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Last Updated 11/06/97 13:01
March 21, 1997
pea JUDICIARY COMMITTEE 11:00 a.m.
PRESIDING CHAIRMEN: Senator Williams
Representative Lawlor
COMMITTEE MEMBERS PRESENT:
REPRESENTATIVES: Scalettar, Farr, Abrams,
Amann, Bernard, Bysiewicz,
Cappiello, DeMarinis,
Doyle, Fox, Graziani,
Fritz, Green, Hamzy,
Henrici, Martinez,
Mazzoccoli, McCavanagh,
Michele, Nystrom, O'Neill,
Roraback, Sauer, Staples,
Winkler
SENATORS: Upson, Kissel, Somma
REPRESENTATIVE LAWLOR: This first hour is reserved for
legislators, agency heads and municipal officials.
We have a separate sign-up sheet for them. And
first on that list is Commissioner Armstrong.
COMMISSIONER ARMSTRONG: Good morning, Senator Williams.
Representative Lawlor, Senator Coleman,
Representative Scalettar and all members of the
committee. I want to thank you for the opportunity
to address HB6991, AN ACT CONCERNING DRUG POLICY
before you this morning.
First I'd like to acknowledge the hard work and the
dedication of the Governor's Blue Ribbon Task Force
on Substance Abuse; the Connecticut Alcohol and
Drug Policy Council and David Bilken and members of
the Connecticut Law Revision Commission. The
efforts to introduce strategy options in the fight
against drug abuse have culminated in an excellent
work product. I also recognize the all entities
are working very hard together in order to
determine the best strategies to pursue toward more
effective action and I certainly support these
continuing efforts.
I did read with great interest the report to the
Judiciary Committee as well as HB6991 and believe
that many of the initiatives discussed are worthy
of pursuit. One issue, however, that gives me
pause is that of introducing methadone into a
correctional confinement setting. While I
understand that many of the researchers have
determined that methadone maintenance and
detoxification may result in greater stability for
certain addicts, I would be remiss in my
responsibilities as the Commissioner of Correction,
if I did not point out several of the down sides of
this treatment regiment, whether detoxification or
methadone maintenance.
The current Department of Correction drug treatment
programming and philosophy relies upon working
toward a drug-free environment and abstinence.
That is, our focus is giving the offender
population an opportunity to break the cycle of
addiction and drug dependent mentality while
incarcerated.
If we offer methadone even with the strict confines
as suggested, we could create a craving within the
drug dependent mentality and offenders would likely
gravitate toward the continued chemical dependency
in what I expect to be significantly large numbers.
Such an approach goes against the model that seems
to be most effective within the confines of the
correctional system.
Although we do continue to experience discoveries
of contraband narcotics within the confines of
prisons, I do believe that our interdiction efforts
are paying off and that there is less now than
previously. It is my professional opinion that
maintaining an addiction within a correctional
setting does not enhance the public safety, the
safety of my staff or the legitimate correctional
objectives which we seek to promote.
As many of you know, the Department of Correction
has a substantial number of inmates who are
diagnosed with substance abuse and substance
dependence disorders. In addition to abstinence we
have always addressed this cluster of disorders
through counseling service, self-help groups, and
where appropriate, medical intervention.
We presently have a detoxification protocol that's
been developed by our health services division to
assist those individuals who experience acute
withdrawal symptoms. This protocol includes
medication such as Vistaril and Clonidine that are
administered when necessary and if the withdrawal
systems are acute, the inmate would be transferred
to one of our five infirmaries for 24-hour medical
monitoring. Such a protocol is consistent with
the standards outlined by both the American
Correctional Association and the National
Commission on Correctional Health Care.
In addition, since the Department of Correction has
been successful in monitoring and treating
withdrawal, I'm very cautious about the use of a
controversial substance such as methadone. My
caution focuses on the security risks that this
drug presents. Not only will the drug dependent
mentality crave the substance, it can also become
an instant black market commodity within the prison
walls that creates a risk of safety to my staff as
well as other inmates.
The Ryker's Island data suggests that without
methadone individuals are likely to re-offend.
While I will not dispute this study in the
statistics, I'm left wondering why there is not a
multitude of prison based methadone maintenance
programs. If the primary concern is that these
individuals will return to the community and resume
a heroin habit, it would seem to me that a
potential option would be for the methadone program
clinicians to re-engage their clients prior to
their discharge from custody upon return to the
community.
The Department of Correction has developed a
similar program with the Department of Mental
Health and Addition Services for inmates with
serious psychiatric disorders. In this
collaborative effort, clinicians from designated
mental health centers follow their clients, track
them through our system in an effort to rap around
services prior to the release from custody for a
successful transition into the community.
Finally, the cost of such a program is high. To
implement such programming would require additional
staff and dollars that we simply do not have. I
would request that you allow me and my staff to
continue to do their jobs in a fashion that is
consistent with the protection of the public,
institutional safety and in the interest of
breaking the cycles of addition, rather than
providing a crutch with which an individual
ultimately delays dealing with a terminal
affliction.
Again, I want to recognize the efforts of everyone
who's been working towards development strategy
options. And I thank them for their hard work and
I'd be happy to answer any questions you would have
for me.
REP. LAWLOR: Thank you, Commissioner. You mentioned
the Ryker Island experiment. My understanding is
that its been there since 1988. How did they in
New York deal with the concerns that you have
raised here?
COMMISSIONER ARMSTRONG: Well, I don't know because I
haven't spoken with the prison officials in Ryker's
Island. I have placed some calls and I would like
to meet with them. David Bilken is brokering a
meeting so that we can continue to explore that.
REP. LAWLOR : And as you read the proposed statutory
language that would mandate you to provide
methadone to inmates?
COMMISSIONER ARMSTRONG: As I read it, I would read that
they would require me in one of the jails to set up
a program which would require me to offer it and
make it available.
REP. LAWLOR: Do you think the current laws would
prohibit you from doing it if you thought it would
be effective?
COMMISSIONER ARMSTRONG: Well, I should add that
currently under a consent decree we have a
methadone detox program for females under West
versus Manson at the York Correctional Facility.
That is because of the risk that withdrawal and
acute symptoms would present to pregnant females.
The program is maintained per order of that consent
decree.
So that does occur. We have had prior experience
with methadone maintenance, I think it's worthy to
note. Often times offenders who are out in the
community under methadone maintenance would come
back in having re-offended. When they came back re-
offended, they were not only taken methadone, but
they had also crossed addictions that were present
as well.
They had resumed shooting heroin or using other
chemical substances as well. So it was not a
simple return to methadone. It was another
withdrawal from additional cross additions as well.
We had some problems before with that, and again, I
think that one of the values of the correctional
setting and the withdrawal process itself began
recognizing that the symptoms is like have the flu.
It's uncomfortable. It's difficult. But it does
fit directing people at that point to effective
treatment strategies.
I think the bottoming out is pretty much a standard
provision that most people who become motivated
towards treatment experience and then look for the
treatment and look seriously at it. And I
certainly wouldn't want to make it comfortable for
someone to face that decision. I think that
that's where they actually make good decisions.
REP. LAWLOR : Is it possible to get heroin in our
prisons today in Connecticut?
COMMISSIONER ARMSTRONG: Is it possible? Sure, if we
have people who are committed to it. We spent
millions of dollars outside the prisons fighting
heroin. You can get it in the free society with
the amount that we've invested there. You
certainly can find ways to breach our security.
I think we're doing much better than we've ever
done in this state. I was just counting up some
numbers. We've done this past year about a dozen
prosecutions for people who have attempted to bring
it in or have brought drugs in and been detected.
We have K-nine sweeps on the average of twice a day
in housing units for offenders. We use telephone
monitoring religiously to prevent that from
occurring. And again, I think just our overall
strategy of drug testing targeting offenders who
are at risk has been tremendously effective in
reducing the amount of occasions where we have
that.
REP. LAWLOR: And do you keep statistics on how often
you find syringes, for example, in prison?
COMMISSIONER ARMSTRONG: Yes. We document every
occasion where we find narcotics. We document
every occasion that we make an arrest, etc. We are
right now in the process of getting some better
statistics in terms of the number of arrests that
we have in process, investigations that are under
way. And we've taken a very strong position on
that.
REP. LAWLOR: So about how many syringes do you find?
COMMISSIONER ARMSTRONG: Syringes not too many at this
point in time.
REP. LAWLOR: About?
COMMISSIONER ARMSTRONG: I couldn't answer from here,
but I'd say very few.
REP. LAWLOR: One a month? One a week?
COMMISSIONER ARMSTRONG: Couldn't tell you from here. I
will get you the numbers though.
REP. LAWLOR: Okay.
COMMISSIONER ARMSTRONG: I'd be happy to get those from
you.
REP. LAWLOR: And how about finding heroin or cocaine or
marijuana inside prisons? That happens I take it?
COMMISSIONER ARMSTRONG: I'd say we probably find a
substance more often than we find a syringe. But
I couldn't tell you. Again, I will get you some
statistics on that.
REP. LAWLOR: So you mentioned that in the women's
prison facility there's an ongoing methadone
program. The problems you outlined on the outset,
how are those dealt with at the women's prison?
COMMISSIONER ARMSTRONG: It's a detoxification program
so it is somewhat limited. It would not be a
maintenance program. There are two very, very
different pieces of this. Basically it's because
of what I understand the half life of heroin
addiction in your system to do.
In other words, the withdrawal symptoms over the
course of time take longer with heroin than it may
other substances.
REP. LAWLOR: So how long is methadone administered to
inmates?
COMMISSIONER ARMSTRONG: I believe it's depending upon
the individual and the acuteness, but I would say
up to about 30 days or so for a detoxification
program.
REP. LAWLOR: So are you aware that in the Ryker's
Island program that it's only for inmates who are
in for a relatively short period of time? A month
or two?
COMMISSIONER ARMSTRONG: Yes, I was aware of that.
REP. LAWLOR: And are you aware that basically what that
is it's a relationship between the in-the-facility
program and the outside-the-facility program to
begin to wean people who are chronic offenders off
of heroin and get them onto some sort of health
treatment program?
COMMISSIONER ARMSTRONG: I am all for that, but I do
believe that we have to recognize that once we have
the controls to the confines of the prison that it
does make a difference in the type of environment
and climate that I believe is very important for me
to maintain.
I am no adverse and I do believe that we should
look at the strategy of how we connect,
particularly when we put the person back to the
free society, recognizing they were short term in
the jail system and will likely return to the ready
availability of whatever drug of choice they have.
That may be the most appropriate point. So that we
have a system that does not cause other problems
within what we have made some great strides in.
REP. LAWLOR: So is what you're saying that you think to
try and do this today would create too many
practical problems, but --
COMMISSIONER ARMSTRONG: If I made methadone available
inside the prison system, it would change both my
procedures and my protocols that have been very
successful. I think it would probably diminish
those people who wish to take advantage of
programs.
I do have to recognize withdrawal is probably very
difficult for those people who have to experience
it. We do have some degree of treatment which
makes it a bit more comfortable. But I think to
make people too comfortable under an addiction is
only going to delay dealing with the problem.
I do again, that's somewhat of a personal
perspective. I used to be a counselor in the
system and I recognize that those people who wanted
to change always told me it was as a result of
bottoming out. That they realized that the jail
experience has been valuable to those individuals
who want to change based upon the withdrawal
experience as well.
It really starts to add things up. They have no
availability of the drug. They start to see much
clearer where they've put themselves. I think it's
very, very important that that is a part of the
process to be recognized in people who desire to
seek treatment.
I think we will only defer some real substantial
steps towards treatment if we make them comfortable
in a process. And again, please don't mistake
this. It's not mean spiritedness at all. I really
do believe in programs, I believe in the
effectiveness of programs. But I think they've got
to be well gauged as to where to do those.
REP. LAWLOR: Well, I think we're just looking to save
money mainly, so I think as I understand the way
they do it in New York, which has been very
successful and documented and studied from here to
kingdom come. The way they do it is they target
only people who are in for a very short period of
time. And these are people who have been in and
out, in and out, in and out for years in many
cases.
And for those individuals they find that they are
successfully getting them into drug treatment,
avoiding future incarceration, returning them to
employment by targeting carefully the methadone
program and they do it only in the facilities which
are dealing with these short-term stays. The pre-
trial type confinement.
COMMISSIONER ARMSTRONG: I hope I didn't sound like I
disagreed with their target group. I do think
that's a good group to focus on. I think if they
are going to do something with that we could
certainly cooperate with the identification.
I think it becomes a problem for me where we
introduce the methadone into facilities. I do
think it's important as these people will be
identified as a high-risk group and will be let
back out into the free society, that we do
gravitate those whom we can towards effective
controls.
That's a public protection issue and I do believe
that's good public protection if again, we don't
compromise it in another aspect, such as inside my
facilities.
I think we can identify those folks. I think we
can be cooperative. I like the model we've had
with the Department of Public Health and Addiction
Services and wraparound services. I think it's
most appropriate as a public protection issue as
they are returning to the community, but as we also
have another support system that's available for
them to be directed into treatments which will
change the cycle of addiction.
REP. LAWLOR: And you'd be willing to meet with Mayor
Guliani's staff and the corrections people from New
York to talk about how they've solved these
problems there?
COMMISSIONER ARMSTRONG: Yes. David Biklen has done a
fine job in the information he's gotten me and he
has also agreed to broker the meeting and I'm
looking forward to that.
REP. LAWLOR: Great. Okay. Other questions?
Representative Farr?
REP. FARR: Just so I understand it, and I think you
expressed your concerns about these programs
before, the methadone program in the jail. We
first envisioned or I envisioned that we would do
it when people got arrested, you know, that were
arrested that a long time drug abuse, people would
be suitable for methadone, and got arrested and you
pointed out that the problem that they haven't been
sentenced yet is you don't know whether they are
going to be long-term or short term.
And, therefore, if you get somebody on methadone
and they get a long sentence, then what do you do
with them? Then you've got to withdraw them from
methadone.
COMMISSIONER ARMSTRONG: That's correct.
REP. FARR: Then if you have somebody who's long term,
they've completely withdrawn from drugs, you now
put them back on methadone right before get
released? I mean, that's -- I don't know whether
that's good or bad. New York's program I gather is
for people as Mike described it, somehow they've
identified those people that are going to be short
term that are long term drug users.
I don't know what -- it seems to me that percentage
of our population is relatively small because most
of the long-term drug users that end up in jail I
think would tend to get longer sentences and if
they get a longer sentence, then why -- how would
you use the methadone program?
COMMISSIONER ARMSTRONG: It gets a bit awkward. I'm
probably not the best person to determine which
people will not come back to me. That's more of a
judicial matter. A lot of the screening which
would occur for the people who might be most
appropriate for this would likely occur at court.
Again, it's sort of a directional process where I
don't have control over who stays and who goes,
especially in the pretrial area.
So as I say, it may be most appropriate to have an
identification system that is set up and not have
the methadone introduced necessarily because of
those other issues, some of which you touched on.
But as well, the commodity inside the prison could
be a black market commodity. A person who is not
on a drug could actually get high on the methadone.
And certainly it's a system of assessment and
gauging the proper amount of methadone so that a
person really does detox without the physiological
problems that occur.
So there are a lot of things in there. Again, my
concern would be community protection, public
protection. And I think that as I see it right now
we could have a part in assisting in the
identification and the screening process for those
individuals who might be most appropriate.
But I think in terms of serving public protection
as well as institutional security and order, it
might be best for those people who haven't been
identified and who will leave the system to be
caught in the net before they go and be brought
directly to the resources.
REP. FARR: Let me just say I asked your staff for some
data on the use of drugs within the prisons and I
talked to somebody this morning and they had
indicated that you were still gathering that data.
But that -- and the one study that he had looked
at, in one institution where they had done targeted
drug testing and these were drug testing at people
that they considered to be high risk, people who
had been out on furlough, people that were short
term there, that might have access. That those
people that the rates were something in the 14 to
17 percent.
They found 14 to 17 percent of those people who had
used drugs. But that was a very targeted
population and if that's population is at 14
percent, then overall population in the institution
would be certainly below single digits and to me
that certainly reflects that we don't have the
situation that's been described in other states
where access to drugs is rampant and that doesn't
surprise me knowing the way you run your
institutions.
So I would appreciate getting that data as well
when you finalized it. Thank you.
REP. LAWLOR: Thank you. Representative Fritz.
REP. FRITZ: Thank you, Mr. Chairman. Commissioner, I
was quite concerned with the section of the bill, I
believe it's section 7 where it talks about your
establishing a pilot research program of methadone
maintenance at the York Correctional Institution.
And additionally over in that same section in line
182 where it talks about you providing up to 500
treatment slots.
I was wondering if you had any inclination or any
estimate about the approximate costs of such beds
and such a program and have you any idea where you
would be putting any of these beds?
COMMISSIONER ARMSTRONG: I don't mean to be flippant,
but it's more than I have. It's quite a
substantial amount of money. Again, I'm guessing
that methadone maintenance would be about $5,000
per year per offender. And again, it's
indeterminant at this point.
REP. LAWLOR: Other questions? If not, thank you very
much, Commissioner.
COMMISSIONER ARMSTRONG: Thank you.
REP. LAWLOR: Tom Siconolfi.
THOMAS SICONOLFI: Good morning, Senator Williams,
Representative Lawlor, and members of the Judiciary
Committee. I'm Tom Siconolfi, Director of Planning
at the Office of Policy and Management. And I'm
here on behalf of Governor Rowland and Secretary
Kozlowski to testify on two subjects.
One, the governor's recommended allocation of block
grant funds under the drug control and system
improvement block grant. And secondly, to offer
testimony on HB6991. I've submitted extensive
written testimony on both and based on the
committee's preference we could deal with the block
grant first or combine my oral comments and get
right into questions. Whatever you think would be
preferable.
REP. LAWLOR: Oh, I'm sorry.
THOMAS SICONOLFI: You weren't hanging on every word,
Mike.
REP. LAWLOR: Testify on the block grant first.
THOMAS SICONOLFI: Sure. The drug control and system
improvement block grant is a grant from the U.S.
Department of Justice that supports a wide range of
initiatives across many justice agencies. The
leaders of those agencies as well as other federal,
state and local officials were instrumental in
helping us to procure the allocation plan that we
submitted for your consideration.
They assisted us by reviewing current grant funded
initiatives, evaluating requests that were made to
fund newer, expanded programs and in reaching
consensus as to the best use of what are really
very limited dollars.
They recommended ultimately that the majority of
these 1997 block grant funds, some $6.7 million, be
used to continue programs already in existence and
supported by grant funds. They also suggested that
the remaining funds, about $1.1 million, be used to
expand the drug court program to two additional
sites.
And overall the allocation plan, I think you'd be
able to find five priorities within it, and those
include alternatives to incarceration, particularly
for juveniles; youth crime through drug education,
school safety and gang initiatives; law enforcement
task forces that target narcotics, fugitives, auto
theft, financial crimes and street crime; court
system improvements including death penalty
litigation, youthful offenders program, judicial
resource enhancements in court security; and also
development of a criminal justice information
system, which is a requirement of these federal
dollars.
And in putting together this program plan and the
priorities, the committee purposely avoided
earmarking any of these so-called DCSI funds for
programs that are well supported with other dollars
that we have available. And accordingly we would
ask the Judiciary Committee to bear in mind that
this allocation plan represents only a small
portion of the total dollars that we're providing
for state and local justice initiatives.
Some of the other money which should be taken into
account includes the state-funded Drug Enforcement
Program, which provides about 100 municipalities
with $9 million for drug enforcement and drug
education activities.
Safe Neighborhoods Program, under which state
support for -- the state is supporting 158 new
police officers in 12 communities at a cost of
about $6 million a year.
And the new federal program, the Local Law
Enforcement Block Grant Program, under which we
received about $3.3 million and virtually every
community in Connecticut is getting some portion of
that, large or small depending on their violent
crime problem.
There are also many other federal grant programs
that I haven't listed that we also use to undertake
special initiatives as well.
But in summary, this allocation plan helps balance
resources across the justice system and I would say
that in our experience looking at issues like
prison overcrowding, curbing the sales of illegal
drugs, cracking down on gangs or violent crime,
we've always been most successful when all
components of the system are adequately funded.
And in conclusion, on the block grant, we would
respectfully suggest that the Judiciary Committee
concur with the Appropriations Committee and
approve the allocation plan as submitted by the
governor.
I'd be happy to answer questions at this point or
move onto HB6991 as you choose.
REP. LAWLOR: I think one of the reasons we wanted to
have a discussion of the block grant as part of
this overall public hearing today was to get some
sense of where the state is deploying its resources
in the fight against drugs, and especially drug
abuse and drug use for children.
How would you basically describe the general state
strategy and why is it that this particular
proposal on spending the federal money is
consistent with that strategy?
THOMAS SICONOLFI: Well, I think it's consistent in a
number of ways. A substantial part of the money --
REP. LAWLOR: Well, first start with what's the strategy
now?
THOMAS SICONOLFI: The strategy as it stands right now,
is again, to balance within the system a
combination of needs including moving on
alternatives to incarceration, particularly for
juveniles in order to help implement juvenile
justice reorganization as the legislature adopted
two years ago.
And secondly, to make sure that the state and local
police have adequate resources to target the kind
of crime that the public is most concerned about
right now, which includes gang activity, drug
sales, gateway crimes among juveniles like auto
theft that lead to other offenses and chronic
criminal careers and so forth.
And what you would see at this point is that about
$1.7 or 8 million supports those special task
forces, mostly run through the State Police, but
also supporting local police with the same dollars.
Several million of this grant is earmarked for
judicial programs to implement some of those
programs in a continuum of juvenile sanctions that
the legislature and the executive branch and
judicial all bought into so completely two years
ago.
And there are other programs relative to -- which I
would call special needs, such as the death penalty
litigation attorneys that we're funding in both the
Division of Criminal Justice and the Chief Public
Defender's Office. Certain court enhancement
programs that we're undertaking. And those dollars
in conjunction with particularly the drug education
part of the drug enforcement program we think give
us a well-rounded strategy that supports
enforcement, treatment through alternative programs
and education to try to keep young people from
being involved with violence, gangs and drugs.
REP. LAWLOR: Other questions? Representative Farr.
REP. FARR: I have a few specific questions on the block
grant.
First of all, we're spending $170,000 of the block
grant on the DARE Program. And from reports that I
get there are other programs, drug education
programs that may be more effective than that. And
I guess my concern in our educational areas is that
we don't do a very effective evaluation of
programs.
And are we spending any of the money in the block
grant in terms of evaluation of educational
programs? Is there any money specifically set
aside for that? Cause I've become convinced that a
lot of the money we spend, not just in drugs, but
in most of our state agencies, we don't measure
results. How do we know whether we're spending it
right?
THOMAS SICONOLFI: The evaluations that are specifically
funded in this program are probably not earmarked
at the drug education component. There's an
evaluation being done now of the Sex Offender
Program that runs through the Office of Adult
Probation.
The DARE Program is a very well supported program,
as you know, among local police and State Police.
But many of our communities are also doing other
programs. Here's Looking at You 2000 and other
anti-drug curricula.
One of the things that we would agree with is that
our whole strategy on drug education needs to be
looked at and the Alcohol and Drug Police Council
which is co-chaired by Tom Kirk from Demus &
Brandacisco from the governor's office, recently
produced a report with a major recommendation that
said: let's take a look at all the dollars we're
putting into drug education and see if we're doing
it as effectively as we might, see if it's time to
reshape curricula in some fashion.
So the State Police participate on that council, as
does OPM, the Department of Education and others.
So we're going to work together in the next few
months to try to take that had look at our drug
education efforts.
REP. FARR: But there's nothing allocated under the
block grant for that evaluation?
THOMAS SICONOLFI: No, there is not.x
REP. FARR: And so where would we get the money to do
the evaluations?
THOMAS SICONOLFI: Well, the evaluations -- I'm not sure
I would call it a formal evaluation from a research
standpoint, but the individuals who are running all
of these programs, prevention experts from Drugs
Don't Work and the like, are going to sit down at
the table together and take a look at what the best
practices are now, what the literature says is
working and isn't. Take a look at what we're
funding and possibly redirect some of that money or
not.
It may be that people will feel comfortable that
what we're doing is the right mix of prevention
programming. I couldn't say yet.
REP. FARR: Let me ask you about a couple of other
specific programs that are funded in here. The
drug session, I know that the drug session we get
anecdotal evidence back about its success.
THOMAS SICONOLFI: Yes.
REP. FARR: But is there a formal evaluation of the drug
session? Do you know? Has there been a formal
evaluation?
THOMAS SICONOLFI: I believe we are. I was just looking
back to Bill Carbone from the Office of Alternative
Sanctions and Judicial Branch which is actually
administering the program and Bill is indicating
that, in fact, there is a formal evaluation
component which is built into the $420,000 that
funds that program.
REP. FARR: But we don't have it back yet?
THOMAS SICONOLFI: No. The program has only been
running I think about eight months.
REP. FARR: Okay. The other concern I have is we're
talking about spending money, a considerable amount
of money on expanding of the drug sessions.
THOMAS SICONOLFI: Yes.
REP. FARR: And the language it says: a new adult drug
session in Waterbury and a pilot juvenile session
in Hartford. The report we got back from the judge
that was running the program is that, in fact, the
program has turned out to be different than it was
envisioned.
THOMAS SICONOLFI: Right.
REP. FARR: In that instead of getting young offenders
we get old offenders instead of getting people that
are, you know, new drug users, we're getting people
who are kind of at the bottom of the barrel.
They've been on drugs and gone through the system
multiple times and they are trying to get off of
it.
And I guess I have questions about how you can have
an effective juvenile drug session based upon all
the reports that we got back in that at the
juvenile level you don't have the juveniles
interested in getting into these programs.
THOMAS SICONOLFI: Well, I think there's a couple of
things happening here. One, our original intent
was to expand the program so that it would be in
four adult court locations. But there was quite a
bit of support within the Alcohol and Drug Policy
Council for trying a pilot program that would
target juveniles. And so we changed the mix and
came up with the notion of doing one juvenile-based
drug program.
I think one of the issues we need to keep in mind
is that in terms of remaking the juvenile system
and developing a continuum of sanctions much like
we have on the adult side, it's in its infancy. A
number of the programs that the legislature deemed
should be enacted and established are just
beginning. DARE reporting centers for juvenile
offenders are just getting off the ground.
And so I think we're in a point similar to where we
were in the adult system several years ago when it
was easier for offenders to take what looked to be
a harsher sanction on face value, prison, to an
tough alternative program. But I think once that
mix of juvenile alternative programs is in place
fully, which will include some tough supervision
programs, then programs like the drug court will
become more attractive because there won't be the
easy out.
We're still dealing with a situation where the
average stay at Long Lane for juveniles is no where
near where we want it to be. It's only about four
and a half to six months and DCF is looking at a 12
to 18 month program. That's our goal in remaking
Long Lane School.
So once those changes are in place I think we do
have fair experience on the adult side that says
that's the point at which tough alternatives can
work. But if you don't have tough sanctions on the
top end as an alternative, then programs like this
will look tough to kids and they'll look for
another avenue.
REP. FARR: I agree. I'm just saying that I don't see
the benefit of saying we're going to set up the
program. We don't have the sanctions out there now
to make this look attractive. It seems to me if we
set up a juvenile court program right now today
nobody is going to opt for it.
THOMAS SICONOLFI: Well, the three day reporting centers
for juveniles that we were describing are just
beginning. I think it's a first quarter and second
quarter of '97 initiative. I'm anticipating that
starting this juvenile program, the drug session,
probably wouldn't begin until September or October
by the time we got it off the ground.
So some of those additional sanctions should be in
place at that point, but we're going to have to
look at it closely. I think your concerns at this
point are valid.
REP. FARR: My overall concern with the way we spend the
money is that we don't have enough money in this
for evaluation. Now you've got administrative
funds $433,000.
THOMAS SICONOLFI: Yes.
REP. FARR: I'm not sure how much of that is evaluation
components? Do you know?
THOMAS SICONOLFI: Of the $433,000, none. At this point
that 5 percent is supporting staff at OPM who are
not only administering this grant, but also the
other grant programs that I mentioned earlier. It's
four or five full time equivalents that are being
funded under the program and there's some equipment
and other operating expense money.
But the administrative side strictly supports OPM
based planning and program management activities.
REP. FARR: Well, I can keep saying that but it's clear
to me that if you don't put evaluations in place
and we keep spending all this money that most of it
or a substantial portion is going to be not spent
wisely.
THOMAS SICONOLFI: Point well taken, sir.
REP. LAWLOR: Representative Scalettar.
REP. SCALETTAR: Good morning. I will follow with two
lines of questioning that Representative Farr was
talking about.
One is with respect to evaluation of programs,
which I think is very important and I know that the
Office of Alternative Sanctions has really made an
effort to incorporate that. When we talk about
drug policy and the importance of drug policy, both
with respect to drug abusers and the safety of the
community, I think it's very important to include
the Department of Corrections in our evaluations.
And that's something where people don't often ask
for it, so I just make that point to you.
In thinking about the future that we want to
compare the results of what's happening by sending
people to prison and programs in prison so that we
can really see how we're -- what's the best and
most cost effective way to spend our dollars.
Also with respect to the juveniles. What Judge
Simone told us about the drug court is that they
expected to get 16 to 19 year olds, not the
juveniles. I think juveniles and what you're
targeting here is very important and new and that's
the 14 and 15 year olds, perhaps even younger.
And they expected to get the 16 and 19 year olds
but are not, and he actually pointed out to us
something in the law which we might be able to
change to make a difference in that.
So I don't know if you have any comments about
either of those.
THOMAS SICONOLFI: Well, relative to the second point,
one of the main features of the juvenile justice
reform bill was to make juvenile records that
previously hadn't been available in the adult
court, available to court personnel.
And so kids who previously looked as if they had a
clean record and would start anew as an adult, can
no longer do that. So I was of the impression that
the availability of those records so that the adult
system would look at those 16 and 17 year olds as
they truly existed in the juvenile justice system,
combined with the sanctions would provide an
incentive to get into these programs.
But again, currently it's not being borne out in
New Haven.
REP. SCALETTAR: Thanks.
REP. LAWLOR: Are there other questions? Representative
Nystrom.
REP. NYSTROM: Thank you, Representative Lawlor.
Through your testimony on one section of 6991,
which is the repeal of Section 21a-278, but I
didn't hear you elaborate too much on that.
THOMAS SICONOLFI: Well, I had oral testimony I had
hoped to offer on 6991 and I thought that perhaps
we would finish the block grant and I would make a
few remarks and answer questions on that, at the
committee's pleasure, of course.
