PUBLIC FORUM: OTSEGO COUNTY PANEL DISCUSSION ON HEROIN EPIDEMIC IN ONEONTA

PANELIST DISCUSSION BEGINS 27 18 19 AUDIENCE PARTICIPATION, Q&A SESSION 125 20 21 ---oOo--- 22 23 24 25 1 SENATOR SEWARD: Well, good morning, 2 everyone, and I want to welcome everyone here for 3 our Senate Special Task Force forum on Heroin and 4 Opioid Addiction to -- here in Oneonta. 5 And, we have a very distinguished group 6 that's gathered here today, and we look forward to 7 your input on our discussion. 8 As we all know, heroin and opioid use has 9 reached epidemic proportions across the state, 10 across the nation, and, unfortunately, right here in 11 our area as well. 12 The statistics are shocking. 13 You know, nationwide, heroin-overdose deaths 14 increased 55 percent between 2000 and 2010. 15 Here in New York State, overdoses killed 16 2,051 people in 2011, more than twice the number 17 just in 2004. 18 Further, drug-overdose deaths are the leading 19 cause of accidental death for people ages 25 to 64, 20 with more than 40 percent attributed to heroin and 21 opioids. 22 These are numbers from the State 23 Attorney General. 24 And these types of statistics mirror what 25 I am told is going on right here in our area, 1 similar numbers, similar trends. Particularly, when 2 you look at the increased hospitalizations, program 3 admissions, for heroin and opioid uses, the numbers 4 are staggering. 5 Lives are being lost, families are being 6 destroyed. Our health-care dollars are being 7 stretched, and law enforcement and prosecution 8 dollars are also being stretched thin. 9 And so that's why, this year, our 10 Senate Majority Coalition created a Special 11 Task Force on Heroin and Opioid Addiction, to 12 examine this rise in heroin and opioid use to 13 develop recommendations for attacking this problem. 14 This is one of 12 forums that are being held 15 across the state, so it is critical that we bring 16 together stakeholders and experts to develop a 17 comprehensive strategy for attacking this problem. 18 We need your information, your insights, and 19 recommendations for action. 20 We have with us today those who have personal 21 stories regarding this issue. We have law 22 enforcement and prosecution; those involved with 23 treatment, medical providers, educators. 24 And I look forward to a productive session 25 here today. 1 I'm honored to be joined here for this 2 hearing by two of my colleagues. 3 First of all, the Chair of our Task Force, 4 Senator Phil Boyle, the former member of the 5 Assembly, now in the Senate, who chairs our task 6 force. He is from Suffolk County; 7 Along with another one of our members of the 8 Task Force, my colleague Senator Tom O'Mara from the 9 Elmira area. 10 And I would ask Senator Boyle, if you would 11 like to make a few remarks? 12 SENATOR BOYLE: Sure, thank you very much 13 Jim, and thank you for hosting this. 14 I want to thank Senator Seward and 15 Senator O'Mara for being part of this Task Force, 16 and for all the panelists today, and all the 17 participants in the audience, for coming. 18 As Senator Seward said, this Task Force that 19 I'm chairing -- we're actually up to 15 forums 20 now -- and we're going around the state, and what 21 we're looking for is: 22 Whether you're a prevention provider, a 23 treatment provider, or a law-enforcement official, 24 every day you deal with this heroin epidemic on a 25 statewide basis. It goes from the west, down to 1 Suffolk County where I live. 2 If you could say, "If I could just change 3 this law, or a couple laws," that's what we're 4 looking for today; some input to say: 5 How can we change the system to better help 6 with prevention, to stop young people from starting 7 the use of heroin and other opioids? 8 The treatment that may not be there when you 9 need it. 10 And, of course, the law enforcement to put 11 these drug dealers away for a very long time. 12 Thank you, Senator. 13 I look forward to an exchange. 14 SENATOR SEWARD: Thank you, Senator Boyle. 15 Senator O'Mara? 16 SENATOR O'MARA: Thank you, Chairman. 17 It's a pleasure to be here this morning. 18 I'm a Senator from the Southern Tier, 19 Finger Lakes region. I live in Big Flats. And, my 20 district goes from Elmira to Hornell, including 21 Ithaca and Penn Yan; so, that's the Finger Lakes and 22 Southern Tier regional. 23 I'm a former prosecutor myself, having been 24 an ADA in Manhattan, and an ADA in Chemung County, 25 and District Attorney of Chemung County, through out 1 the 1990s. 2 And it's amazing the resurgence that heroin 3 and opioids has made since that time, because it was 4 not a significant or major problem back in that 5 time. 6 But, to see this resurgence is very alarming. 7 And, look forward to the product that we come 8 out with this Task Force. 9 I thank Senator Boyle for his leadership on 10 this, and I hope that we can make it 16 forums, with 11 one in Elmira/Corning coming up. 12 But I thank everyone for their participation 13 this morning. I look forward to your input, and a 14 successful product coming out of our Task Force 15 conferences around the state. 16 SENATOR SEWARD: Thank you, Senator O'Mara. 17 At this point, I'd like to go around the 18 table and have everyone, simply, if you would 19 introduce yourselves, and indicate what -- if you're 20 representing an organization or an entity just, let 21 us know that, as well. 22 So, everyone can introduce themselves. 23 Why don't we start right here with you, 24 Justin. 25 JUSTIN THALHEIMER: Hi, I'm Justin 1 Thalheimer. I'm with Otsego County Addiction 2 Recovery Services. 3 NANCY ORTNER: I'm Nancy Ortner. I'm with 4 the Schoharie County Chemical Dependency Unit. 5 CHRISTOPHER KEMP: My name is Chris Kemp, and 6 I'm the director of the Delaware County Alcohol and 7 Drug Abuse Services. 8 DA RICHARD NORTHRUP: My name is 9 Richard Northrup. I'm the Delaware County District 10 Attorney. 11 DA JAMES SACKET: James Sacket, 12 Schoharie County District Attorney. 13 DA JOSEPH McBRIDE: I'm Joe McBride, 14 Chenango County District Attorney. 15 DR. STEVE GRAHAM: Steve Graham. I'm an 16 obstetrician/gynecologist with Bassett. 17 DR. JOSEPH SELLERS: Joe Sellers. I'm an 18 internist and pediatrician with Bassett, and the 19 secretary of the State Medical Society. 20 DR. KELLY ROBINSON: Dr. Kelly Robinson, 21 medical director of A.O. Fox Emergency Department 22 right here in Oneonta. 23 JOE BIVIANO: Joe Biviano, administrator of 24 Take Back Chenango. 25 ROBERT CLIPSTON: Robert Clipston, co-founder 1 of Take Back Chenango. 2 NICK SAVIN: Nicholas Savin, district 3 superintendent at the Otsego Northern Catskills 4 BOCES. 5 JOE BOOAN: I'm Joseph Booan. I'm the 6 director of student services at ONC BOCES. 7 Our two centers are in Grand Gorge and in 8 Milford. 9 NORINE HODGES: Norine Hodges, the executive 10 director of the Schoharie County Council on 11 Alcoholism and Substance Abuse. 12 DAVID RAMSEY: Dave Ramsey, director of 13 Delaware County Alcohol and Drug Abuse Council. 14 JEANETTE TOLSON: Jeanette Tolson, 15 executive director of Friends of Recovery of 16 Delaware and Otsego counties. 17 JULIE DOSTAL: Julie Dostal, 18 executive director of the LEAF Council on Alcoholism 19 and Addictions in Otsego County. 20 UNDERSHERIFF CRAIG DuMOND: Craig DuMond, 21 Delaware County Undersheriff. 22 SHERIFF THOMAS MILLS: Tom Mills, 23 Delaware County Sheriff. 24 SHERIFF ERNEST CUTTING, JR.: I'm 25 Ernie Cutting, Sheriff in Chenango County. 1 SHERIFF TONY DESMOND: Tony Desmond, 2 Schoharie County Sheriff. 3 SHERIFF RICHARD DEVLIN: Richard Devlin, 4 Otsego County Sheriff. 5 SGT. GARY LEAHY: Gary Leahy, State Police, 6 Oneonta. 7 MIKE MacINERNY: I'm Mike MacInerny. I'm a 8 senior investigator with the State Police, assigned 9 Oneonta. 10 MYLEA BUFFO: Mylea Buffo, I'm an addict. 11 DEB FRANCE: Deb France, I'm a parent. 12 SENATOR SEWARD: And I would also mention 13 that, in the audience today: 14 We have Tina Molett, who is with our 15 colleague Senator Bonacic. Also, a supervisor on 16 the Delaware County Board of Supervisors. 17 And, also, we're delighted that the Chairman 18 of the Delaware County County Board of Supervisors, 19 Jim Eisel, is with us today as well. 20 Our format today is that, we have prepared a 21 series of questions and discussion points to help 22 lead us through a discussion on this issue. 23 Everyone should feel free to chime in at any 24 point if they feel that they have something to 25 contribute to the point that's being discussed at 1 that particular time. 2 I would also like to invite members of the 3 audience to submit any questions, you know, for our 4 panel, or any general statements. 5 They are -- there are index cards at the 6 check-in table, and questions and comments can be 7 made at any point during our forum here today. 8 And because of our session schedule, I know 9 the three senators need to be in Albany by 2:00, so, 10 we need to conclude by noon today. 11 Of course, we do have a number of police with 12 us here. 13 [Laughter.] 14 SENATOR SEWARD: I would also like to mention 15 at the outset, that if any one of our panelists or 16 anyone in the audience has prepared any written 17 statements that would you like to have become part 18 of our record of this forum, please submit them to 19 staff at the table, and those comments and 20 statements will become part of our record here 21 today. 22 To start our discussion this morning, I would 23 like to call on both Deb France and Mylea Buffo, who 24 have joined us, who both have personal experience 25 and personal stories regarding this issue. 1 I thought that would be a good way to start 2 our discussion. 3 To the extent you feel comfortable in 4 discussing -- briefly discussing your personal 5 stories, we would like to ask you at this time. 6 DEB FRANCE: Good morning. 7 My name is Deb France, and I'm here as a 8 parent to put a face on this epidemic of heroin and 9 opioid addiction by telling my personal story. 10 My husband, Bob, and I are your typical 11 middle-class family. We have a house, two jobs, 12 two cars, two children, and a dog. We're active in 13 the community and our church, and our sons 14 participated in sports, band, and chorus, as well as 15 Cub Scouts. 16 When our youngest son Jeremy, a talented, 17 personable young man, was 16 or 17, he had his 18 wisdom teeth pulled and was given a prescription for 19 pain reliever. 20 Suddenly, our typical family was turned 21 upside down, and the story goes terribly wrong from 22 here. 23 Whether it was because of his anxiety 24 disorder or an ordinary experimenting teenager, it 25 doesn't matter, but Jeremy found a high from these 1 meds and it became a downward spiral. 2 We don't necessarily know how the path 3 continued or what led to what, but Jeremy went from 4 buying prescription pills from his classmates, to 5 heroin and any other opiate he could get his hands 6 on. 7 When he was 18, he chose to leave home rather 8 than to abide by our rules, and ended up stealing to 9 support his habit. 10 Arrested and put in jail, he came back home 11 and eventually revealed his addiction to us one 12 sleepless night as we helped him go through 13 withdrawals. 14 As parents, we did extensive research and 15 looked for resources to help our son within our 16 community while trying to keep our dirty little 17 secret within our home. 18 At that time, access to outpatient treatment 19 locally was long and cumbersome. This led us to an 20 out-of-state agency which took our money to provide 21 an in-home Suboxone treatment, minus any counseling 22 or support. 23 When this did not work, and, in fact, made 24 matters worse, we researched inpatient facilities 25 and enrolled him in a 30-day program. 1 After 14 days, our insurance company would no 2 longer pay for his inpatient stay, stating he would 3 be okay with intensive outpatient therapy. 4 Of course, they did not take into 5 consideration that the facility was two hours away 6 from our home. 7 We ended up paying out-of-pocket to keep him 8 there for the entire 30 days which the treatment 9 plan indicated was necessary. 10 After his discharge, he was enrolled in the 11 local chemical dependency clinic. He continued to 12 struggle, and around his 19th birthday, could no 13 longer deal with his addiction and attempted 14 suicide. 15 Luckily, he survived, and because of a State 16 mandate, once medically stable, he was transferred 17 to a psychiatric facility. 18 We again struggled with the insurance 19 company, who told the hospital he was a heroin 20 addict, "cut him loose." 21 We were fortunate enough to have a 22 sympathetic nurse-practitioner friend who bucked the 23 system, despite possibly losing her job over it, and 24 because of this, helped him stay in the hospital 25 long enough for us to find an out-of-state rehab 1 facility that our insurance would pay for. 2 Interestingly enough, Marworth was a facility 3 filled with rescue and medical professionals who 4 were being treated for addictions related to their 5 9/11 experiences. 6 From Marworth, Jeremy was transferred to 7 Cayuga Addiction Recovery Services (or, CARS) in 8 Trumansburg, New York. 9 Again, insurance would not pay for his stay 10 there, but we sacrificed his college fund to 11 private-pay, and Jeremy stayed there for 12 seven months, doing well with this highly-intensive 13 program. 14 On discharge, he was again enrolled in the 15 local chemical-dependency center, and we were 16 optimistic that we had our loving son back. 17 As the addiction community will tell you, 18 relapse is a part of the recovery process, and 19 Jeremy would do well for a while, and then he would 20 struggle. 21 He did fairly well for several years, but 22 then relapsed, and because of this probation 23 violation, he was sent to jail. 24 Jeremy was incarcerated alongside some of his 25 dealers, and at the same time, the local king pin 1 was also arrested and put in the Otsego County 2 facility. 3 One month after his release from jail, and 4 one week after his 23rd birthday, Jeremy 5 successfully committed suicide. 6 His final words to us were, that he loved us, 7 but he could not handle this addiction and he did 8 not want to be a burden anymore. 9 What I hope you can learn from the story, is 10 that heroin and opioid addiction does not 11 discriminate based on age, sex, income, or social 12 status. 13 The power of this drug is incredible, and 14 those who become addicted are often helpless to 15 overcome it. 16 Every day, doctors are prescribing opiates 17 for pain relief, and although not everyone becomes 18 addicted, the numbers that do are staggering. 19 When pain relievers are no longer accessible, 20 heroin provides a cheap option that is readily 21 available in our schools and community. 22 Studies show that 1 in 4 of those who try 23 heroin become addicted. 24 The collateral damage to our community that 25 this epidemic brings is staggering. 1 There is -- I'm sorry -- opportunity to set 2 up drug rings to profit, a court system is overrun 3 with drug-related cases, jails are filled with 4 addicts and dealers, and families are torn apart and 5 lives are lost. 6 My husband and I struggled to find accessible 7 resources to provide help for our son. 8 We both feel that we need to invest in 9 prevention programs and community education, as well 10 as treatment centers at the local and state level. 11 Insurance companies need to recognize this 12 addiction is a disease and provide the length of 13 treatment necessary to assist in recovery. 14 We need to recognize that jail is not the 15 place for addicts unless there is a recovery program 16 to assist them and work on the underlying causes. 17 We are pleased that this issue is starting to 18 get some recognition for the crisis that it is, and 19 hope that forums such as these will help to open 20 dialogue and generate effective prevention and 21 treatment options. 22 Thank you for the opportunity to share my 23 story. 24 SENATOR SEWARD: Thank you very much, Deb. 25 I know it's not easy. 1 And, Mylea, did you have anything you wold 2 like to add at this point? 3 (Non-working microphone.) 4 MYLEA BUFFO: I'll share my story. 5 My name is Mylea Buffo, I'm 27 years old. 6 I'm an opiate and heroin addict. 7 I will give you the short version of my story 8 because it's traumatizing, and the things that I've 9 done and seen are unspeakable. 10 My addiction started about seven years ago 11 when I was having back pain and my family doctor 12 prescribed me hydrocodone. 13 I felt superhuman. I had zero pain, slept 14 better than I ever had, zero anxiety, zero 15 depression, and more energy than I could have ever 16 imagined. 17 Soon it was not enough. 18 Within a year, I was seeing a different 19 doctor and I ended up on oxycodone, 30 milligrams, 20 6 times a day; OPANA, 20 milligrams, 3 times a day; 21 and, OPANA, 40 milligrams, 2 times a day. 22 People on their death beds do not receive 23 this type of medication. 24 It's hard not to blame the doctors, but 25 I have to take the responsibility to recover. 1 It no longer felt good. It caused more pain, 2 sleepless nights, the energy was gone. I was more 3 anxious and depressed than ever, and it became I had 4 to have it; it was no longer I wanted it. 5 I was self-medicating, and seems I was on a 6 mission to destroy my life. I was so out of 7 control, and the more out of control it got, the 8 worse I got in my addiction. 9 I was hiding my pain in medications that made 10 my complete healing system numb. 11 I was filling prescriptions for a month, 12 every week, using up to six different pharmacies a 13 month. 14 Every day I would wake up and snort or inject 15 pills, and I would not be able to do anything in my 16 life without doing pills first. 17 To take a shower, I would have to do pills 18 before and after. 19 I was so high I was oblivious to anything 20 going on around me. My only thought was about 21 drugs. 22 Soon my sister got me to go to detox for 23 three days, and my family doctor found out and was 24 so mad, he cut me off. 25 I hid for so many years behind the fact that 1 my scripts were legal, so I was not an addict. 2 And that was now gone: I was an addict. 3 The last conversation I had with my doctor, 4 he said: You'll experience withdrawals for 5 seven days. 6 On the 23rd day of my withdrawals, I was 7 cursing at him. 8 I can remember so many times when I would 9 just watch people at the store and wonder, Why can't 10 I be normal? 