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: MONROE COUNTY
4 PANEL DISCUSSION ON ROCHESTER'S HEROIN EPIDEMIC
5 ------------------------------------------------------
6
7 Monroe County Office Building
39 West Main Street
8 Rochester, New York 14614
9 April 15, 2014
10:00 a.m. to 12:00 p.m.
10
11
12 PRESENT:
13 Senator Philip M. Boyle, Task Force Chairman
Chairman of the Senate Committee on Alcoholism and
14 Drug Abuse.
15
Senator Joseph E. Robach, Forum Moderator
16
Assemblyman Mark Johns
17 State Assembly, Ranking Member of Drug and
Alcohol Committee
18
19
20
21
22
23
24
25
2
1
SPEAKERS: PAGE QUESTIONS
2
William J. Hochul, Jr. 10 15
3 U.S. District Attorney
Western District of New York
4
Theresa DeLone 18 28
5 Personal Story
Resident of Henrietta, New York
6
Jennifer Faringer 31 45
7 Director
National Council on Alcoholism &
8 Drug Dependency (Rochester Area)
9 Jessica Sherman 49 58
Program Director
10 Face 2 Face
11 William Sanborn 59 66
Undersheriff
12 Monroe County Sheriff's Office
13 Lori Dresher 67
Personal Story
14 Resident of City of Rochester, New York
15 James Wesley 78 84
Drug Chemistry Supervisor
16 Monroe County Crime Lab
17 Jeremy T. Cushman, M.D., M.S., 85 94
EMT-P, FACEP
18 EMS Medical Director
University of Rochester
19
Lisa Thompson 102 107
20 Personal Story
Resident of Chili, New York
21
Jeanne Beno, Ph.D. 107 116
22 Chief Toxicologist
Monroe County Medical Examiner's Office
23
Sandra Doorley 119 126
24 District Attorney
Monroe County District Attorney's Office
25
3
1
SPEAKERS (Continued): PAGE QUESTIONS
2
Paige Prentice 131
3 Vice President of Operations
Horizon Health Services
4
Avi Israel 135 140
5 President
Save the Michaels of the World
6
Michael Foster, M.D. 143 149
7 Director
Chemical Dependency at
8 Unity Health Systems
9 Lisette Castro [ph.] 162 167
Harm Reduction Coordinator
10 for Syringe-Exchange Program
Trillium Health
11
12 ---oOo---
13
14
15
16
17
18
19
20
21
22
23
24
25
4
1 SENATOR ROBACH: Sorry for the little slight
2 delay.
3 I try to be Marine Corps-disciplined and
4 right on time.
5 We're gonna start, if everybody could just
6 stand, and we'll start with the Pledge of Allegiance
7 before we start our forum.
8 (All present at the forum recite, as
9 follows:)
10 "I pledge allegiance to the flag of the
11 United States of America and to the Republic for
12 which it stands, one nation under God, indivisible,
13 with liberty and justice for all."
14 SENATOR ROBACH: And, maybe if we could just
15 take one quick moment of silence for people we've
16 lost to this, and other drug addictions, and maybe
17 couple that with all our military people who are
18 serving, just take a moment of reflection.
19 (A moment of silence was observed.)
20 SENATOR ROBACH: Thank you.
21 I am very happy to be joined by my colleague
22 Phil Boyle, who's one of the Co-Chairs of the
23 Task Force.
24 And unlike many very important things we look
25 at, we usually try to, you know, hit key geographic
5
1 points, but because this has been so growing,
2 impacted so many families, so many things, we're
3 actually having 12 hearings across the state, to
4 make sure that we give everybody an opportunity.
5 And we are learning, unfortunately, via a lot
6 of bad incidents, sometimes those that are tragic,
7 that this is certainly not just a New York City
8 problem, a "big city" problem.
9 It is urban, suburban, and hitting every
10 demographic of our community and of our state.
11 So, I want to, first and foremost, thank Phil
12 for heading this up.
13 Senator Boyle, I should be respectful.
14 Can I call you Phil?
15 SENATOR BOYLE: Sure, yes.
16 SENATOR ROBACH: But, you know, we're trying
17 to take a very, very aggressive approach to this,
18 and we really want to hear what people have to say.
19 We've had the first hearing in Long Island;
20 very eye-opening.
21 And I'm sure we're going to hear that across
22 the state from a wide range of people impacted by
23 this heroin epidemic.
24 Very quickly, before we get started, I want
25 to thank my colleague Mark Johns from the Assembly
6
1 for participating today, and showing his interest.
2 And, also, just quickly introduce,
3 Ann Cheweko [ph.], from my colleague
4 Senator Pat Gallivan's Office, who's also a member
5 on the Task Force, and has been participating in
6 these, too.
7 Without further ado, I'll open it up to my
8 colleague Senator Boyle.
9 SENATOR BOYLE: Thank you, Senator Robach.
10 And I'd like to thank my friend and colleague
11 Senator Robach for hosting this forum here in
12 Rochester, and, my former colleague
13 Assemblyman Mark Johns for attending, and
14 Senator Gallivan, as well, and the other Senators
15 and Assembly people in the area, for their
16 participation.
17 This is a serious issue on a statewide level.
18 I can tell you that I -- growing up in an
19 Irish household, I kind of am familiar with
20 addiction, mostly with alcohol, and -- but really
21 got a lesson, when I was recently elected to the
22 State Senate last year, and made Chairman of the
23 Committee on Alcoholism and Drug Abuse.
24 The heroin epidemic that we're seeing on a
25 statewide level is truly staggering, and the numbers
7
1 in the Rochester area are scarry, quite frankly.
2 I've been reading the "Democrat and
3 Chronicle" reports, and watching the news reports,
4 from Long Island, to see a four- and fivefold
5 increase in use and overdoses in the Rochester area
6 in just the last couple years.
7 With this, we've created this Task Force.
8 We're going around the state with 12 forums,
9 as Senator Robach said, including one on the
10 Seneca Nation, because it's a problem cross-country,
11 really.
12 And what we're looking for, and I thank you
13 all for coming here, participating, and watching,
14 however you're going to be involved, because we're
15 looking for a multipronged approach of facing this
16 epidemic.
17 One of them, I believe, is prevention: to
18 stop our kids from ever using heroin in their lives.
19 To teach them about the potential threats and
20 life-threatening situations they can put themselves
21 in.
22 Of course, the second prong is treatment.
23 For those who are addicted now, we have so
24 many tragic stories of people who sought treatment
25 and they could not get it because of the current
8
1 lack of beds and lack of insurance coverage.
2 And, of course, a third, and very important
3 part, is law enforcement.
4 We're gonna hear from prosecutors, from
5 law-enforcement officials, to tell how we can change
6 the current laws, to make sure drug dealers and
7 heroin dealers are put in jail for a very, very long
8 time, to get this scourge off of our streets.
9 We had a very productive hearing.
10 This is actually the second hearing of the
11 twelve.
12 And our first one on Long Island, we good
13 ideas for possible legislation.
14 The mission of the Task Force is to issue a
15 report by June 1st, and then pass subsequent
16 legislation, based on that report, in the remaining
17 weeks of the session.
18 We're under a tight time frame,
19 unfortunately, but I think we can do it.
20 And we also need to convince the New York
21 State Assembly to pass this these needed pieces of
22 legislation, as well.
23 So, today, we look forward to the testimony
24 of the people speaking, and we look to hear about
25 your personal stories, whether you're a treatment
9
1 provider, a prevention expert, or law-enforcement
2 official, give us ideas about, if there -- If I had
3 one way to change the law, a couple of ways to
4 change the law, to make this fight against heroin
5 more effective, please let us know, and we look
6 forward to hearing from you.
7 Thank you so much for coming.
8 And our first witness --
9 Oh, Mark. Sorry.
10 ASSEMBLYMAN JOHNS: Good morning, everyone.
11 Assemblyman Mark Johns, representing the
12 135th District.
13 I appreciate Senator Robach, Senator Boyle,
14 for inviting me down to this.
15 I'm the Ranking Member on the Drug and
16 Alcohol Committee in the State Assembly; here to
17 learn, for the time that I'm here, about some of the
18 problems.
19 We're already too familiar with what goes on
20 in the last couple weeks here in Rochester area: the
21 tragedy with heroin use among young people.
22 And I'm here to learn, and, hopefully,
23 together, we'll cobble together legislation that we
24 can get, and help the people, especially younger
25 people, in New York State avoid this epidemic.
10
1 Thank you very much for having me here today.
2 SENATOR BOYLE: Thank you so much, Mark.
3 Our first speaker will be Bill Hochul, a
4 U.S. District Attorney for the Western District of
5 New York.
6 WILLIAM J. HOCHUL, JR.: Thank you,
7 Senator Boyle, Senator Robach, and
8 Assemblyman Johns, for hosting and convening this
9 very important session here in the western part of
10 New York State.
11 As the United States Attorney, I'm
12 responsible for the enforcement of federal law in
13 17 counties.
14 Those include right here where we're sitting,
15 in Monroe, all the way to Buffalo, down to the
16 Cattaraugus Reservation, and, frankly, to Elmira,
17 New York.
18 From my perspective, we are in the middle of
19 a heroin and prescription-pill epidemic.
20 Frankly, we began seeing alarming statistics
21 several years ago, including when I first became
22 United States Attorney in 2010.
23 Now, as you've already no doubt discovered,
24 the heroin problem frequently begins as a
25 prescription-pill abuse problem.
11
1 One of the problems confronting us in law
2 enforcement is that prescription pills are legal
3 commodities.
4 Nevertheless, what we've seen on rare, yet
5 noteworthy cases, is that medical professionals
6 themselves frequently abuse their Hippocratic Oath
7 and their licenses.
8 We've had cases where medical professionals
9 have exchanged prescriptions in exchange for things
10 like money; sex; a gas grill, in one instance.
11 We've also had instances where other medical
12 professionals take unused prescription pills, such
13 as when a patient in a hospital die, and then put
14 those on the black market.
15 But by far the most common way that
16 prescription pills enter the stream of illegal
17 commerce is the family's own medicine cabinet.
18 Part of this, from our vantage point, is
19 because there's such a large quantity of
20 prescription pills that are frequently prescribed.
21 When not all of them are used, they're stored
22 just down the hall where they can be used perhaps in
23 a future occasion.
24 But, yet, when they're discovered either by
25 other young people or other family members with a
12
1 need, what we see is the thefts now, not just of the
2 family jewels, but, frankly, of these very valuable
3 prescription opiates.
4 To give you a perspective additionally on the
5 size of our problem, you may be familiar with the
6 DEA Drug Take-Back Program.
7 There's now been seven programs, and that's
8 one of the initiatives that we in federal law
9 enforcement believe is as important as strict law
10 enforcement; that is, removing the excess drugs.
11 Well, in Western New York, our prescription
12 take-back has led the nation since it started.
13 And over the seven take-backs we've had,
14 people have turned in over 103,000 pounds of unused,
15 unneeded prescription pills. Literally, millions
16 and million of doses.
17 But when we're not prosecuting
18 prescription-pill traffickers, we in law enforcement
19 are seeing a spike and an increase in heroin
20 trafficking, both in numbers of traffickers and in
21 the amount of seizures that we've been recovering.
22 Frankly, we also see polysubstances, such as
23 heroin mixed with fentanyl.
24 And on that score, what we're able to do, at
25 least under federal law, is ensure that those who
13
1 directly cause the death of their customer, even if
2 it's a small amount of drugs, face substantial
3 periods of time in jail; up to life imprisonment, in
4 some instances.
5 As for suggestions, I continue to applaud
6 your efforts to seek a multifaceted approach.
7 One thing we did in 2011, is we convened many
8 experts from the medical, the treatment, the
9 law enforcement, the educational communities, and we
10 heard from families who have suffered losses.
11 Some of them are here in this room today.
12 What we have found, is that the medical
13 community has a role to play, whether it be
14 increased curriculum and training in medical school,
15 or increased continuing legal or medical education
16 for postgraduates.
17 We also strongly support treatment centers,
18 so that people who certainly have the need, whether
19 they're suffering from addiction, or perhaps they
20 have this urge to get back into their former ways,
21 have a place to go and met with qualified, trained
22 professionals.
23 Well, one of the most valuable things that
24 law enforcement has begun doing, and this happened
25 in Buffalo about two weeks ago, is equipping police
14
1 cars with antidotes or antagonists to these opiates
2 that really act as a way of suppressing the
3 breathing and other respiratory and vital functions.
4 Narcan has been placed in all Buffalo police
5 cars, and also given to other first responders.
6 That's certainly a way, that when somebody
7 who's suffering or is in the throes of an addiction
8 is discovered by law enforcement or first
9 responders, this gives those people a fighting
10 chance to get other medical professionals involved.
11 And then, finally, the treatment piece,
12 which, hopefully, will remove the addicts -- or, the
13 addictions from the person's life.
14 In conclusion, we in law enforcement agree
15 that it is an epidemic.
16 We're doing everything we can, by targeting,
17 investigating, and prosecuting those who illegally
18 sell heroin, and the sometimes legal drug of
19 prescription-pill opiates.
20 But, it is a multifaceted approach.
21 The United States State Attorney General has
22 said it will require a mixture of law enforcement,
23 education, and treatment, and I wholeheartedly
24 concur.
25 I look forward to looking with you in any way
15
1 possible.
2 SENATOR ROBACH: Thank you, Bill, for your
3 very cogent comments.
4 If I could just start:
5 So, you know, you talked about, and I think
6 there's a real difference, obviously, we have --
7 I don't know who or why, but, the market is clearly
8 flooded with very, very potent, yet inexpensive
9 heroin.
10 And I don't mean the street dealers.
11 Somebody's behind this, and making a lot of
12 money.
13 Do you think you have the tools now as a
14 prosecutor, when you get the people that are really
15 in there?
16 Are the sentencing guidelines and punishment
17 adequate for this crime, do you feel?
18 WILLIAM J. HOCHUL, JR.: When it comes to
19 heroin, absolutely. We have very strong guidelines,
20 Senator.
21 And, frankly there is not a lot of weight of
22 drugs which will get the defendant maximum exposure
23 when it comes to opiates, including heroin.
24 We need, though, continued resources when it
25 comes to being able to track the source of the
16
1 heroin.
2 We -- lately, on the DEA side, they've
3 detected, and developed the ability, to try to test
4 where that heroin originated. Literally, send it
5 back to the poppy fields of a particular country or
6 other.
7 But, certainly, we in law enforcement are
8 doing everything we can to identify, with the
9 available resources we have.
10 SENATOR ROBACH: Yeah, thanks.
11 And I was just gonna say, I think that was a
12 good comment on, the Narcan, can help first
13 responders, law enforcement, stop the overdose from
14 being fatal.
15 But -- and we want to do that. I think
16 that's gonna happen all over New York.
17 But, you know, ideally, we'd like to, you're
18 right, a multi-approach; meaning, we'd like to get
19 them much, much earlier, so we don't need the
20 Narcan, and they're not in that situation.
21 But, yeah, I think we're gonna go that route,
22 and I think that's gonna happen even separately from
23 this Task Force.
24 I think it's already in process of happening
25 all over.
17
1 SENATOR BOYLE: Thank you, Bill.
2 Just to follow up on Senator Robach's
3 question:
4 Now, from what I've seen on the state-level
5 penal code, there may be -- need to be an increase
6 in some of the penalties.
7 But you're saying, on the federal level, that
8 there's sufficient criminal penalties against the
9 dealer; it's really just a matter of resources to
10 find out?
11 WILLIAM J. HOCHUL, JR.: That's right,
12 Senator.
13 One way that the law on the federal side is
14 very beneficial, has to do with the supply of any
15 quantity of drug that causes -- directly causes a
16 death.
17 Ordinarily, the sentencing guidelines are
18 driven by the weight of the seizure. Say, a
19 kilogram of heroin would call for a certain amount
20 of jail time.
21 But with the federal law relating to causing
22 a death, even the smallest amount of drugs, if it
23 causes death, can subject the dealer to up to life
24 imprisonment.
25 So that is a very good tool that we are able
18
1 to use.
2 And, frankly, we have charged it last year in
3 a case, where it was just a one small bag that
4 caused the death of somebody.
5 SENATOR BOYLE: Wow.
6 Thank you very much.
7 That's great.
8 SENATOR ROBACH: Thank you, bill.
9 WILLIAM J. HOCHUL, JR.: Thank you.
10 SENATOR ROBACH: Before we get to our next
11 testimony, I just want to introduce
12 Jay Grasso [ph.], over in the corner, who's here
13 representing my colleague Senator Mike Ranzenhofer's
14 Office.
15 Thank you for being here, Jay.
16 And our next testimony will be from
17 Theresa DeLone, who will be sharing a personal
18 story.
19 Hi, Theresa.
20 THERESA DELONE: Hi.
21 Thank you for having this Task Force.
22 I'm not a public speaker, so I apologize if
23 my testimony is not as --
24 AUDIENCE MEMBER: Could she speak up?
25 THERESA DELONE: Yes, I will try.
19
1 SENATOR ROBACH: Yes, just speak right in the
2 mic.
3 Thanks.
4 THERESA DELONE: Okay.
5 So, I'm here today to spend a few minutes
6 talking with you, not as a licensed professional,
7 but a mom who has a son who is a heroin addict.
8 I can't quote any statistics or any studies;
9 however, I can speak to you about my experience, and
10 offer some thoughts on what I believe is needed to
11 help in the fight against addiction.
12 Everyone says, "Not my child, not my family,"
13 but addiction does not discriminate.
14 It affects people from all walks of life:
15 single-family homes -- or, single-parent homes,
16 two-parent homes, and people from every social and
17 economic group.
18 It is an equal opportunity destroyer.
19 My son is more than a heroin addict.
20 He is a loving, caring, and sensitive young
21 man.
22 He was an athlete, a very responsible
23 student, and an employee, prior to his addiction.
24 He had several full-time jobs, was recognized
25 by his employer as hard-working. And even asked to
20
1 travel on behalf of one of his companies.
2 Once his addiction took over his life, he
3 lost friends, jobs, and finally was isolated by his
4 addiction.
5 He has become someone -- he became someone
6 that we did not even recognize.
7 Addiction is called "a family disease," and
8 I can tell from you my personal experience that this
9 is true.
10 As their addiction progresses, your family
11 life becomes chaotic.
12 The family members suffer from various side
13 effects from the addict's behavior, from financial
14 problems, sleeplessness, emotional distress, and
15 some even suffer from physical illnesses.
16 Trusts and respects are lost, and is replaced
17 with suspicion and fear.
18 There are many emotions felt by the family
19 members: anger, helplessness, embarrassment, worry,
20 and fear are just a few.
21 You're angry that your family has been
22 affected by this terrible disease.
23 Angry at your loved ones that they are using
24 drugs.
25 Angry that your sense of a normal family life
21
1 has been destroyed by the drugs.
2 You feel helpless that you cannot either help
3 your family or your addict.
4 There are many sleepless nights and worry,
5 and a lot of tears.
6 You live in fear that you will get the phone
7 call that no family wants to get: that your son or
8 daughter is either in the hospital from an overdose,
9 or has, worse yet, died.
10 The family believes that they are helping
11 their addict, but, many times, what we are doing is
12 enabling the addict.
13 Imagine turning your own son into the police
14 for stealing yet another item from your home?
15 Imagine the shock and embarrassment you feel
16 when police officers are at your door to arrest your
17 son and remove him from your home in handcuffs.
18 The heartache that you feel when your son is
19 calling from jail, asking to be bailed out; and
20 saying "no," not because you don't have the money to
21 bail him out, but because you feel he's safer in
22 jail, off the streets, away from the drugs; or, that
23 you just need a break and some peace and quiet from
24 the addict.
25 My son has missed many holidays, birthdays,
22
1 Mother's Days, important family events, like college
2 graduations.
3 You have an emptiness in your heart that your
4 son or daughter is suffering from this terrible
5 disease.
6 I could tell you many stories that would
7 probably horrify you, but I'm gonna move on to
8 things that I think would help in fighting this
9 addiction.
10 Once our families have reached the limit of
11 what they can deal with on their own from the
12 addiction, they may turn your addict out onto the
13 street, which now you have a homeless addict on the
14 street who is desperate for money to get drugs.
15 They will steal, they will lie, they will
16 manipulate; they will do anything in their power to
17 get a drug.
18 I would believe that many of the homeless on
19 our streets today are either current addicts or are
20 former addicts, and are still looking for a way to
21 find their way to recovery.
22 Our schools are also affected by this crisis.
23 The addiction to pain killers is starting
24 much younger than it ever was in the past.
25 These students are not paying attention in
23
1 class. They're not getting the education that they
2 need. Likely, they're disruptive to other students,
3 if they're even attending class at all.
4 Many of these younger addicts are not gonna
5 continue on to go to college, because they just
6 cannot make it to college, which, then again, is
7 gonna lead to a life of low-paying jobs, or worse
8 yet, they will continue with crime in order to
9 support their addiction.
10 What can we do as a community?
11 This is a question for which I do not have an
12 answer, but I'll offer some suggestions and thoughts
13 that I think will help.
14 We must, must, must continue these
15 discussions.
16 There are so many young people that are in
17 need of help.
18 Parents must be educated about the crisis in
19 our schools, our communities, and our families.
20 They need to learn all they can about
21 addiction, and, also, what treatment options are
22 available if they find themself in need.
