Public Hearing - April 23, 2014
1 BEFORE THE NEW YORK STATE SENATE MAJORITY COALITION
JOINT TASK FORCE ON HEROIN AND OPIOID ADDICTION
2 ------------------------------------------------------
3 PUBLIC FORUM: RENSSELAER COUNTY
4 PANEL DISCUSSION ON TROY'S HEROIN EPIDEMIC
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7 Hudson Valley Community College
Bulmer Telecommunications Center Auditorium
8 80 Vandenburgh Avenue
Troy, New York 12180
9
April 23, 2014
10 9:30 a.m. to 12:30 p.m.
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PRESENT:
13
Senator Philip M. Boyle, Task Force Chairman
14 Chairman of the Senate Committee on Alcoholism and
Drug Abuse.
15
16 Senator Kathleen A. Marchione, Forum Moderator
17 Senator Joseph E. Robach
18 Assemblyman Steven F. McLaughlin
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PANELIST OPENING STATEMENTS: PAGE
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Derek Pyle 13
3 Captain
Rensselaer County Sheriff's Department
4
Daniel Jones 14
5 Lieutenant
Saratoga County Sheriff's Department
6
Craig Apple 14
7 Sheriff
Albany County
8
David Bartlett 15
9 Sheriff
Columbia County
10
Tony Jordan 16
11 District Attorney
Washington County
12
Steven McLaughlin 17
13 Assemblyman
New York State
14
Lisa Wickens 18
15 Registered Nurse, and a parent
16 Theodore J. Adams, Jr., MS, IMH, CAP 25
Department Chair of the Human Services
17 and Chemical Dependency Counseling
Curriculum programs
18 Hudson Valley Community College
19 Daniel Farley 27
Assistant Principal
20 Ichabod Crane High School
21 William Murphy, M.D. 28
Family Physician
22 Chatham Family Care Center
23 Beth Schuster, BC, CASAC 31
Executive Director
24 Twin County Recovery Services, Inc.
25
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PANELIST OPENING STATEMENTS (Continued): PAGE
2
Keith Stack 36
3 Executive Director
Alcoholism & Substance Abuse Providers
4 of New York State, Inc.
5 Katherine G. Alonge-Coons, LCSWR 38
Commissioner
6 Rensselaer County Mental Health
7 Dan Almasi 49
Dual Recovery Coordinator
8 Columbia County Department of
Human Services
9
Peter Lacy, LCSWR, CASAC 55
10 Acting Coordinator
Saratoga County Mental Health Center
11
Stephen Acquario 58
12 Executive Director
New York State Association of Counties
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TASK FORCE MEMBERS Q&A TO PANELISTS 65
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AUDIENCE PARTICIPATION:
17
Father Peter Young 107
18 Chaplain
New York State Senate
19
Patty Hoffman [ph.] 117
20 Field Representative
Office of Congressman Chris Gibson
21
Henry Bartlett 120
22 Executive Director
Committee of Methadone Program
23 Administrators
24 Dr. Ishmael 127
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AUDIENCE PARTICIPATION (Continued): PAGE
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Beth Lane [ph.] 132
3 (Question read by Senator Marchione)
4 Lou Dessau 137
Deputy Commissioner for Mental Health
5 Rensselaer County
6 Unknown Audience Member 146
(Question read by Senator Marchione)
7
Richard Noelle [ph.] 148
8 Resident
Troy, New York
9
Martha Mahoney 157
10 Student
(Question read by Senator Marchione
11
Cassandra Martell [ph.] 158
12 Personal Story
13 Leanne [ph.] 162
14 Jessica Tobin [ph.] 166
(Question read by Senator Marchione)
15
Unknown Audience Member 167
16 (Question read by Senator Marchione)
17 Martha Mahoney [ph.] 170
Student
18 SUNY Albany
19 James Houlihan [ph.] 171
Retired Pastor
20 (Question read by Senator Marchione)
21 Karen Hall 177
Nurse Practitioner
22
Unknown Audience Member 188
23 (Questions read by Senator Marchione)
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AUDIENCE PARTICIPATION (Continued): PAGE
2
Mike 188
3 Personal Story
Resident of East Greenbush
4
Ruth Clements [ph.] 191
5 (Question read by Senator Marchione)
6 David Burns [ph.] 196
Substance-Abuse Counselor
7 St. Mary's Hospital, Amsterdam, NY
8 James Cooper 199
Resident
9 Averill Park, New York
10
11 ---oOo---
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1
2 SENATOR MARCHIONE: [Inaudible] here for
3 today's forum.
4 I'm Senator Kathy Marchione, and I represent
5 the 43rd Senate District, which is comprised of
6 parts of Saratoga, Rensselaer, Washington County,
7 and all of Columbia County.
8 We have a full lineup today of a terrific
9 panel, so with your help, I would like to call our
10 community forum to order and get underway.
11 I'd ask that you please stand and join me in
12 the Pledge of Allegiance.
13 (All in attendance recite, as follows:)
14 "I pledge allegiance to the flag of the
15 United States of America and to the republic for
16 which it stands, one nation under God, indivisible,
17 with liberty and justice for all."
18 SENATOR MARCHIONE: I'd ask that you continue
19 standing for just a moment, for a moment of silence
20 in memory of all those who have lost their lives to
21 drug abuse.
22 (A moment of silence was observed.)
23 SENATOR MARCHIONE: Thank you.
24 Right now, I would like to introduce my
25 colleague Senator Phil Boyle.
7
1 Senator Boyle represents the
2 4th Senate District, which is located in
3 Long Island. And he chairs our Joint Senate Task
4 Force on Heroin and Opioid Addiction, which
5 I proudly serve on.
6 Senator Boyle also chairs the Alcohol and
7 Substance Abuse Committee.
8 He is the driving force behind this
9 Task Force, as well as other forums and hearings
10 that are taking place statewide.
11 I want to commend Senator Boyle for having
12 the foresight, the vision, and the compassion to
13 make addressing this issue a priority.
14 Senator Boyle.
15 SENATOR BOYLE: Thank you, Senator.
16 And I, too, would like to thank
17 Senator Kathy Marchione for hosting this forum, and
18 the Hudson Valley Community College for hosting us.
19 And I also thank my colleague Senator Robach
20 for joining us. Senator Robach is from Rochester.
21 Senator Marchione has been a leader in this
22 fight since we discussed it.
23 As many of you know, this heroin epidemic and
24 opioid epidemic is a statewide problem, and it
25 speaks to what's going on right here.
8
1 I'm from Suffolk County out on Long Island.
2 We have Joe Robach from Rochester,
3 Kathy Marchione from the Capitol Region.
4 And it is affecting lives, and costing lives,
5 throughout the state, and throughout the country.
6 This is the fourth of what's going to be
7 14 forums around the state, and it's -- this --
8 I cannot think of a more distinguished panel than we
9 have here today.
10 I'd like to thank all the panelists, and
11 thank everyone coming here today. I look forward to
12 a great exchange of ideas.
13 We've gotten some good ideas for legislation.
14 Basically, the Task Force is -- the mission
15 of the Task Force is to report to the State Senate
16 by June 1st with ideas for legislation. We'll then
17 have about two or three weeks after that, before the
18 end of session, to pass these bills. And we're
19 focusing on prevention, treatment, and law
20 enforcement, and any other ideas you can think of.
21 So please feel free, if you've had family
22 tragedies, if you have a law-enforcement background,
23 whatever you bring to the table, we need ideas for
24 legislation.
25 Thank you again, Senator.
9
1 SENATOR MARCHIONE: You're welcome.
2 Senator?
3 SENATOR ROBACH: Yes, good morning.
4 We really want to hear from you, but let me
5 just add, very briefly:
6 Thank Senator Boyle for putting these
7 together. There will be 14 of these hearings across
8 the state.
9 And, certainly, Senator Marchione for having
10 it here.
11 It has been amazing, even to me, who --
12 I have worked in the public-safety arena before
13 elected office. But would I just say this:
14 That this usage of the opioids turning into
15 heroin usage, and the strength and the potency, as
16 well as flooding the market with cheap heroin, has
17 been amazing.
18 I'm learning about the rest of the state, but
19 where I live in Rochester, and the Monroe County
20 area, our fatalities went from 12, to 65. And
21 that's with 101 people being saved from OD death
22 through the usage of Narcan, or that number would
23 even be higher.
24 And we're learning from these hearings that
25 this is not isolated even just to one part of the
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1 state. It is the whole state, it is really the
2 whole country, we're finding out, as we go along.
3 So it's very important that we hear from
4 everybody, and as Senator Boyle said, then take the
5 appropriate action.
6 We're getting a lot of good ideas from
7 different areas; but, certainly, we want to let
8 people know, first and foremost, that this is a
9 different, more powerful, potent drug than ever
10 before on the streets anywhere. Number one.
11 And, number two: We're hearing from people
12 that we need some different treatment modalities to
13 try and, hopefully, make people be able to control
14 that addiction a little bit better.
15 And then, lastly, I think we are gonna have
16 to change some laws on distribution, and other
17 things, to stop this flood.
18 And then, lastly, and I'll give
19 Senator Boyle, you'll learn about this if you don't,
20 the usage of Narcan, which for some people has been
21 a little bit controversial, is really now going from
22 EMTs, right into everyday people's homes, where you
23 can save the life of your loved one or your neighbor
24 in the case of a bad incident.
25 So, good things are happening from this
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1 forum, and we're very anxious to see what's on your
2 mind, too.
3 And, hopefully, at the end of this, really
4 make and implement some changes that will be
5 lifesaving, and save some people from this terrible
6 hell and addiction.
7 Thank you.
8 SENATOR MARCHIONE: Thank you.
9 I'd like to give a special thank you to the
10 Hudson Valley Community College President,
11 Drew Matonak, and his professional staff. They have
12 been absolutely amazing to work with. And, the
13 beautiful refreshments. I don't know if you availed
14 yourself of any, but we will have a break and you
15 can go over.
16 But, just, thank you so much for everything
17 you've done in order for us to hold this forum.
18 And I'd like to thank all of you for being
19 here. And I'd like to thank the press for joining
20 us today.
21 You know, today's forum is not about
22 politics. It's a forum about hearing from experts
23 that we have on the panel, and it's about hearing
24 from all of you, and beginning an important
25 conversation, to help find solutions.
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1 Here are some facts and statistics about the
2 rise of heroin and opioid use and addiction that
3 show the scope and severity of this challenge.
4 A 2012 federal Survey on Drug Use and Health
5 reported that the number of people who said they
6 used heroin in the past 12 months rose from
7 373,000 people in 2007, to 669,000 people in 2012.
8 It was reported, the number of people
9 dependent on heroin rose from 179,000 people in
10 2007, to 369,000 people in 2011.
11 In the Upstate Poison Control, reported
12 heroin-related overdose calls in the
13 Capital District alone in 2003 were 14.
14 Increased heroin and opioid use, abuse, and
15 addiction are serious problems affecting real
16 people. Behind each statistic is a real person, is
17 a soul, who needs our help.
18 For the first half of today's forum, we will
19 hear from our distinguished panel.
20 Once we come back from a short break, for the
21 second part of today's forum, we will hear -- we
22 will take questions and comments from the audience.
23 You can submit your question on a card -- on
24 a 3x5 card. If you don't have one, my staff as
25 available. You can just raise your hand at any time
13
1 and they'll be happy to bring you a card so you can
2 do that.
3 Or, you can certainly come to the microphone.
4 We have microphones set here and here, that you can
5 come forward to and speak at.
6 It's my privilege to introduce the members of
7 our expert panel.
8 What I'm going to do, to save time, is I'm
9 going to introduce our first, which is my far left.
10 I'm going to ask our panel to please make
11 their statement at this point pretty short and
12 concise. We've left about 45 minutes for this
13 period of our program.
14 And I'd like to start with Derek Pyle,
15 Captain in the Rensselaer County Sheriff's
16 Department.
17 CAPTAIN DEREK PYLE: Well, I have no problem
18 making it short.
19 SENATOR BOYLE: We want to hear what you say,
20 though.
21 CAPTAIN DEREK PYLE: We are on the same page
22 I think, and I'm sure everybody in this room, with
23 the problems that these issues are causing our
24 communities.
25 So what I'd say I'm sure is gonna be
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1 amplified and expanded upon by the experts farther
2 down the line, but, I will say that I'm happy to be
3 here.
4 And I see a lot of people in the room that
5 the Sheriff's Office and myself have worked with in
6 the past on just these issues.
7 So, I'm very much looking forward today to
8 seeing what comes out of this, and hopefully hearing
9 some new things, and, some resources that all of us
10 can work on.
11 So, thank you very much.
12 LT. DANIEL JONES: Lieutenant Daniel Jones
13 from Saratoga County.
14 I'd like to thank the Senator for inviting us
15 here today.
16 In Saratoga County we've also noticed a rise
17 in heroin over the last few years, and several
18 deaths attributed to that.
19 And, we're happy to come down here and
20 contribute to the cause, to help prevent this.
21 Thank you.
22 SHERIFF CRAIG APPLE: Good morning.
23 Craig Apple, Albany County Sheriff.
24 First of all, thank you to the electeds in
25 the Assembly and the Senate for holding this forum,
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1 and bringing to the forefront, basically, what's
2 going on in the Capital District, and throughout the
3 state.
4 You know, I focus mostly on Albany County,
5 and where we've seen 78 percent increase from '12 to
6 '13, and 62 percent increase from '13 to '14.
7 And right now we're on par to jump by another
8 100 percent in 2014.
9 So it's, uhm -- a lot of people have turned
10 their heads to this, and I truly believe it is a
11 public-health epidemic. I don't think it's,
12 certainly, law enforcement's issue alone.
13 I also want to point out, we've been working
14 closely with Dr. Daly (ph,) who's down in the front
15 row, who took chances before the rest of the state
16 would come out with Narcan and naloxone. And, he's
17 been out pushing it to the law enforcement and to
18 the medics in the area, to try to get this out there
19 and save lives.
20 People have to pay attention to what's going
21 on.
22 So, thank you for hosting this forum.
23 SHERIFF DAVID BARTLETT: My name is
24 David Bartlett. I'm the Sheriff of Columbia County.
25 I'd like to thank, again, all of our elected
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1 officials for having us; Senator Marchione.
2 Again, we have an epidemic going on here,
3 folks.
4 And I would also like to thank Dr. Daly.
5 He's -- he laughed yesterday. He's laughing
6 there in the front row now.
7 I called him a "rock star" yesterday, because
8 he's getting this naloxone -- or the Narcan -- out
9 into our hands.
10 And, we have to work together.
11 It's not just the EMS providers or the
12 law enforcement or our elected officials. This has
13 to be a coalition of everybody, working together, to
14 make our streets safer.
15 And that's what we're here to do.
16 And I'm proud to say, down in
17 Columbia County, we're starting to push the Narcan
18 hard, and I'm sending as many deputies as I can.
19 And my ultimate goal is to get every police
20 officer in Columbia County certified, to get out
21 there and save some lives.
22 So, thank you for having us.
23 TONY JORDAN: Tony Jordan.
24 It's great to join my colleagues, on my left,
25 in law enforcement.
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1 And thanking my former colleagues, to my
2 right, in hosting this very important forum.
3 And it's occurring statewide. It's not
4 limited to New York.
5 And, it very much is a public-health risk.
6 It's a public-health risk for the users.
7 It's a public-health risk for their families,
8 because of the challenges, emotionally, that they
9 face.
10 But, also, you know, I think, unlike any drug
11 we've seen, heroin attacks in such a unique and
12 different way, that the public-health risk to the
13 community at large is from the efforts someone who's
14 addicted will go to gain access to the money
15 necessary to buy the drug that demands their
16 immediate attention.
17 And so, you know, this forum is so very
18 important to keep the attention focused, to find the
19 coalition, or, to develop the resources necessary,
20 quite frankly, to address the problem from far more
21 than just law enforcement; but from across all of
22 those that are [unintelligible].
23 So, thank you.
24 ASSEMBLYMAN McLAUGHLIN: I'm
25 Assemblyman Steve McLaughlin, from the
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1 107th District; most of Rensselaer County, and a
2 little bit of Washington and Columbia, as well.
3 And it's good to be here with my colleagues
4 from the Senate: Senator Robach and Senator Boyle,
5 and, certainly, Senator Marchione.
6 I want to Senator Marchione for putting this
7 panel together.
8 And I'm certainly no expert on the topic,
9 thank God, I guess, in a way, but I am a father of
10 two teenage boys, and this scares the heck of me.
11 As a legislator, it's scary.
12 I know nothing, truthfully, about this world,
13 but we've all been more and more exposed to it, and
14 we're learning every day.
15 And just the other day, I read out in
16 Syracuse, 5 overdoses in a 24-hour period, just in
17 the city of Syracuse.
18 So, as a dad it scares me. As a legislator
19 it scares me.
20 And, I want to thank all of you for being
21 here, as well, so that we can all learn, and move
22 forward together.
23 LISA WICKENS: Good morning.
24 My name is Lisa Wickens. I'm a registered
25 nurse, and I'm a mom.
19
1 I actually have a few comments that I really
2 think is important to go over.
3 It's been 10 years, right now, and my child
4 is good today; so today is a good day.
5 I was also a public servant for 23 years,
6 working for Albany County, and I was the deputy
7 director of the Office of Health Systems Management
8 in the Department of Health.
9 So, I fixed crisis. I was fixing; helping
10 everyone in New York State.
11 But when it came to opioid addiction,
12 I couldn't help my family. I lost a stepson. And,
13 many times, my son actually overdosed.
14 So I'm gonna go over a few issues that
15 happened in our lives, really quickly, very
16 succinctly, and then tell you, I think, where
17 I believe some of the gaps are.
18 So our pediatrician told us: At 16, it was
19 my child's choice.
20 There was no adolescent addiction counselors,
21 or at least at that time, in the area.
22 So, we actually started outpatient treatment,
23 with group therapy, at 17, which was about 20 other
24 kids in the same age group, all talking about
25 something. So they would walk out and exchange
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1 where they could actually go through and get the
2 drugs.
3 So, what we thought we were doing in the
4 right way, was actually putting them in touch with
5 people that could actually get the drugs.
6 So then we actually -- we asked -- he asked
7 for help. He asked for intense help.
8 The insurance would only cover outpatient
9 therapy, so we continued with outpatient therapy.
10 Then he -- then my child actually had his first
11 overdose.
12 Then my child began Narcotics Anonymous,
13 Alcoholics Anonymous; tried many times to stop
14 drugging.
15 And, again, we asked for assistance. Again,
16 denied.
17 Overdoses the second time. Asked for help
18 again.
19 Insurance needs -- says to me: Your child
20 needs to fail so many times within six months in
21 outpatient therapy before you can get your child
22 into inpatient therapy.
23 I said: Well, that's great, but, I'm gonna
24 lose my child before you decide he can go in.
25 So then, thankfully, through working and
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1 trying to educate, and learning from many different
2 folks in the community, we learned about
3 medication-assisted treatment; actually, Suboxone.
4 And, my child began -- starting to recover.
5 Stress and depression, as everyone may know,
6 is part of addiction and recovery.
7 So, at that point, there was a relapse, and
8 then a suicidal attempt.
9 Back -- my child comes and says: I need
10 inpatient therapy. I need help.
11 "Denied."
12 Overdose number three.
13 Now, at this point, in the hospital, rubbing
14 his sternum to keep him breathing so that he doesn't
15 end up on a ventilator.
16 Finally, I leave public service, because
17 I decide I need -- I don't have enough money,
18 unfortunately, working in public service, to get any
19 care.
20 So, I took a home-equity loan -- left public
21 service as the deputy director for the Department of
22 Health. Took a home equity loan, and moved my child
23 out of state, and then to -- into recovery.
24 It's been a hard road, but I'm here to tell
25 you, and to the parents and friends that have lost
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1 friends, and parents that are struggling, it's just,
2 every day, you just take it one day at a time.
3 So, I just gave you some of the highlights.
4 Obviously, I'm not gonna go through some of
5 the trauma that my family has endured, including my
6 grandparents and my parents.
7 But, there's some obvious gaps that are
8 obvious as I go through this. Right?
9 The insurance is one of them. That's pretty
10 obvious.
11 But, there's also some other points or ideas
12 I want to put out there.
13 And I can tell you the Senate has been very
14 active, and the Assembly, in looking for ideas that
15 are more comprehensive, versus, having a one-fix or
16 a Band-Aid so that there will be another problem in
17 another area.
18 So, you know, there's been lots of media
19 attention about the I-STOP bill, which is a great
20 bill, but, one of the things people have said is, it
21 caused an increase in heroin.
22 So, that's been one of the issues.
23 So, now, they're looking at a comprehensive
24 program.
25 So, education, it's gotta be real.
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1 You see those smoking commercials? They're
2 scary. Right? Like, they're scary.
3 We need commercials and public announcements
4 like that for heroin and opiates. Period.
5 We need insurance. There needs to be some
6 parity between insurance.
7 I hear stories, people call me every single
8 day, and say: I got to kick my kid out, get my kid
9 on Medicaid, so I can get my kid into treatment.
10 Right?
11 And, so, some of the things:
12 There should be a standard of practice that
13 all HMOs, Medicaid, Medicare...everyone looks at,
14 so that the treatment is based on an individual
15 outcome: An individual, versus, what's gonna get
16 paid, and how it's gonna get paid.
17 So, that standard of practice is really,
18 really important.
19 The other thing is, when people are looking
20 to get into inpatient, if they're struggling with
21 medication-assisted treatment in the community to
22 get well, when they go into inpatient, 9 times out
23 of 10, they're required to get off of that
24 medication-assisted treatment, so when they come
25 out, it's a high, high incidence of overdose and
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1 death.
2 So, it's something that's, culturally, we
3 have to work through.
4 And then the medical care.
5 I'm a nurse. I love physicians, sometimes.
6 And -- but the issue is: We gotta learn
7 better how to prescribe. And then we also have to
8 have more experts dealing with the kids as they're
9 going through the most difficult transitions in
10 their lives, to start to deal with this issue.
11 Group therapy and treating younger people,
12 that are going through developmental stages, the
13 same as we treat adults just doesn't work.
14 And the highest, the rate, is between 8 --
15 16 and 24, there's more deaths than there are
16 vehicular accidents now, from overdose.
17 And then, also, quality standards.
18 We need to hold -- we need to hold the
19 providers for recovery services and treatment to a
20 standard.
21 Now, we hold hospitals, we hold doctors,
22 nurses, to standards.
23 We need to hold them to standards so that
24 there's good-quality outcomes.
25 So those are just some of the things, that if
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1 we put -- start to look at the package, will really
2 work.
3 So, I'm sorry I look a little bit longer than
4 everybody else, I apologize, but, this is something
5 that I really believe in.
6 And for all the parents and friends that are
7 out there struggling, or those of you who may be
8 struggling yourselves, there is help. It's, just,
9 take it one day at a time.
10 Thank you.
11 SENATOR MARCHIONE: Thank you.
12 And please don't apologize. What you had to
13 say was so valuable to all of us sitting here and
14 sitting out in the audience.
15 Please -- I know I said, you know, that we
16 only have a few minutes.
17 Please don't tell us the stories that you've
18 prepared to tell us, and the profession that you're
19 bringing here, because of that.
20 That's critically important to us here today.
21 THEODORE J. ADAMS, JR.: Hi, everyone.
22 My name is Ted Adams. I am the department
23 chair of the Human Services and Chemical Dependency
24 Counseling curriculum programs here at
25 Hudson Valley. And I'm very proud of those
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1 programs.
2 I know -- just to inform you: We work very
3 closely with OASAS (the Office of Alcoholism and
4 Substance Abuse Services), to ensure that our
5 students are getting the most current and updated
6 information, to help educate them, so that they're
7 prepared to go out in the field and do the work they
8 need to do to be helpful.
9 Our faculty are so well-educated and immersed
10 in the community, in the treatment centers --
11 running them, clinical supervisors, counselors -- so
12 the students are getting the most current and recent
13 information, and examples, on how they can be
14 prepared to intervene, to be helpful to folks once
15 they're out in the field.
16 I wrote a couple notes here.
17 They're also being educated in the most
18 current evidence-based practices that are being
19 used, to be helpful for folks who are dealing with
20 all addictions, but also opiate and heroin
21 addiction.
