Public Forum: Sullivan County Panel Discussion on Monticello'S Heroin Epidemic

PANELIST INTRODUCTIONS:PAGE 7 2

Izetta Briggs-Bolling 3 Executive Director

The Recovery Center 4

Nolly Climes 5 Program Director

Rehabilitation Support Services 6

James Farrell 7 District Attorney

Sullivan County 8

Dr. Carlos Holden 9 Physician

Catskill Regional Medical Center 10 Also, Medical Director for

Mobile Medic EMS 11

Captain Jamie J. Kaminski 12 Zone Commander

New York State Police, Troop F 13

Peter Laizure 14 Parent 15 Nancy McGraw

Director 16 Sullivan County Public Health Department 17 Nick Roes

Executive Director 18 New Hope Manor 19 Michael Schiff

Sheriff 20 Sullivan County 21 Larry Thomas

District Superintendent 22 Sullivan County BOCES 23 Joseph Todora

Director 24 Sullivan County Community Services 25 1

PANELIST INTRODUCTIONS (Continued): 2 3 PERSONAL STORY PAGE 11 4 START OF PANELIST PARTICIPATION PAGE 12 5 AUDIENCE PARTICIPATION AND Q&A PAGE 64 6 7 ---oOo--- 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 1 SENATOR BONACIC: Can you all hear me? 2 First of all, let me say, good afternoon. 3 I'm Senator Bonacic, and to my left is 4 Senator Boyle who's Chairman of this Senate 5 Task Force, to see what we can do to combat the 6 rising epidemic of heroin use. 7 I want to thank our distinguished panelists 8 that are here today. 9 This is an informal -- an informal meeting. 10 What I would like to do, is I'm going to let 11 Senator Boyle make some preliminary remarks. 12 By the way, there are 17 of these statewide 13 forums. This is Number 11. 14 And at the end of May, under the leadership 15 of Senator Boyle, we hope to put forth some kind of 16 comprehensive package, that might include 17 legislation, that might include some infusion of 18 money to be put in critical areas, to help combat 19 the acceleration of the uses of heroin. 20 After Senator Boyle completes his remarks, 21 I'm just going to ask the panelists to briefly 22 introduce themselves, and then we're going to open 23 it upper with questions to the panelists. They're 24 going to share their experiences. 25 And then we're going to ask the audience if 1 you have anything to share or have a question of 2 anyone here. 3 I will tell you that I consider myself a 4 novice when it comes to the subject of heroin or its 5 use, and what is to be done. 6 Quite frankly, I'm here to learn from the 7 experts around this room. 8 So, Senator Boyle, would you like to share 9 some remarks? 10 SENATOR BOYLE: Thank you, Senator. 11 SENATOR BONACIC: Let's make sure your thing 12 is on [adjusts microphone]. 13 SENATOR BOYLE: Thank you, Senator, and thank 14 you for hosting this forum; and to this 15 distinguished panelists from Sullivan County and the 16 surrounding areas, and to everyone who came here 17 today to share and to learn. 18 As Senator Bonacic said, this is the eleventh 19 of 17 forums. 20 We're going to be wrapping it up probably 21 next week. 22 And this includes, I'm from Suffolk County 23 out on Long Island, all the way up to 24 Western New York, where one of the upcoming ones is 25 going to be in the Seneca Nation. 1 So this is -- this heroin and opioid epidemic 2 is pervasive in all communities, all socioeconomic 3 levels. 4 And, we're learning some more about it in the 5 10, now 11, forums that I've been to. 6 There are some similarities in each one, and 7 something different in each one, and that's what 8 we're trying to take away. 9 What I would suggest is, for our panelists 10 and for the members of the audience, whether you're 11 a treatment provider, prevention expert, a 12 law-enforcement official, or a family member, or an 13 addict themselves, if you are affected negatively, 14 obviously, by this heroin epidemic and you say to 15 yourself on a daily basis, "If I could just change a 16 law or two to make it better, to help fight this 17 epidemic, this is what I would change," that's what 18 we want to hear about today. 19 Or if you know of a program that has been 20 helpful for your family member, that has worked, 21 tell us about it. 22 If there's one that hasn't worked, then say 23 "This is a waste taxpayer money." Let us know about 24 that, too. 25 We're trying to get as many -- as much 1 information as possible. 2 The idea for the Task Force, and, obviously, 3 Senator Bonacic is an important member of that 4 Task Force, is to report by June 1st, and then 5 we're going to immediately introduce significant 6 legislation in the days following, and get it passed 7 in this Senate session, and hopefully passed into 8 law, as well, to begin combating this heroin 9 epidemic. 10 I appreciate Senator Bonacic again hosting 11 it. 12 Thank you so much. 13 SENATOR BONACIC: Okay, so why don't we start 14 with Jim Farrell, our good District Attorney from 15 Sullivan County. 16 Jim. 17 DA JAMES FARRELL: Right here. 18 SENATOR BONACIC: Yeah, I can't see too well. 19 SENATOR BOYLE: He's blind. 20 [Laughter.] 21 SENATOR BONACIC: Yeah, no, introduce, just 22 for the -- 23 DA JAMES FARRELL: My name is Jim Farrell. 24 I'm the Sullivan County DA. I've been the DA since 25 2010. 1 My career in law enforcement started here in 2 Sullivan County in 1995, and as an assistant 3 district attorney. And, then, finally being elected 4 to DA in 2010. 5 I was reelected last year for another 6 4-year term. 7 JAMIE J. KAMINSKI: Jamie Kaminski. I'm the 8 Captain, Zone Commander, for the New York State 9 Police in Troop F, in charge of uniformed troopers 10 in Sullivan County. It's about 60 members. 11 I've been in policing for 27 years. 12 JOSEPH TODORO: I'm Joe Todora. I'm the 13 director of community services for Sullivan County, 14 which is the mental-health director for the county. 15 We also are a provider of OASAS-licensed 16 outpatient mental-health services, and are 17 responsible for developing the local government plan 18 for behavioral-health services to meet the needs of 19 the community. 20 NANCY McGRAW: I'm Nancy McGraw. I'm the 21 public-health director for Sullivan County for the 22 last year, almost. 23 Before that, about eight years as deputy 24 public-health director. 25 And I'm also a licensed clinical social 1 worker. 2 And in Public Health, one of our primary 3 missions and goals is to prevent illness and 4 disease. 5 PETER LAIZURE: My name is Peter Laizure. 6 I'm the father of an addict who's experienced all 7 phases of addiction, and tragically lost my son last 8 October. 9 DR. CARLOS HOLDEN: My name is Carlos Holden. 10 I'm a board-certified emergency physician. 11 I'm the medical director of the emergency 12 department at Catskill Regional Medical Center. 13 I'm also the medical director for 14 Mobile Medic EMS. 15 So, I'm involved in both the pre-hospital and 16 in-hospital care for, you know, all emergency 17 medical conditions. 18 SHERIFF MICHAEL SCHIFF: Mike Schiff, 19 Sullivan County Sheriff. Retired from the 20 State Police. 21 With my State Police time, and Sheriff, 22 36 years in law enforcement. 23 NOLLY CLIMES: Nolly Climes from 24 Rehabilitation Support Services. I'm a program 25 director serving both Sullivan and Orange county. 1 We provide residential programs for people 2 with a history of mental illness, as well as 3 care-management services. 4 We also have programs to serve families and 5 their children, primarily to prevent placement out 6 of the homes. 7 LAWRENCE THOMAS: I'm Larry Thomas. I'm the 8 district superintendent for the Sullivan County 9 BOCES. 10 I've been the BOCES District Superintendent 11 for about 5 years, but I'm finishing up 40 years in 12 education. 13 NICK ROES: My name is Nick Roes from 14 New Hope Manor in Barryville. 15 We're an all-female residential 16 substance-abuse treatment center, where I've been 17 there for over 25 years now. 18 And I also teach for Brown University, their 19 online addiction courses. 20 IZETTA BRIGGS-BOLLING: Hello, I am 21 Izetta Briggs-Bolling, executive director for 22 The Recovery Center. 23 We provide a comprehensive array of services, 24 from detox services -- [grabs microphone]. 25 We provide a comprehensive array of services, 1 from detox, to scattered-site housing throughout the 2 community, which include residential treatment for 3 men and women, outpatient day treatment services, 4 prevention services, voc ed, and HIV services. 5 SENATOR BONACIC: Okay, let me start, I think 6 I'm going to go to Mr. Pete Laizure. 7 Pete, tell us your story and your experience 8 with your son, please. 9 And before you speak, thank you for your 10 courage -- 11 PETER LAIZURE: Thank you. 12 SENATOR BONACIC: -- for you being here to 13 tell your story. 14 I know it's painful every time you have to do 15 this. 16 PETER LAIZURE: Thanks. 17 Thank you. 18 I lost my son Ryan last October, 23 years 19 old. 20 I went with Ryan, from some gateway drugs, 21 alcohol and marijuana, graduating to prescription 22 painkillers. 23 When that got too expensive, moving on to 24 heroin. In the beginning, smoking and sniffing. 25 And when that wasn't good enough, moved on to 1 IV-drug use. 2 This went on for four years, in and out of 3 rehab facilities. 4 In the end, you know, 12 hours before he was 5 going to go back into a detox facility and another 6 rehab, he, what we believe tried to do, is get high 7 one more time. And the drug dealer shot him in the 8 head, and a couple days later he passed. 9 SENATOR BONACIC: Thank you, Peter. 10 We have no order in terms of who should speak 11 on the panel. 12 You heard Senator Boyle say we're looking for 13 suggestions. 14 Maybe those that treat heroin addicts, and 15 the programs, could jump in and share some of your 16 experiences with us to help educate us. 17 NICK ROES: I could start. 18 SENATOR BONACIC: Yes, please do. 19 NICK ROES: I see one of the main problems is 20 that there's -- 21 SENATOR BONACIC: I would get closer to the 22 mic. 23 NICK ROES: I think one of the main problems 24 is that there's three separate systems that are 25 designed to help the heroin user, and so there's a 1 lot of duplication of effort and waste of money, and 2 sometimes the systems work against each other 3 instead of working for each other. 4 So depending on which system the person first 5 presents themself to, if they present themselves, 6 say, to the primary-care physician, they might be 7 treated for falling down the steps, being in a car 8 crash, cirrhosis of the liver, high blood pressure, 9 anemia, a lot of other things, without ever treating 10 the addiction that might be at the basis of that. 11 So that's one of the problems, is that we 12 need a more integrated system of care. 13 And, also, in the substance-abuse treatment 14 side, there's 11 different licenses that they have, 15 so people can't really get continuity of care. 16 There's always changing to a new counselor or 17 something like that. 18 So I think the problem is, we designed the 19 system and the way we fund it on the basis of what 20 we knew 50 years ago. 21 And now that we know better how to help 22 people, we shouldn't keep with the system that was 23 designed before we knew how to help people. 24 So, we need to reimburse for services that 25 are really helpful, and not reimburse for some 1 services that aren't helpful. 2 SENATOR BONACIC: Thank you. 3 Maybe someone could talk about the 4 effectiveness of Narcan. 5 I understand that, from the other forums and 6 what I'm reading in the paper, that maybe this 7 particular drug combats a heroin addiction 8 immediately, someone that's going through 9 withdrawals, perhaps it should be carried in a kit 10 by EMS, by police cars. 11 Is it effective? 12 Can anybody share their experiences? 13 DR. CARLOS HOLDEN: Yeah, I'd be happy to 14 address that. 15 Narcan, or the generic name is "naloxone," 16 has been available for a long time. It's 17 inexpensive. 18 It is very effective in treating opioid 19 overdose. 20 So folks who have -- you know, are not 21 breathing very well because of either heroin or an 22 opiate-pill overdose, Narcan immediately reverses 23 that. 24 It's safe. There's no problem giving to it 25 somebody if they've overdosed on another drug. 1 It's widely available. 2 And recently there was an internasal 3 formulation of it. It's, essentially, like a nasal 4 spray, so you don't need any medical training to 5 administer it. 6 It's just like, you know, a nasal spray that 7 you might take for allergies, or something like 8 that. 9 In Richmond County down in Staten Island, 10 they actually have expanded the use of that. 11 They're having, pretty much, every first responder 12 carry it. 13 We do have it available here for our 14 paramedic ambulances, but most of our BLS ambulances 15 don't carry it, nor do law-enforcement officers. 16 I think wider availability of that medicine 17 would be very helpful in terms of, you know, saving 18 lives for acute opiate overdoses. 19 SENATOR BONACIC: Does anyone know the 20 insurance practice, if a person tried heroin, had a 21 withdrawal, and they wanted to access Narcan? 22 Does the insurance company pay right away, or 23 must there be multiple utilizations? 24 DR. CARLOS HOLDEN: Narcan is not really for 25 dependence. It's not for the long-term kind of 1 dependence. It's more for an acute overdoes. 2 There is another medicine, the brand name is 3 "Suboxone," that you may be referring to. And that 4 is, you know, more like long-term dependence 5 treatment. 6 And probably some of the other panelists can 7 better address that, that medicine, than I can. 8 SENATOR BOYLE: If I could, Doctor, that's 9 one of the things we're finding in some of the other 10 counties and other forums, is the disparate use of 11 Narcan among -- like, for example, Suffolk County 12 where I am, we hosted one, and I hosted one myself, 13 a Narcan training session for laypeople. 14 You don't have to be a police officer, you 15 don't have to be a first responder. 16 If you take this 40-minute class -- it's not 17 three weeks, it's 40 minutes -- and you get home -- 18 come home with a kit. 19 And it will, certainly -- Senator Bonacic 20 will do something similar around here, to get it out 21 as widely as possible. 22 One thing I find, though, and it's 23 interesting, because it depends on what your health 24 commissioner of your county has a different 25 procedure for each county. 1 I've gone to several of them, they have 2 different rules. 3 So one of the things we're looking for is to 4 make a unified system to say: This is who can use 5 Narcan and naloxone, and these are not -- you can't. 6 You have to take the class. That's the only 7 thing. 