Healthbeat

Trump’s drug strategy aims to bolster addiction services — despite gutting of government support

2026-05-06T14:01:02+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

The White House’s newly released strategy for tackling the nation’s drug and addiction crisis calls for a number of ambitious public health approaches that some experts say are laudable but will be hampered by the administration’s own actions.

The sweeping 195-page National Drug Control Strategy, published Monday, advocates for making access to treatment easier than getting drugs, preventing young people from developing addictions in the first place, increasing support for people in recovery, and reducing overdose deaths.

Those broad goals are widely supported by public health researchers, addiction treatment clinicians, and recovery advocates.

But accomplishing such goals will be difficult in the face of the administration’s mass layoffs of federal employees, cancellation of research and community grants, attacks on organizations and practices that serve people who use drugs, and cuts to Medicaid, the state-federal health insurance program for low-income people that is the largest payer for addiction and mental health care nationwide.

Many components of the National Drug Control Strategy are “things that we would agree with and that we fully support,” said Libby Jones, who leads overdose prevention efforts at the Global Health Advocacy Incubator, a public health advocacy group.

But there are “disconnects in what the strategy says is important and then what they’re actually going to fund,” she said of the Trump administration. “Those inconsistencies feel particularly loud in this strategy.”

The White House’s National Drug Control Strategy, released every two years, is a touchstone document meant to lay out the federal government’s coordinated approach to what in recent decades has been one of the country’s defining problems.

Since 2000, more than 1.1 million people have died of drug overdoses. Although deaths have decreased recently, the numbers remain elevated compared with earlier decades, and research suggests overdose death rates among Black Americans and Native Americans are disproportionately high.

Psychedelics offer exciting promise for mental health – if rolled out right

The strategy document published this week is the first of President Donald Trump’s current term. In keeping with the administration’s approach to addiction issues, it places heavy emphasis on law enforcement efforts to reduce the supply of illicit drugs. The document repeatedly refers to the ongoing “war” against “foreign terrorist organizations” — the Trump administration’s term for drug cartels — and touts increased enforcement at U.S. borders.

It also outlines plans to implement artificial intelligence technologies to screen for illicit drugs brought into the country and wastewater testing to detect illegal drug use nationwide.

The second half of the strategy focuses on reducing the demand for drugs through public health prevention efforts, addiction treatment, and support for people in recovery. It promotes the role of religion in recovery and calls for the widespread use of overdose reversal medications, such as naloxone.

In a news release, the White House’s Office of National Drug Control Policy called the document a “roadmap” that will “continue dismantling the drug supply and defeating the scourge of illicit drugs in our country.”

The Trump administration did not respond to requests for comment about how the strategy aligns with its other actions.

In December, Trump signed a reauthorization of the SUPPORT Act, which continues several grants related to treatment and recovery and the requirement for Medicaid to cover all Food and Drug Administration-approved medications for opioid use disorder. In January, he announced the Great American Recovery Initiative, including a $100 million investment to address homelessness, opioid addiction, and public safety.

However, few details have been provided about the initiative, and in January, about a month after the SUPPORT Act passed, billions of dollars in addiction-related grants were abruptly terminated and reinstated within a frantic 24-hour period.

That “whiplash” left “a sense of instability and uncertainty in the field,” said Yngvild Olsen, a national adviser with the Manatt Health consultancy. She led substance use treatment policy at the Substance Abuse and Mental Health Services Administration, or SAMHSA, under the Biden administration and left about six months into Trump’s second term.

That insecurity was exacerbated by the president’s 2027 budget request, which proposes cuts to several addiction and mental health programs and the consolidation of key federal agencies working on those matters. Jones’ group and nearly 100 others in the field have signed a letter asking Congress to reject the proposals, as it did with similar requests last year.

The national drug strategy adds new, potentially contradictory information to this confusing landscape.

Increasing access to treatment at odds with Medicaid cuts

One of the most significant public health goals in the strategy, mentioned at least half a dozen times, is to make it easier to get treatment than it is to buy illegal drugs.

National data underscore the necessity: More than 80% of Americans who need substance use treatment don’t receive it.

The administration’s actions on health insurance may make it difficult to improve that statistic.

Medicaid is the main source of health care coverage for adults with opioid use disorder. When implemented, the Medicaid work requirements in Trump’s One Big Beautiful Bill Act are projected to strip that coverage from about 1.6 million people with substance use disorders.

The last time Medicaid rolls were purged — after Covid-era protections expired — many people who had been receiving medication treatment for opioid addiction stopped it and fewer people started treatment, according to a study published last year.

Olsen, who is also an addiction medicine doctor, said she loves the strategy’s emphasis on making treatment readily available to anyone who wants it. But she said that’s “hard to really imagine when now people may have to pay for it themselves because they may be losing their Medicaid insurance coverage.”

One analysis estimated the upcoming Medicaid changes could lead 156,000 people to lose access to medications for opioid use disorder and result in more than 1,000 additional fatal overdoses per year.

An addiction counselor’s ‘aha’ moment: When even saving a life isn’t enough

People with private insurance may be affected, too.

The Trump administration has refused to enforce Biden-era regulations aimed at bolstering mental health parity, the idea that insurers must cover mental illness and addiction treatment comparably to physical treatments. And recently, the administration said it would redo those regulations altogether, raising fears that addiction treatment could become increasingly unaffordable.

The administration did not respond to specific questions about how it reconciles its actions on Medicaid and parity with the goal of increasing treatment.

Prevention efforts may be hampered by funding, staff cuts

The strategy highlights preventing addictions before they begin as one of the keys to reducing demand for drugs. It calls for “promoting a drug-free America as the social norm” and implementing school and community-based programs that are backed by science.

“Investing in primary prevention, before drug use starts, saves lives and resources,” it says, citing several studies about the cost-effectiveness of such programs.

Yet, the president’s budget proposes cuts to these types of programs, and federal layoffs have decimated the agencies that would implement such work.

The White House’s most recent budget request proposes cutting roughly $220 million from SAMHSA’s Center for Substance Abuse Prevention and nearly $40 million from the Drug-Free Communities program.

Since the new administration started, SAMHSA has lost about half of its staff, and the Centers for Disease Control and Prevention is down about a quarter.

“It’s not clear to me that they’re really going to be able to have the funds or the people to be able to carry that out,” Olsen said of the strategy’s prevention goals.

Another wrinkle appears in the strategy’s discussion of marijuana. The document points to marijuana use as one of the drivers of increasing drug use disorders and reports that “convergent evidence from multiple sources” suggests cannabis use increases the risk of psychosis. It calls for developing new tools to treat marijuana withdrawal and addiction.

However, just two weeks ago, the White House moved to reclassify medical marijuana to a lower tier of scheduled substances and is moving to hold a hearing to do the same for marijuana broadly.

“The administration, on the one hand, is moving in a direction of liberalizing access to cannabis,” Jones said, “but at the same time, in the strategy, it talks about the dangers of doing so.”

“There’s a disconnect there that just makes you question: Which one do you believe?” she added.

The administration did not respond to specific questions about its marijuana policies.

‘Rhetoric over reality’ on test strips to detect fentanyl

One of the more surprising elements of the National Drug Control Strategy comes in the last paragraph of the final chapter. It focuses on public drug-checking programs, which often involve using test strips to help people who use drugs determine whether there are more-dangerous substances, such as fentanyl or xylazine, in the batch they bought. That helps them determine whether or how to safely use those drugs.

“Rapid test strips and similar technologies that detect fentanyl and other drugs are an important tool that should be legal,” the strategy document says.

However, SAMHSA announced in a recent letter that it would no longer pay for test strips, as part of the Trump administration’s “clear shift away from harm reduction and practices that facilitate illicit drug use.”

The administration has similarly attacked harm reduction programs in an executive order and its budget requests. It did not respond to specific questions about how this position interacts with the drug control strategy.

Regina LaBelle, a Georgetown University professor who served as acting director of the Office of National Drug Control Policy during the Biden administration, wrote about the contradiction in a blog post: “It is the height of rhetoric over reality to champion a tool while simultaneously cutting off the funding used to acquire it.”

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

‘Demon Copperhead’ author lays foundation for women in Appalachia to beat addiction

2025-10-02T13:59:26+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

PENNINGTON GAP, Va. — On a Saturday evening in June, people of this rural region gathered at the historic Lee Theatre to celebrate the founding of Higher Ground Women’s Recovery Residence.

Author Barbara Kingsolver opened the facility in January with royalties from her Pulitzer Prize-winning novel, “Demon Copperhead,” whose plot revolves around Appalachia’s opioid crisis. The home offers a supportive place for people to stay while learning to live without drugs. Kingsolver had asked the women now living there to join her on stage.

Kingsolver, who grew up in Appalachia, suggested the women share with the audience what they were most proud of having gained from their first weeks at Higher Ground. But she learned they were more eager to brag on one another.

Supporters say Higher Ground provides stability and a reentry point after leaving jail, prison, or a treatment center. It offers a range of services and support in an area devastated by addiction to painkilling pills and other types of opioids. Most fundamentally, it’s a true home, with one- and two-person bedrooms, a communal kitchen, and a den. Residents say they have found affirmation from a cohort of women who understand how addiction can demoralize a person and estrange them from family and community.

Ronda Morgan, a resident, said her family has always been in her corner. But while she was serving a jail sentence for drug possession, she told herself, “I’m sick of them having to do time with me.” She was ready for recovery. Her daughter, who’s a nurse, told her about Higher Ground, the first facility of its kind in sprawling, rural Lee County. Morgan learned she could live there for up to two years to gain the footing that had eluded her in three-plus decades of addiction.

Residents Syara Parsell, left, and Ronda Morgan have found much-needed stability at Higher Ground recovery house in Virginia.

What she didn’t anticipate was the kinship she forged with her housemates — among them, Syara Parsell — and with Higher Ground’s staff.

Parsell, 35, one of Higher Ground’s first residents, said that in her time there she’s received help finding employment and enrolling in community college courses.

