Public Hearing - April 15, 2014
1 BEFORE THE NEW YORK STATE SENATE MAJORITY COALITION
JOINT TASK FORCE ON HEROIN AND OPIOID ADDICTION
2 ------------------------------------------------------
3 PUBLIC FORUM: ONEIDA COUNTY
4 PANEL DISCUSSION ON ONEIDA COUNTY'S HEROIN EPIDEMIC
5 ------------------------------------------------------
6
State Office Building
7 1st Floor Conference Room
207 Genesee Street
8 Utica, New York 13501
9 April 15, 2014
5:00 p.m. to 7:00 p.m.
10
11 PRESENT:
12 Senator Philip M. Boyle, Task Force Chairman
Chairman of the Senate Committee on Alcoholism and
13 Drug Abuse.
14
Senator Joseph Griffo, Forum Moderator
15
Senator David Valesky
16
17
18
19
20
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24
25
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1
PARTICIPATING PANELISTS:
2
Julie Barker-Nagle
3 Director of Services Administrator
Oneida County Jail, through Correctional Medical Care
4
Erin Bortel
5 Director of Prevention Services
ACR Health
6
Tara Costello
7 Director of Substance Abuse
Oneida County Department of Mental Health
8
Phyllis Ellis
9 Director
Oneida County Health Department
10
George Kozminski, M.D.
11 In charge of the medication-assisted program
Insight House
12
Robert Maciol
13 Sheriff
Oneida County, New York
14
Jeanna Marraffa, PharmD, DABT
15 Upstate Medical University at the
Upstate New York Poison Center
16
Scott McNamara
17 District Attorney
Oneida County District Attorney's Office
18
Cassandra Sheets
19 Chief Executive Officer
Center for Family Life & Recovery
20
Donna M. Vitagliano
21 President/CEO
Insight House
22
23
24
25
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PANELIST INTRODUCTIONS 6
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PANELIST STATEMENTS 11
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QUESTIONS AND ANSWERS TO THE PANEL 52
5 FROM FORUM LEADERS
6 AUDIENCE PARTICIPATION BEGINS 68
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8 ---oOo---
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1 SENATOR GRIFFO: Good evening -- well, good
2 late afternoon.
3 Everyone, I want to thank you all for being
4 here today.
5 This is -- I know the weather isn't
6 cooperating, but it really is important, I think,
7 that we all gather, and I really am thankful that
8 all of you are here with us today.
9 My name is Joe Griffo. I represent the
10 Oneida, Lewiston, and St. Lawrence county areas.
11 I'm a member of the Task Force, and I would,
12 today, want to welcome here, Chairman Phil Boyle,
13 who is the Chairman of the Senate Committee on
14 Alcohol and Substance Abuse, and the head of the
15 Senate Task Force, dealing with the heroin epidemic
16 that is confronting and challenging our state.
17 And, Senator Boyle has taken upon himself to
18 go across our state, and is holding a number of
19 Task Force meetings, trying to talk to community
20 leaders, as well as the public, in various regions
21 across New York State, getting a firsthand
22 opportunity to hear, and to interact, with various
23 communities.
24 And we're hopeful, as a result of this
25 statewide activity, that we, when we get back to
5
1 Albany, will be examining and evaluating all of the
2 presentations and all of the information that has
3 been gathered, in hopes that we will continue to
4 deliberate and determine what will be best to help
5 us as we fight this epidemic across the state,
6 whether it be legislatively or with additional
7 resources.
8 So what I'm gonna do, is ask everyone to
9 identify themselves here at the -- the panelists
10 that we've assembled.
11 You will find that we've brought people from
12 a variety of disciplines here: from education, from
13 the medical profession, from rehabilitative and
14 treatment services, to law enforcement, the DA, and
15 the Sheriff, as well as the Health Department of the
16 county, the Mental Health Department of
17 Oneida County.
18 And we want to thank County Executive Picente
19 for his cooperation.
20 And, I'll let everyone introduce themselves
21 from those various disciplines that are here, and
22 then I'll turn it over to Senator Boyle to say a few
23 words.
24 Senator Valesky will be joining us. He's on
25 his way; he should be here very shortly.
6
1 And so we'll do an introduction. I'll turn
2 it over to Senator Boyle.
3 I'd like to ask everyone here, I'd like you
4 to take a few minutes as we -- after we introduce
5 everyone, to just speak to the issue, for about
6 five minutes or less, and then we'll begin this
7 conversation here in the community, and then open it
8 up to the public, too, and any of the press that may
9 be in -- and present, also, because the idea is to
10 have this as an interactive opportunity, if we're
11 going to have the opportunity later to evaluate and
12 examine the various dialogues and panel discussions
13 that have taken place across the state.
14 So, Phyllis, I'll start at your end with
15 introductions, and then we'll go all the way down,
16 and then we'll come back to Senator Boyle.
17 PHYLLIS ELLIS: Okay, thank you, Senator.
18 My name is Phyllis Ellis, and I'm the
19 Director of Public Health for Oneida County Health
20 Department.
21 TARA COSTELLO: Tara Costello, Oneida County
22 Department of Mental Health, Director of Substance
23 Abuse Services.
24 SCOTT McNAMARA: Scott McNamara, the
25 Oneida County District Attorney.
7
1 ERIN BORTEL: Erin Bortel, Director of
2 Prevention Services at ACR Health.
3 DR. JEANNA MARRAFFA: Jeanna Marraffa. I'm a
4 clinical toxicologist at Upstate Medical University
5 at the Upstate New York Poison Center.
6 CASSANDRA SHEETS: Cassandra Sheets, CEO of
7 Center for Family Life & Recovery.
8 JULIE BARKER-NAGEL: I'm Julie Barker-Nagle.
9 I am the health services administrator at the
10 Oneida County Jail, through Correctional Medical
11 Care.
12 DONNA M. VITAGLIANO: Donna Vitagliano. I'm
13 Executive Director of Insight House.
14 DR. GEORGE KOZMINSKI: Dr. George
15 Kozminski. I'm in charge of the medication-assisted
16 program at Insight House.
17 SENATOR GRIFFO: Again, I want to thank all
18 of you.
19 And I know Sheriff Maciol is here, too.
20 Hopefully, he's not tending to a problem out
21 there.
22 [Laughter.]
23 SENATOR GRIFFO: But, the Sheriff will be
24 joining us shortly.
25 We also want to welcome Senator Dave Valesky,
8
1 who borders -- represents part of Oneida County and
2 Onondaga County, and, Cayuga.
3 Did I get that right?
4 SENATOR VALESKY: No longer.
5 SENATOR GRIFFO: No longer.
6 SENATOR VALESKY: No.
7 SENATOR GRIFFO: Okay.
8 So I'm gonna turn it over to Senator Boyle
9 first, and then ask Senator Valesky to offer a few
10 comments, and then we're gonna go right to our
11 panelists.
12 And, Senator Boyle, again, I want to thank
13 you very much for your leadership on this issue, and
14 for your willingness to really commit yourself to
15 move across the state, to gauge public opinion, and
16 to also talk to a number of experts across our
17 state.
18 SENATOR BOYLE: Thank you, Senator.
19 And I'd like to thank Senator Griffo and
20 Senator Valesky for their leadership, in not only
21 the State Senate, but in hosting this forum.
22 And, this is the third of 12 forums that
23 we're going to have with the Heroin Task Force, to
24 try, as Senator Griffo said, to come up with ideas
25 for legislation.
9
1 I think that we've been hearing some of the
2 same concepts, but every time we have a forum, we
3 get some new ideas, and that's exactly what we're
4 looking for.
5 We're going to -- the idea of the Task Force
6 is missioned to have a report due June 1st, and then
7 we'll have about three weeks after that to get
8 legislation passed, hopefully, in the Senate,
9 certainly, and also in the Assembly, to combat this
10 heroin epidemic.
11 And I can tell you that I'm interested to
12 hear the numbers in the Oneida and the surrounding
13 counties, because we're going from Suffolk County
14 where I'm from, the numbers are staggering in terms
15 of heroin use and overdoses; straight on out to, all
16 the way in Western New York where the amount of
17 overdoses have tripled in the last 2 1/2 years.
18 This is an interesting group that we've
19 assembled, some experts.
20 And I thank Senator Griffo and
21 Senator Valesky for bring these people together,
22 and, look forward to getting some new ideas, and the
23 interactions, and for -- when -- after we've had
24 some group discussion here, from interaction with
25 the people in the audience, to learn personal
10
1 experiences that you have.
2 Basically, if you've thought in your
3 situation, whether you're law enforcement, a
4 prevention expert, or a treatment provider, there
5 ought to be a law, that this system is not working,
6 and, whether you're a parent or an addict yourself,
7 something that could change or a service we could
8 provide, to combat this terrible scrouge in our
9 community is what we're looking for.
10 And I thank you for attending.
11 SENATOR VALESKY: Thank you, Senator Griffo,
12 for hosting this Task Force meeting.
13 Thank you Senator Boyle for being here.
14 I guess it's a little embarrassing when the
15 Senator from Suffolk County gets here before the
16 Senator from Syracuse.
17 But, I'm very happy to be here and to
18 participate in this.
19 And appreciate, Phil, your leadership on a
20 statewide perspective.
21 As Senator Boyle indicated, we're anxious, in
22 the final eight weeks of the regular legislative
23 session, to develop a comprehensive legislative
24 package for approval before we adjourn in late June.
25 The only thing I would add, is that this is a
11
1 process that actually did begin as part of the state
2 budget.
3 The Senate, initially, in the one house, and
4 then advancing to the final budget that was adopted
5 on the 31st of March, did include some resources for
6 treatment.
7 So, we have -- we have taken the lead, from
8 the legislative perspective already, and now is the
9 opportunity to hear from the experts in the field,
10 which is the point of these Task Force forums.
11 I would just add that, as we go forward, any
12 additional information or comments or input that
13 anyone would like to provide can certainly do so,
14 through Senator Griffo, through myself, or
15 Senator Boyle, as we move forward.
16 So, thank you very much.
17 SENATOR GRIFFO: And, Commissioner, our
18 Commissioner of Health, we'll start with you; we'll
19 start on that end.
20 And --
21 PHYLLIS ELLIS: Thank you, Senator.
22 Always first, huh?
23 I want to thank you again.
24 Thank you for inviting us, and thank you for
25 coming, and thank you for allowing us to participate
12
1 in this very important endeavor.
2 We're happy to participate as the
3 Oneida County Health Department, because this is
4 definitely a public-health issue in our community.
5 We've obviously gotten involved through our
6 partners in our county health and mental health, and
7 substance abuse through our partners in the county,
8 as well as our partners in the community.
9 As you heard from ACR, we've been
10 participating with them in some of their new
11 endeavors, as well.
12 So we're really excited to be part of this.
13 And, really, the only, probably, data that
14 I could provide you, from a County Health Department
15 perspective, is our medical examiner data.
16 We're fortunate this year to have data from
17 our Onondaga County Medical Examiner, which is our
18 contracted agency.
19 In the past, we did not have this type of
20 program, so we don't have statistics to compare to.
21 But, I do have the data from our
22 medical examiner for 2013, and we had 12 total
23 deaths from heroin overdoses in Oneida County.
24 And that number reaches across our cities, as
25 well as our towns and smaller communities, so
13
1 there's really no geographical spot that had the
2 most.
3 So far, for 2014, which we don't have too
4 much data yet, because there's a lot of pending
5 information, we do have two deaths attributed to
6 heroin overdoses.
7 I think what caught my attention, when we're
8 working with the medical examiner, is that there
9 really is no age-specific deaths in our county.
10 They ranged from, less than 20 years, to
11 60 years, or 59 years, so there's quite a variety of
12 people utilizing this drug.
13 The other comment that we had in some of our
14 toxicology, was many of these deaths also involved
15 either over-the-counter drugs or elicit drugs, as
16 well as heroin; so, there was a combination of drugs
17 in our toxicology reports.
18 So, I think we're just happy to be
19 participating.
20 We'll keep track of this. We'll work with
21 our community partners in both our county government
22 and health, as well as our community providers that
23 provide care to our clients in the community.
24 Senator.
25 SENATOR GRIFFO: Thanks, Phyllis.
14
1 I'm gonna move over now to this side, and ask
2 Donna Vitagliano or Dr. Kozminski.
3 DONNA M. VITAGLIANO: Thank you, Senators,
4 for hosting this event.
5 We're thrilled to have the opportunity to
6 present to you.
