Patricia Strach is a professor of political science and public administration and policy at UAlbany's Rockefeller College of Public Affairs & Policy and the director for policy and research at the Rockefeller Institute of Government, a public policy think tank for the 64-campus wide SUNY system. Strach is the principle investigator of the institute's Stories from Sullivan, a series that examines how opioid misuse affects local communities and what kinds of policies could make a difference.
Patricia Strach is a professor of political science and public administration and policy at UAlbany's Rockefeller College of Public Affairs & Policy and the director for policy and research at the Rockefeller Institute of Government, a public policy think tank for the 64-campus wide SUNY system.
Strach is the principle investigator of the institute's Stories from Sullivan, a series that examines how opioid misuse affects local communities and what kinds of policies could make a difference.
Special thanks to Kyle Adams, host of the institute's Policy Outsider podcast (anchor.fm/policy-outsider), who helped make this episode happen, as well as to Patrick Dodson, for production assistance.
Learn more about Stories from Sullivan:
rockinst.org/stories-from-sullivan/
Photo credit: Rockefeller Institute of Government
The UAlbany News Podcast is hosted and produced by Sarah O'Carroll, a Communications Specialist at the University at Albany, State University of New York, with production assistance by Patrick Dodson and Scott Freedman.
Have a comment or question about one of our episodes? You can email us at mediarelations@albany.edu, and you can find us on Twitter @UAlbanyNews.
Sarah O'Carroll:
Welcome to the UAlbany News Podcast. I'm your host, Sarah O'Carroll.
Sarah O'Carroll:
I have with me Patricia Strach, a professor of Political Science and Public Administration and Policy at UAlbany's Rockefeller College. Strach is also the director for policy and research at SUNY's Rockefeller Institute of Government. She is the principal investigator for the Institute's Stories from Sullivan, a series that examines how opioid misuse affects local communities, and what kinds of policies could make a difference.
Sarah O'Carroll:
Patty, thank you for being here this morning.
Patricia Strach:
It's nice to be here. Thank you for inviting me.
Sarah O'Carroll:
Now, I have you here with me to talk about your research in Sullivan County, New York. So for those of us, myself included, who have never been to this community, can you help us establish a sense of place?
Patricia Strach:
Sullivan County is located between New York City and Albany on the Pennsylvania border. It's about 90 miles northwest of New York City. It's a small county, population-wise, it has only 78,000 people, but it's 1,000 square miles.
Sarah O'Carroll:
Okay. Now what made you choose this community to focus on, and what were some of your questions going into the project?
Patricia Strach:
So Sullivan County has an opioid problem. It has some of the highest opioid death and hospital admission rates in the state. But it also has a problem that many places around the country have, so this is a problem in rural communities across the country that look a lot like Sullivan.
Sarah O'Carroll:
And what are some of the problems that are distinctive about places like Sullivan that are challenges perhaps you wouldn't know about just from reading about the epidemic online?
Patricia Strach:
So, rural communities are different from urban or suburban communities, and I think we all know that, but we don't exactly know how they're different. So one of the things that's a huge problem in places like Sullivan and other rural communities is a lack of transportation. So Sullivan has a bus that runs on Thursday and a bus that runs on Friday and that's it.
Sarah O'Carroll:
Wow.
Patricia Strach:
So although you can get to treatment through Medicaid taxis, it's difficult to do all the other things you need to do to stay healthy, get to the pharmacy, buy groceries, et cetera, without transportation. And so I think that's one thing that a rural community has.
Patricia Strach:
Staffing shortages are problems in rural areas like Sullivan, so there's a real lack of doctors and physicians and addiction specialists that move to rural communities. There's a shortage nationally, but there's a real problem in rural communities. So there's, for example, no child psychiatrists in Sullivan, so the nearest child psychiatrist's in the next county over and it's a two year wait to get in to see that person.
Sarah O'Carroll:
Wow. So being spatially isolated but then also within that municipality there is difficulty in getting the services you need.
