PM: Good morning.
My name is Paul Musgrave. I have the honor and privilege to be
sitting here with Dr. Jerome Jaffe. It's July 29th. We are in Columbia, Maryland at
Dr. Jaffe's house. Thank you for agreeing to participate in the
Richard Nixon Oral History Program. JJ: My pleasure. PM: Let's go ahead and get started. When do you first become interested in the problems of addiction? JJ: I suppose when I was sent
to Lexington, Kentucky as a resident in psychiatry and that was
1959. You had to get interested because that was, at the time, the major center for both research on addiction and the treatment of addiction. PM: And you come over
in the clinical side, right? JJ: I was sent there as a resident, yes. This was the,
we rotated through the clinical service of the US Public Health Service Hospital.
PM: For people who may not know, can you explain to us a little bit what the Public
Health Service is? JJ: Well, the Public Health Service was set up somewhere in the beginning of the 19th century. It was originally to take care of American
seamen and then it evolved. It continues. It's a uniformed service; although, it's
not part of the Armed Forces except in war time and then they serve with the
Coast Guard. So, it provides medical services to the Coast Guard. It also
staffs, there are people in the Public Health Service who serve in the Indian
Health Service. There was, until maybe 20 years ago, a series of Public Health
Service hospitals that took care of certain beneficiaries of the federal
government as well as American seamen, and and then there's the Coast Guard and
there's the US Prison Service that used to have Public Health Service officers
serving as medical officers. PM: And of course, the head of the Public Health
Service is the Surgeon General. JJ: The Surgeon General. Correct. PM: Lexington, Kentucky in 1959. What are the major issues, the major topics that are
being discussed as you guys are on the forefront of addiction research?
JJ: Well, we weren't, I wasn't on the forefront of addiction research; although, the
Addiction Research Center, which was co-located at the US Public Health
Service Hospital in Lexington, was at the forefront of research at that time. The
hospital was a separately administered entity that was taking care of
approximately 1,200 drug addicts, mostly heroin addicts but a few others who were
addicted to other substances, and some were volunteers, others were actually
federal prisoners. So, it was a kind of a hybrid, it was a hospital-prison. PM: When do you move to Illinois? JJ: Oh, that was sometime later. It was nineteen, the end of 1966 in December of 1966 but I'd
been consulting in Illinois for approximately six or seven months prior to that time. PM: And this is kind of a new departure. Where do you start in
Illinois with the treatment program? JJ: Well, it was not really a new departure. After
the Public Health Service Hospital, I went to Albert Einstein College of
Medicine to complete my psychiatric training but also to do some
postdoctoral training in pharmacology, and during that period of time, I did
some research in pharmacology on the biological basis of physical dependence,
and I also got involved with treating addicts because the people from
Lexington somehow found out where I was and asked me to help them in various
ways. So, I had already done some treatment with narcotic antagonists.
I had done some work with opiate maintenance, methadone maintenance.
I had visited some therapeutic communities. So, I had some experience with treatment and
was interested in looking at which kinds of treatment worked best for which kinds
of people. For a variety of reasons, that couldn't be done at Albert Einstein and
I was offered a position in Illinois by Dr. Daniel X. Freedman who was going to
be the new chairperson at the University of Chicago Department of Psychiatry, and
he was asked to consult with the Illinois - I think it was called the Drug
Advisory Council that was thinking of how they could respond to the addiction
problem in Illinois, and he was busy with other things. I was sort of his surrogate
and I offered them a variety of ideas and but I told them very candidly there
was just no way they could pick one of a variety of different treatments and
assume that that would be the right one, that the only sensible thing was to
actually set several of them up and compare them and see which one was best
suited for the people in Illinois. Their response to that was to produce a report,
obtain a, uh, an appropriation from the donor legislature, but then set some conditions.
They said that they would only implement it if I would agree to run it. I had a
career development award that was going to support my research at the University
of Chicago but I just felt by that time I had met enough people who needed
treatment that I felt that if they were the conditions, I'd just have to accept
them and begin to set up a treatment system in Illinois. So, that sort of ended
my laboratory research, uh, and I became maybe a hybrid myself. I was
concurrently a University of Chicago faculty member but I was also the head
of the Illinois drug abuse programs, and we began, with the help of the university,
to build a variety of treatment programs in Illinois. At the time that the
Illinois Advisory Council set this up, there was virtually no treatment at all
for drug addicts in Illinois. And so, that began sometime, the planning stage was
late 1967 and the implementation was January the 1st 1968. We subsequently got
some support from the National Institute of Mental Health. It was a community health
grant. And so, we had two pockets of money and began to build this treatment system.
PM: I want to ask you a couple of follow-up questions about this. The first is that I
assume politicians, folks in government generally always want to hear that
there's a silver bullet. And so, when you tell them that they are going to have to
try several different things, what was their reaction? JJ: I don't know what they
were thinking but, eventually, maybe they found it
refreshing that somebody said there is no silver bullet, that different people
may need different kinds of approaches. Now, there were objections to using
something like methadone, which at that time was still quite investigational, if
you will. There were difficulties in setting up therapeutic communities.
Nobody had ever heard of narcotic antagonists. People knew about detoxification programs. But at any rate, I think, generally speaking, they realized
that what I was saying seemed to make sense. PM: Well, can you talk a little bit
about about narcotic antagonists and how they work, what their function is?
JJ: Well, narcotic antagonists are drugs that essentially get on the same receptor as
drugs like morphine and methadone but they block the effect. At that time,
they were thought to produce no effects on their own but simply block that
receptor so you couldn't get high from an opiate like morphine nor could you
die of an overdose from a drug like morphine. Now, the first antagonist,
partial antagonist that was used was a drug called nalorphine and that had been
studied at Lexington as early as 1954 but somewhere in 1964 or so, Bill Martin
at Lexington at the research division at Lexington worked with a drug called
cyclazocine. It was a longer acting, orally effective, narcotic antagonist and
he and Abe Wikler, who was a very noted, you know, a giant of a researcher, talked
about the use of antagonists in treatment because they thought if people
were maintained on antagonists and could not get high or get the effects of
opiates, eventually, they would, if you will, extinguish the habit of injecting. And back in those days, this was 1965, I think, just after Bill Martin had talked
about it, it was possible to get an investigatory new drug application
approved without a lot of paperwork and I was able to do an experiment with
narcotic antagonists while I was still at Albert Einstein, and the remarkable
thing was that although a lot of people thought that methadone was the only
pharmacological treatment that you could use, there were lots of drug addicts who
simply wanted to be free of being addicted who volunteered to take cyclazocine, which was not a perfect antagonist. If you took too much too early, it had
side effects, made you feel a little weird, but people persisted, people took it. So, it
didn't prove that it was as effective as methadone but it did say that people who
most people thought only wanted to get high would take something that didn't
get high and would only block the effects of opiates because they wanted to change
their lives. And so, I was impressed with the idea that people were motivated to do some things. And so, the story on cyclazocine was that we worked with that
until, I guess, about early 1970 when Martin again had developed and worked
with a new pharmacological compound called naltrexone, and naltrexone was
another antagonist, it did the same thing, it got on the receptor, but it did not have,
you know, unpleasant side effects, it was almost neutral, and it was long enough
acting so you could take it once a day and it would work, and I subsequently had
an opportunity when I was at the White House to accelerate the development of
naltrexone, and that turned out to be an interesting story because although, you
know, it didn't seem to be particularly useful for opiate addicts, it has become
a major treatment for alcoholism. PM: Well, we'll talk about that one when you get
to the White House. I wanted to ask you another - you had an observation that you
felt at this point that it was important for you to help treat - you'd met a lot of
addicts - that it was an important to you. JJ: Yeah. PM: Can you tell us a little bit more about that?