22 What did come to mind, is that these kinds of
23 forums are amazingly wonderful opportunities for
24 everyone.
25 And the solution is here, with everyone at
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1 the panel and everybody in the audience, 'cause it's
2 not something that anybody can do alone or in a
3 small group.
4 It's important to come together as a
5 community to address issues such as this, in order
6 to find solutions.
7 Thank you.
8 DAN FARLEY: Good morning, everyone.
9 I'm Dan Farley.
10 Good morning my fellow panelists, and thank
11 you for having me here.
12 I am probably the least-qualified person to
13 be up here on the panel.
14 I am an assistant principal at the
15 Ichabod Crane High School.
16 I've been in education for 25 years, and,
17 I don't have a lot of expertise in terms of drug
18 treatment, or anything like that, but I've seen a
19 lot of things over the years.
20 And, recently, some of the things that I'm
21 finding when I search kids for drugs in the schools,
22 is I'm finding a lot of pills on them.
23 They've got a lot of pills in their
24 possession that they didn't buy from someone on the
25 street corner. They found it in their parents'
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1 medicine chest. They found it at their
2 grandparents' house. The pills are just hanging
3 out, waiting for them to grab them.
4 And they'll take those pills, and sometimes
5 they'll crush them up and they'll use them
6 themselves, and sometimes they'll sell them so they
7 can get better stuff.
8 We need to come up with a way to fix that.
9 The other side of things that I'm finding is,
10 when I find a student that's got drugs in their
11 possession in school, the tool that I have to work
12 with is to suspend that student.
13 And so the student goes away for a time, and
14 the other students in my building are protected from
15 that student's influence, but, I haven't done a
16 whole lot to solve that student's root problem.
17 I'm trying to build a house with just a
18 hammer. I need more tools.
19 I'm hoping that we can work today, together,
20 to get me some more tools.
21 DR. WILLIAM MURPHY: I'm Billy Murphy. I'm a
22 family physician, practicing in Chatham and Hudson,
23 New York.
24 And, my background:
25 I'm a father of four, mostly teenagers right
29
1 now, I guess;
2 And, a physician;
3 And a former school board member at
4 Ichabod Crane;
5 And, also, a former medical director at the
6 Catholic Charities Substance Abuse Program in
7 Hudson, which is now part of Twin County's Recovery.
8 As a physician, practicing on a daily basis,
9 we have too many challenges that relate to opiate
10 dependence; not the least of which is trying to
11 balance the humane treatment of pain conditions with
12 the risk of a dependence on opiate medication.
13 And in addition to that, I'm hyperacute,
14 I think, to that problem, because I also treat
15 patients who are opiate-dependent, and have been
16 doing so for more than 10 years in the office
17 setting.
18 We have some new tools available to us to
19 help these patients, and that's good, but this
20 problem is very difficult to treat.
21 And our perspective on it, is to try to turn
22 off the spigot of new cases of opiate-dependent
23 persons.
24 And toward that goal, we've been invited by
25 several school districts within our county to have
30
1 presenters -- or, have been invited to bring
2 presenters, patients that I've treated, and others,
3 for opiate dependence, to, essentially, tell their
4 story. Not in a kind of preachy way or anything;
5 just to simply tell students what happened to them.
6 And that's been, I think, a very effective
7 way to improve education, because, in my experience,
8 everybody that -- every young person, anyway, that
9 I treat will tell me outright, and if they don't,
10 I'll actually ask them, I said, if you -- I ask:
11 If you knew, when you started taking pills on
12 the weekends at parties, hydrocodone, oxycodone,
13 that two years later you would be unable to go a day
14 in your life without a syringe containing heroin in
15 your arm, do you think you would have started?
16 They said: Absolutely not. I had no idea
17 that this could have happened.
18 That's an incredibly powerful message,
19 because that allows an opportunity for education.
20 Whenever there's a knowledge gap and we can
21 fill it with education, we have the possibility to
22 turn around outcomes, to change outcomes, before
23 they even get down -- get on a bad road.
24 So this has been a tremendously uplifting
25 experience for me to be a part of that. And these
31
1 kids are my heroes, really.
2 But, unless we can really stem the tide of
3 new cases, we're really gonna be having a lot of
4 trouble treating this problem on the back end.
5 So that's, essentially, been -- been,
6 hopefully, my contribution up here: to bring that
7 perspective of a working physician; not simply --
8 not treating only opiate-dependent patients, but
9 having an important part of my practice devoted
10 toward that.
11 And I'll welcome questions later on.
12 Thank you.
13 BETH SCHUSTER: Good morning.
14 Thank you for having me.
15 Beth Schuster, executive director of
16 Twin County Recovery Services.
17 For those of you who don't travel south,
18 Columbia and Green counties are south of Rensselaer
19 and Albany county. And we're a very rural
20 communities, so our problems may -- although they're
21 very similar, we sometimes address in a different
22 manner, because we actually have the opportunity to
23 reach more people that are decision-makers in a
24 shorter period of time.
25 I would be absolutely remiss if I didn't make
32
1 a statement here about the fact that State aid for
2 treatment providers, which I represent, is going
3 away.
4 Net-deficit funding that we used to receive
5 because, as non-profits, we're obligated to treat
6 people who have no means to pay for treatment.
7 We are still obligated to provide those
8 services; however, the money that we used to get to
9 subsidize that is now going away. And in some
10 cases, it's gone.
11 I'm in a position now, where, although the
12 heroin- and opiate- and many other substance-abuse
13 problems are increasing in my two counties, I'm
14 having to -- actually, yesterday I had to lay off a
15 staff member, a counselor, because we can no longer
16 afford to have the people employed for us that need
17 to take care of these problems, because of a lack of
18 State-aid funding, and because of the changes in
19 insurance and decreasing revenue.
20 And I know that this is not a problem that
21 I am suffering by myself as a provider. It's
22 becoming increasingly difficult.
23 This is my 36th year with this agency, and
24 have I never seen it so bleak, as far as trying to
25 provide the quality treatment that Lisa mentioned,
33
1 that's so important, with less and less funds with
2 which to do it.
3 So, enough about the money.
4 We also, along with what Lisa said, need to
5 do something about the insurance coverage.
6 My staff struggles every day to try to get
7 people to a higher level of care, and are told: I'm
8 sorry, they're not sick enough yet.
9 Which, to me, is so antithetical, it's hard
10 to even fathom that anyone could sit on a phone and
11 say that to a parent or a provider; and, yet, there
12 you have it.
13 In my counties, there is no public
14 transportation, so what we require for people to
15 show up, to really stay in touch, in order to give
16 them the support they need is very, very difficult.
17 There's no way to get to treatment frequently.
18 And I also have to say, though, that we are
19 making what I would consider an incredible inroad,
20 and I just need to take a minute to mention this
21 because I'm very, very happy about it.
22 Despite all the negative things that I just
23 mentioned, we have, in Columbia and Green counties,
24 about a year-and-a-half-old, now, maybe, two years,
25 a controlled-substance awareness task force.
34
1 The County's gotten tired of waiting for
2 something else to happen. And as they should, kind
3 of took the bull by the horns, and both counties are
4 involved in an extremely active task force to deal
5 specifically with the opiate problem.
6 At the core of this is Columbia Memorial
7 Hospital, and all the providers that prescribe,
8 they're trying to come up with a uniform protocol.
9 We have some doctors that don't want to
10 prescribe anything. And we have some doctors that
11 will prescribe anything. And then there are those
12 on the spectrum.
13 We're trying to come up with a standard for
14 them, so too much is not prescribed, and so people
15 with real pain are not turned away because they
16 can't get any medication.
17 Along with that, we have the
18 Sheriff's Department. Mr. Bartlett is here today
19 representing that. We're very happy to have him on
20 hand.
21 We are involved with the District Attorney's
22 Office, The Office for the Aging, the health
23 departments, the mental-health departments, the
24 treatment providers, and, just an incredible amount
25 of people that meet on a regular basis to discuss
35
1 this, because what we've found out was, we were all
2 trying to deal with this specific problem from our
3 own perspective.
4 And there's no way we can deal with this with
5 our own perspective. We need to get together to
6 share it and to do it in a united way.
7 And, oddly enough, that's usually the way
8 community problems get solved.
9 I would just like to finish by saying:
10 I've been absolutely honored to be here
11 today, and to have a few minutes to make some
12 statements.
13 I am hoping that the treatment world changes
14 and that there's more availability for residential
15 programs for people like this.
16 To have someone come in who is addicted to
17 heroin, and try to treat them on an outpatient
18 basis, especially, initially, as they're trying to
19 stay off of it, is very, very difficult.
20 It's very difficult.
21 And as Lisa said, sometimes that's where they
22 make the contacts for more and better drugs.
23 Residential programs, it's a little bit
24 easier to control that type of thing.
25 I would ask for all your support, and,
36
1 please, get to your legislators about the incredible
2 derth of financial support for these services.
3 Thank you.
4 KEITH STACK: Hello, my name is Keith Stack.
5 I'm the executive director of the Addictions Care
6 Center of Albany.
7 I want to thank Senator Marchione and the
8 Task Force members for convening today's event.
9 You know, I think we need to rethink how we
10 view addiction.
11 You know, what do we think about addiction?
12 Addiction is a disease. It's a chronic
13 illness.
14 We don't treat it like a chronic illness.
15 Compare it to how we treat diabetes or
16 hypertension, for example. You know, you go to your
17 doctor. With those two diseases, you control them,
18 you manage them. You're not cured of diabetes; you
19 manage it. It's a lifetime of care.
20 With treating addiction, it's an acute -- we
21 think about it as an acute one-time event: You go
22 to treatment, you get a coin for successfully
23 completing treatment, and you go home.
24 There's really no formal aftercare for
25 addiction, and that's why you see high relapse
37
1 rates.
2 So, you know, we need to rethink how we view
3 and treat addiction.
4 It's a lifetime of recovery.
5 You know, Lisa talked about that, Beth has
6 talked about that.
7 And we have to, you know, in the primary-care
8 doctor's office, the skills need to be in the
9 primary-care physician's office, to recognize the
10 signs of addiction. And there are basic training
11 tools for, you know, nurses and doctors to do that.
12 So, the skills have to be there in the first
13 place, and then the referrals have to be made to the
14 right level of care for treatment.
15 And it's not necessarily always outpatient.
16 Depending upon the severity, it may need to
17 be an intensive inpatient program. Then you step
18 down to an outpatient setting, but you do need a
19 lifetime of aftercare.
20 So, we need more recovery supports in the
21 community.
22 I'm in recovery. I had multiple treatment
23 experiences. I needed every one of them.
24 Actually, my last one was at Twin County's
25 Recovery Services.
38
1 You know, and that's what you need: You
2 know, access recovery supports in my community.
3 You know, in my work, you know, I deal with
4 recovering addicts and alcoholics every day.
5 And our goal is to, you know, stop, you know,
6 the use while they're in treatment, but that's
7 really just the first step. Treatment is not -- you
8 know, it's not recovery. It's arresting the disease
9 of addiction, then, you know, setting people up for
10 a lifetime of recovery.
11 And we need to connect them then, after their
12 treatment experience, with aftercare, whether it be
13 mental-health services, primary-care services,
14 recovery-support services.
15 You know, we spend a lot of money on
16 treatment right now.
17 I would say we'd treat less if we treated it
18 properly in the beginning.
19 Thank you.
20 KATHERINE ALONGE-COONS: Good morning.
21 I'm Katherine Alonge-Coons, and I serve as
22 the Commissioner of Mental Health in
23 Rensselaer County.
24 And for this panel, I have prepared some
25 remarks.
39
1 Rensselaer County Department of Mental Health
2 has been committed to prevention, intervention, and
3 treatment of substance abuse for 40 years.
4 Over the past three years, the department has
5 received information from community members and
6 providers of an upsurge in the abuse of opiates and
7 heroin.
8 Of particular alarm to the community are the
9 anecdotal reports of deaths due to overdose of
10 heroin.
11 Also important to note is that
12 Rensselaer County borders the states of Vermont and
13 Massachusetts with governors who have declared
14 heroin-addiction epidemics in their respective
15 states.
16 The addiction crosses economic, education,
17 gender, race, geographic, and age demographics.
18 The provider community and drug courts report
19 many young adults with heroin addiction first abused
20 opiates as adolescents, and have graduated to
21 abusing heroin.
22 The provider community and treatment courts
23 attribute the increase in heroin addiction as a
24 result of increased affordability and supply.
25 Program recipients report paying
40
1 10 to 15 dollars for a bag of heroin, compared to
2 10 to 20 dollars per opioid pill, depending upon the
3 type and strength.
4 The average amount of heroin used by an
5 addict is three to five bags per day.
6 The average number of pills used by an addict
7 is six to ten.
8 Heroin is clearly more affordable as a drug
9 of choice, and recipients report heroin has become
10 more available over the past year than it had been
11 in the past.
12 Many addicts have progressed from pills to
13 snorting East Coast powder heroin, to intravenous
14 injection.
15 In August 2013, prescribers have been
16 regulated to utilize the New York State Prescription
17 Monitoring Program Registry to review the
18 prescription history of patients being prescribed a
19 controlled substance.
20 An intent of this effort has been to impact
21 the abuse of prescription drugs through doctor
22 shopping. Accordingly, the supply of prescription
23 opioids on the street has been reduced, resulting in
24 a higher price to be paid for the limited amount of
25 pills now available.
41
1 Many addicts have switched to heroin because
2 it is cheaper and provides the same euphoric high.
3 This increase in heroin as the drug of choice
4 for those in treatment has been statistically
5 tracked by substance-abuse providers in the county's
6 network.
7 And in preparation for this morning, local
8 treatment providers have shared prevalence data with
9 our department.
10 The data is submitted to New York State OASAS
11 by addiction-treatment providers in the county's
12 network [unintelligible].
13 Admissions due to heroin addiction in
14 Rensselaer County programs have increased by
15 23 percent, from 2012 to 2013.
16 And New York State OASAS reports a
17 53.4 percent increase in any opioid admissions in
18 Rensselaer County, from 2008 to 2012.
19 Hudson Mohawk Recovery Center operates
20 outpatient clinics in the county, as well as a
21 residential program for women. And the agency
22 reports a rise of 26 percent in admissions, with a
23 primary or secondary diagnosis of heroin addiction
24 from 2012 to 2013.
25 This agency does not offer
42
1 medication-assisted treatment which is the treatment
2 of choice for many heroin addicts.
3 Heroin admissions in the first quarter of
4 2014 remain relatively equal to 2013.
5 St. Peter's health partners, including
6 Seton Addictions and SPARC, reports its data, as
7 follows:
8 With a dramatic increase in heroin admissions
9 to detox at 14.2 percent between 2012 and 2013. And
10 in the same time period, admissions for opioids,
11 other than heroin, to detox remained relatively the
12 same.
13 The same trend is evident for inpatient rehab
14 and outpatient services.
15 Conifer Park operates an outpatient clinic in
16 Troy, New York, and reports an increase of
17 56.5 percent of heroin admissions, from 2011 to
18 2013.
19 In the first quarter of 2014, Conifer reports
20 24.3 percent of their admissions are for heroin
21 addiction, as compared to 10.7 in 2011, and
22 17 percent in 2013.
23 2014 saw, for the first time, the admissions
24 for heroin addiction outnumbered the admissions for
25 marijuana or hashish. And admissions due to heroin
43
1 addiction is now over those than for alcohol
2 addiction.
3 This agency offers medication-assisted
4 treatment of Suboxone which is the treatment of
5 choice for many heroin addicts.
6 The Troy Regional Treatment Misdemeanor Drug
7 Court is currently serving 23 people, 13 of whom
8 used heroin and opiates as their drug of choice.
9 The remaining 10 individuals' drug of choice is
10 cocaine, followed by marijuana and alcohol.
11 Of the 13 individuals with heroin addiction,
12 one is in their 40s, and the average age of the
13 remainder is 24 years.
14 The prevalent population now seen in this
15 court is young adults with heroin addiction.
16 This transition from opiate abuse to heroin
17 abuse is the result of the affordability and
18 availability of heroin.
19 Eight years ago, the treatment court tracked
20 the drug of choice as cocaine, followed by marijuana
21 and alcohol.
22 Heroin is more challenging to treat than
23 these three substances due to the complex
24 physical-addiction issues accompanying it.
25 For the population tracked by the court,
44
1 detox is not as an effective a treatment and is
2 potentially dangerous, as individuals leaving detox
3 are at risk of relapse and using at the same rate
4 and dose as prior to detox, creating a situation of
5 great risk of death due to heroin intoxication or
6 overdose.
7 Rensselaer County Department of Mental Health
8 employs a MICA coordinator -- that is one who works
9 with individuals who have mental-illness and
10 chemical-dependency issues -- and she is tasked with
11 performing assessment and linkage to needed
12 treatment for individuals who have both
13 mental illness and chemical addiction, and are
14 experiencing difficulty in linking to services, or
15 are difficult to engage due to compliance issues.
16 Data reported continues to support the trend
17 of opiates as the drug of choice.
18 Thus far, in 2014, 28 percent of those
19 assessed report opiate or heroin abuse, as compared
20 to 18 percent in 2013.
21 The department also employs a substance-abuse
22 specialist located at Rensselaer County Department
23 of Social Services' Public Assistance Office.
24 The job responsibilities include screening
25 public-assistance applicants for any
45
1 substance-use-disorder treatment needs. This
2 screening is simple and is not a full psychosocial
3 as one might find in an OASAS facility.
4 In addition, the specialist works with the
5 misdemeanor and felony drug courts.
6 Three years ago, the specialist trended an
7 increase in opiate-use disorders among those being
8 screened.
9 Prior to three years ago, a profile of a
10 heroin addict was a male of Hispanic origin.
11 Now, the profile is of a young Caucasian,
12 male or female, residing in a suburban or rural
13 community.
14 Frequently, individuals using heroin report
15 using at a rate of 10 bags of heroin per day.
16 In addition to the heroin abuse, the
17 specialist notes instances of abuse of
18 non-prescribed Suboxone.
19 Most of the individuals screened come to DSS
20 seeking safety-net assistance.
21 Statistics for the first quarter of 2014
22 indicate, those screened who identify their drug of
23 choice to be heroin as one of half the total of
24 those in 2013.
25 Barriers to treatment do exist.
46
1 We have limited access to 28-day rehab due to
2 difficulty in obtaining approval from payers or
3 insurance companies for 28-day rehab admission, and
4 geographic barriers in connecting with treatment
5 providers due to difficulty for persons residing in
6 rural areas to travel for treatment.
7 Methadone maintenance treatment has limited
8 access in the Capital Region.
9 Whitney M. Young Health Center reports, as
10 late as yesterday, 139 individuals on their wait
11 list, 25 of whom are from Rensselaer County.
12 Suboxone treatment is limited, and can be
13 misused or abused.
14 Suboxone can be prescribed as a standalone
15 medical treatment.
16 There are limited opportunities for the
17 prescribing of Suboxone, with no requirement for
18 counseling or psychotherapy to address addictive
19 behavior.
20 The Medicaid portal for the electronic
21 application can delay Medicaid activation, with no
22 in-person to contact for assistance; thus, creating
23 a delay in obtaining coverage for needed treatment.
24 Shortage in residential treatment for
25 females. There are only two programs in the area.
47
1 Lethality risk upon discharge from detox
2 programs, which we noted earlier.
3 VIVITROL injection is very limited in
4 availability and is of high cost. VIVITROL is an
5 intramuscular long-acting preparation of naltrexone,
6 a chemical antagonist of all opiates.
7 With this drug, an addict who attempts to use
8 an opiate finds no euphorigenic effect; thus, a
9 one-time slip by someone in recovery does not
10 necessarily lead to relapse.
11 The early results of success for long-term
12 abstinence with this agent are very promising.
13 We have some recommendations we'd like to
14 share.
15 A response plan must include both prevention
16 and treatment approaches.
17 Rensselaer County has developed effective
18 prevention strategies for underaged drinking. This
19 structure has taken the form of both school-based
20 and community prevention strategies.
21 The same structure with targeted information
22 regarding heroin could be employed.
23 Increased availability of VIVITROL
24 injections, through both mental-health and
25 OASAS-licensed treatment providers.
48
1 Though currently at a high cost, it is
2 effective in decreasing the risk of relapse and
3 sudden death through the prevention of euphoric
4 effects of opiates, and unlike other methods for
5 addiction-maintenance treatment, (a) it only
6 requires only one-time-per-month compliance, and
7 (b) can be monitored by third parties, such as
8 families and courts.
9 The high cost of the drug itself is more than
10 offset by the medical costs which active addicts
11 would have otherwise incurred, and by the return to
12 the pool of economically productive members of
13 society, who, as using addicts, would otherwise have
14 been economic drains.
15 The benefit of the productive lives saved is
16 a societal good beyond calculation.
17 Increase -- naltrexone is an oral medication
18 with the same effects as VIVITROL; however, it
19 requires daily compliance in administration.
20 Increase availability of appropriately
21 prescribed and monitored Suboxone for medication
22 treatment, to suppress withdrawal symptoms and
23 diminish cravings for opiates or heroin, with the
24 requirement of counseling or psychotherapy.
25 Increase availability of methadone medication
49
1 treatment, with the requirement of counseling or
2 psychotherapy.
3 We also recommend supporting Bills A-8637 and
4 S-6477 through the Senate, and now in the Assembly,
5 that would make Narcan more accessible.
6 Requiring insurance managed-care companies to
7 make coverage and payment decisions using the
8 judgment of a qualified health professional as
9 designated by OASAS.
10 And we oppose the use of Zohydro pain drugs,
11 which is a form of hydrocodone, available at 5 times
12 the strength of currently prescribed hydrocodone,
13 and could be lethal to new patients and children
14 with just two capsules.
15 And this is a recommendation and an
16 initiative set forth by Assemblyman McDonald.
17 We encourage the development of ambulatory
18 detox and rehab facilities, and the development of
19 MICA treatment and housing programs.
20 Thank you.
21 DAN ALMASI: Good morning, everyone.
22 My name is Dan Almasi. I am the dual
23 recovery coordinator for Columbia County.
24 And it is my absolute pleasure to be here
25 with you.
50
1 Like many of the panelists have said before,
2 I want to thank you for attending, but on some
3 level, I can't help but think that we're here
4 preaching to the choir.
5 Some of you may have an interest, a
6 curiosity, but I suspect that if you're here with us
7 today, you have some understanding of this
8 "epidemic," as it's been referred to.
9 And that word "epidemic" is not used lightly.
10 There have been many statistics put out
11 today, one of which I'd like to put out to you is
12 that, every 19 minutes, somebody in the
13 United States dies of an opiate-related overdose.
14 Another statistic that I find very, very
15 concerning, is that America makes up about, roughly,
16 5 percent of the world's population; yet, we use
17 80 percent of its opiates. 99 percent of the
18 world's hydrocodone is consumed by America, the
19 United States.
20 That alone should tell us something very,
21 very scary, and that kind of puts this in
22 perspective.
23 In my capacity as a dual recovery
24 coordinator, I work, not so much with clients,
25 I have in the past, but, currently, I work with
51
1 agencies, kind of as a go-between, as a liaison,
2 doing education, cooperation, collaboration; helping
3 the different philosophies see eye to eye in a
4 closer-type perspective.
5 And I look at this problem in a slightly
6 different way; the problem being the heroin and
7 opiate epidemic.
8 I ask myself, why now?
9 What's prompting this demand?
10 What's going on in our society today that
11 this is popping up at this time?
12 And I think we have to ask ourselves those
13 important questions, because the origins of this
14 epidemic, I think the answer lies in those
15 questions.
16 For some, they may answer it with the fact
17 that, you know, our economy is struggling. People
18 are stressed. People are then turning to coping
19 mechanisms that they wouldn't normally turn to.
20 So, when we look at how we're going to
21 address this and treat this, I think it's important
22 to remember that the problem kind of branches out
23 and stems out in a very, very broad way, in a way
24 that might not be as obvious.
25 In treatment there's a saying: That getting
52
1 sober or abstaining is one of the easiest parts of
2 the recovery process.
3 And there is some truth to that.
4 The reality is, is if you take a heroin
5 addict and you were to put them in detox, or, lock
6 them in a room -- which I don't suggest anybody
7 do -- they will withdraw, and they will no longer
8 have that drug in their system.
9 But the secondary parts of the addiction are
10 the emotional, psychological, spiritual,
11 transformations that need to occur.