Patricia Strach:
Right. So in a place like New York City, access may mean you can see the doctor working in the building, and you're not be able to go see them because you lack the right insurance, but in Sullivan that doctor just isn't there.
Sarah O'Carroll:
So I read that you and your research team have completed over 100 interviews. That's quite a lot. Who all have you spoken to in order to better understand the causes and effects of the epidemic, and who are you still hoping to speak to before this project is out?
Patricia Strach:
We have spoken to a lot of people. We've spoken to doctors and nurses and lawyers and district attorneys and judges and activists in the community, and parents who are affected by this problem and people who are in recovery. So we've gotten kind of a broad picture about what the problem looks like. And we still, we've spent a lot of time in Sullivan, we're moving on to Orange County which is the neighboring county, and we'd like to get down into Queens County in the city as well.
Patricia Strach:
And really what we're moving to next is to talk to those people in different geographic areas of the state and to move up the ladder, so once we've finished talking to local government and local folks, we want to talk to state officials and then federal officials. And then come back down to Sullivan and say, "Here's what we've found, what do you think of what they're doing at other levels of government?"
Sarah O'Carroll:
You mentioned that transportation was one facet of this. Was that part of your questions going into it, or can you share a little bit more about, you started with these sets of questions and how that changed throughout your process?
Patricia Strach:
Yes. We are not opioid experts at the beginning of this process, and so we went down there really trying to get a sense of what the problem looks like in the community. We think that there's a lot of research going on, there's a lot of discussion, everyone's talking about opioids at the national level, at the state level. Policy makers are trying to do something about it, but they don't actually understand the problem. And so that's what really, we went down there with very open-ended questions: what are opioids doing to your community, how are you responding, and what would you like people outside your community to know? So those are the three questions we went down to. And it just opened up a whole series of other questions that we then started to pursue.
Sarah O'Carroll:
And can you share some of the misconceptions or the misguided opinions, even myths, that you'd want to clarify?
Patricia Strach:
So, one of the things that we hear a lot is that, well, people are turned away from hospitals or from treatment facilities because you can't die from opiate withdrawal. But you can die from opiate withdrawal. The symptoms are very much like a severe flu, so the same kinds of things, and dehydration that leads to problems with the flu also leads to problems with opiate withdrawal. So that's one of the big myths.
Patricia Strach:
Another big myth is that hospitals can't provide detox services. So we see a lot of people say they get turned away from the emergency room when they show up, because the hospital says they can't treat them. But they can treat people. They can detox people. The state agency that oversees them, OASAS, has granted waivers to hospitals so that they can see people.
Patricia Strach:
And I think the third myth is that high-quality treatment means out-of-state treatment. And so we have a lot of people who are sending their family and their loved ones out of state for treatment. And there's actually very good treatment inside New York State. And although there are some great treatment facilities outside New York State, there's also a lot of predatory facilities in places like Arizona, California, and Florida, who will bring you out there, run your insurance dry, and then leave you there. So...
Sarah O'Carroll:
Oh, wow.
Patricia Strach:
Yes. And so it's a huge problem that families can rack up $100,000 quite easily in bills and their loved one is left in the desert in Arizona or in Florida.
Sarah O'Carroll:
And this person is probably at this out-of-state facility because they were turned away from a hospital within their state.
Patricia Strach:
Well, actually oftentimes people go to those facilities either because they want to keep this quiet, and so will send their loved one out of state, or, you know, there are luxury rehabs, and they have nice pools, and you call and someone answers the phone. So a lot of what we're seeing is that folks can't get into treatment here not because treatment is not available,`` or not because beds are not available, because it might be as simple as, you know, there's staffing shortages, so there's no nurse to do the intake, there's no receptionist to answer the phone, very simple things can lead to very big consequences.
Sarah O'Carroll:
What else would you want those who are battling the issue, like yourself, in research or in policy, what would they need to know in terms of accessing these services, or about the epidemic itself?
