Public Forum: New York County Panel Discussion on Manhattan'S Heroin Epidemic

Executive Director 9 Dynamic Youth Community 10 Karen Carlini

Associate Director 11 Dynamic Youth Community

Also, Co-Chair, Association of 12 Substance-Abuse Providers, Adolescent

and Young Adult Committee for NYS 13

Ruchama Clapman 14 Founder, and Executive Director

Mothers and Fathers Aligned Saving Kids 15

James Hollywood 16 Assistant Vice President, Residential Services

Samaritan Village 17 18

AUDIENCE PARTICIPATION AND Q&A PAGE 151 19 20 ---oOo--- 21 22 23 24 25 1 SENATOR GOLDEN: [No audio.] They'll be 2 right up. 3 I'm going to start with my opening remarks. 4 Simcha's here. 5 Simcha, come on in. 6 I'm joined by Senator Mike Nozzolio, 7 Senator Simcha Felder, who's part of our task Force. 8 And, here comes our chairman now, Phil Boyle, 9 who is the Chairman, and with my co-host here, 10 Simcha Felder. 11 So I'll be turning this over for you to open 12 this up, sir. 13 SENATOR BOYLE: Sure. 14 Thank you, Senator Golden, and thank you 15 Senator Simcha Felder, for co-hosting this forum. 16 And, Senator Nozzolio, thank you for joining 17 us. 18 This is the ninth of 17 forums around the 19 state we're holding as part of this Heroin and 20 Opioid Task Force. 21 The mission of the Task Force is to have a 22 report due about June 1st, and then subsequent 23 legislation before session ends this year, to combat 24 this statewide epidemic. 25 We've gotten some great testimony and 1 feedback interaction over the last several of our 2 forums. 3 And we look forward to hearing from our 4 witnesses today and getting some good ideas. 5 Obviously, as Senator Golden probably 6 mentioned, we're focusing on prevention, treatment, 7 and law enforcement. 8 So any of you, if you, through your 9 expertise, whether it's in any of those areas, 10 thinking outside the box, what has worked, what do 11 you not think will work, and, if you ever thought 12 there ought to be a law, this is the time to talk 13 about it. 14 So thank you, and I appreciate being here. 15 Thank you. 16 SENATOR GOLDEN: Simcha? 17 SENATOR FELDER: I just want to thank 18 Senator Golden for hosting this event, and being 19 gracious enough to include my name. 20 SENATOR NOZZOLIO: Just my comments, briefly: 21 It's wonderful to be with my -- all my 22 colleagues, especially two of them from 23 New York City, Senator Golden and Senator Felder. 24 Thank you for your attention to this issue. 25 What we're finding, is that the epidemic of 1 heroin is not exclusive to the inner cities anymore. 2 Certainly, we're in the biggest city and -- 3 in our state, but today we want to hear your 4 experiences. 5 But, the Task Force is finding this is an 6 issue now, small cities, suburbs, rural areas. It's 7 pervasive across the state. 8 So thank you very much for your testimony. 9 Without further ado, Chairman, thank you. 10 SENATOR GOLDEN: I want to thank again our 11 Chairman and our Co-Chairman, and, of course, 12 Mike Nozzolio for coming today, and being part of 13 this Task Force today. 14 I just want to point out two -- 15 three paragraphs here that are important, and then 16 we're going to open up. 17 In February this year, "New York Times" 18 reported that the federal Drug Enforcement 19 Administration heroin seizures in New York State 20 increased 67 percent over the last 4 years, seizing 21 144 kilograms of heroin, 20 percent of the seizures 22 nationwide, valued at $43 million. 23 My colleague Simcha is from Brooklyn, and 24 myself, southwest Brooklyn, an unfortunate a number 25 of people who have lost their lives, or been 1 hospitalized and currently addicted, to prescription 2 drugs, heroin, and more. 3 We're going to hear from some of the people 4 from southwest Brooklyn. I guess they had another 5 death there last week, and an overdose of heroin. 6 Today's "Daily News," you see an actress in 7 England, they just came up. She had overdosed in 8 early April, and they're saying that that now is a 9 heroin overdose, as well. 10 According to the New York City Department of 11 Health, 84 Brooklyn residents, "84," died, 12 unintentional overdoses involving heroin in 2012, 13 26 more than in 2011. 14 What we've been able to do in the state of 15 New York is to address I-STOP on the opiates, on the 16 prescription drugs, Oxycontin. 17 And in 2011, there were 22 million painkiller 18 prescriptions written in New York State, in the 19 homes of 20 million people. 20 Think about the numbers. Those are 21 astounding. 22 But we did so good on I-STOP in bringing 23 those prescription-drug overdoses down. Still, 24 there's a significant number of opiate deaths out 25 there by pill. 1 But I will tell you that they went -- the 2 water raised itself and to the level [indicating], 3 and heroin has come in and picked up that area, and 4 you can pick up a deck of heroin today, 3, 5, 7, 5 8 dollars. 6 And you can have hundreds of decks of heroin 7 on you and it's not a felony here in the state of 8 New York. 9 It should be. 10 And we're going to listen to testimony, as my 11 good colleague has said, on all areas; not only on 12 the arrests and conviction and jail time for the 13 people that are selling this drug, as well as those 14 for treatment and prevention, as well. 15 So I want to thank you all for being so 16 patient here today, and I turn this back over to my 17 colleague Senator Boyle. 18 SENATOR BOYLE: Thank you, Senator. 19 And we have our initial panel. 20 Just briefly introduce yourself, and then 21 where you're from, for the record. 22 SENATOR GOLDEN: You have to use the mic, 23 Doctor. 24 DR. BRADFORD GOFF: I'm Bradford Goff. I'm 25 the chairman of psychiatry at Lutheran Medical 1 Center in Brooklyn. 2 DR. ANDREW KOLODNY: My name is 3 Andrew Kolodny. I'm the chief medical officer of 4 the Phoenix House Foundation, a national nonprofit 5 addiction-treatment agency located in Brooklyn, 6 throughout New York State, and different parts of 7 the country. 8 I'm also the president of Physicians for 9 Responsible Opioid Prescribing, which is a national 10 organization representing doctors in the fields of 11 pain, addiction, primary care, public health, 12 emergency medicine, and other specialties. 13 HENRY BARTLETT: My name is Henry Bartlett. 14 I'm the executive director of COMPA. And we're the 15 provider coalition in New York State that represents 16 those treatment programs that use addiction medicine 17 as part of the comprehensive treatment of opioid 18 dependence. 19 DR. HILLARY KUNINS: Good morning. 20 I'm Dr. Hillary Kunins. I'm the acting 21 executive deputy commissioner for mental hygiene at 22 the New York City Department of Health and 23 Mental Hygiene. 24 SENATOR BOYLE: Now, the way -- 25 And thank you very much, all of you, for 1 coming, and agreeing to take time out of your 2 schedule to be here. 3 We like to be a little more informal about 4 this. It's not, technically, a hearing. It's a 5 forum. 6 And, so, if we can just ask questions. 7 If any of my colleagues, obviously, want to 8 chime in, or any of you want to answer a question 9 that might have been directed at somebody else, 10 please feel free. We're trying to get as much 11 information as possible. 12 Dr. Kolodny, I'd just like to start with you. 13 You're part of an organization that looks at 14 prescription, and overprescribing, perhaps. 15 A lot of people feel that the current heroin 16 crisis is a result of the I-STOP legislation, 17 perhaps -- or an exacerbating factor of the heroin 18 situation, I should say. 19 Several years ago -- or a couple years ago, 20 we passed the I-STOP legislation, which cut down on 21 prescription overprescribing, and pharmacy and 22 doctors included, which may have led us to go 23 toward -- some of the addicts to go towards heroin. 24 Can you give me an example how you feel about 25 that? Or, do you think that's where we're head -- 1 what we're looking at? 2 DR. ANDREW KOLODNY: Yeah, I think there's a 3 half-truth mixed in there. 4 SENATOR BOYLE: Okay. 5 DR. ANDREW KOLODNY: The explanation for the 6 rising use of heroin and -- across New York State, 7 especially in suburban and rural counties, is 8 actually very easy to find. 9 If you speak to a new heroin user, someone 10 who's become addicted to heroin over the past 11 decade, and this is an individual who is very likely 12 to be White, and between the ages of 20 and 35, what 13 they will tell you is that, their addiction, the 14 reason that they were using heroin, is that they 15 became addicted to opioids. And that addiction 16 began through use of painkillers, and they switched 17 to heroin because heroin was easier to access. 18 This trend of people switching, getting 19 addicted to painkillers and then moving to heroin, 20 has been going on for the past decade. This is not 21 something that just happened overnight in the 22 context of I-STOP. 23 SENATOR BOYLE: Okay. 24 And to what -- 25 SENATOR NOZZOLIO: Can Hillary add -- 1 SENATOR BOYLE: Oh, I'm sorry. Go ahead. 2 DR. HILLARY KUNINS: I'm sorry to jump in, 3 but I just want to add to what Dr. Kolodny 4 mentioned, about New York City data. 5 We know, in New York City, that heroin 6 overdoses began to rise from 2010 to 2011, which 7 predates I-STOP, and predates many of our 8 New York City efforts around promoting more 9 judicious opioid prescribing. 10 SENATOR NOZZOLIO: On that point, the 11 demographic that the doctor presented, is a 12 demographic that has gone through a 13 prevention-education process for most of their 14 school lives in this state. 15 The D.A.R.E. program across New York, the 16 antidrug programs, the -- how did there become such 17 a disconnect for that generation, or that age group, 18 that you mentioned, Doctor? 19 DR. ANDREW KOLODNY: When we talk about 20 opioids, we're talking about painkillers and heroin. 21 And drugs like Vicodin and Percocet are, 22 essentially, heroin pills. The active ingredient in 23 those medications is almost identical to heroin. 24 The effects are indistinguishable. 25 It doesn't mean we should prescribe them 1 because they're, essentially, heroin pills, but we 2 should prescribe them cautiously. They're good for 3 end-of-life care or for short-term use. 4 The young people who are becoming addicted to 5 opioids through use of painkillers are not really 6 aware, I believe, that they are using a drug very 7 similar to heroin. It's not until they're really 8 addicted that they begin to figure out that it's 9 essentially the same thing as heroin. 10 Many of us may have experimented with drugs 11 when we were young, and many of us may have made a 12 distinction in our mind what a soft drug was, maybe 13 marijuana, and what a hard drug was, and we would 14 are known to stay away from heroin. 15 The young people who have become addicted, 16 who are now using heroin, when painkillers came 17 along, to them they were a soft drug. They came out 18 of mom's medicine chest. They were prescribed by a 19 doctor. They were not cut with anything. They 20 didn't realize they were playing with fire. 21 SENATOR NOZZOLIO: It snuck up on them, in 22 effect, an addiction that was never meant to happen, 23 but happened. 24 DR. ANDREW KOLODNY: Correct. 25 SENATOR NOZZOLIO: Senator Boyle mentioned 1 three important components of this Task Force. 2 And, your thoughts on prevention and 3 treatment, particularly from this panel, would be 4 very helpful. 5 Mr. Bartlett, did you -- 6 HENRY BARTLETT: Yeah, I -- thank you for the 7 opportunity to be here. 8 I want to talk about two things, very 9 briefly: One is prevention of overdose, and then 10 second is treatment. 11 I know that Senator Phil Boyle has been very 12 active in promoting overdose prevention, doing 13 trainings, making sure that folks have access to an 14 overdose-prevention kit, like this [holding up an 15 item]. 16 I was in a meeting on Tuesday, in Washington, 17 where SAMHSA is going to make a lot more of these 18 available, they're trying to make a lot more of 19 these available, to the treatment programs in 20 New York. 21 And we're going to play an active role in 22 doing training and handing out these kits. 23 We've already done that in conjunction with 24 the Harm Reduction Coalition and Vocal New York, 25 but, clearly, a lot more needs to be done. 1 Secondly, I just want to talk a little bit 2 about the evidence-base of treating opioid 3 addiction. 4 There's a lot that's going on in the name of 5 treating opioid addiction. Some of it's 6 evidence-based, and some of it is not. 7 And I brought three reports for you folks on 8 the panel, the first of which is the NIH Consensus 9 Statement that was written 14 years ago, which talks 10 about the use of -- I'm sorry, 17 years ago, which 11 talks about the use of addiction medicine as part of 12 a comprehensive approach to treatment, including 13 counseling and wraparound services. 14 And the NIH consensus panel, all that time 15 ago, concluded that, far and away, the most 16 effective way of dealing with chronic long-term 17 opioid addiction was to use an addiction medicine, 18 along with counseling and wraparound services. 19 What's interesting is that, in the 17 years 20 since this has been published, really hasn't been 21 any major contradictions to this. 22 And I want to talk about what I mean when 23 I say "evidence." 24 I mean peer-reviewed outcome studies, subject 25 to the rigors of academia, published in scholarly 1 journals. 2 That ought to be the basis for where we 3 decide to expand our treatment of this epidemic. 4 And the other two reports that are much more 5 recent, these were published in November of 2013 by 6 SAMHSA, one talks about the efficacy of methadone 7 treatment; the other about the efficacy of 8 buprenorphine treatment. 9 What's interesting about all of these is that 10 they support one another, and each of these cite 11 multiple previous studies that have been done. 12 So I want to encourage us to think about, as 13 we move forward with treatment, that if additional 14 resources are made available, and we certainly hope 15 they will be, that the resources are spent in a way 16 that it promotes evidence-based care where we have 17 the highest likelihood of achieving a positive 18 outcome for these newly addicted folks. 19 SENATOR GOLDEN: If you could expand on that: 20 What type of dollars, and what type of -- where 21 would that money be spent? 22 HENRY BARTLETT: Well, I think that there are 23 a number of venues where addiction medicines could 24 be provided where they're not being provided now. 25 One is, for example, is through the 1 drug-court system. We have a very mixed bag with 2 the drug courts. Many of them are simply not 3 embracing the science and best practices associated 4 with addiction medicine. 5 I had a drug court judge say to me: Henry, 6 I'm not opposed to the use of methadone or 7 buprenorphine. We just don't want it because we 8 have a philosophy that is drug-free. 9 And I pointed out to him that "philosophy" 10 was a Greek word that meant the love of wisdom. And 11 I didn't know how you could love wisdom and reject 12 science. 13 So there are a lot of additional venues where 14 addiction medicines could be used, and are not being 15 used. 16 Opioid-treatment programs are certainly, you 17 know, embracing it. 18 The medically-supervised outpatient programs 19 licensed by OASAS, many of them are using it, others 20 are not; residential settings, a number of other 21 outpatient settings. 22 SENATOR BOYLE: If I can just -- can I ask 23 the other doctors on the panel: Do you concur with 24 that conclusion about, whether it's Suboxone, 25 methadone, for -- along with treatment, is that the 1 best way of going about doing it? 2 Or -- 3 DR. ANDREW KOLODNY: So we've got an epidemic 4 of people with the disease of opioid addiction 5 and -- 6 SENATOR BOYLE: Yes. 7 DR. ANDREW KOLODNY: -- and that's why we're 8 seeing heroin flooding into communities. People 9 need to feed that addiction. 10 To bring this epidemic under control, 11 obviously, for the people who already have this 12 disease, we have to see that they have access to 13 effective treatment. 14 For the people with this disease, I think the 15 majority of them will require long-term treatment 16 with a medication. 17 I believe methadone is less useful for the 18 epidemic that we have today than it was for the 19 epidemic we had in the 1970s, when you had an 20 epidemic that disproportionately affected inner-city 21 communities. 22 Having people go to a methadone clinic every 23 day made more sense than when you have an epidemic 24 that's disproportionately affecting suburban and 25 rural communities. 1 I think methadone is very important for a 2 subset of people with this disease who need that 3 structure. 4 But I do believe that Suboxone is probably 5 our best tool for bringing this epidemic, or 6 buprenorphine, under control. 7 SENATOR BOYLE: Doctor? 8 DR. BRADFORD GOFF: Just a little bit to add 9 to my background: 10 I've been in the addiction-treatment 11 business, really, for 30 years, board certified 12 for 20. 13 And I'm a chairman of the department of 14 psychiatry, but I've run treatment programs for 15 addiction and substance abuse and outpatient 16 programs, community-based programs, because, at 17 Lutheran, we have a very large clinic system. 18 And I've also had a private practice. 19 So, I've seen people at all levels. 20 And it's really clear that buprenorphine 21 comes out way ahead. 22 Methadone is very good, used as it's been for 23 many years, and it was groundbreaking in terms of 24 replacement therapy. 25 Buprenorphine adds something new and 1 different because it's more available. 2 It's still expensive, so it's hard to get to 3 the underserved population. 4 Unless people have Medicaid, they can't get 5 it. 6 And they often lose their Medicaid, and then 7 they go out of the hospital and they don't get it, 8 and they come right back in the hospital. 9 And that's something we need to attend to, in 10 addition to the cost of naloxone, which we'll 11 probably speak to, as well. 12 But, for most people who have become addicted 13 to these substances, and these addictions hold on 14 hard. They grab hold of the brain, they hijack the 15 brain. 16 These medications which are replacement 17 therapies and reduce the cravings for drugs, and 18 allow people time to make other choices, are 19 critical. 20 Nothing else has been more effective. 21 Good treatment programs are good treatment 22 programs, but these medications are a blessing to 23 people. And we need to get them out there more. 24 SENATOR BOYLE: Thank you. 25 DR. HILLARY KUNINS: A few words that I'll 1 add. 2 Just to give you a sense my background, also: 3 I'm currently at the City, as you heard. 4 And I'm also an internist and board certified 5 in addiction-medicine practice, both primary care 6 and addiction medicine for 16 years in The Bronx. 7 A few thoughts: 8 I think the City's perspective may be -- we 9 share many of the commonalities that you just heard. 10 We very much support access to availability 11 of awareness of medicines that treat addiction. 12 For us, and for -- as I teach and talk about 13 addiction, I think about diabetes. 14 One would never say to a diabetic: Gee, just 15 really try to lose some weight and exercise. And, 16 if you need insulin, well, that's if it's really bad 17 or if you've failed your other approaches. 18 That's not the approach that we take I think, 19 in medicine, generally. 20 We use the tools that are effective and 21 what's available at the right time, with the 22 patient's consent. 23 And, as Mr. Bartlett said, the evidence 24 surely supports the superiority of medication for 25 the treatment of opioid dependence. 1 And I think we are lucky that we have 2 effective medicines, and less lucky in the 3 addictions from -- to some other substances. 4 That said, there is tremendous stigma around 5 these medicines. 6 And as a public-health practitioner now, one 7 of our most important roles, both at the city and 8 state level, I think is to reduce stigma around 9 addiction, around accessing treatment to addiction, 10 and, in particular, around accessing treatment to 11 medications for addiction. 12 This is a terrible problem we have in the 13 field, and I think it costs many lives. 14 The issue of whether buprenorphine or 15 methadone, I think our view at the City may be 16 slightly different. 17 I think both treatments are effective. 18 I think methadone comes with certain kinds of 19 restrictions at both the federal and state level 20 that makes it sometimes less appealing to some folks 21 interested in accessing treatment. 22 But let us just be clear: We shouldn't 23 confuse the medicine with how we prescribe or 24 deliver it. 25 And I think making both available in as many 1 settings as we can will help us fight against the 2 problem that we're facing right now, both here and 3 nationally. 4 SENATOR BOYLE: Thank you very much. 5 I really appreciate that. 6 Just a couple of follow-up questions. 7 First of all, if anybody in the audience has 8 any questions, please, you have a card. You can 9 give to it my staff there, and we'll be happy to ask 10 it along the way. 11 Regarding methadone, for example, now, having 12 toured some of the treatment facilities upstate, 13 seen that, as you say, Doctor, in the urban centers 14 that might be a different story. 15 But I can think of one I visited upstate, 16 where people were traveling two hours each way, each 17 day, every day. It just didn't seem like the most 18 efficient use of treatment. 19 And, so, this follows up my question with, 20 the drug VIVITROL, which is now a month -- every 21 month you can get a shot, is that the answer, or are 22 there downsides to that? 23 Or, uh -- please. 24 DR. ANDREW KOLODNY: I think for the people 25 with the disease of opioid addiction, there's a 1 small subset who might be helped by VIVITROL. And 2 that subset might be people who are young, who have 3 not been addicted for very long, and who live in a 4 controlled setting, perhaps with their parents. If 5 they miss their monthly injection, the alarm is 6 going off and the parents are bringing them in. 7 Because the big risk with VIVITROL is, if the 8 person misses their injection, they're very high 9 risk for an overdose death. 10 So I think for some people with this disease, 11 it's helpful, but it's a second line below 12 buprenorphine and methadone. 13 HENRY BARTLETT: We support the use of all 14 three of the medications which are approved by the 15 federal government for the treatment of opioid 16 addiction. Each of them have their own strengths. 17 And you're absolutely right, Senator Boyle, 18 the regulations requiring folks to come in so 19 frequently to be medicated on site, at least 20 initially, in methadone clinics are kind of 21 Draconian. And I would say that they don't serve 22 the public-health interest as much as maybe they did 23 20 years ago. 24 But we really are available -- we're 25 promoting the availability of all three medications. 1 We did a whole round of trainings for OTP 2 staff (opioid-treatment program staff) in how to use 3 VIVITROL when it's clinically appropriate. 4 I'd also point out, that unless you get a 5 discount, the cost of the injections is about 6 $1200 a month. 7 SENATOR BOYLE: Right, right. 8 HENRY BARTLETT: So it's an expensive 9 alternative, but, you know, we're in favor of as 10 many tools as possible in the tool kit. 11 SENATOR BOYLE: Thank you. 12 DR. BRADFORD GOFF: I think one more thing 13 that's worth mentioning is, buprenorphine has been 14 out for a while. It's a good drug, an easy drug to 15 administer; and, yet, of all the drugs that we have, 16 it's got very strange requirements as far as 17 physicians to be authorized to prescribe it, and it 18 has the DEA showing up at your office every once in 19 a while, to check and see if you're keeping a log of 20 the prescriptions. 21 And we don't do this for any other 22 prescribed -- any other controlled substances, so 23 it's quite strange. 