Posted on by Nathan Riley

As de Blasio Dawdles on Safer Consumption Spaces, Health Advocates Block Broadway Traffic

BY NATHAN RILEY | Outraged that Mayor Bill de Blasio continues to sit on a city health department study into the efficacy of establishing safe places for drug users to pursue their high — facilities that are in place all over Europe with proven track records of reducing fatal overdoses — protestors sat down in the middle of Broadway across from City Hall bringing downtown traffic to a halt.

Ten activists and City Councilmember Stephen Levin were arrested in the May 2 morning sit-in, as allies chanted slogans directed at the mayor, including “While you wait, we die” and “End overdoses now.”

The city study was finished in December and the mayor promised to release it in April, but then didn’t do so.

“I’m pissed off,” Asia Betancourt of VOCAL-NY said in an interview before joining a speakout that preceded the Broadway civil disobedience. “There’s absolutely no excuse. People are dying left and right.”

[Editor’s update: The day following this protest, de Blasio announced that four such facilities will be opened.] 

An average of three to four people die of overdoses every day in New York City, and those numbers would tumble if users could inject in supervised facilities where medication that interrupts overdoses, professionally delivered, is just steps away.

Called Safer Consumption Spaces among those pushing the issue here in New York, the facilities also provide sterile equipment that reduces the risk of hepatitis C, abscesses, and other ailments that come from using in public bathrooms, city parks, and parking lots. Overdose prevention workers are on hand to explain proper procedures for avoiding contamination and, should a user request it, provide information on sites offering drug treatment. They can also offer assistance on problems like evictions or arrests that often pose more pressing challenges to users than their drub habit.

Most importantly, should a user overdose, the health workers have naloxone at the ready. It’s a public health wonder drug, a nasal spray that is squirted into a person’s nostril to inhibit the effects of opioids and quickly restores normal breathing.

A Google search for Safer Injection Facilities — the phrase most often used when the concept first emerged — shows how far behind New York City is from the services offered in Europe and Canada. The very first article that appeared in the search was written in 2002, reporting that Germany had 13 SIFs operating in four cities; the Netherlands, 16 SIFs operating in nine cities; and Switzerland, 17 SIFs operating in 12 cities. Sixteen years ago, such facilities were regarded as an essential component in AIDS prevention.

Since then, these programs have expanded to 100 cities worldwide. Safer Consumption Spaces differ from needle exchanges “where clients generally visit briefly,” according to the article in the Journal of Drug Issues, and “allow for a more prolonged interaction” with health care staff. The facilities “place trained staff in direct proximity with injectors while they are waiting to consume their drugs, as well as after they have done so and returned to the waiting room to relax. SIFs that offer a café and other services give clients even more reason to remain on-site and interact with staff, during which time the clients become further stabilized.”

Levin, who chairs the Council’s General Welfare Committee, explained he was willing to be arrested to “make sure the mayor does the right thing. The science is clear.”

In a written statement, the Brooklyn councilmember elaborated, “There is a path we can take where fewer of our neighbors, our friends, and our family members lose their lives. That path is through a serious commitment to harm reduction and Safer Consumption Spaces in particular. The drug war has failed… Nearly two years ago, the Council commissioned a study on Safer Consumption Spaces. Today, our message to the administration is simple — release the study.

Council Speaker Corey Johnson, who as the Health Committee chair in 2016 initiated the study, released a statement saying, “I don’t know what the holdup is. Other cities are moving forward and we’re stuck in limbo. Meanwhile, the number of people overdosing continues to skyrocket. This is not a time for inaction. The mayor knows how strongly I feel about this, and we will continue to push for the study’s release.”

Support for Safer Consumption Spaces has widespread support in the medical and political communities. In February, Dr. Mary Bassett, de Blasio’s health commissioner, told a Council budget hearing that “the public health literature is clear” on the benefits of the approach, which has also been endorsed by the American Medical Association.

Former Mayor David Dinkins, a mentor to de Blasio, announced his support last week, as did former Manhattan Borough President C. Virginia Fields, now CEO of the National Black Leadership Commission on AIDS. More than 100 public health workers signed a letter of support for the program, and The New York Times gave the idea its strong endorsement.