11 I was now buying street drugs, and what most 12 people refer to as "risky behavior" was just a 13 normal day in my life. 14 I didn't care where I was. I was injecting 15 drugs, using with people who had hepatitis, and 16 I was always in trouble with the law. 17 Every day, I had in my mind that there was no 18 help, there was no chance for me. 19 While normal people were wishing for good 20 health and happiness, I was wishing with every 21 injection that God would take my pain away and let 22 me die. 23 I wanted it so bad, I could imagine my own 24 kids at my funeral saying goodbye to me. And 25 I truly believed that that was best for them; that 1 they had a better chance in their lives if I was 2 dead. 3 My addiction was so bad, my boyfriend would 4 check me all the time, wherever I passed out, to 5 make sure I was still breathing. 6 By this point in my addiction, I completely 7 signed my life to the devil. Feeling stuck with no 8 way out, I ended up with the heroin. It was 9 cheaper, quicker, and easier to inject. 10 This was a whole nother addiction for me. 11 I would hide it as much as I could from 12 everyone, because I was now addicted to the needle 13 worse than I could have ever imagined. 14 My risky behavior was now off the charts. 15 I was no longer the same person. 16 I have so many classmates, and had awful 17 marks; and still, to this day, I tried to minimize 18 my addiction. 19 I made things worse -- to make things worse, 20 I ended up getting arrested. And I am currently in 21 drug court for criminal possession of a controlled 22 substance. 23 The night of my sentencing was the best night 24 I slept in seven years, because the worry of my 25 legal issues were finally being taken care of, and 1 it was a sense of relief I'd never experienced. 2 I made a choice that I didn't want to live 3 like this anymore, and I take drug court very 4 seriously, because I know, if there's a chance for 5 me, drug court is the way to freedom from my chains 6 of addiction. 7 Today I am five months clean and sober. 8 I do not take any medication except for a 9 blood-pressure medication, because, after 10 seven years of addiction, my heart rate is abnormal, 11 and I take an antidepressant. 12 It took me seven years to completely 13 self-destruct, and I work every day at rebuilding my 14 life. Every day is a struggle. There's a war going 15 on inside my body, with my brain saying, "Go get 16 that magic pill," and my heart saying, "Haven't you 17 had enough?" 18 Every time I hear of a young life being taken 19 from an overdose, it makes me sick to my stomach, 20 because that should have been me. 21 Narcan is a life-saving -- is life-saving, 22 but it is an addict's worst nightmare, because it 23 puts you in instant withdrawals. 24 Five months ago, I can say with complete 25 honesty, that I would have been laughing at New York 1 for the negative feedback with the I-STOP system, 2 because it was so easy to get around the pharmacies 3 and doctors. 4 Today I realize I was naive and 5 undereducated. I have learned more in the past few 6 months about my addiction than I did the last 7 seven years on the streets. 8 I hear a lot of negative feedback from people 9 who are legitimately getting narcotic scripts and 10 believes that the I-STOP system is causing them 11 grief. 12 Maybe we should ask them if they know what 13 they are taking. Or, if they know that pain 14 medication actually causes more pain than the reason 15 they take the pain medication to begin with. 16 And while I'd like to say, those legitimate 17 scripts is how I got started, like most other 18 addicts, and if you have a legitimate medical reason 19 and you follow the rules, then it won't cause you 20 grief, let's not forget it's very easy to become 21 addicted, and you can take them properly and still 22 be dependent on them. 23 I would like to ask them if their grief from 24 the system is worth some child's life, because this 25 is how kids are becoming addicted from your 1 medication cabinets. 2 So many people have been caught from 3 doctor shopping and pharmacy shopping, and with the 4 uprise in heroin, screams "the system is working." 5 It's not good for anyone in recovery to have 6 such access to heroin on the street, but I do 7 believe, in time, with the I-STOP, there will be 8 less addiction. 9 There just needs to be more education for 10 younger people and the already-addicted. 11 I realize that I will always have to deal 12 with my addiction, and, now, only time and education 13 will help me. 14 In my life, if I could save just one kid from 15 the pain and suffering I've been through or seen, 16 I will be completely satisfied with the way that my 17 life has turned out. 18 Thank you. 19 SENATOR SEWARD: Thank you very much, Mylea. 20 You know, we started out the forum talking 21 about statistics, but the both you, and Deb, have 22 reminded us that there are real people behind these 23 numbers and real-life situations. 24 So, I/we greatly appreciate your sharing your 25 personal stories with us. 1 In terms of our discussion this morning, I'd 2 like to first call on our law-enforcement community, 3 and others that may want to join in, but, I'd like 4 to first hear from our law-enforcement partners, to 5 tell us a little bit of what is out there in our 6 communities, in terms of, you know, heroin use, in 7 terms of the arrests that are being made. 8 Is it -- what is it, dealers, or users, or 9 possession? 10 If you would like to -- to just kick off our 11 discussion this morning, from the law enforcement 12 point of view. 13 Who would like to be first here? 14 SHERIFF ERNEST CUTTING, JR.: I'll jump in. 15 Ernie Cutting from Chenango County. 16 About three years ago, in Chenango County, we 17 started seeing more and more heroin on the street. 18 At that point in time, I had sounded the alarm in 19 the media that it was here. 20 In past years, heroin was a minor thing. You 21 know, very few people. There was a stigma to 22 sticking a needle in your arm. 23 But a lot of the kids that we talk to that 24 were addicted to heroin, were -- told us that they 25 were brought on to heroin by saying you could snort 1 it, it's not as addictive. Which was wrong. 2 In that time, this last year, heroin had 3 become such a problem. 4 And I've relayed this story several times: 5 I had gone to a local community. 6 I live in Afton, New York, just down 88. 7 I had gone to Bainbridge for breakfast. And 8 I walked with my son, and I walked in, and I was 9 besieged by the people there, they were so outraged. 10 And I made a commitment, from that day, that 11 we were going to attack this problem. 12 From last March to December, I pulled an 13 officer specifically to handle narcotic arrests. 14 And in that time, he's arrested 60 -- there were 15 60 felony arrests, and 58 misdemeanor and violation 16 arrests, specifically related to heroin. 17 What troubles me even more, though, is the 18 hepatitis issue that's created from the needles. 19 I've had a meeting with our County Public 20 Health on the hepatitis issue. 21 I also am active in inmates working to return 22 something back to the communities. We do roadside 23 pick-up garbage. 24 This last spring, we had gone from the 25 city-of-Norwich line to the village-of-Oxford line 1 on Route 12, approximately 7 miles, and back. And 2 in that time they picked up 46 heroin needles that 3 had been used, and a bunch of other drug 4 paraphernalia just right on Route 12. 5 And I thought of some kid walking along the 6 road, potentially, picking that up and potentially 7 sticking themselves. It was very concerning to me. 8 That brings in that huge -- the public 9 information, you know, on what the problems are out 10 there, potentially. 11 And that's just a little bit of what we're 12 seeing in Chenango County. 13 I'm in it up to my ears. We have several 14 arrests, and it's just never ending. 15 And we have people from all over the county, 16 taking back Chenango. We've joined together, and 17 trying to work together, the citizens of 18 Chenango County and law enforcement, opening lines 19 of dialogue, and working together to try to handle 20 some of what's going on in the community. 21 That's a little bit of what we're facing. 22 SENATOR SEWARD: Thank you, Sheriff. 23 Anyone else? 24 Craig? 25 UNDERSHERIFF CRAIG DUMOND: Thank you, 1 Senator. 2 We saw similar things in 2012 in 3 Delaware County, just alarming statistics. 4 And I can relate to the Sheriff's 5 community-service work program. 6 One of the first things that we did was 7 notice that, as well. 8 We were actually -- initiated our program as 9 garbage pickup along some county roads, and our 10 officers and inmates were experiencing so many 11 hypodermic instruments being discarded along our 12 county roads, that we had to put a sharps container 13 in the sheriff's vehicle, just to properly secure 14 these instruments. 15 It was very alarming. 16 And then we just, basically, saw an explosion 17 in heroin and related drugs in 2012. As a matter of 18 fact, it was up 229 percent from the previous year, 19 our arrests. 20 And then, in 2013, we're up another 21 26 percent from there. 22 So the problem is not -- it's definitely not 23 going away. It's getting larger. 24 Our arrests are up 36 percent, you know, 25 mainly attributable to drug abuse and drug sales. 1 So, we have a significant problem on our 2 hands. 3 We, as well, took one of our road-patrol 4 deputies off the road and assigned him to narcotics 5 full time. That's hard to do when your arrests and 6 your complaints are up, but we made a decision, you 7 know: We can continue to chase around the symptoms, 8 or we can try to attack the disease. 9 And since the common denominator was heroin, 10 we decided we wanted to go there. 11 And our numbers, as Sheriff Cutting has seen 12 over in Chenango County, are a reflection of that. 13 We implemented the canine unit. We did that 14 with -- we had to do that because of the limited 15 resources that the County of Delaware has. We had 16 to do that with private and corporate donations. We 17 were successful in that program. 18 And then we thought, what do we do to start 19 educating our kids? 20 And so we instituted the School Substation 21 Program, where we have deputies in and out of 22 schools on a regular basis; 23 And, a tip line for community individuals to 24 phone in tips, because the community involvement in 25 this problem is key, as well as community meetings. 1 But what we started this year was a 2 task force. It's very similar to what you're doing 3 here, just on our county level. The 4 District Attorney and all of the stakeholders are 5 involved in that task force. 6 And what's -- already, what's very similar to 7 what we're hearing here is, we're seeing that a huge 8 emphasis, and we're all agreeing, that a huge 9 emphasis needs to be placed on education, treatment, 10 and then aggressive law enforcement, if we're going 11 to attack this problem. 12 We're not going to arrest our way out of this 13 problem. It's going to take a collaborative 14 teamwork approach from all the various stakeholders. 15 We're hoping that, you know, you can help us. 16 SENATOR SEWARD: Thank you. 17 Anyone else from law enforcement? 18 Sheriff Devlin? 19 SHERIFF RICHARD DEVLIN: Yeah, I agree fully 20 with the Sheriff Cutting and Sheriff DuMond's 21 statements. 22 We're seeing the same thing here in 23 Otsego County: Arrests are up dramatically. Our 24 resources are taxed. 25 On the correctional side of things, we have 1 jails full of heroin addicts. 60 percent of our 2 current population has some sort of addiction, and, 3 we do not have the resources to treat those people. 4 We're dealing with withdrawal symptoms, 5 underlying medical conditions, which is increasing 6 our local fees for medical costs. Additional 7 manpower for monitoring these people because they 8 cannot be left alone. 9 So. We're seeing that increase on the 10 correctional side, as well as the law-enforcement 11 side. 12 SENATOR SEWARD: Sheriff Desmond. 13 SHERIFF DESMOND: Thank you, Jim. 14 In Schoharie County, we are having a problem 15 that -- getting a lot of crimes committed to obtain 16 money to purchase heroin and other drugs. 17 The sheriffs here, I read in the papers, and 18 they talk to them, and they're doing a tremendous 19 job fighting this problem with arrests. They've 20 taken people off of the road and put them into 21 investigations. 22 Sadly, that we are still experiencing the 23 effects from the flood of 2011, and funds are very 24 limited to do anything like this. 25 If there was some way where we could get some 1 money, we could probably go into the investigations 2 of heroin, and work with our neighboring sheriffs 3 here on this problem. 4 But like I said, the limited number of 5 investigators and deputies we have, and, compounded 6 by the fact that we have to transport all our 7 prisoners into Albany, we just don't have the 8 resources that we need, but, we certainly would like 9 to find some somewhere. 10 Thank you. 11 SENATOR SEWARD: Any comments from the 12 State Police point of view? 13 MICHAEL MacINERNY: I don't really have any 14 statistics to lay out, but, I mean, it's very 15 obvious that a large percentage of the crimes that 16 we investigate are driven by drug addiction, 17 committed by those that are addicted to drugs. 18 We've seen -- recently we've seen a big 19 uptick in robberies of convenient stores. And, 20 we've had a bank robbery, a number of convenient 21 stores, that we later found out were driven by the 22 drug addiction. 23 It just seems that those are things that we 24 probably didn't have near as many, going back a few 25 years. And, it just seems to be more and more 1 prevalent at this time. 2 The State Police, we don't have any part in 3 the treatment of the drug addicts, but, anything 4 that we can do to help any other agency, you know, 5 we're willing, and would like to do. 6 SENATOR SEWARD: You know, the question that 7 I have for, you know, law enforcement, and I'd ask, 8 our District Attorneys perhaps would like to chime 9 in, what recommendations, if any, do you have, you 10 know, for us? 11 I mean do we need, you know, stronger 12 penalties for, particularly, dealers? 13 Or -- or, what can we do to be helpful to 14 you, from the law-enforcement and prosection side of 15 it, in terms of -- is there any recommendations 16 anyone might have for us as we formulate our 17 recommendations? 18 DA JOSEPH McBRIDE: Senator, I'll briefly 19 respond and give you the picture, what's going on in 20 Chenango County. 21 We have a very small rural community of 22 farmlands, manufacturing; great place to raise your 23 kids. 24 Unfortunately, as the Sheriff said, you're 25 going to hear from some other members of our 1 community, that we've had a terrible heroin problem 2 for the last few years. 3 By example: I had to cover a small justice 4 court in the town of Sherborne. 5 And when I was in there, there was a young 6 gentleman with a John Deere hat on and a John Deere 7 shirt, and he was before the judge for possession of 8 heroin. This kid looked like he just got off the 9 field from bailing hay. 10 I would never have imagined that, in my 11 lifetime, that I would have seen that. 12 When something happened, when we were kids, 13 and we were growing up, you knew you could do a lot 14 of silly things, but you would never, ever, go take 15 this drug because you knew it was a death sentence. 16 It was going to change your life. 17 So we need the education out there to make 18 sure that these kids know that. 19 The second thing is, unfortunately, as the 20 Sheriff said, in places where you would never 21 suspect it, including our neighborhoods and our 22 parks, our city parks, our county parks, and on the 23 road, kids are being exposed to drug paraphernalia, 24 which are very dangerous. 25 And, unfortunately, at this point, we have to 1 start educating our kids at the elementary school 2 about, What do we do when we see needles? What do 3 we do when mommy and daddy are using drugs? 4 And we want, not to arrest them, but we want 5 to keep people safe. 6 Somehow, we have to get back to that 7 education, so that every kid in New York State knows 8 that he cannot ever experiment with heroin because 9 it's such an addictive drug. 10 Two things: 11 Heroin's different. 12 When we send these guys to jail for 60 days, 13 90 days, and do whatever, unless they're in 14 treatment, the first place they're going is the last 15 place they got a fix. 16 I don't know what the biology is or what goes 17 on in their mind, but they don't stop. And we need 18 to do something to make sure that they're -- there 19 are people, places, and things, when they change. 20 The next problem that my county has, and I'm 21 sure some of the smaller counties, is we are a very 22 safe community. 23 So, when someone's dealing dope in a big, 24 larger city outside of our jurisdiction, it's very 25 safe to come to our community and to sell narcotics. 1 Now, when I get them, I try to be as tough on 2 them as I can, but that's an ongoing problem, when 3 someone who's dealing the product is, literally, 4 being shot in the bigger metropolitan areas, and 5 think it's safe to come to Chenango. 6 Now, that's a problem for Chenango, and we 7 need help in fighting those issues. 8 That's my 30 seconds, and I'll just pass the 9 mic. 10 JAMES SACKET: Thank you. 11 Senators, just a couple -- actually, a number 12 of points I wanted to touch on. Most -- some of 13 them have already been touched on. 14 Combating this in a small county, and I think 15 most law enforcement would agree with me, it's hard 16 to infiltrate the dealers. 17 The dealers in Schoharie County have a 18 tendency to come from the tri-city areas or outside. 19 Schoharie County has 33,000 people, on a good 20 day, and our communities are still recovering from 21 "Irene" and "Lee." 22 It's very hard to infiltrate. 23 Many of the people that are arrested in our 24 community are -- have misdemeanor weight: criminal 25 possession of controlled substance in the 1 seventh degree, or, possession of a hypodermic. 2 And, many times, just residue, or a very 3 small amount, but we know that they are heroin 4 addicts. 5 The heroin-user community is very tight. 6 A police officer is not going to go up to the 7 door and knock on the door, and say, "Can I buy some 8 drugs?" 9 We have a very tough time infiltrating that 10 tight-knit secret system, so that's one of the 11 problems that we face. 12 I-STOP, unfortunately, has worked, in my 13 opinion, so well, that it's driven the drug people 14 underground, the drug users to an underground arena, 15 where it's very hard, as I said, to infiltrate. 