TOMPKINS COUNTY, N.Y.—The REACH Medical clinic started four years ago as one example of a new era in harm reduction drug treatment programs in Ithaca, adding another option to those that were in place in the city and extending its presence to a wider variety of patients during the pandemic, using telehealth to maintain a connection to the homeless population.
As an opioid overdose program (OOP) site, REACH Medical provides over 300 doses of Narcan to the Tompkins County area every month as well as additional integrative services that focus on low-barrier harm reduction care.
REACH Medical Director of Operations Samantha Stevenson and Judy Griffin, physician and director of research, gave a presentation to the Tompkins County Legislature’s Health and Human Services Committee on Dec. 19, on the range of services that the organization provides. The agenda can be found here, and the meeting can be watched here.
Since opening to the community in 2018, REACH has interacted with over 1,800 patients in Tompkins County, providing primary and acute care, Hepatitis C testing and treatment, HIV care, case management, addiction consult services along with Cayuga Medical Center, and provides a clothing closet and daily food supply.
“We work in the field of addiction, many of us, because we know people living with substance use disorders face tremendous barriers to accessing healthcare,” Griffin said. “When they do access health care, frequently, they receive substandard or inadequate care and services.”
According to Griffin’s presentation, drug overdoses increased 15% between 2020 and 2021, and 30% between 2019 and 2020.
“These deaths are driven by fentanyl. In The United States, we have the highest rate of overdose or drug-related deaths in the world, and at the same time we have the least access to treatment,” she said.
Locally, Griffin said, numbers have been increasing since 2020, which mirrors national trends, and said she anticipates the trend to continue once the final 2022 numbers are tabulated.
With opioids in particular, Griffin said, treatments can be very effective when accessible. REACH uses “maintenance” doses of buprenorphine and a chronic management treatment model, which doesn’t include a detoxification treatment.
“Detox is increasingly less likely to succeed over time,” Griffin said, adding that maintenance buprenorphine is also a cost-effective treatment.
During the pandemic, REACH also administered more than 370 COVID-19 vaccines and is able to administer monkeypox vaccines to individuals with unstable housing as well. REACH also offers the Tdap vaccine (which addresses tetanus, diphtheria and whooping cough) and Hepatitis A and B vaccinations.
Stigma and fear around treatments can hamstring REACH’s ability to help more people, Griffin said.
“We work hard to try and clear up language and deliver just evidence and facts around [treatment],” she said.
Reacting to the presentation, Tompkins County Legislator Randy Brown asked if REACH has had problems getting Narcan, and Stevenson responded that she orders doses directly from New York State and hasn’t had any issues. Fellow legislator Mike Sigler asked when individuals would transition off buprenorphine treatment.
“We see decades of data that supports long-term maintenance, and we know that up to 90% of people who taper off the medication will return to other opioids,” Griffin said. “We’re talking about a life-saving medication that is safe and effective, withholding that medication puts someone’s life at risk because opioid use disorders are a life-threatening condition.”
Griffin also said that she has patients who have been on buprenorphine for more than 10 years. Legislator Veronica Pillar asked about how effective a detox center would be, which is something that has been discussed in Ithaca and Tompkins County over the past several years.
“I strongly believe in people accessing care voluntarily,” Griffin said. “People want safe spaces to transition off of substances, and we don’t provide a lot of options for that. Detox is viewed as one option, and a lot of times our patients are facing tough choices like ‘do you want to go to prison or do you want to go to detox?’ and that’s a scenario in which people would express interest in that kind of treatment.”
Stevenson and Griffin both said that supportive, housing-first models would be complementary services for harm-reduction and case management models like REACH provides.
Sigler also asked what the biggest “barrier is to getting [people] on medication” like buprenorphine.
“The biggest barrier remains stigma — there’s a widespread belief that addiction is a choice and a moral failing, and that type of view of addiction informs how people engage with treatment,” Griffin said.
Other news and notes
- Implementation of security measures at the Human Services building on West State Street is ongoing.
- Interviews for finalists for the deputy county administrator position will be held this week.
- Commissioner of Social Services Kit Kephart said that the department still has between 10 and 12 vacancies but hopes for improvement soon.
- Homeless numbers are steady at 175 people sheltered, and Kephart said that about 125 have applied for additional housing services.
- Kate Shanks-Booth, director of Tompkins County Youth Services, said that a new youth commission will be opening in Newfield in the new year. Shanks-Booth also said that one position is open in the youth services department, which will likely be filled in 2023.
- Brown introduced a resolution urging Gov. Kathy Hochul to adopt universal access to free meals for grades K through 12, which happened during COVID for all schools. The current program will expire in June 2023 and would cost the state approximately $200 million per year. The resolution passed unanimously.
- Committee Chair Dan Klein closed the meeting with a health and human services knock-knock joke. “Who’s there?” “HIPAA, sorry I can’t tell you.”