Put harm reduction first, New York
If more than 107,000 lives were lost in one year due to a single cause — say, toxic waste in a town’s water supply — it wouldn’t just be a tragedy, but an outrage demanding immediate action. If it became the leading cause of death for residents between the ages of 18 and 45 years old, the outrage would become an uproar — especially if we then discovered that virtually every person could have been saved with a highly effective antidote. More than 100,000 mostly young people should not die of a highly preventable cause.
But according to a May 11 report from the U.S. Centers for Disease Control and Prevention (CDC), more than 107,000 Americans died of drug overdoses in 2021, exceeding the 2020 record of 93,000. New York is no different. While the state’s dataset lags by a year, New York City, whose data is not included in the CDC report, paints a troubling picture. In the first quarter of 2021, the five boroughs saw 596 overdose deaths, a 31% increase from the first quarter of 2020.
Like the rest of the nation, New York faces a crisis. But while an estimated three-quarters of overdose deaths today involve fentanyl and other highly potent synthetic opioids, there is hope when people have the right tools. Before the state’s legislative session ends in June, policymakers should take an all-of-the-above approach to the multiple proposals aimed at curbing overdose deaths, such as expanding access to overdose antagonist medications like naloxone to thousands of establishments across the state. Further, there is an opportunity to bring together stakeholders, including law enforcement, to assess the viability of a regulatory framework for the establishment and oversight of overdose prevention centers, informed by the feasibility study created by the city’s Department of Health.
New York is well situated to handle this public health emergency, partially because elected officials have long recognized opioid antagonists, especially naloxone, are a safe and effective measure to reverse overdoses and save lives. Naloxone blocks receptors in the brain to prevent further opioid uptake, only requiring one or two doses of nasal spray. Administering naloxone requires little medical skill but prevents death in around 94% of cases, according to a study from Brigham and Women’s Hospital in Boston. Side effects are few and largely manageable, and since the medication does not cause a high, there is no potential for abuse.
New York passed a law in 2006 to allow any person, including laypeople, to administer naloxone to someone actively overdosing. Since then, new laws ensured that pharmacies are allowed to dispense it without a prescription and local officials can provide it in leave-behind kits, which studies suggest not only reduces fatalities to less than 1% of all overdoses but also encourages broader addiction recovery.
Still, while studies show that overdose deaths decline when laypeople carry naloxone, not enough community members realize the lifesaving role they can play. Legislation moving through the state Senate and Assembly would change that in various ways. One bill would invite bars, clubs and other entertainment venues to apply to receive naloxone free of charge to administer to patrons if needed. Another piece of legislation would require homeless shelters to have both naloxone and at least one staff member on-site trained to administer it. The package that has advanced furthest in the legislative process, passed by both Assembly and Senate committees, would require all public places — schools, restaurants, libraries, shopping malls and more — to stock opioid antagonists. The state Department of Health would provide them free of charge.
Another bill tackles the issue differently, creating a statewide regulatory framework for overdose prevention centers, known in New York as safe injection facilities or safer consumption sites. Worth noting, two of these facilities have been operating in New York City last November under the former mayor’s executive order, and while they have saved nearly 300 lives since then, there are no statewide statutes permitting or regulating their existence. Passing legislation is a first step toward allowing other New York communities to open the conversation on these centers as a path to ensuring opioid addiction doesn’t become an entirely preventable death sentence for countless New Yorkers.
As policymakers wrestle with solutions, several proposals being considered in the Senate and Assembly would help ease the toll that opioid overdoses are exacting on communities across the state. As this year’s session quickly comes to an end, legislators should not allow the perfect to become the enemy of the good. With eyes wide open to this ongoing public health emergency, they should prioritize passage of proposals to expand overdose prevention resources in New York. There’s no time to lose.