To Examine the Issues Facing Communities in the Wake of Increased Heroin and Opioid Abuse

1 NEW YORK STATE JOINT SENATE TASK FORCE

ON HEROIN AND OPIOID ADDICTION 2 ------------------------------------------------------ 3 TO EXAMINE THE ISSUES FACING COMMUNITIES 4 IN THE WAKE OF INCREASED HEROIN AND OPIOID ABUSE 5

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Mildred E. Strang Middle School 8 2701 Crompond Road

Yorktown Heights, New York 10598 9

April 30, 2015 10 7:00 p.m. 11 12 PRESIDING: 13 Senator Terrence P. Murphy

Co-Chair 14

Senator Jack M. Martins 15 16 17 18 19 20 21 22 23 24 25 1

SPEAKERS:PAGE QUESTIONS 2

Rob Astorino 8 12 3 County Executive

Westchester County, New York 4

Hon. James F. Reitz 14 22 5 County Court Judge, Drug and Alcohol

Treatment Court 6 Putnam County, New York 7 George Longworth 30 35

Public Safety Commissioner 8 John Hodges

Chief Inspector 9 Westchester County, New York 10 Dahlia Austin 48 59

Department of Community Mental Health 11 Westchester County, New York 12 Mike Piazza 48 59

Commissioner, 13 Departments of Mental Health,

Social Services, and 14 the Youth Bureau

Putnam County, New York 15

Dr. Andrew Kolodny 71 83 16 Chief Medical Officer

Phoenix House 17

Steve Salomone 101 110 18 Executive Director

Drug Crisis in Our Backyard 19

Frank Reale 20 Founder/President

Peers Influence Peers 21

Patrice Wallace Moore 113 129 22 Chief Executive Officer,

Arms Acres, Inc. 23 Vice President of Substance

Abuse Services for 24 Liberty Behavioral and Management 25 1

SPEAKERS (Continued): PAGE QUESTIONS 2

Marianne Taylor-Rhoades 113 129 3 Chief Operating Officer

St. Christopher's Inn 4

Anthony Eack 137 147 5 Volunteer

Council on Addiction Prevention 6 and Education 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 1 TJ: Presiding tonight, Senator Jack Martins, 2 and, Senator Terrence Murphy, 40th District, from 3 Yorktown. 4 SENATOR MURPHY: Thank you, TJ. 5 Can everybody hear me out there? 6 All right. So I don't want to... 7 Well, alls I'd like to say is, start off the 8 evening: Good evening, and thank you all for being 9 here tonight. 10 This is the first in a series of regional 11 hearings of the New York State Senate Task Force on 12 Heroin and Opioid Abuse, right here in my own 13 hometown, that I'm very proud to say. 14 Of those of you who don't know me, my name is 15 Dr. Terrence Murphy. I am the State Senator of the 16 40th Senate District, and I am proud to serve as 17 the co-chairman of this bipartisan task force, along 18 with Senators Rob Ortt and Senator George Amedore. 19 Unfortunately, they were unable to join us 20 tonight, but would I like to take a moment to 21 recognize their representatives. 22 There's Kevin Crumb, who is on behalf of 23 Senator Ortt. 24 Kevin, would you please stand up. 25 He's outside. Okay. 1 And, Doug Breakell, for -- Senator Amedore's 2 chief of staff. 3 Thank you for coming down here. 4 [Applause.] 5 SENATOR MURPHY: Also with me tonight is a 6 real dear, good friend of mine, and someone who has 7 taken me under his wing in Albany. I'm proud to 8 say, my good buddy who has shown me the ropes up 9 there already, Senator Jack Martins, who came in 10 from Long Island to be here with us tonight. 11 Thank you for coming all the way up here, 12 Jack. 13 [Applause.] 14 SENATOR MURPHY: I'd also like to thank the 15 Yorktown Superintendent Ralph Napolitano for 16 allowing us to use the school here, where I believe 17 more of this conversation needs to be had with our 18 kids. 19 Folks, the issue of the heroin and opioid 20 abuse has reached a crisis level, I believe, in the 21 Hudson Valley region, and also in New York State. 22 There are only so many words that can describe the 23 situation such as the one we're experiencing right 24 here in the Hudson Valley. The numbers and the 25 recent events are absolutely staggering. 1 Earlier this month, stopped due to a simple 2 traffic violation, the Tarrytown police found more 3 than 10,000 bags of heroin in a vehicle, let me say 4 that again, 10,000 bags of heroin, which had the 5 street value of a quarter-million dollars, right in 6 our backyard, right here. 7 This is what's going on. 8 The deaths from the opioid overdoses now 9 outnumber the homicides in some parts of 10 New York State. 11 In 2014, Dutchess County experienced more 12 than one death per week. And the same statistic can 13 be applied to us right here in Westchester County. 14 These deaths span age groups from young teens 15 to middle-age, and across an entire socioeconomic 16 spectrum. 17 Folks, this drug has no religion, it has no 18 race, and it has no ethnicity. It will grab you and 19 shake you down like we've seen. 20 That's why we're here tonight. 21 Right here in the Hudson Valley where we 22 live, there's an intersection of five counties that 23 have all had the dubious label of being a -- labeled 24 a high-intensity drug-trafficking area. You have 25 Rockland County, Westchester County, Putnum County, 1 Dutchess County, and Orange County. 2 That's pretty incredible, right here, and 3 it's usually due from a lot of the people coming up 4 from the city. 5 But I don't want that label anymore, and 6 that's why we're here. 7 The purpose of tonight is to hear from more 8 than a dozen expert witnesses about what the next 9 steps we as a state need to take to end this crisis. 10 It is also our objective to gather as much 11 information as possible from across the entire 12 state, build the necessary partnerships, and finally 13 craft legislation to move us one step forward to win 14 the war on the heroin and opioid abuse that's going 15 on in New York State and the Hudson Valley region. 16 I do not pretend to sit here and let you know 17 I know everything about this, but I want to make it 18 crystal-, crystal-clear that we are here, together. 19 Together. 20 And when we work together, I know we will 21 succeed. 22 I'd just like to say many thanks to all the 23 witnesses that have gathered here tonight. 24 By virtue of their prominent fields, you have 25 a very busy schedule, and I know your time is 1 valuable. But it's your expertise which makes our 2 testimony crucial in the efforts to create impactful 3 legislation. 4 I look forward to hearing from all of you, 5 and thank you very much. 6 And I'll take the first witness. 7 [Applause.] 8 Rob. 9 We have our County Executive, Rob Astorino. 10 Rob, thank you so much for being here 11 tonight. 12 [Applause.] 13 ROB ASTORINO: Thank you, Senator Murphy. 14 I appreciate, very much, what you're doing 15 for the community here. This is really important. 16 Senator Martins, it's nice to have you from 17 Long Island. 18 SENATOR MARTINS: Thank you. 19 ROB ASTORINO: Thank you for being here 20 tonight, and, really, for all the members of the 21 Committee, even though they couldn't be here 22 tonight. 23 It's a topic of enormous concern to me, both 24 as a parent, and, certainly, as County Executive. 25 The resurgence in the use of heroin is a 1 scrouge that has had devastating consequences for 2 many families in Westchester. We've seen the depths 3 of overdose victims, including teens and young 4 adults. It is absolutely heartbreaking, and 5 worrisome, and it demands a continued response at 6 all levels of government. 7 I certainly salute the members of the 8 Joint Task Force on Heroin and Opioid Addiction for 9 your commitment, and I appreciate it. 10 In Westchester, law enforcement continues to 11 lead the fight against the sale of narcotics in our 12 cities, towns, and villages. 13 I've directed Commissioner George Longworth 14 of the Department of Public Safety to utilize the 15 department's resources to combat drug dealing on the 16 street and at higher levels of distribution. 17 The police have had many successes so far, 18 including a significant yearlong investigation that 19 was known as "The Northern Narcotics Initiative," 20 and well over 100 people were arrested, including 21 street-level dealers and their suppliers. 22 And I urge the Committee to ensure that law 23 enforcement has the resources and training it needs 24 to continue this progress. 25 Narcan training is another area of success 1 that we're proud of in this county. We launched 2 this training under the umbrella of our 3 Safer Communities Initiative, which is designed to 4 find lasting solutions to problems facing our 5 communities and our families. 6 Now, Narcan training empowers local police 7 officers to do something that they've never done 8 before, and that is, give drug-overdose victims a 9 lifesaving remedy. And every second counts when 10 somebody stops breathing. 11 Our Health Commissioner, Dr. Sherlita Amler, 12 has personally trained hundreds of officers around 13 the county. 14 And the more officers we train to administer 15 Narcan, the better our chances of keeping people 16 alive. 17 And, if you want a measure of success on the 18 Narcan program, we've had 12 saves so far. 12 lives 19 have been saved. And those lifesaving Narcan 20 interventions occurred in our largest city, and in 21 our smallest towns and villages, and they occurred 22 in communities on our southern and northern borders, 23 as long as -- as well as the Long Island Sound and 24 the Hudson. 25 So, this is not isolated to an urban area, a 1 heavily populated area. This is also spreading, 2 unfortunately, in our very small communities. 3 Narcan is not a panacea, though. It helps to 4 save lives. It does not reduce the incidents or the 5 inherent dangers of heroin use. It's not a 6 quick-fix either. 7 Another proactive step we've taken is to 8 battle the illegal use of prescription drugs, making 9 it easier to safely dispose of them. 10 And our Office of STOP-DWI & Drug Prevention, 11 in conjunction with the community coalitions and the 12 County Department of Environmental Facilities, has 13 purchased med-return units, to be placed in 14 publicly-accessible areas, which are 25 police 15 departments. 16 Despite all that we do, we also know that 17 government can't solve every problem. So, we have a 18 new initiative that we've started, and, hopefully, 19 this can be, maybe, taken statewide and the Senate 20 can get on board. It's The Fatherhood Initiative. 21 And, unfortunately, over the course of 22 50 years, the critically important role of the 23 father in the family has been diminished. And 24 there's a lot of reasons, but, we can't debate the 25 consequences. 1 Strong fathers, strong families, are 2 essential to deterring our young people from the 3 lure of illegal drugs, including heroin. 4 And, you see the Baltimore mom who has become 5 very famous around the world today. 6 We also need Baltimore dads, and we need dads 7 involved in every one of our communities. 8 So as you search for solutions on the heroin 9 epidemic at the state level, I urge you to include 10 efforts to help families be better and stronger, 11 because a good home and a strong family is going to 12 give a child a much better chance in life at a 13 drug-free life than any government program ever can. 14 So, we're working on every front. 15 But I sincerely thank you, Senator Murphy, 16 who happens to be my Senator in the town I live in, 17 and it goes as south as Mount Pleasant. 18 I thank you for your efforts in this. 19 Senator Martins, I thank you very, very much 20 for your concern as well. 21 We'll be a partner in any way we can, you 22 just pick up the phone. We can't fail this one. 23 So, I appreciate it. 24 SENATOR MURPHY: I'd like to just thank you 25 for your efforts, working with Dr. Amler. I know, 1 the Narcan, she's, I think, trained close to four, 2 five hundred of the first responders. 3 ROB ASTORINO: Correct. 4 SENATOR MURPHY: And it's a big point, that 5 I'd like to try and make sure all of our first 6 responders are Narcan-trained. 7 And she's done one heck of a job already, and 8 I commend you for allowing her to do that. 9 ROB ASTORINO: And people should think of 10 Narcan in a way of, if you have an anaphylactic 11 reaction to an allergy, I guess you could think of 12 it like an EpiPen. But what it does is, it restores 13 breathing, and it gives time for paramedics or 14 somebody to come and transport to a medical 15 facility. 16 It won't stop the heroin, but it will open up 17 the breathing tubes and reverse that part of the 18 brain that stops it. 19 So, it's a lifesaver in many ways, and it 20 should be equipped as many EMS and police officers 21 that we can get its hands into. 22 SENATOR MURPHY: And it's completely benign. 23 ROB ASTORINO: That's right. 24 SENATOR MURPHY: So if you give it to someone 25 who's having a seizure, they'll have a little 1 dribble out of their nose. 2 So, it's great. 3 ROB ASTORINO: Correct. 4 SENATOR MURPHY: Well, listen, I thank you so 5 much for coming up here -- 6 ROB ASTORINO: Thank you very much. 7 I appreciate it. 8 SENATOR MURPHY: -- and taking time out of 9 the your busy schedule to, you know, address this 10 important issue here. 11 ROB ASTORINO: Thank you, Senator. 12 SENATOR MURPHY: We'll be working very 13 closely with you, and, I appreciate it. 14 And, the best to Sherlita, and the family. 15 ROB ASTORINO: Thank you very much. Have a 16 great night. 17 [Applause.] 18 SENATOR MURPHY: Next we'll have the 19 Honorable Judge Reitz from Putnam County. 20 [Applause.] 21 HON. JAMES F. REITZ: Ladies and gentlemen, 22 thank you very much for being here. Thank you. 23 Senator Murphy and Senator Martins, I thank 24 you for this opportunity, and I wish you all the 25 best for helping the people that really need your 1 guidance and your support. 2 Ladies and gentlemen, I've had the 3 opportunity for my whole life to live in 4 Putnam County and grow up there. 5 And, for the last nine years I've been the 6 County Court judge in charge of running the 7 treatment court; Drug and Alcohol Treatment Court. 8 And have I to say that, when we started about 9 9 years ago, there was about 15 cases in the court 10 itself. And, today, we average 110 on any daily 11 basis, with 40 and 50 more people waiting to get in, 12 just in the small county of Putnam. 13 It's magnified, to a large extent, throughout 14 the state. 15 This treatment program that we speak of 16 has -- it's a two-year program that's intensive on a 17 daily basis. We hold people accountable. There's 18 nothing easy about it. 19 When we started nine years ago, when 20 I started nine years ago, there was a recidivism 21 rate of about 35 percent. 22 Based on the work with all the team providers 23 in Putnam County, and throughout, of those that are 24 successful and graduate, the recidivism rate is down 25 to 12 1/2, 13 percent. 1 And we've got a long way to go. We're going 2 to do even better. 3 We have a team made up of all the experts in 4 the community, and beyond, from the 5 District Attorney's Office, Legal Aid, the defense 6 attorneys, the Putnam County Sheriff's Department 7 and the correction facility, and all treatment 8 providers that are in this room tonight and those 9 that could not be here. There are so many treatment 10 providers that provide this lifesaving assistance. 11 It is a two-year program, as I have said. 12 We have -- there is no secret. 13 Senators, I want to share something with you, 14 and I'm going to get a point. 15 Senator Murphy, you happen to be kind enough, 16 and spent time at one of our graduations sometime 17 ago. And I want you, in a few moments, to comment 18 about that. 19 But I want to share with you this: For the 20 people that are here that don't know anything about 21 treatment court, you are invited. It's a public 22 forum. We meet every Thursday, for about an hour 23 and a half, and it's a public place. 24 And I wish people would get there to learn 25 more about it, and read more about it. 1 And I want to say something else to everybody 2 here, and to the Senators. 3 If we work together, there is nothing we 4 can't accomplish. There's nothing. 5 This is not smoke and mirrors. You don't 6 need magic. 7 You just need tough-love, hard work, people 8 that are dedicated to changing lives. 9 And, so, we do that one person at a time. 10 Not only are lives being saved, but when you 11 can keep people out of jail, whether it's in the 12 county facility, whether it's in Putnam or 13 Westchester or Dutchess, or wherever, or in the 14 state facility, you're saving millions and millions 15 of dollars that are now being able to be used 16 elsewhere for those people that need it. 17 And, when you keep people out of jail, and 18 you keep them alive, they start to work, because 19 part of recovery is economic responsibility, when 20 appropriate. 21 This is a domino effect. 22 When people start to change their ways, and 23 they stay away from drugs, heroin, and the drug 24 prescriptions, that are leading to so many deaths, 25 then people start to work. They start to help each 1 other. They start to take care of their kids. They 2 get off public assistance -- food stamps, housing, 3 and so on -- when they become responsible and are 4 held accountable. 5 And it works. 6 As I said, the recidivism rate is down to 7 12 1/2 percent of those that graduate, today, in the 8 Putnam County Treatment Court program. 9 Senator Murphy, can I ask you, if you can, 10 would you be kind enough to say, just directly to 11 the people here, what were your first impressions of 12 that graduation that took place? 13 SENATOR MURPHY: Yeah, absolutely, and, thank 14 you. 15 It's unbelievably impressive. 16 I had -- Judge Reitz had invited me up to a 17 drug-court graduation, which I knew nothing about. 18 And I walked in, and it was, literally, in his 19 courtroom, and he had his garb on, and he was up on 20 the -- up on your table there. 21 And the -- your defendants were sitting 22 there. Their next step was jail. State prison. 23 HON. JAMES F. REITZ: Right. 24 SENATOR MURPHY: Six people there, five under 25 the age of 26. 1 One was the United States Marine Corps, that 2 fought in Fallujah for us, and came back. 3 And after 9/11, signed back up, and went over 4 and got blown up in a truck, with his buddies, and 5 ended up having three brain surgeries. Came back 6 home, got hooked on these painkillers, and the 7 system failed him. 8 Our system failed him. 9 And Judge Reitz reached out to him, put him 10 in the court, and he graduated. 11 HON. JAMES F. REITZ: Yes. 12 SENATOR MURPHY: I knew nothing about this. 13 You talk about an economic value to this. 14 Having them out of jail, and productive 15 citizens, and back matriculating into society, thank 16 you for what you do, because I saw it firsthand, and 17 I was incredibly impressed. 18 HON. JAMES F. REITZ: Senator, might I point 19 out one thing that you mentioned? 20 You indicated, as a Senator, at that point in 21 time, you had no clue, really, what treatment court 22 was all about. 23 And I venture to say a lot of people in this 24 room, they don't know much about treatment court. 25 But one thing I can say, it is so easy, if we 1 work together. It is so doable, if we work 2 together. 3 The framework is there. The court system is 4 there. The room is there. The people are there. 5 And all we need are people to stand up and 6 say, Hey, put the resources towards the facilities 7 that would house, that would bed, that would have 8 places for people to go to get this help for the 9 two-year program that we have. 10 And I tell you now, the hundred or so that we 11 have in Putnam County, there are hundreds, 12 thousands, throughout the state that are in jails, 13 that shouldn't be, and that might not be, if this 14 program was taken serious across the board. 15 And you're talking, not only millions and 16 billions of dollars you're saving in incarceration 17 housing costs, but the millions of dollars that 18 you're saving when there are jobs, and people there 19 to treat, and then they go out and get their own 20 jobs. 21 This is amazing. 22 That gentleman you speak of not only was 23 one -- he was on his way, by the way. There was 24 already a state-prison term ready for that 25 gentleman. But, because of this program, he was -- 1 he elected, he volunteered, he signed up for 2 treatment court. And we all agreed: the DA's 3 Office, the defense, and the Court. 4 Not only did we save the state-prison term 5 but, Senator, and he told me, I could say this very 6 clear, he was on death's door. He was going to die. 7 He was so sick from everything. 8 And throughout the program, the first year, 9 we thought we had lost him a couple of times. 10 And, it was amazing. 11 He's now coming back, he's helping out. He's 12 working with the State, with the County, trying to 13 help similarly-situated veterans. 