SOS: Section on Opioid Epidemic

January 8, 2020

Red text = proposal we believe to be new for consideration or executive action during 2020-2021 session.  May have been something discussed previously but not yet operationalized.

Part 2: Combating the Opioid Epidemic

New York is leading the fight against opioid addiction. Since taking office, Governor Cuomo has instituted an aggressive, multi-pronged approach to address the opioid epidemic and has created a nation- leading continuum of addiction care with harm reduction, prevention, education, treatment, and recovery services. New York has expanded access to traditional services, including crisis services, inpatient, outpatient, and residential treatment programs, as well as medication- assisted treatment (MAT), telehealth expansion and mobile treatment and transportation services.

In 2016, Governor Cuomo’s Heroin Task Force recommended new, non-traditional services to provide on- demand care to people who use drugs, especially those who are vulnerable to an opioid overdose or have experienced an overdose and are not yet engaged in formal medical or treatment systems. New York established 12 Drug User Health Hubs located throughout the State. These Hubs are trusted resources in their communities, building on decades of syringe exchange programming experience. The

Hubs provide access to buprenorphine as well as other services essential to provide stability for people actively using substances. Other service innovations include recovery centers, youth clubhouses, expanded peer services, Centers of Treatment Innovation and 24/7 open access centers, which provide immediate assessments and referrals to care. These services have helped people in need access care closer to where they live.

The Governor has advanced legislative and regulatory reform to enable people to get treatment faster by eliminating many insurance restrictions, as well as advanced legislation to reduce opioid prescriptions for the initial treatment of acute pain from 30 days to seven days, and legislation to increase training and education for prescribers. He also took action to combat patient brokering and fraudulent addiction treatment services.

Governor Cuomo has also made naloxone more available, and has increased training on its administration. More than 420,000 New Yorkers have been trained and equipped with the opioid overdose reversal medication. Through Governor Cuomo’s actions, over 2,600 pharmacies around New York State are now able to dispense naloxone without individuals needing a prescription from their health care provider.

These efforts have helped reverse the trajectory of the opioid epidemic. After years of rising opioid-related overdose deaths among New York State residents, 2018 finally saw a drop, from 2,170 deaths in 2017, to 1,824 deaths – a nearly 16 percent decrease – according to preliminary State Health Department data covering areas outside New York City. Furthermore, hospitalizations for opioid related overdoses decreased 7.1 percent — from 3,260 in 2017 to 3,029 in 2018.

Building on this progress, Governor Cuomo is intensifying the State’s efforts to reduce opioid addiction even further. In 2020, the State will increase access to MAT, the gold standard of care for treating Opioid Use Disorder, improve continuity of care, and empower law enforcement to protect New Yorkers from dangerous fentanyl analogs.

Proposal. Banning Fentanyl Analogs to Further Combat the Opioid Epidemic

Although the overall number of overdose deaths is declining in New York State, there has been a dramatic increase in overdose deaths due to fentanyl and its analogs. Fentanyl is a very powerful synthetic opioid that is 50 to 100 times more potent than morphine. Compared to 30 milligrams of heroin, just three milligrams of fentanyl can be fatal. Among New Yorkers outside of New York City, overdose deaths involving fentanyl and its analogs increased 124 percent in 2016 and again by another 28 percent in 2017. Fentanyl analogs are not illegal in New York State. This is because although some analogs are prohibited by the federal government’s controlled substances schedule, they are not listed in the State schedule. This gap poses an increasingly large impediment to effective law enforcement. Currently, selling an unscheduled fentanyl analog is not against New York State law, unless the fentanyl analog is mixed with a banned substance.

The Governor will introduce legislation to explicitly designate fentanyl analogs as controlled substances in New York State. This legislation will give police and law enforcement the authority to prosecute the manufacturing, sale, and distribution of these drugs to the fullest extent of the law. The proposed legislation will also give the State Department of Health Commissioner the authority to add additional analogs to the list of controlled substances, enabling the State to stay in front of these deadly substances as they appear on the market.