24 But what it does is, it is quite intimidating 25 to physicians, especially non-addiction-trained or 1 non-psychiatric physicians, to take this on, which 2 is really the initial intent. 3 And until that changes, I think we're going 4 to continue to see an underutilization of this drug. 5 So anybody who can get the word out anywhere, 6 just talking to Andrew about this, and that there is 7 some promise of some change, is going to be very, 8 very helpful. 9 There's just no reason for any restrictions. 10 And, certainly, physicians need to be trained 11 better in the prescribing of all controlled 12 substances, all narcotics. They need CME training. 13 And I would advocate for that thing, at least 14 one hour mandatory, to get relicensed in the state 15 of New York, about buprenorphine and prescription 16 narcotics. 17 But, I think we'll see more people interested 18 if we just make it a little bit easier to have it 19 accessible, because it's so easy to use. The 20 patients like it, they come back for it. They come 21 back 30 days, and it keeps them off heroin. 22 SENATOR BOYLE: Right. Okay. 23 Yeah, well, one of the things we talked 24 about, Suboxone, that we got testimony from a doctor 25 upstate, the only one in his area that -- and it's a 1 federally regulated, obviously, drug, so it is a 2 certain State issue here, but we can try and lobby 3 our federal colleagues. 4 But he said he's the only doctor that does 5 Suboxone. That the auditor came in, and the first 6 he did was read him his Miranda rights, to say, 7 "You have the right to remain silent." 8 And he wasn't being accused of anything. It 9 was just a normal -- this was the interview, which 10 gave him a bad feeling about even doing it. 11 And that's -- a lot of physicians are going 12 to feel that way. They don't want to be put under a 13 microscope like this. They want to help people, 14 obviously, with addiction. 15 Not the best system, and something that we 16 are going to advocate to change, I believe. 17 Senators? 18 SENATOR NOZZOLIO: Dr. Kunins, I believe it's 19 your testimony, the written submission, that said 20 that there were, to date, over 500 overdose 21 reversals reported in New York City. And you 22 believe that statistic may even be underreported in 23 terms of its quantity. 24 I'm concerned, in the more rural areas of our 25 state, and including our small cities, where 1 hospitals aren't accessible as they are in the major 2 cities. 3 What availability do we have, or should we 4 establish, for the reversal drug of most 5 effectiveness, and how we deploy that? 6 You have a myriad of sheriffs, officers, 7 State Police, local police departments. It's not 8 one department like there is in New York City, 9 primarily. 10 The State Police has just yesterday announced 11 how the Division of Criminal Justice Services and 12 the Office of Alcoholism and Prevention in our state 13 is providing kits to State Police officers. 14 The question is: How much broader can we 15 distribute this with a degree of certainty? 16 And what type of distribution would you think 17 would make sense? 18 DR. HILLARY KUNINS: Thank you for the 19 question. 20 So just to give you a sense of what we've 21 been doing in New York City since late 2008: 22 As you know, the New York -- New York State 23 has an overdose -- Opioid-Overdose Prevention Law 24 passed in 2006, which allowed for the training of 25 laypeople to recognize overdose and administer 1 naloxone, the medicine you're talking about. 2 In New York City, starting in late 2008, we 3 began to fund and distribute intranasal form of the 4 medicine, which is, I believe, what's being used 5 with law enforcement, to train community members, 6 either who themselves were drug users, and, 7 therefore, at higher risk for either observing or 8 experiencing an overdose; and, to their social 9 networks, to their friends and family. 10 And we have -- in that 500, at a minimum, is 11 really from that -- by and large, that work since 12 2009, distributing through community-member work. 13 We believe that distributing through 14 community networks provides, widely, an incredible 15 opportunity to prevent overdose fatalities; that is, 16 to intervene by someone who is close to the person 17 or who is a first responder. 18 And we think that that gives, obviously, the 19 person who may be experiencing an overdose another 20 chance of reducing their risk; getting healthy in 21 the future. 22 I don't -- we don't see much downside to the 23 distribution. 24 It sounds like that's what your question was 25 based on. 1 It's a safe medicine. It has some mild 2 adverse effects that are temporary, not 3 longstanding. 4 From the -- 5 SENATOR NOZZOLIO: What does it -- pardon me. 6 What does -- 7 DR. HILLARY KUNINS: People wake up in a -- 8 can wake up in a start, and can feel uncomfortable 9 in the moment, but it passes really quickly. 10 SENATOR NOZZOLIO: Is there any special 11 expertise necessary to administer? 12 DR. HILLARY KUNINS: So we liken it to other 13 first-aid strategies, EpiPens, and so forth, that -- 14 think about defibrillators that are widely available 15 in airports, and so forth. 16 So it is at that level of administration: 17 easy to recognize, easy to administer. 18 If you don't have an opioid in your body, it 19 doesn't have any ill effects. So if you get it 20 wrong, in other words, it won't cause harm. 21 We also -- another concern that gets raised, 22 is does it promote riskier drug use? 23 We have no evidence to suggest that that's 24 true. 25 SENATOR NOZZOLIO: That was one of my 1 questions. 2 DR. HILLARY KUNINS: And then, finally, you 3 referred to access to hospitals. 4 So, obviously, in New York City, with the 5 density of hospital and health-care facilities, 6 that's not been a huge issue for us; though, part of 7 the training is to encourage laypeople, and, 8 certainly, with first responders to call 911 to get 9 the person in for further monitoring and assessment. 10 SENATOR NOZZOLIO: Thank you. 11 SENATOR BOYLE: Doctor, if could I just 12 follow up with that: 13 One of the things -- I'm a former EMT. I've 14 seen Narcan used like a miracle drug, but those with 15 much more experience than I and others say that, 16 sometimes, the patient who gets Narcan will wake up 17 swinging and agitated. 18 I mean, is there a way to -- for a senior 19 citizen, for example, to administer the Narcan 20 nasally and just step away, or go into the next 21 room? Is that a strategy? 22 DR. HILLARY KUNINS: So, certainly, that's 23 part -- as part of the training is to make people 24 aware of that possibility. 25 In our experience, now monitoring this 1 program for -- since 2009, we've not heard of sort 2 of adverse effects from the people administering it 3 ever, people getting -- I don't know, getting hit, 4 falling down, or something like that. 5 So, that's not been part of our New York City 6 experience at all. 7 SENATOR BOYLE: Great. 8 SENATOR NOZZOLIO: And, excuse me, 9 Mr. Chairman. 10 Administering this drug does not, in your 11 opinion, require any additional expertise than any 12 normal EMT would have in terms of training, in any 13 event? Is that fair to say? 14 DR. HILLARY KUNINS: No. 15 And, again, I encourage you to think of it as 16 a first-aid procedure. Think about how widely we've 17 been able to train laypeople in a variety of 18 first-aid strategies: Splinting, CPR. Again, 19 defibrillation that's available widely. 20 I think it's really at that -- in that kind 21 of domain of procedures. 22 SENATOR NOZZOLIO: Certainly, it's a first 23 step in our -- one of our segments which is 24 treatment. 25 DR. HILLARY KUNINS: Yes. 1 SENATOR NOZZOLIO: It's -- we want to make 2 sure that the person survives this ordeal. 3 Doctor, from Phoenix House perspective, 4 prevention, particularly for this age group seeming 5 to fall into addiction with -- in very unchartered 6 ways, what would you prescribe we could do as a 7 state to focus on prevention measures? 8 DR. ANDREW KOLODNY: So I appreciate that 9 question. 10 All of you should have a graph. 11 And I think to understand really how to deal 12 with this mess, it's important to understand how we 13 got here. 14 And, this is the -- a CDC slide. 15 This graph is the CDC's chief speaking point 16 about the epidemic that we're dealing with 17 nationally, and I'll explain what we are looking at. 18 The green line represents opioid consumption 19 in the United States. 20 And what you see is that, beginning in the 21 late 1990s, prescribing of opioids began to take 22 off. 23 The red line represents overdose deaths from 24 painkillers, specifically. 25 And the blue line represents addiction to 1 opioids, represented by people coming in for 2 treatment. 3 What the CDC is saying is, that this epidemic 4 was really caused by the medical community; that as 5 doctors began to overprescribe these medications, 6 especially for conditions where they're probably not 7 safe or effective, like long-term chronic pain, like 8 low-back pain, that as the prescribing took off, 9 it's led to paralleled increases in addiction and 10 overdose deaths. 11 What the medical community and the dental 12 community has inadvertently done, in many cases, 13 we've gotten our own patients addicted, or, we've 14 wound up stocking our patients' medicine chests with 15 a hazard for their kids. 16 So, to bring this epidemic under control, we 17 need, obviously, to treat people who have this 18 disease, but we have to prevent people from getting 19 the disease in the first place. 20 And I think the most important way to prevent 21 people from getting this disease, and there are many 22 different things that need to be done, but the most 23 important thing is to get the medical community and 24 the dental community to prescribe more cautiously. 25 SENATOR NOZZOLIO: That gets to the supply. 1 How about the demand? 2 How can we engage in enhancing prevention at 3 the outset, by some type of encouraging certain 4 types of behavior? 5 And I think that's -- certainly, you've got 6 the medicine chest, anybody can open it. 7 DR. ANDREW KOLODNY: Yes. 8 SENATOR NOZZOLIO: You've got the pills in 9 there, anybody can take them. 10 But, how do you prevent them from taking them 11 in the first place? 12 DR. ANDREW KOLODNY: Well, I think the 13 message that the medical community and the dental 14 community needs to hear is very similar to the 15 message that the public needs to hear, which is that 16 these pills are, essentially, heroin pills. 17 If young people understood, when they're 18 experimenting with drugs, that there -- that 19 they're -- that this is not a soft drug; that this 20 is a hard drug that could kill them, that can alter 21 the rest of their life through addiction, if they 22 understood that, they might be less likely to 23 experiment with painkillers. 24 But, again, I think the real answer boils 25 down to not exposing such a large percentage of our 1 population to a highly addictive drug. And that's 2 where prescribers come into play. 3 SENATOR NOZZOLIO: That's an excellent point. 4 Thank you. 5 Doctor. 6 DR. BRADFORD GOFF: I want to add, too, that, 7 I-STOP, which I think, tremendous legislation, and 8 has had great effects on beginning to reverse 9 diversion, has had other ramifications. 10 At my hospital, I was -- became responsible 11 for really training physicians in I-STOP, and 12 getting up before hundreds of people in medical 13 staff meetings and beginning to talk to them. And 14 they were not happy at having to take this on at 15 all. 16 And most understood it, of course, to being, 17 It's something I have to do before I send the 18 patient out the door with the usual prescription of 19 a narcotic, or whatever I'm prescribing; rather than 20 thinking of it as something that I'm going to look 21 at when the patient comes in the door, or when 22 I accept the patient for the first time, or I may do 23 on all of my patients, because it, number one, tells 24 me about what medications they're using, what 25 they're prescribing, and compliance habits are, 1 where they go to their pharmacies, what doctors they 2 see. 3 Is that consistent with what they're telling 4 me? 5 So I've trained, certainly, my doctors that 6 I'm responsible for, to get this at the front end. 7 And the response is really very impressive. 8 People really think this is a good system. They've 9 learned a lot. 10 They actually talk to their patients. 11 And a lot of patients wander into this not 12 knowing that accumulation of these drugs that they 13 really don't understand, because doctors haven't 14 really educated them well about it, really do have 15 adverse effects and build up, and you get caught in 16 something you don't want to get caught in, or you 17 get sick, or you're at risk, or your children are at 18 risk. 19 Once they find that out, they make changes. 20 So doctors I think become more respectful 21 with a program like I-STOP. 22 The patients have become more respectful, in 23 understanding what the -- why it's important to pay 24 attention to narcotics, and why we need all of 25 these, not only for what goes on on the street. 1 And everybody favors that among patients I've 2 seen who are not addicts, is this is a good idea: 3 We need to protect people, but, also, I need to be 4 aware myself. 5 So it's -- I'm not sure people talk about 6 I-STOP in terms of a good learning and clinical 7 intervention, but that's what I've found. 8 SENATOR GOLDEN: Doctor, are you still seeing 9 at the -- in Lutheran Medical, is Oxycontin and -- 10 are the pill forms of the opiates still the largest 11 number of visits -- 12 DR. BRADFORD GOFF: It's the -- partly, it's 13 the demographic. I think -- and, partly, where you 14 are in Brooklyn. 15 Of course, there's Sunset Park, Bay Ridge, 16 and so forth, and we know lots of deaths are 17 occurring in that whole area, and have been 18 occurring. There's always been a lot of heroin in 19 our parts of Brooklyn. 20 And the pills have been there, too. They've 21 been prescribed, not so much in our area of 22 Brooklyn, but Staten Island is just across the 23 bridge, and that's like an epicenter of prescribing 24 of narcotics. 25 And then, in Suffolk County, not too far 1 away, as well, in terms of the map. 2 So it gets in and makes its way in. 3 I think there's tending to be less, but it's 4 hard to tell. It's hard to yet tell whether it's 5 affecting heroin use. It's still there. 6 I get very concerned, as everybody else 7 would, with new medications like Zohydro, which is, 8 you know, what are they thinking to approve yet 9 another drug with no deterrents in it? 10 We're putting another Oxycontin out on the 11 streets, potentially. We shouldn't be doing things 12 like that. 13 So, as long as it's available, it's going to 14 be there. 15 And just learning from the gentleman that 16 will speaking about the effectiveness of diversion 17 tactics, and are at work in the state of New York, 18 and how there's still huge diversion of substances 19 going on. It's still there, it's still dangerous, 20 it's still the whole -- 21 SENATOR GOLDEN: What's your capacity right 22 now? 23 Your capacity, obviously, has increased over 24 the last few years now, especially in the last 25 two years. 1 What's your capacity today? 2 And what do you see happening -- 3 DR. BRADFORD GOFF: I think our ER is just 4 like the statistics. I mean, we've seen that, you 5 know, threefold increase in people coming in with 6 heroin overdoses over the last 10 years, and it 7 still continues. 8 I mean, so the visits continue. That's not 9 counting the people who die, of course. 10 And we know, from going to town-hall 11 meetings, and so forth, in Brooklyn, more and more 12 kids, more and more young adults. 13 In terms of availability of naloxone, I think 14 it's great to put it in the hands of the first 15 responders who are policemen and EMTs, but I think 16 the real first responders are family members and 17 friends, and even, sometimes, the victims 18 themselves. 19 And I hope someday we're even talking about 20 having, like an EpiPen for allergic reactions, that 21 parents of adolescents and young adults actually 22 have a naloxone pen in their home as a part of their 23 emergency preparedness kit, because disasters do 24 happen. 25 And in this day and age, maybe everybody 1 should have them, because you just don't know what 2 your kid may get into. 3 SENATOR GOLDEN: Thank the young people that 4 are in the crowd. 5 There were a number of young people in and 6 out of this room, and I want to thank them for 7 coming to this today. 8 Last question for me on this issue: 9 Marijuana. 10 Does anybody believe that marijuana is not a 11 gateway drug, amongst our professionals here? 12 DR. ANDREW KOLODNY: I don't think anybody 13 knows whether or not it is a gateway drug. 14 We do -- you know, it's an interesting 15 question related to today's topic, because when we 16 look at the populations that are most affected by 17 the epidemic today, we're talking about people from 18 suburbs who are White and middle-class. 19 In areas, like Sunset Park, which were hit 20 with a heroin epidemic in the 1970s, or in 21 New York City's inner-city communities which are 22 mostly African-American or Latino, in many of those 23 communities, what we've seen since the late 1970s 24 has been a decline in heroin use, and since the 25 '90s, a decline in crack-cocaine use, but very heavy 1 marijuana use. 2 And when we look at the populations now that 3 are dying of heroin overdoses, it's mostly White 4 people. 5 So what we haven't seen, despite very heavy 6 marijuana use in some of those populations, we 7 really haven't seen heroin or crack coming back into 8 those communities, which would be evidence to 9 suggest that perhaps it's not a gateway drug. 10 It's a very complicated question. 11 There are very good reasons to be concerned 12 about marijuana, especially legalization, but 13 whether or not it's a gateway drug is -- I don't 14 think we know. 15 SENATOR NOZZOLIO: 20 years ago, would you 16 say that Oxycontin was a gateway drug? 17 DR. ANDREW KOLODNY: I wouldn't call 18 Oxycontin a gateway drug because Oxycontin, 19 oxycodone, is, basically, the same drug as heroin. 20 It's basically -- it's essentially the same. 21 SENATOR NOZZOLIO: I have a question that 22 I'd like to pursue with you, Doctor, regarding the 23 pharmaceutical companies' potential willingness to 24 engage in an education program. 25 Again, from your threshold statement, the 1 heroin addiction is a direct result of this use, 2 I know they're in a dilemma. 3 But I wonder what your experience has been 4 with the manufacturers of those products. 5 DR. ANDREW KOLODNY: So that's a terrific 6 question, and I appreciate it. 7 I'm going to refer to this graph again. 8 Now, suppose you're the manufacturer of a 9 product, where, as sales of your product are 10 increasing, you're making enormous profits. It's 11 associated with these horrible adverse outcomes, 12 like addiction and overdose deaths. You're not 13 going to be happy about that. Even if you don't 14 have a conscience, it's not good PR for your 15 company, but at the same time, you don't want to see 16 your sales go down. 17 What the pharmaceutical companies are saying 18 right now, in the context of an epidemic caused by 19 too much prescribing of opioids, what they're saying 20 is that: This green line can and should continue to 21 go up because millions of people have chronic pain. 22 But, if we teach doctors what they call "safe and 23 effective opioid prescribing for chronic pain," we 24 can make the red line and blue line go down. 25 And that's not really true. 1 I think, in many ways, the content of the 2 education, the dominant education for physicians 3 right now, they're being taught that if you monitor 4 your patient very closely -- if you check their 5 urine, if you check I-STOP -- all prudent things to 6 do if you have patients on these treatments. 7 But what they're saying is, by doing these 8 things, you can turn this into something that's safe 9 and effective, that turns out rosy in the end. 10 And it doesn't work. 11 For example, if you start your patient with 12 low-back pain on long-term opioids, and you're 13 checking -- so they say, Well, check I-STOP. 14 So you check I-STOP and you see, four months 15 into this, the young woman starts to visit multiple 16 doctors, what that information is telling you is 17 that the patient is now addicted. 18 The doctor can say, "Well, I guess I can't 19 prescribe for you anymore," but the patient is left 20 holding the bag. The patient now has that disease, 21 and if they can't get a doctor to prescribe 22 painkillers, they'll seek heroin. 23 So, the education for the medical community 24 should be, and it's the message the CDC is trying to 25 deliver, the message should be these are good 1 medicines for end-of-life care. They're good 2 medicines when you use them on a short-term basis 3 for severe acute pain; surgery, a severe accident. 4 But we should not be putting patients on long-term 5 opioids for common chronic problems. 6 And, unfortunately, the pharmaceutical 7 industry does not like that message. 8 SENATOR CARLUCCI: Can I follow up with that, 9 on a question? 10 When we talk about prescriptions, is there a 11 move, or is there something that we can do, to 12 really regulate that; that prescribers can only do 13 it in limited dosage, or, that refills have to be 14 done in person? 15 What would you say to that? 16 DR. ANDREW KOLODNY: That's a terrific 17 question. 18 And I think one of the reasons we have this 19 crisis today was really a failure of regulation; the 20 federal government's part of failure to regulate the 21 companies that were making these products. 22 Had they regulated those companies 23 appropriately, had they applied the Food, Drug, and 24 Cosmetic Act, and prevented them from promoting 25 these medicines for conditions where they're 1 probably not safe or effective, we might have 2 prevented this problem. 3 On the state level, and this is happening 4 across the country, the state agencies that are 5 supposed to protect the public from doctors who are 6 prescribing recklessly are state medical boards. 7 And across the country they have really failed to do 8 that. 9 What should be happening, is that state 10 medical boards should be proactively using the same 11 data that's in I-STOP to notify doctors who are 12 prescribing these medications in high doses, or in 13 combination with drugs like Xanax, that 14 "We're concerned about this. Don't do it." 15 And if they see that it continues, to, 16 potentially, investigate them, to have medical 17 boards possibly take licenses away from doctors 18 before they kill patients, or before we have to put 19 them in jail. 20 And we're not seeing that happen. 21 I think there is quite a bit that we could be 22 doing here. 23 And, you know, at the beginning 24 Chairman Boyle said that this would be an 25 opportunity to suggest potential legislation. 1 I think one thing we could be doing right 2 now, would be to say to doctors that have lots of 3 patients on long-term opioids for chronic pain, 4 perhaps doctors who have 10 or more patients on this 5 treatment, where the data would tell you if you've 6 got 10 patients on this treatment, that maybe 3 of 7 them are addicted, we could be mandating doctors who 8 have multiple patients on long-term opioids to be 9 trained in prescribing buprenorphine. 10 We would be expanding access to this 11 treatment exactly where we need it, where you've got 12 the patients who are addicted. 13 And what's nice about that, is when a doctor 14 finds out on I-STOP that the patient is doctor 15 shopping, instead of firing the patient and saying 16 "You're an addict, get out of my office," they would 17 have the ability to treat that condition. 18 I believe a bill like that may have been 19 introduced by Senator Maziarz last year. 20 I think MSSNY didn't like it because it 21 mandated doctors who have with multiple patients on 22 this treatment to do something. And MSSNY doesn't 23 like when you mandate doctors to do anything. 