14 And, I have to tell you, he's an example of 15 what could be, and what should be, for so many more 16 people. 17 And, Senator, I can't thank you enough for 18 doing what you're doing. 19 This is the first time that I have -- in my 20 nine years, that it's been taken so serious, and 21 because, people's lives, they do matter, and people 22 do need help. 23 And there are people in this room right now 24 that have lost their kids. 25 And, you know something? We should stop 1 that. 2 And this is one thing that we can do, and we 3 can do it together. 4 Senator, thank you very much. 5 I'm here for any questions. 6 [Applause.] 7 SENATOR MARTINS: Judge, thank you. Thank 8 you very much. 9 I appreciate your testimony here today. 10 Just, for purposes of context, can you tell 11 us, the typical defendant in your program, is there 12 a typical defendant, or are we dealing with every 13 background, every age? 14 Why don't you describe for us. 15 ROB ASTORINO: Senator, I thank you. That is 16 so important. 17 Whether you're a young child, an old adult, a 18 veteran, a judge, a lawyer, a senator, somebody 19 sitting in this audience, there are no bounds. 20 It crosses all economic areas, that you could 21 be rich, you could be poor. 22 You could have a great family, you could have 23 great education. 24 And, you're going to get caught somehow, this 25 addiction, these painkillers, the drugs, the heroin, 1 it's so easy. You try it once, and you're hooked. 2 And it's so difficult to get rid, and take 3 care of that disease and manage it on a day-to-day 4 basis for the rest of your life, one day at a time. 5 That's what we teach people in treatment 6 court, how to deal with this addiction that lasts, 7 that stays with you your entire your life: One day 8 at a time. 9 And, so, Senator Martins, I appreciate that. 10 You know now, with the people from the media, 11 the Hollywood that are dying of overdoses, it's now 12 becoming apparent that it crosses all bounds. 13 There's nobody safe, nobody secure. Right in our 14 backyards, right in our community. 15 People are here in this room today, that 16 you're going to hear from, that lost their kids, 17 that lost somebody very close to them. And, they 18 tried everything they could. 19 There was no program like this 20 treatment-court program available back then. 21 There is now for everybody that wants to 22 participate. 23 And I encourage the people here to get a hold 24 of their elected officials, to push them, to ask 25 more information, to get involved. 1 And I have to tell you, working together, we 2 will solve this problem. 3 SENATOR MARTINS: No, I appreciate that. 4 You know, one of the issues that we deal with 5 is, obviously, this stigma that's associated with 6 this type of crime. Nobody wants to acknowledge 7 that their loved one suffered an overdose as a 8 result of an addiction, especially the kinds of 9 stigma that is associated with heroin addiction. 10 So, we find that. We find that in society, 11 we find that in our communities. 12 I find, in many of my communities, people 13 simply not believing that it's stuff that happens in 14 a nice, suburban community; and, yet, here we are, 15 and we see it time and again. 16 If you can, you know, with the examples that 17 you have of people who have gone through your 18 program, how do they get on the path to your court? 19 What kinds of things happen? 20 You mentioned prescription drugs as a gateway 21 to illicit-drug use, and then, your court. But 22 there have to be other examples. 23 And given the years that you've been on the 24 court, and the examples, and the people that you've 25 seen come before you, give us some context. 1 HON. JAMES F. REITZ: Okay. 2 SENATOR MARTINS: You know, we always hear 3 about alcohol and marijuana being gateway drugs. We 4 hear about prescription drugs. 5 Give us your context so that we can also 6 benefit from the years that you've served in your 7 court. 8 HON. JAMES F. REITZ: Thank you. 9 All right. So many people have injuries, 10 like this marine you speak of, that are treated, and 11 they receive strong drugs. And what happens is, 12 they become so reliant upon them, and so addicted, 13 that once the treatment is done, and the injuries 14 are healed, so to speak, that they cannot get away 15 from that -- that need to have that feeling of 16 relief, whatever it is from that particular drug 17 they've been prescribed. 18 And so what happens is, once they form-shop 19 or doctor-shop, as you would call it, and cannot get 20 anymore prescriptions, whatever it might be, because 21 there are good rules and regulations going on now to 22 deal with that, in a database, so to speak, then 23 they buy them on the black market, so to speak, that 24 are expensive. 25 And so when they run out of money, and they 1 run out of prescriptions, they go to heroin, which 2 is very inexpensive and easy to get. And people -- 3 dealers are giving that away to get people hooked. 4 Heroin is very inexpensive, and as you know, 5 that's what starts. 6 Now, several years ago there was an NBC piece 7 on Putnam County Treatment Court. And the young 8 lady that was the center of attention was, again, 9 pretty close to a very lengthy prison term, and, if 10 not dying. And she was, you know, a mess. And she 11 had lost all hope. Lost her child, because of the 12 drug addiction. Was a teacher, doing heroin in the 13 teacher's lounge at the school. Lost her license to 14 teach. 15 And you talk about stigma, and you talk about 16 people getting upset about that? 17 I want to share with you how important it is 18 to educate everybody, that, actually, when somebody 19 stands up and is held accountable, and gets the 20 strength to clean themselves up, the stigma now 21 says, Oh, my God, I'm a survivor. I took 22 responsibility. I'm doing good. 23 And whether it's that marine, that veteran, 24 that had that problem and was going to state prison, 25 he's now serving the community, helping out the 1 Senator, helping out the County of Putnam. 2 And this young lady I speak of, that was 3 featured on NBC, is now, ladies and gentlemen, 4 believe this or not, a team member of the treatment 5 court as an alumni, coming back. And is now, to 6 this day, just about seven years' clean and sober, 7 and she's helping people similarly situated. 8 So, it is amazing what goes on. 9 You can be a teacher, you could be a lawyer, 10 you could be a doctor, and, it doesn't matter. 11 I've had -- I've had judges, lawyers, 12 professionals, IBM'ers...anybody, you name 13 it....they were in my courtroom in Putnam County at 14 one given time for the last nine years. 15 There is no -- nobody is protected from this. 16 SENATOR MARTINS: No, and that's exactly the 17 point: It knows no socioeconomic bounds. It 18 doesn't know any professions. It doesn't know any 19 backgrounds. Broken families, perfect families, the 20 ideal -- whatever that background may be, no one is 21 immune. 22 And, so, it's important that we realize that. 23 And, you know, we had an opportunity to speak 24 before on this issue. 25 Nothing would make me happier than to see, 1 frankly, our newspapers begin to report on the 2 number of overdoses, the number of saves, the number 3 of deaths. 4 You know, we read about things on the front 5 page of our newspapers each and every day. We hear 6 about people who have gotten into trouble. We hear 7 about people who have had successes. We hear about 8 accidents and car accidents, people who have been 9 involved and died in tragic accidents. 10 Why aren't we hearing about these overdoses? 11 Because they're happening, right in our 12 communities, each and every day. 13 I hear it from my E -- emergency medical 14 responders every day, from our volunteers and from 15 our professional responders, when they tell us, We 16 had another one. 17 And it wasn't in an inner city. It wasn't in 18 an urban center. It was in one of our suburban 19 communities. 20 And it's time we started waking up, we talked 21 about it. 22 This is a wonderful program. 23 And I'm thankful for your testimony here 24 today, I truly am. 25 HON. JAMES F. REITZ: Senator, thank you. 1 SENATOR MARTINS: But it's only one element 2 of that which we're speaking. 3 Education is another element. 4 The opportunity that insurance companies now 5 have to provide, because of laws that we've passed 6 that require insurance companies to provide 7 treatment in a meaningful way. 8 But all of these different pieces have to 9 come together. 10 But it starts with us looking in the mirror 11 and realizing, all of us, that this is something 12 that is happening in our backyards. 13 HON. JAMES F. REITZ: We can help each other 14 out, take responsibility. 15 And I think County Executive Astorino said it 16 very clearly, the family needs to be there. We need 17 to help that family out. We need to educate them, 18 and let these people know that there are services 19 out there, there are providers out there, and there 20 is help, and we can do a good job working together. 21 Thank you. 22 SENATOR MARTINS: Thank you, Judge, very 23 much. 24 And I want to take the opportunity to thank 25 our Chair here for his leadership on this issue. 1 Thank you. 2 [Applause.] 3 SENATOR MURPHY: Judge, personally, I want to 4 thank you so much. It's been a pleasure working 5 with you, and opening up my eyes to what you do up 6 in Putnam County, and what you can do for the kids. 7 And like we saw, professionals were right in 8 your court. Professionals, that have law licenses, 9 and health licenses. 10 And, you're doing a great job. 11 And I will continue to work very closely with 12 you. 13 Thank you. 14 HON. JAMES F. REITZ: Senator, I accept your 15 offer. I will not let you go. We need your help. 16 Thank you very much. 17 SENATOR MURPHY: Thank you so much for 18 coming. 19 [Applause.] 20 SENATOR MURPHY: Next, I would like to call 21 Westchester County Public Safety Commissioner 22 George Longworth, and Chief Inspector John Hodges 23 for Westchester County. 24 [Applause.] 25 SENATOR MURPHY: Thank you, guys. 1 I appreciate your coming tonight. 2 COMM. GEORGE LONGWORTH: Good evening. 3 I'd like to thank Senator Murphy for inviting 4 me here tonight, along with Chief Hodges who runs 5 our investigative services division. 6 Senator Murphy has long been a friend of law 7 enforcement, and he is a great supporter of our 8 efforts to combat the distribution and sale of 9 heroin in this county and our state. 10 Let me tell you a little bit more about the 11 Northern Westchester Narcotics Initiative that 12 County Executive Astorino referred to earlier. 13 Our Northern Narcotics Initiative began in 14 early 2014 in response to several factors: The 15 resurgence in heroin, and the use of heroin by young 16 people, and a growing number of heroin-overdose 17 deaths involving young adults. 18 The county police have long used the 19 task-force model, both, to combat violent crimes, 20 and to attack the use of narcotics and other 21 organized-crime activities. 22 We presently have full-time personnel 23 assigned to the DEA task force, which includes a 24 sergeant and two detectives; the DEA diversion unit, 25 which is for diversion narcotics, which includes a 1 sergeant and a detective; the FBI violent-crimes 2 task force; the FBI organized-crime task force; the 3 IRS money-laundering task force; and the FBI joint 4 terrorist task force. 5 Participation in the task-force model has 6 served as such a great force multiplier for us in 7 combating major offenses, that the formation of the 8 Northern Westchester Initiative grew from our prior 9 success. 10 The multiagency task force of officers was 11 formed by the Department of Public Safety and seven 12 northern Westchester police departments: Peekskill, 13 Bedford, Buchanan, Croton-On-Hudson, Yorktown, 14 Mount Kisco, and Ossining. 15 We also partnered with the FBI violent-crimes 16 task force, the U.S. Attorney's Office, and the 17 Westchester County District Attorney's Office. 18 It is challenging for police agencies, 19 particularly smaller ones, to take officers away 20 from their regular duties and commit them to 21 long-term, sophisticated narcotics investigations. 22 Logistically, it is difficult, and, financially, it 23 is difficult. Officers from smaller agencies who 24 are assigned to task forces must be replaced in the 25 patrol rotation, which usually incurs overtime. 1 Sharing resources and personnel is a great 2 force multiplier. It helps law enforcement achieve 3 the results we saw from the Northern Initiative. 4 I'd ask the Committee to support grant 5 funding that will make more of these multiagency 6 task forces and investigations possible. The 7 investment is worthwhile, and you will get the 8 results. 9 Since its formation, the Northern Westchester 10 Task Force has arrested more than 125 people across 11 northern Westchester who were selling heroin. Most 12 were charged with felony counts of criminal 13 possession of a controlled substance with intent to 14 distribute, or criminal sale of a controlled 15 substance -- I'm sorry, criminal possession of a 16 controlled substance with intent to distribute. 17 Fifteen suspects were charged in federal 18 court with conspiring to distribute large quantities 19 of heroin. Many of these gentlemen woke up that 20 morning, not knowing they even were suspected of a 21 crime, to find out that they were facing life in 22 federal prison. 23 The officers and detectives assigned to the 24 Northern Narcotics Initiative spent thousands of 25 hours investigating heroin sales, including 1 intelligence gathering, surveillance, undercover 2 buys, and wiretaps. 3 I'd once again like to publicly commend all 4 of them for their efforts. 5 Some people may think that heroin is only an 6 inner-city problem, but it is not. The 7 Northern Narcotics Initiative reminds us that no 8 community is immune. 9 Our efforts this past year have not been 10 limited to the northern area of the county, however. 11 The Westchester County Police have also 12 participated in lengthy narcotics investigations in 13 the city of New Rochelle which led to numerous 14 arrests in that jurisdiction. 15 Similarly, a narcotics initiative was 16 conducted with the Port Chester Police Department 17 which led to multiple arrests and the seizure of 18 illegal narcotics and numerous handguns. 19 And we worked with the Mount Vernon Police 20 Department last summer to address street-level drug 21 dealing in that city. 22 The young people we have lost to heroin 23 overdoses in Westchester are a reminder to all of us 24 about how high the stakes are. 25 This is everybody's problem, and all of us in 1 county, local, and federal law enforcement are 2 working together to solve it. 3 I thank the members of the Committee for 4 being our partner in this fight. 5 Thank you. 6 SENATOR MURPHY: Thank you, Commissioner. 7 [Applause.] 8 SENATOR MURPHY: I'd really like to commend 9 you on -- after doing a few different forums, of 10 getting a census of where law enforcement was not 11 crossing over, and just what you described to us 12 right here is just unbelievable, with all the 13 different interagencies working with one another. 14 I think if we can continue to do that, you 15 can -- you've already proven the results. 16 So I'd encourage, whatever we can do to help 17 you, to continue the interagencies working together, 18 we're on board. 19 COMM. GEORGE LONGWORTH: Well, lack of 20 coordination amongst law enforcement simply pushes 21 the problem from one jurisdiction to the next. 22 CHIEF JOHN HODGES: Senator, I'd just like to 23 thank you as well. 24 You know, as you now, recently, you came up 25 here to Yorktown. You met with myself, 1 Chief Daniel McMahon, and the rest of the chiefs 2 and narcotics people who were part of the 3 Northern Initiative. 4 And, you know, it was nice that you listened 5 to our thoughts, concerns, and the challenges that, 6 you know, we face in law enforcement. 7 And, you are exactly correct, and I think it 8 would be a good idea to actually build on the 9 Northern Initiative concept, and, you know, possibly 10 talk to the Chiefs Association, and look at this as, 11 you know, something that we would, you know, tackle 12 as from an area command type of standpoint. 13 SENATOR MURPHY: Senator Martins with a 14 question. 15 SENATOR MARTINS: Thank you. 16 I appreciate the testimony. 17 I know how difficult it is to actually stop 18 and -- these efforts and these rings that exist out 19 there, and how much effort it takes. 20 I have had the opportunity to work with our 21 own police down in Nassau County, and, certainly, 22 their efforts with police in Suffolk County. 23 But we are all one state. 24 And I see that much of the effort, in terms 25 of coordination, happens with the federal 1 government, because all of this product is moving, 2 for the most part, across state lines. 3 Is there more that we should do as a state, 4 through the state police, or through some other 5 agency, where we can help coordinate efforts? 6 Because, all of this really comes down to 7 intelligence. 8 And the more data that we have available, and 9 we make available to law enforcement on the ground, 10 whether it's in Nassau County, frankly, whether 11 it's in Westchester County, or whether it's in 12 New York City, they're coming from somewhere, and 13 they're going to somewhere, and, oftentimes, they're 14 going through our communities to get there. 15 How can we do that? 16 How should we as a state also step up, to the 17 extent that we're not, because I know we are, but, 18 to the extent, is there more that we can do as a 19 state to take on some of those responsibilities as 20 well? 21 COMM. GEORGE LONGWORTH: I think municipal 22 and county and state law enforcement across the 23 country needs to be encouraged to participate more 24 in federal task forces. 25 Our presence, the 10 people we have assigned 1 to various federal task forces are all sworn in as 2 U.S. Marshals. Their jurisdictions know no 3 boundaries. We fly them down out of the country 4 several times a year, down to Bogota, Colombia, on 5 cases. They go into Jersey routinely, and 6 surrounding states, under the power of the federal 7 government. 8 From that, you also get the collective 9 sharing of intelligence. You know, things are not 10 put into silos, where state law enforcement is doing 11 one thing, federal law enforcement is doing 12 something else. 13 I mean, it's truly ripe for coordinated 14 effort on both the federal and state level. 15 SENATOR MARTINS: That's great. 16 And there was a point made earlier regarding 17 Narcan, and coordinated effort to try and train as 18 many people as possible. 19 I had the opportunity to take the training 20 myself. 21 For those of you who have thought about it, 22 do it. It's easy. It's very easy. And, you get a 23 kit, and you get to carry it with you. And, 24 hopefully, you'll never need it, but if you do, 25 thankfully, you'll have it with you. 1 Do you have a coordinated program through the 2 police department, or through the County, to train 3 volunteer firefighters and other emergency 4 responders in the use of Narcan? 5 Because, more often than not, if it's not a 6 police officer who's on the scene first, it may be 7 someone else who's been called and responded. 8 Are we taking that initiative as well? 9 COMM. GEORGE LONGWORTH: What we're doing 10 here in Westchester is, our Health Commissioner, who 11 is a medical doctor, is the sponsor of the program. 12 And she has trained a number of instructors in both 13 the police, fire, and EMS service, that are out in 14 the community training first responders on all 15 levels. 16 SENATOR MARTINS: Perfect. 17 SENATOR MURPHY: Yeah, we're going to try and 18 make sure that all first responders are -- in 19 New York State are Narcan-trained. 20 COMM. GEORGE LONGWORTH: Well, the one thing 21 I would like to commend both of you gentlemen for, 22 it's one of the few programs that I've seen come 23 down in recent history from the State that actually 24 had funding for training attached to it. 25 And I thought it was a brilliant move. 1 SENATOR MURPHY: Thank you. 2 It was -- the school nurses; the school 3 nurses were -- can you believe it? -- were not 4 allowed to administer Narcan. God forbid, a kid in 5 school, it was illegal for them to do it. 6 And in this year's bill, we had, not only did 7 we give the right for the nurses to do it, but we 8 also funded it, over $270,000, for each school to 9 have two kits in it. 10 So -- 11 [Applause.] 12 SENATOR MARTINS: Unfortunately, all too 13 often, common sense is not very common. 