Public Forum: Clinton County Panel Discussion on Plattsburgh'S Heroin Epidemic

1 BEFORE THE NEW YORK STATE SENATE MAJORITY COALITION

JOINT TASK FORCE ON HEROIN AND OPIOID ADDICTION 2 ------------------------------------------------------ 3 PUBLIC FORUM: CLINTON COUNTY 4 PANEL DISCUSSION ON PLATTSBURGH'S HEROIN EPIDEMIC 5 ------------------------------------------------------ 6 7 Clinton County Government Center

137 Margaret Street 8 Plattsburgh, New York 12901 9 April 25, 2014

10:00 a.m. to 12:30 p.m. 10 11 12 PRESENT: 13 Senator Philip M. Boyle, Task Force Chairman

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

Senator Betty Little, Task Force Forum Moderator 16 Member of the Joint Task Force 17 18 19 20 21 22 23 24 25 1

SPEAKERS:PAGE QUESTIONS 2

Derek Champagne 9 22 3 District Attorney

Franklin County 4

Andrew Wylie 26 52 5 District Attorney

Clinton County 6

Matthew Bell 26 52 7 Detective

Plattsburgh City Police Department 8 DEA Adirondack Drug Task Force 9 Shawn McKeen 26 52

Personal Story 10 Resident of Plattsburgh 11 Kathleen Camelo, M.D. 56 64

Director 12 Center for Student Health and

Psychological Services at 13 SUNY Plattsburgh 14 Michael Kettle, RN, BSN CASAC 65 83

