[introductory music]
Isabel Byon:
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 those of the agency or state. This is Addiction: The Next Step.
Jerry Gretzinger :
Hello once again and welcome to Addiction: The Next Step. I'm your host, Jerry Gretzinger, and we're coming to you from the New York State offices of Addiction Services and Supports, our lovely little podcast studio, which is actually just tucked into the corner of an unused office. But you know what? We're doing a lot of good work here, having a lot of really great and interesting conversations, and we are going to have another one of those today.
Jerry Gretzinger :
You are probably well aware that the state of New York, certainly our agency and a lot of other partners and providers, have been working really, really hard to address the overdose crisis. We've had far too many people lost to overdose. You know, we know the presence of fentanyl that's come into the country and that's been finding its way into illicit pills and unfortunately, a lot of people have died as a result. But finally we have some good news to pass along. We've been hearing all this kind of talk about the sudden and finally this reduction in the number of overdose deaths that we've been reporting, certainly throughout New York State, and there are some areas in New York who have even greater headlines to tell about this. And we are joined today by a gentleman who's going to tell us about the wonderful headline that they've got to talk about, and that's Steve Kilburn. He's the Substance Use and Addiction Services Coordinator for the Chautauqua County Health Department. Steve, thanks so much for chatting with us today.
Steve Kilburn:
Well, Jerry, thank you for inviting me to be on and, as you've introduced, it's nice to be able to come with I guess what I'll call better news. Good news hard to come by in the topics of overdoses, obviously, but definitely better news than we've been looking at for literally years.
Jerry Gretzinger :
Yeah, and so, as you well know and I think most of the people who are listening to this know, you know we've seen far too many years where the number of deaths attributed to overdoses has inched up, has gone higher and higher to really historic levels, and really it's been all anybody could do to try to, you know, get on top of that and to do anything they can to start bringing the numbers back down. And finally, as I mentioned, we're starting to see some of that and before we even have this conversation, we want people to know we are not saying, hey, great victory, we're done.
Jerry Gretzinger :
We can accomplish.
Jerry Gretzinger :
No, not at all, but it is nice to see that some of the efforts are starting to have an impact. And let's talk about Chautauqua County here. We know we've got some really good information, some really good news to share about the effects of all this work that's being done.
Steve Kilburn:
Yeah, Jerry, you mentioned historic levels. We've seen that nationally, New York State. Sadly, we've also seen that here in our own western New York County, Chautauqua County. 2023, in fact, was our highest recorded number of overdose fatalities. So, you know, we've been tracing, or tracking, rather along with some of the trends that we see on the national level, but the story this year is so dramatically different and happily so, namely here as we're recording this middle of October, so nine and a half months into 2024, compared to the very same time period in 2023, we are literally less than half of the number of overdose fatalities which, you know, really, by any measure as a public health metric, is stunning. And so you know, again, we acknowledge the number is not zero. There are still families grieving, but we also believe that there are many people who aren't, who haven't passed away, that might otherwise have if we, of course, weren't seeing this dramatic reduction.
Jerry Gretzinger :
Yeah, and you know you make that point and it's a good one that you know until that number is zero, there's work to be done. So and really I think what what we take away from this? Now we see some of the efforts and the impact of these efforts bringing these numbers down and I think it just kind of emboldens us to say, okay, something we're doing is working, we've got to keep going at it, right?
Jerry Gretzinger :
So, let me ask you that. So when we talk about, some things must be working. What do you feel? What are you seeing in your area, Some of those things that are making an impact?
Steve Kilburn:
Well, that's the. That's the big question. You know what can account for such a dramatic improvement in the situation, and I certainly have some, I think, somewhat obvious suggestions of what that is, but I also worked in the field long enough to sort of take as a premise that addiction always defies every sort of simple explanation either it's trending up or trending down, or, you know, there's so much about it that it's such a complex issue. Having said that, though, clearly, the distribution of naloxone, Narcan, into the community, and, like a lot of places, we have made that such a priority and, of course, it saves lives, in addition to just the sort of, if you will, common sense conclusion that distributing Narcan widely and broadly and, by the way, we do so with so many avenues, so many partners but beyond just the sort of assumption that that's making a difference, we have a few, certainly a lot of anecdotal evidence to suggest that, you know, this has been one of the reasons why many lives have been saved.
