As State Support Dwindles, New York’s Overdose Crisis is Only Getting Worse

State withholds have left harm reduction providers undersupplied, and informal overdose prevention networks are struggling to fill the gap.

Lee Harris   ·   February 16, 2021
Angel Melendez carries multiple Narcan bottles on him and keeps watch for overdoses in The Hub. He has reversed at least six overdoses in the past few months, he estimates. | Lee Harris

This story was published in partnership with THE CITY.

City health officials, while combating COVID-19, have yet to disclose the number of drug overdoses since the pandemic first gripped New York last March.

But from the streets of the South Bronx, the view is grim. Overdose numbers were already rising before the pandemic, and cutbacks in supplies of hypodermic needles and overdose antidotes such as Narcan pose grave threats to injection drug users at risk of death and infection.

One troubling trend: New York City’s share of injection drug users who report reusing their needles has increased more than fourfold, according to a recent CUNY study, to 22%.

Angel Melendez carries multiple Narcan bottles on him, since, he says, overdoses have spiked in the ‘The Hub,’ the South Bronx neighborhood where he and others inject drugs. He has reversed at least six overdoses in the past few months, he says.

At the AutoZone on 149th Street in December, Bronx resident Angel Melendez stood talking to friends. Out of the corner of his eye, he noticed an acquaintance purchasing a small quantity of heroin. Another man helped the acquaintance inject the drugs into his neck.

“Somebody hit him with the dope,” Melendez said, recalling the morning, “and then immediately he just, boom, he dropped. Within 10, 15 seconds.”

Melendez jumped into action: “We took off his mask, and he was hardly breathing. So we gave him one Narcan. That didn’t wake him up.” The man was turning purple, he said.

“I was asking people to help me out with him. I told ’em, ‘Listen, does anybody else have more Narcan, just in case he still doesn’t wake up?’”

It required two more Narcans — a brand name for the nasal spray Naloxone, which blocks the effects of opioids — to revive the man, Melendez said. He had been carrying bottles of the medicine inside his jacket.

‘You Feel Sad’

Melendez, a familiar face in The Hub for years, said incidents like these have lately become much more common in the South Bronx neighborhood.

Now, he carries Narcan whenever he goes out, he said. He had four bottles stuffed inside his winter jacket when New York Focus met him.

Melendez estimates that he has reversed about six overdoses in the past few months. 

But sometimes, help doesn’t arrive in time. One December morning, Melendez was walking with a group down St. Ann’s, a major artery through the South Bronx. They noticed that benches in St. Mary’s Park, where Melendez had been the day before, were cordoned off.

“We saw that yellow tape they put when somebody dies. And then we looked over to the bench, and it was the guy that we know, Flaco.”

Known by the nickname Flaco, which means “skinny,” the native of Puerto Rico had died overnight from a suspected drug overdose.

Melendez had talked to Flaco just the day before. And the previous week, he had noticed that Flaco was wearing only a thin sweater, and sold him a spare coat for $15. Flaco was found on the bench in St Mary’s, wearing the beige Tommy Hilfiger coat.

Angel Melendez stands in front of the bench where a friend, Flaco, was found dead of a suspected overdose.

“It was scary to me, because I know the person, I talked to the person, and then when you have a certain relationship with a person, you feel some type of way, you know? You feel sad,” Melendez said.

More Need Help

Melendez is part of a growing network of people keeping watch for overdoses. They include drug users, park maintenance crews and community members who frequent public spaces. 

Many carry opioid antagonist medications like Narcan. Others splash water in the face of someone who has overdosed, or hold ice to their testicles.

Nonprofit outreach groups ordinarily provide peer advocates like Melendez with supplies like Naloxone kits and fentanyl test strips, which drug users rely on to look for the presence of the lethal chemical in drugs. But those organizations have come under increasing strain.

Starting last summer, to stem a COVID-connected cash crunch, Gov. Andrew Cuomo began to withhold 20% of nonprofit service providers’ state aid. As a result, groups who rely on state contracts saw rations of key supplies, opioid treatment providers say, including syringes for safe injection.

“We’ll order 50 cases and typically we’ll get around 15 to 20% of those cases,” Mary Brewster, director of harm reduction services at Harlem United, told New York Focus. One month in late 2020, Brewster said, she ordered 75 cases and received 10. 

“I’ve been doing syringe exchange for almost five years,” she said. “For the first time, we’ve had to get bleach and teach our clients how to clean their syringes, so that they can reuse them.”

