2

Table of Contents

2

Executive Summary

9

Developing this Report: Background

10
11

Community Engagement: Film Panel and
Community Focus Groups
Guiding Principles

13

The Scope of the Problem in Ithaca

14
17
17
18
20

The Criminal Justice System
Behavioral Health Systems
The Health System
Drug Policies
A Problem for the Community

21

Consultation Findings

22
26
31
32

Prevention
Treatment
Harm Reduction
Law Enforcement

37

Recommendations

38
40
41
44
46

Governance and Leadership
Education
Recovery-Oriented Treatment, Harm Reduction,
and Ancillary Services
Community and Economic Development
Public Safety

47

Conclusion

48

Appendices

48
49

Appendix A: Drug Policy Innovation in Ithaca
Appendix B: Toward a Public Health and
Safety Approach to Drug Policy
Appendix C: Property Crime Arrests, List of
Reported Offenses and Definitions

51

Publication Date: February 2016
© 2016, City of Ithaca, NY

53

References

58

Acknowledgements

 The city of Ithaca has ranked on lists of America’s
smartest and healthiest cities.1,2
Yet despite Ithaca’s many strengths, it has, like cities
across the United States, been hit hard by problems
related to drug use, drug addiction, and the broader war
on drugs. As overdose deaths rise throughout the region
and the nation, policymakers from across the political
spectrum have joined law enforcement leaders to declare
that we cannot arrest our way out of the drug problem.
Simultaneously, there is a growing acknowledgement
among policymakers that the war on drugs – the dominant
drug policy framework for the past four and a half
decades – has failed and new approaches are needed.
And in the midst of these developments, communities
across the nation are engaged in a powerful dialogue
about race relations, a criminal justice system in need of
reform, and the need to provide people with the support
they need to overcome addiction.
With this backdrop, we present The Ithaca’s Plan:
A Public Health and Safety Approach to Drugs
and Drug Policy. To develop new approaches to
problems related to both drug addiction and our
policy responses to it, Mayor Svante Myrick initiated a process to study the problem, gather input
from the Ithaca community and issue-experts,
and propose recommendations for a coordinated
drug strategy, rooted in public health and safety.
This report is the product of this undertaking and
includes insights, findings, and recommendations
that have emerged from the work of the

Municipal Drug Policy Committee (MDPC), literature reviews, policy analyses, and, critically, consultations with community members and stakeholders, including elected officials, government officials,
policymakers, and service providers. The co-chairs
of this committee are Gwen Wilkinson, Tompkins
County District Attorney and Lillian Fan, Assistant
Director of Prevention Services-Harm Reduction at
the Southern Tier AIDS Program. Drawing on the
extensive work of the entire MDPC, the co-chairs
drafted this report and then submitted it to Mayor
Myrick for review and approval.

 2

Executive Summary
This report grows out of a recognition that the
city of Ithaca, despite being a national leader
in many ways, could do better in its response
to drug use. As in many other parts of the
country, interaction of policies and available
services in Ithaca needs re-imagining to
respond to past approaches that have failed.
This report presents insights, findings, and
recommendations that have emerged from
a yearlong process of consultations with
community members and stakeholders,
policymakers, elected officials, experts, and
service providers to inform Ithaca’s drug
policies. Improving public health and safety are
its guiding framework. As such, Ithaca stands
poised to lead the nation in creating the first
comprehensive municipal drug policy plan
rooted in public health and harm reduction
principles and grounded in the experiences and
needs of the community.
The drug policies and services currently in
place in the city of Ithaca reflect the broader
policy dissonance of a shifting and bifurcated
approach to drug use in New York state and
nationally. While new practices are adopted
to reduce the negative health and social
consequences of drug use, older practices
criminalizing drug use remain. The policy
conflicts underlying these approaches are not
new, but they create serious problems and
inefficiencies when it comes to how drug use

is addressed. Too often, our past approaches
have failed to recognize that fundamentally,
the community prevalence of health problems,
such as problem drug use, and social
problems, such as participation in the illegal
drug economy, reflect deeper issues related
to social and economic opportunity and
racial inequality.
Over the past two decades, changes to drug
policies and practices have been implemented
in Ithaca with positive results. From the start of
his tenure, Mayor Myrick recognized the need
to build on these successes and develop an
overall strategy to address the realities of drug
use in our town.
In April 2014, Mayor Myrick convened a
group of community experts and leaders,
representing the various sectors involved
with responding to drug use. This group
came to be called the Municipal Drug Policy
Community (MDPC). The MDPC was charged
to identify and describe the drug-related
problems we experience in Ithaca and to
recommend policies and practices we could
adopt to improve our local response to drug
use and related policies. MDPC formed four
teams to explore these questions: Prevention,
Treatment, Harm Reduction, and Law
Enforcement – four domains or “pillars” which
reflect the ways our societal response to drug

 use has been structured. The teams met
several times to develop recommendations
for new and reformed policies and practices,
including reviews of the findings from
community engagement activities designed to
inform the process – a community convening
with 200 Ithacans, eight focus groups involving
nearly 100 participants, and dozens of one-onone meetings with key stakeholders.
Summary of Findings:
Prevention
Finding 1: General programming for a
substantial portion of young people is
lacking and available programming is often
inaccessible.
Finding 2: The drug trade is a symptom of
widespread unemployment of young people
and adults in Ithaca.
Finding 3: Geographic isolation, racism, and
poverty contribute to hopelessness, which
increases the likelihood of problematic
drug use.
Finding 4: Drug education and prevention
efforts should focus on both adults and young
people and include information and skills
about delaying the onset of use, preventing
problem drug use, and reducing illness
and death.
Finding 5: There is a lack of general awareness
about drugs, how to navigate systems of care,
and how to prevent drug-related deaths.

Treatment
Finding 1: Abstinence-based treatment programs
predominate in Ithaca, and more varied treatment
modalities are needed.
Finding 2: There are gaps in treatment
accessibility due to limited capacity and
affordability.
Finding 3: The lack of a detox center is putting an
exorbitant amount of pressure on Cayuga Medical
Center and costing hundreds of thousands of
dollars to the tax payer.
Finding 4: Treatment programs may
benefit from more cultural competency and
sensitivity training.
Finding 5: Ithaca needs more medication assisted
treatment options, including but not limited to,
providing methadone in town and increasing the
number of buprenorphine prescribers.
Finding 6: For some people, ancillary services
such as mental health counseling, job training,
and housing are necessary supportive services in
addition to, or instead of, formal drug treatment.
Harm Reduction
Finding 1: More comprehensive training is needed
on how to provide services to people at different
points on the substance use continuum.
Finding 2: Harm Reduction is not widely
understood, and few Ithacans know of the existing
– and effective – local harm reduction programs
already in operation.
Finding 3: Harm Reduction services need to
be expanded.

3

 Executive Summary

4

Law Enforcement
Finding 1: Law Enforcement and community
members alike do not believe that law
enforcement personnel are best situated to
deal with drug use.
Finding 2: Perceived experiences of racial
profiling, difference in treatment, and racial
disparities in arrests rates have created a
perception that law enforcement targets
communities of color and are less willing to
connect them to services than white Ithacans.
Finding 3: Community opinion about drug
courts is mixed. People like that drug courts
connect those in need to resources, but
most thought it would be more effective to
make such resources available outside of the
criminal justice system.
Finding 4: People fear calling law enforcement
to help with drug-related issues because of the
collateral consequences it can trigger.
Finding 5: While most community members
and criminal justice system personnel
recognize the good in diversion programs and
treatment, more education about relapse and
recovery are needed.

Recommendations were made across
five categories and are summarized below.
Governance and Leadership
Goal: Create a mayoral-level office tasked
to reduce the morbidity, mortality, cost, and
inequities associated with illicit drugs and our
current responses to them.
1. The mayor should open an Office of Drug
Policy to orient the work of all city agencies towards reducing morbidity, mortality, crime and
inequities stemming from drug use and our
responses to it. This new approach recognizes
that criminalizing people who use drugs has
not been effective and anchors Ithaca’s policies
in principles of harm reduction, public health,
and public safety. It also recognizes that city
agencies often work at cross purposes and
provides a structure for coordinating their work
with the simple aim of improving the health
and safety of communities, families and individuals across the city.
a. The mayor should appoint a director
to: run the office; advise the mayor and
city agencies; implement the MDPC
recommendations for how the city can
improve its drug policies; coordinate the
activities of various city agencies and
departments; be a liaison between city,
county, state and federal agencies; and act
as a spokesperson for the city on drug
policy matters.

 Education
Goal: Key stakeholders and all Ithacans should
have access to evidence-based practices and
education around drugs, preventing problematic
use, reducing harms associated with drug use,
and helping oneself or others who have a drug
use problem.
1. The Office of Drug Policy would coordinate
with existing Ithaca organizations that provide
services to the community (like Southern Tier
AIDS Program) to host a series of community
education events every year around drugs,
policies associated with drugs, and general
health within the community. The Office would
also coordinate training modules for service
providers to ensure they are informed with the
most up to date treatment options, strategies,
and resources. Where possible, these training
programs should include people who are
directly impacted by drugs or drug policies, be
evidence-based, and be grounded in a harm
reduction approach.
Office of Drug Policy public education
responsibilities include, but are not limited to:
a. General community awareness events
(around drugs/drug policies).
b. Education events for parents and loved
ones of those struggling with addiction
(topics could include: recovery is not linear,
medication assisted treatment, syringe
exchanges, relapse is a part of recovery,
Ithaca resources).
c. Narcan and overdose response trainings for
the public.
d. Education for law enforcement, healthcare
providers, service providers and users on
harm reduction models. Examples include
a train the trainer curriculum based on the
Enough Abuse structure that can be run
by STAP.

e. Cultural competency and sensitivity
trainings for treatment and medical
professionals working with people in
treatment and medical settings.
f.  Training healthcare providers around opioid
prescribing and patient education, such
as a standard concise information sheet
distributed by all providers when opioids
are prescribed that would also include
treatment resources and information for
the Ithaca addiction hotline.
Recovery-Oriented Treatment,
Harm Reduction, and Ancillary Services
Goal: Create a recovery-oriented treatment
continuum that offers access to timely,
individualized, and evidence-based, effective care,
through services that are people-centered and
able to meet the needs of individuals no matter
their current relationship to drug use or recovery.
1. Add an on demand centralized treatment
resource system to the existing Ithaca 211
directory:
a. Conduct short screenings over the phone to
assess appropriate service referral.
b. Provide referrals for treatment centers
in Ithaca with up to date inpatient bed
numbers.
c. Create a parent/loved one hotline (based on
the Partnership for Drug Free.org)
d. Connect people to a treatment navigator
(based on the Affordable Care Act navigator)
to help persons or families in trouble
navigate the treatment and referral process,
including after care assistance.

5

 Executive Summary

6

2. Open a freestanding 24-hour crisis center in
Ithaca – medication assisted and supervised
outpatient detox, with case management
services available on-site.
Activities:
a. Law Enforcement and laypersons can
voluntarily bring an intoxicated individual for
safety and respite.
b. This center will include short-term
temporary beds for persons waiting for
enrollment in treatment centers.
c. The center will also include a “chill out”
space for people who are under the
influence to help assuage the proliferation
of public intoxication. This is not the same
service as detox; the purpose of this space
is not primarily to help someone withdraw
but to even out, provide them with health
education, and potentially connect them to
harm reduction services.
d. The crisis center would also be appropriate
for parents or loved ones to send their
loved one in distress voluntarily, instead
of a PINS or person in need of supervision
process, which involves putting the person
through the court system and often leads
to intense strain on familial relationships,
usually during crucial intervention windows.
Services would include support groups
(abstinence based and non-abstinence),
on- site counseling, case management, and
family support services.
3. The Tompkins County Department of
Health should be encouraged to continue
implementing an aggressive public education
campaign about harm reduction practices to
reduce risks from underage drinking, tobacco
use, and other illicit substances.

4. Increasing awareness around the New York
State 911 Good Samaritan laws can also help
make adults and young people aware of the
resources and the legal protections afforded
victims and people who call for help.
5. The city should partner with the Tompkins
County Health Department and local medical
providers to offer low cost or free Hepatitis A
& B vaccinations and Hepatitis C treatment to
people who actively inject drugs.
6. Implement a Housing First, basic, noncontingent needs model for Ithaca to increase
access to housing, nutrition and health care
services without requiring abstinence or
participation in treatment.
Activities:
a. Maintaining the safety of themselves and
those around them should be the criteria
to receive services, which should not be
dictated by whether or not a person is using
a substance.
b. This model should include but not be limited
to sober living facilities, low threshold
housing, and housing options for people with
families.
7. The city should work with relevant agencies
to integrate mental health care options into
substance use services, with an emphasis
on providing more robust service options for
people with dual diagnoses.

 8. Increase the availability of medication
assisted treatment in Ithaca, including
opening a methadone clinic and increasing
the number of office-based buprenorphine
(i.e., Suboxone) prescribers.
9. Continue and expand proven harm reduction
programs, including but not limited to, syringe
exchange services, opioid overdose education/
trainings, syringe disposal kiosks, and
naloxone distribution.
10. Explore the operation of a supervised
injection site staffed with medical personnel
as a means to: prevent fatal and non-fatal
overdose, infectious disease, and bacterial
infections; reduce public drug use and
discarded needles; and provide primary care
and referrals to basic services, housing,
and substance use services and treatment,
including the integration a basic health care
provider at harm reduction sites.1,2
11. The city of Ithaca should request the New
York Academy of Medicine or another objective
research institute to study the efficacy and
feasibility of heroin maintenance therapy for
people who do not respond effectively to other
forms of opioid replacement therapies.3
Community and Economic Development
Goal: Support and expand existing efforts to
improve youth and family development, economic
opportunity, and public health of communities,
targeting vulnerable communities as immediate
beneficiaries and ensuring that all Ithacans have
the same access to resources and investments.

