Public Hearing: Heroin and Prescription Drug Epidemic on Long Island and Its Impact on Long Island'S Youth

1 BEFORE THE NEW YORK STATE SENATE

STANDING COMMITTEE ON ALCOHOLISM AND DRUG ABUSE 2 ------------------------------------------------------ 3 PUBLIC HEARING: 4 HEROIN AND PRESCRIPTION DRUG EPIDEMIC ON LONG ISLAND

AND ITS IMPACT ON LONG ISLAND'S YOUTH 5

------------------------------------------------------ 6 7

Suffolk County Community College 8 1001 Crooked Hill Road

Van Nostrand Theater 9 Sagtikos Art and Science Building

Brentwood, NY 10

November 13, 2013 11 10:00 a.m. to 2:00 p.m. 12 13

PRESIDING:14

Senator Philip M. Boyle 15 Chair 16 17 PRESENT: 18 Senator Jack Martins 19 Assemblyman Joseph S. Saladino 20 21 22 23 24 25 1

SPEAKERS:PAGE QUESTIONS 2

Arlene Gonzalez-Sanchez 12 18 3 Commissioner

NYS Office of Alcoholism and 4 Substance Abuse Services (OASAS) 5 Dr. Jeffrey Reynolds 26 39

Executive Director 6 Long Island Coalition of Alcoholism

and Drug Dependence 7

Kym Laube 56 78 8 On behalf of

Quality Consortium of Suffolk County 9 and Hugs, Inc. 10 Jamie Bogershutz 56 78

Executive Director 11 YES Community Counseling Center,

and Co-President of the Nassau 12 Alliance for Addiction Services 13 John M. Venza 84 93

Vice President of Adolescent Services 14 Outreach Development Corporation 15 Nancy Beckett-Lawless 96

Director of Provider Relations 16 Seafield Center 17 René Fietcher 108 125

Assistant District Attorney 18 District Attorney's Office of

Nassau County 19 And, also, Director of

Community Affairs 20 Nassau County Heroin Prevention

Task Force 21

Robert Ewald 130 22 Chief of the Narcotics Squad

Suffolk County 23 District Attorney's Office 24 25 1

SPEAKERS (Continued): PAGE QUESTIONS 2

John O'Brien 137 3 Commanding Officer, Narcotics Squad

Suffolk County Police Department 4

Joshua Lafazan 150 5 School Board Member

Syosset Central School District, 6 and, LICADD Board Member 7 Todd Benjamin 160

Educational Social Worker 8 Jericho School District 9 Joanne Hoffman Beechko 166

President 10 Long Island Pharmacists Society 11 Michael R. Delman, M.D., FACP, FACG 178 185