14 SENATOR MURPHY: Quick question for you, 15 Chief. 16 Anything on the streets that -- you know, 17 that you've seen, that's just out of -- you know, 18 out of the ordinary? Anything you would like to, 19 you know, share with us? 20 I mean, is there something that we should be 21 doing out there to help you? Or is there just -- is 22 most of it coming in from the city? 23 CHIEF JOHN HODGES: I think, you know, 24 Senator, some of the things we brought up at the 25 last meeting when we met with you, you know, some of 1 the challenges that we face with the legal process, 2 trying to target. 3 You know, people think it's easy. 4 We get a lot of complaints regarding somebody 5 who may be dealing drugs, but it's a painstaking 6 process to identify them; to either utilize a 7 confidential informant, or to utilize undercover 8 officers that we have. 9 And there are some challenges. Some of 10 the -- of those deal with, you know, how we go about 11 and prosecute those cases. 12 Some things, you know, I may not be able to 13 comment here specifically, on our tactics, but 14 I would love to talk to you about some of the 15 challenges we have, trying to, you know, utilize our 16 undercovers, and to identify people who are actually 17 selling narcotics. 18 But what we are seeing, and as the 19 Commissioner mentioned, what we're trying to do, he 20 mentioned the task forces. 21 And I believe it was Judge Reitz that also 22 talked about this progression from prescription 23 medication to heroin, once the cost becomes too much 24 for the user, and then they transition to the 25 heroin. 1 You know, we're also seeing that prescription 2 medications, and one of the things that the 3 Commissioner mentioned, was our DEA task force. 4 We're partnered with DEA in several task 5 forces, a general task force, because what we're 6 trying to do is, and through this coordination with 7 local law enforcement, we maintain a full-time 8 narcotics unit. And then we team up. 9 We team up like, you know, here in Yorktown 10 with Chief McMahon and his people, and we look at 11 a smaller distribution ring. 12 And then what happens is, we need to get 13 beyond that. So we partner with our, you know, DEA 14 task-force members to look at larger distribution 15 rings. 16 But also is the diversion of prescription 17 medications, that we have been successful with our 18 DEA diversion task force, with getting prescription 19 meds that are getting into the hands of people 20 through diversion, and then they are going out on 21 the street for market. 22 So, we've had some great success with that. 23 And as you pointed out, and the Commissioner 24 said, there are no boundaries. We're trying to look 25 at this. Because what's going to affect, you know, 1 and what happens in Rockland and Putnam and Dutchess 2 and New York City is going makes it's way into 3 Westchester. 4 So we have worked very hard to divert and get 5 those prescription meds, you know, off the street. 6 SENATOR MARTINS: I have just one more 7 question. 8 SENATOR MURPHY: Yeah, sure. Absolutely, go 9 ahead. 10 SENATOR MARTINS: Held a program last week, 11 and we do this periodically, and I'm sure you do the 12 same thing here in Westchester, with a Shed the Meds 13 program. 14 We did a Shed the Meds program in a community 15 on the north shore of Long Island, Nassau County: 16 Manhasset, typical suburban community. 17 In one afternoon we got over 500 pounds, over 18 500 pounds, of medications that were just sitting 19 around the house. The people just went into their 20 medicine cabinets and took it upon themselves to 21 bring those down. 22 And, you know, if we talk about the types of 23 things that are readily available for people to 24 divert, look in your medicine cabinets. 25 I mean, it's incredible to think that, in an 1 afternoon, based on a postcard that was sent out to 2 a small community, people brought down over 3 500 pounds worth of prescription medication. 4 And, so, if you just look at that, and 5 multiply that out over every community, you really 6 get a sense of what we're dealing with out there, 7 and what you're dealing with out there. 8 And, so, for anyone who may be listening out 9 there, I'm assuming that they have the opportunity 10 to do that at home. They have the opportunity to 11 take those and to bring them to their local police 12 precinct and drop them off. Right? 13 CHIEF JOHN HODGES: Yes, absolutely. 14 And, furthermore, what we do is, from there, 15 we take it, where it is actually, you know -- 16 SENATOR MARTINS: It's not flushed down the 17 toilet. 18 CHIEF JOHN HODGES: Well, no, it's not 19 flushed down the toilet, no, no. 20 We take and we dispose of it. 21 And, you know, sometimes even that, I mean, 22 you'd be surprised, we have to take security with 23 us, because the street value of what we will take 24 and has to be destroyed can be significant. 25 SENATOR MARTINS: In my case, we had two 1 County police officers there, who then took the 2 prescription drugs at the end of the day and took 3 them with them, because of exactly that point. 4 It's incredible to think. 5 But, again, it just goes to highlight the 6 point that, you know, when we talk about diversion, 7 we're not nearly talking about a truck full of 8 pharmaceuticals. We're talking about people's 9 homes, their medicine cabinets, and what's readily 10 available to others, including their children. 11 And so, you know, part of that responsibility 12 starts at home as well. 13 CHIEF JOHN HODGES: Right. 14 And, you know, we've actually seen cases 15 where, you know, unwittingly, there are elderly 16 people or people who fall prey to somebody who will 17 actually take them to get them prescription 18 medications, and then take those, where they have 19 gone to the street, you know, and been sold. 20 And that's part of the diversion task force, 21 is targeting those groups that will actually seize 22 upon that opportunity. 23 COMM. GEORGE LONGWORTH: Another area where 24 we've had great success with the DEA diversion task 25 force is the doctors who are inappropriately 1 prescribing prescriptions. In several instances, 2 they've inappropriately prescribed the prescriptions 3 to undercover police officers and have, 4 subsequently, been arrested. 5 In fact, several million dollars have been 6 seized through those investigations. 7 SENATOR MURPHY: Yeah, I think that's where a 8 lot of it is starting from, to be quite honest with 9 you, Commissioner. 10 And, you know, I've just found out that our 11 disabled veterans that are on painkillers, they're 12 becoming victims. Our disabled veterans are 13 becoming victims now. They're going into finding 14 out where they're living and getting into their 15 medicine cabinets, somehow, some way. 16 But, another quick question for you. 17 Any law enforcement, any laws that we can 18 kind of strengthen? 19 Because I -- you know, you watch on TV, you 20 come up with the arrests, they're going in that 21 door, and they're walking out that door, waving to 22 you. 23 How do we make these laws stricter and give 24 it more teeth so we can put these guys behind bars 25 instead of, you know, slapping them on the wrists 1 and letting them walk back out and doing this all 2 over again? 3 Do you have any suggestions for us? 4 COMM. GEORGE LONGWORTH: You know, I think 5 it's going to require a consensus. I think society, 6 as a whole, is spread across the board on whether 7 they think possession or illegal use of controlled 8 substances is something that people should end up in 9 jail over, as the judge was speaking of earlier. 10 But I think where the laws really need to be 11 strengthened, is when distributors and higher-level 12 operators in the system, people who are bringing it 13 into the country, people who are bringing it across 14 state lines, people who are selling to dealers, the 15 distributors, when you get those dynamics, I think 16 that's where the hammer has to drop and people have 17 to face stiffer sentences. 18 Cut off the supply and everything else kind 19 of drops off. 20 SENATOR MURPHY: Okay. 21 Any other questions? 22 SENATOR MARTINS: No. 23 SENATOR MURPHY: Listen, thank you so much 24 for everything you do to keep us protected and get 25 these drugs off the streets, and, really great job. 1 And I'm really proud to know that are 2 interagencies working with one another, because I've 3 heard one story after another that they're not. And 4 you just gave me a good hope. 5 Thank you. 6 Thank you so much for coming out. 7 [Applause.] 8 SENATOR MURPHY: Next I'd like to call 9 Putnam County Department of Social Services, 10 Mike Piazza. 11 COMM. MIKE PIAZZA: And Dahlia. 12 SENATOR MURPHY: Oh, and we also -- I was 13 going to wait and do -- oh, we're going to do them 14 both together. Good. 15 And, Westchester County Department of 16 Community Mental Health is, Dahlia Austin. 17 Thank you so much for coming tonight. 18 [Applause.] 19 DAHLIA AUSTIN: Good evening. 20 Good evening, Senator Murphy and 21 Senator Martins. 22 Thank you for the opportunity to speak before 23 you. It's really an honor. 24 Much has been done at the state and local 25 level to address the issues of opiate use. 1 I'm pleased to say that the State has enacted 2 and enforced state-level parity laws, requiring 3 insurance to pay for inpatient care during insurance 4 denial and approval -- and appeal process. 5 The Combat Heroin campaign was launched, 6 increasing public awareness of the dangers of heroin 7 use. 8 And most recently, as you mentioned, the 9 Legislature has allowed school nurses to be able to 10 administer Narcan, which I think is tremendous. 11 At the local level in Westchester County, as 12 was mentioned before, we do have a significant and a 13 strong Narcan program where we are training not just 14 first responders and police officers, but we're 15 training members of the community. 16 We are training clients who are in treatment 17 to be able to respond if they're in a situation with 18 other addicts. 19 So, just in terms of looking at the community 20 members, first responders, and family members, you 21 know, and to be able to provide them with Narcan 22 training. 23 And also in Westchester, drug and alcohol 24 prevention coalitions have hosted a lot of forums 25 across the county. We have worked with our local 1 treatment providers, New York State OASAS, and 2 community stakeholders to increase access to 3 medication-assisted treatment. 4 In May, Lexington Center for Recovery, a 5 treatment program, will open its doors to provide 6 medication-assisted treatment to residents in the 7 northern part of the county. So I think that was 8 significant. 9 But, more needs to be done. 10 As is evident by the data that has been 11 spoken about in Westchester County, opiate-related 12 deaths increased from 53 in 2010, to 93 for 2013. 13 The number of heroin-related deaths for those 14 under the age of 30 increased more than fivefold, 15 from three in 2010, to sixteen in 2013. 16 For Westchester County residents, yes, there 17 has been a substantial increase in opiate-treatment 18 admissions to New York State OASAS-licensed 19 treatment programs. 20 In 2020 (sic), there were 1,673 admissions, 21 accounting for 90 percent of all admissions. 22 In 2013, 2,320 admissions accounted for 23 26 percent of all admissions. 24 And, in 2014, 1,853 admissions accounted for 25 22 percent of all admissions. 1 The proportion of heroin admissions to 2 treatment for those age 25 and younger increased 3 from 22 percent in 2010, to 26 percent in 2014, 4 and the number of heroin admissions now exceeds the 5 combined total of cocaine and crack, combined. 6 In addressing the critical next steps before 7 us, we must do: 8 One, continue to focus and increase support 9 for prevention and education activities by 10 increasing the capacity to offer community and 11 school-based prevention counseling, increasing 12 support for drug and alcohol community coalitions. 13 Two, support access to treatment and recovery 14 services by increasing resources to support and 15 sustain qualified addiction professionals; ensuring 16 access to addiction medication, such as Suboxone and 17 Vivitrol, by allowing physicians assistants and 18 nurse practitioners to prescribe; requiring private 19 physicians who prescribe addiction medication to 20 collaborate with community-based providers, to 21 ensure addiction counseling and recovery support 22 services; supporting the development of recovery 23 centers to offer patient support services and 24 assistance in maintaining abstinence; and 25 cooperating addiction training and educational 1 programs for physicians, dentists and, other health 2 professionals. 3 Three, increasing the enforcement of the 4 state parity laws. 5 Four, increasing public-education campaign to 6 decrease stigma, and to provide education about 7 addiction and trauma and its effects on the family 8 and the community. 9 Five, increasing cross-systems collaboration 10 to facilitate early identification, with the use of 11 experts in primary-care and child-welfare settings. 12 In closing: 13 The use of heroin is the latest drug of 14 abuse, and it has taken a toll on our community. 15 But let's not lose focus on the broader area of 16 addiction, where, if it's alcohol, cocaine, or 17 marijuana, we must have the infrastructure and 18 resources to fight addiction, to fight for the 19 support of our communities and families. 20 Thank you. 21 [Applause.] 22 SENATOR MURPHY: Thank you, Dahlia. 23 COMM. MIKE PIAZZA: Thank you, Senator Murphy 24 and Senator Martins, for allowing me to provide 25 testimony to the New York State Joint Senate Task 1 Force on Heroin and Opioid Addiction. 2 As you can imagine, my testimony and Dahlia's 3 are going to be somewhat similar in some very 4 important ways. 5 I am Michael Piazza, Commissioner of the 6 Putnam County Departments of Mental Health, 7 Social Services, and the Youth Bureau, and I have 8 served in that capacity since 1984. 9 However, my first position when I came to 10 work in Putnam County in 1979 was as a 11 substance-abuse counselor in the substance-abuse 12 treatment and prevention program. 13 So, I have a long-term view of this issue. 14 Prior to 2010, the overdose death of a 15 Putnam County resident was very rare. 16 However, in 2013, there were 11 such 17 fatalities, and in 2014, there were 12. 18 Of the 23 fatalities, 19 had some form of 19 opiate or opioid as a substance present at the time 20 of death. One died of alcohol overdose, and another 21 five had alcohol present with other medications. 22 The ages of those who have succumbed in the 23 past two years range from 25 to 65. The 24 demographics reveal that six were aged in their 25 20s; five, 30 to 39; three, 40 to 49; seven were 1 aged 50 to 59; and two were aged 60 to 65. 2 Fifteen were male, eight were female. 3 This significant increase is very troubling, 4 and has already seen a specific response on the part 5 of the enforcement and treatment community. 6 I-STOP legislation has encouraged physicians 7 to be weary of prescribing narcotic analgesics to 8 patients seeking drugs for abuse. 9 Many law-enforcement agencies and first 10 responders have been trained to administer Narcan, 11 and have been supplied with it. 12 Anecdotally, we are aware, that within weeks 13 of Narcan training in Putnam County, of one basic 14 life-support ambulance corp in Putnam reversed a 15 potentially fatal overdose of a young man. 16 The Office of Alcohol and Substance Abuse 17 Services has begun a prevention-awareness program, 18 warning of the dangers of the opiate abuse. 19 You may have seen one of their recent 20 messages on a billboard in Albany. It represents a 21 bottle of beer and a prescription-drug container, 22 and announces that these are the gateways to heroin 23 addiction. 24 It is with this image that I now would like 25 to discuss some potential ideas in the area of 1 prevention and treatment. 2 The current -- we don't have just a heroin 3 epidemic, but we have an epidemic to addiction. 4 We've had one for a long, long time. 5 The current heroin epidemic is but the latest 6 in a series of drug epidemics that have occurred in 7 New York State since the 1970s. 8 In Putnam County, while this is the first 9 heroin epidemic that resulted in fatalities, we have 10 previously seen the rise and fall in the popularity 11 of PCP; then cocaine, one by one, in all of its 12 manifestations, as powder, as crack, as combined 13 with heroin; amphetamines; methamphetamines; 14 inhalants of substances such as glue or gasoline; 15 ectasy; and, of course, marijuana. 16 And, I was just reminded of, one of my staff 17 went to -- passed, on one of the local roads in 18 Putnam County the other day, and saw 30 empty 19 bottles of Reddi-wip; meaning that somebody is 20 inhaling some of the stuff that's in there, or else 21 someone's having a really big party with Reddi-wip. 22 But... 23 And through all this time, the number one 24 drug of abuse, the number one drug that has caused 25 the most dysfunction, has remained alcohol. 1 The common denominator has always been that 2 people seek ways to become intoxicated or high, and 3 we have not been able to develop a prevention 4 program that will keep people, mostly young people, 5 but not always, from experimentation with 6 mood-altering chemicals. 7 The disease of chemical dependency results in 8 the destruction of relationships, families 9 destroyed, careers lost and ruined, increases in our 10 jail population, and untimely and tragic deaths. 11 As a social services commissioner, I see the 12 additional damage to families in the increase of 13 children brought into the foster-care system due to 14 the addiction of their parents. 15 Chemical dependency results in death, and 16 death can only be avoided by recovery. 17 What is different about this heroin epidemic? 18 This heroin epidemic has been characterized 19 by the introduction of heroin to suburban young 20 adults. 21 It is well documented that this heroin abuse 22 was begun by the misuse, abuse, and addiction to 23 prescription drugs, such as Oxycodone. 24 In this epidemic, young people with 25 supportive families were encouraged into treatment, 1 and they did become abstinent and began the first 2 tentative steps toward recovery. 3 Like so many people in early recovery, they 4 relapsed. 5 However, in this epidemic, a relapse became 6 an unintentional fatal overdose. 7 What do we need to promote recovery within 8 this context? 9 We have many fine treatment programs in 10 New York State. 11 In Putnam County, three are licensed by the 12 New York State Office of Alcoholism and Substance 13 Abuse Services. 14 Arms Acres provides detoxification, 15 medically-supervised withdrawal, adult and 16 adolescent rehabilitation, and outpatient treatment. 17 St. Christopher's Inn provides primary care, 18 detoxification, medically-supervised withdrawal, 19 rehabilitation, and clinic services. 20 And, Putnam Family and Community Services 21 provides an outpatient chemical-dependency clinic. 22 And representatives from their agencies will 23 speak much more eloquently than I, later. 24 All of our treatment programs do a good job 25 of establishing a therapeutical use and a foundation 1 for recovery from chemical dependency, but the 2 disease of chemical dependency is so difficult that 3 relapse is common. The shame and humiliation that 4 is the hallmark of the feelings of the addict often 5 prevent them from seeking treatment again. 6 People who relapse do not want to relapse, 7 but often find themselves back in a situation where 8 substance abuse is encouraged. 9 While we have great treatment programs that 10 deliver intensive rehabilitation, we need to look 11 differently at what can be offered after 12 rehabilitation. 13 We need to provide persons in early recovery 14 opportunities for sober community living. 15 Halfway houses. There are no halfway houses 16 for persons with chemical dependency in 17 Putnam County, and they are needed. 18 Recovery centers, clubhouses, where people in 19 recovery can gather socially to help -- will help 20 promote recovery. 21 This model with peer-support and -advocacy is 22 growing in the-mental health recovery system. 23 And you may have seen an article this past 24 weekend in "The New York Times," talking about -- 25 that report on how student psychologists, who were 1 in recovery and needed to stay sober, how they were 2 developing social clubs, recovery clubs, 3 alcohol-free dances, and such, in order to be able 4 to have support in their sobriety and their 5 recovery. 