23 We must stay connected to our children, know
24 their friends, support their interests, and stay
25 involved their life.
24
1 Casual conversations about drugs and
2 addiction are not going deep enough for our families
3 to know what addiction looks like, how it affects
4 your life, your family, and how it escalates until
5 your life is totally out of control.
6 Our children need to understand that drugs
7 and addiction will ruin their life and take away
8 their dreams.
9 More treatment options are needed.
10 Everyone is an individual, and every road to
11 recovery is different.
12 No two people will travel the same path to
13 recovery, and each need to find what works for them,
14 and need an opportunity to obtain the best treatment
15 that they can.
16 Many addicts have private insurance, and
17 still, yet, cannot get the treatment that they need.
18 My son, when he was reaching out for help,
19 I had a private insurance policy for which I pay
20 every single month, year after year after year, and
21 he was denied many, many times for getting the help
22 he needs.
23 When you have an addict who is reaching out
24 for help and they are denied the help that they are
25 asking for, this is overwhelming to them.
25
1 They no longer have an option, or they feel
2 they have no options, and they do not know what to
3 do next.
4 Families don't have options either, because,
5 what do you do?
6 You have a child who is doing the right
7 thing, who is trying to get help, yet nobody will
8 help them.
9 Addiction is a disease.
10 I don't think there's a medical professional
11 who will say it is not a disease.
12 Why do the insurance companies not recognize
13 it as a disease?
14 It is a disease that, untreated, will kill
15 the addict. There's is no question about it.
16 I personally know of a young girl who has
17 recently lost her life.
18 She was sent out from detox after seven days,
19 to wait on when a treatment bed would become
20 available to her.
21 Unfortunately, she died before that bed was
22 available.
23 We cannot continue to send our children out
24 on the streets after a 7- or a 10-day detox. It is
25 not enough.
26
1 They are given the option of: To wait until
2 a bed is available, or, they are told to seek
3 outpatient treatment.
4 And if you ever tried to get an
5 outpatient-treatment appointment, you will wait
6 weeks in some cases.
7 My son was recommended many times for a
8 mental-health evaluation.
9 Do you know how long he had to wait for an
10 appointment? Weeks, and months, before anybody
11 would even schedule an appointment for him.
12 By then it was too late.
13 He was either back on the streets or he was
14 in jail.
15 My son has made a lot of mistakes for which
16 he has paid dearly.
17 He has spent many days in jail, which is not
18 where you want an addict because that's not where
19 they're getting any treatment.
20 Intensive inpatient treatment is a level of
21 treatment that our children must have available to
22 them in order to sustain their sobriety.
23 During their stay there, they can concentrate
24 on only themselves. They can get the help they need
25 for both their physical and mental wellbeing.
27
1 Many of these addicts lack coping skills.
2 They need to get coping skills.
3 And by being inpatient, off the streets,
4 where they can access to a counselor at any hour of
5 the day and night, is extremely important.
6 I agree with Phil, in the fact that -- and
7 I apologize for using your first time name, I don't
8 remember your last name -- we need to get Narcan
9 into the hands of all our first responders.
10 And any family who has an addict living in
11 your home, you must have Narcan available to you.
12 If you don't, your child or your loved one
13 may die waiting for a first responder to get there
14 who has Narcan. Some of them do not.
15 These children do not have to die.
16 We have this drug available.
17 It will help get them to at least to the
18 hospital, where their life can be saved, and they
19 have an option of getting recovery.
20 In closing:
21 I am thankful that my son's parole officer
22 saw his potential and recommended inpatient
23 treatment for him over a return to jail.
24 Today my son is almost 9 months clean and
25 sober.
28
1 His journey has been a long and a bumpy road
2 with multiple relapses.
3 Without seven months of intensive inpatient
4 treatment, I believe that my son would not be alive
5 today. His addiction would have taken his life.
6 As a community, we need to ban together to
7 find ways to reduce, and eventually end, this heroin
8 crisis before it's too late.
9 Too many of our young people are dying, and
10 we are not talking about the things that are
11 important.
12 We must find a way to help those who are
13 already addicted, and to prevent others from
14 becoming addicted, and prevent other families from
15 having to go through what many of these families who
16 are sitting here today I'm sure have gone through.
17 Thank you for your time, and thank you for
18 creating this Task Force to address this crisis our
19 families and community is facing.
20 SENATOR ROBACH: Thank you, Theresa.
21 And I'm glad that your son is moving in the
22 right direction.
23 THERESA DELONE: Thank you.
24 And that's a day-to-day thing, I will tell
25 you.
29
1 Today, knock on wood, he is doing well.
2 That could change on a dime, unfortunately.
3 SENATOR BOYLE: Thank you so much, Theresa.
4 And I, too, hope for the best for you and
5 your family.
6 A couple of things you touched on was:
7 The insurance coverage.
8 And that is one of the issues we've been
9 hearing in -- at other forums and discussions; that,
10 these insurance companies -- yours didn't cover at
11 all -- but others of them say: Well, we're gonna
12 give you three days of treatment, and then come out,
13 and I'm sure you'll be free of heroin after
14 three days.
15 THERESA DELONE: That's right.
16 SENATOR BOYLE: It just doesn't happen that
17 way.
18 THERESA DELONE: Exactly.
19 SENATOR BOYLE: It needs to be the medical
20 professionals that make these decisions, and not the
21 insurance companies.
22 And we're certainly looking at that for
23 potential legislation.
24 You also did touch on the Narcan use.
25 I can tell you that, as a former EMT, I've
30
1 seen Narcan work personally, and it is truly a
2 miracle drug.
3 It's Naloxone, and Narcan is a brand name.
4 To watch a young man who is at death's
5 door -- lips were blue, not breathing, not
6 responsive, just about to be pronounced dead,
7 really -- and they gave him Narcan, and within
8 one minute, he was awake, alert, and talking to me
9 in a normal conversation.
10 It's unbelievable.
11 And we need to do it, not just for
12 first responders, but get it available in the
13 general public.
14 We are hosting an opioid-Narcan treatment
15 campaign on Long Island.
16 I know Senator Robach is gonna look into it,
17 one here in Rochester, as well.
18 Where, you don't have to be a first
19 responder. Anybody can get it.
20 It's less-than-an-hour class.
21 And, they will give you a nasal spray.
22 It's not gonna be a syringe you need to stick
23 in someone's arm.
24 You can do it nasally, so you can, literally,
25 save a life.
31
1 Hopefully not your family's life or a
2 neighbor's life, but you will save a life.
3 Thank you so much.
4 THERESA DELONE: And I do have Narcan, I will
5 say. I do have it available to me.
6 But what I find unusual, is that I was told
7 when I was given it, that it may be, if somebody
8 stopped me, if a police officer stopped me, that it
9 may be confiscated.
10 And that to me is unbelievable in today's
11 heroin-addiction crisis, that somebody would
12 confiscate something from me that I could save my
13 child with.
14 SENATOR BOYLE: Well, thank you for making me
15 aware of that. I was not sure.
16 And that's one of the laws we need to change
17 if that's the case.
18 Thank you so much, Theresa.
19 THERESA DELONE: Thank you.
20 [Applause.]
21 ASSEMBLYMAN JOHNS: Okay, we'd now like to
22 introduce Jennifer Faringer. She's director of
23 National Council on Alcoholism & Drug Addiction in
24 the Rochester area.
25 JENNIFER FARINGER: And, good morning.
32
1 And I certainly would like to thank
2 Senator Robach, Senator Boyle, and
3 Assemblyman Johns.
4 This is an important, important issue for our
5 community, and our state.
6 I'd like to talk about a couple of issues.
7 Some of them have been raised, but certainly
8 to address the issue of the rise in heroin use, the
9 fatal-overdose increases, but, without speaking
10 about the related prescription over-the-counter
11 misuse and abuse, the two are inextricable.
12 So, specifically -- let's take section by
13 section.
14 Specifically, the problem is related to
15 prescription or over-the-counter pain meds or
16 opiates.
17 They've reached epidemic proportions in the
18 past decade.
19 According to the Center for Disease Control's
20 Vital Signs Report on prescription pain meds,
21 15,000 people die each year from prescription-med
22 overdoses.
23 One in 20 people, age 12 or older, reported
24 using prescription pain meds for non-medical
25 reasons.
33
1 What does that mean, "non-medical reasons"?
2 It means getting ahold of a script that was
3 never intended for you in the first place.
4 Whether given -- kindly given, or, whether
5 getting through methods of diversion, illegally
6 obtaining, prescription pain meds have been
7 overprescribed, with enough prescribed in 2010 to
8 medicate every adult in the United States around the
9 clock for a month.
10 To me that's a staggering, staggering figure.
11 For women alone, deaths from scripts,
12 pain-meds, overdoses increased more than 400 percent
13 since 1999.
14 That's compared to an increase of 265 percent
15 among men, which already is an alarming statistic in
16 itself.
17 For every woman that dies from pain-med
18 overdose, 30 women seek help at emergency rooms for
19 pain-med misuse consequences.
20 So what are those common scripts and
21 over-the-counter opiates that are diverted, abused,
22 misused?
23 Most commonly, we're looking at Vicodin,
24 Percocet, Oxycontin, and, Opana, one of the more
25 recent.
34
1 Even more recently, sadly, approved by the
2 FDA is the even more potent Zohydro ER.
3 It's now in the market.
4 There's a number of AGs across the country
5 that are looking to revoke that approval.
6 This is more potent than anything we've ever
7 seen, and, certainly, if released widely, will --
8 will -- I can't even imagine the escalate in terms
9 of numbers.
10 So, Zohydro ER, bad thing, needs to be off
11 the -- off the market.
12 Additionally, with kids, we think about the
13 opiate over-the-counter dextromethorphan, which is a
14 primary ingredient in the over-the-counter cough
15 products.
16 If taken as intended, one teaspoon every
17 four to six hours, you're fine.
18 But that's not how it's being taken.
19 It's being taken in the amount of 25 to
20 30 times the amount of recommended doses.
21 That's taking it by the bottle; not by the
22 teaspoon.
23 When you do that, the consequences are
24 enormous. So, any abuse of these products.
25 If taken as prescribed, or taken as
35
1 recommended on the bottle, not a problem.
2 It's when we're prescribed or we take the
3 excess that we get into the issue.
4 So now the problems specific to the rise in
5 our community around heroin abuse:
6 Across multiple sectors in our community, all
7 data points to the fact that we're in the midst of a
8 sharp increase in heroin use, as well as increase in
9 overdose fatalities from heroin.
10 There are so many factors, it's very complex,
11 that are responsible for this shift in demographics
12 across the board, that we see in Rochester, in
13 Monroe County, in the Finger Lakes region, as well
14 as the state of New York.
15 And there's many similarities.
16 We know from research studies that the
17 following factors identified as predictors of drug
18 abuse are responsible for the shifts in demographics
19 that we're experiencing, and those factors include
20 things like: How accessible, how available, is
21 heroin?
22 Unfortunately, it's extremely accessible,
23 extremely available.
24 And that is not limited to what was, prior,
25 its accessibility in the urban area, but it's
36
1 extended out equally into the suburban and rural
2 areas in New York.
3 Increasing, but still variable, is that
4 potency.
5 And a prior speaker addressed that: the
6 potency of heroin itself.
7 So you've got availability, you've got
8 potency.
9 The potency is a variable.
10 That means that the addict that perhaps has
11 been incarcerated, and now goes back on the street,
12 gets ahold, (1) there's the tolerance issue coming
13 into play, but (2) there's the issue of, now, you
14 have perhaps a heroin that's much more potent.
15 And, it's buyer beware. How would you know
16 that?
17 Overprescribing of opioid scripts:
18 Although, with I-STOP, which is a -- is a
19 positive step, we're gradually seeing an impact in
20 this area.
21 But we still hear, unfortunately, there are
22 those physicians that, instead of prescribing after
23 a post-op, a few pills to get you to your
24 primary-care physician, which would be the ideal
25 route, they're being prescribed 60, 70, 80 pills a
37
1 pop.
2 You know, a couple -- it's a bad, bad news
3 all around.
4 So regarding purity:
5 We know that the purity of heroin is
6 available, with 60 to 70 percent range typical, but,
7 there's a real -- a much wider variation, from --
8 anywhere from 3 to 70 percent in actuality.
9 And the issue of potency variance plays a
10 striking role, and it is responsible for the
11 increasing number overdoses and subsequent
12 fatalities, as well as the tolerance issue.
13 If a client has been detoxed and returns to
14 the community and relapses, the likelihood of
15 overdose and death is high due to, again, both
16 tolerance and potency.
17 Additionally, then you've got the issue of
18 heroin possibly being cut with things like fentanyl,
19 an opiate in itself; a synthetic opiate.
20 That's been evidenced in several recent local
21 cases of overdoses.
22 Cutting heroin, already with variable
23 potency, with now a synthetic opioid, fentanyl,
24 serves to further increase the potency of the final
25 heroin combination, making the final product even
38
1 more potent and more deadly.
2 Regarding costs:
3 We know there's a variation in cost, but
4 street-level heroin is currently at an all-time low
5 in our region, as well as in the state.
6 Locally, we're hearing prices such as $10 a
7 bag, and as low as six to eight in New York City.
8 Compare this with the street cost of diverted
9 Oxycontin, for example, you're looking at 80, maybe
10 100 dollars a tab.
11 So it's no surprise then, that the patient
12 who becomes addicted -- if you follow this out:
13 They become addicted to their legal pain med,
14 because they're overprescribed.
15 If you take your full 80 to 90, 100, chances
16 are, you're gonna become addicted.
17 You go to the street -- because you can't
18 obtain another 80 to 90, hopefully, but you go to
19 the street to try to get ahold of Oxycontin, you're
20 paying a huge cost.
21 So it stands to reason then, that the user
22 would then shift to the much more available, much
23 more accessible, and much less costly heroin on the
24 street; the illegal heroin.
25 With overprescribing practices, patients,
39
1 again, following their outpatient dental, following
2 their outpatient surgeries -- or, I think I spoke to
3 this -- have been known to be prescribed opiates in
4 excess of the actual need, the 60 to 80 tabs,
5 versus, the few tabs to get them to their primary
6 care.
7 And at this point, one of two things happen:
8 Either they take it for the few days
9 following the procedure, just to get them over the
10 post-op pain, but, then, put the often large
11 remaining quantity in their medicine cabinets; hence
12 our campaign, through the National Council on
13 Alcoholism & Drug Dependence, has been an awareness
14 campaign around, "Do you know what's in your
15 medicine cabinet?"
16 So being very aware of excess -- the
17 potential excess of opiates in your cabinet.
18 If you place the unused portion of the
19 prescription in their medicine cabinet, they
20 increase the likelihood of diversion of that
21 product, and they become targets in themselves.
22 We try to warn, for example, realtors:
23 When you're having a house showing, are you
24 aware, or do you have a party that's going along
25 with the realtor, and then you have another party
40
1 that's maybe checking out the medicine cabinet in
2 the bathroom?
3 You know, those are all ways to divert.
4 Or is the house targeted, because you know
5 that the occupant is either a senior citizen, one
6 that's had a dental surgery, outpatient surgery, for
7 which there's likely excess opioids in the medicine
8 cabinet.
9 Another scenario might include a patient
10 taking their pain med longer than the time needed to
11 address their post-op pain.
12 In this case, they're likely seeking the
13 euphoric high produced from this family of drugs:
14 the opiates.
15 With the opiate family, there's a fairly
16 rapid progression to addiction; and once addicted,
17 and unable to get more of the script again, it's
18 very likely that they switch to the cheaper and more
19 available heroin.
20 Then regarding the demographic shift, and as
21 a prevention professional, this is something that
22 certainly has caught my attention, our attention, as
23 well as in the treatment community.
24 Recently what we're seeing is a dramatic
25 shift in user demographics across the board, from
41
1 the heroin user -- former heroin-user profile --
2 age, gender, ethnicity -- being one vision, one
3 profile, to the more current and very different user
4 profile.
5 The shift has been seen and verified through
6 surveys at local schools, verified through intake
7 data at treatment-provider sites, through
8 needle-exchange programs.
9 The more current profile includes,
10 unfortunately, a younger population, with an average
11 age now showing up in treatment, at needle-exchange
12 programs, 16 to 29.
13 A very different age range than what we were
14 seeing before, even five years, and, certainly, a
15 decade ago.
16 The shift is also now primarily Caucasian,
17 with increasing number of female users; when,
18 before, the profile was primarily male.
19 Additionally, there's a geographical profile
20 shift, from previous users coming primarily from an
21 urban setting, to current users coming from,
22 equally, all demographics.
23 Urban, suburban, rural, it knows no
24 boundaries now.
25 The broad demographic shift is being driven
42
1 by all of the above factors, and includes,
2 unfortunately, that decreasing perception of risk
3 among young people and young adults.
4 Note the recent case at University of
5 Rochester, the young woman who -- a young college
6 student, who took heroin and it was a fatal death
7 associated with that.
8 Perception of risk in our field is a strong
9 predictor or driving factor in subsequent drug use.
10 So what are some of the solutions?
11 I think they're varied.
12 And I applaud you again for convening a
13 Task Force that addresses all the issues.
14 One of the primary pieces, and Bill Hochul
15 talked about this, certainly, the DA is conducting
16 again a safe Take-Back Day, Saturday, April 26th,
17 from 10 to 2.
18 It's the seventh of those Take-Back days in
19 Monroe County. They've been particularly
20 successful, of course, as well as New York State.
21 And from our region, the take-back has been
22 over 36,000 pounds collected from over
23 16,000 individuals.
24 That's enormous.
25 Additionally, in Monroe, I think we could
43
1 serve as possibly a model for the state of New York
2 in terms of frequency: frequency of location,
3 frequency of dates.
4 So we go above and beyond bragging about
5 Monroe County.
6 But that's okay, Joe. Right?
7 SENATOR ROBACH: Brag on.
8 JENNIFER FARINGER: In Monroe County, if you
9 go to the Monroe County site, HHW, you see multiple
10 opportunities.
11 So we have the wonderful two DA, fall and
12 spring; excellent.
13 But, also, if you go to the Monroe County
14 site, you see several sites, anywhere from three to
15 four a month, multiple locations across the county.
16 So, there truly is no excuse for someone with
17 unused meds to get those scripts off the street.
18 And there's confusion, too, about that.
19 It's a totally confidential way to get things
20 off the street, to get them safely incinerated. No
21 environmental impact.
22 Just the elimination of potential diverted
23 opiates.
24 And then support the full implementation of
25 the needed I-STOP.
44
1 We're in the place right now of, potentially,
2 being fully implemented by the end of this year,
3 perhaps early next year, but this helps to further
4 curb those overprescribing practices; the doctor,
5 pharmacy, shopping; the potential diversion of
6 prescription pain meds.
7 And increased prevention resources, in the
8 form of community education and awareness, similar
9 to those RFPs that were offered a number of years
10 ago -- and I know, certainly, we applied, and
11 participated in this -- around the methamphetamine
12 epidemic.
13 We were so sure it was going to come into
14 Rochester, Monroe County, we did a huge full-blown
15 media community-awareness campaign.
16 And I think this would be a likely strong
17 strategy again.
18 Prevention efforts would also target
19 physicians, pharmacists, linking them to
20 community-based prevention experts.
21 Efforts would need to include broad and
22 intense community-awareness campaigns, targeting
23 youth, targeting parents, regarding the risks of the
24 opiates, both those that are legal and those that
25 are illegal.
45
1 And, certainly, I would like to encourage
2 this support around Narcan (Naloxone).
3 Right now we have an issue where they are
4 being prescribed.
5 They're available, certainly, to first
6 responders. Hugely important.
7 Not the police force.
8 But there are a couple local efforts:
9 One through Strong, where we're educating --
10 they are educating providers, family members, and
11 giving them, actually, scripts.
12 So someone, if they have -- if the education,
13 [unintelligible] education, they're carrying their
14 Narcan. They have a script that allows them
15 permission to carry that Narcan.
16 Needle-exchange programs, or Trillium's,
17 offer -- also are offering the same thing.
18 This is through the Harm Reduction Coalition.
19 So, again, prevention, treatment, harm
20 reduction, I think it's a multifaceted approach.
21 And, I thank you very much for offering us
22 this opportunity.
23 SENATOR ROBACH: Thank you, Jennifer.
24 Just, really quickly --
25 JENNIFER FARINGER: Yes.
46
1 SENATOR ROBACH: -- and I would agree that,
2 you know, I learned a long time ago, believe it or
3 not, even helping seniors with their income tax, how
4 much one doctor was -- I was more, from the medical
5 side, worried, a doctor in Florida was giving them
6 something I knew enough about to know this was
7 upping them, and a doctor in Rochester was giving
8 them something that was gonna take them down.
9 I said, "How could this be?"
10 JENNIFER FARINGER: Yes.
11 SENATOR ROBACH: And we have the turn-in
12 programs, Stem the Meds, all those, those will work
13 well.
14 Would you have any ideas, though?
15 Like, I almost think we have to go more
16 elemental root, and, like, maybe have something with
17 the Medical Society, because what you said is so
18 true.
19 Obviously, if the prescription is for a
20 smaller amount, (a) it's not gonna erroneously
21 addict the individual, which is the most important
22 thing.
23 JENNIFER FARINGER: Right, right.
24 SENATOR ROBACH: But then, secondarily, if
25 you don't have those 30 or 40, or 20, extra doses --
47
1 JENNIFER FARINGER: Floating around?
2 SENATOR ROBACH: Yes.
3 -- it eliminates the risk.
