Dennis Gregg hadn’t heard from his stepdaughter in days. Holland Townsend had just gotten kicked out of her second addiction treatment facility, and for all Gregg knew, she was on the streets of Syracuse.
After years of watching Townsend struggle with substance use disorder, Gregg could only come to the most devastating conclusion. And soon enough, that became a reality.
“Are you Dennis Gregg?” a person on the phone asked.
“Yes,” he answered.
“Are you Holland Townsend’s stepdad?”
“Yes,” Gregg said, beginning to catch on.
“This is Saint Joe’s Hospital. She’s here. She’s on life support.”
Townsend had overdosed on heroin while living on the streets and arrived at the hospital unresponsive. The Narcan did not work, and Townsend was oxygen-deprived.
“We thought we were going to be planning her funeral,” Gregg said. “But in a miracle of miracles, her eyes opened up.”
A few weeks after her overdose, on April 27, 2015 — her 21st birthday — Townsend was transferred to the Northeast Rehabilitation and Brain Injury Center in Kingston.
She has spent the last 10 years there in assisted living care.
“In my case, Holland’s still alive, and the other people that are in this group, their sons and daughters, aren’t alive,” Gregg said. “They paid the ultimate price.”
In 2023, more than 5,000 New Yorkers died of an opioid overdose, according to the state health department. In the first half of 2023, New York had 27.9 overdose deaths per 100,000 people compared with 19.2 deaths per 100,000 in the first half of 2024. That’s the lowest it’s been since at least 2021. But it still represents 1,877 deaths in the six-month period.
The decrease reflects a nationwide downward trend in opioid overdose deaths. Experts attribute the decline to many factors, including “widespread, data-driven distribution of naloxone … better access to evidence-based treatment for substance use disorders, shifts in the illegal drug supply, a resumption of prevention and response after pandemic-related disruptions and continued investments in prevention and response programs,” according to the Centers for Disease control and prevention.
Though overdose deaths are decreasing across the state, the loss of life is still staggering.
“A hundred thousand overdose deaths in the country is still 100,000 more than there should be,” said Barry Weiss, co-chair of the Onondaga County Drug Task Force.
The “Unlocking New York” project focused on five counties along the Erie Canal corridor stretching from Buffalo’s Erie County to Albany County. Of these five Canal counties — Albany, Erie, Onondaga, Oneida and Monroe — all but Albany are at or above the state average.
Erie County was hit the hardest of the Canal counties, with a death rate of almost 34 deaths per 100,000 people, or 160 deaths, in the first six months of 2024.
The rollout of harm-reduction programs like Narcan distribution and syringe services seems to be contributing to a decrease in overdose deaths, as is the settlement money that the government has started to distribute. Still, advocates and experts argue that inefficiencies hinder more meaningful progress.
With so many lives lost and trajectories altered, the people of upstate New York search for solutions as they continue to combat the unforgiving opioid epidemic.
Settlement Money
New York state is receiving billions of dollars as part of nationwide settlements with companies that manufacture, distribute and sell opioids for their contributions to the public health crisis.
The state’s attorney general, Letitia James, has reached settlements totaling over $3 billion with companies such as Purdue Pharma and the Sackler family, Teva Pharmaceuticals, CVS and Walgreens.
In New York, the Office of Addiction Services and Supports (OASAS) oversees the Opioid Settlement Fund (OSF). Of the total OSF pool, 46.1% goes directly to counties, 20% goes to OASAS for discretionary spending, 17.5% goes to the Attorney General’s office, and the remaining 16.4% goes to regional abatement.
“It’s basically blood money,” said Gregg, who now advocates for people struggling with addiction. “It needs to be put to existing resources and creating new ones to support the community.”
Despite the large sums of money coming through the state and local governments, there is a pressing need for transparency in how the state uses these resources, and many are left wondering what the state is spending the money on.
“The biggest thing the state could do (to combat the opioid epidemic) is use the hundreds of millions of dollars they’ve received from opioid settlement funds,” said Rob Kent, who served as general counsel to OASAS from 2007 to 2020. “There’s still about 60% of the money that hasn’t been spent.”
With that money, Kent said, treatment facilities across the state would be better equipped to serve patients. Currently, state organizations face a lack of focus, which inhibits effective decision-making.
“They could address the biggest problem in the field, which is a crisis in the workforce,” Kent said. “The providers cannot recruit and retain staff, so many function below their fully staffed capacity and cannot serve as many people.”
He also said the state should emphasize both front-end prevention, which educates young people about healthy coping mechanisms before they turn to drugs, and back-end recovery, which supports recovery housing and reintegration programs.
The Prevention, Treatment and Recovery
There are now more opportunities for opioid overdose prevention, treatment and recovery than ever. The focus of many facilities’ approaches is the concept of harm reduction.
“If we acknowledge that substance use exists, but people may not be ready for treatment or recovery, we can do things to keep them safe while they are using,” said Mariah Senecal-Reilly, Onondaga County’s director of substance use initiatives.
Among the Onondaga County Health Department’s harm-reduction strategies is a syringe services program. The county is the only one in the state that offers such a program at the county level.
Syringe service programs are another approach to needle exchange programs. Instead of expecting people to return a needle in order to receive a new one, they can receive and dispose of needles as needed. Senecal-Reilly also said the program educates participants on the importance of safe sharps disposal.
Helio Health is another entity that provides prevention, treatment and recovery services. Formerly known as Syracuse Behavioral Services, Helio opened its doors in its current form in 2017. Today, the organization has locations across upstate New York, including Canal cities like Syracuse and Rochester.
Harm reduction is at the heart of Helio’s mission. The network is committed to looking at people holistically and reducing any potential stressors, such as mental health diagnoses and housing insecurity, to a patient’s recovery.
“Harm reduction, for us, is the practical things like widespread mass Narcan training and distribution, handing out fentanyl and xylazine test strips and teaching safe drug-use techniques,” said Dr. Ross Sullivan, medical director of Helio Health. “But on a larger scale, harm reduction is also keeping people engaged in treatment and really taking care of the person, no matter how much they’re struggling.”
In early March, Helio introduced a mobile unit that drives around the community, providing methadone treatment, wound care assistance and basic living supplies.
“The mobile units allow us to go mobile to rural populations that don’t typically have easy access to methadone treatment. We’re giving them treatment in their backyards,” Sullivan said. “We have one stationed in Madison County a few days a week, and we’re also providing treatment at some of the local jails.”
For Helio, opioid treatment does not stop when the patient is in recovery; it also focuses on helping people who have been in treatment or incarcerated for long periods of time get back on their feet. The network offers several home settings for individuals to reside in, tailored to their specific level of assistance, as well as stabilization programs to support long-term recovery.
“We’ve had lots of individuals who have left our residential programs, sought out employment and maintained their recovery using our support services long-term,” said Katie Weldon, chief clinical officer of Helio Health.
Though facilities like Helio are integral to the road to addiction treatment and eventual recovery, challenging the stigma around opioid addiction hinges on the Canal’s community.
“This disease doesn’t discriminate. Anybody can be impacted by this disease; it’s not a choice,” Weldon said. “The stigma surrounding it often prevents so many people from getting the help they need.”
People often blame those struggling with addiction for having a moral failing, but that is a gross misconception, according to Weiss.
“Addiction needs to be treated as a disease,” he said. “Understand that those who are addicted to opioids are dealing with this for a lifetime. They’re always going to need our help and support.”
