We, the board members of Catskills Pathways to Recovery, support substance use treatment in the Catskills. We are concerned that a potential substance use detoxification facility being proposed for the village of Stamford will not provide adequate care for people in recovery and may in fact cause them harm.
Abraham Rubin, a New Jersey investor who is in talks to purchase the former Delaware Inn property in Stamford, is proposing to open an addiction detoxification facility in that space. The village Planning Board has held two public hearings on a special use permit which would allow the proposed business to potentially operate in the space. The village will vote on the special use permit at its May 13 meeting.
Since 2018, Catskills Pathways to Recovery has worked to support people who use substances and those who are in recovery with a variety of initiatives: employing certified peer recovery coaches, recruiting and supporting providers who treat substance use disorder, distributing naloxone (Narcan) to reverse overdoses, and sharing information and best practices about addiction, treatment and mental health.
Recovery is a lifelong process, and it can involve many stages, some which can recur many times. These include periods of acute and chaotic substance use, detoxification and withdrawal, relapse, and times of stability and flourishing. People who use substances need different support during different phases of recovery, and during all phases they require support from a broad range of sources in their communities.
Detox alone rarely leads to long-term recovery. The detoxification and withdrawal portion of a recovery process is unpleasant (often involving physical pain, nausea, vomiting and other symptoms), and withdrawal from some substances, such as alcohol, can be deadly. Detox is a medically sensitive experience that requires, at minimum, medical supervision of withdrawal and access to “an emergency medical system that can transport patients to emergency departments and other sites for clinical care,” according to the Substance Abuse and Mental Health Services Administration’s guidelines.
At the Stamford Village Planning Board public hearing in March, several people representing local EMS organizations expressed concern that Stamford’s EMS services are not adequate to support this need. Stamford is 25 miles from the nearest hospital, and the ambulance services here are already overstretched.
When someone in recovery is medically stable, after the acute withdrawal period, they require support from their community and medical professionals who can supervise any ongoing medical issues or medications they might require. It is helpful to provide discharge support to people as they exit detox, to support them with logistics, transportation, and coordination with the next set of providers (rehabs, local mutual aid meetings, peer recovery specialists, doctors) who will support their recovery. Rubin’s proposed facility does not appear to have plans to offer this kind of coordinated discharge planning, but only a statement that patients will not be allowed to leave the facility without being accompanied by a family member or service.
It is important to understand that recovery from substance use is often a winding, non-linear process that sometimes involves relapse. Relapse is a particularly dangerous time for someone in recovery, because a person who once used substances has a lower tolerance for those same substances after a period of non-use, so a smaller amount of the substance can cause overdose and death. Compounding this risk is the fact that people often relapse in secret, so if they do overdose, they are often alone, with no one to call 911 or administer naloxone. This has led to the deaths of neighbors and friends here in the Catskills.
Any detox facility that cares about the health of its patients must consider the high risk of relapse upon discharge from that facility. It does not appear that Rubin understands or considers this risk, because he and his lawyer have only expressed minimal standards for discharge planning.
There are few facilities or providers in the Catskills who offer substance use treatment or support, although Margaretville Hospital has expanded its substance use services. In order to succeed, treatment providers must treat and support the whole person as they move through the various phases of recovery and ensure that their clients and patients are not abandoned at critical stages in the process.
We do not think Rubin is proposing to build a treatment program that meets these criteria. Rubin and his lawyer have stated at public meetings that no doctor will be onsite at his detox facility and that patients will not require outside services or emergency transport. His plans currently do not involve transportation, provisions for visitors or meaningful discharge planning for his patients. None of this meets our understanding of best practice for treating people with addiction.
We urge the village of Stamford Planning Board to deny the special use permit for this project.