JJ: Well, uh, you know, they, I mean, people's image of the drug addict, you know, did not
necessarily coincide with the people I met. Many of them that I met had jobs,
they worked. I mean, they spent a lot of their money on illicit drugs but
they were otherwise people that I would trust and that were, I guess you
might say, I liked them, and when I got to Chicago, I met people desperate for
treatment, and even before we set up the Illinois drug abuse programs, as I said,
I've been consulting since mid-1966, I met various people, spoke to them. I even
arranged for some of them to go get some training at a therapeutic community in
New York so that we might have a cadre of local people who could form the
nucleus of a therapeutic community or get involved in treatment, but most of it
came later, subsequently, as I, people got better and from the beginning, people in
recovery, I don't know whether everybody would say they were in recovery but they
were certainly doing well not using illicit drugs, were part of the
treatment program. You know, we made arrangements to hire some of them as
counselors and, at certain points, they became supervisors as well and took
various jobs in the Illinois drug abuse program. PM: Did you talk to people outside
of the outside of the clinic? Were people receptive to the idea that, you
know, heroin addicts were not street thugs or lowlifes or whatever the
stereotype was at that point? JJ: I think some were. Some, I think, were still
skeptical, I mean, but a great community that I dealt with were the families of
the drug users who were, you know, more than pleased that people were in
recovery and doing well and families were back together, no longer disrupted
by the running and all the activities associated buying illicit drugs. So, you know, I had lots
of people. It was an odd kind of relationship, not really one of
psychiatrist to individual patient because I was the director of the
program and there were good friendships, close friendships. Periodically, we would
have everybody in the program would come to a party at my house and we made no
distinction between the psychiatrists and the other faculty members who were
working with me and the drug addicts who were working as messengers and other
things in the program. PM: In the summer of 1970, you get a phone call from Jeffrey Donfeld in the White House. JJ: Yeah. PM: What does he ask you to do? JJ: Well, I'm not
sure what he asked me to do first. There was a-- He may have come to visit the
program first or he and then subsequently called me or he-- I think
that might have been the case. He may have visited me and then called me, asked
me to comment on some proposals by the Department of Health, Education and
Welfare and the FDA to restrict the availability of methadone and, apparently,
there was some blowback from the expansion of methadone, and it was not that
great, I mean, there was New York and a few other places. Nevertheless, they
wanted to sort of clamp it down and they proposed regulations that would largely
limit its size, restrict who could get it and for how long, and he asked me to write a, uh,
some comments, and I recall I think I wrote a nine page single-spaced letter
to him on that issue and, subsequent to that, I mean, he visited the program and
then, the next time I heard from him, I think was sometime in October of 1970, and he asked me if I would form a
committee and write a report for, I think, for the White House or the
President, I don't know how he expressed it but this would be a report on what we
should do about the drug problem and I was instructed that I should put
together a committee of experts, and then he began to put qualifications on it. It
had to be done in something like eight weeks and it had to be absolutely secret.
Everybody had to swear to secrecy, it could not be published, they could not
talk about it, and they would not be paid very much either, and, you know, this was I think
unrealistic because the people that you put together are working at other jobs.
They don't necessarily drop everything. So, they would have met, meeting on weekends, and then going through mounds of information. For whatever reason, probably a mistake but I
agreed to do that, to put this group together, and I managed to get a
remarkable group of people to agree to these somewhat odd conditions. They were
professors in various areas. They were pharmacologists and psychiatrists and
sociologists, people of great distinction, and we put together such a report.
I recruited a man named Ed Brecker as a writer. Ed subsequently wrote something
called "Licit and Illicit Drugs" for Consumer Reports. So, very widely read book. Uh, and
we put together a report. It was not a a work of great literary merit but it we
got it done. We got an extension from Jeff to an extra two weeks so we turned
it in mid-December and one of the reasons we got the
extension was because he kept calling up and saying, "Well, what about this? What
about that? How do you answer this? How do you answer that?" So, there's lots of
little appendices, most of which had to do with, you know, methadone and, you know,
I figured out that somewhere in the bureaucracy in Washington, people were
raising various objections to utilizing methadone as a treatment and he wanted
in our report that we would respond to each of those. So, the report looks a
little lopsided but that was the context for it. The report was also colored in a
major way by something I had done just that December before Jeff called me.
Somewhere in the summer of 1970, I was asked by Dale Cameron, who was then
working with the World Health Organization, they had something called
an expert committee on problems of drug dependence, and Dale asked me to join
with Professor Griffith Edwards from the Institute of Psychiatry in London and
draft a white paper that which is a working draft for a report on national
strategies. And so, and I don't know why Dale suggested me or why Griffith or how
that came about but Griffith was interested in the idea of a national
response, some coordinated thought through plan to deal with a problem.
And so, I worked with Griffith, I believe, at his house for several weeks. We put
together a report about national strategies. And so, the beginning of the
report for the White House, you know, paraphrases, maybe that is a
euphemism, in part, maybe we plagiarized ourselves using some of the phrases
about the importance of having a national coordinated strategy to deal
with the problem, and that was what we felt was important,
to get all the pieces together: law enforcement, treatment, prevention. All of
these pieces talking, thought through, and how they interact. In addition, Jeff asked
us to say if you had X dollars, I think he was talking about fifty million
dollars, how would you spend it? And so, we laid out how, maybe it was 100 million, I don't
remember at the point, how would you allocate that, and we
talked about the importance of research, the importance of having outcomes.
You have to say, you have to measure whether you're getting what you thought you were
going to get. So, you have to specify your goals, you have to, and how you will
measure those. So, we talked about the need for research, the need for outcomes
research looking at are you changing what you want to change, and then you
needed to have treatment because there was clear there was a huge treatment gap
all over the country at that time, I guess this was the end of 1970, there
were people waiting to get into treatment, not just in methadone; although, the lines were
longest at methadone programs, but even to therapeutic communities. We were,
apparently, in the midst of a major epidemic and people wanted out and they
wanted treatment and the treatment wasn't there. So, we turned in the report and I
got a note from the President saying 'thank you' sometime in January and I
heard nothing more, and that's the Donfeld story, and that was-- I heard nothing
more until somewhere in terms of April, and in April, I think he asked me to come
to Washington again and we talked about something that had not even been on the
horizon in any way when we wrote this report, just had turned it in in December of
that year, and that was heroin use in Vietnam, and, you know, again he said, "Well, what can we do? What should we do about this?" and I said,
"Well, give me some time to think about it." He said, "Well, you can think about it but you
can't ask anybody about it, you can't say anything about it, you can't..." and this is
one of these sort of strange requests of what would you do if the only resources
you had were inside your own head, if you have to keep it secret.
And so, you know, I said, "Well, the first thing I would try to do is to try to
find out what the real numbers are." So, you have to, essentially, decide which of
these people that, you know, are using heroin are addicted, which are just users,
how much of it is hyperbole generated by the press. PM: And the numbers being thrown
around at this point are ten, fifteen, twenty percent. JJ: Well, the numbers, he said he had gotten a heads-up from two Congressman - Congressmen Steele and Murphy. I think that was a courtesy that
no longer occurs nowadays that Congressmen would give the White House a
heads up about a report coming out. That they thought it was they said something
to 15 to 20 percent of the troops, and this was kind of frightening. At the
time, the policy was to withdraw a thousand people a day. So, if the
numbers are as high as 30 percent, that's 300 heroin addicts addicted who were
just being flown back and released that day into the population. And so, there
were a lot of things that went into what I suggested but some of it was pure
happenstance. The previous January, I had been to a scientific meeting, shared an airplane ride, with Professor Avram Goldstein of Stanford and he told me
about a new technology for detecting drugs in urine that could detect the
presence of opiates within a minute and this new technology required only a few
drops of urine, and this was a major technological breakthrough because other
than that, you'd have to have a thin layer chromatography or gas
chromatography, difficult technologies required a lot more training of technicians, much slower, much more labor-intensive. So what I suggested that
we could do was we would test everybody and before they were discharged, before
they came back to the United States, and those who were positive would be invited
to stay a little longer for detoxification. Now, the reason I felt
that the detoxification should take place in Vietnam was because some
theories that they, Wikler, had suggested - I mentioned Abe in connection with the
antagonists - it was his theory that withdrawal symptoms became linked by
learning, conditioned to environmental stimuli. So that if you were withdrawn,
let's say, in your home environment, that those environmental cues would call
forth craving for drugs. So, I assumed that if there's anything to this theory, we
better get the withdrawal over with in Vietnam because they're unlikely to
encounter those cues again when they returned. PM: So, if they go through
withdrawal in one environment and then they can move them to a new environment,
you won't have, less possibility of a relapse. JJ: That was the theory but, you know, without being able to discuss it with anybody,
could only go on theory. So, I said, "This will give us epidemiology. This will give
you some deterrence. It will give you a chance to treat those who need treatment..."
and, of course, there's only one flaw. Under the current circumstances, using
opiates was a court-martial offense and people
would get either a bad conduct discharge or dishonorable discharge, and I
suggested that, you know, obviously, if you're gonna do this, it's a public
health issue. You're detecting a disorder, a medical disorder, and you have to
change the regulatory situation, the Code of Military Justice, so that you can do
this. It's like taking an x-ray, you know, if you find somebody with a lung disease, you don't give them a bad conduct issue discharge. I mentioned that. And so,
this was, I said, "I guess that's what I would do," uh, and, apparently, they discussed this
and as far as I know, they probably, you know, came up with other ideas or other
people said some things but, you know, as harebrained as it was, nobody had a
better idea. And so, I got another call. I believe it was on just about Memorial Day.