24 SENATOR CARLUCCI: Well, Doctor, what's 25 shocking to me, and I'm sure many of the members of 1 this panel, is we've traveled around the state and 2 we've heard from people that are suffering with 3 this. And we hear about, just recently, doctors 4 prescribing an initial dosage of 75 bills. 5 Why is that continuing to happen when we have 6 these highly educated professionals, you know, 7 having the same data we have? 8 What's the disconnect there? 9 DR. ANDREW KOLODNY: Yeah, the problem is 10 that the prescribers don't recognize that these are, 11 essentially, heroin pills. 12 If the dentist understood that a Vicodin was 13 a heroin pill, I don't think they'd give a teenager 14 40 pills after a wisdom-teeth procedure. They might 15 give them one or two. Or maybe they'd give them 16 Advil. 17 The prescribers are underestimating the risks 18 of these medications, in part, because they've been 19 badly misinformed. 20 The reason the prescribing took off, the 21 prescribing that caused this crisis, was because of 22 a campaign to encourage aggressive prescribing, and 23 that campaign had quite a bit of misinformation in 24 it. 25 SENATOR NOZZOLIO: And there has to be some 1 responsibility here on the patient, too. The 2 patient may not understand what they're getting. 3 I know that's a doctor's responsibility, but, 4 think of yourself in a doctor's office here. He 5 writes a scrip, she writes a scrip, and the patient 6 goes on their merry way, not understanding the 7 complexities of this medicine. 8 Not being educated by the doctor, I think 9 that's the threshold, but doctors have limitations, 10 too. 11 Educating patients may be another component 12 of this. 13 Any of your -- the panel's thoughts? 14 DR. HILLARY KUNINS: I agree. 15 I just want to also reiterate a few things 16 that Dr. Kolodny said. 17 I do think we need to raise awareness about 18 risks of -- 19 SENATOR NOZZOLIO: With patients -- 20 DR. HILLARY KUNINS: -- of prescription 21 opioids with patients. 22 As an example, in New York City, we ran a 23 PSA, highlighting risks to a mom who lives in 24 Staten Island, who perhaps we'll see tomorrow. 25 And that, again, following on the intense 1 marketing of these medicines as really being able to 2 treat much more than they are claimed to treat, and 3 underestimating the risks. 4 So, reeducating the public. 5 In addition, I want to just really reiterate 6 what Dr. Kolodny said, is it is easier to write a 7 prescription for Oxycontin right now than it is for 8 buprenorphine. 9 And that imbalance of regulation is perhaps 10 something that the state or federal government might 11 be able to address. 12 In New York City, we've issued guidelines 13 around what we call "judicious prescribing," to 14 promote the kind of practice patterns that 15 Dr. Kolodny is referring to. 16 For acute pain, 3-day supply of prescriptions 17 is often enough, so the 75 pills is really, 18 typically, not needed. 19 Reducing the -- or increasing awareness that 20 long-term use of chronic opioids typically does not 21 result in better function or in pain control, on 22 average. 23 And, finally, these medicines are excellent 24 for treatment of end-of-life pain. We do not want 25 to see that reduced or access to that very important 1 treatment. 2 But I think raising awareness of doctors, 3 other prescribers, who really, again, underestimate 4 the risks; believe that they can pick out the 5 patient for whom the opioid will be safe, is simply 6 not true. 7 We overestimate our effectiveness in that 8 area, and doctors need to be engaged. 9 And we in New York City have been engaging 10 prescribers. 11 And the State, we would welcome State 12 participation in that, as well. 13 SENATOR GOLDEN: When these kids are 14 taking -- the doctor gives the Vicodin or the 15 Oxycontin, the kids don't know they're taking 16 heroin. 17 DR. ANDREW KOLODNY: Correct. 18 SENATOR GOLDEN: All right, so we're talking 19 about doctor-patient education there. 20 We need to be able to educate the kids that 21 are in our schools. 22 You guys all remember D.A.R.E. 23 Did this work when we seen that here, when 24 those types of operations in our educational system, 25 when we went into the schools? 1 Did you see a drop-off in the -- or not? 2 You know, be honest with us, did you see a 3 drop-off in use of narcotics when you had these 4 programs in our schools? 5 DR. ANDREW KOLODNY: Well, I don't recall 6 D.A.R.E. focusing on painkillers. It may have 7 focused on heroin. 8 And what we're all recognizing is that, the 9 young people who are experimenting with painkillers 10 and ultimately winding up addicted, and then maybe 11 turning to heroin, when they're using those 12 painkillers, they didn't recognize that they were 13 using a drug similar to heroin. 14 It's -- there are, in terms of the evidence 15 that's out there supporting social-marketing 16 campaigns to prevent drug use, many of the campaigns 17 that have been tried over the years haven't worked 18 well. 19 For example, "Just Say No," which was 20 Nancy Reagan's campaign, where the focus there was 21 on modeling "Say No" behavior. 22 But there are effective social-marketing 23 campaigns that can prevent people from picking up a 24 drug in the first place. 25 It's very difficult, once they're already 1 using, to get them to stop through social marketing. 2 But, the effective campaigns are the ones 3 that dramatize the negative consequences of use. 4 For example, the ad that New York City ran, 5 I thought was a very good ad, which showed somebody 6 using painkillers and dying of an overdose. 7 SENATOR GOLDEN: What about the educational 8 system in our schools, you don't believe that we 9 should go into our schools at the early grades of 10 third -- three -- in the third grade, fifth grade -- 11 fourth grade, fifth grade, sixth grade, and be 12 teaching and laying this out? 13 DR. ANDREW KOLODNY: I think that would be a 14 very important thing to do. 15 SENATOR GOLDEN: So a D.A.R.E. program, 16 something similar to a program -- not D.A.R.E., but 17 something similar to a D.A.R.E. would work? 18 DR. HILLARY KUNINS: So my awareness of 19 the -- I just want to summarize a few points about 20 the science behind those programs. 21 The D.A.R.E. program has been studied, and 22 actually not shown to be terrifically effective, 23 unfortunately, in reducing drug-taking behavior. 24 Now, again, it did not focus on prescription 25 opioids. It predates that. 1 The science behind those programs are 2 typically best when the programs focus broadly on 3 social connectedness, family support, all the things 4 that we know work to protect young people from risk. 5 So those programs ought to be, in my view, 6 broad-based focus on integration into communities 7 and families, and around all kinds of risk-taking 8 behaviors. 9 So to -- it is important to raise awareness 10 about this specifically with school children, but, 11 there are educators and -- who are well-informed 12 about these strategies. And we should look to the 13 science. 14 Again, not the medical evidence, but the 15 educational evidence, to formulate those programs 16 thoughtfully. 17 SENATOR GOLDEN: What are our public schools 18 doing? 19 DR. HILLARY KUNINS: So I would defer to my 20 colleagues from the City DOE. 21 There are -- there is health education 22 happening in all the schools, and, there is a 23 standard curriculum. 24 SENATOR GOLDEN: Thank you. 25 SENATOR BOYLE: I think we're going to have 1 to wrap up this panel. 2 I appreciate your time very much. 3 Any final words or thoughts that you wanted 4 to say and didn't get a chance on our question? 5 DR. ANDREW KOLODNY: Just something to 6 encourage you to work on, as you're going around the 7 state. 8 And, I'd also like to just thank you very 9 much for trying to really understand this problem 10 and how to address it. 11 I think we have to recognize that the 12 populations that are most affected right now are 13 very different from the populations previously 14 affected by addiction. 15 The crack-cocaine epidemic of the '80s and 16 '90s disproportionally affected people who are low 17 income and minority, and had Medicaid. Similarly, 18 in the '70s. 19 The people affected most today are people who 20 are working-class and middle-class who have 21 commercial insurance. 22 And our whole system right now, our 23 addiction-treatment system, is very much focused on 24 serving Medicaid populations. 25 I think it's very important for you to sit 1 down with some of the commercial insurers, to make 2 sure that we're funding the right treatment 3 programs; that we've got the right models out there. 4 SENATOR BOYLE: We are doing that. 5 And I can tell you that insurance is going to 6 be a big part of this legislative package, and the 7 question of what medically necessity -- the 8 "medical necessity" is. 9 We're dealing with, not only health-care 10 professionals, but also insurers, as well, to see if 11 we can get an agreement by most. 12 And I will point out, I'm sorry, we've been 13 joined, obviously, by Senator Carlucci, who, along 14 with Senator Nozzolio, is the Vice Chair of the 15 Task Force. 16 Thank you, gentlemen. 17 That is a big issue. 18 Thank you very much. 19 HENRY BARTLETT: I just wanted to point out, 20 briefly, talking about "medical necessity," that, 21 frequently, where a patient winds up in treatment 22 depends on what door they happen to enter. 23 And, you know, we've heard people say for 24 years that there's no wrong door to treatment. 25 I think there's a lot wrong doors to 1 treatment, and some people end up in a level of care 2 that's inappropriate for them. 3 OASAS is working now on a patient-placement 4 instrument and protocol called "Locator 3." 5 And, you know, Locator 3 is going to be used 6 as part of Medicaid managed care. 7 The managed-care companies are going to be 8 required to use this to determine the appropriate 9 level of care, and to use it for utilization review. 10 Well, I say, if it's good enough for the 11 poorest people among us on Medicaid, it ought to be 12 good enough for those of us who have health 13 insurance. 14 And it would be good for the health-insurance 15 companies to use some version of Locator 3, or a 16 similar evidence-based instrument, that places 17 patients at the appropriate level of care to begin 18 with, so we don't wind up with opiate-addicted 19 individuals being seen in a level of care where they 20 have a less-than-optimal chance of achieving 21 recovery. 22 SENATOR BOYLE: Wonderful. 23 Any questions from the audience for our 24 panel? 25 I didn't see any written. 1 Oh, yes. 2 LIZ BARARDI [ph.]: Hi. My name is 3 Liz Barardi [ph.], and I'm here both representing my 4 son Carter, who you described completely. He passed 5 away January 12th of an overdose of heroin. 6 He had back surgery and was prescribed 7 fentanyl patch, after I told the doctor he had a 8 predisposition to addiction. 9 And it was two months before I understood 10 what was in that patch. 11 And, he was denied twice by MVP, Value 12 Options, inpatient treatment that three Columbia 13 doctors insisted he needed. 14 I got him that help, but, he ultimately died 15 three days into a sober home. 16 And I'd like to ask, I know it's an extension 17 of what you're talking about, but, it is an industry 18 that is out of control. 19 There's no oversight. 20 It's a step down for many people. 21 And it's actually, for many people, the only 22 place they can go to get away from their triggers, 23 and to have their addiction addressed on an 24 outpatient level. 25 And I'm just wondering, is anybody -- it's a 1 lifelong disease. 2 Is anybody considering regulations of sober 3 and recovery homes? Standards that people can rely 4 on in a database? 5 SENATOR BOYLE: Yes. We actually just passed 6 legislation like that in the Senate -- on the Senate 7 committee, recently, on regulation of sober homes. 8 It has been a longtime problem. 9 I know Senator Zeldin from Long Island has a 10 bill on that, and it's something that we can -- we 11 should try and address. 12 The problem as, as I'm sure you've heard, the 13 state agencies are pointing at the town, who's going 14 to regulate it. 15 No, it has no treatment per se in some of 16 these sober homes. 17 What I experienced in the district 18 I represent, is we had people buying houses, taking 19 in 30, 35 people with addiction problems, taking 20 their social-services money and paying off the 21 mortgage in two or three years, and then selling the 22 house and kicking everyone out. 23 They ran it just to make the money. They 24 were not there to help the people. 25 LIZ BARARDI [ph.]: The stories I've heard, 1 now that we've started safe sober living, from 2 across this country, but, I'll talk about New York 3 today: 4 One mother, they wouldn't take her son out of 5 detox because he was on Suboxone. They gave her a 6 list of other homes. And, the manager was drunk 7 when she arrived to visit it. 8 A young woman told me that the manager was 9 sexually harassing her. 10 My son's case, the manager had no car. He 11 used my son as his taxi driver, and to visit his 12 friends, and so forth. 13 And the -- I'm not sure if he's a co-owner or 14 he's the head of it, I found out was arrested in 15 2009 for selling-- while on probation for another 16 crime, for selling heroin, Suboxone, and other 17 opiates from his own driveway. 18 And while still on probation, in 2011, this 19 man was managing sober homes. 20 I mean, we have a problem. 21 SENATOR BOYLE: No question. 22 Well, we're very sorry for your loss. 23 Thank you for coming today. 24 LIZ BARARDI [ph.]: Well, yes, but, thank 25 you. 1 And I hope that, really, all these agencies 2 can come together. 3 And you are an amazing panel. 4 So, I'm grateful to be here today and hear 5 you. 6 SENATOR BOYLE: Thank you. 7 In the back? 8 MATT CURTIS: I'm Matt Curtis. I'm the 9 policy director at Vocal New York. We're a 10 grassroots advocacy group that does work on behalf 11 of people affected by drug use, HIV, and massive 12 incarceration. 13 First, a quick "thank you" to all the 14 Senators here today, who all of you voted in favor 15 of a bill that, hopefully, will become law very 16 soon, that Senator Hannon sponsored, to allow much 17 greater community access to naloxone. 18 I think it's through standing-order 19 prescribing. I think it's a pathway that we've seen 20 work in other states, that will be hugely beneficial 21 for the Phoenix Houses of the world, and other 22 things like that, making this important medication 23 more available. 24 Now a question, real quick: 25 One thing that hasn't been discussed here, 1 but I think really needs to be considered as part of 2 the public-health response to this, is syringe 3 access. 4 And, you know, we've had 20-plus years of 5 legal syringe access in New York State. We allow 6 sales through pharmacies. 7 And, you know, what we've seen is, not only 8 has that been incredibly effective at reducing 9 HIV transmission, reducing hep C transmission, it's 10 been a pathway for people to get into drug 11 treatment, into primary medical care, into other 12 kinds of things they need. And, has reached people 13 that wouldn't otherwise get access to those 14 services. 15 So, you know, it's become part of the 16 mainstream continuum of care when you're dealing 17 with opioid or other drug dependency. 18 So the problem is, we're now, with this new 19 rise in heroin use around the state, we're starting 20 to see, for example, through hepatitis C incident 21 surveillance, new pockets of infections among people 22 around the state. 23 And, we've got major gaps in access in parts 24 of Brooklyn, in Queens, in the city, and, certainly, 25 in Long Island and most of upstate, where there are 1 very few providers. 2 So I just kind of want to see if the panel or 3 anyone here has any thoughts about including that in 4 the, kind of, package of things that this Task Force 5 will come up with in the future? 6 DR. HILLARY KUNINS: Thanks, Matt. 7 So that -- I would like to just state our 8 City support, also, for the need for syringe access 9 as part of the continuum of care. 10 As you know, we at the City have oversight, 11 and fund, participate in the funding, of the syringe 12 access programs in New York City. 13 And, that is an area that is very important 14 in engaging folks who may not come into other kinds 15 of care. 16 The syringe-access programs do a lot of 17 community outreach, and are real experts in helping 18 people seek whatever services they are ready for at 19 the time: distributing naloxone, encouraging people 20 to get tested for hepatitis C, engage in other 21 risk-reduction behaviors. 22 SENATOR BOYLE: Needle exchange: yes? no? 23 DR. ANDREW KOLODNY: Yes, but I will say the 24 equation was easier when we had an HIV epidemic and 25 when the heroin wasn't as good; and, so, just about 1 everybody was -- most people were injection-users, 2 and we realized that giving out clean needles wasn't 3 going to turn people into heroin addicts. 4 It's more -- it is a little more complicated 5 today. 6 When the majority of people are beginning 7 this addiction with pills, crushing pills, and when 8 they're snorting heroin, there is a fair question 9 about whether easier access to needles could 10 encourage a transition from intranasal use to 11 injection use. 12 I do however think, overall, they're a very 13 good thing, and they're an opportunity to engage 14 with users, and to test them for hepatitis C. 15 I don't know that we've got evidence -- I 16 would ask Matt -- that syringe exchange is working 17 all that well on reducing hepatitis C. 18 It's worked very well with reducing 19 HIV infections, but the virus is different. It's 20 much easier to get hep C. Even if you're not 21 sharing needles, you're just sharing works. 22 SENATOR BOYLE: Just a quick question before 23 we -- I think we have a debate here: 24 But, is there any evidence of -- are you more 25 likely to overdose with a needle versus snorting it? 1 DR. ANDREW KOLODNY: Yes. 2 SENATOR BOYLE: You are? 3 DR. ANDREW KOLODNY: You are. 4 SENATOR BOYLE: Okay. 5 DR. HILLARY KUNINS: So just -- I think 6 Andrew raises some excellent points. 7 One thing I just want to add, so as to not 8 leave you with this place, is: 9 My clinical experience from the '90s, in 10 The Bronx, is that many, many people came into 11 methadone treatment having never injected. 12 And this was actually, I think, in many ways, 13 a great success story of the syringe-exchange 14 programs and harm reduction, generally; which is, 15 they were the key awareness-raisers about risks of 16 injection. 17 And that was a great success story, that not 18 more of my patients had HIV, and had, in fact, never 19 injected. 20 And we, obviously, should take from those 21 lesson, aggressively, as we're encountering this new 22 epidemic. 23 SENATOR BOYLE: Thank you. 24 DR. HILLARY KUNINS: And we need to work on 25 hep C education, and thinking about risk reduction. 1 Matt may have more. 2 SENATOR BOYLE: Thank you very much. 3 One last question for the panel, please? 4 The gentleman in the back. 5 JEREMY THOATE [ph.]: Hi. My name is 6 Jeremy Thoate [ph.] -- sorry. 7 My name is Jeremy Thoate. I'm actually an 8 educator from Long Island, from suburbia. 9 And just a couple of points I think you 10 should hear. 11 Number one: Kids in suburbia, and 12 everywhere, they know that drugs work; they work for 13 the purpose that they take them. 14 And more and more kids in suburbia, I can 15 say, are taking them to dull the pain; whether it's 16 the stress they have in their lives, whether it's 17 the issues with family, whether it's, you know, all 18 different things that are going on in society. 19 So -- so, uh, you know, those things are very 20 important. 21 So to piggyback on the point before: More 22 needs to be done in the educational system. Nothing 23 even close to enough is being done. 24 And the D.A.R.E. programs are not being -- 25 have not, and are not, effective. 1 And would I just urge this panel to consider 2 putting more money into community coalitions that 3 are popping up all throughout the state. 4 They are -- they give us the ability, 5 locally, to work together in our communities, with 6 the specific community issues that are going on in 7 each specific community. 8 And that may be a very good way to get the 9 attention of that community. 10 [Microphone not working.] Parents aren't 11 educated, and they don't have the skills anymore to 12 deal with this. 13 SENATOR BOYLE: Thank you very much. 14 And I do believe that our Task Force 15 recommendations will be more of a holistic approach 16 in that way. 17 Panel, thank you very much. We truly 18 appreciate you taking your time. 19 And the next panel will be regarding 20 law-enforcement issues and community involvement: 21 Bill McGoldrick; 22 Linda Sarsour; 23 Rabbi Feuerman; 24 A representative of the District Attorney's 25 Office here in New York City, and an undercover 1 investigator. 2 [Pause in the proceeding.] 3 [The proceeding resumed, as follows:] 4 SENATOR GOLDEN: We're going to start. 5 Again, I'm going to point -- I'm going -- a 6 lot of young people in the room, again, I want to 7 point out. Thank you very much for being here and 8 being part of this. 9 I just want to ask, and don't be embarrassed 10 by it, but -- because a lot of people -- 11 professionals don't -- aren't aware of it: 12 Anybody here recognize that Vicodin was 13 heroin? 14 Anybody here did not recognize Vicodin was 15 heroin when they were growing up? 16 Right? 17 How many? Be honest, be honest. Come on, 18 let's go. 19 Right? 20 So when did you -- well, we're going to ask 21 some questions later. 22 When did you figure out Vicodin was heroin? 23 Okay? 24 Linda, I'd like to, real quick, what's going 25 on in your community? 1 And if you can, please, just briefly tell me 2 what happened last week. 3 LINDA SARSOUR: So, thank you, my 4 State Senator, Marty Golden, for having me here. 5 So last -- well, up -- starting, probably, 6 for the past, about, 15 months, we've already had 7 about 9 young men in our community, between 8 ages 17 and 23, up to the last one last week, a 9 young man who died of overdose. All these young men 10 died from overdose. 11 About three months ago, we had two young men, 12 one passed away. 13 One was at Lutheran for quite a while, 14 originally from Morocco. He's out now, and 15 potentially -- trying to help groom, potentially, 16 having him be some sort of spokesperson as someone 17 who, pretty much, went to death, and back. 18 And we support this initiative and this 19 Task Force, and the impact that it has, really, on 20 community, not just on the people who are kind of on 21 the path to addiction or already there. 22 And what we support, also, is a three-pronged 23 approach, which includes the enforcement piece, 24 includes the educational piece, and it also includes 25 an alternative -- alternative programs and 1 opportunities. 2 What we hope to see, also, is that, you know, 3 in a place like Bay Ridge, and with this particular 4 population, we want to see, you know, multicultural 5 and bilingual assistance. And I'm sure that's 6 something that would be helpful to other 7 communities, as well, especially looking at the new 8 populations of folks that are being affected -- 9 SENATOR GOLDEN: Is this community the 10 Arab-American community? 11 LINDA SARSOUR: Yes. 12 SENATOR GOLDEN: Are very new in the past 13 year or so, you'd say that -- 14 LINDA SARSOUR: I would say two years now -- 15 SENATOR GOLDEN: Two years. 16 LINDA SARSOUR: -- that we've been at least 17 hearing about it. 18 And I think the issue around it is that, you 19 know, these are -- like you said before, and others 20 on the panel have said, this is not about, you know, 21 these, like, low-income, you know, kids from the 22 streets. These are from good families. You know, 23 hard-working families. And their parents have no 24 idea. They don't have bad parents. Their parents 25 don't know what the signs are, to understand -- 1 SENATOR GOLDEN: I'm going to go to the Rabbi 2 now. 3 Rabbi, are you similar? 