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APPENDIX

PSYCHOACTIVE DRUGS APPEARING ON I OR MORE FORMULARIES SUBJECT TO NEGATIVE OPINION BASED UPON

5 INDEPENDENT MEASURES OF THERAPEUTIC DISCRIMINATION, MARCH 1976 1-Continued

Number of

negative opinions

Drug entity

Dosage form

St sol.
Capsule.
Tablet..

do..

.do..

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2

do.
Capsule.
Elixir..
Tablet.
Elixir..
Tablet.
Capsule.
Tablet.

do.
Liquid.
Tablet.
Capsule.
Liquid.
Tablet..

do.
Drops.
Elixir.
Tablet.

do
Capsule.

.do.
SR capsules.
Capsule.
SR tablet..
Tablet.
Capsule.
St sol.
Suppository.
SR tablet.
Syrup..
Tablet..
Capsule.

do.
Tablet.

do.
Capsule.
Tablet.

do
Syrup.
Tablet.
Syrup.
SR capsules.
SR tablet.
Tablet.
St Sol.
Tablet..

do.
Liquid..
Tablet..

do

do..
St Sol..

.do.
Tablet.
St Sol.
Suppository.
SR capsules.
Syrup.
Tablet.
Liquid.
St sol.
Syrup.
Tablet.
Cream,
Lozenge.
Syrup
Lozenge..
Syrup

1

Do
Phenaglycodol.
Phenaphen.
Phenaphen plus.
Phenachen with codeine.
Phenelzine sulfate.
Phenergan Cmp:
Phenergan Ped-Exp with DM.
Phenergan-D.
Phenergan-DM.
Phenobarbital.

Do.
Pipenzolate bromide with PB.
Piperacetazine.

Do.
Piperidolate HCI with PB.
Pipradrol HCI.

Do.
Plexonal.
PMB.
Pre anesthetic No. 1.
Pre anesthetic No. 2..
Pro-banthine with dartal.
Prochlorperazine..

Do.
Do.
Do.

do. do. do.

Do. Promazine HCI.

Do. Do.

Do
Promethazine.
Promethazine exp-

Do
Promethazine exp with codeine.

Do.
Promethazine exp pediatric.
Promethazine VC exp.
Promethazine VC with codeine exp.

See footnote at end of table.

2 2 2

1

2

1

APPENDIX

PSYCHOACTIVE DRUGS APPEARING ON 1 OR MORE FORMULARIES SUBJECT TO NEGATIVE OPINION BASED UPON

5 INDEPENDENT MEASURES OF THERAPEUTIC DISCRIMINATION, MARCH 1976 1-Continued

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Sidonna...
Sodium pentobarbital.
Sodium secobarbital/sodium AMOB.

Do.
Solfoton.

Do. Sominex, Spasamin. Sunril.. Synalgos. Synalgos DC. Synate-M.. Synirin... Talbutal.

Do.

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Theoph, ephedrine, guaif, PB.

Doc.

Do..
Theophylline with sodium pentobarb.
Theophylline, ephed, PB..

Do.
Do.
Do.
Do.

Do.
Thiothixene..

Do.
Do.

Tablet.
St sol.
Capsule.
Tablet.

do.
Capsule.
St sol.
Suppository.
Tablet..

do.
SR Tablet.
Capsule.
Liquid.
Capsule.
Tablet.

do. EC tablet Capsule.

do

Do.

Tranylcypromine sulfate..
Triaprin..
Triaprin-DC.
Triclofos sodium.

Do.

Do Tridihexethyl HCI with PB.

Do Triethylperazine.

Do.

Do. Trifluoperazine HCI.

Do.

Do. Triflupromazine.

Do

1 1

do. Tablet.

do.
EC tablet.

