PUBLIC FORUM: RENSSELAER COUNTY PANEL DISCUSSION ON TROY'S HEROIN EPIDEMIC

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

Public Forum: Rensselaer County Panel Discussion on Troy'S Heroin Epidemic

Transcript