1. Partner with alternative to incarceration
programs that connect low level users
and sellers to jobs programs (see LEAD
recommendation); integrate a jobs training
program as an ancillary service in treatment
centers; and create an apprenticeship program
in conjunction with the Downtown Ithaca
Alliance and Tompkins County Chamber of
Commerce and community outreach worker to
encourage youth employment.
2. Pass Ban the Box legislation for private and
public sector jobs and encourage Tompkins
County to do the same in order to expand
job opportunities for people returning from
incarceration.
3. Develop a citywide training/education
program on basic work skills that would be
offered before the start of any potential job
training course.
4. Lobby Tompkins County to create a
dedicated case management program for the
re-entry population.
5. Seek to reform zero tolerance programs in
the school district to incorporate restorative
justice systems in order to curb the rise of
suspensions, expulsions, and dropout rates all
of which contribute to a young person’s general
community disengagement and raise the
likelihood of unhealthy risk behaviors.
6. Integrate comprehensive services to reduce
the risks associated with drug use or alcohol
poisoning at local establishments frequented
by residential college students such as,
safe settings where patrons can sit and rest

7

 8

Executive Summary

away from loud, crowded spaces; setting up
syringe disposal containers in restrooms; and
providing free and accessible water during
school year weekends. 
7. Establish a process through the Ithaca
Office of Drug Policy to monitor, investigate,
and address racial, gender, age, and
geographic disparities in health and socioeconomic outcomes across administrative
and criminal systems. These efforts should
include surveillance, research, and analysis
of the different data systems (including desk
appearance tickets, Unlawful Possession of
Marijuana violation, treatment admissions/
graduations, drug court enrollment, etc.).
ODP should issue a findings report and make
recommendations to reduce unwarranted
disparities.

Public Safety
Goal: Redirect law enforcement and community
resources from criminalization to increasing
access to services. Encourage a shared
responsibility for community health and
safety that extends beyond the Ithaca Police
Department.
1. Pilot a Law Enforcement Assisted Diversion
program, modeled on the successful
Seattle LEAD program (see alternatives to
incarceration program).
2. Train Ithaca Police Department on the
syringe exchange program annually. The
trainings, conducted by Southern Tier AIDS
Program, should include how to make sure
officers are safe when interacting with people
who inject drugs and collaboratively identifying
public spaces to place syringe and medication
disposal kiosks.
Left: Agenda from
Mayor Myrick’s initial
municipal drug
strategy convening
– April 2014

1

  Wood, E., Kerr, T., Spittal, P. M., Li, K., Small, W., Tyndall, M. W., & Schechter, M. T. (2003). The potential
public health and community impacts of safer injecting facilities: evidence from a cohort of injection drug
users. JAIDS Journal of Acquired Immune Deficiency Syndromes, 32(1), 2-8.

2

  Ministry of Health, Canada. (2008). Vancouver’s INSITE Service and Other Supervised Injection Sites: What Has

3

  March, J. C., Oviedo-Joekes, E., Perea-Milla, E., & Carrasco, F. (2006). Controlled trial of prescribed heroin in

Been Learned from Research?. Vancouver, BC, Canada.
the treatment of opioid addiction. Journal of substance abuse treatment, 31(2), 203-211.

  

 

1.

Developing this
Report: Background

 

 

Developing this Report: Background

10

In May 2013, Mayor Myrick was a featured speaker at
a major conference about drug policy at the University
of Buffalo.3 One theme of the conference was citybased drug strategies in different parts of the world.
Conference participants noted that there were few, if any,
municipal drug policy strategies in the U.S. that were
guided by a public health and safety approach; local
drug strategies, to the extent they exist at all in the U.S.,
are too often rooted in some way or another in the war
on drugs. Mayor Myrick began reaching out to drug
policy experts to talk about ways to reimagine Ithaca’s
response to drug use and the illicit drug trade, and
develop a more effective approach for achieving
better outcomes.
In April 2014, Mayor Myrick convened a stakeholder
meeting at City Hall to discuss the potential for developing a municipal drug strategy. Attendees at this initial
meeting included:
•  Gwen Wilkinson, Tompkins County District Attorney
•  Chief John Barber, Ithaca Police Dept.
•  Chief Tom Parsons, Ithaca Fire Dept.
•  Judy Rossiter, Judge, Ithaca City Court
•  Kevin Sutherland, Chief of Staff, City Of Ithaca
•  Ari Lavine, City Attorney, City of Ithaca
•  Gary Ferguson, Downtown Ithaca Alliance
•  Marcia Fort, Greater Ithaca Activities Center (GIAC)
•  Leslyn McBean-Clairborne, GIAC
•  Liz Vance, Ithaca Youth Bureau
•  Ami Hendrix, Tompkins County (TC) Youth Services
•  Kathy Schlather, Human Services Coalition
•  John Barry, Southern Tier AIDS Program
•  Frank Kruppa, Tompkins County
  Department of Health
•  Laura Santacrose, Cornell Health Education
•  Angela Sullivan, Alcohol & Drug Council
•  Seth Peacock, Attorney
•  Judy Hoffman, Ithaca City School District
•  Travis Brooks, GIAC
•  Lillian Fan, Southern Tier AIDS Program
•  gabriel sayegh, Drug Policy Alliance
•  Julie Netherland, Drug Policy Alliance
•  Kassandra Frederique, Drug Policy Alliance

At this initial meeting, participants agreed that there
was room for improvement in Ithaca’s drug policies and
response to drug use, and expressed interest in a process
to develop a new approach.
In July 2014, Mayor Myrick appointed Bill Rusen,
Chief Executive Officer of the Cayuga Addiction
Recovery Services, as chair of the MDPC.
Under Rusen’s leadership, the MDPC held its first meeting in September 2014. Mayor Myrick instructed the
MDPC to identify and describe the drug-related problems in Ithaca and to recommend policies and practices
the city could adopt to improve responses to drug use.
During the meeting, the MDPC formed four working
groups to explore these issues: Prevention, Treatment,
Harm Reduction, and Law Enforcement. The working
groups began meeting to develop and articulate recommendations for new and reformed policies and practices.
In February 2015, Rusen stepped down as chair of
the MDPC, and Mayor Myrick appointed two new coChairs – a representative from law enforcement, Gwen
Wilkinson, District Attorney for Tompkins County –
and a representative from harm reduction, Lillian Fan,
Assistant Director of Prevention Services – Harm
Reduction of the Southern Tier AIDS Program (STAP).
The co-chairs were tasked with managing the workgroups and the production of this report.
Community Engagement:
Film Panel and Community Focus Groups 
To ensure that Ithaca’s drug strategy was guided by
community input, the MDPC held several public events.
In February 2015, the Mayor hosted a community
screening of The House I Live In, an award-winning
documentary about the war on drugs. The event was
attended by more than 180 people from the Ithaca
community, and the conversation and discussion that
followed the screening provided valuable insight into the
concerns and ideas of community members. From this
event and other dialogue around the work of MDPC,
those expressing a desire for further sharing their ideas,
opinions, and experiences were engaged for individual
meetings throughout 2015 with the MDPC co-chairs.

 In addition to the informative community input from
the film screening event, members of the MDPC worked
with representatives from The New York Academy of
Medicine and the Drug Policy Alliance to convene a
series of eight focus groups around the city. The goal of
these community focus groups was to learn how drug
use – and current responses to drug use – affected communities, families, and individuals, and to ask community members how our drug policies can be improved.
Nearly 100 people participated in the focus groups, with
an average of 12 people per group. Each focus group
represented a specific constituency. The eight groups
were: law enforcement personnel; physicians, nurses
and pharmacists; people who use drugs; young people;
people of color; parents; business owners; and people in
recovery. These efforts generated substantial input and
data from hundreds of Ithacans.

Guiding Principles
The work of the MDPC, and this final report,
were guided by a set of core principles, outlined
by Mayor Myrick early in the process at an
MDPC meeting.

1

  Policy proposals should be developed  
  in consultation with those who will be
most directly affected by the proposed changes
– in this case, people who previously used or
currently use drugs as well as the people living
and working in communities hardest hit by
drug use, the illicit drug trade, and our policy
responses to it.

2

 Policy proposals should be based on the  
  best available evidence about need and
effectiveness.

The Ithaca plan was a comprehensive process commissioned by Mayor Myrick in 2014. He created a
Municipal Drug Policy Committee made up of “Pillars”
whose members were stakeholders from [various] county
and city agencies. The Pillars were tasked with brainstorming recommendations for drug policy reform in the city of
Ithaca. To further increase community input, the MDPC
chair and the mayor convened focus groups made up of
a broad spectrum of community members who discussed
the issues and offered their own set of recommendations to
the committee. The focus groups’ recommendations were
then offered to the MDPC for review. The MDPC adopted
many of the recommendations from the focus groups, and
submitted their final recommendations to the co-chairs
who researched and curated all the recommendations. In
addition to reviewing the submitted recommendations,
the co-chairs held individual interviews with providers,
impacted people, and services providers. After their review,
the co-chairs conducted a literature review to determine

3

  Complex social problems, like drug use,  
  will only be solved by addressing both
upstream and proximate causes and employing
both structural and short-term solutions.
To succeed, we must engage multiple sectors
of society, including government, business,
academia, health, social services, treatment,
and religious institutions, as well as
community members.

4

  Different communities and groups of
  people have different needs and priorities.
Therefore, policies must be able to take into
account different local and cultural contexts.

5

  Existing service systems too often operate  
  in silos, and strategies that work across
and integrate these isolated entities are
desperately needed.

11

 Developing this Report: Background

12

whether the recommendations were aligned with the
guiding principles outlined by the Mayor at the
Dec. 8, 2014 meeting. The document was then presented to Mayor Myrick for his review. While not all the
recommendations were accepted, most were, reflecting
a broad sweep of insight and local knowledge among
Ithacans from different areas of the city.
Important Note: Drugs/Substances
Large numbers of substances can be categorized as
drugs, and this document cannot include the breadth of
consequences associated with the use of every substance
considered a drug in Ithaca. We focused our assessments
and recommendations on the drugs that community members and stakeholders reported as substances
presenting the most immediate and intractable problems in the area. Ithaca’s struggle with the nationwide
opioid overdose epidemic most significantly informs the
context and content of this document. It is important

to note that marijuana is not taken up in great detail,
though it is referenced in terms of the collateral consequences and criminalization it causes residents –
particularly Black, Latino, and Native residentsa.
Additionally, alcohol is not often named explicitly in this
report; however the problems it causes are discussed
in some detail and overlap some with those of problem
opioid use.
a

Because we relied on secondary data in some places, we

were not able to use the same racial and ethnic classifications throughout. Some researchers compare Black and white
populations; others group all people of color together; while
still others distinguish between Black, white, Latino, and other
racial groups. While these classifications and comparisons are
all problematic in some way, we felt it important to include information about the racial disparities related to drug use and drug
policies to the degree they were available.

Left: Discarded used syringes
found in front of abandoned
home on State Street in Ithaca
– January 2016

  

 

2. The Scope of the
Problem in Ithaca

 

 

The Scope of the Problem in Ithaca

14

Ithaca is a small city in central New York. Our population of 30,000 includes both lifelong residents and
young people who live in Ithaca to attend one of its colleges and universities. Like many cities across New York,
drug use, addiction, and our policy responses to these
issues are complicated – and widespread – problems.
Indeed, one in thirteen people in New York State suffers
from a substance use disorder,4 yet many New Yorkers
lack access to treatment.5
One of the challenges to devising solutions in Ithaca is
that stakeholders don’t share a common orientation to
the problem. The drug policies and services currently in place in the city of Ithaca reflect the bifurcated
approach to drug use in New York State and nationally:
while new practices have been adopted to reduce the
negative health and social consequences of drug use,
older practices criminalizing drug use remain in effect.
Historically, drug use has been perceived alternately as
a criminal problem, a behavioral problem, and a health
problem, and laws and practices have been developed
from all three perspectives. The MDPC’s work uncovered
this dissonance in Ithaca.

“It’s hard for probation officers to wrap their head
around this syringe exchange program when we
have conditions of probation about being abstinent.
These are not optional conditions about not using
drugs. Conditions of probation are often ‘don’t use
drugs’ – and syringe exchange programs seem
like hypocrisy.”
– Participant in Law Enforcement Focus Group

The Criminal Justice System
A basic problem occurs at the front end, with how a person who uses drugs is treated by the different systems.
Under existing criminal law, a person who uses illicit
drugs is a criminal involved in illegal transactions.
The tools at law enforcement’s disposal are limited:
appearance ticket, or arrest. Arrests for property crimes
have grown by 74% in less than a decade in Ithaca.
Arrest data from Ithaca Police Department shows that
arrests for drug law violations have gone down, likely
attributed to the Mayor Myrick’s order to make marijuana arrests a low priority. While these figures reflect
the criminalization of drug use, they also indicate an
increase in criminal justice costs.

Fig. 1 Misdemeanor Property Crime Arrests in
City of Ithaca, 2005-2014
600

553

500

2008

2010

2011

426

379

2007

396

361

2006

397

372

318

300

479

489

400

200
100
0

2005

2009

Source: Ithaca Police Department
Property Crime Arrests as reported by National Incident-Based Reporting
System. See Appendix C for full list of crimes reported.
160

136

127

133

100

131

120

151

140

2012

2013

2014

 100
0

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

15

Fig. 2 Misdemeanor Drug Law Violation Arrests in
City of Ithaca, 2005-2014
160

96

85

91

80

103

2006

136

133

2005

100

127

131

120

151

140

66

60
40
20
0

2007

2008

2009

2010

2011

2012

2013

2014

Source: Ithaca Police Department
Drug Arrests as reported by National Incident-Based Reporting System
code 35A: Drug/Narcotic Violations, defined as the unlawful cultivation,
manufacture, distribution, sale, purchase, use, possession, transportation,
or importation of any controlled drug or narcotic substance.

Fig. 3 Misdemeanor Drug Law Violation
Arrests in Tompkins County, 2005 - 2014
100
90

87

2011

2012

62
2009

67

64
2008

55

50

67

71

60

76

70

80

87

80

40
30
20
10
0

2005

2006

2007

2010

Source: New York State Division of Criminal Justice Services
Drug offenses include all charges listed under Penal Law Articles 220
(controlled substances) and 221 (marijuana).

2013

2014

 16

600
500

2012

2013

592

2010

546

2009

545

2008

467

2007

493

2006

402

2005

399

383

300

480

400

373

The Scope of the Problem in Ithaca

Fig. 4 Misdemeanor Property Crime
Arrests in Tompkins County, 2005 - 2014

200
100
0

2011

2014

Source: New York State Division of Criminal Justice Services
Property offenses include all misdemeanor charges listed under Penal
Law Articles 140, 145, 150, 155 and 165.

In addition, the relationship between the community
and law enforcement has become increasingly strained.

“We only have certain kinds of tools, and we know
that not everything is a nail, but all we have is a
hammer. We need more tools.”

“When I think about police role in general I think
about people who are supposed to protect and serve
the community. Thinking about communities where
I have lived, that never happens. Innocent until
proven guilty, no it’s guilty until proven innocent.
And the racial profiling, I’ve been profiled. Police
had a goal, it wasn’t to protect and serve, it was
like ‘go get ‘em.’ I feel like they have the right to do
whatever they want. To find any little thing or excuse
to get your locked up. Once they get to know you
and your background, you become a target.”