4 Up in your communities and around the course 5 of the city, what are you seeing, Rabbi? 6 RABBI SIMCHA FEUERMAN: I think that we're 7 seeing plenty of prevalence. 8 We have, at OHEL Children's Home and Family 9 Services, of which I'm director of operations, we 10 receive foster-care placement from mothers that test 11 positive, you know, at birth from drug abuse. 12 At our outpatient centers, we have 13 individuals coming in for treatment. 14 I think that there are two points, I would 15 say, that are important: 16 I think, one, is I actually am also president 17 of an organization, Orthodox Mental-Health 18 Professionals. And I sent out an e-mail to the 19 listserv, asking for people's experience, and 20 polling them. 21 And one of the common things that we found 22 is, I think that abuse starts oftentimes in youth, 23 through experimentation, through very innocent 24 experimentation, because these are not found on 25 seedy street corners. These are found in the family 1 medicine chest. 2 So, clearly, early intervention, and 3 culturally-sensitive intervention, is extremely 4 important. 5 You know, in a parallel fashion, our 6 organization has done a lot of work in the last 7 10 years in terms of sexual abuse in the Orthodox 8 community. 9 And it's a very similar idea, that if you 10 want to help educate a community, an insular 11 community, you really need to understand their 12 underlying beliefs, their assumptions, how they see 13 themselves, and talk to them in a way that they'll 14 get the message; because, otherwise, you know, you 15 provide general education, but they don't think it 16 applies to them, or in some way, it doesn't apply to 17 them, the way it's being said. 18 So we do feel that early intervention and 19 education is very key, and that it should be 20 culturally sensitive. 21 SENATOR GOLDEN: Thank you very much. 22 I want to go over to Mr. McGoldrick. 23 The -- looking at what we're hearing between 24 the communities across Brooklyn and across the city 25 of New York, across the state of New York, 1 unfortunately, I get killed in my own community when 2 I say this, but it's true, Brooklyn is the capital 3 of Medicaid fraud, Medicare fraud, welfare fraud, 4 insurance -- car-insurance fraud. 5 And, we're moving into, number one, into two 6 other areas, and that's drug diversion, and it seems 7 to be heroin death and overdosing death. 8 Since we have concentrated areas, we know 9 that we are the capital of -- in the nation on a 10 number of these different issues. 11 Isn't there a way of coming in here and going 12 and looking at these points across the state, 13 putting our efforts into overlays -- technology 14 overlays, and understanding, not just where these 15 frauds are going, but, specifically in the drug 16 diversion, and specifically in the pain doctors, and 17 specifically in the doctors that are selling or are 18 moving these prescription, and the pharmacies that 19 are selling these? 20 Can you help me out on that one? 21 WILLIAM McGOLDRICK: Yes. 22 Thank you, Senator Boyle, and 23 Senators Nozzolio and Golden, for the opportunity to 24 speak to you today. 25 I'm an attorney with 32 years' experience in 1 New York State, but I'm also a retired detective 2 sergeant from the New York State Police. 3 For the last 20 years, I've been providing 4 Medicaid-fraud investigative and audit services to 5 the United States Health and Human Services, Center 6 for Medicaid and Medicare Services, New York State 7 Department of Social Services, New York State 8 Department of Health, New York State Department -- 9 or, New York State Office of Medicaid Inspector 10 General, and New York City HRA. 11 I'm accompanied here today by a confidential 12 consultant who is a retired NYPD narcotics 13 detective, who has worked with me throughout those 14 20 years in a very specific area. 15 We will refer to him as "The Detective." 16 He is an expert in drug diversion. Our 17 efforts have been focused in that area for the 18 state of New York. 19 The doctors who spoke this morning very well 20 established the proposition that pills and heroin 21 are hand-in-hand. 22 The supply of pills that comes into the 23 problem, that creates the problem, comes from the 24 medicine cabinet, which education and awareness is a 25 key. 1 The Detective, actually, this morning, over 2 coffee, said: Why don't the Senators talk about 3 having a piece of paper handed to people, with the 4 prescription, and say, "Don't keep this in your 5 medicine cabinet." 6 You know, think Eddie Haskell coming to visit 7 your house and asking to use the bathroom. When he 8 knows the pills are worth $40 apiece, what's he 9 going do? You know, he's going to visit everybody's 10 bathroom. 11 So as The Detective was saying, that's a very 12 quick fix, maybe. A little piece of paper, "Find a 13 secure place to put this." 14 That's number one. 15 Number two, for years, I've been trying to 16 get a straight answer on why we can't get a better 17 disposal method. 18 You know, in the old days they used to flush 19 it. It's dangerous stuff, but it's dangerous for 20 the environment. 21 Now people don't know where recovery centers 22 are. And people are not going to get on -- in their 23 car or in the subway and go to some disposal center 24 to get rid of the stuff. 25 So that's one supply: the medicine cabinet. 1 The AMA seems to think that 70 percent of the 2 illicit trade, the stuff that's on the street that's 3 being abused, is coming out of the medicine cabinet. 4 I don't believe that. 5 I believe that the majority of the illicit 6 painkiller pills that are causing the problem now 7 are coming out of drug diversion. Around I have a 8 crystal clear example of that, and it's in the form 9 of two federal cases. 10 Within 18 months, the United States 11 Attorney -- 12 SENATOR GOLDEN: If you can, when you're 13 doing that drug diversion, [unintelligible] you also 14 see how that leads into heroin? 15 WILLIAM McGOLDRICK: Right, and it's -- 16 they're hand-in-hand, obviously, from what the 17 doctor said. 18 The United States Attorney for the Southern 19 District of New York, Preet Bharara, and it's in the 20 package I gave you, announced two federal cases: one 21 in July of 2012, and one only two months ago. 22 And in both cases, the New York State 23 Medicaid program, inadvertently, and through fraud, 24 supplied $500 million worth of pills in each case. 25 So it's a billion dollars worth of 1 prescription painkiller pills that hit the street 2 because the New York State Medicaid system was being 3 defrauded. 4 Now, Social Services, Health Department, and 5 Medicaid Inspector General, all those years, there 6 have been successive contracts for Medicaid-fraud 7 investigators. 8 And, basically, they're retired members of 9 NYPD, multiethnic, and they get out and they 10 investigate the bad doctors. 11 And The Detective can tell you in a moment 12 that that's actually a very fruitful way to do it. 13 You get the word off the street. You know, 14 "Where do I go to get a prescription for Percocet?" 15 or something like that. 16 And it's a very direct way of dealing with 17 it. These are licensed professionals. 18 Unline heroin, which is coming across the 19 borders from many different countries, diversion of 20 prescription painkiller pills is -- involves -- it 21 involves professionals; there are pharmacies and 22 doctors. 23 It's a closed system, so you can take steps. 24 Every bad doctor that you kick out of the 25 system who's prescribing a million dollars worth of 1 this stuff a year is going to save -- it's going to 2 save lives, and save the state a million dollars. 3 SENATOR GOLDEN: The doctor pointed out 4 earlier this morning about the -- how they were -- 5 the diversion, especially in the -- let's say the 6 pain health centers. 7 Isn't there a way that we can do technology 8 overlays to find out which health centers are doing 9 the prescriptions, and what you can find out who 10 they addicted, and how they're going into heroin, 11 and where the heroin's coming in -- and how is the 12 heroin coming into Brooklyn? 13 WILLIAM McGOLDRICK: The New York State 14 Department of Health and the New York State Medicaid 15 Inspector General and the New York Attorney General 16 have access to the "MMIS" system, which is the 17 Medicaid Management Information System; and, the 18 Fraud and Abuse Management System that sits on top 19 of that. That's an IBM product. 20 They can search for every prescription and 21 patterns of prescriptions that were written. 22 You can look for the doctor in The Bronx 23 who's overprescribing and the stuff is all being 24 filled in Suffolk, which is an actual case. 25 They can look for a pediatrician who, maybe, 1 somebody stole his pad. All of a sudden, this 2 pediatrician is ordering oxycodone. 3 They've got all these filters 4 [unintelligible] that they can do, but, they need 5 the staff. 6 Up until September 30, 2011, there were 7 60 people working on this kind of stuff, on 8 outsourced contracts. 9 Those contracts ended on -- at the end of 10 September. Within 10 months, the federal 11 U.S. Attorney had its first $500-million case. 12 There was a limbo period where those 13 contracts didn't exist at all. And at the end of 14 that period, when they just started to come up 15 again, there was the other $500-million case. 16 Instead of 60 people, they've got 6. 17 So that's something that, you know, the 18 Senators can address, is going back to OMIG and find 19 out why that contract -- or those -- there's three 20 of them, why aren't they being used? 21 They're contracts for auditors, nurses, 22 computer people, and investigators. 23 I don't know if it's for lack of funding. 24 If it is for lack of funding, I can tell you 25 this: For 20 years, it's been calculated that it 1 returns at least 10-to-1 on the money. 2 So if it's five million dollars a year, 3 they're saving fifty. 4 The Detective, I wanted him to tell you about 5 something that's happening now, where you have these 6 illegal pharmacies popping up. 7 We just spoke about this, over coffee. 8 Drug diversion has so many ramifications, 9 that it needs a lot of studying. 10 In addition to putting the dangerous pills on 11 the street, part of the act of a criminal diversion 12 ring is to sell the medication back to a pharmacy, 13 who buys it at 10 cents on the dollar, and keeps 14 selling it. 15 Now, it doesn't have to be painkillers. It 16 could be HIV meds. 17 One of the most despicable things I've ever 18 heard was the New York District Attorney -- Attorney 19 General case. They arrested two pharmacists who 20 were buying the lifesaving AIDS/HIV meds from the 21 AIDS patients before they took it. 22 You know, there's a special place in hell for 23 people like that. 24 But, I'll ask The Detective now to explain 25 what's going on in certain areas of the city, and 1 it's kind of part and parcel with that, where 2 legitimate medications are coming out of the 3 pharmaceutical supply chain and then being 4 dangerously reintroduced. 5 "THE DETECTIVE": [Not on video; just audio.] 6 Good morning, Senators, and thank you for 7 having me here today. 8 SENATOR GOLDEN: The mic closer, please. 9 "THE DETECTIVE": [Not on video; just audio.] 10 This is an education thing that -- you know, 11 like the first committee said, people need to be 12 educated. 13 I can go out all day and get you whatever you 14 want, but if you don't educate the public, it's 15 going to keep happening. 16 And, there are pharmacies out there that are 17 buying prescriptions; they're buying your 18 medications back. 19 We have an area in The Bronx where bodegas 20 are getting into the game now. They're buying 21 medications from people and reselling it, or 22 shipping it out of the country. 23 It's a big epidemic. 24 You know, it needs to be -- we also need to 25 educate people on how to get rid of their 1 medications when they don't use it. 2 Not everybody's addicted. There are people 3 that are -- legitimately have their medications, but 4 they need to get rid of it, and there's no way of 5 getting rid of it. 6 SENATOR GOLDEN: Well, stay on that -- the 7 pharmacy; the bogus pharmacies. 8 I haven't -- I got to tell you, I'm getting 9 an education here myself here this morning. 10 Where are they? 11 And how do we know they're out there? 12 And how do we -- 13 "THE DETECTIVE": [Not on video; just audio.] 14 They're in all the boroughs. They're in all 15 our boroughs. 16 SENATOR GOLDEN: [Unintelligible] you're 17 talking about the people that are set up that are 18 inside the operation that are workers within the 19 operation? Or there's actually owners of the 20 pharmacies that are doing this? 21 "THE DETECTIVE": [Not on video; just audio.] 22 It's -- there are people that stand outside 23 the pharmacies that are steers. 24 SENATOR GOLDEN: Okay? 25 "THE DETECTIVE": [Not on video; just audio.] 1 Okay? 2 Sometimes they work with the pharmacies, 3 sometimes they don't work with the pharmacies. 4 Sometimes they're on their own. But sometimes they 5 work with the pharmacy. 6 We have doctors that take money to write you 7 a prescription for painkillers. 8 SENATOR GOLDEN: We've already said that. 9 "THE DETECTIVE": [Not on video; just audio.] 10 Right. 11 So, you know, it's an epidemic, and people 12 need to be educated on it; on how not to do that, 13 and how, you know, to prevent from getting caught up 14 in that. 15 SENATOR GOLDEN: Wouldn't the audits and the 16 overlays -- technology overlays, wouldn't that show 17 where the doctors are, again with the I-STOP, and 18 with the shopping of -- the doctor shopping, and 19 where there's more prescriptions coming out of a 20 certain borough or certain town, village, or city? 21 WILLIAM McGOLDRICK: Yes, the I-STOP will 22 prevent the overprescribing part of the illicit 23 supply. 24 What the I-STOP doesn't stop is this criminal 25 diversion. 1 And very quickly, the way it works is: 2 They borrow a Medicaid card from somebody. 3 You know, they may go to a men's shelter and give 4 the guy a $20 bill, and take his card. They get a 5 prescription that was stolen. 6 In your package, there's a picture of a stand 7 on the Grand Concourse, where all they did, all day 8 long, was buy stolen blank prescriptions, and then 9 they would sell them to the people on these teams. 10 And there's a picture in there, in that 11 package, of a scrip writer. All she does is sit 12 down with them and write the prescription for what 13 they want. That's her job, and she gets paid for 14 that. 15 And then there's a picture of the man who 16 escorts the people into the pharmacy, sees that they 17 get the prescriptions filled, puts them in his 18 shopping bag, and then they move down 19 Tremont Avenue, in that case, to the next pharmacy, 20 and the next pharmacy. 21 That criminal-diversion team is not going to 22 be stopped by I-STOP. It's not going to show up. 23 I-STOP is a very good program, a very 24 worthwhile program, but that's only one segment of 25 the illicit supply. 1 The three major areas, I believe, are: 2 Number 1: Criminal diversion of prescription 3 drugs. 4 And we happen to have a penal-law statute for 5 that, which is a very good statute. It has felony 6 levels, so it's serious. 7 I think the next is the -- the theft out of 8 the medicine cabinet. I think that's in the -- not 9 a volume, that's next. 10 And the last is the doctor shopping. 11 But I want The Detective to tell you about 12 the non-professional locations that are getting into 13 the pharmacy business now. 14 "THE DETECTIVE": [Not on video; only audio.] 15 We have a certain amount of bodegas in our 16 Bronx area that are also getting into it. They're 17 buying the prescription drugs from people, and 18 they're selling it or they're sending it away. 19 Sometimes a big part of that is Viagra, 20 LEVITRA, they're selling it out of their bodegas. 21 You know, you have eight bodegas in a 22 two-block area. You know, they're not all selling 23 groceries, you know? 24 And, you know, we don't know if they're 25 involved with pharmacies, but that's part of it. 1 WILLIAM McGOLDRICK: And the point to take 2 away from that, is there's so much money in this 3 stuff that it's a rapidly growing enterprise. 4 When it's $40 a pill, 180-count pill supply, 5 according to the federal case, by the time they get 6 finished selling it up the chain, that one 7 prescription I got filled could be worth anywhere 8 from 6,000 to 18,000 dollars. 9 And the way I described a criminal-diversion 10 team, you can see it's not hard to assemble, not 11 hard to get a Medicaid card, and, apparently, it's 12 not hard to get scrips, that are all part of the 13 package. 14 So, again, this is one particular area of -- 15 and I believe the major source of these pills that 16 the State can do something about. 17 There are contracts in place, and they just 18 have to put that back to the robust program that it 19 was. 20 SENATOR NOZZOLIO: Let me follow up with you, 21 Counselor and The Detective: 22 The -- you're assured that the statutes we 23 have is -- in terms of criminal deduct, are 24 sufficient? 25 WILLIAM McGOLDRICK: [Nods head.] 1 SENATOR NOZZOLIO: But they're certainly not 2 sufficient to deter this action? 3 WILLIAM McGOLDRICK: Criminal diversion of 4 prescription drugs goes up to a C felony. And 5 that's a pretty good -- that particular segment is 6 covered. 7 SENATOR NOZZOLIO: I'm Chairman of the Codes 8 Committee, and I'm very interested in your 9 assessment here of this. 10 Go ahead. 11 Go ahead. 12 No, you go. 13 SENATOR GOLDEN: How much drugs do you need 14 to get a C felony on a drug diversion? 15 How much -- what sale -- 16 WILLIAM McGOLDRICK: You know, the face value 17 would have to be about 5,000. It kind of goes up 18 like the old grand-larcenies statute. It's by the 19 value of the -- by the drugs. 20 SENATOR GOLDEN: And it goes for the seller? 21 WILLIAM McGOLDRICK: Yeah -- well, yes, yes. 22 SENATOR NOZZOLIO: Back to this inquiry 23 that -- it's -- these graphs that we were shown at 24 the last hearing, where you've got the enormous 25 growth of opiate sales, these are, I assume, the 1 doctor gave us opiate legitimate sales. 2 WILLIAM McGOLDRICK: No, that would be -- 3 SENATOR NOZZOLIO: What kind of graph would 4 we see if this was into the black market that you 5 suggest? 6 WILLIAM McGOLDRICK: Well, ironically, 7 because these -- take the billion dollars in sales 8 that were represented by the two federal cases, they 9 would show up on that chart, because they billed the 10 New York State Medicaid program $1 billion. 11 $1 billion represents 2 percent of the entire 12 state budget for Medicaid. That was over an 13 18-month period. 14 But, I mean -- and that's only two cases. 15 And one of the problems, and I've talked 16 to -- I had lunch with representatives from three of 17 the pharmaceutical manufacturers, two weeks ago, 18 looking to get funding to do something with NYSAC 19 (the New York State Association of Counties) which 20 has a very strong interest in this. 21 And they tell me that the problem is, that -- 22 they keep hitting the system by resale of these 23 drugs, and they're contaminating the drugs. And 24 they have counterfeit drugs coming from foreign 25 countries. 1 I mean, it's so bad, that they're getting 2 calls from Iowa, their security divisions, wanting 3 to know why the 40-milligram stuff is in a 4 30-milligram package. 5 There was a case on Tremont Avenue, reported 6 in "The Post," a 7-year-old boy, who's mother got a 7 prescription filled for Ritalin, accidentally got an 8 adult dose of methadone, and very nearly died. 9 That's a result of a pill-mill operation. 10 The stuff goes out legitimately, but it looks like a 11 legitimate sale. 12 And it is a legitimate sale, because it's 13 billed to the State, but now it comes back in. 14 We've got two pharmacists who work with us, 15 who are also retired NYPD. They've been in some of 16 these pharmacies, where, they were accompanied by 17 law enforcement because now they're -- the place is 18 going to get taken down. 19 And there were dozens and dozens of these 20 pill bottles that were brought back from the street, 21 purchased back, opened, waiting to be resorted. 22 And it's not just limited to painkiller 23 medications. It's limited to anything that's 24 worth -- well, not limited -- it's anything that's 25 worth money: asthma medications, heart medications. 1 Any of us could wind up going to get a 2 prescription filled for anything, and get something 3 that's been out on the street, in somebody's trunk, 4 mixed around, and put back in. 5 So drug criminal -- criminal diversion of 6 prescription drugs is an emerging problem. And 7 I think it's the leading problem of the pills, which 8 the doctors have told you now is the leading 9 problem -- leading cause, or the causal connection, 10 for the heroin. 11 And this is something the State can do 12 something about. They've done it before, and 13 they've done it very effectively. 14 I suspect, that with the Medicaid redesign 15 team and a couple of other things, this kind of fell 16 out. Somebody didn't realize that these 17 three contracts that sit in OMIG right now are being 18 underutilized, and it was an 18-month gap. 19 SENATOR NOZZOLIO: So, Counselor, thank you 20 for this assessment. 21 We're grappling with, as Chairman of the 22 Committee said, it's a three-prong approach. You've 23 got prevention, treatment, and then prosecution. 24 And we need to focus on the supply aspects 25 here, is what you're telling us; the illicit supply? 1 WILLIAM McGOLDRICK: Yes. 2 SENATOR NOZZOLIO: Not the legitimate supply. 3 I mean, I know the doctors are saying it's 4 just more -- that more pills in mommy and daddy's 5 medicine chest. 6 Well, it's not that, according to what you 7 just described. 8 WILLIAM McGOLDRICK: That's the number two 9 source, by volume. I wouldn't know what it is. 10 But the number one source right now is 11 criminal diversion of prescription medications. And 12 it's through -- they're -- New York State Medicaid 13 is getting hit very badly, but other 14 prescription-benefit programs are getting hurt, as 15 well. 16 SENATOR NOZZOLIO: Do you feel, in terms of 17 the elements of prosecution, that the statutes are 18 significant enough to allow and enable the 19 prosecution? 20 It's the investigation and apprehension is 21 where the challenge appears to be? 22 WILLIAM McGOLDRICK: Yes, it's a very 23 specific area; a very specific expertise to 24 investigate it. 25 The NYPD, we've worked with the various -- 1 all the DAs. All the DAs are aware of the 2 problem, but nobody has the resources. 3 And, imagine, I mean, we had a team that 4 included two NYPD members who were pharmacists. We 5 had nurses, doctors. And, again, somehow it fell 6 out. 7 And after it fell out, a billion dollars in 8 fraud occurred in just two case. 9 So, it's a pretty clear indicator of -- or an 10 argument to restore the efforts at OMIG. 11 SENATOR NOZZOLIO: Thank you. 12 SENATOR GOLDEN: On a Medicaid card, and I'm 13 just throwing this out there, it may not be possible 14 because of the large volume, and because of HIPAA, 15 the -- isn't there -- the State, that when they give 16 out the Medicaid cards, isn't there an unusual -- is 17 there any way of doing an unusual medical usage? 18 WILLIAM McGOLDRICK: The State sometimes 19 restricts recipients who are somehow -- who are 20 suspected of abusing the cards. 21 You know, you always have the fine line of 22 wanting people to get treatment. And then, of 23 course, you've always got the criminals who will 24 abuse, you know, any kind of a public-benefit 25 program. 