Because I remember I was supposed to give a lecture and I had to call a
friend, Ed Wolfson, and I had to give him my slides. We met in Princeton. He lived
in New York. So, we met in Princeton, I gave him my slides and said, "You have to
give the lecture. I have to do something else," which, of course, I could not reveal,
and I went to Washington and I was just prepared to talk to Jeff again but I
think, at that time, I met John Ehrlichman, and I guess I met Bud Krogh, and then
they said, again without any great notice, "We're going to visit the Pentagon."
I assumed that the purpose of the visit was to discuss this plan with them but
as it turned out, it was more than just a couple of people at the Pentagon. There was a
whole roomful of generals. There were a couple of colonels but standing around
the wall but mostly they were generals and the Secretary of the Army, and I don't
know exactly how the context was set up but there was just Jeff and I
sitting there, and I guess Jeff introduced me as a consultant of the
President and said, "We're going to talk about this plan," and I told them what I
thought should be done and they said, "Well, can't be done but we were thinking of
doing it in September," and, you know, and, you know, I was, you know, I was just there,
I was the head of the Illinois drug abuse program. Now, I will say one thing.
When Jeff called me to come in, I thought that maybe he was going to implement
this plan - not that it would come about in that way but that maybe they would do
something. So, I called, you know, wearing my Illinois drug abuse director hat, I
called the man who made the FRAT [Free Radical Assay Technique] machines, these are the machines made in California that can detect the opiates in one minute, and I already had one on order for my program in Illinois. It was to be the first prototype actively
being used. They were expensive machines and there were not many people
who were ready to buy them, and I asked him whether he could make another one
and how long it was take, "A few weeks, a month or two." I said, "Well, what about if
you put people on 24 hours a day?" and he allowed us "Maybe we could make it a little
faster," and I said, "Well, I can't exactly tell you why but, you know, if you do that,
I don't think you'll be sorry." I suppose he did that. His name was Bill
McGlashan and he was the vice president for Syva Corporation. And so, when I was
sitting there at the in the Pentagon, I knew that we had these two machines, and
when they said, "Well, maybe we can do it sometime in September. Maybe," and I was
going through my mind that a thousand people were leaving a day, this
the 30th of May as I recall, and I felt just I was sharing them candidly. I said,
"Look, gentlemen." Actually, what I said was, "You know, I can't believe the mightiest
army on Earth can't get its troops to piss in a bottle." I think that might have
been the phrase that got their attention because it seemed to deviate from
protocol given the generals and things and I said, "Look, I know you're busy
fighting a war but if you get me a telephone, I'll get some civilians and I
think we can get it up a little sooner because the President wants it sooner than that,"
and Jeff, to this day, thinks, that I had a plan to sort of, uh, you know, ambush the
military. I didn't have a plan. I was very serious. I thought maybe, you know, we
could get some guys who weren't busy fighting the war and we would set this
thing up but they took it as a threat coming directly from Richard Nixon and, uh,
they called a recess to the meeting. They went in the other room and they
came back and they said, "We can do it. We'll have it up and running by June the
17th," and I said, "That sounds very reasonable." And that was the end of the
meeting at the at the Pentagon. Things went on at the White House, subsequently,
but I think that the recognition that the drug problem was not limited to, you know,
the civilian population but would involve the military and would involve the
Veterans Administration essentially generated the idea that what we needed
was some coordinating mechanism at the White House to make all these people
work together, and that probably was the the origin of what came to be called the Special Action Office for Drug Abuse Prevention [SAODAP] but the thought of doing this,
I think, was came from Jeff and Bud Krogh on how to do this, with some help from
the people in OMB. And so, all of that was going on vis-a-- behind the scenes
subsequent to that meeting at the Pentagon. PM: I have a couple of follow-ups.
The first is, by this point, when you're when you have the night of the
generals, have you met President Nixon? JJ: I think I did. I think after I spoke to
John Ehrlichman I might have met with him. Yes. I'm sure I might have met with
him and it was, um, no, one should remember when one meets with the President the
United States but, you know, I was, frankly, busy running back and forth between
Chicago and the other things. I don't remember whether I met him prior to going
over to the Pentagon. I might have. I know I met with John Ehrlichman because the
plan was run by John Ehrlichman, uh, but I'm certain I might have met him sooner than
that. Uh, you know, it's an embarrassment but I don't know the first time I met
him. I don't recall exactly what day it was. It was certainly before June the 17th.
PM: Well, I'm just asking because you, um, here and other places, you you felt
confident to say, you know, the President wants this, which is kind of a magic phrase, especially if you're a consultant to the President. JJ: Well, I knew that Bud
and Jeff spoke for the President and that this was an urgent issue and that,
you know, they needed to do something about this. Perhaps I had met him.
PM: You take a trip. Bud Krogh does an inspection tour of Southeast Asia.
JJ: Yes. PM: You meet with him in South Vietnam. JJ: No, that was later. PM: Oh, it's later. JJ: Oh, yes. A number of things took place between that meeting at the Pentagon and June the 17th. As I
said, the subsequent events had to do with things that went on with the
President meeting with various people on this issue, including, I guess, the Joint
Chiefs of Staff around this issue, things of this sort. I mean, I'm not sure the exact dates but, uh, this plan for the Special Action Office was developed, slides were made of
all of its responsibilities for coordinating research and prevention and
treatment and education. A long list of things that one had to do, including
producing the first national strategy, a variety of things. At any rate, the, uh, I got called back somewhere
around June the 16th and, again, with out much preparation, I didn't think I was
staying overnight even, as I recall, and they told me I would stay overnight.
So, somebody had to buy me another shirt and then, I had a meeting in the Cabinet Room.
Again, it was a strange experience because nobody told me what I was
supposed to do but they sat me in the corner and the President brought in
members of Congress and told them he was going to launch this major initiative on
drug abuse and he pointed to me and he said, "And Dr. Jaffe is going to run it."
And, you know, one doesn't say 'No, Mr. President. I have other things to do,' but, you know, that was the first time I knew that that was going to happen and lots of people were angry
with me, including the University of Chicago that should have, you know, they
thought I should tell them about this plan, my wife who didn't know that we would
do this. At any rate, and then, I think on the same day, we had a press conference and I
was asked to say what the plan was but I had no idea what the plan was. PM: Did anyone accuse you of having a secret plan?
JJ: They could tell I had no plan but it was clear that, I mean, the one major
task, it seemed to me, was one I tried to put together. I said, "We want to have--"
It was clear, in addition to what we're going to do with the Vietnam situation,
is this treatment gap of lots and lots of people wanting treatment, couldn't get
it, and crime associated with the fact that the drug is illicit and costly, and
I said, "We want to make treatment so available that nobody can say they
committed a crime because he couldn't get treatment." We thought that would
clear up some of the ambivalence that the judges had and other people had
about whether somebody, but for their drug addiction, would have been a decent
citizen or whether they were just a criminal who was using drugs. So, that was
the goal and that was the goal we pursued - to expand treatment so that
people could get treatment rather than committing crimes.
Obviously, the, what we did was far broader and more diverse than that but
that was a centerpiece of what we intended to do, and immediately
thereafter, the President told me I was going to make an inspection tour of
Vietnam. Another small surprise but, uh. So, uh, I had, at that point, the Special Action
Office had one employee. I wasn't even on the government payroll
at that time but I was the the one employee of the Special Action Office. So, my task
was to find people, recruit people, bring together an office that was going to
take care of all of these major tasks, get it done quickly. They talked about
urgency and how important it was to mobilize all the resources to get this
done and while all this was going on, I was going to visit, make an inspection
tour Vietnam, and I think I did leave somewhere around the 1st of July or
something of that sort. Maybe it was the a couple of days after that.
PM: Because Bud has left a little bit before you. Because he comes back. JJ: Yes. PM: And it's-- JJ: Well, we meet in San Clemente. PM: Right. JJ: But as I recall, I left toward the end of June. So, I had
maybe 10 days to wind up my affairs at the University of Chicago, to begin
recruiting people for the Special Action Office, and to prepare for a trip to Vietnam.
PM: I want to spend some time here working on the different levels of this,
and the first one is, I think, an interesting question that people who are
not in government service, people who have never gone through this may not
understand. What happens to you, personally, when you're asked to move
yourself, move your family from Chicago to, in your case, Arlington at the drop of a hat?
