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This is a New York State Public Media special report, COVID 19 and the Overdose Epidemic.

Broadcasting from the WXXI Studios in Rochester, New York.

This program is funded in part by a grant from the New York State Education Department.

Good evening and welcome to this New York State Public Media special report, COVID 19 and the Overdose Epidemic.

I'm your host, Evan Dawson.

This broadcast is part of a statewide collaborative effort to examine New York's addiction and overdose crisis.

Our panelists this hour will help us understand how the pandemic affected the progress made in dealing with this crisis.

And we'll examine possible solutions, including how to get more new Yorkers into recovery and how to prevent addiction in the first place.

I'd like to welcome our panelists now.

Dr. Charles Cunningham is commissioner of Oasis, the New York State Office of Addiction Services and Supports.

Dr. Indu Gupta is the former commissioner of Health for Onondaga County and former co-chair of the Onondaga County Drug Task Force.

She joins us to discuss the impact of the pandemic on the overdose crisis during her tenure.

And she represents herself this hour.

She's not representing Onondaga County.

Professor Elaine Hill is an associate professor of public health sciences and economics at the University of Rochester Medical Center.

Professor Hill is co-leading a study about how COVID 19 affected the overdose crisis.

And Avi Israel is president and founder of Save the Michaels of the World.

The nonprofit raises awareness of challenges faced by people and families struggling with addiction and connects them to needed resources.

During this broadcast, we will also meet New Yorkers in recovery, and we'll hear about harm reduction strategies across the state.

If you or someone you know is struggling with addiction, you can find resources at Oasis dot ny dot gov slash plot project Cope.

You can also call or text the hotline at 18778 Hope and why it's available 24 seven.

You'll see that information on the bottom of your screen throughout this broadcast.

And we want to hear from you during this broadcast.

If you have a question about the overdose epidemic, you can ask it via Facebook, Twitter or email.

You'll see that information at the bottom of your screen when we talk about this crisis.

We often cite statistics, but for every number we see, we want to recognize that there is an individual and a family affected by this epidemic.

In 2017, the US Department of Health and Human Services declared the overdose epidemic a public health emergency.

That year, nearly 4000 New Yorkers lost their lives to drug overdoses.

At that point, the number of annual overdose deaths had been rising for nearly a decade.

Progress was being made until the pandemic hit and the number began to rise again in 2021.

More than 5800 new Yorkers died from drug overdoses.

83% of those overdoses involved opioids.

In just ten years, the number of opioid overdoses had risen 400%.

This crisis is hitting all racial and ethnic groups, including a nearly five fold increase for black New Yorkers since 2010, quadrupling for Hispanic and Latino New Yorkers tripling for white New Yorkers.

I'd like to begin with Dr. Gupta.

Dr. Gupta, you've said that around 2015 and 2016, you saw significant progress being made, but it started to pull back even before the pandemic.

And then the pandemic made everything more challenging.

What was working for a while and why do you think it started to go backwards?

So I would I would start with that.

During 2016, we saw the peak numbers of overdoses in Onondaga County, and we did a 2015.

We started to put together a drug task force which included many all the health systems, community based organizations, even community advocates.

We sort of made a very collaborative effort to bring everybody on board and learn from each other so that we can take a comprehensive, multi-pronged approach to address the crisis, to make sure that we have enough resources in the community for the treatment, because they were not many at that time.

And also address started to talk about prevention and reducing the stigma.

So 2016, we did a first forum, community forum in in the Civic Center and it was very well attended.

What happened that initiation of that resulted in sort of a continued conversation throughout the community all the hospitals, our partners, the physicians, as well as behavioral health partners.

They started to have more and more collaborative relationship with each other.

Community was more engaged as a school started to talk about these things.

I know I went to many schools and presented during their forums, so people came together to address that.

Right?

It's it's like a teamwork.

So that collaborative relationship resulted in more advocacy also.

And we started to see some trickling of some resources that I remember at that time, there was not much attention.

The federal government was not paying that much attention.

We didn't have much grants.

Also, when I did the first time, when we did the first forum in the county, I had to kind of borrow some money from one of the other programs and put it together and put our all efforts together.

The reason we started to see, I think in hindsight because all those people who were involved from the patients to the to the physicians to the treatment center, they started to work together and came under the same umbrella.

And we saw in 2017 the rates actually decrease in our local community.

And it started to go up.

And, you know, the problem is when we perceive there is a crisis, it brings the best on us, which we saw it in during the pandemic also.

And we started to see some sort of it or behaviors come back and people start to work in their silos.

And unfortunately, the pandemic hit in 2020 and had all hell broke loose.

And when you compare from 2017, which was the lowest one, lowest overdose deaths in our community, and if you look in 2020, it tripled about seven.

It was like a 70% increase in that time frame.

