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