From the staff and Kingsolver, Parsell said, she has received judgment-free support. “Together,” she said, “we figure it out.”

Traditional treatment facilities typically operate under highly structured medical supervision. Recovery houses, like Higher Ground, offer a more relaxed environment, helping move a resident “toward being an independent, fully functional, self-reliant human being,” said Marvin Ventrell, CEO of the National Association of Addiction Treatment Providers.

“Recovery occurs in the community,” he said. But reentry must be approached delicately. “When addiction occurs with a human being, it also occurs within a family social structure.” If a person in early recovery returns to a family that’s unprepared, that person’s chances of success “are severely diminished.”

Kingsolver plunged into stories of addiction

For Kingsolver, the opioid crisis became a focal point for what she hoped would be “the great Appalachian novel.” The epidemic “has changed so much of the texture of this place,” devastating families and communities.

Pharmaceutical companies targeted central Appalachia for sales of what they falsely claimed were addiction-resistant prescription opioids. Kingsolver wanted to “cast my net back over all of the extractive industries that have come to this place, taken out what was good, and left behind a mess.”

“The way I put it is, ‘They came to harvest our pain when there was nothing else left,’” she said.

In research for “Demon Copperhead,” she immersed herself in the stories of people who’ve navigated addiction and those who care and advocate for them.

The novel has been an enormous success, having sold more than 3 million copies and earning far more than her previous works. Kingsolver decided to dedicate hundreds of thousands of dollars to address the crisis that has overwhelmed the region where she was raised — and to which she returned full time in 2004.

Again, she set about listening. Drawing on a wide range of expertise, she determined that a women’s recovery home was the wisest investment.

Joie Cantrell works as a public health nurse in harm reduction for the Virginia Department of Health, supporting policies and practices to curb the negative effects of drug use, and serves as Higher Ground’s board chair. She had long recognized the need for just such a home.

“That was the part that was missing,” Cantrell said. Too often, when someone would come out of a treatment facility or incarceration, “we lost them. They fell back into the same old patterns.” She said the region sorely needed a safe, stable environment where women could recalibrate.

Recovery home is full: ‘They’re living life’

By August, the home reached its capacity of seven women. It’s right in town, “which is so important,” Kingsolver said, “because in this part of the country we have no public transportation.”

Parsell has long suffered from social anxieties; drugs were her escape. Here, her housemates embraced her. They’ve offered the support she’d never experienced.

“Every two seconds, someone’s like, ‘Syara’s here!’” she said. “I’m very grateful for it.” If there’s an issue in the house, “one of the seven of us has the solution.”

Four residents are employed outside the home, one is enrolled in community college classes, one is completing her GED with plans to continue her education, and everyone volunteers in the community. Crafting classes are offered. Family members visit.

Subrenda Huff is interim director of the Higher Ground recovery house in Virginia. “They’re living life,” she says of its residents.

“They’re living life,” said Subrenda Huff, who was filling in while director Liz Brooks took maternity leave.

Morgan said she accomplished more in a month at Higher Ground than she had in years. That includes applying for identification documents, taking budgeting classes, and seeking permanent housing. It includes sharing upkeep duties in the house.

Such was Kingsolver’s vision. But, she said, “here’s what I didn’t expect: The community embraced this with loving arms. I thought maybe people would say, ‘I don’t want this in my back yard.’”

Most of the furniture was donated. Kingsolver’s quarter-million or so social media followers have been instrumental in that. “But it’s not just book clubs in Switzerland or in California; it’s people in Pennington Gap,” she said. Church groups have donated “quilts, bedside lamps, things to hang on the walls just to make it homey.”

Before the facility opened, local folks volunteered to pull weeds, take down an old fence, and put up a new one. Kingsolver said the well of support “has been just endless. It’s been deep, and loving, and a wonder to see.”

Higher Ground, with only one paid staff member, has estimated yearly operating costs of $120,000, Cantrell said. Residents are charged $50 a week. Ventrell said that fees at other recovery houses vary widely but that $2,500 a month is an approximate average.

“We want them to focus on saving money and paying any restitution or fines they may have from past charges,” Cantrell said. “Some may be focused on repaying child support they may owe.”

Higher Ground receives no federal or state funding. Donations continue to pour in. And Kingsolver recently bought the building next door with plans to open a thrift shop, which would be a source of additional income for the home and offer retail work experience for its residents.

Supporters aspire to open more Higher Ground homes elsewhere in the region.

What these women are gaining, Kingsolver said, “is not just sobriety, but belief in themselves.”

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

Proposed NYC Council measure aims to reduce overdose-related pregnancy deaths

2025-05-28T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The New York City Department of Health and Mental Hygiene recently identified an alarming pattern: Overdose is the city’s leading driver of pregnancy-associated death. A new measure poised to be introduced in the New York City Council on Wednesday aims to reverse that trend.

Overdoses accounted for 20 of the city’s 58 total pregnancy-associated deaths — deaths due to any cause during pregnancy or within a year from the end of pregnancy — in 2021, the most recent data available. That year, overdoses accounted for 34.5% of the city’s pregnancy-associated deaths, compared to 14.1% for the total five-year period from 2016 to 2020.

“This is something that the city can invest in. We can prevent this,” said Council Member Jennifer Gutiérrez, a Democrat representing parts of Brooklyn and Queens, and the bill’s prime sponsor.

For the City Council, reducing maternal mortality — which disproportionately impacts Black New Yorkers — has been a priority in recent years. Gutiérrez’s measure would narrow in on the intersection of maternal mortality and the opioid crisis, requiring the Health Department to create an educational campaign for health care providers, developed by medical professional organizations, about how to treat opioid use disorder during and after pregnancy. The bill would also expand the availability of naloxone, a medication that reverses opioid overdose, at neighborhood health centers.

New York sees sharp decline in overdose deaths, according to new data

Dr. Leah Habersham, a physician-scientist at Mount Sinai, works with the patient population at the center of this issue: pregnant people with substance use disorders. Overdose-related deaths during or after pregnancy are preventable, she said, and increasing awareness of this issue is critical — for health care providers, patients’ family members, and the broader public.

“We need to destigmatize this medical condition and get people to realize that this is a medical problem that is treatable,” said Habersham, who is also a member of the city’s Maternal Mortality and Morbidity Review Committee, which reviews pregnancy-related deaths.

Habersham directs the Bridge Program, a Mount Sinai initiative launched in 2022, that offers patients a unique combination of prenatal care and substance abuse treatment. By prescribing medications for opioid use disorders, like methadone, she helps patients avoid withdrawal, which can make the pregnant person and their baby ill, or heighten the risk of preterm labor and delivery.

The patients that Habersham works with tend to be overlooked and ostracized, she said. Distrust of medical providers or fears around disclosing drug use can keep pregnant people from seeking help, and the consequences can be deadly, with a heightened risk of overdose seven to 12 months after delivery.

“If they find out about my program, many of them are oftentimes relieved to find out that there’s this doctor who actually will help them,” said Habersham, an assistant professor of psychiatry and assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai.

In its alert last year, the Health Department described medications for opioid use disorder as “lifesaving” and encouraged health care providers to initiate discussions with patients about the treatment as soon as possible. The alert also noted that postpartum people should be encouraged to breastfeed, given its associations with reductions in neonatal abstinence syndrome.

The 20 pregnancy-associated deaths related to overdoses reported in 2021 reflected a sharp increase from the nine deaths reported in 2020 — as well as from the 34 pregnancy-associated overdose deaths that were reported out of a total of 241 pregnancy-associated deaths from 2016 to 2020. The Health Department pointed to heightened isolation during the pandemic and a fentanyl-laced drug supply as drivers of the increased mortality.

Gutiérrez hopes that with a robust educational campaign around overdose and pregnancy, the city could make progress in its efforts to reduce these deaths — as well as the “ultimate goal of reversing Black maternal morbidity.”

Her measure would require the educational campaign to be developed with medical professional organizations and local health agencies, and focus on the benefits of using medications for opioid use disorder, as well as the dangers of withdrawal during pregnancy.

Habersham says that part of what makes her work meaningful is that pregnancy is often a catalyst for a patient to try to stop using substances — for their own health and their baby’s.

“It’s the one time that they’re really, really motivated to get help, even if it’s initially not for themselves,” she said. “Oftentimes, it does become for themselves, because they know they have to get better in order to be a better parent.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

New York sees sharp decline in overdose deaths, according to new data

2025-05-22T14:19:17+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Overdose deaths in New York state declined 32% last year, a significant drop that officials and experts attribute to the state’s efforts to expand harm reduction and addiction treatment services.

An estimated 4,567 New Yorkers died of a drug overdose in 2024, compared to 6,688 in 2023, according to provisional data from the Centers for Disease Control and Prevention. About 77% of those deaths involved an opioid like fentanyl or heroin.

The statewide decline mirrors a national trend, said Dr. Magdalena Cerdá, a professor and director of the Center for Opioid Epidemiology and Policy at the Department of Population Health at NYU Grossman School of Medicine. Last year, about 80,000 Americans died of a drug overdose, down from about 110,000 deaths in 2023, a reduction of almost 27%, according to the CDC.

“We’re still definitely in the middle of an overdose crisis,” Cerdá said. “But the substantial decline in the past year gives me a lot of hope.”

The reduction in deaths is promising but tenuous, experts say. Although overdose deaths have declined overall, racial disparities in mortality have widened, and uncertainty around federal funding related to addiction services could imperil recent progress. The Trump administration’s recently released budget plan calls for more than $1 billion in cuts to the Substance Abuse and Mental Health Services Administration, the federal agency focused on addiction and mental health.

In New York, the reduction in deaths reflects a combination of forces, including wider availability of the overdose-reversing medication naloxone, expanded access to medication for opioid use disorder, and deeper investments in harm reduction services, experts say.

“There’s likely multiple reasons for this decline, but one of them is the substantial investment that states have done, and in particular, New York state has done, in terms of the provision of harm reduction services and services to treat substance use disorders,” Cerdá said.

