This form does not yet contain any fields.

    NYSAM Public Policy

    Tuesday
    Jan242017

    Substance Use Disorder Treatment for Adults and Adolescents

    Introduction

    Scientific evidence has firmly established that substance use disorders represent a chronic, relapsing disease requiring effective treatment with a view toward long-term management. This position statement reflects this science and new national guidelines for treatment of opioid use disorder and is intended to ensure that people with substance use disorders in custody receive evidence-based care in accordance with national medical standards.

    This position statement primarily focuses on alcohol, benzodiazepine, and opioid use disorders because of the high rates of death from withdrawal and overdose from these substances. However, the principles of screening, evaluation, provision of evidence-based treatment, and prerelease coordination of care apply to all substance use disorders. While pharmacotherapy options differ among types of substances use disorders, the general principles are similar.

    Effective treatment for substance use disorders, including pharmacotherapy (referred to here as medication-assisted treatment [MAT]), particularly when coupled with evidence-based behavioral treatment, improves medical and mental health outcomes and reduces relapses and recidivism1 (Amato et al., 2005; Bird, Fischbacher, Graham, & Fraser, 2015; Egli, Pina, Skovbo Christensen, Aebi, & Killias, 2011). Care for opioid use disorder has evolved such that MAT and medication-assisted withdrawal (when indicated) with approved medications have become the national medical standard (Amato et al., 2005; Kampman & Jarvis, 2015). Unfortunately, many jails and other facilities do not use MAT, or provide it only in limited circumstances.

    Opioid withdrawal in pregnancy can lead to miscarriage, preterm birth, stillbirth, and other adverse outcomes. Therefore, withdrawal, including medically assisted withdrawal, must be avoided through the use of MAT. Among pregnant women, facilities must ensure continuation of MAT or initiate MAT to prevent withdrawal.

    Drug use is known to occur in correctional facilities. Consequences of drug use in prison and jail may include drug-related overdose deaths, suicides, increased criminal activity related to drugs and distribution, disciplinary actions, self-harm, and spread of bloodborne infections through needle sharing. Effective treatment for substance use disorders, including long-term MAT, has been shown to reduce these problems in correctional institutions.

    Inmates released from prison without MAT have more than 10 times higher risk of dying from overdose in the first 2 weeks following their release than the general population (Binswanger et al., 2007; Merrall et al., 2010). MAT significantly reduces postrelease overdose deaths (Bird et al., 2015; Gisev et al., 2015). While both methadone and buprenorphine treatment pose some risk for diversion within prisons and jails, some evidence suggests that overall rates of illicit drug use decline following introduction of MAT (Larney et al., 2014).

    Although pharmacological treatments have an important role in the treatment of individuals with substance use disorders, the greatest success is seen when psychosocial treatments are combined with pharmacological treatment as part of a comprehensive treatment plan. Behavioral therapies (e.g., contingency management), cognitive behavioral therapy, motivational interviewing, and other types of individual, group, and family psychotherapies have proven effective. Treatment includes many types of additional psychosocial interventions in a variety of treatment settings. Community-based self-help support groups such as Alcoholics Anonymous, Narcotics Anonymous, and other peer-to-peer and self-help approaches represent a potentially important adjunct, but are not a substitute for evidence-based pharmacological and behavioral treatment for substance use disorders.

    Individuals entering correctional facilities with opioid dependence are at high risk for opioid withdrawal syndrome (OWS). Suboptimal treatment for OWS creates risk for suffering; potential interruption of life-sustaining medical treatments, such as HIV treatment; exacerbation or masked symptoms from other life-threatening illness; and in some cases death.

    With the exception of buprenorphine, the U.S. Drug Enforcement Administration (DEA) holds that it is illegal for a physician to write a prescription for any other opioid, including methadone, for the treatment of opioid dependence except in a licensed treatment program. Thus, it is important for facilities to predetermine how they are going to meet the needs of inmate-patients by continuing or initiating MAT, whether through coordination with an existing licensed treatment program, by seeking stand-alone licensing, or by physician licensing for prescribing buprenorphine.

    Clonidine is an antihypertensive medication that is helpful for less severe OWS. However, it is not appropriate during pregnancy or for patients with severe vomiting, diarrhea, and worsening dehydration where hypotension can be fatal.

    Persons with alcohol and sedative dependence who enter a correctional facility are at high risk for alcohol withdrawal syndrome (AWS) and related sedative withdrawal syndrome. If not recognized and adequately treated, such withdrawal can progress to delirium tremens and death. AWS is prevalent among those entering holding centers and jails, often beginning during the first 24 hours following the person’s last drink. It complicates management of medical and psychiatric problems. Importantly, withdrawal is associated with suicide, an important preventable cause of death in corrections.

    The American Society of Addiction Medicine National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use establishes a national benchmark for treatment. Providers in correctional settings should follow these guidelines when treating people with substance use disorders. Effective treatment of those with substance use disorders is key to halting the national epidemic of drug abuse, particularly opioid use disorder, and interrupting the costly cycle of recidivism resulting from this underlying disorder.

    Position Statement

    The National Commission on Correctional Health Care advocates the following principles for care of adults and adolescents with substance use disorders in correctional facilities; these principles reinforce and expand on principles articulated in NCCHC’s Standards for Health Services. Several points are of primary medical focus in this position statement: screening and identification, continuation or initiation of MAT while incarcerated, monitoring and withdrawal according to national medical standards (if needed), prerelease initiation of treatment and care coordination, and linkage of medication treatment programs with nonpharmacological treatment options.

