ALBANY - In April 2017, Gov. Andrew Cuomo held a ceremonial bill signing on Long Island proclaiming the state would now invest $200 million a year to fight the scourge of opioid addiction in New York.
There was just one missing point: The state was already spending that much money on the epidemic.
A review by the USA TODAY Network's Albany Bureau found that despite New York's insistence that it is adding significantly more money to fight the abuse of heroin and other dangerous drugs, the state has largely just shifted funds from other addiction programs to pay for it.
"There was no infusion of $200 million in new dollars," said John Coppola, executive director of the Alcoholism & Substance Abuse Providers of New York State.
"Most of the dollars were already there, already being utilized by prevention and treatment programs, but now their emphasis shifted to address the opioid epidemic."
State officials countered that they properly moved resources amid an unprecedented surge in opioid deaths in New York and the nation, saying New York has done more than other states to fight the problem — either through legislation or funding.
But the Albany Bureau found a series of troubles with the state's efforts, which has frustrated providers and left patients struggling to find adequate help to kick their addiction and potentially save their lives.
Among the findings:
- New York's spending on heroin and opioid treatment has, in fact, doubled since 2011, but the numbers are tricky. It's mainly redirected funding from other treatment programs, leaving other services neglected, critics said. The budget for the agency overseeing the programs grew just 1 percent between 2012 and 2018 — in part because of new federal aid. More money is pledged this year, though.
- The number of opioid deaths in New York skyrocketed 135 percent between 2013 and 2016. In 2016 alone, the state had nearly 3,800 opioid deaths, yet the state has only increased its number of treatment beds by 4 percent since 2014 — to about 11,000 overall.
- A 2016 law banned prior insurance authorization before a patient could get 14 days of care for substance abuse. But that only led to another issue: After 14 days, addicts can end up back on the streets, creating a "revolving door" of care, as one provider said.
- This year, New York took another important step: A surcharge on pharmaceutical companies to pay for opioid programs. But the $100 million it may bring in is another fiscal sleight of hand. The money will mainly supplant existing state funds for treatment and recovery — not increase them.
"There is a lot of hocus pocus with the numbers," said Lauri Cole, executive director of the state Council for Community Behavioral Healthcare.
Fighting the epidemic
Every special-interest group in New York is generally charged with trying to lobby state leaders for more public money for their various causes — whether it's substance-abuse treatment, school aid or social services.
But, at this moment, what makes the battle over funding for opioid addiction unique is the seismic nature of the problem.
New York is one of just five states in the nation — and the largest among them — where deaths from suicide, alcohol and drug use doubled between 2005 to 2016.
The others were Delaware, New Hampshire, Ohio, and West Virginia, according to a report last month from The Commonwealth Fund, a health-care advocacy group based in Manhattan.
So when Cuomo last year touted the $200 million investment in fighting the opioid epidemic, industry leaders criticized it for being little more than a public-relations event.
The money wasn't new, nor was it new what he pledged to do with the money, such as investing in treatment beds and community-based providers.
It was what the state already had committed to do. The state even admitted as much.
"It was a calculation, a projection, of how much the hundreds of millions of dollars our agency receives to do prevention, treatment and recovery is dedicated to addressing opioid-related issues," said Rob Kent, general counsel for the Office of Alcoholism and Substance Abuse Services (OASAS), the state agency that oversees the programs.
State officials said OASAS' budget grew slightly as the state installed efficiencies and consolidated functions -- not to the detriment of addiction services. Since taking office in 2011, Cuomo has demanded a 2 percent cap on state spending, which has included a edict that many agencies keep spending flat.
In the current fiscal year, OASAS' budget is set to grow to nearly $679 million, up 13 percent from last year. Most of it is state money.
Providers said they have seen some new funding for programs, such as new 24/7 open access centers that are starting to open in some places, including in Rochester.
But in some cases, money has been slow to arrive.
"It was a system that had gaps in it before any of this happened, and then once it’s a crisis, you feel those acutely," Angela Sullivan, executive director of the Alcohol and Drug Council of Tompkins County.
