Gotham Gazette Thu, 04 Mar 2021 21:48:13 +0000 Joomla! - Open Source Content Management en-gb (Webmaster) As State Withholds Contract Payments, Substance Use Treatment Providers Worry About Rising Overdoses, Disease Outbreaks comm train college

Naloxone training to reverse overdoses (photo: Edwin J. Torres/Mayoral Photo Office)

With the pandemic blowing a hole in the economy and leading to a drastic drop in state tax revenue, budget officials have for months been withholding payments for state contracts to manage cash flows. Among the victims of that fiscal approach are substance use treatment providers who are being forced to cut already-limited services and consider staff layoffs and furloughs, which they say will likely lead to a sharp increase in overdoses and new disease outbreaks around the state. 

The pandemic caused a 14% drop in expected revenue for the state in the current fiscal year, roughly $13.3 billion, leading the state to reduce $4 billion in spending so far by withholding contract payments across the board and imposing freezes on new contracts, hiring, and pay raises, according to the Division of Budget. Governor Andrew Cuomo has said the state cannot meet the shortfall unless the federal government provides aid, failing which he would cut about 20%, or $8.2 billion, of funding for local governments for everything from education and social services to health care programs. 

But several nonprofit providers that contract with the state to run substance use treatment programs – including syringe exchanges, sexually-transmitted infection (STI) screenings, naloxone overdose rescue training, and more – are already feeling the crunch, having gone months without being paid by the state. The state has also cut local funding for substance use and addiction treatment programs by 31%, according to news reports, exacerbating providers’ worries about being able to provide services.

In interviews, providers and harm reduction advocates painted a dire picture. They say that the already rising rate of overdoses that they are witnessing is at risk of spiking to the same levels as 2016, when the opioid epidemic reached its peak and spurred local and state officials into action. Since official data lags behind and could be unavailable until even a year after the fact, they fear that by the time the actual numbers become apparent, it will be too late. A generational crisis could be underway.  

Syracuse-based ACR Health receives nearly 90% of its funding from the state Department of Health and has been grappling with months of delayed payments. The nonprofit has had to furlough 70 out of 142 staff members and close three of its five offices. “We've really been struggling with the lack of consistent payments from the state,” said Wil Murtaugh, ACR Health executive director, in a phone interview, noting that the state was more than $1 million behind in payments. The first notice they received that funds would be placed on hold was near the end of June, leaving the group scrambling for solutions. 

Alessandra Miller, director of ACR’s Department of Drug User Health, said the organization was planning to resume outreach operations that were suspended when the pandemic hit. “We're no longer really able to perform physical outreach to this population because of this lack of funding,” she said. 

Besides Syracuse, ACR also has centers in Utica and Watertown, but they have had to cut services at those two centers down from five days a week to two. Their programs cover nine counties in and around the area, where people have the highest needs.

“Of course, that's going to increase overdoses and consequently deaths related to overdoses. But also, you're talking about latent consequences of drug use and substance use like HIV and Hepatitis C,” Miller added. Miller and Murtaugh said their testing program has already seen a massive increase in STIs.

Jay Dewey, a spokesperson for Hudson Valley Community Services, similarly said his organization has not been paid for most of its state contracts since February. They’re owed as much as $1.6 million and they may have to resort to dipping into reserve funds while also relying on a federal Paycheck Protection Program loan. “But the TPP funding will be gone within a few days and so we estimate that by the end of August, we may need to look at furloughs, layoffs and a reduction of some of our services,” he said. 

The nonprofits may also have no option to enforce the contracts. Dewey said a state elected official suggested that they may have grounds to file a lawsuit against the state for nonpayment. “But that's kind of laughable because if we don't have money to continue programs, how will we have money for legal fees to sue the state of New York? So, it was an answer from a representative but not a very satisfactory one,” he said. 

At Evergreen Health Services in Buffalo, Emma Fabian, associate vice president of harm reduction, expressed concern about what cuts to programs could mean for rural communities that rely on their services. Evergreen runs syringe exchange programs in Buffalo and Jamestown and runs a mobile unit that serves surrounding areas. Between the two sites, the program serves more than 100 people per day, providing naloxone, sterile injection equipment, as well as medication-assisted treatment for addiction.

Already, Fabian said, fatal and non-fatal overdoses in Erie County are on track to be higher than in 2016. “What the numbers are showing is it’s not only statewide,” she said. “It’s perhaps a serious issue our entire country's going to be facing, again.” 

A spokesperson for the state Division of Budget emphasized that funding has not been cut, but is being withheld, at least for now. “There has been no permanent reduction in support for these services at this time,” said Freeman Klopott, the spokesperson. “Instead, the State is holding back a portion of payments as it contends with a cash crunch caused by a 14% drop in revenue due entirely to the pandemic and the State needs the federal government to deliver much-delayed funding to cover this revenue loss so that we can continue to provide support for the most vulnerable New Yorkers.”

The End Overdose NY coalition has been lobbying lawmakers and the governor to address the current crisis with more urgency, as service providers across the state increasingly head towards a fiscal cliff. Alexis Pleus, executive director of Truth Pharm and the co-chair of the New York State Harm Reduction Association, said the twin issues of non-payment of contracts and the cuts to funding for services are colliding, as localities without resources of their own cannot afford to step in to fill the gaps. “It's not even as if a county could suddenly support these programs that New York State is under contractual obligation to pay,” she said in an interview. 