In an announcement, Gov. Kathy Hochul’s administration linked the decline in deaths to the state’s distribution of nearly $400 million in opioid settlement funds, which are funding efforts to expand access to medication for addiction, supportive services, and recovery programs.

“These numbers show that our hard work and innovative approaches to establishing services are making a difference across the state,” Dr. Chinazo Cunningham, the commissioner of the Office of Addiction Services and Supports, said in a statement.

Through a new online portal, the state has distributed more than 13 million fentanyl test strips and 10 million xylazine test strips — used to test drug samples — and 296,000 naloxone kits to residents for free, according to Hochul’s administration. Additionally, the state Health Department distributed more than 537,600 naloxone kits from January 2024 through April 2025.

The declines in mortality have not been evenly distributed across demographic groups. In New York City, while overdose deaths in 2023 declined for the first time in four years, including among white New Yorkers, they were unchanged among Black New Yorkers, and increased among Latino New Yorkers. Recent data from the city Department of Health and Mental Hygiene show that high rates of overdose mortality persist in parts of the Bronx, Upper Manhattan, and Central Brooklyn.

Addressing those disparities will require deeper investments in the impacted communities, including by reducing barriers to care and services, Cerdá said.

In its annual report released in November, New York’s Opioid Settlement Fund Advisory Board — a committee tasked with making recommendations for the allocation of the funding — stressed the need for racial equity in the distribution of settlement funds, describing ongoing overdose deaths in Black and Latino communities as an “overarching concern.”

Dr. Silvia Martins, a professor of epidemiology and director of the Substance Use Epidemiology Unit in the Department of Epidemiology at the Columbia University Mailman School of Public Health, raised concerns that cuts to federal programs related to addiction could slow or stop the recent overall reduction in overdose deaths.

Reduced funding for SAMHSA and looming cuts to Medicaid could curtail many Americans’ access to addiction prevention and treatment programs, she said. And if federal funding for addiction services dries up, opioid settlement funds won’t be able to fully close the gaps, she cautioned.

“I truly hope that the federal government realizes now is not the time to stop these efforts, because it’s trending, in most states, in the right direction,” she said. “We see that these efforts are working.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

How Georgia community groups are looking to use $70M of opioid funds — and what challenges lie ahead

2025-02-13T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Over the past decade, fatal opioid overdoses have prematurely ended the lives of over 10,000 Georgia residents. National lawsuits have directed much of the blame for this state and U.S. epidemic at dangerous marketing practices by companies within the pharmaceutical supply chain — which have responded by agreeing to pay tens of billions of dollars in settlements.

The Georgia Opioid Crisis Abatement Trust has begun to use much of the state’s portion of the money to attempt to build on recent reductions in deadly overdose rates. In December, the trust’s overseer, state Department of Behavioral Health and Developmental Disabilities Commissioner Kevin Tanner, awarded $70 million of settlement money to 128 organizations focused on addressing the public health consequences of the crisis.

Throughout the country, some local and state spending has come under scrutiny for being used on efforts that don’t directly address addiction in hard-hit communities. Many analyses have compared these decisions to state settlements from tobacco companies in the 1990s — money that was supposed to address the public health harms caused by nicotine addiction but was spent on a variety of other uses.

Tanner has said the Georgia Trust is trying to avoid this pitfall by conducting analyses of the greatest addiction needs and trying to fund efforts to address them. The trust’s first 128 grants went to projects that seek to address, prevent, and research substance use disorder.

“This settlement is set up in a very restrictive way to try to make sure that states and local governments spend the money in the way it’s intended,” Tanner told Georgia lawmakers at a meeting in late January. “Which is to prevent harm and to reduce harm from the use of opioids.”

Georgia trust awards first $70 million of opioid settlements

As organizations begin implementing their opioid settlement grants, Georgians who study and research addiction are optimistic about building on the recent state and national progress in preventing overdose deaths.

J. Aaron Johnson, director of Augusta University’s Institute of Public and Preventive Health, helped guide which Eastern Georgia projects received funds. He said that aside from the state’s overdose death rates continuing to decline, it may be difficult to determine the impact of the grants.

“I don’t know how easily visible that will be to the public,” he said. “And certainly it’ll be a long-term impact more than short-term.”

In the meantime, he said, there is more the state could do to battle the decades-long overdose crisis, like implement regulations for recovery residences. Future settlement grants could also be used to reduce the stigma of opioid addiction and encourage doctors to treat it with medication.

Opioid trust funds new and continuing projects

In the waiting room of the McDonough clinic Bright Star Healthcare in early January, there was a sign posted on a bulletin board with the highlighted, red-type, all-caps title “ATTENTION GRANT RECIPIENTS.”

The message was aimed at uninsured patients who, through a state-funded grant, receive addiction treatment there. The clinic is approved to use methadone, an effective medication that reduces opioid withdrawal symptoms. It uses the grant money to subsidize the clinic transportation and treatment costs for 15 patients.

A flyer in the lobby of Bright Star Healthcare warns residents that funding for their treatment is temporary.

As the bulletin board message went on to detail, it’s intended to be a temporary program as the clinic helps people find insurance options like Medicaid, the federal program for low-income residents. The state funding for the program ended in October, but Bright Star is set to use about $500,000 from the trust to keep the initiative running.

“I don’t want that treatment to end for them — those who can’t afford it,” said George Coley, the clinic’s founder. He added that the funds will also help Bright Star reach out to local hospitals and urgent care clinics about the addiction treatment services it offers.

West of Atlanta in Paulding County, Tony Moon has grown more concerned about the lack of addiction treatment and recovery services for young adults. One of his daughters has struggled with substance use disorder, and he said he couldn’t find organizations near their home to help.

“There was like nothing,” said Moon, who has been in addiction recovery for decades.

The executive director of Rising Sun Recovery, a Hiram-based nonprofit that provides drug-free housing and social services for people with addictions, Moon felt obliged to create services to fill the gap. Over the next two years, he’ll be using just under $500,000 to expand Rising Sun’s services to house and serve clients between ages 18 and 26.

Another addiction recovery nonprofit Moon runs, Paulding RCO, will receive around $360,000 of opioid settlement funds this year to bolster peer services support for these new Rising Sun members and other young people at risk of addiction. The grant will allow Moon to hire full-time staff. He’s excited to be expanding.

“I got in recovery at 20 years old,” he said. “I experienced that, so I help out with creating the environment.”

Moon’s organization is certified by the Georgia Association of Recovery Residences, an arm of a national group that aims to ensure homes are safe for people in recovery. But the credential is voluntary, as the state has yet to implement laws governing how these housing options should operate.

Candice Whittaker, the GARR executive director, said there are likely homes that she hasn’t been in touch with yet that create healthy recovery environments. But other uncertified residences may not be following best practices and could heighten the risk that residents may relapse.

“I couldn’t tell you how many places are operating unethically, because I have no idea,” she said. “Because there’s no way to check.”

Some doctors reluctant to prescribe addiction medication

Johnson, the Augusta University professor, said another factor that could help reduce overdose deaths is increasing the number of providers who prescribe buprenorphine, another medication that reduces opioid withdrawal symptoms. Unlike methadone, most licensed physicians can prescribe it to treat addiction.

But Johnson said there are still pockets of Georgia without doctors who prescribe this gold-standard treatment, often because of stigma related to opioid addiction. He and his colleagues help train physicians on best practices for prescribing buprenorphine, and he often faces hesitancy from health care workers.

“It’s not at all uncommon to have an entire clinic saying, ‘We’re not going to do that because we don’t want those kinds of people in our clinic,’” he said.

Johnson said he didn’t remember seeing many Eastern Georgia opioid settlement applications that would address this issue. Whether it’s through the state’s opioid trust or other efforts, he said Georgia needs to continue addressing providers’ unwillingness to connect their patients to this medication.

“It’s been around for decades,” he said. “I don’t know that you’re going to suddenly change people’s minds, but I do think we’ve come a long way over the last several decades.”

Awardees want to develop tools for long-term recovery

Georgia will likely continue to face challenges addressing the overdose crisis, but Jeff Breedlove said he is optimistic about the future. Breedlove, who’s in recovery himself, has had a hand in the state’s opioid settlement distribution as a former employee of the state’s Behavioral Health Department and as an adviser with the Georgia Council for Recovery.

With the opioid trust’s $70 million set to be distributed in March and another funding application cycle set to open in April, Breedlove said he believes the funded organizations could make substantial progress toward preventing death and anguish related to addiction.

“I don’t feel like any of the awards that were given would embarrass my community or the state of Georgia,” he said.

But there’s more to be done, he said. He and the Council for Recovery are advocating for several bills in this year’s legislative session, including a proposal that would begin state regulation of recovery residences.

To reduce stigma around substance use disorder and ensure the opioid settlements are spent effectively, Breedlove said it’s incumbent upon community advocates, especially those who’ve experienced addiction, to reach out to award recipients and offer their insight.

“That’s when the magic happens,” he said. “When the organization that wants to do good has a relationship with the people they’re trying to do good for, we’ll save lives.”

That’s something BreNita Jackson, executive director of the Decatur women’s residential treatment center Breakthru House, looks to continue doing with her organization’s opioid settlement grant. It’s set to receive just over $100,000 soon.

Jackson said the grant will allow Breakthru to continue its pro-bono work serving women with little financial means. Although recovery can be a private experience, she hopes some in the community may see the ripple effects of her organization’s work.

“To be able to see these women return to a healthy and productive life is what folks should be watching for,” she said. “That they have the tools to be able to maintain long-term recovery.”

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

New pharma opioid settlement funds will bolster harm reduction, treatment in New York City, officials say

2025-01-29T22:34:08+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

As the opioid crisis persists in parts of New York City, some overdose prevention programs, treatment initiatives, and recovery efforts may soon see fresh infusions of funds, city officials said during a City Council oversight hearing.

New York City has received $154 million from settlements with the pharmaceutical companies that drove the opioid crisis, a total that will reach $500 million by 2040. An additional settlement agreement with Purdue Pharma and members of the Sackler family, announced last week, could bring in another $250 million to New York state, some of which might be allocated to the city.