7 Insight House, just for your information, is
8 in its 43rd year of operation.
9 We have a residential program which has
10 44 beds; day-treatment program, 60 patients; and
11 outpatient clinic, 220-plus people.
12 Right now what we're seeing, in terms of
13 heroin and opiate use, it's 27 percent of that total
14 of patients.
15 So, it's a considerable increase in terms of
16 numbers. I think up, about, almost 10 percent from
17 last year.
18 So it's a considerable -- it's a considerable
19 problem, in terms of what we see in terms of
20 treatment on a daily basis.
21 We know that the I-STOP program that has been
22 in place for the past year or two has restricted the
23 availability or -- prescribed opiates on the market.
24 So, in terms of people that have used
25 opiates, they're now turning to heroin, which is
15
1 available, affordable, and very prevalent.
2 And, so, we're seeing people present every
3 day with problems that are a result of their use.
4 We currently -- and I'll let Dr. Kozminski
5 talk in terms of the Suboxone treatment that we are
6 providing, but that is -- that is something that we
7 have currently started making available to our
8 patients.
9 And, we look for that -- those --
10 Bless you.
11 -- those numbers to increase in the future.
12 Right now, our suggestion: I think what we
13 would like to see, probably, is education.
14 Prevention and education.
15 We certainly know New York State isn't gonna
16 build anymore prisons. It's not gonna go in that
17 direction.
18 Treatment is available, but we know that
19 education, like we have done in the past with
20 smoking, seat belts, any kind of -- anything that's
21 been productive in the past I think is what we need
22 to focus on in terms of the heroin problem at the
23 current time.
24 We currently also have a prevention unit
25 that's in six school districts. And, unfortunately,
16
1 we don't reach students, to give them the
2 information they need to make healthy choices, until
3 junior high.
4 And, we really need to be doing that in
5 elementary school.
6 We teach our children everything else
7 imaginable. We start with sports, we start with
8 music, art, anything. They're so computer savvy.
9 The unfortunate thing is, we don't do
10 anything -- we don't do enough in terms of
11 drug-and-alcohol education, and I think that's where
12 we have to focus in the future.
13 And, the other thing we don't have locally,
14 unfortunately, is a local detox.
15 People that are experiencing a problem here
16 locally have to at least travel to Syracuse and look
17 for help in terms of detox, there.
18 So, I think that is something we could use --
19 we could use on a local level in the future.
20 SENATOR VALESKY: Thank you very much.
21 SENATOR GRIFFO: Thank you, Donna.
22 DR. GEORGE KOZMINSKI: Hi. I have the
23 advantage, or disadvantage, I've been working in
24 addiction for about 12 years now, and I've seen the
25 scourge of heroin expand itself in our sector also.
17
1 I work in private practice, and I also work
2 as a consultant at Insight House.
3 And, I can tell you that, on a daily basis,
4 when I see patients there, and "clients,"
5 "patients," whatever you want to call them, is the
6 fact that it's very common that heroin is the major
7 factor that brings them to Insight House at this
8 time.
9 And, it's very common for me to hear from an
10 individual that one or more friends of his or hers
11 have passed because of this disease.
12 And, it is a scourge that really needs to be
13 addressed in terms of education, and, also, the
14 availability of treatment.
15 The availability of treatment is just not
16 there yet.
17 And, it's getting there, in terms of a nudge,
18 but we're way, way -- there's a lot more work to be
19 done there.
20 And the education needs to be done in terms
21 of, not just the patient, in terms of the
22 availability of care, but, also, their parents,
23 their friends.
24 The schools; the schools need to be more
25 involved in this, also.
18
1 As well as law enforcement, which also is
2 very involved, I understand it, because they deal
3 with it on a daily basis.
4 But, we need to partner up.
5 And that's why I'm really appreciative of
6 this forum, because we're finally partnering up to
7 really address this issue.
8 Thank you.
9 SENATOR GRIFFO: Thank you.
10 I'm gonna go to Tara now, from the
11 Oneida County Mental Health Department.
12 TARA COSTELLO: Thank you.
13 And, I want to thank everybody for being here
14 tonight.
15 And thank you, Senator, for inviting me.
16 At the Oneida County Department of Mental
17 Health, my role as the director of substance-abuse
18 services is to do coordination and planning based on
19 the needs in the community.
20 I have been tracking -- actually have been
21 tracking this since 2011.
22 This was on our County plans since 2011, and
23 we've looked at significant data, and we've seen --
24 and I'm not gonna -- I'm just gonna comment on what
25 Donna mentioned, because some of her data is very
19
1 similar to mine -- we actually have seen a 25
2 percent increase of admissions for opiate,
3 specifically, since 2011.
4 We also have seen a 20 percent increase in
5 IV-drug use.
6 This year we -- which is very concerning when
7 we talk about education and other chronic diseases
8 that come with the use of using opiates.
9 We also have seen, since -- believe it or
10 not, since 2011, we've seen there's a difference
11 between the opiates that are being prescribed, and
12 heroin.
13 And we've seen, as Dr. Kozminski mentioned,
14 heroin being on the rise, and prescription drugs
15 being on the low.
16 From the County's perspective, what we've
17 worked with, is we have worked with all of our
18 community providers, all of our outpatient
19 providers, our inpatient providers, to look at
20 increasing the doctor coverage for Suboxone, but
21 that's just putting a Band-Aid on the problem.
22 As Donna had mentioned, prevention is key.
23 We are seeing a new face of addiction.
24 We're not seeing that typical -- you know,
25 there's a stigma out there, and I think we need to
20
1 relook at what we're really seeing on the street.
2 I get calls frequently from the office on how
3 to navigate the system. How to best get the
4 services they need.
5 And if there's anything that we can see, from
6 a systems perspective, is managed care is really
7 dictating what we can do with individuals, which is
8 very sad.
9 Yes, we need a detox; however, that is not
10 encompassed in the changes that are coming with
11 insurance.
12 Insurance is dictating what we can do for our
13 patients.
14 Unfortunately, our outpatient providers have
15 done the best they can with what they have, but, we
16 really need to look at that system, and really look
17 at what the needs are; and either provide a
18 standardized tool for individuals to be able to get
19 the services they need, based on their clinical
20 need.
21 We are seeing -- and I know, Donna, you can
22 comment on this -- we are seeing a lot of people
23 that are being served in the outpatient setting that
24 really need more intensive services.
25 And, unfortunately, there's a systemic
21
1 barrier that causes us to have to keep them in an
2 outpatient setting, which creates more crime.
3 I'm not gonna steal your thunder, Sheriff.
4 [Laughter.]
5 TARA COSTELLO: But, it really -- it's a
6 trickle effect.
7 And, I think that's a major area to comment
8 on from a systems perspective.
9 Yes, it's great to have education, and get
10 some fundamental understanding of what's out there,
11 but, we also have to look, from a system, we put
12 things in place to avoid people from seeking help.
13 We make it more difficult.
14 Some other suggestions is, you know, we have
15 a lot of rural areas in Oneida County.
16 I'm sure in other counties you see that as
17 well: You know, there's a transportation issue,
18 with people accessing services, to get to
19 Insight House, or -- you know, all services are in
20 Utica, or Cam- -- you know, that Camden, Rome, area,
21 they lack services.
22 So those folks have to travel to Utica to get
23 to those services.
24 So, we need more support in that area.
25 We in Oneida County have worked, actually,
22
1 recently, we hosted an opiate forum for the
2 community back in January.
3 The Sheriff was present. Many of our
4 providers were present, as well.
5 And, we had about 75 people that work with
6 opiate individuals in the community, represented.
7 And what we did was, we identified some
8 areas, which are just all have been mentioned here
9 today, on what is needed in this community.
10 The County has partnered with the Sheriff's
11 Department, UPD, and also our Rome PD, to talk about
12 how we can better educate.
13 And we are continuing that conversation.
14 Actually, we have a meeting coming up on
15 Tuesday, to continue that dialogue; to discuss what
16 we can do as a community to spearhead this.
17 We have worked with our coalition partners,
18 CFLR, to really spearhead some of this.
19 You know, we're really trying to work as a
20 community to come up with a better way to handle
21 this problem.
22 Because, yes, we are the experts, but we also
23 need individuals like yourself to give us some
24 ideas.
25 So, thank you.
23
1 SENATOR GRIFFO: Thank you, Tara.
2 I'm gonna ask Cassandra Sheets next to speak,
3 from the Center for Family Life & Recovery.
4 Cassandra.
5 CASSANDRA SHEETS: Okay, thank you.
6 I first do want to thank everybody for coming
7 today, and thank you, Senator, for inviting me as
8 well.
9 Just a little bit about Center for Family
10 Life & Recovery: Our whole vision is to create a
11 community mindset to help sustain recovery.
12 So, to have a model in our community to look
13 at, where we have issues with substance abuse: How
14 do we create a community that embraces, to be able
15 to not only get past that, prevent it, but also to
16 maintain some recovery?
17 And, be able to have an opportunity to talk
18 in how we are more of a clean community, rather than
19 a community that's always struggling with issues
20 coming into it; how do we embrace that?
21 And the way that CFLR really looks at it is,
22 prevention is key.
23 Donna's right on top of it.
24 And the primary prevention is probably the
25 one that we've left out the most.
24
1 The kid are the ones that, I don't know, we
2 assume, maybe, they get it at home. We assume that
3 it's coming from someplace else.
4 And it's -- you know, do you ever remember
5 being told, like: It takes a village to raise a
6 child?
7 And that hasn't changed; but, yet we've kind
8 of changed that village.
9 And I think that we have to go back to that.
10 We have to go back and look at that primary
11 prevention piece, and remember that, yeah, some of
12 them get it at home, and some of them understand
13 that information, but, we are teaching them -- my
14 kids know more about diabetes than they do about
15 drug use.
16 And our drug use is pretty high in this
17 community.
18 So, it's important to know all that
19 information.
20 So, prevention is key.
21 But, it's also important to have a mobilized
22 community around that, because, they can be in a
23 school -- let's use a child, for example: They can
24 be in a school and they can hear this information,
25 but they have to be able to go out to different
25
1 sectors in the community and hear the same
2 information.
3 They have to learn to be more tolerant, we
4 have to learn to be more tolerant, too, so that we
5 can have a mission and have a statement to say: We
6 want heroin to be lessened in our community, but how
7 are we going to come together to do that?
8 And that's what's important.
9 That's what I hear, when we look at this.
10 One of the roles that CFLR plays in the
11 community, is we spearhead the Suicide Prevention
12 Coalition.
13 And, in 2013, there was 35 suicides, and 9 of
14 them were drug-toxin-related. And then there's some
15 that are pending as to the results of that.
16 And -- and that's really large, because are
17 those ones that could be prevented?
18 They certainly could be.
19 So, how do we as a community begin to protect
20 each other?
21 Common language is something that's very
22 important, so one of the things that we do, is we
23 work on training.
24 The medical profession is probably one that
25 could work on being connected; like, we could all be
26
1 talking the same thing.
2 They talk about overprescribing-doctors, or
3 doctors not talking with each other to know what's
4 happening with their patients.
5 A specialist I was talking to the other day
6 said: We're just -- managed care has created a
7 whole specialist-type system, so there's the loss of
8 the primary care.
9 That's kind of the one that can help focus
10 where people get, and how they're maneuvering
11 through the medical system. So, they tend to get
12 lost, and then there's more issues that way.
13 Being able to talk; you know, Dr. Kozminski
14 is in the field of addiction medicines, but, how
15 many doctors really talk and ask their patients, you
16 know: Do you have a problem with drugs and alcohol?
17 How many ask if they have any mental-health
18 issues that may cause them to want to be able to
19 have -- you know, take that medication?
20 And -- and that the prescription medication
21 begins to go down, and then it's easier to get to
22 the heroin.
23 And that's where the issue has become more of
24 a community-wide problem.
25 So, from the CFLR standpoint, our role is to,
27
1 really, just mobilize the community in each sector.
2 You know, if you're not feeling safe in your
3 home community, if you don't feel like you have a
4 purpose, if you're not feeling healthy and you're
5 not feeling comfortable, then -- you know, then the
6 kind of behaviors that you're gonna partake in are
7 gonna be the ones that are gonna continue to make
8 that happen.
9 So, as a community, we have to mobilize that
10 message to say: This isn't something we want to do.
11 And, how can we, though, help people, and be more
12 tolerant to that, to make that kind of change?
