they talk about
heroin? How do they talk about it? Do they talk about it like
they talk about marijuana?
I go to high schools all up and down this State. One of the
disturbing things, and I have talked about this with Mrs.
Aiken, whether it is a fine private school, an expensive
private school like Tower Hill or Archmere, Catholic or
nonsectarian, or whether it is a local public school, a small
one like Del Mar, or a big one like any number of the large
high schools in the State, I ask them about marijuana. One of
the disturbing things that has happened in the last 15 years,
and I have been doing this a long time, I asked them if it is
dangerous. Most of them do not think it is dangerous.
Now, 15 years ago, you asked that question, we went through
a period where they raised their hand and said, yes, it is
dangerous. It was accepted that it is a dangerous thing. Today,
it is not.
What do kids say when you say heroin? In our generation,
and I was still on a college campus in 1968 when the drug
epidemic was real there, and you say heroin, they go, oh, man,
heroin, man, that is bad stuff. But if you said marijuana, if
you said doing a line of coke, if you said, with these same
people who were in a drug culture, they would say, I can handle
that. But today, what are they saying about heroin? How are
they talking about it?
Ms. Matos. It is da bomb.
Senator Biden. It is da bomb. I know the phrase, but
explain what you mean by they say it is da bomb.
Ms. Matos. It makes you higher faster. I mean, it is
faster.
Senator Biden. But do they look at it in terms of--do they
have a sense of the gravity of it? I am sure--I should not say
I am sure.
Sergeant Hernandez. Senator.
Senator Biden. Yes.
Sergeant Hernandez. If I may, it all depends on their
knowledge base. If they have not been equipped with that
knowledge of how dangerous this drug is, they are likely to be
drawn to it, again, by their friends, in a context that you
should try this. This is the greatest stuff. If they are not
equipped with that knowledge, what we have found, once they
have seen the Heroin Alert Program, they walk away from it
saying, I did not know.
Senator Biden. What I am trying to get at is, I am trying
to make your case for you. What do they say before they see the
program? If you said to kids in high school today, if you
walked up--if I were a 16-year-old kid and I walked into any of
the high schools that I went to, any one, and I said, man, I
tell you what, I got the greatest high last night. I got this
hypodermic right here. All I have got to do is give you a shot,
man.
Ninety percent--99 percent of the kids, unless they are
already addicted to something else, would go, whoa, wait, keep
that thing in your pocket, man. I do not want any part of that.
I do not know anyplace anyone has ever testified that kids do
not understand that when you stick a needle in your vein, that
is something bad. That is worse.
Sergeant Hernandez. That is not the process, though.
Senator Biden. No, I know it is not. That is what I am
trying to get at.
Ms. Matos. Senator, here is what I am going to do for you.
Senator Biden. Talk to me like it is a street.
Ms. Matos. Here is what I am going to do. I am going to go
back and I am going to ask the kids and then I am going to send
it to you in writing. I am going to go back and ask the kids,
just like I asked them how available it is.
Senator Biden. Let me tell you what they tell me, because I
go around and I ask, and I would like your response. Let me
tell you what they tell me. They tell me that doing this is not
a big deal. I can handle this. There is nothing to this. It is
like back in the 1920's, they used to have a phrase called
``chasing the dragon.'' Do you know what ``chasing the dragon''
means? We are only about 60 years behind. It was they would
smoke, these rings of smoke, and they would follow the smoke,
and it was heroin they were smoking because it used to be real
pure. It is no problem, man. This is not like that crack crap.
Ms. Matos. Exactly. That is----
Senator Biden. This crack stuff, man, I have got that
figured out. You use that, you never get back. That is all this
stuff. But this, this is no big deal. I wish some of the
students out there who experienced it would tell me how they
talked about it before they used it--before they used it--
because somehow, that is the reason why I think your program is
so important.
The only problem I have with the program, and I am going to
yield to Ms. Allen here because she wants to say something, I
think--the only problem I have with some of the education
programs, and I have none with yours, is whether or not they
are real, whether or not they get to these kids. I mean, you
can get up there and all the adults can get up and talk all
they want about drugs and drug use, and there are certain
things like seeing that video, Lieutenant. That would get their
attention, in my view.
I am an old man now, I am not a kid anymore, but part of
the problem is that when we do all these education programs
that keep kids away from bad things, whether it is drugs or
other things, it is like, get a life, will you? You are adults.
You are not talking--I mean, we have to figure out what they
are saying, what they think, before we can figure out how to
deal with it.
