Isabel Byon: 0:00

The New York State Office of Addiction Services and Supports, or OASAS, provides this podcast as a public service. Thoughts and opinions expressed do not necessarily represent or reflect the agency or state. This is Addiction: The Next Step.

Jerry Gretzinger: 0:17

Hello everybody, Jerry Gretzinger, here, your host of Addiction: The Next Step, brought to you by the New York State Office of Addiction Services and Supports, and this episode that we've got for you is one that we're going to be reflecting and looking ahead. You know we're looking at the end of the year of 2024 and planning for 2025. So what a good time for us to think about where we've come from and where we're going to, and to help us do that is Commissioner Dr. Chinazo Cunningham sitting here with us. Thanks for sitting in on the podcast today.

Dr. Chinazo Cunningham: 0:43

Absolutely. Happy to be here, Jerry.

Jerry Gretzinger: 0:44

And you know you look back on a year and you know when a year starts. There's so many things you want to do and you get to the end of the year and sometimes you look back and say, boy, this was a great accomplishment, boy, this is something we want to do more on. So we thought let's have you on. And how they're going.

Dr. Chinazo Cunningham: 1:04

Yeah. So I agree, I mean it is, you know, the perfect time to really look back and think about what we've done and what we need to do going forward. And so I think you know, one of the biggest, you know accomplishments here and changes has been the reduction of overdose deaths. And so that's happening across the United States and that's also happening across New York, and so we see about a 17% decrease in overdose deaths, and so that's the first time that we're seeing these reduction in overdose deaths in many, many years. So you know, we are optimistic about this and, you know, showing that we're certainly on the right path in terms of the work that we've been doing here. But you know, we also know that we still have a lot more work to do. Some of these numbers are provisional, so we're still, you know, waiting for those final numbers, but we're very happy and optimistic about that change.

Jerry Gretzinger: 2:02

Yeah. So I mean, obviously that is. That is something that everyone is very happy to see. What are some of the things that you would say helped that along? And certainly we don't want to suggest that, hey, OASAS did this. I mean, it was OASAS and so many others who partnered together to make this happen but through all those combined efforts, like what were the things that finally started to move us in the right direction?

Dr. Chinazo Cunningham: 2:23

Yeah. So I think a lot of that has to do with awareness and embracing harm reduction. So, as you know, Jerry, we've put a lot of effort into making sure that people are aware of what is happening and what the risks are. And so, knowing that fentanyl is really driving you know these overdose that's really important. And knowing that fentanyl can be an anti-substance, including counterfeit pills you know these overdose that's really important.

Dr. Chinazo Cunningham: 2:44

And knowing that fentanyl can be in any substance, including counterfeit pills, you know we've done a lot of work to get that message out to the public and then to make sure that the public also had the tools that are needed to address that, and so that's using naloxone and making that easily available. You know we've changed our website. We have a portal that anybody can go to in New York and order naloxone, and we've shipped out over 200,000, you know naloxone kits and then, in terms of fentanyl test strips and xylazine test strips, have shipped out over 21 million of those test strips so that people can use these tools to stay safe, to stay alive, to reverse somebody who's having an overdose, to save a life, and so you know, that kind of harm reduction work and those harm reduction tools I think are really important and have certainly contributed to this improvement that we see with less overdose deaths.

Jerry Gretzinger: 3:45

Yeah, and you know, on that part of it too, as we continue to talk about things that went well and that we're happy to have seen develop, it's access to those types of harm reduction tools, but also to treatments as well.

Dr. Chinazo Cunningham: 3:58

Absolutely. And so you know, when we talk about harm reduction, it's really about focusing on reducing the risks of harm. A lot of that is, you know, can mean just keeping people alive at first, so that people then can work on other parts of their life and their health. So part of that includes harm reduction materials, but part of that is also an approach, and that approach includes going out into the community and meeting people where they are, you know, getting to those who are at highest risk of overdose, and so things like outreach, you know, having an outreach team go on the streets, go on the corners, go under the bridges, right, having a mobile unit go and do outreach in rural areas. So those are really important things so that people can get the harm reduction tools they need, people can be linked to care and people can actually get care outside of the walls of the clinics. And so you know, we have really spent millions of dollars to support that kind of work of really meeting people where they are, and that's, you know, part of harm reduction and part of treatment.

