NY Has $1.5 Billion To Fight Opioid Overdoses—And 3 Weeks To Decide How To Spend It

New York is among the states collecting a massive monetary windfall from opioid manufacturers and distributors, thanks to recent settlements in lawsuits that accused the companies of fueling America’s addiction and overdose crisis.

The settlements total about $1.5 billion so far, and New York Attorney General Letitia James began a tour across the state this week to announce how much localities could each expect to receive, promising New York City somewhere between $140 million and $257 million.

The funding comes in the wake of the year with the highest number of drug overdose deaths on record in the United States — with 69,000 fatalities from opioids recorded nationally by the Centers for Disease Control and Prevention in 2020. At least 4,289 opioid deaths occurred in New York State. The city accounted for a significant portion, about 1,800, a nearly 50% increase over the previous year.

Former Gov. Andrew Cuomo and the state legislature set out plans for these settlement funds before he resigned in August. Cuomo signed legislation requiring the funds to be deposited in an Opioid Settlement Fund and used for services addressing substance use disorder through education, harm reduction, treatment, and a range of social services. The money must enhance, rather than replace, existing state funds.

But the specific policies and programs that the state will fund are still being determined. The advisory board that’s supposed to oversee those decisions is in the process of being formed, the attorney general’s office has confirmed to WNYC/Gothamist. Gov. Kathy Hochul, the State Legislature and other entities are responsible for appointing the board and will “hopefully [be] done soon,” a spokesperson said. The advisory board is running out of time to make recommendations for allocating the funds, which it’s supposed to do by November 1st.

So, WNYC/Gothamist checked in with some advocates for opioid overdose prevention about what they think should be top priorities for the funding.

Ending The Era of Scarcity

“The argument during the Cuomo era that we don’t have any money, that we’re operating under austerity, is now moot because of Attorney General Tish James’ leadership,” said Jasmine Budnella, the drug policy campaign coordinator at Vocal-NY. “There’s no reason anymore that this one area of public health has to be starved.”

Budnella and other advocates said harm reduction has long been underfunded in general, but the pandemic exacerbated the problem.

“One of the big things that we're calling for is a rapid, immediate scaling up of the harm reduction infrastructure, which includes syringe service programs,” Budnella said.

Local grassroots or nonprofit organizations are typically the ones providing drug users with direct support such as clean syringes, information on safe drug use, drug testing strips and the overdose reversal medication naloxone.

“When we're in crisis mode like we are right now, those are the types of things that we really need to be focusing on,” said Christine Khaikin, senior health policy attorney at the Legal Action Center.

Some organizations doing this work had their payments delayed last year while the state struggled with budget issues during the pandemic. Some also experienced shortages of syringes and other medical supplies.

Joyce Rivera is the founder and CEO of St. Ann’s Corner of Harm Reduction in the Bronx. The borough has rivaled Staten Island in recent years for having the highest rate of opioid overdose deaths in the city. Rivera said Staten Island, the Bronx and other hard-hit areas should be prioritized for funding.

“I don't think the Bronx is ever prioritized for any resource,” she said. “We maximize whatever we get.”

Rivera said she appreciated the state’s commitment to funneling settlement money into drug education, but she said the type of education is essential, emphasizing information over abstinence.

“We need educational programs that deal with drugs using science-based knowledge and community knowledge to start to be more pragmatic,” Rivera said.

Removing Barriers to Treatment

Advocates said funding should also go toward boosting access to buprenorphine — a medication people can take instead of heroin or other opioids that prevents them from going into withdrawal. Improving access would likely mean setting aside more cash for the treatment under Medicaid, the state-run health insurance program for low-income New Yorkers.

Despite evidence of its effectiveness in treating opioid use disorder, buprenorphine has been subject to a range of restrictions over the years, partly because of fears it would be diverted to the street and because of the stigma attached to the idea of replacing one opioid with another.

In 2020, Cuomo signed legislation that lifted one barrier to access by prohibiting private insurers from making health care providers obtain prior approval before prescribing buprenorphine. Such a requirement can delay care at a critical moment for someone seeking treatment. But at the same time, he vetoed a bill that would ban that same practice under Medicaid.

Cuomo then didn’t sign a similar bill to expand access lawmakers passed in June of this year before leaving office. Meanwhile, his administration drew up a new list of approved drugs for Medicaid plans that went into effect this month that categorized three forms of buprenorphine as “non-preferred,” meaning they still require prior approval.

This change has already interrupted some patients’ access to their medication, Budnella said.

Advocates are calling on Hochul to sign the bill, which would go into effect after 90 days, and to issue an executive order eliminating prior approval for medication-assisted treatment that would take effect immediately.

Hochul has not weighed in on this specific issue but recently acknowledged the extra paperwork and delays prior authorization requirements from insurers can cause. She suspended the practice for certain types of medical procedures for 30 days as part of an effort to address staffing shortages in hospitals resulting from the state’s COVID-19 vaccine mandate.

Hochul signed a separate bill this week expanding access to medication-assisted treatment such as buprenorphine in prisons and jails. Advocates are optimistic that Hochul, who led the state’s task force on opioid addiction as lieutenant governor, will help advance policies to reduce overdoses at the state level.

“There are a lot of people that are dealing with substance use disorder in the correctional system and not being given medication,” Khaikin said, adding that particular attention should be paid to ensuring people are able to immediately access medication and treatment when they transition back into the community.

“That's a hugely vulnerable time,” she said.

New York's opioid fund could also address other insurance challenges people face when seeking to enter drug treatment programs. Often there are greater barriers to accessing behavioral health services than other types of medical care. Khaikin suggested increasing funds for CHAMP, the state ombudsman program that helps people resolve issues accessing such care.

Localities are still unclear on the process for allocating funds from the settlement program, a spokesperson for New York City’s health department said. Starting in 2022, each New York locality receiving the funds will have to report how the money is being used every year on November 1st.