March 8, 2018

New York City’s Response to the Opioid Epidemic

Guest Contributor: Gail Goldstein

Every seven hours, someone dies of an overdose in New York City.
Over 80 percent of these overdoses involve an opioid. Like the rest of the country, NYC is in the midst of an opioid crisis. More New Yorkers die from overdose than homicides, motor vehicle crashes and suicides combined.
These statistics are even more heartbreaking because opioid-involved overdoses are preventable. Overdose is the top cause of preventable death for NYC residents aged 25 to 34.
Deaths from opioid overdose have steadily risen since 2010. From 2015 to 2016, overdose deaths in NYC jumped 47 percent, from 937 to 1,374. This dramatic increase was driven by the introduction of non-pharmaceutical fentanyl, an opioid 50 to 100 times more powerful than morphine, into the drug supply. Non-pharmaceutical fentanyl is produced in illicit laboratories and has been found in heroin, cocaine and illegally manufactured benzodiazepines (anti-anxiety pills) and opioid analgesics (painkillers).
By the end of 2016, nearly half of all overdose deaths involved fentanyl. When cut into other drugs, fentanyl is not detectable by sight, smell, or taste, which puts people at increased risk of overdose.
Originally fueled by increased prescribing of prescription opioid painkillers like Percocet and Oxycontin, many people who developed a problem with painkillers turned to heroin when they could no longer access a prescription.
Fentanyl increases the risk of overdose for both new and long-time users of heroin and other drugs. Lack of information and access to the most effective treatments for opioid addiction, namely the medications methadone and buprenorphine, is also driving this American epidemic. Additionally, America’s moralistic approach to drug use has stigmatized people who use drugs, preventing them from getting the help they need.
I work at the NYC Department of Health and Mental Hygiene. After years working on cardiovascular disease, obesity, and tobacco at the Department, I started working in the Bureau of Alcohol and Substance Use Prevention, Care, and Treatment a few years ago, just as addressing this crisis became a top priority for the City.
In March of 2017, Mayor Bill de Blasio launched HealingNYC, a $38 million campaign comprised of a variety of programs to expand access to effective treatment, provide overdose prevention to individuals at highest risk, educate clinicians to prevent problem use, and use new methods to reduce the supply of drugs.
The Department has committed to distributing 100,000 kits per year of naloxone, a medication that can reverse an opioid overdose and save a life. We also aim to connect an additional 20,000 New Yorkers to medications for addiction treatment, including methadone and buprenorphine. These medicines are used to stop cravings and allow people to get their life back, go back to work and rebuild personal relationships.
Methadone and buprenorphine are not only the most effective treatments for opioid addiction; they are also effective means of preventing overdose. The Department is also aiming to train an additional 1,000 health professionals to prescribe buprenorphine.
Additional education of clinicians focuses on promoting more judicious prescribing of painkillers, to use them only when needed, for a shorter period of time, and at the lowest effective dose.
Last year we started a new and innovative program in hospitals called Relay. Through Relay, we send wellness advocates to emergency rooms 24/7 to meet with people who have survived a drug overdose to offer health and overdose prevention services. Wellness advocates keep in touch with the patient for up to 90 days after the overdose.
The advocate is a peer – someone with lived experience with drug use – so the patient is more likely to engage with that person, and surviving an overdose offers a window of opportunity where the patient might be open to changing her or his behavior. Relay currently operates in four hospitals and will expand to 10 hospitals citywide.
It looks like NYC is on track to have roughly the same number of overdoses in 2017 as in 2016. We are a long way from success, but are confident we are on the right track to save lives and improve the health of people who use drugs in NYC.

Gail Goldstein works for the Bureau of Alcohol and Drug Use Prevention within the New York City Department of Health. She is currently the Director of Planning and Programs for the Bureau as is doing important work in order to stop the scourge that is the Opioid crisis.

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