8 Yeah. 9 JOSEPH TODORO: And I do believe it would be 10 very helpful to make it a little wider-spread 11 availability. You know, family members, you know, 12 the treatment facilities ourselves, as well as some 13 of the other public-health facilities. 14 NANCY McGRAW: If I can address some of what 15 we've done so far, in terms of the -- we have a 16 local Sullivan County Prescription Drug-Abuse 17 Prevention Task Force that has been in existence for 18 at least a couple of years, and that's through 19 Public Health, and through a -- sponsored by a grant 20 we have through the State Office of Rural Health. 21 One of our primary goals is to reduce 22 premature mortality in this county, which is one of 23 the highest in the state. 24 And a significant portion of that is due to 25 drug overdose and accidental and intentional 1 poisonings. 2 So, in terms of the Narcan training, we had 3 worked with our task-force members, which includes 4 many of the people who are sitting on this panel 5 today, as well as some people in the audience, and 6 we sponsored a training at The Recovery Center for 7 27 people. This was last August. 8 So, that was our initial attempt to get these 9 kids, and get the training out there into the 10 community. 11 We are currently working with the 12 Sheriff's Office to identify some training 13 opportunities for law enforcement, as well as with 14 EMS. 15 So that's something that's high on our radar 16 screen right now. 17 SENATOR BOYLE: Now, can you tell me, in 18 terms of the first responders, do volunteer 19 firefighters have Narcan on their trucks? Do you 20 know? 21 UNKNOWN SPEAKER: [Off video.] No, I don't 22 believe so. 23 UNKNOWN SPEAKER: [Off video.] Not yet, no. 24 SENATOR BOYLE: That would be a good place, 25 too, because I'm one. We often to the get scene 1 before the ambulance does. 2 SENATOR BONACIC: I have a stupid question, 3 because I told you I'm naive. 4 If there's an acute overdose of heroin, and 5 they take Narcan, is it just gets them through that 6 withdrawal period? 7 Does it diminish, in any way, the addiction? 8 UNKNOWN SPEAKER: [Off video.] No. 9 JOSEPH TODORO: No. 10 SENATOR BONACIC: It does not. 11 JOSEPH TODORO: What it is, is it's a 12 neurotransmitter inhibitor. 13 So, when the Narcan is injected into the 14 individual who is overdosing, what happens is, 15 the -- it blocks the opiate from going into that 16 neurotransmitter. 17 What happens with opiate overdose is that all 18 of your autonomic nervous system shuts down, so you 19 stop breathing, your heart stops. 20 And once the Narcan is injected, it freeze 21 those systems up, and begin to work again. 22 SENATOR BONACIC: So what it does is, it gets 23 them through the withdrawal period. 24 If they use it the time first time, it scares 25 the heck out of them -- 1 JOSEPH TODORO: No, it doesn't get them 2 through -- 3 SENATOR BONACIC: -- and they don't want to 4 use it again? 5 JOSEPH TODORO: It doesn't get them through 6 withdrawal. What it does is, it jump-starts them. 7 SENATOR BONACIC: It jump-starts. 8 JOSEPH TODORO: It brings them back. 9 It doesn't cure addition, it doesn't prohibit 10 addiction. And it's definitely not used in terms of 11 treatment. 12 Treatment, we would look at Suboxone or other 13 type of neural blockers, too. And there are a 14 couple of courses of treatment that's available to 15 that. 16 Right now, the studies show that sometimes 17 Suboxone alone is enough to assist somebody in 18 recovery. 19 But, I think more -- my professional opinion 20 is, more times than not, you should be having that 21 type of a medication used with therapies. 22 SENATOR BOYLE: One question: 23 For those of you who are not familiar with 24 Narcan, I'm a former EMT and I've seen it work, and 25 it is truly a miracle drug. 1 You're talking about someone going from the 2 brink of death, not breathing, just about gone, and 3 [snaps fingers] awake, alert, and talking to you a 4 minute later. Literally, a minute later. 5 It's truly amazing. 6 But you're right, it is a short-term thing. 7 It gives them a second chance to get to the 8 hospital, whatever the true medical thing. 9 But you mentioned, on Suboxone, the more 10 longer-term drug. 11 What we're seeing in some areas is that it's 12 almost being used -- now, you can become addicted to 13 Suboxone; correct? 14 JOSEPH TODORO: It doesn't cure the 15 addiction. 16 SENATOR BOYLE: Doesn't cure it. 17 So -- but people are using their Suboxone 18 thing to sell for heroin in some areas. 19 JOSEPH TODORO: Yes. 20 SENATOR BOYLE: So it's a difficult thing. 21 I mean, as you mentioned, Doctor, that -- you 22 need Suboxone with treatment, certainly. 23 And what about VIVITROL? Are you familiar 24 with this -- 25 JOSEPH TODORO: Yes, I'm familiar with that, 1 too. 2 I think the issue really is -- well, there 3 are a couple of things. 4 One is, you know, if you took all the 5 prescriptions that have been written for opiates, 6 you know, recently in the United States, everybody 7 in the United States would be high for an entire 8 month, 24/7. 9 Okay? 10 So that's how much is out there in terms of 11 the prescription stuff. 12 The other piece is that, you know, this is a 13 disease that's treatable. Period. 14 It's treatable, and we need to remember that. 15 And I think that the real issue for us is 16 access to treatment, and good treatment, as well as 17 prescribing practices. 18 There's no reason in the world for anybody to 19 get a 30-day supply of medication when all they did 20 was strain their back. 21 You know, a 3-day supply, if you must, in 22 terms of an opiate, at most. 23 But, we don't have those types of formularies 24 set up for prescribers at this point in time. 25 DR. CARLOS HOLDEN: Well, actually, we do, 1 and that's been a recent, I think, policy success at 2 the state level. 3 We now have something called the 4 "Prescription Monitoring Program." 5 JOSEPH TODORO: "I-STOP." 6 DR. CARLOS HOLDEN: It's mandatory for a 7 prescriber to consult that database and see what 8 other medicines a patient is on before writing a 9 prescription for a controlled substance. 10 This is to eliminate the practice of what's 11 called "doctor shopping," where folks go to one 12 doctor, they get a prescription for a bunch of meds. 13 Then they go down the street to another doctor, tell 14 the same story, get, you know, more meds, and more 15 meds and more meds. 16 So with that statewide law, I think, you 17 know, it's definitely helped deter abuse of the 18 prescription products. 19 Unfortunately, one side effect of that is 20 more folks are, you know, headed towards heroin now. 21 But I definitely think we've made great 22 strides in terms of the prescription-drug abuse 23 problem. 24 One other policy recommendation that I would 25 have, regarding prescription meds, is we know that 1 there are some particular formulations of 2 prescription meds that are vulnerable to abuse. 3 Several years ago, when Oxycontin first came 4 out, it was referred to as "hillbilly heroin", 5 because you could crush it, you could snort it. 6 It was just prepared in such a way that it 7 was prone to abuse. 8 The manufacturer of that product subsequently 9 did what I think was a very responsible thing, and 10 chemically modified the drug so that you can't, you 11 know, crush it up and snort it like that, which is 12 really good. 13 Unfortunately, we had a recent FDA approval 14 of a medicine called "Zohydro," against the advice 15 of their own subcommittee that investigated this 16 medicine. And similar to the initial formulation of 17 Oxycontin, it's very, very prone to abuse. 18 There's no -- it's a product that one could 19 crush and -- you know, and consume that way. 20 So I'm worried that we're going to start to 21 see, you know, the same problems that we had with 22 Oxycontin early on. 23 So one recommendation that I would have, 24 if -- you know, for policy, is, if we're going to be 25 marketing long-action prescription opiates, they 1 need to have some sort of an abuse-deterrent, you 2 know, formulation inside them, like Oxycontin now 3 has. 4 SENATOR BOYLE: Yeah, that's an excellent 5 point. 6 And I, for the life of me, do not understand 7 the FDA's decision there. Their own advisory board 8 voted 9-to-2 against the idea of this; and, yet, 9 they still allowed it. 10 And I think you're right, we may be seeing 11 some overdoses in this area unless they change their 12 mind very quickly. 13 SENATOR BONACIC: Just, I'd like to get a 14 consensus with the panel. 15 If I used heroin for the first time, am 16 I automatically addicted? 17 Or, it depends on my immune system and my 18 health? 19 Or -- because people say that. They say, 20 "one shot and I could be addicted." 21 Is -- can you share your knowledge on that 22 question? 23 IZETTA BRIGGS-BOLLING: Well, I think that 24 you could be, depending on your brain mechanism, 25 because different substances affect the brain in 1 different ways. 2 So, heroin might be the substance that 3 affects your brain. Cocaine could be the substance 4 for someone else. 5 A lot of times it could be -- there are 6 gateway drugs that people progress through, which -- 7 I think your name is Peter? 8 PETER LAIZURE: Yes. 9 IZETTA BRIGGS-BOLLING: -- which I wanted to 10 say thank you so much for sharing your story, 11 because you took us through a timeline of a young 12 adolescent who began experimenting with marijuana, 13 and progressed all the way to IV-heroin, and 14 overdosed at the age of 23. 15 And from a community perspective, I think the 16 community needs to understand and recognize and 17 address that the youth of our community are 18 experimenting with these substances. 19 And sometimes we don't want to address it or 20 we don't want to acknowledge it, but the 21 progression -- the progression of the disease of 22 addiction can happen very quickly. 23 So someone can begin at 16, and actually 24 be -- their life be ended at the age of 23, and they 25 have -- their life -- they have experienced the 1 entire progression of this disease. 2 So, it depends on the individual. 3 Someone could use one time and become 4 addicted; and someone, their progression could 5 develop over a lifetime; but they still could end up 6 in the same place, which is death at the end. 7 So I really want to impress the importance of 8 community involvement, and us addressing, not only 9 our young people, but also our elderly individuals, 10 who we're seeing a rise in their opiate and 11 prescription use, as well. 12 Because you also expressed a progression from 13 one substance, all the way to heroin, which is, a 14 lot of people begin with prescription, which Joe was 15 talking about. 16 You're prescribed a medication for 30 days 17 for something that you may have only needed 18 3 to 5 days, but, you became physically dependent on 19 the substance and you began to use it more readily. 20 And then the -- a problem was recognized 21 somewhere down the road, and the medication was no 22 longer available. So the next option is heroin, 23 which we -- there's no way to determine what level 24 of drug or substance the person may be injecting or 25 ingesting into their body. 1 SENATOR BONACIC: Thank you. 2 NOLLY CLIMES: Just wanted to add, in terms 3 of a recommendation, to keep in mind that -- 4 SENATOR BONACIC: Keep close to the mic, 5 Nolly. 6 NOLLY CLIMES: -- Mr. Laizure was talking 7 about his son, that the -- one of the largest 8 increase in heroin use, it seems to be in that age 9 group, 18 to 25. 10 And that we need to -- any recommendations, 11 we need to understand this group, and prioritize 12 their needs, and how to reach them in terms of 13 prevention and education, because this is an age 14 where a lot of decisions are being made in terms of 15 education, career, relationship, life plans, all of 16 which are high risk or interrupted once a person 17 starts to use heroin. 18 So I think that, as we discuss, and there are 19 plans developed, we need to take into account that 20 there is this special population that is really 21 increased the use of heroin; and that's the 18 to 22 25. 23 SENATOR BOYLE: Okay. 24 Why don't we -- if I could just ask a 25 question, for those of you in treatment: 1 A typical case we're hearing around the state 2 is, say, a 19-year-old finds himself or herself 3 addicted to heroin or another opiate, and finally 4 says, "I want off, I'm ready to get clean." 5 They get into a detox. 6 And then, from the detox, in most parts of 7 the state, it's a wait to get into rehabilitation, a 8 recovery, a treatment center. 9 The insurance says, No, we're going give you 10 four days, five days. 11 You know, what are you experiencing out here 12 around Sullivan County? 13 JOSEPH TODORO: It's very similar. 14 What we find -- and I think that's the policy 15 issue, really, that we need to grapple with, is 16 access to appropriate levels of treatment. 17 Depending upon your insurer, depending upon 18 your HMO, depending upon -- all of those things are 19 a huge play. 20 And the issue that you're talking about, with 21 a young person who may be able to go into a crisis 22 bed, and, you know -- you know, be somewhat 23 chemically-free, and then needs to go into a 30-day 24 program, or things like that, they're quite often 25 told, not just young people, also, that, No, you 1 need to try to kick this on an outpatient basis 2 first. 3 And Izetta will tell you, we have 4 professionals in our offices who can look at 5 somebody, and go: This is not going to work on an 6 outpatient basis. 7 Because it has a lot to do, also, with, you 8 know, the person being in a willing environment, 9 too. 10 You know, so it's not often that you have a 11 drug addict who can go someplace and be safe and 12 away from all those people who have influenced their 13 drug use, too. 14 So that becomes an issue. 15 So, access to treatment is paramount. 16 We don't have enough treatment for 17 adolescents and young people. 18 Because of some of the rules and regulations 19 that, you know, adults can't -- you know, we can 20 treat kids who are 19-plus, but we can't treat them 21 who are, you know, down -- below the age of 18 in 22 certain settings. 23 So, you know, access to treatment. 24 And, you know, quite frankly, through the 25 recession, the prevention budget out of OASAS has 1 been cut dramatically. 2 UNKNOWN SPEAKER: [Off video.] Yes. 3 JOSEPH TODORO: We used to have quite a bit 4 of ability to fund community-wide prevention 5 services. 6 Now, not so much. 7 LAWRENCE THOMAS: From the BOCES standpoint, 8 I mean, we have had great relationships and 9 partnerships with county agencies. 