13 And I have to say that, the resources are a
14 big piece.
15 With the change with the managed care --
16 I mean, I'm primarily prevention -- and with the
17 managed-care piece of it, the public dollars dry up.
18 And, so, you get calls from schools to go and
19 do some of this work, and you can't afford it, so
20 now you're trying to cut corners to be able to
21 provide at least a partial message.
22 But, the consistency of being able to follow
23 through with a model, to be able to say, "This will
24 really help and work for your kids," we -- we're not
25 able to really make that long-term commitment.
28
1 And I think that's what -- that's really the
2 frustration on our part of it.
3 So, I want to see families get involved.
4 I want to see us do more training in the
5 medical profession on a consistent basis.
6 I want the medical, mental-health, and
7 substance-abuse providers to be talking the same
8 language that will really mobilize people to get the
9 support that they need.
10 And, to look at freeing up some public
11 dollars for prevention, it's key, including the
12 health department, and a more holistic focus, is --
13 is right on track with moving this forward.
14 And we will, actually, I know we will, create
15 a community that will sustain recovery.
16 SENATOR GRIFFO: Thank you.
17 We'll turn to the District Attorney.
18 SCOTT McNAMARA: Thank you, Senator.
19 I would like to thank:
20 Thank you, Senator Griffo, I'd also like to
21 thank Senator Boyle and Senator Valesky, for being
22 on the Committee; but more importantly, for coming
23 to Utica, and showing your presence here, and
24 listening to our community.
25 Heroin addiction, and deaths resulting from
29
1 heroin, are nothing new, and it's really -- it
2 hasn't left our community without being touched.
3 Some of the more notable things that have
4 happened recently in our community:
5 Stephanie Bon Jovi almost died. She
6 overdosed on heroin while at Hamilton College.
7 That case received some national attention
8 because of an exception in the law, where her --
9 because help was called for, she couldn't be
10 prosecuted.
11 Last year, a baby came up missing. The
12 father of that baby, after the baby was missing, was
13 hanging around people that were using heroin
14 heavily, and he became involved in dealing heroin.
15 So, those are just two cases that happened
16 locally.
17 And then, if we just think back in time, and
18 I kind of scanned the audience, I see a lot of you
19 are about my age, so some of these names you will
20 remember: Jim Morrison, Janice Joplin, and
21 John Belushi.
22 So, heroin addiction and heroin abuse, and
23 death as a result of the abuse of heroin, is nothing
24 new.
25 What I can say I have seen in my 21 years
30
1 while working at the District Attorney's Office, is
2 this:
3 In 1992, when I started, I would say, 1 out
4 of every 10 cases that we would handle that was a
5 drug case, would be heroin.
6 And they stuck out because they were the
7 exception and not the norm.
8 Crack cocaine was the norm.
9 Today, as recently as today, when I spoke to
10 the Utica Police Department, it's about 50 percent
11 now.
12 So every case that they do, and execute a
13 search warrant, or that they're trying to buy drugs
14 undercover, about 50 percent of it is heroin.
15 And, so, then we kind of go back and you look
16 at: What has changed recently? And, what do
17 I think the contributing factors are?
18 I'm not gonna talk about the decrease in the
19 Rockefeller drug laws. I really don't have a
20 problem with that, and I understand that.
21 Some people make the argument that, you know,
22 we're not putting enough effort on putting drug
23 dealers away.
24 I don't really agree with that. I think that
25 we continue to fight from that angle.
31
1 But, what we're talking about here with
2 heroin, is we're talking about: What we see locally
3 is, approximately, 80 percent of the people that we
4 encounter -- and there are studies out there that
5 support that number -- start off abusing
6 prescription medicine, and then turn to heroin.
7 So when you look at, how do we -- you know,
8 "How do we solve the problem?" we have to go back
9 and figure out where the water's coming from that's
10 coming over the dam.
11 And what I believe's happening is, we've got
12 to look at the prescription-drug abuse, because we
13 see a lot of that, and it starts at a very young
14 age.
15 And, when you look at whether it's Oxycontin
16 or hydrocodones, and the way that they're being
17 prescribed, there was a philosophy years ago that
18 those drugs were not addictive; and, therefore, they
19 prescribed them. And they still do.
20 I mean, as recently as this year, my daughter
21 had some teeth pulled, and she got a prescription
22 for 20 Oxycontins.
23 She took two.
24 Now we've got 18 Oxycontins laying around.
25 That overprescribing puts these drugs out
32
1 there, and not everyone's the DA's daughter, who the
2 DA makes her get rid of the drugs the right way.
3 So, you know, those are -- that's where I see
4 the problem.
5 And what we see locally is, what happens is,
6 when the people can no longer get the prescription
7 drug that they've now become addicted to, they turn
8 to heroin, because, heroin, the average price of a
9 hit of heroin is about $10.
10 The average price of an Oxy or a hydro on the
11 street is $20.
12 So, you're talking about two for one.
13 So, it's pure economics on the street for
14 these people.
15 And then, plus, the heroin, especially when
16 they start shooting it up, is a much more powerful
17 and lasting high.
18 So that's what we're seeing.
19 And, you know, and I really think if we could
20 address some attention into, "How can we stop the
21 abuse of the prescription drugs?" I think we would
22 ultimately see a reduction in the number of heroin
23 addictions, and heroin deaths.
24 So that's -- that would be what I would hope
25 that you would look at.
33
1 Thank you, Senators.
2 SENATOR GRIFFO: Thanks, Scott. I appreciate
3 that.
4 And we'll continue with law enforcement now.
5 Sheriff, I know you're here, and you have
6 someone with you, too.
7 SHERIFF ROBERT MACIOL: Yes.
8 Thank you, Senator.
9 Again, to echo the words of the DA: Thank
10 you to Senator Griffo, Valesky, and Boyle, for
11 taking the time to address this important issue.
12 You know, when you look at the
13 law-enforcement perspective, the first thing that
14 comes to mind, obviously, is the stuff that the
15 police officers and deputies and troopers are
16 dealing with on the street.
17 Certainly, whether it be the officer or
18 deputy that's doing a traffic stop, who sometimes
19 can encounter the illegal substance; whether it's
20 our partnership; and, again, none of us can do this
21 job alone, and I think this panel proves it.
22 You know, the walls are all down when it
23 comes to barriers of jurisdiction, if you want to
24 call it that.
25 When there's a problem, this area has always
34
1 been known to come together, so we can look at it
2 from all angles.
3 But, again, like I said, on the cooperative
4 approach, whether it be our involvement, all the
5 law-enforcement agencies' involvement, under the
6 lead of the DA, with the drug task force, I mean, we
7 have to continue to be tough with those who are
8 dealing in these drugs.
9 So, we deal with it on that approach.
10 Then the educational approach, from the
11 law-enforcement community, just about each and every
12 school district in the entire county, with the
13 exception of a couple, have school-resource officers
14 in them.
15 The Sheriff's Office, specifically, we're in
16 6 of the 11 or 12 districts in Oneida County.
17 Obviously, they deal with a whole realm of
18 different things, but one of their jobs is to
19 educate.
20 Certainly, one officer in a large school
21 district isn't gonna be able to reach to every --
22 reach everyone.
23 But I think, again, going back to
24 partnerships, I know our County Probation Department
25 has probation officers in several schools.
35
1 So, again, we're partnering with that
2 educational message, and I think that's where the
3 community comes into play; whether it be the
4 parents, or the media.
5 I mean, when we dealt with a bath-salt issue
6 here a year or two ago, the media did a fabulous job
7 of constantly putting it in the headlines, the first
8 story, you know, telling these tragic things that
9 have occurred when people have taken bath salts.
10 And I think that's important that the media,
11 you know, like I said, remain a strong partner with
12 us. And they've always been there when it comes to
13 these important things.
14 But, we have to reach out. We have to think
15 outside the box.
16 We have to -- certainly, we're dealing with
17 the issue at hand right now, but we have to reach
18 these people before they start taking the drugs,
19 before they start overdosing on the prescription
20 drugs, before they -- you know, whether -- you know,
21 we could talk all kinds of drugs.
22 Obviously, the one we're focusing on here
23 tonight is heroin, but think I we need to stop it at
24 the early stages, and that comes from a strong
25 educational program, that we reach out to everybody.
36
1 And, you know, the unique perspective of the
2 Sheriff's Office, not only are we dealing with it on
3 the street, whether it be our -- like I said, our
4 uniform or our undercover people, but on the
5 corrections side of this issue.
6 Here in Oneida County, we have a 632-bed
7 jail. It's one of the larger jails in the state.
8 And, we struggle with this issue each and every day.
9 And that's why, you know, I wanted to take a
10 little different approach, and, tonight, I brought
11 with me our health-services administrator who
12 oversees the medical unit in the Oneida County Jail.
13 And, she's got some staggering statistics.
14 I mean, it's scary when -- what you'll hear
15 her speak in a moment. But, again, that's the issue
16 that we deal with on the other side.
17 Not are we and all the other law-enforcement
18 agencies dealing with that on the street, but then
19 we bring them into the correctional facility.
20 And, again, that opens up a whole nother
21 array of various things we have to deal with when
22 we're treating these individuals and housing them.
23 And to backpedal just a little bit, before
24 I turn it over to our administrator, but Tara had
25 mentioned, you know, the decrease in services.
37
1 And the more we continue to -- to -- whether
2 it be through the insurance, of not providing the
3 coverage for these inpatient services, or, we -- you
4 know, if we continue to cut programs or close
5 facilities, these people, you know, these
6 individuals, when they end up on the street, and
7 they have no other alternative but to steal, or
8 whatever the case may be, they end up in our
9 facility. And that's not always the best place for
10 these people to be.
11 Let's be honest about that: Many of them
12 don't belong with us, because they need treatment.
13 And by being inside a correctional facility,
14 we're dealing with them daily, but, again, we're not
15 giving them the treatment that they really need.
16 So, with that, I'd like to turn this over to
17 Julie Barker-Nagle, our health-services
18 administrator for CMC, which is the medical provider
19 at the Oneida County Jail.
20 Julie?
21 JULIE BARKER-NAGEL: Thank you, Sheriff.
22 And thank you, Senators, for inviting us
23 today.
24 When I talked to Sheriff on Friday, and was
25 asked to speak on this panel, gathering statistics
38
1 for 2013 and first quarter 2014, it was all a manual
2 review of charts, because we never really thought
3 about keeping those statistics specific to heroin.
4 So, in 2013, if it gives you any idea: We
5 had approximately 5700 inmates come through
6 Oneida County Jail.
7 Whether they were there for 10 minutes, or
8 county-long terms, 5700 inmates is a lot of folks.
9 On the average, last year, in 2013, our
10 monthly statistic showed about 476 inmates per month
11 that we had within our population.
12 And our first-quarter average is keeping
13 right about there for 2014, as well; and that's
14 about 464 inmates.
15 So, our monthly population, of course, is
16 fairly significant.
17 So what I did is, I looked at the total
18 heroin use for the time period of 2013 and the first
19 quarter of 2014, to try to compare and contrast what
20 our inmates are sharing with us.
21 And, of course, when the inmates come in, it
22 may not necessarily be a drug charge or anything
23 related. It could be a robbery.
24 But when you sit down and you talk with them
25 from a nurse's standpoint, they admit to robbing
39
1 somebody's house because they needed the money to
2 support their heroin problem.
3 So, when we took a look at the statistics,
4 surprisingly, males are double females as far as
5 usage.
6 And I'm saying "admitted usage," because
7 maybe not everybody admits to us that they have used
8 a heroin substance.
9 So we're looking at, for that time period,
10 161 men and 82 women.
11 Now, breaking down even further is, age
12 ranges.
13 Out of all those folks that we had, those
14 243 people in that time frame, we had one teenager,
15 a 19-year-old.
16 But, alarmingly, out of that population,
17 there was 96 "20-year-olds," and 116 "30-year-olds,"
18 when we broke it down even further.
19 And then, of course, we had some minor
20 numbers in the 40s, 50s, and even 60s, as far as
21 the heroin use.
22 Digging in even further, what was more
23 astonishing, is to look to see if there really is an
24 increase in usage of heroin.
25 And, the first-quarter comparison from 2013
40
1 and '14 showed, actually, a 39 percent increase.
2 So, January, February, March of last year,
3 compared to January and February and March of this
4 year, we saw a 39 percent increase in heroin usage.
