Another story on the Ithaca drug policy. This was all reported in two days after the plan rolled out, but the story ran another week later. The not-for-profit heads quoted below were a bit offput by the plan’s rollout: the short of their complaint was “We’re working on more solutions … but we don’t go around announcing projects until the funding is worked out.” Photo is of the Dick Van Dyke Center in Seneca County, which, from what I hear, has no connection to the actor Dick Van Dyke.
A lack of places to go for people to get off addictive substances is a common complaint around Ithaca. Tompkins County has neither an inpatient detox facility nor a crisis walk-in detox. The perception, at least, is that one must be court-mandated or fail out of an outpatient program like those at the Alcohol & Drug Council (ADC) or Cayuga Addiction Recovery Services (CARS) to get a spot in an inpatient detox – the closest of which are in Syracuse, Binghamton, Elmira, and the state-run Dick Van Dyke facility in Seneca County.
Take this quote from someone in the “business” focus group convened to give input to the new Ithaca drug policy for an example of this frustration: “Most people addicted to heroin are going to be on Medicaid. In order to get into in-patient, you have to fail out of outpatient … They need to have three or four dirty drugs screens before they can qualify to get into inpatient, which is where they needed to be initially, which can take 3-4 months.” Or read our June 2014 feature on the heroin epidemic “No Question It’s Gotten Worse” on ithaca.com, which features the frustrations of several people in recovery.
“Insurance is probably our biggest struggle with the inpatient (facility),” said Monika Taylor, director of chemical dependency services at Crouse Hospital, Syracuse, which hosts a 40-bed unit. “There’s supposed to be parity with behavioral health and primary health, but I don’t know if that’s fully happening quite yet.”
Once a patient does get into treatment, sometimes the insurance company might only end up covering a few days of treatment, Taylor said.
“You hardly ever see 28 days (of treatment) anymore,” said Rich Bennett, director of the Ithaca Rescue Mission. “You have to ask if it’s worth it to go into treatment for a week, and then whatever jobs and relationships are there might go away.”
Nevertheless, when someone walks into the Rescue Mission and says “I can’t take it anymore, get me into treatment,” Bennett said they do their best to get someone help because their attitude might “drastically change in three days.”
ADC has been in talks “for a while” with New York’s Office of Alcoholism and Substance Abuse Services (OASAS) to bring an inpatient detox to Ithaca, according to executive director Angela Sullivan. For now, ADC offers what they call “intensive outpatient” programming, which includes three three-hour meetings a week along with medically-assisted treatment for most of its clients trying to get off opiates – a number which has increased from about 5 percent of people calling them their primary drug in 2011 to about a third of the approximately 500 people ADC served last year.
As a state-certified provider of addiction services, ADC does have to reveal a positive drug test to probation or social services, whoever the referring partner might be.
“We do not automatically discharge someone for a positive test,” Russell said. “That is an old school myth that I don’t even think was true 10 years ago. When someone tests positive there’s always a conversation.”
Bill Rusen, CEO of CARS, found the lack of detox options in the Ithaca Plan to be its most objectionable omission.
“Imagine (Cayuga Medical Center) without an ER,” Rusen said. “When CMC was being built, they might have said we’re going to have shamans in there, it’s going to be fantastic. We’re going to have aromatherapy, an ICU, cancer care, cardiac care, but we’re not putting an emergency room in. If you’re having a heart attack you’re really not too interested if the shaman shows up. In this unfair, fallen universe we live in where there’s not enough time, energy, or resources for everything I think the first choice has to be a detox.”
CMC did host a detox until 2009, but “it’s a loser” financially, Rusen said. “You have to have a nurse and a medical person on duty all the time, even if they never saw a patient that day. Even insurance which pays better than Medicaid doesn’t pay enough to cover the costs.”
Rusen said he’s had a proposal “sitting around for about two years” to cover a walk-in outpatient detox, which would cost about $150,000 a year to cover staffing.
Though there’s no inpatient detox for Ithaca in the new plan, one of the recommendations is a 24-hour crisis center, which would serve as a place for law enforcement to bring intoxicated people without going to the CMC ER, a place with short-term temporary beds for people waiting an inpatient bed, and a safe “chill out” spot for people to go rather than being inebriated in public.
At the moment of crisis, the idea for the 24-hour center is to replace trips to the CMC ER, which cost the hospital, Bangs Ambulance, and Ithaca police $413,526.91 in 2015, according to the plan – one of the very few hard numbers included in the report, and one that CMC has made clear is not sustainable.
There is money available for this kind of diversion right now, according to Rusen and Russell, in the form of the Delivery System Reform Incentive Payment (DSRIP). The idea of DSRIP is to reduce avoidable hospital trips by people on Medicaid 25 percent in the next five years, with up to $6.42 billion available statewide.
“I assume this center is going to piggyback on (DSRIP) a little bit,” Rusen said.