6 And we need non-transitional safe and secure 7 housing for all persons in recovery from 8 behavioral-health issues. 9 So you'll hear me say that about 10 mental-health recovery, as well as substance-abuse 11 recovery. 12 I thank you for the opportunity to present 13 tonight. 14 I applaud you for your devotion to the cause 15 of resolving this terrible problem, and I appreciate 16 all that you are doing to further the cause of 17 recovery. 18 [Applause.] 19 SENATOR MURPHY: Dahlia, you mentioned the 20 education to stamp out the stigma. 21 I think that's pretty important. 22 It's not a needle in the arm anymore. It's a 23 pill that you can take. It's something that you can 24 snort. 25 It's -- you -- I would -- I'm not sure if 1 he's here, but, Officer Frank Chibota (ph.), was 2 kind enough, in your pamphlets, some of the forms 3 that I did, the signs and symptoms. 4 You wouldn't even know -- you know, if 5 someone was smoking a joint, their eyes get red and 6 you realize they're -- they might be high. 7 With this, you have no idea. 8 He was kind enough to put together the signs 9 and symptoms, that's in each one of these packets. 10 Frank, thank you very much. I appreciate 11 that. 12 But, to your point of education on the stigma 13 of this, I think it's extremely important to know 14 that it's not just the needle in the arm anymore. 15 And what you've seen at the health 16 department, I'm sure, has got to blow your mind. 17 DAHLIA AUSTIN: Well, the heroin campaign 18 that's been funded and OASAS is spearheading, that 19 is a great opportunity to expand that, and to be 20 more specific about reducing stigma. 21 It's difficult to open treatment programs, 22 because of that. 23 It's difficult for family members to come 24 forward to accept help, because of that. 25 It's difficult, not just for the individual, 1 the family members. The disease affects everyone. 2 And I think we need to be able to speak about 3 that. I think we need to be able to come together 4 to develop solutions that assist with the problem. 5 I don't think there's any one answer, to wave 6 a wand and say, This will fix it. 7 But it's a combination of problems. It's a 8 combination of stakeholders coming together to find 9 a solution. 10 SENATOR MURPHY: Yeah, shedding the light on 11 it is a good start, I believe. 12 Mike, quick question for you. 13 What type of time frames, as far as recovery 14 is concerned? 15 Because the people that I've talked to, 16 15 days is a joke. 28 days is not working. 17 If you were -- you talked about recovery 18 and -- or, you can, obviously, Dahlia, you can chirp 19 in here, whatever. 20 If you guys were to craft any type of time 21 frame of someone being able to stay in recovery, 22 what type of number would you give that, meaning 23 days-wise? 24 COMM. MIKE PIAZZA: I think, in terms of the 25 rehabilitation and the actual therapeutic 1 community -- 2 SENATOR MURPHY: God willing you can get them 3 there. 4 COMM. MIKE PIAZZA: Right, right. And, you 5 know -- I mean -- 6 SENATOR MURPHY: That's the start. 7 COMM. MIKE PIAZZA: -- well -- and 8 you and Senator Serino, when we were at 9 St. Christopher's Inn a couple of weeks ago, 10 when you heard the men talk about how long 11 they had been able to stay free, by being in 12 a safe place -- 13 SENATOR MURPHY: Good point. 14 COMM. MIKE PIAZZA: -- it was about 15 six months. It was about six months. 16 And I know people very close to me in 17 recovery from alcohol, not heroin, from alcohol, 18 that when they reached a year, it was a very crit -- 19 of sobriety, it was a very critical time. 20 Recovery is a lifetime process. 21 And early recovery can last, as far as I'm 22 concerned, beyond a year. 23 How long can you keep someone in a rehab 24 center? 25 But that's why I brought up the issues of 1 recovery centers and of halfway houses, safe places 2 where people can stay for long periods of time, and 3 at least a year, maybe more. 4 DAHLIA AUSTIN: It's really looking at the 5 continuum. 6 And, if someone has a medical condition, 7 diabetes, you don't look to say, well, there's an 8 end factor. You support them throughout that health 9 process. 10 And to look at addiction in the same light, 11 there's an acute phase which needs intense services 12 and intense treatment, but there's a maintenance 13 phase; and being able to hop from one to the next to 14 the other, and it being okay to be able do that, and 15 insurance being able to pay for that. 16 But, it's a lifelong process, as with any 17 disease, and it should be recognized as such. 18 SENATOR MURPHY: Yeah, I mean, it was at 19 St. Christopher's, and we'll hear from Mary Ann here 20 shortly, is that was unbelievable. You had the 21 two kids -- two adults, two alcoholics; and, two 22 kids that were really hooked on heroin. And one 23 kid, I think it was 20-some-odd-years old, and he 24 was hooked on heroin for 14 years? He started when 25 he was 11? 1 COMM. MIKE PIAZZA: Yes. 2 SENATOR MURPHY: Or something like that? And 3 he was on death row. He said, I want to kill 4 myself. And then found St. Christopher's, and sings 5 in the choir over there. 6 He's not ready to leave. He's not ready to 7 leave, but he's finding peace with himself. 8 And it was interesting to see. 9 And that's why I ask that question, if you 10 guys had any idea of what type of time frame. 11 It's for the rest of your life, I get that. 12 But there's a time frame where -- where 13 they've got to come in and be treated -- be treated. 14 And then, you know, the halfway house, step out, 15 come back; step out, and then matriculate back out. 16 So, I was trying to -- any kind of sense from 17 the professionals of you two, if, 45 days? 90 days? 18 Because, to be quite honest with you, I'm 19 trying to find out, when I go back and I talk to the 20 insurance companies, I want to figure out, what the 21 time -- you know, we need to get coverage for these 22 people. We're -- they're wasting their money, 23 I believe, when they turn around and they put you in 24 there for 15 days, and then 28 days. It's a no -- 25 it's not happening. It's just not happening. 1 COMM. MIKE PIAZZA: And we support your 2 efforts to extend the length of treatment, and 3 that's very important. 4 SENATOR MURPHY: Well, that will continue. 5 That will continue. I don't believe 28 days is 6 enough. I'm not sure if it's 45. I'm not sure if 7 it's 60. 8 And that's why I was trying to kind of get a 9 little taste of it. 10 DAHLIA AUSTIN: There's really no panacea to 11 say, 2 days, or 10 days. 12 SENATOR MURPHY: Right. 13 DAHLIA AUSTIN: And that's why it's difficult 14 to put a time frame. 15 And that's why a continuum of services are 16 appropriate, once someone needs to step down from 17 intensive services, to have somewhere to go to 18 provide that alternate level of support and 19 services. 20 SENATOR MURPHY: I know Senator Martins had a 21 question. 22 SENATOR MARTINS: Thank you. 23 First, thank you very much for your testimony 24 here today. 25 How many inpatient beds do we have in 1 Putnam County and in Westchester County for 2 recovering drug addicts? 3 COMM. MIKE PIAZZA: So, rehab beds, we 4 have -- actually, Mary Ann and Patricia are here. 5 They can tell you exactly. 6 I think we have 127 beds in Arms Acres, but 7 some of them are for adolescents. Actually, maybe 8 more than 127 beds. 9 And I'm not sure exactly how many beds in 10 St. Christopher's Inn. 11 MARIANNE TAYLOR-RHOADES: 190. 12 COMM. MIKE PIAZZA: Okay. There you go. 13 I knew she'd know the answer. 14 SENATOR MARTINS: Thank you. 15 So we have over 300 beds available for 16 recovering, rehab beds, available in Putnam County? 17 COMM. MIKE PIAZZA: In Putnam County. And 18 those beds are used regionally. 19 SENATOR MARTINS: Of course, of course. 20 Because I can tell you we have far fewer in 21 Nassau County. And that really -- and I'm 22 assuming -- how many do we have in Westchester? 23 DAHLIA AUSTIN: Westchester, we have 24 approximately three or four providers that provide 25 inpatient rehab beds. Some of them are 1 OMH-licensed, and some are just strictly 2 OASAS-licensed. And then we do have a provider that 3 provides detox beds. 4 So we -- and we do serve clients from the 5 city that come up and access the services. 6 SENATOR MARTINS: And that seems to be one of 7 the issues that we really need to grapple with. 8 Yes, we've passed laws that require insurance 9 companies to provide coverage in a more meaningful 10 way than they did in the past. And, perhaps, we 11 need to again reevaluate those. 12 But if there aren't beds available, whether 13 detox beds in the short-term, or whether rehab beds 14 in the long-term, that really seems to be a 15 significant issue. 16 And it's an issue that, perhaps, we haven't 17 done enough as a state; certainly, perhaps we 18 haven't done enough locally, to actually make those 19 facilities available, make those a priority, so that 20 when there is somebody who has that epiphany, and 21 I do believe that, at some point, someone who needs 22 help, and decides and realizes that they need help, 23 there's a very short window there where the person 24 either gets the help, or they relapse, because it 25 isn't enough to have an outpatient center. We need 1 to have the kind of care that is going to remove 2 them from all of the stimuli that they have around 3 them, and put them in a caring facility where they 4 will get the help that they need. 5 And we don't have it. We just don't. 6 Congratulations to Putnam. 7 You are the exception, by the way, not the 8 rule to, have that many beds available. 9 But you are also caring for the region in 10 those 300-plus beds. They're not just, obviously, 11 for the residents of Putnam County. 12 And so, you know, perhaps efforts to 13 coordinate our own priorities when it comes to this 14 is long overdue. 15 And I think about -- I think about, you know, 16 how perceptions in society have changed over time. 17 And I think about my parents' generation, and 18 their views on things like smoking cigarettes, and 19 how prevalent it was, and it was obviously something 20 commonplace. There were -- you know, there were 21 ashtrays in public places. There were ashtrays in 22 hospitals. It was prevalent on TV. 23 And then you see our generation, and you see 24 it less so. 25 And then you see my children's generation, 1 and they want nothing to do with it. It is not even 2 an issue. They're not even curious about it. They 3 just don't do it. 4 And so, you know, obviously, there's a path 5 there. And, obviously, nicotine isn't as addictive 6 as some of the things we're dealing with here. 7 But there is an educational component here 8 that we have to strive, to try and incorporate into 9 our public-education system, and, societally, 10 I think is critically important. 11 But when -- just to reiterate a point, when 12 that child, when that person, when that adult, has 13 that -- that brief lucid moment where they reach out 14 for help, how we respond societally, and the tools 15 that we have available, are critically important. 16 What else can we do? 17 What should be we be looking at? 18 DAHLIA AUSTIN: When you talked about 19 residential beds, there is a need for community 20 residences, and that's a lower level of care. 21 Mike mentioned the need for that. 22 COMM. MIKE PIAZZA: Group homes. 23 SENATOR MARTINS: Group homes, you know, it's 24 a bad word, obviously, in our suburban communities 25 to talk about group homes, but we have to talk about 1 sober houses and group homes, and the ability to 2 have transitional places for people who are 3 transitioning back into a suburban community. 4 I mean, we can't hide from it. We -- let's 5 call it what it is. These are suburban homes that 6 are going to provide for a transitional location for 7 people who are recovering, to be able to get back on 8 their feet, find that job, create or start a new 9 routine. 10 That's what you're talking about. Right? 11 DAHLIA AUSTIN: Yes. 12 COMM. MIKE PIAZZA: Yes, yes. 13 The community residences and the halfway 14 house is a safe place, a supported place, a 15 supervised place, where a person can be in the early 16 stages of recovery, and can stay for a good long 17 time. 18 But you'll also hear, Senators, you know, 19 when you hear on the (unintelligible) side of the 20 discussion, social -- you -- you will hear -- we're 21 talking about safe, secure housing, for both people 22 with mental illness and in recovery from chemical 23 dependency, that are non-transitional, that are 24 long-term. 25 But before you get to that point, you do need 1 the supervised settings, the community residences 2 and the halfway houses. And that's something that 3 we do not have. 4 SENATOR MARTINS: Thank you. 5 SENATOR MURPHY: Well, listen, thank you 6 Mike, thank you, Dahlia. 7 I appreciate your testimony here. 8 DAHLIA AUSTIN: Thank you. 9 [Applause.] 10 SENATOR MURPHY: Is Doc in the house? 11 There he is. 12 How are you, sir. 13 DR. ANDREW KOLODNY: Good. How are you? 14 SENATOR MURPHY: Good. 15 Thank you for coming tonight. 16 We have Dr. Andrew Kolodny from the 17 Phoenix House. 18 Thank you for coming tonight. 19 DR. ANDREW KOLODNY: Thank you, Senator, for 20 inviting me. It's an honor to have this opportunity 21 to talk with you about the opioid crisis. 22 Just a little bit of background about me. 23 I'm the chief medical officer of 24 Phoenix House, which is a national nonprofit 25 addiction-treatment agency. We're in 11 states. 1 And I'm the director of an organization 2 called "Physicians for Responsible Opioid 3 Prescribing," and we represent 1100 physicians from 4 different specialties, including addiction, pain, 5 primary care, and public health. 6 And I -- also, my clinical specialty is 7 treating opioid addiction. I've been treating it 8 for 10 years. And my writing and research is on the 9 cause of this epidemic, and on policy interventions 10 necessary to bring it to an end. 11 SENATOR MURPHY: Love to hear you. Keep 12 going. 13 DR. ANDREW KOLODNY: So, I'm going to 14 describe the problem. I'm going to try and define 15 it a little better for you. 16 I'll talk about what got us into this mess, 17 and what I think needs to be done to bring it under 18 control. 19 So, you hear this problem described in 20 different ways. You'll hear it described as a 21 prescription-drug-abuse crisis, or a heroin-abuse 22 crisis. 23 It's actually the wrong language to use, it's 24 the wrong way to frame the problem, not only because 25 it's inaccurate, but it's also misleading. It makes 1 us think that the problem that we're dealing with is 2 people behaving badly: people using dangerous drugs 3 recreationally, and then dying from them. 4 That's really not problem we're dealing with. 5 The problem that we're dealing with is an 6 epidemic of Americans who have become addicted to 7 opioids. 8 And when I use the term "opioid," I'm talking 9 about both heroin and prescription opioids. 10 Something that's very important to keep in 11 mind is that drugs, like Vicodin or Oxycontin 12 (hydrocodone and oxycodone), to make them you start 13 with opium, in the same way to make heroin, you 14 start with opium. 15 And the effects that oxycodone and 16 hydrocodone produce in the brain are 17 indistinguishable from the effects produced by 18 heroin. 19 What that means is that, when we talk about 20 opioid painkillers, we are, essentially, talking 21 about heroin pills. 22 To say that doesn't mean we should never 23 prescribe them. These are very important medicines 24 for easing suffering at the end of life, and when 25 used on a short-term basis for severe acute pain; 1 for example, someone who has just had surgery. 2 But the vast majority of opioid prescribing 3 in the United States is not for palliative care or 4 short-term use. 80 percent of the U.S. opioid 5 consumption is for what would generally be called 6 "chronic non-cancer pain." These are conditions 7 like low-back pain, fibromyalgia, chronic headache; 8 conditions where opioids are probably not safe or 9 effective. 10 The United States, with about 5 percent of 11 the world's population, is consuming 80 percent of 12 the world's oxycodone supply and 99 percent of the 13 world's hydrocodone supply. 14 The CDC has been very clear about the cause 15 of our current opioid-addiction epidemic. In fact, 16 the CDC is calling this the worst drug epidemic in 17 the United States history. 18 What the CDC is telling us is that this 19 epidemic has been caused by overprescribing of 20 opioid painkillers, beginning in the late 1990s, as 21 doctors began to prescribe opioid painkillers more 22 aggressively than they ever had before. 23 As the prescriptions began to soar, it led to 24 parallel increases in rates of addiction and 25 overdose deaths. 1 Between 1997 and 2011, there was a 2 900 percent increase in opioid addiction in the 3 United States, measured by people seeking treatment 4 for opioid painkillers. 5 So when we talk about this problem, the 6 reason that we're seeing -- the reason that we're 7 seeing historically high levels of opioid-overdose 8 deaths, the reason that we're seeing skyrocketing 9 rates of infants born dependent on opioids, the 10 reason that we're seeing heroin flooding into 11 non-urban areas, is because the prevalence of this 12 disease, opioid addiction, the number of people with 13 this disease, has increased rapidly over a brief 14 period of time because these medications were 15 overprescribed. 16 Now, you can ask if I'm suggesting that this 17 epidemic was caused by doctors prescribing too many 18 painkillers. 19 You can ask, Well, why did we suddenly start 20 to prescribe painkillers so aggressively, beginning 21 in the late 1990s? 22 And the reason that happened, is that the 23 medical community was responding to a brilliant 24 marketing campaign. It was a campaign that 25 misinformed the medical community about the risk of 1 these medications, especially the risk of addiction, 2 and exaggerated the benefits of using them 3 long-term. 4 The medical community was led to believe that 5 the compassionate way to treat any complaintive pain 6 was with an opioid prescription. 7 That was incorrect. 8 As the prescribing took off, it's led to this 9 public-health catastrophe. 10 I'd like to just briefly talk about the 11 heroin connection. 12 And what we're hearing in the media right now 13 is that efforts to crackdown on painkillers have 14 created this new heroin problem. 15 That's not accurate. 16 From the very beginning of the 17 opioid-addiction epidemic, we have very clear data 18 on this going back to around 2000, 2001, from the 19 beginning of that epidemic, young people who were 20 becoming opioid-addicted, if they lived in areas 21 where heroin was accessible, they were switching to 22 heroin because it was easier to access. 23 This is not a new problem. 24 What's happening that may be new is that, 25 beginning in 2010, we're seeing more people dying 1 from heroin overdoses, and it's likely due to the 2 fact that the heroin supply has become more 3 dangerous. 4 But heroin is not a new problem. It began at 5 the beginning of the opioid-addiction epidemic. 6 We have, roughly, two groups that are 7 addicted right now. 8 There is the younger group that I think most 9 of the discussion today has focused on. This is the 10 group that becomes addicted to opioids through 11 exposure to painkillers. They could be painkillers 12 that they were using, that were prescribed by a 13 doctor for a sports injury or wisdom teeth, and 14 maybe they liked the effect. They used them 15 recreationally, or maybe used them as directed; they 16 became addicted. 17 These young individuals who are becoming 18 addicted through either medical or non-medical use, 19 because they're young, if they don't have serious 20 medical problems, once addicted, it's very difficult 21 for them to maintain their opioid supply visiting 22 doctors. 23 Even doctor-shopping, if you're young and 24 you're healthy, doctors are not going to want to 25 prescribe you 240 tablets of oxycodone. 1 Very quickly, the younger group winds up on 2 the black market. The pills are about $30 apiece 3 for an immediate-release 30-milligram oxycodone. 4 They switch to heroin because it's less expensive. 5 That's one group, the younger people now 6 switching to heroin. 7 The other group are individuals in their 40s, 8 50s, 60s, and 70s. These are individuals who do 9 not have to turn to the black market, once getting 10 addicted. They have no trouble getting pills from 11 doctors. 