Public Hearing - April 28, 2014
1 BEFORE THE NEW YORK STATE SENATE MAJORITY COALITION
JOINT TASK FORCE ON HEROIN AND OPIOID ADDICTION
2 ------------------------------------------------------
3 PUBLIC FORUM: OTSEGO COUNTY
4 PANEL DISCUSSION ON HEROIN EPIDEMIC IN ONEONTA
5 ------------------------------------------------------
6
7 SUNY Oneonta
108 Ravine Parkway
8 Oneonta, New York 13820
9 April 28, 2014
9:30 a.m. to 12:00 p.m.
10
11
12 PRESENT:
13 Senator Philip M. Boyle, Task Force Chairman
Chairman of the Senate Committee on Alcoholism and
14 Drug Abuse
15 Senator James Seward, Task Force Forum Moderator
Member of the Joint Task Force
16 Chairman of the Senate's Standing Committee on
Insurance
17
Senator Thomas O'Mara
18 Member of the Joint Task Force
19
20
21
22
23
24
25
2
1
PANELIST INTRODUCTIONS: PAGE 10
2
Justin Thalheimer
3 Chemical Dependency Program Manager
Otsego County Addiction Recovery Services
4
Nancy Ortner
5 Chemical Dependency Program Manager
Schoharie County Chemical Dependency Unit
6
Christopher Kemp
7 Chemical Dependency Program Director
Delaware County Alcohol and Drug Abuse Services
8
Richard Northrup
9 District Attorney
Delaware County
10
James Sacket
11 District Attorney
Schoharie County
12
Joe McBride
13 District Attorney
Chenango County District Attorney
14
Steve Graham, M.D.
15 Obstetrician/Gynecologist
Bassett Healthcare Network
16
Joe Sellers, M.D.
17 Internist and pediatrician
Bassett Healthcare Network
18 Also, Secretary of the State Medical Society
19 Kelly Robinson, M.D.
Medical Director of the Emergency Department
20 A.O. Fox, Oneonta
21 Dr. August J. Leinhart
Chief of Emergency and Trauma Services
22 Bassett Healthcare Network
23 Joe Biviano
Administrator
24 Take Back Chenango
25
3
1
PANELIST INTRODUCTIONS (Continued):
2
Robert Clipston
3 Co-founder
Take Back Chenango
4
Nicholas Savin
5 District Superintendent
Otsego Northern Catskills BOCES
6
Joseph Booan
7 Director of Student Services
Otsego Northern Catskills BOCES
8
Norine Hodges
9 Executive Director
Schoharie County Council on Alcoholism and
10 Substance Abuse
11 Dave Ramsey
Executive Director
12 Delaware County Alcohol and Drug Abuse Council
13 Jeanette Tolson
Executive Director
14 Friends of Recovery of Delaware and Otsego counties
15 Julie Dostal
Executive Director
16 LEAF Council on Alcoholism and Addictions
in Otsego County
17
Craig DuMond
18 Undersheriff
Delaware County
19
Thomas Mills
20 Sheriff
Delaware County
21
Ernie Cutting
22 Sheriff
Chenango County
23
Tony Desmond
24 Sheriff
Schoharie County
25
4
1
PANELIST INTRODUCTIONS (Continued):
2
Richard Devlin
3 Sheriff
Otsego County
4
Gary Leahy
5 Sergeant, Assistant Zone Commander
New York State Police, Troop C
6
Mike MacInerny
7 Senior Investigator, BCI
New York State Police, Troop C
8
Dr. Judy Weinstock
9 Primary-Care Physician
Bassett Healthcare Network
10
11
PERSONAL STORIES: PAGE
12
Deb France 14
13 Parent
Personal Story
14
Mylea Buffo 20
15 Opiate and Heroin Addict
Personal Story
16
17
PANELIST DISCUSSION BEGINS 27
18
19 AUDIENCE PARTICIPATION, Q&A SESSION 125
20
21 ---oOo---
22
23
24
25
5
1 SENATOR SEWARD: Well, good morning,
2 everyone, and I want to welcome everyone here for
3 our Senate Special Task Force forum on Heroin and
4 Opioid Addiction to -- here in Oneonta.
5 And, we have a very distinguished group
6 that's gathered here today, and we look forward to
7 your input on our discussion.
8 As we all know, heroin and opioid use has
9 reached epidemic proportions across the state,
10 across the nation, and, unfortunately, right here in
11 our area as well.
12 The statistics are shocking.
13 You know, nationwide, heroin-overdose deaths
14 increased 55 percent between 2000 and 2010.
15 Here in New York State, overdoses killed
16 2,051 people in 2011, more than twice the number
17 just in 2004.
18 Further, drug-overdose deaths are the leading
19 cause of accidental death for people ages 25 to 64,
20 with more than 40 percent attributed to heroin and
21 opioids.
22 These are numbers from the State
23 Attorney General.
24 And these types of statistics mirror what
25 I am told is going on right here in our area,
6
1 similar numbers, similar trends. Particularly, when
2 you look at the increased hospitalizations, program
3 admissions, for heroin and opioid uses, the numbers
4 are staggering.
5 Lives are being lost, families are being
6 destroyed. Our health-care dollars are being
7 stretched, and law enforcement and prosecution
8 dollars are also being stretched thin.
9 And so that's why, this year, our
10 Senate Majority Coalition created a Special
11 Task Force on Heroin and Opioid Addiction, to
12 examine this rise in heroin and opioid use to
13 develop recommendations for attacking this problem.
14 This is one of 12 forums that are being held
15 across the state, so it is critical that we bring
16 together stakeholders and experts to develop a
17 comprehensive strategy for attacking this problem.
18 We need your information, your insights, and
19 recommendations for action.
20 We have with us today those who have personal
21 stories regarding this issue. We have law
22 enforcement and prosecution; those involved with
23 treatment, medical providers, educators.
24 And I look forward to a productive session
25 here today.
7
1 I'm honored to be joined here for this
2 hearing by two of my colleagues.
3 First of all, the Chair of our Task Force,
4 Senator Phil Boyle, the former member of the
5 Assembly, now in the Senate, who chairs our task
6 force. He is from Suffolk County;
7 Along with another one of our members of the
8 Task Force, my colleague Senator Tom O'Mara from the
9 Elmira area.
10 And I would ask Senator Boyle, if you would
11 like to make a few remarks?
12 SENATOR BOYLE: Sure, thank you very much
13 Jim, and thank you for hosting this.
14 I want to thank Senator Seward and
15 Senator O'Mara for being part of this Task Force,
16 and for all the panelists today, and all the
17 participants in the audience, for coming.
18 As Senator Seward said, this Task Force that
19 I'm chairing -- we're actually up to 15 forums
20 now -- and we're going around the state, and what
21 we're looking for is:
22 Whether you're a prevention provider, a
23 treatment provider, or a law-enforcement official,
24 every day you deal with this heroin epidemic on a
25 statewide basis. It goes from the west, down to
8
1 Suffolk County where I live.
2 If you could say, "If I could just change
3 this law, or a couple laws," that's what we're
4 looking for today; some input to say:
5 How can we change the system to better help
6 with prevention, to stop young people from starting
7 the use of heroin and other opioids?
8 The treatment that may not be there when you
9 need it.
10 And, of course, the law enforcement to put
11 these drug dealers away for a very long time.
12 Thank you, Senator.
13 I look forward to an exchange.
14 SENATOR SEWARD: Thank you, Senator Boyle.
15 Senator O'Mara?
16 SENATOR O'MARA: Thank you, Chairman.
17 It's a pleasure to be here this morning.
18 I'm a Senator from the Southern Tier,
19 Finger Lakes region. I live in Big Flats. And, my
20 district goes from Elmira to Hornell, including
21 Ithaca and Penn Yan; so, that's the Finger Lakes and
22 Southern Tier regional.
23 I'm a former prosecutor myself, having been
24 an ADA in Manhattan, and an ADA in Chemung County,
25 and District Attorney of Chemung County, through out
9
1 the 1990s.
2 And it's amazing the resurgence that heroin
3 and opioids has made since that time, because it was
4 not a significant or major problem back in that
5 time.
6 But, to see this resurgence is very alarming.
7 And, look forward to the product that we come
8 out with this Task Force.
9 I thank Senator Boyle for his leadership on
10 this, and I hope that we can make it 16 forums, with
11 one in Elmira/Corning coming up.
12 But I thank everyone for their participation
13 this morning. I look forward to your input, and a
14 successful product coming out of our Task Force
15 conferences around the state.
16 SENATOR SEWARD: Thank you, Senator O'Mara.
17 At this point, I'd like to go around the
18 table and have everyone, simply, if you would
19 introduce yourselves, and indicate what -- if you're
20 representing an organization or an entity just, let
21 us know that, as well.
22 So, everyone can introduce themselves.
23 Why don't we start right here with you,
24 Justin.
25 JUSTIN THALHEIMER: Hi, I'm Justin
10
1 Thalheimer. I'm with Otsego County Addiction
2 Recovery Services.
3 NANCY ORTNER: I'm Nancy Ortner. I'm with
4 the Schoharie County Chemical Dependency Unit.
5 CHRISTOPHER KEMP: My name is Chris Kemp, and
6 I'm the director of the Delaware County Alcohol and
7 Drug Abuse Services.
8 DA RICHARD NORTHRUP: My name is
9 Richard Northrup. I'm the Delaware County District
10 Attorney.
11 DA JAMES SACKET: James Sacket,
12 Schoharie County District Attorney.
13 DA JOSEPH McBRIDE: I'm Joe McBride,
14 Chenango County District Attorney.
15 DR. STEVE GRAHAM: Steve Graham. I'm an
16 obstetrician/gynecologist with Bassett.
17 DR. JOSEPH SELLERS: Joe Sellers. I'm an
18 internist and pediatrician with Bassett, and the
19 secretary of the State Medical Society.
20 DR. KELLY ROBINSON: Dr. Kelly Robinson,
21 medical director of A.O. Fox Emergency Department
22 right here in Oneonta.
23 JOE BIVIANO: Joe Biviano, administrator of
24 Take Back Chenango.
25 ROBERT CLIPSTON: Robert Clipston, co-founder
11
1 of Take Back Chenango.
2 NICK SAVIN: Nicholas Savin, district
3 superintendent at the Otsego Northern Catskills
4 BOCES.
5 JOE BOOAN: I'm Joseph Booan. I'm the
6 director of student services at ONC BOCES.
7 Our two centers are in Grand Gorge and in
8 Milford.
9 NORINE HODGES: Norine Hodges, the executive
10 director of the Schoharie County Council on
11 Alcoholism and Substance Abuse.
12 DAVID RAMSEY: Dave Ramsey, director of
13 Delaware County Alcohol and Drug Abuse Council.
14 JEANETTE TOLSON: Jeanette Tolson,
15 executive director of Friends of Recovery of
16 Delaware and Otsego counties.
17 JULIE DOSTAL: Julie Dostal,
18 executive director of the LEAF Council on Alcoholism
19 and Addictions in Otsego County.
20 UNDERSHERIFF CRAIG DuMOND: Craig DuMond,
21 Delaware County Undersheriff.
22 SHERIFF THOMAS MILLS: Tom Mills,
23 Delaware County Sheriff.
24 SHERIFF ERNEST CUTTING, JR.: I'm
25 Ernie Cutting, Sheriff in Chenango County.
12
1 SHERIFF TONY DESMOND: Tony Desmond,
2 Schoharie County Sheriff.
3 SHERIFF RICHARD DEVLIN: Richard Devlin,
4 Otsego County Sheriff.
5 SGT. GARY LEAHY: Gary Leahy, State Police,
6 Oneonta.
7 MIKE MacINERNY: I'm Mike MacInerny. I'm a
8 senior investigator with the State Police, assigned
9 Oneonta.
10 MYLEA BUFFO: Mylea Buffo, I'm an addict.
11 DEB FRANCE: Deb France, I'm a parent.
12 SENATOR SEWARD: And I would also mention
13 that, in the audience today:
14 We have Tina Molett, who is with our
15 colleague Senator Bonacic. Also, a supervisor on
16 the Delaware County Board of Supervisors.
17 And, also, we're delighted that the Chairman
18 of the Delaware County County Board of Supervisors,
19 Jim Eisel, is with us today as well.
20 Our format today is that, we have prepared a
21 series of questions and discussion points to help
22 lead us through a discussion on this issue.
23 Everyone should feel free to chime in at any
24 point if they feel that they have something to
25 contribute to the point that's being discussed at
13
1 that particular time.
2 I would also like to invite members of the
3 audience to submit any questions, you know, for our
4 panel, or any general statements.
5 They are -- there are index cards at the
6 check-in table, and questions and comments can be
7 made at any point during our forum here today.
8 And because of our session schedule, I know
9 the three senators need to be in Albany by 2:00, so,
10 we need to conclude by noon today.
11 Of course, we do have a number of police with
12 us here.
13 [Laughter.]
14 SENATOR SEWARD: I would also like to mention
15 at the outset, that if any one of our panelists or
16 anyone in the audience has prepared any written
17 statements that would you like to have become part
18 of our record of this forum, please submit them to
19 staff at the table, and those comments and
20 statements will become part of our record here
21 today.
22 To start our discussion this morning, I would
23 like to call on both Deb France and Mylea Buffo, who
24 have joined us, who both have personal experience
25 and personal stories regarding this issue.
14
1 I thought that would be a good way to start
2 our discussion.
3 To the extent you feel comfortable in
4 discussing -- briefly discussing your personal
5 stories, we would like to ask you at this time.
6 DEB FRANCE: Good morning.
7 My name is Deb France, and I'm here as a
8 parent to put a face on this epidemic of heroin and
9 opioid addiction by telling my personal story.
10 My husband, Bob, and I are your typical
11 middle-class family. We have a house, two jobs,
12 two cars, two children, and a dog. We're active in
13 the community and our church, and our sons
14 participated in sports, band, and chorus, as well as
15 Cub Scouts.
16 When our youngest son Jeremy, a talented,
17 personable young man, was 16 or 17, he had his
18 wisdom teeth pulled and was given a prescription for
19 pain reliever.
20 Suddenly, our typical family was turned
21 upside down, and the story goes terribly wrong from
22 here.
23 Whether it was because of his anxiety
24 disorder or an ordinary experimenting teenager, it
25 doesn't matter, but Jeremy found a high from these
15
1 meds and it became a downward spiral.
2 We don't necessarily know how the path
3 continued or what led to what, but Jeremy went from
4 buying prescription pills from his classmates, to
5 heroin and any other opiate he could get his hands
6 on.
7 When he was 18, he chose to leave home rather
8 than to abide by our rules, and ended up stealing to
9 support his habit.
10 Arrested and put in jail, he came back home
11 and eventually revealed his addiction to us one
12 sleepless night as we helped him go through
13 withdrawals.
14 As parents, we did extensive research and
15 looked for resources to help our son within our
16 community while trying to keep our dirty little
17 secret within our home.
18 At that time, access to outpatient treatment
19 locally was long and cumbersome. This led us to an
20 out-of-state agency which took our money to provide
21 an in-home Suboxone treatment, minus any counseling
22 or support.
23 When this did not work, and, in fact, made
24 matters worse, we researched inpatient facilities
25 and enrolled him in a 30-day program.
16
1 After 14 days, our insurance company would no
2 longer pay for his inpatient stay, stating he would
3 be okay with intensive outpatient therapy.
4 Of course, they did not take into
5 consideration that the facility was two hours away
6 from our home.
7 We ended up paying out-of-pocket to keep him
8 there for the entire 30 days which the treatment
9 plan indicated was necessary.
10 After his discharge, he was enrolled in the
11 local chemical dependency clinic. He continued to
12 struggle, and around his 19th birthday, could no
13 longer deal with his addiction and attempted
14 suicide.
15 Luckily, he survived, and because of a State
16 mandate, once medically stable, he was transferred
17 to a psychiatric facility.
18 We again struggled with the insurance
19 company, who told the hospital he was a heroin
20 addict, "cut him loose."
21 We were fortunate enough to have a
22 sympathetic nurse-practitioner friend who bucked the
23 system, despite possibly losing her job over it, and
24 because of this, helped him stay in the hospital
25 long enough for us to find an out-of-state rehab
17
1 facility that our insurance would pay for.
2 Interestingly enough, Marworth was a facility
3 filled with rescue and medical professionals who
4 were being treated for addictions related to their
5 9/11 experiences.
6 From Marworth, Jeremy was transferred to
7 Cayuga Addiction Recovery Services (or, CARS) in
8 Trumansburg, New York.
9 Again, insurance would not pay for his stay
10 there, but we sacrificed his college fund to
11 private-pay, and Jeremy stayed there for
12 seven months, doing well with this highly-intensive
13 program.
14 On discharge, he was again enrolled in the
15 local chemical-dependency center, and we were
16 optimistic that we had our loving son back.
17 As the addiction community will tell you,
18 relapse is a part of the recovery process, and
19 Jeremy would do well for a while, and then he would
20 struggle.
21 He did fairly well for several years, but
22 then relapsed, and because of this probation
23 violation, he was sent to jail.
24 Jeremy was incarcerated alongside some of his
25 dealers, and at the same time, the local king pin
18
1 was also arrested and put in the Otsego County
2 facility.