16 We know, we have an idea, who's using the 17 heroin. 18 Finding the dealers as they come into 19 Schoharie County are very difficult. 20 These are -- the people that we arrest are 21 not driving around in Lexuses or BMWs, with two or 22 three cell phones. These are people that are 23 struggling. They're young people that don't have a 24 lot of education or skills, and, sadly, they're 25 caught in a downward spiral. 1 Many of the crimes that we see -- burglaries, 2 larcenies, home invasions -- in Schoharie County, 3 daytime residential burglaries, in my 17 years, 4 I can't remember so many of them. It was very rare. 5 We used to have the camps, the summer camps, 6 those types of burglaries, where people would 7 steal -- break in and steal items. 8 But now we're seeing cash, jewelry, weapons, 9 electronics...brazen daytime burglaries, where 10 people just break in with no regard. 11 And even in villages it's happening. 12 So, it's very difficult to be everywhere all 13 the time. 14 Areas you would think that it wouldn't happen 15 are now being attacked. 16 So, another thing I really want to emphasize 17 is the Good Samaritan laws that we have. 18 The Good Samaritan Law is, if a young person, 19 or anyone, sees a person in the throes of an 20 overdose, please call the medical providers, the 21 ambulance, 911. Get the people the help before they 22 overdose so we have a chance to at least try to 23 treat them. 24 That also goes for alcohol, too. 25 Our most abused drug, our legal drug, I'm 1 sure law enforcement also would agree with me, 2 causes an awful lot of problems in our community, 3 and has for years. 4 But, if you see someone overdosing from 5 heroin or from alcohol, young people need to know 6 they need to call help and they won't be arrested, 7 so long as there's no evidence of drug trafficking. 8 Thank you very much. 9 DA RICHARD NORTHRUP: I would certainly agree 10 that education and prevention, in my opinion, are 11 the key to attacking this problem. 12 Virtually every crime that we prosecute is 13 somehow drug-related: assaults, sex offenses, 14 burglaries, larcenies, forgeries. 15 Virtually everything is now drug-related, and 16 a large percentage of that is heroin-related; 17 whereas, just a few years ago it was more oxycodone 18 and hydrocodone. 19 And, we've made some strides, the 20 Sheriff's Office in Delaware County, a lot of the 21 Village departments, the State Police, have made a 22 lot of undercover, confidential-informant buys. 23 We're prosecuting those cases. 24 We don't necessarily need tougher sentencing 25 for drug sales. 1 To sell just a pinch, just a pinch, of heroin 2 is a high-grade felony. It's a Class B felony. You 3 can do up to nine years in prison for that. 4 We don't need tougher sentencing laws. 5 We need more education and prevention before 6 people get to that point. 7 A lot of the people that we're seeing making 8 sales are not the drug dealers from the Syracuse, 9 Albany, Binghamton, New York City area, that channel 10 the stuff here. 11 We're getting the street-level dealers who 12 are selling to perpetuate their own addiction. 13 Those people don't necessarily need to go to prison. 14 They need to go to rehab, they need to get 15 straightened out, so they're not doing that anymore 16 when they get out. 17 And the key, really, is rehab for a lot of 18 these people, but, they shouldn't be in the system 19 to begin with, most of these people. 20 They should -- if they just increased the 21 education, take on an initiative like we have in the 22 past with other things, smoking and drinking, things 23 like that, it would make a huge difference. 24 I think that's where the legislation needs to 25 be implemented, because if we can do that, we'll see 1 a dramatic decrease in the crime, in many respects. 2 SENATOR SEWARD: Thank you. 3 Let's move on to some of those other 4 alternatives. 5 I first would like to mention the -- you 6 know, the drug courts. 7 I understand that this is -- and, Mylea, 8 you're a product of the drug court? 9 MYLEA BUFFO: Yes, I am. 10 SENATOR SEWARD: Which county? 11 MYLEA BUFFO: Otsego. 12 SENATOR SEWARD: Right here in Otsego. 13 Is -- could somebody share with us your 14 experiences in terms of the drug-court process? 15 Is that a good alternative? 16 DA RICHARD NORTHRUP: It has here in 17 Delaware County. It has been a good alternative. 18 We've seen quite a lot of success. 19 There's some failures, too. 20 But the way we operate in Delaware County is 21 that, if someone is deemed an appropriate candidate 22 for drug court, they have to plead guilty to the 23 felony charge, or a felony charge, and they sign a 24 contract. And they go in, and they are in the 25 drug-treatment program as part of a 5-year probation 1 sentence, and they have to participate in the 2 drug-treatment court for up to 18 months. 3 They're under heightened supervision, 4 heightened treatment. 5 And if they successfully complete, they get a 6 watch and a cake, and sobriety. 7 And they stay on probation for the rest of 8 the five years, but, while they're in the drug 9 treatment program, if they don't succeed, if they 10 flunk out of drug court, they contractually agree 11 that they'll go to prison for the maximum term. 12 So there's a big incentive, and it has 13 resulted in some good success in Delaware County. 14 SENATOR SEWARD: Anyone else would like to 15 share the experience regarding that option? 16 NORINE HODGES: One thing I was going to 17 express is, we've instituted in Schoharie County a 18 program for people new to drug court. We call it 19 our "Drug Court Recovery-Coach Program." 20 I was sharing it with my colleagues here 21 today. 22 And, it's to help people new to drug court 23 become more successful. We run it for three weeks, 24 two nights a week. 25 The first night is educational, about 1 addiction; about all the pieces you were talking 2 about, Mr. Northrup. 3 And the second night, we actually bring folks 4 in who have sobriety; who have gone through drug 5 court and have sobriety under their belt for some 6 time, and they talk about how it was, what they did, 7 and where they are today. 8 And then each of the participants has to 9 relate to what they heard, and the stories are very 10 similar. Many of them start out with a sports 11 injury in high school and/or dentists. 12 You know, that -- that dentist piece is very 13 important. The wisdom teeth, the Vicodin, that kind 14 of thing. 15 And then they talk about, in and out of 16 institutions, and treatments, and so forth. 17 Many of them say they wish, that when they 18 had originally gotten caught, that it was stricter 19 at that end; that someone stopped them earlier on 20 their path. 21 And then the last night, they actually chair 22 a mock AA meeting. 23 They do these three weeks in lieu of going to 24 AA or self-help. And we really focus on sobriety, 25 sponsorship, AA; the value of the 12 steps, going 1 through all the 12 steps. 2 And, I think it really helps. 3 Everybody tells the story, "We're only as 4 sick as our secrets," so it allows that piece as 5 well. 6 SENATOR SEWARD: Thank you. 7 Anyone else? 8 JUSTIN THALHEIMER: I'd like to speak on 9 behalf of the drug court. 10 It's well-represented today, drug court 11 works. 12 It gives people a chance. It's, uhm -- 13 excuse me, I'm a little nervous. 14 But, it really gives people a good chance. 15 They're monitored regularly. 16 They're -- there's -- if they get out of 17 jail -- once they plead to whatever they have to 18 plead to, or it's a diversion, or however it goes, 19 they get out of jail, and they're monitored so 20 closely, and asked to do so much, and they have to 21 do it sober. 22 And if they don't, they -- if they don't, 23 then it's easier for us to get them into treatment 24 because, sometimes, you have to pull teeth to get 25 somebody into rehab. 1 And what drug court does, you can get a Court 2 order, and it gets people into treatment. 3 And, my only wish for drug court is that it 4 was easier to get into. 5 Why wait until they have a felony that's 6 going to be disruptive to your life for the rest of 7 your life? 8 Long after treatment ends, that felony is 9 still there. 10 The people, I consider them very lucky. 11 If you're on probation, and you get asked to 12 go to drug court by a probation officer, I consider 13 you very lucky, because you might actually get into 14 drug court with misdemeanors. 15 SENATOR SEWARD: Are you saying that we 16 should have people get into the drug court, perhaps 17 on lesser charges? 18 Is that what you're suggesting? 19 JUSTIN THALHEIMER: Right. Or have that 20 felony wait until the end of five years, possibly. 21 I don't know, at the end of probation, just 22 have that sentence -- I don't know all this legal 23 stuff, so, bear with me. 24 UNKNOWN SPEAKER: "Expunged." I think 25 "expunged" is the word you're looking for. 1 JUSTIN THALHEIMER: Excellent. 2 Yeah, absolutely, at the end of five years, 3 if they've demonstrated they haven't been back into 4 the law enforcement after they graduate from drug 5 court, it just doesn't stay with them forever. A 6 felony does. 7 I think a lot of people are doing these 8 online applications, where the felony just -- they 9 never even get to see a human. They never even get 10 to interview. 11 So, I really think that would make a great 12 difference. 13 And, if we can get them into drug court, with 14 misdemeanors, with a lesser charge, that would be 15 great. 16 SENATOR SEWARD: Thank you. 17 JAMES SACKET: Senator? 18 SENATOR SEWARD: Yes? 19 JAMES SACKET: May I respond to that? 20 In Schoharie County, we have approximately 21 60 people in our drug court. Around 50 criminal 22 cases, and 10 around -- from the family court. It's 23 a combined court. 24 We have misdemeanors in there. 25 There's also a program called 1 "Judicial Diversion," where the person is placed on 2 interim probation for two years, and then the final 3 three years can then be placed on regular probation 4 once they complete the treatment core program. 5 What that allows them to do is, seal their 6 conviction. Or, also, there's also the possibility 7 of vacating the conviction. 8 So what we do is, place the ball in the 9 court -- in their court. If they walk the walk and 10 talk -- if they talk the talk, and then walk the 11 walk, they're able to come out of that with a clean 12 record, just as Justin was mentioning. 13 That allows them, if they've done what 14 they're supposed to do, on our end, then we either 15 seal the record, or look to vacate the conviction 16 with either no conviction at all or a misdemeanor. 17 In our drug-treatment core program, we take 18 misdemeanors. We want to get these young people 19 before they get a chance to get too far into the 20 system, so they don't -- we don't have to wait for 21 their felonies. 22 We also expect people to relapse. 23 Part of that is, if you have a treatment 24 issue, what we try to do is up the level of 25 treatment. 1 If you commit crimes, then you're going to go 2 to prison. 3 However, the incentive, the 10-ton weight 4 over your head, is always there for many people. 5 What we found is, that many -- keeping people 6 out of prison, in the community, either have to work 7 or go to school, or, they have to do community 8 service. They're monitored. They have to do three 9 to five self-help meetings a week. They're in 10 treatment; they have group and individual. They 11 meet with their probation officer once a week. And, 12 they're required, they're also randomly tested for 13 drugs and alcohol. 14 So what we found, in our experience in about 15 10 years in Schoharie County is, people, while 16 they're in drug court, do well. 17 We often speculate, it would be nice to see 18 people, in a way, in lifetime drug court, because 19 that's where they do their best. 20 Once they get off of drug court -- and we 21 also treat alcoholics, too, in our treatment 22 courts -- they slip back into their old ways, they 23 go back to the old neighborhoods, they fall into the 24 bad habits again. 25 But while they're on drug court, we're saving 1 the money from having them in prisons. 2 But what we really need, in my opinion, is 3 more resources for treatment. 4 Heroin, we've gone to long-term inpatient 5 residential for months, even up to a year, year and 6 a half. That seems to be the only way to really 7 attack the heroin problem for some of these serious 8 heroin addicts. 9 We need the resources. 10 If we're going to treat this public health 11 issue, that's the way we have to treat it, in my 12 opinion. 13 SENATOR BOYLE: Just a quick question, Jim, 14 or one of the other prosecutors: 15 What we're seeing in other parts of the 16 state, is a case where actual dealers are kind of 17 using the drug court to say, Well, I just need to -- 18 some treatment, and then -- to reduce what they're 19 looking at. 20 Are you seeing anything like that? 21 DA JOSEPH McBRIDE: Actually, that goes on 22 all over the state. 23 And in every drug court, every county has 24 different rules. 25 There are state guidelines. And every DA and 1 judge and every treatment team makes the evaluation 2 of who comes in, and who doesn't. 3 As was stated before, local dealers who are, 4 you know, young kids, young adults, who get involved 5 in the wrong system, are treated differently than 6 gentlemen or women who come from out of town and try 7 to sell heroin. 8 So that does happen, but it's not effective, 9 because we usually, the rules, when they were 10 started, say, We are the gatekeepers. 11 Now, Judicial Diversion changed that a 12 little, so they can get people into drug court 13 without our permission. 14 But most of the time, they have to have the 15 DA's consent before they're allowed into the 16 program. 17 Just to drug-treatment court, and our person 18 here today who is a member can probably say, it 19 changes your life. 20 It's not a "you show up and you talk once." 21 In our county, you are there at least once 22 for three hours at a meeting, where you listen to 23 your problem and everyone else's problem. You know 24 that you're going to be monitored. 25 In our county, you have to phone in every 1 day. And if you don't phone in, you miss a phone 2 call, they are very strict with the excuses. 3 Because I'm sure, as all the people in 4 treatment know, that they are very good at not 5 telling the truth. They've been doing it for a long 6 time and being very successful. 7 So -- but it changes your people, places, and 8 things. You have to start hanging out with people, 9 you have to go to work, and have you to go to 10 school, or you have to do some community service. 11 And when those people do get into the 12 program, and they buy into the program, and they're 13 not just trying to get over, it changes their life 14 forever. 15 It seems that, not only their lives, but 16 their family lives and the community lives. 17 And in the small towns, and all three of us 18 here are from small communities, you know these 19 people. They're your friends' kids. They're people 20 you see from the community. Its not like it's just 21 the people from the other side of the railroad 22 tracks. 23 Heroin and drug addiction affects all of us. 24 And so, drug court, with all of its flaws, 25 has been very effective. 1 If you wanted to open it up to the 2 misdemeanor level, you can't do that with the 3 tremendous amount of resources that we don't have 4 right now. 5 There's probably 10 or 15 professionals on 6 the County court treatment court, and it's -- they 7 are straining their schedules to make all the 8 meetings and do everything that needs to be done. 9 So, if you're going to do anything, please 10 fund those positions, and that would help it make it 11 effective, and we could start earlier, and identify 12 those people who are in the city courts and the 13 justice courts, who we can tell, from our 14 experience, aren't going to have this one-time 15 experience, but seem to have a problem with a 16 particular drug. 17 Thank you. 18 SENATOR SEWARD: We have some representatives 19 here from Taking [sic] Back Chenango. 20 ROBERT CLIPSTON: Yep. 21 SENATOR SEWARD: And if you could share with 22 us, briefly, what that organization is all about, 23 and would that serve as a model for other counties? 24 ROBERT CLIPSON: Well, what we do is, we 25 travel to every town and city within 1 Chenango County, where we're asked to go. 2 People normally from the town will ask us to 3 come in. We try to educate adults and local law 4 enforcement, mayors, whoever shows up to the 5 meeting. 6 It is an open forum. They have the 7 opportunity to speak with the sheriff or the DA. 8 They both come to any meeting. 9 We try to educate them on the addiction of 10 heroin. What they need to do with their children. 11 Education is very important. It starts 12 early. You got to start in kindergarten, or before, 13 because a lot of people are going to parks and 14 finding needles. 15 What does the little kid do with the needle? 16 First thing you do is pick it up. 17 So educating children, all children, is very 18 important. 19 And, to educate them on the addiction, and 20 everything, would be a plus, because you're seeing a 21 lot of heroin addicts coming out, ranging from 22 12-years-old, and up. 23 So by the time they're in sixth grade, 24 they've already been hit; they've already been 25 approached, and they've already seen it. 1 So, we kind of tell them, you know, education 2 is the key. 3 We also -- we're working on setting up a 4 neighborhood-watch network throughout the county, 5 because, in our view, if you don't know your 6 neighbors and who is around you, you're not going to 7 know if there's something going that shouldn't be 8 going on. 9 A lot of these drug dealers are coming into 10 our county from the city -- from Utica, from 11 Syracuse, from Binghamton -- and you can see by the 12 arrests in the paper. 13 And what the Sheriff and the DA have done, 14 that, we live in a box. And the way I describe it 15 in most meetings is: Everybody lives like 16 this [indicating]. You got shutters on both sides. 17 Your neighborhood is actually your house. If it 18 doesn't happen here, it's not happening. 19 And you see that all over the state. 20 People have closed-up. 21 Social media has pretty much said: You don't 22 have to go out and talk to people. You don't need 23 to know everybody. You can do it on the computer. 