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 6 ---------------------------------------------------- 7

SUNY Albany 8 D'Ambra Auditorium

Life Sciences Research Building 9 1400 Washington Avenue

Albany, New York 12222 10

June 2, 2015 11 6:00 p.m. to 8:00 p.m. 12 13 PRESIDING: 14

Senator Terrence Murphy, Chair 15

Senator George Amedore, Jr., Co-Chair 16

Senator Robert Ortt, Co-Chair 17

Senator Richard Funke 18

Senator Kathy Marchione 19 20 21 22 23 24 25 1

SPEAKERS:PAGE QUESTIONS 2

PANEL I 15 35 3

Dr. Peter Provet, Ph.D. 4 President & CEO

Odyssey House 5

Father Peter Young 6 CEO

Peter Young Housing, 7 Industries & Treatment 8 PANEL II 40 54 9 Debra Rhodes

Alcohol and Substance Abuse Coordinator 10 Albany County Department of Mental Health 11 Joe LaCoppola, MSW

Clinic Director 12 Conifer Park - Troy 13 PANEL III 58 77 14 Dr. Charles Argoff

Pain Management Specialist 15 Albany Medical Center Neurology Group 16 Dr. Christopher Gharibo

Medical Director of Pain Medicine 17 NYU Langone Medical Center 18 PANEL IV 84 98 19 Micky Jimenez

Regional Director of the Capital District 20 Promesa 21 Julie Dostal, Ph.D.

Executive Director, LEAF Council on 22 Alcoholism and Addition

President, Council on Addition of NYS 23 24 25 1

SPEAKERS (Continued): PAGE QUESTIONS 2

PANEL V 101 111 3 113 126

Robert Lindsey 4 CEO

Friends of Recovery - New York 5

John Coppola 6 Executive Director

NY Association of Alcoholism and 7 Substance Abuse Providers, Inc. 8 PANEL VI 127 145 9 Lisa Wickens-Alteri