While reusing one’s own syringe does not pose the risk of acquiring HIV, it does bring the risk of other infections for users.

The supply shortage is being felt statewide, service providers in Rochester, Utica, Syracuse and elsewhere report, even as demand for services spikes.

No Numbers

The New York City Department of Health and Mental Hygiene issued its last quarterly report on drug overdose in fatalities in December, covering January through March 2020. It provisionally showed 440 confirmed fatal overdoses — a 28% increase over the same quarter in 2019.

The final number of overdoses in 2020 has not been certified. 

“This is by far the longest delay that we’ve seen,” said Melissa Moore, New York State director for the Drug Policy Alliance, a policy and advocacy organization. “It’s really egregious.”

“We’re responding to a public health crisis from two years ago,” said Jasmine Budnella, a drug policy expert at VOCAL-NY. “We know that the need is increasing. We’re losing more people, but if we don’t have the data to show that, we’re not able to respond.” 

A spokesperson for the New York City Department of Health and Mental Hygiene, Patrick Gallahue, said to expect numbers shortly.

“We are preparing to post our most recent quarterly data very soon,” he said. “We fully understand the urgency to make this information available to New Yorkers and are working to do so as quickly as possible.”

Meanwhile, other counties have delivered full 2020 numbers — revealing spikes in fatalities.

Erie County, home to Buffalo, saw a spike from 156 opioid overdose deaths in 2019 to at least 194 deaths in 2020. That number could rise further when final results are certified, according to the county health commissioner.

Albany logged more overdose deaths in 2020 than in any recent year, with 99, Mental Health Commissioner Stephen Giordano said — up 60% from 62 in all of 2019. Of the deaths last year, he said, 88% were related to fentanyl, the powerful synthetic opioid.

The intersection at Willis Ave, E 149th St and Third Ave is one of the liveliest in the Bronx. Many residents have become involved in makeshift harm reduction efforts.

Giordano noted that he has no way of tracking non-fatal incidents, in which people use Narcan to reverse an overdose without calling paramedics. Anecdotally, Giordano noted, “We hear that those are way up.”

State Sen. Pete Harckham (D-Westchester), who chairs the Committee on Alcoholism and Substance Abuse, says more information is crucial. “We have very poor reporting from many counties,” he said. “So we don’t even know the full scope of the problem, in order to advocate for more resources.”

COVID-19, he added, shows “we have the capability to collect data very quickly.” Quarterly reporting by the state Department of Health is also delayed, prompting Assemblymember Linda Rosenthal (D-Manhattan), who served as Chair of the Committee on Alcoholism and Drug Abuse in 2020, to write Commissioner Howard Zucker in October.

“We know anecdotally that many areas of the State have seen increases in overdoses and by having this data available, we will be better equipped to allocate limited resources,” Rosenthal wrote.

She said she has not received a response.

The most recent quarterly report, issued in July, provides preliminary county-by-county details on Narcan administration for the first three months of 2020, but statistics on overdose emergency room visits, hospitalizations and deaths only run through the end of 2019.

The state has not yet issued a 2020 annual report. The lag in information puts lawmakers at a disadvantage as they craft the state budget, Rosenthal argued.

“As we negotiate the state budget, it is exceptionally challenging to target resources to the communities needing them most without access to the most recent overdose numbers statewide,” Rosenthal said. “We're working with data that is more than a year old, which obscures the true scale of the crisis and makes it more likely that once again substance use disorder services will be severely underfunded.”

Reusing Needles

Academic researchers attempting to fill the information void have independently uncovered troubling trends. 

Pedro Mateu-Gelabert, an opioid researcher at CUNY, has been conducting interviews with people who inject drugs for an ongoing study on infectious disease such as HIV. 

Since the pandemic hit, Mateau-Gelabert told New York Focus, his team has found an increase in syringe reuse, up from 5% to 22% of the population actively using drugs in New York City. The quadrupling of needle reuse puts people at risk for severe infections.

CUNY researchers also discovered reduced visits to needle exchanges among the population using drugs — down from 42% prior to March to 24% since the pandemic began. The trend is an early indicator for a potential spike in HIV and Hepatitis C infections. A new HIV cluster has already been discovered upstate.

Jose Valle loves Roberto Clemente plaza in the South Bronx, named after a Puerto Rican baseball player he idolized as a child, but worries about the spike in overdoses he has seen in the community.