– Participant in Law Enforcement Focus Group

– Participant in People of Color Focus Group

Police identify a lack of resources available to the police
force and report that their capacity is over-extended.
Community members highlight the use of unnecessary
force and ongoing stop-and-frisk tactics that are experienced as harassment and targeting.6 In 2014, Mayor
Myrick issued an eight-point proposal to improve police-community accountability, partly in response to the
expressed concerns.7

 Behavioral Health Systems
Problematic drug use is often related to mental health;
the relationship between these two health issues is intertwined. People may use drugs to self-medicate their psychological or psychiatric symptoms, and the psychoactive effect of drugs can impact mental health symptoms.8
Unfortunately, it can be very difficult for people who use
drugs to access mental healthcare and treatment. In New
York State, drug treatment programs are licensed and
overseen separately from mental health clinics and programs, by a different entity and under different regulations.9 This artificial separation in the behavioral health
system interferes with access to care from either provider
type and with coordination between them.10
Moreover, mental health providers frequently exclude
from their care people who are actively using drugs, citing a lack of expertise for addressing drug use, difficulty
discerning mental health symptoms from the effects
of psychoactive drug use, and concerns regarding the
potential interactions of psychiatric medications with
illicit drug use.11 But drug treatment providers are often
ill-equipped to respond to mental health issues – they
are neither trained nor funded for this capacity – and
so people with unresolved mental health problems and
active drug use can wind up in limbo, disconnected
from both systems.

“Cross addiction, alcohol, heroin, and crack.
There is so much focus on chemical dependency
or mental health. You have chemical dependency
counselors with no training in mental healthcare
and you have mental health workers who don’t have
training in chemical dependency.”
– Participant in People in Recovery Focus Group

An additional tension arises from the abstinence-based
position of many drug treatment providers. If a person participating in treatment continues to use drugs,
they risk being discharged from treatment, because
continued drug use represents non-compliance with

an abstinence-based plan.12 Although we have come
to understand drug use as a chronic condition,13 most
drug treatment programs, including those in Ithaca,
are structured with an end-goal of abstinence through
a prescribed period of participation.14 In addition, the
availability of medication-assisted treatment is severely
limited in Ithaca – there is no methadone maintenance
treatment program, and the physicians who can prescribe buprenorphine have restricted capacity.
The Health System
The growing problem of opioid use in Ithaca has driven
more and more people into Ithaca’s medical care system.
Treatment providers report that the rate of participants
coming in with opioid dependence has more than tripled in less than a decade, and the proportion of young
people (19 to 25 years) coming in with opioid dependence has doubled.15 In less than a decade, overdose
deaths have more than tripled in Tompkins County,16
and drug-related hospitalizations now number 15.5 per
10,000 people, up from 14.4 during 2009-2011.17
In Ithaca, many people who use drugs end up seeking
care at Cayuga Medical Center, nearly 5 miles away
from the city. Emergency room care is expensive, and
ineffective for longer-term care needs, but people who
use drugs are often reliant on this setting to address their
immediate urgent care needs, cycling in and out without
achieving overall improvements to their health or resolving their underlying drug use issues.18

“If people want more than a night’s stay in the ER,
they have to have a mental health problem or lie to
get into the mental health unit.”
– Participant in Healthcare FocusGroup

17

 18

16

15

14

14

13

12
10

10

8

8

6

6

2004

2005

4

5

4

5

The Scope of the Problem in Ithaca

Fig. 5 Number of Drug-Related Deaths per Year
in Tompkins County

2

2

1

0

2006

2007

2008

2009

2010

2011

2012

2013

2014

Source: Tompkins County Health Department
Note: Population of Tompkins County in 2014 increased by 3% to 104,691 from 101,595 in 2010
(US Census Bureau).
Deaths include those where drugs were identified as the cause of death (including illicit and
prescription) or may have contributed. The data may not reflect all deaths related to drugs.

Drug Policies
In a situation not unique to Ithaca, overlap, redundancy,
contradiction, and disconnection among the various
components of our health system and between our
health and criminal justice sectors complicate our ability
to provide responsive, meaningful care and services
to people who use drugs in Ithaca. Approaching the
same person in such distinctly different ways, with such
completely different views of the problem and how to
address it, has reduced the effectiveness of our response.
Our criminal justice and health sectors need to align
policy and practice among our local health and healthcare providers, to deliver and coordinate services to
people struggling with drugs.

For example, the recent growth in heroin use is not only
a local phenomenon; it has been observed at the national level, and is linked to the expanded medical use of
prescription pain medication since the 1990s – opioids,
such as oxycodone and hydrocodone.19 As physicians
became increasingly comfortable with prescribing these
medications to patients for acute and chronic pain, two
problems resulted.
First, a portion of these patients developed dependence
on the medications, and when their condition became
apparent to the healthcare system, their access to further
prescriptions was reduced or eliminated. This, in turn,
fostered the development of a new heroin market to

 19

Fig. 6 Cayuga Addiction Recovery Services Admissions
Based on Drug, 2012-2014
45%
40%
35%
2012

30%

2013

25%

2014

20%
15%
10%
5%
0%

Alcohol

Crack/Cocaine

Opiates &
Opioids

Marijuana/
Hashish

Methamphetamine/
Other Amphetamines

Other

Source: Cayuga Addiction Recovery Services, an agency providing inpatient and outpatient
substance use services to city of Ithaca and greater Tompkins County area
Total number of admissions per year: 2012: 499; 2013: 450; 2014: 540
Note: Other includes Xanax, benzodiazepam, ecstasy and hallucinogens

meet the demand from people with opioid dependence
who could no longer access or afford prescription
opioids.20 Second, the over-supply of medications by
physicians has resulted in an excess stock of prescription
opioids in circulation in the community, whether unused in someone’s medicine cabinet at home or passed
along to a friend or family member who is experiencing
some pain.21

“I’m not going to stop using dope until I get real
help for my pain.”
- Participant in People Who Use Drugs Focus Group

These circumstances have resulted in an expanded
heroin market, which poses a problem for law enforcement and created a new group of people struggling with
opioid use. For this emerging population, seeking care is
often dependent on their level of access to services and
their ability to avoid the criminal justice system. Policymakers are faced with the conundrum of how to balance
the maintenance of public safety while increasing access
to public health interventions.

 20

The Scope of the Problem in Ithaca

Left: Free
Community Film
Screening of
“The House I Live
in” at Cinemapolis
– February 2015

A Problem for the Community
Fundamentally, the community prevalence of health
problems, such as problem drug useb, and social problems, such as participation in the illegal drug economy,
reflect deeper issues related to social and economic
opportunity. This problem is especially marked for
young people, whose early experiences can give shape
to their futures in distinct and long-lasting ways. Young
people and people of color in low-income communities
are considerably more vulnerable to negative consequences from experimentation with drug use and even
brief forays into the illegal drug economy. A wealth of
evidence demonstrates that criminal justice encounters,
social stigma, and a lack of access to resources are more
likely to affect these populations, given the structural
and social discrimination found in US society.22 These
experiences are familiar to young people and people of
color in low-income communities in the city of Ithaca.

“Kids will talk about Center Street as the ghetto…
This is no ghetto. Anytime we are gathered together,
that’s a ghetto. There’s a way that children live into
the stereotype they were expected to fill. Unless you
have a lot of people around you constantly affirming
you, saying you are so smart, you are so talented,
you have so many good ideas, that was so helpful
and always reinforcing the positive, it’s so easy to
get polluted by the negative expectations of people
in this community.”
– Participant in People of Color Focus Group
  As we discuss more fully below, we lack a common lan-

b

guage for how to talk about drug use. In fact, the definitions of
drugs, substances, drug/substance use, drug/substance abuse,
chemical dependency, and addiction are hotly contested. We have
chosen to use “drug use” or “harmful drug use” because we feel
that these terms are more neutral than some others. In addition,
when we need to make a distinction between drugs whose use is
against the law and those not so designated, we use the terms
illicit and licit. However, where we are relying on data or literature that uses other language, we employ the terms used by the
original authors.

  

 

3. Consultation
Findings

 

 

Consultation Findings

22

Findings are structured in four areas: Prevention,
Treatment, Harm Reduction, and Law Enforcement.
This model reflects the framework used in European
and Canadian cities, where coordinated, municipal drug
strategies have been operational for decades.c
Although these four areas are not mutually exclusive,
they represent an attempt to organize and categorize
policies and practices addressing the various aspects of
drug use. We heard from some of the MDPC members
and focus group participants that the Treatment and
Harm Reduction pillars should be integrated into one
pillar, since the aims of both are often quite similar,
even as the methodologies may differ. However, as our
findings show, the community has much to learn about
harm reduction and its important role in fostering health
and safety in Ithaca.
Prevention
Finding 1: General programming for a substantial
portion of young people is lacking and available
programming is often inaccessible.

The focus group process exposed that effective drug
prevention efforts had to include the community, family,
schools, peers, social infrastructure and resources. Best
practices require building resiliency, and programs
and initiatives that focus on this – with whole family
programs demonstrating more success than youth-only or parent-only approaches.23 In effect, drug use was
recognized as being motivated by factors influencing
individuals from their external environment more often
than factors internally specific to the individual. Therefore, robust prevention programming and activities were
seen as imperative to diminish the appeal of drug use.
Studies have demonstrated that spending on counseling
and treatment costs for drug abuse produce significant
savings.24 Youth programming and afterschool activities
abound for young people from well-resourced backgrounds. However, early prevention efforts targeted at
young people were found to be inaccessible in Ithaca,
and the wealth gap was cited as the culprit.

“There’s nothing here for young people to do after
5pm, unless they have the money to pay for it.”
– Participant in Parents Focus Group

Boredom was described as a primary motivator for youth
drug use. Young people described a lack of age diverse
programming and parents explained that the high costs
of after-school and summer activities largely prevented
that programming from being accessible to families of
various income levels.

c 

Among children living at or below the poverty line,
effective and affordable programs are over capacity and
under-funded. These disparities are especially glaring for
working-class families, who may not make enough to
afford cost-prohibitive programs, while making slightly
too much to qualify for programming targeting low-income families.

The Four Pillars approach grew out of municipal efforts in Europe and Canada. Frustrated by the lack of prog-

ress at the federal or provincial level, cities began thinking through how they could transform their drug policies to
become more effective. Bringing stakeholders from all four pillars together, these efforts are typically grounded in
a harm reduction and pragmatic approach that seeks to improve public health and safety outcomes of individuals,
families and communities. The model has looked different in each jurisdiction but often starts with an agreement
from all sectors on a set of shared objectives and outcomes.  For a detailed description of the four pillars process
in Vancouver, B.C., see MacPherson, D., Mulla, Z., & Richardson, L. (2006). The evolution of drug policy in Vancouver, Canada: Strategies for preventing harm from psychoactive substance use. International Journal of Drug Policy,
17(2), 127-132.

 Finding 2: The drug trade is a symptom of
widespread unemployment of young people and
adults in Ithaca.
The drug trade is an economic opportunity for people
who may face barriers to entering the legal job market.25
Several people talked about the multiple barriers to
employment for people in general in Ithaca, including people with criminal records.26 Though Ithaca is
known for its low unemployment rate, unemployment is
heavily skewed by the large college populations and the
inclusion of higher education professionals.27 A closer
look at the stats shows a more dire situation, especially
in communities most historically affected by the war on
drugs – low income and people of color. For example,
while 59.7% of white people own their own homes,
only 25.6% of Black people and 25.6% of Latino people
do. And in 1999 (the last year for which data are available), the poverty rate for whites was 14.9% compared
to 20.3% for Blacks, 33.4% for Latinos, and 41.6% for
Asian and Pacific Islanders.28

“I don’t think that telling a young person that they’ve
got opportunity and potential is enough. They’re too
smart and you can’t sell them a bill of goods. If you
tell them you’ve got opportunity and potential but
they don’t see it around them, you’re lying to them.”
– Participant in People of Color Focus Group

Focus group participants articulated what the research
already shows – that where opportunities for economic growth were absent, participation in the illicit drug
market flourishes.29 One young person attending a focus
group reported having applied to a host of different jobs,
only to realize that no one wanted to hire him because
he wasn’t yet 18 years old. Having that experience, he
could understand why some of his peers had chosen to
sell drugs.

“It’s fast, long money instead of short, slow
money. Some people don’t have money so they
decide to sell.”
– Participant in Young People Focus Group

The focus groups identified jobs for young people as
essential to instilling a sense of purpose, connection,
positivity and esteem that could function to overcome
the factors leading to problematic drug use. Community
disconnection, the lack of opportunities, racial bias born
of structural racism were all cited as root problems that
must be addressed to prevent harmful drug use or participation in the drug economy.30 Recognizing that some
people use drugs to cope with extenuating circumstances, like unemployment and poverty, people remarked
that providing job opportunities could provide the
motivation some need to either moderate or end their
drug use.31,32,33,34
Finding 3: Geographic isolation, racism, and
poverty contribute to hopelessness, which
increases the likelihood of problematic drug use.
Among the focus groups, there were a few echoes of
hopelessness about the utility of investing in prevention
in Ithaca. Ultimately, some believed that prevention was
an exercise in failure because individuals are bound
to do what they want, and drug use is an individual
choice based on people’s surrounding circumstances.
Participants continuously cited that some use drugs to
escape their reality. Contributing factors – like isolation,
racism, and poverty – can create an avalanche of poor
choices and risky behavior.35,36,37,38,39,40, 41 In fact, most
focus group participants identified Ithaca neighborhoods
that had high crime and drug rates and noted these were
geographically isolated from the rest of the community.
In addition to poverty, racism was seen as playing a
role in drug use. Focus group participants indicated the
types of negative messages to which young people are
subjected. In multiple focus groups, there were constant
references to young people of color receiving messages
that communicate their inferiority.

