08/28/19 Jasmine Budnella

This week on Century of Lies we hear portions of hearing and roundtable discussion held by the New York State Senate Joint Senate Task Force on Opioids, Addiction and Overdose Prevention on August 9 in The Bronx. Speakers include Jasmine Budnella, Drug Policy Coordinator with VOCAL New York; Mike Selick, Hepatitis C Training and Policy Manager with the Harm Reduction Coalition; and Ken Robinson, Executive Director, Research for a Safer New York.

Program: 
Century of Lies
Date: 
Wednesday, August 28, 2019
Guest: 
Jasmine Budnella
Organization: 
Drug Policy Alliance
Download: Audio icon COL082819.mp3
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TRANSCRIPT

CENTURY OF LIES

SEPTEMBER 28, 2019

DEAN BECKER: The failure of the drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization – the end of prohibition. Let us investigate the Century of Lies.

DOUG McVEY: Hello and welcome to Century of Lies. I am your host, Doug McVey, Editor of drugwarfacts.org. The New York State Senate’s Joint Senate Task Force on Opioids, Addiction and Overdose Prevention is holding a series of hearings and roundtable discussions across the state. The task force plans to carry out a holistic review of New York’s overdose crisis and the states approach to drug use with a focus on saving lives and improving individual and community health. They’ll be holding discussions with stakeholders and carrying out a review of best practices to identify gaps in the current system and develop short and long term legislative and budgetary solutions. The first hearing took place on August 9th, in the Bronx. Subsequent hearings and roundtables are gonna take place in Central New York, Buffalo, Staten Island, The Hudson Valley, Long Island, and Albany.

On today’s show we’re gonna hear a portion of that first hearing. A panel on harm reduction, syringe exchange, and supervised consumption sites. The speakers are introduced by State Senator Gustavo Rivera, Chair of the New York State Senate’s Health Committee. They are in order of appearance, Jasmin Budnella, Drug Policy Coordinator with VOCAL New York, Mike Selick, Hepatitis C Training and Policy Manager with the Harm Reduction Coalition, and Ken Robinson, Executive Director of Research for a Safer New York.

STATE SEN. GUSTAVO RIVERA: Next we will be joined by Ken Robinson, Executive Director for Research for A Safer New York, Inc., Mike Selick, Hepatitis C Training and Policy Management at Harm Reduction Coalition, and Jasmine Budnella, Drug Policy Coordinator with VOCAL NY. (CLAPPING). Welcome. Why don’t we go from left to right, Jasmine how about you kick it off?

JASMINE BUDNELLA: Okay. I would like to start by thanking Senator Rivera for his relentless leadership and commitment to elevating the voices of the Bronx as well as his legacy for fighting for compassionate and evidence based solutions for the overdose crisis. Also special thanks to Senator Harcum, and then Senator Carlucci for prioritizing this issue. This gratitude comes not just from me but from the members, leaders and our statewide team at VOCAL New York, as well as the End Overdose New York Coalition statewide.

To be clear, my testimony and the testimony you heard today as far as care throughout the state is directed at the whole entire New York State Senate. We are in a defining moment of history. One that will forever be judged and seen as an opportunity for those in power to show leadership and course-correct the decades long humanitarian disaster that is the war on drugs. The overdose crisis demands urgency in order to heal our communities, dismantle deadly stigma, and ensure that the thousands of lives we’ve lost throughout the state are not lost any more.

Taking action to confront this crisis can be the great unifier of our state or it can be the great divider. Today we lay that responsibility at the Senate’s door and challenge all of you to choose courage and heed the words of evidence to not fall back on failed tactics that have proven to perpetuate poverty, incarceration, and death in our communities.

Many of us here have already testified at hearings, participated in statewide roundtables and brought in experts to educate elected officials as well as engaged in deep dialogue with state agencies on evidence-based solutions. With that, I will leave the ethic plan with you all. This is a blueprint that is by no means exhaustive, right? But it just does demonstrate that we’ve done this before and we’re ready to move to action.