5 And that's, again, "admitted."
6 So, January to January, 60 percent increase.
7 And when we looked at February, specifically,
8 was 27, and March was 58, percent increase as
9 compared to last year.
10 So the heroin usage and admittance to heroin
11 usage is really on the rise.
12 When these inmates come in to us, it presents
13 a unique problem, because we don't have a true
14 infirmary. We have a medical-observation unit.
15 And we do our best, that anybody who's even
16 said that they've touched heroin within a certain
17 amount of time or admitting current use, we put them
18 right on a protocol right away, because we want to
19 make sure that we monitor them, from the time they
20 walk through the building, until the time our
21 medical doctor gives them that final blessing to
22 say, Yes, they're kind of through that withdrawal
23 period.
24 The pharmacy cost isn't -- isn't as bad as
25 I thought. It's about $4 per inmate.
41
1 But as you can see, last year we spent a
2 total of $783 just on heroin-withdrawal treatment
3 alone within the jail setting.
4 That's just within the jail setting.
5 That doesn't include the inmates that we've
6 had to send to the hospital for further evaluation,
7 for further treatment.
8 In this year, we're already at a 30 percent
9 of that number from last year.
10 So the rise is, definitely, definitely
11 significant as far as the heroin usage.
12 We have treated pregnant females who have
13 been on methadone, which is very tricky and scary
14 for us within the jail system.
15 We don't like anybody pregnant, in jail.
16 And now to add that methadone, because of the
17 heroin addiction, keeping them on a regimen.
18 We oftentimes see violent withdrawals when
19 these folks are withdrawing from medication.
20 And a lot of them admit that they had been on
21 a -- some type of opioid, the hydros, or whatever
22 the case is, and they couldn't afford it anymore,
23 or, they couldn't get another doctor to prescribe
24 it. And so, now, they turn to heroin, which we've
25 heard is much, much cheaper.
42
1 So the statistics I think, you know, if this
2 trend continues, we're gonna see numbers quadruple
3 by the end of the year.
4 So, it really -- it's really something,
5 Senators, that need to be looked at.
6 And, thank you.
7 SENATOR GRIFFO: Thank you.
8 Dr. Marraffa.
9 DR. JEANNA MARRAFFA: Hi.
10 Thank you, Senators, for -- for, really,
11 I think, bringing light to this issue in your
12 efforts across the state.
13 Obviously, with everyone sitting here on a
14 Tuesday night, I think it highlights, really, the
15 problem that we're having.
16 I'm a clinical toxicologist at the poison
17 center. And the poison center is physically located
18 in Syracuse, but, just to give you an idea:
19 The Upstate New York Poison Center covers,
20 pretty much, all of Upstate New York.
21 So our catchment area is, everything -- all
22 of the counties in Upstate New York, with the
23 exception -- or, in New York State, excuse me, with
24 the exception of Westchester County, the
25 five boroughs of Manhattan, and Long Island.
43
1 So, our population served is 7.4 million
2 people.
3 And with that being said, I echo what
4 everybody has said here today: That we are seeing
5 that rise in both, heroin, as well as
6 prescription-opioid use.
7 To give you an idea of some numbers, just to
8 orient you a little bit:
9 Last year, in 2013, the calls to the poison
10 center regarding heroin, in our catchment area, was
11 243 calls.
12 And that could be a range from, anywhere of
13 an information call, to someone who is experiencing
14 toxicity.
15 And to break those numbers down a little bit
16 more, because I think it's even more compelling when
17 you look it just more in the Central New York
18 region:
19 In 2013, we had 150 calls, really, when you
20 pare down those numbers, into the Central New York.
21 And to compare that, for example, in 2009, we
22 only had 29 calls from Central New York.
23 2012, we had 89 calls.
24 2013, 150 calls.
25 So you can see a dramatic increase in numbers
44
1 called in to the poison center.
2 Year-to-date this year, across our catchment
3 area, we have 77 calls regarding heroin.
4 And then if you just pare it down just to
5 Oneida, Onondaga, and Madison counties, it's about
6 33 calls.
7 So, a significant number of calls that we
8 have experienced.
9 And, a little bit about poison centers:
10 People call poison centers when they're
11 having a problem.
12 So we know that, just that -- even though
13 we're showing that rapid increase in numbers, it
14 really is an underrepresentation of the real problem
15 that exists out there.
16 And I echo, really, what
17 District Attorney McNamara said, because this really
18 did -- the prescription-opioid problem that we face,
19 both in this community and nationally, is a
20 significant problem.
21 And I think that we're seeing all of this
22 sequelae of that.
23 According to CDC, unintentional poisoning
24 deaths -- so, predominantly, not people who are
25 trying to hurts themselves, but, usually, just the
45
1 face of addiction -- unintentional poisoning deaths
2 are the leading cause of death in the United States
3 in 2013. And those are, predominantly, opioid
4 deaths.
5 And when you look at that, and break that
6 down even further, women are at a high likelihood of
7 dying.
8 And I think that that echos what everybody
9 has said, is that the face of addiction is now
10 different. The demographics is different.
11 It crosses all socioeconomic statuses. It
12 crosses all age range. It's equal among sexes.
13 And that's consistent with what we're seeing
14 at the poison center as well.
15 Another staggering statistic that I think is
16 very important, as you mentioned: pregnant women.
17 In Onondaga County, in particular, we have a
18 huge problem of babies being born to drug-addicted
19 mothers, who then are in the neonatal ICU for
20 withdrawal symptoms.
21 And this actually is a -- it really is --
22 when I say "Onondaga County," it really is a
23 trickledown effect of even Oneida County, because
24 the neonatal ICU is a referral center for all of
25 Central New York.
46
1 And, Onondaga County has the highest rates of
2 babies born that have neonatal withdrawal in the
3 state of New York. "The highest rates."
4 So this is, I think, a big problem.
5 This, of course, heroin is a significant
6 problem.
7 But I agree with you, I think prescription
8 opioids is a large, large problem.
9 I think I-STOP has helped tremendously, but
10 I think we have new battles to face.
11 There was a recent drug that was just
12 approved by the FDA, called "Zohydro," that's
13 extended-release hydrocodone that can be up to
14 50 milligrams.
15 That was approved by the FDA. It is going to
16 be out there.
17 And, it has so much hydrocodone that, one
18 pill, accidentally, in a 2-year-old is enough to
19 cause that 2-year-old to die.
20 So, while we're combating these heroin
21 issues, I think, I agree, we have to talk about the
22 prescription-opioid epidemic that we're faced with,
23 and, really, the public-health risk and concern that
24 all of us are dealing with on a daily basis.
25 So, thank you for organizing this and
47
1 bringing light to these issues.
2 SENATOR GRIFFO: Thank you, Jeanna.
3 Okay, Erin, we're gonna let you close this
4 component of the panel decision.
5 ERIN BORTEL: Thank you so much, Senators,
6 and community members, for coming tonight, and for
7 the invitation to speak this evening.
8 I'm really here to represent the
9 public-health perspective.
10 ACR Health has a deep history in the
11 community.
12 We've provided HIV services over -- for over
13 30 years in both, Oneida County, as well as
14 Onondaga County, and seven other counties in
15 New York State.
16 So, to give you some more statistics, and my
17 apologies if you've been burned out:
18 A 2005 survey conducted in the city of Utica,
19 by -- the Utica Neighborhood Survey, indicated that
20 over 55 percent of youths who responded to the
21 survey actually observed drugs being sold in their
22 communities.
23 Jumping into public-health data, one concern
24 about injecting drugs is the shared use of needles
25 and other equipment.
48
1 And once you start sharing equipment, you
2 have exposure to things like HIV, as well as
3 hepatitis C. And hepatitis C is actually killing
4 more people now than HIV is.
5 So, these are imminent public-health threats
6 that we're facing.
7 At the end of 2010, in Oneida County, over
8 50 percent of newly diagnosed HIV cases among males
9 were directly because of injection-drug use. The
10 rate for females was 29 percent.
11 Statewide, our injection-drug-use
12 transmission category is only 4 percent.
13 So you can see the significant disparities
14 that this region is suffering.
15 Similarly, the 3-year average of newborn
16 drug-related hospitalizations -- so those are babies
17 who are being born into hospitals, that are then
18 admitted for drug-withdrawal symptoms -- has
19 increased every year since 2006 in Oneida County.
20 So, we're now seeing a pattern of
21 drug-babies.
22 This opioid-conversion conversation is really
23 significant.
24 And what that is, is people who start with
25 prescription drugs, and, for whatever reason, decide
49
1 to migrate towards heroin.
2 ACR Health has run a syringe-exchange program
3 since 2011. We currently have over 700 consumers
4 enrolled in that service.
5 85 percent of them are within
6 Onondaga County.
7 The other 15 percent come from all over our
8 region, including Oneida County, so, we have people
9 traveling up to an hour to receive education
10 services from us, as well as the access to clean
11 needles.
12 I would say that over 90 percent of the folks
13 that we see; so, over 90 percent of those
14 700 consumers, are using heroin today because they
15 started with prescription drugs.
16 That's significant.
17 So we're here to help propose some solutions
18 and offer ideas.
19 The founding philosophy of ACR Health was
20 harm-reduction approach.
21 The World Health Organization has stated that
22 attempts to reduce drug use can't overlook the
23 prevention efforts addressing HIV, AIDS, and now
24 hepatitis C.
25 Harm reduction supports a comprehensive
50
1 approach in helping instead of punishing users.
2 And it's -- really, the approach is anything
3 that helps to reduce the risk of injury, whether or
4 not the individual is able to control or abstain
5 from risky behavior.
6 Harm reduction accepts that some harm
7 inevitable; whereas, the idea of zero tolerance is
8 almost impossible, and it excludes all compromise
9 and sets impossible goals for people to achieve.
10 Harm reduction doesn't preclude abstinence.
11 That's always the goal of the program: We
12 always want to see users stop using.
13 However, it suggests that professionals treat
14 patients and provide lifesaving education and
15 opportunities, with respect, and without judgment.
16 Programs and services rooted in the
17 harm-reduction philosophy include:
18 Syringe-exchange programs which were
19 established over 20 years ago in New York State;
20 They include the Expanded Syringe Access
21 Program which was enacted in 2000 in New York State;
22 And the Opioid Overdose Prevention Program
23 enacted in Public Health Law in New York State in
24 2006.
25 These services are typically characterized by
51
1 flexibility and fluidity, and are tailored to the
2 unique needs of each individual.
3 Syringe-exchange programs create a viable
4 access point for substance users to enter care,
5 including substance-treatment services, and, reduce
6 the risks of users contracting HIV, hepatitis C,
7 other sexually transmitted infections, and,
8 certainly, improving the overall wellbeing, so,
9 they're connected to insurance, they're connected to
10 medical care for the first time; as well as other
11 wraparound services that agencies, such as ours, and
12 the other panelists, can offer.
13 Wraparound services for chemically addicted
14 have been shown to improve the overall wellbeing of
15 substance users, including housing, nutrition,
16 mental health, and substance treatment, leading to
17 more pro-social behaviors and improved health
18 outcomes for these participants.
19 SEP programs (syringe-exchange programs) have
20 helped reduce needle-stick injuries among
21 public-works employees.
22 So, the people that are collecting our
23 garbage and trash, among police officers and other
24 first responders in the field, as the community's
25 cleaner, these professionals are facing less risks
52
1 as they respond to emergencies in the community.
2 And then, also, just to touch briefly on the
3 opioid-overdose program or service: That overdose
4 is the most frequent cause of death among
5 injection-drug users.
6 And, there is a viable option to help people
7 be trained in the administration of Narcan, or,
8 Naloxone.
9 Tens of thousands of lives have already been
10 saved because of Narcan training and the education
11 that goes along with it.
12 In the United States, over 53,000 people have
13 already received this training, and, have saved more
14 than 10,000 lives because of it.
15 So ACR Health recently received a certificate
16 from Department of Health to offer this service, and
17 we're in the process of rolling that out.
18 We're also trying to expand syringe-exchange
19 programs into places like Watertown and Utica, so
20 that the service is more immediately available to
21 users in the community.
22 SENATOR GRIFFO: Thank you, Erin.
23 What we're like to do now is, just, maybe
24 have a few questions asked right here at the panel,
25 and then open it up also to the public that are
53
1 here, if you have some questions or suggestions that
2 you with like to present.
