Opioid Use and Resources

All calls that come into Tompkins County's 9-1-1 center are coded based on the type of the emergency. The code (called a Nature Code) informs the dispatcher on whether to assign the emergency to police, fire, or EMS.

When the 9-1-1 dispatcher receives a call for medical assistance, they will ask the caller certain key questions to ascertain if the cause might be drug induced based on protocols established by the department’s emergency medical dispatch program. Sometimes the cause is known by the caller, and other times the dispatcher makes the coding decision based on answers to their questions and other circumstances, and years of experience.

Total number of 9-1-1 calls per month that are C.A.D. coded as "Overdose/Poisoning," 2019-present. Computer Aided Dispatch (CAD) calls, Nature Code for “Overdoses/Poisoning.” Source: Tompkins County Department of Emergency Response (DoER).

Data source: TC Department of Emergency Response (DoER).

Like many communities, Tompkins County has experienced an increase in unintentional overdose deaths. When reviewing these datasets it is important to always remember that they represent individuals who are sons and daughters, families and friends whose lives have been interrupted or tragically ended, in some cases without warning.

The graphs below provide demographic information about the 100 people who died in Tompkins County from accidental drug overdose from 2019-2023. The larger sample size provided by totaling across five years increases the confidentiality of the individuals, and the confidence in how the data is interpreted.

“Unintentional Fatal Overdoses” includes those for which the “Manner of Death” is classified as an accident and substances identified in a toxicology screening are ruled as the immediate cause of death.

The US Census data (American Community Survey 2022 5-year estimates) compare the demographics of the deceased with the county population as a whole.

The deaths in this dataset may include overdose deaths due to pharmaceutically and illicitly produced, naturally occurring, semi-synthetic, and synthetic drugs. These deaths may not be attributed to an overdose.

“Drug Related Deaths” includes all deaths in which drugs are involved. In these cases, the immediate cause of death is not or not solely drugs, and drugs are often listed under “Other significant contributions.” These also include those in which the manner of death is not ruled as an accident.

In accordance with the recommendations of the New York State Heroin and Opioid Task Force and 2016 legislation, the NYSDOH provides quarterly reports with opioid overdose information (deaths, emergency department (ED) visits, and hospitalizations) by county. Please note that the data presented in these are considered preliminary by the NYSDOH and should be used and interpreted with caution. Subsequent quarterly reports may contain figures which differ from a previous report due to additional confirmations, updates, and timing of data received. The reported cases are based on county of residence.

Quarterly Rate Calculation (Person-Years): [# events / (population X 0.25 years)] X 100,000.

Summary of Tompkins County Data Published October 2024

(Provisional data as of July 2024)

Full Report on the NYSDOH Website

• Complete current Quarterly Report dashboard for counties (July 2024 edition)
• Opioid Quarterly Report Archives (links to PDF reports and data files in Excel)

NYS Opioid Data Dashboard - County
(use the Select County dropdown menu to display the Tompkins dataset)

NYSDOH Opioid Data & Reports

The trend of naloxone use is considered an indicator of the level of opioid use. The graph below is a visualization of these quarterly reports for Tompkins County (lower is better). You can see that overall naloxone use dipped in the first half of 2022, then did not fall again until Spring 2023. Numbers for Q2 2024 should be available October 2024.

Narcan Training and Distribution

Many individuals carry Narcan with them so they are ready to act if they see someone who appears to be overcome by a drug overdose. Tompkins County Whole Health and its partners are working to distribute Narcan to more residents and train them in how to use it.

• How to Give Narcan

Across the state, the NYS Department of Health is setting up Opioid Overdose Prevention Program (OOPP) sites to distribute Narcan and train the public in its use. TCWH is a Registered OOPP, and members of the public may request Narcan at both our Brown Road and Green Street offices. View a list of OOPP locations.

As part of its distribution program, TCWH is tracking the number of people trained and Narcan kits distributed by local OOPPs and reporting this information to the public. In the following graphs you can see how training dipped during the COVID-19 pandemic and has risen in the last three quarters of 2023.

The distribution of Narcan spray kits varies more from quarter to quarter since 2019, then increases at the end of 2023. Together, the graphs illustrate the increasing effort in Tompkins County to build a safety net across the community focused on reducing the number of deaths we experience due to drug overdoses.