3 One month after his release from jail, and
4 one week after his 23rd birthday, Jeremy
5 successfully committed suicide.
6 His final words to us were, that he loved us,
7 but he could not handle this addiction and he did
8 not want to be a burden anymore.
9 What I hope you can learn from the story, is
10 that heroin and opioid addiction does not
11 discriminate based on age, sex, income, or social
12 status.
13 The power of this drug is incredible, and
14 those who become addicted are often helpless to
15 overcome it.
16 Every day, doctors are prescribing opiates
17 for pain relief, and although not everyone becomes
18 addicted, the numbers that do are staggering.
19 When pain relievers are no longer accessible,
20 heroin provides a cheap option that is readily
21 available in our schools and community.
22 Studies show that 1 in 4 of those who try
23 heroin become addicted.
24 The collateral damage to our community that
25 this epidemic brings is staggering.
19
1 There is -- I'm sorry -- opportunity to set
2 up drug rings to profit, a court system is overrun
3 with drug-related cases, jails are filled with
4 addicts and dealers, and families are torn apart and
5 lives are lost.
6 My husband and I struggled to find accessible
7 resources to provide help for our son.
8 We both feel that we need to invest in
9 prevention programs and community education, as well
10 as treatment centers at the local and state level.
11 Insurance companies need to recognize this
12 addiction is a disease and provide the length of
13 treatment necessary to assist in recovery.
14 We need to recognize that jail is not the
15 place for addicts unless there is a recovery program
16 to assist them and work on the underlying causes.
17 We are pleased that this issue is starting to
18 get some recognition for the crisis that it is, and
19 hope that forums such as these will help to open
20 dialogue and generate effective prevention and
21 treatment options.
22 Thank you for the opportunity to share my
23 story.
24 SENATOR SEWARD: Thank you very much, Deb.
25 I know it's not easy.
20
1 And, Mylea, did you have anything you wold
2 like to add at this point?
3 (Non-working microphone.)
4 MYLEA BUFFO: I'll share my story.
5 My name is Mylea Buffo, I'm 27 years old.
6 I'm an opiate and heroin addict.
7 I will give you the short version of my story
8 because it's traumatizing, and the things that I've
9 done and seen are unspeakable.
10 My addiction started about seven years ago
11 when I was having back pain and my family doctor
12 prescribed me hydrocodone.
13 I felt superhuman. I had zero pain, slept
14 better than I ever had, zero anxiety, zero
15 depression, and more energy than I could have ever
16 imagined.
17 Soon it was not enough.
18 Within a year, I was seeing a different
19 doctor and I ended up on oxycodone, 30 milligrams,
20 6 times a day; OPANA, 20 milligrams, 3 times a day;
21 and, OPANA, 40 milligrams, 2 times a day.
22 People on their death beds do not receive
23 this type of medication.
24 It's hard not to blame the doctors, but
25 I have to take the responsibility to recover.
21
1 It no longer felt good. It caused more pain,
2 sleepless nights, the energy was gone. I was more
3 anxious and depressed than ever, and it became I had
4 to have it; it was no longer I wanted it.
5 I was self-medicating, and seems I was on a
6 mission to destroy my life. I was so out of
7 control, and the more out of control it got, the
8 worse I got in my addiction.
9 I was hiding my pain in medications that made
10 my complete healing system numb.
11 I was filling prescriptions for a month,
12 every week, using up to six different pharmacies a
13 month.
14 Every day I would wake up and snort or inject
15 pills, and I would not be able to do anything in my
16 life without doing pills first.
17 To take a shower, I would have to do pills
18 before and after.
19 I was so high I was oblivious to anything
20 going on around me. My only thought was about
21 drugs.
22 Soon my sister got me to go to detox for
23 three days, and my family doctor found out and was
24 so mad, he cut me off.
25 I hid for so many years behind the fact that
22
1 my scripts were legal, so I was not an addict.
2 And that was now gone: I was an addict.
3 The last conversation I had with my doctor,
4 he said: You'll experience withdrawals for
5 seven days.
6 On the 23rd day of my withdrawals, I was
7 cursing at him.
8 I can remember so many times when I would
9 just watch people at the store and wonder, Why can't
10 I be normal?
11 I was now buying street drugs, and what most
12 people refer to as "risky behavior" was just a
13 normal day in my life.
14 I didn't care where I was. I was injecting
15 drugs, using with people who had hepatitis, and
16 I was always in trouble with the law.
17 Every day, I had in my mind that there was no
18 help, there was no chance for me.
19 While normal people were wishing for good
20 health and happiness, I was wishing with every
21 injection that God would take my pain away and let
22 me die.
23 I wanted it so bad, I could imagine my own
24 kids at my funeral saying goodbye to me. And
25 I truly believed that that was best for them; that
23
1 they had a better chance in their lives if I was
2 dead.
3 My addiction was so bad, my boyfriend would
4 check me all the time, wherever I passed out, to
5 make sure I was still breathing.
6 By this point in my addiction, I completely
7 signed my life to the devil. Feeling stuck with no
8 way out, I ended up with the heroin. It was
9 cheaper, quicker, and easier to inject.
10 This was a whole nother addiction for me.
11 I would hide it as much as I could from
12 everyone, because I was now addicted to the needle
13 worse than I could have ever imagined.
14 My risky behavior was now off the charts.
15 I was no longer the same person.
16 I have so many classmates, and had awful
17 marks; and still, to this day, I tried to minimize
18 my addiction.
19 I made things worse -- to make things worse,
20 I ended up getting arrested. And I am currently in
21 drug court for criminal possession of a controlled
22 substance.
23 The night of my sentencing was the best night
24 I slept in seven years, because the worry of my
25 legal issues were finally being taken care of, and
24
1 it was a sense of relief I'd never experienced.
2 I made a choice that I didn't want to live
3 like this anymore, and I take drug court very
4 seriously, because I know, if there's a chance for
5 me, drug court is the way to freedom from my chains
6 of addiction.
7 Today I am five months clean and sober.
8 I do not take any medication except for a
9 blood-pressure medication, because, after
10 seven years of addiction, my heart rate is abnormal,
11 and I take an antidepressant.
12 It took me seven years to completely
13 self-destruct, and I work every day at rebuilding my
14 life. Every day is a struggle. There's a war going
15 on inside my body, with my brain saying, "Go get
16 that magic pill," and my heart saying, "Haven't you
17 had enough?"
18 Every time I hear of a young life being taken
19 from an overdose, it makes me sick to my stomach,
20 because that should have been me.
21 Narcan is a life-saving -- is life-saving,
22 but it is an addict's worst nightmare, because it
23 puts you in instant withdrawals.
24 Five months ago, I can say with complete
25 honesty, that I would have been laughing at New York
25
1 for the negative feedback with the I-STOP system,
2 because it was so easy to get around the pharmacies
3 and doctors.
4 Today I realize I was naive and
5 undereducated. I have learned more in the past few
6 months about my addiction than I did the last
7 seven years on the streets.
8 I hear a lot of negative feedback from people
9 who are legitimately getting narcotic scripts and
10 believes that the I-STOP system is causing them
11 grief.
12 Maybe we should ask them if they know what
13 they are taking. Or, if they know that pain
14 medication actually causes more pain than the reason
15 they take the pain medication to begin with.
16 And while I'd like to say, those legitimate
17 scripts is how I got started, like most other
18 addicts, and if you have a legitimate medical reason
19 and you follow the rules, then it won't cause you
20 grief, let's not forget it's very easy to become
21 addicted, and you can take them properly and still
22 be dependent on them.
23 I would like to ask them if their grief from
24 the system is worth some child's life, because this
25 is how kids are becoming addicted from your
26
1 medication cabinets.
2 So many people have been caught from
3 doctor shopping and pharmacy shopping, and with the
4 uprise in heroin, screams "the system is working."
5 It's not good for anyone in recovery to have
6 such access to heroin on the street, but I do
7 believe, in time, with the I-STOP, there will be
8 less addiction.
9 There just needs to be more education for
10 younger people and the already-addicted.
11 I realize that I will always have to deal
12 with my addiction, and, now, only time and education
13 will help me.
14 In my life, if I could save just one kid from
15 the pain and suffering I've been through or seen,
16 I will be completely satisfied with the way that my
17 life has turned out.
18 Thank you.
19 SENATOR SEWARD: Thank you very much, Mylea.
20 You know, we started out the forum talking
21 about statistics, but the both you, and Deb, have
22 reminded us that there are real people behind these
23 numbers and real-life situations.
24 So, I/we greatly appreciate your sharing your
25 personal stories with us.
27
1 In terms of our discussion this morning, I'd
2 like to first call on our law-enforcement community,
3 and others that may want to join in, but, I'd like
4 to first hear from our law-enforcement partners, to
5 tell us a little bit of what is out there in our
6 communities, in terms of, you know, heroin use, in
7 terms of the arrests that are being made.
8 Is it -- what is it, dealers, or users, or
9 possession?
10 If you would like to -- to just kick off our
11 discussion this morning, from the law enforcement
12 point of view.
13 Who would like to be first here?
14 SHERIFF ERNEST CUTTING, JR.: I'll jump in.
15 Ernie Cutting from Chenango County.
16 About three years ago, in Chenango County, we
17 started seeing more and more heroin on the street.
18 At that point in time, I had sounded the alarm in
19 the media that it was here.
20 In past years, heroin was a minor thing. You
21 know, very few people. There was a stigma to
22 sticking a needle in your arm.
23 But a lot of the kids that we talk to that
24 were addicted to heroin, were -- told us that they
25 were brought on to heroin by saying you could snort
28
1 it, it's not as addictive. Which was wrong.
2 In that time, this last year, heroin had
3 become such a problem.
4 And I've relayed this story several times:
5 I had gone to a local community.
6 I live in Afton, New York, just down 88.
7 I had gone to Bainbridge for breakfast. And
8 I walked with my son, and I walked in, and I was
9 besieged by the people there, they were so outraged.
10 And I made a commitment, from that day, that
11 we were going to attack this problem.
12 From last March to December, I pulled an
13 officer specifically to handle narcotic arrests.
14 And in that time, he's arrested 60 -- there were
15 60 felony arrests, and 58 misdemeanor and violation
16 arrests, specifically related to heroin.
17 What troubles me even more, though, is the
18 hepatitis issue that's created from the needles.
19 I've had a meeting with our County Public
20 Health on the hepatitis issue.
21 I also am active in inmates working to return
22 something back to the communities. We do roadside
23 pick-up garbage.
24 This last spring, we had gone from the
25 city-of-Norwich line to the village-of-Oxford line
29
1 on Route 12, approximately 7 miles, and back. And
2 in that time they picked up 46 heroin needles that
3 had been used, and a bunch of other drug
4 paraphernalia just right on Route 12.
5 And I thought of some kid walking along the
6 road, potentially, picking that up and potentially
7 sticking themselves. It was very concerning to me.
8 That brings in that huge -- the public
9 information, you know, on what the problems are out
10 there, potentially.
11 And that's just a little bit of what we're
12 seeing in Chenango County.
13 I'm in it up to my ears. We have several
14 arrests, and it's just never ending.
15 And we have people from all over the county,
16 taking back Chenango. We've joined together, and
17 trying to work together, the citizens of
18 Chenango County and law enforcement, opening lines
19 of dialogue, and working together to try to handle
20 some of what's going on in the community.
21 That's a little bit of what we're facing.
22 SENATOR SEWARD: Thank you, Sheriff.
23 Anyone else?
24 Craig?
25 UNDERSHERIFF CRAIG DUMOND: Thank you,
30
1 Senator.
2 We saw similar things in 2012 in
3 Delaware County, just alarming statistics.
4 And I can relate to the Sheriff's
5 community-service work program.
6 One of the first things that we did was
7 notice that, as well.
8 We were actually -- initiated our program as
9 garbage pickup along some county roads, and our
10 officers and inmates were experiencing so many
11 hypodermic instruments being discarded along our
12 county roads, that we had to put a sharps container
13 in the sheriff's vehicle, just to properly secure
14 these instruments.
15 It was very alarming.
16 And then we just, basically, saw an explosion
17 in heroin and related drugs in 2012. As a matter of
18 fact, it was up 229 percent from the previous year,
19 our arrests.
20 And then, in 2013, we're up another
21 26 percent from there.
22 So the problem is not -- it's definitely not
23 going away. It's getting larger.
24 Our arrests are up 36 percent, you know,
25 mainly attributable to drug abuse and drug sales.
31
1 So, we have a significant problem on our
2 hands.
3 We, as well, took one of our road-patrol
4 deputies off the road and assigned him to narcotics
5 full time. That's hard to do when your arrests and
6 your complaints are up, but we made a decision, you
7 know: We can continue to chase around the symptoms,
8 or we can try to attack the disease.
9 And since the common denominator was heroin,
10 we decided we wanted to go there.
11 And our numbers, as Sheriff Cutting has seen
12 over in Chenango County, are a reflection of that.
13 We implemented the canine unit. We did that
14 with -- we had to do that because of the limited
15 resources that the County of Delaware has. We had
16 to do that with private and corporate donations. We
17 were successful in that program.
18 And then we thought, what do we do to start
19 educating our kids?
20 And so we instituted the School Substation
21 Program, where we have deputies in and out of
22 schools on a regular basis;
23 And, a tip line for community individuals to
24 phone in tips, because the community involvement in
25 this problem is key, as well as community meetings.
32
1 But what we started this year was a
2 task force. It's very similar to what you're doing
3 here, just on our county level. The
4 District Attorney and all of the stakeholders are
5 involved in that task force.
6 And what's -- already, what's very similar to
7 what we're hearing here is, we're seeing that a huge
8 emphasis, and we're all agreeing, that a huge
9 emphasis needs to be placed on education, treatment,
10 and then aggressive law enforcement, if we're going
11 to attack this problem.
12 We're not going to arrest our way out of this
13 problem. It's going to take a collaborative
14 teamwork approach from all the various stakeholders.
15 We're hoping that, you know, you can help us.
16 SENATOR SEWARD: Thank you.
17 Anyone else from law enforcement?
18 Sheriff Devlin?
19 SHERIFF RICHARD DEVLIN: Yeah, I agree fully
20 with the Sheriff Cutting and Sheriff DuMond's
21 statements.
22 We're seeing the same thing here in
23 Otsego County: Arrests are up dramatically. Our
24 resources are taxed.
25 On the correctional side of things, we have
33
1 jails full of heroin addicts. 60 percent of our
2 current population has some sort of addiction, and,
3 we do not have the resources to treat those people.
4 We're dealing with withdrawal symptoms,
5 underlying medical conditions, which is increasing
6 our local fees for medical costs. Additional
7 manpower for monitoring these people because they
8 cannot be left alone.
9 So. We're seeing that increase on the
10 correctional side, as well as the law-enforcement
11 side.
12 SENATOR SEWARD: Sheriff Desmond.
13 SHERIFF DESMOND: Thank you, Jim.
14 In Schoharie County, we are having a problem
15 that -- getting a lot of crimes committed to obtain
16 money to purchase heroin and other drugs.
17 The sheriffs here, I read in the papers, and
18 they talk to them, and they're doing a tremendous
19 job fighting this problem with arrests. They've
20 taken people off of the road and put them into
21 investigations.
22 Sadly, that we are still experiencing the
23 effects from the flood of 2011, and funds are very
24 limited to do anything like this.
25 If there was some way where we could get some
34
1 money, we could probably go into the investigations
2 of heroin, and work with our neighboring sheriffs
3 here on this problem.
4 But like I said, the limited number of
5 investigators and deputies we have, and, compounded
6 by the fact that we have to transport all our
7 prisoners into Albany, we just don't have the
8 resources that we need, but, we certainly would like
9 to find some somewhere.
10 Thank you.
11 SENATOR SEWARD: Any comments from the
12 State Police point of view?
13 MICHAEL MacINERNY: I don't really have any
14 statistics to lay out, but, I mean, it's very
15 obvious that a large percentage of the crimes that
16 we investigate are driven by drug addiction,
17 committed by those that are addicted to drugs.
18 We've seen -- recently we've seen a big
19 uptick in robberies of convenient stores. And,
20 we've had a bank robbery, a number of convenient
21 stores, that we later found out were driven by the
22 drug addiction.
23 It just seems that those are things that we
24 probably didn't have near as many, going back a few
25 years. And, it just seems to be more and more
35
1 prevalent at this time.
2 The State Police, we don't have any part in
3 the treatment of the drug addicts, but, anything
4 that we can do to help any other agency, you know,
5 we're willing, and would like to do.
6 SENATOR SEWARD: You know, the question that
7 I have for, you know, law enforcement, and I'd ask,
8 our District Attorneys perhaps would like to chime
9 in, what recommendations, if any, do you have, you
10 know, for us?
11 I mean do we need, you know, stronger
12 penalties for, particularly, dealers?
13 Or -- or, what can we do to be helpful to
14 you, from the law-enforcement and prosection side of
15 it, in terms of -- is there any recommendations
16 anyone might have for us as we formulate our
17 recommendations?
18 DA JOSEPH McBRIDE: Senator, I'll briefly
19 respond and give you the picture, what's going on in
20 Chenango County.
21 We have a very small rural community of
22 farmlands, manufacturing; great place to raise your
23 kids.
