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Mr. NELLIS. Urine samples ?
Mr. NELLIS. If we really wanted to know what the effect of the drug was, we would have to talk to your doctor, right?
Mr. STEVE RUGENSTEIN. Yes.
Mr. NELLIS. Ms. Scrafford, I want to ask you some questions, if I may.
We heard a good deal about your program, but I still don't know much about it. How is it funded ?
Ms. SCRAFFORD. About one-third of our funding does come from NIDA. Another part from the State of Virginia, Commonwealth of Virginia. And the rest by the county of Fairfax.
I would say it is about one-third each.
clinic? Ms. SCRAFFORD. Counting outpatient and inpatient, I believe we now have about 17.
Mr. NELLIs. How many patients total do you have? ?
Ms. SCRAFFORD. Totally, since our inception, we have had over 1,700. At the time, our bed capacity in residential is around 26. Our outpatient capacity is about 60. And that is generally 100-percent utilized. In fact, both are.
Mr. NELLIS. I think you mentioned that the treatment you afford there runs from heroin to many other types of drugs, is that correct?
Ms. SCAFFORD. Right.
Mr. SCRAFFORD. Fairfax County has a separate alcohol program. I think it only fair to mention that I would say 99 percent of the drug abusers that we have do also abuse alcohol at times,
Mr. NELLIS. Yes, the committee has heard much testimony about the cross-addiction between alcohol and polydrug use and so on.
May I ask you also, in terms of the program itself, have you had any evaluation or followup studies to determine how successful you have been in keeping people away from drugs, once they have been through your program?
Ms. SCRAFFORD. I think we have been fortunate, because we have had two followup evaluations. The first one was done in 1973 by Georgetown University's Department of Psychiatry, and the second one was done in 1976 by the Northern Virginia Planning District Commission. Because of the longitudinal nature, I feel there is a great deal of validity in the conclusions, which were pretty much the same, there was a dramatic improvement in the severity of drug use, and the frequency of drug abuse. There was a sharp drop in the return to criminal justice system in that our recidivism rate was less than that for first offenders, and most of our clients were not first offenders.
One of the dramatic things that came out was there was an increase in the use of alcohol.
In the first study, we included the families in the study to verify the findings. We also used urine gathered at that time to verify the drug use.
Since I am sworn in, I guess I can't say in all candor it is entirely the program's credit. I would like to take the credit, I like to take all of the credit I can get. But I do think that some adolescents simply grow up and perhaps we were there to lend them support during that time.
Mr. NELLIS. What percentage of the people you have in either inpatient or outpatient are PCP users or ex-PCP users?
Ms. SCRAFFORD. As of calendar 1977, which is our latest statistics, over 32 percent admitted frequent use of PCP, more than once a week.
Mr. NELLIS. Is that your highest rate of abuse of any drug? Is it higher than heroin?
Ms. SCRAFFORD. No, marihuana would be the highest rate, most drug abusers in our program do smoke marihuana and probably more frequently than anything else. But we are a polydrug abuse program. They are using other drugs as well.
In 1974 less than 1 percent were admitting use of PCP. So from 1974 to 1978, that is quite a jump. Heroin use has remained fairly stable. I think it was 20 percent of our clients in 1974, and it is about 18 percent now, although we do see an increase in the use of other narcotics.
Mr. NELLIS. Steve, there is no chance in the world you will ever go back to smoking PCP, is there?
Mr. STEVE RUGENSTEIN. Well, the way I feel, no. I don't think I would.
Mr. NELLIS. I didn't ask you that to extract a promise from you. Mr. STEVE RUGENSTEIN. Šee, that is why I was kind of hesitating.
Mr. NELLIS. Because nobody ever knows what tomorrow brings. But in your own mind, am I correct in assuming at this point you had a bad experience and don't want to repeat it? Is that about right?
Mr. STEVE RUGENSTEIN. Yes.
Mr. GILMAN. Ms. Scrafford, did you get any real assistance from any of the Federal programs, any that have been of special value to you?
Ms. SCRAFFORD. The money.