12 And one of the interesting findings that 13 rarely gets reported on, is that when you look at 14 which group has the higher rate of overdose death, 15 overdoses are much higher in the group getting the 16 pills from doctors. 17 The age group with the greatest rate of 18 drug-overdose death in the United States from 19 opioids is 45 to 54. Far more middle-aged people 20 are dying of opioid-painkiller overdoses, even more 21 so than the young people who are switching to heroin 22 that they're purchasing on the street. 23 What needs to be done about this epidemic? 24 Well, I was very careful to define this 25 problem as an epidemic of people with the disease of 1 opioid addiction. 2 Now, I don't mean to imply that everybody who 3 is dying of an overdose death was addicted. 4 There are certainly deaths occurring in 5 people who were making the mistake of experimenting 6 with a very strong painkiller, had no tolerance, and 7 died of an overdose: young people who were not 8 addicted. 9 There are also pain patients dying of 10 overdoses, who accident -- forgot they took their 11 80-milligram Oxycontin before going to bed, they 12 take a second one, and they don't wake up in the 13 morning. 14 Deaths like that are very significant. 15 But the vast majority of the overdose deaths 16 appear to be occurring in people who were 17 opioid-addicted, and they got that disease in one of 18 two ways. 19 They got that disease through medical use; 20 they were taking the pills exactly as prescribed, 21 and became addicted. Or, from using them 22 recreationally. 23 So how do we bring this epidemic under 24 control? 25 Well, if we understand this is an epidemic of 1 people with the disease of opioid addiction, the 2 strategies for bringing this problem to an end are 3 very similar to the strategies we would employ for 4 any disease epidemic, whether we were talking about 5 Ebola or measles or HIV. 6 The way you end an epidemic is you contain 7 it. You prevent new people from getting the 8 disease, and you see that people who are suffering 9 from that disease are able to access effective 10 treatment. 11 These are the same strategies we need to end 12 the opioid-addiction epidemic. We need to prevent 13 new people from developing opioid addiction, and we 14 need to see that the people who have that disease 15 are accessing effective treatment. 16 To prevent opioid addiction, that mainly 17 boils down to getting doctors and dentists to 18 prescribe more cautiously, so that they don't 19 directly addict their patients, and so that they 20 don't indirectly cause addiction by stocking 21 medicine chests with a hazard. 22 In terms of treatment, there's been quite a 23 bit of discussion about treating this disease. 24 If we don't rapidly expand access to 25 effective treatments, we are going to see heroin 1 continuing to flood into communities to meet the 2 demand, and we will see overdose deaths remain at 3 historically high levels. 4 One of the most important treatments is a 5 medication called "buprenorphine," or, "Suboxone." 6 And I just spent a while telling you that 7 overprescribing of an opioid led to this 8 public-health catastrophe. It may sound strange 9 that I'm now going to say that an opioid medication 10 may be the answer for this problem. 11 But I do believe that for the -- that one of 12 the first-line treatments for people suffering from 13 the disease of opioid addiction is treatment with 14 Suboxone, or, buprenorphine. 15 And, unfortunately, there is not nearly 16 enough access to that particular treatment, in part, 17 because of federal barriers. 18 Now, I just want to end by pointing out 19 something that also was not measured. 20 I think the purpose of this forum, in part, 21 is to discuss what this community can do to tackle 22 this problem, and, of course, that's the right thing 23 to ask. 24 But I'd like to point out that the federal 25 government is failing to help states and counties 1 with this public-health crisis. 2 In 2013, 44,000 Americans died of a 3 drug-overdose death. That's the same number of 4 Americans who had died of AIDS at the height of the 5 AIDS epidemic in 1994. And it was -- and it's been 6 the same trajectory of increases in deaths. 7 I'd like to point out that Ronald Reagan was 8 rightly criticized, because during the AIDS 9 epidemic, it wasn't until around 1987, and around 10 20,000 American deaths, before he would say "HIV" or 11 "AIDS" in public. 12 We have not heard once from President Obama 13 about this epidemic. 14 More than 220,000 Americans have died of 15 opioid overdoses, half of them on his watch since he 16 came into office. Not once has he addressed this 17 crisis. 18 And it wasn't until this year's budget that 19 he's ever talked about finding funding for this 20 problem. 21 In fact, the President has cut funding to 22 NIDA. 23 It would be nice if we had other treatments 24 beside buprenorphine, where NIDA could be investing 25 in research. 1 And he's cut funding to SAMHSA which funds 2 treatment around the country. 3 So I'd like to point out that the federal 4 government could be doing more. 5 And in terms of what New York State could be 6 doing, I would hope that they would advocate with 7 the federal government to be helping out with this 8 crisis. 9 Thank you. 10 [Applause.] 11 SENATOR MURPHY: Thank you very much for your 12 testimony here. 13 A few things, just so you know what we have 14 done, Senator Martins, myself, our conference, we 15 made sure there's close to $12 million in this for 16 the heroin and opioid abuse that's going on in 17 New York State. It's the most that's ever been. 18 We realize that there's a problem here, and 19 this is why we're doing these things. 20 So, it is, crucial importance to continue, 21 and like you said, getting funding for some of these 22 things. 23 A few quick questions, though, that I'd like, 24 if you don't mind. 25 You say -- how do we contain it? 1 How do we contain it? 2 You said that's a very important component to 3 this, is how we're going to contain it. 4 How do we get these kids to stop going into, 5 you know, getting these prescriptions, stealing 6 these things, and then going out on to the streets? 7 Any idea of how to -- you said "contain it," 8 that's a crucial thing. 9 DR. ANDREW KOLODNY: Sure. 10 You know, I think it's -- we can ask, you 11 know, how can we prevent kids from using these 12 drugs? 13 But I really think that -- and there are 14 efforts that are important there, but I think the 15 pills that these kids are getting their hands on 16 have been prescribed by doctors -- 17 SENATOR MURPHY: Uh-huh. 18 DR. ANDREW KOLODNY: -- and in many cases, 19 for inappropriate indications. 20 If someone has just had a major surgery, or 21 severe acute pain, usually they need a few days of 22 these medications. 23 We have doctors and dentists giving 24 30 days worth of medications to teenagers, in some 25 cases. 1 So I think there needs to be an effort to get 2 the medical community to prescribe much more 3 cautiously so that these pills aren't available. 4 Young people are curious about experimenting 5 with drugs. And, in fact, there are psychologists 6 who would argue that experimenting with drugs is 7 normal behavior in adolescents. 8 Young people do try to determine if a drug is 9 a soft drug or a hard drug. 10 When I was in college, if somebody brought 11 pot to a party and went around, some people would 12 try it. Had somebody brought heroin to that party, 13 they would have looked at them like they were crazy. 14 The young people who are experimenting with 15 drugs don't recognize that an opioid painkiller is, 16 essentially, a heroin pill. They think they're 17 playing with a soft drug. It's after they get 18 addicted they realize it's the same. 19 But the prescribers and the parents also 20 don't recognize that these are, essentially, heroin 21 pills that they're putting in their medicine chests. 22 SENATOR MURPHY: The interesting point, I had 23 the opportunity of meeting, up in my office, with a 24 group yesterday, with regards to, possibly, a new 25 medication coming out that can, basically, with the 1 pain medication -- you have the neurotransmitter -- 2 to, basically, encapsulate the neurotransmitter 3 after you take this. 4 And then, this, instead of taking the opioid 5 every 3 to 4 hours, or 5 hours, this has the 6 possibility of lasting 12 to 24 hours, without 7 giving the euphoria that these people are looking 8 for, smashing it up, smoking it, snorting it, 9 doing -- ingesting it. 10 So this type of drug, if they try and 11 manipulate it would, basically, how I understood it, 12 pretty much, turn to honey. 13 DR. ANDREW KOLODNY: Yeah, I'm not familiar 14 with the specific type of abuse-deterrent 15 formulation that you're describing. 16 But I would say that there's a temptation to 17 think that technology can get us out of this mess. 18 That if we simply made these pills harder to crush 19 for snorting or injecting, that that would somehow 20 help this problem. 21 It wouldn't, because making a pill harder to 22 crush or snort is not really doing anything to make 23 the active ingredient less addictive. 24 And almost everyone who develops this 25 disease, it starts by taking pills orally. 1 Some people will switch to snorting and 2 injecting, but most just continue to use orally. 3 So, it's much more important to get across to 4 the medical community, that when you prescribe 5 opioids long-term for common chronic conditions, 6 that you are much more likely to hurt patients than 7 help them. 8 The problem that we're talking about today is 9 not new. From the early 2000s, it was clear, that 10 as the prescribing was going up, we were seeing 11 rates of addiction and overdose deaths rise. 12 The strategies for controlling it back then 13 are the same as today, and they're not that 14 complicated. 15 The reason that we -- I believe, policymakers 16 have been failing to address this problem with the 17 appropriate interventions is that, the opioid lobby, 18 the pharmaceutical companies that have been earning 19 tremendous profits as the prescribing took off, and 20 it's not just the pharmaceutical companies, it's the 21 retailers, the wholesalers, the distributors, what 22 they keep telling policymakers like yourselves, is 23 that we have two problems in America. 24 They'll tell you we have the problem of drug 25 abuse and the drug abusers, and we have the problem 1 of 100 million Americans suffering with chronic 2 pain. And your challenge as the policymaker is to 3 not do something about the drug-abuse problem that 4 will make the pain problem worse. Don't do anything 5 that might jeopardize access for the millions who 6 are benefiting, or penalize them for the bad 7 behavior of the drug abusers. 8 That is a false framework. We do not have 9 these two distinct populations. There's a 10 tremendous amount of overlap. 11 And I would say the group that's been 12 disproportionally harmed, harmed more than any other 13 group, would be Americans suffering from chronic 14 pain, because these medications are not helping 15 them, and, in many cases, are ending their lives. 16 SENATOR MURPHY: Yeah, well, ending their 17 lives, is it due to the concentration of it? 18 DR. ANDREW KOLODNY: It's due to the fact 19 that these -- what happens, if you take an opioid 20 long-term, is that you become tolerant to the 21 analgesic effect. The only way to continue to get 22 pain relief is to keep going higher and higher on 23 the dose. 24 As the dose gets higher, you see people's 25 quality of life and function begin to decline, and 1 the medicine they're on becomes very dangerous. It 2 becomes very easy for them to overdose and die from 3 it. 4 The other thing we see is that the opioids 5 can make pain worse. It's a phenomenon called 6 "hyperalgesia." 7 Back in 1995, before this problem exploded, 8 that was the time when the medical community 9 understood that you don't treat low-back pain, 10 headache, fibromyalgia, with long-term opioids. 11 It was when we were convinced that this was 12 the compassionate way to treat all of these 13 problems, the prescribing took off, and that's how 14 we wound up here. 15 SENATOR MURPHY: Thank you. 16 Thank you very much. 17 [Applause.] 18 SENATOR MARTINS: Uhm, Doctor, it's not fair 19 to bring your own fan club with you when you come to 20 these hearings, you know that. 21 [Laughter.] 22 SENATOR MARTINS: I do have a couple of 23 questions. 24 And, obviously, as we discuss this issue, 25 there have been suggestions made that we as a state, 1 and perhaps the rest of the country as well, should 2 require, in medical schools, that doctors have to 3 take specific classes on pain management as a 4 precondition to being permitted to prescribe 5 opiates. Period. There should be no exceptions. 6 Do you believe that that's the case? 7 DR. ANDREW KOLODNY: I have very mixed 8 feelings about discussions for mandatory education 9 of -- mandatory pain education. 10 And I think Senator Kemp Hannon has a bill 11 out there that would mandate docs in New York State 12 to get education in pain. 13 The problem I have with it is the content of 14 the education. 15 And I think, even in his bill, it talks about 16 groups, like the American Pain Society, sponsoring 17 these educational programs. 18 It was education in using these medications 19 for pain that, in many ways, led to this change in 20 practice. 21 I think that we do want -- if we could 22 mandate really good education, I would be in favor 23 of it. But I would be concerned about the content. 24 What we want is for the prescriber to have 25 accurate information about the medications' risks 1 and benefits. If they understood that these are 2 highly addictive, and if they understood they don't 3 work well when used long-term, they would prescribe 4 much more cautiously. 5 SENATOR MARTINS: I don't disagree with you. 6 I would just think that the profession 7 itself, frankly, has an obligation to provide that 8 guidance for itself. 9 And so, you know, we've all heard the 10 nightmare scenarios, where a dentist will prescribe 11 30 days -- 30 days worth of painkillers for someone 12 who goes in for a root canal. And, you know, they 13 could have prescribed aspirin. 14 DR. ANDREW KOLODNY: Correct. 15 SENATOR MARTINS: And so, you know, that 16 can't happen. 17 And to the extent that there's legislation 18 that's being proposed, I would suggest that, in the 19 absence of the profession taking this -- the 20 initiative and developing those protocols 21 themselves, the State will have to take some action. 22 And I would hope that the profession would 23 take action on its own. 24 DR. ANDREW KOLODNY: They won't. So you will 25 not find the New York State Medical Society 1 supporting anything that's mandatory. 2 The medical society, in many states, the 3 doctors' groups would like to think of this problem 4 as all about the bad apples. They would like you to 5 think that this is all about the doctors running 6 pill-mills, and the patients who are drug abusers. 7 In many states, the medical societies are 8 opposed to interventions that would impact what they 9 do in their everyday practice. They think that they 10 know how to prescribe appropriately. 11 The reality is, that the well-intentioned 12 doctors may be a bigger part of the problem. The 13 well-intentioned doctors and dentists are 14 inadvertently causing addiction. 15 Once people get addicted, they seek out the 16 pill-mill doctors. The pill-mill doctors are 17 responsible for a disproportionate number of the 18 deaths. 19 But it's well-meaning doctors that really do 20 need that education. 21 And if there was a smart bill, I don't know 22 that you'd get the medical groups to support it, but 23 I think you could get a lot of support for it. 24 SENATOR MARTINS: I appreciate that. 25 You know, it is a statistic that jumps out at 1 me, and I think it jumps out at most people who see 2 it: In 2011, there were 21 million prescriptions 3 written in New York State for an opioid. 4 21 million prescriptions. 5 There are only 19 million people in the 6 entire state. That's infants, right up to 7 nonagenarians. 8 So the idea that there are that many opioids 9 available, being prescribed, obviously, heightens 10 the sense that, you know, this has been a problem 11 for a long time. And there are only a couple of 12 people who knew that it was a problem for a long 13 time. 14 The pharmacy. 15 The drug companies that knew that they were 16 shipping these quantities into the state, and, 17 certainly knew how many were being sold, obviously. 18 And those who were prescribing them. 19 DR. ANDREW KOLODNY: I'd say there's another 20 group, potentially, that would know, which would be 21 New York State's Bureau of Narcotic Enforcement, 22 which has had access to the I-STOP data, which could 23 be using the PDMP data to identify doctors who are 24 prescribing aggressively, and intervening. 25 These are doctors who the State could be 1 telling them, you know, you shouldn't be prescribing 2 high doses of opioids in combination with Xanax. 3 They could be sending them letters. They could be 4 requiring targeted educational programs for risky 5 prescribers. 6 The State has this database, and they've also 7 not utilized it. 8 SENATOR MARTINS: You know, Doctor, 9 I appreciate that. 10 I did use 2011 as the date for those 11 statistics because I-STOP didn't come into play 12 until 2012. 13 Because, having been there, and having 14 participated in not only the discussion, but also 15 the vote for I-STOP, we now have a tool that we 16 didn't have before. 17 To your point about the 45-to-54-year-old 18 population, frankly, I am -- I appreciate it. 19 I'm surprised, because that wasn't 20 something -- and, obviously intuitively, I think we 21 can all understand that that population would 22 certainly have the ability to continue to access 23 opioids through prescriptions, because nobody 24 perceives them as being addicts. 25 DR. ANDREW KOLODNY: Correct. They're seen 1 as chronic-pain patients. 2 There was a study that was done in Utah. In 3 2012 they published a study, looking at everybody 4 who had died in the state of Utah in 2008. And of, 5 roughly, 300 people who had died of an 6 opioid-painkiller overdose in the 2008 year, 7 92 percent of them were people who were getting 8 these medications legitimately prescribed to them by 9 a single doctor for chronic pain. 10 When they interviewed the next-of-kin, what 11 they found for almost all of the patients who had 12 died, was that their close contacts were worried 13 that they were badly addicted to these medications, 14 but they were also seen as legitimate chronic-pain 15 patients. 16 SENATOR MARTINS: You know, and I'll just 17 make a point, and I appreciate that context, but, 18 anecdotally, I have a real -- obviously, a real 19 interest in this issue. 20 And when I discuss this particular issue, 21 overdoses, the demographics, the types of people who 22 are the victims of these overdoses, with emergency 23 responders, volunteer firefighters, who are 24 responding in their ambulances, time and again, the 25 demographic that I am aware of is a much younger 1 demographic that is overdosing today in 2 New York State. Certainly, in my suburban 3 communities. 4 That the EMS personnel that are responding to 5 those overdoses, and I can't speak to what happened 6 in Utah, and I can't speak to other parts of the 7 state or other parts of the country, but this is 8 still very much a significant issue for younger 9 adults who are hooked, who are taking these drugs, 10 who, perhaps, decided to seek treatment, and then 11 relapsed. 12 And, in relapsing, there's a common scenario, 13 went back to the dosages that they were taking 14 before they sought treatment, thinking that that was 15 the proper dosage, and ended up overdosing, because 16 their body no longer could tolerate that level of 17 opioid abuse. 18 So, I appreciate it. It's something I'm 19 going to follow up on personally. 20 But when I discuss these issues, and, 21 unfortunately, there are too many instances, it is, 22 time and again, the young adult, the teenagers, or 23 those in their early 20s that are succumbing to 24 these issues, and not necessarily the 45- to 25 54-year-olds. 1 DR. ANDREW KOLODNY: Yeah, if you check with 2 the Nassau County Medical Examiner's Office, you'll 3 find that the age group in Nassau County, because 4 I'm familiar with their data, where they've got 5 the highest rate of overdose deaths, is the 6 45-to-54-year age group. 