Director of Regional Services 15 Joseph LaCoppola

CASAC 16 Conifer Park 17 Beth Lawyer 85 93

Director 18 North Star Behavioral Health Services

For Citizen Advocates, Inc. 19

Charles Everly, M.D. 95 112 20 Medical Director, Emergency Room

CVPH Hospital 21

Kenneth Thayer 95 112 22 Nursing Director, Emergency Care Center

CVPH Medical Center 23

Connie Wille 115 127 24 Executive Director

Champlain Valley Family Center 25 1

SPEAKERS (Continued): PAGE QUESTIONS 2

John Schenkel, M.D. 128 3 Clinton County Addiction

Treatment Services 4

Peter Bacel 133 138 5 Counselor

Friends of Recovery New York 6 7 AUDIENCE PARTICIPATION BEGINS: 139 8 9 ---oOo--- 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 1 SENATOR LITTLE: Let me begin by thanking 2 everyone for being here, and especially thank our 3 panelists. 4 What we're going to do is, hear a number of 5 presentations, and then it will be open, if anyone 6 has any questions or comments, that would like to 7 say something or question at the end, all right, as 8 we get through with the program. 9 I'd also like to thank Clinton County for the 10 use of their legislative room. 11 And we have two of our County legislators 12 here today. Patty Wadell and Pete Pat Keenan are 13 here, and I appreciate their efforts in having us 14 use the room. 15 Across New York State, not just in 16 Clinton County, but communities large and small, 17 rural and urban, are seeing an increase in the use 18 of heroin and prescription opioids, and the impact 19 of this abuse and addiction is multifaceted: crime 20 increases, emergency-care-needs rise, and more and 21 more is asked of our mental-health providers. 22 The impact on families is profound, as loved 23 ones struggle to help a son, a daughter, husband, or 24 wife break the dependency from heroin, or a 25 narcotic, like Oxycontin or Vicodin. 1 And the greatest, and certainly the most 2 tragic impact, is the one that is endured by the 3 addict, particularly, as we see the number of 4 overdoses increasing in the past couple of years. 5 We've had way too many lives lost as a result 6 of this. 7 All of us here today recognize that heroin 8 and prescription-drug addiction is a public-health 9 crisis in desperate need of a comprehensive cure and 10 solution. 11 My colleagues in the Senate want to ensure 12 that our response as a state is more effective than 13 what we have had in the past, and that means, being 14 here today, talking to local stakeholders, and 15 hearing, really, from the people who are involved in 16 the issue, what the needs are and what the concerns 17 are out there; what we need, and what type of really 18 good legislation would be helpful. 19 I was pleased to be asked to join the 20 bipartisan New York State Senate Task Force on 21 Heroin and Opioid Addiction which we had formed this 22 past March. 23 Many forums and hearings have already been 24 held across the state, with several more to follow 25 in the next couple of weeks. 1 But leading our effort is my colleague and 2 friend Senator Phil Boyle. 3 I remind everyone, turn off our cell phones, 4 and I will do mine as soon as I'm finished, because 5 I hope it doesn't ring. 6 [Laughter.] 7 SENATOR LITTLE: But, we need to do that. 8 I served with Senator Boyle in the Assembly, 9 as well as welcomed him into the Senate recently. 10 And he is Chairman of the Senate Committee on 11 Alcoholism and Drug Abuse, and he is also the Chair 12 of this Task Force. 13 This is an issue that he is very passionate 14 about, and I'm grateful to have him come to the 15 North Country to be with us here in Clinton County 16 today. 17 And I would ask all of you to join me in 18 welcoming him today, and having him here with this 19 Task Force. 20 So, Senator Phil Boyle. 21 Thank you. 22 [Applause.] 23 SENATOR LITTLE: I should have also said he's 24 from Long Island. One of our Long Island guys. 25 SENATOR BOYLE: Thank you so much, Betty, and 1 thank you for your leadership in the Senate, as 2 joining the Task Force, to combat this heroin 3 epidemic. 4 And thank you for our panelists today, and 5 for everyone. 6 What we're looking for is for input from 7 everyone, whatever the reason. 8 And as Betty has said, she and I served 9 together in the Assembly, and it's my first time in 10 her district, but I didn't realize how popular she 11 was, until I was getting in the elevator this 12 morning, and I said to a woman: Well, how you 13 doing? 14 She goes: Great. I just got a hug from my 15 Senator. 16 I was, like, Wow! 17 [Laughter.] 18 SENATOR LITTLE: My friend Donna. That's 19 great. 20 SENATOR BOYLE: But this is a statewide 21 epidemic. 22 And, we've been to Buffalo, Long Island where 23 I'm from, the North Country now, to get input. 24 We're really focusing on three areas: 25 Prevention, treatment, and law enforcement. 1 And, so, as we hear from the panelists today, 2 what we've been asking for, and we've had a very 3 good exchange of ideas, and gotten a number of good, 4 potential pieces of legislation which we'll be 5 passing in these areas, so whatever area you're 6 in -- prevention, treatment, or law enforcement, or 7 others; a family member, if you've lost someone -- 8 if you said, "If I could change the law, one law or 9 two laws, what would I do?" that's what we're 10 looking for here today. 11 The mission of the Heroin Task Force is to 12 come up with a report; we're going to report by 13 June 1st. And then, in the final weeks of the 14 session, we're going to pass legislation to combat 15 this heroin/opioid problem that's caused so many 16 tragedies throughout the state. 17 And, I'm looking forward to the testimony 18 today. 19 Thank you, Senator. 20 SENATOR LITTLE: Thank you, Phil. 21 We're going to change the program just a bit. 22 Our District Attorney from Franklin County, 23 Derek Champagne, does have a court appearance coming 24 up shortly, so, we're going to move him up to the 25 front, and our Clinton County District Attorney has 1 agreed to go along with that, too. 2 So, appreciate that. 3 Derek, thank you very much for being here. 4 DA DEREK CHAMPAGNE: Thank you, Senator. 5 Good morning, and thank you for the 6 opportunity to speak today. 7 Franklin County, my county, just to the west 8 of here, has a population of 51,000 people. We 9 have, over 17 percent of our population lives below 10 the poverty level. We have no interstates, we have 11 no throughways. And 12 months ago, we had little, 12 if any, heroin in our county. 13 Today, we can buy heroin in any community, at 14 any time, in Franklin County. 15 I can't buy a 2-by-4 piece of lumber in my 16 county anytime after noon on Sunday, but I can buy 17 heroin seven days a week, anytime of the day or 18 night, in one of the most rural counties in the 19 great state of New York. 20 Current prices in our county are between 21 20 and 30 dollars per dose, compared to 4 to 22 5 dollars in some of our cities. Even so, it's 23 cheap, even at $20 in our communities. 24 As you're well aware of, it's highly 25 addictive, and has, unfortunately, become glamorized 1 by popular culture and the users themselves. 2 On a recent investigation, we discovered a -- 3 Facebook photos of one of our target's friends with 4 needles in their arms, actually on Facebook, like it 5 was something cool or something to be impressed 6 about. 7 My investigator recently bought heroin from a 8 girl who showed him, with pride, the fact that she 9 had hundreds of needle marks in her arms like it was 10 some impressive feat. 11 I've police officers with 15 years on the job 12 who have never seen heroin until the past 12 months. 13 I've probation officers who have asked me to 14 buy them gloves so they don't get punctured or 15 stabbed from needles, because their searches -- in 16 their searches, as part of their daily jobs, they're 17 now finding needles on a regular basis as part of 18 their daily duties. 19 It's as if we turned off the faucet in my 20 particular county for prescription drugs, due to 21 some of the very good legislation that we passed, as 22 well as working with the drug companies, and, 23 essentially, turned on five faucets worth of heroin. 24 Drug dealers in our county were organized 25 24 months ago. We would target houses, we would 1 target individuals, we would target known dealers. 2 Today, it's as if every user in my county has 3 become a heroin dealer to support their habit. 4 I mentioned our poverty level up front 5 because the obvious question is: Where do people in 6 a poor county, in a rural county, get money to buy 7 their heroin? 8 What we've seen is there's, essentially, 9 two ways for them to do it: 10 The first is, to become a dealer themselves; 11 Or the second is, to engage in criminal 12 conduct to obtain money or funds to support their 13 habit. 14 In the packet that I've provided to you, I've 15 provided three statements of defendants. 16 The first exhibit is Exhibit A, the 17 defendant's statement, in summary -- and I provided 18 it for you -- is the same from a defendant talking 19 about, how he was sitting around with 20 four individuals who were all going through 21 withdrawal one night, and, they had no money to 22 purchase drugs that night. 23 So the defendant thought that night about, 24 What can I do, and what should I do? 25 And, he thought about breaking into cars for 1 money, and he realized that he couldn't get enough 2 money from breaking into cars. 3 So he walks up the road and he breaks into 4 his neighbor's garage. And then, after breaking 5 into the garage, he walks up to the next house and 6 breaks into his neighbor's house. 7 He used all of the money from the items sold 8 and the cash he found for drugs, as did his 9 co-defendant, as you can read in the statement. 10 And in the last line of his statement, he 11 says: I only took the items to pay for drugs, and 12 I'm sorry for my action. 13 The second exhibit I provided to you is 14 another defendant's statement -- and these are all 15 very recent cases -- where the defendant was with 16 two of his friends, having a discussion about 17 needing money. 18 One of the friends goes to the neighbor's 19 house and steals 100 silver dollars, prescription 20 pills, and a .45-caliber pistol. 21 You can then read through the statement, how: 22 They go and sell the gun that same night for 23 cocaine and heroin. 24 A week later, they drive to Albany, after 25 selling the silver dollars, to buy heroin and 1 cocaine. 2 A few days later, they go and sell the coins 3 from another home they burglarized, and they again 4 buy heroin. 5 A few days after that...this is, through the 6 statement, you can, essentially, read it being 7 repeated again and again. 8 And a few weeks later, another burglary, with 9 another handgun stolen in county to sell, so they 10 can buy drugs. 11 In the last paragraph of the defendant's 12 statement in Exhibit B, I'm paraphrasing, he states: 13 All three of us have been involved in selling 14 heroin for a while. I usually would sell heroin to 15 get money to buy enough heroin to support my habit. 16 We would make at least two trips to Syracuse a week 17 to buy heroin. Because of my addiction to drugs, 18 I participated in the above crimes. I hope I can 19 attend a court-ordered inpatient program so I can 20 get off drugs for good. 21 The third statement I provided, Exhibit C, 22 the defendant talks about buying $200 worth of 23 heroin. 24 He tells you how he shoots up five bags of 25 heroin, then he shoots up five more bags; and then, 1 in this condition, he decides to walk to one of our 2 gas stations in the village of Malone and buy 3 cigarettes. 4 When he gets inside, he realizes he doesn't 5 have enough money, but he realizes there's a lot of 6 money in the drawer that the clerk just opened. 7 So he pulls out a knife and he robs a clerk. 8 He then takes that money, he runs to friend's 9 house, immediately orders up $200 of heroin, which 10 is immediately delivered to his friend's house. 11 He shoots up five bags of heroin, goes 12 looking for one of his other friends, to enjoy the 13 evening, and ends up passing out in a snowbank. And 14 the Malone Village police arrest him in the snow 15 bank. 16 The problem, and the reason why I illustrate 17 these three examples, is that they all involve 18 serious crime; crimes against real people in the 19 community. 20 It's not someone abusing a script or faking 21 symptoms for a script. It is violent crime to 22 purchase a substance which has no legitimate source 23 or ability to be purchased. 24 And we're seeing these same facts played out 25 in our county again and again. 1 Heroin is also easy to hide. 2 And I brought with me, which you've seen, 3 which I need back 'cause there's heroin in here. 4 [Laughter.] 5 DA DEREK CHAMPAGNE: But one of the problems 6 we're having with law enforcement, obviously, is 7 when we had cases regarding 50 pounds of marijuana, 8 or 100 pounds of marijuana, it wasn't so easy to 9 transport, and it wasn't so easy to hide. 10 The reason I illustrate this is, the size of 11 heroin, it's -- essentially, it's a hinderance to 12 law enforcement. 13 And, unfortunately, it illustrates that more 14 enforcement likely isn't the answer -- and that's 15 coming from a prosecutor -- as heroin can be quickly 16 hidden and secreted from law enforcement. 17 Another issue that is obviously concerning, 18 is the tolerance which is built up to heroin by 19 users means that either more crimes must be 20 committed or more products must be sold by the user. 21 One defendant we recently arrested in our 22 county was using $500 of heroin a day. He had to be 23 closely watched when he was finally caught and 24 incarcerated because of concerns he would die coming 25 off that much heroin, as far as his addiction. 1 His habit obviously led to his arrest, 2 because he was willing to sell to anyone and 3 everyone in our county. 4 Obviously, most of what I just spoke about 5 you probably know, so, what, if any, recommendations 6 do I've? 7 My first recommendation that I outlined is 8 better coordination, which would likely involve 9 funding for advocacy groups. 10 One of the issues that we've seen from 11 law enforcement is, we need some referral system for 12 law enforcement when they respond to a scene and 13 meet someone who's high on drugs. 14 Presently, if that person is not committing a 15 crime, we could, essentially, have law enforcement 16 respond to a scene with four or five or six people 17 who are all high on drugs, and we're in a situation 18 of telling law enforcement: You have to leave, and 19 tell them "Have a nice day," if there's no crime 20 being committed in your presence. 21 I'd ask the Task Force to consider: Is there 22 some way we can get those names or those people -- 23 people's names to advocates? Or, to work with some 24 sort of new system regarding advocacy for 25 law enforcement with those types of situations? 1 Some sort of intervention, or at least, at a 2 minimum, give them some card, or some sort of 3 information, regarding what we're obviously 4 observing on a day-to-day basis in our communities. 5 What can or should law enforcement do of 6 calls from people asking for help? 7 My investigator, on Wednesday night, received 8 a call regarding a 17-year-old girl who is now 9 selling heroin to support her addiction. 10 What system can we put in place for 11 law enforcement when they receive these types of 12 calls? 13 My second area for you to consider would be 14 source funds for law enforcement. 15 And that would be, obviously, as I'm sure 16 you've heard, many of the narcotics funds have 17 dried-up for the law enforcement, for the police 18 agencies, and there's really not the funds that we 19 have anymore to use for investigations. 20 But what I'm talking about, as far as 21 thinking outside the box in a new area, is source 22 funds to pay citizens who want to help 23 law enforcement, who aren't addicts, and who aren't 24 working off criminal charges. 25 Typically, confidential informants are users 1 who have an addiction. 2 One of the problems that we have, is these 3 people, quite often, are not willing to give up 4 their main supplier. They may give us everybody 5 else, and they may give us all of their friends' 6 suppliers, but if you think they're going to truly 7 give you their supplier, it's typically not the 8 case. 9 Lately, however, though, we have had a number 10 of concerned citizens willing to work for money. 11 I believe a question for your Task Force to 12 answer is: Can funds be provided to police for this 13 purpose? 14 These people are often good citizens and not 15 criminals. They may simply be unemployed or on hard 16 times, but funds for this purpose to law enforcement 17 across the state could be a valuable tool for you to 18 consider, if we can have those people assist 19 law enforcement through either controlled buys or 20 through reliable information. 21 The third area I'd ask you to look at is 22 tracking of overdosed deaths, and distribution of 23 that data to the public, as well as law enforcement. 24 As an example: It's my understanding that 25 22 people died in the New York-New Jersey area from 1 heroin laced with fentanyl during the three-week 2 period that the media was covering the death of 3 Actor Philip Seymour. 4 These deaths were, essentially, a footnote in 5 a couple articles, and from law enforcement which 6 I spoke to. 7 That number of 22 deaths in a 3-week period 8 is truly a staggering number, and it's important for 9 the public and for law enforcement to know this type 10 of information. 11 Every county in New York State should be 12 tracking heroin and drug overdoses. 13 I don't know how many currently are, but 14 I can tell you, until last week, my county was not. 15 We had nothing in place to track drug overdoses. 16 The death certificate might simply say, 17 "Cardiac failure of a 22-year-old adult male." 18 The State needs to track why people are dying 19 in each county, and each county department of health 20 would likely be a good place to start. 21 This information needs to be available to 22 multiple agencies, as well as the public, and could 23 be part of a media campaign by the State to 24 deglamorize heroin. 25 The fourth area I'd ask to you consider is 1 expansion of intelligence centers. 2 Expansion of funding to DCJS or the 3 New York State Police for intelligence centers in 4 each geographical area I believe is critical. 5 Analysts need to be aware the problem is not 6 200 or 250 miles away. 7 How are these addicts -- how do these addicts 8 know how go to Syracuse? How do they know to go to 9 Albany? How do they know how to go to 10 Massachusetts? 11 How can we, as law enforcement, connect the 12 dots and understand the trade and flow of product? 13 Funding to establish additional 14 crime-analysis centers is critical to understanding 15 trends, understanding patterns, quicker responses, 16 and a coordinated approach to this epidemic problem. 17 The fifth area would be treatment funding. 18 Obviously, you're going to hear from 19 treatment experts, and you have, so this is just our 20 view from law enforcement and defense attorneys 21 dealing with the situation. 22 But from our perspective, we believe the 23 28-day programs are simply not working. We believe 24 they're too short. 25 And we believe, our observation, is that, 1 quite often, it's insurance issues or cost issues 2 which are not allowing us to put these people in 3 longer treatment. 4 If our view from law enforcement is correct, 5 I would ask you to analyze and address if there's 6 some way for us to deal with that issue statewide. 7 In the final area I'd ask for, is money for 8 testing, for probation departments. 9 In my county, some of the officers are 10 reluctant to test because, quite frankly, the 11 defendants are required, typically, pursuant to 12 their terms and condition of probation, to pay for 13 the test. 14 Many of these individuals are unemployed, 15 they're going through rough times. They're trying 16 to get Probations working with them to get them 17 reestablished. And many of them have children. 18 So, we're in an awkward situation, where 19 I see there's a hesitation to go ahead and tell 20 somebody, Yes, you have to pay 30 or 40 dollars for 21 a test; but, yet, we want to catch these people 22 before they relapse. 23 So, I do believe some sort of funding to 24 probation departments for testing would be 25 important. 1 Hopefully, my testimony, Senators, somewhat 2 surprises you, because I'm a career prosecutor who's 3 not asking for more police, I'm not asking for more 4 prosecutors, and I'm not asking more people to be 5 arrested. 6 Rather, I'm asking for coordination, I'm 7 asking for assistance, and I'm asking for new 8 approaches. 9 The Rockefeller drug laws were imposed during 10 the last heroin epidemic that devastated urban areas 11 nearly 40 years ago. 12 Our current situation may very well devastate 13 rural and urban areas if we do not quickly find 14 solutions. 15 Please find a coordinated, aggressive 16 approach before we are forced to lock up these 17 addicts for the violent crimes which they are 18 starting to commit. 19 If they are not free from addiction, 20 I believe they will be locked up in another way. 21 Thank you very much for your time and 22 attention today. 23 SENATOR BOYLE: Thank you, Derek. That was 24 tremendous testimony. Really, just very concise. 25 And, I feel like a judge with all the -- 1 [Laughter.] 2 SENATOR BOYLE: I would say -- I ask you one 3 question, though: 4 In the cases that you prosecuted -- and 5 I understand what you're saying about the weight of 6 heroin, which adds to the problem of finding out the 7 correct laws on how we're going to increase the 8 criminal penalties. 9 I've legislation that would make possession 10 of 50 bags or more a felony. It's now a 11 misdemeanor. 12 And, I'm not foolish enough to think that's 13 going to be the final law, because we need to get it 14 passed through the Assembly. 15 But, how would you do it, in terms of 16 changing the actual language to the law, to say: We 17 want to increase the penalties, but not go by 18 weight? 19 Is there anything you can think of, as a 20 prosecutor? 21 It's tough, I know. 22 DA DEREK CHAMPAGNE: I'd have to really sit 23 down and think about it. 24 SENATOR BOYLE: Oh, yeah, you can think about 25 it. You don't have to answer it now. 1 But, I mean, if you could talk to your fellow 2 prosecutors, of a way. 3 And I understand, you're absolutely right, 4 we're not going to arrest our way out of this 5 epidemic. 