But nothing seems to move the mayor.

Advocates at the speakout said that since the Council first authorized the study, 1,500 people have died in New York City from fatal overdoses. Any one of them who had been injecting in a Safer Consumption Space would still be alive. Nobody — as in zero —has ever died from an overdose in such a facility, a fact made even more profound when consideration is given to the millions of injections that have taken place in them all over the world.

Posted on by Nathan Riley

Health Department Gives Peer Support to OD Survivors

The article was posted on GayCityNews.com on March 15, 2018.

BY NATHAN RILEY | Once she received the call, Cathy Kelleher dashed to the emergency room at Columbia Presbyterian and asked the man whose overdose had been reversed, “What can I do to help?” Hesitantly, he mentioned his need for a birth certificate, but the office in Puerto Rico closed after the hurricane. From this simple request, she knew a successful intervention might be possible.

Kelleher is a trained peer, a person with “lived experience with substance use” as the city health department characterizes her job description. And when the department is alerted that an affiliated hospital is treating a non-fatal overdose patient, Kelleher and her co-workers travel to meet the patient. The goal is to be in the ER in less than an hour. The program is called Relay because the workers only show up after information has been relayed to them that there is a patient recovering from an overdose.

Kelleher knew she could help the man get a birth certificate. Unlike emergency room personnel, her duties include personal contact in the days following an overdose. And what can be more helpful than accompanying a stigmatized person when they go to strange places? She called the city Department of Human Resources and arranged for the birth certificate’s retrieval and, with this critical document, she helped him obtain vocational training as a food service worker.

City moves to prevent fatalities but remains skittish on safe consumption spaces

The overdose also gave Kelleher a chance to talk about naloxone. That drug is to overdoses what a defibrillator is to heart attacks. Take it and in a matter of minutes breathing is restored. Opiate poisoning leaves a person incapacitated, so another person must administer the medicine. An ingenious innovation now permits injection without using needles. A piece of plastic, with a tip like the one used in cold medicines, fits into the nose. Squirting half the solution into each nostril allows normal breathing to resume within two to five minutes. This medicine is the key ingredient for averting fatal overdoses.

It is carried by emergency medical personnel, some police, and members of the public. With an hour training, anyone can administer naloxone. The city aims to distribute 100,000 of its kits, especially to family members and other people who know drug users. Already, 45,000 kits have been disbursed, so officials believe the goal is realistic.

Kelleher has nearly 25 years experience in the field. In her last job, she ran a for-profit sober house, but she prefers the emphasis on helping people offered by the non-profit Relay Program. With her experience, empathy comes naturally and this, combined with her shared understanding of living with a habit, helps her establish trust with drug users who survive an overdose. The patient she met at Columbia Presbyterian had heard of fentanyl — a common additive to opioids that increases the risk of overdoses — but she introduced him to naloxone.

Another service that the Relay worker can offer is medically assisted treatment where a user’s life is stabilized with the help of methadone or buprenorphine to wean them from opioids. Only specially trained doctors may prescribe buprenorphine, the most convenient form of treatment because the medicine is taken in pills. New York City has 14 clinics where people on Medicaid or without insurance can access it. Relay workers call ahead and get a user an appointment at the appropriate clinic.

The Relay Program is an effort to get care to people who are at the highest risk of having a fatal overdose.

Dr. Hillary Kunins explained that after a person has an overdose, “they are at a higher risk” of having another and possibly fatal OD. The Relay Program is “also an opportunity to provide peer support” that hospitals can’t. The assistant health commissioner for the Bureau of Alcohol and Drug Use Prevention, Care and Treatment, Kunins expects that the program will “reduce the risk of a reoccurrence” and introduce more naloxone kits to drug users, who themselves are the most likely people to be near someone becoming unresponsive after drug use.

This is harm reduction done patient by patient, and it should save lives but it is doubtful that this program alone will turn the tide. Step by step by step New York City is dispensing naloxone kits. Homeless shelters also have naloxone kits and train residents in their use.

One obstacle is that about half the patients decline Relay help. After an overdose, they just want to get away. Isolating is their immediate reaction.