10 And one of the things that we have witnessed 11 over the short period of time, is that it's getting 12 harder and harder to have those partnerships, and 13 have some folks from some of those other agencies 14 come into the schools, partially because those 15 individuals aren't even available. 16 And, so, that is a concern for us. 17 I mean, we want to provide prevention 18 services before students even get to the point where 19 they -- where they may be forced to make a decision 20 with regard to heroin. 21 And what we're finding is, it's difficult to 22 have the manpower, to have the service providers -- 23 prevention-service providers, even available to 24 bring them into the schools. 25 Some of it is -- some of it is a financial 1 issue. 2 Some of it is community acceptance, too, in 3 allowing us to go far enough down into the lower 4 grades. 5 NICK ROES: There's at least a six-week wait 6 to get into our program, and it's really 7 heartbreaking to have to talk to parents whose 8 daughters are really in trouble, and want -- we have 9 to try to place them in shorter-term programs or 10 crisis centers. 11 You feel almost like you're playing God, and 12 it's a really horrible position to be in. 13 UNKNOWN SPEAKER: [Off video.] Yeah, no 14 question. 15 PETER LAIZURE: I would just look to add 16 that, my experience has been that the insurance 17 companies will do that; just give you limited time, 18 and the facilities have to continually call the 19 insurance companies to get more time. 20 30 days is not enough. 21 30 days is not nearly enough for most 22 addicts. 23 This is a very powerful addiction. 24 And you're right -- is it Larry? -- we got to 25 get to these kids before they try it. 1 And I'm, you know, in a grassroots group 2 called "Not One More," and we are trying to get into 3 the schools. 4 We have plenty of people ready to volunteer, 5 set up programs, and it's really difficult to get 6 in. 7 SENATOR BONACIC: Yeah, I'd like to touch on 8 that subject. 9 I know that, you know, there's TV ads on 10 smoking. They show the horrific effects if you 11 smoke, what happens to your lungs. 12 I know the State Police used to do -- come to 13 the schools with crushed cars to show what happens 14 if you drink and drive. 15 Do we have, number one, enough instructional 16 material, education material, on the effects of 17 heroin? 18 And, do you think it's an obstacle to get it 19 in the schools as part of an education program? 20 I'm just throwing it out there. 21 PETER LAIZURE: From what I'm hearing from 22 some of the schools, is they don't have the time, 23 and they don't have the money in the budget, to have 24 an ongoing program. 25 They're saying that a one-day assembly is 1 just not going to do it. It needs to be a 2 consistent program over and over and over. 3 I understand, you know, the budgeting, but, 4 there are a lot of people who have been affected, 5 who are willing to step up and help up and do some 6 volunteer work for these programs. 7 LAWRENCE THOMAS: Yeah, the one-time shots 8 are just -- are, in fact, that; they're one-time 9 shots. 10 And what we really need is a program that 11 lasts a long period of time. 12 I'm not even just talking about a year. 13 I'm talking about years at different levels, 14 and provides opportunities for students to really 15 process the information that they get, to be placed 16 in -- or have, perhaps, simulations or assignments, 17 where they need to think about, you know, what kind 18 of decisions they're going to make. 19 I mean, these decisions that they make are 20 life skills, life-success decisions, and they 21 certainly relate to whether or not I'm going to 22 become -- I'm going to experiment with heroin, or 23 not. 24 But they need to be placed in these kinds of 25 decision-making opportunities frequently, and 1 practice that skill of positive decision-making. 2 SENATOR BONACIC: Do you think paid TV 3 messages are a waste of time, or it's good? 4 LAWRENCE THOMAS: I think that they're good 5 for themselves, but, again, they're a one-time shot. 6 They're a very limited exposure. They don't go deep 7 enough into the content. 8 They don't go deep enough into how it 9 affects, not only you as an individual, but, also, 10 how it affects your family; how does it affect your 11 community? 12 And so, you know, as one layer, okay, but 13 it's just one layer. 14 There needs to be a lot of other layers. 15 SENATOR BONACIC: Thank you, Larry. 16 NANCY McGRAW: I'd like to address, a little 17 bit about, echoing the sentiments that have been 18 said so far, about the need for funding for 19 prevention services. 20 We as a task force have -- among many of 21 these organizations, have pooled our resources for a 22 number of years, and have met with the 23 superintendents, and tried to scrape together 24 materials, have offered volunteer time on our own 25 time, to go in and provide presentations. 1 I think what we really need, on the 2 prevention side, is just that; we need more funding. 3 All of our organizations and departments have 4 been cut. 5 Public health has been cut. 6 Mental health has been cut. 7 Law enforcement has been cut. 8 The educational system has been cut in terms 9 of mental-health resources. 10 And I think we really need more funding for 11 prevention resources that are evidence-based. 12 IZETTA BRIGGS-BOLLING: Yes. 13 SENATOR BONACIC: If that happened, would it 14 be -- and it was earmarked for heroin specifically, 15 would there be an assurance that it would be used 16 for that, and not for other things? 17 I mean, let's say we, generically -- 18 JOSEPH TODORO: Well, typically, prevention 19 isn't paid by insurance. 20 SENATOR BONACIC: -- gave more money into a 21 budget. 22 JOSEPH TODORO: Prevention is rarely paid by 23 insurance. It's usually -- 24 SENATOR BONACIC: No, I don't mean insurance 25 companies. 1 I mean -- 2 NANCY McGRAW: For the purpose of heroin 3 prevention. 4 SENATOR BONACIC: -- if the State gave more 5 money to public health for this specific purpose of 6 fighting heroin addiction, that it wouldn't be used 7 for pamphlets to go vote, or something. 8 NANCY McGRAW: I -- you know, all of the 9 grants and funding that we have through 10 Public Health is earmarked for specific purposes. 11 SENATOR BONACIC: Okay. 12 NANCY McGRAW: And we have to demonstrate 13 outcomes and evidence-based, you know, reports that 14 we have used it for its intended purpose. 15 And I'm sure, as all of these other 16 organizations do, research on what works. 17 And I think that we need to do more of that. 18 And in terms of preventing, specifically 19 heroin addiction, what Larry was talking about was 20 specific to teaching kids life skills, and teaching 21 them how to cope with making decisions. 22 And that's what leads to, when they're faced 23 with that peer pressure, making the decision not to 24 use heroin, or something else. 25 JOSEPH TODORO: And, Senator, I would warn 1 against just going after the heroin addict, because 2 as you've heard today, and many of the stories 3 across the state, it starts with other things. 4 SENATOR BONACIC: Yeah, no, I got that. 5 JOSEPH TODORO: So I think providing 6 prevention efforts and funding to look at, you know, 7 addiction, to try to develop these pro-social skills 8 in our young people, to be able to, you know, resist 9 some of the peer pressure that goes along with being 10 a teenager, or a 20-something, I think that's where 11 your money is well spent. 12 You know, the treatment piece, access to 13 treatment, is critically important, you know. 14 But, if you can separate the toxic agent from 15 the willing host in the enabling environment, you 16 know, you're going to be in a much better place. 17 And prevention dollars help us do that. 18 NOLLY CLIMES: Just wanted to emphasize that 19 there is a direct correlation between reduction of 20 funding on prevention program and the challenges 21 that we face to meet the needs of the people that 22 need the services. 23 So I think that, if through this Task Force, 24 there could be an emphasis to say that, the outcome, 25 the crisis, the challenges, directly relate to what 1 has happened in terms of funding for providers that 2 know what to do, but there many other program has 3 been reduced over the last few years. 4 SENATOR BONACIC: There's no question of 5 that. 6 And prevention not only saves lives, it's a 7 lot of bang for the buck -- 8 UNKNOWN SPEAKER: [Off video.] Yes. 9 SENATOR BOYLE: -- when you look at the 10 crimes that are committed by addicts to get the 11 money for their drugs, and for putting them in 12 prison. 13 Because, right now, a great percentage of our 14 jail population, statewide, is -- are solely there 15 because of their addictions, no doubt. 16 SENATOR BONACIC: I see last week there was 17 an arrest in New Hampton. A car was stopped, with 18 $12 million worth of heroin. 19 Do you think we need tougher drug laws, you 20 know, legislation, against the people with heavy 21 trafficking in heroin? 22 Or, does anyone on the law-enforcement end 23 want to comment on what they're seeing, whether in 24 prosecution or in arrests? 25 DA JAMES FARRELL: Well, I can address that. 1 One of the things that I think's important to 2 note, is that, as Joe said, this is an evolution; 3 and as the parent down on the panel said, as well, 4 there is an evolution. 5 It starts with marijuana. Evolves to the 6 next level; maybe a painkiller, an opiate, 7 hydrocodone, and oxycodone. And then we're into 8 heroin. 9 There really is no difference in the way the 10 drug affects the body between heroin and synthetic. 11 It's a synthetic version of the street-drug 12 heroin. It's what it is. 13 So -- and Sullivan County, New York, 14 "Sullivan County, New York," leads the state in 15 per-capita prescriptions for oxycodone. 16 399 per 1,000 Sullivan County residents have 17 a prescription for oxycodone. 18 Now, what does that also tell you? 19 Now, these people are driving cars. 20 "They're driving cars." 21 And one of the things that's very difficult 22 for law enforcement, extremely difficult for law 23 enforcement, and I think a recommendation that 24 I would urge, is that we have some sort of per se 25 "driving while ability impaired by drugs," just like 1 we do with alcohol. We pick a number, .08, that's 2 what it is. 3 Well, when someone's driving under the 4 influence of prescription drugs, you know what they 5 say? "I have a prescription for that. So my doctor 6 told me I could use it." 7 IZETTA BRIGGS-BOLLING: Uh-huh, and they pull 8 it out. 9 DA JAMES FARRELL: Of course, they ignore the 10 label on the bottle that says, "Do not operate heavy 11 machinery." They ignore that. 12 Well, I can do it; I can do it; I can do it. 13 We need to have a per se, because, otherwise, 14 our police -- and when our police come up, they 15 don't smell oxycodone, they don't smell hydrocodone. 16 We have to have a way to enforce that. 17 People are dying on our roads because of it. 18 And when I look at the autopsy reports, what 19 do I see? 20 I see the prescription painkillers. 21 I see the THC. 22 And I see the three words "acute drug 23 intoxication." 24 That's what I see. 25 [Applause.] 1 UNKNOWN SPEAKER: [Off video.] Beautiful. 2 DA JAMES FARRELL: So -- and I think the 3 education piece, we're fooling ourselves if we think 4 we can educate these kids, and at the same time, 5 pass laws that legalize marijuana. 6 We cannot do that. 7 We cannot out of one side of our mouth say, 8 "This is bad for you"; but, this is okay. 9 And we've got states that are doing it. 10 And the feds are against it. 11 And I hope the Legislature here in New York 12 remains steadfast, because it is a gateway. 13 And when we see people who are in trouble 14 with the law, people who are imprisoned now because 15 of their actions, what do we see in their 16 presentence reports that are filed with the court? 17 They started with marijuana. 18 It progressed to painkillers. 19 It led to cocaine. 20 It led to heroin. 21 That's what we see. 22 That's what we see. 23 So I think we're kidding ourselves if we send 24 our kids a counterproductive message that one's 25 okay, and one's not. 1 I really do. 2 IZETTA BRIGGS-BOLLING: And I'd like to just 3 add that, even though New York State may say no, our 4 youth have access to the world. They have the 5 Internets, they have them on their cell phones. 6 So if it's okay in Colorado, Okay, mom and 7 dad may say that it's not okay, New York State may 8 say it's not okay, but if marijuana is available or 9 any other substance is available, they have -- they 10 already have identified a favorable attitude to, "It 11 must be okay if other states are doing it. New York 12 is just behind the times." 13 DA JAMES FARRELL: And the other thing is, 14 these prescription pills, and when you see kids and 15 you talk to them, and I have, they think they're 16 safe because they're made by big pharma. 17 "Big pharma makes them and they got to be 18 safe. My mom takes them, my dad takes them, my 19 relative takes them. They must be safe. I can take 20 them." 21 IZETTA BRIGGS-BOLLING: Yep. "And it's right 22 in the medicine cabinet, so let me go get one." 23 SENATOR BOYLE: One of the other things we're 24 seeing, and as amazing as it is, someone like me, 25 you know, gray hair, I think of heroin, to 1970s, 1 inner city, with the needle. 2 A lot of these kids have never heard of 3 heroin before. 4 They're addicted to the painkiller. 5 They go to their friend in school. 6 Like, on Long Island, for example, because of 7 the I-STOP legislation, that unintended consequence, 8 the price of oxycodone is $30 a pill now in 9 Suffolk County. A bag of heroin is $6. 10 So their friend says to them, Hey, there's a 11 new drug called "heroin." It's a lot cheaper and a 12 lot stronger. 13 They never -- they don't -- they're not from 14 the '70s. You know, they're thinking this is a new 15 thing. 16 And that's what we're seeing. 17 So, prevention and education is going to be 18 key, too. 19 SENATOR BONACIC: Just one thing: I'm going 20 to take something out of order. 21 Lisa Wiles is the superintendent of the 22 Ellenville School District. 23 We had asked her to be on the panel, but she 24 said she could only give us one hour. 25 She has to leave, but she's indicated that 1 she would like to speak on the issue of education 2 and heroin. 3 Lisa. 4 LISA WILES: Thank you very much, 5 Senator Bonacic. 