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