Covid-19 has killed over 200,000 Americans and upended the lives of millions more, causing unemployment, failed businesses, anxiety and social isolation. For those struggling with addiction, drugs can be a tempting way to cope. The result has been an increase in overdoses across the nation, including in Ulster County, where County Executive Pat Ryan declared a public health emergency after overdoses increased over 150 percent compared with 2019. In response, the county, together with local health-care providers, is expanding its outreach and support efforts to try to prevent further loss of life.
New and ongoing initiatives
Prior to the pandemic, things seemed to be moving in the right direction in Ulster. Deaths from opiates dropped from 56 in 2018 to 33 in 2019. This year, there have already been 46 fatal overdoses, as well as 325 non-fatal overdoses. This makes the total number of overdoses the highest ever recorded at 371. (In 2019 there were 303 total overdoses and in 2018 there were 296.)
County officials have turned their attention to the issue, with increased funding and partnerships across different departments. For example, the Ulster County Healing Communities Study (HEAL) team is partnering with the Ulster County’s Sheriff’s office to create a spike alert communications plan. The new plan gives real-time updates to treatment providers so they are aware of a spike in overdoses, which may indicate there’s a bad batch of fentanyl-laced drugs in circulation. The HEAL team also created a public-education campaign on the risks of fentanyl.
“People are tired of talk, they want action from their government and law enforcement to combat this epidemic that is continuing to rip apart our communities,” said Ulster County Sheriff Juan Figueroa in a press release.
An ongoing effort launched by Figueroa is the Opioid Response As County Law Enforcement initiative, or “O.R.A.C.L.E,” a rapid-response team that was created in August of last year. The team has worked closely with addicts to get help and assist family members who need support. The program was recognized in January with the New York State Sheriff’s Association Innovation Program Award.
“There is a big stigma associated with people addicted to opioids that family members aren’t going to call,” said Figueroa. “When a family member calls law enforcement they’re afraid they’re going to have to pay for bail and an attorney if they’re arrested for drugs. I had to do something about that.”
Families can reach out to the hotline number at 888-996-0940, the cellphone number at 845-768-2410 or email oracle@ulstercountyny.com for help. If someone calls the O.R.A.C.L.E team and asks for treatment, they are then brought to the Ellenville Regional Hospital.
Following the declared public health emergency at the end of August, Ryan signed an executive order that established a new initiative, which places Narcan kits in 60 county buildings near the defibrillators and in high-risk locations in other parts of the county. All county staff will receive Narcan training.
“It’s so heartbreaking every time we lose someone,” said Ryan. “But, it re-energizes us to keep fighting on this.”
Partnership with Ellenville Regional Hospital
Talking with local officials, it becomes clear they view fighting the opioid epidemic as a collaborative effort. Ellenville Regional Hospital has been working actively with the county on this issue, particularly since receiving a grant from the Bureau of Justice Assistance in January, awarded around the same time the HEAL program started in Ulster County.
“We started talking about what’s the next step,” said Victoria Reid, executive director of the hospital’s Rural Health Network. “We came up with the idea for a High Risk Mitigation Team.”
As with other initiatives, the stress with the team is on intervention and education— identifying addicts at greatest risk of overdose and helping them get treatment. The county executive is asking for increased funding to expand the team in his proposed 2021 budget, adding a care manager to serve Kingston. Meanwhile, the hospital would fund two additional care managers to serve communities outside of Kingston.
“Their sole purpose every morning when they wake up and before they go to bed at night is to just think about how we can help this group of individuals who are at the greatest risk right now,” said Ryan. “They can personally, human-to-human, work directly with those struggling with addiction to make sure they are making progress on their recovery path.”
The High Risk Mitigation team is divided into three parts. The first is the fatality review team, which is made up of medical examiners, death-scene investigators, coroners, and treatment providers. They analyze fatal cases to determine how interventions could have prevented loss of life.
The second sub-team is the overdose prevention response team, which includes community health advocates, peer advocates, and those with personal experience with addiction. This team works directly with those struggling with an addiction.
“If we meet someone who is in treatment or using substances, we ask them if they’d like to be assigned a member of the team,” said Reid. “It’s to help them along their treatment plan.”
The final group is the overdose response team, which is O.R.A.C.L.E.
“We must double down on our efforts to combat the opioid epidemic,” said Ryan “I am confident that these initiatives—the High Risk Mitigation Team along with our strong partnership with Ellenville Regional Hospital—will help to save lives.”
Steve Kelley, President and CEO of Ellenville Regional Hospital, called the new approach “innovative” and “the first true prevention program to monitor and respond to events that predict overdoses.”
New funding would make it easier to attend treatment
Over the past two years, the county has put $1.3 million towards opioid-prevention spending. The county executive’s proposed 2021 budget includes $670,000 for this purpose.
“Like most budget documents, where you spend your resources shows what you take seriously,” said Ryan. “We are taking the threat from the opioid epidemic very seriously.”
The money would allow residents in need of a safe place to stay to obtain housing vouchers at local hotels when seeking treatment, provide childcare during appointments, and offset transportation costs.
“These funds will go a long way in helping to educate the public, provide needed treatment and support, and to ultimately save lives,” said Ryan “Ulster County will not just talk about the issue, we are taking real action and putting funding behind stopping an epidemic that has ripped apart too many families in our community.”
In addition, the county received a federal grant of $501,853 to be used over three years to help deliver a comprehensive intervention package to prevent the use of opioids, treat addiction and promote recovery.
Ellenville Regional Hospital also received federal money: $635,000, to develop an overdose response and fatality review team serving rural communities in Ulster County.
Treatment at the jail
Ulster County Sheriff Juan Figueroa has changed the way the jail treats addicts, administering methadone and Suboxone to addicted inmates.
It was introduced toward the end of 2019 as a part of a three-phase anti-opioid approach. The strategy combines public education, direct outreach, and the introduction of “medically assisted treatment.”
Last year, Sheriff Figueroa said it was time “to try a new approach.” In 2019 it was reported that on any given day about 200 inmates are placed at the jail on pretrial detention or are serving sentences of less than one year. Ten to 15 percent self-reported an opioid addiction.
Before the change to medically assisted treatment, addicts were forced to withdraw with only antacid and Motrin to dull the symptoms. Then they could decide whether to join a 12-step group offered within the jail.
With medically assisted treatment, patients use opioid replacements to “slowly wean themselves off of opioid dependence, or they may remain on a maintenance dose for years.”
“We have an unprecedented pandemic, but we still have an epidemic going on here,” said Figueroa. “On top of bail reform, budget constraints, anti-law enforcement rhetoric, we’re still going to press on. We are obligated to help people. It’s easy to have someone here, lock them up and throw away the key. All they’re going to do is keep coming back here. Our job is to correct that.”
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