6 SENATOR BONACIC: Yeah, come on up. 7 LISA WILES: So, good afternoon, and I really 8 applaud all of you for being here. 9 I just want to talk -- I think that your -- 10 I think there's a lot of great ideas coming here. 11 I think there's two issues I see. 12 The first is one definitely prevention, and 13 what best-practice prevention looks like in 14 elementary schools, in middle schools, and 15 high schools. 16 But before I get to that, I want to talk 17 about the access to treatment programs. 18 And I've had -- I see a lot from my position, 19 and I see a lot personally in my county. 20 And, unfortunately, thanks to law enforcement 21 here, I've seen, like, a very big heroin bust in a 22 small sleepy town in Sullivan County called 23 "Woodridge," where I live, four blocks away, that 24 I'm, like, floored that it could happen. 25 So it's all over. It's in Long Island, it's 1 in Westchester. My colleagues are talking about it. 2 It's not limited to just heroin. It does 3 start earlier on and move its way up. 4 But, there needs to be better access. 5 I know of a family that had to wait three or 6 four weeks to get into a program; for their daughter 7 to get into a long-term program with an educational 8 component. 9 You know, I worked at New Hope Manor many, 10 many years ago. 11 Those types of programs that tout the skills; 12 teaching, you know, addicts skills to reenter into 13 society so that they have something when they're 14 done. 15 But the prevention piece is huge. 16 So if you have a prevention council, we have 17 one in Ulster County, and we work together to look 18 at best practices that could be used. 19 In the schools we are taxed for time. With 20 Common Core, everyone's worried about testing. 21 You know, these are the basics. 22 I keep saying we have to get back to the 23 basics here. 24 And basics are basics; it's not okay to use 25 drugs, and this is what happens. You know, 1 hearing -- hearing definite, you know, experiences. 2 With bullying, you know, we've brought in 3 so -- I'm using that as an example, because we've 4 brought in specialists, we've talked about how to 5 handle this, how to have students understand it, how 6 to react to it. 7 We need to do the same thing with drugs. 8 And it is, sometimes, a dirty little secret. 9 We don't like talking about it. 10 We don't like that, you know, my school has 11 it, your school. 12 All the schools have it. 13 And if anyone tells you they don't have it, 14 they're not being forthcoming. 15 The schools that have -- that are poor, and 16 that are high-needs, have it. 17 And if schools that have all the money in the 18 world have it, maybe it's a different kind of drug. 19 But we need best practices, 20 scientifically-based programs. 21 I don't have the time to go look at what 22 works best. 23 Show us some programs. 24 And then we will need some funding. We're 25 taxed. 1 But, we're open to working with volunteers 2 coming into the building, also. 3 So I think on -- I'm not speaking for my 4 colleagues, but I think that we definitely see a 5 need for help, and I think it has to be a 6 collaboration of law enforcement, you know, seeing 7 that end of it, what the consequences are. 8 But before you even get there, you know, what 9 do -- what is somebody who's recovering say about 10 how bad it was to get off of it? 11 I know a family that's really struggling with 12 a heroin-, you know, addicted child, and they could 13 not get off -- she thought they could get off of it 14 herself. 15 It's not -- you cannot -- we can't go there. 16 And there are people, there are kids, dying 17 every day. And people are -- they don't put it in 18 the papers, in the obituaries, because it's shameful 19 to them. 20 And we have to get beyond that if we really 21 want to try to help people and help our kids. 22 And it goes -- I agree wholeheartedly with 23 you, District Attorney Farrell, it's not okay. 24 It's not okay that our kids drink when 25 they're not allowed to drink, and it's not okay to 1 condone it. 2 I'm not popular sometimes with my kids and 3 their friends, but, it's just the way it is. 4 And we all have to take a stand on it, but we 5 need some best practices. 6 We set up drop-offs for prescriptions. 7 If you have oxycodone from surgery or 8 something, we have something in Ellenville, I know 9 we have them around the county, too, where you can 10 drop off your prescriptions. 11 But how many people in the county know how 12 important it is not to have it out? 13 More public-service announcements. 14 Our kids in Ellenville are developing them. 15 We have to work collaboratively and come up 16 with you know, better best practices. 17 So I don't want to take your time, but 18 I appreciate it very much, and we're open. 19 I know my colleagues are open. 20 We surely don't want to -- we didn't go into 21 education to watch children suffer. 22 We want them to move ahead as far as they 23 can, you know, in the future. 24 SENATOR BONACIC: Thank you, Lisa. 25 Does anyone from the panel want to conclude 1 with any remarks they'd like to share? 2 Because we're going to open it up to the 3 audience, if they have any questions of the panel. 4 PETER LAIZURE: I just had a quote somebody 5 gave me along the way. 6 "Addiction hates awareness, and recovery 7 demands it." 8 SENATOR BONACIC: Beautiful. 9 [Applause.] 10 SENATOR BONACIC: Yes. 11 IZETTA BRIGGS-BOLLING: I just wanted to say, 12 on my way here, an individual came into the crisis 13 unit seeking services. 14 She had been -- this individual had been in 15 withdrawal for seven days. 16 And when I asked, "Why did it take you so 17 long to get here?" it was because there was no 18 transportation. 19 They live at the far end, almost by 20 Pennsylvania, and there was no way for the 21 individual to get to treatment. 22 We do have transportation availability once a 23 person is in a treatment program. 24 But there are people that may be dying, just 25 because they don't have a way to get here, to get to 1 the treatment facility in Sullivan County. 2 And I just didn't want this to conclude 3 without addressing the transportation issue. 4 SENATOR BONACIC: Thank you. 5 DR. CARLOS HOLDEN: Yeah, and I think it's 6 impossible to overstate the magnitude of this 7 crisis. 8 Ten years ago, the most common cause of death 9 between the ages of, like, say, 15 to 45, was 10 trauma. You know, that would be traumatic 11 accidents, like car accidents, and stuff like that. 12 We've done better at treating trauma. 13 And this substance-abuse crisis has exploded, 14 so that now the most common cause of death between 15 the ages of 15 and 45 is substance abuse. 16 It's an epidemic. It's killing people right 17 and left. 18 We're seeing it in the emergency department. 19 We're seeing it all around the community. 20 So this is a true public-health crisis, and 21 we appreciate your help in addressing it. 22 NANCY McGRAW: And I'd just like to say one 23 final thing, from a public-health perspective, and 24 the drop-boxes that you mentioned, we have 25 implemented, through the task force, 1 three drop-boxes. 2 And if everybody is not aware, they are at 3 their local police stations. 24/7, people can drop 4 off their unwanted prescription medications or any 5 other drugs that you don't want: Fallsbury, Liberty, 6 and Monticello. 7 And the last two Take-Back days alone, we 8 collected over 500 pounds of unwanted medication and 9 getting them out of people's homes. 10 So thanks to law enforcement for transporting 11 them for us to the incinerator. 12 We're making some efforts, but we do need 13 funding for comprehensive prevention strategies for 14 treatment, getting people into treatment, and the 15 elephant in the room, in terms of mental-health 16 resources, that cause people to use drugs in the 17 first place. 18 SENATOR BONACIC: Thank you. 19 Anyone else on the panel? 20 Yes, Sheriff. 21 SHERIFF MICHAEL SCHIFF: First, I'd like to 22 thank both Senators for hosting this. 23 It's a complex problem; it's going to call 24 for complex answers. 25 From law enforcement, I go along with Nancy, 1 everyone's budget has been slashed. 2 Law enforcement, nationwide, is having 3 trouble coping with this problem. 4 We have to approach it on every level in a 5 cooperative effort. 6 We need more law enforcement, and we need aid 7 from the feds; from the State, meaning State Police; 8 for more technological aid, whether that be 9 eavesdropping, scoping out areas, doing our 10 intelligence work. 11 And we really have to address the "dealing" 12 problem heavily. 13 That being said, we also have to hit on every 14 one of the other components. 15 We have a D.A.R.E. program. We're going to 16 be trying to expand ours. 17 Hopefully, there will be programs like that 18 in the schools that will start addressing the upper 19 grades. 20 We have not been able to address that from 21 our end. We're going to be working on that this 22 fall. 23 The other problem is getting into, which has 24 been discussed, long-term programs. 25 There aren't too many people anywhere who 1 aren't related to or know someone who has a problem 2 with drugs. 3 One of my daughters has a heroin problem. 4 She's an addict, and she happens to be in New Hope. 5 I lived through all the things you've talked 6 about. 7 The short-term programs, just detoxing, not 8 effective. 9 She's finally in New Hope, long-term program. 10 She had been in other programs, where she 11 told me stuff got smuggled in. 12 Not in New Hope. They run a tight ship. 13 I think there may need to be more State 14 monitoring of these programs. 15 But, to take a young person and want them to 16 fail in an outpatient setting, three, four, 17 five times, is courting disaster. 18 You need to go at the problem aggressively, 19 and get them the best help in the beginning. 20 And I think the programs are reversed, so 21 I think we need aid in that end. 22 Another component that I would bring up that 23 wasn't discussed yet here: 24 My daughter was out in California for a 25 while, and she got out of a short-term program. And 1 what she found was, after she got out of that 2 program, there was all kinds of support. 3 Young people who met, like in AA or Al-Anon, 4 they got together, they supported each other. They 5 understood their problem in a way that none of us 6 can. 7 And she found that to be very helpful; that 8 the success rate after getting out of a rehab, that 9 made all the difference. 10 She came back to Sullivan County. 11 She went to Ulster County to one meeting, 12 went to a couple here, and found that there were 13 mostly elderly people with alcohol problems. No one 14 she could relate to. 15 And I think we need to work in the schools, 16 but this goes beyond the schools. 17 A lot of these kids are going to be out of 18 school. 19 I think once you get them out of a short-term 20 or a long-term program, the key to success is, once 21 you're back out on the street, who is there to help 22 them? 23 And I think if there's any component we can 24 walk away from this with, that is lacking, it would 25 be that. 1 I mean, every aspect of this needs to be 2 beefed up, but, I'm finding, locally, there is 3 nothing. There is no support group. 4 And at the end of the day, anybody can learn 5 to live within the environment of a rehab program or 6 in a medical setting where they're being watched, 7 but when you come out and you're allowed to make 8 those decisions on your own again, you need someone 9 who you can relate to; not somebody who's totally 10 out of your age group and maybe having a totally 11 different problem. 12 So I would advocate, these programs don't 13 seem, in the rural areas, to be put together on 14 their own. 15 There are a lot of dedicated people that do 16 it, but there aren't yet a lot of young people. 17 I think we're going to have to figure out a 18 mechanism, whether through mental health, health 19 services, the schools. I think we have to figure 20 out a mechanism to create that environment. 21 I don't think it's going to do it on its own. 22 So if there's anything I would bring to the 23 table, that would be it. 24 SENATOR BONACIC: Yeah, buddy system, that 25 makes sense. 1 DA JAMES FARRELL: Senator, I would also say 2 one other thing -- 3 SENATOR BONACIC: Sure. 4 DA JAMES FARRELL: -- I think it's important. 5 And Dr. Holden did a terrific presentation as 6 part of the rural drug task force that we have here 7 against prescription drugs. 8 I think we have to ensure responsible 9 prescribing practices by physicians. 10 If you look at these numbers, and 11 Dr. Galarneau was there, as well, from the hospital, 12 and they're engaged, and we need our physicians to 13 be engaged in this problem, but if you look at the 14 sharp rise in opiate-overdose deaths nationwide -- 15 and he brought the maps, and it's nationwide, it's 16 all over -- it parallels the increase with the 17 prescribing patterns of physicians. 18 So I think education, not just to the kids; 19 obviously, we want to get through to them. And as 20 Larry said life skills, life -- and these are 21 life-altering decisions that they're going to make 22 if they decide to get hooked. 23 "Life-altering." It could end their life. 24 But we also need to engage the folks who are 25 prescribing these dangerous drugs, as well; and 1 that's our physicians. 2 SENATOR BOYLE: One of the proposals we're 3 looking at is, is -- as part the continuing medical 4 education every doctor has to go through, SBIRT; a 5 program of treating people, screening, figuring out, 6 what is an appropriate opioid. 7 Because we hear it statewide, I mean, it was 8 talked about before, a wisdom tooth taken out, and 9 90 Vicodin is prescribed. 10 It's all crazy. 11 DA JAMES FARRELL: One of the things that 12 Dr. Galarneau said, and he could probably speak 13 better to it, is we treat pain. 14 We treat pain in America now. We don't treat 15 the underlying cause. 16 So we have a bad appendix, it will bust and 17 kill us if we're taking pain medication. 18 Doctor? 19 SENATOR BOYLE: Please, yeah. 20 Go ahead, please, yeah. 21 Do you have a microphone? 22 We just want to get it for the record, 23 though. It needs to be on a microphone to record 24 it. 25 Sorry. 1 DR. GERARAD GALARNEAU: I'm Dr. Galarneau. 2 I'm the CEO of Catskill Regional Medical Center. 3 I'm also a practicing urologist. 4 No, I agree; I think it's a shame that it 5 takes a lot of training to be able to prescribe 6 Suboxone and to treat addiction, but it actually 7 takes no training, other than having your doctorate 8 degree, to prescribe Oxycontin and addict people. 9 You know, the treatment of pain, if I -- you 10 know, as a urologist, if someone comes to me with a 11 kidney stone, I can treat them with pain medicine, 12 make them feel great, but I'm not treating the 13 underlying condition. 