6 But, there are some situations, and we had 7 one in our county: There was a guy caught with over 8 600 bags of heroin, and they could only charge him 9 with a misdemeanor, based on whatever circumstances 10 it was, you know. 11 We can't have things like that. 12 And I understand Philip Seymour Hoffman had 13 77 bags in his apartment. I know 14 Philip Seymour Hoffman was not dealing drugs. 15 So how we make that line, is the question. 16 And any input you can think of, we'll be 17 happy to get the information. 18 DA DEREK CHAMPAGNE: Okay. 19 SENATOR BOYLE: Thank you, Derek. 20 SENATOR LITTLE: I've one question, Derek. 21 When you talked about the 22-year-old that 22 just gets listed as, you know, heart failure, or 23 something, there is no drug testing when someone 24 dies like that, and, suddenly? 25 DA DEREK CHAMPAGNE: We -- law enforcement 1 and -- actually, we just -- I just -- we just put in 2 place in Franklin County, last week, that we have 3 asked the department of health to go and, 4 essentially, look behind each death certificate. 5 So our department of health is making the 6 added effort to, basically, call and see what goes 7 on. 8 But, no, we've had -- well, there's typically 9 a toxicology, but, unless there's an active criminal 10 investigation, or there's circumstances surrounding 11 the death that would warrant a full-scale criminal 12 investigation, we honestly, Senator, never hear 13 about it. 14 I mean, quite often, because we're a small 15 county, we hear: Oh, there was a drug overdose in 16 St. Lawrence County. 17 I've a situation right now that, 10:00 last 18 night I received a call, where we have a young man 19 who was deceased. 20 There's is -- that's the belief. 21 But, no, if we don't look into it, or the 22 department of health doesn't look into it, we had 23 nothing in place in our county. 24 And my concern is, what are the other 25 61 counties doing as well? 1 SENATOR LITTLE: Right. 2 SENATOR BOYLE: One other quick question. 3 I was reading some of the media reports on 4 the heroin situation up here in the North Country, 5 and I saw several arrests on Suboxone. 6 Are you finding that, too, that it's being 7 used -- I mean, I know some people deal it as part 8 of their heroin addiction. 9 Are you finding an increase in that, as well? 10 DA DEREK CHAMPAGNE: Suboxone, we've seen a 11 lot more selling of Suboxone. And we have had a 12 couple of cases where it's being sold, to go ahead 13 and, you know, support their other addictions. 14 Yes, definitely. 15 SENATOR BOYLE: Thank you very much. 16 SENATOR LITTLE: Thanks very much. We really 17 appreciate it. 18 So our next speaker is going to be our own 19 Clinton County District Attorney, Andrew Wylie. And 20 he has with him, Shawn McKeen, and Detective Bell. 21 And I would ask that we have no photographs 22 of the detective or no video of the detective while 23 he is here. 24 I would ask you to please respect that. 25 DA ANDREW WYLIE: (Speaking off video.) 1 Senators, I want to thank you for the 2 opportunity to be here today. 3 It's nice to, uh -- I guess we haven't 4 formally met Senator Boyle, but we can do that 5 afterwards. 6 With me today, I do have 7 Detective Matthew Bell, who's with the 8 Adirondack Drug Task Force, the Plattsburgh City 9 Police Department; as well as, Shawn McKeen. 10 And I think what we'd like to do is, to 11 present more of a storyline of a heroin addict; how 12 it's impacted -- or, how it impacts his life, and 13 give you kind of a brief history of what we've had 14 here in Clinton County. 15 Before I move on to Shawn's story, I'd like 16 to just touch base with what we've been seeing here 17 in Clinton County over the last four or five years. 18 Heroin, in Clinton County, as in most of the 19 North Country communities, has increased over the 20 past four to five years, very drastically so here in 21 Clinton County, as far as our prosecutions. 22 There was a point in time, and Shawn may be 23 able to discuss this as well, that heroin -- heroin 24 is sold in -- referenced in "bindles" and "bundles." 25 A "bindle," we can use that as, let's say, 1 one bag. And a "bundle" is 10 bags. 2 So they're purchasing -- back in, let's say, 3 2009, 2010, they're purchasing a bag of heroin for 4 approximately $50; 5 Whereas, today, here in Clinton County, at 6 least, you can pretty much buy a bag of heroin for 7 about 25, to 30 dollars; 8 Where, it's sold down in New York City or in 9 the Syracuse area, or further south in the larger 10 communities, probably at 10 or 15 dollars a bag. 11 So they're, almost, a true heroin trafficker 12 is, basically, doubling their money. 13 And as DA Champagne mentioned, we find a lot 14 of these situations, where we have the addicts that 15 are making runs to Albany, they're making runs to 16 Syracuse, they're making runs to the city, New York, 17 or New Jersey, or even Boston, to buy the heroin, 18 and then coming back, selling what they can, to 19 continue their habit, and also feeding their habit 20 with the heroin that they buy. 21 So those are the situations that we're 22 looking at. 23 And I'll just show you, in 2010 -- we have 24 this chart, referencing: 25 Going back, from 2010, these are prosecutions 1 that have occurred in Clinton County over the last 2 four years. 3 And, we can see that in -- the blue graph 4 represents heroin buys, and the reddish graph 5 represents morphine. Both opiates. 6 And we're just focusing on these for today's 7 purposes, obviously. 8 But, we've had a drastic increase in that, 9 where you can see we've had -- in 2010, we had about 10 two prosecutions. And in 2013, we have over 11 40 prosecutions. 12 And those were a result of a drug roundup 13 that we had in December; the largest drug bust that 14 has ever occurred in the North Country. 15 And of the 60 individuals that were arrested 16 in December, 40 of them were relative to heroin, and 17 then the additional, morphine, as well. 18 We also have the synthetic opiates. 19 There's been a -- there hasn't been as large 20 of an increase in the prosecutions, with the 21 exception of 2013, with the number of arrests that 22 we did do in that December drug roundup. 23 But you can see, from the different synthetic 24 opiates that are here, what we find that -- is that 25 these individuals, such as Shawn, start off with, 1 and I think DA Champagne mentioned it, you'll have 2 an individual who is injured. They go to the 3 hospital, or they go to their doctor, and they are 4 prescribed some type of a controlled substance to 5 regulate their pain. They will then proceed from 6 that medication to becoming addicted to it. 7 And at some point in time, that addiction 8 leads to, they need something more to -- it's not 9 really, maybe, for the pain anymore; it's the 10 addiction. 11 And to satisfy that addiction, it's bumped up 12 to heroin and morphine. 13 And, that's where we're seeing a lot of these 14 overdoses that we've had. 15 Just within the last few weeks, we had a 16 young male who overdosed on heroin. 17 He was a star athlete at our local high 18 school. There were some injuries that he received. 19 Started with the pain medication, and then it just 20 grew to a heroin addiction, and overdosed and died. 21 So, we're really looking at, you know, trying 22 to see what we can do, on the law enforcement end, 23 to, obviously, prosecute the people that are 24 bringing it. 25 My main concern: 1 Not that an addict who is making trips down 2 south and bringing the heroin back here and selling 3 it in our community. That is, obviously, a large 4 concern of ours, and we will continue to prosecute 5 those individuals, as we can, with the appropriate 6 sentencing, involving mostly treatment. 7 But it's the drug traffickers that are coming 8 up here, just for the sole purpose of profit, 9 selling the heroin; and what it does to us. 10 And, so, in addition to each and every one of 11 the points that DA Champagne mentioned, we certainly 12 are looking for, as Senator Boyle mentioned: What 13 can we do to -- probably, these are the individuals 14 that you're referencing, of how can we impose 15 greater sanctions or penalties on these individuals? 16 And I think that's the one thing that we have 17 to look at, legislatively: To raise the penalties, 18 to show that, you know, this is not going to be 19 tolerated in New York State; whether it's here in 20 Clinton County, or whether it's in, you know, 21 Suffolk County, or Long Island, or out in Rochester, 22 or Buffalo area. 23 The last chart that I've is the opiate 24 blockers, and these are the drugs that we are seeing 25 being sold, as well: Methadone. And, Suboxone, 1 which you were talking about. 2 So, I know we've had, you know, issues here 3 with Clinton County, whether we were going to have a 4 methadone clinic placed here in the county. And 5 those are all issues that are still, you know, 6 coming up. 7 One of the things that, uhm -- treatment is 8 the biggest thing, I think, that we need, obviously, 9 for our addicts that are suffering from heroin 10 addiction, or some of the other synthetic drugs that 11 we have. 12 And, one of the things that we were 13 discussing, we've been discussing, is that we need, 14 probably, more localized treatment programs, and 15 lengthier treatment programs in our communities. 16 You know, we have a situation, where, we have 17 very limited facilities here locally. Basically, we 18 have, what, Canton-Potsdam facility is one inpatient 19 program, where you have an individual -- I'll just 20 use Shawn as an example: 21 He'll go to Canton-Potsdam. And he will, at 22 Canton-Potsdam, because there's no other facilities 23 there, he's going to meet up with somebody from 24 Rochester, or he may meet up with somebody from 25 Long Island, or he may meet up with somebody from 1 Syracuse. And through those connections that 2 they're making, they're making connections 3 throughout the state. 4 And while there, they're talking about their 5 heroin addictions. They're talking about where they 6 get their heroin from. 7 And, so, they're now they're receiving, you 8 know, new roads to travel, to seek out and find 9 heroin. 10 So, if we can have more facilities available, 11 which not only would prevent, you know, some of 12 those situations from occurring, it will also 13 provide open beds for individuals. 14 If I've an arrest today, and we make a 15 determination that this is an individual that needs 16 treatment, well, there may not be a bed available 17 for that individual for -- you know, for days or 18 weeks. 19 And, if there comes a point in time where a 20 bed becomes available, and they don't have 21 transportation to that facility, that becomes a 22 problem, too. 23 And we have -- I guess we don't have the 24 sheriff on our list, but, you know, Dave Favreau is 25 a prime example of being able to talk about the cost 1 that it is, you know, to house individuals at the 2 county jail, regarding, uhm -- if we use, just in 3 this situation, the heroin addicts. 4 I mean, we've talked about it before, with 5 meth. 6 But, dealing with what we have here today, if 7 we can have more facilities available for treatment 8 of these individuals, we're going to lessen the cost 9 of the counties at the jail, we're going to lessen 10 the costs of medical treatment that's going to be 11 required for the county to pay, through individuals 12 that are being detained at jail, when they should 13 really be in treatment. 14 You know, I don't have any issue with him 15 housing those drug traffickers that are coming up 16 from -- you know, from the city, or from other parts 17 of the state, that are just selling for their sole 18 purpose of profit, but that's where we're focused 19 on. 20 So those are the issues that I think are 21 important to bring out. 22 If you have any questions regarding those, 23 I'll be happy to answer those. 24 Otherwise, I would just turn this over right 25 now to Detective Bell. He can tell about some of 1 the law-enforcement issues that we have. 2 And then I'd like to you have a few minutes 3 with Shawn, which I think you will be very impressed 4 with his story. 5 SENATOR LITTLE: Thank you. 6 DET. MATTHEW BELL: (Speaking off video.) 7 Good morning. 8 My name is Matthew Bell. I'm a detective 9 with the Plattsburgh Police Department. I've about 10 17 years, a little more, working with the police 11 department, 10 of which now have been, primarily, 12 just narcotics investigations. 13 I started narcotics in about 2004. 14 And from about, 2004, to 2011, heroin, pretty 15 much, was $50, as Mr. Wylie said, a bag. 16 The terms are: A bag; or, a "bindle" is one 17 bag of heroin, a "bundle" is ten. 18 It was unheard of to buy a bundle, or, 19 10 bags, of heroin, from 2004 to 2011. It had never 20 been done before. It was always $50 a bag. 21 And, typically, from 2004 to 2011, as far as 22 Plattsburgh goes, you'd have a group of heroin 23 addicts, they'd get together, they would pool their 24 money, and they would either go to Utica, Albany, 25 Schenectady, or, a huge source was called the 1 "Red Hook Projects" in New York City. 2 And the lengths they would go to get the 3 heroin down in Red Hook Projects: 4 We went down there for an investigation as 5 part of the DEA, and the officers down there told us 6 not to get out of our cars, because they would throw 7 TVs off the roof at us if they knew we were 8 law enforcement. 9 So, typically, from 2004 to 2011, it was just 10 a group of people, they pooled their money, they'd 11 go down and get it. And we'd have, like, outbreaks 12 of heroin for, maybe, four, five, or six months, but 13 then we'd clamp down on it. 14 And -- as with, we had a rash of meth before, 15 now it's backed down a little bit. But, at this 16 juncture, the heroin is, it's unprecedented. 17 We could go out every day, buy, buy, buy. 18 As Mr. Champagne alluded to, our resources 19 are limited. 20 Right now, typically, we can buy a bag of 21 heroin, from between 20 to 30, maybe 35 if we're 22 buying it individually. 23 Our stats say, basically, to get a bundle, 24 or, 10 bags, of heroin in New York City, right now 25 it's $70. 1 So, if these individuals that are coming up 2 here to traffic per se, that's their main reason for 3 being up here. 4 If they spend $70, and they come up here and 5 they sell it as a bundle for 220, they're making 6 $150 profit. That's just on 10 bags; so, they're 7 doubling their money. 8 If they -- their $70 investment, if they come 9 up here and sell it as single bags, they're making 10 about $270. 11 So, it's just crazy, the amount of profit 12 these guys have; and that's what they're doing it 13 for at this point. 14 We're not seeing the local people travel down 15 as much, because they don't need to. They come 16 up -- it's everywhere. 17 Again, I had never purchased, until last 18 year, 10 bags of heroin at once. 19 In 2011, just to bring things home to us, 20 I had a mother and father contact me, and said: We 21 found something in the storage room of our house 22 where our 18-year-old child stores his stuff. 23 They brought me 599 bags of heroin. 24 This kid had just graduated from a local 25 high school here in Plattsburgh. 1 In 2012, for the very first time, we 2 purchased heroin from a Plattsburgh State University 3 student. 4 My previous eight years, nine years, we would 5 buy marijuana, sometimes a little cocaine, some 6 hallucinogenic mushrooms. Never heroin. 7 And, that 2012 buy of heroin is just the 8 beginning. They're doing it now, it's so lucrative. 9 And, as Mr. Champagne alluded to, I think the 10 pharmaceutical companies have done a really good job 11 in making the oxycodones and OPANAs and other drugs, 12 the morphines, that the addicts would crush and 13 shoot, difficult to do. 14 And I think Shawn will allude to that. 15 Right now, our intel is telling us, Albany, 16 Schenectady, and New York City are our main sources. 17 Our investigations are very difficult. We're 18 here in Plattsburgh; I can't go out and buy heroin. 19 Pretty much, the only people that can go out 20 and buy heroin are people that use heroin. 21 Again, Mr. Champagne alluded to the fact: 22 I've got -- or, the task force, as a whole, 23 we might have five or six different people that, 24 mainly, they're just buying the heroin for us, as 25 confidential informants, because they've been 1 arrested. And between their attorneys and the 2 District Attorney's Office, they're trying to work 3 charges off. 4 But the big thing is, a heroin addict is not 5 going to go out and buy heroin for you during a 6 controlled buy, unless he's got somewhere else, or 7 she's got somewhere else, to get more heroin from. 8 Prior to working at the City Police 9 Department, I worked at the Sheriff's Office for 10 five years, and I've seen people that are -- the 11 term is "dopesick." And, I've seen it. 12 I think Shawn will get into it. 13 It's horrible. These people will do anything 14 they can to not be dopesick. 15 Probably, I don't know, it was about 16 five years ago, we had some individuals that were so 17 sick, in broad daylight, they went to Kinney Drugs 18 here in Plattsburgh, with knives, jumped over the 19 counter, into the pharmacy, and demanded narcotics. 20 If that's the only good thing that heroin's 21 done here, the pharmacies aren't really a target 22 anymore, because the people don't need to break into 23 the pharmacies because heroin is so available to 24 them. 25 So our investigations are very difficult. We 1 have to use informants that are addicts. 2 And, I'd be fooling myself, or anyone else in 3 this the room, if I said, I didn't have any 4 indication that, after we got done this control buy, 5 and we got the heroin from the person, that they 6 probably weren't going to go back to that same 7 individual later on in the day and buy heroin for 8 themselves; because, it's a sickness that I, 9 obviously, can't describe. 10 As far as getting into -- obviously, I'm 11 law enforcement. Obviously, people do need help. 12 We had an 18-year-old, the other day. We 13 were doing a surveillance on a house that we knew 14 they were dealing heroin from. 15 We followed her. We lost her for a few 16 minutes. And we pulled up to the car, 18 years old, 17 and as I got to the car, she had a needle loaded 18 with heroin and was right about to inject herself 19 with it. It was right in front of her apartment 20 complex. Her mother and her 12-year-old sister were 21 witness to this whole thing. 22 As far as penalties go, you alluded to 23 50 bags is a felony. 24 I guess the North Country's a little bit 25 different than Albany, New York City. 1 50 bags of heroin here, we're charging a 2 B felony: criminal possession with intent to sell. 3 Again, as I've said, the majority of this 4 heroin is not coming from Keysville, New York, or 5 Westport, New York. 6 I think it would be very good to try to enact 7 some type of legislation that, uhm -- put a mileage 8 on it. 9 We have all kinds of resources, that I'm not 10 going to get into, that we know exactly, sometimes, 11 when these people are leaving Albany, when they're 12 leaving Schenectady, when they're leaving 13 New York City. 14 Why not put a mileage on it? 15 If you travel more than 60 miles, either with 16 a narcotic drug with the intent to sell it, and we 17 can articulate and prove that in court, why not -- 18 right now, the biggest penalty is a Class B felony 19 for a sale, if it's -- weight-wise, if you don't get 20 over a half ounce or more. 21 Why not enact some type of legislation: If 22 you are coming up here for the sole purpose of 23 selling this, either bump that up, regardless of the 24 weight, to an A-II felony; or, possibly doubling the 25 sentencing guidelines? 1 And, if anything, if we can charge this, and 2 these people get into court, minimum they're going 3 to have to do is take the stand and say: Okay, 4 I transported this up here, but I didn't transport 5 it 60 miles away. 6 I mean, they're going to have to -- you have 7 a defendant, and if we can articulate that, I think 8 it would be a -- very good for us in the North 9 Country. 10 I said, we have ways to tell when they're 11 coming. We're not going to, obviously, get into 12 those ways. 13 But, either doubling sentencing guidelines, 14 or upping it, if they're bringing it up here, 15 regardless of the weight. 16 SENATOR LITTLE: Thank you. 17 Wow. That is... 18 DET. MATTHEW BELL: I'll introduce Shawn, 19 quickly. 20 Shawn and I met in 2004. And, you guys can 21 all probably figure out how Shawn and I met. It 22 wasn't -- we weren't going out to have lunch 23 together. 24 I think, probably, in 2006, I actually took 25 Shawn -- myself, and another detective, that's since 1 retired, actually drove him to Canton-Potsdam for 2 rehab. 3 You know, we realize it's not just throwing 4 the cuffs on people, but people do need help. 5 But, Shawn and I met in 2004. You know, we 6 stayed in contact then. And, you know, I've tried 7 to help, you know, friends of his out. 8 And I think, when you guys listen to Shawn's 9 story, you guys are -- your eyes are going to, you 10 know, be widened greatly. 11 So, this is Shawn McKeen. 12 SHAWN McKEEN: Hi. 13 First, I want to thank Mr. Wylie and Mr. Bell 14 for asking me to come speak here. 15 It's an honor and a privilege to be able to 16 share my experience and my story. 17 You know, this really hits home for me, not 18 only because of my experience with opiates or 19 heroin, but because I've seen many of my friends get 20 lengthy prison sentences, and I've seen loved ones 21 of mine die. 22 I grew up in Plattsburgh, middle-class. My 23 mom was an accountant, and my dad worked for the 24 City. I had a really good childhood. There was no 25 abuse, no neglect. Not a broken home. 1 I had a really good life. 2 When I was in my early 20s, I was 3 prescribed a pain killer, hydrocodone, for a pinched 4 nerve in my neck. 5 And I can't explain what happened when 6 I began taking it. I don't know why some people can 7 take it and be okay, and why some can't. I don't 8 know, chemical reaction? I really don't know. 9 I just know that, from the moment I first 10 took hydrocodone, that euphoric feeling that it gave 11 me, I clung to it. What it gave me was so amazing, 12 the euphoria, the confidence, I felt, or at least 13 I thought at the time, I was a better worker, a 14 better son, a better father, a better employee, a 15 better student, while on this medication. 