24 Well, if you're not out talking, you're 25 leaving a very open field for these drug dealers to 1 come into your neighborhood, because that's what 2 they want. They don't want you to know them. They 3 don't want you to know anything. 4 If, as communities, we can come together and 5 get people to know everybody, and have people 6 watching out for their communities, you'll prevent 7 these drugs from coming to your neighborhood. 8 And that's something that we really express. 9 The first thing we tell them is: We want you 10 to go out and we want you to meet two neighbors. 11 You don't have to be best friends, you don't have to 12 have a barbecue. Go out and say "Hi." You know, 13 introduce yourself. Get to know their kids. 14 Because kids get a bad rap. 15 I don't care where you go, if you see a group 16 of kids walking down the street, you automatically 17 assume they're in trouble, they're doing something 18 wrong. 19 Well, when I was a kid, you walked down the 20 street, you were in a group of kids, you were going 21 to play football or do something. You're trying to 22 find something to do. 23 But a lot of these kids now are looked at as 24 hoodlums, so we try to take that view away, and say: 25 You know, these are kids. If you get to know them, 1 maybe you're going to stop them from doing something 2 that you don't want them to do, like, doing heroin 3 or an opiate drug. 4 We also -- we do a lot of training classes. 5 We have one coming up on May 1st. We're 6 working with Chenango County Drug and Alcohol. 7 They're doing an addiction training for us at the 8 local Elks Club, which is great. 9 We also work with Catholic charities. We 10 work with the Elks Club. 11 Any organization that's already established, 12 we try to work with them, what they are already 13 doing, and build on it. 14 Chenango County is 911 square miles, and 15 there's 23 towns and villages within 16 Chenango County, which makes it a pretty widespread 17 thing. 18 And as the Sheriff says, there's usually, 19 with what he has in resources, two cars in 20 Chenango County at one time. 21 If you get a call in Afton, and your cars are 22 out in [unintelligible] and over in Sherburne, it's 23 going to be a while before someone gets there. 24 So, you know, funding and education is very 25 important for this if we're actually going to 1 stop -- 2 SENATOR SEWARD: Now, is your group, I mean, 3 is that all volunteer? 4 Or is there -- 5 ROBERT CLIPSON: Right now, we're a 6 grass-roots group. 7 My wife actually set this up after a death of 8 one of her high school friends, that never should 9 have happened. 10 And what happened was, she went out to her 11 car at 6:30 in the morning, as normal, getting ready 12 to go to work. Ex-boyfriend shows up, pretty much 13 beat her to death right in her driveway. 14 All the neighbors heard something. They all 15 rolled over and went to sleep, assuming there were 16 kids outside. 17 Well, if we had a watch program, or we built 18 awareness, and someone actually got up and went to 19 their door to see what was going on, she'd still be 20 alive today. 21 JOE BIVIANO: Strongest part of our group -- 22 we're 1700 members. We're fastly approaching 23 2,000 members. We started in December. The first 24 thing we did was seek out law enforcement. 25 We are in partnership with the Sheriff of 1 Chenango County. We are in partnership with the 2 DA of Chenango County. We support law enforcement. 3 It's just like he says, we've educated 4 ourselves. 5 The strongest part of our group is 6 grandmothers. "Grandmothers." 7 They see their grandchildren being raised by 8 an addict, what can they do? What are their rights? 9 The strongest part, when a grandmother says: 10 My daughter went to an apartment and there were 11 needles in there, and the boy got a needle in his 12 foot, what do we do?" here's the question you have 13 to ask yourself: 14 Law enforcement is operating on a 1950s 15 budget throughout the United States. You ask them 16 and ask them and ask them to do more. 17 I worked 25 years in a jail. I was also a 18 mayor. I know what it is to keep budgets down, but 19 I respect these people. 20 Our group works 100 percent with law 21 enforcement. We work in every community. 22 When a grandmother says, What do I do about 23 these needles? Who picks up the needles in the 24 park? Who picks up the needles in a day-care 25 center? Who picks them up?" what's the answer? 1 We have no answer. 2 When I first started in the jail over a 3 quarter of a century ago, I was a hardhat. 4 Today I've turned myself around. I really 5 believe in the needle-exchange program. 6 Who's going to pick up these needles? Who's 7 going to do something with these needles? 8 You know, hepatitis C is the biggest disease 9 we have in each one of these counties. 10 Now, having worked in a jail and knowing, 11 like, in Chenango County, and I assume all of you 12 are the same way, with limited budgets, and asking 13 to be more and more, and more and more, piled on 14 you, how do you expect a guy to patrol 15 911 square miles with two cars? 16 That's 1950s-style stuff. 17 They need help, and the State Police need 18 help. 19 And the State Police have been very good with 20 the CNET. The CNET's been very good to us in 21 Norwich in Chenango County. 22 But some of the things that I want to tell 23 you is, the jails. 24 I worked in a jail, and we used to give a guy 25 who had heroin, we would give him stewed prunes 1 three times a day to get the cramps out of them. 2 Today they got meds. 3 Okay, so the guy goes to jail, then he goes 4 to rehab. Goes to rehab for 28 days. 5 Do you really think 28 days is going to help 6 end rehab? Never in a chance in life. 7 95 percent of the addicts today go back to 8 being a drug addict if they're in heroin. 9 "95 percent." 10 The way to help is the jails; the jails have 11 the resources. Give them the monies. Give them the 12 education. Give them the nurses and the staffing to 13 go out another level: the level of rehabs. 14 Now, you've closed jails throughout the 15 state. 16 Chenango County, you closed Pharsalia, and 17 then you closed Georgetown. 18 We need rehab centers. 19 But the one thing I found, with working with 20 the DA and the Sheriff, we work in every town, and 21 we work strongly with law enforcement, and we found 22 their hands are tampered. They cannot do their job 23 because they don't have the money. 24 That's where the help is needed. 25 And the rehabs; the rehabs are important. 1 28 days doesn't work. 2 You send a kid to shock camp. 3 I heard these guys, 28 days. 4 You go to shock camp 92 days, you're out. 5 You come back, you failed the program, okay, you go 6 away for a little bit. Then they go back and they 7 go to shock camp again. 8 I know a guy in Chenango County who's been to 9 shock camp four times, with the same judge. 10 Boy, that really makes you mad, because 11 I hear what him when he says, "I learned how to sell 12 drugs better in my community." 13 Take Back Chenango works for grandmothers. 14 We're growing with grandmothers, believe it or not. 15 That's the strongest key. 16 Thank you. 17 SENATOR SEWARD: Well, I commend you for 18 your, you know, community members coming together 19 and, you know, attacking this problem from a 20 neighbor-by-neighbor basis. That's very, very 21 important. 22 I wanted to talk, in mentioning the treatment 23 programs, I know we have a number of representatives 24 of groups that are involved in treatment here today, 25 and I would just like to give you an opportunity at 1 this point, to -- let's shift our focus over to, you 2 know, the treatment opportunities that exist in this 3 region. And, what could we be doing to make it 4 that -- better or more effective in attacking this 5 problem? 6 Who would like to go first? 7 CHRISTOPHER KEMP: First of all, just some 8 statistics: 9 From 2003 to 2008, we treated less than 10 10 people through those years for heroin addiction. 11 In 2013, 65 of our admissions were directly 12 related to heroin. 13 So, it is a big deal. 14 I also -- drug court has been very 15 successful. I think it's a great program, but 16 something needs to happen earlier in the process. 17 Something needs to happen with the 18 misdemeanor-level arrests, that we tell you, that 19 one of the problems we have in Delaware County, is 20 people will choose county jail over treatment. 21 So I would love to see some way for us to be 22 able to get into the jails and work with these 23 individuals while they're incarcerated at the 24 county level, because at this point, you go sit in 25 your county six months, and you get out, and you're 1 leaving with the same information you went in with, 2 and, sometimes, information you shouldn't have. 3 So, I would love to see some way to get in 4 the jails and work with these individuals, and at 5 least set them up with some aftercare plans and give 6 them some education. 7 I love that program you were talking about. 8 And, certainly, I just think it's a shame 9 that we have to rely on Court orders to get people 10 into inpatient treatment. It's ridiculous that 11 someone has to get a felony-level arrest to get the 12 level of treatment that they need. 13 I would like to see managed care -- I would 14 like to see the decisions be left in the clinicians' 15 hands; not in the managed care, someone sitting in 16 front of a computer screen. 17 I can tell you a number of cases, where the 18 person is sitting in our office, crying, saying, 19 "I cannot do this on outpatient level." And the 20 insurance company saying, "Well, you have to fail at 21 outpatient treatment first." 22 And, unfortunately, what we're dealing with 23 these days, one failed attempt at outpatient 24 treatment can be death. It can be a felony-level 25 arrest. 1 And, you know, the other reason for earlier 2 interventions, I mean, by the time people get to 3 felony-level arrest, they've lost their family, 4 they've lost their kids, they've lost, you know, all 5 their supports. 6 So I would like to find some way to intervene 7 in this process at a much earlier level. 8 You know, I concur with everyone else, 9 I think, without exception, in Delaware County, the 10 heroin starts with prescription drugs. 11 You know, we were talking about this the 12 other day. I can't think of a case in 13 Delaware County where it didn't start without 14 prescription drugs or their first drug use was 15 heroin. 16 That may not be true in all the counties, 17 that's just my experience. 18 I-STOP is excellent legislation. It 19 certainly has caused a spike in heroin use, there's 20 no denying that. But I think in the long run, 21 I think that will level out if people aren't 22 starting with the addiction prescriptions. 23 So I hope that that's the case. 24 The other problem that we've experienced is 25 the lack of Suboxone providers that will accept 1 Medicaid. That's a problem in Delaware County. 2 I wanted to thank, my colleagues and I have 3 discussed, the possible legislation to allow 4 nurse practitioners to prescribe Suboxone. 5 One of the problems that we have is, the 6 OASAS regulations are, that you need to have the 7 Data 2000 Waiver for your medical director. 8 Medical directors, locally, don't want to 9 prescribe Suboxone, so we end up referring out, and 10 that gives you very little control over that drug. 11 Diversion of Suboxone is a big problem. 12 It's -- the evidence shows that Suboxone is a 13 very effective drug in the treatment of opioid 14 addiction. There just needs to be some way we can 15 work to have more control over that medication. 16 And I think, you know, having that in the 17 clinic where we can say, "Do the films." It's 18 distributed in films. That we can do the counts and 19 say: If you don't come to your treatment 20 appointment, you don't get your Suboxone. 21 I think one of the problems is, people are 22 seeing Suboxone as a be-all and end-all. You know, 23 "I take this medication and I'm all better." 24 That's not true, because if you don't make 25 those recovery lifestyle changes when that Suboxone 1 isn't there, you're going to be left as the same 2 person you were when you started. 3 I don't want to monopolize what we have here, 4 so I will, uh... 5 And I think it is a multilevel approach. 6 I think prevention, treatment, and law enforcement, 7 we all need to work together. 8 And I will say, in Delaware County, we're 9 definitely all working together on this project. 10 The board of supervisors have been very supportive 11 in this project. And I think its -- it's a -- the 12 whole community needs to be involved in this. 13 Because I really like what you said about the 14 guy that -- the kid in the John Deere hat, because 15 it's absolutely true. This is everywhere. This 16 isn't who you think it is. 17 And, I just want to close on saying: 18 Recovery is possible. 19 The people in recovery often don't get the 20 press. There are people in long-term recovery from 21 heroin addiction. They're aren't the ones in the 22 newspaper. And due to the confidentiality of 23 treatment, we see them; you don't. 24 You know, I run into them every day in the 25 grocery store. They're in long-term recovery from 1 opioid addiction. 2 So it is possible, and it does happen. 3 Thank you. 4 SENATOR SEWARD: Thank you. 5 Any other comments from the treatment 6 community? 7 DR. STEVE GRAHAM: Senator, if I may? 8 SENATOR SEWARD: Yes. 9 DR. STEVE GRAHAM: I'd like to add to 10 Mr. Kemp's comments. 11 Some people require ongoing ready access to 12 opiates to meet the physiologic needs of their 13 opiate addiction. 14 I'm an obstetrician/gynecologist. Addiction 15 medicine was not part of my training. Until the 16 last five years, it was not part of my practice; 17 however, opiate-addicted women do become pregnant, 18 and, they are at increased risk for adverse 19 reproductive outcomes. 20 In May 2012, the American College of 21 Obstetricians and Gynecologists, and the 22 American Society of Addiction Medicine, issued a 23 joint opinion titled "Opiate Abuse, Dependence, and 24 Addiction In Pregnancy." 25 In that committee opinion, they cited a 1 2008 study that estimated that 1 out of 1,000 2 pregnant women had used heroin in the past 30 days. 3 Be that as it may be, in our practice at 4 Bassett, I'm presently aware of seven pregnant 5 heroin users who are presently enrolled in programs 6 of opiate-agonist therapy. 7 That would be a rate 10 times the committee 8 opinion's estimate. 9 Those are only patients that we know about. 10 During pregnancy, chronic untreated heroin 11 use is associated with an increased risk for a 12 variety of obstetrical complications, and although 13 heroin withdrawal is not fatal to a healthy adult, 14 fetal death is a risk in the obstetrical patient. 15 The injection of opioids carries with it the 16 risk of infection at the injection site, in the 17 heart, bones, blood, hepatitis B, C, HIV. 18 And, additionally, the lifestyle issues 19 associated with illicit heroin use in the pregnant 20 woman puts the woman at risk for engaging in 21 activities such as prostitution, theft, drug 22 dealing, violence, to support herself or to support 23 her addiction. 24 Such activities expose these women to 25 sexually-transmitted infections, becoming the 1 victims of violence themselves, legal consequences, 2 including loss of child custody, criminal 3 proceedings, and incarceration. 4 Since the 1970s, methadone maintenance has 5 been the standard treatment of heroin addiction 6 during pregnancy. 7 Recently, this treatment has also been used 8 for prescription-opioid abuse. 9 The rationale for opioid-assisted therapy 10 during pregnancy is to, first, prevent the 11 complications of illicit opiate use and narcotic 12 withdrawal, encourage prenatal care and drug 13 treatment, reduce criminal activity, and avoid the 14 risks to the patient of associating with the drug 15 culture. 16 Treatment reduces the risk of obstetric 17 complications. The babies aren't born addicted. 18 And, neonatal abstinence syndrome is an expected but 19 treatable condition that follows prenatal exposure 20 to opiate agonist, and it requires collaboration 21 with the aftercare team, but, there are road blocks 22 to treatment. 23 Methadone maintenance is dispensed on a daily 24 basis only by a registered substance-abuse treatment 25 program. 1 For my patients, the local 2 methadone-maintenance treatment programs can be 3 found in Amsterdam, Albany, Binghamton, and 4 Syracuse. These are trips ranging from one to 5 nearly two hours, each way, every day, and these 6 logistical issues make methadone maintenance 7 functionally unavailable for many of my patients. 8 It has been illegal for physicians to write a 9 prescription for any opioid for the treatment of 10 opioid dependence outside of a licensed treatment 11 program. 12 Now, the Drug Addiction Treatment Act of 2000 13 did change the law, permitting physicians who meet 14 certain qualifications to treat a limited number of 15 opioid-addicted patients with buprenorphine. 16 Unlike methadone, which may be administered 17 only through a very tightly controlled program, 18 buprenorphine may be prescribed by an approved 19 physician in a medical-office setting. 20 Patients considered for using buprenorphine 21 must be able to manage and also administer their 22 medications safely and adhere to the drug program. 23 The Substance Abuse and Mental Health 24 Services Administration website lists 25 1736 physicians with buprenorphine waivers in the 1 State of New York. 2 Though that number of buprenorphine-approved 3 physicians might suggest that the urban-centered 4 distribution of methadone-maintenance programs 5 has been mitigated, rural New York, likewise, 6 experiences a misdistribution of 7 buprenorphine-waived physicians. 8 The Bassett Healthcare System is an 9 integrated health system with 6 affiliated 10 hospitals, 28 regional health centers, and it 11 provides care and services to people living in an 12 8-county area covering 5600 square miles; yet, 13 within that system, I am the single physician who is 14 licensed to prescribe buprenorphine for opiate 15 addiction. And my practice is strictly limited to 16 pregnancy. 17 So why are physicians not rushing to embrace 18 office-based opiate-agonist therapy with 19 buprenorphine? 20 Well, there may be a variety of reasons, but 21 would I like to address one that can be solved only 22 by government. 