Senior Vice President for 12 Academic Affairs,

Southside Hospital Assistant 13 Professor of Medicine

Hofstra North Shore-LIJ School 14 of Medicine 15 16 17 18 19 20 21 22 23 24 25 1 SENATOR BOYLE: I'd like to thank everyone 2 for coming this morning to the Suffolk Community 3 College. 4 I'd like to thank President McKay, 5 [unintelligible], and others of the 6 Suffolk Community College, for allowing us this 7 venue, this wonderful venue, for a very important 8 hearing. 9 My name is Phil Boyle. I'm a senator for the 10 State Senate District Number 4. 11 And, in 30 years in public service, this is 12 actually the first hearing I've ever chaired, and 13 I can't think of a more important topic. 14 I'm joined with my colleagues: 15 Senator Jack Martins from Nassau County. 16 Jack, thank you so much for joining us. 17 And, Assemblyman Joe Saladino. 18 Joe, thank you very much. 19 Today we're going to hear testimony on the 20 Long Island epidemic among our youth for 21 prescription drugs and heroin. 22 Those of you who live on the island, you know 23 that this is a growing problem, not just here on 24 Long Island, but throughout the state. And I think 25 we might hear from testimony from experts from a 1 statewide perspective, but we're focused mostly here 2 on Long Island. 3 What I find is that, over the course of -- 4 I've been a lifelong resident of Long Island, we've 5 had various drug problems, many epidemics, over the 6 course of decades. 7 However, this problem now, and it started 5, 8 10 years ago with the prescription-drug epidemic, we 9 saw an explosion in the amount of prescription-drug 10 overprescribing; our young getting addicted, adults 11 getting addicted, to prescription drugs, raiding the 12 kitchen -- the bathroom cabinet for medicines, and 13 stuff like that. 14 As a result of that, we passed legislation 15 last year called "I-STOP," which was intended to 16 allow law enforcement better access to information 17 and to prosecute prescription-drug overprescribing 18 by doctors. Giving -- making doctors, mandated 19 reporting, on how much they were prescribing. And, 20 a network where you can see where patients were 21 over -- were doctor-shopping; increasing the amount 22 of going from one doctor to the next and getting 23 prescription drugs, OxyContin, Vicodin, whatever it 24 may be, and becoming addicted. 25 As a result of that, we saw individual 1 tragedies: families, overdoses; parents losing they 2 are children. And public tragedies, like the 3 pharmacy deaths in Medford and in Nassau County. 4 So we passed this legislation, and what we've 5 been hearing anecdotally, and we're gonna hear 6 experts today tell us about the actual facts, is 7 that a lot of these young adults and children who 8 were -- had been addicted to prescription drugs are 9 now seeking that opiate high, if you will, and 10 turning directly to heroin. 11 The name of this hearing is "Prescription" -- 12 "Heroin Addiction Among Our Youth on Long Island: 13 Connecting the Dots To Our Youth," and that's 14 exactly what we intend to do. 15 We have a great panel. 16 And if -- Jack, if you'd like to have -- 17 would you like to make an opening comment, if you 18 wouldn't mind? 19 SENATOR MARTINS: Thank you. 20 Good morning, everyone. It's great to be 21 here. 22 Certainly, I want to congratulate and thank 23 my colleague Chairman Phil Boyle for holding this 24 hearing. 25 You know, we hear so much about the 1 prescription-drug epidemic, and the issues we have 2 with prescription drugs and with heroin, and, you 3 know, it's always someone else's problem. 4 "It's an issue that's happening out there, 5 but it's not in our local communities." 6 "It certainly isn't in our local schools." 7 "It certainly doesn't affect us." 8 "It's not in my neighborhood." 9 It certainly doesn't help that, you know, 10 many of our communities feel this way. 11 The reality is, it is in our backyards. 12 It doesn't know any boundaries. 13 It doesn't stay to those 14 socioeconomically-challenged areas that are 15 stereotypically linked with drug abuse. 16 There is no community on Long Island that has 17 not seen the scourge of drug abuse, that does not 18 have it in their schools, that does not have it in 19 its communities, and that is not struggling with it 20 just below the surface. 21 And if you go out there and you look, and you 22 look at the signs, and you follow the police 23 reports, and you look at the incident reports, and 24 you look at the overdose for heroin and 25 prescription-drug abuse, there isn't a community on 1 Long Island that isn't affected, whether it's the 2 most-affluent community or the least-affluent 3 community. 4 And so this is important. 5 This dialogue that we're having today is 6 important, because we're raising the consciousness 7 of our communities when it comes to this epidemic, 8 because the first step, as always, is to recognize 9 that there's an issue, and then you can begin to 10 address it. 11 Now, I think the State Legislature took a 12 wonderful first step last year with I-STOP, but now 13 we have to take that next step, which is, to begin 14 addressing the real issues on the ground. 15 And when kids who are on Oxy and who are on 16 prescription drugs now look for heroin as the 17 alternative, what are we as a society doing to deal 18 with that? And how are we providing a path to 19 recovery and to sustainability for our kids? 20 So, again, I want to thank Phil for chairing 21 this event, holding this forum, and allowing for 22 this dialogue so critically important to all of our 23 communities. 24 Thank you. 25 SENATOR BOYLE: Thank you, Senator. 1 And this issue of drug abuse and heroin abuse 2 on Long Island among our youth, it's a bipartisan 3 issue. Both Republicans and Democrats, 4 Independents, Conservatives...all of us are 5 concerned about it, seeking legislation. 6 I would point out, actually, that the I-STOP 7 legislation passed both Houses of the Legislature 8 unanimously. 9 Almost unheard of. 10 And it just shows how unified people are 11 across the party lines and across Houses of the 12 Legislature in wanting to combat this epidemic. 13 And with that, we're joined today by 14 Assemblyman Joe Saladino; Joe, from Nassau County. 15 Joe, thank you very much for coming. 16 And, would you like to make an opening 17 remark? 18 ASSEMBLYMAN SALADINO: Thank you, Phil. 19 I would like to first thank and commend 20 Senator Phil Boyle, who has championed this issue, 21 and so many issues. 22 Phil and I worked together in the Assembly, 23 and now Phil's leadership in the Senate continues to 24 protect our communities, just like the way 25 Jack Martins is doing in protecting our schools and 1 students in our schools. 2 You know, our role as elected officials must 3 be, first and foremost, for the protection of our 4 communities. 5 And no issue is hitting home more drastically 6 than the deaths and scourge of heroin and 7 prescription-drug addictions. 8 I've been working with a team in a task force 9 in my Assembly District. 10 Many of you here today have been members of 11 that, and have guided us on the proper solutions. 12 So your role is so important in getting that 13 message across, and your help, along with great 14 leaders like Senator Phil Boyle, is the reason we 15 got I-STOP passed. 16 We have been increasing the pressure on the 17 community to identify the problems. 18 We've been presenting those solutions. 19 All of my colleagues have been collecting up 20 prescription drugs at collection sites, which gets a 21 lot of dangerous drugs out of the medicine cabinets, 22 out of the homes; not only in our homes, but grandma 23 and grandpa's home, where we found there's a lot of 24 drug stealing going on there as well. 25 So, your testimony is so important. 1 And our role, with your support, to get these 2 issues passed, will clearly make a difference to 3 reduce the dangers. 4 I'm here because three of my dear friends 5 lost their children, and those children, including 6 Natalie Ciappa, who I've represented for years, 7 Brittany LaGrega, and Jonathan Sieckouski, kids that 8 didn't have to die. 9 Didn't have to die; bright children with 10 promising futures, but because they started to play 11 with fire, they got burned, ultimately. 12 And with your help, and the leadership of one 13 of our greatest elected officials in 14 Senator Phil Boyle, we can greatly reduce this 15 program. 16 And I'm so pleased to be a part of it. 17 SENATOR BOYLE: Thank you, Assemblyman, and 18 thank you for being here. 19 This hearing is a little bit different. 20 We've asked the people who are testifying to 21 give their remarks, but, also, as part of their 22 remarks, to give us some legislation that they think 23 could be helpful; whether creating new legislation, 24 or maybe changing existing legislation, to help us 25 fight this epidemic. 1 And in terms of time, I'm going to ask our 2 panelists to -- you can read your testimony if you'd 3 prefer. I think that not too of them are too long. 4 If we get stuck for time, we might ask people 5 at the end to paraphrase. 6 But, we are very delighted to have with us as 7 our first witness, commissioner of the New York 8 State Office of Alcoholism and Drug Substance Abuse 9 Services (OASAS), 10 Commissioner Arlene Gonzalez-Sanchez. 11 Commissioner, thank you very much for being 12 here. 13 If you would like to join us. 14 [Applause.] 15 ARLENE GONZALEZ-SANCHEZ: Good morning. 16 Good morning, Senator Boyle, Senator Martins, 17 Assemblyman Saladino. 18 Thank you so much for having this very 19 important meeting, public hearing, and I'm grateful 20 that I was able to participate. 21 I also want to thank you for the interest and 22 support on the important topic of prescription-drug 23 and heroin misuse among youth, especially here in 24 Long Island. 25 The increased misuse of prescription drugs 1 and heroin remains a critical and pervasive 2 public-health concern. 3 This growing crisis is being experienced, not 4 only in Long Island, but throughout our communities 5 in the state. 6 As the commissioner of New York State 7 addictions-treatment agency, and former commissioner 8 of Nassau County, I am very keenly aware of the 9 issues here on the island, and how those issues have 10 progressively gotten worse, unfortunately, and that 11 is why I personally made an attempt to be here. 12 I didn't want to send anyone, because I need 13 all of you to understand that this is very important 14 to us at OASAS. 15 And I hope that throughout this session, we 16 could walk away with some ideas and initiatives that 17 we could all, together, work on, because this is not 18 only something that one person could do, or one 19 division. 20 This has to be a combination of communities, 21 the LGUs (the local governmental units) in both 22 Nassau County and in Suffolk, as well as the 23 Legislatures, so that we could really start 24 addressing this issue widely. 25 Addiction does not discriminate, and it 1 impacts the lives of many New Yorkers -- excuse 2 me -- from all walks of life. 3 OASAS will continue to provide prevention, 4 treatment, and recovery services to anyone addicted 5 to alcohol, prescription painkillers, heroin, or any 6 of other addictive substances. 7 OASAS currently has 134 treatment programs on 8 Long Island: 54 in Nassau County, 80 in Suffolk. 9 Many of these programs have the capability of 10 serving adolescents and young adults. 11 Additionally, OASAS has approved the opening 12 of 25 new treatment beds for young adults, ages 18 13 to 25, in Long Island, with another 25 in 14 Western New York, which is also experiencing a 15 significant problem in the area of adolescent 16 addiction. 17 The Outreach Development Corporation will 18 house and manage the new beds on Long Island. 19 OASAS has heard from concerned parents about 20 the difficulty of getting treatment for their family 21 members, especially their adolescent children, 22 because of the high cost of insurance and insurance 23 copays. 24 While OASAS does not have the power to 25 regulate the cost of insurance, we are in close 1 communication with the New York State Department of 2 Financial Services to make them aware of this issue. 3 While OASAS remains committed to providing 4 access to treatment services, we are also dedicated 5 to making interventions and resources available for 6 parents who are desperately trying to convince their 7 children that they are addicted and that they need 8 help. 9 We will work together with these families by 10 making interventions available. 11 And we also welcome your assistance in this 12 area. 13 I know that, in Nassau County and Suffolk 14 counties, law enforcement and other first responders 15 are already using Narcan to counteract the effects 16 of opiate overdose, including heroin and 17 prescription painkillers, and they are saving lives. 18 OASAS is also working to expand the 19 availability of Narcan kids, and training to more 20 first responders, school nurses, and others to help 21 save lives. 22 OASAS is working to increase the quality and 23 accessibility to treatment services for youth by 24 promoting the use of evidence-based practices, like 25 the seven challenges and the multi-dimensional 1 family therapy. 2 These practices, and others, are being used 3 by Hope for Youth in Amityville, Outreach 4 Development in Bellport, and a number of other 5 providers throughout the island. 6 OASAS supports school and community-based 7 prevention services on Long Island, representing 8 more than 45 school districts and 20 other 9 providers. 10 These evidence-based programs are staffed 11 with qualified health professionals with expertise 12 in providing counseling to young people and their 13 families. 14 Too Good for Drugs, Reconnecting Youth, 15 Second Steps, and Life Skills Training are four of 16 the most effective and most used prevention programs 17 now in use here on Long Island. 18 In collaboration with the New York State 19 Department of Health, we developed a series of 20 educational public-awareness brochures to bring 21 attention to prescription-drug misuse. 22 The brochures and other forms are being 23 distributed to school health services, social 24 workers, counselors, and nurses. 25 Over 100,000 brochures have been ordered thus 1 far. 2 These brochures can be ordered online at the 3 OASAS website. 4 And, again, this is a way of us trying to get 5 the word out, to educate everyone on the issue of 6 addiction. 7 We are also looking at how parents might help 8 us with providers, on how to best engage them in the 9 treatment process from the very beginning. 10 To do this, we have engaged a parent 11 consultant who will be conducting focus groups 12 across New York State, and here on Long Island, in 13 the early part of 2014. 14 This is also very critical, because we really 15 need to hear from the parents themselves to 16 understand better what they're going through and 17 what they need. 18 In addition to promoting more effective 19 practices, we're also looking to improve recovery 20 services that support the youth in the community and 21 allow them to learn how to live a drug-free life. 22 OASAS works closely with our partners at the 23 Department of Health to monitor the introduction of 24 harmful new drugs that can lead to addiction and 25 overdose, especially among adolescents. 1 Prescription opiates, and substances like the 2 designer-drug bath salts and Molly, which is a type 3 of amphetamine, also known as "ecstasy," often mixed 4 with bath salts, and, synthetic marijuana, also 5 known as "spice," though they're banned in New York, 6 are becoming more and more widespread. 7 In closing, through all of these programs and 8 activities, OASAS looks forward to working with 9 members of the State Legislature, our state agency 10 partners, our county government, our schools, our 11 provides, and others, to combat the spread of 12 prescription-drug misuse, and heroin, and substance 13 abuse, alcohol addiction; addiction in general. 14 So, I stand here, looking, and willing to 15 work with all of you, as well as the participants of 16 this public hearing, to see if we could start making 17 a dent in this big issue. 18 Thank you. 19 SENATOR BOYLE: Thank you, Madame Chairman, 20 and thank you for taking the time to be with us here 21 today. 22 Thank you for what you have done in your new 23 position, and what you've done throughout your 24 career, to combat addiction. 25 I just have one quick question, if you 1 wouldn't mind. 2 You mentioned the 25 new beds for treatment 3 on Long Island, and 25 in Western New York. 4 It seems to me, anecdotally, that we need 5 more than that. 6 The parents are coming to my office, and 7 calling, saying, that their child is addicted. 8 Their uncle, aunt, you name it, is addicted. 9 They're looking for treatment services. 10 And I know we want to expand as much as 11 possible. 12 Have you -- has OASAS done any investigation 13 to actual needs? 14 I know that 25 is a good start, but, where we 15 might go from there? 16 ARLENE GONZALEZ-SANCHEZ: Well, Senator, 17 great question. 18 You know, we work very closely with the local 19 governmental units, and, we look to them to provide 20 information in terms of needs in their local 21 community, and that's what we really rely on. 22 So having said that, we will continue to work 23 with the different LGUs from both counties, to 24 assess the needs for new development in whatever 25 program is needed. 1 OASAS stands prepared and ready to work with 2 the LGUs along this area. 3 Similarly, how we were able to reallocate 4 funding from programs that, perhaps, were not 5 functioning well, and reallocate them to programs 6 where we need it, we will continue to do that. 7 We will continue to assess, with the help of 8 the LGU, the needs, and address them appropriately. 9 SENATOR BOYLE: Very good. Thank you very 10 much. 11 Gentlemen, any questions? 12 SENATOR MARTINS: Sure. Thank you. 13 Obviously, this is a widespread issue, but, 14 is there an opportunity to work through our local 15 schools, in partnering, in dealing with some of 16 these issues? 17 I know that, oftentimes, a lot of our efforts 18 are with different agencies, local groups, 19 governments, but our kids are in school. 20 And, if there's gonna be an opportunity to 21 reach them, I would think that that would be a -- an 22 effective way. 23 Can you speak to that? 24 ARLENE GONZALEZ-SANCHEZ: Sure. 25 We do work with the local school districts. 1 It's just that, in some areas, for example, 2 in Long Island, I think you have, like, over 3 300 different school districts. You know, 4 127 public, and the rest, 200, private and 5 parochial. 6 So -- and each school district has its own 7 ways of dealing with things, and have their own 8 needs. 9 We continue to work with them. 10 We have school-based prevention programs in a 11 variety of these schools. 12 And all I can say is, that we will continue 13 to work with them to the best of our ability, 14 because you're right, it's not just one area. We 15 need to start at various different places. 16 Schools is, obviously, a big place where we 17 need to address the youth and address the teachers, 18 and so on and so forth. 19 So the answer to your question is, we will 20 continue to work with the school districts. 21 And, maybe, those that we haven't been 22 successful in, we will continue to try to work 23 better with them. 24 SENATOR MARTINS: I'll just make a suggestion 25 that, perhaps, in lieu of trying to reach the 1 56 school districts in Nassau County, and the, you 2 know, 80 or so in Suffolk County, that we, perhaps, 3 work through BOCES, and allow BOCES to interact with 4 those school districts, because our kids are there. 5 And if I had to ask, I know that, you know, 6 one of the points you spoke to, and I appreciate 7 this, is trying to provide a vehicle or an avenue or 8 a path for parents who are looking to get help for 9 their child. 10 I mean, that is the prototypical issue here: 11 How do you help a parent get help for a child 12 who doesn't realize that they need help? 13 And, you know, maybe they're not aware of an 14 agency. 15 Maybe they're not aware that there are 16 resources out there for them. 17 And more often than not, you know, as a 18 parent, we reach out to our local schools and ask 19 for help. 20 So, there has to be a connection there, and 21 if we're going connect those dots, I would hope that 22 there's an opportunity where we can -- you know -- 23 ARLENE GONZALEZ-SANCHEZ: Absolutely. 24 SENATOR MARTINS: -- go -- you know why we go 25 to schools? Because that's where the kids are. 1 And, so, if we have an opportunity to connect 2 that way, I would hope that that would work. 3 You know, there's been an effort -- just to 4 get off topic slightly -- certainly, over the last 5 year or so, to change the rules with regard to 6 marijuana use. 7 You know, there are some efforts in the 8 Legislature with regard to legalizing marijuana, you 9 know, some initiatives from some of our colleagues. 10 I was wondering if you had an opinion with 11 regard to that, since we're dealing with substance 12 abuse, in addition to the heroin and the 13 prescription-drug abuse, you know, whether or not 14 marijuana is a gateway drug; whether or not we 15 should be concerned about restricting or lessening 16 the restrictions on its availability; and whether or 17 not there are any consequences, that you see, to our 18 youths specifically, for us to take that kind of a 19 policy decision? 20 ARLENE GONZALEZ-SANCHEZ: Well, we're still 21 looking at the issue. 22 We still haven't rendered a decision one way 23 or another. 24 But as I indicated in my testimony, synthetic 25 marijuana has been banned in the state. 1 But, the issue of legalizing marijuana is 2 still something that we still haven't taken a 3 position on. 4 SENATOR MARTINS: But it's still illegal in 5 New York? 6 ARLENE GONZALEZ-SANCHEZ: Yes. 7 SENATOR MARTINS: And, lastly, again, I want 8 to thank you for your testimony here, and, 9 obviously, the efforts. 10 OASAS has been at the forefront of our fight, 11 and, certainly, it's very much appreciated. 12 Thank you. 13 ARLENE GONZALEZ-SANCHEZ: Thank you. 14 SENATOR BOYLE: Thank you, Senator. 15 And, Assemblyman Joe Saladino. 16 ASSEMBLYMAN SALADINO: Yes, Commissioner, in 17 an effort to identify the best practices to 18 determine what's working and how we can expand upon 19 that, we have a new and improved I-STOP. 20 We're still working out some of the kinks 21 involved with that, to better that program. 22 Of the programs that you oversee, the 23 preventative programs, which one do you find has 24 been the most effective? 25 And, what -- how do you see our expanding 1 that program to help more young people? 2 ARLENE GONZALEZ-SANCHEZ: Yeah, that's a 3 difficult question to answer, because I don't think 4 there's one real model program. 5 I did mention in my testimony a couple of 6 best practices. 7 I think the issue really is, looking at the 8 population, and looking what works for that 9 individual, or that group. 10 I think that, too long, we have tried to 11 delineate what's best for everybody, you know, and 12 that's usually not the way to address the issues. 13 ASSEMBLYMAN SALADINO: Like a "one size fits 14 all." 15 ARLENE GONZALEZ-SANCHEZ: Right. 16 So, I'm trying to move away from that in 17 OASAS. 18 We're looking at patient-centered, 19 family-focused: What works for that individual? 20 What works for that individual family? 21 And develop that as a best practice. 22 So I don't like to tie myself into saying one 23 model is better than the other, because we're 24 talking about individual lives here, and everyone's 25 different, and everybody has a different way of, you 1 know, reacting to different models. 2 So while there are a couple of models, and, 3 you know, I mentioned them, there may be others. 4 So, that's the best I can do in answering 5 your question. 6 SENATOR MARTINS: Thank you. 7 SENATOR BOYLE: Thank you, Joe. 8 And thank you, Commissioner, for your 9 testimony. 10 We truly appreciate you being here, and for 11 your expert testimony. 12 ARLENE GONZALEZ-SANCHEZ: Thank you. 13 Okay. 14 And I may have to leave -- 15 SENATOR BOYLE: Understood. 16 ARLENE GONZALEZ-SANCHEZ: -- so I will leave 17 staff here to listen. 18 SENATOR BOYLE: Well, we'll get you the 19 testimony for those who are after you. 20 ARLENE GONZALEZ-SANCHEZ: Okay, great. 21 Thank you. 22 SENATOR BOYLE: Thank you so much. 23 Our next witness is a longtime friend of 24 mine. He is the director of the Long Island Council 25 on Alcoholism and Drug Dependence (LICADD). 1 Dr. Jeff Reynolds is a long-time leader in 2 the addiction services here on Long Island, and his 3 Ph.D., I did not know until today, was actually 4 entitled "Using the Transtheoretical Model of 5 Behavior Change to Explore Substance Use Patterns 6 and HIV Risk Behaviors in a Suburban Sample." 7 Well, I can't think of a more fitting person 8 to be here testifying today on this important topic. 9 Jeff, thank you for being here, and we look 10 forward to your testimony. 11 DR. JEFFREY REYNOLDS: Thanks, I certainly 12 appreciate the opportunity. 13 As you mentioned, I'm proud to be the 14 executive director of the Long Island Council on 15 Alcoholism and Drug Dependence. 16 Incorporated in 1956, LICADD provides 17 prevention programs to more than 20,000 young people 18 per year, and provides a variety of addiction 19 services, including screening, brief intervention, 20 and referrals to treatment, to more than 21 7500 families annually. 22 Last month, we served 763 families at our 23 offices in Ronkonkoma, River Head, and Mineola, a 24 record number in our 57-year history, and 7 times 25 the number we were serving this time 4 years ago. 1 I want to thank you for convening this 2 hearing, and for taking the time to gather input 3 from experts in substance-abuse prevention, 4 addiction treatment, law enforcement, and education. 5 Senator Boyle, you've consistently been a 6 powerful voice for Long Island, and I'm thrilled 7 that you have been named Chair of this important 8 subcommittee. 9 It's no secret that Long Island, and, in 10 fact, New York, and our entire nation, is struggling 11 with an unprecedented opiate crisis that is tearing 12 families apart, destroying communities, and claiming 13 the lives of far too many young people. 14 You've seen the data about arrests, treatment 15 admissions, and overdoses, and I know that you've 16 heard firsthand from parents who have lost children 17 to addiction, as well as from treatment providers 18 and people in recovery themselves. 19 In convening this hearing, you've asked for 20 concrete action items that, if implemented, would 21 begin to turn to tide of addiction that continues to 22 sweep across our communities, and I'm pleased to 23 share with you a few ideas. 24 You've wisely included the phrase 25 "connecting the dots" in the public hearing 1 announcement, and that's a great theme, because 2 adequately addressing addiction is all about 3 connecting the dots and creating a continuum of 4 prevention, access to treatment, and recovery 5 support. 6 Despite all the press and awareness about the 7 opiate crisis, there are still huge gaps in the 8 continuum, and in some areas, those gaps are growing 9 wider almost by the day. 10 Prevention is one such example. 11 The advent of the much-maligned Common Core 12 curriculum has thrown school administrators and 13 teachers, not to mention parents and students, into 14 a spin. 15 Though our educators have conducted 16 prevention programs in 58 Long Island schools so far 17 this year, we are already beginning to hear that 18 many schools, with little time and too few 19 resources, are limiting so-called "discretionary 20 activities," like substance-abuse prevention 21 programs in favor of activities that relate directly 22 to reading, writing, and arithmetic. 23 But here's the thing: Kids who are drunk, 24 high, or dead of an overdose don't do well on 25 standardized tests. 1 We need to make sure that the New York State 2 Department of Education gets that, and if need be, 3 requires districts to maintain or adopt 4 evidence-based K-to-12 substance-abuse prevention 5 programs as part of an overall approach to help our 6 kids become more successful. 