4 And, clearly, what we're hearing everywhere:
5 Nobody goes out and starts, as the
6 entry-level drug, is not heroin.
7 It's something else, working up the chain.
8 JENNIFER FARINGER: It is, it is.
9 SENATOR ROBACH: So, do you have any thoughts
10 or -- I don't know, in the field?
11 I mean, maybe there should be some merging
12 of, like, the Medical Society, with the
13 drug-prevention side, to get doctors a little bit
14 more in tune to that, in doing what they could do to
15 help?
16 I mean, we don't want them to not prescribe
17 what they need, but, clearly, that's where it comes
18 from.
19 JENNIFER FARINGER: Right, and those
20 conversations are already happening.
21 We have two physicians right here that are
22 part of Monroe County Medical Society, Addiction
23 Medicine Committee.
24 And as a prevention provider, I sit on that
25 committee as well.
48
1 But that's been a constant conversation, to
2 get it out, and how do you best get it out to the
3 broader community?
4 Those that are in attendance at the meeting
5 are full aware of the implications.
6 But, then, how do you we get it out?
7 And we're trying through a variety of
8 sources.
9 But, can we do more? Absolutely.
10 And you bring up a target population that
11 I typically include, and didn't today -- thank you,
12 Joe -- around senior citizens.
13 Because I think it's -- it's interesting:
14 Working closely with our DEA agent around,
15 how do we better get out the information about the
16 DEA Safe Take-Back days?
17 There was an attempt to, how can we connect
18 with senior facilities?
19 Because that's an issue as well.
20 You've got senior facilities, who, through a
21 variety of regulatory issues, aren't able to
22 participate.
23 So maybe lessening some of those blocks that
24 prevent those.
25 Or treatment providers that have a med cab
49
1 that's full of opiates; and, yet, there's a block
2 from connecting them.
3 So private citizens can go to the
4 Safe Take-Back days.
5 We need to eliminate -- that would be another
6 recommendation: We need to eliminate any barriers
7 that would prevent any organization, agency, with,
8 actually, bags of unused scripts, because these are
9 all potential diversions.
10 SENATOR ROBACH: Well, thank you.
11 JENNIFER FARINGER: You're welcome.
12 SENATOR BOYLE: Thank you, Jennifer.
13 We really appreciate your testimony.
14 ASSEMBLYMAN JOHNS: Thank you.
15 JENNIFER FARINGER: Thank you.
16 SENATOR BOYLE: Our next speaker will be
17 Jessica Sherman, the program director for
18 Face 2 Face.
19 SENATOR ROBACH: Good morning.
20 JESSICA SHERMAN: Good morning to all of you,
21 and thank you for organizing this forum, and for the
22 opportunity to speak.
23 I'm a licensed master social worker from
24 Kids Escaping Drugs.
25 Kids Escaping Drugs is a foundation that
50
1 focuses on community outreach, education, and early
2 intervention for youth and their families.
3 The foundation also supports, and is
4 affiliated, with Renaissance Addiction Services,
5 Incorporated, known for their Renaissance Campus,
6 long-term residential rehab in West Seneca for
7 youth, ages 12 to 20.
8 I wanted to speak to all of you today because
9 drug addiction among adolescents has become an
10 epidemic in Western New York, across our state, and
11 all over our country.
12 Addiction is attacking the average American
13 teenager.
14 Prescription medications are being passed
15 around school hallways like candy, as the profit
16 from selling these pills far exceeds any allowance
17 our kids receive.
18 Heroin, which is initially seen by teens as
19 something only used by desperate drug fiends, is
20 making its way in our communities and into our
21 homes.
22 Too many of our young people are sliding down
23 the slippery slope of addiction due to the physical
24 dependence that comes with these opiates.
25 Unfortunately, there is still a very powerful
51
1 stigma attached to the disease of addiction.
2 This stigma prevents our youth from reaching
3 out from help, and it prevents their parents from
4 being educated about the warning signs of this
5 terrible life-altering disease.
6 While treatment may be available, too many of
7 our kids do not receive the amount or the type of
8 treatment that is necessary; and, therefore, do not
9 experience the positive outcomes treatment can
10 provide.
11 Circumstantially, countless teens often wind
12 up right back on the street, sticking the needle
13 back in their arm.
14 I'd like to take the next few moments to
15 paint you a picture of how this happens.
16 The disease of addiction does not
17 discriminate.
18 Athletes, honor-role students, musicians,
19 artists, all cliques of kids, and all types of
20 families are being affected.
21 What starts out as harmless curiosity and
22 experimentation turns into a living nightmare.
23 Kids are lying and manipulating; stealing
24 medications from their sick family members; crashing
25 cars; pawning family valuables, like wedding rings;
52
1 and, oftentimes, becoming violent and aggressive
2 while under the influence.
3 Parents are at a loss as to how their
4 good-hearted innocent child has turned into someone
5 who only cares about getting the next fix and who
6 will go to any extreme to obtain it.
7 In my experience working with students from
8 all schools across Western New York, I can report to
9 you, with confidence, that there is a very strong
10 stereotype about who a drug addict is.
11 They are usually described as a man with
12 frizzy hair, and yellow teeth, in a flannel shirt,
13 with a paper bag in his hand, and he usually lives
14 under a bridge.
15 Society is still teaching teenagers that
16 addiction could not possibly happen to them because
17 they don't fit this stereotype.
18 Our kids also have no fear about taking
19 prescription medications.
20 The media and society is constantly
21 bombarding them with messages to take this pill or
22 that pill for whatever may trouble them.
23 Too many teenagers are under the false
24 impression that these pills are safer than street
25 drugs because they come from our doctors.
53
1 The message society isn't delivering is that
2 these medicines will destroy their lives and may
3 kill them.
4 90 percent of adolescents who receive
5 treatment on the Renaissance Campus enter addicted
6 to prescription medications.
7 Our young people are starting out with pain
8 killers, like hydrocodone and Loratab [sic]; pills
9 they can buy from their peers with their lunch
10 money.
11 Very quickly, they become tolerant to these
12 medications, and may need as many as 15 at a time to
13 achieve the high they are seeking.
14 Before too long, many kids progress into
15 stronger pain pills, like Opana and fentanyl.
16 However, these pain killers are much more expensive,
17 and due to the passing of I-STOP, the supply has
18 been limited on the street.
19 Many teens will need to spend hundreds of
20 dollars a day to maintain their physical tolerance
21 to these pills and to prevent opiate withdrawal.
22 This is when heroin comes into the picture
23 for most of them.
24 This is evidenced by the fact that 70 percent
25 of the patients who receive treatment on the
54
1 Renaissance Campus are addicted to heroin at the
2 time of their admission.
3 I don't know about you, but this percentage
4 disturbs me greatly.
5 Due to the availability of heroin in a powder
6 form, many desperate kids will begin purchasing
7 $10 bags they can snort, the same way they're used
8 to snorting the pills.
9 All of them swear they will never stick a
10 needle in their arm; however, most times, in a
11 matter of months, or even weeks, this is exactly
12 what they are doing.
13 Our teens are full-blown heroin addicts, but
14 they don't see it as a problem because they still
15 don't fit that stereotype that they've been taught.
16 Most young people get so desperate in their
17 addiction that they will go to any length to get
18 high.
19 Almost all of them begin selling drugs,
20 stealing and robbing, to support their habit.
21 Inevitably, a high percentage of these kids
22 end up interfacing with the legal system, and many
23 are placed in drug-treatment courts.
24 90 percent of teens who receive treatment on
25 the Renaissance Campus are Court-mandated to be
55
1 there.
2 Unfortunately, in too many instances, legal
3 trouble is the first time the parents have the
4 opportunity to realize just how involved in drugs
5 their children are.
6 It is extremely important to educate parents
7 and family members about addiction.
8 When parents have the opportunity to learn
9 about the struggle their child is going through,
10 they are much more likely to support them in their
11 recovery and to not enable them to relapse.
12 Many of the parents we work with on
13 Renaissance Campus have no idea about the dangerous
14 situations their children have been in, nor do they
15 understand the desperation their children experience
16 to remain under the influence and avoid withdrawal.
17 By educating parents and families about these
18 struggles, we empower them to understand why their
19 child's behavior has changed so drastically, and we
20 teach them how they can support their children in
21 healthy ways.
22 When adolescents are mandated into rehab, it
23 provides addiction professionals the opportunity to
24 implement the intense counseling that we know is
25 necessary, but, oftentimes, that children and their
56
1 parents are not ready to accept.
2 When young people are addicted to drugs as
3 strong as opiates, it is extremely imperative that
4 they receive long-term residential treatment.
5 Many teens who succeed at the
6 Renaissance Campus state that it took them several
7 months just to feel normal and for the drugs to get
8 out of their system.
9 The strong denial that comes with addiction
10 is especially evident with teenagers, as they have
11 not faced as many severe consequences as adult
12 addicts.
13 Once their mind is clear, we are able to
14 address the denial, and empower the teens to accept
15 their addiction and begin to work towards recovery.
16 There is also a strong social influence
17 present with teens who use.
18 Many of them are very attached to the people
19 they purchase from and the people they use with.
20 For these reasons, a 28-day program is not,
21 and will never be, an effective form of treatment
22 for an adolescent who is addicted to such powerful
23 substances. It is not enough time away from the
24 influences or the drug.
25 We are doing our kids a disservice by
57
1 treating them the same way adult addicts are
2 treated.
3 Teenage addicts do not experience the same
4 symptoms as an adult, but we treat them like they
5 do.
6 As long as we continue to treat our addicted
7 kids this way, we will continue to see a high rate
8 of relapse, and, inevitably, countless teenagers
9 will continue to die as a result of accidental
10 overdose.
11 If we want to give our youth any chance of
12 remaining clean, sober, and healthy, we need to give
13 them the opportunity to pursue long-term, intensive
14 residential treatment, and we need to work closely
15 with their families.
16 What I ask of you today, is to support
17 prevention and education for our youth about how
18 dangerous prescription drugs can be.
19 We need to make sure that our kids understand
20 the strong correlation that exists between opiate
21 pain killers and heroin.
22 I also ask your help for our teens who are
23 already in the depths of addiction.
24 Please support long-term residential
25 treatment for adolescents, and encourage your
58
1 colleagues to do the same.
2 Please help us advocate for these services so
3 we can give these kids a second chance at life, as
4 they are our future.
5 Thank you.
6 [Applause.]
7 SENATOR ROBACH: Thank you.
8 ASSEMBLYMAN JOHNS: Jessica, let me just ask
9 you one question:
10 As some of the previous speakers have said,
11 are you finding that there's a problem with
12 insurance companies paying for --
13 JENNIFER FARINGER: Absolutely.
14 With the treatment that we provide on the
15 Renaissance Campus, some insurance companies are
16 only providing three days of coverage. And then
17 it's up to the family to try and come up with the
18 means to do what they have to do to keep their kid
19 in treatment. And, oftentimes, they may not be able
20 to.
21 We see a tremendous problem with that.
22 SENATOR BOYLE: What is the cost for what you
23 consider adequate stay, would you say?
24 JESSICA SHERMAN: Treatment on our campus can
25 cost a family as little as $11 a day.
59
1 It's on a sliding scale. It varies, based on
2 a family's income, but we can treat kids for as
3 little as $11 a day.
4 Medicaid also covers treatment for our youth
5 if they qualify for that.
6 SENATOR ROBACH: Thank you.
7 SENATOR BOYLE: Thank you, Jessica.
8 Actually, as Chairman of, not only the
9 Task Force, but the Senate Committee on Alcoholism
10 and Drug Use, I'd like to come and visit the campus,
11 if I could --
12 JESSICA SHERMAN: Please do. We would be
13 thrilled to have you.
14 SENATOR BOYLE: Thank you very much.
15 JESSICA SHERMAN: Thank you.
16 SENATOR ROBACH: Thank you.
17 ASSEMBLYMAN JOHNS: Okay, now we'd like to
18 welcome up our Monroe County Undersheriff,
19 William Sanborn.
20 Come on up.
21 UNDERSHERIFF WILLIAM SANBORN: Good morning,
22 and thank you for the opportunity to represent
23 Sheriff O'Flynn at this very important discussion.
24 Monroe County, New York, has been seeing an
25 increase in both heroin sales and use.
60
1 In the area of illegal drug sale and use,
2 historically, Rochester has recognized cocaine as
3 the leading problem drug; however, the availability
4 of heroin at a cheap price is steadily increasing
5 its use.
6 It is believed that a large portion of the
7 heroin users today began with their use of
8 prescription opiate drugs, the most common being
9 Percocet and Oxycontin.
10 Percocet contains about 5 milligrams of the
11 drug oxycodone, and is designed to be a
12 quick-release pain reliever that lasts about
13 5 hours.
14 Oxycontin contains between 2 to 16 times more
15 oxycodone than Percocet. It is designed to be a
16 slow-release pain-relieving pill, but if you crush
17 the pill, the effects are almost instantaneous.
18 Opiates have addictive properties.
19 Although opiates are designed to be pain
20 relievers, they also have a psychological and
21 physiological effect of making you feel good,
22 bringing a sense of euphoria no matter how bad
23 things really are.
24 For some, this is the reason why they
25 initially start abusing the medication, but they
61
1 continue its use because their bodies begin to feel
2 that they need the drug to keep them from feeling
3 horrible.
4 The body begins to adapt to the drugs and
5 completely upsets the body's natural hormones, such
6 as serotonin.
7 The abuser needs to take more of the opiate
8 to feel normal, and when they aren't high, they do
9 not feel well.
10 That being known, the reason that some may
11 switch from prescription opiates to heroin might
12 really come down to availability and price.
13 The Drug Enforcement Administration has
14 stepped up their enforcement efforts by cracking
15 down on prescription-drug crimes.
16 Additionally, efforts have been made to
17 reduce Oxycontin abuse by adding an ingredient to
18 the pill which makes it very difficult to crush into
19 a powder, which is the preferred method of ingestion
20 because it produces the quicker high.
21 I'm told that the patent on that substance
22 will soon expire and the FDA has to make a
23 determination whether they are going to require all
24 manufacturers of opiate pills to use that
25 ingredient.
62
1 An issue with imposing this requirement is
2 that it adds significant cost to the drugs.
3 In our area today, the average 20-milligram
4 Oxycontin pill sold on the street is usually going
5 between 30 and 50 dollars. Compare this cost to
6 that of a deck of heroin which costs about $10.
7 For a bundle of heroin, which is 10 decks,
8 the cost found locally range from 50 to 80 dollars.
9 We are seeing more and more young adults
10 turning to heroin as a cheap and more readily
11 accessible alternative to the more costly and
12 difficult-to-obtain prescription opiate.
13 Fentanyl is one of the most powerful
14 prescription opioids. It is designed to be a
15 slow-release pain killer, and is usually prescribed
16 to cancer patients.
17 It typically comes in a patch form, but if
18 you cut the patches, there's a powder inside.
19 The drug dealers can add fentanyl to the
20 heroin as a booster and to make it more powerful.
21 The goal of any drug dealer is to make you a
22 long-term customer.
23 Once they have you, they can quickly increase
24 prices for it, knowing that will you need the drug.
25 Known as "speedballing," heroin can also be
63
1 combined with cocaine.
2 Of course, none of these drug dealers are
3 licensed pharmacists so you never really know what
4 exactly you're getting.
5 That presents a great danger to the user.
6 The Drug Task Force, in which the
7 Sheriff's Office participates, reported that 2013
8 yielded almost 2 1/2 times more seized or
9 confiscated heroin than the year before.
10 According to our Director of Alcohol and
11 Chemical Dependency for the Monroe County Sheriff's
12 Office, Craig Johnson, we have seen a quadrupling of
13 heroin addiction in the inmate population over the
14 last two or three years.
15 The Monroe County Jail has observed a large
16 number of opiate and heroin addicts enter our
17 custody.
18 In 2013, there were 634 self-reported opiate
19 addicts.
20 The below statistics were obtained when the
21 inmates, at the time of their booking, came into the
22 jail and made a self-report of opiate use on the
23 streets.
24 These individuals who reported their
25 addiction are placed on withdrawal protocols while
64
1 in our custody.
2 In 2013, there were 634 individuals that came
3 into our jail custody who reported their addiction.
4 For the first quarter of this year, we have
5 168 persons who entered the jail and reported their
6 addiction.
7 In March alone, there were 71.
8 These are only the people that are
9 self-reporting. This isn't the total number.
10 An overwhelming percentage of property crimes
11 are directly related to drug addiction. This
12 includes heroin.
13 A recent police shooting involving one of our
14 deputies is just one tragic example of the effects
15 of heroin.
16 The suspect, being a heroin user, is now
17 facing charges for having stolen a car, robbing a
18 bank, stealing from Wegman's Supermarket, attempting
19 a carjacking, and pulling out a gun and threatening
20 the deputy, before he was shot.
21 Fortunately, he lived, and is presently in
22 the custody of the jail, while the police officer
23 and no one else in the community were physically
24 injured.
25 According to the Centers for Disease Control
65
1 and Prevention, drug overdoses are now the leading
2 cause of accidental death.
3 Statistics recently released by the
4 Monroe County Medical Examiner reports 65 regional
5 heroin deaths in 2013, 29 deaths in 2012, and
6 11 deaths in 2011; a significant increase year to
7 year.
8 We are currently seeking grant funding for
9 Narcan -- or Naloxone -- a drug that reverses an
10 opiate overdose instantly.
11 The Quincy Police Department, a Boston
12 suburb, have been using Narcan since 2010. Officers
13 have administered the drug 221 times, and reversed
14 211 overdoses.
15 Ocean County, New Jersey, has begun training
16 police officers in all 31 local police departments
17 to use those drugs, since overdose deaths doubled,
18 from 53 in 2012, to 112 in 2013.
19 Ambulance and EMS providers actively utilize
20 this drug in our community.
21 We have it also with our nurse and
22 medical care in the Monroe County Jail.
23 Going forward, we must identify current and
24 emerging trends relative to opiates and heroin.
25 Law enforcement must have shared
66
1 communication, and work together with the
2 Public Health Department, the Medical Examiner's
3 Office, non-profit organizations that deal with
4 matters of drug addiction and rehabilitation,
5 schools, our law-enforcement partners, the
6 District Attorney's Office, and the courts.
7 We must promote public awareness and
8 education to combat this threat to which, at a great
9 expense, compromises our health, our safety, our
10 wellbeing, and our quality of life for everyone in
11 our community.
12 Thank you.
13 [Applause.]
14 SENATOR ROBACH: Thanks, Bill.
15 SENATOR BOYLE: Thank you.
16 Thank you, Bill.
17 And your statistics are truly mind-boggling.
18 And I can tell you that, it gets to -- the
19 former hearing we had on Long Island, there's a lot
20 of taxpayer money being used to jail, and give
21 services in the jails to drug addicts, purely are
22 there for the reasons of being an addict, and them
23 needing the money for that.
24 We actually had a treatment provider,
25 probably the preeminent one on Long Island, give
67
1 testimony last week, that when parents come to him,
2 desperate, because their children are addicts and
3 they're going to crime to do it, they actually give
4 advice on how to get the child arrested, because the
5 treatment they're gonna get is going to be in
6 prison.
7 The insurance companies are not covering
8 them. They're not giving the treatment services
9 they need.
10 So they're saying: Listen, make sure -- this
11 is the way you get your child arrested, but make
12 sure he or she doesn't have a lot of drug on them so
13 they don't go to prison for a long time; just long
14 enough to get treatment.
15 And that's a sad state of affairs here in
16 New York, and we need to change that.
17 Thank you, Bill.
18 ASSEMBLYMAN JOHNS: Thank you, Bill.
19 UNDERSHERIFF WILLIAM SANBORN: Thank you.
20 SENATOR ROBACH: Thanks, Bill.
21 Our next testimony will be Lori, who will be
22 sharing a personal story.
23 LORI DRESHER: Thank you.
24 Thank you Senators and Assemblyman, and all
25 of you in the back for being here today.
68
1 I apologize for my back being to you.
2 Kind of rude.
3 SENATOR ROBACH: It's either them or us.
4 [Laughter.]
5 LORI DRESHER: So -- can you hear me back
6 there okay?
7 I believe I'm here today to actually be the
8 voice of many parents who aren't able to find their
9 own voices, either because they're too bereft, too
10 overwhelmed, or too depleted to stand here today.
11 My son is 23 years old. His story, while
12 gut-wrenching to our family, is not unusual, sadly.
13 And just to dispel the myth that heroin and
14 opioid addiction is a ghetto problem, I am a White,
15 college-educated, middle-income taxpayer.
16 I raised my kids in Penfield, New York.
17 I'm a self-employed organization development
18 and business consultant.
19 And my former husband of 22 years, and father
20 my children, has been employed by Xerox for the past
21 35 years.
22 Our son started using opiates in high school,
23 like so many other kids.
24 I quote him, "It was so easy. So many
25 parents had these drugs in their medicine cabinets.
69
1 You could use them in school, and they didn't make
2 your breath smell or your eyes red."
3 And then towards his senior year in 2008,
4 access started to dry up. Pills became harder to
5 get, and more and more expensive.
6 It was then that my son was introduced to
7 heroin. It was cheap, and readily available, as
8 you've heard here already on a number of occasions.