REP. NYSTROM: Okay.
THOMAS SICONOLFI: With the permission of the chair,
could we move off the block grant and --
REP. LAWLOR: Sure. Oh, I'm sorry. I thought we had
kind of were mixing. Representative Fritz.
REP. FRITZ: Thank you, Mr. Chairman. I have one
question on the block grand and it deals with this
communication that came from the governor that
talks about that has the chart at the back and I
would assume this is the drug control and system
improvement fiscal year '97 funding plan?
THOMAS SICONOLFI: Yes.
REP. FRITZ: I would assume that you had put these
numbers together. Could you explain to me why
there's $1,123,890 left if I'm reading this
correctly, in terms of carry over from the 1996
funding? Or is that the money supposedly from
January to July of '97? Could you elaborate on
that please?
THOMAS SICONOLFI: Sure. We try to keep programs for
funding on the fiscal year cycle. It works better
for us and it also works better at a point where we
ask the legislature to pick up funding for a
program. And often programs there are people who
are expected to be employed who are not. There are
programs expected to start in September that may
not start until October or November.
And it's not until the end of the fiscal year, when
we get our final reports, that we identify the
amount of money that was unspent. And so the
amount that you're referring to would be an
accumulation of funds from any of a number of grant
programs that simply spent less money than we
anticipated.
There was one area where we had a substantial carry
forward and that was from a school safety
initiative which we deferred for one year. And so
we didn't spend any of the money we had originally
earmarked for that. But those would be the causes
of carry over funds.
REP. LAWLOR: Representative O'Neill.
REP. O'NEILL: Over the last couple of years we've done
a lot of studying about the issues related to drugs
in the legislature and the governor's had I'm not
sure if it was a task force or a study that his
people put together that I guess culminated in the
council.
And the Law Revision Commission did about a two-
year study and the program review and investigation
did one targeted for teenaged drug use,
particularly and aside from the drug courts which
sounds like from what we're hearing, at the present
time they attract adults more than teenagers. And
sort of agreed that that probably will continue
until or unless we change some systems to
incentives teenagers to use the drug court rather
than the other things that are available to them.
But that may or may not happen. That's kind of
like potentially, but I'm not sure that I know of
anything specifically that leads us in that
direction. So I guess my first question is in
following up on that question or issue of
incentives, changing the incentive structure. Is
there anything proposed to do that?
THOMAS SICONOLFI: Well, as I mentioned earlier, I think
the incentives will come to pass in the form of
tougher sanctions that are being put in place for
younger offenders through juvenile justice
reorganization, combined with the opening up of
records that people amass as a juvenile to the
adult system.
I think when that is fully in place the adult court
will begin to treat 16 and 17 and 18 year olds who
previously looked like they were just beginning
their criminal career appropriately based on their
record, which wasn't available in the past.
And so when that happens I think the alternatives
to participation in a program like the drug court
will be a tougher sentence than might be faced by
that 16 year old or 17 year old. And that's the
incentive to get into the program.
Right now, again, as a juvenile there's little
incentive. If terms at Long Lane are insufficient
and as a 16 or 17 year old there may not be
sufficient incentive if, in fact, your full record
was not known to the adult court and you're likely
to face a non-conviction sanction for the offense.
REP. O'NEILL: But these are things that are in effect
already past in terms of legislation?
THOMAS SICONOLFI: Yes, and also things that are
happening budgetarily relative to juvenile
sanctions. The judicial branch has a program over
three years to dramatically increase the programs
that are out there for younger offenders and that's
being implemented across that period of time. Not
everything is in place yet.
REP. O'NEILL: Because so in effect we won't know maybe
for a year or two whether what we think intuitively
which should work which is that if there are higher
sanctions, not so much that we've changed the
sanctions while we've done that a little bit, but
mostly because we've changed the rules by which we
evaluate someone to decide what sanction they are
likely to get as a juvenile?
But we won't know that for a couple of years
whether that's really working. I mean, but we're
going to be doing the drug courts before that
happens.
THOMAS SICONOLFI: Well, I would hope and I would expect
that we'll make adjustments to the court program on
the move. As we learned from our first experiences
in New Haven, we'll hopefully make adjustments that
will get incorporated into the new sites and also
into New Haven program.
But again, that program I believe is quite a bit
less than a year old and so we're really just
beginning to see how it's working, whether or not
people are staying in it, whose failing. There is
a formal evaluation underway. Judicial also has a
formal evaluation underway of its full juvenile
sanctions program.
So that kind of information is going to take awhile
to get back. But the kind of adjustments that can
be made internally there's no reason why we can't
make those as we go.
REP. O'NEILL: Okay, but in other words, we don't, in
effect we don't know if the drug courts are going
to get at the teenagers right now.
THOMAS SICONOLFI: All the evidence would say that it's
not getting to the population we had hoped and I'm
not certain whether or not we've identified the bet
way to make that change in the short term.
REP. O'NEILL: But we're going to go ahead and do more
drug courts?
THOMAS SICONOLFI: Because the feedback has been that
even the target population that is participating,
or the population that is participating as opposed
to the target population, is benefitting from the
program.
So the feedback we're getting from prosecutors and
public defenders and Judge Simone and others in the
New Haven district is that the program works very
well. It's just not working, it's not drawing the
same group we expected to draw earlier, which is
not to say that it's not valuable (tape ended) for
the slightly older population than it's actually
getting.
And based on that the assumption is that the
program has value for either. We would prefer to
target the younger population. We're going to try
to make adjustments to do that.
REP. O'NEILL: Because the main problem that seems to be
reported in the media and seems to have cropped up
in all the research that I was on the Law Revision
Commission and I worked fairly closely with keeping
track of the research that was being collected and
so forth, is that we've had a fair amount of
success with older drug users.
Or put it this way, the problem that we've had
failure with more than anything else is with the
younger people, teenagers. And that for better or
for worse the programs that have been put in place
over the last 15 years if their objective was to
discourage adult drug use, have been somewhat
successful.
Over the last five or six years teenage drug use is
what seems to have gone up. And so if that's where
people want to focus or at least right now they are
saying well, this is where the rise is. This is
where we should focus our attention. And that I
guess isn't based on what we know now isn't really
addressed by anything in here. Or am I
misunderstanding what we're doing?
I mean, assuming that, you know, if we don't know
for sure whether the new incentives will get the
teenagers into the drug courts and basically the
drug courts is where we're putting what little new
money we have.
THOMAS SICONOLFI: My sense is that the alarm that
people are experiencing about an increase in drug
use among youth is primarily in the non-criminal
justice population. And the initiatives that
people want to undertake in response are primarily
drug education activities at the school-age
populations who are involved recreationally, if
that's the right word, in drug use before they
become more seriously involved or for some, and
it's going to be a small number before some become
involved with the criminal justice system.
So that's one of the reasons that we want to take a
hard look at the current drug education programs
we're funding and try to say wait a minute here.
If, in fact, drug use is up among that population
yet we're still spending $4 or $5 or $10 million on
drug education in the schools, then it's time we
take a hard look at our drug education curricula
and decide if it needs to be adjusted.
Is it stale? Are there new initiatives that should
be incorporated into it? That's the purpose of
looking at those programs. But I think the general
concern that's out there is for a population
perhaps different from this one. The one addressed
by either the drug court or by any of the programs
funded in the DCSI grant program.
REP. O'NEILL: Well, but the DARE Program really is --
is it supposed to be model for younger children of
an anti-drug education that's kind of a broad
spectrum not really targeted? At least as far as I
understand it's not like you find the children of
heavy drug users and --
THOMAS SICONOLFI: Right.
REP. O'NEILL: I mean, this is something that's
available to the general student population. And
that's the target audience for that program. So it
does seem like there's nothing programmatically or
legally that inhibits the use of this money for
educational type of purposes.
THOMAS SICONOLFI: Well, actually this money -- that's a
good point. This money has to be used for criminal
offenders. Either to prosecute them, treat them.
This particular block grant is not available for
general prevention activities.
The DARE money that's in the small amount of DARE
money here supports training, which is allowable.
But that's the reason why we use the state drug
enforcement program to fund actual drug education
in schools. This money must be used for a justice
population.
Libby Graham from OPM just pointed out another good
point which is that you can only do drug education
with this money if it's done by law enforcement
officers and that's why we've been involved with
DARE. By and large drug education activities are
being funded elsewhere because the money is more
appropriate from those other sources.
REP. O'NEILL: The other thing that we cropped up with
and I realize this is relatively new and you've
been putting this package together for some time.
But there's a lot of thinking that's kind of -- at
least in my mind is moving in a direction towards
something like these methadone programs that do
seem to have a fair amount of success with the hard
core drug user that nothing else seems to be able
to reach, and the criminal justice system doesn't
necessarily represent an effective way of
converting them if they are essentially being
treated as a physical problem that has to be cured
with a medical type or a physical cure, not
psychological type of approaches.
And I don't see anything in here. Is this
something that is in the process of being looked
at?
THOMAS SICONOLFI: Not through this particular
initiative, but I think Deputy Commissioner Tom
Kirk from DMHAS will also be testifying this
morning. He's the co-chair of the Connecticut
Alcohol and Drug Abuse Policy Council and I think
he's going to be making remarks and answering
questions relative to some of the features of the
law revision proposal that talk about methadone
programs and the like.
So I think Dr. Kirk might be in a better position
than I to answer that question.
REP. O'NEILL: Thank you.
REP. LAWLOR: Other questions? I think you wanted to go
onto 6991, right?
THOMAS SICONOLFI: I understand the committee's time
constraints and I would just quickly summarize for
you.
REP. LAWLOR: Can I -- rather than that let me just ask
you two quick questions.
THOMAS SICONOLFI: Okay.
REP. LAWLOR: You mentioned during your discussion that
we need to take a look at our drug policy to decide
what to do. Especially as it relates to kids.
THOMAS SICONOLFI: Drug education policy I think is the
specific comment that I made.
REP. LAWLOR: The reason that sort of sparked my
interest is because I think that if nothing else,
everyone would have to agree that over the past two
years more effort has been invested in rethinking
our drug policy and looking at alternatives that
might be options for us to consider.
And I think one of our goals is this year, rather
than to look at it some more, is to make some
policy decisions about whether or not there are
other things which we can explore which might be
more effective and are there -- do you see options
like that in any of the bills that are before us
today? Things we haven't tried before that might
be worth taking a look at to see if they'd work for
us?
THOMAS SICONOLFI: Well, we are generally supportive of
the expansion of drug courts, although I think
based on the proposal in 6991 financially it's not
workable right now. We anticipate that that would
cost as written $10 to $12 million to implement.
Having done four courts in one year based on the
proposal we have now it would be quite an
accomplishment and future expansion really ought to
be tied to available dollars.
So that's one area that we would certainly agree.
REP. LAWLOR: Well, can I just ask you in terms of money
have you ever taken a look at the current prison
population and determine how many or rough
percentage of inmates are there purely on drug
possession and sales charges?
THOMAS SICONOLFI: I saw numbers recently which would
indicate that I think there were about somewhere
over 3,000 who you could categorize as being
incarcerated for a possession or one of the sales
statutes. About 330 or 350 of them were in for
sales by non-drug dependent persons. One of our
concerns.
Eighteen hundred or so were incarcerated for under
2182-77 general drug sales by what could be drug
dependent individuals and a spattering of others.
REP. LAWLOR: Two thousand four hundred? Okay. And do
you have any idea if we're talking 3,300-3,400
inmates, what the cost of that is every year?
THOMAS SICONOLFI: Well, a figure that's been thrown
around often and I'm not sure it's really an
accurate one, is a figure of about $25,000 per
person per bed.
REP. LAWLOR: Is that too low or too high?
THOMAS SICONOLFI: Well, I think it depends on how you
look at it because there's a basic cost to open a
prison. And whether you put five people in there
or 500 there's a certain cost to run that facility.
The incremental cost to add a certain number of
inmates is very low, until you reach a point where
you have to add additional staff or build
additional space onto it.
So I don't think it's a simple number. We've used
25,000 to give us a ballpark figure of the global
cost of all corrections and all the facilities we
run based on the number of inmates we hold.
But I would not want to hazard a guess as to if we
were opening a new facility specifically for these
offenders? Then that cost would be somewhat higher
than the $25,000. If we were incorporating them
into prisons we already had, quite a bit lower.
I don't believe there's one number you would want
to hang you hat on at this point.
REP. LAWLOR: But if you did multiply 3,400 times
$25,000 it would come out to be $86 million.
THOMAS SICONOLFI: Our sense at this point is that is
again, the notion of balance, Representative
Lawlor. It's that we need to invest in drug
education which we're doing. We need to invest in
local policing so that communities can do a better
job of suppressing crime and drug sales than they
are doing now.
We need to be tough when repeat criminal offenders
come before the courts and make sure that there's
accountability for those offenders. And we need to
provide treatment opportunities so that those
involved with drugs have an opportunity, more than
one opportunity, depending on the setting, to break
that habit.
And so what we're urging is a balanced approach.
We think the funding plan we described is a
balanced approach, but we would also suggest that
some of the changes in 6991 removing mandatory
minimums, allowing multiple participation in those
special pre-trial programs, would upset that
balance --
REP. LAWLOR: How many people are in on mandatory
minimums today?
THOMAS SICONOLFI: Excuse me?
REP. LAWLOR: How many people are actually convicted on
mandatory minimum charges?
THOMAS SICONOLFI: I don't know about convictions, but
as I mentioned on 21a-278 which has a mandatory
minimum, that's sales by a non-drug dependent
person, there are 350 people incarcerated. Of
those who are not serving a mandatory minimum on
those drug charges it would seem to be over 2,000.
REP. LAWLOR: Well, the statistics I have show six on
21a-278 on December 31, 1996.
THOMAS SICONOLFI: I was looking at a chart from DOC
that showed as I said I think 350. The one that
was very low was 21a-278a which is the three
special conditions sales within 1,500 feet of a
school, public housing project, day care center,
sales where an adult uses a minor as an agent and
the like, those are add-on penalties and I could
find few people serving sentences currently for
those.
Most of the people selling drugs fall into the two
categories of 277, sales by someone who may be drug
dependent and 278, sales by non-drug dependent
individuals. And as you know, charging those
higher offenses, the offenses with the greater
penalties and the mandatory minimums is a very
effective plea bargaining tool and for the courts
and prosecutors in moving cases.
And so you can't underestimate the number of
individuals charged with either 278a or 278 who
show up in DOC on those 277 charges because of a
plea bargain. So I think again, the DOC
information is one snapshot, but doesn't give you a
really complete picture of who those people are and
what kind of offense they actually committed.
REP. LAWLOR: Well, if you could help us find that 300
number somewhere. I mean, the chart I've got I
don't see it. The only one I see for 278 it says
six.
THOMAS SICONOLFI: I was looking at a March 16, 1997 DOC
summary chart which I will provide to the
committee. But the total number I had was about
330.
REP. LAWLOR: And second, Representative O'Neill was
asking some questions about the drug court and
stuff and as I recall, Judge Simone's what he said
when he participated in the forum we had last week
was that the main obstacle appeared to be the
lawyers who were advising the young people to take
AR or YO rather than go into drug court. Not
because they couldn't benefit from drug court, but
because they'd be exposing themself to a seven year
felony conviction by going. So, maybe that would
solve that problem if we could eliminate those
options.
THOMAS SICONOLFI: Well, I think as I mentioned earlier
if we look at our experience on the adult side some
years ago we had the same problem with many of our
alternative programs when prison time served limits
were very low. And what corrected it wasn't
changing the statutes relative to the charges, but
providing sufficient bed space so that prison was a
real deterrent.
I think we could look at this the same way and say
it may not be a matter of changing the penalties
for the offenses, but making sure that there's
adequate sanctions for the most serious offenders
so that it represents a genuine threat.
REP. LAWLOR: I thought the other part of that was the
alternative sanctions program? Building prisons
and --
THOMAS SICONOLFI: It's a combination. No question
about it. But what really helped the participation
in the programs was the fact that prison became a
real deterrent, not changes we made in penalties
for any particular offenses.
REP. LAWLOR: Are there other questions? If not, thanks
very much. Oh, Representative Nystrom has a
question.
REP. NYSTROM: Thank you. Just one follow up. Could
you tell the committee that if we, in fact,
eliminate these revisions for higher penalties and
the restrictions on the treatment programs, is that
going to actually cause a higher cost to be
incurred?
And the reverse of that since '95 when we put these
restrictions in on access, has there been a
decrease in cost to the state?
THOMAS SICONOLFI: I'd have to be honest and say that I
haven't seen any information one way or the other
about cost relative to those programs. The
restrictions were put in place because prosecutors
said clearly that individuals at the time when
juvenile records were still being held as
confidential, that an individual would have an
extensive record on the juvenile side, start fresh
on the adult side and have two or three non-
conviction programs available to them before they
ever had their first conviction.
And that was the impetus for making the change.
But I have no information concerning costs one way
or the other.
REP. NYSTROM: Do you think it exists or may exist in
the future? I mean, the change is relatively
recent being in '95 it was enacted. Is that
something you might be able to get your hands on?
THOMAS SICONOLFI: We may. Honestly I would suspect
there may be some increased costs from some
individuals who go to prison who otherwise wouldn't
have. On the other hand there may be an offsetting
cost of crimes that those individuals might have
committed if they were out that they are not
committing while they are incarcerated.
So I'd like to think about how we could give you
good information about that. But I think there's
items on both sides of the ledger.
REP. NYSTROM: Thank you.
REP. LAWLOR: Are there other questions? Is there
anything else you needed to say? Or are you all
set?
THOMAS SICONOLFI: I'm okay. Thank you.
REP. LAWLOR: We're just beyond our first hour and what
we've done the last couple of meetings is rotate
back and forth between members of the public and
state agency speakers. So why don't we switch to
the first person on the public sign-up sheet is
Jack Reige.
We're going to go back and forth. So it will be
Jack Reige followed by Deputy Commissioner Kirk
followed by Dr. Alvin Novik followed by David
Biklen followed by Steven Duke followed by John
Bailey.
JACK REIGE: Good afternoon, Senator Williams,
Representative Lawlor and members of the committee.
My name is John Reige and I'm a practicing attorney
in Hartford, Connecticut. I also have been
involved in educational matters for a number of
years serving on boards of several private
secondary schools, a college and a graduate school.
And have been on the state Board of Education for a
four-term term.
But my interest has really been sparked in this
whole area by serving as a tutor in an elementary
school in Hartford, Connecticut for 15 years. And
I've seen in all of these institutions the tragic
results of drug abuse which cuts across all lines,
all communities.
I am greatly encouraged by the amount of attention
which is being given in the country and in
Connecticut to this whole issue. I am aware of the
report of the Governor's Blue Ribbon Task Force on
substance abuse. The recommendations of the Law
Review Commission and the initial report of the
Connecticut Alcohol and Drug Policy Council.
An obvious conclusion from all of these seems to me
that we certainly need and I think what you're
going to be providing is an integrated plan for
alcohol and drug enforcement, treatment and
prevention. From my perspective, however, I
particularly urge you to consider shifting from the
emphasis on criminal justice to an equal emphasis
on treatment and prevention.
In this connection, I heartily endorse the policy
council's recommendations to increase the
effectiveness of school-based drug prevention and
refocussing school-based efforts to identify and
treat substance abusers at earlier stages of drug
involvement. And to increase the use of
indeterminent sentencing and court ordered
treatment. Thank you.
REP. LAWLOR: Thank you, Attorney Reige. Are there
questions? If not, thank you very much.
Deputy Commissioner Kirk.
DEPUTY COMMISSIONER KIRK: Good afternoon. Senator
Williams, Representative Lawlor, members of the
Judiciary Committee, I'm Tom Kirk. I'm wearing two
hats today. One as the co-chair of the Connecticut
Alcohol and Drug Policy Council and secondly,
deputy commissioner within the Department of Mental
Health and Addiction Services.
Let me preface my comments by emphasizing the
significance of the hearing and the events that
have taken place in Connecticut over the past year
related to drug policy. All the various reports
really have produced an extremely important
positive focus on the issue of drug policy in
Connecticut.
The various forums and hearings that have taken
place in the past two weeks at the legislature have
reinforced the valuable information presented in
the various reports. Legislative activities are
now taking place that appropriately address
substance abuse as an economic, health and public
safety issue.
I want to stress the importance of that point
because it has far-reaching implications for how we
purchase our services, substance abuse services,
particularly since 90 percent of the substance
abuse services in the state of Connecticut are not
state operated. They are provided through
community-based private nonprofit funders.
It also has significance for how we approach
resource development strategies, how we address
program evaluation and outcomes. It even extends
to something as simple and fundamental as what is
treatment versus what is supervision?
The four reports consistently call for Connecticut
to adopt an informed drug policy. Of the four
reports, the Alcohol and Drug Policy Council's is
viewed by some as the most conservative. That is
for good reason. The perspective of the Council
was quite comprehensive with its recommendations
placing equal emphasis on health, criminal justice
and economic issues. The members of the Council
extended their focus to pragmatic issues, for
example, specific resource development strategies
to support the implementation.
In the spirit of promoting an informed policy as
far as substance abuse, I offer the following
comments on the bills before you today:
SB1064, AN ACT ESTABLISHING A DRUG INTERVENTION AND
COMMUNITY SERVICE PROGRAM FOR FIRST-TIME OFFENDERS.
It's a pretrial diversion program for persons
charged for the first time with violations of
possession of drug paraphernalia or of drugs. It's
an eight-week drug intervention program which is
appropriate for persons with the particular level
of disease or disorder that would be identified for
this program.
Following the eight-week intervention program the
person would then participate in four days of
community service in the community service labor
program. Upon successful completion of the program
the charges would then be dropped.
This unique program was first recommended by the
Blue Ribbon Task Force on substance abuse in
February '96. It was affirmed by the Law Revision
Commission. It was affirmed by the Connecticut
Alcohol and Drug Policy Council.
It offers a great opportunity to interrupt the
progression of substance abuse and reduce
recidivism. The requirement to participate in the
community service program would reinforce the
therapeutically valuable notion that persons must
be held accountable for their activities.
I wish to emphasize a particularly important point.
From my 25 years in working the area of prevention
and treatment including within the criminal justice
system, I cannot emphasize enough the concept of
user accountability as a critical component of
effective prevention, intervention, treatment and
criminal justice initiatives.
We cannot deny the reality of that particular
concept. Please note that Section 37 of HB6991
also establishes a pretrial drug education and
community service labor program, as compared to the
one that emanated from the council. But there are
some significant differences.
The Criminal Justice Committee of the Connecticut
Alcohol and Drug Policy Council which was co-
chaired by Judge Ment and Chief James Thomas, the
past president of the Police Chief's Association
support of this bill. Unlike HB6991, the Council's
bill is restricted to first-time offenders, it has
a fixed number of days that persons must
participate in community services, and excludes
from the program persons accused of selling or
distributing drugs from the program.
The Department of Mental Health and Addiction
Services as a member of the council, therefore,
urges your support for SB1064.
Pretrial education system, SB1063. Several months
ago I pulled together all the providers of pretrial
education services in the state of Connecticut
because they were interested in an increase in
their rate. I said we would not go for an increase
in your rate until you had the opportunity to
review the quality of the program and the content
of the program.
They came back with an outstanding design which is
being proposed here. The PAES program, Pretrial
Alcohol Education System, last year in 1996 there
were about 6,000 persons who participated in it.
That's about 20 percent increase from 1995.
And if you keep in mind the fact that the National
Traffic Safety Association estimates that for every
traffic fatality the cost involved are close to
$750,000. This is an extraordinary effect of
investment.
The PAES Program has a 92 percent completion rate.
Again, an indicator of something worth supporting.
The bill would update and streamline PAES Program.
Under the current program there's an eight-week
version and a 10-week version. And what the group
suggested and deemed to support is the 10-week
version with an increase in the fee.
These providers, it should be noted, have not had
an increase in their fee since 1981 when the
program first started.
SB1256, THE DEPARTMENT OF MENTAL HEALTH AND
ADDICTION SERVICES COURT LIAISON PROGRAM AND
DISCLOSURE OF CERTAIN INFORMATION. It is being
requested by the department because it will improve
the utilization of costly, intensive residential
treatment beds.
Under the current court liaison program, which is
an option for drug-dependent offenders, DMHAS must
guarantee a treatment space within 45 days of the
date it submits examination report to the court.
We have to reserve this bed or the slot before
there has been a court referral for treatment.
SB1256 is going to change the requirement so that
the bed is provided within five days of the actual
court order for treatment.
I wish to emphasize here some data which supports
the need for this particular program. Between July
and December of 1996 a total of 406 persons were
identified by DMHAS evaluators for residential
treatment at state-operated facilities. Of those,
only 37 percent were actually granted. The balance
were no shows.
Two hundred fifty-four persons who were not ordered
for treatment we had to reserve the beds for their
use. SB1266 would free up treatment space by
ensuring the beds are held only for those persons
for whom the court has granted referral to
treatment.
I now wish to comment on HB6991, AN ACT CONCERNING
DRUG POLICY. This provides the statutory language
to implement the recommendations of the Law
Revision Commission. I would like to compliment
the Law Revision Commission and its executive
director, David Biklen, for the quality of their
report.
Several of the recommendations parallel the themes
of the Connecticut Alcohol Drug Policy Council as
well as other reports.
I also wish to emphasize that this consensus offers
the opportunity for starting points for working
together for a balanced drug policy for
Connecticut. While there is consensus for many of
the themes, there are some differences which I
think we need to keep in mind.
On the positive side, the Council agrees with
HB6991's proposal to establish standards and
responsibility for collection, management,
evaluation of information related to substance
abuse.
There is also consensus on the need to analyze data
and to report annually on client demographics and
trends, risk factors and measures of effectiveness.
As we strive to meet these objectives, the Council
recommends that we build upon the current strengths
of existing systems rather than starting totally
anew.
I've enclosed in your folder some briefing
materials that have been drawn from part of the
data system that DMHAS has responsibility for
managing. Every licensed substance abuse program
in the state of Connecticut, as well as the
community providers that we have under contract
have to report their admissions and discharges via
this system. And this is where the data comes
from.
Review of this material will reflect that the basic
data system and the academic partnerships with Yale
and UConn already exist within DMHAS pursuant to
Section 17a-451 to meet HB6991's data objectives.
That by itself we know will not do the tasks that
we have ahead of us.
What the Council concluded was the development of
this collaborative, cross agency data system could
best be directed by an outcome implementation work
group of which OPM would be a member, as would be
our academic partners from Yale and UConn and other
state agencies who designed the Council's outcome
recommendations.
The Law Revision Commission on the other hand
recommends that OPM bear this responsibility. Let
it be clear that whatever options chosen,
significant new resources would be required to
comply with this mandate, but less so if built upon
existing data systems such as that maintained by
DMHAS.
Let me also emphasize that whatever approach you
come up with you can count on the Council and DMHAS
as a state agency to fully cooperate to achieve the
objectives that we've set out based upon this goal.
Section 4 would also require the establishment of
an advisory council to be chaired by OPM. The
Connecticut Alcohol and Drug Policy Council which
is composed of representatives of legislative,
judicial, executive branches, as well as private
experts, is already in place to advise on statewide
policy. This Council has a proven track record of
successful development of policy as well as
effective plans for implementation and resource
development.
In fact, I think it's interesting that many of the
ideas originating with the Blue Ribbon Task Force
and further developed by Alcohol and Drug Policy
Council, contributed to many of the uniform themes
in the various report.
Relative to the value of the Council and how it is
being handled, I reference a letter from Dr. James
Liebermann who is the Director of Health for the
Town of Greenwich and who is a member of the
Alcohol and Drug Policy Council. He sent it to the
co-chairs of the Judiciary and Public Health at the
time of the forum. He's a retired U.S. Assistant
Surgeon General of the United States.
In his comments on the Council: "Indeed, in my
view, the governor made a wise decision allowing
the public and private membership of the Council to
experience the kind of freedom that's necessary to
fashion recommendations designed to effect societal
changes. What a mistake it might have been had the
Council become an organizational entity of state
government. Surely it might have lost its
spontaneity, enthusiasm, innovative design and
momentum as frequently happens at various levels of
government."
On another point, methadone. Section B of HB6991
establishes a pilot program for methadone treatment
to be provided in locations separate from a
methadone treatment programs. I agree with the
concept of a pilot program involving participating
physicians, but I do not share the emphasis on the
increased access noted in the Law Revision
Commission report as being the reason for this
effort.
What I think we should pay more attention is the
current best thinking on methadone maintenance
approaches, and particularly attention to phases of
treatment. I think you also have to give thought
to the future implications of financing a methadone
maintenance program in accord with this
recommendation.
I'm sure it's a given, but obviously you need to be
aware of the fact that Methadone treatment is
highly regulated by the DEA and FDA and whatever
efforts we intend to pursue have to be consistent
with that.
As part of the recommendation, the HB6991 requires
two participating physicians per region on the
first year of the program. No fewer than five per
region thereafter. I question whether the latter
is essential. What's the basis for these numbers?
These physicians will have to have special
qualifications. It's not clear how DMHAS could
ensure the designated level of participation.
While DMHAS supports the efficacy of methadone
treatment and adoption and testing of best practice
models, we ask that all be very careful in their
examination and prioritization of the demands for
limited substance abuse resources as we make
decisions regarding new programs.
The Council supported progressive implementation of
a full capacity service system. What we all have
to understand is that when you're talking about
treating substance abusers there's not one method
of approach. There are at least nine different
levels of care for substance abusers. Methadone
maintenance is one of the levels of care. We are
interested in a full, comprehensive effective
system.
Section 9 of HB6991 requires the Department of
Public Health to study issues related to the
development of substance abuse screening and
intervention protocols to be used for hospital
admissions. This theme was the same one that was
echoed by the Health Care Committee of the
Connecticut Alcohol and Drug Policy Council. That
committee, in my view, was one of the most
effective. It included representatives of the
Department of Health, HMO's, the Commissioner of
the Department of Insurance, private physicians and
other health care stakeholders.
There are differences in strategies between Law
Revision and our committee as to how this
particular recommendation should be implemented.
But here again, you can be sure that all the
critical stakeholders will work together to find
common ground to ensure the success of this
initiative.
My written testimony reflects comments about CON.
I'm not going to mention that. The essence of it
basically is that the CON as reflected in HB6947 we
think will provide broader exemptions for health
care than the one included in the current bill.
Needle exchange drug, the needles and syringes. I
would urge us to give thought to the fact that one
of the primary benefits of those who support needle
exchange is that it brings the participants closer
to health care services. If you increase the
number of needles, the available supplies to them,
they are going to have less frequent contact with
health care providers.
