Foundational Questions
Why is there no explicit goal to end addiction or restore individuals to drug-free functioning? This directly affects overdose and fatality rates.
We are committed to improving the lives of those impacted by substance use and we are committed to collaborate as a community to reduce stigma, protect the vulnerable, coordinate resources based on data-driven need, initiate and implement prevention and treatment strategies, and support those who protect our county. However, ending addiction as a societal issue is simply not feasible at the local level. Addiction is a disease and eradication of addiction in the same sense as the eradication of measles and polio requires national level commitments to population health, which includes not just preventing and treating addiction; it also means work on issues like housing, access to nutritious food, and family and other social supports. While we would love to be a part of a dedicated national effort to end addiction (and in a sense, we are part of at least one national effort via HIDTA), there are too many factors beyond our control to be able to hold ourselves accountable for fully ending addiction in our county.
Restoring individuals to "drug-free functioning" is a more nuanced potential goal. The members of the Task Force support a goal that our efforts focus on restoring persons to independence from harmful substances. However, there would be substantial, justified pushback to any goal that excludes medication-assisted therapies (MAT). While responsible prescribing is an essential component of successful MAT outcomes, our collective view is that suggesting that successful outcomes require complete abstinence from medications such as methadone, buprenorphine, etc. is akin to suggesting that we should expect Type 2 diabetics to rely only on diet and exercise to successfully manage their disease. We do not agree with taking such a position.
At the same time, members of the DTF recognize that many people in recovery define success for themselves as living fully drug-free, without MAT. Under New York law and federal constitutional principles, adults who have decision-making capacity generally retain the right to refuse or discontinue medical treatment, unless very strict criteria for involuntary care are met. This emphasis on self-determination means that treatment plans are developed collaboratively with the individual, and that for some people a long-term goal of drug-free functioning will be appropriate and supported, while for others long-term MAT may be the safest and most effective way to reduce overdose risk and maintain stable recovery.
How does the Task Force define "success"? Are outcomes measured by reduction in addiction, or by activity metrics (retention, participation, naloxone distribution, etc.)?
There is no defined success metric, at present, that would enable the DTF to say that our mission is accomplished and we can disband when X is accomplished. Our strategy is more closely aligned with a "continuous quality improvement" approach that looks at both outcome and performance metrics. Current outcome metrics include overdose death rates, 911 calls, and hospitalizations. Performance metrics include those mentioned in the question along with many others, and we welcome input from the public on which performance metrics deserve the most attention.
Because substance use disorder is a chronic, relapsing condition, individual success is better understood as movement along a continuum than a single end point. For example, reductions in the number of opioid overdose deaths, EMS calls for overdose, and opioid-related hospitalizations in Sullivan County, as reported in the NYS Opioid Quarterly Reports and Opioid Data Dashboard, indicate that fewer residents are experiencing the most severe and life-threatening outcomes, even while some level of addiction remains present in the community.
In this context, success includes increased engagement in care (treatment entry, retention, and re-engagement after relapse), safer use when abstinence is not yet achievable, and improved functioning in housing, employment, family life and community participation—all of which are consistent with individuals' legal right to set their own recovery goals.
Most simply put, individual success in treatment is determined by the accomplishment of treatment goals that are set in a collaboration between the client and their clinician.
Will the Task Force commit to publishing transparent, public, quarterly outcome reports (not just spending reports)?
Quarterly outcome reports are already compiled, by county, and published by the NYS Department of Health. You can review the data here: Opioid-related Data in New York State. Of note, for the most recent quarter of available data (Jan–Mar 2025), published in October, Sullivan County had the 10th highest opioid overdose death rate in New York State. Still much higher than we want obviously, but another indicator that our death rate is declining faster than the State's overall death rate – in many previous quarters Sullivan County's death rate was in the top three, if not the worst.
Going forward, the DTF will pair state-provided data with local metrics like treatment referrals, naloxone trainings, and QRT contacts in future reports – many of which are provided in monthly reports to the Sullivan County Legislature from the Division of Health and Human Services.
We do commit to making continuous improvements to our reporting.
What is the county's plan to close gaps in the treatment continuum (detox → stabilization → long-term care → reintegration)?
In our recent past, Catholic Charities provided the only full continuum of treatment services in Sullivan County. Since the DTF was established in its current form in 2021, our treatment focus has been on generating more long-term care and reintegration options. In 2024, when OASAS refused to commit to the level of state funding needed to sustain Catholic Charities' detox, stabilization, and long-term care operations, the DTF shifted focus to working with OASAS and other regional providers to get a new full-continuum provider established. We're not there yet, but Lexington Centers for Recovery, in collaboration with Garnet Health, is on track to open detox, stabilization and long-term care services in Garnet Health-Catskills' Harris campus early in 2026. Our focus will then shift to ensuring the success of the new facility while looking to which gaps can sustainably be addressed next.
As part of preparing for the new facility in Harris, Sullivan County will align local navigation efforts (Hope Not Handcuffs, QRTs, hospital social workers, probation, drug court, community providers) so that there are clear protocols for moving an individual from overdose or crisis into the appropriate detox, stabilization, long-term care, and then step-down and reintegration services.
The county's role is less about directing individual clinical decisions—since patients retain the right to accept or refuse care—and more about ensuring that whenever someone is willing to engage, there is a realistic, timely pathway available.
1. Financial Management / Grants
Why is more than 50% of all opioid settlement funding being used for prevention and media instead of treatment?
The best balance of prevention vs. treatment remains a hotly debated topic among academics and medical providers. However, the consensus assessment of our American healthcare system is that treatment receives 95% or more of the funds going into the system, while prevention-focused activities receive less than 5%. Given that most treatment services are already funded by Medicare, Medicaid, and the private insurance market AND that approximately 94% of Sullivan County citizens are covered by health insurance, it is our assessment that more of our limited funds should be devoted to prevention and increasing access to treatment, rather than directly funding treatment itself.