7 I suspect that the reason you get a different 8 picture, talking to EMS workers, is they may be more 9 likely to respond to an overdose involving a young 10 person or involving illicit-drug use. 11 Typically, the way a pain patient dies of an 12 overdose is in bed, sometimes next to their spouse. 13 In fact, many of these deaths go uncounted as 14 drug overdoses. If it's an elderly person, it's 15 usually attributed to a natural medical problem. 16 SENATOR MARTINS: It's fascinating. 17 I really appreciate the context, because 18 it's -- the first time that that's actually been 19 presented at one of these forums. 20 Thank you, very much. 21 SENATOR MURPHY: One more quick question for 22 you, Doc. 23 I know in medical school, they don't -- it's 24 minimal training on pain control. It's absolutely 25 minimal training there. And, we all have to do our 1 CEUs in the profession. 2 And, as the drug field changes, I know I have 3 to do at least 12 units in ethics. 4 I would not see any reason why the M.D.s 5 wouldn't have to do anything in a specific line, 6 whether it's pain control, or learning about the new 7 drugs coming out. 8 The reality is, is that the drugs are 9 changing on a constant basis, as you say, and we 10 have to do certain CEUs (continuing education 11 requirements), in case people don't know what 12 they're about. 13 And making one of those mandatory is -- 14 I would not see a problem in it. 15 DR. ANDREW KOLODNY: I agree. I wouldn't see 16 a problem, depending on the content of the 17 education. But there's also very little taught 18 about addiction in medical school. 19 And what we're dealing with right now is a 20 severe epidemic of addiction. 21 SENATOR MURPHY: Great point. 22 DR. ANDREW KOLODNY: I'd like to see 23 mandatory education on addiction before we let 24 doctors prescribe addictive medications. 25 [Applause.] 1 SENATOR MURPHY: I think those two would be 2 linked very closely. They would, most certainly, 3 overlap. 4 One last thing? 5 SENATOR MARTINS: Yeah, just one last point. 6 You know, we hear statistics, Doctor, about 7 the number of overdose deaths, usually by region. 8 And, you know, those are statistics that are held up 9 to identify this problem. 10 To your knowledge, when they publish these 11 results, are they including everyone, including 12 those that are, you know, under care and doctor's 13 care, and receiving pain medications to deal with a 14 chronic condition, the example you gave about dying 15 in bed, as opposed to somebody responding to an 16 emergency? 17 Are all of those included in those statistics 18 as well? 19 DR. ANDREW KOLODNY: What happens when 20 somebody doesn't -- dies of an overdose? 21 911 is called. The police or 911 come on the 22 scene. 23 If there's a young person there, and a 24 syringe or crushed-up pills, or there's a young 25 person with no medical problems and an empty pill 1 bottle, almost always, the body will be sent to the 2 medical examiner, toxicology will be performed. And 3 if it was, in fact, an opioid overdose, it will be 4 counted as such. 5 What happens very often, though, is if it's 6 an elderly person, if it's grandma, even if 7 everybody knew grandma had a problem with her pills, 8 if grandma doesn't wake up, and the police come, 9 typically what the police will do is, they'll find a 10 pill bottle, they'll call the doctor who was the 11 prescriber, and they'll say, Will you come to the 12 home and sign a death certificate? 13 When you lose your loved one, you -- 14 generally, you want your loved one to be buried. 15 You don't want them to be -- to have died of one of 16 the most stigmatized conditions possible. 17 So we wind up undercounting many of the 18 deaths. 19 SENATOR MARTINS: Of course, of course. 20 And we have instances, obviously, where 21 people die under tragic circumstances, and they had 22 a seizure, because no one wants to discuss, again, 23 going back to the issue of stigma. 24 Doctor, I appreciate your testimony. Thank 25 you very much. 1 SENATOR MURPHY: Thank you so much, Doctor. 2 DR. ANDREW KOLODNY: Thank you. 3 [Applause.] 4 SENATOR MURPHY: We are going to have 5 Steve Salomone, Drug Crises In Our Backyard, and, 6 Frank Reale, Peers Influencing (sic) Peers. 7 Thanks for coming, Steve and Frank. 8 FRANK REALE: Thank you. 9 SENATOR MURPHY: Steve, do you want to start? 10 STEVE SALOMONE: Yeah, I'll start. 11 Thank you, Senators, for the -- for this 12 forum to get the word out. I think it's very 13 important that we continue to do that. 14 I believe that I was asked to come today -- 15 I'm not a professional, not credentialed, I'm not in 16 the field. I am a parent. 17 I believe the reason I was asked to come 18 today, is because I represent the face of addiction. 19 I could put a face to addiction. 20 Erik Christiansen is the face of addiction. 21 29-year-old who died of a heroin overdose in 2012, 22 June 9th. A decorated New York City police officer 23 who was working undercover, and became addicted to 24 painkillers after an injury, and switched to heroin. 25 Very stereotypical story. We all know it. 1 Justin Salomone is the face of addiction, my 2 son. Died at 29 years old in 2012. 3 Another stereotypical story. 4 Good family, dinner every night, all the 5 right things; and, yet, Justin struggled with 6 addiction for 10 years. Six of those years he was 7 in and out of rehab, struggling to get clean, and 8 could not. 9 So, I believe that I am here tonight to let 10 people know what it's like to have that struggle, 11 because the stigma of addiction is very pronounced. 12 And what I think a lot of people don't 13 understand is that it's not a bad life choice, it's 14 not a bad decision, and it's not something that 15 people choose to do. 16 When your life is being destroyed, and you 17 continue to do something, that gives you an evidence 18 of how bad this addiction is, and how bad it is to 19 be addicted to an opioid, because that's what these 20 individuals and other individuals have gone through. 21 As a result of Erik's and Justin's death, we 22 founded a group called "Drug Crisis in Our 23 Backyard." 24 We decided just to get the word out. My wife 25 wrote an open letter to the "Mahopac News," and it 1 was published. 2 And what happened was, our phone began to 3 ring off the hook. And the reason it did, was 4 because people were coming to us, saying, Thank you 5 for your bravery in coming out. We have the same 6 problem. 7 And people were coming up to me at work and 8 telling me the same thing. 9 And what I quickly learned was that most of 10 the people, a predominant number of the people that 11 I knew, were struggling with this in their homes, in 12 this community. 13 And that's when the light went on for us. 14 So we formed the group, and we started to get 15 the word out. 16 And what we found out, in my opinion, was the 17 common denominator was shame and fear of coming out 18 because of the stigma of addiction. 19 So, in being out there and being out, we 20 started to get a lot of calls. 21 And what I would say was -- most commonly 22 what I heard from a lot of parents was, when they 23 would tell me that they found out that their son or 24 daughter was using heroin, they were shocked. 25 And that was something that was a real 1 eye-opener to me, because with all of the forums 2 that we have going on, and with all of the word 3 that's getting out, and with all of the articles 4 about overdose, parents are shocked when they learn 5 that their children are using drugs. 6 That, to me, is a predominant problem that we 7 have in this community. 8 So if we're looking for where we can make a 9 change, we hold a lot of forums. We hold a lot of 10 them throughout the course of a year. 11 I see the same faces at those forums. 12 I see the same people at them; I see people 13 that are struggled -- that have struggled, and that 14 have gone through it, and that want to hear and be 15 soothed by it. 16 The parents that need to come don't come, 17 because the parents that need to come think they 18 don't have a problem. 19 And until we get ahead of this, and until we 20 change that mindset, we're not going to get ahead of 21 this problem. We will never have enough beds if we 22 don't change that. 23 So I think that what we -- and I don't know 24 what the answer is, I'm proposing the issue, but 25 I think that we need to let the common citizen in 1 this community know that it's not somebody else. 2 It's them. 3 I go through it with my own family. My 4 brother has a graduate from college, who went to the 5 West Coast to go into the music industry. And 6 I said to him, Be careful. Be careful about Tony, 7 because he's at the age, and he's going out to the 8 West Coast, and he's not going to -- and my brother 9 says, You don't have to worry about Tony. Tony's a 10 good kid. 11 That's the problem. 12 That's the problem. 13 So, I don't know what the answer is, but 14 I propose that issue. And, I think that a cultural 15 change is in order. I think that if we can't change 16 the culture among our young people, we may never get 17 ahead of the problem, because I don't know that we 18 can put everybody in a recovery program. 19 I think we need to get people to not think 20 it's cool to take drugs. Or not think it's -- as 21 Dr. Kolodny points out, not -- it's not low-risk. 22 That it is a game-changer when you take an opiate. 23 And I think -- I don't know how to get that 24 word out, but I think we need public-service 25 announcements. I think we need cultural education. 1 I think we need to get to kids at an early age, to 2 let them know that this is not something that they 3 should be fooling around with. And they don't need 4 to hear it from adults. They need to hear from it 5 kids. They need to hear from it peers. 6 We have had the occasion to speak to -- in 7 workshops, and the kids told us, flat out, that we 8 didn't have any credibility with them. And they 9 were being very honest, and I appreciated it. 10 But we don't have credibility with the kids. 11 They need to hear it from their peers. 12 So, a couple more -- other points before 13 I hand it over. 14 There is a good program at the state level 15 called "Combat Heroin." The Governor has a good 16 program. I commend him for addressing it. 17 There is legislation that's being voted on. 18 There is some that's been pass recently. 19 I know April 1st, there were some changes relative 20 to parity, and the way the insurance companies were 21 required to deal with the issue. 22 My point is that, the average person, like 23 me, doesn't know what's going on at the legislative 24 level. And I think we need to know what our rights 25 are, what's changing? Okay? What has been voted 1 on? What's in front of the floor? What didn't 2 pass? 3 We need a central point to go to so we know 4 what's going on. We don't -- the average person 5 doesn't know what's going on, legislatively, about 6 this problem. We hear a lot of good press about it, 7 and it's all well-intentioned. 8 But I want to know, when I call the insurance 9 company, have the laws changed? 10 I heard that they have, but I don't know. 11 So we need, I think, a central point of 12 information about what's going on in that regard. 13 Other than that, gentlemen, thank you again. 14 That concludes the testimony I wanted to give 15 to you. 16 Thank you. 17 [Applause.] 18 FRANK REALE: Thank you so much, 19 Senator Murphy, and to your staff, for putting 20 together this very engaging and informative forum. 21 This is excellent. 22 And, certainly, Senator Martins, for your 23 travel from another country. Nassau, is that -- was 24 that where you're from? 25 [Laughter] 1 FRANK REALE: Excellent. 2 I have to tell you, I've been in education 3 for 44 years. And for 21 years, I have been with 4 the Peers Partnership, and we have young people who 5 work all year long, putting together PSAs and 6 films, and we've done things on drug use in the past 7 and alcohol and texting and driving and domestic and 8 dating violence and bullying. 9 But I have to tell you, in 2013, we had a 10 local youth die of a heroin overdose. And that same 11 summer, Cory Monteith passed away, and then you had 12 Philip Seymour Hoffman. And that those deaths seem 13 to bring a sharp focus, particularly to our kids, 14 about the issue of opiate abuse and addiction. 15 So we decided to do a film, and we 16 interviewed a father whose son passed away in 2013. 17 We traveled to Baltimore and we interviewed 10 young 18 addicts in recovery, and Dr. Marc Fishman. I'll 19 tell, almost as good as Dr. Kolodny. 20 But -- and I want his autograph, because he's 21 great. 22 But we interviewed 10 young addicts. And our 23 young crew, camera crew, of high school students, 24 they came away with something that will affect them 25 for the rest of their lives. 1 And what they wanted to do, is they wanted to 2 make every effort that they could to make sure that 3 no parent will ever have to bury their child. And 4 no 17-year-old will ever have to bury a friend. 5 Now, Dr. Kolodny mentioned that, in the 6 United States, we use 99 percent of Oxycontin, and 7 something like 80 percent of the opiate supply. 8 Well, we use -- I think, Senator Murphy, you 9 pointed out to me, that we use about 30 percent of 10 that in New York. 30 percent of the heroin 11 production in this entire world is used in the 12 Empire State. 13 Now, we've heard great efforts that -- of 14 interdiction, and we've seen the great strides that 15 are being made in treatment, but we all know that 16 that's not enough. 17 We also have to make every effort we can to 18 educate our youth, to encourage them to find a joy 19 and pleasures of life, not in a pill, a bottle, or 20 syringe, but from living a drug-free life. 21 We must educate our schools, administrators 22 and teachers, because they need to know that a dead 23 child will never pass a math test. 24 We need to educate our parents so that they 25 understand what this addiction is. 1 We need to educate our communities, and 2 everybody, to make sure that the stigma of this 3 disease is forever removed. 4 Thank you. 5 [Applause.] 6 SENATOR MURPHY: Frank -- 7 FRANK REALE: Yes, sir. 8 SENATOR MURPHY: -- like I said, I had the 9 privilege of being over at St. Christopher's, and 10 we'll get to Mary Ann, I think, next. But, really, 11 the peers talking to the kids over there, that I've 12 talked to, the peers versus -- peer-to-peer, that 13 was unbelievably crucial for them. 14 FRANK REALE: Yes. Yes, it is. 15 SENATOR MURPHY: It's really, really crucial 16 for them to know that there's not a badge sitting in 17 front of them, and it was someone who feels their 18 pain, someone who's been on the streets, someone 19 who's been down in the dumps, someone who they can 20 relate with. 21 FRANK REALE: Yes. 22 SENATOR MURPHY: That was -- that was what 23 I took out of there. 24 The other thing that I took out of there, 25 they're finding love with themselves again over at 1 St. Christopher's. It was unbelievable. It was, 2 the kids were in the choir, they were rushing to get 3 there. It was -- they're finding themselves to be, 4 you know, I'm here, I'm back, and I'm not down in 5 the dumps. 6 And it was quite invigorating to see, you 7 know, a transformation of a kid, to sit there and 8 tell you, "I love myself, I love myself again," when 9 they were down in the dumps, they were ready to kill 10 themselves. 11 So it was interesting what you do, the 12 peers-to-peers, is -- the other forums that I've 13 done, that has come up in every forum. 14 FRANK REALE: We did an interview in 15 Syracuse, as a matter of fact, back in the year 16 2000, where we interviewed a 16-year-old, and he 17 said something very along the lines of what you just 18 said. 19 You get a lot of wisdom in a 16-year-old too. 20 And he said, "Find purpose and meaning in 21 your life, and everything's going to just play out 22 okay." 23 SENATOR MURPHY: Yeah, yeah, yeah. 24 And, Steve, to your point, you know, the 25 stigma, the stigma's got to go away. And that's 1 what -- if we shed the light on it, I believe it can 2 go away. You'd be surprise what your neighbor's 3 doing. You know what I'm saying? 4 It's like I said in the beginning, it has no 5 boundary, it has no race, it has no ethnicity. It's 6 everywhere. And it's going to take you, grab you, 7 and it's going to hold on to you. And unless you 8 can shake it off, you're a pretty strong person, 9 without help. 10 STEVE SALOMONE: I agree. 11 You know, I think the insidious part about 12 this is that it's hitting the well-to-do family-- 13 the good families. And I think that's where it's so 14 much of a surprise, is that, you know, it's not 15 expected, and, in a sense, it blindsides you. 16 And it blindsides a lot of these parents. 17 SENATOR MURPHY: Well, I will continue to 18 work, obviously, with both of yous, but I know we've 19 been working very close together. 20 And thank you and the Mrs. for all of the 21 things you do for our community. 22 STEVE SALOMONE: You're welcome. 23 SENATOR MARTINS: Thank you, both. 24 [Applause.] 25 1 SENATOR MURPHY: Patricia (sic) Wallace-Moore 2 from Arms Acres. 3 PATRICE WALLACE-MOORE: Good evening. 4 And, I know that a lot of people have already 5 gone, and people want to go home, so I will do the 6 best I can to shorten my thing, but talk about it as 7 much as possible. 8 SENATOR MURPHY: No, we're here. 9 PATRICE WALLACE-MOORE: My name is 10 Patrice Wallace Moore, and I am the chief executive 11 officer of Arms Acres, Incorporated, in Carmel, 12 New York, and, vice president of substance abuse 13 services for Liberty Behavioral and Management, 14 which also includes a 225-bed program in 15 Upstate New York. 16 We have, total, 162 beds in Carmel, 225 in 17 Schenectady County, which is a total 18 387 OASAS-licensed beds. 62 of them are detox, 19 48 adolescents, and 277 are adult rehabilitation 20 between the two inpatient facilities. 21 And from Rochester, all the way down to 22 Queens, we are -- we have eight -- a total of eight 23 outpatient programs. 24 So when dealing with the disease of the 25 opioid epidemic, we have been fighting this for 1 quite some time. 2 Our -- I want to, first of all, thank 3 Senator Murphy, Senator Ortt, Senator Amedore, and 4 Senator Martins for all being a part of this. 5 I think it's very important that we address 6 it. 7 Years ago, after the Columbine shooting, 8 I believe it was President Clinton that said it was 9 a wake-up call for everybody in the community about 10 violence. 11 And I remember watching that and said, Well, 12 I've always been awake. I don't know where the rest 13 of you have been sleeping. 14 That's the same way I feel about this. The 15 heroin and opioid addiction has been something that 16 we have been dealing with for many years. We've 17 been awake. Everybody else is now waking up. 18 And, we're glad that they've been awakened, 19 but, it's unfortunate how the awakening has 20 happened, and it has happened as a result of the 21 death of many young people. 22 When I think about Steve Salomone and his 23 wife, and all of the things that they've done, I've 24 said often that they have taken -- I give them great 25 credit, because they've taken their pain and turned 1 it into a campaign. And I think that they could 2 have wallowed in their anger, and have done a lot of 3 different things. But they caused a lot of people 4 to move, and mobilization will result in change. 5 And I think that is something that is 6 definitely necessary. 7 We, unfortunately, live in a time where we've 8 become more reactive than we have been proactive. 9 We wait for people to die, we wait for many people 10 to die, before change occurs. 11 But we have been, with the prevention and 12 treatment programs, seeing the writings -- we've 13 seen the writings on the wall for many years. 14 We've been fighting this battle, to try to convince 15 managed-care companies and other insurers the 16 importance of providing treatment for those who have 17 been dealing with these addictions, again, for many 18 years. 19 We have found ourselves in the inpatient 20 treatment-provider community, having to scholarship 21 many people because the managed-care companies have 22 denied their ability to receive treatment. 23 Access to care is absolutely necessary, and 24 required, in order for you to contain anything, as 25 Dr. Kolodny has said. 1 I have found that we've spent -- in the last 2 year or so, we've spoken about Ebola so much. It 3 was on television, it was on the news. Four people 4 died in the United States. And it was everywhere 5 you turned on the news, you saw that. 6 But, you didn't see the same impact when it 7 came down to heroin addiction. 