Dr. Chinazo Cunningham: 5:08

So some of the other in terms of treatment things is really expanding access to medication. So we know that medication treatment is extraordinarily effective. It reduces the risk of overdose death by more than 50%, and there's not many things we do in healthcare that have those kind of results, and so really focusing on improving access to buprenorphine also known as Suboxone, and methadone, have been really key strategies, and so we have mobile units that provide methadone treatment, so we have two of them that are being implemented right now and nine more that are going to be coming online in the next, you know, coming months. That's revolutionary. That was not even possible, you know, a year or two ago. We also are working in jails and prisons, and so this is something I'm very proud of. So we in New York, when people are incarcerated in every single jail all 58 of them and all 42 prisons they are offered medication treatment. That's a game changer. That's a group of people who are at very high risk of overdose death, and so that is life-saving treatment.

Jerry Gretzinger: 6:19

And people might ask okay, well, isn't that something that was always available? Doesn't everybody do that?

Jerry Gretzinger: 6:23

And the answer is no.

Dr. Chinazo Cunningham: 6:24

No not at all, and in fact we are the only state that is scaling this work up to this degree. Again, 42 prisons and 58 jails. Every person who goes through those systems is screened for addiction and then is offered treatment with every form of FDA-approved medication. So that's really really, you know, success, and it's really success in partnerships with our counties, with the other state agencies that work with jails and prisons.

Jerry Gretzinger: 6:57

Yeah, and just I'm thinking on that line too when we talk about some of these things. If people are curious, you can go online, you can Google treatments that are available in jails and prisons across the country and you can see where different states are at, and it is really something to see how New York is leading the way with that. And also, you know, handing out the opioid settlement dollars, putting those to work.

Dr. Chinazo Cunningham: 7:17

Absolutely. Y eah. And so you know, again, New York is leading the country in terms of opioid settlement funds, and so we, you know, have over $350 million that we've made available. You know we're the state that's had the most money available of all the states. There are some states, many states, that have made zero dollars available or less than a million dollars available, you know. So those dollars are going to communities where people can get the help that they need, and so that's through outreach, that's through prevention, that's through recovery centers, that's through medication treatment, it's through working with jails and prisons, it's, you know, the public awareness right, it's all of those things. And so, you know, this was also important because we worked with the Opioid Settlement Fund Advisory Board. You know we followed their recommendations and their recommendations were really consistent with our approach too, in terms of supporting harm reduction and outreach and, you know, and prevention and recovery and really the special populations that are at highest risk.

Jerry Gretzinger: 8:16

Yeah, I know people ask sometimes like well, what's happening with those dollars? Who's in charge of seeing where they go? I can tell you from all the podcasts that we've done, there's so many people working so hard to put those dollars to work where they're most needed. And again we talk about the reduction in overdose deaths. That's just a part of the good work that it's helping to do.

Dr. Chinazo Cunningham: 8:33

Absolutely

Jerry Gretzinger: 8:34

So what else? Let's look back again at the 12 years. Anything else that kind of comes to the top and you say, boy, this really worked. Well, I'm proud of this.

Dr. Chinazo Cunningham: 8:41

Absolutely. So what I heard as the commissioner time and time again was the challenges with workforce right, so you can't provide services if you don't have the staff and the workforce there. And so we've done a lot of work to really think about how we can better support the workforce and expand the workforce. And I have to say, you know, this issue became really a problem that was magnified with COVID, but there's really been an underinvestment in the addiction workforce for decades and now we're just feeling it, you know, in this way after the COVID pandemic. So there's not one answer, and so there's many different strategies that we've used, so including, you know, three years in a row of cost of living adjustments.

Dr. Chinazo Cunningham: 9:25

We've had bonuses for the workforce. We have paid internships to bring people in. We have scholarships that's a really popular program where people can get scholarships to become a certified substance use counselor. They can get their bachelor's degree or associate's degree. That allows them to continue to grow in their field. We're working on loan repayments. So, um, there's all these ways in which we're really thinking about how to support the existing workforce and expand it, and so that is happening right now. It's, it's very popular and we're, you know, continuing to expand it as we go forward in 2025.

