Opioid addiction is not a new problem; it is however growing. On June 22, 2016 Governor Cuomo signed legislation to address this epidemic. (NYS Governors Press Office 2016). The recent work of the Governor’s Heroin Task Force defined the current problem well enough so that the Governor and other policy actors coalesced in support of this new legislation. The political and public awareness of the heroin epidemic created a window of opportunity for this legislation. The new legislation is the latest in a series of policies and legislation directed at addressing the problem of opioid addiction. It is a good attempt at addressing a historically difficult problem.

A Familiarization and the Current Scope of Opioid Use in New York State.

Narcotic use has a long history in the United States. In recent decades the drug of choice ranged from marijuana and hallucinogens in the 60’s, heroin and cocaine in the 70’s, crack in the 80’s, ecstasy and designer drugs from the 90’s and a now, recent uptick in the use of opioids. Opioids are made from the poppy plant. Afghanistan is the largest opium producer in the word. Opium derivatives include heroin and prescription painkillers Codeine, Hydrocodone, Oxycodone, Tramadol and Fentanyl. The most commonly prescribed opioid analgesics between 2009 and 2015 are Hydrocodone and Oxycodone (NYS Department of Health 2015). The prevailing wisdom is these narcotics are overprescribed and facilitate addiction. The rise in heroin dependence is due to the low cost and availability of the narcotic.

In 2014, 2,028 New Yorkers died of an opioid drug overdose including 608 in New York City. Specifically, heroin overdose is the leading cause of accidental death in New York State. There has been a 222% increase in admissions to treatment programs for opioid addiction in the 18 to 24 year range between 2005 and 2014 (NYS Department of Health 2015). The lead state agency in regulating treatment facilities and tasked with prevention of opioid addiction is the Office of Alcohol and Substance Abuse Services (OASAS). Their budget for 2016 is 1.4 billion. The budget includes 74 million for prevention programs.

The Problem Stream- Opioid Addiction a Social or Healthcare Problem?

The problem of opioid addiction can be viewed as a social or healthcare problem. Viewed through a social lens, the problem effects both the family and the community. At the family level, addiction can break families apart. The personality and behavioral changes the untreated addict exhibits can cause frustration for family members trying to help the addict. Unreliability, mood swings and physical sickness become stressors for the family. The large increase in 18 to 24-year-old admissions to treatment programs highlights the risk to the youth of New York and the potential of losing a generation. Conservative values hold the family unit in high regard. For conservatives, there is a lot at risk to do nothing.

Documentary Video: Ben-Diary of a Heroin Addict

Newborn’s at Risk: Funding lacking for addicted newborn babies

Outside the family, addiction negatively impacts the community as well. Crime is typically thought of as a consequence to addiction. Addicts stealing property and burglarizing homes to feed their habit is true to some extent. There is also truth to the realization the illegal sale of narcotics precipitates violence. Dealers compete for locations to sell their product and often turf battles result is shootings or other assaults. Addiction also effects the quality of life the community experiences as a whole. Often substance abusers are the unfortunate homeless observed on the streets. The effects of a fresh high on a heroin addict are apparent to adults and children alike. Public health is jeopardized by the unsanitary conditions presented by used needles and the excrement left behind by addicts. Crime, homelessness and public health issues secondary to addiction also add to the financial burden to the community.

Addiction can also be viewed as a healthcare problem. Addiction is a treatable medical condition. There were 37,747 emergency room visits for the treatment opioid related narcotics use in 2014. This is a 73.1% increase from 2010. Additionally, in 2014 there were 75,110 inpatient admissions to hospitals for treatment of opioid related conditions (NYS Department of Health 2015). This high volume comes with a high cost in both expenditures and resources.

Related: Addiction in newborns

Addressing addiction through prevention and treatment can cut the spread of HIV and Hepatitis. Medical screening and needle exchange programs facilitate improved health. Addicts are also more susceptible to disease than the non-addict. The secondary medical complications to addictions are additional costs and stressors to the healthcare system. Liberal values hold viewing addiction through the lens of a healthcare problem as the best means to address the problem. Again, there is a lot to risk to do nothing.

The Political Stream.

Public pressure is a motivating force for policy actors. The people of the State of New York are aware of the addiction epidemic and have brought pressure on the visible cluster of policy actors to legislate. Part of the public awareness is attributable to the Combat Heroin and Prescription Drug Abuse Awareness Program. This program was begun in September 2014. The program used public service announcements, a social media campaign and print materials to inform the public of the problem and resources available. The public again faced the problem almost daily with news reports of tragic deaths of our youth and arrests of major narcotics dealers.