Naloxone is only effective if it is in the right place at the right time. The city is close to releasing a feasibility study on allowing needle exchanges to permit users to bring the drugs they purchase on the street and ingest them on the premises in the presence of an overdose prevention worker. It’s a program that brings the user to the naloxone.

There are such programs in 100 cities across the globe, and Canada is expanding its program from Vancouver to cities from coast to coast. Philadelphia and San Francisco will initiate programs this year.

Kunins said that the health department’s feasibility study would be made public soon. But there is trepidation among city officials, with a fear of neighborhood backlash. She abruptly ended the interview when I moved the discussion toward safer consumption spaces.

Unlike the AIDS crisis where gay men and their allies united into a politically potent force, drug users remain stigmatized and usually don’t come out to fight for the programs that will save their lives. The lack of a powerful voice from drug users and their allies leaves city officials worried that people who want drug users punished and not coddled will grab center stage, damning their good intentions.

Posted on by Nathan Riley

What to Make of Heroin Deaths

THIS IS AN OLDIE, BUT I’M QUITE PROUD OF THE POINTS I MADE AND THE DESCRIPTION OF NALOXONE IS MY ATTEMPT AT ELOQUENCE. FOUR YEARS LATER WE ARE STILL WAITING FOR SAFER CONSUMPTION SPACES. THIS ARTICLE APPEARED ON THE GayCityNews.com website on March 5, 2014.

BY NATHAN RILEY | Philip Seymour Hoffman’s end was no anomaly. Overdose deaths have risen dramatically in New York City and the nation. He is one among thousands.

The fact that he was the object of critical accolades was also not unusual. Hoffman was a high-performing heroin user — Charlie Parker, Billie Holiday, John Belushi, and Robert Downey, Jr., are other celebrities who spring to mind in that regard. Famous yes, but perhaps more to the point, they have all been acclaimed for their exceptional artistry.

Hoffman’s death reminds us that drug use cannot be attributed solely to poverty. It’s not just a Bronx problem. It may affect homeless members of the transgender community, but it also has its impact on affluent gay white men. In fact, the rate of drug poisoning deaths involving heroin among white New Yorkers (8.9 per 100,000) in 2012 was higher than among Hispanics, at 6.2, or blacks, at 4.6. Well-to-do neighborhoods in the city experienced a 300 percent increase in heroin deaths between 2010 and 2012. It is a racist myth to say that the black and brown are plagued by drug use, which in turn drives crime. People — including criminals — like their drugs, regardless of skin color or socioeconomic status.

Stigmatizing of users, crackdown on prescription pain meds aggravate a problem for which progress is possible

Nor is it unusual that Hoffman’s death is used to reinforce the misleading legend that heroin causes misery. It is likely that Hoffman took drugs seeking relief from some form of misery in his life. You will seldom read a word about the pleasure Hoffman might have found in heroin or the attractions of opioid use generally — an allure that persists in the face of government sanctions and social hostility.

Ignoring the pleasures people find in taking drugs hampers drug education. The relentless focus on the harms doesn’t really help the group that matters the most — those individuals who experience a revelation when they use drugs, a moment that tells them this is something they want in their lives. The exclusive focus on harm makes it harder for users to relate those warnings to their own experiences and, in turn, to devise strategies for coping. And it makes it harder for the rest of us to understand the pleasure these individuals experience and to develop any feeling of solidarity with them.

For health workers, Hoffman’s death offers a chance to talk about Naloxone. That drug is to overdoses what a defibrillator is to heart attacks. Take it and in a matter of minutes breathing is restored. Opiate poisoning leaves a person incapacitated, so typically a bystander must inject the antidote. An ingenious innovation now permits injection without using needles. A piece of plastic with a foam tip, attached to a syringe, fits into the nose. Injecting half the solution into each nostril allows normal breathing to resume within two to five minutes.

With training anyone can use Naloxone, and Dr. Sharon Stancliff, a physician at the Harm Reduction Coalition, believes the treatment should become more easily accessible. That’s the goal of new legislation in Albany that would allow people who might observe an overdose to have Naloxone at the ready and be trained in its use. According to a memorandum prepared by the bill’s legislative sponsors, the measure would make Naloxone available to “a family member, friend, or other person in a position to assist a person experiencing an opioid-related overdose and allow them to store and dispense” it. People close to drug users are in the best position to be on hand when an antidote needs to be administered.