The agency received $450,000 in state aid in February to open an access center — basically an urgent-care center for addicts seeking help. It hopes to open in August, with a goal of serving 1,000 people a year.
But just three of the 10 24/7 access centers have opened so far after the state pledged them last year.
And the state has added just 420 treatment beds in its residential facilities since 2014, though another 130 beds are planned this fiscal year.
In April, for example, the state added a 50-bed unit in Binghamton at the former Broome County Developmental Center.
Actions by New York
The access centers are among the many steps New York officials have taken to fight the opioid-abuse problem, giving people seeking help a new way to find care, state officials said.
The state is receiving $50 million in federal money over two years to fund programs, such as mobile units that go into communities trying to link drug abusers with services.
With the federal money, state aid and funding from Medicaid, the health insurance program for the poor and disabled, New York probably is spending billions on addiction services, Kent said.
"We’re creating a pretty large infrastructure to address addiction issues generally and the opioid addiction in particular," he said.
The state Legislature, especially the Republican-led Senate, has pushed for additional aid and laws to fight opioid abuse.
The state has toughened laws against drug dealers, mandated more treatment coverage by insurance companies and limited access to prescription drugs — which can often fuel an opioid addiction.
"We’re doing everything we can do," Cuomo said on Long Island in April 2017 when he discussed the $200 million in funding, saying incorrectly, records show, that New York was doubling funding from the previous year.
"I’m proud of what this state has done in this regard. We’ve been aggressive all along."
Yet he added, "We are still falling behind."
Patients say the problem is a mix of more state resources needed and their own will to seek help.
Stephen Hill explained his battle with recovery in a recent interview with The Journal News/lohud as part of the USA TODAY Network's review of New York's spending.
“All of these treatment programs were 28 days long, and I was addicted to opiates and prescription painkillers and later on heroin…and 28 days just is not enough for an opiate addict,” said Hill, 30, who is from Rockland County.
Hill would bounce from state-run treatment to costly private rehabs and sober homes, but he continues to struggle with recovery.
“Every time I would come out of treatment and I would say to myself, ‘I’m just going to drink alcohol, or maybe I’m going to smoke marijuana every now and again,’ he said, recalling the inevitable return to his drug of choice, OxyContin.
“Every single time I would drink I would get that thought in my head, ‘This is not what I’m looking for, I need opiates.' That’s what my body wants, that’s what my brain wants.”
Deaths continue to rise
Indeed, the problem is far from subsiding.
Some counties had remarkable growth in opioid deaths, particularly in New York City, where deaths more than doubled between 2013 and 2016, according to the state Health Department.
Outside the city, opioid deaths have surged, too.
In Broome, the number of deaths more than doubled over the same period from 22 to 57, and it doubled in Monroe County: from 68 to 149.
In Westchester, the number of deaths jumped 75 percent, from 71 to 124, from 2013 to 2016.
Overall, the deaths due to opioids in New York rose from 1,604 in 2013 to 3,766 in 2016, a 135 percent increase, according to the most recent data available.
It is unclear, however, how the state aid is distributed by county and the criteria used.
OASAS said it does not compile county-by-county funding on opioid services because people can travel across county borders for treatment.
So, the agency said, "a representation of funding by county would not provide an accurate assessment of where these services are available and who is able to receive them."
Providers said they still experience waiting lists to get patients into treatment facilities, particularly long-term care.
Jeremy Klemanski, president of Syracuse Behavioral Healthcare, one of upstate's largest providers, said the state's efforts are encouraging.
But he added: "I would just hope at some point we can look at some of the structural financial challenges to existing programs so that we can reinforce them so we can help more people also."
Revolving door
Health-care experts said that New York has improved immediate access to care for opioid abusers.
But the system hasn't added enough services for people needing months of in-patient help — leading them to often return for short-term treatment time and again.
"We’re clogging the system because it becomes such a revolving door," said Jonathan Westfall, program director of the Find Your Path community outreach program in Rochester.
