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Agency of Fear
Opiates and Political Power in America
By Edward Jay Epstein
Chapter 14 - The Magic-bullet Solution
It was Jeffrey Donfeld, the youngest member of Krogh's staff, who discovered what appeared to be a magical solution to both the narcotics and law-and-order problems. Donfeld first became involved in politics in 1965, when he was elected president of the student union at the University of California at Los Angeles, where he majored in political science. When he went on to law school at Berkeley, he made a name for himself by opposing the free-speech movement there. Then, in the summer of 1967, he interned with the New York law firm of Richard Nixon and John Mitchell. He impressed Nixon with sharp questions about the war in Vietnam, and after working briefly in California Republican politics, he was asked at the age of twenty-five to join the administration as a staff assistant in the field of drug control. Initially working on such projects as inviting disc jockeys to White House conferences and arranging drug propaganda for the administration, he acquired the belief that "all government is 75 percent PR."
In June, 1970, Krogh sent Donfeld on a whirlwind tour of New York and Chicago to evaluate treatment programs in those cities. Donfeld said that the doctors operating the various programs tended to be zealots, with each "believing that his program is the true
panacea." When he demanded some statistics to confirm the effectiveness of the treatment program in terms of "drug recidivism arrest [records], employment or schooling, program drop-out rates and per patient costs" he found to his dismay that "most programs ... did not have, or would not provide, these statistics because their programs were 'too new."' He added sarcastically in his report to Krogh, entitled "Different Strokes for Different Folks," "If they [the treatment programs in New York and Chicago] were 'too new' it is because prior efforts proved to be failures and the current program is the latest hopeful effort." Moreover, he reported that there was no agreement at all in the medical community about what the goal of drug rehabilitation should be. Donfeld found, however, that one form of treatment promised to reduce crime statistics for the administration-methadone maintenance.
Methadone, a synthetic opiate which can be manufactured in laboratories, was developed by German scientists during World War II as a substitute for heroin and morphine, since these natural opiates could not be obtained from the prewar suppliers in the Middle East. After the war the formula for this synthetic drug was given to American drug companies, and it was subsequently manufactured for "investigative use" by Eli Lilly and Company. In distributing the drug to doctors, the Lilly Company described it as a "synthetic narcotic analgesic with multiple actions quantitatively similar to those of morphine" and warned that it was "a narcotic with significant potential for abuse with dependence-producing characteristics." Although methadone was slightly less powerful than heroin, it produced virtually the same sort of pain-deadening and sedative effects and was no less addictive than a natural opiate. Because of its similarity to heroin, methadone was initially used in government hospitals for detoxifying addicts-a procedure in which doctors gave addicts progressively decreasing dosages of a narcotic until they were- drug free. Since methadone could be administered to patients orally every twenty-four hours, it proved to be a convenient detoxifying agent in hospitals. However, it was hardly viewed as a cure-the vast majority of detoxified addicts eventually returned to the use of illicit heroin.
In 1964 two New York City doctors found a radically different means of using methadone to treat addiction. Under the auspices of the prestigious New York Health Research Council, Dr. Vincent P. Dole, a research associate at the Rockefeller Institute, and Dr. Maria E. Nyswander, a psychiatrist, initiated a series of experiments which laid the groundwork for what was to become known as "methadone maintenance." Rather than using methadone to withdraw addicts from heroin progressively, Dole and Nyswander actually increased the dosages of methadone for twenty-two addicts participating in the experiment until they were stabilized on a higher daily dosage of methadone than they had previously used of heroin. Since methadone was as addictive as heroin, Dole and Nyswander merely succeeded in substituting the methadone for heroin as the addictive agent. The idea of attempting to cure one form of drug addiction with another, it will be recalled,-was not new. Dole and Nyswander, however, provided a medical rationale for maintaining patients on methadone rather than heroin. They postulated that the use of heroin caused a permanent and irreversible metabolic change in the nervous system of an addict. This meant that an addict could never be normal unless he had a narcotic in his system that compensated for this metabolic disease. According to their theory, there was no possibility of an addict's being permanently withdrawn from drugs: it was simply a question of which narcotic he would use. Even though methadone had all the pharmacological properties of heroin, Dole and Nyswander found that an addict needed less-frequent administrations of the dosage--that is, every twenty-four hours rather than every four hours-and he Could live a more normal life on methadone than on heroin, working normal hours. The objective of their rehabilitation program was not to render the addict drug-free but to make him socially useful. They justified- maintaining addicts on extremely high dosages of methadone-80 to 150 milligrams, a dosage previously given only to terminal cancer patients-on the basis that this established a pharmacological block against the addict's returning to heroin. They also claimed that since addicts received their methadone free, they had no further reason to steal money or property. In 1966, the medical team reported, "The blockade treatment... has virtually eliminated criminal activity [among the patients in the program]."