President, Whiteman, Osterman & 10 Hanna, LLP, Health and

Human Services 11 Personal Story 12 Patty Farrell

Personal Story 13 Mother of Laree Farrell-Lincoln

Resident of Albany, New York 14

PANEL VII 146 173 15

Elizabeth Berardi 16 Founder, Safe Sober Living,

Vineyard Haven, MA 17 Personal Story 18 Daniel Savona

Personal Story 19 Resident of Kingston, NY 20 Peter Nekos

Personal Story 21 Resident of West Hurley, NY 22 PANEL VIII 176 23 Melody Lee

Policy Coordinator 24 New York Drug Policy Alliance 25 1 SENATOR AMEDORE: Okay. We are -- we're 2 going to get started. Sorry for a couple-minute 3 delay, but I waited for some of my colleagues, and 4 I'm glad to see that they were able to make it. 5 Welcome, everyone, who is present. 6 And I want to thank and welcome all of you to 7 the fourth in a series of statewide forums hosted by 8 the Senate Task Force on Heroin and Opiate 9 Addiction. 10 I'd like to thank my Co-Chairs, 11 Senator Terrence Murphy, and Senator Robert Ortt, 12 and all of my colleagues on the Task Force, the 13 members who are here this evening, which we have, 14 Senator Funke, and I know I saw out in the lobby, 15 Senator Kathy Marchione, for being here tonight. 16 Thank all of you for being here: those who 17 will give testimony and share their stories, to -- 18 as well as all of those who are just here to listen. 19 You know, being a part of this helps us make 20 good public policy and help eradicate this problem 21 in the state. 22 The purpose of the Task Force is to develop 23 solutions to help eradicate the problem, once and 24 for all, and to do so we need to approach this from 25 very different -- many different sides, by 1 increasing prevention and awareness, by providing 2 treatment options for those who need it, by 3 supporting continued recovery to prevent relapses, 4 and, from a law-enforcement perspective, by cracking 5 down on mid- and high-level dealers who are putting 6 these deadly drugs on the street. 7 Heroin addiction and abuse is an issue that 8 touches every single person in this room and in our 9 community. It's in our neighborhoods, it's in our 10 schools. It's just not an urban issue. It is in 11 rural communities, it's in suburban communities. 12 And this is an issue that we need to work 13 together on, and it's going to take the whole 14 community effort to help bring the -- help bring a 15 significant difference to families who are suffering 16 and who are going through this nightmare, and those 17 who are addicted, how we can help them overcome 18 their addictions. 19 We must remove the stigma that too often 20 comes with heroin abuse. People should not be 21 ashamed to seek help, and know where they can go and 22 seek that help. 23 So family members and loved ones who are here 24 this evening, and the ones that you know, if they're 25 going through this nightmare like I said, they need 1 to help tell their story, and be supportive in the 2 communities, because there's many others who really 3 don't know where they can turn for help. 4 No one person will end this epidemic, and we 5 need to all work together. 6 And I want to thank all of you for your time, 7 for your efforts, and your passion. 8 At this time, I would like to introduce one 9 of the task Force co-Chairs, and that is 10 Senator Murphy, for any opening remarks. 11 SENATOR MURPHY: Yes, sure. 12 First of all, thank you, Senator Ortt, for 13 allowing me to be here. 14 SENATOR AMEDORE: Ortt's down there. 15 SENATOR MURPHY: Ortt's down there, and 16 you're right here. Okay. 17 [Laughter.] 18 SENATOR MURPHY: Thank you, Senator Amedore. 19 But, no, in all seriousness, this is -- thank 20 you, the people, for showing up tonight. 21 This is an unbelievably important topic for 22 New York State, nonetheless the Hudson Valley 23 region. 24 I've got -- had the opportunity to go up 25 and -- oh, excuse me -- and be in Rochester 1 with Senator Funke at a Task Force that he held. 2 And this is an epidemic, like Senator Amedore 3 said, and we are here to address it head on. 4 We understand it is a major problem. 5 We understand that it has no boundaries. 6 It has no religion, Father. 7 It has no race. 8 It has no ethnicity. 9 You would be surprised what your neighbor's 10 doing. 11 And we want to, like Senator Amedore said, 12 take the stigma off. It's not a needle in the arm 13 anymore. It's in pill form that these kids are 14 overdosing on. 15 And it has multiple, multiple avenues that we 16 need to address. 17 And why we're all sitting up here tonight as 18 the Task Force, and as -- with my colleagues, is to 19 hear what we need to do to improve. 20 And we've listened already, with this year's 21 bill. This year's bill, after the Task Force got 22 together, we understood that nurses in schools were 23 not allowed to administer Narcan. And we all 24 thought, how ridiculous was that? 25 And we made sure, not only did we allow that 1 the school nurses have the ability to administer the 2 Narcan, but we also funded it, to make sure that 3 they had the opportunity of (a) getting certified, 4 and (b) having the naloxone kits within the school 5 district. 6 So we are listening. 7 We do want to hear your testimony. 8 And, again, it's an honor and a privilege to 9 be here, and I will turn it back over to 10 Senator Amedore. 11 SENATOR AMEDORE: Thank you, Senator Murphy. 12 We also have Co-Chairman of the Task Force, 13 Senator Robert Ortt. 14 SENATOR ORTT: Thank you, Senator Amedore. 15 I can't think of a worse insult than to call 16 you Senator Ortt, so I apologize for my colleague, 17 but... 18 [Laughter.] 19 SENATOR AMEDORE: What are friends for? 20 SENATOR ORTT: Yeah, exactly. 21 But, I really want to echo the comments of my 22 Co-Chairs. 23 This is the fourth -- as Senator Amedore 24 said, this is the fourth hearing we've done around 25 the state. I've been at three of them. This is my 1 third. 2 And, certainly, in the first two, and I'm 3 sure tonight, you hear certain themes that sort of 4 recur. 5 Whether it's the family members who are here 6 tonight, and, certainly, for those family members 7 who are here, who have lost a child or lost a loved 8 one, my heart, our hearts, go out to you. You're 9 living this, you live this every day; 10 To the service providers, you're on the front 11 lines fighting this every day. You've been fighting 12 it, you've known it's an issue for probably many 13 years; 14 And, obviously, I don't know if there's any 15 law-enforcement officials, but I know there were 16 law-enforcement officials in Rochester, and at the 17 hearing up in Niagara County, which is the area that 18 I represent. 19 And one thing you learn, is this is a 20 multi-component issue. There is not one area, or 21 one silver bullet, that is going to fix this. 22 There is a law-enforcement component. There 23 is a service-provider component. There is an issue, 24 when you talk about insurance companies, and access 25 to care and access to services. There is certainly 1 a funding component. But there's also an education 2 component, and a community component. 3 And all of you who are here, we need your 4 help. 5 There are certainly things that we can do at 6 our level, and I know we will. 7 But, ultimately, for the parents out there, 8 hopefully, there's some parents here, that have 9 children, that haven't dealt with this, and you will 10 be able to take some things away tonight, or, when 11 you go talk to your friends, you will be able to 12 take some things away, as this discussion continues, 13 because I believe we're doing this the right way. 14 We're doing it as a bottom-up approach. 15 It's not someone from Albany saying, Here's 16 what we need to do. 17 We need to hear it from all of you who are 18 here. 19 And from the folks who are testifying 20 tonight, who are on the front lines, who have dealt 21 with this, who have either looked at a young person 22 addicted to opioids or heroin in the face, or have 23 seen a young person, addicted, pass away, or 24 whatever it might be, we need to hear from you. 25 And that is what's going to collectively, 1 myself, Senator Murphy, Senator Amedore, and the 2 rest of our colleagues, to be able to formulate some 3 sort of solutions, some legislation, that will, 4 hopefully, save lives, and help alleviate this 5 epidemic from getting worse, because I think we can 6 all agree it's certainly not going in the right 7 direction. It's getting -- I think it's getting 8 worse at this point. 9 And every time I pick up a newspaper and 10 I see, you know, statistics, they're not going in 11 the right direction. 12 So that's what this is about tonight. 13 I certainly want to thank my colleagues for 14 being here, and for their commitment. 15 Many of them have traveled around the state 16 to multiple hearings as well, so, it shows that they 17 care. 18 And, I want to thank all of you for being 19 here. 20 And, certainly, we are here to try and help 21 you, and be part of a long-term conversation, to 22 save our communities and save our families. 23 So, I thank you for having me. 24 SENATOR AMEDORE: Thank you, Senator Ortt. 25 At this time, I'd like to introduce two 1 Task Force members; and one person, particular, in 2 the Capital Region you're very familiar with, and 3 that's Senator Kathy Marchione. 4 SENATOR MARCHIONE: Thank you. 5 First, I would certainly like to echo my 6 thanks to both, you, Senator Amedore, and to 7 Senator Ortt, for putting these forums together, and 8 for traveling throughout the state. 9 You know, this is the second year that I've 10 sat on the Task Force. 11 And, I had a hearing myself last year at the 12 Hudson Valley Community College, and it was at 13 9 a.m. in the morning, and there are about 250 seats 14 in the auditorium, and there was hardly a seat 15 available, and we needed to overflow that into 16 another room and people watched it on a screen. 17 And I sat there and I gulped hard because, at 18 that point, if it wasn't real to me before that 19 time, it certainly is real to me what a problem this 20 is in our community. 21 You know, we've all seen, it was last year, 22 or two years ago, that the governor in Vermont, 23 through his State of the State, did nothing but talk 24 about heroin. 25 It is a critical problem. 1 And, you know, the State has done a lot in 2 the last year. There were a number of pieces of 3 legislation that they looked at, that we passed, and 4 there is a lot further to go. 5 And that's why I thanked Senator Amedore and 6 Ortt for continuing. 7 There are a number of pieces of legislation 8 that have already been introduced, that they are 9 introducing, that will continue to fight the heroin 10 epidemic. 11 And I think what is also good, and I think 12 why people looked at this as a real effort, is we 13 are looking at it holistically. We're not just 14 looking at a heroin problem. 15 That we're looking at law enforcement and 16 saying, well, let's toughen penalties, because that 17 will do it. 18 We looked at legislation, and passed 19 legislation, and still have more to do, that 20 prevents opioid abuse and overdoses. So you have 21 that component. 22 And, also, increasing the availability of 23 addiction treatment. 24 So, I am very happy to be with you this 25 evening. This is a very serious issue that I've 1 taken very seriously. 2 And, I look forward to listening to all of 3 our presenters this evening. 4 SENATOR AMEDORE: Thank you, 5 Senator Marchione. 6 And, a Senator that is all the way from 7 Rochester, and someone who is doing a marvelous, a 8 great job in the State Senate, that is 9 Senator Funke. 10 SENATOR FUNKE: Thanks, George, very much. 11 Heroin killed 65 people in my district in 12 2013, which was double what it was the year prior to 13 that, which was double the year prior to that. 14 So, here we are. 15 Nobody wakes up in the morning and says, Let 16 me try heroin. 17 You know, it could be a high school football 18 player who has a knee injury and winds up on 19 oxycodone for the pain, and becomes addicted to 20 oxycodone. And when that treatment is over, what's 21 next? 22 It could be a peer-pressure circumstance at a 23 party. 24 The problem is that, that one time, can be 25 the first step on the road to-full blown addiction. 1 So tonight we want to hear from you, we want 2 to hear from those affected by this. 3 And the most important thing I think is, what 4 comes next after tonight? 5 What comes next? 6 What are we willing to do as a group, all of 7 us in this room, to solve this horrible problem? 8 And make no mistake, it's going to take all 9 of us to get our arms around this and figure it out, 10 and work toward some solid solutions; not just talk 11 about this anymore, but come up with real ways to 12 combat this problem. 13 So I thank Senator Amedore and Senator Murphy 14 and Senator Ortt for co-chairing this really 15 important Task Force, and for Senator Marchione for 16 all her work last year before us three freshmen 17 arrived on the scene here. 18 I have to be the oldest freshman in the 19 history of freshmen -- 20 [Laughter.] 21 SENATOR FUNKE: -- but, here I am, and it's 22 wonderful to be here with you tonight. 23 Thanks. 24 SENATOR AMEDORE: Thank you, Senator Funke. 25 At this time I would like to invite to the 1 table here, Dr. Peter Provet from the Odyssey House, 2 and, Father Peter Young, who is the CEO of 3 Peter Young Housing, Industries & Treatment Center. 4 And what we have done this evening, is we 5 have kind of a long list of participants, so we kind 6 of doubled and sometimes tripled up, you know, the 7 groups, so that we can get everyone in and speak 8 without being here until 2 a.m. 9 So, I appreciate you coming, and thank you 10 for your time. 11 Doctor. 12 DR. PETER PROVET, Ph.D.: Good evening. 13 It's my pleasure to be here. 14 And thank you, Senators, so very much, for 15 holding these important testimony hearings on heroin 16 and opioid abuse in New York State. Your interest 17 and support are vital, and very much appreciated. 18 I also want to thank the many concerned 19 citizens who are here this evening to learn and talk 20 about what is happening in our communities, and how, 21 together, we can stop heroin and other drugs of 22 abuse from taking more lives. 23 My name is Dr. Peter Provet. I'm the 24 president of Odyssey House. 25 Founded in 1967 in New York City, 1 Odyssey House is a human-service organization 2 serving New Yorkers with substance-abuse and 3 mental-health disorders, including young families, 4 older adolescents, adults, and senior citizens. 5 The people we serve enter treatment in a 6 variety of ways: as an alternative to incarceration, 7 from homeless shelters, hospital detox centers, 8 psychiatric hospitals, and with the support of 9 concerned family and friends, some just walk into 10 our mission office and ask for help. 11 However people reach us, whatever their 12 history of substance abuse, we offer the same: a 13 place of safety, understanding, and opportunity to 14 grow and engage in a lifesaving recovery. 15 Odyssey House has a long history with heroin. 16 As I mentioned, our organization was founded 17 in 1967 as a self-help model for heroin addicts in 18 New York City. 19 For close to 50 years, we've saved lives, 20 reunited families, stabilized communities. Hundreds 21 of thousands of New Yorkers have started the journey 22 to recovery in our programs. 23 Each day, around 2500 men, women, and 24 children participate in our residential outpatient 25 and peer-recovery services. 1 Last year we provided over 200,000 days of 2 residential treatment; 18,000 outpatient visits, and 3 individual and group counseling sessions; 4 11,000 primary-medical and dental visits; and 5 7,500 classroom hours to youth. 6 Much has changed in addiction in 50 years. 7 Today we know more about brain chemistry and 8 the effect drugs of abuse have on the neural 9 pathways that govern our behavior. 10 We can offer people medically-assisted 11 treatments to help control cravings, blunt the 12 effects of powerful narcotics and stimulants, and, 13 potentially, save the lives of people who have 14 overdosed, as you just spoke to. 15 These are vital advances and welcomed by all 16 of us in the treatment field, but detox, which 17 includes, often, buprenorphine and naloxone 18 treatment, are not really treatment. They're the 19 start of a treatment process that requires a 20 long-term commitment to behavioral change. 21 We have all heard the data on the increased 22 abuse of heroin. 23 In New York City, deaths from heroin were 24 higher last year than they have been since 2003. 25 In 2013, 420 New Yorkers died from a heroin 1 overdose. 2 In 2013, the same year, Odyssey House, 3 coincidentally, treated the same number of opioid 4 abusers, 420 people who did not lose their lives. 5 In the last three years, from 2012 to 2014, 6 the number of people coming into our treatment 7 programs reporting opioids as their primary drugs 8 increased by 18 percent. 9 100 percent of our outpatient-services staff 10 are trained in opioid-overdose prevention 11 techniques, including the emergency use of 12 lifesaving naloxone injections, which you mentioned, 13 Senator. And we're training our residential staff 14 in these very same techniques. 15 We all know the ones we reach in time are the 16 lucky ones. 17 We also know that drug addiction is a complex 18 illness, characterized by intense, and at times, 19 uncontrollable, drug craving, along with compulsive 20 drug-seeking and use that persists even in the face 21 of devastating consequences. 22 While the path to drug addiction begins with 23 the voluntary act of taking drugs, over time, a 24 person's ability to choose not to do so becomes 25 compromised, and seeking and consuming the drug 1 becomes compulsive. This behavior largely results 2 from the effects of prolonged drug exposure on brain 3 functioning. 4 Simply put, addiction is a brain disease and 5 affects multiple brain circuits, including those 6 involved in reward and motivation, learning and 7 memory, and inhibitory control over behavior. 8 Because drug abuse and addiction have so many 9 dimensions and disrupts so many aspects of an 10 individual's life, treatment is far from simple. 11 Effective treatment programs typically 12 incorporate many components, each directed to a 13 particular aspect of the illness and its 14 consequences. 15 Addiction treatment must help the individual 16 stop using drugs, maintain a drug-free lifestyle, 17 and achieve productive functioning in the family, at 18 work, and in society. 19 Because addiction is typically a chronic 20 disease, people cannot simply stop using drugs for a 21 few days and be cured. Most patients require 22 long-term or repeated episodes of care to achieve 23 the ultimate goal of sustained abstinence and 24 recovery of their lives. 25 And allow me to mention and emphasize this 1 point: We speak of a "chronic relapsing disease." 2 NIDA (the National Institute of Drug Abuse) 3 coined that term, under its director Alan Leshner, 4 so, maybe 10 or 15 years ago. "Chronic relapsing 5 disease." 6 One of our biggest struggles in breaking the 7 stigma -- and I heard several of you Senators talk 8 to this outside -- breaking stigma is directly 9 related to this, because when people see an addict, 10 they get treatment, but they still go back to using 11 drugs, often people blame the addict. 12 Not that the addict doesn't have a great deal 13 of responsibility for their behavior. Of course 14 they do, and we have to address that. 15 However, if we think of this as a chronic 16 relapsing disease of the brain, it helps address 17 that problem of blaming the addict. 18 Just like with cigarette smoking, as I'm sure 19 many people in the audience have struggled with, or 20 perhaps continue to do, the number-one way people 21 stop smoking cigarettes is a process. They stop, 22 and they start. They stop, and they start. They 23 stop, and they start. They stop, and it clicks. 24 This has been researched and found, 25 consistently, that is the most successful way to 1 stopping cigarettes: it's a back-and-forth. 2 Same with drugs, unfortunately. 3 Scientific research published by NIDA, which 4 I have mentioned, and others, since the mid-'70s, 5 shows that treatment can help patients addicted to 6 drugs stop using, avoid relapse, and successfully 7 recover their lives. 8 Based on this research, key principles have 9 emerged that form the basis of any effective 10 treatment program. 11 Addiction is a complex but treatable disease 12 that affects brain function and behavior. We 13 emphasize this over and again. 14 No single treatment is appropriate for 15 everyone. Treatment needs to be readily available. 16 Effective treatment tends to multiple needs of the 17 individual, not just his or her drug abuse. 18 Remaining in treatment for an adequate period 19 of time is critical. 20 Counseling, individual or group, and other 21 behavioral therapies, are the most commonly used and 22 necessary forms of drug-abuse treatment, and, more 23 and more, we're discovering medications are an 24 important element of treatment for many patients, 25 especially when they're combined with counseling 1 techniques. 2 Individual's treatment and service plans must 3 be assessed continually and modified, as necessary, 4 to ensure that they meet the individual's changing 5 needs throughout the treatment process. 6 Many drug-addicted individuals also have 7 other mental disorders, and we've come to refer to 8 this issue as a "co-occurring" problem. 9 Medically-assisted detoxification is only the 10 first stage of addiction treatment, and by itself, 11 does little to change long-term drug-abuse patterns. 12 Treatment does not need to be voluntary to be 13 effective. 14 Drug use during treatment must be monitored 15 continuously, as lapse during treatment do occur, 16 and the individual shouldn't be blamed. They need 17 to be addressed and confronted, not blamed. 18 Treatment programs should assess patients for 19 the presence of HIV/AIDS, hepatitis B and C, 20 tuberculosis, and other infectious diseases, as well 21 as provide targeted risk-reduction counseling to 22 help patients modify or change behaviors that place 23 them at risk of contracting or spreading infectious 24 diseases. 25 Medication and behavioral therapy, especially 1 when combined, are important elements of an overall 2 therapeutic process that begins often with 3 detoxification, followed by treatment and relapse 4 prevention. 5 Easing withdrawal symptoms can be important 6 in the initiation of treatment, preventing relapses 7 necessary for maintaining its effects. 8 And sometimes, as with other chronic 9 conditions, episodes of relapse may require return 10 to prior treatment components, which I've mentioned. 11 A continuum of care that includes a 12 customized treatment regimen, addressing all aspects 13 of an individual's life, including medical and 14 mental-health services, and follow-up options, 15 community- and family-based support systems, for 16 example, can be crucial to a person's success in 17 achieving and maintaining a drug-free lifestyle. 18 A young resident in our long-term youth 19 program in lower Manhattan recently talked about the 20 swift and steep decline he experienced from abusing 21 prescription drugs that went to heroin addiction. 22 Tomas (ph.) is a 26-year-old young man 23 originally from Ukraine. He immigrated to this 24 country with his family when he was 10. His family 25 settled in Philadelphia, opened a construction 1 business. 2 Tomas went to school, he graduated, and went 3 to work in the family business. But family 4 problems, a breakup with a girlfriend, and other 5 issues led to or were exacerbated by an onset of 6 depression. 7 At 21 he started using cocaine, 8 benzodiazepines, alcohol, and marijuana. 9 At 23 he progressed to heroin. By this time 10 he had stopped going to work. His family told him 11 to leave, and he was supporting his growing heroin 12 addiction by shoplifting, stealing, and forging 13 checks. 14 He left his hometown and made his way to 15 New York City to escape. Several times he tried to 16 quit heroin on his own, each time he failed, and 17 each time he started using more. He also started 18 stealing again to support his $100-a-day habit. 19 Eventually he was arrested and sent to 20 Rikers Island, where, as part of his sentencing, he 21 was referred to Odyssey House as an alternative to 22 incarceration. 23 Tomas counts himself one of the lucky ones. 24 While he saw other addicts overdose, he never 25 did. He's grateful for the chance to be in 1 treatment. It's a slow process, but he is getting 2 his life together. His family is supportive. He 3 plans to go back to school. 4 But he also knows he runs a real risk of 5 relapse, and he's volunteered for monthly Vivitrol 6 injections, and to attend outpatient recovery 7 support groups when he leaves residential treatment. 8 Tomas is only 26 years of age. He has his 9 life in front of him. He's lucky to be in 10 treatment. 11 But how many others will not survive the 12 biggest opioid-abuse epidemic our country has faced? 13 Thank you, Senators, for hearing my 14 testimony, and thank you so much for your support. 15 SENATOR AMEDORE: Thank you, Doctor. 16 Appreciate the testimony. 17 And I want to go right to Father Peter Young 18 for your witness. 19 FATHER PETER YOUNG: Thank you, Senator. 20 I am very happy -- I am coming from a very 21 different kind of background. 22 SENATOR AMEDORE: That's why we put you two 23 together. 24 FATHER PETER YOUNG: Good combination. 25 [Laughter.] 1 FATHER PETER YOUNG: You know, it's an 2 important kind of thing, because I'm coming in from 3 the experience of dealing with the guys and gals on 4 the street. And in -- the Green Street was, at that 5 time, that I was sent to in '58, '59, that was known 6 as the largest brothel in the east, which is 7 something about Albany. More than Rochester, it's 8 Lyell Avenue. 9 When we know the routine of what goes on in 10 the different cities, the big thing was, and I had a 11 great benefit of growing up in Albany with 12 Harry Albright, a guy that became secretary to 13 Governor Rockefeller. So I'd go up and have coffee 14 with him in the morning, and I would sit there, and 15 we would often sit down with -- Rocky would be 16 there, and he would say, Well, Father, what are you 17 doing today? And, I would say, Come down. 18 And he came down to visit. 19 So the governor came down to visit. 20 Trouble? Okay. 21 And when the governor would come down, he 22 would come down and visit, and he would often be 23 amazed at the 100 or so guys I would have sleeping 24 on the floor, and he would say, What are you doing 25 with them? How are you helping them? They've got 1 the Harlem problem. 2 I said, Harlem? What do you mean by the 3 "Harlem problem"? 4 He said, Well, they're using some kind of a 5 drug there. You seem to have the same kind of guy 6 and gal in there. And you're taking in and taking 7 care of them, but what do you with them? 8 And I said, It's not Harlem. It's a heroin 9 problem, Governor. It's the heroin, it's heroin. 10 And I tried to explain to it him at that 11 time. And we became very great buddies. 12 And he then said, You know, I'm very 13 interested, and I want to try to -- he gave me a 14 parking place on the ramp, which was a big help. He 15 got me in and off the Capitol. 16 And with that kind of fun, we had a good 17 time, because we would have lunch with him and enjoy 18 the opportunity. 19 And he said, You know, Father, what we need 20 to do, we need to try to get you to try to give us a 21 little bit of the idea, you're working with these 22 people, and Harry thinks you're a nice guy. So 23 let's -- if we can -- what do we do? Let's plan, 24 and I'll sign the bill in 10 years. 25 I said, That's great. 1 That was for 240.40 in the penal code. That 2 was the decriminalization of alcoholism as a crime. 3 And that was a big one, because 35,000 meetings and 4 14 years of my life later, we had the bill signed, 5 and it did what the-- Senator Amedore was talking 6 about: it destigmatized. 7 And that's a -- very important. I'm glad you 8 brought that up, Senator, because that's so 9 important. 10 If you were to go to an AA meeting before 11 that, you would never really see any kind of women 12 represented. 13 After that bill passed, you couldn't believe 14 what happened. The people came out of the woodwork, 15 out of the closet, so to speak, and they came, and 16 they participated. And it was a very important 17 thing because, then, it opened the door and it 18 created an environment of friendship, and an 19 environment that would welcome people. 20 And women were the beneficiary. 