23

 Consultation Findings

24

“The lack of cultural competence [in schools] is so
huge, the assumptions that are being made about
our kids. And kids get it. By the 2nd grade, my
daughter was already saying, I’m dumb, because
those were the messages she was getting.”
– Participant in Parents Focus Group

This is in direct contradiction to evidence-based drug
prevention messages, which focus on building selfesteem and self-efficacy.42 Young people and adults
consistently referencing racial profiling and unequal
treatment by law enforcement and the school system
illustrates the need for there to be additional prevention
measures that focus on disrupting harmful messaging in
addition to traditional drug prevention modules.
The isolation and the stigma associated with living in a
“red flagged” community can contribute to a community’s sense of wellbeing and that is shown to translate to
poor health outcomes.43
Integrated communities that foster support and connection among their members were essential in preventing
drug use, drug problems, and drug selling44 Because of
stigma, people who use drugs often become pariahs cast
out of supportive communities – and this stigma and
isolation can drive more use.45,46,47,48

“…Coming back to a community that loved me…,
people who complimented me, encouraged me, who
said I deserved more, that stuck with me.
Everyone in this community has played a part in
who I am today. Encourage people when they are
coming home, let them know we have their back. I
don’t stop, when I see people who are using…, we
have that conversation.”
– Participant in People of Color Focus Group

Many focus group participants – especially people of
color – expressed a strong opinion that problems with
drugs and drug policy in Ithaca constituted a proxy for
more global issues of racism, social control, and structural inequality; these participants suggested that the
focus group conversation, therefore, should not solely

focus on drugs. In contrast, many white focus group
participants expressed that the landscape of drug issues
could be repaired by exclusively focusing on reforming
practices related to drug treatment and enforcement.
Many focus group participants, particularly participants
of color, expressed that the only way to deal head-on
with drug use and selling issues was to invest in the
undoing of the matrix of racial inequality that produces
the problem drug issues apparent in Ithaca today.
Finding 4: Drug education and prevention efforts
should focus on both adults and young people and
include information and skills about delaying the
onset of use, preventing problem drug use, and
reducing illness and death.
Drug use among youth is a concern, and the prevention
of drug use, particularly among young people, is almost
always a central goal in national and international policies on illicit drugs. The consequences of drug use affect
every sector of society and hamper the ability of both
young people and adults alike to reach their full potential. Prevention is a cost-effective and common-sense
way to lessen the consequences of drug use among
youth and to prevent or reduce drug use among adults.49
Drug education and prevention programs come in many
shapes and forms, and, unfortunately many prevention
programs are neither evidence-based nor effective.50
Much of the drug prevention programming that is
directed toward youth (and parents too) is marked by
exaggeration, misinformation, and misinterpretation
and is rooted in scare tactics that lack credibility among
young people.51,52 Parents, teachers, caregivers and
other important adults in the lives of young people
know that talking with them about drugs is an important responsibility. But, many are questioning the
wisdom of the black-and-white pronouncements of
“just say no” anti-drug messages that oversimplify the
complex lives that teenagers lead. Scare tactics weaken
young people’s confidence in law enforcement, parents,
and other adults.53

 No parent wants his or her teenager to use drugs, and
abstinence for teens is the safest choice. The reality,
however, as the Monitoring the Future drug prevalence
survey shows, by the time teens finish high school, half
of them will have tried a psychoactive substance.54 Given
the prevalence of youthful experimentation and to help
prevent teens from falling into abusive patterns of drug
use, we need to create strategies that promote abstinence
but transcend the “just say no” rhetoric of the past as
well as emphasize knowledge, safety and responsibility
for those teens who do try drugs.55
Research shows that evidence-based prevention interventions are built around building resiliency.56 Moreover,
programs and initiatives that focus on building resiliency
– with whole family programs demonstrate more success
than youth-only or parent-only approaches. There is also
resiliency drug education.57

Finding 5: There is a lack of general awareness
about drugs, how to navigate systems of care, and
how to prevent drug-related deaths.
Ithacans consistently expressed feelings of isolation and
lacked the awareness about drugs, drug use, prevention,
and the dfferent kinds of help available.
In multiple focus groups, there was an expressed interest among participants for more open discussions about
drugs, drug use, drug policy, and the service systems
currently available to address drug misuse and addiction. Parents shared feelings of complete isolation and
hopelessness when trying to navigate the system for a
child or a loved one, the incredible amount of shame of
telling people their family is facing a problem, and their
deep desire to learn more. Service providers shared their
general lack of awareness about newer drugs, policies, and
general harm reduction models. People in recovery and
people who are actively using drugs consistently called for
a greater say in the education of providers and community
members, since they are experts in their own lives and

Left: Mayor
Svante Myrick,
Tompkins County
District Attorney,
Gwen Wilkinson
and gabriel sayegh
– April 2014

25

 Consultation Findings

26

have particularly relevant knowledge about drugs and
related issues, such as overdose. In both the MDPC and
the public film-screening event, participants expressed
strong interest for conversations about drug policy to
take place with greater regularity.

“Parents need education so they’re not in denial
about their kid’s problems. Parents need to be
supported and not ashamed that the kids have
problems. Kids have a right to good treatment.”
- Participant in Parents Focus Group

“Large quarters of the medical community are
uneducated about addiction. This is not just an
ethical or character issue at all, it’s a medical issue.
Until we get to that point, these specific solutions
mentioned are little steps, but we need to do more
educating. The mainstreaming of addiction in
America is going to bring more knowledge and look
at people with more compassion. [We want] mainstreaming of the conversation around addiction,
more community conversation around this issue.”
– Participant in People in Recovery Focus Group

prescribers in Ithaca with 100 slots each, so only
400 people in the larger Ithaca area can obtain a
buprenorphine prescription. This low number does
not fit the growing need of those in Ithaca trying to
manage their opioid use. Moreover, the oldest and
most researched medication-assisted treatment, methadone, is not available at all in Ithaca. To participate in a
methadone treatment program, Ithacans must travel to
Syracuse or Binghamton; such trips, taken regularly, can
quickly become costly to either the individual or to the
health insurer if travel is an included benefit, as is the
case with Medicaid. Additionally, the waiting time to be
admitted to a methadone program can be upwards of
several months.
Harm reduction as an approach was unfamiliar to many
focus group participants. Some were uncomfortable
with the idea that treatment’s ultimate goals could be
housing or stabilizing someone’s use in lieu of complete
abstinence. Most focus group participants understood
that for a significant portion of people, abstinence based
treatment models were not an effective modality for
everyone, and that meeting people “where they’re at” can
lead to improved health outcomes over time.

Treatment
Finding 1: Abstinence-based treatment programs
predominate in Ithaca, and more varied treatment
modalities are needed.
The treatment programs available in Ithaca are abstinence based. Both MDPC members and focus group
participants understood that it may be in the best health
interest of people to have access to a variety of treatment
modalities. Decades of research has consistently proven
that medication-assisted treatment, for example, is very
effective for treating opioid dependence but most people
in Ithaca cannot access medication-assisted treatment,
including methadone and buprenorphine, commonly prescribed under the names Suboxone or Subutex.
Unlike methadone, which must be dispensed from a
specialty substance use disorder treatment program,
buprenorphine can be prescribed and dispensed from
a private physician’s office. Treatment does not require
daily visits, like methadone, and can be provided in the
privacy of the office. There are only four buprenorphine

Finding 2: There are gaps in treatment
accessibility due to limited capacity and
affordability.

“There’s the timeframe kind of thing, waiting lists
and capacity. There’s the lack of cultural competency. The people who need the services do not
look like those who provide the service. Incredible
mismatch. Cultural competency issues and lots of
structural racism.”
– Participant in Business Community Focus Group

While Ithaca has made historic strides in providing drug
treatment services in the last twenty years, there is still
a significant portion of people travelling to treatment
facilities in neighboring counties to receive services. This
is due largely to capacity issues; the treatment facilities
in Ithaca simply cannot keep up with the demand for
inpatient treatment services. In addition to capacity issues, focus group participants talked about gaps in terms
of who was able to receive treatment because of insurance or eligibility requirements. They noted that some

 treatment facilities lacked the capability to address the
specific needs of certain populations, including people
from different cultural backgrounds or people who required different treatment modalities that are simply not
available in Ithaca. As a consequence, for some people in
Ithaca, treatment is simply out of reach.
Finding 3: The lack of a detox center is putting
an exorbitant amount of pressure on Cayuga
Medical Center and costing hundreds of
thousands of dollars to the tax payer.
In 2009, the City of Ithaca closed its only detox center.
With the rise in heroin usage and increase in overall
population, the lack of a detox center in town is seen as
a huge gap in services for Ithaca. Without a detox center,
people in need are sent to the emergency room at
Cayuga Medical Center where they are typically assessed, hydrated, and then released. Sometimes the

same person will return back to CMC several times
a day. Between CMC, Ithaca Police Department, and
Bangs ambulance there was roughly $413,526.91 spent
in transporting and housing people last year. The CMC
is committed to serving the Ithaca community but has
been very clear that they cannot continue to provide
“detox” through their emergency room. In addition, the
CMC acting as a “detox” center has clear limitations.
CMC is not centrally located and inaccessible for most
people unless they are transported by IPD or Bangs. This
is both expensive and, in the case of IPD, could unnecessarily expose people to criminal consequences.

“If we call for the ambulance, the county bears
the cost, they sit in the ER and then they are kicked
out – and it’s repeated the next day. The cost is
astronomical.”
– Participant in Law Enforcement Focus Group

Fig. 7 Drug-Related Hospitalizations by Race in Tompkins County, 2012

54.4

14.7
7.5
White

Black

Asian / Pacific
Islander

Latino

Source: New York State Department of Health
Note: For Asian/Pacific Islander, data do not meet reporting criteria for drug-related hospitalizations.
Drug related hospitalizations defined as: The number of hospitalizations per 10,000 population with one of the
following primary diagnosis ICD-9 CM codes: 292, 304, 305.1-305.0,648.3,655.5,763.5, 779.4, 779.5, 965.0, 967.0,
968.5, 969.6, 969.7, 760.70, 760.72, 760.73, 760.75, 760.79, E850-E858, E950.0-E950.2, E962.0, E980.0-E980.2.

27

 Consultation Findings

28

Finding 4: Treatment programs may benefit from
more cultural competency and sensitivity training.

“To get help out here is crazy; you have to
wait weeks and then you have to have the
right insurance.”

In focus groups with people in recovery and people
who are actively using drugs, many of those who had
experience with treatment services expressed frustration
from interactions with program staff. Some participants
said they felt like staff treated them as if they were trying
to game the system. For some, the experience of being
treated like a child or a criminal has impacted the way
they see themselves, spurring distrust and dissatisfaction
with service providers, and raising obstacles to reaching
out for help. Participants expressed resentment towards
treatment providers, social services, law enforcement,
and medical providers because of the perceived lack of
sensitivity displayed in interactions. These groups in
particular expressed a desire to be treated with dignity
and in ways that recognized their agency and autonomy.

– People Who Use Drugs Focus Group

Research shows how culturally competent treatment
programming – including for people of color, LGBTQ
people, immigrants, and women – can improve
health outcomes.58
Finding 5: Ithaca needs more medication-assisted
treatment options, including but not limited to,
providing methadone in town and increasing the
number of buprenorphine prescribers.
The current healthcare landscape is reinforcing the
importance of addressing drug use as a component
of general medical care, and increasingly, medical
providers can play a role in treating addiction because
of the availability of new medications and integrated
treatment modalities.59 Opioid dependence can now be
treated with a prescribed medication – buprenorphine
(most commonly prescribed brand is Suboxone) –
from a certified physician. In the Ithaca area, only
four providers are offering this service. With a long
waiting list for these providers, the unmet need is great.
Both the MPDC treatment pillar group and numerous
focus groups participants highlighted the dearth of
available options for opioid dependent people seeking
treatment in Ithaca and emphasized the need for more
Suboxone prescribers.

Some physicians are reluctant to take on the provision
of medication-assisted treatment in their practice due to
lack of experience, misgivings about caring for people
who use drugs, and fear of diversion. SAMHSA has
created a toolkit to support doctors and healthcare providers navigate this process. Ithaca could partner with
Providers Clinical Support System-MAT (PCSS-MAT)
to establish mentoring arrangements with experienced
providers to help them overcome these issues. With
the use of technology, virtual case conference meetings
could be arranged with experienced providers in other
parts of the state, to develop and expand local expertise.
With a concerted effort, we can expand this important
resource for people who are requesting treatment in
our city.
The MPDC treatment pillar group and many focus
groups also advocated the opening of a methadone
maintenance treatment program in Ithaca. Syracuse and
Binghamton host the closest methadone treatment program available to Ithacans. While Medicaid will cover
the cost of a one-hour trip in each direction for daily
treatment, this travel could go on for years. Depending on the program, daily or near daily travel could be
required for at least two years. Some area programs are
daily for 90 days, after which a person could receive
weekend doses, which would bring travel down to
5 days a week. That would go on for two years and if the
person is successful, they may receive additional take
home doses.
The time and distance involved represent an unnecessary obstacle to engagement.
The desire to expand methadone and buprenorphine in
Ithaca was based on the knowledge that these are among
the most effective treatments known for opioid dependence.60 Numerous studies conducted in New York, in
other parts of the US, and in other countries around the

 Left: Ithaca
stakeholders at
Mayor Myrick’s
initial municipal
drug strategy
convening
– April 2014

world have shown the inarguable benefits of methadone
treatment for reducing the risk of death and disease in
participants.61 Methadone programs reduce the likelihood of overdose and new cases of HIV infection, while
providing participants with the opportunity to stabilize
their physical health and address their social needs such
as family, housing, education, and employment.62

Finding 6: For some people, ancillary services
such as mental health counseling, job training,
and housing are necessary supportive services in
addition to, or instead of, formal drug treatment

Historically, methadone programs have operated
separately from the general healthcare system, because
they are licensed by OASAS, the New York State Office
of Alcoholism and Substance Abuse Services, as drug
treatment programs.63 Medical and mental health services have not often been incorporated, and methadone
programs are often viewed as basic treatment stations for
participants, without other available services and support. Now, with the care coordination mandate and the
models offered by the Affordable Care Act, an integrated
healthcare-methadone clinic is feasible for both licensing
and funding.64

– Participant in People Who Use Drugs Focus Group

“We need a clearinghouse agency that a person
could walk into and say ‘I’m in crisis and I need
help now.”

When asked why people develop drug problems, participants continuously identified reasons ranging from
homelessness, incarceration, familial issues, or joblessness. One commonly held belief, expressed in the focus
groups and among some in the MDPC, is that people are
using drugs as a coping mechanism to deal with other

29

 30

Consultation Findings

Left: Ithaca
Municipal Drug
Policy Committee
briefing on
recommendations
– November 2015

issues. Statements like, “people need jobs” or “people
need housing” continuously came up. Some treatment
facilities in Ithaca offered housing support but require
abstinence, and facilities that did not offer housing were
not equipped to make recommendations to shelters and
other basic services.
In Ithaca, where both shelter and drug detoxification
service options are limited, homeless people using drugs
could also benefit from a crisis center service model.
Shelter stays are often contingent upon abstinence and
substance use is not allowed on-site, putting people at
risk for infections or overdose when forced to consume
their substances in public spaces. Many people are experiencing precarious housing or intermittent homelessness in combination with their drug use. Over and over
again, participants called for some kind of crisis center.

