How$to$End$the$Drug$Overdose$$

Epidemic$in$New$York$
$
!
New!York!has!a!drug!overdose!crisis."Now"the"leading"cause"of"accidental"death"in"the"state,"
overdose"death"rates"have"soared"alongside"increasing"prescription"opioid"use"and"as"people"
transition"from"pills"to"heroin."Heroin:related"deaths"have"increased"by"70%"in"New"York"City"in"the"
past"two"years,"and"cocaine"poisoning"continues"to"be"involved"in"about"half"of"deaths."We"have"many"
tools"at"our"disposal"to"reduce"the"harms"and"death"associated"with"drugs,"but"unfortunately,"the"bulk"
of"resources"are"given"over"to"law"enforcement,"the"legacy"of"a"failed,"40"year"war"on"drugs"approach."
"
It!doesnt!need!to!be!this!way."People"will"continue"to"use"drugs."What"New"York"needs"are"drug"
policies"based"on"public"health"and"scientific"evidence."We"need"a"concerted"effort"to"promote"the"
health,"wellbeing,"and"safety"of"communities,"not"a"foolhardy"quest"to"eliminate"drugs"from"society"
that"perversely"leads"to"more"people"dying"from"overdose,"becoming"infected"with"HIV"or"viral"
hepatitis,"or"being"incarcerated"to"no"public"good."
"
New!York!already!has!the!tools!and!know:how!to!greatly!reduce!overdose!deaths."We"only"need"
the"political"will."The"following"approaches"to"prevent"overdose"deaths"value"health"over"punishment"
and"are"based"on"decades"of"experience"and"public"health"research."
"

Solutions!

(1)!Make!it!easier!for!people!in!need!to!access!the!opioid!overdose!antidote!naloxone!
and!get!first!aid!training.""
Community:based"programs"have"distributed"naloxone""a"safe,"effective,"easy:to:administer"antidote"
"to"people"likely"to"witness"an"overdose"for"10"years."Such"programs"are"associated"with"up"to"50%"
reduction"in"heroin"overdose"mortality."But"despite"important"support"from"our"public"health"
authorities,"overdose"prevention"services"remain"few"and"far"between"in"much"of"the"state."New"York"
can"take"immediate"steps"to"fix"this"through"the"following"policy"changes:"
"
Allow!non:patient!specific!naloxone!prescribing"so"that"designated"health"professionals""
like"community"outreach"staff""can"not"only"train"people"in"need"but"dispense"naloxone"
without"a"prescribing"physician"present."A"bill"to"do"just"that,"sponsored"by"Assemblyman"Jeff"
Dinowitz"(D:Bronx)"and"Senator"Kemp"Hannon"(R:Nassau),"is"now"before"the"state"legislature."
Provide!dedicated!funding."Existing"programs"supported"by"the"NYS"and"NYC"departments"of"
health"are"cobbled"together"as"best"they"can,"with"barely"enough"to"cover"the"modest"cost"of"
the"medication"and"little"left"over"to"pay"prescribers"or"other"professionals."This"is"an"
especially"acute"problem"in"many"largely"underserved"communities"Upstate"and"on"Long"
Island."
Allow!pharmacists!to!dispense!naloxone"to"eligible"individuals"without"a"prior"prescription,"
much"as"they"do"with"flu"vaccine."
Increase!naloxone!distribution!in!other!settings,"including"by"building"on"successful"police"
EMT"pilot"programs,"improving"access"through"drug"treatment"and"homeless"services"
agencies,"prescribing"take:home"naloxone"to"anyone"treated"for"opioid"overdose"in"an"
emergency"department,"and"giving"naloxone"to"eligible"individuals"upon"release"from"jail"or"
prison."

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Expand!911!Good!Samaritan!protections"to"ensure"that"no"one"loses"public"benefits"because"
they"tried"to"save"someones"life."
Improve!insurance!coverage."As"of"January"1,"2014,"NYS"Medicaid"covers"the"naloxone"
formulation"used"for"intramuscular"injection."Medicaid"should"also"cover"the"nasal"spray"
formulation,"and"the"state"should"extend"coverage"to"other"public"insurance"programs"such"as"
Medicare"and"ADAP"and"encourage"private"insurance"coverage."