In that context, Sullivan County's choice to use a larger portion of its non-insurance dollars for prevention, early intervention, and access/navigation is a way of counter-balancing a system that already heavily prioritizes late-stage treatment. This approach is also consistent with evidence that delaying onset of use—especially among youth—substantially lowers the lifetime risk of addiction and overdose. It also translates to substantial cost reductions in treating the drug epidemic overall. The National Institute for Drug Abuse states that preventive activities save anywhere from $2–$20 for every dollar invested. Another in-depth analysis of this issue is available here: Prevention-Set-Aside-September-2021-2.pdf
That said, because the State tends to focus their funding exclusively on clinical programs, we are also making investments in non-clinical, long term recovery options, such as Oxford House Recovery Residences (multiple county locations) and the Corona Self-Help Center in Jeffersonville, and we are planning to invest funds in the RESTART early intervention program to help Sullivan County school age children who are at high-risk for long term substance use disorders through their use of tobacco, vapes, and other illicit substances in school.
What evaluation tools are used to determine whether spending is having any impact on reducing addiction or overdoses?
Primarily, we review the reports of the agencies to confirm they are providing the services they said they would when they signed their contract. Because direct causation is hard to prove at the individual level, the goal is to look for consistent patterns across multiple data sources that suggest programs are contributing to reduced harm and improved recovery stability. In any case, we will work with current funding recipients over the course of the next six months to compile data across the largest possible sample sizes to determine whether or not it is in the community's interest to continue investing in their programs.
It is important to note that our current preventive service providers and their curricula were selected because they were able to report a significant evidence base in national-level studies that their programs had some level of effectiveness, and while we don't have enough data to show direct causal links, the fact that the opioid overdose death rate is declining faster in Sullivan County than in the rest of the state, that numbers of 911 calls to respond to patients experiencing overdose have dropped more than 50% since 2022, and that employment and engagement in employment activities have improved significantly since the pandemic.
For additional information on this topic, please visit the "Additional References" section at the end of this Q&A.
Why were funds allocated to out-of-county entities when no long-term drug-free programs exist locally?
Based on other questions provided for this Q&A, the questioner seems to believe we are providing funds to an entity based in Queens. The Corona Self Help Center is in Jeffersonville and is a long-term drug free program. It is part of a broader organization that operates in three different states and is based in Queens, but Sullivan County's opioid settlement funds are only going to the facility operating in Jeffersonville.
How are vendors selected, and is there a competitive process?
All current service providers were selected through a competitive process established by Sullivan County Government's Request for Proposals (R-23-17). We are currently in the final effective year for this RFP. A new RFP will be issued, likely in February–March 2026 that will establish the competitive process for the next round of funding applications.
In addition to the formal RFP, the county is bound by state procurement and conflict-of-interest rules intended to ensure that awards are based on documented capacity, experience, and alignment with allowable uses of the Opioid Settlement Fund, rather than on personal or political preferences. This structure is designed to protect public trust while still allowing the Task Force to prioritize proposals that support prevention and fill local gaps in our care network.
Why is there no allocation for long-term residential rehabilitation despite being the only model proven to produce multi-year recovery?
Effective long-term residential rehabilitation programs are multi-million-dollar operations. Sullivan County attempted to support Catholic Charities in sustaining their long-term residential treatment operations with an offer of $218,210 in funding for clinical staff positions in the county's settlement fund 2024–25 fiscal year. Ultimately, that money was left unspent because Catholic Charities was unable to fill the positions described in their RFP response and did not make any claims for the funds.
Going forward, the county can reassess the feasibility of supporting long-term residential services once Lexington/Garnet's treatment center is operational and staffing patterns are clearer. It may be more cost-effective and consistent with individual choice to use settlement funds to support components that make long-term care more accessible—such as transportation, peer navigation, or housing supports after discharge—rather than attempting to underwrite the full clinical cost of residential care, which is generally expected to be covered by Medicaid, Medicare, or commercial insurance.
Also, it is not the position of the Sullivan County Drug Task Force that long term residential is the "only model proven to produce multi-year recovery." It is certainly a valid model, but there are persons out there who are able to overcome addiction without long-term inpatient stays.
1A. Specific Budget Accountability Questions
Corona Self Help Center (Queens-based)
What services does this program provide specifically to Sullivan County residents?
From their RFP response:
Our recovery residence continues to provide a drug and alcohol free ambient for the individual in recovery. It is clear to us that there is a solid need for a place, for peer support and peer operated services. While providing a dignified area, food, clothing and access to 12 step meeting. This fraternal ambient is conducive in the healing process for individuals in recovery.
Our strategy supports the capacity of our organized recovery residence to respond to challenges of substance use, prevention and recovery utilizing tools in community settings. Our goals are to increase access to community members, to address the need for recovery services, establish linkages with other community organizations working with recovery.
Continue to provide counseling as a peer to peer organization. Assist in the navigation of members within the health system which will provide access to those that require additional treatment. Support members in their realization of integration into society and their families. Providing access to needed social services programs. Educational support to members that want to return to school or enhance their skills in order to secure reasonable employment.
Our community recovery awareness campaign reaches out to individuals in need throughout the Sullivan county and bordering areas. Members in recovery disseminate recovery awareness information through testimonies and flyers. Engaging other nonprofits, faith-based organizations such as churches, community coalitions and business. The campaign reduces the stigma on effective treatment and informs the public of services available at no cost for men with addiction.
Why were $73,032 (2024–25) and $32,500 (2025–26) allocated out of county?