12 And I think we have to start looking at
13 ourselves as a society, and take inventory of what
14 is it about us, as an American culture, that we are
15 drawn to a solution in the form of a powder;
16 a liquid; a pill; a plant, like marijuana; and so on
17 and so forth.
18 I think you see where I'm going with this.
19 Because it's very concerning.
20 I believe, you know, the answer to why we're
21 in this epidemic lies in that question, you know, as
22 to what's going on that there's such a draw at this
23 point to these substances that are very, very
24 effective?
25 And, the opiates especially, are, what? They
53
1 are pain killers.
2 So to me it's fairly obvious that we are a
3 country in pain, and many people are finding a very,
4 very effective but dangerous solution, in terms of
5 the pain medications.
6 I also want to say a few words about the
7 stigma.
8 I've worked in the mental-health field, I've
9 worked in the substance-abuse field, and I've also
10 worked in that capacity in a correctional facility,
11 in my career.
12 If I had to rank it, I would say that it goes
13 something like this:
14 A person would rather be mentally ill before
15 they would be a substance abuser or an inmate;
16 Then, a person would probably rather be a
17 substance abuser before they'd be an inmate;
18 And then, finally, an inmate.
19 We as a society have to, I think, take a look
20 at ourselves, in how we see addiction, how we
21 categorize what an addict or a mentally-ill person
22 is, and what they look like, and incorporate that
23 into where we put our priorities, and, ultimately,
24 where we put our funding.
25 Several of the panelists spoke about the
54
1 withdrawal or the removal of funding sources.
2 To me that's not much of a surprise.
3 If we're struggling as a country, and as a
4 nation, if we don't value something, that thing, or
5 that topic, does not get funding.
6 That's the reality of it.
7 So, I am hopeful that we're here today
8 talking about this, but, as a dual recovery
9 coordinator, I'll be honest with all of you:
10 I attend many, many meetings. And when
11 I tell my friends what I do for a living, part of it
12 is, I tell them go to many meetings.
13 They say: Well, Dan, does anything get done
14 at those meetings?
15 And we joke and we laugh, and I say,
16 Sometimes yes, sometimes no.
17 So I hope this isn't one of those meetings
18 and gatherings where nothing gets done.
19 I really hope, because people's lives are at
20 stake, as we all agree and know.
21 I really hope some change comes out of this;
22 either a mental shift, but I hope that mental shift
23 translates into a financial shift, because these
24 programs that currently exist cannot continue to
25 exist at the rate they're going.
55
1 They need support, and they need that support
2 in the form of dollars and cents.
3 It's that simple, as far as I'm concerned.
4 Thank you very much for listening.
5 PETER LACY: Hi, I'm Peter Lacy,
6 Saratoga County Mental Health.
7 Thank you, Senators Marchione and Boyle, for
8 your concern about this problem.
9 In Saratoga County, there's been a
10 significant increase in the number of people
11 entering treatment for opiate addictions in our
12 programs.
13 2013, the number of people coming in for
14 opiate addictions has doubled from the previous
15 year.
16 The heroin addict is no longer part of an
17 inner-city subculture of men. Now we're finding
18 that more and more people are coming in younger,
19 more females, and including young pregnant women.
20 I had a conversation with Dr. Brooks
21 recently, the director of the Saratoga Hospital
22 emergency department. He said that, 20 years ago,
23 when he first came to the hospital, he saw one or
24 two opiate problems per year. Now it's one or two
25 per week.
56
1 Heroin and other opiates are the easiest to
2 get addicted to, they're the easiest to overdose on,
3 and the easiest to die on. And it's also the
4 hardest to recover from, especially for the
5 IV-heroin addict. The cravings, urges, and drug
6 dreams can persist for years after the last use.
7 Many addicts we see today, when opiate pain
8 pills are prescribed to them for legitimate pain
9 conditions.
10 In some cases, pharmaceutical companies
11 oversold the safety of these drugs and recommended
12 their use for moderate chronic pain.
13 When patients develop tolerance, became
14 addicted, they began to doctor shop or buy pills on
15 the street.
16 The I-STOP program made doctor shopping
17 almost impossible, and as an unintended consequence,
18 many addicts turned to heroin. This transition was
19 made easier by the fact that heroin is now cheaper
20 and purer than ever before.
21 Many started using heroin by snorting or
22 smoking, and eventually used the needle to get that
23 immediate rush. This rush is very powerful. The
24 user experiences an immediate warmth and extreme
25 comfort. It makes all the problems go away.
57
1 As one addict put it: It's like mother
2 wrapping her arms around me and telling me
3 everything will be okay.
4 It's very seductive, it's very addictive, and
5 that's what we're up against.
6 So what do we do?
7 No single approach is gonna solve the
8 problem. We all have to work together.
9 Law enforcement and the court systems need to
10 have resources necessary to combat the supply side.
11 Law enforcement and the court systems can
12 also do a lot to stem the demand side.
13 Addicts in the throes of their addiction have
14 very little insight and don't often voluntarily seek
15 treatment. They just want more drugs.
16 Many enter treatment in order to avoid
17 prison, but once in treatment, they begin to accept
18 that they need help and work toward a successful
19 recovery.
20 Statistically, mandated clients are just as
21 successful in treatment as voluntary ones.
22 Alternatives to incarceration programs, such
23 as TASC and drug-treatment courts, need to be funded
24 and expanded. This carrot-and-stick approach works
25 well for many people.
58
1 If the addict is arrested and merely sent to
2 prison, we are contributing to a wasted life and
3 taking away any hope.
4 In a managed-care environment,
5 substance-abuse-treatment episodes are getting
6 shorter and shorter.
7 Because opiate addiction is so insidious and
8 enduring, treatment programs need to match up with
9 the addiction, pound for pound. Treatment programs
10 need to have adequate resources. They need to be
11 more intensive, and be able to treat the opiate
12 addict for longer periods of time.
13 Thank you.
14 STEPHEN ACQUARIO: Good morning, everyone.
15 I guess to conclude the panel's perspective:
16 My name is Stephen Acquario, and I'm the
17 executive director of the New York State Association
18 of Counties.
19 I would like to -- our organization has been
20 here since 1925. We serve, exclusively, the elected
21 county government officials, and the departments and
22 agencies that they run across the state of New York,
23 including the city of New York.
24 I would like to, at this point in time, in
25 the few minutes that I have, thank
59
1 Senator Marchione.
2 There are many demands of a state lawmaker
3 that are put before them: economic, social,
4 business, community-based, needs.
5 The fact that Senator Marchione convened this
6 forum in this region of the state speaks volumes.
7 It speaks volumes of the problem of this
8 issue, and it speaks volumes of the character that
9 she has.
10 I would also like to commend Senator Boyle,
11 the Chairman of this Task Force, who traveled
12 four to five hours to be with us here today, to
13 dedicate his day;
14 Senator Robach, also, traveling from
15 Rochester, four to five hours away, to spend time
16 with this community, with all of us in this part of
17 the state.
18 They are the lawmakers.
19 We're the local lawmakers.
20 They're the state lawmakers. They're in the
21 best position to try to help all of us at the
22 local-government level and the community-based level
23 address this very serious problem.
24 So a very significant and sincere thank you
25 to the State Senate, to
60
1 Assemblyman Steve McLaughlin, also contributing in
2 the New York State Assembly, to bring attention to
3 this in the State Assembly.
4 "USA Today" dateline, January 31, 2014:
5 "Heroin Epidemic Seeping into our Suburbs."
6 The heroin epidemic claiming the lives of
7 young adults locally and across the nation is
8 continuing, despite a crackdown on suppliers and
9 increased efforts to warn users of the drug's deadly
10 effects.
11 This week, January of 2014, three -- this
12 weekend, three deaths: Tommy, 23; Whitney, 28;
13 Tyler, 19; all died of heroin overdoses.
14 "Dozens of area young men have died of heroin
15 overdoses in the past few years, including four men
16 from Putnam and Westchester county in late 2012,"
17 said Christopher Gold, the director of the
18 Rockland County Narcotics Task Force.
19 Well over a dozen, if not more, overdosed in
20 the past four years.
21 In western Pennsylvania, 17 deaths blamed on
22 tainted heroin.
23 In Vermont, the governor dedicating his
24 entire State of the State Address on January 8th,
25 the entire address, to what he called
61
1 "Vermont's full-blown heroin crisis."
2 In Westchester County, a father quoted as
3 saying, "Three kids in a week. When are they going
4 to learn?" as this Croton-On-Hudson father, whose
5 24-year-old daughter, a recovering addict, was
6 profiled by the newspaper.
7 The father contacted a reporter Friday,
8 because he'd seen too many of his daughter's friends
9 die from heroin. At the time, Christina [ph.] had
10 already lost seven friends to heroin, including her
11 25-year-old best friend who overdosed while the
12 newspaper was profiling her.
13 Quote, "Aren't they afraid of what's
14 happening to their friends? It doesn't make any
15 sense to me. Once they take the needle, stick it in
16 their arm, don't they know it could be their last
17 breath?"
18 Clearly, we're not doing enough that we can
19 in the community to educate our children and schools
20 on the deadly effects.
21 From one end of the state to the other, there
22 is a heroin epidemic. I represent a statewide body
23 of counties. There are 57 regions, 57 counties, of
24 the state. 2,000 people die a year from heroin- and
25 opiate-related deaths.
62
1 County agencies are extensively involved.
2 You've heard from many of them here today.
3 The county sheriffs at the point of arrests
4 or education, the county youth bureaus, the county
5 coroner in cases of fatal overdoses, county district
6 attorneys.
7 And we've heard from Tony Jordan here today
8 from Washington County, who prosecute those
9 arrested, or move them to drug-treatment programs,
10 or have county narcotics task forces.
11 Public defenders who defend those that cannot
12 otherwise afford an attorney.
13 County jails, where there's no other place to
14 go but behind bars, but where there may be treatment
15 available.
16 Significantly, county probation departments,
17 to make sure that those arrested and released from
18 jail stay clean, or make every effort to stay clean.
19 Significantly, county departments of
20 mental health and chemical dependency, and we've
21 heard from them today.
22 County executives, county legislative boards.
23 And the judiciary who house
24 alternative-to-incarceration programs and drug
25 courts.
63
1 In Chautauqua County, our most furthest
2 western New York county, one of the first acts of
3 the new county executive, of all the acts that this
4 man could have taken, he convenes a heroin summit,
5 where more than 250 people from this very rural
6 community of New York convened -- community members,
7 family members, children whose parents are affected,
8 counselors, police officers, health officials -- all
9 involved in the prevention and treatment of heroin.
10 In Oneida County, where the city of Utica is
11 housed, 11 people died from heroin last year.
12 Last month, 20 people arrested in
13 Orange County; seized $8,000 in heroin.
14 Yates County: I'm on the phone yesterday
15 with the Yates County Sheriff, responding to a call
16 Sunday night. Heroin death; needle in the arm.
17 In January, New York City police officers
18 seized $8 million of heroin.
19 As this panel knows, Long Island especially,
20 in particular, over 1,000 arrests happening.
21 400, almost, so far in 2014.
22 There are too many deaths in these past few
23 years. There are things that can be done.
24 You are doing your part as a Task Force.
25 The community that's with us here today can
64
1 help us shape those things.
2 A few final comments:
3 In talking with the Rensselaer County
4 Commissioner just a few moments ago, one suggestion
5 could be: Upon -- I've learned recently, that
6 almost 80 percent of the jail county admissions have
7 substance-abuse problems.
8 Perhaps we could look into, upon inmate
9 discharge, providing prescriptions, so that Narcan
10 and other necessary treatment can be provided to
11 these inmates upon discharge, and in communities.
12 Anonymous tip lines through county district
13 attorneys' office be can be expanded all across the
14 state, centralized by the State.
15 There's a disproportionate number of
16 individuals on Medicaid who are overdosing on
17 opiates and heroin.
18 Perhaps using salient technology, with -- the
19 State recently used to redesign the state's Medicaid
20 program, we could dive deeper into Medicaid outliers
21 and statistics where providers are providing certain
22 medications.
23 There's a backlog of Narcan, I've come to
24 understand.
25 Why is that, and what can be done about that?
65
1 Is I-STOP, the mandatory program that was
2 passed a few years ago, being enforced? Are
3 providers actually participating with this system?
4 Can, and should, we be expanding programs,
5 such as the city of Buffalo's drug court, which is a
6 nationally renowned model of
7 alternative-to-incarceration programs?
8 Finally:
9 Working to form a partnership, through the
10 leadership of the New York State Senate's
11 Task Force, of community, social, government
12 agencies, dedicated to reducing the demand for
13 heroin;
14 To education: Educating our citizens of
15 heroin problems, the signs and symptoms of
16 addiction, the resources that are available;
17 Eliminating drug-related crimes through
18 further education, advocacy, the media, law, and
19 legislation; will all play a significant role.
20 Again, I commend you, Senator Marchione, for
21 leading this Task Force in this region of the state.
22 Thank you.
23 SENATOR MARCHIONE: Thank you.
24 Thank you to all our panelists for sharing
25 with us. It was very, very informative.
66
1 At this time, we're going to take the next
2 45 minutes to offer some questions related to heroin
3 and opioid addiction, and I want any one of our
4 panelists to feel free to answer any of the
5 questions that we have.
6 And the first question will come from
7 Senator Boyle.
8 SENATOR BOYLE: Thank you, Kathy.
9 We start out this part with the education
10 perspective. As I say, we're gonna look through
11 education, treatment, and then, finally, to law
12 enforcement.
13 And, education, I guess to Dan from
14 Ichabod Crane:
15 In terms of education, we had this discussion
16 on Long Island forum.
17 I know you're assistant principal in a
18 high school; right?
19 DAN FARLEY: Right.
20 SENATOR BOYLE: But what do you think is an
21 age-appropriate grade level to start this education
22 process? I mean, the younger the better?
23 Or, can you give us any idea?
24 Any programs that you guys have been doing in
25 your district that you believe are effective?
67
1 DAN FARLEY: Age-appropriate, I think in
2 elementary school: fifth grade, fourth grade.
3 And, you hate to scare little kids with this
4 kind of information, but this is scary stuff.
5 I think I would rather have a kid be afraid
6 of heroin and afraid of these drugs, than not, and
7 then get exposed to them and die from them.
8 So, yeah, I guess earlier the better is
9 probably the best thing.
10 In our district, as far as a program that
11 we're doing, we have brought Dr. Murphy and his
12 speakers into our district, and the kids had a very
13 eye-opening presentation, where former addicts and
14 recovering addicts spoke to them very candidly about
15 their experiences.
16 Right now, one of the things that I'm doing,
17 is we've got a task force in the district, that our
18 superintendent, George Zinni, asked me to make
19 happen.
20 I've invited Dan Almasi. He's been coming to
21 our meetings.
22 And, in fact, I'll see you again this
23 afternoon, Dan.
24 We've got teachers on that committee from all
25 the different levels. We've got primary-school
68
1 teachers, elementary-school teachers, middle-school
2 teachers, high school teachers, health teachers,
3 regular-education teachers.
4 There's a lot of people involved, that are
5 looking to solve the problem as best we can.
6 Right now, a lot of what we're doing is
7 learning about the problem, which, as I understand
8 it, is why we're here today: is to learn about the
9 problem. Maybe develop some solutions.
10 Education is a big piece of that solution.
11 But a lot of what we know already about kids
12 is, they're aware. They've been getting this
13 information about the dangers of drugs, in their
14 health classes, and in their -- in the presentations
15 that we have brought to the school, right through --
16 right from early on in middle school.
17 But as Dan mentioned, as well, there's a pain
18 that many people are looking to treat. And that
19 treatment that they're choosing is cheap and it's
20 very effective, but it's also very dangerous.
21 And, so, we've got to come up with a more
22 effective way to stop it.
23 And that's why we're all here; is to learn
24 more about what we can do together to solve this
25 problem.
69
1 Thank you.
2 THEODORE J. ADAMS, JR.: I would like to say
3 that research supports that the earlier we intervene
4 with prevention with our youths, the more likelihood
5 they are to not turn towards drugs and alcohol.
6 In addition to that, along with prevention,
7 the more education youth have, it's more likely
8 they're going to see symptoms in their family or
9 neighbors or parents, and then they start
10 questioning some of those things and/or asking for
11 help, which may not come until much later in life if
12 they don't have that information.
13 KATHERINE ALONGE-COONS: I'd like to add to
14 that, that, in Rensselaer County, we have a
15 student-assistance program, which is a prevention
16 program that we have in 13 schools throughout the
17 county, only one of which is an elementary school.
18 The student-assistance program is a
19 prevention program. And in the -- at the elementary
20 level, we use evidence-based curriculum to help the
21 children, as early as pre-K, develop healthy
22 emotional coping skills and skills of wellness.
23 Unfortunately, the prevention program has
24 received no additional funding since 1992. We used
25 to be in over 20 schools throughout the county, and
70
1 now we're in 13 schools. And we really try to
2 stretch what we can do, to hit as many kids as
3 possible.
4 But in the comments I made, I note how very
5 important prevention is. And the earlier the
6 better, to improve the skills that children have.
7 DAN ALMASI: If I may, I just want to add
8 something that's going on in Columbia County.
9 I encourage Beth to help me out on this in
10 case I get any of it wrong.
11 But, she mentioned the task force that was
12 created between Columbia County and Greene County.
13 That particular task force is broken down
14 into two specific subgroups. One of them is a
15 prevention subgroup.
16 One of the things that we've done, is we've
17 worked with Catholic Charities who is in
18 Columbia County, at least, in charge of offering the
19 prevention services within the schools.
20 In Greene County, it's Twin County Recovery
21 Services.
22 Through the task force we've developed a
23 toolkit that is being distributed, and it has
24 already been distributed to all of the schools in
25 Greene and Columbia county. And in that toolkit,
71
1 it's comprised of everything, from, a fast fact
2 sheet that goes home to the parents about the opiate
3 epidemic, the signs and symptoms of opiate
4 addiction, so that they can have a little heads-up,
5 and get a better understanding of what to look for
6 in their child, or even in their child's friends.
7 In addition, there are lesson plans that have
8 been created for Grades K through 12, so the
9 teachers can voluntarily choose.
10 And from what I understand, you know, the
11 reception to this toolkit has been phenomenal; so
12 that's very encouraging. The teachers are buying
13 into it, and starting to use it in the classrooms.
14 There's also something, like a poster
15 contest, which we're encouraging the children,
16 again, Grades K through 12, to work in their
17 classrooms or the art departments, to come up with a
18 poster that gives a message about treatment or about
19 addiction, specifically with regards to the opiate
20 addiction and the dangers of prescribed medication,
21 narcotics.
22 And it's, again, an attempt to bring about
23 awareness, to get kids involved, to help them learn
24 in a creative way, so that they're comfortable
25 talking about it, have a greater understanding of
72
1 it.
2 So that's something that we've tried to do
3 with the schools.
4 And as people have said, it's never too early
5 to offer prevention and education.
6 The more knowledge you have, knowledge is
7 power, as we know. And you can use that power to
8 help yourself and those around you.
9 Beth, did I leave anything out as far as that
10 toolkit?
11 BETH SCHUSTER: Not that I'm aware.
12 DAN ALMASI: Okay.
13 Thank you.
14 KEITH STACK: At the Addictions Care Center,
15 we have a prevention education program, and we have
16 3 1/2 prevention educators that go into the
17 Albany County school districts. We're in virtually
18 all of the school districts in the city of Albany,
19 Cohoes, Watervliet, and -- and Ravena, which is
20 experiencing, a very suburban area -- or, a rural
21 area experiencing a very serious heroin and opiate
22 epidemic.
23 But the fact is, is that prevention-education
24 funding has been cut, and is continually cut, both
25 at the federal and the state levels.
73
1 So, you know, our 3 1/2 educators are
2 expected to do more with less. You know, the
3 problems are growing, and they are getting more
4 complex.
5 But what we do, we focus on Grades 4, 5, 6,
6 and, you know, we give the facts about drugs,
7 alcohol, and addiction. But, we really try to
8 present information about healthy lifestyles and
9 decision-making and choices.
10 So, you know, we need to do more prevention
11 education.
12 I think what we really need to do, as well,
13 is get -- we really need to expand our
14 community-based education. You know, not
15 necessarily just focus on the schools, but we have
16 to get out into the communities; really get the
17 information in the hands of parents, family members,
18 you know, relatives. Everyone has to be, you know,
19 educated and aware.
20 Narcan training is prevention. I mean,
21 you're preventing death from overdose. You're
22 turning around the effects of an overdose.
23 You know, we train all of our staff at the
24 Addictions Care Center of Albany. I know other
25 providers have been doing the same training.
74
1 We've actually been training our residents,
2 prior to discharge, you know, because the fact of
3 the matter is, is that they may well use again.
4 But -- or they may be in an environment where other
5 people are, so we want them to have the skills to
6 address those problems that come up.
7 So, Narcan training is prevention education.
8 BETH SCHUSTER: I wanted to also add, as far
9 as the prevention education goes, I think it's great
10 if we can get into schools and do that.
11 In Greene County, we used to be in six school
12 districts. We're now in two, because of funding
13 cuts. But because of that, we can't just give up.
14 What we've been trying to do, and we've been
15 pretty successful so far, is starting community
16 volunteer groups, to get out and do some awareness,
17 and raise some money, and try to get up some
18 billboards, and try to get flyers around, and hold
19 our own community forums in small towns all through
20 there, because the schools can't do it. It's not
21 just their responsibility. It's the parents and the
22 community.
23 THEODORE J. ADAMS, JR.: I think two of the
24 other things that just occurred to me, relate to our
25 relationship with Sheriff Bartlett.
75
1 We've recently added an SRO program into our
2 district, which keeps a deputy in the buildings all
3 the time. So, we've got that additional resource
4 available us.
5 We've also got some professional development
6 coming up for our teachers, that the
7 Sheriff's Department is facilitating for us, where
8 they're going to show the teachers what these things
9 look like; what drugs look like.
10 And these are incredibly valuable resources
11 that I wanted, also, to make sure I mentioned.
12 SENATOR MARCHIONE: That's terrific.
13 SHERIFF DAVID BARTLETT: Another thing with
14 that, as far as the SRDs or the SROs going out
15 into the communities, I feel it's a great asset,
16 getting into our schools, working in partnership
17 with our school personnel and with the kids.
18 But, unfortunately, we get back to funding
19 again.
20 Ichabod's helping me out. Taconic Hills is
21 helping me out.
22 Any of the other deputies that I'm putting
23 out, the board is calling it budget negative -- or,
24 "budget neutral." And, basically, they aren't
25 giving me any money towards this.
76
1 So I don't know if there's anything, as far
2 as the State can do, going forward, you know, with
3 financing any type of SRO program, or, as I like to
4 say, the "school resource deputy," so I can get the
5 best bang for my buck there.
6 But it would be beneficial, because it's a
7 great program to have out there. And funding was
8 cut back a while ago.
9 I know some other agencies had it, and they
10 took it out.
11 But I feel it's very beneficial in our
12 county, and that's why we're going forward doing
13 that.
14 SENATOR MARCHIONE: Terrific.
15 Anyone else want to respond to that question?
16 AUDIENCE MEMBER: I just want to say,
17 recently, I viewed two YouTube videos [inaudible].
18 SENATOR MARCHIONE: If you don't mind, we're
19 gonna have an audience-participation section, ma'am,
20 at 11:00.
21 AUDIENCE MEMBER: Oh, okay.
22 SENATOR MARCHIONE: If you -- go right ahead,
23 you're at the microphone now.
24 But would I ask, that audience participation
25 will begin after this portion of the program.
77
1 But go right ahead.
2 AUDIENCE MEMBER: Okay.
3 Recently, I viewed two videos -- YouTube
4 videos on the neuroscience of the brain -- addicted
5 brain, which I think was, amazingly, in educating
6 anybody about what's actually going on when the
7 brain becomes addicted.
8 And so I would highly recommend those for
9 everybody to view.
10 And I sent them to your office, Kathy.
11 SENATOR MARCHIONE: Okay, thank you.
12 AUDIENCE MEMBER: Uh-huh. Thank you.
13 SENATOR MARCHIONE: Go ahead.
14 SENATOR BOYLE: Thank you very much for these
15 comments on education prevention. It's very
16 enlightening, and some good ideas.
