Tackling the Opioid Crisis in New York State

Nearly 9 million opioid prescriptions were dispensed in New York State in 2015. Between 2011 and 2014, approximately 145,000 New Yorkers annually abused or were dependent on opioids.

The opioid crisis in New York State is multifaceted, and solving it will require a whole range of interventions. Among other approaches, curbing the epidemic will involve: analyzing and sharing data to demonstrate the scope and diversity of the problem; educating health care providers and giving them tools to address prescribing patterns; encouraging public health departments to screen for opioid use and refer users to treatment; and working with law enforcement to emphasize treatment over incarceration.

NYHealth is supporting a number of activities to combat the opioid crisis.

Analytic Work

Follow the Money: Pharmaceutical Manufacturer Payments and Opioid Prescribing Patterns in New York State
This report examines how payments from opioid manufacturers to physicians may have influenced opioid prescribing in New York State. Financial relationships between physicians and drug manufacturers are common, including payments for speaking and consulting fees, as well as for various gifts such as meals. Between 2013 and 2015, drug manufacturers spent more than $3.5 million in opioid promotion activities with thousands of New York State physicians. The report finds roughly 1 in 10 physicians who prescribe opioids received a payment, and physicians who prescribe more opioids got more opioid-related payments.

Targeting an Epidemic: Opioid Prescribing Patterns by County in New York State
To better understand the scope of the epidemic, NYHealth produced this data snapshot examining trends in opioid prescriptions and opioid abuse in New York State. The analysis examines prescribing trends by county in New York State from 2010 to 2015, using publically available data from the Centers for Disease Control and Prevention. Most research on the opioid epidemic has focused on state-level data, which masks important differences between smaller geographic areas. Understanding geographic variation within New York State is essential to ensure that resources and interventions are targeted appropriately.


A Coordinated Response to the Opioid Epidemic in North Country
In 12 upstate New York State counties alone, the number of heroin overdoses jumped 417% between 2009 and 2013. In response to this emerging crisis, Essex County Public Health established the Essex County Heroin and Opioid (ECHO) Prevention Coalition, a multiagency collaboration to prevent and reduce heroin and opiate use and addiction. A top priority for the coalition is to launch a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program in Essex County and beyond. An evidence-based, effective approach to combat substance use disorders, SBIRT can reduce health care costs, decrease severity of drug and alcohol use, and reduce risk of trauma. With a 2016 NYHealth grant, Essex County Public Health is introducing and implementing SBIRT in Essex County, and eventually in other North Country counties.

Women, Pregnancy, and the Opioid Epidemic in New York: A Health Care Provider Educational Approach
Health care clinicians often lack familiarity with key guidelines related to opioid use and safety, knowledge about opioid addiction, and the necessary skills to address the unique needs of these patients. With a 2016 NYHealth grant, the American Congress of Obstetricians and Gynecologists (ACOG) is working to improve obstetricians’ and gynecologists’ knowledge and awareness of opioid use and safety in pregnant women. The project will focus on engaging women’s health care providers in rural and upstate regions of New York State. ACOG will organize a multidisciplinary town hall meeting in upstate New York to gain a local perspective on the issue, as well as assemble a workgroup of experts to help develop, vet, and implement clinical education. Based on these meetings, ACOG will develop and implement hospital-based provider toolkits that include best practices on the care management of pregnant women who use opioids, targeting five upstate academic medical centers and their affiliate locations as pilot sites for training and education. ACOG will publish a final report on the implementation process, outcomes, and lessons learned from the pilot as a guide for how to best replicate the program.

Addressing the Opioid Epidemic by Improving the Electronic Health Record Prescription Process
One of several critical factors causing the opioid epidemic is physician-prescribing practices. Misused prescription opioids contribute to the epidemic of heroin use and heroin and fentanyl fatalities. In 2017, NYHealth awarded Weill Cornell Medicine a grant to encourage physicians at hospitals and federally qualified health centers (FQHCs) to prescribe opioids at levels consistent with Centers for Disease Control and Prevention (CDC) guidelines. Under this project, Weill Cornell Medicine will adapt a successful electronic health record (EHR) prescribing interface for generic drugs and modify it specifically for opioid prescriptions. This modified EHR will default opioids to CDC-recommended short-duration and low-dose formulations, but allow those defaults to be overridden by providers to ensure that clinical judgment is not constrained. The adapted EHR will be piloted first in a small setting to ensure that the system performs as expected, and then it will implemented at primary care sites within Weill Cornell Medicine’s system. Based on provider experiences with and evaluation of the EHR, a freely shareable implementation procedures toolkit will be developed and disseminated throughout the State. The toolkit will be used to replicate this intervention at the Institute of Family Health, an FQHC with 19 sites in New York City and rural regions outside of the City.