The Corona Self Help Center is in Jeffersonville and is a "long-term drug free" (aka abstinence-based) program. It is part of a broader organization that operates in three different states and is based in NYC, but Sullivan County's opioid settlement funds are only going to the facility operating in Jeffersonville.
What outcomes are expected, tracked, or required?
As discussed above, it is somewhat difficult to track long term outcomes – we are only in our third full year of providing settlement funds to community partners. However, the Corona House staff has been providing us regular statistical updates on the achievements of their program.
Catholic Charities & Sullivan 180 (School-Based Prevention Programs)
Why are two separate organizations funded for what appear to be overlapping school-based programs?
Catholic Charities and Sullivan 180 run different programs in different schools. We have extensive data on both programs that we will use to evaluate whether or not one, both, or neither of these programs should continue into a new contract period in 2026.
What school districts receive services?
Too Good for Drugs is provided by Catholic Charities and is operating at Sullivan BOCES and in the Fallsburg Central School District. Sullivan 180's programs have been made available and presented in all local school districts.
What measurable changes in youth substance use have resulted?
As discussed above, it is somewhat difficult to track long term outcomes – we are only in our third full year of providing settlement funds to community partners. Sullivan 180 has provided extensive quarterly reports with evidence provided of wide-ranging prevention activities. However, we do not have a lot of data yet on what outcomes these efforts are producing.
The most recent data from Catholic Charities is suggesting to us that their program has been clearly effective in educating kids on how to make better decisions for themselves in general and sustaining gains made toward reducing youth tobacco use. On the other hand, peer pressure and temptation to use alcohol and marijuana among young adults are proving more difficult to counter.
There is extensive reporting available from both agencies since their contracts began. Due to their length, the reports are not included with this Q&A but can be provided upon request.
Action Toward Independence
What are the credentials of case managers?
In connection to this service, case managers typically are required to have a bachelor's degree, but there is no specific credential required. The case management services are typically focused on helping clients get re-established in the community as part of the recovery process. ATI is not contracted to provide clinical services with opioid settlement fund dollars.
What transportation is offered, and how many individuals used it?
Although it was authorized in the contract as per their RFP response, ATI has not provided this service to clients via opioid settlement funds.
What outcomes were achieved for housing stability and treatment connection?
ATI's goal with this funding is to aid in stabilizing a clients' situation and potentially help avoid possible relapse occurrences that are often triggered by crisis situations. However, because the contract was necessarily targeted at a specific population (individuals with Opioid Use Disorder (OUD) and any co-occurring substance use disorder or Mental Health (SUD/MH)), ATI has found that the consumers seeking direct rental assistance are not acknowledging any SUD/OUD or any such history within the household. Even with the lack of assistance requests under this funding, ATI continues to work with clients who have a history of SUD/OUD via case management and general advocacy efforts (as many of these clients find themselves unsheltered or in and out of treatment). We continue to work towards filling the gaps in services wherever possible in Sullivan County within this disability category.
In any event, because ATI has had a small number of clients they were actually able to help with this funding to date, the DTF intends to work with ATI on submitting a new funding request that will allow funding to flow more effectively to persons and families looking to get re-established in the community after a long-term battle with drug use. In particular, we will look to connect ATI's efforts to the soon-to-be inpatient residential treatment center coming to Garnet Health-Catskills.
Fund Distribution
Why are only $74,704.72 of $346,641.30 spent on treatment—and almost all of it out of county?
DTF spending covers a variety of different community needs because we believe in an "all of the above" approach that incorporates the variety of activities each pillar undertakes. As discussed above in Section 1, treatment services, especially inpatient services, are extremely costly and are often funded by insurance dollars anyway, so it would not make a lot of sense to dedicate a majority of Sullivan County's funds to this purpose.
At the same time, we are not ignoring treatment when we feel the funding has the potential to add significant value. Aside from the funds referenced in the question, the following additional funding provided by OASAS was dedicated to Sullivan County treatment activities over the last year:
- Restorative Management (Treatment/Peer Services) – $57,914.40
- Oxford House (Treatment/Sober Living Homes) – $11,076.45
- Vendtek (Treatment/Harm Reduction Supplies) – $1,960
- Total OASAS-funded Local Treatment Spending – $70,950.85
All of the $145,655.57 in funding was utilized by vendors for their operations in Sullivan County.
Why were $218,210 in clinical support funds unspent and not reallocated to treatment?
The funds were unspent because Catholic Charities' drug treatment operations were shut down before they could utilize the funds. The funds remain unspent and available for future allocations.
1B. Questionable Classification: Hope Not Handcuffs
Hope Not Handcuffs is a referral portal—not treatment. It does not provide detox, counseling, medication management, or long-term rehabilitation. It should not be classified as treatment.
Why is a referral portal classified and funded under treatment instead of navigation or outreach?
It's fair to say that Hope Not Handcuffs is not a treatment modality, but it has been a very effective vehicle for the DTF to refer persons into treatment, especially inpatient treatment. It has been categorized as treatment in our budget tracking because it more closely fits treatment activities than law enforcement operations which are tracked differently because there is a limited amount of settlement funds we can devote to law enforcement operations, while the Hope Not Handcuffs activities are considered an unrestricted use of such funds because they create access to treatment.
What percentage of referrals result in admission to treatment?
Over the life of the program so far in Sullivan County (January 1, 2021 – October 31, 2025), 320 individuals participated in intake. 174 were placed into inpatient treatment – 54.4%.
What percentage of those admissions complete treatment?
While Hope Not Handcuffs does engage in follow-up with each individual, the current method of tracking makes it challenging to compile solid data on completion rates. For a number of non-clinical reasons (e.g., losing contact if someone changes their phone number), it's tough to maintain a consistent dataset that leads to a clear percentage.
