(bright atmospheric music) - On this week's edition of "New York NOW," we examine the ongoing opioid epidemic in New York State.

First, we dive into the history of drug policy in New York, then we unpack how medicated-assisted treatment is being used to battle addiction recovery.

And we learn how the state has been using its billions of dollars in opioid settlement money.

I'm Shantel Destra, and this is "New York NOW."

(formal atmospheric music) - [Reporter] Today, the Senate majority will cancel legislation.

- [Politician] I will fight like hell for you every single day like I've always done and always will.

(reporter muttering indistinctly) - [Announcer] Get another stand.

- Welcome to this week's edition of "New York NOW."

I'm Shantel Destra.

The gravity of the opioid addiction epidemic in the country and in New York State cannot be overstated.

The crisis dates back decades and has affected countless people, families and communities.

To put things in perspective, in 2021, the CDC determined most of the reported fatal overdoses in New York were due to synthetic opioids.

Prescription opioid drugs gained popularity nationally in the 1990s as families saw and felt the grim effects of addiction coupled with rising overdose deaths, restrictions were placed on the highly-addictive drug through policy.

Those restrictions, however, resulted in people looking for drugs elsewhere, sometimes shifting to illicit drugs such as heroin, which led to an increase in overdose deaths across the country.

But then the powerful synthetic opioid, fentanyl, entered the picture and overdose deaths have since skyrocketed.

Here in New York, advocates and state-elected officials have continued to speak out against the opioid crisis.

Governor Kathy Hochul has even shared her own personal tragedy of a family member who had an opioid overdose.

To begin to understand the gravity of this ongoing crisis in New York State, we'll need to first look back several decades.

As part of WMHT's series on stories and solutions on the opioid crisis in New York, we sat down with professor and drug historian, Nancy Campbell, to discuss the state's early approaches to drug policy.

(formal atmospheric music) - Opioid crises are very old in New York.

(pensive atmospheric music) There was a particular problem right after World War II with heroin injection.

Governor Nelson Rockefeller in the early '60s decided that federal criminalization was simply not enough, so he decided to try treatment.

Now, that treatment was punitive.

It was mandatory treatment.

Most treatment prior to methadone maintenance, which began in New York in 1965, was talk therapy, abstinence based, stuff we know does not really work.

And so although methadone maintenance began in New York in 1965, it was not scaled up until about 10 years later.

Governor Nelson Rockefeller became impatient with what he saw as the failure of drug treatment prior to the 1970s.

He didn't really give methadone maintenance a chance and he decided, in 1973, to double down on criminalization.

He decided we should lock people up and if we took people off the streets for possession and trafficking, then we would nip it in the bud.

That turned out not to work, in part because of the way that illicit drug suppliers responded.

In many ways, the Rockefeller laws spur innovation among illicit drug dealers and suppliers.

Mass incarceration disproportionately affected communities of color, families, partners, spouses, and, of course, the incarcerated individual.

In the late '70s, opioid overdose deaths begin to tick up at a rate of 9% a year into the present day.

It began to become a public problem.

It had to be made a public problem.

The people who made it a public problem are what we call harm reductionists.

Harm reduction is practical intervention, any positive change, that you can make in a drug user's life or health.

In New York City, harm reduction grew out of the HIV AIDS movement in the 1980s.

It doesn't criminalize, it doesn't punish.

It was meant to address health at a much broader social level.

So treatment and harm reduction are the main ways that we are going to reduce opioid overdose deaths in this country.

(formal atmospheric music) - And the work to address the overdose and addiction crisis does not end with policy.

Since 2019, State Attorney General Letitia James has been at the forefront of national efforts to go after some of the biggest suppliers and distributors of prescription opioids.

In 2021, national settlements were reached and New York won over $2.6 billion in settlements.

This year, the first of those funds have been used to help stem the tide of the crisis.

The rest of the funds will be distributed over the next several years.

For more on how the state has been using its opioid settlement funds, I sat down with Reporter Raga Justin of the "Times Union."

(formal atmospheric music) Raga, thank you so much for being here today.

- Of course.

Thank you.

- [Shantel] Now, of course, there are so many different ways of diving into the state's response to the opioid crisis, but I thought a natural place to start would be the Opioid Settlement Fund.

Can you give viewers some insight into how the state has been spending the settlement fund?

- Yeah, I mean I think what we've seen is that the state legislature had appointed a group to oversee the allocation of these funds, right?

So it's the Opioid Settlement Fund Advisory Board.

It's a panel composed of a lot of people who have been working in this field for decades, some of them, and some people with lived experience who have struggled with addiction.

And together, they are trying to tell the state, "Look, here's where we think the money should be going."

So that includes harm reduction has been a top focus recently.

Secondarily to that, we've got recovery, housing, treatment, I mean all the things you could think of.

