LIBERTY — For someone struggling with opioid addiction in Sullivan County, getting help can be difficult. Finding a doctor willing to prescribe treatment, a pharmacy that will fill the prescription or transportation to an appointment can all stand in the way.

Those were some of the concerns raised Wednesday morning, October 21, when U.S. Congressman Paul Tonko met with members of Sullivan Allies Leading Together (SALT) for a roundtable discussion on expanding access to addiction treatment.

Tonko, a Democrat representing New York’s 20th Congressional District in the Capital Region, traveled to Liberty at the invitation of SALT Chair Martin Colavito to hear from local healthcare providers, law enforcement officials and community advocates.

The discussion focused on the Mainstreaming Addiction Treatment (MAT) Act, legislation Tonko authored that became law in December 2022.

The law eliminated a federal requirement that medical providers obtain a special waiver from the Drug Enforcement Administration (DEA) before prescribing buprenorphine, a medication used to treat opioid use disorder.

According to Tonko’s office, the law expanded the estimated number of medical providers eligible to prescribe the medication nationally from approximately 130,000 to 1.8 million.

However, being eligible to prescribe treatment does not necessarily mean providers are doing so.

Tonko told those gathered that getting the legislation passed was only part of the work.

“I thought the tough job was getting the legislation through the Congress,” said Tonko. “But little did I know the real work, well, more heavy work, was to follow, and that was to implement the legislation.”

He said the goal is to make treatment available when someone is ready to seek help, rather than forcing them to wait or navigate additional obstacles.

Local challenges

Martin Colavito, chair of Sullivan Allies Leading Together (SALT), described Sullivan County as a community facing several challenges, including a shortage of healthcare providers, growing homelessness and limited transportation in rural areas.

Although transportation services have improved over the past decade, he said many residents still cannot easily reach medical appointments or treatment facilities.

Colavito also raised concerns about the shortage of primary care and mental health providers and what he described as high rates of opioid prescribing in Sullivan County.

He said SALT is conducting a health disparities report and hearing from residents who are losing confidence in the healthcare system.

“If I’m hopeless, why wouldn’t I use [drugs], right?” Colavito said, describing the connection between hopelessness and substance use.

SALT is a coalition of community members, businesses and organizations working together to improve services and quality of life in Sullivan County through prevention, information sharing and cooperation among agencies.

Another concern raised during the discussion was the difficulty of filling prescriptions.

One healthcare representative described calling six pharmacies in an effort to find one that would fill a patient’s prescription. Some pharmacists cited limited capacity, while others expressed concerns about taking on patients receiving addiction treatment.

Village of Liberty Police Chief Steve D’Agata said stigma remains a major problem among medical professionals.

“The stigma that is attached with a lot of physicians that don’t want to treat that type of individual,” D’Agata said.

He said the negative attitudes surrounding addiction can discourage doctors and pharmacists from providing treatment, even when federal regulations allow them to do so.

D’Agata said the Liberty Police Department has worked with community organizations to shift its response to addiction from primarily a public safety issue toward one that also focuses on public health.

Housing and health

The roundtable also talked about how homelessness can create additional problems for people trying to receive medical care.

A healthcare representative explained that residents without permanent addresses can lose their health insurance coverage when important correspondence is returned to the state.

Without coverage, they may arrive at a pharmacy only to discover they cannot obtain their medication.

The representative described helping one unhoused resident become re-enrolled in health insurance, but said the person still faced a delay of at least 48 hours before coverage could be used.

D’Agata said the Liberty Police Department has sometimes allowed unhoused residents to receive important mail at the police station, where officers and outreach workers can help get it to them.

However, those at the meeting said that such arrangements may be harder to establish across Sullivan County because of transportation problems and the distance between communities.

Christina Ruiz, a social care manager with Catholic Charities who serves Sullivan, Orange and Ulster counties, spoke about the importance of love and compassion when helping people struggling with addiction and financial hardship.

Ruiz said she is seeing families struggling to afford groceries, electricity and other basic needs, including two-income households facing homelessness.

She said those financial pressures can leave people feeling overwhelmed, with some turning to substance use as a way to cope.

But Ruiz said providing services is only part of helping someone. People also need to feel that someone cares about them and is willing to listen.

“Love is important because when love is not there, people feel lost,” Ruiz said.

She described receiving calls from people struggling to pay their electric bills, including older residents and people dealing with serious illnesses.

For Ruiz, listening to those people and making them feel cared for is just as important as connecting them with available resources.

Tonko acknowledged those concerns, saying addiction is often connected with feelings of despair.

What comes next?

Colavito asked Tonko about continuing the conversation through regular meetings, possibly quarterly or twice a year, to follow up on the issues raised.

Tonko says he supports continued communication and discusses bringing together medical providers, pharmacies, insurance companies and local organizations to identify potential solutions.

He also suggested that participants develop a list of specific barriers and determine which organizations or levels of government could address them.

Tonko said he hopes the discussion will help turn the federal legislation into meaningful changes for communities like Sullivan County.

“There was so much work in developing this legislation and passing it that we shouldn’t drop the ball now,” Tonko said. “We just need to do the work to get it implemented, because that’s where the hope rests.”