Public Forum: Oneida County Panel Discussion on Oneida County'S Heroin Epidemic

PARTICIPATING PANELISTS:2

Julie Barker-Nagle 3 Director of Services Administrator

Oneida County Jail, through Correctional Medical Care 4

Erin Bortel 5 Director of Prevention Services

ACR Health 6

Tara Costello 7 Director of Substance Abuse

Oneida County Department of Mental Health 8

Phyllis Ellis 9 Director

Oneida County Health Department 10

George Kozminski, M.D. 11 In charge of the medication-assisted program

Insight House 12

Robert Maciol 13 Sheriff

Oneida County, New York 14

Jeanna Marraffa, PharmD, DABT 15 Upstate Medical University at the

Upstate New York Poison Center 16

Scott McNamara 17 District Attorney

Oneida County District Attorney's Office 18

Cassandra Sheets 19 Chief Executive Officer

Center for Family Life & Recovery 20

Donna M. Vitagliano 21 President/CEO

Insight House 22 23 24 25 1

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PANELIST INTRODUCTIONS 6 3

PANELIST STATEMENTS 11 4

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