16 And it went like that for a long time. 17 I didn't really -- when I would see friends stealing 18 from their families or from each other, I would kind 19 of, you know: Who does that? You know, who steals 20 from your family? You have serious problems, you 21 know? 22 And I came to realize why they were stealing 23 from their families, because it's only a matter of 24 time before the drugs turn on you. The first time 25 you have to go without them; when you run out of 1 your prescription, or, you're cut off by your doctor 2 because he knows you're abusing them, or, when the 3 dose that you started off on is no longer working. 4 It happened to me really quickly, and 5 I progressed to, at the time, there was a big craze 6 with Oxycontins. And I became addicted to 7 Oxycontins, and I stuck with Oxycontins for quite a 8 while. 9 But I can't stress that, see, withdrawal is, 10 there's two pieces to withdrawal: 11 There's the physical aspect of it, which is 12 horrible: diarrhea, vomiting, muscle cramps, 13 lethargy, no motivation, hot flashes, cold flashes. 14 Then there's the mental component: the mental 15 obsession, the mental cravings, that don't go away. 16 Even when the physical is gone, the mental 17 stays. The brain never forgets that euphoric 18 feeling. 19 After a while, using isn't fun anymore. It's 20 more necessary to survive. 21 I got clean in 2008. 22 And, when I first -- I'm going to jump back. 23 When I first was into Oxycontins and 24 hydrocodones, in Plattsburgh, there was never really 25 heroin around. 1 If you could find it, it was $50 a bag, and 2 you usually didn't want to do it because you didn't 3 know what you were getting. Sometimes it could be 4 really good; other times it could be not good. 5 So, I got clean in 2008; and, I graduated 6 from college, and I got a job as a counselor. And 7 there were some circumstances that happened in my 8 life at that time, in 2010, where I relapsed. 9 And when I relapsed, I noticed that these 10 pharmaceutical companies had revamped their 11 formulas. You could no longer abuse Oxycontin or 12 OPANAs. You couldn't crush them up; you couldn't 13 shoot them, you couldn't snort them. 14 And that's when I noticed that it was no 15 longer pharmaceuticals that were in this town. It 16 was heroin, and no longer was it $50 a bag. It was 17 20 to 30. And, you could buy as much of it as you 18 wanted. There were -- there are so many dealers, 19 that they're in competition with each other now, so 20 they have to offer cheaper prices and have better 21 quality. 22 You know, the sickest part of this is, when 23 I would -- you know, in active addiction, when 24 I would hear stories of heroin killing people, or 25 hurting them, you know, overdosing, that's the 1 heroin that I would want, because I know it's good. 2 That's sickness, that's insanity. And 3 I would do anything to get it. 4 You know, the best way I can compare it is 5 like a Dr. Jekyll and Mr. Hyde. 6 When I'm clean and sober, I'm a good member 7 of my community. I help my family out. I'm a good 8 employee, a good student. 9 When I'm actively using opiates or heroin, 10 I'm a monster. I will steal, I will lie, I will 11 snitch, I will cheat, I will break into my grand -- 12 anything I can do, just because the physical and 13 mental component to withdrawal is so horrible. 14 Sorry, I'm really nervous. 15 SENATOR LITTLE: That all right. Take your 16 time. 17 SHAWN McKEEN: So, with talking about the 18 withdrawal: The first day getting through it isn't 19 usually as bad as the next day. But when day two or 20 day three or day four come, that's when I'm ready to 21 rob a pharmacy, rob a house, rob my friends. 22 Really, rob anybody. 23 Thank God I've never had to resort to 24 violence to ever acquire a drug, but I'm sure that 25 that's not that far away. 1 You know, being a heterosexual male, and 2 thinking, could I do a homosexual act to get this 3 drug? 4 It's sick. A sickness. 5 Nobody enjoys it after a while. Addicts 6 don't enjoy it. 7 We do at first; it's fun at first, you know. 8 But after a while, it's not fun. The things 9 you have to do, the desperation that comes with it; 10 the despair in your mother's and father's eyes, 11 I wouldn't wish it on anybody. 12 And how bad heroin is up here, it's on every 13 street corner. It's not just people from, you know, 14 poverty that are doing it. It's not low-economic or 15 socioeconomic backgrounds that struggling with it. 16 It's middle-class America. 17 It's kids that I went to school with, that 18 graduated from Rutgers, from Clemson, that are into 19 this stuff. It's not just people that are poor. 20 It's affecting this whole county and everybody in 21 it, one way or the other. 22 I've been clean again for almost a year. 23 May 27th, I'll have a year clean again. 24 And, I'm getting ready to graduate from 25 Plattsburgh State University. 1 And, so, my story is kind of a happy one 2 right now, but everybody's story isn't happy. 3 There was a picture... 4 DET. MATTHEW BELL: Do you want the picture? 5 SHAWN McKEEN: Yeah. 6 This is Anna. 7 Anna was a girlfriend of mine for 8 three years. She was from Venezuela. She was so 9 beautiful, so smart; the type of girl to walk in a 10 room and everybody would looked because of how 11 bubbly she was. A true gem, in every sense of the 12 word. 13 Anna was also -- struggled with opioid 14 addiction. 15 And we met in a Narcotics Anonymous meeting. 16 And, we dated, and fell in love. 17 And Anna found out, in 2010, that she had a 18 rare kidney disease, hereditary. Her father had had 19 it, and it killed her father. 20 And when she found out she had this kidney 21 disease, we both were devastated, because of how 22 young she was, and because it was a death sentence. 23 There was nothing they could do besides slow it 24 down. 25 We both relapsed. 1 And, how we had met these connects to get our 2 heroin, was when we were both in rehab, going from 3 rehab -- in Plattsburgh, there isn't one around 4 here. 5 So, if you don't have private health 6 insurance, you're not going to go to a very 7 prestigious place. You're going to end up at a 8 pretty big facility. There are some downstate. 9 And me being from the North Country, going 10 down there, I was put in with a bunch of folks that 11 were from Syracuse, Albany, New York City. 12 Like Mr. Bell and Mr. Wylie touched on, this 13 is where we meet our connections. There is no rehab 14 facility in this area. 15 So when we do get help, and we're fortunate 16 enough to get help, we get to these rehabs, and we 17 talk about how much we're paying for heroin in the 18 North Country. And other people hear this, and 19 they're amazed, they're astonished, that somebody 20 would pay $30, 40, upwards of 50 dollars, a bag. 21 And that's how that deadly cycle begins. 22 In 2012, I was arrested for a DWAI, and I was 23 given the opportunity to go out to Rochester and 24 live in a halfway house, and get clean again. 25 And I made the decision to do that. 1 When I was gone to Rochester, Anna's health 2 deteriorated, and she ended up passing away. 3 And, I didn't want to share a lot about Anna 4 because it's really emotional for me, but I just 5 want to end with: 6 She would choose, instead of -- she had to go 7 to dialysis to survive, to clean her blood. And the 8 withdrawal was so bad, even knowing that if she 9 skipped dialysis, her potassium levels could rise 10 and it could kill her, she would make the decision 11 to skip dialysis to go get high, knowing she could 12 die. 13 But the withdrawal, on top of that physical 14 and mental obsession, was so strong, that it 15 eventually led her to skipping dialysis, and having 16 a heart attack and passing away. 17 And while my life is good right now, there's 18 no guarantee that Mr. Wylie won't be prosecuting me 19 next year for a crime. 20 Because it never goes away. I still crave 21 it, I still think about it, I still miss it. 22 Even knowing the devastation it will cause in 23 my life, even knowing that to use is to die, and not 24 just physically; mentally, spiritually, emotionally; 25 I still think about it, I still fantasize about it, 1 I still miss it. 2 And the worst part is, that it's everywhere 3 up here, and it's so easy to get. 4 No matter how much, or how good of a job 5 these guys do with locking people up, you see the 6 same people that get out of prison and go right back 7 to it. 8 You see people that are coming up, it almost 9 seems by the bus load, from places like Albany, and 10 the city, you know, that are preying on the weak. 11 I think it would really help this area if we 12 had an inpatient rehab facility. 13 I know that they've done, you know, work with 14 methadone and Suboxone, and I think that has its 15 place, as well, but that's not the solution. That's 16 putting Band-Aid on a wound that needs stitches. 17 We need an inpatient program up here; or at 18 least a detox unit. 19 Thanks for letting me share. 20 SENATOR LITTLE: Shawn, I just want to say, 21 it took a lot of courage, and I really admire you 22 for coming here and telling your story, and it 23 definitely is an eye-opener. 24 But, you will be in my prayers, that you can 25 continue, because you certainly -- I just admire you 1 for coming here. 2 Thank you so much for being here and sharing 3 your story. 4 SENATOR BOYLE: Thank you, gentlemen. 5 Thank you Shawn, very much. 6 I appreciate the fact that you say there 7 needs to be treatment centers, and that's one of the 8 things we're working on now. 9 We did include some funding in the last 10 budget for an expansion of treatment facilities, 11 but, for an area in North Country to have something 12 like that, to help Shawn, and others, is vitally 13 important. 14 I was interested, you talk about the price 15 here. 16 I'm from Suffolk County, and what we saw was, 17 after the I-STOP legislation on prescription drugs, 18 the price of an oxycodone pill, for example, went up 19 to $30, but a bag of heroin is $6. 20 So I can imagine, and I appreciate your 21 telling me this, that when you go to rehab, down, 22 and talk to downstaters, these drug dealers are the 23 people who maybe get addicted, and realize they can 24 sell a bag of heroin for that much more money 25 upstate, they're coming upstate. 1 And, I love the idea of a mileage limit, and 2 I think that that would be a good piece of 3 legislation, to say: You're not traveling -- if 4 you're an addict, you are not traveling 5 60 miles-plus to just take it yourself. You're 6 selling it. 7 And I think that's a good idea for 8 legislation. 9 DA ANDREW WYLIE: Just in closing on that, 10 with what Detective Bell said: 11 For the 8-plus years that I have been a 12 prosecutor here in Clinton County, it's very common 13 to see these dealers come up here to Clinton County. 14 An investigation, you know, commences; we do 15 an indictment, we do an arrest. 16 And, I pull their rap sheets, and we look at 17 their rap sheets, and they have -- you know, they 18 have several previous convictions. It could be for, 19 you know, an arrest for Criminal Possession and 20 Criminal Sale of a Controlled Substance, 3rd; 21 whether it's cocaine, whether it's heroin, and, down 22 in the city areas. And, their sentences, they're 23 reduced down to misdemeanors, and they're given, you 24 know, a slap on the wrist, basically, and they find 25 they can, you know, profit so much here in 1 Clinton County. 2 And I guess it's always, you know, I've said 3 it more than once to many criminal defendants, 4 I said: You're not in Kansas anymore. You know, 5 this is Clinton County. You're here for the sole 6 purpose of trafficking, whether it's cocaine, 7 whether it's heroin, whether it's, you know, some 8 other opiate, and, we're going to prosecute you for 9 that, and we're going to send you away for that. 10 When it comes to the individuals that are the 11 addicts, like Shawn, we try to find avenues to help 12 them. 13 And that's what we do in Clinton County. 14 SENATOR LITTLE: You know, working together, 15 I think we do need something, and I will make that a 16 priority. And, immediately can think of, in 17 Skylar Falls, the buildings, the state buildings, 18 that are sitting there empty. 19 So, we have a place, and I'll do my best. 20 So, thank you. 21 DA ANDREW WYLIE: Thank you, Senators. 22 SENATOR BOYLE: And, District Attorney, real 23 quickly: You did mention the fact that, the 24 multiple convictions. 25 We had a forum in Putnam County last night, 1 and we had a defense attorney saying: It's 2 ridiculous what they're giving my clients, in term 3 of lenient consequences. 4 He had one -- one defendant, one client of 5 his, 30 misdemeanors. 6 He says: You know, you have a third DWI and 7 you're getting a felony charge, perhaps. 8 We gotta do it for drugs as well. 9 Thank you very much, gentlemen. 10 Good luck, Shawn. 11 SENATOR LITTLE: Thank you. 12 [Applause.] 13 SENATOR LITTLE: And our next speaker is 14 Dr. Kathleen Camelo, who is the director of the 15 Center for Student Health and Psychological 16 Services. 17 I'm assuming at SUNY Plattsburgh? 18 DR. KATHLEEN CAMELO: Yes. 19 SENATOR LITTLE: Thank you. 20 DR. KATHLEEN CAMELO: Thank you, Senators. 21 I really do want to thank you for the 22 opportunity to address your Task Force, on behalf of 23 our campus at SUNY Plattsburgh, and on behalf of our 24 Center for Student Health and Psychological 25 Services. 1 As we already know, OASAS estimates that 2 1.9 million residents, age 12 or older, experience 3 substance dependence or abuse, and this number 4 actually includes 153,000 adolescents. 5 Our community is not immune to this growing 6 problem. 7 So what is the scope of opioid, heroin, and 8 illicit-drug use on our campus? 9 Our recently hired AOD Coordinator, 10 Patrick Minnet [ph.], who is a certified alcohol- 11 and substance-abuse counselor, has experienced the 12 same level of addiction on our campus as in the 13 community. 14 In the previous two years, we have had at 15 least 150 to 200 student visits to our previous 16 alcohol-and-other-drug coordinator for assessments 17 and counseling. 18 Currently, we are awaiting the results of the 19 Campus Course Survey, which is a tool that's 20 developed specifically to assess alcohol and 21 substance use on the college population. 22 Once we receive these results, our 23 alcohol-and-other-drug coordinator will convene our 24 Alcohol and Drug Campus Task Force, to analyze these 25 results, discuss and update targeted prevention 1 programming and social-marketing campaigns, to 2 address those areas of greatest use and abuse. 3 We really need to focus on prevention, as 4 well as treatment. 5 In addition to programming, we really need to 6 train our residence-hall staff, and we are expanding 7 that training, so they can recognize substance abuse 8 and use in their peers, and refer those patients for 9 treatment and counseling. And we are doing this. 10 We continue to educate our center staff, our 11 physicians, our counselors. 12 And, recently, we had Champlain Valley Family 13 Services provide an in-service on training on heroin 14 and opiate use to our center staff, which includes 15 counselors and medical professionals. 16 Our center is actually one the first centers 17 in the SUNY system to combine health, mental-health, 18 and alcohol- and substance-abuse services in one 19 center. And we really want to provide a 20 comprehensive, holistic approach to the health and 21 wellbeing of our student population. 22 Our center is actually housed with university 23 police; we're in the same building. And that's 24 actually helped us to create a very good working 25 relationship with the university police. 1 Daily, we are informed, our center, of any 2 911 transports of our students to CVPH if they've 3 experienced any alcohol intoxication or any 4 suspected drug overdose. 5 We are then able to proactively contact these 6 students and offer our services in a timely manner. 7 Our dean of students is also made aware of 8 these students if they are charged with violating 9 the code of conduct. 10 So at Plattsburgh State, if you have an 11 alcohol intoxication or a drug overdose suspected, 12 you will actually be violating an "endangerment" 13 clause in the code of conduct; and, therefore, you 14 will get a judicial charge, and you will have to 15 meet with the dean of students, who then, at this 16 point, really will mandate UCR 17 alcohol-and-other-drug coordinator for an 18 assessment. And, hopefully, that will open the door 19 for continued treatment. 20 Our University Police Chief, 21 Arlene Sabo [ph.], is committed to the training of 22 our university police officers in the use of the 23 emergency Narcan kits, which our officers will be 24 available in the event that they are first 25 responders to see those students, if they've 1 encountered an overdose. 2 We know that this first response, if a 3 student or a patient has had an overdose, using 4 Narcan right away can save a life. 5 So, our university police are committed. 6 Our alcohol-and-other-drug coordinator is 7 also currently creating a listserv, where we are 8 actually looking at SUNY AOD coordinators across the 9 SUNY system, so that we can meet together and 10 discuss ideas on best practices in addressing 11 alcohol and substance abuse on our campus. 12 And this group will actually be having their 13 first meeting at Plattsburgh State, since we are 14 actually hosting the College Counseling Centers of 15 New York Annual Conference, and they will be meeting 16 together to share ideas. 17 And, again, Patrick has spearheaded that. 18 Our athletic department actually realizes 19 this isn't -- obviously, we have within our 20 athletes. And, actually, that decreases their 21 performance, if they have been using alcohol or 22 substances. 23 They actually just received a grant from the 24 NCAA, for the purpose of the grant, is to provide a 25 framework to address alcohol and related behaviors, 1 using research-based initiatives, and focusing on 2 student athletes and residence-hall students. 3 Our students don't drink and use drugs in 4 isolation. They do this behavior with their peers, 5 so we can't just target one group. 6 As you are very much aware, our campus is 7 located in the City Center. 8 And, in 2003, our Center of Student Health 9 and Psychological Services applied, and received, a 10 small grant from OASAS to create a campus and 11 community partnership. 12 Over the past 11 years, the partnership has 13 had members from key stakeholders, including the 14 college campus, Clinton Community College, campus 15 and city police, local government officials, school 16 districts, Champlain Valley Family Services, 17 Behavioral Health Services North, and interested 18 parents of school-aged children. 19 The purpose of the partnership is to address 20 our communities' needs. 21 Alcohol and substance use has been a priority 22 for the partnership, and with this key framework in 23 place, we were eligible and received grant funding 24 from OASAS in the past, to establish a social 25 norming campaign, to address alcohol use in the 1 18- to 25-year-old college population and workforce. 2 And in addition, because we have this 3 partnership in place, it makes us eligible for other 4 grant funding. And we did receive a 5-year, 5 500,000, drug-free community grant, to focus on 6 alcohol and substance use specifically in the 7 18-and-younger age group. 8 We are currently in the final year of that 9 grant, which will end on September 23rd. 10 Funding from OASAS for grants to prevent 11 substance use and abuse and treatment in the college 12 population has been severely cut. 13 And if we have opportunities, our task force 14 and our partnership will apply for those grants, and 15 continue these programs so that we can continue to 16 work on this growing problem. 17 Finally, our center, in talking about 18 treatment, and the need for continued treatment and 19 more extensive treatment, our center, with the 20 assistance of our AOD coordinator, and with the 21 support of the director of community services, 22 Sherry Gillette [ph.], campus administration, and, 23 of course, OASAS, is in the process of partnering 24 with Champlain Valley Family Services, under the 25 directorship of Connie Wille, to provide 1 comprehensive outpatient treatment services for our 2 students experiencing alcohol and substance abuse 3 and dependence. 4 Our students like don't like to leave campus. 5 They actually like our services, but, they oftentime 6 need more treatment. 7 So this service will be provided on campus by 8 Champlain Valley Family Services' staff. And we are 9 waiting funding approval -- the final approval from 10 OASAS, and their support. And we will actually be 11 the first SUNY comprehensive college partnership 12 with a community service. 13 So, hopefully, this is something that will 14 happen across other SUNY campuses, with us taking 15 the lead. 16 As we heard from Shawn, we have students that 17 are in withdrawal. And, unfortunately, it's very, 18 very difficult for family members, or for anyone, to 19 actually try and care for someone when they're 20 experiencing such severe withdrawal symptoms. 21 So, again, I guess I reiterate, that we 22 really do need a treatment facility for 23 detoxification. 24 It's that time when the student comes to you 25 and says, "I want to quit"; yet, they're in the 1 midst of withdrawal. 2 And if you can't help them, again, as we 3 know, they'll fall by the wayside and start 4 searching for drugs. 5 And it's very hard for a caregiver. 6 And, also, I think we need to look at 7 insurance coverage. 8 Although we have insurances that will pay for 9 alcohol detoxification, because it's considered a 10 life-threatening illness, or withdrawal, we're -- 11 insurances will not cover detoxification -- 12 inpatient detoxification. 13 So I think that's one other area that we 14 really need look at. 15 So, we're looking to you for increased -- 16 helping to find us funding, and helping us with our 17 treatment and prevention efforts. 18 So, thank you very much. 19 SENATOR LITTLE: Thank you. 20 SENATOR BOYLE: Thank you. 21 Doctor, a quick question: Could you just -- 22 how much are the grants you're talking about, from 23 OASAS, that you receive? 24 DR. KATHLEEN CAMELO: Actually, we received a 25 $250,000 grant in the past. And that was working, 1 again, with the 18- to 25-year-old college 2 population, and the workforce, again, knowing that 3 these two groups, you know, intermingle, and we 4 can't just work with one group and not the other. 5 So, $250,000. 