S. HRG. 98-392 DRUG USE AND MISUSE: A GROWING CONCERN FOR OLDER AMERICANS JOINT HEARING BEFORE THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE AND THE SUBCOMMITTEE ON HEALTH AND LONG-TERM CARE OF THE SELECT COMMITTEE ON AGING U.S. HOUSE OF REPRESENTATIVES NINETY-EIGHTH CONGRESS FIRST SESSION WASHINGTON, D.C. JUNE 28, 1983 HCOA 98-392 Printed for the use of the Senate Special Committee on Aging and the House Select Committee on Aging U.S. GOVERNMENT PRINTING OFFICE 24-861 0 WASHINGTON 1983 SPECIAL COMMITEE ON AGING JOHN HEINZ, Pennsylvania, Chairman PETE V. DOMENICI, New Mexico JOHN GLENN, Ohio CHARLES H. PERCY, Illinois LAWTON CHILES, Florida NANCY LANDON KASSEBAUM, Kansas JOHN WILLIAM MELCHER, Montana S. COHEN, Maine DAVID PRYOR, Arkansas LARRY PRESSLER, South Dakota BILL BRADLEY, New Jersey CHARLES E. GRASSLEY, Iowa QUENTIN N. PETE WILSON, BURDICK, North Dakota California CHRISTOPHER J. DODD, Connecticut JOHN C. ROTHER, Staff Director and Chief Counsel DIANE LiFsny, Minority Staff Director ROBIN L. KRopp, Chief Clerk (II) SELECT COMMITTEE ON AGING EDWARD R. ROYBAL, California, Chairman CLAUDE PEPPER, Florida MATTHEW J. RINALDO, New Jersey, MARIO BIAGGI, New York Ranking Minority Member IKE ANDREWS, North Carolina JOHN PAUL HAMMERSCHMIDT, Arkansas DON BONKER, Washington RALPH REGULA, Ohio, THOMAS J. DOWNEY, New York NORMAN D. SHUMWAY, California JAMES J. FLORIO, New Jersey OLYMPIA J. SNOWE, Maine HAROLD E. FORD, Tennessee JAMES M. JEFFORDS, Vermont WILLIAM J. HUGHES, New Jersey THOMAS J. TAUKE, Iowa MARILYN LLOYD BOUQUARD, Tennessee JUDD GREGG, New Hampshire STANLEY N. LUNDINE, New York GEORGE C. WORTLEY, New York MARY ROSE OAKAR, Ohio HAL DAUB, Nebraska THOMAS A. LUKEN, Ohio LARRY E. CRAIG, Idaho GERALDINE A. FERRARO, New York PAT ROBERTS, Kansas BEVERLY B. BYRON, Maryland COOPER EVANS, Iowa WILLIAM R. RATCHFORD, Connecticut JIM COURTER, New Jersey DAN MICA, Florida LYLE WILLIAMS, Ohio HENRY A. WAXMAN, California CLAUDINE SCHNEIDER, Rhode Island MIKE SYNAR, Oklahoma THOMAS J. RIDGE, Pennsylvania BUTLER DERRICK, South Carolina JOHN McCAIN, Arizona BRUCE F. VENTO, Minnesota MICHAEL BILIRAKIS, Florida BARNEY FRANK, Massachusetts GEORGE W. GEKAS, Pennsylvania TOM LANTOS, California MARK D. SIIJANDER, Michigan RON WYDEN, Oregon CHRISTOPHER H. SMITH, New Jersey DONALD JOSEPH ALBOSTA, Michigan GEO. W. CROCKETT, JR., Michigan WILLIAM HILL BONER, Tennessee IKE SKELTON, Missouri DENNIS M. HERTEL, Michigan ROBERT A. BORSKI, Pennsylvania FREDERICK C. (RICK) BOUCHER, Virginia BEN ERDREICH, Alabama BUDDY MAcKAY, Florida HARRY M. REID, Nevada NORMAN SISISKY, Virginia TOM VANDERGRIFF, Texas ROBERT E. WISE, JR., West Virginia BILL RICHARDSON, New Mexico JORGE J. LAmBRINos, Staff Director PAUL SCHLEGEL, Minority Staff Director SUBCOMMrIrEE ON HEALTH AND LONG-TERM CARE CLAUDE PEPPER, Florida, Chairman IKE ANDREWS, North Carolina RALPH REGULA, Ohio, JAMES J. FLORIO, New Jersey Ranking Republican Member HAROLD E. FORD, Tennessee THOMAS J. TAUKE, Iowa MARILYN LLOYD BOUQUARD, Tennessee GEORGE C. WORTLEY, New York MARY ROSE OAKAR, Ohio HAL DAUB, Nebraska THOMAS A. LUKEN, Ohio LARRY E. CRAIG, Idaho WILLIAM R. RATCHFORD, Connecticut PAT ROBERTS, Kansas BUTLER DERRICK, South Carolina JIM COURTER, New Jersey RON WYDEN, Oregon THOMAS J. RIDGE, Pennsylvania GERALDINE A. FERRARO, New York JOHN McCAIN, Arizona HENRY A. WAXMAN, California MICHAEL BILIRAKIS, Florida BRUCE F. VENTO, Minnesota MATTHEW J. RINALDO, New Jersey IKE SKELTON, Missouri *(Ex Officio) DENNIS M. HERTEL, Michigan ROBERT A. BORSKI, Pennsylvania EDWARD R. ROYBAL, California (Ex Officio) BILL HALAMANDARIS, Staff Director KATHLEEN GARDNER CRAVEDI, Assistant Staff Director JAMES P. OBERLE, Ph. D., Minority Staff Director (111) CONTENTS Page Statement by Senator John Heinz, cochairman ........................................................ 1 Statement by Representative Claude Pepper, cochairman ...................................... 4 Statement by Representative Mary Rose Oakar ....................................................... 7 Statement by Representative Michael Bilirakis ........................................................ 7 Statement by Representative Tom Lantos ............................................................... 8 Statement by Representative John McCain ............................................................... 9 Statement by Representative Hal Daub ............................................................... 10 CHRONOLOGICAL LIST OF WITNESSES Flaherty, Michael T., director, Addiction Treatment Center, St. Francis Gen- eral Hospital, Pittsburgh, Pa ............................................................... 13 Powell, Nettie Apple, Pittsburgh, Pa .............................................................. 