24 Unfortunately, as the Sheriff said, you're
25 going to hear from some other members of our
36
1 community, that we've had a terrible heroin problem
2 for the last few years.
3 By example: I had to cover a small justice
4 court in the town of Sherborne.
5 And when I was in there, there was a young
6 gentleman with a John Deere hat on and a John Deere
7 shirt, and he was before the judge for possession of
8 heroin. This kid looked like he just got off the
9 field from bailing hay.
10 I would never have imagined that, in my
11 lifetime, that I would have seen that.
12 When something happened, when we were kids,
13 and we were growing up, you knew you could do a lot
14 of silly things, but you would never, ever, go take
15 this drug because you knew it was a death sentence.
16 It was going to change your life.
17 So we need the education out there to make
18 sure that these kids know that.
19 The second thing is, unfortunately, as the
20 Sheriff said, in places where you would never
21 suspect it, including our neighborhoods and our
22 parks, our city parks, our county parks, and on the
23 road, kids are being exposed to drug paraphernalia,
24 which are very dangerous.
25 And, unfortunately, at this point, we have to
37
1 start educating our kids at the elementary school
2 about, What do we do when we see needles? What do
3 we do when mommy and daddy are using drugs?
4 And we want, not to arrest them, but we want
5 to keep people safe.
6 Somehow, we have to get back to that
7 education, so that every kid in New York State knows
8 that he cannot ever experiment with heroin because
9 it's such an addictive drug.
10 Two things:
11 Heroin's different.
12 When we send these guys to jail for 60 days,
13 90 days, and do whatever, unless they're in
14 treatment, the first place they're going is the last
15 place they got a fix.
16 I don't know what the biology is or what goes
17 on in their mind, but they don't stop. And we need
18 to do something to make sure that they're -- there
19 are people, places, and things, when they change.
20 The next problem that my county has, and I'm
21 sure some of the smaller counties, is we are a very
22 safe community.
23 So, when someone's dealing dope in a big,
24 larger city outside of our jurisdiction, it's very
25 safe to come to our community and to sell narcotics.
38
1 Now, when I get them, I try to be as tough on
2 them as I can, but that's an ongoing problem, when
3 someone who's dealing the product is, literally,
4 being shot in the bigger metropolitan areas, and
5 think it's safe to come to Chenango.
6 Now, that's a problem for Chenango, and we
7 need help in fighting those issues.
8 That's my 30 seconds, and I'll just pass the
9 mic.
10 JAMES SACKET: Thank you.
11 Senators, just a couple -- actually, a number
12 of points I wanted to touch on. Most -- some of
13 them have already been touched on.
14 Combating this in a small county, and I think
15 most law enforcement would agree with me, it's hard
16 to infiltrate the dealers.
17 The dealers in Schoharie County have a
18 tendency to come from the tri-city areas or outside.
19 Schoharie County has 33,000 people, on a good
20 day, and our communities are still recovering from
21 "Irene" and "Lee."
22 It's very hard to infiltrate.
23 Many of the people that are arrested in our
24 community are -- have misdemeanor weight: criminal
25 possession of controlled substance in the
39
1 seventh degree, or, possession of a hypodermic.
2 And, many times, just residue, or a very
3 small amount, but we know that they are heroin
4 addicts.
5 The heroin-user community is very tight.
6 A police officer is not going to go up to the
7 door and knock on the door, and say, "Can I buy some
8 drugs?"
9 We have a very tough time infiltrating that
10 tight-knit secret system, so that's one of the
11 problems that we face.
12 I-STOP, unfortunately, has worked, in my
13 opinion, so well, that it's driven the drug people
14 underground, the drug users to an underground arena,
15 where it's very hard, as I said, to infiltrate.
16 We know, we have an idea, who's using the
17 heroin.
18 Finding the dealers as they come into
19 Schoharie County are very difficult.
20 These are -- the people that we arrest are
21 not driving around in Lexuses or BMWs, with two or
22 three cell phones. These are people that are
23 struggling. They're young people that don't have a
24 lot of education or skills, and, sadly, they're
25 caught in a downward spiral.
40
1 Many of the crimes that we see -- burglaries,
2 larcenies, home invasions -- in Schoharie County,
3 daytime residential burglaries, in my 17 years,
4 I can't remember so many of them. It was very rare.
5 We used to have the camps, the summer camps,
6 those types of burglaries, where people would
7 steal -- break in and steal items.
8 But now we're seeing cash, jewelry, weapons,
9 electronics...brazen daytime burglaries, where
10 people just break in with no regard.
11 And even in villages it's happening.
12 So, it's very difficult to be everywhere all
13 the time.
14 Areas you would think that it wouldn't happen
15 are now being attacked.
16 So, another thing I really want to emphasize
17 is the Good Samaritan laws that we have.
18 The Good Samaritan Law is, if a young person,
19 or anyone, sees a person in the throes of an
20 overdose, please call the medical providers, the
21 ambulance, 911. Get the people the help before they
22 overdose so we have a chance to at least try to
23 treat them.
24 That also goes for alcohol, too.
25 Our most abused drug, our legal drug, I'm
41
1 sure law enforcement also would agree with me,
2 causes an awful lot of problems in our community,
3 and has for years.
4 But, if you see someone overdosing from
5 heroin or from alcohol, young people need to know
6 they need to call help and they won't be arrested,
7 so long as there's no evidence of drug trafficking.
8 Thank you very much.
9 DA RICHARD NORTHRUP: I would certainly agree
10 that education and prevention, in my opinion, are
11 the key to attacking this problem.
12 Virtually every crime that we prosecute is
13 somehow drug-related: assaults, sex offenses,
14 burglaries, larcenies, forgeries.
15 Virtually everything is now drug-related, and
16 a large percentage of that is heroin-related;
17 whereas, just a few years ago it was more oxycodone
18 and hydrocodone.
19 And, we've made some strides, the
20 Sheriff's Office in Delaware County, a lot of the
21 Village departments, the State Police, have made a
22 lot of undercover, confidential-informant buys.
23 We're prosecuting those cases.
24 We don't necessarily need tougher sentencing
25 for drug sales.
42
1 To sell just a pinch, just a pinch, of heroin
2 is a high-grade felony. It's a Class B felony. You
3 can do up to nine years in prison for that.
4 We don't need tougher sentencing laws.
5 We need more education and prevention before
6 people get to that point.
7 A lot of the people that we're seeing making
8 sales are not the drug dealers from the Syracuse,
9 Albany, Binghamton, New York City area, that channel
10 the stuff here.
11 We're getting the street-level dealers who
12 are selling to perpetuate their own addiction.
13 Those people don't necessarily need to go to prison.
14 They need to go to rehab, they need to get
15 straightened out, so they're not doing that anymore
16 when they get out.
17 And the key, really, is rehab for a lot of
18 these people, but, they shouldn't be in the system
19 to begin with, most of these people.
20 They should -- if they just increased the
21 education, take on an initiative like we have in the
22 past with other things, smoking and drinking, things
23 like that, it would make a huge difference.
24 I think that's where the legislation needs to
25 be implemented, because if we can do that, we'll see
43
1 a dramatic decrease in the crime, in many respects.
2 SENATOR SEWARD: Thank you.
3 Let's move on to some of those other
4 alternatives.
5 I first would like to mention the -- you
6 know, the drug courts.
7 I understand that this is -- and, Mylea,
8 you're a product of the drug court?
9 MYLEA BUFFO: Yes, I am.
10 SENATOR SEWARD: Which county?
11 MYLEA BUFFO: Otsego.
12 SENATOR SEWARD: Right here in Otsego.
13 Is -- could somebody share with us your
14 experiences in terms of the drug-court process?
15 Is that a good alternative?
16 DA RICHARD NORTHRUP: It has here in
17 Delaware County. It has been a good alternative.
18 We've seen quite a lot of success.
19 There's some failures, too.
20 But the way we operate in Delaware County is
21 that, if someone is deemed an appropriate candidate
22 for drug court, they have to plead guilty to the
23 felony charge, or a felony charge, and they sign a
24 contract. And they go in, and they are in the
25 drug-treatment program as part of a 5-year probation
44
1 sentence, and they have to participate in the
2 drug-treatment court for up to 18 months.
3 They're under heightened supervision,
4 heightened treatment.
5 And if they successfully complete, they get a
6 watch and a cake, and sobriety.
7 And they stay on probation for the rest of
8 the five years, but, while they're in the drug
9 treatment program, if they don't succeed, if they
10 flunk out of drug court, they contractually agree
11 that they'll go to prison for the maximum term.
12 So there's a big incentive, and it has
13 resulted in some good success in Delaware County.
14 SENATOR SEWARD: Anyone else would like to
15 share the experience regarding that option?
16 NORINE HODGES: One thing I was going to
17 express is, we've instituted in Schoharie County a
18 program for people new to drug court. We call it
19 our "Drug Court Recovery-Coach Program."
20 I was sharing it with my colleagues here
21 today.
22 And, it's to help people new to drug court
23 become more successful. We run it for three weeks,
24 two nights a week.
25 The first night is educational, about
45
1 addiction; about all the pieces you were talking
2 about, Mr. Northrup.
3 And the second night, we actually bring folks
4 in who have sobriety; who have gone through drug
5 court and have sobriety under their belt for some
6 time, and they talk about how it was, what they did,
7 and where they are today.
8 And then each of the participants has to
9 relate to what they heard, and the stories are very
10 similar. Many of them start out with a sports
11 injury in high school and/or dentists.
12 You know, that -- that dentist piece is very
13 important. The wisdom teeth, the Vicodin, that kind
14 of thing.
15 And then they talk about, in and out of
16 institutions, and treatments, and so forth.
17 Many of them say they wish, that when they
18 had originally gotten caught, that it was stricter
19 at that end; that someone stopped them earlier on
20 their path.
21 And then the last night, they actually chair
22 a mock AA meeting.
23 They do these three weeks in lieu of going to
24 AA or self-help. And we really focus on sobriety,
25 sponsorship, AA; the value of the 12 steps, going
46
1 through all the 12 steps.
2 And, I think it really helps.
3 Everybody tells the story, "We're only as
4 sick as our secrets," so it allows that piece as
5 well.
6 SENATOR SEWARD: Thank you.
7 Anyone else?
8 JUSTIN THALHEIMER: I'd like to speak on
9 behalf of the drug court.
10 It's well-represented today, drug court
11 works.
12 It gives people a chance. It's, uhm --
13 excuse me, I'm a little nervous.
14 But, it really gives people a good chance.
15 They're monitored regularly.
16 They're -- there's -- if they get out of
17 jail -- once they plead to whatever they have to
18 plead to, or it's a diversion, or however it goes,
19 they get out of jail, and they're monitored so
20 closely, and asked to do so much, and they have to
21 do it sober.
22 And if they don't, they -- if they don't,
23 then it's easier for us to get them into treatment
24 because, sometimes, you have to pull teeth to get
25 somebody into rehab.
47
1 And what drug court does, you can get a Court
2 order, and it gets people into treatment.
3 And, my only wish for drug court is that it
4 was easier to get into.
5 Why wait until they have a felony that's
6 going to be disruptive to your life for the rest of
7 your life?
8 Long after treatment ends, that felony is
9 still there.
10 The people, I consider them very lucky.
11 If you're on probation, and you get asked to
12 go to drug court by a probation officer, I consider
13 you very lucky, because you might actually get into
14 drug court with misdemeanors.
15 SENATOR SEWARD: Are you saying that we
16 should have people get into the drug court, perhaps
17 on lesser charges?
18 Is that what you're suggesting?
19 JUSTIN THALHEIMER: Right. Or have that
20 felony wait until the end of five years, possibly.
21 I don't know, at the end of probation, just
22 have that sentence -- I don't know all this legal
23 stuff, so, bear with me.
24 UNKNOWN SPEAKER: "Expunged." I think
25 "expunged" is the word you're looking for.
48
1 JUSTIN THALHEIMER: Excellent.
2 Yeah, absolutely, at the end of five years,
3 if they've demonstrated they haven't been back into
4 the law enforcement after they graduate from drug
5 court, it just doesn't stay with them forever. A
6 felony does.
7 I think a lot of people are doing these
8 online applications, where the felony just -- they
9 never even get to see a human. They never even get
10 to interview.
11 So, I really think that would make a great
12 difference.
13 And, if we can get them into drug court, with
14 misdemeanors, with a lesser charge, that would be
15 great.
16 SENATOR SEWARD: Thank you.
17 JAMES SACKET: Senator?
18 SENATOR SEWARD: Yes?
19 JAMES SACKET: May I respond to that?
20 In Schoharie County, we have approximately
21 60 people in our drug court. Around 50 criminal
22 cases, and 10 around -- from the family court. It's
23 a combined court.
24 We have misdemeanors in there.
25 There's also a program called
49
1 "Judicial Diversion," where the person is placed on
2 interim probation for two years, and then the final
3 three years can then be placed on regular probation
4 once they complete the treatment core program.
5 What that allows them to do is, seal their
6 conviction. Or, also, there's also the possibility
7 of vacating the conviction.
8 So what we do is, place the ball in the
9 court -- in their court. If they walk the walk and
10 talk -- if they talk the talk, and then walk the
11 walk, they're able to come out of that with a clean
12 record, just as Justin was mentioning.
13 That allows them, if they've done what
14 they're supposed to do, on our end, then we either
15 seal the record, or look to vacate the conviction
16 with either no conviction at all or a misdemeanor.
17 In our drug-treatment core program, we take
18 misdemeanors. We want to get these young people
19 before they get a chance to get too far into the
20 system, so they don't -- we don't have to wait for
21 their felonies.
22 We also expect people to relapse.
23 Part of that is, if you have a treatment
24 issue, what we try to do is up the level of
25 treatment.
50
1 If you commit crimes, then you're going to go
2 to prison.
3 However, the incentive, the 10-ton weight
4 over your head, is always there for many people.
5 What we found is, that many -- keeping people
6 out of prison, in the community, either have to work
7 or go to school, or, they have to do community
8 service. They're monitored. They have to do three
9 to five self-help meetings a week. They're in
10 treatment; they have group and individual. They
11 meet with their probation officer once a week. And,
12 they're required, they're also randomly tested for
13 drugs and alcohol.
14 So what we found, in our experience in about
15 10 years in Schoharie County is, people, while
16 they're in drug court, do well.
17 We often speculate, it would be nice to see
18 people, in a way, in lifetime drug court, because
19 that's where they do their best.
20 Once they get off of drug court -- and we
21 also treat alcoholics, too, in our treatment
22 courts -- they slip back into their old ways, they
23 go back to the old neighborhoods, they fall into the
24 bad habits again.
25 But while they're on drug court, we're saving
51
1 the money from having them in prisons.
2 But what we really need, in my opinion, is
3 more resources for treatment.
4 Heroin, we've gone to long-term inpatient
5 residential for months, even up to a year, year and
6 a half. That seems to be the only way to really
7 attack the heroin problem for some of these serious
8 heroin addicts.
9 We need the resources.
10 If we're going to treat this public health
11 issue, that's the way we have to treat it, in my
12 opinion.
13 SENATOR BOYLE: Just a quick question, Jim,
14 or one of the other prosecutors:
15 What we're seeing in other parts of the
16 state, is a case where actual dealers are kind of
17 using the drug court to say, Well, I just need to --
18 some treatment, and then -- to reduce what they're
19 looking at.
20 Are you seeing anything like that?
21 DA JOSEPH McBRIDE: Actually, that goes on
22 all over the state.
23 And in every drug court, every county has
24 different rules.
25 There are state guidelines. And every DA and
52
1 judge and every treatment team makes the evaluation
2 of who comes in, and who doesn't.
3 As was stated before, local dealers who are,
4 you know, young kids, young adults, who get involved
5 in the wrong system, are treated differently than
6 gentlemen or women who come from out of town and try
7 to sell heroin.
8 So that does happen, but it's not effective,
9 because we usually, the rules, when they were
10 started, say, We are the gatekeepers.
11 Now, Judicial Diversion changed that a
12 little, so they can get people into drug court
13 without our permission.
14 But most of the time, they have to have the
15 DA's consent before they're allowed into the
16 program.
17 Just to drug-treatment court, and our person
18 here today who is a member can probably say, it
19 changes your life.
20 It's not a "you show up and you talk once."
21 In our county, you are there at least once
22 for three hours at a meeting, where you listen to
23 your problem and everyone else's problem. You know
24 that you're going to be monitored.
25 In our county, you have to phone in every
53
1 day. And if you don't phone in, you miss a phone
2 call, they are very strict with the excuses.
3 Because I'm sure, as all the people in
4 treatment know, that they are very good at not
5 telling the truth. They've been doing it for a long
6 time and being very successful.
7 So -- but it changes your people, places, and
8 things. You have to start hanging out with people,
9 you have to go to work, and have you to go to
10 school, or you have to do some community service.
11 And when those people do get into the
12 program, and they buy into the program, and they're
13 not just trying to get over, it changes their life
14 forever.
15 It seems that, not only their lives, but
16 their family lives and the community lives.
17 And in the small towns, and all three of us
18 here are from small communities, you know these
19 people. They're your friends' kids. They're people
20 you see from the community. Its not like it's just
21 the people from the other side of the railroad
22 tracks.