“I don’t think the governor’s paying attention at all,” she said. “He's literally taking this population and just throwing their lives away, saying their lives are not valuable at all.” 

“Without those programs, diseases will run rampant, again,” Pleus said. The “ripple effect” of the lack of services could last a decade, if not more, she added. 

As advocates and service-providers have pointed out, the general public health guidance during this pandemic is in direct opposition to the advice that harm reduction providers give to substance users. People who would usually be told to avoid use alone are now being told in glaring public notices to maintain social distancing and isolate as much as possible. 

“We had a substance use disorder and opioid crisis before the pandemic hit, and because of the pandemic, we are now having more people suffering in isolation,” said State Senator Pete Harckham of Long Island, who chairs the Senate’s Committee on Alcoholism and Substance Abuse and who has discussed his own battles with substance use and addiction. Harckham has called for a $38.5 billion federal emergency aid package for behavioral health programs across the country. 

Harckham said the state’s withholding of contract payments is akin to “taking a tattered safety net and just shattering it. This is like cutting emergency rooms and ICUs in the middle of a pandemic. These clinics and these nonprofits are the ICU for people with substance use disorders.”

Harckham acknowledged that the state is in a difficult position as it lacks the necessary revenue to shore up these services. “But this is among the most vulnerable populations and for them to be on the brunt of this is really concerning,” he said.

“We're taking a step backwards with our health-care delivery,” said Murtaugh of ACR Health. “A program is a person, and if you have less persons, then you have less programs. Period. That's exactly what it is and it's very scary to step backwards like that.”

by Samar Khurshid, senior reporter, Gotham Gazette

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As State Withholds Contract Payments, Substance Use Treatment Providers Worry About Rising Overdoses, Disease Outbreaks Thu, 30 Jul 2020 04:00:00 +0000
Have Drug Overdoses Spiked During the Coronavirus Crisis? It Depends Who You Ask 2 drug overdose

Mayor de Blasio makes an announcement (photo: Ed Reed/Mayor's Office)

As the coronavirus ravaged New York, hospitals were flooded with patients and city services ground to a halt. Activists and elected officials worried that in the fray of the pandemic, with New Yorkers ordered to mostly stay inside and millions losing work, the already prevalent opioid epidemic in the state could be further exacerbated. But city and state health officials don’t have full grasp on the scope of the problem, and may not know for months, because of a lag in how drug overdose data is tracked and classified.

The NYPD, on the other hand, reports that while overdoses have fallen overall in the first half of 2020, overdose deaths appear to have significantly increased during that period, according to preliminary reports.

Reports from across the country indicate that overdose deaths have likely increased as a result of COVID-19. In a brief report, updated June 18, the American Medical Association’s Advocacy Resource Center noted, “More than 30 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder in counties and other areas within the state.” Among the examples the report cited were reports from New York.

But city and state officials say it’s too soon to tell if there has been a spike in overdose deaths or hospitalizations. “Fatalities may still be pending classification and more data is needed for a reliable comparison to previous years,” said Michael Lanza, a spokesperson for the city’s Department of Health and Mental Hygiene, in an email earlier this month. According to Lanza, since March, just before the coronavirus outbreak in New York, there has not been a larger increase in overdose-related hospital intensive care unit (ICU) visits than what was expected based on historical data. At the state level, a Department of Health spokesperson said the most recent confirmed data is from 2019, even as the calendar shows 2020 nearly halfway over.

Asked about overdose data from this year so far, Edison Albany, a spokesperson for the state Office of Addiction Services and Supports, said in an email, “Official data regarding relapses and/or overdoses for this period is not available at this time. OASAS recognizes the potential consequences of isolation during the pandemic, and how it relates to the possibility of increased alcohol and substance use. To combat this and other risk factors, all OASAS providers remain open during the pandemic, and we are committed to ensuring that all of our services remain available.”

A New York City health department spokesperson said it’s hard to definitively say whether overdose deaths have gone up since classifying them takes time because of the need for additional investigations and to conduct toxicology reports. The department monitors several metrics, including ICU visits, for this data.

The lag in data production is evident from past reports. It was only in August 2019 that the city health department released a full picture of overdoses in 2018 and the first three months of 2019. The report found that drug overdose deaths fell for the first time eight years, to 1,444 from 1,482 in 2017. In the first three months of 2019, there were 45 fewer overdose deaths than in the same period in 2018.

The NYPD’s overdose squads, created in 2016, investigate all overdose deaths in the city and also respond to hospitals to interview people who have survived overdoses. The department also holds quarterly RxStat meetings, which involve about 35 different law enforcement and public health agencies, to discuss data on overdoses.

According to an NYPD spokesperson, preliminary data shows that overdoses overall are slightly lower, even during the months of the pandemic peak, but overdose deaths have increased over last year. The numbers will likely change after further investigation but there does seem to be an indication of a spike.

The Queens and Staten Island District Attorney offices have also noticed local spikes in overdoses. Queens District Attorney Melinda Katz’s office, in a June 1 press release, pointed to 86 suspected overdoses in the first five months of 2020, a 56% increase compared to the same time in 2019, it said. The data is sourced from the NYPD and the city Office of the Chief Medical Examiner.

“We are living through an extraordinary time. We are fighting battles no one would have expected, but still we push forward with hope and unrelenting resolve to succeed,” Katz said in a statement at the time. “Unfortunately, the coronavirus pandemic has made the opioid epidemic even worse for those fighting for their sobriety.”