3 I would like to start, just based on what
4 Erin had said, and we had -- we were talking about
5 this earlier:
6 With the opportunity to have Naloxone
7 available right now, I'm asking some of the
8 treatment professionals, whether or not you believe
9 that actually gives a false sense to the abuser;
10 that there is this opportunity to have something
11 overcome the potential threat to their lives?
12 So if they're now realizing that this exists,
13 and they are using and abusing the drug, will this
14 contribute to further abuse, knowing that there is
15 something out there that "can save me, ultimately,"
16 so this is not a potential death sentence?
17 So I would ask some of the treatment people
18 if they're feeling if that is a factor?
19 And then I have a question for
20 law enforcement.
21 Then I'll ask my colleagues, also.
22 DONNA M. VITAGLIANO: I don't know that that
23 would encourage people. You know, I don't know that
24 new people would continue to use.
25 But, I think you have to have it available in
54
1 the event, you know, if it is a family member or
2 somebody that you're concerned about.
3 How would you say no?
4 How would you say no to somebody that was
5 unconscious, or on the verge of that, to say,
6 "I have this available but I'm not gonna administer
7 it"?
8 I don't think, as a treatment provider, we
9 could say that.
10 Correct?
11 DR. GEORGE KOZMINSKI: No.
12 It's almost like denying a person who wants
13 to take a walk in the woods who's allergic to bees.
14 I mean, would you deny them a bee-sting kit?
15 Would you deny a diabetic access to different
16 types of medicine?
17 It's the same thing.
18 SENATOR GRIFFO: It's not so much denying.
19 The question isn't whether or not you
20 would --
21 DR. GEORGE KOZMINSKI: It's not encouraging
22 drug use.
23 SENATOR GRIFFO: Do you believe that a user
24 or an abuser now sees something out there that
25 exists, that could save them, ultimately, and -- as
55
1 opposed to knowing that this potentially is a death
2 sentence, "If I take this drug, I could die"?
3 You heard the statistics that were used.
4 I mean, do you believe that anybody out there
5 gets false sense of --
6 DONNA M. VITAGLIANO: Security?
7 DR. GEORGE KOZMINSKI: Security?
8 SENATOR GRIFFO: -- of security?
9 Not -- I'm not discussing the availability
10 options.
11 DR. GEORGE KOZMINSKI: Right, right.
12 SENATOR GRIFFO: I think we all agree there,
13 that if you have an antidote that's available, it
14 needs to be used.
15 But I'm asking any of the -- from a
16 mental-health perspective, or --
17 JULIE BARKER-NAGEL: Senator, I would like to
18 chime in a little bit on that.
19 Do I believe that -- Narcan is other name for
20 that drug -- that maybe family members who knowingly
21 have people at home who are addicted to heroin,
22 should have that available? Yes, I do.
23 As far as the users go, where my mind goes
24 with that, is the morning-after pill.
25 That, now, are we really doing anything to
56
1 prevent unwanted pregnancy? No, because there's a
2 cure-all the next morning if you don't want to keep
3 it.
4 So, my emotions are kind of mixed as far as
5 that goes.
6 Do I believe it should be available to first
7 responders, family members of known drug abusers?
8 Absolutely.
9 But as far as the drug user themself, I don't
10 know, I think you'd really have to weigh the
11 options.
12 SENATOR GRIFFO: Dr. Marraffa?
13 DR. JEANNA MARRAFFA: So I think -- I'll
14 comment. I have a little bit of a different sense
15 of that.
16 We have used Narcan, or, Naloxone, both
17 pre-hospital and in hospitals for years.
18 This antidote has been around, it's
19 effective. It's certainly not without its own
20 risks, but, certainly, we know that it's effective.
21 And, you know, in reality, when we think
22 about these people who are using and addicted to
23 heroin, they're dying, not because -- it really is
24 unintentional.
25 So, they're using either a higher dose of
57
1 heroin or any other opioid that they normally used.
2 They're getting -- they get a different batch of
3 heroin, so there's a lot more of contamination and
4 other different potencies, and things, that are now
5 in heroin. And they use what they believe to be
6 their regular dose, and stop breathing relatively
7 quickly.
8 And, you know, depending on where you live,
9 pre-hospital providers can get there relatively
10 rapidly.
11 But, if you're not breathing for 6, 7, or
12 8 minutes, that's a very long time.
13 And when I see patients, particularly when
14 they hit our emergency department -- in addition to
15 being the poison center, I also see patients at
16 Upstate Medical University -- it's devastating to
17 see people that maybe you could have got to early,
18 and now they're on a respirator. They, perhaps,
19 maybe are brain-dead, and now they're in the
20 hospital for days, and their family has to face --
21 be faced with very difficult decisions, and -- in
22 something that's very preventible.
23 So, I am on the other end of things, and
24 really say, and thinking, that while abuse is a huge
25 problem, and we have to speak to the bigger issue of
58
1 abuse, and try to help people that are addicted, and
2 speak to their mental-health issues and why they're
3 abusing things, making this antidote available to a
4 mom of a 19-year-old who is drug-addicted, who has
5 already been on a respirator three times, the next
6 time, probably, isn't gonna be -- is probably not
7 gonna get her to the hospital.
8 And if we can save that one person, I think
9 that there's some value in that, recognizing some of
10 the inherent problems with Narcan.
11 So, that's my experience.
12 JULIE BARKER-NAGEL: And I a hundred percent
13 agree with you.
14 And being in the medical field,
15 a critical-care nurse here, a nurse for 25 years,
16 I've used, I've seen it.
17 But, also, the disadvantages, that the Narcan
18 half-life is very short. So, oftentimes, patients
19 immediately relapse back to the condition in which
20 you gave it in the first place.
21 So, there would have to be an immense amount
22 of education if that is made available to the
23 public, versus, again, health-care professionals and
24 first responders.
25 TARA COSTELLO: And I would like to comment
59
1 on the mental-health side, because I think that one
2 of the things we're missing here, is that a lot of
3 these individuals are using, not just to use. Some
4 of them from using because they have to, because now
5 they're at that point where they're self-medicating
6 to avoid the withdrawal, which we talked about
7 earlier today.
8 But at the same token, when you take that
9 substance away, there are a lot more underlying
10 issues that they are facing that they're not able to
11 face.
12 And, sometimes, when you allow for them to --
13 sometimes they're sick and tired of being sick and
14 tired, and that could be the opportunity for them to
15 actually seek the help that they need.
16 I worked very diligently with ACR, and I know
17 that they've had a great deal of experience with
18 working with the street-folks outreach, and
19 sometimes that's where they capture them.
20 When they're ready to stop, they're gonna
21 stop, but, they may not be ready when we want them
22 to be ready, unfortunately.
23 But, it's an opportunity to get them to get
24 to that point.
25 So from a mental-health perspective, as well,
60
1 we want to keep that mindful, because there is some
2 other stuff going on with that individual, not just
3 the addiction.
4 Because, let's be real here: I mean, there's
5 brain chemistry that's changing, so, these folks,
6 depending upon how long they've been using, there's
7 some other issues that they definitely are
8 encountering at that present moment.
9 So, I would have to say, that I think it's a
10 great, you know, opportunity to educate, and get our
11 folks kind of on board with that.
12 But I think, again, there needs to be a lot
13 of education. And I think family needs to be part
14 of that conversation, as well.
15 SENATOR BOYLE: Thank you for your insights
16 on this, and I'm certainly not the expert; you guys
17 are.
18 I would say, although I'm an active volunteer
19 firefighter, and I was an EMT for six years, and
20 have seen Narcan used, and, personally, it truly is
21 a miracle drug, in my opinion.
22 But, in terms of the mind of an addict, not
23 that I can get in there, but I can tell you that,
24 having seen it a few times, and heard countless
25 stories, actually, of my colleague who are EMTs,
61
1 that the user is actually -- wakes up with the
2 Narcan administered, and they're mad.
3 They're -- the old line, "They came up
4 swinging."
5 They're not happy you saved their life, so
6 I don't think that they're saying: Well, I got the
7 Narcan now, so I'll be fine.
8 They're thinking, they want the drug, they
9 need it, and they're, quite frankly, pissed that you
10 use it on them. Even though you can say, "Hey, pal,
11 I just saved your life," it doesn't make a
12 difference to them.
13 ERIN BORTEL: I do have one study, if you're
14 interested?
15 So, a study of a San Francisco program that
16 implemented an overdose-training initiative, trained
17 24 participants who were active injection-drug
18 users.
19 In a six month period, those 24 participants
20 used their kits 20 times, resulting in a successful
21 reversal, overdose reversal, each time.
22 And six months later, when they were
23 reassessed for their usage, their heroin usage had
24 actually decreased.
25 So, there is some promising data out there.
62
1 There was also a really good 4-year study
2 done by New York City Department of Health and
3 Mental Hygiene, that determined a 27 percent
4 reduction of overdoses in New York City after the
5 implementation of this program.
6 CASSANDRA SHEETS: And just to add a real
7 quick piece to that: With the -- you know, you've
8 gotta to look at it, too, then, from the system
9 perspective, you know, so you can look at lessening
10 the overdose.
11 But then the education piece, too; keeping
12 the family.
13 So how do we keep them from them continuing
14 to use? You know, sort of make the treatment
15 actually work?
16 So, it's more -- it's education, but it's,
17 like, on every level.
18 So, getting the families involved, yeah, they
19 come up swinging, but, how do you keep them from,
20 and then wanting them to continue to stay?
21 But if you send them back to the same
22 situation, they're just gonna keep using.
23 So we as a community have to change our
24 message, and be consistent with it, too.
25 SENATOR GRIFFO: Law-enforcement perspective;
63
1 just, we heard about some of the changes in the drug
2 laws.
3 What kind of profits can a dealer see from
4 heroin?
5 Is it a significant profit for those who are
6 selling?
7 And do you think those sellers have any fear
8 of the system?
9 SCOTT McNAMARA: Two questions there.
10 There's a lot of profit, and, it depends.
11 Like, for example, in Utica, heroin is a
12 little bit cheaper than it is in Rome.
13 So, even in a very small world, if I was to
14 become involved in dealing heroin, I could come here
15 and buy a bundle for, say, like 80 to 90 dollars,
16 and go to Rome and sell it for 140 to 150.
17 Likewise, to some of the more rural areas of
18 the county.
19 So, you know, as you go farther towards the
20 source of heroin, which, you know, locally, many of
21 our drugs come from the New York City area, you
22 know, it's a lot cheaper there, and then they bring
23 it up here.
24 So, definitely, the people do it, and there's
25 a huge profit margin.
64
1 And depending on different drug dealers that
2 we've debriefed, some of them make more money in a
3 year than I do.
4 So, I mean, there's -- you know, that's --
5 that is the problem with drug dealing, is it's a
6 very, very profitable thing to get into.
7 Your second question was about, Do they fear
8 us?
9 SENATOR GRIFFO: Yeah, is there a
10 requirement?
11 And we talked about how some of the laws
12 changed.
13 I mean, is this a situation where we target
14 something specifically, legislatively, to go after
15 these dealers who are selling this specific type of
16 drug that has become such a scourge?
17 SCOTT McNAMARA: That's a tough -- that's a
18 tough question to answer, because it's a unique --
19 the one thing I've seen, and before I was the DA, as
20 some of you know, I was a narcotics prosecutor here.
21 Most drug dealers believe that they're not
22 gonna get caught.
23 So, it's like the young kid that engages in
24 risky behavior, they don't think they're the one
25 that's gonna get killed in the risky behalf.
65
1 The drug dealers think the same way: I'm not
2 the one that's going to get caught.
3 So, I often think about that, like, how tough
4 do you make the laws?
5 And, honestly, before the Pataki reforms, and
6 then before the Paterson reforms, we had some of the
7 toughest drug-dealing laws in the country, and we
8 really weren't seeing any -- we weren't seeing it
9 stop drug dealing.
10 So, you know -- and, right now, I mean, we
11 continue to put people away, we continue to put a
12 lot of attention on it.
13 One of the things that we do see, which is
14 unique, and I'm not quite sure I know the answer to
15 this, but, for some reason, when we do -- especially
16 when we do wire taps or eavesdropping warrants in
17 cases involving heroin, most of the people involved
18 speak Spanish.
19 And I'm not quite sure if that's where the
20 drug comes from; and, therefore, it basically
21 filters up the chain.
22 But I know that is one thing, that we see a
23 lot of the "heroin wires," as we call them, we have
24 to get Spanish interpreters.