7 When we talk about connecting the dots, it's 8 important to understand the connection between 9 alcohol, marijuana, and the opiates that are getting 10 all the attention these days. 11 Young opiate users will tell you that they 12 didn't simply wake up one day and decide to snort a 13 chopped Vicodin or put a heroin-filled needle into 14 their arm. 15 Many began with alcohol at an increasingly 16 young age, experimented with marijuana, and a 17 certain percentage moved on to other drugs. 18 As New York State has spirited policy debates 19 about medical marijuana, and even legalization, 20 given what's happened in some other states, young 21 people are being led to believe that pot is 22 harmless, and as their perception of risk decreases, 23 use of the drug is on the rise. 24 We must continue to educate young people 25 about the impact of cannabis on the developing 1 brain, and increase access to psycho-ed services for 2 chronic marijuana users who may be 3 treatment-resistant or whose level of care -- whose 4 level of use doesn't yet require formal treatment. 5 New York State should be funding such 6 initiatives as it has this discussion. 7 I'd be lax if I didn't simultaneously mention 8 New York State's data commitment to reducing 9 criminal-justice costs by lowering incarceration 10 rates. 11 We, of course, applaud this move, and ask 12 that you help ensure that dollars saved don't simply 13 land in the State's General Fund; but, instead, are 14 reinvested in alternatives to incarceration, 15 addiction treatment, and reentry programs. 16 As you review the Governor's proposed budget 17 for 2014, I hope you'll advocate for this kind of 18 reinvestment. 19 New York's passage and subsequent 20 implementation of the historic I-STOP legislation is 21 having the desired effect. 22 We finally closed the spigot and limited the 23 supply of prescription painkillers into our 24 communities, making it harder for those who use the 25 drugs non-medically to get their hands on OxyContin, 1 Vicodin, Percocet, and other opioids, but we haven't 2 taken steps to reduce the demand for such drugs by 3 making treatment more affordable and more 4 accessible. 5 If folks turned away by doctors and 6 pharmacists aren't entering treatment, they're 7 likely to be turning to heroin dealers, robbing 8 pharmacies, and engaging in other crimes to pay the 9 rising street prices for enough pills to simply 10 stave off withdrawal symptoms. 11 The lack of detox beds has been a persistent 12 problem on Long Island for more than a decade. 13 The loss of beds at Long Beach Medical Center 14 post-"Sandy" and the institution of a phone 15 screening system at Nassau University Medical Center 16 has compounded the problem precisely at a time when 17 the needs have never been greater. 18 New York State OASAS should investigate 19 options for ambulatory detox services on 20 Long Island, and immediately fund new demonstration 21 projects in both medical and non-medical settings 22 across both counties. 23 Wait times at some outpatient treatment 24 agencies can be three to four weeks because there, 25 too, demand has skyrocketed while county funding has 1 been cut. 2 On the inpatient-treatment front, I'm aware 3 of several prospective providers who, wanting to 4 respond to the incredible needs on Long Island, have 5 contemplated projects; yet walk away when they find 6 out that the approval process from OASAS can take a 7 minimum of two to three years. 8 In the midst of a crisis that's inexcusable. 9 The Affordable Care Act promises to make 10 treatment more accessible to tens of thousands of 11 New Yorkers; yet here on Long Island, the victory 12 may be a hollow one, as we lack the bed capacity 13 necessary to meet the needs of local residents. 14 The recommendation here is actually pretty 15 simple: Properly fund the full range of addiction 16 services, including licensed treatment, 17 family-support services, interventions, advocacy, 18 and peer counseling, through the existing network of 19 qualified providers and fast-track the approval of 20 new applications. 21 As we think about barriers to care, it's 22 absolutely critical that we make -- take treatment 23 decisions out of the hands of insurance companies 24 and put them in the hands of qualified addiction 25 professionals. 1 Too often, insurers refuse to pay for 2 inpatient care until a patient fails at outpatient 3 treatment, despite a duration and a level of 4 substance use and/or comorbidities that call out for 5 a more intense level of care. 6 When an insurer finally does agree to pay for 7 inpatient care, they do so for only a few days at a 8 time when every shred of research we have ties 9 outcomes to duration of care. 10 The end result is a cost shift to Medicaid, 11 expensive jail cells, and emergency room visits, all 12 paid for, not by the private insurers who collected 13 premiums month after month for years, but to the 14 taxpayers. 15 The end result is an epidemic out of control 16 that's punctuated by overdose fatalities. 17 2014 must be the year that New York State 18 enacts legislation similar to the way Pennsylvania 19 did several years ago, to make sure that addiction 20 treatment on demand becomes a reality and we put an 21 end to the discriminatory and dangerous 22 insurance-company practices. 23 As we connect the dots between treatment and 24 recovery, I truly hope the New York State 25 Legislature will approve Senator Zeldin's 1 Healthy Sober Home Act. 2 Too many of these so-called "sober homes" are 3 anything but. 4 They're run by absentee landlords who 5 threaten public health by jamming as many people as 6 they can into rundown homes in communities that 7 already face a number of challenges. 8 These landlords are preying on families and 9 individuals whose dream of a new life is quickly 10 robbed from them by unsafe living conditions, 11 insufficient food, drug dealing, violence, and 12 little or no access to continuing care. 13 Beyond passing this bill, we at LICADD 14 continue to believe that recovery housing is an 15 important part of the treatment continuum, and as 16 such, should be fully regulated by New York State 17 OASAS. 18 And while we're on the topic of recovery, how 19 come Long Island still doesn't have a recovery 20 center for young people, given what's happened in 21 this region? 22 OASAS has funded such centers in other areas 23 of the state, but hasn't funded one here in this 24 region, a place, that given the numbers, needs the 25 help as any other region. 1 Our recovering kids need a safe place to go 2 to access services, attend 12-step meetings, and 3 connect with other sober kids in a safe, supportive 4 environment. 5 OASAS should help us create that place on 6 Long Island, and they should do it now. 7 Access to good treatment, safe and sober 8 housing, and recovery support all depends on our 9 ability to keep people alive long enough to ever 10 make it through the doors of LICADD or a treatment 11 center or a recovery home. 12 We're doing a lousy job at that and we're 13 losing too many young people to fatal overdoses. 14 An overdose-prevention program funded by the 15 New York State Department of Health AIDS Institute 16 has put Naloxone in the hands of civilians and 17 resulted in more than 1,000 overdose reversals to 18 date. 19 Given that most overdoses happen after a 20 period of forced or voluntary abstinence, 21 New York State OASAS should support treatment 22 providers in the provision of Narcan to patients and 23 their families as they leave care. 24 Local jails and state prisons should be 25 distributing the drug to releasees. 1 The New York State Department of Education 2 should be encouraging, rather than discouraging, 3 schools from stocking Narcan in the nurse's office. 4 And to those who worry about sending the 5 wrong message, Narcan doesn't promote drug use any 6 more than seatbelts promote unsafe driving, though 7 overdoses have certainly outpaced car crashes as a 8 leading cause of death in many areas here in 9 New York. 10 I know I'm running a little bit short on 11 time, but I just wanted to give you a quick list of 12 five other things New York State can do immediately 13 to address the epidemic. 14 First, require physicians and others who 15 prescribe a certain level of opioids annually to 16 receive mandatory training in addiction, even if the 17 training is done online to minimize cost and 18 inconvenience; 19 Second, encourage the New York State Health 20 Commissioner to speak out more forcefully about 21 prescription-drug abuse, and use his office to 22 educate both patients and physicians; 23 Three, the Department of Environmental 24 Conservation (the DEC), and DOH should be doing more 25 together to educate the public about proper and safe 1 drug disposal; 2 Next, appeal to the Federal Drug Enforcement 3 Administration to modify the drug-collection 4 requirements, to make it easier to hold drug 5 take-back events; 6 And then, finally -- and I know 7 Joanne Hoffman is here -- train and support 8 pharmacists who are very often the last person 9 standing between a desperate addict and a bottle of 10 pills. They need that kind of support, given what 11 we're seeing in the way of robberies. 12 As much as we often refer to the opiate 13 crisis as a "new thing," it's not. 14 It's been steadily growing for more than a 15 decade, and our collective failure to respond faster 16 and in a more comprehensive way has given heroin a 17 10-year running head start our kids. 18 Recovering the advantage requires action from 19 all levels of government, including New York State, 20 and the changes we make now will certainly help us 21 with the next drug crisis as it appears on the 22 horizon. 23 I know that there are folks who are lined up 24 to speak who will probably amplify some of the 25 recommendations I've made here, or at least speak to 1 them, as it relates to prevention or access to care, 2 but I certainly want to thank you for your time this 3 morning. 4 I welcome any questions or comments you might 5 have. 6 SENATOR BOYLE: Thank you so much, 7 Dr. Reynolds. 8 This was excellent testimony, and just what 9 we were looking for in terms of recommendations. 10 Just a quick question: 11 You mentioned about the treatment centers 12 that they have in other -- for our youth in other 13 parts of the state, but not on Long Island. 14 DR. JEFFREY REYNOLDS: Yeah, recovery 15 centers. 16 SENATOR BOYLE: Recovery center? 17 How does that work? 18 I have not visited one yet, in my capacity. 19 Can you tell me a little bit about a recovery 20 center and what they do? 21 DR. JEFFREY REYNOLDS: You know, one of the 22 things that happens here, is that you have young 23 people who go through the journey of active 24 addiction, who make it through to the other side, 25 who find the miracle of recovery, and then have a 1 hard time readjusting to a safe and sober life. 2 By and large their, friends are not safe and 3 sober. Our high schools certainly have a certain 4 number of challenges. 5 And there ought to be a safe place where 6 young people can go to hang out with other clean and 7 sober young people. That if they need to see a 8 primary-care physician, they can do that. If they 9 want to go a 12-step meeting, they can do that as 10 well. 11 You know, often, in -- here in suburbia, kids 12 will say they're bored. 13 And although my parents always found chores 14 for me to do when I said that when I was a kid, 15 there's something to that; in that, we haven't 16 created a lot of options for kids, generally, when 17 it comes to recreation and peer support. 18 And we certainly haven't done a good job at 19 creating those safe spaces for those children. 20 When you look at the profile of the folks 21 that we're seeing, you have this entire cohort of 22 kids who are, you know, 13 to 21, maybe who have 23 struggled, maybe who are resisting drugs and 24 alcohol. 25 We need to give them a place to go. 1 SENATOR BOYLE: Great. 2 Well, I -- that's a wonderful suggestion, 3 among the other ones, we'll follow up on as we seek 4 legislation to the new session. 5 We look forward to working with you on that, 6 and getting as many things on your agenda, that is 7 possible, in the new legislative session starting in 8 January. 9 And, a question from Senator Martins. 10 SENATOR MARTINS: Thank you. 11 I appreciate your testimony. 12 DR. JEFFREY REYNOLDS: Thank you. 13 SENATOR MARTINS: I appreciate the candor. 14 You mentioned that there were 700-plus 15 individuals who were helped last month -- 16 DR. JEFFREY REYNOLDS: Yeah. 17 SENATOR MARTINS: -- 20,000 a year. 18 Talk to me about where these families and 19 where these kids are coming from. 20 DR. JEFFREY REYNOLDS: You name it. 21 SENATOR MARTINS: Okay. 22 DR. JEFFREY REYNOLDS: It's across the board. 23 I will say, and I think you, Senator, made 24 mention of this, I think, kind of, our reluctance on 25 Long Island to acknowledge some of the hard-hitting 1 issues has put us at a strategic disadvantage. 2 And, so, as you look at communities right 3 now, even some in Nassau County in areas that you 4 represent, those parents are shocked and horrified 5 when they find needles in their kid's bedroom, and 6 often will come to us and say, "I found these in my 7 kid's room. What do you think that means?" 8 And, unless your kid's a diabetic, it's 9 generally not a good sign. 10 I think that sense of denial has set us back 11 a little bit. 12 When you have upper middle-class families, 13 heroin never enters their lexicon. 14 And as we talk about prescription painkillers 15 and heroin, I do worry that things like alcohol and 16 marijuana seem so much less threatening in the 17 scheme of things, and that parents get this false 18 sense of security and don't understand the 19 connection between underage drinking, for example, 20 and, later, substance abuse, or, the lifetime risk 21 to addiction; and, also, tend to ignore the fact 22 that, in and of itself, alcohol use is a problem for 23 young people. 24 So, folks are coming from all over. 25 I think if you've got some means and 1 resources, in some cases, it can help you access 2 care. 3 In some cases, that level of denial is even 4 higher than it would be in other populations. 5 SENATOR MARTINS: And let's talk about 6 alcohol, and, I guess, marijuana as gateway drugs. 7 You know, I agree with you, you know, we 8 can't put our heads in the sand and pretend that 9 this doesn't exist, and that we're not sending the 10 wrong message at the wrong time, because we see it 11 firsthand. 12 Certainly, I know you've seen it. 13 We've seen it in our communities. 14 Opening that door a crack, you might as well 15 kick the door down; because what's gonna happen, and 16 the influence that's gonna have on our children, 17 going forward, is significant. 18 And we're losing sight of that. 19 So, I did appreciate your comments in that 20 regard. 21 But, are we handling this issue on a 22 statewide basis the way we should? 23 And I appreciate the comments you made here, 24 but, I mean, it seems to me that our approach to 25 this particular issue, and substance abuse in 1 general, and its impact on our kids, needs to be 2 addressed in a coordinated way through schools. 3 And you mentioned your efforts in working 4 through our schools, and that we have these 5 agencies, but if we're not working in a 6 collaborative way, we're missing that opportunity to 7 connect in a very real sense. 8 How do we do that? 9 I mean, do we need to sort of reset that 10 paradigm for the realities of today? 11 And maybe this was okay for, you know, a 12 decade ago, two decades ago, when we were dealing 13 with different issues. 14 But to deal with the issues we have at our 15 door, or, actually, in our living room today, don't 16 we have to rethink how we're approaching substance 17 abuse amongst teenagers and younger adults? 18 DR. JEFFREY REYNOLDS: So on the coordination 19 issue, you know, one of the things I'd say is, 20 I think this crisis has brought together folks who 21 perhaps didn't work together very often. 22 So a great example of that, I think, is the 23 treatment community and law enforcement. 24 Very often, you had a law-enforcement 25 approach, and then you had those of us on the other 1 side of the world who were perceived as being soft 2 on drugs and said, "Let's rehab folks," and, the two 3 never really had a lot of conversations. 4 And I think this crisis has brought us 5 together in a very real way. 6 I think the same thing goes for schools and 7 treatment providers. 8 I don't see it so much as an issue of 9 coordination, as an issue of resources. 10 I think -- and the Commissioner mentioned 11 some of the evidence-based programs that are out 12 there that work really, really well. 13 They're not happening in a lot of districts 14 because there isn't the time or the resources to do 15 it. 16 I will tell you that, you know, if you're a 17 personal struggling with addiction and you call my 18 organization today, we're going to see you today. 19 Our response will be, "Get in the car and 20 come now." 21 If you're a school, though, calling for an 22 educational program now, I'm probably not going to 23 get to you until after the first of the year. 24 Those are missed opportunities. 25 And so the school district that, last year, 1 did a series of eight Too Good for Drugs sessions, 2 now is saying, "Can you come in and talk to a 3 thousand high school kids?" 4 "We'll worry about this when we need to. We 5 won't do the K-to-6 education that we need to do, 6 and do it in one shot, and wrap it up in 45 minutes, 7 and that's the same thing." 8 It's not. 9 So I think a lot of this is a "resource" 10 question. 11 You mentioned the issues of marijuana. 12 And just to say two words about that, and it 13 wasn't kind of the heart of your question: 14 The debate about medical marijuana is a very 15 difficult debate for a lot of folks. 16 I will tell you that I don't believe it's the 17 role of the New York State Legislature to determine 18 what's medicine and what's not. 19 I believe that's the role of the federal 20 Food and Drug Administration. 21 And I think when we have these conversations, 22 not only to suggest to young people that marijuana 23 perhaps isn't as harmful as you think it might be, 24 and then go the extra step and say, "Oh, it's 25 actually medicine," it creates a false sense of 1 security that we're beginning to see played out in 2 community after community. 3 And the organizations who are pushing this 4 don't have to deal with the fallout and don't have 5 to clean up the mess. 6 These are ideological fights for them. 7 Medical marijuana is a step towards 8 legalization. 9 They will go on and probably make a fortune 10 off the legalization of marijuana in other states. 11 The treatment providers here, who already 12 have folks spilling out of their waiting rooms, are 13 the ones who are gonna have to clean up the mess 14 after we have this debate. 15 SENATOR MARTINS: And our families, and our 16 communities -- 17 DR. JEFFREY REYNOLDS: Yeah. 18 SENATOR MARTINS: -- and we can go on and on 19 and on. 20 I was at a forum, probably about a year ago. 21 I was asked to speak to a junior and senior class at 22 a high school. 23 We don't need to mention which one. 24 And I asked if anyone in the audience, a few 25 hundred kids, knew what a "skittles party" was. 1 Now, you know what it is. 2 DR. JEFFREY REYNOLDS: Of course I do. 3 SENATOR MARTINS: Okay. 4 And I was shocked, because they all did. And 5 they all -- you know, they were giggling about it 6 and they were -- 7 Now, for those who don't know what a 8 "skittles party" is, it's when you go to your 9 parents' medicine cabinet and you take, you know, 10 whatever drugs they happen to have in the medicine 11 cabinet, and you go to the party, and you stick it 12 in a punch bowl at the front door on your way in. 13 And so, as kids come into the party, they 14 just take whatever drugs they want, they don't know 15 what it is, and they take it. 16 And this is going on in our communities 17 today. 18 And if you think it's not happening, and, 19 again, I'm not going to mention the high school that 20 I was at, but let's just say it was, you know, a 21 mainstream community here on Long Island, these kids 22 knew exactly what I was talking about. 23 They're, 16, 17 years old, and, not only did 24 they know what I was talking about, they were -- 25 very clearly, had already participated. 1 This is a real issue. 2 And the sooner we have discussions like this, 3 and begin addressing that issue, the better off 4 we're gonna be. 5 Thank you. 6 DR. JEFFREY REYNOLDS: Thank you, Senator. 7 SENATOR BOYLE: Thank you, Jack. 8 Joe? 9 ASSEMBLYMAN SALADINO: Thank you. 10 You know, as I just -- as I hear this, I just 11 envision a "skittles party" as dangerous as playing 12 Russian roulette with a gun. 13 Jeff, thank you for the information that 14 you're providing today, the testimony, but also for 15 all the help you've given me over the years, in 16 understanding this problem, and trying to seek out 17 the solutions. 18 What you have mentioned, what 19 Jamie Bogenshutz has mentioned, and René Fietcher, 20 and Dr. Kristi Golden, and so many others, have -- 21 the point you've driven home, is that we need to 22 provide better services, and make them more 23 affordable, for people who find themselves addicted. 24 Can you speak to us about the problems and 25 the solutions associated with providing health care 1 for inpatient treatment? 2 Right now, we have a bill that a number of 3 legislators are pushing, to make it mandatory for 4 health-care companies to provide coverage when the 5 physician feels that inpatient treatment is a 6 necessity. 7 I have learned through you and others about 8 people having to fail, not once, but twice as an 9 outpatient. Sometimes children die in that process. 10 Talk to us about the importance of getting 11 legislation like that passed: What it means to 12 parents. What it means to addicts. What it means 13 to health care. 14 DR. JEFFREY REYNOLDS: You know, getting 15 someone to agree to treatment, typically, is a 16 process. 17 Addiction is the only disease that will tell 18 you, and sometimes your family, time and time again: 19 you don't have it. It's not that serious, and not 20 that bad. 21 And, so, you'll spend months trying to get 22 someone into treatment, working with the family. 23 You'll get them to the front door, and then 24 the insurance company will say, We don't think it's 25 that bad that they're using ten bags of heroin a 1 day. Let's try outpatient first and see what 2 happens. 3 I know what happens. 4 Those kids wind up in funeral homes. 5 Those kids wind up in jails. 6 That's why we're building a new one in 7 Suffolk County. 8 Those kids wind up in emergency rooms. 9 And we then said to that person, you know, 10 We've been telling you for three months, you got a 11 serious problem, that you need to deal with it. 12 This almost becomes license for that person 13 to say, See, I told you it wasn't so bad. 14 And the family is left dejected, saying, 15 How could this happen? I've paid my premiums, year 16 after year, for more than a dozen years. 17 We now know, in addiction medicine, kind of 18 what an inpatient case potentially looks like, 19 versus what an outpatient case potentially looks 20 like. 21 Just like when someone goes to the emergency 22 room, a physician is able to do an analysis and say, 23 This is what I think the course of action should be. 24 The way we handle addiction is unlike what we 25 do with any other disease. 1 And when you take a young person who's been 2 using 10 to 15 bags of heroin a day, consistently, 3 for a year, you know an hour-long session at night 4 in an outpatient center is not going to solve their 5 problem; just the same way as if you were in a car 6 accident and, God forbid, you have a limb ripped 7 off, showing up at the emergency room and then 8 putting a Band-Aid on it is not going to solve your 9 problem. 10 The notion that insurance companies then say, 11 "Okay, we'll pay for inpatient treatment," and they 12 say, "Look, we'll pay for four days. Let's see what 13 happens." 14 When we know that, if you've been using for 15 five or six years, by the time you get to a 16 treatment door, you're not going to be cured in 17 four to five days. 18 The analogy there is saying to somebody, 19 Look, you've got a serious diagnosis. You need 20 ten chemo treatments, but let's just stop after two, 21 and kind of see how things are going, and see what 22 happens. 23 We know what's going to happen: the disease 24 is going to get progressively worse. 25 We spend a fair amount of time talking with 1 folks about how to get off their parents insurance 2 and onto Medicaid. 3 It's the ultimate cost shift. 4 And so when you guys have to deal with 5 Medicaid budgets that are out of control, this is 6 part of the problem. 7 The insurance industry has been the 8 number one barrier to care. 9 That has to stop. 10 It's costing us all money, but it's also 11 costing us lives. 12 You know, one of the things that drives me 13 nuts is we've had a lot of these conversations for a 14 long time. 15 We're in the midst of an unprecedented 16 crisis. 17 I don't feel the urgency. 18 And, quite frankly, I'm tired of going to 19 funerals. I'm tired of going to shiva calls. 20 They're happening with increasing frequency, 21 and there are key things that are not changing. 22 Passage of I-STOP is great. 23 Let me tell you, it was a priority for us, 24 and, thank God, it happened. 25 But the "access to treatment" question is the 1 bigger question. We're dealing with a brain disease 2 that requires treatment, and the insurance industry 3 needs to do its fair share to deal with this. 4 And I'll tell you, you know, anecdotally, you 5 have insurance companies that have no qualms about 6 paying for tens of thousands of dollars worth of 7 opiates, with no questions asked. 8 But when you come back and say, Spring for a 9 $5,000 treatment stint, the answer is always "no." 10 There's a double-standard: Willing to pay 11 for the problem; not willing to pay to help clean it 12 up. 13 ASSEMBLYMAN SALADINO: And just a follow-up 14 to that: 15 You have consistently provided those of us in 16 the Legislature who are listening -- and, thank God, 17 for people like Phil Boyle and Senator Martins -- 18 where does this particular piece of legislation fall 19 on your priority list, in terms of addressing this 20 issue of providing a real cure? 21 Where does this particular piece of 22 legislation, of forcing insurance companies to pay 23 for inpatient treatment; where does that fall? 24 DR. JEFFREY REYNOLDS: It's a no-brainer; at 25 the very top. 1 ASSEMBLYMAN SALADINO: At the very top of the 2 priority list? 3 DR. JEFFREY REYNOLDS: If folks can't get 4 access to treatment, nothing else matters. 5 Right? 6 We're taking decades worth of science and 7 good practice, and everything we know, and throwing 8 it out the window, and saying, Look, we're gonna 9 shut off the supply, but, the demand, you deal with 10 that. 11 Desperate people do desperate things. 12 That's why you're seeing an increase in 13 pharmacy robberies. 14 I sat with a "News 12" reporter recently, and 15 we called the Nassau County Medical Center's detox 16 line. 17 It went from a busy signal, to ringing, to a 18 voice-mail loop. 19 So imagine I'm a person who has just been cut 20 off by my doctor. Great, maybe today is the day 21 I make some changes. I pick up the phone, I call, 22 and that's what I get. 23 I'm getting sicker and sicker as time goes 24 by. What's my next move? 25 It's to find a way to make those symptoms go 1 away. 2 We have a great way of making those symptoms 3 go away: engage them in treatment. 4 There's more than enough folks who are 5 willing to go. 6 We're not letting them in, and that's 7 criminal. 8 SENATOR BOYLE: Thank you, Dr. Reynolds. 9 We truly appreciate your testimony, and we 10 look forward to working with you in the new session 11 on the legislation. 