DMHAS is strongly opposes one part of HB6991 that
involves administering heroin as a method of
treatment. While the Blue Ribbon Task Force and
Connecticut Alcohol and Drug Policy Council support
exploration of alternative treatment models for
chronically dependent persons, prescribing heroin
could never be supported as a valid treatment
protocol.
In closing, I wish to emphasize a couple of things.
At the outset of my testimony I applaud the efforts
you are making to develop informed decisions
related to drug policy for Connecticut. The
reports that have been produced all emphasize
coordination collaboration. They all emphasize
efficiency effectiveness and they all urge the
development of sound drug policies.
What I urge us all to do is to pool our collective
commitment and wisdom to draw upon the best points
of each of these reports to yield a balance
substance abuse policy for Connecticut citizens.
I'm sure that you can count on the members of the
Alcohol and Drug Policy Council, DMHAS as a state
agency is a member of that council, to work closely
with you to provide further information as you
continue this process. Thank you for your
attention.
REP. LAWLOR: Thank you, Commissioner, and obviously you
have gone well beyond the normal three minute
limitation we have, but I thought in light of the
extensive work that has gone into this, especially
by the group that you have chaired, it was
important for this committee to hear what you had
to say.
And also I think it's one of the problems in drug
policy historically has been two separate tracks
seemingly heading in opposite directions. The
criminal justice track and the public health track.
And I think for the first time beginning to steer
each towards the other and as you pointed out, and
I'm glad you emphasized it, that user
accountability is such an important part of this
whole process of discouraging drug use by children
and by adults.
And I think the best suggestion that included in
your remarks was sort of the DWI program like
recommendation for drugs. And that to make sure
that people coming in on entry level get
immediately referred to at least a minimum of
screening and treatment because I think one of our
greatest frustrations and if you look at the
statistics they are very scary and that is the
overwhelming majority of people arrested for first
or second or third offenses of drug use, walk out
the court with nothing happening to them.
In other words, the charges are normally dropped. I
think two thirds of the cases, we've got the
numbers here somewhere, the charges are just
dropped and nothing happens till the fourth or
fifth time around and by then often it's too late,
etc.
And I think you're quite right that if we could
enhance accountability by making sure the first
time in something constructive happens, not
necessarily cart you off to jail, but get you into
a treatment program. That's a great suggestion so
I appreciate it.
Are there other questions? Representative
Scalettar and Representative O'Neill.
REP. SCALETTAR: Thank you. Good afternoon, Dr. Kirk.
I also wanted to comment on the fine work of the
Council and the work that you and Brenda Cisco did
in this report and how important it is that so many
segments of our society and of our government here
are coming together to really look at drug policy.
And I particularly appreciated your
characterization of the issue which I've been
working on also that it's an economic health and
public safety issue. And I think if we all look at
it that way and work on maximizing all of those
aspects of it, we'll come up with a very good
result and thank you for your help in this.
DEPUTY COMMISSIONER KIRK: Thank you.
REP. LAWLOR: Representative O'Neill.
REP. O'NEILL: One of the comments that is in your
written testimony and I think you also read it is
that prescribing heroin would never be a treatment
protocol. And I was wondering if you could
elaborate as to why that is. I mean, is that sort
of like that I should know that off the top of my
head? Or why?
DEPUTY COMMISSIONER KIRK: Maybe it's more of a
philosophy. I've run methadone programs. I've
been involved in all forms of treatment. I'm a
psychologist by training and I simply cannot accept
a conclusion that there is not a form of effective
treatment that can be provided for persons with
different levels of substance abuse difficulties.
That recommendation in my judgement concludes that
these folks are failures. There's nothing we can
do other than give them pharmaceutical heroin. So
maybe it's more of a philosophical point of view.
I think there are approaches. I think one of the
things that you have to pay a great deal of
attention to and you're really hinting at it in
several points is the fact of intervention. I
talked about this the other day when you went
through the drug forum.
If you look at Law Revision, if you look at Program
Review, if you look at the Blue Ribbon, if you look
at Alcohol and Drug Policy Council, they use the
word intervention very, very frequently. Do not
look, do not approach that word very, very loosely.
As I mentioned to Representative Scalettar the
other day in a separate conversation, you have to
understand that intervention is a formal activity.
It's a formal approach.
The block grant, for example, the federal block
grant does not allow us to spend a dime on
interventions. Most health care plans will not
allow -- they are not going to pay for
interventions. But when your questions to Tom
Siconolfi about the drug court and many of the
things that were good doing here, we have to get to
the point of being able to convert what I call need
into demand.
There are lots of people out there who need
services. But please understand. It's one of the
hardest lessons I had to understand from my point
of view was that if everything about alcohol and
drugs was so terrible, none of us would be here.
We wouldn't need treatment programs cause people
wouldn't do it.
The reality is these are mood-altering substances.
They make people feel good. And as a client once
told me after we had a counseling session for an
hour he said, doc, your sessions are very, very
good, but it's like a dose of codeine. It wears
off in 30 minutes.
What he had was better than what I had to offer to
him. So when we talk about the severe methadone
chronic dependent population, the challenge for us
is to come across with better interventions, and to
get them to the point where as a result of some
exposure to these interventions, as exposure to
treatment, they will improve.
I just can't accept writing off these persons as
non-responsive to any form of treatment.
REP. O'NEILL: Okay. So what it really is is if we
didn't call it heroin treatment, but sort of just
abandonment of treatment and supplying them with
heroin so they don't steal.
DEPUTY COMMISSIONER KIRK: That's my opinion.
REP. O'NEILL: Okay, that's how you would view it and
then okay, that's how you would say we should
instead of pretending that it's treatment, we just
sort of give up on them as untreatable and just
make them comfortable sort of approach.
DEPUTY COMMISSIONER KIRK: As formidable as substance
abuse is, as a reality to this state and elsewhere
in the nation, I just don't think we should be
putting our resources in that particular approach.
REP. O'NEILL: Although if the only way to prevent
someone who's a heroin addict from either being in
prison and costing us whatever it costs, $25,000,
$30,000, $35,000 whatever pick a number. Or out on
the street doing perhaps $40,000 or $50,000 worth
of damage by burglarizing and stealing cars and
jeopardizing everybody's health because he's doing
all kinds of other things in the process of that,
certainly from a pure utilitarian kind of
standpoint it would arguably make sense to just
give him what it is he seems to want.
DEPUTY COMMISSIONER KIRK: To me that's a social policy
issue for all of us to consider whether we would be
willing to accept that.
REP. O'NEILL: Okay, but you're not because you think
that everyone is treatable?
DEPUTY COMMISSIONER KIRK: I think that everyone is
treatable and that the challenges to come up with
the approaches. I think there's enough data from
all the different studies that demonstrate the
efficacy of treatment.
I was up at Harvard two weeks ago from today at a
conference in which some of the major players were
reviewing what has really worked in treatment.
What has worked in prevention. And one of the
points that was mentioned based upon extensive
reviews of the literature is that -- and it goes
back to the user accountability.
One of the critical components, critical
requirements for effective treatment is what they
called compulsory supervision. Now compulsory
supervision can take many forms. It can be my
sponsor in AA. It can be my sponsor in the
Narcotics Anonymous. It can be my employer through
an EAP program.
The mentoring programs that you will hear people
push as far as prevention activities, they are all
examples of compulsory supervision of one form or
another. I think we should pay more attention to
them.
As an aside to that but related to that, if you
look at the drug survey results that UConn did for
us for 1995 and the new study is beginning for
1997, most kids do not substances. And one of the
interesting parts of that study was asked why don't
they use? What was the number one reason why 80
percent of these kids did not use substances? They
were concerned about their health.
What was the number two reason why they didn't use?
Parental disapproval.
What was the number three reason? Self-esteem.
For us to walk out of this room and to think that
due to all the attention that we're paying to
substance abuse that the policies of prevention and
treatment have failed all these years is simply
there's no basis to it.
What we have to do is reinvigorate what we have and
pay more attention. I share Representative Farr's
emphasis on let's pay a great deal attention to
what works. And that's the kind of approach that
we are flagging at this point in time.
I think it's a policy, but I think it's a
philosophical issue.
REP. O'NEILL: Okay, thank you.
REP. LAWLOR: That's interesting, Dr. Kirk, because as I
understand this thing it's based on something that
goes on in Switzerland. I guess its been
relatively successful there. But I guess what
we're groping at is what is, and you would know
better than us, how do you deal with these guys?
I guess what they do is they target people who have
been heroin addicts for 20 or 30 years. They don't
respond to any treatment. They go to jail. They
come out of jail. They get arrested again and they
come back in. And how do you deal with people like
that now? What effective treatment programs are
there for people in that category?
DEPUTY COMMISSIONER KIRK: If you keep in mind the
methadone maintenance, to get to the point of
beyond methadone maintenance, one has to have tried
alternative treatment approaches and demonstrate X
amount of time of dependence.
It's a very extensive review that goes on. I think
my own view is that the essence of good care is
dependent upon your ability to keep me involved
with the care. One of the things we're doing, it's
in the package that you have in front of you. One
of the things we're paying a lot of attention to is
the ability of programs to retain the person in
treatment particularly in the early months.
You can call it engagement. You can call it
intervention. You can call it what you wish. One
of the advantages of compulsory programs such as
you may have within a prison setting, such as you
may have in some of these other areas, is that
forces the individual to stay involved with an
opportunity where over a period of time they will
pick up the value of the particular methods.
And so I think that the mandatory component from an
intervention point of view is critical. I think
related to that and again, this is what we're
doing. We're looking at the drop out rates from
programs from different types of modalities. We're
looking at some of the client characteristics that
contribute to that.
Your health care plan. My health care plan. They
pay a lot of attention to what they call best
practice patterns and they will only reinforce best
practice patterns. That type of approach is -- do
I have an answer for you right now specifically?
Not necessarily so. But that's the type of
approach which is going to give us that.
If we paid more attention from a dollar point of
view, an investment point of view to the kind of
population that you're talking about,
Representative O'Neill is talking about, and say
let's come up with an alternative.
I'll just as soon somebody say fine. I'll take X
number of dollars. I'll take a group of people who
are skilled in methadone treatment. I'll take a
group of people who understand how difficult it is
to give up substances and let me do a pilot for a
year to see if I can come up with an alternative
approach to simply saying let's give them heroin
for whatever period of time.
I think there's better ways to approach it.
REP. LAWLOR: Great. You had mentioned alcohol and I
think in your remarks and I think we sort of get
off the track sometimes and we only focus on, you
know, marijuana, cocaine, heroin, etc., and I
remember from some of the early meetings that
alcohol seemed to be as big as, if not bigger
problem than drugs, especially for young kids.
And I'm sure we'd all agree that alcohol in the
hands of kids is illegal, dangerous and wrong. So
what should we -- what should our policy be there
and what are the current penalties for that kind of
stuff and is that a bigger problem among the young
kids and how does that work?
DEPUTY COMMISSIONER KIRK: Clearly when you look at the
younger population you're more likely to find
alcohol as part of the substance profile, from an
experimentation point of view.
If you look at the data that I've given you over
the last year, we pay a great deal of attention to
age of first use. Alcohol, marijuana (tape ended)
frankly they are about equal to one another in
terms of the age of first use.
If you look at the data from the surveys that we
did through UConn, alcohol in the northeast part of
the country as well as in Connecticut continues to
be a heavily used substance among that population.
We have had improvement in that area let's say from
'89 to '95. But none of us, I don't think any of
us in this room as parents, grandparents or
whatever it is we are, are willing to accept that X
percent of the kids in this state within the course
of a month are driving with someone who is using,
who is under the influence of alcohol.
What we've done in the prevention area within the
dowers of Mental Health and Addiction Services
provides or has responsibility for, we have at
least 12 programs that we call research and
demonstration programs that were started before I
came on about 15 months ago.
They are intended to identify best practices in the
prevention area that would be effective
alternatives from a prevention point of view. Some
of them range from mentoring. Some of them range
from peer support. Some of them range from
attention to high-risk kids.
These programs will be finishing up and October and
our intention then is to what we call seed and
feed. Take the best of these principles that are
developed from these 12 programs and seed them
around the state. So that as appropriate for the
particular populations we can come up with
alternatives.
If you also recall in the materials I sent you some
months ago, one of the big advantages of the study
that was done for us at UConn as far as youth
substance abuse was to tell us how the state, how
the different areas of the state vary. What
happens in the eastern part of the state with youth
is not the same as it is for south central.
And when you talk about a well developed strategic
strategy you better pay attention to aligning
resources in accord with what each individual area
needs. This may sound simplistic, but I truly
believe it. And that is that the most effective,
the most critical element for an effective
substance abuse approach, from prevention point of
view, is what I call the Connecticut Partnership
for a Healthy Community.
And what a Connecticut Partnership for a Healthy
Community means that I as a parent, you as
legislators, everyone in this room, whatever our
role is, that we must take individual and full
responsibility for accepting the fact that
substance abuse, whether it be for underage youth
or substance abuse among illegal substances, is
simply an unacceptable reality.
When you look at the effective programs, what has
worked well, it's where the entire community gives
the same message as to what is and is not
acceptable. So yes, we can concentrate on high-
risk kids, but when I indicate to my 13 year old
daughter and when she and her brother understand
that in our family there are certain things and
values that are acceptable, and those that are not.
When she hears the same message from her school,
when she hears the same message from her peers,
when she hears the same message in church and
wherever it is that we do our worship, that is the
single most important theme for an effective
prevention strategy. It sounds simplistic, but I
tell you folks, it works.
REP. LAWLOR: And your concern about mixed messages,
alcohol, drugs --
DEPUTY COMMISSIONER KIRK: And this is why there's so
much --
REP. LAWLOR: -- tobacco.
DEPUTY COMMISSIONER KIRK: Fair amount of, you know,
when someone talks about something that is
perceived as well we're giving it more approval,
the concern is a mixed message.
REP. LAWLOR: Other questions? Representative Hamzy.
REP. HAMZY: Thank you, Mr. Chairman. Dr. Kirk, if you
can, if it's possible, can you just take me through
what the steps are when someone is referred for
treatment let's say it's someone who has been
convicted of possession and use of heroin. What
happens to that person when they are referred for
treatment?
DEPUTY COMMISSIONER KIRK: If they are coming through
the criminal justice unit, at some point, and
whether it's our court liaison staff or Bill
Carbone's unit where alternative incarceration.
Somewhere there is an assessment that's done as to
the severity of the problem.
Based upon that assessment a recommendation is made
as to appropriate treatment or appropriate care.
In the court and my colleagues in the criminal
justice system could probably give a better read
than I can, is that there's a linkage that's made
between the fact that the person has this
particular difficulty and entering them into a
formal treatment program.
If you were talking about someone who was not
incarcerated, but the judge what I call made him an
offer he couldn't refuse, he will go ahead and make
an arrangement within his locality for an
assessment. The assessment for someone with heroin
is going to be a comprehensive assessment. It's
going to be asking them about the pattern of use,
how long they've used, how frequently they use.
Because as I mentioned right at the beginning,
everybody doesn't need the same level of care.
So we have to pay attention to severity. Based
upon that assessment, let's say it was made today
at clinic X, some part in the state, that person
would then be assigned to a level of care that is
appropriate for what it is they need preferably
within two days of the time the assessment is made.
In the eastern part of the state one of the
interesting things that occurred as a result of the
Norwich Hospital closing is that we put into place
what we call pretreatment services. If there's a
problem with available bed, or a problem with
available slot for particular care, the providers
in that region are mandated to provide some type of
bridge services until the person can be put into
the care.
That's the essence of it. A very, very good
assessment and then assignment to a level of care.
As I said in the beginning and when you look at the
materials that we've given you, there are probably
six or seven, nine different levels of treatment
that are appropriate to a particular person.
If you want to look at what the literature says and
what works best, what works best is matching the
level of care to the severity of the particular
person's problems.
REP. HAMZY: And when you talk about treatment, what's
involved in treatment?
DEPUTY COMMISSIONER KIRK: Good question. The most
common forms of treatment approaches are going to
include at least three things. One of them is that
educating the person involved as to the substances
they are using and the effect they have on the
individual.
If you look at what we call interventions, they
have an acronym called frames, F-R-A-M-E-S. And
what you have to do is No. 1, give me feedback as
to the effect of the substance on me. So, there's
feedback through that education.
Secondly, you've got to communicate to me that I
have responsibility for my actions. I may not be
responsible for having developed the problem for
drug because of possibly genetic factors, but I
have full responsibility for using the tools
available to maintain my sobriety.
So there's an emphasis not only on here are the
tools, but this is what you need to do to take
responsibility for your actions. I think the third
point that in terms of the types of approaches is
some type of mix between individual and group
counselling. Because one of the advantages that
effective treatment highlights is how I compare to
my peers.
Why is AA so effective? Because if I go to an AA
meeting and you go to an AA meeting we have a
problem. We can look at people in the room as they
say, who have a problem that we had. I may not
think in my first time at an AA meeting that I can
do anything about my problem. I am buoyed. My
spirits are lifted by the fact that other people in
that room who had worse problems than I did are
able to get back.
I have to find somebody who took the medicine and
got better as a result. Because I know my
medicine, whatever it is, alcohol, heroin or
whatever, it does something for me. I pay a
terrible price.
So the combination of education, the combination of
counseling, the combination of clearly accepting
responsibility and finally what some say are the
most important, show me somebody who got better
taking the medicine that we have. That's why
alumni groups as part of treatment programs are so
critical. That's why mentoring programs and
prevention.
I've got to see, my daughter has to see an eleventh
grader who she admires who doesn't use substances
and say, I want to be like her.
REP. HAMZY: Now, but in order for this to be effective
doesn't someone have to be -- doesn't someone have
to respond positively?
In other words, you have to be, you have to want to
reform your ways?
DEPUTY COMMISSIONER KIRK: Right. And that's where the
interventions that the comments Representative
Lawlor before. Intervention strategies that have
been defined, the folks at UConn have come up, have
major studies that have defined very, very
effective intervention strategies.
And what I've tried to emphasize before is that
whatever the formats that we approach through
DMHAS, through Alcohol and Drug Policy Council, Law
Revision Commission. We have to pay more attention
to those intervention strategies.
In a way what we're saying is you have to make me
an offer I can't refuse. Now, you cannot make me
get well from my substances. But you can help to
make me sit at the table until I can realize as a
result of these different approaches, that I can
turn my life around.
It goes back to the point of converting need into
demand. So the mandatory types of approaches that
keep me involved in services for X period of time
they are going to help to convert my need into
demand. But you're right. You cannot make someone
suddenly say I want to do this.
But I think the approaches that are out there and
with the emphasis on intervention that's the way we
should be going.
REP. HAMZY: Now I heard talk about the use of
methadone. Methadone, is that a substance that's
used to treat a specific type of addiction?
DEPUTY COMMISSIONER KIRK: Yes. Methadone is the most
effective approach for people who are opiate
dependent. In the substance abuse population that
we've treated in the state of Connecticut, we have
about 35,000 people in treatment during the course
of a year. Those 35,000 people are involved about
in what we call episodes of care, about 55,000
episodes of care.
If you look around the state, in different regions
at any given time about 8 to 12 percent of that
population is involved in methadone treatment.
They have been involved in other courses of
treatment before. If you look at the age of them,
typically they are in their mid-30's. They are
older than the rest of the population.
But it's an effective approach. It's the most
effective approach for those for whom opiate
dependence is not only current but has been for
some period of time.
What I do have an issue with with the Law Revision
Commission and I've spoken with David about this,
is that not everybody who uses heroin who comes
into our system should be on methadone maintenance.
It has to be for a certain period of time that
their problems occur. It's got to be severe.
So methadone maintenance is the effective approach
for the certain level of case that needs that
particular service.
REP. HAMZY: If I can just one last question. What are
your thoughts on the legalization of drugs? I
didn't mean to put you on the spot in the last
question.
DEPUTY COMMISSIONER KIRK: No, it's just my personal
opinion as having worked in the field for as long
as I have, is that you never underestimate the
power of the substance. And if you never used the
substances that these folks use, it's hard to
understand why people would take the point of view
that to legalize that and take the risk that
someone would go ahead and try this substance.
I mean, we're not talking about trying a cigarette.
We're not talking about trying a drink. We're
talking about trying substances that within six
seconds are going to allow sensations in my brain a
pleasure that I can't get from other types of
alternatives.
I simply would not want any of us to take the risk
of having such powerful substances out there.
REP. HAMZY: Thank you.
REP. LAWLOR: Representative Martinez.
REP. MARTINEZ: Hi, Tom. How are you? First of all,
let me just congratulate you on a really terrific
job with the Council. And also on the tenacity of
the work you've been doing over at DMHAS.
DEPUTY COMMISSIONER KIRK: Thank you.
REP. MARTINEZ: Because you've been doing very good work
over there.
DEPUTY COMMISSIONER KIRK: It helps to hear that once in
awhile.
REP. MARTINEZ: All of us that understand what you're
trying to do, certainly know that it's not easy and
certainly know that you've been doing a bang-up
job. I just wanted to say for the record that 99
percent of what you're saying I agree with.
And we do have some individuals who are sitting in
the audience who are probably going to be able to
talk about their experience and exactly prove some
of the things that you're mentioning now as
intervention techniques and methods and what works
and what doesn't work.
I was wondering if you could just to further
enlighten committee members and members of the
public, if you could concentrate a little bit on
talking about when we talk about particularly the
hard users and those individuals that end up
usually needing methadone or heroin use.
A lot of times we find that those folks aren't like
the rest of us and don't have a family that they
can go home to and say, and tell them, look, don't
do that. A lot of times we find that there's a lot
of generational issues involved in use.
And a lot of these social economic issues that are
involved in today's climate when we talk welfare
reform, we talk about the lack of jobs for that
population. And we talk a lack of real training
for that population. The engagement part of being
part of an effective tool to treat this disease.
Because as you were mentioning before having sort
of the family plan where we as legislators and
other folks have to become involved in what is out
approach as a state, as citizens to treat the
problem.
So if along with that if you could just add what
support services mean and wrap around support
services mean to effective interventions, I think
that would really help.
DEPUTY COMMISSIONER KIRK: Okay. No one should believe
that the methadone maintenance by itself is going
to be the solution to accomplish all the ends that
a person may have for restoring their life.
So the wrap around services are extremely important
because what you're trying to communicate to the
person is that as a result of putting their
substance abuse into remission, there are
alternative lifestyles.
Let me just give you a quick example. I remember
treating a woman who was on methadone maintenance,
had long-term problems. And she was a hairdresser
by trade, but she had not worked in years because
of her substance abuse.
So we finally got her to the point of being stable.
She was on a stable dose. She was in treatment for
quite some period of time. Then it was time to go
back and apply her trade. But you get an idea of
the self-confidence of the persons involved when I
tell you what she did is she went to try to find a
job.
And what she would do is she would go into a
particular place, a hairdresser shop, and she would
say you're not hiring today, are you? And she
couldn't understand why it was that over a period
of time how vivid a message that was. She had to
get to the point of feeling confident about her
skills and that she was a worthwhile person.
And when you talk about methadone maintenance or
persons with that level, here is where the group
component is so important. Because as you said,
they are different. They are further along on the
way. The family component much of it may well have
been dissipated. So there's not that support
there.
Where are they going to get their support? They
are going to get their support from the peers to
the point where internally they begin to kick in on
their on. So the support services in terms of
income. The support services in doing something
worthwhile.
One of the things that we used to tell people that
I would work with, clients, is that they would say
well, I feel better, but I don't really see what
worthwhile I'm doing. So how much did you used to
spend a day for your substances? And so usually
it's whatever -- it would be $100 a day.
So did you have the $100 to spend? Not really.
They would steal. They would do whatever they had
to do. So do you have any children? You know,
who's important in your life? And one of the
suggestions was as they move from the point of the
early stages, take some of the money that they had
been spending, which they really didn't have. They
couldn't afford, and do something, buy something
for somebody that you could look at, who's
important to you and say, that was an example of
the fact that I didn't use last week.
So it could be a kid in your neighborhood. It
could be -- whatever it is. That's vivid evidence
of that. Last week you would have spent it on
substances. They have to have some type of
feedback. Is that, I mean, obviously is that a
formal treatment approach? No, but you got to get
feedback that says I'm worthwhile. That what I'm
doing is effective.
REP. MARTINEZ: Thank you. Just one more comment, Mr.
Chairman. On the issue of heroin and heroin use, I
can't help but just reiterate again that I agree
with you 100 percent on that point of view.
I have seen camps set up where people are taken and
the issue is religion and how religion even in the
world of substance abuse treatment the higher power
and all that becomes so important and you focus on
religion and religion becomes sort of the what sort
of takes place of family and a lot of other things.
That keeps your mind focussed on doing the right
thing, and helping you throughout.
So I've seen camps for really down and out heroin
addicts work without the drugs basically kicking,
sort of doing the cold sweat kick. Although I
certainly agree that methadone use on those stages
is probably what's appropriate with a quick weaning
down.
But I've seen people be able to kick that habit
without being on methadone all their life. So I
certainly agree that there's other alternatives
that we have to look at when it comes to methadone
treatment. Thank you very much.
DEPUTY COMMISSIONER KIRK: Let me just add one quick
comment because I know this is something of
interest to you. If you look at the data that I
gave you in the materials and in some we have given
you before, we are greatly, greatly concerned about
the latino population in this state with IV drug
use and use of heroin.
If you look at the profiles that you have there, of
the persons that we have in treatment, and we do
things based upon all sorts of variables that we
think are important. The IV rate among the latino
population is the highest of all the groups that we
have. Men, women -- it's close to 40 percent.
When you look at the black population that we have
in treatment, it's closer to 15 percent. The white
population is around 20 to 25 percent. The HIV
rate, the concern with this group here, the concern
that when we now look at some of the outcome data
that was pointed out before, we are not doing as
well with that particular group and keeping them in
treatment.
At a session with one of your colleagues from New
Haven the other day we were talking about detox and
the fact that the latino population we were having
a hard time keeping them in treatment. And her
point was that what usually occurs is that if one
of the persons, latino persons in her detox unit
walked, usually a group walked with them.
REP. MARTINEZ: That's very true.
DEPUTY COMMISSIONER KIRK: We are not getting good
results. And you talk about heroin and problems in
this state, that's one of the critical points you
must emphasize. It's out of control.
REP. MARTINEZ: Yeah, I've noticed that and I agree and
just this is an excellent document by the way.
It's a lot of good work went into this monitoring
of Connecticut's future. Thank you.
REP. LAWLOR: Thank you, Dr. Kirk. We should invite
doctors here more often. We're sort of soaking up
all this knowledge where we're used to the other
side of it.
Dr. Alvin Novik, speaking of doctors. And as Dr.
Novik comes up I think it's appropriate to point
out two things.
First of all, that there is a mandatory democratic
house members caucus going on starting now in
another part of the building? And also although
there are many members of our committee they come
and go during the public hearing. And for those of
who you don't come here a lot you should know that
all of what is said here is broadcast throughout
the building on an intercom system we each have in
our offices.
And everything you say is taken down in a verbatim
transcript and kept with the bills that you're
testifying on for the life of those bills. So just
because people aren't sitting here listening to you
speak at this moment doesn't mean that your words
won't have an impact on legislation, on this
legislation as it moves through the process.
So welcome, Dr. Novik.
DR. ALVIN NOVIK: Thank you. Good afternoon. I'm Alvin
Novik. I'm Professor of Ecology and Evolutionary
Biology at Yale and I'm the Editor-in-Chief of a
national journal called AIDS and Public Policy
Journal. I'm also the founding chairman of the
mayor's task force on AIDS in New Haven and was the
originator of the project that the General Assembly
approved as a pilot project in 1990 that is the New
Haven Needle Exchange project.
And I'm the director designate of a new, what we
believe will be a new center, activated probably on
July 1st at Yale called the Center for
Interdisciplinary Research on AIDS. I will be
directing the section on law policy and ethics.
My research and public service are directed at the
interface between the AIDS epidemic and the illicit
drug epidemic and I'll be speaking to bill 6991.
In the realm of these two highly interactive
epidemics, neither of which has been easily
addressed, the most difficult task of all is to get
the dialogue going that will lead to the
development of rational cost-effective policy in an
atmosphere of alienation, disdain and controversy.
Our state almost entirely through the General
Assembly has actually been a leader in developing
drug and HIV policy that have benefitted all
Connecticut, all Connecticut citizens, not just
those who are directed affected. And policies of
which th real goal has been to protect us all to
benefit us all and to be cost effective and in that
path by our example to benefit the citizens of many
other states.
And that has been the case, for example, with our
needle exchange programs. Essentially every aspect
of 6991 directly addressed profoundly serious
problems and does so in a way that is truly
mainstream. That's the startling thing about 6991.
Mainstream to benefit the people of Connecticut and
to be cost effective.
We have become so accustom to severe drug policy or
severity on any proposed changed in policy that we
often fail to see what is truly rational and
actually conservative in the proposals that are
being proposed.
The proposals raised in my opinion are purely good
public health and good medical practice. We're
taking the first step in shifting our state in its
war on drugs from total focus on law enforcement
and degradation to the incorporation of good public
health practice. And as a result I believe we'll
be a beacon.
Essentially every aspect of 6991 represents
successful and often daring and brilliant
exploratory pilot projects in other communities
that Mr. Biklen and others of the Connecticut Law
Revision Commission have searched out for us and
have helped us see as models.
That's the advantage of our nation with 50
sovereign states. Each can and does explore and
when it does so successfully, we can benefit from
their successes. The proposals in 6991 are largely
based on those successes.
Finally, the HIV and illicit drug epidemics meet in
the most devastating fashion in our prison system,
in a way that confronts us as policy makers and
also gives us an opportunity to bring prevention
education and enlightened care to bare for the
first time.
These incarcerated men and women will re-enter our
communities. It's to the advantage of all of us
that they re-enter our communities in the best
possible health...illicit drug-free if possible and
free of HIV. To do so would be both cost effective
and indeed conservative.
I am truly excited to live in our state at a point
where we are addressing serious problems finally.
Many years, 70, 90 years into the drug epidemic and
15 to 18 years into the HIV academic, but I'm proud
that we have a history of having addressed some of
these problems previously and I feel with stepping
onto a path, a mainstream path actually of new
policy clarification.
The time limitation, of course, doesn't allow me to
address all the aspects of 6991. But I would be
particularly prepared to answer questions if you
wish to raise them about needle exchange, about
methadone maintenance programs and about the
realistic possibilities of what kind of drug
treatment we can bring to our citizens.