    Screening, Evaluation, and Care Coordination Upon Entry

    1. Universal screening of all inmates for risk factors and symptoms of withdrawal must be conducted upon entry into the facility from the community. Valid screening instruments for alcohol, benzodiazepine, and opioid withdrawal should be used; these are available from a variety of sources (e.g., National Institute on Drug Abuse; see also NCCHC standard E-02 Receiving Screening).

    2. All inmates who screen positive should receive a medical evaluation that includes the following:

    a. Evaluation of current use and status, including current enrollment in a substance use disorder treatment program, e.g., opioid treatment program (OTP), primary care-based buprenorphine treatment, or alcohol treatment program.
     
    b. Pregnancy test, at minimum for all females reporting opioid use, and conversely, opiate use history for all pregnant females. Facilities should follow national medical standards of care in providing appropriate MAT (methadone or buprenorphine), and not withdrawal, to pregnant women with opiate dependence.
     
    c. Assessment for comorbidity and confirmation of medications and dosing, including those used to treat substance use disorders, e.g., naltrexone, acamprosate, methadone, and buprenorphine.
     
    d. Formal assessment for withdrawal severity using validated, standardized instruments such as
    the Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar), Clinical Institute Withdrawal Assessment for Benzodiazepines (CIWA-B), and the Clinical Opiate Withdrawal Scale (COWS).

    Medication-Assisted Treatment

    3. Continuation of prescribed medications for substance use disorders: Continuation of opioid agonist treatment treats the physiological and psychological symptoms of dependence and minimizes risk from opioid withdrawal, failure to reinitiate treatment, and relapse due to unexpected inmate release. As with many ongoing medical conditions, stability of treatment and medical condition is important. Continuation of maintenance medications and therapies for substance use disorders in incarcerations of less than 6 months has proven beneficial to the patient in medical evidence based on randomized controlled studies (Rich et al., 2015). Longer-term stays (when expected confinement is more than 6 months) have less evidence, and the treatment plan, including decisions about continuation, should be evaluated on a case-by-case basis. MAT offers the potential to reduce illicit opioid use inside correctional facilities, which may benefit the individual and the facility.
     
    4. Inmates not receiving MAT prior to entry, or whose MAT is discontinued while incarcerated (which is not preferred), should be offered MAT prerelease when postrelease continuity can be arranged (Kampman & Jarvis, 2015). Use of methadone or buprenorphine avoids medication-assisted withdrawal and improves engagement in treatment upon release (Rich et al., 2015). Some facilities may opt to withdraw inmates with expected confinements that exceed 6 months. In these cases, opioid agonist treatment should be initiated 30 days prior to release to prevent postrelease death from overdose and promote engagement in treatment. Use of naltrexone (an opioid antagonist) requires complete withdrawal before initiation.
     
    5. Appropriate prerelease planning with community OTPs and community buprenorphine prescribers is critical to ensure there is no interruption of treatment. Where there are no community programs, inmates should undergo medication-assisted withdrawal prior to release.
     
    6. Correctional facilities should have several strategies for provision of buprenorphine or methadone to inmates, including during pregnancy. These strategies differ in the level of planning and licensing required.

    a. Transport inmates to community OTPs or a hospital (this is sometimes used during pregnancy). OTPs may obtain waivers for use of takeout doses under the custody of the jail or prison in order to minimize the number of transports.

    b. Partner with community OTPs for dosing of inmates within the facility. In this case, the dosing is done under the license of the community OTP.

    c. Have correctional physicians obtain buprenorphine licenses. This license permits use of buprenorphine for MAT as well as for medication-assisted withdrawal.

    d. Obtain an OTP license for the facility. This permits use of methadone and buprenorphine for both treatment and withdrawal. (Note: NCCHC accredits facilities for OTP.)

    e. Obtain state and DEA licensing as a health care facility. This entitles the facility to the same exemptions as hospitals for use of methadone or buprenorphine during pregnancy or to ensure treatment of other conditions, e.g., HIV, mental illness.

    7. Attention to the needs of pregnant women with substance use disorders, including following national standard of care2 to provide MAT, and not withdrawal, to pregnant women with opiate dependence, is essential. Treatment should be provided by clinicians with expertise in this area. Initiation of MAT may require inpatient hospitalization. Other opioid medications, such as acetaminophen with codeine, hydrocodone, or oxycodone, should not be substituted for appropriate medication-assisted treatments because of risk to mother and fetus.3

    Psychosocial Treatments

    8. Correctional facilities should provide nonmedication-based therapies as part of a comprehensive substance use disorder treatment plan.

    Medication-Assisted Withdrawal When Indicated

    9. Inmates with clinically significant alcohol, opiate, or other drug withdrawal should be treated with evidence-based effective medications, including opioid agonists for severe withdrawal.

    10. Inmates should be evaluated and appropriately treated for physical and mental health comorbidity, including concurrent mental health disorders, by qualified health care professionals trained and experienced in managing comorbid disorders.

    11. If a patient is on pharmacotherapy for substance use disorders while incarcerated, referral and coordination of community resources is provided for continued treatment for substance use and mental health disorders after release.

    12. For individuals who screen positive for substance abuse and are not already involved in a community treatment program, a prerelease evaluation should occur to determine referral and coordination of community resources for treatment for substance use and mental health disorders.