When you take 2021, it was 100% increase in there because there was a significant social isolation.

Everybody, you know, the community was shut down.

The things which our support system for the people who are suffering from addiction and getting their treatment, they all somehow came in to standstill.

They disappeared.

And that created the problem in in in reaching to those people who really needed the resources the most.

And on top of it, the physicians, the behavioral the the providers, behavioral health providers.

But also, I mean, everybody was confused, you know, how to deal with the pandemic, which we saw that ourselves quite a bit, because we wanted to make sure that people that are not suffering are not getting impacted by the COVID 19, because that was the more that was creating more negative health consequences.

So the the COVID literally took over the opioid part and pretty much everything superseded.

As a result, we started to see the overdoses and non-fatal overdoses as well as the fatal overdoses started to spike during that time because of lack of treatment, because of lack of connectivity during those those 2020 and part of 2021.

And we will certainly talk about where we go next in solutions.

Coming up, let me turn to Dr. Cunningham.

What has Oasis seen during this pandemic that has affected the ability to provide resources in care?

Yeah, so I think we have to start by talking about stigma.

So stigma is certainly one of the biggest barriers for people to receive care.

And certainly the you know, with the COVID pandemic, you know, people were also concerned about whether or not they should go into, for example, residential treatment.

You know, if outbreaks occurred in residential treatment, that was certainly also a barrier.

People had to be quarantined and isolated.

So I think, you know, that both the stigma which has been around for a long time and continues, although I think it's getting a little bit better, is really the major barrier stigma towards addiction itself.

Stigma towards the treatment for addiction as well, and particularly medications.

And then, you know, I think that people have been cautious in terms of entering treatment programs and particularly residential programs.

Well, let me turn to Professor Hill.

Are we starting to see evidence now that COVID infections contributed to an increase in substance use overdose in the last three years?

So in terms of infection specifically, are we have some preliminary work.

So this is still need to go through peer review.

But we started looking at sort of co-occurring factors for long COVID and one of the top conditions or complaints is chronic pain.

And we know that chronic pain is associated with, you know, seeking analgesics and possibly, you know, needing pain relief.

And so we started to look into this as a specific, you know, post-COVID outcome.

And we do find that COVID severity is associated with, you know, more likely to develop chronic pain.

And then for those who develop and these are new onset pain, this is not a population that had pain, but prior to the pandemic, you know that some of those who develop this chronic pain or a higher risk of of developing substance use disorder.

So, you know, this is preliminary and we're working on it.

And we're we're beginning to think about the mental health component as well.

But, you know, our research is suggesting that there is a new population at risk as well.

And those stories can be so devastating for families.

Perhaps no one knows that better than Abby.

Israel lost your son, Michael, in 2011.

And I know you've had to tell this story before.

As difficult as it is, let viewers know a little bit about what has happened to your family.

Well, Michael was diagnosed with Crohn's disease early around the age of 13 and, you know, we did good for for a while.

We were actually coming over here to Rochester, to Monroe County, to to take to have him treated.

He did really good for a while.

When he got to the age of 18, things have changed.

He went to University of Buffalo, wanted to to behave just like everybody else.

And got sick, went through the first surgery.

And that's when opiates were being prescribed to him as as, you know, as a father or as as a family.

Together, we had no idea how dangerous opioids were until 2009 ten when Michael said that, Dad, I need to talk to you.

And I said, Well, let's talk.

And he said, Dad, I'm addicted.

And I didn't know what he was addicted to.

And my question was, what are you addicted to?

And he says, My painkillers.

Hydrocodone, hydrocodone.

And so we went to see his doctor the next week and I got dismissed, got a tap on the shoulder.

And the doctor told me that Michael needs those right now.

And he actually his disease got a little worse and he needed to go into the hospital again.

And Michael was so depleted of nutrients, it took three months before he got the surgery.

At that time, Michael was being fed high doses of painkillers.

And you can see on his face that it changed from pain relief to really he was getting high in the hospital.

And again, we reached out to his doctor and he says or don't worry, Michael, we're going to wean him off when he get out of the hospital.

Well, the way he got weaned off by several prescriptions of controlled substances was to take home.

We got him home.

Michael went through his painkillers real quick.

At that time, there was no any there was I didn't know it was no control over opiates.

Any doctor can prescribe them as many as you need, whatever you needed, you could just get many times a week.

So he knew he.

Wanted help, didn't he?

He did want help.

He did want help.

But he also was addicted and he recognized that.

And at the time, some of the stuff that were available today were not available 12 years ago.

And unfortunately, some situation even today here are the same situation exists when we tried to get Michael help.

There was no one around that can direct us.

Nobody there was there was not there was nobody that blazed that trail and created and saved the Michael's of the world at the time.

Were there any beds, no beds for him to go to?

Well, Michael spent three days in a detox facility in downtown Buffalo.

Okay.