In this original experiment Dole and Nyswander were treating a few dozen middle-aged addicts who for the most part had begun using heroin during or just after World War 11, each volunteer demonstrated a strong motivation to give up his life of addiction (and crime) before he was selected for the experiment. Working with such a small and well-motivated group, it was not especially surprising that Dole and Nyswander achieved successful results. As more patients were admitted for methadone maintenance, Dole and Nyswander resorted to using various forms of statistical legerdemain to make their results appear more impressive than they were in terms of reducing crime and narcotics addiction.* Indeed, other doctors tried to replicate Dole and Nyswander's program of methadone maintenance but found that many of the methadone patients continued their criminal careers despite the fact that they were receiving free dosages of methadone to take home with them every night.
* For an analysis of the various statistical artifices employed by Dole and Nyswander, see my article "Methadone: The Forlorn Hope" in The Public Interest magazine, Summer 1974.
In reviewing these programs, Donfeld fully realized that the data were seriously flawed, if not intentionally distorted, to gain additional funding, and that most of the claims of dramatic crime reduction resulted from evaluations by self-interested parties. And though he doubted that methadone maintenance would provide a permanent solution to the problems of either drug addiction or crime, he did think it possible that it could temporarily alleviate the administration's law-and-order problem by bringing about a reduced crime statistic in urban centers with large addict populations. The distribution of free methadone would lessen the need for addicts to steal, he reasoned, and furthermore, local police departments had adopted the policy of not arresting, where possible, addicts who were enrolled in rehabilitation programs (thus, massive enrollment of street addicts in methadone programs would automatically reduce arrest statistics in some cities). Donfeld therefore recommended to Krogh, "Drug rehabilitation is a virgin, yet fertile area for social and political gain."
As liaison with the District of Columbia government, Krogh had already been briefed by Dr. Robert DuPont on the possibilities of using methadone in Washington, D.C., based on a "filling-station" principle, in which addicts would have the same easy access to acquiring methadone as motorists have to gasoline. However, any sort of a national methadone program presented a problem, as Krogh explained to Donfeld, because it implied that the administration sanctioned the use of an addictive and highly controversial-drug. Donfeld nonetheless suggested a way around this political problem. In his June II visit to Chicago he spent a full day with Dr. Jerome Jaffe, who was then director of the Illinois State Rehabilitation Program, and found him to be not only an impressive administrator but also "politically sensitive" to the emotional issues involved in methadone maintenance. To avoid the charge that he was forcing addicts to become dependent on methadone. Dr. Jaffe olffered in his programs "modalities" of treatment, including detoxification and drug-free therapy as well as methadone maintenance. This "mixed modality approach," or what Donfeld called "different strokes for different folks," effectively masked the methadone program from political criticism. Donfeld noted in a memorandum, "Jaffe sells his mixed modality approach, though he believes that 90% of the addicts will require methadone ... the balanced program Is political protection." One month later Donfeld argued in a policy paper that "it goes without saying that the primary goal [of treatment] should be to create law-abiding citizens and thereby reduce crime" and that "methadone maintenance is the modality which can best fit our needs." He also recommended disguising the policy of maintaining heroin addicts on another addictive drug, explaining:
I believe that there are a number of sound reasons for describing any new drug rehabilitative initiative of the Nixon Administration in terms of a multi-modality approach rather than a methadone maintenance approach.
Implicit in the multi-modality approach is the notion that we are still searching for effective techniques to rehabilitate the drug abuser. If, therefore, there is not a perceptible decrease in the rate of crime once this rehabilitation program is introduced, we can always claim that the effective modality has not been found yet.