    13. Facilities ensure the availability of naloxone (Narcan®) and personnel trained to use it when opioid overdoses occur. Consideration may be given to providing naloxone to high-risk inmates upon release.

    14. NCCHC supports high-quality research regarding best practices related to treatment of substance use disorders in corrections. Although a substantial evidence base exists for such treatment, there is a high need for research to determine the best practices for provision of treatment in different types of correctional facilities. Such research is needed to inform optimal treatment type, intensity, timing, and postrelease coordination for different populations (e.g., adolescents, those with chronic persistent mental illness, and those with different types of substance use disorders). Research should also address issues related to risk stratification as well as composition and training of substance use disorder teams.

    Adopted by the National Commission on Correctional Health Care Board of Directors
    October 23, 2016

    Notes

    1. For more information on MAT, visit the Substance Abuse and Mental Health Services Administration at http://www.samhsa.gov/medication-assisted-treatment.

    2. Current medical guidelines are available from the following sources:

    National Center on Substance Abuse and Child Welfare. Treatment for Opioid Dependence During Pregnancy. https://www.ncsacw.samhsa.gov/resources/resources-mat.aspx

    American College of Obstetricians and Gynecologists. Women’s Health Care Physicians Committee Opinion. Opioid Abuse, Dependence, and Addiction in Pregnancy. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy

    3. By law, buprenorphine is the only opioid agonist-type drug that physicians can prescribe (outside of an OTP) to treat opioid dependence in any patient, regardless of pregnancy. The law allows for prescribers to write for up to three days as a bridge to MAT.

    REfeRenCEs

    Amato, L., Davoli, M., Perucci, C. A., Ferri, M., Faggiano, F., & Mattick, R. P. (2005). An overview of systematic reviews of the effectiveness of opiate maintenance therapies: Available evidence to inform clinical practice and research. Journal of Substance Abuse Treatment, 28, 321-329.

    Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison—a high risk of death for former inmates. New England Journal of Medicine, 356,157-165.

    Bird, S. M., Fischbacher, C. M., Graham, L., & Fraser, A. (2015). Impact of opioid substitution therapy for Scotland's prisoners on drug‐related deaths soon after prisoner release. Addiction;110, 1617-1624.

    Egli, N., Pina, M., Skovbo Christensen, P., Aebi, M., & Killias, M. (2011). Effects of drug substitution programs on offending among drug-addicts. Campbell Systematic Reviews. Retrieved from http://www.campbellcollaboration.org/lib/project/79

    Gisev, N., Larney, S., Kimber, J., Burns, L., Weatherburn, D., Gibson, A., . . . Degenhardt, L. (2015, June). Determining the impact of opioid substitution therapy upon mortality and recidivism among prisoners: A 22 year data linkage study. Trends & Issues in Crime and Criminal Justice (No. 498). Australian Institute of Criminology.

    Kampman, K., & Jarvis, M. (2015). American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. Journal of Addiction Medicine, 9, 358-367.

    Larney, S., Gisev, N., Farrell, M., Dobbins, T., Burns, L., Gibson, A., . . . Degenhardt, L. (2014). Opioid substitution therapy as a strategy to reduce deaths in prison: Retrospective cohort study. BMJ Open, 4(4), e004666.

    Merrall, E. L., Kariminia, A., Binswanger, I. A., Hobbs, M. S., Farrell, M., Marsden, J., . . . Bird, S. M. (2010). Meta-analysis of drug-related deaths soon after release from prison. Addiction, 105, 1545.

    Rich, J. D., McKenzie, M., Larney, S., Wong, J. B., Tran, L., Clarke, J., . . . Zaller, N. (2015). Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: A randomised, open-label trial. Lancet, 386(9991), 350.

    From the National Commission on Correctional Health Care website:

    http://www.ncchc.org/substance-use-disorder-treatment-for-adults-and-adolescents

     

    Wednesday
    Jun222016

    Strategies to Address the Heroin/Prescription Opioid Epidemic 

    Strategies to Address the Heroin/Prescription Opioid Epidemic

    Traditional treatment for opioid addiction has a high failure rate unless the patient is receiving medication assisted treatment. Once buprenorphine, methadone, or naltrexone injections are added to the treatment, the treatment success rate goes up significantly. When a person relapses and re-enters treatment, success rates are even better the second time around. 

    • Medication assisted treatment must be more readily available.
    • More opioid treatment programs must be created
    • More physicians must be certified

     

    Strategies to Engage Wider Participation from the Physician Community in the Provision of Treatment for Addiction

    • Create a regional addiction medicine training initiative
    • Implement an enhanced payment system. Insurance companies are providing quality incentives for diabetes and hypertension. For patients on buprenorphine products, New York should create an incentive payment system such as a monthly management fee in addition to a visit fee, or a supplemental payment tied to quality. This would reduce the number of physicians who do not take insurance, increase the number of physicians who are willing to prescribe, and improve access and overall quality
    • Provide resources to medical societies like NYSAM to provide mentoring and assistance to doctors who are starting to prescribe buprenorphine
    • Create a better payment model for physician’s offices that give Vivitrol injections. The current ten dollar injection fee does not cover all the work the office has to do
    • Engage major healthcare systems in a statewide effort to recruit and train physicians to offer medication assisted treatment in their practices and to publicize the availability of addiction medicine

     

    How to Address Insurance Protocols that Create Barriers to Treatment

    • No prior approval for addiction medicines
    • Use approved criteria to determine level of care

     

    Challenges Posed by Poor Pain Management Practices and How to Address Those Challenges

    • All primary care residents should be required to be trained in the use of buprenorphine
    • All pain clinics should be able to prescribe buprenorphine on site or have a place to refer patients with pain and addiction.