6 The original seed money to start the 7 partnership was around 8,000 to 10,000. 8 SENATOR BOYLE: All right, very good. Very 9 good. 10 DR. KATHLEEN CAMELO: But we have the man 11 force, we have the power; we continue to need the 12 funding. 13 And, of course, no budget cuts, et cetera, 14 may have made that difficult. 15 So thank you for your time. 16 SENATOR BOYLE: Thank you. 17 SENATOR LITTLE: Well, thank you for all that 18 you're doing at SUNY Plattsburgh, in recognition of 19 the needs that are there. 20 Thank you. 21 [Applause.] 22 SENATOR LITTLE: Next we're going to hear 23 from Michael Kettle, who is an RN, BSN, and CASAC 24 counselor. He is director of regional services of 25 Conifer Park. 1 He came up today from Broome County; so, 2 thank you. 3 And, Joseph LaCoppola, who is also from 4 Conifer Park. Thank you. And he is from the local 5 area. 6 So, thank you. 7 MICHAEL KETTLE: Good morning, 8 Senator Little. Good morning, Senator Boyle. 9 Thank you so much for hosting this 10 Task Force, and others around the state. 11 It's clear that this is not just limited to 12 this area, but it's a statewide epidemic right now, 13 and I believe it's a nationwide epidemic right now. 14 I'm here today representing Conifer Park, but 15 I'm here on behalf of three people, as well: 16 Phil Graham, and Andrea, and now, Shawn. 17 I want to thank Shawn for sharing his 18 experience, strength, and hope with this group. 19 As all folks who find the strength and the 20 courage to not remain anonymous, that's the stories 21 that you need to hear more of, and there's lots of 22 those stories out there. Those are success stories. 23 These people that have found treatment, or found a 24 way to discover recovery; and whatever that means to 25 them. 1 I've been in health care since 1980. 2 I'm actually an alumnus of Plattsburgh State. 3 And, I've been in the addictions field for 4 30 years. I've been with Conifer Park for 26 of 5 those years. 6 One year into the field of addiction, and 7 I didn't know a whole lot, but I had a family member 8 that found recovery. 9 Actually, I have three generations of 10 recovery in my family: father, brother, and a 11 nephew. 12 I know treatment works. 13 But I know the end result, if it doesn't 14 work, or if people don't have access to treatment. 15 And it's death for many people. 16 One year into the field -- I had worked in 17 the ER for 4 1/2 years, and then stepped into an 18 addictions-field position at this hospital I was at. 19 But I got a call from a colleague of mine 20 I had worked with, and went to college with, had 21 meals with his family. 22 What I didn't know about him, is that he was 23 a recovering heroin addict. And once he got his 24 nursing license and started to work in the OR, he 25 had access to narcotics unlike ever before. 1 But I got a call from him, as a reference, 2 could he come over and work at our ER, that I had 3 just left. 4 I said, "Absolutely." Didn't hesitate. 5 Within two months, I was getting a call from 6 the head nurse, saying: Mike, I'm wondering about 7 this Phil you recommended. We're -- we're -- our 8 narcotic counts are off. He always got a story. 9 Clearly, what had occurred, he had relapsed. 10 We got him into treatment, and, six months 11 later, he was dead from an overdose. 12 He found a way into a hospital in 13 Upstate New York, got access to a prescription, and 14 that illness that never left him, and it never 15 does -- and I think Shawn made that very aware to 16 everybody in this room -- came back with a 17 vengeance. 18 So he left two sons and a wife behind. 19 Two years ago, I got a call from a very good 20 friend of mine, whose son played lacrosse with my 21 son. Great kid. Great sport. 22 He had had a sports injury, was prescribed 23 Vicodin, and off to the races. For whatever reason, 24 he became addicted. 25 Not everybody does. 1 He was in his second year at the university 2 locally, and he was on the street now, finding what 3 he could no longer get from his physician. 4 He's in recovery. He's one year two months 5 one day and probably 13 minutes clean right now. 6 The last young lady, and I'm going to 7 reference my phone here, only because, social media, 8 I believe, will have something -- a part to play 9 when we look at things that we can do. 10 Our young people today are text-savvy. 11 So, when we talk about prevention, we talk 12 about access to better knowledge, and what things 13 are out there as a resource, social media is there. 14 But this was an e-mail I received from 15 Andrea, just yesterday morning. 16 On our Web site, there are -- it's a 17 screening tool you can take, and there's ways to ask 18 for help, and we're happy, obviously, to try to do 19 that. 20 Her name: "I'm Andrea. I'm 19, and I'm a 21 student at OCC." 22 That's a community college. 23 "I've been addicted to pain killers, oxys, 24 hydros, et cetera, and marijuana and alcohol, since 25 I was 17." 1 I won't read her whole thing. 2 Her last statement to me: "This is really a 3 cry for help." 4 Phil was 42, Graham. 5 Two years ago, he is 23 right now, I believe. 6 But she was 17, and she's addicted. 7 And I say that, very importantly, that this 8 is an addiction. This is a different epidemic than 9 in the '60s. 10 And, heroin, I think today, a lot of people 11 still think of heroin as hippies and long hair. 12 That doesn't -- it's not there anymore. 13 These are younger people dying today, for sure. 14 So I'm here on behalf of Conifer Park. We 15 are a chemical dependency provider; have done so for 16 30 years. 17 We do offer medically-supervised detox, adult 18 rehabilitation, and adolescents, over two hours away 19 from here. And we do provide those services to 20 people in this community, as best we can. 21 We provide medication-assisted treatment 22 through treatment, as well as many other 23 evidence-based practices. 24 We also have six outpatient clinics, one of 25 which is here in Plattsburgh. All of our 1 six locations offer medication-assisted treatment. 2 Recently, in the fall of November 2013, we 3 were granted a license from OASAS to provide 4 methadone in this area. We currently have 5 23 individuals on methadone. 6 We recently also got approved by the 7 Department of Health to provide Narcan training, and 8 to become certified to provide that training to 9 families and members of the community. 10 All of these initiatives, in the last year, 11 have been because, in the last three to five years, 12 the significant increase in opiate use we're seeing 13 come through the outpatient and the inpatient 14 sector, for sure. 15 Some problems that I'd like to identify, and 16 these are not -- these are not blameful problems, 17 these are not finger-pointing problems, but they are 18 reality today of what we face. 19 Treatment is one thing, but having access to 20 that treatment. And somebody mentioned the 21 insurance piece. 22 Access to all levels of care, with regards to 23 managed care and medical-necessity criteria, 24 resulting in denials and limited stays at 25 detoxification and inpatient levels of care, are 1 part of the problem. 2 The limited number of Suboxone X-licensed 3 physicians to continue dosing as many patients 4 complete our outpatient program who may be in need 5 of further medication-assisted treatment, is part of 6 the problem. 7 Narcotic-prescription practices vary from one 8 discipline to another, and many times results in 9 access of unused medication, and continued 10 prescribing, with no intervention for 11 substance-abuse treatment in the course of treating 12 the whole patient. 13 I have a colleague of mine whose mother was 14 just placed in a nursing home about a month ago. 15 She is a chronic-pain patient, and in the last 16 10 years, she has stockpiled her meds under her bed 17 because she would use one or two, three or four, and 18 then boxed up the rest. 19 I don't want to put a street value of what 20 was underneath her bed, but it certainly contributes 21 to some of the problems and issues that we're seeing 22 today; and that's supply and demand. 23 Some of the solutions, I just offer these, is 24 an insurance task force. 25 And some of these may actually be occurring 1 as we speak. 2 An insurance task force that brings insurance 3 providers, OASAS, and treatment providers together, 4 to establish and better define a standardized 5 medical and clinical necessity tool for all 6 inpatient levels of care, that promote access, 7 rather than restrictions, to care. 8 A collaborative initiative to bring hospitals 9 and primary-care practices together with alcohol- 10 and drug-treatment providers, to explore the 11 possibility of having a limited number of physicians 12 on staff who are X-licensed to be able to prescribe 13 Suboxone. 14 I can go to a hospital today and find 50 to 15 100 physicians that can write a prescription for an 16 opiate, but not for a prescription for Suboxone that 17 is evidence-based and shows that it can work for 18 some, but not for all. 19 To continue to build the upon I-STOP laws in 20 reducing the amount of narcotic prescription 21 medication that is being abused and prescribed. 22 And, lastly, to educate identified services 23 and implement SBIRT, which is a screening tool. The 24 acronym stands for "Screening, Brief Intervention, 25 Referral To Treatment." 1 And I'd like to see this in all hospital 2 emergency rooms, primary-care practices, and other 3 identified health-care settings, including college 4 medical-counseling centers. 5 So I'm grateful to hear some of the things 6 that are taking place here locally at Plattsburgh. 7 And, an attempt for earlier intervention and 8 education for those starting on the path to abuse. 9 Thank you. 10 SENATOR LITTLE: Thank you, Mike. 11 Joe. 12 JOSEPH LaCOPPOLA: Yes, good morning, 13 Senator Little; good morning, Senator Boyle. 14 And thank you very much for inviting us to 15 participate on this panel, and most importantly, 16 thank you for convening these hearings throughout 17 New York State. 18 I'm a CASAC. I've been in the field for over 19 23 years, and the majority of my career has been 20 working in medication-supportive recovery, assisting 21 patients and individuals with the disease of opiate 22 addiction, with either methadone or Suboxone. 23 New York State is in the midst of a 24 public-health crisis. As we know, the disease of 25 opioid addiction has no boundaries and does not 1 discriminate. It has destroyed families, and its 2 death toll continues to rise on a daily basis. 3 As you've heard at past hearings, the 4 increased use of illicit opiates has increased at an 5 alarming rate, and the implementation of I-STOP, 6 being that the intent was positive, has resulted 7 into this. 8 This is due to individuals that were getting 9 prescribed opiates and are abusing them, who have 10 been discharged from their provider's practice. 11 These individuals continue to need the 12 illicit opiates, not for the euphoric effect, but to 13 be able to function on a daily basis, as what we 14 heard this morning from Shawn. 15 When meeting with individuals in the act of 16 withdrawal, they compare it to having the flu times 17 10 to 100 times over; not only the physical, but the 18 mental-health piece to it. 19 Again, no one, and I repeat, no one wakes up 20 every day wanting to use the illicit opiate, as what 21 they tell us every day, is they just want to feel 22 normal. 23 Our patients seeking admissions are younger, 24 with the average age being 19 to 25. 25 They report their first use around the age of 1 15. 2 Many report that their illicit use was due to 3 the availability of the opiates in the home, and the 4 medicine cabinet became the new dealer. 5 They also report, that after being prescribed 6 opiates after a surgery, a dental procedure, or 7 injury, with many of the conversations, are 8 teenagers that have had wisdom teeth pulled, receive 9 a script for oxycodone, with three refills at 30 a 10 pop. 11 We don't have to tell you what happens after 12 that. 13 Patients reported, when the prescribed 14 opiates are not available, they quickly turned to 15 using heroin, and the dealers soon had a new market. 16 This, in turn, has caused the havoc in 17 communities due to the increase in crime, and also 18 the public-health concern due to increases in 19 infectious diseases like hepatitis C. 20 Throughout the state, our substance-abuse 21 programs have seen an increase in opiate admissions. 22 We at Conifer Park in Plattsburgh have been 23 no different. 24 In 2011, the total number of patients 25 admitted for opiates was 62, compared for 88 for 1 alcohol diagnosis. 2 In 2012, that number increased to 146, which 3 outnumbered alcohol admissions were at 88. 4 And in 2013, we now have over 120 admissions 5 for opiates. 6 This past November, as Mike reported, that is 7 addressing this, and being able to afford medication 8 treatment to everyone, assisted treatment to 9 everyone, we at Conifer Park opened the first new 10 methadone program -- I think this is significant to 11 hear -- in New York State in 18 years. 12 Again, in 18 years, this is the first new 13 program, the first located. 14 Any other time anybody wanted 15 medication-supported recovery methadone services, 16 would have to travel to Albany to receive that 17 treatment. There was no other program outside of 18 Albany. 19 This is the first, upstate, in this area, 20 ever. 21 The program is integrated in 22 medication-supportive recovery. 23 And let's make sure that that's clear today: 24 It's not just the medication. It's 25 medication-supportive recovery. 1 Patients are required to engage in treatment, 2 which includes individual and group counselings, and 3 at their first visit, it's strongly and thoroughly 4 talked to them in regards to, their participation is 5 mandatory. 6 Again, it medicationally supports them so 7 they can engage in treatment without experiencing 8 the cravings and withdrawals from opiates. 9 We as a treatment field need to embrace 10 medication-supported recovery. No other modality of 11 substance-abuse treatment has been studied and 12 researched. 13 The results clearly show better outcomes for 14 patients who participate in medication-supported 15 recovery than those who are not afforded the 16 opportunity to do so. 17 Too many times we hear, and also see, the 18 providers require patients to be free from all 19 illicit substances so they can remain in the 20 program. 21 To expect someone to engage in treatment when 22 they are experiencing cravings and withdrawals is 23 setting them up for failure, and possible death. 24 Also, our treatment field needs to embrace 25 the harm-reduction model. To expect any patient 1 that has used a substance, and to comply 100 percent 2 with an attendance agreement, is, again, setting the 3 patient up for failure. 4 We as a field need to take baby steps, meet 5 the patients where they're at, and the field has to 6 remind ourselves, this is not our treatment, but 7 it's the patient's treatment. 8 Another area that we have to look at is, not 9 all -- and, again, I want to be very clear -- it's 10 not all, but some court judges -- drug-court judges 11 and coordinators do not support medication-supported 12 recovery. They require patients to taper from the 13 medication before they can participate, and/or not 14 allow one to graduate from drug court, because they 15 have a belief that they're not completely free from 16 the illicit substance. 17 They do not, and I repeat, they do not 18 require an individual to taper off of their 19 medications for psychotropics for mental health, 20 and/or they do not allow -- they allow them to 21 participate with psychotropics for mental health, 22 and they allow them to participate with medications 23 for any physical-health conditions. 24 I believe that a legislation is needed that 25 would require all drug-court coordinators and judges 1 to participate in medication-supported recovery 2 in-service, and to be required to accept the 3 clinic's recommendations, which would include 4 medication-supported recovery if it is recommended 5 from a licensed OASAS medical facility. 6 [Applause.] 7 JOSEPH LaCOPPOLA: I conclude with some 8 recommendations that I believe, if acted on, can 9 immediately improve access to treatment and 10 assisting the public crisis -- the public-health 11 crisis. 12 One: Methadone programs are the only 13 outpatient substance-abuse treatment services that 14 have a patient capacity. 15 That means, when applying for a license, the 16 state agency, OASAS, says that you can only 17 have 100, or some programs only can have a capacity 18 of 300. 19 This, in turn, has led to patients being 20 placed on waiting lists, and as we know, many of 21 those patients may not live till their number is 22 called. 23 I believe it's unethical to have to tell 24 someone who is wanting treatment today, that: 25 Sorry, we have no available spots, but we'll be 1 happy to put you on a waiting list. 2 No other medical profession that treats 3 anyone for any diseases has a licensed capacity. 4 Programs who seek to have their capacity 5 increased, to meet the needs of the community and 6 patients, have to complete a lengthy application, 7 and a review process can take over a year by our 8 regulatory agency to approve. 9 I'm asking for a legislative action to 10 eliminate census capacity for all 11 methadone-treatment programs immediately. 12 Two: Methadone programs embrace all 13 medications, including methadone, Suboxone, and 14 VIVITROL, that address the disease of opioid 15 addiction. 16 We, the methadone programs, have the ability 17 to dispense Suboxone to patients, but are not able 18 to do so at this time because of the inadequate 19 reimbursement that is presently offered. 20 For a year and a half, the Committee of 21 Methadone Program Administrators, who I'm a member 22 of the board, has been working with DOH and OASAS to 23 agree on a reimbursement rate that adequately covers 24 the expense of the medication. 25 As of today, we still do not have an 1 agreement on that. 2 You have heard at these hearings that one of 3 the concerns, is some providers prescribing Suboxone 4 do not require patients to participate in treatment, 5 or do not even meet with the patients. 6 And another concern is the availability of 7 Suboxone on the streets. 8 By intervening, and asking that you 9 intervene, with DOH and OASAS to agree on a 10 reimbursement rate, will adequately reimburse 11 providers, increase access to treatment, and also 12 address the issues just mentioned. 13 Third, and, lastly: All methadone programs 14 in the United States are required to be accredited. 15 The programs, we pay for this, and are 16 reviewed every three years, and have to submit 17 yearly reviews, to ensure we're meeting the 18 compliance and standards. 19 Soon after they leave our programs, OASAS 20 comes in with their agency and does a complete 21 review of the programs that were just completely 22 just seen by the accreditation agency. 23 I am recommending legislative assistance, 24 that OASAS reviews be discontinued, or as we say, 25 the programs be deemed, and the savings that is 1 going to be -- the savings from this be reinvested 2 back into the budget for funding additional 3 substance-abuse treatment and prevention services. 4 I again thank you very much for having us 5 today, and affording us the opportunity to present. 6 SENATOR LITTLE: Thank you for some really 7 good recommendations, too. 8 Thank you. 9 SENATOR BOYLE: Thank you, gentlemen. 10 One question: You mentioned the Suboxone and 11 the VIVITROL. 12 Not being a doctor or a chemist, what do you 13 think is better? Or is it just on an individual 14 basis? 15 JOSEPH LaCOPPOLA: Totally an individual 16 basis, Senator. And that's one of the pieces that 17 we offered our program. 18 We don't make that decision at the beginning 19 when the person comes in for the intake. 20 That's between the doctor and the patient, in 21 deciding what medication would be best to assist 22 them. 23 SENATOR BOYLE: Okay. 24 MICHAEL KETTLE: There's some patients that 25 would not be a good fit for methadone and/or 1 Suboxone and/or VIVITROL. 2 But having those three as an option is a tool 3 that I think today we need. 4 And just -- I do have to hold this up. 5 When I worked in the ER for four years, I had 6 the opportunity to use Narcan/naloxone, to bring 7 somebody back from death's doorstep. 8 It worked 30 years ago. It works today. 9 I got this kit. I carry this in my car. 10 I got this kit from the Northern Tier 11 Providers Association that did a training back in 12 the fall of 2013, and I've kept this in my car 13 since. 14 Only because you referenced Broome County: 15 Our sheriff's department just got trained in the 16 last two weeks. They've had three lives saved, and 17 the last one was 23 years of age. 18 In a matter of two weeks. 19 "Two weeks." 20 SENATOR BOYLE: That's an excellent point. 21 And would I recommend, perhaps, a Narcan 22 training program up here. 23 As a former EMT, I've seen Narcan work, and 24 it truly is a miracle drug. 25 SENATOR LITTLE: [Unintelligible] was 1 trainer. Is that right? And he can do the 2 training. 3 SENATOR BOYLE: Thank you, gentlemen. 4 MICHAEL KETTLE: Thank you very much. 5 JOSEPH LaCOPPOLA: Thank you. 6 SENATOR LITTLE: Thank you. 7 [Applause.] 8 SENATOR LITTLE: Now I have, Beth Lawyer, who 9 is the director at North Star Behavioral Health 10 Services Citizen Advocates, Inc., which operate in 11 Clinton, Essex, somewhat; and Franklin counties. 12 BETH LAWYER: Thank you, Senators, for the 13 opportunity to speak today. 14 And, you know, I have -- I will submit to you 15 in my written testimony a number of statistics 16 around the current problem. I don't think I need to 17 repeat them right now. 18 I think we've had, you know, a clear visual 19 of the nature of the problem. 20 But I really appreciate the opportunity to 21 share today. 22 I know you're looking for recommendations. 23 I'm the director of North Star Behavioral 24 Health Services for Citizen Advocates. 25 And I'm also a vice president -- second 1 vice president for the Association of Substance 2 Abuse Providers in New York State. 3 At North Star, we provide the full continuum 4 of behavioral-health services. 5 We serve Franklin County, and some of the 6 communities in the neighboring counties, and our 7 services include school and community prevention 8 programs, outpatient clinic services, recovery 9 supports for substance abuse and mental illness, as 10 well as a comprehensive array of community-support 11 services. 