| COMPA The Committee of Methadone Program Administrators of New York State, Inc. |
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Testimony of
Henry M. Bartlett, COMPA Executive Director Before a Joint Hearing of the Assembly Standing Committees on Corrections, Codes, and Alcoholism and Substance Abuse December 20, 2010 I want to thank Chairman Aubry of the Corrections Committee, Chairman Lentol of the Codes Committee, and Chairwoman Paulin of the Alcoholism and Drug Abuse Committee; as well as the other Assembly Members for the opportunity to testify today about the implementation of the Rockefeller Drug Law reform legislation. As the Executive Director of COMPA, I represent a coalition of treatment programs in New York State which utilizes pharmacotherapy as a component in the comprehensive treatment of opiate addiction. The pharmacotherapy programs licensed by OASAS across New York State will treat approximately 38,000 of our fellow citizens today. This represents about 40% of the treatment capacity of all OASAS licensed treatment services is all inpatient and outpatient settings in New York. COMPA applauds Governor Patterson, and the members of the New York State Legislature for the courage and foresight to overturn the punitive and counterproductive Rockefeller era drug laws. Clearly treatment is a better alternative than incarceration, and in this bleak fiscal environment it is even more prudent to treat rather than incarcerate. Based on research done here in New York by Dr. Vincent Dole and Dr. Don DesJarles, SAMHSA estimates that the cost of an untreated addict on the street, in terms of crime and security costs is about $45,000 a year. Nationwide, the cost of an addict in prison is approximately $35,000 a year. But the cost of an addict in treatment is a mere fraction of these numbers. The average annual cost of a patient in Methadone treatment in New York is only about $6,000. So treatment is not only the right thing to do from a humanitarian perspective, it is also the right thing to do from a hard-nose dollars and cents perspective. Allow me to quote Dr. H. Westly Clark, Director of the Center for Substance Abuse Treatment within the United States Department of Health and Human Services. Relying upon multiple published studies Dr. Clark said; “The data shows treatment saves money. One dollar spent saves four to seven dollars. If you’re an altruist, making treatment available is a good thing. If you’re a narcissist it’s also a good thing, since you save money in taxes”. But treatment is not one-size-fits-all. For treatment to have the maximum potential to be successful the patient must be matched to the appropriate treatment modality and level of care. This is where there is much room for improvement when it comes to the criminal justice system placing patients in an appropriate treatment setting. Today I want to focus on finding the appropriate level of treatment for individuals suffering from chronic, long-term opiate addiction. This population represents a very high percentage of the individuals likely to be impacted by Rockefeller drug law reform. What we know about chronic long-term opiate abuse is that it creates long lasting changes in brain chemistry and physiology. This was first hypothesized in 1964 when Dr. Vincent Dole, Dr. Marie Nyswander, and Dr. Mary Jeanne Kreek at Rockefeller University said that they thought opiate addiction was a “metabolic disease” which altered the brain to create a “drug hunger”. They further hypothesized that this metabolic disease could be treated with pharmacological interventions. This hypothesis was later bolstered by volumes of clinical research and by the documented efficacy of Methadone treatment, but it could not be confirmed by hard evidence until decades later when PET Scans and other nuclear imaging techniques were invented. These new technologies allowed scientists to look inside living human brains to see the long term damage done by opiate addiction, and to see how medications like Methadone and Buprenorphine help to normalize the functioning of the addicted brain. The research is clear, overwhelming, and unambiguous. When dealing with a chronic, long-term opiate addict the very highest probability of success comes from utilizing pharmacotherapy as part of a comprehensive treatment program. Unfortunately, there has been a historic reluctance from many levels of the criminal justice system to embrace the use of addiction medicine. There seems to be a kind of willful ignorance of the science, and an active attempt to hide from the evidence. This data resistance is doing a serious disservice to the individuals in need to treatment. Without access to appropriate addiction medicines, as part of a comprehensive treatment program, the opiate addict has a much higher likelihood of relapse. This in turn is likely to create more criminal recidivism and re-incarceration. Many drug courts judges actually require existing Methadone patients who are progressing in treatment to rapidly taper off methadone as a condition of participating in drug court. The choice if often; “Give up a medicine which is helping you, or go to jail.” The sad fact is that the choice is really: “Go to jail, or go to jail.” Since we know most patients who stop using methadone too soon will relapse and eventually face re-incarceration. This is all too common across the criminal justice system, and is having the effect of diminishing the success of treatment as an alternative to incarceration. C. West Huddleston, CEO of The National Association of Drug Court Professionals (NADCP) in writing to a Los Angeles Drug Court judge spoke of the undisputed value of using pharmacotherapy in the treatment of opiate addiction. He said “NADCP unequivocally supports patient access to opiate replacement therapy, of which methadone is a form, when medically appropriate. Similarly, NADCP opposes attempts, no matter how well-meaning, to interfere with or otherwise undermine considered clinical judgments regarding proper treatment protocols arrived at by qualified treatment professionals overseeing the care of drug court participants.” He went on to say, “…decades of research indisputably instructs that for many patients long-term maintenance yields excellent treatment results. Indeed, cessation or reduction of Methadone treatment when not medically indicated is highly predictive of relapse and other negative outcomes that may cause serious harm to patient health and well-being”. The full letter from Mr. Huddleston is attached to this testimony. The science supports the use of addiction medicines, and the national drug court leadership does as well, but many judges and D.A.s in New York do not. This is evidenced by the fact that only a tiny percentage of the chronic opiate addicts who come through the criminal justice system are referred into pharmacotherapy treatment. COMPA asks the legislature to investigate and study this issue in more detail than can be allowed in this hearing. We also suggest that the legislature consider requiring the use of a standardized assessment and placement instrument and protocol to insure that individuals are matched with the appropriate level of care, where they have the best chance to achieve a good treatment outcome. Such an instrument and protocol could be developed by OASAS utilizing the latest science and evidence-based treatment. Many patients do not get the level of care which is best for them because it is prevented by, out-dated views on treatment held by judges, district attorneys, and other judicial officials. It’s time to replace dogma with science and evidence. This will go a long way toward improving the success of Rockefeller Drug Law Reform. |
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