     

    Protocols for Connecting People to Treatment after a NARCAN Intervention

    Unfortunately, patients receiving Narcan and are taken to emergency departments, observed for a short, and sent home without making contact with an addiction treatment resource. Ideally patients should receive counseling and medication as needed.

     

    Thursday
    Jan142016

    Update from the American Academy of Pediatrics on the Impact of Marijuana Legalization

    The AAP has issued a policy statement entitled, "The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update." This is an update on their 2004 statement, "Legalization of Marijuana: Potential Impact on Youth." To read the entire document, see the attached PDF.

    Thursday
    Jan142016

    ASAM Statement on Marijuana, Cannabinoids and Legalization

    Adoption Date:
    September 21, 2015

    Below is an excerpt from the policy statement. To read the entire document, please view the attached PDF.

    In light of the evolving legal landscape surrounding cannabis in the United States, which is giving rise to increased availability and use of cannabis and cannabis products, ASAM’s viewpoint is that it is imperative that Americans promote and adopt public policies that protect public health and safety as well as protect the integrity of our nation’s pharmaceutical approval process, which is grounded in well-designed and executed clinical research. Currently, the legalization of cannabis in some states but not others provides a unique opportunity for a thorough investigation into the societal and public health impact of broader cannabis use. Such research is critical to inform other jurisdictions in how they can best protect and promote public health as they consider the legal status of marijuana use. 


    Wednesday
    Jun042014

    Senate's Joint Task Force on Heroin and Opioid Addiction Releases Report and Legislative Recommendations

    CONTACT: Kelly Cummings, Scott Reif,  Mark Hansen (GOP) (518) 455-2264 
            Jennifer Rainville, Jason Elan (IDC) (518) 455-2495 
            Krista Knoblauch or Christine Geed (Boyle) (631) 665-2311

    FOR RELEASE: Immediate, Wednesday, May 28, 2014

    http://www.nysenate.gov                                    


    SENATE’S JOINT TASK FORCE ON HEROIN AND OPIOID ADDICTION 
    RELEASES REPORT AND LEGISLATIVE RECOMMENDATIONS

            The New York State Senate Joint Task Force on Heroin and Opioid Addiction today released a report summarizing the findings of statewide forums held to examine the issues surrounding the increase in drug abuse, addiction and drug related crimes in New York. The report includes a comprehensive package of bills recommended for action this legislative session that target prevention, treatment, and enforcement issues raised during extensive testimony provided by dozens of experts, parents, and concerned New Yorkers. 

            In March 2014, New York State Senate Majority Coalition Co-Leaders Dean Skelos and Jeffrey Klein created the Joint Task Force on Heroin and Opioid Addiction to examine the alarming rise in use of heroin and opioids that has claimed lives and hurt families across New York State.   

            The task force is chaired by Senator Phil Boyle (R-C-I, Suffolk County), Chairman of the Senate Committee on Alcoholism and Drug Abuse. Members include Vice-Chair David Carlucci (D-Rockland), Chairman of the Senate Committee on Mental Health and Developmental Disabilities; Vice-Chair Michael Nozzolio (R-C, Fayette), Chairman of the Senate Codes Committee; Senator Greg Ball (R-C-I, Patterson), Senator John Bonacic (R-C-I, Mount Hope), Senator Simcha Felder (D-Brooklyn), Senator Pat Gallivan (R-C-I, Elma), Senator Martin J. Golden (R-C-I, Brooklyn), Senator Joseph A. Griffo (R, Rome), Senator Kemp Hannon (R, Nassau), Senator Andrew Lanza (R-I-C, Staten Island), Senator William Larkin (R-C, Cornwall), Senator Betty Little (R-C-I, Queensbury), Senator Carl L. Marcellino (R, Syosset), Senator Kathleen A. Marchione (R-C, Halfmoon), Senator Jack Martins (R-C-I, Mineola), Senator George Maziarz (R-C, Newfane), Senator Thomas O’Mara (R-C, Big Flats), Senator Michael Ranzenhofer (R-C-I, Amherst), Senator Patty Ritchie (R-C, Heuvelton), Senator Joseph Robach (R-C-I, Rochester), Senator Diane Savino (D, Staten Island/Brooklyn), Senator James L. Seward (R-I-C, Oneonta), Senator David J. Valesky (D-Oneida), and Senator Cathy Young (R-I-C, Olean). 

            Senator Boyle said, “The current heroin and opioid epidemic has touched untold lives and brought immeasurable suffering to New Yorkers. The proposals our Heroin Task Force bring forward today mark the most significant efforts ever undertaken to combat an addiction crisis in our state. I can promise you one thing - the report we issue today, along with 25 separate pieces of legislation the state Senate will pass in the coming weeks, will save countless lives.” 

            Over the past nine weeks, task force members held 18 forums throughout New York including in Cayuga, Chautauqua, Chemung, Clinton, Genesee, Jefferson, Monroe, Nassau, New York, Oneida, Orange, Otsego, Putnam, Rensselaer, Richmond, Rockland, Suffolk and Sullivan counties. Task force members traveled over 8,000 miles, spoke with more than 200 panelists, and listened to over 50 hours of testimony. Forum participants examined the issues surrounding the increase in drug abuse, addiction and drug related crimes, solicited input from experts and other stakeholders, and developed recommendations that were used to create a comprehensive package of legislation to address these issues.   