23 Drug addiction is a disease that government 24 first views as a crime, as most of the conversation 25 today has been centered on the legal issues. And, 1 as a treating physician of addicts, I become 2 associated with criminality. 3 This was distressingly demonstrated to me 4 when I was subjected to a routine audit of 5 buprenorphine-waived physicians by the 6 Drug Enforcement Administration. They opened the 7 conversation with me by reading me my Miranda 8 rights, and advised me that anything that I said to 9 them could be used against me in a court of law. 10 It was not an endearing moment. 11 Yet drug addiction involves presumptive 12 criminality only for those drugs that we choose to 13 define as "illegal." 14 Nicotine is a highly addictive psychoactive 15 substance that is legally marketed in a variety of 16 forms. Its use is associated with disease, 17 disability, and death at rates that dwarf the 18 problem of opiate addiction; and, yet, nicotine 19 addicts can call 1-86-NY-QUITS [sic] and receive 20 nicotine-replacement therapy from New York State. 21 The NYsmokefree.com website asserts that 22 nicotine-replacement therapy, such as patches or 23 gum, may double your chances of quitting because it 24 works by reducing uncomfortable nicotine-withdrawal 25 symptoms. 1 What an idea? 2 Nicotine addicts have a chemical dependency, 3 and we as a society offer to address the physiologic 4 needs of their chemical dependency without 5 repercussion, and with a view toward improving their 6 overall health. 7 Like the much larger problem of tobacco, 8 opioid addiction is very serious, but the 9 law-enforcement approach that we have taken over the 10 years has unquestionably failed. 11 We need fundamental changes and reforms in 12 drug policies, and I long for a day in which we can 13 treat opiate addiction in the same relaxed, 14 realistic way that we apply to tobacco. 15 [Applause.] 16 SENATOR SEWARD: Thank you, Dr. Graham. 17 Just one quick question: What's the protocol 18 when a baby is born, you know, with -- from a -- the 19 mother is an addict -- heroin addict? 20 DR. STEVEN GRAHAM: The babies typically 21 demonstrate difficulties on, about, day three or 22 four of life, and so they need to be in the hospital 23 longer for initial observation. 24 We have a scale in which we assess various 25 signs and symptoms that the baby is demonstrating -- 1 heart rate, respiratory rate, feeding difficulties, 2 jitteriness -- that indicate to us the degree of 3 withdrawal that the baby is going through. 4 We then start to replace, uhm -- morphine as 5 our substitute of choice, and administer that in a 6 decreasing dose over a period of four to six weeks, 7 until the baby is completely withdrawn, and has been 8 observed for several days without any demonstrable 9 symptoms of neonatal abstinence, and then the baby 10 is discharged from the hospital. 11 SENATOR SEWARD: Thank you. 12 Any other comments from the treatment or 13 medical community here? 14 JUSTIN THALHEIMER: I have seen Suboxone or 15 buprenorphine work. And under the right 16 circumstances, generally monitored very tightly, it 17 does work. 18 I'm also seeing that we are treating people 19 for buprenorphine addiction at the clinic. They get 20 it from the streets. 21 If there is a way that we could have it 22 prescribed at our OASAS facilities. 23 And in a rural county, like Chris was saying, 24 that's really difficult to get someone to, not only 25 get the Data 2000 Waiver, but be an addiction 1 specialist, the OASAS requirements for a medical 2 director is really difficult to -- really difficult 3 to find somebody in a rural county who's going to be 4 an addiction specialist, plus get the 5 Data 2000 Waiver. 6 So we've also seen -- I've seen -- like 7 I said, I've seen Suboxone work. I've seen it not 8 work more. 9 It's -- out in the streets, they can exchange 10 one film for one bag of heroin. 11 Right now, I think the price is 20 bucks 12 apiece for either a bag or a film of Suboxone. 13 It works if it's able to be monitored 14 tightly, and that means, when people come in to see 15 me, and if they are on Suboxone, I am doing Suboxone 16 counts that I put in their progress notes. 17 It has to be monitored very tightly. 18 I also want to speak on -- really quickly, on 19 VIVITROL. 20 VIVITROL is a medication, where a heroin 21 addict is given an injection every 28 days, and, you 22 know it's in their system. You know that their 23 motivation for quitting is high when they sign on to 24 give VIVITROL. They're very motivated to be done 25 with it. They get sick and tired of being sick and 1 tired. 2 And this medication, VIVITROL, is every 3 28 days, and I can't speak regarding the risks and 4 all that stuff you see on TV, but, you know it's in 5 their system. And, they can shoot heroin if they 6 want, but it's a waste. It blocks the receptors. 7 I don't know, and, actually, I was asked in 8 the past week, "How does it work with opiates?" 9 because -- because it does work; it blocks the 10 receptors. It blocks the receptors until their next 11 injection 28 days later. 12 And after three months, they go on a holiday, 13 to see how they're going to take. And the second 14 they want to get back on it, you get them back on 15 it. 16 But it's a -- with our heroin addicts who 17 have been on VIVITROL, and there's not very many, I 18 wish I had a higher end number to tell you, but 19 we're at 100 percent. 20 They're all in recovery and doing well. 21 Thank you. 22 SENATOR SEWARD: Thank you Justin. 23 Dr. Sellers. 24 DR. JOSEPH SELLERS: On behalf of the 25 physicians of the State Medical Society, I want to 1 thank the Senate for convening this panel, and for 2 hearing from the community. 3 You asked for some specific things you folks 4 could do in state government, and I'm going to give 5 you a few that I hope will be pursued. 6 But I think that this is such a complex 7 issue, and it requires some work on the part of the 8 federal government, you know, as my colleague 9 mentioned, about Suboxone. 10 Suboxone prescribing is a federally regulated 11 issue, but it does require us to talk to our 12 Congressmen and to our -- you know, the federal 13 government, and advocate there. 14 Many of the things, though, that can help our 15 communities are things that the state government can 16 do. 17 But the bottom line still is, I think the 18 solution to our problem is going to be local, and 19 it's going to be done by community groups. 20 Community groups like the ones that have spoken to 21 us here. 22 Just to maybe set the tone for why young 23 people turn to drugs, why young people do the things 24 they do: 25 I don't know if it's education. It's more 1 attitude. They know things are wrong. 2 I raised four teenagers. I know they did 3 many things that were wrong, and they knew they 4 shouldn't do them, but they had an attitude, 5 "Bad things aren't going to happen to me." 6 And what we know from brain studies is that, 7 your brain, when you're born, starts developing at 8 the bottom of the head, moving up, and forward. And 9 this part here [indicating] is the last part to 10 develop, the prefrontal cortex: the part that has 11 wisdom; the part that can predict consequences; the 12 part that can plan to the future. 13 The prefrontal cortex in women is pretty well 14 developed by about age 19. 15 In men, maybe 25, 26. 16 So those that do law enforcement near college 17 campuses notice that most of the trouble is by young 18 men. 19 [Laughter.] 20 DR. JOSEPH SELLERS: With that said, we do 21 know that exposure to drugs earlier in life alters 22 brain chemistry. 23 And so one of the things that's really 24 concerning is the use of opioids by men before 25 age 25, by women before age 19. 1 If they can get through this, we don't see -- 2 I don't see too many patients who started using 3 substances of any sort in their 30s and 40s, and 4 there is a biological reason for that. 5 Mylea did mention the I-STOP, and how that 6 may be helping prevent some of the availability of 7 opioids in the community. 8 And, you know, the State Medical Society 9 worked closely with the Health Department, and 10 educating the physicians, and getting this program 11 up and running, but I think we need the 12 Health Department to do some data check, to let us 13 know. 14 I hear, anecdotally, about the turning to 15 heroin, but I haven't seen any actual statistics on 16 that. And I think that would be important if we're 17 going to refine I-STOP and make it work better. 18 I hear, anecdotally, from physicians, I know 19 in my own practice, we share when we have been 20 fooled by somebody. 21 There are patients that we didn't ever 22 believe would be doctor shopping, but we find out 23 they were using multiple pharmacies and multiple 24 physicians to gain access to opiates. 25 And, again, it can be that young man in the 1 John Deere hat. People can -- when they're looking 2 for drugs, they can do a great sales job. 3 And, so, I-STOP is, I think, has been helpful 4 there. 5 I would like to see more data, if the 6 Health Department can mine data about that. 7 And then, talking to physician colleagues, 8 physicians I think have changed their prescribing 9 habits to a great degree in New York State, which 10 I think is very good. 11 Hopefully, the dentists are being more 12 careful about what they give when you have your 13 wisdom teeth extracted, or the quantity of 14 medication they provide. 15 But, again, I think that should be looked at; 16 and, so, some study by the State Health Department. 17 We worry about the death rate from opiate 18 overdose, and there are some specific things that 19 can help with that. 20 There is an "opiate antagonist, non-patient 21 specific order" bill that Senator Hannon has in the 22 Senate and Assemblyman Dinowitz has in the Assembly. 23 The State Medical Society strongly supports 24 the ability of physicians to give a prescription for 25 Narcan nasal spray to the family members of somebody 1 with an addiction problem. 2 And, again, this is not a total solution, but 3 it's one part that could be done in this legislative 4 session to get that going. And to follow that up 5 with the training, the education to the community, 6 and to make this a less-common event for somebody to 7 overdose on an opiate. 8 The Medical Society also is very concerned 9 about the availability of treatment. 10 And we heard Deb France talk about the hassle 11 she had to go through with insurance companies, and 12 having to leave the state. And this is a family 13 that had some resources. They had money saved for a 14 college education. 15 Many of our families have no resources and 16 are encountering similar problems. 17 Treatment is essential for combating our 18 opiate issues. Treatment, though, needs to be 19 geared to the individual, not just his or her drug 20 abuse. They need to remain on treatment for an 21 adequate period of time. Professionals need to be 22 given the ability to steer patients to inpatient 23 versus outpatient, based on that individual's needs, 24 and the professional assessment. 25 And, again, we need to have proper funding. 1 We need to make sure that insurance is not 2 standing in the way, and not preventing people from 3 getting the care they need. 4 On a personal note, I've been living in 5 Schoharie County for 25 years, practicing internal 6 medicine, caring for adults, and, pediatrics, caring 7 for children, so I have a lot of the crossover, a 8 lot of the adolescents in my practice. 9 I see all families being affected by this 10 issue, but, some families more than others. Some 11 things we know that are risky. 12 There was a great study done over the last 13 10 years by the Kaiser Foundation in California, 14 that talks about adverse childhood experiences, and 15 the things that happen to children that lead to them 16 being more susceptible to substance abuse and other 17 untoward consequences. 18 And it was interesting to hear the talk about 19 grandmothers, because the one thing that was shown 20 in a study, and I can get you the references for 21 this, there be a protective influence, was for a 22 child to have a strong grandmother relationship. 23 So, you know, I think that there are things 24 that maybe we need to think differently about. 25 You know, how do we, as a community, support 1 grandmothers' involvement in their grandchildren's 2 lives, where maybe parents are overwhelmed? 3 Lastly, I think there's a strong correlation 4 with our current rural upstate drug issues and the 5 court [unintelligible] upstate, for opportunity for 6 young people, that when unemployment goes up, when 7 economic opportunity goes down, we know that drug 8 abuse also goes up. 9 And, so, I know that, Senator Seward, you're 10 a strong supporter of moving our business community 11 forward in Upstate New York. 12 We -- you know, we've been in, essentially, a 13 recession in our area for the past 50 years. 14 And, you know -- and I don't think we can 15 address this issue without addressing the economy. 16 If the economy is better, there's more 17 opportunity for young people. There's more resource 18 for law enforcement, and education, and all the 19 other partners that need to participate in solving 20 this problem. 21 So I'll close by saying: 22 The physicians of the state are very 23 concerned. 24 And the State Medical Society, as the 25 organization representing all the physicians in the 1 state, stands prepared to do whatever we can to help 2 state government, to help local community agencies, 3 to work within education, to work in helping to 4 gather data and best practices, and so that we can 5 all work together, every aspect of society. 6 Because this is a total society problem, and 7 no one solution is going to bring about a change 8 that we need. 9 Thank you. 10 SENATOR SEWARD: Thank you, Doctor. 11 Any other comments from the medical or 12 treatment -- 13 DR. KELLY ROBINSON: Yes, we have two 14 emergency physicians over here. 15 We'd like to say something on this. 16 SENATOR SEWARD: Sure. 17 DR. KELLY ROBINSON: Augie, you want to 18 start? 19 DR. AUGUST J. LEINHART: Sure. 20 Thank you for this opportunity. 21 I'm here on behalf of the New York Chapter of 22 the American College of Emergency Physicians. 23 I'm a board-certified emergency physician. 24 I'm the chief of the emergency services at 25 Bassett. 1 I'm the Chairman of the Regional Advisory 2 Committee of the Adirondack Appalachian Regional EMS 3 Council. 4 And, I'm a member of the New York State 5 Emergency Medical Advisory Committee, the CMAC. 6 I will not underscore the epidemic causing 7 all of us to be here. 8 Both prescription narcotics and heroin now 9 account for more national fatalities than 10 motor vehicle crashes among young Americans. 11 Both New York and Massachusetts have enabling 12 legislation. 13 In New York it's Title 10, Section 80.138, 14 with Good Samaritan protection; 15 For the creation of in-sequence programs; 16 Trainers, who can also dispense naloxone 17 kits, naloxone being the antagonist for overdose, 18 and responders. 19 In Massachusetts, police departments have a 20 front-line 911 response role in responding to 21 overdoses. And it's very analogous to automatic 22 external defibrillator deployment. AEDD is, they're 23 deployed in airports, they're deployed in police 24 cars. So, very similar deployment scheme is in 25 place in Massachusetts. 1 New York State needs to deepen and broaden 2 its deployment program, architecture, and process 3 across the state. 4 Once money programs are registered by the 5 New York State Department of Health, the training of 6 registered trainers can begin, and the intranasal 7 naloxone widely available to users, addicts, 8 bystanders, family members, and police, and other 9 registered certified responders. 10 Multiple distribution sites for naloxone kits 11 can be identified. 12 I particularly applaud the State of 13 Massachusetts, and encourage New York to develop 14 methods of: 15 One, defining the contents of a standardized 16 kit to include, not just naloxone and the method and 17 tools for intranasal administration, but other 18 relevant materials, encouraging engagement with 19 systems of care, starting with 911 for police and 20 EMS, and contact information for those seeking 21 assistance with rehab programs; 22 Establishing a statewide 1-800 information 23 hotline for accessing naloxone counseling and rehab 24 programs; 25 And, establishing a statewide protocol with 1 standing orders. 2 Standing orders are used in EMS, and they 3 allow prescription to a person not personally 4 examined by the prescriber. 5 In the state of Massachusetts, it's signed by 6 a single medical director for the entire state, 7 permitting the dispensing of naloxone kits under his 8 authority. Emergency departments and other 9 prescribers can then readily provide standardized 10 state -- standardized and deployed kits. 11 In the meantime, wide dispersal of the 12 opioid-overdose prevention program, as outlined in 13 existing legislation, is needed now throughout the 14 state of New York. 15 Thank you. 16 DR. KELLY ROBINSON: Hi, Dr. Kelly Robinson, 17 medical director of the ED at A.O. Fox. 18 My colleagues have already touched on a 19 number of things that I wanted to mention, so I'm 20 just going to reemphasize the most salient points. 21 How do we keep our opioid-addicted patients 22 out of jail? 23 How do we keep them out of the morgue? 24 I think there are, like, four points that 25 I would just like to emphasize that have not been 1 mentioned. 2 One is, we need to have more widespread detox 3 rehab on demand. 4 I don't know whether the current ACA 5 legislation includes coverage for rehab and/or 6 detox, but, if that -- if we're going to keep the 7 ACA, it can be fixed and not thrown out, I think 8 that is definitely something we need to work 9 together to have implemented with ACA. 10 Next, Dr. Leinhart already touched on more 11 widespread use of Narcan. That's going to keep a 12 lot of patients alive until they get to the 13 emergency department. 14 Police, firefighters, EMS, family members, 15 all need to be versed at using these medications 16 intranasally. You don't need IV access. It's very 17 efficacious. 18 So, that should be looked at further. 19 We should actually implement what we've seen 20 in New York City, where emergency physicians are 21 regulated, in that, they cannot write prescriptions 22 for more than 12 opioids in any ER visit. 