Gotham Gazette http://www.gothamgazette.com/component/tags/tag/1993 Mon, 19 Nov 2018 03:14:43 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) City Health Commissioner Explains Essential Path to Fight Opioid Epidemic http://www.gothamgazette.com/city/7830-city-health-commissioner-explains-essential-path-to-fight-opioid-addiction http://www.gothamgazette.com/city/7830-city-health-commissioner-explains-essential-path-to-fight-opioid-addiction brasset hac

Dr. Mary Bassett (photo: @nycHealthy)


Last year, 1,441 individuals in New York City died of a drug overdose, most of which were opioid-induced, and current trends indicate that the death count in the city only stands to rise. But as much as these drugs can cause death, Dr. Mary Bassett, the city’s health commissioner, is arguing that others can prevent it.

During a recent appearance on the What’s the [Data] Point? podcast from Gotham Gazette and Citizens Budget Commission, Bassett, the commissioner of the city’s Department of Health and Mental Hygiene, said that the controlled use of narcotics like methadone and buprenorphine do wonders for those addicted to opioids, and that the city must increase accessibility to and use of these life-saving treatments.

Methadone treatment has long been the primary means of treating opiate addiction. Methadone is an opioid, like morphine, heroin, and oxycodone, but its relative mildness is meant to alleviate a recovering addict’s desire for the stronger opioids. By inhibiting opioid receptors in the brain, methadone is also meant to reduce feelings of withdrawal.

Similar to methadone, buprenorphine is a drug that can minimize cravings and withdrawal symptoms in a person with an opioid-use disorder. Unlike methadone, it is a partial opioid agonist, meaning that its euphoric effects are weaker than those of full opioid agonists like methadone and heroin. Buprenorphine’s opioid effects intensify with increases in dose size only up to a certain point, meaning that a user would get no stronger effect from a large dose than they would from a medium one, an appealing trait for addiction specialists.

“People on methadone or buprenorphine get their lives back, they restore their relationships with their family and they go back to work,” Bassett said on the podcast, pointing to their significantly more prevalent use elsewhere in the world.

Methadone and buprenorphine treatment regimes are strictly regulated in the United States.

Methadone is one of the most extensively controlled therapeutic drugs in the country, according to the National Institutes of Health, and its medical use is regulated by a host of government bodies, including the Drug Enforcement Administration, the National Institute on Drug Abuse, the Substance and Mental Health Services Administration, and the Food and Drug Administration. Federal regulations require patients to take methadone in-person at a treatment site while medical professionals observe. Patients who take the medication regularly for six months can receive permission to take home up to a month’s supply of methadone, according to the Pew Charitable Trusts.

Buprenorphine has similarly strict regulations. In the United States, doctors must take a special, eight-hour class in order to qualify for a physician waiver that would allow them to dispense buprenorphine. However, barriers like the high cost of classes, the daunting nature of treating drug-addicted individuals, and lack of information can discourage medical professionals from receiving the waiver.

New York City Mayor Bill de Blasio and his wife, Chirlane McCray, who helps coordinate the administration’s health care initiatives, have both spoken about the need to expand the number of doctors and physicians who can prescribe buprenorphine. Nevertheless, the development of buprenorphine prescribers has been slower than expected.

Bassett said she’s dedicated to training more physicians so that they can get the authorization required to distribute Buprenorphine.

“Physician’s assistants and nurse practitioners can now prescribe it due to a new law which expands the access to buprenorphine prescribing,” Bassett said during the podcast. “But getting trained to prescribe it isn’t enough, so we have a nurse care-manager program where we work with primary care practitioners to actually make sure that they start prescribing and identifying people who are using opioids.”

The city has a goal of increasing the number of patients who receive buprenorphine treatment from 38,000 to 58,000 over the next five years. Bassett said that there is no definitive estimate of the number of New Yorkers who are misusing opioids, but the number has clearly increased, as has the death toll.