21 You would go to a meeting or a participation 22 with a fellowship, and you'd see the women 23 participating as much as the men; and, therefore, 24 that door is open. 25 I think the Senator hit a very important key 1 word, that this really needs to be addressed, and 2 that's what I think we're about: Trying what we 3 could to find a way to do it. 4 I was lucky, I was a friend of the governor, 5 and the governor knew a lot of rich people. He knew 6 Brinkley Smithers. And Brinkley Smithers and 7 Senator Harold Hughes then were -- then working with 8 me. They sent me all over the country on all of 9 these different "missionary trips," as they would 10 call it. 11 Harold Hughes, and the senator from Iowa, and 12 he and I did all the speaking at the different 13 conferences about the disease of addiction, talking 14 about it as a disease, an illness, as the doctor had 15 said, very carefully, and I was listening to that 16 and I said, Amen, Doctor. 17 It's a disease, an illness; an illness that 18 we need to address, and do it as best we can with 19 the most competent care. 20 We did it, with the idea of traveling around 21 with those two, and traveling around, and 22 Brinkley Smithers would take care of everything, 23 because he was one of the founders of IBM. 24 And in talking with him, we started many of 25 the journeys. At that time, we were fighting a 1 temperance movement. That tells you how old I am. 2 And we were trying still to talk about the 3 "i over the e," the "intellect over the emotions." 4 The brain. 5 The brain, the cortex of that brain, has got 6 the thinking power. 7 The doctor would know more than I. 8 But the craving is the mesolimbic area of the 9 brain, and that needs to be addressed; and, 10 therefore, we're looking at the kind of competence 11 that they have to put that together, and try to get 12 that competent kind of feeling to take care of that 13 craving, so we have time. 14 And that's what I try to stress: You need 15 time for this miracle to happen. You just can't do 16 it quickly and say, He's better now, he's had a week 17 in a rehab. 18 That's not going to work. 19 We often think about the many things that are 20 going on. 21 One of the problems I would like, if I could, 22 just to put out on the table, we have a terrible 23 time, we're talking about merging right into mental 24 health now in New York State. 25 We have been there, and we know what 1 happened. We were one-half of 1 percent in the 2 budget in addictions for alcohol and drugs. 3 One-half of 1 percent. 4 If we merge, I think we need to be 5 well-represented financially, and being capable to 6 do what we need to do to take care of the people 7 that are sick and suffering with this progressive, 8 insidious disease. 9 I just keep thinking about how all of that 10 happened, because you need to have the kind of 11 foundation, and you need to have the idea of what 12 they have to have in order to take care of that 13 disease, that Rocky was so competent in thinking of, 14 and what he needed to do. 15 He was really the person that had a 16 dedication. 17 His father tried to give money to AA, and 18 they refused it. And he said, I don't understand 19 it, but I'll work with Marty Mann and you, and we'll 20 try to find out if we can get that kind of program 21 going here in New York State. 22 But it was, again, a council on alcoholism, a 23 council that took care of the need. And at that 24 time it was an easy thing, because working with 25 heroin at that time, it was only 7 percent potency. 1 Now it's about 47 percent potency. 2 So we're dealing with many different kinds of 3 drugs. They're getting now with a little fentanyl 4 in here and there. It's dangerous kind of routine. 5 The kind of routine that I'm proud of is, to 6 know, and to know what happened with that 7 administration, the kind of way that they dealt with 8 the problem: competently, compassionately, and in a 9 very dedicated way. 10 But then came the Medicaid kind of funding. 11 When the Medicaid funding came, then you were 12 caught with a lot of the paperwork. 13 The fun in the field is gone. There's no 14 longer an enjoyable counselor that I've met lately. 15 They are finding it very difficult to work in the 16 field because there's always, the Medicaid kind of 17 fraud unit will come in and check, and find out, 18 knocking on your door, and finding out where you 19 are, what you're doing, for anything you ever do, 20 because, anything, if you give a free day of care, 21 then you're under Medicaid fraud. 22 So there's a fear, an anxiety, in the field 23 right now. 24 It does not mean that we are bad. It means 25 that we need to be carefully able to endorse and 1 support and help people that are still sick and 2 suffering, and be as wide open in the field as we 3 can. 4 I plead on that kind of score, because I know 5 the unhappiness that I find in the field with 6 counselors, it's just overwhelming. 7 They're no longer eager to get in the field. 8 They're trying to get out of the field, rather than 9 in it. 10 So I just beg you to try to address the idea: 11 How do we merge Article 28 and Article 31? 12 How do we do that? 13 How do we work with the Article 30 -- those 14 two sections of law need to be addressed, so we can 15 get a team approach. 16 And I know Senator Murphy would well know 17 better than I how that all happens. 18 When you're running a wellness center, you're 19 dealing with that kind of game all the time, trying 20 to figure out how you put the two of those together, 21 the public health to the mental health, and try to 22 blend them, putting them together into -- 23 SENATOR MURPHY: It's a difficult challenge. 24 FATHER PETER YOUNG: Difficult. Thank you. 25 I thank you for that vote. 1 And I just appreciate it. 2 So I just feel grateful again, as the doctor 3 said, to be here, to be able to share the idea. 4 And in the 58 years that I've had of doing 5 it, I'm a little -- kind of sorry now that I don't 6 have any answers. I just have experience. 7 SENATOR MURPHY: We need your experience. 8 FATHER PETER YOUNG: Thank you, Senator. 9 SENATOR AMEDORE: Well, thank you, 10 Father Young. 11 I want to just put out, any of my colleagues, 12 if they have questions, I would just ask that you 13 probably keep them kind of pointed and short. 14 We're here, really, to do more listening, and 15 we'll ask questions as we see fit. 16 But, we can sit here all night long and go 17 over a lot of different back-and-forths, but, 18 there's a lot speakers, and, there are -- everyone's 19 important, and everyone should be heard. 20 SENATOR FUNKE: I just have one question. 21 SENATOR AMEDORE: Yeah, go ahead. 22 Senator Funke. 23 SENATOR FUNKE: I'd just like to ask the 24 doctor, about Vivitrol. 25 Can you tell me about that, and the 1 effectiveness of that, and where in the treatment 2 Vivitrol comes in? 3 DR. PETER PROVET, Ph.D.: I mean, you go back 4 to methadone, and how these drugs work are, now, we 5 understand a little more, in blocking opiate 6 receptors in the brain. 7 And for people who are willing to accept 8 administration, it's definitely something that is a 9 promising part of a treatment regimen. 10 The downside, of course, is to think that a 11 pill, however it works effectively in blocking the 12 opiate receptor in the brain, is a cure for 13 addiction, because we know addiction is far more 14 than the drug. Addiction is a lifestyle. Addiction 15 is lack of motivation. Addiction is walking away 16 from life and its challenges. 17 And so what we want to make sure doesn't 18 happen is, as we embrace medical-assisted treatment, 19 we don't leave behind behavioral (inaudible) 20 critical in helping the person change their 21 attitudes, their behaviors, their family, 22 relationships, and so forth. That must be 23 emphasized. 24 People who are looking to cut budgets too 25 quickly want to say, Well, you have all these 1 medications now. Aren't they the answer? 2 Because the real treatment takes time and far 3 more of a financial investment. 4 FATHER PETER YOUNG: If I could just share 5 one comment about Vivitrol, and naltrexone has been 6 around, and it does what he's talking about. 7 I think it's better than the pill form 8 because, now, if you take pills, you can sell the 9 pills. And a lot of them are being sold on the 10 street all the time. 11 At least if you take a shot of Vivitrol, at 12 $1300-plus a day -- a shot, with that $1300 or so in 13 the butt, that takes a commitment. 14 I know -- either -- I'm the same school that 15 Odyssey is talking about, Amen, that takes a 16 treatment plan. That only will take care of the 17 chill-down, so you can begin to talk with a guy 18 before he shakes-out. 19 SENATOR MURPHY: So you need the wraparound 20 approach? 21 FATHER PETER YOUNG: Yes. Absolutely. 22 SENATOR MARCHIONE: I have just one question. 23 Doctor, you stated that it does not need to 24 be voluntary, the program, to be effective. 25 I always thought, at least what I have been 1 led to believe, that someone has to hit bottom, and 2 they have to want to change, in order for change to 3 be effective. 4 But I didn't hear that from you. 5 DR. PETER PROVET, Ph.D.: Yes, very important 6 and interesting issue. 7 Someone does have to get to a bottom to 8 really want to change, but that doesn't always 9 happen before they get into treatment. 10 Treatment helps them find the bottom very 11 often. 12 Having alternative-to-incarceration programs 13 has probably been one of, if not the most important, 14 policy move in New York State to advance treatment. 15 At Odyssey House, and other fine programs in 16 New York -- Phoenix House, Samaritan Village, 17 Daytop, so forth -- all of our programs work with 18 the criminal justice system. People get a choice: 19 Come into treatment or be prosecuted for a low-level 20 drug crime. 21 They choose coming into treatment. 22 Once they get into treatment, we help them 23 find motivation to change. That takes time. People 24 aren't immediately ready to quit their addiction. 25 So, getting forced into treatment sometimes, 1 often, is necessary to get them to that bottom, to 2 help them realize they have nothing in their lives, 3 that they want to change and live a far more 4 successful and happy life. 5 SENATOR MARCHIONE: Thank you. 6 And just a statement for Father Young, and 7 I told this story once, and I think it's so 8 indicative of Father. 9 I heard a story one time, because he's been 10 running these programs for a very, very long time, 11 that someone needed a pair of shoes, and it was very 12 cold outside. And Father got out of his car, went 13 in, took his shoes off, and came back out in his 14 stocking feet, to help someone. 15 And that should never go unnoticed, Father. 16 Thank you. 17 FATHER PETER YOUNG: Thank you. 18 Thank you, Senator. 19 SENATOR AMEDORE: That's why you're wearing 20 no socks tonight? 21 FATHER PETER YOUNG: That's it. 22 [Laughter.] 23 SENATOR AMEDORE: Thank you so much for being 24 here, and your testimony. 25 FATHER PETER YOUNG: I thank you for the word 1 "destigmatize" and "de-stigmatize." 2 SENATOR AMEDORE: Very important. 3 Next I would like, we have on the agenda, 4 Deb Rhodes from Albany County Substance Abuse, and, 5 Joe LaCoppola from Conifer Park. 6 FATHER PETER YOUNG: Hi, Deb. How you doing? 7 DEBRA RHOADES: Good. You're a hard act 8 follow. 9 SENATOR AMEDORE: Hello, Deb. How are you? 10 DEBRA RHOADES: I'm well, thank you. 11 SENATOR AMEDORE: Ladies always go first. 12 DEBRA RHOADES: Okay. Thank you. 13 Thank you, Senators. 14 My name is Debra Rhoades, and I am the 15 alcohol and substance abuse coordinator for 16 Albany County. I'm here on behalf of 17 Dr. Steven Giordano, the Albany County Director of 18 Community Services, and Daniel P. McCoy, our 19 Albany County Executive. 20 First, I would like to thank the Joint Senate 21 Task Force on Heroin and Opiate Addiction for your 22 interest in learning about the issues our 23 communities are facing in the wake of an 24 unprecedented opiate and heroin epidemic. 25 In my role as alcohol and substance abuse 1 coordinator, I work for the Albany County local 2 government unit, or, "LGU," as stipulated in 3 Mental-Hygiene Law, to oversee, coordinate, and plan 4 for local substance-use-disorder services. 5 We are fortunate in Albany County to have 6 multiple substance-use-disorder prevention and 7 treatment providers; however, I'm here to tell you 8 that we are just touching the tip of the iceberg in 9 terms of the needs of our residents. 10 The opiate epidemic has created a huge 11 challenge for our local community providers. 12 In Albany County, we have seen the number of 13 individuals seeking treatment for opiates as their 14 primary drug of abuse increase 300 percent over the 15 last decade. 16 Local governments, schools, community-based 17 providers, are experiencing an increased demand for 18 services that is challenging to keep up with. These 19 demands include ever-more frequent calls from 20 desperate parents and other family members seeking 21 help and direction in getting their loved ones the 22 care that they so often urgently need. 23 The number of requests for expert 24 presentations about the opiate, heroin, epidemic 25 coming from professionals, schools, parents, and 1 community groups to provide education and guidance 2 is unprecedented. 3 Similarly, on the national and state levels, 4 the data indicates that the prevalence of 5 substance-use disorders, in general, far outpaces 6 the availability of and access to science-based, 7 quality prevention and treatment options. 8 The local government unit in each county is 9 uniquely situated, and we are your eyes and ears on 10 the ground in each local community. 11 In Albany County we routinely assess the 12 needs of individuals and their families impacted by 13 addiction in our community and link them to 14 available services. We identify service gaps and 15 plan for needed services, and, we monitor 16 effectiveness of existing services. 17 The LGU is constantly taking the pulse of 18 what is going on, and we know that addiction, not 19 simply limited to heroin and opiate addiction, is a 20 public-health problem requiring multiple solutions 21 and a partnership of multiple stakeholders. 22 We strongly support the many voices you've 23 heard calling for increased funding. 24 Without additional resources, we will never 25 be able to adequately confront this multifaceted 1 problem. And although we also know that money alone 2 is not the answer, we have identified several 3 specific areas that we believe, with adequate 4 funding, can positively transform how we treat 5 addiction in Albany County and across 6 New York State. 7 First, we must do a better job educating the 8 medical and behavioral-health workforce to treat 9 addiction like other chronic medical illnesses. 10 A crucial step towards meeting this goal is 11 to require that addiction education be an integral 12 part of the academic training and preparation for 13 all New York State-licensed medical and 14 behavioral-health professionals. 15 With this training, physicians, 16 psychiatrists, psychologists, dentists, social 17 workers, nurses, and nurse practitioners, physician 18 assistants, and licensed mental-health counselors 19 will be better prepared to meet the challenges they 20 will face on the front lines in our communities 21 serving those with substance-use disorders. 22 Although hard to fathom, given the 23 seriousness of this current situation, addiction 24 education is often an afterthought in many 25 professional and academic training settings at 1 present. 2 We must double our efforts to make naloxone 3 widely available to those who could benefit from its 4 use. 5 A logical next step would be to make 6 naloxone, or, Narcan, available at all pharmacies. 7 This epidemic is not limited only to those 8 addicted to heroin. The potential for opiate 9 overdose extends to those who are prescribed opiate 10 pain medication across the age spectrum, and who, 11 for one reason or another, are unable to use the 12 medications as prescribed. Having naloxone 13 available to these individuals and their families 14 has the potential to save additional lives. 15 Also, increasing opportunities for medication 16 disposal at local pharmacies will remove unsafe, 17 frequently-abused medications off the streets and 18 out of the hands of our youth. 19 Third: In order to effectively combat this 20 epidemic, we need to be able to reliably ascertain 21 what it is we are actually up against. Too often 22 the available data, particularly as it relates to 23 overdose deaths, is difficult to obtain, inadequate 24 in one way or another, typically vague and dated, 25 and varies from one source to another. 1 We need a comprehensive statewide database to 2 help us understand the full extent of the heroin 3 epidemic in real time, as close -- or as close to it 4 as possible. 5 We need to put in place a standardized, 6 mandated reporting system, requiring specific 7 details about all alcohol- and drug-related deaths, 8 including the enumeration and identification of all 9 drugs discovered upon autopsy. 10 Such a reporting system would allow for a 11 better understanding of what specifically is 12 happening in each of our communities, and serve as a 13 public-health alert system, much like we have in 14 place for contagious diseases. 15 Knowledge of surges in drug-related deaths, 16 as well as deaths involving new drugs, could allow 17 health, behavioral-health, and law-enforcement 18 professionals to pinpoint outbreaks and respond to 19 emerging local trends in real time. 20 Four: Access to science-based, quality 21 treatment is often hampered as a consequence of 22 inadequate health insurance, or, as a consequence of 23 having no health insurance at all. 24 Please continue to in your efforts to ensure 25 that addiction treatment is a covered benefit like 1 all other medical conditions, and that treatment is 2 affordable for all that seek it. 3 Additionally, please continue in your efforts 4 to ensure access to treatment as an alternative to 5 costly incarceration, when deemed appropriate. 6 Drug courts and other diversion programs are 7 a proven mechanism to disrupt the cycle of 8 addiction, and are integral to local efforts to get 9 ahead of this community problem, and should include 10 all of the options currently available to the 11 general public. 12 Five: We have mentioned science-based 13 treatment more than once tonight, or at least 14 I have. 15 The science is growing and the results are 16 increasingly irrefutable. 17 We urge you to support efforts that propose 18 to increase access to medication-assisted treatment 19 for opiate addiction. 20 We must follow the science, and utilize and 21 increase access to all addiction medications, 22 including, but not limited to, Suboxone, methadone, 23 and Vivitrol. 24 Equally important, is ensuring that there are 25 mechanisms in place for insurance reimbursement of 1 these vital adjunct treatments. 2 Presently, we continue to hear of situations 3 in which medications are available, but the 4 insurance coverage and reimbursement simply is not. 5 Finally, please do not let yourself be 6 seduced by believing this is just a heroin problem. 7 Many experts in the field believe that we 8 missed an opportunity to fully address problems 9 associated with alcohol abuse when we focused our 10 attention solely on drunk-driving. 11 We have an opportunity not to repeat history. 12 Please consider -- oh. 13 The heroin epidemic is the battle. Addiction 14 is the war. 15 Please consider, favorably, all prevention 16 and treatment efforts designed at thwarting the 17 largest -- the larger problem of addiction in our 18 homes, schools, and communities. 19 On behalf of Dr. Giordano and 20 County Executive McCoy, please accept our 21 gratitude for this opportunity to present testimony 22 before the Task Force. 23 Under their leadership, Albany County has 24 taken many important steps to address these 25 problems. We've identified opiate abuse as a 1 priority problem. 2 And our community-health improvement plan, as 3 part of the New York State prevention agenda, we are 4 involved in sponsoring opiate-awareness events in 5 the community. We are hosting Narcan trainings 6 across the county. And we recognize the importance 7 of treating co-existing mental-health problems which 8 plague many living with addiction. 9 We are grateful for the many community 10 partners with whom we stand unified, in hopes of 11 turning the tide, one individual at a time. 12 And we hope that the recommendations we have 13 presented to you tonight will be helpful as you join 14 us in these efforts. 15 Thank you very much. 16 SENATOR AMEDORE: Thanks, Deb. 17 Can you go back in your remarks there? 18 DEBRA RHOADES: Uh-huh. 19 SENATOR AMEDORE: "The battle and the war," 20 say that again, so everybody here understands. 21 DEBRA RHOADES: My favorite line, I must say. 22 The heroin epidemic is the battle. Addiction 23 is the war. 24 [Applause.] 25 DEBRA RHOADES: Thank you. 1 SENATOR AMEDORE: Good evening, Joe. How are 2 you? 3 JOE LaCOPPOLA: Good evening, Senator. I'm 4 doing well. Thank you. 5 And good evening, Senators, and thank you 6 again for inviting us, and myself, and most 7 importantly, thank you for convening these hearings 8 throughout New York State. 9 We, as every other state, and as you've heard 10 this evening, are in the midst of a public-health 11 crisis. 12 The use of illicit opiates has no boundaries 13 and does not discriminate. It has destroyed 14 families, and its death tolls continue to rise on a 15 daily basis. 16 We, as a state, and as providers, need to 17 take responsibility and come forward, as we've heard 18 tonight, to support medication-supported recovery 19 and become leaders in its acceptance, and be able to 20 leave our biases at the doors, to be able to work 21 with individuals with the disease of opiate 22 addiction. 23 And I think the important piece is looking at 24 this as a disease, and that we are blessed to have 25 medications to be able to address this disease of 1 opiate addiction. 2 The importance of using medication-supported 3 recovery is not to just address the disease alone, 4 but to assist individuals to be able to engage into 5 treatment, and to be comfortable to gather the tools 6 that are necessary to assist them in their recovery. 7 It is also important for individuals to 8 understand the medication, and medication alone, is 9 not the answer, and to understand, as with any other 10 medications, to treat the disease of opiate 11 addiction, as treating other medical diseases, that 12 individuals do not have to see this as a lifelong 13 commitment to that medication. 14 But programs, and the individuals that are 15 working with individuals with the disease of opiate 16 addiction, understand, at some point, to explore 17 options without medication-supported recovery. 18 We heard about the stigma associated to the 19 disease of addiction. 20 We also have to understand that the stigma 21 that's associated with individuals who participate 22 in medication-supported recovery, individuals have 23 great difficulties to walk out the side of the door 24 and be looked at, and not being -- and being told 25 that they are not truly in recovery because they are 1 using a medication. 2 That's inappropriate, and that they are truly 3 in recovery, and we need to be able to strongly give 4 that message to them. 5 A successful program integrates 6 medication-supported recovery with talk and group 7 therapy. Scientific evidence has shown 8 medication-supported recovery assists the community, 9 due to patients no longer engaging in criminal 10 activities to support his or her illicit use, and 11 also assists in decreasing the spread of infectious 12 diseases. 13 Some of the recommendations that I present 14 tonight is the one -- is looking at: How can we get 15 more money into the treatment-services program? 16 One of them is looking at deeming all 17 medication-supportive recovery-services treatment 18 programs -- opiate-treatment programs, in the 19 country, and in New York State, have to be 20 accredited. 21 And as soon as the program is accredited by, 22 for example, the Joint Commission or CARF, the 23 sooner OASAS can come in and do a complete review of 24 the same standards that are reviewed by the 25 Joint Commission, which programs to pay for. 1 What we're saying is that, we cease, and we 2 go to deeming, and allow just the Joint Commission 3 of the accreditation that's been given to programs, 4 and take the money that's saved from those reviews 5 and reinvest it back into treatment. 6 Secondly, and we're working on this, is the 7 removal of a census capacity. 8 Again, you talk about stigma, and you talk 9 about programs. 10 And, presently, any OTP (opiate treatment 11 program) has to give a census capacity. 12 And here we have -- are now in the midst of 13 an epidemic, and programs have waiting lists, and, 14 presently, can only have certain capacity of 200, 15 300, depending on their location. 16 It's a rigorous process to get that census 17 capacity lifted when we submit those applications. 18 We are working closely with the State, but we 19 have to go through an application process and have 20 to meet certain criteria. 21 We understand, in regards to public 22 perception and programs, we have to understand, too, 23 we're in the middle of a crisis right now, and the 24 sooner we eliminate the capacity, the more 25 individuals we can get into treatment. 1 We ask that we be looked at just like any 2 other outpatient program that does not have census 3 capacity, and be able to show that we have the 4 staffing and the resources to be able to meet the 5 needs of the patients. We'll be able to soon -- be 6 able to get patients into programs much sooner than 7 we are now presently. 8 Lastly, we ask that you look at the 9 implementation of the managed care in a manner that 10 protects our patients, the field, and the delivery 11 of treatment services. 12 As we move our state to a full managed care, 13 we want to ensure that the services that are being 14 provided presently, continue to be provided without 15 any interruption from the managed-care providers. 16 Also, we have to look at, as a state, that 17 when we look to open an OTP, that we stand together. 18 The bias and the stigma that's associated 19 with it, to open a program anywhere, is very high. 20 We have many of the (unintelligible) saying, 21 that we're going to draw an element to the 22 community; when, in fact, we are trying to help a 23 community. 24 We need to eliminate that and stand together 25 as we open these programs. 1 I conclude by again thanking you for 2 convening these hearings, and willingness to hear -- 3 to begin the development of legislation that would 4 address the public-health crisis, and, most 5 importantly, show the residents of New York State 6 that we have a problem, and we want to work together 7 to address this problem, so that individuals that 8 need treatment can get the treatment they so 9 deservedly deserve. 10 Thank you. 11 SENATOR AMEDORE: Thank you, Joe. 12 I got a quick question for you. 13 I know you gave us three or four good points. 14 One of the questions that I have is: What 15 laws or regulations would you like to see changed? 16 JOE LaCOPPOLA: Well, I want to thank you, 17 for one, is we have the bill presently, that's 18 coming to the Senate floor for a vote. 19 That bill will allow individuals who are 20 receiving medication-supported recovery not be 21 required to be tapered off their medication, as some 22 drug courts do require right now. 23 So that's a huge bill that I ask that we 24 continue to move forward and get passage, that that 25 bill pass. 1 I think another piece of legislation, as 2 I said, is that we get some movement in regards to 3 having programs deemed. I think that that would 4 allow much more funding back into treatment, what is 5 spent right now on the resources for reviewers, and 6 we can actually treat more individuals. 7 Secondly, is, again, looking at the census 8 capacity, and eliminating that for all 9 opiate-treatment programs, and allowing programs to 10 be able to show that they're physically -- have a 11 physical plan to treat patients, and fiscally able 12 to do it and provide the staffing. 13 SENATOR AMEDORE: Thank you. 14 Anyone have any questions? 15 SENATOR MURPHY: Very quickly, Deb? 16 DEBRA RHOADES: Yes. 17 SENATOR MURPHY: Over-the-counter Narcan, 18 that you were talking? 19 DEBRA RHOADES: Yes. 20 SENATOR MURPHY: The kids are having pill 21 parties now. You, Deb, would be in charge of the 22 Narcan, to come to the party. 23 So it's a false sense of security. 24 I understand it, we are treating a symptom. 25 Totally understand where you're 1 (unintelligible), but this is exactly the next level 2 these kids have taken it to, where they come in and 3 put the pills in a bowl, and everyone picks one up, 4 and, Deb, you're in charge. 5 They make sure someone is in charge of the 6 Narcan for the party. 