Monroe County Tackles Addiction Crisis from all Angles

By Joe Mahoney
Contributing Author

 
A cadre of Monroe County public health staffers has made giant strides in countering drug overdoses by meeting people in places where they are most vulnerable and distributing thousands of boxes of medication capable of knocking back the potentially fatal effects of opioids.

A combination of prevention and harm-reduction efforts helped Monroe County achieve a dramatic 43 percent drop in fatal overdoses in 2024, recording 292 drug deaths compared to 512 in 2023.

In building a strategy to take on addiction, Dr. Marielena Vélez de Brown, Commissioner of the Monroe County Department of Public Health, said it was vital to listen to those who have struggled with substance abuse and recovery challenges.

"This team has really sought the voice of the community and asked people to give us input on how do we use our funding," she said.

The addiction program seeks to connect people to treatment and other services in a variety of ways. The program includes a post-overdose response team, with members going to the homes of people who survived an overdose once they've been released from a hospital.

Another arm of the team does street outreach, distributing educational materials and providing people with food and clothing and wound care supplies as well as Narcan, with test strips for assessing the drugs they have acquired.

Monroe County has greatly expanded access to Naloxone, a medication that is a proven life-saver, by reversing overdoses.  Naloxone distribution boxes are available now at more than 600 sites, including the Frederick Douglass Greater Rochester International Airport, the University of Rochester, Innovative Field and various county offices.

As part of the harm reduction focus, the IMPACT team has begun to include test strips for fentanyl and xylazine inside the naloxone boxes.

Since the county began distributing the kits in what the county has dubbed naloxboxes, more than 35,000 Narcan packages have been distributed. And outreach workers keep coming up with new ways to get  the medication into the hands of people who may encounter individuals using Fentanyl, heroin or other narcotics.

Recognizing that Monroe County was being heavily impacted by the national opioid epidemic, County Executive Adam Bello consulted with his mental health and treatment experts on ways to meet the needs of families being impacted by addiction.

"We started back in 2020 with seven people, including me, doing all the functions that our existing team does," Vélez de Brown recalled. "I quickly learned that we were going to need more people. So I approached the county executive, and he said, 'How many?' And here we are, 24 people later."
 
As a member of the New York State Association of Counties, Monroe County has been making the kind of resourceful  response to the challenges of addiction that the association envisioned when, during national litigation, it advocated for county governments to have their needs and damages addressed from being on the front lines of the opioid crisis. NYSAC represented New York counties during settlement negotiations resulting from that litigation

"I would challenge you to find any other county -- across the country -- that has installed 645 naloxboxes over the last two or three years," .Vélez de Brown said. "And the way we did that is you build relationships to get them in every town or city hall, every civic center and into the restaurants and the corner stores where the overdoses are happening.  You get to know these folks and show them the information and say, 'Look, we've had four different calls in the last two weeks of people overdosing behind your store."

So convinced of the necessity of making sure the kits were accessible as possible that Impact team members learned how to use drills and levels to install distribution boxes in locations where they could be reached.

"This wasn't my idea," Vélez de Brown pointed out. "It came completely from the team. They got tired of waiting. They got tired of giving someone a box and then it doesn't go up. So they got trained in how to install the boxes themselves. So we didn't have to wait for some owner to get around to it."

Dr. Tisha M. Smith, who has served as Monroe County's Director of Addiction Services for the past five years, said the boxes have become an emblem of the continually nurtured relationships the IMPACT team has hammered together with its partners in local communities. The team has used a database to help identify the boxes that get the most use, she noted.

"We have a different type of refill system for these boxes," Smith said.

The fact that the local airport is overseen by a county authority helped pave the way for the IMPACT team to convince airport officials to allow it to install boxes inside the terminal.  "Those have turned out to be our highest used boxes," Smith pointed out.

Recognizing that every overdose death is a life cut short, the county's overall response to addiction includes its involvement in the Overdose Fatality Review initiative.

The multi-disciplinary team reviews the circumstances of fatal overdoses in Monroe County, looking to fine-tune strategies for prevention and offering treatment while identifying the contributing factors. That team includes representatives of law enforcement agencies, mental health, social service agencies and community members such as the non-profit Common Ground Health.

"Despite our community's aggressive efforts to stem the tide in Monroe County, we continue to see far too many individuals and families impacted by addiction and overdose, and it's just unacceptable," County Executive Adam Bello said after the review initiative was announced.

County officials saw an opportunity to tap into the relationships that Common Ground Health had with local businesses such as beauty shops and barbershops from previous public health initiatives.

"These barbershops and beauty salons became hubs, where we could give them the Narcan, and then they could use these trusted relationships with not only their clients but also with other community members around their establishments," Vélez de Brown noted. "They have been able to give out hundreds of boxes of Narcan. This has been huge for us."

One of the top priorities of the IMPACT workers is to make treatment options available to narcotics users and to address barriers that have stood in the way of people going into a treatment program. For instance, they are worried that their cherished pets won't get care while they are in treatment, Vélez de Brown said the IMPACT team will work to line up placements for those dogs and cats.

IMPACT team members have also added visits to local high schools and universities as part of their outreach efforts.

"This has been challenging because of the stigma attached to substance abuse and some people not wanting to have these topics broached with young folks," Smith said. "But it is needed. Now our local universities have opened the floodgates and let us come in. We are trying to hit all of the populations that have been affected  -- which goes all the way up to our elderly population."

The consistency of outreach efforts has been yielding dividends as more and more people in local communities become familiar with the team members, Vélez de Brown said.

"Now we have community members coming up to my team, and saying, 'Hey, So and So isn't in his or her normal spot. I think there might be a problem.' Or, 'There's a bad batch on this corner.'"

Relations formed with public health nurses during the COVID crisis have also proven to be beneficial in raising awareness about the availability of the county's intervention and prevention efforts.

Smith noted she has enlisted a medical professional she became acquainted with during the COVID response to assist in educating social workers at a large hospital system about the availability of services offered by IMPACT and related programs. "We have been able to capitalize on these partnerships post-COVID," Smith said.

Still another vehicle for raising awareness about the risks associated with narcotics use has been Operation Cocktail, designed to reach people gathered in bars and restaurants by distributing coasters.

The county's telephone hotline for overdoses and a QR code on the coasters can connect people fearing relapse to an abundance of information about addiction services.