NYS PSA on Opioid Abuse

The visible cluster of policy actors is a high profile group of bi partisan elected officials on the federal, state and local levels. Federal initiatives include The Comprehensive Addiction and Recovery Act of 2016. The bill was introduced by Democratic Senators in a Republican controlled Senate, passed and was sent to the House of Representatives. The House also passed a version and currently the differences in the two bills are being resolved. This federal legislation has many similarities to the New York State legislation. On the State level, Governor Cuomo established the Heroin Task Force in 2014. The task force was co-chaired by the Lieutenant Governor and the Commissioner of the Office of Alcoholism and Substance Abuse Services (OASAS). In the report the task force clearly defined the current state of opioid abuse in New York State and published 25 recommendations to address the epidemic. The day after Governors Cuomo signed the opioid legislation the New York City Council announced a hearing to reorient drug policy toward health and safety. If adopted a new city agency would be created to coordinate drug strategy between city agencies. The agency goal would be to promote health and public safety and reduce negative impact of past or current policies. The increases in opioid addiction in every demographic and community across New York State coupled with public awareness and a clearly defined problem caused a tilt effect resulting in the current wave of legislative initiatives and policy revision at all levels of government.

The Policy Stream

The movement in New York City to reorient drug policy may signal the end of the previous policy regime. Previous drug policy focused in large part on police enforcement and methadone treatment programs. The current policy has expanded on these two basic principles of previous policy. The last step of the multi stage policy cycle is policy evaluation. This enables the continued development and evolution of policies. Drug policy has evolved considerably since 2006. Early incremental legislation includes the 2006 legislation directing first responders be trained in and allowed to administer naloxone. Naloxone is similar chemically and has the same effects as Narcam. The drug reverses the effects of opioid overdose. The 2012 Prescription Drug Reform Act was enacted to curtail the over prescription of narcotics. The legislation created the Prescription Monitoring Program (PMP) commonly known as I-Stop. I-Stop is an application that tracks the dispensing of prescriptions in real time. The benefit is twofold. It identifies addicts engaged in “doctor shopping”. Doctor shopping is seeking prescription for an illness requiring pain relief from multiple doctors. The second benefit is it also identifies doctors that over prescribe narcotics. In 2016 New York and New Jersey agencies agreed to share I-stop information. In 2014 Good Samaritan legislation passed protecting those who administer naloxone.

Video Administer Naloxone:https://www.youtube.com/watch?v=Jis6NlZMV2c

Published on Feb 10, 2014

Sarah Mackin, Program Manager at the Boston Public Health Commission explain the signs of someone who has taken an overdose and how to administer the Narcan nasal spray to hopefully save a life. – Boston Herald staff video by Matt Stone

The hidden cluster of policy actors tasked with dealing with opioid addiction as part of their daily functions are lower level elected officials, administrators and special interest groups. Criminal Justice policy actors are among the most outspoken advocates for treatment and enforcement. Staten Island has the highest overdose rate in New York City (Staten Island Advance 2016) and District Attorney Michael McMahon, also a member of the Governor’s Heroin Task Force has begun an Overdose Response Initiative. In this initiative investigators from the District Attorney’s Office will probe the circumstances surrounding overdose victims in an attempt to identify dealers that sold the fatal dose of narcotic. The New York City Special Narcotics Prosecutor Bridget Brennan criticized the city’s efforts by saying “This city is just not doing enough, if we don’t do enough on the prevention end, it’s really like shoveling sand.” during a Council budget hearing at City Hall (Staten Island Advance 2016).

Public interest and advocacy groups also perform in the roles of a hidden policy actor. Drug Policy Initiative (DPI) is an example. DPI advocates for better means to quantify the success of current drug policy. Harm, such as number of overdoses, persons in treatment, disease transmission are the key data points. They see treatment as a better option for offenders instead of incarceration.

The cyclical swing from enforcement to treatment shows a trend of distributive and substantive policy elements replacing a protective regulatory policy. The new legislation signed by Governor Cuomo includes provisions for eliminating insurance barriers to treatment, expanding the training and use of naloxone, limiting of prescriptions to a 7-day supply and directing data collection overdoses and prescription and overdoses reversals by the use of naloxone.

Overall the legislation is a solid attempt at reducing the rate of addiction. Realistically opioid abuse will not end as a result of the legislation but as D.A. McMahon noted, “it is one step forward” (NYS Governors Press Office 2016). The policy cycle begins anew as the current legislation is implemented. The data collection requirement will provide new analytical avenues the will result in additional policy development. There will again be a time when the problem, political and policy streams converge resulting in a new drug policy and possible even a new policy regime.

Bibliography

Drug Policy Alliance. http://www.drugpolicy.org/new-solutions-drug-policy/states-laboratories-reform .

Governor’s Heroin and Opiod Task Force Final Report. 2016. Combatting the Heroin and Opioid Crisis. June 9. Accessed July 15, 2016. https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis .

NYS Department of Health. 2015. New York State OPIOID POISONING, OVERDOSE AND PREVENTION 2015 Report to the Governor and NYS Legislature. http://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/docs/annual_report2015.pdf

NYS Governors Press Office. 2016. June 22. Accessed July 15, 2016. https://www.governor.ny.gov/news/governor-cuomo-and-legislative-leaders-announce-agreement-combat-heroin-and-opioid-abuse-new .

Staten Island Advance. n.d. http://www.silive.com/news/index.ssf/2015/10/staten_island_heroin_now_deadl.html .

—. 2016. May 24. http://www.silive.com/news/index.ssf/2016/05/de_blasio_overdose_prevention.html .

—. 2016. March 23. Accessed July 20, 2016. http://www.silive.com/news/index.ssf/2016/03/da_9_fatal_drug_overdoses_on_s.html.