Naloxone (Narcan®) is a medication that can reverse the effects of an overdose from opioids, including fentanyl, heroin, and opioid-based pain killers. It is a tool that community members can use in emergency situations where opioid overdose occurs, providing a chance for individuals to receive further medical care and treatment.

Using Narcan

Used correctly, naloxone can reverse an opioid overdose. When Narcan is administered, it attaches to receptors in the brain and blocks opioids from having their usual effects. This helps to rapidly reverse an overdose by restoring normal breathing and providing an opportunity for medical assistance. There is no safety risk associated with naloxone.

How to Give Narcan

1. Call 9-1-1
2. Carefully remove Narcan from packaging
3. Hold the nasal spray with your thumb on the plunger
4. Tilt the individuals’ head back
5. Place the tip of the nasal spray in either nostril of the person experiencing an overdose, firmly press the plunger and release the entire dose of medication.
6. Wait 2-3 minutes while checking for responsiveness
7. If there is no response, give additional dose, switching nostrils, until help arrives.

5-Step Guide for Giving Naloxone Nasal Spray(PDF, 389KB)
Remember to always dial 9-1-1 first.

Videos

Watch This 30-second Video for a Quick "Naloxone/Narcan How-To" (30 seconds):

The video below shows you the signs of an overdose and how to respond and take the steps to prevent opioid overdose.

For additional information on how to use Naloxone (Narcan®), dial 2-1-1 for information about where you can get trained on how to use Naloxone (Narcan®) in our community.

Carry a Narcan Kit With You

Opioid Overdose Prevention Programs (OOPPs) are organizations that provide individuals with training and a free Narcan kit to carry and dispense this potentially life-saving medication. OOPPs are registered by NYS Department of Health.

Free Narcan kits are available at one of the local registered OOPP community agencies listed below.

• TC Whole Health, 201 E. Green St., Ithaca (downtown), and 55 Brown Rd., Ithaca (northeast).
• Cayuga Addiction Recovery Services (CARS), 334 W. MLK/State St. Ithaca, 607-273-5500, ext. 5811.
• Cayuga Health Emergency Department, 101 Dates Dr., Ithaca
• REACH Medical, 1001 W. Seneca St., (First Floor), Ithaca
• Southern Tier AIDS Program (STAP), 314 W. MLK/State St., Ithaca. STAP also provides free Drug Checking services.

For additional options Dial 2-1-1 (1-877-211-8667) 24/7. Or text your Zip code to TXT211 (898211). Available M-F 9 AM to 4 PM

Pharmacy Standing Order

A statewide pharmacy standing order allows anyone to get naloxone (Narcan®) nasal spray at a pharmacy without a prescription in NYS. Ask for it at the pharmacy counter. Insurance covers up to $40 copay. If you don’t have insurance, you can buy naloxone at the pharmacy.

Note: Dispensing to adolescents under age 18 is at the discretion of the pharmacist.

Fentanyl is a highly addictive synthetic substance that is added into illicit street drugs to increase consumption. It is also highly associated with risk of overdose death. The Tompkins County Health Department has issued a Health Alert warning of the high risk of the presence of Fentanyl locally in street drugs.

Harmful Side Effects Include

Sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression.

Signs of Overdose Include

• Stupor, changes in pupillary size (pinpoint size pupils), cold and clammy skin, cyanosis (blue discoloration of the skin), coma and respiratory failure leading to death.

Overdose Prevention Strategies

• Never use alone
• Use fentanyl test strips(PDF, 2MB) as a precaution
• Carry Narcan and be trained in its use
• Seek treatment and support

Xylazine (also called “tranq” or “tranq dope”) is a powerful non-opioid sedative or tranquilizer that is increasingly being found in the US illegal drug supply and linked to overdose deaths. Due to its impact on the opioid crisis, fentanyl mixed (adulterated) with xylazine has been declared an emerging threat by the White House’s Office of National Drug Control Policy. In one study, xylazine was found in almost 80% of drug samples that contained opioids (Maryland, 2021-2022). In another, xylazine was found in 31% of heroin and/or fentanyl overdose deaths (Philadelphia, 2019). [Source: CDC]

Symptoms and Health Risks of Xylazine

Sedation, difficulty breathing, dangerously low blood pressure, slowed heart rate, wounds that can become infected, severe withdrawal symptoms, death.