23 Heroin and drug addiction affects all of us.
24 And so, drug court, with all of its flaws,
25 has been very effective.
54
1 If you wanted to open it up to the
2 misdemeanor level, you can't do that with the
3 tremendous amount of resources that we don't have
4 right now.
5 There's probably 10 or 15 professionals on
6 the County court treatment court, and it's -- they
7 are straining their schedules to make all the
8 meetings and do everything that needs to be done.
9 So, if you're going to do anything, please
10 fund those positions, and that would help it make it
11 effective, and we could start earlier, and identify
12 those people who are in the city courts and the
13 justice courts, who we can tell, from our
14 experience, aren't going to have this one-time
15 experience, but seem to have a problem with a
16 particular drug.
17 Thank you.
18 SENATOR SEWARD: We have some representatives
19 here from Taking [sic] Back Chenango.
20 ROBERT CLIPSTON: Yep.
21 SENATOR SEWARD: And if you could share with
22 us, briefly, what that organization is all about,
23 and would that serve as a model for other counties?
24 ROBERT CLIPSON: Well, what we do is, we
25 travel to every town and city within
55
1 Chenango County, where we're asked to go.
2 People normally from the town will ask us to
3 come in. We try to educate adults and local law
4 enforcement, mayors, whoever shows up to the
5 meeting.
6 It is an open forum. They have the
7 opportunity to speak with the sheriff or the DA.
8 They both come to any meeting.
9 We try to educate them on the addiction of
10 heroin. What they need to do with their children.
11 Education is very important. It starts
12 early. You got to start in kindergarten, or before,
13 because a lot of people are going to parks and
14 finding needles.
15 What does the little kid do with the needle?
16 First thing you do is pick it up.
17 So educating children, all children, is very
18 important.
19 And, to educate them on the addiction, and
20 everything, would be a plus, because you're seeing a
21 lot of heroin addicts coming out, ranging from
22 12-years-old, and up.
23 So by the time they're in sixth grade,
24 they've already been hit; they've already been
25 approached, and they've already seen it.
56
1 So, we kind of tell them, you know, education
2 is the key.
3 We also -- we're working on setting up a
4 neighborhood-watch network throughout the county,
5 because, in our view, if you don't know your
6 neighbors and who is around you, you're not going to
7 know if there's something going that shouldn't be
8 going on.
9 A lot of these drug dealers are coming into
10 our county from the city -- from Utica, from
11 Syracuse, from Binghamton -- and you can see by the
12 arrests in the paper.
13 And what the Sheriff and the DA have done,
14 that, we live in a box. And the way I describe it
15 in most meetings is: Everybody lives like
16 this [indicating]. You got shutters on both sides.
17 Your neighborhood is actually your house. If it
18 doesn't happen here, it's not happening.
19 And you see that all over the state.
20 People have closed-up.
21 Social media has pretty much said: You don't
22 have to go out and talk to people. You don't need
23 to know everybody. You can do it on the computer.
24 Well, if you're not out talking, you're
25 leaving a very open field for these drug dealers to
57
1 come into your neighborhood, because that's what
2 they want. They don't want you to know them. They
3 don't want you to know anything.
4 If, as communities, we can come together and
5 get people to know everybody, and have people
6 watching out for their communities, you'll prevent
7 these drugs from coming to your neighborhood.
8 And that's something that we really express.
9 The first thing we tell them is: We want you
10 to go out and we want you to meet two neighbors.
11 You don't have to be best friends, you don't have to
12 have a barbecue. Go out and say "Hi." You know,
13 introduce yourself. Get to know their kids.
14 Because kids get a bad rap.
15 I don't care where you go, if you see a group
16 of kids walking down the street, you automatically
17 assume they're in trouble, they're doing something
18 wrong.
19 Well, when I was a kid, you walked down the
20 street, you were in a group of kids, you were going
21 to play football or do something. You're trying to
22 find something to do.
23 But a lot of these kids now are looked at as
24 hoodlums, so we try to take that view away, and say:
25 You know, these are kids. If you get to know them,
58
1 maybe you're going to stop them from doing something
2 that you don't want them to do, like, doing heroin
3 or an opiate drug.
4 We also -- we do a lot of training classes.
5 We have one coming up on May 1st. We're
6 working with Chenango County Drug and Alcohol.
7 They're doing an addiction training for us at the
8 local Elks Club, which is great.
9 We also work with Catholic charities. We
10 work with the Elks Club.
11 Any organization that's already established,
12 we try to work with them, what they are already
13 doing, and build on it.
14 Chenango County is 911 square miles, and
15 there's 23 towns and villages within
16 Chenango County, which makes it a pretty widespread
17 thing.
18 And as the Sheriff says, there's usually,
19 with what he has in resources, two cars in
20 Chenango County at one time.
21 If you get a call in Afton, and your cars are
22 out in [unintelligible] and over in Sherburne, it's
23 going to be a while before someone gets there.
24 So, you know, funding and education is very
25 important for this if we're actually going to
59
1 stop --
2 SENATOR SEWARD: Now, is your group, I mean,
3 is that all volunteer?
4 Or is there --
5 ROBERT CLIPSON: Right now, we're a
6 grass-roots group.
7 My wife actually set this up after a death of
8 one of her high school friends, that never should
9 have happened.
10 And what happened was, she went out to her
11 car at 6:30 in the morning, as normal, getting ready
12 to go to work. Ex-boyfriend shows up, pretty much
13 beat her to death right in her driveway.
14 All the neighbors heard something. They all
15 rolled over and went to sleep, assuming there were
16 kids outside.
17 Well, if we had a watch program, or we built
18 awareness, and someone actually got up and went to
19 their door to see what was going on, she'd still be
20 alive today.
21 JOE BIVIANO: Strongest part of our group --
22 we're 1700 members. We're fastly approaching
23 2,000 members. We started in December. The first
24 thing we did was seek out law enforcement.
25 We are in partnership with the Sheriff of
60
1 Chenango County. We are in partnership with the
2 DA of Chenango County. We support law enforcement.
3 It's just like he says, we've educated
4 ourselves.
5 The strongest part of our group is
6 grandmothers. "Grandmothers."
7 They see their grandchildren being raised by
8 an addict, what can they do? What are their rights?
9 The strongest part, when a grandmother says:
10 My daughter went to an apartment and there were
11 needles in there, and the boy got a needle in his
12 foot, what do we do?" here's the question you have
13 to ask yourself:
14 Law enforcement is operating on a 1950s
15 budget throughout the United States. You ask them
16 and ask them and ask them to do more.
17 I worked 25 years in a jail. I was also a
18 mayor. I know what it is to keep budgets down, but
19 I respect these people.
20 Our group works 100 percent with law
21 enforcement. We work in every community.
22 When a grandmother says, What do I do about
23 these needles? Who picks up the needles in the
24 park? Who picks up the needles in a day-care
25 center? Who picks them up?" what's the answer?
61
1 We have no answer.
2 When I first started in the jail over a
3 quarter of a century ago, I was a hardhat.
4 Today I've turned myself around. I really
5 believe in the needle-exchange program.
6 Who's going to pick up these needles? Who's
7 going to do something with these needles?
8 You know, hepatitis C is the biggest disease
9 we have in each one of these counties.
10 Now, having worked in a jail and knowing,
11 like, in Chenango County, and I assume all of you
12 are the same way, with limited budgets, and asking
13 to be more and more, and more and more, piled on
14 you, how do you expect a guy to patrol
15 911 square miles with two cars?
16 That's 1950s-style stuff.
17 They need help, and the State Police need
18 help.
19 And the State Police have been very good with
20 the CNET. The CNET's been very good to us in
21 Norwich in Chenango County.
22 But some of the things that I want to tell
23 you is, the jails.
24 I worked in a jail, and we used to give a guy
25 who had heroin, we would give him stewed prunes
62
1 three times a day to get the cramps out of them.
2 Today they got meds.
3 Okay, so the guy goes to jail, then he goes
4 to rehab. Goes to rehab for 28 days.
5 Do you really think 28 days is going to help
6 end rehab? Never in a chance in life.
7 95 percent of the addicts today go back to
8 being a drug addict if they're in heroin.
9 "95 percent."
10 The way to help is the jails; the jails have
11 the resources. Give them the monies. Give them the
12 education. Give them the nurses and the staffing to
13 go out another level: the level of rehabs.
14 Now, you've closed jails throughout the
15 state.
16 Chenango County, you closed Pharsalia, and
17 then you closed Georgetown.
18 We need rehab centers.
19 But the one thing I found, with working with
20 the DA and the Sheriff, we work in every town, and
21 we work strongly with law enforcement, and we found
22 their hands are tampered. They cannot do their job
23 because they don't have the money.
24 That's where the help is needed.
25 And the rehabs; the rehabs are important.
63
1 28 days doesn't work.
2 You send a kid to shock camp.
3 I heard these guys, 28 days.
4 You go to shock camp 92 days, you're out.
5 You come back, you failed the program, okay, you go
6 away for a little bit. Then they go back and they
7 go to shock camp again.
8 I know a guy in Chenango County who's been to
9 shock camp four times, with the same judge.
10 Boy, that really makes you mad, because
11 I hear what him when he says, "I learned how to sell
12 drugs better in my community."
13 Take Back Chenango works for grandmothers.
14 We're growing with grandmothers, believe it or not.
15 That's the strongest key.
16 Thank you.
17 SENATOR SEWARD: Well, I commend you for
18 your, you know, community members coming together
19 and, you know, attacking this problem from a
20 neighbor-by-neighbor basis. That's very, very
21 important.
22 I wanted to talk, in mentioning the treatment
23 programs, I know we have a number of representatives
24 of groups that are involved in treatment here today,
25 and I would just like to give you an opportunity at
64
1 this point, to -- let's shift our focus over to, you
2 know, the treatment opportunities that exist in this
3 region. And, what could we be doing to make it
4 that -- better or more effective in attacking this
5 problem?
6 Who would like to go first?
7 CHRISTOPHER KEMP: First of all, just some
8 statistics:
9 From 2003 to 2008, we treated less than
10 10 people through those years for heroin addiction.
11 In 2013, 65 of our admissions were directly
12 related to heroin.
13 So, it is a big deal.
14 I also -- drug court has been very
15 successful. I think it's a great program, but
16 something needs to happen earlier in the process.
17 Something needs to happen with the
18 misdemeanor-level arrests, that we tell you, that
19 one of the problems we have in Delaware County, is
20 people will choose county jail over treatment.
21 So I would love to see some way for us to be
22 able to get into the jails and work with these
23 individuals while they're incarcerated at the
24 county level, because at this point, you go sit in
25 your county six months, and you get out, and you're
65
1 leaving with the same information you went in with,
2 and, sometimes, information you shouldn't have.
3 So, I would love to see some way to get in
4 the jails and work with these individuals, and at
5 least set them up with some aftercare plans and give
6 them some education.
7 I love that program you were talking about.
8 And, certainly, I just think it's a shame
9 that we have to rely on Court orders to get people
10 into inpatient treatment. It's ridiculous that
11 someone has to get a felony-level arrest to get the
12 level of treatment that they need.
13 I would like to see managed care -- I would
14 like to see the decisions be left in the clinicians'
15 hands; not in the managed care, someone sitting in
16 front of a computer screen.
17 I can tell you a number of cases, where the
18 person is sitting in our office, crying, saying,
19 "I cannot do this on outpatient level." And the
20 insurance company saying, "Well, you have to fail at
21 outpatient treatment first."
22 And, unfortunately, what we're dealing with
23 these days, one failed attempt at outpatient
24 treatment can be death. It can be a felony-level
25 arrest.
66
1 And, you know, the other reason for earlier
2 interventions, I mean, by the time people get to
3 felony-level arrest, they've lost their family,
4 they've lost their kids, they've lost, you know, all
5 their supports.
6 So I would like to find some way to intervene
7 in this process at a much earlier level.
8 You know, I concur with everyone else,
9 I think, without exception, in Delaware County, the
10 heroin starts with prescription drugs.
11 You know, we were talking about this the
12 other day. I can't think of a case in
13 Delaware County where it didn't start without
14 prescription drugs or their first drug use was
15 heroin.
16 That may not be true in all the counties,
17 that's just my experience.
18 I-STOP is excellent legislation. It
19 certainly has caused a spike in heroin use, there's
20 no denying that. But I think in the long run,
21 I think that will level out if people aren't
22 starting with the addiction prescriptions.
23 So I hope that that's the case.
24 The other problem that we've experienced is
25 the lack of Suboxone providers that will accept
67
1 Medicaid. That's a problem in Delaware County.
2 I wanted to thank, my colleagues and I have
3 discussed, the possible legislation to allow
4 nurse practitioners to prescribe Suboxone.
5 One of the problems that we have is, the
6 OASAS regulations are, that you need to have the
7 Data 2000 Waiver for your medical director.
8 Medical directors, locally, don't want to
9 prescribe Suboxone, so we end up referring out, and
10 that gives you very little control over that drug.
11 Diversion of Suboxone is a big problem.
12 It's -- the evidence shows that Suboxone is a
13 very effective drug in the treatment of opioid
14 addiction. There just needs to be some way we can
15 work to have more control over that medication.
16 And I think, you know, having that in the
17 clinic where we can say, "Do the films." It's
18 distributed in films. That we can do the counts and
19 say: If you don't come to your treatment
20 appointment, you don't get your Suboxone.
21 I think one of the problems is, people are
22 seeing Suboxone as a be-all and end-all. You know,
23 "I take this medication and I'm all better."
24 That's not true, because if you don't make
25 those recovery lifestyle changes when that Suboxone
68
1 isn't there, you're going to be left as the same
2 person you were when you started.
3 I don't want to monopolize what we have here,
4 so I will, uh...
5 And I think it is a multilevel approach.
6 I think prevention, treatment, and law enforcement,
7 we all need to work together.
8 And I will say, in Delaware County, we're
9 definitely all working together on this project.
10 The board of supervisors have been very supportive
11 in this project. And I think its -- it's a -- the
12 whole community needs to be involved in this.
13 Because I really like what you said about the
14 guy that -- the kid in the John Deere hat, because
15 it's absolutely true. This is everywhere. This
16 isn't who you think it is.
17 And, I just want to close on saying:
18 Recovery is possible.
19 The people in recovery often don't get the
20 press. There are people in long-term recovery from
21 heroin addiction. They're aren't the ones in the
22 newspaper. And due to the confidentiality of
23 treatment, we see them; you don't.
24 You know, I run into them every day in the
25 grocery store. They're in long-term recovery from
69
1 opioid addiction.
2 So it is possible, and it does happen.
3 Thank you.
4 SENATOR SEWARD: Thank you.
5 Any other comments from the treatment
6 community?
7 DR. STEVE GRAHAM: Senator, if I may?
8 SENATOR SEWARD: Yes.
9 DR. STEVE GRAHAM: I'd like to add to
10 Mr. Kemp's comments.
11 Some people require ongoing ready access to
12 opiates to meet the physiologic needs of their
13 opiate addiction.
14 I'm an obstetrician/gynecologist. Addiction
15 medicine was not part of my training. Until the
16 last five years, it was not part of my practice;
17 however, opiate-addicted women do become pregnant,
18 and, they are at increased risk for adverse
19 reproductive outcomes.
20 In May 2012, the American College of
21 Obstetricians and Gynecologists, and the
22 American Society of Addiction Medicine, issued a
23 joint opinion titled "Opiate Abuse, Dependence, and
24 Addiction In Pregnancy."
25 In that committee opinion, they cited a
70
1 2008 study that estimated that 1 out of 1,000
2 pregnant women had used heroin in the past 30 days.
3 Be that as it may be, in our practice at
4 Bassett, I'm presently aware of seven pregnant
5 heroin users who are presently enrolled in programs
6 of opiate-agonist therapy.
7 That would be a rate 10 times the committee
8 opinion's estimate.
9 Those are only patients that we know about.
10 During pregnancy, chronic untreated heroin
11 use is associated with an increased risk for a
12 variety of obstetrical complications, and although
13 heroin withdrawal is not fatal to a healthy adult,
14 fetal death is a risk in the obstetrical patient.
15 The injection of opioids carries with it the
16 risk of infection at the injection site, in the
17 heart, bones, blood, hepatitis B, C, HIV.
18 And, additionally, the lifestyle issues
19 associated with illicit heroin use in the pregnant
20 woman puts the woman at risk for engaging in
21 activities such as prostitution, theft, drug
22 dealing, violence, to support herself or to support
23 her addiction.
24 Such activities expose these women to
25 sexually-transmitted infections, becoming the
71
1 victims of violence themselves, legal consequences,
2 including loss of child custody, criminal
3 proceedings, and incarceration.
4 Since the 1970s, methadone maintenance has
5 been the standard treatment of heroin addiction
6 during pregnancy.
7 Recently, this treatment has also been used
8 for prescription-opioid abuse.
9 The rationale for opioid-assisted therapy
10 during pregnancy is to, first, prevent the
11 complications of illicit opiate use and narcotic
12 withdrawal, encourage prenatal care and drug
13 treatment, reduce criminal activity, and avoid the
14 risks to the patient of associating with the drug
15 culture.