23 I would like to see that statewide. I think 24 that would really help us in our battle to keep 25 patients from becoming opioid-addicted. 1 If we could have legislation protecting us, 2 we would not have the dilemmas we go through, 3 confronting these patients who present to the 4 emergency department, requesting opioids. 5 If we had a law to back us up, it would make 6 our job a lot easier. 7 I haven't heard anyone mention what I've seen 8 work in other communities. 9 They have -- community organizations have 10 pill-gathering sessions. 11 What they do is, they advertise in the 12 community, that everybody bring in their 13 prescription opioids to a pill dump. 14 And, literally, you have thousands and 15 thousands of pills out in the community that are 16 just waiting for your kids to take and/or 17 distribute. 18 So I would love to see more community 19 organizations have those type of programs. 20 And everything else has been touched upon. 21 NORINE HODGES: Just to that last one, I'm 22 very excited. 23 We did do our Prescription Take-Back on 24 Saturday, as well did my colleagues along here. We 25 collected over 150 pounds' worth. 1 But I'm very excited, our head of our 2 pharmacy at our local hospital has found some money, 3 and I believe Dr. Sellers' group as well, to help us 4 collect. And in the sheriff's department and our 5 local police departments have a permanent site. 6 The prohibited piece was the expense of 7 disposing of them. And they have put together, 8 themselves, enough money so we can do that on a 9 regular basis. Its about $1,000 a trip to dispose 10 of these. 11 In between, right now, the DA picks them up 12 the last Saturday of April and the last Saturday of 13 October for the National Take-Back. 14 SENATOR SEWARD: And we recently, I was 15 involved with a press conference here in Oneonta. 16 And the Oneonta Police Department, on 17 Main Street, there's is a dispense -- there's a site 18 there for disposal of these unused pharmaceuticals, 19 which -- on an ongoing basis. 20 And I would just like -- before we move on, 21 I would just like to highlight: I know, in 22 Schoharie County, tomorrow evening, there's a free 23 Narcan training opportunity, from 6:30 to 8:00, at 24 the Cobleskill Fire Department, right on 25 East Main in Cobleskill. 1 So looking -- perhaps you'd like to share 2 more on that? 3 NANCY ORTNER: I just want to add to that, 4 that Mr. Sacket is going to be speaking about the 5 Good Samaritan Law, as well, then, at that forum. 6 SENATOR SEWARD: Great. 7 And I'm in the process of scheduling 8 additional training opportunities here in Oneonta, 9 and others throughout my district. 10 So, this is something that I think is 11 certainly very much needed. 12 Any other? 13 JULIE DOSTAL: Prevention? 14 SENATOR SEWARD: Yes, Julie. 15 JULIE DOSTAL: Okay. I would like to speak 16 from the prevention education. We've heard a lot of 17 that. 18 At LEAF, we do education, information, and 19 referral, and I can speak to some of the points that 20 we've heard. 21 There's nothing more heartbreaking to have a 22 parent, a mom or a dad, or a grandparent, call up 23 and ask us where we might find help for a son or a 24 daughter or a grandchild, and have to tell a mom or 25 a dad, that because of current insurance laws and 1 rules, that their child or their grandchild has to 2 fail at outpatient before they can go to an 3 appropriate level of care. 4 I'm not sure what other disease we function 5 in our culture, where we tell people they have to 6 fail in order to get an appropriate level of care. 7 So that's really hard from our point, and it 8 points out for us, in the prevention and education 9 side of things, that we are dealing with an 10 epidemic, with real people and real lives and real 11 families. 12 And this is not the epidemic, the addiction 13 epidemic, of "those people." 14 This is the addiction epidemic of 15 "our people." 16 And we actually, I -- LEAF just recently had 17 an art and poetry contest, and we had a 14-year-old 18 write a poem about his experience with his older 19 brother who is also a teenager. 20 And I have just a few lines to read from his 21 poem, a 14-year-old, this is Eric: 22 "Friends thought it was a joke because all 23 they did was seem to provoke. 24 "Nowadays, I'm just torn inside out because, 25 to express it, I'm writing these raps that no one 1 wants to hear me in, and when I relapse, no one 2 wants to hear me out. 3 "I'm always looking for the answer, and 4 I swear, I need some heroine. No, not the monster. 5 I need "a heroine"; something to believe in, a hero, 6 just because me is too much feeble to let go of the 7 needle." 8 That's Eric, a 14-year-old. 9 And we have the opportunity now to be Eric's 10 hero. We have the opportunity to be every Erics' 11 hero, and every Erics' older brother's hero. 12 And one of the main things, from a prevention 13 standpoint, that I want to put out there, is that we 14 need to be able to have the opportunity to address 15 the broader social norms that make the use of 16 intoxicants normal, and even embraced by a growing 17 number of people. 18 From a purely prevention standpoint, the 19 State of New York is limiting its own potential for 20 addressing the larger societal questions by actively 21 promoting and seeking revenue from the sale and 22 manufacture of intoxicants. 23 An environment that champions intoxicants 24 will inevitably reap the harm from intoxicants. 25 I work with a group of my peers from around 1 the state, and we developed some strategies that we 2 would like to suggest as prevention-level 3 strategies. 4 One, of course, is to confront the broader 5 social and cultural messages that reduce the 6 perception of harm related to intoxicants, including 7 opiates, alcohol, and marijuana. 8 We would like to see programs and strategies 9 that help to decrease the accessibility to 10 prescription medications through a variety of means, 11 including: 12 Educating those same grandparents and parents 13 on prescription-medication management in their home; 14 Increasing the number of drop boxes in each 15 community, as has already been talked about; 16 Promoting the frequency of Drug Take-Back 17 days; 18 And exploring commonsense approaches to 19 facilitate medication disposal at pharmacies. 20 We would also like to suggest an increase in 21 the perception of harm in regard to prescription 22 medication and heroin. 23 Many of the young people that we talk to, and 24 that talk to us, will say: It's medication, what's 25 the harm? 1 And, so, we really need to talk to young 2 people about the fact that, just because it has an 3 "Rx" on the bottle does not mean it's safe. 4 We would love to be able to work with you in 5 educating key impactors, especially in physicians 6 and the pharmacists, on this disease model of 7 addiction. 8 And to -- and in support of my colleagues who 9 also work in treatment and law enforcement, I say 10 that we would like to further increase 11 community-wide access to trainings on naloxone. 12 That is a lifesaving opportunity that we 13 have, to be able to give treatment, and to be able 14 to give folks the opportunity to have a naloxone kit 15 that can save a life. 16 And that takes resources and that takes 17 training. 18 And, so, we would like to promote that. 19 Thank you. 20 SENATOR SEWARD: Thank you, Julie. 21 Sheriff, did you want -- do you have a 22 comment? 23 SHERIFF THOMAS MILLS: Yes, I would like to 24 say a few words. 25 I think it's important, the education 1 component. It's extremely significant. 2 It's got to start young, and you got to 3 continue it. It's that age group that is critical, 4 because they're the source of everything. 5 I think they're always looking for something 6 to do. 7 There's activities out there they can get 8 involved in: the Girl Scouts, the Boy Scouts, 4-H. 9 And it's important for them to have something 10 to do. 11 Idle time creates problems. 12 Treatment: Treatment is a huge issue, and 13 trying to address it. 14 Sometimes I think just giving them something 15 else to replace something is not real treatment. 16 You got to get people off. 17 I'm not trained in that, but you also have to 18 have the law enforcement involved. 19 You got to have some teeth in the program, 20 you know. 21 I don't object with any of the ideas you 22 have. You're the ones that end up pushing the cases 23 before the courts. 24 But, you talk about addicts, they should be 25 brought into treatment. 1 Dealers, they ought to ratchet down. 2 I've been involved nearly 50 years in law 3 enforcement, and I can still remember my first 4 marijuana arrest right here in Oneonta. And it's 5 been nothing but downhill. 6 But, if you don't do anything about that, 7 it's just going to keep getting worse. 8 Thank you. 9 SENATOR SEWARD: Thank you. 10 I'd like to ask our educators at the table to 11 please comment. 12 We've been talking about education and 13 prevention, and, I'd like to take a couple of 14 minutes to call on our educators at the table, in 15 terms of what we're seeing today in the schools, and 16 this issue of greater, you know, education, and as 17 part of our prevention efforts, some say starting 18 right in kindergarten. 19 So, I'd like to call on Mr. Booan and 20 Mr. Savin, if they would like to comment at this 21 point. 22 JOE BOOAN: Thank you, Senator Seward, and 23 I appreciate the invitation today. 24 Mr. Savin and I represent ONC BOCES. 25 ONC BOCES is a consortium of 19 different 1 school districts in Delaware, Otsego, Schoharie, and 2 Greene counties. 3 We have two centers: one in Grand Gorge and 4 one in Milford. 5 And primarily at those centers we're serving 6 middle school- and high school-aged students. 7 Occasionally, we have sites inside our 8 component districts that serve other students 9 younger than middle school. 10 I can speak a little bit about our centers. 11 I was a principal at one of those centers for 12 many years, and now I'm the director and oversee the 13 two centers. 14 I think it's difficult to determine the true 15 picture of substance use and abuse in our schools. 16 As you can imagine, middle-schoolers and 17 high-schoolers don't readily go to the principal's 18 office, or even to our counselors, to talk about 19 things that they are doing illegally or abusing, but 20 we do hear a lot of chatter around substance abuse. 21 I can tell you, to date, we have not 22 processed an intervention or interaction specific to 23 heroin in either one of our two centers, but that's 24 not certainly to say that it's not occurring. 25 We have processed several interactions and 1 interventions related to prescription medication: 2 the oxys and the hydros. That's, I would say, is a 3 significant problem in our school, as is marijuana 4 abuse. 5 In terms of the supports that we would have 6 in our centers and our school centers, I can tell 7 you that we make it our goal that every teacher know 8 every student in our schools. And we believe very 9 strongly, it starts with having our staff connected 10 to everybody that comes through our door. 11 Our teachers, just by nature of running a -- 12 technical-education programs in our schools, speak 13 to students, but more from -- about substance use 14 and abuse, but more from an employability 15 perspective. 16 They're not substance-abuse counselors, and 17 they're not family counselors. They are instructors 18 and teachers, but we do talk about it in every one 19 of our programs. 20 We have school-based counselors, but their 21 mission is pretty specific: Their mission is to 22 address successes experiences around academic and 23 social issues that are occurring in schools. 24 They're not substance-abuse counselors, 25 they're not family counselors. 1 When we recognize abuses, we refer out to 2 many of the agencies that are seated around this 3 table. 4 A lot of times our first stop is with the 5 Otsego County Sheriff's Office or the 6 Delaware County Sheriff's Office or the 7 New York State Police, who are -- who play a 8 critical role in supporting us and keeping our 9 schools safe. 10 Education in New York State, you know, 11 perhaps could be said across the country, has gone 12 through a huge transformation over the last few 13 years, in terms of standards-based education, 14 assessing students, collecting data. 15 We've focused very -- we have focused very 16 intently on how we're educating students at a time 17 when I think resources have been significantly 18 challenged. 19 There was a time when we had substance-abuse 20 counselors located directly in our schools. We had 21 resource officers or D.A.R.E. officers to provide 22 prevention. And those things are sadly missed. 23 When funding goes away, the reality is, 24 programs that support and prevent go away. 25 So, personally, what I would like to see from 1 where I sit, in addition to our emphasis on 2 standards-based education, which is critically 3 important to the mission of educators, we need to 4 have an education initiative surrounding how we 5 prevent. Get back to more of a prevention model 6 with the issues that we're talking to today. 7 That cannot happen without the proper 8 resource and funding. 9 Thank you. 10 ROBERT CLIPSTON: This is actually something 11 we've seen in Chenango County. 12 We've heard it from several people, that they 13 would love to see resource officers in our schools. 14 It does happen in -- Unadilla Valley, there 15 is a resource officer there. That's actually very 16 successful. He can talk to, and, you know, 17 incorporate himself with students, from 18 kindergarten, all the way up to seniors, which is 19 great, because a lot of our young people are scared 20 of officers. 21 They see a cop and they want to go the other 22 way. 23 Well, this gives the law-enforcement side of 24 things a chance to -- you know, co -- you know, they 25 can mingle with everybody. And, after a while, 1 everybody comes around and they start -- they start, 2 you know, liking each other, and they look up to 3 him, and they'll go to him with their problems. 4 But right now, in a lot of schools, you see 5 kids aren't going to go to an adult, they're not 6 going to go to their counselors, they're not going 7 to go to the principal, and tell them about problems 8 they're seeing. It's not something they do. 9 We need peer programs. 10 You know, you take five or six teenagers and 11 go in and talk to third- and fourth-graders, you're 12 going to get a better result than you're going to 13 get if you bring someone in with a textbook. 14 Kids are more likely to listen to other kids 15 that they look up to. They're not going to listen 16 to us first. 17 So, you know, in our county, we've actually 18 expressed trying to get peer programs together, and 19 trying to get local teenagers involved, to help 20 younger kids so they don't end up in serious 21 problems. 22 But -- and the resource manager would be a 23 great asset to all schools in New York State, 24 because you want to have that camaraderie. You want 25 the kids to be able to go to law enforcement and 1 say: Hey, this is what I see. This is what's going 2 on. 3 You know, kids see a lot more than we do. 4 You know, they're around a lot more than we are. 5 We're at work all the time. 6 They could be walking with their buddies down 7 the street and see a number of things going on that 8 we will never see. 9 And something else I wanted to touch on: 10 A lot of people have talked about treatment. 11 But what we've found, we've reached out to 12 several people out-of-state, in Florida, and other 13 places, trying to find proper treatment facilities 14 and what really works. 15 And what really seems to work with a heroin 16 addiction is a long-term treatment, and it has to be 17 caught early. You're looking at a 14-month 18 treatment. 19 And to get a 14-month treatment, insurance 20 companies have to come around. 21 We can't have, which we see in 22 Chenango County, is insurances refuse to pay for 23 this treatment. 24 A lot of these kids, and a lot of these 25 addicts, cannot afford treatment. They're not rich. 1 You know, they don't have money sitting in the bank 2 that they can spend it on. 3 You know, you see addiction, they're not 4 robbing people because they just want more. They're 5 robbing people because they've already gotten rid of 6 everything they have. They've gotten rid of their 7 job, their family, their money...everything. 8 So we need to come up with some kind of 9 solution that is localized treatment, where, you 10 know, you could have a treatment center in 11 Chenango County, or a treatment center in 12 Delaware County, or Otsego County, that they're not 13 traveling 800 miles to get what they need. 14 I mean, we found a treatment center through a 15 church that's relatively cost. You know, the cost 16 is down, it's 14 months, but it is out of state. 17 And it's for 18 and younger. 18 Now, there's nothing available for 18 to 25. 19 So we need to come up with a solution for 20 that problem. 21 Something else that I've seen in 22 Chenango County is the amount of foster kids due to 23 the drug problem that we have. 24 The amount of foster kids is going through 25 the roof. I mean, we have 64 kids currently, this 1 year alone, in foster care. And close to 30 of them 2 are because of drugs. 3 So this isn't just affecting the addicts; 4 it's affecting the families. 5 When he talked about grandparents, those are 6 grandparents that are taking care of their kids' 7 kids, because their kids are addicts. 8 SENATOR SEWARD: Thank you very much. 9 JEANETTE TOLSON: May I say just a few words? 10 I just wanted to say that our organization 11 offers recovery services in the community, which are 12 support services for people who are not in 13 treatment, support services for people in 14 conjunction with their treatment, and support 15 services when they're done with treatment. 16 And one of the things that we try to assist 17 people with, is, you know, rebuilding that life that 18 took years and years of an addiction to break -- you 19 know, to fall apart. 20 And some of the things we've heard today 21 about people feeling very overwhelmed with trying to 22 put that life back together, causes people to give 23 up, causes people to feel like there aren't enough 24 resources available. 25 And one of the things that's very, very 1 beneficial to people when they're rebuilding their 2 life, is the ability to gain employment. 