17 In terms of the funding, I would say that,
18 our recently passed state budget, we increased
19 funding for that by 2.8 million.
20 So, we're getting there. It's not quite as
21 much as it should be, but we're gonna continue to
22 fight.
23 I know in our Senate budget, we actually
24 added 5 million for prevention and treatment
25 programs.
78
1 In terms of education and prevention, I can
2 tell you that, as Chairman of the Alcohol and Drug
3 Abuse Committee, I go to a lot of treatment centers
4 around the state.
5 And it was mind-boggling to me, I didn't
6 quite understand, as I'm talking to these young
7 kids, just, literally, in high school, and a couple
8 college-age, and I was saying -- I'm thinking:
9 Really, heroin? You know, this is such a terrible
10 drug.
11 And I didn't realize, and it reminded me of
12 the [unintelligible] thing: Well, someone graduated
13 high school this year, didn't know about this, that,
14 and that.
15 To them, they don't remember the
16 '70s heroin epidemic. Heroin is not some terrible
17 drug. It's a new thing to them.
18 It's what their friend told them: Oh, we
19 can't afford the oxycodone pill anymore. There's
20 this new thing, $6 or $10 a bag. It's heroin.
21 They never heard of heroin before.
22 So that was truly enlightening.
23 And what I would say to them, and I often do,
24 is: Remember, that about 1 out of every 4 people
25 who try heroin get addicted to it.
79
1 Would you get in a car or get in a plane if
2 you had a one in chance -- 1 in 4 chance of getting
3 in an accident that's gonna ruin your life?
4 Well, that's what they're looking at when
5 they try heroin.
6 And I think that we need to get that word out
7 to the young kids, as well.
8 SENATOR MARCHIONE: Terrific. Thank you,
9 Senator.
10 Our second question will come from
11 Senator Robach.
12 SENATOR ROBACH: Yeah, we're trying to, you
13 know, cover the spectrum here. And, certainly, once
14 people go down that road, we want to do addiction
15 education, preventably.
16 I'm kind of shifting gears a little bit.
17 In some of the earlier comments we've had at
18 these forums, I wanted to ask
19 District Attorney Jordan, one of the things we heard
20 time and time again, since we've gone through the
21 Rockefeller drug laws, we now know that this heroin
22 that's out there now is the most potent ever.
23 So, in my earlier days in public safety, if
24 you found heroin, it was 10, 15 percent pure. That
25 was the average or high.
80
1 This what they're selling now is 50 percent.
2 And, Phil, you're gonna have to help me:
3 What is the opioid they cut it with?
4 I can never --
5 LISA WICKENS: Fentanyl.
6 SENATOR ROBACH: Fentanyl, which makes this
7 so, just so, so powerful, so addicting, and so
8 damaging.
9 Yet, the people that are selling this,
10 knowing they're flooding the market, it can do a lot
11 of damage oftentimes, is overdosing people, even
12 killing them, the penalties and the weights are
13 very -- I think our laws in New York are lax
14 compared to federal statutes.
15 Do you think -- and I know Senator Boyle's
16 been working on some legislation, and given
17 testimony.
18 Do you think you have the tools to put the
19 people away adequately, under New York State law,
20 right now?
21 TONY JORDAN: Thanks, Senator.
22 I think, you know, one of the challenges that
23 we're seeing, is there needs to be a distinction
24 drawn in our sentencing guidelines, between users
25 and dealers.
81
1 And the heart -- it's easy on the edges to
2 identify the difference between the two.
3 When you get closer to the center, with most
4 things, it gets more difficult.
5 I am going to take a little liberty, because
6 I -- so I won't come back to it, but, in terms of
7 incarceration, imprisonment, you know, one of the
8 things, it's interesting to note, in 2014, it was
9 20 years ago now that Kings County started the
10 twelfth drug-treatment court program in the country.
11 10 years later, in 2004, I was fairly active
12 in the Washington County treatment-court program,
13 that had two treatment coordinators, and, really, in
14 an era that was so very different than today.
15 Ten years later, no one would question that
16 the problems that we face today are so much worse
17 than they were in 2004; yet, to continue the earlier
18 theme, funding has been dramatically cut, where we
19 have one coordinator, to the point where someone
20 said to me the other day: Perhaps we should
21 reconsider putting alcoholics in our drug-treatment
22 court program to make room for the heroin addicts.
23 And I don't think that's a public-safety
24 choice we should be making.
25 So I think that is really very much a
82
1 challenge that we face.
2 In terms of incarceration, sentencing
3 guidelines are being looked at today.
4 I will tell you this: Sitting at all of our
5 task force meetings on the drug-interdiction effort,
6 it is debilitating to our law enforcement to see
7 someone in my office, or in neighboring counties,
8 sentence a known dealer, who has come to our area
9 for the sole reason of selling drugs and addicting
10 our youth, be sentenced to 8, 9, 10 years
11 determinate in state prison, and then be rearrested;
12 "rearrested" for selling 11 months later.
13 That, I think would shock anybody in here
14 into saying, That's not right.
15 And these are not the people who are the
16 sentimental -- or, the -- your -- the people you
17 have compassion for, in the sense that they're
18 trying to support a habit.
19 They look with disdain at the users they sell
20 to because they recognize the horrors of the drug.
21 You talk about fentanyl.
22 I mean, our heroin -- you do hear statistics
23 that our heroin is far more pure, but it's not. It
24 is laced with, you know, fentanyl.
25 I think fentanyl is the one that's used --
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1 authorized for use on equine only.
2 12 pounds of it were seized --
3 That's not it, is it?
4 No, but --
5 AUDIENCE MEMBER: That's actually
6 acetyl fentanyl [inaudible.]
7 TONY JORDAN: Oh, okay.
8 But, I'm gonna get it wrong, but, 12 pounds
9 of an equine drug was seized, you know, being
10 brought into the United States illegally in
11 California, and its destination was New York City,
12 which is the source of our heroin here.
13 They lace it, they use it solely for the
14 addictive quality and the impact the drug has.
15 So, back to your original question, though,
16 Senator: You know, I think that the issue is
17 twofold at the law enforcement end.
18 One, we need to greatly improve our
19 alternatives to incarceration.
20 And, sadly, and an important ingredient, that
21 is funding. Funding for the treatment centers,
22 funding for the court personnel, to manage.
23 Secondly, as we look at sentencing
24 guidelines, I would encourage you all to be very
25 careful in your works with the Department of
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1 Corrections, to make sure that our dealers, you
2 know, the source of the drugs, are appropriately
3 punished and kept off the streets.
4 SENATOR ROBACH: I think, just for
5 clarification, what we're looking at very
6 seriously -- and maybe I should let Senator Boyle
7 chime in because he's sort of the one that opened
8 the door -- but I concur 100 percent that, I think
9 if you sell this in any volume and it results in a
10 death, I think that should be a different and
11 separate statute for that dealer personally.
12 I feel that that would give law enforcement a
13 better tool, or district attorneys a better tool.
14 They have the federal statute. I think
15 New York should have it. And I think, then, that
16 might also send a message to the people right now
17 who seem, as you say, very comfortable selling this
18 very deadly drug with no fear of long-term
19 sentencing, currently so.
20 We may get back to you and the
21 District Attorneys Association before we introduce
22 that legislation.
23 TONY JORDAN: That would be great, because
24 they do -- I mean, the true dealers do understand
25 that their length of time in prison is going to be
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1 short, and they'll be right back in their former
2 neighborhoods selling once again.
3 SENATOR BOYLE: Yeah, Tony, if you could,
4 the -- and it's great to see my former colleagues
5 here, in the Assembly. I served there for many
6 years before the Senate.
7 One of the things, and we saw this in
8 Suffolk County, and they arrested a guy down there
9 with 864 bags of heroin, and they could only charge
10 him with a misdemeanor.
11 Now, this is -- and I'm not a prosecutor, you
12 know, and -- but the way they read the law, as it's
13 written.
14 And now I have a bill currently, to say: If
15 you're caught with 50 bags or more, it would be a
16 felony.
17 We can argue about the number. And I realize
18 that Philip Seymour Hoffman had 77 bags himself,
19 and, obviously, Philip Seymour Hoffman was not a
20 drug dealer. And -- but, we're realizing that we're
21 starting from a negotiating standpoint. And,
22 whatever legislation we're gonna introduce here is
23 also gonna have to get past the Assembly at the same
24 time, a different mindset, perhaps, on a lot of
25 these issues.
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1 So, it's a negotiating thing, but we look
2 forward to getting your expertise as we go along.
3 TONY JORDAN: And I think these forums are
4 important because, our -- and I think my colleagues
5 that really are on the front line, the
6 law enforcement, we don't want to have to address
7 this problem, in the sense of, we would rather it be
8 stopped with prevention and education, and we're
9 here to clean up what gets missed.
10 But we would rather not be -- we would rather
11 not be needed in this problem, but we certainly are
12 here.
13 SENATOR MARCHIONE: Thank you very much.
14 Our third question will come from
15 Assemblyman McLaughlin.
16 ASSEMBLYMAN McLAUGHLIN: Thank you, Senator.
17 My question would be for Sheriff Apple and
18 Sheriff Bartlett, maybe kind of a two-part question
19 that you both could certainly chime in on.
20 The question I would have is, you know,
21 the source. It's coming from somewhere. And as
22 Tony has said, largely, it's New York City.
23 And I guess I'm wondering: How's the
24 interaction between you?
25 At the sheriffs' level, the State Police, and
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1 the feds, how is that interaction going?
2 Is there a lot of interplay between the
3 agencies?
4 What could be done better, that's not being
5 done? Or, you know, where are we seeing success?
6 That's one part of the question.
7 The other part would be, this is back before
8 any of us were in public service: But back in the
9 '70s there was a huge heroin problem. And it was,
10 largely, kind of stomped out, and kind of driven
11 back, if you will.
12 How did we do that then?
13 And what can we do now to really achieve the
14 same thing?
15 SHERIFF DAVID BARTLETT: As far as our
16 partnership with other agencies, we work very close
17 with the State Police.
18 I actually have a -- one of my investigators
19 that's assigned to the DEA Task Force.
20 So, all of us work to their to fight this
21 problem.
22 We do joint raids. We do joint operations.
23 There's -- as far as intelligence gathering,
24 we share it with our neighboring counties. And
25 especially with Columbia County, where we are, we
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1 border Massachusetts and Connecticut, so we also
2 work with Litchfield County, we also work with
3 Berkshire County, and because, let's face it, they
4 go back across county lines.
5 And, so, we do work very close with all our
6 different partners.
7 SHERIFF CRAIG APPLE: Assemblyman, we have a
8 very good relationship with the federal authorities,
9 as well as the State.
10 We've got deputies and investigators on
11 numerous task forces, and we're trying to combat it
12 as hard as we can.
13 Unfortunately, the flow is, it's prevalent.
14 It's, you know, easy to target New York City. And
15 I do believe a large percentage of it is coming up
16 from New York City. And then, in Albany, we're at
17 the crossroads. But I think we are getting it,
18 also, from our bordering states.
19 It's not an inner-city issue. It's a rural
20 issue.
21 I've had as many overdoses in the rural areas
22 of the county as I've had in upper middle-class
23 suburban areas and inner city.
24 You know, the bottom line is, I can probably
25 go out in the parking lot and find somebody to sell
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1 them to me in uniform. I mean, that's how prevalent
2 it is.
3 People are just looking to score. You've got
4 addicts out there trying to score.
5 We've had -- we've broken up sex rings in
6 area hotels. We've had a runaway girl taken from
7 the Southern Tier, who was being told to -- for a
8 lousy three bags of heroin a day, which equates to
9 about $15, to sell her body in a local motel.
10 I mean, we're getting calls constantly.
11 We're taking thousands and thousands of bags
12 of heroin, but, unfortunately, our jails are getting
13 full and the resources are getting slim.
14 And it's easy to say that, yes, we do need
15 more money. I'm always looking for more money, to
16 do more programs, and to try to be more creative.
17 But, you know, I tell a story that:
18 Addictions Care Center in Albany, we have a
19 very close relationship with. And, you know, it
20 does touch everybody.
21 I had a family who I've coached their son for
22 years, all the way through Babe Ruth, reach out for
23 me to tell me that their son was a heroin addict.
24 Upper middle-class White family, not in my
25 family, not in my backyard; sure as anything, he was
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1 addicted.
2 But to get help, it was gonna take weeks, and
3 the problem is, is that we can't wait weeks. This
4 kid would have been dead in days.
5 Now, fortunately, because of who I was,
6 I firmly believe he was able to get help sooner.
7 But it shouldn't have to be that way.
8 Anybody should be able to pick up the call
9 and be able to get their kid or a family member or a
10 friend assistance that they need. And it's not
11 happening.
12 We've tried in a lot of different programs.
13 We can -- you know, I've got 850 people in my
14 jail. We have one of the largest jails in
15 Upstate New York. Of that, 25 percent are in there
16 directly related for drugs.
17 Of the other 75 percent, I'd probably say,
18 80 to 90 percent of that are in there because of
19 trying to steal or rob or kill to get their drugs.
20 So, almost everything out there today is
21 related to some sort of opiate crime.
22 To say it's an epidemic is an understatement.
23 Everything that's occurring out there,
24 crime-related, has got a nexus to heroin.
25 And that's what's going on.
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1 So, it's great to participate in the
2 task forces, but -- and I've been on a couple of
3 them. We have some great thoughts, but we seem to
4 be stuck in the mud, our wheels really aren't
5 turning much, because I think it's gonna come back
6 to, we need money from the State.
7 And I'm not blaming the electeds here.
8 I think it's a national issue, it's a state
9 issue, and we need to do something, and we need to
10 do it quickly.
11 [Applause.]
12 ASSEMBLYMAN McLAUGHLIN: Thank you.
13 SENATOR MARCHIONE: Anyone want to respond to
14 that before we move on?
15 Okay, I have a question.
16 From a treatment and recovery perspective,
17 how far have we come, if at all, in understanding
18 the complexity and difficulty of recovery?
19 BETH SCHUSTER: I think one of the biggest
20 successes we've had over the last, probably
21 10 years, is, as someone mentioned earlier, I think
22 it was Keith, actually, that we have stopped looking
23 at addiction as this thing, where you go in one door
24 and come out the other, and you should be okay now.
25 And I say that as a field that's working with
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1 this, that it is a chronic illness. And it is
2 sometimes relapsing and remitting, like other
3 illnesses.
4 I think the problem is, that we are still not
5 seeing that [unintelligible] by most of society.
6 I think we are still seeing with a lot of stigma,
7 with a lot of ignorance, about what truly, truly an
8 addict is.
9 And I thank whoever it was that talked about
10 the YouTube videos on, you know, the brain's change.
11 I don't think people have any idea what
12 really goes on, physiologically, with someone who
13 becomes addicted.
14 So that's just my own aside thing.
15 But I think the fact that we're starting to
16 look at it, at least in the medical field, like a
17 chronic illness is very helpful, because what that
18 means is that, like other illnesses that are chronic
19 and relapsing and remitting, we should not have the
20 difficulty with treating this, knowing that people
21 are going to come back to us for "tune-ups" -- for
22 adjustments in medication, for adjustments in
23 therapy -- for all the things that other chronic
24 illnesses have the ability to do, such as, you know,
25 people with diabetes and other -- cardiac problems.
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1 And it was interesting, I was at a conference
2 a couple years ago.
3 And I think -- I apologize to doctors ahead
4 of time if I -- if you think this is at all
5 insulting.
6 But, I do have to say there's lot of medical
7 doctors that don't necessarily understand this
8 concept, and don't really see and want to treat this
9 as a disease.
10 But I was at a conference in DC a few years
11 ago, and there was a doctor there from the midwest,
12 speaking, who deals exclusively with this problem.
13 And we asked him: What is the biggest
14 pushback you get from other doctors on why they
15 don't want to treat people with addiction problems?
16 And he said: They always tell me that
17 they're non-cooperative. "They don't follow my
18 instructions. I tell them to do this, and they
19 don't do it. They argue with me. They lie to me.
20 I don't like to work with those kinds of patients."
21 And the doctor that was speaking, said back
22 to this physician who was, you know, saying why he
23 did not like working with addicts: How many
24 compliant diabetic patients do you have? How many
25 compliant cardiac clients do you have?
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1 When you say, "I want to you exercise, cut
2 back on your fat, take your medicine as prescribed,
3 cut back on your alcohol consumption, et cetera,
4 et cetera, are they all doing that?"
5 "Well, no, not all of them."
6 "And do they ever lie about the amount that
7 they drink or the food that they eat?"
8 "Well, of course they do."
9 And it was -- it became very obvious to me
10 that this is really an approach that all of us need
11 to take to look at this.
12 I will also make a comment: That we were
13 asked by someone who e-mailed us, asking for
14 comments yesterday, I believe. I can't remember who
15 it was. I think it was a reporter.
16 At any rate, he asked for comments, and just
17 a brief comment.
18 And my comment was: That if any other
19 illness or issue was making the impact on our
20 communities and families, any other disease, people
21 would be screaming from the rooftops to make this
22 stop.
23 But I have yet to see the CDC come out with
24 anything calling this an epidemic, and do a general
25 treatment recommendation.
95
1 We hear very little from the federal
2 government.
3 We are now hearing things from our state
4 government. I can't tell you how happy I am about
5 that.
6 I'm very happy about this today.
7 I'm very happy that the Governor's paying
8 attention, and getting I-STOP in place. Although,
9 again, that's the beginning of an issue.
10 But, think about it.
11 If this is truly the illness that it is, and
12 I totally believe it is, addiction was identified as
13 an illness by at the AMA in 1955.
14 Do you know how long ago that was?
15 And even the medical profession still doesn't
16 look at it that way.
17 So if they're not gonna look at it that way,
18 why would the community look at it that way?
19 So, we have a lot of work to do, but I do say
20 that we are going in that direction, and that's a
21 success.
22 The other comment I'd like to make is that,
23 as quickly as the treatment field can come out with
24 new ways to treat something, or new ways to figure
25 something out, the people out there that are doing
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1 the using and the selling, et cetera, are right on
2 the bandwagon, and they are so clever and
3 resourceful, and they're so good at coming up with
4 ways to convolute that.
5 You know, things like urine drug screening,
6 et cetera, very, very important to do.
7 Are there ways to get around it? Absolutely.
8 And the minute you come up with a way to stop
9 that one, another one comes along.
10 It's like playing Whac-A-Mole. I mean, it is
11 really, really, a very difficult thing to do.
12 And I don't say that to make light of it, but
13 it's a challenge, on a daily basis, to try to stay
14 ahead of this problem.
15 DR. WILLIAM MURPHY: Thanks, Beth.
16 Those are really very good comments.
17 And the identification of addiction as a
18 chronic illness is really important. And its
19 similarities to other illnesses are very important,
20 as well.
21 Patient engagement is sort of the
22 sine qua non for effective treatment of an illness.
23 But this one really is problematic, because
24 the patient often doesn't really appreciate just how
25 bad the disease has gotten, and how bad shape the
97
1 disease has gotten them into.
2 So -- so, it's challenging.
3 There are -- as I mentioned earlier, there
4 are some tools that we have at our disposal for
5 treating this on the -- as I said, on the back end.
6 And I have to reiterate the importance of
7 prevention and stemming the tide here.
8 But there are some important tools.
9 Physicians can become trained in the use of
10 buprenorphine/naloxone, which is marketed as
11 Suboxone, and other brand names.
12 This drug was approved by the federal
13 government for use in this regard in the year 2000,
14 and has helped a lot of patients stay in counseling.
15 It's disturbing to me, though, that I've
16 encountered a lot of patients who have come to me
17 for Suboxone, from other providers, that had no
18 counseling requirements whatsoever, although they
19 were being prescribed Suboxone.
20 As I mentioned to -- every patient that
21 I have sign a contract for treatment with this drug.
22 The treatment for the disease is the
23 counseling. The drug helps them stay in that
24 treatment. And this is not a replacement, and it's
25 certainly not a pathway to an easy fix at all.
98
1 The hard work takes place in programs, like
2 Beth's at Twin County Recovery Services.
3 So -- so some enforcement in that regard, to
4 make sure that this drug is properly used by those
5 who become certified to use it. You actually have
6 to apply for a special DEA license to prescribe it.
7 Unfortunately, I sense, anyway, that at least
8 some minority of prescribers are not using the drug
9 in the way that it's supposed to. And it's, in some
10 regards, become merely a buffer to support their
11 practices.
12 I don't know how you solve that problem, but
13 it's -- in my experience, that that is a concern.
14 So, in conclusion of these comments, anyway:
15 The treatment is improving. It's still very
16 challenging. And, prevention of new cases is
17 critically important.
18 And just to pick up on just one last thing,
19 I'm sorry, on the 1970s epidemic: I actually have
20 patients who became addicted to heroin in the
21 1970s, and sort of traversed the -- I guess, the
22 area of time where it was perceived that heroin was
23 not a problem.
24 But heroin really always has been a problem,
25 actually.
99
1 There are -- I've recently read an editorial
2 from 100 years ago, in the "Journal of the American
3 Medical Association," that -- that -- it showed how,
4 even back then, in the early part of the last
5 century, that America was really outpacing the rest
6 of the world in the use of addictive drugs.
7 Somewhat concerning.
8 And that picks up on the comments of Dan
9 earlier, about the -- sort of the national
10 character, and sort of how we see ourselves.
11 So that's a big part of the treatment of this
12 problem, as well.
13 I think it's gonna take a real
14 self-examination, as a society, about how we wish to
15 perceive ourselves.
16 Thanks.
17 KEITH STACK: Yeah, you know, I think we've
18 learned a lot about addiction, and we're doing a
19 much better job.
20 You know, the fact that we're talking about
21 addiction medicines that weren't available
22 five years ago is very significant. And they do
23 help recovery.
24 However, as Dr. Murphy says, they have to be
25 used in conjunction with treatment: with group
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1 treatment, with individual treatment sessions.
2 That's how it works; otherwise, you're just
3 taking medication, but you're not changing the
4 behaviors that may lead you back to drug use or
5 alcohol use.
6 But we have physicians here, you know,
7 apparently, and obviously -- I shouldn't say
8 apparently -- obviously, very knowledgeable about
9 addiction and the science of addiction.
10 And, you know, there are a lot of different
11 treatment modalities, but we have to remember that
12 one size doesn't fit all, and that when we're
13 making, you know, the decision about treatment, you
14 know, we can't assume that you need to just go to,
15 you know, a couple days of outpatient, and that will
16 be enough.
17 You have to make a decision, it may require
18 long-term residential care. And, you know, the
19 insurance companies have to be willing to make that
20 decision, rather than start at the lowest common
21 denominator, allow any number of failures before a
22 person gets the treatment that they truly need.
23 And as Dr. Murphy pointed out, it really is a
24 relationship between -- much like diabetes or other
25 illnesses.
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1 You know, if you have sleep problems, you go
2 to your primary-care physician, he recommends that
3 you go to a specialist.
4 You go to the specialist, you receive your
5 treatment there, and then you get referred back to
6 your primary-care physician.
7 You know, addiction is like that. You know,
8 it needs to be recognized at the primary level, and
9 decisions made, in conjunction with addiction
10 experts. What is -- whats the right level of care
11 for that person?
12 And then you follow that continuum.
13 And recovery is -- I'm in recovery today,
14 I'll be in recovery tomorrow; so it's a lifetime
15 experience for me.
16 It's hard to -- you know, initially, it's
17 very, very hard, but today it's not so hard, because
18 I have the -- you know, the supports that I need.
19 And that's true of everybody.
20 That's true of diabetics. It's true of
21 people with, you know, I'm gonna say sleep problems,
22 again. I don't have one.
23 But -- you know, but those are illnesses
24 that -- arthritis. You know, you're watching TV,
25 there's any number of different medications that you
102
1 can take for these other health conditions.
2 You know, and addiction is a health
3 condition. It's a chronic illness. We need to
4 accept that as a society.
5 And I think we really are beginning to.
6 This forum is testament to that.
7 But, we have to get better at it, and, you
8 know, our health-care system, the payer system,
9 whether it's Medicaid or private insurance, needs to
10 view it that way, as well.