Krogh, who himself had never used any drug-not even cigarettes, alcohol, or caffeine-felt some reluctance about recommending a massive methadone-distribution program, but he was persuaded by Donfeld that it might be the only answer to the law-and-order problem. Moreover, New York City's Mayor John V. Lindsay, who then seemed a possible candidate for the Democratic nomination in the 1972 election, was implementing a major methadone program in his city-certainly a concern to Nixon's political strategists. Krogh thus ordered Donfeld and his Domestic Council staff to consider the option of a massive federal methadone program. The resulting 1970 Domestic Council summary option paper stated:
Mayor Lindsay has recently announced a 4.4 million dollar methadone program in New York City.... If methadone does prove to be successful in New York on a large scale, Lindsay can claim credit for taking a bold step while the Administration remained cautiously skeptical. -
Is the goal of' decreased crime more important than the inevitable outcry from some people in the medical community, liberals, and black militants that the Administration is subjugating the black addict to the white man's opiate?
In 1972 citizens will be looking at crime statistics across the nation in order to see whether expectations raised in 1968 have been met. The federal government has only one economical and effective technique for reducing crime in the streets-methadone maintenance.
John Ehrlichman, like Krogh, expressed serious doubts about the ,'morality and wisdom" of distributing an addictive narcotic in the ghettos as part of an administration program. Nonetheless, persuaded by Donfeld's assertion that this was the only means of reducing crime before the 1972 election, he recruited Dr. Jaffe to organize a drug review for the Domestic Council which would develop the methadone strategy. After Jaffe completed the study, Donfeld was assigned the task of analyzing this report and comparing it with an earlier in-house study prepared by the National Institute of Mental Health and other government agencies with an interest in the subject. In December, 1970, less than six months after he first learned about the possibilities of rehabilitation, Donfeld discredited in tile resulting Domestic Council staff report virtually all the reservations expressed by other government agencies about the proposed massive methadone scheme. NIMH objected to the "government ... sanctioning one addiction in order to reduce the burden on society of heroin addiction." Donfeld effectively attacked the objectivity of NIMH by writing, "It would be an overt admission that the profession of psychiatry has failed to deal with heroin addiction if the National Institute of Mental Health endorsed methadone chemotherapy"; for good measure he characterized NIMH as "privately [believing] marijuana should be legalized." Similarly, the Food and Drug Administration (FDA), which objected because "the long-term physiological effects of methadone are not known," was depicted as a bureaucratic morass. The staff report commented, "FDA bureaucrats have not made it clear to researchers precisely what data will suffice. The researchers, who are arrogant egocentrics, are incensed at anyone who questions their research." The failure of either the government or researchers in private programs to produce satisfactory data about the effects of methadone on the health of long-term users was thus cavalierly dismissed as "bureaucratic intransigence."
The most serious objections came from the Bureau of Narcotics and Dangerous Drugs, which suggested that methadone from government programs would inevitably be diverted into the black market and thus lead to an entirely new drug as well as a new law-enforcement problem. Donfeld granted that there was no way to prevent such leakage into the illegal market, but argued that even if this happened, it would work, at least in the short run, to the advantage of the administration. He explained, "Though non-addicts may die from methadone overdoses, one must question whether the costs to society are greater than the certain deaths from heroin and attendant crime or the potential death of innocent people." He even suggested that the leakage of methadone from treatment programs to the black market would undercut the price of heroin, thereby diminishing the addicts' level of criminal activity. He reasoned in the staff report: ". . . if heroin addicts were to obtain supplies of methadone [illegally], society is not hurt in a direct way because methadone will help to sustain an addict until he gets his next heroin fix: The addict will have less compulsion to commit crimes to obtain money to buy that fix."
One important objection to the massive distribution of methadone remained: the American Medical Association (AMA) still expressed doubts as to the medical safety and effectiveness of the drug itself. Since John Ehrlichman believed that there would be great political risks attached to the government's distributing a drug that did not have the sanction of that powerful medical group, Donfeld met on February 4, 1971, with Raymond Cotton, whom he described in a memorandum to Krogh the next day as "second in command of the American Medical Association's congressional liaison office ... in Washington." Donfeld then reported on this meeting to Krogh:
The gist of his conversation was that in view of the fact that in the last election the AMA gave 85% of its money to the Republican party and 15% of its money to Democrats who usually support the President on key issues, he felt that there was no reason for the AMA ever to be in the position to oppose the substantive proposals of the Administration and Congress. He made it quite clear that he wanted to be in the position to support the Administration on any issue on which we might want AMA's assistance.
Donfeld responded by asking for help on the methadone problem.
He [Cotton] said that a committee of AMA was currently preparing a trial position on methadone. I told him that it would meet with great favor at the White House if the position paper concluded that initial results in methadone projects seemed to indicate that it is efficacious and safe for the treatment of heroin addiction. He got the point and said that he would keep in touch with me on the progress of the documents....