Patricia Strach:
So I think one thing we would like people to know, and one of our finding is that there's what we call an illusion of services in New York State. So services that are available on a computer screen are very hard for people to access in person. So one of the things that we kept hearing over and over again on the ground is it's a long wait to get into treatment, it's very hard to get into treatment, there are not enough beds, there are not enough beds. And then we would talk to folks at the state level who say, "We have 1,000 extra beds a day. New York State does not have a lack of options."
Patricia Strach:
And so we tried to figure out why you had these very different perceptions, and what we found out is that there's real barriers that keep people out of treatment, such as showing up at the hospital and not being able to be detoxed at the hospital. Such as admissions criteria that requires, there's an empty bed but it's only for a male, or it's only for a female, or it's only for someone over the age of 21. That the staffing shortages make it really hard for treatment facilities, good treatment facilities, to take all the people who might be showing up at their door because they can't keep it staffed at the level they need to.
Patricia Strach:
And then there's, probably one of the biggest barriers to treatment is restriction on medication-assisted treatment. So right now the federal government limits how many doctors can prescribe medication-assisted treatment, you have to go through training to be able to prescribe it. And it also limits how many patients you can treat once you go through that training. So, if you are a doctor or a nurse or a veterinarian you can prescribe opioids, but only a very small number of physicians are qualified to prescribe medication-assisted treatment to fight the opioid use disorder that people have. And so you have a really upside-down system where it's much easier to prescribe these drugs than prescribe the treatment to help people get off of them.
Sarah O'Carroll:
Which of course only compounds the problem.
Patricia Strach:
Which, exactly, compounds the problem. And that's one of the things that we're seeing is that the governments at the local level are not the ones that created this problem, and they're the ones tasked with cleaning it up. And the other thing that we notice is that the governments who are least well-resourced in terms of dealing with the problem are dealing with the hardest crisis in their counties, so small rural communities are being hit really hard, and they just don't have the resources that a place like New York City or Los Angeles or Chicago has. Not just in terms of dollars but in terms of doctors and facilities and treatment options that may not be available in their communities.
Sarah O'Carroll:
I feel like when we talk about policy it seems easy to be very distanced, but that's of course the opposite of what you all have been doing by going to these communities and talking to people. Are there any stories or anything you'd want to share from talking to those who are physically struggling with this issue, and what you learned from them?
Patricia Strach:
I think there's two lessons from being out on the ground, and the one thing is when we show up at these facilities and these community treatment centers that are clearly overwhelmed, they have a huge problem on their hands and they don't have very many resources to address that problem... and what we expected when we said, "What do you need to do a better job? What would you like from other levels of government?" And the surprising answer was like, "Sure, money would be great, but..." And then a long discussion of how they wish that state officials, that federal officials, would come out to their community and see what they see, and understand what the problem looks like. So there was a real sense that really what they wanted more than anything else was for officials to listen to them, and listen to what's going on in their communities.
Patricia Strach:
So that was one very striking thing that we found that we hadn't expected to find. And the other thing that we found is that in the middle of this very bleak, very difficult crisis, that, in communities that are very challenged by it, there's a large local response. Like folks on the ground are not just sitting there and throwing their hands up and saying, "Wow, this is really terrible... too bad for us." So you see a lot of very kind of creative solutions.
Patricia Strach:
So we were out at a public housing facility in Monticello, New York, and we saw a community garden. And so where there had been basically an open-air drug market with people coming in from other parts of the county and other counties to sell drugs and to trade drugs, they put a garden there instead to give fresh fruits and vegetables. And they did it without any money, without any outside resources, it was a really homegrown kind of operation.
Patricia Strach:
And we see stuff like a way station that's in a local community in Sullivan County that tries to give individuals things to do other than drugs, and tries to give them a place where they can kind of experience their community in a very positive way. And programs that try to get people help before they need police help.