Unlike the uncertainty that surrounds so many efforts at drug law reform, it’s a good bet this bill will pass. Even before Hoffman’s death brought heroin overdose foursquare before the public, Republicans and Democrats had reached agreement. “Strengthening access is the best tool we have to prevent overdose deaths,” according to Bronx Democratic Assemblyman Jeffrey Dinowitz, the measure’s sponsor. Dinowitz is optimistic; the Senate sponsor is a Republican and the chair of the Health Committee, Long Island’s Kemp Hannon.

But the bill is not a panacea; barriers remain. Methadone and buprenorphine are highly regarded substitutes for heroin, but patients using them are typically drug-tested. If other drugs are found, they might be forced to leave the treatment program, an irrational response similar to a weight control program forcing a person out for going off their diet. In general, the obsessive search for drug abstinence creates difficulties for programs offering services to users — and a person cut off from a heroin substitute is likely to become an injecting user once more. The use of drug testing also generates suspicion between the program and its clients, making it difficult for them to take charge of their health. Program members typically want to be non-judgmental but the rules may force them in the other direction.

Another significant factor in the current heroin picture is the recent crackdown on prescriptions of Oxycontin and other drugs containing opioids. From 2006 until 2010, overdose deaths declined an average of 22 percent a year, but after 2010 a dramatic reversal occurred. By 2012, deaths had risen from 541 to 730. By then, Staten Island had become the center of the Oxycontin epidemic, with the highest rate of overdoses in the five boroughs. Education meetings in the borough were welcomed enthusiastically, but the level of ignorance, while understandable, was scary. Audience members had no idea that Oxy was related to heroin. That a “good drug” prescribed by a doctor shares traits similar to those of a “bad” drug like heroin was a revelation.

Supplies of such prescriptions have since been restricted. This may reduce overdose deaths from Oxycontin, but it also means users will switch to heroin, use of which was already on the rise when the prescription curbs took effect.

Shutting off access to Oxycontin no longer seems an obvious solution. A drug that is created in an underworld where potency varies radically and is injected by users replaced a pharmaceutical pill that delivers a uniform dose. And, going from pills to injection is a social initiation into a community of hard-core drug users. The newbie has to identify suppliers and then be taught how to inject. According to Joyce Rivera, the executive director of St. Ann’s Corner of Harm Reduction in the Bronx, this process changes a person’s social life and increases their health risks.

The displacement of prescription opioids by heroin may be undercutting the drug education efforts and outreach in Staten Island. An effort that was directed at pill users must now be adapted for needle users. Staten Island is already the part of the city where needle exchange programs are least available.

Though trading reduced use of opioid prescriptions for increases in needle intake of drugs has little to recommend it, greater heroin use is something that must now be confronted. St. Ann’s (where, full disclosure, I formerly served as the chair of the board of directors) has drafted a report called a drug users’ need assessment that found injecting users in the Bronx no longer have access to abandoned buildings. With economic conditions improving in the borough, users are once again shooting up in public — in hallways, alleys, and parks. The conditions are unsanitary, infections are up, and a hazard is created from needles being discarded in public places.

St. Ann’s is asking the New York State AIDS Institute to support safer injecting facilities (SIF), rooms with a nurse present where a user, after purchasing their drugs in the illegal market, can inject in a peaceful and sanitary environment. Rather than being rushed, a shooter can use the alcohol wipes and clean syringes that reduce infection. SIFs are entry points for education and assistance in helping drug users manage their lives. More than 90 SIFs are in place in Europe, Canada, and Australia, where they are a part of the overall repertoire of harm reduction options, as discussed in a publication by the European Monitoring Centre for Drugs and Drug Abuse available at emcdda.europa.eu. According to the Centre, “the facilities reach their target population and provide immediate improvements through better hygiene and safety conditions for injectors.”

“Immediate improvement.” How often can we say that about a drug program?

No one is saying Hoffman would have been saved, but if somebody in his situation had the opportunity of using such a facility, an overdose might turn out to be an incident not a fatality.