“Buprenorphine is very underused in the United States compared to other countries,” Bassett said. “France, for example, stopped its opioid use almost entirely with buprenorphine…We’re training people, we’ve committed to training 1,500 new prescribers.”

Bassett said the U.S. should look to follow in the footsteps of other countries that have distributed buprenorphine at higher rates. In France, in response to a severe heroin crisis, doctors have been able to prescribe buprenorphine without special licensing or training since 1995. As a result, ten times as many addicted patients received medication-assisted treatment than they had before the loosening of restrictions, and, within four years of the policy’s initiation, overdose deaths had declined by 79 percent.

New York City is also expanding the distribution of naloxone, a synthetic drug similar to morphine that blocks opiate receptors in the nervous system and can be used to halt potentially-lethal overdoses. The city recently added $22 million to its citywide plan to fight the opioid crisis, HealingNYC, increasing total investment to $60 million a year. The new investment will be used toward establishing peer intervention programs at more hospitals and increasing the distribution of naloxone. Since the launch of HealingNYC, the city has distributed nearly 100,000 naloxone kits to opioid overdose prevention programs. Some of the money has also been dedicated to policing efforts, which has drawn criticism from some advocates. The city is also planning to pilot four "overdose prevention centers," a controversial program by which people can find a safe place to take drugs, while also being pitched on counseling and other services.

Bassett said she helped spearhead the initiative to provide those struggling with addiction greater access to naloxone, which included making the drug available over-the-counter at every major pharmaceutical chain in New York City.

“We began with a real press to get naloxone out to people who are using drugs, to people who know people who use drugs, and we want anybody who’s using drugs to have naloxone around so that they can be reversed,” Bassett said during the podcast. Individuals suffering from an overdose “start out blue and you give them naloxone and they pink up. They start breathing again and it’s really a miracle, and now it’s provided in formulations that are really easy to administer.”

But she cautioned that naloxone is not a form of treatment: “It literally just reverses overdoses.” Bassett stressed that people “want to live” and that people abuse drugs because they are addicted, while there are often other underlying causes.

Naloxone is more important than ever now, Bassett said, due to the rise of fentanyl, a potent street opioid said to have helped caused overdose rates to increase by 50 percent between 2016 and 2018.

“Our street drugs have never been more dangerous,” she warned.

Bassett said that, though New York City has seen some successes, it has more work to do.

“What the numbers show is that we’ve flattened the curve,” Bassett said of opioid overdose deaths. “We want to see it go down, and it has gone down in Staten Island and Manhattan, but it still hasn’t gone down in the Bronx or in Brooklyn.”

Race complicates the matter, as well. Bassett spoke frankly about race affecting perceptions of opioid users; the current opioid epidemic, wherein victims are mostly coded as white, has spurred far more sympathetic, public health-oriented action than previous opioid epidemics wherein victims were mostly represented as black.

While white Americans do suffer from opioid addiction at higher rates than black Americans, the nation recently experienced a 50% increase in overdose deaths of African-Americans, said Bassett. She also pointed to the stigma around methadone as something that needed to be further tackled, while indicating that stigma is another reason to pursue more prescription of buprenorphine.

For all the geographic, racial, and class-based distinctions among opioid users, though, Bassett’s guiding public health principle is that “Every life counts.”

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A methadone provider in the city can be found here, buprenorphine providers are found here, and anyone struggling with addiction can contact NYC Well, New York’s confidential hotline, by calling (888) NYC-Well (888-692-9355) or texting “WELL” to 651-73.