I have not been very convinced, and maybe because I am
getting hoarse hollering about this issue. I have been
hollering about this issue for 5 years. By the way, when I
first brought this up, none of the police agencies in the
State--I had a meeting with you all; you all yawned. We met
down at Buena Vista. It was, like, OK. Joe has got another
warning. Here we go. This is it.
I talked to the school administrators. Heroin? Oh, come on,
heroin. Marijuana, cocaine, yes; heroin, no. So these guys have
figured out a way to package, man. They give it a name. It is
cheap--cheap to start with, and it is real easy. You either
snort it or you smoke it, but you do not have to stick it in
your vein. Now, they all want to stick it in their vein once
they get addicted because that is quicker, that is higher, it
is faster.
But you all are talking like adults to me. Maybe that is
because you are adults. Maybe I should have young kids here.
Sergeant Hernandez. We do have some youths that I have
been asked to recognize. If I may, we have a peer group of
these young folks who are here.
Senator Biden. Why do you not introduce them?
Sergeant Hernandez. There are here to change the world.
That is what they are here to do.
Senator Biden. Why do you not stand up. [Applause.]
Let me ask you a question, and you do not even have to
identify yourself. Let me ask you a question. The first time
you were around somebody--first of all, is heroin the first
drug you used?
Male Floor Speaker. No.
Senator Biden. How many people do you know, their first
introduction to a drug is heroin?
Male Floor Speaker. Nobody.
Female Floor Speaker. None.
Senator Biden. Nobody? So you think that, or your
experience is that the heroin users that you are associated
with all came with a bit of sophistication to the process. They
had either used coke or methamphetamines or something. What is
the experience of the drug most often used before heroin in
your circles?
Male Floor Speaker. Marijuana.
Female Floor Speaker. Marijuana.
Senator Biden. Marijuana? Now, why marijuana to heroin? Why
not marijuana to coke?
Male Floor Speaker. From my experience, it goes both ways.
Female Floor Speaker. Right. Yes. If they go from marijuana
to cocaine, then usually, like in my experience, they need the
heroin to come down from the high of cocaine.
Senator Biden. Is that the old parachute? The way crack
cocaine was being marketed, it got real sophisticated. You get
that immediate high, but you lace it with heroin so that you
come down slower.
Female Floor Speaker. Right.
Senator Biden. How many totally brand new, in any of your
experience, the two young people or any of you at the table,
how many of you experienced the circumstance and could tell me
about it where a kid just flat out, first time out, after being
drunk or whatever or just straight, and tries heroin for the
first time? Any experience with that? Mom, what was your
experience with your daughter? How did she talk to you about
how she got introduced?
Ms. Allen. She told me that the first time she was
attending an AA meeting.
Senator Biden. Attending an AA meeting?
Ms. Allen. Someone offered it to her and she did it, and
she snorted it.
Senator Biden. All right. How long, kids, and I am calling
you kids because I do not want to identify you, young people,
how long after snorting--I assume you started by snorting
heroin as opposed to injection, right?
Female Floor Speaker. Right.
Senator Biden. What is your experience of watching your
friends and acquaintances? How long before they start to
mainline it?
Male Floor Speaker. For me personally, it was about 1\1/2\
years after I smoked it.
Senator Biden. About 1\1/2\ years after?
Male Floor Speaker. About 1\1/2\ years after smoking, I
started injecting, because I found out--I mean, it would have
started me off cheaper to go back and start shooting, for the
quicker high and the immediate high, instead of spending the
$130 a day, where the sniffing just to feel normal again, I
decided I am just going to start shooting and pay $10 and $20 a
day and get that same effect.
Senator Biden. So it was the economics of it that sent you
that way?
Female Floor Speaker. Yes.
Ms. Allshouse. They are not stupid.
Senator Biden. No. By the way, I asked one of the leading
experts in drug addiction in 1981, I asked one of the leading
guys in the world on drug addiction, what makes somebody use
drugs in the first instance? Is there any common denominator?
Do you know what they said? They said, they tend to be the kids
who are the brightest. They tend to be the kids who are most
inclined to take risk. They tend to be the kids who, when they
were 4 years old, you said, do not cross the street, and they
said, OK, fine, and get out there and decided they are going to
cross the street. It is an amazing phenomenon. So I have no
doubt they are not dumb.