Posted on by Nathan Riley

Advocates Charge Homeless Shelters Lax in Supplying Narcan to Prevent Overdoses

first published on ManhattanExpressNews.nyc on Oct 5, 2017

BY NATHAN RILEY | Advocates for the homeless are pressing the City Council to mandate that shelter staff from the Department of Homeless Services (DHS) as well as their clients have ready access to medicine that reverses overdose poisonings, allowing the victim to breathe unassisted almost immediately.

Nobody disputes the need for making Narcan available at the shelters. Overdoses are the leading cause of deaths among the homeless. Minimal training is required; Narcan can be administered by a person after a single training session. Also known as Naloxone, it is sprayed into the nose and, in most cases, after one or two squirts normal breathing is restored.

Narcan use in city shelter facilities is up, according to records supplied by DHS.

“We support the HealingNYC goal” of “increasing Naloxone training,” said Isaac McGinn, the department’s spokesperson, referring to the city’s multi-agency effort at preventing opioid deaths .

Despite such assurances, Vocal-NY, the Legal Aid Society’s Homeless Rights Project, and the Coalition for the Homeless are pushing for legislation to make this training mandatory for the staff at shelters and to require that their homeless residents be taught how to administer Narcan.

These advocates are angry because in their view the city is not making public health its priority in the battle again opioids. The NYPD receives the lion’s share of the new funding, with additional detectives hired and every overdose investigated as a potential homicide. For groups representing the homeless and others who use drugs, an approach based on actions after a person has died is callous. Users are at risk from overdosing, but it need not be fatal. Narcan will save their lives, and a public health approach based on prevention must be prioritized, advocates say.

The HealingNYC initiative was announced in March, and it calls for homeless shelters to make Narcan available. Public health experts see it as an indispensible tool in bringing down a death toll that reached a new record last year. In 2016, there were 1,374 overdose deaths in all settings citywide, a 46 percent increase over the previous year.

The bill advocates are pressing for was introduced on Jan. 17 by Bronx Councilmember Ritchie Torres, and its 22 co-sponsors include Upper West Side Councilmember Helen Rosenthal, East Councilmember Ben Kallos, and Health Committee Chair Corey Johnson from Chelsea. Despite the wide co-sponsorship, the measure has languished and was a bit player at an April 20 Council hearing.

Angered by the delay, advocates and residents from homeless shelters held a news conference on the steps of City Hall on Sept. 27 blasting both the Council and DHS.

“What have you been doing for nine months?” demanded Kassandra Frederique, the New York State director of the Drug Policy Alliance.

Joshua Goldfein of the Legal Aid Society’s Homeless Rights Project summed up the groups’ frustrations by saying there is “not a medical reason, not a legal reason, not a policy reason” to oppose Torres’ legislation.

Their complaints are being heard.

 

Councilmember Ritchie Torres’ office said he is negotiating the fine points of legislation he authored with DHS and expects his measure to pass this month. | Photo by Donna Aceto

Torres’ office said negotiations are proceeding with DHS about the legislation’s fine points, and he expects a bill will pass this month. McGinn, speaking for DHS, confirmed that agency officials “are collaborating closely” with the Council.

At last week’s press conference, shelter residents claimed that staff there are slow to respond to overdose incidents and prevent residents from using their own kits to reverse overdose crises.

Whatever may have happened in the past, DHS says it has adopted new procedures and has now trained all staff members. Shelter residents at City Hall last week, however, voiced skepticism about those claims.

With overdose deaths mounting across the city, DHS recently filled a long-time vacancy by hiring a medical director, Dr. Fabienne Laraque, a public health specialist with a background in HIV and hepatitis C prevention who formerly worked at the city health department. Laraque has taken the lead in training DHS police and staff in the use of Narcan, tapping medical school students from NYU late last year in “a massive effort” to get all agency staff up to speed on overdose prevention.

OD reversals are increasing at DHS shelters, with the agency boasting that it intervened successfully on more occasions in the first eight months of this year than in all of 2016 — 99 versus 97.

Each use of Narcan is reviewed the DHS medical staff, which can offer suggestions for follow-up. The agency may recommend, for example, that a homeless person who has called an ambulance for an overdosing partner be trained in the use of Narcan to enable immediate help if another incident arises.

