NYC Revamps Pharmacies’ Role in Preventing Overdose Deaths

January 6, 2021

New York City, like the rest of the country, is facing a historic overdose crisis driven by illicit fentanyl adulterating the unregulated drug supply and exacerbated by the COVID-19 pandemic. In response, the city’s health department has made naloxone, the overdose-reversal medication, available free-of-charge at chain pharmacies in highly impacted neighborhoods from which the city has historically divested.

Beginning in May 2020, Walgreens, CVS, and Rite Aid began distributing free Overdose Rescue Kits at 16 (later 18) commercial pharmacies across all five boroughs, thanks to a new pilot program by the city’s Department of Health and Mental Hygiene (DOHMH). Each kit contains naloxone (Narcan) nasal spray, non-latex gloves, a face shield for rescue breaths and a bilingual info insert.

Specific storefronts were strategically chosen due to their locations in neighborhoods that have suffered the highest rates or numbers of fatal overdoses during the COVID-19 crisis, Nawshin Ahmed, DOHMH’s naloxone projects coordinator, told Filter. The DOHMH website provides a complete list of the partnering pharmacies and instructions on responding to an overdose.

All pharmacies in New York City are already able to dispense naloxone to patients lacking a prescription, thanks to a city-wide standing order, while large chain pharmacies are required by law to do so. The partnership’s intervention is making overdose reversal equipment free and bundled in standardized kits usually found at harm reduction centers that have been forced to reduce their hours and capacity to maintain social distancing measures and prevent infection in the times of COVID-19.

Two Brooklyn locations were added after VOCAL-NY, a harm reduction services and activist organization, expressed concerns to the health department that its relocation and programmatic changes may disrupt participants’ naloxone access.

Losing access to a life-saving medication would’ve been particularly problematic amid the 2020 surge in fatal overdoses as the city went into lockdown, drug markets were destabilized, people became more isolated and services were disrupted. Leading up to and in the early days of New York State’s shelter-in-place policy, New Yorkers were dying of largely preventable overdoses in record numbers; more drug users (440 people) died between January 1 and March 31 in 2020 than in previous years since at least 2015, according to provisional data.

Such deaths had already been on the rise throughout 2019, according to a data brief published by DOHMH in December 2020. For the second year in a row, Latinx New Yorkers were dying fastest (26 people per 100,000) out of all other racial groups, with Black and White New Yorkers dying at similar rates (about 23 people per 100,000, each). But both deaths were increasingly involving Latinx and Black people, while whites and Asian/Pacific Islanders less so. The city’s most-neglected and criminalized borough, the Bronx, which is predominantly Black and Latinx, had the highest overdose mortality rates, as well.

Since it’s a pilot program, the longevity of free naloxone’s availability at commercial pharmacies is unclear, given that it emerged in response to the COVID-19 crisis. And Ahmed emphasized that the pilot is not intended to edge out the work of syringe service programs (SSP). “We don’t have all the answers quite yet, but we’re open to exploring possibilities,” Ahmed said, regarding the program’s future. “We don’t want to overshadow the valuable work of SSP. They still carry most of the the work of dispensing naloxone.”

Although free Overdose Rescue Kits may be closer to home now that they’re distributed at some commercial pharmacies, they may still be more socially accessible at SSPs, where staff tend to be committed to upholding drug users’ dignity. In contrast, pharmacies across the country have been shown to be frequently hostile to serving people who use drugs, especially injectors, according to some studies.

DOHMH hopes to mitigate stigma through the pilot. “Stigma is real,” Emily Winkelstein, DOHMH’s director of Overdose Education and Naloxone Distribution, told Filter. “In the years that we have been working with pharmacies, we’ve heard feedback of not so great experiences,” she said. However, “[some] folks really value going into a pharmacy to get it, instead of a different location” because of its ease of accessibility.

By providing education and technical assistance to pharmacists, DOHMH is using the pilot program as an “opportunity to engage with pharmacists, and build relationships and reduce stigma in these situations,” Winkelstein said.

“There’s so much potential to make things more accessible through pharmacies.”

Photograph of an Overdose Rescue Kit by the Department of Health and Mental Hygiene via Facebook/Public Domain

Sessi Kuwabara Blanchard

Sessi is an independent drug journalist and drug-user activist. She lives in New York City.

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