14 So, for the most part, treating pain with 15 opiates is sort of a cop-out. 16 Other doctors might disagree with me. 17 But you could keep somebody going and 18 actually never diagnose them with anything. 19 So I think that if we worked on -- I mean, 20 the biggest thing, if I had one thing on my wish 21 list, it would be to have very strict educational 22 criteria to be -- to have your DEA to be able to 23 write for a prescription. 24 Because I think a lot of doctors would 25 relinquish that right. I think that would be great. 1 Because you could make an argument that the 2 health of this county would be better if no doctor 3 showed up to work tomorrow. 4 [Laughter.] 5 DR. GERARAD GALARNEAU: I mean, that is a 6 provocative thing to say, but, you could make that 7 argument. 8 So, you know, decreasing the ability for 9 physicians to write those pain medicines, in some 10 sort of legislation, and requiring specific criteria 11 before they can, I think that would go a long way. 12 SENATOR BOYLE: What was it you said, the 13 "DEA"? Is that a -- 14 JOSEPH TODORO: Your DEA number for -- to be 15 able to write controlled substances -- 16 SENATOR BOYLE: Oh, on the scrip? Like -- 17 okay. 18 Thank you. 19 SENATOR BONACIC: Thank you, Doctor, very 20 much. 21 SHERIFF MICHAEL SCHIFF: Senator -- 22 SENATOR BONACIC: Any of the panel want to 23 share any other thoughts? 24 We'll open it up to the public, but if 25 anybody wants say something -- 1 SHERIFF MICHAEL SCHIFF: Senator, one other 2 thing I would like to add -- 3 SENATOR BONACIC: Sure. 4 SHERIFF MICHAEL SCHIFF: -- I think Jim 5 mentioned it before, we don't want to focus on 6 opiates, we don't want to focus on heroin. 7 This is an ever-changing -- everything we do 8 changes the landscape. 9 And when we went into Afghanistan, the 10 Taliban used to cut your hands off if you grew 11 poppies. 12 Now the Taliban has pushed back, I believe 13 there was a United Nations study, 80 to be 14 90 percent of the heroin coming into this country 15 will be from Afghanistan. 16 When we did the I-STOP, people went from the 17 prescription pills, it became harder to get, more 18 expensive, they went to heroin. 19 If law enforcement changes and we do some 20 other things, and heroin becomes hard to get, 21 becomes expensive, it's like going to a farmers' 22 market. These people are going to buy what's 23 available to them at the farmers' market. 24 And we can't focus on any one type of drug. 25 It's got to be a broad, comprehensive view, because, 1 six months from now, heroin may dry up to some 2 extent, and it may be something else that's 3 available. 4 So, if we do earmark, it's just got to be for 5 drug addiction and illegal drugs, and have that 6 broad shotgun approach to what might be. 7 Or like Jim always brings up, synthetic stuff 8 that's not even on the books yet. 9 DA JAMES FARRELL: It is in Sullivan County. 10 SHERIFF MICHAEL SCHIFF: Yes. 11 [Laughter.] 12 NANCY McGRAW: Senator, I would just like to 13 add, in terms of these -- legislation for -- or 14 doing something about all these energy drinks, these 15 5-Hour shots that are available to kids in the 16 grocery store, that's a gateway drug. 17 Do we know what's in those? Kids are using 18 those all the time. 19 So that's part of the issue, as well. 20 And, overprescribing, let's not forget the 21 dentists. 22 I got a 20-day prescription for something 23 I didn't need. 24 So, it happens every day. 25 We have women coming into our clinics with 1 newborn babies, who are on Oxycontin and they can't 2 take care of their kids because they had a 3 C-section. 4 They don't need that. They need Tylenol. 5 So, overprescribing, absolutely. 6 JOSEPH TODORO: And I would just like to 7 emphasize that, you know, the way that we tackle 8 addiction, and the way that we prevent things in our 9 community, are a wide and varied thing. 10 You're not going to find one -- you know, 11 "one size fits all" in your attempts to look at 12 this. 13 I think that it would behoove the State to 14 look at the localities, engage the localities, and 15 have the localities say, yes, this is where our 16 efforts should be. 17 You know, at one point in time we were very, 18 very married to our local BOCES to do prevention 19 programs in all of our school districts. And, 20 unfortunately, that got pull away from us. 21 It was not my local decision; understand 22 that, okay, because that becomes the critical mass. 23 You know, if you write something that's in 24 general, and you don't rely on the localities to 25 make a decision in where those resources need to go, 1 that's a mistake. 2 DR. CARLOS HOLDEN: Senators, I wanted to 3 thank you very much for inviting me. 4 I, unfortunately, am going to have to excuse 5 myself. 6 But my colleague, Dr. Galarneau, I'm sure, 7 can address any questions that come up regarding the 8 hospital treatment for these. 9 So, thank you very much. 10 SENATOR BOYLE: Well, thank you for being 11 here. 12 DR. CARLOS HOLDEN: I appreciate it. 13 [Applause.] 14 SENATOR BONACIC: I think there's a series of 15 questions that have been given to MJ, so why don't 16 you read the question, MJ. 17 MJ: This question is from Lisa. 18 The question is: What is local law 19 enforcement doing to target underaged drinking and 20 drug use at parties? 21 SENATOR BONACIC: Did they hear the question? 22 MJ: Did you hear the question? 23 DA JAMES FARRELL: Yep. 24 SENATOR BONACIC: Why don't we just respond. 25 DA JAMES FARRELL: We have a local law that 1 we passed, that holds people who host these types of 2 parties, with underaged drinking or drug usage 3 occurs, responsible. 4 We have had -- unfortunately, we haven't had 5 that many arrests under the law. 6 We did have one in Fallsburg. 7 But we are actively enforcing the law, should 8 we come across that type of event. 9 Obviously, with prom season and graduation 10 season upon us, those things will become more 11 prevalent. 12 What our local police officers, all of 13 them -- Liberty police, Fallsburg police, our 14 Monticello police, and our Sheriff's Office -- have 15 given us a commitment to enforce that local law; 16 which unlike the state law, which requires the 17 person to provide the alcohol, the local law only 18 requires that the person allow the consumption of it 19 on their premises. 20 So it's a little bit different standard, and 21 that's one of the things that we have in our quiver, 22 so to speak, to combat that. 23 We have to be consistent with our children. 24 And I think sometimes when we get 25 inconsistent, as we have seen in Colorado and in 1 other states, it screws things up. 2 And I think we need to be consistent in our 3 message that these things are not okay. 4 We know from studies, with respect to 5 alcohol, and we'll start there, that on the 6 adolescent brain it causes enormous damage. 7 Now, not so much on an adult brain because 8 it's already grown and it's gotten to its position. 9 SENATOR BONACIC: [Unintelligible.] 10 [Laughter.] 11 DA JAMES FARRELL: But on a growing brain, 12 it's life-altering. 13 Again, go back to what Larry is saying about 14 life -- you know, life events, and you're talking 15 about altering your life forever when you consume 16 alcohol, when your brain is growing. 17 So we have to be consistent; we have to have 18 a consistent message. 19 We can't say one's okay, and one's not, 20 because then we confuse them, and we send mixed 21 messages. And I believe that's counterproductive. 22 JOSEPH TODORO: And if I could just add, with 23 regard to the parents who host, the statute that 24 we've passed locally, if you're aware of that stuff 25 is going on, call the police. 1 DA JAMES FARRELL: Absolutely. 2 JOSEPH TODORO: Otherwise, you're an enabler. 3 IZETTA BRIGGS-BOLLING: Right. 4 DA JAMES FARRELL: Correct. 5 Correct. 6 [Applause.]. 7 SENATOR BONACIC: Lisa, are you satisfied 8 with the answer? 9 If you have a follow-up question, you know, 10 please continue, or else we'll go to the next 11 question. 12 Are you okay? 13 Okay, MJ, the second question. 14 MJ: This is from Cora Edwards. 15 Cora, are you here? 16 Okay. 17 SENATOR BONACIC: Yeah. 18 MJ: Cora asks: How has heroin become so 19 accessible in this area? 20 CORA EDWARDS: [Off video.] "In this era?" 21 MJ: "In this era?" 22 I'm sorry. 23 SENATOR BONACIC: Okay. You know, I didn't 24 hear the question. 25 MJ, could you step in front of the podium and 1 you say it louder? 2 MJ: Sure. Sure, yes. 3 "How has heroin become so accessible in this 4 era?" 5 SENATOR BONACIC: Okay. 6 MJ: From Cora. 7 SENATOR BONACIC: All right, thanks, MJ. 8 Does anybody -- 9 JOSEPH TODORO: I think it's always been 10 accessible, but I also do believe that it's really 11 the overprescribing that's occurred, you know, 12 across the nation, in terms of managing pain. 13 And once we start to, you know, limit the 14 availability of those pain medications, then 15 heroin's a pretty easy choice for somebody. Instead 16 of a $30 pill, I can get a $6 bag of heroin. 17 And I think that's why it is. 18 And, it's the new flavor, apparently, you 19 know, but, it's really accessible. 20 Just ask, you know, our DA and the 21 State Trooper here, they'll tell you, that they 22 bring it up the Hudson, drop it off in Newburgh, and 23 they've got, you know, both the Thruway and 84 to 24 distribute from. 25 NOLLY CLIMES: It's also the price, that it 1 costs less now, and that makes it a lot easier in an 2 alternative choice. 3 SENATOR BONACIC: On something of a macro 4 scale, too, the cartels, the drug cartels, they're 5 evil people, but they're very smart. And they 6 realize that we've got an American generation 7 addicted to opioids, painkillers overprescribed, and 8 say: Well, when they pass these laws to stop the 9 prescription drugs from going, they're going to 10 still be a addicted to opioids, because they're not 11 doing anything about that. 12 And, so, they put heroin out very cheaply. 13 And one important thing is, we used to get 14 the heroin from the Golden Triangle of Afghanistan, 15 stuff like that. Now it's only about 20 percent 16 coming in. 17 Most of it's coming from Mexico; being 18 manufactured and grown in Mexico. So it is a lot 19 cheaper, obviously, just in terms of transportation. 20 They bring it from Mexico, up to 21 New York City, Philadelphia, Newburgh, and out to 22 here. 23 DA JAMES FARRELL: And I think people -- 24 SHERIFF MICHAEL SCHIFF: I think, also, on 25 that subject -- 1 DA JAMES FARRELL: I think people are also 2 using it, they're snorting it, as opposed to using 3 in it needles; whereas, years ago, it was used in a 4 needle. 5 But even now, you have individuals who are 6 not afraid of the needle. 7 You know, AIDS is kind of like, and HIV is 8 kind of like, off the map. We've got great 9 treatment for that. People can live with it for 10 years and years and years, so people are not afraid. 11 SHERIFF MICHAEL SCHIFF: I was going to 12 basically say the same thing. 13 In the '80s, they had to market the heroin to 14 snort it because it was a very negative connotation. 15 If you used the needle, you were an addict. 16 If you didn't use the needle, it was 17 recreational drugs. 18 I'm not seeing any stigma, I don't know think 19 anyone else is, with a needle. 20 It's become so acceptable for someone to have 21 a needle and use it, and I think that's part of the 22 huge change which has put heroin where it is, in 23 addition to the cost. 24 NOLLY CLIMES: I think it is, also, there is 25 a misunderstanding that snorting heroin is safer 1 than injecting, when we're talking about the same 2 thing. 3 SENATOR BONACIC: Well, I remember that if 4 you used a needle, you could catch AIDS. 5 NOLLY CLIMES: Right. 6 SENATOR BONACIC: So, you know, you didn't 7 want to try a needle that could be infected, that 8 leads us to AIDS. 9 NOLLY CLIMES: Right. 10 I'm talking about for younger people who 11 think that there is a difference between a pure form 12 of heroin versus a less-pure form, in terms of the 13 drug per se. 14 SENATOR BONACIC: Yeah, okay. 15 Next question, MJ. 16 MJ: "TV media is not allowed to do ads about 17 liquor. In Europe certain products are not allowed 18 to be advertised. 19 "Can we, you, the government, stop ads for 20 pharmaceuticals?" 21 [Laughter.] 22 [Applause.] 23 SENATOR BONACIC: A constitutional issue. 24 SENATOR BOYLE: Yeah, I think there's a 25 constitutional issue there. 1 I think -- well, we have seen a change in the 2 advertising. 3 If you watch a typical drug commercial now, 4 the side effects are longer than the normal part of 5 the commercial. 6 So we're coming away, but I think we're going 7 to be constitutionally off-kilter by trying to ban 8 them completely. 9 DA JAMES FARRELL: But I do think that the 10 question raises a good point. 11 I mean, look at smoking in America. 12 Look at how smoking, how everybody came 13 together and drove that down to levels we've never 14 seen before. 15 It's at its low point. 16 And a lot of that was done through 17 legislation, with respect to the big tobacco 18 companies. 19 And I think that maybe if you look at some of 20 the strategies that were used with tobacco, because 21 tobacco kills you, it's addictive, it's highly 22 addictive, may not be as acute, but it certainly has 23 the same end result, we might use some of those 24 strategies in this fight. 25 MJ: I have Alan Sorensen, Legislative 1 District 9, who had asked to speak. 2 SENATOR BONACIC: Hi, Alan. 3 Welcome. Thank you for stopping in. 4 ALAN SORENSEN: Thank you, Senator. 5 I just want to follow up on the same topic. 6 In the -- the United States -- there's only 7 two countries in world that allow direct-to-consumer 8 advertising of pharmaceutical products; it's the 9 United States and New Zealand. 10 And in the United States, it wasn't until 11 1997 that there was Congressional legislation that 12 really expanded what pharmaceutical companies could 13 advertise. 14 And to follow up on Jim's point, I think that 15 is the crux of a lot of the problem that our -- 16 where children getting addicted to opiates. 17 If you look at the advertisements that 18 they're placed, they're targeted to children. 19 They not only identify the symptoms, but they 20 give, in the advertisement, a list of the symptoms. 21 And at the end of the advertisement, they 22 say: Go see your doctor and tell him you have these 23 symptoms, and he'll give you the drugs that you want 24 him to prescribe. 