The rise in drug overdose in New York City

The spike in drug overdose deaths in New York City is concerning. The opioid epidemic in New York City has been on the increase in recent years. According to Delreal (2017), between 2010 and 2016, the number of deaths from chronic drug misuse, especially heroine, increased by 71%. While the number of fatalities from heroin overdose was 9.1 per 100,000 New Yorkers in 2010, it is now 15.2 per 100,000 New Yorkers. Furthermore, heroin usage is more prevalent in the state's suburban and upstate areas. In Erie County, for example, drug-related deaths climbed by 256 percent. Also, when the effects of heroin overdose were examined in relation to gender differences, it was discovered that men were more prone to heroin related deaths than women. All these figures point out that the rise of drug abuse in New York City is a crisis which must be dealt with before it escalates further. The rising rates in the heroin misuse related deaths are an indication that over the past years, there is an increase in the use of drugs in the state. To prevent further mortalities due to heroin usage in the city, it is important to enact proper legislations which will reduce drug usage and addiction in the city.

Background

According to a report by the Drug Enforcement Administration released on March 5, 2017, New York City as well as its suburbs is facing a heroin epidemic problem. The report indicated that there is a sharp rise in street heroin overdose. The increase in heroin overdose incidences is deadly given that the drug is mixed with other dangerous chemicals. More people in New York City are turning to heroin as their drug of choice because the drug is more powerful and is also cheaper. The majority of people in the city prefers this drug because it is mixed with several other drugs. The report illustrated that the current heroin which people buy has a chemical concentration of between 40 and 50 percent (Kramer, 2017). When taken 4 or 5 decades back, the concentration was single figures. The implication of this assertion is that the current heroin substances which people consume is more deadly than it was several years ago. The New York Police Department (NYPD) reported that in the whole of 2016, there were 1200 cases of heroin overdose. If this figure is compared to the city’s homicide rate, it stood at 335 (Kramer, 2017). The implication of this observation is that the rate of causalities due to heroin overdose is almost four times as much as the rate of homicide in the city. According to the figures from the Department of health comparing drug overdoses in five boroughs between 2015 and 1026, heroin overdose and incidences rose from 115 to 252 (Kramer, 2017). In Queens, heroine issues rose from 104 to 144. In Brooklyn, the usage of the drug rose from 120 to 223. In Staten Island, the substance usage rose from 51 to 69, and in Manhattan, it rose from 104 to 144 (Kramer, 2017). These figures show that heroin and related problems are a concern to the New Yorkers and it is important to attack it on many levels including regional, state, and international levels.



Figure 1: How overdose of opioids result in deaths of all New Yorkers

Source: The City of New York Office of the Mayor (2016)



Figure 2: The deaths resulting from opioid overdose as compared to deaths resulting from murder and collision

Source: The City of New York Office of the Mayor (2016)

The borders of the United States are not strong enough to prevent smugglers from breaching and taking drugs into the country. Some decades ago while the Federal drug agents used to seizure 100 kilos of drugs a day at the border, however, the amount has increased to over 1000 kilograms every day. Of all these seizures, New York accounts for a third of the entire heroin in the United States.

When compared to the United States’ national averages, the New Yorkers are more likely to be admitted to hospitals for abusing heroine and other subscription opioid abuse.







Figure 3: The aggregate drug-related deaths in New York State between 2010 and 2015

Source: The City of New York Office of the Mayor (2016)

Prescription drugs continue to be an important player in the New York City’s opioid epidemic. Since 2011, heroin and fentanyl have driven to the rise of deaths related to overdose. Fentanyl is more dangerous because it is 50 to 100 times stronger than the ordinary morphine and pain killers (Penm et al., 2017). Heroin overdose is more dangerous than other opioids because it is usually combined with other dangerous substances such as fentanyl.

The majority of suppliers continue to combine heroin with cocaine and fentanyl as well as other illegally manufactured pills which include pain killers and sedatives (Achenbach, 2017).

What is of more concern is that the misuse of heroin in New York City cuts across different races, neighborhoods, class, and age. According to the research by Hochul et al. (2016), the leading cause of deaths in New York City before turning the age of 65 is the misuse and overdose of opioids. It is also the leading cause of all deaths related to unintentional injuries in New York City.