Prevention has been a big focus too, and the state has tried to make it, I think, as transparent as possible by appointing this group of people to tell them independently where they think, you know, with their cumulative experience, where they think the money would best be spent.

- And to your point, the state has focused a lot on harm reduction.

So I'm curious how that approach stacks up against other states or other areas in the United States.

Is New York a leader or is it kind of following the curve in its approach?

- That's a good question.

I think that because the money is going to be distributed over a period of 18 years, we don't know what's gonna happen at the end of this, right?

If we can look back, I mean hindsight's always 20/20.

And we might look back and say, "Wow, West Virginia actually ended up doing something way better than New York did."

From what we have right now is a lot of messaging.

A lot of the funds have yet to be released.

So I think that's been a barrier for some folks who say, "Okay, we're getting all these promises, harm reduction, treatment, housing."

The money, we haven't necessarily seen yet.

But other states are in the same boat.

And to be perfectly honest, other states haven't been as transparent as New York has been.

There's a couple of organizations out there who track where states are with their opioid settlement funds.

And New York has committed to, you know, public transparency in that we've got opioid settlement tracker online.

You can theoretically see where the money is going along the process and when it is going to be released and what have you.

And there's also a secondary question of what we talked about earlier, where the money's actually going.

For us, it's again, harm reduction or housing, for example.

But in other states where the opioid crisis has also been, you know, really, really devastating, there's a bit more of a turbulent battle over where that money should go.

So, for example, I mentioned West Virginia and I recently read this, that some of the money at the very most local municipal department, you know, the police department, took 750,000 of it for a police cruiser, right?

Because they say law enforcement has been on the front lines of this epidemic as they have been in many cases.

But, of course, it ties into bigger questions that we've got about who needs this money the most.

Is it the police department?

Is it law enforcement?

Is it people on the ground who are actually struggling with addiction?

I mean I think that's what a lot of states, you know, outside of New York, are dealing with.

So in that sense, we are leading the pack.

I think we're saying the money needs to go to the people who actually need it the most and the organizations that are helping those people.

But in another sense, we're not the most progressive on this.

Rhode Island has actually been a leader.

A lot of experts and academics have told me that they all point to Rhode Island as the model for how to treat people, you know, who have an addiction specifically to opioids.

They've legalized safe injection sites, so, and that's something that we can't seem to do.

- And going back to what you said about New York kind of being very transparent as it relates to the opioid crisis is, you know, the awareness there for the average New Yorker?

Does the average New Yorker, from your purview, understand the gravity of the opioid crisis and is really paying attention to how the state is using the opioid settlement funds?

- I think as with any other highly technical government process, the allocation of the opioid settlement funds probably isn't getting that much attention among the everyday New Yorker.

I don't even think I knew about it really until I started digging into it 'cause it's a big, I mean, you know, billions of dollars is, of course, it's a huge number.

- [Shantel] Yeah.

It's hard to follow, right?

- It is hard to follow.

And I think for that reason, a lot of people simply don't follow it.

But if you've got somebody, if your boot's on the ground, and by that I mean somebody who struggled with addiction or somebody who has lost a loved one, right?

I think there are a lot of those people in New York.

I mean more than I think if you hadn't had experience with either of those situations, there's a ton of people out there, more than you might think.

And so I think for those people, this is, of course, very personal because to them, this settlement money represents a chance to get it right for the future, a chance to prevent situations like that had happened to them or their family.

So I think for those people, of course, there is an eye towards where the money is going.

And, you know, apparently, there's public transparency.

Ostensibly, there's public transparency.

I don't think we've seen it play out 100% that way yet.

But the messaging around it from the administration has been, we are going to tell you where this money is going as best as we can.

- And as we said, you know, when you look at the areas in which the state is spending its opioid settlement money, there's so many different buckets.

I was looking at the tracker this morning.

There's so many different areas.

So are there any underutilized resources that the state should be tapping into more as it continues to address the opioid crisis?

- You know, I think we keep going back to safe injection sites because from what advocates say, I mean they feel really strongly that that is the best way, that is the untapped resource in preventing future deaths.

- Now, I know you don't have a crystal ball or anything, but I'm curious about the way that you would say New York would have its legacy in addressing the opioid crisis and specifically spending the settlement money.

Will it have a positive or negative legacy?

- I think, as with probably everything else, it's gonna be a bit more multifaceted.

I mean I think one of the things that New York has had its strongest focus on has been moving away from dealing with addiction in the criminal justice system and instead as a public health issue, right?

And that's, I think, worked really well in terms of removing the stigma from addiction in general.

And less stigma allows more people to access the resources that they do need in order to combat addiction.

So I think in that respect, we are, again, leaders, we are saying, "This is not a personal failing.

It's not a moral failing, it's a systemic issue.

It's a public health issue.