"

(2)!Make!high:quality,!evidence:based!drug!treatment!available!to!everyone.""
It"is"common"for"people"living"with"drug"dependency"to"relapse"after"treatment,"and"many"people"find"
better"results"in"one"kind"of"treatment"versus"another."Though"New"York"has"a"substantial"drug"
treatment"infrastructure,"too"often"artificial"barriers"prevent"people"from"accessing"the"best"kind"of"
treatment"for"them."New"York"should"move"to"end"waiting"lists"for"treatment,"eliminate"insurance"
coverage"barriers,"and"ensure"that"improvements"in"health"and"wellbeing""not"merely"abstinence""
are"seen"as"valid"and"important"goals"of"treatment.""
"

(3)!Opioid!agonist!maintenance!therapy!with!methadone!or!buprenorphine!is!the!gold!
standard!for!opioid!dependence!treatment!and!must!be!fully!supported!as!such.""
Maintenance"therapies"immediately"reduce"overdose"risk,"as"well"as"help"reduce"or"eliminate"injecting"
and"drug"use"overall,"especially"the"longer"people"remain"in"treatment."New"York"should"promote"
much"greater"access"to"buprenorphine."While"highly"restrictive"policies"burdening"methadone"patients"
are"primarily"set"at"the"federal"level,"New"York"should"ensure"that"clinics"are"not"instituting"additional"
policies"that"undercut"patient"wellbeing,"such"as"limiting"take:home"dosing"or"hours"of"operation."In"
addition"to"community:based"maintenance"programs,"New"Yorks"prison"and"jail"systems"should"
immediate"adopt"such"services,"as"has"been"done"at"Rikers"Island"and"a"small"number"of"other"
facilities."
"

(4)"Safe!injection!facilities!(SIFs)!prevent!overdose!deaths,!as!well!as!reduce!disease!
transmission!and!improve!public!order.""
SIFs"offer"an"environment"monitored"by"medical"staff"where"people"can"inject"drugs"hygienically"and"
without"fear"of"dying"from"overdose."SIFs"exist"in"a"number"of"countries,"and"have"been"rigorously"
evaluated."Vancouver,"Canadas"Insite"program,"for"example,"has"never"had"an"overdose"death,"has"
reduced"overdose"mortality"in"the"community,"reduced"public"drug"use"and"increased"public"order,"
and"increased"the"number"of"people"entering"drug"treatment"by"providing"direct"linkages."New"York"
would"greatly"benefit"from"SIFs,"especially"as"a"means"of"supporting"the"health"and"safety"of"homeless"
people"who"use"drugs.""
"

(5)!Pay!attention!to!cocaine.""
Cocaine"poisoning"prevention,"which"cannot"be"reversed"by"a"medication"like"naloxone,"has"received"
relatively"little"attention"despite"killing"a"significant"number"of"New"Yorkers,"and"more"Americans"
than"heroin."Public"health"authorities"should"devote"appropriate"resources"to"research"and"program"
development"in"order"to"identify"at:risk"individuals"and"link"them"with"services"including"
cardiovascular,"mental"health,"and"primary"care,"harm"reduction,"and"drug"treatment."
"

(6)!The!relationship!of!criminal!justice!to!drug!use!needs!to!change.""
Police"and"the"courts"have"an"important"role"in"combatting"major"crime,"and"in"many"ways"can"be"
supportive"toward"public"health,"as"we"have"recently"seen"in"the"case"of"Staten"Island"police"carrying"
naloxone."But"too"often"New"Yorks"criminal"policies"emphasize"punishing"people"for"drug"dependency"
or"even"actively"interfere"with"public"health"or"drug"treatment.""New"York"should:"
"
Decriminalize!simple!drug!possession,"as"has"been"done"in"several"countries"and"many"
other"jurisdictions,"with"consistently"positive"results"in"terms"of"improving"health"and"allowing"
law"enforcement"to"concentrate"on"serious"crimes."Pre:arrest"diversion"initiatives,"such"as"