8 I was very grateful to see the Governor bring 9 the Combat Heroin campaign. I was a part of that; 10 I was part of the process with his task force, and 11 discussing that. And it was great to see it happen. 12 But, again, it was a campaign off of other 13 people's pain. 14 One of the things that concerns me is that, 15 when we first started fighting this battle, one of 16 the things that managed-care companies would say to 17 us is that, a person, in order to go into an 18 inpatient treatment, had to be in danger of their 19 withdrawal. They had to be in danger of dying. 20 That there was no medical necessity needed for a 21 person to be in an inpatient setting. 22 Well, what they failed to realize is that, 23 maybe it wasn't about whether a person was going to 24 die from withdrawal, but die in spite of the 25 withdrawal. 1 We had people who were trying to prevent 2 withdrawal, because once they begin to withdraw from 3 heroin, the pain begins to raise its head. And to 4 prevent the pain, you use more, and people were 5 accidentally overdosing. 6 It became a battle that we had to fight on an 7 ongoing basis. 8 Yes, we are a detox program. 9 Yes, we are a short-term rehabilitation 10 program. 11 But out there in the world of treatment, you 12 are finding programs that were almost in silos; you 13 had long-term, short-term. 14 I think one of the incentives, or shall 15 I say, one of the directions we need to take, is 16 trying to find a way to encourage providers to work 17 together, and maybe not necessarily a continuum of 18 care, but a circular type of care, where treatment 19 is accessible on any level, and that prevention and 20 treatment and short-term and residential become part 21 of a group of people that are not competing for 22 care, but are coordinating care. 23 I think that is a direction that we need to 24 take. 25 One of the things that we recognize at 1 Arms Acres was, all of a sudden, in about -- about 2 two or three years ago, we started recognizing that 3 adolescents were in need of detox, because of the 4 opiate addiction. 5 And when we -- when I sought to try to 6 receive maybe a license that was detox-specific for 7 adolescents, there isn't one. 8 So what you find is, that when kids need 9 detox, they have to be detoxed with adults. 10 At some point we've got to recognize that 11 this is hitting our young people, and maybe we need 12 to figure out a way to have a detox program specific 13 to adolescents. 14 Just a thought, but it's something that seems 15 to be raising its ugly head as of late. 16 We need to figure out how to maintain 17 accessibility on all levels of care, including 18 outpatient, intensive outpatient, 19 medication-assisted treatment, detox, 20 rehabilitation, and residential services. 21 I am grateful of the new language that's 22 coming out with the regulations, as far as 23 residential treatment. 24 I am part of the Behavioral Services Advisory 25 Council. I chair the regulation committee for the 1 State of New York, for OMH and OASAS. I'm very 2 familiar with the changes in legislation and law and 3 regulations that's coming out. So I'm active and 4 being involved in that. 5 So, I'm looking forward to seeing some of the 6 changes that are coming forth. 7 We are -- we are, at Arms Acres, an 8 opioid-overdose-prevention training site, so we do 9 have Narcan on site. We are excited to be able to 10 provide that for individuals in the community. 11 I was excited to hear about it being provided 12 in the schools. 13 But there are other communities-based 14 organizations that need it. Boys and Girls Clubs, 15 things like that, people that -- wherever there are 16 kids and young people at risk, we need to make sure 17 that there's resources provided so that it is in the 18 community and available to those sites and services. 19 Last, but not least, we've got to make sure 20 that when we're looking for treatment being provided 21 in -- or care through insurance companies, if you 22 begin to look at the Massachusetts and the 23 Pennsylvania laws, they allowed medical providers to 24 determine the care that people get, as opposed to 25 the managed-care company determining the care that 1 people get. 2 If a medical provider thinks that a person 3 needs 14, 28, 30, or 6 months of care, that medical 4 provider should be able to determine that, because 5 they're seeing the needs of that individual. 6 So those would be the main things. 7 And, also, prevention is necessary throughout 8 the entire treatment process. 9 I think sometimes we look at prevention as if 10 it's a separate entity. But prevention is also 11 ongoing. It's an ongoing service that is needed, 12 and resources need to be provided for both treatment 13 and prevention. 14 And, again, as I said, if you can figure out 15 a way that would encourage all of the services to 16 work together, we would be able to contain this 17 disease. 18 [Applause.] 19 SENATOR MURPHY: Thank you. 20 We also have Marianne from 21 St. Christopher's Inn. 22 Good to see you again, Marianne. 23 MARIANNE TAYLOR-RHOADES: Yes, it's good to 24 see you. 25 And I'd like to thank you for giving me the 1 opportunity to represent treatment providers, and, 2 I'm very happy to be here, I'm honored to be here. 3 And I'm actually very glad to meet 4 Senator Martins, and I'm glad you're here, because 5 as we said earlier, St. Christopher's Inn does have 6 190 beds. 7 The unfortunate thing is, that only 3 percent 8 of those beds are used from -- by Putnam County, 9 14 percent by Westchester County, but 20 percent 10 from Nassau and Suffolk. 11 We know of your problem, and we know how 12 great it is. 13 So, I'm glad to see the two of you together, 14 Hudson Valley working with Long Island. 15 First, I'd like to start by saying, we are 16 very grateful for the efforts to save lives through 17 the training and use of Narcan, and we believe that 18 it is an important first step. 19 However, we feel that the second step is 20 truly lacking, and that is, once a person receives 21 Narcan, if they are fortunate to have their life 22 saved, what happens next? 23 Where is the intervention? 24 Where is the treatment? 25 People who have been saved by the use of 1 Narcan, many of them have had Narcan administered to 2 them several times, sometimes twice in the same day. 3 What happens? 4 There's no requirement, once Narcan is used, 5 for the person to receive an intervention or to go 6 into treatment. 7 Secondly, intervention is not even recognized 8 by New York State OASAS, or by any of the insurance 9 companies, or Medicaid, as a reimbursable treatment 10 option. 11 Intervention is actually the gateway to save 12 lives. It's the act of getting someone into 13 treatment and having ongoing treatment. 14 When a person receives Narcan, if they come 15 out of it, if they are lucky enough to survive, what 16 happens next? 17 Do we just walk away? 18 Would we do this in an emergency room? 19 I mean, these are some of the things that we 20 have to start thinking about. 21 I'd like to present some points from the 22 providers' perspective, but, I hope by the end of 23 this conversation, I'll also be able to give you 24 some solutions. 25 And I hope that by being here tonight and 1 providing these solutions, that it will go further 2 throughout our government, and we will have -- we 3 will actually see the solutions. 4 There's not a week that goes by when we don't 5 hear -- I live right here in Yorktown, and there is 6 not a week that doesn't go by that I don't hear of a 7 death of someone in my community or a surrounding 8 community. 9 Parents are watching their children die, and 10 they don't know where to turn for help. 11 As a provider, I can see what it's like for 12 parents and families to navigate the insurance 13 system. It's difficult, and it's a different 14 experience for all of us. 15 If the providers have such difficulty in 16 negotiating with insurance companies, you can 17 imagine what the families and the parents are going 18 through. 19 Coverage is often denied for heroin 20 detoxification. 21 Inpatient rehab-treatment stays are capped at 22 21 or 28 days, and that's for Medicaid. It's 23 actually worse for people with private insurance, 24 who may get approved for three to five days in the 25 hospital. 1 This is tantamount to treating cancer with a 2 flu shot. 3 We are wasting our money. 4 When treatment is not long enough to provide 5 a strong foundation, recidivism rates increase. 6 Outpatient treatment is authorized for short 7 lengths of stay, such as 14 days, or, authorized 8 piecemeal, three days at a time. 9 The providers, like Arms Acres and myself and 10 many others, we're dealing with increased 11 competition for financial resources. We can't stay 12 alive. In a time when the worst epidemic we're 13 facing, programs like ours are closing. We do not 14 have the finances. 15 Some programs, the Medicaid rate has dropped 16 by 13 percent in the last 6 years. We have to fight 17 for every penny of reimbursement, and this takes 18 infrastructure. We need more people to help us get 19 the reimbursement, to send out a bill, so we can 20 stay alive. We have to hire more people who are not 21 treating clients, but are getting reimbursement to 22 keep us open. 23 As I said, there are more programs closing 24 when we are needed the most. 25 There are so many changes in health care 1 taking place in 2016, going from fee-for-service 2 Medicaid to managed-care Medicaid. Providers like 3 us are scrambling to negotiate with new insurance 4 companies and get our message across. 5 We are unsure, our future is uncertain. Many 6 of the programs are ending up with deficit budgets. 7 St. Christopher's Inn has been in existence 8 for over a century. We've been successful at 9 treating homelessness and addiction; and, yet, last 10 year, for 2014, we had a deficit budget, first time, 11 ever. And we are facing one in 2015. There is no 12 funding available. 13 What are the solutions, and what can we do? 14 There are many, many problems. And the 15 excellent witnesses who spoke here tonight named so 16 many of them, from law enforcement, to the medical 17 field, to grassroot organizations. 18 What can we do? 19 Okay. First, let's talk about interventions. 20 They play a powerful role in getting the 21 addict into treatment, as well as educating family 22 members. 23 Can we look at the act of interventions, can 24 we look at them professionally? 25 Can we possibly recognize them as treatment? 1 An intervention is so powerful when a family 2 doesn't know what to do and they're dealing with a 3 child who is addicted to heroin. 4 Looking at interventions as a true level of 5 care and treatment will help to remove some of the 6 barriers. 7 The next is so important to us, especially in 8 behavioral health care. 9 Please enforce parity, and put in place 10 regulations regarding reimbursement rates and length 11 of stay for those of us who provide 12 chemical-dependency treatment. 13 Please, I am begging you, bring all the 14 stakeholders together, including state agencies, 15 insurance companies, treatment providers, and 16 grassroot organizations. 17 We need to work together to establish 18 treatment standards for the purpose of determining 19 appropriate standards and benchmarks for admissions 20 to inpatient and outpatient treatment. 21 We need to agree on appropriate lengths of 22 stay and reimbursement rates. We need to keep our 23 treatment providers working and the treatment 24 programs open. 25 While meetings have taken place through the 1 Governor's Combat Heroin initiative, little has been 2 done to address these issues. We still are waiting 3 to hear about more regulations. 4 As a provider, I can tell you that, insurance 5 companies, we don't receive the same rate for a 6 specific service from each insurance company. 7 And how could this be? 8 Where is the regulation? 9 So we can't guarantee we're going to get this 10 to provide that. 11 And all of this is, today's world, in terms 12 of addiction, has become so complicated, as you've 13 heard throughout the night. More than 58 percent of 14 our admissions are also dual-diagnosed. 40 percent 15 of our admissions are coming straight from jail 16 programs. 17 We need skilled professionals to be able to 18 deal with these populations. Skilled professionals 19 do not come cheap. They are licensed professionals: 20 Social workers. Nurses. Doctors. Nurse 21 practitioners. CASACs. 22 How do we pay for them? 23 How can we attract a workforce and be able to 24 treat these clients? 25 Please look at funding for crisis respite 1 centers for addiction. 2 This is an excellent resource when immediate 3 assistance is needed. It's cost-effective. A 4 peer-run respite center is very cost-effective. 5 It's a safe haven, out of the house and off the 6 street, until the person can get into treatment, and 7 sometimes it even prevents the person from going to 8 the next level of care. 9 Sitting in jail does not cure addiction. 10 Even though the addict may have already gone through 11 withdrawal, more often than not, when that person 12 returns to the community, they are -- the first 13 thing they're going to do is seek their drug of 14 choice. 15 We are looking to work, and Judge Reitz and 16 I have had many conversations about this, to put in 17 jail-based programs. Jail-based treatment programs. 18 There is a program like that in 19 Westchester County called "Solutions," and it saves 20 taxpayers hundreds of thousands of dollars a year, 21 and it also reduces the recidivism rate of people 22 going back into the jail system. 23 A one-year study found that the Solutions 24 program graduates were 67 percent less likely to 25 return to the Westchester County Jail. 1 This is also a cost-effective method. Start 2 the treatment before the person even gets out of 3 jail. 4 Look at requiring intervention or treatment 5 for the person who has been revived by Narcan. 6 There may not be another chance to save that life. 7 I thank you very much for being able to be 8 here tonight, and I hope that we can reach some of 9 the targets and goals that have been discussed in 10 this room. 11 Thank you. 12 [Applause.] 13 MARIANNE TAYLOR-RHOADES: And, 14 Senator Murphy, thank you very much for coming to 15 St. Christopher's Inn. 16 SENATOR MURPHY: I was just going to say -- 17 I was going to say, you know, it was really an 18 eye-opener for me when I came for my visit. And you 19 were so gracious to show me around the whole 20 facility. 21 And it was unbelievable to see, how many 22 guys? 200 guys, was it? 23 MARIANNE TAYLOR-RHOADES: About, 24 approximately. 25 SENATOR MURPHY: 200 guys were sitting there, 1 on a straight line, not a word, breakfast, lunch, 2 and dinner you serve them, every day? 3 MARIANNE TAYLOR-RHOADES: Every day. 4 SENATOR MURPHY: Incredible. Absolutely 5 incredible. 6 We did talk about the reimbursement. We did 7 talk about, you know, there should be some sort of 8 form or mechanism, when someone does have a Narcan 9 save, for that person to go back home to their 10 mother who's -- they might be 19, go back inside the 11 house, to know that that 19-year-old had an overdose 12 this morning. 13 There's got to be some sort of -- we're 14 missing out something, I believe, right there, where 15 there's some -- there's got to be a bell that rang 16 off, that this person had an overdose, goes home, 17 and the mother and father, who she's living in their 18 house, didn't even know. 19 I don't know how we do that. 20 There's HIPPA violations, and things like 21 that, but that's something I most certainly will 22 look into. 23 And, Patricia (sic), one quick question. 24 Any beds tonight? 25 PATRICE WALLACE-MOORE: Very few, to be 1 honest with you. 2 We increased our beds from 129, to 162. 3 We're probably going to need more as a result of 4 some of the things that have gone, but we do have a 5 few beds tonight. 6 SENATOR MURPHY: Yeah, I know you guys are 7 always full. 8 PATRICE WALLACE-MOORE: Yeah, yeah. 9 But you're welcome to come visit us as well. 10 SENATOR MURPHY: Absolutely. You know I will 11 be there. 12 PATRICE WALLACE-MOORE: I am looking forward 13 to that. 14 SENATOR MURPHY: I have been making my rounds 15 as quick as I can. 16 Senator Martins. 17 SENATOR MARTINS: At St. Christopher's, which 18 state agency do you rely on for funding, or for 19 partial funding? 20 Does it come from any one of our state 21 agencies? 22 Is it primarily insurance and 23 private insurer-based? 24 MARIANNE TAYLOR-RHOADES: It's primarily -- 25 our reimbursement comes primarily from Medicaid. We 1 are not a net-deficit-funded agency. 2 St. Christopher's Inn is a very unique model. 3 The 190 beds are shelter beds. And what 4 makes it so unique is that it's cost-effective 5 because the men are really in outpatient treatment, 6 but they're living at the inn in a supportive 7 sheltered environment. 8 We recently reactivated our 9 medically-supervised outpatient withdrawal program, 10 which means we are providing that service as well. 11 And, in 2013, we opened up our 12 first transitional housing, 11 beds, in 13 Westchester County, in White Plains. 14 SENATOR MARTINS: I appreciate that. 15 Certainly, your suggestion with regard to 16 Narcan interventions is well made. 17 Thankfully, there are things we should be 18 looking at, and not simply ignoring the fact that 19 there's a reason that Narcan was administered, and 20 that child, or that adult, will return to those same 21 circumstances. It's a cry for help. 22 And, you know, shame on us for not having 23 responded appropriately. 24 So I appreciate the fact that you highlighted 25 that, and certainly gives us food for thought. 1 I will say that, you know, through 2 discussions like this, through hearings like this, 3 we did pass some good legislation last year. 4 PATRICE WALLACE-MOORE: Yes, you did. 5 SENATOR MARTINS: And we still have more to 6 do, and I recognize that. 7 You know, very few people understand and 8 realize that, until we passed the law last year, 9 kids who were in treatment programs could sign 10 themselves out. Unless they were there pursuant to 11 a Court order, they could simply sign themselves 12 out, even if they were minors, without their 13 parents' consent. 14 No longer. 15 Many people may not remember, because it was 16 over a year ago, but most, if not all, of our 17 private insurers required failure at outpatient 18 before allowing people to go inpatient, which was 19 absurd. 20 And we were able to pass laws to deal with 21 that as well. 22 And now we have the luxury of being able to 23 take the next step and actually determine, how long 24 is appropriate? 25 But first we had to deal with the basic issue 1 of requiring failure, before. 2 I mean, let's think about that for a second. 3 We have people who have had a lucid moment 4 and decided they need help. And our insurers would 5 require them to fail as a condition of sending them 6 for inpatient treatment, which was, again, absurd. 7 So we have taken strides as a state, and 8 positive strides, through these efforts, and through 9 these discussions. 10 And I dare say that, through testimony such 11 as yours, I do believe that we will have even more 12 to do as we go forward to address these issues, 13 because we are not done. 14 PATRICE WALLACE-MOORE: Can I add, that the 15 one thing that law also did, which was very good for 16 providers, was there were times that we would get 17 denied care. 18 And in the denial of that care, the 19 managed-care company could often take three days 20 before they would let us know on the appeal. 21 And if they denied the appeal, the provider 22 would be caught out there for three days with no 23 coverage for that individual or that family. 24 The law now says, that while the appeal 25 process is going on, the managed-care company has to 1 cover that care. 2 Now, what has happened as a result, the 3 managed-care company has now quickly figured out a 4 way to say no. They just say "no" faster. But we 5 still have the ability for an external appeal, which 6 is -- again, is part of that law, and has been very 7 instrumental. 8 And it also lets us know that, during an 9 appeal process, the person who we are appealing with 10 must also be a behavioral provider -- behavioral 11 health-care provider, so they do understand the 12 language, so we're talking the same language. 13 The newer language also out there is going to 14 help us a little bit more with the 15 locator threes (ph.), and different things that are 16 happening. 