9 Once he tried smack, he never really went
10 back to pills.
11 Over the course of the past six years:
12 My son was arrested three times, maybe by
13 someone in this room, who knows.
14 Has been on probation, and gone through
15 intense outpatient rehab twice.
16 He's completed a 30-day inpatient rehab in
17 July of 2012, because, according to the insurance
18 companies, you must fail numerous times before they
19 will allow you into an inpatient-care facility. And
20 even then, they will dole out your time at a few
21 days at a time.
22 He relapsed two months later. Stayed clean
23 then for 14 months. Relapsed again this past
24 November. Detoxed twice. And issued a suicide note
25 to his family on April 3rd, less than two weeks ago.
70
1 We have spent countless thousands of dollars
2 on lawyers, doctors, health insurance, outpatient
3 and inpatient programs. And possibly the most
4 humbling of all, and humiliating of all, pawn shops.
5 After my son's suicide threat, we detoxed him
6 at home because no detox facility in the surrounding
7 area would take him.
8 Apparently, it is rare to die from a heroin
9 detox, and they reserve these beds for alcohol and
10 crack addicts instead.
11 His physician called us with a lengthy set of
12 instructions for drugs and doses, and explained the
13 hell that my son would experience over the next
14 three to five days.
15 I recall thinking, I wonder if immediately
16 after my recent heart surgery, my doctor would have
17 sent me home with a pocket full of pills and said:
18 Good luck. Sorry, we don't have a facility
19 to help provide aftercare in a hospital environment
20 where you'll be safe. You may die, but chances are
21 you'll survive. And try the Internet for aftercare.
22 A week ago tomorrow, my ex-husband drove my
23 son to Pennsylvania for extended rehab.
24 They explained the cost for the first 30 days
25 would be $38,000, payable in advance.
71
1 The aftercare would cost twenty to
2 fifty-four thousand dollars, and they would make
3 their recommendation in three weeks.
4 They explained that they would submit a claim
5 to our insurance company, but there were no
6 guarantees.
7 The best we could hope, was that one-half of
8 the first 30 days would be reimbursed.
9 We once again drained bank accounts and
10 retirement accounts, because there is no limit
11 beyond which you would not go to help your kid get
12 better.
13 We sent our son away as though he were going
14 to summer camp, with a bag and toiletries, and a
15 letter from me, stating: That things would have to
16 be different this time. This time there would be no
17 bailout. This time his option, should he choose the
18 wrong path, is Medicaid and The Salvation Army.
19 And even as I wrote the words, I knew my
20 resolve would dwindle if there were a next time.
21 I came here today, not to tell yet another
22 tragic story of an addict and his family's pain to
23 find peace, but to share with you my belief, and
24 that of my son's, the key priorities for preventing
25 and treating this national, state, and
72
1 community-wide epidemic that is destroying and
2 claiming the lives of our young and their families.
3 On my son's drive to Pennsylvania last week,
4 I called him on his dad's cell phone, and in a
5 sense, interviewed him for this talk.
6 I asked him to share his unique and highly
7 informed perspective, as an addict.
8 The following four points are our combined
9 ideas:
10 Number one: Create broad and free access to
11 addiction prevention and treatment services.
12 This illness of addiction is not afforded the
13 same access and ongoing care of almost all other
14 chronic illnesses.
15 There is also so little funding,
16 comparatively, for research into recognizing,
17 treating, and preventing these conditions.
18 Limits are placed on doctors, and filters,
19 like "medical necessity," are applied so much more
20 stringently.
21 If we treated more and had fewer
22 incarcerations, we would save our community a lot of
23 time, and, importantly, a lot of lives.
24 Number two: Apply a dual-focused approach to
25 addiction and mental-health issues.
73
1 According to my son, every addict he knows
2 suffers from other mental-health afflictions,
3 primarily depression and anxiety.
4 My son's primary physician medically treated
5 him for these conditions.
6 As of last week, he was prescribed Zoloft,
7 clonidine, hydroxyzine, Neurontin, and Zofran, and
8 in addition to Suboxone and Subutex, but no
9 mental-health counseling or cognitive therapy were
10 offered.
11 Number three: Stop incarcerating, and start
12 treating the illness of addiction with funding,
13 research, treatment, and compassion.
14 There is so much judgment and stigma around
15 opioid and heroin use in our community, it is no
16 wonder our criminal justice system follows suit.
17 We incarcerate addicts to remove the scourge
18 from our streets to prevent them from infecting our
19 young.
20 They are our young, and they're sick.
21 The prevailing perception that addicts get
22 high because they enjoy the euphoria of drug is a
23 myth.
24 Addicts primarily use heroin in order not to
25 get sick from withdrawal; and, yet, we put them in
74
1 jail where they're unlikely to receive proper
2 medical treatment.
3 We need to treat addiction as a disease and
4 go after its cure as aggressively as we do cancer,
5 heart disease, and AIDS.
6 We successfully overcame our funding
7 preventive stigma of AIDS.
8 We should be able to do the same thing to
9 save our children.
10 According to my son, one of the most
11 successful interventions available is drug court,
12 where non-violent offenders are successfully treated
13 and reformed through drug court right here in our
14 own Monroe County.
15 Rather than judgment-based incarceration,
16 offenders sustain a year-long program of treatment,
17 and are held accountable to their own reform.
18 Many go on to be productive members of
19 society.
20 Unfortunately, there are currently less than
21 2500 drug courts operating in the United States
22 today.
23 Imagine the price to society and communities
24 where the only treatment option is incarceration.
25 And, number four: Block the sophisticated
75
1 street system that supports drug addiction.
2 There is an incredibly strong street system
3 and infrastructure to support opioid and heroin
4 addiction.
5 If there were only such a strong system to
6 support their treatment.
7 And as much as we want to point the finger at
8 drug dealers, many of them are our children simply
9 being resourceful in their need to survive.
10 This system --
11 (A This system includes social media.
12 A simple Facebook request can garner private
13 messages, locating sources for any street
14 prescription drug available.
15 And I learned this firsthand by going into my
16 own son's Facebook account.
17 My son's Facebook account and text messages
18 read like the who's who of an underground drug
19 cartel.
20 (B) This system includes well-meaning, as
21 well as conscience-avoidant physicians, dispensing
22 Suboxone and Subutex to recovering addicts, often
23 well beyond the optimum period of detoxification and
24 stability.
25 My son was on and off Suboxone for the
76
1 two years since his inpatient rehabilitation, with
2 no plan to get him off.
3 Instead of insisting on drug testing before
4 dispensing the drug on a monthly basis, which
5 creates a revolving door of dependent patients, my
6 son's doctor would simply write the prescription.
7 And I mean no disrespect to the doctors who
8 are here with us today, because a number of them are
9 doing a tremendous amount of good, trying to help
10 our addictive children.
11 Addiction specialists are well aware of the
12 street value of Suboxone to addicts. It is the only
13 way they can possibly detox from the drug, and most
14 have no way of obtaining it legally.
15 My son and other friends took advantage of
16 this, and used their Suboxone scripts as street
17 currency to afford their heroin.
18 And, again, I'd like to note that Suboxone is
19 highly effective in treating heroin addiction.
20 Unfortunately, the manufacturer of Suboxone
21 has made it cost-prohibitive recently for addicts to
22 afford it. 300 to 500 dollars a month; thus, the
23 high street value.
24 And, (C) Pawn shops, and even reputable
25 jewelry stores, know an addict when they see one.
77
1 They happily turn a blind eye, knowing these
2 items were likely stolen from family members and
3 friends, as they predict the profits they will rake
4 in from their sales.
5 Addicts are welcomed into their shops, and
6 either given cash for the value of the gold or
7 silver when melted, or given a fraction of the cash
8 value of the items being pawned.
9 Again, I learned this firsthand when I went
10 to try to recover some of my stolen goods.
11 In theory: If the seller comes back to claim
12 the pawn, they are charged an excessive fee, and the
13 item is returned.
14 But as we all know, more often than not, the
15 addict never returns for the item, and it is sold in
16 an extraordinarily profitable return.
17 In the past two years, my son has sold all of
18 my valuable jewelry, a large-screen TV, a laptop
19 computer, two electric guitars, and untold other
20 valuables.
21 In conclusion: I am cautiously optimistic
22 that this epidemic of heroin and opioid addiction is
23 finally gaining the attention of our legislators and
24 community leaders.
25 We must start with this important dialogue.
78
1 And I commend our leaders for initiating this
2 in the state of New York, where New York City alone
3 saw an 84 percent rise in fatal overdoses between
4 2010 and 2012.
5 The dialogue must quickly be followed by
6 radical action, and I will help in any way that
7 I can: my son's life is on the line.
8 Thank you.
9 [Applause.]
10 SENATOR ROBACH: Thank you.
11 SENATOR BOYLE: Thank you.
12 SENATOR BOYLE: Our next speaker will be
13 James Wesley, Drug Chemistry Supervisor for the
14 Monroe County Crime Lab.
15 JAMES WESLEY: Good morning, Senator Boyle,
16 Senator Robach, and Assemblyman Johns, and thanks
17 for the opportunity to speak today.
18 I've been working, identifying drugs, since
19 1976, first in the clinical lab intox; and then,
20 beginning in 1993, in the crime laboratory.
21 So let's start with narcotic prescriptions,
22 because that's kind of where this all started.
23 Beginning in the late 1990s, there was a
24 large increase in the use and abuse of narcotic pain
25 relievers throughout the United States.
79
1 There's a chart that I've included. It's
2 The National Forensic Lab's statistics, where we've
3 tracked this, and it documents the increase.
4 The potency of these pain relievers also
5 increased.
6 In the '90s -- in the early '90s, all there
7 was was a 5-milligram Percocet. But with the
8 introduce of Oxycontin in 1996, that ramped up to
9 10, 20, 40, and 80 milligrams; essentially, almost a
10 sixteenfold increase in the potency.
11 On this 12-year ramp up, of note is the
12 substantial increase in oxycodone, hydrocodone, and,
13 alprazolam, something that we don't talk about much,
14 but it's followed these two opiates up in a very,
15 very high increase.
16 And, also, the recent mention of the
17 buprenorphine, which is, Suboxone is up 700 percent
18 in terms of misuse, which, that's really phenomenal.
19 During that time, narcotic-pill submissions
20 to crime labs, as a proportion of all drug
21 submissions, and what I refer to as the "big four"
22 across the United States -- cannabis, cocaine,
23 heroin, and meth -- were 95 to 99 percent of
24 everything they got in.
25 But during that time frame of 2000 to 2012,
80
1 these drugs increased, from 1.3, to 8.3 percent, of
2 all drugs coming into the crime labs.
3 There was also a substantial increase in,
4 which we don't talk about much, but, hydromorphone,
5 which is Dilaudid, methadone, and, again, the
6 buprenorphine.
7 However, the absolute numbers are not as
8 extreme as the absolute numbers of hydrocodone,
9 oxycodone, and alprazolam.
10 So now to heroin:
11 After a slight decrease in 2011, heroin began
12 a dramatic increase in 2012, and continued through
13 2013.
14 If you review the Monroe County Crime Lab
15 heroin statistics, which I've provided, there's an
16 800 percent increase in the number of decks
17 submitted to the lab in that two-year period.
18 The average number of heroin items submitted
19 per case also dramatically increased.
20 So, for instance, a typical bust in 2011
21 would have 16 decks. Now it has 49.
22 The biggest case submitted in 2011 was
23 126 decks.
24 In 2013, we had a case with 1500 decks of
25 heroin.
81
1 And the composition also changed.
2 Before 2011, it was very unusual to see
3 anything in the heroin other than the heroin.
4 They would cut it with mannitol and some
5 other things, but it didn't have any properties.
6 A review of the cases from the second half of
7 2013 indicates that 64 percent of the items contain
8 heroin plus another drug.
9 And what are these other drugs?
10 The biggest ones are caffeine and procaine.
11 And people might think: What's that, that's
12 nothing. Caffeine's coffee, and procaine has no
13 effects.
14 Procaine actually is a stimulant in the body
15 and acts a lot like cocaine. So when you have
16 procaine in with the heroin, you have a manufactured
17 speedball, and now you have additional effects on
18 the heart in addition to the effects on the
19 breathing.
20 Other more dangerous drugs, such as xylazine,
21 which is a horse tranquilizer, fentanyl, have been
22 identified in the submissions, but a deck of heroin
23 doesn't have to have these to be toxic or fatal.
24 We talk a lot about potency, and we talk a
25 lot about it, is it more concentrated?
82
1 I don't -- we don't have a concentration
2 data.
3 The typical heroin in Rochester used to be
4 about 50 percent. And, I don't have potency data
5 because we don't quantitate heroin anymore.
6 But let's assume it's 50 percent, and that
7 isn't changing.
8 What's changing is the amount in the bags.
9 In a typical submission; in other words,
10 30 bags in the dealer's pocket, that heroin could
11 range from 50 to 70 milligrams.
12 So just depending on what he pulls out, you
13 could have four times the amount, or half the
14 amount, just what he pulls out of his pocket.
15 And if you're cooking up five bags at a time,
16 look at the range in which you might be sticking in
17 your arm.
18 So, that's really phenomenal.
19 In my opinion -- and I've got one more thing
20 to talk about -- but in my opinion, for millions of
21 Americans, narcotic prescriptions, and now heroin,
22 have become a daily solution to dealing with stress
23 and anxiety.
24 I know it's hard to believe that, but I think
25 that's how it has been used; and that's both
83
1 dangerous and sad.
2 The other thing, the other chart, was people
3 have said: What's this accessibility? I don't
4 understand, what's changed?
5 Ten years ago we would see heroin, from being
6 distributed only in a small part of the community,
7 and you would go just there to get heroin.
8 And I just pulled some cases, just to look as
9 an example.
10 In 2000, of 20 cases that I pulled: Fifteen
11 were just heroin; in other words, the busts only had
12 heroin in them. And five had heroin plus either a
13 little bit of marijuana or a little bit of cocaine.
14 In 2013 -- I call this the "case mix" - I
15 also pulled 20 cases. Only 10 cases had just
16 heroin. But believe it or not, the biggest one was
17 1291 decks, versus 40 decks in 2000.
18 But more cases have additional drugs in them;
19 meaning, they have coke, they have marijuana, they
20 have heroin, they have pills.
21 So it's almost a one-stop shop now. If you
22 go to someone that used to only have weed, now they
23 also have pills, heroin, and coke.
24 So the availability, as I see it, is more
25 dealers dealing with a polydrug availability, and
84
1 then making it easier for that to spread.
2 And, pretty much, that's it.
3 Thank you.
4 SENATOR BOYLE: Yeah, just quick:
5 Thank you so much for your testimony. It's
6 very enlightening.
7 What was said earlier about trying to find
8 out the source of where this heroin is coming from,
9 and, not being a chemist by any stretch of the
10 imagination, is it possible to find out, do you
11 think, like, what region or what country, based on,
12 I don't know if it's got, not DNA, but, I mean, it's
13 some other specifics of that heroin, where it's
14 coming from?
15 JAMES WESLEY: The DEA used to have a source
16 program, that they did that on special testing.
17 And there's kind of a move to, maybe,
18 revitalize it.
19 SENATOR BOYLE: Yeah, yeah.
20 JAMES WESLEY: So what it would mean is, the
21 labs, and we've got an intern from Roberts Wesleyan
22 now, who's actually pulling out a really good bunch
23 of statistical data.
24 So by the summer, we're gonna have a lot more
25 data on the nuances of this whole heroin.
85
1 But, yeah, you would need to actually look at
2 the data, and not just what's in the reports, which
3 is the heroin.
4 You have to drill down to the mass-spec data
5 and see: What are the relative peeks? Which one
6 has the dipyrone? Which one has this? and almost
7 come up with a little profile of what's down low.
8 With those profiles, you might be able to
9 source it back, but that's gonna need a little --
10 probably a little bit funding, because the labs
11 are -- I mean, they're overworked, and they're
12 getting cases out.
13 We're gonna have to revisit the cases, and
14 look down low and see if we can make comparisons,
15 but I think it's possible.
16 SENATOR BOYLE: Thank you.
17 SENATOR ROBACH: Thanks, Jim.
18 [Applause.]
19 SENATOR ROBACH: Our next testimony will be
20 provided by Dr. Jeremy Cushman, who is the
21 EMS Medical Director at the University of Rochester.
22 DR. JEREMY T. CUSHMAN: Gentlemen, thank you.
23 I appreciate the opportunity to share with
24 you my experience with our current epidemic of
25 opiate use, and my role as EMS Medical Director for
86
1 Monroe County and the City of Rochester, as well as
2 an emergency physician at the University of
3 Rochester.
4 Although I certainly support the efforts of
5 my colleagues in treating and preventing opiate
6 overdose, my testimony this morning is gonna center
7 specifically on the role of first responders in
8 providing the reversal agent, Naloxone, as you
9 mentioned earlier, Senator, to individuals that have
10 sustained an overdose; an important action that the
11 Senate may wish to consider to help us battle this
12 public health crisis.
13 As you are likely aware, opioids are an
14 important tool in managing pain, whether it's part
15 of care for a broken ankle or contributing to a
16 patient's postsurgical recovery.
17 However, when opiates are taken in
18 super-therapeutic doses, whether pharmaceutical or
19 heroin, prescribed or illicit, these medications can
20 cause respiratory depression.
21 Slowing of the respiratory rate can progress
22 to apnea -- or the absence of breathing -- and this
23 is the primary cause of death in opiate overdoses.
24 Importantly, there is a very narrow window
25 between respiratory depression and irreversible
87
1 death as a result of an opiate overdose.
2 This is where the medication called
3 "Naloxone," otherwise known as "Narcan," comes into
4 play.
5 By pharmacologically blocking the opiate, it
6 rapidly reverses the respiratory depression that's
7 caused by an opiate overdose.
8 Now, the advantage of Naloxone is that it
9 will not harm the patient, even if the cause of the
10 respiratory depression or absence of breathing is
11 not due to an opiate, as is often the case for
12 someone using other drugs of abuse, or after a
13 trauma or a medical emergency.
14 Further, Naloxone can be administrated by
15 attaching a small device to the medication syringe,
16 allowing the medication to be sprayed up the nose.
17 Just as effective as delivered through a
18 needle, this dramatically decreases the risk to any
19 type of user or responder.
20 Although it is important that we be cautious
21 to not interpret that every overdose -- every opiate
22 death is reversible, there is no doubt that Naloxone
23 can reverse many opiate overdoses.
24 The culture of heroin and prescription-drug
25 use is different in different communities, and so
88
1 the recognition of an opiate overdose is critical in
2 order to provide that lifesaving care.
3 In many communities, the use of prescription
4 opiates or heroin is done in seclusion, and so the
5 patient may not be recognized to have overdosed
6 until 15 minutes, or 15 hours, after the overdose,
7 in which case no amount of Naloxone is, quite
8 frankly, going to make a difference and reverse
9 their death.
10 In other circumstance, groups of individuals
11 who use or abuse opiates, and an overdose will be
12 rapidly identified and emergency assistance is
13 summoned.
14 This is where we have the greatest potential
15 for Naloxone being a successful intervention.
16 Along with my colleagues at the
17 Albany Medical Center, and in Suffolk County, the
18 Rochester Fire Department, under my supervision,
19 began participation in the pilot project nearly
20 two years ago, which demonstrated to the
21 Department of Health that emergency medical
22 technicians can safely identify patients with an
23 opiate overdose and successfully administer Naloxone
24 as a nasal spray.
25 To date, we have had 112 uses, of which 101
89
1 were successfully reversed.
2 Eleven, unfortunately, died, often, but not
3 exclusively, as a result of complications from
4 opiate use.
5 This data was integral to providing the
6 evidence to then-State Department of Health
7 Commissioner Shaw, to add this medication to the
8 scope of practice of all certified EMS responders in
9 the state.
10 Fast-forward a few months: We now have seen
11 the State's Attorney General and the
12 Executive Deputy for the Division of Criminal
13 Justice Services announce important programs
14 designed to get Naloxone into the hands of the
15 law-enforcement officers, who, in many
16 jurisdictions, are the first responders on scene, to
17 render this potentially lifesaving medication.
18 These represent further extensions of our
19 pilot program, given the successful demonstration by
20 law-enforcement officers, particularly in Rensselaer
21 and Suffolk counties.
22 To date, we have had a number of different
23 and disparate programs aimed at the same goal, which
24 is, essentially, to get Naloxone into the hands of
25 first responders.
90
1 I would offer, that the Senate Task Force on
2 Heroin and Opioid Addiction has a unique opportunity
3 to codify its support for Naloxone programs, and do
4 so in a medically responsible way, through
5 legislation modeled after the Public Access
6 Defibrillation and Epinephrine Auto-Injector
7 statutes.
8 So to take a step back:
9 About 20 years ago, automated external
10 defibrillators became widespread in our communities;
11 and to this date, along with CPR, are the two single
12 most important predictors of someone surviving a
13 cardiac-arrest event.
14 And just like Naloxone, these devices save
15 lives every single day.
16 Now, the wisdom of the Legislature at that
17 time, was to codify a process by which AEDs could
18 become pervasive in our community, while not
19 restricting their use to a particular responder.
20 Furthermore, the program retains the
21 importance of physician oversight for the
22 AED program, to assure that the medical standards
23 are being met, despite those standards changing
24 significantly over the last 20 years, and to assure
25 the quality assurance of individual utilizations.