1 One of the problems in the system, I'd have 2 to double-check, but for as long as I can remember, 3 a lost Medicaid card was replaced with another card 4 with the exact same number, which -- you know, so 5 you have dozens and dozens of cards with the same 6 numbers. 7 So you couldn't even track, you know, the 8 guy -- the guy could say, Well, it wasn't the card 9 that I have. 10 SENATOR GOLDEN: Could they track the same 11 person that lost the card four times in a year, or a 12 stolen card three times in a year? 13 WILLIAM McGOLDRICK: You know, again, they 14 can put some people, if their numbers, they can -- 15 you can tell, from the Fraud and Abuse Management 16 System that sits on MMIS, you can tell if certain 17 recipients' cards being abused. And that's for 18 New York. 19 If it was New York City, that would be 20 New York City HRA to call the person in and evaluate 21 what's going on. 22 They can be put on restriction, where they 23 have to go to a certain pharmacy and use certain 24 doctors. 25 But that's not the part of the problem. 1 The fact that you can rent a Medicaid card, 2 you know, from the indigent population, people who 3 are homeless, people who are out at a men's shelter, 4 that's hard to control. 5 But what you can control, because it's a 6 closed system of professionals, is the prescribing 7 doctors, the ordering providers, and the pharmacies, 8 things that are going wrong on the pharmacies. 9 And, you don't need -- I mean, it's great to 10 have it, and it's a great way to make the cases, but 11 you don't even need the sophisticated computer 12 models and all that. 13 The Detective will tell you, he can go out on 14 the street right now and get the name of six doctors 15 that are writing prescriptions. 16 It's not that much of an investigation to 17 build up a case to have the person -- the doctor 18 arrested and thrown out. 19 We had one pharmacy on Tremont Avenue, you 20 know, with video and audio, we had pictures of them, 21 buying Medicaid cards, and buying drugs back. 22 You know, they're not difficult cases to 23 make, but there's a lot of them to be made, and 24 there's not enough effort. There's, virtually, no 25 effort. 1 SENATOR GOLDEN: Is there any legislation 2 that you think we can pass at this -- this Senate 3 that you think could help? 4 And are the DAs -- are there enough 5 incentives for the DAs to take these cases, and to 6 help in the city and the state? 7 WILLIAM McGOLDRICK: Within the last year 8 I've met with each of the five DAs in 9 New York City, and I've met with DA Kathleen Rice in 10 Nassau, and Tom Spota out in Suffolk. They're all 11 dying to do something. They all said they would 12 love to have resources like this. 13 There's a proposal that we have, through the 14 Suffolk County DA, to put together teams for 15 Long Island, where they're losing 10 people every 16 month for 2 years. 17 The statistics that the doctor from the city 18 had, it was 58 people a year in New York City. 19 Two western counties, six a month in -- 20 Fifty-eight people a month in New York City, 21 I mean. Six in the western counties of the state. 22 So you're talking about 60, 70 people a 23 month. 24 It's time to get a couple of projects 25 together and get it studied, you know. There are 1 enough knowledgeable people around who can look at 2 the different aspects of the problem and come back 3 to you with suggestions for changes in the law. 4 SENATOR NOZZOLIO: Your testimony is very 5 helpful. 6 Elaborate a bit on the abrupt ending of those 7 contracts that were used to -- for the Medicaid 8 Inspector fraud -- Medicaid Inspector General in 9 terms of this ferreting out fraud. 10 You say the contracts abruptly ended; then 11 restored after two years of dormancy? 12 WILLIAM McGOLDRICK: Yes. 13 SENATOR NOZZOLIO: And then -- but you said 14 18 months, those investigations' contracts were 15 restored, but on a very minimal and ineffective 16 basis. 17 Could you elaborate on the "minimal" and 18 "ineffective" part? 19 WILLIAM McGOLDRICK: There are 6 -- instead 20 of a staff of 60, there are 6: 2 investigators each 21 from 3 companies, who have -- they're were 22 experienced companies. 23 And because of that 2-year gap with no 24 investigations, the Medicaid Inspector General's 25 Office had a 9,000-case backlog. 1 So, they're trying to prioritize. 2 And, their mission is not only prescription 3 drugs. It's all forms of Medicaid fraud: fraud in 4 transportation, ambulettes, labs...all manner of 5 fraud. 6 So that's one segment of it. 7 To my knowledge, of the six investigators 8 there right now, there may be one or two, and that's 9 it; so it's not a program anymore. 10 And it's -- of all the things they do, if you 11 want to put saving lives first, and reducing the 12 public-health crisis, that, to my mind, would be the 13 primary mission of that unit right now. 14 SENATOR NOZZOLIO: Although, certainly, the 15 costs -- or the benefits are also -- 16 WILLIAM McGOLDRICK: It always pays 10-to-1. 17 We had an HIV case, there's was a growth 18 hormone by the name -- called "Serostim" that was 19 being diverted and sold back to the pharmacies. And 20 it was a very, very expensive medication. 21 The State was spending $120 million a year 22 for, like, 10 years on that stuff. 23 When the investigation was concluded, it was 24 reduced to $80 million a year, and stayed at that 25 number for 10 years. 1 So to my mind, those contracts paid for 2 themselves forever, right then and there. 3 And that case was found by a New York City 4 detective, Patrick Kelly -- Lord have mercy on him, 5 he's no longer with us -- just by doing what cops 6 do. 7 He was out by a pharmacy, he saw something 8 suspicious. They found out the person had a forged 9 prescription. They brought it back. They got the 10 pharmacist and they said, "What is this is stuff?" 11 And the guy said: Well, that's a growth 12 hormone for AIDS patients. 13 "Why are they selling it?" 14 "Well, we didn't know." 15 Well, it just was because it was an expensive 16 medication. And by getting it for nothing with a 17 Medicaid card and then selling it back to the 18 pharmacy, they were able to bill the State $2,000 a 19 dose for every one of those that they did. 20 And nobody was treated with the drugs. It 21 was just a -- what -- you know, a classic pill-mill, 22 where they sold it over and over again. 23 So, if the outsourcing of Medicaid 24 investigations ever proved itself, it proved itself 25 on that one case. 1 The investigator himself brought the 2 information back to them from the street, and it 3 resulted in a $40-million-a-year savings for many 4 years. 5 So that's -- the diversion part is something 6 that the State can actually doing something about. 7 And I -- and this is -- the marijuana 8 discussion about gateway, whether it is or it isn't, 9 we now know that the pills are the superhighway. 10 There's -- it is the direct route. You know, the 11 direct cause. 12 SENATOR GOLDEN: Is there -- did -- anything 13 that popped up here today that you think that we can 14 do that -- to strengthen some of our laws here in 15 the state of New York that would help in preventing 16 more actual overdoses and sales and death? 17 LINDA SARSOUR: I definitely highly support 18 the crackdown on the pharmacies and the doctors, and 19 that partnership. That's absolutely happening. 20 I won't deny that that's happening. 21 But what I'm concerned about, is that the -- 22 people that are being impacted from our community 23 are not the kids that are going into a pharmacy with 24 the prescription. That's not what they're doing. 25 So I'm trying to figure out, to balance the 1 enforcement piece and the legislation around, you 2 know, monitoring the criminal diversion, which 3 I think -- the drug diversion, which I think is a 4 big issue. 5 And I know that, even stories that we've 6 heard, where there's been a couple of doctors. 7 I remember, two years ago, there was one in 8 Sunset Park that got caught on that. 9 But I just don't think that that's what's -- 10 this population of 17 to 23 are not the ones going 11 into the pharmacies. 12 So I'm trying to figure out -- 13 SENATOR GOLDEN: Going into their mother's 14 and father's medicine cabinets, though? Aren't 15 they -- don't these kittle [sic] parties -- 16 LINDA SARSOUR: They're doing -- they're 17 doing -- they're doing the skittle parties, but 18 they're also being sold those pills, buy the pills. 19 So there are some pills that they're buying for, 20 like, $5 a pill. 21 They're buying -- the kids are showing us, 22 you know, little Ziploc bags that they find with 23 their friends, or at their friends' houses. 24 So the kids are being really honest about the 25 stories, and how they're getting the pills, or how 1 they see their friends taking the pills. 2 But, you know, back to the original, like, 3 the legislation passes, and then there's always the 4 enforcement piece, and how long does that take? 5 But in the meantime, how many more kids in 6 our community have to die. Right? 7 So I'm trying to figure out, also, back to 8 the gentleman in the back who's an educator from 9 Long Island, the idea of, like -- like, for example, 10 in Bay Ridge, you know this, Senator, like, we don't 11 have youth programs. Like, we don't have a 12 PAL program in Bay Ridge. 13 Kids don't want to go to McKinley Junior 14 High School if they're 16, to play at a junior high 15 school. 16 Just figuring out, what other alternative 17 programs can we add to a larger holistic approach to 18 combating this issue? 19 Because we -- I just don't want to see 20 another mother in my office, crying, and telling me 21 she didn't know why her son didn't wake up in the 22 morning, because he came all home and -- that's how 23 all our kids are die. They're -- literally, they 24 just don't wake up. 25 That's most of the stories that we -- at 1 least seven of the eight kids, their mother went to 2 wake them up in the morning, to go to school, or to 3 go to work, and they just don't wake up. 4 And that's how their mother finds out that -- 5 later on, that it was an overdose. 6 They can't tell. They don't smell like 7 marijuana. They can't smell it on them. They can't 8 see it in their eyes. 9 They just don't how to -- so how do we get 10 all those points? 11 But we, as a community, wholeheartedly 12 support the enforcement mechanisms. 13 And any legislation, we would be willing to 14 stand to say that we would crackdown on doctors and 15 pharmacies in this work. 16 SENATOR CARLUCCI: Now, Linda, how about, in 17 cases, and I don't know if you've experienced this, 18 where it is obvious that someone has a problem, and 19 they maybe come to you or and look for help, have 20 you had experiences like that, with -- and finding 21 treatment for people that need it? 22 Because we've heard this problem, where it's 23 obvious someone has a problem. They've actually -- 24 they're actually looking for help, and not able to 25 get the treatment that they need. 1 And we've heard from private insurance, but 2 other issues, as well. 3 Do you have any experience with that? 4 LINDA SARSOUR: And my colleagues from 5 Lutheran, I used to work at Lutheran, actually, but, 6 you know, people think it's an easy process. They 7 think that they show up to a center, like a 8 Lutheran, and then they, like, take you, and then 9 it's all, like, great. 10 That's not how it is. 11 I mean, there's a waiting list. There's also 12 an age limit. 13 Like, Lutheran, for example, they don't do 14 adolescents. Like, that's not their focus area. 15 So, like, our population, talking about kids 16 between, you know, that are -- I mean, the ones that 17 have passed away are 17 to 23, but we know kids 18 using this as young as 13. 19 That's not a population that they focused on. 20 And the other issue around it is, like, you 21 want to be able to treat kids with the partnership 22 of the parents, right, but if you don't speak their 23 language, if you don't -- back to my brother over 24 here, like, this -- this -- the assumptions, that 25 when we're talking about drugs in the community, 1 this community doesn't think that it's them. 2 They don't -- for example, we don't even talk 3 about things like HIV in our community because, you 4 know us, we're, like, religious, and we're, you 5 know, monogamous. 6 Like, there's a lot of issues in our 7 community that require a level of sensitivity. 8 And I think the way you do that is, you go 9 through faith-based, community-based, organizations 10 who understand these. 11 So back to another proposal in the back, 12 around building coalitions of government, you know, 13 and this is something that's already happening in 14 our area, government, faith-based, community-based, 15 organizations, and others, you know, school system, 16 and creating this partnership. 17 Because, our community also is about, you 18 know, you don't want -- you don't want to think I'm 19 a bad parent because my kid's on drugs. 20 So, sometimes they wait too long. 21 Maybe they do know. They wait too long, 22 because they're worried that people are going to, 23 you know, talk about them, like, as if that's more 24 important than their child's life. 25 And I think we could be very helpful in being 1 the liaisons between the community and this issue, 2 but also having community members stand up and say: 3 If the pharmacies are getting this on the 4 streets of our community, then we're going to stand 5 against it. 6 If the doctors in our community are bringing 7 this to the streets, we're ready to stand against 8 them. 9 And, how do we create that holistic approach? 10 SENATOR BOYLE: One of the things, Linda, 11 that we've seen in other forums, and I'd like to get 12 out of this Task Force, is to change the stigma 13 involved. 14 You mentioned that, where, you know, if you 15 walked up to someone on the street and they said, 16 "Well, my son has cancer," you'd say, "Oh, my God, 17 what can we do to help?" 18 No one wants to mention that their child is 19 an addict, but it is a disease. 20 LINDA SARSOUR: Absolutely. 21 SENATOR BOYLE: And that's the bottom line. 22 And I think that that mindset is changing, 23 but we're not there yet. 24 LINDA SARSOUR: Absolutely. 25 SENATOR GOLDEN: The -- Rabbi, did you want 1 to add anything? 2 RABBI SIMCHA FEUERMAN: Well, first of all, 3 I absolutely concur with what Linda said. 4 And, also, just share with you that there's a 5 saying in the Talmud, that the mice does not -- the 6 mouse does not steal; rather, it is the hole that 7 steals. 8 And, you know, clearly, enforcement and 9 prevention are very, very important, no question 10 about it. 11 But I do think that when you're dealing with 12 families and young children, the education piece is 13 extremely important. 14 And, also, somehow, you have to find a way to 15 balance the fear that comes with enforcement, 16 versus, you want people to feel comfortable coming 17 forward. 18 And that's always a problem in any area of 19 mental health, because there's a criminal aspect to 20 many kinds of mental-health crimes and related 21 crimes. 22 So we need to find a way, and part of that is 23 with cultural sensitivity; however, just plain old 24 sensitivity, too, to find a way, where people feel 25 comfortable to get treatment, and to talk about 1 their problems; and, yet, that we have strong 2 enforcement, because you have to have both. 3 LINDA SARSOUR: Could I just ask a quick 4 question? 5 So, about two months ago, we actually brought 6 information to the 68th Precinct about a potential, 7 actually, apartment, where we think that someone -- 8 a mother and her sons, actually, were part of this, 9 like, selling. Right? 10 And when these kids told us this, and I asked 11 them, like, "How long do you think has been 12 happening?" they're, like, "Oh, this has been 13 happening a long time." 14 I'm, like, "Why didn't you ever tell anyone?" 15 And what they were worried about, and this 16 something we should think about, is they were 17 worried that if the, you know, NYPD undercovers are 18 going to be monitoring this, like, location, that, 19 would the kids who are coming out of that apartment 20 be then subject to the enforcement around that? 21 So, our kids are the ones with the 22 information. They know who's selling in our 23 community, but what they're worried about, is if 24 they come forth, or they find something on them, 25 that they're going to be part of that. 1 And I personally can't guarantee to them, 2 because I'm not in law enforcement, to say to them: 3 No, we want this information. You can be helpful to 4 us, and what that looks like. 5 Because I think that's the apprehension about 6 bringing information, is that these young kids who 7 are -- need just -- they just need -- they just need 8 a lot of things, but they don't need to be arrested 9 and put behind bars, because, it's not them; they're 10 not the problem. 11 So I'm wondering if that's something we're 12 thinking about when we're looking at the enforcement 13 piece, that these young kids are not caught up in 14 the system. 15 That's actually, kind of -- 16 SENATOR GOLDEN: In most cases, NYPD uses 17 undercovers, and they use those that are coming out 18 into a drug sale. Generally, they've watched and 19 observed this individual several times. 20 The unfortunate reality, we did do a -- an 21 event in Bay Ridge, and it takes, you know, a good 22 several months, by the time you do a number of buys, 23 to be able to get that -- to -- crime to stand in a 24 court. 25 So it takes a period of time to build a case. 1 So while that takes that time, that drugs are 2 still being sold at that location, so people get 3 upset because they think the police department's 4 doing nothing, or, you know, Why is this allowed to 5 go on and to exist? 6 What they're doing is, are building cases. 7 And you've seen a number of cases that have 8 been brought in the past several weeks, and how many 9 people have been arrested in that community because 10 of drugs. 11 So it does take time, but it does come -- the 12 community has to let us know. 13 The Muslim- and Arab-American community is 14 very insulated. And the same in the Jewish 15 communities. 16 So, they have to be the ones that have to 17 come forward, to let us know where the locations 18 are, and we have to be able to get in there and get 19 our undercovers in there, and make sure we make 20 those arrests. 21 And we will, and we have; and we will save 22 lives, as long as there is a communications. 23 Which I think is a good communication today 24 with NYPD. I think Lutheran is doing a good job, 25 but Lutheran's limited, and HIPAA, and they're 1 limited in why they can intervene in a family. 2 We've had families come into our office that 3 did not want the community to know that they had a 4 problem, and that we've taken those children. 5 There's going to be some providers coming up 6 here and they're going to speak very shortly. 7 And we've gotten them into treatment; and 8 that's what it's about, is getting the people into 9 treatment that are addicted. 10 What we want to do, though, we want to make 11 sure we get the drugs out of the community. 12 And if they're in the community, the 13 community knows; so they've got to let us know. 14 And I think we have a much better working 15 relationship today than we had in the past, when it 16 came to drugs. And we're going to continue to do 17 that. 18 Anything else you can add? 19 Anybody from the audience want to a question 20 here, that -- go ahead, sir. 21 LUKE PARDNER [ph.]: My name is 22 Luke Pardner [ph.]. I'm a member of Dynamic Youth, 23 and I've been a recovering drug addict for the past 24 year. 25 And my question is about education, because, 1 when I was a kid, I was educated as to what drugs 2 were. My cousin was a recovering heroin addict, and 3 I knew what it could do, but that didn't stop me 4 from doing any of the drugs. 5 I went to the D.A.R.E. program, I did all of 6 these things, knowing what could possibly happen, 7 and it didn't really stop me. 8 I feel that, when it comes to education, if 9 you put a group of children or young adults in with 10 an adult or an older figure or someone that holds, 11 you know, authority, it's less interesting, it holds 12 less value to you. 13 When I was younger, I would get more advice 14 and I would take it in better from people that were 15 my age. 16 I feel that when it comes to education, it 17 would be better if someone that was going through it 18 or has done it recently, and of the same age range, 19 could teach the younger children about what we've 20 gone through, how we've dealt with it, and what it 21 will cause. 22 I feel, like, if -- I wanted to know if 23 there's a way that that could happen? 24 SENATOR BOYLE: Yeah, we are certainly 25 advocating for peer-to-peer education. And I think 1 that we've heard that a lot around the state, too. 2 I mean, it's one thing to have the police 3 officer come in, the person you can't relate to, but 4 some -- we have young people who are still going 5 through it, that explain what they went through, and 6 that scares people. I think it has much more of an 7 effect, let's say. 8 And were certainly going to try and add that 9 to our package. 10 LUKE PARDNER [ph.]: Thank you. 11 SENATOR GOLDEN: Any other questions? 12 NAZAR ANOWI [ph.]: Yeah, hi. My name is 13 Nazar Anowi [ph.]. I'm a CASAC with OASAS. Also, a 14 resident of the Bay Ridge area. 15 I've known -- my family and I have known 16 Marty Golden. [Inaudible] to try to do our best. 17 I honestly think a big part of the 18 law enforcement is going to have to get involved. 19 The community -- the kids are very private, 20 very quiet. They are scared, but not scared in the 21 manner where it could be beneficial to them, 22 themselves, and their families. 23 So that is one factor. 24 Also, maybe like an anonymous toll-free 25 number that can be used, that families can speak, 1 because it's a two-part disease. The family 2 suffers, as well as the children, and the community 3 as a whole. 4 So that is one area I think maybe the 5 Arab-American Support Center can work on, you know, 6 having some type of, also, like a liaison between 7 Medicaid, because it's very expensive to get 8 treatment. A lot of people want treatment, and a 9 lot of people don't know how to go forth in getting 10 it. 11 So maybe somebody from, like, Medicaid, 12 informing them of long-term HRA-type benefits that 13 are available. 14 But I think a big part has to do with what 15 the NYPD has been working on, and just applying a 16 little bit more pressure in not giving so many 17 options, other than to work with them or to be 18 mandated to a long-term treatment program, which 19 I feel is probably the best treatment plan. 20 It would give the families time to heal. It 21 would give them time to heal. 22 But it all falls into the place of 23 enforcement of, like the Rabbi mentioned, fear. 24 There is a lot of fear, but not a fear in the sense 25 where they can recover from it. It can be a 1 motivator. 2 And that is a key area of which I think 3 that -- you know, I know, Marty Golden, you have a 4 lot of these pamphlets in your door, you know, with 5 Internet, and safety, and parents. And that looks a 6 lot towards the generation that has not been 7 affected by it, you know, and parents really getting 8 involved, you know. 9 I work a little bit with Apple, with 10 development, and they would love to participate in 11 different kind programs, to work with the kids who 12 are not just from the Arab. Bay Ridge is very 13 diverse. You have every nationality in there. 14 So getting them in there prior to them going 15 to high school, and the peer-pressure factor is very 16 big. 17 So, kind of breaking it up in that area, but, 18 I think that would be a positive. 19 SENATOR GOLDEN: There are faith-based 20 operations out there that do get a person from their 21 home, to Medicaid, to a treatment center. 22 My office does it, others will do it. 23 They're out there. 24 The unfortunate part is, a lot of people 25 don't know they're out there. 