Critical Measures for Tracking the Opioid Epidemic

It’s no secret that Staten Island is facing one of the worst drug epidemics in history. Leaders and organizations across New York State, New York City and Staten Island have come together to respond to this crisis by expanding efforts and interventions to save lives and connect people to needed services and care. The 15 evidence-based indicators below were identified by national experts* in addiction medicine and public health to accelerate progress on the opioid epidemic.

Click here to see the full report on North Star Measures for Tracking the Opioid Epidemic and Accelerating the Response on Staten Island.

This effort is supported by John’s Hopkins Bloomberg School of Public Health, Governor Andrew Cuomo’s office, the Office of the Staten Island Borough President, the Staten Island District Attorney Michael McMahon’s office, Northwell Health, the Department of Health and Mental Hygiene, New York State Office of Alcoholism and Substance Abuse Services (OASAS), Staten Island Partnership for Community Wellness (SIPCW) and Staten Island PPS.

1. Fatal Drug Overdose

Since January 2019, there were 52 total fatal overdose deaths on Staten Island.

Staying on top of the opioid epidemic requires meaningful, timely, and geographically specific data. Key measures can provide a shared understanding of whether the situation is improving or deteriorating, help identify areas of greater need for intervention, and create urgency for action. Because of the unprecedented loss of life that has been driven by the opioid epidemic, the working group recommends tracking the number of fatal overdoses related to opioids.

Data Source: Staten Island District Attorney Michael McMahon’s Office

2. Nonfatal Drug Overdose

Since January 2019, there were a total of 279 non-fatal overdoses on Staten Island.

Tracking the extent and location of suspected non-fatal opioid overdoses can yield important information about areas of high opioid use on Staten Island and risk of death among residents and lead to interventions such as targeted naloxone distribution. It can also shed light on the effectiveness of campaigns to make naloxone more accessible to first responders and members of the public.

Data Source: Staten Island District Attorney Michael McMahon’s Office 

3. Schools on Staten Island Offering Evidence-Based Substance Use Prevention Programs

As of December 2018, there are 64 schools on Staten Island offering evidence-based substance use prevention programs.

One important area of prevention involves the promotion of substance use educational programs for youth. Adolescence and young adulthood is a critical time for brain development and the formation of habits and decision-making processes. Thus, programs and activities that promote healthy behaviors, positive coping strategies, and safe and informed decision-making may go a long way to improve well-being overall and prevent risky behaviors related to substance use. The New York State Office of Alcoholism and Substance Abuse Services (OASAS) certifies curricula for youth as based on evidence. There are also evidence-based interventions in early school years that are associated with positive behavioral outcomes and school success.

Data Source: Office of Alcoholism and Substance Abuse Services (OASAS) and Tackling Youth Substance Abuse (TYSA)

4. Opioid Prescriptions for More than 3 Days and More than 7 Days

As of December 2018, there are 12,342 opiod prescriptions for more than 3 days on Staten Island. The number of opioid prescriptions for more than 7 days is 9,624 on Staten Island. These numbers are for Medicaid patients only.

Another key area of prevention that is critical to halting the course of opioid misuse and overdose on Staten Island is continuing to curb the inappropriate prescribing of opioids and other risky medications. In addition, the New York City Department of Health and Mental Hygiene recommends that for acute pain, “a 3-day supply [of opioids] is sufficient; do not prescribe more than a 7-day supply.

The purpose of tracking this measure is to assess progress over time and to assess opioid prescriptions at the population level, not to determine care for specific patients.

Data Source: Salient

5. Prescriptions for More than 90 mg Morphine Equivalents Per Day

As of December 2018, there are 59 prescriptions for more than 90 mg Morphine equivalents per day. This number is for Medicaid patients only.

It may be unnecessary and potentially ill-advised for providers to reduce dosages for longstanding patients, including patients with cancer and in palliative care. The purpose of tracking these measures is to assess opioid prescriptions at the population level, not to determine care for specific patients.

Data Source: Salient

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6. Rate of Co-prescription of Opioids and Benzodiazepines

As of 2018, there is a 20.4% rate of co-prescription of Opioids and Benzodiazepines (556/2726). These numbers are for Medicaid patients only.

Another class of controlled medications that have been linked to many opioid related harms and death are benzodiazepines. These medications have respiratory depressive properties that can lead to risk of overdose, especially when combined with opioid medications. In 2016, Staten Island had the highest rate of benzodiazepine prescriptions of all boroughs in NYC at nearly 300 prescriptions per 1,000 residents. Some of these co-prescriptions are from the same clinician; others occur when multiple clinicians prescribe medications to the same patient. Highlighting this measure will encourage greater use of the prescription monitoring program and better coordination of care.

Data Source: Salient

7. Naloxone Kits Dispensed

Since January 2019, there were 3,327 naloxone kits dispensed in Staten Island zip codes. 

Naloxone, an antagonist that blocks opioid receptors in the brain and can be administered to reverse opioid overdose, plays a critical role in saving lives. Communities that have made naloxone readily available and have trained persons to use it have been successful at saving many lives from opioid overdose. New York State, New York City, and the Borough of Staten Island, in particular, have already embarked on impressive efforts to make naloxone available to the community through organizing trainings for naloxone use and supplying naloxone kits via registered opioid overdose prevention programs, as well as through a standing order to make naloxone available without a prescription at all NYC pharmacies.