91
1 After all, we want to be sure that every
2 medical intervention, whether it's defibrillating or
3 administrating Naloxone, is being done properly, and
4 with appropriate training, oversight, and tracking
5 to fully measure the impact on the community's
6 public health.
7 Anecdotally, as the Medical Director for
8 Monroe County, I am the physician responsible for
9 over 1400 AEDs in this county alone. And, by
10 requirement, and statute, review every one of those
11 uses, to make sure that it was appropriate. And in
12 some cases, we find errors that allow us to improve
13 the system in which we provide care.
14 Now, Article 30 of Public Health Law;
15 specifically, Section 3000-B, outlines the use of
16 AEDs, much like Section 3000-C outlines the use of
17 epinephrine auto-injectors.
18 I would encourage the Senate to consider
19 legislation modeled after these two existing
20 statutes for the use of Naloxone, and have taken the
21 liberty of providing sample legislation in my
22 written testimony that is modeled after that exact
23 existing statute.
24 Now, this would accomplish a number of goals:
25 Number one: It would increase the
92
1 availability of Naloxone to first responders of all
2 backgrounds -- fire, EMS, law enforcement -- as it
3 does for AED and epinephrine auto-injector programs.
4 Number two: It would increase the
5 availability of Naloxone to other responders with
6 unique opportunities to intervene.
7 This could include things like,
8 college-campus security, probation officers, jails,
9 courts, schools, other public interests, and
10 individuals.
11 Number three: It would assure the proper
12 training and recognition of opiate overdoses is
13 received prior to carrying or administering the
14 medication.
15 Four: It would assure that all state and
16 federal regulations regarding the procurement,
17 handling, distribution, storage, administration, and
18 disposal of a pharmaceutical are met.
19 Fifth: It would assure that any use of
20 Naloxone is reported immediately to the appropriate
21 emergency medical-services system, to allow
22 additional medical evaluation and stabilization.
23 And although Naloxone is a wonderful
24 medication to reverse an opiate overdose.
25 Despite, many times, these people walking --
93
1 waking up and, literally, walking away, there is a
2 small number of individuals that have rebound
3 symptoms, and can be very sick, even though,
4 initially, they look very well.
5 Next, to assure that the use of Naloxone is
6 reported to the emergency health-care provider who
7 can facilitate community surveillance and quality
8 assurance for proper use. It could assist in the
9 development of a system of Naloxone distribution
10 that would be both operationally and fiscally sound,
11 so as, we can assure that Naloxone is placed where
12 it is most likely to be used.
13 And, lastly, and, unfortunately, most
14 importantly: It would extend Good Samaritan
15 protection to those who render assistance or oversee
16 such a Naloxone program, consistent with statute.
17 I applaud the Senate Majority Coalition
18 leaders for announcing this Task Force, and for the
19 invitation from you, Senator Robach, for attending
20 this Senate -- this hearing today.
21 And I certainly believe that by responsibly
22 enabling public-access Naloxone programs, through
23 the statute modeled after existing, highly
24 successful programs, we will undoubtedly save more
25 lives.
94
1 SENATOR ROBACH: Thank you, Dr. Cushman.
2 This is good to have in here.
3 And I think it's our intent, we're even --
4 go -- we want to go above and beyond first
5 responders.
6 DR. JEREMY T. CUSHMAN: Absolutely. And
7 that's --
8 SENATOR ROBACH: And I think it was Theresa
9 who made the comment that, you know, if you
10 unfortunately know you may be more likely to have
11 that need in your family or with your loved one,
12 that you'd be able to have that, and be under no
13 liability or any criminal activity.
14 Senator Boyle's actually had a training in
15 Long Island, to even help people who are at the most
16 desperate part of their lives with their family
17 members, do that.
18 But, you know, while it doesn't save
19 everybody, the Boston one, I think, was 210 out of
20 222. Rochester, 101 out of 112. Those are pretty
21 good numbers.
22 So, that's definitely gonna be a portion of
23 it, I think.
24 Some of it's already underway, on the
25 emergency side.
95
1 We'd like to take it somewhere else; and
2 you're right.
3 Interestingly enough, Senator Alesi, and
4 myself, who was a former legislator from here, did
5 the defib regulation, which was controversial at the
6 time, because we were mandating public buildings had
7 to have these.
8 Roll it back, eight years later, every year
9 we have a ceremony with the people whose lives have
10 been saved.
11 And, again, it's the same demographic.
12 Everybody thinks it's only gonna be these
13 80-year-old grandparents.
14 It's 45-year-old fathers, 50-year-old
15 mothers, and it's saving their lives.
16 So, hopefully, we won't have to do this with
17 [unintelligible].
18 DR. JEREMY T. CUSHMAN: Absolutely. I think
19 that legislation would allow that safety net for
20 everyone, not just first responders, to be able to
21 do that, but provide some consistency, so that we
22 can measure it. And as things change over time,
23 provide additional guidance to those individuals.
24 SENATOR ROBACH: Thank you for your expert
25 testimony, and we have every intention to
96
1 implementing that.
2 SENATOR BOYLE: Yes, Doctor, that was
3 tremendous.
4 And, we're gonna act on your recommendations,
5 certainly, especially regarding the Good Samaritan
6 Law.
7 I know -- for those of you unfamiliar with
8 the Good Samaritan Law we passed a few years ago in
9 the State Legislature, it provides an opportunity
10 for, if someone is in a situation where someone is
11 experiencing an overdose, you can call the police,
12 and even if there's drug paraphernalia there, heroin
13 around, you will not be prosecuted for it.
14 If there's, you know, 1,000 bags of heroin
15 and a gun, that doesn't count for those; but, for
16 small users.
17 I remember, as I say, when I went for
18 EMT training, I'd be in the hospital, getting the
19 training, and, a car would pull up, and, "thump,"
20 and everyone would run out there. And the kids had
21 got their friend who was having an overdose, they'd
22 throw him out of the car, and just keep going.
23 But, now, the situations, we've had it on
24 Long island, tragedy, where were a dozen kids
25 getting high on heroin, and they all left, and the
97
1 girl died right on the couch.
2 No one called the police, and when she --
3 they easily could have saved her life.
4 A quick question about the use of this
5 modification:
6 Now, as Senator Robach said, we're having the
7 training on Long Island for average individuals.
8 Not first responders; everyone should have it.
9 I totally agree, get it out as much as
10 possible.
11 Are you familiar with the law in terms of how
12 that occurs, that we can -- have you -- can you do
13 that now in Suffolk County, where a family of
14 citizens, a group of citizens, can take a class, and
15 walk away with a spray Narcan?
16 Or what kind of training; what does the law
17 say about that?
18 DR. JEREMY T. CUSHMAN: So the law says
19 nothing.
20 SENATOR BOYLE: Okay.
21 DR. JEREMY T. CUSHMAN: So if I wanted to,
22 I can take all these people right now and I can
23 spend a half hour training all of them.
24 I can provide them that medication, under my
25 license.
98
1 SENATOR BOYLE: Okay.
2 DR. JEREMY T. CUSHMAN: And so, then, it is
3 my responsibility, as a physician, that I have,
4 essentially, bestowed that upon them to administer,
5 as my agent.
6 And my concern for other physicians is that
7 they might not feel comfortable with that.
8 SENATOR BOYLE: Right.
9 DR. JEREMY T. CUSHMAN: And that's where some
10 of those liability protections come into place.
11 SENATOR BOYLE: Well, that's something we
12 need to look at in terms of this legislation.
13 DR. JEREMY T. CUSHMAN: I think it also
14 addresses some of the comments mentioned earlier, in
15 terms of, "I'm afraid that if I get pulled over and
16 I have this medication in here," and so forth.
17 We have some individuals that are very
18 well-meaning physicians, that are going out and they
19 are teaching folks how to draw up with a needle, the
20 Naloxone, before they give it.
21 That's -- there's too many risks, there's too
22 many hazards, to that.
23 When, essentially, we have the best practices
24 that Michael Daley [ph.] in the Albany area, myself,
25 others, have come up, that work for first
99
1 responders, that we know work for laypeople, if you
2 will, and, how do we standardize that?
3 Just as AED programs, whereby that individual
4 obtains authorization to use that, and identifies
5 what training curriculum they are using, and,
6 provided that training curriculum meets the
7 expectations of the Department of Health, then, it
8 is a done deal.
9 SENATOR ROBACH: I think I know the answer,
10 but I just want to be sure, for my own general
11 knowledge:
12 There is no, really, other usage for Narcan,
13 except for that. There's no nefarious or "high"
14 purpose for that. Right?
15 If somebody who wasn't -- let's say if a kid
16 got ahold of it, it really wouldn't do anything to
17 them. Right?
18 DR. JEREMY T. CUSHMAN: Yeah, so that's very,
19 very important, Senator, and that there's a couple
20 of things.
21 Not only will it not harm anybody, it won't
22 harm them -- so if I gave myself some Naloxone right
23 now, I wouldn't notice anything.
24 I'd probably have a little bit of nasal drip
25 because I squirted it up my nose. But beyond that,
100
1 I wouldn't notice anything.
2 I also am not aware of any published case
3 reports of anyone having an allergy to it.
4 Right, there's certainly medications that
5 some people are allergic to.
6 To my knowledge, there are no public case
7 reports of an allergy to it.
8 So, literally, there is no harm, that I know
9 of, in administering this, even to someone that has
10 not had an opiate overdose.
11 SENATOR BOYLE: Great.
12 SENATOR ROBACH: Thanks.
13 SENATOR BOYLE: Thanks.
14 Real quick, Doctor, one other area that
15 I need to look at, in terms of getting this out to
16 first responders is:
17 Now, I'm a volunteer firefighter. I've been
18 there for 18 years. And, ironically, we can see,
19 we've studied it a little bit, that I know that
20 there's, what, paid firefighters in Rochester in the
21 city? But you have --
22 SENATOR ROBACH: Uh-huh. Both.
23 SENATOR BOYLE: -- you have -- okay, you have
24 some volunteers in the outskirts, maybe.
25 That, we can be trained with Narcan
101
1 individually, but not as a volunteer fire
2 department.
3 And, now, we do not have an ambulance with
4 our fire department. We don't have a bus
5 [unintelligible], you know.
6 But, we often arrive before the ambulance
7 does, and, there may be five of us that have got the
8 training.
9 We can individually use Narcan, but, we can't
10 carry it on the fire equipment, the rescue
11 equipment, where it would do the most good, and we
12 have -- where we can have training for the entire
13 fire department.
14 So I really would like to, you know, follow
15 your lead.
16 And I thank you for your leadership in this
17 last couple of years to get it out to every first
18 responder.
19 DR. JEREMY T. CUSHMAN: Well, I have it on a
20 bunch of fire trucks around this area --
21 SENATOR BOYLE: You do?
22 DR. JEREMY T. CUSHMAN: -- the volunteers --
23 SENATOR BOYLE: On volunteer. Okay, good.
24 And it's on the rig?
25 DR. JEREMY T. CUSHMAN: Uh-huh.
102
1 SENATOR BOYLE: That's great.
2 DR. JEREMY T. CUSHMAN: Where it needs to be.
3 SENATOR BOYLE: Perfect.
4 Thank you very much.
5 SENATOR ROBACH: Thank you, Doctor.
6 DR. JEREMY T. CUSHMAN: Thank you both,
7 Senators.
8 [Applause.]
9 SENATOR ROBACH: Our next testimony will be
10 provided by Lisa Thompson, who will also share a
11 personal story.
12 Thank you, Lisa.
13 LISA THOMPSON: Thank you for having me here
14 this morning, or, almost this afternoon.
15 My name is Lisa Thompson, and I'm here today
16 to share with you my personal experience, in hopes
17 of shedding light on a horrible opiate and heroin
18 addiction in the state of New York.
19 I am one of those parents that has dealt with
20 a son that was addicted to opiates, and then heroin,
21 along with other drugs.
22 He began at the age of 16.
23 I was going through divorce, and found out he
24 was smoking marijuana.
25 As time went on, his personality began to
103
1 change more, so I searched his room and found a
2 bottle with a few pills of Oxycontin.
3 I confronted him, and he came clean. He said
4 a family member gave him one, and he thought it gave
5 him a better high.
6 After a long talk with him, I sent him to
7 Park Ridge Chemical Dependency outpatient.
8 To him it was a joke.
9 Had I been more educated, I would have known
10 at the time he didn't want help, because he didn't
11 think he had a problem; therefore, he stopped going,
12 and continued to use.
13 I began to educate myself on drug abuse so
14 I can learn how an addict thinks, so I would somehow
15 be able to help my son.
16 Five years into it, he finally sat me down
17 and told me he's still using and wants to stop, but
18 can't.
19 He tried on his own, but failed. Even found
20 a Suboxone doctor for help.
21 He would then lie to the doctor and told him
22 he was going to counseling, but he wasn't.
23 With Suboxone, if you feel the urge to get
24 high, you don't take it.
25 After failing numerous drug tests, the doctor
104
1 would no longer treat him. So because of
2 withdrawal, he continued to use.
3 This turned into a 10-year battle, to the
4 point that it almost took his life.
5 He desperately wanted help and didn't know
6 how to stop on his own.
7 After an attempt of suicide because he didn't
8 want to live a life of addiction, he was brought to
9 Strong Memorial Hospital Mental Health.
10 I'll never forget the look on his face when
11 he saw me. It was heart-wrenching.
12 I sat in on his evaluation and was crushed to
13 find out he had been using heroin for a few years.
14 He was told it was the same thing as opiates, but
15 cheaper.
16 He then turned to me and said, "I didn't want
17 to see the look of disappointment on your face
18 again. I just can't do this anymore."
19 Sixteen hours later, in the midst of
20 withdrawal, they released him to me, citing he was
21 no longer a threat to himself.
22 I was told they didn't have the resources to
23 help him any further because they had no rehab
24 program.
25 Then the hunt for help began.
105
1 Making numerous phone calls to what I knew of
2 the drug rehabs here in Rochester, New York,
3 thinking there would be no problem getting him in
4 one, unfortunately, I was wrong.
5 I was told there were no beds available for
6 two weeks, or no beds at all.
7 Another rehab center could take him, but
8 didn't take health insurance. The cost was $3,000;
9 money I didn't have.
10 I also knew they had detox centers in the
11 city because he had been to one, but the State shut
12 them down.
13 I ran out of resources, and began to break
14 down and cry, because my son was going through
15 withdrawal and I had no help, no more places to
16 call, because there are not enough places to get
17 help.
18 Being a mother and feeling helpless to the
19 point of knowing my son could die was the most
20 difficult and frightening time of my life.
21 I would not wish the pain I went through with
22 him on anyone.
23 I am asking you if there is, somehow, we can
24 open more rehab centers, not just for detox, but
25 counsel for addicts.
106
1 Long-term counsel is the key to recovery.
2 It is also important for medical
3 professionals, not insurance companies, to decide
4 who needs treatment, and to what extent.
5 We help people that are in need of welfare,
6 the disabled, and the unemployed.
7 Why not help this life-threatening disease,
8 because people are dying.
9 Fortunately, we found help, the help we
10 needed, through Teen Challenge, a Christian-based
11 rehab in Syracuse, New York.
12 They are extremely limited and rely on
13 donations.
14 My son spent 16 months in inpatient recovery
15 this time, because he wanted to be there.
16 You don't fix a 10-year addiction with
17 3 months of inpatient.
18 He is doing well, and two years' clean.
19 With continued support, he is making a new
20 life for himself.
21 I have my son back.
22 Unfortunately, some families aren't as
23 blessed, which is the reason why I am here today.
24 SENATOR ROBACH: Thank you.
25 [Applause.]
107
1 SENATOR BOYLE: Thank you very much, Lisa.
2 And that is what we're hearing from a number
3 of people, so you're not alone in this struggle.
4 And, I believe that we -- we did increase the
5 funding for treatment by $2.8 million in this state
6 budget, not nearly enough, but it's a first step in
7 the right direction.
8 LISA THOMPSON: Thank you.
9 SENATOR BOYLE: And with your testimony, and
10 the testimony of others, we're gonna look to do
11 more.
12 LISA THOMPSON: Okay. Thank you very much.
13 SENATOR BOYLE: Thank you.
14 SENATOR ROBACH: Thank you.
15 SENATOR BOYLE: Next speaker is Jeanne Beno.
16 Dr. Beno?
17 And Dr. Beno is the chief toxicologist in the
18 Monroe County Medical Examiner's Office.
19 DR. JEANNE BENO: Thank you.
20 Thank you for the opportunity to speak today.
21 I'm here as a representative of the
22 Medical Examiner's Office.
23 I direct the forensic toxicology laboratory
24 for the ME's Office in Monroe County.
25 Now, while we are a County-funded laboratory,
108
1 we are a regional lab, because we contract with the
2 region to perform testing, so, I'll have data to
3 present that includes a much larger region than
4 Monroe County itself.
5 For the Medical Examiner's Office, we receive
6 cases from up to 12 counties. And in
7 driving-impairment cases, we receive cases from
8 7 counties beyond Monroe County.
9 We began to see this problem in
10 heroin-related deaths beginning, approximately,
11 July of 2012.
12 Prior to that time, you can see in the data
13 I provided, we were averaging perhaps one heroin
14 overdose fatality a month in the Medical Examiner's
15 Office in Rochester.
16 In July of 2012 we had a sudden spike to
17 four. Although, then, in August we had none.
18 But then, beginning in September, the number
19 of deaths rose, and continued to rise, and stay at a
20 much higher rate until the present time.
21 In 2011, we had 11 deaths due to heroin that
22 were investigated by the Medical Examiner's Office.
23 In 2012, there were 29.
24 In 2013, there were 65 fatalities.
25 Of those deaths, 77 of them occurred in
109
1 Monroe County, 10 in Chemung, 6 in Wyoming,
2 4 in Ontario, 4 in Steuben, 3 in Livingston, and
3 1 in Orleans.
4 Now, while the death investigation in
5 Monroe County is all coordinated by the
6 Medical Examiner's Office. In surrounding counties,
7 there isn't uniform death investigation. They are
8 coroner systems.
9 Some of those counties send, virtually, any
10 suspicious death to our office for investigation and
11 autopsy, but others send only selective cases.
12 So, I believe that our total number of heroin
13 deaths is an underrepresentation of what the true
14 problem is.
15 If you look at our data on age of
16 heroin-addicts' deaths, our oldest in this time
17 period, I believe, was 67 or 68.
18 So you can imagine that if a coroner is
19 investigating the death of a 67- or 68-year-old,
20 unless there's clear evidence of heroin
21 paraphernalia at the scene, they're probably gonna
22 simply release that body as coronary-artery disease.
23 So lack of uniform death investigation leads
24 to an underrepresentation of the number of deaths.
25 The other thing is, the reliance,
110
1 particularly in those other counties, perhaps, on
2 clear signs of heroin use.
3 You can, of course, and most often you do,
4 inject heroin intravenously.
5 But the purity is high enough that it can be
6 very effective as a drug if snorted intranasally,
7 like, commonly, lines of cocaine are snorted, or by
8 smoking it, so that the evidence of track marks or
9 recent puncture marks in the arm as your criteria
10 for looking for a possibility of drugs, particularly
11 heroin, may not be present. It may not be the
12 appropriate choice to make your decision on.
13 In addition, it's very common that the scene
14 of a heroin death is cleaned up prior to
15 investigators getting there.
16 Family, friends, clean up the paraphernalia
17 so that there's nothing there.
18 Even when there's clear signs from our
19 investigators' standpoint of -- that they were using
20 intravenous drugs, based on the signs on the body,
21 the families often deny it.
22 So, there's still a lot of this attempt to
23 kind of cover up.
24 Looking a little more at the demographics of
25 the heroin deaths, part of what's happened in this
111
1 rise in heroin deaths that's particularly
2 disturbing, is the change in the ages.
3 In the early 2000s, we had a spike in heroin
4 deaths. That occurred when the street purity of
5 heroin really started to rise.
6 So, again, because you could smoke or snort
7 heroin, you could introduce a lot of people to
8 heroin who weren't willing to use needles.
9 There was always this barrier we commonly
10 heard from families, no, they wouldn't abuse heroin.
11 They would abuse -- they might abuse cocaine,
12 or they might abuse marijuana, but they would never
13 use an intravenous drug. There was somehow this
14 stigma of intravenous-drug use.
15 I don't think that's there any longer, but it
16 was at that time.
17 But once the purity increased, you could
18 administer this drug by other routes effectively.
19 Once you're addicted, you'll go to the intravenous
20 route.
21 So in that period of time, we had a spike in
22 heroin deaths, but the average age, or the most --
23 the age with the highest frequency of death, was
24 individuals in their 40s, and these were people that
25 were chronic heroin users.
112
1 In our demographics from this period of time,
2 our highest number of heroin deaths has occurred in
3 the 20- to 24-year-old age range.
4 Obviously, these are young heroin users;
5 people that have not been abusing heroin for a very
6 long time, and it's, obviously, a very disturbing
7 trend.
8 More than half of the heroin deaths are in
9 people under 35.
10 In terms of gender: 80 percent of the heroin
11 deaths are in males, 20 percent are in females.
12 Now, if I back up just a moment to the
13 heroin -- number of heroin deaths:
14 A problem we saw in December, and then
15 January of this year, is that, on the street, we
16 started seeing heroin that was cut with fentanyl, or
17 fentanyl that was substituted for heroin, in the
18 packets.