Steve Kilburn:
One of the kind of hard metrics that we can point to is and this is data that really was tracked over 2023, but by the last quarter of 2023, our largest EMS service that covers the two cities in our county, Jamestown and Dunkirk. They were reporting that in literally half of the occasions where they would respond to an opioid overdose the patient had already been administered Narcan. And that may have only grown in the months, since that's again data that's a little dated, but at least and that was trending in the right direction up. So we do see strong evidence that Narcan distribution has made a profound difference. So clearly we would attribute our improvements to that in large measure.
Steve Kilburn:
But I would say there are other things as well.
Jerry Gretzinger :
Yeah, I was just going to continue on the naloxone point for a moment. I think even at the state level we've been doing as much as we can to make sure that naloxone and even test strips are available and sent to whoever wants them, for free, I mean. So it's really been a focus of ours. I know of so many other organizations as well, and I think what you just said kind of gives us the other side of the picture. Right, we know the significant amount of supplies that we've shipped out, but to know that they're being utilized, that's the kind of story that we've been looking to hear, that it's not just arriving in someone's hands, but that they're putting it to use.
Steve Kilburn:
Yeah, no, I'm glad you have said that, because as a public health intervention, the availability that the state of New York has made to communities across the state for Narcan freely, I mean, to us, you know, available from the state and then of course we're able to freely and broadly distribute it it has been a massively, I would say, successful public health campaign and you know, kudos to the state of New York I hear from colleagues now and then from other states where you know access to Narcan isn't nearly, I don't think, as available as New York State has made it. So this has been. I think really it's taken, you know it takes time to. It takes time to build, I guess, systems of distribution. It takes time to build awareness kind of normalize the fact that this is first aid and should be on hand. But I think again, as one of the contributors to, in our case, a dramatic decrease, I think we've got to acknowledge that the state of New York has been wise in investing in the wide distribution of Narcan.
Jerry Gretzinger :
And, like I say too, I just I think it's great that the supplies are utilized the way they intended to be utilized, and we're actually I will say this a plug for us. We're trying to get people to share their stories with us about utilizing these products, so that people who may not have received them yet and may not know about how to use them can see other people's stories and say, okay, I can do this, I want to do this, I want to be a part of this, part of the solution.
Steve Kilburn:
You know that's right, and I mean not that I'm personally aware of them, but we would literally have hundreds of those stories just in our county. I feel sure that that's the case and you know the distribution of Narcan too is. You know there's no. It's one of the easiest medications to make widely available. First of all, there's no diversion. You know there's no other reason to use it and you know no medication.
Steve Kilburn:
I guess is harmless. But in terms of its capacity to cause really any kind of harm if it's used, you know, in an instance where an overdose hasn't happened, you know it's essentially nil, so it's lent itself very well to getting out into the hands of the public.
Jerry Gretzinger :
So just getting back to the presence of fentanyl.
Jerry Gretzinger :
Certainly, and while we're seeing a downward trend in the number of deaths related to overdose, I don't have any information saying that we're seeing a downward trend in the presence of fentanyl.
Steve Kilburn:
Well you know I was looking at that in preparation for our conversation today. Clearly it's fentanyl principally that's accounting for the deaths and that remains the case. So we don't have, when I report the numbers you know, a nearly 52% decrease at this point. Not all of those are actually confirmed at this point, so I don't have the well, the toxicology reports from all of the fatalities in 2024. So what I'm about to say is, you know, limited in that it's based on maybe half of the year or so that we've gotten that data back and what we're seeing.
