Tompkins County
New York

Report or Discussion Item

Mental Health Services - Update on County Opioid Epidemic


Department:Mental Health DepartmentSponsors:
Category:Public HealthFunctions:Mental Health

Meeting History

Sep 18, 2017 4:30 PM  Health and Human Services Committee Regular Meeting

Mr. Kruppa and Ms. McDougall provided a PowerPoint presentation entitled Addressing Opiate Use & Other Substance Use Disorders (SUD), Tompkins County Public and Mental Health Services. Mr. Kruppa stated there have been inquiries made about what the Public Health and Mental Health Departments are doing about the opiate epidemic. He explained that the majority of what they do is behind the scenes work and it may appear that there is nothing being done but there is plenty they have done.

Ms. Kelles stated Dr. Klapeck will be doing a presentation at the October Committee meeting regarding the supervised injection sites. Mr. Burbank suggested inviting Gwen Wilkinson to the meeting also.

Ms. Kelles inquired about the goals of the treatment centers. Ms. McDougall explained that agencies started abstinence as a goal model but the model has shifted with evidence-based practices and both treatment centers in the County provide an abstinence-based model of care but also provide harm reductions as a model of care. Ms. Kelles is supportive of introducing the harm-reduction model and she hopes that it will expand the mentality throughout the system including the judicial and health systems.

Ms. Black asked if there was a number of drug related deaths available to date for 2017. Mr. Kruppa explained that those figures are not easily available due to ongoing testing and privacy issues.

Ms. Black inquired about the number of cases involving the use of narcan and its reversal affects. Mr. Kruppa stated Bangs Ambulance has been following the number of cases and the Hospital has been also. The problem is that there are a number of people with narcan administration kits and the only way to track the use of those kits is when they request a replacement kit. Mr. Kruppa stated currently there is not a manner in which to obtain an accurate count.

Ms. Black expressed concern about the length of time it takes for an individual to be admitted to detox and treatment and asked if providing those services within the County will fill the full need. Mr. Kruppa stated they will fill a dramatic gap in services and be more effective. He will have additional information once these facilities are up and operational and be better able to determine the additional supports needed.

Ms. Kelles stated the rate of usage has increased so quickly that it is very difficult for the State to track the information. Mr. Kruppa and Ms. Kelles explained that information gathered is passed on to the State. Mr. Kruppa said the Department is trying to provide numbers on a more timely basis knowing that the official numbers may change once the State completes there calculations.

Ms. Kelles is concerned about the average number of treatment days having decreased from 108 days to 50 days and inquired if there was any potential of increasing those days. Ms. McDougall explained the intention behind the State regulatory change of decreasing the length of stay in inpatient treatment is the hope of enrolling the individual in outpatient treatment and returning them to the community setting as quickly as possible to avoid using institutionalization as a type of treatment. This follows the model to not have people in the most expensive type of care facilities; however, this is shortening the treatment at the facility to provide certain types of residential treatment and skill building to enroll that person in outpatient services. She stated this is a tough balance as to the cost effectiveness and the most treatment effective and the new regulation changes include a great deal of new treatments.

Ms. Kelles is also concerned about the problem individuals have in obtaining treatment following a period of incarceration once their Medicaid status changes. Ms. McDougall stated Medicaid Managed Care is an issue taking place statewide and explained the changes that have taken place with Medicaid. The problem is that some treatment facilities do not accept straight Medicaid and the individual must change their status to Medicaid Managed Care and this takes 30 to 40 days to do. She said New York State Office of Mental Health Services and New York State Office of Medicaid are looking into this.

Mr. Burbank inquired about what mechanism is used to determine a “bad batch” of a certain drug being circulated in the community. Mr. Kruppa explained that generally law enforcement are making those announcements as they have access to that information and they feel the need to make a public service announcement and spoke of some risks going along with those announcements. There is a need for education for the entire community to better understand from all directions how to better address this issue.

Ms. Black asked if there are any known intentions of New York State decreasing the time frame it takes to establish a methadone clinic. Ms. McDougall stated that methadone clinics involve complicated regulations and numerous oversight agencies and to further complicate this, a clinic is usually only allowed if there is a certain population in need in the community. She said there are also other types of medications that can be used in recovery steps.