            Parents told harrowing stories about loved ones addicted to opioids and the difficulty in receiving critical treatment. Law enforcement officials testified that they needed stronger tools to prevent criminals from putting more deadly drugs on the streets. Treatment and medical professionals urged lawmakers to treat opioid addiction as a disease, and to make treatment more readily and widely available. Prevention groups and educators focused on eliminating the stigma associated with addiction and supported the creation of more programs to inform the public about the dangers of substance abuse. Recovering addicts advocated for more treatment options, more beds, and more recovery time. 

            Dr. Jeffrey Reynolds, Executive Director of the Long Island Council on Alcohol and Drug Dependence, said, “As Long Island and all of New York State struggles under the weight of a continuing opiate crisis, I’m heartened by the work of the Senate Task Force and elated to see such a well-rounded package of proposals designed to enhance access to substance abuse prevention, addiction treatment and recovery support services. I’m particularly proud of the fact that Long Island’s own Senator Phil Boyle chaired the Task Force, traveled across New York gathering community input, and is leading the effort to make policy changes that will reduce barriers to care and strengthen our state’s approach to addiction.” 

            Sullivan County Sheriff Michael A. Schiff said, “I am pleased to see that the New York Senate is taking a comprehensive approach to a very complex issue.  We cannot simply arrest our way out of this problem. We must attack it at several levels including education and treatment.” 

            Testimony at the forums directed the task force’s legislative response to three key areas: preventing drug abuse and overdoses; increasing the availability and efficacy of addiction treatment; and enhancing the tools provided to law enforcement to keep heroin off the streets. As a result, the task force is recommending the following 25 bills for the Senate to consider during the 2014 legislative session:   

    Preventing Opioid Abuse and Overdoses 

    ·        Preventing opioid overdoses in schools (S7661, Hannon): Clarifies that school districts, Board of Cooperative Educational Services (BOCES) programs, charter schools, and other educational entities may possess and administer naloxone to treat opioid overdoses, and will be protected by Good Samaritan laws. 

    ·        Increasing the effectiveness of overdose prevention (S7649, Marchione): Provides that naloxone kits distributed through an opioid overdose prevention program must include an informational card with instructions on steps to take following administration, as well as information on how to access addiction treatment and support services.  Opioid overdose prevention programs provide those at risk of an overdose, their family members and their friends with naloxone kits and training on proper administration. 

    ·        Limiting prescriptions for acute pain (S2949A, Hannon): Limits the number of Schedule II and III controlled substances prescribed for acute pain to a 10-day supply to prevent excess pharmaceuticals from being dispensed, and therefore reduce the risk of diversion. This restriction would not apply to the treatment of cancer pain, chronic pain or palliative care. Further, the bill provides that only one co-payment may be charged for a 30-day supply.     

    ·        Increasing public awareness (S7654, Boyle): Requires the Office of Alcoholism and Substance Abuse Services (OASAS) and the Department of Health (DOH) to establish the Heroin and Prescription Opioid Pain Medication Addiction Awareness and Education Program.  The program would utilize social and mass media to reduce the stigma associated with drug addiction, while increasing public’s knowledge about the dangers of opioid and heroin abuse, the signs of addiction, and relevant programs and resources. 

    ·        Establishing school drug prevention programs (S7653, Martins): Adds age-appropriate information about the dangers of illegal drug use to junior high school and high school health class curriculums.   

    ·        Promoting pharmaceutical take-back events (S6691, Boyle): Requires OASAS to post guidelines and requirements for conducting a pharmaceutical collection event on its website.  According to the Substance Abuse and Mental Health Service Administration (SAMHSA), nearly 70 percent of those who first abuse prescription drugs get the pills from a friend or relative. Facilitating proper and timely disposal of unused narcotics helps to reduce the danger of diversion.   

    ·        Ensuring prescribing practitioners stay abreast of best practices (S7660, Hannon and Maziarz): Creates a continuing medical education program for practitioners with prescribing privileges. DOH and the State Education Department (SED) would establish standards for three hours of biennial instruction on topics including Internet System for Tracking Over-Prescribing (I-STOP) requirements, pain management, appropriate prescribing, acute pain management, palliative medicine, addiction screening and treatment, and end-of-life care.     

    Increasing the Availability and Efficacy of Addiction Treatment 

    ·        Creating a new model of detoxification and transitional services (S2948, Hannon): Establishes the Opioid Treatment and Hospital Diversion Demonstration Program, requiring the development of a new model of detoxification and transitional services for individuals seeking to recover from opioid addiction that reduces reliance on emergency room services. 

    ·        Establishing a relapse prevention demonstration program (S7650, Carlucci):   Creates a Wraparound Services Demonstration Program through which OASAS would provide case management or referral services for nine months to individuals who successfully complete substance abuse treatment programs.  These community supports - access to which is intended to prevent a relapse - include educational resources, peer-to-peer support groups, social services and family services and counseling, employment support and counseling transportation assistance, medical services, legal services, financial services, and child care services. 