Additionally, the definition of "successfully completed treatment" is nuanced. Some individuals might leave against medical advice, or insurance coverage limitations might shorten their stay. Others might continue treatment longer than initially planned. All these factors make this a complex question to answer definitively.
Is law enforcement the appropriate lead for treatment navigation?
There isn't a "lead" for treatment navigation. Treatment navigation is a cooperative effort amongst many providers. Hope Not Handcuffs and the QRTs are merely one way that we accomplish navigation to treatment.
Why is treatment being counted when no treatment is performed?
Hope Not Handcuffs is simply tracked this way for budget planning purposes. As stated above, it has proven to be an effective method for connecting persons to long term treatment, but it is of course, not a clinical treatment method.
2. Medical Provider Services
What is the mission of MAT programs—maintenance or eventual tapering to drug-free recovery?
Under OASAS guidance and prevailing medical standards, MAT programs are expected to individualize care: for some people, a slow taper toward drug-free status may be appropriate; for others, indefinite maintenance on medications such as buprenorphine or methadone may be the safest course with the lowest overdose risk. New York law does not allow providers or government to require a patient with capacity to discontinue a medication that is clinically indicated and beneficial simply to meet an abstinence ideal.
Because of this legal and ethical framework, program success is generally measured by reductions in illicit use, reduced overdose risk, improved functioning, and patient-reported quality of life—not by whether or not someone discontinues MAT.
How many participants are tapered off all substances each year?
OASAS and NYS DOH do not publish county-level statistics on MAT taper completions, overdoses among MAT participants, or rates of dual use of street opioids plus prescribed medications. Public data are typically aggregated at the level of "treatment admissions" and "overdose events," without linking individual treatment episodes to specific overdose outcomes for privacy and methodological reasons.
That said, local providers do offer continuing care to clients who taper off MATs, which involves remaining connected with a counselor on a monthly basis, though documentation, again, is only clinical.
How many MAT participants overdose while enrolled? Does OASAS or DOH maintain any statistics on this?
This is rather difficult to track at the state and local government level. Providers generally do not keep aggregated data on overdoses beyond what is anecdotally reported by clients during sessions, which is only clinically documented in individual charts. It is very difficult to aggregate this data because it is contained in individual case notes which, aside from being qualitative and not quantitative are also difficult to share because of privacy and confidentiality rules. However, we do have some academic reports from the Journal of the American Medical Association (JAMA) on this topic:
Patients on medication-assisted treatment (MAT) experience substantially lower overdose rates compared to those not receiving treatment, with rates varying by medication type, treatment adherence, and patient characteristics. Among patients initiating medications for opioid use disorder (MOUD) following hospitalization or emergency department visits, the fatal or nonfatal overdose rate was 2.9% at 6 months and 5.1% at 12 months. In a large pragmatic trial of 2,199 patients, 1.8% experienced at least one overdose event within 24 weeks, with rates of 1.15% for buprenorphine, 1.51% for methadone, and 5.30% for naltrexone (though 27.9% of naltrexone-assigned patients never initiated treatment). The fatal or nonfatal overdose rate at 6 months was 2.9% (n = 244) and at 12 months was 5.1% (n = 423).
Data Source — Scott G. Weiner, MD, MPH, et al., Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts and other institutions. "Opioid Overdose After Medication for Opioid Use Disorder Initiation Following Hospitalization or ED Visit." JAMA Network Open. June 30, 2024.
On the other hand, overdose risk is dramatically elevated during treatment gaps and after discontinuation. A meta-analysis found crude mortality rates of 0.24 per 100 person-years during MAT, increasing to 0.68 after cessation and 2.43 during untreated periods. Patients who failed to initiate or discontinued medication had hazard ratios of 6.64 and 4.04, respectively, for experiencing overdose compared to those maintaining treatment.
Data Source — "Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder." JAMA Psychiatry. November 30, 2022.
How is dual use (street opioids + prescribed opioids) being tracked and addressed? Does anyone track this? OASAS? Law enforcement?
Most providers address dual use through urine toxicology, clinical assessment, and care planning at the program level, but there is no single statewide database that can show, for example, "percentage of MAT patients in Sullivan County who overdosed while actively enrolled."
One way treatment programs help to prevent dual use is through the New York Central Registry (also known as Lighthouse) to ensure that clients presenting for services are not receiving MATs elsewhere. This serves the dual purpose of ensuring clients are not receiving multiple MAT prescriptions and reduces the potential for diversion of MATs into the illicit market. If a client is flagged as receiving MAT from another program or provider, new providers cannot treat a patient until discharged from their previous program or provider.
Why is drug-free rehabilitation absent from the provider network?
Drug-free rehabilitation is not absent from the provider network in Sullivan County. The DTF supports the operation of the Corona House in Jeffersonville as well as three Oxford House Recovery Residences operating in the county. Corona House remains very focused on total abstinence. Oxford House is an abstinence-based program that encourages their residents to stay on track with whatever they are prescribed by their doctors to stay free from illicit, dangerous drug use.
By supporting the Corona and Oxford Houses, the DTF is also acknowledging that state-licensed, medication-focused treatment is not the only legitimate recovery pathway, and that people who choose drug-free environments should have that option without being forced into or out of MAT by policy. This is consistent with both self-determination principles and with federal anti-discrimination protections for people receiving or declining MAT.
3. H.O.P.E. & Prevention
Why is prevention funded heavily through media (billboards, PSAs, advertising) instead of direct youth programming?
Both approaches have received significant funding. Youth programming has actually received more funding than mass media. For the program year from July 2024 – June 2025, youth programming was funded with $171,136.60 ($90,415.47 County-sourced / $80,721.13 State-sourced). $117,960 ($93,000 County, $24,960 State) was expended on all-ages public service announcements. It is important to remember that prevention is not ONLY for youth. It is also important to get prevention messages to adults.