25 Right? We all see it. 1 So, you know, you can watch 10 minutes of CNN 2 and you're seeing pharmaceutical commercial after 3 pharmaceutical commercial for every imaginable 4 symptom out there. 5 If you're having trouble sleeping, take 6 Lunesta. 7 There's a whole variety of other products 8 that are out there. 9 UNKNOWN SPEAKER: [Inaudible.] 10 ALAN SORENSEN: Exactly. 11 And so they're conditioning our children. 12 And I do see this as no different than the 13 attack that the big tobacco companies put on our 14 children back in the '70s and '80s. 15 We did, after people making -- connecting the 16 dots, passed Congressional legislation to prohibit 17 the tobacco companies from targeting our children. 18 And I think the time is long overdue for 19 the -- for our leaders to get after the big pharma 20 to stop targeting our children with these 21 advertisements that are definitely targeted to our 22 children. 23 That is part of the reason that there is such 24 a high rate of addiction in this country. 25 And, you know, when that law passed in 1997, 1 the amount of pharmaceutical advertising in this 2 country went from a few hundred million, to over 3 2 billion, within a matter of a year or two, so 4 there's no question that's part of the problem. 5 And I think we need -- I would recommend 6 two actions: 7 One, to pursue legislation that would 8 dramatically limit the ability of pharmaceutical 9 companies to do direct consumer advertising in the 10 United States of America; 11 And, two, that similar to the tobacco 12 settlement, where the big tobacco companies were 13 required to pay into a fund to offset and to help 14 address the high cancer rates as a result of tobacco 15 smoking, that we need someone, whether -- I don't 16 know what group out there, but there's got to be an 17 attorney out there in the U.S. who wants to pursue a 18 class-action settlement, to go after the big 19 pharmaceutical companies who are targeting our 20 children with this direct consumer advertising. 21 And there should be a pharmaceutical 22 tobacco -- or, settlement fund that's set up to help 23 pay for some of these things that our municipalities 24 are having to fund. 25 [Applause.] 1 ALAN SORENSEN: So, you know, it's -- I can't 2 help but get emotional about it, because I do think 3 it's an intentional selling of this product to our 4 children, from the time they're born, and watching 5 any advertisements on TV, they're being told that if 6 you have any type of symptom, there's a 7 pharmaceutical "magic pill" to solve your problem, 8 and that's not the message we should be sending to 9 our children. 10 SENATOR BONACIC: Thank you, Alan. 11 ALAN SORENSEN: Thank you. 12 SENATOR BONACIC: I just want to react a 13 little bit. 14 It's an excellent point, Alan. I think it 15 parallels what you said about the smoking industry 16 and tobacco. 17 I think it has to be done on a national 18 level. That's where the pressure has to come. 19 And, you know, special interests that may pay 20 money to try to block something like that in the 21 Congress, but, it's something that has to get 22 traction in every state, with messages sent to the 23 Congressional delegation, to take that point up. 24 It was a good point. 25 Thank you, Alan. 1 MJ: I have, next question, is Dr. Salsberg. 2 His question is: How can we expand treatment 3 programs in Sullivan County? 4 SENATOR BONACIC: More money. 5 MJ: Do you want to expand? 6 DR. SALSBERG: Hi, I'm Dr. Salsberg. 7 I have a conflict of interest. 8 I'm the medical director of The Recovery -- 9 SENATOR BONACIC: Can you speak louder, 10 please. 11 DR. SALSBERG: I'm Dr. Salsberg. 12 I have a conflict of interest. 13 I'm the medical director of The Recovery 14 Center, one of the treatment programs represented by 15 Ms. Bolling. 16 About a month or two ago, they actually 17 stopped The Recovery Center from taking in patients. 18 Now, The Recovery Center was the last 19 treatment program in the county. 20 The hospital doesn't have a program anymore. 21 I've been doing this for 20 years here. 22 And there's been three or four programs in 23 the county that have just disappeared. 24 So if we want to deal with a program, we need 25 availability here to treat people. 1 So I think I'd like to you address that, if 2 there's any funding, or something we can do for 3 this? 4 SENATOR BOYLE: In the most recent budget, we 5 did get another $1.8 million to go towards treatment 6 and prevention. 7 But tell me, did they give -- what's the 8 reason? 9 Was it just funding that they are shutting it 10 down? 11 DR. SALSBERG: Well, they closed The Recovery 12 Center for -- it's back open now. 13 SENATOR BOYLE: Oh, okay. 14 DR. SALSBERG: But there was a few, like, 15 very bureaucrat things, and it put a great strain on 16 our whole county, since this was the last treatment 17 program we had. 18 So instead of, like, talking about it, we 19 need some action, we need some programs here. 20 SENATOR BOYLE: Thank you. 21 SENATOR BONACIC: Thank you. 22 Okay, MJ, next one. 23 MJ: Thank you, sir. 24 Okay, I have Carol Shepherd [ph.] asks: What 25 are the -- the county pays money for people to 1 receive treatment outside of the county. 2 "Are there similar plans?" 3 Is that your question? 4 CAROL SHEPHERD [ph.]: [Inaudible.] 5 MJ: Can you stand up? 6 SENATOR BONACIC: Let her come up. 7 MJ: Can you stand up? 8 SENATOR BONACIC: Let her come up and take 9 the mic. Go to the podium. 10 Yeah, and let her come forward. 11 CAROL SHEPHERD [ph.]: I know, I've worked 12 with clients who have a history of heroin addiction. 13 And they're -- they've received methadone. And the 14 county pays a lot of money for these people to be 15 transported down to Newburgh. 16 With the increased problem of heroin 17 addiction in the county, are there going to be any 18 arrangements for them to receive treatment locally? 19 And what are the local options for people, 20 for heroin? 21 I mean, you go to The Recovery Center for 22 alcohol, but what about heroin? 23 JOSEPH TODORO: Well, Carol, at one point, 24 there wasn't an overarching need to really work with 25 opiate addictions, and it was felt that, regionally, 1 we could address the folks who were on methadone 2 maintenance with that clinic in Newburgh. 3 As we've seen the increased need for opiate 4 treatment, you know, there are a number of 5 physicians who prescribe Suboxone, which is 6 different, but a similar kind of medication to be 7 used with somebody who has an opiate addiction. 8 I have yet to see somebody come, at least to 9 the Department of Community Services, with a request 10 to open a methadone clinic here. 11 But, I would entertain a request. 12 CAROL SHEPHERD [ph.]: Are there any plans to 13 expand the license at The Recovery Center to deal 14 with folks that are addicted to heroin? 15 IZETTA BRIGGS-BOLLING: We do provide 16 Suboxone treatment for individuals, and we have 17 two different programs. 18 We have the 822, mild-to-moderate withdrawal, 19 and we have a residential crisis unit, where 20 Suboxone treatment is administered. 21 And their residential program has been in 22 existence since about 2007. And the newer one 23 opened in 2013. 24 JOSEPH TODORO: Yeah, and in our outpatient 25 clinic, we now have some treatment groups that are 1 working with those people who are on Suboxone 2 maintenance, or trying to come off of Suboxone. 3 So, we've opened that up. 4 We've actually let the prescribers know that 5 that's a service that's available through our clinic 6 at this point. 7 So, yes, we're trying to address some of the 8 local need. 9 SENATOR BOYLE: What's the average length of 10 time your patients stay on Suboxone? 11 JOSEPH TODORO: Again, I think it depends 12 upon the person. 13 But, to detox somebody is usually a week. 14 And some people are able to go that week, and then 15 get into a treatment program and do just fine. 16 The people who are unsuccessful, they may be 17 taking a maintenance dosage of Suboxone for the rest 18 of their life. 19 Because one thing that we do know about this 20 disease of addictions, is that it's chronic; and, 21 so, you live with it. 22 It's like diabetes; you learn to live with 23 it, you learn to manage your recovery from that 24 disease, from the day that you admit that you have 25 that problem, to the day that you die. 1 SENATOR BONACIC: Okay, MJ? 2 MJ: Jennifer Brian [ph.], did you want to 3 come up and ask your question? 4 JENNIFER BRIAN pph: Hi, my name is 5 Jennifer Brian, and I work for the 6 Mid-Hudson Prevention Resource Center. We're 7 located in Goshen, out of the Alcoholism and 8 Drug-Abuse Council. 9 And what I heard a lot today was about 10 evidence-based programs in schools, and the 11 prevention programs, and things like that, which are 12 phenomenal and fantastic, and we definitely need 13 them. 14 But what I want to ask about is, 15 community-based prevention, which is changing the 16 norms; making it so, that way, the prescription 17 drugs are not something that's considered safe for 18 everybody. 19 And, so, what kind of things can be done in 20 order to support the community coalitions? Which 21 I know they have them in Sullivan County, because we 22 work with them. 23 So what can be done to help support them, 24 both funding- and non-funding-wise, in terms of the 25 government? 1 And, what kind of things can we, hopefully, 2 see from you guys to help them make that 3 community-based change, that we need to match the 4 evidence-based programs that happens in the schools? 5 IZETTA BRIGGS-BOLLING: Well, The Recovery 6 Center is supportive of your statement, because 7 environmental strategies are very important to 8 making that change occur. 9 And every time an RFP comes out, we have 10 people in the back that are always writing for them. 11 JOSEPH TODORO: The other thing that I'm 12 sure, that we would both invite our community to 13 come out and participate in our planning and 14 implementation of prevention programs in our 15 community. 16 We have attempted to do some community 17 development around that. 18 We had caught fire at one point in time, and 19 had a countywide committee, and then we had a few 20 smaller committees in different communities, but, it 21 kind of petered out, as did some of the funding. 22 But, you know, we would both invite the 23 community to come out. 24 If you're interested, if you want to 25 participate, if -- you know, then come -- you know, 1 give Izetta a call, and we'll get you participating. 2 JENNIFER BRIAN pph: Thank you for those 3 answers, but I also want to know, maybe from the 4 Senators, what kind of things can we see from the 5 federal government and our state government that 6 will help to support these initiatives that are 7 really necessary in order to make this change? 8 SENATOR BOYLE: Well, that's exactly one of 9 the things we're looking for in these forums. 10 As I say, we did put a few million dollars 11 in, and we'll probably be putting more in, towards 12 prevention and treatment; primarily, towards 13 prevention, and to see which one are base. 14 Of the 17 forums, we've heard some very good 15 programs. We've heard some not-so-good programs. 16 So, we will have answers for you in a couple 17 weeks on that. 18 JENNIFER BRIAN pph: Thank you. 19 SENATOR BONACIC: Thank you. 20 MJ? 21 MJ: Speaker? Come, sir. 22 Dr. Thomas. 23 DR. THOMAS: Hi, good afternoon, everybody. 24 SENATOR BONACIC: Good afternoon, Doc. 25 DR. THOMAS: I'm not an expert, but I've been 1 prescribing Suboxone and dealing with addiction for 2 the last 12 years. 3 SENATOR BONACIC: I don't think we can hear 4 that you well, Doctor. You've got to speak louder. 5 DR. THOMAS: I'm not an expert, but I've been 6 a physician for almost 40 years, and the last 7 12 years I've been dealing with addiction. 8 And it's very -- probably the best 9 satisfaction, as a physician, is when a parent comes 10 to you and hugs you, and tells you, "Thank you for 11 giving me back my son." 12 I've been able to turn some lives in my life, 13 and it's very sad when some -- [unintelligible] 14 anybody over 40 years old -- below 40 years old, 15 because I'm going to be 70 soon. And, they come in 16 with a good intention of getting rid of this 17 disease. 18 We write the prescription for the medication. 19 We do what we call an "induction," so that we 20 know how much Suboxone he needs. 21 We know how much he needs, we write a 22 prescription. 23 The insurance company says "no." 24 So I go to the pharmacy and I write a 25 prescription for 120 Oxycontins, oxycodones, and 1 they immediately approve it. 2 And I have here proof of it: 3 The letters of denial; 4 With the prescription for the oxycodone, 5 signed by me, for 120 tablets; 6 And the receipt from the pharmacy for the 7 120 tablets of oxycodone. 8 So, I think that New York State is giving 9 money to drug dealers, because these are drug 10 dealers, these insurance companies. 11 [Applause.] 12 DR. THOMAS: These insurance companies have 13 been contracted to run Medicaid in this state, and 14 this is a shame. 15 And this is at least one every week. Every 16 single week. 17 Yesterday I had another one. One week 18 waiting for the approval. Still, they didn't have 19 it. 20 I called them and I said: Let me speak with 21 the medical director. Who's your medical director? 22 No name, no telephone number. 23 I even left them my cell phone number, 24 because the medical director was going to call me. 25 So before they closed the pharmacy, I went to 1 the pharmacy, I called them again. 2 "Oh, still it's not approved." 3 So I wrote a prescription for 120 Percocets. 4 Immediately approved. 5 So I call them back and I say, "You don't 6 want to give the medication? You already gave the 7 120 Percocets just a while ago." 8 In 10 minutes they called me, "The medication 9 has been approved," because I told them, "This is 10 going to be in the newspapers tomorrow morning." 11 So, I think New York State has to do 12 something with all these insurance companies, 13 because we're trying to solve a problem, and they 14 are creating the problem. 15 That's one of the things that I wanted to 16 say. 17 The other thing, I got some of the questions 18 and things that they say here. 19 Opiate addiction is a chronic disease, and 20 it's categorized as a "chronic disease." 21 Diabetes mellitus is a chronic disease. 22 Hypertension is a chronic disease. 23 We have some physicians here. Which of you 24 take the insulin off a diabetic because it's 25 expensive? 1 It's a crime. 2 They are doing this with our patients, with 3 our [unintelligible] patients. 4 And in my practice, my experience, they come 5 in dirty, not shaved, nothing. Arrogance. 