By Pete Angie
A comprehensive drug plan for the City of Ithaca, released in February by Mayor Svante Myrick, has garnered national media attention because of one component: a supervised injection site for users of illegal inter-venous drugs, the first such site proposed in the U.S.
The injection site, however, is but one facet of a far-reaching proposal. The attention paid to the site has overshadowed conversations about other aspects of the plan, such as Law Enforcement Assisted Diversion (LEAD) program, as well as some elements of fighting drug abuse that are not included in the plan.
“It will force us to all get better at what we do,” says Bill Rusen, CEO of Cayuga Addiction Recovery Services, of the LEAD program. LEAD allows law enforcement to redirect some drug users and sellers to community-based services, instead of jail or prosecution, and implementing it would likely increase demand for local mental health, housing, employment and drug treatment services.
Rusen served as the first chair of the Municipal Drug Policy Community (MDPC), the group convened by Myrick in April 2014 to begin work on what would be dubbed The Ithaca Plan: A Public Health and Safety Approach to Drugs and Drug Policy. The MDPC comprised local service providers, police, community leaders and others that respond to drug use in Ithaca, with representatives from four key areas: prevention, treatment, harm reduction and law enforcement.
According to the plan’s executive summary, groups from each of those areas met several times, a community forum was held, eight focus groups with almost 100 participants were formed, and there were dozens of one-on-one meetings with stakeholders. Input was also drawn from experts and literature in the fields of drug policy and treatment.
The completed version of the drug plan states several findings about local drug use and response, and makes 22 recommendations for how to move forward in handling the drug crisis in Ithaca. Examples of recommendations include opening a city office of drug policy, phone screenings for service referrals, a 24-hour walk-in crisis center, education programs, hepatitis vaccinations, expanding opportunities for those returning from incarceration, changes in school discipline policies, syringe disposal stations in rest rooms, increased access to housing and health care, and a supervised injection site, among others.
Rusen and others in the treatment community have expressed disappointment that a local detox facility was not included in the Ithaca Drug Plan. “Not having a detox in our line of work…is like having a hospital without an ER,” Rusen says. “If you don’t have that you’re not meeting the most immediate need people have to save their lives.” Rusen likens the lack of a detox site to bringing someone to the hospital after a car accident and telling them a bed will be available in a few weeks. He feels that robust use of the LEAD program, combined with a local detox center, would have a major impact on local drug use and recovery.
Angela Sullivan, Executive Director of the Alcohol and Drug Council of Tompkins County, also sees the potential for success through LEAD, and the need for a local detox facility. “Having a place for people to go when they’re ready is huge,” she says.
Currently, Ithacans seeking detox must join a lengthy waiting list to receive treatment at Syracuse Behavioral Health, in Syracuse. Not only does transportation limit this option for many, but by the time a bed is available a person’s readiness to take that step toward recovery may have passed.
Of the supervised injection site, Sullivan is less certain of its effectiveness. “I’m of two minds,” she says, noting that supervised injection does not address the collateral harms of drug addiction such as the effects on one’s family, children, employment and legal issues. On the other side of the issue she see that if an individual dies that also does a great deal of harm.
Michelle D’Angelo is a senior media relations officer at Vancouver Coastal Health, which operates the Insite injection center in Vancouver, BC, and has developed a pragmatic view of the services an injection center can provide.
“It’s not a safe injection site—it’s a supervised injection site,” she says, adding “It’s never safe to inject street drugs and it’s a bad idea.” Still, she sees Insite as providing an opportunity for drug users to reduce the risk associated with their habits, including risk of death, and come into contact with opportunities for treatment and recovery.
Unlike the injection center proposed in the Ithaca Drug Plan, Insite is directly connected to a detox center called Onsite. In addition to referrals to Onsite and other services, Insite provides primary medical care, including treating wounds and foot issues often associated with their clients.
D’Angelo says money has been saved on emergency responder services by reducing the number of overdose incidents in the city. Some 2 million injections have been done at Insite and there have been no deaths. “We are mandated to provide care to the vulnerable,” says D’Angelo of Canadian socialized medicine, and she is uncertain how such an operation would operate in the U.S.
Sullivan also sees more questions than answers associated with the proposed supervised injection site in Ithaca, including how state and private insurers would cover costs, and is discouraged by the emphasis placed on one aspect of the Drug Plan. “I don’t want to wait for a supervised injection site (to exist) to get the other things done,” she says.
Sullivan and Rusen both note that while the local Drug Plan contains recommendations in a variety of areas, it does not cover the how or when of implementing them. It is a blueprint, not a work order, says Rusen.
By Pete Angie