Public education campaigns (billboards, PSAs, social media) are intended to complement, not replace, direct programming. They can reach adults who influence youth (parents, employers, community leaders) and can quickly disseminate information about emerging threats, such as fentanyl contamination, in ways that school-based programs alone cannot.
Because individuals ultimately decide whether to enter treatment, broad messaging that reduces stigma and encourages help-seeking is also an important tool for making it more likely that when someone is ready, they will see treatment as a viable and acceptable option.
What prevention programs actually reduce first-time drug use—not just increase awareness?
Increasing awareness of the dangers of substance use reduces first-time drug use. That said, plenty of studies and strategies have been developed to determine which prevention programs are more effective. More information on this topic is provided in the "Additional References" section at the end of this Q&A.
Are faith-based, family-based, or community mentoring programs included in prevention strategies?
They certainly can be, and these programs do exist in and around Sullivan County. This is part of the Corona House and Oxford House strategies mentioned above, and a number of these programs are funded by the Office of Children and Family Services, Office of Mental Health, Sullivan County Youth Bureau, ATI, Cornell Cooperative Extension, Independent Living, Sullivan 180 and others.
How many youth have participated in prevention programs, and what are the outcomes?
We don't have exact numbers to share, but Too Good for Drugs has focused on 4th, 6th, and 8th grade classes at Fallsburg. It's important to note that while the Fallsburg and BOCES programs are all that has been funded for Catholic Charities by Sullivan County's direct share funds, Catholic Charities engages in a wide variety of other prevention activities around the county.
In contrast to the very specific focus of Too Good for Drugs, Sullivan 180 has utilized their funding to supplement the wide variety of activities included in their broader youth behavioral and physical health portfolio, commonly known as Empowering a Healthier Generation. These activities have had some impact in every K-12 school building in the County.
Additional details on this topic are provided in the "Additional References" section.
4. United Sullivan
Which employers partner with rehabilitation programs for skills training, jobs, or apprenticeships?
This is not tracked by the Drug Task Force, but we do work closely with our Center for Workforce Development who can provide more information on this topic.
How is the county building a reintegration pipeline from overdose → treatment → employment?
The emerging County Quick Response Team structure, combined with Hope Not Handcuffs and the Social Care Network, is designed to create that pipeline: overdose → rapid outreach → facilitated entry into detox/stabilization or outpatient care → linkage to housing, benefits, and workforce services. Because employment programs cannot force someone into treatment, their role is to be ready to engage as soon as the individual is medically and clinically stable and willing to work toward vocational goals.
Are individuals in long-term recovery advising this pillar?
This pillar has a handful of individuals in long-term recovery who regularly attend the pillar's meetings and contribute to partner updates.
How are families engaged as part of recovery and reintegration?
To a great extent, this is up to the individual family. Depending on the circumstances, there are a variety of services and supports that can be offered. Within the limits of federal privacy laws, providers can and do involve families when the individual in treatment authorizes it. In New York, adults generally have the legal right to decide which family members, if any, can receive information or be involved in care. This protects privacy but also means that some families who want to help may feel excluded when a loved one chooses not to sign releases.
5. Policy Reform
Why is the Marchman Act being framed as a treatment model when it is a legal framework? Failures are due to inconsistent implementation.
Unsure what this question is getting at – The Marchman Act is not a treatment model. It is a law from Florida which mandates treatment after an overdose.
The DTF's assessment of Marchman's failures as a policy come from a variety of factors. Perhaps most concerning is that legally mandated withdrawals reduce a substance user's tolerance. Data clearly confirms the highest risk of overdose is immediately after inpatient/detox treatment and periods of incarceration.
That said, the DTF is working hard on finding public policy alternatives to Florida's Marchman Act that meet the same intent while reducing future overdose risks.
Has the Task Force analyzed which treatment programs produce the highest long-term success rates?
In general, the DTF's position is that long-term success comes from any program that keeps someone in the journey of recovery on a path to their goals. A large body of scientific evidence indicates that a combination of behavioral health therapy and MAT is the most effective method, but the exact combinations that work best will differ from one patient to the next.
Would the county support a temporary legal incapacitation model for overdose survivors to receive long-term care?
The DTF, especially the policy pillar, is looking very closely at the models other states are using to advocate for legislative change in Albany. It is important to note that the County does not have the legal authority to override the key provisions of New York Mental Hygiene Law that govern the concept of "temporary legal incapacitation."
Why does state policy exclude long-term drug-free rehab as a recognized treatment category?
This is a question that needs to be asked of OASAS. As mentioned in our answers to other questions, the DTF strongly believes in an "all of the above" approach that takes advantage of any and every possible treatment method that will help someone recover from a substance use disorder.
6. Law Enforcement
What are the consequences for repeat dealers? Are they consistently enforced?
State law governs penalties for drug distribution, including enhanced penalties where sales result in serious physical injury or death. Local law enforcement and the District Attorney's Office have publicly emphasized their focus on major suppliers and repeat dealers, alongside diversion and treatment options for people primarily struggling with addiction.
What is being done to ensure Sullivan County sends a clear message: "Not here"?
Aside from the prevention advertising and other prevention activities discussed above, the District Attorney and Sullivan County Sheriff provide frequent updates to local media outlets on the progress and outcomes of narcotics investigations.
Are overdose death investigations being linked to prosecutions of suppliers?
Yes.
How does law enforcement coordinate with treatment providers when a user is in crisis?
This is what Hope Not Handcuffs does so well – it provides clear and direct paths from law enforcement intervention to inpatient treatment access. Going beyond Hope Not Handcuffs, Sullivan County also operates a very active Drug Court. Separate but related, Sullivan County Jail provides treatment and discharge planning for persons who are incarcerated.