1 And I think that's the education part that my 2 colleague Senator Boyle has talked about as 3 something that we have to do look to do better. 4 NAZAR ANOWI [ph.]: Absolutely. 5 Thank you. 6 SENATOR NOZZOLIO: I have a question for the 7 young that man stood up. 8 Could you be so kind as to indulge me in a 9 question? 10 First of all, thank you for your courage. It 11 took an awful lot to stand up in the middle of the 12 room and tell us about your personal journey. 13 And I appreciate that very much, and respect 14 it very much. 15 Help us by understanding how -- you said you 16 had the D.A.R.E. education, you said you were a 17 participant there. 18 What elements encouraged you to begin this 19 type of conduct, the -- taking the opiates? 20 Was it availability? 21 Was it opiates themselves? 22 Were there gateway drugs? 23 What got you engaged in this? 24 LUKE PARDNER [ph.]: For me, it started with 25 smoking marijuana when I was very young. And then, 1 I was probably about 16, I started smoking 2 marijuana. 3 And what happened, the opiates was, Clonopin, 4 was something that I liked, because my mom had it in 5 her -- in her -- in the bathroom in the little -- 6 SENATOR NOZZOLIO: Medicine chest. 7 LUKE PARDNER [ph.]: -- medicine chest, 8 exactly. 9 And once I got that, my other friends knew 10 about other drugs, and I kind of just experimented a 11 little bit. And it kept going until I ended up in 12 rehab. 13 SENATOR NOZZOLIO: That was Senator Golden's 14 question earlier today, in terms of, what is -- is 15 marijuana, in fact, a gateway drug? 16 LUKE PARDNER [ph.]: To me I believe it is, 17 yes. 18 SENATOR NOZZOLIO: Well, again, thank you for 19 your courage, and your comments. 20 BRETT WILSTENSTOFF [ph.]: Thank you all for 21 having this panel. I really appreciate it. 22 My name is Brett Wilstenstoff [ph.]. I'm a 23 graduate student at the Albert Einstein College of 24 Medicine up in The Bronx, and a volunteer with the 25 syringe exchange up there, as well. 1 So I found my brother when he had overdosed 2 on heroin. We didn't know he was using, so we had 3 no naloxone on hand. We were at the mercy of the 4 paramedics getting there on time to bring him back, 5 which, thankfully, they did. 6 So, I was in the situation of not having any 7 resources available. And it seems like a lot of 8 other people are in the same situation. 9 And, so, we all, though, have in our 10 households fire extinguishers for that rare 11 occurrence of a fire. 12 Why don't we all have naloxone in our 13 medicine cabinets on the rare chance of an overdose? 14 It seems kind of a very pragmatic approach. 15 There's different ways of going about it. 16 I mean, of course, education was a huge role. 17 And being it more available for, like, 18 over-the-counter availability would be one thing 19 which I know is moving through right now. 20 Another would be a co-prescribing mandate, 21 which I've suggested, in which the first opioid 22 prescription, per year, per patient, regardless of 23 dosage, would get naloxone with it. 24 And what that would do, is it would widen the 25 naloxone-distribution network, so that any household 1 that has an opioid in it, also has naloxone. 2 And the naloxone lasts, the shelf life, for 3 two to three years. So even if that dosage is gone, 4 and then some problem arises later on down the line, 5 naloxone is available and a person's life can be 6 saved. 7 And, so, I just want to know your thoughts, 8 and, also, I'd just like your ideas on wider 9 naloxone distribution. 10 Thanks. 11 SENATOR BOYLE: Well, I think we all 12 certainly support the wider distribution. 13 I know that many of us have had classes. 14 I mean, I held one on Long Island last week. 15 We had 150 people taking the class. 16 One of the things is, we need to straighten 17 out and have a uniform system in New York State on 18 how to get that into people's hands. 19 These classes, you have to take the class to 20 get certified, obviously. And it's about a 21 45-minute class, it's not that hard. 22 And we are looking for a wider prescription. 23 The idea of giving -- a doctor giving it with 24 the prescription, the problem is, they haven't taken 25 that class. 1 But we do want to make it as widely available 2 to first responders, certainly to laypeople, family 3 members of addicts, addicts themselves. 4 We have done a pretty good job of getting it 5 more widely distributed, but we're going to go 6 further with it this legislation, too. 7 Thank you. 8 Oh, yes? 9 CLARENCE BOWDEN: Good afternoon, and thank 10 you, gentlemen. 11 My name is Clarence Bowden. I'm one of the 12 directors of New York Therapeutic Community 13 Serendipity 1. 14 And this is more of a comment and statement, 15 but it's also going towards that gateway question of 16 marijuana. 17 I haven't heard anything about alcohol being 18 mentioned. 19 I've done sessions with older gentlemen who 20 talked about, 6 and 7 years old, being sent, to 21 bring a drink to the parent, the alcohol spilling on 22 their hand, them licking it off, and it progressing 23 over time till they becoming addicted. 24 All right, so let's not forget alcohol and 25 its role in this gateway process. 1 Yes, I agree, marijuana is one of those 2 gateway drugs, but alcohol is right up there in that 3 same realm. 4 So that's just my comment and my statement. 5 SENATOR GOLDEN: I don't think anybody here 6 disagrees with you. 7 Go ahead. 8 Thank you. 9 CLARENCE BOWDEN: Okay, but that's what my 10 statement was. 11 SENATOR NOZZOLIO: Thank you. 12 SENATOR BOYLE: Thank you very much. 13 And I'd like to thank the panel very much, 14 for your input and insights. 15 SENATOR NOZZOLIO: Thank you very much. 16 [Applause.] 17 SENATOR BOYLE: Our next panel is a 18 representative of Dynamic Youth Community, 19 Samaritan Village, Bridge Back to Life Center, and 20 MASK. 21 [Pause in the proceeding.] 22 [The proceeding resumed, as follows:] 23 SENATOR BOYLE: Thank you very much. 24 This is our final panel; and if you could 25 briefly introduce yourself and tell us where you're 1 from. 2 GARY BUTCHEN: Good afternoon. 3 I'm Gary Butchen, the president and CEO of 4 Bridge Back To Life Center. We're a network of 5 outpatient chemical-dependency programs located 6 throughout the city and out on Long Island. 7 SENATOR BOYLE: Thank you. 8 WILLIAM FUSCO: Good afternoon, Senators. 9 My name is Bill Fusco. I'm the executive 10 director of Dynamic Youth Community, which is a 11 43-year-old residential program with outpatient 12 services in Brooklyn, but also servicing 13 Long Island, Staten Island, Upstate New York. We 14 have 86 beds in Fallsburg, New York; 16 beds in 15 Brooklyn, New York. 16 And, we're very glad to be here. 17 Thank you. 18 KAREN CARLINI: Good afternoon, and thank you 19 for this opportunity today. 20 My name is Karen Carlini. I'm the associate 21 director at Dynamic Youth Community. 22 But I think also important to note, that I'm 23 the co-chair for the ASAP (Association of 24 Substance-Abuse Providers), Adolescent and Young 25 Adult Committee for the state. 1 So I'm here representing both. 2 Thank you. 3 SENATOR BOYLE: Thank you. 4 RUCHAMA CLAPMAN: Good afternoon. 5 I'm Ruchama Clapman. I'm the founder and 6 executive director of MASK. "MASK" is Mothers and 7 Fathers Aligned Savings Kids. 8 I started the organization, we just started 9 our 16th year. 10 Senator Golden and Senator Felder have been a 11 partner and supported MASK through many, many years. 12 Thank you again. 13 MASK, we have a help line. We are a referral 14 agency. We have support groups for parents. We are 15 a school liaison. We do inpatient and outpatient 16 referrals and placements for families that, children 17 do drugs, alcohol, eating disorders, gambling, and 18 Internet addiction. 19 Thank you. 20 JAMES HOLLYWOOD: Good afternoon, Senators. 21 My name is Jim Hollywood from 22 Samaritan Village. 23 Samaritan Village has a number of 24 substance-abuse treatment programs throughout 25 New York State: 839 beds in total, 2 outpatient 1 programs. 2 Our residential programs focus on specialized 3 services for young mothers and children, veteran 4 services for men and women, and a 5 methadone-to-abstinence residential treatment 6 program. 7 SENATOR BOYLE: Great. 8 Thank you very much. 9 And if I could, first question -- we'll get 10 into a lot of the issues, and the insurance, and 11 stuff like that. 12 My first question out of the box, and for the 13 treatment providers, inpatient: What's the magic 14 number of days that you think, minimum, is needed 15 to -- you have an opioid addict, heroin addict, come 16 in, they went through detox, they're there; how long 17 do you need to keep them? 18 KAREN CARLINI: I'll take it. 19 I'm in the middle, so, you know, we have both 20 sides. 21 I think it's -- it's a hard question to 22 answer. 23 I think that -- you know, we provide 24 long-term residential treatment. 25 We provide long-term residential treatment of 1 one year, with an aftercare program, with outpatient 2 follow-up, because the people that come to our 3 program, that's what they need. That's what, you 4 know, the level-of-care determination told us. 5 I think that it's really important that the 6 treatment provider is the person that's making that 7 assessment. 8 I know that there's pending legislation right 9 now that would make that happen. 10 But the idea of long-term residential, 11 I would say, you know, at least, you know, 6 months, 12 in terms of the emerging adults, that 18- to 13 25-year-old, for what happens to them: What happens 14 for the brain, and what happens, you know, 15 scientifically, to people, and then what happens to 16 them, emotionally. 17 For a family, someone talked about before, 18 the time it takes for a family to heal. I think 19 they need that time. That can't happen in a short 20 period of time. 21 So, I can answer it, you know, from our 22 perspective; although, I think that there are 23 shorter terms that might work in different 24 circumstances. 25 JAMES HOLLYWOOD: Can I -- 1 SENATOR BOYLE: Go ahead. 2 JAMES HOLLYWOOD: So when the research -- 3 when you look at the research, any treatment over 4 90 days seemed to be more effective when people stay 5 engaged in treatment, whether it's outpatient 6 treatment, residential treatment. 7 So, you see the most positive effect when 8 people stay engaged over 90 days. 9 And, so, when we look at "What is the magic 10 number?" it really also talks about the severity of 11 the addiction, the co-occurring disorders that might 12 accompany someone's addiction. 13 Addiction is a biopsychosocial disease, and 14 how far it impacts someone's development. 15 Employment becomes an issue. 16 Housing becomes an issue. 17 So when you really try to boil down, What is 18 the essential elements of treatment? it's a holistic 19 approach that looks at the mind, the body, and, as 20 well as the social connectedness of an individual. 21 So, there's no magic number. 22 90 days seems to be indicated in research, at 23 minimum. And that goes for regardless of which 24 level of care you're in. 25 The more contact people have in treatment, 1 the better outcomes that are available. 2 GARY BUTCHEN: You know, just building on 3 Mr. Hollywood's point, it's difficult to give you an 4 exact number, especially if we're talking about 5 legislation that's going to force the insurance 6 companies to pay for what's being called 7 "medical necessity." It's very difficult to hammer 8 down a certain amount of days. 9 If Dr. Kolodny was still in the room he could 10 tell you, every patient is different, and the 11 physician from Lutheran. 12 So, just from a detox point of view, you 13 know, managed-care companies are now telling the 14 inpatient folks, three to five days. 15 And, you're lucky to get five. They start 16 doing discharge planning 24 hours in on a detox. 17 You can't move a person over to an inpatient 18 rehab while they're still tremulous and going 19 through withdrawal. 20 Then they want to route them out of the 21 emergency room down to my level of care, in the 22 outpatient system of care, but folks are coming in, 23 they're still in mild withdrawal symptoms. 24 So, I'd love to be able to sit here and give 25 you an exact number, but Jim's point is right on the 1 money. I mean, SAMHSA and NYDA and all the research 2 has shown, the longer a person's engaged in 3 treatment, the better the outcomes. 4 The juxtaposition of all of that, is the 5 insurance companies aren't allowing us to hold 6 people in treatment that long anymore. You know, 7 they're sending us fewer and fewer patients, and 8 they want them out of treatment faster and faster. 9 SENATOR NOZZOLIO: Yes. 10 RUCHAMA CLAPMAN: You know, from a parent 11 point of view, and from dealing with over 12 15,000 families, I have a whole different spin. 13 My spin is, is that, the first month when a 14 kid gets put into a rehab, or young adult, or 15 whatever, they're there against their will. They're 16 not even listening. 17 The second month, the 60 days, they're 18 finally coming to accept that they need to be there. 19 By 90 days, they're like, Wow, I'm really 20 here? 21 The first 90 days are not treatment. It's 22 just really a holding pen, to get them to understand 23 that's where they need to be, and then they start to 24 listen. 25 So, if anyone thinks that the first 90 days 1 they should be out of there, I mean, you're really 2 wasting your money, because all of them that come 3 out after 90 days, we have documented, do not do 4 well. 5 They need, minimum, not a day less, than 6 six to nine months. "Not a day less." 7 SENATOR BOYLE: Karen, you mentioned 8 "level-of-care determination." 9 Can you walk me through that process? 10 KAREN CARLINI: Well, right now, I know 11 somebody mentioned before that OASAS is in the 12 process of developing what would be called the 13 "Locator," and that would be able to determine that 14 level of care. 15 But for an assessment, a counselor goes 16 through a process of, you know, assessing the client 17 to determine whether they need, you know, outpatient 18 care, residential, you know, and various other 19 things. There could be mental health is considered. 20 Family support is considered. 21 So there's all sorts of things that would 22 determine where that person needs to be. 23 Currently, obviously, we do that as treatment 24 providers. 25 What I think we fear is that, with insurance 1 coming in, and what's happened already for people 2 that are working with the insurance companies, 3 they're making that determination. 4 That's really what -- people aren't getting 5 what they need because the determination is being 6 made by someone who's not a practitioner. 7 SENATOR NOZZOLIO: And that's our dilemma. 8 Our dilemma is, and that's why the Chairman 9 asked the question, because, in the three-prong 10 approach that the Task Force is taking -- the 11 prevention, treatment, and additional prosecution -- 12 in a three-prong approach, the treatment end, 13 we're -- began, at least I did, with -- at a loss. 14 And, it was 19 years ago that I worked to set 15 up the first drug-treatment prison in this state's 16 history, if not the nation's history, and that was a 17 90-day model. Willard, was a 90-day model. 18 And I agree with you, it's a very subjective 19 issue, and it's very difficult to say "90 days." 20 I mean, I can just -- as you mention, the 21 person in treatment, I can mention the inmate at 22 Willard, that their motivation was, if they get out 23 of the program, they'll go to jail, a longer jail 24 sentence. 25 So they had some, at least recognition. 1 But, 90 days is -- but, at the same token, 2 the Chairman asked this question, because we're 3 going to have to ask the same question, and maybe 4 even tell the insurers what they're going to have to 5 provide. 6 And they're not going to like it no matter 7 what it is. 8 9 days, 9 minutes, 90 years, I mean, it's not 9 going to matter, from their perspective, except the 10 question of cost. 11 And, we'll have to be sensitive to that, too, 12 because everybody pays enormous insurance costs when 13 we have to pay them, in health insurance. 14 And the fact is, we need some guidance. 15 I think that's just the -- the beginnings 16 are: We'd like it longer, we understand that, we 17 get it. 18 But the question is: How can we measure the 19 stick so that the insurance companies will 20 appreciate the fact that this is a more effective 21 way to approach the problem? 22 GARY BUTCHEN: Well, we're at an interesting 23 point, because Senator Hannon's bill, 4623, the 24 Access to Care Bill, talks about all levels of care 25 within OASAS, including residential, which the 1 insurance companies have never paid for before. 2 That's always been either on the families or on the 3 State or it was funded in particular ways. 4 So it is going to be an interesting debate as 5 to whether or not the Access to Care Bill is going 6 to include all the levels of care, as it should; or 7 if the insurance companies are going to give an even 8 greater pushback on covering only what's in the 9 essential-benefit package. 10 So that's going to be a juggling act that the 11 Senators are -- you know, you're going to have to 12 deal with. 13 But we -- we, I think, all agree, regardless 14 of our focus or our level care, that we agree with 15 you. I mean, the Minnesota model that came out of 16 treatment 30, 40 years ago was 30 days of rehab. 17 The average length of stay in rehab now is 18 under 16 days. That's all predicated on what 19 managed care is willing to pay for, unless, as -- 20 as -- the families are willing to go into bankruptcy 21 and foreclose on their homes, and take out second 22 mortgages, for their children. 23 So when the insurance companies come back to 24 the Legislature and say, "We don't want to pay for 25 it because we're going to have to raise premiums," 1 that's a weak argument because they raise premiums 2 in New York State every year. 3 You know, I'm also, you know, a 4 small-business owner, and I pay the premiums for my 5 company. I can tell you that my premiums go up 6 anywhere from 8 to 10 percent every year regardless 7 of the bills that you pass or don't pass. 8 So that's something that really should not be 9 the prevailing argument, whether or not it's good 10 policy or not, because, obviously, as some of the 11 other folks have testified earlier, and 12 The Detective and the investigator have said, if we 13 invest a few dollars early on, the fiscal 14 implications, the economic implications, down the 15 road pay huge dividends. 16 SENATOR NOZZOLIO: Mr. Butchen, that's very 17 well stated, and I certainly agree with your 18 concept. 19 We're just trying to hammer out the 20 appropriate guidance to give the carriers, in terms 21 of this focus, and what will be effective; what is 22 necessarily the evidence coming from providers like 23 yourselves who have to deal with these issues. 24 It's certainly subjective. I understand it's 25 different, one size doesn't fit all, but, one policy 1 will have to fit all in this state, in a sense, of 2 at least guidance. 3 So, any kind of guidance you can give us to 4 give the carriers, we appreciate. 5 And we're willing to make the statement that, 6 yes, you need to provide this care. 7 We did it with a lot of other things over the 8 last few years. 9 But the question becomes, how much? 10 WILLIAM FUSCO: Senator, could I just mention 11 the fact that the amount of monies necessary really 12 varies tremendously. 13 For Dynamic Youth, it's under $30,000 a year. 14 For one year in treatment, it's under 15 $30,000. 16 I can quote you programs that are one month 17 for $30,000. 18 So, I mean, to just look at it from a sense 19 of time or length is not necessarily the best 20 measuring stick. 21 You know, honestly, I thought the measuring 22 stick really should be, you know, what the cost is. 23 And the fact is, is that we've run studies a 24 number of times, you know, throughout our years, 25 about short-term and what we call "Band-Aid 1 approaches." 2 And, we have a lot of kids who have been in 3 the 15 days, 20 days in Florida; 15 days here, 4 15 days there; all over the place for millions of 5 dollars. "Millions of dollars." 6 So, if you shorten the length of treatment so 7 short, whatever you're spending really is just 8 throwing money away. 9 So, you know, you really need to think, not 10 necessarily -- you really need to think of, what's 11 going to be effective? 12 We stand by the model of 9 months to a year 13 for severe opiate addicts who are between the ages 14 of 17 and 24. We think that that really is the 15 model that, you know, works, and gives a young 16 person a chance to really get their -- you know, 17 their recovery in place for themselves. 18 SENATOR BOYLE: And so -- 19 SENATOR NOZZOLIO: How many children -- I'm 20 sorry, Mr. Chairman. 21 SENATOR BOYLE: Go ahead. 22 SENATOR NOZZOLIO: How many children, 23 Mr. Fusco, have -- in that age -- not children -- 24 how many young adults in that age group is your 25 agency done -- dealt with, and, in terms of 1 experience level? 2 What numbers are we talking about in terms of 3 population you're familiar with? 4 WILLIAM FUSCO: Well, we deal exclusively 5 with 17- to 24-year-olds, and we have for the last 6 43 years. We've been -- we're the first residential 7 program exclusively for adolescents in 8 New York State. 9 Right now we have 86 beds in Fallsburg, 10 New York, which, you know, is near Monticello, 11 New York. And we have 16 beds in Brooklyn, 12 New York. And we have an aftercare of about 100, 13 125, who, after being in treatment, continue on with 14 their families, on a -- sometimes, starting on a day 15 basis, and then moving on to night basis, and moving 16 on from there. 17 So, in total, we probably serve somewhere 18 around 175 to 200 families a year. 19 SENATOR GOLDEN: What's the drug of choice? 20 WILLIAM FUSCO: Absolutely. 21 I just wrote it down. 22 We're running right now, 30 percent, 23 prescription drugs; 63 percent, heroin. 24 SENATOR GOLDEN: And how's that changed over 25 the last two years, three years? 1 WILLIAM FUSCO: I have that number, too. 2 In 2011, it was 47 percent, prescription 3 drugs; 27 percent, heroin. 4 Going back to 2007, it was 13 percent, 5 prescription drugs; 21 percent, heroin. 6 So we went from a little bit over 40 percent 7 in '07. In 2011, 73 percent. 93 percent today. 8 SENATOR GOLDEN: And how has it changed 9 the -- getting these drugs over the last 10 three years: By purchasing illegally? Homes? 11 Prescription? Doctor shopping? 12 WILLIAM FUSCO: I don't have that -- 13 KAREN CARLINI: I think there are various 14 reasons. 15 You know, some of the kids in the program are 16 here today, so I think they're probably the best to 17 ask. And we -- believe me, we ask them a lot. 18 But, there's different answers. 19 Some, like one of the kids that stood up 20 earlier today, from the medicine cabinet. 21 Some from a party. 22 You know, some, even from an injury. Maybe 23 they were an athlete and there was an injury, and it 24 started that way. 25 But, their stories aren't very different than 1 most of the stories you've heard in the last few 2 years, in terms of how people start, especially 3 young people. 4 SENATOR GOLDEN: Can I ask that young man to 5 stand up again? 6 We're going to pick on you today. 7 How many pounds you weigh? 8 LUKE PARDNER [ph.]: How much do I weigh? 9 165. 10 SENATOR GOLDEN: 165 pounds. 11 How many times did it take before he's 12 addicted to heroin? 13 How many times before he takes a hit on 14 heroin, before he goes to the actual crushing, 15 snorting, taking that pill? 16 How long does it take him to get addicted? 17 KAREN CARLINI: Level of pain -- 18 SENATOR GOLDEN: How long did it take you to 19 get addicted? 20 WILLIAM FUSCO: That's a tough call. 21 I can't give that call. 22 I mean, I'm going to say, the average amount 23 of opioid addiction in the program is going anywhere 24 from one year to about six years. 