Steve Kilburn:
Whether this is the case across the state and other places, I don't know. But Well, we had been seeing for at least a couple of years, similarly, of course, fentanyl rising. But stimulant use has actually this year reached a level where it's really about the same level appearing as frequently in the cases of fatal overdoses as fentanyl does. Now, often, of course, both are appearing right. So, methamphetamine and fentanyl. But the presence of stimulants, especially in our kind of corner of the state, methamphetamine, some cocaine, has increased dramatically and I think the other piece that demonstrates how much that's increased, while the percentages are low, there's more instances where people are dying with an. Well, it's almost always methamphetamine and no fentanyl Not again the majority, but definitely more than last year in percentage. So fentanyl is clearly the deadliest drug in the drug supply, but much to the's consequences tend to be, you know, physical health, morbidity and and psychiatric problems.
Jerry Gretzinger :
Yeah, well, as you mentioned earlier and rightly so, you know, when it comes to substance use and the work that you're doing and the work that we're doing, it's a landscape that seems to constantly change and evolve and it's just, it's a, you know, trying to keep up with it and, if possible, when we can stay ahead of it, but that's that can be a challenge. So, steve, so I think you know again, this is, this is the kind of news we want to be hearing about. We certainly want to hear more of it. You know, hopefully other counties will be reporting similar information as we. As we go forward and get closer to the end of the year, what would you say is the major push or focus or hope as 2024 begins to come to an end and we get into 2025, with where things should be, need to be, where you want to see it go?
Steve Kilburn:
Well, of course we want to see the trends continue right. So 50-ish percent this year. Of course the year is not over, but we're optimistic that we can say something like this come the end of this calendar year and we want to be able to say something again the next year. You know, another reduction that's dramatic and significant. But beyond that, you know, I think in some ways it's being careful that we don't, not that we would consciously, but that we would lose some of the motivation maybe, or the urgency, let me call it that has, you know, fatal overdoses have led to this issue Because, as I said, we still have extremely significant issues, said we still have extremely significant issues.
Steve Kilburn:
Stimulant use is extremely high and its consequences are, I mean, at the human level, of course, are just really the morbidity is just so high and it's, quite frankly, straining systems that aren't prepared really to deal with that. And with stimulant use, of course, we face, you know, unique challenges as how do we treat it, et cetera, in ways that we, you know, we don't have the medications yet that, for example, could be a contributor. So that's a big issue. There's going to be subpopulations, stimulant users, of course. We want to here really keep our eye on moms and babies, and that kind of actually translates into another major emphasis that we have, and that is prevention. That's our long-term strategy, if you will, and so we want to really lean into the next generation and their preparedness to face a world that who knows what it'll look like. I wish you know you, and I could say, oh, you know, addiction will be largely a thing of the past. Then I just think the drugs will be possibly different, but the problem is they're going to remain.
Jerry Gretzinger :
Yeah, like I was saying, it's a constantly changing landscape, right, but we'll keep doing what we can. And you know, as you mentioned, prevention is so critical raising awareness, making sure people are educated about what's out there and how to respond to it. Steve, thank you so much for sitting down and chatting with us. We're so happy again to hear numbers like these and hopefully we'll hear more and more of the same. I just want to mention quickly too if people would like some more information on how to get their hands on some naloxone or test strips, have it sent to them. You can go right to our website. It's oasas.ny.gov, o-a-s-a-s. Dot N-Y, dot. G-o-v. We send it to you for free, no questions asked, and you know it'll be just having more of that important medication out there in the population, so we can be continuing to support the type of things that are happening there in Chautauqua County. Steve, thank you again, and we'll have you back, hopefully, to talk about even more positive news.
Steve Kilburn:
Absolutely. I look forward to being back again sometime.
Jerry Gretzinger :
Sounds great. Thanks so much, and thank you for joining us here for Addiction: The Next Step brought to you by the New York State Offices of Addiction Services and Supports. I'm your host, Jerry Gretzinger, and until we see you again, be well.