When Quannacut Outpatient Services’ substance abuse treatment center was preparing to move into its new facility across Riverhead in July, a rumor quickly spread through patients that it may be closing. But that rumor was quickly replaced with the real news, which is quite good: Not only has the facility tripled in size in its new location, but it is now better able to accommodate its mission to treat not only substance abuse, but also mental and physical health needs that are often unavailable to people in substance abuse treatment.
Stony Brook Eastern Long Island Hospital and Quannacut held a ribbon-cutting celebrating the opening of the new 14,000-square-foot offices at 905 East Main Street in Riverhead on Nov. 20, and they’re planning to open another satellite outpatient center at 291 Hampton Road in Southampton this month, which will fill a gap in outpatient substance abuse treatment on the South Fork.
The expansion was made possible by a $1.6 million grant received in 2017 from the New York State Department of Health’s Statewide Health Care Facility Transformation Program. A goal of this program is to make it easier for people, especially those with Medicaid, to receive preventative medical services, in an effort to reduce emergency room visits for non-emergencies.
The new Quannacut outpatient center in Riverhead has three medical examination rooms, and is in the process of hiring medical staff under the guidance of Medical Director Dr. Jarid Pachter, said Quannacut Outpatient Services Director David Cohen on a mid-November tour of the facility. He said some of the top medical needs among patients there are infectious diseases, often related to substance use, and basic primary care needs, often longstanding chronic conditions that have gone untreated.
There’s a general rule of thumb, he said, that about 1/3 of people who visit the emergency room also have an untreated behavioral health need, while 1/3 of the people in Quannacut’s program also come in with untreated medical needs.
Stony Brook Eastern Long Island Hospital, which is in Greenport, opened Quannacut as an inpatient rehabilitation program in 1989, expanding with an outpatient program that moved from Mattituck to Harrison Avenue in Riverhead in 2001. Quannacut is a Native American word that means hope.
Mr. Cohen said that, when he arrived shortly after that, the outpatient program was seeing around 70 patients at a given time. Now, he said, they have about 300 active patients, and accept walk-in patients on Mondays and Fridays from 9 a.m. to noon.
This new integration of medical and psychiatric services builds on strengths already existing within ELIH and Stony Brook University Hospital.
ELIH has long had the only inpatient psychiatric facility on the East End, and the hospital’s recent affiliation with Stony Brook University Hospital, which has a psychiatric emergency room, is designed to integrate mental health and substance abuse treatment throughout the continuum of care.
This is a sea change for health care, where traditionally medical, psychiatric and substance abuse professionals had worked in separate silos. Mr. Cohen said some medical and substance abuse practices “don’t want to deal with people with certain mental health issues or medications,” he said, in part become some psychiatric medications are addictive.
“We’re experts here on co-occurring conditions,” he said. “Our staff is heavily trained. Not one thing works best for each individual.”
Dr. Richard Rosenthal, director of the Division of Addiction Psychiatry at Stony Brook University, said the addition of Quannacut’s services to the Stony Brook network “is part of a larger endeavor integrating addiction, mental health and primary care.”
“Substance use disorders are classified as psychiatric disorders, but they are overseen by different regulatory agencies,” said Dr. Rosenthal. “The truth is a continuum is the rule rather than the exclusion.”
Dr. Rosenthal added that, as part of this integration of care, the Stony Brook University Hospital network is training doctors to administer buprenorphine shots in the emergency rooms in Southampton and Greenport.
Buprenorphine has not gotten as much public attention as naloxone, better known as Narcan, an immediate opioid antidote carried by first responders to revive people from opioid overdoses. But once they survive an overdose, opioid users who want to quit will need a way to manage their withdrawal symptoms. That’s where buprenorphine, a medically administered opioid used to treat withdrawal, comes in.
Dr. Rosenthal said Dr. Kenneth Kaushansky, the dean of the University’s Renaissance School of Medicine, has fully backed training Stony Brook doctors to administer buprenorphine, which has historically had a difficult time gaining traction with medical doctors.
“To prescribe buprenorphine, you need to be trained, and it’s substantive training,” said Dr. Rosenthal. “Patients come in and agree to go into treatment, they’re given a couple doses, which they complete at home, and they get a referral and connection to outpatient treatment. They may need to stay overnight.”
“It’s very safe, and it’s really no big deal,” he said, adding that 130 Stony Brook doctors have been trained to administer buprenorphine. “The patient feels better. It protects them from the nods and it medically stabilizes them. It’s a lifesaver.”
Dr. Rosenthal added that the way doctors are trained also plays a role in alleviating the opioid crisis.
“We’re training doctors differently regarding pain,” he said. “That’s a big, big shift in terms of what we were doing even five years ago.”
Even primary care doctors operating in practices affiliated with Stony Brook are now giving patients screening questionnaires for substance abuse and mental health issues as soon as they walk in for routine medical appointments.
“Doctors are practical people. They believe the same thing regular people do,” said Dr. Rosenthal. “There’s a culture change. We want to know if people are thinking of self-harm. We need to do a better job helping people when they feel desperate and hopeless.”
Despite the major leap the new facility is bringing to Quannacut, the staff there aren’t resting on their laurels. They are currently working on an adolescent program, and they run two sober houses within 15 minutes of the Riverhead center.
But those houses, which have just 18 beds, all for male residents, are just a drop in the bucket compared with the need. Quannacut would ultimately like to add a female sober house as well.
“Housing is the number one thing that undermines treatment,” said Mr. Cohen. “A lot of people we see are one step away from homelessness. Our houses are always filled, and there’s always a waiting list.”