As opioid settlement funds have flowed into the city in recent years, city officials have come under fire for not being transparent enough about how the money has been allocated. Last year, Mayor Eric Adams released broad plans for allocating $50 million annually by fiscal year 2027, but harm reduction advocates and local leaders have urged further details be released.

Meanwhile, the opioid crisis continues to claim lives. The Department of Health and Mental Hygiene recently released data showing that drug overdose deaths declined in New York City in 2023, decreasing for the first time in four years. Still, more than 3,000 New Yorkers died of drug overdoses that year. Overdose mortality disproportionately impacts Bronx and Staten Island residents, as well as Black New Yorkers.

New York City data show first decline in overdose deaths in four years — but widening disparities

As part of its HealthyNYC campaign — an effort to extend life expectancy for city residents — New York City aims to reduce drug overdose deaths by 25% by 2030.

During the oversight hearing on Tuesday, city council members pressed officials from the Health Department, NYC Health + Hospitals and the Office of the Chief Medical Examiner on how millions of dollars in settlement funds had been used so far, and where they would go in the coming years.

“It is imperative that the settlement money that the city receives is allocated toward appropriate harm reduction and treatment programs,” said Council Member Mercedes Narcisse, the chair of the Committee on Hospitals.

Dr. Rebecca Linn-Walton, the assistant commissioner for the Bureau of Alcohol and Drug Use at the Health Department, noted the “welcome stabilization” of opioid deaths in recent city data, but emphasized that the agency remains focused on reducing deaths and addressing stark racial disparities.

The Health Department has previously used opioid settlement funds to expand wraparound services at syringe service programs, which provide access to sterile syringes and distribute naloxone to drug users, among other services. Those efforts will continue with an added $4.1 million in fiscal year 2026, Linn-Walton said.

The agency also plans to invest $3 million in substance use services on Staten Island and to expand its Relay program — a hospital-based initiative supporting people who have experienced nonfatal overdoses — to two additional emergency departments, for a total of 17 departments citywide. Other funds will be used to expand methadone and buprenorphine treatment programs, as well as recovery programs.

“This year is the big ramp-up year,” Linn-Walton said.

She noted that most of the funds will flow through community-based organizations selected through a procurement process.

At NYC Health + Hospitals, opioid settlement funds have been used to support a broad array of work, including the funding of mobile harm reduction teams, which offer testing, vaccinations and wound care to homeless New Yorkers, said Dr. Daniel Schatz, the health system’s medical director of addiction services.

Robert Van Pelt, chief of staff at the Office of the Chief Medical Examiner, said that the agency’s opioid settlement funds have supported the Drug Intelligence and Intervention Group, which connects families and survivors to support services following an overdose death. He added that the agency has also used settlement funds to hire additional staff and equipment to reduce the time it takes to certify opioid overdose deaths.

In remarks during the hearing, Christine Khaikin, senior health policy attorney at the Legal Action Center, a law and policy organization, urged greater transparency in the city’s opioid settlement fund disbursements, and called for the creation of a regularly updated public spending dashboard that would enable real-time monitoring.

“Broad-stroke summaries of programs available to the public so far aren’t enough, and leave open questions of whether any of these funds are going places not included in reporting,” Khaikin said.

Other speakers drew attention to parts of the city where the opioid crisis remains acute.

Bronx Borough President Vanessa L. Gibson urged city leaders to devote more funds to stemming the tide of fatal overdoses in her borough. Bronx residents experience the highest rate of overdose mortality among city residents, according to the most recent data.

“The Bronx cannot wait,” Gibson said. “We need this money, we need the funding, right now. Every life we lose is a reminder of the work that must be done.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Overdose is New York City’s leading cause of pregnancy-associated death, Health Department says

2024-12-16T21:49:30+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Overdose is the leading cause of pregnancy-associated death in New York City, the Department of Health and Mental Hygiene alerted health care providers in an advisory letter on Friday.

Overdoses accounted for 20 out of the city’s 58 total pregnancy-associated deaths (34.5%) in 2021, according to the most recently available city data. Of those 20 overdose deaths, 16 involved an opioid. Infection, cancer, hemorrhage, and seizure disorders were among the less common causes of death.

The Health Department defines a pregnancy-associated death as a death from any cause during pregnancy or within one year from the end of pregnancy. The department has conducted surveillance of those deaths since 2001, releasing annual data, as well as five-year reports from the Maternal Mortality Review Committee.

The city’s 2021 data reflect a significant increase from the nine pregnancy-associated deaths related to overdose reported in 2020 — and a jump in comparison to longer-term trends. From 2016 to 2020, 34 of the city’s 241 pregnancy-associated deaths (14.1%) were due to overdose, according to a Maternal Mortality Review Committee report published this fall.

The recent rise in overdose-related maternal deaths sits at the intersection of two of the city’s persistent public health challenges — maternal mortality and the opioid epidemic — and the racial disparities within both. The city’s maternal health crisis, which disproportionately impacts Black women, has become a top priority for the New York City Council. Meanwhile, recent data show that the overdose epidemic has started to stabilize in the city, but overdose deaths continue, particularly among non-white New Yorkers.

In 2021, Black non-Hispanic and Hispanic birthing parents accounted for the highest proportions of the city’s pregnancy-associated deaths (39.7% and 36.2%, respectively), while accounting for only 17.7% and 28.9%, respectively, of live births, according to city data.

Acting Health Commissioner Dr. Michelle Morse and two of her deputy commissioners said in the advisory letter that the city’s recent maternal mortality data should “serve as a call to action for all providers to play a role in reducing the risk of overdose among New Yorkers, especially for pregnant and postpartum people where the majority of these deaths are preventable.”

The officials attributed the increase in overdose-related pregnancy-associated deaths to increased isolation during the height of the Covid-19 pandemic and an influx of fentanyl in the drug supply in recent years.

The Health Department aims to achieve a 10% reduction in maternal death rates by 2030, through increased access to health care, social support, and sexual and reproductive health care, according to HealthyNYC, the department’s framework for improving life expectancy. Black women are four times more likely than White women to die from pregnancy-associated causes, according to the Health Department.

Morse and the other officials urged providers to screen for substance use, substance use disorders, and co-morbid mental health conditions, and to talk with patients who are pregnant and have opioid use disorder about initiating buprenorphine or methadone as soon as possible. The officials also advised continuing to screen patients for substance use throughout the postpartum period.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Georgia trust awards first $70 million of opioid settlements

2024-12-11T22:11:12+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

After receiving recommendations from a government advisory commission last month, the Georgia Opioid Crisis Abatement Trust announced awards of just over $70 million of opioid settlement funds Wednesday for 128 projects to combat the state’s overdose epidemic.

The grants, set to be used in 2025 and 2026, are intended to help prevent Georgians from developing opioid addictions, connect people with substance use disorders to harm reduction and treatment programs, and bolster recovery resources across the state. The Trust published a list of accepted grantees on its website.

In mid-November, a commission made up of people who work in governments across Georgia recommended that the trust’s manager, Department of Behavioral Health and Developmental Disabilities Commissioner Kevin Tanner, allocate $71 million for this first round of awards.

A department spokesperson said she believed Tanner adjusted those numbers slightly to get to a final award total of $70.3 million. She said she hopes award recipients will receive their funds soon after they accept the grant terms.

“Opioid-related overdoses have devastated families, but these grants will start to turn the tide,” Tanner said in a press release. “Through strategic partnerships and targeted investments, we are equipping communities with the resources they need to combat this crisis and save lives.”

During the holidays, harm reduction groups offer a lifeline to New Yorkers facing overdose risks

He awarded four organizations — the Decatur Prevention Initiative, Gwinnett County Board of Health, Positive Transition Services, and View Point Health — grants collectively worth about $1.3 million to address opioid addiction in the metro Atlanta region. Additionally, the City of Atlanta and Cobb, DeKalb, Gwinnett, and Fulton counties collectively received $5 million for additional crisis-abating projects.

Drug overdose is one of the leading causes of death in Georgia, especially among adolescents and young adults. From 2013 to 2023, the overdose death rate more than doubled in Atlanta and Georgia.

The trust is funded by a $638 million settlement from four pharmaceutical companies — AmerisourceBergen, Cardinal Health, Janssen, and McKesson — accused of marketing prescription pain opioids in ways that endangered the public. Of that payout, $479 million is managed by the trust, and $159 million is set to be distributed directly to local Georgia governments.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

During the holidays, harm reduction groups offer a lifeline to New Yorkers facing overdose risks

2024-12-09T19:21:14+00:00

This story was originally published by Epicenter NYC. Sign up for their newsletters here.

Ed Manchess can’t wait for the pernil, or slow-cooked pork roast, his team is serving up for Christmas at the Bronx-based harm reduction center he directs. It has less to do with Manchess growing up alongside boricuas in Uptown Manhattan — and more that, for some, this kind of gathering could mean the difference between life and an overdose death.

“Holidays are traumatic for people that use drugs,” Manchess said. Being in community at a traditional meal can help, he says.

Drug overdose rates tend to spike by about 22% during in December and January around the holidays, according to data from the Centers for Disease Control and Prevention. Holiday stressors lead some people to increase their substance use as a coping mechanism, or for people in early recovery to relapse.

Not everyone can celebrate a decline in overdose rates

In October, the Department of Health and Mental Hygiene released data that sounded off a celebratory note — drug overdose deaths in NYC had declined in 2023 for the first time since even before the pandemic.

New York City data show first decline in overdose deaths in four years — but widening disparities

But this good news was mostly for white New Yorkers, for whom overdose deaths fell by 14%. They rose 2% for Latinos in the city and stayed just as high for Black New Yorkers. Older Black New Yorkers, aged 55 to 84, face the greatest risk overall compared to other groups: 115.5 deaths per 100,000 residents. The Bronx continues to carry the highest overdose death rate of all boroughs.