This also pertained to mental health services. Mental
health and drug treatment services in Ithaca have been
historically disconnected despite the general consensus
that for some people problematic drug use belies deeper
issues. Unless basic needs and metal health issues are
addressed, treating someone’s addiction can be difficult
if not impossible. Research shows that, for homeless
people struggling with drug use, a “housing first”
system of care can be successful in helping someone
moderate their use.65 General linkages to ancillary
services can dramatically improve someone’s outcomes
in drug treatment.66

 Harm Reduction
Finding 1: More comprehensive training is needed
on how to provide services to people at different
points on the substance use continuum.
Multiple groups noted that the general public as well
as medical professionals needed more comprehensive
training about drugs and drug use in order to provide
compassionate care and support that combats stigma.
In multiple focus groups and in the MDPC, participants
expressed a strong interest to improve various systems of
care and safety, which people who use drugs come into
contact with. There was overwhelming interest among
participants to make changes that could lead to better
care outcomes.
Many community members’ comments reflected the
sentiment of a participant in the Business Community
Focus Group, who noted:

“More education about what the issue is. There isn’t
a difference between the people dying of heroin and
the people in this room. One of the people who died
of overdose was a successful business owner.”
– Participant in Business Community Focus Group

Participants expressed a strong interest in cross-training
among different systems actors to provide active users
the supports they need across agencies.
Finding 2: Harm Reduction is not widely understood, and few Ithacans know of the existing – and
effective – local harm reduction programs already
in operation.
Ithaca has only one human service provider that is
based in harm reduction – the syringe exchange program at STAP – and other organizations have adopted
formal and informal policies that are in line with the
harm reduction philosophy. For example, Cornell
University and Ithaca College both have Good Samaritan
policies that are in addition to the statewide 911 Good
Samaritan Law.

Yet a majority of focus group participants knew very little if anything about the local harm reduction programs,
or the basic concept of harm reduction. Some expressed
a belief that harm reduction enables drug use or contributes to drug selling, although the extensive research on
harm reduction strategies shows otherwise.67,68,69,70
This lack of understanding of harm reduction presents a unique opportunity for education and dialogue.
Evidence demonstrates that harm reduction practices –
from seat belts to syringe exchanges – can be incredibly
effective at reducing morbidity, mortality, and/or public
disorder.71,72,73,74 Harm reduction practices and services
do not lead to higher rates of drug use.75 Even within
the space of the focus group, people’s attitudes shifted
when they were exposed to analogies to alcohol or the
overconsumption of food.

“We’ve all practiced harm reduction, driving an
automobile is deadly dangerous, we still do it with a
seatbelt on. I know as an overweight guy, I shouldn’t
be eating as many Oreos as I do so I eat 10 rather
than 20. That’s harm reduction, right?”
– Participant in Business Community Focus Group

When addressing drugs and drug policy, evidence-based
practices, like harm reduction, can aid Ithaca in improving outcomes related health and safety. Increasing
awareness of such practices will be important to any
coordinated strategy.
Finding 3: Harm Reduction services need to
be expanded.
Aside from the establishment of a syringe exchange
facility in Ithaca, other robust practices and services of
harm reduction are still glaringly absent in the service
landscape. In addition, some providers, families and
people impacted by drug use are unsure of what harm
reduction modalities exist. Harm reduction practices like
ride shares to discourage drunk driving, providing free
snacks and water at establishments serving alcohol, safer

31

 Consultation Findings

32

injection kits, adulterant screening kits, naloxone opioid
overdose prevention training, medication-assisted treatment and mental health counselors are just a few ways to
expand harm reduction practices across Ithaca.
Some members of the harm reduction MDPC group
suggested Ithaca should continue its tradition of innovation by partnering with Cayuga Medical to pilot different
treatment options for people who are unable to moderate their drug use. This included exploring options like
expanding available opioid maintenance therapies by piloting a heroin maintenance program, which is standard
medical practice in countries like Britain and Germany76
or reducing both public drug consumption and overdose
fatalities by hosting a supervised injection facility for
people who are unwilling to stop using. Both in Europe
and in Canada, supervised injection facilities and heroin
maintenance have been in operation for decades with
great success in preventing overdose deaths, infectious
disease, and bacterial infections. It has also reduced
public drug use and discarded needles, and provided
primary care and referrals to basic services, housing,
with great success.77 The research into these facilities also
shows that the clients of these sites have increased rates
of participation in drug detox services.78
Law Enforcement
Finding 1: Law Enforcement and community
members alike do not believe that law
enforcement personnel are best situated to deal
with drug use.
Given the existing laws, our society is taught to respond
to drug use as a crime problem. From the work of the
MDPC law enforcement team and the many stakeholders who contributed t the development of this report,
we found broad agreement that it is “not the job of law
enforcement to solve people’s drug problems.” As a city,
we can choose to reorient how we implement these laws

and to develop an alternative pathway for police to offer
services and support to people involved with drug use.
In a focus group of law enforcement personnel, they
expressed frustration at being responsible for drug use
problems when they saw this as more appropriately
handled by social service agencies. They expressed many
of the same frustrations and desires of other focus group
participants for law enforcement to have a different role
in dealing with drug use in Ithaca.

“These officers are being forced to do the work of
managing community’s drug problem without the
proper resources, partnerships, and tools.”
– Participant in Law Enforcement Focus Group

Finding 2: Perceived experiences of racial
profiling, difference in treatment, and racial
disparities in arrests rates have created a
perception that law enforcement targets
communities of color and are less willing to
connect them to services than white Ithacans.

“It bothers the hell out of me that we’re having a
conversation about drug policies being developed
for our community and our whole conversation
is about drug addiction but we all know those
policies are going to impact drug dealers more
and differently. It’s in our own conversational
structure who are the people deserving of our help
and who aren’t.”
– People of Color Focus Group

Focus group participants and MDPC members expressed
concern that users in Ithaca are seen by law enforcement
and the broader community as white, and sellers are
largely seen as Black or Latino – and that outcomes from
drug law enforcement vary, in an unfair fashion, by race.
There was a geographic element to these conversations,
as participants raised the upstate/downstate divide and
noted the tendency for some community members or
law enforcement (or both) to suggest that the “drug
dealers” are from downstate. This view implies that the
Black/Latino sellers are alien to the community, entering
into Ithaca from downstate areas to take advantage of

 Fig. 8 Percentage of Drug Law Violation Arrests by Race in Ithaca, 2014
80

70

Actual Racial Demographics
Percentage of Drug Arrests

60

50

40

30

20

10

0

Black

White

Asian / Pacific Islander

Sources: Ithaca Police Department, US Census Bureau
Note: Ithaca Police Department does not keep track of Latino population. General Population data for 2014 is
an estimate from US Census Bureau.
Drug Arrests as reported by National Incident-Based Reporting System code 35A: Drug/Narcotic Violations,
defined as the unlawful cultivation, manufacture, distribution, sale, purchase, use, possession, transportation, or
importation of any controlled drug or narcotic substance.

upstate markets, labeling them as interlopers instead
of community members. This perceived assumption
translates into a widely held belief among community
members of color that law enforcement and treatment
providers are more lenient and compassionate towards
white community members’ drug use, possession, or
selling versus Black or Latino community members
who use, possess, or sell.

Finding 3: Community opinion about drug courts is
mixed. People like that drug courts connect those
in need to resources, but most thought it would be
more effective to make such resources available
outside of the criminal justice system.

“Treatment court needs to give people chances.
It’s the consequence that the judge is trying to
impose. I don’t think jail is the answer, but it’s the
judge’s way of showing them where they could be.”
– Participant in People in Recovery in Focus Group

33

 Consultation Findings

34

Reactions to the utility and effectiveness of drug courts
were mixed. Many people articulated an appreciation
of drug courts because they give participants an alternative to jail and a requirement of sobriety. However,
criticisms of drug courts were strong and varied. Many
participants noted the abstinence restrictions, the strict
and narrow requirements that must be met to remain in
programs, and the racial disparities in who gets presented with drug court as an option as reasons why drug
courts are not a sufficient solution. These observations
were confirmed by the data we collected, which shows
Blacks making up only 11% of drug court participants,
although they make up 26% of total drug arrests.

Some research shows that court-based programs and
interventions such as drug courts and mandatory program participation can show poor outcomes and that the
programs are time-intensive and scrutinizing.79 Among
people who use drugs, only some are eligible, and only
some of those eligible choose to participate, in lieu of jail
or prison time. Even then, because the attrition rate is
high due to the stringent requirements, very few people
actually complete the program.80
Embedding health and social service programs as components of the criminal justice system preserves the
view that the issues they address are criminal problems.

Fig. 9 Race of Drug Law Violation Arrests & Race of Drug Court
Participants in Ithaca, 2012
80%

70%
Percentage of Drug Arrests
Percentage of Drug Court Participants

60%

50%

40%

30%

20%

10%

0%
White

Black

Other/Unknown

Sources: Ithaca Police Department, New York State Unified Court System
Other includes Latino population. As IPD does not track Latino population, no comparison could be
made for this group.
Drug Arrests as reported by National Incident-Based Reporting System code 35A: Drug/Narcotic Violations,
defined as the unlawful cultivation, manufacture, distribution, sale, purchase, use, possession, transportation,
or importation of any controlled drug or narcotic substance.

 For example, the threat of incarceration remains in place
as an escalation tactic when a defendant struggles with
continued drug use or misses program dates. This has
the effect of reinforcing, rather than preventing, the
criminalization of drug use. In addition, drug courts often have non-experts making therapeutic decisions best
left to trained treatment providers, not court personnel.
It should be acknowledged that in Ithaca and Tompkins
County, treatment providers do have significant roles in
the treatment court system. What we are emphasizing
here is that the criminal justice system should not be the
initial point of entry for drug misuse treatment services.
Implementing an alternative at the front-end of the criminal justice system, before jail or prosecution, by giving
service referral tools to the police and increasing access
to voluntary treatment would have a greater effect on
reducing incarceration, while assuring people get direct
access to support and assistance to improve their health
and social situation.81
Finding 4: People fear calling law enforcement
to help with drug-related issues because of the
collateral consequences it can trigger.
People repeatedly asked for another solution that did
not involve the police not only because of the costs of
criminalization, but also the collateral consequences
associated with involving law enforcement.

“I want choices. I can’t call a health person to
get the user any help. The only choice we have
is criminalization. We keep putting police in the
place where they’re dealing with things they’re not
equipped to deal with.”
– Participant in Business Community Focus Group

“We’re missing this - guys can leave their job
and go to treatment. Women don’t want to go to
treatment because they’re afraid they’ll lose their
children. I’ve seen women who don’t want to come
to an AA meeting because their afraid there are
social workers.”
– People in Recovery Focus Group

This was also a concern for people currently in mandated or outpatient treatment structures, who felt that
divulging their struggles would incur consequences that
would cause severe disruptions to their well-being.
Finding 5: While most community members and
criminal justice system personnel recognize the
good in diversion programs and treatment, more
education about relapse and recovery are needed.
A significant group of participants believe many drug
users manipulate treatment services and diversion
programs in order to evade punishment and the larger
criminal justice system. This practice of manipulation
was also thought to apply to how drug users interact
with medical services. There was a belief that people
who use drugs play up pain in order to get prescriptions
or hospital admission to avoid the street. This has had a
significant impact on medical providers, who now feel
pressure to police patients to avoid prescription drug
abuse. Patients resent this and report being less likely to
seek care or help because of stigma and fear
of mistreatment.

“I have transformed from caregiver to police
officer because it has become too easy to get
prescriptions.”
– Participant in Healthcare Focus Group

The criminalization of drug use has reached far beyond
the criminal justice system to establish a sprawling array
of penalties related to drug use, particularly for people
utilizing social support services.82 From getting kicked
out of half way houses, losing custody of children, to
triggering immigration hearings, some participants described not calling for help because they feared it would
cause more harm than good. These are concerns even
for people who are not using drugs themselves, but may
have a family member in their home that does.

“Because you made a bad choice, you’ll be
carrying around a red flag for the rest of your life
–to be constantly treated a certain way because
of your bad choice is unfair, but it’s hard to break
through that.”
– Participant in Healthcare Focus Group

35

 36

Consultation Findings

Left: Mayor
Svante Myrick
speaking at the
International Drug
Policy Reform
Conference about
the Ithaca Plan
– November 2015

There is a disconnect between the experiences of doctors and people who use drugs. People who use drugs
expressed moments of pain, being accused of “faking
it”, and being turned away from needed services and
medical care. Healthcare providers, on the other hand,
expressed difficulty in understanding how to effectively
help these patients, especially given the pressure they
are facing around better control of prescription narcotics. Healthcare providers also felt ill-equipped to deal
with their patients’ drug use, in part, because of a lack
of knowledge and, in part, because of a lack of appropriate referral services. Education for healthcare providers
and law enforcement about addiction, how diversion
programs work, and general mental health are desperately needed. Efforts to bridge the gap between people
who use drugs and these professionals are also needed.
In other jurisdictions, people who use drugs have been
part of trainings for such professionals on how to most
effectively meet their needs83.