16 Treatment reduces the risk of obstetric
17 complications. The babies aren't born addicted.
18 And, neonatal abstinence syndrome is an expected but
19 treatable condition that follows prenatal exposure
20 to opiate agonist, and it requires collaboration
21 with the aftercare team, but, there are road blocks
22 to treatment.
23 Methadone maintenance is dispensed on a daily
24 basis only by a registered substance-abuse treatment
25 program.
72
1 For my patients, the local
2 methadone-maintenance treatment programs can be
3 found in Amsterdam, Albany, Binghamton, and
4 Syracuse. These are trips ranging from one to
5 nearly two hours, each way, every day, and these
6 logistical issues make methadone maintenance
7 functionally unavailable for many of my patients.
8 It has been illegal for physicians to write a
9 prescription for any opioid for the treatment of
10 opioid dependence outside of a licensed treatment
11 program.
12 Now, the Drug Addiction Treatment Act of 2000
13 did change the law, permitting physicians who meet
14 certain qualifications to treat a limited number of
15 opioid-addicted patients with buprenorphine.
16 Unlike methadone, which may be administered
17 only through a very tightly controlled program,
18 buprenorphine may be prescribed by an approved
19 physician in a medical-office setting.
20 Patients considered for using buprenorphine
21 must be able to manage and also administer their
22 medications safely and adhere to the drug program.
23 The Substance Abuse and Mental Health
24 Services Administration website lists
25 1736 physicians with buprenorphine waivers in the
73
1 State of New York.
2 Though that number of buprenorphine-approved
3 physicians might suggest that the urban-centered
4 distribution of methadone-maintenance programs
5 has been mitigated, rural New York, likewise,
6 experiences a misdistribution of
7 buprenorphine-waived physicians.
8 The Bassett Healthcare System is an
9 integrated health system with 6 affiliated
10 hospitals, 28 regional health centers, and it
11 provides care and services to people living in an
12 8-county area covering 5600 square miles; yet,
13 within that system, I am the single physician who is
14 licensed to prescribe buprenorphine for opiate
15 addiction. And my practice is strictly limited to
16 pregnancy.
17 So why are physicians not rushing to embrace
18 office-based opiate-agonist therapy with
19 buprenorphine?
20 Well, there may be a variety of reasons, but
21 would I like to address one that can be solved only
22 by government.
23 Drug addiction is a disease that government
24 first views as a crime, as most of the conversation
25 today has been centered on the legal issues. And,
74
1 as a treating physician of addicts, I become
2 associated with criminality.
3 This was distressingly demonstrated to me
4 when I was subjected to a routine audit of
5 buprenorphine-waived physicians by the
6 Drug Enforcement Administration. They opened the
7 conversation with me by reading me my Miranda
8 rights, and advised me that anything that I said to
9 them could be used against me in a court of law.
10 It was not an endearing moment.
11 Yet drug addiction involves presumptive
12 criminality only for those drugs that we choose to
13 define as "illegal."
14 Nicotine is a highly addictive psychoactive
15 substance that is legally marketed in a variety of
16 forms. Its use is associated with disease,
17 disability, and death at rates that dwarf the
18 problem of opiate addiction; and, yet, nicotine
19 addicts can call 1-86-NY-QUITS [sic] and receive
20 nicotine-replacement therapy from New York State.
21 The NYsmokefree.com website asserts that
22 nicotine-replacement therapy, such as patches or
23 gum, may double your chances of quitting because it
24 works by reducing uncomfortable nicotine-withdrawal
25 symptoms.
75
1 What an idea?
2 Nicotine addicts have a chemical dependency,
3 and we as a society offer to address the physiologic
4 needs of their chemical dependency without
5 repercussion, and with a view toward improving their
6 overall health.
7 Like the much larger problem of tobacco,
8 opioid addiction is very serious, but the
9 law-enforcement approach that we have taken over the
10 years has unquestionably failed.
11 We need fundamental changes and reforms in
12 drug policies, and I long for a day in which we can
13 treat opiate addiction in the same relaxed,
14 realistic way that we apply to tobacco.
15 [Applause.]
16 SENATOR SEWARD: Thank you, Dr. Graham.
17 Just one quick question: What's the protocol
18 when a baby is born, you know, with -- from a -- the
19 mother is an addict -- heroin addict?
20 DR. STEVEN GRAHAM: The babies typically
21 demonstrate difficulties on, about, day three or
22 four of life, and so they need to be in the hospital
23 longer for initial observation.
24 We have a scale in which we assess various
25 signs and symptoms that the baby is demonstrating --
76
1 heart rate, respiratory rate, feeding difficulties,
2 jitteriness -- that indicate to us the degree of
3 withdrawal that the baby is going through.
4 We then start to replace, uhm -- morphine as
5 our substitute of choice, and administer that in a
6 decreasing dose over a period of four to six weeks,
7 until the baby is completely withdrawn, and has been
8 observed for several days without any demonstrable
9 symptoms of neonatal abstinence, and then the baby
10 is discharged from the hospital.
11 SENATOR SEWARD: Thank you.
12 Any other comments from the treatment or
13 medical community here?
14 JUSTIN THALHEIMER: I have seen Suboxone or
15 buprenorphine work. And under the right
16 circumstances, generally monitored very tightly, it
17 does work.
18 I'm also seeing that we are treating people
19 for buprenorphine addiction at the clinic. They get
20 it from the streets.
21 If there is a way that we could have it
22 prescribed at our OASAS facilities.
23 And in a rural county, like Chris was saying,
24 that's really difficult to get someone to, not only
25 get the Data 2000 Waiver, but be an addiction
77
1 specialist, the OASAS requirements for a medical
2 director is really difficult to -- really difficult
3 to find somebody in a rural county who's going to be
4 an addiction specialist, plus get the
5 Data 2000 Waiver.
6 So we've also seen -- I've seen -- like
7 I said, I've seen Suboxone work. I've seen it not
8 work more.
9 It's -- out in the streets, they can exchange
10 one film for one bag of heroin.
11 Right now, I think the price is 20 bucks
12 apiece for either a bag or a film of Suboxone.
13 It works if it's able to be monitored
14 tightly, and that means, when people come in to see
15 me, and if they are on Suboxone, I am doing Suboxone
16 counts that I put in their progress notes.
17 It has to be monitored very tightly.
18 I also want to speak on -- really quickly, on
19 VIVITROL.
20 VIVITROL is a medication, where a heroin
21 addict is given an injection every 28 days, and, you
22 know it's in their system. You know that their
23 motivation for quitting is high when they sign on to
24 give VIVITROL. They're very motivated to be done
25 with it. They get sick and tired of being sick and
78
1 tired.
2 And this medication, VIVITROL, is every
3 28 days, and I can't speak regarding the risks and
4 all that stuff you see on TV, but, you know it's in
5 their system. And, they can shoot heroin if they
6 want, but it's a waste. It blocks the receptors.
7 I don't know, and, actually, I was asked in
8 the past week, "How does it work with opiates?"
9 because -- because it does work; it blocks the
10 receptors. It blocks the receptors until their next
11 injection 28 days later.
12 And after three months, they go on a holiday,
13 to see how they're going to take. And the second
14 they want to get back on it, you get them back on
15 it.
16 But it's a -- with our heroin addicts who
17 have been on VIVITROL, and there's not very many, I
18 wish I had a higher end number to tell you, but
19 we're at 100 percent.
20 They're all in recovery and doing well.
21 Thank you.
22 SENATOR SEWARD: Thank you Justin.
23 Dr. Sellers.
24 DR. JOSEPH SELLERS: On behalf of the
25 physicians of the State Medical Society, I want to
79
1 thank the Senate for convening this panel, and for
2 hearing from the community.
3 You asked for some specific things you folks
4 could do in state government, and I'm going to give
5 you a few that I hope will be pursued.
6 But I think that this is such a complex
7 issue, and it requires some work on the part of the
8 federal government, you know, as my colleague
9 mentioned, about Suboxone.
10 Suboxone prescribing is a federally regulated
11 issue, but it does require us to talk to our
12 Congressmen and to our -- you know, the federal
13 government, and advocate there.
14 Many of the things, though, that can help our
15 communities are things that the state government can
16 do.
17 But the bottom line still is, I think the
18 solution to our problem is going to be local, and
19 it's going to be done by community groups.
20 Community groups like the ones that have spoken to
21 us here.
22 Just to maybe set the tone for why young
23 people turn to drugs, why young people do the things
24 they do:
25 I don't know if it's education. It's more
80
1 attitude. They know things are wrong.
2 I raised four teenagers. I know they did
3 many things that were wrong, and they knew they
4 shouldn't do them, but they had an attitude,
5 "Bad things aren't going to happen to me."
6 And what we know from brain studies is that,
7 your brain, when you're born, starts developing at
8 the bottom of the head, moving up, and forward. And
9 this part here [indicating] is the last part to
10 develop, the prefrontal cortex: the part that has
11 wisdom; the part that can predict consequences; the
12 part that can plan to the future.
13 The prefrontal cortex in women is pretty well
14 developed by about age 19.
15 In men, maybe 25, 26.
16 So those that do law enforcement near college
17 campuses notice that most of the trouble is by young
18 men.
19 [Laughter.]
20 DR. JOSEPH SELLERS: With that said, we do
21 know that exposure to drugs earlier in life alters
22 brain chemistry.
23 And so one of the things that's really
24 concerning is the use of opioids by men before
25 age 25, by women before age 19.
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1 If they can get through this, we don't see --
2 I don't see too many patients who started using
3 substances of any sort in their 30s and 40s, and
4 there is a biological reason for that.
5 Mylea did mention the I-STOP, and how that
6 may be helping prevent some of the availability of
7 opioids in the community.
8 And, you know, the State Medical Society
9 worked closely with the Health Department, and
10 educating the physicians, and getting this program
11 up and running, but I think we need the
12 Health Department to do some data check, to let us
13 know.
14 I hear, anecdotally, about the turning to
15 heroin, but I haven't seen any actual statistics on
16 that. And I think that would be important if we're
17 going to refine I-STOP and make it work better.
18 I hear, anecdotally, from physicians, I know
19 in my own practice, we share when we have been
20 fooled by somebody.
21 There are patients that we didn't ever
22 believe would be doctor shopping, but we find out
23 they were using multiple pharmacies and multiple
24 physicians to gain access to opiates.
25 And, again, it can be that young man in the
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1 John Deere hat. People can -- when they're looking
2 for drugs, they can do a great sales job.
3 And, so, I-STOP is, I think, has been helpful
4 there.
5 I would like to see more data, if the
6 Health Department can mine data about that.
7 And then, talking to physician colleagues,
8 physicians I think have changed their prescribing
9 habits to a great degree in New York State, which
10 I think is very good.
11 Hopefully, the dentists are being more
12 careful about what they give when you have your
13 wisdom teeth extracted, or the quantity of
14 medication they provide.
15 But, again, I think that should be looked at;
16 and, so, some study by the State Health Department.
17 We worry about the death rate from opiate
18 overdose, and there are some specific things that
19 can help with that.
20 There is an "opiate antagonist, non-patient
21 specific order" bill that Senator Hannon has in the
22 Senate and Assemblyman Dinowitz has in the Assembly.
23 The State Medical Society strongly supports
24 the ability of physicians to give a prescription for
25 Narcan nasal spray to the family members of somebody
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1 with an addiction problem.
2 And, again, this is not a total solution, but
3 it's one part that could be done in this legislative
4 session to get that going. And to follow that up
5 with the training, the education to the community,
6 and to make this a less-common event for somebody to
7 overdose on an opiate.
8 The Medical Society also is very concerned
9 about the availability of treatment.
10 And we heard Deb France talk about the hassle
11 she had to go through with insurance companies, and
12 having to leave the state. And this is a family
13 that had some resources. They had money saved for a
14 college education.
15 Many of our families have no resources and
16 are encountering similar problems.
17 Treatment is essential for combating our
18 opiate issues. Treatment, though, needs to be
19 geared to the individual, not just his or her drug
20 abuse. They need to remain on treatment for an
21 adequate period of time. Professionals need to be
22 given the ability to steer patients to inpatient
23 versus outpatient, based on that individual's needs,
24 and the professional assessment.
25 And, again, we need to have proper funding.
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1 We need to make sure that insurance is not
2 standing in the way, and not preventing people from
3 getting the care they need.
4 On a personal note, I've been living in
5 Schoharie County for 25 years, practicing internal
6 medicine, caring for adults, and, pediatrics, caring
7 for children, so I have a lot of the crossover, a
8 lot of the adolescents in my practice.
9 I see all families being affected by this
10 issue, but, some families more than others. Some
11 things we know that are risky.
12 There was a great study done over the last
13 10 years by the Kaiser Foundation in California,
14 that talks about adverse childhood experiences, and
15 the things that happen to children that lead to them
16 being more susceptible to substance abuse and other
17 untoward consequences.
18 And it was interesting to hear the talk about
19 grandmothers, because the one thing that was shown
20 in a study, and I can get you the references for
21 this, there be a protective influence, was for a
22 child to have a strong grandmother relationship.
23 So, you know, I think that there are things
24 that maybe we need to think differently about.
25 You know, how do we, as a community, support
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1 grandmothers' involvement in their grandchildren's
2 lives, where maybe parents are overwhelmed?
3 Lastly, I think there's a strong correlation
4 with our current rural upstate drug issues and the
5 court [unintelligible] upstate, for opportunity for
6 young people, that when unemployment goes up, when
7 economic opportunity goes down, we know that drug
8 abuse also goes up.
9 And, so, I know that, Senator Seward, you're
10 a strong supporter of moving our business community
11 forward in Upstate New York.
12 We -- you know, we've been in, essentially, a
13 recession in our area for the past 50 years.
14 And, you know -- and I don't think we can
15 address this issue without addressing the economy.
16 If the economy is better, there's more
17 opportunity for young people. There's more resource
18 for law enforcement, and education, and all the
19 other partners that need to participate in solving
20 this problem.
21 So I'll close by saying:
22 The physicians of the state are very
23 concerned.
24 And the State Medical Society, as the
25 organization representing all the physicians in the
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1 state, stands prepared to do whatever we can to help
2 state government, to help local community agencies,
3 to work within education, to work in helping to
4 gather data and best practices, and so that we can
5 all work together, every aspect of society.
6 Because this is a total society problem, and
7 no one solution is going to bring about a change
8 that we need.
9 Thank you.
10 SENATOR SEWARD: Thank you, Doctor.
11 Any other comments from the medical or
12 treatment --
13 DR. KELLY ROBINSON: Yes, we have two
14 emergency physicians over here.
15 We'd like to say something on this.
16 SENATOR SEWARD: Sure.
17 DR. KELLY ROBINSON: Augie, you want to
18 start?
19 DR. AUGUST J. LEINHART: Sure.
20 Thank you for this opportunity.
21 I'm here on behalf of the New York Chapter of
22 the American College of Emergency Physicians.
23 I'm a board-certified emergency physician.
24 I'm the chief of the emergency services at
25 Bassett.
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1 I'm the Chairman of the Regional Advisory
2 Committee of the Adirondack Appalachian Regional EMS
3 Council.
4 And, I'm a member of the New York State
5 Emergency Medical Advisory Committee, the CMAC.
6 I will not underscore the epidemic causing
7 all of us to be here.
8 Both prescription narcotics and heroin now
9 account for more national fatalities than
10 motor vehicle crashes among young Americans.
11 Both New York and Massachusetts have enabling
12 legislation.
13 In New York it's Title 10, Section 80.138,
14 with Good Samaritan protection;
15 For the creation of in-sequence programs;
16 Trainers, who can also dispense naloxone
17 kits, naloxone being the antagonist for overdose,
18 and responders.
19 In Massachusetts, police departments have a
20 front-line 911 response role in responding to
21 overdoses. And it's very analogous to automatic
22 external defibrillator deployment. AEDD is, they're
23 deployed in airports, they're deployed in police
24 cars. So, very similar deployment scheme is in
25 place in Massachusetts.
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1 New York State needs to deepen and broaden
2 its deployment program, architecture, and process
3 across the state.
4 Once money programs are registered by the
5 New York State Department of Health, the training of
6 registered trainers can begin, and the intranasal
7 naloxone widely available to users, addicts,
8 bystanders, family members, and police, and other
9 registered certified responders.
10 Multiple distribution sites for naloxone kits
11 can be identified.
12 I particularly applaud the State of
13 Massachusetts, and encourage New York to develop
14 methods of:
15 One, defining the contents of a standardized
16 kit to include, not just naloxone and the method and
17 tools for intranasal administration, but other
18 relevant materials, encouraging engagement with
19 systems of care, starting with 911 for police and
20 EMS, and contact information for those seeking
21 assistance with rehab programs;
22 Establishing a statewide 1-800 information
23 hotline for accessing naloxone counseling and rehab
24 programs;
25 And, establishing a statewide protocol with
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1 standing orders.
2 Standing orders are used in EMS, and they
3 allow prescription to a person not personally
4 examined by the prescriber.
5 In the state of Massachusetts, it's signed by
6 a single medical director for the entire state,
7 permitting the dispensing of naloxone kits under his
8 authority. Emergency departments and other
9 prescribers can then readily provide standardized
10 state -- standardized and deployed kits.