12 We have residential programs, supportive 13 housing, case management, et cetera. 14 I would say that I concur greatly with some 15 of our other representatives this morning, 16 particularly the comments that Joe just made around 17 medication-assisted treatment. 18 We also provide medication-supported 19 recovery. And, certainly, that linkage with 20 Suboxone and treatment is critical. 21 And I'll talk more about that in a minute. 22 We've also had a great opportunity to work 23 with DA Champagne. He's been a real advocate for 24 prevention and intervention. And, he works with us 25 on our Franklin County Task Force to address some of 1 these issues. 2 The one piece that I will share with you 3 about statistics, that I think matches what we've 4 seen already this morning, is that our North Country 5 communities have not been isolated from the problem. 6 We've seen this increase directly in our 7 outpatient clinics over the past year and a half. 8 In 2001 and 2012, less than 1 percent of all 9 our outpatient admissions were coming to treatment, 10 reporting heroin as their primary substance use. 11 "Less than 1 percent." 12 That rose to 5.3 in 2013; very quick rise. 13 And in 2014, to date, it's 7 percent of our 14 total admissions related to heroin. 15 Over 20 percent of all our outpatient 16 admissions, right now, are related to a primary use 17 of opiates. 18 I note that I'm not here to convince you that 19 there's a problem, but to offer some suggestions. 20 I do, however, want to point out, and thank 21 you for your leadership in some things that have 22 worked: 23 The passage of I-STOP has been a great 24 success in helping curb the unknowing, reckless, or 25 irresponsible prescription of opiate pain relievers 1 to folks who were not likely to use them 2 responsibly. 3 The positive recent legislation to support 4 naloxone, and Narcan, that we've already discussed 5 this morning. 6 Safe Take-Back days and unused 7 prescription-drugs boxes, they collect harmful 8 prescriptions, they get them off the street, and 9 they prevent misuse and abuse. 10 I want to highlight the expansion of the 11 treatment beds, by 50 beds, that was made. 12 Also, your support of innovated treatment 13 opportunities. 14 At our outpatient clinics, we've long 15 documented that over 60 percent of those who come to 16 us for substance-use-disorder treatment have a 17 co-occurring mental illness. 18 And we are -- we are really pleased to be 19 part of an integrated supported pilot for a 20 collaborative care model that integrates 21 substance-use-disorder treatment and mental-health 22 treatment under one roof, through one door, one 23 treatment plan; shared staff. 24 Our early indications are showing that it's a 25 cost-savings to Medicaid, as well as showing some 1 improved outcomes. 2 So, we thank you for your support of that. 3 There's still much to do. 4 And as Senator Little said, the critical 5 solutions lie in a three-pronged approach, and that 6 includes: Law enforcement. Treatment, being access 7 to care that is readily available, and effective. 8 And, cost-savings and lifesavings investments in 9 prevention. 10 So, I have a couple of recommendations I'd 11 like to propose; and the first is around prevention, 12 which very dear to my heart. 13 As an unintended consequence of school 14 funding and school-budget issues, many of our local 15 school districts have been forced to drop or 16 decrease contractual arrangements they had with 17 OASAS-certified prevention programs that used to 18 support fully embedded full-time prevention 19 professionals in our school. 20 These prevention experts worked in close 21 partnership with school staff and administrators. 22 They provided comprehensive, evidence-based 23 prevention education, intervention, screening, and 24 brief counseling. They identified and referred 25 indicated use to treatment. 1 The prevention workforce decline in 2 New York State as a result of these lost 3 partnerships with our schools is significant. 4 In Franklin County alone, we've seen a loss 5 of 2 out of the 7 school-district contracts, and a 6 decrease to part-time and others, leaving many of 7 our children without the comprehensive prevention 8 programming that we know can work. 9 Without a reversal of this trend, I fear 10 we'll see the negative impacts well into the future. 11 Rather than a decline, the prevention 12 infrastructure in New York State should be expanded 13 and utilized to address, not only the opiate crisis, 14 but early intervention and education around all 15 areas of substance abuse, mental health, suicide 16 prevention, and physical and emotional wellness. 17 We must also expand statewide and local 18 prevention efforts in the form of community and 19 medical education and awareness, targeting parents 20 and community leaders, as well as physicians and 21 pharmacists. 22 We're organizing a community forum on heroin 23 and other opiates in Malone on May 12th, with a 24 panel and some guest speakers, but, that's only a 25 beginning, and it's certainly not enough. 1 Budgeted resources identified for prevention, 2 to address the opiate and heroin problem, need to be 3 funneled to the community-based prevention experts 4 who can utilize evidence-based prevention strategies 5 that will work. 6 Efforts also need to include a broad and 7 intense community-awareness media campaign that 8 targets our youth and parents regarding the risks of 9 opiates, both legal and illegal. 10 We need to expand access to and the 11 availability of the Narcan and the opioid-overdose 12 training beyond emergency services, law enforcement, 13 and fire departments, to include the broad scope of 14 human-services professionals. 15 I'm glad to hear that we have an opportunity 16 to get some training. 17 But there's been a lot of red tape, and it's 18 not easy to get training up here, or for 19 human-service professionals to have access to the 20 kits. 21 Expanding treatment access, that's come up a 22 number of times. And I cannot emphasize that 23 enough, about removing insurance-coverage barriers 24 that are currently preventing our clients from 25 getting the care that they need. 1 We need a mechanism to hold insurance 2 companies accountable, to create access to care and 3 not impose barriers. 4 We need to look at establishing humane and 5 standardized criteria for coverage authorization and 6 the level of care determinations that were just 7 discussed. 8 Another thing that we're seeing is that, in 9 some of the insurance plans, the deductibles that 10 clients have are so high, that there's no way 11 they're going to reach them or enter treatment, or 12 can even begin to look at that. 13 Another suggestion, after Kathleen spoke, 14 that struck me, was as she was describing all the 15 work they've put into creating an outpatient clinic 16 on the campus site. 17 Those barriers don't have to be -- that 18 shouldn't be so difficult. 19 And we find the application process; the 20 ability to establish outpatient clinic services or 21 satellites in schools, on campuses, it's just too 22 difficult right now when we're facing this epidemic. 23 So I would really suggest looking at those, 24 at what regulations at this juncture can be waived 25 or simplified, so that we can have an easier time 1 creating sites of service where the clients are at: 2 meet them where they're at, and meet where the need 3 is. 4 And, again, as my colleagues have said, 5 I would advocate for -- I would encourage you to 6 advocate to our federal officials to allow those 7 physician-extenders to provide Suboxone. 8 And, also, assure that linkage to treatment 9 and collaborative care. We need that to be a 10 cornerstone of opiate-dependence care. 11 If we want community-based detoxification 12 programs to be successful, if we want to reduce 13 hospitalizations and ER presentations, we must 14 increase the number of medical providers that not 15 only can prescribe, but understand addictive 16 diseases and the treatment. 17 I thank you. 18 I believe that there's an opportunity here; 19 I believe there's hope, moving forward; that we can 20 work together, we can address the needs of the 21 communities, the issues of heroin and opioid 22 addiction in New York State. 23 So I thank you for your time and your 24 attention, and the work ahead. 25 1 SENATOR LITTLE: Thank you, Beth. 2 And thank you very much. 3 SENATOR BOYLE: Thank you, Beth. Very 4 insightful. 5 Just a real quick question: You mentioned 6 the prevention. 7 In terms of age-appropriateness, do you have 8 programs, what's the youngest you start, or you 9 would recommend? 10 BETH LAWYER: Well, we've actually had the 11 opportunity in the -- and as my prevention 12 colleagues could concur, to work from kindergarten, 13 right on through. 14 And using evidence-based curriculum, if we're 15 talking about pushing classroom work, those are 16 designed and developed in an age-appropriate 17 sequential way. 18 We now that the times of transition are 19 critical, from elementary to middle school, middle 20 school to high school. 21 And I think in light of the health crisis 22 that we're talking about today, that that middle and 23 high school age is so critical. 24 And, you know, it saddens me deeply when 25 I think of the districts we're not serving, because 1 they can't afford to contract. And our base funding 2 doesn't give us enough to go everywhere all the 3 time. We need that supplement. 4 So, you know, I really think that middle-, 5 high school level, is critical right now. 6 SENATOR BOYLE: Thank you. 7 SENATOR LITTLE: Thank you. 8 Our next speakers are from CVPH: 9 Dr. Charles Everly, who is the medical director of 10 the emergency room at CVPH Hospital here in 11 Clinton County; and, Kenneth Thayer, who is the 12 nursing director of Emergency Care Center at 13 CVPH Medical Center. 14 Thank you both for coming today. 15 DR. CHARLES EVERLY: Okay, well -- so, the 16 number one fear is public speaking, and the number 17 two fear is death. 18 So -- 19 [Laughter.] 20 DR. CHARLES EVERLY: Jerry Seinfeld said 21 that -- 22 SENATOR LITTLE: I only have number one to 23 fear today. 24 DR. CHARLES EVERLY: Jerry Seinfeld said, 25 that, "If you're at a funeral, that means you'd 1 prefer to be in the casket than giving the eulogy." 2 So that's how I feel. 3 [Laughter.] 4 DR. CHARLES EVERLY: So, Kenny and I are here 5 to offer a perspective from the emergency 6 department. Certainly, we don't try and represent 7 the entire medical community. 8 But, in terms of our responsibility in the 9 emergency department, you know, I gathered some 10 numbers, and I just wanted to share some with you. 11 So, the second leading cause of accidental 12 death in the United States is from prescription 13 narcotics. Not from heroin overdose; from 14 prescription narcotics. 15 Death from opioid analgesics, prescription 16 narcotics outnumbered deaths from cocaine and heroin 17 combined. 18 Sales of opioid analgesics to hospitals, 19 practitioners, and pharmacies have quadrupled 20 between 1999 and 2010. 21 In 2010, we distributed enough narcotics to 22 supply every American adult with 5 milligrams of 23 hydrocodone every four hours for one month. 24 SENATOR LITTLE: Wow! 25 DR. CHARLES EVERLY: So, it's a huge number. 1 So -- so that's the entire medical community. 2 From the emergency department, how big of a 3 role do we play? 4 Well, between the ages of 10 and 29, we 5 prescribe -- we're third on the list of numbers of 6 prescription written for narcotics? And then, from 7 30 to 39, we're fourth. 8 So, we write a lot of prescriptions for 9 narcotic medications. 10 You know, the emergency department, it's a 11 difficult place to work. We're the safety net for 12 the community. 13 We don't know our patients. We receive them 14 and we get a snapshot of their life. A lot of times 15 we don't have any medical information about them. 16 So, 42 percent of all emergency department 17 visits are pain-related; and, so, part of what we do 18 is pain relief. And there's nothing more satisfying 19 than to be able to relieve somebody's pain. 20 We have a joint-commission focus pain 21 management. 22 When -- if you've ever gone to the emergency 23 department recently, within the first 60 seconds, if 24 you have pain, they're going to ask to you grade 25 your pain. And you'll probably hear that question 1 five, six, seven more times as you go through the 2 department. 3 And if you don't speak English, then we'll 4 have smiley faces to frowny faces that you can point 5 to. 6 So, we want to know about your pain. 7 In addition, patient-satisfaction scores 8 actually have questions regarding: Did your doctor 9 manage your pain well? 10 And, initially, these were simply scores that 11 would inform the doctors whether, you know, our 12 patients liked us, and whether we did a good job. 13 But now they're going to be linked to 14 reimbursement; and, so, there's even more importance 15 on being able to adequately control somebody's pain. 16 So, I'm giving you a perspective on the 17 impetus for us to be able to control pain and to 18 prescribe medications. 19 Having said that, we're afraid of narcotics, 20 and we were very happy to have the I-STOP law 21 passed. It allowed us to take some of the 22 responsibility off of us when we're speaking to 23 patients and we say: Look, this is a state law. 24 This is what we can do for you. We can't give you a 25 30-day supply of your narcotic medication. 1 So, when you're practicing in the department, 2 you've got two patients: you've got an acute-pain 3 patient and you've got a chronic-pain patient. 4 And the acute-pain patient is quite easy. We 5 treat their pain, we prescribe narcotic medications 6 for them, if necessary, and a lot of times it is. 7 But, we won't give them more than a 5-day course, 8 sort of in conjunction with the I-STOP law. 9 But it's the chronic-pain patients that come 10 in with an acute exacerbation. And, it's a much 11 smaller number, but, the people who we believe are 12 drug-seeking. 13 Those are the difficult patients, because you 14 have somebody with chronic pain who is on 15 medication. They may have lost their medication, 16 they may have an acute exacerbation, and we're put 17 in a difficult spot, because we want to make people 18 feel better. 19 It's very difficult to send somebody out the 20 door, hunched over and grabbing their back in pain. 21 It's just -- it's not satisfying, as a physician. 22 So we want to help them, but we're putting 23 people in danger. 24 So what we have done within the past 25 six months, is to author, and this is what I put in 1 front of you, a -- "Prescribing Guideline for 2 Narcotics and Sedatives for the Emergency 3 Department." 4 And this is nothing unique. I think, back in 5 2010, people were starting to do this. 6 And this was put together, after reviewing 7 "American College of Emergency Physicians: Clinical 8 Guidelines for Narcotic Prescribing from the 9 Emergency Department." 10 And essentially what it's doing, is it's 11 allowing us to responsibly provide analgesia, 12 narcotic analgesia, for those patients in acute 13 pain, but, it recognizes that chronic-pain 14 management is a complex issue, and it is not managed 15 well from the emergency department. 16 And, so, this is what our physicians in the 17 emergency department are now leaning against and 18 using. 19 What we need to do with this, is we need to 20 provide this as general information in our waiting 21 room and to our patients so that there's a mutual 22 expectation. 23 SENATOR LITTLE: Understanding, yeah. 24 DR. CHARLES EVERLY: Yeah. 25 So -- and we're working on that. 1 We've got a clinical pharmacist in our 2 emergency department that helps us review patients' 3 medications, because it's very time-consuming to 4 call pharmacies and to find out what medications 5 people are on. And, so, that helps us. 6 A lot of times they'll let us know that this 7 patient is on a pain-management contract that we 8 didn't know about, or the patient had visited 9 several other facilities in the area or several 10 other pharmacies in the area and had gotten 11 medications. 12 So, that's a layer of protection for us that 13 we're trying to engage in. 14 We need to communicate better with our local 15 providers. 16 Kathy came over to us from SUNY Plattsburgh, 17 with her staff, and we were able to talk about how 18 we could coordinate our services better, because we 19 do, unfortunately, get students from her -- from the 20 university, that are either under the influence of 21 drugs and alcohol. And once they're treated, we 22 don't just want to release them out the door. 23 So, they have follow-up there. 24 You know, I'm going to stop yammering and 25 stammering and let Kenny talk about, sort of, what 1 we need in terms of community services. 2 And you've already heard it from everybody 3 here, because, frequently, we can help -- a patient 4 will come in with a narcotic-withdrawal syndrome, 5 and, you know, we've deemed them "medically stable." 6 There's not really anything we can do. 7 And, we can give them information for 8 outpatient services, but, frequently, there's not 9 much more that we can do. And we want to be able to 10 give them an alternative than just sending them out 11 the door and handing them a piece of paper with some 12 phone numbers on it. 13 KENNETH THAYER: Thanks, Charles. 14 So, I'm just going to share with you some 15 brief numbers I've put together, just for 2013, at 16 least for our ED. 17 Related to overdoses and drug abuse, and 18 comparatively to 2012, you know, know, we're, 19 primarily, about a 50,000-visit ER. Of that, a lot 20 of it ends up becoming a lot of primary care because 21 of primary-care resources in the community. 22 Of that approximately 50,000, we're doing 23 about 3,000 crisis interventions per year. A lot of 24 that's a dual-diagnosis. Whether it's psychiatric 25 or if it's substance abuse, a lot of them are hand 1 in hand. 2 But the breakdown out of that is, you know, 3 that we can directly attribute back to narcotic 4 overdose. We've got about 300 cases in 2012, and up 5 to about 400 in 2013. So, it's an increase of 6 100 narcotic-directly-attributed overdoses. 7 Some of those overdoses would range from, the 8 person coming in completely apneic; not breathing. 9 We give them a shot of Narcan. They wake up, and 10 they sign themselves out of the emergency department 11 45 minutes later, against medical advice. 12 We've fixed them, we've gotten rid of their 13 high, basically, and now they're going to sign 14 themselves out and they're going to go try to find 15 themselves their next dose, or fix, basically. 16 So, we clearly are seeing our numbers, you 17 know, elevate over the last few years. 18 And I think it was pointed out earlier that 19 the data out there that directly tracks narcotic 20 overdoses and abuse are not that great. 21 We basically -- we base -- my data is based 22 off of diagnosis codes, and it's all lumped together 23 in a series of numbers, and then we just pull our 24 reports based on that. 25 You know, the effects that it's having on the 1 ED relates to patients: the other patients that are 2 in the emergency department, the staff that are in 3 the emergency department. 4 From a patient -- basically, from a safety 5 perspective, we have seen a tremendous increase in 6 the utilization of Plattsburgh City police, 7 sheriff's department, State Police, and, basically, 8 making a desperation call. And, you know, city 9 police has about a one-minute, two-minute response 10 time to the emergency department, and we've seen 11 that on several occasions this year compared to 12 previous years. 13 January, last year, we had a patient that was 14 using some unknown substances. I can't directly 15 attribute it back to an opiate or a heroin, but it 16 pretty much presented that way. 17 He ended up assaulting ten of my staff, one 18 of which ended up having to be treated, and lost 19 days from work, which, obviously, impacts, you know, 20 our staffing. 21 What we have done, in replacement of that, is 22 that we have now established an agreement with 23 law enforcement, related to those patients coming in 24 of serious threat to our staff, and law enforcement 25 is now staying in our ED, with those individuals, 1 because of the risk for safety of our other patients 2 and our staff members. 3 The violence in the ED has increased also, 4 tremendously, directly related to not understanding 5 I-STOP laws. 6 And if the physicians, two years ago, were 7 prescribing, sometimes, you know, a 30-day supply of 8 Lorcet or Vicodin or oxycodone, and now we've cut 9 that down to a max of five days, that has obviously 10 generated some serious questions. And, we've had 11 holes kicked in our walls. We have had staff, 12 again, assaulted. And we've had people arrested 13 from the emergency department for assaulted behavior 14 on our staff. 15 As far as support from the Legislature, 16 I thank you for the legislation that was passed 17 related to a felony as being charged for individuals 18 that assault a health-care worker. 19 I think consistency amongst the -- you know, 20 the prosecution, as far as not getting just charged 21 with menacing, which is a misdemeanor, and 22 continuing with the felony, would be supportive. 23 A lot of times my staff have went to the 24 police department, they have filed the reports, and 25 the person ends up getting charged with menacing 1 because it's related to, they did not have capacity 2 to make that decision. 3 They personally put that medication into 4 their arm, they took it by mouth, they're making 5 that decision. 6 The challenging part becomes, with these 7 patients, we are trying to support them, we're 8 trying to treat them, and is a two-way street. 9 We can offer them the services, but they've 10 got to be willing to take the services that we are 11 giving them. 12 We give them the information. It's up to 13 them to make that phone call to arrange the 14 services. 15 One practice that previously took place was, 16 I believe it was Tom Latinville from Conifer Park, 17 several years ago, we had actually made a phone call 18 to him, on patients that were in the emergency 19 department seeking rehab and detox. 20 He would physically come to the 21 emergency department and do the intake of 22 [unintelligible], right then and there. 