Jerry Gretzinger: 10:05

Yeah, we've. We've spoken to a few of the uh colleges, the institutions who provide those trainings and are helping to put those scholarship dollars to work, and they've said, oh my gosh, we've used it all, all of our scholarships are out there and we're looking forward to having a new round because it's been in such high demand.

Jerry Gretzinger: 10:22

So obviously that has been a great success.

Dr. Chinazo Cunningham: 10:23

Ab solutely, and I think the other thing that's been interesting for me is the demand for people with lived experience, so with peers. So we have the certified recovery peer advocates and I think people are just now coming around to understand how important peers are. And so we, you know, we hear from more and more hospitals and emergency rooms or jails and prisons or courts about, you know, people want peers because they really can connect with people with addiction and you know very unique and important ways, and so we're really, you know, focusing as well as building that part of the workforce and again, there's plenty of scholarships and waiving the administrative fees and application fees and all of those things to build up that part of the workforce, as well as the certified, you know, substance use counselors.

Jerry Gretzinger: 11:12

So I don't want to. You know, challenges are always tough to talk about, and if there are more positives to talk about, let's do that first. But otherwise, do you want to start talking about some of the things that we look forward to going? Okay, this is the next mountain to climb.

Dr. Chinazo Cunningham: 11:24

Yeah, so the other, the other comment I would make in terms of some of the successes is you know, we hear from the field and and we know this from our data about the challenge with people who have both mental health and substance use disorders, and so we have worked very closely with the Office of Mental Health at every level from commissioner, you know, down to all of the staff to really think about how we can do better to really address people who have both conditions, both mental health and substance use conditions, and so there are many, many ways in which we're working together to improve this work, and so things like, you know, working on housing and, you know, programs working in the schools to make sure that both mental health and substance use are addressed.

Dr. Chinazo Cunningham: 12:07

We have tripled the number of certified community behavioral health clinics, and so those are the really comprehensive outpatient clinics that provide care for both people with substance use and mental health disorders. We have crisis stabilization centers for people who are experiencing a mental health crisis or a substance use crisis or both, again, funding 22 of those around New York State, and we're working with the workforce and trainings so that we can make sure that both the workforce and mental health and substance use have adequate training. Our outreach teams. Similarly, we're doing trainings to make sure that you know when these teams are doing outreach on the streets they can address both the mental health and substance use. So many many ways in which we're really coming together to think about how we can continue to do better to address both of those conditions.

Jerry Gretzinger: 12:54

And as much of a success as the work that that's been. I'm sure that is something that continues going into the new year and it continues to be a challenge because we want to be able to expand and enhance that as much as possible.

Dr. Chinazo Cunningham: 13:04

Absolutely, absolutely.

Jerry Gretzinger: 13:06

So, all right. So, looking at the new year right when we start thinking to ourselves okay, so here we are, we've got some good information that's come back with the work that's been done. What are the challenges that we have? To kind of continue that trajectory, if you will.

Dr. Chinazo Cunningham: 13:19

Money

Jerry Gretzinger: 13:19

Yeah, well, that's always the case right. Yeah.

Dr. Chinazo Cunningham: 13:22

So, yes, so here's what we know. So we, you know, had a lot of I would say, quote unquote extra funding, enhanced funding from the federal government during the COVID pandemic. Right, it's not just with addiction or healthcare, but many parts of our society got additional dollars to get us through the COVID pandemic. Well, those dollars are going away, and so, you know, we are going to see a decrease in funding from the federal government because of that. In addition, the opioid settlement funds, while they last for 18 years, we also know that a lot of the settlements happen in a way where many of the dollars were given out in the first two years. So we know that the dollars coming into the state from those opioid settlement funds are decreasing and will continue to decrease over the next, you know, 15 years as well. So there's a bit of a cliff, both from the federal dollars and from the opioid settlement funds, in terms of, you know, dollars going down.

Dr. Chinazo Cunningham: 14:25

Now, we did know this, I mean, it's not a surprise and so we have, you know, structured our initiatives such that we are using the dollars from the first couple of years and we're funding things that last three years or four years. So we're not going to necessarily feel that immediately, but that is the reality of the dollars are changing and from these two important sources of funding. So that you know, that's something that we're working on and we know and we're preparing for, so we'll see. That is just one of the realities in terms of what happens with funding.