To monitor the reach of these efforts, it is important to track the extent, location and setting through which naloxone is being made available on Staten Island. This is especially critical to assure policy efforts on this front are being translated effectively into practice.

Data Source: Community Health Action of Staten Island and Staten Island University Hospital

Under Development

8. Patients Receiving Buprenorphine for at Least 30 days

Under Development

According to a recent report from the U.S. Department of Health and Human Services, “addiction is a chronic treatable illness” that “often requires continuing care for effective treatment rather than an episodic…treatment approach. In addition to counseling and social support, and residential care when necessary, experts recommend that medications such as methadone, buprenorphine, and depot naltrexone be offered to patients. “

Tracking all patients in OASAS-funded or licensed treatment provides a birds-eye view of specialty addiction treatment as well as perspective on the number of patients receiving medication-assisted treatment.

Data Source: New York State prescription monitoring program

Under Development

9. MD, NP, and PA Prescribing MAT for 30 Days to At Least 5 Patients

Under Development

According to a recent report from the U.S. Department of Health and Human Services, “addiction is a chronic treatable illness” that “often requires continuing care for effective treatment rather than an episodic…treatment approach. In addition to counseling and social support, and residential care when necessary, experts recommend that medications such as methadone, buprenorphine, and depot naltrexone be offered to patients. “

Tracking all patients in OASAS-funded or licensed treatment provides a birds-eye view of specialty addiction treatment as well as perspective on the number of patients receiving medication-assisted treatment.

Data Source: Department of Health and Mental Hygiene and New York State prescription monitoring program

10. Patients in OASAS Addiction Treatment Programs for at Least 30 Days

The number of residents who show as admitted to treatment over 30 days and not yet discharged is: 1,050 (any substance) or 720 (opioids only).

Tracking all patients in OASAS-funded or licensed treatment provides a birds-eye view of specialty addiction treatment as well as perspective on the number of patients receiving medication-assisted treatment.

Data Source: Office of Alcoholism and Substance Abuse Disorder

11. Patients Started on Treatment with Buprenorphine in the ED

As of December 2018, there are 30 patients started on treatment with buprenorphine in the ED. 

In addition to counseling and social support, and residential care when necessary, experts recommend that medications such as methadone, buprenorphine, and depot naltrexone be offered to patients.  These outcomes, for methadone and buprenorphine, include substantially reduced overdose mortality, less infectious disease, and less criminal activity.

Data Source: Hospitals, Office of Alcoholism and Substance Abuse Services

12. Certified Peers

As of December 2018, there are 60 peers working on Staten Island.

One recovery support strategy that has been promoted by the substance use treatment community for many years, is the integration of persons with lived experience, often referred to as peer recovery coaches, to help guide and assist persons throughout the process of recovery. Peer recovery coaches have been shown to be helpful in both engaging persons in initial care, in settings such as hospitals, and in helping persons stay engaged in treatment and connected to health services. Currently, there are efforts on Staten Island to train and certify peer recovery coaches. In addition, peers are used in emergency department programs, law enforcement diversion programs, and other locations on Staten Island.

Data Source: Staten Island PPS, Staten Island Partnership for Community Wellness, and Office of Alcoholism and Substance Abuse Services

Under Development

13. OASAS-Certified Supportive Housing Units

Under Development

Safe and affordable housing is vital to combatting the opioid crisis on Staten Island. Indeed, as a basic human need, stable housing can make recovery possible.

Data Source: Office of Alcoholism and Substance Abuse Services

14. People in HOPE Who are Meaningfully Engaged

Since the start of the HOPE Program in 2017, there were 603 people meaningfully engaged.

Given the increasing rates of opioid use on Staten Island and the frequent criminal justice involvement of persons with addiction due to possession of illicit substances, the Office of the District Attorney has implemented an innovative program to divert persons with low-level drug offenses from arrest into support services. The Heroin Overdose Prevention & Education, or
“HOPE” program, works in conjunction with recovery centers on Staten Island to execute individualized needs assessments and connect persons to needed recovery services. This program has already begun to show success in connecting persons with services and avoiding future criminal justice involvement.

Data Source: Staten Island District Attorney Michael McMahon’s Office with assistance from recovery centers

15. Individuals Referred by Recovery Centers to Evidence-Based Treatment

From January to December of 2018, there were 327 individuals referred by recovery centers to evidence-based treatment.

The more people who can access care and receive help for their addiction without an arrest, the fewer will likely be arrested in the first place.

Data Source: Substance Use Disorder Resource Centers

*The Opioid Data Working Group consists of:

  • Anthony C. Ferreri, DBA (Chair). Dr. Ferreri is the former CEO of Staten Island University Hospital and is now Regional Director for Region 2 – New York, New Jersey, Puerto Rico and The US Virgin Islands, at the United States Department of Health and Human Services
  • Chinazo O. Cunningham, M.D., M.S. Dr. Cunningham is Professor and Associate Chief of General Internal Medicine at the Albert Einstein College of Medicine
  • Marc N. Gourevitch, MD, MPH. Dr. Gourevitch is Professor and Chair of the Department of Population Health at the NYU School of Medicine
  • Jonathan Morgenstern, PhD. Dr. Morgenstern is Assistant Vice President for Addiction Services at Northwell Health and Professor of Psychiatry at the Donald and Barbara Zucker School of Medicine
  • Nora Santiago, M.S. Ms. Santiago is Urban Policy Analyst and GIS Specialist at CUNY College of Staten Island