11 BETH SCHUSTER: I just wanted to add one
12 thing, that Keith reminded me of when he was
13 speaking, and it has to do with the whole thing
14 about looking at this as a chronic illness, and
15 insurance coverage, and, you know, how many people,
16 how many doctors, would call to try to cover someone
17 with high sugar or with pneumonia, and be told: No,
18 I'm sorry, we can't cover that person until they
19 develop COPD. Or, we can't cover that person until
20 they become an insulin-dependent diabetic. They
21 have to get worse.
22 KATHERINE ALONGE-COONS: I'd also like to add
23 that we found, on the mental-health side of
24 behavioral health, with a great deal of success in
25 integrated-care opportunities, with having licensed
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1 mental-health professionals in -- located in
2 primary-care practices, to assist physicians in
3 identifying mental-health issues early on, and
4 providing care in this natural setting for
5 individuals.
6 And I'd really like to encourage the
7 development of integrated-care opportunities for
8 addiction, to come alongside primary-care practices
9 and pediatric practitioners, having addiction
10 counselors located in the practices, to assist them
11 in identification, and providing care early on, and
12 having the payment structures to allow that to
13 happen.
14 LISA WICKENS: I just -- I want to jump in
15 before I miss my turn.
16 So, I wanted to make a couple of points.
17 Listening to Keith and to Dr. Murphy, and
18 some of the other panelists:
19 Again, as a parent, I wanted to mention to
20 some of those out there, that are kind of, not
21 necessarily looking for answers, but I don't want
22 anyone to walk away thinking, like, Suboxone, or
23 Narcan, or some of these drugs, in and of
24 themselves, are going to be a treatment.
25 I think you've heard Dr. Murphy mention, it
104
1 has to be in combination with programming and
2 support. Sometimes it takes inpatient, sometimes it
3 takes outpatient.
4 But, if anything, when you leave here today,
5 I don't want you to, you know, look -- you know, go
6 seeking that.
7 Another thing I just want to make a point of
8 is:
9 There's a lot of physicians in New York State
10 that are certified to actually be Suboxone
11 prescribers. And they're all across the state, and
12 they're everywhere. They're in clinics, but they're
13 also primary-care physicians.
14 And one of the problems is, many of them, as
15 you've heard, don't want to prescribe. And we've
16 heard a couple of the reasons.
17 I've also heard that physicians don't want to
18 be dealing with addicts.
19 They've actually said that. They don't want
20 them in their waiting room.
21 The other issue is, when you get someone
22 started, it takes a while, because you have to
23 actually talk to the person and understand what all
24 the different life circumstances that are happening,
25 as they're coming and seeking treatment.
105
1 So a lot of those physicians aren't actually
2 prescribing, so that's another issue.
3 And, hopefully, if we can try to take the
4 stigma away, some of the physicians will actually
5 not be as uncomfortable. And, if we can improve the
6 reimbursement for that.
7 Another issue, just one other point, is that
8 we've heard addicts are really, really smart.
9 You know, look it, the disease is driving
10 them to get that drug, not for a high. But,
11 actually, when they start using, it's just to feel
12 normal and not to feel sick. So they're -- you
13 know, at a certain point, they're not using it for
14 the high.
15 So they also, though -- now there's also a
16 market to get Suboxone and methadone, which is a
17 medication-assisted treatment. Right?
18 But there are ways, again, as we're looking
19 at comprehensive plans, that we start to look:
20 Okay, so this is something that does works for a lot
21 of folks, but, maybe we should be tracking that.
22 Maybe we should make sure that people, if they are
23 on Suboxone, they're followed up and they're
24 accountable for it in the system.
25 Again, that hasn't been really dealt with in
106
1 New York State yet, so, it's something we could
2 actually work on. It makes a lot of sense, because
3 they're always five steps ahead.
4 So I just wanted to leave you with some of
5 those points.
6 Thanks.
7 SENATOR MARCHIONE: Thank you very much.
8 At this time, we're going to stop this
9 portion of the program, because we really do want to
10 hear what you have to say, the ideas you have; the
11 comments, the questions.
12 And, we're gonna take, if you would, just a
13 5- or 10-minute break; allow you to stand up.
14 If you want to do it by question, you want to
15 write it down, please get one, and we'll be back
16 here in 10 minutes.
17 (A recess was taken.)
18 (The forum resumed, as follows:)
19 SENATOR MARCHIONE: As people entered
20 today -- I'd like to ask that we could start,
21 please.
22 As people entered here today, we took down
23 the names of those people who are elected officials,
24 or department heads in the mental-health profession,
25 or worked for the State Police, and we have
107
1 three pages of names. And I really want to leave
2 more time for questions, because we have a
3 tremendous amount of questions.
4 So, I would just like to thank them all for
5 being here with us as part of our group today, and
6 really appreciate their attendance, as well as, of
7 course, everyone else's.
8 How we're going to do this section, is I'm
9 going to have a speaker come to the microphone, and
10 then I'm going to use a question from a card; so, we
11 will go back and forth.
12 I have told Father Peter Young that he can be
13 our first speaker here today, and I would like to
14 ask him to come to the microphone.
15 And welcome you, Father.
16 SENATOR ROBACH: He gets to go first because
17 he does the prayer in the Legislature.
18 [Applause.]
19 SENATOR MARCHIONE: Yeah, Father Young, very
20 often, leads us in prayer in the Legislature; opens
21 us up in prayer. And we're very thankful that he is
22 there and asking for divine intervention for all of
23 us.
24 FATHER PETER YOUNG: Thank you, Joe, for the
25 plug.
108
1 I've been Senate chaplain for 55 years; so,
2 been there and done that, have a chance to
3 meet-and-greet.
4 And it's that kind of history that I'm
5 trying, if I can, to bring out and talk about.
6 I can grab it later.
7 I just wanted to mention, this is offering me
8 a tremendous amount of hope, because, 55 years ago,
9 I was sitting, having lunch with
10 Governor Rockefeller, Harry Albright, Bobby Douglas.
11 And while I had lunch, the Governor said -- turned
12 to me and he said: You know, Father --
13 He had been visiting our program at that
14 time, coming down, looking at what was going on in
15 the south end of Albany.
16 And he said: You know, father, what are we
17 gonna do about the Harlem problem?
18 I said: Governor, what do you mean by
19 "the Harlem problem"?
20 He said: It's that new drug they've got down
21 there that they're using. It's called "heroin."
22 What are we gonna do about that?
23 I said: The Harlem problem? That's a drug
24 problem. That's a very common drug right here on
25 Green Street.
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1 And he said: Well, isn't it just a Black
2 problem?
3 And I'm saying: It's not just a Black.
4 And that's why I'm looking to you, and I'm
5 saying: Unbelievable, to see 92, 94 percent,
6 98 percent, White people here, because White people
7 have power. Black people do not have power.
8 And if we have power here, we're gonna see
9 the legislators, Joe, Steve, and Phil, do something
10 about the things that the need to be done.
11 We're no longer now powerless in the inner
12 city. We're no longer powerless in the community.
13 The suburban power has the chance to get out
14 and vote, and with that kind of vote, they're going
15 to make a difference. We're gonna see something
16 done about the problem, because the power is only
17 then given to the legislators, so the legislators
18 will speak adequately for us.
19 So we empower these people to be elected
20 representatives, and they know now that they are now
21 accountable to a White population which gives them a
22 tremendous amount of power.
23 There was a lot of denial for years and years
24 and years. In the 55 years of trying to get the
25 word out about addiction, we couldn't get it out.
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1 We couldn't hear it, we didn't hear it. We never
2 got it communicated to the people that were the
3 powerbrokers.
4 Now we are today.
5 My thought is -- trying, if I can, to look at
6 a few things here.
7 And I apologize to Joe Robach, especially,
8 because we're pulling out, and he was a member
9 [unintelligible] kind of friend of mine. And he
10 supported me in putting programs in Buffalo --
11 I mean, Rochester. And then, we're pulling out of
12 Buffalo, Rochester, Syracuse, Troy...we're pulling
13 out of many locations all over the state.
14 We're pulling out -- we serve over
15 5,000 people a day in 117 sites.
16 We're pulling them out, because we can't get
17 funding; and, basically, one of the big reasons are,
18 we're pulling them out because of the Medicaid kind
19 of problem that I have with my dear friend Steve,
20 that he knows about, that I've been trying to work
21 with for a long time, representing the state
22 counties, because the counties are talking about
23 now, their duty and their responsibility is to the
24 county.
25 Block-grant funding will tell me, that if
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1 I try to take a client -- and, you know, I'm sure
2 Katherine knows more about this than I do -- if
3 I take a county [sic] across the river, and he comes
4 over here, I'm not really appropriate to serve; and,
5 yet, they cross county lines.
6 If I take anyone from Saratoga crossing over
7 the Mohawk River, I'm guilty for taking a person,
8 because they don't have a facility of that type in
9 Saratoga. That guy is given a bus ticket and sent
10 down to me, and they wind up on our doorstep,
11 pending.
12 And it's the "pending" I'm caught with.
13 And I'm pending-caught, and I have sympathy.
14 I meet the person, I talk with them; I try to
15 find out if they have the third tradition or desire
16 to recover. And with that desire, I say, "Okay,
17 come on in the program," and we try to offer them
18 help.
19 But I'm looking at the kind of problem we've
20 had.
21 As a result of that "pending," I'm being
22 brought before a grand jury on Monday, because
23 I have violated the state law of taking people that
24 I'm not qualified to serve, because I'm out of the
25 county that they're from, and they don't have the
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1 CMU, the approval, that goes with it.
2 And I'm sure Beth and others will speak to
3 that better, more adequately, than I.
4 But I know that we're caught by the founding
5 of this kind of thing, block-grant funding, and it's
6 divided our counties, it's divided our state.
7 If I, God forbid, take anyone from Vermont
8 that keep running over to me, knocking on the door
9 for help, I'm in deep trouble, because I violated
10 the idea of where they're coming from, and then I'm
11 giving tax money that is from this county to those
12 people who don't deserve it; but, yet, they're in
13 pain.
14 And that's certainly something I'm kind of
15 worried about.
16 What are we gonna do about that?
17 How we gonna handle that?
18 How we gonna do what need be done to try to
19 serve the people that are seeking recovery?
20 I just worry about a few things of that type,
21 but I'm aware that -- and 19 -- well, over the
22 years, I saw two friends here, having a coffee break
23 with me, they were with me on the staff at
24 Mount McGregor.
25 We had 896 people there in that prison for a
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1 great time. In 10 years, we did a study.
2 In 10 years, by the State School of Graduate
3 Studies, in the criminal justice, we had with the
4 idea of founding a program in the prison system, and
5 then offering them treatment, housing, and
6 employment afterwards.
7 Those inmates that were there, 896 for
8 10 years: 8 percent were reincarcerated.
9 92 percent never went back into prison.
10 I think, you know, that's the kind of program
11 we need.
12 I saw McGregor in its heyday. I was in
13 charge after the -- I founded the program for the
14 alcohol and drug substance-abuse programs, and I had
15 41,000 clients on my caseload when I retired from
16 DOCS.
17 And we need to reinstitute the foundation
18 that we can with those men that are incarcerated.
19 We need to again get the counties to put pods
20 in there, so that they can reeducate the kind of guy
21 that we know, or the kind of gal that we know, who
22 wants to get into recovery.
23 If we can do that, we can turn this around,
24 because those people are the people that will
25 convert the other people to better identity and
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1 better idea of how to surrender, and how to be a
2 better person in our society, and become a taxpayer.
3 So we gotta make them taxpayers.
4 Therefore, our mission statement has been for
5 55 years, of becoming a taxpayer.
6 How do we get to become a taxpayer?
7 And that's our mission statement today?
8 I thank you very much, and I'm eager to
9 respond to any questions.
10 [Applause.]
11 SENATOR MARCHIONE: Any questions for
12 Father Young?
13 Father, I would just like to thank you for
14 the services that you have provided for 55 years to
15 the community.
16 This is a man who doesn't just do the talk;
17 he walks the walk.
18 And I tell the story of one that I heard of
19 him: That a drug addict came in to him, and didn't
20 have shoes. And father walked out without his
21 shoes, in the snow.
22 Amazing man.
23 Thank you, Father.
24 STEPHEN ACQUARIO: Senator, may I add
25 something --
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1 SENATOR MARCHIONE: Sure.
2 STEPHEN ACQUARIO: -- to what Father has
3 brought up?
4 I've recently learned, in Westchester County,
5 they are -- have also integrated, through the
6 Sheriff's Office, and certain jail administrators
7 around the state, but, in Westchester, they have
8 established a partnership to create treatment
9 programs within the jail itself.
10 So I encourage the Task Force here to look at
11 that.
12 In particular, in Westchester, they use the
13 Yonkers General Hospital, which is now
14 St. John's Riverside, partnered with the jail, in
15 order to make certain jail space available and
16 create an internal therapeutic facility.
17 And when the County renovated its jail, it
18 created a special housing unit targeted towards drug
19 treatment.
20 And, if we could look at, and perhaps consult
21 with our -- of course, consult with our sheriffs, to
22 provide outpatient treatment options, including
23 Narcotics Anonymous, within our jail community,
24 I think that what Father Young said would be
25 constructive towards what we're talking about.
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1 SENATOR MARCHIONE: Thank you.
2 Yes, Father.
3 FATHER PETER YOUNG: [Inaudible.]
4 SENATOR MARCHIONE: One of the questions --
5 we're gonna have to bring you a microphone.
6 We are taping this, so everyone who speaks
7 needs to either have a microphone brought to them or
8 has to come to a microphone to speak.
9 FATHER PETER YOUNG: Thank you.
10 Thank you very much.
11 Steve, in regard to the idea of the
12 block-grant funding, we have to be able to cross
13 over state lines, but we have to do it within the
14 institution, too.
15 We, for years, and years, and years, are
16 wandering around, trying what we could to find out
17 why this is a statewide program.
18 The County itself has to be strong in its
19 recovery effort. And you begin in the pod in the
20 jail, but then you have to have a continuity of
21 care. You have to have the networking opportunity
22 of where you give safe, clean, sober housing. And
23 then you have to have an opportunity of training for
24 employment, and then placement.
25 And that's where the dead end happened.
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1 We've tried for years to get to serve
2 Westchester County. We have been invited there to
3 do everything by way of the programs, and we
4 couldn't afford it, because the price of what we get
5 is well below the cost of operation.
6 When you try to buy anything in
7 Westchester County, wow, you can't do it.
8 Therefore, it doesn't -- I can build in
9 Buffalo, I can put programs in Buffalo quite easily,
10 and upstate, but you can't put programs in
11 Westchester County.
12 So, they have to get their act together and
13 be able to give a little kicker in to try to help
14 that happen.
15 SENATOR MARCHIONE: Thank you, Father.
16 The next question we have is from
17 Patty Hoffman [ph.]. She's a field representative
18 from Congressman Chris Gibson.
19 She would like to speak.
20 She said: The Congressman has held a recent
21 summit on a heroin crisis, and wants to report the
22 results and his initiatives.
23 PATTY HOFFMAN [ph.]: Thank you.
24 Yes, the Congressman, Chris Gibson, just held
25 a recent summit in Dutchess County, and he brought
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1 together agencies -- the police agencies,
2 district attorneys, county executives, assemblymen,
3 and senators -- to come and discuss the problem, to
4 see where Washington can help.
5 So as a direct result of that summit, he is
6 working on a couple of initiatives.
7 One is, putting more money into the cops
8 grants, so that there is more cops and surveillance
9 on the streets. You know, we need to tackle this
10 problem at the source.
11 Another initiative is, changing the language
12 in the mental-hygiene and mental-health programs.
13 There are money -- there is money available;
14 however, the language is so archaic that it doesn't
15 really address the problem that we're dealing with.
16 So if we can change that language and make it
17 more accessible for organizations and agencies to
18 access funding, that would be helpful.
19 Addressing the standard of recovery: We know
20 that there are statistics, that a heroin addict --
21 the brain in a heroin addict is -- the cells are
22 destroyed. And it takes 90 to 100 days just for the
23 brain to start recovering, to start healing.
24 However, the reimbursement really drives the
25 treatment.
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1 And, we really need that 21 days of
2 reimbursement changed to 90, to 100 days.
3 That, of course, you know, takes a lot of
4 work.
5 And he -- we in Dutchess County --
6 I represent mostly Dutchess County in his
7 11 districts -- counties in his district.
8 -- we have a real problem, in that, the first
9 couple of months in 2014, we had 150 overdoses,
10 resulting in 4 deaths.
11 And -- and even though this is such a huge
12 problem that we all know, the community still is
13 unaware of this epidemic. And we need more
14 education.
15 That was the result, again, of the summit:
16 more education.
17 You know, what do the parents look for? What
18 are the signs in their kids?
19 We have to really teach them.
20 So, the Congressman stands ready to assist
21 your panel.
22 And thank you, Senator Marchione and
23 Senator Boyle, for all that you're doing.
24 And, we'd like to help in your endeavors.
25 Thank you.
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1 SENATOR MARCHIONE: Patty, thank you.
2 Do you think that you could put that in
3 writing to us --
4 PATTY HOFFMAN [ph.]: Absolutely.
5 SENATOR MARCHIONE: -- and send it to us, so
6 we have it to refer to?
7 PATTY HOFFMAN [ph.]: Sure. I have a report
8 from the summit that I will forward to you.
9 SENATOR MARCHIONE: Thank you very much.
10 The next person who would like to come to the
11 microphone is Henry Bartlett, who's the executive
12 director of the Committee of Methadone Program
13 Administrators.
14 HENRY BARTLETT: Thank you, Senator.
15 Senator Boyle, Senator Marchione, we really,
16 deeply appreciate the work that you're doing, and
17 bringing attention to this problem.
18 There are times we sort of feel like we're
19 not being paid attention to in the treatment field.
20 And, I also want to talk, specifically, to
21 congratulate Senator Boyle about hosting a training
22 session, just last night, in Long Island, about
23 overdose prevention. You had over 100 people
24 trained, and left certified, and left with kits for
25 overdose prevention.
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1 I've had this training. It takes about
2 two hours.
3 You know, I'm certainly not a trained
4 clinician, but I carry a Narcan kit with me wherever
5 I go. And if I'm unfortunate enough to come across
6 somebody who's overdosing, I feel good that I'm
7 going to have a shot at least out of saving their
8 life, keeping them alive, until the medical
9 professionals can arrive.
10 This training is readily available.
11 If you don't know how to get it, I would say,
12 you can contact me. You could certainly contact
13 Senator Boyle, and he can tell you how to get the
14 training.
15 And I'm amazed, the number of people who are
16 in the addiction-treatment field who don't have this
17 kit, and don't carry it, and don't know how to use
18 it.
19 There's kind of no excuse for that, from my
20 perspective.
21 Beyond prevention, we have to know how to
22 treat addiction appropriately, and, I want to make a
23 pitch for evidence-based treatment.
24 I was really encouraged to hear on the panel,
25 you know, a very enlightened approach to
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1 evidence-based treatment.
2 I wish I could say that I hear that
3 universally across the state.
4 The evidence on successful treatment for
5 opioid addiction is pretty overwhelming, and it's
6 been known for a long time.
7 In 1997, the National Institutes on Health
8 published a consensus panel. Dozens of doctors and
9 addiction professionals around the country reviewed
10 hundreds of research articles; peer-reviewed,
11 outcome-based articles, published in scholarly
12 journals.
13 Not anecdotes, not testimony, not philosophy.
14 "Data."
15 And it concluded that the most effective way
16 of treating chronic, long-term opioid addiction, is
17 to use an appropriate addiction medicine in
18 conjunction with a comprehensive treatment approach.
19 Now, this was 14 years ago.
20 There were reports published before this.
21 But the most striking thing about this, is
22 not that we had a consensus on this issue 14 years
23 ago, but that, since then, not one major study has
24 been published that in any way contradicts this.
25 In fact, beyond that, there are
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1 two additional studies out, just in late 2013.
2 One -- this is in a series called
3 "Assessing the Evidence of Treatment": One on the
4 efficacy of methadone. Another on the efficacy of
5 buprenorphine.
6 This was a review of existing studies.
7 So if you look on the tables inside, it cites
8 dozens of other peer-reviewed studies published in
9 scholarly journals that completely supports what was
10 said first in 1997.
11 And I made copies of those available to
12 Senator Marchione.
13 They're available electronically. I couldn't
14 bring enough for everyone, but if you want to reach
15 me, I can tell you how to get those reports
16 electronically.
17 But, do we see that evidence embraced across
18 the treatment system? And the answer is no.
19 We still see lots of treatment programs
20 treating chronic, long-term opiate addicts,
21 insisting that they do it in an entirely drug-free
22 fashion, insisting that they leave treatment without
23 the benefit of addiction medicines.
24 We see extraordinarily high levels of
25 relapse.
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1 We don't see the volumes -- and I could,
2 literally, produce hundreds of studies for you -- we
3 don't see the volumes of reports that claim that
4 that's an effective way of treating people.
5 The drug courts are a mixed bag. Some of
6 them are wonderful. Some of them are right out of
7 the Middle Ages.
8 We've had drug courts say to us that, you
9 know: We will not allow somebody in our drug court
10 who's using an addiction medicine. We want to treat
11 somebody with chronic, long-term opioid addiction;
12 and, yet, we're not gonna use the approach that is
13 demonstrated to have the highest likelihood of
14 success.
15 I had a drug-court judge say to me: You
16 know, Henry, I'm not opposed to addiction medicine,
17 you know. It's just that we have a philosophy of
18 recovery.
19 I pointed out to him that "philosophy" was a
20 Greek word, and that it had its roots in two other
21 Greek words, "philos" and "sophia": love of wisdom.
22 So I don't know how you can love wisdom and
23 reject science.
24 So we have an approach to treatment here that
25 works. We need more funding for it.
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1 But we don't need just blind funding from the
2 Legislature. We need it to be tied to a requirement
3 that the funding is spent to expand evidence-based
4 treatment.
5 So that's what I would want to say.
6 Thank you.
7 [Applause.]
8 SENATOR MARCHIONE: Thank you very much.
9 LISA WICKENS: You know, I think that's a
10 good point.
11 One of the things that I -- someone just
12 mentioned on break, that I think is important, you
13 know, may of us have talked about the Narcan
14 certification. I think it's critical; I think
15 everyone should go do it.
16 The issue is, does anyone realize that the
17 nurses in school districts don't actually, can't
18 actually, give Narcan?
19 SENATOR BOYLE: That's one of the things
20 we're looking at.
21 LISA WICKENS: So one of the problems is,
22 here we have some of the kids in college, and in
23 nurse -- no, not nursing homes, oh, my gosh -- and
24 in high schools, and the nurses can't give the
25 Narcan.
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1 So, it's something that I believe the
2 Senate's addressing, hopefully, with the
3 State Education Department.
4 So...
5 THEODORE ADAMS: But, yes, I would also say,
6 from an educational perspective, it is important to
7 get that training out there so folks have access to
8 save lives, because, in saving lives, then there's
9 an opportunity for recovery. Number one.
10 Number two: Traditionally, treatment
11 facilities have really been focused and based on an
12 abstinence-based model.
13 When we're looking at heroin and opioid
14 addiction, we're looking more at a harm-reduction
15 model, and, where, when they're in treatment -- the
16 folks are in treatment, we have seen that folks get
17 kicked out, or there's a punitive approach.
18 I know that there's been a shift with that
19 over time, but we need to all be on the same page so
20 that that can change, so other folks have an
21 opportunity for recovery.
22 SENATOR BOYLE: That is correct, this is --
23 the idea of Narcan and naloxone, it really is an
24 immediacy issue.
25 And I can tell you that, for those of you who
127
1 have not seen how it works, I'm a former EMT, and it
2 is truly a miracle drug, Narcan.
3 To see a young man go from, on death's
4 door -- lips are blue, not breathing -- give them
5 the Narcan and he is awake, alert, and speaking to
6 you in a normal tone and conversation in a
7 minute and a half.
8 I mean, most of us think of drugs, taking
9 once, or sometimes years, to fix a situation.
10 It is immediate, but it gives you a second
11 chance, and it gives the addict a second chance.
12 As has been said, treatment is the answer
13 after that.
14 SENATOR MARCHIONE: And I will tell you
15 I will be hosting a Narcan training session in the
16 very near future, so, we'll let you know that.
17 Next, who would like to speak, is
18 Dr. Ishmael [ph.].
19 Doctor.
20 DR. ISHMAEL [ph.]: Thank you very much,
21 Senator. That's great.
22 I was not expecting that you will have this
23 much crowd.