Ryan Lavis, a spokesperson for Staten Island District Attorney Michael McMahon, said that through June 18 there has been an apparent year-over-year increase in overdoses in the borough, from 35 to 47, based on data collected by the office’s Overdose Response Initiative which collaborates with the NYPD. Lavis emphasized that data for 2019 and 2020 is “preliminary, incomplete, and subject to change as additional information is collected, including completed toxicology reports from the Medical Examiner, which have been delayed due to the effects of COVID-19.”

The confusion in the data is part of a persistent problem, said Jasmine Budnella, drug police coordinator at Vocal-NY, an advocacy group. Budnella said that activists like herself have seen anecdotal evidence that suggests an increase in overdoses across the state. “What that looks like in actual numbers, I don't think we'll know for a long time,” she said.

The pandemic, she said, has illustrated the need to track overdoses in real-time, just as the city is tracking covid infection rates on a daily basis. “I think if we can get covid numbers out that fast, then we should be able to get overdose numbers out that fast,” she said.

Budnella noted that the pandemic has posed particular challenges for those struggling with addiction. The state and city lacked a clear plan for dealing with the coronavirus outbreak, let alone specifically for those with a substance use problem. “Covid kind of goes against everything that we tell people, like don't use alone…don't isolate,” she said. If the city had a better system to track overdoses, they could have “responded in real time to a public health crisis on top of a public health crisis,” she said.

The city did eventually respond in May, just over two months after the lockdown, rolling out a program to deliver methadone to people sick with COVID-19 or a similar illness and those at high risk of contracting the virus. The program was first piloted at certain city-run isolation hotels. Additional measures were also taken to expand eligibility for the home delivery program, which was possible after the federal government eased certain regulations for the medication.

A separate issue that Budnella raised concerns about, particularly at a time when protests to defund the police have taken place across the country, is the NYPD’s involvement in overdose investigations. Treating overdoses as a police issue, she said, could discourage people from calling 911. Budnella’s group, Vocal-NY, is among those leading the advocacy for establishing safe injection sites for people suffering from addiction. Though Mayor de Blasio has outlined a plan to create four such “Overdose Prevention Centers,” with a strong police presence around them, the city has yet to receive permission from the state to follow through.

City Council Member Mark Levine, a Manhattan Democrat who chairs the Council’s health committee, noted that the city has seen a staggering 5,000 more deaths above normal that haven’t been attributed directly to COVID-19 but have been caused by the conditions created by the pandemic.

“We were losing a New Yorker approximately every six hours prior to the pandemic,” he said of the overdose crisis, while noting that since then, people have lost access to primary care and addiction treatment services. “We have every reason to fear that the number of overdose deaths has only increased over the last three months.”

Levine said he is considering holding an oversight hearing to press the administration on its response to the overdose crisis, though the Council and his committee have a full docket because of the outbreak and its many impacts. Levine said he has also submitted a request to draft legislation that would require monthly reporting by the health department on the number of overdose deaths in the city.

As the Council negotiates the budget for the next fiscal year with the de Blasio administration, Levine said the city will need to invest more funds in services for people struggling with addiction. “We have to respond now by ramping up our efforts,” he said.

For those who need help, the state’s “HOPEline” is at 1-877-8-HOPENY or text 467369.

by Samar Khurshid, senior reporter, Gotham Gazette

Read more by this writer.

Have Drug Overdoses Spiked During the Coronavirus Crisis? It Depends Who You Ask Wed, 24 Jun 2020 04:00:00 +0000
What New York Can - and Must - Do Right Now to Help End the Addiction Crisis gov protecting womens

(photo: Mike Groll/Governor's Office)

When your medical career is bookended by two of the worst public health emergencies in modern American history – the heroin epidemic of the 1970s and our country’s current crisis of overdose and addiction – it gives you a unique perspective on the problem and the solutions.  

To overcome this deadly crisis we must begin by viewing addiction for what it is – a treatable disease – and then bring to scale evidence-based medical strategies that we know give patients the best chance for a positive outcome. 

Medication Assisted Treatment – or MAT – is the quickest, easiest-to-start weapon we have to prevent patients from exposure to possible overdose. In combination with counseling as needed, it is the most effective tool we have to combat the opioid epidemic.

MAT involves prescribing medication approved by the Federal Drug Administration to treat opioid dependence. The medications reduce cravings and withdrawal and support patients who are recovering from illicit opioid use. Patients respond differently to the dose, formulation, and delivery method given their histories and prior experiences, as agreed upon with their physician. In my experience, MAT coupled with regular counseling and medical supervision is the best chance patients have for success.

New York is poised to become the latest to join a growing list of states – politically blue, red, and purple – that are removing obstacles to MAT and instead rightly focusing on patient care and access. On-demand access to all FDA-approved medications for opioid dependence is the national trend because it is smart public health policy. California, Ohio, Texas, and Missouri are just some of the states to embrace the wisdom of MAT and pass laws or regulations to increase access and availability.

New York’s bi-partisan legislation removes burdensome and potentially deadly barriers to treatment like prior authorizations and covers the medicine under both private insurance and Medicaid. Enacting these reforms now requires Governor Andrew Cuomo’s signature. 