19 And there's was a lot -- it's an -- it a very
20 important, disturbing issue, but it doesn't undercut
21 the importance of understanding that heroin is toxic
22 in and of itself.
23 But at that point in time, we had six heroin
24 deaths in December of 2013.
25 But at the same time, I believe we had
113
1 five individuals who died from -- who were known to
2 be heroin users, they were injecting intravenously,
3 but they had fentanyl in their heroin packets
4 instead of heroin.
5 So -- and in one case, we had several die in
6 one night, and many other people hospitalized, from
7 a batch of fentanyl-tainted heroin that was released
8 on the street.
9 Okay, going back to our demographics:
10 82 percent of the heroin fatalities are
11 Caucasian.
12 Again, this kind of -- the perception
13 oftentimes in the public has been that this is an
14 inner-city problem.
15 It is clearly not an inner-city problem.
16 13 percent are African-American; 1 percent,
17 Asian; 1 percent, Hispanic; and 1 percent other
18 nationalities.
19 That may mean that they're mixed-race or
20 American-Indian, or that the racial profile wasn't
21 clear at our -- at the time we received that case.
22 A problem we see in heroin deaths is that
23 heroin isn't the only drug, as some of the parents
24 spoke to the number of drugs their kids are
25 prescribed.
114
1 These individuals are, oftentimes, on many
2 other drugs. We may see as many as a dozen other
3 drugs in their system at the same time.
4 So it's a very complicated phenomenon. It's
5 not only the toxicity of the heroin, but it's the
6 added effects of all these other drugs that are
7 underlying the toxicity and the number of deaths.
8 One of the types of cases where we see heroin
9 deaths are in individuals who have just been
10 released from rehab or just been released from jail.
11 It's a real problem with not having a long
12 enough rehabilitation period.
13 If you simply keep somebody in rehab for a
14 month, and long enough for them to lose their
15 tolerance to the heroin, and you put them back out
16 on the street, their urge is to go and use
17 immediately. And, commonly, they go back and use
18 the amount of heroin that they'd been using prior to
19 incarceration or prior to treatment, and that is,
20 oftentimes, too much for them at that point in time,
21 and it's lethal.
22 So one final point I wanted to make is, that
23 the heroin and the opiate problem does not just
24 affect those individuals who become addicted.
25 It affects the rest of the population at
115
1 large, as can be demonstrated on our data on
2 driving-impairment due to opiates.
3 So, in 2013, the number of cases seen by our
4 office in -- for driving under the influence of
5 drugs in which opiates were detected, increased
6 48 percent.
7 The number of cases that were positive for
8 morphine, which is the primary analyte that you test
9 for when looking for heroin, increased 80 percent.
10 So, clearly, the prevalence of heroin on the
11 street is seen also in the prevalence of heroin in
12 drivers.
13 And one other small point: While the numbers
14 are small, the number of driving-impairment cases
15 positive for buprenorphine, which is the active drug
16 in Suboxone, increased, from four, to twelve.
17 So that may also be reflective of the fact
18 that it's being used a lot more to treat heroin, or,
19 that the Suboxone that's being prescribed to heroin
20 addicts, to try and prevent them from going back to
21 heroin, is being diverted to the street so they can
22 pay for their heroin.
23 So I appreciate your time.
24 Thank you.
25
116
1 SENATOR ROBACH: Thank you.
2 SENATOR BOYLE: Thank you, Doctor.
3 A quick question: Regarding the use of
4 fentanyl mixed with the heroin, is it more likely
5 that someone is gonna overdose?
6 I know that it's a very strong drug,
7 obviously.
8 And I think of the case of
9 Philip Seymour Hoffman, Rochester-area native,
10 obviously, that, they said he had 77 decks in his
11 apartment, and they think that he might have been
12 using it, and because of the delayed reaction of the
13 fentanyl, he might not have realized how much he was
14 putting in his system.
15 Or other addicts, obviously.
16 Is it -- are they more likely to overdose
17 with these mixed, or with pure heroin?
18 DR. JEANNE BENO: Well, I think they're more
19 likely to overdose with fentanyl, for the simple
20 reason that it's an extremely potent drug.
21 And, so, the knowledge of the person
22 preparing this powder in a packet, and diluting or
23 cutting that powder down to an amount that's a
24 reasonable amount for a high, but not so much that
25 would kill you, the ability, or the knowledge,
117
1 really isn't there.
2 When we're talking about heroin, we're
3 talking about milligram doses.
4 When we're talking about fentanyl, we're
5 talking about microgram doses.
6 And, so, the idea that somebody can cut a
7 powder down so that you're only administering a
8 certain number of, you know, micrograms is pretty
9 difficult to understand that they could do that.
10 SENATOR BOYLE: Thank you.
11 SENATOR ROBACH: Kind of continuing on
12 Senator Boyle's question: You know, with this
13 alarming rate of increase all across the state, now
14 we're -- I think we're finding out, believe it or
15 not, from having this, unfortunately, seems to be
16 going on all over the country.
17 Do you think that's due to the increase in
18 the volume of people using the heroin? If it's the
19 potency in what they're cutting with? Or if it's,
20 you know, even the age of the users seems to be
21 aging to younger and younger?
22 Maybe I'm answering the question.
23 Or is it all of the above?
24 DR. JEANNE BENO: Well, I mean, certainly,
25 all of the above are a factor.
118
1 I think the potency --
2 Jim Wesley could probably speak to that a
3 little better, although, I don't think they're
4 running potency all the time.
5 -- but I think the potency's been relatively
6 high since the early 2000s.
7 I think there has to have been a real shift
8 in the number of users, and the age of the users,
9 because we would never see the number of young
10 people like this that we -- in the past.
11 SENATOR ROBACH: Well, and you raise such a
12 good point, but I think when you're at that point
13 where you're addicted, you just want to get it.
14 But, you know, because it's not measured, you
15 don't know exactly what you're getting.
16 And even the comment he made, about the
17 difference in one dose to the next being sometimes
18 three times stronger, I mean, man, whew!
19 DR. JEANNE BENO: 20 years ago, heroin on the
20 street, you probably thought it was a good deal if
21 you got a 10 percent pure heroin.
22 Now it's just pretty common to have
23 50 percent.
24 And, again, if your dealer is commonly giving
25 you 20 percent or 30 percent, and the next day you
119
1 get much higher, whether intentionally, whether it's
2 because some drug comes into town and the dealer is
3 worried that, you know, somebody's gonna bust them,
4 so they just, you know, break it out into packets
5 and throw it out on the street without cutting it,
6 all of those are variables, that the user can't
7 control and has no knowledge of.
8 SENATOR BOYLE: Thank you, Doctor.
9 SENATOR ROBACH: Thank you, Doctor.
10 DR. JEANNE BENO: You're welcome.
11 SENATOR ROBACH: Our next testimony will come
12 from our dynamic Monroe County District Attorney,
13 Sandra Doorley.
14 DA SANDRA DOORLEY: As always, Senator, it is
15 a pleasure.
16 SENATOR ROBACH: Thank you.
17 DA SANDRA DOORLEY: Senator Boyle, nice to
18 meet you.
19 I'm Sandra Doorley, the District Attorney of
20 Monroe County.
21 I deal with Senator Robach very often.
22 So, thank you.
23 It's actually really a pleasure to be here
24 and speak to both of you today.
25 Two years ago, a young woman, she was a
120
1 gifted athlete, she graduated from a suburban
2 Monroe County high school, with plans of attending a
3 respected out-of-state university on a full
4 scholarship.
5 Months later, she was implicated in a rash of
6 violent armed robberies that had occurred throughout
7 the county.
8 That once-promising young woman is now
9 serving 11 years in the New York State Department of
10 Corrections.
11 Three months ago, a 22-year-old man, once a
12 decorated high school athlete, entered the
13 Wegman's Supermarket in Pittsford Plaza and was
14 observed shoplifting several items.
15 He was pursued from the store, and the young
16 man then attempted to force a woman from her car
17 before fleeting to another business across the
18 street.
19 Moments later, that same young man drew a
20 weapon on a police officer who responded with deadly
21 force.
22 Just weeks ago, a 19-year-old woman, a
23 recovering addict with a promising future, was found
24 dead in her dorm room at the University of
25 Rochester.
121
1 Her death prompted the president of that
2 institution to issue a plea to the student body,
3 young scholars attending one of the most
4 distinguished universities of our nation, to seek
5 help if they find themselves battling the same
6 demons that led to their classmate's ultimate and
7 untimely death.
8 Three tragic events affecting three different
9 people whose paths had never crossed.
10 Three heartbreaking stories with the single
11 common denominator, that being heroin.
12 Ten years ago, these stories and the fates of
13 these three individuals would have shocked the
14 community.
15 Today, they are considered pedestrian.
16 They're regrettable, tragic, and
17 all-too-common stories which fill up our daily
18 newspapers and newscasts with images of sobbing
19 parents, memorial services, and emaciated,
20 vacant-eyed mugshots.
21 This is the face of heroin; the face of the
22 opiate epidemic that is sweeping our nation; an
23 epidemic whose effects are felt no less in
24 Monroe County than in any other urban center in
25 America. And we are woefully unprepared.
122
1 For decades, heroin use and the addiction was
2 associated with poverty and blight, a drug of the
3 urban poor, conjuring up images of needle-filled
4 parking lots, homelessness, and long lines at
5 methadone clinics.
6 In the last several years, heroin has crawled
7 out of the alleyways and the drug houses into our
8 high school, into our dorm rooms, and into kitchens
9 across New York State, and our nation.
10 No longer is heroin a drug of some imagined
11 junky underclass.
12 It is a drug that has impacted every strata
13 of society without regard for income, education,
14 race, or gender.
15 Heroin and its opiate cousins have become the
16 crack cocaine of the twenty-first century; an
17 epidemic that's having a profound impact on a
18 generation of young people growing up in our
19 community.
20 Heroin is fueling a frightening wave of
21 violent crime in our community, the likes of which
22 we have rarely seen and in places that we've never
23 seen it before.
24 After this body has deliberated over the
25 testimony that you will hear today, I'm confident
123
1 that appropriate and thoroughly considered action
2 will be taken in the Legislature of our state.
3 Today, many qualified and experienced people
4 will make many important observations and give voice
5 to many worthy ideas.
6 As District Attorney, I appreciate the
7 opportunity to speak to you, and I ask that you
8 consider the following recommendations:
9 First, please curtail the ability or the
10 availability of opiate pain killers in the community
11 by passing laws that limit the frequency with which
12 these drugs are prescribed, and by further
13 encouraging the use and development of less
14 addictive alternatives.
15 It's no secret that the recent rise in the
16 use of heroin is fueled by the accessibility of
17 opiate-based medications.
18 Young people who would never have considered
19 experimenting with an illicit stigmatized drug like
20 heroin feel safe experimenting with drugs produced
21 by reputable pharmaceutical companies and prescribed
22 by physicians.
23 Many realize too late, however, that these
24 drugs have the same addictive properties as their
25 inexpensive street-level cousins.
124
1 Before long, that young people who might
2 never have considered trying heroin are driven by
3 addiction to this lower-priced, readily available,
4 and powerful alternative.
5 Secondly, please consider amending the
6 Penal Code of the State of New York to make drug
7 dealers responsible for the results of their sales.
8 In short, amend the law to make the sale or
9 dispensing of a drug which results in a death a
10 homicide offense.
11 Currently, a person who provides an illicit
12 drug that results in the death of a user can
13 typically only be charged with criminal sale of a
14 controlled substance, unless unusual facts exist
15 that may allow us to charge a homicide offense.
16 While amending our current laws would
17 certainly not eradicate the illicit-drug trade on
18 our street, holding drug dealers accountable for the
19 true cost of their activities would significantly
20 diminish the open availability of these dangerous
21 drugs, and would perhaps give drug dealers reason to
22 pause before selling to young, inexperienced users
23 seeking cheap alternatives to prescription
24 medication.
25 Here in Monroe County we have seen a drastic
125
1 rise in the number of felony offenses involving the
2 possession or sale of heroin or other opiates.
3 A comparison of the first quarter of 2013 to
4 the first quarter of 2014 shows nearly a 45 percent
5 increase in the total number of felony indictments
6 for heroin and other opiates.
7 And perhaps more telling, the number of
8 defendants indicted for felony possession or sale of
9 heroin or opiates more than doubled in the first
10 quarter of 2014 as compared to the first quarter in
11 2013; going from 11 defendants charged in 2013, to
12 24 in 2014.
13 It's documented here in Monroe County, we've
14 seen the rise.
15 The destruction caused by heroin and opiate
16 addiction is a problem confronting all New Yorkers.
17 And I would like to thank the members of this
18 body for bringing this issue before the public, and
19 for working with those of us in law enforcement and
20 the treatment community to begin working towards a
21 solution.
22 This problem has been years in the making and
23 it will not be solved overnight.
24 Today's forum, however, is an important first
25 step towards a lasting solution, and I appreciate
126
1 the opportunity to share my thoughts and
2 recommendations.
3 Thank you.
4 SENATOR ROBACH: Thank you, Sandra.
5 SENATOR BOYLE: Thank you so much, Sandra.
6 [Applause.]
7 SENATOR BOYLE: Quick question.
8 DA SANDRA DOORLEY: Sure.
9 SENATOR BOYLE: And thank you for your
10 leadership in prosecuting these drug dealers and
11 other -- in heroin, particularly.
12 One question is: That we're looking at
13 possession charges, and how we can change the law,
14 the criminal code, to make it stronger.
15 I have legislation, for example, which would
16 make possession of 50 bags of heroin a felony.
17 Now, as you understand, there's a little bit
18 of the politics involved here --
19 DA SANDRA DOORLEY: Exactly.
20 SENATOR BOYLE: -- because, several years ago
21 we rolled back the Rockefeller drug laws, and we
22 have to get legislation, not just past the
23 State Senate, where Senator Robach and I serve, but
24 also the New York State Assembly, maybe in our
25 New York City-focused and not quite "throw the book
127
1 at them" types; we'll say.
2 Now, without going full-boards back to the
3 Rockefeller drug laws, how would you recommend, if
4 you could write a law tomorrow, to increase the
5 penalties on possession, because you know it's going
6 to -- this person is a dealer?
7 For example, though, when I mentioned the
8 Philip Seymour Hoffman case, obviously,
9 Philip Seymour Hoffman was not dealing drugs, but he
10 had 77 bags in his apartment when he died.
11 What is an appropriate amount to say, You are
12 dealing this drug, this is not for personal use?
13 Or how do you do it?
14 You can't do it by weight because it's
15 lighter than cocaine. Right?
16 I mean --
17 DA SANDRA DOORLEY: You've gotta to redraft
18 or recreate the definition of "the seller."
19 You know, one of the problems that I see:
20 You know, I'm a big supporter of drug courts
21 and drug-treatment facilities in our community, you
22 know, but the problem is the seller.
23 You know, our judicial-diversion program,
24 Section 216 of the Penal Law, that's all well and
25 good for the user; for the person who really and
128
1 truly wants help in battling this hideous addiction.
2 But we have to stop -- we have to stop the
3 sellers from using this as a tool to get out of
4 their criminal ramifications and their penalties.
5 We need to make the statutes tougher for
6 sellers.
7 Sellers are the ones that are addicting our
8 children in the cities and the suburbs.
9 We've got to stop them.
10 And perhaps if -- and the most frustrating
11 thing, when I tried to gather all the information,
12 I was only able to track our felony offenses,
13 because criminal possession of a controlled
14 substance in the seventh degree, which captures so
15 much of the heroin that we're seeing on the street,
16 we don't keep records.
17 That's a low level of your decks and your
18 bundles, and those are just getting disposed of,
19 because of the weight.
20 SENATOR BOYLE: Yeah, right, and that gets
21 to -- just to follow up, that gets to another
22 situation.
23 We had a case in Suffolk County, where they
24 arrested a guy with 864 bags. Only a misdemeanor.
25 DA SANDRA DOORLEY: Right, right.
129
1 SENATOR BOYLE: Crazy.
2 DA SANDRA DOORLEY: So you've gotta lower
3 those thresholds. Or, just create a -- you know, we
4 have our own statute for marijuana offenses.
5 Perhaps take the heroin and opiates out of
6 the "controlled substance" and create a separate
7 statute.
8 SENATOR ROBACH: I think a good first step,
9 and I was wondering what you thought of that:
10 Bill Hochul was here earlier.
11 And, in the federal statute, I can't remember
12 what the amount was, but it's relatively low,
13 coupled with a death caused by it, then that seller
14 can actually be given a life sentence -- up to a
15 life sentence.
16 I mean, I think we -- I think, as a local
17 prosecutor, you ought to have that tool, as well.
18 DA SANDRA DOORLEY: Absolutely. They use the
19 murder or the homicide as the aggravating factor for
20 the possession or sale of the controlled substance.
21 That's a suggestion as well.
22 SENATOR ROBACH: You would favor that; right?
23 DA SANDRA DOORLEY: Yes.
24 I mean, one of the most frustrating things,
25 and I don't mean to keep talking: We charged a
130
1 woman with the death of another woman.
2 What had happened was, she had sold or given
3 her enough heroin to cause her to overdose and die.
4 We had facts and allegations that this seller
5 knew that this woman had, or was having, bad
6 reactions to heroin, but despite that, helped her
7 inject herself the final and last time.
8 Because of the facts as we knew it, we were
9 able to charge a homicide, but that's not always the
10 case.
11 And people who do that, people -- the sellers
12 who provide that, should be penalized as well.
13 SENATOR ROBACH: Yeah, we need to do
14 something, 'cause right now, they're flooding the
15 market, and they're flooding it cheap.
16 And I don't think they're too afraid of
17 getting caught, or what's gonna happen, from the
18 seller's side.
19 DA SANDRA DOORLEY: Exactly.
20 It's very cheap.
21 SENATOR ROBACH: Thank you very much.
22 SENATOR BOYLE: Thank you very much.
23 DA SANDRA DOORLEY: Thank you very much.
24 [Applause.]
25
131
1 SENATOR BOYLE: Our next speaker is
2 Paige Prentice, the vice president of operations at
3 Horizon Health Services.
4 PAIGE PRENTICE: Good afternoon.
5 Kind of going towards last, you end up being
6 a summary, so...
7 Thank you for convening this forum and
8 inviting testimony from the community to help guide
9 your actions.
10 The opiate epidemic and its devastating and
11 fatal impact on our communities, on our neighbors,
12 our families, and our children, is, unfortunately,
13 well documented.
14 According to the (CDC Center for Disease
15 Control), in 2001, 4,000 people died directly
16 related to overdose from prescription opiates.
17 This figure does not include heroin overdose;
18 only those from prescription pain relievers.
19 In 2010, that number increased to 16,500.
20 Last year, as people have stated, the
21 overdose deaths are still climbing, with the
22 fastest-growing population being our adolescents and
23 our young adults.
24 In 2011, heroin was the second most commonly
25 used drug by patients presenting to our emergency
132
1 departments.
2 Having said this, I'm relieved to think that
3 I'm not here to convince you that there's a problem.
4 Obviously, you're well aware.
5 Today I will offer suggestions on important
6 steps to effectively intervene for long-term
7 resolution.
8 We are making progress, and I thank you for
9 your leadership in making these things happen.
10 The passaging of I-STOP legislation in 2013,
11 which helped stop the unknowing and/or reckless
12 prescription of pain relievers to those who are
13 likely not going to use them responsibly, was
14 helpful.
15 Treatment bed capacity was increased by
16 50 beds in New York State, with 25 of those beds
17 specifically designated to Western New York.
18 And, very recently, the positive support for
19 Naloxone legislation, the life-threatening
20 opiate-overdose reversal medication.
21 Last week, two parents that were trained by
22 Horizon in opiate-overdose prevention were able to,
23 literally, save the lives of their children who
24 overdosed in their home.
25 Naloxone is a powerful tool that must be more
133
1 widely available, but there's more to do.
2 We must dramatically expand treatment access,
3 and this is a multifaceted task.
4 We must further increase treatment bed
5 capacity in New York State, especially in
6 Western New York.
7 Currently in Western New York, we have a
8 70-person waitlist to get into intensive residential
9 treatment.
10 It is agonizing and devastating to look a
11 parent in the face and tell them: I'm sorry,
12 there's no bed for your son today.
13 We must hold insurance companies accountable
14 to create access to care; not impose barriers to
15 care.
16 This means establishing humane and
17 standardized criteria for coverage authorization,
18 and keeping deductibles and co-pays at manageable
19 levels.
20 And I say "humane," because it is a moving
21 target. Every day, you'll have an insurance
22 carrier, and he says you only have to suffer this
23 much to get in.
24 But the other insurance carrier feels
25 differently, and they think have you to suffer a
134
1 little bit more, and "we can't give you treatment
2 until you're suffering just enough."
3 That's inhumane.
4 We must advocate to federal officials to
5 allow physician extenders -- nurse practitioners and
6 physician assistants -- to be able to prescribe
7 Suboxone.
8 Currently, only a medical doctor can
9 prescribe Suboxone.
10 If not nurse practitioners and physician
11 assistants together, then start with just
12 nurse practitioners.
13 If community-based detoxification programs
14 are going to be successful, we have to increase the
15 number of medical providers that can prescribe
16 Suboxone.
17 We must further enhance community-wide access
18 for Naloxone.
19 We must educate the medical community on the
20 signs and symptoms of problem drug use, and options
21 for referral.