11 In the meantime, wide dispersal of the
12 opioid-overdose prevention program, as outlined in
13 existing legislation, is needed now throughout the
14 state of New York.
15 Thank you.
16 DR. KELLY ROBINSON: Hi, Dr. Kelly Robinson,
17 medical director of the ED at A.O. Fox.
18 My colleagues have already touched on a
19 number of things that I wanted to mention, so I'm
20 just going to reemphasize the most salient points.
21 How do we keep our opioid-addicted patients
22 out of jail?
23 How do we keep them out of the morgue?
24 I think there are, like, four points that
25 I would just like to emphasize that have not been
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1 mentioned.
2 One is, we need to have more widespread detox
3 rehab on demand.
4 I don't know whether the current ACA
5 legislation includes coverage for rehab and/or
6 detox, but, if that -- if we're going to keep the
7 ACA, it can be fixed and not thrown out, I think
8 that is definitely something we need to work
9 together to have implemented with ACA.
10 Next, Dr. Leinhart already touched on more
11 widespread use of Narcan. That's going to keep a
12 lot of patients alive until they get to the
13 emergency department.
14 Police, firefighters, EMS, family members,
15 all need to be versed at using these medications
16 intranasally. You don't need IV access. It's very
17 efficacious.
18 So, that should be looked at further.
19 We should actually implement what we've seen
20 in New York City, where emergency physicians are
21 regulated, in that, they cannot write prescriptions
22 for more than 12 opioids in any ER visit.
23 I would like to see that statewide. I think
24 that would really help us in our battle to keep
25 patients from becoming opioid-addicted.
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1 If we could have legislation protecting us,
2 we would not have the dilemmas we go through,
3 confronting these patients who present to the
4 emergency department, requesting opioids.
5 If we had a law to back us up, it would make
6 our job a lot easier.
7 I haven't heard anyone mention what I've seen
8 work in other communities.
9 They have -- community organizations have
10 pill-gathering sessions.
11 What they do is, they advertise in the
12 community, that everybody bring in their
13 prescription opioids to a pill dump.
14 And, literally, you have thousands and
15 thousands of pills out in the community that are
16 just waiting for your kids to take and/or
17 distribute.
18 So I would love to see more community
19 organizations have those type of programs.
20 And everything else has been touched upon.
21 NORINE HODGES: Just to that last one, I'm
22 very excited.
23 We did do our Prescription Take-Back on
24 Saturday, as well did my colleagues along here. We
25 collected over 150 pounds' worth.
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1 But I'm very excited, our head of our
2 pharmacy at our local hospital has found some money,
3 and I believe Dr. Sellers' group as well, to help us
4 collect. And in the sheriff's department and our
5 local police departments have a permanent site.
6 The prohibited piece was the expense of
7 disposing of them. And they have put together,
8 themselves, enough money so we can do that on a
9 regular basis. Its about $1,000 a trip to dispose
10 of these.
11 In between, right now, the DA picks them up
12 the last Saturday of April and the last Saturday of
13 October for the National Take-Back.
14 SENATOR SEWARD: And we recently, I was
15 involved with a press conference here in Oneonta.
16 And the Oneonta Police Department, on
17 Main Street, there's is a dispense -- there's a site
18 there for disposal of these unused pharmaceuticals,
19 which -- on an ongoing basis.
20 And I would just like -- before we move on,
21 I would just like to highlight: I know, in
22 Schoharie County, tomorrow evening, there's a free
23 Narcan training opportunity, from 6:30 to 8:00, at
24 the Cobleskill Fire Department, right on
25 East Main in Cobleskill.
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1 So looking -- perhaps you'd like to share
2 more on that?
3 NANCY ORTNER: I just want to add to that,
4 that Mr. Sacket is going to be speaking about the
5 Good Samaritan Law, as well, then, at that forum.
6 SENATOR SEWARD: Great.
7 And I'm in the process of scheduling
8 additional training opportunities here in Oneonta,
9 and others throughout my district.
10 So, this is something that I think is
11 certainly very much needed.
12 Any other?
13 JULIE DOSTAL: Prevention?
14 SENATOR SEWARD: Yes, Julie.
15 JULIE DOSTAL: Okay. I would like to speak
16 from the prevention education. We've heard a lot of
17 that.
18 At LEAF, we do education, information, and
19 referral, and I can speak to some of the points that
20 we've heard.
21 There's nothing more heartbreaking to have a
22 parent, a mom or a dad, or a grandparent, call up
23 and ask us where we might find help for a son or a
24 daughter or a grandchild, and have to tell a mom or
25 a dad, that because of current insurance laws and
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1 rules, that their child or their grandchild has to
2 fail at outpatient before they can go to an
3 appropriate level of care.
4 I'm not sure what other disease we function
5 in our culture, where we tell people they have to
6 fail in order to get an appropriate level of care.
7 So that's really hard from our point, and it
8 points out for us, in the prevention and education
9 side of things, that we are dealing with an
10 epidemic, with real people and real lives and real
11 families.
12 And this is not the epidemic, the addiction
13 epidemic, of "those people."
14 This is the addiction epidemic of
15 "our people."
16 And we actually, I -- LEAF just recently had
17 an art and poetry contest, and we had a 14-year-old
18 write a poem about his experience with his older
19 brother who is also a teenager.
20 And I have just a few lines to read from his
21 poem, a 14-year-old, this is Eric:
22 "Friends thought it was a joke because all
23 they did was seem to provoke.
24 "Nowadays, I'm just torn inside out because,
25 to express it, I'm writing these raps that no one
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1 wants to hear me in, and when I relapse, no one
2 wants to hear me out.
3 "I'm always looking for the answer, and
4 I swear, I need some heroine. No, not the monster.
5 I need "a heroine"; something to believe in, a hero,
6 just because me is too much feeble to let go of the
7 needle."
8 That's Eric, a 14-year-old.
9 And we have the opportunity now to be Eric's
10 hero. We have the opportunity to be every Erics'
11 hero, and every Erics' older brother's hero.
12 And one of the main things, from a prevention
13 standpoint, that I want to put out there, is that we
14 need to be able to have the opportunity to address
15 the broader social norms that make the use of
16 intoxicants normal, and even embraced by a growing
17 number of people.
18 From a purely prevention standpoint, the
19 State of New York is limiting its own potential for
20 addressing the larger societal questions by actively
21 promoting and seeking revenue from the sale and
22 manufacture of intoxicants.
23 An environment that champions intoxicants
24 will inevitably reap the harm from intoxicants.
25 I work with a group of my peers from around
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1 the state, and we developed some strategies that we
2 would like to suggest as prevention-level
3 strategies.
4 One, of course, is to confront the broader
5 social and cultural messages that reduce the
6 perception of harm related to intoxicants, including
7 opiates, alcohol, and marijuana.
8 We would like to see programs and strategies
9 that help to decrease the accessibility to
10 prescription medications through a variety of means,
11 including:
12 Educating those same grandparents and parents
13 on prescription-medication management in their home;
14 Increasing the number of drop boxes in each
15 community, as has already been talked about;
16 Promoting the frequency of Drug Take-Back
17 days;
18 And exploring commonsense approaches to
19 facilitate medication disposal at pharmacies.
20 We would also like to suggest an increase in
21 the perception of harm in regard to prescription
22 medication and heroin.
23 Many of the young people that we talk to, and
24 that talk to us, will say: It's medication, what's
25 the harm?
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1 And, so, we really need to talk to young
2 people about the fact that, just because it has an
3 "Rx" on the bottle does not mean it's safe.
4 We would love to be able to work with you in
5 educating key impactors, especially in physicians
6 and the pharmacists, on this disease model of
7 addiction.
8 And to -- and in support of my colleagues who
9 also work in treatment and law enforcement, I say
10 that we would like to further increase
11 community-wide access to trainings on naloxone.
12 That is a lifesaving opportunity that we
13 have, to be able to give treatment, and to be able
14 to give folks the opportunity to have a naloxone kit
15 that can save a life.
16 And that takes resources and that takes
17 training.
18 And, so, we would like to promote that.
19 Thank you.
20 SENATOR SEWARD: Thank you, Julie.
21 Sheriff, did you want -- do you have a
22 comment?
23 SHERIFF THOMAS MILLS: Yes, I would like to
24 say a few words.
25 I think it's important, the education
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1 component. It's extremely significant.
2 It's got to start young, and you got to
3 continue it. It's that age group that is critical,
4 because they're the source of everything.
5 I think they're always looking for something
6 to do.
7 There's activities out there they can get
8 involved in: the Girl Scouts, the Boy Scouts, 4-H.
9 And it's important for them to have something
10 to do.
11 Idle time creates problems.
12 Treatment: Treatment is a huge issue, and
13 trying to address it.
14 Sometimes I think just giving them something
15 else to replace something is not real treatment.
16 You got to get people off.
17 I'm not trained in that, but you also have to
18 have the law enforcement involved.
19 You got to have some teeth in the program,
20 you know.
21 I don't object with any of the ideas you
22 have. You're the ones that end up pushing the cases
23 before the courts.
24 But, you talk about addicts, they should be
25 brought into treatment.
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1 Dealers, they ought to ratchet down.
2 I've been involved nearly 50 years in law
3 enforcement, and I can still remember my first
4 marijuana arrest right here in Oneonta. And it's
5 been nothing but downhill.
6 But, if you don't do anything about that,
7 it's just going to keep getting worse.
8 Thank you.
9 SENATOR SEWARD: Thank you.
10 I'd like to ask our educators at the table to
11 please comment.
12 We've been talking about education and
13 prevention, and, I'd like to take a couple of
14 minutes to call on our educators at the table, in
15 terms of what we're seeing today in the schools, and
16 this issue of greater, you know, education, and as
17 part of our prevention efforts, some say starting
18 right in kindergarten.
19 So, I'd like to call on Mr. Booan and
20 Mr. Savin, if they would like to comment at this
21 point.
22 JOE BOOAN: Thank you, Senator Seward, and
23 I appreciate the invitation today.
24 Mr. Savin and I represent ONC BOCES.
25 ONC BOCES is a consortium of 19 different
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1 school districts in Delaware, Otsego, Schoharie, and
2 Greene counties.
3 We have two centers: one in Grand Gorge and
4 one in Milford.
5 And primarily at those centers we're serving
6 middle school- and high school-aged students.
7 Occasionally, we have sites inside our
8 component districts that serve other students
9 younger than middle school.
10 I can speak a little bit about our centers.
11 I was a principal at one of those centers for
12 many years, and now I'm the director and oversee the
13 two centers.
14 I think it's difficult to determine the true
15 picture of substance use and abuse in our schools.
16 As you can imagine, middle-schoolers and
17 high-schoolers don't readily go to the principal's
18 office, or even to our counselors, to talk about
19 things that they are doing illegally or abusing, but
20 we do hear a lot of chatter around substance abuse.
21 I can tell you, to date, we have not
22 processed an intervention or interaction specific to
23 heroin in either one of our two centers, but that's
24 not certainly to say that it's not occurring.
25 We have processed several interactions and
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1 interventions related to prescription medication:
2 the oxys and the hydros. That's, I would say, is a
3 significant problem in our school, as is marijuana
4 abuse.
5 In terms of the supports that we would have
6 in our centers and our school centers, I can tell
7 you that we make it our goal that every teacher know
8 every student in our schools. And we believe very
9 strongly, it starts with having our staff connected
10 to everybody that comes through our door.
11 Our teachers, just by nature of running a --
12 technical-education programs in our schools, speak
13 to students, but more from -- about substance use
14 and abuse, but more from an employability
15 perspective.
16 They're not substance-abuse counselors, and
17 they're not family counselors. They are instructors
18 and teachers, but we do talk about it in every one
19 of our programs.
20 We have school-based counselors, but their
21 mission is pretty specific: Their mission is to
22 address successes experiences around academic and
23 social issues that are occurring in schools.
24 They're not substance-abuse counselors,
25 they're not family counselors.
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1 When we recognize abuses, we refer out to
2 many of the agencies that are seated around this
3 table.
4 A lot of times our first stop is with the
5 Otsego County Sheriff's Office or the
6 Delaware County Sheriff's Office or the
7 New York State Police, who are -- who play a
8 critical role in supporting us and keeping our
9 schools safe.
10 Education in New York State, you know,
11 perhaps could be said across the country, has gone
12 through a huge transformation over the last few
13 years, in terms of standards-based education,
14 assessing students, collecting data.
15 We've focused very -- we have focused very
16 intently on how we're educating students at a time
17 when I think resources have been significantly
18 challenged.
19 There was a time when we had substance-abuse
20 counselors located directly in our schools. We had
21 resource officers or D.A.R.E. officers to provide
22 prevention. And those things are sadly missed.
23 When funding goes away, the reality is,
24 programs that support and prevent go away.
25 So, personally, what I would like to see from
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1 where I sit, in addition to our emphasis on
2 standards-based education, which is critically
3 important to the mission of educators, we need to
4 have an education initiative surrounding how we
5 prevent. Get back to more of a prevention model
6 with the issues that we're talking to today.
7 That cannot happen without the proper
8 resource and funding.
9 Thank you.
10 ROBERT CLIPSTON: This is actually something
11 we've seen in Chenango County.
12 We've heard it from several people, that they
13 would love to see resource officers in our schools.
14 It does happen in -- Unadilla Valley, there
15 is a resource officer there. That's actually very
16 successful. He can talk to, and, you know,
17 incorporate himself with students, from
18 kindergarten, all the way up to seniors, which is
19 great, because a lot of our young people are scared
20 of officers.
21 They see a cop and they want to go the other
22 way.
23 Well, this gives the law-enforcement side of
24 things a chance to -- you know, co -- you know, they
25 can mingle with everybody. And, after a while,
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1 everybody comes around and they start -- they start,
2 you know, liking each other, and they look up to
3 him, and they'll go to him with their problems.
4 But right now, in a lot of schools, you see
5 kids aren't going to go to an adult, they're not
6 going to go to their counselors, they're not going
7 to go to the principal, and tell them about problems
8 they're seeing. It's not something they do.
9 We need peer programs.
10 You know, you take five or six teenagers and
11 go in and talk to third- and fourth-graders, you're
12 going to get a better result than you're going to
13 get if you bring someone in with a textbook.
14 Kids are more likely to listen to other kids
15 that they look up to. They're not going to listen
16 to us first.
17 So, you know, in our county, we've actually
18 expressed trying to get peer programs together, and
19 trying to get local teenagers involved, to help
20 younger kids so they don't end up in serious
21 problems.
22 But -- and the resource manager would be a
23 great asset to all schools in New York State,
24 because you want to have that camaraderie. You want
25 the kids to be able to go to law enforcement and
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1 say: Hey, this is what I see. This is what's going
2 on.
3 You know, kids see a lot more than we do.
4 You know, they're around a lot more than we are.
5 We're at work all the time.
6 They could be walking with their buddies down
7 the street and see a number of things going on that
8 we will never see.
9 And something else I wanted to touch on:
10 A lot of people have talked about treatment.
11 But what we've found, we've reached out to
12 several people out-of-state, in Florida, and other
13 places, trying to find proper treatment facilities
14 and what really works.
15 And what really seems to work with a heroin
16 addiction is a long-term treatment, and it has to be
17 caught early. You're looking at a 14-month
18 treatment.
19 And to get a 14-month treatment, insurance
20 companies have to come around.
21 We can't have, which we see in
22 Chenango County, is insurances refuse to pay for
23 this treatment.
24 A lot of these kids, and a lot of these
25 addicts, cannot afford treatment. They're not rich.
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1 You know, they don't have money sitting in the bank
2 that they can spend it on.
3 You know, you see addiction, they're not
4 robbing people because they just want more. They're
5 robbing people because they've already gotten rid of
6 everything they have. They've gotten rid of their
7 job, their family, their money...everything.
8 So we need to come up with some kind of
9 solution that is localized treatment, where, you
10 know, you could have a treatment center in
11 Chenango County, or a treatment center in
12 Delaware County, or Otsego County, that they're not
13 traveling 800 miles to get what they need.
14 I mean, we found a treatment center through a
15 church that's relatively cost. You know, the cost
16 is down, it's 14 months, but it is out of state.
17 And it's for 18 and younger.
18 Now, there's nothing available for 18 to 25.
19 So we need to come up with a solution for
20 that problem.
21 Something else that I've seen in
22 Chenango County is the amount of foster kids due to
23 the drug problem that we have.
24 The amount of foster kids is going through
25 the roof. I mean, we have 64 kids currently, this
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1 year alone, in foster care. And close to 30 of them
2 are because of drugs.
3 So this isn't just affecting the addicts;
4 it's affecting the families.
5 When he talked about grandparents, those are
6 grandparents that are taking care of their kids'
7 kids, because their kids are addicts.
8 SENATOR SEWARD: Thank you very much.
9 JEANETTE TOLSON: May I say just a few words?
10 I just wanted to say that our organization
11 offers recovery services in the community, which are
12 support services for people who are not in
13 treatment, support services for people in
14 conjunction with their treatment, and support
15 services when they're done with treatment.
16 And one of the things that we try to assist
17 people with, is, you know, rebuilding that life that
18 took years and years of an addiction to break -- you
19 know, to fall apart.