REP. LAWLOR: Thank you, Dr. Novik. One concern I think
Dr. Kirk mentioned when it came to the clean needle
issue was that I guess one of the proposals in 6991
is to lift the limitation of 10 needles per
exchange or whatever it is. And I think his
concern was that one of the advantages of the clean
needle program is to get people coming back and
intervention each time they come back and
treatment, etc.
And that if you had more needles at a time you'd
lose some of that. What are your thoughts on that?
DR. ALVIN NOVIK: One of the chief successes of needle
exchange programs has been indeed to establish a
relationship between substance abusers and the
health care community. That's been very powerful.
That I believe will actually be enhanced by raising
the level on the number of needles that can be
provided at each visit. There are -- for the
following reasons:
One of the other major objectives of needle
exchange is to increase the likelihood that people
will have available and use sterile equipment when
they inject rather than to share equipment with
their colleagues, which is the route by which HIV
is transmitted.
We also wish to reduce the time that dirty needles
remain in the community, available to being shared.
And the best way to reduce the time that dirty
needles remain in the community available for
sharing is to make it easy for people to turn them
in. That's the objective. To make it easy for
people to turn in contaminated equipment and to
pick up sterile equipment. That's what it's all
about. That's the goal.
To make sure people use sterile injection equipment
and not dirty. They continue to have contact with
the program. Some people need more than 10
syringes. We don't like that necessarily as public
health spokespersons or physicians. We would like
them to be drug free.
But some people need more than 10 syringes and we
sometimes block them from using sterile equipment
by having the cap. It also appears to them and you
recall that this is, of course, a voluntary program
that people have to participate in because they
believe it's for them. It appears to them that the
cap is a deliberate offense or deliberate blocking
qualification that keeps them from getting maximum
service. I believe it is.
REP. LAWLOR: So if I understand you correctly what
you're saying is that given the fact of the program
the theory at least, it requires a one-for-one
exchange. If you could bring in 20, that would be
doing -- the 20 used needles would be a public
service?
DR. ALVIN NOVIK: It's better for all of us. Best of
all maybe for the community. Of course, whatever
is good for the user is good for the community in
that sense by saving the health and life and cost
of health care.
REP. LAWLOR: And since the -- I mean, our main focus
today is saving money and having a more effective
policy and I know there's been tremendous studies
of the effectiveness of the clean needle program in
Connecticut. Could you just give us a couple of
quick statistics? If you know them off the top of
your head.
DR. ALVIN NOVIK: Well, needle exchange we believe
reduces transmission of HIV in the using community
by at least a third and maybe totally. Maybe
reduces it to zero in the using community if they
are clients. And that saves us all of the cost of
health care for the people who would have become
infected, which is very substantial.
Surely at least $50,000 perhaps over $100,000 per
person infected with HIV, but needle exchange also
reduces other costs. It's not a costly program.
It reduces other costs. It reduces probably law
enforcement costs and corruption costs in the
community.
REP. LAWLOR: We all know there was a problem in the
Windham program, the allegation being that they
weren't doing the one-for-one exchange. And did
you have anything you wanted to say about that?
DR. ALVIN NOVIK: Every program realistically may have
some times when it has to be tightened up,
sharpened, administered more strictly. Every
program should be overseen and I believe that other
programs in the state are being overseen.
REP. LAWLOR: Representative Hamzy.
REP. HAMZY: Thank you, Mr. Chairman. I just had a
couple of questions about the needle exchange
program. What's the goal of the program?
DR. ALVIN NOVIK: The goal of needle exchange is to keep
people uninfected with HIV.
REP. HAMZY: Does it conflict with the overall drug
policy of prevention and treatment do you think?
DR. ALVIN NOVIK: No, it actually is an ally of policy
and prevention and treatment for drug addiction you
mean.
REP. HAMZY: Right.
DR. ALVIN NOVIK: It's an ally because it brings people
in who are otherwise very alienated and
distrusting. It brings them in and establishes a
friendly or at least a working relationship between
the clients and the outreach workers of the needle
exchange program and it gives them access to
counselors who can help them enter drug treatment.
It's an ally of prevention and treatment. Needle
exchange by itself does not alleviate addiction.
It alleviates HIV transmission. But, it provides
the path for alleviating addiction because it
creates links between the users and the health and
public health communities.
REP. HAMZY: Is there any requirement to receive
treatment as -- in order to take part in this
needle exchange program, is there any requirement
that a participant has to submit to treatment or
anything like that?
DR. ALVIN NOVIK: No, there's no requirement. The
person has to submit to treatment in order to
participate in the needle exchange. The reasoning
there when it was first authorized by the General
Assembly I believe I can say was that such a
requirement would appear to the potential clients
as a trick to manipulate them.
These are clients who are accustomed to being
disdained in a variety of ways and they stay away
from programs that look to them not to be in their
favor. The concept was to be as favorable to them
in the sense of opening pathways so returning them
to mainstream without decreeing the pathways.
REP. HAMZY: What's the percentage of participants who
eventually do get treatment?
DR. ALVIN NOVIK: The experience in New Haven is that 20
percent or something more enter treatment through
the needle exchange program. We don't have data on
those who enter treatments through other pathways
because our clients are anonymous. We can't track
them that way.
REP. HAMZY: Okay. So how do you know that 20 percent
of the --
DR. ALVIN NOVIK: They are directly linked because they
ask for the help in becoming linked. We can track
them in that sense. They are known to us as
people. They use program names. These are not
their real names, but they have a program name, an
ID card with the program name, and if they ask for
help the program helps them enter drug treatment
programs.
So we can count those people. But if they went to
someone else to be entered we wouldn't be able to
track them.
REP. HAMZY: So how does the program work? I mean, in
reality. Is there a truck that goes to a certain
designated spot, you meet people there, they bring
you five needles, you give them five clean ones?
DR. ALVIN NOVIK: We have a van that travels to several
locations four days a week and that's exactly what
happens. They clients come to the van with their
contaminated or potentially contaminated used
syringes and they are given sterile syringes in
exchange.
They identify themselves by their program name.
REP. HAMZY: What does that mean?
DR. ALVIN NOVIK: Well, each person when he or she first
register picks a name by which they will be known.
REP. HAMZY: Is this an alias?
DR. ALVIN NOVIK: It would be like an alias. It could
be like street cat, fatso, whatever they are
comfortable with. And then by having that record
we can link the returned syringes to a particular
person. We have a record of how many syringes that
person picked up, how many he or she returned, on
what dates they picked them up, what dates they
returned them, how many months or how many years
they continue to be our clients, whether they
sought entry into drug treatment.
But the record is entirely in terms of say fat cat,
not in terms of their real name. And the clients
are particularly interested in that kind of
protection of their real name because of fear of
various, you know, punishments that they might
experience if their name were public.
REP. HAMZY: So there is an enrollment procedure?
DR. ALVIN NOVIK: There's an enrollment procedure. They
are asked questions about their addiction, what
they are addicted to, how long they've used, what
their age is. That sort of thing.
REP. HAMZY: What's the age group?
DR. ALVIN NOVIK: The typical client is around 40. They
tend to be older users and they tend to be long-
term users. We have very few youth.
REP. HAMZY: Okay, and how long has this program been in
effect?
DR. ALVIN NOVIK: It went on line in mid-November 1990.
REP. HAMZY: So for seven years or six and a half years
roughly.
DR. ALVIN NOVIK: Right.
REP. HAMZY: And what's the average length of stay on
the program?
DR. ALVIN NOVIK: Retention in the program? I can't
answer that. It was very long until the General
Assembly authorized the purchase, sale and
possession of syringes through pharmacies. That
was in 1992 the General Assembly authorized
purchase, sale and possession and many of the
clients switched from the needle exchange program
to simply purchasing the syringes they needed in
the pharmacies and that chopped off some of the
long-term clients.
So there was a switch. But in general they are
long term. The highest proportion I might say are
people who appear once. But for those who appear a
second time mostly they become long-term clients.
REP. HAMZY: Okay, thank you.
REP. LAWLOR: Senator Williams.
SEN. WILLIAMS: Yes, good afternoon. How important is
the one-to-one needle exchange in your opinion?
DR. ALVIN NOVIK: Well, you see there's a major goal to
have a way of getting contaminated syringes out of
the community. We all agree on that. That's not
an easily implemented goal, but that's one of the
goals of needle exchange.
Because if we get contaminated syringes out of the
community people will not become infected from
using them.
SEN. WILLIAMS: Should that just be a goal? Or should
that be something that's required in every
instance?
DR. ALVIN NOVIK: I think it should be a serious goal
and that it probably would be an error to make it
an absolute requirement. Absolute requirements in
this kind of public health work are not helpful.
SEN. WILLIAMS: I guess my -- you may continue. Sorry.
I apologize. Go ahead.
DR. ALVIN NOVIK: Sorry. It should be and is a serious
goal.
SEN. WILLIAMS: My concern there I guess in addressing
public health issues is that in the instance of the
Windham program hundreds of needles were being
found on children's playgrounds and a young girl
got pricked with a discarded needle in a program
where there was not a one-to-one requirement being
enforced.
So I think that there's an array of public health
issues here, not only to users and addicts, but
also to those around them. And that if a program
is not being run properly there can be other very
significant public health issues that can affect
others who are innocent bystanders.
DR. ALVIN NOVIK: Absolutely. But the principal source
of syringes in children's playgrounds is not the
needle exchange programs of Connecticut. Addicts,
users in general have many roots of access to
injection equipment. And the vast majority,
probably the horrendously vast majority of syringes
out there, and especially abandoned ones, have
nothing to do with the needle exchange program.
It's very important for our state to develop policy
around how to get those needles back. I see that
as a very, very, very high priority. I agree with
you. That's a high priority. But it's not the
fault of needle exchange programs.
SEN. WILLIAMS: Well, the problem, of course, is that if
there are needles being handed out for free without
a requirement that individual is to turn in the
same number, then there's certainly a perception if
not a reality that that contributes to the problem,
both from the fact that needles would be handed out
and an equal number not taken back in.
Also from the human nature point of view that if
something is handed to you for free, it's worth
less to you. And simply discarding it in a place
like a playground might be more likely.
DR. ALVIN NOVIK: I can't quarrel with any of what
you're saying, except that's not where the needles
in the playgrounds come from. They don't come from
our needle exchange programs and I believe that we
should invest significantly in developing not just
needle exchange returns, but other ways of
accepting used equipment from the user community.
And, of course, one of the ways that we can, we
hope that that will happen, this is hard to
guarantee, we hope that what will happen is that
the cap is raised that people who are sufficiently
engaged to go to the trouble to collect say 20 or
30 needless, will have a reason to do it now
because we will be prepared to accept those from
them.
SEN. WILLIAMS: But if the cap is raised then wouldn't
that effect perhaps what is one of the best
features in your testimony of the needle exchange
program the idea of the linkages and the contact?
What's wrong with 10 or why should there be 50 or
100 or 20 or it seems to me that if you're
encouraging the common linkages you want people to
reinforce those linkages as often as possible. In
a realistic way, not one needle at a time
necessarily.
DR. ALVIN NOVIK: I don't think it intrudes on that. On
the whole people don't come in every day. They
come in every few days. It won't change that. If
people have say 50 contacts with user friendly
public health system a year, it's not that
different from say if they have 75 contacts.
The contacts on the whole tend to be positive,
reinforcing. For many of these people they are the
only humane contacts that they may have in their
life and I don't think the cap is going to intrude
on that. It may actually enhance it. It may lead
many of the users to believe that the program
really is designed for them.
SEN. WILLIAMS: Why shouldn't treatment be required at
some point if our goal really is to intervene and
to help rid our communities of addiction?
DR. ALVIN NOVIK: I would like us to reach the point
where treatment was available first for every user
who wished to have treatment. We're a long way
from that. I would say everyone who wishes
treatment in our state should have it accessible
and available.
That's a terrific goal that I've been lobbying for
at least since 1984. I see that as the first goal.
If we achieve that, that is, if we can actually
open the system to the point where treatment is
available when the addicts are ready to seek it,
that will be terrific.
Then we'll see what happens and maybe we can have a
new goal which is to try to enter everyone into
treatment. But the first step surely has to be to
enter all those who are seeking it into treatment.
And we have blocks of them. We do not enter them
into treatment. We send them away. That's what we
do now.
SEN. WILLIAMS: And I guess finally you mentioned that
needle exchange programs can be an ally or are an
ally of public health issues helping to discourage,
if not curtail the spread of blood diseases, AIDS,
hepatitis, etc.
But is there not a trade off, are needle exchange
programs also an ally of illegal activity? Either
the consumption or the use of a controlled
substance and perhaps other associated activities
where some individuals not all, but may have to
resort to other illegal activities, burglary, etc.,
in order to obtain the resources to sustain their
addiction?
DR. ALVIN NOVIK: That argument has been raised with me
and I think with our community for many years, that
developing programs that are helpful to addicted
people will, in fact, be harmful to them. It's a
kind of saying black is white. Helpful programs do
not endanger people. Helpful programs protect
people.
That's the (tape ended) that any program is
absolutely perfect on all occasions, no. But
needle exchange doesn't lead people to addiction.
It doesn't lead people to robbery and stealing and
to other petty crimes. It indeed reduces their
likelihood. It doesn't cure addiction. That's not
the goal of needle exchange. The goal is to keep
people healthy.
It has been said that it's not right to keep
addicts healthy. That they should get ill and die
as a penalty for their addiction. I find that an
unacceptable argument. In our nation we try our
best to keep people healthy, even those that
transgress the rules. We don't penalize
transgression by death sentences.
SEN. WILLIAMS: Thank you.
REP. LAWLOR: Representative Farr.
REP. FARR: I have a number of questions for you. Let
me start off, first of all you made a statement
about the -- on the question of treatment that our
first goal ought to be make treatment available.
I've looked at the statistics on a statewide basis
for methadone and the last report I had was that
the whole waiting list statewide is 11 people. And
that, in fact, in the vast majority of communities
there is zero waiting list for methadone programs.
So I don't know why you say that the first issue is
treatment because it's there.
DR. ALVIN NOVIK: Representative Farr, there will be
other people today that are much more familiar with
that than I, but let me answer it as best I can.
The methadone programs have certain criteria for
entry that often exclude a significant proportion
of those who are seeking care. And those who are
excluded by the entry criteria are not in the
programs. They are seeking care. They are not
there. But they are also not on the waiting list.
And so in the statistics that derive from the
methadone maintenance programs that list doesn't
appear. In real life you're --
REP. FARR: You're saying that the methadone program is
not, as designed, is not an appropriate one for
all?
DR. ALVIN NOVIK: No, no, sir. I'm saying it's not
inclusive of all those who would benefit. It's
only inclusive of those that the programs wish to
accept.
REP. FARR: Well, they have criteria and you're saying
the criteria is not the appropriate criteria is
what you're saying.
DR. ALVIN NOVIK: Correct.
REP. FARR: Okay. Another question is since, I mean,
you make the statements about how the needles are
used and that the needles in the school yards are
not from your exchange program. But the fact of
the matter is that I don't think anybody knows
where those needles come from. And we've gone
through this before.
At one point we've enacted a lot of legislation in
this country concerning hospital waste because we
were concerned about the discarded needles that
were found on beaches and it was presumed that that
was because of the dumping of waste in the ocean
from hospitals and we put in place an extensive
system of controlling the disposal of waste from
hospitals.
As it turned out that the waste needles were not
being washed ashore, they were coming from storm
systems, etc. And in some studies it demonstrated
a lot of that was from people who were carelessly
discarding needles that they might be using for
appropriate medical purposes.
Is there any reason why we can't require needle
exchange programs that we put some identification
on the needles? Have the needles in a color or
have an identification on the needle so that if
those needles are, in fact, discarded we know that
they've come from that program? Is there any
reason we can't do that?
DR. ALVIN NOVIK: There's no reason that can't be done.
Indeed the New Haven needle exchange syringes have
always been marked. We can recognize them. That's
not to say that the marks are 100 percent
indelible.
REP. FARR: No, I understand. I mean, at least if you
had them marked. People are not likely to go and
try to eliminate the markings on needles, but I
mean, at least that would give some people
assurance that if these needles were showing up
that we'd have some idea where they are coming
from.
DR. ALVIN NOVIK: There's no reason not to mark them.
REP. FARR: And I guess the other concern I have is the
question about the health care benefit from needle
exchange programs. Quite frankly I am extremely
skeptical about the validity of these programs.
Because the underlying premise to me is that of
your program is that is what I call the theory of
safe intravenous drug use and that to me is
probably a worse oxymoron than thoughtful
legislation or reasonable attorneys fees or a whole
bunch of things that I can come up with.
That I don't consider it healthy for people to be
using intravenous drugs in the first place. And
the real skepticism with a lot of people is that if
someone exchanges a needle and gets clean needles
99 times a year, but once doesn't and shares a
needle with somebody who's HIV, he's got a great
shot that he's going to have HIV.
And the only way to really to be 100 percent safe
is to not use the needles in the first place. And
the skepticism of the programs is whether or not
they are really effective in reducing the use of
needles by people for whom it isn't healthy in the
first place. And that the goal ought to be to
reduce the use of intravenous drugs and the
question is are we doing that effectively.
DR. ALVIN NOVIK: I agree with most of what you said.
Our goal ought to be to reduce or eliminate the use
of the illicit drugs, especially intravenously, of
course. I'm not against that. That's my goal too.
That's a hard goal to achieve. We've been working
hard at that since 1915 and the results have been
in the wrong direction. The results actually of
our policy since 1915 to reduce drug use have been
in the other direction. We've increased it. We've
increased it and we've increased it.
I'm in favor of reducing drug use. I don't think
there's any such thing as safe intravenous drug
use, but there is safer intravenous drug use.
There are all kinds of risks every time a person
shoots up, but at least we can eliminate the risk
of hepatitis B, hepatitis C and HIV infection.
Maybe not 100 percent.
You know, we haven't eliminated the risk of HIV or
hepatitis viral infections in the rest of our
nation 100 percent. If we can reduce it, as your
example, by 99 percent, I have to tell you I would
be out shooting up rockets and celebrating.
Of course we don't achieve the perfect goal. It's
my perfect goal too, Mr. Farr. I think all of us
in this want the perfect goal. What we're aiming
at is the practical, the pragmatical, the steps
that we can achieve at the moment and then we'll
raise the ante and we'll try to achieve the next
step.
REP. FARR: And just one last question. You just made a
statement that drug use is going up and up. My
understanding of drug use is its actually gone down
significantly since 1980 in America and that the
only drug use that has gone up in recent years is
the increase use of marijuana.
DR. ALVIN NOVIK: Well, the statistics are very hard to
interpret in terms of my interests, that is HIV
transmission, hepatitis B and C, and intravenous
use we don't have good numbers.
REP. FARR: But specifically on heroin use my
understanding is heroin use, I mean, the nature of
the illegal drugs people use changes over time and
people are using crack cocaine now and I think a
lot of that is in lieu of heroin. And my
understanding is that heroin use is actually down
significantly from what it was, you know, 15 or 20
years ago.
DR. ALVIN NOVIK: That's what I understand too. There
are loops, there are curves, there are ups and
downs of heroin, of injecting cocaine and in some
communities, not very popular in our own, of
injecting med-amphetamines and other kinds of
illicit drugs.
The overall picture though has certainly gotten
bleaker since 1915. We've taken control of some
things in a minor way, but I think we have to be
frank. The overall picture of use of the major
drugs, heroin and cocaine and several others, has
been an unsuccessful story.
We won't succeed in changing that completely just
by having the mainstream legislation before you in
our state. But we'll have made a major step
forward because we'll have shifted the goal from
being simply law enforcement to being law
enforcement plus public health. To me that's the
crucial step.
REP. FARR: The last question that I keep hearing people
saying that we're shifting -- just law enforcement.
I'm not aware, I mean, I've been here for a long
time and I've never been aware of a period in our
history when we've ever looked at drug use as
simply law enforcement. We've always had major
components to our budget for "education prevention"
and for treatment.
And we've been running treatment centers for drugs
and drugs are not -- as you're aware, alcohol is
probably the major drug that's abused in our
society. Cigarettes are the most costly. But
we've been doing that forever. I mean, I'm not
aware of any time in our society where we said
we're just going to do law enforcement.
DR. ALVIN NOVIK: I can't sit here and tell you we
haven't had prevention programs or treatment
programs. They have always been severely
inadequate. A pale shadow of what we needed.
Really in prevention we have Mrs. Reagan's slogan
of say no to drugs, which works beautifully with
the middle class white kids who are well behaved.
And that does not work well in the other
communities of our state.
We don't have serious prevention. We spend money,
but we don't have serious prevention. That's a
long story. We have to evaluate that. We have to
know what we're doing. Of course we have some
treatment, but I don't believe we've reached the
goal where we have to go which is to make sure that
people who want treatment, who need our help and
want our help and wish to return to mainstream
lives, have that opportunity.
REP. LAWLOR: Representative O'Neill.
REP. O'NEILL: I think I've heard a fair amount of your
testimony before I came back in the room
downstairs, but I don't think I heard it all. I
probably missed some of it.
And so please forgive me if I'm repeating something
that you've already been asked.
First question is do you test, as part of the
program, do you test the needles to see if they, in
fact, are contaminated with HIV or hepatitis when
they come back in?
DR. ALVIN NOVIK: In the New Haven program we don't test
for hepatitis B virus. We test for HIV and we test
a sample, not all of the needles, a sample.
REP. O'NEILL: Okay. And over the life of the program
has there been any kind of change in the number or
the percentage of when you do that sampling, has
the percentage of HIV-infected needles gone up,
down, stayed the same?
DR. ALVIN NOVIK: According to Dr. Edward Caplan and Dr.
Robert Heimer who were the people who do this
directly, when you analyze everything and subject
it to very high power mathematical exploration they
believe that you can, that we cannot distinguish
the number of people in the program who became
infected during that period from zero.
That's not to say its been zero, but that
statistically that's the best estimate that people,
that clients in the program have not become
infected.
We test the needles rather than the clients and the
reason for that is that these clients don't
particularly like to be called in and tested. But
testing the needles represents the clients since we
can connect each needle with the person that it
came from. That is, we have their pseudonyms,
their program names.
REP. O'NEILL: Right.
DR. ALVIN NOVIK: And statistically and in terms of
mathematical modelling it appears that our clients
do not become infected. That's wonderful news. I
think that's our goal.
REP. O'NEILL: But has this testing of the needles been
going on since the beginning of the program?
DR. ALVIN NOVIK: Yes. It started by testing a cohort
of needles that were brought in the first time. So
they were not ours. They were what we call
community needles or street needles. That was the
first set and then as the people came back the
second time and third time we've been testing and
that went on from the beginning.
REP. O'NEILL: Okay, so I mean one of the things that
while on the one hand you can look at those results
and say it's great that those people are not
becoming infected. On the other hand you are not
in effect isolating a group of infected people so
that they are constantly getting new, clean needles
as opposed to sharing needles with other people who
are not themselves infected and spreading.
In other words, do you see what I'm driving at?
We're not isolating a group of infected people and
keeping them from infecting other people by using
these needles.
DR. ALVIN NOVIK: It has a kind of isolating effect in
the following sense: that if user, a man or woman
who was a user and is infected has available
sterile injection equipment, they don't share it
with others. And so they are isolated by not
having shared their injection equipment.
REP. O'NEILL: But what the study seems to show though
is that the population of clients that you are
working with do not have HIV?
DR. ALVIN NOVIK: Oh, no, that's not true. Lots of the
clients had HIV when they originally came to us and
they still do. We have many infected clients and
we have uninfected clients.
REP. O'NEILL: Oh, okay. But the needles you are
getting are not contaminated? Don't show HIV? I'm
confused now, I'm sorry.
DR. ALVIN NOVIK: There are no clients or seemingly as
best we can estimate essentially no clients who
have switched from being uninfected to infected
while they have been clients.
REP. O'NEILL: Oh, okay. So if somebody came in HIV
infected --
DR. ALVIN NOVIK: They continue to be infected.
REP. O'NEILL: And those needles, when you get somebody
who has a street name of some Hamzy or something,
that's the first word I saw looking over at you.
When somebody has a street name, cat, mouse or
something, that person came in, was HIV infected,
still is, but his needle is put off to one side.
When somebody else comes in as some other street
name, his needle, you test his over a period of
five years and it's over those five years as its
come in, not that you've ever done this exactly,
but as a model for the whole thing.
DR. ALVIN NOVIK: Essentially that's true.
REP. O'NEILL: That's what -- okay.
DR. ALVIN NOVIK: Right. The street cats needles are
marked. They have a number and we have a record.
There's a record of who returned them and what the
number was so you don't have to set the needle
aside in that literal a sense. It's identifiable.
REP. O'NEILL: Right. Okay. And you said you don't
test the people that come in. You said, I think
you said that the Windham needles that were found
in large numbers of needles were found in public
parks were not the needles from the exchange
program?
DR. ALVIN NOVIK: Well, I'm not an authority on the
Windham needles. I'm not part of the police system
or the public health system. But the truth in
general is that so we don't find or hear of
exchange needles in New Haven in the playgrounds or
on the streets.
REP. O'NEILL: Okay. So when you say --
DR. ALVIN NOVIK: Because the people who have exchanged
needles on the whole, I think it's almost
universally true, return them.
REP. O'NEILL: Okay, so that your statement that the
needles don't come from our program, I think this
was in response to Senator Williams' question.
When you say our program, you're specifically
talking about New HaveN?
DR. ALVIN NOVIK: I can only testify for New Haven, but
I believe it can be generalized. That is, people
who are engaged in the needle exchange program are
on the whole not the people who are going to
discard the syringe carelessly. Some will. But
are the people who have undertaken this kind of
additional responsibility and structure in their
life.
I mean, that's a major advance because on the whole
people who use illicit drugs don't have the kind of
discipline and structure in their lives that we
would like them to have.
REP. O'NEILL: Again, I may have missed -- let me just
try to ask a couple of questions because I think
what happened in Windham is an important thing. I
mean, I think that program is now terminated and --
DR. ALVIN NOVIK: It's important to all of us that
positive, negative. It was a bad lesson.
REP. O'NEILL: Right. So just be sure I understand.
When you have some kind of an accounting system
internally so that if you have 100 needles into
your program, that is you buy 100 needles from some
source or 1,000, whatever it is, and there is an
accounting system that keeps track of needles in,
needles out.
So that when you give one out, you get one back and
if there's a way that your, in other words, in
effect as if you were treating these instead of
needles, money. Or stock in a company where you
were selling a product. So that if did an
inventory or you can do an inventory so you know
that you dispensed 100 needles, you should have 100
needles accounted for.
At least a piece of paper that says we took 100
needles in. There should be record keeping so that
that's demonstrable.
DR. ALVIN NOVIK: We have that kind of record, yes.
REP. O'NEILL: Okay. I'm not sufficiently familiar with
the facts of what happened in Windham, but I'm
assuming that they either didn't have any records
or their numbers didn't add up in some ways for
people to come to the conclusion that those needles
came from them.
I mean, there was some basis for believing that
Windham was doing something wrong with what they
were doing?
DR. ALVIN NOVIK: That's what I understand, but I'm not
an expert on the Windham events.
REP. O'NEILL: Okay. So you don't know anything about
what happened in Windham?
DR. ALVIN NOVIK: Just the newspaper accounts.
REP. O'NEILL: Okay. Is there any indication, have you
done any surveys in connection with your program or
have any been done that would indicate that the
program is having an effect on the overall spread
of HIV among intravenous drug users, including
people who are not part of your program?
In other words, some kind of street surveys or
medical screenings or anything like that that would
indicate that the program in New Haven is having an
effect?
DR. ALVIN NOVIK: It's very difficult to prove that kind
of effect. We would like to be able to do such
studies. That's very hard. But we have had some
indications and I can't testify to you that I know
that it traced the needle exchange, but let me give
you an example of what I mean.
At the last I heard we had not had an HIV infected
baby born in New Haven to a New Haven mother for
two and a quarter years. I have to emphasize that
that's like a miracle because New Haven had a
major, has a major HIV epidemic and the mothers in
our city were among those who were infected and we
were having regular births of infected babies.
It hasn't happened recently. There are probably a
variety of reasons why that hasn't happened. But
it may have been I would hope that it might in part
have been because of the needle exchange program.
REP. O'NEILL: Are you familiar with any statistics from
other cities that would suggest, especially ones
that don't have a needle exchange program, either
in Connecticut or elsewhere, that the infected baby
birth rate is otherwise stable? That would sort of
suggest that the differences in New Haven that
there's something and presumably it's not just the
fact that it's in New Haven.
DR. ALVIN NOVIK: I don't want you to go away thinking
that I've said that I know it was the needle
exchange program. I think it's partly the needle
exchange program. It's partly that the Board of
Alderman in 1987 authorized an outreach worker team
for prevention in our poor minority communities.
And there are probably other reasons.
I think I believe I can say that our good news on
infected babies is better good news than I've heard
from other communities. But we're not in a
position to say that we can tie it to the needle
exchange. I think we can tie it surely to
prevention programs and to treatment programs.
We also in New Haven were very early to have
specialized programs for women and for minority
women of child-bearing age. We had a major
prevention and education program in 1987 and maybe
we're bearing the fruit from that.
It's very hard to pinpoint this kind of fruit.
What we can pinpoint is we seem to be bearing
better fruit now and that's good new for all of us.
And part of it probably is the needle exchange.
REP. O'NEILL: Okay, thank you.
DR. ALVIN NOVIK: Thank you.
REP. LAWLOR: Representative Farr.
REP. FARR: I know we've run pretty long here, but since
you seem to have a lot of information I don't know
where else I'd get it from.
Male versus female in the program, how many are
male versus female? What percentage is female?
DR. ALVIN NOVIK: I should remember that but I'm sorry I
don't.
REP. FARR: Okay. You can give it to me later.
DR. ALVIN NOVIK: There will be a later testifier who
can give it to you.
REP. FARR: Okay. The last question though is as I
understand it now you've identified everyone of the
people in the exchange has some kind of street name
so you know the needles?
DR. ALVIN NOVIK: Yes, sir.
REP. FARR: And you know then ultimately whether they
are HIV positive or not?
DR. ALVIN NOVIK: Yes, sir we do know that.
REP. FARR: Do you then notify the individual that they
are HIV positive? Do you take any effort to work
with that individual who is HIV positive?
DR. ALVIN NOVIK: We don't directly notify them, but we
do have counseling in terms of HIV.
REP. FARR: Well, what -- I mean, if this was -- this is
a program for that purpose. I mean, and you can
identify the users that are out there that are HIV.
It would seem to me the program ought to target
those HIV positive individuals, notify them that
they are positive, notify them that there are
programs that we could get them into to save their
lives and urge them not to share needles because
they are positive.