6 And the next day, they are a completely 7 different person. 8 And I'm very, very proud of all of them. 9 We also have another problem that we are 10 going to talk about here, at least what we calling 11 in medicine, "endorphin deficiency syndrome." 12 I believe that everybody remembers from 13 high school what word "endorphins." 14 It's a substance that we have in our brains 15 that make us happy. 16 Okay? 17 The word "endorphins" is a compound word. 18 "Endo," that means built by our own body. 19 And we are left with morphine. 20 So we have, our body produces morphine. 21 So some kids are never happy. If you have 22 low endorphin, you're never happy. 23 And these kids have been diagnosed of 24 depression. They go to the psychiatrist, and they 25 give them one medication. 1 No results. 2 Add -- increase the dosage. 3 No results. 4 Give another medication. No results. 5 Because they're not treating the problem that 6 the kid has. 7 And usually this kid is in his house, his 8 mother is always telling him, "Pick up your room." 9 He never picks it. 10 The father tells him, "Mow the lawn." 11 He doesn't mow it. 12 He goes to the dentist, he gets some Vicodin 13 or some kind of with codeine. 14 The mother tells him, "Pick up your room," 15 and in 5 minutes, the room is picked up, because he 16 had a morphine substance a little bit more in his 17 brain now. Now he is functioning normal. 18 Then when we sit at the table at night with 19 him, we as parents tell him: Why can't you be like 20 this? You see how nice it was today? I just asked 21 you and you did it right away. Why can't you be 22 like this? 23 And then this kid says: Wow, when I take 24 this pill, I get along better with my dad and my 25 mom. I get along better with my teacher in school. 1 I perform better. 2 And it's true, he's doing everything better. 3 So he needs a boost on his endorphin. 4 So Suboxone is going to give him that boost 5 because he needs morphine-like substance. 6 But then we have, what are we going give him? 7 Heroin? Morphine? Oxycodone? 8 What are we going to give him? 9 We have to give him the safest one. That's 10 the only alternative we have now. 11 It's the only alternative we have, or he's 12 going to live, like, depressed all his life. 13 It's the same thing as if, you don't produce 14 insulin, you're diabetic. And you need some 15 insulin. 16 So if you don't have endorphin, you need to 17 have some endorphin. 18 That's why this is a disease, and that's the 19 way to treat it. 20 I'm talking about Suboxone and the insurance 21 companies. 22 They are forcing us to lower the dosage on 23 the patients and to get them off the Suboxone. 24 We have to make prior authorizations for the 25 Suboxone. And on the prior authorizations, I have 1 to write when I'm going to lower his dosage, and 2 when I'm going to get him off the medication, like 3 if you're telling me, "Your diabetic patient, when 4 are you going to lower the insulin, and when are you 5 going to get right of -- get him off the insulin?" 6 It's the same thing. 7 SENATOR BOYLE: Doctor, could I just ask you, 8 your license, you started with 30 Suboxone patients, 9 and then you can go to 100 after a year? Is that 10 correct? 11 DR. THOMAS: Yes, sir. 12 SENATOR BOYLE: You're at 100 now? 13 DR. THOMAS: Not yet. 14 SENATOR BOYLE: Not yet. Okay, okay. 15 DR. THOMAS: I'm very choosy. 16 They come to play games, they don't fit in my 17 practice. 18 SENATOR BOYLE: Okay. 19 Well, thank you very much. 20 SENATOR BONACIC: Doctor, we're not here to 21 cut you short, but we have others that we have to 22 get through. 23 So if you could conclude, we would appreciate 24 it. 25 DR. THOMAS: Okay, so, I just want to make 1 sure that everybody understands that this is a 2 disease, and that the insurance companies are not 3 helping us. 4 They want these kids in the narcotics, 5 because Suboxone is $8 a dose, and the oxycodone is 6 5 cents a dose. And we cannot [unintelligible] 7 economics against health. 8 Okay? 9 Health is first. 10 Thank you. 11 SENATOR BONACIC: Thank you, Doctor. 12 [Applause.] 13 IZETTA BRIGGS-BOLLING: I just quickly wanted 14 to say that Suboxone used to be -- you could get it, 15 across the board, with Medicaid. 16 Now Medicaid clients are all required to be 17 in an HMO. And different HMOs, it will take much 18 longer for clients that are in need of Suboxone to 19 get it. And sometimes it can take up to a week, 20 which is what he was saying. 21 SENATOR BONACIC: Okay, MJ? 22 MJ: I have a comment here from 23 Dr. Roux [ph.], and I'll just start it briefly. 24 We do have an event coming up in a little 25 while, so we'll ask any comments to be as condensed 1 as they can. 2 "With the gravity and the extent of the 3 epidemic, what are your thoughts on in-service 4 trainings for judges and other legal professionals?" 5 Is that the general consense [ph.] of the 6 question? 7 MR. ROUX [ph.]: [Not using a microphone.] 8 I'll keep it short. 9 First, I just wanted to say I'm a doctor, and 10 I don't want to pretend to be. 11 MJ: I'm sorry. 12 MR. ROUX [ph.]: That's okay. 13 I'm a licensed mental-health counselor, and a 14 credentialed alcoholism- and substance-abuse 15 counselor, in private practice in Monticello. 16 The only other partner I have in the practice 17 is my wife, Carmen Roux [ph.], who's the office 18 manager. 19 We have a very busy day, though, all day 20 long. There is no shortage of people who are 21 seeking treatment. 22 I want to thank the Senators and the State of 23 New York for their interest in the panel 24 discussions, and all the panelists. 25 I heard very little disagreement from among 1 the panelists on hardly any point, which I think is 2 notable. 3 What I wanted to point out, though, to 4 emphasize, to accentuate, is the access-to-treatment 5 issue. 6 The last speaker spoke at length about the 7 access to Suboxone. 8 And, Joe Todora, I really appreciated what 9 you pointed out, that some people need a detox 10 protocol to get off of heroin. 11 Suboxone works wonderfully for that. 12 Some people need to stay on it for years or 13 for life. 14 And it's approved by the FDA for maintenance. 15 If it's prescribed by a medical doctor, 16 there's nothing wrong with that. 17 It's a health-care decision, and it should be 18 left between the medical doctor and the patient. 19 And that's a point that was raised in my 20 question, is that I get concerned sometimes, when 21 I see the criminal justice system expressing 22 reservations about the medical care that people are 23 receiving from their doctors who prescribe, for 24 example, Suboxone. Maybe methadone, as well. 25 I see people who are on probation, people who 1 are on parole, who are told they have to get off of 2 that. Or when they're sentenced, are told that they 3 must stop taking their Suboxone because that would 4 be a violation of the terms of their sentence. 5 I think that needs some -- a careful look. 6 And I would respectfully suggest that 7 consideration be given to training judges and 8 law enforcement, in terms of the people who 9 supervise the officers of the court who supervise 10 people under the direction of the judges. 11 Biopsychosocial treatment, counseling, is 12 limited in some ways. 13 And I think this is a law that could be 14 addressed. I think it would come under the 15 social-service law. 16 If someone has SSI or SSD, their managed-care 17 Medicaid does not cover any sort of substance-abuse 18 treatment. 19 It reverts to straight Medicaid. It's called 20 a "carved-out benefit." 21 What that means is, that the most disabled 22 people, the people who are most in need of help, 23 because of their mental-health condition or their 24 concurrent physical disabilities that have qualified 25 them for SSI or SSD, have the hardest time finding 1 providers who can give them treatment. 2 I cannot be reimbursed by Hudson Health or 3 Fidelis if a person has SSI or SSD. And I know that 4 it's not just me in my licensed capacity. 5 It really makes it much more difficult 6 because of that carved-out provision. 7 I would like to see that eliminated. I would 8 like to see the disease of addiction treated like -- 9 treated by managed-care Medicaid treated like any 10 other disease. 11 Getting approval for levels care is also a 12 big issue that's been mentioned -- a big problem 13 that's been mentioned here. 14 We need to have what's called "failed 15 attempts at outpatient." 16 Multiple failed attempts at outpatient 17 treatment for heroin addiction can be fatal. 18 And, also, I wanted to emphasize, I think the 19 point that's been made, is that there's too much of 20 a sharp line drawn between mental health and 21 substance-abuse treatment. 22 There's -- and when you look -- when I see a 23 person, I see a person; I see a human being; I see a 24 whole package. 25 I don't see half of you is an addict and half 1 of you is bipolar, and today I'm going to treat the 2 bipolar half, and come back next week and we'll talk 3 about heroin. 4 It needs to be treated together. 5 And I'm not suggesting that OMH and OASAS 6 should be merged. 7 I retired from OASAS in October, and I've 8 been full-time in the private -- Office of 9 Alcoholism and Substance Abuse Services. I've been 10 in private practice full-time since then. 11 But I do think that the two agencies need to 12 blur their boundaries a bit. And, respectfully, the 13 local clinics, work more hand in hand. 14 We need to treat people as people, and not as 15 diagnoses. 16 Thank you. 17 SENATOR BONACIC: Thank you very much. 18 SENATOR BOYLE: Thank you very much. 19 [Applause.] 20 MJ: I have our next comment from 21 Deborah Fuchs Nadu [ph.]. 22 Is Deborah here? 23 I'll ask if you can keep them, if you can, as 24 brief as possible. 25 DEBORAH FUCHS NADU [ph.]: It's very hard for 1 me, but I'll try. 2 Hi, thanks. 3 Thanks for being here today, and I want to 4 thank everybody for what they've presented. 5 I have a lot of colleagues on this panel, and 6 people, that we have worked on this for the last 7 25 to 30 years, so I'm having some what have a 8 deja vu moment. 9 I'm thinking back, and, Joe, you will 10 remember this, and I don't know who else was here 11 with us: 12 We sat in this room, maybe not with the 13 Senators, but with Steve Lungen [ph.], 14 Frank La Budda [ph.], and a lot of old names, and 15 had drug task-force committees -- in 1985? 16 JOSEPH TODORO: Yeah, I'd say. 17 DEBORAH FUCHS NADU [ph.]: Yeah. 18 -- addressing some of the same issues. 19 The drug of choice this week might be 20 different, but we have addressed the same issues. 21 We had a very, very strong prevention 22 presence in this county. And I can speak to that 23 because I was that presence. 24 I was, in my previous life, before I became 25 the clinical director of BOCES, I was the director 1 of prevention services, and worked with all the 2 community agencies that worked really hard on a 3 shoestring, and with all the school districts, to 4 provide prevention programming. 5 So I've heard lots of great things today, but 6 it's the same old story for me. I've heard the same 7 things over and over again. 8 We were minimally funded in this county back 9 in 1985. 10 We started on a $30,000 grant to provide 11 services to all the schools and work with the 12 community. 13 10, 15 years later, it was 45,000, Joe? 14 46,000? And then it was pulled away. 15 "It was pulled away." 16 We talk about what works in prevention? 17 We've known that for years. 18 I've been a prevention researcher for the 19 last 25 years. 20 And they -- all you have to go is to the 21 federal websites and you will see what works in 22 prevention. 23 We can Google those things. 24 Same kinds of things that work in drug 25 prevention, by the way, work for violence 1 prevention, work for bullying prevention, work 2 for -- prevention is prevention. 3 Somebody coined it with "life skills" 4 earlier? 5 That's what we're teaching: people to be 6 people. 7 Yes, we're torn between what happens, 8 Common Core in education, time constraints for what 9 comes first, but we miss -- we've missed many 10 opportunities. 11 And I'm trying to rush, but I have a couple 12 more points. Sorry. 13 So we do know what works. We've been looking 14 at that for years. We've been promoting that for 15 years. 16 We do know -- not to disrespect anybody in 17 what they're doing -- crash-cars do not work. 18 Those of us that read the research know that. 19 It's a nice addition to things, but they do 20 not work. 21 There are comprehensive programs and 22 strategies. 23 It's a science, folks. 24 We've been out there and we've been doing 25 this work. 1 I just want to address a couple of things. 2 In the 1970s and 1980s -- 3 You can chop me off in a second. 4 In the 1970s and 1980s, you could get a bag 5 of heroin for $10. 6 It's an old story. It's nothing new. 7 You take away one thing. 8 We had methadone. 9 We're talking about Suboxone? 10 How long has methadone been around? 11 JOSEPH TODORO: Oh, how long's heroin been 12 around? 13 DEBORAH FUCHS NADU [ph.]: Yeah, okay. 14 So, thank you. 15 So it's there. 16 It's, what are we going to do about it? 17 The answers are out there. 18 And this community, this county, had worked 19 very, very hard with The Recovery Center, with 20 New Hope, with the schools, with law enforcement, 21 with Public Health, with community services. 22 We have had many different prevention task 23 forces. 24 Now we need the fiscal support to have that 25 happen again for us. 1 Thank you. 2 SENATOR BOYLE: Thank you. 3 [Applause.] 4 MJ: I have Eric Alleva [ph.], who said he 5 had a lot to say, but I have asked him to keep it to 6 the fine points. 7 Okay, sir? 8 ERIC ALLEVA [ph.]: My name's Eric Alleva. 9 I've been a drug addict for 53 years. 10 I'm 65 years old. 11 UNKNOWN SPEAKER: Hold it up. We can't hear 12 you. 13 ERIC ALLEVA [ph.]: I've been a drug addict 14 for 53 years. 15 I'm 65 years old. 16 Back in, I don't know, my chronologic clock 17 is broke, so back, I guess it was in '70s, the State 18 Police, the Sheriff's Department, and myself were 19 successful in arresting 23 -- we got arrested and 20 convicted 23 drug dealers. 21 I can stand here with an open face and tell 22 you that because, hopefully, nobody in this room is 23 going to recognize me, since that was in the '70s. 24 Why can't, from the beginning, there's the 25 arrest. Whether it's in the Sheriff's Department's 1 car or in the State Police car, it's an arrest on a 2 drug dealer. 3 Why can't that picture be posted in Fallsburg 4 on their screen? In Monticello on their screen? 