How do you arrange that? JJ: Well, I think you arrange it in different ways. I think that, under ordinary circumstances, the first thing people do is they set up
some kind of trial balloon to see if you have something in your background that
you had somebody working for you who didn't pay taxes, something of this sort, but
that didn't happen with me. So, I don't know exactly, you know, why what happened
happened so quickly. Bud said it occasionally happens when you have,
you're not sure whether somebody will accept, you do recruitment by ambush and
so they can't really turn you down, but I suspect that, you know, they negotiate a few months in advance and you have some time.
This didn't happen. So, I don't know how typical it is that these things go on. It was
tremendously stressful for me and my family and certainly for everybody at
the program. I mean, I was running a program with several hundred employees
and many, many treatment situations but there were some faculty people there
more than willing to take on the grants and to run the program, and I suppose in
some ways, although that the people were also pleased that I had been selected.
So, you lose something, you gain something, but I don't think my family was. I mean, we
were, the kids were in school. So, uh, I don't know how other people react. I just took it as,
you know, I suppose what I thought was, in a way, compared to the stresses on the
people who are actually serving in Vietnam, who are actually fighting, dying, being
wounded, this isn't that much of a burden. And so, I felt in some ways, you know,
complaints would be inappropriate. PM: And the next question is about organizing this at a bureaucratic level. I assume that there, you know, you had to go
through some sort of clearance process once the President had appointed you.
Or or was this more or less automatic? JJ: You know, I don't know. I mean, they may have
been checking me out even, and Faith would know, because there are FBI people going
around asking neighbors, exactly when that took place but maybe they were
doing some checking even as I was producing that report. Because, after all,
they want to know who is writing this report but I just can't recall now. You know, I know they spoke to neighbors and things and did
check me out but, you know, I didn't have time to reflect much on it. Now, in terms of
getting the program organized, there's something called detailees where you can
actually, because the White House can ask to borrow people from other agencies, and they were,
they're very good at that. And so, we pulled some good people from
OMB. There was a guy named Jim Gregg who was a young, Harvard trained lawyer who was
really a, you know, well-organized, knew bureaucracy. There were other people more
than willing to help put it together. Obviously, Bud knew a lot of them, so did
other people in the White House. Uh. We recruited some other people. We had
people detailed from NIMH. So, the military sent a couple of people. So, we
had a little core group and then began to expand. Jeff actually left his
position on the White House staff to come over and help. PM: Jeff Donfeld? JJ: Jeff Donfeld. And so, he was invaluable in that. PM: Because there's another Jeff later on in the story. JJ: Oh, yes. PM: Right. JJ: This is Jeff Donfeld. PM: So, that you use a lot of detailees to staff this this program.
JJ: For the first few days, for the first couple of weeks, yes.
PM: How did you go about recruiting people to fill out your organization on a more permanent basis?
JJ: Well, I will say that this was very unusual, I think, in any White House. I was
given carte blanche. There were no litmus tests. You didn't have to be a Republican.
You didn't have to agree with the President. And so, we recruited almost in
a snowball fashion. Jim Gregg knew some people that he believed in and I
recruited Paul Perito who I had known. He was a congressional staffer. He was a
lawyer. I had worked for Claude Pepper's, I think it was the House Committee on
Crime, and, uh, and he had met me because I gave some testimony before Congress on
the drug problem and crime. And so, I got Paul to come as
the general counsel and he's a Democrat, and, uh, I had Jeff and Paul, and Paul knew some people and he had some people on his staff. So, you know, people recruited other
people. I had some people I knew at NIMH but the Special Action Office, from its
beginning, was given extraordinary power. It was called the drug czar's office and
that extraordinary power had to be limited in some way and it was limited
by this will not last more than three years. So, I had to tell everybody,
carefully, that if you give up your civil service position, you know, you may not
have to anything to go back to because this thing is going to end in three years.
I was committed to that but people wanted to come anyway. There's something
about working in the White House that was in, you know, to them, had some appeal,
and I guess there were some people whose positions they didn't like that much anyway.
PM: Rarely helps, uh, rarely hurts anyone to have "White House" on their CV.
JJ: I suppose so. At the time, that didn't occur to me. So, that's how it, you know, began to, you know,
by accretion. We recruited an executive officer, Ralph Howard. Ralph was a wily guy
who really knew the bureaucracy. He was working at OEO and, uh, OEO was one
Lyndon Johnson's favorite vehicles and Ralph would often be on the other end of
a telephone call with the President, 'I want this done by next week or next year,
tomorrow.' Ralph knew how to get it done. And so,
they brought in Ralph Howard as the executive officer and that was important
because there were things that needed to be done or, at least, I perceived them, would need to be done with extraordinary alacrity. I mean, they wanted it done tomorrow.
And so, we were doing it and we had much more flexibility than the other
agencies did. And so, we were able to do some things like that. For example, when we got,
when I got back from Vietnam, I guess it was somewhere around July the 12th or 13th,
something like that, we met with the President at San Clemente and he said,
you know, we gave him a report of what we saw and he said, "You know, in the past, great
advances in medicine have come about in the context of war and I want you to write a
book about what you're finding here." In addition to everything else, I mean, I had
write a book. Well. Now, so, it's important and I would
have done it anyway but what he said gave me the imprimatur that I needed to do
what I thought needed to be done anyway, which is what happens to these people,
how successful was this intervention, and that allowed me to recruit Lee Robins
who was a professor of sociology in the Department of Psychiatry in Washington
University at Saint Louis, and she had done some early work on drug addiction.
She's just a brilliant lady. Dan Freedman said, "Call her." I think I knew her from
some review committees we were on together but I asked her to do a
follow-up study, to do a study of what we did in Vietnam, but in order to do it
before it disappeared, we can't wait a year to make the grants. So, we sort of
ground, got money from various agencies, plus a little bit that we had, and we
melded them together and wrote a contract with Lee. And so, she was able to
do what turns out to be one of the classic, classic studies in all of the
history of addiction - the Vietnam follow-up study, and Ralph was critical
pulling those grants together and making it happen. So, it's important to know people
who know how to move the levers, turn the knobs, to get things done in government.
And so, we had our share of those. Paul recruited somebody named Grasty Crews
from the from the Federal Reserve. Grasty Crews was a lawyer, a master legislative
draftsman, a writer with phenomenal clarity and brevity unparalleled. And so, he began
putting together the actual legislative material to give a statutory base for
the Special Action Office. I mean, we were created by Executive Order, which meant
that we existed on the White House budget. So, there are limits to how long
that could go on. We needed a legislative basis and that meant going to Congress.
So, somebody had to begin to draft the various pieces of legislation so they
could be given to the Congress and Grasty did that. Grasty subsequently
drafted confidentiality regulations that are still in existence and played a role,
a small role, in working with methadone so we-- Because that was another major initiative.
And so, we had a number of savvy, competent players who joined us in this
effort. I was simply the talking head, if you--
PM: I'm impressed you got somebody to leave the Fed. They have a much better pay scale.
JJ: Paul knew him. I don't know how Paul persuaded him. PM: I want to ask a couple more
questions here. Because this is important and a lot of what comes later, of course,
is determined by what comes at the beginning but this may seem like a
trivial point but I think it's actually an important one. Where were SAODAP's
offices located? JJ: Well, in the very beginning, it was located in one of townhouses
on Lafayette Square and that was a very pleasant office.
It overlooked Lafayette Square and it had some prestige but most of the action was
going on in the, uh, I guess it was the New Executive Office Building. That's where
our offices were. And so, the only purpose for the office in that small townhouse,
which was sufficient for, you know, the first few weeks, you know, was for ceremonial
purposes and I didn't believe that much in ceremony. So, after a while, I moved my office up to the New Executive Office Building and that's where we were. PM: Was it a New Exec or Old
Exec? The red brick or the-- JJ: No, it was the red brick. It was the New Exec not the Old Exec. PM: Um. The other point is where, to whom did you
report on a day-to-day basis - not just on paper but on on a regular basis within
the White House hierarchy? JJ: Well, until, for some time, I reported to Bud Krogh but, as you probably know, on the, I guess it was the 13th of July, he was given other tasks.
