Opioids are responsible for more than 60 percent of America’s nearly 50,000 annual drug overdose deaths, and New York has not been spared. Since 2014, heroin has caused more deaths in the city than homicide. Finally, naloxone, the overdose prevention drug, is available without a prescription to anyone in 650 pharmacies citywide, including Duane Reade, Walgreens, Rite Aid, and CVS.
Naloxone, sold under the brand names Narcan and Evzio, is an “opioid antagonist” that counteracts the effects of overdose, particularly the cessation of breathing and the dangerously reduced functioning of the central nervous system. It has no effect in the absence of opioids. It comes in the form of nasal sprays or auto-injectors; even those with minimal training can administer it to an overdose victim.
“Opioid overdose is preventable — yet it continues to claim hundreds of lives in our city,” Mayor Bill de Blasio said in a statement. “By making naloxone even more widely available, we are literally saving lives and helping New Yorkers on the path to recovery.”
The widespread availability of naloxone has been met with a great deal of enthusiasm, even from more conservative community leaders such as Staten Island Borough President James Oddo, who had previously criticized other programs for opioid users, such as safe injection facilities. Staten Island has been among the hardest hit by the opioid epidemic, averaging one overdose death every four days, according to Luke Nasta, executive director of the Camelot Counseling Service. “If we can own this problem, we can beat it,” says Nasta, who adds that the availability of naloxone can help society move forward in acknowledging and treating the issue.
The epidemic can be traced in part to the overprescription of painkillers. “We’ve seen an increase in heroin use that’s riding on the tail of the rise in use and misuse of prescription painkillers like OxyContin,” says Daniel Raymond, policy director at the Harm Reduction Coalition.
In the 1980s, opioids were rarely prescribed outside of end-of-life care, such as for cancer patients, Raymond notes. In the Nineties, however, a push came from patients without terminal illnesses but with chronic pain for doctors to treat their physical suffering more aggressively. “Painkillers like oxy[codone] also came onto the market,” he says. “They were marketed under the belief that there was little risk of addiction if you’re prescribing them to somebody who had a legitimate pain complaint. We know now that’s not true.” Painkillers also became part of a trend in health care to treat complex health problems with a prescription, says Raymond, rather than with a regimen of treatments like acupuncture, physical therapy, and overall lifestyle changes.
Once the protocol of opioid prescription was established, it made abusing the drugs easier, adds Nasta. “It sanitized it. In a way, it legalized it,” he says. “No longer did you have to go to the ghetto on the corner and risk your life and arrest.” Prescriptions also made opioid use more socially acceptable, he says. “It made its way into the mainstream of white Middle America in its insidious fashion.”
Between 2000 and 2014, the rate of heroin-involved overdose deaths increased 88 percent in New York City. Between 2010 and 2014, drug overdose deaths from opioids in New York increased by 42 percent: from 8.2. deaths per 100,000 residents in 2010 to 11.7 per 100,000 residents in 2014, accounting for nearly 80 percent of all overdose deaths.
Activist groups began lobbying state and city lawmakers to address the epidemic. In 2014, New York State’s Opioid Overdose Prevention program went into effect. The new law not only allowed pharmacy distribution of naloxone but also permitted health care providers and harm reduction groups like VOCAL-NY to dispense naloxone without a prescription.
While naloxone is still technically a prescription medication, the New York law, modeled on similar legislation in California and Massachusetts, allows physicians to issue “non-patient-specific orders,” also called standing orders. “Basically that means they lawfully designate a non-prescriber, like a healthcare worker at a syringe exchange, to deliver education and dispense naloxone to people of a designated class — in this case, anyone deemed to be at risk of witnessing an opioid overdose,” says Matt Curtis, policy director at VOCAL-NY. “With pharmacy access, it’s essentially working the same way — the Department of Health and Mental Hygiene has issued a standing order for pharmacies citywide. That said, I’m still shaking my head trying to figure out why, in the middle of this epidemic, it took eighteen months from the passage of the law to getting the pharmacy component started.”
Curtis says legislators should make a more serious commitment to harm reduction programs by taking actions like authorizing supervised injection facilities, expanding treatment programs such as providing affordable access to addiction medication (e.g., methadone) when a drug user is ready to take it, and encouraging faster development of new supportive housing programs for homeless people with mental health issues and drug dependency.
Even though naloxone is now available for purchase, the price of the drug is around $40, and it is not covered by insurance. “That’s a concern and a potential barrier,” says Peter Schafer, senior policy associate at the New York Academy of Medicine. Schafer is concerned about the ability of those who can’t afford the drug being able to access it.
Many people still don’t know the medicine exists, adds Alyssa Aguilera, political director of VOCAL-NY. Moreover, there’s a “missing connection” between New York’s opioid problem and the state’s nascent medical marijuana program, she says. “You have this crisis, but at the same time medical marijuana has proven medicinal benefits [for pain relief] and continues to be so hard to access,” Aguilera says.
“[Still] this is a major step forward, making sure naloxone gets in the hands of people who need it, particularly for those who aren’t connected to organizations like VOCAL or syringe exchange programs [which already carry naloxone]. This is a mainstream way to get a medicine that’s saving lives.”