25 So, you know -- but I don't really know if
66
1 that has an effect, because there's just that
2 mentality amongst the drug dealer, that, if there's
3 two drug dealers sitting next to each other,
4 "It's gonna be him, not me." That's the mentality
5 that they have.
6 So, I don't know how tough we could make our
7 laws and make them think that.
8 I just don't think they think like that.
9 SENATOR GRIFFO: Why do we think this is so
10 readily available, though?
11 Do we have an idea why this drug is so
12 accessible and readily available?
13 I mean, beyond, is it access and price?
14 UNKNOWN SPEAKER: And price. Absolutely,
15 it's the price.
16 SCOTT McNAMARA: You know, it's -- you know,
17 I'm just speaking from my experience.
18 If there's a demand, there will be a supply.
19 UNKNOWN SPEAKER: Yeah.
20 SCOTT McNAMARA: I mean, that's just the way
21 it goes.
22 And, you know, so, regardless, if there's a
23 demand for weed, there's gonna be a supply for weed.
24 If there's a demand for heroin...
25 Like I said, in 1992, when I started in the
67
1 DA's office, heroin was typically shot up. It was
2 not that popular.
3 Crack cocaine was very popular.
4 It was almost unheard of that heroin was
5 snorted back then.
6 And then what happened was, the people that
7 were smuggling cocaine in figured out: Hey, wait a
8 second, we can smuggle heroin in, too.
9 Then the heroin was coming into the
10 United States, and it was coming in in larger
11 supplies.
12 So, therefore, when people used it, they
13 weren't using heroin that's like 2 or 3 percent
14 heroin; and, therefore, you had to get it in your
15 vein to get high. They were, you know, snorting
16 heroin that was, maybe, 40 or 50 percent, and they
17 could actually snort it and get high.
18 So, you know, a lot of these things, if you
19 look at what has happened, you know, because it's
20 more readily available, and because it -- and as was
21 alluded to, when we see the overdoses, from the
22 law-enforcement perspective, a lot of times what we
23 start doing immediately, is trying to figure out who
24 the dealer is, because a lot of times, it's the same
25 heroin batch that's killing everybody.
68
1 Because it's either -- it's either very
2 potent or there's something in it that's also
3 affecting the people, and what had been their normal
4 dosage is now killing them.
5 And so, you know, it's not uncommon for us to
6 see a couple -- two, sometimes three, sometimes it's
7 even worse, number of people die from or become
8 very, very sick. And, you know, ultimately, their
9 lives will be saved at different times from a
10 certain batch of heroin.
11 SENATOR GRIFFO: We have a question out
12 there.
13 Go ahead.
14 AUDIENCE MEMBER: (No microphone used.)
15 I would like to thank having this forum.
16 When you're talking about this issue, it
17 always seems to come up, is the pharmaceutical
18 industry. And people tend to talk about the drug
19 dealer.
20 Where is the accountability, exactly, for the
21 doctors who are overprescribing these pills, and
22 giving them out to the society?
23 And, also, the banking: Growing up in Utica,
24 HSBC was a popular bank around here. They were
25 found guilty of laundering over $500 million of drug
69
1 money, and no one was prosecuted or went to jail.
2 Then they packed up and left the area.
3 How do we confront these corporate entities
4 that seem to put us in this situation, and create
5 this demand, and create such a dire situation,
6 especially in our city, and other cities of all
7 upstate are suffering from these issues?
8 That, it seems that we're unable to confront
9 them.
10 So, maybe there's a solution in what the
11 Governor's saying, who I really think is a great
12 guy, [unintelligible], possibly, reforming the
13 marijuana laws, for treatment.
14 And, I'm not saying, I just -- you know,
15 I wish there would be more of a debate, maybe toward
16 the legalization of marijuana, where one market
17 might kill another market, and there could be a
18 free-market solution instead of -- because we're
19 already having budget problems, we're already having
20 a lot of -- you know, I would hate to see another
21 drug lord unleashed on people.
22 And, maybe it's time to go toward a different
23 direction, a more progressive one.
24 But my main -- my main -- my main thing
25 I want to get out there is, I've seen a lot, growing
70
1 up in Utica, especially my generation. I'm 31 years
2 old.
3 I've seen the drug war.
4 I've seen two wars, Iraq and Afghanistan.
5 I've seen guys my age leave, you know, happy.
6 One of the guys leave, go to war, come back, and
7 serious problems, mental problems.
8 I mean, I've been at somewhat of a loss.
9 It's despair that has -- [unintelligible],
10 it's been here for a long time, not just heroin,
11 but, people go back to crack and all these things,
12 and foreclosures, and into situations that are
13 creating this situation of where people want to
14 escape.
15 And, I'm hoping for maybe a more progressive
16 solution.
17 And, if not, there's no accountability for
18 any of these pharmaceutical industries or banking
19 industries.
20 Maybe it's time for us to just go out on our
21 own and look to other markets that could bring about
22 a state of peace, basically.
23 Because I feel, like, there is some sort of
24 state of war that we're in right now, that we
25 can't -- we seem to be trapped in.
71
1 But, maybe there's a free-market solution,
2 like Ron Paul said, you know, that we could go
3 about.
4 And if you look at Colorado, the first day of
5 legalizing marijuana, it created over $33 million
6 just generated in the communities.
7 And the people circulating amongst the
8 people. Not sent to China, but within the state.
9 There's other communities that are attacking
10 this, and they're mainly legalizing it -- the reason
11 they legalized it was to combat the crystal-meth
12 epidemic, which is West Coast -- which is more of a
13 West Coast drug.
14 And, I just -- you know, I hope for more
15 progressive solutions, in general, you know.
16 SENATOR GRIFFO: Thank you.
17 From a clinical standpoint, and I guess, Doc,
18 you're here: How does the medical profession work,
19 so that you can do what you've heard here tonight:
20 Get a quarterback, so to speak, when you have a
21 number of physicians prescribing drugs relative to
22 whatever the patient is coming in for, and the way
23 the system continues to evolve?
24 I mean, now you have nurse practitioners as
25 an entry point sometimes, as opposed to general
72
1 practitioners, because you see more specialization.
2 What can be done in the medical and the
3 clinical arena to try to coordinate and communicate
4 better, so that we can -- and when you talk about
5 I-STOP, and what I-STOP has done, or can do, but --
6 DR. GEORGE KOZMINSKI: I can tell you, in the
7 short time that I-STOP has been in existence, it's
8 done a lot. It's done a great deal.
9 I can see that some of the clients, patients,
10 that I see are turning to heroin because their
11 doctor cut them off.
12 "Cut them off."
13 But I do agree there should be greater
14 accountability from the standpoint in the medical
15 profession.
16 Unfortunately, I don't think there is enough
17 of a check-and-balance at this point, at this time.
18 UNKNOWN SPEAKER: I agree.
19 DR. GEORGE KOZMINSKI: And I think there
20 really -- that really needs to be implemented.
21 SENATOR BOYLE: I think -- just to follow up
22 on that, I think that I-STOP has been very
23 effective, and one of the unintended consequences of
24 that is the move to heroin.
25 And some of the law enforcement were talking
73
1 about the difference in price of pills: $20 for
2 Oxycodone, and $10 a bag.
3 Well, in Suffolk County where I'm from,
4 Oxycodone is $30 a tab, and, a bag of heroin is $6.
5 So you know where these kids are gonna go.
6 And -- but one of the questions I have, for
7 some -- from -- for the treatment providers, is what
8 we've been hearing in different forums, is the need,
9 obviously, for more treatment, more beds, and for
10 insurance coverage.
11 Right now, we have a situation where the
12 insuring -- insurers -- and not to bad-mouth
13 insurers. There are very good insurance companies
14 out there who do wonderful stuff. -- but, they're
15 the ones making the decision on what is
16 "medically necessary" treatment.
17 And I hear from many parents, and addicts
18 themselves, to say: My kid went, we sat there, and
19 the insurance company said, We'll give you
20 three days in the facility, then you gotta get out.
21 And no one, of course, is getting over heroin
22 in three days.
23 But, do you see any way we could possibly
24 change the laws, in your mind, to help in this
25 situation, to get the people the treatment they
74
1 need?
2 DR. GEORGE KOZMINSKI: Well, they did
3 implement a law, where there -- there's now parity
4 between mental-health treatment and, also, regular
5 medical treatment. That's helping a lot, also, but
6 that's also gonna take time, because the insurance
7 companies are not willing to give up the money,
8 unfortunately.
9 And access is the key.
10 Education access is the key.
11 SENATOR BOYLE: Well, I can tell you that, as
12 a former member of the Insurance Committee in the
13 Assembly, the insurance company never wants to give
14 up the money, but a lot of times, we mandate that we
15 do. And this might be a case here.
16 SENATOR GRIFFO: Gentleman in the back first,
17 right there. You had your hand up, yeah.
18 Then we'll come up to the --
19 AUDIENCE MEMBER: (No microphone used.)
20 I want to thank you, Senators, and the
21 health-care representatives. I really appreciate
22 what you do, and I'm happy that you're doing that.
23 I guess what I'm feeling is, that we need to
24 even move upstream further.
25 So, I grew up in this area. I left for
75
1 15 years to get my Ph.D., and came back, and now
2 I teach at Utica College.
3 And, I'm happy to be back in this area.
4 What I am concerned about, is some of the
5 young people who are not -- maybe don't have
6 mental-health issues, who end up, uhm, what is the
7 phrase, "Idle hands make the devil's playground," or
8 something like that?
9 And, I know that this may be too far upstream
10 for this group, except for the Senators: You really
11 need to think about jobs in this area.
12 I am teaching at Utica College. I teach
13 students who have the privilege of going to college,
14 and I feel happy to be there.
15 And I feel bad for those students, because,
16 even with a college degree these days, there's not a
17 lot available.
18 And, so, before they turn to the drugs, it is
19 very -- there's a lot of disparity. Like this
20 gentleman said, there's a lot of disparity here.
21 And it's -- it's gotten worse, and this is
22 when the temptation to start doing drugs for, maybe,
23 folks that wouldn't normally do them, and then they
24 get in trouble.
25 I know that's upstream, and it's maybe a step
76
1 before prevention and before education; and that is,
2 we need to have hope and opportunity in this
3 community, in the Central New York area.
4 And we don't have that.
5 Young people who are vulnerable to choosing
6 drugs as a way to escape or to deal with problems,
7 I think that's one of the reasons you see increases
8 that you've seen over the last ten years.
9 Drugs have been around forever; and, yet, we
10 have this increase and problem with heroin.
11 So, it's a very complex problem, but I really
12 think, you know, I don't want to be too Pollyannish,
13 but, there needs to be opportunity and hope for
14 young people beyond minimum-wage jobs, or I think
15 we'll see it increase even more.
16 Thank you.
17 SENATOR GRIFFO: Thank you, Professor.
18 SENATOR BOYLE: [Unintelligible], and that's
19 exactly -- Senator Griffo has brought that -- and
20 Senator Valesky, both brought that very issue up in
21 our Conference in the Senate, and it is a key thing
22 to look at.
23 AUDIENCE MEMBER: (No microphone used.)
24 I really appreciate you coming here.
25 SENATOR GRIFFO: Thank you.
77
1 We're gonna go here, Ma'am.
2 Then come to you.
3 In the pink?
4 AUDIENCE MEMBER: (No microphone.)
5 Hi.
6 Thanks for having this conversation.
7 [Unintelligible] situation, that this --
8 addiction is an illness.
9 And, the economic situation, if you're prone
10 to addiction, you're going to do things. You know,
11 you're gonna get addicted, you know, if you're prone
12 to it.
13 The economic situation in Utica, or this
14 area, has a lot to do with it.
15 There was -- the new drug that just came out,
16 the opiate, the Committee did not recommend the --
17 that the FDA approve that drug, and they approved it
18 anyway.
19 That's -- it's the government that did that.
20 Limitations on practice: When we see -- I'm
21 a nurse practitioner that used to work at
22 Chubs [ph.], which is a mental-health facility
23 [unintelligible] area. And then I also did -- I did
24 the health care.
25 Well, we have 15 minutes a patient, so, how
78
1 do we ask them about mental-health problems? about
2 their opiate addiction?
3 You know, how do we get the time to treat
4 them?
5 You know, and you just don't have the time.
6 And when they initiated this new prescription
7 model, what did you expect?
8 I mean, if you can't get them prescriptions,
9 they're gonna turn to alternatives.
10 You know, that should have been overseen, in
11 the future, you know, because, if they're not gonna
12 get it from their doctor, they're gonna get it
13 someplace.