    ·        Enabling parents to require children to undergo treatment (S7652, Martins): Provides that a parent or guardian may petition to have a minor child designated as a Person in Need of Supervision (PINS) due to a substance use disorder, and that a court may require a PINS child to undergo substance abuse treatment. 

    ·        Establishing assisted outpatient treatment for substance use disorders (S7651, Carlucci): Enables a court to order Assisted Outpatient Treatment (AOT) for an individual with a substance use disorder who, due to his or her addiction, poses a threat to him or herself or others. 

    ·        Promoting the affordability of substance abuse services (S7662, Seward, Hannon, Martins and Ritchie): Improves the utilization review process for determining insurance coverage for substance abuse treatment disorders, and requires insurers to continue to provide coverage throughout the appeals process. 

    Providing Additional Resources to Law Enforcement 

    ·        Studying the conversion of correctional facilities to treatment centers (S7655A, Boyle and Nozzolio): Directs OASAS and the Department of Corrections and Community Supervision (DOCCS) to study the feasibility of converting closed correctional facilities to provide treatment for substance use disorders.  Agencies would examine the feasibility of such centers providing both inpatient residential and outpatient care.   

    ·        Establishing the crime of homicide by sale of an opioid controlled substance (S7657, Robach): Creates an A-I felony for the unlawful transportation or sale of an opioid that causes the death of another. 

    ·        Restricting drug dealers from participating in the SHOCK incarnation program (S7656, Nozzolio): Holds drug dealers accountable by preventing participation in the SHOCK incarceration program – under which young adults receive substance abuse treatment, academic education, and other services to promote reintegration – by individuals convicted of a A-II felony drug offense, except if he or she tests positive for a controlled substance upon arraignment. 

    ·        Improving safety at judicial diversion programs (S1879, Bonacic):  Requires a court, in determining a defendant's eligibility for a judicial diversion program for alcohol or substance abuse treatment, to consider the underlying charges and the defendant's propensity for violent conduct.  The bill also requires the facility treating a defendant under this diversion program to notify the local law enforcement of the defendant's placement and arrest record, and to submit a security plan to the Division of Criminal Justice Services (DCJS) to provide for the safety of staff, residents and the community.  Finally, this bill allows a defendant to appear via video conference, and makes unauthorized departure from a rehabilitation facility a D felony. 

    ·        Reallocating funds from asset forfeitures (S7658, Nozzolio): Reduces the state share of certain asset forfeitures to increase allocations for the reimbursement of expenses incurred by localities for investigation and prosecution, and provides additional monies for the Chemical Dependence Service Fund. 

    ·        Creating Drug-Free Zones around treatment facilities (S1388, Skelos): Establishes a B felony for the sale of a controlled substance within 1,000 feet of a drug or alcohol treatment center or methadone clinic. 

    ·        Expanding the crime of operating as a major trafficker (S7663, Nozzolio): Facilitates convictions for operating as a major trafficker by reducing the number of people that must have participated from four to three, and lowering the minimum required proceeds from the sale of controlled substances during a 12-month period from $75,000 to $25,000. 

    ·        Establishing the crime of transporting an opioid controlled substance (S7659, Boyle): Allows prosecution for a new crime when an individual unlawfully transports an opioid any distance greater than five miles within the state, or from one county to another county within the state, to address diversion and distribution of heroin and prescription drugs.   

    ·        Facilitating the conviction of drug dealers (S7169, Boyle): Provides that possession of 50 or more packages of a Schedule I opium derivative, or possession of $300 or more worth of such drugs, is presumptive evidence of a person’s intent to sell. 

    ·        Preventing illegal drug sales by doctors and pharmacists (S2941, Hannon): Provides for an enhanced penalty – a B felony – for practitioners and pharmacists who abuse the standards of their respective profession and violate the public trust by illegally selling controlled substances. 

    ·        Establishing criminal penalties for the theft of blank official New York State prescription forms (S2940, Hannon):  Expands grand larceny in the fourth degree to include the theft of a blank official New York State prescription form.  This bill would also redefine criminal possession of stolen property in the fourth degree to include the possession of a stolen New York State prescription form, and create an A misdemeanor of criminal possession of a prescription form.   

    ·        Increasing the penalties for theft of controlled substances (S2431, Klein, Passed Senate 3/24/2014):  Provides enhanced penalties for the theft of controlled substances, treating such crimes similarly to a theft of firearms, credit or debit cards, scientific secrets, or certain methamphetamine precursors. 

    ·        Prosecuting acts by street gangs (S4444A, Golden): Creates the Criminal Street Gang Enforcement and Prevention Act to provide a comprehensive approach to protecting the public from gang-related crimes and violence, including those that relate to drug trafficking, and establishing the criminal street gang prevention fund. 

            The full report can be viewed here

            The report also highlights other recent legislative actions to protect the well-being of people suffering from the drug addiction.  In 2012, the state enacted a law sponsored by Senator Lanza and Senator Hannon to create the successful Internet System for Tracking Over-Prescribing (I-STOP) Act (S7637), which created a real-time database for healthcare practitioners to consult prior to prescribing potentially addictive medicines such as oxycodone and hydrocodone. 

            Earlier this year, the Senate passed a bill sponsored by Senator Hannon (S6477B) to allow authorized health care professionals to increase public access to Narcan/naloxone. Also, the Fiscal Year 2015 enacted budget included $3.3 million in funding to support substance abuse services. 