In March, 1971, after trying to influence the scientific findings on methadone by the American Medical Association, Donfeld proceeded to draw up a final Domestic Council decision paper, which discounted all objections to launching a national methadone-maintenance program. In the rush to prepare analyses for the Domestic Council on this issue, Donfeld found there simply wasn't time to commission any independent studies or statistical evaluations of the existing methadone programs in various communities. The data which he originally found unacceptable because it was shaped by the self-interest of the various local programs was presented to the Domestic Council as "suggestive though not conclusive" that methadone "may significantly reduce arrest and crime records." Ehrlichman, who was never apprised of the vulnerability of the data, accepted Donfeld's and Krogh's logic on methadone in April, 1971.
Though Donfeld and the White House staff easily overwhelmed the muted resistance to methadone of the discredited bureaucrats in NIMH, FDA, and BNDD, there still remained the problem of convincing Mitchell, Richardson, and President Nixon of the political merits of the Domestic Council plan to distribute a highly addictive drug in urban centers. Krogh subsequently explained:
With the President as well as Mr. Mitchell and Mr. Richardson there was a basic hostility to developing this kind of [methadone] program.... The President in fact expressed himself that methadone was, if anything, more dangerous than heroin itself.... There was at first quite a strong feeling that the government should not be funding drug addiction.... Why should we be actually funding programs that addict people to methadone if it is nothing more than a synthetic opium? ... It took some time to persuade both Mr. Mitchell and John Ehrlichman that it was better to have a person on methadone maintenance where he was identified, where he could be counselled, where he could hopefully get a job, than to have them on the streets using heroin....
There was a feeling that it was moving too fast and more time was necessary to study the effectiveness of it. Nevertheless, we [were] persuaded ... that it was a doable program, that it could be on line within a year, and that some very direct results could be presented to the President in time for the 1972 election.
When John Mitchell and Elliot Richardson read the Domestic Council decision paper on methadone, they both reacted. is Krogh predicted, "negatively." According to a memorandum to John Ehrlichman written on March 30, 1'971, Mitchell recommended instead a small pilot project monitored by "a prestigious independent committee with a staff of highly qualified experts who have full access to the data generated by methadone and possibly other treatment programs." Secretary Richardson expressed his opposition even more forcefully and eloquently in a memorandum intended for the president:
All the professional agencies involved (NIMH, FDA, BNDD) are extremely wary of a greatly expanded federal emphasis on methadone maintenance. Their fears of an expansion of federal activities in this area must be treated with great respect, particularly given the conjunction of these views coming from greatly different programmatic interests.
My own view is that embarking on a national program of methadone maintenance may court potential disaster. We would be forced into the posture of pushing this program without the support of a generally accepted consensus of scientific knowledge and in the face of a judgment of our professional advisors.
The resistance was not sufficient to stop the methadone project in an election year. On April 28, 1971, Ehrlichman arranged a high-level meeting including himself, Mitchell, Richardson, Krogh, and their respective staff members to resolve the methadone issue. Before the meeting Krogh met with Mitchell and primed him on the political importance of launching the methadone program in time to obtain results for the election; the attorney general then reluctantly agreed "not to oppose." Handwritten notes of the meeting, taken by Krogh's assistant, reveal that Richardson counseled against anything more than "a careful pilot study," while Mitchell tried to assure him that methadone was "not the answer ... but only an interim measure."
In the days following that cabinet-level meeting Krogh and Donfeld became increasingly concerned that Richardson's articulate opposition to a crash program would undercut their plans for reducing crime statistics. As the time came for a presidential decision, however, Ehrlichman reassured them that Nixon was now haunted by the specter of "hundreds of thousands of heroin addicts returning from the wars in Vietnam." He would thus be disposed to approve of a White House-controlled treatment program, especially if it could be defined as a positive step toward restoring law and order. In writing the briefing paper for the president, Krogh and Donfeld skirted around the criticisms of Richardson and Mitchell, stating only: "Although controversial on moral, social, and medical grounds, and although not the answer to heroin addiction, methadone is the most effective technique now available for reducing heroin and criminal recidivism and increasing the employment of drug dependent persons...... The stage was thus set for the White House to direct millions of dosages of methadone into treatment centers in selected cities in the hope that it would bring about the dramatic results that the president demanded.
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