The law requiring 14 days of care is helpful for getting addicts into the system, but then there isn't enough resources to give them adequate care thereafter, Westfall said.
"Fourteen days, that is not even nearly enough time to get the drugs out of your system, much less have your head on straight," he said.
"And they’re throwing people back on the streets again because there’s no halfway housing or supportive living situations."
Kent, the OASAS counsel, disputed the lack of access, saying on any day there are many available beds short and long-term treatment. The agency keeps an up-to-date website on availability.
"I think our commitment is unlike any other state," Kent said.
"When we sit here and there are empty treatment beds around the state, we are making good investments. We’ve seen through a whole bunch of initiatives over the last five years that have absolutely increased access."
Spinning through that door
Critics said there may be beds, but they could be far away from a person's home and not easily gotten to. And some facilities have better reputations than others.
New York's spending on opioid programs is more than some other large states, but less than others.
New York, for example, appears to be outpacing California, which has more than double the population. California officials said the state spent $243 million on opioid-treatment services in the 2016-17 fiscal year — mainly through federal aid.
But Florida, which is slightly larger than New York, said it has committed $310 million in the current fiscal year for opioid treatment, up from about $200 million in 2012. So that's more than New York.
Susan Salomone, founder of Drug Crisis in our Backyard in Carmel, Putnam County, also referred to New York's system as a "revolving door."
Her son died of a heroin overdose.
"You’re in and you're out, and it’s really no more than an interruption of use," she said.
Using again while in treatment may mean getting tossed out of a program, said Westfall of Find Your Path. In areas where services are scarce, that bed then goes to someone else.
Von Porter of Rochester used crack cocaine and alcohol for 30 years. He had entered treatment when ordered by the courts and to avoid losing parenting rights to his son, which happened in February.
But it wasn’t the right motivation.
“If you’re not ready, it doesn’t work,” Porter, 54, said.
He said he finally grew tired of the lifestyle. On April 10, Porter went to Westfall for help, and Westfall took him to Open Access on University Avenue. He said he had little problem getting treatment.
The next day, he went to the Binghamton detox center and then to Albany for a 28-day program. He said the facilities helped him qualify for insurance to pay for the treatment.
“If you’re willing, services are out there,” he said.
Opioid tax
Advocates were hopeful that New York this year would impose a tax on opioid manufacturers that would boost state spending on treatment and recovery.
They got half of what they wanted.
As part of the state budget for the fiscal year that started April 1, the state Legislature and Cuomo agreed to a surcharge on pharmaceutical companies to pay for opioid programs.
The surcharge is expected to bring in $100 million a year to the state coffers, and it is designated to go specifically to OASAS for opioid addiction.
But therein lies the rub.
The surcharge doesn't mean that another $100 million is go to the epidemic — in other words, to bring state spending to $300 million a year.
It will largely supplant existing state spending. Maybe there will be more, but certainly not the full $100 million on top of what is already spent.
"We would have been better suited if that money that we were taking in by way of the surcharge was being put in for new services, which is not happening. We’re simply supplanting money," Sen. Fred Akshar, R-Binghamton, who co-chairs the Senate's committee on drug abuse.
Akshar called it the state's "needs versus wants," pointing to how New York continues to spend $420 million a year on film-tax credits for television and movie productions, for example.
Cuomo's office defended the structure of the opioid tax, saying it will provide a dedicated funding stream for treatment and prevention at no cost to taxpayers.
“The opioid stewardship fund will allow OASAS to support and expand needed services, and avoid cuts to critical programs that are being used to fight opioid addiction across New York," said Morris Peters, spokesman for the state Budget Division.
"This fund is designed to hold opioid manufacturers and distributors accountable for their role in the opioid crisis and help recoup taxpayer costs related to this epidemic."
Joseph Spector is chief of USA TODAY Network's Albany Bureau.
Includes reporting by Democrat and Chronicle staff writer Patti Singer and Journal News staff writer David Robinson.