7 DEBRA RHOADES: Except for, it's my 8 understanding that when you revive somebody with 9 Narcan, it's very unpleasant. 10 SENATOR MURPHY: Oh, yes. 11 DEBRA RHOADES: Very, very unpleasant. 12 SENATOR MURPHY: They're very violent. Very 13 violent. 14 Secondly, drop-box. 15 Drop-boxes, you said, the Shed Your Med 16 program. 17 Senator Martins did one, I'm going to say, a 18 few months ago in Long Island. 500 pounds of 19 medication he took in, in one day. 20 DEBRA RHOADES: Believable. 21 SENATOR MURPHY: But those drop-boxes have to 22 be under supervision 24 hours a day, whether it's at 23 a police station, or get with your pharmacist. 24 And, I can't agree with you more, and I think 25 a lot of us can agree with you: 15 days in a rehab 1 is a joke. It's a waste of money. 2 Keep your money. 3 Let's just do it the right way, and that's 4 why we're trying to get -- you know, have these 5 forums. 6 DEBRA RHOADES: Thank you. 7 SENATOR AMEDORE: Thank you. 8 Appreciate it, Deb. 9 SENATOR FUNKE: It occurs to me that it's 10 about attitudes, too, and about changing attitudes. 11 Because, you know, I don't know, I watched 12 television this morning for an hour, getting ready 13 to go to the office, and so on, and I don't know how 14 many drug commercials I saw on TV. 15 But, we are producing drugs in this country 16 at such a rapid rate. And you listen to the 17 side-effect part of the commercial, you know, you'll 18 grow the head of a German Shepherd. 19 [Laughter.] 20 SENATOR FUNKE: It is longer than the 21 commercial itself, and, you know, kids see this, and 22 on and on and on it goes, and I wonder about the 23 attitudes. 24 And, I don't know, when I was a kid, I got 25 hurt, you know, I was told to "suck it up." 1 Today, we have every kind of drug known to 2 mankind as a pain reliever to deal with this kind of 3 a problem. And we've got doctors prescribing this 4 stuff over and over and over again. 5 So, you know, I just wonder sometimes about 6 the attitudes that we're all living with in this 7 society today, and how we begin to change that, that 8 a pill can fix everything in your life. 9 DEBRA RHOADES: Agreed. 10 SENATOR FUNKE: I don't know if we have any 11 answers for that, but we better start to figure it 12 out, though. 13 SENATOR AMEDORE: Thank you. 14 Next we have, Dr. Charles Argoff from Albany, 15 med pain management specialist, and, 16 Dr. Christopher Gharibo from NYU Langone Medical 17 Center. 18 And if I pronounced your name wrong, please 19 still testify, come and speak. 20 [Laughter.] 21 SENATOR AMEDORE: You know how many times 22 everyone gets my name wrong? And it's the most 23 simplest name. Easy. "I'm-a-door." 24 [Laughter.] 25 DR. CHARLES ARGOFF: Good morning, Senators. 1 SENATOR AMEDORE: Thank you. Good 2 afternoon -- or, good evening, and thank you for 3 being here. 4 And, why don't you start. 5 DR. CHRISTOPHER GHARIBO: Thank you for the 6 invitation. It's a privilege to be here. 7 I'd like to give a background on myself. 8 I'm a pain-medicine physician. I'm an 9 anesthesiologist by training. 10 I've been practicing in New York State for 11 the last 17 years, and I do both acute- and 12 chronic-pain medicine, and I believe I can give some 13 context with respect to the beginning of the 14 beginning on how opioid overprescribing can, 15 potentially, become an issue, and then give you four 16 specific suggestions on what we can do to mitigate 17 this problem as much as possible. 18 I applaud the growing concern, I applaud the 19 industry-wide effort on the part of the legislators, 20 on the part of the clinicians, and the patients, as 21 well as the pharmaceutical industry, to get ahead of 22 this problem. 23 But I think we need to have a certain degree 24 of balance within the conversation. 25 There's, clearly, abundant opioid misuse, 1 abuse, and diversion, but I think we also need to 2 recognize that there is a chronic-pain problem in 3 the country as well. 4 And to a large extent, it could be tolerated 5 and dealt with, but, we also need to recognize that 6 we are dealing with an aging population, with a 7 spectrum of pain problems, that, at some point, are 8 not good orthopaedic candidates for surgery, for 9 joint replacements, or for spine surgery, that have 10 advancing disease, that need to be functional, 11 psychosocially, physically, and in many respects. 12 And that's where a credible pain-medicine 13 program comes into play with respect to maintaining 14 our population's function. 15 So, we need to recognize both sides of the 16 issue. 17 What I have seen is that there's been a lot 18 of anti-opioid talk, and I believe a lot of it is 19 for a good reason. But I think we need to 20 acknowledge that controlled substances, especially 21 opioids, are evidence-based, to the extent of 22 evidence supporting opioid use in chronic pain, when 23 appropriately prescribed, is mechanism-based, 24 physiologically, and is literature-based, based on 25 the literature that's available out there, that's as 1 good as any, and better than most. 2 Now, I'm not here as a pro-opioid candidate, 3 but the extent of literature supporting opiates 4 expands from 3 months to 6 months, to up to 5 12 months, with good pain reduction and improvement 6 in functionality and quality-of-life parameters. 7 Now, having said that, clearly, there has 8 been an overprescribing that has developed in the 9 last 15 years, through my career, that has reached 10 ridiculous levels, usually as part of opiate 11 monotherapy, not pain medicine. 12 There is a group of drug-peddling physicians 13 that overprescribe opioid monotherapy. It's the, 14 sort of, 5 to 10 percent that calls themselves 15 "pain-medicine physicians," but are simply 16 drug-pushers that are prescribing to addicts and 17 diverters and misusers and abusers, where the doctor 18 is, essentially, acting as a dealer. 19 But, nevertheless, it's that 5 percent that 20 gives the 95 percent a bad name. 21 Appropriately trained, pain-medicine 22 physicians practice a multidisciplinary, 23 opioid-sparing, multi-mechanistic, analgesic plan of 24 care that focuses on function, not just giving out 25 opioids. 1 And I think there are a lot of legitimately 2 trained and well-meaning pain-medicine physicians 3 that are doing the right thing. 4 Now, there are many physicians that are 5 misprescribing, in good faith, and are not aware of 6 the evolving standard within pain medicine, because 7 there has been inadequate training in pain medicine 8 during their internship as residency, and throughout 9 their attendingship. 10 There has been no ongoing follow-up with 11 respect to opiate-prescribing standard of care 12 across the country, and this starts at the beginning 13 of the beginning. 14 For somebody -- for example, for somebody who 15 has had a knee replacement, that is given 16 120 oxycodones 10s, is probably not the good 17 beginning of the beginning for that individual 18 patient. 19 A subset of those patients may be at a high 20 risk for addiction, and then it starts innocently as 21 misuse, because, I want to dance a little bit more 22 at my daughter's wedding. 23 And then they get a withdrawal from that. 24 The next morning they double-up on it because 25 of that withdrawal. 1 And that's the pattern that we don't want. 2 So what I'm here to propose to you, for 3 New York State, is that many physicians out there 4 are lacking knowledge. 5 And many pain-medicine physicians that are 6 legitimately trained are not the problem, but the 7 clinical community is undertrained with respect to 8 pain medicine. 9 There needs to be a mandatory educational 10 program that covers non-opioids interventional 11 therapies, not pharmacological therapies, 12 physiotherapies, and appropriate opioid prescribing 13 that mitigates risk, where opioids are prescribed in 14 a responsible fashion, in a limited fashion, when 15 the pain is acute and subacute. And if the pain is 16 chronic, the opioids are prescribed as part a 17 multimodal or a multidisciplinary plan of care. 18 We're not in the area -- era of opioid 19 monotherapy. 20 We're in the era of balanced analgesia, where 21 the dosing needs to be reasonable and the pill units 22 needs to be reasonable. The prescriber should not 23 give three separate lines of, and four separate 24 lines of, an opioid, plus a benzodiazepine, and so 25 on and so forth. 1 And that is currently taking place in the 2 community, with a very simplistic evaluation, an 3 excessive overprescribing, poorly focusing on 4 controlled substances. 5 And when you speak with those physicians that 6 are being reviewed by OPMC, or whoever else, they're 7 saying -- all they say is, Well, aren't these pain 8 medications? 9 Well, it's more complicated than that, and 10 I really think they lack a foundation and education 11 for appropriate prescribing. 12 So I propose a mandatory educational program 13 for all prescribers. 14 I think the federal REMS can be a start, but 15 it can be expanded to include other areas of pain 16 medicine, as to how to appropriately go about 17 prescribing. 18 The second area that I think we need help 19 with is integration of the prescription-database 20 monitoring program, where it integrates with the 21 surrounding states. 22 Preferably, it should be a federal program, 23 but we need to integrate with the surrounding -- as 24 many surrounding states and second-level states as 25 much as possible, so that we know what else is going 1 on in Connecticut, New Jersey, Vermont, and so on, 2 and that we're also aware of benzodiazepine 3 prescriptions by primary care or by psychiatry or 4 any other clinician, because most of these deaths -- 5 or, about 30 percent of the deaths that are 6 occurring are due to combination controlled 7 substances that have a synergistic effect on 8 respiratory depression, and they also increase the 9 addiction risk, the psycho-active response, and the 10 withdrawal magnitude upon taking these substances. 11 Another effort that we propose, that has 12 already been mentioned, last year, Attorney Holder 13 announced an expanded drug take-back program. 14 We support a similar measure in 15 New York State. 16 This needs to be done discreetly. Maybe a 17 police station is not the best place to deposit 18 these medications. But, it really needs to be quite 19 discreet, where it is easy for the patient, and 20 practical for the patient, to be able to return 21 their unused prescriptions. And this can be done by 22 the patient or by parents or by loved ones. 23 And the fourth measure is that we're -- 24 I think technology can help us as well. 25 Appropriate prescribing needs to limit the 1 pill units, needs to be part of a combination 2 non-pharmacological and a non-opiate plan. 3 But abuse-deterrent opioids have also shown 4 to be of some benefit in mitigating risk, misuse, 5 and abuse. They have lower street value, and they, 6 potentially, prevent the most common form of misuse 7 and abuse, and that is oral. You either crush it, 8 dissolve it, pulverize it, or you solubilize it in 9 Coke, Sprite, alcohol...take your solvent. 10 And these are the step in the right 11 direction, but I believe these need to be quite 12 comprehensive. They need to cover long-acting and 13 short-acting opioids. 14 If you leave a way out, it's like squeezing 15 parts of a balloon, where, the clinician may just 16 opt to prescribe the non-abused deterrent 17 formulation, because it is cheaper to prescribe and 18 is covered by the patient's insurance company. 19 So the abuse-deterrent opioids need to be 20 covered, different molecules need to be available, 21 but they still need to be prescribed in a 22 responsible fashion. They shouldn't lower the 23 threshold for prescribing opioids, but need to be 24 made available in the marketplace. 25 So, I will sum up by saying that: We need to 1 balance the benefit and the risks of these 2 controlled substances. 3 They clearly offer benefit to millions of 4 patients across the country. They just need to be 5 given responsibly. 6 But, the doctors often lack the know-how, 7 because they lack the education, and they need the 8 tools to be able to do it the right way. 9 Thank you. 10 SENATOR AMEDORE: Thank you. 11 Doctor, you brought up an interesting point. 12 As a matter of fact, Senator Murphy and I, 13 today, had a meeting with the Chairman of the Health 14 Committee, and that's Senator Kemp Hannon, and we 15 talked about the I-STOP, and the technology and the 16 database, and how we can make it more integrative 17 with surrounding states. 18 But the statistics is astonishing, and how 19 the tracking and finding that even the shoppers of 20 doctors are, considerably, being eliminated, almost 21 80 percent, by tracking and seeing and watching 22 what's happening with the I-STOP prescriptions. 23 DR. CHARLES ARGOFF: Senator, I have -- 24 I know you may have other questions, but I just want 25 all of us in this room to feel extremely proud in 1 New York State, that that program is the best -- in 2 my -- I mean, we are national educators. And, in 3 fact, we spoke at a MSSNY-sponsored CME Pain 4 Conference recently, and work with MSSNY and the 5 foundation, to enhance physician education in 6 New York State, and beyond. 7 But, there is no better PMP in the country. 8 And the fact that it -- that none of us can write a 9 prescription for a controlled substance without 10 having to query it, we have a lot to be proud of. 11 There are many states that have APMP, but it 12 is by no means as comprehensive, and it is not even 13 man -- and it's not always mandated. 14 So I think we have -- it's a big step in the 15 right direction. 16 And I echo the Dr. Gharibo's thoughts about 17 being able to see what's going on around us as well. 18 But I think we have a lot to be proud of. 19 SENATOR AMEDORE: We do, and that was also 20 brought up, because the individuals who really 21 helped put that database, the programmers, and, 22 really, the brains behind it, were in the room, and 23 we discussed this. And we are leading the way in 24 New York State with the I-STOP, in the 25 United States, New York State is. 1 So we -- we're proud of that, and how we can 2 continue to improve it, and make sure that it's 3 really benefiting in this situation. 4 So, thank, you for that. 5 Yes, sir. 6 DR. CHARLES ARGOFF: You know, when -- 7 I heard earlier -- so I'm a neurologist by training, 8 and so I'm very nerdy, and I'm very 9 mechanistic-oriented. 10 We get along, even though he's an 11 anesthesiologist, and that's good. 12 But, you know, others pointed out earlier 13 that there's a disease of addiction. 14 And what many of us may not realize, that 15 there are 100 million adults in this country, based 16 upon an Institute of Medicine report, that 17 experience disease of chronic pain, and that disease 18 affects every part of our body, and by no means is 19 the use of opioid pharmacology and opiate 20 medications the answer. 21 But approximately five medical schools in 22 this country teach an undergraduate medical-school 23 course on pain management. 24 Comprehensive pain management is not taught. 25 The average prescriber is not -- so I echo 1 Dr. Gharibo's concerns about education. 2 The average prescriber has never had a formal 3 course on pain management. 4 We could lead the way, and we have so many 5 wonderful medical schools, nursing schools. 6 Look at this community, those of you from 7 around here, right, law school, Albany College of 8 Pharmacy Health Sciences. 9 We have so many programs that we could 10 integrate, and pave the way, to showing how we can 11 all work together to help curb disease of both 12 addiction and chronic pain. 13 Many people, a person comes in, I hate to say 14 it, a certain percentage of people in this room, 15 have both diseases. It's just the nature of being a 16 human being. 17 And so we need to all be adequately trained 18 to do that. 19 I got a referral recently from a primary-care 20 physician in Hudson Valley. 21 And, literally, I presented this to the FDA 22 at a hearing not too long ago as well. 23 And the basic referral is: This is a 24 65-year-old woman who's been under our care for 20-- 25 I'm sorry, a 60-year-old woman who's been under our 1 care for 20 years. During that time, she's had neck 2 surgery, she's had various pain complaints. She's 3 been on opioid therapy for 10 years and has done 4 well. We've tried other things: Nerve blocks. 5 Other medications. Physical therapy. Acupuncture. 6 Just living with it, as you mentioned earlier. But 7 she functions on a stable dose. 8 Then the tone of the letter in the referral 9 changes. 10 It then says: Our group practice has been 11 very concerned about the changes in the way opioids 12 are being viewed, and we've decided not to prescribe 13 opiates to anyone who doesn't have cancer. We'd 14 like you to consider taking over this person's care. 15 I'm -- I see a lot of -- I see about 16 30 patients today. That's a lot. I start at seven 17 in the morning. I work at an academic institution, 18 but I take care of real people. 19 I can't take care of everyone. 20 Chris can't take care of everyone. 21 We can't -- we need -- 100 million people in 22 this country have chronic pain. Some of them need 23 opioid therapy. 24 People are shying away from prescribing what 25 may be the best treatment for individual people, 1 because they're afraid of being chastised, gone 2 after, reported to OPMC, et cetera. 3 So, we need to find the right balance. 4 We need to be able to properly treat, both, 5 the disease of addiction, the disease of chronic 6 pain. We need to find what's best for each person, 7 but there's a huge obstacle in this. 8 And I don't know if your efforts can do 9 anything about this, but I hope they can. 10 There are views to turn opioid -- there are 11 medicines which are safer than others. 12 And, by the way, have any of you ever gone 13 and gotten Tylenol? 14 You know there's a tamper-proof top. Right? 15 It doesn't mean you can't -- isn't that 16 better than having a kid being able to open it? 17 Doesn't deter everything. 18 So, why is it that a payer of health care, 19 not a purveyor or provider of health care, can 20 decide that they won't -- they will choose to pay 21 for a less-safe medicine in a category, because they 22 don't want to pay for it. 23 How is that allowed in our state? 24 How is it allowed that a patient has to 25 default to whatever they can afford, and that may be 1 the most dangerous medication? 2 Many people who become addict -- who become 3 addicted, they -- patients -- people -- people -- 4 we're all people. Patients are people. 5 They don't go into a room and -- into an 6 office and say, By the way, Doctor, or, Nurse, 7 I just want you to know I'm a drug addict. 8 Many of us don't know what would happen if we 9 were exposed to certain substances, and how our 10 nervous systems would behave. 11 So why aren't we putting forth in 12 New York State, to help curb heroin and opiate 13 addiction, comprehensive pain management? 14 Meaning that, physical therapy is also 15 important, cognitive and behavioral therapy, 16 learning mindful meditation, all the non-medical 17 approaches, interventions. 18 This morning I spent -- I know I'm a 19 neurologist. You know, you don't think of 20 neurologists doing nerve blocks, but she knows I do. 21 I did nerve blocks. I assess people for 22 non-medical therapies through nerve blocks and 23 injections. Those are important. 24 Why are we not being person- and 25 patient-focused and finding out what's best? 1 But what's really happening, is because the 2 path -- the way that the medical care is going, is 3 the path of what is paid for. And we have to stop 4 that. And that's leading, that's leading, to heroin 5 and opioid addiction. 6 If hydrocodone and acetaminophen or oxys are 7 cheap, that's what people are getting in the 8 urgent-care centers right now. Everywhere around 9 here, that's what they're getting, they're getting 10 20 pills. 11 I have three children, two of whom have 12 undergone wisdom-tooth extractions. One on 13 Long Island, where we lived before moving up here, 14 the north shore of Long Island, and one up here. 15 Each of them got 60 hydrocodone and 16 acetaminophen pills. 17 For -- 60, with -- in those days there were 18 refills -- with refills, because that was the path 19 of least resistance. 20 But, getting back to the payers: If they are 21 not curbed, let's put -- I hate to be blunt, but I'm 22 from Brooklyn originally, so please accept that. 23 [Laughter.] 24 DR. CHARLES ARGOFF: United Healthcare, for 25 example, for example, or a publicly-traded 1 health-care insurance company -- 2 OFF-CAMERA SPEAKER: Like Blue Cross and 3 Blue Shield. 4 DR. CHARLES ARGOFF: -- or, you know -- a 5 not-for-profit, that's thing that joke. 6 But, anyway, any public -- they have a 7 fiduciary responsibility -- I'm not a lawyer, but 8 I think I'm right here -- to their shareholders 9 first. 10 That's perverse. 11 They're not providing health care. They're 12 not looking at curbing that, because they don't 13 usually cover addiction services. They're off their 14 doles once that happens. 15 You see how sick that is? 16 So they don't -- they actually allow -- 17 they're not going to -- they don't want to invest. 18 We have a -- the FDA has published guidance 19 for how industry can develop abuse-deterrent 20 opiates. 21 We have designated both short-acting that -- 22 "short-acting" means they're used -- they only last 23 a couple hours. 24 Longer-lasting, they can last 12 hours, 25 24 hours. 1 We have abuse-deterrent opioids, those which 2 have been proven to prevent abuse, not full-proof, 3 not like the tamper-proof. 4 But what would you rather: Just anything out 5 there, like, any cap that can be opened by any 6 child, or are we accepting of a tamper-proof 7 approach? 8 We're accepting of seat belts. Seat belts 9 save lives. 10 Abuse-deterrent opioids, already, with 11 extended-release oxycodone, which is Oxycontin, 12 there's epidemiologic evidence that since the new 13 formulation, which is considered abuse-deterrent is 14 out there, we now know that we can reduce morbidity 15 and mortality. We can reduce abuse and misuse. 16 Why -- why are we allowing -- it's -- pain 17 management is not about opioids only. But if 18 opioids still are an effect -- there are many people 19 who need these medications, with cancer or not 20 without -- by the way, there are more people without 21 cancer with chronic pain, than with cancer. 22 Are we going to discriminate against people 23 with non-cancer because they're not dying? 24 That's crazy. 25 But if we do -- if we're talking and focusing 1 on opioid therapy, just for a second, and there are 2 those therapies which are available, which have 3 proven to be more effective at curbing abuse, can 4 anyone on this panel please tell me why we would 5 allow a non-abuse deterrent-opioid to be sold in 6 this state? 7 I'm just asking. 8 If we all want to work together as a 9 community, I need to take care of people and 10 control, God forbid, anyone in this room should have 11 pain that needs pain control, and an opioid might be 12 what would help you. 13 Do you want me to prescribe medicine that's 14 based upon what's -- you know, not what's best? 15 Of course not. 16 So why aren't we focusing on the best and 17 most safest ways to approach this? 18 We also represent the New York State Pain 19 Society, which was developed several years ago to 20 advance the mission of comprehensive pain care. 21 And I hope that our comments have been 22 helpful. 23 SENATOR AMEDORE: Very helpful. Thank you. 24 And, I kind of understand, me personally 25 going through a recent surgery, and being treated as 1 such with different medications, and then going 2 through in the healing process. 3 It is about managing, with the whole process 4 of physical therapy, and pain management, and how we 5 can -- how I can do that without relying on one 6 specific prescription of drugs or pain pills, that 7 then could completely overtake your system very 8 easily. 9 But there's a lot of people that are needing 10 that extra help. 11 And, it's interesting, this past 12 Memorial Day, I spoke with a veteran who had back 13 surgery back in 1991, and he's still on all of these 14 various pain medications, the same that were even 15 prescribed to me just six weeks ago. 16 And I got to thinking, boy, what's the 17 difference between him and me? 18 Now, the doctors are continuing to give it to 19 him. 20 And, you know, is there a system or a check 21 in place that needs to be? 22 And it's one of the reasons why we had this 23 discussion today with the whole I-STOP, in finding 24 out, you know, how we can really target and stop the 25 overprescribing of these drugs. 1 Yes, sir. 2 DR. CHRISTOPHER GHARIBO: Just one comment, 3 Senator. 4 I think one of the problems has been in the 5 last 15 years or so, is that we sort of went through 6 an era where we thought we could treat all pain. 7 The bottom line is, we can't. We can only 8 limit it to a certain degree, and some pain is to be 9 expected and is a part of our existence, that there 10 needs to be coping mechanisms in place to accept 11 certain degree of pain. 12 But the patient comes in with the expectation 13 that we could do omnipotent, we can abolish pain, 14 which is just not the case. 15 SENATOR AMEDORE: So if I stood up right now, 16 you would totally understand that sitting down is 17 very painful for me, and I do need to kind of 18 relieve myself from the pain. 19 [Laughter.] 20 SENATOR AMEDORE: But thank you so much for 21 your coming in. It's very helpful, and it's a 22 totally different perspective that we're really not 23 hearing sometimes. And it's all about that little 24 pill that really starts this problem, but it's being 25 abused, and it's not the physician's fault. 1 But in those instances, there are physicians 2 that are kind of overprescribing, or they are 3 working the system, and they're being caught because 4 of the system, the new database, which is good. 5 So... 6 SENATOR FUNKE: I just have one question, 7 George. 8 And, you know, we can pass a bunch of laws. 9 I guess that's -- I'm new at this. 10 DR. CHRISTOPHER GHARIBO: Isn't that what you 11 do? 12 SENATOR FUNKE: I guess that's what they do 13 down here, is they pass a bunch of laws. 14 But my question is: What's going on within 15 the medical community itself in terms of discussing 16 this? 17 What's going on in medical programs where 18 docs are being trained right now? 19 Are there programs in place now where you're 20 talking about this all the time and trying to come 21 up with solutions and better programs and better 22 awareness and -- and that on your own? 23 DR. CHARLES ARGOFF: So the federal 24 government has mandated education -- has mandated 25 that education be developed -- continuing medical 1 education be developed -- it's called the "REMS" 2 programs (risk evaluation mitigation strategy 3 programs) -- for various types of pain medications, 4 so that physicians and nurse practitioners, 5 physician assistants, other prescribers, can be 6 adequately better trained. 7 There -- we -- this weekend we have a 8 three-day meeting in Manhattan, that is open to 9 anyone who wants to go, at the Marriott Marquis, the 10 New York State Pain Society, an annual scientific 11 meeting. There are multiple societies. 12 I am president of the American Academy of 13 Pain Medicine Foundation, which has launched 14 numerous education programs across the country, and 15 beyond, to do this. 16 But, it really starts at the level of 17 undergraduate medical education, undergraduate 18 nursing education, where, to the Senator's point 19 earlier, it's not about the little pill. It's about 20 looking at the whole person, getting to know how is 21 he going to recover from his surgery, maybe a little 22 medication, maybe physical therapy, maybe getting up 23 every 30 minutes so he can stretch and feel better. 24 And, how does somebody -- you learn so much 25 during your undergraduate years in medical and 1 nursing school and pharmacy school, and I think 2 would you agree that -- too, that that's how you 3 practice, going forward. We need to start earlier, 4 during the development of health-care professionals. 5 But there are many things that are going on 6 right now. 7 It's -- it's -- we are seeing nationally, as 8 well, a decrease in deaths. 9 But what wasn't made, one other point, 10 though, see, even when people are prescribing 11 medications appropriately to non-addicts, people are 12 dieing unexpectedly. 13 So we have a lot of work to do, because who 14 here doesn't want to have access for themselves or 15 their loved ones for the right medication for you? 16 And we have to be safer about it, but we have 17 a long way to go. 18 I don't know if you want to add -- 19 SENATOR FUNKE: Thanks. 