Overdose Death Rates Go Down Citywide — But Rise Sharply in East Harlem

Much of the national focus on drug addiction has been focused on the opioid crises in the suburbs and rural areas.

But there's a different kind of crisis in the poorer areas of New York City. Opioids in the form of pain killers never took off in poor areas of the Bronx, said Doctor Chinazo Cunningham, a professor at Albert Einstein College of Medicine who's been researching and providing care to marginalized communities for decades. Cunningham says people of color are less likely to have their pain taken seriously and therefore less likely to be prescribed drugs for it.

"And in a lot of ways it protected communities of color and so it's a little bit of a different epidemic that has been happening," she said. "Because of this history of the disparities in care."

Instead, people — especially Latino men — in East Harlem, Crotona and the South Bronx are dying from overdosing on cocaine and fentanyl. These three neighborhoods have the highest overdose death rates in the five boroughs; the city's health department says the overdose death rate rose nearly 50 percent between 2017 and 2018 in East Harlem. Even though citywide, the overdose death rate is going down for the first time in seven years. 

What's behind the disparity? Doctor Shadi Nahvi, who runs methadone clinics for Montefiore Medical Center in the Bronx, said being homeless, unemployed, in jail and living in concentrated poverty all contribute to drug problems. 

"These are things that put our patients at risk for substance use disorders, that decrease access to treatment, put our patients at risk for relapse, and overdose and are just profoundly destabilizing," Nahvi said. 

The city's health department said data on drug overdose deaths do not tell the full story of who experiences addiction, because it's possible to use drugs infrequently and still have a fatal overdose. 

But there are limited resources for those who want to combat their addictions in these high-overdose areas. Methadone is the most common form of treatment in the Bronx — but it must be taken at a clinic while under supervision. Cunningham said middle class communities are more likely to use Buprenorphine, a prescription drug you pick up at the pharmacy and take at home.

"So there are just fundamentally different ways in which these populations have experienced opioids that are being prescribed or opioid addiction treatment," she said. 

Buprenorphine requires prior authorization, a health insurance process that Cunningham said middle class families are better able to navigate. The state legislature recently passed a bill that would remove prior authorizations for all medications used to treat addiction. But Governor Andrew Cuomo has yet to sign it. 

Nahvi said that until people are ready — or able —to enter treatment, they need to be protected. 

"We need to ensure that people who are not yet ready to quit are using drugs in locations that are safe with sterile injecting equipment and they have access to medications to prevent overdose," she said.