95TH CONGRESS 2d Session

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SENATE

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REPORT No. 95-820

DRUG ABUSE OFFICE, PREVENTION, AND TREATMENT AMENDMENTS OF 1978

MAY 15 (legislative day, April 24), 1978.-Ordered to be printed

Mr. HATHAWAY, from the Committee on Human Resources, submitted the following

REPORT

[To accompany S. 2916]

The Committee on Human Resources, to which was referred the bill (S. 2916) to extend programs of assistance under the Drug Abuse Office and Treatment Act for drug abuse prevention, education, treatment, and rehabilitation, having considered the same, reports favorably thereon with amendments and recommends that the bill as amended do pass.

I. CONSIDERATION OF LEGISLATION

On April 13, 1978, Senator Hathaway introduced S. 2916, the Drug Abuse Office, Prevention, and Treatment Amendments of 1978. The Subcommittee on Alcoholism and Drug Abuse held one day of hearings on S. 2916 in Washington, D.C. on April 19.

The bill was ordered reported unanimously from the Subcommittee on Alcoholism and Drug Abuse on April 25. It was considered in open executive session by the Committee on Human Resources on May 10, amended, and ordered reported favorably to the Senate. The bill is cosponsored by Senators Williams, Hatch, Javits, Cranston, and Riegle.

II. SUMMARY OF THE BILL

As reported from Committee, S. 2916 revises and extends the authorizations of appropriations for one year under the Drug Abuse Office and Treatment Act of 1972 (Public Law 92-255) to continue the drug abuse research, prevention, treatment and rehabilitation programs of the National Institute on Drug Abuse (NIDA) in the Department of Health, Education and Welfare. It proposes a total of $229 million in authorizations of appropriations during fiscal year

29-010-78 1

1979 for these programs. Under existing law, $212 million is appropriated for fiscal year 1978.

The bill provides greater emphasis on prevention and demonstration activities within the special grants and contracts program, and on evaluation of such activities. It requires a report on drug abuse in rural areas, and encourages the Gederal Drug Abuse Strategy to focus on prevention and on the needs of both urban and rural areas. It encourages greater coordination of drug abuse planning at the state and local levels with the planning activities of health and educational agencies. It stipulates activities peer review of grant and contract proposals within the National Institute on Drug Abuse. S. 2916 provides for an annual report on the health consequences and extent of drug abuse.

III HISTORY OF LEGISLATION

On March 21, 1972, the Drug Abuse Office and Treatment Act of 1972 (Public Law 92-255) was signed into law. The purpose of the 1972 Act was to "focus the comprehensive resources of the Federal Government and bring them to bear on drug abuse with the immediate objective of significantly reducing the incidence of drug abuse in the United States within the shortest possible period of time, and to develop a comprehensive, coordinated long-term Federal strategy to combat drug abuse."

In 1972, illicit drug abuse was widely perceived as having reached epidemic proportions, afflicting between 200,000 and 300,000 individuals. A message from the President to the Congress stressed that in New York City, narcotic deaths rose from 200 in 1969 to over 1,000 in 1970. At the same time, Federally funded community treatment facilities had the capability of providing services for only 16,000 addicts. The linkages between drug abuse and other societal problems and costs were also widely recognized. These other factors included increased crime rates, rates of death, increased health costs, lost productivity and other associated costs.

In response to the drug abuse problem, the 1972 Act established several programs. First, it established the Special Action Office for Drug Abuse Prevention (SAODAP) within the Executive Office of the President. It required the Director of SAODAP to provide overall planning and policy and to establish objectives and priorities for all Federal drug abuse prevention functions. Second, it provided for the establishment of the National Advisory Council for Drug Abuse Prevention to advise the SAODAP Director. Third, it required the President to establish a Strategy Council composed of the SAODAP Director, the Attorney General, the Secretaries of Health, Education, and Welfare, State and Defense, the Administrator of the Veterans Administration, and other officials to prepare a comprehensive Federal drug abuse strategy.

Finally, it provided authority for an expanded drug abuse prevention and treatment program within the Department of Health, Education, and Welfare. Specifically, it established the National Institute on Drug Abuse within the National Institute on Mental Health. It provided for formula grants to states for drug abuse programs under section 409. It provided for special project grants and contracts for drug abuse treatment and prevention programs

under section 410. It also contained other directives relating to other drug abuse functions and programs within NIDA and other agencies in the Department of HEW. In 1974, Public Law 93-282 removed NIDA from the National Institute of Mental Health and located the agency in the newly established Alcohol, Drug Abuse, and Mental Health Administration.

On March 19, 1976, the Congress enacted new legislation to amend the Drug Abuse Office and Treatment Act of 1972 (Public Law 94237). The purpose of the 1976 Amendments was to continue the focus of governmental resources on the problem of drug abuse while recognizing that durg abuse problems could not be solved as rapidly as envisioned by the 1972 Act.

The 1976 amendments recognized that drug abuse was not a crisis which could be solved but rather a continuing problem calllng for a continued Federal responsibility. These amendments made several changes in the drug abuse program. They established the Office of Drug Abuse Policy (ODAP) within the Executive Office of the President. SAODAP's drug abuse programmatic responsibilities were transferred to the National Institute on Drug Abuse within the Department of Health, Education, and Welfare. In addition, the authority and role of the Secretary of HEW and the Director of NIDA respecting drug abuse functions were clarified and the authorizations of appropriations for section 409-state drug abuse formula grants and section 410-drug abuse project grants and contracts were extended for three fiscal years through FY 1978.