Reduce the Overdose and the Harms of Overdose

• Never use alone.
• Provide rescue breaths, especially for people who have used xylazine since xylazine causes breathing to slow down. Harm reduction experts also suggest rolling individuals on their side, into the recovery position.
• Carry naloxone and learn how to use it. Because xylazine is often mixed with opioids like fentanyl, naloxone should be given in response to a suspected overdose to reverse any possible opioid effects. Importantly, naloxone will not reverse effects of xylazine. In the event of an overdose, call 911 for additional medical treatment.
• Reduce injection-related risks by using sterile injection equipment, rotating injection sites, allowing skin veins time to heal before another use, and taking drugs in other ways besides injection.
• Test drugs before using. There are commercially available test strips to test for the presence of xylazine in a sample of drugs. Test strips are available free of cost at a variety of local programs (see "Local services and support" section below).

• Fentanyl and Xylazine Test Strips can tell you if your drugs contain the synthetic opioid Fentanyl or the non-opioid sedative Xylazine. Both are frequently found in street drugs. Xylazine is always cut in with fentanyl, so drugs that test positive for xylazine will also contain fentanyl.
• If used correctly, these test strips can help to prevent overdose deaths and, with other risk reduction practices, save your life.
• Fentanyl Test Strips are blue and marked with the letters “FYL”.
• Xylazine Test Strips are red and marked with the letters “XYL”.

How to Use Xylazine and Fentanyl Test Strips(PDF, 382KB)

• Southern Tier AIDS Program (STAP): provides comprehensive HIV/AIDS services in the Southern Tier of NY. They provide the Opioid Overdose Prevention Program, which provides individuals with training, a Naloxone kit, and a prescription to be able to carry and dispense this potentially life-saving medication.
• Mental Health Association in Tompkins County was established in 1954, to address mental health needs in the Ithaca community.
  • The Jenkins Center for Hope and Recovery is a drop-in center for those who use or have used mental health services. The Jenkins Center provides a safe environment where mental health consumers can relax, have fun with peers, and share information and support.
• The New York State Office of Addiction Services and Supports hosts “Project COPE”, a website which promotes overdose prevention and harm reduction education in New York State. The goal of this initiative is to empower people to learn how to prevent overdoses and save lives in their community.
• Additional resources for prevention services: NYS AIDS Institute Provider Directory

Using

• Sharps Collection and Disposal Sites in Tompkins County
• Never Use Alone hotline. Dial 1-877-696-1996. An operator will stay with you while you use, and call emergency services if needed.
• Test strips for Fentanyl and test strips for xylazine are available for free at the Southern Tier AIDS Program, REACH Medical, Cayuga Addiction Recovery Services, and Tompkins County Whole Health's office at 201 E. Green St.
• Narcan, fentanyl testing strips and xylazine testing strips can be ordered free of cost and delivered to your home via NYS OASAS. Complete the order form online.
• MATTERS facilitates rapid referrals to outpatient treatment for opioid and substance use disorders. Referrals are submitted online 24/7, 365 days a year by participating referral sites throughout NYS. Individuals may request test strips through the MATTERS website. Find them at mattersnetwork.org. Get the MATTERS Network mobile app on the App Store or Google Play.
• Community-based support groups are available for individuals to help navigate your personal recovery, as well as for friends and families affected by their loved one’s substance use.

Treatment

• Cayuga Addiction Recovery Services (CARS) offers intensive residential and out-patient treatment services, including Medication Assisted Treatment (MAT). CARS offers Open Access Monday thru Thursday from 8:30 a.m.–4:00 p.m. Clients need only to bring an insurance card, if they have one. 607-273-5500.
• REACH Medical provides medical and behavioral services, including MAT. The REACH Project is a non-profit operating as a low threshold, harm reduction medical practice in Ithaca. Reach Medical offers a wide range of services including: opioid replacement therapy, medical cannabis certification, Hep C treatment, primary care and behavioral services, in a stigma-free, inclusive setting. 607-273-7000. REACH Project Facebook page.
• NYS Office of Addiction Services & Support (OASAS): Treatment Finder
• About Medication Assisted Treatment (MAT)

• Ithaca Community Recovery, is a non-profit organization that provides a meeting and activity space for Ithaca’s recovering community. They host a variety of meetings, including Alcoholics Anonymous, Al-Anon Meetings, Narcotics Anonymous, and more. Go to their website for meeting schedules.
• Mental Health Association in Tompkins County was established in 1954 to address mental health needs in the Ithaca community.
  • The Jenkins Center for Hope and Recovery is a drop-in center for those who use or have used mental health services. The Jenkins Center provides a safe environment where mental health consumers can relax, have fun with peers, and share information and support.