23 However, I do not feel that any of our 24 outpatient services right now have the resources or 25 the funding to support that. 1 And I think, as far as, from the legislation, 2 and from that perspective, where could you help us? 3 That would be a great resource to our outpatient 4 services, as far as getting them the resources and 5 the funding to be able to provide that. 6 Insurances is another barrier for us. 7 A lot of times we can offer these individuals 8 inpatient services. Most of the time we're 9 transferring to Conifer Park; St. Joe's, 10 Saranac Lake; St. Peters; Canton-Potsdam. 11 Canton-Potsdam is the only one that will 12 really take anybody as long as they have an 13 available bed. 14 However, sometimes the insurance companies 15 get in the way, in that, they want a failed 16 outpatient before they'll take an inpatient. 17 And a lot of the different services are like 18 that. 19 These individuals that are addicted, they 20 can't afford a failed outpatient. That failed 21 outpatient may be their one and only. 22 So we need to make that access available, 23 and, working with the insurance companies to -- to, 24 you know, take down some of those barriers from that 25 would be highly appreciated. 1 The other thing that -- I also recently 2 started working with North Country Health-Care 3 Providers, which is a group of seven hospitals 4 around the region. We meet in Potsdam. And, I was 5 asked to sit on this. It's part of the New York 6 State Prescription Drug Task Force. 7 And as the seven hospitals, a group, we were 8 focusing on some key goals, and we're still working 9 through that. 10 One of them is, consistency across the 11 North Country related to policies in our emergency 12 departments, primarily, for prescribing guidelines 13 around narcotics, which we have, you know, put in 14 place. 15 But the other one focuses around 16 law enforcement having the ability to have Narcan on 17 board. You know, the police cars, giving them 18 appropriate training. 19 Again, that comes back to funding, and making 20 sure they have the appropriate education with that. 21 And then the other one is prescription-drug 22 drop-offs. 23 I know our City police department here in 24 Plattsburgh does honor that, but I do not know if 25 they have -- they still have to provide the funding 1 to pay for that to be disposed of. That is a 2 medical waste. It is highly expense to get rid of. 3 But that is only one location in 4 Clinton County. And I feel, by broadening that, and 5 giving that ability for the grandmas that have been 6 stockpiling medications, to get rid of them more 7 consistently, it eliminates some of those 8 prescription drugs that are on the street. 9 With the -- you know, going on to the -- you 10 know, with the I-STOP legislation, it's almost that 11 it's -- it's kind of turned focus away from 12 prescription drugs and it's made it easier for 13 heroin, and it's kind of created a market, as it was 14 said earlier. 15 Heroin is now the lucrative market instead of 16 the prescription drugs, because of the 17 pharmaceutical companies. 18 You know, we've done a little bit of work 19 with Conifer Park, as far as introducing the SBIRT 20 program. That is an Emergency Nurses 21 Association-supported, you know, assessment. 22 It's a matter of being able to -- us, on our 23 side, having the resources to implement that. 24 That's an -- approximately, a 15-minute 25 assessment. There's specific training that I know 1 Mike has offered to the hospital. It's a matter of 2 getting the appropriate people there, and trained, 3 and then giving us the time to do it. 4 As with anything, whether it's education or 5 health care, we are all experiencing, you know, 6 financial situations, where it's not easy to, you 7 know, mobilize a boatload of resources to pull out 8 and make that happen. 9 So, you know, it comes down to, you know, we 10 need to have the appropriate funding, we need to 11 have the appropriate resources. 12 I think the greatest impact that we see in 13 the emergency department, is access on the 14 outpatient side. 15 We can see the patient, we can refer them to 16 treatment. Our resources are limited in the 17 North Country. 18 I believe the three services that we have 19 here in Plattsburgh do a phenomenal job at trying to 20 get our patients in as quickly as possible. But, 21 again, that's only an intake eval, and a lot of 22 times, it doesn't get them started on the treatment 23 plan, and then they have -- they get put on that 24 so-called "waiting list." 25 We need more resource in the community. 1 Inpatient detox, rehab, we do not have that 2 at CVPH; so, therefore, it's creating a transport to 3 another facility, which is sometimes two hours away. 4 I'll leave with you just one recent -- 5 actually, two recent experiences. 6 We had, a female in our department wanted 7 help. We spent 36 hours; kept her in the emergency 8 department. 9 Could have discharged her, probably, after 10 6 hours, and said, you know: We just -- we're 11 giving you the resources. 12 We didn't feel that was in the best interest. 13 We kept her for 36 hours. We finally got a bed 14 secured at St. Peters in Albany. 15 We put her in an ambulance to send her down 16 there, because we didn't feel it was comfortable 17 putting her in a personal auto that we couldn't 18 guarantee that she would actually make it there. 19 We put her in an ambulance. She got there; 20 she signed herself out as soon as she got to the 21 facility. And she probably arranged for somebody to 22 pick her up in Albany. 23 And -- you know, so she did not extend her 24 treatment. 25 The other one, I'll go back to about a year 1 ago, which is just an experience that kind of just 2 opens your eyes, is a -- you know, I've cared for a 3 lot of overdoses in the department myself. 4 This one was a pregnant female. She, 5 literally, delivered in my arms. 6 And the first question she asked is, "I need 7 my fix." 8 It wasn't about the baby. 9 It was about, "I need my fix." 10 This is truly a disease that needs some 11 serious focus and some serious attention to. 12 So, anything from a perspective from -- that 13 you can do to support the North Country in combating 14 this serious disease that's affecting us, and -- as 15 well as the rest of the state, would be appreciated. 16 Thank you. 17 SENATOR LITTLE: Thank you. 18 I think just being here and hearing the 19 different stories and testimony and figures will 20 help us get more attention and get more services. 21 The I-STOP program, Doctors, do you get a 22 complete rundown on just about everyone you put in, 23 or is it a work-in-progress? 24 DR. CHARLES EVERLY: Well, as you know, the 25 emergency department -- the emergency physicians are 1 exempt, because the work involved in looking up 2 patients and their narcotic history, it would take 3 too long, it would slow things down. 4 And that's part of the role of the clinical 5 pharmacist. 6 But, when we have time, when the department 7 is not overwhelmed, yes, we do use it, and it's 8 actually very helpful. 9 SENATOR LITTLE: But that's the point of only 10 giving five days of a prescription; right? 11 DR. CHARLES EVERLY: That is correct. 12 SENATOR BOYLE: One of the other issues, you 13 mentioned about the insurance coverage, and it's 14 been a statewide problem, as well. 15 There are some pieces of legislation: One 16 from Senator Kemp Hannon from Long Island, to 17 mandate insurance coverage of treatment. 18 We're going to work on that. It's going to 19 be, obviously, a tough thing to get passed. 20 However, one of the things that I've been 21 looking at, is dealing with the insurance companies, 22 and I think a blue-ribbon panel was mentioned 23 earlier, about the definition of 24 "medical necessity." 25 Because you have a dozen different insurance 1 companies, and they have a dozen different 2 definitions of "medical necessity," I think we need 3 a unified answer to see: Does this person meet 4 these criteria? Yes, they need to get coverage. 5 KENNETH THAYER: Absolutely. 6 I mean, the inconsistencies between the 7 insurance companies create several barriers. 8 You know, a lot of the high-deductible 9 health-care plans, it was already mentioned earlier. 10 These -- you know, even middle-class 11 families, it is very difficult to, either, meet that 12 deductible, or you get hit with -- you know, right 13 now, an ER visit, if you get -- if you come in for 14 an ER visit, whether it's in the fast-track for an 15 ear infection, or for chest pain, if you get 16 discharged, you're going to get hit with a 17 $500 deductible, in most places. 18 It used to be 50. Right? 19 You know, so, it is twofold. 20 Now, I understand that's to bring down 21 health-care costs, and, maybe, some of the 22 overutilization of the emergency department, but, 23 again, these patients can't afford that. Most of 24 them are either unemployed or they have, you know, 25 the entry-level positions. 1 SENATOR BOYLE: Thank you very much. 2 SENATOR LITTLE: Thank you. 3 [Applause.] 4 SENATOR LITTLE: We'll next hear from the 5 Champlain Valley Family Center, executive director, 6 Connie Wille. 7 CONNIE WILLE: Good morning. 8 SENATOR LITTLE: Thank you, Connie. 9 CONNIE WILLE: Good afternoon. 10 On behalf of the staff and the board of 11 directors from Champlain Valley Family Center, and 12 Jack and myself, I want to thank you, Senator Little 13 and Senator Boyle, for making the time to come to 14 our community, to learn about the heroin/opioid 15 crisis in our community. 16 Before I address the group, I want to 17 introduce you to Jack. Jack is in recovery from 18 opiate dependence, and courageously volunteered to 19 speak with you today. 20 SENATOR LITTLE: Thank you. 21 Thank you, Jack. 22 JACK: Thank you. 23 Well, when I was asked to speak here today, 24 initially, I was very afraid of being judged for who 25 I was and not for who I am today. 1 Who knows or cares about a junkie who has 2 overdosed four times by the age of 23? 3 At the age of 12, I began smoking cigarettes. 4 At the age of 13, I had drank and got drunk 5 for the very first time. 6 From 14 to 18 I was smoking pot daily. 7 At age 14, I began seeing commercials on TV, 8 warning parents to lock up your medicine cabinets. 9 This is what peaked my curiosity, and I started 10 looking in those medicine cabinets. 11 I would read the names on the bottles, go to 12 my computer in my room, type the medicine name into 13 Google, find out what it was for, and how it would 14 make me feel. 15 I found several that were for moderate to 16 severe pain. I would then go back and type the word 17 "high" next to the medicine name, and it would tell 18 me what to feel, what to expect, how much to take, 19 the side effects, and so on. 20 From age 14, I continued using Percocets, 21 oxycodones, Xanax, fentanyl, hydrocodones...pretty 22 much any opiate you could imagine. 23 I did this all the way up until to age 18, 24 when I was arrested and sentenced for burglary. 25 Shortly after my release at age 21, 1 I discovered heroin, and began using it, initially, 2 by snorting several times a week. 3 It only took about a month before I was doing 4 what I said I would never do: I started shooting 5 heroin on a daily basis. 6 My first overdose happened 2 1/2 months after 7 I started. By chance, my parents had found me. 8 My heart had stopped three times on the way 9 to the hospital before emergency surgery saved my 10 life. 11 However, this did not stop my addiction. 12 I overdosed three more times and needed 13 hospitalization for each of them. 14 After the third overdose, I thought I was 15 ready for help. I went to an inpatient treatment 16 and to a halfway house. 17 While at the halfway house, I started using 18 heroin again and overdosed for the fourth and final 19 time. 20 In the throes of my addiction, my parents 21 kept my disease a secret to only my immediate 22 family. 23 My parents and sisters felt afraid, ashamed, 24 embarrassed, and most of all, helpless. Often they 25 lied or covered for me with others, with my job, 1 with other things that I could never meet. 2 Meanwhile, I was so overwhelmed with my 3 disease, I could see no possible way out. There 4 were days when I just didn't really care about 5 living anymore. I was so terrified of running out 6 of money and not being able to buy the next bag, and 7 scared to death of going into withdrawal. 8 My life was constant turmoil. I felt as if 9 I was just surviving, like I wasn't even alive. 10 I couldn't see any possible way out. 11 But thank God for that fourth overdose, 12 because without it, I wouldn't be here today. 13 I have suffered some severe consequences due 14 to my addiction. I have had heart surgery, suffered 15 from a pulmonary embolism. I now have hearing loss, 16 with some pretty severe tinnitus, which is caused 17 from also brain damage, and, some, you know, 18 short-term memory loss, a little bit of long-term 19 memory loss. 20 But, in spite of all the consequences of my 21 disease, to my family and myself, my motivation to 22 remain clean has finally overpowered my desire to 23 get high. 24 Today I am nine months and three weeks clean. 25 It is the longest period of time I have been clean 1 since the age of 12. 2 Before I ever touched a drug, I did very well 3 in school. My grades were As and Bs. 4 I obtained my GED in 2009, and now I have a 5 goal of, one day, going back to college. 6 And today, most of all, I have hope. 7 Connie told me that talking here today may 8 help with the addiction policies in New York. 9 If there is anything that can be done to 10 reduce the stigma for families and addicts, then 11 I will be glad I did this today. 12 Too many people, my friends included, are 13 dying from addiction. 14 Please do not judge them, and find a way to 15 help them. 16 If it wasn't for what has been available to 17 me, then I wouldn't be alive today. 18 [Applause.] 19 SENATOR LITTLE: I can't thank you enough for 20 having the courage to come here. 21 And I do think that your words today will 22 help, for people to avoid the stigmatization, and to 23 help people, and to feel as though, you know, these 24 problems exist, and we need to do something about 25 it, and help them. 1 Thank you. 2 CONNIE WILLE: I've had the privilege of 3 serving as the executive director of 4 Champlain Valley Family Center for the past 5 14 years. It has been my good fortune to work with 6 a staff and board that is passionate about the 7 mission of the agency, absolutely committed to 8 preventing, intervening, and treating chemical 9 dependency, and always eager to improve their skills 10 to serve our clients. 11 It is a profession that is filled with both 12 heartbreak and miracles, and always with an 13 abundance of hope and hard work. 14 With regard to the opiate/heroin crisis in 15 Clinton County, there are three New York State 16 OASAS-certified outpatient providers, and they are: 17 Clinton County Addiction Services, Conifer Park, and 18 Champlain Valley Family Center. 19 There is also one OASAS-certified halfway 20 house called "Twin Oaks." 21 I decided to give you a picture of the 22 increase in opiate diagnoses in this county for the 23 past three years. 24 In 2011, there were 429 individuals diagnosed 25 with an opiate disorder, and of that number, 1 169 were using opiates by IV-injection. 2 In 2012, there were 507 individuals diagnosed 3 with an opiate disorder, and of that number, 4 254 were using opiates by IV-injection. 5 In 2013, there were 646 individuals diagnosed 6 with an opiate disorder, and of that number, 7 417 were using opiates by IV-injection. 8 Over the past three years in Clinton County, 9 there has been over a 40 percent increase in 10 individuals that have a diagnoseable opiate 11 disorder, and over a 65 percent increase that are 12 of -- in those, that are using by IV-injection. 13 I want you to understand that there is a far 14 greater pool of individuals in Clinton County that 15 are abusing opiates, that have not sought treatment 16 services for a variety of reasons. 17 At Champlain Valley Family Center, we have 18 observed the population of opiate abusers decrease 19 in age, whereas, it used to be an average age of 20 late 30s, we now see the population shift to 21 very-early to mid-20s. 22 In looking at the first quarter of 2014 at 23 Champlain Valley Family Center, the trend looks 24 worse. 25 In terms of a diagnoseable opiate disorder 1 and IV-injection, over 50 percent of the clients 2 admitted to the CVFC outpatient clinic had a 3 diagnosis for opiate disorder. 4 I am sure that the physicians can affirm, 5 that in looking at the IV-drug use in our community, 6 medical costs that will continue to increase are 7 related to hep C, HIV, a variety of infections at 8 IV sites, cardiovascular and pulmonary issues, 9 high-risk pregnancies, and most traumatic of all is 10 the overdoses. 11 This is the tip of the iceberg, as the county 12 is experiencing an increase in the need for homeless 13 housing, foster-care placement, arrests. 14 And, personally, I have met with many parents 15 in our community who have an adolescent or young 16 adult that is abusing opiates, and their fear and 17 anxiety is palpable. 18 You heard in Jack's story about the absolute 19 chaos that comes with the addiction. 20 The families of the addicts suffer terribly. 21 The stigma and withdrawal from opiates 22 attached to this disease is preventing many people 23 from seeking services. 24 The dilemma that faces outpatient clinics is 25 that, with opiate addiction, we have been challenged 1 to move from the role of a traditional 2 chemical-dependency counselor to crisis managers and 3 family interventionists. 4 The cost for heroin has decreased and the 5 availability has increased significantly. 6 I have had staff tell me that clients 7 reported -- that clients are telling them that it is 8 cheaper to purchase heroin than it is marijuana in 9 our community. 10 In thinking about and preparing for today's 11 meeting, I focus my attention on significant issues 12 that Champlain Valley Family Center, like other 13 providers, have experienced since 2009, and there 14 are seven items I would like to bring to your 15 attention. 16 I have done countless assessments on clients 17 over the past 27 years. Not one of those clients 18 started out with IV-drug use. 19 The progression is, typically, alcohol, 20 tobacco, and marijuana. 21 Please consider resources for prevention 22 services when you convene in Albany; and, please, 23 don't make it a one-shot deal. 24 Ongoing, thoughtful policy would really help 25 what we're doing in our communities. 1 Federal and State grants for prevention 2 services have evaporated. CVFC has lost a total of 3 $519,000 since 2009 for prevention services. 4 I'm not a researcher. I cannot tell you 5 there is a direct cause and effect between the loss 6 of prevention dollars and subsequent prevention 7 services, and the increase in opiate addiction. 8 I personally believe that there is. 9 CVFC had obtained grant dollars to provide 10 services to the Clinton County Jail. Those services 11 included assessments, group sessions, and referral 12 services. Individuals that participated in the 13 programming all left the jail with an appointment at 14 an outpatient clinic or a bed in a rehab. 15 The grant that funded this programming was a 16 line-item cut in CVFC dollars that we received from 17 OASAS. This cut occurred in 2009, and that was a 18 real loss, I believe, to our community. 19 Like other outpatient clinics, 20 Champlain Valley Family Center is represented at all 21 three drug courts in Clinton County. 22 On an average, eight hours each week of 23 clinical-staff time is devoted to the drug courts, 24 and there is absolutely no fiscal support for this 25 service. 1 Drug courts are having a positive impact in 2 this community, and CVFC remains committed to the 3 process. 4 Growth and fiscal support of drug courts is 5 needed. 6 It is common now for clients coming into 7 Champlain Valley Family Center for treatment 8 services to have an insurance deductible of at least 9 $3,000. 10 Imagine working for minimum wage in 11 Clinton County, needing treatment, and learning that 12 your insurance company will not pay for treatment 13 until you have paid $3,000 out-of-pocket for medical 14 and/or treatment services. 15 Quite frankly, the amount might just as well 16 be $100,000. 17 Since 2009, there has been no COLA for our 18 field in the New York State budget. 19 What that means to a not-for-profit is 20 absolutely no salary increases. This, of course, 21 results in staff turnover, with the vast majority of 22 the staff taking jobs with the State of New York; 23 primarily, prisons and colleges. 24 And that's a loss to our field. 25 Understanding what tolerance and withdrawal 1 from opiates feels like is critical to understanding 2 the addiction. 3 I had a client one time explain his 4 withdrawal to me, like this: 5 "Connie, imagine the worst flu that you ever 6 had in your entire life, multiply that times 100, 7 and also know that even the marrow in your bones 8 hurt." 9 People regularly come into Champlain Valley 10 Family Center in acute withdrawal. 11 Insurance companies will not pay for 12 inpatient detox services, as there is no medical 13 necessity. This perpetuates the ongoing use of 14 opiates, as the addict cannot be safely and humanely 15 detoxified. 16 An inpatient or an ambulatory detox is 17 greatly needed in this county, but who can take the 18 financial risk knowing that the service will not be 19 reimbursed? 20 And, regularly, we send people to inpatient, 21 and watch them back into our community within 22 7 to 10 days. 23 It's just not long enough. 24 Many of those same folks that we're sending 25 to inpatient are still coming back and testing dirty 1 after an inpatient stay. 2 They need more time. 3 Early in this discussion I mentioned the 4 increase in homelessness. 5 Additional resources for housing and housing 6 staff, including recovery coaches, is essential to 7 helping people feel safe, move forward in their 8 recovery, and, quite simply, have an address that 9 their name is attached to. 10 I'm a pragmatic realist, and know that there 11 is a finite amount of money in the state coffers; 12 however, I implore you to consider what is happening 13 in this county, and in New York State, in your 14 policy and budgeting sessions. 15 Please remember that young people are dying 16 out here and families are being torn apart. 17 I want to sincerely thank you for coming to 18 Clinton County and listening to our experiences, our 19 concerns and suggestions, related to this growing 20 epidemic. 