According to the research by Kramer (2017), one of the sturdiest risk factors for drug use is drug dependence and abuse of pain relievers. There is a strong connection between abuse of pain killers and abuse of drugs such as heroin and cocaine, and as such, it is important for policy makers to consider the effects of protective and risk factors which relate to abuse of nonmedical prescriptions.

There are different issues which put individuals at higher risk of heroin abuse. First, Penm et al. (2017) contends that mental health disorders such as high attention impulsivity is closely associated with increased misuse and dependence on opioids. Second, high levels of chronic pain are related to increased abuse of heroin. Third, individuals who have a previous history drug use can also increase the risk of abusing opioids and heroin. Individuals who feel discriminated are also more likely to increase their use of heroin. Finally, individuals who experience physiological and genetic reactions are more likely to increase their use of addictive drugs such as heroin. A research by Penm et al. (2017) provided several factors which place individuals at increased use of heroin. These factors include having high level of anger and cynicism, an early exposure to drug use such as tobacco use, a history of using poly-drugs combined with marijuana and inhalants, ability to easily access heroin-using networks, and engaging in several deliquescent behaviors.



Internal Players:

The State Senate Majority Coalition (SSMC) of New York recently created a joint senate task force on heroin addiction. The primary function of this task force, as advocated for by Governor Cuomo, was to examine and explore the current rise in the use of heroin and opioids in New York City. The policy also aims to reduce the limits of addictive opioids prescription from the 30 to 7. The law also aims to mandate insurance coverage for all the individuals with overdose medications. It is specifically important because it ended the pre-authorization from the insurance companies whenever someone sought medication and treatment in the area. The law also allows family members of affected individuals to seek treatment for 72 hours. Initially, the family members could seek treatment only within the first 48 hours of overdose. The implication of the current laws is that they recognize that one of the reasons for the heroin usage in the city is as a result of over prescription of dangerous opioids (Hochul et al., 2016). Also, the laws recognize the existence of divide in relations to appropriate community treatment. The current legislation is aimed at protecting the safety and health of New Yorkers. The New York mayor recently launched the HealingNYC initiatives which aim at preventing deaths related to overdose of opioids in New York City.

Other Stakeholders:

Non-governmental organizations in New York City have played a significant role in the fight against heroin addiction and mortality in the state. The interest groups have organized for community engagements as a basic way of advancing education about the effects of heroin addiction. NGOs in the city also have school-based education programs about drug addiction. The interest groups have also advocated for treatment of the affected individuals and their subsequent integration into the society.

The majority of NGOs have advocated for collaboration between the government and the NGOs through legislative lobbying, participation through blogs, and use of regional summits to increase awareness about the effects of heroin addiction in the city.

Interest groups such as the National Institute on Drugs Abuse have conducted research and studies about heroin abuse in new york city and developed measures to ensure that mortality which rise from heroin overdose are minimized. The interest group believes it will be able to reach out to a large number of people through its outreach programs. The initiatives will offer treatment to the affected individuals.

Options

There are several options which New York City can use to deal with the rising overdose of heroin and other drugs. The options include establishing safe injection sites, prescribing heroine, medication assisted treatment, using marijuana as a medicine/anti-addiction medication, treating the heroin addicts instead of arresting them, use of Naloxone,

Providing access to naloxone

One of the ways New York City can help curb the rising use of heroin is to enable the addicts get naloxone. Naloxone which is currently available in nasal spray can easily block respiratory suppression which most of the time is deadly. Families, narcotic dependents, and first responders should easily access naloxone. One of the advantages of readily availing naloxone is that it will expand access to antidotes which can easily reduce the rates of mortality resulting from overdose. However, one disadvantage of this option is that it can encourage the use of heroin among drug dependents because they know that they can easily access antidotes.