24 I would like to have first, comment, and then
25 I would like to have request.
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1 The comment is, that, yes, the treatment
2 should start from the home, from the parents, before
3 they are introduced, before they have used any
4 opiate.
5 Once they use the opiate, that's it. Then it
6 becomes a continuous problem of relapse.
7 The best thing is -- many times I have seen,
8 I mean.
9 When I treat a patient -- I have been in
10 addiction for a long time. Me and
11 Kristen Hanson [ph.], we are -- she is the manager
12 of the program at St. Mary's Hospital. We have
13 30-beds hospital: 20 rehab, 10 detox.
14 When I treat a patient, I get surprised many
15 times. Many times they have been drinking alcohol
16 too much.
17 Simple question: What age you started
18 drinking?
19 You will surprise, actually, the answer
20 I get: 5, 6, 10.
21 "At the age of 5, how come you started
22 drinking?"
23 "Oh, I was sitting on my dad's lap and he
24 gave me the sip. And after that, I become -- I know
25 where I find it."
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1 That's ready to start.
2 Marijuana: Many times we take it as a --
3 it's common, it's available, and it's going to be
4 legal, so that's fine, they can use it.
5 No, that's not fine. I think that's the
6 gateway. Once they start using the marijuana,
7 that's the gateway. And then they progress on
8 slowly to the cocaine, heroin.
9 The heroin will not come all of a sudden.
10 They will go for the prescription drug.
11 Many times they will have the prescription
12 drug from the physician. They may have some injury,
13 fracture. They may get for a month, two month.
14 Once they get more than a month, then it
15 becomes difficult for them to stop or cut down.
16 When they cut down, they feel as if they're
17 sick; they are getting flu, or anything like that.
18 And they will try to look, and they will go to the
19 physician and insist that they are having pain, and
20 they want more.
21 They will continue for three or four months.
22 And when the physician stop giving them, they will
23 like to buy from the street.
24 When they know that the prescription drug is
25 very costly, they will switch to the heroin.
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1 Earlier I heard the comment about a physician
2 that -- who did not like the non-compliance of the
3 patient.
4 I think one has to be very polite with them.
5 I think we have to take that they are the
6 patient. They are human being. They need help.
7 They are just like a diabetic, just like a
8 hypertensive patient.
9 But we have to be -- I never -- I will hear
10 many times, that, "How many bags you use?"
11 20, 30. Many times, 40.
12 I say: My God, 40, that's too much.
13 But I will not be very critical. I will be
14 polite. I will encourage them. Actually,
15 motivational interviewing. That I will motivate
16 them towards their recovery, even though knowing
17 that they have some problem, even knowing that
18 I don't like that kind of problem, but, it doesn't
19 mean, this is not my likeliness.
20 I'm treating a patient, I'm looking at the
21 patient; and that's my patient. And I have to
22 treat, politely, just like any other patient.
23 And that's how I maintain my relation with
24 the patient, and then he will listen to me.
25 Unfortunately, we do come across many
131
1 problems in this situation.
2 Opiate is looked down by the insurance
3 companies.
4 If [unintelligible] comes, some may get
5 seizure. That becomes dangerous. Sometimes end up
6 in the ICU.
7 Opiate, many times, is not dangerous when
8 they stop. They will suffer.
9 Many times when they are put in jail, they
10 don't get any medicine. They suffer for a week or
11 two weeks, and they are clean.
12 But what it mean that, of course, detox is
13 not too dangerous, but, they are carrying this
14 lifelong, and, some -- and somewhere they overdose.
15 That's the major problem.
16 Insurance company don't realize that.
17 Insurance company will not accept, except for
18 a day or two at the most. They may not provide the
19 inpatient rehab.
20 And that's where I would like to have the --
21 first, to all of you, please, that we would like to
22 have that kind of help from you, if it can get the
23 insurance to provide the help.
24 We are all working to help them. I know many
25 times their personalities, totally different, but,
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1 I've to accept, as a physician; and as they are my
2 patient.
3 Thank you very much.
4 SENATOR MARCHIONE: Thank you, Doctor.
5 Appreciate it.
6 Next question is from Beth Lane [ph.], and
7 says: What are the steps to make the changes
8 suggested here today within the health-insurance
9 system regarding coverage, et cetera?
10 This system is currently flawed, and
11 powerful; most resistant to interference and change.
12 SENATOR BOYLE: Yeah, for those of you who
13 are not familiar, there's a bill in the Senate, by
14 Senator Kemp Hannon, which would, in essence,
15 mandate insurance coverage of treatment for
16 addiction services.
17 And this is a convoluted area, because it
18 also -- we have to look at what ObamaCare is gonna
19 cover. That's one of the -- addiction treatment is
20 one of the 10 areas that are mandated.
21 So, it's an influx issue, but we are well
22 aware of it, as the doctor said, and has been best
23 said.
24 We have situations where insurance companies
25 are, people get out of detox and they want to go --
133
1 we want to go get treatment. And they go to their
2 insurance company and they say: We'll give you
3 three days.
4 And no one's getting off of heroin in
5 three days, obviously.
6 So, I think what we're heading towards, also,
7 is legislation.
8 And one of the issues, if I can get some
9 comment from the treatment providers, perhaps, or
10 some of the audience, about the definition of
11 "medical necessity," because we have had testimony
12 in different hearings on what --
13 [Applause.]
14 SENATOR BOYLE: -- people go to their
15 insurance company and they are told that your
16 treatment you need is not medically necessary.
17 And there is a list of 9, 10, or 12 items
18 that you need to get for "medical necessity."
19 No one in the world is meeting all twelve, so
20 they're not covered, according to that insurance
21 company.
22 We're gonna sit down in the coming weeks with
23 health-care providers, treatment providers, and
24 insurance officials, to say: Let's get one
25 universal definition of "medical necessity," so
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1 we're all agreeing on this, what is needed to help
2 people get through these addictions, get the
3 addiction treatment they need.
4 And that is gonna be a big thing.
5 The mandate I'd like to see happen.
6 I don't know if it can happen legislatively,
7 but, "medical necessity," I think that we can get
8 legislation done. That's going to be worked on in
9 the coming weeks.
10 SENATOR MARCHIONE: Thank you.
11 Go ahead.
12 Please feel free.
13 LISA WICKENS: No, it's okay.
14 I'm just, like, Hooray!
15 [Laughter.]
16 SENATOR MARCHIONE: Is there anyone from the
17 audience that would like to speak in the microphone?
18 Yes, please feel free.
19 DAN ALMASI: If I may, I'd like to make a
20 quick comment about the insurance piece, and it's
21 not gonna speak directly to the insurance companies,
22 but I feel -- I'm gonna allude to the comment that
23 I made earlier this morning, in terms of a shift of
24 consciousness.
25 Insurance companies, as we know, are a
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1 business, and they're in that business to make
2 money.
3 What I feel, and this is my personal opinion,
4 is that they've been allowed to get away with
5 viewing chemical-dependency issues, and up until
6 recently, mental-health issues, as well, in a very
7 stigmatized, negative, derogatory way; therefore,
8 the insurance companies have not drawn a parallel
9 between something like a medical condition, like
10 diabetes, which has come up numerous times today,
11 and addiction.
12 They've been allowed to get away with that.
13 They've been allowed to not reimburse
14 equally, not cover equally, there hasn't been
15 parity, because, again, the consciousness is, you
16 know: This group over here deserves our sympathy
17 and empathy. This group over here -- and I'm
18 speaking about, in this case, the addicts -- deserve
19 blame, shame, guilt; Why don't you pull yourself up
20 by your bootstraps?
21 That type of an attitude, and that's
22 pervasive.
23 And until we shift that consciousness on an
24 individual basis, as well as a business-type
25 philosophy, and that's where I think the insurance
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1 companies need to make a shift, but, I wonder and
2 I question, whether they would ever do that, unless
3 they were forced to do that, because, right now,
4 nobody's forcing them to do that.
5 And I don't think they will change until they
6 are forced to do that.
7 Because it is cruel, in terms of turning
8 somebody away, because they don't meet or jump
9 through all of those hoops requiring the
10 medical-necessity expectations, which are virtually
11 impossible to meet all of those.
12 So, I think it comes down to how we interpret
13 addiction, as a group, as a society, as a business,
14 and as an individual.
15 Thank you.
16 BETH SCHUSTER: Kathy, could I just add one
17 thing, also?
18 We're talking about insurance here, and
19 there's nobody more than me in the room that agrees
20 with everything that's been said.
21 My concern is for those people who end up,
22 whether it's through ObamaCare or not, with
23 phenomenally high deductibles and co-pays that they
24 can't possibly pay.
25 What do we do for those people?
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1 Because, technically, they have insurance.
2 And even if insurance approves treatment for them,
3 they can't afford it.
4 [Applause.]
5 SENATOR MARCHIONE: Did you have a comment,
6 as well?
7 THEODORE ADAMS: Well, I mean, one piece in
8 the discussions that may come up is, I know in our
9 programs, we have a large recovering population of
10 folks. But, also, there's a huge recovering
11 community out there.
12 And so, once people do recover, they become
13 productive members of society, and they are working,
14 and they do have insurance, and they are paying into
15 the system, as Father Young was saying.
16 And that may be an argument to make to the
17 insurance companies when you're talking because, on
18 the back end, they are getting some of that money
19 back.
20 SENATOR MARCHIONE: Would you mind stating
21 your name, please.
22 LOU DESSAU [ph.]: I would, sure.
23 I'm Lou Dessau [ph.]. I serve this county as
24 a deputy commissioner for mental health.
25 And, I'm really happy that you folks are here
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1 today in our county, and in my town. I'm a resident
2 of North Greenbush.
3 You know, when I heard that this was
4 happening, I was so excited, because what we're
5 seeing in our county, as our commissioner has
6 already said, there's a dramatic increase in heroin
7 use.
8 And, you know, I've been -- before a
9 commissioner, I was in the addiction field for 28 or
10 29 years, and I've seen a lot of people get well,
11 but I've seen many more not get well.
12 You know, we're in the epidemic, a heroin
13 epidemic, at the moment, but we've always had
14 something going on, you know.
15 The number one drug of choice has always been
16 alcohol. That's been our main problem.
17 In the '70s, we had the heroin problem, as
18 the Senator mentioned.
19 In the '90s -- early '90s, we had the crack
20 epidemic.
21 And now we have a heroin epidemic.
22 I think the difference with this epidemic,
23 though, is that people are dying quicker. People
24 are dying quicker, and it's heartbreaking.
25 I just want to say, quickly, you know, I --
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1 you know, just my own personal experience:
2 Two years ago, a young boy that I coached in
3 Little League died from an overdose of heroin.
4 Last year, a young lady who lives about
5 three blocks from me died from an overdose of
6 heroin.
7 But I guess the most disheartening one that
8 I think about, is a young lady, with two small
9 children, 2 and 1, that we put in a rehab about
10 7 weeks ago. Got out of rehab, and was found a week
11 later with a needle in her arm, and dead.
12 It's heartbreaking.
13 And -- so I've been watching this. I've been
14 watching this for many years, but now I'm watching
15 it more closely. Okay?
16 And a lot of things have been said here today
17 that I believe are really accurate.
18 The gentleman from Saratoga I think talked
19 about treatment being -- needed to be longer.
20 I believe that.
21 You know, I believe, if we take someone away
22 from their drug of choice, if we take someone away
23 from the neighborhood where they get their drugs, if
24 we take someone away from that area that's really
25 killing them, for a period of time, they have a
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1 better shot. And the longer we can take them away,
2 the better their shot.
3 So, I want to talk about four young men that
4 I've worked with, who are heroin addicts, over the
5 last three years.
6 All four of them are clean and sober and
7 working today.
8 All four of them started at a rehab, went to
9 a halfway house for three to six months, some, maybe
10 nine, then came back, and went into outpatient
11 treatment, and they're all clean today.
12 I have a loved one -- we're talking about
13 medicated -- medical-assisted treatment --
14 medication-assisted treatment.
15 I have a loved one who's very close to me,
16 who's in -- eight months clean now, using Suboxone.
17 Now, her life, and her family's life, are
18 much better than it was nine months ago, believe me,
19 but I sit back and I wonder: Is she gonna get
20 hooked on Suboxone?
21 That's a concern I have.
22 Now, I -- the gentleman talked about
23 medical-assisted [sic] treatment for long-term
24 heroin addicts, and he's right.
25 But we have a lot of short-term heroin and
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1 pill addicts today.
2 And I think that Suboxone and the medication
3 that we're talking about can help them get a start
4 in recovery, but in my opinion, it has to be
5 time-limited.
6 And I know -- I don't know, everyone's gonna
7 have a different time, but my opinion, it has to be
8 time-limited.
9 The only other thing I wanted to say, that
10 hasn't been talked about much too much, is: I think
11 we need to embrace the recovering community, embrace
12 the peer support, that -- to help in this process.
13 Now, I'm not sure exactly how we do that, but
14 I think that, one, not only is it cost-effective,
15 it's highly effective.
16 One addict reaching out to another addict is
17 highly effective.
18 And, finally, I want to talk to my -- to the
19 law-enforcement folks, because I think that we need
20 to embrace law enforcement more readily in this
21 process, as well.
22 You know, it's been my experience that when
23 someone has something hanging over their head, what
24 we call a "treatment mandate," whether it be from
25 law enforcement, it could be a parent; the four
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1 fellows I talked about, two had legal mandates, and
2 two had parent mandates.
3 But, no one wakes up on a bright sunny
4 morning and say: Hey, I'm a heroin addict. I'm
5 gonna go get clean.
6 That just doesn't happen.
7 Everyone had -- most people are mandated in
8 for treatment.
9 And -- so I think we have to find a way to
10 embrace law enforcement more in the process, in the
11 front of the process, and I think we have to find
12 how to embrace the self-help community in the end of
13 the process, or at the back end of the process.
14 Thank you.
15 SENATOR MARCHIONE: Thank you, Lou. We
16 appreciate that.
17 [Applause.]
18 LISA WICKENS: One comment?
19 I actually agree with everything.
20 I just want to make -- one point, is that:
21 Medication-assisted treatment, I think, has to
22 always be individualized.
23 So, I think just a -- you know, a line in the
24 sand that this has to be time-limited doesn't work
25 for everybody.
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1 Another comment: In regards to peer support,
2 the State has recognized that the peers really do --
3 really assist.
4 And I think Keith actually will know about
5 this, too.
6 There's actually a program for certification
7 for recovery coaches, or, peer recovery coaches,
8 that they can actually work, and have a job, doing
9 just that.
10 So, that is something that the State's
11 already looked at.
12 KEITH STACK: Yeah, the concept of peer
13 support, recovery coaches, certified recovery peer
14 advocates, is a relatively new concept. We've
15 started to develop training for recovery coaches in
16 New York State.
17 The Office of Alcoholism and Substance Abuse
18 Services, the state regulatory agency, just created
19 a credential for recovery peer advocates. And, you
20 know, right now, the curriculum is being developed
21 for that.
22 ACCA received a small mini grant from OASAS
23 earlier this year, and it's a pilot project.
24 What we're going to is, we train -- we're
25 gonna train 20 recovery coaches; some from the
144
1 community.
2 Deb Rose [ph.] is here from Albany County
3 Mental Health. She's gonna be taking the training.
4 And, then, 15 people around ACCA -- former
5 clients, non-clinical staff, and some alumni -- and
6 we're gonna to hire -- we're going to hire
7 six recovery coaches, and start connecting them with
8 our clients when they're in what we call "Track 3"
9 of their treatment experience.
10 So they're -- they've begun Track 3.
11 They're -- you know, we're starting to talk about
12 life after treatment, about their discharge, you
13 know, employment, housing...those types of things.
14 And we want to connect them up with a peer
15 support at that point, that then they can leave
16 treatment with.
17 So, we've made this, you know, aftercare
18 connection for them.
19 And, you know, the training is -- you know,
20 it's not clinical in nature, but it's very practical
21 in nature. They -- you know, it's really -- it's a
22 resource for the individual leaving treatment.
23 This person will help them, you know,
24 navigate, you know, getting back in the community:
25 Primary care. Mental health care, if they need it.
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1 You know, dental work.
2 Whatever it might be, just, help them make
3 those connections that, you know, we've really been
4 talking about before. Kind of coordinating -- well,
5 care coordination.
6 So that really is starting to happen.
7 The insurance companies, certainly, Medicaid,
8 the Medicaid system, you know, is looking to start
9 reimbursing that, to a degree, next year.
10 And that's why, you know, the training is
11 important. It's not just some random, you know,
12 connection between people. It's, you know, someone
13 trained in the -- kind of the spirit of recovery:
14 What it takes. You know, what it's like. And, what
15 a person in recovery is going to need immediately
16 after treatment.
17 SENATOR MARCHIONE: Okay.
18 The next question --
19 AUDIENCE MEMBER: Oh, ma'am?
20 SENATOR MARCHIONE: Yes?
21 AUDIENCE MEMBER: [Inaudible.]
22 SENATOR MARCHIONE: Okay, be we -- sure.
23 What we're going to do: One question from
24 people who wrote, and then one from the microphone.
25 But, if you would like to go?
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1 AUDIENCE MEMBER: Oh, okay.
2 Sure, go ahead.
3 SENATOR MARCHIONE: Oh, thank you.
4 It's a quick question.
5 It says: What's the responsibility of a
6 landlord if he has drug dealers on his property?
7 If anyone can answer that?
8 [Laughter.]
9 SENATOR MARCHIONE: Can you answer that?
10 SENATOR ROBACH: You know, it's a tough
11 question, but, you know, I'll just take it.
12 It's different from jurisdiction to
13 jurisdiction.
14 So, literally, in the city of Rochester, the
15 drug situation has gotten so bad in certain areas,
16 that the city itself has come up with a code for
17 landlords, that even though you're not the one doing
18 the crime, that if you have a certain amount of
19 incidents and reports, that house will become
20 unoccupied, and the landlord will lose money; trying
21 to put a little bit of onus on everybody to try and
22 clean it up.
23 Now, it's made it a little bit better, but it
24 certainly hasn't been the panacea.
25 So the answer is: Anything.
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1 And I'm going to say this, too:
2 So, I go to a lot of neighborhood meetings, a
3 lot of crime prevention. A lot of PAC-TAC, where we
4 walk.
5 People in the neighborhood have to turn the
6 information over to the police.
7 A lot of people don't want to do that. They
8 think they're gonna stumble upon it. They're not.
9 The people buying drugs are not gonna be the
10 ones to tell them where the drug dealers are.
11 It has to be the law-abiding people, or the
12 other people in the neighborhood.
13 And then, certainly, arrests will also make
14 that apartment or that facility empty and not
15 occupied.
16 So, you could do it 100 different ways, but,
17 you know, this is what it's all about: We're trying
18 to get the whole thing. It's supply, demand
19 treatment; all of it.
20 But, yeah, I'm kind of in that camp.
21 I just think it's -- I drive around the city
22 I live in. I know where they are, I see them.
23 I see them on the corner. I see them on the
24 porch. I see them in their house.
25 I think we gotta really go after that side of
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1 it, too.
2 ASSEMBLYMAN McLAUGHLIN: There's, also -- we
3 had a pretty heated debate on the Assembly floor not
4 too long ago about this.
5 There's a very strong push, largely, I will
6 say, from the New York City legislators that are all
7 about tenant rights. And sometimes this gets in the
8 way of trying to do what we need to do to protect
9 the public.
10 So there's a -- it's just an ongoing battle
11 I think that we face down there in the Legislature.
12 SENATOR MARCHIONE: Well, thank you very
13 much.
14 Sir, it's your turn.
15 Would you give us your name, please.
16 RICHARD NOELLE [ph.]: Sure.
17 Richard Noelle [ph.]
18 I live right down the road here in
19 Wynantskill.
20 I've got a, kind of, combination of comments
21 and questions here, so I'll just kind of lay it all
22 out. A lot of it you all have spoken about before.
23 And I do want to thank you all for being
24 here.
25 I've learned an awful lot today, probably
149
1 more than I ever wanted to know about heroin
2 addiction, but, unfortunately, that's the way life
3 is at the moment.
4 But, you know, I think, through your efforts,
5 we're gonna get over this.
6 Okay, the -- it has been mentioned by a
7 couple of you all on the panel about learning from
8 your peers. And Lou mentioned it, and a couple of
9 other folks. And I think it's a really good way to
10 do things. Very often we do learn better from our
11 peers.
12 And I'm thinking now, specifically, and this
13 has been addressed a couple of times already, for
14 recovering -- especially kids, recovering or
15 recovered addicts to speak to their peers. And
16 they're already in school. It's not gonna really
17 cost a lot of money. You just need to, somehow, get
18 those kids to present, appropriately, I guess is
19 probably a good word, to their peers.
20 You know, and the impression I'm getting here
21 today is, we got kids in grammar school that are
22 already hooked.
23 And, you know, so that's the way to do it.
24 You know, from -- that I would think so.
25 I would, you know, definitely promote that one.
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1 The other thing is: Can primary-care
2 physicians, and maybe even pharmaceutical companies,
3 get more involved?
4 And I'm thinking, kind of now, maybe -- and
5 I don't know if this is even possible, because it's
6 a medical thing, maybe some of these prescriptions
7 of opiates, and I guess there's a lot of them out
8 there, do they have to be as strong as doctors
9 currently prescribe them? And do they have to last
10 as long? Maybe the dosage could be less?
11 I don't honestly know that.
12 That might be something that could be
13 investigated by folks in the medical field, you
14 know, with regard to certain illnesses.
15 The -- also, the community programs I think
16 would be a very good idea, you know, to prevent this
17 from happening, rather than trying to treat it.
18 Because, for one thing, that's gonna be a lot
19 cheaper.
20 You know, there's an old saying, and I'm sure
21 you all have heard it, quite a few have, at least:
22 An ounce of prevention is worth a pound of cure.
23 And in this case that could apply. And it
24 would be cheaper, because I've heard a lot of
25 discussion today, and I understand, because I know
151
1 money is always at the bottom, perhaps it would be a
2 way to not be so concerned about the money that can
3 go into these programs.
4 You know, if the community programs and
5 volunteers, and I think people, you know, are
6 becoming more aware of this problem, would be
7 certainly willing to, you know, jump in there and
8 partake.
9 And this I think is -- I guess is more of a
10 question. I don't know if any of the statements
11 I made are questions, but, this thought just
12 occurred to me while I was listening to you all
13 talk. And I know it's been, and is on the agenda
14 with this State, to legalize recreational marijuana.
15 Now, we have medical marijuana. And other
16 states have been legalizing, and we're getting
17 reports every once in a while about what's going on
18 in various states with recreational marijuana.
19 Do you think that if we legalized
20 recreational marijuana, and I'm thinking now,
21 somehow, and I don't know how legal or illegal this
22 would be, maybe somewhat promoting this as an
23 alternative to heroin addiction?
24 Because I know some heroin addicts just start
25 taking heroin. They don't have to necessarily have
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1 been on opiates before. Right? They can just start
2 shooting up.
3 And, you know, maybe that's a possibility.
4 Would that potentially reduce the use of
5 heroin?
6 Because I know marijuana is not addictive.
7 I mean, I've smoked grass for a few years
8 myself, and --
9 (Mixed audience reaction vocalized.)
10 RICHARD NOELLE [ph.]: So -- and I know it's
11 a very touchy subject, just that whole idea of
12 legalizing marijuana.
13 But, it does give you a good feeling, and,
14 you know, it doesn't make it, to me -- I know -- it
15 looks like nobody likes that idea, but, it's an
16 option.
17 [Laughter.]
18 SENATOR ROBACH: Let's go Yankees!
19 [Applause.]
20 UNKNOWN SPEAKER: We definitely respect
21 your --
22 RICHARD NOELLE [ph.]: The Sox are winning
23 tonight, I hate to tell you.
24 [Laughter.]
25 SENATOR BOYLE: Well, thank you very much for
153
1 your --
2 RICHARD NOELLE [ph.]: It's going to be a
3 very good year.
4 Thank you.
5 SENATOR BOYLE: Thank you for your comments.
6 And regarding your one question, very
7 quickly: Obviously, Colorado, Washington State, and
8 some other states, have legalized recreational use.
9 I do not see that happening in New York State
10 for years to come.