21 Thank you. 22 SENATOR LITTLE: Thank you. 23 SENATOR BOYLE: Thank you very much, Connie. 24 [Applause.] 25 SENATOR BOYLE: I would say, Jack and Shawn, 1 if we get one thing out of this, besides 2 legislation, to change the stigma in New York State 3 is something I would like to see, so, six months 4 from now, if a parent talks to a friend and says, 5 "My son or daughter is addicted to" heroin or an 6 opiate, they're going to have the same reaction, or, 7 if someone has say, "I'm an addict," they have the 8 same reaction to say, I have cancer, or, a cardiac 9 problem. 10 It is a disease, and New Yorkers need to 11 understand that. And I think they will very 12 shortly. 13 [Applause.] 14 SENATOR LITTLE: Dr. John Schenkel, who is 15 with the Clinton County Addiction Treatment 16 Services. 17 Thank you, Doctor. 18 DR. JOHN SCHENKEL: Hello, and I'd like to 19 thank both of you for being here, and, in 20 anticipation of the work you're going to need to do, 21 because it's not a small amount of work to change 22 things, is it? 23 I'm going -- we're out of time, really, so 24 I'm going to really cut my dissertation very short. 25 I would just like to mention that, there's 1 been a lot of discussion over gateway drugs. And 2 I don't think people understand how important sugar 3 happens to be in that. Most children are solidly 4 addicted to a drug before they ever try alcohol or 5 cigarettes. 6 I don't know what can be done about that, 7 but, I just think people's thinking needs to be 8 cleared up. 9 I also think that the age, as was mentioned 10 before, of addicts has gone down considerably, and 11 that's because pain pills have been so available. 12 I've had clients whose very first drug of 13 abuse was OPANA, in the seventh grade. Not 14 cigarettes, not alcohol; OPANA. 15 And, so, we have a lot of younger addicts who 16 have started in middle school and high school. 17 And, it used to be that addicts were older, 18 and you could sort people out. 19 People who have had problems, early problems 20 with mothering, would be very attracted to opiates. 21 Now it's not like that, because, at the age 22 of middle school and high school, these kids don't 23 believe that anything could possibly overpower their 24 will. 25 They will try it, they will get into it, even 1 if they think they know the consequences. 2 It's very sad. 3 But, there is also an older population of 4 addicts. 5 I would guess, about 40 percent of the people 6 presenting for treatment for addiction became 7 addicted being treated for pain. And, we can treat 8 their addiction, and buprenorphine is actually a 9 very good drug for treating pain. 10 The elephant in the doctor's office happens 11 to be the fact that opiates are very, very good at 12 treating acute pain. They actually make chronic 13 pain worse. That is a process called 14 "hyperalgesia." 15 Buprenorphine is the only drug I know that 16 can treat pain without inducing hyperalgesia, but, 17 when we discharge people from a treatment program 18 who are in pain and in need of pain relief, they may 19 be on, by that time, a fairly low dose of 20 buprenorphine. Like, 8 milligrams is usually enough 21 to cover pain once the hyperalgesia is gone, but 22 there are no physicians in the community who are 23 willing to prescribe buprenorphine to treat pain. 24 And this is a direct result of the DEA. 25 And, I'm going to skip a lot of the other 1 stuff I have here, and get to what I think you could 2 do. Okay? 3 SENATOR LITTLE: And you could give us a copy 4 of your remarks when you leave, too. 5 DR. JOHN SCHENKEL: Okay, I can do that. 6 I just typed these up last night. 7 SENATOR LITTLE: Oh, that's all right, but 8 we'd be glad to hear your ideas. 9 DR. JOHN SCHENKEL: I don't know what can be 10 done about insurance companies, but insurance 11 companies are, basically, calling all the shots; not 12 treatment agencies. 13 Insurance companies decide what I can 14 prescribe and what I cannot prescribe. 15 Insurance companies decide whether somebody 16 can go into rehab or detox, and it's usually "no." 17 But, agency burnout is a big problem. All 18 agencies in the community are simply overwhelmed. 19 Just, for example: Just the facilities for 20 supervised visitation for children who have been 21 taken from their parents because their parents are 22 using, there's a three-month waiting list. 23 Now, what do you think that does to the kids? 24 It's everywhere. 25 And, of course, you know, you can always say, 1 "Well, you know, throw more money at it," but, 2 there's no money to throw at anything, these days. 3 The counselor at Clinton County Addiction 4 Services, who runs the buprenorphine group, has -- 5 follows 85 clients. 6 Now, 50 percent of a clinician's time is now 7 taken up with paperwork. This is due to two things: 8 Bureaucrats who are constantly requiring more 9 and more paperwork, because they equate paperwork 10 with treatment. 11 And, actually, everything -- every 12 requirement that is placed on the system for more or 13 better paperwork actually decreases the amount of 14 time spent with patients. 15 When I started as a physician back in the 16 '70s, I think we spent 20 percent of our time 17 recording what we did. 18 It's now 50 percent. 19 Computers have actually increased the amount 20 of time it takes to do the paperwork, by at least 21 50 percent. 22 Computers, electronic medical records, are 23 very time-consuming. 24 The electronic prescriptions have been sold 25 with the promise that they're going to reduce 1 medication errors. 2 They have actually increased medication 3 errors by at least a factor of 20. And this is 4 because these programs are written by people who 5 know nothing about the processes that these programs 6 are supposed to be organizing. 7 Please, get the bureaucrats off our back. 8 SENATOR LITTLE: Okay. 9 [Laughter.] 10 SENATOR LITTLE: Something we've been trying 11 to do in a lot of areas, actually. 12 [Laughter.] 13 DR. JOHN SCHENKEL: And I think I'll leave it 14 at that. 15 SENATOR LITTLE: Thank you very much for 16 being here today. 17 [Applause.] 18 SENATOR LITTLE: Our last speaker today is 19 Peter Bacel, counselor, Friends of Recovery 20 New York. 21 PETER BACEL: I'm a counselor at 22 [unintelligible] House [unintelligible] in Syracuse. 23 I work in their detox program, but I was in the 24 methadone program for seven years. I've been in 25 their detox for the last year. 1 But I came here as a Friends of Recovery. 2 If you haven't heard of them, we promote 3 recovery coaching. 4 And I know Phil probably knows 5 Richard Buckman from Long Island. He's one of our 6 board members. I'm a board member from the Syracuse 7 area. 8 There's Bill Bowman from Watertown, and he 9 has the whole North Country. 10 We could use somebody, probably -- I could 11 have thought, you know, him as North Country, but 12 when I got to Watertown, I was still three hours 13 from Plattsburgh. 14 So, you know. 15 [Laughter.] 16 SENATOR LITTLE: Big area. And I'll attest 17 to that. 18 PETER BACEL: And I did -- I'll leave these 19 here. These are some brochures on For New York. 20 And, I'm also on the advisory board for 21 Hope Connections. That's a recovery-coach facility 22 in Syracuse that was funded by the Office of Mental 23 Health, through a grant. 24 And, I'm also a person in long-term recovery. 25 I know we've run out of time. 1 I wanted to talk about, to me, I consider 2 "north," when I worked in the methadone clinic in 3 Syracuse, we have patients that come from Watertown, 4 and that's quite a few. 5 And, I'll just try to shorten this. 6 I had a couple that came in from there. 7 Well, I saw her for -- she was with our 8 clinic maybe three times, and she had -- oh, 9 nine months was her longest sobriety with me. And, 10 she wasn't with our clinic, but, she overdosed. 11 But at the time, I had her significant other, 12 and I helped him get through that. 13 But, there's a good part to this story, I was 14 thinking of this couple from up north, because, she 15 overdosed. 16 But, he has tapered off methadone, and now is 17 being sustained on Suboxone. And, you know, he's 18 employed, four years later, you know, living a 19 productive life. But, he travels to Syracuse for 20 Suboxone. 21 And I know there aren't enough facilities up 22 north. There just aren't enough facilities up here. 23 And I think that, I was hired to treat her, 24 living, you know, an hour away, that if there, you 25 know, had been more in her area, might have been a 1 different outcome. 2 And there's also this Senate Bill 4623. 3 I guess it's -- we'd like it moved to the 4 Insurance Committee agenda for a vote. 5 SENATOR BOYLE: Is that the Hannon bill? 6 PETER BACEL: Richard Buckman told me to tell 7 you about it. 8 SENATOR BOYLE: I'm not very good at numbers, 9 but I'll look it up. 10 PETER BACEL: Yeah, it's the one that's going 11 to put treatment in the hands of the doctors instead 12 of the insurance companies. 13 SENATOR BOYLE: Yeah, that's Senator Hannon's 14 bill I was referring, yeah. 15 PETER BACEL: Yeah. 16 And, so, I know he's been working on it for a 17 couple of years. 18 And that's another thing: This For New York, 19 we've been working on legislation, and this is an 20 important bill. Everybody's been talking about it, 21 really, here. 22 And, I had another testimony. I'll just skip 23 through it. I'll leave a copy with you. 24 SENATOR LITTLE: Thank you. 25 PETER BACEL: But, basically, this was 1 somebody who the insurance company denied treatment 2 I had recently in our detox. 3 And the punchline really is: He never had 4 treatment, but I had to release him to outpatient, 5 and he's an officer that carries a firearm. 6 And, Sandra Manell [ph.], she had another 7 similar story, of somebody who never had treatment, 8 and she had to release them to, you know, 9 outpatient. And, he's a school bus driver. 10 You know, and these are people we clearly 11 feel needed, you know, at least a 28-day program. 12 And I was thinking, too, when I came out: 13 I went by St. Joe's. And in the last year, 14 I got one female in there, I think, to their 90-day 15 program. 16 But, we need more 90-day programs; not 30-day 17 programs. 18 Like, St. Joe's is a very good facility in 19 Saranac. I know it's mostly alcoholics that are 20 referred there. 21 But, a lot of times, 30 days isn't long 22 enough. 23 And, lastly, my management at work wanted me 24 to talk about Zohydro, if you could keep it out of 25 New York. 1 It's a new hydrocodone that's been approved 2 by the FDA, that is probably coming, but it's 3 five times stronger than what's on the market now. 4 It's time-released, but it's abusable. 5 It's not like -- they were talking about, 6 it's abusable, it's more addictive. And, it's just 7 going to create problems, we feel. I think it's 8 going to outweigh it's benefits. 9 But, yeah, I'll leave these here. 10 And if there's anybody from this area that 11 would like to join For New York, we would be glad to 12 have you. 13 SENATOR LITTLE: Thank you. 14 And we're glad you got to appreciate the size 15 of the North Country, and the need for more 16 facilities; so, it's one more voice joining us and 17 saying this. But it's very true. 18 And we appreciate you coming from Syracuse, 19 so... 20 SENATOR BOYLE: And I agree with you on 21 Zohydro, it's very dangerous. 22 The FDA has approved this, despite the fact 23 their own advisory board voted 9-to-2 against 24 allowing it. 25 And I think this is an issue that's going to 1 be ongoing in the coming months. 2 Thank you for your testimony. 3 [Applause.] 4 SENATOR LITTLE: You know, it's a testament 5 to the people that we've had, and the information 6 that has been given here, that so many of you have 7 been able to stay. And it's only since I started 8 noticing, about twenty after twelve, that people had 9 to leave. 10 So, that really said a lot about it: that 11 were you willing to stay and listen to everyone, 12 even after your own presentations. 13 We are running late. 14 If there's anybody that wanted to make a very 15 quick and brief comment, something that we could 16 talk to you about later, or do if you wanted to make 17 any kind of a statement, we would let do you that. 18 Quickly. 19 AUDIENCE MEMBER: My name is -- 20 SENATOR LITTLE: You can use the microphone 21 if you want. 22 AUDIENCE MEMBER: And if I may impose 23 five more minutes of your time, I would like read a 24 prepared statement. 25 I am a mother who seeks assistance for my 1 20-year-old son, my only child, who has fallen into 2 the tragedy of heroin addiction existing in our 3 community, state, and nation. 4 November 28th, our family's nightmare began 5 with our fears and concern over our son's life. 6 I suspected he may be using drugs. 7 December 16th, my worst fears were confirmed, 8 as I observed the signs and symptoms of my son's 9 substance abuse. 10 December 17th, fear, frustration, pure chaos, 11 now existed in our home. 12 Immediately, we educated ourselves regarding 13 substance abuse, and sought the advice of local 14 law enforcement. 15 After many desperate visits with our son, to 16 communicate our concerns and offer our support, he 17 refused to listen, as well as accept the support of 18 his family. 19 December 26th, upon arriving at my son's 20 apartment, to bring him food items, I entered the 21 apartment and witnessed my son sleeping on the 22 couch. 23 Unaware that I was there, I observed his arms 24 for the first time. I awoke him. When I left that 25 day, he told me he would never speak to me again. 1 Five long days passed before I heard from my 2 son. 3 January 2nd through January 20th, 4 communication did begin with our son. 5 He asked us to pick him up several times from 6 his apartment, and also asked for money, as he was 7 unemployed at this time. 8 We provided transportation and money to him, 9 realizing that he may be using the money for drugs. 10 January 21st, our son came to us and asked 11 for help. He confirmed even more of our worst 12 nightmare and fears, and requested that we bring him 13 to Canton-Potsdam detox. 14 I drove him immediately towards this 15 facility. 16 He informed me that, over the past month, he 17 had tried on his own to seek help and assistance 18 from this addiction that he knew was spiraling out 19 of control. 20 Unable to find the help he knew he needed, he 21 came to us. 22 At Canton-Potsdam detox, as I sat with my son 23 during the intake process, my heart broke again, 24 listening to him reveal to a nurse this 25 drug-addiction path that he had taken. 1 While I thought my prayers had been answered, 2 the nurse then informed us that they could not help 3 him, as, they did not meet medical necessity; 4 therefore, the beds were full. 5 We left the facility. 6 My son, now convinced that he did not have a 7 problem because he's not a good enough drug addict. 8 My husband and I, much determination to seek 9 the assistance and treatment that our son 10 desperately needs has been quite challenging, and 11 confusing to say the least. 12 Our quest for assistance has included: 13 Many phone calls to many of these agencies 14 that are here today. 15 Many local professionals. Canton-Potsdam 16 detox, and Conifer Park in Plattsburgh, provided 17 conflicting available treatment information. 18 We have excellent medical insurance that 19 covers, are you ready, 100 percent. 20 I have a paper: Substance-abuse treatment, 21 only if our son is deemed medically necessary. 22 This criteria was not explained to us until 23 we continuously, continuously, asked for the 24 definition of "medically necessary." 25 During a February snowstorm, we drove to 1 Conifer Park detox, as an admission counselor told 2 us to come down to this facility. 3 After waiting an hour in the waiting room, 4 our son was called for an evaluation. 5 The first question from staff was: How will 6 you be paying for this treatment? 7 Costs were explained to our son, and he was 8 back out in less than five minutes. 9 I intervened, and explained he was covered 10 under my insurance. 11 The evaluation then was conducted by an 12 admissions nurse who provided different information 13 than the admissions counselor. 14 Again, our son was not deemed a medical 15 necessity. 16 During our drive back home in the snowstorm, 17 anger, resentment, fear, and frustration were the 18 feelings we experienced, as it seemed that the 19 professionals in which we sought treatment from for 20 our son were willing to let his life slip through 21 the cracks. 22 We will not and cannot let this happen. 23 Continuing to not know how to get the 24 treatment necessary to save our son's life, and 25 after more advice from law enforcement, we made a 1 heartbreaking and toughest decision we had ever had 2 to make: We had our son charged with criminal 3 possession of a forged instrument third degree, a 4 felony that even drug dealers don't even get 5 felonies, and petty larceny. 6 We knew he had stolen a personal check and 7 cashed it for $120 earlier in the year. Minimal, 8 considering the large amount of money that we had 9 already given him. 10 This would get him into what I determined to 11 be protective custody, and our hope that a judge 12 would order treatment for his drug addiction. 13 On February 7, 2014, Canton-Potsdam detox 14 informed us that they would have a bed available 15 that day, and our son needed to confirm that he 16 wanted it. 17 But it was too late. 18 State Police were in the process of picking 19 him up for these charges, and as they did, I was 20 speaking with him on the phone, telling him the bed 21 was available, three weeks later. 22 Our son was taken to Clinton County Jail, and 23 then released on pretrial release. 24 Our son violated his pretrial release on 25 purpose. 1 When his lawyer informed him there was a 2 bench warrant for his arrest, he turned himself into 3 authorities the same day. 4 In his mind, jail was a safety net for the 5 time being, and he began to believe that the 6 treatment he wanted could be attained through this 7 pathway. 8 He is set to appear in front of a judge next 9 month, for felony charges, for $120 check, keep that 10 in mind. 11 Unfortunately, sadly, without our support, he 12 is doomed to fall through the cracks, and who knows 13 what would happen to him and others around him. 14 Unable to accept this confusing and daunting 15 system and path that we seek for treatment, and 16 determined to save our son's life, we are here to 17 speak on his behalf. 18 There are major holes in our system for those 19 who seek treatment to save their lives, and we do 20 believe that it starts with our getting the word out 21 to you, our elected officials, and as many people as 22 we can speak to. 23 Finally, because, how do you expect an addict 24 to receive the help and treatment they painfully 25 seek when those doors are opened slightly, then 1 closed more often than not, time and time again? 2 How can two educated parents, and all the 3 parents who are experiencing this nightmare of their 4 children's addictions, get accurate advice and 5 treatment doors opened, and keep them opened, to 6 save a life? 7 Please help me. 8 Thank you. 9 [Applause.] 10 SENATOR LITTLE: Thank you. 11 And it is -- that, too, is an eye-opener. 12 And I think that we've learned a lot here of 13 things that we need to be doing in the Legislature. 14 And, certainly, I give a lot of credit to 15 Senator Boyle, who chairs the Alcohol and Drug 16 Committee, and this Task Force, for taking it on, 17 and realizing. 18 It somewhat reminds me of a few -- several 19 years ago, when we spent years getting mental-health 20 parity in our insurance. 21 And I think that we are seeing the same thing 22 happening here, as we have a crises in this drug 23 addiction, and the accessibility is mind-boggling, 24 just how accessible it is, and learning that today, 25 that we have to continue working with the insurance 1 companies, working so that there isn't a stigma. 2 And, very definitely, doing something about 3 this "medical necessity." 4 Waiting until you're almost so far into it 5 that it's going to be too late before anything gets 6 done, is not acceptable. 7 And there's something that we have to do, as 8 we go forward. 9 So, thank you to so many of you for being 10 here today, for testifying. 11 Shawn and Jack who did, and you as well, 12 really appreciate it. You put a face on the issue, 13 and you make it very, very clear to us that we need 14 to do something. 15 And, we need more services here in the 16 North Country. 17 Thank you very much. 18 SENATOR BOYLE: Thank you, Senator Little, 19 for hosting this, and the Clinton County government. 20 And thank you, everyone, for testifying, and 21 the audience members. 22 I think the most recent testimony and -- 23 reminded me of one we had on Long Island, where one 24 of our drug counselors, a preeminent one on 25 Long Island, told us, in front of all the 1 district attorneys and the prosecutors down there, 2 that they actually advise parents in your situation 3 on how to get their child arrested. 4 AUDIENCE MEMBER: It is exactly what 5 happened. 6 We have many friends in law enforcement. My 7 husband and I are very prominent people in this 8 community. And, I work for a local school. 9 So, yes, unfortunately, knowing exactly what 10 we were willing to do to save a life, who wasn't 11 destroyed yet, who hasn't walked that horrible path. 12 And I sat in those waitings rooms, my husband 13 and I. 14 And, St. Joseph's I think would have been the 15 perfect fit for my child, but one of the 16 stipulations there, was that you needed to be clean 17 for 30 years -- or, not 30 years -- 30 days prior. 18 That's very difficult for someone who is an 19 educated teenager, who had the world at his hands, 20 in his hands. An accelerated student. 21 We're not talking -- these are very bright 22 individuals. 23 And I commend both of these young men for 24 standing here today. 25 I pray one day my son is standing here doing 1 this, advocating for people. 2 SENATOR BOYLE: There's no question that the 3 system is broken. 4 And that's why, with the leadership of 5 Senator Little and others in Albany, I promise you 6 that we're going to change this system for the 7 better to protect our children's lives. 8 Thank you so much for coming today. 9 [Applause.] 10 11 (Whereupon, at approximately 12:52 p.m., 12 the forum held before the New York State Joint 13 Task Force on Heroin and Opioid Addiction 14 concluded, and adjourned.) 15 16 ---oOo--- 17 18 19 20 21 22 23 24 25