5 Why can't that picture be printed out and 6 that police officer take that picture home? 7 He may know that person, whether that person 8 be a male or a female, and say, Wow, I recognize 9 that person. That person was just arrested in drugs 10 this afternoon. 11 That may be a help. That may be a key to 12 opening the door, to finding out where that person 13 got the drugs and stop that. 14 It's very easy. 15 You go to High Street, the same street that, 16 in the '70s, is still selling drugs today. 17 The same street. 18 And it's now, it's not called "Moon Manor," 19 but the same place. Moon Manor, is the same -- not 20 the same apartment, but the same place is still 21 selling drugs today. 22 And you want to know why the insurance 23 companies won't pay? 24 It's because the amount of -- they ratio to 25 how many failures and successes. 1 Here's the insurance company willing to put 2 out money, but how many failures do you have? 3 You see, when I was in recovery, when I was 4 in the Veritas Villa, two men are walking down the 5 street and these church bells go off, and the bells 6 ringing, ringing, and ringing, and the other guy 7 says: Listen, I didn't hear what you were saying. 8 I was listening to those bells, those stupid bells. 9 And the guy said, What stupid bells? I was 10 listening to the music. It was beautiful music. 11 See, one guy heard the music; the other guy 12 heard the noise. 13 The police officers themselves can determine, 14 they can see the difference, between the guy's who's 15 got an attitude, who doesn't want help, who just 16 wants to -- who just needs -- thank God, there's a 17 jail for him; and the people that need help, because 18 there are people. 19 And if you can be more selective in picking 20 the people that really need the help, and put those 21 people in a program, then maybe the insurance 22 companies will say, Wow, look at the amount of 23 success we've got in the programs. 24 And whether you're a good parent or a bad 25 parent, you can't take responsibility for having a 1 good kid. 2 I've got five good kids, and I was never a 3 good parent. 4 And you can be a lousy parent and have great 5 kids. 6 And you can be greatest parent and have 7 miserable kids. 8 It's, just, that's the way God made us. 9 SENATOR BONACIC: Okay. I want to thank you 10 for your comments. 11 We have three more speakers. 12 We're going to ask that they limit their 13 remarks to two minutes. 14 We have to be out of here by four. 15 Our panelists have obligations, and so do we. 16 And there's going to be a County State of the State, 17 I understand, here after we leave. 18 So, MJ, you have the next speaker? 19 Okay, yes. 20 Go ahead, tell us your name. 21 CAROL RYAN: Hi. 22 Is this working? 23 Yes. 24 My name is Carol Ryan. I'm the past 25 public-health director before Nancy McGraw. 1 I just retired in July. 2 So, we're very instrumental in starting the 3 Prescription Drug-Abuse Task Force in this county. 4 And I'm also personally affected by a family 5 member that's been impacted by mental-health and 6 substance-abuse issues. 7 So I see this from two perspectives. 8 I just have a couple of suggestions. I'm not 9 going to be long-winded. 10 But in thinking about this, I think the 11 I-STOP law was a great start, but it did have 12 unintended consequences. 13 One thing, it's driving people to heroin, as 14 you heard. 15 And I think that there were some things that 16 need to be set in place, along with the I-STOP law, 17 that you might want to consider. 18 Maybe some of these exist and I just don't 19 know it. 20 I think that when people get turned away, at 21 that moment, from getting a prescription, there's a 22 big lack in what happens then, and there needs to be 23 some kind of support system set up. 24 I mean, there should be, maybe -- you know 25 how we have the I-Quit line for smoking? "New York 1 Quits?" -- we should have a line like that for 2 addicts. 3 We should have a 24-hour hotline, I think, 4 for addicts; but not just for addicts, for 5 counseling. 6 It should be three-prong. 7 I would suggest that, one, it be for the 8 addicts, and you should have trained mental-health 9 and addiction-treatment personnel on it, not 10 operators. 11 Okay? 12 Also, it can serve the pharmacists who are 13 dealing with some of these people. 14 And they're also dealing -- you haven't heard 15 from anybody, this huge amount of increased 16 robberies and violent crimes against -- in 17 pharmacies. 18 So, to help the pharmacists know how to deal 19 with addicts who show up, and it's something they 20 have no idea what to do with. 21 And, also, to help to be a consultation for 22 physicians. 23 I also think that hotline, the person serving 24 on it, the people should have access to an 25 up-to-date database of available treatment beds 1 right now, so that -- because, right now, what 2 I think happens, unless it's changed, is they're 3 calling around, maybe from the emergency room, or 4 wherever, place after place after place, trying to 5 find a bed. 6 There's -- I don't think there's any 7 available, uhm -- a consolidated database where you 8 can just call and say, I've got somebody here. 9 The doctor can call. He looks on I-STOP. He 10 can't prescribe this kid Percodan [sic], or this 11 adult. 12 The person, they break down, they say, "Okay, 13 I'm an addict. I need help. What do I do now?" 14 what does that doctor do? 15 There is nothing. 16 So if they could pick up the phone and say, 17 Where's a bed? 18 Pick up, call this hotline, say, "Where's a 19 bed right now? I have somebody who needs help." 20 That does not exist. 21 Okay? 22 So I suggest that there be something like 23 that. 24 I also suggest required training in addiction 25 recognition and screening for all physicians, nurse 1 practitioners, and physician assistants, maybe in 2 conjunction with renewing their licenses; just like 3 we have now child-abuse training that's required. 4 This should be required, so you can stop this 5 problem at the beginning where it often starts, 6 which is when writing the prescription. 7 And then, not just in recognizing addiction, 8 but training, and what kind of interventions that 9 they can suggest for these patients who show up and 10 need help, because these people are sick. 11 They're not criminals. 12 They become criminals when they are desperate 13 and they have to find ways to get drugs. 14 And two more things, that's all. 15 More affordable substance-abuse treatment 16 facilities. 17 If you put money into that, you're going to 18 lower prison costs. 19 People go to prison because they commit 20 crimes, because they need drugs. 21 And the last thing is: Please, please, do 22 something to require insurance companies to cover 23 immediate inpatient admission, rather than requiring 24 a failed trial as an outpatient first, which is 25 dangerous and unrealistic. 1 [Applause.] 2 SENATOR BONACIC: I want to thank you very 3 much. 4 They were very excellent suggestions. 5 Thank you. 6 UNKNOWN SPEAKER: [Off video.] There is an 7 OASAS helpline that operates 24/7, that maybe is a 8 resource people should know about. 9 I'm sorry I don't have the number, but they 10 would have access into where beds are available. 11 MJ: Okay, next? 12 KITTY VETTER: Kitty Vetter. 13 I am a nurse by career, an R.N., and I dealt 14 with health issues like this for a long time. 15 And I'm presently one of the County 16 legislators. 17 I would strongly support what Alan is 18 suggesting as far as prevention. 19 Prevention is the main modality in any kind 20 of nursing intervention. 21 So I would suggest to you, as the legislators 22 of our state, to move forward to stop the present 23 form of pharmaceuticals that are out there in the 24 media, that are out there on the TV. 25 We stopped Joe Camel many years ago. 1 We can stop this now, and I think that's the 2 main way to go. 3 Endomorphins are a reality. 4 The other thing is encouraging kids to 5 exercise. 6 I don't mean doing jumping jacks. 7 Anybody who did anything with a runner's 8 high, which is kicking in your own Endomorphins, 9 kids are not being physically active so they are 10 being depressed, because they don't have the 11 physical activity. And many of the schools are 12 slowing down on that. 13 So physical activity for the children, and 14 stopping the commercials on the TV. 15 SENATOR BONACIC: Thank you, Kitty. 16 [Applause.] 17 KITTY VETTER: You're welcome. 18 SENATOR BONACIC: The last speaker is who, 19 MJ? 20 MJ: We have time for one more? 21 Laurie Rotolo [ph.]. 22 Is Laurie here? 23 LAURIE ROTOLO [ph.]: Thank you. 24 Hi, my name is Laurie Rotolo. 25 I work with Ulster Prevention Council in 1 Ulster County. 2 I also am a part of the prescription-drug 3 task force. 4 And we are working really strongly with the 5 medical community on prescribing practices. 6 One of our -- one of our physicians in 7 Ulster County is starting a prescription for 8 wellness, which is something that they're trying to 9 institute in their clinics as an alternative to -- 10 as an alternative to prescription -- for 11 painkillers, to -- just to piggyback on what the 12 person before me just said, to encourage more 13 proactive, health-oriented exercise and alternative 14 medicines. 15 And so my other question is: What can we do 16 to support alternative insurance coverage for 17 alternative treatment for people with addictions and 18 other problems as an alternative to the medication? 19 And, also, to also say about the prescription 20 drugs that the pharmaceutical companies, I agree 21 with everything that was said about the 22 pharmaceutical companies. 23 In Ulster County, we did get a $6,000 check 24 from a pharmaceutical company, in terms -- so that 25 we could purchase more medication drop-boxes. 1 And, so, we're recommending that everyone 2 reach out to your pharmaceutical companies and ask 3 them to help clean up the mess by making sure that 4 these medication boxes are installed all over the 5 sheriffs and police stations and -- in all the 6 counties. 7 That basically was it. 8 SENATOR BONACIC: Thank you very much. 9 I think we're going to conclude this forum. 10 Do you have another person that would like to 11 say something? 12 MJ: Can we fit one in, Senator? 13 SENATOR BONACIC: Yeah, sure. Go ahead. 14 Come up on. 15 MJ: Priscilla, come on up. 16 Thank you, Priscilla. 17 PRISCILLA BASSETT: Priscilla Bassett from 18 the Sullivan County SLAC, which is the 19 Senior Legislative Action Committee. 20 I was up in Albany on Tuesday and I picked up 21 the "Legislative Gazette." 22 The headline on the second page, and the 23 whole page, said, "Senate Dems Unveil Bill Package 24 To Fight Heroin Epidemic." 25 There was also reference to something in the 1 Senate, a single bill that was mentioned. 2 I just want to urge the Legislature to set 3 aside these problems of cooperation between the 4 Senate and the Assembly, between the Democrats and 5 the -- 6 Oh, I don't know what that other Democratic 7 group is called. 8 [Laughter.] 9 PRISCILLA BASSETT: I don't mean to make a 10 joke. 11 -- between the Democrats and the Republicans. 12 These laws -- these proposed laws, 13 legislations, are vital to moving ahead. 14 And I hope that you can all work together in 15 the spirit that we're all here today, to do 16 something as quickly and as sensibly as possible. 17 Good debate, yes. 18 But action, too. 19 SENATOR BONACIC: Thank you, Priscilla. 20 [Applause.] 21 SENATOR BOYLE: Without a doubt, this is a 22 non-partisan issue. 23 We're here to save lives. 24 And I don't think you were forgetting the 25 Republicans. 1 It was the IDC, the Independent Democratic 2 Conference, which is the other group. 3 But we have members of that on our -- of the 4 IDC on our task force. 5 And I read the proposals by the Senate -- 6 regular Senate Democrats, and they got very good 7 ideas, and we're definitely going to incorporate 8 whatever we can. 9 We're going to work together on it. 10 SENATOR BONACIC: Do you want to close? 11 SENATOR BOYLE: I'd like to thank, certainly, 12 Senator Bonacic for hosting this great forum. 13 We got wonderful ideas. 14 Our panelists, thank you so much for all your 15 unsights. 16 And for the audience members who 17 participated, and those who came to listen and 18 learn, I appreciate it very much. 19 Realize that this is not the end. 20 If you come up sometime tonight and you say, 21 "Oh, I forgot to say something," contact my office. 22 It's, "Senator Boyle," just Google it. And 23 we've got staff people working on this till -- for 24 the next couple weeks, and thereafter, as well. 25 And I would like just to mention, in closing, 1 that we do realize, and one of the things I really 2 want to get out of these 17 forums, is the stigma 3 involved. 4 We have so many people that are ashamed about 5 talking about family members that are addicted or 6 themselves being addicted, and we still heard such 7 courageous stories here today. 8 It's not a shame. 9 We're going to get rid of the stigma. 10 This is a perfect start, and to learn that, 11 when someone walks up to you and they say, "Oh, my 12 child has cancer," the reaction you'll have, we want 13 to have it so, when you walk up and say, My child is 14 a drug addict, or heroin addict, you're going to 15 have that same exact reaction. 16 And we're going to work together to end this 17 heroin epidemic. 18 Thank you so much for allowing me to be here. 19 [Applause.] 20 SENATOR BONACIC: Again, to everyone that's 21 here -- our panelists, our audience -- government 22 does not have a magic cure for the problems that 23 we're facing with heroin. 24 One of the things that I thought was very 25 helpful, is that the flavor of the drug may change 1 from one decade to the other, and that point was 2 made over and over again. 3 We need everyone involved: government, 4 community, the experts, law enforcement. 5 We must cure this epidemic as best we can. 6 And as Senator Boyle said, everybody in 7 Albany, both sides of the aisle -- three sides of 8 the aisle, want to attack this problem, because it 9 pervades every area of our society, regardless of 10 our race, regardless of our economic strata. 11 So thank you for coming, and you will keep 12 your eye on this. 13 We're going to work very hard to get this 14 done before the end of session, and that's the third 15 week in June. 16 Thank you all for coming. 17 [Applause.] 18 (Whereupon, at approximately 3:56 p.m., 19 the forum held before the New York State Joint 20 Task Force on Heroin and Opioid Addiction 21 concluded, and adjourned.) 22 23 ---oOo--- 24 25