20 DR. CHRISTOPHER GHARIBO: (Unintelligible) 21 Voluntary education has not worked. There are also 22 tens of thousands of physicians that are just not up 23 to date with respect to appropriate prescribing. We 24 need to have mandatory education that can be tied 25 to, for example, DEA registration. 1 SENATOR ORTT: It would be, if I'm not 2 mistaken, when you go through your CMEs, you have 3 a menu of things you can to take that year to 4 fulfill that requirement. 5 It could be added to your CME, couldn't it, 6 pain medication or pain management? 7 DR. CHARLES ARGOFF: It could be like, 8 I can't -- we can't work in New York State without 9 infection control, without child-abuse -- 10 SENATOR ORTT: You make it mandatory, so many 11 hours -- 12 DR. CHARLES ARGOFF: -- make it mandatory. 13 I know it was just fought, and I don't 14 understand how that -- that's not going to benefit 15 our state. 16 SENATOR MURPHY: I have to do it with ethics. 17 I need 13 -- I need 12 credits of ethics every 18 3 years. 19 You can make it mandatory for -- 20 SENATOR FUNKE: As a Senator, or as a 21 chiropractor? 22 [Laughter.] 23 SENATOR MURPHY: I don't know, why don't you 24 tell me, Funk. You should tell me. 25 But, you know that, in every three years, 1 there's a certain amount, that you just make it 2 mandatory. That's all. 3 Well, listen, thank you so much for coming 4 in, and I really appreciate every -- your-all 5 testimony. 6 Next we'll have Mickey Jimenez -- 7 SENATOR ORTT: Jimenez, right? 8 MICKY JIMENEZ, RN, BSN: Right. 9 SENATOR MURPHY: Jimenez? Okay. I'm sorry. 10 -- and Julie Dostal -- Dostal. 11 See? 12 Sorry. I'm bad at pronouncing names. 13 Well, thank you very much for coming tonight. 14 MICKY JIMENEZ, RN, BSN: You're welcome. 15 SENATOR MURPHY: Would you like to start? 16 MICKY JIMENEZ, RN, BSN: Sure. 17 Good evening members of the Senate Task 18 Force. 19 Let me begin by thanking you all, and all the 20 members of the Senate and your staff, for the 21 incredible effort involved in holding this, and all 22 the other forums across the state. 23 It is an incredibly timely opportunity for me 24 and other providers in the Capital District 25 treatment and recovery community to discuss a 1 problem of staggering proportions: the explosion of 2 heroin and opiate addiction in the region. 3 My name is Migdalia Jiminez, also known as 4 "Mickey," for short, and I am the regional director 5 of Camino Nuevo, an Acacia affiliate of the 6 Capital District, of the only bilingual 7 chemical-dependency program, offering both 8 counseling and methadone treatment. 9 Acacia Network is an integrated-care 10 organization with offices in New York City, Buffalo, 11 and in Albany. It is the second-largest Hispanic 12 not-for-profit organization in the country. 13 The organization's mission is to partner up 14 with its community, lead change, and promote healthy 15 and prosperous individuals and families. 16 The mission is realized through three main 17 delivery systems: primary-care health care, 18 behavioral health care, and housing. 19 With 63 years of combined experience, the 20 Acacia Network has demonstrated ability to scale 21 high-quality, comprehensive services for thousands 22 of residents. The network operates 3 methadone 23 ambulatory treatment programs and 1 methadone 24 residential treatment program for over 1100 people 25 every day. 1 While we distinguish our services from other 2 providers with the regards to our language and 3 cultural competency, our services are available to 4 English and Spanish-dominant speakers alike. 5 And while we have been open slightly more 6 than a year as an outpatient counseling, it's only 7 in the last five weeks that we opened our methadone 8 clinic here in Albany, and we have, as of this week, 9 100 people already in our clinic. 10 I have been leading the effort at 11 Camino Nuevo, "new path" in English, for the last 12 six months; yet, in the short span of time, I have 13 witnessed firsthand how great the need for treatment 14 in general, and how acute the need is for 15 Spanish-language services in particular. 16 My career in health care spans some 30 years. 17 I am a registered nurse. I have a bachelor's in 18 nursing, and some graduate work in business. 19 Needless to say, I am no stranger to the 20 world of heroin addiction, with all of its attendant 21 problems, whether medical such as HIV and AIDS, 22 hep B and hep C, or social, such as poverty, low 23 educational achievement, or domestic abuse. 24 When you come from an inner-city minority 25 neighborhood, as I did, Williamsburg, Brooklyn, you 1 see it all around you, from the time you get your 2 first warning from your parents or siblings saying, 3 Stay away from a particular corner, or, Look out for 4 the so-and-so who is known in the neighborhood as a 5 dealer. 6 And that was the public's perception of the 7 problem; that is, this is mainly a problem for 8 certain people or certain communities. 9 But the truth was almost never so. 10 Heroin has been an American problem for at 11 least a century. The difference now, is that it has 12 bled out from these communities into the suburbs and 13 rural areas with all deadly force and 14 unpredictability of a hurricane. 15 There are those more imminently qualified 16 than me to discuss the numbers and the data. There 17 is also no lack of study, either written or being 18 written, that can paint the dire picture with 19 greater effectiveness than what I can offer. 20 But having considered these questions that 21 have -- that are the subject of this hearing and all 22 of its elements, it is my opinion that all of our 23 efforts will fall short unless we change the 24 paradigm and transform the conversation. 25 In fact, we need a radically different 1 approach to this problem, and for that we need new 2 vocabulary. 3 Instead of waging a war on drugs, we need to 4 begin a campaign of compassion. 5 Instead of winners and losers, we need to be 6 pursuers of dreams and goals, trying to, each day, 7 to make it to the next without risking our lives on 8 the main streets of our cities, towns, and villages. 9 We need to go from bleakness of incarceration 10 to hope of transformation through treatment. 11 The stigma inherent in the vocabulary of 12 warfare makes people soldiers locked in mortal 13 combat. 14 In many neighborhoods of color, it makes 15 people view our police force, officers of the peace, 16 an occupying force instead of what they should be, 17 members of the community with a vested interest in 18 helping its residents. 19 If we are to lock in a war on drugs, then why 20 are so many casualties just ordinary citizens, and 21 not narco traffickers or money launderers? 22 So many years after the war on drugs was 23 declared, it's all like we're all become prisoners 24 of war, unable to escape its effect or escape from 25 becoming collateral damage. 1 I would like to conclude by saying that 2 I have a fairly unique perspective on the problem of 3 heroin and opiate addiction. 4 Beyond the confines of Camino Nuevo's clinic 5 I have become so fond of, I am a mother of two 6 law-enforcement children. My son is a 7 New York State police investigator, and my daughter 8 who works for the Attorney General as an 9 investigator. Both have firsthand experience with 10 this issue. 11 I would rather they be part of a campaign of 12 compassion than soldiers in a war of Pyrrhic 13 victories. 14 Addiction is a disease, and those afflicted 15 and those who love them married out compassion. 16 I have additional exhibits for your 17 consideration. 18 Thank you. 19 SENATOR MURPHY: Thank you so much. 20 Julie. 21 JULIE DOSTAL, Ph.D.: Thank you, Senators. 22 Thank you very much for inviting me here 23 tonight. I'm so glad to be here. 24 Thank you for convening this very, very 25 important hearing. 1 And I really want to say, thank you, for the 2 advances that were made, based on the last rounds of 3 hearings. 4 I would also be very remiss if I didn't offer 5 a big thanks to my Senator, Senator Seward, who has 6 been very, very supportive in my area, in helping us 7 work on this epidemic. 8 So I wanted to pass that along. 9 I am Julie Dostal. I'm the executive 10 director of the LEAF Council on Alcoholism and 11 Addictions in Otsego County. 12 Tonight, though, I am here representing CANYS 13 (the Council on Addiction of New York State). I'm 14 the president of that organization. 15 The councils are an interesting part of 16 New York State history. Actually, New York State 17 has the most extensive council system of any state 18 in the United States, and it is something worth 19 being very proud of. 20 Right now, currently, there are 37 councils 21 in New York State. 22 And back in the beginning, in 1988, OASAS had 23 the foresight with New York State to support 24 community members and the New York Council in 25 establishing councils all around the state, and the 1 councils have been working hard ever since. 2 We do currently have 37 members in CANYS that 3 cover the state, and we are the folks that are out 4 there doing the work; a lot of work, not all of the 5 work, but we are doing work out there. 6 And we are happy to stand in the proud 7 tradition of NCADD (the National Council on 8 Alcoholism and Drug Dependence), as was mentioned 9 earlier, founded by Mrs. Marty Mann, who was the 10 first woman to become sober in AA. 11 So it's a wonderful tradition that we are 12 happy to be out there working on. 13 We are doing the work; we are happy to be 14 doing the work. 15 Councils like to think of ourselves as the 16 friendly front porch to the community, or for the 17 community, into the prevention, treatment, and 18 recovery system. 19 When people need help, they call us, they 20 say, What do we do? Where do we go? How do we find 21 help? 22 And, in doing so, we are able to do a lot of 23 great work with families, and with youth, and with 24 schools, and people in our community. We are out 25 there, doing, and working with opiate task forces in 1 nearly every community that we're in. 2 We are helpful in helping to provide Narcan 3 trainings. 4 We are in the forefront of providing 5 universal prevention. 6 I'm going to get back to universal 7 prevention. 8 We've been working with the Combat Heroin 9 media campaign. 10 And, we do community town halls. We bring 11 the community together for discussions around opiate 12 and heroin. 13 We consult with local elected officials. 14 And, we are able to provide education, 15 information, and referral to family and individuals 16 who need and want help, and are ready to take that 17 step. 18 We have the privilege of being the neutral 19 door. We don't have a horse in the race. It 20 doesn't matter to us if people go to this treatment 21 center or that treatment center; if people get this 22 medication or that medication. 23 What matters to us is that people have a 24 pathway to recovery. 25 This is the system that, tonight, I'm very 1 honored to represent. And I want you to know and, 2 I want all of our elected officials to know, that 3 the Councils of New York State stand ready to 4 partner with this Task Force to do the work 5 necessary to save lives. 6 And that's why we're here. 7 I want to step back for just a second to that 8 idea of universal prevention. 9 I'm a preventionist, that's what I do. 10 I worked in intervention for a long time on 11 the mental-health side. I worked in a 12 crisis-intervention unit in an emergency department. 13 And the idea of being able to prevent 14 something before it ever started, called my name. 15 And that is what we do in the field of 16 prevention. 17 It's really hard to prove prevention, it's 18 really hard to prove what hasn't happened, but 19 that's the work that we do. And we want to move way 20 back and try to stop this heroin and opiate crisis 21 back at the kindergarten level before those kids 22 ever have to face it at 13, 14, and 15 years of age. 23 Unfortunately, some younger. 24 Here's what I know: For every dollar spent 25 on prevention, $7 is saved on the associated costs 1 of addiction. 2 Here's something else that I know: 3 Based on the Shoveling Up II report from 4 CASAColumbia, big, big report, it reports that 5 New York State spending on addiction and risky use 6 constitutes 21.6 percent of the state budget. That 7 constitutes $13.4 billion spent on addiction in 8 New York State. 9 This is from the CASA II report. 10 I am very sad to say, that 2 cents of every 11 one of those dollars is spent on prevention and 12 treatment. 98 cents of those dollars goes to the 13 consequences of addiction. 14 The science informs our practice in 15 prevention, and what we know, is that universal 16 prevention moves the dial. An effective long-term 17 view of the opiate crisis can only mean that every 18 child gets prevention, early, and often. 19 Currently, with state resources, we are 20 only -- now, we're 37 councils, and then all the 21 other prevention providers, I think there's a total 22 of 300 prevention providers that are OASAS-funded 23 providers. 24 Currently, with those providers, we are able 25 to reach only 8 to 12 percent of New York State 1 children in any given year. 2 8 to 12 percent. 3 To move the dial, we, as New York State, have 4 to do better. We have to do better at that. 5 Also, to go to where this particular crisis 6 has taken us, I am a preventionist, I really want to 7 look at preventing a problem before it ever starts. 8 In my community, I've had to redefine a 9 little bit what I do, because, right now, I find 10 myself, my agency finds ourselves, our community 11 finds ourself, in the position of having to prevent 12 death. Not just prevent addiction to begin with, 13 but to prevent death. 14 And I was able to submit written testimony 15 from my agency, and I believe that's submitted. 16 And -- so that was before I was asked to 17 speak as the president of CANYS. 18 So I'm going to share the last few paragraphs 19 of that testimony, because I believe that they apply 20 to circumstances that most councils find themselves 21 in. 22 The people of our community are dying because 23 of lack of access to pathways out of their 24 addiction. 25 The startling facts in my county are: 1 That we have zero Suboxone prescribers for 2 the general population. 3 We have zero methadone prescribers for the 4 general population. 5 We have zero inpatient beds within the 6 county -- within my county. 7 And we have zero sober-housing options for 8 people in crisis or people coming out of treatment. 9 When a person with addiction reaches out to 10 councils for a referral, the only quick option many 11 of us have is to offer them outpatient treatment. 12 We are very fortunate to an excellent 13 OASAS-funded outpatient clinic in our area; however, 14 for the opiate-addicted individual, outpatient 15 treatment with no withdrawal medication leaves them 16 with two gut-wrenching choices, and this is what the 17 recovering community tells me: 18 Their choice is: 19 To "sick it out" and deal with the horrendous 20 withdrawal, which an option that is universally 21 feared by the addiction population; 22 Two: Find a way to get enough drugs to stave 23 off the withdrawal. 24 People in recovery have shared with me that 25 this last option often includes committing a felony. 1 I took a quick poll of my peers and found 2 that many counties are in the same situation as 3 Otsego. 4 I do not have the full picture, but I can 5 say, without reservation, that in a state with 6 resources like New York State, even one county 7 without access is too many. 8 We would -- would we tell a person with 9 diabetes, who has no transportation, that they had 10 to figure out a way to drive more than an hour to 11 get their insulin? 12 Would we limit a doctor, who sees diabetics, 13 to 100 patients? 14 Would we -- would a doctor refuse to give a 15 patient their insulin because they weren't being 16 compliant with their dietary restrictions? 17 The answer is "no." 18 Addicted people should have the same access 19 to health care as people with diabetes and other 20 chronic diseases. 21 Our system pushes people to illegal activity 22 just so they won't get sick. 23 It is time we stopped treating addicts like 24 inmates, and began to treat them like people with an 25 illness who deserve equal access to treatment. 1 So what do we need? 2 One: We need universal, evidence-based 3 prevention. 4 Number two: We need equal access to all 5 paths of recovery. 6 Number three: We need safe and sober housing 7 for people who want recovery; affordable housing. 8 And, number four: We need no limits on 9 doctors who want to treat people with addiction. 10 Thank you for your time and consideration in 11 hearing my testimony. 12 We are heartbroken in our area. Too many are 13 dying, and too many families are impacted in 14 extremely negative ways. 15 Councils stand ready to stand with you as we 16 work to solve this problem together. 17 Thank you. 18 [Applause.] 19 SENATOR AMEDORE: Thank you. 20 Julie, could you go back and hit Point Number 21 2? 22 JULIE DOSTAL, Ph.D.: Point Number 2, yes, 23 sir. 24 Equal access to all paths of recovery. 25 Whether that includes inpatient treatment, 1 outpatient treatment, medication-assisted treatment, 2 straight from use to recovery without treatment, 3 sober housing...all of those things. All pathways. 4 In my field of work, and with councils, we 5 respect all paths of recovery. 6 And we think that, since it is an illness, 7 that the pathway to recovery should be between a 8 patient and their doctor. 9 SENATOR AMEDORE: You know, one of the things 10 that we looked at during the budget process -- 11 I chair the Alcohol and Substance Abuse Committee -- 12 in speaking with OASAS and the Commissioner, you 13 always hear these stories that there's long waiting 14 lists, and there's long waiting lists for treatment 15 centers and for a bed. 16 And then you talk to others, and there's no 17 waiting lists. As a matter of fact, we got all 18 kinds of beds that are open and vacant. 19 And so, you know, in this process, we have to 20 kind of divert our resources, because, as you've 21 said, there are counties that don't have anything. 22 And I just don't think that it's right to 23 have families or a patient having to travel 4 hours 24 to get to a bed, and then stay there just for 25 7 days, or maybe 14 days, and think that the problem 1 is solved and it goes away. 2 So, we are working on that. 3 JULIE DOSTAL, Ph.D.: Thank you. 4 SENATOR AMEDORE: It's something that our 5 Committee, I'm committed, as a Chair, to try to make 6 sure that we have the funds, but the bed's available 7 across the State of New York. 8 JULIE DOSTAL, Ph.D.: Thank you very much. 9 SENATOR AMEDORE: And I know, Senator Ortt, 10 he chairs Mental Health. 11 Correct? 12 SENATOR ORTT: Yes. 13 SENATOR AMEDORE: He and I have had some 14 field trips as well, and -- in looking at this 15 problem. 16 So, we're working on it. 17 JULIE DOSTAL, Ph.D.: Thank you. 18 SENATOR AMEDORE: You're welcome. 19 I'm sorry, Mickey, if I missed -- did you 20 already -- 21 MICKY JIMENEZ, RN, BSN: Yeah, I did it. 22 SENATOR AMEDORE: Okay. 23 Thank you so much for attending and being 24 here. 25 Your submitted report and testimony is much 1 needed. Appreciate it. 2 SENATOR AMEDORE: At this time, I'd like to 3 call up, Robert Lindsey, CEO of Friends of Recovery, 4 and, John Copolla, executive director of Alcoholism 5 and Substance Abuse Providers in the state of 6 New York. 7 ROBERT LINDSEY: My name is Bob Lindsay. 8 I am the CEO of Friends of Recovery - New York. 9 We represent the voice of individuals and 10 families living in recovery from addiction, families 11 living with active addiction, families who have lost 12 a family member to addiction, or people who have 13 been otherwise impacted by addiction. 14 I want to thank all of you for your 15 leadership in hosting these hearings, and I can do 16 that at length, but I really want to focus on the 17 comments. 18 Number one, I am absolutely living proof of 19 the value of New York's prevention efforts. 20 I started in this field as a volunteer when 21 I was in college, connected to a local Council on 22 Alcoholism and Drug Abuse. I chaired a local 23 narcotics guidance council when I was still in 24 college, and there I learned that addiction is a 25 primary, chronic, progressive, fatal, if untreated, 1 and genetically-predisposed, disease, like other 2 chronic diseases which run in my family, heart, 3 diabetes, and cancer. 4 And, for me, since 1976, made the choice not 5 to use alcohol and other drugs, and the reason's 6 simple: 7 I have 11 family members living life today in 8 recovery from addiction, ranging from a cousin who 9 is 36 years in recovery, to my brother-in-law who is 10 now 30 days in recovery. They are nurses, corporate 11 executives, teachers, businessmen, musicians, and 12 moms and dads. None of them ever chose to become 13 addicted. 14 Plain and simple, their body responded 15 differently to the effects of alcohol and drugs than 16 other people. 17 It has to be overwhelming for you to sit here 18 today, and as you have in all the other hearings, 19 and to listen to the pain and the suffering, and the 20 scope of the problem. It is so far-reaching. 21 It must feel at times that it is hopeless, 22 and you must ask yourselves: Can we make a 23 difference? Is there hope? Where do we begin? How 24 can we help? 25 The reality, it is all about the miracle of 1 recovery. 2 I have been privileged to help, both directly 3 and indirectly, thousands of individuals and 4 families, and much of that was doing direct clinical 5 work. 6 And I loved it, and I was good at it, but 7 I stopped doing it, because I saw too many people 8 die, not because we couldn't help them, but because 9 what they needed was not available to them, and 10 decided the policy is what this is really all about. 11 Fundamentally, we've got to change the way we 12 do this. 13 It is time to stop investing in the problem: 14 active addiction. 15 Time to start investing in the solution, 16 which is all about recovery. 17 The hearing today is focused around heroin, 18 but as Deb so well said: Heroin is the battle. 19 Addiction is the war. 20 This is not just about heroin. 21 And, again, we cannot repeat what we did with 22 drinking and driving. We've been effective. We 23 reduced 28,000, down to 10,000. 24 But the reality is, now, 88,000 people a year 25 die from alcohol-related deaths. 44,000, all other 1 drugs. 15 people per hour. 2 22 million people live with active addiction. 3 $57 million per hour is the cost that you and 4 I pay as taxpayers for the consequences that Julie 5 talked about. 6 The solution, real simple, is all about 7 recovery. 8 23 million people today live life in 9 recovery. 10 The world at large is clueless to that fact, 11 because they do it quietly, they do it silently, 12 they do it in secret, in too many cases. 13 They have shifted from being a tax burden, to 14 a taxpayer. 15 78 percent went on to further their 16 education, in their recovery. 17 28 percent have started their own business, 18 in recovery. 19 87 percent vote. 20 84 percent volunteer in their community. 21 They are breaking the cycle of addiction in 22 their family. 23 They've reduced arrests, from 53 percent, to 24 5 percent. 25 On, and on and on. 1 That is the value of what recovery is all 2 about. 3 With one individual, lifetime savings of 4 $3.2 million to $5.2 million. One person, that's 5 what we're talking about. 6 Next point: Family, family, family. 7 This is a lot about facts and data, but this 8 is really about heart. 9 Plain and simple, hearts are breaking all 10 over New York State. Families are absolutely 11 desperate for a neutral resource that they can go to 12 to get the information they need as primary client; 13 somebody to sit down with me, help me understand 14 what addiction is, how it's affected my family 15 member, how it's affecting me, and what we need to 16 do together. 17 So frequently, they are viewed only as an 18 attachment to the patient. 19 They need to be seen as primary client. 20 Next one: We need to change the conversation 21 from the drama and the chaos of active addiction, to 22 the hope and health of recovery. 23 And to do that, Friends of Recovery - 24 New York, with support from OASAS, is launching a 25 groundbreaking initiative to educate and engage 1 millions of New Yorkers and families who are living 2 in recovery, families who have lost family members, 3 and people who have been impacted by addiction, to 4 really give a voice to recovery. 5 For decades, shame and stigma have kept too 6 many of us quiet. 7 We will be silent no more. 8 Stigma and discrimination: 9 Stigma and shame prevent millions of 10 individuals and families from seeking help. 11 We are dedicated to breaking down the 12 barriers that are created by stigma, that result in 13 discrimination, and that discrimination plays itself 14 out in policy, whether that be access to treatment, 15 whether it be in housing, whether it be education, 16 or employment. 17 So, our call to action, we want to be very 18 specific here in terms what have we want to 19 recommend, and I've included here a very interesting 20 quote from the police chief in Gloucester, 21 Massachusetts. 22 He says, "I've never arrested a tobacco 23 addict, nor have I ever seen one turned down for 24 help when they develop lung cancer, whether or not 25 they have insurance. The reasons for the difference 1 in care between a tobacco addict and an opiate 2 addict is stigma and money; petty reasons to lose a 3 life." 4 So recommendation number one, is that it is 5 all about making this a priority in terms of 6 funding. 7 OASAS is grossly underfunded in terms of 8 dollars and resources. 9 The increase in the mental-health budget this 10 year alone was equal to the entire budget of OASAS. 11 Plain and simple, we are not making this a 12 priority, when we're spending $4.4 billion on 13 developmental-disability services, $3.9 billion on 14 mental-health services, and less than $600 million, 15 total, on alcoholism and addiction services. 16 So, what we need to do: 17 Number one: We need to expand support for 18 public awareness of addiction and recovery. 19 The Combat Heroin campaign has been terrific. 20 It has raised awareness of the problem, increased 21 hope for recovery, providing information about how 22 to get help. But, we need to invest in this 23 campaign, going forward, and we need to make it 24 available all the time. 25 The only time that somebody knows what 1 resources are out there is when they start looking. 2 So if we don't make it available all the time 3 when they need it, they may not have any idea where 4 to go or who to call. 5 Family education and recovery support: 6 Again, as I said earlier, families are 7 desperate for that resource that is neutral, as 8 Julie referenced, in terms of the role the councils 9 play. 10 Years ago, I met with a CEO of a Fortune 500 11 company, who came to me because of his wife's 12 alcoholism and addiction, and he said, I don't have 13 a clue as to what to do. 14 And I sat with him and I said, Here's what 15 alcoholism and addiction are. Here is how your wife 16 has been affected. Here is how it's affecting your 17 family. Here's what we need to do, together, going 18 forward. 19 He said, My father died of alcoholism. My 20 brother died of alcoholism. My wife is dying of her 21 addiction. I have been to psychiatrists, social 22 workers, clergy, and everybody, but nobody has ever 23 helped me understand, until now, what we need to do. 24 And his wife is now 14 years in recovery. 25 They have a son who is now six years in recovery, 1 married with three children. 2 We need to expand access to addiction 3 treatment through insurance coverage. 4 Insurance pays all of the consequences for 5 someone's active alcoholism and addiction, and, 6 regrettably, far too infrequently, pays to actually 7 provide treatment for the disease, which is the only 8 way out. 9 Next one, physician education, we heard about 10 it before. 11 We need to pass Senate 4348, requiring that 12 physicians receive education on addiction and 13 prescription medications. 14 We need to provide more access to 15 medication-assisted recovery: Suboxone, methadone, 16 Vivitrol, etc. 17 Regulation of sober-recovery homes. 18 We have a major crisis going on in New York, 19 if you read "New York Times," with an outrageous 20 organization that is providing services to people in 21 recovery, and not providing them the help and 22 support that they so desperately need. 23 For those who go through a reversal with 24 Narcan, we need to get them engaged in treatment. 25 And then my last point, is that we need to 1 invest $30 million in recovery support-services 2 infrastructure. 3 One of the biggest gaps in the system, is 4 that when people leave treatment, when people leave 5 correctional facilities, they do not have the 6 supports needed and necessary to support their 7 ongoing recovery in the community. 