20 And some of the things we've heard today
21 about people feeling very overwhelmed with trying to
22 put that life back together, causes people to give
23 up, causes people to feel like there aren't enough
24 resources available.
25 And one of the things that's very, very
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1 beneficial to people when they're rebuilding their
2 life, is the ability to gain employment.
3 And, you know, we help -- we have some
4 employment services for people who are trying to get
5 back into the workforce, but one of the challenges
6 is getting employers to hire people and take a
7 chance on someone who has a history of addiction.
8 And I think that if we had some additional
9 incentives from the state government, to hire people
10 who have an addiction, and to -- you know, tax
11 incentives, or whatever, to have them take that
12 step: hire people who have a history of addiction
13 and are in recovery.
14 They will start to see that people can get
15 back into the workforce, be productive members of
16 society, which will help change the stigma, and
17 allow people to start feeling like they can
18 contribute to society again.
19 So, thank you.
20 SENATOR SEWARD: Thank you.
21 Before we get to some of the questions from
22 the audience, I just wanted to -- just ask the
23 question from -- to our -- to those involved with
24 treatment:
25 In terms of the detox option here, where
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1 would an addict go to complete a detox program in
2 this area?
3 JUSTIN THALHEIMER: Want me to take this?
4 First of all, I want to thank
5 law enforcement, because they've saved a lot of
6 lives by just taking people right off the streets --
7 [Applause.]
8 JUSTIN THALHEIMER: -- and putting them in
9 jail. It's not the prettiest detox, but it's better
10 than no detox at all. It's not pretty, but they
11 save lives. Even recently, they've saved lives.
12 Detox for opiates is really tough because
13 it's never been treated as a life-threatening thing.
14 It's just -- it's -- you're going to feel
15 really uncomfortable, like uncomfortable that most
16 of us can't imagine, but it's never been treated as
17 life-threatening, so it's very difficult to keep
18 somebody in -- or, to get them into detox.
19 And, unfortunately, when they're going into
20 the local emergency rooms, which are overwhelmed, if
21 they're intoxicated, a lot of times, before they go
22 into really active detox symptoms, they're
23 discharged.
24 I mean, like everybody else, as soon as
25 they're fixed, they're discharged, so they don't get
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1 to the services they need.
2 Unfortunately for us, we've got,
3 Delaware Valley Emergency Room does middle, mild,
4 detox, and that's with some -- with other things
5 attached.
6 And then there's Spark up in Schenectady.
7 We do not have the resources for detox
8 locally.
9 Like I said, I mean, if somebody gets pulled
10 off of probation or parole and they get pulled into
11 the jails to detox there, it's not pretty, but it's
12 better than no detox at all.
13 DA RICHARD NORTHRUP: One of the
14 difficulties, opiate withdrawal is not considered a
15 medical necessity, and often what they'll recommend,
16 Suboxone was originally designed for withdrawal of
17 opiates.
18 So, really, there are little or no resources
19 for opiate detoxification.
20 I -- with the -- I'm a proponent of inpatient
21 detoxification for opiates, because I think it works
22 the best.
23 And as I said earlier, there are no
24 [unintelligible] Suboxone providers locally, so
25 these people are really left hanging out there.
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1 Like Justin said, unfortunately, a lot of
2 detox is done in jail.
3 NANCY ORTNER: And I would add to that, in
4 Schoharie County, if someone comes in and is looking
5 to be detoxed, we send them to St. Peter's in
6 Albany. So it's not in Schenectady; it's in Albany.
7 JUSTIN THALHEIMER: Oh, thank you.
8 NANCY ORTNER: So it's a bit farther.
9 Or, St. Mary's in Troy, or Amsterdam.
10 And it's a gamble, because we can't call
11 ahead.
12 If we call ahead, they say, "We can't
13 guarantee a bed."
14 And, so, they get to whichever facility they
15 decide to go to, and then they may or may not be
16 admitted, depending on whether there's a bed
17 available. Or, depending on whether they're really
18 showing some withdrawal symptoms.
19 So, they have to be very sick, and have a
20 bed, in order to get detoxed.
21 UNKNOWN SPEAKER: And have the right
22 insurance.
23 DAVID RAMSEY: Senator --
24 SENATOR SEWARD: Yes.
25 DAVID RAMSEY: -- if I might?
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1 UNKNOWN SPEAKER: And have the right
2 insurance.
3 NANCY ORTNER: And -- yes. Thank you.
4 And have the right insurance.
5 DAVID RAMSEY: I can kind of echo a lot of
6 the comments about the frustrations that I have.
7 As a council director, one of the services
8 I provide is doing formal interventions for
9 families. Someone calls, their -- a relative is in
10 trouble.
11 And it's a laborious multistage process, but
12 it can be very effective, but over the years, and
13 I've been doing this for 16 years, the customer has
14 changed. It's no longer the middle-aged alcoholic
15 that used to be who I was called to assist.
16 And now, as, sadly, in the last four or
17 five year, is reflecting the statistics that we're
18 talking about here. They are young people in teens
19 or in their 20s, and the parents that are calling
20 are frantic. Their world has been turned upside
21 down.
22 And, again, it is not a stereotypical
23 profile. These are good families -- so-called good
24 families. These are people unemployed. It's a very
25 democratic medical illness that we're dealing with
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1 here. It will take anybody.
2 But one of the things I have been extremely
3 frustrated about, is I get someone at that
4 intervention, agreeing to go to treatment for heroin
5 addiction, and as has been said here, it's a very
6 uphill battle to persuade, you know, first of all,
7 to get them into a detox. Some of these places will
8 not detox from opiates.
9 But if you are successful, then the battle
10 becomes, and it is a battle, with the insurance
11 company.
12 There is legislation, I think, being
13 considered now in Albany, and I really, really hope
14 that it's given serious consideration, because we
15 are losing people, losing their lives, because, you
16 know, the decisions are made for profit reasons.
17 That's what insurance companies are about:
18 They are ultimately beholding to their shareholders.
19 And there is a conflict of interest there.
20 These are public-health issues. They cannot
21 be allowed to be in the driver's seat when these
22 decisions are being made.
23 Turn that back to the professionals. The
24 medical professionals that are here today, the
25 professional CASACs, the alcohol and drug
114
1 counselors; people who are on the ground with the
2 patient, who understand that you can't tell a heroin
3 addict who is shooting, you know, 15, 20 bags of
4 heroin a day, to go to an outpatient clinic and
5 "You'll be okay." That's not going to work.
6 And, so, they have to be held accountable for
7 this. I think it's absolutely criminal what's going
8 on with the insurance companies.
9 [Applause.]
10 DAVID RAMSEY: The other, more promising
11 trend, is someone sitting right next to me here,
12 Jeanette Tolson, who runs the local recovery center.
13 Which, and by the way, we are very grateful
14 for your support, early support for that
15 Senator Seward. Your funding of that at a critical
16 time for us, I think, turned everything around.
17 But we know, the statistics are clear, that
18 when people come out of treatment, and we're
19 assuming that you're giving them the very best
20 treatment possible, they still tend to relapse in
21 the first three to six months of discharge from
22 those treatment facilities.
23 If we provide them with recovery centers,
24 that rate of relapse plummets.
25 So this is smart money to invest in recovery
115
1 centers.
2 It's also smart to invest in recovery
3 coaches.
4 Norine, myself, and Jeanette are all trained
5 recovery -- master trainers for recovery coaching.
6 We have approximately, in the state now,
7 close to 1,000 people trained up as recovery
8 coaches. And that's a rigorous 35-hour training of
9 peer support.
10 OASAS has been the state agency that oversees
11 substance abuse in New York State. OASAS has been
12 very helpful in that effort, too. They have also
13 trained peers in this area.
14 And that provides someone who is newly sober,
15 who is frustrated, intimidated, about just about
16 everything that's coming their way, because they're
17 newly sober, this gives them, literally, a hand to
18 hold, to go through these frustrations that precede
19 a relapse.
20 And so we know that recovery coaches are
21 having a huge effect on reducing relapse with
22 addicts and alcoholics. We can certainly do that.
23 My final comment would be, just, you know,
24 ditto the comments here this morning about getting
25 to them early, getting to them in the jail. That's
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1 where they end up, in the criminal justice system.
2 If we can provide them with treatment, and
3 there's no reason, I think, that we can't do this,
4 it's just the will to do it, to get them in the
5 county jails, in the state prisons, with good, solid
6 treatment and counseling.
7 Otherwise, you're just having them sit in a
8 box for up to a year, with nothing. No insight, no
9 change in their attitude or approach to life.
10 Those things are being tried, particularly
11 now in Maryland. They're having great success with
12 programs that are taking place in the county jails.
13 So there's encouraging signs there, but we're
14 missing an opportunity there.
15 We have that captive audience. We can get to
16 them with a message of hope.
17 So, thank you, Senator.
18 SENATOR SEWARD: Thank you.
19 Yes --
20 NORINE HODGES: I'm sorry, Dr. Sellers.
21 I just wanted to address, before we move on,
22 and it's the last thing I will address, but,
23 prevention education.
24 We are in every classroom, from kindergarten
25 through high school. Every grade, every student,
117
1 we're loaves and fishes. One full-time and three
2 part-time, we go into every class with an
3 evidenced-based [unintelligible] life skills, as
4 well as a few others.
5 We do twenty-thousand 101 contacts.
6 We have reduced the early initiation of
7 alcohol for our tenth-graders -- that 15-year-old
8 brain we've been talking about, it's pretty crazy --
9 by 87 percent.
10 And our twelfth-graders look at using
11 prescription drugs the wrong way, to use them for
12 not what they're attended, 65 percent.
13 This program works, every student gets it.
14 It's a scaffolding program. It's relevantly
15 designed so it's meaningful for every age group,
16 working on decision-making, how to handle emotions,
17 communication skills, social skills.
18 We've got our first tenth-grade class that's
19 had the program since kindergarten. The numbers for
20 that particular age group, because it is a strange
21 time in life, there, with the brain development,
22 amazing.
23 And now OASAS (the Office for Alcoholism and
24 Substance Abuse) has agreed to survey in the fall.
25 We do it every two years. And that, my
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1 tenth-grade group, will be seniors. And it really
2 does work.
3 And I think, those monies, that every school
4 used to get those monies. They were the drug-free
5 and safe-school monies.
6 They -- with the federal government took that
7 away, made them into big block grants that only a
8 few schools -- I've been a peer reviewer for those
9 grants -- only, you know, 10 to 20 schools in the
10 country can access those monies; whereas, before,
11 every school had those monies.
12 So we did have counselors in the schools, and
13 then we did have other education programs.
14 But my colleagues and I struggle to get into
15 all the classrooms. And we've just been very
16 blessed in Schoharie County. Every teacher loves
17 it, every teacher wants us back. Children do
18 petitions to have us come back.
19 We do bullying now, violence in the
20 classroom, as well.
21 So these programs work.
22 [Applause.]
23 DR. JOSEPH SELLERS: My colleague
24 Dr. Leinhart pointed out to me that we don't always
25 interact with the people sitting around this table.
119
1 That, you know, one of things, we don't have
2 a system for communicating between medicine, the
3 community resources, education, law enforcement.
4 And many of the folks who are having
5 difficulty with substance abuse wind up in
6 emergency-medicine facilities on a regular basis,
7 multiple times, before they would ever be seen by
8 law enforcement.
9 And, so, I think one of the -- hopefully, a
10 good outcome from this, would be for all of us to
11 commit to interacting more.
12 And, so, I'm going to volunteer these guys
13 to --
14 [Laughter.]
15 DR. JOSEPH SELLERS: -- anybody who wants to
16 meet with the ER directors from Bassett and Fox
17 should get their cards today before you leave.
18 And they should know about the programs that
19 are out there.
20 Law enforcement should know what's going on.
21 They should talk to you guys about how do you
22 interact with the EMS system, and the rescue squads,
23 and the people who are out in the community. Or the
24 EMS guys are going into people's house all time, and
25 see things, and report to us, things that would, you
120
1 know, turn your hair gray.
2 Lastly, if I can, because I know you wanted
3 to switch to taking questions, and there is a
4 physician from Bassett I asked to come here today,
5 who is putting together, with the LEAF group, a
6 community event that's going to be in Cooperstown on
7 May 22nd.
8 And I think it would be helpful for the group
9 here to hear about what Dr. Weinstock [ph.] has to
10 say.
11 DR. WEINSTOCK [ph.]: Do you want me to talk
12 about the event? Or [inaudible].
13 DR. JOSEPH SELLERS: I think it would be nice
14 if you talked about the "why" of your event, and
15 then the "what," because I think it's -- it's an
16 example, I think, of finding a community-based
17 solution.
18 SENATOR SEWARD: Okay, go ahead.
19 DR. WEINSTOCK [ph.]: Sure.
20 Hi, I'm Judy Weinstock, and I'm the newest
21 physician, I think, in the entire Bassett system.
22 I'm a primary-care physician, and I moved --
23 I moved here with my husband nine months ago, to
24 come to a place that had a slower pace of life.
25 And, was never interested in drug addiction or
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1 prescribing opioids.
2 And this has become a passion of mine by
3 accident.
4 So, Dr. Sellers asked me to tell you a little
5 bit about my experience.
6 So I came to Bassett to be -- work part-time
7 as a primary-care physician. Just a regular family
8 doctor.
9 And my first three days, most of my patients;
10 so I saw 10 patients a day, so about 9 a day were
11 seeking opioid prescriptions.
12 And I kind of went like this [indicating],
13 and said, "You know, these are not appropriate
14 prescriptions. This is not how I was trained." And
15 immediately started looking for resources to help
16 me.
17 And what Mylea said in the beginning really
18 resonated with me.
19 She said, "It's hard not to blame the
20 doctors."
21 Well, the doctors blame themselves.
22 It's hard for the patients not to blame the
23 doctors, but, also, we get blamed when we don't
24 prescribe, when someone's in back pain and they're
25 seeking opioids.
122
1 So in four months, I have received more
2 threats, more complaint letters, you know, I've had
3 more patients fire me, and every single one of those
4 has been a narcotic-related complaint or threat or
5 firing.
6 So, the resources that I was looking for was
7 pain management. I needed help. These patients are
8 in pain, and some of them have been on these
9 medications for 20 years. They're not even close to
10 admitting they have a problem with opioids. They
11 have a problem with pain first.
12 And I found -- I spent, I don't know,
13 80 hours a week my first three weeks of working
14 there, looking for resources.
15 And I have a handout for patients of
16 12 pain-management clinics they can go to, which
17 include neurologists and board-certified
18 fellowship-trained pain-management specialists,
19 et cetera.
20 Well, I've had to whittle down the -- the
21 list down to nine, because I just can't get patients
22 into four of them.
23 And the closest one is Syracuse, and the
24 waiting list is nine months, and "I" must detox a
25 patient off of opioids before they'll be seen.
123
1 So how do I do that? I give them Imodium and
2 Zofran and clonidine, and say, I know you're going
3 to get diarrhea, but Imodium works a little bit
4 better, you know.
5 So that -- so the second resource is
6 psychiatry mental health. I need help.
7 Addiction and mental-health problems are like
8 this [indicating.] They're not separate issues.
9 And to get -- I need help with this.
10 And then, of course --
11 [Applause.]
12 DR. WEINSTOCK [ph.]: And then, of course,
13 the addiction problem.
14 So those are the resources I want. And,
15 really, that's what all the primary-care and
16 emergency-med docs want, and that's really what the
17 law enforcement wants, and what the patients want,
18 and what the families need.
19 And, you know, Mylea, I feel like I've seen
20 you 20 times last week. You know, I don't want you
21 to go to jail. I don't want to you live on the
22 street. I want to hug you and take care of you.
23 And that's what all the doctors want.
24 That's what we all want, you know?
25 So I can talk forever.
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1 I will stop and talk about the events,
2 though.
3 I think, probably on my second month of
4 living here, I said: Not enough people know about
5 this, and not enough people get together.
6 The docs know about it, the cops know about
7 it, the detox centers know about it, but not enough
8 of the community knows about it.
9 We've got to get the word out there.
10 So there's a similar town in Vermont,
11 St. Albans, and there was a documentary made about
12 that town and the drug problem there.
13 And the kids in this documentary, they wear
14 the John Deere clothing, they work on farms. You
15 know, they work at Wal-Mart.
16 It's our community.
17 And, so, together with LEAF and
18 Justin Thalheimer's helping, and the docs are
19 helping. I mean, everybody who hears about it wants
20 to get involved.
21 So we're having the movie shown as a free
22 community event in Cooperstown at the
23 Fenimore Museum on May 22nd, which is a Thursday
24 night. And the director of the movie is coming.
25 And one of the kids who is a recovering addict is in
125
1 the movie.
2 And this is what the poster looks like, and
3 the movie is called "The Hungry Heart."
4 And the idea is, to get everybody to come
5 together and talk about the fact that this is a
6 community problem.
7 And, so, I have a lot of these posters if you
8 want to put them up. They were graciously donated
9 by LEAF.
10 Thank you, Julie.
11 And -- oh, Judge Burns [ph.] will be there,
12 as well, talking about how the problem affects us
13 from a law standpoint.
