Three possibilities for future of St. Lawrence County mental health, substance abuse services
Monday, February 17, 2020 - 1:12 pm

BY ANDY GARDNER
North Country This Week

CANTON -- The Community Services Department director is outlining three possible paths forward for chemical dependency and substance abuse treatment in St. Lawrence County.

Jay Ulrich, Community Services director, presented the possibilities at the Monday, Feb. 10 county legislature services committee meeting.

The three options, according to Ulrich, are making no changes at all, using telemedicine more than clinic appointments, or adding an opioid treatment program aimed more at helping the severely addicted.

He said the status quo option is "with the anticipation of increasing both our reimbursement rates and our productivity" and "based on filling all positions in the 2020 budget."

The telemedicine option would move clinicians out of the satellite clinics and have them working out of main sites. Patients with smartphones and tablets would be able to do their appointments virtually.

Ulrich said this does not mean closing satellite clinics. Some services require face-to-face interaction, such as a mental health intake, he said.

"What we're trying to envision, instead of being there, we're looking at becoming more virtual, continue to try to serve those same people in those same communities," he told the legislators. "My guess is there are a lot of people out there struggling with addictions, maybe in trouble with the law ... if they could get services in the privacy of their own home, we could get more referrals."

He said moving the clinicians to main sites would initially save $100,000. And his department is working on writing a $15,000 grant application "to continue to augment our telepsych equipment," he said.

The third option, adding an opioid treatment program (OTP), would be in addition to transitioning from face-to-face out of the satellite clinics.

Ulrich said the OTP would give daily allotments of medications like Vivitrol, Suboxone, Sublicate or methadone, which are prescribed to help addicts get past their cravings.

They currently have a medication-assisted treatment (MAT) program, but that doesn't include methadone.

"(New York State Office of Alcoholism and Substance Abuse) wants all forms of MAT to be provided … we don't have methadone treatment," Ulrich said Wednesday, Feb. 12. "You have to go to Watertown or Plattsburgh."

Ulrich said people on methadone tend to stay on it, but they stay clean.

"People in methadone treatment are typically in methadone treatment for the remainder of their life," he told the county board. "People on methadone tend to be more employable because they're more stable. They're able to salvage their family life that a lot of times people on Suboxone continuing to use other substances are not able to do."

He said the OTP also starts off medication administered by the daily dose. Patients who respond well can down the road be given prescriptions for three days, seven days or longer.

"There are people who stabilized and there are people who can bring home doses and take their medication at home," Ulrich said Feb. 12. "We'd like to get people to the point where they don't need daily dosing."

Ulrich told the legislators that he feels the OTP is a good fit for the local need because of their 212 active clients with opioid-use disorder, 80% of the caseload are diagnosed with severe opioid-use disorder. And 90% require a seven-day prescription or less because of the risk to abuse the medication.