7. Treatment Programs
How many drug-free rehabilitation programs exist in Sullivan County?
As discussed above, the Corona House in Jeffersonville is an abstinence-based program. We also now have three Oxford Houses (recovery residences) operating in Sullivan County providing long-term, abstinence-based recovery support – one house for males, one for females. $200,000 has been allocated to Oxford House and we are interested in doing more with Oxford and/or with another program, if another were to come forward.
How many MAT patients successfully reach drug-free outcomes?
Specific metrics are not currently available for Sullivan County from public NYS DOH or OASAS datasets. State dashboards focus on aggregate overdose and treatment utilization statistics, not on individual-level longitudinal outcomes tied to particular medications or programs. Where providers track this internally, results are often considered part of confidential quality-improvement processes rather than public reporting. Given these limitations, the Task Force finds it more feasible to track broader indicators of recovery stability—such as reduced re-admissions, decreased criminal justice involvement, and improved housing or employment—rather than focusing exclusively on "drug-free" status.
Are there peer-run recovery programs with measurable success?
Programs such as Narcotics Anonymous (NA) have helped persons achieve sobriety for many years. However, NA also has a lot of relapses in its history as well. These programs are not considered evidence-based interventions and do not have a lot of data to confirm whether or not these programs produce "measurable success" in comparison to other programs.
On the other hand, the DTF doesn't deny that peer-run programs have value. They provide persons, especially those in long-term recovery, with other vital supports such as a sense of community and connection to persons who have endured similar struggles. These are obviously difficult feelings to quantify as contributors to "measurable success" but are no less a part of many recovery journeys.
Why are treatment pathways overwhelmingly pharmaceutical rather than abstinence-based?
Medication, overall, is designed to reduce symptoms by half or more and therefore equip an individual with the strength to engage in other domains of their recovery programming.
At the state and national level, strong evidence shows MAT significantly reduces mortality and improves retention in care for opioid use disorder, which has led medical and regulatory bodies to prioritize these treatments. However, this does not mean abstinence-based approaches are discouraged; rather, they are often positioned as one option among several. For individuals who choose an abstinence-based path, programs like Corona House and Oxford House are intended to make that choice viable. Though, as mentioned earlier, Oxford House supports the long-term recovery community by being supportive of both approaches.
The DTF does not have data that can confirm that one method is particularly dominant over the other, so we can't say whether or not the premise of this question is accurate. While not an endorsement of the author or their services, the following link provides a balanced explanation of the pros and cons of each modality that the questioner may find helpful: MAT vs. Abstinence-Based Treatment
What percentage of people entering treatment overdose within one year?
We are not aware of reliable statistics that can answer this question.
Data & Outcomes Transparency
The public needs monthly and annual comparisons on the following:
Total participants by treatment type (MAT, abstinence, detox, etc.)
OASAS tracks admissions by treatment modality statewide, but reliable counts of abstinence-only program participation are limited, as many programs use mixed or evolving treatment models and do not consistently report "abstinence-only" as a distinct category.
Total overdoses (fatal & non-fatal)
This information is tracked and reported by New York State: New York State Opioid Data Dashboard
Overdoses among MAT participants
A valid question, but this would be nearly impossible to track. Relapses can occur without crossing the line of overdose, and it would be very difficult to quantify who relapsed and later OD'd, who OD'd while still in treatment, or who was sober via MAT, continued on with an abstinence program, and then relapsed while in the abstinence program.
Overdoses within one-year post-program
This is not systematically tracked or publicly reported in New York due to privacy constraints, lack of longitudinal patient-level data, and individuals moving across programs and systems.
Number of individuals drug-free at one year
There is no standardized or publicly available metric for "drug-free at one year," largely because definitions vary (e.g., abstinence vs. MAT stability), follow-up is inconsistent, and post-discharge monitoring is limited. It is also unfortunately true that while some persons gain their independence from substances after some limited outpatient assistance, others relapse after well more than one year sober. Therefore, this is not a data point that would be particularly informative.
MAT taper completion rates
There is no value in tracking "completion" of MAT tapering because completion may come at a variety of different levels depending on the medication and the patient.
Program retention and dropout rates
Yes. OASAS tracks retention, engagement, and discharge status, but reporting is generally aggregate and internal; limited summaries may appear in OASAS annual reports, not in a regularly updated public dashboard.
Cost per successful outcome
This metric is not routinely tracked or reportable. Costs are captured at the program or payer level, but "successful outcome" lacks a uniform definition and cannot be consistently linked to individual cost data across systems.
9. Veterans
What veteran-specific recovery services exist in Sullivan County?
Information for veterans on accessing treatment resources (in and outside of Sullivan County) is available here: Substance Use Treatment For Veterans | Veterans Affairs
Are there sober-living recovery homes for veterans?
Yes. VA operates about 250 programs at around 120 residential rehab sites across the country, including in Alaska and Hawaii, with enough beds to accommodate more than 6,500 Veterans. Residential Rehab for Veterans: Drug & Alcohol Addiction – Mental Health
How are veteran overdoses tracked and connected to treatment?
There are no specific tracking mechanisms for veteran vs. non-veteran overdoses at the county level. However, there are a number of veteran-specific services that can be made available once veteran status is identified.
Are peer-run veteran support programs funded?
Yes! Locally, this is funded by the state Office of Mental Health. Information is available here: Sullivan County | NYS Dwyer Coalition
10. Social Care Networks & Coordination
How does the Social Care Network function specifically for addiction cases?
Just as it does for any other situation, the Social Care Network has been established to refer persons to services from a single entry point to the complete set of issues that are preventing them from achieving good physical and mental health.
Who tracks individuals across medical, legal, and social systems?