Advocates rattle off the social determinants for high overdose rates in the most vulnerable New Yorkers: poverty, housing instability, less access to health care, and policing, to name a few.

How stigma affects older at-risk New Yorkers

Stigma and isolation are less visible but crucial factors. Kristin Goodwin, associate vice president of Harlem United‘s Integrated Harm Reduction department, points out that the vast majority of people who have a fatal overdose are using drugs alone.

And contrary to popular misconception, most are not overdosing on the streets. They are most often in their own home, or the home of someone they know — but where no one’s around to respond in the case of an overdose.

“What that tells us is that people are still using unsafely, largely because they’re afraid to talk to people in their lives about their substance use,” Goodwin said.

Her department sees a hesitance to seek healthcare, especially in their clients aged 50 and older. It might sound counterintuitive: This is the age group more likely to have chronic health issues like diabetes and heart disease, who could really use regular doctor checkups.

“Some of that is stigma related, where they’re afraid to talk to a doctor about their other health issues because they’re afraid the doctor is going to shame them for their substance use,” Goodwin said. “So they just disconnect themselves from the health care system in general.”

Dr. Carolann Slattery, the chief clinical officer at the nonprofit Samaritan Daytop Village, says adults aged 55 and older they often isolate themselves, which limits access to care and increases health issues like chronic pain. These conditions also worsen due to systemic addiction to opioids and other substances.

“Do we still have stigma? Of course,” Slattery said, adding that groups like Samaritan are working hard to reduce the related racial and ethnic discrimination around it. “But unless we get providers to understand cultural competency and incorporate trauma-informed care, the message will fall short.”

How policing makes things harder

Policing also plays a role in limiting access to treatment in places like the Bronx. Just a decade ago, Harlem United’s clients were still getting arrested for carrying clean syringes, Goodwin said. While that has stopped, there’s still an obvious stigma toward people who use drugs because of the legality around it.

Police competency around stigma varies — even from one precinct to another in Harlem. Goodwin has seen officers from East Harlem’s 25th precinct escort people to the overdose prevention center and engage with staff. Meanwhile, one precinct in Central Harlem has a different training culture. These differences impact access to substance use treatment and overdose prevention.

New HIV diagnoses rose slightly in New York City in 2023, but testing efforts ‘may be working’

“In marginalized communities, people are fearful of the police, so accessing a place like a harm reduction center to get whatever goods they may need [is difficult],” Manchess said. “It really appalls me that you don’t see this on Park Avenue, you don’t see this in Central Park, but you see it in all the parks in the Bronx — kids having to climb over syringes and stuff like that.”

But policing of mostly Black and Latino New Yorkers doesn’t stop what Manchess, who lived in the Bronx for years, calls an open drug market: “Go to the hub over there by 149th Street or the North Bronx near Valentine Ave — it’s like they run the community,” he said.

Moreover, the market carries an unsafe drug supply. This includes often fatal drugs like fentanyl, carfentanil, and xylazine. He says the other day, the BOOM!Health nonprofit got a sample through drug testing that was 21-25% fentanyl.

“That’s a death sentence for anyone without a tolerance,” Manchess said.

Hardening the lines of treatment

While Black and Latino New Yorkers in Uptown Manhattan also continue to struggle with some of the highest overdose rates, gentrification plays a role in keeping it that way. Goodwin says the large push against substance use treatment programs and street outreach has come largely from new Harlem residents. They claim the presence of substance use treatment programs is behind a perceived rise in crime.

“It’s very hard to argue, because it’s not good cause and effect, but they’ve convinced elected officials that there’s merit to that argument,” Goodwin said.

Notably, Gov. Kathy Hochul has hardened her stance on funding overdose prevention centers, as Politico has reported. This is despite the only two overdose centers in New York (which are in Washington Heights and East Harlem and are managed by nonprofit OnPoint NYC) having helped thousands of people since opening in late 2021. It’s also despite the state Opioid Settlement Fund Advisory Board twice recommending that the Hochul administration allocate money to these centers.

What loneliness has to do with it

Manchess knows too well how stigma can compound isolation to set someone on the path to a possible overdose. He started using heroin at age 13 in Washington Heights. He recalls being introduced to drugs by older peers.

“There must have been something missing in my life,” Manchess said. “So many people who use drugs are seeking something — a sensation, an escape, a way to detach from pain or trauma.”

It quickly spiraled into addiction.

“Heroin allowed me to detach emotionally, even mentally, from traumatic events in my life,” he said. “But it also isolated me from my family and the world around me.”

The stigma surrounding drug use made it harder to get help. “In that life, it’s so hard to trust people,” Manchess said.

Stigma can hinder someone from getting care and others from caring for someone who needs help. Xylazine creates sores and wounds. And nobody wants to treat these wounds because of the associated stigma: “Ask anybody who uses drugs how they’re treated when they walk into a medical institution — it’s dehumanizing,” Manchess said.

He only started his journey to recovery, peer leadership, and ultimately leader in harm reduction because of an arrest. The judge gave him an ultimatum: time in prison or in a substance use treatment program. He chose Samaritan Daytop Village.

More than three decades later, Manchess is leading harm reduction efforts focused on meeting people where they are — providing clean needles, overdose prevention kits, and nonjudgmental support.

“We need more spaces where people can feel safe to talk,” Manchess said. “People are carrying so much pain. They don’t just use drugs because they want to — it’s often about what’s been taken from them, or what they’re trying to forget.”

It never fails to hurt him to see fellow New Yorkers walk by people who seem to be overdosing. “It’s ‘there go those junkies again,’” Manchess said. “I’m just hoping that somehow, someday, somebody can deliver the golden message: ‘Stop for a moment and help your fellow man.’ People that use drugs are people, and they deserve to live, too.”

Opioid settlement advisers recommend $71M for projects to reduce Georgia’s overdose crisis

2024-11-14T23:51:44+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Building more beds for women in recovery, increasing access to the overdose-reversing drug naloxone and other projects to help abate Atlanta’s overdose epidemic were among those recommended Thursday to receive funding from Georgia’s opioid settlement dollars.

The Georgia Opioid Settlement Advisory Commission met in downtown Atlanta to discuss which of over 300 project applications should get an award from the state’s Opioid Crisis Abatement Trust.

The funds came from lawsuit settlements with AmerisourceBergen, Cardinal Health, Janssen Pharmaceuticals, and McKesson. In those lawsuits, experts alleged the companies spent years selling addictive prescription pain medications in ways that endangered Americans.

The commission made recommendations for projects across the state of about $44 million for 2025 and $27 million for 2026. In the Atlanta area, the commission recommended the trust spend about $1.3 million over the next two years.

The actual decisions will be made by the trust’s manager, Department of Behavioral Health and Developmental Disabilities Commissioner Kevin Tanner. He left the meeting before it started to allow the commission to make its recommendations independently. Tanner’s spokesperson said he expects to make the official awards in the next few weeks.

In recent years, Georgia and Atlanta have seen dramatic increases in drug-related deaths. The state and capital city’s 2023 overdose rates are more than double what they were a decade ago, mirroring national statistics.

Earlier this year, Tanner had the Behavioral Health Department evaluate what regional and state resources were missing to help residents with addiction. The department published eight reports, which showed that many Georgia communities lacked services like clinics for people to withdraw from opioids safely and medication to make that process less painful and more effective.

In the metro Atlanta region, one of the analyses found that Gwinnett County was lacking many key resources needed to address opioid addiction, including treatment centers for women, in-patient options, and housing for people in recovery.

The only project the committee recommended specifically for Gwinnett County was a proposal from its Board of Health for about $200,000 to expand naloxone access. Gwinnett programs can also receive settlement funding through the Opioid Trust’s Qualifying Block Grantee program, and trust Executive Director Holly Lynde said those funding decisions will be made separately from the advisory committee.

Lynde spent the meeting reading the names of recommended organizations, how much funding was recommended, and a one-line description of their plans. But the commission spent nearly no time discussing the recommendations before signing on to them.

For the over $20 million of recommendations for projects specific to one of six Georgia regions, the applications were considered by regional advisory committees, which do not hold public meetings. The project applications Tanner accepts will be published online, but the public will not have an opportunity to learn more details about the grantees’ plans until after he approves them.

Lynde also proposed that the advisory committee recommend the Opioid Trust fund an additional 1,000 grants worth $5,000 each for Rotary District service projects. The motion was unanimously approved.

Commission Chairperson Evan Meyers said he expects the next advisory committee meeting to be held in late February or early March, and he proposed holding it somewhere other than Atlanta.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Opioid settlement fund advisory board criticizes state for insufficient data, lack of transparency

2024-11-05T22:59:13+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The New York State Opioid Settlement Fund Advisory Board urged deeper investments in harm reduction initiatives and reiterated its call for Gov. Kathy Hochul to declare the opioid crisis a public health emergency in its 2024 report.

But the report, publicly released on Tuesday, also laid bare the board’s growing frustration with the state agencies that work on the opioid crisis.

The report — the third of the advisory board, which first convened in 2022 — included an unusual “letter of concern” in which the board criticized state agencies for their “inability to provide comprehensive timely information for the board to make full data-driven recommendations.” The board also appealed to Hochul and the state legislature for support in its efforts to be transparent and collaborative.

“We are making recommendations based on air,” board member Tracie Gardner said during the panel’s last meeting on Oct. 28, at which many members’ concerns boiled over.

Gardner added that she did not feel prepared to vote on the report, given lack of sufficient data from the state on current overdose trends and the impact of previously dispersed funds.

The advisory board is tasked with making recommendations for the millions of dollars that New York received through legal settlements with the pharmaceutical companies that drove the opioid crisis. The Office of Addiction Services and Supports, which disperses the funds, has made hundreds of millions of dollars available so far. The board anticipates $65 million in opioid settlement fund appropriations in the 2026 fiscal year, including more than $45 million earmarked for the state and about $19 million for local efforts, according to the report.

The board’s 2024 report repeated many recommendations from previous years, including prioritizing funds for harm reduction initiatives like syringe service programs and overdose prevention centers. The board also renewed its call for a public health emergency declaration for the opioid crisis, which Hochul has resisted.