“This woman had never shot up before and she
did not know how to use. I took a woman who was
afraid to leave the building because she knew she
would use. She showed me her arm and it was infected. They weren’t compassionate at the hospital;
they treated her like a junkie. They dug in her arm
and she’s screaming in pain and they just said she’s
gonna have to deal with it. If you didn’t want to deal
with this then you shouldn’t have done it. To me it
was torture. It’s like no you’re a junkie we can’t give
you pain meds. I didn’t think our Ithaca medical
professionals would treat someone that way. We
need people in the community who aren’t afraid of
being compassionate.”
– Participant in People in Recovery Focus Group

  

 

5. Recommendations

 

 

Recommendations

38

Governance and Leadership
Goal: Create a mayoral-level office tasked to
reduce the morbidity, mortality, cost, and
inequities associated with illicit drugs and our
current responses to them.
1. The mayor should open an Office of Drug Policy to
orient the work of all city agencies towards reducing
morbidity, mortality, crime and inequities stemming
from drug use and our responses to it. This new approach recognizes that criminalizing people who use
drugs has not been effective and anchors Ithaca’s policies
in principles of harm reduction, public health, and public safety. It also recognizes that city agencies often work
at cross purposes and provides a structure for coordinating their work with the simple aim of improving the
health and safety of communities, families and
individuals across the city.
a.  The mayor should appoint a director to: run the
office; advise the mayor and city agencies; implement
the MDPC recommendations for how the city can
improve its drug policies; coordinate the activities of
various city agencies and departments; be a liaison
between city, county, state and federal agencies;
and act as a spokesperson for the city on drug
policy matters.
The director would also chair a drug policy committee
that would work with the director to implement the
objectives of the Office of Drug Policy. Membership of
the committee would include representatives from the
public sector as well as experts and those directly impacted by the city’s drug policies – to advise the director
and the mayor. For example, it should include representatives from but not be limited to, representatives from
the county department of health, county department
of mental health, the Ithaca school district, the Ithaca
police department, county department of social
services, the department of human resources, the county
department of probation and community justice, the
speaker of the council and up to three designees of
the speaker, and representatives of any other agencies
that the director may designate, as well as at least eight
representatives from continuum of care providers, those

directly affected by drug use, those in recovery from
drug use, people formerly incarcerated for drug related offenses, and experts in issues related to illicit and
non-medical drug use and policies.
In addition to implementing the MDPC recommendations, the office would also be tasked to develop an
annual drug policy plan and report on the status of the
city’s drug policies, programs, and services, and establish
goals and objectives for how these can be improved to
reduce morbidity, morality, crime and disparities.84 This
group would also be responsible for conducting a needs
and assets assessment of the community and act on this
information by recommending appropriate initiatives
in an ongoing way, this would also include creating a
centralized databank with all data sets associated with
drug use, treatment center effectiveness, and drug
related arrests.
Rationale:
Within the MDPC committee, members recognized that
their fields were interconnected and that some of the
limitations of their current initiatives were engineered
by the structural tendency to operate in silos. While not
the intent of those operating in the fields of prevention,
treatment, harm reduction, and law enforcement, the
disconnect often has negative impacts on the people
moving through these different systems. The compartmentalization and discontinuity of the services and policies in Ithaca create a strong need for a coordinated drug
strategy, especially given the rising number of heroin
overdoses in Tompkins County.85

“I’m now in the homeless shelter. You have to break
up your day to day at DSS doing paperwork to get
approved for the shelter, but to get a cot you have to
sit in line at 2:30. It’s a full time job.”
– Participant in People Who Use Drugs Focus Group

Focus group participants consistently asked for a centralized place that had the authority to call these groups
together to assess what was happening in Ithaca and to
address the various drug problems in town. Currently,
there is no formal process to identify and reform

 harmful and racially disproportionate criminal justice policies and practices. And while there are many
different organizations and agencies that are working
to improve the lives of people in Ithaca, they are often
underfunded and working out of sync.

eluded simple solutions. In turn, community collaboration would enable residents to contribute to making
a difference and creating the political will necessary
to influence the development and implementation of
lasting policy.87

For example, the Community Coalition for Healthy
Youth (CCHY) grew out of the Community Drug Task
Force established by former Mayor Alan Cohen in the
late 1990s. After successfully obtaining federal funds
over several years, the CCHY is currently in a period of
transition since the end of its most recent grant. While
their contributions to the county cannot be overstated,
the current mandate by Mayor Myrick calls for an enhanced approach that requires the scope of their work
to include not only youth, but also adults and families.

“People who make decisions about people who
look like me and have problems like me, don’t
look like people in this room. It’s important for us
to be a voice in what we need in this community.
“Who knows better what we need than we?”

New initiatives must also do more to involve community
members and key stakeholders as research consistently
illustrates that coalition-like structures are effective in
harnessing the community’s power to create change.86
A well-functioning structure that engages residents, law
enforcement, schools, nonprofit organizations, the faith
community, youth and other key groups working in tandem to address community concerns, would ensure that
the Office of Drug Policy is well positioned to sustain
action on pervasive community problems that have

– Participant in People of Color Focus Group

Address and Reduce Racial Disparities
Amid the growing national conversation around racial
disparities and institutional racism, the Ithaca Office
of Drug Policy can lead by example by thoroughly assessing the degree to which racial disparities are present in other discrete, but drug policy-related, systems
in New York (criminal justice, child welfare, housing,
economic development, etc.), and develop strategies to
reduce them.
Absent a budget allocation to conduct such an assessment, the director should seek to partner with local
academic institutions, which may have the resources
available to assist this activity.

Left: Mayor Svante
Myrick, MDPC
co-chairs Lillian
Fan and Gwen
Wilkinson, and
Drug Policy Alliance
Kristen Maye
and Kassandra
Frederique

39

 Recommendations

40

Education
Goal: Key stakeholders and all Ithacans should
have access to evidence-based practices and
education around drugs, preventing problematic
use, reducing harms associated with drug use,
and helping oneself or others who have a drug
use problem.
1. The Office of Drug Policy would coordinate with
existing Ithaca organizations that provide services to the
community (like Southern Tier AIDS Program) to host a
series of community education events every year around
drugs, policies associated with drugs, and general health
within the community. The Office would also coordinate
training modules for service providers to ensure they are
informed with the most up to date treatment options,
strategies, and resources. Where possible, these training programs should include people who are directly
impacted by drugs or drug policies, be evidence-based,
and be grounded in a harm reduction approach.
Office of Drug Policy public education responsibilities
include, but are not limited to:
a.  General community awareness events (around
drugs/drug policies).
b.  Education events for parents and loved ones of those
struggling with addiction (topics could include:
recovery is not linear, medication-assisted treatment,
syringe exchanges, relapse is a part of recovery, Ithaca
resources).
c.  Narcan and overdose response trainings for
the public.
d.  Education for law enforcement, healthcare providers,
service providers and users on harm reduction models. Examples include a train-the-trainer curriculum
based on the Enough Abuse structure that can be run
by STAP.
e.  Cultural competency and sensitivity trainings for
treatment and medical professionals working with
people in treatment and medical settings.

f.   Training healthcare providers around opioid prescribing and patient education, such as a standard
concise information sheet distributed by all providers
when opioids are prescribed that would also include
treatment resources and information for the Ithaca
addiction hotline.
Rationale:
Prioritizing cultural competency in treatment and
healthcare must mean equipping providers to treat
disease by recognizing the structurally specific
patterns of illness among Black, brown and low-income
populations. Research establishes that systemic factors
like racism and poverty result in Black, Latino and
low-income populations suffering disproportionate rates
of preventable disease and morbidity.88 Healthcare and
treatment services for people of color are consistently
poorer in quality even when controlling for impediments
like cost and access.89 Incorporating practices of intentional, direct communication to assess patient needs,
establish accurate diagnoses, develop effective treatment
plans and evaluate results can work to mitigate these
disparities in care.90

“There are a lot of people who are in the treatment
providing profession… They’ve gotten it out of the
textbook and you can’t share my experience if you
don’t know what it’s like to be in my shoes.”
– Participant in People in Recovery Focus Group

“As a person in recovery going through many
different treatment programs – I stayed in one for
28 months, 9 months, and 3 months. Didn’t get
clean till I was 43 What worked for me was not
those treatment programs except for one because
there was an African woman who helped me see
things that took me a while to see. This program
had an afro-centric theme. Group just for African
American people and I was honest about living in a
society and feeling less than white people. And she
stopped me right there and told me I should never
feel less than.”
– Participant in People of Color Focus Group

 With research connecting increasing rates of heroin use
to the rise in prescription opioid dependence, there is
an immediate need for education and awareness around
addiction and harm reductions services as well as dosing, misuse, and adverse reactions to prescription drugs
for patients and providers.91 Research has consistently
shown that medical providers receive minimal education
about addiction as part of their formal training and that
they remain uncomfortable with people who use drugs
and with discussing drug use more generally.92 More
comprehensive training and education must be made
available to prescribers in order to curb the rise of problematic prescription opiate and heroin use, increase the
likelihood that patients will be made aware of potential
risks, and help patients connect to available services
if needed. These efforts provide opportunities to not
only ensure that providers are adequately equipped to
prevent and address harmful prescription drug use but
harmful use of all drugs.
Recovery-Oriented Treatment, Harm Reduction,
and Ancillary Services
Goal: Create a recovery-oriented treatment continuum that offers access to timely, individualized,
and evidence-based, effective care, through services that are people-centered and able to meet
the needs of individuals no matter their current
relationship to drug use or recovery.
1. Add an on demand centralized treatment resource
system to the existing Ithaca 211 directory:
a.  Conduct short screenings over the phone to assess
appropriate service referral.
b.  Provide referrals for treatment centers in Ithaca with
up-to-date inpatient bed numbers.
c.  Create a parent/loved one hotline (based on the
Partnership for Drug Free.org)
d.  Connect people to a treatment navigator (based on
the Affordable Care Act navigator) to help persons or
families in trouble navigate the treatment and referral
process, including after care assistance.

2. Open a freestanding 24-hour crisis center in Ithaca
– medication-assisted and supervised outpatient detox,
with case management services available on-site.
Activities:
a. Law Enforcement and laypersons can voluntarily bring
an intoxicated individual for safety and respite.
b. This center will include short-term temporary beds for
persons waiting for enrollment in treatment centers.
c. The center will also include a “chill out” space for
people who are under the influence to help assuage
the proliferation of public intoxication. This is not the
same service as detox; the purpose of this space is not
primarily to help someone withdraw but to even out,
provide them with health education, and potentially
connect them to harm reduction services.
d. The crisis center would also be appropriate for parents or loved ones to send their loved one in distress
voluntarily, instead of a PINS or person in need of supervision process which involves putting the person
through the court system and often leads to intense
strain on familial relationships, usually during crucial
intervention windows. Services would include support groups (abstinence based and non-abstinence),
on- site counseling, case management, and family
support services.
3. The Tompkins County Department of Health should
be encouraged to continue implementing an aggressive
public education campaign about harm reduction practices to reduce risks from underage drinking, tobacco
use, and other illicit substances.
4. Increasing awareness around the New York State 911
Good Samaritan laws can also help make adults and
young people aware of the resources and the legal protections afforded victims and people who call for help.
5. The city should partner with the Tompkins
County Health Department and local medical providers
to offer low cost or free Hepatitis A & B vaccinations and
Hepatitis C treatment to people who actively
inject drugs.

41

 Recommendations

42

6. Implement a Housing First, basic, non-contingent
needs model for Ithaca to increase access to housing,
nutrition and healthcare services without requiring
abstinence or participation in treatment.
Activities:
a.  Maintaining the safety of themselves and those
around them should be the criteria to receive services, which should not be dictated by whether or
not a person is using a substance.
b.  This model should include but not be limited to
sober living facilities, low threshold housing, and
housing options for people with families.
7. The city should work with relevant agencies to
integrate mental healthcare options into substance use
services, with an emphasis on providing more robust
service options for people with dual diagnoses.
8. Increase the availability of medication-assisted treatment in Ithaca, including opening a methadone clinic
and increasing the number of office-based buprenorphine (i.e., Suboxone) prescribers.
9. Continue and expand proven harm reduction programs, including but not limited to syringe exchange
services, opioid overdose education/trainings, syringe
disposal kiosks, and naloxone distribution.
10. Explore the operation of a supervised injection site
staffed with medical personnel as a means to: prevent
fatal and non-fatal overdose, infectious disease, and
bacterial infections; reduce public drug use and discarded needles; and provide primary care and referrals to
basic services, housing, and substance use services and
treatment, including the integration a basic healthcare
provider at harm reduction sites.93 94
11. The city of Ithaca should request the New York
Academy of Medicine or another objective research institute to study the efficacy and feasibility of heroin maintenance therapy for people who do not respond effectively to other forms of opioid replacement therapies.95

Rationale:
Ithaca needs an expansion of existing harm reduction
services and integration of harm reduction practices
in the treatment sectors. This also includes providing
treatment options that are not abstinence-based. Because
OASAS does not fund those treatment modalities,96
Ithaca should identify and obtain sources of funding to
address the issue. Participants also recognized that drug
use for some people may be a result of different circumstances such as mental illness, joblessness, or homelessness and the treatment options for these people are
deficient, as the limited supportive services are usually
contingent on sobriety. Participants belabored the point
that, even if someone were ready to be abstinent and
seek intensive inpatient care, the current service system
requires them to fail out of outpatient services before
they can access inpatient services. Everyone agreed that
this practice defeats the purpose of connecting someone
to services.

“The only programs here are drug free – they give
you no chances.”
– Participant in People Who Use Focus Group

“That’s what I envision when I talk about a crisis
center. It would be part shelter but would walk in
and say this is where I am right now. They should
help meet you where you are. Most people addicted
to heroin are going to be on Medicaid. In order to
get into in-patient, you have to fail out of outpatient. That means that person has to go through
that 3-week process of meeting at drug and alcohol counseling once a week. Preferably not dying.
Maybe every other week they get drug screens.
That drug screen takes 2-3 weeks to process before
the counselor can even tell if they’ve been clean.
They need to have 3 or four dirty drugs screens
before they can qualify to get into inpatient, which is
where they needed to be initially, which can take 3-4
months. And if they drop out, that doesn’t count as
failing. That’s why they have people dying in Ithaca.”
– Participant in Business Community Focus Group

 Left: MDPC
Treatment Pillar
team Blue Sky
exercise
– September 2015

Focus group participants called for the treatment service
sector to provide on demand services and support,
whether it be through the referral process, treatment, or
after care services. Some participants described feeling
isolated and in need of a centralized place for them to
navigate the treatment systems. Creating a centralized
point of entry into the care system can help alleviate
some feelings of isolation. One benefit of a hotline, aside
from immediately assisting people, is that it can help
assuage some of the stigma and shame that people face
when reaching out for help. There was also a clear cry
for ancillary services and better coordination as the road
to non-problematic use has many stops and starts. And
while people called for centralized efforts like a hotline
and a crisis center, they also need multiple points of
access across the systems of care and access so that they
can be served regardless of their stage in use or recovery.