Individuals who participate in the Social Care Network are not "tracked." Their private information is protected from improper disclosures by the Unite Us system. However, we have the ability to obtain significant de-identified data to determine which service providers in the network are most/least successful at making effective referrals and resolving patient/client issues.
How are overdose survivors identified and connected to treatment?
This is not a direct function of the Social Care Network. However, there are many participating agencies in Sullivan County who work every day, on and off the Unite Us platform, to connect with overdose survivors and connect them to treatment. The most significant of these outreach efforts is conducted by the Quick Response Teams (in Liberty, Fallsburg and now, countywide) working in partnership with Hope Not Handcuffs:
District Attorney Brian P. Conaty unveiled a new countywide interagency collaboration between the District Attorney's Office, the Village of Liberty Police Department, and Hope Not Handcuffs to strengthen Sullivan County's fight against the opioid epidemic.
This new collaboration expands the Quick Response Team (QRT) model—a proactive, data-driven approach that connects individuals who experience non-fatal overdoses with immediate outreach, treatment, and recovery services. The initiative underscores the District Attorney's ongoing efforts to reduce overdose deaths, interrupt cycles of addiction, and protect public safety through collaboration and compassion.
Conaty said: "The opioid crisis is not a law enforcement problem alone—it's a community challenge that demands a coordinated response. This new QRT Agency represents a unified front with law enforcement, public health, and community partners working side-by-side to provide support, save lives, and strengthen families across Sullivan County."
The new QRT Agency, anchored by the partnership between the District Attorney's Office, the Village of Liberty Police Department and Hope Not Handcuffs, will bring together local law enforcement, public health agencies, treatment providers, and social service organizations. The team will respond rapidly after overdoses to engage individuals and families with care, resources, and recovery options—reducing recidivism and preventing future fatalities.
Who is accountable when individuals fall through system gaps?
This is a very difficult question to answer. The State of New York rightfully gives great deference to each person's individual liberties and right to self-determine. There are unfortunately many stories that members of the DTF have where we believed someone could have been saved if only someone in "the system" had the authority to make better choices on the part of the persons who "fall through system gaps." There are, of course, situations where "the system" is not able to help someone in need, in time. There are also people who, sadly, isolate themselves and refuse to engage the supports and services that are available from family, friends, and the community. The DTF is committed to continuously improving our strategies, tactics, and processes to narrow these gaps and provide every possible opportunity for successful outcomes.
Appendix A – Opioid Settlement Fund Overview & Key Observations
Key Observations:
More than half of the budget is spent on prevention/media campaigns.
This is an accurate statement, the reasons for which were answered in other areas above.
Almost all treatment dollars go to a Queens-based program, not Sullivan County.
While the reason for this observation is understood, it is not accurate. As stated above, the Corona Self-Help Center has a corporate office in Queens that operates centers around the country, but the Corona House itself is in Jeffersonville and all of the county money that goes to Corona goes to the operation of that house. We invest in that house because they provide an abstinence-based treatment model that OASAS will not fund because it does not rely on MAT or clinical counseling methods.
No long-term drug-free programs received funding.
As explained above, this is not true.
$218,210 in clinical support was unspent.
The funds were unspent because Catholic Charities' drug treatment operations were shut down before they could utilize the funds. The funds remain unspent and available for future allocations.
Prevention and advertising receive far more funding than direct care.
As discussed in Section 1, inpatient treatment is exceptionally expensive to operate, and really needs to be sourced by private entities that have the capacity to make their operations sustainable. If Sullivan County were to devote all of our limited funds to a single modality such as inpatient treatment (which is the amount it would take to make it work), it would crowd out everything else we're trying to do. Also, Lexington and Garnet are receiving state assistance to get the inpatient facility opened in Harris, so that is already happening without County dollars having to go into it. Also, most direct care for drug treatment is paid by Medicaid and private insurance. Directly funding patient care from drug company settlement funds would be a significant drain on our limited allotments.
11. Community & Faith Integration / Lived Experience Accountability
Church Integration
Are churches formally recognized as partners within the Social Care Network?
Because the Social Care Network (SCN) of the Hudson Valley is a government-contracted operation, those who are involved with the SCN must be conscious of our First Amendment obligations to avoid the promotion of one religion over another. However, churches who provide important community services (including food pantries, clothing closets/thrift shops, and hosting of AA/NA groups) are eligible to have their services included for participation in the Social Care Network.
If not, why are faith communities—often the first support system for families in crisis—excluded from formal coordination?
As stated above, government is obligated under the First Amendment of the US Constitution to "make no law respecting an establishment of religion." While we certainly value what faith communities have to contribute and are happy to work with them, we are also strictly forbidden from promoting one religion over another. As an example of how we strike this balance, County government provides funding to churches who provide warming centers to help the homeless and impoverished during the winter months through a competitive and open public bidding process. However, we avoid promoting or proselytizing the religious activities of these same institutions so that we do not promote any particular faith over another.
Are pastors or church ministries included in crisis notification or follow-up when families request it?
This would be a decision that rests purely in the hands of individual patients, families, and the faith community leaders they practice with. Especially with regard to adults suffering with addiction, their privacy rights guaranteed by HIPAA can be waived by that person to include members of the clergy in notifications. It would be unlawful for a medical provider to share such information with a member of the clergy without the patient's consent. A more detailed (though not fully-inclusive) answer of how HIPAA and clergy interact is available here: Are hospitals able to inform the clergy about parishioners in the hospital? | HHS.gov
Does the county maintain a registry of churches willing to participate in mentoring, crisis intervention, or recovery navigation?
Not as such, but we are willing and able to share information with religious institutions about available services as discussed above. More information specific to available substance use disorder resources is available here: United Sullivan Resources and Community Resource Guide | Sullivan 180
What standards or requirements must a church meet to be included as an official community partner?
