ITHACA, N.Y. – At an event Thursday in Ithaca, the names of 35 people who have died due to overdoses in Tompkins County were remembered. The names affixed to a purple ribbon represent “just a minor fraction of all those who we’ve lost,” Mindy Thomas, Tompkins County Family Treatment Court coordinator said.
Ithaca marked International Overdose Awareness Day by highlighting the toll opioid addiction has taken on the local community. In the first six months of 2018, six drug-related deaths were recorded by the county’s medical examiner.
The second annual community forum, held Thursday at the Space@Greenstar, featured a panel discussion about local addiction treatment services and a remembrance ceremony for community members lost to drug overdoses.
Panelists included Honorable John C. Rowley, Tompkins County and Family Court Judge; Angela Sullivan, executive director of the Alcohol and Drug Council; William Rusen, executive director of Cayuga Addiction Recovery Services; Frank Kruppa, commissioner of mental health and the public health director for Tompkins County; and John Barry, executive director of the Southern Tier AIDS Program.
Shifting to a medical model to treat opioid addiction
Panel members highlighted the county’s shift to a medical model for treating opioid addiction from a punitive model. Barry said in other Southern Tier counties, “People are still trying to incarcerate themselves out of this problem.” Barry praised Tompkins County’s work to reduce its jail population, bring medication assisted treatment into the jail and establish on-demand medical treatment facilities throughout the community.
“Our organization works in eight counties. I can tell you without any hesitation that you are far ahead of the curve,” Barry said.
Sullivan, of the Alcohol and Drug Council, said her organization has raised $1.2 million to open a facility offering services along a continuum of care.
“We’re trying to fill the gap at the front end, for people interested in accessing treatment on the path to recovery,” she said.
The facility will include a 24-hour Open Access Center offering walk-in assessments, medication assisted treatment and referrals; a 20-bed detox facility for medically supervised withdrawal; and a 20 bed stabilization facility for longer-term treatment prior to discharge.
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Despite raising funds, the Council has struggled to find a location for the new facility. Sullivan said the stigma surrounding substance abuse treatment makes it challenging to find sites that are zoned appropriately and have receptive landlords. “We actually looked at 44 different sites to come to one,” Sullivan said.
Sullivan said the Council hopes to announce a location for the clinic in the not-too-distant future.
Cayuga Addiction Recovery Services is also preparing to expand its services. A walk-in medication assisted treatment clinic is due to open by early-October. Rusen said the facility will be a “dispensing pharmacy” where patients can receive daily doses of Suboxone or Vivitrol.
What local options are available for treatment?
Suboxone is an agonist that partially replaces the effects of illicit opioids on brain receptors, easing symptoms of withdrawal and treating physical dependence after detox. Vivitrol is an antagonist that blocks the effects of opioids on brain receptors, preventing patients from experiencing opioid highs. Patients must detox before using Vivitrol. Research has shown each medication to be effective for longterm treatment, with the caveat that successfully detoxing is a hurdle to using Vivitrol.
CARS is also in the planning stages for a new 25-bed women’s detox facility on its current grounds. Rusen did not confirm a schedule for the project, but said the organization hopes to break ground soon.
Rusen said changes at CARS are in keeping with a shift toward a medical model for treating addiction. “We’re evolving into looking a lot like a healthcare facility that treats addiction, not an addiction center that offers some medical services on the side,” Rusen said.
Kruppa, of the Tompkins County Health Department, said he is working with the Corrections Department to address substance use disorders at the county jail. Tompkins County was one of 17 counties to receive New York state funding this year to expand jail treatment services. Kruppa said the jail is beginning to offer medication assisted treatment to inmates and is working to ease transitions back into the community.
“We want to, first of all, reduce the number of people we have in jail. But then if they are there, we want to give as much services as we can so that when they are released from the jail they don’t ever come back, for good reasons,” Kruppa said.
He said the jail now employs a full-time social worker, a reentry caseworker, and has contracted a psychiatrist. “We want to get people started on the road to recovery while they’re still in the jail,” Kruppa said.
Several panelists cited the REACH Project as an important addition to Ithaca’s resources since last year’s forum. The REACH Project is a primary care facility specializing in treatment for people who are often stigmatized in healthcare settings, including drug users. Since opening last February the center has served over 650 patients, according to practice manager Samantha Stevenson.
While Thursday’s event celebrated progress made throughout the county in the last year, it also underlined ongoing challenges and unmet community needs.
Gaps in local services
During a Q&A session, community members raised concerns about gaps in the county’s treatment services. One speaker questioned why patients using methadone still need to go as far as Elmira, Binghamton or Syracuse to access the medication. Another asked how the jail planned to address withdrawal symptoms in addition to longterm dependency management.
Panelists acknowledged that methadone is a useful tool for treating opioid addiction. Because methadone is an opioid, patients who begin taking it prior to detoxing can avoid withdrawal symptoms. However, strict regulations make it difficult for organizations to dispense methadone, panelists said.
Rusen said CARS has the regulatory approvals to offer methadone at their new dispensing clinic. He said they do not plan to prescribe methadone initially, though. Rusen said he would be open to another conversation on the topic once the clinic finds success distributing Suboxone and Vivitrol.
Ithacan Stacey Dimas asked the panel how they plan to address barriers to treatment for women with children.
“What solutions do you have for women who are scared that if they come forward and seek treatment, they’ll lose their kids?… It’s not like they lack the love for their children, they’re just suffering from a disease that needs treatment. How do you address that?” Dimas asked.
Sullivan said supporting mothers in recovery remains a huge problem. She said supportive community forums can play a role by reducing the stigma mothers who seek care face. At the same time, she said broader changes to regulations and funding are needed to provide adequate services.
Recognizing those lost to addiction who never found their way to treatment, Judge Rowley said, “We’re not meeting people where they’re at.” He said that in the years to come, “the doors have to be open a lot wider than they are now.”