Jose Cinteno, 68, of Monticello, reflected on his time as an active user of heroin.

"I was stealing and robbing people," he explained as he settled into his seat at a pizza shop near downtown. "It was stuff like that. It got crazy."

Cinteno said he got sober from heroin in the 1970s, a time when medication assisted treatment (MAT) was unheard of, and addiction was not widely viewed as a medical condition. He is pleased to hear these measures -- deemed controversial in many communities -- are being instituted in Sullivan County.

"It's just like any other thing you treat," Cinteno emphatically said. "Cancer, or whatever. It's a disease."

That is the same approach that Sullivan County Health and Family Services Commissioner Joseph Todora factors into every drug policy decision he makes. Todora said that in recent years, residents of Sullivan County have warmed up to evidence-based policies that might have seemed counter-intuitive before.

"The issue around addiction has always been a huge issue," Todora said. "It's just now [though] that people are recognizing it."

Todora has been hard at work securing grants and setting a timeline for rollouts of new programs aimed at curbing, preventing and treating "the disease of addiction." He is planning a telemedicine program to get care and needed prescriptions for addicts in rural areas.

He has already helped equip all police in the county with narcan (naloxone), which has also come to be called the "overdose reversal" drug. Todora said the county is also planning to begin a diversion program, by which some low-level offenders would get chances to go to a resource center for help, instead of going to a jail for punishment.

"If you're an addict or if you're somebody who's troubled and you need help, stop in, and we'll have somebody there who will be able to help engage you in those services and educational information that may help you with that trouble that you're dealing with," Todora said. "We'd like to have it open by next year."

Sullivan County may be almost dead last in an annual report detailing health rankings county-by-county across the state (Sullivan is again ranked 61st of 62 counties),  but leaders here say they've made progress in key areas that determine quality and length of life. These include smoking, obesity and drug policy -- which Cinteno hopes they build on with full cooperation from the legal system.

"They should institute more programs," Cinteno said, "and judges should be more lenient."

Sullivan County avoided last place this year, as the Bronx came in last. The healthier counties include some in the Hudson Valley and the Capital Region. Saratoga County came in near the top.