8 I lost a very good friend this last year, and 9 his son, both, because of their addiction, and this 10 was exactly the reason: not the support in the 11 community they needed. 12 We need local recovery community 13 organizations, which we are committed to developing. 14 These are individuals and families that want to give 15 back and help others. 16 We want to build recovery community centers 17 in communities across the state. 18 And we need to engage peer recovery support 19 across the board, because these are individuals with 20 lived experience with alcoholism, addiction, and 21 recovery, either as an individual or family, who can 22 provide an invaluable role of support throughout. 23 So my last comment, and this comes from one 24 of the women sitting behind me who testified at a 25 Recovery Talks Community-Listening Forum, that four, 1 hosted in Saratoga on April 30th. 2 And she says, "Finally, recovery is made up 3 of many miracles, but finding a place for help 4 should not have to be one of them." 5 Thank you very much. 6 [Applause.] 7 SENATOR AMEDORE: Great testimony. 8 Rob, where did the $30 million come from. 9 ROBERT LINDSEY: The $30 million, in terms of 10 the reinvestment -- 11 SENATOR AMEDORE: Is it a number that -- is 12 there data backing it, or is it just an idea, or a 13 wish-list? 14 ROBERT LINDSEY: No, I mean, we do have some 15 data that we can back it up with. 16 Essentially, what we're saying is, we need a 17 recovery community organization built in every 18 county. 19 And what we're doing on this one in 20 particular, in many cases what we're doing, is 21 partnering with the local council, which has been a 22 voice in that community for many decades. 23 And what we're doing is, becoming a program 24 of the council. That way, all the volunteer life 25 and energy behind it gets devoted to going out into 1 the community and doing the work. 2 So the $30 million is about building the 3 recovery community organizations, and, opening the 4 recovery community centers. 5 SENATOR AMEDORE: Okay. I get the use for 6 it. I just -- $30 million, when you're dealing 7 with, sometimes, a state budget, and you're looking 8 at billions of dollars. Or some people say, when 9 you look at OASAS's budget, like you said, it's 10 grossly underfunded. Grossly, without question. 11 And if the federal government even gives -- 12 passes down 9, 11 million dollars, $30 million 13 seems -- you know, seems like a lot of money, on 14 paper here, for the whole entire state. 15 And that's why I asked where the 30 -- 16 ROBERT LINDSEY: Well, I think, ultimately, 17 the question is: Do we care about people that 18 suffer from alcoholism and addiction: yes or no? 19 And if we do, we have got to put up the 20 money, plain and simple. 21 I mean, it's really that simple. 22 [Applause.] 23 ROBERT LINDSEY: And these are individuals, 24 many of them who are here, we're paying our taxes 25 like everybody else. And we're saying, this is a 1 priority, and we've got to back it up. 2 I mean, that's really where we are. 3 That's the choice we have to make. 4 SENATOR AMEDORE: Great. Thank you. 5 ROBERT LINDSEY: You're welcome. 6 SENATOR AMEDORE: John, how are you? 7 JOHN COPPOLA: Good, good, good, Senator. 8 You know, I want to start my remarks, first, 9 by just pointing out, Senator Amedore, 10 Senator Marchione, Senator Murphy, and Senator Ortt, 11 as I was listening to the testimony, I was thinking 12 to myself, none of you are responsible for the 13 system that we have in place right now. You're all 14 relatively new to the Senate, and, it puts you in an 15 unenviable position, that if you wanted to champion 16 something, you know, maybe you would be up against 17 whatever the rules of the -- you know, the Chamber 18 are, whatever the rules are in the Assembly, or 19 whatever, you know, the dynamic is between the 20 Governor and the Senate and the Assembly. 21 And, so, to think about, you know, something 22 landing on your laps like this crisis, and having to 23 sit through the testimony that you sit through, if 24 you said, Okay, so, this is a crisis, it's an 25 epidemic, and we want to do something about that, 1 right, and I would go immediately to your question, 2 Senator Amedore, about the $30 million, which, 3 again, as I listened to Bob, think about $30 million 4 and those other budgets, is a rounding error. 5 It's a rounding error. 6 And so -- but you're so correct, when we 7 reduce the conversation -- and it should never, 8 ever, be reduced to this -- when we reduce the 9 conversation to, What is the current OASAS budget? 10 And what is the current system? And the Governor's 11 2 percent cap, and we got to be mindful of that, and 12 we can't do something in OASAS, we can't do it in 13 other places, we're now subscribing to an absolutely 14 horrific way of thinking about, you know, this 15 issue. 16 When Julie gave her testimony, and she went 17 through this litany of services that are not 18 available in her community, and we think, okay, so 19 how do we stretch that just a little bit, and think 20 about some family that needs those services? And 21 then, physically, what do they have to do? 22 Mom gets on the phone, dad gets on the phone, 23 we start calling the people that we know. We start, 24 you know, looking. 25 And so what does that feel like, and, what 1 does it feel, like that person who is ready for 2 treatment, and there is none anywhere close to home? 3 And, so, this is dropped in your laps, day 4 one, when you walk into the Senate. 5 And so, you know, on some level, what can we 6 do to help you? 7 All right? 8 But it is, totally, 100 percent, unacceptable 9 what we're putting on your plate and asking you to 10 sort of do a report to fix this. Right? 11 So I think that, you know, it's a little 12 ridiculous to talk about $30 million. 13 But when we go to Julie's example of what 14 it's like in our county, and we start thinking and 15 start asking Bob, So, Bob, tell us. Right? 16 Bob, you tell us what we have in recovery 17 services; not, OASAS, please tell us what you have 18 in services. 19 Because OASAS is going to tell you about the 20 good work that they've done. They're not going to 21 tell you about the ridiculous amount of work that 22 still remains to be done. 23 SENATOR AMEDORE: They're the ones that say, 24 there's is no waiting list. 25 JOHN COPPOLA: Right. So -- 1 SENATOR AMEDORE: There's no empty beds. 2 JOHN COPPOLA: -- Senator -- Senator, let's 3 talk about that for a minute. All right? 4 Let's talk about that. 5 So in your backyard, right, I get a phone 6 call. 7 I know the system, I know the names, I got 8 the phone numbers. 9 Somebody calls me and says, I got a 10 23-year-old, who's addicted to heroin, who wants 11 help, and wants it now. 12 My first question is: Where are they? 13 Part of me is hoping that they're in jail, 14 because that will buy me a little bit of time, you 15 know, to see if I can find a bed. 16 So I call Hope House. Hope House had a 17 waiting list at the time. 18 I called Hospitality House. Hospitality 19 House was full. 20 This was somebody who has been in and out of 21 treatment multiple times, and my instincts said to 22 me, long-term residential treatment is what this 23 person needs, or, or, medication-assisted treatment. 24 What is the waiting list at Whitney Young 25 right now? 1 Acacia Network comes to Albany, God bless 2 them, they open up a clinic, and we have 100 people, 3 did I hear that, in the first month? 4 MICKY JIMENEZ, RN, BSN: Five weeks. 5 JOHN COPPOLA: Five weeks, 100 people. 6 Okay. So, if we simply say, what is the 7 minimally acceptable level of services for us to 8 have? Right? And, then, how do we construct that 9 system? 10 So what we don't do, is we don't wave a magic 11 wand at OASAS and say, Okay. 12 So what we do -- 13 And I hope that you're all around for a long 14 time to be working on this over the course of time. 15 -- but, how do we build a system that is 16 okay? 17 So, Senator Amedore, it is not okay for 18 anybody to tell you there's no waiting list, because 19 if you scratch below the surface, we're playing 20 games with words. 21 Crouse Hospital in Syracuse has a waiting 22 list of over 300 people. 23 As far as I'm concerned, there is no 24 conversation about why, right, because you're going 25 hear 15 reasons why we have a waiting list, and why 1 we need to jump through 8,000 hoops to create at 2 least some additional treatment for the folks. 3 Right? 4 So if the conversation was not about, why do 5 we have waiting lists in Syracuse? but, how do we 6 create treatment on demand in New York State? 7 How do we make sure, as Julie pointed out a 8 little bit earlier, prevention, right, what 9 resources are currently being committed to 10 prevention in New York State? 11 How does that compare to resources that were 12 committed 10 years ago or 20 years ago? 13 The federal government bailed on 14 New York State and the other 49 states when it 15 eliminated safe-and-drug-free schools. Right? 16 So was there an alarm that went off in the 17 Capitol, and we said, What can New York State do to 18 fill the hole created in our prevention system? 19 No, no, there wasn't. 20 No, there wasn't. 21 So we have about a third to half the number 22 of school-based people in our prevention system 23 right now that we had back in the '60s during that 24 heroin crisis, and during the '70s. 25 So we have a depleted workforce doing 1 prevention in our schools and communities, and we -- 2 and at a time when there's this demand. 3 Right? 4 So, again, it's unacceptable. 5 It's a bigger problem than we're going to 6 solve by waving a magic wand, but, I think if we 7 have a conversation about what each one of you in 8 your district, right, just in your district, be 9 selfish about this, what is reasonable for the 10 people in your district? 11 What do you want in the way of prevention? 12 What do you want in the way of treatment? 13 And what do you want in the way of recovery 14 supports? 15 I don't think $30 million is going to give us 16 a recovery center in every one of the counties, and 17 in some reasonable distribution on Long Island and 18 New York City, Rochester, Syracuse, and any other 19 place where we have a high concentration of folks. 20 Right? 21 But, again, I think there's an academic 22 question here about, what is reasonable? 23 Right? 24 So what is a -- I think this is a fair 25 question, I think: What's reasonable? 1 What's the reasonable distance to drive every 2 single day to a methadone clinic to get your 3 medication? 4 What's reasonable: an hour? two hours? 5 three hours? four hours? 6 I mean, some people do it every day, 7 three hours, and four hours, one way. Right? 8 Okay. So that's not reasonable. 9 It's indefensible, and it's not acceptable. 10 Right? 11 So I would just suggest that, as it relates 12 to waiting lists, there should be none. 13 So the question is: How do we eliminate all 14 of them? 15 And I'm not -- you know, I don't think we 16 should be interested in whether we're talking about 17 licensed capacity or treatment capacity or the 18 census. These are words that are code words for 19 regulations and a bunch of other things that, 20 frankly, I don't think the moms and dads in this 21 room who have lost children, who haven't been able 22 to get their kids in, I don't think they could give 23 a darn about anybody's census or license capacity or 24 anything else. 25 But when somebody needs treatment, how do we 1 get them in, and what's reasonable? 2 Right? 3 Again, so I would just like to, sort of, 4 frame the question there. 5 I would like to talk about one specific issue 6 that hasn't been touched on tonight, which is -- 7 and, again, the things I'm talking about, in my 8 view, are not acceptable and they're indefensible. 9 So when Governor Pataki was governor, he had 10 a brilliant idea, that we should create more 11 community-based detox. 12 Why? 13 Well, because not everybody who was being 14 detoxed in a hospital setting needed to be in a 15 hospital setting. 16 So the idea was, to create this less 17 expensive and more appropriate community detox 18 system, so that not everybody who needed detox would 19 have to go into a hospital if there wasn't a medical 20 need for it. 21 So what do we have 20 or 30 years later? 22 We have less community detox. Less, not 23 more. Less community detox. 24 And in the wonderful programs that we've just 25 sort of constructed to drive down Medicaid costs in 1 New York State, only 4 of the 26 DSRIP projects have 2 detox as one of the main projects that they're 3 working on. 4 So -- so what we could easily do, is take a 5 look -- and, again, it's hard for me to imagine that 6 we wouldn't want to have some kind of detox 7 resources also available in every county in the 8 state, within driving distance, so the police, 9 et cetera, could drop people off and let them get 10 detoxed in a community setting. 11 So, again, I would sort of leave that on your 12 laps as a reasonable topic that's been talked about 13 for years, and it's not acceptable for us to have a 14 conversation about why we haven't solved this 15 problem. 16 Right? 17 We've come up with rates that are horrible. 18 There is no incentive for people to start that 19 business in the first place. 20 And, again, if it's less expensive than being 21 in a hospital, why in God's name wouldn't we give 22 people the rates they needed to pay their expenses 23 to provide the service? 24 Right? 25 So if people go bankrupt -- and we had a 1 meeting in Senator DeFrancisco's office. 2 Representative from Crouse Hospital, 3 representative from Syracuse Behavioral Health Care, 4 both of whom do detox in the communities, both of 5 whom said to Senator DeFrancisco, We will be 6 closing our community detox programs. 7 Why? 8 Because they're sucking the money out of our 9 whole agency. It's a service that's losing money, 10 and it's just draining the resources for our 11 organization, and we're not going to be fiscally 12 viable. 13 So that's not acceptable. 14 And I think he recognized that, and I think 15 that's something we really have to look at, because 16 what parents are being told, is it's not medically 17 necessary to admit your child to the hospital, or, 18 what adults are being told, your husband or wife, 19 it's not medically necessary to admit them to a 20 hospital. So what -- and, we don't have a 21 community-based alternative. 22 So where do you go, and what do you do? 23 You get arrested. 24 You know, please, God, you get arrested, and 25 you detox on the floor of your cell, maybe. Right? 1 So, again, I would just like to suggest that 2 there are a host of unacceptable things about this 3 system that you inherited. It does not -- you did 4 not create it. 5 And I'd like to think that you each will make 6 a decision that somehow you'll find a way, when you 7 do whatever report you do, that you're going to be 8 the champions of whatever the recommendations are 9 that you make, and to the -- you know, to the extent 10 that some of them might not be politically correct, 11 right, in terms of budget recommendations. 12 You know, I mean, I remember one of the 13 things I learned, and I'm -- I'm just as guilty as 14 anybody who works in any of the chambers, you know, 15 this Albany lingo that we use. Right? 16 Will our budget request -- and this is 17 something we talk about: Will our budget request 18 pass the "laugh" test? 19 Right? 20 So we make a reasonable request for support 21 for people who have addiction, and we have to figure 22 out what the "laugh" test is. 23 You know, what's the number, you know, the 24 magic -- so there is no science to this number, so 25 what's the number that's not going to be -- that 1 will sort of fly under the radar, that maybe we can 2 work with you-all to try to squeeze out of the 3 budget? 4 Right? 5 That's not acceptable when we're talking 6 about a crisis. 7 So I will end my testimony here by saying, 8 you know, I have testimony from the New York Society 9 of Addiction Medicine. 10 They're very concerned about physician 11 education. You heard about that a little bit 12 earlier. 13 There are folks who are really looking at the 14 possibility of mandatory physician education so that 15 we're not prescribing inappropriately, and that's 16 something I think really deserves attention. 17 The whole access to addiction medicine is 18 something that the society is concerned about, 19 particularly addiction medicines, et cetera. 20 Bob mentioned the insurance issue, and I'll 21 leave that alone. 22 I, again, would suggest that your final 23 report be balanced; that you talk about prevention, 24 you talk about treatment, and you talk about 25 recovery support, and that we really look at, you 1 know, what is there that we need to do in each of 2 our counties to make sure we have a comprehensive 3 continuum of services? 4 Thank you. 5 SENATOR AMEDORE: Thank you, John. 6 [Applause.] 7 SENATOR AMEDORE: You're right, we did not -- 8 we inherited this. 9 But I can tell you that this team up here has 10 already been willing to stand against status quo in 11 Albany, in many different ways. 12 [Applause.] 13 ROBERT LINDSEY: Just one point I want to 14 make, in terms of the myth of the waiting list. 15 We send thousands and thousands of 16 individuals out of New York State for treatment 17 because it's not available here. 18 When families hear "wait list," they say 19 "unacceptable," and they send their kids to 20 Pennsylvania, to Florida, to California. 21 When I was at the Betty Ford Center, our 22 number-two source of referral was New York State. 23 It's unacceptable. 24 It is absolutely unacceptable, because the 25 capacity to put together a continuum of care, when 1 we're sending people two or three thousand miles 2 away from hope, is very, very problematic, to say 3 the least. 4 JOHN COPPOLA: And just one other final 5 point. 6 You know, when you start thinking about 7 adolescents, or you think about women with children, 8 senior citizens, you know, to what extent are there 9 specialized services available, not necessarily in 10 every community, because that might be a little 11 excessive, right, if we don't have enough of a 12 population in that particular area? 13 But at least, regionally, to have services 14 available for senior citizens who have addiction 15 issues, for women, for young adults, young working 16 adults, right, who have addiction issues. 17 These are all important issues for to us 18 think about. 19 SENATOR AMEDORE: Certainly are. 20 Thank you. 21 ROBERT LINDSEY: Really appreciate your 22 support. 23 SENATOR AMEDORE: Next up we have, 24 Lisa Wickens-Alteri, and, Patty Farrell. 25 Now, the titles I could say are "moms." 1 How's what? 2 And Lisa is the president of Whiteman, 3 Osterman & Hannah, Health and Human Services. 4 And, thank you for being here. 5 LISA WICKENS-ALTERI: Hi. Good evening. 6 So I'll try to make this brief. I know that 7 we're losing people quickly. 8 I want to thank you for being here, and 9 having this, the Task Force. 10 I've been involved with this, and was 11 happy -- Senator Marchione actually invited me last 12 year to speak, and was thrilled some of the 13 legislation got passed last year. 14 So I did bring notes so that I wouldn't get 15 too emotional. 16 So I'm a mother of an individual with 17 substance-use diagnosis, currently in recovery. 18 I'm a registered nurse, and, formerly, I'm 19 the deputy director of the Office of Health Systems 20 Management for the Department of Health. 21 My role was oversight of many divisions, 22 including, but not limited to, surveillance of 23 hospitals, nursing homes, bioterrorism, health-care 24 reimbursement...the list kind of goes on and on. It 25 was a big job, and it was one of the reasons I left. 1 The other reason was, because I couldn't 2 afford to get my son treatment. 3 I have told my story too many times to 4 recount, but my purpose here has been to raise 5 awareness of substance use, specifically of opiates. 6 Without explaining the horrific stories we 7 went through, I believe the following illustrates 8 our experience with addiction. 9 I looked into your eyes, I watched your gait, 10 and I wait for the nod. I count your respirations, 11 take your pulse, and keep watch through the night. 12 I attempt to listen to your phone 13 conversations, not wanting to know, but afraid not 14 to listen, so I can stop you, maybe protect you. 15 The hospital calls. You were found not 16 breathing. I rush to your side. I rub your sternum 17 to keep you breathing. 18 You made it for now, but what will tomorrow 19 bring? 20 10 years. 21 My family and I spent 10 years living this 22 scenario over and over and over again. 23 And I mentioned to you, I was the deputy 24 director of the Office of Health Systems Management. 25 I knew all the people in the hospitals, I knew the 1 people across the country, and I worked with CMS on 2 a daily basis, but we couldn't get answers. 3 I lost a stepson to suicide because of his 4 addiction. 5 When I was told, "You need to come," by the 6 police, "but you need to bring a ski hat before 7 they'll let you see him." 8 This is the disease that is just as deadly as 9 heart disease or cancer. 10 The purpose of this forum is to hear 11 recommendations regarding raising awareness, 12 treatment options, preventing addiction, and 13 informing people of the dangers of drugs, and, what 14 action can our state and communities take to prevent 15 potential drug-related crimes and keep heroin off 16 the streets? 17 First, this forum needs to continue. 18 So, again, I thank you, and I commend you for 19 your efforts. 20 Last year we began to share our stories, 21 because people in the suburbs of New York State 22 didn't believe it was happening in their backyard. 23 It is; it continues to do so. 24 Recent headlines point to the fatality of 25 using heroin laced with fentanyl. 1 Some recent studies indicate that the peak of 2 this heroin epidemic isn't going to reach until 3 2017. 4 So raising awareness needs to continue. 5 Last year we passed a comprehensive set of 6 laws that addressed barriers to treatment, improving 7 public education, inclusion of educational programs 8 in our schools that are specific to popular drugs in 9 our communities and updated every three years, 10 increased naloxone, for instance, just to name a 11 few. 12 That education that we had said we need, 13 comprehensive education, based on developmental 14 levels of the children, and based on the drugs that 15 are in vogue in this time, still hasn't happened 16 yet. 17 I believe we need to continue to empower 18 change, and charge our communities and leaders and 19 parent advocates, to give them the tools that they 20 need to coordinate positive forums like this one. 21 We need to organize and hold forums that are 22 specific to what our communities are asking for, 23 including topics such as: 24 Where do I go to talk to someone about 25 substance abuse for myself, my spouse, my child? 1 Are there pediatricians with experience in 2 this area? 3 I have a 15-, 16-, 17-year-old at home that 4 as abusing substances. What do I do to protect 5 myself, my family, and my home. What are my 6 options? 7 We need to develop a warm hotline. 8 We have a hotline. You can call and you can 9 find out, when you call, and, you know, where are 10 the treatment centers? and things like that. 11 But not a day, a week, goes by that I don't 12 get an e-mail. 13 I've gotten emails, I've gotten calls, from 14 Senators, Assemblymen, from across the state. I've 15 gotten calls from government-relations people down 16 in Long Island, saying, Can you help me? 17 I'm in Albany, but, we're making the call. 18 I sit there, we talk. We try to get -- I listen. 19 And we need a hotline to talk to these 20 parents, and to these uncles, nephews. 21 I'm actually getting calls from people at the 22 hospital association. I've worked with these people 23 for 20 years. They're experts. They know as many 24 people as I do, but they're calling. They're not 25 calling the head of OASAS. They're not calling, you 1 know, the big addiction centers where we know 2 everybody. 3 They're calling because they need someone to 4 talk to, someone that's real. 5 What do I say? How do I talk to my nephew 6 about this? What's going to actually reach him? 7 And so my answer is, Tell him you love him, 8 tell him you're right there with him, and I'm going 9 to stick by you, and I'm not going to give up. I'm 10 here. 11 That's my answer. 12 I'm a registered nurse, but I'm not a 13 counselor. 14 But we do need a hotline, and something 15 that's supported. 16 I know that there's probably hundreds of 17 parents that would step up and do this. 18 I already said, I'll do it. I'll take three, 19 five hours a week, and just answer the phone. 20 At one point I was calling every rehab 21 I could find on the Internet, just to talk to 22 someone, and listen. 23 Now, their motivation was, they wanted 24 admission. But I wanted someone just to talk to 25 that was empathetic, that understood. I knew that 1 they didn't care, but I wanted to listen -- I wanted 2 someone to listen to me. 3 Treatment options, our culture, you know, 4 what is medication-assisted treatment? 5 You know, it's one of the reasons my son's in 6 recovery right now, is because there is 7 medication-assisted treatment. 8 The problem is, going back to the original 9 conversation that Bob and other people have raised, 10 is that there's a certain stigma in this area of 11 medication-assisted treatment. 12 And some of the best experts in addiction 13 have said: Heroin and opiates is a really different 14 addiction. It's tough. 15 And every addiction is hard. 16 And I don't want us to ignore any of them, 17 but the one I am definitely personalized -- you 18 know, I personalized is opiates. 19 The addiction goes up, like this. It's not a 20 slow, progressive disease. It is a -- it's 90 miles 21 per hour, straight. 22 And I'm telling you, we really need to 23 actually break that. 24 I have asked people, some of the people that 25 have already spoken are friends of mine, that 1 I called and I said, What's your take on Suboxone, 2 methadone, on these -- on Vivitrol? 3 People are telling me that that's actually 4 just as bad as their addiction. And I listened. 5 So we kept trying the hard fight of 6 abstinence, and three overdoses later, and almost on 7 a respirator, I said, You know what? Something 8 doesn't feel right to me. 9 There is not one treatment modality for 10 someone with high cholesterol. 11 There is not one treatment modality for 12 cancer. 13 It's based on individual, their 14 circumstances, and other parts of their body, where 15 they are in a community. Everything. 16 Why is it any different for this? 17 So we need to start to work on that. 18 No one -- no one treatment works for 19 everyone, and so I can't say that enough, because 20 it's still something that I think even OASAS and 21 clinicians in this disease space still struggle 22 with. 23 We've mentioned dollars for treatment and 24 education and prevention. 25 One of the things I think we've missed is, 1 what about the money for actually trying to get best 2 practices, and to research evidence-based practices? 3 There are some great models in Europe. There 4 are some great models in other states. 5 And Senator Hannon, who has been very 6 supportive of myself and my family, show me -- you 7 know, I can get -- we fought to get the insurance, 8 right, because people would tell you us, you can't 9 get in unless you fail three times in the outpatient 10 over 12 months, blah blah blah. 11 But then once we get them in, what's the 12 outcome we're looking at? 13 Someone said earlier, it's really hard to 14 measure, what's a good outcome for addiction? mental 15 health? 16 Well, if they're still breathing, and they 17 start to actually decrease the times that they use, 18 the longer they go, decrease in recidivism rate, 19 those are actually good outcomes. 20 We don't have those to look at. 21 Supportive housing: 22 There has been lots of articles, we follow 23 them. I follow everything across the country. 24 And, supportive housing is something that 25 I think you've heard, but, there's, like, it's all 1 or nothing, in regards to addiction. 2 You use once, you get kicked out. You talk 3 back. You do anything. 4 I took out a home-equity loan to put my son 5 into something. And, they didn't give him the 6 medication they had told him they were going to give 7 him, and he said, But that's my medication. You 8 have to give to it me. 9 And he got upset. 10 And they said, "You have to leave." And they 11 kept the money. 12 And I was, like, well, you know, when I have 13 a post-op patient, after they've had surgery, and 14 they're telling me their pain's an 11 on a scale of 15 1 to 10, and you don't give it to them, they're 16 going to get a little grumpy. 