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by Daniel Yadin for Gotham Gazette

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City Health Commissioner Explains Essential Path to Fight Opioid Epidemic Thu, 26 Jul 2018 04:00:00 +0000
City Awaits State Permission to Open ‘Overdose Prevention Centers’ http://www.gothamgazette.com/city/7819-city-awaits-state-permission-to-open-overdose-prevention-centers http://www.gothamgazette.com/city/7819-city-awaits-state-permission-to-open-overdose-prevention-centers de Blasio opioid

Mayor de Blasio & HealingNYC (photo: Ed Reed/Mayor's Office)


More than 1,400 New Yorkers died of drug overdoses in 2017, most of them the result of opioid abuse, and one of the next steps the administration of Mayor Bill de Blasio plans to take in fighting rampant opioid addiction is to open safe injection sites, which the administration is calling “overdose prevention centers.” There is currently no timeline for the four planned pilot sites to open, the city’s health commissioner said during a recent interview, as the de Blasio administration waits for approval from its state-level counterparts.

At a safe injection site, individuals struggling with addiction are allowed to inject and consume drugs under the supervision of medical professionals. Over 100 safe injection sites operate around the world in more than 60 cities, and the first North American location launched in Vancouver, Canada in 2003. It prevents approximately 35 cases of HIV and three deaths a year, according to a 2008 study conducted by the University of Pennsylvania.

Safe injection sites are generally thought to reduce the health risks of drug addiction by providing sterile and safe equipment, like needles, access to medical staff, and treatment referrals, with the hope that users will seek a pathway out of drug use. They also concentrate drug use in controlled locations, reducing the public disorder associated with public injections and improper syringe disposal. According to New York City officials, no one has ever died inside a safe injection site.

The New York City Department of Health and Mental Hygiene plans to run a one-year pilot program establishing four safe injection sites, with one each in Manhattan’s Washington Heights and Midtown neighborhoods, Brooklyn’s Gowanus, and Longwood, in the Bronx --- all at sites currently run by community non-profits that offer needle-exchange programs and would run the “overdose prevention centers” with the city’s blessing and a beefed up police presence nearby.

As DOHMH released a report studying the possibility and recommending the pilot, de Blasio, a second-term Democrat, gave his blessing, pending certain next steps. The decision immediately provoked blowback from Republicans and some moderate Democrats, like the Staten Island district attorney, Michael McMahon. Some don't want city government sanctioning any drug use, others worry about impacts on communities where the sites may be opened, either in the first round or beyond.

De Blasio has said that the program “will save lives and get more New Yorkers into the treatment they need to beat this deadly addiction.” The city plans to open facilities only after a six-to-twelve-month period of outreach to residents of the planned neighborhoods, and once it receives a permission of sorts from the State.

Department of Health and Mental Hygiene Commissioner Dr. Mary Bassett discussed her support of the opening of the sites and the larger context of the city’s efforts to fight drug abuse and addiction in New York City during a recent appearance on the “What’s The [Data] Point?” podcast from Gotham Gazette and Citizens Budget Commission.

She said that a recent modeling exercise showed that these sites could save up to 130 lives a year. New York City recently reached record numbers of overdose-related deaths, with 1,441 New Yorkers killed in 2017.

“These deaths are all preventable and we want to ensure that people survive opioid use,” she said. “These sites will save lives, they will reduce transmission of preventable diseases like HIV or Hepatitis B or C, and they will provide people with a first step towards being in a safer place, including being on treatment.”

Bassett also said that the facilities would provide safety and protection for those struggling with addiction, particularly women, who may be subject to predatory activity while under the influence of opioids.

The plan, however, is contentious.

For one, it may violate federal law. The legality of safe injection sites has never before been tested in court, but a Department of Justice attorney in Vermont stated last year that workers at safe injection sites would be exposed to criminal charges, and the sites’ property would be vulnerable to federal forfeiture.

Bassett said that the city has requested that the state Department of Health “provide a legal umbrella” for the plan, but that nothing has yet been developed.