Patricia Strach:
So, in the midst of this crisis, I think the real spark, the real thing that can bring joy to what is otherwise a very difficult topic, is the very positive steps that local communities... I mean, the very extraordinary measures they're taking, by very ordinary, everyday people.
Sarah O'Carroll:
And I hope that that would encourage other communities to do the same, and that it's not just trying to help someone who's detoxing by going before that person is at the point where they're addicted.
Patricia Strach:
Yes. Right, so putting more resources into thinking about how to keep people off drugs to begin with, but also not giving up, which is what I think is the best experience about being down there, is to see all the ways that they are trying to make a difference.
Sarah O'Carroll:
Is there anything else you'd want to share about the next step, of moving more towards the state level and then federal beyond that?
Patricia Strach:
So one of the things that we're noticing is that different levels of government are involved in a policy response in different ways. So the local level of government, you have the sheriff, and you have the local police, and you have the local health officials, who are putting in place policies and programs. And then on top of them are the state officials through which dollars flow, often to these local programs. And above that are the federal officials who make the dollars available, but who also regulate the drugs that kind of kicked this epidemic off to begin with.
Patricia Strach:
So as we move up, we want to understand to what degree each of these levels of government is responding, what resources they have to respond with, and what they're doing with those resources. But we also want to understand to what degree are they a part of the cause, or could they have stepped in to kind of prevent this problem, so that we can learn from it. And to understand really how the system of government works with these very different levels of government.
Sarah O'Carroll:
And then perhaps prevent families, like the Sackler family, I was reading about the coverage from the New York Times on how this family was knowingly prescribing, or being involved in the business of selling opioids.
Patricia Strach:
Yeah, so one of the... yes, yes. So the Sackler family's very interesting, and New York State just joined a lawsuit, or just created a lawsuit today. In the newspaper, in the New York Times. One of the things that's very interesting is the prescription rates. So in Sullivan and in rural communities, the prescription rates are just astronomical. Sullivan's opioid prescription rate is 725 prescriptions per 1,000 people.
Sarah O'Carroll:
Wow.
Patricia Strach:
That's more than three times what it is down in Queens in the city. So doctors are prescribing lots of opioids in these communities, and they don't necessarily have the doctors to provide medication-assisted treatment to help them.
Patricia Strach:
So you can just see right there, you have like a tinderbox that's ready to be lit, not just in Sullivan but other rural communities who are dealing with the same kind of thing. A flood of legal, legitimate prescription drugs without the resources necessary or the out necessarily to get them out of the problem.
Sarah O'Carroll:
Well, an intensely complicated issue, but I'm inspired by people like you who are trying to get on the ground, as you say, and talk to people, and try to find real policy measures that could make change.
Patricia Strach:
Thank you so much. And one of the things that we've found in being in the community and making change is how people perceive both state government and the university. And so when you come down there into a community and you say, "Hey, I'm here from the university, I'm here to listen, to hear what you have to say," the reaction is totally different, because what they want to do is they want to be heard. They want their voices to be heard.
Sarah O'Carroll:
That they are not alone, that someone cares beyond their community and is seeing what's going on.
Patricia Strach:
Yeah. That the kind of problems they're going through, and a lot of human suffering is not in vain, that other people will learn from these experiences that they have and policy makers will do something concretely about it.
Sarah O'Carroll:
Patty, thank you so much.
Patricia Strach:
Thank you, Sarah, for having me.
Sarah O'Carroll:
Thank you for listening to the UAlbany News Podcast. I'm your host, Sarah O'Carroll, and that was Patricia Strach, a professor of Political Science and Public Administration and Policy at UAlbany's Rockefeller College.
Sarah O'Carroll:
Special thanks to Kyle Adams of SUNY's Rockefeller Institute of Government, for introducing me to Strach's work.
Sarah O'Carroll:
This was the 20th episode of the UAlbany News Podcast, and you can let us know what you thought of the second season so far by emailing us at mediarelations@albany.edu, or you can find us on Twitter at @UAlbanyNews.