It was run by an organization that is out of business right now for three days, that kid said on a bench there was no medication assisted treatment.

And then the same insurance company that subsidized his addiction called and said that we're not going to pay for him and come and take him.

And we took him home.

Michael attempted suicide on May 17th of 2011.

He sent me a text that said, Dad, I love you.

You don't deserve a son like me and I found him in a garage with the car running.

I called 911 and we went to the Erie County Medical Center and we spent 12 hours in there at 12:00 at 2:00 in the morning.

They told me to take Michael home, that he's a liar.

He was just doing that for attention.

And he was he wasn't going to kill himself.

And the advice that I was given to start to treat them with tough love, change the locks and the door and so forth.

And I didn't know what to do.

I followed directions.

And I'll never forget Michael's face when he came home and his key did not fit in the lock and on June 4th, we had a conversation and I said, Michael, you need to ask for help.

You need you need to call.

I called your counselor and she wants you to call.

And he did call that morning.

And he called to ask for help.

And she said, Let me call you back.

She called him back in 5 minutes and 47 seconds.

That's how long it took for her to say, Michael, there, there's no bed.

And he handed me the phone, went into the back bedroom, took a shotgun that he was using for hunting and put it under his chin and pulled the trigger.

And I kicked the door and Michael died in my arms.

I think we all feel the power of that story.

And you're trying to build a monument to your son now.

We're going to have a chance to talk to Avi later in this program about how he sees the resources now and what has to happen to prevent more stories like that.

And as heartbreaking as that tale is, there are new Yorkers in recovery as well.

For many of them, the pandemic sabotaged their progress.

We're going to hear from one of them now.

I'm Cara Izzo and the peer support program manager at Recovery Fitness.

Recovery Fitness was started in 2015 by a couple of people that were in recovery and wanted to do something more and do something that included fellowship and connection and the the premise became sober, living through fitness.

I was struggling pretty bad, not afraid of myself and the outside world.

And I came in here as a safe place.

And Chiara was very warm and welcoming.

I was able to talk to her and kind of unload and process the things that were going on in my mind.

So she started here as a member and then quickly became one of our volunteers.

And then shortly after that we hired her and staff.

I started substances socially, maybe drinking and smoking marijuana.

As a teenager, I started using cocaine at the age of 21.

It was just socially fun going out, hanging out with friends, drinking at bars, partying.

And then it quickly escalated to use misuse dependance and then addiction.

I decided to get help.

Before the pandemic, I was taking group sessions, counseling sessions that consisted of anger management, coping with intrusive thoughts, depression, anxiety, stress management, things like that.

It was going amazing when the pandemic hit and we had to shut down.

I could no longer come into the facility.

I had to stay home.

My kids had to stay home.

And I struggled very hard through that time.

I went from being on top of my sobriety, my recovery, and doing the things I needed to do to a decline in life.

So I began using again during that time the loss of connection, the interpersonal conversations that we would have during group sessions or as a group, sharing our feelings and emotions and what's going on with us in person was really beneficial.

So having that all erupt and it happened like it seemed like it happened overnight, like one day I was there and then the next I couldn't come in.

There was no medic cab to pick me up, to take me to my appointment.

And I was just at home drowning in my sorrows.

A huge part of recovery for many of us is having connection face to face.

Connection.

And we lost that during the pandemic.

So we had to find ways to continue to connect with people that didn't include being in-person and so we started doing that by making a lot of phone calls, reaching out via text.

As an organization, we started doing a lot of things online, anything we could do to keep the connection with people that we lost because we couldn't be face to face.

I came out of my slump summer 2022 and I came here not wanting to use but not knowing how not to use.

I just was coming here every day because it was safe.

I could sit in here and have a cup of coffee or work out.

I could get out of my own head and talk to other people.

And then I started volunteering and quickly they they loved my presence that I had and they hired me.

And it's been the most amazing.

Her words can't describe the feelings that I feel, how I came alive.

Again, I'm helping other people where I was in that dark place.

The service that I provide is what's keeping me out of that dark place.

The pandemic taught us how important our mission is and that we're we're on the right course.

And so when we did have that per we don't regret that decision.

We shut down because it was what was safe to do.

But if that ever happened again, we wouldn't shut down.

We've learned that it is more important for us to continue our mission and to do it safely.

Today, I am so super proud of myself and my sobriety.

I am coming up on a six month milestone free of any mind altering substances, drugs and alcohol.

I am here every day as a person with lived experience, helping people give them hope.

I'm not ashamed of who I am today.

I'm very proud of the shinies.

I am the best version of myself that I have been in my entire life.

My kids are proud of me.

My family's proud of me.

Let's talk about their let's ask all of our panel about this.

And I'm going to start with Abby Israel, because we heard about the loss of Michael, the resources that weren't available for Michael in varying degrees, depending on where you live, they may be accessible.