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Seattles"innovative"Law"Enforcement"Assisted"Diversion"(LEAD)"program,"are"an"important"
means"by"which"police"can"directly"support"public"health"while"reducing"crime."
Stop!courts!from!interfering!in!medical!decisions."Some"New"York"drug"court"judges"
routinely"require"individuals"to"cease"treatment"with"methadone"or"buprenorphine,"
contravening"medical"judgment"and"putting"people"at"greater"risk"of"overdose"and"other"health"
repercussions."Judges"should"receive"education"on"drug"treatment"and"harm"reduction"and"
should"defer"to"doctors"and"patients"when"it"comes"to"choosing"the"right"course"of"treatment.""
End!police!interference!with!drug!user!health!initiatives."Harassment"of"individuals"for"
participation"in"syringe"exchange"programs"and"arrests"for"possession"of"public"health"supplies"
like"condoms"and"syringes"drives"people"away"from"help,"undermining"public"health"efforts"
and"increasing"overdose"risk."

"

(7)!Strengthen!surveillance!and!use!data!for!overdose!prevention.""
Great"strides"have"been"made,"especially"in"New"York"City,"in"improving"overdose"data"collection"and"
using"it"in"targeted"prevention"programs."Public"health"authorities"should"expand"such"work"statewide"
and"more"aggressively"communicate"information"on"overdose"and"drug"use"trends"to"community:
based"organizations,"healthcare"providers,"and"the"public."In"addition,"recently"established"
Prescription"Monitoring"Programs"such"as"I:STOP"and"RxStat"should"incorporate"overdose"prevention"
interventions,"including"by"building"in"systems"to"encourage"doctors"to"co:prescribe"naloxone"to"at:
risk"individuals."
"

(8)!Create!a!New!York!City!Office!for!Drug!Policy.!!

Overdose"prevention""as"well"as"a"host"of"other"policies"affecting"drug"user"health""relate"to"many"
parts"of"government,"from"the"departments"of"Health,"Homeless"Services,"to"the"NYPD,"the"NYC"
Housing"Authority,"the"Human"Resources"Administration,"and"others."A"citywide"drug"policy"office"is"
the"best"way"to"coordinate"between"the"myriad"agencies"to"ensure"that"public"health"oriented"drug"
policies"are"consistently"put"into"practice."
!

(9)!Take!drug!use!and!dependency!out!of!the!shadows.""

Stigma"and"discrimination"against"people"who"use"drugs"perpetuates"shame"and"maximizes"the"
potential"harms"of"drug"use."We"need"forceful"leadership"from"elected"officials,"other"prominent"
individuals,"organizations,"families,"and"people"who"use"drugs"themselves"to"challenge"the"
demonization"of"people"who"use"drugs."After"40"years"of"destructive"drug"war"policies,"it"will"be"an"
uphill"fight"to"reorient"people"and"institutions,"but"the"time"has"come"to"build"rational"drug"policies"
that"affirm"life"and"dignity"in"our"communities."
"
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VOCAL$New$York$builds'power'among'low1income'people'affected'by'HIV/AIDS,'mass'
incarceration'and'the'war'on'drugs'in'order'to'create'healthy'and'just'communities.'Through'base'
building,'leadership'development,'participatory'research,'civic'engagement'and'direct'action,'we'
ensure'that'those'who'are'directly'affected'by'these'issues'have'a'say'in'programs'and'policies'
that'affect'their'lives."

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Find$us$at'www.vocal1ny.org'|'facebook.com/vocalny'|'@VOCALNewYork"
80A'Fourth'Ave,'Brooklyn,'NY'11217"

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For$more$information,$contact"
Matt'Curtis,'Policy'Director"
Tel:'(direct)'646123419062,'(office)'718180219540"
Email:'matt@vocal1ny.org"
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