And so, he could not, on a regular basis, confer with us. So, in a way, we were
sort of using our best judgment. I mean, we talked to Bud from time to time but I
suspect that, at some point, you know, Geoff Shepard might have played a role. There
were a couple of other people but it was really not that clear. Until Bud left,
he was our guy but he didn't have that much time. PM: And Bud, of course, doesn't formally
leave until early '73, late '72, early '73. JJ: That's right. PM: So, for a long time, you were almost quasi-autonomous. JJ: Yes. PM: And you did get your separate legislative base, so you weren't
on the-- JJ: Well, Paul negotiated very effectively. I mean, we spent so much of
our time in congressional hearings. You know, Paul says we we testified
before Congress a hundred times in the first 18 months because our jurisdiction, uh, spanned, you know, at least a dozen
agencies. We had to talk in front of the VA, in front of Government Org. We went
over and over and everybody and, in a sense, we were the idea of this
extraordinary power was at the expense of some of the committees and OMB. So, on
the one hand, you get extraordinary power but you instantly make lots of enemies
because you've essentially usurped, if you will, some of their prerogatives. Now,
but Paul negotiated this and we had some help. I mean, he was a Democrat, he knew
people, but there was virtually no opposition, very little opposition to the
idea of this new thrust because Nixon's original war on drugs was a rebalancing
of what was going on before that, which was almost an emphasis on law
enforcement and arresting people. So, this was the first time in the history of the
country where more resources were going into treatment and research and
prevention than were going into law enforcement and, you know, there were very
few people who opposed that, and at the end, it passed unanimously and the
President, I told you, the President said, "You know, I rarely get the sign a bill
like this." And so, you know, it was very successful, you know, and we did get the
legislation but took almost a year, I think, to the following March, and during that
time, it left you a little bit uncertain as to where you could push. Because
everybody in any, any of the bureaucracies had their own
relationships with different people in Congress, and
although you might want to get some things done, you had to do it very, very
gingerly. You had the authority but not necessarily was it wise to push too hard
because that might give rise to opposition to the legislative base in
the Congress. So, we were, you know, for from June until the following March, we were sort of in a, not in limbo but we did not really have a firm budget or legislative base. PM: A couple more points on this.
You mentioned earlier, um, well, actually, let me ask you a different
question. We'll come back to the other one. What was your relationship with with
one particular agency, BNDD [Bureau of Narcotics and Dangerous Drugs]? JJ: BNDD was not problematic, from our perspective,
because, you know, it was clear that the President did not want this office to
actually dictate to BNDD; although, Congress insisted that they wanted one
person they could hold accountable. So, there was an assistant director of the
Office for Law Enforcement but, largely, it was a coordinating kind of thing.
I didn't feel I had the expertise or anybody in the organization had the
expertise to second-guess what they were doing. The one thing we were able to, you
know, I think that we probably, I mean, they were not great fans of the, you
could say, the regularization of methadone. They had opposed that. And so,
actually, the first thing we did, you know, very early on was this is going to be part of
what we do. We thought that it was probably enough of a of a sacrifice they
were making from their their interest perspective. And so, largely, they were
pretty much on their own. I don't think we controlled their budget even. So, we
didn't have the same span of responsibility or authority over BNDD.
We did have one thing, yes. One of the things BNDD was prone to do
through the 1970s was they had control over all of the Schedule One drugs. These
were drugs without medic-- without medical uses but that didn't mean they didn't
have uses, they just weren't approved medical uses, and that included things
like cannabis, hallucinogens, things of that sort, but it might even include
things like LAAM, L-alpha-acetyl-methadol methadone, it's a long-acting opiate
that we had done some investigative work on in Chicago even, and they were reluctant
to allow researchers to get any and they were complaining bitterly that they
would try to get a grant and this was worth researching but they couldn't get
any of the materials, and on that one I did suggest to them that they move on it
with a little bit more rapidity and to the extent as long as I was, there they
were cooperative and people got what they needed. This was not the threat to
the to the body politic, one researcher doing some work on some rats.
So, uh, yeah. They did give more attention to that. Other than that, I don't recall anything.
When Miles Ambrose took a role in working on a broader coordination in
law enforcement, Miles was the Commissioner of Customs at the time and was given a
role. Miles and I, I thought, worked reasonably well together and we talked
about what the priorities ought to be. PM: You've mentioned a few times the sense
that there was a feeling that you had, that some of your peers had, that the
White House apparently shared, that there needed to be a national strategy. JJ: Yes.
PM: Was there from the beginning a sense that national meant federal or did you see
this as being a coordination of existing agencies at the federal and state level?
JJ: No, national meant national. The idea that it had to be federal was, I think, mine.
The fact is that we were in tremendous turmoil at the time that, you know, and
the, at the time we were trying to produce this strategy, the idea that you
could get 50 states and localities to agree that this ought to be the strategy
seemed to be a reach. I mean, we could really talk realistically about this is
what the federal government will try to do but you had tremendous disparities.
I mean, Governor Rockefeller was putting in, you know, his more or less draconian laws.
Other people were doing other things. So, you had a notion that you can put
together a federal strategy but the idea of a national strategy where you can get
the states and localities to come together and agree on exactly what our
priorities ought to be and how we would approach this thing was something for a
later time. And so, although it's called the national strategy and that's what I
was supposed to do, I knew I couldn't do it. We, within that time frame, it couldn't
be done. And so, the first national strategy was called the federal strategy and
I take responsibility for that. PM: One last point here. This is kind of a broader
point. It seems like what really captured the federal government's attention, when
it came to treatment, was not the prevalence or the incidence of addiction
in the civilian population in the United States but it was this acute
problem of Vietnam veterans. That this is what really, you know, catalyzed action. Is
that, is that fair or? JJ: Well, you know, you're kind of asking me to look into
the minds of people that I never had this discussion with - the President, John
Ehrlichman, Haldeman, the real decision-makers, the deciders, as it's
now said. Uh, and it's clear that they got our report, that Krogh and Donfeld were
pushing for a broadened emphasis on treatment, and that, clearly, they thought
that, you know, methadone could have an impact on addiction and on crime, and
that was a commitment the President had made. I don't think they had the same
enthusiasm that I had for expanding research or even at looking at outcomes the
way I wanted to but I think it would have happened anyway. It might have
happened three or four months later, maybe not with as much, you know, public
attention, maybe not a big presidential initiative. So, you could say that the, I
think fair to say that the addiction among Vietnam troops was a catalyst, a
precipitating factor that determined the time and maybe even that the scope and
the the breadth of the initiative but there would have been an initiative.
It might have been, you know, just the fifty million or the hundred million and not
the 300 million that we, you know, ultimately allocated to this. So, I think something
would have happened. It might have, as I said, not been of the same magnitude.
PM: It also strikes me that we were talking earlier about the stereotypical addict
and how you'd found in your own work that this was not a picture that really
comported with reality. It does strike me that the soldiers, almost by definition,
are not in anybody's, you know, stereotype or we're not at that point of
anybody's portrait of the stereotype. Was there, since that, you know, if it could be
shown that addiction was a medical and not a moral failing, that this would be?
JJ: Well, I think that the President, I'm certain because he said things like this, was
aware, as most of us were, that when you start to say that 20 or 30 percent of
the troops are addicted to heroin, you're essentially stigmatizing everybody who's
coming back, in terms of getting jobs, in terms of whether people will trust them,
in terms of a variety of things. And so, given the the stereotypes available, it
was important to demonstrate either that that number was probably not realistic
or that people recover. Now, I knew they recovered because I saw them all the
time in Illinois. I mean, people that I would trust with my life
I had treated a year before. So, you know, this was not anything new to me but it
was important if our treatment has any value and people can recover, it's
important that the notion of recovery, of to normality, to trustworthiness, become
part of the way we think about things. Because, without going deeply into the
past history of what we did with addicts, particularly opiate addicts, people were
saying 'These are doomed souls,' 'Once an addict, always an addict,' and everybody
used things like that to justify some of the draconian penalties we used. I mean,
there were places where if you were in possession of an opiate, you would get
ten years in prison. Now, in order to justify that, you had to think that
anybody who uses gets addicted, and anybody gets addicted, they're lost souls,
never useful. That was wrong, inaccurate, and costly in terms of making
it possible for people to recover. If everybody thinks that once you're an
addict, you're forever an addict, how do you expect to be able to get a job and
how do you expect to do all the things we expect them to do? So, we had to change
the stereotype. We had to say recovery is possible and, particularly, we wanted that
to be known about the people who were serving in Vietnam, and we did everything
we could for that. PM: One thing, because you, I wanted to close us off because we're
about to take you to Vietnam again, what were the actual numbers of troops who
were coming back with with addiction? JJ: Well, I'm glad you asked the question
because, uh, there are two sets of numbers that sometimes cause confusion.