Tablet.
Elixir.
Tablet.

do.
Suppository.
Elixir.
EC tablet.
Suppository.
Suspension.
SR tablet.
Tablet.
Capsule.
Drops..
St sol.
Tablet.

do
Capsule.

do.

do.
Liquid.
Tablet.
SR capsules
Tablet..
St sol.
Suppository.
Tablet.
Liquid
St sol.
Tablet.
St sol..
Suspension.
Tablet..

do
Capsule..

Do. Two-dyne. Tybamate..

1 Data obtained from survey of 52 hospital and 12 medicaid formularies. See Rucker, T. D. and Visconti, J. A. "A Descriptive and Normative Study of Drug Formularies," College of Pharmacy, Ohio State University, Columbus, Ohio. June/ August 1978. 213 pp.

ABUSE OF DANGEROUS LICIT AND ILLICIT

DRUGS—TALWIN

FRIDAY, OCTOBER 6, 1978

HOUSE OF REPRESENTATIVES,
SELECT COMMITTEE ON NARCOTICS ABUSE AND CONTROL,

Washington, D.C. The Select Committee met, pursuant to notice, at 9:10 a.m., in room 2525, Dirksen Building, Chicago, Ill., Hon. Morgan F. Murphy (acting chairman of the Select Committee) presiding.

Present: Congresswoman Cardiss Collins and Congressman Tom Railsback.

Staff present: Joseph L. Nellis, chief counsel; Doreen Thompson, staff counsel; Alma Bachrach, investigator; and Dan Stein, researcher.

Mr. MURPHY. Ladies and gentlemen, this open hearing by the House Select Committee on Narcotics Abuse and Control will commence.

I would like to make an opening statement, and then we will hear from our first witness. The gentlelady from Illinois, Mrs. Collins, wishes to make a statement. We will hear from her.

Although the Select Committee has held several hearings concerning the abuse of narcotics, what we must not lose sight of is the fact that the major source of drugs and costs for social services relate to the abuse of licit drugs. The phenomenon of Talwin abuse, which has emerged in Chicago, is a prime example.

Law enforcement officials will confirm that the purity of heroin in Chicago is so low that the addicts quickly and effectively sought out a substitute. Unfortunately, this resulted in a rash of 39 Talwinrelated deaths in a short period of time.

Moreover, since August 1977, the Central Intake Unit for Chicago drug abuse treatment programs has screened and processed more than 900 clients seeking treatment for Talwin abuse. This represents between 25 and 30 percent of the total number of new clients.

In the 1-year period April 1977 to April 1978, there were 384 emergency room visits of this nature in the Chicago metropolitan area.

Another alarming element we will hear of today is the large sums of public aid funds—your tax dollars—which were used to supply the Talwin to addicts; to increase the income of unscrupulous doctors, pharmacies, and clinics.

The major focus of this hearing is twofold-an examination of the extent and nature of the abuse of Talwin and Pyribenzamine, and an assessment of the role of the public and private sectors in preventing the abuse of licit drugs.

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As the latter, special emphasis will be placed on the role of the Food and Drug Administration and its general practices in anticipating the abuse of drugs that have a clear potential for abuse.

It would seem that new drugs are constantly introduced into the market faster than their potential for abuse can be adequately evaluated. Yet, even after abuse potential has been proven, FDA relies on a congressional definition of "abuse potential” that requires in the case of a new drug significant actual abuse before action to control is taken by that agency.

For example, Bristol Laboratories recently won marketing approval from the FDA for a new drug named Stadol. The company reports Stadol can replace such highly addictive painkillers as morphine and Demerol without subjecting the patient to the risks of addiction.

Yet, later today, we will learn that Stadol has many of the same properties as Talwin. Therefore, why is it that studies have not been conducted to place Stadol on schedule IV prior to marketing? Talwin was available for 10 years before any significant street abuse occurred. Why should we wait to see if Stadol will also be diverted before making a decision to automatically place a similar drug under the same schedule?