17 So there is movement in the positive 18 direction. We are grateful for that, we are 19 thankful for that. 20 There's a proverb that says: The best time 21 to influence a child is 100 years before it was 22 born. 23 So maybe 100 years ago we would have been 24 better if we had fixed this. 25 But, hopefully, 100 years from now, we'll be 1 in a much better place than we are today because of 2 the efforts and work that each of you has done, and 3 our Legislature has done. 4 SENATOR MARTINS: I appreciate that. 5 The best time to start on any journey is 6 right now. 7 PATRICE WALLACE-MOORE: Right now. 8 SENATOR MARTINS: And so I agree with you. 9 I thank you for your testimony. 10 I again want to compliment, you know, 11 Senator Murphy, for his leadership and his 12 initiative in pursuing this. 13 This is the first hearing. 14 We will be holding hearings throughout the 15 state, from various stakeholders, from various 16 communities, from urban centers and rural 17 communities throughout the state, to suburban 18 communities very much like this one here. 19 And so the opportunity exists, as we go 20 forward, to take those suggestions, like those that 21 we received today, and to put together a package 22 that will take that next step. And it's all 23 positive. 24 So, again, thank you very much. 25 And, Chairman, congratulations. Thank you. 1 SENATOR MURPHY: Thank you. 2 [Applause.] 3 SENATOR MURPHY: Anthony. 4 How are you? 5 ANTHONY EACK: How you guys doing? 6 SENATOR MARTINS: All right. 7 Senators, thank you for hearing me. 8 I believe I was asked to speak here tonight 9 because I'm known as the guy in the trenches. 10 I wear several hats. 11 I live in Dutchess County. 12 One of my hats is, I'm a person in long-term 13 recovery. 14 The other hat is, I volunteer with the 15 Council on Addiction Prevention and Education. 16 I became, a couple years ago, maybe three 17 years ago, a keynote speaker. 18 And I was asked at John Jay High School, as a 19 keynote speaker, I would come out and say, This is 20 who I am. 21 And, when it came the stigma issue, I said, 22 Absolutely. I wear it on my soul. I wear it on my 23 sleeve. 24 You know, I let people know that, right off 25 the bat. 1 I let them know that I run a 2 2-million-square-foot building in Manhattan, a 3 skyscraper. 4 And, yes, I had that problem. 5 I still do. 6 As a person in recovery, there is no 7 graduation for me, I'll tell you right now. I live 8 on a day-to-day basis, and I'm okay with that. 9 You know, being in trenches, and being part 10 of a 12-step group, I -- AA is what saved my life. 11 It doesn't work for everybody. But that's what 12 works for me, so I continue to use that. 13 And what I've noticed, what brought me to 14 this plight, was the fact that the kids were getting 15 younger and younger. 16 When I first started coming around, they were 17 coming in at 40 years old, on an average. 18 About 6 or 7 years ago they were coming in at 19 14 years old. From 14 to 25, and it was 20 heartbreaking. 21 And I says, What are we doing wrong? 22 You know and that made me start to look, to 23 get in the volunteering, and try to get out some of 24 that knowledge I did. 25 One of the things I found, and being in the 1 trenches, I call it "trenches," because in -- 2 knee-deep in this epidemic that we're in, I deal 3 with nothing but kids. You know, and when I say 4 "kids," anything from the age of 16 to 25 years old. 5 All right? 6 I'm inside their minds every day. 7 Right now I have about 35-some-odd kids 8 I mentor. Not sponsor, but, I help them get sober, 9 stay sober, and I help them find their way. 10 One of the things I do, which is very 11 important, is -- which we have to address, big time, 12 is to change their thinking, and that's -- when you 13 go away for treatment. 14 You know, if you're going to go away for 15 treatment and -- you know, which, by the way, since 16 we're on that topic, real quick, I believe, in my 17 personal opinion, nothing less than six months in 18 treatment, you go away. 19 And if they can change their thinking, you 20 know, they can change their life. Because once you 21 remove any opiate, any form of addiction, you're 22 left with a big hole in your chest. You have to 23 fill it somehow. 24 But if they change their thinking, if you're 25 thinking changes, you have a shot. 1 That means that, when you get out, what's 2 waiting for them when they get out? 3 Are they going to go back to the same 4 friends, people, places, and things? 5 Because if they are, they're going to go 6 right back to where they started from. 7 Every kid that went away, before they went 8 away, chances are, he has a stash somewhere in his 9 house that mom didn't find yet. 10 The kids are smart. 11 I get all the intel, all from kids and their 12 parents. And this intel, it's mind-boggling. 13 It's mind-boggling when they say to me, 14 I hide my dope in my mother's bedroom, because she 15 don't look there. 16 It's that simple. 17 These kids are scientists today. 18 They come out with new pills. You can't 19 crush them, you can't do this. 20 But there are kids that can say, Yeah, well, 21 I put it in a little -- a little cap of water, add a 22 little hydrogen peroxide, 35 minutes later it 23 dissolves, it's ready to be used. 24 So they have a way around everything. These 25 kids are scientists today. 1 You know, I have no problem, I have no 2 problem, dealing with the hopeless, because at one 3 point in my life I was hopeless. And I will work 4 with them till my dying day. 5 But I do struggle with working with the -- of 6 working with the clueless. And when I talk about 7 "the clueless," that means a lot of parents. 8 I believe in prevention, wholeheartedly, at a 9 very, very, very early age. I don't care if it's 10 kindergarten, you start them young. 11 When you teach your kid not to talk to 12 strangers at the school bus stop, you teach your kid 13 about drugs. 14 If you're not a pharmacist and you don't know 15 how, take them to a video on YouTube!. Show them 16 pictures of before and after of a kid on heroin, and 17 let them visually see this. You're not going to 18 shock your kid. Kids are strong today. They have 19 access to every kind of phone and computer, they can 20 do all this. 21 But, I believe that the biggest thing right 22 now is prevention. 23 I mean, law enforcement's doing their part, 24 they're doing an amazing job, man. You read about 25 it in the "Poughkeepsie Journal" every day up in 1 Dutchess. 2 They are doing an amazing job, but they need 3 help. All right? 4 As they're doing their job, coming in from 5 this end, the prevention has to come in from this 6 end. 7 What's in the middle? Treatment and 8 recovery. Long-term treatment. 9 We change their thinking, we save their 10 lives. Then the recovery process begins. 11 I work with all these kids in recovery. 12 I help build up their self-esteem. I give them 13 hope. I help remove that shame, that blame. And on 14 top of everything else, I work on the stigma. 15 I have a different language. I have a 16 different name. I go by under -- my nickname is 17 "Tony Gatz." 18 I started a campaign last summer with this 19 mobile unit. I went from every town to town in 20 Dutchess County every, shopping center, with a 21 "heroin awareness" sign, and a table like this with 22 information. 23 Because, when I spoke at several high 24 schools, I probably spoke at about nine high schools 25 CAPE, and when you see 700 seats, and only 1 75 parents there, it's heartbreaking. 2 So I said, I got to do more. So I said, let 3 me go in front of CVS in Hopewell Junction. Now 4 when they walk out that door, they have no choice 5 but to see me. And they do come over. 6 You know, doctors. I talk to my own personal 7 doctor. 8 Give you a bit of information, real quick, 9 on -- here. What is "Lomotil?" 10 Here's something parents don't know, and this 11 you get from being in the trenches. 12 Anti-diarrhea, Imodiums, has a chemical in it 13 that's pretty much Demerol. 14 So I got a mother who calls me and says, 15 Listen, I just found 100 boxes, 100 packs, you know. 16 I know what it is, but I try not to spread 17 that information so other kids don't use it. 18 They know. 19 So the parents don't know. They're not 20 educated. 21 I got parents send me pictures of these 22 little orange caps. "I keep finding these 23 everywhere." 24 They don't find the kid's needles or the 25 works, but the orange caps. 1 These are the little caps that go on the 2 needles. 3 You know, these parents don't know about 4 this. 5 These parents should know, the minute that 6 kids hits kindergarten, these parents should have a 7 pamphlet, hand it out to them in school and say, 8 Let's get busy. 9 That, to me, personally, should be mandatory. 10 You're not scaring anybody. They need to know right 11 away what they're in for. 12 You tell your kid, Don't talk to strangers. 13 If someone has a van and little puppy, don't -- run 14 and scream. 15 Why don't we tell our kids about these 16 things? 17 Why don't we tell them about the heroin? 18 The alcohol, the cigarettes, the tobacco, the 19 marijuana, these are all gateway things. 20 Every kid I dealt with so far, and it's 21 several hundred at this point, started out with 22 marijuana and alcohol. That's a fact. Every last 23 one of them, common denominator. And that's coming 24 from their mouths. 25 Some of the information I get, the other part 1 of my role -- and, mind you, I only have two hours a 2 day to do this, and weekends, because I work 3 14 hours a day -- is, last week, I met with certain 4 law enforcement -- local law enforcement in 5 Dutchess County, and I gave up the names, addresses, 6 license plates, and phone numbers of at least 7 35 drug dealers, because those parents don't know 8 what to do with that information. They're afraid to 9 come forward with that information because they're 10 afraid their kids might get jammed up. 11 So I said, Give to it me, I'll pass it 12 forward. 13 And I keep everybody's name out of it, and 14 I let law enforcement connect the dots. 15 Now, when I read in the 16 "Poughkeepsie Journal," because I keep a record of 17 all the numbers and all the names, I see certain 18 names and certain people getting pinched now for 19 this. 20 And whether it's part of me, or what the job 21 they're doing, because they're doing a phenomenal 22 job, I'm glad, because we got to hit this from all 23 sides. 24 So you have prevention, number one, very 25 early age. Very early age. 1 And you're not going to stop it all. 2 You know, don't forget, we live in a society, 3 a culture, that glamorizes this behavior, and then 4 we condemn the very kids who fall prey to it. 5 You know, and I'm talking kids. 6 I got a phone call from someone who was 7 53 years old, an alcoholic, asked me for help. 8 And it's sad when I have to say, It's so good 9 to talk to someone my age. 10 You know, your rehabs, and everything else, 11 from what I'm understanding, just from gathering my 12 own personal information, they're doing an amazing 13 job, but a lot of them are stuck in 1977. 14 You know, and it's not a shot at anybody. 15 That's just the way we are. 16 Alcoholics Anonymous, NA, all these groups, 17 they're still stuck behind the times. 18 You know, kids go there, whether it's 19 mandated or not, and they don't feel at home. 20 So when I go, I grab those kids. And what 21 I did was, I created an underground network of about 22 40-something kids. I got kids helping kids now. No 23 names involved. It's just kids helping kids. 24 If you got six months or better of sobriety 25 time, I'll put you with a kid who that has two 1 weeks, and I'll sit there with a supervised thing, 2 on my time, and have kids work with kids, because 3 they relate to each other. 4 You know, I'm 52 years old. I might have 5 some of the knowledge, some of the street-smarts 6 but, I'm not 19 years old. 7 I know where they're coming from. We shared 8 the same thing. It's called "pain." 9 But, when kids are able to help kids, like we 10 were talking about earlier, that's one of your 11 biggest weapons out there. 12 The Council on Addiction Prevention Education 13 has been using young people in recovery to speak at 14 their forums, and that hits home. 15 And the idea is, to give the parents the 16 ammo, because those kids will bare their heart and 17 soul, and tell the parents, This is what to look 18 for. And do not co-sign (unintelligible), because 19 we will scheme and scam you till the very end. 20 And that's the disease; that's not the kid. 21 SENATOR MURPHY: You were with me up in 22 Paulin. 23 ANTHONY EACK: Yes. 24 SENATOR MURPHY: And came right onto the 25 floor, peers versus peers. 1 ANTHONY EACK: Yes. 2 SENATOR MURPHY: You know, I mean, just 3 talking to one another. And that was the common 4 denominator, that they were comfortable talking to 5 one another. 6 ANTHONY EACK: Yes. 7 SENATOR MURPHY: And the job that you're 8 doing out there, volunteering your efforts, and the 9 things that you do, are just, honestly, incredible. 10 I mean, look at -- take -- please take a look 11 at his book. It's absolutely unbelievable what this 12 guy has done with regards to trying to educate. 13 He, literally, has a mobilized van, that he 14 goes around to the different schools, the different 15 places, to educate the parents and the kids. And, 16 he's really made a difference. 17 And I applaud your efforts, and keep up the 18 good work. 19 And, we're here to help. 20 ANTHONY EACK: I'm trying. 21 Let's change the language. 22 We used the word tonight several times, 23 "relapse." 24 That's part of some of the training I have. 25 "Relapse" is an ugly word. 1 You know, I say "slipped." I say "used 2 again." 3 The stigma behind the word "relapse" creates 4 a little bit of shame for kids to come back. 5 So when they say "I relapsed," I say, Nah, it 6 happens. You used it. 7 You know, I just changed the language across 8 the board. 9 Start a campaign, "Change That Language." 10 Because when the stigma is removed, they'll 11 raise their hands, they're not so ashamed to get 12 help. 13 I know from personal experience. 14 SENATOR MARTINS: And you'll end up with more 15 than 75 people in a 700-seat auditorium, willing to 16 have an open discussion on -- as to what they need 17 to do. 18 So for anyone who's watching, and there will 19 be people who watch this, believe it or not, on the 20 Internet, or on TV, check your own rooms. 21 Right? 22 Parents, check your own rooms. 23 There are little tidbits that we all have to 24 be attentive to. 25 But, you know, as we look at it from a policy 1 standpoint, yes, the State passed I-STOP. Wonderful 2 move, we squeezed the balloon. 3 ANTHONY EACK: Absolutely. 4 SENATOR MARTINS: We squeezed the balloon. 5 ANTHONY EACK: Absolutely. 6 SENATOR MARTINS: We put some real teeth into 7 the ability of health-care professionals to write 8 those prescription. We really put some controls 9 there. 10 But we pressed on a balloon. That balloon 11 opened up somewhere else. 12 And so we have to continuously deal with 13 these issues. That's why these forums are so 14 important. 15 And your point's well made: You educate the 16 young. 17 ANTHONY EACK: Teach them young. 18 SENATOR MARTINS: Yeah, educate the young, 19 to, hopefully, get to them before they get to this 20 point. 21 You treat, and you provide services for those 22 who are struggling with addiction right now. 23 I have no patience whatsoever for dealers. 24 None. People who are pushing this stuff, put them 25 in jail. 1 That's my opinion. 2 ANTHONY EACK: Zero tolerance. 3 SENATOR MARTINS: That's my opinion. 4 No tolerance at all. 5 If you're peddling death, you go to jail. 6 No tolerance at all. 7 But, if you're an addict, you didn't get 8 there because you want to be there. There are 9 circumstances. You need treatment. We treat those 10 people. 11 And, so, there has to be a holistic approach 12 to this. 13 And I think, again, these examples that we 14 have from people like you, and others that we've 15 heard from today, it's remarkable. 16 There is a plan that is developing. Maybe 17 it's taking longer than it should. But, societally, 18 we're taking those necessary steps. 19 And I thank you, I really do. 20 ANTHONY EACK: Can I just say one more thing, 21 real quick? 22 SENATOR MURPHY: Absolutely. 23 ANTHONY EACK: And it has to do with the 24 shot, Vivitrol. It's 30-day shot, it reduces the 25 cravings. 1 It's $1,000, or $1200, a shot. 2 SENATOR MARTINS: A shot of, what? 3 ANTHONY EACK: Vivitrol. 4 SENATOR MURPHY: Vivitrol. 5 SENATOR MARTINS: Vivitrol? 6 ANTHONY EACK: Yes. 7 A lot of insurance companies do not cover 8 this. I've got a lot of parents paying 9 out-of-pocket to help their kid when they do get 10 out. 11 Like, if I'm not mistaken, Dutchess County, 12 now, when you get out of jail for whatever it is, 13 they'll give you that 30-day shot, to buy you some 14 time of craving, till you get acclimated back into 15 society. Hopefully, it works. 16 But, it's still $1,000, or $1200, a shot, and 17 a lot of parents are paying out-of-pocket. 18 There's only two doctors I know of in 19 Dutchess County that are actually trained and 20 licensed to do this. 21 So, I do see success. 22 As much as I don't like treating a chemical 23 dependency with another chemical -- 24 SENATOR MARTINS: Suboxone? 25 ANTHONY EACK: -- Suboxone, this is a 30-day 1 Suboxone, for the most part. 2 But kids who are -- if the kids are doing 3 some sort of form of recovery, if they're working 4 some program, what it is, it doesn't matter what it 5 is, whether they're going to church, NA, AA, 6 whatever, then the Vivitrol seems to have good 7 effects. 8 SENATOR MARTINS: Thank you. 9 ANTHONY EACK: I just wanted to get that out 10 there. 11 SENATOR MURPHY: Who makes Vivitrol? 12 ANTHONY EACK: Pharmaceutical companies. 13 SENATOR MARTINS: Same pharmaceutical 14 companies -- 15 ANTHONY EACK: The devil. The devil himself. 16 [Applause.] 17 ANTHONY EACK: Thank you for your time. 18 SENATOR MURPHY: Thank you for being here, 19 and all the work you do. 20 Keep up the good work. 21 ANTHONY EACK: Thank you. 22 SENATOR MURPHY: We're here. 23 And this is why we're going on the little 24 tour through New York State. 25 ANTHONY EACK: Thank God. Thank you for 1 doing this. 2 SENATOR MURPHY: Well, listen, I thank you 3 for being here, and thank you for what you do up 4 there. 5 I met you up in Paulin. It was unbelievable. 6 And I appreciate you coming down here 7 tonight. 8 [Applause.] 9 SENATOR MURPHY: That is the extent of people 10 who will be testifying tonight. 11 But, in closing, what would I like to say is, 12 thank all the witnesses for coming here tonight. 13 [Applause.] 14 SENATOR MURPHY: I appreciate it. 15 And, honestly, I appreciate you people for 16 being here tonight, for listening. And maybe we can 17 get the message out there. 18 [Applause.] 19 SENATOR MURPHY: It's unbelievably important. 20 And, you know, maybe next time, we can have a 21 few hundred people here. 22 And we'll -- I'll be in Rochester on 23 Wednesday, and in Niagara on Thursday. 24 SENATOR MARTINS: If any of you are in the 25 neighborhood. 1 SENATOR MURPHY: Yeah. 2 [Laughter.] 3 SENATOR MURPHY: But, honestly, I would just 4 like to thank everybody for coming here tonight. 5 I would like to thank my staff for putting 6 all this on. 7 And, Senator Amedore and Senator Ortt's chief 8 of staffs, thank you for coming down here, and, the 9 guys from Albany. 10 You know, to put this all together is a team 11 effort. 12 And, most importantly, to my dear friend who 13 came all the way up from Long Island to be with me 14 tonight. And he didn't have to be here. This guy 15 did not have to be here. 16 He's got three little girls at home that he 17 could be home there with -- four? I am sorry. Four 18 little girls. 19 [Laughter.] 20 SENATOR MURPHY: But what I've learned from 21 him already up in Albany, it's already been a world 22 of information. 23 And it's an honor and privilege to sit next 24 to him up at the State Senate. 25 And, Jack, thank you so much for making an 1 effort to come up here tonight -- 2 [Applause] 3 SENATOR MURPHY: -- allowing people your 4 information, your knowledge, that have been up there 5 for a few years. 6 And, you know, this show was going on the 7 road. 8 And before -- the last thing I'll leave you 9 with is that, you're not alone. The people out 10 there, the addicts out there, you're not alone. 11 We're here, and we're here to help, and help 12 is on the way. 13 And, good night. 14 [Applause.] 15 (Whereupon, at approximately 9:47 p.m., 16 the public hearing held before the New York State 17 Joint Senate Task Force on Heroin and Opioid 18 Addiction, concluded.) 19 20 ---oOo--- 21 22 23 24 25