Our First Amendment obligations do not permit any level of government to describe a particular faith institution as an "official community partner."
Families Who Lost Loved Ones
Are families who lost loved ones included in the Lived Experience leadership team, or only those in personal recovery?
While the DTF is relying on the experience of a Sullivan County Government official in long term recovery to coordinate meetings of the Lived Experience Advisory Group, there is no "leadership team" per se. Any and all inputs will be welcomed through this group and the DTF will not dictate which voices should be favored over others.
Why is lived experience defined so narrowly that it excludes the perspectives of families impacted by fatal overdose?
This was never anyone's intent and is not the position of the DTF. Families impacted by overdose are absolutely welcome to contribute to the work of the DTF in any way they can. Incorporating bereaved families more visibly into the lived experience advisory work can help ensure that discussions of "success" and "recovery" do not focus solely on people in active recovery or on MAT, but also reflect the perspectives of those who have experienced fatal overdose in their families. Doing so is entirely consistent with the broader understanding of the concept of "lived experience" and does not conflict with any treatment or privacy laws, as long as family members share their own stories rather than confidential clinical details of others without consent.
How many bereaved families have been invited into advisory roles, workgroups, or committees?
Sullivan County Government officials and our partners across the DTF have always welcomed input from bereaved families, most notably through our semi-annual public meetings, and now expanding through the newly-formed lived experience advisory group. The DTF has not quantified a number of persons or families who should be invited – all are welcome.
How will the Task Force prevent lived-experience representation from being dominated by MAT-centered narratives alone?
The whole purpose of lived-experience representation in the DTF is to ensure the input of those who have been most impacted by illicit drug use has a space to be heard and incorporated into our collaborative decision making. The DTF should not and will not attempt to influence those inputs, except to ensure that all perspectives have a chance to be heard.
Has the county formally defined "Lived Experience," and does this definition explicitly include families of overdose victims?
We have not formally defined "lived experience," but we have always welcomed the input of families of overdose victims.
Additional References
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DATStats: Results From 85 Studies Using the Drug Abuse Treatment Cost Analysis Program. Roebuck MC, French MT, McLellan AT. Journal of Substance Abuse Treatment. 2003;25(1):51-7. doi:10.1016/s0740-5472(03)00067-9.
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Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder: A Cohort Study. Larochelle MR, Wakeman SE, Ameli O, et al. Medical Care. 2020;58(10):919-926. doi:10.1097/MLR.0000000000001394.
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Medical Costs of Substance Use Disorders in the US Employer-Sponsored Insurance Population. Li M, Peterson C, Xu L, Mikosz CA, Luo F. JAMA Network Open. 2023;6(1):e2252378. doi:10.1001/jamanetworkopen.2022.52378.
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Treatment for Substance Use Disorders in a Privately Insured Population Under Managed Care: Costs and Services Use. Greenfield SF, Azzone V, Huskamp H, et al. Journal of Substance Abuse Treatment. 2004;27(4):265-75. doi:10.1016/j.jsat.2004.07.002.
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Cost-effectiveness of Treatments for Opioid Use Disorder. Fairley M, Humphreys K, Joyce VR, et al. JAMA Psychiatry. 2021;78(7):767-777. doi:10.1001/jamapsychiatry.2021.0247.
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DATStats: Results From 85 Studies Using the Drug Abuse Treatment Cost Analysis Program. Roebuck MC, French MT, McLellan AT. Journal of Substance Abuse Treatment. 2003;25(1):51-7. doi:10.1016/s0740-5472(03)00067-9.
-
Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder: A Cohort Study. Larochelle MR, Wakeman SE, Ameli O, et al. Medical Care. 2020;58(10):919-926. doi:10.1097/MLR.0000000000001394.
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Medical Costs of Substance Use Disorders in the US Employer-Sponsored Insurance Population. Li M, Peterson C, Xu L, Mikosz CA, Luo F. JAMA Network Open. 2023;6(1):e2252378. doi:10.1001/jamanetworkopen.2022.52378.
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Treatment for Substance Use Disorders in a Privately Insured Population Under Managed Care: Costs and Services Use. Greenfield SF, Azzone V, Huskamp H, et al. Journal of Substance Abuse Treatment. 2004;27(4):265-75. doi:10.1016/j.jsat.2004.07.002.
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Cost-effectiveness of Treatments for Opioid Use Disorder. Fairley M, Humphreys K, Joyce VR, et al. JAMA Psychiatry. 2021;78(7):767-777. doi:10.1001/jamapsychiatry.2021.0247.
Regarding Prevention Activities
CATCH (Coordinated Approach to Child Health) My Breath is an evidence-based program designed to prevent electronic cigarette (e-cigarette) use among middle and high school students. It offers a comprehensive approach to addressing the risks and consequences associated with vaping, equipping students with the knowledge and skills necessary to make informed decisions about their health. Prevention programs focused on vaping primarily aim to prevent and reduce e-cigarette use among youth, addressing the potential health risks and addictive behaviors associated with vaping. By discouraging nicotine addiction and substance experimentation at an early age, these programs can indirectly contribute to reducing the likelihood of future substance misuse, including opioids. The Substance Abuse and Mental Health Services Administration (SAMHSA) named CATCH My Breath as the only school-level youth vaping intervention in the evidence-based resource guide series 'Reducing Vaping Among Youth and Young Adults'. SAMHSA also noted that training was "vital" for successful implementation of CATCH My Breath and to build program capacity.
How it Works – Mendez Foundation (Too Good for Drugs evidence basis and program explainers)
ENGAGE: Evidence-Based Strategies to Prevent Youth Substance Use | CDC (CDC study on this topic which provides insight on the types of programming that are proven to be effective)