They may not obvi.

You said you don't mind being blunt.

Let's talk about right now.

Let's talk about this pandemic, what resources are not there and where are the gaps as you see them?

Well, the number one thing that I think is missing is some sort of urgency for our government if people are dying every single day.

Okay.

Right now, Oasis is sitting on over $200 million.

That can help people.

Why isn't it out in the street?

You know, why isn't it out helping people?

And you saw the young lady speak about recovery centers.

Recovery centers make a huge difference.

We have a recovery center in Niagara County.

There's over 1100 people a month that go through it.

I would urge New York State, I would urge the commissioner.

She knows how that works.

Support Recovery Center support peer to peer program works fantastic.

Those are people who would live to experience, who can understand a person who goes to a.

The other thing that is missing right now are you go to treatment for 28 days.

That is nothing.

That's a pimple on an elephant.

It doesn't do a damn thing.

Not enough.

Not enough.

But when you get out of it, when you get out of treatment, you have no wraparound services to help you.

It's time that Oasis got involved with that.

We have plenty of money sitting there.

We can do that.

We need housing, we need transportation.

We need recovery centers that work.

We need people who can understand what's going on.

We need access to medication, assisted treatment, whatever it takes to keep a person alive.

I cannot make it up to Michael.

Commissioner Cunningham could I make it up to Michael?

Nobody can.

But there's a lot of people in this country who can use to help, who want to get better but just don't have access to treatment.

All right.

Let's talk to the commissioner.

Commissioner Cunningham, you want to respond to that?

Absolutely.

So we totally agree.

There's urgency like we've never seen before.

I mean, more people are dying of overdose deaths than ever on record in New York and across the country.

And I also want to say that we, as Avi had mentioned, have over $200 million from the opioid settlement fund.

So this was money coming from pharmaceutical companies and distributors who were, you know, sued across the country and across the state.

So we had an opioid settlement fund advisory board, of which Abby was a member of it.

And we have met ten times in 2022, and we received recommendations from the advisory board.

We were also told by the board that they didn't want us to really make the money available until the recommendations were received.

And so when we received a formal report of those recommendations on November 1st and to date we have made available $120 million and we expect that another $11 million will be available by the end of this month.

So we we we definitely, you know, agree with the priorities that that the board had, which includes harm reduction, which is bringing services to where people are reducing the barriers so that people can access those services.

And that is a top priority of of Oasis and of the governor.

And so just some examples of the kinds of initiatives that we've that we're doing include low threshold buprenorphine.

So buprenorphine is also known as Suboxone.

That's a brand name.

It's a medication that treats opioid use disorder and reduces the risk of death by 50%.

That's a tremendous a tremendously effective medication, you know, and all of health care.

And I can certainly say that as a physician, there aren't that many other things we do that are that effective.

So this initiative is to get buprenorphine and make it available to people so that when they are ready for treatment, that that treatment is available in the same day.

And so we are supporting that with 15 sites across the state and with $15 million.

And so that's one example.

Another example is, you know, making sure that Naloxone or Narcan is available across the state also, and also fentanyl test strips so that people can test their their drugs if they're using them and then can change their behaviors accordingly.

Other kinds of examples are expanding methadone treatment.

Again, another very effective medication treatment for opioid use disorder and bringing that treatment out to where people are.

So in communities that don't have a brick and mortar opioid treatment program that provides methadone, actually having mobile units go out into those communities to provide that care.

So so we we definitely know that this is important.

We have tools that can help keep people alive.

We have to make sure that the treatment and the services get to people who need it.

And we're really taking innovative ways.

We're really trying to expand our reach and in embracing the harm reduction approach to do that.

And so so that's some of the initiatives we're working on right now.

And just in terms of that, you know, this discussion, certainly we also support you the harm reduction prevention, treatment and recovery services.

So we support recovery centers across the state.

We support youth clubhouses.

So that's specifically for youth to also engage in healthy activities.

For those who are working on the recovery, we provide transportation.

So up to $5 million in transportation grants and we really support peer.

So people with lived experience, as we heard on that clip, are so important and they have a, you know, an active role in the whole continuum of services and so supporting peers to become certified recovery, peer advocates providing scholarships to do that and integrating them in our services is also, you know, really important.

And part of what we support.

Just briefly, because we want to work everyone in.

But I know Abbie wants to follow up for just a moment.

Go ahead.

Well, I think that the governor's been the commissioner said is great.

Unfortunately, it's not getting to the people on time and let me explain that to you.

Okay.

I live in Buffalo, outside of Buffalo.

Erie County is basically a rural county.

When when you go to the next county, which is Niagara County, it's the second highest overdose rate in New York State.

There are no services.

So when you go outside, what.

Kind of services are lacking?

There's nothing.

There's basically nothing.