Education initiatives

The city should make use of the radios, televisions, and the social media to educate the public about the effects of heroin and other narcotics such as pain killers. New York should start an extensive education program so that it can increase awareness that heroin overdose is dangerous and can lead to deaths. One of the advantages of this option is that it will make more people aware about the dangers associated with use and overdose of opioids thereby acting as a prevention measure (Veilleux et al., 2010). Also, it may reach to a wide demographic. The education programs may also be used to create awareness about other forms of addiction. However, some people may fail to take the programs seriously as long as opioids and heroin are readily available.

Use of prescription drug monitoring programs (PDMPs)

The Center for Disease Control and Prevention (CDC) asserts that PDMPs are important state-level interventions which can be used to inform clinical practice, improve opioid prescription, and protect heroin addicts who are at risk. It involves use of multiple providers and patients and has been found to decrease substance abuse treatment.



Figure 4: how PDMPs work

Source: CDC (2017).

As can be seen in figure 4, PDMPs play an important role and have several benefits in the fight to eliminate drug overdose as it inspires the universal use of hospital facilities within New York. It also promotes real time and controlled dispensations of drugs to the affected individuals (Straussner, 2012). The option is easily accessed and used by the affected individuals. However, it is disadvantageous because of the need of a lot of resources to establish and operate.

Treating the heroin addicts instead of arresting them

There is a tendency in New York City that heroin addicts will be arrested and incarcerated instead of being treated. However, New York police department should emulate similar programs in Massachusetts where instead of arresting the drug addicts, the Massachusetts police offers them free treatment. The city should encourage all addicts to voluntarily surrender their stash so that they avoid being arrested as long as they agree to be treated and helped. Treating heroin addicts instead of arresting them is beneficial because it will enable more people in the city to achieve heroin addiction treatment. However, the option is more expensive for the city because while the people will be treated for free, the cost will be on the state government.

Recommendations

To help curb the problem of heroin addiction and mortalities in New York, it is recommended to use a multipronged. It should include the distribution of naloxone, establishment of heroin awareness education programs, use of PDMPs, and making access to treatment readily available. However, political opponents may argue that such programs may be too costly for the city and that this may drain the taxpayers. Other may also argue that such bills are draconian and may catalyze the current crisis especially when individuals are aware that treatment is readily available and naloxone is cheaper than before.





End Notes

Achenbach, J. (2017). Wave of addiction linked to fentanyl worsens as drugs, distribution, evolve. The Washington post. Retrieved from https://www.washingtonpost.com/national/wave-of-addiction-linked-to-fentanyl-worsens-as-drugs-distribution-evolve/2017/10/24/5bedbcf0-9c97-11e7-8ea1-ed975285475e_story.html?utm_term=.0b24dade126e

CDC. (2017). What states need to know about PDMPs. Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/drugoverdose/pdmp/states.html

Delreal, J. (2017). The Brox’s Quiet, Brutal war with Opioids. The New York Times. Retrieved from https://www.nytimes.com/2017/10/12/nyregion/bronx-heroin-fentanyl-opioid-overdoses.html

Hochul, K., Gonzalez-Sanchez, A., Vullo, M., Zucker, H., Green, M. (2016). Combating the Heroin and Opioid Crisis. Heroin and Opioid Task Force Report. Retrieved fromhttps://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/HeroinTaskForceReport_3.pdf

Kramer, M. (2017). NYC Area heroin Epidemic is Worst in years if not ever, DEA Says. CBS New York. Retrieved from http://newyork.cbslocal.com/2017/03/06/nyc-heroin-epidemic/

Penm, J., MacKinnon, N. J., Boone, J. M., Ciaccia, A., McNamee, C., & Winstanley, E. L. (2017). Strategies and policies to address the opioid epidemic: A case study of Ohio. Journal of the American Pharmacists Association, 57(2), 148-153.

Straussner, S. L. A. (Ed.). (2012). Ethnocultural factors in substance abuse treatment. New York: Guilford Press.

The City of New York Office of the Mayor. (2016). HealingNYC: Preventing overdoses, saving lives. Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/basas/healingnyc-book.pdf

Veilleux, J. C., Colvin, P. J., Anderson, J., York, C., & Heinz, A. J. (2010). A review of opioid dependence treatment: pharmacological and psychosocial interventions to treat opioid addiction. Clinical psychology review, 30(2), 155-166.