Ms. Allshouse. But, you know, Senator, what they said, I
think, is also true, that a lot of people who were using
cocaine have switched to heroin, and when the DEA was here and
talked about combining the markets, that is when I think our
program really saw an increase, because you could do one-stop
shopping then. It was not someone else selling heroin and
someone else selling cocaine. They learned to market that to
younger kids, then.
Sergeant Hernandez. Senator, some of the cocaine users
have indicated to us that the programs that they have been
introduced to heroin, as you heard already, to soften the crash
of crack cocaine, and as a result, now they are heroin addicts.
One young lady, in particular, I recall, she said, it kicked me
in the rear end. It is not what I wanted.
Senator Biden. One of the things we have known for a long
time is that there is a market for--and the reason why I
predicted 10 years ago they would double market this stuff--is
that there is a market for, just if you look how they started
to lace crack, so that the down would not be so devastating,
the paranoia would be impacted on, and so on.
The reason I ask this question, my last question, because I
promised I would get everybody out of here by 1 o'clock, if, in
fact, this little bag, if we knew, 90 percent or 95 percent or
100 percent of the time were used by someone only after they
had already been consuming a dangerous and controlled
substance, then with all due respect, the program is not very
effective.
Let me get right to it, cut to the chase here. I do not
mean to be critical of any program. I do not know enough about
the program to tell you whether it is effective or not, because
if you sit with somebody who is already hooked on coke and you
tell them, this is going to be a very bad thing for you, and
you tell them all the dangers of heroin, they are going to, the
way the mind works, anyone's mind, say, hey, man. I am already
strung out on coke. Do not give me a lecture on this is bad for
me. I have already figured out what is bad. I am strung out on
coke. At least this way, it can give me the kind of lasting
effect that I want, does not bring me down with such a crash.
On the other hand, if, in fact, kids are using this stuff
for the first time, if this becomes, you do not need a gateway
beyond marijuana, it is just here, marijuana to here, then you
have got a different deal. Then you have got a different deal
in terms of what you sell.
One of the things that I cannot afford, to be honest with
you, as being the guy most out front in this for so long, is I
have got to make sure what I am supporting works or I lose my
constituency. That is, taxpayers are willing to come up and pay
for a Biden crime bill that provides, or a drug program that
provides billions of dollars. And so that is why I want to
know, I want to know how you get here the first time. If the
first time you get here is after you are already addicted, then
it is a different kind of program.
You wanted to say something?
Female Floor Speaker. Back to when you were saying how they
treat cancer and all of those diseases, well, addiction starts
before anybody even picks up the drug. Most heroin addicts do
not know when their addiction started until they are in
recovery. Addiction starts long before you actually pick up the
drug.
Senator Biden. Unfortunately, the medical science does not
sustain that. That is part of the problem. So that is the
assumption addicts make and that is the assumption many in the
field make, but there is not hard data to sustain that.
Female Floor Speaker. That is why you need us up on this
table, rather than them.
Senator Biden. Yes.
Male Floor Speaker. Like she was just saying, the chances
of that happening, about you telling somebody else about that,
the reason they are not going to listen to you is because, 99
percent of the time, you have not been there, unlike us, who
have been there and who have experienced this, because they
would rather hear it coming from somebody our age, which is
their age, telling them, I have been there. I know what is
going to happen to you. It is different from somebody given
your age who has never been there, with only textbook
knowledge.
Senator Biden. I do not disagree with that assumption. I do
not disagree with that assumption.
Ms. Matos. Senator.
Senator Biden. Yes.
Ms. Matos. Sobert Silagy, who is the subdirector of Hogar
Crea, is here. Maybe you can ask him.
Senator Biden. Where is he?
Ms. Matos. Is he still here?
Mr. Silagy. Yes. How are you doing? My name is Robert
Silagy.
Senator Biden. Robert, how many folks come to you after
having been just introduced with this little bag and end up
being addicted? They say, look, the first drug other than
marijuana I tried was heroin.
Mr. Silagy. I think, realistically, everybody starts with
the least effective drugs and works their way up to harder
drugs, except maybe in Puerto Rico, because where our program
is founded from in Puerto Rico, it seems that heroin usage down
there starts at such a young age, I would think that there are
people there that jumped right into heroin without trying
anything else.
But for the most part, in the United States, I think that
most of the people grew up with the knowledge that they just do
things for experimentation, but it goes a little further than
they want it to and they find themselves stuck somewhere that
they cannot get out of.