If you need methadone, there's no transportation to get to Niagara Falls.

Eastern Niagara County is is a desert county.

I would urge the commissioner to really get out there and start looking at what's missing.

Are you talking about beds as well?

There's also there's those three treatment facilities in Niagara County that are there are bed on.

Fortunately, we just don't have the manpower.

But let me just mention I just want to mention that if you take a look, viewers are taking a look at the screen in terms of beds per 100,000 people, beds per capita.

Erie County, where Abby lives, is six than the state, and it still has only a third of the beds per capita as Manhattan.

More than 30 counties in the state have none.

None.

That's what the commissioner needs to understand.

What Dr. Gupta said in 2016 and 2017, the community got together right now, Oasis Act is an adversary to the community are probably going to get slapped for what I'm saying today and I'm probably going to suffer some consequences by Oasis and and I want to put it out front.

I don't doubt it, because that's the way Oasis is working lately.

Okay, look, we need let me just finish, please.

Well, we need to get back to that community organization.

They work together.

That is not happening.

That is not has not happened since since COVID.

Okay.

I would urge the commissioner I would urge the governor who lost a nephew to get involved.

Okay.

I see every single day.

And I get very passionate about this because every single day I put people in my car.

We provide transportation to go to treatment all the way from the Pennsylvania border, all the way to New York City.

Okay.

There's people in the north country that has nothing.

There's people and and get out of Buffalo, which is the second largest city in New York State.

And you have nothing go into Rochester.

I don't know what's available in Rochester, but I'm sure if you get out to the City of Wrath of Rochester, you're basically on your own.

So to so to say that there's mobile units getting there were two mobile units that went to New York City.

Why it has the best transportation system in the world, for God's sake.

It has more beds and more treatment facilities than any other place on this planet.

Let's let let's let the commissioner respond.

They'll go ahead, Commissioner.

So I certainly appreciate the passion that Avi brings.

And, you know, we also have similar passion in our goals are really the same as to save lives and to make sure that there are appropriate services out in all communities.

And, you know, what I would say is we certainly have made money available across all the economic development zones.

Have do programs have problems and challenges getting mobile units?

Of course, it's been covered and, you know, so, for example, there have been delays in getting automobiles across the United States.

And so so programs are experiencing that as well.

So we certainly work with them to try and troubleshoot.

And, you know, and again, I want to just reiterate that that that dollars has been made available.

But there are challenges.

And we know that during this COVID pandemic, there are challenges with the workforce.

But we're also doing, you know, a lot to try and support in different ways.

And addressing cost of living adjustments, giving scholarships, having health care worker bonuses a variety of ways.

But there are challenges across the field for programs to implement, you know, these initiatives.

So we are working to get them together with them.

We absolutely care about what the community has to say.

And, you know, we we're there to partner and to support the community.

All you know, each community is different and the needs are different and we understand that and we want to support that accordingly.

And so, you know, we certainly are working with communities making dollars available to enhance and expand services that really address the whole continuum of services, prevention, treatment, harm reduction and recovery.

Dr. Gupta, you've worked both as a leader in public health and as such a doctor on the ground trying to help people who need it the most.

What do you see as the most important step that needs to be taken coming out of this pandemic to change some of these outcomes?

So let me start first extending my condolences to Mr. Tisdale.

I'm so sorry for your loss and you have taken such a great initiative, which is going to impact so many people's lives.

So thank you for doing it.

What I see as a as an internal medicine physician and former commissioner is there are one is we can address the problem of access to care, right.

There are so many resources now available as they were not there in 2015 and 2016 when we were struggling.

There are more treatment places and there are more, you know, three different kind of medications are available.

Narcan is also a Naloxone is available.

There are so many of them and soon it will be available over the counter.

FDA just recently advisory panel has has put forward their recommendation and article I.

In my opinion, I think the primary role of primary care physicians and any touchpoints where patients are encountering their health care professional, for example, if they go to emergency room, if they go to their regular physical, if they are woman is pregnant and going through GYN or the pediatrician they are the kids are going for a routine check.

Everyone need to ask a couple of questions about screening for the anxiety or depression or the use of substance.

They have been trying to they have contemplated or they have done it in the past.

That make is a normal part.

It's like a diabetes.

It's like hypertension, it's like HIV.

It used to be, you know, I when I was a medical resident, that was the the peak of the AIDS epidemic at that time.

And in 40 years, we have normalized talking about that.

And this is the same thing which we need to make it not like a project.

I think when we take this issue as a project and and funded the projects, that kind of moves it away from making that part of day to day.

So if the person is going to their family physician or to their OBGYN, if they see that they should be trained enough to prescribe, initiate the, the, the buprenorphine which is so widely available now and SAMHSA has pretty much taken away the barriers in prescribing it.

Same thing is for the naltrexone.