At Damian Family Care Centers, in our various clinics in New York City and hard-hit Upstate New York, we regularly witness the difficulties involved when a patient has to wait for MAT because the insurance company or Medicaid requires prior authorization. Patients who are struggling with opioid dependence often have challenges with impulse control as part of their addiction. It is essential that the medications prescribed for the patient are available to the patient as soon as possible. Otherwise the patient will not tolerate the wait and will turn to the streets. And the streets are more dangerous than ever because of the proliferation of fentanyl, which is exponentially more powerful than prescription opioids or heroin. When fentanyl becomes part of the equation, a “regular” dose can easily become a lethal dose.

Any delay, let alone 24 to 48 hours or more, can make the difference between life and death for a patient who agrees to Medication Assisted Treatment. 

The bottom line is we are in the midst of a raging opioid epidemic. If people were dying from an infectious illness, would we think it was ethical to require prior authorization for any of the possible medications? Would it be effective to limit the medicines we know can help? The doctors, nurse practitioners, and physician’s assistants on the front lines of the crisis must be able to make medical judgments in the best interests of their patients. That requires the ability to prescribe all the medications the FDA has approved for the treatment of opioid dependence.

Nearly 4,000 people died in New York State from drug overdoses in the last year, including one every six hours in New York City. 

The barriers to treatment – while well-intended – were built during a different time under vastly different circumstances. The most meaningful action New York State, and all states, can take right now regarding the opioid, heroin, and fentanyl crisis is to ensure MAT is readily available to the thousands of people who need it. 

Sonia Lopez, MD, is the Director of Addiction Medicine at Damian Family Care Centers.

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What New York Can - and Must - Do Right Now to Help End the Addiction Crisis Sun, 24 Nov 2019 05:00:00 +0000
In Opioid Fight, City Expands Access to Crucial Medication-Assisted Treatment New York City opioid treatment

(photo: Edwin Torres/Mayor's Office)

New York City is showing modest progress in the fight to curb the explosion in drug overdoses, with the health department reporting 38 fewer deaths last year compared to 2017, after a concerted $60-million effort focused on substance abuse prevention, treatment, and education, especially with regard to opioids.

One aspect of that fight has been the expansion of access to medication-assisted treatment, which experts and activists say is a crucial element in preventing overdoses, curbing addiction, and helping those suffering from substance abuse disorders to reclaim their lives. The city has continued some advancement on that front, training thousands of more prescribers, while a state bill that could help that effort, which passed the Legislature this year, languishes unsigned by Governor Andrew Cuomo.

Medication-assisted treatment involves prescribing and administering drugs such as methadone and buprenorphine, which help mitigate the symptoms of withdrawal and curb cravings.

Methadone is itself an opioid, albeit a relatively weaker one, that can help those suffering from addiction wean off stronger narcotics. Buprenorphine acts similarly and is an even more effective treatment drug since its effects level out no matter the size of the dosage. Both, however, are stringently regulated.

Methadone treatment programs are subject to oversight by numerous federal agencies, and the drug must be administered to patients on site under observation. For buprenorphine, doctors must receive waivers to prescribe the drug after undergoing an eight-hour training. In the United States, compared to other countries, the treatment remains vastly underutilized.

“Medication-assisted Treatment (MAT) is a standard of care for opioid use disorder and it is critical for treating addiction, and also is a protective factor against overdose,” said Dr. Denise Paone, Director of Research and Surveillance at the city Health Department’s Bureau of Alcohol and Drug Use. “So we've invested a lot of effort into the expansion, particularly of buprenorphine, because as you know, methadone is federally regulated.”

Since the March 2017 launch of HealingNYC, the city’s multi-faceted strategy to combat the opioid crisis, the Department of Health and Mental Hygiene has trained 1,800 new buprenorphine prescribers, surpassing the original goal of 1,500. The aim of the program has been to increase buprenorphine prescriptions by 20,000 by 2022.

There has already been some success, with prescriptions up from 115,167 in 2017 to 126,002 in 2018.

Besides training new prescribers, the city has also expanded a Nurse Care Manager program – where registered nurses coordinate treatment for patients and with providers – to 26 primary care clinics around the city, and is funding 9 of 14 syringe service programs to provide on-site buprenorphine.

“In actual clinical practice, we are providing funding to these federally qualified health centers that serve those that are underinsured or not insured. And we provide support so that these primary care clinics can provide on-site buprenorphine,” Paone noted.

It’s hard to draw a through line from the investments in buprenorphine access to the reduction in overdose deaths, Paone said, because of the many elements of HealingNYC that work in concert. “But buprenorphine obviously plays a major role,” she said.

There are still numerous challenges as the city attempts to increase the number of doctors prescribing the life-saving drug. The first is the required physician waiver. “There is an effort across the country, supported by a lot of attorneys general, as well as health departments to work at the federal policy level to have this waiver removed,” Paone said, citing a letter sent by several attorneys general to congressional leadership, calling for eliminating the waiver. But that effort has seen little movement. 

In New York State, buprenorphine prescribers are also required to get prior authorization from insurance companies. A bill sponsored by Assemblymember Dan Quart and State Senator Pete Harckham passed the Legislature earlier this year and would do away with that requirement but it has yet to be signed by Cuomo. “The bill is under review,” said Caitlin Girouard, a Cuomo spokesperson, in an email. 

