Although one of the states hardest hit by the opioid crisis, New York may soon see some marked improvements — thanks largely to recent preventive, compassionate policies that focus on rehabilitation over punitive measures.
New York’s Opioid Crisis
Throughout the northeast, opioid use has moved away from the prescription opioids that have been attributed with starting the epidemic towards cheaper — and often more dangerous — illicit opioids, including heroin. With much of the state’s early efforts to combat the problem going towards curtailing improper prescribing practices, prescription opioid use is on the decline. Between 2010 and 2014, 4% fewer patients seeking addiction treatment reported prescription opioids as their primary drug and 13.6% fewer reported daily use. However, the epidemic as a whole is far from facing a decline, as many of those still addicted look to other sources. This past August, the NY State Office of Alcoholism and Substance Abuse Services (OASAS) issued a “Fentanyl Alert,” stating that NY’s opioid crisis is worsening with the increased presence of illicit (rather than diverted) fentanyl on the drug market.
Public Health Costs
In addition to the toll of human suffering, the opioid epidemic continues to be a major drain on the NY economy. Annual NY State health expenditures related to opioids has reached $1.2 billion. Prescriptions for buprenorphine — an opioid often used in recovery treatment — alone rose by 58% between 2010 and 2014. However, while approximately 1.4 million New Yorkers suffer from a substance use disorder, only 107,300 received treatment for opioid use disorder in 2015.
Emergency Services Utilization
Across the state, opioid-related emergency department visits increased by 73% between 2010 and 2014. Additionally, the opioid antagonist and potent overdose treatment drug naloxone was administered during 57% more EMS calls in 2014 compared to 2013 (23). While some of this rise can be attributed to better access to care, these numbers still paint a worrying picture.
Overdose Deaths in New York
The number of opioid-related deaths in NY doubled between 2010 and 2015 and heroin-related deaths specifically increased five times over. Similarly, in 2009 heroin was involved in just 16% of drug-related deaths but had risen to 29% by 2013. More troubling is that these trends continue: the state experienced 2,028 reported drug overdose deaths in 2014, a significant rise from 1,601 in 2013. Additionally, heroin and other opioids have become the leading cause of accidental death in the state, with heroin in particular killing roughly two New Yorkers each day.
While in many ways the NY opioid epidemic typifies the national experience, in some ways it also displays some interesting trends.
Although there has been an emphasis on the impact of opioid addiction on young adults, the epidemic’s victims may skew even younger in NY than in other heavily affected states. Those under 35 have made up half of all NY heroin fatalities over the past few years. According to data collected by the Youth Risk Behavior Surveillance System, 1.6% of NY high school students surveyed reported having used a needle to inject an illegal drug in 2010 — a figure more than doubling 2015. Illicit drug dependence data also suggest the problem is most common among young adults ages 18–25 at prevalence of more than twice that of adjacent age cohorts. Those under age 40 also made up 64% of opioid treatment admissions in 2010 through 2014. 39% of those admitted were between the ages of 20–29, a 49% increase in this age group since 2010.
Additionally, while New York City is seeing the highest death rates among residents 35 to 54, this group is traditionally the most vulnerable to opioid-related mortality — it was the 15 to 34 age bracket that saw the biggest increase in death rates between 2010 and 2015.
in 2013, Whites died of heroin overdose at nearly twice the rate of Black New Yorkers and 35% more than Hispanics. However, some officials have suggested this discrepancy may be due in part to improper and imprecise reporting methods. Among Hispanic high school students, reported injected-drug use peaked at an alarming 8.3% in 2009 before going down. Today, use in this age group is relatively even between races and ethnicities.
In NYC specifically, Latino residents experienced the largest increase in unintentional overdose deaths. In contrast, there was a modest decrease in heroin-associated unintentional overdose death rates among Black residents of NYC between 2005 and 2015. As a result, the death rates among Whites and Latinos have both reached roughly twice as high.
In 2013, nearly four times as many men died from heroin-related overdoses as did women. However, injected drug use among male and female high school students has followed roughly the same trends in recent years. While young men are still significantly more likely to have tried injected drugs, that gap may be closing: 0.7% of female high schoolers to 2.5% of men in 2005 rose to 2.2% and 4.4% respectively in 2015.