The Office of Drug Abuse Policy was the successor coordinative agency to SAODAP which had been phased out.

The legislative intent made clear that this Committee and Congress as a whole were dissatisfied with inconsistent and sometimes conflicting Federal drug abuse policies, with no clear overall direction. The involvement of the Justice Department, Treasury, the Central Intelligence Agency, and the State Department in enforcement issues; the involvement of the Department of Health, Education, and Welfare, and the Department of Labor, and Veterans Administration in treatment and rehabilitation; and the involvement of HEW, DoD, and Justice, along with the Department of Transportation in prevention and education, created special problems.

The Congress was particularly concerned with establishing a central mechanism for accountability to avoid the prior situation where individual agencies or departments were able to assert that a particular aspect of the drug problem was outside their realm of responsibility, or that the drug problem was primarily one of enforcement, or treatment, or prevention, to the exclusion of an integrated strategy.

In Title II of the Drug Abuse Office and Treatment Act, as amended in 1976, ODAP's functions are spelled out in great detail. Its role was to insure a coherent Presidential drug abuse policy throughout the Executive Branch. It was to be headed by a Director and Deputy Director, both of whom were subject to Senate confirmation. Both were by statute required to testify before Congressional committees when so requested. Previously White House aides had refused to testify when requested, citing executive privilege. Other ODAP personnel were designated in the statute as well.

Generally, ODAP was required by statute to oversee all organizational and policy issues and to recommend and implement resource and program priorities. President Ford signed the legislation authorizing ODAP on March 19, 1976, but did not implement the Office, despite enactment of a specific line-item appropriation. On March 14, 1977, President Carter issued a memorandum to initiate the Office, urging full cooperation on the part of all Cabinet members. On May 25 a director and deputy director were confirmed by the Senate.

On July 15, 1977, the President sent to Congress Reorganization Plan Number 1. Among other things, this plan proposed to abolish ODAP. Under the Reorganization Act of 1977, this plan was to take effect at the expiration of 60 days (both Houses in session) unless either House vetoed the whole plan by majority vote. Senator Hathaway as Chairman of the Subcommittee on Alcoholism and Drug Abuse questioned the ODAP aspect of the plan in testimony before the Committee on Governmental Affairs on July 27, 1977.

Subsequent meetings occurred among Members of Congress, the reorganization staff of the Office of Management and Budget and Mr. James McIntyre, Deputy Director of OMB to discuss these issues.

On September 25, 1977, Mr. McIntyre wrote to concerned Members of Congress outlining the Administration's proposals for continued coordination of drug policy in lieu of ODAP. He indicated that the overall functions of ODAP would continue to be carried out within the Executive Office of the President. ODAP's policy development and coordination functions would be handled primarily by the Domestic Policy Staff, with several members of that staff assigned exclusively to drug abuse issues. He assured Members of Congress that Dr. Peter Bourne, Director of ODAP, would continue to take the lead in formulating a comprehensive drug abuse policy, subsequent to the termination of ODAP as a discrete entity, including planning, enforcement, and other critical issues, in his capacity as the Special Assistant to the President for Health Issues. He would remain available to testify before Congressional Committees on drug abuse issues. Subsequent to its termination, the reorganization functions of ODAP would be transferred to the President's Reorganization Project. Mr. McIntyre also indicated that ODAP could continue to exist until April 1, 1978 to complete its ongoing studies and policy recommendations.

With respect to ODAP, the President's Reorganization Plan took effect on March 26, 1978. Its staff members were assigned to various offices in the Executive Office and in other departments and agencies of the Federal government. A core staff of ODAP was transferred directly to the Domestic Policy Staff under the supervision of the former deputy director. All of these individuals report directly to the Special Assistant to the President for Health Issues.

IV. NEED FOR THE LEGISLATION

The Committee strongly believes that Federal drug abuse policy, if it is to be effective, must continue to be coordinated at the highest levels of the Executive Branch. While many problems in our complex society inevitably cut across multiple Federal departments and agencies, none appears to be more insidious in impact or intractable in cause than drug abuse. Further, to help stem these tragic social and

economic costs, continued Federal support of prevention, treatment, and rehabilitation is vitally needed.

The scope of licit and illicit drug use and abuse is staggering in its magnitude. In 1977, 1.4 billion prescriptions were written-or seven for every individual in the Nation. The per capita consumption of alcohol was slightly over two gallons for every person over 15 years of age. Fifty-five million Americans smoke cigarettes daily. There are between 450,000 and 500,000 daily users of heroin, and over 4 million Americans who have tried cocaine.

Active nonmedical use of other drugs, such as amphetamines, tranquilizers, and barbiturates is estimated on the part of at least 5 percent of the adult population, or among at least 7 to 8 million Americans. So-called "poly-drug" abuse, or use of more than one drug at a time, appears to be reaching epidemic proportions. And the deadly drug Phencyclidine, PCP, or "Angel Dust," is increasingly becoming a favored chemical of abuse, especially among our Nation's youth.

In this regard, the following three tables adapted from the March, 1978 Office of Drug Abuse Policy study "Drug Use Patterns, Consequences, and the Federal Response: A Policy Review" are instructive.

TABLE 1. ESTIMATE OF RECENT NONMEDICAL USE (IN THE PAST MONTH) BY AGE GROUP, BY DRUG OF ABUSE

Marihuana:

TABLE II.-Annual use by high school seniors for 1975, 1976, and 1977

1977.