Mr. GILMAN. Have you received substantial assistance by way of funding?
Ms. ŠCRAFFORD. Yes.
Mr. GILMAN. What portion of your program is funded by the Federal Government?
Ms. SCRAFFORD. Going back to our beginning, 90 percent of our money came from LEAA. For the first 5 years we were funded by LEAA.
Mr. GILMAN. Up to 90 percent? Ms. SCRAFFORD. Up to 90 percent. Well, it was in de-escalating order. We went down to 60 percent in the last year before we applied for NIDA funds. As of now, I believe about 33 percent comes from NIDA, which goes directly to the State, and the State adds to that. We really get about 66 percent from State and Federal combined, and the other one-third comes from the county.
Mr. GILMAN. Have there been any consultative or informational services of the Federal Government that have helped you?
Ms. SCRAFFORD. No.
Mr. GILMAN. Thank you. I want to thank the panelists for taking the time to be with us today, and I am sure your testimony is going to be helpful to our committee, and hopefully to the entire Congress.
I will now call the second panel of witnesses, which consists of Dr. Paul Luisada, psychiatrist and Acting Deputy Medical Director, St. Elizabeths Hospital; Hon. Frank E. Minyard, coroner of Orleans Parish, New Orleans; and Lt. James Elkins, director of Vice-Narcotics Division, Montgomery County, Md., Department of Police.
Gentlemen, if you would please rise and raise your right hand so we can swear you in. [Panel of witnesses sworn.]
Mr. GILMAN. We welcome our panelists today and we appreciate you giving your time to give testimony to the committee.
Dr. Luisada, we will be pleased to have you start our panel discussion.
TESTIMONY OF PAUL LUISADA, M.D., PSYCHIATRIST AND DEPUTY
MEDICAL DIRECTOR OF THE AREA D COMMUNITY MENTAL HEALTH CENTER, NATIONAL INSTITUTE OF MENTAL HEALTH
Dr. LUISADA. Thank you, Mr. Chairman. My name is Dr. Paul Luisada, and I am a psychiatrist and Deputy Medical Director of the Area D Community Mental Health Center. The Area D Community Mental Health Center is operated by the National Institute of Mental Health as a division of St. Elizabeths Hospital. We provide mental health services to residents of the District of Columbia who live east of the Anacostia River and south of East Capitol Street.
My involvement with treating patients who have suffered from the effects of PCP began in 1973, when the Director of the Community Mental Health Center, Dr. Roger Peale, became alarmed at the increase in what appeared to be admissions for paranoid schizophrenia. These pateients were extremely violent, rather psychotic, and were extremely resistant to treatment.
We subsequently discovered through a research project undertaken in 1973 and presented to the American Psychiatric Association in 1975, that these patients had been suffering the aftereffects of using the drug POP.
I am here to discuss the effects of the drug phencyclidine, also known as PCP.
Because of the brief time I have, I will come right to the point.
From a medical standpoint, PCP is so different from any other drugs you may have heard about, that it is in a class by itself. Èxperts in the field disagree about how to categorize it.
PCP is not an addictive sedative like alcohol, barbiturates, or the minor tranquilizers, although it can produce a type of sedation at adequate dose levels, and its use tends to be repetitive.
PCP is not a stimulant like amphetamine or “uppers," although some users become agitated and do not sleep for days after a single
dose. PCP is not an analgesic like heroin or morphine, although it can make the user completely insensitive to the most severe pain. PCP is not a hallucinogen like LSD, although most users experience some type of hallucinations while they are under its influence.
Because PCP does not fit into any of these categories, its effects are often initially misunderstood. I shall attempt to be as specific as possible.
PCP has two major effects in humans: First, it separates the user from reality to an extreme degree. This separation from reality is more severe than has been seen with the other drugs mentioned earlier, and it is different, in the sense that the user may lose his identity as a person while under its influence.
Second, PCP disrupts the user's ability to think rationally. He may lose control of his thought processes, lose the capacity for making rational decisions, and from false beliefs about the world around him.