So what we need from you all is immediately increase funding for Harm Reduction agencies and services across the state. You’ve heard this time and time again today. Gov. Cuomo’s recycled talking point of $200 million dollars is not true. We need more funding. We demand the overdose prevention – the approval of overdose prevention centers and the pilots. Ken will talk more about them. We’ve heard a lot about them and today we need them. We need universal access to medication assisted treatment and when we say that, we mean Buprenorphine and methadone. When we say universal access – we need it in the community, in emergency rooms, in shelters, and in prisons and jails across the state. While we urge the state to move towards decarceration, until we get there we cannot forget about our brothers and sisters on the inside. That means we must also remove Medicaid barriers. You heard from a lot of doctors today about the barriers that exist under Medicaid for universal access to (UNINTELLIGIBLE). One being prior authorization, but thank you to Senator Harcum for his leadership on helping us pass this bill this session. To remove prior authorizations for all formularies of MAT, for people on Medicaid. We are still waiting for the Governor to sign that.

We also need to have fair reimbursement rates for providers. We heard a lot about what it is, what are the barriers that providers are experiencing; one is reimbursement rates. We’ve heard from providers across the whole entire state that they’re trying to keep their lights on because they’re not getting reimbursed enough. We need to change that. We also need fair reimbursement rates for pure educators who are so critical in this work and need to get paid a living wage. We demand that decriminalization of public health tools. We have been fighting alongside Senator Rivera for over a decade for a bill to remove the criminalization of syringes and expand syringe access across our whole entire state – this year, let’s get it done!

We need to rapidly increase and fully fund the 20,000 units that the Governor promised of supportive housing. Housing is a huge issue in this crisis and we must address homelessness. We need to fight back against failed drug war tactics. We know this doesn’t work. Criminalization will never decrease the overdose crisis. In fact, what it will do is dismantle critical public health responses and interventions to the crisis and inevitably will always harm communities of color and poor and low income New Yorkers.

Proposals like scheduling Fentanyl in the Controlled Substance Act, increasing penalties for possession and sales and drug induced homicide laws like Senator Armador’s Laurie’s Law must end today. That does not work. We see the last 40 years proves that and it’s actually dangerous to our addressing this crisis.

The road to accomplishing these proven interventions cannot end with a statewide tour or a report. We need the whole entire Senate to carry our voices and center them into the next legislative session. We need the whole entire legislature to stop asking why did this person do this to themselves, but instead to ask; how did we let this happen to our people?

We look forward to working with all of you and thank you for letting me testify today.

STATE SEN. GUSTAVO RIVERA: Thank you, Ms. Budnella. Mr. Selick?

MIKE SELICK: Good afternoon, Co-Chair Senators Rivera, Harcum, and Carlucci, and thank you to the entire Senate Task Force on Opioids, Addiction, Overdose for this opportunity to testify. My name is Mike Selick, I am the Hepatitis C Training and Policy Manager for the National Harm Reduction Coalition, a national organization with offices in New York City and Oakland, California that promotes the rights, dignity, and health of people who use drugs. As part of my role at Harm Reduction Coalition, I coordinate the injection drug user’s health lines or a DUHA, which is made up of all health department waivered Syringe Exchange Programs in New York City.

In my testimony today I will briefly outline a variety of ways to further reduce drug related harms and overdose deaths in New York State. As you’re all well aware we are currently dealing with a crisis of overdose deaths in this city and in this state. Although overdose death rates increased only 6% from 2016 – 2017, that increase would likely have been significantly higher had it not been for all the important harm reduction and overdose prevention work across the state. The highest rate of overdose deaths in New York City are right here in the Bronx. Clearly more needs to be done to address this issue. The Bronx has been hit hard by decades of racialized drug policies and biased policing and prosecutions that have contributed to increased harms from drug use to individuals in the community. Our responses to opioid use and overdose deaths must keep our history front and center in order to deal with the harms caused by punitive response to drug use. The gold standard of interventions for opioid use disorder is medication as treatment. A note about the language there; we keep calling it medication assisted treatment. I’ve heard multiple doctor’s talk about the need for counseling, for inpatient treatments – those are all great supports. However, the medication works on its own. You shouldn’t be required to go to a group once a week in order to get Bupe if you’ve been on it for 10 years. All the research points to that and I just want to be clear about that now.