"Unfortunately, the timeline is really dependent on actions that the city doesn’t entirely control," Bassett said. "The mayor made a couple of conditions, he said that he wanted to see the state provide a legal umbrella for a demonstration project that Deputy Mayor Herminia Palacio wrote to the State Health Commissioner requesting this research designation and there’s been some back and forth on that but it hasn’t been acquired. The next thing was to have the elected official who represented the district where the OPC, as we call them now, was planned should support its implementation, and finally that there would be a community consultation process whereby communities can express their concerns and efforts can be made to address those concerns. That’s the process but at the moment it doesn’t have a timeline. Obviously as health commissioner, I’m confident that these would save lives."

Jonah Bruno, the New York State Department of Health director of communications, wrote in an email to Gotham Gazette that the city’s plan is currently being evaluated.

“We are reviewing the City’s proposal,” Bruno wrote. “We support the mission of reducing opioid related deaths and have been studying multiple options for combating the opioid epidemic.”

Special Narcotics Prosecutor Bridget Brennan highlighted the legal risks of safe injection sites during a televised forum on the opioid crisis broadcast by NY1 in May, during which Bassett also participated.

“First and foremost, they’re not legal,” Brennan said. “They’re not legal under state law and they’re not legal under federal law.”

“When you look at the potential benefit from the safe injection site and you balance it off against the downsides,” she continued, “I think you just come up saying, ‘this just isn’t a good deal.’”

The plan is also controversial for reasons beyond its legality. Bassett said that, while de Blasio supports the proposal, he has several preconditions for its enactment, including the approval of elected officials representing districts slated to host sites and the implementation of a community consultation process.

Bassett acknowledged on What’s the [Data] Point? that the facilities would only be a relatively small part of the city’s broader response to the opioid epidemic. While they are projected to save hundreds of lives, the city has thousands of overdose deaths to eliminate, and a much more expansive set of programs that opening the injection sites.

Last year, as part of its HealingNYC plan to reduce drug overdose deaths by 35 percent over the next five years, DOHMH unveiled a campaign to encourage judicious prescribing, including one-on-one educational visits with clinicians. Bassett said that doctors should prescribe opioids less often, for shorter durations, and at lower doses.

“[The overdose prevention centers] would never be enough, and we really shouldn’t start thinking of them as a magic bullet,” she said. “They’re part of a multi-pronged response.”

What it boils down to, Bassett said, is that people with a drug addiction “don’t want to die. They want to be in a safe place...We want to make sure people survive opioid use.”

[LISTEN: What's The [Data] Point? 1,441, with City Health Commissioner Dr. Mary Bassett]

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by Jordan Kimmel & Daniel Yadin
@GothamGazette

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City Awaits State Permission to Open ‘Overdose Prevention Centers’ Sun, 22 Jul 2018 04:00:00 +0000
What's The [Data] Point? 1,441, with Health Commissioner Dr. Mary Bassett http://www.gothamgazette.com/city/7797-what-s-the-data-point-1-441-with-dr-mary-bassett http://www.gothamgazette.com/city/7797-what-s-the-data-point-1-441-with-dr-mary-bassett whats the data point


What's The [Data] Point? Episode 46 -- 1,441, with Dr. Mary Bassett, Commissioner of the NYC Department of Health and Mental Hygiene [You can download What's The [Data] Point? wherever you get your podcasts, including on iTunes]

wtpd dr bassett w maria and ben

Dr. Mary Bassett is the city's health commissioner, a position she has held since 2014, when newly-elected Mayor Bill de Blasio appointed her. Her portfolio includes helping New Yorkers achieve better health practices and outcomes, fighting the opioid addiction epidemic, combatting lead poisoning of children, and more. She joined the podcast to discuss some of her efforts to improve health equity in New York City.

Listen to the conversation and let us know what you think: Ben Max of GG (@TweetBenMax), Maria Doulis of CBC (@MariaDoulis). Listen below or download wherever you get your podcasts!

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by Ben Max, Gotham Gazette
     

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What's The [Data] Point? 1,441, with Health Commissioner Dr. Mary Bassett Wed, 11 Jul 2018 04:00:00 +0000