11 [Applause.]
12 RICHARD NOELLE [ph.]: It was just a thought.
13 SENATOR ROBACH: Could I just chime in?
14 And, you know, one of the things that you
15 said is already going on.
16 The Medical Society and other people are
17 doing a lot of training, to make sure that doctors
18 aren't overprescribing, and trying to take out
19 prescriptions where people have, you know, 60- or
20 90-day supply of these pills who really don't need
21 them maybe that much.
22 And we've had other testimony.
23 There was one story reported, where these
24 people that were addicted to the opiates were,
25 literally, making appointments, even though they had
154
1 no intention of buying homes of the elderly people,
2 so the woman could occupy the real-estate agent
3 while the other partner went through the medicine
4 cabinets, trying to see what they had, to take.
5 It's at that desperate level.
6 So, there is a real concerted effort to try
7 and shrink that part, which I think you mentioned,
8 which is already happening, and a good idea.
9 RICHARD NOELLE [ph.]: Well, that's great.
10 Thanks, that's good to know.
11 BETH SCHUSTER: I wanted to commend you on
12 your bravery for bringing up that last item.
13 [Laughter.]
14 SENATOR MARCHIONE: One of the articles that
15 I've recently read really confirms what's being
16 said, is that: When someone now is coming in to rob
17 your home, they're not only taking what you would
18 perceive as your valuables, but they're actually
19 going through your medicine cabinets and looking for
20 your drugs.
21 So, another program that I personally am
22 gonna be looking at is, you can have a
23 "Drug Collection Day"; that when you're through with
24 your drugs, you can bring your drugs and have them
25 collected.
155
1 So that's something else that we will be
2 doing through our office, as well.
3 TONY JORDAN: On that end, just, Saturday is
4 Take-Back Day, which is great, but it's also telling
5 of the very real problem.
6 Try to establish in your own community the
7 ability to have a Take-Back Day, and you will
8 encounter significant pushback and challenges.
9 So I think one thing that our Legislature
10 could probably help with, is to ask DEC and DOH to
11 establish simple, easy guidelines.
12 Because, if you live in rural New York, where
13 I certainly do, and many do, it's not easy to get
14 rid of the drugs.
15 We all say, "Get them out of your house, get
16 them out of your house, but don't throw them in the
17 garbage, don't burn them, and don't flush them down
18 the toilet." But, you don't have a local police
19 that has the ability.
20 So, I think we need to make it easier to do,
21 because people want to. They just need to be able
22 to do it when they think of it; not on
23 this Saturday, which is one of three this year.
24 SENATOR MARCHIONE: Now, Tony, where is it
25 going to be? Just in case anyone wants to know.
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1 TONY JORDAN: Various law-enforcement
2 agencies. I think probably every county sheriff's
3 department will be taking part.
4 SHERIFF CRAIG APPLE: Yes.
5 SHERIFF DAVID BARTLETT: Yes.
6 SENATOR MARCHIONE: Terrific.
7 UNKNOWN SPEAKER: Hoosick Falls.
8 TONY JORDAN: Local cities.
9 SENATOR MARCHIONE: Hoosick Falls? Good.
10 TONY JORDAN: But, it just needs to be
11 easier, so that when I'm done with the Oxycontin
12 prescription, I can walk out my door, go to somebody
13 and hand it to them, and be done with it; rather
14 than try to remember to do it.
15 CAPTAIN DEREK PYLE: I'll just say, at least
16 in Rensselaer County, I can't speak for the others,
17 there's six drop-off locations.
18 And, I have a listing. I'll put it on the
19 front table as soon as we're done.
20 SENATOR MARCHIONE: I also know the Senate
21 does run another program called "Shed The Meds."
22 And as you say, because it's even three times
23 a year, there's always a need to run a program to
24 help people in the community.
25 So, thank you very much.
157
1 Next we have a question from a student,
2 Martha Mahoney.
3 Number one: Is this Task Force working
4 with -- sharing data, feedback, resources, et
5 cetera -- with the AG's Office; specifically, the
6 community overdose program?
7 And, Question 2: What is Senator Boyle's
8 bill numbers that relate to the convictions of
9 persons with 50 bags-plus of opioids as a felony?
10 SENATOR BOYLE: I'm not very good with
11 numbers. That's why I'm a lawyer.
12 But, you can find out the bill number, just
13 talk to Dianna [ph.], my staff person there. She
14 can -- we do have the bill. I'm just not sure of
15 the number.
16 It beings with an "S," I know that much.
17 [Laughter.]
18 SENATOR BOYLE: And regarding, working with
19 the Attorney General's Office, we are certainly
20 going to be working with the Attorney General's
21 Office.
22 Once this report is filed June 1st, we're
23 gonna be dealing with the Governor's staff,
24 obviously, the AG, and the Assembly in getting these
25 pieces of legislation passed, and discussing ways
158
1 that we can work together.
2 I know Attorney General Schneiderman has been
3 a leader on the Narcan issue, statewide, and we look
4 forward to working with him on that, as well.
5 SENATOR MARCHIONE: Next person actually
6 wants to come to the microphone. Her name is
7 Cassandra Martell [ph.], and she wants to share her
8 experience of her husband's struggle.
9 SHERIFF DAVID BARTLETT: Senator, if I could
10 just jump in real quick, DEA.org will give you all
11 the Take-Back locations in your areas, if you need
12 to locate that.
13 CASSANDRA MARTELL [ph.]: Hi. My husband,
14 Daniel Martell, passed away in November of 2012 from
15 acute heroin intoxication.
16 His addiction came to light when he actually
17 got arrested for possession of cocaine, which, until
18 that point, I had no idea that my husband was an
19 addict.
20 He came home every night. He was a good man.
21 He worked. He was normal.
22 I don't know where I got my perception
23 from -- of addiction from, but I viewed a heroin
24 addict as somebody who's homeless, had no job, and,
25 no feelings.
159
1 I was wrong.
2 My husband was addicted to cocaine and
3 heroin.
4 The process of trying to get him help was
5 awful. Treatment was not available.
6 He was -- I'm sorry, this is hard.
7 I was also pregnant at the time, and he
8 didn't make it to meet our son.
9 But he wanted the help, and we started with
10 detox. One day was covered through private
11 insurance.
12 "One day."
13 They released him with nothing. No follow-up
14 care. Nothing.
15 The staff at the detox center, which was
16 local, was extremely unprofessional to myself and to
17 my husband. Treated him as if he was not a person,
18 to the point where I had to say to the manager: You
19 know, you're acting very unprofessionally, and I do
20 not appreciate it.
21 Which didn't help at all, anyway.
22 He -- after that, he relapsed, which was
23 good, because he failed that outpatient, so then he
24 got back into detox, which, you need to be high to
25 get into detox.
160
1 And then, from there, he got into a 30-day
2 program, which he was approved for 17 days.
3 Two weeks later, he died.
4 He was doing well. And, he was offered
5 heroin from somebody he went to treatment with.
6 He was found in a public restroom in a gas
7 station.
8 There's so many points, there are so many
9 things that are broken.
10 I was clueless.
11 And, you really don't know, until you have to
12 walk through those steps, to realize how broken it
13 is.
14 And, the stigma is awful.
15 The way people view me and my son, because my
16 husband had a disease, is unacceptable.
17 But I did it myself, too, because there's a
18 lack of knowledge. There's a lack of education.
19 There's -- education is needed just as much
20 for adults as children, to break the stigma.
21 When you hear the word "addict," nothing warm
22 and fuzzy comes to mind. You think of law
23 enforcement. You think of people stealing. You
24 think the worst. You think of the people not as
25 people.
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1 One of the things that I've been trying to do
2 is not say the word "addict," but to put the person
3 first.
4 So, instead of saying "my husband was an
5 addict," I'll say, "My husband, Dan, struggles with
6 addiction," which breaks that stigma, at least for
7 me.
8 My husband did, before detox, when I didn't
9 know he was using, he was on the Suboxone program;
10 which I found out after his death. And, he received
11 no counseling requirements with that.
12 And I do believe that a lot of people who
13 have addiction have a core, a reason, why they are
14 coping with these drugs. And that's, in my opinion,
15 not focused on.
16 A lot of times it's abuse, trauma, mental
17 illness.
18 And, it's not a one-sided disease. There's
19 other components that need to be looked into, and
20 the person needs to be treated as a whole, to figure
21 it out.
22 Thank you.
23 [Applause.]
24 SENATOR BOYLE: Thank you so much for sharing
25 that.
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1 And I can tell you that one thing that
2 I would like to take out of this Task Force, and
3 I can speak for my colleagues as well, is to change
4 the stigma involved with this.
5 I think that you should have the same
6 reaction when you tell about how your husband
7 passed, as if he had died of cancer or any other
8 disease, because it was a disease.
9 And we're sorry for your loss.
10 SENATOR MARCHIONE: Absolutely.
11 Thank you.
12 [Applause.]
13 SENATOR MARCHIONE: Well, we did use a card,
14 but she came to the microphone.
15 Is there someone else who would like to
16 speak?
17 Please go ahead.
18 LEANNE [ph.]: Hi. My name is Leanne, and I,
19 also, am a mom of a 20-year-old heroin addict;
20 however, I'm not here for that, 'cause, thank you to
21 Twin Counties. They helped me a lot, and they
22 accept my insurance, which is nothing towards the
23 addiction world.
24 I'm not up here for this.
25 I'm up here for what we're supposed to be
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1 here for today, which is, maybe, some kind of
2 program: an intervention, with prevention.
3 So when you implement a program, it starts
4 with our children, because all of us need to
5 understand what this woman just said.
6 And a mother, and another mother, we all do
7 not know the signs and symptoms.
8 Yes, we see it.
9 Yes, we say, but who wants to look at your
10 11-year-old and say, "Oh, my God, he's an addict"?
11 So, we close our eyes, and we don't want to
12 open it.
13 And, yes, we see the letters that come home,
14 but you know what I do with the letters? They go in
15 the garbage.
16 Whose fault? Everybody's.
17 And, so, when I went to Ichabod and said, "My
18 son's an addict," gave him my son's cell phone, what
19 happens? Nothing.
20 What can happen? Nothing.
21 My son's already addicted.
22 Who am I helping? Maybe a whole mess of
23 other mothers, parents, I don't know.
24 But, as a new grad, I just graduated with my
25 MSW, and I'm gonna think out of the box here: Let's
164
1 take our D.A.R.E. program, and we start implementing
2 that in kindergarten.
3 We do not do that in fifth grade.
4 In fifth grade, these kids already know what
5 a joint is, what the smell of crack is.
6 Let me tell you what; when I did my
7 internship down at Twin Counties, these kids already
8 knew what crack smelled like.
9 I did not know.
10 Why didn't I know? I'm the mother of a
11 heroin addict.
12 I was taught by all these addicts. I was
13 taught by Twin Counties.
14 And, I am here maybe to teach Ichabod Crane,
15 the cops: Bring your D.A.R.E. program into
16 kindergarten, and then we do a continuum. And you
17 get your social workers in there, and you educate
18 the social workers how to become KSACs [ph.], and
19 you do the prevention, which is, every year these
20 kids get a program of some sort; some kind of drug
21 education. And it's not implemented once with the
22 D.A.R.E. program.
23 Because what are we saying to our children?
24 That you're gonna get it one time in
25 fifth grade, and we don't care about the matter
165
1 anymore? Is that what we're saying?
2 We're saying that to the parents.
3 No. We need to do it every day. It's got to
4 be part of their education. It's gotta go right
5 through.
6 And then the intervention part, the
7 social worker's right there, and she can start doing
8 all of the treatment as far as counseling, and then,
9 even, family counseling.
10 And that's another thing that we don't do in
11 any of our outpatient treatment. We don't implement
12 family. It's always individualized.
13 And I get that.
14 And I -- you know, being very well-educated
15 now, I get it's individualized, but it's also
16 individualized with the parents, and sisters and
17 brothers, because it doesn't affect just the addict.
18 It affects all of us.
19 And when I see somebody else cry, and, my son
20 was put into an ambulance and given this Narcan
21 twice in one week, what can anybody say to me?
22 Nothing.
23 Okay? Nothing.
24 But you know what I can say to all of you, as
25 a mom, as a new grad? Get it into our schools, into
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1 kindergarten. Get your MSWs, your counselors;
2 KSAC; get them to learn what OASAS wants us to
3 learn, and not be, you know, this is what it is.
4 Every addict is individualized.
5 You need dialectic therapy.
6 We need to make our families involved.
7 We need -- you know, thank you to the, you
8 know, cops who bring in the D.A.R.E., and start that
9 at kindergarten, and we educate right through.
10 And, maybe, that is the best intervention,
11 and prevention.
12 [Applause.]
13 SENATOR MARCHIONE: Thank you.
14 Our program was supposed to end, but we do
15 have a lot of questions, so, we're gonna take some
16 more. We're gonna stay till about one, and try to
17 get through as many questions as we can.
18 I'd ask our panelists if they would keep
19 their comments back as, you know, answering, but as
20 succinct as possible, so we can answer as many of
21 these questions as we've got today.
22 Here is -- it's about the D.A.R.E. program.
23 It was from Jessica Tobin [ph.], and she wanted to
24 see if we could go back to having the D.A.R.E.
25 program.
167
1 "What happened to the D.A.R.E. programs in
2 the school?
3 "People are turning to drugs because of the
4 way the economy is. Kids, teens, are turning 'cause
5 there is nothing for them to do, for them these
6 days, but hang out on the streets."
7 So I think we've really -- we've talked about
8 the D.A.R.E. program, but thank you for your
9 question.
10 We'll take another one.
11 This is from a mom of an addict:
12 "How expensive is VIVITROL?
13 "How can a family monitor this?
14 "There is a wait list to see a doctor with a
15 license for Suboxone.
16 "For funding, why not put a line on the
17 IT-201 New York State tax return, which is a
18 voluntary contribution, allowing that contribution
19 to go to the taxpayer's county?"
20 So, does anyone want to talk about the
21 expense off --
22 KEITH STACK: I can address the VIVITROL
23 issue.
24 We have a psychiatrist, who's our medical
25 director, and we prescribe VIVITROL to clients who,
168
1 you know, fit the criteria for it.
2 It's -- oh, let's see, it just went up.
3 $1,039 for an injection. It's a one-month
4 injection, so it's not like you're taking a pill
5 every day, which makes it, actually -- you know,
6 people tend to stick with that regimen if it's an
7 injection.
8 People are hesitant to get an injection, and
9 you do have to be careful with heroin addicts, when
10 you start talking about, you know, needles and
11 injections, because, you know, honestly, that could
12 be a trigger to them.
13 But, it's reimbursable through Medicaid, and
14 at least in this area, CDPHP. We pay for it up
15 front, and then we get reimbursed for it.
16 So, it's not cheap, but it -- we're finding
17 that it is effective.
18 It's not -- and I think we have to continue
19 to stress this: You can't give an addiction
20 medicine alone without treatment. I mean, they have
21 to be coupled.
22 And even when a person leaves treatment, you
23 know, they leave with a prescription of VIVITROL.
24 You know, what we try to do is, we find them a
25 doctor who will continue to prescribe it, but, you
169
1 know, the recommendation really is, is that they
2 still continue to receive some type of
3 behavioral-health treatment.
4 And, you know, that's the great thing about
5 having these recovery peer supports, because you can
6 make that connection as well.
7 But, you know, that really -- so it's an
8 expensive product. It reduces the craving for the
9 drug. It makes them more open to the actual
10 treatment.
11 I took naltrexone when I was in treatment,
12 and that's a -- you know, it's a pill form of
13 VIVITROL.
14 And, you know, I guess the way I describe it
15 is: As opposed to sitting on my hands for an hour,
16 looking at the clock, you know, waiting to get out
17 of the -- you know, the treatment session,
18 I actually was, you know, paying more attention to
19 what was happening in the treatment section --
20 session.
21 You know, it took me a while to realize that
22 that actually was the result of the medication; but,
23 it was. It made me, you know, crave the drug less,
24 focus more. And that's really what it is.
25 It's not a silver bullet. It doesn't, you
170
1 know, magically lift, you know, an addiction
2 problem.
3 You know, recovery is lifetime; it's ongoing.
4 But definitely is a helpful tool, and it
5 should be readily available, both in treatment
6 programs and primary-care offices.
7 And, emergency rooms and hospitals need to at
8 least be aware of it, and consider making that a
9 recommendation for future care.
10 SENATOR MARCHIONE: Thank you.
11 State your name, please.
12 MARTHA MAHONEY: Hi, thank you.
13 I'm Martha Mahoney [ph.]. I'm a student at
14 SUNY Albany.
15 And, I was just wondering if you could
16 elaborate a little bit on your answer for
17 collaboration with the Attorney General's Office, in
18 regard to their community overdose-prevention
19 program that was just announced in early April?
20 So, are you working with the AG's Office
21 before the -- your report is published, or, you're
22 waiting until after the report is published?
23 SENATOR BOYLE: Probably after, because we
24 have to get our proposals together in a legislative
25 form, and, certainly, getting -- get the input from
171
1 the Attorney General on it.
2 We're -- likely talk to him about the
3 possible, especially when it comes to law
4 enforcement and those programs.
5 And I know a -- Narcan, he's been going
6 around the state, talking about that program, as
7 well.
8 But, we'll make his office aware of our
9 legislative proposals, but then work with him on the
10 passage of it.
11 MARTHA MAHONEY: Okay.
12 And then, a -- same with, senator Schumer, in
13 early March, he announced an initiative called
14 "DrugStat," which would be an electronic monitoring
15 system of opioid overdose in New York State.
16 And have you -- has the Task Force worked at
17 all with the Senator's office?
18 SENATOR BOYLE: We have not, but I did read
19 about that program. I think it's a good one. And,
20 if we can help with some funding in that, we'd be
21 happy to try.
22 MARTHA MAHONEY: Okay. Thank you.
23 SENATOR BOYLE: Thank you.
24 SENATOR MARCHIONE: The next card is from
25 James Houlihan [ph.], who's a retired pastor.
172
1 He says: Given the climate of stress that
2 leads to addiction, and the susceptibility of youth
3 to peer pressure, what's the [unintelligible]
4 programs for youth are available, or could be
5 implemented, for all youth, as normal peer-support
6 groups?
7 TONY JORDAN: Sure, I'll jump in.
8 As a father of four, I always do this to my
9 kids at Sunday School.
10 How many -- there's a lot of adults in here:
11 all adults, many parents.
12 How many are afraid of talking to their kids
13 about drugs because they're afraid that that will
14 then make them experiment? (Raising hand.)
15 Am I the only one?
16 [Laughter.]
17 TONY JORDAN: I don't think that's correct,
18 because I think the reason we don't see it in
19 schools, is because teachers are afraid to talk
20 about it.
21 Parents are afraid to talk about it.
22 If you ask teachers, we need to implement a
23 program in your classroom, how many teachers, the
24 first response would be: Where am I gonna find the
25 time?
173
1 I think, from my perspective, we don't have
2 time. And I think a lot of it is, you have to talk
3 about it.
4 The woman who said bring it into kindergarten
5 is 100 percent correct. We have to talk about it.
6 Parents have a huge responsibility here.
7 Because your child is prescribed Percocet for
8 pain doesn't mean they have to take the full
9 allotted prescription.
10 It's not just the doctors that are
11 prescribing; it's the patients that are taking.
12 And I think we have to own a certain amount
13 of that responsibility.
14 I think, as parents, we have a greater
15 responsibility to our kids than our communities do
16 to our kids.
17 The mom said earlier, you said: Parents have
18 to be involved. We have to be in school.
19 The wife said: Don't diminish the person.
20 Senator Boyle said it perfectly.
21 So I get -- I bristle at the notion that the
22 community has to solve the problem.
23 We have to hold our families accountable.
24 Our communities have to support our families.
25 Where families aren't, or can't, then the
174
1 communities have to be brave, and walk into schools
2 and volunteer.
3 Don't be afraid to talk to your kids about,
4 if you see -- the overdose in a public bathroom,
5 that's a public-health issue, because addicts are
6 using single-locked stalls.
7 They have -- these people who have the
8 addiction have to go someplace, and will. We can't
9 stop that.
10 We can try to help them, but we have to
11 educate everyone to realize that this is the reality
12 of that person's life. It doesn't diminish them as
13 a person.
14 I just -- I guess I get -- I want to
15 emphasize, with all of us, don't be afraid to talk
16 to your own kids, your neighbor's kids, the
17 next-door neighbor's child, the child you see on the
18 street; just to stop and talk to them.
19 Because they will laugh at you, just like we
20 would have laughed at that adult, but one of them
21 might listen.
22 And I think when we talk age-appropriate,
23 let's not have adults design it, because I haven't a
24 clue what will grasp a 6-year-old, a 12-year-old, a
25 15-year-old, or an 18-year-old's mind; but they do.
175
1 So I think that's the real challenge, is,
2 because they're doing it, they know about it. We're
3 naive if we think they don't.
4 But I would ask again, in your own mind,
5 raise your hand if you're afraid to talk to your
6 neighbor's kid about drugs, because I think most of
7 us are.
8 SENATOR MARCHIONE: Thank you, Tony.
9 I'm not sure which one of you was first,
10 but --
11 DAN FARLEY: Can I respond to that last one?
12 SENATOR MARCHIONE: Oh, okay. If you just
13 could do it as quickly as you can?
14 DAN FARLEY: I'll keep it as quick as I can.
15 SENATOR MARCHIONE: Thank you.
16 DAN FARLEY: I think that one of the
17 things -- and I'm talking as -- also, as a father of
18 six, and all of mine are from 10 to 18 right now,
19 so, particularly scary time.
20 And one of the things I use as a parent is
21 horror stories. I don't have a problem with scaring
22 my own children.
23 I don't have a problem with scaring other
24 people's children in the school day. That's kind of
25 what I do all day.
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1 We need to do that, but we need to be aware
2 of what is involved in these horror stories. We
3 need to listen to these people that have lived the
4 trauma in their lives.
5 The other piece of that is, we've -- most of
6 the teachers in my building don't have any
7 experience with knowing what these drug signs are,
8 and what the indicators are, that somebody's using
9 drugs.
10 We know that, when someone stops being
11 involved in sports, stops being involved in their
12 extracurricular activities, stops being involved in
13 family activities, those are indicators for us that
14 there's a real problem here.
15 Sometimes that problem is related to drug
16 use, sometimes it's related to other things. And we
17 have to deal with those problems immediately.
18 SENATOR MARCHIONE: Thank you.
19 That's okay.
20 If any of our panelists need to leave,
21 I absolutely understand that.
22 We're gonna go just till one. It's
23 twenty-five of.
24 If you would like to ask your question?
25
177
1 KAREN HALL: My name is Karen Hall. I'm a
2 nurse practitioner. I'm also a 12-year veteran, and
3 a 20-year student of academics.
4 And a lot of the points that have been
5 brought up today have been really valid.
6 I'd like to pull in a couple of other points.
7 As a provider in primary care and emergency
8 medicine, it's extremely frustrating as a provider
9 to see those patients who come to the ER begging for
10 assistance for withdrawal treatment.
11 "I can't offer it to you. The State says
12 I can't, you don't qualify. The hospital says you
13 don't qualify. The insurance company says you don't
14 qualify. I cannot offer it to you."
15 It's a frustration for providers.
16 It's a frustration, as well, to see parents
17 bring their children.
18 And, understanding, we need to teach parents,
19 we need to teach providers. Providers need to know,
20 quite frankly.
21 I get lots of education on treating diabetes,
22 hypertension, congestive heart failure.
23 Ask your primary providers how much education
24 they get on addiction, behavior-modification
25 therapies, proper prescribing practices for these
178
1 controlled substances.
2 12- to 18-year-olds, 80 percent of them
3 people have tried an opioid. Most of them have got
4 it from a parent, a family, a loved one.
5 "My kid had a headache. I gave him my
6 Loratab [sic]."
7 We have to educate our prescribers on who and
8 where and why they're prescribing.
9 We have to educate our parents on:
10 I understand you don't want your children to be in
11 pain. I don't want them to, either. But a sprained
12 ankle and an earache doesn't warrant Percocet and
13 morphine.
14 And I'm seeing providers give this to
15 12-year-olds, to 15-year-olds. I've seen
16 3-year-olds getting this.
17 These things need to be better educated for
18 all parties involved. We are all responsible.