PCP produces these effects in nearly all users. Our experience has been that the severity and duration of these symptoms depend to a great degree on the unpredictable individual sensitivity of the user. We have treated some patients who remained psychotic for over 2 weeks after a single dose of PCP.
As one patient told me: "It makes people crazy." I would therefore classify PCP not as stimulant or hallucinogen, but as a new type of drug, a psychotogen, meaning a creator of psychosis or a producer of insanity.
I will now review some of the more specific effects of this drug. Which of these effects may occur in a given user, how severe they may be, and for how long they may last, depends upon at least two factors: First, how much of the drug has been used, and, second, the unpredictable sensitivity of the individual user to the drug.
PCP causes feelings of depersonalization, a sense of not being oneself, and distortions of body image. The user experiences a sense of distance and estrangement from his surroundings, and a sense of timeexpansion. The perception of touch and pain are reduced, and this may result in a floating sensation. There is loss of the sense of direction, and of which way is up or down.
Muscular coordination, and the user's ability to visualize and accurately perceive his surroundings are impaired. The PCP user loses control of his thoughts and feelings, becoming subject to delusions, experiencing at times severe anxiety and terror, paranoia, and hostility, depression and hopelessness or elation or superhuman strength and invulnerability. He may remain in such a state for several hours, several days, or several weeks. The user may become delusional, believing, for example, that portions of his body are missing, that the world is about to end, that he is possessed by demons, or that everyone near him is attempting to kill him.
What is alarming about PCP is the behavior which results from these feelings, particularly violent behavior. Feelings of depression and hopelessness have resulted in suicides, as I am sure you have heard. PCP users have died in fires, apparently through lack of concern and inability to feel the heat; they have drowned either because of inability to tell which way is up, or because of believing they could breathe under water.
However, behavior induced by PCP may go beyond being simply bizarre or dangerous to the user himself. It becomes dangerous to those around him as well. One of the patients we treated was brought to us by the police in an agitated paranoid state under the following circumstances: He had been involved in a minor automobile accident. When the police officer approached to investigate, he attacked the armed police officer as well as several bystanders with his bare hands. The man was eventually manually restrained by a number of officers after he persisted in attacking them even though he was surrounded. In a similar incident in California, the attacker was eventually shot and killed, because he would not succumb.
Another man brought to us had deliberately driven his car into a brick wall, believing he was invulnerable. A third was apprehended by police after a struggle after he walked down a street attacking everyone he met. Despite the best treatment we could deliver, many of these patients remained psychotic for as much as 2 weeks, and continued their violent and aggressive behavior for as much as half that time.
This leads me to my final point. For over half a century, the Government has controlled certain addictive drugs, such as heroin, and, more recently, the barbiturates and amphetamines. These drugs are considered dangerous, but their danger was to the user; he could easily become addicted. The danger of PCP to the user is of a different kind: It impairs him to such a degree that he may die unwittingly, perhaps by his own hand.
Moreover, PCP is different from what we have been taught to think of as dangerous drugs, in an entirely new way: It can be as dangerous to those near to the user as to the user himself.
Mr. GILMAN. Dr. Minyard.
TESTIMONY OF FRANK E. MINYARD, M.D., CORONER OF ORLEANS
PARISH, NEW ORLEANS, LA. Dr. MINYARD. Thank you. First of all, thank you for the opportunity of allowing me to testify. My paper I request be submitted in full, and I would like to address myself to some of the testimony that I have heard here today.
This is my first time testifying before Congress, and I have heard some things that are very confusing to me. Being from New Orleans, I am the coroner of the city of New Orleans, and also president of the International Association of Coroners and Medical Examiners.
Mr. GILMAN. Doctor, your testimony will be received and placed in the record in full.
Dr. MINYARD. Thank you. First of all, there has been an enormous amount of information stating that there is lack of information on the part of the Federal agencies about PCP.
That struck me this morning immensely, to see that there had been so little investigation into the effects of PCP, not only in emergency rooms around the country, but also the effects of PCP in the criminal justice system, and the effects of PCP on traffic fatalities.
I think the point was brought up that there was no communication between the various Federal agencies and this body about what is