Through testimony presented today, it will soon become clear that drug abuse is a problem that requires the attention of all sectors of the community. It is unfortunate that the drug abuser through his ingenuity always seems to be a few steps ahead of the bureaucracy.

The first witness this morning will be Michael J. Bilandic, mayor of the city of Chicago, who will be followed by State Senator Richard M. Daley.

I will turn to the gentlelady from Illinois who has a statement to make.

Mrs. Collins. Yes; I do, Mr. Chairman.

I would like to join you in expressing my thanks to the witnesses for appearing here today.

I am also encouraged by the interest that the public has shown in our continuing efforts to shed light on the very serious problem of illicit drug abuse. This problem is, indeed, a tragedy of the first magnitude, and I am convinced that it is going to require everyone's best effortand that certainly includes the public—to get to the bottom of it.

As the representative of a district in Chicago which has been plagued by drug abuse problems of every kind, I am particularly pleased that the Select Committee on Narcotics Abuse and Control is holding this hearing on Talwin in the city of Chicago.

I would add, however, that I am equally displeased over the fact that such a hearing has become necessary, and I am convinced that this is indicative of a serious breakdown somewhere within the system of controls that we are supposed to have over the flow of licit drugs.

I would not like to rush to judgment, but it is abundantly clear that something is dreadfully wrong when substances designed for the relief and healing of persons are themselves permitted to become a deadly nemesis to society.

For some time now, Chicago has been recording over 100 illicit drugrelated deaths each year. This is in itself quite bad enough, but now here we are with the finding that in one recent 6-month period,

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Cook County recorded 39 deaths due to the abuse of licit drugs; that is, due to the combined use of Talwin and the antihistamine Pyribenzamine.

We know that for the most part, many of those who abuse these substances are already addicted to the use of heroin. Although some members of the community may not be inclined to think much about the death of these addicts, I submit that life is life, and it is a sad situation when any member of society can licitly obtain the instrument of his or her death with apparent ease and little or no warning.

Moreover, there is evidence that a number of young people with no prior history of addiction are also falling victim to these drugs. The allegation, which I understand will be made here today, that some pharmacies and clinics actually exploited this situation, apparently for profit, is a scandalous and unconscionable outrage against society,

Given the present level of this problem, its already dramatic spread in a relatively short period of time, and the FDA finding that use and dependence on substances such as Talwin “becomes epidemic throughout the United States in a manner similar to an infectious process, I do not believe that a minute can be spared in sorting out the facts and taking effective action. Anything less would be comparable to fiddling while Rome burns.

The Select Committee's last hearing left us fairly well informed of the manner in which a number of physicians are contributing to the licit drug abuse problem by indiscriminately issuing prescriptions for a number of so-called mood drugs.

I am hopeful that this hearing will enable us to pinpoint the practices of manufacturers and distributors, as well as governmental regulatory agencies that may also be contributing to the magnitude of the licit drug abuse problem.

I hope that no one will make the mistake of thinking that this is a crisis unique either to Chicago or the inner cities, simply because it happens to have surfaced here first. Already, there are reports of substantial Talwin abuse in several other major American cities, including New York, Detroit, New Orleans, and St. Louis.

We must make no mistake, this is an American problem, and if it is not checked, Americans, individuals and families, young and old, black and white, all over this country are going to have to pay a dreadful price.

Thank you.

Mr. MURPHY. Thank you very much, Mrs. Collins. Our first witness today is the mayor of the city of Chicago, Mayor Michael Bilandic.

TESTIMONY OF HON. MICHAEL J. BILANDIC, CHICAGO MAYOR

Mr. BILANDIC. Thank you very much, Chairman Morgan Murphy. Congresswoman Collins and Congressman Railsback who will shortly join us—I am indeed grateful to both of you on behalf of all of the citizens of the city of Chicago for the fine work that you and the Members of Congress have been performing in this very important area.

It is my privilege this morning to welcome you to the city of Chicago. I know the hearings that you will be conducting here and throughout

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