We Are the Drug Policy Alliance
We are the Drug Policy Alliance.
November 15, 2019
To: NYS Joint Senate Task Force Public Hearing on Opicids, Addiction & Overdose Prevention
From: Dionna King, New York State Policy Manager, Drug Policy Alliance
Testimony for November15 Joint Senate Task Force Public Hearing On Opiolds, Addiction & Overdose Prevention
My name is Dionna King and I am the New York State Policy Manager for the Drug Policy Alliance, the nations leading organization working to advance policies and attitudes to best reduce the harms of both drug use and drug prohibition.
I have had the pleasure of attending multiple public hearings convened by this task force and have learned from those working to end the current overdose crisis and prevent needless drug-related death. Policyproposals that were once considered political anathema are now the center of discourse as policymakers and legislative leaders continue to see the value of harm reduction. Overdose prevention sites, syringe exchanges, low- or no-threshold medication maintenance and supportive housing are all effective interventions and if New YorkState commits to sustained investment in developing a harm reduction infrastructure, lives can and will be saved.
I have also witnessed multiple service providers and physicians discuss the impact of stigma and stress an urgent need to change the narrative regarding drug use and addiction. This isvital and Iwant to plainly say that we cannot erode stigma, we cannot fullycommit to harm reduction, ifwe continue to criminalize and incarcerate people who use drugs. Iimplore the members of this taskforce to put forth a policyagenda that makes the case for removing drug use from the purview of the criminal legal system and instead centers other avenues for engaging with people who use drugs in a way that reinforces their humanity and individual needs.
Felony and Misdemeanor Drug Arrest Post-Rockefeller Drug Law Reform
Drug arrests across the state fell precipitously following Rockefeller Drug Lawreform, however, New Yorkers can still be arrested for felony and misdemeanor drug offenses. In 2018, there were over 20,000 felony drug arrests in New York,with the majority of those arrests for pos5ession of meager quantities of controlled substances or for low-level sales. While 20,000 is a dramatic decline considering New York’srole in mass incarceration, the current overdose crisis should force lawmakers to reckon with the impact of criminalization on access to healthcare, housing, employment and other social determinants to health that have an effect on substance use disorder.
The social environment in which people engage in substance use impacts their overall health and influences drug users’ risk behaviors. Incarceration in and of itself negatively impacts an individual’sh We are the Drug Policy Alliance.
eath, and for those experiencing opioid dependency the cycle of release and reentry contributes to increases in morbidity and mortality.1
Alldrug decriminalization and public health
Portugal’s model of all drug decriminalization is touted as a global model of success. Portugal’s shift toward decriminalization effectively curbed the transmission of HIV,and removing criminal penalties for drug possession was a component of a plan that emphasized low- or no-threshold treatment access and a robust harm reduction infrastructure. New YorkState has taken steps toward providing alternatives to incarceration and drug treatment services allocated through judicial diversion programs, but the state has failed to fullydivest from criminalization --and to what end?
Judicial diversion, jail-based treatment, or other coercive forms of treatment do not have to be the sole driver connecting people to healthcare systems. In2001, Portugal ceased criminalizingdrug use, the results have been dramatic. The number of people voluntarily entering treatment has increased significantly, while overdose deaths, HIVinfections, problematic drug use, and incarceration for drug- related offenses have plummeted. 2 Drug decriminalization has had a remarkable impact on overdose death rate. In 1999 Portugal recorded 369 drug overdose deaths, by 2015 that number had fallen to 54•3
Subjecting individuals who experience substance use disorder or use drugs non-problematically to incarceration or contact with the criminal legal system does nothing to mitigate the harms of problematic substance use. Lawenforcement interventions exacerbate the overdose epidemic; people who are subjected to law enforcement interaction can be rendered vulnerable to conditions that weaken their civilliberties and the social and economic connections that create stability and recovery capital. Materially, incarceration and judicial diversion programs isolate individualsfrom harm reduction and treatment resources that reduce the risk associated with drug use such as disease transmission. The threat of law enforcement diminish the effectiveness of strong public health laws, such as the Good Samaritan Lawand syringe decriminalization.