Jerry Gretzinger: 15:04

Yeah, yeah, and, as you said, it was something that we knew about and tried to build into the planning. But you know, not that you're not prepared for that clip, but when you're standing at the edge of it, you go. Okay, here we go,

Dr. Chinazo Cunningham: 15:14

Absolutely yeah.

Jerry Gretzinger: 15:16

And as far as too, I mean, I think you know nationally we see a change in administration coming and there's always the question is okay, what will that change? How will that change ?

Dr. Chinazo Cunningham: 15:31

yeah. So that's a big question, we all have right, and I think we don't totally know the answer to that yet and that's going to, you know, evolve over time. But we know, you know, there's a new Secretary of Health and Human Services, RFK Jr, who's been appointed, you know. So we'll see what happens with that as that evolves. But you know, he clearly in his past statements have has, you know, indicated differences and changes in terms of some of the priority areas now at the federal level. So again, he's been nominated, we don't know if he'll be confirmed and then we don't know how things are going to, you know, exactly play out. So we're watching this closely, as are many other people in states, and you know, and you know we're. So we definitely are watching and making sure that we are going to be as well prepared as possible as we go forward

Dr. Chinazo Cunningham: 16:19

with a different administration at the federal level. .

Jerry Gretzinger: 16:22

Some changes coming our way, but nothing that we can't navigate and still continue to do the good work Absolutely coming our way, but nothing that we can't navigate and still continue to do the good work

Dr. Chinazo Cunningham: 16:27

Absolutely.

Jerry Gretzinger: 16:28

And anything else you see as like a challenge, you know in the next, you know year or so, that you're like this is something we've really got to try to tackle.

Dr. Chinazo Cunningham: 16:35

Yeah, so you know, the biggest challenge, I always say, in this field of addiction is stigma, and you know that maybe has gotten a little bit better, but there's still so much work that we need to do to really address the stigma.

Dr. Chinazo Cunningham: 16:51

And so you know there's stigma against addiction. You know we have this history in this country where people think it's a moral shortcoming of an individual, where we know it's a medical condition, right, that where the brain gets rewired, and so we need a public health and healthcare solution to that, and we have shifted in that direction and so that's been very positive. But there's still a lot of stigma around addiction and around the treatment for addiction, and so you know this is something that we are really thinking about how to address comprehensively in the coming year. We know that the stigma, you know, reduces people's ability to identify that they have addiction, ability to get help for the addiction right, and we know, if we can, you know, reduce that stigma, that people are going to be more likely to get life-saving treatment. So more to come, but certainly working on this and many different areas of how to really take on and reduce stigma in 2025.

Jerry Gretzinger: 17:56

Yeah, and I can tell you too, some of the awareness projects we have coming up address stigma head on. We want to make sure that people start to understand, as you said, medical condition. You know it's having to retrain the way people think. I think sometimes.

Dr. Chinazo Cunningham: 18:09

Absolutely, and I think an important part of this too is that you know treatment works, prevention works, people you know recovery supports work, and so also just knowing that and hearing the stories, the positive stories of people who have changed their lives right and how that ripple effect is their families, their communities right and society, I think is really important because so much of the time we only hear the negatives about addiction but there's so many positives that are out there and we wanna make sure that we amplify that.

Jerry Gretzinger: 18:40

And you know, I'm gonna take that as an opportunity to say if you're looking to hear one of those positive stories about people who've been able to turn things around and have really written themselves a terrific story, Check out the other episodes of our podcast. We've had several folks on who've shared their stories and you can hear that for yourself, and they are. They're really powerful stories. Commissioner, thanks so much for sitting down for us. We appreciate it.

Dr. Chinazo Cunningham: 18:59

Yeah, thanks for having me here.

Jerry Gretzinger: 19:01

And the good work carries on. It continues as we head into 2025. Thank you so much for joining us for Addiction: The Next Step, the podcast brought to you by OASAS. Don't forget, if you want more information about services supports, go to oasas. ny. gov, O-A-S-A-S dot N-Y, dot G-O-V. Hope Line 877-8- HOPE NY. I'm Jerry Gretzinger. Until we talk to you again, be well.