22 We must promote and increase the frequency of
23 national Drug Take-Back days, and we must promote
24 and increase the prevalence of accessibility of
25 community medication drop-boxes.
135
1 Thank you for your time and attention.
2 SENATOR ROBACH: Thank you, Paige.
3 [Applause.]
4 SENATOR BOYLE: Our next speaker is
5 Avi Israel. He's the president of Save the Michaels
6 of the World.
7 AVI ISRAEL: My name is Avi Israel.
8 And I want to take a moment, Senators, and
9 thank you for giving me the opportunity to speak
10 here.
11 On June 4th of 2011, I lost my only boy to
12 suicide. My son put a shotgun to his head and
13 pulled the trigger, in my back bedroom.
14 My boy, Michael, was prescribed into
15 addiction by his doctors. He was prescribed opiates
16 for Chron's disease.
17 Since that day, my family and I have been
18 fighting to inform the public of the danger of
19 opiates and pain killers, and a subsequent rise in
20 heroin use.
21 We have formed a group of parents who, like
22 us, have lost kids, and have kids addicted to these
23 drugs.
24 We have named our group "Save the Michaels of
25 the World," and our group was very instrumental in
136
1 the passing of I-STOP.
2 I'd like to take a minute and get from my
3 script, and touch on something that was not touched
4 here at all.
5 The creation of this epidemic, and we cannot
6 deny it, was started by the medical community.
7 There's no way -- and there's no way to get
8 around it.
9 The overprescribing, they're prescribing of
10 opiates for ridiculous minor pain, has gone out of
11 control.
12 So New York State has passed a great law
13 that's called "I-STOP."
14 It has curbed the doctor shopping, and
15 reduced the overprescribing of this dangerous drug;
16 however, I-STOP was never completed, and very
17 important components of this legislation were never
18 implemented, such as prescriber education,
19 pharmacist education, and a public-awareness
20 campaign.
21 For that, gentlemen, we can go right down to
22 the second floor to Capitol Hill and speak to our
23 Governor and the Department of Health.
24 There was a workgroup in charge of education
25 and certification standards for prescriber and
137
1 pharmacists, has come up with 15 recommendations,
2 but failed to reach a conclusion on any one of the
3 recommendations; so, subsequently, everything was
4 dropped by the Department of Health.
5 The Department of Health has not done
6 anything to implement any of those recommendations.
7 The provision in I-STOP to educate and inform
8 the public never got off the ground.
9 I know this one for a fact; I was part of
10 that committee.
11 In a recent meeting in Albany, with the top
12 personnel at the Department of Health, I asked a
13 question: What happened to the public-awareness
14 campaign?
15 The answer was a shoulder shrug and
16 "I don't know."
17 The Department of Mental Health and OASAS
18 were supposed to be combined together, to one
19 department, to give the public an easier access for
20 treatment.
21 Nothing ever happened.
22 So subsequent to that, we have mental
23 treatment; mental facilities that can treat mental
24 treatment, that can also treat addiction, with empty
25 beds sitting there empty. Nobody's getting the
138
1 treatment.
2 In my opinion, to get the answers for this
3 epidemic, and it is an epidemic, all we need to do
4 is get down to the second floor and get somebody
5 moving over there.
6 Number one: We need to make a mandatory
7 prescriber education in recognizing addiction early.
8 "Early," is a must.
9 If we could get doctors to understand and
10 recognize the dangers of overprescribing that leads
11 to addiction, and how to treat the addiction, this
12 will be half the battle.
13 As for DEA statistics, 4 out of 5 overdoses
14 start with pain killers.
15 Now, just to add to those numbers:
16 In Erie County, last year alone, we had
17 124 deaths. 84 of them were from prescription pain
18 killers, 20 of them were heroin, and the rest were
19 other prescription drugs.
20 Number two: Educate the public as a whole of
21 the danger of abusing opiates, starting with kids,
22 parents, and educators.
23 This is a must.
24 We have accomplished this with Buffalo with
25 great success.
139
1 And, you have this [unintelligible] right in
2 front of you.
3 With the help of BlueCross and BlueShield of
4 Western New York, a public-awareness campaign was
5 launched last October, and included every media
6 outlet in Western New York: television, radio, and
7 print.
8 Our community welcomed and embraced the
9 information.
10 School systems around the Buffalo area have
11 extended invitation to our coalition of parents,
12 treatment providers, law enforcement, and media, for
13 the purpose of informing students of these dangers.
14 Senators, if we are going to win this war,
15 it's gonna be with the same spirit that helped pass
16 I-STOP, with the legislative body and the Executive
17 Branch working together for the good of the people.
18 The Governor and his staff must get involved
19 and make some bold decisions.
20 We need mandatory education for all
21 prescribers. That's got to be a must.
22 Public-awareness campaign is a must. We have
23 to do it, we have to educate the public.
24 Easy access to treatment, I don't even have
25 to say it, that's got to be a must.
140
1 Making sure that doctors recognize, and able
2 to treat addiction, will save on the waiting time
3 for people who are suffering from this disease.
4 That is -- that must be a must.
5 Mandating these simple requirements can save
6 the future of our kids.
7 So, we have an epidemic in this country.
8 I mean we, cannot deny it.
9 We have an epidemic in this state.
10 The antidote for this is education.
11 Thank you.
12 SENATOR ROBACH: Thank you, Mr. Israel.
13 And let me say how sorry I am for your loss,
14 and -- but thank you at the same time.
15 I can't remember if it was Senator Maziarz or
16 Senator Grisanti --
17 AVI ISRAEL: Yes.
18 SENATOR ROBACH: -- who told me how helpful
19 you were in getting I-STOP legislation, which while
20 not perfect, I think is saving some people, or
21 helping us avoid it.
22 But I think we all agree up here that we
23 definitely do have to do more.
24 And, you know, I have a great deal of respect
25 for doctors, but they're like everybody else,
141
1 there's such a wide spectrum.
2 And you're right, every doctor needs to know
3 that there has to be a cost-benefit ratio.
4 So, what you're talking about is prescribing
5 the right thing, which is different than prescribing
6 huge amounts, which also gets out in the community.
7 When the person using it may only need five
8 instead of twenty-five, there's twenty there that
9 are kicking around.
10 But, yes, we have to do a better job with all
11 of it.
12 AVI ISRAEL: I think it's important to
13 understand that the medical community has a
14 responsibility here.
15 SENATOR ROBACH: Absolutely.
16 AVI ISRAEL: There's no reason to prescribe
17 30 pills for a root canal. We can do it with two or
18 three.
19 You know, but more important, I think, than
20 anything else, is the fact that none of the doctors,
21 not any doctor, really understands addiction.
22 And the way to treat it, in my opinion, is to
23 recognize it early. Not wait 8 or 10 months down
24 the road when it's late.
25 If a doctor can recognize it, and a doctor is
142
1 able to treat it, and have the knowledge in treating
2 addiction, we can save a lot of lives.
3 We don't have to wait 10 months down the
4 road.
5 SENATOR BOYLE: I, too, would like to thank
6 you, Mr. Israel, and I'm sorry for your loss. And
7 thank you for your advocacy.
8 I will say that one of the pieces of
9 legislation that we've already drafted for this
10 package does require mandatory education for
11 physicians on their continuing medical education
12 about the dangers of overprescribing and
13 prescriptions.
14 And you also touched upon the prevention.
15 At our Long Island forum, we had a
16 forward-thinking superintendent of schools who has a
17 program in the schools for the kids, and prevention.
18 And someone asked him: Well, how young is
19 appropriate to start?
20 They start in kindergarten, right away.
21 AVI ISRAEL: I just want to mention that
22 Senator Maziarz does have legislation, it's S-6671,
23 which deals with doctor education, which I think we
24 need to give it a very serious look.
25 SENATOR BOYLE: Absolutely.
143
1 AVI ISRAEL: And hopefully we can --
2 SENATOR ROBACH: And, obviously, the purpose
3 for this forum is to push those things.
4 And we're gonna have a new
5 Health Commissioner, too.
6 And maybe, as you talked about, you know,
7 maybe the Commissioner's on the second floor, doing
8 something different. Maybe this will help be the
9 catalyst, as well.
10 AVI ISRAEL: The second floor definitely need
11 to get -- they need to get involved.
12 SENATOR BOYLE: Thank you.
13 SENATOR ROBACH: Thank you, Mr. Israel.
14 AVI ISRAEL: Thank you.
15 [Applause.]
16 SENATOR ROBACH: Our next testimony will be
17 from Dr. Michael Foster, who is the clinical
18 director of chemical dependency at Unity Health
19 Systems.
20 DR. MICHAEL FOSTER: My name is Mike Foster.
21 I'm a family physician by training, and
22 practice primary-care medicine here in Rochester for
23 23 years.
24 I also am board certified in addiction
25 medicine, and I currently am the director over at
144
1 the Unity Park Ridge Chemical Dependency Treatment
2 Center.
3 Thank you very much, Senator Robach and
4 Senator Boyle.
5 Some of this that I'm gonna say has been said
6 so many times over that I hesitate to say it, but
7 I'm gonna spin on ahead here.
8 Opiate addiction, and heroin addiction in
9 particular, continues to strain our health-care and
10 criminal justice systems.
11 SENATOR ROBACH: Amen.
12 DR. MICHAEL FOSTER: The enormous burden of
13 suffering and ongoing media coverage of the problem
14 has left little room for doubt that we are indeed
15 dealing with an epidemic.
16 The Data 2000 Act provided a very significant
17 tool for treatment of opiate addiction, by making
18 medication-assisted treatment with buprenorphine,
19 also known as "Suboxone," and other manufacturers,
20 by making this medication-assisted treatment
21 available to addicted persons in physician offices
22 and clinics.
23 The recent I-STOP law has already contributed
24 to a drastic reduction in the supply of diverted
25 prescription pain pills.
145
1 These legislative actions have provided
2 essential infrastructure support for
3 addiction-treatment efforts.
4 The American Society of Addiction Medicine
5 defines "addiction" as a chronic, progressive,
6 incurable brain disease characterized by relapses
7 and remissions.
8 The definition is disheartening, but
9 accurate.
10 With treatment, however, there is hope.
11 Remission can be longstanding and sustained
12 with proper treatment.
13 We call this "recovery."
14 Abstinence and recovery allows for
15 normalization of the neurochemical dysfunction that
16 drives the apparent and often criminal behavior
17 associated with active addiction.
18 Recovery is associated with a community-wide
19 reduction in crime and joblessness and
20 incarceration.
21 Recovery results in lives saved and families
22 salvaged.
23 Historically, accepted experience with opiate
24 addiction is that less than 10 percent of patients
25 remain in treatment long enough to achieve a
146
1 remission; whereas, upwards of 80 percent can
2 achieve this with medication assistance.
3 This observation is described in this
4 2003 study from "The Lancet," which I've referenced
5 in my notes, in which the retention rate for opiate
6 addicts with medication-assisted treatment was
7 75 percent, compared to zero percent for patients
8 treated with detox and counseling only.
9 Retention and treatment is of critical
10 importance when dealing with opiate addiction,
11 because retention and treatment is the one variable
12 most strongly associated with a sustained recovery.
13 Medication assistance is essential because
14 the medication allows for the gradual restoration of
15 the neurochemical milieu, which allows the addict to
16 remain in treatment and engage functionally during
17 the treatment process.
18 Today I'd like to make a remark about a
19 lingering encumbrance which I believe hampers our
20 efforts to adequately treat the disease of opiate
21 addiction.
22 First and foremost would be the cap which
23 limits the number of patients that a DEA-waivered
24 physician may treat with buprenorphine or
25 buprenorphine/Naloxone.
147
1 The current law places a 30-patient limit on
2 newly waivered physicians, and allows them to apply
3 for a 100-patient waiver after a year.
4 The cap was surely a prudent and
5 well-intentioned measure at the onset, but our
6 collective experience has subsequently shown that,
7 despite this dramatic success that we have
8 experienced with buprenorphine, the duration of
9 treatment is lengthy, almost always involving a
10 year, or several years, of continuous treatment.
11 This has resulted in a very serious
12 bottleneck effect, such that, in this community, our
13 waivered physicians are nearly always at a point of
14 complete saturation.
15 It's difficult to imagine any other epidemic
16 disease for which a patient might seek care, only to
17 be told the treatment's not available because the
18 doctor can only treat 100 patients in aggregate.
19 This limitation to access expands
20 geometrically in addiction-treatment centers, such
21 as my workplace, where we have thousands of addicted
22 patients who are self-referred and referred by other
23 clinicians; and, yet, that 100-patient cap still
24 applies to the doc.
25 And even with several doctors on staff, we
148
1 really cannot adequately meet the needs of our
2 population.
3 Certainly, it would be more helpful if more
4 physicians obtained the DEA waiver and availed
5 themselves as buprenorphine prescribers.
6 The promised DEA audit is a disincentive for
7 many physicians who might otherwise be willing to
8 apply for the waiver. Indeed, one might even
9 question the need for a waiver in the first place.
10 Why do we require a waiver for the treatment
11 of a disease, when no waiver is required to
12 prescribe the pain-killer medications that
13 perpetuate the addiction problem?
14 SENATOR ROBACH: Amen.
15 DR. MICHAEL FOSTER: Arguably, buprenorphine
16 is safer than most other mainstream opiates.
17 It's my hope that this Task Force might make
18 recommendations to lawmakers to remove or amend the
19 patient-cap limitation for DEA-waivered
20 buprenorphine prescribers.
21 Specifically, I might suggest that we make an
22 effort to double or triple the limit; or, perhaps to
23 make such allowances available for physicians who
24 work in treatment centers that specialize in the
25 treatment of addictive disease.
149
1 This would certainly improve access for vital
2 medication-assisted treatment for heroin- and
3 opiate-addicted people.
4 Opiate addiction is a deadly disease.
5 It's unfathomable to me that our society
6 would limit access for lifesaving treatment to a
7 person with cancer or any other lethal disease; yet,
8 we end up doing just that for those stigmatized with
9 the disease of addiction.
10 Thank you.
11 SENATOR BOYLE: Thank you very much.
12 SENATOR ROBACH: Could I just ask a question,
13 because [unintelligible] won't say.
14 I used to always make my joke, and say: The
15 federal government's a pay cut above us, but, in
16 this one, we really have to work together.
17 And, you know, I think we were all thinking
18 the same thing before, you said: Why have a waiver
19 at all?
20 And I was just wondering why, the federal
21 government, why did they put that waiver in place to
22 begin with?
23 Was there some abuse of the other drug?
24 Or --
25 DR. MICHAEL FOSTER: I thought you guys would
150
1 know that.
2 [Laughter.]
3 DR. MICHAEL FOSTER: I believe that the
4 waiver is in place, because there was significant
5 discussion and back-and forth about whether
6 buprenorphine should be scheduled for use, you know,
7 as an outpatient drug in a more broad setting, like
8 physicians offices; as opposed to a drug like
9 methadone, which can only be administered in a
10 licensed methadone-treatment facility.
11 So I think on one side we had an argument,
12 trying to make access more achievable, less
13 stigmatized. You could go into the doctor's office
14 and get treatment.
15 On the other hand, there was a pushback, I'm
16 sure, that was saying: Look, the doctors are not
17 responsible in how they're prescribing other drugs.
18 Why would we assume they'll be responsible in how
19 they prescribe this one?
20 And there were comments even earlier today in
21 some of the fantastic testimonials that we heard,
22 about Suboxone being misused on the street. About,
23 maybe doctors perhaps not being as scrupulous as
24 they ought to be in -- regarding the behavior of
25 their addicted patients.
151
1 And, certainly, diversion happens.
2 You know, heroin-addicted individuals, when
3 they stray from their -- you know, from their right
4 course of action with their recovery, they will use
5 Suboxone as currency on the street.
6 And that's not okay, and it is vexing.
7 One of the challenges of treating the disease
8 of addiction, is that -- is the behavioral aspect of
9 the treatment.
10 You know, it is a disease, without question.
11 We see the neurochemistry, we see the
12 brain-image studies, we see the neural pathways that
13 open up, that are not there in normal people, that
14 actually emanate from the primitive reptile brain,
15 the mid brain, the source of our instinctive drives,
16 that connect directly to the frontal lobe which is
17 where action and the plans are executed.
18 We see those pathways light up in addicted
19 brains, and normal folks don't have that.
20 So when a normal person gets an impulse to do
21 something to pleasure one's self, it normally
22 circuits through the part of the brain that thinks
23 about consequences and values, and all those --
24 logic, and prior experience.
25 But in the addict's brain, the notion about
152
1 using, it comes on with the strength of a visceral
2 drive, and it goes right to the part of the brain
3 that initiates that action.
4 That's why these folks that normally are
5 loveable and, you know, honorable, and enjoyable,
6 and great people, they become impulsive, and they
7 become criminal.
8 And, you know, in treatment, we can pull them
9 back from the edge.
10 But the other thing that nobody wants to hear
11 is, that this is not a curable disease.
12 You know, in AA they toss about the analogue
13 of saying: Once the cucumber becomes a pickle, it
14 can never again be the cucumber.
15 So those "pickled" folks in AA, they get to
16 decide, you know, number one, if they're gonna live
17 or die. And then they get to decide if they're
18 gonna be a sweet pickle or a sour pickle, but they
19 accept the fact that they are pickles.
20 And so it is with addicts.
21 And there isn't a patient anywhere in the
22 world that wants to hear that kind of story.
23 SENATOR ROBACH: But I just want to make two
24 comments.
25 One is, going back to, I guess I'm in the
153
1 camp, where it's federal or state, or what we can
2 do, that the motivating guide posts should be on the
3 other drug.
4 Your numbers said it exactly.
5 So, without treatment of the appropriate
6 length and some other medication, and you can call
7 it, you know, you're never cured, but you can
8 control it, so we have a different definition of
9 what "cured" is.
10 DR. MICHAEL FOSTER: You can have an almost
11 normal life, and it can be a damned good life.
12 SENATOR ROBACH: Right, but 80 percent, to
13 10, I think were the numbers you used --
14 DR. MICHAEL FOSTER: Yes.
15 SENATOR ROBACH: -- that, to me, would seem
16 that they outta let you use that on the patient's
17 benefit, without waiver, I guess.
18 I'm gonna suggest that's something that we
19 include in ours, because --
20 DR. MICHAEL FOSTER: This is the -- this is
21 the -- there are numerous -- this -- there's all
22 kinds of data to support that perspective.
23 But that is the article that I cited.
24 SENATOR ROBACH: Right. Got you.
25 SENATOR BOYLE: You just also mentioned, from
154
1 your -- in your --
2 SENATOR ROBACH: Now you're hearing from the
3 reptile brain center.
4 [Laughter.]
5 SENATOR BOYLE: -- from your -- in your
6 system, now you said you had numerous physicians,
7 and they're maxed out, if you will, and they're
8 still --
9 Can you just give me actual numbers, or
10 approximate numbers?
11 DR. MICHAEL FOSTER: We have, between myself
12 and other docs, some of whom are part-time, we
13 probably have the equivalent of three full
14 physicians.
15 Nobody wants to hear about the economics of
16 physician reimbursement, but -- but I would point
17 out that somebody has to pay the doctor, and the
18 doctor's gotta earn his keep.
19 And, so, if a doc is so inclined as to be
20 willing to treat addicts, and take the training
21 that's necessary to do that, and avail themselves to
22 that, and then you tell them they can only have
23 100 patients, he can't make a living to do that.
24 And the institution that hires him cannot generate
25 the revenue to hire another doctor.
155
1 It just isn't possible to do that.
2 And the role for physicians in addiction
3 treatment is a limited role.
4 SENATOR ROBACH: Right.
5 DR. MICHAEL FOSTER: You know, traditionally,
6 addiction is treated probably poorly by almost
7 everybody, but, mostly treated by non-physician
8 clinicians. And doctors have a role.
9 You know, I can go on about how important
10 that may be, but it's a peripheral role, it's a
11 niche role. And in the case of opioid addiction, we
12 provide the medicine, we provide the drug, that
13 allows that addict to be well enough to be in
14 treatment, and to stay; hopefully for a long enough
15 time to get better.
16 So of the thousands of patients, my
17 institution, we have over 130,000 outpatient visits
18 a year, but -- and I'm sure there's a lot of money
19 that gets generated doing that, but most of those
20 visits don't involve seeing a doctor.
21 And so, you know, for them to pay me, you
22 know, I see these Suboxone patients, but I can only
23 see 100, and I do a few other things here and there.
24 But there isn't enough role to hire like
25 10 more doctors for the treatment center.
156
1 So the treatment center needs a break.
2 They need -- they need their doc to be able
3 to see more Suboxone patients.
4 And that's just the -- that's the economics
5 of it.
6 AUDIENCE MEMBER: Can I say something,
7 please?
8 SENATOR BOYLE: Yeah.
9 AUDIENCE MEMBER: (No microphone used.)
10 My name's [unintelligible]. I'm here
11 [unintelligible] for Horizon Health Services, and
12 [unintelligible].
13 In Western New York, we have a 45-day wait
14 for somebody to see a Suboxone doctor.
15 We have a 4-month wait to get into a
16 methadone clinic.
17 So you have kids -- again, I'm going back to
18 the insurance nightmare.
19 You have kids that are going through detox,
20 that have no place to go, that are being put back
21 out on the street. And then they have to wait
22 another 45 days to see a Suboxone doctor.