“From social stigma to regulatory barriers, people seeking treatment for substance use disorders are faced with significant obstacles,” Quart said in a statement. “While this bill won’t remove all existing roadblocks, it will cut red tape and wait times, guaranteeing New Yorkers faster access to lifesaving treatment. The opioid epidemic has devastated communities across the state and I encourage the Governor to sign my bill into law, and ensure those seeking treatment have swift access to the care they need.”

Harckham, a Democrat representing parts of Westchester and the Hudson Valley, chairs the Committee on Alcoholism and Substance Abuse and is also co-chair of Joint Senate Task Force on Opioids, Addiction & Overdose Prevention, which was created earlier this year and held its first hearing last month.

“We want to find out what's working, what the gaps are, what we need to do from a legislative standpoint, what we need to do from a regulatory standpoint,” he said in a phone interview. “And certainly we have to break down any barriers we can to medication-assisted treatment because evidence shows, that's what saves lives.” Harckham expects that next year, the Legislature will pursue a robust package of bills to fight the opioid crisis based off the task force’s work. 

Removing the stigma around buprenorphine and methadone also remains a priority for the city, and the Health Department has sought to fight it with a $2.8-million mass media and advertising campaign called “Living Proof” displaying real stories of individuals who have benefited from treatment.

The ads ran on local television (2,141 times), newspapers, online, in social media, and on the subway system. Besides the millions that saw the ads on the subways and ferries, the health department provided data that social media ads led to 2 million online video views and over 80,000 visits to NYC Health’s “Opioid Addiction Treatment with Buprenorphine and Methadone” web page. “It was actually quite powerful, and then we're in the process of doing an evaluation of that campaign,” Paone said. 

“Expanding access to medication treatment is really probably the most critical response right now to the opioid epidemic,” said Dr. Chinazo Cunningham, professor of medicine at Albert Einstein College of Medicine at Montefiore Medical Center, which has trained several hundred buprenorphine prescribers. “But what we also know from research is only about half of the people who are trained, actually go on to prescribe it and actually treat addiction and so we need to do more than just train people,” she added.

Besides that, Cunningham said the city needs to invest more in nurse care managers and that service providers need more support for mentoring and education in addiction treatment. “I think that the issue is there's not one thing to turn this epidemic around,” she said. “But all of these approaches are based in evidence to show that these are what the barriers are and these are the kinds of supports that are needed for providers to take this on and to provide treatment.”

Jasmine Budnella, drug policy coordinator at VOCAL-NY, an activist group, was among dozens who protested outside the governor’s New York City office last month, calling on him to take more action towards fighting the overdose epidemic. She said the prior-authorization bill is an important step to increase access to buprenorphine. “For low-income New Yorkers, that was the only bill that we were able to pass this last session that we know has proven evidence will work in reducing the overdose crisis,” she said in a phone interview.

Budnella believes the city’s approach to medication-assisted treatment needs to be more holistic and expanded past the areas where overdose deaths have been highest. She noted, for instance, that overdoses are a leading cause of death in homeless shelters.

“We need to continue expansion, but not just in areas of high need,” she said. “We need to make sure that we're extending to all people.” She urged the mayor to provide more funding to the health department and to the Department of Social Services, to ensure that the city tackles the nexus of the overdose and homelessness crises, particularly by investing in supportive housing for those who require addiction-treatment services.

“We need to make sure that we have wraparound services for folks,” she said. “We also need to make sure that the criminal justice system is not the first to get employed for people who use drugs…What we really need is infrastructure where we have social workers and public health experts who are the ones employed to go help people with substance use disorder or mental health issues, so that the police don't have to police poverty.”

by Samar Khurshid, senior reporter, Gotham Gazette

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In Opioid Fight, City Expands Access to Crucial Medication-Assisted Treatment Thu, 05 Sep 2019 04:00:00 +0000
Drug Overdose Deaths Drop for First Time in 8 Years, City Reports mayor bdb first lady chirlane

(photo: Ed Reed/Mayoral Photography Office)

The New York City Health Department announced on Monday that the city’s efforts to curb the ongoing opioid crisis are showing progress, with 38 fewer drug overdose deaths in 2018 compared to the previous year. It is the first year over year drop in eight years, the city said.

There were 1,444 drug overdose deaths last year, down 3% from 1,482 in 2017, according to Health Department data. And the first three months of this year saw 331 overdose deaths, down 45 from the same time last year, and two fewer than the last three months of 2018.

“The decrease in drug overdose deaths is promising, but far too many New Yorkers are still dying,” Health Commissioner Dr. Oxiris Barbot said in a statement. “We are closely monitoring the trends of the epidemic as they evolve and responding to upticks in emergency department visits and deaths with targeted strategies and community engagement. We remain firmly committed to expanding life-saving services and caring for New Yorkers who use drugs.”

The announcement from the city did not include comment from Mayor Bill de Blasio, though First Lady Chirlane McCray was quoted saying, in part, “There is no one solution to the pain and tragic consequences of the opioid epidemic and New York City’s multi-faceted response reflects that.”

Although there was a reduction in overdose deaths citywide, disparities exist across boroughs. Deaths rose in the Bronx, Manhattan, and Staten Island but dropped in Brooklyn and Queens. Among New Yorkers between the ages of 55 and 84, overdose deaths increased for the fourth year in a row. The rates of overdose increased by 5% for Latinos, and decreased 13% for black New Yorkers and 5% for white New Yorkers.

In 60% of all drug overdose deaths in 2018, the deadly synthetic opioid fentanyl was detected.