19 They say it takes a community to run a
20 village, to raise a child?
21 It takes a whole society.
22 We expect law enforcement to clean up the
23 mess once we've made it.
24 We have to start owning what we do, how we
25 do, when we do.
179
1 My question is for academics.
2 We've had [unintelligible] staff here. We
3 have physicians here. We have human services here.
4 What are we doing, from an academic
5 standpoint, for our medical professionals, and even
6 our teachers?
7 We talked about bringing it to the school.
8 How many teachers are forced to go through
9 drug awareness-courses to understand, what are the
10 street names that kids are using today for the drugs
11 that they're -- because I don't know. I hear it
12 from my students.
13 The signs are not readily available until
14 they're well down the path of addiction.
15 My patients don't come in and say: Yeah,
16 I use crack and heroin four times a day.
17 They might say: Yeah, I take my Percocet a
18 little more than I should. And, yeah, I'm smoking
19 marijuana every three to four hours.
20 But, they're not forthcoming with these other
21 addictions.
22 We don't know about it, we can't treat it, we
23 can't address it. But we also don't ask about it.
24 Most people don't ask about: How often are
25 you taking this? Why are you taking that? How long
180
1 have you been on this?
2 The Suboxone treatments, much like methadone,
3 I understand it's a long-term treatment plan, but
4 I have 26-year-olds who have been on Suboxone for
5 8 years.
6 I don't think that's how it was intended to
7 be used.
8 Most of them get a monthly, or weekly,
9 meeting with their provider.
10 "Here's your prescription. How you doing?
11 Everything okay?"
12 Maybe a drug test.
13 "I'll see you next month."
14 I have physicians who meet their patients in
15 McDonald's and Dunkin Donuts for their Suboxone
16 meetings, because, "Well, hey, it's easier for them
17 to get to me here."
18 You're a street dealer who's legalized.
19 Where's the counseling?
20 Where's the therapy?
21 Where's the behavior modification?
22 I own this, I'm passionate about it. I'm
23 doing a dissertation on this topic for
24 New York State, because I'm pissed, as a provider,
25 how much we're owning it.
181
1 [Applause.]
2 KAREN HALL: I would also like to point out,
3 based on the statistics for drug addiction, we've
4 got a few users in here.
5 It's not the Black problem. It's not the
6 poor problem.
7 I have physicians who are addicted.
8 We have professionals who we talk to every
9 day. We have no clue, until they're found in the
10 bathroom somewhere, or their family finds them. And
11 they're mothers, they're parents, they're nieces,
12 they're professionals.
13 It's a huge problem.
14 We all have to take a holistic look at this.
15 And I'm just curious: Academic-wise, what
16 are we doing to train our professionals?
17 Are we teaching students in med school more
18 about addiction, behavior, how to proper prescribe,
19 how to be accountable?
20 I-STOP is great. Love it.
21 Love it!
22 It's not mandated use at this point in most
23 states.
24 Can anybody tell me, what are we gonna do to
25 change that?
182
1 THEODORE J. ADAMS, JR.: I have some limits
2 here to Hudson Valley Community College, and we
3 don't train doctors here, unfortunately.
4 KAREN HALL: Nurses. Train nurses.
5 THEODORE J. ADAMS, JR.: Nurses. Well,
6 that's a good piece, and I could talk to the
7 department chair.
8 KAREN HALL: They can advocate for their
9 patients.
10 THEODORE J. ADAMS, JR.: I'm sorry?
11 KAREN HALL: They can advocate for their
12 patients.
13 THEODORE J. ADAMS, JR.: Absolutely. No,
14 that is a good point. And that's a piece where
15 I may have some control over, and I can talk to the
16 department chair about that, and see what kind of
17 addiction piece she has in her curriculum for her
18 program.
19 And that's a place where I can have a change,
20 or try to provide a change.
21 As a -- I have 20 years of experience in the
22 field of addictions, as well. And I would, as a
23 director, go into some primary-care physicians and
24 provide in-house trainings during lunch, to provide
25 some information to the nurses, the nurse
183
1 practitioners, to the doctors, at times. And
2 I would reach out to the community.
3 Because I, too, am passionate about this
4 topic, as well.
5 I think one of the lax -- what's lacking in
6 our medical society, is there is not an educational
7 component when they're working on their M.D.
8 And I do not know the answer of where that
9 gets addressed, or how that should be started.
10 I've only tried to do it how and when
11 I could.
12 SENATOR BOYLE: I can say that, I think it's
13 certainly a good idea for our medical schools.
14 But we -- as part of this legislative package
15 coming out of this Task Force, we are going to have
16 legislation, mandating that, with continuing medical
17 education, that doctors need screening, prevention
18 treatment.
19 Ideas will be part of that, and looking at
20 addiction, and how they may overprescribing and
21 causing the problem.
22 KAREN HALL: If I may to that?
23 SENATOR BOYLE: Yeah.
24 LISA WICKENS: There are millions of CMA
25 opportunities for providers. It's all elective.
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1 You choose what you want to train.
2 If I'm a provider that doesn't want to treat
3 addicts, I'm not going to that CMA for addiction,
4 because I'm gonna go to the CHF one, because that's
5 what I treat.
6 "Prescribing" education has to be mandated,
7 or started at the academic level.
8 Just a suggestion.
9 SENATOR BOYLE: Understood. Thank you.
10 SENATOR MARCHIONE: Thank you very much.
11 DR. WILLIAM MURPHY: Yeah, I was just going
12 to comment on that, from a practicing physician's
13 viewpoint.
14 I agree, as well, that -- that, you know,
15 New York State is a tough place for mandates,
16 obviously. But, I think this is an area that really
17 has to be recognized as a point of intervention.
18 For -- it was probably starting about 20, or
19 25 years ago, the treatment of pain became a major
20 issue in medicine. We were kind of beaten over the
21 head and shoulders about -- about not, you know,
22 treating the common problems of pain in our
23 patients.
24 And I think -- I don't have any data to
25 support this statement, but my guess is that, is
185
1 that our opiate problem today is, essentially, the
2 chickens coming home to roost in the -- in this push
3 toward answering patients' requirement for better
4 pain management.
5 That having been said, I think there --
6 I just want to raise, again, the equipoise that it
7 takes to properly and responsibly prescribe.
8 And I want to -- I do a lot of reading,
9 actually, on this subject, and I'm unaware of any,
10 you know, articles that go out broadly to
11 physicians, about: How long do you need to treat
12 acute pain following a knee-replacement operation?
13 Fill in the blank.
14 You know, how long do you need to treat the
15 pain from a laceration?
16 You know, what have you.
17 You know, we really don't have a lot of
18 research in this regard.
19 And when you've kind of been beaten over the
20 head about not prescribing, or answering, your
21 patient's pain needs, the answer is, unfortunately
22 for our society, was to overprescribe.
23 And, in fact, absolutely, many children, and
24 probably the vast majority, really -- or, a
25 majority, anyway, that start out using opiates, get
186
1 them right from their home or from their friend's
2 home.
3 So, it's really -- it's education, really,
4 across the board, is what we really need.
5 We need to educate parents. We need to
6 educate children. We need to educate physicians.
7 And we need to educate medical consumers, as well.
8 So -- but I think, practically speaking, what
9 the Senators can take from this, is that -- is that,
10 a mandate, with respect to proper prescribing of
11 opiates, would probably be a good one.
12 Just as I think that the I-STOP mandate in
13 New York State, although it was met with, I heard a
14 lot of grumbling from my colleagues about this,
15 I think it's a very good thing.
16 The unintended consequence of raising the
17 profile of heroin in the community is unfortunate,
18 but -- but that's manageable.
19 I think this is a step in the right
20 direction.
21 KEITH STACK: You know, there is an
22 evidence-based practice. It's SBIRT.
23 It's called "SBIRT": Screening, Brief
24 Intervention, Referral to Treatment.
25 And it's targeted, or intended, primarily,
187
1 for primary-care physicians, emergency room doctors,
2 nurses, physicians' assistants.
3 And Dr. Stanley Glick at Albany Medical
4 Center is a real advocate of SBIRT training. And,
5 you know, he's been running programs, at least in
6 the medical college, and training students in that
7 technique.
8 I know the Albany Police Department -- the
9 City of Albany Police Department has taken SBIRT
10 trainings.
11 And, Sheriff Apple's director of Stop DWI,
12 Marty, has taken the SBIRT training, as well.
13 And it's a 4-hour training. And what it
14 really does, it gives the individual the ability to,
15 you know, recognize the early signs of abuse. And,
16 it also is a -- you know, kind of a casual approach
17 to it, that opens up individual to talk more freely
18 about -- you know, about his use, whether alcohol or
19 drugs.
20 But, you know, it's -- you know, it's short;
21 it takes about 15 minutes, to administer SBIRT.
22 And, the end result, you know, frequently, is
23 a recognition that this person should be referred to
24 treatment.
25 But, it's a very early intervention.
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1 So that -- you know, that's the training
2 that's out there.
3 I'll make that available to the Task Force.
4 SENATOR BOYLE: That's actually the
5 legislation we have, is to mandate the SBIRT
6 programs.
7 SENATOR MARCHIONE: Okay. Thank you.
8 Next question is, "What can I do?" from
9 someone in the audience.
10 You can take a Narcan class.
11 You can talk to your kids, as the
12 District Attorney said. You can talk to your
13 neighbors kids.
14 You can be an advocate.
15 You can -- once our program comes out -- our
16 proposal comes out, please be an advocate of that
17 program if you agree with it. You know, call other
18 Assemblymen and Senators; help us move this through.
19 Does anyone else have anything else?
20 Sir.
21 MIKE: Good afternoon.
22 I really appreciate your coming together, and
23 bringing the community together.
24 My name is Mike. I'm from East Greenbush.
25 And, I'm the father of a heroin addict.
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1 And, I just want to share with you, I guess,
2 a few words in my ordinary day, and my family's
3 ordinary day, before November of last year, were:
4 Family, health, and finances.
5 But now I have words that we struggle with,
6 my wife, my daughter, and myself, along with my son,
7 that are in addition to those three words:
8 Shattered.
9 Shock.
10 Addiction times two, because his girlfriend
11 is also addicted.
12 Granddaughter; a 2-year-old granddaughter,
13 who was neglected by both parents.
14 The word "custody."
15 My wife and I have custody of our
16 granddaughter, along with my daughter.
17 Lies.
18 Theft.
19 Relationship.
20 Career went down the drain.
21 He was in union as a second-year apprentice.
22 Down the toilet.
23 Employment. Can't find employment now.
24 Jail.
25 Legal.
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1 Landlord. I'm their landlord, and they are
2 tenants.
3 Now, jail went away, hopefully, for the long
4 term, and forever.
5 But all these words, and I'm sure I'm not the
6 only one that's sharing this, continue to slowly
7 kill us every day.
8 Now, you graciously gave us some statistics,
9 but one thing that bothers me the most is that one
10 you told me earlier: That 80 percent of the
11 drugs --
12 Drugs, or heroin?
13 DAN ALMASI: 80 percent of the opiates,
14 nationwide, are used by America --
15 MIKE: Worldwide.
16 DAN ALMASI: -- which makes up 5 percent of
17 the global population.
18 MIKE: Okay.
19 That bothers me.
20 So that's a weapon of mass destruction, is it
21 not?
22 So it's not an epidemic. This is a war.
23 And, Sheriff Apple, you started with it
24 earlier.
25 We had minimal discussion about federal.
191
1 It's got to go to the federal.
2 And I apologize for my being upset.
3 Thank you.
4 [Applause.]
5 SENATOR MARCHIONE: Thank you so much for
6 sharing.
7 You know, a person who's living it can really
8 give us the insight on what it's like to be living
9 with a heroin addict.
10 And, it compels those of us who are sitting
11 up here to want to do even more.
12 Very sorry for where you are.
13 We have Ruth Clements [ph.]. She wrote a
14 card, but wanted to speak.
15 Is she still here?
16 Okay.
17 And -- oh, she has a question, though.
18 "To Dan Farrell [sic], or anyone else on the
19 panel: What further can community members and state
20 agencies do, SED, to help the schools, particularly
21 middle and high school?
22 "Mr. Farrell [sic] already mentioned
23 committees.
24 "How do school personnel identify the
25 students in need?
192
1 "Is there any information reported,
2 available, on violent and disruptive incident
3 reports regarding this?
4 "And what should we do to get more funding?"
5 So I think we've answered a lot of that, but
6 if there's anything we haven't, I'd ask that you
7 address it.
8 SHERIFF CRAIG APPLE: Senator?
9 SENATOR MARCHIONE: Yes.
10 SHERIFF CRAIG APPLE: Just, real quick,
11 I know everybody's in a hurry, but --
12 SENATOR MARCHIONE: No, no.
13 SHERIFF CRAIG APPLE: -- one point of
14 interest, is that State Ed really needs to get to
15 the table, because we still have schools in
16 Albany County that will turn their head, that don't
17 think there's even marijuana in their schools.
18 So they're just fooling themselves.
19 We are constantly battling, trying to get
20 into schools, to check schools, to talk to people.
21 But you really -- and, you really need to
22 create that paradigm.
23 You really need to -- the stigmatism's there.
24 You just gotta kind of get through it, and realize
25 that, Hey, it's here. It's not going anywhere,
193
1 unless we deal with it.
2 A lot of the school districts in
3 Albany County turn their head. They're, like, We
4 don't have any drugs in here.
5 And, unfortunately, what's gonna happen, is
6 we're gonna find a dead student.
7 And, we're constantly battling with them, to
8 let us get in there.
9 We've talked about D.A.R.E.
10 Again, the schools don't really want it.
11 They don't want to draw attention to it.
12 So it really needs -- in my belief, is that
13 State Ed needs to get involved, and mandate.
14 I love the idea of getting every grade. Just
15 have a quick, even if it's half a year, just
16 something, integrated with health class, or
17 something. That's only a half-a-year course.
18 Integrate it in there, just to draw more
19 attention to it.
20 Because I do -- I believe -- I think she's
21 absolutely correct: Where, you hit them quick in
22 fifth grade, you're done for the rest of your
23 high school, and college, everything. Move on.
24 But we're seeing more and more youth addicted
25 to the heroin.
194
1 And until the State gets in and mandates
2 something, and they're pretty good at it, you know,
3 the mandate portion, anyway.
4 [Laughter.]
5 SENATOR MARCHIONE: Don't let Kathy
6 [unintelligible] know you're saying that.
7 [Laughter.]
8 SHERIFF CRAIG APPLE: Until they do get
9 involved with that.
10 And that's not something that's gonna cost a
11 lot of money. I mean, that's something that they
12 can integrate into their curriculum, and get out
13 there, and make the kids go home and ask questions,
14 and have the parents ask questions; and now you've
15 got true community involvement, you've got family
16 involvement, because the kids are gonna ask.
17 If there's one good thing they're at -- that
18 they're good at, is asking questions.
19 SENATOR MARCHIONE: You know, if the forum
20 like this would draw this crowd at 9:00 in the
21 morning, what would a school draw --
22 SHERIFF CRAIG APPLE: Exactly.
23 SENATOR MARCHIONE: -- if they went out and
24 said: We're gonna give you some education for the
25 parents, and the students, and have an evening
195
1 program?
2 SHERIFF DAVID BARTLETT: Let me answer that.
3 We've actually done forums before, and this
4 is one big thing that you have to get across to
5 everyone in the community: Get out and get
6 involved.
7 Because we've done forums before, and it's
8 been the panel, and about four people that would
9 show up.
10 SENATOR MARCHIONE: Really? Wow.
11 SHERIFF DAVID BARTLETT: Their thing's great.
12 We still run it down in Columbia County. We
13 can only do it in fifth grade. We tried to do it in
14 eighth. It comes down to money for me, and, I only
15 have so many deputy sheriffs.
16 But, do me a favor, keep pushing it. I love
17 it.
18 SENATOR MARCHIONE: Well, the best that
19 I can -- if any of you here have forums and you need
20 a little bit of advertisement, the best that I can,
21 we're willing to help, I'm willing to help, within
22 my district.
23 Sir, you have your hand --
24 AUDIENCE MEMBER: While you guys are on this,
25 [unintelligible], this just popped into my mind:
196
1 What about --
2 SENATOR MARCHIONE: Oh, he's not on a
3 microphone.
4 Sir, you're gonna have to wait. I'm sorry.
5 We've had people waiting.
6 If you don't mind, we'll be -- and I'm really
7 gonna have to tell you how sorry I am that we're not
8 gonna get to all questions, either.
9 I mean, thank you so much. The participation
10 has been amazing today.
11 But if we could, I'd like to come to you.
12 DAVID BURNS [ph.]: Actually, I'd just like
13 to thank everybody.
14 My name is David Burns.
15 I work for St. Mary's Hospital in Amsterdam.
16 I'm a substance-abuse counselor.
17 There were so many good things said here.
18 You know, and I got to be honest: On my way,
19 I was going, Oh, it's going to be a blah blah blah
20 blah blah.
21 [Laughter.]
22 DAVID BURNS [ph.]: But it wasn't. It was
23 great, you know?
24 SENATOR MARCHIONE: Thank you.
25 DAVID BURNS [ph.]: I mean, I've been in this
197
1 field for a long time. I'm a former heroin addict.
2 I am a heroin addict; I'm just not active.
3 I've been sober about 30 years.
4 [Applause.]
5 DAVID BURNS [ph.]: I see everybody here,
6 and, please, please, go after these insurance
7 companies.
8 You know, there's nothing worse in my field
9 than to have to go to somebody and say: I can't
10 help you, pal.
11 You know what I mean?
12 And I was listening to the lady down there
13 about the detox statistics.
14 They are poor, but they're poor because we
15 can't get the people help.
16 You know, and somebody else said it.
17 I call insurance companies, and they give me
18 three or four days, you know.
19 And I'm not here telling my story, but you
20 know what? When I got help, in three or four days,
21 I didn't even know my name yet.
22 And, you know, and they're sending these
23 people out the door.
24 And, you know, I respect these guys.
25 Mr. Apple, I see him all the time on TV. He
198
1 seems to be aware of what's going with the drug
2 situation.
3 And -- and -- but, please, again, thank you
4 very much.
5 And, please, somebody, where do we go?
6 Where do we go?
7 Do you -- does anybody have any answers?
8 Do I go to my legislator?
9 Where do I go?
10 Someone?
11 I just got a statistic.
12 I belong to this thing, it's called
13 "Join Together."
14 If anybody's -- it gives you all the drug
15 news, and all, blah blah blah, what's going on on
16 the streets, and everything.
17 It's a great web site.
18 And, I just read something from the
19 Attorney General, where they went after a major
20 insurance company in the Capital District. They
21 were only approving 14 percent of -- of -- you know,
22 where's the other 86 percent?
23 And, last year, in the United States, over a
24 million -- over 12 million people applied for
25 treatment, and less than a million got it.
199
1 Something's wrong. You know what I mean?
2 We got to straighten this out with this
3 insurance industry. They're killing people.
4 Thanks again for coming.
5 [Applause.]
6 SENATOR MARCHIONE: Thank you very much.
7 I'm going to -- it is three minutes to one.
8 You've been standing there, so I don't want
9 to not take your question. It will be the last
10 question of the forum.
11 But, please, go ahead.
12 JAMES COOPER: All right.
13 My name's James Cooper. I'm from
14 Averill Park.
15 As far as the funding for rehab:
16 I mean, you have guaranteed loans for
17 students.
18 Why can't they have guaranteed loans for
19 people to go to the bank and borrow money to put
20 their kids in treatment?
21 Or -- I mean, I'm sure a lot of people are
22 willing to pay for treatment, I mean, if they get
23 access to the money.
24 And then, as far as taking the drug dealers
25 off the street, I mean, if you go out and take all
200
1 the drug dealers off the street, all these people
2 that are gonna be left without drugs, are gonna need
3 a place to go.
4 They all rush to the hospital, who's gonna
5 take care of them? You gonna turn them all away?
6 I mean, you's gotta be able to do something
7 about that.
8 SHERIFF CRAIG APPLE: The problem is, when
9 you take the drug dealers off the street --
10 JAMES COOPER: I guess that's probably why
11 you don't take them off the street.
12 SHERIFF CRAIG APPLE: When you take the drug
13 dealers off the street, the users become drug
14 dealers. And it just is a constant vicious,
15 vicious --
16 JAMES COOPER: Or you drive down the street
17 in Troy, you know, you stop at a red light, people
18 walk up to your car and they try to sell you
19 something. I mean, there's cops all over the place.
20 Why are those people allowed
21 [unintelligible]?
22 SHERIFF CRAIG APPLE: Well, I trust -- I'm
23 not gonna speak for every other agency, but, I mean,
24 we're out every day, getting search warrants signed.
25 Every single day, getting warrants signed,
201
1 and hitting houses, and hitting houses.
2 But, again, you can't just focus on the low
3 level. We need the big fish in order to even make a
4 dent, the slightest dent.
5 We took two people off, consecutively,
6 three weeks ago, with over 2500 bags a piece --
7 2500 bags, each, with heroin. That's 5,000 bags of
8 heroin that would have been distributed through the
9 Capital District.
10 The next day, we were hitting houses again,
11 because it's just a vicious cycle.
12 That, problem is, with these low-level
13 dealers, if you don't get them any treatment and
14 just throw them in jail, when they get right back
15 out, that's what keeps your recidivism going,
16 because they just reoffend. They go back out and
17 they find more, and then I get them back in.
18 I mean, there was times last year -- or,
19 two years ago, where I had a grandfather, a father,
20 and a son in our jail. That's pretty sad.
21 Where do you think the next generation's
22 going, until you can break that cycle?
23 And that's why I'm saying, it's one thing
24 just to lock them all up.
25 They did this with the mental health.
202
1 When they closed mental-health facilities, we
2 had to add an $11 million expansion for
3 mental-health inmates.
4 They don't belong in there. All right? They
5 belong, getting treatment somewhere else.
6 It's no different than a drug user. They
7 need to be getting treatment somewhere; otherwise,
8 we're just going to spend more money, your money,
9 sitting in our county jail for 23 1/2 hours a day in
10 a cell. And then when they get out for that half an
11 hour, they come up with different ways with how to
12 get their drugs when they get back out.
13 I mean, I've been seeing it for 27 years.
14 And until we start to do something more
15 actively with treatment providers, I'm gonna see it
16 for -- well, I don't know about another 27 -- but
17 I'm gonna see it for a couple.
18 So, trust me, sir, we're trying. We're
19 fighting the war.
20 You know, we don't fight the war. We fight a
21 battle at a time. And, you know, some battles we
22 win, some battles we lose.
23 But, every day, it's in the rural areas, it's
24 in the suburban areas, it's in the inner city, we're
25 trying to fight.
203
1 But you know what? There wouldn't be -- the
2 population would diminish if I had them all in the
3 jail, trust me. But then those users become
4 dealers, because they gotta feed their habit. So
5 they go out and sell three bags in order for them to
6 use three bags.
7 So we're trying, I assure you.
8 SENATOR MARCHIONE: Thank you very much.
9 Thank you for your questions.
10 I'd like to turn it over to Senator Boyle for
11 a wrap-up.
12 SENATOR BOYLE: I'd just like to thank you,
13 Senator Marchione, and my colleagues Senator Robach
14 and Assemblyman McLaughlin, and all the panelists,
15 for your comments, and your good insights;
16 And all the people in the audience,
17 questions, comments. And just your support for
18 being here.
19 We got some good information out of today's
20 forum. It was a great exchange.
21 And I can tell you that, undoubtedly, some of
22 the comments that we got today will be in our
23 report, and viewed towards future legislation to
24 finally combat and win this heroin epidemic.
25 Thank you.
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1 SENATOR MARCHIONE: Thank you.
2 I'd also like to thank, again, Hudson Valley
3 Community College, President Drew Matonak.
4 Amazing.
5 Thank you for your facility, to his wonderful
6 staff.
7 And I want to thank my staff for all the
8 wonderful work they've done on this forum.
9 And as Senator Boyle said, this is not the
10 last word. This is just the beginning, and you can
11 count on us to move forward on this issue.
12 Thank you all for coming.
13 [Applause.]
14
15 (Whereupon, at approximately 1:09 p.m.,
16 the forum held before the New York State Joint
17 Task Force on Heroin and Opioid Addiction
18 concluded, and adjourned.)
19
20 ---oOo---
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