23 SENATOR ROBACH: Right.
24 AUDIENCE MEMBER: That's unacceptable.
25 SENATOR ROBACH: Well, if the federal
157
1 government lifted the waiver, I think it would
2 shorten the time period.
3 So, that's what I meant when I said that
4 should be the guidepost, because, besides medical
5 reimbursement, you have all these people waiting,
6 I don't know what you want to call them, clients,
7 people needing service that you can't service, even
8 though it may save their life.
9 That's pretty crazy.
10 AVI ISRAEL: We only have six doctors in the
11 Buffalo area. The second largest city in
12 New York State, only six doctors that can prescribe
13 Suboxone.
14 SENATOR ROBACH: Is that pretty, uh -- pretty
15 standard for here, too, in Monroe?
16 DR. MICHAEL FOSTER: We have more than that
17 number here, but, you know, there's a lot of docs
18 that will get the waiver. But a lot of these docs
19 are primary-care docs who are very busy, and they'll
20 get the waiver, and they might be willing to see a
21 handful of addicts in their own practice, but they
22 don't necessarily want to throw open the flood gates
23 to the whole city; and, so, you know, that limits a
24 funny thing.
25 You know, for a lot of docs out there, that
158
1 limit doesn't even come close to the number that
2 they're actually seeing. It doesn't affect them.
3 But for docs who have dedicated their
4 practice to the treatment of addiction, or where
5 that's a big part of their practice, it puts a
6 governor on things that really kind of chokes them
7 off.
8 SENATOR ROBACH: And just so I make sure
9 I understand this correctly: So -- you know,
10 I don't mean to diminish this, but let's say you've
11 got somebody who's seeing 30, somebody that's seeing
12 100, if you knew that there was a patient that
13 needed that, would that doctor then refer to this
14 other guy that may not be using his full 30?
15 DR. MICHAEL FOSTER: Oh, sure.
16 SENATOR ROBACH: Okay.
17 DR. MICHAEL FOSTER: Yeah, absolutely.
18 Yeah, in fact, there's enough --
19 SENATOR ROBACH: It sounds like, in
20 Buffalo --
21 DR. MICHAEL FOSTER: -- water finds its level
22 here.
23 Almost all the docs that are willing to see
24 patients in the Rochester area are always near
25 capacity; and that's just how we are.
159
1 And, you know, once we get them in treatment,
2 and they do well and they've shaped up, and it's
3 really the most fantastic thing to observe how
4 desperately ill some of the folks are when they come
5 in, and how really fantastic they look after a
6 while. But then, sometimes, it's hard for us to
7 know what to do with them.
8 Because the best data out there really
9 supports this notion that this is a chronic disease,
10 and, it doesn't mean you're gonna be chronically
11 sick with it, but you gotta take care of it
12 long-term.
13 For a lot of -- nobody knows yet what the
14 optimal duration of Suboxone treatment is.
15 One woman made a comment about, you know,
16 some frustration that her son had been on for years.
17 And, clearly, not everybody needs to be on
18 that long, but there really are a lot of cases
19 where, probably, they need to be on that long.
20 And the end point is hard to define, because
21 there's never a point where there's no risk of
22 relapse.
23 And when relapse happens, you know, then we
24 kind of wish we had thunk the other way, you know.
25 But -- so -- so the incentive to force people
160
1 off Suboxone is not there.
2 That's been tried. There's been studies that
3 have done that. They have disappointingly high
4 relapse rates.
5 So we'd like to be able to let people come
6 off Suboxone at a rate that they're comfortable
7 with, and not always be saturated --
8 SENATOR ROBACH: And I do think, though, that
9 what -- you know, usual medical, science, or
10 quantification sort of dictate that the more you use
11 that, and the more people do it and control it,
12 you'll have some idea.
13 And I know everybody's different, and we're
14 very complex --
15 DR. MICHAEL FOSTER: Oh, absolutely.
16 SENATOR ROBACH: -- but, you know, the
17 physiology of that will come out that, you know,
18 maybe the average of length of time is about a
19 certain amount of years.
20 And then maybe if you got somebody that's not
21 responding, you put them back --
22 DR. MICHAEL FOSTER: We're probably close to
23 that.
24 You know, we talk about best practices in so
25 many areas of medicine. And I think that kind of
161
1 information is, you know, coming forth, people are
2 sharing their experience.
3 And I think we'll have some consensus with
4 time, but it isn't gonna be that this is a
5 short-term quick fix. You know, that isn't going to
6 be the result.
7 SENATOR ROBACH: Thank you very much.
8 SENATOR BOYLE: Thank you very much, Doctor.
9 DR. MICHAEL FOSTER: Thank you very much for
10 having me.
11 SENATOR ROBACH: We have one last --
12 Thank you, Doctor.
13 [Applause.]
14 SENATOR ROBACH: I just want to say, before
15 we get to our last speaker, too, in addition, and
16 thank everyone who came, testified, this has been
17 great, I think. And I think you're gonna see some
18 good results from this.
19 I don't always say this at every hearing
20 I participate in on different things, but, a number
21 of people, also, and I want to thank them, did give
22 written testimony, too. And some people who had
23 very personal stories were not comfortable with
24 standing up and saying them, but they included their
25 testimony in this, too. And that's going around the
162
1 state as well.
2 So, thank you.
3 And with that, we will get to our last
4 speaker, who is Lisette Castro, from
5 Trillium Health.
6 LISETTE CASTRO: Hi.
7 Thank you for letting me speak,
8 Senator Robach and Senator Boyle.
9 My name is Lisette Castro, and I'm the
10 Harm Reduction Coordinator for Trillium Health's
11 Syringe-Exchange Program.
12 "4,011 clients."
13 4,011 clients since the program started in
14 1994.
15 1,907 clients since April 2012, to April of
16 2013.
17 18,234 syringes handed out last month.
18 We do have Narcan available for clients and
19 their families, and anyone who is willing to carry
20 Narcan, who is around somebody who is using, can
21 properly inject them and reverse an overdose.
22 Last week I had 14 clients who came to us and
23 told us that they had reversed an overdose.
24 So on top of the people that did pass away
25 within the last couple of months, that number would
163
1 have increased substantially.
2 We can hand out Narcan; however, because
3 Narcan has to be given in a prescription form, that
4 is what's stopping us in getting more Narcan out
5 there.
6 This is not a problem that is new to us. We
7 have been seeing this problem for quite a while.
8 We knew; because of history, and the quantity
9 and the quality of heroin out on the street was weak
10 for a couple of years, we knew that this would come
11 back around.
12 Back in 2000 we had quite a few overdoses
13 because of the tainted batches of heroin. Then that
14 kind of slowed down.
15 So the price of heroin went from $20 a bag,
16 to $10 a bag, because of the lack of quality.
17 Now it's back up to $15, and in some places
18 $20 a bag, because it's more potent and people
19 overdose.
20 People are still scared to come and ask for
21 help because, here I get 10, 15 clients a week that
22 want to go into treatment. We have one detox with
23 37 to 40-some beds.
24 Like I said, I'm serving 1,097 clients a
25 year.
164
1 What is that amount of beds?
2 It does nothing for our clients, at all.
3 The one thing that all the clients always
4 say, "It sucks to be an addict in Monroe County."
5 I've been in this field 16 years, and when
6 I first started, we were able to send people outside
7 of Monroe County for detox and inpatient because
8 they were lengthier programs.
9 With the changes in the HMO, no outside
10 Monroe County help.
11 And, now, the insurance companies have to
12 decide whether this patient can detox at home, or
13 needs to be detoxed medically.
14 And who's the one with the pain? The client.
15 They know their situation best.
16 We need more education in high schools.
17 When I do have conversations with clients,
18 which is every day, because, the way I know my
19 information, is I get it from them.
20 There is no education in high schools, in
21 elementary, about heroin.
22 SENATOR ROBACH: Right.
23 LISETTE CASTRO: When I do educational
24 presentations about the effects of heroin to
25 juvenile delinquents, and in some high schools, the
165
1 first thing I ask is: Do you know you can die from
2 heroin?
3 And the answer is: No.
4 They do not know the addictiveness of heroin.
5 They believe it's a drug just like marijuana, where
6 you can smoke marijuana one day, and then never
7 touch it again.
8 They're not knowing the addictiveness of
9 heroin.
10 And, as parents, as educators, we urge people
11 to educate their kids, and, put in more education.
12 We have come a long way as far as HIV
13 prevention with IV-drug users.
14 When we first started our program right in
15 Rochester, in Monroe County it was pretty high,
16 people getting infected with HIV because of IV-drug
17 use.
18 It has dramatically decreased because of our
19 program; however, heroin is on the rise again.
20 We do meet people where they're at, but when
21 they want to get into a program, we refer them, and
22 we put them where they're supposed to be.
23 But as a -- as human-service workers, it
24 sucks when our hands are tied behind our back when
25 we have a client saying: Look, I can't do this
166
1 anymore. I need to go in a program.
2 Insurance barriers. Bed availability.
3 Do the treatment actually works for the
4 person?
5 The Suboxone, buprenorphine, the reason why
6 the 30 patient, was because they wanted the doctor
7 to be able to not just prescribe the pill, but to
8 take care of the client all the way around:
9 inpatient, counseling.
10 If a regular primary doctor, who does not
11 work with people and drug addiction, they're not
12 gonna -- they're just gonna prescribe the pill, and
13 then you're gonna get those that constantly
14 relapsing from the pill.
15 More of the Suboxone providers are in
16 mental-health facilities and substance-use
17 facilities.
18 Do we need to get more out there? I believe
19 so.
20 But, of course, it has to -- you have to work
21 around the whole thing. It just can't be
22 prescribing the pill, "I'll see you back in 30 days
23 for your refill."
24 It's not gonna work.
25 Methadone program here in Rochester,
167
1 six months to a year waiting list, two programs in
2 Rochester.
3 I have 4,000 clients.
4 Two methadone programs.
5 Thank you for your time.
6 SENATOR ROBACH: Yeah, let me -- just to --
7 Thank you.
8 And, you know, I would say this: I sense
9 your frustration.
10 But I do want to thank you, because I think
11 Trillium does a lot of good things.
12 LISETTE CASTRO: Thank you.
13 SENATOR ROBACH: And we'd be worse off
14 without it.
15 I was just curious again, because I don't
16 want to get all bogged down in it:
17 So, do you have doctors that work with you?
18 How do you get Narcan now?
19 LISETTE CASTRO: Our Narcan is through the
20 Harm Reduction Coalition.
21 SENATOR ROBACH: Okay.
22 LISETTE CASTRO: So anyone can come to us and
23 be trained on Narcan. Preferably our clients, but
24 anybody who's around.
25 SENATOR ROBACH: And that's like a waiver;
168
1 right?
2 LISETTE CASTRO: Right. They'll have this
3 little blue card that I sign off on, that says
4 they've been trained in opiate overdose. And they
5 can legally administer the Narcan, with that card.
6 Our physician also gives them a prescription
7 that legalizes them to carry the Narcan.
8 So part of that: They're supposed to call
9 911 in between that, but they are legal to carry and
10 administer the Narcan.
11 SENATOR ROBACH: I just want to ask you one
12 other question, too, because, you know, this has
13 really been helpful, and I think we really are gonna
14 come up with some good things. And maybe this is my
15 old-guy brain.
16 See, I don't get that what you said about
17 that.
18 I'm always thinking that these people are
19 getting addicted, the young people, because there
20 are similar receptors in the brain, and they're
21 doing this other stuff, that they think that's not
22 as dangerous, which leads them to what really is
23 dangerous.
24 You kind of said something different.
25 I mean, I don't even like getting a shot from
169
1 a doctor when I know it's gonna help me, go to that
2 step.
3 You know, it's hard for me, really, like a
4 16-year-old girl is going: I'm not afraid to inject
5 myself, and I don't think there's anything bad.
6 But if that's the case, we have to then
7 really gotta, maybe, even have some multipronged
8 approaches, even inside our public awareness,
9 because that's kind of a different thing.
10 I mean, I don't want to get too
11 autobiographical, but, you know, I grew up in the
12 city of Rochester, too, and there were certain
13 things that you just -- even your older brothers, or
14 even the kids you who were doing other stuff with,
15 or drinking, they would say: Get away from that
16 guy, you don't mess around with that. That'll kill
17 you.
18 If the kids don't know that now, that's very
19 scary to me.
20 LISETTE CASTRO: And --
21 THERESA DELONE: (No microphone used.)
22 Can I just add something?
23 My son -- I'm sorry [unintelligible].
24 If you would talk to my son, he would tell
25 you, he was one of the ones who said: I will never,
170
1 ever stick a needle in my arm.
2 SENATOR ROBACH: Right, but that's what I'm
3 saying. So there's two different --
4 THERESA DELONE: It makes no difference.
5 They're way far into their addiction.
6 SENATOR ROBACH: Right. There seems to be
7 two different tracks.
8 And what's coming out in the testimony very,
9 very much, it seems like the explosion of this has
10 definitely been linked to, I'm really starting to
11 believe, almost scientifically, that using those
12 other opioid drugs that are over this --
13 pharmaceutical, and I won't call them controlled,
14 but you know what the dosage is.
15 It's a little bit more controlled; therefore,
16 Not good, but not as explosively dangerous to death,
17 is leading to people that normally wouldn't do what
18 your son did, Well, if I can't go get that, I'll
19 take whatever I can get, because I need something.
20 But, what this young lady, Lisette, said, is
21 in addition to that, there's people that think
22 trying heroin maybe at a party, or something, is no
23 different than smoking marijuana, that's a different
24 population group, and that's very scare to me.
25 LISETTE CASTRO: And it's different.
171
1 I mean, I've been working in this field
2 16 years. And when I first started, the age
3 difference from the ones I'm seeing now, were more
4 than 30s, 40s late 50s.
5 Now, the youngest client have I right now,
6 I believe she's 16 years old.
7 SENATOR ROBACH: Oh, geez!
8 LISETTE CASTRO: The regular clients right
9 now on a regular basis are between 16 and 25.
10 And another thing with this crowd, your older
11 crowd would sniff the heroin or sniff the opiates
12 until, you know, they were spending too much money,
13 so then they would mainline and go ahead and inject.
14 See, the younger generation is sniffing,
15 maybe, for less than 30 days, or maybe not even
16 sniffing the heroin, and then going straight to
17 injecting.
18 So it's a lot different than what we used to
19 see back 15, 20 years ago.
20 So I hope, and I'm --
21 SENATOR ROBACH: Well, hopefully they're
22 seeing now, because it's all over, from our
23 backyards, to our colleges, to Hollywood, and
24 everywhere else, people are dying.
25 So, I hope people are paying attention to it
172
1 for their own sake.
2 LISETTE CASTRO: So do I.
3 Thank you so much for this opportunity.
4 SENATOR ROBACH: You're welcome.
5 Thank you.
6 SENATOR BOYLE: Thank you very much. We
7 really appreciate it.
8 SENATOR ROBACH: You want to close us out?
9 [Applause.]
10 SENATOR BOYLE: I'd like to thank
11 Senator Robach and his staff for hosting this today,
12 and for all the presenters, and everyone who came in
13 support, and advocates.
14 I do know that if you were not able to speak
15 today, you can contact my office.
16 Just Google it, in Albany. Deanna and Susan
17 here, we're gonna be taking testimony and ideas from
18 everyone.
19 Anything you can think of between now and
20 June 1st, please let us know.
21 And I can say that we got a lot of good ideas
22 out of today's testimony, and, it's gonna be part of
23 the report, and part of the legislation, presumably,
24 that we see in the coming weeks and months.
25 And thank you again.
173
1 We're gonna beat this heroin epidemic
2 together.
3 Yes?
4 THERESA DELONE: (No microphone used.)
5 [Unintelligible.]
6 SENATOR ROBACH: Theresa, could we stop you?
7 I don't think we could.
8 THERESA DELONE: I'm wondering, as people who
9 are sitting here listening to all this testimony,
10 what can we continue to do to help you get these
11 things through?
12 Because as I said, many times, our kids are
13 dying.
14 SENATOR ROBACH: We will come back to you.
15 So, there will probably be some
16 recommendations. Probably some -- not probably.
17 Definitely be some kind of legislation to deal with
18 some of these things, on everything from, you know,
19 the very end, the other way, to, you know, what
20 Mr. Israel talked about, of how we can advertise
21 better, to how we can enforce.
22 And then I think the big one and the hardest
23 one will be, you know, what we can do, you know,
24 Senator Boyle has been working on legislation about
25 insurance coverage.
174
1 And then, also, creating a little bit more of
2 an infrastructure, uhm, so if people do need that
3 longer stay, they can get that. And then deal with
4 the things Dr. Foster talked about. Maybe even
5 after that, they may need something else.
6 I'm not an expert.
7 I don't know if the other drug is better than
8 methadone.
9 I just think it's so hard, because everybody,
10 you know, on length of their addiction, their own
11 physiology, it's not an exact science kind of thing.
12 But we're gonna do all those things.
13 And so when those come out, I think that will
14 also be in the newspaper.
15 And we'll hope that, you know, you will
16 advocate for those things, and talk to people who
17 are in the legislative field, from the Governor, on
18 down, to say: Let's at least try some of these
19 things, if not all of them, and then maybe we'll see
20 a different environment in the future.
21 And then, again, we could all do that, you
22 know, whether it's Facebook, whatever it is.
23 I mean, I do have to say, it's just -- you
24 know, I'm a father, too, and it kills me when I hear
25 those things.
175
1 It's almost hard for me to believe that, in
2 today, with all the medicine we have, that, you
3 know, people are dying from this. But they are.
4 But, my God, we also got all do a part early
5 on.
6 You know, we're gonna try to do what we can.
7 But, quite frankly, I'm gonna know my kids.
8 And I know, probably, more kids in the community.
9 But I don't know yours.
10 And, earlier, people also can't be afraid to
11 make that jump and say it's bad.
12 You know, you've gone through it: The longer
13 you wait to take the fight, the harder it's gonna
14 be.
15 So, we can all do that, too.
16 I don't know what else to do.
17 It's a challenge, but, we're gonna be on it.
18 AUDIENCE MEMBER: (No microphone used.)
19 Could I mention something?
20 SENATOR BOYLE: Yeah.
21 AUDIENCE MEMBER: [Unintelligible.] I'm a
22 senior vice president of marketing communications at
23 BlueCross/BlueShield of Western New York.
24 I know health-insurance companies get banged
25 a lot, but I have to tell you that, Horizon Health
176
1 Services came to us about three years ago, saying,
2 outpatient treatment is not working, and it's not
3 effective.
4 You'd spend less money by paying and covering
5 residential treatment that goes for at least
6 three months, than to pay all this, and cover by
7 insurance all this outpatient treatment.
8 And we said: We're in.
9 In five minutes, we said: We will run the
10 pilot.
11 And then we expanded the pilot a year ago.
12 So I just ask for -- to -- you know, we --
13 when Avi Israel came to us, I mean, we put 300,000
14 bucks behind this thing, and 100 meetings, to get
15 this thing off the ground.
16 95 percent awareness in Western New York in
17 the 8 counties in 4 months.
18 So, not everything that health-insurance
19 companies do is bad, and I just ask you for that,
20 for that perspective.
21 And also for those -- for the
22 health-insurance companies who are actually stepping
23 into this thing, recognizing that there's better
24 ways and better solutions, and that we have an
25 obligation to leverage our example, to put pressure
177
1 on other health-insurance companies who aren't doing
2 it, because we are a community-based not-for-profit
3 health-insurance company.
4 And there's a lot of not-for-profit
5 health-insurance companies in this state, but
6 leverage some of the stuff that we're doing and
7 other people are doing that are really completely
8 surprising by the community that we would ever do
9 it.
10 And, yet, we're making decisions in
11 five minutes, not by committee.
12 So I just want to bring that perspective,
13 because, you know, we put a lot behind it, because,
14 you know what? We have 1800 associates that work
15 for our company, and we're parents, too.
16 SENATOR ROBACH: Right, and that's a good
17 point.
18 You know, the other thing, certainly not
19 hostile to insurance, but, you know, maybe those
20 pilots, and that's why they're called "pilots," if
21 they're working, maybe we can see some expansion of
22 those across the state.
23 AUDIENCE MEMBER: And we are expanding, and
24 we love to share that information, so that we can
25 leverage what we're doing to put pressure on other
178
1 health-insurance companies to follow suit.
2 SENATOR ROBACH: Thank you.
3 AUDIENCE MEMBER: I just don't want to be --
4 we're not all -- you know, I mean, we are doing some
5 good things, and, often, we're above oil and tobacco
6 on a good day.
7 [Laughter.]
8 SENATOR BOYLE: Well, I do want to thank you
9 for those comments. And, you have a great company.
10 That's why I use you.
11 AUDIENCE MEMBER: We're not Excellus.
12 We're BlueCross/BlueShield of
13 Western New York.
14 SENATOR BOYLE: But, do you -- if you could,
15 please, we're gonna have 10 more forums around the
16 state. If you could have someone give some
17 testimony, or let us know about your program and
18 your pilot, we would love to hear about it.
19 AUDIENCE MEMBER: Great.
20 SENATOR ROBACH: Thank you very much.
21 (Whereupon, at approximately 1:03 p.m.,
22 the forum held before the New York State Joint
23 Task Force on Heroin and Opioid Addiction
24 concluded, and adjourned.)
25 ---oOo---