But in this year’s report, the board placed a greater emphasis on supporting grassroots organizations and investing in a system of care that helps those facing multiple challenges, including substance use and mental health disorders.

The board also emphasized the uneven landscape of the crisis and the need for racial equity in the disbursement of funds, describing the increasing rate of fatal overdoses among Black and Latino communities as an “overarching concern.” While local and national data indicate that the crisis stabilized somewhat in 2023, in New York City, overdose death rates remain disproportionately high among Black and Latino communities.

At the Oct. 28 meeting, many board members complained that they did not have sufficient data from state agencies, including OASAS and the state Department of Health, on which to base their recommendations.

Some members raised the prospect of delaying the board’s report, which is due annually on Nov. 1. This year’s report, due on Friday, was not made publicly available until Tuesday afternoon.

Dr. Justine Waldman, a board member, accused the state of “gaslighting” the board and deliberately withholding information and data, particularly surrounding harm reduction approaches to the crisis.

“We asked for data from the Department of Health about syringe service programs, we never received that,” Waldman said. “We asked about Hepatitis C. All these things that we’ve asked for, we haven’t received. And I’m very clear that all of this has been absolutely deliberate.”

During the meeting, OASAS Commissioner Dr. Chinazo Cunningham responded to members’ frustrations. She said OASAS had presented multiple times to the advisory board and that she was proud of her agency’s work to “integrate the recommendations into how the money has been distributed.”

“This Nov. 1 deadline is something that has been clear from the very, very beginning,” she said. “And I think that we certainly, as a state agency, have been working very closely with the chair since the beginning.”

Board member Anne Constantino raised concerns that the board’s recommendations were siloed from the state’s broader opioid crisis strategy, but advised moving forward with an “imperfect process.”

“I want to get a report out, because there’s money there, and we’ve got to hold people accountable to make the best decisions within the framework we’re presenting,” she said. “We’re just advisory. We can’t dictate anything. At the end of it, they’ve got to do the right thing with the money, and we’ve got to hold them accountable to it.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Georgia looks to use first $50M in opioid settlement to bridge gaps in help for drug abuse

2024-11-04T18:33:05+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

As the Georgia Opioid Crisis Abatement Trust prepares to distribute its first $50 million to address the overdose epidemic, state analyses show what prevention, harm reduction, treatment, and recovery resources Atlanta and the state need.

The analyses by the state’s Department of Behavioral Health and Developmental Disabilities on behalf of the trust focus on what services are missing in Georgia as a whole and different regions of the state.

The metro Atlanta region report points to a gap between the health needs of people with substance use disorder and the number of detox facilities, treatment centers, housing options, and addiction support services in the region — especially in Gwinnett County.

Kevin Tanner, the Department of Behavioral Health and Developmental Disabilities commissioner and the opioid trust’s manager, said these analyses will help him decide where he’ll award funding before the end of the year. The trust received over 300 grant applications earlier this year, according to a department spokesperson.

“That’s going to be the measuring stick we’re going to be using as we start looking at which grants should be funded,” Tanner said.

Over the past few years, Georgia’s overdose deaths have eclipsed all precedence in the state. The death rate in the state and the Atlanta region has tripled over the past two decades, as over 2,500 Georgia residents fatally overdosed in 2023.

Across the country, much of this rapid rise in overdose death has been attributed to companies within the pharmaceutical supply chain, which experts allege marketed and dispensed addictive opioid pain medications in ways that endangered the public. Studies show those past practices continue to have deadly consequences.

To address that harm, over a dozen companies have agreed to collectively pay over $50 billion to states across the country. Georgia is set to receive $638 million of those funds from AmerisourceBergen, Cardinal Health, Janssen Pharmaceuticals, and McKesson over the next 18 years. Settlement transparency groups expect the state will also receive around $200 million from Allergan, CVS, Mallinckrodt Pharmaceuticals, Teva Pharmaceuticals, Walgreens, and Walmart.

After attorney’s fees, a quarter of that money will go directly to local governments, and the remainder will go to the state’s Opioid Trust — with Tanner at the helm and a group of government officials advising him.

Gwinnett County lacks many drug recovery services

While the Behavioral Health Department’s statewide analysis found that Northern Georgia and Atlanta have more resources than other areas, its regional reports found needs in every part of the state.

In the metro Atlanta region, some of the sparsest services are centers for people to detox safely and housing for people early in their recovery. The report says Dekalb is the only county in the area that has both men’s and women’s recovery housing, which researchers view as crucial for addressing substance use disorder.

Gwinnett County, with a population of nearly 1 million, has neither services and lacks many other important ones, according to the report. Many ZIP codes in the county are economically disadvantaged, which the Behavioral Health Department says could be further adding to residents’ risk of a fatal overdose.

The government advisory group is set to meet publicly for the first time in mid-November and recommend how Tanner should award about $50 million of Opioid Trust funding. The public notice will go out soon, but a firm date for the meeting hasn’t been set, Tanner said. Soon after that meeting, he expects to grant the first round of funding.

Bill Carruthers, executive director of the Conyers addiction recovery support center Grit and Grace, is optimistic about how Georgia’s opioid settlements could help people with substance use disorders.

His nonprofit organization helps people, especially those who have recently left jail or prison, stay in recovery by connecting them with peer support, employment aid, and other resources. It also maintains a vending machine for the overdose-reversing drug naloxone at its building.

But he knows metro Atlanta organizations like Grit and Grace, which had a budget of $46,000 in 2022, need more money to bolster their services and help more people. While working on other grants kept him from applying for settlement money this year, Carruthers is pleased that a Rockdale group he closely partners with — Stepping Up Initiative — submitted a funding request.

“All one big team,” he said.

When the government advisory committee meets, it will also be reviewing the recommendations of councils representing six Georgia regions — which have been conducting workshops over the summer. Those meetings have not been open to the public, but Tanner said the council compositions are representative of the community’s interests, and their recommendations aren’t final.

By discussing these recommendations at a public meeting, publishing every winning application on the Trust’s website, and using a third-party group to evaluate whether Georgia’s overdose crisis is abating, Tanner hopes Georgia residents will be confident that funds are being well spent.

“We’ve brought in experts to really look at what do we currently have in Georgia and what are we missing,” he said. “And that’s what we’re going to be funding.”

Some groups more vulnerable in overdose crisis

Some of those experts are at the Emory University School of Medicine. Addiction psychiatrist Dr. Santosh Patel, who works in the university’s Department of Psychiatry and Behavioral Sciences, said he and his colleagues collaborated frequently with Tanner on his overdose response efforts with the trust and the state behavioral health department.

He said he was pleased to see Tanner incorporated some of their recommendations into the analyses the Opioid Trust published, and the reports do a good job considering all the different resources needed to help Georgians with substance use disorders.

But it is important, Patel said, to keep in mind that there are groups more vulnerable than others to the overdose crisis’ most harmful and deadliest impacts — groups like racial minorities, LGBTQ+ residents, pregnant Georgians, and people who are or have been incarcerated. He also expressed the desire to see more programs developed specifically for kids at risk of developing addictions.

He said the focus of these funding decisions should always be what can help those who have suffered the most in the past and may suffer the most in the future.

“Having the money to back up some good ideas is going to be incredibly important,” Patel said.

Carruthers sees the Georgia settlements as an opportunity to not only fund good ideas but also create a coordinated, collaborative, and sustainable approach to address addiction in the area.

He knows Georgians with addictions need both immediate aid and long-term solutions — and one nonprofit or government group can’t do it all.

“Somebody has to have the five-year plan, somebody has to have the five-minute plan,” he said.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

New York City data show first decline in overdose deaths in four years — but widening disparities

2024-10-17T22:16:39+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Drug overdose deaths in New York City decreased in 2023 for the first time in four years, according to data released Thursday by the Department of Health and Mental Hygiene.

The decline — from 3,070 deaths in 2022 to 3,046 deaths in 2023, a 1% decrease — was slight but promising, city officials said.

“I’m very cautiously and humbly excited about these data, because it shows overall that our comprehensive efforts here in New York City are starting to have an impact,” Health Commissioner Dr. Ashwin Vasan said during a media briefing on Thursday organized by The Big Cities Health Coalition, which represents health officials from major cities across the country.

Provisional data for 2024 released by the Health Department suggest a continuation of that downward trend, with 616 overdose deaths in the first quarter of this year — the lowest number of deaths per quarter since 2020.

“The first time since 2018 without a significant increase represents the beginnings, the green shoots, of progress,” said Vasan, who plans to step down from his post on Friday.

The city’s data mirror national trends. Earlier this year, the Centers for Disease Control and Prevention announced provisional data showing a 3% decrease in nationwide drug overdose deaths, from 111,029 estimated deaths in 2022 to 107,543 estimated deaths in 2023 — the first annual decrease since 2018.

In a statement, Mayor Eric Adams applauded the city’s decline in overdose deaths.

“A 1% decrease in drug overdose fatalities may not seem like a statistic worth celebrating to some — but those are still 24 fewer lives that were lost this past year, 24 families who still have their loved one around — and I believe that is a milestone worth recognizing,” he said.

Even so, New York City’s overdose death rate remains high. The rate of overdose death in 2023 (44.0 per 100,000 residents) has more than doubled since 2018 (20.2 per 100,000 residents) and nearly quadrupled since 2013 (11.4 per 100,000 residents).

The data released on Thursday also show widening disparities among the city residents who die of overdoses.

The rate of overdose death among white New Yorkers decreased 14% in 2023 — but increased 2% among Latino New Yorkers and remained high and largely unchanged among Black New Yorkers, according to the data.

Black New Yorkers ages 55 to 84 had the highest rate of overdose death (115.5 per 100,000 residents) compared to other demographic groups, and Bronx residents shouldered the highest rate of overdose death (78 per 100,000 residents) among residents of the five boroughs.

Vasan acknowledged the disproportionate burden of overdose deaths on older Black men in the city during Thursday’s briefing.