I also wonder since you know which ones are
positive can we give them -- why don't we have an
orange needle or something to those people who are
HIV positive so that when they are using the needle
nobody else is going to touch it because they know
it's HIV positive?
DR. ALVIN NOVIK: On the first matter I believe you're
correct that we should have enhanced HIV
counseling. It's a matter of funding. All
programs I don't have to call to your attention as
Assembly persons and Senators, all programs cost
money.
And the objective here initially was to focus the
program on reducing sharing of needles and we have
some HIV counseling. I would love to have what we
would call major HIV counseling tied to the
program. That makes sense. I agree with you. I'm
not in any way resisting that.
I would have to think about the consequences of
separately marked needles. I'm not prepared to say
what my view there was. I think it would probably
have an effect of making the clients feel
stigmatized. And you would say well, they are
stigmatized.
REP. FARR: Well, frankly it's a stigma that would be
not a bad thing. I mean, you stigmatize somebody
who is HIV and that means that nobody is going to
share the needle. I think that's the home run
we're looking for.
DR. ALVIN NOVIK: We have to discuss that home run. I
don't mean to be flippant, but we have to discuss
that. It's a very complicated issue.
REP. FARR: Because if that's the goal, I mean the
problem as I say is you're concept of if you stop
sharing needles. But if we could really focus in
on the sharing needles with the people who are HIV
positive and direct the resources there, that
really --
DR. ALVIN NOVIK: Mr. Buckley, the editor or one of the
editors of the National Review about 12 years ago
proposed that we tattoo the arms of injection drug
users who were infected and the butt of gay men who
were infected so that their partners would know.
He subsequently withdrew that proposal. I'm not
making fun of you. We have to come up continually
with new methods of engaging people creatively.
REP. FARR: But you've got a needle out there that you
know has got HIV -- was used by somebody who is HIV
positive. And people are concerned about these
needles being discarded, about being shared, etc.
And if we could identify that particular needle as
a highly dangerous one for everybody's sake, I mean
that seems to me the ultimate public health thing
we can do. I mean, we're not telling the HIV
individual to go around with a sign on them. But
we're saying if you use this needle, if you give it
to somebody else they are going to take one look at
this orange needle and say, I don't want it.
DR. ALVIN NOVIK: I hear what you're saying. As I said,
I think we would have to engage in additional
discussions. I'm not rejecting it.
REP. LAWLOR: Are there other questions? If not, thank
you very much.
DR. ALVIN NOVIK: Thank you.
REP. LAWLOR: The next two state officials, Dave Biklen
and Jack Bailey have graciously agreed to allow us
to call a couple more members of the public before
we come back to the state officials list.
So next is Professor Steven Duke.
STEVEN DUKE: Thank you, Mr. Chairman and Vice Chairman,
members of the committee.
REP. LAWLOR: Professor Duke, if you could just pull the
microphone in the direction of your talking please.
STEVEN DUKE: I guess I'm in the wrong chair. Is that
better?
REP. LAWLOR: Yeah, that's it.
STEVEN DUKE: I would first of all like to comment the
committee for requesting the study by the Law
Revision Commission. I think it was a masterful
stroke and I think the results are simply
astonishing. I think it is a magnificent study and
it's going to have reverberations well beyond the
state of Connecticut.
Rather -- first of all, let me introduce myself as
a member of the faculty of the Yale Law School.
And my principle academic interest for the last
decade or so has been the study of the drug control
policy at the national/international levels.
Rather than make specific observations about
pending bills let me simply say that I generally
approve every recommendation in the Law Revision
Commission study and more generally than that, I
think that the following proposals are almost risk
free.
That is to reduce the penalties for possession, use
and sale of marijuana. Reduce or eliminate
mandatory penalties for any drug offenses. Expand
drug courts. Expand the availability of
alternatives to incarceration. Expand availability
of treatment including but not limited to --
REP. LAWLOR: Hold on just one second, Professor.
Something has been activated on our sound system.
It sounds like the system they have in some courts
when they want to have a bench conference so the
jury can't hear. Can you hear that?
STEVEN DUKE: Yes.
REP. LAWLOR: The problem is it's a verbatim transcript
kept and this noise would -- the problem is there's
a transcript kept and this noise would interfere
with that. Okay.
STEVEN DUKE: Expand availability of alternatives to
incarceration. Greatly expand availability of
treatment. I recall that our president when he was
first running for the presidency said that he
believed in treatment on demand. I believe in
treatment on demand.
Most health professionals believe in treatment on
demand. It is not available in Connecticut. It is
not available anywhere. We should certainly expand
the availability of maintenance programs including
methadone and I think even heroin in rare cases.
Needle exchange, you've heard the case for needle
exchange. It's an overwhelming case. We also have
to do a much better job in education. And we heard
some testimony earlier about the DARE program. Let
me simply remind the committee that every study of
the DARE program that has been conducted the last
five or six years has shown that the DARE program
doesn't work.
Now, let me say in defense of the DARE program that
the focus of the study has been does exposure to
DARE prevent people from -- kids from using drugs?
Does it produce abstinence? And the answer is no.
It does not.
Kids are no less likely to use drugs if they have
the DARE program than if they don't. However,
seems to me the objective of drug education should
be to reduce indeed the objective of all drug
policy. Should be to reduce the harm to the
community from drug use.
And if DARE although it doesn't produce abstinence,
if in fact, kids exposed to DARE emerge from their
period of drug experimentation alive and healthy,
to a greater extent than kids who are not expose to
DARE or any other education program, then the
educational program is not a failure.
We should, our education should take a harm
reduction approach. The primary objective of
course is that our kids do not kill themselves or
get their brains permanently damaged or even emerge
as hopeless addicts.
Now the most desirable way of avoiding those
consequences is abstinence. But if we don't get
abstinence the second best is that we don't get
addiction or we don't get brain damage or we don't
get AIDS or whatever.
So I would just suggest that when the committee
thinks about educational programs it should keep in
mind the idea of harm reduction.
Let me just conclude by saying that the importance
of the work of this committee cannot be
underestimated because if, in fact, innovative
legislation emerges it will certainly go well
beyond the borders of the state of Connecticut
because, in fact, our national leadership is
politically paralyzed.
We started off with a drug war in the early 1970's.
As with Vietnam, we have escalated it and escalated
it and it has been a failure and the only thing the
politicians in Washington can think of doing or at
least can acknowledge thinking about, is more of
the same. It hasn't worked so let's do some more
of it.
They have gotten themselves into a corner where
they can't see any way to reverse field or innovate
or acknowledge that maybe something we've been
doing isn't working very well so it has to start at
the state level where we do not have all that
massive commitment to the mistakes of the past.
So again, unless the members have any questions, I
again am euphoric at the results of the drug policy
study commission.
REP. LAWLOR: Professor Duke, you seem to be somewhat --
in fact, I know you to be someone whose thought a
lot about the sort of history of the drug war and
the drug control strategy. Dr. Novik was
commenting before that it's hard to argue that
things have improved at all since 1915, let alone
the last 20 years in terms of drug use, drug abuse
among kids, among adults.
And maybe that should be the standard by which we
measure the effectiveness of our current strategy.
Looking at it as a lawyer, as a scholar, what are
you comments on the success of the current drug
policy or the historic drug policy since 1915?
STEVEN DUKE: Well, I think that the policies from the
early 1970's when Nixon declared drug war, have
been an absolute disaster. Prior to that, from
1914 until the declaration of the drug war we had a
position that was not dissimilar to our treatment
of prostitution and gambling and other vices.
That is it was illegal, but we didn't put people in
prison for lengthy periods of time for succumbing
to these vices. There is something to be said for
law enforcement involvement in drug control. But
there is nothing to be said, at least in terms of
our experience, there's nothing to be said for the
scorched earth policy that we've been conducting in
the lat 25 years.
We have spent trillions of dollars. I mean, the
amount of money that we've spent on this drug war
is just almost immeasurable. We have locked up
kids for life with no possibility of parole all
over this country. We have wrecked hundreds of
thousands of lives with insane penalties for
relatively minor infractions.
We have gotten ourselves in a position where any
lie we want to tell about marijuana is acceptable.
Where the government is telling kids that marijuana
will kill you. That it's don't listen to your
parents, although they said they used marijuana,
marijuana today is an entirely different drug.
It's 10 or 20 times more powerful than the drug
your parents used.
It's a gateway drug if you have marijuana you will
end up on heroin. We've gotten ourselves in a
position where lying has become standard. It is a
close case I think whether the tobacco industry or
the United States Government tells more lies about
drugs. And that is a pathetic situation in which
we've gotten ourselves.
I would say that there is some evidence that the
use of opium and cocaine was more common in the
late 19th century and very early 20th century than
it is today. That is cocaine. Opium has
practically disappeared from the American sea.
It's been replaced by a much stronger version which
is heroin, much more lethal version. A much more
addictive version. And we have drug prohibition to
thank for that.
We have crack which has been discovered some say
because of the economics of drug prohibition which
makes cocaine, powder cocaine far too expensive for
most consumers. That may be a long-winded answer
to your question.
REP. LAWLOR: I appreciate it. Are there questions?
Representative O'Neill.
REP. O'NEILL: Yes, I guess I have a couple of
dissenting opinions about a lot of the comments
that you've made. I read some of the materials
that you've written because you may have heard I
was one of the people on the Law Revision
Commission. I spent a fair amount of time trying
to keep track of what was going on in terms of
learning about drugs which I would say that prior
to a couple of years ago I really didn't know much
more than what most people would know by just
reading the newspaper or watching television.
But I guess I'd say that probably the war metaphor
is a bad one. I don't know who started using it.
I certainly know that we had a war on poverty that
started in the Johnson administration and we still
have poverty. People would argue that we did a lot
of stupid wasteful things in an effort to try to
eradicate poverty during the last 25 or 30 years
and have not eradicated poverty.
Or made a really meaningful dent in the people that
were most concerned about, which is sort of inner-
city, urban minority population poverty. We had a
war on cancer that President Nixon also declared
about the same time as the war on drugs. I don't
know that anybody is suggesting that because we
still have people dying from cancer that we should
quit in that regard either.
I mean, it's perhaps a bad thing to use the war
metaphor because the presumption is you either win
it or you lose it. And we have a terminal point
that you can identify that you can say well, we won
or we lost. Somebody won or somebody lost.
And as opposed to having a policy that doesn't sort
of treat this as something that's going to come to
and end that you're going to be able to identify.
And that may be a mistake, but it's an easy one for
policy makers to fall into, especially people who
are trying to mobilize large efforts to try to deal
with the problem, to try to treat it like a war
because that's the most compelling model that we've
ever had to deal with any kind of problem that we
have as a society.
We call it a war and we get all kinds of resources
thrown at it and throw away a lot of safe guards
that ordinarily would restrain people's behavior
and whether it's locking people up for espionage on
mere suspicion as opposed to needing evidence and
stuff like that as you actually do during war time.
So I understand that from that standpoint if we're
going to use the metaphor of war it certainly
didn't -- the metaphor hasn't worked very well
because 20 years, 30 years later we're still at it.
But I don't know that necessarily trying to do
something to reduce what was in the last 1960's a
burgeoning utilization of all kinds of different
types of drugs. And this is anecdotal I'll agree,
but I've talked to lots of World War II veterans in
Burma, China, Southeast Asia in general. People
who were in the India Theater of War, and also in
North Africa where heroin and morphine and other
opiate derivatives were generally available.
Nobody that I've ever talked to will admit that
they ever saw, never mind themselves, but they ever
saw another U.S. servicemen utilize any of those
substances. And I'm using a little example here of
how time shifted things.
By 1968, I mean, we had filmed video coming back
from Vietnam of guys sticking joints into one end
of their M-16's and puffing it out the other. I
mean, this is stuff I remember seeing on TV pretty
vividly.
So there was a big change in American society in
terms of who and how widespread the utilization of
these substances was going to be. I think the
first federal law against marijuana if I remember
correctly was in 1936 so we didn't even try to
prohibit marijuana at the federal level that I
recollect.
Maybe it was part of the 1915 law. I mean, you
can correct me if I'm wrong, but I'm pretty sure it
was '36.
So for a long time no one even thought it was worth
trying to regulate or prohibit that particular
substance. But clear there was a big change. I
mean, I lived through the '60's and never met a
person who used drugs until 1966. It was a kid
that transferred in from a private prep school to
my high school was the first person that I ever met
that had ever talked about using drugs.
So the idea that some thing was happening that
called for a change in the relatively lax and
benign neglect mentality that probably prevailed.
You're right, I think that in the '50's it was
essentially viewed as something that nobody cared
about more than they did gambling or prostitution
or other things that were considered wrong but were
not going to go crazy trying to stamp it out
because the only people that are getting hurt are
themselves in the immediate community there.
Cause now it seems like this thing was starting to
spread out in all directions and towards people who
maybe we cared more about or we suddenly realized
if everybody was doing it it changed everything
that was related to that whole subject area.
I mean, for example, if in 1915 we said you can
smoke cigars, you can chew tobacco, but you can't
smoke cigarettes, we're going to stamp it out.
Maybe we'd all be better off today as a society
cause that's when cigarettes came into vogue as a
result of World War I and the soldiers going off
and not having, as I understand it, access to the
more conventional types of tobacco that were
available.
It was a cheap easy way to sell tobacco to people
and we didn't do anything about cigarettes and
maybe we made a big mistake and took a wrong turn
there and should have focussed on cigarettes as
opposed to heroin and morphine.
STEVEN DUKE: You seriously think that by prohibiting
cigarettes we would have eliminated them?
REP. O'NEILL: Well, maybe we wouldn't have 25 percent
of the population smoking cigarettes, which is what
we are down and down from one third at its height
as I understand it. As opposed to the availability
-- certainly we have fewer people utilizing as I
understand now, correct me cause the statistics I
agree, you know, liars and band liars and then
there's statisticians.
But, the real problem that we have I think is that
we've got a problem that we've pushed back from
becoming as widespread almost marijuana I think in
the late '60's, early '70's was on the verge of
achieving social acceptability. And I think
cocaine in the late part of the '70's was
approaching that within certain parts of this
country almost the same level that alcohol and
tobacco.
And I say probably tobacco is because it's being
pushed -- it's becoming increasingly unacceptable
now and is approaching the level of say where
marijuana was circa 1970 today 25 years later, 27
years later as people shouldn't do it, it's bad.
The degree of social disapprobation, regardless of
the legal thing, I think that there's a shift.
They are kind of going in opposite directions a
bit.
But that what we're trying to do, at least what I
see we've been trying to do with our drug policy is
ultimately harm reduction. I don't think we've
ever put the kind of resources into it that we
really wanted to suppress it. And I guess by point
of comparison you look at a country like Japan or
Singapore or other places where they did suppress
it. It took a lot more resources and not only just
money, but a willingness to lock up anybody,
everybody, shoot everybody that they had to,
whatever they had to do to get where they wanted to
go.
And really made it a major public policy. We've
never done that. We've talked about it and we've
made a lot of noise about, but we've never actually
done that. We've always I think been as long as it
didn't harm people too much or relatively smallish
number of people or maybe people we didn't care
that much about because (tape ended) comments you
made, but I don't think the drug policy has been a
total failure if you view it from that perspective.
That we're willing to tolerate a certain amount of
it and maybe we should cut back on the rhetoric. I
certainly think we should not spend money on
programs that don't work and maybe we should put
more money into ones that seem to have better
chances of achieving something. Maybe the
methadone is one of those. That's one that
certainly has caught my attention.
STEVEN DUKE: Could I respond briefly?
REP. O'NEILL: Yeah, I didn't mean to -- you said a
great deal and there were a lot of things there
that I had some dissent with.
STEVEN DUKE: Right. Well, I don't think that drug
policy has been a total failure. I think its been
a disaster. There's a difference. I agree with
you that we have probably reduced the -- there's no
doubt that the casual use of hard drugs and indeed
marijuana is down from where it was in the late
1970's.
And I do not deny that the drug war has had some
probable impact in producing that reduction and
casual use. It has not had anything to do, that is
studies I've seen suggest that our addiction to
cocaine and heroin has not dropped substantially in
the last decade.
But I would certainly agree with you that it would
be more than countertuitive to suppose that the
fierce policies, law enforcement policies that
we've applied in the last 20-25 years have not
deterred anyone from using drugs. I'm sure that is
the case.
So I would agree that probably our casual drug use
if half what it would be otherwise. But the
consequence of it is that we have eliminated the
less potent, dangerous forms of opiates. For
example, opium is gone. The most dangerous form
available is heroin. That's the only thing you can
buy on the street.
We have produced crack so that our drug prohibition
policies have in effect created or concentrated the
market in the more dangerous, more addictive forums
of the drugs, which is not a health benefit. So
that there are effects even if you don't look at
the secondary effects of law enforcement, just
looking at the drug use themselves and we have, of
course, the AID problem and the needle problem and
all these other problems that are associated with
the black market in drugs.
So I certainly did not mean to suggest that our
drug war approaches had no effect whatsoever on
drug consumption. I agree that it does, but some
of them have been good and some of them have been
bad from a health standpoint.
REP. O'NEILL: I certainly would agree with that and a
lot of the stuff that we've done has -- and the
needle prohibition which was done in the 1980's, I
tend to view that as sort of the most advanced
front guard so to speak, vanguard of the war on
drugs was to prohibit paraphernalia and the needles
which we discovered later: A) didn't have much
impact on stopping people from taking drugs cause
it was hard to get needles; and B) had a secondary
consequence when the AIDS epidemic hit to do a lot
more damage than it could possibly do by way of
goods.
So that's one of the reasons I think the needle
exchange program makes a lot of sense. But I just
wanted to voice a dissenting opinion as far as what
I thought and what you were saying about some of
the aspects of the drug war. Thank you.
REP. LAWLOR: Are there further questions? If not,
thank you Professor Duke. Next is Bill Carroll.
BILL CARROLL: My name is Bill Carroll and I'm the
Director of Substance Abuse Services at Veterans
Memorial Medical Center in Meriden, Connecticut.
I want to thank you for the opportunity to be here
today and to speak on the legislation before you,
particularly bill 6991. I'm speaking today as a
member of the Alcohol and Drug Policy Council that
was appointed by the governor and co-chaired by
Deputy Commissioner Kirk of DMHAS and Ren DeCisco
of the governor's office.
I was representing the Connecticut Association of
Substance Abuse Agencies, CASAA, on the council and
whom I'm representing here today also. The council
report outlines the scope and course of the
alcohol-drug problem that we're facing today in the
state of Connecticut.
Many of their recommendations speak to the need for
new initiatives in the prevention and intervention
areas. As a treatment provider, I am well aware of
the need for continued treatment resources for
those who have advanced in the progression of the
disease. However, it's well known that the earlier
the identification of the problem, the greater the
positive outcomes and at a much lower cost and
lower level of care required.
The report recommends the establishment of
intervention strategies that can be effected both
in treatment outcomes and reduction of cost, and
avoid the pain and suffering that families and
individuals that further progression in the disease
would involve.
Several of the recommendations are incorporated in
your present legislation that you're considering.
One of which is the drug diversion programs. Both
for education and treatment, both for on a pretrial
basis and a post-conviction basis. These programs
are similar to what we now have in the pretrial DWI
program.
We've also had a program for adolescents at our
program with the cooperation of the Meriden court
system which referred individual adolescents to us
who had been involved in minor crimes around
alcohol and drugs. We found this program to be
particularly effective and we certainly had the
referrals and the involvement of the individuals
concerned.
A couple of very clear things that I think as you
look at these diversion programs should be
involved. Particularly the requirement that
further treatment be required if it's clinically
indicated.
A second, especially for adolescent programs that
would be required to have family involvement be
part of the program. We found that to be
especially helpful.
Another recommendation deals with the expansion of
the drug court models to other parts of the state.
This could be a much more efficient way of handling
cases and could achieve better outcomes than the
present systems.
A third recommendation is the establishment of a
pilot project to involve the health care system as
a point of intervention for alcohol and substance
abuse problems. Many of these individuals interact
with the health care system and a number of
different points from the private practitioner to
the hospitals and the emergency rooms.
These systems need to be trained in responding and
to identifying these needs of these individuals and
identifying substance abuse as a problem and to
effectively move them into treatment. There's a
lot of research, several studies that show that a
very high percentage, in some studies up to 40
percent of all admissions into any of our general
hospitals are caused by addictive processes of
alcohol and drug and smoking.
The section dealing with the modification of the
CON process for substance abuse programs would
certainly be very helpful and effective in helping
programs respond to the changing environment.
These initiatives are needed and represent progress
in our attempts to deal with the problem. However,
there are other bills before the legislature that
involve significant cuts in the substance abuse
funding that would drastically reduce the service
capacity and would effect the ability to
incorporate these initiatives.
CASAA also has concerns about some of the other
provisions of the bill. The provision that allows
physicians to prescribe methadone in their private
practice concerns us. These patients need a
comprehensive range of treatment services such as
they obtain in the present methadone maintenance
programs and it's very important that this range of
services still be available to individuals.
The idea of a heroin pilot project is just simply
very scary. There are concerns about the half life
of the heroin, although in this country we don't
produce it in medical form, but basically the half
life is much less than that of methadone and so the
effects would be much less in duration of time and
those people would probably have to come into the
clinic much more often. There may be attempts to
deal with this as we look at actually manufacturing
heroin.
Another area of concern is the establishment of a
division of substance abuse policy and management
in OPM. The responsibility for alcohol and drug
policy in management and funding has been
restructured several times in the past few years at
the state level.
First there was the state alcohol council, the
state drug councils. These were combined into
CADAC with the administration of the state operated
programs remaining in the Department of Mental
Health. This was later changed to the state
operated programs moved into being administered by
CADAC.
Then alcohol and drugs went over to the Health
Department and this past year has been placed in
the Department of Mental Health and Addiction
Services.
It seemed that over these several years more energy
was put into restructuring the policy and
management of substance abuse programs and policy
than providing direct leadership into forming of
policy. There was stagnation of progress in
dealing with alcohol and drug issues in the state.
There was confusion over who was responsible for
what. There was a lack of policy direction and
fragmentation of effort.
During the past year DMHAS has been responsible for
the establishment of policy and for funding.
Although at all times we have not agreed with the
department, one thing we do agree upon is some of
the accomplishments they've accomplished in the
past year.
For the first time in a number of years there has
been a vision developed. There has been a
direction established in developing behavioral
health service networks and there has been a
leadership on the state level that has been absent
for many years. There has also been an energy that
you'd seen demonstrated in the reports that you've
gotten, the data that you've gotten from the
department and that energy has gone out to the
field and again, is something we have not seen in
our field in some time.
I have seen more data in the past year generated by
DMHAS than I've seen in several years and previous.
And there are real serious attempts at looking at
outcomes, generating data that can be useful that
we can then make some educated decisions on what's
going on in the field.
The movement of substance abuse policy and
management to OPM would continue the problems we
have experienced over the past several years.
Mainly there would be confusion over who had
responsibility for what area and there would be a
fragmentation of effort and a duplication in many
areas of the effort, which of course would come
down to increased expenditures.
The goals outlined in the legislation for the
reason for creating this policy council are
certainly very positive and DMHAS should be held
responsible for obtaining those and meeting those
goals. The existing council has been an effort to
bring together many leaders in the field and is
made up of representatives of state agencies, the
Judicial Department, the treatment community and
other interested provider organizations.
They have worked very hard at coming up with some
very clear recommendations. I think that this
council could be made permanent and any concerns
that the legislature had about all the policy and
management remaining with DMHAS could be addressed
by incorporating into the present council some safe
guards that the committee and the members of the
council as well as CASAA would certainly be willing
and interested in working with the committee to
establish.
REP. LAWLOR: Thank you, and I think I share your
thoughts about hoping that once and for all we can
have a fully coordinated drug and alcohol policy
and bureaucracy and one of the problems and I
missed this earlier is that there's two separate
tracks. It seems like all the resources are in the
-- predominantly the resources appear to be in the
criminal justice system. Most of the favorable
results appear to be in the public health system
and if we can sort of merge those two more
effectively we might have a better all around
policy and that's what our goal is today.
Are there other questions? Other members of the
committee? Okay, thank you very much.
Is Mr. Bailey still here? Okay, well, we'll call
on somebody else when he gets -- how about David
Biklen.
DAVID BIKLEN: Thank you, Mr. Bailey. I'm David Biklen.
I'm Executive Director of the Law Revision
Commission and I appreciate you letting me speak to
you today about Bill 6991. This bill is based
essentially on the strategy options that the Law
Revision Commission had in its January report on
drug policy to this Judiciary Committee.
Some 18 month ago the Judiciary co-chairs had asked
the commission to review Connecticut's policies on
drugs and alternatives that work elsewhere and the
commission found that our current reliance in this
state, over reliance in this state on the criminal
justice system to address drug policy and drug
dependence is misplaced and, in fact, a federal
prosecutor in Connecticut observed that we cannot
arrest our way out of our current situation in drug
dependence, and the chief state's attorney also has
pointed out that incarceration has not proven to
have been the solution to the drug problem.
Essentially all the studies that the commission and
experience that the commission and experience that
the commission has reviewed in other states and in
other countries point out that treatment and
prevention and intervention services are much more
successful than incarceration in reducing drug use
and the attendant crime and risky health behavior.
And recent reports by Governor Rowland's Alcohol
and Drug Policy Council and by the Legislative
Program Review Committee also support that view,
similar review that the Law Revision Commission
report has.
Therefore, the strategy options that are in this
bill focus on increasing the availability of
treatment and prevention services and on using the
criminal justice system where its appropriate, as
an intake point for treatment for those drug
involved offenders. Essentially for those who can
be treated safely and more effectively than in
supervised residential settings.
It's still, of course, using the criminal justice
system to protect the public safety where that's
appropriate. Last week Dr. David Lewis, the
addiction specialist from Brown University spoke
very well I think both to the Public Health
Committee and the Judiciary Committee's about the
fiscal savings that are there for the state. And
fiscal savings that begin tomorrow for a person
whose placed under treatment rather than
incarcerated and without risk to public safety.
And this bill presents alternatives we believe to
the legislature for you to consider that will move
us in that direction. I'll be glad to entertain
questions of the committee.
REP. LAWLOR: Representative Farr.
REP. FARR: Yeah, just one disagreement and that is you
said that the reports demonstrate that treatment is
better than incarceration. I don't get that out of
the reports. If you're looking from a public
safety point of view, if somebody is incarcerated
obviously from a public safety point of view we're
safer than if they are out.
And you can argue that well, they ought to be
treated and I don't disagree with that. And
certainly we want to have effective treatment. The
reports demonstrate that we ought to treat people
sometimes while they are incarcerated, sometimes in
lieu of incarceration. But I don't find anything
that says that not incarcerating people is going to
improve public safety. I don't know where you came
up with that spin on it.
DAVID BIKLEN: I don't mean to overstate it, but let me
give you two examples of what I mean by that.
There's a recent study done for the Alternative
Incarceration Programs, for example. And this is
we were talking about folks that of course we need
to incarcerate for public safety, but I think
there's a belief that we can treat a great number
of folks in our criminal justice system safely for
less cost and have less recidivism and less drug
use and less impact on our social fabric than we do
by incarceration.
The study by the Alternative Incarceration Programs
compared a set of folks who were incarcerated with
similar crimes with a set of folks who were treated
in the community with intensive supervision. Their
longitudinal study showed less reactivate, less --
REP. FARR: Recidivism.
DAVID BIKLEN: -- recidivism with those folks over the
next two years in the criminal justice system by
folks who were in the community with intensive
supervision. That is the sort of point I'm trying
to make.
The other --
REP. FARR: Okay, let me just stop you because there's
two things. One is I spent a lot of time on that
study cause I was very curious on any of these
studies and how they arrived at the data. And
quite frankly it's a flawed study which doesn't
surprise me. It's a very difficult thing to do to
measure results.
But if you look at the pool of people that they
looked at who are incarcerated versus the pool that
went into the alternative sanctions program,
obviously the pool that got into the alternative
sanctions turned out to be a lower risk group than
they were, in fact, had committed fewer crimes
initially. They didn't even, weren't even able to
match up the identical crimes.
So when I looked at that study I mean it doesn't
say that the alternative incarceration doesn't
work, but it clearly, it's clear to me that that
study is not a very strong indication of what they
are trying to argue that there's less recidivism
because they are not comparing apples with apples.
And the second point that they miss is that if
somebody is in jail incarcerated for two years and
someone else is out on the street in the
alternative sanctions program for two years, and
you say well, in the alternative sanctions program
they were only committed likely that only a 50
percent chance that they committed a crime. If
they were in jail for two years, when they got out
there was only a 50 percent -- there was a 60
percent chance they committed a crime.
For that two-year period when they were
incarcerated there was a 0 percent. So for the
first two years there clearly is less crime going
on. I mean, that's a given and that's part of the
function of the criminal justice system. It
doesn't mean again that ought not to use this. But
it's not as simple as saying that treatment reduces
crime. Or is better than incarceration cause
clearly incarceration is expensive, but clearly it
reduces crime when somebody is off the street more
than any other program.
That's just a given. If they are not on the
streets, they are not committing crime. And we've
got to recognize that. The question is is that the
best way in the long run to reduce crime when you
have the med resources? Probably not, and that's
where you have to have the balance.
But I just think it's a little bit disingenuous to
put a spin on it that incarceration that the issue
isn't incarceration or treatment. Cause I don't
think that's really the issue. The issue is how do
you balance the right amount of treatment, at what
point, in order to protect society?
DAVID BIKLEN: You're absolutely right in pointing that
out. We recognize that difficulty in the study and
as you pointed out almost any studies in this area
are very difficult to do because the control groups
are so hard to match up.
But the best information we have to date points in
that direction. And you've also pointed out that in
trying to boil this stuff down for you in three
minutes is very difficult to do also. And it takes
a much more than this sort of conversation we're
having here to understand the full nuances of it.
But generally the notion is and I think most
commentators and most observers and persons with
experience who look at that and say we are going to
keep the criminal justice system. We ought to.
But how do you best use that to reduce the negative
impacts of drug use. And there are a number of
ways that we can be using that we aren't currently
using.
For example, the alterative incarceration folks
tell us, judges tell us and the Department of
Correction folks tell us that we probably
incarcerate at least 500 people every year who are
drug-involved offenders who could safely and more
effectively be supervised in the community. And we
simply don't have the residential community slots
to do that. And it's costing us whatever two to
three times as much to treat those, to maintain
those folks in the prison setting, than to maintain
them in the community.
We already do a great number of folks in the
community very safely and effectively out of prison
and folks in the alternative programs. But the
folks who run those programs say they have at least
that many, 500 folks every year who we jail who
otherwise we would put in community supervision and
probation. But we can't do it simply for lack of
treatment slots.