Senator Biden. One of the things, again, medical science
has indicated, based on all the reports I have read and, like I
said, a little bit of knowledge with a legal background, not a
medical background--it is dangerous, but I have been doing this
for so long--one of the things I have found is that a
significant number of people who try heroin for the first time,
it does not work on them. They get sick. So that is why, up to
now, particularly before it became so pure, it was not
something as many people stuck with.
I will not tell you the analogy that Dr. Klieber and others
who are leaders in the field have used, but it is a little like
trying something for the first time in the back seat of a car
in some lousy circumstance and not getting much pleasure from
it and doing it and getting much pleasure from it.
One thing that brings you back is peer pressure. The other
thing that brings you back is the pure joy of it, and there is
not a lot of, for the first time, pure joy, especially when
folks were mainlining heroin, especially when purities were way
down.
So what we have got to figure out is what the dynamic has
changed in terms of the purity being up, the impact upon use,
and whether or not this is a case of first instance, because if
these folks are right, Marie, and I think they are, the
students, the young people as well as all of you, that it is
not a gateway drug, it is the drug that you work your way up
to, then there are a whole lot of signs that come before we get
to this and we have got a chance of getting a lot of people off
of this beforehand, as opposed to what I have been hearing up
until now.
I have been hearing, and students tell me, literally in the
high schools when I go around, that they have seen people who
have never used drugs after getting drunk and hanging out
trying this. It is no big thing, a little bit like the first
time somebody tries a hallucinogenic drug. You do not have to
already be addicted to anything to try a hallucinogenic. That
is not the experience. It is not automatic. You do not have to
be strung out on anything. It is the dare. It is the time. It
is the moment. It is told you can control it. It is told it is
a one-time effect, and so on and so forth.
So one of the things that is important for parents to know
is whether or not the first thing they are going to find is one
of these little blue bags, these plastic bags, or the first
thing they are going to find is paraphernalia for smoking
marijuana, to give some guidance to parents. If, in fact, this
is in the vast majority of time only after being a habitual
user of marijuana, or only after being on some other drug, then
what you have got to do, with all due respect, is spend your
time in the schools talking about those other drugs and what it
leads to, as opposed to talking about what this effect is
alone.
Yes.
Mr. Prickett. Senator, I am William Prickett.
Senator Biden. I know who you are, Bill. I used to work for
you.
Mr. Prickett. Your memory is wrong. Let me say briefly,
thank you for these hearings today. They are very meaningful.
You have the cream of the enforcement group, Federal and State,
here, and you have the cream of the treatment people. What you
do not have is what Senator Specter referred to, that is, the
leadership of this community. Where are the church leaders?
Where are the industry leaders?
Sergeant Hernandez. They are here. They are here.
Mr. Prickett. Some, but not all. And your message, Senator,
should be much wider, because, as Senator Specter said, the
societal response has not been adequate to the peril that we
face from drugs. There is not one family in Delaware that does
not have a member or a friend who has not either been
devastated or threatened by drugs.
So I appreciate what you have done and told all of us. What
I suggest, the most important thing is to get the forces of the
community as well-educated and as dedicated to the problem as
is warranted. Thank you.
Senator Biden. Thank you.
Would any of you like to make a closing comment? It is now
1 o'clock.
Ms. Matos. I would like to say something, Senator, that
while you have treatment on your mind and treatment works, we
also have to remember not to give up on prevention, because we
want to prevent it. We want to prevent the alcohol and then the
drugs and the tobacco before it starts. So remember prevention,
because prevention also works.
Senator Biden. As you well know, and I will just state the
obvious, the purpose of this hearing was to focus on one drug,
one time. I am the author of that prevention bill that calls
for spending $10 billion on prevention, as well as the
treatment side of it, as well as the medical side of it,
because unless we can figure out how to treat these diseases of
the brain better than we are now and prevent them as well as
treat them, this is a problem that is just going to be the drug
of the week, the drug of choice. We will be back in 5 years and
we will be rediscovering crack cocaine, or 10 years.
Ms. Allen, do you have any comment you would like to make?
Ms. Allen. Yes; I just wanted to say one thing. For the
young people, the parents know this, that they should never
give up on their young people that are addicted, but another
thing is, I do not want them to give up on us for our efforts.
Senator Biden. Thank you.
Gentlemen, any comment?
Again, I thank you all very much. I can hang here a little
bit for those who want to talk to me, but I thank you all very,
very much for your time and your effort and we are adjourned.
[Whereupon, at 1:06 p.m., the subcommittee was adjourned.]