Save a life. Carry Naloxone.

Scope of the Problem –
The NIH defines opioids as a class of drugs that produce euphoria in addition to pain relief. Opioids include heroin, fentanyl, oxycodone, hydrocodone, codeine, morphine and many others and some are prescribed necessarily to patients for pain relief. However, in New York City, these drugs are often abused causing an opioid epidemic, leading to dependence, overdose and death.

In 2016, there were 1,374 unintentional drug overdose deaths in New York City alone, that averages to nearly four drug overdose deaths each day, compared to 937 unintentional drug overdose deaths in 2015. This 46% increase from 2015 to 2106 indicates a growing problem and a need for continued intervention. Additionally, the rate of unintentional drug overdose death increased for the sixth consecutive year in New York City showing a 143% increase from 2010 to 2016 and highlights a need for change.

Naloxone is a medication designed to rapidly reverse the opioid overdose and can quickly restore the normal respiration to a person whose breathing has slowed or stopped as a result of an opioid overdose (NIH). Naloxone is easily accessible in New York City but the broader population does not know the ease of obtaining it, which is why this program will work to improve the awareness and effectiveness of naloxone and its purpose for New York City Residents.

The ‘Save a Life. Carry Naloxone’ program was designed as a harm reduction program for individuals who abuse opioids and their families. This program is working but not to its fullest extent. With better public knowledge and understanding as to the benefits of this drug and this type of program, the general public will benefit from less unintentional drug overdose deaths and lives will be saved. In New York City, most overdoses are witnessed and happen at home. With that in mind Naloxone can be used to reverse the overdose in the user and save their life. For this to work, users and their friends/family have to know about Naloxone and have to understand the ease with which they can obtain it and how to use it in a real life setting. It starts with educating people of its availability and that is where this program failed.

Although the information is easily available and accessible online, if someone does not know to look, they won’t look and that point alone may lead to more unintentional overdose deaths. With greater awareness of the benefits and effectiveness of Naloxone, this program will work to save lives and towards eliminating the greater opioid epidemic in this country.

Planning –
The ‘Save a Life. Carry Naloxone’ program has many strong qualities and has set up online instructions detailing how to obtain naloxone from pharmacies across the New York City area. The site also details how you can sign up to become a Certified Opioid Overdose Responder and how you can work to prevent overdose related deaths.

That said if the individuals do not know what naloxone is and the positive impact it could have on their lives, the program in itself is ineffective. A key change I would make is to execute and share a better ad campaign with all New York City residents. I would work with the Mayor’s office, as the First Lady of New York Chirlane McCray’s was involved with this initiative when it took off in December 2016. I would recommend that Ms. McCray should appear with her husband on New York 1 during Mayor DeBlasio’s Monday Segment. I would have them spend a few minutes to plug the naloxone program and the benefits of being aware of an antidote for opioid overdose.

Bringing the conversation to mainstream media will work to decrease the stigma associated with any sort of harm reduction program and encourage people to become more informed and able to assist if needed. I would say that Ms. McCray should spend time speaking to the ease of access by highlighting the different pharmacies across the New York City area where Naloxone is available as well as the free NYC DHMH centers where you can obtain a dose.

NY1 can also provide the link to the NY Department of Health Site where additional information and resources are available. Spreading the word beyond local newspapers, convenience stores, nail/hair salons, and ferry terminals is essential to ensuring that the largest number of people see the ads and feel empowered to act if needed. Given the DeBlasio Family’s commitment to mental health, I wouldn’t foresee an issue bringing them onboard with the plan for a bigger ad campaign across the city as I believe this plan to increase the awareness of this program will in turn help to save lives.

In addition to Ms. McCray, I would work with the New York City Health Commissioner Dr. Mary T. Bassett to ensure we would have the full support and backing of the New York City Department of Health and Mental Hygiene. There is a $5.5 million initiative to reduce drug overdoes in New York City and I would ask for a bigger portion of that funding to be spent on addressing those that are unaware of the effectiveness of naloxone. I would say in helping to spread the word about a program we would see a decrease in the number of unintentional drug overdose deaths in New York.

The Bureau of Alcohol and Drug Use Prevent, Care and Treatment works to reduce morbidity and mortality related to alcohol and other drug use among New Yorkers. The BADUPCT works to host the Overdose Prevention and Reversal Training sessions in conjunction with the program and I would encourage them to put out additional information about how important harm reduction is and the associated statistics about the difference it makes in practice. There are a lot of people that do not believe in any sort of harm reduction programs as they believe it was the individual’s choice to begin abusing drugs. These opinions are more challenging to change and may not be changed overnight or with additional ad coverage. Rather the statistical results of increased awareness and decreased unintentional drug overdose deaths may help to change opinions in the longer term. If each Mayor has the commitment to decreasing the opioid epidemic and saving lives in New York City, I feel that this program will be feasible in the long run. Working to educate the public on the purposes of naloxone and its effectiveness in practice will save more lives.

Using the data from the NYC Office of the Chief Medical Examiner and NYC DOHMH Bureau of Vital Statistics, I will continue to obtain information on the unintentional drug overdose deaths in New York City and hopefully with greater awareness of the Save A Life. Carry Naloxone Program, will see it decrease for years to come.

