Thursday's International Overdose Awareness Day spurred conversations about how state officials can combat New York overdose deaths, which have reached an all-time high in correlation with elevated substance use and mental health disorders since the pandemic.

More than 6,300 New Yorkers died by overdose in 2022, up from more than 5,800 people in 2021, according to the state Office of Addiction Services and Supports and the state Comptroller's Office. The spike is significantly tied to the rise in the prevalence of fentanyl, which is an opioid, or the medication xylazine added to drugs that increase the chance of an overdose.

"We are at the worst point ever on record in terms of the number of overdose deaths that are happening in New York and the United States," Office of Addiction Services and Supports Commissioner Dr. Chinazo Cunningham said. "Our provisional numbers from 2022 show that over 6,300 people overdosed and died, so that's about one person every 90 minutes who's dying of an overdose in New York."

Most of the deaths are related to fentanyl, Cunningham said. 

Senate Health Committee Chair Gustavo Rivera continues to have conversations with his fellow policymakers about solutions to address the heightened drug use and related overdose deaths. State lawmakers, who range in age from their mid-20s to early 80s, prefer to have the talks in private, because the senator says addiction and drug use are difficult for people to talk about.

"Some people still have baked in their brains that addiction is a moral failing, and not the public health crisis that it is, not the disease that it is," said Rivera, a Bronx Democrat.

Rivera has led the fight to expand overdose prevention centers, otherwise known as supervised injection sites, in the state. The sites allow people with addiction-related disorders use illegal drugs in the presence of health staff to prevent death.

He'll continue fighting hard next session, he said, pushing colleagues to support his legislation to allow overdose prevention centers be run by community-based organizations that apply for a specific license.

But state leaders are hesitant to allow the consumption of drugs illegal under federal law. A federal attorney recently warned the private company that operates two overdose prevention sites in New York City about its practices, according to a New York Times report, but the sites remain open. 

The privately owned sites have not received additional warnings from federal officials to date, Rivera said.

"We have not heard any further movement from the Southern District on this," he said.

Health staff who work at the operating centers have prevented overdoses from resulting in death more than 1,000 times since opening.

The senator noted New York City Mayor Eric Adams supports expanding the centers, adding, "There are folks at every level that are supportive of it. If people are here, they continue to be alive, and they can recover."

Rivera says he continues to have conversations with Gov. Kathy Hochul about supervised injection sites after her administration rejected a recommendation from the Opioid Settlement Fund Advisory Board to use a portion of the state's share to create more centers.

About $40 million of New York's more than $2 billion in settlement agreements with opioid manufacturers could be used to support safe injection sites across the state, Rivera said. The funds, part of a settlement led by state Attorney General Letitia James's office, will be administered to the state and its 10 regions in installments for at least the next 17 years. The settlement will serve as the state's primary funding source to combat the opioid epidemic, and will not be impacted by the $9.1 billion deficit estimated in next year's budget.

Localities have received $64 million of the state's opioid settlement funds to increase access to addiction treatment, fentanyl and xylazine test strips and medicine like Narcan and naloxone to reverse overdoses. State law requires the funding be committed to be spent to bolster harm reduction and prevention services statewide.

"Harm reduction is really a philosophy, and also a practical set of strategies that really focus on reducing harms associated with substance use," Cunningham explained. "So the philosophy is about recognizing people use substances. They have for hundreds, for thousands, of years. ...Opium, tobacco, I mean, this is not a new phenomenon in the human race."

Sen. Patrick Gallivan, a former law enforcement officer from Erie County in Western New York, would rather see the state focus on building up existing local community organizations and prevention and treatment programs.

He says nonprofits and community organizations lacking staff and other resources can't rely on donations and government funding.

He also wants to make fentanyl illegal in the state in addition to more funding for police and increased narcotics training.

"We have to provide the support with the laws to ensure that there's proper penalties in place, and I'm not suggesting that we go back to the Rockefeller drug laws or draconian laws, but we have to be realistic until we work on that supply side and try to reduce the flow of that bad stuff," Gallivan said. "[To reduce] the poison that is going into the bodies of the people that have problems that are addicted, who we should still be trying to help and provide funding for prevention and treatment." 

Gallivan understands how overdose prevention sites save lives, but he is one of many lawmakers concerned about impacts on the surrounding community.

"Neighbors have concerns about bringing that type of activity into their neighborhood," he said. "It does not discourage the illegal use of drugs."

In addition to harm reduction services, Cunningham says the state remains focused on better education to end the stigma around addiction and improve available medical treatment.

"We should be talking about addiction like we talk about diabetes or heart disease," the commissioner said. "Addiction is a medical problem. It's a medical condition where when people have addiction, their brain gets rewired and it really requires medical treatment and a public health approach. And so I think we just have to keep that in mind."