The numbers I got when I was over there, and I was over there I guess it was starting
roughly the beginning of July, they were dropping rapidly from 10%. By the time I
was ready to leave and report to the President, they were down to about 5%
positives. Now, keep in mind the 5% positives were made up of every single
soul that wanted to get on an airplane. I think they might have been
testing Brigadier Generals but I'm not sure. I know they were testing Colonels
and they were testing everybody. So, depending on who was leaving that day, if it was mostly officers, mostly Air Corps, mostly Navy, you would get less. If it was
mostly in Army enlisted men, you'd get more. So, there was a fluctuation that had
to do with the randomness of who was being discharged on that day.
PM: So there were different populations within the-- JJ: Oh, yeah. I mean, what we found within a matter
of four months or so was that there was virtually no heroin use
among the military personnel above the level of sergeant, just almost didn't happen. So, you didn't see it among the second
lieutenants, first lieutenants, captains, majors. It just didn't happen. It was much
less again among the Navy people, much less among the Army people. It was,
predominantly, a problem of Army enlisted men because they were where the the
heroin was, and, in that group, what Lee Robins found, because she selected a
group who left in September, that 40% of those Army enlisted men - this is, again,
below the level of sergeant, sergeant and down - 40% had tried opiates while in Vietnam.
So, trying it was common. 20% of them, roughly, said at some point they had been hooked. So, the if you look at what the Congressmen said, 15 to 20,
they weren't that far off. Their problem was to extrapolate that to every single
person there rather than say among Army enlisted men. Now, uh, so, the two are compatible.
What we saw was everybody, what she studied was the group with the
highest levels of addiction, and she studied that not because we weren't
interested in the other people but because when we wrote that contract, we just
didn't have the money to launch a bigger study. You know, we were on the White
House budget trying to grab money from various agencies to make Lee Robins'
study possible so she could begin it with the people who left in September.
PM: Was this study longitudinal or cross-sectional? JJ: She got a sample of men
leaving in September. She over-sampled those who were opiate positive. She got a
sample of and obviously, she had people who were opiate negative, and she also
got a sample of people who were serving but not in Vietnam, and I
believe she got a comparable sample of people not in the military from the
Selective Service registries. It was a beautifully done study.
PM: This is a huge study at this point. JJ: It was large but it also required a lot of
cooperation. It required the cooperation of local Selective Service boards and all
of which required that commitment that said from the President 'you will write a
book,' and I said that is a directive. And so, every time people said, well, we don't
want to give you that data or you can't get that or it's too hard, I had to make a
phone call. PM: So, President Nixon says 'you will write a book' and this becomes... JJ: This became-- PM: ...at the working level. JJ: This became the key that opened the doors to allow Lee
Robins to do that study. I mean, I think there were people who did not want to
find, you know, who were afraid of what they would find and I said, "Well, you know,
I can understand their anxiety but we need to know." You know, truth may hurt but
it'll be the truth. And so, that's what we did. PM: That's, that is a classic story and
this is a good a good reminder of what happens when presidents say something. It
may not turn out to be what they were expecting. JJ: Well, I think it turned out to
be surprising, so surprisingly positive in that of all of those addicted, instead
of a hundred percent relapsing, there are only five percent of those who are
addicted in Vietnam who continued to be addicted in the United States in that
first year back. Nobody believed that. There were people who accused Lee Robins
of spinning the data and she spent a lot of her professional activity defending
her integrity and it's one of the reasons I've never, you know, wanted to be
a co-author; although, I helped design it in some ways and made it happen. I did
not want to participate in the writing because that might have given people
even more ammunition to say the White House was spinning this. PM: Let's talk then about your inspection tour of Vietnam. JJ: Well, it, uh. What is there to say?
I went and I was amazed to see how extensive they were. They they
had to set up these detox facilities, they had to set up the urine testing
facilities. They didn't really believe in the FRAT machine, by the way. So, what
they did and they didn't want to hold anybody accountable for a positive
opiate unless they confirmed it, so they set up banks of gas chromatography
machines and brought trained technicians in from trained at Walter Reed and other
places. So, if anybody came up with a positive, it had to be confirmed with
gas chromatography. PM: So, they were using the FRAT machines as just an initial
screening? JJ: They were the initial screens. Now, you know, were there people who got
through the screen that shouldn't have? I don't know. Were there people who were
positive but the gas chromatograph was not as perhaps didn't pick it up or
was this accurate? I don't know that either but we did send some experts of gas
chromatography over to inspect, who had more technological background than I did,
to make sure that that was not the case and they didn't come back with any
complaints about the technology. So, we think that it was probably accurate. So, I
was it was really, when I think of it, I think that civilians could have never done that.
I mean, they had that plumbing and a variety of things that far beyond, and when I
think of it and I have to say that it's was astounding to me that they were able
to accomplish all of that from May the 30th of June the 17th. They even had to
do things with the electrical current because the FRAT machine and the gas
chromatography equipment required better, steadier electrical current than
they were able to get at those Army bases. So, they organized all of that in under
three weeks. Really quite astounding, remarkable, and I was sick for
a couple of days in Vietnam. I don't know what I had but it, uh, it persisted for the
next three months. So, you know, I got some kind of virus, I think, and I met with
various military people, Creighton Abrams, things of this sort. They were kind of
sympathetic to change this into something more medical than dishonorable discharge.
Nobody complained. I mean, there were some initial complaints from some
of the military - this was stateside when I met with them about wanting to get
these people out of their outfits. I can understand that but the fact is that we
don't want them shipped home as soon as you detect them. That's exactly what we
don't want. We want them to not be dependent when they left. So, there were
there were little squeaks here and there but I think they, you know, things got
ironed out. I did have to tell the press that I didn't want the data released on
a daily basis. You know, I told them why. I don't, I think I guess they were they
thought it was their prerogative to see though the data coming out of the
machines but the fact is that you could get these wildly fluctuating things
depending on who came. So, one one guy would report eight percent and another guy would report three, and somebody else would report nine. They were all true but what counts is what
was the average for the week because they almost never tell you the context of
how this is an issue of the mix of who's coming for the testing. There were some
other things as well. There were obviously people trying to beat a system. There
were people who were buying urine or switching urine but they made allowances
for all of that. I don't think a lot of that happened. Uh, what else? I mean, there
were some interesting adventures that I don't have a clear recollection of because I had a fever
but, apparently, we were flying to Cam Ranh Bay and we lost an engine over Vietcong
territory but uh. PM: It's probably a very good time to have a fever. JJ: Yeah, well, those
things happen. I don't have a good, clear recollection of it, uh, and then we met with
people at the, uh, at the Embassy, things of this sort. All in all, you know, I'm not
really sure. Well, I guess it was useful for me to see what they had accomplished
and to actually get the data and show this is the data and I think the President
trusted me to get it. He had reason, as Bud Krogh indicated to
you, probably, that he had some reason to be a little skeptical about the reports
he was getting from the military. Because up until the time of the Murphy and
Steele report, the military was saying we only had 100 addicts. That's it and it
just didn't make sense because Bud's visit had said that heroin is just flowing freely. PM: How did things
proceed after the summer of 1971? What becomes your big initiatives? You're
supporting research, you're supporting clinics. How do you start to work through
the rest of '71 and '72? JJ: Well, the list of what we had to achieve was so long that it began to, you know, it was clearly not achievable within the time frame that we
had but some of the things we wanted to do was demonstrate that you could get
treatment up, that you could show that people were getting into treatment.
The problem was, you know, within the bureaucracy, some of the things that they
do take months and months and months. If you make an application for a grant, for example, then it has to go out for review. And so,
it's six months often before it's even reviewed and another six or nine months
before the money actually flows down, and then maybe people take another three or
four months before they open the first treatment and, basically, the problem with
some of what was being done in in the form in which the government supported
treatment was in the form of grants, for the most part. Now, a grant is technically a gift. So, if you don't do anything with a gift, that's okay, and we've seen this
subsequently that if you give somebody money sufficient to treat a hundred
people and they only treat ten, well what can you do about it? It's a gift. So, based
on my experience in Illinois, we changed things around with the help of OEO.
Things we developed sort of a, you might call it, a quasi-contract, was, again, another
hybrid, sort of a contract gift. It said, 'This is enough,' you know, 'to treat X number of
people. This is,' we developed a new technique, if you will, a new terminology,
'this is enough for this kind of slot and that means you keep it filled and we're
going to come back and we're gonna measure what you kept filled and whether
you get any more will be a function of whether you do it.' Now, the other thing is
that when you, under the old system, when you put in grants, you could have a four
or five fold factor and how much each episode of treatment was going to cost
because that was up to the investigator or the applicant, and we tried to say,
'Look, we know what it costs and,' you know, 'we're going to accept people willing to
take these contracts, these quasi contracts, but if you're three times
higher,' you know, 'if Minnesota is three times
higher than Baltimore, then we'll fund Baltimore first.' We had to introduce some
competition so that people would say, 'I think that we may not
get any if we ask for that much.' PM: How did recipients respond to this?