Proposal. Expanding Access to Medication-Assisted Treatment in Hard to Reach Communities

Under Governor Cuomo’s leadership, more New Yorkers than ever have access to Medication-Assisted Treatment (MAT) for Opioid Use Disorder. In combination with counseling, MAT helps people reach and sustain recovery from Opioid Use Disorder. Governor Cuomo has expanded access to MAT both by increasing the number of medical professionals who are designated to prescribe addiction-treatment medication and by expanding the number of settings in which such medication can be prescribed.

He has also introduced innovative care delivery models such as telehealth and the deployment of mobile clinics. These services have expanded access to addiction treatment services for people that may not otherwise engage in care because of transportation and other barriers to accessing treatment. In 2019, the Governor directed DOH to require all hospitals statewide to develop protocols for their emergency departments to address opioid use disorder based on the standard of care for treatment or referral for treatment.

In 2020, the State will take still further steps to expand access to MAT in hard to reach communities.

Expand Access to MAT in Emergency Departments: The opioid epidemic is greatly affecting Emergency Departments (EDs). From July 2016 to September 2017 there was a 30 percent increase in visits for opioid overdose. The Governor will propose a multi-pronged approach in order to better connect ED patients with OUD to ongoing community care. The proposal will expand the Buffalo MATTERS pilot which provides MAT to patients identified with Opioid Use Disorder in Emergency Departments. These individuals will rapidly be transitioned into long-term treatment at a community clinic of their own choosing, all within 24-48 hours. The Department of Health (DOH) and the Office of Addiction Services and Supports (OASAS) will also establish a Buprenorphine prescription voucher program that provides a seven-day emergency supply of MAT as a bridge to insurance coverage and formal care. Finally, the proposals will improve access to MAT by connecting emergency departments with doctors who can prescribe buprenorphine through telehealth.

Expanding Access to Telehealth and Mobile Clinics: The Governor will direct OASAS to add ten new mobile clinics, one in each economic development zone statewide. In addition, in order to ensure access to addiction treatment in rural areas of the state, OASAS will provide funds for at least one treatment program in each county across the state to acquire equipment needed for telehealth services.

Expanding Access to MAT in Correctional Settings:  New York State leads the nation in criminal justice reform and will continue to build upon this success by expanding access to medication-assisted treatment in state correctional settings. Governor Cuomo will direct Department of Corrections and Community Supervision (DOCCS) to expand access to medication-assisted treatment by providing buprenorphine in the seven facilities currently offering methadone. In addition, the Governor will direct DOCCS to seek national certification and accreditation to operate an Opioid Treatment Program (OTP), creating the Nation’s first state corrections-operated OTP in the country.

Connect New Yorkers Seeking Addiction Assistance to Peer Support

As we continue our efforts to combat the opioid epidemic another area that has been highlighted is how immediate connection to help is essential. To address this concern, Governor Cuomo has ordered OASAS to reorient its existing HOPEline Services to provide a compassionate and supportive resource to find treatment, recovery or other supports. This centralized point of contact will utilize certified recovery peer advocates with lived experiences that can connect individuals with substance use disorders or their families with local resources, general referrals and a live person to speak with who will actively listen, engage and support the caller. OASAS will work with the Office of Children and Family Services to utilize their Human Services Call Center allowing for seamless connection to a peer network that is localized.

Ensure Efficient Access to MAT through Medicaid: New York has made significant reforms to ensure that those struggling with opioid use disorder have the opportunity to utilize medication assisted treatment, which has a proven track record at ensuring long-term recovery. This administration has already required that Medicaid and each plan have one MAT drug per therapeutic class with no prior authorization, and that if there is a prescription or refill for a drug not on the formulary that a five-day supply be given, and prior authorization is completed within 24 hours. There is more to be done. This year, Governor Cuomo will propose a single formulary for Medicaid that will ensure access to medication assisted treatment is granted quickly and efficiently without erecting unnecessary barriers to care.