And if you, you know, you are somebody who struggles with this, we do not need to see you caught up in, you know, in law enforcement, in jail as treatment for this.

What it actually needs to be is a harm reduction approach.

It needs to be you're going to, you know, a medical setting to help you, you know, treat that to help you deal with that."

That's, again, more than some other states are doing.

So I think New York has really been pioneering that in a lot of ways, that single-minded approach, and that focus on this is a public health issue, this is not criminal.

- [Shantel] Yeah, and it definitely sounds like a hands-on deck approach is needed for this particular issue.

- [Raga] Absolutely.

- So thank you for highlighting that.

- [Raga] Of course.

- And, you know, it's a issue that we'll continue to have to keep watch, but that's all we're gonna touch on today.

So thank you so much for being here today.

- Of course.

Thank you.

- [Shantel] And we were speaking with Raga Justin, reporter for the Albany "Times Union."

Thank you.

(formal atmospheric music) And as Raga underscore, the state's current approach to the opioid crisis is one that is heavily focused on harm reduction and drug abatement programs.

Chinazo Cunningham, commissioner of the State's Office of Addiction Services and Supports unpack the work the state office is doing to lead partners in addressing the opioid crisis.

(formal atmospheric music) - So OASAS really oversees all addiction services in New York State.

(pensive atmospheric music) We oversee prevention, treatment, harm reduction and recovery services.

We certify these programs, we regulate programs, we provide training and technical assistance and support.

So we're really responsible for overseeing the whole continuum of services for addiction.

New York is not immune to what's happening across the entire country, and we see overdose deaths in all parts of the state.

So we have to follow the data, right?

And so how many people are dying?

Who's dying?

What are they dying of?

And so we have to make sure that we're reaching those populations that are at the highest risk.

We also know that people who are dying at the highest rates are Black people and Hispanic people and Indigenous people.

One of the, you know, biggest strategies that we're using and really embracing is harm reduction.

Harm reduction is an approach and a set of strategies that really focus on reducing negative consequences of substance use.

So we have to keep people alive, right?

That's the primary purpose here, because obviously, if people are not alive, then there's not anything else that we can do for them.

Making sure that people have naloxone, making sure that we have fentanyl test strips and xylazine test strips.

Harm reduction also includes bringing services to where people are.

So not waiting for people to come to us, but go in and doing outreach.

We know that, you know, among those people who need treatment, only about 20% of people actually get treatment.

One of the medications that is more effective now than ever is methadone.

And so we are expanding access to methadone.

We're using mobile units to go out into parts of the community that don't have a brick-and-mortar program that can provide methadone.

You know, we've invested over $6 million in mobile units so that the actual mobile unit can be purchased.

It has to be outfitted for methadone treatment.

There's a lot of federal regulations around that that have to be met.

We help sort of broker the relationships with the federal agencies and with the local providers.

So we're really there to help facilitate and provide support for the treatment.

We really have to just see this as a public health emergency.

This is a medical condition that has effective medical treatment, and we have to make sure that it's okay for people to identify as having an addiction and to seek treatment and services.

Because treatment works, it works, and we have effective treatment.

And so it's about making sure that people know that it's available, making sure that we provide the access, easy access, you know, to effective treatment so that we can match the needs of New Yorkers with the services that we have.

(formal atmospheric music) - Part of addressing this crisis includes unpacking the various ways of tackling addiction.

We spoke with public health officials and patients at Greene County Family Planning to explore how medication-assisted treatment can assist with addiction recovery.

(formal atmospheric music) - Medication-assisted treatment is the use of medication to help someone with a substance use disorder, we often refer to it as MAT.

Here at Greene County Family Planning, we offer a low threshold harm reduction program, and that means that we don't really have any requirements such as counseling or other things that patients need to do to receive medication.

Historically, a lot of treatment programs have been abstinence based and have a lot of rules.

You can't use alcohol, you can't use marijuana or any other substances.

They also would have a lot of requirements for counseling, attending groups.

And here, we kind of see what the patient thinks will help them.

Not everyone wants to go to groups and talk about their use with other people.

We let them lead their own recovery.

We can use three different medications for opioid use disorder, they are Vivitrol, buprenorphine and methadone.

- [Laura] So in our brains, we have receptors that take up the opioids, whether it's a prescription for oxycodone, whether it's heroin or fentanyl.

The way that buprenorphine works is it sits on that receptor site and tightly closes it off so that even if a person uses additional opioids on top of it, they will not have impacts.

It has a ceiling effect at about 24 milligrams.

And at that dose, people feel well, they don't have the need to use and they are protected from additional opioids.

So it's actually a harm reduction measure on its own.

It's a safer alternative to opioids.

- I'm a patient here on MAT, I've been in recovery for seven years, and I switched to the SUBLOCADE injection about two years ago from the regular Suboxone strips.