14 I think I'll end there.
15 SENATOR BOYLE: Thank you very much.
16 SENATOR SEWARD: Thank you very much, Doctor.
17 [Applause.]
18 SENATOR SEWARD: In the few -- the very few
19 minutes that we have remaining, I wanted to get to
20 some of the audience questions that's been raised.
21 And the first one is -- regards -- it's from
22 Pete Maloney [ph.], the assistant chief of the
23 Oneonta Fire Department.
24 He's asking: "Is there a plan to provide
25 continuous supplies and support to law enforcement
126
1 for the Narcan kits?
2 "And will EMS agencies, who also respond to
3 overdoses, be supplied by this program?"
4 I'd like to ask Senator Boyle to address
5 that, what we're doing at the state level. I know
6 he's involved.
7 SENATOR BOYLE: Yeah, that's an excellent
8 question, Chief.
9 And what I found going around the state is,
10 that there's really no clear-cut program or agenda
11 on the way to address this Narcan situation.
12 It -- the irony is unbelievable, given the
13 fact that there are Narcan trainings.
14 And I'm glad to see you're having one here.
15 We had one on Long Island the other night.
16 We had 150 people participating.
17 Now, I'm a former EMT, and I've seen Narcan
18 work, and it is truly is a miracle drug.
19 And I'm sure the emergency room doctors have
20 seen it numerous times over their career.
21 The irony is, right now, under state law, we
22 can get it prescribed and give a course, and have it
23 given out to a citizen, a concerned citizen, but you
24 cannot have it on your first responder vehicle for a
25 fire department, for example, because the department
127
1 itself cannot be trained.
2 It's really a county-by-county thing.
3 And I can tell you that, as part of this
4 legislative package that's going to come out of
5 these hearings, we're going to have a unified
6 system, so as many people -- first responders,
7 parents, addicts themselves -- will get access to
8 Narcan.
9 [Applause.]
10 SENATOR SEWARD: Both Bob Kerry and
11 Pamela Tillman [ph.] have asked questions regarding,
12 and it's come up several times in the discussion
13 here today, regarding, you know:
14 "Why are insurance companies, rather than
15 recovery professionals, dictating whether or not an
16 inpatient receives treatment?
17 "And what is the status of Senate and
18 Assembly bills?"
19 And, you know, as -- I chair the
20 Insurance Committee in the Senate, and, of course,
21 as a member of this Task Force, I can report to you
22 that, between now and June 1st, when we look to come
23 up with the recommendations from this Task Force,
24 that this is certainly going to be a key issue for
25 us, because, number one, we need a much more
128
1 uniformed standard in terms of coverage in the
2 state.
3 Because I've heard stories of people showing
4 up at the inpatient centers, and, you know, they --
5 their families are in tears, they're in a crisis
6 situation, and they're on the phone with someone in
7 a cubicle at an insurance company.
8 And, you know, it's a very uneven standard
9 that's used, and, it does not help us with our
10 efforts with recovery, with what the current
11 situation is.
12 So, I can't give you a specific answer here
13 today but other to say, that this is a key issue for
14 us. And I suspect that we will have a much better
15 answer as part of these Task Force recommendations,
16 so people can get the treatment that they need.
17 There's a question here about -- this is from
18 Pastor Romano?
19 Oh, yes, yes.
20 Shall I read your question?
21 Yeah.
22 It says: "I have a daughter incarcerated.
23 Involved in prison ministry, I would like to know
24 about easier ways to get funding and help for more
25 faith-based rehab housing and traditional" -- "and
129
1 transitional, and programs."
2 There's that question.
3 Obviously, I think, I suspect, that that will
4 also be part of our -- Senator Boyle, wouldn't you
5 say that would be part of our deliberations?
6 SENATOR BOYLE: Absolutely. You know,
7 faith-based, whatever community groups, will be a
8 part of it.
9 But we heard a little bit of the testimony
10 here today, where, again, the irony, where you're
11 trying to get treatment from an insurance company.
12 And I've had parents across the state say:
13 I purposely had my child incarcerated because that's
14 where they could get help.
15 That is a messed-up system, and it's going to
16 change.
17 [Applause.]
18 SENATOR SEWARD: Absolutely.
19 [Applause.]
20 SENATOR SEWARD: This would be brass for our
21 medical folks that are here with us.
22 Pastor Romano had a further question.
23 "What are the side effects of VIVITROL?"
24 Anyone?
25 Do you have the answer to that question?
130
1 BETH: It has not been around --
2 SENATOR SEWARD: Could you identify yourself.
3 BETH: [Speaking without a microphone.]
4 Beth Viviani [ph.], [unintelligible].
5 SENATOR SEWARD: Right.
6 BETH: Some reviews that have been done on
7 that shows that there have been no long-term studies
8 yet. That [unintelligible] going on long enough for
9 there to be studies.
10 SENATOR SEWARD: Excellent answer.
11 We have a question regarding the legal --
12 this is from Henry Azblofox [ph.] --
13 Yes.
14 -- from Oxford.
15 I'm going to try to read this question.
16 It says: "The legal pain killers are
17 dangerous in too many instances.
18 "Even Purdue Pharmacy, the manufacturer, has
19 admitted their so-called 'safe formularies' was a
20 problem.
21 "Can the State ban or drastically restrict
22 medical use?
23 "Maybe pain is preferrable to risk of
24 addiction."
25 Is there a response for that?
131
1 DR. KELLY ROBINSON: I think we spoke to
2 restricting the use of prescriptions from the
3 emergency department.
4 If we could be limited in the number of
5 opioids we could prescribe, such as what they have
6 in New York City, that would benefit the rest of the
7 state.
8 SENATOR SEWARD: I remember you making that
9 point.
10 Yes, Doctor, do you have a response to that?
11 DR. WEINSTOCK [ph.]: Yes. I was asked to
12 give a lecture to the medical students about
13 appropriate opioid prescribing, and there are no
14 guidelines at all, really.
15 These are FDA-approved for patients who
16 have -- who are dying of cancer.
17 That's really who it's approved for: people
18 who are dying.
19 And so, when somebody comes in with back
20 pain, what do you do?
21 Do you treat a 20-year-old with back pain the
22 same way as you treat a 99-year-old with back pain,
23 as you treat somebody who just got back surgery?
24 And, so, I gave seven scenarios to the med
25 students, and these are people who are being trained
132
1 to be doctors, and there was no straight answer for
2 each one.
3 As Mylea said, these medications didn't just
4 help her back pain. They helped her mental pain,
5 they helped her despair, they helped her depression.
6 She felt superhuman.
7 How do you take that away?
8 DR. JOSEPH SELLERS: You know, one of the
9 things that's unfortunately happened, there's a
10 pendulum.
11 And when I started in medicine, giving
12 opioids was considered to be something that you
13 didn't do. People would become addicted.
14 And then there was the movement, What about
15 people with cancer pain? What about people with
16 terminal pain?
17 And then the overall organization that
18 certifies and inspects hospitals, the Joint
19 Commission on Health-Care Organizations put through
20 that everybody should have a fifth vital sign every
21 time they encounter the medical system, and that
22 should be their pain level.
23 So if you're ever in a hospital or an ER and
24 you see those pictures, [unintelligible], the thing
25 is, everybody has a right to be treated for pain.
133
1 Medicare still requires hospitals to survey
2 the patients that leave the hospital, the emergency
3 room, a series of questions, and one is: How is
4 your pain? Was your pain adequately addressed?
5 A pendulum swung, because of, I think
6 well-intended, you know, actions on the part of the
7 regulators, but it was -- it swung too far.
8 And it still is a very tough dynamic, and
9 it's very tough, because, unfortunately, addicts
10 can, and drug-seekers, people trying to get drugs so
11 they can sell them on the streets, can be very
12 convincing about their pain.
13 And it's a tough, tough situation.
14 But I think that the more we educate
15 ourselves, educate our patients, and be just careful
16 use of potentially addicting drugs.
17 But we can't stop using them, because there
18 still are people who cannot work, whose lives would
19 be turned upside down, without adequate pain relief.
20 It's just very difficult to sort out who, and
21 when, and how much.
22 And, again, we need more government help,
23 more government, research. I think this is at the
24 federal level, about best practices for, you know:
25 What is the ideal practice for somebody having their
134
1 wisdom teeth extracted, that minimizes the risk of
2 long-term addiction, but still gives the person some
3 relief?
4 Because, you know, there is significant pain
5 associated with having your wisdom teeth extracted?
6 SENATOR SEWARD: Thank you.
7 DR. STEVEN GRAHAM: [Speaking without a
8 microphone.] If I may?
9 SENATOR SEWARD: Yes.
10 DR. STEVEN GRAHAM: One of the problems with
11 opiates is that they work.
12 [Laughter.]
13 DR. STEVEN GRAHAM: And, one of the principal
14 mechanisms of action that they have, is they
15 function as an antidepressant.
16 One of the things that we're going to be
17 seeing, perhaps in the near future, is a novel
18 antidepressant that is in Phase 3 trials right now.
19 The principal active ingredient is
20 buprenorphine.
21 [Microphone handed to speaker.]
22 DR. STEVEN GRAHAM: That's actually all I had
23 to say.
24 [Laughter.]
25 DR. STEVEN GRAHAM: Other than the fact that,
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1 again, narcotics are antidepressants.
2 One of the reasons people use narcotics, is
3 because they act as an effective antidepressant.
4 SENATOR SEWARD: Thank you, Doctor.
5 JUSTIN THALHEIMER: I'm sorry.
6 I just wanted to say that, based on what you
7 were saying, I know a lot of people will go into the
8 emergency room, looking for these meds, or to their
9 primary-care physicians.
10 These medications are also mimicking and
11 magnifying the pain.
12 So it's not like the addict is going in
13 without pain. They just don't know where it's
14 actually come -- a lot of times, they don't know
15 where it's coming from. It mimics and magnifies it.
16 If the scale of 1 to 10 is a 4, after you're
17 opioid-dependent, that same scale is going to be at
18 about a 7 or an 8.
19 It's -- it doesn't -- when you're looking for
20 the -- when you are addicted to the opiate,
21 you're --
22 DR. WEINSTOCK [ph.]: There's a medical term
23 for that. It's called "hyperalgesia." And it's --
24 that is, that your body isn't able to produce it's
25 own pain killers.
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1 So I always tell my patients: When you stub
2 your toe, it hurts a lot more than when I stub my
3 toe. And I believe you.
4 And anybody who's delivered babies, I used to
5 deliver babies, and I used to deliver the
6 methadone-addicted babies, and it was so hard to
7 control their labor pain. The regular epidurals
8 didn't work. And it wasn't -- it was real.
9 Doctors want their patients to be pain-free.
10 SENATOR SEWARD: Thank you.
11 There's one other question on the pain-meds
12 issue.
13 Is it, Bridgette Brown [ph.]?
14 Bridgette, yeah, why don't you give her the
15 microphone.
16 Did you have any -- did you have a follow-up
17 question on this issue?
18 BRIDGETTE BROWN: I've been in recovery since
19 1990, from alcoholism.
20 And in '97, I was put on -- where I had
21 fourth-stage breast cancer, I was put on opioids.
22 And I was told there was Oxycontin, and I would
23 never become addicted to it.
24 Well, I don't take opioids anymore.
25 I never, as far as I'm concerned, engaged in
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1 drug-seeking. But, I have had a lot of pain, and
2 the doctors are afraid to prescribe -- and I know
3 many people like myself, to prescribe pain
4 medication. They're afraid, because of the I-STOP
5 laws, and everything else.
6 And there are, definitely, many people pain.
7 That I had sciatica for seven weeks. I went
8 to the emergency room three times. I saw Dr. Kelly,
9 and I was given nothing for my pain.
10 I didn't want opioids, but there really isn't
11 else.
12 The pharmaceutical companies are not
13 producing pain medication that will help us, because
14 they make so much money from the opioids, I guess.
15 So we need help.
16 I mean, there are legitimate people, and, of
17 course, you said that, that need pain medication.
18 Thank you.
19 SENATOR SEWARD: Thank you very much.
20 Just a couple of more here.
21 We had, from Karen Van Vauckenberg [ph.], who
22 said: "What is the political stance on making
23 access for levels of care available, such as
24 insurance paying for treatment, acupuncture, pain
25 management, recovery coaching, and peer-support
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1 groups?
2 "All the different pathways, together, are
3 more successful than are intervention one at a
4 time."
5 I think that sums it up very well in terms of
6 why we're here today.
7 It's, obviously, going to take a multipronged
8 strategy to address this problem.
9 And, obviously, that's -- you know, we have
10 this wide-ranging panel here.
11 There are others at various other forums that
12 have been held around the state, and with all of
13 this input, we will be looking to develop that
14 multipronged strategy.
15 BRIDGETTE BROWN: Thank you, Senators.
16 SENATOR SEWARD: And, finally, Matthew Ward?
17 We're way over time, but if you would like to
18 make your point briefly, we would very much like to
19 hear your comment.
20 MATTHEW WARD: I'm Matthew Ward. I am a
21 drug-court participant, as well.
22 And, you know, my story, you know,
23 originated, you know, through drinking, moving on,
24 blah, blah, blah.
25 The "Emerald City" you hear, that we're
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1 talking about, is opioid addiction. But, without
2 putting, you know, a specific substance, you know,
3 into the discussion, I think that we all in this
4 room, it's fair to say, 100 percent of us are
5 affected by addiction.
6 And, you know, I just want to see, you know,
7 that same willingness that's asked of me in my
8 recovery. You know, if I want what, you know,
9 people living clean and healthy have, and I'm
10 willing to go to any length to get it, you know,
11 I want to see the same things occur.
12 You know, I'm accompanied by a set of parents
13 that had, you know, their child, just back and
14 forth, and back and forth, trying to get the
15 insurance company to pay for this.
16 Myself, four times I went to rehab before
17 I wound up with a felony, you know.
18 And, I am educated, I have a deep career, all
19 these things that went circling the drain, you know,
20 as I attempted, over and over and over again.
21 You know, the window of time, when an addict
22 says, "I need help," might be 15 seconds. And we're
23 supposed to wait 30 days for some response from an
24 insurance company?
25 You know, so, I just -- I do thank everybody
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1 who's up there today, for assembling on this.
2 I think that it's a huge step in the right
3 direction.
4 And, you know, collaboratively, I think input
5 from everybody -- law enforcement; government; the
6 counselors, you know, that advocate; you know,
7 people in recovery; people who are still active,
8 seeking recovery -- you know, we can all make this
9 happen if we work hard at it.
10 So, thank you.
11 [Applause.]
12 SENATOR SEWARD: Thank you, Matthew.
13 I just want to close, ask Senator Boyle to
14 give the concluding comments.
15 But I just want to close by saying how much
16 I appreciate all of you being here this morning.
17 This is a huge problem for our area. It's no
18 longer a big-city problem. We have it right in our
19 small towns and our rural communities in this part
20 of the state, as well.
21 It's a growing problem, and we need to deal
22 with it.
23 And, I appreciate the comments that everyone
24 has made here today. They've been very insightful
25 and helpful to us, our Task Force, as we do our
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1 work.
2 And, no question that, you know, we need to
3 look to expand treatment opportunities earlier, and
4 also look to additional education and prevention
5 measures to be taken.
6 The insurance-coverage issue is huge, and
7 very key in many, many cases.
8 We're going to look for a better answer
9 there, so people can get the treatment that they
10 need, and get it earlier.
11 And, there are many other aspects of this
12 issue that we need to deal with.
13 So, I want to just say thank you all for
14 participating.
15 And those of you in the audience, I hope you
16 found it to be interesting, and I appreciate your
17 input, as well.
18 I particularly want to thank Deb and Mylea
19 for being here, to remind us that we may talk
20 statistics, but they are real people behind these
21 numbers. And, we owe it to you, and all those you
22 represent, to deal with this problem successfully.
23 So with that, I would like to ask our Chair
24 of our Task Force, Senator Boyle, to close.
25 I appreciate my colleague Senator O'Mara for
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1 joining us, as well.
2 SENATOR BOYLE: Thank you, Jim, and thank you
3 so much for hosting this, and SUNY Oneonta;
4 Senator O'Mara, for participating, and all the
5 panelists.
6 We got some good ideas today. I know we can
7 think of three or four bills -- potential bills to
8 come out of here.
9 As Dr. Sellers says, this communication
10 should continue.
11 And if you think about something, in talking
12 in the next few months, or the next few years,
13 please contact us, because there's always room for
14 legislation to help us combat this drug tragedy.
15 And, thank you for all the people
16 participating in the audience, for coming today.
17 I was looking forward to this forum probably
18 more than any of them, because I knew I had the
19 Chair of the Insurance Committee here, and this was
20 going to be -- he's the man, on this.
21 And, also, to Deb and Mylea, thank you so
22 much.
23 And I know, I'll end with saying:
24 Mylea, I know you said in your beginning,
25 that your goal was to, someday, help save a life.
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1 Well, you did today.
2 Thank you for participating.
3 Thank you all.
4 [Applause.]
5
6 (Whereupon, at approximately 12:11 p.m.,
7 the forum held before the New York State Joint
8 Task Force on Heroin and Opioid Addiction
9 concluded, and adjourned.)
10
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