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Miscellaneous Statements on Drug Policy


Last Updated 11/06/97 13:01

March 21, 1997

pea  JUDICIARY COMMITTEE             11:00 a.m.

PRESIDING CHAIRMEN:      Senator Williams

                         Representative Lawlor


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,


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


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


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


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


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


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


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


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.


COMMISSIONER ARMSTRONG:  I'd be happy to get those from


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


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


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


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


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


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


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



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


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.


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


REP. LAWLOR:  Oh, I'm sorry.

THOMAS SICONOLFI:  You weren't hanging on every word,


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


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


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


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


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


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


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


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


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


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


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.


REP. FARR:  But is there a formal evaluation of the drug

session?  Do you know?  Has there been a formal


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.


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



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


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.


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


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. LAWLOR:  Are there other questions?  Representative


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.


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?


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


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


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


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


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


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


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 --


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


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


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


REP. LAWLOR:  Can I -- rather than that let me just ask

you two quick questions.


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


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


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?


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


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


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


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


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


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


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


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


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


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:



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


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.




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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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,


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.


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.


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


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


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


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


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


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


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


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.


REP. MARTINEZ:  Because you've been doing very good work

over there.

DEPUTY COMMISSIONER KIRK:  It helps to hear that once in


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


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


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


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


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


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


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


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


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


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


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


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


DR. ALVIN NOVIK:  It went on line in mid-November 1990.

REP. HAMZY:  So for seven years or six and a half years



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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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?


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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.


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


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


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


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


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


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


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


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.


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 --


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


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


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


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


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


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


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


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


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


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.


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


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


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


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



REP. LAWLOR:  And even if you have it, does it cover


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


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


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


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


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


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


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?


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


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


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


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


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


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


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


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?



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,


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


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


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


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.


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


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


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


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


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


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


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


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


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


REP. FARR:  Was this a mental hospital?  Or a general --

ALICE DIORIO:  Yeah, it was a mental -- a psychiatric


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


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


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


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


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


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


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


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


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


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


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


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


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


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.)

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