Those deaths, he said, reflect “the cumulative effects of long-term physical and health neglect, long-term social and economic need and marginalization, certainly the impacts of racism underlying all of that, and the impact on their fragility in the face of a shifting drug supply.”

Fentanyl, a synthetic opioid roughly 100 times more powerful than morphine, appeared in 80% of the city’s overall overdose deaths in 2023. The presence of xylazine, a veterinary tranquilizer, has become increasingly common, appearing in 31% of the city’s fatal overdoses last year.

In his remarks, Vasan highlighted the city’s use of opioid settlement funds to expand the hours of the city’s overdose prevention centers, invest in other syringe service providers, and support Relay, an emergency department-based nonfatal overdose response program.

His agency has weathered criticism from some harm reduction advocates, including members of the New York State Opioid Settlement Fund Advisory Board, over a perceived lack of transparency in the city’s allocation of its funds earmarked for treatment, recovery and prevention.

The funds come from legal settlements with pharmaceutical companies that produced and distributed opioids.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Poppy seed tea triggers morphine overdose, drawing attention of lawmakers

2024-10-09T16:40:54+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

It sounds like a joke: poppy seeds infused with opioids.

Indeed, it was a plotline on the sitcom Seinfeld. But for some it has been a tragedy.

People have died after drinking tea brewed from unwashed poppy seeds.

And after eating lemon poppy seed bread or an everything bagel, mothers reportedly have been separated from newborns because the women failed drug tests.

Poppy seeds come from the plant that produces opium and from which narcotics such as morphine and codeine are derived. During harvesting and processing, the seeds can become coated with the opium fluid.

Members of the House and Senate have proposed legislation “to prohibit the distribution and sale of contaminated poppy seeds in order to prevent harm, addiction, and further deaths from morphine-contaminated poppy seeds.” The bill was one of several on the agenda for a Sept. 10 House hearing.

The day before the hearing, The Marshall Project and Reveal reported on a woman who ate a salad with poppy seed dressing before giving birth, tested positive at the hospital for opiates, was reported to child welfare, and saw her baby taken into protective custody. Almost two weeks passed before she was allowed to bring her baby home, the story said.

“It’s not an urban legend: Eating poppy seeds can cause diners to test positive for codeine on a urinalysis,” the Defense Department warned military personnel in 2023.

The U.S. Anti-Doping Agency long ago issued a similar warning to athletes.

Watchdog sues FDA over seeds’ opiate content

The Center for Science in the Public Interest, a watchdog group, petitioned the FDA in 2021 to limit the opiate content of poppy seeds. In May, after more than three years with no response, it sued the agency to force action.

“So far the FDA has been negligent in protecting consumers,” said Steve Hacala, whose son died after consuming poppy seed tea and who has joined forces with CSPI.

The lawsuit was put on hold in July, after the FDA said it would respond to the group’s petition by the end of February 2025.

The FDA did not answer questions for this article. The agency generally does not comment on litigation, spokesperson Courtney Rhodes said.

A 2021 study co-authored by CSPI personnel found more than 100 reports to poison control centers between 2000 and 2018 resulting from intentional abuse or misuse of poppy seeds, said CSPI scientist Eva Greenthal, one of the study’s authors.

Only rarely would baked goods or other food items containing washed poppy seeds trigger positive drug tests, doctors who have studied the issue said.

It’s “exquisitely doubtful” that the “relatively trivial” amount of morphine in an everything bagel or the like would cause anyone harm, said Irving Haber, a doctor who has written about poppy seeds, specializes in pain medicine, and signed the CSPI petition to the FDA.

On the other hand, tea made from large quantities of unwashed poppy seeds could lead to addiction and overdose, doctors said. The risks are heightened if the person drinking the brew is also consuming other opioids, such as prescription pain relievers.

Benjamin Lai, a physician who chairs a program on opioids at the Mayo Clinic in Rochester, Minnesota, said he has been treating a patient who developed long-term opioid addiction from consuming poppy seed tea. The patient, a man in his 30s, found it at a health food store and was under the impression it would help him relax and recover from gym workouts. After a few months, he tried to stop and experienced withdrawal symptoms, Lai said.

Another patient, an older woman, developed withdrawal symptoms under similar circumstances but responded well to treatment, Lai said.

Some websites tout poppy seed tea as offering health benefits. And some sellers “may use specific language such as ‘raw,’ ‘unprocessed,’ or ‘unwashed’ to signal that their products contain higher concentrations of opiates than properly processed seeds,” the CSPI lawsuit said.

Poppy seeds ‘very likely’ caused man’s death

Steve Hacala’s son, Stephen Hacala, a music teacher, had been experiencing anxiety and insomnia, for which poppy seed tea is promoted as a natural remedy, the lawsuit said. In 2016, at age 24, he ordered a bag of poppy seeds online, rinsed them with water, and consumed the rinse. He died of morphine poisoning.

The only source of morphine found in Stephen’s home, where he died, was commercially available poppy seeds, a medical examiner at the Arkansas State Crime Lab said in a letter to the father. The medical examiner wrote that poppy seeds “very likely” caused Stephen’s death.

Steve Hacala estimated that the quantity of poppy seeds found in a 1-liter plastic water bottle in his son’s home could have delivered more than 10 times a lethal dose.

Steve Hacala and his wife, Betty, have funded CSPI’s efforts to call attention to the issue. (The publisher of KFF Health News, David Rousseau, is on the CSPI board.)

The lawsuit also cited mothers who, like those in the investigation by The Marshall Project and Reveal, ran afoul of rules meant to protect newborns. For example, though Jamie Silakowski had not used opioids while pregnant, she was initially prevented from leaving the hospital with her baby, the suit said.

Silakowski recalled that, before going to the hospital, she had eaten lemon poppy seed bread at Tim Hortons, a fast-food chain, CSPI said in its petition. “No one in the hospital believed Ms. Silakowski or appeared to be aware that the test results could occur from poppy seeds.”

People from child protective services made unannounced visits to her home, interviewed her other children, and questioned teachers at their school, she said in an interview.

While on maternity leave, she had to undergo drug testing, Silakowski said. “Peeing in front of someone like I’m a criminal — it was just mortifying.”

Even family members were questioning her, and there was nothing she could do to dispel doubts, she said. “Relationships were torn apart,” she said.

The parent company of Tim Hortons, Restaurant Brands International, which also owns Burger King and Popeyes, did not respond to questions from KFF Health News.

In July, The Washington Post reported that Trader Joe’s Everything but the Bagel seasoning was banned and being confiscated in South Korea because it contains poppy seeds. Trader Joe’s did not respond to inquiries for this article. The seasoning is listed for sale on the company’s website.

The U.S. Drug Enforcement Agency says unwashed poppy seeds can kill when used alone or in combination with other drugs. While poppy seeds are exempt from drug control under the Controlled Substances Act, opium contaminants on the seeds are not, the agency says. The Justice Department has brought criminal prosecutions over the sale of unwashed poppy seeds.

Meanwhile, the legislation to control poppy seed contamination has not gained much traction.

The Senate bill, introduced by Sen. Tom Cotton, R-Ark., has two co-sponsors.

The House bill, introduced by Rep. Steve Womack, R-Ark., has none. Though it was on the agenda, it didn’t come up at the recent hearing.

David Hilzenrath is a reporter for KFF Health News, Healthbeat’s national reporting partner.

Amid opioid crisis, NY settlement fund advisory board members urge emergency declaration

2024-09-13T22:59:28+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

As New Yorkers continue to die of opioid overdoses, Gov. Kathy Hochul has resisted calls to declare a public health emergency, frustrating advocates and providers who believe the move could accelerate efforts to mitigate the crisis.

During a meeting Friday of the Opioid Settlement Fund Advisory Board — which is tasked with making recommendations for the allocation of money from settlements with the pharmaceutical companies that drove the crisis — many members expressed dismay over the absence of an emergency declaration from the state.

Joyce Rivera, a member of the advisory board and chief executive officer of St. Ann’s Corner of Harm Reduction, a syringe exchange program in the Bronx, argued that the advisory board should push for a public health emergency declaration.

“When you have power, as we do, you should use that power,” she said.

New York City recorded 3,026 overdose deaths in 2022, the highest number since reporting started in 2000, according to the city Department of Health. That record-high number of deaths reflected the significant spike in overdose deaths during the first years of the Covid-19 pandemic. In 2022, overdose deaths in the city were concentrated among Black New Yorkers, as well as among residents of the Bronx and Staten Island.

Hochul’s reticence to declare a public health emergency – which would expand the state’s power to address the crisis — has long frustrated advocates, New York Focus reported last year.

This year, pressure has mounted on Hochul to make the move. In April, 56 state lawmakers signed a letter urging Hochul to declare an emergency, which they said could waive cost-sharing for those seeking substance use treatment services, increase Medicaid rates for such services, better address staffing issues, and allow community-based organizations to improve their overdose prevention services.

A bipartisan task force on Staten Island also called on Hochul to declare a public health emergency earlier this year.

“Our administration is engaged in aggressive, ongoing efforts to address the opioid and overdose epidemic, which has tragically taken far too many neighbors, friends, and family members in New York and across the nation,” a spokesperson for Hochul said in a statement. “Our efforts are making an impact, as recently released federal data showed that overdose deaths are declining across New York – and we’re working every day to keep deploying the resources that save lives and ensure New Yorkers struggling with addiction get the support they need.”

Every NYC school building now has Narcan to reverse opioid overdoses. Is it enough?

Provisional data from the Centers for Disease Control and Prevention indicate a 13.8 percent decrease in overdose deaths in New York state in the 12-month period ending in April 2024, compared to the prior 12-month period, and a 6.4 percent decrease in the same period in New York City, although the data are incomplete.

The federal government declared the opioid crisis a public health emergency in 2017. Some states, including Arizona, Massachusetts and Florida, have issued statewide emergency declarations, enabling actions such as new prescription guidelines and expanded access to naloxone.