REP. LAWLOR: Other questions? Representative Fritz.
REP. FRITZ: Good afternoon, David. I am concerned
about the language and I think it's in Section 33
where it talks about the signs, you know, that we
all worked so hard to have put up for drug-free
zones around schools and around day care centers
and public housing with regard to the selling of
drugs within 1,500 feet.
Can you tell me what the rationale was for
bracketing out in lines 1451 and in similar places
throughout Section 33 and 34 with regard to this
signage. With regard to the sentencing where we've
removed "shall not be suspended"? Can you tell me
what the rationale was for Law Revision why the
chose to do that?
DAVID BIKLEN: This is consistent with what the
commission had found elsewhere as far as mandatory
sentencing is concerned. The commission is not
suggesting that folks who are selling drugs within
distances of schools, that the statute has
presented, should not be punished for that
particular act and perhaps with enhanced
punishments as the legislature has described.
What we have found though that at times that by
bracketing that language out a judge can still, in
fact, sentence the person to the full time that the
statute permits. But there are occasions in which
the judge tell us and prosecutors tell us and in
which public defenders and treatment officials tell
us where folks who fall within this category are,
in fact, better treated by us as society to protect
us without the mandatory minimum.
They can still sentence them for that length of
time, but putting that kind of mandatory language
in there prevents the judge from individualizing
the sentence that is most appropriate and we've
learned that from the various folks who are in
using that system. It's not to say that judges
should not impose those penalties, but tell the
judge that they should individualize the sentences
depending on what's most effective for that person
and for society.
REP. FRITZ: But David, we're talking about pushers
here. We're talking about sellers. We're talking
about school children. We're talking about
something that the legislature worked so hard to
make a mandatory minimum. Do you think the general
public of the state of Connecticut believes that
there should not be a mandatory minimum for
pushers?
DAVID BIKLEN: I think -- we were asked to look at what
other states have done. Most states don't have
mandataries in this way. And this is unique to
Connecticut and maybe one or two other states. The
judge would still be able to impose that sentence,
the full amount that the legislature had placed
there, but in the appropriate cases the judge could
individualize that sentence where necessary.
We recognize that, of course, for the legislature
to make that ultimate policy decision. But we were
asked to present to you folks how other folks have
done this and if the legislature were to choose to
change that policy would have factored then make
available treatment and other sorts of alternatives
for certain individuals that perhaps are not
available to David because our statute is one size
fits all and we need to understand that folks who
are in the criminal justice system, folks who are
using drugs, one size doesn't necessarily fit all.
And that we hire judges to make those kinds of
decisions. That's what they are paid to do is to
individualize the sentencing policy and they can
well do that under the proposals here.
Now you folks may disagree with that and that's of
course what we expect you to do.
REP. FRITZ: Thank you.
REP. LAWLOR: Are there other questions? If not, thank
you very much. Jack Bailey.
JOHN BAILEY: Good afternoon. I want to introduce Kim
Shagrue and he will be speaking. He has gone over
every word of the bills. He has looked at other
states. He has read the reports and he's our
resident expert at the chief state's attorneys
office now.
I would just like to speak on -- well first, I'm
going to begin all my remarks from now on that if
we all admit that drugs are illegal, wrong and
dangerous, and if people don't get involved in
drugs we won't have to worry about treatment,
education or incarceration. All right?
One section I will speak on because I can't figure
out where this came from. And that is Section 30
of HB6991 which requires the Department of Mental
Health and Addiction to establish a pilot program
for pharmaceutical heroin maintenance. All right?
The one critique of the eligibility is that the
person has already failed at least two attempts of
treatment for heroin dependency. The bill exempts
participants and program employees from criminal
liability violations of the state drug laws during
this period when they are on this drug.
Well, my point on this, Mr. Chairman, this section
of the bill not only removes the incentive to kick
a heroin habit, but to positively encourage heroin
use among chronic users by providing a free, legal
and potentially endless source of heroin. And I
feel very strongly about this because I don't think
any legislator in this building ran on the
proposition that if you can't make it through
treatment and you can't make it through methadone
treatment, we're going to supply you with heroin.
I don't think anyone in this building ran on that
proposition.
REP. LAWLOR: Well, since you bring it up let me just
respond to that. You know, I think that's probably
true. But I also think that many people who ran
for election this year were committed to come to
the State Capital, listen to the experts, evaluate
proposals on their merits and to make policy
decisions based on the facts.
And I think if we simply rule out options because
they sound like they might create political
problems, then we're doing a disservice to our
constituents.
As I understand it, this particular initiative
grows out of something that actually has been
successful in another country, in Switzerland, and
is being suggested as just for something to think
about. No one has said that they feel this has to
be part of a bill.
But apparently the data from Switzerland are
basically this: it's limited to people who have
been using heroin for more than 20 years. They've
dropped out, failed, refused to participate in
other programs and the experts in Switzerland
decided to see what would happen if there was a way
to prescribe pharmaceutical heroin to people in
that category. See what the results would be.
And the results have been unchallenged. And that
is, starting with 100 participants growing over
time to 1,000. Those who participate in it are
involved in less crime and have fewer health
problems. It's as simply as that.
So if we measure what works on the basis of less
crime and fewer health problems, then this is an
option we might want to think about.
JOHN BAILEY: I've heard about Switzerland, Amsterdam.
What you have is zombies walking around. Zombies.
REP. LAWLOR: Yeah, but that's not the case in
Switzerland in this particular program.
JOHN BAILEY: Mr. Chairman, I must admit I think the
discussion is I said right from the beginning,
having these reports coming forth, having a day
like this, having a day where you were the catalyst
last Wednesday. It is important that we raise new
ideas, new suggestions.
And would I totally support some of the proposals?
I'd support I think the drug programs, the drug
courts, putting them down at the juvenile level. I
think that's excellent. I think we should look for
treatment programs. I believe when a person who
wants treatment and there's not a bed for that
person to get treatment, there is a problem.
I'm worried about the person who has gone through
the treatment, decided he's not going to do any
more treatment and robs you or me or breaks into my
home or your home.
REP. LAWLOR: And that's what apparently is not
happening with these people in Switzerland because
they don't have to get the money to pay for the
heroin. So there's a lot of parts --
JOHN BAILEY: But you can carry that to extremes, Mr.
Chairman. Then if we have a sex offender and he
doesn't get treatment, we supply him with a
prostitute when he comes out.
REP. LAWLOR: Well, who would the victim be in this
Switzerland case?
JOHN BAILEY: The victim? I think the person we are
giving the heroin to.
REP. LAWLOR: Okay.
JOHN BAILEY: Because it gives them all incentive not to
get the treatment to get off because if he knows if
he fails he will be given heroin.
REP. LAWLOR: But in this particular case, I mean,
intellectually it's obvious what we're talking
about. We're talking about people who have failed
every program there is, that they've been
chronically addicted to heroin for more than 20
years. And this might be an option.
And to me, although I'm not sure whether it's good
policy or not, to me it doesn't sound like some
martian idea of craziness. It sounds like some
basic thing why not give it a shot? And it's worth
talking about. That's all.
JOHN BAILEY: Even California has not decided. This in
California they brought this up three years ago and
it went down in California. So I would suggest
Connecticut with its make up will not adopt it.
REP. LAWLOR: Do you feel the same way about methadone?
JOHN BAILEY: I think methadone there is a place for
methadone. We had the first program right up here
on Main Street here. I think it has a purpose. I
think it has done good. I think we can look at
other -- I talked with someone out in the hallway
today where they have to drive 75 miles to get it.
If they are not there within that time period, they
don't get it.
I think we can look at other programs like that.
That's why I think, Mr. Chairman, your bringing
these issues up have helped a number of people
opening their minds.
REP. LAWLOR: But in your mind what is the difference
between methadone and heroin when it comes to the
question we're talking about? The distribution of
it?
JOHN BAILEY: Heroin -- the problem I see with heroin,
the more you take -- you begin with a little
heroin. What we're seeing now is heroin as you
know is about 40 percent pure from where it was 10
years ago at 4 to 5 percent pure. People are now
sniffing it and snorting it.
But that's fine. But then after about two or three
months of doing that they have to get higher. So
then they begin to inject it. And I'm saying
heroin eats upon itself. Methadone is saying I'm
not going to be drug addicted. I'm going to try to
maintain a level.
Heroin I do not agree with you, Mr. Chairman. You
and I have agreed on a lot of things in your
programs.
REP. LAWLOR: I understand, but the doctors tell us that
basically the methadone and the heroin are
essentially the same thing. The effects, the high
you get off of it is different.
JOHN BAILEY: I would ask you to call Dr. James O'Brien
who headed up Dempsey's treatment center out in
Farmington. And I think he will give you a
different philosophy and he has been treating drug
addicted people for almost 40 years. James
O'Brien.
REP. LAWLOR: Okay. I'll do that.
JOHN BAILEY: Mr. Chairman, I know the time is --
KIM SHAGRUE: Thank you. I'm going to keep my comments
brief. I realize we've all been here for awhile so
I'm just going to hit the other high points of 6991
that we'd like to address.
The first are Sections 32, 33 and 40 which repeal
21a-278 and thereby remove the enhanced and
mandatory penalties for non-drug dependent drug
dealers. Those are the people who sell one ounce
or more of heroin or cocaine, half a gram of more
of crack cocaine or five milligrams of LSD.
It's precisely these people who are non-drug
dependent who sell for profit that underwrite gang
activities and lead to increases in violence and
fund people who are of a mind to commit crime.
These are not drug dependent people and we believe
that it would send a wrong message to society,
especially to our youth and it would be a
retraction of the position that we've taken that
with respect to these people who sell for profit,
and who are nowadays particularly gang related,
that we're not going to tolerate it and we're going
to treat you differently than other people and
you're going to go to prison and you're going to go
to prison for a certain amount of time no matter
what.
REP. LAWLOR: Can I ask you something? Do your
prosecutors ever drop these charges?
KIM SHAGRUE: Do they ever drop? Oh, I'm sure in terms
of plea negotiation that they probably do.
REP. LAWLOR: Doesn't that send the wrong message?
KIM SHAGRUE: No, I don't think so because they have to
look at what they can prove and what they can't
prove. If they don't think they can prove
something, if there's somebody who says I'm drug
dependent but we don't think they are drug
dependent.
The alternative is to go to trial when we can get a
plea agreement that we think is acceptable and just
that that may be an appropriate place to drop
charges like this. I'm sure it happens.
REP. LAWLOR: Do you think it happens a majority of the
time?
KIM SHAGRUE: I couldn't tell you. I mean,
statistically I can't tell you. So, I won't say.
REP. LAWLOR: It does happen the majority of the time.
KIM SHAGRUE: I don't want to tell you as I can't tell
you honestly.
REP. LAWLOR: Well, we can have mixed message in the
legislature and mixed message in the court room.
That's my only point.
KIM SHAGRUE: Oh, I agree. I agree and I think if it
was our policy, but the difference is --
REP. LAWLOR: Well, what is the policy?
KIM SHAGRUE: We have no policy that says hey, if you
come in on a charge of 21a-278 we're going to drop
it. We're not going to pursue it. We're not going
to treat it seriously.
REP. LAWLOR: Why don't we consider --
KIM SHAGRUE: That's not a policy of the division.
REP. LAWLOR: Why not consider the opposite policy? Why
not say that any time someone comes in charged like
this we will never reduce the charges because we
want to send a clear message that we don't --
KIM SHAGRUE: Because it would be irresponsible. What
if you can't prove the charges?
REP. LAWLOR: In every case where you can prove the
charges.
KIM SHAGRUE: Because you know how many charges there
are? We have trials then we'll be backed up. We
already have 300 murder cases waiting. Now we have
500 21a-278 trials waiting.
REP. LAWLOR: And that's our point.
KIM SHAGRUE: It's in the best interest to say, hey look
if we can negotiate a plea agreement that is in the
best interest of society, and that's just and fair
under the circumstances, then that's what we'll do.
And the carrot is that you have to remove the 21a-
278 charge and that's the price you pay.
REP. LAWLOR: So can you rule out the possibility that
the policy makers, meaning legislators, not all of
us. I'm speaking for myself, maybe we'd like to do
the same thing that you're doing which is saying
that we think a greater parity should be given to
the violent cases, the murderers, the rapists, and
others. And in order to do that we need to
eliminate the mandatory minimums that we have for
the non-violent drug offenses. Is that a
legitimate position for a policy maker to take?
KIM SHAGRUE: I don't understand your question.
REP. LAWLOR: You're saying that prosecutors in the
court house make a decision that there's a
difference between violent cases and drug cases.
And in order to move a less serious drug case,
engage in plea bargaining to reduce the charges, in
order to have the time to spend on the violent
cases. Now I think that's a legitimate decision
and I think, in fact, that's what goes on most of
the time.
KIM SHAGRUE: Prioritization.
REP. LAWLOR: Right.
KIM SHAGRUE: Right.
REP. LAWLOR: And I'm saying is it illegitimate for us
as policy makers to say that we'd like to put even
more emphasis on the violent cases, and a little
bit less emphasis on the nonviolent drug cases and
one way of us doing what you do is to eliminate the
minimum mandatory for drug offenses. Is that a
legitimate --
KIM SHAGRUE: No.
REP. LAWLOR: You may disagree with it.
KIM SHAGRUE: It is certainly not illegitimate for you
to prioritize.
REP. LAWLOR: Okay, then that's all I'm saying.
KIM SHAGRUE: No, it is legitimate. It is not
illegitimate.
REP. LAWLOR: Okay. So we could have a difference of
opinion, but if that's where we're coming from it's
not some sort of communist conspiracy, right?
KIM SHAGRUE: Oh, absolutely not.
REP. LAWLOR: Okay. That's all I'm asking.
KIM SHAGRUE: I wouldn't mean to suggest that. Section
33 is a similar situation where we have the
elimination of mandatory minimums to people who use
youngsters to sell drugs or use youngsters to deal
drugs or sell drugs in protected zones.
Again, I think it sends a message that we've
protected these areas and now well, maybe they are
not that worthy of protection. And I think it's
different because where it's codified in the law of
the state where the state has said as a matter of
state policy, you know what? Maybe these aren't so
important. Maybe it's not so bad to use youngsters
to sell drugs. Maybe it's not so bad that you sell
drugs to youngsters. Maybe it's not so bad that
you sell in a school zone.
Again, by dropping those into the greater mix of
drug offenses, they don't stand out. People are
going to perceive them as not as serious and the
message is going to be clear that we now don't
really care about those things any more. We have
become more tolerant and our resolve is weakening.
REP. LAWLOR: I hope you don't mind, but it makes me
crazy to hear this because I can't tell you how
many people from the block watches in New Haven to
the victim groups elsewhere have called and say,
you know, why is it that if there's a law on the
books that says there's a minimum mandatory for
selling drugs near a school, why is it when the
cases go to court that the prosecutors always drop
the charges?
And I know that happens. And you know it happens.
Almost all the time. And I'm saying if you're
making the argument here that it sends the wrong
message for us to do it, why doesn't the same
argument apply in the court houses when the
prosecutors do it? We can have a policy
disagreement, but why is it outrageous for us to
make it look like we're somehow watering down the
penalties when the same objection isn't made when
the prosecutors do it?
For legitimate reasons there we're making money and
policy decisions and priority decisions here. How
is it different from the prosecutors?
KIM SHAGRUE: Well, first of all, I don't mean to
suggest that any of this is outrageous. I don't
mean to suggest that it's stupid.
REP. LAWLOR: I'm only saying what you said. You said
it sends the wrong message. It looks like we're
stepping back from our commitment to punish drug --
people who sell drugs to school kids. That's what
you said.
KIM SHAGRUE: I agree and I --
REP. LAWLOR: And so why when it happens in the court
house when prosecutors say hey we've got bigger
fish to try. We're going to get rid of this case
by a plea bargain instead of taking it to trial
with the minimum mandatory. How is that different
from what we're talking about, thinking about here?
How is it different?
KIM SHAGRUE: It's not different, but the decisions are
based on is different is there's a practical
reality that you have only so many resources and so
many prosecutors and so many court rooms.
REP. LAWLOR: Well, listen. Just on the other side of
this building right now the democratic members of
the House of Representatives are debating policy
choices, budget choices which effect your agency
and Department of Corrections and health and
hospitals and everything else. And I would argue
that we have even bigger problems than what you
have.
All we're saying is if there's a more cost
effective way to do it, and we're making rationale
decisions, why not at least talk about doing it?
But as politicians ought to stand for election
every two years, if we even raise the issue we're
told look what they are doing. They are talking
about giving heroin to heroin addicts and stuff
like that. And I'm just saying we have tough
choices too. And we like to make them in a
thoughtful, rational way. That's all.
And I sort of take exception to people coming here
saying that we're sending a message it's okay to
sell drugs to school kids cause nothing could be
farther than the truth. That's my pitch.
KIM SHAGRUE: I think I'd like to conclude by saying
that we've heard here today that our recent efforts
in drug abuse don't work. And I think that's wrong
and I think Representative Farr is about the only
person I've heard express that opinion. That since
1979 there's been an overall decline of 50 percent
in drug use.
As many of you may know, there have also been
recent corresponding drops in the rate of violent
crime. Some significant. New York City is one
example that stands out. It's, therefore, our
opinion that the message of gloom and doom is not
supported by the facts or by what we all know to be
true and that, therefore, our present policy must
be doing something right because there must be some
reason for this to attribute this decline in the
use of drug use.
I think a wholesale change in our drug policy is
ill founded because we don't know what the
consequences will be and it suggests that the
initiatives that we've taken over the past decade
or the past 20 years have failed and I don't think
that that's true.
We'd urge you to review 6991 with caution and to
exercise your responsibilities in a diligent way.
Thank you.
REP. LAWLOR: Representative Farr.
REP. FARR: I can see that we're going to have a lot of
fun in this committee on this bill. Just make two
comments.
One is Representative Lawlor asked you about don't
you, in fact, reduce your mandatory minimums to
move cases. But, in fact, you reduce in my
experience probably the majority of the cases in
order to move cases.
If this were in a content of a bill that said we're
going to reduce all mandatory minimums and (tape
ended) I suppose that we could do that and then say
well, then we're going to really -- but this time
we really mean it I suppose we could do that.
But I guess I'm not somebody whose a big fan of
mandatory minimums, but I do think that it sends a
clear message where you single out the drug cases
and say we're going to reduce those charges and not
reduce everything.
But let me get back to the question of the
methadone because we keep hearing questions and the
Switzerland model. I mean, I was here and I'm a
little confused cause I was here when we had the
methadone -- I'm sorry, not the methadone issue the
heroin issue in Switzerland. I was here when we
had the methadone presentation and every doctor
that I heard explained that there was a clear
difference between methadone and heroin.
And the explanation I got out of every doctor that
testified was that heroin you build up a tolerance
for it. And that the problem with heroin is that
you need more and more and more. And you have to
keep feeding it. And it also is the nature of that
versus methadone is that it creates some behavior
problems because you get more focused on it.
Whereas, methadone apparently as long as you get it
every day you don't think about it all day and if
you get heroin you get the rush and then you spend
the rest of the day worrying about the rush.
I think there are some clear differences and I have
some real concerns about suggesting that we could
successfully have heroin maintenance because I
think that's what methadone is all about is a
substitute for that. I think it's a far safer
substitute and I'm just kind of confused based upon
that testimony how heroin would work.
I mean, I haven't studied the swiss model but I
understand England tried it and also abandoned it.
So, you know, I think we're going to have fun in
this committee on a few policy decisions.
REP. LAWLOR: Representative Scalettar.
REP. SCALETTAR: You spoke about the 50 percent drop in
drug use and we've heard that from different
people. But at the same time we've heard testimony
that harm from drug abuse has really increased over
the same period of time and that perhaps the drugs
that don't cause as much harm have been decreasing
in use, whereas, really the harm to people, if
that's what you measure has increased. Do you have
any comment on that?
KIM SHAGRUE: No, because I'm not aware of the studies
that suggest that the harm associated with drug
abuse has increased. I'm not saying it hasn't. I
just don't know. I'm not well voiced in that area
so I couldn't tell you.
REP. SCALETTAR: Well, what studies are you relying on?
KIM SHAGRUE: The President of the United States
released his 1997 drug policy just very recently. I
read it this morning and that's where they cite the
evidence in the studies as statistics that drug
abuse has declined 50 percent since 1979.
REP. SCALETTAR: Was there a breakdown of which drugs?
What the rate was on different drugs?
JOHN BAILEY: We can get you the report.
REP. SCALETTAR: Was that in that report?
KIM SHAGRUE: I'm not sure. I didn't have -- the fellow
who had it left and I didn't get a chance to read
it cover to cover. But I'd be glad to give you a
copy of it because I know we have it at the office.
REP. SCALETTAR: But you're not sure that it's in that
report?
KIM SHAGRUE: I'm not sure.
REP. SCALETTAR: Okay, thank you.
REP. LAWLOR: Mr. Cronin has it. He'll get it up to
you Monday. Are there other questions? If not,
thank you very much. Richard Brown.
A VOICE: He's gone.
REP. LAWLOR: Dr. Henry Blansfield.
DR. HENRY BLANSFIELD: Thank you for allowing me to
testify before your committee. A couple of things
I noted this morning. One is that the Commissioner
of the Department of Corrections stated that he had
a methadone detoxification program in place. That
may be the case, but in addition as I recall from
going over the materials when I was on the working
group, methadone group, they also have a methadone
maintenance program for female prisoners who are
pregnant because of the high rate of miscarriage if
they are detoxified and abstinent.
And they are maintained on methadone as far as I
can recall until they deliver the child and then
they are detoxified from it. So there is a
methadone treatment program already in please in
the women's prison in Connecticut.
I think that one of the important things that I
have to say is about my comprehension over the past
25 years of the disease aspect of chemical
dependency. Recently as you've seen with the
availability of Prozak and other analogs of that
medication, they are designed to take care of
imbalances in neurotransmitter mechanisms in the
central nervous system as treatment.
And we now know that the continued use of opiate
drugs, for instance, like heroin produces a change
in the neurotransmitter receptor mechanism in the
central nervous system that may be long lasting and
even permanent and that these changes explain the
development of tolerance to the drug where more and
more has to be used and withdrawal symptoms when
stopped and the persistence of craving for the
drug.
That explains the high incidence of relapse
amounting to 85 to 90 percent of people who
detoxify from heroin or methadone and then find
themselves in what we call the abstinence syndrome
which is depression, anxiety and craving for the
drug that drives them back to either illegal drugs,
back to methadone or back on heroin and on street
heroin.
Now in our state there are approximately 3,200
people on methadone, whereas, Susan Addis two years
ago in print stated that we really needed 20,000
slots for heroin dependent people. And it is, you
know, logical that methadone patients on public
programs that have been stable participants, that
is not using other drugs and cooperative with the
program, that they be referred to qualified
physicians to take care of their methadone needs to
be seen every 28 days, for instance, and provided
with methadone through existing methadone program
pharmacy supplies.
Or by prescription so that they can continue on
methadone as the proper treatment for their opiate
dependency. Someone stated that there was no
waiting list in methadone programs prior to my last
participation in December with the working group.
We called several programs in the state of
Connecticut. One was called the Legion Avenue
program in New Haven. The waiting list was over 60
people and the waiting list was approximately 90
days. I called the one in Waterbury and was told
the same story and the one in Danbury where I'm a
resident the waiting list was about six weeks.
So the availability on demand is certainly very
questionable. It would be a very good idea to
provide methadone treatment to heroin dependent
prisoners who qualify for it as having sentences at
a year or less. So if they could be maintained in
a comfortable state until the time of their
discharge when they could then be remanded to local
community programs and treated there with
methadone, this would keep them from relapsing to
the black market purchase of opiates and also to
felony crimes to support that habit.
I'd be happy to answer any kind of questions if you
so desire.
REP. LAWLOR: Thank you, doctor. Representative Farr.
REP. FARR: Yeah, I wonder when you leave I guess maybe
if you have the telephone number for the clinic in
New Haven that you said has a six month waiting
list. I'm confused. I mean, I don't know the
facts.
DR. HENRY BLANSFIELD: Ninety days I said.
REP. FARR: Okay, 90 days. I talked to a representative
from DMHAS, you know, five minutes ago. He told me
that the total statewide waiting list is 13 people.
And that there is no waiting list in any place. He
showed me where the waiting lists were and there
were I think a waiting list of four or five in New
Haven. He also showed me Paul's data that they had
done where they were telephoning each of these
places and asking how long it would take to get in
and we're being told that we could take you this --
I saw the results and it showed me that you can do
it this afternoon or you can come in tomorrow by
1:00.
I'm not sure, you know, you give me such radically
different information than what I'm getting from
our own agency. I wonder if when you leave here
maybe if you have some telephone numbers I'll call
myself and try to get the right scoop because --
DR. HENRY BLANSFIELD: Well, I would suggest that you do
that, Representative Farr, but I would suggest too
that you call the Department of Health and
Addiction Services and get the numbers of the
clinic if they have them. Cause I called them and
they didn't provide me with that.
REP. FARR: Well, if you give me the number you called
and you said 90 days.
DR. HENRY BLANSFIELD: Well, I haven't got it
immediately on me.
REP. FARR: Okay.
DR. HENRY BLANSFIELD: I'd have to get in touch with
you.
REP. FARR: What clinic was it?
DR. HENRY BLANSFIELD: It was the Legion Avenue clinic
down in New Haven.
REP. FARR: Okay.
DR. HENRY BLANSFIELD: That was with APT Foundation.
REP. FARR: Okay. Well, that's good to know.
DR. HENRY BLANSFIELD: You can call, you can give the --
what I would do is pretend that you are --
REP. FARR: No, I can work undercover. No, but I would
--
DR. HENRY BLANSFIELD: Wait a minute. I'm giving you a
number. You want a number?
REP. FARR: Okay.
DR. HENRY BLANSFIELD: Now I called this clinic that
Little Joe is talking about and I'll give you this
interesting anecdote. Have you got a minute?
REP. FARR: Go ahead.
DR. HENRY BLANSFIELD: The anecdote --
REP. FARR: Well, you had three. I think --
DR. HENRY BLANSFIELD: -- is that I called and I said
I'd like to come in because I'm a dependent person
and I want to go on methadone I finally decided.
And they said, well, what's your name? So I gave
them an alias and they said, well, what's your
address? Well, I said I'm a street person. They
said well, what's your phone number? And I said,
gee, I'm at a public telephone so calling me back
would be difficult.
Well, what's your social security number? See, I
was blowing whatever cover or anonymity I would
have by having to give them this information. And
then they said, well, you'll have to come in for an
intake and that's 10 days from now. Bring $35 and
bring an affidavit from another user or another
person who knows you. And affidavit? I didn't
know whether it had to be notarized or not that I
was a user for over one year. Okay?
And then I would have to have a physical
examination which I would have to pay for privately
before any kind of evaluation is made as to whether
or not I qualify.
REP. LAWLOR: Before you give out the phone number, it
may look like we're a small audience here, but this
is going to be broadcast --
REP. FARR: Yeah, why don't you give it to me afterwards
so we won't have people --
REP. LAWLOR: Several of our radio stations pick up --
DR. HENRY BLANSFIELD: You don't want the phone number?
REP. FARR: Well, you just give it to me afterwards.
REP. LAWLOR: Putting it over this system might have
other consequences.
DR. HENRY BLANSFIELD: I'd be glad to. And what else
you want me to tell you? You've got to really --
you're talking about the difference between
methadone maintenance which is an opiate
maintenance. The difference between that and
heroin is that methadone is given orally preventing
AIDS, okay?
Number two is that it has a very slow, even
metabolism over 24 hours whereas heroin has a very
short one, okay? But a lot of people don't want to
take methadone and those are the ones that go to
the clinic in Switzerland and get their heroin.
REP. FARR: But what about the argument, the
representations that were made by all the doctors
about the fact that the beauty of methadone is it
doesn't build up a tolerance. So you can keep --
DR. HENRY BLANSFIELD: Oh, no, that's completely false.
It builds up tremendous tolerance. There are some
people in this room today who are taking 200
milligrams of methadone a day and are just as lucid
as you are, Representative Farr.
REP. FARR: That doesn't say much. Okay.
DR. HENRY BLANSFIELD: You know what I mean?
REP. FARR: I think we all know what you mean. But the
testimony from the doctors as I understood it was
that heroin you immediately build up a tolerance
and that one of the problems with heroin is it
requires more and more to get the same result.
DR. HENRY BLANSFIELD: Absolutely.
REP. FARR: And methadone when you got your -- you might
have a high tolerance level and, therefore, the
level of methadone you needed to get that feeling
of wellness I think it's been described as with
methadone that you get a feeling of wellness that
you feel that you can function again.
And that for different people the dosage of
methadone will vary significantly depending on how
big the heroin addiction was and also the chemistry
of their particular body. But that the testimony
as I understood it was that once you get onto your
methadone and once you get a stable dosage you can
take that stable dosage for a long period of time
without building it up.
And if you're a heroin addict you don't keep a
stable dosage, you want to continue to increase the
dose.
DR. HENRY BLANSFIELD: Well, I don't think that's true
either, Representative Farr. You see the
difficulty with street heroin is you never know
what dosage you're really getting, okay? And you
don't know what the contaminants are. You don't
know what potency it is.
So it's very difficult for a street junkie to get a
nice even dose unless he has a supplier who's going
to give him constantly the same dose of medication.
That's why there's so many overdose deaths with
some of this high potency stuff, you see?
But with methadone at least you know what the dose
is that you're taking and then you get to a point
where you have a dose that produces relief from
craving and prevents withdrawal and that's all you
really want. You can't get high on it because it's
sitting on all your receptors, you see?
So even if you shot heroin there you wouldn't get
any further high because all your receptors are
covered. You got me? Anything else?
REP. LAWLOR: Representative Scalettar.
REP. SCALETTAR: Yes, one other question. You said that
you made some calls when you were part of a study
group. What group were you part of the --
DR. HENRY BLANSFIELD: I worked for the methadone
working group for the Law Revision Commission.
REP. SCALETTAR: Oh, thank you.
DR. HENRY BLANSFIELD: In fact, if you looked at the
report I have a very extensive bibliography in
there which is so full of stuff that you may want
to discard it. Just forget it.
REP. SCALETTAR: Thank you.
REP. LAWLOR: Thank you, doctor. Next is Representative
Newton.
REP. NEWTON: I want to -- I'm Representative Newton. I
represent the 124th District and I want to thank
Mike Lawlor and this committee for the first time
since I've been here going on 10 years that we've
ever raised a conscience about treatment and rehab
and those kinds of things.