The city has been undertaking a concerted effort for the last two years to decrease accidental overdose deaths. In March 2017, de Blasio and McCray launched HealingNYC, which has since invested $60 million in overdose treatment, prevention, and outreach measures, according to Monday’s announcement.

Since then, the city has distributed 230,000 kits of naloxone, a drug that can counter an overdose, for free through programs across the city. The Health Department also conducts free trainings in administering naloxone and has launched nonfatal overdose intervention programs in 11 city hospital emergency departments, and will expand it to 15 private hospitals by June 2020. 

The city has undertaken a broad outreach effort as well, working with 374 community-based venues, 88 substance use treatment programs, 140 pharmacies, and nine shelters in the Bronx and northern Manhattan.

The Health Department has trained 1,800 individuals to prescribe buprenorphine, which can reduce opioid dependency, and has funded 14 syringe service programs that helped 18,274 last year. Prior Health Commissioner Dr. Mary Bassett has identified expanded use of buprenorphine as one essential key to bringing down opioid addiction and overdoses. The city also wants to open safe injection sites, but has yet to receive state approval to do so.

Also in her Monday statement, McCray said, “Individuals struggling with substance use disorders and families caught up in this scourge are our responsibility, and we will continue innovating to make sure communities have access to the lifesaving resources, services, and treatment they need.”

The city’s five district attorneys – Darcel Clark of the Bronx, Eric Gonzalez of Brooklyn, Michael McMahon of Staten Island, Cyrus Vance Jr. of Manhattan, and acting DA John Ryan of Queens – welcomed Monday’s news and called for greater action from the state to target the import of fentanyl and its variants, which remain largely unregulated. They called on the state Legislature to designate all those variants as Schedule I controlled substances and for increased funding for public awareness campaigns and police labs, coroners, and medical examiners.

“Fentanyl analogs serve no legitimate medical purpose and are produced by clandestine laboratories outside of the U.S. New types of fentanyl analogs are continually emerging as international labs slightly tweak chemical formulations. As long as fentanyl analogs in all their variants remain unregulated in New York State, they will proliferate unchecked and more lives will be lost,” the DAs said in a joint statement.

by Samar Khurshid, senior reporter, Gotham Gazette

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Drug Overdose Deaths Drop for First Time in 8 Years, City Reports Mon, 26 Aug 2019 04:00:00 +0000
City Health Commissioner Explains Essential Path to Fight Opioid Epidemic 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.”

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.

by Daniel Yadin for Gotham Gazette

Read more by this writer.

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’ 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]

by Jordan Kimmel & Daniel Yadin

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 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!

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
End of Session Menu Previews Next ‘Big Ugly’ in Albany heastie cuomo flanagan june 2015

Heastie, Cuomo, Flanagan June 2015 (photo: Kevin P. Coughlin/Governor's Office)

Last week, the Senate came to standstill as the star of popular beer commercials came to the Capitol as a guest of Senate Republicans. Legislators of both parties fawned and snapped pictures with Jonathan Goldsmith, of Dos Equis fame. Senate Majority Leader John Flanagan’s office proudly posted a picture of the two men together on Twitter; Democratic legislators quoted catchphrases of “the most interesting man in the world” on the Senate floor. While it's fairly customary for both houses of the Legislature to honor various heroes and celebrities, it was striking to see the house come to standstill with less than two weeks left in the legislative session and a myriad of major policy issues not being given a moment of public debate.

On Wednesday, the Legislature will return to Albany after a long Memorial Day weekend facing just nine remaining scheduled session days. Many legislators and advocates have abandoned hope for any significant, substantive policy victories. After a particularly contentious budget process that yielded major victories for Governor Andrew Cuomo on a path toward a $15 minimum wage and paid family leave, the leadership of both houses appear to be more concerned with the impending election season than hashing out deals on a variety of subjects. The spectre of U.S. Attorney Preet Bharara has also chilled legislators’ appetites for deal-making. And yet there remain some policy matters that will likely be smashed together into a casserole of legislation that has come to be be known as “The Big Ugly.”

The convictions of both former Assembly Speaker Sheldon Silver and former Senate Majority Leader Dean Skelos on multiple federal corruption charges led many legislators and advocates to assume that this year would see significant action on government ethics reform. Gov. Cuomo put forth an ambitious ethics agenda during his January State of the State speech.

New Senate Majority Leader John Flanagan refused to negotiate ethics reforms in the March budget deal and has since stonewalled on any reform issue other than legislation to strip pensions from state employees convicted of felonies. The Assembly has refused to move on the Senate version of that bill because labor unions are concerned their members would lose their pensions after offenses.

Despite a standoff on ethics, legislators don’t appear worried that passing bills to allow fantasy sports gambling, online poker, mixed martial arts fighting, and easier access to liquor will hurt their chances at reelection this fall.

However, a new Siena Poll released Tuesday shows that 96 percent of voters say passing ethics reform legislation should be the top priority for legislators at session’s end - with 81 percent calling it “very important.”

Good government groups see the pension forfeiture measure as a token reform and have pressed for the closing of the “LLC loophole” that allows businesses to create multiple limited liability companies to donate virtually unlimited amounts of campaign cash; public financing of candidate campaigns; the end of lump sum appropriations in the budget; limits on political contributions by companies with business before the state; limits on legislators’ outside income; and a renovation of Albany’s ethics watchdog, the Joint Commission on Public Ethics (JCOPE).