12 DR. JEFFREY REYNOLDS: Thanks very much. 13 SENATOR BOYLE: Our next panel, we have two 14 panelists: 15 Kym Laube, from the Quality Consortium and 16 Hugs, Inc., will be joining us; 17 And, Jamie Bogenshutz, executive director of 18 YES Community Counseling Center, and co-president of 19 the Nassau Alliance for Addiction Services. 20 And while they're taking their positions, 21 I just want to let people know that they found a 22 single car key on the check-in table outside, so, if 23 someone left a car key, check your keys. 24 If you have lost yours, then just see the 25 Senate staff people and we can get it back to you. 1 Kym, Jamie, thank you so much for joining us. 2 And, Kym, if you would like to start. 3 KYM LAUBE: Thank you. 4 Good morning, Senator, my name -- and thank 5 you for this opportunity. 6 My name is Kym Laube. I'm here today on 7 behalf of the Quality Consortium of Suffolk County 8 and Hugs, Inc. 9 I'd like to commend you and your staff for 10 their attention to this critical issue of heroin and 11 prescription drugs, and its impact on Long Island. 12 The Quality Consortium is pleased to submit 13 this testimony on the behalf of the 14 20 substance-abuse prevention and treatment 15 providers across the county, as well as the 16 200 individuals who are professionals in the 17 treatment and prevention field. 18 Quality Consortium members help individuals 19 recover from alcoholism and drug dependence, work to 20 prevent problems among those at risk, and change 21 community norms. 22 Additionally, we serve over 23 70,000 individuals and families from Suffolk County. 24 In a few short years, the use of prescription 25 drugs and heroin, and the demand for treatment, has 1 exploded across the landscape of Long Island. 2 I have shared many platforms with my 3 colleagues, many of which are here today, to tell 4 the story that needs to be told. 5 In the speakers to come, you will hear many 6 roadblocks, including access to care, need for more 7 services, and other unique challenges our field 8 faces. 9 Hopefully, you will also hear some potential 10 solutions for change. 11 My esteemed colleagues will cover the issues 12 that one faces when wanting help. 13 I would like to address some of the reasons 14 we got here. 15 I have been publicly quoted as saying, 16 "We need to stop blaming the fish for dying after 17 they've swam in polluted ponds, and work to figure 18 out why the pond became polluted in the first 19 place." 20 Although that statement is true, it was not 21 my original, and it was certainly stated by folks 22 smarter than I. 23 When we looked at our pond -- in this case, 24 Long Island -- we immediately know there is work to 25 be done. 1 We cannot change what we don't acknowledge or 2 understand. 3 If anything, this hearing will bring a fuller 4 understanding to light. 5 No one wants to grow up to be an alcoholic or 6 drug addict. 7 We know for many, those who find themselves 8 addicted to prescription drugs or heroin simply did 9 not start there. 10 In most cases, those who find themselves in 11 active addiction began their journey with alcohol 12 and marijuana. 13 For many, they began drinking prior to the 14 age of 15. 15 We know one in ten individuals will face 16 addiction, one in four families suffer from 17 alcoholism. 18 Of those identified as addicted, 90 percent 19 began drinking in their teen years, and, sadly, 20 90 percent will not get help. 21 The average age a young person picks up their 22 first drink on Long Island, for males is 11, and 23 13 for females. 24 The age of onset is a predictor of a lifetime 25 of use. 1 On Long Island, the past 30-day use of 2 alcohol amongst twelfth-graders is 60 percent, 3 compared to the use of prescription pain pills at 4 3 percent and heroin at .5 percent. 5 If we are going to change the sails of the 6 ship, we need to understand the perfect storm we are 7 navigating. 8 Heroin addiction simply does not start with 9 heroin. 10 The extensive research into substance abuse 11 prevention by Drs. Hawkins and Catalano gave us 12 knowledge into the risk and protective factors for 13 individuals and communities. 14 For the first time, the field of prevention 15 was to move from feel-good strategies to a 16 science-based approach. 17 In this research, risk and protective factors 18 are identified in four [sic] domains: community, 19 family, school, individual, and peer. 20 If young people are to change their behavior, 21 we as adults need to change ours. 22 Just working in one area is not enough, and 23 we will need multiple strategies across multiple 24 domains. 25 If I am a young person in any school on 1 Long Island, the odds are stacked up against me as 2 I navigate through the social and substance-abuse 3 minefield. 4 As I look to find who I am, I have a strong 5 desire to belong. 6 It is possible I have had information through 7 health classes and one-shot assemblies about the 8 dangers of alcohol and drugs, but these have often 9 come in the way of scare tactics and are sporadic 10 and inconsistent. 11 Certainly, I can -- certainly, they cannot 12 stand up to the constant pressure and minimization 13 of use by my peers, and how could that information, 14 given at times by a complete stranger, mean more to 15 me than my trusted friends? 16 Commonly, my parents put me in sports as a 17 way to keep me out of trouble and away from drugs, 18 not realizing that that just might be one of the 19 riskiest groups around. 20 By the time I hit eighth grade, 23 percent of 21 my peers have picked up alcohol. 22 By the time I hit tenth grade, that number 23 has tripled. 24 Until this time, my exposure to sound 25 prevention is lacking. 1 Chances are, for valid reasons, my school no 2 longer does DARE. 3 The demand for Common Core have stopped 4 prevention programs from being able to push in and 5 everyday pressures of school life are mounting. 6 More and more, the adults in my life are 7 allowing for alcohol use, and in many instances, 8 becoming my main supplier. 9 If I choose a substance-free lifestyle, I am 10 seen as an outcast, and my peers that are drinking 11 on the weekends are often the ones being picked to 12 be captain or school representatives, so the rewards 13 for a chemically-free lifestyle go unacknowledged 14 and unawarded. 15 The first place I will choose to pick up a 16 drink will be at my house or my neighbor's house, 17 not at school. More often, this is done with adult 18 knowledge. 19 My family or my friends' families' 20 fully-stocked liquor cabinet and an extra 21 refrigerator in the garage become the easiest place 22 for us to obtain alcohol. 23 If for some reason I cannot get it there, for 24 less than $100, I can purchase a fake ID right off 25 the Internet. 1 As I celebrate and party with my friends, a 2 similar scene can easily take place with the adults 3 I know, and we're simply youth mirroring adult 4 behavior. 5 I'm a good kid. 6 I play sports, I'm in honors class. 7 In some cases, my parents have done 8 everything right and established clear no-use 9 messages. 10 I find it harder and harder, however, to obey 11 them, as the messaging for use becomes louder and 12 more consistent than the ones of no-use. 13 On an individual and peer level, the norm is 14 perceived to be for alcohol and marijuana use. 15 I will listen to music where 95 percent of 16 the top 20 songs reference Molly, marijuana, and 17 alcohol. 18 I will turn on social-media sites and find 19 images of my friends at the party that they say 20 I should have been at. 21 At my school, there are fewer and fewer 22 resources available, and stress pressure is 23 increasing. 24 Budget cuts have forced my school to make 25 calculated choices, and the first to always go are 1 the arts and the prevention programs. 2 At home, my family works hard and plays hard 3 to maintain a life here on Long Island. 4 My parents will let me go to parties where 5 alcohol is present, feeling that this is best, to 6 allow for safe use. 7 At least they will know where I am. 8 In my community, availability of drugs and 9 alcohol are abundant, from family homes, to density 10 of retail outlets that are often fooled by fake ID 11 or simply don't even ask. 12 The advertising is geared towards my group 13 and the community. 14 While I'm watching a sporting event, I'm 15 bombarded by messages showing me a more 16 fun-fulfilled life. 17 So, yes, we are messaging -- yes, with all 18 the messaging and permission that I -- to use, 19 I might make a choice to pick up at a party, and it 20 could be with or without my parents' permission. 21 If I am one of the ten where addiction takes 22 off, then alcohol will simply just be the beginning 23 of the storm. 24 Should I be a competitive sports player with 25 the potential for a sports scholarship, like many 1 others on Long Island, I will need to play injured 2 at times. 3 It is conceivable to believe that, at some 4 point, I will sustain an injury and have need for 5 medical treatment. 6 This can be a pivotal moment for me. 7 Well-trusted family physicians will prescribe 8 painkillers, and until recently, would do so in 9 abundance. 10 When my prescription runs out, I will have to 11 find more. 12 Maybe it's in grandma's medicine chest, or 13 maybe mom has some left over from her back injury. 14 When these sources run out, maybe I'll have 15 to buy it on the street. 16 Eventually, I might turn to heroin as it will 17 be cheaper. 18 It will be hard for my parents to tell when 19 they should intervene. 20 They will struggle with it and notice signs, 21 and when they seek advice from their peers, they 22 will be met with statements, like, "It's just kids 23 being kids. It's a phase, and he or she will grow 24 out of it." 25 The stigma of addiction is present and alive, 1 and no parent wants his or her kid to be addicted, 2 so my parents will sometimes become frozen with fear 3 and pray that I will grow out of it. 4 If I don't grow out of it, we can only hope 5 that I choose to get help. 6 Once I choose to get help, then we can only 7 hope that help is available. 8 Then we can only hope that my dad's insurance 9 will cover the treatment. 10 In the middle of this waiting game, should 11 I overdose, I can only hope that there is someone 12 who is trained in Narcan that is close by. 13 Before I turn this over to my peers for their 14 sage advice in the area of expertise, I would offer 15 some suggestions: 16 In adjusting the sails of this perfect storm, 17 we must include comprehensive, accurate prevention 18 programs for youth, grades K through 12; 19 We need to strengthen community-based 20 prevention; 21 We need to support environmental strategies, 22 Prescription drop-offs available in all communities; 23 Strengthen education around prescription 24 drugs, and to the consumer; 25 Parent forums being focused on prevention 1 strategies; 2 Stricter alcohol advertising policies; 3 Stricter laws that limit the access to youth; 4 And when we make those laws, make sure the 5 prevention professionals are at the table; 6 Make it easy to partner with law enforcement 7 for prevention strategies; 8 More training in Narcan; 9 Strengthening assets to treatment; 10 And, move this discussion from what is right 11 or wrong, or good and bad, to a discussion of simply 12 public health. 13 It is true it is easier to get a bump of 14 heroin on Long Island than it is to buy a pack of 15 cigarettes. 16 It is true that we will always be facing the 17 drug du jour. 18 It is true that we live in an area with a 19 culture that unknowingly sets itself up for 20 addiction. 21 It is also true that addiction is 100 percent 22 treatable and 100 percent preventable. 23 Sadly, it is also true that people are dying 24 at an unexcusable [sic] rate. 25 Whatever we do, we must to do better. 1 The Quality Consortium Hugs, Inc., and its 2 members, sincerely appreciate the treatment and 3 prevention focus of this hearing, and are willing to 4 work with policymakers in any manner, so that we may 5 deal with this crisis. 6 Thank you. 7 SENATOR BOYLE: Thank you so much, Kym. 8 That was wonderful testimony, we truly 9 appreciate it. 10 Jamie, if you would like to speak now, and 11 then we can ask questions to both, that would be 12 great. 13 JAMIE BOGERSHUTZ: Good morning. 14 I serve as the co-president of the 15 Nassau Alliance for Addiction Services, and as the 16 executive director of YES Community Counseling 17 Center. 18 I would like to thank you for this 19 opportunity to provide you with feedback from my 20 colleagues, and those that we serve within the 21 addiction, prevention, treatment, and recovery 22 field. 23 The challenge for me is to be able to present 24 the voices of not only my 25 colleagues that 25 represent the local neighborhood-based network of 1 treatment providers, but the thousands of clientele 2 that will receive our services. 3 Collectively, we serve residents in 4 Nassau County, from early childhood, through senior 5 citizens in their 80s. 6 We are a system that, for the past 7 four decades, have responded to trends and traumas 8 that have emerged in our communities. 9 This is not a new problem for us. 10 Our communities are diverse, as are our 11 clientele. 12 Our agencies are located on the north and 13 south shores, from the east and west borders. 14 Income, culture, race, and career track cover 15 the entire spectrum of socioeconomic factors. 16 Our agencies are led by some of the finest 17 and most competent of addiction experts practicing 18 evidence-based treatments that we know have positive 19 outcomes for the people that we serve. 20 Over the years, we have borne witness to 21 profound change in our field. 22 We have advocated with our elected officials. 23 We have worked collaboratively with our 24 businesses, criminal justice, fraternal, religious, 25 and educational partners, and of critical 1 significance, we have endured the epidemics of PCP, 2 crack cocaine, ecstasy, heroin, and 3 prescription-drug use. 4 It has been a long, troubling, and 5 frustrating journey. 6 And while our field has changed dramatically 7 in some areas, in other domains, we face the same 8 challenges as we have historically faced. 9 Approximately 6.1 million Americans are 10 abusing prescription drugs. 11 Our state has implemented many promising 12 strategies that are making an impact; and, yet, with 13 each child that dies, and someone new is arrested, 14 we are reminded that there is still so much that 15 needs to change. 16 We are partnering with our schools, but their 17 fiscal limitations and their changing to 18 Common Core, new obstacles become created for us. 19 We continue, however, to persevere, because 20 we know that to succeed means that we must have 21 schools and parents as our partners in this effort. 22 I can begin by presenting you with some 23 specific recommendations that would have a positive 24 impact in our field. 25 You have heard from my colleagues about the 1 importance and support of passage of legislation 2 that addresses prevention, treatment, and recovery. 3 We urge you to recognize the profound effect 4 that use and misuse, particularly related to 5 prescription-drug use, has on our communities. 6 It has become a public-health crisis. 7 If legislation comes before you related to 8 legalizing marijuana, we ask that you oppose any 9 efforts that bring more turmoil and instability to 10 our streets. 11 There is still so much more we need to 12 understand before we can consider such a dramatic 13 change. 14 We urge you to support legislation that 15 ensures that insurance companies cover the cost of 16 treatment and recovery. 17 No one should be denied treatment. 18 No insurance company should be able to create 19 barriers to care. 20 The current practice of "having to fail 21 first" needs to end. 22 Failing first means that someone looking to 23 enter an inpatient facility for help for their 24 addiction must first fail in an outpatient setting 25 before they can be considered for admittance, and, 1 sadly, sometimes that failure means death. 2 As experienced and licensed practitioners, we 3 are well-schooled to be able to assess what level of 4 care is best needed. 5 I would implore you to mobilize your 6 colleagues and get behind every opportunity to 7 strengthen the Office of Substance Abuse Services, 8 through additional funding, so that they can 9 adequately fund their service providers and respond 10 to the growing concerns of every community. 11 I would implore you to support the 12 recommendation of a 2 percent COLA (cost of living 13 adjustment) for the workforce who are on the front 14 lines and who are desperately trying to remain in 15 this complicated field and change lives. 16 But perhaps it becomes easier to really 17 understand what we need from you and every 18 legislator. 19 We need champions; we need leaders. 20 We need leaders who look for opportunities to 21 make change. 22 We need leaders who are wise and thoughtful. 23 A leader is not afraid to ask questions and 24 take actions. 25 And like Kym's story of the fish in the 1 water, I want to share a story with you, and it's 2 called "The Day Wisdom was Born." 3 Once upon a time, in a community not so far 4 away, there lived a legislator and his townspeople. 5 The community, "Status Quo," was a beautiful 6 community, snug in the midst of parks, gentle 7 waters, and much sunshine. 8 A natural flowing river divided much of the 9 community, but a beautifully landscaped bridge 10 allowed the townspeople to easily move back and 11 forth for hundreds of years, and life in 12 "Status Quo" was relatively peaceful and calm for 13 generations and generations; not much change, and 14 that made the people very happy, as they could keep 15 doing everything that they had always done, day 16 after day, week after week, and year after year. 17 A good life for most. 18 But one day, the newspaper reported that a 19 young boy was found drowning in the river. 20 A heroic townsperson lept in the water and 21 saved his life. 22 The hero was celebrated, and the child of 23 15 years survived. 24 And then, in what appeared to be an uncanny 25 twist, a young mother was also rescued from the 1 moving waters, and then there were others, and many 2 that followed. 3 The community leaders and townspeople decided 4 that they must respond because more and more people 5 needed to be rescued from the turbulent waters. 6 And with an air of urgency, the community 7 decided they needed to take some immediate action, 8 as they knew this crisis was growing worse day by 9 day. 10 And so they formed a force of strong swimmers 11 to guard the river where the victims had been 12 spotted; and they waited, and they watched, 13 furiously jumping into the water to save anyone who 14 they saw was in trouble. 15 And the community leaders went even further. 16 They developed a swimming course, and a 17 first-aid team, and they, too, joined the team of 18 qualified swimmers to respond to all those 19 townspeople who were drowning. 20 But the months passed, and, somehow, even the 21 most skilled and devoted people were beginning to 22 become concerned that so many people kept drowning 23 even though they were such good swimmers, and they 24 were watching their spots in the river so 25 diligently. 1 Something seemed very wrong in the small, 2 sweet community of "Status Quo." 3 It was right about that time when a small 4 voice turned to the legislator and questioned him 5 aloud, something that rarely happened in the 6 community. 7 And the voice asked rather simply, Has anyone 8 sought to ask why these people are finding their way 9 into the river in the first place? 10 The legislator looked puzzled, particularly, 11 as he had worked so hard to treat the drowning 12 people. 13 And in that moment, he gathered the residents 14 and walked up the hill. 15 To his amazement, his attention focused on a 16 large section of protective rail that had broken 17 free from the crumbling foundation, creating a 18 rather treacherous situation on the bridge that 19 would almost always ensure future tragedies. 20 And so, in that moment, the legislator 21 realized he had been using a very misguided 22 judgment. 23 Instead of trying to stop the people from 24 falling into the raging water, he was focused only 25 on pulling them out as they were drowning. 1 Now, imagine what would have happened if he 2 had focused all his resources on just fixing the 3 bridge. 4 Think of how many drowning lives might have 5 been saved, if only. 6 So from that moment on, the legislator, to 7 his credit, and to the dismay of some of the elders, 8 decided he would devote all his resources to 9 repairing the bridge and to ensuring that its 10 foundation remained strong and sturdy. 11 And he appointed a committee of people, some 12 young, some old, some good swimmers, some afraid of 13 the water, whose job it would be to watch, not just 14 over the bridge, but all the other areas that might 15 deteriorate after years of neglect. 16 And on that day when the voice asked "Why?" 17 wisdom was finally born in "Status Quo"; and, 18 ultimately, the people learned many things. 19 Number one: That doing things the way they 20 had always been done is not necessarily the best way 21 to grow and prosper, and so we all can appreciate 22 the opportunity to be here today. 23 Number two: Saving drowning people is 24 critical, but while critical does not prevent people 25 from getting into the water in the first place, if 1 we truly want to understand, we need to stop and 2 consider the pain and the turmoil that our children 3 face, that our young adults and our families face, 4 each day. 5 We need to make sure that resources are 6 available and accessible in our local communities. 7 We need to try to understand why our young 8 children and why our young adults are turning to 9 substances in the first place. 10 Number three: Every foundation needs to be 11 strengthened and repaired over time in spite of its 12 appearance of strength. 13 Number four: Asking "why?" and how things 14 can be done differently, and how we can save lives, 15 is everyone's responsibility. 16 Number five: Taking action and doing the 17 right thing, because it is the right thing to do, 18 takes courage, wisdom, and vision. 19 And I thank you for today. 20 And, number six: Most often, when we fall 21 into drowning waters, it is not because of one 22 choice in one moment. 23 It is more likely that we find ourselves in 24 those waters because of so many things gone wrong, 25 or not enough things going right. 1 Either way, it is our responsibility to 2 ensure that no more lives are lost regardless of how 3 they got into the water. 4 So thank you for this opportunity. 5 Please let our messages here today have 6 meaning, and know that after you leave this room, we 7 will return to our agencies and our communities. 8 We will continue to work. 9 We will watch lives change. 10 And, sadly, we know we will lose others. 11 Keep us by your side. 12 Let us provide you with our insights and our 13 recommendations, and allow us to inspire you to be 14 our champions in the field. 15 We have not had enough heros, and we know 16 that all of us need heros. 17 Thank you. 18 SENATOR BOYLE: Thank you very much, Jamie. 19 Thank you, Kym. 20 Just a quick question. 21 I have to run out for a couple minutes, but 22 I'll be back for the next panel. 23 You mentioned one of the things is the cost 24 of heroin, and being less than a pack of cigarettes, 25 Kym, I believe you said in your testimony. 1 What are we really talking about? 2 And I've been hearing different things about 3 the availability of heroin, both, in the pure form 4 now which can be snorted, as opposed to shot in the 5 arm or other places. 6 Can you describe the availability of heroin 7 for our youth in this current situation on 8 Long Island? 9 KYM LAUBE: Sure. 10 So my focus is always prevention; so the 11 folks at my agency relies heavily on getting kids 12 before they even get to that point. 13 And our treatment friends often rely on them 14 for their expertise in that, because they hear the 15 stories of -- going on. 16 We've heard stories from young people, 17 telling us it's very easy, they can get a hit for 18 5 to 8 dollars. 19 That's generally what we hear about, and that 20 there's no real roadblocks to that. 21 Where, a pack of cigarettes I think is 22 somewhere of 9 to 10 dollars, depending on where 23 you're at. 24 So those are the stories we hear. 25 Jamie, obviously, deals on the clinical end, 1 so she may have further insight than I do on the 2 prevention end. 3 SENATOR BOYLE: Great, thank you. 4 JAMIE BOGERSHUTZ: I think the only thing 5 that I would probably add to what Kym is saying, is 6 that what we have certainly learned, and what we see 7 just about every day, is that, when a younger 8 person, or, an older person, for that matter, has 9 the need, has the desire, they will find it. 10 No matter what community they live in, no 11 matter what resources are in front of them, if 12 there's need, they'll find it. 13 It's accessible, it's available. 14 SENATOR BOYLE: Great. 15 Thank you very much. 16 Joe, real quick? 17 ASSEMBLYMAN SALADINO: I'd like to thank both 18 of you for being here today. 19 Jamie, I've been working with you for over -- 20 JAMIE BOGERSHUTZ: Forever. 21 ASSEMBLYMAN SALADINO: -- 20 years-plus. 22 I really appreciate all you've done in our 23 communities, and all you have done. 24 And thanks for sharing that very poignant 25 story. 1 I had heard a version of that story. It had 2 a slightly different ending. 3 In the end, everyone was arrested by the DEC 4 for doing these activities in a fresh-water 5 wetlands. 6 [Laughter.] 7 ASSEMBLYMAN SALADINO: You've been a part of 8 many, many groups, looking at many solutions. 9 Can you talk to us about the issue of 10 providing inpatient treatment and covering it by 11 health insurance? 12 And how that -- how you feel that relates on 13 the priorities of what we need to get accomplished 14 next? 15 JAMIE BOGERSHUTZ: You know, I can't stress 16 enough how important it is that -- you know, and 17 I think Jeff touched on it very well, by the 18 statement that we need to be able to make sure that 19 anyone who is willing and ready to get care has 20 access to that care. 21 And it should not be the responsibility of an 22 insurance carrier to be able to say to anyone, No, 23 you can't be here. No, you can't get the help you 24 need. 25 We've watched, and I've held the hands of way 1 too many moms who have lost their children because 2 they were denied treatment. 3 So it's something that, really, I would hope, 4 and it sounds like it is going to the top of your 5 list, and I think that's something that's really 6 very, very critical for our field. 7 You know, and the other piece I think that is 8 so very important, that sometimes I really do 9 believe we lose sight of, is, why our kids are 10 turning to drugs and alcohol in the first place. 11 And I know that's something, you know, as we 12 look at the prevention piece, that is also something 13 that is so very, very critical to explore. 14 Our schools are a very important place for us 15 to work. 16 And I appreciate the fact that that, 17 obviously, is very important to you as well, 18 Senator. 19 And many of our agencies, most of our 20 agencies, all work really, really hard to partner 21 with their school districts. 22 But some of the edicts that are coming down 23 from State Ed are making it really difficult for 24 schools to embrace, even when they want to embrace, 25 because their teachers are overwhelmed, there are 1 not enough resources to be able to provide, even 2 within the school setting, and parents are 3 overwhelmed. 4 If they have the choice to coming out and 5 learning and understanding about drugs and alcohol, 6 or making sure their child does well for the 7 standardized test, they're going to those workshops 8 first, because that's what's more important to them, 9 because they can never envision that their 10 7-year-old, their 8-year-old, their 9-year-old, is 11 going to be using drugs at any point in their lives. 12 So, we're really up against a very, very, 13 very tough, tough big hill. 14 Tough battle. 