At Friday’s meeting, while some advisory board members expressed caution about straying too far from their task of allocating settlement funds, others stressed that a public health emergency declaration was an untapped weapon in the state’s arsenal.

“We have a responsibility to hold the governor accountable, because at the end of the day, she is the one that continues to not pay attention,” said advisory board member Ashley Livingston.

Tracie Gardner, an advisory board member and co-director of the National Black Harm Reduction Network, emphasized that the advisory board should use every possible tool to address the opioid crisis and increase pressure on the state for its response.

“I don’t understand the resistance to declaring the public health emergency, other than the fear that that will make the case for the establishment of some pilot overdose prevention centers,” Gardner said.

New York City has two overdose prevention centers, where users can consume drugs in a supervised setting. The sites exist under an agreement between the mayor and the police, although they remain illegal under federal, state, and local law.

The advisory board has repeatedly urged the state to use some of its settlement funds to support overdose prevention centers. But Hochul has voiced opposition to doing so.

At Friday’s meeting, some board members also reiterated frustration toward New York City for a lack of transparency in its spending of settlement funds, an issue the THE CITY reported on earlier this year.

In a report issued this month, New York City reported receiving a total of $154.3 million in settlement funds. In the past fiscal year, the city appropriated $33 million in funds, according to the report. Earlier this week, New York City Mayor Eric Adams released broad plans for allocating $50 million in settlement funds annually by fiscal year 2027.

The advisory board is scheduled to reconvene on Sept. 24.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Every NYC school building now has Narcan to reverse opioid overdoses. Is it enough?

2024-08-20T19:26:14+00:00

This story was originally published by Chalkbeat New York. Sign up for Chalkbeat New York’s free daily newsletter to keep up with NYC’s public schools.

Vince Muccioli will never forget the terror he felt waiting for paramedics as one of his students lay unresponsive on the classroom floor, color draining from his face.

It was a quiet Friday afternoon in March 2022, and Muccioli, a math teacher at West Brooklyn Community High School, had given the student permission to lay his head on his desk.

When a classmate later nudged the student and he wouldn’t wake up, Muccioli knew something was very wrong. The student’s pulse was racing, but he was barely breathing, recalled Muccioli, who immediately alerted the school nurse and told a student to call 911.

The thought of a drug overdose crossed Muccioli’s mind, but in his 15 years teaching, he’d never seen a student have one and didn’t know how to respond.

Fortunately, paramedics arrived within 15 minutes and administered Naloxone, a nasal spray that can reverse the effects of an overdose. The student revived immediately, Muccioli said.

“Those 15 minutes,” Muccioli said, “could’ve been the difference between life and death.”

Soon after the incident, Principal Malik Lewis invited the nonprofit Harm Reduction Coalition to train his staff on using Naloxone and provide educators with their own kits.

Nearly two-and-a-half years later, the rest of the nation’s largest school system has moved in a similar direction. Every school now stocks Naloxone, all school nurses are trained on administering the overdose reversal agent, and the Education Department is bringing the training to additional school staff, city officials said. This spring, the city partnered with New York University’s Langone Hospital to train roughly 300 educators on administering Naloxone, said Kelleyann Royce-Giron, the Education Department’s head of substance abuse programs.

“We see what we’re seeing in emergency rooms … youth that are coming in with overdoses,” said Royce-Giron at a training for about 50 educators last month at NYU’s Tisch Hospital. “The biggest space that we can help our New York City youth is in the biggest school district in the world, the New York City public schools.”

A participant at the June 24, 2024 Naloxone training displays the free Naloxone kits distributed to educators.

The effort to bring Naloxone, also known by the brand name Narcan, into schools is part of a larger push to make the reversal agent as widely available as possible in the city, including in pharmacies, bars, and public health vending machines created by the city Health Department. Some NYPD officers also carry Naloxone, though a police spokesperson didn’t immediately respond to a question about whether school safety agents — the more than 4,000 unarmed police officers stationed inside public schools — carry it.

This push follows similar moves in school systems across the country. As of 2023, 33 states including New York had laws permitting schools to stock Naloxone, according to an analysis by Kaiser Health News. A smaller number went further by requiring schools to carry the reversal agent, the analysis found, though some schools and districts have resisted for fear that carrying Narcan would indicate a larger drug problem. Several districts in Long Island require schools to stock Naloxone, and the state offers a program for school districts to train staff in administering the reversal agent.

A 2023 survey by NPR found that 11 of the nation’s 20 largest school districts require schools to stock Narcan.

Overdoses in schools appear to be rare, but the risk is real, according to staffers and experts. Los Angeles Unified School District, the nation’s second largest, required all schools to carry Naloxone and began training staff and volunteers after a 15-year-old died of an overdose at school in 2022.

In New York City, the number of 15- to 24-year-olds who have died from opioid overdoses has nearly doubled in recent years, from 48 in 2019 to 87 in 2022, the last year for which the city Health Department published data. Almost all of those deaths involved fentanyl, an extremely potent synthetic opioid that can be lethal in even small doses, or heroin, the Health Department analysis found.

Fentanyl is 30 to 50 times more powerful than heroin and is often mixed into drugs like heroin or cocaine or found in counterfeit pills meant to look like Adderall or Percocet, NYU trainers told educators.

A Health Department spokesperson said the agency isn’t aware of any confirmed opioid overdoses of students in school last school year. Two city principals have told Chalkbeat they’re aware of Naloxone being administered on a student during school in recent years, though the Health Department spokesperson noted that the use of Naloxone doesn’t mean the incident was a confirmed opioid overdose.

In New York City, the 2023 death of a 1-year-old in a Bronx daycare from inhaling Fentanyl-laced dust captured the attention of the city and helped spur City Council legislation to stock Narcan in middle and elementary schools.

Larrisa Laskowski, a doctor of emergency medicine at NYU Langone Hospital and director of NYU’s Prevention Education Partnership, which works with the Education Department to offer Naloxone training, said the city shouldn’t wait for a similar tragedy in a public school.

“We can be proactive. We can get this perfect, very effective, very safe antidote in schools to protect young people as we’re trying to deal with the Fentanyl crisis in many other ways,” she said.

Educators point to gaps in Naloxone training, access

Teens are not immune from the growing opioid crisis that has gripped the city and the country in recent years, health officials said.

Educators across the city have reported an uptick in visible drug use during the school day since the return of in-person schooling following the COVID school shutdowns. Grappling with an ongoing mental health crisis, some teens have turned to substances as a coping mechanism. At the same time, the city’s drug landscape has rapidly changed due to the proliferation of smoke shops following the state’s rocky rollout of legalized marijuana.

“After we came back from the epidemic, I definitely see that there’s definitely a higher usage of students just self-medicating,” said Manolo Polanco, a dean at Fordham Leadership Academy in the Bronx, who attended one of the recent Narcan trainings. He said he’s had to call 911 several times for students feeling unwell after taking drugs, though fortunately none of the cases were serious.

Despite the recent progress in trainings, some educators worry there are still gaps in the city’s efforts to ensure schools are prepared to respond to student overdoses.

At Brooklyn Technical High School, the city’s largest school with nearly 6,000 students spread across eight floors, “having one or two nurses dealing with an overdose … means nothing because you won’t get to them in time to save their life,” said a staffer at the school, who spoke on the condition of anonymity because they weren’t authorized to talk to the media.

Naloxone training should be mandated for multiple staffers at each school, similar to the way epi-pen training is mandatory for multiple staffers at schools where a student has a documented risk, the Brooklyn Tech staffer said.

Education Department officials said that anyone trained in Naloxone can carry and administer it at school, but the Brooklyn Tech staffer said that message “is not going out to everyone,” noting that many staffers at the school are under the impression that only the nurse can administer the reversal agent.

The city has also long struggled with nursing shortages: Roughly 140 schools didn’t have a nurse before the pandemic, according to the nonprofit Advocates for Children. The city used $65 million a year in one-time federal pandemic aid to hire an additional 400 contracted school nurses, but that money expired this year and was not replaced in the budget, according to advocates.

An Education Department spokesperson said officials are still “placing [a] nurse in every school and do not expect schools to be without a nurse,” but didn’t elaborate on where the funding will come from.

Trainings seek to make educators confident first responders

The technical requirements of administering Naloxone are fairly simple. It’s a nasal spray that doesn’t require any special technique and has no adverse side effects, according to Laskowski.

But the training sessions for school staffers are less about the technique than about giving educators “the confidence they need to feel like they can act,” Laskowski said.

That’s part of why Laskowski said she’s pushed back against suggestions to make the training sessions virtual, even though that might make them accessible to more people. It’s important to build the kind of comfort and familiarity that comes with in-person training, she said.

Royce-Giron — who oversees the school system’s roughly 260 Substance Abuse Prevention and Intervention Specialists, or SAPIS — appreciates the chance to dispel some commonly held concerns, including assuring attendees that fentanyl can’t be absorbed through the skin. She also takes pains to remind the educators that the state’s “Good Samaritan” law offers legal protection to people who intervene to try to save someone during an overdose.

Sherille Sheppard, a special education teacher who attended the training, said she found it “very informative.”

“I was glad to get the hands-on piece to really show me how easy it is to use Naloxone,” she said. “It’s really just as easy as using a nasal spray.”

Polanco, the Bronx high school dean, left the training feeling “a little bit more prepared” to identify an overdose. “Before, I don’t know if I even would have been able to identify it, to me it would have just been a kid passed out.”

At West Brooklyn Community High School, the importance of carrying Narcan wasn’t the only lesson to emerge from the close call with the student overdose.

The incident was a vivid reminder to staff that no matter how ill-equipped they might feel in the moment to deal with some of the complex challenges students are facing – from serious drug use to suicidal ideation – it’s vital to engage.

“When a student comes to confide in you, talk to them,” Muccioli said. “No matter how heavy the situation is, talk to them. Because there’s a window where they might tell you and only you.”

Michael Elsen-Rooney is a reporter for Chalkbeat New York, covering NYC public schools. Contact Michael at melsen-rooney@chalkbeat.org .