Methadone is another issue, but not everybody is, you know, ready for the methadone.

That's one thing I think we can make.

It is a part of the society.

The second part, Mr. Israel was talking about having those people who really need intense therapy for the beds, those things having a peer support, having connectivity in a real time will be so important.

Like, for example, if the person has almost near-fatal overdose and ends up in the emergency room or the or the first responder have identified them somewhere, instead of leaving them, maybe try to convince them and connect them with with the provider, right then with the peer have that support and electronic referral also can be part of which has been initiated by the state.

I know that before I, you know, during my tenure we saw that those programs were working.

But role of I cannot emphasize this enough the role of primary care is so significant or any actually physician or health care provider when they are having the touchpoints, whether they are in surgery, whether they are engaging in those things, make a huge, huge impact that the most of the time being a physician, practicing physician who did, you know, as as a internist, as a hospitalist, you actually can read the patient's cry for help.

And what we need to do as the physician, as a health care provider, listen to that and try to help them make a societal norm.

That's the only way we can turn the tide of this if this opioid epidemic.

One thing which I would say that pandemic has taught us anything, I think we should take that lesson that it put us under the one tent.

What I mean by that, when the COVID hit us so intensely, I, as a health commissioner, was able to lead the community and work with all the health, health care organizations, businesses, schools, you know, community based organization to have this one uniform voice and collaborative work in which we were all independent entities, but we were independent.

Independent with the one goal.

The only one goal was, how can we save lives?

How can you how can we protect that?

And that's the same sort of philosophy need to take into this, addressing this the opioid epidemic.

Otherwise we will be spinning our wheels throughout.

So I know I'm very passionate about that and I really mean it when I say that the pandemic this is has given us a blueprint and that we should take it.

Well, as a reminder, if you've got questions for the experts this hour, we're asking you to send them via Facebook, Twitter or email that information at the bottom of your screen.

And with overdoses increasing at a staggering rate during the pandemic, there have been efforts across the state to decrease the harm associated with substance abuse.

Those efforts include, as you've heard, everything from syringe exchange programs, the distribution of medications like Narcan and Naloxone, which can reverse overdoses.

Here's a look at some of that work.

Okay.

I'm just going.

Today in Far Rockaway, Queens, Jenni Simmons started with handouts at McDonald's.

Her good friend Robert Chelios waited outside while she distributed bags filled with the overdose, reversing medication, naloxone and fentanyl test strips.

We were asked not to film inside.

These are fentanyl test strips.

Are you familiar with those?

Simmons, who is an associate research scientist at New York University, has a special arrangement with the manager here who allows her to connect with the using community who gather in and around the restaurant for privacy.

Funded through the city, Simmons started Rockaway Gets Naloxone in 2017.

McDonald's is just the first stop.

Next is a nearby park.

Right?

So someone's overdosing.

Someone here in the park that's overdosing.

I think I started working in opioid overdose prevention because I began to recognize that the sense that, you know, opioid overdose deaths were surging very similarly to the beginning of the AIDS epidemic.

And we realized that a lot of people were going to die.

I don't take drugs.

Doesn't matter.

I don't take drugs.

It doesn't matter.

You still may be in a situation where you're seeing someone.

Who said, Yeah, we care about.

Harm reduction is all about treating people like human beings.

Just treating someone decently like you would anybody else is is a kind of intervention, often a simple engagement, I think like just offering somebody a tool that can help save their life is really effective for keyless.

This approach was born from his own experience.

He has been in recovery since 1991.

Harm reduction is not a simple thing to explain to individuals.

They they just don't understand what it is.

When you're talking about harm reduction, you mean harm reduction to them is like, oh, you want me to stop using no, I don't want you to do anything you don't want to do.

I just want you to use Safer.

What was your drug of choice?

Well, heroin was my drug of choice.

Heroin, though I was.

I wasn't ashamed to say I use whatever drugs came my way.

But if we talk about drugs of choice, it was heroin.

But as Carlos points out, his experiences through the early days of the HIV AIDS crisis illustrate how, even with the presence of a known risk like infection or a potentially deadly overdose, it can be difficult to reach users.

They started to give it a name HIV and how do you get HIV while we're getting it mainly through injection drug use.

Right.

And we really didn't care.

We used today is the same situation.

They don't care.

They use it knowing that there is a fact known maybe in the mix of the product they are buying, they still use it.

We think that we have to really improve the message.

Right.

And and in a way to deliver that message with with enough information and enough force to make them realize the danger that's involved right now.

Does the fact that New York now has an office dedicated to harm reduction, does that change your work?

Does it help your work?

We'll I don't know.

This is going to be a process, but it's it sometimes it takes a really long time.

And in the meantime, a lot of people die.

My name is Ed Fox.

I'm the director of Project Safe Point.

I'm going to do an overdose opioid overdose prevention training for you all today.