There has been much work to expand MAT through the city and state which is one of the many reasons the death rate from opioid overdose has not climbed even further. However, we cannot realistically end overdose until MAT is easier to access than buying drugs on the street. In order to make that a reality we need to lower barriers to treatment by changing policies, regulations, and modes of delivering services that better fit the needs of people who use drugs. I think I heard Dr. Shinazo talking about mobile methadone vans, which they have in many other countries but not here. That’s one more thing that we could do to add to this. Harm Reduction Coalition has been working with the New York City Department of Health and Mental Hygiene, as well as the ADUHA agencies to implement low threshold Bupe prescribing, which early research has shown can engage and retain some of the hardest to reach people in treatment. This modality is promising because it connects people at local syringe exchange programs where they are already receiving services and built up trust with providers. It’s a way to give people Buprenorphine on demand with clear instructions on how to do a home induction, bypassing a lot of the barriers faced in more traditional treatment centers that have been outlined throughout the day so far. More emphasis on this type of low barrier prescribing is an important avenue to explore.

One of the biggest risk factors for death from accidental overdose is reduced tolerance and people released from prison or jail have a risk of overdose forty times greater than the general population in the first two weeks following incarceration. MAT helps reduce overdose deaths substantially. One more (UNINTELLIGIBLE) study found that the provision of MAT prior to release resulted in a 60 percent reduction in overdose deaths in the six months following their incarceration. Although there is a MAT program that has been supporting incarcerated individuals at Riker’s Island for many years, this program has not been expanded in to all prisons and jails statewide. Some efforts have been made with the state budget last year to fund local jails to add this service and Harm Reduction Coalition supports the full expansion of MAT to all incarcerated people in New York State who are interested in receiving this service without preconditioned or restrictive punitive policies.

There are currently 12 drug user health hubs across New York State funded by the Department of Health AIDS Institute. The state funding helps syringe exchange programs integrate higher threshold medical care, mental health, and MAT services for people who use drugs. These services can be provided onsite or through facilitative linkage to culturally competent care and treatment services so it’s great that there are 12 of them, we would like to see these programs better funded and we would like to expand it from 12 to all of the syringe exchange programs that are waivered by the Health Department in New York.

The final intervention I want to highlight which is one I’ve been happy to hear. Everyone has been supportive or at least not willing to come out against of it this hearing. We would like to see the syringe exchange programs be able to implement supervised consumption services. New York has an opportunity to be a leader in the United States by passing this legislation to allow for already obtained drugs to be administered under the supervision of program staff in a hygiene that’s a safe and controlled environment and it would do a lot to reduce deaths and connect people to the care they need. Thank you.

SEN. GUSTAVO RIVERA: Thank you very much, Mr. Selick. Last but certainly not least, Mr. Robinson.

KEN ROBINSON: Good afternoon. My name is Ken Robinson and I am the Executive Director of Research for A Safer New York.

Research for A Safer New York is a consortium of harm reduction providers that has been established to oversee a pilot research study in the form of the operation of 5 overdose prevention centers, or OPCs in New York State – four in New York City and one in Ithaca. The 24-month pilot study will evaluate the efficacy of OPCs as a crucial strategy to prevent opioid overdose fatalities, reduce public drug use and needle sharing, create a pathway to addiction treatment and recovery and mitigate the HIV and Hepatitis C epidemics.

Senators, we must pass the Overdose Prevention Center Act, this bill, Senate Bill 5289A, sponsored by Senator Rivera, and Assembly Bill 7813, sponsored by Linda Rosenthal is currently in committee in both houses. It does not ask for blanket authorization of overdose prevention centers. It will authorize the previously mentioned 24-month Senate pilot. The 5 overdose prevention centers will be paired with well-established harm reduction and syringe exchange programs. Dr. Holly Hagan, a world renowned Epidemiologist at NYU has already been recruited to conduct the research.