3 And, you know, we help -- we have some 4 employment services for people who are trying to get 5 back into the workforce, but one of the challenges 6 is getting employers to hire people and take a 7 chance on someone who has a history of addiction. 8 And I think that if we had some additional 9 incentives from the state government, to hire people 10 who have an addiction, and to -- you know, tax 11 incentives, or whatever, to have them take that 12 step: hire people who have a history of addiction 13 and are in recovery. 14 They will start to see that people can get 15 back into the workforce, be productive members of 16 society, which will help change the stigma, and 17 allow people to start feeling like they can 18 contribute to society again. 19 So, thank you. 20 SENATOR SEWARD: Thank you. 21 Before we get to some of the questions from 22 the audience, I just wanted to -- just ask the 23 question from -- to our -- to those involved with 24 treatment: 25 In terms of the detox option here, where 1 would an addict go to complete a detox program in 2 this area? 3 JUSTIN THALHEIMER: Want me to take this? 4 First of all, I want to thank 5 law enforcement, because they've saved a lot of 6 lives by just taking people right off the streets -- 7 [Applause.] 8 JUSTIN THALHEIMER: -- and putting them in 9 jail. It's not the prettiest detox, but it's better 10 than no detox at all. It's not pretty, but they 11 save lives. Even recently, they've saved lives. 12 Detox for opiates is really tough because 13 it's never been treated as a life-threatening thing. 14 It's just -- it's -- you're going to feel 15 really uncomfortable, like uncomfortable that most 16 of us can't imagine, but it's never been treated as 17 life-threatening, so it's very difficult to keep 18 somebody in -- or, to get them into detox. 19 And, unfortunately, when they're going into 20 the local emergency rooms, which are overwhelmed, if 21 they're intoxicated, a lot of times, before they go 22 into really active detox symptoms, they're 23 discharged. 24 I mean, like everybody else, as soon as 25 they're fixed, they're discharged, so they don't get 1 to the services they need. 2 Unfortunately for us, we've got, 3 Delaware Valley Emergency Room does middle, mild, 4 detox, and that's with some -- with other things 5 attached. 6 And then there's Spark up in Schenectady. 7 We do not have the resources for detox 8 locally. 9 Like I said, I mean, if somebody gets pulled 10 off of probation or parole and they get pulled into 11 the jails to detox there, it's not pretty, but it's 12 better than no detox at all. 13 DA RICHARD NORTHRUP: One of the 14 difficulties, opiate withdrawal is not considered a 15 medical necessity, and often what they'll recommend, 16 Suboxone was originally designed for withdrawal of 17 opiates. 18 So, really, there are little or no resources 19 for opiate detoxification. 20 I -- with the -- I'm a proponent of inpatient 21 detoxification for opiates, because I think it works 22 the best. 23 And as I said earlier, there are no 24 [unintelligible] Suboxone providers locally, so 25 these people are really left hanging out there. 1 Like Justin said, unfortunately, a lot of 2 detox is done in jail. 3 NANCY ORTNER: And I would add to that, in 4 Schoharie County, if someone comes in and is looking 5 to be detoxed, we send them to St. Peter's in 6 Albany. So it's not in Schenectady; it's in Albany. 7 JUSTIN THALHEIMER: Oh, thank you. 8 NANCY ORTNER: So it's a bit farther. 9 Or, St. Mary's in Troy, or Amsterdam. 10 And it's a gamble, because we can't call 11 ahead. 12 If we call ahead, they say, "We can't 13 guarantee a bed." 14 And, so, they get to whichever facility they 15 decide to go to, and then they may or may not be 16 admitted, depending on whether there's a bed 17 available. Or, depending on whether they're really 18 showing some withdrawal symptoms. 19 So, they have to be very sick, and have a 20 bed, in order to get detoxed. 21 UNKNOWN SPEAKER: And have the right 22 insurance. 23 DAVID RAMSEY: Senator -- 24 SENATOR SEWARD: Yes. 25 DAVID RAMSEY: -- if I might? 1 UNKNOWN SPEAKER: And have the right 2 insurance. 3 NANCY ORTNER: And -- yes. Thank you. 4 And have the right insurance. 5 DAVID RAMSEY: I can kind of echo a lot of 6 the comments about the frustrations that I have. 7 As a council director, one of the services 8 I provide is doing formal interventions for 9 families. Someone calls, their -- a relative is in 10 trouble. 11 And it's a laborious multistage process, but 12 it can be very effective, but over the years, and 13 I've been doing this for 16 years, the customer has 14 changed. It's no longer the middle-aged alcoholic 15 that used to be who I was called to assist. 16 And now, as, sadly, in the last four or 17 five year, is reflecting the statistics that we're 18 talking about here. They are young people in teens 19 or in their 20s, and the parents that are calling 20 are frantic. Their world has been turned upside 21 down. 22 And, again, it is not a stereotypical 23 profile. These are good families -- so-called good 24 families. These are people unemployed. It's a very 25 democratic medical illness that we're dealing with 1 here. It will take anybody. 2 But one of the things I have been extremely 3 frustrated about, is I get someone at that 4 intervention, agreeing to go to treatment for heroin 5 addiction, and as has been said here, it's a very 6 uphill battle to persuade, you know, first of all, 7 to get them into a detox. Some of these places will 8 not detox from opiates. 9 But if you are successful, then the battle 10 becomes, and it is a battle, with the insurance 11 company. 12 There is legislation, I think, being 13 considered now in Albany, and I really, really hope 14 that it's given serious consideration, because we 15 are losing people, losing their lives, because, you 16 know, the decisions are made for profit reasons. 17 That's what insurance companies are about: 18 They are ultimately beholding to their shareholders. 19 And there is a conflict of interest there. 20 These are public-health issues. They cannot 21 be allowed to be in the driver's seat when these 22 decisions are being made. 23 Turn that back to the professionals. The 24 medical professionals that are here today, the 25 professional CASACs, the alcohol and drug 1 counselors; people who are on the ground with the 2 patient, who understand that you can't tell a heroin 3 addict who is shooting, you know, 15, 20 bags of 4 heroin a day, to go to an outpatient clinic and 5 "You'll be okay." That's not going to work. 6 And, so, they have to be held accountable for 7 this. I think it's absolutely criminal what's going 8 on with the insurance companies. 9 [Applause.] 10 DAVID RAMSEY: The other, more promising 11 trend, is someone sitting right next to me here, 12 Jeanette Tolson, who runs the local recovery center. 13 Which, and by the way, we are very grateful 14 for your support, early support for that 15 Senator Seward. Your funding of that at a critical 16 time for us, I think, turned everything around. 17 But we know, the statistics are clear, that 18 when people come out of treatment, and we're 19 assuming that you're giving them the very best 20 treatment possible, they still tend to relapse in 21 the first three to six months of discharge from 22 those treatment facilities. 23 If we provide them with recovery centers, 24 that rate of relapse plummets. 25 So this is smart money to invest in recovery 1 centers. 2 It's also smart to invest in recovery 3 coaches. 4 Norine, myself, and Jeanette are all trained 5 recovery -- master trainers for recovery coaching. 6 We have approximately, in the state now, 7 close to 1,000 people trained up as recovery 8 coaches. And that's a rigorous 35-hour training of 9 peer support. 10 OASAS has been the state agency that oversees 11 substance abuse in New York State. OASAS has been 12 very helpful in that effort, too. They have also 13 trained peers in this area. 14 And that provides someone who is newly sober, 15 who is frustrated, intimidated, about just about 16 everything that's coming their way, because they're 17 newly sober, this gives them, literally, a hand to 18 hold, to go through these frustrations that precede 19 a relapse. 20 And so we know that recovery coaches are 21 having a huge effect on reducing relapse with 22 addicts and alcoholics. We can certainly do that. 23 My final comment would be, just, you know, 24 ditto the comments here this morning about getting 25 to them early, getting to them in the jail. That's 1 where they end up, in the criminal justice system. 2 If we can provide them with treatment, and 3 there's no reason, I think, that we can't do this, 4 it's just the will to do it, to get them in the 5 county jails, in the state prisons, with good, solid 6 treatment and counseling. 7 Otherwise, you're just having them sit in a 8 box for up to a year, with nothing. No insight, no 9 change in their attitude or approach to life. 10 Those things are being tried, particularly 11 now in Maryland. They're having great success with 12 programs that are taking place in the county jails. 13 So there's encouraging signs there, but we're 14 missing an opportunity there. 15 We have that captive audience. We can get to 16 them with a message of hope. 17 So, thank you, Senator. 18 SENATOR SEWARD: Thank you. 19 Yes -- 20 NORINE HODGES: I'm sorry, Dr. Sellers. 21 I just wanted to address, before we move on, 22 and it's the last thing I will address, but, 23 prevention education. 24 We are in every classroom, from kindergarten 25 through high school. Every grade, every student, 1 we're loaves and fishes. One full-time and three 2 part-time, we go into every class with an 3 evidenced-based [unintelligible] life skills, as 4 well as a few others. 5 We do twenty-thousand 101 contacts. 6 We have reduced the early initiation of 7 alcohol for our tenth-graders -- that 15-year-old 8 brain we've been talking about, it's pretty crazy -- 9 by 87 percent. 10 And our twelfth-graders look at using 11 prescription drugs the wrong way, to use them for 12 not what they're attended, 65 percent. 13 This program works, every student gets it. 14 It's a scaffolding program. It's relevantly 15 designed so it's meaningful for every age group, 16 working on decision-making, how to handle emotions, 17 communication skills, social skills. 18 We've got our first tenth-grade class that's 19 had the program since kindergarten. The numbers for 20 that particular age group, because it is a strange 21 time in life, there, with the brain development, 22 amazing. 23 And now OASAS (the Office for Alcoholism and 24 Substance Abuse) has agreed to survey in the fall. 25 We do it every two years. And that, my 1 tenth-grade group, will be seniors. And it really 2 does work. 3 And I think, those monies, that every school 4 used to get those monies. They were the drug-free 5 and safe-school monies. 6 They -- with the federal government took that 7 away, made them into big block grants that only a 8 few schools -- I've been a peer reviewer for those 9 grants -- only, you know, 10 to 20 schools in the 10 country can access those monies; whereas, before, 11 every school had those monies. 12 So we did have counselors in the schools, and 13 then we did have other education programs. 14 But my colleagues and I struggle to get into 15 all the classrooms. And we've just been very 16 blessed in Schoharie County. Every teacher loves 17 it, every teacher wants us back. Children do 18 petitions to have us come back. 19 We do bullying now, violence in the 20 classroom, as well. 21 So these programs work. 22 [Applause.] 23 DR. JOSEPH SELLERS: My colleague 24 Dr. Leinhart pointed out to me that we don't always 25 interact with the people sitting around this table. 1 That, you know, one of things, we don't have 2 a system for communicating between medicine, the 3 community resources, education, law enforcement. 4 And many of the folks who are having 5 difficulty with substance abuse wind up in 6 emergency-medicine facilities on a regular basis, 7 multiple times, before they would ever be seen by 8 law enforcement. 9 And, so, I think one of the -- hopefully, a 10 good outcome from this, would be for all of us to 11 commit to interacting more. 12 And, so, I'm going to volunteer these guys 13 to -- 14 [Laughter.] 15 DR. JOSEPH SELLERS: -- anybody who wants to 16 meet with the ER directors from Bassett and Fox 17 should get their cards today before you leave. 18 And they should know about the programs that 19 are out there. 20 Law enforcement should know what's going on. 21 They should talk to you guys about how do you 22 interact with the EMS system, and the rescue squads, 23 and the people who are out in the community. Or the 24 EMS guys are going into people's house all time, and 25 see things, and report to us, things that would, you 1 know, turn your hair gray. 2 Lastly, if I can, because I know you wanted 3 to switch to taking questions, and there is a 4 physician from Bassett I asked to come here today, 5 who is putting together, with the LEAF group, a 6 community event that's going to be in Cooperstown on 7 May 22nd. 8 And I think it would be helpful for the group 9 here to hear about what Dr. Weinstock [ph.] has to 10 say. 11 DR. WEINSTOCK [ph.]: Do you want me to talk 12 about the event? Or [inaudible]. 13 DR. JOSEPH SELLERS: I think it would be nice 14 if you talked about the "why" of your event, and 15 then the "what," because I think it's -- it's an 16 example, I think, of finding a community-based 17 solution. 18 SENATOR SEWARD: Okay, go ahead. 19 DR. WEINSTOCK [ph.]: Sure. 20 Hi, I'm Judy Weinstock, and I'm the newest 21 physician, I think, in the entire Bassett system. 22 I'm a primary-care physician, and I moved -- 23 I moved here with my husband nine months ago, to 24 come to a place that had a slower pace of life. 25 And, was never interested in drug addiction or 1 prescribing opioids. 2 And this has become a passion of mine by 3 accident. 4 So, Dr. Sellers asked me to tell you a little 5 bit about my experience. 6 So I came to Bassett to be -- work part-time 7 as a primary-care physician. Just a regular family 8 doctor. 9 And my first three days, most of my patients; 10 so I saw 10 patients a day, so about 9 a day were 11 seeking opioid prescriptions. 12 And I kind of went like this [indicating], 13 and said, "You know, these are not appropriate 14 prescriptions. This is not how I was trained." And 15 immediately started looking for resources to help 16 me. 17 And what Mylea said in the beginning really 18 resonated with me. 19 She said, "It's hard not to blame the 20 doctors." 21 Well, the doctors blame themselves. 22 It's hard for the patients not to blame the 23 doctors, but, also, we get blamed when we don't 24 prescribe, when someone's in back pain and they're 25 seeking opioids. 1 So in four months, I have received more 2 threats, more complaint letters, you know, I've had 3 more patients fire me, and every single one of those 4 has been a narcotic-related complaint or threat or 5 firing. 6 So, the resources that I was looking for was 7 pain management. I needed help. These patients are 8 in pain, and some of them have been on these 9 medications for 20 years. They're not even close to 10 admitting they have a problem with opioids. They 11 have a problem with pain first. 12 And I found -- I spent, I don't know, 13 80 hours a week my first three weeks of working 14 there, looking for resources. 15 And I have a handout for patients of 16 12 pain-management clinics they can go to, which 17 include neurologists and board-certified 18 fellowship-trained pain-management specialists, 19 et cetera. 20 Well, I've had to whittle down the -- the 21 list down to nine, because I just can't get patients 22 into four of them. 23 And the closest one is Syracuse, and the 24 waiting list is nine months, and "I" must detox a 25 patient off of opioids before they'll be seen. 1 So how do I do that? I give them Imodium and 2 Zofran and clonidine, and say, I know you're going 3 to get diarrhea, but Imodium works a little bit 4 better, you know. 5 So that -- so the second resource is 6 psychiatry mental health. I need help. 7 Addiction and mental-health problems are like 8 this [indicating.] They're not separate issues. 9 And to get -- I need help with this. 10 And then, of course -- 11 [Applause.] 12 DR. WEINSTOCK [ph.]: And then, of course, 13 the addiction problem. 14 So those are the resources I want. And, 15 really, that's what all the primary-care and 16 emergency-med docs want, and that's really what the 17 law enforcement wants, and what the patients want, 18 and what the families need. 19 And, you know, Mylea, I feel like I've seen 20 you 20 times last week. You know, I don't want you 21 to go to jail. I don't want to you live on the 22 street. I want to hug you and take care of you. 23 And that's what all the doctors want. 24 That's what we all want, you know? 25 So I can talk forever. 1 I will stop and talk about the events, 2 though. 3 I think, probably on my second month of 4 living here, I said: Not enough people know about 5 this, and not enough people get together. 6 The docs know about it, the cops know about 7 it, the detox centers know about it, but not enough 8 of the community knows about it. 9 We've got to get the word out there. 10 So there's a similar town in Vermont, 11 St. Albans, and there was a documentary made about 12 that town and the drug problem there. 13 And the kids in this documentary, they wear 14 the John Deere clothing, they work on farms. You 15 know, they work at Wal-Mart. 16 It's our community. 17 And, so, together with LEAF and 18 Justin Thalheimer's helping, and the docs are 19 helping. I mean, everybody who hears about it wants 20 to get involved. 21 So we're having the movie shown as a free 22 community event in Cooperstown at the 23 Fenimore Museum on May 22nd, which is a Thursday 24 night. And the director of the movie is coming. 25 And one of the kids who is a recovering addict is in 1 the movie. 2 And this is what the poster looks like, and 3 the movie is called "The Hungry Heart." 4 And the idea is, to get everybody to come 5 together and talk about the fact that this is a 6 community problem. 7 And, so, I have a lot of these posters if you 8 want to put them up. They were graciously donated 9 by LEAF. 10 Thank you, Julie. 11 And -- oh, Judge Burns [ph.] will be there, 12 as well, talking about how the problem affects us 13 from a law standpoint. 14 I think I'll end there. 