It helps with cutting the cravings, it makes you to where you can get up every day and remind yourself how good you're doing and that you're not going back to using something else.

It gets me through my life day to day, seven years later, and I'm now working as a recovery peer advocate.

And I never thought I'd be on that side of the table at all.

- The itch of wanting to potentially use substance to get me through a hard time and make it easier or make a great time even better, buprenorphine is like a safety net and removes that itch in the back of my mind so that I could build the pillars of a, you know, healthy, stable foundation and a healthy life and just not have shaky ground underneath me, you know?

Stigma is huge because a lot of what fuels addiction and substance abuse is shame.

And that's hiding, lying, trying to cover up this sneaky, dark lifestyle that you don't want people to find out because of either judgment or being treated differently.

- When you stigmatize it, you make people feel ashamed.

They're already feeling ashamed of themselves, and it makes it to where they don't wanna ask for help.

It means that they're gonna be at their rock bottom forever.

Letting them know that someone's there to walk them through their journey and that it's possible will change everybody, everything.

- There is no judgment walking in these doors here.

If I were to show up one day for an appointment and say, "Hey, I used heroin today," they will still work with me to find, you know, the help that I need in any way that they can.

- We understand that people may use again and that they're not perfect, but everyone makes mistakes, it's a struggle.

I always tell people that if it was easy, then we wouldn't have lots of people requesting to come in because it's a really hard problem.

(formal atmospheric music) - And like with any addiction, it is vitally important for those battling opioid addiction to have access to resources, support and a sense of community.

We spoke with peer recovery support specialist, Meghan Hetfield, to unpack how technology is being used to help with recovery services.

(formal atmospheric music) (gentle atmospheric music) - I am a peer recovery support specialist.

The work I do is supporting people through challenges they might be facing in their lives, whether it's to do with their mental health or whether it's to do with their substance use.

And I do that through, you know, the internet, which is like amazing.

And we set up calls or video chats to explore what they're trying to work on and how I can help them.

When I was 18 years old, I went to my first outpatient treatment program.

My very first meeting with my counselor, before I even was able to say anything, he said, "All right, Meghan, well, you know, you have a disease, you're an addict.

There's no cure."

At no point did he ask me, like, "So why are you using these substances?

What are they doing for you?

You know, well, what are your goals?"

And the point is, you know, it is groundbreaking and door-opening to just ask someone like, "How are you?

What do you like?

What do you want?

What do you need?"

So I do try to navigate that, you know, when I am working with others and to hold back, you know, some of my own experiences while also holding true that the more solutions you offer someone, the more likely they are to try something.

Maybe now that they've got the support, a cheerleader, like someone that's standing next to them in the process to help them feel less scattered and to get their steps and goals kind of lined up so that they can achieve those small incremental changes.

That to me is what success looks like.

And sometimes people don't want to try anything, and that's okay too.

I can just be there with them.

Virtual web-based support, peer support, the uniqueness of that is the accessibility, right?

Many people, because of the shame, because of the stigma, they're not willing to walk in the door somewhere and ask for help.

Meeting with someone as their peer, they can remain anonymous physically.

So if somebody would prefer to remain anonymous and not be seen on camera, that's okay.

A lot of what we do in remote peer work is supporting folks with harm reduction practices like making sure they know about the Never Use Alone hotline, for example, which is an amazing nonprofit that's national.

It's a free number someone can call to have someone virtually there with them while they're using substances, because most people die alone when they have an accidental fentanyl poisoning.

(gentle atmospheric music) There's apps referred to as spotting services that you can use if you have to use alone, which we highly don't recommend anyone ever use alone.

But if you have no choice, you would sign into the app, you know, press a buttons, like say who you are anonymously.

If you don't check in by a certain time, it alerts local emergency services to come and check to make sure you're okay.

And these things work.

These tools really work well.

There's harm reduction works.

It is basically structured like any other mutual aid support meeting.

There's meetings happening every single day, every single night, and they happen online, they happen in person.

There's someone that acts as the host, who reads the script, and then there's a topic or some sort of exercise that's introduced, whether that's a guest speaker or a short video.

And then there's a part where people get to share, have dialogue, have conversation.

It's a really low barrier way of finding community and support and we hope love and connection.

It's the only mutual aid support meeting where someone could go and just by listening to the script alone, it could potentially save a life 'cause they'll get real information in that script of how to stay safer or keep their loved ones safer if they're currently using substances.

(formal atmospheric music) - The episodes you've seen today are part of our series focused on stories and solutions of the opioid epidemic in New York State.

To access these episodes along with more information and resources, you can visit our website, that's at nynow.org.

Now, that does it for this episode of "New York NOW."

Thank you for tuning in and see you next week.

(formal atmospheric music) - [Narrator] Funding for "New York NOW" is provided by WNET and by the New York State Education Department.