15 ASSEMBLYMAN SALADINO: And if I may, as a 16 brief follow-up question, another problem that I've 17 heard of, and I'd like to get your perspective on 18 it: 19 Parents who have a difficulty of getting 20 their children into rehab when they're 21 non-compliant, is this a problem you've seen over 22 and over? 23 And is this something we should be 24 addressing? 25 JAMIE BOGERSHUTZ: We absolutely have seen 1 that. 2 And I think, you know, you and I both have 3 met some of those moms who have shared their 4 frustration. 5 And, moms whose children have died; who have 6 died because their children have said, "I'm not 7 going. I'm not going, and you can't make me." 8 And I'm not sure what the answer to that is, 9 because, you know, on some levels, we do have to be 10 respectful and mindful of a decision, but when that 11 decision is not made of sound mind, that's the time 12 when I think we need some more ammunition to be able 13 to intervene to save lives. 14 ASSEMBLYMAN SALADINO: Thank you. 15 SENATOR BOYLE: Thank you very much, Jamie 16 and Kym. 17 And be assured, we're going to share your 18 important testimony with our colleagues in the 19 Senate and the Assembly. 20 Thank you so much. 21 SENATOR MARTINS: Our next witness is 22 John Venza, vice president, Adolescent Services 23 Outreach Development Corporation. 24 Good afternoon, Mr. Venza. 25 JOHN M. VENZA: Good afternoon. 1 Senator Martins, Assemblyman Saladino, and, 2 thank you, Senator Boyle, for convening this hearing 3 on the devastating impact that heroin, 4 prescription-drug, epidemic presents for the 5 families and communities of Long Island, 6 particularly as it pertains to our youth. 7 As the vice president of adolescent services 8 for Outreach, a non-profit organization that helps 9 people address issues stemming from drug and alcohol 10 abuse, I have a unique view to the pervasive, 11 destructive consequences of opiate addiction among 12 youth and young adults. 13 For over 30 years, Outreach, an 14 OASES-licensed provider, has been a recognized 15 leader in behavioral health, specializing in 16 residential programs for adolescents, 17 and 17 younger; outpatient programs for teens, young 18 adults; and intensive day treatment for women and 19 women with children. 20 Through continually evolving evidence-based 21 dynamic approaches to chemical-dependency treatment, 22 Outreach intervenes with more than 4,000 individuals 23 and families a year in the greater New York City 24 area and Long Island. 25 Outreach House II, our adolescent residential 1 treatment community in Brentwood, Long Island, was 2 established in 1992, and has a residence capacity of 3 50 adolescents. 4 It offers a residential substance-abuse 5 treatment for youth, ages 12 to 17 years of age, in 6 both Nassau and Suffolk County. 7 Outreach House is designed to address the 8 needs of substance-using adolescents who are 9 experiencing problems in multiple-life domains: 10 legal, family, educational, psychological, and 11 social. 12 Outreach is well-positioned to offer a real 13 life perspective on the impact of prescription drugs 14 and heroin epidemic that has overwhelmed our 15 Long Island communities and schools for the past 16 several years. 17 While great attention has appropriately been 18 given to opiate use by young adults, commonly called 19 "transitional age" today, I wanted to assert that 20 Outreach is treating an alarming number of 21 under-17-year-olds school-aged adolescents for both 22 prescription drugs and heroin. 23 This is a slightly different shift in 24 perspective because it's the younger kids. 25 A recent case admitted to Outreach House is a 1 13-year-old female from Suffolk. 2 At 12 years old, she started with marijuana 3 and alcohol. 4 Quickly, by 13, she progressed to Molly, 5 Xanax, cocaine, and then heroin. 6 She was sniffing heroin, and then a couple of 7 times IV use, before we got her admitted into 8 Outreach House. 9 13 years old, eighth grade; this is truly a 10 tragedy. 11 I think when we think about 13-year-olds in 12 eighth grade, we think about travel, sports, school 13 clubs, and middle school; hardly, injecting heroin. 14 The opiate epidemic has clearly accelerated 15 the progression of substance use in our young 16 people. 17 In Outreach, a majority of the children have 18 substance-use onsets at the age of 12, generally 19 marijuana and alcohol. 20 This age of onset has remained pretty 21 constant over the past several decades; however, on 22 average, most of the teens that we are treating have 23 progressed to other substances much quicker by ages 24 of 14 and 15, trying opiates and heroin. 25 Consequently, it's no coincidence that I am 1 treating an alarmingly increasing number of children 2 less than 17 years of age for fully-progressed 3 heroin addiction. 4 I'm truly concerned that the number of young 5 people addicted to heroin will increase even 6 further, as their willingness to use powerful 7 prescription painkillers at younger ages continues. 8 Sadly, it's a weekly occurrence that cases 9 like these walk through Outreach's doors, families 10 desperately looking to save their children. 11 The ages may vary, 13, 15, 17, but the often 12 fatal and highly-addictive drug of choice, opiates, 13 continues to increase. 14 An additional element to this perfect storm 15 is how these children are presenting with untreated 16 co-occurring mental-health needs. 17 The severity of these cases makes the 18 intensive residential setting critical for the 19 stabilization and treatment of opiate use, the 20 mental health, and other life areas that have eroded 21 prior to the treatment episode. 22 As everyone can conclude, treatment of such 23 complex cases with young people requires the 24 appropriate level of care for the appropriate length 25 of time. 1 Unfortunately, the commercial insurance 2 companies have been unwilling to pay for the 3 clinically-determined treatment of these young 4 people. 5 Outreach has a history of collecting of 6 commercial insurance for adult and adolescent 7 chemically-dependent clients for more than 25 years. 8 For outpatient chemical-dependency treatment, 9 co-payments vary, from 25 to 40 to 50 dollars per 10 session, with deductibles ranging from $1,000 to 11 $10,000. 12 For rehab and intensive residential services, 13 commercial insurance pays a minimal amount of days, 14 often ranging from 3 to 10 days. 15 Medical criteria is not the same for all 16 insurance programs, and getting approval for 17 residential treatment can take between 15 minutes 18 and 2 hours, depending upon the company, for a 19 clinical review. 20 Often, appropriate levels of residential care 21 are rejected, and Outreach is then informed that 22 they can appeal the insurance decision through a 23 doctor-to-doctor review, which can take 30 to 24 60 days for approval, or, ultimately, another 25 rejection. 1 Medical need for this level of care is 2 determined by the commercial insurance company and, 3 unfortunately, not the clinician. 4 It is common practice that an individual 5 needs to "fail out," as we've heard here earlier 6 today, for two or three times before being approved 7 for residential services. 8 Another complication for young people 9 addicted to prescription drugs and/or heroin is 10 they're often not approved, and only given detox 11 services, and then to the outpatient, because they 12 did not have the lengthily history of substance use 13 that their older counterparts do. 14 Parents find out that they have no coverage 15 for the appropriate level of care under their 16 commercial insurance only at the point that they're 17 desperate to get their child help. 18 Children and young adults under the age of 25 19 are dying every day because commercial insurance 20 companies are not approving and reimbursing at the 21 appropriate levels of care. 22 In conclusion: 23 Outreach strongly supports the hearing, and 24 Senator Boyle's efforts, to bring about sensible and 25 effective legislation that would remove barriers to 1 treatment and allow for effective interventions with 2 adolescents and young adults of our communities who 3 are so severely impacted by prescription drug and 4 heroin abuse. 5 It is our hope that this view into our 6 experience at Outreach will help move towards a 7 rational and meaningful solution to this very human 8 tragedy. 9 I would like to just comment, since the issue 10 of the marijuana did come up. 11 You know, with my younger kids, clearly, this 12 is what I see invariably with all my children in 13 Outreach: constant, chronic marijuana use. 14 I often hear the conversations about whether 15 marijuana will be legalized; whether it's for 16 medicinal purposes. 17 But, I don't often hear about folks talking 18 in depth about, in comparison, marijuana is just one 19 brand of marijuana. 20 What's the average THC concentration levels? 21 Are we talking 2 percent THC by 22 concentration, or are we talking about 50 percent 23 THC by concentration? 24 You know, if we look at over the last 30 or 25 40 years, the potency of the substance has changed 1 dramatically. 2 And I think, unfortunately, the conversation 3 by a lot of parents and folks are very shortsighted, 4 not looking in depth about the dangers of that. 5 It was mentioned earlier, and I concur 6 adamantly, none of my kids in inpatient treatment, 7 you know, just got there by picking up Molly or 8 Xanax or their opiates. 9 They started with alcohol and marijuana, and 10 it progressed to chronic marijuana use, and it 11 clearly paved the way. 12 A second and final comment about the 13 commercial insurance: 14 Unfortunately, we're not just being met with 15 resistance and denials, but there's almost a sense 16 of arrogance that's beginning to come about by some 17 of the insurance companies. 18 When some of my workers are being told, Well, 19 they've had a month in jail to think about it. They 20 really, probably, don't need this level of care. 21 That -- "it" being their drug abuse. 22 Or, being given comments, like, It hasn't 23 worked before. What makes you think it's going to 24 work now? 25 It really makes us begin to wonder where 1 we're standing, and the work we really need to be 2 able to do to bring this on par, where we can 3 hopefully get real reviews of what our needs of our 4 people are. 5 Thank you very much. 6 SENATOR MARTINS: Thank you, Mr. Venza. 7 I appreciate those comments, and the insight. 8 Certainly, we've got some work that we can 9 now pass off to our colleagues on the 10 Insurance Committee, so we can begin looking at some 11 of those issues as well, because it is important, 12 and it is seamless. 13 Would you describe for me how a -- one of 14 these children arrives at your program? 15 Are they referred by their doctor? 16 Do they come with a parent? 17 Is it by word of mouth? 18 Does there -- is there someone at the school, 19 a social worker or someone, who refers them to you? 20 How does the typical, if there is a typical, 21 child arrive at your door? 22 JOHN M. VENZA: Yeah, I think -- you know, we 23 do a lot of networking with the schools: school 24 social workers, school administrators. Outpatient 25 programs. 1 There's not one venue that they arrive to us 2 by. 3 We've tried to work closely, we work very 4 closely with, Nassau County Treatment Court. 5 We, you know, historically, have tried to 6 work very closely with probation departments. 7 It seems that, though, and I think -- I think 8 someone, [unintelligible] made mention earlier, that 9 the difficulty for parents to get their children, to 10 connect them to help, has become very difficult; 11 whereby, parents are struggling to get their kids 12 down there. 13 Parents really want their kids to get help. 14 I think that, very often, without the 15 assistance of, sometimes, the superpower of the 16 probation officer or the PINS diversion worker, or 17 whatnot, it becomes more difficult for these parents 18 to get their kids the help they need. 19 SENATOR MARTINS: But in the context of a 20 child who is not yet in the criminal justice system, 21 you know, all of these examples that we're hearing 22 are, where you have either a probation officer or a 23 similarly situated person who is directing the young 24 adult or the child to your services as part of their 25 treatment, and as part of their -- perhaps, even of 1 their sentence. 2 Without the need for judicial intervention, 3 without the need for, you know, some sort of 4 criminal justice system intervention, do you have, 5 is there an avenue, is there a pathway, to your door 6 that comes from either community groups, churches, 7 or schools? 8 JOHN M. VENZA: Absolutely. 9 SENATOR MARTINS: Because we've got to get 10 the kids before, or we gotta -- to use a metaphor we 11 used earlier, before they jump in the river. 12 How do we get them there before they get 13 involved in the criminal justice system? 14 JOHN M. VENZA: We send a lot of our kids out 15 to various school districts to do speaking 16 engagements. We then meet with the support-service 17 staff at the schools. 18 We try to build those relationships. 19 I think the schools are critical. 20 Schools have gotten a lot better with 21 understanding treatment, and seeing how it has 22 helped. 23 I think, though, as has been mentioned 24 earlier, there are competing demands for their 25 attention today. 1 Community-based programs have constantly fed 2 the inpatient facilities, because I think, you know, 3 again, as has been mention earlier, that folks 4 pretty much know where the cutoff is when folks 5 begin to need that higher level of care. 6 I think we can continue to build on the 7 school-treatment relationships. I think that 8 clearly is something that can always be built on. 9 Some schools have different workers that know 10 of different providers and different programs better 11 than others, and I think it really shouldn't be left 12 up to the individual relationships. 13 I think, somehow, to raise that floor and 14 increase those relationships would be a really 15 important thing to do. 16 SENATOR MARTINS: I appreciate that. 17 Thank you, sir. 18 SENATOR BOYLE: Thank you for your testimony, 19 John. 20 Thank you, Senator Martins. 21 Our next witness is from the Seafield Center, 22 a leading treatment center here, 23 Nancy Beckett-Lawless. 24 Nancy, thank you for joining us. 25 NANCY BECKETT-LAWLESS: Good afternoon. 1 Good afternoon, Senator Boyle, 2 Senator Martins. 3 My name is Nancy Beckett-Lawless, and I'm 4 director of provider relations for Seafield Center. 5 I'm co-chair of the managed-care committees 6 for two statewide provider organizations: "AASAP," 7 which is the Association of Alcoholism and Substance 8 Abuse Providers, and, "ATPA," Addiction Treatment 9 Providers Association. 10 I also co-chair the Long Island Insurance and 11 Managed Care Committee. 12 And, I'm co-founder of the East End Clinical 13 Connection, a group of behavioral-health 14 professionals who provide addiction and 15 mental-health treatment to residents living on the 16 east end of Long Island. 17 First of all, I would like to recognize and 18 thank you, Senator Boyle, and your colleagues in the 19 Senate and the rest of the Legislature, for your 20 support of the Attorney General's successful 21 initiative in passing a law at the forefront of the 22 prescription-drug epidemic, the I-STOP legislation, 23 which we have already seen is effective in curbing 24 the overprescribing and misuse of prescription pain 25 medication. 1 I would also like to acknowledge the role 2 that New York State played in achieving federal 3 parity, by leading the way with the passage of 4 Timothy's Law in 2006. 5 New York always leads the way in assuring 6 quality care is delivered to our most vulnerable 7 citizens, and we thank you for that. 8 I'm here today to ask you to step up one more 9 time, to help us close an unintended loophole 10 created by parity: access to care. 11 The actions I will suggest today do not cost 12 the state of New York any additional money, but 13 could save the lives of countless young people who 14 overdose from opiates when they're turned away from 15 treatment too early, not admitted to treatment at 16 all, because they cannot access the treatment 17 benefits of their own insurance policy by not 18 meeting the proprietary medical-necessity criteria 19 demanded by their insurance or managed-care 20 organization. 21 Every insurance company has their own 22 criteria and has a fiduciary interest in denying 23 care. 24 Young people are being denied treatment every 25 day. 1 We had a young man present to one of our 2 outpatient facilities, and after we did an 3 assessment, he had just had an overdose the day 4 before. 5 We called the insurance company, and we were 6 able to get him three days' detox in an acute-care 7 setting. 8 The detox did another level-of-care 9 determinator and recommended inpatient treatment, 10 and when the insurance company was called, they 11 denied it. 12 The client was released after three days from 13 the detox. He overdosed that night. 14 Came back to us the next morning. We did 15 another assessment level-of-care determinator and 16 appealed to the insurance company for inpatient 17 rehab. 18 He was denied, and he was admitted to IOP 19 three times a week. 20 This was a Friday. 21 The following Sunday night he overdosed a 22 third time. 23 This time, it wasn't just Narcan that brought 24 him back. They had too to use paddles to bring him 25 back. 1 We called the insurance company the next day, 2 expecting there would be no doubt that this young 3 man would be able to go to inpatient rehab. 4 He was denied again. 5 The family did what most families do in a 6 situation like that. 7 They were lucky enough to have an 8 out-of-network benefit, so they called a Florida 9 treatment provider who doesn't have the great 10 guidelines and clinical expertise that all the 11 OASAS-licensed facilities here in New York State do. 12 He was sent to Florida, where they utilized 13 his out-of-network benefit, to go to an out 14 outpatient treatment program that was located in 15 strip mall. 16 They kept him overnight in a local motel. 17 They kept him there for 60 days, utilizing 18 his out-of-network outpatient benefit. 19 He went through everything he had. 20 By the time he came back to New York State, 21 there was absolutely no benefit left. 22 When we asked the parents what they would do 23 if he relapsed again, they said that they would put 24 him on Medicaid. 25 What's not -- what -- the State is supposed 1 to be the payer of last resort. 2 And with these young people, because of this 3 problem, it's becoming, oftentimes, the payer of 4 first resort. 5 We need to do two things: 6 First, we need to create a definition of 7 "medical necessity" that meets the needs of the 8 residents of New York and of the State; 9 And, second, we need to enforce the use of 10 our state level-of-care determinator, Locator 2, or 11 its equal, for all level-of-care placement by 12 insurance companies. 13 New York State has designated the Office of 14 Alcohol and Substance Abuse Services (OASAS) as the 15 single state agency responsible for the coordination 16 of state and federal relations in the area of 17 addiction services. 18 Section 32.01 of the Mental Health Law 19 authorizes the commissioner to adopt and promulgate 20 any regulation necessary to implement and 21 effectively exercise the powers and perform the 22 duties conferred by Article 32 of the Mental Hygiene 23 Law. 24 Article 32 of the New York State Mental 25 Hygiene Law discusses the regulatory power of the 1 commissioner, and gives the commissioner, in 2 consultation with the commissioner of health, the 3 ability to adopt standards, including the necessary 4 rules and regulations, including determining the 5 necessity of appropriate level-of-care admission, 6 controlling the length of stay, and the provisions 7 of services, in establishing methods and procedures 8 for making such determination. 9 OASAS regulation provides for the use of 10 Locator 2, or equal, to determine that level-of-care 11 placement. 12 So, by law, OASAS has the authority to 13 determine medical necessity using Locator 2. 14 Therefore, if we consider amending 15 New York State Mental Hygiene Law to include a 16 provision which states the following: All insurance 17 companies doing business in New York State are 18 required by New York State Mental Hygiene Law to use 19 the New York State level-of-care determinator, the 20 locator, or any tool approved by OASAS when making 21 medical-necessity decisions and level-of-care 22 recommendations, not their own tool which prohibits 23 access to treatment for all New York State 24 residents. 25 How else can we further expand existing 1 New York State law to ensure that New York State 2 residents with substance-use disorder will receive 3 appropriate care within the guidelines of federal 4 parity? 5 To answer this question, let's look at how 6 New York State currently defines 7 "medically necessary treatment." 8 According to New York State's Social Services 9 Law, 365-a, New York law defines "medically 10 necessary medical and dental remedial-care services 11 and supplies" in the Medicaid program as those 12 necessary to prevent, diagnose, correct, or cure 13 conditions in the person that cause acute suffering, 14 endanger life, result in illness or infirmity, 15 interfere with such person's capacity for normal 16 activity, or threaten some significant handicap, 17 which are furnished an eligible person in accordance 18 with state law. 19 Officials at the state Medicaid's agency 20 report that this definition applies to both 21 fee-for-service and managed-care population. 22 It's in this definition lies a problem. 23 These criteria are not significantly clear or 24 unambiguous. 25 Today, I would like to recommend that we 1 develop a new definition of "medical necessity" for 2 New York State law that would be a model definition 3 of medical necessity meeting the needs of the 4 residents and state. 5 While we have several models that we can 6 follow, I'm going to give you a couple examples of 7 what two other states have done, that have been 8 upheld over time, and proven not to cost those 9 states any considerable money. 10 In 1999 the Stanford Research Project 11 presented preliminary findings to a workshop of key 12 stakeholders in California, and developed a model 13 definition for "medical necessity" that was adopted 14 by the state Medicaid program and private plans. 15 They defined "medical necessity" shall mean 16 health-care services that a physician exercising 17 prudent clinical judgment would provide to a patient 18 for the purpose of preventing, evaluating, 19 diagnosing, or treating an illness, injury, or 20 disease or its symptoms, and that are (a) in 21 accordance with generally accepted standards of 22 medical practice, (b) clinically appropriate in 23 terms of type, frequency, site, and duration, and 24 considered effective for the patient's illness, 25 injury, or disease, and, lastly, (c) not more costly 1 than an alternative service or sequence of services 2 at least as likely to produce equivalent therapeutic 3 or diagnostic result for the diagnosis of treatment 4 of that patient's illness, injury, or disease. 5 For our consideration today, "generally 6 accepted standards of medical practice" might mean 7 standards and guidelines outlined by our own 8 New York State Department of Health and 9 New York State Office of Alcohol and Substance Abuse 10 Services and New York State Office of Mental Health. 11 Another example, in 1988, Pennsylvania 12 enacted Act 152; and 152 was legislation that came 13 under the Department of Public Welfare, which 14 established placement criteria for use by drug and 15 alcohol programs governing the type, level, and 16 length of care or treatment of drug and alcohol 17 clients, including hospital detoxification, as the 18 basis for the services provided. 19 That criteria was updated in 1999 with the 20 development of what is called 21 "Pennsylvania Placement" -- "Client Placement 22 Criteria," which remains in effect today. 23 In 1989, a year after Act -- PA Act 152 was 24 developed, they enacted Act 106 -- 25 I know Senator [sic] Saladino is quite aware 1 of Act 106. 2 -- which, to date, remains hugely successful, 3 and has been upheld through the passage of federal 4 parity. 5 PA Act 106 requires all commercial group 6 plans, HMO, ands children's health insurance to 7 provide mandated minimums on detox, rehab, and 8 outpatient treatment when authorized by a licensed 9 physician or a licensed psychologist, referred to a 10 licensed in-state program. 11 Again, this law not only meets federal 12 parity, but exceeds that, and has been upheld, and 13 is still in effect today. 14 The recommendations for a new definition of 15 "medical necessity" is about unifying the language 16 when anyone writes policy to provide insurance 17 coverage for New Yorkers. 18 This step will cost New York State exactly 19 zero dollars to the taxpayer, and if done 20 appropriately, will reduce premiums and costs to the 21 plans by keeping people out of emergency rooms with 22 overdoses, heart attacks caused by drug use, admits 23 due to alcohol- and drug-related accidents, and even 24 dollars needed to fund the criminal justice system. 25 Simple language levels the playing field and 1 is good social policy for New York State. 2 How often does the Legislature get to craft 3 policy that saves lives, supports the health and 4 welfare of the citizenship, and does not cost the 5 taxpayers a single dollar? 6 Thank you for your time, consideration, and 7 interest. 8 SENATOR BOYLE: Thank you so much, Nancy. 9 That was truly wonderful testimony. 10 And if you wouldn't mind, the copy we have is 11 shorter than what was actually read. 12 NANCY BECKETT-LAWLESS: Yes. 13 SENATOR BOYLE: Could you get us a written 14 copy of that? 15 NANCY BECKETT-LAWLESS: Absolutely. 16 SENATOR BOYLE: Because I think that some of 17 the language that you're talking about, that was in 18 California that -- 19 NANCY BECKETT-LAWLESS: Yes. 20 SENATOR BOYLE: Okay. It's always good to 21 steal some language that's already been done and 22 worked successfully, so, we may contact you about 23 that. 24 NANCY BECKETT-LAWLESS: Great. 25 SENATOR BOYLE: And, Joe, do you have any 1 questions? 2 ASSEMBLYMAN SALADINO: Thank you very much. 3 NANCY BECKETT-LAWLESS: You're welcome. 4 You're welcome. 5 SENATOR BOYLE: Appreciate it. 6 And thank you very much for your testimony, 7 appreciate it. 8 NANCY BECKETT-LAWLESS: Thank you. 9 SENATOR BOYLE: Thank you. 10 Senator Martin had to leave early. 11 He is, for those of you know, hosting a 12 hearing, a meeting, a forum, tonight, with the 13 State Education Commissioner King, about the 14 Common Core. 15 And, if it was anything like the raucous one 16 that they had last night, I think Senator Martins 17 went to get some body armor on for this evening. 18 [Laughter.] 19 SENATOR BOYLE: Our next testifier is 20 René Fietcher. He's the assistant district 21 attorney, director of community affairs, for the 22 Nassau County District Attorney's Office, and 23 Nassau County Heroin Prevention Task Force. 24 René, thank you so much for coming. 25 RENÉ P. FIETCHER: Thank you, Senator Boyle. 1 We join in wishing success 2 for Senator Martins this evening. 3 Before I begin formally, I'm going to be here 4 in the capacity of both the 5 District Attorney's Office of Nassau County, as well 6 as the heroin task force, so, our remarks are gonna 7 be split in two. 8 Also, we also take advantage of this to let 9 you be aware of some of the activities that have 10 gone on to date, and then to make concrete 11 recommendations as to where we go in the future. 12 SENATOR BOYLE: Great. 13 RENÉ P. FIETCHER: Well, first of all, thank 14 you for inviting us. 15 This is an important thing, because getting 16 the word out and taking action is absolutely 17 critical. 18 And, we're really delighted that you're at 19 the head of it, and want you to know that you have a 20 very strong ally in District Attorney Kathleen Rice. 21 She has really spoken out and worked very, 22 very hard to provide funds and staff for treatment 23 programs and for prevention programs. 