17 Are you going to kick them out of the bed and 18 say, See ya? 19 Not going to do that. 20 But in this world, we do it. 21 And so we do it in supportive housing, we do 22 it in inpatient treatment, we do it -- and it's 23 acceptable? 24 Totally unacceptable. 25 So we have to do something like that. 1 We also have to regulate some of the sober 2 homes. 3 There's people, you see the articles in the 4 paper. It's something that we've brought up to 5 OASAS, that they want do something about, too. 6 So, I think it's something we should actually 7 identify, and possibly look at in the report, 8 because there's a great -- there's a big need. 9 And, you know, the drug courts. 10 There's many people -- you heard John say, 11 you know, I hope that when they call me, or they 12 want help, that they're in jail. 13 And Craig Apple, who's a friend of mine, we 14 were kids across the street, growing up together, 15 since we were, like, four, says you can't arrest 16 your way out of this. Right? 17 But, it's a first stop. 18 But then when they -- if they have the 19 opportunity to go through a drug court, we have drug 20 courts that are telling them they can't be in the 21 drug court and get the benefits of that if they're 22 on medication-assisted treatment. 23 So it's a law -- it's the drug courts stating 24 that, what your treatment is supposed to be; not the 25 clinician. 1 So maybe we should look at kind of stable -- 2 maybe making that kind of a little bit more 3 standardized, because depending on what county you 4 are, and depending on what city you are, what drug 5 court it is, you'll have a different set of rules. 6 I have a whole list of other ideas, but 7 I think those are the primary ones. 8 I thank you again. 9 I'm happy to take any questions. 10 Thank you. 11 SENATOR AMEDORE: Thank you, Lisa. And, hang 12 in there. 13 Hang in there. 14 LISA WICKENS-ALTERI: Thanks. I will. 15 SENATOR AMEDORE: Patty, she -- Patty Farrell 16 is a mom who -- well, I'm sure she'll tell you the 17 story, but, we have -- hopefully, very soon, we will 18 have Laree's Law passed in Sente and, hopefully, 19 passed in the Assembly, and -- and that would be 20 great. 21 PATTY FARRELL: Yes, it would. 22 Thank you very much for inviting me today. 23 I really appreciate being here. 24 My daughter, Laree Farrell-Lincoln, 5 days 25 shy of her 18th birthday, I found her deceased in 1 her bed from a heroin overdose. 2 She was using for about four months. I had 3 gotten her to detox. There were insurance issues. 4 Two-day stint, that's it. 5 She was 18, so she could check herself out. 6 She did. 7 She got her Suboxone when she was there, so 8 she felt better, no withdrawals. 9 Left. 10 I begged her, kept begging her, go inpatient, 11 go inpatient, go inpatient. 12 I was to a point where I was going to have 13 her arrested, just to get her off the streets. 14 I figured she was safer in jail, which is a pretty 15 horrid thing for a parent to think, but I really 16 believed that. 17 Finally, she came to me and she said, "I'm 18 ready, I'm ready, I'm ready." 19 At this point, she had lost 30 pounds, wasn't 20 taking care of herself, wasn't doing her hair, 21 makeup, shower...wasn't doing anything. She was 22 falling away to absolutely nothing. I watched her 23 deteriorate in front of my face. I watched her high 24 in front of my eyes a couple of times. 25 I had people say, Throw her out. 1 Well, guess what? I'm not going to throw out 2 my 18-year-old daughter onto the streets, when this 3 is just the beginning of a long, long road. And 4 I knew I had a long road ahead of me. 5 So, she finally decided she needed help. Got 6 her into detox. And, thank God, I found a woman 7 that was working at detox, that took to Laree, took 8 to me. 9 And like a gentleman said earlier, I found a 10 rehab -- she found me a rehab in Connecticut. There 11 was nowhere to put her in New York State. 12 There were two doctors at detox that were 13 saying, she needed to go inpatient. And there was 14 one doctor at the insurance company that was saying, 15 We're not paying for it. 16 So, basically, the girl at detox said, 17 I remember them coming in, doing a presentation, 18 this place from Connecticut, and they will take 19 payments. 20 I said, Fine. Let's get her there. 21 So we got her there. 22 28 days, you're done. 23 You are done. 24 There is nothing better than long-term care. 25 28 days, she flat-out said, I am not ready to 1 go back out. 2 There was no -- she could have went to a 3 sober house, which she would have had to work, have 4 a car, et cetera, et cetera. 5 She chose to do the sober house, which was 6 also down in the same area. So I brought her home, 7 to get her car, get her bedding, because it was like 8 an apartment, with four other girls that were 9 detoxing or in recovery. 10 And, ultimately, she never made it to the 11 sober house. She relapsed when she left my house, 12 and went there the next morning, and, absolutely 13 not, they wouldn't take her. 14 As you were just talking about Lisa, they 15 would not take her because she had relapsed just 16 that one night. And she was already prepared to be 17 in that sober house for three months. 18 There's no sober houses locally. 19 There's -- long-term care is just, like, you 20 don't even -- it's not even heard of, long-term 21 care. 22 And that is the only thing that is going to 23 help these guys come out of this. 24 It is -- this drug is just not prejudice. 25 It's starting with the young kids. 1 It's going to the 60-year olds. Because they 2 started the I-STOP program, so now you've got 3 grownups that are buying heroin. 4 I mean, it just -- the list goes on and on 5 and on. 6 I had spoken a couple times in high schools. 7 Amazing, the reception I got from the kids. 8 Amazing. 9 They basically told the teacher, I'll never 10 do that, because I'll never do that to my parents. 11 It was amazing, the reception that I got from 12 these kids. 13 Which isn't -- it's a thought. It's actually 14 something that I had -- I had written down a few of 15 my ideas, because I was told we were kind of running 16 short of time. 17 So, I'll give you guys what I had -- saw a 18 couple of my ideas. 19 Laree's Law, I haven't heard enforcement 20 since I walked in, but I also did walk in late. 21 I think enforcement, small-time drug dealers, 22 the kids that are out there dealing just for their 23 own use, maybe a couple days in jail, and then your 24 drug court. 25 But we really got to start going after these 1 bigger guys that are selling to our families. 2 I mean, they're coming in. They're bringing 3 it in from New York City, they're bringing it in 4 from Mexico. They're selling it, they're 5 transporting it on Heroin Highway. 6 I spoke at Senator Schumer's press 7 conference. 8 I mean, it's just out of control, and we need 9 to start getting these bigger sellers, and, the 10 sellers, the bigger sellers, need to be start being 11 held accountable, and being charged with a murder, 12 homicide, charge. 13 They're walking out the door, and it's 14 garbage. 15 They need to start being held accountable. 16 They know they can come into New York State. 17 They know they can go over to Vermont. They know 18 they can go over into Pennsylvania. 19 You got it, slap on the hand, Senator, and 20 they're out the door. And we can't have it. 21 I mean, it's just going to keep coming in, 22 more and more and more, it's just gonna keep on 23 coming in, and you're going have more and more of 24 this: my deceased daughter. 25 And it's every day in the obituaries. 1 Every single day. 2 And I'm a little over two years of losing 3 her. She was my whole world. 4 She still is my whole world, which is why I'm 5 sitting here. I don't want to see families go 6 through this kind of hell. 7 So... 8 SENATOR AMEDORE: Well, thank you. 9 And for the listeners, there is -- on 10 Route 155, New Karner Road, there's a big billboard. 11 If any of you drive by it, it's kind of near between 12 the corner of Central Avenue, when -- the Kohl's, 13 kind of, shopping center there, that entry, and it's 14 a -- it says "Heroin Kills, and there's a little 15 picture on the bottom of that billboard, and it's 16 Laree. 17 And that was -- the design was chosen, it was 18 made by the students of Colonie school -- 19 High School, and we unveiled that just a few weeks 20 ago. 21 PATTY FARRELL: Yep. The design's 22 incredible. It's a handgun, with a needle sticking 23 out of the end of the handgun. 24 SENATOR AMEDORE: Yes. 25 PATTY FARRELL: That pretty much said it all. 1 SENATOR AMEDORE: It says "Heroin Kills." 2 PATTY FARRELL: Yeah, and the art teachers 3 dedicated it to my daughter because she went to 4 school there. 5 So, it's pretty incredible, if you want to 6 take a look at it. It really is. 7 SENATOR AMEDORE: So we're working on it. 8 I sponsored the bill, and we will see it on 9 the floor very shortly. It's already gone through 10 the committees, and we're working with the -- with 11 Assemblymember Mike DenDekker. And, hopefully, we 12 can get -- 13 PATTY FARRELL: I hope we get them. 14 SENATOR AMEDORE: -- keep our fingers 15 crossed, and get it passed in the Assembly, so -- 16 and that would go after, and hold these drug dealers 17 much more accountable; not slapping them on the 18 hand, but now charging them with homicide. 19 Thank you very much, Patty. 20 PATTY FARRELL: Absolutely. 21 Thank you, Senators. 22 Thank you very much. 23 [Applause.] 24 SENATOR AMEDORE: Next we have 25 Elizabeth Berardi, Daniel Savona, and Peter Nekos. 1 I hope I got that one right. 2 Thank you. 3 Thank you for waiting, and thank you for 4 being here. 5 Elizabeth, if you would be so kind as to 6 start. 7 ELIZABETH BERARDI: Thank you, Senators, for 8 inviting me to participate in this hearing. 9 My name is Elizabeth Berardi. I'm the 10 founder of the non-profit organization Safe Sober 11 Living, and a member of the Ulster County Task Force 12 on Heroin. 13 Most importantly, I'm here as the mother of 14 Carter Berardi, my son who suffered from the disease 15 of substance-use disorder, and, ultimately, died 16 January 12, 2014, at the age of 23, from acute 17 heroin intoxication. 18 As my son bravely attempted to save himself 19 from the disease of substance-use disorder, my 20 efforts to navigate and save him from the addiction 21 industry itself would prove be the hardest thing 22 I've ever done. 23 Since Carter's death, I've been driven to 24 understand exactly what occurred, and what I've 25 learned has both stunned and sickened me. 1 My son's death was absolutely preventible. 2 I've been told Carter was put on a wait list 3 when he inquired about methadone. It's happening in 4 New York State and lives are being lost because of 5 it. 6 I'm told many clinics choose not to expand 7 the number of people they serve. They're all too 8 aware that quotas must be met, and fear coming in 9 under that quota which would cost them important 10 state funding. 11 This clinic was the first point of contact 12 that failed my son. As far as I'm aware, no help 13 was given, no Narcan distributed, no clean needles 14 offered, no harm-reduction counseling, and no 15 contact with treatment. 16 My son also tried to find local doctors to 17 help him, and in one case was told, "I don't deal 18 with this in my practice." 19 The doctors in the emergency rooms that 20 Carter went to time and again also let him walk out 21 the door, either with more narcotics, or hopeless 22 and ashamed, definitely not connected with 23 treatment. 24 We need doctors and nurses that are educated 25 about addiction. The time has come for the State to 1 mandate they receive further substance-abuse 2 training. 3 Carter's doctor put him on fentanyl patches 4 when he was recuperating from back surgery. The 5 doctor did not consider an alternative, even after 6 I told him my son had a genetic predisposition to 7 addiction, which, according to CASAColumbia, 8 accounts for 50 to 75 percent of the risk of 9 addiction. 10 This should be a red flag for any physician. 11 The drug fentanyl that he prescribed, as 12 stated by Wikipedia, is approximately 80 to 13 100 times more potent than morphine, and, roughly, 14 15 to 20 times more potent than heroin. 15 My son's insurance company, Value Options, 16 denied him coverage. 17 New York State Attorney General 18 Eric Schneiderman has since held them accountable 19 for parity. 20 It will not bring back my son. 21 I do, however, believe it takes us one step 22 closer to holding people responsible within the 23 industry itself. There's no doubt other lives will 24 be saved. 25 My son eventually relapsed, and while he was 1 in a Hudson Valley detox, I was told by a nurse that 2 his insurance, once again, denied him inpatient 3 treatment. 4 I took notes on the reasons stated by the 5 detox for his insurance denial in order to appeal at 6 a later date. 7 Since Carter's death, I've learned from the 8 insurance company that the detox never requested the 9 inpatient treatment for my son. 10 It's been a painful road trying to get the 11 hospital to address the issue. 12 After misleading me for many months, they've 13 now stated there was, indeed, a disconnect. Of 14 course, this is the same detox that had my son sign 15 a discharge plan that stated he was going to the 16 wrong rehab in the wrong state. 17 Even worse, when I tried to report this error 18 to several New York State departments, none seemed 19 to feel it was within their purview. 20 This disconnect which occurred, altering my 21 son's ability to obtain the best treatment possible, 22 matters. 23 I do not want it to happen to anyone else's 24 child. 25 There must be a point-person for this 1 epidemic with the authority to actually fix a 2 problem in the system. 3 I'm asking that this epidemic and issues 4 surrounding it be given emergency and expedited 5 status. 6 The addiction industry has, basically, no 7 guidelines and almost no oversight. Treatment 8 centers are not rated or quality-controlled. 9 Joe Califano at CASAColumbia, and, 10 separately, Thomas McClellan at the Treatment 11 Research Institute, have been trying to rate rehabs 12 for years. 13 As I read the clinical notes from my son's 14 treatment center, I saw he was, literally, having 15 cravings the day before he was discharged. The 16 treatment center that claimed to be evidence-based 17 had him use the Serenity Prayer to cope with his 18 heroin cravings, and released him to a 19 less-restrictive and -supportive environment. 20 This rehab even checked, the very next day, 21 they even checked the "Finished Program" box on his 22 discharge papers, as opposed to checking the 23 "Against Medical Advice" box. 24 One week before he left the center, my son's 25 therapist told me that his life depended on staying 1 in inpatient treatment longer. 2 The next week she said, "We need to strike 3 while the iron's hot," and supported Carter's 4 transfer to an unregulated sober home which they 5 recommended. 6 My son died just after being discharged. He 7 was three days out of that rehab. 8 There must be standards of care implemented 9 that can be relied on by all. 10 To this point, according to a published 11 report by CASAColumbia, while residential treatment 12 programs must be licensed at the state level, 13 standards vary widely. 14 For no other health condition are such 15 exemptions from routine governmental oversight 16 considered acceptable practice. 17 The sober-home industry, unless state-funded, 18 is totally unregulated. It's an insidious one where 19 patient brokering is not uncommon. We don't even 20 know how many exist because they hide behind the FHA 21 as if it were to protect the owners, not those 22 suffering from substance-use disorder or other 23 mental-health issues. 24 While there are some wonderful homes, many 25 others purely serve as cash-cows. 1 The owner of Carter's sober home had 2 previously been arrested for selling heroin and 3 Suboxone in his own driveway while on probation for 4 another crime. 5 I'm a great believer in second, third, or 6 more chances for everyone. This, however, defies 7 common sense, because he started managing sober 8 homes while still on probation for that crime. 9 Further, as founder of Safe Sober Living, the 10 stories I've been told about sober homes are 11 heartbreaking. Sexual assaults, drugs, financial 12 scams, ten people in a room instead of two, are 13 common scenarios. 14 Most sober homes will expel someone if they 15 prove positive on a drug screen. Most sober -- it's 16 part of the house policy, rather than a continued 17 care plan. 18 Michael Botticelli, referring to 19 substance-use disorder, said, "We don't predicate 20 saving someone's life from other diseases based on 21 their compliance with treatment. We save their 22 lives because their lives are worth saving." 23 NARR (the National Association of Recovery 24 Residences) is a voluntary organization from the 25 recovery community, and it's noted on the 1 White House web page. It's trying to implement such 2 standards and oversight. 3 The majority of sober homes, however, that 4 are causing the harm will not be voluntarily joining 5 this. They will remain in the shadows until given 6 absolutely no choice. 7 Those that have easily made it through the 8 House and Senate in Florida, with the support of 9 FARR, the Florida affiliate of NARR, will, 10 I believe, quickly make its way around the country. 11 To ensure -- it ensures safe sober housing with 12 oversight and standards. 13 New York State should follow suit. 14 Florida House Bill 21 and Florida Senate 15 Bill 326 are bipartisan-supported efforts to fix a 16 seriously dangerous situation on the continuum of 17 care. 18 In Gloucester, Massachusetts, the police 19 chief has determined it best to offer detox to 20 anyone that walks in and requests help. He's 21 treating addiction as a medical condition, rather 22 than a criminal one, when possible. 23 New York State should do the same. 24 Since my son's death -- and this is 25 addressing stigma, really, on a larger scale -- 1 since my son's death, I have found out the needle he 2 used was simply thrown out. I asked the detective 3 if they would throw a gun away at a crime scene. 4 I'm told that policy has now been changed. 5 That is because the police, the law 6 enforcement, were open to change. 7 The investigation into my son's death is 8 still ongoing. I've waited over a year for Apple to 9 respond to a subpoena for Carter's phone texts so 10 that the person who sold him the heroin can be found 11 and stopped. 12 Until Apple feels this is a priority, I must 13 wait. 14 I can only wonder why law enforcement is not 15 being supported in their investigation of a death. 16 On a state and local level, much can be done. 17 Evidence-based treatment beds are needed, and 18 must be rated on a regular basis to ensure the 19 quality of care. 20 At the very least, up to three months of 21 inpatient treatment should be covered by insurance. 22 I support Senator Murphy on this. 23 The LGBT community of which my son belonged 24 has found certain specifically targeted supports 25 help those in recovery. 1 These should be recognized and made 2 available. 3 Harm reduction must be implemented across the 4 state. 5 Like the recent AIDS crisis in Indiana, we 6 will see the spread of hepatitis C and HIV if we 7 don't offer clean needles to those already 8 injecting. This point of contact also serves as an 9 opportunity to offer testing, treatment, and 10 support. 11 While legal in New York State, we need to 12 make sure all county health departments are on the 13 same page regarding implementing syringe-exchange 14 programs. 15 I can tell you firsthand, this is not yet 16 happening. 17 Emergency rooms could follow the recent Yale 18 study, by offering buprophine (ph.) to anyone found 19 to have an opioid addiction, and they could directly 20 refer them to treatment. 21 The Massachusetts Senate has put aside money 22 to develop two recovery high schools. 23 New York should do the same. 24 Sober dorms and collegiate recovery programs 25 should be implemented across the state as well. 1 There should be protocol that 2 medically-assisted treatments are available for 3 those in the criminal justice system. Drug courts 4 should have assigned addiction specialists to 5 oversee the programs that could change the rate of 6 recidivism dramatically. 7 An ombudsman in each New York State county 8 could help with insurance parity, locate and point 9 out community supports that may be available, answer 10 basic questions to those in need, and help navigate 11 on a local level. 12 As the laws of the disastrous war on drugs 13 are pulled back, those who are incarcerated can now 14 receive the mental-health and addiction treatment 15 they deserve. 16 Communities will need to be a part of the 17 solution, because city development and its 18 environmental factors have a direct impact on 19 addiction and the mental health of its residents. 20 Community recovery centers are also an 21 important gathering spot, and should be considered 22 part of any plan to solidify an area's commitment to 23 healthy community. 24 My son was swept up in a crisis that 25 continues to face our nation, stealing another life 1 approximately every 14 minutes. 2 On the fateful day of January 12, 2014, it 3 was my precious son Carter's life who was stolen. 4 Carter tried very hard. He was forgiving of 5 the stigma, silence, and lack of emotional and 6 medical support. 7 Inside his gentle soul was a courageous man 8 who suffered from a horrific illness. 9 My son, Carter Berardi, is, and will forever 10 be, my hero. 11 I thank you for allowing me to be here today 12 and share a story. 13 Thank you for what each one of you are doing 14 to stem the tide of this epidemic. 15 I'm grateful for your efforts to understand 16 and save lives. 17 Thank you. 18 [Applause.] 19 DANIEL SAVONA: Senator, how are you? 20 SENATOR AMEDORE: Very well, Daniel. How are 21 you? 22 DANIEL SAVONA: I'm good. 23 Thank you for having us here. 24 SENATOR AMEDORE: Thanks for being here. 25 DANIEL SAVONA: Thank you for having us. 1 My name is Daniel Savona, and I'm a 2 recovering addict, currently celebrating 2 years -- 3 2 1/2 years in recovery, after a good 10-year, 4 15-year battle with opiate addiction. I struggled 5 for many years, trying to find help in recovery. It 6 wasn't until I found the 12-step program -- 7 I started in a detox facility, and then went into a 8 rehab, and followed by a 12-step program. 9 I struggled for many years, in silence, as 10 I've shared with you in the past, with the stigma of 11 addiction. 12 I think addressing our concerns with the 13 stigma of addiction, because we hide, and we're 14 ashamed, and we're afraid to ask for the help, and 15 that had prolonged my addiction for many years. 16 I think addiction touches all of us, as we 17 can see. 18 I use the term "three degrees of separation" 19 quite often, but, you know, as I become more 20 familiar with people in recovery, and I speak a 21 little bit more, I meet more and more people, that 22 addiction touches everyone. 23 So, to have that stigma over me today, no. 24 I'm proud of where I'm at. 25 I'm not proud of the things I've done, but 1 I'm definitely proud of where I am, and who I am 2 today, and that's because of recovery. 3 I think we need to change the face of 4 recovery, and that's why I'm sitting here today with 5 you. 6 You and I met, you know, going back a few 7 months ago, and, you didn't realize I was in 8 recovery. And when I shared my story with you, 9 I could tell you were surprised. 10 I think a lot of people out there are 11 suffering from the same things. 12 I tried Suboxone for many years. 13 This is where Liz and I tend to agree to 14 disagree on that. 15 I didn't find sobriety, what I call 16 "sobriety," until I was free of all opiates. 17 I struggled. 18 I struggled with the Suboxone, the 19 depression, the isolation, you know, all the side 20 effects that came with it. 21 I think what it does, it beats you down. The 22 depression, anxiety, that came with it were too 23 much. 24 They talk about the expense of Vivitrol 25 compared, you know, to the expense of Suboxone. 1 They want to put people on Suboxone when they 2 come out of a 28-day program. At that point, the 3 opiate is out of their system. To put them back on, 4 they say, well, they're high risk. 5 Well, anyone that comes out of rehab is high 6 risk at that point. But to put them back on an 7 opiate, a Suboxone or a drug, that's going to start 8 the addiction all over again, there's Vivitrol. 9 Vivitrol may be a little bit more expensive, 10 but Vivitrol is non-narcotic, there's no opiates 11 involved, and, it's a one shot a month. They can do 12 a shot, where it beats the cravings, and it's a 13 blocker, where, you know, you can't get high, you 14 can't overstack it with heroin or alcohol. 15 So there are other options out there. 16 You know, we talked about the insurance 17 companies in the past. 18 I was denied insurance on several occasions. 19 Right now I'm going through something. 20 I failed three detox, and with the three 21 detoxes, and when I tried to get into rehab, I was 22 denied coverage for rehab because they said my 23 addiction wasn't bad enough. I needed to fail three 24 outpatient programs. 25 Fortunately, at the time, we were able to pay 1 for rehab. 2 Now, 2 1/2 years sober, I'm having my 3 life-insurance policy denied coverage. They're 4 taking my life-insurance policy away because they 5 said my addiction is -- I have a history of a drug 6 addiction. 7 I'm in the best shape of my life, I'm the 8 cleanest I've ever been, I'm the most healthiest 9 I've ever been, and, now, it's life insurance. So 10 if anything happens to me, it's about my family, 11 it's not about me. And I'm being denied my -- 12 they're taking it away from me, which I don't know 13 how. 14 That's something we'll have to talk a little 15 bit more about. 16 The disease of addiction, we're all 17 predisposed. 18 You know, you and I talked about taking the 19 opiates and stuff. And you were fortunate, you 20 could put them down. 21 Guys like me, you know, I've used the 22 expression before, when we use, there's, like, bells 23 go off, bells and whistles go off, in our heads. 24 And for some of us, it takes a long time to get them 25 to stop. 1 I use -- it's a -- it's not the best 2 expression, but, when I got into the opiates from 3 chronic back problems, I was put on Oxycontin. And, 4 you know, at one point, you know, my addiction, 5 I had probably a $2,000-a-week drug habit. 6 And the first time I used Oxycontin, you 7 know, and with cocaine, of course, I used, it's a 8 bad expression, but, it was like kissing God. 9 For some of us addicts, you know, like 10 I said, bells and whistles go off in our heads, and 11 we're predisposed. 12 You know, other people can -- you know, 13 they -- it doesn't affect them the same way. 14 So, as far as addiction being a disease, 15 I think we need to change something with 16 legislation, because it makes it so much easier for 17 insurance companies to deny us help and coverage 18 when we go into the hospital, when we go to detox, 19 and ask for help. We're denied, you know. 20 And when an addict is asking for help, in 21 that moment of clarity is the best time to pull them 22 in, is when they're asking for help. 23 You know, I believe, you know, when people do 24 want help -- it's hard to bring someone kicking and 25 screaming to get recovery. Sometimes it takes what 1 it takes, incarceration, your bottom, whatever it 2 is. 3 But when someone's asking for help, it's the 4 best time to get them. 5 And when they go to the hospital, and they're 6 asking for help, and they're denied because of 7 insurance companies, I mean, there are people going 8 back out and they're running, and maybe never to 9 come back again. 10 And that's when these people, that's when we 11 have to help them. 12 So -- I mean, you have your work cut out for 13 you, you know, but, I can't sleep at night without 14 trying to give back to the community that saved my 15 life, and it was through recovery that I'm here 16 today. 17 And as you well know, I'll share a little 18 tidbit, 3 -- 2 1/2 years ago I was a full-blown 19 raging drug addict. I had a significant drug 20 problem. 21 2 1/2 years ago I found recovery. 22 And just 6 months ago my, wife won a family 23 court judge in Ulster County. 24 And through -- you know, through the blessing 25 of recovery, and through the miracle of recovery, 1 that's possible today. 2 So, I want to give back to the community that 3 has helped me and has given me what I have today. 4 So, I'm here for whatever you need me for. 5 So, thank you. 6 SENATOR AMEDORE: Thank you. 7 Dan, you are a champion, truly. 8 [Applause.] 