JJ: Some were happy that the money was available and some were a little annoyed that they
wouldn't have as much as they were used to spending. We were also concerned about
how much disappeared on the way down to the treatment level and there's lots of
bureaucratic siphoning off and we tried to deal with that as well. PM: By the recipients themselves or?
JJ: No, no. It's the money often went to a city or a state,
and somehow it never got down to where it, it never met the road, it never produced
anything. So, we worked on those issues. A lot of our time was spent in working
through how can you use a drug like methadone, which, you know, for a non-tolerant individual the doses used in methadone treatment programs could be
lethal. So, if you were treating somebody and he sold that dose of methadone meant
for him to somebody else, he could kill them. So, how can you build a system that
minimizes that diversion and make certain that people get a certain amount
of treatment and support it in a reasonable way? And I had been, what we
had already had some experience because people had been using methadone, I guess,
since about 1966 when it began to, oh maybe '67, it began to be used in various places.
We had used it '68, '69, and '70, and we knew that there were some, you might call them
outliers, mavericks, but there were physicians who were prescribing in ways
which seemed to be both risky for the patients and risky for the public, and
just recommendations did not seem to be sufficient to bring that under control.
So, we needed a way to say 'yes, we're going to have more
treatment but it's going to be constrained in ways that will minimize
the likelihood of bad outcomes for the patients being treated and for the public.'
Now, that meant, in some ways, actually interfering with the practice of
medicine and it was. You know, no apologies. And so, working with Peter Hutt at the
Food and Drug Administration, we crafted something called a hybrid IND drug
approval. So, yes, we approved it for this use but it was still an IND in terms of
we can constrain the way you use it. PM: IND is? JJ: Investigational new drug. So,
usually, when a drug is approved, it has a label, you can read the label, and but the
doctor is then free to use the drug using his or her best judgment, clinical judgment, with respect to dose, with respect to frequency. So, all of that's
left to clinical judgement. There is no enforcement mechanism. It's rare.
Even when you think the drug has some risks, the best you can do is a what's
called a 'black box warning', you put it in big bold letters this drug could cause
this or that or the other thing so the clinician is aware of that, makes the
patient aware of that, presumably, but still uses it according to his or her
best judgment. We didn't think that was sufficient. At the time, given the
shortage of treatment, methadone had considerable street value. And so,
physicians willing to prescribe, and there were such, for, uh, they would
basically, the amount that you would get was proportional to the amount that you
were willing to pay. So we created, Peter Hutt did, this hybrid IND approval that
said, 'Under these circumstances, you can run a methadone program,' and we also
specified, and this was the difficulty, how can you support something
if you don't know the amount of treatment you're supporting? What is a
unit of treatment? And so, we defined a unit of treatment within those
regulations and that allowed us to go out with these hybrid contracts and say
'You want to treat 150 people, this is how much money we'll give you. Go to it.' And so,
that took a lot of time, a lot of negotiation and, at the same time, we were
funding research, we were thinking about the upcoming national strategy, we were
doing work on prevention. We had a variety of things, in that respect, and we
did all of this, I guess, between testimony before Congress a hundred
times, and people were always asking us about what's the latest data from
Vietnam, what's the latest data from this and that. So, uh, I guess-- What were some of
the other? Oh, yes. We we launched some other studies. We were interested in
finding, uh, another to see whether we could further develop something now
called LAAM, it's a long-acting methadone, because then there would be no diversion.
You could take it three times a week and there'd be nothing that would cause anybody
to have an overdose. And so, that had to be structured and we had to work on that.
We tried to further develop naltrexone, which had not yet been approved, in that
effect, it didn't get approved for another ten years but that's not because
we didn't launch the initial studies. PM: Now, you mentioned that naltrexone,
these days, is mainly used for alcohol. JJ: Yeah. That was an interesting discovery
that came about somewhere, I think, in the early 1990s. They found that animals
given naltrexone don't self-administer alcohol and they tried it with people
and it also reduced it. So, its approval for the use of alcoholism was
interesting and it's widely, most widely used now for alcoholism.
PM: What I'm wondering is you're talking to Congress, you're talking to the public,
you're talking to the bureaucratic community, the broader public community
that's involved with all this. Through as your programs begin to mature, do people
express skepticism about methadone? Do they call for a harsher law and order?
Because, obviously, there's a turn in 1973 toward a more repressive system. JJ: I'm not
sure how that came about. I think that, uh, and this comes to me from Bud. He said
that when he and the President, I guess it was Miles Ambrose, were flying over
the Bronx, you know, the President said, "Look. We know the treatment is important but what
those people down there want is for us to lock all the addicts up. Lock up the
pushers. They just want it off the streets." And so, you know, I think that there's a
place for responding to that concern and there still is drugs being sold on
street corners and things of this sort, and there's also a place for treating
those who want treatment. So, I think that once the crisis of demonstrating that, you
know, all of our veterans aren't addicted had passed and we had funded treatment, I
mean, two-thirds of the federal budget was now going to treatment, research, prevention,
as compared to law enforcement, the President was able to say now we have to
return to the other issues. Because he has a constituency as well and, by that
time, Rockefeller had already sort of moved further to the right.
Now, Rockefeller, interesting, you know, concluded, at that point, treatment
doesn't work. Well, the treatment he selected and spent a lot of money on
was not working because what he selected was civil commitment. He spent a lot of
money on bricks and mortar, a lot of money pushing people into treatment
situations that weren't therapeutic and that didn't really work. Now, he did
support methadone as well but it's clear that the major thrust of treatment was a
disappointment to him. And so, he came up with the Rockefeller laws, with minimum mandatories,
and minimum mandatory penalties for drug users was not unique or it was did not
occur for the first time. Actually, in 1951, in 1956, there were minimum
mandatories for narcotics violations but they had been, I think they had been
largely done away with under the Controlled Substances Act. And so, the
President decided that we ought to go back to minimum mandatories. Now, my concern,
at that time, was looking at the overall resources. Because the President was also
concerned with deficits. I was also concerned with deficits and, you know,
maybe it wasn't my place to be but I didn't feel that everything we were
spending was taken from somebody who didn't part with it willingly. They were
taxes and that you needed to be prudent about how you spend taxes.
And so, if you began with minimum mandatories for simple possession or other things,
you know, it doesn't take, you know, higher level calculus to figure out that the
size of the prison population would increase, and prisons cost much more than
anything we do on the treatment side, even residential programs, and, you know, as long as
you're doing, if you're doing that, you're making a commitment that goes on for
another decade that only increases. And so, I was sort of saying 'maybe you
should wait on this a little bit' because I was not convinced that the
people who they were arresting are necessarily deterred by the size of the
penalty. They're deterred by the likelihood of the penalty. That was just
from reading, you know, I'm not an expert on criminal justice but everything I read
says it's probability of the consequence not the severity of the consequence that
necessarily changes the behavior. So, I wrote a long memo, I think Grasty
drafted it, and we said, 'Don't do this yet,' and with that came my end of my tenure
at the White House. And so, I left in June of 1973. PM: I wanted to ask you, and this seems the
appropriate time, you showed me a document earlier and, in it, you discuss a
typology of critics, that there's two kinds of critics. Um. JJ: Oh yeah. Well, you know, we, you know, we took a
lot of criticism. Some of it justified. We certainly didn't do everything the way it could have been done but and there are people who criticize
constructively - you didn't do this, you didn't do that - they're not necessarily
mean-spirited but they're saying 'You ought to do this.' Some of it was, you know,
you know, what are you gonna do about jobs for addicts? Well, you know, we don't
control the economy, we're just dealing with drug addiction. What are you gonna do
about this, what are you gonna do about that, and there are others who clearly
had political motives. They just didn't like the President and they used any
means to attack and those people didn't really need to find anything wrong. They
would make up things or they would exaggerate things. They would take an
occasional extreme example and portray it as the typical. And so, you know, that was
the other kind of critic that was perhaps more difficult to deal with
because we don't control the media, and it makes for a better story when you
can take something out of context and say we made this kind of stupid mistake.