“We need a clearinghouse agency that a person
could walk into and say ‘I’m in crisis and I need
help now.’”
– Participant in People Who Use Drugs Focus Group

Current developments in healthcare demonstrate the
potential for growing an expansive, integrated system of
care. For example, the Delivery System Reform Incentive
Payment (DSRIP) model calls for the incorporation of

a wide variety of stakeholders involved in health and
human service delivery to members of a prescribed
community, such as a geographic area. Although the
model is focused on healthcare access and coordination,
it is based in the recognition that many social issues
impact health.97 For example, inadequate housing can
impede healthy eating, sleeping, and good hygiene, all
basic needs, which impact health outcomes. Unresolved
legal problems create stress, which negatively impacts
health. The concept presented by the DSRIP model
acknowledges these associations with individual and
community health, and brings service providers into
direct relationship with healthcare providers, to ensure
the breadth of needs are met, to improve health. This
approach illustrates a model for practical service integration for a shared goal of health among all participating
providers, and suggests a developing movement for
integrated systems.
Heroin maintenance and supervised injection facilities, while new to the US, have been used in dozens of
jurisdictions in Canada and Europe and would meet
the demand by not requiring participants to stop drug
use as a means of success.98 Research has made clear
that such interventions can lower public intoxication,
stabilize users’ lives, and link a hard-to-reach population
to services.99

43

 Recommendations

44

Community and Economic Development
Goal: Support and expand existing efforts to
improve youth and family development, economic
opportunity, and public health of communities,
targeting vulnerable communities as immediate
beneficiaries and ensuring that all Ithacans have
the same access to resources and investments.
1. Partner with alternative to incarceration programs
that connect low level users and sellers to jobs programs
(see LEAD recommendation); integrate a jobs training
program as an ancillary service in treatment centers; and
create an apprenticeship program in conjunction with
the Downtown Ithaca Alliance and Tompkins County
Chamber of Commerce and community outreach worker to encourage youth employment.
2. Pass Ban the Box legislation for private and public
sector jobs and encourage Tompkins County to do the
same in order to expand job opportunities for people
returning from incarceration.
3. Develop a citywide training/education program on
basic work skills that would be offered before the start of
any potential job training course.
4. Lobby Tompkins County to create a dedicated case
management program for the re-entry population.
5. Seek to reform zero tolerance programs in the school
district to incorporate restorative justice systems in order
to curb the rise of suspensions, expulsions, and dropout
rates all of which contribute to a young person’s general
community disengagement and raise the likelihood of
unhealthy risk behaviors.
6. Integrate comprehensive services to reduce the risks
associated with drug use or alcohol poisoning at local
establishments frequented by residential college students
such as safe settings where patrons can sit and rest away
from loud, crowded spaces; setting up syringe disposal
containers in restrooms; and providing free and accessible water during school year weekends. 

7. Establish a process through the Ithaca Office of Drug
Policy to monitor, investigate, and address racial, gender,
age, and geographic disparities in health and socioeconomic outcomes across administrative and criminal
justice systems. These efforts should include surveillance, research, and analysis of the different data systems
(including desk appearance tickets, Unlawful Possession
of Marijuana violation, treatment admissions/graduations, drug court enrollment, etc.). ODP should issue a
findings report and make recommendations to reduce
unwarranted disparities.
Rationale:
Economic development and community development
build healthier and safer communities.100 In Ithaca, there
are great strides being made in community development
through the Downtown Commons project, coffee hour
talks with the mayor and the IPD chief, and processes
like the Municipal Drug Policy Committee.101 Ithaca is
working to engage its citizens in building a community
in which they can live and thrive. Yet the message we
heard repeatedly was the hopelessness of a small town
without job opportunities, particularly for low-income
communities. Research shows that areas with the highest
rates of poverty are also those with the highest rates of
diabetes, HIV/AIDS, other chronic diseases, and harm
from drug use.102 Building on the current initiatives
to revitalize the downtown area and raise community
morale alone will not help leverage resources to decrease
drug use and the drug trade. We are encouraging the
city to invest in an expansive jobs development initiative
to help revitalize and develop low-income communities
in Ithaca.

“I’m going through hell with my 14 year old,
when I go to the community to help my very
brilliant, very angry son. Only options were to put
my son in the system and criminalized him. If I’m
concerned about my kid, it’s about what he’s getting
into. It’s about the lack of opportunity. People deal
drugs b/c it’s economically motivated; people take
drugs because it’s about despair; if I didn’t have my
kids, I might tell you that life has kicked my ass
and I might be a raging alcoholic. I’m here because
it’s personal.”
– Participant in People of Color Focus Group

 “You can’t give your kids unrealistic hopes. It’s not
about their lack of potential or their lack of intelligence. It’s about the reality that the opportunities
are not there. You can’t fake that for them. They see
right through that. The hopelessness that impacts
our young people. We live in a community with incredible educational opportunities and yet our kids
stay uneducated.”
– Participant in People of Color Focus Group

Recognizing the expansive and deleterious effects of
mass incarceration, if the city wants to turn a new corner
on drug policy, it must invest in its returning citizens
by creating linkages to services, housing, treatment,
and job training programs that lead directly to job
placements. Efforts like President Obama’s My Brother’s
Keeper are necessary as more attention needs to be paid
to underserved communities by increasing their access
to resources, especially when current strategies do not
effectively benefit or target low-income communities,
disadvantaged workers including young people, veterans, individuals with disabilities, and individuals with
criminal records.103

Vibrant local economies where large groups of underserved community members are employed can help
to remediate some of the effects of mass incarceration.104,105,106,107 Strong emphasis on youth employment,
like an apprenticeship program, can improve academic achievement and lessen the likelihood of boredom,
disengagement, and lack of civic engagement, all of
which are factors contributing to drug use or illicit
involvement in the drug trade.108,109,110,111 People need
and want opportunities to contribute to the development of their community as opposed to being outsiders
looking in.

“We need to do a better job of giving
people purpose.”
– Participant in Healthcare Community Focus Group

“I come from the hood and I relate myself because
of my experience. There are people out there
because the only way to support their family is by
selling drugs. I don’t support it but if we had better
jobs, with better pay I think we wouldn’t have this
problem with abuse and drug selling.”
– Participant in Parents Focus Group

“A young Black man that I’ve known forever came
home from a relatively short stay in prison and got
a job at Wegmans doing carts. I ran into him and
he was feeling good about himself. A police officer
who had known him before [he went to prison] went
and told the people [at Wegmans] and – they hired
him knowing he had a record, he had to get permission from his parole to work there – but the police
officer went and told one of his friends in security
– a number of the security officers at Wegmans are
off-duty police officers – and they fired him. Despite
the fact that he had been doing a fine job, he hadn’t
even been there that long. Doing a fine job, feeling
good about himself and they got rid of him. It’s one
particular story, but I hear that story all the time.
That’s one way it (stigma) manifests itself.” 
– Participant in People of Color Focus Group

It is also crucially important to recognize the distinct set
of circumstances that Ithaca is operating under being
largely described as a “college town.” Tompkins County
is home to three colleges - Cornell University, Ithaca
College and Tompkins Cortland Community College.
The university presence brings a robust blend of young
people to the area whose health and safety are bound
up with that of the Ithaca community during their time
as residents. Among many traditional university-aged
students, the use of alcohol and other drugs is seen as
normal, almost a rite of passage, even though that use
is almost always illicit. Honest and responsible drug
policies should not only aim to prevent drug use among
youth, but also acknowledge that illicit use of alcohol
and other drugs by college-aged students will not disappear with mandates and penalties that say it should.
With such a robust university presence in a relatively
small town, business owners whose establishments
largely cater to college students should adopt pragmatic
approaches to managing drug and alcohol use in and
around their businesses, which can save lives.112

45

 Recommendations

46

Public Safety
Goal: Redirect law enforcement and
community resources from criminalization to
increasing access to services. Encourage a shared
responsibility for community health and safety
that extends beyond the Ithaca Police Department.

Santa Fe, NM, and more recently announced in Albany,
NY, can help community members re-imagine what is
possible when criminalization is taken off the table.

“I believe strongly that the criminalization of what’s
a psychological, physical and spiritual sickness is
not working at all.”
– Participant in People in Recovery Focus Group

1. Pilot a Law Enforcement Assisted Diversion program,
modeled on the successful Seattle LEAD program
(see alternatives to incarceration program).
2. Train Ithaca Police Department on the syringe exchange program annually. The trainings, conducted by
the Southern Tier AIDS Program, should include how to
make sure officers are safe when interacting with people
who inject drugs and collaboratively identifying public
spaces to place syringe and medication disposal kiosks.
Rationale:
Law enforcement officials, parents, and young people
agreed that drug use is a health problem and legal intervention does little to deter the usage of drugs. Under our
current system, law enforcement officials frequently act
as the first point of contact for services. Services should
not have to be accessed through the criminal justice system, and police encounters, as well-intentioned as they
may be, often lead to criminalization and other punitive
responses. Research shows that the harms associated
with criminalization can outweigh the harms associated with drug use.113 These types of encounters deepen
mistrust between police and community members. All
participants in this process recognize that the reliance
on criminalization is impeding the kind of new direction
that the MDPC wants to take. Ithaca does not have the
authority to change state and federal laws governing
drugs. For example, while respected civil rights and
public health organizations call for decriminalization
of all drugs nationwide, that falls outside the authority
of the municipal government.114,115,116,117,118,119,120 Ithaca,
however, is able to shape the policies and practices of its
police department, evidenced by the Mayor’s directive to
make marijuana arrests a low priority. Piloting a pre-arrest or pre-booking diversion program like the Law
Enforcement Assisted Diversion program in Seattle, WA,

Creating multiple points of entry for services outside of
the criminal system – including outside of drug courts
– would also help lessen the stigma for people who use,
encouraging them to seek help without fear of criminalization in the form of arrest, court sanctions, and
incarceration.121 Because of law enforcement’s changing
role in the conversation around health and safety, it
is important that IPD be integrated in the network of
service provision in the city. That includes getting more
information on how to interact with people who use and
people who are in recovery and having a deeper understanding of the guiding principles of harm reduction.
Law enforcement officials respecting and supporting
harm reduction measures like the syringe exchange
program and public kiosks for syringes and medication,
will demonstrate that police officers believe in healthbased initiatives that increase public safety. Trainings
and familiarity with community services will enable
police to make referrals, and the use of community crisis
intervention teams or community response teams made
up of civilians and service providers have been shown to
facilitate access to appropriate services, decrease arrests
and recidivism, and improve community relationships.122 It’s time for Ithaca to recognize that the burden
of responding to drug use should not fall solely on the
shoulders of IPD.

 47

Conclusion
This report has illustrated that our city’s drug
policies have grown more harmful than the actual
drug use it is charged with curbing. We are experiencing a desperate need for services among many
of our most vulnerable community members and
exposing others to the lure of a growing heroin
market, all the while responding with a failed
approach. We can no longer tackle the growing
problems associated with drug use, employing
a policy approach based in fear, criminalization,
and punishment. Community members and those
most impacted by these increasingly defunct policies have powerfully enumerated how unresponsive policies have been to their needs. As a result,
unlikely allies have been made of drug users, the
medical community, treatment professionals, law
enforcement officials, and countless others who
have joined together to insist that a new way
forward is not only possible but necessary and fast
approaching. We are ready to ground our city’s
new drug policies in science, reason, compassion,
and public health.

We’ve always known that Ithaca’s greatest resource
is its people. We’ve already proven that we have
the ability to convene the minds in this town to
create amazing opportunities for the benefit of
everyone. Our 13-year old syringe exchange program is a testament to what we’re able to do when
we identify a need in our community and commit
to filling it. The vision of progressive Ithacans
15 years ago to convene a similar process of reimagining our drug policies laid the groundwork
for the transformation of our city’s policies today.
We’re continuing the tradition of living up to our
greatest potential.
Rather than punish individuals and their
families for drug use, we can expand services to
tackle drug problems at the community level and
adequately fund the range of health and social
approaches to improve the health and wellbeing
of individuals. We can create an environment of
effective responses where drug use doesn’t have
to compromise the public health and safety of
Ithacans, and impact the quality of life for everybody. It is time for Ithaca to take a new approach
to drug policy.

 48

Appendices

APPENDIX A:
Drug Policy Innovation in Ithaca
During the 1980s, the HIV/AIDS epidemic settled in
to New York City, and by 1990, NYC had earned the
horrific label as the global epicenter of AIDS. People
injecting heroin and other drugs were particularly
susceptible to the blood-borne disease. Syringe-sharing
was common, because syringes were a scarce commodity; prescription laws had been in place in New York
since the early twentieth century. While four hours away
from New York City, HIV/AIDS and the growing heroin
epidemic were very much a part of the Ithaca, NY narrative. In the early 1990s, Ithaca recognized that it had
not avoided the national problems. Over the last twenty
years Ithaca has made strides to address the
issue head on.
1991
A 1991 study completed by William Benjamin concluded that 72% of inmates housed at the Tompkins County
Jail were alcohol and/or drug addicted. Tompkins
County and Ithaca specifically were overwhelmed by
the same problems that made New York City infamous
Transcripts at the Cornell University library hold a rich
history of local Ithaca activism to address the health
problems associated with HIV/AIDs and drug use as a
health problem instead of a criminal problem, including minutes from local meetings from Ithaca’s ACT UP
(AIDS Coalition to Unleash Power) chapter. Ithaca,
smaller in size than New York City, believed then as it
does now, that they could do something different and
direct funds to resources that would help people.

1998
Following the lead of central New York town,
Rochester, in January of 1998, Ithaca City Court opened
a specialized program for defendants with charges
arising from substance use, the Ithaca Drug Treatment
Court. The mission of the Ithaca Drug Court was to
establish coordinated mechanisms for identifying
defendants at the earliest stages of the judicial process
whose crimes were either directly or indirectly related
to alcohol and drug addiction; insured that these defendants received appropriate drug treatment; and provided
education, vocational training, and employment to
those who entered and successfully completed the
rehabilitation process associated with the Ithaca Drug
Treatment Court.
1999
In 1999, Ithaca Mayor Alan Cohen assembled the Ithaca
Drug Taskforce to address the rising prevalence of drugs
in the Ithaca community. Taskforce recommendations
resulted in the creation of the Community Coalition for
Healthy Youth, an increase in drug education in schools,
and increasing resources to law enforcement.
2002
In 2002, Southern Tier AIDS Program (STAP) began
operating a fixed-site syringe exchange in Ithaca, located
in Tompkins County. This exchange was the first to
serve rural populations in New York and a second fixedsite opened in 2008 in Johnson City, which also serves
rural communities. The initial proposal for the Ithaca
site estimated service delivery to 60 individuals; by the
end of 2014, STAP had enrolled over 4,200 participants
between the two fixed sites, the Peer Delivered Syringe
Exchange Program (PDSE), which utilizes volunteers
that offer safer injection supplies to their social networks, and a mobile van unit that enables staff to reach
those that are unable to access services due to transportation barriers.