And I've listened to the testimony from my office
and popping back in between caucuses on this
serious debate and I want to share something with
you and come June 26th of this month I will have
gone without drugs or drinks for two years.
And I say that to let you know that I had to go to
rehab. I had to get some treatment and my
fortunate situation was that I had a MD health card
and I was able to go to a treatment center to get
some help.
The individuals that we're talking about without
substantial funding they can't. They don't have
that luxury of having cards and Medicaid/Medicare.
Let me say that we've tried to build new prisons.
We've locked people up for years and years. It's
not working. Representative Lawlor shared some
statistics with me of the people who are just
arrested for drug charges. Out of those
individuals I'm willing to bet the numbers that you
showed me, that 95 percent of those people that are
arrested for drug charges have some sort of drug
problem.
Because you start out by selling and then you
become your best customer and you start using and
you get a habit and those kind of things happen.
If we don't provide the kind of funding that we
need for treatment, we've got a couple of options.
Ninety percent of the people that have drug charges
or have drug problems, when they do get out of
prison they go back to what they know how to do
best. And that's either selling and using. That's
what they do.
Without some sort of treatment, you know, you can't
help them. You can't help them because the disease
of addiction, and I heard them talking about
methadone. I heard them talk about cocaine and
crack. Methadone is a lot different because your
body aches for that drug. It's like crying out I'm
hurting, I'm in pain. Crack and cocaine deals with
the mind.
Your body doesn't ache for those drugs. You know,
and unless, you know, my wife's pregnant. She'll
be eight months and I can sympathize with her on
having a baby. But I could never ever tell her
what it's like, the pain and those kind of things
that she goes through in giving birth unless I've
been through that.
And I hear people testifying and I hear people
giving observations and those kind of things, but
unless you've really been through it you can
diagnose, you can look at a person and sympathize.
What we ought to be talking about today is how do
we move people from methadone to not using at all.
That's what we ought to be talking about.
What kind of treatment can we give those
individuals? And I've been to detox centers and
I've watched people come in on dope and how their
bodies ache and how they've had to go through cold
turkey. I've watched that.
And so I wonder with all our doctors and our people
who are experts on drug abuse, why we never talk
about how do we move a person from methadone to not
wanting to use drugs at all? And I think that the
only way we can begin to do that is talk about
treatment centers. Because they work.
And I heard somebody mention AA and NA and CA group
therapy. Those kinds of things do work. And I'm
just happy because for the first time in my 10
years of being here we've ever raised the question
of maybe we're doing something wrong. Why is it
when we let people out of prison they return to the
same crime, they return to that same corner
standing on the corner doing the same thing that
they got arrested six months, nine months, a year
ago. Why are they doing that?
It's because we have not provided any kind of help
to weed those people from addiction, from using to
not to want to use. You know, and I can truly say
that as I travel throughout this state it's sad
when a person wants help and there's no beds for
you to get the help.
But yet we can justify by spending millions and
millions of dollars to incarcerate a person if we
just took half of that and put it towards treatment
and rehabilitation. I think that some people
wouldn't use drugs again.
And so I came here to let you know, maybe you know,
they say God works in mysterious ways and so maybe
by me having experienced it, gone through it, I
might be able to let my colleagues know that we
need to look at treatment. If we don't need to
look at locking a person up who has a drug problem,
because 90 percent of the reason that person has
the drug problem is because he can't get no help.
He needs some help and we haven't put any emphasis
on that.
So I would hope and I will help you and argue and
human services, public health that we've got to
restore funds for treatment. That's how it works.
If I had cancer and my doctor told me that I needed
chemo three days a week to five days a week, I
would get that chemo.
But if you cut chemo I'm going to die. If you cut
treatment, all it's going to do is be a revolving
door in our prison system. And don't take my word
if you ask Jack Bailey and you ask some people here
who are from the prison population, just ask them
how many times do we get a person going through the
revolving door and the same reason, the first
reason he came there was either selling drugs or
using drugs that they come back through our penal
system here in Connecticut.
And I'm willing to bet that the statistics, okay,
would be outrageous because we do have quite a few
of returning people in our prison system. So I'm
just glad that the Judiciary Committee had the
courage to begin to talk about treatment instead of
building prisons because evidently it's not
working. Evidently it's not working. Thank you
all for allowing me to come.
REP. LAWLOR: Thanks, Ernie. I just wanted to say that
it's quite right and this is the first time anyone
in any kind of comprehensive way has talked about
this and it's not just starting this week or
anything. It's been going on for two years and
we've got three very thoughtful studies and the
most interesting thing to me in all three of these
studies we asked the question what could we do that
would be more effective.
And there's all kinds of recommendations in these
three studies. And not one of them is more jails,
tougher laws, longer sentences, more cops, anything
like that. It's all principally based on treatment
and alternative ways for prosecutors and judges to
deal with people. And that includes the governor's
recommendations and others.
And secondly, one of the most frustrating for me
and you pointed it out. I get the phone calls and
I'm sure all of our colleagues get the phone calls
from friends, neighbors, constituents, and they
say, you know, my kid, my spouse, my employee, my
brother, has a problem and wants to get some help.
What do I do? The first question is, do you have
insurance?
REP. NEWTON: Yep.
REP. LAWLOR: And even if you have it, does it cover
treatment?
REP. NEWTON: That's right.
REP. LAWLOR: And that's one of the recommendations in
the Law Revision report is all insurance should
cover it and there ought to be -- and secondly, the
thing I end up having to say to a lot of these
people who don't have appropriate insurance is
well, is he or she on probation or something. Is
the only other way I know to get into treatment is
to get arrested and get prosecuted?
Unfortunately that's the main referral mechanism of
the drug treatment system in our state and I'm
pretty sure every state at the moment. So maybe
there's an easier, quicker way to do it and
certainly there's a cheaper way to do it.
Appreciate your comments. Representative Farr.
REP. FARR: The problem though that we're not talking
about is two things. One is that the drug of
choice for most people in the criminal system is
actually alcohol, not -- and so that's not even a
question of legal or illegal use.
And the real problem that I see is that not so much
the availability, and we have some serious
questions here about the availability of treatment
services, but that so many people don't have any
interest in doing those treatment services.
I mean, we have testimony on the juvenile system
and kids come in and we all agree we ought to treat
kids right away. But when you ask the majority of
these kids, do you want into a treatment program
the majority of them say no. And so the problem is
it's as simple as saying well, we'll just have all
the treatment programs out there when a lot of
people don't have any interest in going.
REP. NEWTON: Let me say how you can tie that in and
here's how I think where the judicial system could
work hand in hand.
I'm willing to bet that if the judge stood before
Representative Newton and said, Ernie, I'm going to
give you five years in prison or you have an option
because we know you have a drug problem, an alcohol
problem, to go to a rehab with a suspended term or
whatever that might be. I'm willing to bet that 90
percent of the people that we have locked up today,
not serious offenders, I'm talking about people who
have drug problems who sell it, got busted and they
are just sitting there until their trial date could
come.
I'm willing to bet 90 percent of them would go to
rehab tomorrow if those kind of things happen. And
I know that in the judicial system those things do
happen, you know, they give you an alternative
either AIC or they give you an alternative to get
some sort of help.
So I'm willing to bet that the people that we have
in prison today who have a substance abuse alcohol,
drugs or whatever it might be. We need to look at
how can we tie the judicial system and treatment
hand in hand. So maybe instead of serving a term
they might have to stay in rehab as part of their
incarceration, as part of their treatment to do
better.
And I know of some cases in the city of Bridgeport
where judges have allowed them to go to places like
Guenster or the Goodwill -- not the Goodwill, but
the Salvation Army another place there, and a lot
of those individuals have taken advantage of it.
Now, let's face reality. It took me three rehabs
to go to. And you're going to have some people who
are going to go back out and use again. But that's
when you get a little tougher. Okay? You're going
to have to get -- I mean, we've got to face
reality. We might have to get a little tougher.
But I think the way the system is set up now as far
as people who aren't serious offenders like
murderers and those kind of crimes, we need to do
something to try to get them some treatment. At
least -- listen, what we're doing now definitely is
not working. And I don't have to tell you because
you know we're talking about the budget right now
in caucus.
And the money that we spend on our judicial system
is not working. You know, we would probably be
better off having people for what we pay for people
in prisons putting that person in rehab for a year,
okay, for what we pay, and I guarantee you we'll
get a better return on our dollar than leaving them
locked at the North Avenue and some of our finer
prisons in this country.
So I think that we've got to do a little better job
than what we're doing and you might be right that
people don't want it. But then those who don't
take it then we have to do what we have to do, you
know, to keep them off our streets.
REP. LAWLOR: Representative Martinez.
REP. MARTINEZ: Ernie, certainly you and I have had a
lot of private conversations about this issue and
certainly you've made many comments that you
thought that what we've been doing here that you
were happy as a matter of fact with what we've been
doing here in regards to the kinds of information
that we're starting to really have others provide
for us and then have at our disposal to provide for
the public to come and participate in.
So I certainly know that you know what you're
talking about. But I want to publicly take this
opportunity to thank you for coming in front of us
and giving us a great deal of respect for doing
that. Coming in front of us to enlighten us and
also confirming that we're on the right track.
So my brother that's a huge thing to do. It's very
big of you and I just wanted to give you the kudos
that you deserve publicly. Thank you.
REP. NEWTON: Thank you.
REP. LAWLOR: Any other questions? If not, thanks a
lot.
REP. NEWTON: Thank you.
REP. LAWLOR: Peter Rostenberg. Just so people know
where they stand, we're still switching back and
forth. Is Deb Fuller still here and is going to
testify? She left. How about Senator Prague? Or
Gerry Smyth? Okay. Gerry will be next and then
John DeMayo I think it is, Frederick Attice, Anne
Higgins, James Reed, Kathryn Sutton and others.
DR. PETER ROSTENBERG: Thank you. My name is Peter
Rostenberg and I'd like to say how proud I am of
our state government that we have the courage to
deal with these issues, combining science, debate,
consensus, and courage is what we need to help our
fellow citizens. I would ask for all the courage
you have plus 10 percent.
I am a practicing internist. I make my living
treating people's mistakes. And I say that not
facetiously because when you were talking about the
needle exchange there was all this stuff, well,
they are bad, we need to stop them from doing this.
Well, the last patient I treated before I came over
here today was an obese man who had a coronary
artery bypass a year and a half ago and continues
to smoke and continues to weight 245 pounds.
Yet, I give him lipid lowering agents, fat reducing
agents, and it's not a matter of whether he
deserves them or doesn't deserve them because he
can't stop smoking or he can't lose weight. The
fact is I'm helping him reduce harm.
And I see the medical profession as existing as a
reaction to human suffering and, therefore, I'm
just doing my job. I also was a member of the
Governor's Blue Ribbon Task Force and I was on Dave
Biklen's methadone work group. Prior to being on
that work group I had no particular interest in
methadone except that I was involved with a
methadone program when it first started in Harlem
where I worked for four years and also at Ryker's
Island Prison in the tombs as I mentioned the other
day.
But I realize that if we're going to broaden the
use of methadone, we have to realize that the
methadone clinics as they are set up now or the
assumption was that the barbarian was at the gate
and he's going to break in our house. And what
I've realized over time is that the barbarity is in
the program itself because heroin addiction like
anything else can be treated and people recover.
And when they do recover they are entitled if they
are going to receive appropriate medical attention,
they are going to require high quality, lower
intensity program. And as the state chair --
excuse me, I'm also -- I do a lot of different
things, but I'm the state chair of the American
Society of Addiction Medicine.
We have about 45 physicians in this state who have
focussed their professional careers to a greater or
lessor extent in addiction medicine. Some of us
have passed a certifying exam that qualifies us as
being competent in the field of clinical addiction
medicine.
There's also an added credentialed area in the
American Psychiatric Association. I'm an internist
so I don't belong to that, but they also have added
credentials. And I think that if we're going to
increase the use of methadone, if we're going to
address the issue of heroin addiction, we need to
make the methadone programs more appealing. And it
would be nice if at the end of the tunnel they knew
that if they recovered that if they got a job, if
they had insurance, they could go and receive their
drug from an approved physician who was supervised
by a monitoring state organization. Someone like
me.
And that would give them the chance to say hey, I
don't have to say in this all the time.
The other issue that I'm concerned about, I'm going
to jump now to this. I think you all have received
copies of this? This is a treatment improvement
protocol put out by the Department of Health, the
U.S. Department of Health. And I had the privilege
of being the chair of this federal consensus panel
and I ask you to read chapter one at your leisure.
And if you don't have that much leisure and I
suspect you don't, read the highlighted portions of
chapter one.
I think this whole process gives you our lawmakers
the opportunity to deal with what is the third
leading cause of death in our state, which is
alcohol. And the leading cause of death
attributable to alcohol are injuries. We need to
be able to -- and people who have injuries that are
alcohol related are far more likely to have
subsequent injuries from alcohol.
I think we need to give physicians and hospitals
and other health care institutions licensed in this
state the opportunity to ask patients about this.
In New York, they've done it in 18 hospitals.
Doctors have agreed that a system be set up
parallel with them where patients are asked,
patients what to know what their risks are. They
want to know what their choices are even if they
don't listen. Or if they don't do exactly.
If they don't lose weight after their bypass
surgery, they still want to know what their choices
are. And I think you have the opportunity to see
that that happens.
The bill that talks about a study group I don't
think we need a study group. That is superfluous.
It's being -- we know that screening works. We
know what screening instruments to use. We know
what it costs to do them. We know what an
intervention is and very often if you look at the
entire array of alcohol problems in hospitals, the
intervention is Dr. R talking to Ms. Q. That's all
there is. That's all that's needed. You know,
Doc, I never thought of that. You know, I'm going
to do that.
Or gee, I'm your doctor and I'm concerned about
your admission and I'd like to have someone talk to
you about it. They almost always say yes to me.
The attending physician they almost always say yes
to the screener. The barrier is not the patient.
The barrier is the system. And I hope that you'll
correct that and I will be glad to help in any way
I can to advise you or whatever. Thank you.
REP. LAWLOR: Thanks, doctor. You mentioned that you
were participating in the methadone project in the
tombs in New York. And I don't know if you were
here earlier when Commissioner Armstrong testified
about some of his concerns involving methadone
distribution in the prison system?
DR. PETER ROSTENBERG: No.
REP. LAWLOR: His essential concern was he thought that
number one it would be very costly. He had some
concerns about further distribution of the drugs
after -- you know, if the methadone got into the
prison system there'd be some risk that it could be
distributed further among inmates that kind of
thing.
And I'm sure those are similar concerns raised in
New York when it first started. I don't know if
you were involved at the outset of that program,
but if you could enlighten us a little bit on how
those issues were dealt with.
DR. PETER ROSTENBERG: Well, I was on the patient side
and that I was taking care of patients who were on
methadone and who had medical illnesses and they --
my conclusion years later is that they were
chronically under dosed. They weren't given enough
of the medication.
Yeah, I guess, you know, just common sense will
tell you that there's alcohol in prisons. Why
wouldn't there be a diversion of other drugs? I
think to some extent that occurs. But I think that
it could be kept to a minimum. I think in terms of
diversion of methadone in a practice like mine
while I don't think I would be distributing it, it
would be prescribed and they'd go somewhere else to
pick it up.
But Vincent Dole who actually developed the use of
this methadone at the Rockefeller University with
Dr. Niswander, wrote a editorial or an essay in
JAMA, the Journal of the American Medical
Association last fall saying that the comments
about diversion of methadone are far and
exaggerated.
And we have to look at this as a public health
problem. Are we helping these people be stabilized
and are we going to throw the baby out with the
bath water. That would be --
REP. LAWLOR: Are there other questions? Okay, thanks
very much. Gerry Smyth.
GERRY SMYTH: Good afternoon, Representative Lawlor and
members of the committee. The Office of Chief
Public Defender supports the provisions of Bill No.
6077 which would eliminate the distinction that
exists under current law as to drug dependent
versus non-drug dependent persons.
And also the provisions of Bill No. 6077 which
would give the court the discretion to deviate from
mandatory minimum sentences for good cause.
Non-drug dependent status and mandatory minimum
sentences are two aspects of what we consider to be
the same problem that need to be addressed. Now
there was some prior discussion when Mr. Bailey and
Mr. Shagrue testified about the fact that most
prosecutions may be brought as non-drug dependent
persons, but are resolved through plea bargaining
by pleas to 21a-277 which is applied to persons who
are drug dependent.
And that is certainly very true, but there's
another aspect of the statutory scheme that is at
work that I think is a real problem that I'd like
to discuss and that is this: because the burden of
proof is on an accused to establish his or her drug
dependency in a criminal prosecution, prosecutors
routinely charge all defendants initially,
particularly in sale and possession with attempt to
sell cases, as being non-drug dependent under 21a-
278 or 278a.
Even though in the overwhelming majority of these
cases the defendants are, in fact, drug dependent
and the burden is then on the defendant to
establish his drug dependency. While many of these
cases are plea bargained out there's another
scenario and that is that many prosecutors in many
courts will refuse to change the charge, even in
the face of evidence of drug dependency and leave
it to the defendant to choose between going to
trial and proving his own drug dependency or
pleading guilty under the mandatory minimum section
of the statutes as a non-drug dependent person.
If a defendant elects to go to trial on such
charges, he risks receiving a greater prison
sentence after trial because generally speaking
sentences after trial are longer than those when
you plead guilty. A greater sentence then that he
would receive if he pleads guilty as a non-drug
dependent person and accepts the mandatory minimum
sentence of five years.
So as a consequence many of the people who are
pleading guilty as non-drug dependent persons under
21a-278 are actually people who are drug dependent
and as a result are mislabeled as non-drug
dependent.
As a further result because of the mandatory
minimums, judges are precluded from imposing a
sentence of less than five years and also foreclose
from drug treatment options even if an alternative
sentence is appropriate and warranted under the
circumstances.
Connecticut is one of only three states that make a
statutory distinction between drug dependency and
non-drug dependency in the criminal statutes. The
rationale for the distinction is totally defeated
when a system induces drug dependent persons to
plead guilty and be sentenced as if they were non-
drug dependent or plea bargains with persons who
are non-drug dependent and views them as the same
as people who are drug dependent.
And so for both of these reasons I would urge your
support for repeal of 21a-278 in accordance with
Section 40 of Bill No. 6991. And for adoption of
Bill No. 6077, which would give judges authority to
deviate from mandatory minimum sentences in
appropriate cases.
In addition, the Office of Chief Public Defender
supports Bill No. 1064 which would establish a
pretrial drug intervention and community service
program for first offenders who commit possessory
offenses. This proposal is one of the
recommendations of the Connecticut Alcohol and Drug
Policy Council of which I was a member or am a
member, and was approved unanimously by the
Criminal Justice Committee which had the support
(tape ended)
JOHN DeMAYO: Bill 6991 as it refers to Section 37 for
treatment as an alternative to incarceration as
prescribed there.
Treatment clinics in Connecticut are currently
working with DCF with similar situations and are
being successful. We also work with Department of
Probation for mandatory treatment and we are also
having pretty good success there.
Is there 100 percent success? No. There isn't 100
percent success in drug treatment anywhere.
However, you know, it's our feeling that if we can
take the drug dependent person, put him into
treatment, it would be a lot more cost effective
than putting him into prison and we feel if the JIT
series system can give us the bodies, treatment
programs can take and get the mind soaker.
But we need the bodies. And we can do it. We have
been doing it. I have personally seen many, many
success cases. However, my expertise is limited to
the methadone treatment. But keep in mind that
methadone is usually considered the treatment of
last resort.
So if we're having success in methadone, then the
drug-free clinics are having success too. Thank
you.
REP. SCALETTAR: Thank you. Any questions? Thank you
very much.
Frederick Attice.
FREDERICK ATTICE: My name is Rick Attice. I am a
physician with the Yale University AIDS Program. I
am the Director of the HIV-in-Prisons Program at
Yale and also the developer of the community health
care van which provides needle exchange based
health services.
I'm here actually to speak on behalf of the opiate
addicted clients. I've treated over 1,000 patients
who have had opiate addiction. I treat them for
mostly their HIV disease, but also for their
infection disease complications. And I would also
like to point out that as well as has been pointed
out to other people the place for methadone as
treatment as a medical condition, such as diabetes,
hypertension, chronic diseases.
I think a fair amount of the neurotransmitter
information was shared by Dr. Blansfield.
Just to give some background, in the Department of
Correction. First of all, 60 percent of the women
who come into York, which is the old Niantic have
opiates in their screening. Among the HIV infected
population, which on any given day is 180 women.
Eighty-two percent of those people come in who have
urine screens that are positive or opiates.
The recidivism rate for the entire population at
the women's prison is 20 percent per year. It is
higher among those who are HIV infected and for
those who are drug users within the population.
About 25 to 26 percent of the women who come in are
injection drug users and fully 60 to 70 percent are
chronic drug users. So we have a huge problem
within our prisons. The recidivism rate is high,
however, there are ways to break that recidivism.
One of the programs which we have developed to
provide case management and discharge planning for
prisoners has been to develop direct links to drug
treatment programs. The first being the Hartford
Dispensary. The second being the APT Foundation to
take clients immediately on the day of release from
the correctional system and put them into methadone
treatment if they have a long history of opiate
addiction in the past.
With that we have had 0 percent recidivism at one
year among that population, demonstrating that
putting these clients into drug treatment has a
profound impact on recidivism into a costly
correctional system.
I would also like to respectfully beg to differ
with a few comments that were made earlier by the
Commissioner of Correction. I do a fair amount of
clinical work at the women's prison where there is
the methadone program. I would like to confirm
that methadone is used for maintenance for women
who are pregnant there.
There is also a very successful detoxification
program. This program was instituted in 1986 as
part of a consent decree which is West versus
Manson. It has been extremely successful. It has
decreased utilization of health services which are
also very costly. And there has been only one case
of diversion in 11 years.
And the way that the system is done is very similar
to that which is done with other medications. Any
of the psychotropic medications and a number of the
people are on psychotropic medications are
dispensed in liquid format -- formulation.
That is the same for methadone as well. There is a
mouth check to make sure that there is no
diversion. It would be very hard to divert a
liquid substance when you have mouth checks in
place. So there are a number of issues.
Now, have there been problems with correctional
officers with the methadone program? Not at all.
And, in fact, methadone has a calming effect on the
patients and they actually will request that the
nurses medicate the patients earlier rather than
later in the day in order to calm them down.
So at least in terms of having a system here and of
course the people from New York have given a fair
amount of information. It seems to be a very
successful program.
We need to find ways for a patient who have medical
illnesses to have medical providers treat them.
And in the Department of Correction medical
services or health services is completely separate
from the drug treatment services.
Drug treatment services use only behavioral
modifications. They do not address the needs of
the people who come into the system for short
periods of time and go out. We know that behavior
programs in order to be successful require a fair
amount of time.
When we have individuals who come in who are drug
users and recidivists, they come in, they may spend
30 days. A behavioral intervention will not work
in that period of time. However, methadone, which
will decrease recidivism at least in our population
of HIV positive people, and for those individuals
who are opiate addicted to basically give them
continuity of care into the community, will have a
successful benefit in terms of cost effectiveness.
Also, we do know that there is drug use which is in
prisons and jails. Needles have been found. Urine
tox screens were reported to us at least among the
selected population to be 14 to 17 percent for
drugs within this population. That seems quite
high suggesting that there probably is drug use
within prisons and if injection drug use -- what
happens is there are clusters, social networks of
people who use.
And when you know that one out of four of the
people who are in the prison who are injection drug
users are HIV positive, it's very likely when you
have a cluster of injection drug users that people
are going to share needles with those people who
are HIV infected and if you have methadone, which
would decrease the craving for those individuals,
and you could decrease the amount of drug use and
drug sharing within prisons, averting one HIV
infection would save us $119,000.
So the cost for these programs are cheap. It does
not require hospital beds. In fact, we would
dispense the medication in the same way that we
provide for any of the psychotropic medications.
The cost is estimated to be $3,000 to $5,000 per
year per inmate.
If you want to divide that sort of number into
$119,000 just to prevent one HIV infection, it
would be a very, very cheap intervention.
I will be happy to address any sorts of questions
about the Department of Correction, needle exchange
in New Haven where we provide a number of linkages
to health services, HIV counseling and testing, to
drug treatment services, etc., or any other aspect
on the bill.
REP. SCALETTAR: Thank you. First I want to ask you
about the methadone treatment. You said there was
methadone treatment available for pregnant women at
York.
FREDERICK ATTICE: That's correct.
REP. SCALETTAR: But not for women who are not pregnant,
I presume?
FREDERICK ATTICE: There is only detoxification which is
available. And basically the consent decree
mandates that minimum standard.
I should also point out that at least for medical
conditions we are really required to provide what I
would call the community standard of care for
medical illnesses. And indeed the community
standard of care is not maintained in the
Department of Correction.
Other issues to think about for maintenance, if a
women comes in from the street and she's been
maintained on 100 milligrams of methadone, those
people are detoxed, actually usually within 30
days, off of these medications at least for men in
Connecticut. And we wouldn't do this on the
outside either, they come in and they have to go
cold turkey.
REP. SCALETTAR: But do you see any difference then in
the pregnant women and the non-pregnant women who
are drug dependent since some are getting the
methadone treatment and some are not?
FREDERICK ATTICE: Do you mean are the differences --
REP. SCALETTAR: Well, in their behaviors in prison or
in the recidivism rates or what happens then when
they leave prison?
FREDERICK ATTICE: The problem -- that would be a hard
situation to evaluate unless a woman had an
extremely long sentence. There's a number of
programs whereby if a women delivers in a prison
they try to find drug treatment programs on the
outside that she can go to so that she can bond
with her baby. If she has a capital offense,
obviously the women is separated from the child and
the numbers would be too small to really assess.
REP. SCALETTAR: I also wanted to ask you about the
preventing of HIV by methadone as opposed to
possibly having people using needles in prison.
Are there any documented cases of someone
contracting HIV while in prison?
FREDERICK ATTICE: There have actually been several
cases. There have been cases in Scotland and
Australia.
REP. SCALETTAR: Any in Connecticut?
FREDERICK ATTICE: There has not been any documented
cases of sera-conversion. In some of the research
that we've done in terms of looking at social
networks there are people who are HIV positive who
have reported sharing.
REP. SCALETTAR: Thank you. Any other questions?
Thanks.
FREDERICK ATTICE: Thank you.
REP. LAWLOR: Anne Higgins. Is Anne still here? Anne
Higgins. James Reed and James will be followed by
Kathryn Sutton, Alice Diorio, Joseph Sciortino,
Monte Dunn, Raymond Pavlak, Ron Cretaro, Cliff
Thornton, John Gardner.
JAMES REED: Hi. My name is James Reed and I was
advised to let you know that I'm a teacher or was a
teacher. I have several master's degrees. I'm a
Ford Foundation fellow, a Rockefeller Foundation
fellow. I'm also a recovering drug addict,
alcoholic and a convicted felon.
I quit teaching in college in Connecticut in 1987
and around 1993 I was arrested for possession and
sales, conspiracy to distribute on four counts,
cocaine.
I spent 30 months in the Department of Corrections
in Connecticut. Within two weeks after I arrived
in Whalley Avenue, I was approached by the drug
dealers. I was also convicted under the one whose
an addict and I was finally diagnosed by CADAC as
drug dependent, which was no shock to me.
Within two weeks I was approached by drug dealers
inside. It took me four months to get to see a
drug counselor. I was in 30 months I was in
approximately six different prisons throughout the
state of Connecticut.
REP. LAWLOR: How long ago was this?
JAMES REED: This was in -- I got out in 1995. I went
in in 1993. On every cell block there was a drug
dealer. I had easier access if I chose to buy
heroin in prison than I did on the street because
they came to my cell.
It was -- the amount -- it was as easy as, like I
said on the street the only difference was the cost
and the cost was determined by the level of
security of any particular cell block. But it was
available in all of them.
I've been clean and sober for four years. I got
sober in prison thanks to certain addictive service
programs, substance abuse programs. I also
attended voluntarily attended WSATU. WSATU is
Western Substance Abuse Treatment Unit volunteer
24-hour rehab program run by the DOC. I was the
last of the men that was there.
I don't know where to go with this. Like I said,
it took me four months to get to a program of any
kind to see a drug counselor in prison. They are
there. They are extremely difficult to get to. I
was one of the fortunate ones that got there and
made it work for me.
I was also, like I said evaluated by CADAC and
CADAC labelled me as drug dependent. This was my
first offense. CADAC labelled me, diagnosed me as
drug dependent and recommended to the court that I
be sent to Dutcher Hall for long-term rehab
program. The prosecution said no and said that I
should be sentenced and I was sentenced to nine
years suspended after four.
Fortunately or not I went in when they still had
the good time rules and 50 percent probation or
parole rules and so I ended up only spending 30
months in prison.
I personally think that someone said something
about giving the option of going to prison or going
to rehab that they would take the rehab. Obviously
they will. I don't know that that's the right
move. I don't know anybody in rehab that is there
and clean and sober who didn't want to be there.
Anybody whose obligated to go there I don't think
that they are going to get the program. But that's
just a personal thing. I don't know statistically
what it is.
They talk about 16 percent or 17 percent of tested
inmates. Those are select groups that they watch
regularly. I know people personally who went into
prison and did not have heroin habits that came out
with heroin habits. You don't need needles to do
heroin. They don't need them in prison. The only
substance I could not get in prison was a can of
beer. Alcohol was readily available and every
street drug that I can imagine was readily
available.
What was not available was the programs. Not
across the board. Some prisons it seemed had
better programs and more active than others. Some
the waiting list was very, very long. Others the
particular counselors were more active and more
demanding. Or the particular warden was more
sympathetic.
No matter what the commissioner from the DOC says,
no matter what's written on paper, it still comes
down to the warden's sympathy, the warden's
actions. It also has a lot to do with the
particular correction officer that's on the block,
whether or not he allows you to go to the program
even though you are scheduled to go.
There were many that they had a list and just
because I was on the list didn't mean that I got to
go to my particular meeting or group. They might
be written down on the paper, but I'm sitting here
telling you that they are not enforced and not
active and they just need more of it.
And I don't know what the solution is. I know the
solution is not optional programs though or not
mandatory programs. Programs have to be optional
or it doesn't mean anything. All it means is an
easy bid and that's the way it was looked at.
An easy bid, an easy time, a sweet time in jail.
Sure, let's go to the rehab. I get to wear my own
clothes. I get to sleep a little later. I get to
bitch a little more. In the prisons you don't get
to do that.