Access to clean needles was supposed to be well underway in New York City by now. In 2018, Mayor Bill De Blasio committed to bringing four safe injection sites to the city. Governor Andrew Cuomo also privately expressed his support for the sites, advocates said.

“That was 2018, we’re in 2021,” Budnella told New York Focus. “The governor signaled before the election that he was in support, and told advocates, ‘Hold off, I can’t do anything until after the election.’ Now, the governor has again gone completely silent.’”

Lacking designated sites for safe consumption staffed by health care professionals, people who inject drugs rely on each other to reduce the likelihood of fatal overdose.

Even when they are well-supplied, makeshift harm reduction networks aren’t ideal. Conditions are unhygienic, and people’s ability to keep watch is often impaired when all parties are consuming drugs.

‘I Started Shaking Her’

George Williams and Jose Valle have each been coming to The Hub in the Bronx more often, throughout the pandemic. Both have friends in the area, which bustles with Mexican fruit vendors, Dominican pastry shops and open-air jewelry sellers.

Born in Puerto Rico, Valle especially loves the benches in Roberto Clemente Plaza. So he’s troubled by the number of overdoses he has seen lately in the square. 

Valle, who said he used heroin for years and now attends a methadone program, has stepped in to prevent overdoses several times in the past several months, administering Narcan when he has it on hand.

The first time he reversed an overdose was in mid-autumn, Valle recalled. He noticed a woman sitting with her son, who looked about 6 or 7, suddenly keeling over. “Before she hit the floor, I grabbed her,” he said.

“I started shaking her, started slapping her on her face. My friend went and got some water, we put some water on her face. And her son, who was playing right next to her — he didn’t know what was going on. So my friend went and started talking to him, he went and bought a slice of pizza with him, while I was trying to bring his mother back — that way he wouldn’t know what was going on.”

The woman drifted in and out of consciousness, he recalled. 

“She was almost gone — I had to hold her, keep slapping her, throwing water on her face, and I kept shaking her and slapping her a little bit, and they kept telling me, ‘Yo, call the ambulance,’ he recalled.

The child’s presence precluded that call. 

I said, ‘I’m not gonna do that, because she’s got her kid, they’re going to take her kid away from her.’”

After the woman finally roused, Valle berated her for using drugs while with her son.

“I told her, ‘Are you stupid or what? What’s wrong with you?’” Valle recalled. “That’s when I guess it hit her. Her eyes got watery. I said, ‘Don’t worry, everything’s going to be fine, but next time don’t do that.’”

The next time he found somebody who had overdosed, he used Narcan.

‘More Than a Maintenance Man’

Williams, Valle, and other regulars at Roberto Clemente Plaza praised the maintenance workers who sweep and sanitize the area, saying they were grateful to the cleaning crew for their vigilance about overdoses.

One maintenance worker, who asked not to be named, estimated that over the four months he’s been on the job, he has seen eight to 10 overdoses. 

George Williams often comes to the plaza for fresh air. He has called paramedics a dozen times to respond to suspected overdoses, he estimates. Williams praised the park maintenance workers who look out for overdoses.

Members of his cleaning crew carry two bottles of Narcan, and he has had to administer the nasal spray more than once. Sometimes, he receives guidance from paramedics over the phone, while he waits for an ambulance to arrive.

“The first time I saw someone overdose, I was with my boss. And he said this was a regular thing, and I would have to look out for people like this,” he recalled. 

Kicking the brakes on their rolling trash cans last fall, he said, he and his boss approached a man who appeared unconscious. 

“I thought he was just sleeping. He had his head back. But it was a little too far back, and my boss said he might be having an overdose. So we went up to him. My boss tapped him, he said, ‘Hey, hey, are you alright? You doing okay?’ He didn’t respond. He opened his eyes to check his pupils, and they were dilated. So he said, ‘We’ll call the EMT.’”

When paramedics arrived a few minutes later, the worker said, “I felt a relief off my shoulders. It makes me feel like I’m kind of more than a maintenance man.”

When he took the job, the maintenance worker added, “I thought I was just going to be sweeping up.” But now, he is making an active effort to learn the names of regulars in the plaza, since he’s watching out for them: James, Rafael, Grandma. 

“The lady in the red coat — we call her Grandma,” he explained.

Lee Harris co-founded New York Focus and currently works part-time on strategy and development as contributing editor. She is also a staff reporter at The American Prospect, where her reporting focuses on climate, finance, and labor, and her work has appeared in outlets… more
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