Only one of those proposals, closing the LLC loophole, appears to have any life left this session. Meanwhile, top priorities for lawmakers appear to include legislation around the aforementioned topics like daily fantasy sports, but also regulations of for-hire vehicle services like Uber, combating the heroin epidemic and a couple of more serious issues - the governor has also mentioned an interest in a breast cancer screening program. High-profile legislation like the DREAM Act, which would make undocumented students eligible for state financial aid, and raising the age of criminal responsibility from 16 to 17 or 18, appear completely off the table.

There is, though, the issue of mayoral control of New York City schools, which will expire at the end of June unless it is renewed, and whether Cuomo and legislative leaders can reach a memorandum of understanding around how $2 billion in budget money targeted for affordable housing will be spent.

As lawmakers, lobbyists, and advocates hit the home stretch of legislative session, the following issues may be on the verge of some action:

Campaign Finance Loophole
Gov. Cuomo recently proposed eight bills, all of which would restrict each LLC to giving $5,000, for every combination of different elected offices, and make the people behind LLCs more transparent. The legislation would not limit the number of related LLCs that can donate, though, nor would it address the issue of labor unions and their local subsidiaries, which some compare to the issue of LLCs.

One bill would cover only the Governor’s race - Cuomo said that bill was to “show that I’m willing to go first, and I’m willing to go it alone.”

State Senator Liz Krueger, a Democrat from Manhattan, said that she welcomes the effort despite not thinking the legislation goes far enough and not believing Senate Republicans will pass anything. Action on the LLC loophole would likely force Krueger and her allies who are suing the State Board of Elections to end the loophole to have to start the process all over again. “It might interfere with my lawsuit and yet I welcome it,” Krueger told Gotham Gazette. “Yes it will only limit LLCs to $5,000 and most of these real estate guys have tons of LLCs, but it's a start that I would welcome. However I don't have much faith the Senate will allow it.”

Senator Daniel Squadron, also a New York City Democrat, has repeatedly tried to force his bill to close the loophole to a vote in the Senate only to have it bottled up in committee. Squadron issued a statement supporting the governor’s menu of reforms. “However,” wrote Squadron, “it’s critical the Loophole be closed for the Legislature, especially given the central role the Loophole has played in ethics scandals in both houses. Anything else would be a cop-out by the Senate Republican Majority.”

Flanagan quickly shot down Cuomo’s efforts in a statement, rejecting the LLC loophole as a reform issue and insisting reform efforts should focus exclusively on reforms related to activities of Mayor Bill de Blasio, despite the fact that his predecessor, Skelos, was convicted on corruption charges that involved the influence of real estate groups that have flooded legislators’ campaign coffers with donations through the loophole. De Blasio is being investigated for efforts he led to flip the Senate into Democratic hands in 2014 and is the subject of other controversies that Flanagan referenced.

“We need to bolster our money laundering laws, move aggressively against straw donors and unmask the identity of those groups or individuals who want to operate in the shadows. We should take action to stop non-profits who flout transparency and who donate unlimited sums to directly support a politician’s agenda by regulating them through the Board of Elections, JCOPE or another appropriate agency with jurisdiction. We should clarify the laws which could potentially shield the so-called “agents of the City” and subject these secret agents to the same code of ethics and disclosure laws as the government officials they work for. And, we must provide more frequent and more timely disclosure, and insist on strict enforcement of the laws that are already on the books,” reads Flanagan’s statement.

Krueger said she is disappointed by what she sees as an attitude held by many legislators that there is nothing wrong with the status quo. “I can’t believe my colleagues wake up in the morning and think things are really OK here because things really are not OK,” said Krueger.

Heroin Opioids
Senate Republicans have made dealing with opioid and heroin addiction a priority for the year and Cuomo and legislators have held panels across the state in the last few weeks on how to address the problem. There will be another in Brooklyn on Wednesday.

“We will get a comprehensive plan done before session ends,” Cuomo said at a related event on Long Island on Wednesday. “We are not going to leave Albany until this state has the best plan to deal with this. Period.”

Cuomo is calling the crisis a health issue and said he agreed with a panel member who called on insurers to cover rehab for prescription pill addiction and said he would also like them to fund education efforts.

“Pharmaceutical companies have made a fortune selling these drugs,” Cuomo said. “We should now go back to them and say, 'you have to do an education effort and tell people about the dangers of these drugs,' which they have not done. And I would make them pay for it at their cost.”

Senate Republicans issued a report on May 17 proposing a “four pronged” approach to fighting heroin and opioid addiction. The report focuses on increasing awareness of the problem, expanding treatment through insurance coverage, providing better treatment programs, employment and diversion programs for recovering addicts, and giving law enforcement more leeway to fight drug trafficking.

“This report reinforces the notion that the scourge of heroin and opioid addiction does not affect one region of the state, or one race, or one ethnic group,” said Sen. John Bonacic, a Republican from Mount Hope, in a statement accompanying the release of the report. “It’s a global problem that affects everyone, and this report along with its recommendations, is a positive step towards the goal of one day ending this terrible epidemic.”

It is unclear how Cuomo’s task force will interact with the Senate findings, but a package deal on the crisis is expected to be reached before the end of session. Some of the criminal justice aspects could be contentious.