25 So, you know -- and the level of addiction, 1 you know, I mean -- Senator, let's start with the 2 fact that, you know, a lot of our kids like to get 3 high, unfortunately. 4 And as these drugs -- as these drugs vary, 5 and modify, and go back and forth, there is an 6 underlying fact of, you know, working with families, 7 of trying to help people stay clean and sober, is a 8 really, really, really important task. 9 SENATOR GOLDEN: What I was trying to point 10 out, I think a man of this weight -- a young man of 11 this weight, three to four to five hits of heroin is 12 enough to addict him. 13 That's what I was trying to point out. 14 You had your hand up back there. Real quick. 15 ANTHONY ALVERNO [ph.]: [Not using a 16 microphone.] 17 My name is Anthony Alverno [ph.]. I'm 18 currently in treatment. 19 And, it takes three to five days of 20 continuous use to get an opiate habit. 21 WILLIAM FUSCO: Right. 22 SENATOR GOLDEN: Thank you. 23 ANTHONY ALVERNO [ph.]: From what 24 I understand. 25 SENATOR GOLDEN: Thank you very much. 1 I'm sorry. Go ahead be, Mr. Fusco. 2 WILLIAM FUSCO: So I guess, when -- you know, 3 when talking about the level of care, and, honestly, 4 it was really the first thing that came to mind for 5 me, I think it is essential that we think in terms 6 of length of stay. 7 It can be, not necessarily, an intensive 8 medical model. I don't think that that's necessary. 9 So there are ways of making costs, I think, 10 you know, for, you know, inside the peer situation, 11 reasonable. 12 But I think that the length of stay in a 13 supportive environment is very, very critical to a 14 lot of young people getting a chance of getting 15 their lives back. 16 JAMES HOLLYWOOD: And if I could, just back 17 to the point of insurance, you know, it's sort of 18 coming at the worst time, I think, that health-care 19 reform, as the opiate addiction has risen. 20 Because, like the gentleman had pointed out, 21 three to five uses and you're addicted. 22 The prescription-drug epidemic really sort of 23 heightened the fuel of the addiction, because it was 24 pharmaceutical grade. It was always, you know, 25 Oxycontin is Oxycontin is an Oxycontin. Right? 1 And, so, a bag of heroin varies considerably. 2 And that's the concern about heroin overdose, 3 you know, when people transition, is the dosing is 4 not regulated or controlled. 5 So what happens with -- and I think, is that, 6 the prescription-pill epidemic which might be waning 7 because of I-STOP, or other trends that might be 8 happening. 9 But the heroin epidemic is the thing that 10 I most worry, is because there's going to be an 11 inconsistency in the supply and the quality, which 12 would only fuel other behaviors which get folks in 13 trouble. 14 So back to the impact of the health care, is 15 that this is a lifelong chronic, progressive disease 16 which people can recover from. 17 The length of time in treatment is an 18 impacting element in terms of people's overall 19 recovery. 20 So, to really think about the fact that we 21 have such increasing numbers of young adults who 22 have a chronic, progressive relapsing disease, 23 starting at 16, 17, 18, and 19, now that's going to 24 project over their lifetime. 25 That's going not just affect us in this 1 budget year or this funding year, but you're going 2 to talk about, this is going to be a protracted 3 experience for us as a state and a community. 4 SENATOR BOYLE: Thank you very much. 5 And let's just ask, I'm asking about the 6 insurance aspect of this: 7 So, now, can you tell me how your patients 8 are paid for, and what's the process to come in? 9 You argue with the insurance company for a 10 couple days and then you finally get coverage? 11 Or how does that work? 12 KAREN CARLINI: Well, I think one thing 13 that's important to note, is some of us aren't 14 necessarily collecting insurance. 15 Remember, we provide residential services. 16 SENATOR BOYLE: Right. Well, however it is, 17 yeah. 18 KAREN CARLINI: So how that's happened, up 19 until now, is through State aid, and, you know, 20 other third-party funding that we've tried to secure 21 to make that happen. 22 The process for the insurance companies 23 varies from one insurance company to the other; and 24 it depends. It is never close enough to what the 25 cost, you know, should be, or what the prescribed 1 visit should be, you know. 2 And I think Gary probably should talk about 3 this a little bit more, in terms of what happens for 4 you in the process. If you don't mind? 5 GARY BUTCHEN: No, that's fine. 6 Well, we're in a unique position because 7 we're a private program. We receive no funding. 8 So, we're dealing with managed-care companies 9 every single day for everything that we do, and we 10 have been for 20 years, so we've seen the genesis of 11 managed care since its inception. 12 Theoretically, as an outpatient system of 13 care, the managed-care companies would want to use 14 my level of care as opposed to residential or 15 inpatient or even detox. 16 But even at the outpatient system, it's an 17 argument. 18 So we have clinicians, physicians, 19 psychologists, who do full-blown evaluations on 20 patients. And when we determine that someone needs 21 a higher level of care, there's no better expert in 22 the room at that moment than us. 23 We're on the phone with the insurance 24 company, and it could be a-managed company based in 25 Salt Lake City, or Philadelphia, or anywhere around 1 the country, and we're arguing with a nurse who 2 hasn't seen the patient; we're arguing with a 3 physician who, by the way, is not a an addiction 4 psychiatrist, it could be a podiatrist; who's 5 telling us what level of care. 6 "Try to hold the patient in your outpatient 7 system." 8 Or, "We'll give you one to two days of detox, 9 and then we want them back into your ambulatory 10 detox to manage the mild to moderate withdrawal 11 symptoms." 12 So we're saying to them: So you know that 13 you're going to send me back a patient who's going 14 to be uncomfortable, you're not going to allow them 15 to complete their course of care, and I am supposed 16 to pick up the pieces? 17 That's, if, they even come back into my door, 18 as opposed to going to cop on the streets again 19 because they're horribly uncomfortable. 20 So we deal with this issue every single day. 21 We offer the intensive-outpatient level of 22 care, also. 23 And I know that you've probably heard 24 testimony from around the state about how difficult 25 it is to get people into detox or rehab. 1 We can't even get them authorized for the 2 intensive-outpatient level of care. 3 They just want them in standard outpatient, 4 and then the old argument, let them go to a 12-step 5 program. 6 SENATOR BOYLE: Give me an example of the 7 difference between regular outpatient and intensive 8 outpatient. 9 What kind of service -- 10 GARY BUTCHEN: Intensive outpatient is -- 11 should be at least 9 hours a week, or more. 12 We offer it 5 days a week, 3 hours a day; so 13 it could be up to 15 hours. And that's, 14 theoretically, a step down between the rehab and 15 standard outpatient. 16 Standard outpatient is psychotherapy, 17 45-minute session once a week. A couple of groups, 18 60 minutes, 90 minutes, once or twice a week. 19 SENATOR BOYLE: Right. 20 GARY BUTCHEN: So it's a step down in the 21 continuum. 22 So we're offering that buffer level between 23 residential and outpatient. And that was created 24 back in the early '90s by managed care, because they 25 didn't want to pay for the residential-treatment 1 component. 2 So it became a level of care that the 3 managed-care companies created. 4 SENATOR BOYLE: Regarding the -- now, any you 5 take Medicaid or -- any facilities? 6 GARY BUTCHEN: Yes. 7 SENATOR BOYLE: Okay. 8 GARY BUTCHEN: On a fee-for-service basis. 9 SENATOR BOYLE: Any trouble -- 10 GARY BUTCHEN: Outpatients. 11 SENATOR BOYLE: Just outpatients? 12 GARY BUTCHEN: Any outpatients not in the 13 residential-treatment program. 14 SENATOR BOYLE: Any trouble with coverage of 15 that, or arguing about -- 16 JAMES HOLLYWOOD: In the Medicaid, or -- 17 SENATOR BOYLE: Yeah, Medicaid. I'm sorry. 18 Medicaid, yeah. 19 JAMES HOLLYWOOD: I'll defer to you. 20 KAREN CARLINI: No, not necessarily. I mean, 21 there aren't problems with accessing treatment. 22 If someone is on Medicaid and they come into 23 our program, we're able to bill for that. 24 The issues with Medicaid have nothing to do 25 with people being denied treatment as a result of 1 being on Medicaid. 2 I think that's what you're asking? 3 SENATOR BOYLE: Yes. 4 JAMES HOLLYWOOD: Except the concern is now, 5 we're -- this -- so, substance-abusing population 6 had a carve-out, which is no longer going to exist. 7 And as we move to managed care, managed Medicaid, 8 then we're going to be subject to -- 9 KAREN CARLINI: We'll experience the same 10 problems with managed care. It is important to say 11 that. 12 With straight Medicaid, we don't have the 13 kinds of problems that we anticipate with managed 14 care that Gary's program already experiences. 15 SENATOR BOYLE: That was my question: So 16 you're not experiencing it yet, but you may -- 17 KAREN CARLINI: We're not yet, but, yeah, we 18 will. 19 I think we anticipate the same thing that 20 everybody else is experiencing now. 21 SENATOR BOYLE: I mean, obviously, one of the 22 big questions is, ObamaCare comes in, and addiction 23 services are supposed to be one of the 10 areas 24 covered. 25 How much, and what limits are going to be put 1 in place with that, is going to be a question. 2 KAREN CARLINI: Right, we're very -- yeah, 3 we're very concerned about that. 4 We're very concerned about co-pays. 5 We're very concerned, you know, yeah, about 6 limits on length of stay. And visits. 7 WILLIAM FUSCO: We would also like to say 8 that the block grant certainly has been a major part 9 of the funding for the residential programs. And we 10 would like to see that continue. And, of course, 11 the State aid to localities. 12 They really are the umbrella. That's really 13 the safety net. 14 KAREN CARLINI: Yeah, I think that that's 15 important to say, because, while I say that, 16 currently, we don't have issues with Medicaid in 17 terms of the treatment, we would never be able to 18 support our program solely on Medicaid. 19 So -- and especially our program, and maybe 20 some others, with younger people, many aren't on 21 Medicaid anyway. 22 So we have, about, 40 percent of our 23 population are on Medicaid in the outpatient 24 program. And that's certainly not a lot. 25 SENATOR GOLDEN: The other 60 percent? 1 KAREN CARLINI: Private insurance, that we're 2 really not able to access enough, you know, to 3 support the program. 4 Some are getting on now. There is a little 5 bit of a difference with ObamaCare. 6 But, the private insurance, we haven't been 7 able to access private insurance at this point. 8 SENATOR GOLDEN: Samaritan, James, your 9 situation? 10 JAMES HOLLYWOOD: So, the 11 residential-treatment programs are funded, as Billy 12 pointed out, by net-deficit funding, which is 13 State -- uhm, uhm -- 14 KAREN CARLINI: State aid. 15 JAMES HOLLYWOOD: -- State aid, comes with a 16 block grant. And that's a part of the match. 17 The other part is local DSS supports through 18 congruent care level to funding, from both the 19 County or the City, in that regard. 20 And back to, the number for us, it's a little 21 bit over $20,000 a year per bed. And it's built, 22 basically, on an economy of scale. 23 I mean, the programs are bigger than even the 24 research might support. 25 So when we look at, not just the length of 1 time, also want to look at the size of programs. 2 Want to look at how effective our programs could be, 3 especially in light of the residential redesign, 4 which is occurring right now. 5 And, you know, there's a hope that the 6 residential redesign would look at incorporating 7 insurance money alongside of State aid and congruent 8 care support. 9 SENATOR GOLDEN: Is there anybody on that? 10 Is there a task force on that? 11 How's that being created? 12 JAMES HOLLYWOOD: It's a task force led by 13 OASAS and a number of providers. 14 SENATOR GOLDEN: Are you on that? 15 JAMES HOLLYWOOD: Samaritan Village is 16 represented on it, yes. 17 KAREN CARLINI: Yes, TCA -- regional TCA and 18 OASAS co-chair the group. And it's a pretty wide 19 representation. 20 SENATOR GOLDEN: And you're comfortable the 21 way it's moving? 22 JAMES HOLLYWOOD: We're encouraged by it. 23 Uhm -- and the big thing -- 24 SENATOR GOLDEN: That's a good word. 25 JAMES HOLLYWOOD: Yes, we are encouraged, the 1 fact that residential treatment is being -- is 2 looked to be -- being preserved as part of the 3 treatment continuum. 4 For the severely addicted, the removing 5 people from their social environment and bringing 6 them to a much more therapeutic environment has 7 benefits. 8 And as other panel members have pointed out, 9 you know, the length of time, six to nine months 10 seems to be much more impactful, especially for a 11 younger population. 12 For folks that we serve, who are adults, you 13 know, the length of stay, again, anything over 14 90 days is helpful. 15 The worry that we have, is that we become -- 16 we become like an inpatient rehab, which is more of 17 a 30-day model. You know, that we'll get pressed to 18 drop below even the 90-day that we're hoping to at 19 least get out of the residential redesign. 20 Because that, for us, is a bare minimum. You 21 know, that's sort of the minimum dose, effective 22 dose, of residential services for severely addicted 23 individuals. 24 SENATOR GOLDEN: I'm not sure we can do this, 25 but I'm going to ask my Chairman. I guess we'll 1 have to sit down and discuss this. 2 I don't know if there's any way we can 3 support some of your recommendations, from this 4 Task Force. And, I guess we'd have to look to the 5 Committee Chair, and to the chair -- the chair 6 members, as, you know, which ones we could support, 7 if, in fact, we could support. 8 JAMES HOLLYWOOD: Certainly. 9 Thank you. 10 SENATOR BOYLE: Any other questions from the 11 audience? 12 Yes. 13 KEN: [Not using a microphone.] 14 How you doing? 15 I'm Ken [unintelligible] from Serendipity 1. 16 I have two things to say, real quick. 17 SENATOR GOLDEN: Louder and slower. 18 KEN: Two things to say. 19 One, I want to reiterate how hard it is to 20 get into detox. 21 I got turned away from five different 22 hospitals on Long island, and I was told to go home 23 and don't use. 24 And that's not happening for a person who has 25 an addiction problem. 1 SENATOR GOLDEN: I'm not going to pick on my 2 friends from Long Island, but Lutheran Medical would 3 take you in, like that [snaps fingers]. 4 Go ahead. 5 [Laughter.] 6 KEN: I've been to quite a few. 7 The other thing, as far as how long you need 8 to be in rehab, or a long-term treatment facility, 9 the longer, the better. 10 For me, I -- that's why I'm in a one-year 11 program, because I know I need it. 12 But, for a lot of people I know out on 13 Long Island, that have jobs, and, you know, actually 14 work and just aren't homeless, you can't just take a 15 year off from work. 16 So having the 28-day programs, or the short, 17 the Band-Aid programs, as they said, still available 18 is definitely necessary, too. 19 So you want to keep that in mind, not to try 20 to cut them out. 21 But the long-term is definitely vital, too. 22 SENATOR BOYLE: Thank you? 23 JAMES HOLLYWOOD: If I could just add -- 24 SENATOR GOLDEN: Go ahead, James. 25 JAMES HOLLYWOOD: If I could just add to 1 that, and I appreciate you bringing up that point: 2 I think we need to have -- look at all levels 3 of care as being effective. Right? And we look at 4 what's -- you know, what is needed for that 5 individual. 6 And, clearly, people who are employed and 7 need to go back to a supporting a household, and 8 themselves, and they have those means, they might 9 actually be indicated in terms of their social 10 connectedness, and that they could return to the 11 community. 12 But back to what Gary said, is then, maybe, 13 it's an intensive outpatient program; one that could 14 be intensified in services that support working 15 folks, because it's the aftercare. It's not the -- 16 you know, detox works. 17 But it's really the aftercare that follows up 18 around the detox that will ensure that it sticks. 19 So -- so it really is, you know, there's no 20 one model that works. If it was, we would have 21 maybe discovered it and not have a panel today. 22 But, it's really going to be, I think, a 23 broad-based approach, looking at varying levels of 24 care: medication-assisted treatment incorporated in 25 that. Naloxone incorporated, even in 1 treatment-provider programs. Providing education to 2 our patients and our family members. 3 So, I support what was said. 4 SENATOR GOLDEN: Narcotics, obviously, is a 5 terrible disease. And, whether it's Oxycontin or 6 hydrocodeine [sic] or heroin, I don't know, there 7 might be one or two in there. 8 Any of you that progressed quickly enough to 9 using a needle, in the crowd, that would want to? 10 [Some audience members raise hand.] 11 SENATOR GOLDEN: Why don't you just -- 12 anybody want to talk about it, how long it took 13 them? 14 Go ahead. Right there. 15 AUDIENCE MEMBER: I did Oxycontin for, like, 16 six years, I would say, you know. 17 Lower? Higher? [Motioning with microphone.] 18 SENATOR GOLDEN: No, higher. 19 AUDIENCE MEMBER: I did Oxycontin for about 20 six years. And once I progressed to heroin, 21 I was -- ended up shooting heroin within a month. 22 And when you learn on the streets how much 23 easier it is to, how much better it is, from 24 everybody, they just -- it's just -- the talk about 25 it, you know, nobody can resist it. 1 And once you start doing it, there's really 2 no other way of, like, you know, putting it down, 3 because once you get that sensation, I guess you 4 could say, it never changes. You know? 5 SENATOR GOLDEN: And you're constantly 6 chasing the high that never comes back? 7 AUDIENCE MEMBER: Yeah, you could say that, 8 I guess. 9 It's more of, like, the -- just the fact that 10 you think you need something that you don't actually 11 need. You know, what I mean? 12 And until you are able to get away from it, 13 which is what the long-term treatment centers are 14 able to do for you, you know what I mean, is to put 15 you away from your environment and away from, like, 16 being on the streets, and stuff -- 17 SENATOR GOLDEN: How did you get the help 18 that you've gotten? 19 AUDIENCE MEMBER: How did I get there? 20 SENATOR GOLDEN: How did you get here? 21 How did you get to the facility? 22 AUDIENCE MEMBER: I actually got lucky, 23 because I live on Long Island, and it was a lot 24 harder for me to get to a program that was upstate. 25 So my mom actually knew -- through a psychiatrist, 1 was able to get me into Dynamite. 2 SENATOR GOLDEN: Okay. 3 And how long have you been in the program 4 now? 5 AUDIENCE MEMBER: Almost 13 months. 6 SENATOR GOLDEN: 13 months. 7 And how are you progressing? 8 AUDIENCE MEMBER: I'm doing fine. I haven't 9 used or picked up anything in 13 months. 10 I actually just came down from the upstate 11 facility, so now I'm in outpatient facility down 12 here. And, you know, it's working. It works very 13 well. 14 The people at Dynamite are just fantastic, 15 with the way that the program works, you know. And 16 that's really -- 17 SENATOR GOLDEN: Give it to the -- the mic to 18 the young man with the white suit on, right back 19 there. 20 Right there. 21 You had your hand up? 22 Okay, I'm sorry. 23 Okay, whoever wanted to speak back there, go 24 ahead. 25 CHALID HUSSEIN [ph.]: Would you mind if I -- 1 SENATOR GOLDEN: Yeah, go ahead. 2 CHALID HUSSEIN [ph.]: Okay. Since I have 3 it, I figured I might as well, anyway. 4 SENATOR GOLDEN: Closer to you. 5 CHALID HUSSEIN [ph.]: My name's 6 Chalid Hussein [ph.]. I'm actually a member of 7 Dynamite Youth right now. 8 I'm actually a member of the Bay Ridge 9 community, as well. I have been for about 18 years. 10 And I relate a lot to a lot of things that 11 were said here today, particularly, I mean, just the 12 way prescription pills have kind of taken over my 13 life, and the life of so many of my close friends. 14 Linda Sarsour that was speaking earlier, she 15 mentioned a few deaths in the Bay Ridge community 16 over the past -- 17 SENATOR GOLDEN: How did you get to 18 prescription drugs? 19 CHALID HUSSEIN [ph.]: My first time, I got 20 it prescribed by a doctor. I was about 19 years 21 old, I had gotten in a car accident. I was having 22 acute knee pain, and he prescribed me 23 ninety 10-milligram Oxycodone pills, without any 24 instruction how to use them. 25 He said, "Follow the bottle." 1 And the bottle said, "Take every 4 hours, or 2 take as needed." 3 But that's how I got my hand on them, 4 initially. 5 I mean, after I become addicted, me and my 6 friends, we started taking them out of our parents' 7 medicine cabinets. 8 Just, any way we could get our hands on them. 9 Doctor shopping. 10 Just, everything, it just followed. It just 11 became about, any way we could get them. 12 And it eventually progressed to heroin, once 13 I found out about heroin, after doing it the first 14 time. Just, after experiencing that initial high, 15 there was just no going back to that -- 16 SENATOR GOLDEN: Using a needle? 17 CHALID HUSSEIN [ph.]: Yes. Eventually 18 I did, yet. 19 SENATOR GOLDEN: And how many of your friends 20 were using -- went to needles? 21 CHALID HUSSEIN [ph.]: It's hard to give you 22 a number, but almost every single person that I used 23 the prescription pill with, that I ever used an 24 opiate with, eventually ended up doing heroin. 25 SENATOR GOLDEN: And how many would you say 1 that was? 2 CHALID HUSSEIN [ph.]: Maybe, about, 20, 3 25 of my close friends. 4 SENATOR GOLDEN: And you all hung out in the 5 same areas in Bay Ridge? 6 CHALID HUSSEIN [ph.]: Yes. 7 SENATOR GOLDEN: Okay. 8 CHALID HUSSEIN [ph.]: Two of them, actually, 9 the most recent ones, the one that just left the 10 hospital in a coma, and the one that just passed 11 away. 12 I had about six friends, six personal 13 friends, die this past year in Bay Ridge alone. 14 Just overdoses of heroin. 15 SENATOR GOLDEN: What woke you up? 16 What brought you to the realization that you 17 needed this program or you were going to die? 18 CHALID HUSSEIN [ph.]: It's hard to word 19 this, but, uhm, I was lucky enough to go to the 20 point of abuse, like abusing myself to the point 21 where I realized I needed help. 22 I was sitting -- I was sitting in a jail cell 23 on Rikers Island, at the bottom, at my rock bottom, 24 when I realized I needed help. 25 And, I was lucky enough to get referred to 1 Dynamite, actually. 2 I was lucky enough to get referred to this 3 program, where, I mean, just the model is so much 4 more intense. It's not just, like, about taking the 5 drugs away, because there's so much underlying the 6 drugs. 7 You take that out of the picture, but there 8 was just so much more damage that I had done to 9 myself, like, emotionally, behavioral-wise, and, 10 just, there's so much underlying the drug use that 11 needed attention, that I was able to get the help. 12 SENATOR GOLDEN: Thank you very much. 13 CHALID HUSSEIN [ph.]: Thank you. 14 SENATOR GOLDEN: Do me a favor, anybody else 15 wants to briefly, and you don't have to share. 16 I know honesty is a big part of this program. 17 We just want to see the importance of the 18 program, and try to -- how the program has helped 19 you. 20 JOE: My name is Joe, I'm 24 years old. I'm 21 currently with Dynamite Youth Center. 22 I have been to countless detoxes, countless 23 30-day rehabs, 60-day rehabs. 24 SENATOR GOLDEN: How old are you? 25 JOE: 24 years old. 1 SENATOR GOLDEN: Go ahead. 2 JOE: My addiction started, I was 21 years 3 old, I was injured in an accident. I was prescribed 4 Oxycontin. 