Bronx, NY (June 11, 2019)—In New York State the numbers are staggering: in 2017, there were 3,224 opioid-related deaths and in 16 of New York’s counties, the number of overdose deaths is nearly double the national average. To tackle this crisis, the National Institute on Drug Abuse (NIDA) is dedicating $86 million—to studying new ways to get resources in these 16 counties to people most in need. $4 million dollars will go to Montefiore Health System and Albert Einstein College of Medicine.
“We desperately need to remove the barriers that block primary care doctors, social support services, and community-based organizations from providing the best care to people suffering from opioid use disorder,” said Bruce Rapkin, Ph.D., division head of community collaboration & implementation science, Epidemiology & Population Health, Einstein and Montefiore. “We have therapies and programs that we know are effective in treating this disorder, but there are significant hurdles that prevent access from occurring. By partnering with the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA), I’m confident that we will more effectively deliver needed resources for underserved patients and families throughout New York.”
Tackling an Evolving Crisis
Despite well-publicized changes in opioid prescribing guidelines, the crisis continues. The first wave of opioid overdoses, from the 1990s until 2010, was associated with prescription opioid painkillers. The second wave, from 2010 until approximately 2013, was associated with a large increase in heroin-related deaths, often occurring when people had moved from prescription opioids to more accessible alternatives. The third and current wave, which began around 2013, involves a rapid increase in deaths associated with synthetic opioids, such as fentanyl.
The U.S. Centers for Disease Control and Prevention reports that drug overdose deaths have more than tripled since the late 1990s, when prescription opioids first hit the market. Nearly 70 percent of the 700,000 overdose deaths since then have been from opioids. While the national toll is high, certain states and counties have been particularly hard hit, many in the northeast.
The new multi-year study, part of the NIH’s Helping to End Addiction Long-Term (HEAL) Initiative, and led by Columbia University, aims to reduce overdose deaths by 40 percent over three years. The focus in New York will be 16 counties with the most opioid deaths.
Montefiore and Einstein’s “No Wrong Doors” Approach
The HEAL Initiative will leverage Montefiore and Einstein expertise in three areas: improving community health services, addiction treatment, and developing scientific models to help forecast behaviors in order to tailor care services and resources.
We desperately need to remove the barriers that block primary care doctors, social support services, and community-based organizations from providing the best care to people suffering from opioid use disorder.
Bruce Rapkin, Ph.D.
A key component is leveraging the partnerships established by the Montefiore Hudson Valley Collaborative (MHVC), which since its inception five years ago, has brought together providers, community-based organizations, and government programs to improve the quality of care to Medicaid recipients in the Hudson Valley.
The team will take a “no wrong doors” approach, meaning no matter how and where, people will get directed to the appropriate services. Specialists in the treatment of substance use disorders from Montefiore and Einstein will provide guidance and training to local providers in areas of the state that lack needed expertise. This includes working with community stakeholders, such as behavioral health centers and prevention and outreach programs, in each county to develop their own action plans. Plans will focus on community members’ understanding of local patterns and opioid use trends in their area. Models will be used to help each community decide on strategies, based on the number of people they can reach and impact on communities they can have.
“Last year, only 20 percent of people with an opioid use disorder received suitable medications,” said Damara Gutnick, M.D., medical director of MHVC and clinical associate professor, Epidemiology and Population Health, Einstein. “This grant money will really help us build on our relationships with local partners, like the police and faith-based organizations, to bolster education, increase the number of trained prescribers, and reduce stigma related to this disease. By transforming the treatment landscape, we can get to the heart of what each community requires and ensure people get the medications they need.”
Einstein will also lead the analysis of the community-level decision making and how different counties and states can organize their local responses to addiction.
The 16 New York counties of focus are: Lewis, Broome, Yates, Cayuga, Chautauqua, Columbia, Cortland, Erie (Buffalo), Geneseo, Greene, Monroe (Rochester), Orange, Putnam, Suffolk (Brookhaven), Sullivan and Ulster. Montefiore and Einstein will be working with Columbia University, City University of New York, Weill Cornell Medical College, New York University School of Medicine, University of Miami and Yale School of Medicine.
In addition to Drs. Rapkin and Gutnick, other Montefiore and Einstein collaborators include Joan Chaya, senior director, Workforce Development at MHVC, David Lounsbury, Ph.D., assistant professor, Epidemiology and Population health; Family and Social Medicine, Einstein, Chinazo Cunningham, M.D., M.S., professor and associate chief, General Internal Medicine, Aaron Fox, M.D., M.S., associate professor, General Internal Medicine, and Joanna L. Starrels, M.D., M.S., associate professor, General Internal Medicine.
The study is supported by the NIDA, part of the National Institutes of Health (1 UM1 DA049415 01). It is being carried out in partnership with the Substance Abuse and Mental Health Services Administration.