Replicating the Law Enforcement Assisted Diversion (LEAD) Model in New York
LEAD is an evidence-based, harm reduction-oriented program designed to reduce low-level arrests and recidivism and promote better health outcomes. Instead of making an arrest for certain criminal offenses (such as low-level drug charges), police officers, prosecutors, and defense attorneys work together to divert individuals directly to a case manager, who then facilitates access to a comprehensive network of services for drug addiction, alcoholism, mental illness, and other health-related issues. These individuals receive intensive case management and targeted social services, with greater coordination among systems of care. In 2014, the City of Albany, with NYHealth support, launched its own LEAD program, making it the first jurisdiction on the East Coast and only the third in the nation with this program. In 2016, NYHealth awarded a grant to the Katal Center for Health, Equity, and Justice to help replicate LEAD in other communities in New York State that are struggling with the devastation of the opioid epidemic. Katal will convene government agencies, policymakers, private funders, and other stakeholders, providing them with technical assistance to establish LEAD planning teams in their communities. Project staff will also facilitate peer-to-peer guidance and develop strategies for collaboration among police officers, prosecutors, service providers, community public safety leaders, and case managers to familiarize them with the concept of diversion and the LEAD model and protocol.


Care for the Whole Family

Lori*, a mother of two, could not afford health insurance. Luckily, her children were able to qualify for low-cost health insurance—with the help of the North Country Children’s Clinic, she enrolled them in Child Health Plus, which helped pay for doctor’s visits, dental visits, and prescriptions. The North Country Children’s Clinic was a boon to the community. Unfortunately, it did not have the capacity to serve adults, and Lori’s only access to health services was through costly urgent care visits. “It was expensive,” said Lori, “so I would put it off as long as I could and hoped I would just get better.”

Many adults in the North Country faced the same problem in accessing affordable health services. Throughout the years, the clinic’s nurses would see many parents like Lori who needed care but could not afford it. A survey in 2010 found that as many as 8,000 parents visiting the North Country Children’s Clinic did not have a primary care provider.

In 2012, NYHealth awarded a grant to the North Country Children’s Clinic to expand its primary, mental health, and dental care services to adults, as well as its clinic hours to better accommodate the schedules of working, low-income adults. With this expansion, the clinic changed its name to North Country Family Health Center (NCFHC).

In the fall of that same year, Lori was back in the pediatric office with her daughter, although she herself was sick and coughing. Much to Lori’s relief, the nurse happily shared news of the clinic’s expansion and helped her make an appointment for the same day. “They didn’t care that I didn’t have insurance, and they didn’t care that I didn’t have enough to pay for my appointment,” Lori said. “They just wanted to help me feel better.”

Before the expansion of the clinic, adults in the North Country had long faced a shortage of primary care providers that were willing to take publicly insured patients. A health center survey showed that there was an eight-month wait to become established with a primary care provider—provided one had health insurance—and that many providers were not even accepting new patients. The newly expanded NCFHC brought much-needed care to adult patients within a 75-mile radius of the clinic.

With NYHealth’s support, NCFHC became a federally qualified health center and won a federal New Access Point award in 2012. Another NYHealth grant in 2013 helped NCFHC develop a long-term, sustainable solution for its continued operation. Since then, NCFHC has expanded its medical and behavioral health services for adults from 381 patients and 562 visits in 2012, to 25,000 patients and more than 5,000 visits in 2015.

“I am so glad that North Country Family Health Center isn’t just for children anymore,” said Lori. “And I am so glad that I can get the same great care for myself that I do for my kids!”

*name changed to protect privacy