            Task Force Vice-Chair Senator David Carlucci (D-Rockland) said: “We can no longer ignore the fact that there exists a frightening heroin epidemic that is plaguing our communities and putting our children at risk. Heroin does not discriminate and sadly affects too many New Yorkers irrespective of all backgrounds. This legislative package and recommendations will save lives.” 

            Task Force Vice-Chair Senator Michael Nozzolio (R-C, Fayette) said: “The Task Force learned that the heroin crisis is an epidemic and is no longer contained to just inner big cities, but is having a horrendous impact on our suburbs, small cities and rural areas. Our focus is on providing additional resources for prevention and the treatment of those addicted, while strengthening criminal justice laws to prosecute criminals who are spreading heroin in our local communities.” 

            Senator Greg Ball (R-C-I, Patterson) said: “As legislators, we must do everything in our power to protect our children from drug addiction. We must require insurance companies to provide proper coverage for those addicted and we must enable family members to get their loved ones into treatment. I am eager to work with my colleagues in a bipartisan way to combat this epidemic.” 

            Senator John Bonacic (R-C-I, Mount Hope) said: “I thank our panelists who joined us at the Sullivan County Government Center, which I hosted on May 9.  Their experiences, comments, suggestions and personal stories have been taken into careful consideration as our Senate Task Force colleagues and I put forth legislation to try to combat this epidemic. Government has to step up and do everything possible to fight back against this heroin problem, but we will still need the entire community to help us.  Heroin addiction affects everyone: youth and adults alike. It transcends regions, race, gender and economic status, and only by learning from these informed professionals can we begin to address this crisis. We must do everything in our power to help stop this highly accessible and addictive drug from poisoning our residents.” 

            Senator Simcha Felder (D-Brooklyn) said: “Heroin and opioid addiction does not discriminate across racial, ethnic, or socio-economic lines. An addict in the throes of an addiction destroys not only their health and their futures, but the lives of their family and friends as well. For every addict who doesn’t get the help they need, there is a progressive breakdown in the fabric of society-at-large. I am proud to be part of the Senate Joint Task Force on Heroin and Opioid Addiction charged with tackling this devastating disease. Together with my colleagues and input from experts and concerned New Yorkers, I am hopeful we can reverse the tide on this issue.” 

            Senator Pat Gallivan (R-C-I, Elma) said: “As a former state trooper and Sheriff of Erie County, I have seen firsthand the devastating impact that drugs and drug addiction can have on our communities.  As heroin use and opioid addiction continues to rise, New Yorkers are demanding action.  This package of legislation gives law enforcement the tools they need to go after the criminals who sell drugs on our streets, makes drug treatment more widely available, and provides programs to better inform the public about the danger of opioid addiction.” 

            Senator Martin J. Golden (R-C-I, Brooklyn) said: “I am so proud of the work that this State Senate Task Force was able to achieve and the recommendations we have made. There is no doubt in my mind that prescription drug abuse, and heroin overdoses, are among the most significant problems of our time facing New York. We have lost too many lives and we cannot, and will not, let this epidemic continue to destroy families. I commend Chairman Phil Boyle and my colleagues for taking on this monumental task so successfully. I am also grateful that working with this task force, we have recognized the need to increase the penalties against gang violence in an effort to curb this drug problem.” 

            Senator Joseph A. Griffo (R, Rome) said: “Our task force has put together a comprehensive package that addresses many of the problems I heard about from addiction treatment and law enforcement experts during the forum I hosted. These bills would stop addiction before it starts by better educating the public, especially teenagers, about the risks of heroin; preventing overdoses by arming people with naloxone; making the treatment more affordable and available when needed; and helping us get tough on dealers and traffickers. We’ve had great success in curbing prescription abuse through the I-STOP program. It’s my hope that this legislation will stem the flow of heroin and other opioids through the Empire State.” 

            Senator Kemp Hannon (R, Nassau) said: “Every day we hear more stories of lives tragically being adversely affected by heroin use and abuse. Young, old, rich and poor alike are all feeling the effects of heroin, and the Task Force continues to gather information to help us address this crisis.  Throughout our hearings across every corner of the state, we’ve heard from New Yorkers on how they’ve been impacted, and this has helped to guide us and prepare our legislation to combat this scourge.” 

            Senator Andrew Lanza (R-I-C, Staten Island) said: “Heroin and opioids are crippling, highly-addictive drugs that are causing overdoses and deaths in all corners of the state. By bringing together area stakeholders at regional forums across New York we gained a better understanding of this mushrooming crisis and have crafted legislation and policies to address this state-wide medical emergency. I thank Leader Dean Skelos and Task Force Chairman Phil Boyle for their leadership on this life and death issue.” 

            Senator Bill Larkin (R-C, Cornwall-on-Hudson) said: “Throughout this process it has become painfully clear that heroin and other opiates are quickly taking over our state.  There isn’t one segment of society that hasn’t been impacted by these dangerous, addictive drugs.  We have listened to families, healthcare providers, law enforcement officials and emergency responders and everyone has a compelling story that demonstrates we need to change the way we think about these drugs and how we deal with their presence in our communities.” 

            Senator Betty Little (R-C-I, Queensbury) said: “Heroin and opioid addiction will continue to worsen absent a comprehensive strategy and adequate funding to combat this growing crisis. With several weeks remaining in session, we have sufficient time to move forward on this package of bills that will help combat the problem and give hope to addicts and their loved ones.  A great deal of credit goes to our task force chair, Senator Phil Boyle, and the many dozens of presenters, including those in Plattsburgh, who made time to share their perspectives and offer compelling viewpoints.” 

