In 2018, when Ulster County had the second highest number of overdose fatalities in the state outside New York City, the county decided to prioritize the opioid epidemic in our own back yard. Several crucial state and federal grants and county strategic planning and implementation helped achieve a dramatic decrease in opioid overdose fatalities. In 2022, overdose fatalities in Ulster County have been trending 50 percent from the previous year.
This past August told a far different story. Ulster County lost ten people to substance-use disorder in just one month. Though that epidemic-level was extremely alarming, the annual statistics show the overall trend continues moving in a positive direction.
“We are still seeing a decrease in overdose fatalities overall at 39 percent, but August has been a really hard month,” according to Juanita Hotchkiss, project manager for the Healing Communities Division at the Department of Mental Health.
This sudden spike in overdose fatalities was an opportunity to alert the public, increase awareness and provide education about substance-abuse disorders, and remind the community that an abundance of resources are available.
“We are seeing a change. We want the public to know about it, so we can work to prevent more deaths,” said Phoenix Kawamoto, education coordinator for the New Paltz prevention and response team. “Every fatality is devastating,”
Hotchkiss and Kawamoto say the type of drugs that are in the community is the reason for the spike. Asked about which drugs, Hotchkiss doesn’t hesitate. “It’s fentanyl,” she said. “A drop can kill, and we are seeing fentanyl in the majority of our overdose fatalities, and not just in opioids.”
Fentanyl is a narcotic, a powerful synthetic opioid used to treat cancer patients. According to the United States Drug Enforcement Agency, fentanyl has a potency that is 50 to 100 times stronger than morphine. Produced in Mexico in clandestine circumstances, it is used as an additive to other drugs such as heroin.
High-risk mitigation
Ulster County uses a ‘no-wrong-door’ approach. Any individual seeking help for themselves or a loved one can walk through any door and learn how to connect to resources and support. The OSAT team’s 45 members meet monthly to look at data, identify trends, and develop strategies that stakeholders can implement in their communities.
“The overarching goal is always to reduce opioid overdose fatalities by 40 percent [annually], and if we do that every single year, we will hopefully be down to zero,” Hotchkiss explained. “We choose strategies and implementation plans based on evidence-based, best, and promising practices.”
The work never ends. Opioid Response As County Law Enforcement (ORACLE), launched in 2019 as an initiative of sheriff Juan Figueroa, seeks to educate the community through Narcan (naloxone) training, outreach, and connecting to individuals who have had prior overdoses. It expanded in 2021, launching a high-risk mitigation team that provides two peer-support staff and a social worker to respond to overdose reports.
Hotchkiss said the program has been “extremely, extremely impactful.” There have been 683 referrals. Some 98 percent of the individuals engaged agreed to receive peer services. This team will stay with the individual until they are confident that recovery has taken place.
Hotchkiss and Kawamoto stress the importance of Narcan distribution and education, anti-stigma education, and harm reduction as vital evidence-based practices. “The message to the public is to get trained and for businesses to install a Naloxbox,” says Hotchkiss.
Businesses can access Naloxboxes through the county’s mental-health department. “It’s really important to have this resource available if someone were to encounter someone having an overdose.”
These boxes are installed similarly to Automated External Defibrillators (AEDs) in public buildings and organizations. Businesses that have these boxes in their establishments should have stickers on the doors to acknowledge the resources available. Narcan training takes place regularly throughout the county both in-person and online.
Signs of addiction
Preventive strategies such as harm reduction and anti-stigma education are equally important. The opioid epidemic does not discriminate.
“At this point, it’s really hard to find someone who has not been touched by it,” said Hotchkiss. “Anyone who takes opioids is at risk of becoming addicted, regardless of age, social status, or ethnic background.”
Among the common signs of opioid addiction are:
• Regularly taking an opioid in a way not intended by the doctor who prescribed it, including taking more than the prescribed dose or taking the drug for the way it makes a person feel
• Taking opioids “just in case,” even when not in pain
• Mood changes
• Changes in sleep patterns
• Borrowing medication from other people or “losing” medications so more prescriptions must be written
• Seeking the same prescription from multiple doctors, to have a backup supply
• Drowsiness
• Weight loss
• Frequent flu-like symptoms
• Isolation from family or friends
• New financial difficulties
Harm reduction is an evidence-based approach that “meets individuals where they are” and works directly with individuals to set achievable goals to prevent transmissible disease and overdose, provide attainable treatment, and improve mental and physical health, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Ulster County distributes harm-reduction kits and provides training and counseling services.
“We want people to feel safe to get help and we will meet them where they are.” Kawamoto said. Kawamoto distributes free harm-reduction kits and medication disposal bags, and leads a free Narcan training session at the New Paltz farmers’ market (45 Main Street, New Paltz) from 10 a.m. to 1 p.m. The market will run through November 19.
A whole-health approach
Anti-stigma education beginning at a young age is one of the most important initiatives that can take place. Learning about addiction and substance-use disorder allows individuals, family members, colleagues, and friends to talk about risky behaviors, to learn to notice warning signs, and to have the language to navigate difficult situations to reach a common goal of recovery. Family of Woodstock and the Ulster Prevention Council serve as Ulster County’s youth-prevention providers, involved in education in six school districts across the county.
Ulster County school systems will this year be a part of a program called Mental Health in Schools in partnership with the LaSalle School organization in Albany. This new program will work with families, connecting them to resources such as mental health, physical health, housing, employment, and nutritional needs.
“Essentially, this team will address the whole-family system, taking a whole-health approach, addressing each social determinant of health that is adversely impacting the family,” said Hotchkiss. “This is exciting because it’s mental health and case management rolled into one.”
This past April, Ulster County executive Pat Ryan announced the purchase of a building in Kingston that will be the home of the crisis stabilization center in Ulster County. The center will provide a safe space for residents to go 24/7 who may be seeking mental-health or substance-abuse support. The establishment of this center is a part of a larger goal to provide sustainable and creative strategies to help individuals.
The public is invited to attend the fourth annual Recovery Fest this Saturday, September 18 from noon to 4 p.m. This event, co-sponsored by Step One and Ulster Prevention Council, is free to the public. All are welcome. The festival is “a day of fun, support and honoring the journey.’
Attendees have the opportunity to take Narcan training, learn from wellness practitioners, visit information tables, and listen to speakers in recovery. There will be live music, a barbecue picnic, a bounce house, games and face painting. For information, call Phoenix Kawamoto at 845-275-5413.
Where to find help
For connection to mental-health and substance-use resources:
Ulster County Mental Health. Address: 239 Golden Hill Drive, Kingston. Phone: 845-340-3150. Email: dmh@co.ulster.ny.us
New Paltz Overdose Prevention & Response Team. Phone: 845-256-5014. Email: Phoenix Kawamoto, pkawamoto@townofnewpaltz.org
New Paltz Office of Community Wellness. ORACLE Hotline: 888-996-0940
Family of Woodstock Teen Intervene. Phone: 845-647-2443, x115. Email: ycms@familyofwoodstockinc.org
Ellenville Regional Hospital Textline: Text ERHRescue to 21000
Learn more about the NYS recovery-friendly business initiative: Contact Dennis Morgan — People USA. Phone: 845-645-2714
For information on obtaining fentanyl test strips or Naloxboxes contact: Ulster County Department of Health, Vincent Martello. vmrt@co.ulster.ny.us Phone: 845-334-5585
Join the family! 
