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Times Union: Fentanyl is Winning Opioid Overdose Experts and Survivors Call on NY State to Allow Higher Doses of Lifesaving Naloxone


New York has failed to keep pace with the overdose epidemic. A simple change in the state's naloxone policy would make a difference.

By Mark Kaplan, Ashley Livingston and Lori Drescher

March 3, 2024

How would state leaders respond if the entire population of Saratoga Springs died within a six-year window, or if every resident of Rotterdam died in the same time frame? Far differently, one can imagine, than they have collectively responded to the 30,000 New Yorkers who have died from opioid overdoses since 2018.


In just six years we have lost the equivalent of an entire city, due mostly to the explosion in fentanyl overdoses. In any other setting, the magnitude of these unnatural deaths would constitute an emergency — a catastrophe, in fact.

Instead, at great human cost, New York’s response has failed to evolve with the epidemic.

Our policies and investments as a state, especially as they relate to the procurement and distribution of overdose reversal medication, have become frozen in time. New lifesaving overdose reversal options that have been embraced by other states such as California, Tennessee, Ohio and Pennsylvania have been ignored or eschewed by key state decision-makers in New York.

More than a decade ago, hundreds of thousands of New Yorkers became addicted to prescription pain killers. The state responded by making such prescriptions far more difficult to obtain, which drove thousands to seek illicit drugs, chiefly heroin. As overdose deaths began to climb, the state — via a mechanism known as a “standing order” — widely distributed 4 mg intranasal inhaler doses of naloxone, a drug proven safe and effective in reversing an opioid overdose.

Satisfied with its response, the state’s overdose reversal strategy entered stasis. The epidemic roared on, however, killing more New Yorkers in each successive year.

Fentanyl is now by far the leading cause of overdose deaths. It is 50 times more powerful than heroin, so powerful that a single 4 mg dose of naloxone typically will not reverse an overdose. The state Department of Health completed a multiyear study through 2022 and found that in 66% of nearly 12,000 naloxone administrations, two, three or more 4 mg doses were required to revive the person. Moreover, a recently published study by the federal Food and Drug Administration found a 4 mg dose of naloxone to be generally inadequate in reversing a fentanyl overdose.

The takeaway is inescapably clear: First responders, community groups and family members need higher-dose formulations of naloxone to be fully prepared to reverse fentanyl overdoses (among other proven harm-reduction approaches). And yet, inexplicably, the state still sticks with its single-source contract for only 4 mg doses.

A critical factor in overdose reversals is time. The directions for administering naloxone intranasal inhalers require a wait of two to three minutes between successive doses. In most overdoses today, this equates to several minutes lost during the administration of multiple 4 mg doses — precious minutes where death and permanent brain injury can occur. Higher-dose options would eliminate or reduce these delays and save more lives, and there is solid evidence that these options are effective and safe.

The solution is simple: The Department of Health must expand its “standing order” to include all FDA-approved forms and doses of naloxone. This simple change will save lives. What’s more, opening it up to competitive bid will no doubt save taxpayer dollars.

A New Yorker dies every 90 minutes from a fentanyl overdose. Around 15 more will die today.

We can only hope and believe that if more state leaders were aware of New York’s failure to keep pace with the fentanyl epidemic, then they would act swiftly to make this simple but immensely impactful change.

Mark Kaplan is founder of the Mission for Marcus Foundation. Ashley Livingston is co-chair of Friends of Recovery Warren & Washington. Lori Drescher is founder of Recovery Coach University in Monroe County. Livingston is an overdose survivor; Kaplan and Drescher each lost a child to overdose.



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