September 26, 2023
(NYC) Health Department recommends ALL NEW YORKERS carry naloxone amid record overdose deaths…(link)
(Also, see attached document for a look at 2022 EpiData Brief for NYC)
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Crain’s Health Pulse, 9/26
New York City experienced record-high drug-related deaths last year, setting off calls from the city health commissioner for greater efforts to address the overdose crisis.
There were 3,026 overdose deaths in 2022, a 12% increase in deaths from 2021, according to provisional data from the city health department released Monday. More than 300 additional New Yorkers died of a drug overdose in 2022 compared to the year before.
The overdose death count in 2022 was the highest rate that the city has seen since 2000, the year it began reporting these deaths.
The overdose crisis kills one New Yorker every three hours, said city health commissioner Dr. Ashwin Vasan, noting in a statement that the epidemic is impacting individuals and families across the city. “No one is spared, even if you think otherwise,” Vasan said.
Fentanyl was again determined as the primary driver of overdose deaths, the health department found. The synthetic opioid—which is 50 to 100 times more potent than morphine—was involved in 81% of all fatalities. Cocaine was involved in approximately half.
While a rise in overdose deaths occurred among most racial and ethnic groups, deaths were highest among Black New Yorkers. Older individuals also died at a disproportionate rate, with people between the ages of 55 and 64 years old facing the steepest overdose death rate.
The Bronx had the highest rate of deaths, with overdoses killing nearly 74 per 100,000 residents in 2022. The neighborhoods with the highest overdose death rates across the five boroughs were Crotona-Tremont, Hunts Point-Mott Haven, Highbridge-Morrisania, East Harlem, and Fordham-Bronx Park.
Steven Gray, drug policy campaign coordinator at the nonprofit organization VOCAL-NY, said that while the new data on overdose deaths in the city was disturbing and heart-breaking, it was not surprising. “This is a testament to how dire the situation is,” Gray said.
Vasan outlined actions to address the overdose crisis in a commissioner advisory also released Monday. He encouraged all New Yorkers to carry and learn how to use naloxone, a medication that can reverse opioid overdoses, as well as put out guidance stating that people should not use drugs alone. The commissioner also said that providers should widely screen for substance use disorders, and attempt to break down stigma and encourage people to seek information about drug use.
Gray said that the state data and the commissioner’s advisory call attention to the need for public health solutions to prevent overdoses and save lives—including overdose prevention centers.
New York City has two overdose prevention centers, which are supervised drug-use sites operated by OnPoint NYC, in East Harlem and Washington Heights. The centers—which are the only publicly operating sites of their kind in the country—have intervened in more than 1,000 overdoses in the two years since they’ve been open, the health department said.
In addition to the health advisory, the department of health published new guidelines for overdose prevention centers on Monday. The guidelines, which it states were created “in the absence of federal and state regulations,” provide a roadmap for organizations already running these sites or planning to.
The guidelines don’t represent the first time that New York City officials have vocalized support for overdose prevention centers. Mayor Eric Adams has made the opening of new centers central to his plan to address the overdose crisis, aiming to have five centers in operation by 2025. While the city has been opaque around its spending of opioid settlement funds, it has dedicated a significant portion of that money to the opening of new overdose prevention centers and services surrounding those sites.
The city stands in opposition to the state’s position on overdose prevention centers. Gov. Kathy Hochul has publicly supported the centers and has not allowed opioid settlement funds to be allocated to them—despite recommendations from the opioid settlement fund advisory board to do so.
Toni Smith-Thompson, New York state director at the Drug Policy Alliance, said that the city has done its part to put forth a clear framework for overdose prevention centers to operate—but it needs state officials to do their part as well.
“We are not going to get out of this crisis overnight,” Smith-Thompson said. “But we do need to use everything we have to get out of it.” —
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Note: The NYS Council has been updating all members regarding the potential implications of a government shutdown from time to time, with information regarding the likely impact on MH and SUD Programs and Services if a shutdown occurs. Last week we wrote that while MH and SUD Programs under the federal Medicaid Program would not be directly impacted, CCBHC Expansion Grant payments may be disrupted since the Expansion Grant Program is not a mandatory federal program while the CCBHC federal demonstration program is an entitlement program that would not be impacted.
We also sent members the HHS Contingency Plan in the event of a shutdown. With just 5 days to go, there is a mad dash going on in both houses on the Hill, however most government experts seem to be saying that (at this juncture) the likelihood of a shutdown is high. Today, the House and the Senate are expected to take two different paths to resolve this critical problem
Uncertainty for healthcare as government shutdown looms
MICHAEL MCAULIFF, MODERN HEALTHCARE 9/26
A government shutdown could thrust healthcare providers into unpredictable and uncharted territory, even though vast portions of the federal healthcare apparatus, including and Medicare and Medicaid, are immune from annual budget showdowns in Congress.