Development & Dissemination of the Intervention –
The goal of this intervention is to decrease the total death count of unintentional drug overdose deaths in New York City by spreading and increasing awareness about the availability and effectiveness of naloxone in practice. With greater awareness of naloxone and broader understanding of it’s availability in New York City, this intervention is hoping to achieve a more knowledgeable population and one that is prepared to and equipped with the ability to save the life of someone suffering from an overdose.

The framework of this input includes the $5.5 million in funding that has already been set aside for this program plus additional funds required to continue and diversify the ad campaign. Given the Mayor already appears on NY1 for his weekly, Monday’s with the Mayor segment, it is just about devoting a portion of that segment to ‘Save a Life. Carry Naloxone.’ intervention each week. During these segments the mayor or Ms. McCray can introduce different individuals who have been positively impacted from this program to humanize the effort and provide some personalization with the hope that this personalization may yield stronger support for this type of harm reduction program.

Supplementing those sessions with the additional ad campaigns taking place around the city, we would hope to see a decrease in the total number of unintentional drug overdoses in NYC and broader use and support of naloxone. These ads (copied below) should continue to be displayed in subways, on busses, at CUNY schools and any NYC private schools that grant permission to display them in order to ensure that this intervention is reaching as much of the city population as possible.

As a part of this intervention, I would ensure that all New York City Residents with a smart phone downloaded the Stop OD NY App. This app, which already exists, shows users how to recognize and prevent opioid overdoses and where to find naloxone near them. Again, if individuals do not know this program exists, how will the broader public benefit from its creation and that is why it is so important for our intervention to spread the word about the effectiveness and availability of naloxone in New York City.

The intervention involves the Mayor and First Lady and their staffs participation, cooperation from NY 1 for the air space each week, the approval/monetary buy in to continually run the ad campaigns across all New York City Transit, the data and statistical information from NYC Office of the Chief Medical Examiner and NYC DOHMH Bureau of Vital Statistics to manage monthly findings, the support of the BADUPCT to provide insight into the naloxone trainings and the NYC Department of Health for continued funding for this project. This project would also involve all of the sign hangers and individuals who are involved for getting the necessary permits for the naloxone ads to go up across the city and the web designers to ensure the site is functioning properly for the hopeful influx of individuals utilizing the resources as they were intended to be used.

Lastly, if possible and the school boards allowed for both high school and college aged students, mandatory seminars could be held to share the effectiveness of the drug and the broader program. The advertisement alone won’t save lives it will be the individuals it impacts and their desire to share the learned information with others in their community. The intervention isn’t intended to increase the use of opioids but rather to reduce the unintentional deaths associated with overdose and with that word of mouth from these populations; this program may be able to do just that.

Evaluation & Maintenance –

This program holistically will be evaluated on a yearly basis and compared across the previous years statistics as it relates to unintentional drug related overdose deaths. That said, monthly statistics will be monitored and tactics will be adjusted if there isn’t significant progress. Change and implementation are expected to take some time but if the intervention weren’t successful over a period of time, I would have to change the approach to ensure that as many individuals benefit from naloxone as possible. It is possible that a more targeted approach will have to be taken for specific boroughs where the greatest number of opioid related over dose deaths are recorded as in 2016 alone, the rate of overdose deaths involving any substance was highest among Staten Island residents, increasing 66% from 2015. That said, it is important in its first state that the broader population is targeted to ensure as many people are aware of naloxone and its effectiveness as possible.

This program is easily maintained over the next 5-10 years as there is vast federal support awarded to its maintenance. The CDC is awarding more than $28.6 million in additional funding to support responses to the opioid overdose epidemic built on the announcement 3 months earlier that the CDC already provided $12 million to states to support overdose prevention activities. Health and Human Services Secretary Tom Price states, “One piece of HHS’s five-point strategy for combating the opioid crisis is improving our understanding of the epidemic through better public health data,” and New York does really well at reporting this data. Additionally, the U.S. Department of Health and Human Services has awarded an additional $144.1 million in grants to prevent and treat opioid addiction and NYS is set to benefit from these awards. Lastly, Governor Cuomo indicated that $25 million of additional federal funding would be distributed to New York State in the attempt to further fight the opioid epidemic. With continuous monitoring over the next 5-10 years and partnership with national counterparts, NY City and State should hope to see this intervention program help to decrease the number of unintentional opioid related deaths and the increased awareness working as a helpful aid in this fight against the opioid epidemic.

Sources –
http://www1.nyc.gov/site/doh/health/health-topics/naloxone.page
http://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief89.pdf
http://www1.nyc.gov/site/doh/health/health-topics/naloxone.page
https://www.cdc.gov/media/releases/2017/p0905-opioid-funding.html
file:///Users/jessicabrown/Documents/DRUGS2.pdf
file:///Users/jessicabrown/Documents/DRUGS%201.pdf
https://www.health.ny.gov/statistics/opioid/data/pdf/nys_opioid_annual_report_2017.pdf
https://www.drugabuse.gov/drugs-abuse/opioids
https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio
https://www.dnainfo.com/new-york/20161212/great-kills/opioids-naloxone-painkillers-addition-substance-abuse-health-department
http://www1.nyc.gov/office-of-the-mayor/news/383-16/mayor-de-blasio-launches-series-initiatives-reduce-drug-overdose
https://www.governor.ny.gov/news/governor-cuomo-announces-distribution-25-million-federal-funding-address-opioid-crisis-new-york