It is very important that all of the committee members and the public understand that New York State currently has one of the most extensive syringe exchange networks on the planet. The amazing success of syringe exchange programs as a public health intervention is widely known and accepted. However, under current law when we give someone a clean syringe we must send them out the door to consume their drugs. Many of these folks are gonna go to public restrooms, parks, playgrounds, and alleyways. We are just asking for one small additional step that we be allowed to offer IV drug users a clean and safe place to consume their drugs where they will be monitored by staff to prevent overdose and where they will be offered a pathway to life saving services. There is nothing radical or nefarious about this. This is an evidence-based, best practice and medical intervention that saves human lives.

Many of you will have heard – and we heard a little about them today – heard of the Insight Overdose Prevention Center in Vancouver. Insight was the first OPC in North America and is widely viewed as one of the most successful OPCs in the world. On their website they say that in 2017, they engaged in 1,983 overdose interventions and in 2018, they engaged in 1,466. On July 31st, just a week or so ago I had the opportunity to speak with their current Director, Elizabeth Holiday. I asked Elizabeth if she would say that each one of these interventions was a life saved. She replied quite emphatically that she knew with a high level of certainty that each of those 3,449 interventions was a human life saved. Think about that. That’s 3.449 families that did not have to bury their son, daughter, brother, or sister. 3,449 mothers that didn’t have to suffer the crushing grief of burying a child.

I am saddened to say that one life that was not saved out in Binghamton, New York was the life of Jeff Dugan. Jeff died of a heroin overdose in 2014. I had hoped to introduce you all to Jeff’s mother, my friend, Alexis Pluce, but unfortunately she had to cancel her trip to join us at the last minute.

Alexis channeled her grief – a grief that most of us can only imagine – in to founding the extraordinary nonprofit organization, Truth Harm. But Alexis did offer me this quote to share with you all – I want to make sure I do this justice. “As a mother who has lost her son I am experienced in contemplating what could have happened to produce a different outcome for Jeff. There are a lot of things that might have helped but in the end, a safe place to use is the only thing I know for sure that would have”. There is a saying that we advocates use in this campaign to authorize OPCs – dead drug users don’t recover. Please think about that.

SEN. GUSTAVO RIVERA: Thank you so much, Mr. Robinson.

DOUG MCVEY: You are listening to Century of Lies, I am your host, Doug McVey, Editor of drugwarfacts.org. We’re listening to portions of a New York State Senate Joint Senate Task Force on Opioids, Addiction and Overdose Prevention that was held in the second week of August at St. Barnabas Hospital in the Bronx. The speakers you just heard were Jasmine Budnella, Drug Policy Coordinator with VOCAL New York, Mike Selick, Hepatitis C Training and Policy Manager with the Harm Reduction Coalition, and Ken Robinson, Executive Director of Research for A Safer New York. They were introduced by New York State Senator Gustavo Rivera, Chair of the Senate’s Health Committee.

Now let’s hear some questions from the Senators. The first question will come from Senator Rivera, then we’ll have Senator Peter Harcum, Chair of the Alcohol and Substance Abuse Committee, and they are followed by Senator Jamal Bailey.

SEN. GUSTAVO RIVERA: I wanted to ask two quick questions. The first one – and I want to make sure that all of you have an opportunity to answer this. It is not a secret that I am obviously a big supporter of if you’re talking about overdose prevention centers with conservative facilities. That is not a secret. Let me step for a second and be a devil’s advocate and give you an opportunity to respond. To a concern that I have heard from some of my colleagues and some other folks who might not be policy makers and for some less – much less educated people out in the universe that creating this would actually encourage people to use drugs and that creating such a thing would be saying that it’s okay to use drugs and that it’ll be just saying to people it’s okay – you should use drugs and that that’s terrible and we should not do it. What would be each of your responses to anyone who makes an argument like that?