Alcohol Business
Gov. Cuomo is backing an overhaul of the state’s liquor control laws that date back to the days of prohibition as one of his top priorities. Cuomo has sought to make New York’s breweries and wine-making operations a draw for tourists and a boon for local agriculture. His omnibus bill introduced on May 18 would cut back restrictions on when alchohol and liquor can be served, lessen some burdens for the permitting process to serve alcohol, and reduce fees for wholesalers.

However, Democrats in the Assembly and Senate have expressed concerns that the bill goes too far and could create tension in New York City neighborhoods where bars are sited close to churches and residential areas. “I have a real concern that the governor’s alcohol legislation will end up locating bars near churches,” Krueger told Gotham Gazette. “It is an issue of space unique to New York City, and I’m not sure that has been taken into account.”

Assemblymember Robin Schimminger, a Democrat from Buffalo, expressed similar concerns to Politico New York. “It looks as though this bill would allow ex-cons to get licenses to operate taverns adjacent to churches and sell shots and beers as early as 8 a.m. on Sunday mornings,” said Schimminger. "Obviously, there are many issues with this package.”

Schimminger told Politico he doubts the bill will pass this session as it stands.

Daily Fantasy Sports & Other Betting
Attorney General Eric Schneiderman had barely announced his suit against major fantasy sports operators FanDuel and DraftKings for violating the state’s gambling laws before legislators rushed to promise to legalize the practice. The companies reached a settlement with Schneiderman in late March, promising to cease operations in the state to give the Legislature a chance to change the law.

Assemblymember Gary Pretlow, a Democrat from Mount Vernon, and Sen. Bonacic have led the charge to legalize in their respective houses to legalize daily fantasy sports betting. Bonacic’s bill has moved forward in the Senate while Pretlow introduced his on Friday. There are differences in the bills, but both include legalization as well as a licensing fee and a tax. Both bills would tax companies 15 percent.

Bonacic is also sponsoring a bill to legalize online poker.

Some legislators are concerned that the allure of money - both revenue for the state and campaign contributions from major gambling interests - has effectively killed any debate about the impact of gambling on New Yorkers, especially as the state just recently allowed the construction of a number of casinos.

“It is telling that this is a priority at the end of session,” Krueger said. “This is just another example of an industry with loads of money that is going to get what it wants without any real consideration of how what they are asking for will impact the state.”

A number of Democrats say even without the question of morality they wonder when the legalization of so many ways to gamble in the state - from racetrack betting to video slots, casinos, online games, the state lottery, and more - will eventually lead to diminishing returns.

Senate Republicans and Gov. Cuomo have been pushing for a renewal of the 421-a property tax credit used toward the development of affordable housing that expired at the end of last year. Housing advocates insist that if any discussion of the issue comes up, rent regulation laws must be renegotiated as the two were tied together last year. The tax break expired after real estate and labor failed to come to a deal. The fate of the bill was put in their hands by Cuomo and legislative leaders after the governor insisted any deal had to include wage guarantees for labor - a position the governor still holds despite the fact that no deal has been reached and there are concerns about the development of affordable rental housing in New York City. With few days left in session many doubt anything will come to pass on 421-a or the rent laws.

However, one major housing issue remains that can’t be legislated but should be taken up in a technical process by the governor and legislative leaders. Two billion dollars in funds was included in the state budget to be spent on the creation of affordable housing. While the cash was appropriated Cuomo and legislative leaders neglected to actually spell out how any of the cash would be spent. They are now expected to negotiate an memorandum of understanding to spell it all out. Legislators concerned with how the plan will be decided have said for weeks they expect negotiations with Cuomo’s office to start soon but it is unclear where things currently stand.

A group of housing advocates especially focused on funding supportive housing, which includes social services, has launched a campaign to push Cuomo to finally cut a deal and release the funds. “Promises don't build housing," Mary Brosnahan, president and CEO of the Coalition for the Homeless, told The Daily News. "Tens of thousands of homeless New Yorkers await the governor to take immediate action and make good on his promise to build supportive housing. We need Gov. Cuomo's leadership to secure the required MOU."

Mayoral Control
It is assumed, despite Flanagan’s repeated lashings of de Blasio and the fact that his conference is set on using the mayor as a boogeyman in upcoming Senate races, that there will be some sort of extension of mayoral control of New York City schools in order to keep the system alive. How long the extension will be is unclear - some legislators have begun to assume that Senate Republicans will demand another simple one-year extension as they did last year in order to punish de Blasio. Assembly Democrats recently passed a three-year extension, which is what the governor proposed in his budget.

'Playing Defense'
The budget deal or end-of-session “Big Ugly” are notorious for packaging major bills with a number of narrow, industry-tailored pieces of legislation that are not subject to appropriate scrutiny. Last year, the Legislature barely managed to tackle any substantive issues in the budget, but did approve a tax break for luxury yacht buyers that was supported by yacht retailers. One of the arguments for the bill, made by Assembly Speaker Carl Heastie at the time was that “Right now, no one purchases their yachts in the State of New York because Florida offers a similar program.”

Krueger said that at this point in session she is past thinking about what good might get done and is focused on trying to catch bad legislation that may get forced through in a last-minute deal.

“I’m really playing defense now. I don’t have much hope for this session,” Krueger said. “I’m on the outlook for those really bad bills that tend to sneak out while no one is paying attention.”

by David King, Albany editor, Gotham Gazette

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End of Session Menu Previews Next ‘Big Ugly’ in Albany Tue, 31 May 2016 04:00:00 +0000