15 Hall, James N., director, Up Front, Inc., Coconut Grove, Fla ................................. 16 Zimny, Mrs. Rose, Everett, Mass.; accompanied by Ms. Gloria Zimny ................. 21 Lieff, Jonathan D., M.D., director of psychiatry and chief of geriatrics, Lemuel Shattuck Hospital, Jamaica Plains, Mass ............................................................... 23 Lamy, Peter P., Ph. D., director, Center for the Study of Pharmacy and Therapeutics for the Elderly, School of Pharmacy, University of Maryland, Baltimore, Md .............................................................. 48 Avorn, Jerome L., M.D., assistant professor of social medicine and health policy, Division-on Aging, Harvard Medical School, Boston, Mass .................... 50 Christy, Jack, Washington, D.C., legislative representative, American Associ- ation of Retired Persons; accompanied by Nancy Olins, AARP pharmacy service............................................................................................................................. 57 McMahon, F. Gilbert, M.D., director, Clinical Research Center, Tulane Uni- versity, New Orleans, La .............................................................. 66 Novitch, Dr. Mark, Washington, D.C., Deputy Commissioner, Food and Drug Administration, U.S. Department of Health and Human Services; accompa- nied by Dr. Robert Temple, Acting Director, Office of New Drug Evaluation; and Dr. Lloyd G. Millstein. Acting Director, Division of Drug Advertising and Labeling .............................................................. 88 APPENDIX Material related to hearing: Item 1. Letter from Arthur Hull Hayes, Jr., Commissioner of Food and Drugs, U.S. Department of Health and Human Services, to Senator John Heinz, chairman, Senate Special Committee on Aging, dated July 29, 1983 .............................................................. 115 Item 2. Letter from Jerome L. Avorn, M.D., assistant professor of social medicine and health policy, Division on Aging, Harvard Medical School, Boston, Mass., to Senator John Heinz, chairman, Senate Special Committee on Aging, dated August 18,1983 .................................................. 117 Item 3. Letter from Jonathan D. Lieff, M.D., director of psychiatry and chief of geriatrics, Lemuel Shattuck Hospital, Jamaica Plains, Mass., to Senator John Heinz, chairman, Senate Special Committee on Aging, dated July 18, 1983 ............................................................... 117 Item 4. Excerpt from forthcoming book, "Your Parents Keeper-A Hand- book of Psychiatric Care for the Elderly With Case Histories," submit- ted by Dr. Jonathan D. Lieff .............................................................. 118 Item 5. Premarketing studies, prepared by Peter P. Lamy, Ph. D., direc- tor, Center for the Study of Pharmacy and Therapeutics for the Elder- ly, School of Pharmacy, University of Maryland, Baltimore, Md ............... 121 Material related to hearing-Continued Item 6. Statement of Thomas W. Pauken, Director, ACTION, Washington, D.C .......................................................... 123 Item 7. Statement of the American Pharmaceutical Association, Washing- ton, D.C ........................................................... 125 (v) DRUG USE AND MISUSE: A GROWING CONCERN FOR OLDER AMERICANS TUESDAY, JUNE 28, 1983 U.S. SENATE, SPECIAL COMMITTEE ON AGING, AND THE SUBCOMMITTEE ON HEALTH AND LONG-TERM CARE, OF THE SELECT COMMITTEE ON AGING, U.S. HOUSE OF REP- RESENTATIVES, Washington, D.C. The joint committees met, pursuant to notice, at 9:02 a.m., in room 628, Dirksen Senate Office Building, Hon. John Heinz, chair- man of the Senate Special Committee on Aging, and Representa- tive Claude Pepper, chairman of the Subcommittee on Health and Long-Term Care, copresiding. Present: Senators Heinz, Grassley, and Burdick; Representatives Pepper, Oakar, Bilirakis, Lantos, McCain, Daub, Ridge, and Fer- raro. Also present: From the Senate Special Committee on Aging: John C. Rother, staff director and chief counsel; Isabelle Claxton, communications director; Trish Neuman, professional staff member; Robin Kropf, chief clerk; and Angela Thimis and Nancy Mickey, staff assistants. From the House Select Committee on Aging Subcommittee on Health and Long-Term Care: Bill Hala- mandaris, staff director; and Kathleen Gardner Cravedi, assistant staff director. STATEMENT BY SENATOR JOHN HEINZ, COCHAIRMAN Chairman HEINZ. Good morning, ladies and gentlemen. This is a joint hearing between the House Select Committee on Aging and the Senate Special Committee on Aging. I am very pleased that my good friend and former colleague from the House, the distinguished chairman of the Rules Committee, Congressman and former Senator, Claude Pepper, is here to cochair these hear- ings with us