JASMINE BUDNELLA: I would say do seat belts make people drive more? Do condoms make people have sex more? Do bars make people drink more? I mean it’s a conversation that there’s a lot of stigma around this issue. This is about public health. It’s not about encouraging drug use and in fact if we look up what encourages drug use, its trauma. So we should really identify that as the issue of what would enable somebody to use. Its trauma, its housing, its mental health issues, its income disparities. So that would be my answer.

SEN. GUSTAVO RIVERA: Mr. Selick?

MIKE SELICK: The only thing that we’re enabling is for people to take care of their health. A lot of the other issues people from communities raise like syringe litter, overdoses, and public drug use in public are all mitigated by having a place that is not public. Nobody wants to be shooting up in a park where the cops might find them or no one’s gonna help them if they die. So it doesn’t make anybody want to use drugs. It makes people want to use drugs in a more safe way and also gives them connections to opportunities to change if they want.

KEN ROBINSON: I would say two things. One, we know that this group of folks – regardless of what any of us in this room do or do not do are going to be consuming these drugs. So number one I would say that. Number two, I would say there is good, good science that refutes what you just proposed, Senator Rivera.

SEN. GUSTAVO RIVERA: Well, the person I was playing. It wasn’t me.

(LAUGHTER)

KEN ROBINSON: Yes, sir. I understand. But there is good science – there is so much empirical evidence that supports the efficacy of these. It just blows my mind that we can’t wrap our arms around and embrace that we have evidence based – this is supported by the American Medical Association, by the Preventive Medical Association, even by – I forget the name of the organization – but the family docs and their organization ad they tend to be pretty conservative. All of those guys do appreciate the science.

SEN. GUSTAVO RIVERA: Thank you so much. Senator Harcum?

SEN. HARCUM: Thank you, Mr. Chair. Thank you all so much for your testimony. It was really important. I have a question for you, Mike, of particular. There has been a lot of talk today about how we expand medication assisted treatment. A lot of it focusing on barriers to physicians, others on requirements within insurance plans and whatnot, and you took it to another level. You spoke about lowering the barriers almost, I think it was with home use if I am not mistaken. Talk more about that if you would. Educate me please.

MIKE SELICK; ADUHA and the Medical Director for Harm Reduction Coalition in tandem with DOHMH have been doing a low threshold Bupe prescribing program at a lot of the syringe programs. So councilors and peers will get people prepared to know what it will take to start Bupe. You need to be in a little bit of withdrawal before you’re able to start. So it’s not that it’s home use, it’s more of a home induction. You meet with our medical director or some of the other programs have other medical services that they’re bringing in if it’s not our medical director and they’ll counsel somebody on what it takes to induce on Bupe, get all the insurance in line gets you a prescription for 7 days right there, right then. Then you go home and then can induce on your own later that day when you’re at the appropriate time instead of multiple day waiting periods to get on it. For a lot of these prescribers – they’re doing one week of Bupe, because they don’t have the capacity to have ongoing caseloads, but that’s the way a lot of harm reduction programs work. Somebody comes in very low threshold, gets what they need and then gets referred to ongoing treatment somewhere else and that gets you around the limit on your caseload. You do 1 week for somebody and then transfer them to a longer term treatment and now you can go and do somebody else – and get them on. So it’s also been called Medication First, Lowe Barrier, Low Threshold – new on this treatment, but its reaching people that are not gonna be reached by any other means and seems to be engaging them in care so it’s a model that we’d like to keep pursuing and expanding across the state and city.

SEN. HARCUM: Terrific. Thank you.

SEN. RIVERA: Senator Bailey?

SEN. BAILEY: That was a quick hello. I am wondering who it is?

(LAUGHTER)

SEN. RIVERA: We talk about the entrance that Senator Bailey made – so we’ve been joined by Senator Bailey who will be asking the next set of questions.