24 This year, she is now the president of the 25 New York State District Attorney's Association, and 1 as such, she has made it very clear that she would 2 like to move that organization or -- to speak out 3 and to act strongly on the world of prevention and 4 treatment. 5 In fact, in her acceptance speech, she said, 6 and I quote, her "priority is going to be fighting 7 prescription-drug abuse and related crimes, sharing 8 intelligence on the role of doctors, targeting 9 websites and insurance-fraud operations that fuel 10 the problem, developing model education programs to 11 take to high schools and to use to educate parents, 12 and band together as the state's prosecutors and to 13 tell policymakers to finally and fully fund drug 14 treatment programs that we agree are often the only 15 pathways out of addiction and crime." 16 Very clearly, there is a substance-abuse 17 problem on Long Island; not only on Long Island, 18 nationwide, if not internationally. 19 We know that. 20 We have had heard so many stories of 21 heartbreaking overdoses; of crimes related to 22 addiction: burglaries, robberies, assaults, 23 homicides. 24 We know that. 25 The Senator and the Committee have asked that 1 we not really go through the horror stories, because 2 we're all too painfully aware of that, but let's get 3 on to, "What are we going to do about it?" 4 And, so, that's what I'd look to do at this 5 point. 6 First off, the DA's Office, actually, most 7 people don't realize, has been very, very active in 8 the field of prevention. 9 Most of you see us as the legal technicians 10 to work after the police have done their good work, 11 and then leave it off to the judges. 12 That's not true today. 13 District attorneys consistently advocated and 14 staffed and funded prevention efforts geared to 15 dissuade youths from substance abuse and the serious 16 damage it can cause to them; not only them, but 17 friends and families and the community. 18 Even before the death of Natalie Ciappa, from 19 your sector, the tragedy that shook us all, the DA's 20 office has reached out to schools and youth 21 organizations, with educational programs and 22 presentations, such as: 23 "Well, Not My Child," which is that wake-up 24 call to students and parents about prescription 25 drugs and heroin; 1 "Choices and Consequences," a presentation on 2 drunk, drugged, reckless driving, and distracted 3 driving; 4 "Project Safe Neighborhood," which teaches 5 violence-prevention diplomacy, conflict-resolution 6 skills, to middle schools; 7 And now, recently, "COTA," or Council of 8 Thought and Action. 9 We recognize that we have to prosecute very, 10 very strongly, and we are, and we have to hold 11 people accountable. 12 The fact of the matter is, that when people 13 go into the jails, they're coming out again, and 14 probably not better off. 15 So for that reason, we've invested 16 substantial funds in working with offenders who come 17 back to the communities, on the Council of Thought 18 and Action. 19 And quite a few of them are coming back, 20 well, clean and sober, but they're going back in a 21 very septic environment, and we want to work with 22 them. 23 We also figure that one of the best ways to 24 work is in collaboration and in partnership with 25 people. 1 It doesn't cost a whole lot to do, and it 2 really works to get everybody who's part of the 3 problem and part of the solution into the same room. 4 With that, for example, we set up the 5 Long Island Youth Safety Coalition. 6 Over 300 teachers and youth workers developed 7 strategies to protect youth from today's challenges, 8 including substance abuse. 9 In fact, we'll be holding a conference called 10 "Smart Decisions" on December 10th at Hofstra. 11 We'll have over 15 workshops on a variety of 12 problems, including substance abuse, and what 13 parents and teachers can do; practical things that 14 they can take home. Toolboxes, if you will. 15 In fact, we have Judge Kay who will be our 16 keynote. 17 And, we have a panel of the really top 18 [unintelligible], including our friend 19 Joshua Lafazan, who will be testifying today, 20 saying, as we see it, solutions coming from the 21 voices of our younger generation. 22 I'd also like to thank -- and after that, we 23 created the heroin prevention task force. That was 24 set up about five years ago. 25 The District Attorney's Office was asked by 1 the county executive to manage it. 2 I happen to be its chairperson. Been very, 3 very fortunate to work with over -- that we over 4 300 members, and about 60 professionals, many of 5 whom, including Jeff Reynolds and Jamie Bogenshutz, 6 and Michael Delman is going to be speaking with you, 7 have far more concrete and specific information on 8 their areas of expertise for you. 9 I'd also like to hear this -- thank the 10 Senator for Stevie Dittmeyer [ph.], who has come to 11 our events, and we're very, very pleased about that, 12 and, we like that kind of collaboration. 13 And, of course, we've worked with 14 Assemblyman Saladino in many of his efforts as well, 15 and we like that very much. 16 DA Rice has vigorously prosecuted drug 17 traffickers, and worked closely with our 18 law-enforcement partners. 19 And the police -- we see here Pam Stark -- 20 and Detective Stark is here. 21 We have work very closely with them at the 22 local, state, and federal level. 23 It takes everybody to do that to protect this 24 village, and to stave off the supply of drugs coming 25 into our community. 1 At the same time, we recognize the need to 2 curtail the demand, and help people with a problem 3 get out from a cycle of dependency that leads to a 4 cycle of criminal behavior. 5 People must be held accountable, but we 6 recognize that, eventually, most will return to the 7 community, perhaps worse off than before. 8 We recognize that some addicts are, in some 9 ways, victims, and can benefit from treatment; and 10 for that reason, we strongly believe in using the 11 power of the criminal justice system to place those 12 who can be saved into treatment programs. 13 As such, we support a range of what's known 14 as "diversion programs." 15 Our office has taken a proactive role, and 16 then opened the first, in Nassau, a countywide youth 17 court. 18 And, also, we partner with 19 Judge Jonathan Lippman, and were able to get one of 20 the first experimental adolescent diversion parts 21 for Nassau County. 22 Both of these programs link kids, well, 23 16 and under, into treatment programs, using, well, 24 basically, the fear of imprisonment, to kind of wake 25 up and say, Maybe this is as bad as I'm going to 1 get. Maybe it's time to get better. 2 All of our rehabilitative efforts depend 3 critically on the existence of well-managed 4 treatment resources. 5 If we build a bridge, it better go someplace. 6 For that reason, we strongly support the 7 adequate funding of inpatient and outpatient 8 treatment programs, as well as counseling centers in 9 the community and in the schools. 10 Again, you heard in far more eloquent and 11 better detail what we're talking about there. 12 A little over five years ago, in the wake of 13 a series of overdoses, the Nassau County executive 14 asked that a task force be created to develop 15 heroin-prevention efforts. 16 I can't believe it has been five years. 17 The District Attorney took on the project of 18 organizing and directing this task force. 19 I've had the privilege of serving as its 20 chair. 21 And to date, it has a network and a large 22 advisory group of about 60 leaders, from law 23 enforcement, treatment education, as well as youth 24 and concerned citizens. 25 Our strategy is simple; and it's to empower 1 the agencies and concerned citizens working to 2 prevent heroin addiction. 3 And to do that, the group looks to the root 4 causes of the problem; mainly, alcohol, marijuana, 5 and most of all, prescription-drug abuse. 6 We're set up with several committees covering 7 topics including treatment, prevention, 8 prescription-drug abuse, and drug-reclamation 9 programs. 10 We have two major strategies: 11 And the first was the development of a 12 website, heroinprevention.com. 13 The website is an interactive, seamless 14 method for people to be able to get themselves to 15 treatment. 16 It cuts out the middleman, but it also 17 provides a huge amount of information and resources 18 to people building other coalitions and working. 19 We're amazed that we have been averaging, in 20 the last four years, averaging 43,000 hits a year. 21 People are using this thing. 22 I've also been amazed to see what kind of 23 national attention. 24 We get calls from Kentucky, from Wisconsin, 25 Tennessee, several states. Several attorneys 1 generals, in fact, have asked to borrow information 2 from that. And I'm in regular consultation with 3 other people who are building their coalitions. 4 In fact, just recently, this -- yesterday, 5 I got a call from a judge in Marshall, Wisconsin, 6 who tells me his town of 18,000 has one of the 7 highest education levels, the greatest amount of 8 affluence, huge number of tremendous professionals 9 in athletics there; a happy place that happens to 10 have a huge heroin problem. 11 So now we in Nassau can see that this is not 12 a problem of minority or poverty. 13 It's a problem, actually, of affluence, 14 because they have the money to get into deep 15 trouble, and, we set very high standards. 16 When the kids can't make those standards, 17 they feel defeated. 18 They get defeated and they're not talking to 19 you, what are they gonna do? 20 So, anyway, I share that, because we've been 21 working, and other groups are sharing the same 22 problem, and we work together, and we get advice 23 from them. They just sent me their report, as a 24 matter of fact. 25 The website is the first thing. 1 The second strategy that we do, is we run 2 training programs. 3 Throughout the year, each of our committees 4 puts on training programs for a variety of people. 5 Parent-training programs for parents, 6 training programs for teachers, training programs 7 for doctors, including things, for example, 8 examining how -- Obamacare, and how it affects the 9 treatment community, trainings on prescription-drug 10 instruction for medical students and doctors. 11 In fact, our next event is this Friday at the 12 Morelle [ph.] Center, another real practical program 13 for teachers on what they can do in their schools 14 effectively. 15 I want to mention on the aside, that we -- a 16 few moments before the shootout at the pharmacy, and 17 it was -- the Laffers created such horrendous 18 crimes, we held a forum on -- the medical 19 association, on prescription-drug abuse and 20 problems. We had top officials from the state. 21 I got to say, with some sadness, there was a 22 reporter there and they never wrote an article. 23 Not saying it had anything to do that would 24 have stopped the shooting that occurred, but it 25 would have been brought a little bit more publicity 1 a little sooner, so we could use that publicity. 2 Just holding these hearings is terrific, if 3 it gets out there. 4 During the course of our work over the past 5 five years, and it's been fascinating, because 6 you've got many, many veterans who have been through 7 several cycles of substance abuse, and carried on 8 the ongoing war, came up with a number of issues, 9 many of which you've already heard today, so I'll 10 just summarize rather quickly what I hear from the 11 coalition, what they're recommending for you that 12 you might find useful. 13 Number one: Repair the anomalies in the 14 insurance laws -- you've heard that a lot today -- 15 and the practices that prevent addicts from getting 16 the necessary treatments suited to their condition. 17 One example that we heard very early on, that 18 hit me even four years ago, was a situation where, 19 apparently, the insurance companies have a kind of 20 continuum of intervention; meaning, you should try 21 outpatient first before you try inpatient, which 22 makes some sense, but it breaks down under certain 23 situations and gets in the way. 24 For example, I have somebody who may have 25 been overdosed or wound in the emergency room, that 1 is in detoxing for three days. And when they come 2 out of detox, you'd think they would go straight to 3 inpatient. 4 But, no, they're told to go to outpatient, 5 have them try that first, where they're going to 6 strike out, where it's really a bomb. 7 And that's a real shame. 8 And, so, that's just one example. 9 You've heard others about the problem with 10 insurance. 11 Number two: We fought hard, and we applaud 12 your work with I-STOP. 13 It's terrific. 14 But as you said, it needs -- it constantly 15 needs tweaking, as everything. 16 I mean, look at the national rollout of 17 health care. 18 It always needs tweaking, so we want you to 19 stick with it. 20 Congratulations for setting it up. 21 It's already seeing results. 22 Of course, unfortunately, the consequence, as 23 predicted, that addicts are now successfully being 24 cut off from the prescription-drug pipeline and are 25 now turning to either treatment or crime. 1 I-STOP is continuing to be improved, and the 2 treatment needs to be expanded, as I-STOP has done a 3 lot to reduce it. 4 Narcan: 5 From the very beginning, we began issuing and 6 working on harm reduction, bringing Narcan kits. 7 Frankly, I was, at first, skeptical. 8 So when am I going to come across somebody 9 who's OD'ing? So why are we giving it to everybody? 10 Then I forgot: you know, and I know, we have 11 so many people whose kids are in treatment and are 12 having relapses. 13 Those kids, during in between the relapses 14 and coming back home, they will stumble back to the 15 house. They may be found passed out on that couch. 16 And there's a couple of hours before overdose 17 becomes lethal. 18 There's time to intervene. 19 Our Suffolk Police Department, 20 [unintelligible], have shown they've actually had 21 some record numbers of using Narcan well. 22 So, we really believe that. 23 We did come across something that was a bit 24 of a problem. 25 We'd like to see as many people have access 1 to it as possible, and we'd like to see our coaches 2 and our nurses in the schools have access. 3 That's not happening. 4 That's not happening, I understand, I think 5 because counsel at the State Department of Education 6 sent a note, saying, Good Samaritan Law can get you 7 into all kinds of lawsuits. 8 So -- and as an attorney, I know we do this, 9 you know, because I'd rather have said no than yes 10 and get in a huge amount of trouble. 11 So they say no. 12 Well, the problem is, "no" means that, and 13 the nurses and the coaches don't have the Narcan 14 kits. 15 We really think that should be looked at, and 16 maybe corrected. 17 And, finally, drug-reclamation programs: 18 What started off as a way to cure our 19 aquifer, to keep it safe for our drinking supply, 20 turned out to be a remarkably useful technique to 21 keep prescription drugs out of the hands of all the 22 potential addicts. 23 And so we salute the many, many 24 drug-reclamation programs, many of which have been 25 done by senators and elected officials, mainly 1 because it brings attention to the problem. 2 And that's really important. 3 We also think that we need to create 4 permanent structures, such as the police department 5 has done in both Nassau and Suffolk county, you 6 know, places to deposit, but not everybody wants to 7 go to a police department to bring their drugs; so, 8 we need others as well. 9 It could be in our recycling centers, and all 10 that. 11 And, so, we want you to continue with that. 12 And we also set up a forum that meets only 13 twice a year, about 60, 70 managers of 14 drug-reclamation programs throughout the area, they 15 all get together. They're all very proud of what 16 they do. 17 So we didn't want to, like, disabuse anybody 18 of that, so we thought, let's all share what we do, 19 and after you've talked about how good yours is, you 20 might actually listen to what the other guy is 21 doing, and pick up a trick to bring home, and all 22 ships will rise with the tide. 23 So, those are the projects that we do. 24 Again, we thank you very, very much for doing 25 that. 1 You have a partner in the 2 District's Attorney's Office, and in our heroin task 3 force, and we look forward to working with you. 4 Thank you. 5 SENATOR BOYLE: Thank you so much for your 6 testimony, René. 7 And, please, thank District Attorney 8 Kathleen Rice for her leadership on this important 9 issue. 10 I would just want to touch on one of the 11 aspects of your excellent testimony, about the 12 drug-reclamation program. 13 In my office, we've done some "Shed the Meds" 14 programs. Other senators and Assembly people have 15 different names for them, at our local fire 16 departments. 17 And I remember, the first one I hosted a few 18 months back, maybe five months ago, I was stunned. 19 I mean, I -- it started at 11:00, and I got 20 there about 11:15, and we already had two garbage 21 bags full of prescription drugs. 22 Senior citizens, old, young, bringing 23 prescription drugs in. 24 And one of the mothers explained to me, she 25 said, you know, her son had a minor operation done, 1 and the doctor prescribed 30 OxyContin. 2 He took 2, 2 1/2, and the rest was sitting in 3 the cabinet for a number of years, only just waiting 4 for trouble. 5 And, so, I think that we'd like to see that 6 done on a more permanent basis, as you recommend, in 7 a program, so politicians don't have to do this 8 themselves, and there's a system in place to make it 9 happen. 10 But I thank you for your testimony. 11 And, Joe, if you have any questions? 12 ASSEMBLYMAN SALADINO: Yes. 13 ADA Fietcher, thank you for being here today. 14 Thank you for your, at this point, beginning 15 to become your life's work on finding the solutions. 16 Two questions: 17 The first is a question that I asked before, 18 the issue of forcing insurance plans to cover 19 inpatient treatment. 20 From your experience, from your research, how 21 important; where do you put that issue on the 22 priority list? 23 RENÉ P. FIETCHER: I think I would have to 24 agree with Jeff, I'd say, pretty much, number one. 25 I mean, I think back, when we were first 1 starting with this in the '70s, the conventional 2 wisdom that treatment for somebody, you know, with a 3 "Rockefeller" drug plan, really needed, like, 4 18 months. 5 Then there was a change in some of the 6 insurance laws, and there was only funding for 7 30 days; and, miraculously, there were 30-day 8 treatment programs. 9 People didn't change, the problem didn't 10 really change; just simply the dynamic between the 11 insurance policy and the availability of treatment. 12 So that struck me as odd. 13 So, it seems to me that the insurance company 14 are driving [unintelligible]. Just listen to the 15 examples of people what really needed inpatient 16 treatment, but because of the standard that was 17 being used, they were denied it. 18 And then -- and especially from a 19 criminal-justice point of view, when we're talking 20 about people who've been -- committed burglaries, 21 and, you know, robberies, we know that they're going 22 to come out. 23 We also know we're just gonna say "thank you 24 very much" and go home. 25 We're gonna make it a compulsory form of 1 treatment, and it can't be short term. 2 Now, if they turn around and say, Well, we're 3 too poor, we can't afford it, but, you know, we're 4 not that poor that we don't qualify for Medicaid, 5 but we're in that in-between horrible middle-class 6 situation that tends to -- [unintelligible] all get 7 abused, I think that the mandated insurance 8 companies to step up is really critical. 9 ASSEMBLYMAN SALADINO: And my second 10 question, tougher, what we've learned from so many 11 of your experts -- yourself, Jeff, Jamie -- over and 12 over, is that parents are very frustrated when they 13 can't get their child -- their non-compliant child, 14 into treatment. 15 We have begun to look at this issue, and 16 I would really like to hear your suggestions on how 17 we could craft effective legislation, which respects 18 the individual's rights, that can get non-compliant 19 addicts into treatment, perhaps utilizing the family 20 court or the treatment court. 21 What should we be looking at as we try to 22 come up with legislation that would be effective and 23 fair? 24 RENÉ P. FIETCHER: That is a really important 25 and key question, and it's one that's bedeviled 1 people for quite some time, so that's why you have a 2 series of cobbled-together answers for different 3 populations of people. 4 So as you said, we do have the world of the 5 drug courts, which -- in both in family court and 6 in -- at the adult court, which has certain 7 [unintelligible] legislation. 8 You have Task, you have DTAP, you have a 9 number -- you have the adolescent diversion program; 10 each one has its own unique set of laws and 11 standards. 12 The case of Natalie Ciappa, where the parents 13 very clearly said, you know, when she got a certain 14 age, they couldn't force her anymore. 15 The criminal justice system has figured, 16 already, that once you've got somebody arrested and 17 facing a conviction, we've got that compulsion that 18 we need to work with. 19 So that's good. 20 The other issue is, the person who's not been 21 arrested, and with compulsion, and that's the 22 question that we want to bring to the other experts. 23 My suggestion, especially now that we have 24 the state DA's Association involved, is that I would 25 like to bring that one back to our counsel, to 1 bring -- put the minds together of the attorneys 2 from the state, to see what we can come up with, and 3 answer you -- and give you a good, intelligent, 4 practical answer. 5 ASSEMBLYMAN SALADINO: Thank you. 6 SENATOR BOYLE: Thank you very much, René. 7 And thank you for your testimony, and for the 8 work you've done. 9 I know Stevie from our office, a young lady 10 who suffered her own family tragedy due to fatal 11 overdose, speaks very highly of the work you do, and 12 we thank you for it. 13 RENÉ P. FIETCHER: Thank you. 14 SENATOR BOYLE: Our next witness is 15 Robert Ewald, from -- the chief of the narcotics 16 squad of the Suffolk County District Attorney's 17 Office. 18 Welcome, Robert. 19 Thank you for coming. 20 ROBERT EWALD: Thank you. 21 On behalf of Tom Spota and the 22 District Attorney's Office, we appreciate the 23 opportunity to be here today. 24 One additional comment to my submitted 25 testimony, is that, back in December of 2011, the 1 DA's Office sought, and was granted approval by the 2 Office of Court Administration, to seek permission 3 for a special grand jury to be impaneled in 4 Suffolk County to look at this entire issue. 5 It was granted, and from January through 6 June, we, in fact, heard testimony from countless 7 witnesses, both abusers, as well as substance-abuse 8 experts, some of whom are here today; others who 9 offered their testimony from the neurobiological 10 standpoint; and so forth. 11 The report covers everything, from the 12 history of the first commercial manufacturer of 13 heroin, by Bayer, back in Germany, all the way 14 through our problems here in the United States, and 15 locally here in New York. 16 It's available on our website. 17 It's also available, if you want a hard copy, 18 through our office. 19 And if people in Albany, and anyone here, and 20 interested in the problem, has not had an 21 opportunity to see it, it's about 85 pages of 22 substance, and about 15 pages of recommendations, 23 that cover everything from regulatory, down to 24 administrative, executive, and criminal suggestions. 25 So, it's a fairly easy read in that 1 standpoint; in that, it's not more than about 85 2 pages, as I say, of substance. Very well footnoted, 3 I might say. 4 One comment, just as a side issue if you want 5 it, when it comes to what other people have 6 mentioned about marijuana: 7 I know marijuana is classified separately 8 under our penal law than the controlled substances; 9 however, the active ingredient in marijuana is still 10 THC. 11 And THC, as THC, is a Schedule 1. 12 Schedule 1 encompasses heroin and cocaine and 13 all of those other drugs that nobody is sitting here 14 saying should be legalized. 15 So I think, to take that substance and have a 16 discussion, saying, that, "Oh, well, marijuana can 17 be legalized, and we should talk in that vein," is 18 ignoring the fact of exactly how addictive it can be 19 in its pure chemical form. 20 No one sitting here is saying that we should 21 be legalizing cocaine or heroin, certainly. 22 In fact, we're looking at the exact opposite 23 of how to deal with all of problems with those 24 substances. 25 As far as the testimony for today is 1 concerned, I'm gonna start with our last 2 recommendation, and work backwards. 3 When the drug laws were modified, and put 4 into effect in their modified form in 2010, the 5 criminal justice system was fundamentally changed. 6 You traditionally had a judge who's the 7 arbitrator between the prosecutor and the defense 8 attorney in the course of plea bargaining and 9 determining a disposition on a case. 10 When all three agree, that's when something 11 happens. 12 For all practical purposes, on most cases, 13 when the law was modified in 2010, the prosecutor 14 was, for the most part, effectively neutered in that 15 process. 16 If the defendant asked for diversion and the 17 Court wants to grant it, the prosecutor can ask for 18 a hearing, but now the burden is on him, as opposed 19 to being part of this three-legged stool in deciding 20 on who's going to go into diversion, and who's not. 21 So, effectively, one-third of that process 22 was removed. 23 So for all the recommendations I can make 24 today on criminal-law violations, if the law's not 25 modified to put the prosecutor back in that 1 position, these recommendations are gonna be 2 meaningless. 3 Prior to the 2010 change which created 4 diversion, which definitely serves a purpose with 5 the JDP program, our office, going back to the '90s, 6 participated with EAC Task, for a drug-diversion 7 program. And we were also on the steering committee 8 for what I believe was the second or third only-drug 9 court in New York State at the time. 10 And both of those programs were very 11 effective. 12 And they worked, in part, because all 13 three legs on that chair were present. 14 And so I just can't say strongly enough, that 15 the other recommendations we can make today will be 16 meaningless unless that's revisited. 17 As far as the other four recommendations are 18 concerned: 19 When it comes to the diversion of the 20 prescription pain killers in particular, or any 21 controlled substance, it all starts with the 22 prescription, obviously; and that starts with the 23 alleged patient who comes in and either fakes the 24 symptoms, and so forth, or, gets the script, 25 apparently legitimately, and then modifies it. 1 Well, currently, that crime is fraud and 2 deceit. It is an unclassified misdemeanor under the 3 Public Health Law. It is not a criminal violation. 4 If we want to stop the initial person from 5 being able to get those drugs into circulation by 6 lying to a practitioner; a doctor, for instance, 7 then that crime has to be made a penal-law crime, 8 and we believe it should be reclassified as a 9 Class E felony. 10 And that's our first recommendation. 11 Following from what that alleged patient 12 does, we believe that the prescribers, and most of 13 the prescribers are legitimate and well-intentioned, 14 but there are prescribers out there who have been 15 investigated federally and locally who are not 16 legitimate. 17 There is currently one Class C felony 18 violation for issuing a prescription in bad faith. 19 We believe there should be two. 20 We believe it should not just be a C felony, 21 which does not mandate jail time, but it should be a 22 B felony at the very least. 23 And if this prescription being improperly 24 issued is for one of these pain killers, there's 25 something even more severe or stronger, then it 1 should be a Class A-II felony. 2 And, again, for that small level of offender 3 who's gonna do it, we think that's an appropriate 4 deterrent. 