According to President Joe Biden’s proposed budget for fiscal 2024, which begins Sunday, 91% of Health and Human Services Department spending is categorized as mandatory, not as discretionary spending that is subject to yearly appropriations bills or periodic reauthorizations.
That still leaves more than $150 billion worth of health-related spending that Biden seeks from Congress unfulfilled as House Speaker Kevin McCarthy (R-Calif.) contends with a revolt from within the GOP conference that threatens to bring the machinery of government to an abrupt halt.
Exactly how Congress’ failure to pass spending would impact specific agencies and the providers and patients they serve is difficult to predict.
HHS released an updated contingency plan last week that details how many employees would be permitted to continue working in the absence of new appropriations and how many would be furloughed. The department also specified what vital functions would continue, even if the
According to that document, 51,293 HHS employees would stay on the job and 37,325 kept away until Congress agrees to a spending deal. Those who remain would work on programs that have mandatory funding such as Medicare, activities supported by user fees such Food and Drug Administration reviews of new pharmaceuticals and medical devices, areas supported by supplemental COVID-19 funding already on the books, and programs with multi-year funding that has already been enacted, such as the Indian Health Service.
Some programs and workers affected by a shutdown would still be pressed into service—with pay delayed until after a shutdown is resolved—if their jobs are critical to treating patients or maintaining sensitive experiments, for example, at the National Institutes for Health.
Others whose jobs are essential to protecting property or supporting funded activities would also be expected to work.
“HHS will continue any necessary activities in the event of a lapse in appropriation,” the department wrote in its contingency plan. “For example, the Administration for Strategic Preparedness and Response will maintain the minimal readiness for all hazards, including COVID-19, pandemic flu and hurricane responses.”
Nevertheless, the Administration for Strategic Preparedness and Response would retain just 47% of its roughly 1,000-person workforce. As with all of HHS contingency plans, this agency’s blueprint does not specify what the consequences may be for the public.
The White House, HHS and several departmental agencies did not respond to numerous requests for interviews.
There are some important differences facing the healthcare sector under this potential shutdown that make it both more alarming and harder to anticipate than the congressional deadlock that spanned 35 days from late 2018 into early 2019. At that time, five of the 12 annual appropriations bills that Congress is supposed to pass had already been enacted, including the HHS budget. This year, lawmakers have not sent any fiscal 2024 spending measures to Biden.
Another wrinkle this year is that Congress has also failed to approve reauthorizations for key health programs that are due to sunset along with the fiscal year on Saturday, including federally qualified health centers, the graduate medical education program and the National Health Service Corps.
According to HHS’ contingency plan, federal workers would continue to support all of those programs in a shutdown, but stakeholders are already worried.
“Any disruption to our delicate financial balance, and even a brief interruption in our federal funding, could have a devastating impact and long-term impact on community health centers and on our ability to continue to treat all of the patients who walk through our doors,” Michael Taylor, CEO of New Haven, Connecticut-based Cornell Scott-Hill Health Center, said at a news conference last week.
National Association of Community Health Centers spokesperson Amy Simmons lamented the confluence of stalled reauthorizations and a potential federal shutdown. “It’s creating a lot of anxiety and disruption in the health center community,” she said. “You can’t run healthcare delivery for 31.5 million patients on a month-to-month basis. We have thousands of advocates who are aware, concerned and reaching out to Congress.”
The community health centers organization is hoping that Congress at least passes a stopgap measure to extend the federally qualified health centers program and its funding.
But the contingent of House Republicans forcing the showdown on Capitol Hill has already rejected the notion of a temporary fix to prevent a shutdown. Furthermore, House GOP leadership has scheduled the full-year FDA funding bill for a vote this week, but none of the other major health spending bills or reauthorizations.
The White House has warned there will be consequences if Congress doesn’t act by Saturday.
“A Republican shutdown would stall critical research on diseases like cancer and Alzheimer’s because the National Institutes of Health would be forced to delay new clinical trials,” the White House said in a news release last week. “New patients, many of whom are desperately waiting for a chance at new treatment through a clinical trial, will be turned away.”
Like the NIH, the Centers for Disease Control and Prevention is especially exposed. “The CDC and NIH are certainly vulnerable because they rely primarily on discretionary appropriations. They’re not running mandatory programs like Medicare or Medicaid,” said Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities, a left-leaning think tank.
According to HHS, less than a quarter of NIH employees and 41% of CDC staff would remain on the job absent new appropriations.
While specific short-term problems might be hard to identify, the longer-term effects of a shutdown—or just coming close to one—are easier to envision, said Beth Resnick, assistant dean for practice and training at the Johns Hopkins Bloomberg School of Public Health. For instance, this kind of political disruption is discouraging to the federal workforce, which has implications for retaining and recruiting people to manage government programs.
“It’s really hard to live your life like that and try to have a functioning system when everything’s always up in the air,” Resnick said. “The damage to morale and all that, that might even be bigger than the actual impact of whatever the shutdown ends up being.