14 So -- and, also, when I used to practice,
15 I used to be able to call the pharmacy, and other
16 doctors, to see if they would give medications,
17 opiates, from other people.
18 Now I can't, because of the HIPAA laws, you
19 can't call the pharmacy, you can't call another
20 doctor, because that's all limited.
21 So you want to coordinate services, but you
22 can't.
23 So, there's a few thoughts.
24 SENATOR GRIFFO: Thank you. Excellent
25 points.
79
1 I'm gonna come over to the lady right here,
2 and then come over to you.
3 AUDIENCE MEMBER: (No microphone used.)
4 [Unintelligible.]
5 [Applause.]
6 AUDIENCE MEMBER: [Unintelligible].
7 I personally, [unintelligible].
8 Thank you for being here, and inviting the
9 community in here [unintelligible].
10 Because I've heard a lot of great things
11 about Narcan, I want to ask: How many family
12 members do you know that sit there while they're
13 shooting up?
14 UNKNOWN SPEAKER: Not many.
15 AUDIENCE MEMBER: [Unintelligible].
16 They need to have more training, and they
17 need to get Narcan out there.
18 And as far as the treatment is concerned,
19 I have been through [unintelligible], I've have
20 through Chubs, I have been through each and every
21 [unintelligible]. I have been through facility
22 available.
23 And the approach that wasn't taken with me,
24 is the mental health mixed with drugs.
25 I personally am [unintelligible]. I have
80
1 four months clean.
2 And, I had to say that, in my opinion, and
3 then, what I see broke in myself, is that this
4 treating drug addiction doesn't work. Just treating
5 mental health doesn't work.
6 I have two issues.
7 And I know, from my partners in crime,
8 whether it be addiction, or whatever, that most of
9 us have mental-health issues.
10 My problem is, that it wasn't addressed as a
11 child. Nobody saw that I had a problem.
12 So as I grew older, my first marijuana,
13 I wanted to escape. I felt better. I don't have to
14 deal with it, and nothing bothered me. I was no
15 longer afraid.
16 I had mental-health issues that wasn't being
17 addressed.
18 So today I have to say that I'm benefiting.
19 I don't know if it's right or not for me to
20 say where I'm going, but I'm gonna be
21 [unintelligible] Center. And I'm benefiting from
22 [unintelligible] approach, which is mental health
23 and drug addiction.
24 This is not just a one-thing problem.
25 You know, I never did heroin in my life.
81
1 The last time I went out, I wanted that
2 30 percent increase.
3 I tried heroin for the first time in my life.
4 I'm 48 years old, you know. And, uhm -- I'm a
5 little nervous.
6 And I don't have that [unintelligible], and
7 I don't have the higher education, you know, but
8 what I have is hands-on experience for what you guys
9 are trying to work with.
10 You know, and I have to say that, you know,
11 I could probably -- what I see, with me,
12 [unintelligible] with me, is that I need more
13 treatment, yeah.
14 But sometimes I don't get along with, like,
15 [unintelligible] said, I don't belong in jail.
16 And I have committed many crimes, and I have
17 been in jail many times, you know, but they were all
18 the direct result of my mental health and my drug
19 abuse.
20 And putting me in jail did not help.
21 Putting me in jail allowed me to come back
22 out and be angrier at the system, and do it all over
23 again.
24 The last time I committed a crime, the judge
25 allowed me [unintelligible].
82
1 I'm on [unintelligible]. That's not
2 lifesaving to me.
3 [Unintelligible], because I lost one of my
4 best friends to the addiction of heroin. She also
5 had mental-health issues [unintelligible].
6 With that said, [unintelligible].
7 SENATOR GRIFFO: Thank you.
8 [Applause.]
9 SENATOR GRIFFO: Sir.
10 AUDIENCE MEMBER: (No microphone used.)
11 I appreciate everybody meeting here, and
12 [unintelligible] I appreciate your story.
13 I was in the field of addiction for 31 years,
14 so I recognize a great deal of what I'm hearing
15 here.
16 I'm concerned about the amount of heroin
17 addicts that we have just everywhere here.
18 And I think, as we look at evidence-based
19 methods of dealing with it, you will see
20 medication-assisted treatment being the better ways
21 to approach the problem of dealing with all these
22 addicts.
23 And, we only have one medication-assisted
24 treatment in this county, which is Suboxone, but
25 what we really should have is a methadone program,
83
1 as well.
2 In the 31 years I spent in the world of
3 treatment, it seems to me that access to treatment
4 was diminished mostly at the end of my career.
5 At the beginning of my career, it was
6 completely different.
7 Our outreach [unintelligible] would bring the
8 drugs over from Plattsburgh. We'd give them alcohol
9 on the way to keep them out of withdrawal.
10 [Unintelligible], we'd call up the psych
11 center, and the psych center took the person into
12 their med-surge ward and they did detox.
13 They sent their outpatients -- they sent
14 their inpatients over to us so they could have
15 day-treatment addiction treatment.
16 In 1979, there was no conversation about
17 money.
18 It cost you [unintelligible] money.
19 If we were to look at that venue, why don't
20 we consider dedicating a tax on alcohol,
21 [unintelligible], and treat the substance abusers
22 that we have.
23 Statistically speaking, we know that
24 15 percent of the people consume 85 percent of the
25 booze.
84
1 So then that should work, and there should be
2 enough left over for treating the drug addicts that
3 we have, as well.
4 We need to do this, and it needs to include
5 everything I've heard here: Prevention to stop
6 future addicts. Our reduction to get people into
7 treatment. Treatment providers working together.
8 Absolutely [unintelligible]. That's proven.
9 A methadone treatment center would help a
10 great deal for the addict who has to get up every
11 morning to go out and commit crimes to get drugs to
12 get high.
13 If you're in inpatient treatment, you're not
14 gonna go and get arrested. You're not gonna go and
15 use drugs.
16 There's a lot of unemployed people and a lot
17 of [unintelligible] people, and a lot of space.
18 We should be able to find a way to increase
19 capacity so that we have what I always dreamt of,
20 which was treatment on demand.
21 Now, [unintelligible] schedule your
22 admission, [unintelligible]. But when you were
23 ready for treatment, we used to be able to
24 [unintelligible]. We lost staff due to the
25 insurance world.
85
1 Thank you all for listening.
2 [Applause.].
3 SENATOR GRIFFO: Thank you.
4 AUDIENCE MEMBER: (No microphone used.)
5 [Unintelligible.]
6 [Unintelligible.]
7 [Unintelligible], treatment programs,
8 [unintelligible].
9 My concern is, that none of the treatment
10 programs that he was in, [unintelligible].
11 [Unintelligible] he fell, uhm, after about
12 four months, because he had cut himself.
13 He had mental-health issues. He had cut
14 himself.
15 I mean, when they kicked him out, they put
16 him in jail.
17 This is a child. He was 17 years old, put
18 him in jail.
19 And, then, that just led to more problems for
20 him.
21 And, I'm really concerned about, you know,
22 people who are facing this disease of addiction.
23 In treatment programs, where they're being
24 treated like prisoners, in some ways, not
25 completely. I mean, it's better than jail, for
86
1 sure.
2 But. It still is almost -- it seems to be
3 kind of a shame-based kind of approach.
4 And, when people are feeling ashamed, they're
5 more anxious and more likely to use.
6 And, so, it seems as though he's struggled,
7 and he really -- everybody says: You don't want to
8 get clean.
9 He wanted to get clean. He tried really hard
10 to get clean.
11 And then he was -- he was caught, and he had
12 to go back to jail [unintelligible].
13 [Unintelligible] another program after a long
14 period of time, and, he wasn't able to get the
15 Suboxone that he had been prescribed.
16 And so because of that, he ended back using
17 heroin, and got caught with a small amount of
18 heroin, and had to go to the county jail again.
19 Now he's in jail for almost four months,
20 clean.
21 We fought to get him out of Rochester. He
22 wanted to? He wanted to start all over, and he
23 wanted to start fresh.
24 [Unintelligible] day treatment,
25 [unintelligible] workers [unintelligible].
87
1 And he was.
2 He was with us for two weeks, and we were
3 with him almost all the time. Almost all the time.
4 And he was able to meet somebody here in
5 Oneida County. And in two weeks -- less than
6 two weeks, he was able to meet someone by using my
7 computer.
8 I had no idea he was able to connect.
9 And his reason, and how he was able to do
10 that, was to look for people selling marijuana,
11 because then he could get marijuana; that he would
12 know somebody else that could get him something
13 more.
14 And that's what he did.
15 He met some young people; young people that
16 delivered it to our house like a pizza.
17 So, you know, getting away from people,
18 places and things, did not work.
19 There's a network of them.
20 And, of course, we didn't even know anything
21 about Narcan.
22 This was November 5th that he died.
23 But, his grandfather found him, and we tried
24 to resuscitate him.
25 I'm sorry.
88
1 SENATOR GRIFFO: Okay.
2 AUDIENCE MEMBER: But what families go
3 through, too, [unintelligible].
4 My grandson had a great support system.
5 He was not -- this was a kid who was the only
6 child. Till he was 12 years old, he was the only
7 grandchild on both sides of the family. And if he
8 was playing trumpet in school, the whole family
9 went. He had all kinds of people who were following
10 him. We were all supportive of this kid.
11 He ended up with mental-health issues, that
12 he never, ever had complete -- he was never
13 completely diagnosed with, because he was using.
14 And, then, we lost him.
15 And we don't want anybody else to go through
16 this. And we don't want families to have to go
17 through what we've been through.
18 And, so, we just are very thankful that
19 you're here, and we're hoping something will come
20 from this.
21 Thank you for listening.
22 SENATOR GRIFFO: Thank you for sharing, and
23 our condolences.
24 Thank you very much.
25 SENATOR BOYLE: Yeah, thank you very much.
89
1 I am very sorry for your loss.
2 I do want to say that, one of the things that
3 have come out in our hearing in Suffolk County was
4 about stigma and the shame.
5 And, I believe that one thing that we'd like
6 to see come out of this Task Force, as well as
7 legislation on treatment prevention and law
8 enforcement, is to stop the stigma.
9 I mean, if someone said, My grandchild has
10 cancer, or a brain tumor, or something like that, it
11 would be a huge outflow of support and sympathy and
12 compassion and help.
13 But if it's, My grandson or my son is an
14 addict, it's, Hold on a second.
15 And most people are ashamed to say it if they
16 learn about it.
17 That must stop in New York State, and I think
18 we're gonna play an important role in that as part
19 of this Task Force.
20 SENATOR GRIFFO: Thank you.
21 AUDIENCE MEMBER: [Unintelligible.]
22 SENATOR GRIFFO: Well, that's the other
23 point, Tara, with you here.
24 One of the overriding factors that we hear,
25 not only when we're dealing with issues such as
90
1 confronting this scourge of heroin, but some of the
2 other crimes that we hear across the nation, some of
3 the horrific violence, we really need to do better
4 with a mental-health component.
5 We need to --
6 [Applause.]
7 SENATOR GRIFFO: -- you hear so much of a
8 debate, nationally, about everything else, except
9 the mental-health system.
10 And I think that is imperative.
11 So we can start, maybe in New York,
12 hopefully, to really make that emphasis, and to look
13 at a number of components, from resources, funding,
14 identification, treatment.
15 You know, this is something that I just
16 cannot believe, as a nation, that we really don't
17 emphasize and focus on the problems facing our
18 communities across this country from a mental-health
19 perspective.
20 So I'm gonna let Tara speak, and then we will
21 come back to the crowd.
22 TARA COSTELLO: On behalf of the Department
23 of Mental Health, I have to say --
24 Can you hear me?
25 -- I have to say that, you know, as
91
1 I mentioned earlier, the addict isn't using because
2 they want to use. There's something underlying
3 going on.
4 And when we talk about prevention, you know,
5 we are very -- in Oneida County, I'll speak for
6 Oneida County, we are savvy in providing the service
7 at the most restrictive, versus the least
8 restrictive.
9 We are a reactive community.
10 So when there's an issue, we like to react,
11 versus try to be proactive. As this gentleman in
12 the audience had mentioned, to be more progressive.
13 I'm not gonna name the number of tragedies
14 that have occurred locally, along with, you know,
15 nationwide, but, we really need to look at the
16 mental-health laws on a number of levels.
17 And I could go on for hours, but I will speak
18 to a couple.