5 Third: These crimes must then be brought for 6 investigative purposes, and made part of the 7 "enterprise corruption" and "wire-tap" sections, 8 because to effectively investigate people who, by 9 very nature, have confidential relationships with 10 the alleged practitioner, you need a method to 11 investigate them properly and prosecute them. 12 So, these crimes that we're proposing have to 13 be made part of enterprise-corruption amendments, as 14 well as the wire-tap sections. 15 And, last, I-STOP is a great program, and 16 it's necessary, but that information all flows 17 through the Bureau of Narcotics Enforcement. 18 The Bureau of Narcotics Enforcement is 19 prohibited by the Public Health Law from calling up 20 the local prosecutor of a local police department 21 and saying, We think you have a problem with a 22 certain doctor, or with a certain patient. 23 They cannot do it under the Public Health 24 Law, Section 3371. 25 We believe that with the appropriate standard 1 put in place for them to follow, they should be 2 allowed to proactively notify local law enforcement 3 so they can begin an effective investigation of a 4 bad practitioner or a doctor-shopper. 5 And those are our recommendations. 6 SENATOR BOYLE: Robert, I cannot thank you 7 enough for your testimony, and the leadership of 8 Tom Spota. 9 I love the fact that you not only gave us 10 recommendations, you highlighted the exact language 11 we're supposed to use. 12 Very concise, and just what we need for the 13 new session. 14 Thank you so much for your testimony today. 15 ROBERT EWALD: Thank you. 16 ASSEMBLYMAN SALADINO: Thank you to you, and 17 to the DA. 18 SENATOR BOYLE: Our next witness is 19 John O'Brien. He is the commanding officer of the 20 narcotics squad, Suffolk County Police Department. 21 John, thank you for joining us. 22 JOHN O'BRIEN: First, I would like to thank 23 Senator Boyle and the Panel for the opportunity to 24 speak with you today. 25 My name is John O'Brien. I'm a detective 1 lieutenant with the Suffolk County Police 2 Department, and I am currently assigned as the 3 commanding officer of the narcotics section. 4 I've been a police officer for almost 5 32 years. 6 During that time, I have seen the horrors and 7 sufferings associated with the drug epidemic 8 affecting our society today: from the poor suffering 9 addict, to the ones that have expired as the result 10 of an overdose. 11 I have also seen the hidden, and in many 12 cases, not so hidden, victims of this epidemic. 13 I've seen the shattered and 14 financially-ruined family members, the abused and 15 neglected children, of the addict. 16 And I have also personally witnessed one of 17 the most horrific scenes in Suffolk County history, 18 where four innocent victims were executed in 19 Medford Pharmacy by a drug addict who was desperate 20 for prescription drugs. 21 I've seen the death and destruction 22 associated with motor-vehicle accidents caused by 23 persons under the influence of drugs or alcohol. 24 Almost everyone in society today has been 25 touched in one way, shape, or form by the effects of 1 someone's misuse of alcohol or drugs. 2 Today the abuse of prescription medications 3 and heroin is a growing problem. 4 The recent increases in crime can directly be 5 attributed to the growing prescription and heroin 6 problem. 7 Increases in pattern crimes -- thefts, 8 burglaries, robberies, home invasions, and violent 9 crime -- have been, one way, shape, or form, a drug 10 component as a causational factor. 11 There are many experts in the audience today 12 that have dedicated their lives to addressing the 13 problems of addiction and how to fix them. 14 They are eminently more qualified than I am 15 to speak on the subject. 16 I am representing the police department who 17 is tasked with apprehending individuals who commit 18 crimes. 19 To that end, I will limit the scope of my 20 presentation. 21 SENATOR BOYLE: John, if you would, we have 22 your written testimony. 23 Could you summarize the provisions? 24 We're getting a little time-sensitive. 25 JOHN O'BRIEN: Great. 1 SENATOR BOYLE: Thank you. 2 JOHN O'BRIEN: First recommendation, is to 3 revise the weights associated with drug possession 4 and sale statutes as it relates to Article 220 in 5 the penal law. 6 In general, there is a disparity involving 7 heroin and cocaine possession and sale amounts as it 8 relates to Article 220. 9 Controlled substances: 10 With the exception of criminal possession, 11 controlled substance in the fifth degree, the 12 weights are the same; however, the values associated 13 with the drugs are not. 14 The packaging and distributional amounts of 15 the two differ dramatically. 16 The same quantity of heroin as compared to 17 cocaine has a much higher monetary value, and, 18 arguably, a greater destructive power than that of 19 cocaine. 20 The profit margin on heroin, and how it is 21 sold, is markedly different than that of cocaine. 22 A comprehensive review of the statute is 23 required to eliminate the potential loopholes in the 24 law, and place more of an emphasis on the drugs that 25 are presently destroying the fabric of our society. 1 As it relates to criminal possession in the 2 fifth degree: 3 Cocaine is clearly delineated in criminal 4 possession of a controlled substance, fifth degree. 5 Heroin is not. 6 Presently, 500 milligrams (a half a gram) of 7 cocaine or more is a D felony. 8 However, in order to charge a subject with 9 felony heroin possession requires the possession of 10 one-eighth of an ounce or more -- approximately 11 3 1/2 grams -- and they would be charged with 12 criminal possession in the fourth degree. 13 A half gram of cocaine sells on the streets 14 for between $30 and $50. 15 3 1/2 grams of heroin sells for between 16 six and eight hundred dollars on the street. 17 Heroin is usually sold at the street level in 18 individual packets, "decks," if you will, in groups 19 of 10 bags commonly known as "bundles," or in 20 100-bag lots, commonly known as "sleeves." 21 An individual bag usually contains about 22 30 milligrams of heroin. 23 A sleeve will contain approximately 3 grams 24 of heroin. 25 Under present law, a drug dealer could easily 1 walk around with 100 bags of heroin, and if caught, 2 would only be charged with a misdemeanor criminal 3 possession in the seventh degree. 4 A heroin dealer could carry enough heroin to 5 sell to 100 customers, as compared to a cocaine 6 dealer who could carry enough for a few customers. 7 Accordingly -- according to national 8 statistics, the average heroin addict uses between 9 8 and 10 bags a day. 10 Using national statistics, this equates to a 11 10- to 12-day supply of drugs an individual would be 12 walking around with. 13 Recommendation: 14 One possible solution is to incorporate 15 heroin into criminal possession of a controlled 16 substance in smaller quantities. 17 An example would be, possessing 18 300 milligrams or more of heroin, or 10 or more bags 19 of individually packaged heroin. 20 This would inhibit the drug dealer from 21 walking around with larger quantities of heroin with 22 impunity. 23 The prescription-monitoring program; I-STOP, 24 if you will: 25 In prescription fraud and abuse cases, time 1 plays an important role in determining the outcome 2 of the investigation. 3 Under present law, in conducting criminal 4 investigation that relates to prescription abuse and 5 fraud, law-enforcement officials must subpoena 6 individual records from the State Bureau of 7 Narcotics Enforcement in order to further an 8 investigation. 9 This creates an unnecessary delay in 10 obtaining valuable information which can lead to the 11 successful conclusion of a criminal investigation. 12 Often, by the time the investigating officer 13 receives the information, the pharmacist is 14 hard-pressed to remember the specific incident 15 and/or the video surveillance of the transaction has 16 been compromised or destroyed. 17 Recommendation: 18 Permit -- excuse me, specifically designated 19 officers within the department charged with 20 investigating prescription fraud to access the 21 database to reference specific investigations. 22 The officer should be given a specific 23 health-commerce account number, identifying the 24 officer making the inquiry. 25 This ability would enable the investigating 1 officer to quickly identify where an individual is 2 passing fraudulent prescriptions and the multiple 3 locations where the prescriptions were being 4 submitted. 5 Jurisdictional issues, as it relates to 6 narcotic enforcement: 7 At present, if a drug dealer goes to another 8 jurisdiction to purchase drugs from his supplier, 9 the jurisdiction which the transaction takes place 10 has jurisdiction over the prosecution. 11 The exception, is if the supplier knows that 12 the drugs are intended for sale in the buyer's 13 jurisdiction. 14 This is extremely problematic to 15 investigating agencies, particularly as it relates 16 to large-scale drug investigations. 17 For example, a drug dealer from 18 Suffolk County travels to New York City to purchase 19 drugs from their supplier. 20 The supplier can only be prosecuted for sale 21 of drugs in Suffolk County if it is clearly 22 established that they, the supplier, know the drugs 23 are intended for resale in Suffolk County. 24 This often precludes the prosecution of the 25 supplier. 1 Recommendation: 2 Eliminate prosecutorial jurisdictions as it 3 relates to illegal drug transactions. 4 For example, in a homicide statute, a 5 penal-law-jurisdiction prosecution of a homicide 6 could take place in the county where the homicide 7 took place, any county in which the body passed 8 through, or the county where the body was 9 discovered. 10 Enacting this type of legislation would 11 eliminate the major drug suppliers from hiding 12 behind jurisdictional boundaries to avoid 13 prosecution. 14 Subpoenas: 15 In today's society, with the advances in 16 technology, in particular, as it relates to 17 telecommunications (cell phones) the drug dealers 18 are becoming more sophisticated in their methods of 19 operation. 20 Dealers often carry multiple cell phones and 21 change them quite frequently in order to avoid 22 detection and apprehension by law enforcement. 23 They have also become more sophisticated in 24 where and how to hide their elicit-gotten gains. 25 At present, federal law-enforcement officials 1 have the power to subpoena records of an individual 2 to aid in criminal investigations. 3 In New York State, only officers of the 4 court -- district attorneys and defense lawyers -- 5 can issue subpoenas. 6 Local law enforcement must go to the local 7 district attorney's office to obtain a subpoena. 8 This becomes problematic when the dealers are 9 constantly changing their cell phones, carriers, 10 et cetera. 11 Again, time becomes an issue in these type of 12 investigations. 13 Officers must constantly go back to 14 district attorney's office for them to issue new 15 subpoenas. 16 This can slow the investigative process down 17 and burden an already overburdened 18 district attorney's office. 19 Recommendation: 20 After obtaining the initial subpoena from the 21 district attorney's office, permit law-enforcement 22 officers the power to issue subpoenas only for books 23 and records as it relates to the particular criminal 24 investigation. 25 This would enable law-enforcement officers to 1 more quickly react to drug dealers' attempts to 2 evade apprehension and streamline the investigative 3 process. 4 Diversion: 5 Recent changes in sentencing guidelines has 6 created an avenue for the sophisticated drug dealer 7 to avoid prosecution and incarceration. 8 The intent is to get the individual addicted 9 to drugs the much-needed that help they need. 10 This is a noble cause of which I support 11 wholeheartedly. 12 However, crafty drug dealers have taken -- 13 has taken this noble intent and used it as a shield 14 to avoid prosecution. 15 By selling narcotics in smaller quantities, 16 the dealer can always claim that they were a drug 17 addict and become eligible for diversion. 18 This has become extremely problematic for law 19 enforcement. 20 In today's fiscally restrictive times, this 21 perceived loophole is causing law enforcement to 22 repeatedly revisit the same drug dealers who know 23 how to play the system. 24 This is both cost-ineffective and 25 counterproductive in our efforts to suppress the 1 supply of drugs on our streets. 2 Recommendation: 3 In determining whether a person is eligible 4 for diversion, it is key that the 5 district attorney's office be included in the 6 process. 7 One suggestion is, in order to make a subject 8 who has been arrested for a criminal sale of 9 controlled substance, which is a B felony, eligible 10 for diversion, they must first plead guilty to the 11 felony charge. 12 Any subsequent arrest for the same charge 13 would make them ineligible for diversion. 14 Although not perfect, it would help separate 15 the drug addict from the drug dealer. 16 Prescription medicine bottles: 17 We live in a mobile society. Particularly on 18 Long Island, automobiles are the main mode of 19 transportation. 20 There are many prescribed medications on the 21 market that alter one's ability to safely operate a 22 motor vehicle on our roadways. 23 The most common warning label on the side of 24 a medicine bottle is "Do not operate heavy machinery 25 when taking this medication." 1 A lot of individuals, through a variety -- 2 through naivety, or, in more instances, denial, do 3 not consider an automobile to be heavy machinery. 4 It should be clearly marked on the 5 prescription bottles that you cannot operate a motor 6 vehicle when taking this medicine, and that it's 7 against the law. 8 The net effect would be to present the 9 individual with a clear choice. 10 Most informed individuals would take the 11 medication for the minimal amount required to 12 recuperate from the illness; thereby, reducing the 13 risk of becoming addicted to the medication. 14 In conclusion, I would like to thank you for 15 giving me the opportunity to speak today, and I will 16 answer any of your questions. 17 ASSEMBLYMAN SALADINO: Thank you. 18 SENATOR BOYLE: Yes, thank you very much. 19 You were very concise. 20 And I thank the chief, and the 21 County Executive, for your testimony today. 22 We will act on your recommendations, 23 I promise you. 24 JOHN O'BRIEN: Thank you very much. 25 1 SENATOR BOYLE: Our next witness is 2 Joshua Lafazan. 3 Josh, come on up. 4 Josh, as many of you know, is probably the 5 most famous board of education trustee on 6 Long Island. 7 And more importantly, he's a member of the -- 8 board member of LICADD, and a leader of our youth, 9 for trying to end the addiction problem among our 10 youth. 11 And, Joshua, thank you very much for what 12 you've done, and your testimony today. 13 JOSHUA LAFAZAN: Thank you very much for that 14 introduction, Senator Boyle. 15 And good morning, Senator Boyle and 16 Assemblyman Saladino. 17 Thank you for giving me this platform to 18 share my knowledge and insights regarding one of 19 most pressing issues facing Long Island today: the 20 heroin and prescription-drug epidemic that is 21 wreaking havoc on today's youth regardless of 22 education, race, ethnicity, or economics. 23 To familiarize you with my background. 24 I am 19; 25 An elected official on the Syosset School 1 Board of Education. 2 I am on the Nassau County Youth Board of 3 Directors; 4 The Board of Directors of the Long Island 5 Council on Alcoholism and Drug Dependence; 6 A member of the Nassau County Heroin 7 Prevention Task Force, with René; 8 And the Long Island New Safety Coalition, 9 also with René; 10 In addition to being a volunteer firefighter 11 in the Syosset Volunteer Fire Department. 12 My perspective on this issue, however, really 13 comes from my experiences as the founder and CEO of 14 Saferide Syosset. 15 Saferide Syosset is a community outreach 16 program aimed towards eradicating teenaged drinking 17 and driving in the Syosset community. 18 I began this program to offer an option for 19 those students who would choose to get in the car 20 with a drunk driver, rather than call their parents. 21 I offer a "no questions asked, no judgments 22 passed" option for those students who want to get 23 home safely. 24 As my program evolved, I also ended up 25 driving home students who chose to call me rather 1 than drive drunk in addition to driving their 2 passengers. 3 By choosing to abstain from alcohol and drug 4 use in high school, I was in the minority within my 5 school. 6 My athletic, social, political, and 7 educational involvement within school helped foster 8 new relationships while retaining old ones, allowing 9 me to be connected to a large percentage of the 10 student body. 11 These peer relationships have provided me 12 with a deeper understanding of the current youth on 13 Long Island. 14 While operating Saferide Syosset, I learned 15 that most of the teens are aware about the dangers 16 of drinking and driving. 17 It was only a small minority that were 18 leaving themselves exposed to this problem. 19 My experiences confirmed the significant 20 success education and awareness had regarding the 21 issue of drinking and driving. 22 Even some of the worst abusers of alcohol 23 would abstain for one evening to be a volunteer 24 sober driver for Saferide Syosset. 25 However, it is only the separation of these 1 two issues that has improved. 2 Unfortunately, the number of overall youths 3 who drink to excess continues to rise. 4 It is an unfortunate reality that many of my 5 former classmates are now addicted to prescription 6 drugs and heroin. 7 This group of young adults has the common 8 denominator among them: all, not just some, began 9 their journey towards addiction with the gateway 10 drugs of alcohol and marijuana. 11 Once kids have become addicts, the success 12 rate of recovery is very low. 13 The amount of resources and energy required 14 to save these kids is disproportionate to the level 15 of success. 16 We continue to fight, and try, because no one 17 wants to give up or admit this problem is 18 unsolvable. 19 The medical analogy is smoking and lung 20 cancer. 21 We can spend all our resources fighting the 22 inevitable losing battle to lung cancer, or, we can 23 expand our resources, preventing kids from smoking 24 in the first place. 25 We need to fight the cause of the illness, 1 not the results. 2 No one can predict with certainty which teens 3 will elevate their use of drugs, going from 4 recreational marijuana and alcohol use, to harder 5 drugs, such as heroin and oxycodone. 6 We need to fight more fiercely on the 7 battlefield of prevention. It is where we have a 8 chance to succeed before so many are lost. 9 Stopping all teens from recreational use of 10 alcohol and marijuana is an unrealistic expectation. 11 What we can do, is identify which teens, and 12 which environments will lead kids at a greater risk, 13 to succumb to drug abuse and the eventual spiraling 14 down to heroin and prescription-drug abuse. 15 Parents need to play a more active role in 16 identifying the potential risks to their children 17 much earlier on before recreational use goes too 18 far. 19 Too many parents today expect the schools to 20 assume responsibility to educate, develop, and 21 prepare their children for life. 22 We have to challenge parents to once again 23 take responsibility for their children in all 24 aspects of life. 25 Education in this area is where we can 1 achieve the greatest success through prevention. 2 No teen says they intend to become a drug 3 addict, as they most likely think they are 4 recreational users; however, their level of 5 self-esteem and self-respect play a huge role in 6 predicting who will eventually become an addict. 7 The students who have difficulty fitting into 8 a social group are very susceptible to joining a 9 peer group of drug users. 10 The parents need to become more aware of 11 their children's habits, activities, and friends. 12 Lack of parental supervision allows abuses 13 with a lack of consequences. 14 Parents need to be provided with more 15 educational resources to help identify the 16 beginnings of recreational use turning into abuse. 17 Much in the same way as peer groups now take 18 away the keys of their friends and stop them from 19 driving drunk, we need to educate the youth to 20 protect their friends, by challenging them to get 21 help when they see their peers abusing the gateway 22 drugs of alcohol and marijuana. 23 The kids in ninth grade that are drinking a 24 couple of beers on the weekend evolve into the kids 25 who are drinking hard liquor regularly in 1 tenth grade, and then experimenting with 2 prescription drugs in eleventh, and are soon out of 3 control. 4 The sophomores who smoked marijuana casually 5 with friends on a Saturday night, became the seniors 6 who smoked every morning before school started. 7 Whatever their gateway drug of choice, they 8 are all now fully engulfed in the wrath of 9 addiction, and very few of them are receptive or 10 will succeed to kick the habit even with treatment. 11 The teen who is a casual drinker and smoker, 12 and does not realize that he or she is at risk, can 13 be identified and helped before it is too late. 14 With early screenings and preventive care, 15 millions of teens can be saved. 16 Parents should be encouraged to give their 17 children simple urine drug tests randomly and 18 frequently. 19 If it became an acceptable part of parenting, 20 there would be less criticism of the practice. 21 Since all drug abusers lie to hide their 22 abuse, we need to educate parents to stop being 23 naive about their children. 24 They need to take their heads out of the sand 25 and stop looking the other way. They need to stop 1 the attitude of "that is not my child." 2 America needs to wake up and realize it is 3 everyone's child. 4 We need to attack this problem with 5 aggressive tactics. 6 When you add up the cost of addiction on 7 society, the resources that should be allocated to 8 prevention should be formidable. 9 Educate the children, educate the parents, 10 educate the peers, and educate the teachers. 11 Car insurance for teens should be tripled in 12 price, with those passing drug and alcohol tests 13 regularly receiving deep discounts. 14 That would motivate parents to test their 15 children. 16 Health plans should also offer a discount for 17 those teens that pass the same test. 18 Unpopular, politically incorrect actions are 19 part of the recipe for success for this problem. 20 We need to be pragmatic and realistic, and 21 not choose the easy way out. 22 The children of this country are at risk. 23 When will we take massive action to change 24 the course of our society? 25 This will take courageous governmental 1 leaders to find the resources for experts to develop 2 a comprehensive plan to save the children of our 3 society. 4 We have to call on our finest child-care 5 professionals, school counselors, and drug 6 professionals to address these issues and develop 7 ways to help parents accurately diagnose their 8 children's actions at a young age. 9 The four years of high school are the 10 battleground. 11 We need to help parents determine if their 12 own kids are susceptible to becoming addicts, and 13 help them identify those children heading down the 14 dark path of addiction, and give them the tools to 15 fight this behavior while it is still controllable, 16 or we will continue to lose the battle, and continue 17 to fight addiction after our teens have fallen prey 18 to this disease. 19 As we are focused here this morning on heroin 20 and prescription-drug abuse, we must also address 21 the abuse of Adderall among high school and college 22 students. 23 Too many students link the positive objective 24 of good grades with the abuse of Adderall, and fail 25 to recognize its dangers. 1 They perceive they are not doing anything 2 wrong because its use is for a good result. 3 In conclusion: 4 Despite the help of dedicated school 5 counselors and faculty, we are still seeing kids on 6 Long Island becoming addicted to heroin and 7 prescription drugs in record numbers. 8 Despite the work of private organizations, 9 such as LICADD and Caron, we are still seeing a 10 record number of overdoses. 11 Despite the unprecedented advocacy from 12 mothers and fathers who have lost loved ones, such 13 as "FIST," which is an acronym for Families in 14 Support of Treatment, we are still seeing insurance 15 companies deny those who are in need. 16 So my message here this morning is that our 17 fight is tougher than ever, and we have to continue 18 to build our coalition so we can finally see the day 19 where every kid who needs help gets help, and every 20 family who needs support gets support. 21 Thank you again for this wonderful 22 opportunity to speak out on an important issue. 23 SENATOR BOYLE: Thank you so much for your 24 testimony, Joshua. It was very well done. 25 And I appreciate your advocacy here, and for 1 the work that you've done. 2 I think few people of your age can say they, 3 literally, have saved lives. 4 I'm sure that you have. 5 JOSHUA LAFAZAN: Thank you so much. 6 SENATOR BOYLE: And, we look forward to 7 working with you as we go into the new session on 8 legislation. 9 And, thank you. 10 And we'd love to have you up to Albany with 11 your passion and advocacy. 12 JOSHUA LAFAZAN: Thank you so much for your 13 time this morning. 14 SENATOR BOYLE: Thank you. 15 Our next witness is Todd Benjamin, 16 educational social worker with the Jericho School 17 District. 18 SENATOR BOYLE: We are gonna run over a 19 little bit, I believe. 20 We have just three more witnesses. 21 But, again if you can summarize, and we have 22 your written testimony. We'd be happy to make it a 23 part of the record and share it with our Senate and 24 Assembly colleagues. 25 TODD BENJAMIN: Sure. 1 Well, first, thank you very much for inviting 2 me here today. 3 I'm a clinical social worker at KSAC and at 4 Jericho High School for the last 28 years. 5 And in the realm of teaching old dogs new 6 tricks, I went back recently and got my master's in 7 school leadership. 8 So, I really bring a lot of different 9 elements of school functioning to our meeting today. 10 I would like to focus on what I call the 11 "why, what, and where?" of my talk today. 12 The "why?": 13 Why are we finding it so challenging to raise 14 healthy drug-free kids in Long Island? 15 "What?" 16 What works for us in Jericho? 17 And, "where" do we go from here? 18 I think we all know we're living in 19 challenging times, and in Jericho, these are some of 20 the things that we have been exposed to as far as 21 what's been challenging: 22 Shrinking school dollars with even greater 23 academic demands placed upon our young people; 24 Increasing stress on students, parents, and 25 teachers with the introduction of the Common Core 1 and APPR; 2 Emerging advances in technology are impacting 3 teens emotionally and socially, creating students 4 who often feel isolated and alone; 5 We're finding increased availability of 6 prescription drugs has lowered the age of first use, 7 and heightened the chemical complexity of substances 8 as they're introduced to the teenaged brain; 9 We're finding kids are confused and have 10 incorrect information about medical marijuana, and 11 it has decreased the perceived risk of illegal 12 marijuana use and increased abuse among teens; 13 We have also noticed economic strain on 14 families has reduced access to treatment, and the 15 economic strain on schools have reduced school-based 16 mental-health and substance-abuse services 17 So the second talking point was, "What do we 18 do about it?" 19 And I can really only talk about what we do 20 in our school. 21 I think some of your other presenters have a 22 much larger scope. 23 We're working in one school. 24 I think what's worked for us is the ability 25 to think outside the box. 1 You know, we've used some Japanese business 2 techniques, and -- called "Kaizen," which is this 3 idea of small improvements. 