            Senator Carl L. Marcellino (R, Syosset) said:  “The heroin epidemic has had a devastating effect all across New York State.  Far too many lives have been destroyed by this powerfully addictive drug.   This Task Force has worked diligently to hear from experts in addiction, treatment and law enforcement on how we can combat this seemingly out of control attack on the public health.  I am proud to support this comprehensive legislative package and look forward to its passage.” 

            Senator Kathleen A. Marchione (R-C, Halfmoon) said: “Our report represents months of hard work in hearing and learning from recognized experts in the fields of law enforcement, addiction recovery and treatment, educators, health care and, most important, families who tragically lost a loved one to heroin and opioid addiction. The successful community forum I hosted at Hudson Valley Community College confirmed the fact that heroin abuse is a major challenge for our Capital Region. The fire of heroin and opioid addiction is still raging across New York, but this report – and our specific, community-based solutions to combat the abuse of these dangerous drugs – is the first step toward extinguishing that fire and saving lives. This report cannot be the final word though. We need positive, proactive, bi-partisan policies enacted this session that will help save lives. I want to acknowledge and thank our Task Force Chair, my colleague Senator Phil Boyle, for the tremendous leadership, advocacy and interest he has shown in directing our Task Force and keeping the focus solely on public policy solutions and saving lives, not politics.” 

            Senator Jack Martins (R-C-I, Mineola) said: “Every single community in New York State has been affected by the growing heroin epidemic. Continuing the status quo is not an option; more must be done to save lives and prevent tragedies. Improving treatment options, strengthening law enforcement's ability to get drug dealers off the streets, and increasing awareness and education about the dangers of heroin and opioids is a comprehensive approach to reversing the terrible damage these substances are causing in each and every one of our communities.” 

            Senator George Maziarz (R-C, Newfane) said: “The Heroin Task Force has been extremely active in holding hearings around the state, meeting with experts, and formulating sound reforms to address today’s heroin problem.  This has been an intensive process and there is no doubt that it is moving our state in the right direction.” 

            Senator Thomas O’Mara (R-C, Big Flats) said: “I appreciate everyone on the front lines locally who helped us zero in on the heroin crisis. Their firsthand experience and their input is extremely valuable.  We’re going to keep working to determine the most effective combination of law enforcement, awareness and education, and treatment and prevention to try to stop the spread of heroin, better protect our communities and save lives.” 

            Senator Michael Ranzenhofer (R-C-I, Amherst) said: “Heroin and opioid addiction is a very serious issue facing communities all across the state. This legislative package will help to combat the rise in heroin and opioid addiction and its negative effects on our communities. I commend Senator Boyle for taking the lead on this issue.” 
      
            Senator Patty Ritchie (R-C, Heuvelton) said: “In the North Country and Central New York regions, there’s been a dramatic increase in the use of heroin and related drugs.  But, it’s not just here—it’s a problem that is affecting all of New York State and our entire nation. This task force and the forums we have hosted have given us an opportunity not only to get an inside look at addiction, but also, to learn from experts and those who have had direct experience with heroin and similar drugs about what can be done to step up prevention efforts, treat dependence and fight back against drug abuse and its related crimes.” 

            Senator Joseph Robach (R-C-I, Rochester) said: “Having sat on multiple public forums and panels for the Joint Senate Task Force on Heroin and Opioid Addiction, we heard firsthand from many drug addiction professionals and family members of addicts who testified about the dangers of heroin and opioid usage. This is a growing epidemic statewide that knows no boundaries and does not discriminate against gender, race or economic status. This proposed legislation will help put an end to this problem and help better educate the public about the risks of heroin and opioid usage.” 

            Senator Diane Savino (D, Staten Island/Brooklyn) said: “I want to personally thank Senator Boyle and his staff for having and correctly identifying Richmond County, Staten Island, as ground zero for this heroin and opioid epidemic.  Eighteen hearings were held across New York State to get ideas and information from doctors, treatment experts, etc; however none were more emotionally raw than in Staten Island where we heard directly from the victims and their families, including the parents of John Crupi and James Hart who had just recently passed from overdoses to heroin. It is my hope this task force and its report will lead to action that will prevent deaths like the ones we have endured on Staten Island and across the state.”   

            Senator James L. Seward (R-I-C, Oneonta) said: “The heroin task force forums gave rise to tangible evidence underscoring the dangers and depth of this epidemic we are fighting.  The expert testimony and tragic real-life stories opened eyes across the state, and are at the core of this comprehensive legislative package.  I am particularly pleased to sponsor a bill that will ensure addicts receive the medical treatment they need to help turn their lives around.  Taken collectively, these measures will reinforce and build on current education,  prevention, and law enforcement efforts, and save lives.”   

            Senator David J. Valesky (D-Oneida) said: “The heroin and opioid epidemic sweeping the state is deadly and is doing significant damage to our communities. This comprehensive legislative package addresses the scourge on all fronts and it is my hope we can affect positive change with its passage.” 

            Senator Cathy Young (R-I-C, Olean) said: “The hearings that have been taking place across the state are yielding significant results as families are stepping forward, giving their heartfelt testimonies, and telling us what we can do to help. The feedback has been tremendous and with today’s legislation, we are providing answers that will help bring this epidemic under control and provide help to those suffering from addiction.” 

    ###