As Gov. Kathy Hochul prepares her executive budget proposal and priorities for the next legislative session, harm-reduction advocates are urging her to expand the overdose reversal medications purchased by the state to reduce overdose deaths.

The uptick of fentanyl-laced drugs, synthetic opioids and substance abuse has made the traditional 4 mg dose of Narcan nasal spray less effective — requiring multiple rounds spaced minutes apart to reverse an overdose.

"We haven't updated this since 2016," said Mark Kaplan, an advocate whose son, Marcus, died from an accidental overdose in 2019. "New York state should be a leader in this. They should not be a follower."

The state Health Department has purchased Narcan, or the brand name for the overdose reversal drug naloxone, from the same pharmaceutical manufacturer for years. State health leaders have expressed their intent to buy other overdose reversal medications, but not until the multi-million dollar contract with Emergent Devices Inc. expires next summer. 

But advocates say with the rise in substance abuse and related deaths, Hochul must direct the state to change course sooner than that.

"Why wait?" said Kaplan, who co-founded the nonprofit Mission for Marcus. "Every day that you wait puts more people at risk of dying of an overdose."

Legislation gained traction this session to require the state Health Department to expand the type, and potentcy, of opioid antagonist medications distributed to first responders and the public with the rise in fentanyl-related deaths.

Assemblyman Phil Steck sponsors the bill, which would force the department to consider all overdose reversal drugs approved by the U.S. Food & Drug Administration.

It ultimately cleared the Assembly, but failed in the Senate — fueling calls for Hochul to direct the state Health Department to include all FDA-approved opioid overdose reversal agents in the state Opioid Overdose Prevention Program. Advocates are pushing for her to include the change in her State of the State address or executive budget proposal to be released next month.

"Overdose reversal antagonists are advancing with time, and newer ones are coming on the market," Steck said.

Steck credits state Health Commissioner Dr. James McDonald for calling him about the issue earlier this year. 

The pair had a long talk about the best way forward, but the commissioner has concerns that higher doses of naloxone options lead to more side effects of withdrawal, and wants to be cautious about newly approved medications.

McDonald carefully considers all opioid overdose reversal medications approved by the FDA, according to the department. The commissioner evaluates the efficacy, clinical data of withdrawal experiences and feasibility of the use of the product by first responders and health professionals.

"Reviewing this information in a complex and dynamic space is a continual process," DOH spokesperson Cadence Acquaviva said in a statement.

Steck argues the FDA approval is sufficient for the state to diversify its supply of opioid antagonists.

"We are not scientists in the New York state Assembly and they have scientists at the FDA to review these things," the assemblyman said. "And while the FDA is not perfect, neither is the New York state Department of Health."

And advocates say having symptoms of a withdrawal is better than dying from an accidental overdose.

Tim Murdick, president of the Nopiates Committee, has focused on connecting New Yorkers with treatment, recovery and other community events since his son, Sean, died of a heroin overdose in 2015.

"Would you rather have somebody irate and annoyed, or would you rather have them dead?" Murdick said of concerns about withdrawal symptoms from a more potent opioid antagonist drug. "...[If] you have a heart attack and someone performs CPR on you, a lot of times you end up with cracked ribs. So would you rather die from the heart attack or have a couple of cracked ribs?"

The prevalence of fentanyl has increased overdoses among naive users, or people who do not suffer from substance abuse disorders — especially young people and college students.

Hochul signed a law in 2022 requiring State University of New York campus student housing facilities maintain supplies of opioid antagonists.

"Colleges and universities train resident assistants and other members of our institutions to administer these overdose-reversing medications in the event of an emergency," a spokesperson with SUNY said Thursday.

University police officers have not requested larger dosages of Narcan, according to SUNY.

Officials with the Health Department said the department continues to ensure it buys naloxone at the lowest possible cost, adding Narcan has a longer shelf life than comparable brands, and is the most cost-effective.

“The opioid epidemic continues to impact every community across New York and fighting the epidemic includes equipping individuals, communities, organizations and agencies with the right tools," Acquaviva said. "While the latest Centers for Disease Control and Prevention provisional data on overdose deaths is encouraging, there is still work to be done to prevent overdose deaths in New York state. The department remains committed to harm reduction by making lifesaving overdose reversal medications like naloxone available to the public, increasing access to fentanyl and xylazine testing strips, funding drug user support programs and supporting community-based organizations that work directly in communities impacted by the opioid epidemic.”