15 SENATOR BOYLE: Thank you very much. 16 SENATOR SEWARD: Thank you very much, Doctor. 17 [Applause.] 18 SENATOR SEWARD: In the few -- the very few 19 minutes that we have remaining, I wanted to get to 20 some of the audience questions that's been raised. 21 And the first one is -- regards -- it's from 22 Pete Maloney [ph.], the assistant chief of the 23 Oneonta Fire Department. 24 He's asking: "Is there a plan to provide 25 continuous supplies and support to law enforcement 1 for the Narcan kits? 2 "And will EMS agencies, who also respond to 3 overdoses, be supplied by this program?" 4 I'd like to ask Senator Boyle to address 5 that, what we're doing at the state level. I know 6 he's involved. 7 SENATOR BOYLE: Yeah, that's an excellent 8 question, Chief. 9 And what I found going around the state is, 10 that there's really no clear-cut program or agenda 11 on the way to address this Narcan situation. 12 It -- the irony is unbelievable, given the 13 fact that there are Narcan trainings. 14 And I'm glad to see you're having one here. 15 We had one on Long Island the other night. 16 We had 150 people participating. 17 Now, I'm a former EMT, and I've seen Narcan 18 work, and it is truly is a miracle drug. 19 And I'm sure the emergency room doctors have 20 seen it numerous times over their career. 21 The irony is, right now, under state law, we 22 can get it prescribed and give a course, and have it 23 given out to a citizen, a concerned citizen, but you 24 cannot have it on your first responder vehicle for a 25 fire department, for example, because the department 1 itself cannot be trained. 2 It's really a county-by-county thing. 3 And I can tell you that, as part of this 4 legislative package that's going to come out of 5 these hearings, we're going to have a unified 6 system, so as many people -- first responders, 7 parents, addicts themselves -- will get access to 8 Narcan. 9 [Applause.] 10 SENATOR SEWARD: Both Bob Kerry and 11 Pamela Tillman [ph.] have asked questions regarding, 12 and it's come up several times in the discussion 13 here today, regarding, you know: 14 "Why are insurance companies, rather than 15 recovery professionals, dictating whether or not an 16 inpatient receives treatment? 17 "And what is the status of Senate and 18 Assembly bills?" 19 And, you know, as -- I chair the 20 Insurance Committee in the Senate, and, of course, 21 as a member of this Task Force, I can report to you 22 that, between now and June 1st, when we look to come 23 up with the recommendations from this Task Force, 24 that this is certainly going to be a key issue for 25 us, because, number one, we need a much more 1 uniformed standard in terms of coverage in the 2 state. 3 Because I've heard stories of people showing 4 up at the inpatient centers, and, you know, they -- 5 their families are in tears, they're in a crisis 6 situation, and they're on the phone with someone in 7 a cubicle at an insurance company. 8 And, you know, it's a very uneven standard 9 that's used, and, it does not help us with our 10 efforts with recovery, with what the current 11 situation is. 12 So, I can't give you a specific answer here 13 today but other to say, that this is a key issue for 14 us. And I suspect that we will have a much better 15 answer as part of these Task Force recommendations, 16 so people can get the treatment that they need. 17 There's a question here about -- this is from 18 Pastor Romano? 19 Oh, yes, yes. 20 Shall I read your question? 21 Yeah. 22 It says: "I have a daughter incarcerated. 23 Involved in prison ministry, I would like to know 24 about easier ways to get funding and help for more 25 faith-based rehab housing and traditional" -- "and 1 transitional, and programs." 2 There's that question. 3 Obviously, I think, I suspect, that that will 4 also be part of our -- Senator Boyle, wouldn't you 5 say that would be part of our deliberations? 6 SENATOR BOYLE: Absolutely. You know, 7 faith-based, whatever community groups, will be a 8 part of it. 9 But we heard a little bit of the testimony 10 here today, where, again, the irony, where you're 11 trying to get treatment from an insurance company. 12 And I've had parents across the state say: 13 I purposely had my child incarcerated because that's 14 where they could get help. 15 That is a messed-up system, and it's going to 16 change. 17 [Applause.] 18 SENATOR SEWARD: Absolutely. 19 [Applause.] 20 SENATOR SEWARD: This would be brass for our 21 medical folks that are here with us. 22 Pastor Romano had a further question. 23 "What are the side effects of VIVITROL?" 24 Anyone? 25 Do you have the answer to that question? 1 BETH: It has not been around -- 2 SENATOR SEWARD: Could you identify yourself. 3 BETH: [Speaking without a microphone.] 4 Beth Viviani [ph.], [unintelligible]. 5 SENATOR SEWARD: Right. 6 BETH: Some reviews that have been done on 7 that shows that there have been no long-term studies 8 yet. That [unintelligible] going on long enough for 9 there to be studies. 10 SENATOR SEWARD: Excellent answer. 11 We have a question regarding the legal -- 12 this is from Henry Azblofox [ph.] -- 13 Yes. 14 -- from Oxford. 15 I'm going to try to read this question. 16 It says: "The legal pain killers are 17 dangerous in too many instances. 18 "Even Purdue Pharmacy, the manufacturer, has 19 admitted their so-called 'safe formularies' was a 20 problem. 21 "Can the State ban or drastically restrict 22 medical use? 23 "Maybe pain is preferrable to risk of 24 addiction." 25 Is there a response for that? 1 DR. KELLY ROBINSON: I think we spoke to 2 restricting the use of prescriptions from the 3 emergency department. 4 If we could be limited in the number of 5 opioids we could prescribe, such as what they have 6 in New York City, that would benefit the rest of the 7 state. 8 SENATOR SEWARD: I remember you making that 9 point. 10 Yes, Doctor, do you have a response to that? 11 DR. WEINSTOCK [ph.]: Yes. I was asked to 12 give a lecture to the medical students about 13 appropriate opioid prescribing, and there are no 14 guidelines at all, really. 15 These are FDA-approved for patients who 16 have -- who are dying of cancer. 17 That's really who it's approved for: people 18 who are dying. 19 And so, when somebody comes in with back 20 pain, what do you do? 21 Do you treat a 20-year-old with back pain the 22 same way as you treat a 99-year-old with back pain, 23 as you treat somebody who just got back surgery? 24 And, so, I gave seven scenarios to the med 25 students, and these are people who are being trained 1 to be doctors, and there was no straight answer for 2 each one. 3 As Mylea said, these medications didn't just 4 help her back pain. They helped her mental pain, 5 they helped her despair, they helped her depression. 6 She felt superhuman. 7 How do you take that away? 8 DR. JOSEPH SELLERS: You know, one of the 9 things that's unfortunately happened, there's a 10 pendulum. 11 And when I started in medicine, giving 12 opioids was considered to be something that you 13 didn't do. People would become addicted. 14 And then there was the movement, What about 15 people with cancer pain? What about people with 16 terminal pain? 17 And then the overall organization that 18 certifies and inspects hospitals, the Joint 19 Commission on Health-Care Organizations put through 20 that everybody should have a fifth vital sign every 21 time they encounter the medical system, and that 22 should be their pain level. 23 So if you're ever in a hospital or an ER and 24 you see those pictures, [unintelligible], the thing 25 is, everybody has a right to be treated for pain. 1 Medicare still requires hospitals to survey 2 the patients that leave the hospital, the emergency 3 room, a series of questions, and one is: How is 4 your pain? Was your pain adequately addressed? 5 A pendulum swung, because of, I think 6 well-intended, you know, actions on the part of the 7 regulators, but it was -- it swung too far. 8 And it still is a very tough dynamic, and 9 it's very tough, because, unfortunately, addicts 10 can, and drug-seekers, people trying to get drugs so 11 they can sell them on the streets, can be very 12 convincing about their pain. 13 And it's a tough, tough situation. 14 But I think that the more we educate 15 ourselves, educate our patients, and be just careful 16 use of potentially addicting drugs. 17 But we can't stop using them, because there 18 still are people who cannot work, whose lives would 19 be turned upside down, without adequate pain relief. 20 It's just very difficult to sort out who, and 21 when, and how much. 22 And, again, we need more government help, 23 more government, research. I think this is at the 24 federal level, about best practices for, you know: 25 What is the ideal practice for somebody having their 1 wisdom teeth extracted, that minimizes the risk of 2 long-term addiction, but still gives the person some 3 relief? 4 Because, you know, there is significant pain 5 associated with having your wisdom teeth extracted? 6 SENATOR SEWARD: Thank you. 7 DR. STEVEN GRAHAM: [Speaking without a 8 microphone.] If I may? 9 SENATOR SEWARD: Yes. 10 DR. STEVEN GRAHAM: One of the problems with 11 opiates is that they work. 12 [Laughter.] 13 DR. STEVEN GRAHAM: And, one of the principal 14 mechanisms of action that they have, is they 15 function as an antidepressant. 16 One of the things that we're going to be 17 seeing, perhaps in the near future, is a novel 18 antidepressant that is in Phase 3 trials right now. 19 The principal active ingredient is 20 buprenorphine. 21 [Microphone handed to speaker.] 22 DR. STEVEN GRAHAM: That's actually all I had 23 to say. 24 [Laughter.] 25 DR. STEVEN GRAHAM: Other than the fact that, 1 again, narcotics are antidepressants. 2 One of the reasons people use narcotics, is 3 because they act as an effective antidepressant. 4 SENATOR SEWARD: Thank you, Doctor. 5 JUSTIN THALHEIMER: I'm sorry. 6 I just wanted to say that, based on what you 7 were saying, I know a lot of people will go into the 8 emergency room, looking for these meds, or to their 9 primary-care physicians. 10 These medications are also mimicking and 11 magnifying the pain. 12 So it's not like the addict is going in 13 without pain. They just don't know where it's 14 actually come -- a lot of times, they don't know 15 where it's coming from. It mimics and magnifies it. 16 If the scale of 1 to 10 is a 4, after you're 17 opioid-dependent, that same scale is going to be at 18 about a 7 or an 8. 19 It's -- it doesn't -- when you're looking for 20 the -- when you are addicted to the opiate, 21 you're -- 22 DR. WEINSTOCK [ph.]: There's a medical term 23 for that. It's called "hyperalgesia." And it's -- 24 that is, that your body isn't able to produce it's 25 own pain killers. 1 So I always tell my patients: When you stub 2 your toe, it hurts a lot more than when I stub my 3 toe. And I believe you. 4 And anybody who's delivered babies, I used to 5 deliver babies, and I used to deliver the 6 methadone-addicted babies, and it was so hard to 7 control their labor pain. The regular epidurals 8 didn't work. And it wasn't -- it was real. 9 Doctors want their patients to be pain-free. 10 SENATOR SEWARD: Thank you. 11 There's one other question on the pain-meds 12 issue. 13 Is it, Bridgette Brown [ph.]? 14 Bridgette, yeah, why don't you give her the 15 microphone. 16 Did you have any -- did you have a follow-up 17 question on this issue? 18 BRIDGETTE BROWN: I've been in recovery since 19 1990, from alcoholism. 20 And in '97, I was put on -- where I had 21 fourth-stage breast cancer, I was put on opioids. 22 And I was told there was Oxycontin, and I would 23 never become addicted to it. 24 Well, I don't take opioids anymore. 25 I never, as far as I'm concerned, engaged in 1 drug-seeking. But, I have had a lot of pain, and 2 the doctors are afraid to prescribe -- and I know 3 many people like myself, to prescribe pain 4 medication. They're afraid, because of the I-STOP 5 laws, and everything else. 6 And there are, definitely, many people pain. 7 That I had sciatica for seven weeks. I went 8 to the emergency room three times. I saw Dr. Kelly, 9 and I was given nothing for my pain. 10 I didn't want opioids, but there really isn't 11 else. 12 The pharmaceutical companies are not 13 producing pain medication that will help us, because 14 they make so much money from the opioids, I guess. 15 So we need help. 16 I mean, there are legitimate people, and, of 17 course, you said that, that need pain medication. 18 Thank you. 19 SENATOR SEWARD: Thank you very much. 20 Just a couple of more here. 21 We had, from Karen Van Vauckenberg [ph.], who 22 said: "What is the political stance on making 23 access for levels of care available, such as 24 insurance paying for treatment, acupuncture, pain 25 management, recovery coaching, and peer-support 1 groups? 2 "All the different pathways, together, are 3 more successful than are intervention one at a 4 time." 5 I think that sums it up very well in terms of 6 why we're here today. 7 It's, obviously, going to take a multipronged 8 strategy to address this problem. 9 And, obviously, that's -- you know, we have 10 this wide-ranging panel here. 11 There are others at various other forums that 12 have been held around the state, and with all of 13 this input, we will be looking to develop that 14 multipronged strategy. 15 BRIDGETTE BROWN: Thank you, Senators. 16 SENATOR SEWARD: And, finally, Matthew Ward? 17 We're way over time, but if you would like to 18 make your point briefly, we would very much like to 19 hear your comment. 20 MATTHEW WARD: I'm Matthew Ward. I am a 21 drug-court participant, as well. 22 And, you know, my story, you know, 23 originated, you know, through drinking, moving on, 24 blah, blah, blah. 25 The "Emerald City" you hear, that we're 1 talking about, is opioid addiction. But, without 2 putting, you know, a specific substance, you know, 3 into the discussion, I think that we all in this 4 room, it's fair to say, 100 percent of us are 5 affected by addiction. 6 And, you know, I just want to see, you know, 7 that same willingness that's asked of me in my 8 recovery. You know, if I want what, you know, 9 people living clean and healthy have, and I'm 10 willing to go to any length to get it, you know, 11 I want to see the same things occur. 12 You know, I'm accompanied by a set of parents 13 that had, you know, their child, just back and 14 forth, and back and forth, trying to get the 15 insurance company to pay for this. 16 Myself, four times I went to rehab before 17 I wound up with a felony, you know. 18 And, I am educated, I have a deep career, all 19 these things that went circling the drain, you know, 20 as I attempted, over and over and over again. 21 You know, the window of time, when an addict 22 says, "I need help," might be 15 seconds. And we're 23 supposed to wait 30 days for some response from an 24 insurance company? 25 You know, so, I just -- I do thank everybody 1 who's up there today, for assembling on this. 2 I think that it's a huge step in the right 3 direction. 4 And, you know, collaboratively, I think input 5 from everybody -- law enforcement; government; the 6 counselors, you know, that advocate; you know, 7 people in recovery; people who are still active, 8 seeking recovery -- you know, we can all make this 9 happen if we work hard at it. 10 So, thank you. 11 [Applause.] 12 SENATOR SEWARD: Thank you, Matthew. 13 I just want to close, ask Senator Boyle to 14 give the concluding comments. 15 But I just want to close by saying how much 16 I appreciate all of you being here this morning. 17 This is a huge problem for our area. It's no 18 longer a big-city problem. We have it right in our 19 small towns and our rural communities in this part 20 of the state, as well. 21 It's a growing problem, and we need to deal 22 with it. 23 And, I appreciate the comments that everyone 24 has made here today. They've been very insightful 25 and helpful to us, our Task Force, as we do our 1 work. 2 And, no question that, you know, we need to 3 look to expand treatment opportunities earlier, and 4 also look to additional education and prevention 5 measures to be taken. 6 The insurance-coverage issue is huge, and 7 very key in many, many cases. 8 We're going to look for a better answer 9 there, so people can get the treatment that they 10 need, and get it earlier. 11 And, there are many other aspects of this 12 issue that we need to deal with. 13 So, I want to just say thank you all for 14 participating. 15 And those of you in the audience, I hope you 16 found it to be interesting, and I appreciate your 17 input, as well. 18 I particularly want to thank Deb and Mylea 19 for being here, to remind us that we may talk 20 statistics, but they are real people behind these 21 numbers. And, we owe it to you, and all those you 22 represent, to deal with this problem successfully. 23 So with that, I would like to ask our Chair 24 of our Task Force, Senator Boyle, to close. 25 I appreciate my colleague Senator O'Mara for 1 joining us, as well. 2 SENATOR BOYLE: Thank you, Jim, and thank you 3 so much for hosting this, and SUNY Oneonta; 4 Senator O'Mara, for participating, and all the 5 panelists. 6 We got some good ideas today. I know we can 7 think of three or four bills -- potential bills to 8 come out of here. 9 As Dr. Sellers says, this communication 10 should continue. 11 And if you think about something, in talking 12 in the next few months, or the next few years, 13 please contact us, because there's always room for 14 legislation to help us combat this drug tragedy. 15 And, thank you for all the people 16 participating in the audience, for coming today. 17 I was looking forward to this forum probably 18 more than any of them, because I knew I had the 19 Chair of the Insurance Committee here, and this was 20 going to be -- he's the man, on this. 21 And, also, to Deb and Mylea, thank you so 22 much. 23 And I know, I'll end with saying: 24 Mylea, I know you said in your beginning, 25 that your goal was to, someday, help save a life. 1 Well, you did today. 2 Thank you for participating. 3 Thank you all. 4 [Applause.] 5 6 (Whereupon, at approximately 12:11 p.m., 7 the forum held before the New York State Joint 8 Task Force on Heroin and Opioid Addiction 9 concluded, and adjourned.) 10 11 ---oOo--- 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Public Forum: Otsego County Panel Discussion on Heroin Epidemic in Oneonta

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