There are many individuals with health conditions such as diabetes, allergies or arthritis who manage their care at home and use syringes. For example, people with diabetes use syringes to inject their own insulin and lancets, or finger stick devices that use short blades to test their blood glucose or sugar every day. Other conditions that use sharps in their care management include osteoporosis, multiple sclerosis, hepatitis B and HIV.

Sharps also refer to syringes and needles used by substance abuse injection drug users.

Additional sharps include auto injectors (epipens for bee stings) and needles on infusion sets for antibiotics or home dialysis.

The FDA estimates 9 million Americans use needles or other sharps to manage their own and their pet’s medical conditions in the home.

Improperly disposed sharps can injure people or pets by causing needle sticks, especially to the hands and feet or to your pet’s nose and paws.

Throwing sharps in open trash containers in public restrooms and hotel rooms expose sanitation workers and housekeepers to risk.

Improperly disposed sharps in recycle bins expose workers to undue risk when handling.

Glass bottles can break, soda bottles and milk cartons can be punctured and lids can easily come off coffee cans exposing needles to your family, pets and sanitation workers.

Anytime there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission. The risk of catching a serious infection as a result of an accidental needle stick injury is very low, because HIV, Hepatitis B and C viruses do not survive for long outside of the body. Most community needle stick injuries involve needles that have been discarded for some time.

Although the risk of disease transmission may be low, if an exposure occurs the anxiety and concern of the person or the parent is high and there is considerable time and cost to follow-up with your medical provider if exposed.

• The best local option for safe disposal is to use hospitals and nursing homes in your area who accept home-generated sharps as a free community service. Call them to get specific information about dates and times and whether they require a bio-hazard sharps container or accept a substitute. Directory of local sharps collection sites.
• Another free option is the Southern Tier Aids Program, 314 West State Street, who operate the syringe exchange program. They also accept community generated sharps.
• Paid options include sharps mail-back programs, such as the BD Company that use pre-paid special mailers at a relatively low cost.
• And lastly, although it is not the recommended method, sharps can legally be disposed of in the household trash with the following caveats. Use a sturdy, leak resistant, and puncture proof empty detergent bottle or bottle made of rigid plastic, mark it to say ‘contains sharps’ ‘do not recycle’, cap it and tape the cap as an extra precaution. But, it is important to note, private refuse haulers may have restrictions.

• Never dispose bio-hazard marked containers in the trash.
• Never use glass bottles, soda bottles, milk jugs or coffee cans to store and dispose of sharps.
• Never dispose of sharps in the toilet.
• Never attempt to take the remove the needle from a syringe from someone other than yourself. And if it is your own sharp only remove the needle if you have a device specifically designed for this purpose.
• Never overfill sharps containers.
• Always keep sharps containers out of reach of children and pets.
• If you use sharps, be prepared if away from home and carry a portable sharps disposal container. Public places such as airports are beginning to post lockable sharps containers. In time hopefully more public restrooms will install these lockable boxes for their customers and for the safety of their workers.

If you are injured by a sharp from an unknown source wash the area as soon as possible with soap and water or hand sanitizer and call your medical provider immediately to determine the best response.

If you find a sharp, obtain an empty detergent bottle that will safely hold the sharp (see above for details), use a barrier to protect yourself such as plastic gloves or tongs and place the sharp needle side down into the container. Do not attempt to take the needle off. Cap the bottle; mark the container, tape the cap and then it can be transported safely. The container may be placed in the household trash or be taken to the Southern Tier Aids Program at 501 South Meadow Street. Inform local law enforcement that you’ve found the sharp(s) so they are aware of the problem. Lab testing is not done on sharps found in the community.

Visit the New York State Safe Sharps Collection Program website.