Finding New Ways to Fight the Opioid Epidemic

The opioid epidemic has recently emerged as a hot topic, but for me, it’s a personal and professional passion. It’s a family’s love and trust in each other shattered by drugs; it’s hiding a secret; missed birthday parties; and the painful realization that when substances are involved, sometimes love isn’t enough. The opioid epidemic is a friend from my teenage years, who died of an overdose during her eighth time in an adolescent detoxification facility because she withheld her methadone and swallowed it all at once; it’s my previous client, who spent years shooting dope, pawning anything within reach, including his wedding ring and his child’s shoes, who agreed to treatment only when he learned that he was HIV positive with less than six months to live.

My interest in studying substance use goes back more than a decade, so as a Mailman student I was overjoyed at the prospect of doing macro-level work on the opioid epidemic for my practicum. Although I had never worked in research and surveillance, I was selected for an internship with the Bureau of Alcohol and Drug Use, Prevention, Care, and Treatment at the New York City Department of Health and Mental Hygiene (DOHMH) through the Health Research Training Program (HRTP). There, I quickly learned that I’d be studying the anthropological circumstances surrounding unintentional overdose deaths. In other words, whenever mortality cases came in, I’d read the documents provided by the Office of Chief Medical Examiner and the Office of Vital Statistics to record the substances that came up in toxicology screens of the deceased; any notable socioeconomic or psychological pieces of information about the person; and any medical interventions or treatments they received, if any. What I found was more harrowing than I anticipated: I noticed that many people were overdosing and dying alone in their apartments without any noted next of kin. Given a morbid, solemn glimpse into the last moments of a person’s life, I wondered how they became so estranged and isolated in a city like New York. 

As medical examiner records continued to show users overdosing alone, our data also showed an increase in the presence of fentanyl in cocaine-involved overdose deaths, without any heroin involved.
 
A Health Advisory published by the Bureau in 2016 stated that “of the overdose deaths involving cocaine without heroin, 37 percent involved fentanyl, up from 11 percent in 2015. Provisional 2017 data suggests that fentanyl is present in more than one-third of overdose deaths involving cocaine without heroin.” ​(Paone and Kunis). It was unprecedented that such a powerful opioid would be laced with cocaine, which has the opposite effects. It also presented a unique opportunity to do public health messaging around this relatively unknown issue.

In a meeting with my unit director at DOHMH, I asked her about this discovery and told her that I wanted to investigate further in order to target recreational cocaine users with harm reduction messages. I pointed out that cocaine use was ubiquitous in New York City’s nightlife, and suggested that non-judgmental harm reduction messaging in bars and nightclubs could open up conversations and create an unlikely alliance between the DOHMH and the hospitality industry.

It was a mere passing comment at the end of a brown-bag information session that suddenly exploded with possibilities: after our meeting, my awareness campaign came to fruition.

Currently, a small group of people in our unit is working tirelessly to make it happen and we’re set to begin piloting harm reduction messaging in the Lower East Side neighborhood of Manhattan soon. My supervisor and I will be visiting participating bars and clubs with posters and drink coasters we designed that give the facts about fentanyl in cocaine. Working with bar owners and staff, our goal is to open up conversations about substance use and overdose prevention and to eventually have the staff at participating establishments trained in overdose prevention, including administering Naloxone, a medication designed to rapidly reverse opioid overdose.

The DOHMH has never attempted to reach recreational users in this way because the need has never been this urgent. We can’t predict the impact that the campaign will have here, but as the death toll of unintentional overdoses continues to increase, we’re committed to approaching the opioid epidemic in a different way. 

Ariel Hurley is a second-year graduate student pursuing a dual Masters degree in Social Work with a clinical focus on health, mental health, and disabilities, and an MPH in Sociomedical Sciences. She received her Bachelor of Science degree in Public Health from Temple University. 

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