So everybody opted for that. And it doesn't work
on everybody. What I've seen personally didn't
work. I had to fight to get into the programs. I
had to fight to get access to attend the programs.
I had to stand in line a long time to get to the
interview to go to WSATU. I wanted it very bad. I
didn't want to go back there and I don't want to go
back there, so I continue to participate in rehab
programs and volunteer situations.
REP. LAWLOR: You're not on parole now? That's over,
right? You're on probation?
JAMES REED: No, I'm on probation now and I had a nine-
year suspended after four. So I have a couple more
years of probation and my suspended sentence ends I
think 2002. So now until then I'm under some
scrutiny by the state of Connecticut one way or
another.
REP. LAWLOR: So Commissioner Armstrong said at the
outset that he took over in 1993 which was about
the time you were leaving the system.
JAMES REED: Right.
REP. LAWLOR: Do you have any lines of communication now
into the facilities? I mean, is it possible -- I
mean, I personally believe that Commissioner
Armstrong is one of the brightest stars in the
administration. I mean, he really has done an
excellent job from our vantage point in the
legislature.
But I'm just wondering cause in talking to former
inmates, guards, others, it seems to be still a
major drug issue in the facilities already.
JAMES REED: Well, I entered in 1993 when Armstrong came
in.
REP. LAWLOR: I'm sorry, he started in '95.
JAMES REED: Right. My only connection with the people
coming out who go to 12-step programs the same 12-
step programs that I go to, people who live in
halfway houses, etc., because I do -- I am allowed
to go into a halfway house to speak. I am not
allowed to go into a prison system. But I do know
that in the halfway houses and the drug problem is
just as bad. From what I hear the drug problem is
just as bad in prisons except they've added one
more piece of contraband to it and that's
cigarettes since they've outlawed -- done away with
smoking in all the prisons.
Now cigarettes sell for approximately $50 a pack.
REP. LAWLOR: We'd like to have that price throughout
the state, $50 a pack. But that's another issue.
Are there other questions? Representative Farr.
REP. FARR: Yeah, I'm sorry I heard most of your
testimony back, but I didn't hear the very
beginning of it. What were you in jail for?
JAMES REED: Possession and sale and conspiracy to
distribute cocaine.
REP. FARR: And I think you indicated that the problem
with programs can be that people go there for an
easy time and I agree with you. I mean, one of the
major problems we face, see I don't care how many
programs you have and certainly I've dealt with
people and alcoholics etc., where there's no
question that there are programs for them.
But they just choose not to participate. And I
don't know the answer to that. If you could ever
come up with the answer how to get people who ought
to get help to get help, that would --
JAMES REED: Well, I think there was some gentleman that
sat here, I don't remember which one it was. He
said when people can take responsibility for their
actions and when somebody -- the thing about
addictions how I see it is that my addiction began
with the desire to feel good.
If you can show me someone who doesn't use drugs,
who is a peer who feels good about themselves and
gives me a model to work from, then I too can live
that way. That's the way the 12-step programs
work. That seems to be what keeps me reasonably
sober and clean.
REP. FARR: I think your drugs are alcohol and cocaine?
Is that what it was?
JAMES REED: Well, I was a non-specialized actually. It
was alcohol, cocaine, opiates, marijuana. In fact,
when I was interviewed by CADAC I came up with a
couple of combinations that they hadn't heard of.
I would use clonidine for fun and meloril and these
other --
REP. FARR: And the program that worked to keep you off
was the 12-step program?
JAMES REED: Well, it was an educational program about -
- I didn't actually believe that I was an alcoholic
until I was educated in the substance abuse
programs in prison about what the hell an alcoholic
is. I didn't become involved in the fellowship of
the 12-step programs until after I had actually
intellectually understood what was going on.
Once I could get through that intellectual thing I
think the problem with the young people where they
don't take the programs is this thing called
denial. And the inability to surrender their
control. We're taught I guess in our society that
we have to -- men especially have to be in control.
It's a very hard thing to accept the fact that I'm
out of control and my problem is out of control.
Once I could get through that, that educational
thing, in the prisons they talked about that they
don't do therapy, but they do psychoeducation. And
so I spent a couple of years educating myself about
addictions, specifically my own. Not so much why
but how it works. And with that education I was
then able to participate in the fellowship of
whatever 12-step programs that I belong to.
So the education is a great deal of it and a real
understanding of what my addiction entailed.
REP. FARR: Okay, thank you very much. Good luck to
you.
JAMES REED: You're welcome.
REP. LAWLOR: Representative Cappiello.
REP. CAPPIELLO: Thank you for coming. From your point
of view, do you think that there is a way that the
system can differentiate between people who truly
want these programs and people who are just opting
out?
JAMES REED: Probably not in the beginning. The option
needs to be there. Like I said, it took me four
months to get to see a counselor. And I wasn't
sure I needed it then. I might have just been
looking for an easy way out, especially after CADAC
had recommended that I go to drug rehab instead of
prison. I told my lawyer to jump on it, of course.
The last thing I want to do is go to Cheshire.
But I think the counselors in the programs are
astute enough and educated enough to see whose
pulling the wool over whose eyes. And I found that
at WSATU there seemed to be this fear of sending
people back because it would make their program
look bad. So they dealt with the people to the
detriment of those who wanted the program. They
dealt with those who didn't want the program,
rather than admit a certain amount of defeat.
If they had more freedom of leaving, of going back
and forth from the system to the -- or from the
prison system to the program or back again with
less stigma attached to it, both to the program
people and for the program attendee, there might be
more people in the program who are there because
they wanted it, not because they are there trying
to duck the system.
REP. CAPPIELLO: Thank you very much.
REP. SCALETTAR: Any other questions? Thank you.
Alice Diorio.
ALICE DIORIO: Good afternoon. Thank you for having me
here to speak at the Judiciary Committee. I'm
here from Vermont. I'm here to speak especially
about methadone.
I'm currently President of the New England Regional
Chapter of the National Alliance of Methadone
Advocates. I'm also a methadone patient. Being in
Vermont although I'm dual diagnosis I am on
methadone for chronic pain, therefore, I'm able to
be treated by a physician by prescription.
And I want to say what a wonderful experience its
been for me. I think that what its meant to me is
by being able to be helped by a doctor, by a
physician who has worked to help me get involved in
my own treatment.
I have gone from feeling like a bad person because
I was on methadone, the stigma around it, feeling
like I was sort of in a prison being on methadone.
The clinics can be very restrictive and one of the
things I'm here to talk about is the fact that
people I believe patients in methadone clinics
should have the opportunity if they are doing well
in clinics to be able to be treated by a general
physician, if somebody is stabilized on methadone.
There is very rigid rules that are associated with
the methadone clinics and when you first get on
methadone that's important. I think methadone
should be accessible to everybody. We have AIDS
out there, HIV and AIDS. We have crime as we know.
We have many diseases, tuberculosis, hepatitis C,
and we have to reduce the harm that goes along with
that. And methadone has shown to be the most
effective treatment that's there for heroin
addiction.
It's interesting in 1993 the American Psychiatric
Association came out with their position statement
stating that methadone maintenance requires years
for adequate rehabilitation and some patients will
need methadone for their lifetime, as a diabetic
needs insulin.
And I think that's what we have to think about.
It's a medical disease and I think people often in
treatment are meant to feel as if they are being
controlled and I think the control scares a lot of
people and that may be one of the things that's
keeping people from accessing or trying to access
treatment, is control.
My doctor trusts me and the fact that my doctor
trusts me helped me to learn to trust myself and by
learning to trust myself it's allowed me to become
the person that I wanted to be, to do something
with a purpose in my life, to not feel that I was a
bad person.
And I understand I have a disease. I understand I
also have chronic pain and I understand I'll
probably be on this medication for the rest of my
life. It's saved so many lives and I know so many
people whose lives have been saved by methadone.
To me it should be available to everybody
regardless of their ability to pay.
And I think the other thing is that I went out to
the harm reduction conference in Oakland,
California this past year and one of the biggest
things that everybody talked about was options.
And everybody here has said not everyone gets
treatment the same way. One treatment doesn't
work for everybody.
And so people need options. They need options
whether they can make it in abstinence, whether
they can make it with methadone, whether they don't
do well in methadone and they need heroin. It's
the fact that the person is involved in making
decisions as to what they can and cannot do.
It's very difficult. I've had so many people say
to me, well, I did it. Why can't you? Talking
about getting off of drugs and staying abstinent.
Well, a lot of people have done a lot of things
that I can't do and I've done a lot of things that
other people can't do.
And I think that if we start treating people with
dignity and respect and not making people that are
drug users that have this disease to feel that they
are criminals, that they are bad people, that they
ar failures, self-esteem is something that's
missing tremendously in most drug addicts.
And it seems like in treatment so much time is
spent on trying to control behavior rather than
build self-esteem and let the person themselves
make decisions about their behavior and want to
change their behaviors.
I think the people unless somebody has been
addicted to an opiate and knows what abstinence
syndrome is, it's almost impossible to describe
what the feeling is and I understand when people
say to me I can't go through it. I can't go
through this withdrawal again. Most people who
have tried abstinence and it's got a very low
success rate.
So I think that methadone should be offered in a
number of ways. It should be offered in clinics.
It should be offered in prison. It should be
offered by general practitioners to patients that
are doing well. And it should be offered with low
threshold services. In other words, people that
don't want comprehensive services of everything and
feeling the control, but would like to choose their
own counselor maybe on the outside.
REP. SCALETTAR: How long --
ALICE DIORIO: Things like that I think would really
help.
REP. SCALETTAR: How long have you been on methadone?
ALICE DIORIO: Cumulative years 20 years.
REP. SCALETTAR: And for how many years did you have to
go to a clinic?
ALICE DIORIO: Well, I had to drive to -- I was down
here originally, all but the last seven years.
REP. SCALETTAR: And that's only been in Vermont where
you can go to a private doctor?
ALICE DIORIO: Right, and see we don't have methadone
clinics in Vermont. This is something that I'm
working very hard at. Is trying to get methadone
available in the state of Vermont.
REP. SCALETTAR: Well, how do you get methadone now?
You get it not from a clinic, but from?
ALICE DIORIO: I get if because I was on a methadone
clinic in Massachusetts who decided that my main
problem at the time was not addiction, but chronic
pain. I've had 26 surgeries that they had me
transferred to a chronic pain clinic where I am
treated by an internist and anesthesiologist.
REP. SCALETTAR: Thank you. Representative Farr.
REP. FARR: If you don't mind some -- obviously you're
testifying so I guess you're not going to mind some
personal questions.
ALICE DIORIO: Not at all.
REP. FARR: When did you get addicted to drugs?
ALICE DIORIO: I was 15 years old when I started using
drugs.
REP. FARR: And when did you start using heroin?
ALICE DIORIO: When I was 16 I was put in New York
Hospital in White Plains and I started using heroin
in there.
REP. FARR: Why? How did you come to use heroin in a
hospital?
ALICE DIORIO: Well, just like the other gentleman said
about prison, that there was a dealer in every cell
block drugs were probably more accessible there to
me than they were on the outside.
REP. FARR: What were you in the hospital for?
ALICE DIORIO: Rebellion. My parents were both very
acute alcoholics. I came from a very wealthy
family.
REP. FARR: Was this a mental hospital? Or a general --
ALICE DIORIO: Yeah, it was a mental -- a psychiatric
hospital.
REP. FARR: Oh, okay.
ALICE DIORIO: And I was one of their first drug
problems --
REP. FARR: And what did you start off with? What drug?
ALICE DIORIO: I started off with marijuana.
REP. FARR: And I guess you know the real question for
us, the bigger -- I think there's probably going to
be a consensus about the desirability of methadone
and letting it be done outside of clinics and I
think I don't speak for the whole committee, but I
sort of feel that from reactions I've gotten from
people that there's sort of an acceptance of the
desirability on this committee.
But the real bigger question is how do we ever
prevent somebody like you, how could we have
prevented you from getting on drugs in the first
place? Cause that's obviously, you know, when this
is such an addiction that you're going to face it
the rest of your life, the question is how could we
have prevented that from happening?
ALICE DIORIO: That's a good question. I came from a
family in a -- I came from Fairfield County,
Connecticut, from Greenwich where there's lots of
money, there's lot of drugs, there's lots of
alcohol. When I was growing up, alcoholism was
rampant and because there was a lot of money there
was a lot of addiction, but it was all kept quiet.
It was a lot different than it is today. I have to
say that I was born to a mother that was actively
using alcohol, addicted to alcohol. And addicted
to benzodiazopines. Therefore, I believe I was
born an addict. And under the circumstances of
which I grew up I don't know if there's anything
you could have done to tell you the truth.
REP. FARR: That's not very encouraging.
ALICE DIORIO: I was hoping to -- I know that and I'm
not saying that you can't help people, you can, you
can help youth. I deal with youth every day and I
think the way, the best way of dealing with youth
is rather than telling them what to do, is giving
them choices and letting them see how things can
harm them, but helping them to make decisions for
themselves that are good decisions. And enforcing
the positive, reinforcing the positive in them
rather than the negatives.
REP. FARR: Did you have any help -- I gather you said
you went to psychiatric hospital and was that
partly because of the drug use that you were doing
then?
ALICE DIORIO: Yeah, I was also because of a stepmother
that --
REP. FARR: It was a way in which to deal with your
behavioral problems?
ALICE DIORIO: Yes, it was partly because of --
REP. FARR: And had you had -- did you have any early
intervention in terms of your drug use prior to --
ALICE DIORIO: No, I didn't. You know, my mother
committed suicide. I basically was an adult from
the time I was born. I was carrying my mother to
bed. I was carrying my father to bed. I was
pulling my mother out of cars while she was trying
to commit suicide. But in the -- living in a very
affluent society there people didn't talk about
those things.
I mean, you know, DSS didn't come to your house and
say, you know, I went to a private school and
nobody ever said to me well, geez, I saw that you
had to go home with a stranger the other day and
pull your mother out of a car.
REP. FARR: Okay. I appreciate that. We've had a lot
of testimony about people who are addicts now and
how and what they think we can do to deal with
other people who are addicts today. But I also
wish we had a little bit more input from the
addicts themselves as to what they think we could
have done to prevented them from becoming addicted
in the first place.
ALICE DIORIO: I think possibly for me obviously living
without any kind of support in the family. I mean,
there was total denial in the family that I was in.
Even when I was in New York Hospital nobody
discussed my family's problems. It was just my
problems.
And I think that if children feel that you care
about them and that you think they are worthwhile
people, that they listen to you. It's when people
come across as authoritative rather than with
concern and care, with love and compassion. I
think that is a very big key to getting children to
listen.
REP. LAWLOR: Thank you. Any other questions? Thanks
very much. Joseph Sciortino.
JOSEPH SCIORTINO: Good afternoon and first of all I'd
like to thank you all for taking time out of your
busy schedules to hear what I have to say.
My name is Joseph Sciortino and I'm 43 years old
and I've been on the state's methadone programs on
and off for the past 20 years.
Right now there are only a couple of programs that
know of that have open admissions. That's in New
Haven and one of them requires $500 down and $90 a
week to be a member. And when I got on the program
in New Haven it took me not too long to get on,
this was back in the '70's.
The program I'm on now in Waterbury has open
admissions, but it takes at least a month to two
months -- it took me with Dr. Blansfield's help it
took me about two and a half to three months to get
on the program and that's with open admissions
because you need doctor's statements, you need
proof that you're an addict of course. You have to
go for counseling and so it does take time. You
just don't get right on the program, okay?
Money problems can lead to detox with people. If
you can't pay for your methadone and your
counseling, you end up back on the streets. I
believe open admissions and more methadone programs
also doctors being able to prescribe methadone are
the answers to helping the plague of addiction.
I myself became addicted from a car accident. I
had a very, very bad car accident when I was 19
years old and what happened was I was on morphine
for four months and then I was on percodan for like
about two years and then they just cut me off. So
I went to the streets because I was addicted
legally and then the doctor just cut me off.
And so I had no thing to do but to go on the
streets and that's how I became addicted. I've
seen many people fall through the cracks and the
misery and I've seen unaccountable deaths
associated with today's drug treatment practices.
It's really unaccountable.
I've been in a lot of these states mental hospitals
and the treatments there they treat you like they
loathe you. I can count on my hands the number of
people that understand treatment cause if you're
not an addict you really can't understand. In
fact, the last time I was in drug treatment a nurse
said to me, you sound like you're proud that you've
been on methadone for 20 years and I says, here you
ask me to give my heart out to you and tell you
exactly what's happened to me.
And I let you know. I says, have you ever been to a
methadone program, this is a nurse that's supposed
to be an addiction specialist. And she's never
been to one. She says, I don't see what that has
to do with anything. I says, well, maybe you'll
learn something. And it took patience to tell her
how they agreed with me, you know.
I was told by one member of CADAC that if you're on
a program you basically given up all your rights.
Forget about living a regular life. I'm talking
about vacations and rights to privacy. Right now I
drive 170 miles three times a week to pick up my
dose and I have only one hour in which to be
medicated. And if I'm late, no medication.
About six years ago I made the stupid mistake of
using tranquilizers with illegal prescription. And
after 17 years of being clean I was detoxed in
three days, and that's from methadone. It was a
horrible, horrible detox. I almost got my mother
to come here today but she had to watch my son for
me so I couldn't.
After that my immune system was weakened by the
discontinuation of my dose. In the end I was
hospitalized 14 times. My liver levels shot up due
to serosas and hepatitis and right now I got cured
with the hepatitis through interferon. I also
contracted a number of illnesses (tape ended)
seizures that the doctors could only attributed to
my rapid detox.
Before this, right now I'm on social security
disability, though I am now looking for work and
want to be a vital member of society, like I was.
Before this I worked two full-time jobs on
methadone for 17 years and never had any of these
ailments before I was taken down so fast. It's
like the carrot, you know, if you do good they'll
give you your methadone.
I feel this would have never happened if I was
detoxed slowly. I never robbed or I never stole or
used a gun or anything like that to support my
habit and I'm not asking for compassion or pity.
You know, I take full responsibility for what is
befallen me.
Since I've been back on methadone for the past
three and a half years I've been clean and I'm
starting to like I said look for a full-time job,
since I've worked on radio, news reporting and
such. I feel much better and I do want to be a
contributing and a vital member of society.
To get on the program I had to do illegal drugs. I
had to go out in the street, take my chances of
either getting arrested, OD'd or shot so I could
have a dirty urine so I could get back on the
program.
You'd be surprised to see the diversity of people
on methadone programs. There's health
professionals, fire fighters. I've seen CEO's of
companies and such. I bet there isn't at least one
person in any of your families, I'm not pointing
fingers or anything, who hasn't been affected by
alcohol or drugs.
I feel we should leave medical practices to be
dealt with my doctors instead of bureaucrats. We
don't need the DEA, the Board of Pharmacy, Police
and other government agencies on the doctors back
telling them how to treat medical issues.
And the spirit expressed by politicians as varied
as Bill Clinton to Bob Dole, let's remove big
government from the front lines of this plague and
return it to the family physician to treat addicts
in the confines of their office. Especially to
people who have successfully stayed clean on
methadone. I'm not talking about people who just
got on it.
And they can move onto doctors offices instead of
having to travel untold miles in snowstorms and
other traffic problems. These methods to me are
archaic and I feel they should be changed and I
humbly thank you for your time.
REP. LAWLOR: Thank you. Are there questions?
Representative Cappiello.
REP. CAPPIELLO: Thank you for coming down. Was that
one time the only time that you were off methadone
in the past 20 years?
JOSEPH SCIORTINO: One time I was off for two years.
And in that two years I had all those illnesses I
was talking about.
REP. CAPPIELLO: Now did you say that you had to before
you went back on methadone go and the only way to
get back on is to do --
JOSEPH SCIORTINO: I had to go back on the street and
get dirty. I had to go cop. I had to have an
opiate urine
REP. CAPPIELLO: Okay, thank you.
JOSEPH SCIORTINO: That's what I had to do to get back
on. It's a shame.
REP. LAWLOR: Thank you very much. Next is Raymond
Pavlak followed by Monte Dunn, Ron Cretaro, Cliff
Thornton and John Gardner.
RAYMOND PAVLAK: Good afternoon and thank you for
allowing me to speak to you about the issue of
substance abuse, which is a problem I feel in need
of new approaches.
My name is Raymond Pavlak and I'm a retired state
employee who served in the Department of Correction
as a business manager of Litchfield Correctional
Center and then at Western Substance Abuse and
Treatment Unit and at Gardner Correctional Center
in Newtown from the years 1986 to my retirement in
1993.
During those years I helped service and saw the
number of inmates increase dramatically. This
increase was largely the result of incarcerating
drug offenders. Many of them first offenders. I
also witnessed and helped provide for those who
return again and again for the same reason, a drug
violation.
Incarceration has been a feudal treatment, where
it's to be called a punishment by some for many of
the these cases. I'm here to appeal to you for
careful study and I hope implementation of the Law
Revision Commission's report on drug policy.
Actually on my own I have for several years
recommended that unused space and beds in
Connecticut hospitals and other health care
facilities be used for substance abuse treatment.
Programs instituted with the help of the courts and
correction, instituted with the -- could utilize --
well, they could actually set up and utilize out
and in patient treatment approaches with first time
offenders particularly.
I heard mention here of a choice between
incarceration and treatment. And I think this is
really what I had in mind in recommending this.
Cause we do have in our state today, I'm from
Winsted and we went through a very tragic
experience of losing a hospital closing down our
hospital and we're trying to get health facilities
re-established in Winsted.
One use of the hospital buildings could be for
substance abuse treatments. And well I really feel
that under utilized hospitals could benefit and
also effectively treat drug abusers could benefit
from this kind of a program. Thank you for your
consideration.
REP. LAWLOR: Thank you. Are there questions? Thank
you very much. Monte Dunn.
MONTE DUNN: Before I actually get underway, I'd just
like to say that I'm really honored, proud and
humbled. I feel this is a privilege to be here
before you people who are serving our state and the
wonderful, compassionate physicians and especially
the methadone patients and recovering addicts who
have opened a vein and spilled their blood here in
this room and shared their deepest sorrows and
experiences with you.
There's an old saying that our problems are not
caused by what we don't know, but by what we know
that ain't so. That's pretty much I think where it
is with the drug problem. As to prevention, I
think we've got to fall back with Forest Gump. You
know, you never know what you're going to get.
Some people -- I mean, I've been a musician, a
music therapist. I've worked with the mentally
retarded. I've worked with troubled youth. I've
driven a cab. I'm a journalist. I've done a lot
of different things and I've seen people who use
drugs without any consequence. I've seen people
who have never used drugs, never been tempted to
use them and I've seen people who have died, in
some cases horrible deaths.
I myself view it as a lifestyle disease, like
diseases I've got. I'm a diabetic. I've got
hypertension, hypercholesterolemia. You know, and
I helped bring them on myself. My own actions.
Before it was asked how do you get off methadone?
Well, how do you get a diabetic off insulin? You
know, for some it's just not possible.
Brooks Spinoza once said he tries to determine
everything by law will foment crime rather than
lessen it. Another little bit of dog rule that I
like in New York Sun when there was the Wickercham
Commission that President Hoover convened
discussing whether to end prohibition someone wrote
this in the newspaper: Prohibition is an awful
flop. We like it. It can't stop what it's meant
to stop. We like it. It's left a trail of graft
and slime. It's filled out land with vice and
crime. It don't prohibit worth a darn,
nevertheless we're for it.
So we're left with a lot of problems here. At any
rate, I really think amongst other things that we
should be having doctors able to prescribe
methadone pretty much at their discretion. The
diseases we call addictions are no different than
other medical afflictions as well.
I can't imagine what it would be like if to get my
medications for hypertension or diabetes I had to
sneak around alleys and pay outrageous prices, risk
arrest, just to buy medication to help me survive.
Shakespeare once said that the quality of mercy is
not strange for those who are addicted to drugs of
which we do not approve, mercy is a rare commodity
indeed. There's a lot of talk today as to whether
or not we are a civil or even civilized society. A
civilized society would not persecute and even
imprison doctors as we do now for treating opiate
addiction, or even chronic pain or addiction of
medical origin as Joe so ably pointed out, with a
therapy.
Methadone maintenance that has a 30-year proven
track record. Is this surgery perfect? Is
chemotherapy for cancer perfect? Even quadruple
bypass surgery winds up with patients dying. The
only perfect therapy I know of is Jack Kevorkian's,
and that kind of perfection we can do without. A
dead patient no longer suffers from the disease
which was killing him or might or might not have
been had not Mr. Kevorkian intervened.
The patient is beyond human help or earthly hope.
A civilized society would not merely allow but
encourage the family physician, internist or any
primary care physician to prescribe methadone to
his or her patients. If the legislature is afraid
of methadone mills, perhaps limit the number of
patients that the regular general practitioner can
treat. Ten, a dozen, 20, whatever, without having
to meet the tremendously red tape laden
bureaucratic requirement that clinics must meet.
You know, clinics certainly have their place, but
the down side of them is that while it has peer
counseling, JA started on, the drug culture does
not consist of legal alcohol merchants, taverns and
bars.
When initiates to drugs now patients gather the
talk often becomes street. Whose in prison, who
got kicked off the program, what illegal drugs are
available, etc. In this manner they are actually
encouraged to keep the very street drug, dope fiend
culture that we as a society want to end, alive and
well.
Now imagine the same patient sitting in a doctor's
office for his weekly, biweekly or monthly
prescription for methadone next to a person with
chronic sinus condition, a woman with diabetes, one
with their leg in a cast. They certainly are not
going to engage in drug culture type talk.
If we're going to have a law changed that will
allow doctors to prescribe methadone, we're going
to run into a problem with the federal government.
However, the DEA is going to try and jump all over
the state of Connecticut.
In 1925, and this has never been overturned, there
was a case called Linder versus United States. And
this is what the Supreme Court had to say. It is
the business of the physician to alleviate the pain
and suffering of patients as well as to effectuate
their cure. If we are to believe the literature on
the subject, the suffering of an addict caused by
depravation of his customary drug is as intense as
any suffering caused by disease.
It is perhaps more so in the insistent demand for
relief. Why should not the physician in the course
of his ordinary practice take cognizance of that
fact and administer relief? The Supreme Court went
on to say: If the mere catering to a diseased
appetite in the matter of narcotic drugs has no
tendency to impair the drug laws of the time, and
the drug laws today or so slight a tendency as to
be negligible, then such an act is clearly
unconstitutional.
Congress cannot, and this is the Supreme Court
talking not me, under the pretext of executing
delegated power, pass laws for the accomplishments
of objects not entrusted to the federal government.
Here we have an act of Congress under power granted
by the constitution not in actually and reasonably
adopted to the effect of exercise of such power,
but solely to the achievement of something plainly
within power, reserved to the states and invalid
and cannot be enforced.
Obviously direct control of medical practice in the
states is beyond the power of federal government.
The opinion cannot be accepted as authority for
holding that a physician who acts bonafide and
according to fair medical standards, may never give
an addict drugs for self-administration in order to
relieve conditions incident to addiction.
Enforcement demands no such drastic rule and if the
act had such a scope it would certainly encounter
grave constitutional difficulties. We cannot say
that by so dispensing narcotics the doctor
transcended the limits of that professional conduct
which Congress never intended to interfere.
So, the Supreme Court has spoken and nobody has
ever overturned this. The Drug Enforcement
Administration, the Federal Bureau of Narcotics
before has simply ignored what the Supreme Court
said in order to maintain its agenda, which at the
time was to perhaps keep what would assume to be
unemployed prohibition agents employed.
The Federal Bureau of Narcotics was founded in 1930
when it looked like prohibition was about to end.
And, you know, welfare for cops I appreciate cops.
I like cops. I've gone to the range and shot with
cops and, you know, but to put them in charge of
medical business, it's just not the right thing. I
mean, even what drugs go into what schedule at the
federal level. It's not decided by the surgeon
general or even the person who is in charge of
Health, Education and Welfare, but the attorney
general.
Now, I don't know about y'all, but if I had a
medical problem I'd go to a doctor, not a lawyer.
And I think we should be doing that as far as the
drug problems such as it is to be dealt with. The
first line of defense should be the family
physician and beyond that the clergy because if you
look at the facts, other than methadone the thing
that tends to work the most are religious oriented
things where someone can find the love and identity
and belief in themselves that Alice spoke so
passionately about before.
And well, I could go on for hours about this thing
but you all have more important things to do and my
wife expects me home. So, thank you very much.
REP. LAWLOR: Thank you, Monte. Next is Ron Cretaro.
Ron's not here. Cliff Thornton. Is he here?
Cliff Thornton? John Gardner? That's it. Oh,
there's more. Sorry. Germano Kimbro and Harvey
Fair. Anyone else like to testify? Bill, do you
want to testify? Okay.
BILL COLLINS: Mr. Chairman, Bill Collins. I just
wanted to mention a case that we had in Norwalk as
a response to your dialogue with chief state's
attorney and some others about mandatory minimums.
I presume that everybody on the Judiciary Committee
understands that this is how mandatory minimums
work. We had a case in Norwalk a friend of mine is
defending this guy.
He's a person known to the law, as they say. He
was walking down a commercial street in a low
income part of town on Saturday night about 11:00.
Between 11:00 and 12:00. He stopped to look in a
store window. It's commercial, there's a lot of
store windows. Police car came by, recognized the
guy, it was a slow night, they stopped, found a
pretext to search him, found drugs.
Took him to headquarters, went to the map that they
have on the wall which has a 1,500 foot circle
around every school. This store window he was
looking in happened to be within 1,500 feet of a
school. And so they were able to charge him with
possession with intent to sell or whatever they do,
within 1,500 feet of school, raised his stake
tremendously when he went to trial or when he went
to see the prosecutor.
Had nothing to do with school. Had nothing to do
with sending a message that this legislature cares
about kids or keeping kids away from drugs or drugs
away from the kids. In our city I know that the
mandatory minimums are simply used as a tool by
police.
They have a 1,500 foot radius around all the
schools. And when someone is arrested within that
radius it doesn't matter whether school is in
session. It doesn't matter whether it's day time,
night time weekends or what, it's just an
additional tool to get at an offender and
strengthen the police's hand.
It has nothing to do with what I assume was the
sincere legitimate attempt of this body to protect
school children. And I think that that ought to be
part of a discussion when we're talking about
mandatory minimums. That whatever the message is
that the chief state's attorney is worried about
we're sending out some messages right now that seem
to me awfully unhealthy.
REP. LAWLOR: Thank you, Bill. If no one else would
like to testify, we'll call the public hearing to a
close. Everyone have a nice weekend.
(Whereupon, the hearing was adjourned.)