9 SENATOR AMEDORE: And it's astonishing, 10 because if anyone could see what Dan -- and he's a 11 big fella, I mean, he's very fit, trim, but if you 12 could see the pictures that he showed me, months and 13 months ago what he looked like -- 14 DANIEL SAVONA: I was 163 pounds. 15 SENATOR AMEDORE: -- it was just -- it was a 16 different person. 17 Different person. 18 He's a -- he's a loving father. You're a 19 successful business person, businessman. You got a 20 great family. And, you're a champion. 21 Thank you. 22 DANIEL SAVONA: Thank you. Thank you very 23 much. 24 [Applause.] 25 SENATOR AMEDORE: Peter. 1 PETER NEKOS: Hi. My name is Pete Nekos. 2 I've been a pharmacist for 40 years, and 3 I have 27 years in recovery, and, I work every day 4 with this drug -- this problem. I see it all day 5 long. 6 I'm an active member of AA. 7 People often ask me, after 27 years, Why do 8 you still do it? 9 And I tell them I never expected to be an 10 opiate addict, and I'm not taking any chances on 11 relapsing, so I still go all the time. 12 SENATOR AMEDORE: Good for you. 13 PETER NEKOS: And I guess why I'm here is, 14 I'm, pretty much, a summary of everybody that spoke 15 today. 16 Being in the medical field, what all the 17 doctors are talking about, I see that every day. 18 I currently have a son in state prison, 19 because of drug addiction. He has seen -- he's only 20 seen me sober, so, the knowledge was there. And he 21 was so predisposed to it, with Attention Deficit, 22 and everything, he just self-medicated. 23 And, you know, I can identify with all these 24 people, because I've had to call 911, and perform 25 CPR on him before they get there because he was all 1 blue, and -- you know. 2 I got more stories than you can talk to. 3 I also have not shied away from who I am and 4 what I am. 5 I can remember when I developed this problem, 6 you know, I had a back operation -- well, I had a 7 ruptured herniated disk, and I ended up taking 8 Percocet, and it became a way of life for me. 9 And, you know, tragedy had struck at a 10 certain point in my life, where my wife's father was 11 killed in a boat accident, my father was hit by a 12 car, and my oldest son died, and I went into some 13 four years of serious addiction. 14 And it came to the point where I wanted to 15 get clean and sober. 16 And nobody knew what I was doing. I did it 17 by myself. I had one friend that I did it with. He 18 was a detective. And, we just partied together. 19 But I had a friend that was a lawyer that got 20 into cocaine recovery. He saw me one day, and why 21 that day, I decided to tell him. 22 He said I looked terrible, and I did look 23 terrible. I was about 118 pounds. 24 And, that day, the miracle happened for me. 25 I took him in the back room and told him 1 I had a problem. 2 I had had cancer before that, so, you know, 3 I really didn't think I was going to live forever 4 anyway. That was in '75. You know, that goes back 5 a ways and when I had that. 6 So, I got into recovery, and they told me 7 I had to come back and do 90-90 (ph.). 8 And, I was a local pharmacist. 9 And the first day I got back, I stood up and 10 said, I'm -- at that point in time I was only 11 alcohol, I share, and I said, "I'm an alcoholic," 12 stood up in a local meeting. 13 And I think that was a very big turning point 14 in my life, instead of sitting in the back room and 15 hanging my head. And I've been doing it for 16 27 years. 17 And I developed a program with 18 Alcoholics Anonymous that's a spiritual program. 19 I can identify with Father over there, and 20 everybody that spoke. I totally get it. 21 And, this program, I've been called by 22 numerous people. I've helped undercover narcotic 23 agents get clean and sober. I've been called into 24 judges' chambers to help local policemen get clean 25 and sober. My sister-in-law. It just goes on and 1 on and on. 2 And my family's been devastated by it. 3 The punitive aspects of getting in trouble as 4 a young kid, drinking and driving, lost his license, 5 drove again -- these aren't the only incidences by 6 the way -- but when he had an accident without a 7 license, they sentenced him to a year in state 8 prison. Got out of that, went down to Key West, got 9 busted with a tenth of a gram of Coke, and he's 10 spending 18 months in the Florida state prison right 11 now, where the guards and everybody are worse than 12 the prisoners. 13 So, I've been around the whole spectrum: the 14 sadness, the family fights. 15 And I ended up calling to have him arrested 16 this past time, and that's when he violated parole 17 and they took him down. 18 So I've done the hard things, calling the 19 police on my kid. 20 And -- but recovery for me is a way of life. 21 And, just yesterday, I was talking to a 22 retired football player from the NFL, and he was on 23 Suboxone. And I took him aside and shared my story. 24 I have housewives. 25 Every line of work you can think of. 1 And I don't go out standing on a soapbox 2 about this, but when they come to me, the kids, 3 I take them aside and let them know I'm in recovery. 4 And it makes a huge difference for them to know that 5 someone else is there and I'm not judging them. 6 And I also have people on Suboxone that tell 7 me it's a great drug. 8 My son used it to get off heroin. And then 9 he got off of that, and he had a full year clean and 10 sober, and he started smoking pot. It took him 11 five weeks to go skyrocket again. 12 The people that are on it now, their life is 13 dictated by the doctor's prescriptions, their 14 vacations, everything. They all tell me that if 15 they knew what they were getting into, they wouldn't 16 have done it as a maintenance drug. 17 And I feel, from my experience, that the only 18 maintenance in this program is a spiritual 19 experience sufficient enough to help you recover 20 from addiction. 21 And once you can find that little, that 22 piece, you're on your way to a better life. 23 And my life has been, by far, better than my 24 wildest dreams I could ever have imagined. 25 And, it's not all roses. Like I say, I still 1 have a son in prison right now. 2 So -- but life is good. 3 And, without recovery, for me, and the 4 spiritual part of the camaraderie with 5 (unintelligible), I've known guys in that program 6 for 25, 27 years now, and we -- there's nothing we 7 don't know about each other. And that camaraderie, 8 and these guys helping you share your problem and 9 lifting you up, it's not like any other group I 10 know. 11 Every other group, it's who's got the 12 biggest, whatever. 13 In Ulster County, you want to think about the 14 incarceration of these young kids into the 15 Ulster County Jail, when you have a rehab right 16 there, Veritas Villa, that if a contract could be 17 made somehow with them to get these kids in there to 18 the rehab. 19 Because I had a reason. I had a business, 20 I had family. 21 Danny had a business, he had a reason. 22 Kids that are coming in now, they don't have 23 anything. 24 And if some type of a program could be 25 developed, instead of putting them in jail to 1 support that system, and it's a money-making system, 2 the whole thing with alcohol and fines, and every 3 other thing, in conjunction, maybe with a 4 Community College, to get these guys into the rehab, 5 to teach them lawn-caring skills, carpentry skills, 6 anything, that's the best thing to do is, because, 7 when Danny came to me, he called me up one day, 8 years ago, came up to the pharmacy and sat with me 9 while I worked. He saw something that he liked. 10 It's a program of attraction. They want what 11 you have; they just don't know how to get it. 12 The best kind of thing you can do is get 13 these addicts to get a degree in counseling, or 14 something else, so they can go out and promote it to 15 their friends, and their friends see what they have, 16 and then they want what they have, too. 17 And, you know, with the Community College 18 down there, if something could be worked out with 19 that, Veritas Villa, instead of throwing them in 20 jail, I think would be a real big plus. 21 But I want this Committee to know there are a 22 lot of guys like me out there, after 27 years, 23 holding your head high. 24 And I don't care what anybody says. 25 I haven't had a drink or drug in 27 years. What are 1 you going say to me? You know? 2 And I'm proud of it. 3 And I do know you guys have a daunting task. 4 And the fact that you are even here doing it, 5 it's about time somebody's doing something. 6 SENATOR AMEDORE: Well, Peter, you know, you 7 lead by example. 27 years is a life testimony that 8 it can be done, it can -- you can overcome. And you 9 give a lot of hope to a lot of parents in this room 10 tonight. 11 And, you know, it's Friday evening, my wife 12 and I shared our time with Teen Challenge of Albany, 13 and what a great organization. It was a banquet, 14 and they had their graduation ceremony of 14 men who 15 hit rock bottom, but went through a 14-month 16 program. 17 And I talked to each and every one of them, 18 and they're changed, and they are set free of their 19 addiction. 20 They're going to go through some hard times 21 when they leave that facility. They know that. But 22 it was a whole -- it was faith, it was treatment, it 23 was a whole inside-out experience for them that has 24 really set them on a path that they're going to be 25 reacclimated into the community. 1 And God bless them, because they were great, 2 and it was a success. 3 PETER NEKOS: You know, one of the things 4 I wanted to say, with the pain-addiction guy, he 5 left here, I was at a pain-addiction thing, and he 6 couldn't explain certain things about addiction. 7 Everybody's going to get a physical addiction 8 to narcotics. 9 I've had four operations the last four years. 10 I had a toe cut off. I had my knee replaced. I had 11 an Achilles tendon torn. And I had a hip replaced. 12 And for my knee -- my hip, I didn't use any 13 pain pills. 14 But my knee, I had prescribed Percocet. 15 I had 60 of them, and I took -- the most I took were 16 3 a day, the 5-milligram. I still was in a lot of 17 pain. 18 The difference with an addict is, most 19 people, when pain subsides, they reduce the 20 medicine. 21 And after being in recovery for these years, 22 I remembered the day that my wife was away, and the 23 Yankees were coming on preseason, and I was going to 24 take a shower, and I said, Oh, I'm going to take a 25 pain pill, and sit and watch the Yankees. 1 And I realized at that point, that was the 2 point of no return, because I didn't need the pain 3 pill. That was a point of my experience of being in 4 the program long enough, I was not taking the 5 medication for the right reason. And at that point 6 I dumped it away. 7 But it's the intent of why you're taking it. 8 And, if I had taken it -- and I remember 9 another time, I was -- tore my Achilles tendon. And 10 I was -- I had the operation on a Tuesday. On a 11 Saturday I was in work, with a cast, and they had 12 given me some pain pills, and I took them for one 13 day, and I gave them back. And there they were in 14 the -- in our cabinet. 15 When I had gone Saturday, a girl came in, 16 3:00 in the afternoon, beautiful day, and I go to 17 get them, and there are my pills, my label. And I'm 18 counting them out, and I'm talking to myself. I'm 19 saying, Jesus Christ, I'm the one that's in pain, 20 you know. 21 My very next thought was, I wonder how many 22 I'll need tomorrow, because the next day was Easter. 23 That's what recovery does: It teaches you 24 what your sickness, your illness, what your disease, 25 is going to talk you into doing, and you're gonna 1 cross that line, and it starts all over again. 2 SENATOR AMEDORE: Well, again, thank you for 3 coming, coming up from Ulster County, for your 4 testimony, your story, because it brings -- gives a 5 lot of hope to a lot of people. 6 [Applause.] 7 SENATOR AMEDORE: Bless you. 8 Our last speaker is Melody Lee. She's the 9 policy coordinator of New York State Drug Policy 10 Alliance. 11 MELODY LEE: Good evening, everyone. 12 So my name is Melody Lee. I'm a policy 13 coordinator with the Drug Policy Alliance. 14 The Drug Policy Alliance is the nation's 15 leading organization working to end the war on 16 drugs, promote drug policies based in science, 17 compassion, health and human rights, and works to 18 reduce the harms associated with drug use, as well 19 as drug prohibition. 20 So I'd really like to thank the Senate Drug 21 Task Force tonight for inviting me to provide 22 testimony. I really appreciate having the 23 opportunity to share my recommendations. 24 I'd also want to take a moment just to thank 25 all the folks who shared really personal stories 1 tonight, because I want to acknowledge that, no 2 doubt, that's challenging, and it's very -- it's 3 incredibly hard to kind of reexperience that in 4 sharing, not only how it's touched your life through 5 your family, but personally. 6 So, thank you again, for all who have come 7 tonight. 8 So, I just want to begin with saying that, 9 the reason that many of the folks are here in the 10 room tonight is because we know that our current 11 approach is not working, that it's failed. That 12 people are dying. 13 We know that this is happening, and the 14 result is, folks are feeling stigmatized, folks are 15 not being able to access treatment. Folks are 16 dying. 17 So the result is from a number of problems, 18 including fragmentation of services, contradictory 19 policies, and increased racial disparities. 20 Some of these things stem from, historically, 21 bifurcated approaches. 22 One approach in which looks at drug use, 23 really, as a crime that can't be tolerated, that 24 should be punished. 25 And another that sees addiction as a chronic, 1 relapsing health issue or behavioral condition that 2 requires ongoing treatment and support. 3 Neither of these views is all-encompassing, 4 and should be recognized that there are patterns of 5 drug use that do not result in significant harm or 6 health problems, and don't actually require any 7 intervention. 8 A public-health approach takes the view that 9 our focus should specifically be on the harm caused 10 by drug use, and our policy responses to it. 11 Above all, we need policies grounded in 12 science that are effective. 13 As we've heard tonight, law-enforcement 14 officials across the country are saying, we can't 15 arrest our way out of the problem. 16 We have to be innovative. We have to think 17 of really comprehensive solutions. 18 One of the complications in New York State 19 around drug policies is that there are multiple 20 actors at play, and, oftentimes, are responding in 21 very different ways. 22 What we need to do is have a unified 23 framework and better coordination to prevent us from 24 working at cross-purposes. 25 Drug use and its associated harms continue. 1 What we see is mass incarceration of 2 New Yorkers. 3 As I mentioned, racial disparity is at 4 extreme rates. 5 Continued stigmatization of individuals and 6 expenses that we can't afford. 7 As Father Young said earlier, stigmatization 8 is a major issue that we must address. When we 9 stigmatize folks, what ends up happening is, they 10 fear accessing treatment, they fear asking for help. 11 And we really need to work to prevent that. 12 We need to work to prevent those barriers 13 from being built so that folks can continue to know 14 and ask for help, and be able to access the services 15 that they need. 16 In New York State, the number-one treatment 17 provider is DOCCS (the Department of Correction and 18 Community Services (sic)). 19 So I'll say that again, just so people can 20 really let that sit: The Department of Corrections 21 and Community Supervision is the number one 22 treatment provider. 23 That's incredibly problematic. We really 24 need to address that issue. Folks need to be able 25 to access treatment through a number of means, and 1 not through the criminal justice system. 2 More and more people are recognizing that the 3 criminal justice system is costly, and, oftentimes, 4 it results in worse health outcomes, and, 5 oftentimes, as I said earlier, really extreme racial 6 disparities. 7 A public-health approach works to really 8 improve individual, family, and community outcomes 9 by focusing on health and social needs through 10 improved access and quality of services. 11 The Drug Policy Alliance and the 12 New York Academy of Medicine worked for years on 13 publishing a report that came out in 2013, called 14 "A Blueprint for a Public Health and Safety Approach 15 to Drug Policy in New York." 16 We did a series of community consultations 17 with academics, physicians, experts, and hundreds of 18 New Yorkers across the state, and the blueprint 19 details a number of specific findings. 20 Two clear, overarching themes emerged from 21 that work. 22 First, that structural issues, like 23 disparities in income, education, and opportunity, 24 profoundly shape individual experiences of drug 25 policies, as does the neighborhood in which a person 1 lives. 2 In New York, these structural issues are 3 overlaid with issues of race and racism, so that 4 communities of color, just as affected by 5 problematic drug use as white communities, are far 6 more profoundly and detrimentally affected by our 7 current policies' responses. 8 And I know that, earlier, Miss Jimenez spoke 9 to this in her work. 10 So simply put, even though drug use is 11 spread, roughly, evenly throughout the population, 12 our responses are not, so we see police and services 13 and resources available to people in need, varying. 14 Poorer communities, communities of color, 15 generally have fewer resources which prevent and 16 address drug use. They face more intensive 17 policing, surveillance, and penalties. 18 Most of our current approaches tend to 19 intervene at the level of the individual, but what 20 we need to look at is a larger structural solution. 21 We need to recognize that there are a lot of 22 intersections with problematic drug use, to access 23 to housing, to employment, to mental-health 24 services, and more. 25 I'm hoping, that as a result of the many 1 conversations you've had across the state, that 2 we'll have a drug-policy framework that expands 3 beyond just the punitive approach, and one that 4 looks at how we can have a comprehensive, 5 service-oriented discussion. 6 So the second overarching theme that emerged 7 from this report is that, what we need to do is look 8 at harm-reduction services more broadly. 9 And I know Elizabeth spoke to this as well. 10 So -- and I really want to just also thank 11 Lisa who said this: We need to focus on the fact 12 that we need a variety of treatment modalities. Not 13 one single modality fits for everyone. 14 This is not the way that physicians approach 15 any disease or condition. They recognize that 16 individuals have very different needs and 17 experiences, and so we have to have a variety of 18 options at the table. 19 So to explain a little bit more about what 20 "harm reduction" is, it means reducing the harms as 21 best we can. 22 And someone earlier spoke to a really great 23 metaphor around the use of seat belts. 24 So what we know is, for example, when people 25 drive in a car, it's a risky -- it's a risky 1 behavior. That there are incredible rates of 2 accidental death, because of people driving cars. 3 So what have we done in order to address the 4 potential, you know, risks of driving? 5 We've established a lot of harm-reduction 6 approaches. We have seat belts. We have stop 7 signs. We have speed limits. 8 And so we need to think about our drug 9 policies in the same way: That not all people are 10 able to be abstinent. Not all people are willing to 11 be abstinent. 12 That's just a reality. 13 And so what we need to do is, we need to come 14 up with harm-reduction services that are very 15 prevalent throughout the state that address a 16 treatment continuum. 17 So in addition to providing, exclusively, 18 treatment, we must also provide mental-health 19 services, all sorts of wraparound services, 20 including connections to housing and employment. 21 I'd also like to add that I really appreciate 22 the leadership of both Senator Murphy and, you, 23 Senator Amedore, on your legislation around 24 medication-assisted treatment and drug courts. 25 I think a lot of folks have said throughout 1 this evening, how important it is that we have 2 medication-assisted treatment available, and that 3 folks have access to it, and that they are not 4 prevented from having access if they're in a drug 5 court. 6 Lastly, I think a really important point to 7 make is that New York has had a track record of 8 evidence-based approaches. 9 This has been demonstrated through the 10 2011 passage of the 911 Good Samaritan Law. 11 We know that that legislation passed 12 unanimously in the Senate, and almost unanimously in 13 the Assembly, with only two "no" votes. 14 I think that demonstrates that the 15 Legislature knows that overdose fatalities are 16 unbelievably preventible; that if we provide people 17 with education, if we let people know that they 18 should not fear arrest, that the number-one priority 19 is to save a life, that they should call 911, they 20 will. 21 And so, in that vein, we must continue to 22 educate New Yorkers across the state around 23 overdose-prevention services, and we need to 24 increase naloxone access. 25 I think we've done some fantastic things 1 across the state by equipping a lot of law 2 enforcement and first responders with naloxone, but 3 we also need to dedicate funding for community-based 4 organizations to continue to distribute naloxone. 5 A lot of these groups are in first contact 6 with people who are using drugs or who are at risk 7 of overdose, and so they need to have access to 8 naloxone as well. 9 Families, and individuals who are prescribed 10 opiates, they should know that naloxone exists. 11 And with the 911 Good Samaritan Law, I think 12 we need to continue to push education around the 13 existence of that law, because not -- there are a 14 lot of New Yorkers who still do not know that law 15 exists; that they do not know that there are 16 protections that allow them to call 911. 17 They shouldn't feel like, when they pick up 18 the phone, that what will be coming is a police car. 19 They should know that an ambulance should be coming. 20 So with that, I would like to just say, 21 again, thank you, to the Joint Senate Task Force, 22 for continuing to push forward with an 23 evidence-based approach. 24 And that I hope you will continue to hear 25 many of the recommendations that were shared 1 tonight, particularly by a lot of the families who 2 have experienced tremendous loss. 3 And that, know, we need to have solutions. 4 We need to have comprehensive solutions. 5 Thank you. 6 [Applause.] 7 SENATOR AMEDORE: Thank you, Melody. 8 You know, one of the goals and objectives of 9 this Task Force was not to just go and do what 10 our -- my colleagues did last year when they started 11 the Task Force, and they went around 18 different 12 cities or -- and towns throughout the state of 13 New York, and they came up with some excellent 14 legislation, and they got a lot -- some of it passed 15 and chaptered into law; but, literally, this time, 16 having four different task forces that were in 17 different parts of the state, that would really kind 18 of start filling in the gaps and voids, and 19 listening to, and not just come up with a whole 20 barrage of different legislations that could 21 probably just be a bunch of one-House bills and 22 never get chaptered and make a difference. 23 This is about every member of this 24 Task Force, of getting together, listening to the 25 communities, and getting down deeper, and deeper, 1 because it's sometimes just not government that's 2 going to solve this problem. It's we, the people, 3 that are going to solve this problem. 4 And by engaging in conversation, and coming 5 and sitting, you know, for the times that you have 6 here tonight, and many of you testified in other 7 Task Force meetings that we've had, we appreciate 8 that. 9 Like I said in my opening remarks, there's 10 not one person that is going to solve and eradicate 11 this problem. 12 But, there's definitely services, there's 13 definitely support, and there's definitely, I think, 14 wise investments that the State of New York can 15 make, and needs to make, in helping we, the people, 16 eradicate this problem. 17 So thank you all for being here. 18 You have given us a tremendous amount of 19 information. You have given us excellent testimony. 20 And, we will take it, and collaborate, 21 and put forth a good package of bills that we know, 22 and we've already been working on some, like 23 I mentioned, Laree's law, that -- you know, that is 24 a great thing. We talked about some law 25 enforcement. 1 But the four-prong approach is constantly 2 working at: 3 Prevention; educating, and preventing things 4 from happening. 5 Treatment, and making sure we have the proper 6 amount of treatment. And it's got -- I like the 7 whole idea of treatment on demand. 8 And -- and, recovery, and making sure that 9 those peer-to-peer services, those support 10 wraparound services, are available. 11 There was a group of young adults who came 12 into my office, oh, about a month -- no, probably 13 about two months ago, before budget, and they were 14 all recovering addicts. And they wanted to know how 15 they can continue to stay relevant in this fight, 16 and they wanted to get more involved, and they 17 wanted to make sure that they're counseling or 18 they're giving that support, and having their arm 19 around the shoulder of someone going through a 20 horrible time in their life. 21 And, you know, I told them -- Father, you'd 22 like this. 23 I told them that, your effort, and grassroots 24 effort, is a lot like what we read about, even in 25 the Bible, where one person came and tried to create 1 this crusade, which, today, thousands of years 2 later, people still have faith and worship in that 3 God. And their efforts is not unnoticed, and it can 4 catch fire in the communities where that -- it will 5 create the wraparound services that we need. 6 And they can -- and we don't have to use 7 taxpayer dollars to do that. 8 So, it is an effort that we all need to make, 9 and we are. 10 And I look forward to working alongside all 11 of you to help this problem, and end this problem. 12 Thank you so much. 13 Kathy, did you -- 14 SENATOR MARCHIONE: Yeah, if I could just say 15 a few closing remarks. 16 First, I want to say, thank you, to all of 17 you who testified. 18 You know, I -- this is my second year at 19 this, and I can tell you that, last year, we heard 20 things that were very different than what I'm 21 hearing tonight. 22 We are going deeper. We are hearing -- I'm 23 hearing so many different things that evidence-based 24 is what we need. I'm listening to best practices, 25 is what we're looking at. 1 We talk money, but I'm not sure that we have 2 the program that we believe, or the programs that we 3 believe, will be the best for people who are in 4 need. I'm not sure we've established those yet. 5 And sometimes I think that we can throw as 6 much money at everything as we want, but if we 7 haven't done the due diligence of looking at the 8 best practices, and having information that would 9 work. 10 We hear things like the treatment facilities 11 aren't very good in locations, and they're better in 12 others, and there aren't standards. 13 These are things I didn't hear last time. 14 This was a terrific forum for me tonight, to 15 give me, and probably all of you, much more 16 information. 17 And, you know, sometimes you start, you go to 18 a hearing, and you get into it like we did last 19 year, and you think you got to know a lot about a 20 situation. 21 And then, the more you learn, the more you 22 realize what you don't know, and the more we need to 23 have the conversation continue, and come to some 24 resolve, so that we can truly help people who are in 25 need of help, with best practices, with best 1 programs, with best medications. 2 So, I just want to say, thank you, to all of 3 you for opening up my horizons on completely 4 different topics this time that we need to look at. 5 And, absolutely, I want to thank 6 Senator Amedore and Senator Ortt for being the 7 Co-Chairs of this very important committee. 8 SENATOR AMEDORE: Thank you, 9 Senator Marchione. 10 And I would be remiss, I have to say one 11 shout-out, thank you, to SUNY Albany for hosting us 12 tonight. 13 So, thank you so much. 14 [Applause.] 15 SENATOR AMEDORE: Have a good night, 16 everyone. 17 18 (Whereupon, at approximately 9:41 p.m., 19 the public hearing held before the New York State 20 Joint Senate Task Force on Heroin and Opioid 21 Addiction concluded.) 22 23 ---oOo--- 24 25