It is for these reasons, the Drug PolicyAlliance,the United Nations and the World Health Organization support the repeal of laws that criminalize drug use and possession of drugs for personal use. Additionally, the UNAIDSstrategy firmly declared that drug decriminalization is a necessary ifwe are to fully protect people who use drugs from the social and legal environments that fail to protect people against stigma and discrimination.4
In 2009, New Yorklawmakers took a tremendous step towards scaling back their contribution to the war on drugs by reforming the Rockefeller Drug Laws.Although the number of arrests for drugs across the state declined in the wake of these reforms, the criminal legal system continues to have negative contacts with people who use drugs. Now 10 years removed, it’stime to assess the impact of those efforts and the validity of shifting from jails to drug courts and other forms of surveillance.
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becomes burdensome when defendants fail to meet these metrics and are required to stay in the program for periods of time that are beyond the possible sentence. 8 • While it is recommended that drug courts use assessment tools to determine the level of care/treatment needed for a particular defendant, they are not required to do use a certified alcoholism and substance abuse counselor (CASAC)nor are they required to use the New York State Levelof Care for Alcohol and DrugTreatment Referral (LOCADTR).The purpose of these tools is to place defendants in the most appropriate and least restrictive programs. However, judges may prefer more restrictive in-patient programs even when it’s not necessary, meaning defendants have to upend their lives to participate programs; this can contribute to loss of employment, interruption of education and place burdens on defendants with children. • To enter drug court, defendants must often plead guilty without a preliminary hearing and/or grand jury indictment.9 • Through RDLreform, individuals who succeed in drug court are supposed to be given the offer to have their sentenced sealed post drug court completion, but a low percentage of drug court graduates have had their records sealed, leaving individuals burdened by criminal records.’° • Drugcourts enjoy some success at reducing the recidivism rates of participants (definitively in the short term, with more variation in long-term recidivism), but they fail to significantly reduce prison populations for various reasons. Just from sanctions alone, a drug court participant may spend more days injail than they would had they pleaded not guilty and received a sentence reduction.’1 • The costs for drug court treatment are usually paid for by the participant’s insurance, which can be a barrier to people without private insurance or with plans that do not cover the drugs. Failure to meet treatment recommendations or abstain from drugs can also result in sanctions administered by the judge. • Accessibilityisa crucial factor in determining who will be able to participate and receive the diversion services of the drug court. Participants are regularly drug tested and must attend frequent hearings. But getting to court can be difficult for people who do not have cars, especially when public transportation is not available. • At a time when drug courts are being proffered as a solution to the opioid crisis by state and federal lawmakers, it is crucial to understand and measure their effectiveness. However, many courts do not make any statistics, even basic facts, about the courts available either online or upon request. In fact, any attempts to get basic facts were repeatedly rejected by court administration. Inorder to better measure the effectiveness of drug courts, data must be made available to researchers for the purpose of evaluating these programs.
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a at We are the Drug Policy Alliance. with community groups to develop the DrugAddiction Treatment and Recovery Act which will repeal criminal possession laws and allocates tax-revenue, generated through recreation marijuana sales, for treatment and harm reduction resources.
New Yorkhas yet to pass marijuana taxation and regulation policy, but the pending legislation does require a percentage of the revenue to go toward health programs that willsupport people who use drugs and harm reduction. With this new source of income, and the potential settlement funding provided through current pharmaceutical lawsuits, we encourage New Yorkto invest in the following as an alternatives to criminalization:
Overdose Prevention Centers: These legallysanctioned facilities allow people to consume pre-obtained drugs under the supervision of trained staff and are designed to reduce the health and public order issues often associated with public drug consumption.
Peer Recovery Coaches: Peers with lived experience are able to assist people access harm reduction and treatment resources and can serve as a non-judgmental mediator. Peer support has demonstrated success when applied in hospitals and outpatient clinicalsettings.14
Reproductive Health Clinicsfor Women Who use Drugs: Pregnant people who use drugs or who are in recovery from substance use with the aid of medications experience stigma and surveillance when seeking access to reproductive health care. The fear ofjudgement, criminalization or child welfare intervention can lead people to not seek healthcare services. In order to promote parent and newborn health, cities have developed specialty health reproductive health service for people who use drugs. Vancouver’s Sheway Clinicis an excellent service model. The program consists of prenatal, postnatal and infant health care, education and counseling for nutrition, child development, addictions, HIVand Hepatitis C, housing, and parenting. Sheway also assists in fulfillingbasic needs, such as providing daily nutritious lunches, food coupons, food bags, nutritional supplements, formula, and clothing. 15
Syringe Access and Harm Reduction Programs: There are some communities in New YorkState that lack a centralized harm reduction service provider or do not have adequate public transportation infrastructure to support access to brick and mortar harm reduction services. Providers, such as Community Action for SocialJustice in LongIsland, have adapted to meet the needs of their clients by
commuting directly to their clients but this istaxing on organizations. New YorkState must support the expansion of harm reduction service providers in high need communities that willbenefit from a brick and mortar institution while also investing in mobile services that can provide naloxone, clean syringes, and other safe use supplies and administer buprenorphine.
