Public Forum: Monroe County Panel Discussion on Rochester'S Heroin Epidemic

1 BEFORE THE NEW YORK STATE SENATE MAJORITY COALITION

JOINT TASK FORCE ON HEROIN AND OPIOID ADDICTION 2 ------------------------------------------------------ 3 PUBLIC FORUM: MONROE COUNTY 4 PANEL DISCUSSION ON ROCHESTER'S HEROIN EPIDEMIC 5 ------------------------------------------------------ 6 7 Monroe County Office Building

39 West Main Street 8 Rochester, New York 14614 9 April 15, 2014

10:00 a.m. to 12:00 p.m. 10 11 12 PRESENT: 13 Senator Philip M. Boyle, Task Force Chairman

Chairman of the Senate Committee on Alcoholism and 14 Drug Abuse. 15

Senator Joseph E. Robach, Forum Moderator 16

Assemblyman Mark Johns 17 State Assembly, Ranking Member of Drug and

Alcohol Committee 18 19 20 21 22 23 24 25 1

SPEAKERS:PAGE QUESTIONS 2

William J. Hochul, Jr. 10 15 3 U.S. District Attorney

Western District of New York 4

Theresa DeLone 18 28 5 Personal Story

Resident of Henrietta, New York 6

Jennifer Faringer 31 45 7 Director

National Council on Alcoholism & 8 Drug Dependency (Rochester Area) 9 Jessica Sherman 49 58

Program Director 10 Face 2 Face 11 William Sanborn 59 66

Undersheriff 12 Monroe County Sheriff's Office 13 Lori Dresher 67

Personal Story 14 Resident of City of Rochester, New York 15 James Wesley 78 84

Drug Chemistry Supervisor 16 Monroe County Crime Lab 17 Jeremy T. Cushman, M.D., M.S., 85 94

EMT-P, FACEP 18 EMS Medical Director

University of Rochester 19

Lisa Thompson 102 107 20 Personal Story

Resident of Chili, New York 21

Jeanne Beno, Ph.D. 107 116 22 Chief Toxicologist

Monroe County Medical Examiner's Office 23

Sandra Doorley 119 126 24 District Attorney

Monroe County District Attorney's Office 25 1

SPEAKERS (Continued): PAGE QUESTIONS 2

Paige Prentice 131 3 Vice President of Operations

Horizon Health Services 4

Avi Israel 135 140 5 President

Save the Michaels of the World 6

Michael Foster, M.D. 143 149 7 Director

Chemical Dependency at 8 Unity Health Systems 9 Lisette Castro [ph.] 162 167

Harm Reduction Coordinator 10 for Syringe-Exchange Program

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