September 3, 2024

Recently, DoH announced the appointment of Dr. David Holtgrave who will serve as a special advisor to DoH Commissioner McDonald and focus on New York’s response to the opioid epidemic.  See summary below (thank you Marcy!)

Interview on The Capitol Pressroom with Dr. David HoltgraveOn August 30, 2024, The Capitol Pressroom interviewed Dr. David Holtgrave, a former Biden administration official who the state Department of Health recently brought in to help steer New York’s response to the opioid epidemic.

Below is a summary of the interview which can also be listened to here.

Background

In Dr. David Holtgrave’s previous position at the White House Office of National Drug Control Policy, he focused largely on translational research to transform substance use data into the best policies and programs. He also worked on emerging threats, essentially determining how we can address them early on and prevent more widespread use and harm from these emerging substances. NYS Department of Health (DOH) personally recruited him as senior policy advisor to the Commissioner and he previously got to know the Department through his position in the 90s at the Centers for Disease Control and Prevention (CDC). He also collaborated with DOH on a paper on hepatitis C in 2008 and he was the dean of the University at Albany’s School of Public Health where he worked closely in partnership with DOH. He recognizes and appreciates DOH’s long standing focus on using data to inform public health programs. Some of the most groundbreaking work in this area happened at DOH’s AIDS Institute, they were the first to look at how to end the epidemic, the Wadsworth Lab continues to look at data in several areas in real time, and DOH’s Office of Drug User Health is very important to bringing harm reduction to persons who are using drugs in New York and providing a wide variety of services.

Dr. Holtgrave feels that the key to public health is compassion and listening. It is critical in this work to learn the needs and interests of the community in order to strategically plan. While he was at the CDC, he helped start HIV Prevention Community Planning which included persons with lived experience, persons who do research, and others to the table to determine the needs and how to best address them. Community-based partnerships and relying on the best data and science also are critical to addressing the social determinants of health and building health equity.

New Position

Focusing on the opioid epidemic, in his first month at DOH, Dr. Holtgrave has started to take federal resources such as the National Drug Control Strategy and comparing that to what New York is doing now. He is asking questions at this stage and learning what is going on, what are the met and unmet needs, goals for the coming years, and more. The National Drug Control Strategy also focuses on recovery-ready workplaces in both the public and private sector to provide opportunities for persons with experiences of using drugs and people working there can get access to drug treatment and receive assistance. This model also supports employees that may be experiencing substance use by a loved one, a friend, a neighbor, etc and would like better direction to resources to assist and support that individual. New York is performing well compared to other states for several reasons including drug checking – New York has provided millions of test strips and is a leader in harm reduction further evidenced by being the only state to include harm reduction as Medicaid providers as Medicaid-qualified providers. New York’s opioid overdose reports also are very informative with almost 100 metrics and they are turning some of these key metrics into a dashboard to determine how we are doing as a state. Lastly, they are also determining which new substances should be declared official emerging threats such as a veterinary tranquilizer being used as an adulterant of fentanyl and nitazene, a kind of synthetic opioid.

His public health approach is acting based on what the data says, not just trying things to see what sticks. He wants to use evaluations of services and programs to make evidence-based decisions that best utilize resources, provide the appropriate scale of services that meet people’s needs, and have the greatest public health impact. In terms of reducing the opioid crisis, the national goal is no more than 81,000 overdose fatalities by 2025 and the trend is turning since the increase from 2019 to 2021. It is still an open question whether we will get down that, but we are down from the peak and for the last 12-month period, ending in March of 2024, there were 103,000 deaths. Looking at New York State, outside of NYC there was a 9% decrease between March 2023 and March 2024 in NYC and a 3.1% decrease. This is an important accomplishment, but we have to continue to double down and do everything we can to continue the decrease. Dr. Holtgrave said he doesn’t plan to get involved in the State’s efforts to reduce the transmission of HIV and hepatitis, but he is very interested in their work because what they are doing there can inform opioid reduction strategies. He also notes it’s essential to look at all topics comprehensively, not in isolation, because the work being done on substance use, hepatitis C, HIV, social determinants of health like housing, and more affect each other.