SEN. BAILEY: Thank you, Senator Rivera, thank you to the Co-Chairs, Senators Rivera, Harcum and Calucci and all of my colleagues in government and thank you for those who have testified prior to my arrival and those who are here today. I just want to thank you, Ms. Budnella, for your advocacy for the MAT bill during session and I truly appreciate that. My question for you is rather nebulous, so bear with me. We see bill numbers, we know that there are legislative fixes and we know there are funding fixes. Those are two givens. As legislators who are not necessarily experts on these subject matter areas. How can we help break down the stigma that Senator Rivera spoke about – what can we as legislators do as people who are not necessarily as well versed as you may be in this matter. What can I do as an individual who is not trained medically or trained in harm reduction, or trained in anything related to substance abuse? What can I do to let my constituents know that this is not what it may appear to be?

JASMINE BUDNELLA: You are talking about constituents and the senate or just your colleagues?

SEN. BAILEY: I am talking at large – individuals who believe that we should not be doing harm reduction methodology – that we should not be doing MAT because of cost. Whoever it may be – whether it’s a colleague, whether it’s a constituent, whether it’s somebody that’s watching that doesn’t believe in the work that you are doing. What can I do to make sure that people understand it better?

JASMINE BUDNELLA: I think it’s about what we can do, right? I think it’s about there is a large network of folks not only here, but other folks who aren’t here who are working on this issue and have for decades and a lot of that work started here in the Bronx. So we are happy - I am speaking for the whole community but I am sure that they would be happy as well to do a joint forum with you, to do a teach-in, or a community forum to have listening sessions with your community or even just do a one on one with you. I think there is also a ton of information but people who have dug in to this work for years and years and years – it comes. I think that we are willing as not only here in the Bronx, not only across the whole entire state but we are willing and wanting to work with you all in the community, outside the community, in the senate. Do briefings for the senate – all of those things. I don’t know if anybody else wants to –

KEN ROBINSON: One thing that I would like to add and I have given this offer to some of you and some of your staff. I have met with a lot of you, if not you individually – with your staff and I am willing to come to you – to your district and help you with some kind of town hall or constituent forum. I don’t know if you guys know who Jenny Shubert is, she is one of the co-founders of Housing Works, and Jenny is one of the pioneers of harm reduction in New York State and in the world, and Jenny and I put together what I think is a really good presentation to educate people about this and I would be happy to come to you guys and help you in any way I can and give a presentation and talk to your constituents – at any time.

SEN. BAILEY: You wanted to add something, Mr. Selick?

MIKE SELICK: Yeah. I think all of us would be happy to do that. In addition, I appreciate the question. One thing is to elevate the voices of people who are using drugs to help de-stigmatize this and humanize the issue – share the evidence. But also I think it is good for you all to come out in favor and support us. We see terrible New York Post articles saying syringe litter which is caused by over policing and lack of services – not by the services. We write press releases and try to speak out against that but at the end of the day, we are the freaks who give out needles and it doesn’t sound so good coming from us because of course we care about the work we do. Hearing it come from you all saying this is why we fund these services – this is why we’re leading these bills to help educate your communities is gonna mean a little bit more than the people whose livelihood and entire passion is based on doing this work because of course we support what we do. Why would we do it if otherwise? It’s not the money. (LAUGHTER)

SEN. BAILEY: Thank you, Mr. Selick.

DOUG MCVEY: That was a portion of a New York State Senate Joint Task Force on Opioids, Addiction and Overdose Prevention Hearing and Roundtable Discussion that was held the 2nd week of August at St. Barnabas Hospital in the Bronx. You heard Jasmine Budnella, Drug Policy Coordinator with VOCAL New York, Mike Selick, Hepatitis C Training and Policy Manager with the Harm Reduction Coalition, and Ken Robinson, Executive Director of Research for A Safer New York.

That’s it for this week. I want to thank you for joining us. You have been listening to Century of Lies, we are a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at drugtruth.net. I have been your host, Doug McVey, Editor of drugwarfacts.org.

For now, for the Drug Truth Network, this is Doug McVey saying so long.
For the Drug Truth Network, this is Doug McVey asking you to examine our policy of drug prohibition, The Century of Lies. Drug Truth Network programs archived at the James A. Ba