19 You know, HIPAA, this lady mentioned HIPAA,
20 in the audience, that is a huge issue for people who
21 are working in the mental-health field, trying to
22 access information on people who are violent or have
23 issues in the community.
24 Another one, AOT Court orders, where
25 individuals that are accessing our emergency rooms,
92
1 that are being stabilized, for mental-health
2 concerns that could be drug-induced, sometimes, the
3 process for that, in our department, is horrific to
4 get somebody Court-ordered.
5 We have to spend months to get court
6 documentation, just to bring them to court, so that
7 they can be medicated, over objection of these
8 individuals.
9 Let's -- how can they make their own
10 decisions if they are mentally unstable?
11 They're not gonna sign release forms. There
12 are systemic barriers that avoid us trying to get
13 them the help that they need.
14 They can't make the proper decisions because
15 they're not able to.
16 And it could be substance-induced, for that
17 matter.
18 We can't mandate substance abuse, folks, but
19 as we know, there are a lot of folks that have
20 mental-health issues.
21 So under the AOT Law, if you look at that,
22 the barriers of getting somebody Court-ordered
23 really is an issue.
24 And, just to speak to some of the tragedies
25 that we've heard, you know, nationally, some of
93
1 those people could have been put on an order, but,
2 the system kind of fails that.
3 I -- I don't want to be negative, but,
4 I mean, it's reality.
5 So that's one area that I have to mention.
6 But, when we're talking about mental health,
7 and a lot of people -- I'm gonna echo a lot of what
8 you all mentioned -- is that, we don't get enough
9 time to spend in the mental clinics with these
10 patients. And, psychiatrists are trying to see as
11 many people as possible.
12 And then we put regulations in place to serve
13 the most needy, which then puts those others on the
14 back burner that might not reach that level.
15 So then we have those folks that aren't able
16 to access the service because our clinics are all
17 full, and they're doing the best they can, but --
18 and they're trying to survive.
19 I can tell you, when I worked at the
20 department, I started in 2011, our budget has
21 reduced immensely, as a result, and it's all mental
22 health.
23 All of the OMH dollars has gone away.
24 And we're seeing -- it's like this
25 [indicating], we're seeing, you know, a rise, but
94
1 the funding isn't there.
2 And, again, we have to rely on insurances to,
3 obviously, get the reimbursement. And we just --
4 there's just not enough.
5 So, that's my comment in that retrospect.
6 SENATOR GRIFFO: Thank you, Tara.
7 Now, where did I -- in the back.
8 AUDIENCE MEMBER: (No microphone used.)
9 I'm (inaudible). I am an addict.
10 [Unintelligible.] I don't want to be, but I don't
11 have insurance.
12 And, I know I'm breaking the law, but I don't
13 have any choices.
14 I mean, I know you guys, like, everybody is
15 trying to crack down on the dealers.
16 Now, have you guys heard of "crocodile"?
17 Now, that's what happened when they cracked
18 down on dealers in Russia, or when there was --
19 there was no heroin in Russia, so they created this
20 stuff.
21 And that's what addicts do.
22 I mean, we will find a way.
23 There was one time, Oxycontins, everybody
24 remembers the Oxycontin epidemic, and they changed
25 the pill. Right?
95
1 And I remember calling this kid, and he's
2 immediately, like, Yeah, I think it's mostly.
3 I'm, like, Yeah, but you can't shoot it up.
4 And he's like, Oh, yeah, you can.
5 Okay, you stick them in a microwave, a
6 freezer, in the oven, and back and forth, shave them
7 down.
8 And addicts figured this out.
9 That they will find a way.
10 I don't know what to do, I don't know where
11 to go.
12 I don't have insurance.
13 I don't have choices.
14 It's just not available.
15 And [unintelligible] crack down on the
16 dealers, but that's not gonna help us.
17 We will find a way.
18 UNKNOWN SPEAKER: Bath salts.
19 AUDIENCE MEMBER: Yeah, bath salts.
20 But, anyway, [unintelligible], but people
21 will find a way.
22 UNKNOWN SPEAKER: [Unintelligible.]
23 AUDIENCE MEMBER: And then I'm left in limbo.
24 I have a great support system. And I know
25 I've had a 10-year habit, that I just don't see.
96
1 I mean, I try every day, and every day it's a
2 failure.
3 And you can only get so sick before you're
4 just not gonna -- you're just not gonna be sick
5 anymore. You're just gonna be like, Okay, I'll just
6 solve this problem, because it just hurts too much.
7 And the Suboxone, so now I get -- sometimes
8 I'll get black-market Suboxone, but that's only
9 available so often.
10 So then you -- and now you're taking away
11 somebody else's solution.
12 I don't know, I feel like a lot of us are in
13 this gray area that doesn't get any attention or any
14 help.
15 And, like, the funding, instead of going to
16 rehabs and to mental health, and, et cetera, is
17 going toward police, and to crack down, which is --
18 it isn't gonna help us.
19 If I don't get in trouble with the law,
20 there's nobody.
21 Like, I don't know what to do.
22 Walk up with a bag of dope to an officer and
23 be, like, "Please"?
24 AUDIENCE MEMBER: (No microphone used.)
25 Mr. Griffo, is there any way to just
97
1 [unintelligible] to just end the whole war on drugs
2 and focus on the health-care issues,
3 [unintelligible]?
4 [Unintelligible], and try to help these
5 people make this [unintelligible]?
6 DONNA M. VITAGLIANO: We can -- Insight House
7 can you take you, with no -- you don't have to have
8 insurance.
9 Have you tried that locally?
10 I'm -- just a suggestion.
11 I mean, you don't have to have insurance.
12 SENATOR GRIFFO: Maybe what we can do is,
13 Donna, somebody, could speak to you.
14 We appreciate you coming tonight, because
15 that shows that you obviously have an interest and a
16 concern to take care of yourself.
17 And I think there are people here, hopefully,
18 that can talk to you tonight.
19 And you're right, we need to look at this
20 from a health perspective. It has to be looked at
21 from a number of ways, but health is not an area
22 that a lot of people initially start from, and they
23 should, because as you looked at the various
24 elements from a public-health perspective,
25 particularly the mental-health system.
98
1 I'm gonna continue to go back to the
2 mental-health system, because I think that is really
3 where we're having some issues here right now.
4 But -- and I'm gonna turn to the former
5 Commissioner of Mental Health, who is here, right
6 now, who was my Commissioner of Mental Health when
7 I was in Oneida County: Commissioner Bramzic [ph.]
8 FORMER-COMMISSIONER BRAMZIC [ph.]: (No
9 microphone used.)
10 Just to follow up on Tara: The State has
11 been systematically defunding the mental-health and
12 substance-abuse system for about the last 15 years.
13 When I first started, a long time ago --
14 [Laughter.]
15 FORMER-COMMISSIONER BRAMZIC [ph.]: -- there
16 was the mental health [unintelligible]. They're all
17 one unit of the Department of Mental Hygiene, so
18 people could talk.
19 Then it went into the Office of Substance
20 Abuse, Office of Alcoholism, Office of
21 Mental Health.
22 It took, oh, probably 20 years to have
23 alcohol and substance abuse to be recognized by the
24 State as being one.
25 So, now there's OASAS, but, the two can't
99
1 talk.
2 We started about, oh, 15, 20 years ago, a
3 dual-diagnosis committee.
4 The State went rampant, until they
5 [unintelligible].
6 We had mental health and substance abuse and
7 alcohol people sitting in the same room, talking.
8 When Oneida County Mental Health had clinics,
9 out alcoholism-office waiting room had to be
10 separate from our mental-health waiting room. We
11 had to have separate entrances.
12 So what we were doing is creating barriers to
13 do just what we need here.
14 I think Oneida County has come a long way.
15 We're -- we were looked as one of the premier
16 counties on dual diagnosis [unintelligible].
17 HIPAA regulations, it needs tweaking, because
18 we don't need to reinvent the wheel. What we need
19 to do is, make it round again.
20 And I just thought -- I appreciate this, and
21 I think that you being here is just giving us the --
22 knowing that there's gonna be some discussion in
23 Albany about, What are the needs of the state, at
24 the community level, and not necessarily at the
25 state level?
100
1 Thank you.
2 [Applause.]
3 CASSANDRA SHEETS: Can I just make a -- can
4 I just add a comment to that?
5 Being a non-profit, we spend a lot of time
6 having to report to the State on the services that
7 we're providing, and it's incredibly difficult to
8 make those reports, when each of those, like, the
9 OMH and OASAS, are so separate, that it's more time.
10 You know, if you look at the amount of time
11 that we spend making these reports, it takes away
12 from the ability to provide to the community.
13 And so it's -- and it continues to get worse,
14 and primarily because the State systems just have --
15 they've even gotten worse. It's really pulled apart
16 even more.
17 And so you never know, I get the funding from
18 both sides, and what the left and the right hand are
19 doing are which hand they are.
20 That's the one part that they -- I know that
21 it's -- it's a dual issue. It has been for a long
22 time.
23 And what came first isn't really the matter,
24 whether it was the mental health or the addiction.
25 It's treating the person wholly.
101
1 But, it's also looking at it from a community
2 perspective, to say, that every individual who
3 struggles with mental illness, behavioral issues,
4 addiction, have the right for services, and they
5 have the right to be heard. And they have the right
6 to be -- to have us to be more tolerant in
7 understanding that.
8 And that's where it comes to creating a
9 community that's about recovery, because, if we can
10 embrace that people can get well, and they can be
11 productive, then we can really be more successful.
12 And that's where it comes with the
13 progressive and the proactive kinds of ways.
14 We react all the time.
15 Somebody gets hurt. All of a sudden, we have
16 a mental-health issue.
17 Somebody dies from heroin, we have a heroin
18 issue.
19 That's -- it's there. The availability is
20 there.
21 Whether they get it by finding someone who
22 sells marijuana, they're going to find it.
23 But how is we, the community, to say: No, we
24 don't want to tolerate that anymore.
25 What we want to do is, tolerate the kind of
102
1 help and hope that we can provide.
2 And, I truly feel that that is something that
3 you've inspired today, and I want to thank you.
4 SENATOR GRIFFO: I want to thank everyone for
5 coming out here this evening.
6 And I know Senator Boyle has been traveling,
7 as I indicated, from Buffalo to Rochester, and he's
8 on his way to Albany.
9 So, we're gonna continue this. This is a
10 beginning for us.
11 And I think it was very important that all of
12 you came out tonight, even with the weather as it
13 was.
14 It shows that you really care.
15 And, we need you involved, and we need to
16 have that input.
17 I want to thank the members of the panel that
18 have come together tonight, because I think it also
19 shows that they have a great concern for their
20 community, and they really want to continue to
21 develop a partnership in order to make things
22 better.
23 So, I'll let Senator Boyle close here, and
24 ask Senator Valesky if he wants to add anything.
25 And then...
103
1 SENATOR BOYLE: I would again like to thank
2 Senator Griffo for hosting this forum.
3 And thank, Senator Valesky for his support,
4 and the panelists for your insights, and everyone in
5 the audience for coming this evening.
6 I can tell you that, when we envisioned these
7 forums for the Heroin Task Force, this is exactly
8 the type of open exchange that we were hoping for
9 and expected.
10 And the ideas that we got this evening,
11 I thought of, you know, three or four different
12 bills, I'm sure, that will be included in the
13 report, and potential pieces of legislation, to get
14 treatment for those who truly need it, and for
15 prevention purposes, and some law enforcement, as
16 well.
17 I can say that, this is not the end, as
18 Senator Griffo said.
19 If you have any other ideas; if you're
20 thinking tonight, Oh, I didn't want to say that
21 'cause I'm shy, or, I just came up with a new idea,
22 you can contact my office, for the Task Force in
23 Albany. It's Senator Boyle.
24 And just Google -- Deanna [ph.] is in our --
25 and Susan are in our office there.
104
1 So just -- I'll give you -- Google the
2 number, and look it up, and they can give us ideas,
3 and say: What about doing this? What about doing
4 that?
5 And we'll be happy to include it in the final
6 report.
7 Thank you again for coming.
8 Thank you, Senator Griffo, and Valesky.
9 And thank you to the panelists.
10 SENATOR GRIFFO: Thank you all.
11 [Applause.]
12
13 (Whereupon, at approximately 6:46 p.m.,
14 the forum held before the New York State Joint
15 Task Force on Heroin and Opioid Addiction
16 concluded, and adjourned.)
17
18 ---oOo---
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