Action Step 2

Action Step 2:

Invest in innovative strategies for an evolving epidemic: The new challenges of fentanyl bring a renewed urgency to not only intensifying and scaling up existing approaches, but embracing new, evidence-based interventions to save lives.

New York must move beyond addressing the symptoms and acute manifestations of the overdose epidemic and tackle five key drivers of vulnerability: inadequate treatment, criminal justice involvement, housing instability, heightened risk among overdose survivors, and unobserved overdoses. Neglecting these core factors has fueled New York’s crisis and left our communities ill-equipped to manage the threat of more potent opioids. New York’s continued leadership – and our ability to make an impact on the overdose epidemic – requires taking bold new steps to save lives.

 

Rapidly scale up low-threshold buprenorphine in jails and prisons, emergency departments, and harm reduction programs: Broader availability of buprenorphine at critical points of contact will be essential to ending overdose in New York. So far, New York’s efforts to broaden access to buprenorphine have largely focused on primary care settings. However, many New Yorkers at risk of overdose do not have stable access to health care. Innovative strategies to link more people to buprenorphine must include expansion to settings that have high rates of contact with people at heightened risk of overdose: jails and prisons, emergency departments, and harm reduction programs. Correctional settings are particularly critical opportunities for reducing overdose risk through buprenorphine. People newly released from prison are at 4.6 times higher risk of drug related death than the general population. New York State has yet to fully embrace in-prison opioid agonist treatment: only two New York jails offer methadone and buprenorphine, and only five facilities provide naloxone training and distribute kits to reentrants, despite recommendations in the Ending the AIDS Epidemic report to expand opioid agonist treatment in correctional settings. More than 80 percent of people in New York’s state prisons are in need of substance abuse treatment, and about 10 percent are heroin users.

 

Expand pre-arrest diversion programs: There is a growing recognition nationally that arrests and incarceration do nothing to end the overdose crisis, nor do they help people struggling with substance use disorders. In fact, contact with the criminal justice system can exacerbate the struggles of people with opioid use disorders to find a path toward health and recovery. Given dramatically higher rates of overdose following even brief periods of incarceration, it is critical to reduce overreliance on arrest and provide meaningful pre-arrest diversion opportunities. A growing movement in New York and around the country has developed effective pre-arrest diversion models that link people to life-saving case management and support through harm reduction programs, including Law Enforcement-Assisted Diversion (LEAD). These promising strategies are in urgent need of replication and scale-up to benefit all New Yorkers at risk of overdose that come into contact with law enforcement.

 

Supportive housing and housing first approach: We support the statewide campaign for the creation of 20,000 units of supportive housing. People in crisis must be able to access such housing immediately. Housing is a critical support for people in recovery. Housing First models provide effective ways to link people struggling with opioid use to supportive housing, reducing their risk of fatal overdose. While New York’s housing crisis extends beyond people at risk of overdose, our efforts to end overdose will require emphasis on affordable, permanent housing.

 

Post-overdose support: One of the greatest predictors of subsequent overdose is a history of prior overdose. Unfortunately, too many New Yorkers that survive an opioid overdose do not receive follow-up counseling nor linkage to support services. People who received naloxone from emergency services during an overdose had a 1 in 10 chance of surviving the year, according to a national study. New models to ensure that overdose survivors receive harm reduction counseling and recovery support are springing up around the country, and must be replicated and scaled up to protect the New Yorkers most vulnerable to fatal overdose.

 

Safer consumption spaces: Overdose mortality data from New York City and elsewhere indicates that one of the greatest predictors of death is unobserved overdoses – overdosing in a private or public space where no witness is present and able to provide critical aid in time. Safer consumption spaces have emerged as a compelling option to increase the likelihood that overdose events are witnessed and promptly responded to by trained observers. Substantial research has demonstrated the broad public health and public safety benefits of these services, and several states and cities are moving toward implementation. New York should be a national leader on safer consumption spaces.

 

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