Combating city’s opioid crisis

Naloxone, a drug that can reverse an opioid overdose, is now available free of charge through many community-based health organizations and without a prescription at major chain pharmacies in New York City. Photo: Jeff Anderson, via Flickr
Officials hope data-driven approach will reduce overdose deaths

There were 1,374 drug overdose deaths in New York City last year, over 80 percent of which involved an opioid. And NYPD officials said during City Council testimony earlier this year that preliminary data for the first quarter of 2017 showed opioid-related deaths outpacing last year’s record-high rate.

Fatalities stemming from the use of heroin, fentanyl and prescription pain medications have skyrocketed in recent years, a trend that has proven stubbornly persistent. Since 2010, the city has seen a 143 percent increase in the rate of overdose deaths. In Manhattan, 244 residents died of overdoses in 2016, up 50 percent over the previous year — the largest increase of any borough.

“It started with the over-prescription of opioid pills,” said Chauncey Parker, executive assistant district attorney for the Manhattan District Attorney’s Office. “That then expanded into a heroin market where dealers started to provide high purity heroin cheaper than pills so that people addicted to opiates switched over to heroin and the user base expanded. The latest trend is that they’re cutting it with fentanyl.”

Fentanyl, a synthetic opioid 50 to 100 times more powerful than morphine, is chief among the drivers of the spike in overdose deaths in the last two years, experts say. Fentanyl is significantly more potent than heroin and prescription opioids, but also significantly less expensive —about one-tenth the cost of heroin on the wholesale market. A flood of black market fentanyl produced in China and Mexico has created an economic motive for distributors to mix the product with heroin to increase profit margins. Users are often unaware that they have purchased heroin laced with fentanyl and, without knowing that they are using a vastly more potent drug, the potential for overdoses skyrockets.

The fentanyl problem is a relatively recent development. Before 2015, fentanyl was generally involved in less than 3 percent of overdose deaths in New York City. In 2015, that figure increased to 16 percent. By 2016, 44 percent of all overdose deaths in the city involved fentanyl.

Fentanyl is most commonly mixed with heroin, but it is also sold in pure form and is increasingly mixed with cocaine or counterfeit prescription pills. Last year, 35 non-heroin overdose deaths in Manhattan involved fentanyl and cocaine, and fentanyl was involved in 37 percent of overdose deaths citywide involving cocaine but not heroin.

New York City has emphasized data collection and analysis in its efforts to combat the opioid crisis. In 2012, the city launched RxStat, a data-focused interdisciplinary initiative to develop comprehensive strategies for reducing overdose deaths. Based on the model of the NYPD’s CompStat crime data collection program, RxStat brings together officials from the public health and public safety realms to present and analyze the latest records on relevant data points such as overdose deaths, emergency room admissions, treatment center intake, dispensed prescriptions and drug-related prosecutions.

At monthly meetings, representatives of over 20 agencies — including the city Department of Health and Mental Hygiene, city police, district attorneys’ offices and the Office of the Chief Medical Examiner — meet to review the most recent available data from an array of local, state and federal government sources.

“New York City has the most timely analysis of overdose data of anywhere in the country,” said Parker, who is also director of the NY/NJ High-Intensity Drug Trafficking Area. “In some places, people are still looking at 2015 data, whereas New York City is probably just about done with data for the second quarter of 2017.”

“That timely data becomes absolutely critical, because you can then map and see who’s dying, where are they dying, are they dying from sniffing or shooting the drug,” he added. “If you’re answering those questions with data from a year and a half ago, you’re really handicapped.”

Despite this concerted multiagency push, overdose deaths in New York City rose for the sixth consecutive year in 2016. In March, Mayor Bill de Blasio announced an initiative to reduce overdose deaths by 35 percent over the next five years. The mayor’s plan calls for the city to spend $38 million annually to expand access to addiction treatment, invest in laboratory testing and information sharing, and fund dedicated opioid units within the NYPD to disrupt supply chains.

The city has been aggressive in its distribution of naloxone, a drug that can reduce the effects of an opioid overdose. Naloxone is now available free of charge through many community-based health organizations and without a prescription at major chain pharmacies in New York City. Under a new program announced August 7, individuals with prescription health insurance, including Medicaid and Medicare, can receive co-payment assistance to purchase the drug at pharmacies in New York state. Soon, all NYPD officers and all court officers in New York State will be equipped with naloxone and trained in its use.

Without the broad availability of Naloxone, experts say, overdose rates would be even higher. In Manhattan, EMS alone reported administering the drug nearly 2,000 times in 2016, according to state records.