Both general opioid-related and heroin-related death rates are increasing at a higher pace outside NYC. Between 2005 and 2014, hospitals in upstate NY saw a 115% increase in opioid-related admissions. Also in upstate NY, there has been a 222% increase in admissions to OASAS-certified treatment programs among residents 18 to 24. Likewise, Long Island also experienced a 242 percent increase among the same demographic.
In NYC, 80% of unintentional overdose deaths involved an opioid. In 2015, the Bronx and Staten Island had the highest opioid-related death rates out of the boroughs. However, residents in the Bronx were dying of fentanyl at roughly twice the rate. There was also a dramatic 46 percent jump in opioid deaths in the Bronx between 2015 and 2016.
Over the last few years, NY has implemented a number of policies including:
- Limits on opioid prescriptions for acute pain to 7 days, down from 30.
- Expanded insurance coverage for substance use disorder treatment.
- A ban on prior authorization requirements for emergency supplies of addiction treatment drugs and for the first 14 days of inpatient treatment, ensuring immediate access.
- The Community Overdose Prevention (COP) program, which give law enforcement agencies funding for naloxone kits, as well as overdose response training for police officers and firefighters.
- The Prescription Drug Reform Act in 2012, also known as the I-STOP law, which established an electronic prescription drug monitoring program.
While NY has shown strong state-level support, work has been largely delegated to experts at the city and county levels.
This past March, NYC Mayor de Blasio committed $38 million in annual funding to programs with the aim of reducing opioid deaths by 35% over the next five years. In general, the city has been tackling the opioid crisis with a mix of prevention — via education, accessible counseling, awareness campaigns, and public health surveillance — and treatment.
Albany has also taken the “LEAD” through the Law Enforcement Assisted Diversion program. Through this formal, coordinated approach to public health policy, law enforcement divert individuals directly to case managers who can facilitate their access to a comprehensive network of services for drug addiction, alcoholism, mental illness, and other health-related issues. The program’s goal is to allow drug users to treat both their addiction and any underlying mental or physical illnesses that caused them to begin using in the first place. Staten Island, Brooklyn, Buffalo, Ithaca, Orange County, Rochester, and Essex County are also considering adopting LEAD or similar policies.
Plans for Fiscal Year 2018
In his 2017 State of the State, Governor Cuomo outlined a plan that included: expanded the use of I-STOP in emergency rooms, eliminating barriers to care for both inpatient and outpatient addiction recovery, and supporting “recovery high schools” that help youth to continue their education and maintain sobriety.
Earlier this April, Cuomo enacted some of these measures by signing legislation for a FY 2018 Budget that will invest $213 million to fighting epidemic, an overall increase of over 100% since 2011. Its provisions include:
- $145 million for community-based providers, such as funds for 8,000 additional residential treatment beds, housing units, outpatient services, crisis/detox programs, and other opioid treatment programs.
- $27 million for state-operated addiction treatment centers.
- $6 million for naloxone kits and training.
- $25 million for expanded support programs, including peer engagement, family support navigators, adolescent clubhouses, and 24/7 urgent access centers.
Throughout most NY anti-opioid programs, a major thrust has been in educating individuals — first responders, health workers, loved ones, and bystanders — to recognize and properly handle cases of overdose while also providing the tools to do so. Overdose prevention training programs registered with the New York State Department of Health (NYSDOH) have trained more than 75,000 responders and have documented over 1,800 cases of overdose reversal. Additionally, more than 1,800 NY pharmacies offer naloxone without a prescription, with locations listed on a public online directory maintained by NYSDOH.
The 911 Good Samaritan Law, which went into effect September 2011, gives special legal protections in cases of overdose to both the person seeking assistance and the person in need. Since then, additional legislation has extended these protections to those administering any emergency treatment.
While these comprehensive strategies are sound, significant changes are unlikely to be immediately measurable. After all, most of the information used to evaluate opioid usage trends is based on lagging indicators — data points that are not typically captured until years after an individual begins using, such as overdose deaths, emergency admissions, and treatment program enrollment.