Statewide Prison and Jail-based MATPrograms: Many of New York’sjails and prisons lack the resources to provide adequate, evidence-based treatment for substance use disorder. Facilitiesthat offer
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“Social Determinants and the Health of Drug Users: Socioeconomic Status, Hornelessness, and Incarceration on JSTOR.’ Columbia.Edu, 2019. www-jstor-org.ezproxy.cul.columbia.edulstablel2574764flseq=1#metadata_info_tab_contents. Accessed 21 Oct. 2019. 21 Drug Policy Alliance, “It’s Time for the U.S. to Decriminalize Drug Use and Possession,” (2017), Available at: http:Hww’w.drugpolicy.org/resourcefits-time-us-decriminalize-druguse-and-possession; Caitlin Hughes and Alex Stevens, A Resounding Success or a Disastrous Failure: Re-Examining the Interpretation of Evidence on the Portuguese Decriminalization of IllicitDrugs, Drug and Alcohol Review. 33,1. (2012); Pippa Grenfell et al, Accessibility and Integration of HIV,Tb and Harm Reduction Services for People Who Inject Drugs in Portugal: A Rapid Assessment, World Health Organization (2012) Serviço de lntervenço nos Comportamentos Aditivos e nas Dependéncias (SICAD),Relatorio Anual 2016- ASituação do Pals em Mathria de Drogas e Toxicodependencias (2016). Health, Rights And Drugs, Harm Reduction, Decriminalization And Zero Discrimination For People Who Use Drugs IUNAIDS2019) Riggs, R., Parsons, L, Wei, U. et al. Health Justice (2014) 2: 10, https://doi.org/10,1186/2194-7899-2-10 Ibid
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King,Ryan, and Jill Pasquarella. Drug Courts A Review of the Evidence. 20D9. “Cuomo, Andrew, eta!. Divisionof Criminal Justice Services Criminal Justice update Drug LawSeries 2009 Drug LawChanges 2014 Update. 2014 “Drug Courts Are Not she Answer: Toward a Health-Centered Approach to Drug Use. 12 Christopher, Paul P., eta!. “civil commitment Experiences among Opioid Users.” Drug ond Alcohol Dependence, vol. 193, Dec. 2018, pp. 137— 141, www-sciencedirect-com.ezproxy.cul.columbia.edu/science/article/pii/S0376871618305386, 10.1016/j.drugalcdep.2018.10.001. Accessed 7 Oct. 2019. ‘ Welch, Alice E,DrPH,M.P.H., R.Ph, et al. “Relay: A Peer-Delivered Emergency Department—Based Response to Nonfatal Opioid Overdose.” American Journal of Public Health, vol. 109, no. 10, 2019, pp. 1392-1395. Prociuest, http://ezproxy.cul.columbia.edu/login?url=https://search proquest.com.ezproxy.cul.columbia.edu/docview/2287894251?accountid=10226, doi:http://dx.doi.org.ezproxy.cul.co!umbia.edu/1O.2105/NPH.2O19.3052D2. 14 Ashford, Robert 0., Brenda Curtis, and Austin M. Brown. ‘Peer-Delivered Harm Reduction and Recovery Support Services: Initial Evaluation from a Hybrid Recovery Community Drop-in Center and Syringe Exchange Program.” Harm Reduction Journal, vol. 15, 2018. Prociuest, doi:htlp://dx.doi.org.ezproxy.cul.columbia.eduJaO.U86/s12954-018-D258-2. “Sheway,” Vnhs.Net, 2012, www.vnhs.net/programs/sheway.Accessed30 Oct. 2019. ‘6Owcarzak,JiIl, etal. “Whatis “Support’ in Supportive Housing: Clientand Service Providers’ Perspectives.” Human organization, vol. 72, no. 3,2013, pp. 254-262, ABIJINFORMCollection; Arts & Humanities Database; Earth, Atmospheric & Aquatic Science Database; International Bibliography of the Social Sciences (IBSS);Prociuest Central; Psychology Database; Research Library; Social Science Database; Sociolo (TRUNCATED),
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