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.

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

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.

VOCAL New York builds power among low-income 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.

Find us at www.vocal-ny.org | facebook.com/vocalny | @VOCALNewYork

80A Fourth Ave, Brooklyn, NY 11217

For more information, contact

Matt Curtis, Policy Director
Tel: (direct) 646-234-9062, (office) 718-802-9540
Email: matt@vocal-ny.org