The “Epidemic Within the Pandemic”: New York’s Overdose Crisis

While doing errands this weekend, I came across a man passed out in an ATM vestibule. He seemed to be actively overdosing. I checked his breathing, which was faint; he was conscious, but only barely. I called emergency services and paramedics quickly arrived at the scene. I haven’t been able to quite shake him from my mind: is he ok? Is he alive?

This was not the first time I’ve encountered such a situation; scenes like this play out every day in New York. It’s only gotten worse during the COVID-19 pandemic. A researcher at Northwestern University has dubbed the surge in opioid overdoses “the epidemic within the pandemic.”

The latest New York State data on opioid-related overdoses are out and they’ve never been worse. Nearly 5,000 New Yorkers died of an opioid-related overdose in 2021 — a 14% increase over the prior year and the highest number on record. More than half of those deaths were in New York City, with local data showing the highest rates of overdose in the Bronx, among Black New Yorkers, and among residents ages 55–64. And fentanyl is a growing problem across the board; more than 80% of overdoses statewide involved fentanyl, and emergency departments statewide saw a 30% increase in opioid overdoses other than heroin between 2020 and 2021. I’m not being melodramatic when I say these numbers are a five-alarm fire for public health.

It’s especially frustrating that the scourge of the opioid epidemic is raging despite numerous efforts — both traditional and out-of-the-box — by the City and the State to turn the tide. Here are just a few examples:

• In New York City, bars and nightclubs are receiving supplies of Narcan, along with training for employees who may need to administer it. The Mayor’s Office of Nightlife has distributed more than 12,000 kits through its “Narcan Behind Every Bar” campaign.
• The MATTERS Network, initially established in Buffalo, works with hospitals, primary care offices, correctional facilities, first responders, and telemedicine services to link patients with community-based treatment services. It offers clients transportation support and medication vouchers and distributes supplies like Narcan and fentanyl test strips. With support from State, local, and federal funding, the network now operates statewide and includes more than 135 referral sites, 1,000 pharmacies, and 190 treatment organizations.
• The New York State Department of Health supports more than 900 Opioid Overdose Prevention Programs, which provide training to community members in recognizing and responding to overdoses.
• Last month, Governor Hochul announced the availability of up to $7.5 million in grants for as many as 15 opioid use treatment programs across the State.

I applaud all of these efforts. And I shudder to think where our overdose numbers would be without them. And yet, all of the resources and services in place haven’t been enough; overdose numbers are still going up. What more can be done?

I’ve written before about New York’s first-in-the-nation overdose prevention centers (OPCs) and the life-saving work they do. OPCs are clinical, safe, hygienic spaces where people can use drugs under the supervision of trained professionals to prevent deaths and get connected to care and drug treatment. They are co-located in existing needle exchange programs and provide medical and social services like free meals, counseling services, and showers. In their first 12 months of operation, the two centers — in East Harlem and Washington Heights — were used more than 45,000 times by more than 2,000 participants. In that time, they prevented more than 600 potentially fatal overdoses.

When I visited one of the centers late last year, the compassion, skill, and professionalism on display were impressive. I’m incredibly proud that the New York Health Foundation is an early funder of OnPoint’s life-saving work. Other philanthropic colleagues like the New York Community Trust are also providing financial support. But private philanthropy alone isn’t sufficient.

The real key to sustaining and growing the operations of overdose prevention centers is decisive action by the U.S. Department of Justice, which would free up significant public dollars. The DOJ has been expected to drop its opposition to OPCs, but it has repeatedly delayed its decision. These delays have left OnPoint and others who are poised to establish OPCs in New York and across the country in limbo; without the DOJ ruling, most legal experts agree that opioid settlement dollars and other funds can’t flow to these centers.

We must use every tool at our disposal to address the overdose epidemic. I’ve said before that crises require courage, and it’s critical that we embrace that idea. From everyday New Yorkers looking out for their neighbors and getting them help, to using opioid settlement funds wisely, to eliminating the bureaucratic hurdles that have blocked the proliferation of OPCs — there’s much more work to be done if we’re serious about saving lives. The fire is burning out of control; we can’t let it do any more damage.