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ADDRESSING THE ADDICTION EPIDEMIC IN DUTCHESS COUNTY



From a public health perspective, taking steps to combat an epidemic of any kind requires an accurate and reliable assessment of the problem at
hand and a comprehensive plan to intervene where needed. The Dutchess County substance abuse initiative developed in response to the
growing concern expressed by numerous county agencies about prescription and opiate drug abuse at regional and local levels.

A subcommittee of the Dutchess County Health and Human Services Cabinet convened in 2013 to begin efforts to develop an integrated county
response to the crisis. This effort involved a number of agencies and officials with the leads being the Dutchess County Department of Mental
Hygiene and the Dutchess County Department of Health.

A link to the report of this group, released in December of 2013, can be found at the end of this document.

Below are descriptions of activities underway as well as issues being addressed or needing to be addressed:

Department of Health/Medical Examiner perspective and involvement of law enforcement, other first responders and emergency rooms

The magnitude of the problem in Dutchess County could be accurately assessed thanks to the collaborative efforts of law enforcement agencies
and the Medical Examiners Office, a division of the Department of Health. Since 2004, protocols established by the updated medical examiner
program reflect best practices for death scene investigations and toxicology analysis. Investigators from the Medical Examiners Office respond
to all death scenes along with law enforcement and are required to produce a detailed report summarizing the circumstances of death, the
medical history of the deceased, physical characteristics of the death scene, and to list all medications and drug paraphernalia found.
Comprehensive toxicology testing is performed in all cases accepted for autopsy/postmortem examination and consists of a screening for over
300 therapeutic and abused drugs and their major metabolites and a quantitative confirmation of all positive results.

This approach has enabled the Medical Examiner to accurately certify drug fatality deaths and record mortality trends due to heroin,
prescription opiates and other types of drug use over the course of the past ten years, and to identify contaminants in drug batches when
present. Since 2009, the Medical Examiner has shared this information with the Dutchess County Drug Task Force, a program led by the
Dutchess County District Attorneys Office, and with the Special Operations Unit of the Dutchess County Sheriffs Office, providing real time data.

Concurrently, information shared between Dutchess County Emergency Response and the Department of Health provides an overview of non-
fatal drug overdose trends in the county. These numbers are more difficult to assess, given that some overdose victims respond to opiate
antagonists and refuse to be taken to the hospital, and that comprehensive toxicology testing is rarely done in emergency room settings due to
cost constraints.

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Since November 2013, in response to a sharp increase in heroin use within the region, the Dutchess County Department of Health changed its
procedures and is now calling the emergency departments of all three local hospitals on a daily basis to inquire about non-fatal drug overdose
admissions and fatalities.

Strategies of the Department of Mental Hygiene and Department of Health

In the context of the NYS Prevention Agenda for 2013-2014 and in collaboration with its many community partners, the Dutchess County
Department of Health chose prescription drug abuse as one of the four main focus areas of its Community Health Improvement Plan. This plan
calls for the development of evidence based strategies to address the addiction epidemic, and aims to reduce by 10% the incidence of
prescription drug use among teenagers, the number of drug-related emergency room visits and hospitalizations, and the number of overdose
fatalities by 2017. On a larger scale, the comprehensive Dutchess County initiative to address substance abuse proposes to 1) increase public
awareness and engage the community, 2) support public policy that regulates the accessibility of prescription drugs and promotes harm
reduction, and 3) advocate for prevention and facilitate access to treatment.

Prevention

In its planning activities, the Dutchess County Department of Mental Hygiene (DMH) identified prevention as its number one priority for
chemical dependency in 2010 and outlined an agenda for prevention in its 2011 Local Governmental Plan for chemical dependency. In 2013,
through the efforts of County Executive Molinaro, the NYS Office of Mental Health provided additional funding which was used to support a
comprehensive prevention plan for mental health and chemical dependency. DMH adopted the SAMSHA Prevention Model as its road map. This
approach is an evidence-based, data driven approach which will reduce identified risk factors in the community while strengthening protective
factors. Currently there is an active educational component utilizing Mental Health First Aid which will provide training to address stigma,
youth surveys have been administered in the schools and the data will be used to develop Logic Models in local communities. Coalition
development is moving forward in several areas of the County. Environmental strategies, modifying/changing policies as well as prevention
programming for both adults and youth and enhancing skills of primary care providers are part of these Logic Models.

Treatment

Early identification and treatment are essential components for successful recovery. DMH has actively partnered with the criminal justice system
for years to identify individuals who become involved in the criminal justice system as a result of their chemical dependency. Last year over 600
individuals were evaluated for treatment as part of an alternative to incarceration approach. In addition, DMH staff are embedded at the DC Jail
to identify and link individuals to needed treatment and supports once released from jail to reduce relapse and recidivism. DMH staff members
are also stationed at the Department of Children and Family Services to identify and link individuals to necessary treatment when applying for
benefits. DMH also participates in the local Drug Court and Diversion Court programs, has embedded staff in the Probation Department to work
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side by side with Probation Officers to address behavioral health issues and has an Intensive Treatment Alternative Program (an outpatient day
rehabilitation program for offenders) which has a Probation Officer embedded in the treatment program.

Identified Gaps and Barriers

Although the initiatives of the Medical Examiner described above have yielded success in the ability to collect and analyze data, the Office has
identified access to accurate and reliable data concerning non-fatal overdoses as one area for additional focus.

DMH has identified several barriers to care and treatment, two in particular are:

Stigma. In the past several years the Beacon community has objected to allowing treatment programs to operate/expand in their
community. Recently, the Rhinebeck Zoning Board implemented a Cease and Desist order for a treatment program in the Village.
Currently, Millbrook is reviewing a request to re-open a program for long term treatment and is facing community objection to the
request.

Insurance. Insurance companies will not authorize long term inpatient treatment for the majority of patients (unless they have failed
at outpatient treatment) which is the most effective treatment for opioid addiction. Outpatient treatment needs a stable housing
component coupled with daily outpatient day treatment which again can be costly and often not fully covered by insurance. Stable
housing is not always available for these individuals making outpatient treatment difficult, presenting an additional barrier.

December 2013 Health and Human Services Cabinet Report and most recent statistics

Link to report - http://www.co.dutchess.ny.us/CountyGov/Departments/Health/publications/PrescDrugRpt_Oct_2013_FINAL_12202013.pdf