 2005
In 2005, Gwen Wilkinson won the Tompkins County
District Attorney race on a “no more drug war”
platform. In her interview with the Cornell Daily Sun,
D.A. Wilkinson said her first order of business was to
“get the D.A. back as an active member of the drug
treatment program.”
2011
In 2011, New York State passed a Good Samaritan law,
which provides medical amnesty to persons involved in
a medical emergency related to illicit substances and/or
alcohol. The law was passed to help prevent overdose
deaths by encouraging New Yorkers to call for help in
the case of an emergency.
2012
In 2012, nodding to the changing public opinions
around marijuana and recognizing the devastating
collateral consequences associated with a marijuana
arrests, Mayor Myrick instructed IPD to make marijuana
possession the lowest level enforcement priority.
In August of 2012 Mayor Myrick proclaimed August 26,
2012 as “Harm Reduction Awareness Day” in the City
of Ithaca.123
2014
In summer 2014, Ithaca Fire Department begins to carry
the overdose reversal drug naloxone (Narcan) and saves a
life on August 31st. A month later, Ithaca Police Department equips its officers with the lifesaving antidote to
help the rising number of overdose victims in the city.
The growing rapidity of change in the city and the
state’s drug policy landscape represents the beginning
of a transformational shift for New York, away from a
criminal justice framework and towards a public health
approach. In Ithaca, we can build on these successes
by carrying change forward together in our city. The
opportunity to improve the health and well-being of our
residents and communities has never been greater.

APPENDIX B:
Toward a Public Health and
Safety Approach to Drug Policy
The gathering of ideas, opinions, and expertise for this
report generated a common understanding of drug use
– that drug use should be addressed as a health behavior, not a criminal behavior. This approach infuses our
recommendations and stands in sharp contrast to traditionally moralistic assumptions about drug use based in a
binary view: that no drug use is acceptable and that, where
there is drug use, it must be treated as a crime. From this
perspective, it is clear to see how we have arrived at the
current punitive framework for US drug policy, visible
in our uncoordinated law enforcement, healthcare, and
human service systems and responses in place today.
Over the past forty years, harm reduction practices and
concepts have occupied the space ignored by this framework – namely, to acknowledge and respond to the simple
fact that there will always be some drug use in society.
Harm reduction acknowledges that drug use does not
simply disappear because policy dictates it should. Harm
reduction recognizes that drug use happens for innumerable reasons, and that it is a behavior with physical,
psychological, and social consequences, sometimes negative. If we are to be reasoned, honest and compassionate
in approaching solutions to failed drug policies in Ithaca,
exploring harm reduction as a lens through which we
view drug intervention practices may realistically improve
health and safety outcomes. While the MDPC and the
Mayor are committed to being guided by a harm reduction
approach as they reformulate Ithaca’s drug policies, we
learned that many in Ithaca are unfamiliar with the concept, so below we sketch out some of its basic tenets.
Understanding harm reduction
Drug use is a common human behavior. People use drugs
for innumerable reasons - to escape a feeling, to find a
feeling, to relax or get energized, etc. – as diverse as our
humanity. Drug use reflects our instinctive drive to escape
pain and to seek pleasure, not unlike a desire for rich or
sweet food, physical intimacy, or the adrenaline rush of a
rollercoaster ride. The use of drugs causes psychoactive
changes in the brain, which can alter our perception and
sensory experience. But drug use, in and of itself, is not a
pathological behavior.

49

 Appendices

50

Some psychoactive drugs are legal – for example,
alcohol, tobacco, caffeine, and sugar – and most drugs
which have been categorized as illegal for personal use
can be used safely. In fact, many drugs are frequently
used for medical purposes, and researchers continue
to investigate the medical value of many others. Moreover, many drugs deemed illegal for personal use in the
United States and other countries carry traditional and
sacred meaning in local indigenous cultures around
the world (e.g. coca). Throughout history, the use of
drugs has been incorporated into practices, rituals, and
celebrations in ways that respect the strength of the drug
and optimize the benefits of its use.
To mitigate the negative consequences of psychoactive
drug use today, harm reduction introduces a healthbased response. This approach acknowledges a
continuum of drug use, from infrequent or episodic
experimentation and recreational use, to routine use, to
use that sometimes becomes frequent, escalating, and/or
heavy. Harm reduction recognizes the variety of ways in
which drug use happens and how it is shaped by
both the individual’s decision to use and the context in
which that use occurs.
The theory of “drug, set, and setting” provides a framework for the harm reduction approach: what is the
physical effect of the drug use, what is the mindset that
drives the person to use, and what is the environment
and ways in which it occurs.124 This framework helps us
shift our concern to how we can prevent or reduce all of
the potential harms related to drug use.
The health harms related to drug use are not insignificant – acute and chronic illness and injury, transmission
of blood-borne diseases such as HIV and Hepatitis C,
overdose and death. However, much of the harm caused
by illicit drug use – the use of drugs which are prohibited by law – is also related to the criminalization of the
drug and the environment created by these policies in
our country, rather than the effects of its use. The abstinence-based perspective shaping current drug policy is
informed by this punitive, zero tolerance approach of
the war on drugs. People who use drugs are punished,

controlled, or excluded, simply for reason of their use.
Laws and policies create and reinforce social stigma
against people who use drugs, and shape the environment for illicit drug use, multiplying the harms by
driving it into secrecy, shame, and an unregulated and
risky market. A health-based approach to drug use could
prevent and reduce these harms considerably.
The actual physical harms of drug use are related to the
dose consumed, how often it is used, the way it is used,
whether it is used in combination with other substances,
and the chemistry of the drug itself. Understanding the
risks involved with each of these factors helps to adjust
for potential harm, just as we do in medicine.
The class of drugs called opioids, such as heroin,
morphine, or oxycodone, can cause overdose when
consumed at high doses, in combination with other
drugs, including alcohol, or by a person with low or
no tolerance to the drug. Using an opioid more often
will increase tolerance and habituate a person to the
drug, creating physical dependence and symptoms of
withdrawal without it. Injecting a drug can maximize its
effect, but requires sterile and careful injecting practices
to prevent viral and bacterial infections. The sense of
euphoria created by opioid use could temporarily interfere with intense physical activity or mental concentration. Each of these factors represent important potential
harms, and managing them will reduce the potential
physical harms of opioid use.
Of particular importance in shaping the experience of
drug use is the mindset of an individual’s drug use, and
whether and how it reflects an effort to self-medicate.
Many people find temporary relief in drug use. For some
people, this is relief from unresolved physical pain, mental health problems, structural experiences of racism or
the psychological effects of past trauma. In effect, drug
use is a self-managed therapeutic intervention for some
people, helping them to treat or mask feelings or sensations which they experience as problems in their lives.

 Drug problems
Drug use occurs along a continuum, and many people
who use drugs do so only periodically or in small,
controlled doses. Among all people who use drugs,
approximately 10% will develop, at some point, what
is known as “drug addiction.”125 This situation is best
understood through the harms of the drug and mindset involved for that specific person. What qualifies as
harmful drug use for one person may not be harmful for
another. Ultimately, the loss of control, or the desire to
use drugs before or in place of anything else in one’s
life, is a certain marker of a problem, and could be
labeled “addiction.”
This problem is not intractable. Often, people age out
of “drug addiction,” simply deciding to change their
behavior. Many people are able to resolve a problem of
“drug addiction” on their own, to achieve a state they
may view as “recovery”126 For those who continue to
use and who experience health or social risks related to
their use, it is the responsibility of public systems and
services to provide services and care to reduce the
likelihood of problems.
While it is our responsibility to make sure resources are
available to people when they are prepared to change
their drug use behavior, it is also our responsibility to
ensure their health and human rights while they are
using drugs.
Stigma
Stigma is the principal driver for the harms involved in
the settings and environments of drug use. US drug laws
and policies have criminalized drug use, forcing it into
secrecy and labeling it a shameful behavior. For people
with fewer material resources or less available social
support, stigma drives their drug use into dangerous,
often-public spaces. This experience presents a threat to
their physical health because spaces are often unsanitary
for drug use and a risk to their social health because of
the potential for violence and the vulnerability to arrest
in an unregulated public setting. Moreover, stigma
reinforces discrimination and may even further the want
to use drugs by decreasing a person’s sense of self-worth
as a result of being marginalized and treated as a lesser
member of the community.

Even for people with ample material wealth, such as
celebrities, the stigma of drug use can cause them to hide
their behavior; we learn about this problem only after
they have died from an overdose, because they were using
alone, in secrecy and shame. Reducing the potential for
harms created by the settings of drug use requires that we
acknowledge its occurrence. Once we formally recognize
the fact of continued drug use in our communities, we can
address it with the health interventions that will reduce the
potential for physical and social harm.
A harm reduction approach incorporates treatment,
prevention, and law enforcement, with an overarching
commitment to the health and human rights of all people
affected by drug use. The strategy and recommendations
presented in this report flow from this perspective and
reflect its strength as an approach for valuing the lives and
livelihoods of all members of the Ithaca community.
We look forward to partnering with you all to bring this
vision to fruition.
APPENDIX C:
Property Crime Arrests, List of
Reported Offenses and Definitions
Arson - 200       
Definition: To unlawfully and intentionally damage, or
attempt to damage, any real or personal property by fire or
incendiary device.
Burglary/Breaking and Entering - 220    
Definition: The unlawful entry into a building or other
structure with the intent to commit a felony or a theft. 
Counterfeiting/Forgery - 250    
Definition: The altering, copying, or imitation of something, without authority or right, with the intent to deceive
or defraud by passing the copy or thing altered or imitated
as that which is original or genuine; or the selling, buying,
or possession of an altered, copied, or imitated thing with
the intent to deceive or defraud. 

51

 Appendices

52

Destruction/Damage/Vandalism of Property - 290     B.  Purse-snatching - 23B    
Definition: To willfully or maliciously destroy, damage,
  Definition: The grabbing or snatching of a purse,
deface, or otherwise injure real or personal property
handbag, etc., from the physical possession of
without the consent of the owner or the person having
another person.
custody or control of it.
C.  Shoplifting - 23C    
  Definition:  The theft by someone, other than an
Embezzlement - 270    
employee of the victim, of goods or merchandise
Definition: The unlawful misappropriation by an
exposed for sale.
offender to his/her own use or purpose of money,
D.  Theft From Building - 23D    
property, or some other thing of value entrusted to
  Definition: A theft within a building that is either
his/her care, custody, or control.
open to the general public or where the offender has
legal access.
Extortion/Blackmail - 210
F.  Theft From Motor Vehicle - 23F    
Definition: To unlawfully obtain money, property, or
  Definition: The theft of articles from a motor vehicle,
any other thing of value, either tangible or intangible,
whether locked or unlocked.
through the use or threat of force, misuse of authority,
G.  Theft From Motor Vehicle
threat of criminal prosecution, threat of destruction
Parts/Accessories - 23G 
of reputation or social standing, or through other
  Definition: The theft of any part or accessory affixed
coercive means.
to the interior or exterior of a motor vehicle in a
manner which would make the item an attachment
Fraud Offenses - 26    
of the vehicle or necessary for its operation.
Definition: The intentional perversion of the truth for
H.  All Other Larceny - 23H    
the purpose of inducing another person or other entity
  Definition: All thefts which do not fit any of the
in reliance upon it to part with something of value or to
definitions of the specific subcategories of Larceny/
surrender a legal right.
Theft listed above.
A.   False Pretense/Swindle/Confidence Game - 26A    
  Definition: The intentional misrepresentation of
Motor Vehicle Theft - 240    
existing fact or condition, or the use of some
Definition: The theft of a motor vehicle.
other deceptive scheme or device, to obtain money,
goods, or other things of value.
Stolen Property Offenses - 280    
C.  Impersonation - 26C    
Definition: Receiving, buying, selling, possessing,
  Definition: Falsely representing one’s identity or
concealing, or transporting any property with the
position, and acting in the character or position thus knowledge that it has been unlawfully taken, as by
unlawfully assumed, to deceive others and thereburglary, embezzlement, fraud, larceny, robbery, etc.
by gain a profit or advantage, enjoy some right or
privilege, or subject another person or entity to an
Robbery - 120    
expense, charge, or liability which would not have
Definition: The taking, or attempting to take, anyotherwise been incurred.
thing of value under confrontational circumstances from
the control, custody, or care of another person by force
Larceny/Theft Offenses - 23    
or threat of force or violence and/or by putting the
Definition: The unlawful taking, carrying, leading,
victim in fear of immediate harm.
or riding away of property from the possession, or
constructive possession of another person.
Source: US Department of Justice Federal Bureau of
A.  Pocket-picking - 23A    
Investigation, Criminal Justice Information Services Division
  Definition: The theft of articles from another person’s
physical possession by stealth where the victim usually does not become immediately aware of the theft.

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Authors and Acknowledgements

Authors
Gwen Wilkinson
Tompkins County District Attorney
Lillian Fan
Assistant Director of Prevention Services –
Harm Reduction
Southern Tier AIDS Program

Acknowledgements
Mayor Myrick and co-chairs Lillian Fan and Gwen
Wilkinson give immense thanks to the countless service
agencies, organizations, stakeholders, officers, officials
and community members who generously offered their
time, perspectives and insights to this process. Over
350 Ithacans participated in meetings, consultations,
interviews, focus groups, phone calls, and each one of
them contributed immeasurably to the development
and release of the document you hold in your hands –
The Ithaca Plan.
While far too numerous to list, we would also like to
lift up the names of organizations that hosted meetings
and focus groups. Thank you to Cinemapolis, Southern

Tier AIDS Program, Cayuga Medical Center, Tompkins
County Chamber of Commerce, The Quaker House,
Tompkins County Public Library, Ithaca Community
Recovery, First Baptized Church of Jesus Christ, and
the Greater Ithaca Activities Center. We’d also like to
thank the Ithaca Police Department, Cayuga Addiction
Recovery Services, the Alcohol and Drug Council,
Ithaca City Treatment Court and Bangs Ambulance for
their generous provision of the data represented in the
contained graphs. Thank you to William J. Rusen who
served faithfully as the first chair of this process, his
direction and guidance helped lay the foundation.
Special thanks to Annie Sherman, upon whom this
process leaned heavily to convene dozens of meetings
wherein the ideas in this document emerged. For their
expert insight and assistance in strengthening the
document, we humbly thank Don MacPherson of
Canadian Drug Policy Coalition, Susan Shepard,
Manager of the Toronto Drug Strategy Secretariat,
Peter Schafer of the New York Academy of Medicine,
Daliah Heller of the City University of New York School
of Public Health, gabriel sayegh of the Katal Center for
Health, Equity, and Justice, and Julie Netherland,
Andrew Abundiz, Kristen Maye, and Kassandra
Frederique of the Drug Policy Alliance.