And Project Safe Point is a public health program that provides harm reduction services to the Capital District.

Our service area is 12 counties surrounding the capital region.

It's a big area to serve with a lot of different needs and a lot of different ways to deliver service.

So we do Narcan trainings in the community and we will do a Narcan training in the middle of the street, in a jailhouse, in a treatment center, in someone's home, anywhere there is opiates.

There also needs to be Narcan.

I don't want to walk out that door until everyone in the room is comfortable using Narcan.

That's like a number one point Narcan.

It's an opiate antagonist.

All it does, it kicks that opiate after its receptor.

I like to say that when you're doing a Narcan training, it's a conversation as much as anything else, because we're always wanting to hear your feedback and people's questions.

Hi, how's it going?

Come on in.

So identifying an overdose, there's a couple of things that you want to look out for.

The person will be unresponsive, have either very shallow breathing or no.

Really breathing.

When we talk about just your overdose crisis we've seen over the years, I think everyone has been impacted in some way.

Everyone knows someone who's been affected by this.

We see how communities are impacted and how individuals are impacted, how families are impacted.

Fentanyl is in everything.

Being such a powerful opiate itself.

It's, you know, super, super dangerous.

You know, it's 15 to 20 times strong and heroin is 80 to 100 times stronger than morphine.

It's out there.

It's cheap, it's available.

It's everywhere.

Our approach as a harm reduction agency, a harm reduction program, is to actually you tell me, what do you need to do?

I'm we work for you today.

And taking that approach, whatever services needed when the services need us and no judgments ever.

Eight years ago was the last time I used heroin.

Sometimes it takes addicts multiple rehabs and multiple tries, and for them to actually get it, you know, for the recovery to stick.

And a lot of addicts don't even get that chance.

Narcan has saved my life.

I've saved two boyfriends lives with Narcan.

I've saved a few other people's lives.

I've been doing this for ten years.

I've been doing this before.

I was even old enough to drink.

You know, I was 19 when I started this process.

I'm 29 now, and where I am in my journey, even and even sober, you know, it's safe to always have Narcan in my car because I think it's safe to say that everybody's been affected by this opiate epidemic.

And, you know, instead of turning a blind eye to what's going on, let's let's get together and, you know, be safe and, you know, go to the Narcan trainings and carry the Narcan in our glove box.

Our community is struggling and people are overdosing a lot.

It's happening more often than I think our community really is aware of.

One of the things that we need to do is recognize that it affects all all aspects of our community.

And it's not just an inner city thing.

It's not just a black white thing that this is affecting all of us and it's touching all walks of life.

We decided to look at ways to communicate to our community that we have a problem.

And so then the last box kind of came out of that, that desire to have a harm reduction response to the opioid issue in our.

Community and we just really kind.

Of looked at, you know, from a data perspective where the overdoses were occurring in our community.

So there's a lot of foot traffic in here.

There's also a lot of foot traffic at Monroe Avenue.

There's been an uptick of overdoses in this area based on the 911 reports that we got.

That's why we wanted to kind of target the areas that are having the overdoses to make sure that we have these on hand when our outreach team isn't physically in the community to provide them their.

So basically what we do is we come in and check our no box boxes that are all throughout Monroe County and the suburbs and in the city.

When we come out and we see that some of them don't have enough Narcan in them, which would be 12 boxes of two doses.

We just go ahead and refill them.

So it's simple to get into the box.

And then this is where we store the Narcan, which is the medication that is used to reverse opioid overdoses.

The good thing is, is that in this area, we've seen an uptick of family, friends and bystander kids that are actually administering the Narcan as opposed to law enforcement officers and EMS.

I think it's a very good idea.

There are many people in this area that need access to it.

Many people are strung out on it.

If it's accessible, there probably won't be as many overdoses.

This particular box usually gets filled up about once a week.

It's in a high traffic area, and folks in this neighborhood know that this box is here.

They know what Narcan is, they know what it's used for.

So they know when the stores open.

I can come right over here.

I can grab this Narcan and I can help save a life if needed.

I've had my own experience where it wasn't accessible.

What about access?

Well, maybe my son might not have died of an overdose.

It was an accessible to us when we needed it.

I know myself, being an addict, if I would have had more resources available, I probably would have got help sooner.

I just kind of.

Separated out.

Our cases and actually I went for the whole entire year.

So if you can see is your fatal column, this is the naloxone was used and this is by whom?

And so I've highlighted family and friends because that's what I'm most concerned with, where it was used.

They didn't die.

Where it was used.

They didn't die where it was used.

They didn't die.

If we're looking at the data, you can clearly see I kind of color coded it on my chart.

You clearly see that those people that get naloxone tend to live.

There is definitely a conversation that needs to be had with people after they survive an overdose.

We we haven't really met with a lot of resistance when we pop up at their doorstep to again offer services and motivation and encouragement.