So, you know, if if we had had a longer lifespan, perhaps under less divisive
political circumstances, I mean, this was, as you recall, our last six months of, uh, working at the White House was, in some
ways, colored by the growing concern with Watergate. And so, anything that people could, you know, aim at the White House, probably they would. PM: How did that affect
you on a day-to-day basis? JJ: Well, it, in some ways, had very little effect, you
know, technically, but it was demoralizing. In April, you know, John Ehrlichman was forced to resign. Uh. I don't know, I don't think I knew
at that time Bud Krogh's involvement but, clearly, we felt that, you know, the leadership
was distracted and uh. You know, people you respect, when they're in difficulty, it
has an effect, and I certainly felt that people, at least in the area of drug
abuse, had made remarkable commitments to things that I had devoted myself to - to
research, to treatment, to prevention, things of that sort. And so, to see them leave under
those circumstances was, um, demoralizing. It was also demoralizing
for the staff. The other thing that I think was perhaps equally demoralizing
was the, uh, was the decision, and maybe it's a good one, that we needed new blood after
the election. So, I think sometime, you know, in that spring, you know, the decision
came down from the White House they were going to ask for resignations. Now, people
had been working 18 and 19 hours a day for me. I wasn't going to push them out.
It was just not something that I could do and I would rather leave than have to
tell people who had worked that hard that you have to leave not because you
didn't do what you were supposed to do but because somebody at some other place
thinks that you should leave. So, uh, you know, those two things taken together, you know, had some impact. So, I did not-- I wish I could have left differently but they
were the terms. They, that was the, they were the times I lived in. PM: A little bit after you leave, um, I want to ask about this because it's an important point about
what had happened earlier, President Nixon makes a comment that he thinks
that America is turning the corner, it's turning the corner. We were talking about
that off-camera a little bit. What did that mean? What did the media think or
said that they thought it mean and what is the distinction between incidents and
prevalence? JJ: Well, I guess I take part responsibility for the President making that statement. He was so smart that he grasped things that some of his staff didn't. I mean, he knew the difference between incidents and prevalence.
Incidence mean the number of new cases and prevalence meaning the total number
of existing cases. We were gathering data, as we should,
about what's happening what are the trends, and everything we saw indicated
to us that the number of new cases was had turned, had reached the peak by
roughly '72, '71-'72 it had reached the crisis, and that we were seeing in '73
fewer new cases. Now, when you have something that's long-lasting, let's say
like heroin addiction, it doesn't mean the prevalence will disappear. I mean, you can
get a reduction in a number of people with a disorder only if they die or get
cured, but some do get, some do leave the system because they've recovered and
some do die. So, if you have fewer new cases, it means that, over time, it will
not be growing as rapidly. So, that the prevalence will not be growing at the
rate it was growing, and if you're a public health person and you're looking
at something like flu or some other disorder and the number of new cases
goes down, it means that the epidemic has crested, it's peaked, and it, with some good
fortune, the prevalence will go down. Now, uh,
I thought that, I think I told the President that, at some point, that this
is what we're looking at. So, it may mean that, you know, that the number of new
cases is going down ,the prevalence will stabilize, and then, if we're effective in
treating people, the number of chronic users, the prevalence, will go down. And I
think that sometime later in the, maybe it was September after my resignation, and
some Bob DuPont took it on, he had a little conference and he spoke in those terms.
So, that's turning the corner, and I think what he meant was exactly
what I just said. Not that the crisis, you know, not that the problem is over but
that it's not going to keep getting worse as it has for the previous four or five
years. Because he took office almost as this thing was further going up and up.
We'd been in almost an eight-year crescendo of more and more new cases.
I think that people interpret that in two different ways.
There was consternation among the people who were getting money on the treatment
and prevention side that this meant he would turn off all the money, and I think
that, you know, people who expected that to mean that, you know,
drug addiction was finished, that it was all over, took it to mean he was declaring
premature victory, and he didn't mean either of those things but he thought that maybe just a
little bit of, you know, better news would be welcome, and, you know, it was just too bad that nobody wanted to see it for what he meant it to be and, frankly, I guess there are times when being smarter than everybody else has
its price, and he understood incidence and prevalence and he understood it
without notes. Really quite remarkable. PM: I want to ask for your recollections of
some of the White House staff members that that you worked with. Some of them
are still with us, some of them aren't, but John Ehrlichman has come up a few times. What were your relations with him like? JJ: They were always pleasant. John had a wry sense of humor, very smart, and my few interactions with him were always cordial, pleasant. That's all I can tell you. I didn't see him that often. PM: Bud? JJ: Bud Krogh was an amazing man. You know, he,
you know, Bud exudes competence, leadership. Somebody, you know, you can
trust. Understood things, got things done, and I always found it remarkable that he
was younger than I was and he knew all these things, did all these things and,
you know, a man, you could, I trusted, you know, and I always felt that, and still do,
that there but for the grace of God, go I. I mean, I think that as I said to him, "I
don't know that I would done anything differently than you did," and, uh, and I spoke
to him about that on various times, you know, that the context in which he was
behaving was one in which he knew well. He was told he was dealing with national
security. He had been there watching people fighting. Might have been in the Navy
himself. So, he understood this issue and, uh. So, it's a, you know, a man I admire. PM: Walter Minnick.
JJ: Walter was very smart. I think I was, I think, if I'm not mistaken, he graduated summa
cum laude from from Harvard, not easy to do, and Walter was, you know, very quick,
very sharp, and we worked together, I think, toward the end of my tenure on
finding a new way to produce medicinal opiates without the risk of diversion of
opium, and I think that was successful. I always liked Walter and still talk to
him, smart, decent, honorable man. PM: I wanted to ask you about this earlier
but we got caught up with other things. What was your neighborhood like on the south side of Chicago? You had some interesting neighbors. JJ: Well, the south side of Chicago, we lived in something called the Jackson Park
Highlands and they were, generally speaking, large houses going for far
less than they were worth because it was a kind of an ethnically mixed
neighborhood not far from some apartments of lower income people but
there were faculty members. I mean, Arthur Laffer, who was an
economist with George Shultz, lived across the street. We had other
University of Chicago faculty living down the street. There were some wealthy
people still living across the street but walking through the neighborhood was
could be risky. Oh, Jesse Jackson lived, I think, a block down on our side of the
street, but it was, um, it was risky in the sense that even though our babysitter
lived only halfway down the block, when I had to take her home late at night, we
got in the car and I drove her to her door and watched her in. There were some-- It was a tough time in 1968, '69, and '70 on the south side of Chicago. PM: Looking-- JJ: No, no, I should mention that two
streets away, one of the houses, which had been occupied by a well-known musician,
had been sort of abandoned and we were able to get at a reasonable price and we
used it for one of our therapeutic communities. PM: Who was it? JJ: It was, I think, Bo Diddley. PM: [Laughs] JJ: And so, his house became one of the houses. It backed onto the house of a faculty member. You know, he lived on one street, they lived on the other and the two back yards, but it was a large house and we began one of the therapeutic communities there.
We kept it there for about a year. PM: How did the faculty member react? JJ: He was very, I don't-- He got to know them and was reasonably pleased, in a way. They were
good neighbors. PM: Looking back on it, how do you see SAODAP as fitting into the broader sweep?
JJ: How do I see what? PM: SAODAP. JJ: Oh. PM: As fitting into the broader sweep of American anti-drug politics? JJ: Well, I think that you can probably overdo
expectations, that something as divisive as how we will deal with drugs in a society
can be resolved by some special office with a drug czar. I mean, you can more
rationally allocate resources, you can articulate goals and if you can, perhaps,
rein in spending that is not productive, but beyond that, there are issues
that go far beyond anything that government can do. And so, what that first
agency did was perhaps create a model for how you
coordinate something that is so, that touches on so many aspects of a society,
that you need coordination across agencies, and that can't be done by just
one or two staff people in the White House or OMB, and apparently, they
continue to have something called, you know, a drug office and it has had good
times and bad times in terms of its influence, in terms of, you know, how
effective it's been, but it's 40 years later, they still have somebody called
the drug czar. So, I suppose it was a model and, you know, in some ways, they
continue to recreate this idea of a czar's office to coordinate things across agencies.
They have an energy czar and this czar and that czar. Given the, you know, the diversity of
government agencies, and their, you know, they each have their own mission but
their missions overlap, something in the Executive Office has to be able to
coordinate them, to get them to work together to reduce the redundancy and
the waste and, I guess it's a useful model. Whether we demonstrated that it
could do something useful is for the historians to say but I think that it
played its role in showing that, from time to time, you need that. Whether you
always need that is another question but apparently the decision is well, we'll let it go.
