The country’s health is in dire straits. Addictions and overdoses are on the rise, and cardiovascular disease continues to reign as the leading killer. But thanks to health initiatives promoted by institutions like Ellenville Regional Hospital, we may be on the cusp of a healthy upswing.

“We have been in the ‘sick care business’, taking care of people after they fall ill,” said Steve Kelley, CEO of Ellenville Regional Hospital. “As things shift, we see an opportunity to be in the ‘wellness’ business. And that is the only way we can reduce health costs, by having a healthier population. We have to help people become more attuned to their health.”

The hospital, with various partners, is tackling the big issues in Wawarsing and Ellenville, in particular, cardiovascular disease and the opiate crisis. The key is to identify people with risk factors and come up with ways to get them to see viable alternatives.

It may seem incongruous to compare someone hungering for a third Whopper at dinner time with someone thinking only of shooting up some of that gram of smack they just scored, but addictions are sprinkled throughout our culture — sugar, TV, alcohol, tobacco, porn — and some are more obvious at the hospital than others.

Victoria Reid, Executive Director of the Rural Health Network at the hospital, is actually tackling the two that “present” more often in the ER.

“Cardiovascular disease is four times higher in Wawarsing than in Ulster County as a whole,” Reid said with some fairly chilly precision. “Hypertension here is twice the county number.” And just to be clear about things, Reid noted, “Cardiovascular disease continues to be the number one cause of death in the US.” Indeed, it results in about 610,000 deaths a year and is said to cost the country $200 billion annually.

That remains the biggest health challenge, but surging numbers regarding the use of heroin and the opioid pills that began the current crisis have put opiates high up on Reid’s list of crises to tackle.

When the US finally cracked down on pill mills that sold millions of OxyContin tablets, as well as other opioid painkillers, the price shot up and very quickly the supply of heroin increased. The Sinaloa Cartel saw a magnificent commercial opportunity and took it with gusto. In the hazy world of illegal powder drugs, there’s always a thirst for something stronger, something “killer.” Enter fentanyl, the synthetic opiate that is only prescribed in the US in two forms: as a patch worn by someone with intense localized pain, or in anesthesia in the operating theater. If you were wondering what an “overdose” means, it’s that opioids affect the brain region that regulates breathing. Overdose and you stop breathing.

Now, about 70,000 Americans die from overdoses each year, and fentanyl is involved in almost half of those. All opioids bind to opioid receptors in the brain. Fentanyl binds tighter and harder than almost anything else, hence very small amounts can have an enormous impact. The difference between a therapeutic dose and a deadly dose of fentanyl is reportedly very small. Indeed, fentanyl is between thirty and fifty times as potent as heroin.

Heroin took over the top spot in overdose deaths in 2012 from oxycodone. Fentanyl began to shoot up the charts at the same time, from a stable base number of 1,600 a year (nationwide) to 4,200 by 2014, and now to about 30,000.

In the study, Heroin uncertainties: exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’ or FASH, (authors Daniel Ciccarone, MD, MPH, Jeff Ondocsin, MA, and Sarah Mars, PhD), published in 2017 and focused on Massachusetts, heroin users were interviewed about the difference between heroin and fentanyl. “Participants noted three primary differences: perceived fentanyl had a more intense ‘rush’ (i.e. explosive onset of strong opioid effect), greater potency and a shorter duration of effect than heroin, typically one to two hours. Jackson, a man in his twenties injecting heroin for nine years, gave a typical answer: ‘[Fentanyl] has an excellent rush. The rush is way better than heroin but it only lasts a couple hours, then you’re sick again. Heroin will last half a day.’”

At Ellenville Regional, they began the effort to combat opioid addiction with a program to move regular, habituated opioid pill users to lower doses, and to alternate ways to manage pain. Kelley, at that time, noted that many opioid users came to the ER late at night and complained of terrible pain as they sought a prescription for Percocet or OxyContin. The tactic was clear, overwhelm the Emergency Room at a time of minimal staffing and squeeze out a script.

Now the Rural Health Network is promoting the “Angels Initiative” at the hospital.

The initiative began when police in Gloucester, Massachusetts, called on people who sincerely wanted to get off addictive drugs. They could come in, hand over any drugs they had, and be introduced to “Angels” who were “peer navigators,” or people who’ve been affected by addiction and have a “relatable lived experience.” Since, as Reid observed, seventy percent of referrals come from the criminal justice system, the police play a vital role in this initiative. “We’re proposing here a path to recovery,” Reid added. “Police can bring them to the ER and the peer navigator will assist in making referral to treatment.”

That last point is crucial, because Reid also noted that “opiate addiction is a very difficult disease to treat and only ten percent receive treatment.”

The Angel Initiative is now part of the widespread Police Assisted Addiction and Recovery Initiative. The concept is simple, provide “non-arrest pathways, treatment and recovery.” It reframes addiction as a disease rather than a crime and works with a wide spectrum of partners, including social workers, clinicians, and trained volunteers. The desired outcome appears to be to encourage users chasing ever bigger highs to instead get help.

And this fits into Kelley’s “wellness” model, too. With cardiovascular disease, the trick is to get people to recognize the risk factors. Smoking, diabetes, and being overweight are the most common. The hospital has a program run by Shanna Nigro (845-647-6400, ext. 336) that seeks to assist people once they have realized they need dietary help. Sometimes it’s as simple as taking them on a walk around “the outside of the store” at ShopRite (the places where fruits, vegetables, meats and dairy can be found, instead of packaged foods). Sometimes it’s just attending a class on basic cooking.

Reid noted that the Ellenville/Wawarsing area is a “bit of a food swamp” with a lot of fast food everywhere. “It’s cheap, it’s easy to access and it’s calorie-dense.”

And yes, there are many people now who don’t know how to boil an egg. If they live on pizza and other fast foods, then there is a price to be paid.

While the personal cost of fast food addiction takes a while to manifest itself, the cost of shooting fentanyl adulterated and substituted heroin can show up very quickly.

One hopeful note that shouldn’t be missed, Reid said that all the pharmacies in Wawarsing now participate in the Naloxone (Narcan) program. Naloxone is an opioid antagonist that cleans off the opiate receptors and ends the high, helping to save the life.

“Reframing the subject” is what Kelley is seeking. “We need people to be more aware of their health and prepared to take actions that will keep them healthy.”