But we do know that this is a really good opportunity for people to get the help that they need.

Now, whether or not they take it or not is is a whole other story.

But that's okay.

We'll be back.

We're out in these communities on a daily basis.

We're out meeting the community members.

We're providing them with life saving measures.

I'm glad you're out of that, though.

Let's keep everything.

Positive.

It's high time that we debunk that myth.

So like the myth that, you know, the probe writing harm reduction is somehow encouraging use.

The data clearly shows that it helps to save life.

And the moment that you're able.

To save a life.

Presents the opportunity to help that person change the course of their life.

Whether or not they take it again is another thing.

But as long as they're alive, we have the opportunity to kind of intervene and help get them on the right path, which is to not use them.

Yeah, good, good, good.

So, yeah, I'm going to give you my card.

Please, please, please reach out to me tomorrow.

We're trying.

Those are a range of ideas being used now moving forward from the pandemic.

And Professor Hill, your research indicates more people are maybe willing to try telemedicine since the pandemic.

That's one option going forward.

But you're also researching the economic conditions that underpin this.

And what are you learning?

Yeah.

So on the research prior to the pandemic, we learned a lot about how economic conditions can contribute to the overdose crisis.

And that was a central focus of my research leading to this new grant to try to understand how the pandemic is contributing.

And new research from my from colleagues and collaborators in the nation have found that even in this first segment of the pandemic, that the recession effect on the overdose crisis is quite significant.

And so the economic conditions are massive.

I mean, we're not using that term recession economically, but the way that this has impacted individuals and communities is certainly in terms of telemedicine.

There are some limited studies that show that because telemedicine became available during the pandemic for the various reasons that have been discussed this evening, that is creating retention for receipt of amyloid and or medication for opioid use disorder, and also preventing overdose.

More research to come.

Out, more research that can.

Absolutely.

A couple of questions from our audience have come in.

Let's take a look at one of the comments that came from a viewer tonight.

And it looks like this.

I think we can get it on the screen.

Steve is wondering, why don't we have safe injection sites?

That is just one example of harm reduction.

The commissioner of Oasis, Dr. Cunningham, how do you feel about safe injection sites?

Yes, it is part of harm reduction.

And harm reduction is a full continuum of a lot of different services.

But what we do know is that overdose prevention centers, also known as safe injection sites, are not permissible by federal or state law.

So that's really what the issue is.

It's it's a legal issue.

Okay.

And in our last 30 seconds, a piece here, Dr. Cunningham, what do you want to leave with the audience as this work continues?

So I think it's great to have conversations like this.

We need to talk about addiction and its treatment.

We need to really break down the stigma.

There are effective services.

There is effective treatment.

It's really about getting treatment to people who need it.

And if people are not ready for treatment, making sure that they are, they can stay alive by using harm reduction strategies and then approach.

So we have the tools.

We just need to make sure that people can access them and that we bring the treatment and the services out to where people are and those who need it the most.

And we have been emphasizing those resources.

I hope people are accessing them.

Dr. Gupta, what do you want to leave with the audience tonight?

So what I would like to leave with is that opioid epidemic continues to impact our lives throughout each and every community.

It is here right now.

And what we need to do, we certainly can, if we work together, can can address the needs of the community with the multi-prong approach by the prevention, addressing the crisis and making sure everybody has the access to treatment.

So when we are talking about access to treatment and harm reduction techniques, all the harm reduction support system which we talked about it, the one thing which I would like to leave with people is the medical community.

Medical treatment is, you know, it can impact, it saves lives, it's available.

That's we know that it's in can impact 20% of the health outcomes 80% we know that.

And public health is impacted by what we call social determinants of health.

What is out of those clinic walls?

Hospital was really needs to be addressed.

Whether person has a you could have a lot of treatment facilities available, but if person doesn't have information about that, there is a language barrier there is no transportation or they are facing stigma because of how they look or how they speak.

All these things are not going to be there for them.

So I think it's important to to have a comprehensive, holistic approach to address that.

And if we can.

Yeah.

Right.

Get out of the silos and work together and we can do that.

30 seconds, get to keep it really tight.

Go ahead.

One thing that I'm going to add to that get out of the silos is we need to integrate integrated care.

And this state or inmates does not talk to voices or wishes, does not talk to our inmate with every single person who comes in and asks for treatment, has anxiety, has depression, has PTSD one way or the other.

We take them to treatment do not get what they need.

So what we have here is people get on this merry go round and we keep going around and around and around and we keep taking money and throwing it into supposedly treatment.

But the people are not getting what they need.

It take care of also grassroot organization.

They make a huge difference.

Well, I greatly appreciate all of our guests.

And you can see we have got to conclude the special report.

Thank you for watching.

And please use the resources we've been sharing with you.

Goodnight.