5 Within a month, I was, you know, addicted, 6 bad. 7 Six months later I was IV'ing heroin, which 8 led me to -- you know, in between that time period, 9 I was in countless detoxes. I couldn't even tell 10 you. 11 I'm a resident -- I was a resident from 12 Staten Island. 13 Countless detoxes. 14 Landed me in my first rehabilitation center 15 in Florida. I was there for 30 days. 16 Halfway house, my parents had continued to 17 send me from one place to another. 18 I became homeless a dozen times, you know, in 19 three different states. Bounced around all over the 20 place. 21 I came to my realization 18 months ago. 22 Walked into Dynamite. 23 I was in a shelter in Staten Island. I was 24 sitting on a cot. I had lost everything. 25 I come from an upper middle-class family, 1 grew up good, good high schools. 2 You know, sitting on a cot, homeless, in the 3 street, back in Staten Island, and had realized that 4 I didn't want to live this way anymore. I was going 5 to die. I had overdosed four times. I almost lost 6 my left arm. 7 And, I'm 18 months sober now, due to 8 long-term treatment. 9 UNKNOWN SPEAKER: Congratulations. 10 SENATOR GOLDEN: Very good. 11 [Applause.] 12 SENATOR BOYLE: Quick question, I'm sorry. 13 Describe the first time you tried heroin. 14 So you're injured, you tried Oxycodone, 15 opioids. 16 The first -- could you say, Well, it's 17 cheaper? 18 Did someone say, Hey, we can get it, this 19 thing, for the same high? 20 Or how did it work? 21 JOE: Well, for oxycodone, Oxycontin, at this 22 point, at $25 a pill, I mean, my habit had increased 23 to $200 a day. 24 Now, I have been -- you know, I was let go. 25 I had worked for a family business. I was let go, 1 because of stealing, and other, you know, things 2 I was doing. 3 So, I mean, to support that was -- you know, 4 it was astronomical, which had led me to, you know, 5 a cheaper -- you know, a cheaper high. 6 SENATOR BOYLE: Financially. 7 JOE: Financially cheaper, you know, which 8 had brought me into -- you know, dealing with pills, 9 you're dealing with an upper -- you're dealing with 10 a middle-class group of people, growing up on 11 Staten Island. 12 Doing heroin, and other drugs that I had 13 explored, it led me into bad places. You know, bad 14 areas. 15 You know, so... 16 SENATOR BOYLE: Thank you. 17 JOE: You're welcome. 18 SENATOR BOYLE: Good luck. 19 SENATOR GOLDEN: If there's just two more, if 20 we can, because it's near our end. 21 And do me a favor, again, just be brief, and 22 help us out, where you think you can give us a 23 description of how we can be more helpful, as a 24 Task Force, to get more help for you, and for your 25 family. 1 LEEANN [ph.]: My name is Leanne. I'm 25, 2 and I'm part of Dynamic Youth. 3 And, you were speaking before about, like, 4 how -- you were wondering if marijuana was a gateway 5 drug, and that's exactly how I started. 6 I started drinking and using marijuana, and 7 also with the Vicodin, that was the opening for the 8 opioid addiction for me. 9 SENATOR GOLDEN: Did you know Vicodin was 10 heroin? 11 LEEANN [ph.]: No, not at the time. 12 At the time, I didn't have an injury. I was 13 just experimenting. And a lot of, I guess it was 14 peer pressure, were taking it. And once I did that, 15 it just led on and on. 16 It was more of like a tolerance thing for me, 17 where that wasn't enough, so I moved to Oxycontin, 18 and then eventually to heroin. 19 And for me -- 20 SENATOR BOYLE: Was that a financial thing 21 for you, too -- 22 LEEANN [ph.]: Absolutely. 23 SENATOR BOYLE: -- because you realized 24 Oxycontin was so much more expensive? 25 LEEANN [ph.]: Absolutely. I mean, it was a 1 tolerance thing, where I would have to -- at the 2 time, I felt like I needed it, or else I would, you 3 know, withdraw. 4 And, so, it was a financial thing, it was a 5 tolerance thing. 6 And I've been to countless 28-day rehabs, 7 30-day rehabs, where I would get out and I would use 8 right away, because I felt very awkward in society. 9 I was just taken out for a little bit, just 10 to, pretty much, for me, I feel like it's just 11 getting the drugs out of your system at that point. 12 Where, someone said that -- you know, my 13 mother wanted me to go in, and I was still battling, 14 like: I don't need to be here. This is not me, I'm 15 not like them. 16 You know? 17 So, with the long-term treatment, for me, 18 I feel like there's no other way, than to go away 19 for a while, to get out of -- see, I'm from 20 Staten Island. I needed to get away from there. 21 And, also, it's long enough for me to feel, 22 like, comfortable without using, because I've been 23 using for so long, that I can interact with other 24 people. I can learn how to, like, just be in life 25 without, you know, using after so long. 1 And then, coming down, also, the big part for 2 me was maintaining it. Going to, you know, the 3 outpatient part, you know, five days a week, and 4 adjusting back in, because that's where I mess up, 5 where I feel uncomfortable, and stuff like that. 6 You know what I mean? 7 So, for me, to get into Dynamite, it took an 8 arrest, which, honestly, was -- it was a bad time in 9 my life, but it was the best thing that ever 10 happened to me, because it got me in; it opened my 11 eyes. 12 And I feel like that's a big thing for a lot 13 of people, sometimes that is case. 14 And, unfortunately, that was my case, but, it 15 was the best thing, you know, that ever happened to 16 me. 17 SENATOR NOZZOLIO: When you were arrested, 18 what was the next step? 19 LEEANN [ph.]: The next step was, they 20 already knew my history of me trying to get clean 21 before; going into rehabs was not working. 22 And they said: You know, you can't just do a 23 28-day. It doesn't work for you. 24 So they said, you know, "You should go away 25 for a while," and they told me to go away for 1 nine months. 2 In Dynamite, you know, my nine months went 3 up, and I was, like, "I'm not leaving. This is 4 great. You know what I mean? I'm not going to 5 leave this place. It just saved my life, and I'm 6 going to continue with it." 7 So that's what I did at that point. 8 But, I don't -- you know, I could have gotten 9 to a worse place, if that -- if I didn't get stopped 10 there. You know, I feel like it was like a sign, or 11 something. That's how I look at it. 12 SENATOR NOZZOLIO: Thank you. 13 SENATOR GOLDEN: Well, coming back to you 14 guys in a minute, anybody else wants to share? 15 SENATOR BOYLE: Got one more back there. 16 SENATOR GOLDEN: Okay. 17 We're going back to the panel, shortly. 18 If there's anything that you think we left 19 out, that we should be focused on, please, give 20 us -- right after this person, give us some 21 direction. 22 Go ahead. 23 PATRICK: Hi, my name is Patrick. I'm 21 24 years old, and I am a member of Dynamic Youth 25 Community. 1 And the thing I wanted to stress the most was 2 about how the insurance companies treated me, 3 because Dynamic Youth Community is my 4 17th program. 5 I started at the age of 16 with the opiates. 6 I was in lacrosse accident, and I shattered my 7 thumb, and the doctor, he prescribed me Roxicodone, 8 and he said I had "the good stuff." 9 Didn't even -- which I thought was absolutely 10 terrible. He didn't explain to me how addictive the 11 substance was, or anything about that. 12 I mean, I don't even know if he was educated. 13 But the way it worked with the insurance 14 companies was, I go to a 30-day program, and then 15 they would say, "No, you need two weeks," even 16 though it was against what the -- what they had 17 said -- what the rehabilitation center had said. 18 So I kept going back and forth through that, 19 and it ended up being a disaster. 20 I went from program to program to program, 21 until finding a long-term treatment program, which 22 showed how to -- along with the addiction, how to 23 rebuild your life skills, which someone who became 24 an addict as young as I did, did not achieve. 25 So now -- now, aside from the addiction and 1 learning how to stay sober, and learning how to 2 stay -- learning how to have fun again in recovery, 3 now I know how to hold a job, how to -- 4 UNKNOWN SPEAKER: [Inaudible.] 5 PATRICK: And, I just wanted to know if 6 there's any steps that you guys are taking in order 7 to go against what the insurance companies are 8 saying? Or, with the funding, how it's going the 9 work towards long-term treatment? 10 Because, obviously, the success rates with 11 that, with extreme cases like me and some of my 12 peers that are here, what's going to happen? 13 What are the steps that are going to be taken 14 to go forth with that? 15 SENATOR GOLDEN: Well, I believe I'm going to 16 let the Chairman speak to that in the a moment. 17 But I'm going to tell you, the more I listen 18 here, and the more I see you stand up and tell me 19 how many times you've gone to detox, how many times 20 you've been in programs, how long it took you to 21 finally get it, and to get the help that you needed, 22 it looks like it was extremely more costly, had we 23 made the investment up front and put you into a 24 program that would have fixed you and put you on the 25 right track in the first place. 1 I think it was much more costly, the path 2 that many of you have taken, unfortunately. 3 But I guess that comes to the professionals, 4 and understanding and keeping the -- those different 5 people that are affected in the program. 6 I guess, then, how long that program lasts 7 is -- and you guys have to make the diagnosis, as to 8 what the -- you know, what that deadline or what 9 that timeline is. 10 So I do believe that, the more we look at 11 this, the more we hear, the smarter thing to do here 12 is to make the investment up front, and sooner. 13 Of course, having to deal with our insurance 14 companies and Medicaid and the redesign team here in 15 the state of New York, as well as the Obama health 16 care, is going to be a lot more difficult to do than 17 what I've just said. 18 Chairman. 19 SENATOR BOYLE: Yes, Senator Golden, 20 I couldn't agree more. And, we've heard this over 21 and over again, and whether it's 4 rehabs, or 17, it 22 really is, the system is not the most efficient that 23 it can be, in terms of tax dollars, and helping 24 young individuals, such as yourselves, to go through 25 recovery, and an important thing Patrick said, 1 learning the life skills that you weren't able to 2 the first time. 3 And that's exactly what we're going to look 4 to do as part of this Task Force. 5 And when we issue our report, which is going 6 to come out June 1st, you can look at it, and I can 7 promise you young people that what you said here 8 today is going to be part of that report. 9 And we've learned a lot from you. 10 I appreciate it very much. 11 Our panelists, if you'd like to, any final 12 comments or thoughts? 13 SENATOR GOLDEN: Mr. Fusco, I know you got a 14 word or two. 15 [Laughter.] 16 GARY BUTCHEN: That's why I'm going to go 17 first. 18 You have a Herculean task in front of you. 19 There are so many moving parts to this 20 problem; from the physicians who spoke earlier about 21 the medicines that are available to us; versus the 22 stigma; to the woman who spoke earlier about the 23 debacle in sober homes; to the -- really, the 24 Mason-Dixon Line between the Medicaid and managed 25 Medicaid versus pure commercial insurance plans; and 1 what the juggling act that all of us sitting here 2 have to deal with every single day. 3 The system that exists, and the variety of 4 programs that we all offer, does have remarkable 5 outcomes, when the people who have tried 17 times; 6 or 16 times, try the 17th time to get in. 7 That should never be the case. 8 What I'm imploring you to do, is really take 9 a good hard look at "medical necessity," regardless 10 of whether it's 4623, or any other version of it. 11 Because, if this panel, if we were replaced 12 by the medical directors of the managed-care 13 companies operating in New York State, they would 14 convince you that they've got fantastic policies 15 that dictate medical necessity for the treatment of 16 addictions. 17 The problem is, they're all different, 18 they're all proprietary, and they're not shared with 19 their own provider network unless you FOIL them. 20 If New York State puts on the books a 21 definition of "medical necessity" that they all have 22 to be held accountable to, then what we were talking 23 about earlier would bear better results. 24 SENATOR BOYLE: We are going to. That's one 25 thing I'm pretty certain is going to come out of 1 this in terms of insurance. 2 When we deal -- when I've talked to 3 10 different insurance companies with 10 different 4 definitions of "medical necessity," and all of them 5 are trying to sneak their way out of coverage, 6 basically, we're going to put their feet to the 7 fire, I can promise you. 8 And thank you for those comments. 9 SENATOR NOZZOLIO: Well, in our -- and you 10 mentioned this earlier, Mr. Butchen: You pay them 11 now or you pay them later. 12 I mean, that's the kind of issue that, you 13 have a problem that can be dealt with financially, 14 appropriately, and significantly now; or we pay more 15 because the problem wasn't resolved. 16 KAREN CARLINI: Last week I attended the 17 National Prescription Drug-Abuse Conference in 18 Atlanta. And for three days, they threw all sorts 19 of statistics to us, many of which we know, and we 20 know in New York, it's happening all over the 21 country. 22 But one of the things they talked about was, 23 just in this last decade, 125,000 people died from 24 overdose from just hydrocodone. 25 And that number was just compelling to me. 1 For all I know and for all I hear, that 2 number was compelling, because they talked about, if 3 we did a moment of silence for those 125,000 people, 4 it would take three months to accomplish; 5 And that it's, also, twice as many people who 6 died in Vietnam. 7 And when we think about the spillover from 8 Vietnam, and everything that's happened as a result 9 of what people suffered in Vietnam, where are we 10 going to be as this problem continues? 11 The thing that made me feel good, or what 12 I walked away with, was in every workshop, every 13 plenary, every session that I attended, everyone had 14 the same message about collaboration. 15 And I think we're finally there. 16 I can't thank this panel enough, and what's 17 happened, you know, in the New York Senate, in terms 18 of pulling us all together as a group, and every 19 component of it, because, without collaboration, 20 this is not going to get solved. 21 And as Gary said, there's so many different 22 pieces. And we're trying to balance that, as well. 23 I mean, to us, it's like a moving machine 24 every day; it changes, and what we have to do. 25 So I think what -- maybe what we're asking 1 is, that you be sensitive to the fact that we don't 2 overregulate. 3 You know, we don't want to look at, you know, 4 and talk about law enforcement, we want to make sure 5 that those that need treatment get treatment. 6 Those that -- you know, so we look at that. 7 When we look at prevention, we look at 8 education. 9 We look at what we have to -- we do have to 10 mandate people to do, but that you lean on the 11 treatment community to help provide that, because of 12 our experience. 13 Like Bill said, we're 43 years. 14 You know, I'm with the program 42. 15 Bill's with, from day one. 16 So, we've certainly seen it all -- well, no, 17 we haven't seen it all, unfortunately. 18 This was a lot for us. More than we had seen 19 in the 30 years in the past. 20 So, we have work to do. 21 But, again, I thank you, and appreciate the 22 effort. 23 SENATOR BOYLE: Thank you Karen. 24 Thank you very much. 25 Yes. 1 RUCHAMA CLAPMAN: I'd like to touch on the 2 issue of family. 3 The families -- once the young adult is put 4 into rehab, the families must get educated, whatever 5 they're learning in the rehab, so when the kid gets 6 out, the family recognizes the red flags, et cetera. 7 But, prevention is the number one message 8 that I'd like to leave today with; is that, a 9 regular parent, after interviewing 15,000 parents, 10 I interview every family myself, and the one thing 11 for sure, they don't know the connection between 12 their medicine cabinet and heroin, opiates, or 13 anything. 14 So, ads, user-friendly, to a regular mom and 15 dad that are not in the drug community, is very 16 important. 17 And, also, prevention in the elementary 18 schools, to make it more user-friendly, so that it 19 gets translated from their point of view; not from 20 adults and us that are sitting at the tables. 21 Thank you very, very much for today. 22 SENATOR BOYLE: Thank you. 23 SENATOR GOLDEN: Thank you. 24 JAMES HOLLYWOOD: And all I can do is 25 reiterate the -- what the panel said here, is, 1 really, it's a broad-based approach that will 2 soften, or try to solve, this problem: from 3 education, from prevention, from the use of Naloxone 4 and first emergency responders for the families 5 members, for those suffering with addiction, as 6 well. 7 And, really, to look at the need for a 8 spectrum of treatment intervention. 9 Community-based care, community-based detox, 10 does work and is effective. 11 Medication-assisted treatments are important. 12 They mentioned it earlier, the first panel: 13 methadone and Suboxone and VIVITROL, and the like, 14 finding the right mix for people. 15 And an important thing to recognize the need 16 for, the severely addicted, is a long-term 17 residential treatment does work; has been an 18 effective part of the New York State model in 19 treating addictions. 20 You know, over the past 30 years, starting 21 with the DTAP and TASK initiatives, have solved a 22 great problem of court diversion, and the need for 23 court diversion; and, so, it has served the state 24 well when that was a crisis, when crack cocaine was 25 a crisis. When jails were overcrowded. 1 And I think it will serve a great role, 2 moving forward, during this epidemic, is to be able 3 to provide long-term care for those who need it, as 4 the members of this audience sort of testified to. 5 SENATOR BOYLE: Thank you. 6 WILLIAM FUSCO: Senators, could I just say, 7 back in 2007, Jerry Kasar [ph.] -- 8 SENATE A/V PERSON: [Not using a microphone.] 9 I don't mean to interrupt. We've got to get 10 all this in, and then change the tape. And then you 11 can -- 12 SENATOR GOLDEN: Two minutes. 13 WILLIAM FUSCO: I've got two minutes, that's 14 simple. 15 KAREN CARLINI: No, no, no. He has to change 16 the tape in two minutes. 17 WILLIAM FUSCO: Oh, two minutes to wait? 18 We have a couple kids that can sing back 19 here. 20 SENATOR GOLDEN: Well, I got to tell you, 21 I got to give all these kids credit. 22 I tell you, you guys are the lucky ones. 23 Right? 24 [Applause.] 25 SENATOR GOLDEN: How many kids don't make it? 1 How many people, and how many more wakes are 2 we going to go to? 3 How many more families' hearts are going to 4 be broken? 5 So, God has been good and gifted you. 6 And I thank you. 7 And I thank all the different providers here 8 today for the great work that they've been able to 9 do, to return these young men and women back to 10 their families and to the society, and to allow them 11 to go forward and to be productive. 12 So, we thank you, too, this panel, for all 13 its good work that they've done, and they continue 14 to do. 15 Give this panel a round of applause, and the 16 previous panels. 17 [Applause.] 18 WILLIAM FUSCO: I did want to mention, 19 Senator, that back in 2007, Jerry Kasar and myself, 20 under your leadership, went to Albany and talked 21 about the tremendous amount -- the tremendous 22 percentage of prescription drugs, young people that 23 were coming into our program. 24 And at that time, we were told that nobody 25 can tell the AMA what to do. 1 And, we've been on a mission ever since, 2 trying to say, as we saw what was happening in our 3 communities. 4 And I do have to say, I think one of the 5 things that we try to tell the young people here, 6 who don't necessarily come forward all the time, 7 that they're contributing. 8 That it's time that people come out and say 9 what's going on. 10 And that's part of the solution. 11 And I think they see themselves as part of 12 the solution now. 13 Thank you. 14 SENATOR GOLDEN: For those that testified 15 here today, I just want to say, all of my colleagues 16 here today that came in from across the state, take 17 this very, very seriously. 18 And they're all approachable. 19 So if there's something that you did not get 20 out, that you're -- either you're one of the ones 21 that testified, or if you're one of the audience, 22 please, contact any one of us. 23 The Chairman will make sure that it's taken 24 into consideration, any of your thoughts that you 25 have that that may not have been brought up, that 1 you -- you know, you're walking out the door and 2 said, "Gee, I should have said this." 3 Please, we are all approachable. 4 SENATOR BOYLE: Thank you. 5 Mr. Vice Chairman, any final comments? 6 SENATOR NOZZOLIO: There was one lady that 7 asked to speak, in the blue? You rose your hand a 8 couple of times? 9 I don't know if anybody saw you behind the 10 post here, but I did. 11 AUDIENCE MEMBER: I practice in Bay Ridge. 12 I'm a medical provider. I know what's being done to 13 look into -- 14 UNKNOWN SPEAKER: They can't see you. 15 AUDIENCE MEMBER: Oh. 16 Hello. 17 I'm not a very good public speaker. 18 But I know what's being done to -- in terms 19 of monitoring pharmacies and physicians, and we're 20 aware of this. 21 What is being done to get the drugs off the 22 streets? 23 If we had no heroin, would we be even having 24 this discussion today? 25 SENATOR NOZZOLIO: I don't know if you were 1 here when the prior panel was here -- 2 AUDIENCE MEMBER: I was. 3 SENATOR NOZZOLIO: -- but, 4 Attorney McGoldrick and a detective went through a 5 laundry list of items that are ongoing deficiencies, 6 not necessarily in the punishment statutes, but in 7 the investigative areas. 8 And that we're going to be working, in terms 9 of helping eliminate a lot of the supply that the 10 taxpayers actually are paying for, in putting it out 11 into the streets. Not the taxpayers, but other 12 unscrupulous individuals are putting it out into the 13 street. 14 And I think that's certainly something. 15 And our mission, stated by Chairman Boyle, is 16 threefold: 17 It's prevention, first; 18 Treatment, second; 19 And, prosecution, third. 20 And that's an approach, a lot of moving 21 parts, as Gary said, but that's what we're focused 22 on. 23 AUDIENCE MEMBER: Do you feel that it's 24 working? 25 SENATOR NOZZOLIO: Obviously, if it was, we 1 wouldn't be here. 2 I think much of it's working. 3 When I see our young people in the center 4 here, standing up and saying they're drug-free, that 5 gives us hope. 6 And that's -- it can be done, if it's done 7 the correct way. 8 And that's what you all have given us 9 evidence about today. 10 But as our law-enforcement officers have 11 given us evidence today, that it's a problem where a 12 lot more resources need to be deployed to defeat it 13 at that end. 14 Again, it's many moving parts to this very 15 important problem. 16 And thank you, from my personal standpoint, 17 for adding to the discussion in a very, very great 18 way. 19 Thank you. 20 SENATOR BOYLE: And I'd, too, like to thank 21 you, Vice Chairman Nozzolio. 22 And, Senator Golden, thank you for hosting 23 this forum. 24 Thank you to our panelists, and each of the 25 panelists. 1 And to the young people, best of luck in your 2 recovery. We'll be praying for you. 3 And, thank you for everything. We got a lot 4 of good ideas out if this. 5 And as Senator Golden said, if you think of 6 something you didn't remember to say now, contact 7 our office, because we've got until June 1st. 8 Thank you very much. 9 [Applause.] 10 11 (Whereupon, at approximately 12:42 p.m., 12 the forum held before the New York State Joint 13 Task Force on Heroin and Opioid Addiction 14 concluded, and adjourned.) 15 16 ---oOo--- 17 18 19 20 21 22 23 24 25