What the latest overdose data says about NYC’s efforts to curb the crisis

The five boroughs are in the throes of a worsening drug overdose crisis, with widening disparities between which New Yorkers are affected the most, according to the latest data brief from the New York City health department. A record 3,026 New Yorkers died from overdoses last year, a 12% increase from 2021, according to the report.

The number of overdose deaths did not increase quite as sharply as it did during the first two years of the COVID-19 pandemic, when fatalities increased 40% and 28%, respectively, year over year. But the figures still show that, like many other public health threats, the overdose crisis is taking the greatest toll on Black New Yorkers and residents of neighborhoods with high levels of poverty – especially in parts of the Bronx.

Epidemiologists who spoke with Gothamist said the data breakdown highlights the need to not only bring more targeted interventions to the most affected communities, but also to address the inequalities that make some New Yorkers more susceptible to overdoses and other public health threats in the first place.

“These inequities are not just in overdoses,” said Bennett Allen, an assistant professor of epidemiology at NYU’s Center for Opioid Epidemiology and Policy. “They're across the board in the criminal legal system, in housing and the homelessness crisis, education and educational outcomes, income and wealth, employment outcomes.”

The overwhelming majority of New York City’s overdose deaths involve the powerful opioid fentanyl, which has made illicit drugs deadlier in recent years. New York City first saw a jump in overdose deaths between 2015 and 2017, around the time fentanyl entered the drug supply. The figures were relatively steady until 2020. Fentanyl was involved in 81% of overdose deaths in 2022 according to the new data brief.

“One interpretation could be that the pandemic not only accelerated overdose deaths, but also accelerated those structural inequalities within the city,” Bennett said.

Still, researchers who spoke with Gothamist agreed that fentanyl has introduced a specific challenge because of its potency. Mayor Eric Adams is hosting a closed-door summit next week with elected officials, public health leaders and law enforcement from across the country to discuss how to address what his office called the “fentanyl crisis in America.”

As the crisis drags on, so does the debate over whether to focus on criminalizing fentanyl or interventions that aim to reduce the harms of the drug.

Pedro Mateu-Gelabert, an assistant professor of sociology at CUNY who studies the epidemiology of substance use, emphasized that, despite the rising death count, there is still evidence to support the efficacy of individual measures the city health department has been implementing to reduce the harms of fentanyl. These include promoting access to the opioid overdose reversal medication naloxone and medications to treat addiction like methadone and buprenorphine.

The two overdose prevention centers that opened in Harlem and Washington Heights, where people can use drugs under staff supervision, may have also helped prevent the death count from rising further. Staff at those centers, which opened in late 2021, intervened in more than 600 overdoses in their first year.

“Expanding these services to neighborhoods with high rates of overdose is necessary to prevent overdose deaths, especially in public settings,” the city concluded in its overdose report. While most overdose deaths take place in private homes, the share that occurred in public places rose to 16% last year, up from 11% in 2019.

The city's health department also put out its first set of guidelines around the operation of overdose prevention centers this week. But Mateu-Gelabert said he worried that a lack of city and state funding is hampering their expansion. One nonprofit trying to open a center in the Bronx has had its plans delayed due to a combination of local opposition and funding challenges.

East Harlem had one of the city's highest overdose death rates last year despite having an overdose prevention center, suggesting that additional interventions are needed.

In conjunction with the release of the overdose data earlier this week, the city's Health Commissioner Dr. Ashwin Vasan also issued an advisory urging all New Yorkers to learn the signs of an overdose and carry naloxone.

While the city continues to grapple with fentanyl, other drugs may also be compounding the overdose problem. The animal sedative xylazine is showing up in drugs that are being tested as part of a drug checking pilot program the city launched last year. Xylazine was involved in 22% of overdose deaths recorded in 2022, up from 19% in 2021.

Ultimately, researchers tracking the crisis said it’s hard to tell how bad it would be without the measures New York has already put in place.

“Even if overdoses are going up, maybe they could have been worse had we not been promoting certain policies,” said Sheila Vakharia, deputy director of research and academic engagement at the Drug Policy Alliance.

Vakharia also noted that it’s difficult to compare New York to other parts of the country that have experienced different trends in overdose deaths.

While the death toll rises in New York, the Biden administration has touted data showing that overdose deaths are “leveling off” nationally. But Vakharia cautioned against looking at the United States as a monolith when it comes to the opioid epidemic.

A map of the U.S. that accompanies the latest data from the Centers for Disease Control and Prevention shows that overdose fatality rates have risen in some states, while falling in others. And Vakharia said there could be myriad reasons for those shifts, depending on the local context.

“Drugs have emerged in certain states and in certain regions at earlier or later times and also the policy choices in different states have varied dramatically,” Vakharia said.

She added that policy efforts may take longer to show results in populous places like New York.