4 We're not -- you know, we've embraced sort of 5 a harm-reduction model with some of our early kids 6 who are using, making bad decisions, and at-risk 7 kids. 8 So we have this idea that, in your brain, is 9 the amygdala, the part of the brain that shorts -- 10 when you get frightened, the amygdala 11 [unintelligible] up. 12 And so we find, that when we ask kids to make 13 major changes in their life, the amygdala shuts -- 14 starts up, and they don't hear us. 15 So we do what we call "small continuous 16 changes." 17 So we'll work with a kid, you know, What 18 would it be like to go to treatment? 19 "Well, I'm nervous about it." 20 "Well, what would a referral be like?" 21 Sometimes I'll take them to the agency. 22 Sometimes we'll call. 23 We'll look at the website. 24 So we break things down into what education 25 calls "chunking," so we can get the kids moving 1 towards their goal. 2 I think we've done some unusual programming 3 in Jericho. 4 We've created a cafe-style counseling center. 5 We have a large room that has free coffee, 6 decaf coffee, hot chocolate, tea, snacks. 7 We got some small funding. 8 And kids come in the room all day long, and 9 rather than a more traditional sit-down therapy, we 10 kind of have a more [unintelligible] treatment 11 approach. 12 Friday night -- we call that room "Cafe 126." 13 This Friday, we're starting our first 14 Cafe 126 After Dark. 15 My son who's in -- a 12-year-old, came up 16 with the name. 17 Then he said, Dad, isn't there a 18 "Playboy After Dark?" 19 He got nervous about the name. 20 He saw it on TV. 21 So, we're offering an evening event, a 22 coffee-house event, for students. 23 And Josh is one of our guest speakers that 24 night. 25 We have 35 kids who have registered to date, 1 and we hope to reach 50. 2 I think the other small things we're doing 3 is, when we apply for grants, we look for small 4 grants. 5 We're not trying to -- you know, we have a 6 Pledge 99 event four times a year, which are 7 programs, we try to get 99 different parents each 8 time we do it, to come in, and to have safe 9 drug-free parties at their house. 10 And the new thing we're working is what's 11 called, you may have heard, 12 "Restorative Justice/Restorative Discipline." 13 And this idea, when a kid does an infraction, 14 the school to look at, who has he hurt in that? 15 What relationship has he broken? 16 And we're trying to build that. 17 We have a very active Jericho wellness 18 coalition. 19 We do staff lunching-and-learn meetings. 20 We have peer drug educators. 21 And that was sort of the Talking Point 2. 22 And the last part, "Where do we go from 23 here?" 24 Educational priorities that go beyond ELA and 25 math assessments. 1 We need to examine the impact that the 2 2 percent tax cap has on school-based mental-health 3 services and substance-abuse prevention. 4 We need to increase funding for 5 resiliency-based initiatives and restorative justice 6 programs. 7 We need to have greater funding for community 8 school coalitions. 9 And I think, as group, we need to have a 10 greater willingness to think outside of the box. 11 Thank you. 12 SENATOR BOYLE: Very good, Todd. 13 Thank you so much for your testimony. 14 We'll certainly share it with our colleagues. 15 ASSEMBLYMAN SALADINO: Thank you. 16 TODD BENJAMIN: You're welcome. 17 SENATOR BOYLE: Our next witness is 18 Joanne Hoffman Beechko. 19 Joanne is the president of the Long Island 20 Pharmaceutical [sic] Society. 21 Joanne, thank you for joining us today. 22 JOANNE HOFFMAN BEECHKO: Thank you, Senator. 23 Thank you, Assemblyman. 24 I'm not only the president of the 25 Long Island Pharmacists Society, but I also own a 1 community pharmacy in East Northport that's been 2 serving the community for about 23 years, since 3 1990. 4 You've heard from experts in addiction and 5 rehabilitation, enforcement, and from some of the 6 surrounding school districts with a lot of great 7 ideas. 8 I, too, raised -- I also raised two children 9 in Lindenhurst, where they lost schoolmates to 10 heroin overdoses, and that was back in 2001, 2007. 11 So this is not really a new problem; it's an 12 ongoing problem. 13 I am not an expert in how heroin and drug 14 abuse is specifically affecting the children, 15 because I deal with the community at large as a 16 pharmacist in the community. 17 And, so, I'll speak on this from my direct 18 contact with the community, and the impact that I've 19 seen with the beginning of the I-STOP law. 20 I also want to remind everybody, as it has 21 not been mentioned yet this afternoon, of the 22 immense importance for the continued uninterrupted 23 availability of pain medications when prescribed and 24 dispensed appropriately. 25 Okay, so how do kids get their hands on 1 controlled substances? 2 The only legitimate way is, really, through a 3 written prescription for pain associated with an 4 injury or surgical procedure, an anxiolytic for 5 psychological stress, a stimulant for a diagnosis of 6 ADHD or a related syndrome, or many other 7 indications that are appropriately determined to 8 require pain medications. 9 Something as simple as a tooth extraction, an 10 earache, a bad case of mononucleosis. 11 We all know that greater than 70 percent of 12 the controlled substances that are gotten by our 13 children are from the medicine chests from the homes 14 of friends and families. 15 This is the center of our problem. 16 And Josh mentioned the need to educate 17 families and friends and schools as to how we get 18 this information to everyone. 19 Startling data is being presented regarding 20 this non-medical prescription-drug use. 21 There was a study, November 2013, just 22 recently, University of Cincinnati reported that 23 13.7 percent of 54,000 seventh- to twelfth-grade 24 students surveyed used prescription drugs without a 25 doctor's prescription during their lifetime. 1 "13.7 percent of 54,000 students." 2 A University of Michigan survey of 3 2100 teenagers, between 14 and 20, who visited the 4 ER at the University of Michigan Medical Center: 5 10.4 percent of them admitted having abused 6 prescription pain killers or sedatives within the 7 past year; 8 8.7 percent of those who reported using an 9 opioid, like OxyContin, Vicodin, 15 percent had a 10 prescription; 11 Of the -- 5.4 percent who reported using a 12 sedative, 12 percent had a prescription. 13 So this is -- clearly indicates that the 14 drugs are coming, not from legitimate pathways, but 15 from the schools, from the streets, from sales, 16 et cetera. 17 There's also what's called the "YRBS"; The 18 Youth Risk Behavior study from the CDC. 19 The reason I bring these things up, is 20 because I think it's important for our legislators 21 to look outside of New York to see some of the 22 studies that are going on, and maybe where we can 23 look for answers. 24 The YRBC -- YRBS (Youth Risk Behavior Study) 25 showed, from 1999 to 2011, it looked at the trends 1 in prevalence of alcohol use, and the trends in 2 prevalence of marijuana, cocaine, or other 3 elicit-drug use and their behaviors. 4 Believe it or not, according to the CDC 5 study, alcohol numbers showed a decline in all 6 behaviors, from 1999 to 2011; 7 Whereas, marijuana, cocaine, and other 8 elicit-drug use showed increases or no changes in 9 behaviors. 10 The reason I bring this up, is that perhaps 11 we should look, to try and determine why we're 12 seeing those declines in these alcohol behaviors. 13 What are we doing correctly to alter alcohol 14 use and behaviors in our young, that we're not doing 15 yet with the elicit drugs? 16 There was no study on prescription drugs, 17 which, probably, should be recommended to the CDC. 18 Another little interesting study, the 19 Center on Addiction and Substance Abuse at 20 Columbia University did a survey in 2006, and it 21 showed that a survey of Internet pharmacies, 22 6 percent, required a prescription. 23 Now, I do know that the DEA does require all 24 online pharmacies to be licensed within the state 25 that it does business with, and that there are 1 strict guidelines on the dispensing of controlled 2 substances by Internet pharmacies. 3 But I think maybe New York State needs to 4 look at what our laws currently say. 5 Where's the pharmacists' and pharmacies' 6 responsibilities in this scenario? 7 Pharmacists are obligated to follow both 8 state narcotic laws and federal laws regarding the 9 filling and dispensing of controlled substances. 10 Before the I-STOP law, and, currently, we 11 rely on schooling, advisements from state and 12 federal agencies, DEA regulations, and 13 communications with the prescribers to determine the 14 appropriateness of the prescriptions written. 15 Prescribers have had access to the 16 Department of Health's prescription-monitoring 17 program since 2008 to monitor patients, but, it was 18 a cumbersome system. 19 The I-STOP law now requires all prescribers 20 to check the PMP before writing a controlled 21 substance, and the BNE (the Bureau of Narcotics 22 Enforcement) has stepped to up the plate extremely 23 well to streamline this system. 24 Now all prescribers are expected to not only 25 ensure the fact that they are prescribing 1 appropriately, that's done in the office, before pen 2 to paper, but, that there's not something that they 3 do not know about their patient, by checking the 4 website. 5 Pharmacists now, finally, have access to the 6 site as well. 7 We are not required to check in. 8 And I was unable to get data from the BNE, 9 but I have heard that we are checking in with 10 unbelievable numbers, just to make sure that those 11 people that are coming into our stores are doing so 12 in a legitimate manner. 13 This does not say that we are not still doing 14 due diligence, checking physicians, and using all of 15 our skills to determine whether prescriptions should 16 or should not be filled. 17 There's a great deal of confusion, what we're 18 finding, and fear on the prescribers' parts now with 19 regards to I-STOP. 20 We're hearing from our patients that many 21 prescribers are misinformed about what they can and 22 cannot write for a prescription, and they're making 23 unreasonable requests of their patients. 24 They're asking them to come to the office to 25 pick up prescriptions, when, in fact, they can still 1 call in prescriptions for short term, or for a 2 month's supply, and then follow through, check in 3 with the I-STOP, record it in their records. 4 So there's a lot of misinformation out there. 5 Patients addicted to pain medications, who 6 started out with legitimate pain, now have nowhere 7 to turn when their prescribers refuse to write 8 prescriptions for them and give them no alternative. 9 I see this constantly in my pharmacy alone. 10 Patients coming in, not knowing what to do; 11 they can't get their medications that they have been 12 on for years. 13 We're seeing poor management of patients, 14 post-surgery, who fall into addictive patterns, as 15 there seems to be a lack of ability to determine who 16 and -- who will and who will not become addicted to 17 pain medications. 18 I have Suboxone patients who have to go for 19 surgical procedures. 20 Suboxone is to try and get somebody off of 21 addictive pain medications, opioids. 22 And once they go for surgery, they're put on 23 pain medicines, which throws them right back into 24 the fall of addiction. 25 So I believe that our -- we need to better 1 determine who is and who is not going to become 2 addicted to pain medicines. 3 On the other side of the coin, and we heard 4 this a lot -- 5 I actually thought that perhaps we should 6 have invited Senator Seward to this hearing. 7 -- that our insurers are not paying for 8 procedures, injections, nor surgeries, but they will 9 pay for narcotics. 10 I had a gentleman in my store the other day 11 with prescriptions for narcotics. 12 All he wanted was some shots in his back, and 13 the insurance company denied it. 14 So, now, he is very concerned. 15 He knows himself; very concerned about 16 getting readdicted to pain medications. 17 What can we do? 18 First, this is the Information Age, and 19 I think we need to start to use some new pathways. 20 Maybe Facebook, maybe Twitter, blogs, to communicate 21 the information that's already available. 22 We know the research, if do you a search, 23 there's huge amounts of material available. 24 Presentations, we heard all this morning, 25 there's an enormous amount from the federal 1 government, SAMHSA, from OASAS, from local agencies, 2 towns, from Perdue, from Generation Rx. 3 NCPIE (National Council on Patient 4 Information and Education), they have terrific 5 pamphlets on what's called "Teen Influencers." 6 That's those of us in the field -- parents, 7 teachers, prescribers, pharmacists -- how we can 8 influence teens in positive ways regarding drug 9 abuse. 10 I would recommend using these materials in 11 public-awareness campaigns, perhaps subsidized by 12 some of the pharmaceutical companies or by federal 13 funds. 14 Second, a new bill, S5392, by 15 Senator LaValle, and, A7702, Assemblyman Glick, is 16 going to come before the Legislature this year, 17 requiring that supervising pharmacists in a 18 non-resident pharmacy; namely, a mail-order 19 pharmacy, have a New York State pharmacy license. 20 I would suggest that this pertain to Internet 21 pharmacies as well. 22 So any prescription coming into the state 23 must meet the laws of New York State. 24 Third, pharmacists need to be recognized 25 nationally, and at the state level, as health-care 1 providers. 2 If you can believe it, we are not recognized 3 as health-care providers. 4 We are just recognized for the medications 5 that we dispense. 6 Almost like grocers. 7 We're probably the most accessible 8 health-care provider, and we constantly engage our 9 patients regarding their prescription questions. 10 It's been shown that we can improve outcomes 11 when we employ MTM, which is called "medication 12 therapy management" with our patients. 13 Continuing education on pain management is 14 now mandated for New York State pharmacists, as 15 continuing ed, every year, and we are ready and 16 willing to fight, and participate in this -- in the 17 fight against drug addiction and proper pain 18 management as part of the health-care team. 19 Lastly, I would be remiss in addressing the 20 safety concerns of my fellow peers if I did not 21 reiterate the cry for severe penalties for 22 burglarizing pharmacies, and even more severe 23 penalties for robbing a pharmacy, for controlled 24 substances. 25 I would like to close with the reminder that 1 whatever we do do to stop the abuse and diversion of 2 controlled substance that is harming, and sometimes 3 killing, our children, we are cautious not to 4 restrict access for patients in legitimate need of 5 pain medications. 6 Thank you. 7 SENATOR BOYLE: Thank you, Joanne. 8 Thank you so much for testifying today, and 9 for all you've done in your career. 10 And you are making a very big -- an important 11 point, that we're not trying to take away 12 legitimately-prescribed pain medication for those 13 who truly need it; just problems of overprescribing 14 and other addictive -- things that help people 15 become addicted. 16 And we look forward to working with you as we 17 go into the next session, on legislation to modify 18 I-STOP legislation for your membership, and also to 19 do away with the epidemic that we're seeing on 20 Long Island. 21 Thank you so much. 22 ASSEMBLYMAN SALADINO: Thank you, Joanne. 23 You should be commended for the tremendous 24 amount of time that you put in on this subject, and 25 many other subjects, especially when you're also 1 trying to run your own business. 2 JOANNE HOFFMAN BEECHKO: Thank you, Senator. 3 SENATOR BOYLE: Our final witness today is, 4 Dr. Michael Delman, the senior vice president for 5 academic affairs, Southside Hospital assistant 6 professor of medicine, Hofstra North Shore-LIJ 7 School of Medicine. 8 Doctor, thank you for testifying today. 9 Oh, just one second, please. 10 [Pause in the hearing.] 11 [The hearing resumed, as follows:] 12 DR. MICHAEL R. DELMAN: First of all, before 13 I morphed into Don Quixote, I was a -- 25 years, 14 I was an internist and gastroenterologist. 15 So, I want to thank you, and the audience, 16 for foregoing their hemorrhoid treatments, to sit 17 here for this past two hours. 18 I think that the first thing I would like to 19 tell you about -- first of all, I'm only gonna take 20 about ten minutes, since I'm batting cleanup. I'm 21 not number four, but this is cleanup. 22 I don't have a written presentation for you, 23 but I do have some notes here. 24 We are 4 percent of the world population, 25 using 90 percent of the world's OxyContin, 1 60 percent of the world's hydrocodone. 2 I think that probably explains the problem 3 that my colleagues have been presenting to you. 4 One of the things that Casa Columbia did in 5 August of 2012, was they did a survey. They used 6 over 7500 different reports. They actually 7 interviewed people in New York State, both, users, 8 as well as treatment professionals. 9 And they found that about 40 million 10 Americans are addicts when you include nicotine. 11 80 million individuals are at-risk users. 12 That is a very important number, because 13 those 80 million, for which we spent nothing, are 14 responsible for $600 billion a year in health-care 15 costs. 16 That's preventable costs. 17 That's nearly two-thirds of a 18 trillion dollars, especially when we're running 19 short on funds, at least according to the government 20 we are. 21 In any event, having said that, we do very 22 little to address those individuals. 23 Let me give you an example of that. 24 A woman who was positive for the BRCA gene 25 that indicates she's at risk for breast cancer, and 1 drinking one drink a day, is doubling her risk for 2 developing breast cancer. 3 Now, this is evidence-based medicine, but, we 4 don't have physicians who actually counsel their 5 patients about it. 6 It's not to tell her that she can't have that 7 drink a day; it's to tell her that we don't know 8 what the safe number is, and that she is increasing 9 her risks. 10 We also don't teach this in the medical 11 schools, at least not in the first four years. 12 I think there are only, now, two or three 13 medical schools that have decided to address 14 addiction as part of their curriculum. 15 And, in fact, we do have SBIRT (screening 16 brief intervention referral to treatment). 17 And one of my recommendations is, just like 18 we do for infection control, or for child abuse or 19 spousal abuse, the State should mandate SBIRT 20 training for all physicians at least once every 21 two years, as part of their licensure requirements. 22 Because, right now, we are trying, and that's 23 why I say "Don Quixote," to bring this out to 24 primary-care physicians, and we're meeting all kinds 25 of resistance, despite the fact that the State is 1 actually paying for that. 2 Having said that, we also have to address the 3 qualifications of individuals who claim that they 4 have special expertise. 5 And I included in your little three-page 6 outline that I gave you, some special populations 7 who frequently are told, Oh, yes, we handle this. 8 I'm talking the GLBTQ group. 9 "Oh, yes, we handle addiction." 10 And they have a higher instance of addiction, 11 but they don't really provide any services that are 12 special for that group; and as a result, a lot of 13 disappointed individuals have not good care being 14 provided. 15 We need to promote more prevention programs, 16 and incentives, particularly in the school 17 districts. 18 I am one of the people in New York State that 19 teaches Narcan rescue. 20 And I -- when I go to a school district, I am 21 told, either by the superintendent of schools, or 22 the principal of the school, if it's a high school, 23 that they will not permit me to in-service their 24 teachers or their nurses on Narcan usage because 25 they're concerned about the insurance liability, or 1 they're concerned about needles being present, 2 because the State has some conservation measures. 3 And the Narcan training, provided on the 4 state level, is, generally speaking, done with 5 needles rather than the inhalational form of 6 Naloxone. 7 Having said that, if that's the only barrier, 8 then I think that we have to supply the nasal spray. 9 So, I think that becomes very important, and 10 it's something that we can do at the state level. 11 Where there are things that have been 12 addressed regarding insurance, the American Society 13 of Addiction Medicine has just published the 14 patient -- "Patient Placement Criteria." 15 It's the third edition of that volume, and, 16 it is an evidence-based source for what kind of 17 patient should be in what kind of treatment. It has 18 five different levels. 19 I would like to address the issue of 20 marijuana, I think it's very important. 21 I want to tell you that the prefrontal 22 cortex, which is the part of your brain that 23 determines the risk benefits and alternatives to 24 doing anything, does not completely develop until 25 about age 25. 1 What we have been able to document 2 scientifically, is that the prefrontal cortex of the 3 brain can be adversely affected by exposure to 4 addictive chemicals, particularly early on in life, 5 below age 18. 6 This, again, is evidence-based. 7 So when you think about permitting or 8 legalizing anything, whether it be alcohol, 9 marijuana, or nicotine, and you look at the young 10 brain, while society has gained some significant 11 strides forward, by the Wright Brothers, for 12 example, because, the risk benefits and alternatives 13 to them weighed in a young brain said, Ah, I'd 14 rather learn how to fly than worry about whether 15 I'm gonna die. 16 So as a result, we got a benefit out of that. 17 But when you look a substances of abuse, 18 we're not gonna get any benefit out of that. 19 And if we prevent it, we are gonna save a lot 20 of money. 21 I have a young man who I saw about a year 22 ago, who came in with a substance-use problem. 23 I know him, as a matter of fact, since he was 24 about age 6. 25 He was now 36. 1 He had a substance-use problem. He could not 2 get into treatment. 3 Two weeks after I saw him, he was admitted to 4 the hospital with endocarditis. 5 He is now three open-heart surgeries later, 6 and a number of other procedures. 7 I would estimate the cost of somewhere over 8 $1 million, as opposed to, whatever, ten or 9 twenty thousand would have been spent in getting him 10 into a treatment program. 11 The last thing that I'd like to tell you, is 12 that the Risk Evaluation Mitigation Strategy, the 13 "REMS" program, which is part of the I-STOP 14 legislation that has not yet been enforced by the 15 State of New York, we received a grant from a 16 federal organization. 17 We put this online, using the federal slides. 18 It's a two-hour presentation at the 19 North Shore-LIJ Health System. 20 And as a result of putting that online, we 21 also put into that some guarantees that the user 22 will actually have to stay for the two hours, just 23 as a way of questioning them about what went on. 24 And, I would suggest that we could use that 25 REMS program, again, if we mandated that to all 1 physicians who write prescriptions in the state of 2 New York. 3 Aside from that, I'm open to any questions 4 you may have. 5 SENATOR BOYLE: Just one quick question, 6 Doctor, and thank you for your testimony. 7 I took the Narcan training course, and they 8 gave us the nasal one to take home. 9 Are there any problems? 10 I can understand the needle question on the 11 school, they're getting a little queasy about maybe 12 allowing people to have needles, administering it 13 from needles, without training. 14 But, the nasal, now, if someone is having 15 what's appeared to be an overdose, they gave them 16 Narcan, and -- but they're not really doing that, 17 it's something else is, is there any other adverse 18 effects that could happen to someone that, because 19 of the Narcan, that -- 20 DR. MICHAEL R. DELMAN: If you're using the 21 nasal spray, the worst thing that'll happen is they 22 may sneeze. 23 SENATOR BOYLE: Okay. 24 DR. MICHAEL R. DELMAN: Otherwise, Narcan, 25 Naloxone, has absolutely no ill-effects in 1 combination with any drugs that we know of. 2 I know of no instance of allergies to 3 Naloxone. 4 It's a great drug. 5 In fact, when you look at medication-assisted 6 treatment, which is the way many addiction 7 professionals are starting to approach patients, 8 Naloxone long-acting is available by injection. 9 It's actually covered by Medicaid. 10 It lasts for a month when its given by 11 injection. 12 It's very effective for opiate abuse. 13 It's fairly effective alcohol abuse. 14 And there are now new formats coming out that 15 will be implantable, and, perhaps, if they're 16 approved by the FDA, will actually provide 17 six months worth of treatment. 18 Of course, other medication-assisted 19 treatments, buprenorphine, is one of them. 20 "Suboxone," you probably know it as. 21 Again, I would ask the State to look into 22 forcing the federal government to lift the 23 "100 patient per physician" cap that's currently on 24 it, because, quite honestly, there are about 25 3500 addiction professionals in the country, that's 1 all. 2 But primary-care physicians can, with the 3 right training, supply Suboxone. 4 And there are a lot more users than there are 5 primary-care physicians, even at 100 per physician. 6 SENATOR BOYLE: Well, thank you very much, 7 Doctor. 8 Assemblyman Joe, Saladino, do you have any 9 questions? 10 ASSEMBLYMAN SALADINO: No, but I really 11 appreciate your being here. 12 And all of your testimony, and your resume, 13 is absolutely amazing, so you, obviously, are going 14 to be -- 15 DR. MICHAEL R. DELMAN: Don't say anything 16 about "Don Quixote." 17 [Laughter.] 18 SENATOR BOYLE: Thank you very much, Doctor. 19 And, for a closing remark, Assemblyman. 20 ASSEMBLYMAN SALADINO: You know, this issue 21 has been going on for sometime, and we've been 22 engaged in this issue for sometime. 23 But I really want to thank my good friend and 24 colleague in the Senate, because he is someone who 25 understands the needs of digging a lot deeper than 1 what we normally deal with in Albany, and, you've 2 all been frustrated with the slow pace of change in 3 Albany. 4 But having Phil Boyle champion this issue, 5 and the many issues that he continues to strive to 6 champion, really makes a difference. 7 All of you, whether you travel upstate or 8 not, have been an important part of this process. 9 We are learning more and more, what the 10 solutions are, and we need to continue to work with 11 you and your organizations. 12 And I know that you will provide us the 13 support and the information and the teams of people, 14 so that we can climb some big ladders, overcome some 15 big hurdles, go up against tremendously powerful 16 organizations, and the insurance industry is one of 17 those. 18 But by delineating what the highest 19 priorities are that we should be focusing on, really 20 is tremendously helpful. 21 And I see today's event, and thank you, Phil, 22 and your staff, and everyone involved today, in 23 helping us with the playbook to win this war and 24 protect our communities. 25 SENATOR BOYLE: Thank you very much, 1 Assemblyman. Well said. 2 And I would like to associate myself with 3 Joe's remarks. 4 We have a lot of big issues we're gonna be 5 facing in the new session in Albany, come January, 6 but none are more important than stemming this 7 epidemic of heroin and prescription-drug use among 8 our youth on Long Island, and throughout 9 New York State. 10 The testimony that you people gave today are 11 going to help us. 12 This is just the beginning of the battle, but 13 we know it's gonna be long one, but, we want to work 14 with you to get exact language. 15 We made a few steps in stemming this tide, 16 but we're nowhere near where we need to be. 17 I want to thank you again for testifying. 18 And we will be in touch with you in the 19 coming months as we look forward to legislation in 20 Albany. 21 Thank you very much for being here. 22 (Whereupon, at approximately 1:08 p.m., 23 the public hearing held before the New York State 24 Senate Standing Committee on Alcoholism and Drug 25 Abuse concluded, and adjourned.)