CATSKILL — Greene County is among the counties hardest hit in the state by the opioid epidemic, according to health officials.
Jason Fredenberg, county director of community services and mental health, and Laura Churchill, deputy director of Greene County Public Health, presented the county’s response to the health crisis to the Greene County Legislature on Wednesday.
“Unfortunately, Greene County is not doing well with regard to the opioid epidemic,” Fredenberg said.
The county was among those hardest hit in the state by the “opioid burden,” which considers overdose deaths, nonfatal emergency room visits and opioid abuse and dependence, according to 2018 data from the state Department of Health.
“In a recent study, when they looked at the opioid burden in Greene County, it was 33% higher than the rest of the Capital Region and 45% higher than the state as a whole, so Greene County has been hit very hard,” Fredenberg said.
The number of overdose fatalities in the county has been on the rise in recent years, he said.
“In 2019, there were nine, in 2020 there were 14, and in 2021, as of July 31, we were already up to 11, so that number is increasing each year,” Fredenberg said.
The number of overdoses in the county — fatal and nonfatal — has also been rising, peaking in 2020 when the majority of overdoses could be attributed to heroin and fentanyl, a synthetic opioid.
Prescription drugs provided by physicians also contribute to the problem.
“Many people in our community here in Greene County are being affected and their addictions may have started or been escalated by prescription drugs,” Fredenberg said. “There is a very high incidence of prescribing dangerous prescription drugs in Greene County.”
There are ways to battle the problem.
“Addiction is treatable,” Fredenberg said.
The county is taking a multi-tiered approach to addressing the addiction problem, he said, with multiple agencies collaborating.
Prevention of overdoses or getting addicted is the first key action area.
“For prevention, there are a number of services,” he said. “There are certified recovery peer advocates. This is a relatively new certification for people that can train that have lived experience with addiction. They might be someone who is in recovery that can get certification from the state and they can serve as a certified recovery peer advocate. They can be helpful in a number of ways, especially with linkage to treatment center services and supports.”
Prevention counselors are also available in schools in grades 7-12 and youth support groups aim to prevent addiction, Fredenberg said. Medication destruction bags are also provided to destroy leftover painkillers so they don’t fall into the wrong hands, along with medication takeback events sponsored by police departments and others.
When an individual overdoses and survives, there are additional interventions in Greene County that provide overdose reversal medications such as naloxone and Narcan, including services by the sheriff’s office, Greene County Paramedics and Greener Pathways.
“Naloxone is given when somebody has respiratory depression and is no longer breathing,” Churchill said. “Naloxone reverses the overdose by literally going to the receptor in the brain and throwing off the opioid, and the person can wake up. Sometimes they need more than one dose before they wake up.”
In 2019, law enforcement officers, paramedics and emergency medical services successfully completed 59 overdose reversals in Greene County, and in 2020 there were 86, with 17 so far in the first quarter of 2021, Churchill said.
Harm reduction services have drawn some controversy in the community, Churchill said.
“Harm reduction has a negative connotation — some people don’t necessarily agree with harm reduction, but I propose that harm reduction is a pathway for some people who are actively using drugs towards improving their life’s outcome to get to a place and time where they might be ready to stop,” Churchill said. “Maybe not the first, second, third or fourth time, but maybe the fifth, sixth or seventh — we don’t know. We are not in their shoes.”
Harm reduction for drug addiction is similar to providing nicotine replacement for a smoker who is looking to quit, Churchill said.
“Harm reduction decreases the health risks of an activity without requiring them to stop the activity itself,” she said. “It does not encourage substance use and we do not force people to stop using, but it is kind of a nonjudgmental approach to helping people to get on their path. Small successes lead to big successes.”
Other harm reduction services include Narcan training and distribution to train individuals in the use of overdose reversal medications, and fentanyl test strips, which aid users in determining if their drug supply is contaminated with fentanyl.
Churchill said she has seen fentanyl added to other drugs such as cocaine and methamphetamine, and has even heard of it being added to marijuana.
“A person thinks they are getting one drug when in fact they are getting fentanyl, and they go into respiratory depression and they are dead,” she said. “The reason we are encouraging the use of fentanyl test strips is to provide people with the knowledge and tools to be safer. This is a pubic health measure.”
For individuals in recovery, the county offers services such as mental health treatment, support groups, 12-step harm reduction, certified peer recovery advocates and programs for young people to promote a drug-free life, Churchill noted.
Drug-treatment court is another potential way to reach people, she added. There has been a drug-treatment court in the county for years, but next the county is looking at a court specifically geared to opioid use, to help guide people toward treatment for their addiction.
But the county also faces challenges in fighting the battle against drug addiction, she said.
“We don’t have a recovery outreach center in Greene County,” she said. “Stigma — when people feel that they’re being judged they will not seek services and that’s a huge, huge barrier in this county.”
The county does not have a detox facility or methadone treatment program.
“We don’t even have pain management, so somebody with legitimate pain who needs narcotics, we don’t have that service in Greene County so people sometimes use illicit substances when they are in pain,” Churchill said.
She urged legislators to help destigmatize drug addiction and view it as a chronic disease.
“We really have to rethink what is harm reduction and how do we not stigmatize people who use drugs and then not use drugs and then use drugs again,” Churchill said. “The word ‘addict’ is not helpful — a person who uses drugs is a lot less stigmatizing. We don’t use the word ‘clean’ — people are not dirty, they are using drugs. Substance-free is a better way to say it.”
Greene County Legislature Chairman Patrick Linger, R-New Baltimore, said county agencies working together helps matters.
“One of the positives I see here, just thinking back over the past, is we had all these segmented agencies that were all trying to do their thing. I don’t know that we had the collaboration that you’ve got now,” Linger said. “Collaboration is what really seems to bring out the good ideas and makes sure you are hitting as many people as possible.”