The city health department’s goal is to have drug users, their friends, and families all have Narcan readily accessible. In addition to homeless shelters, needle exchange programs, the Harm Reduction Coalition, and Vocal-NY offer training in properly administering the medication.

According to health department statistics, overdose deaths among homeless New Yorkers rose 13 percent in 2016 over the previous year to 239, though most of those deaths occurred outside the shelter system. The city medical examiner has found that many of the deaths that occurred in shelters were due to multiple causes, such as a heart attack occurring along with an overdose.

DHS voiced confidence this week that its new procedures can reverse more than 90 percent of ODs among shelter residents. Those residents who joined advocates at City Hall last week, however, remain convinced that deaths are higher than acknowledged and that legislation is needed to make certain that Narcan is available when needed in every city shelter.

Posted on by Nathan Riley

City Shelters to Guarantee Overdose Prevention Staffing

first published on ManhattanExpressNews.nyc Nov 16, 2018

BY NATHAN RILEY | A measure approved by the City Council on October 31 guarantees that homeless shelters across New York will be staffed by people trained to prevent fatal overdoses.

Three years ago, drug overdose became the leading cause of death among the homeless. The new legislation expands the city’s public health commitment to reduce fatal ODs. The bill, sponsored by Ritchie Torres, an out gay councilmember from the Bronx, requires that employees at city shelters and those at non-profit providers who operate single-room-occupancy hotels under contract with city agencies, such as the HIV/ AIDS Services Administration (HASA), be trained in the use of naloxone, which is sold under the brand name Narcan.

Facilities serving opioid at-risk populations must train staff, residents in Narcan use

Torres told the Council that his bill “will save lives. The city will be required to train shelter providers and shelter residents in the administration of naloxone, which has been shown to reverse, in real time, the impact of an otherwise fatal opioid overdose.”

The device is injected into a person’s nose and sprays an opioid antagonist that revives a person’s breathing. The device is designed for use by lay persons and can be used after just one training session.

The new local law requires that in every city shelter and single-room-occupancy hotels under its jurisdiction there be at least one trained person on duty at all times. It is expected that training will be offered to many shelter employees to ensure that a trained staff member is always on duty.

The legislation expands existing programs and represents an extensive collaboration among advocates for the homeless, including VOCAL-NY and Torres. In an emailed statement, city Human Resources Administration Commissioner Steven Banks offered an upbeat assessment of the new measure, writing, “This legislation would take our comprehensive training efforts even further, expanding preparedness programming to additional facilities and offering new training opportunities to clients.”

Under the law, homeless shelter and SRO residents will also be trained in the use of Narcan, something that VOCAL-NY, which works directly with the city’s drug-using population, hailed as a step forward in public health responsiveness.

Jeremy Saunders, co-executive director at VOCAL-NY, was ebullient in telling Gay City News, “Passage of 1443 would not have been possible without Councilmember Ritchie Torres and Commissioner Steve Banks. But most importantly, it took shelter residents telling their stories and demanding that they be included into the legislation.”

Saunders then praised several homeless New Yorkers who pressed the importance of training shelter residents themselves in the use of Narcan, saying, “Thanks to people like Stevie Weltsek, Sarah Wilson, Jeffery Foster, and many others, the law was expanded to include the training of shelter residents and reporting to ensure it is really happening.”

Banks echoed that message, saying, “We remain committed to continuing to empower more New Yorkers to be overdose first responders, ready to save lives.”

Public health prevention of overdose deaths depends on wide distribution of Narcan kits so that a user gets immediate help from others during a crisis. During an overdose episode, breathing is suppressed and while waiting for an ambulance a person might suffocate. The city health department has long encouraged ordinary New Yorkers to become overdose first responders. This legislation creates a framework for helping drug users to help themselves in preventing fatal overdoses.

In his remarks to the Council, Torres summed the issue up saying, “One need not be a doctor to administer naloxone, and one need not be an emergency responder to save a life on a moment’s notice. All that is required is a basic training, a basic drug, and a basic show of compassion towards those in crisis.”

 

Posted on by Nathan Riley

Murder Prosecutions of Low-Level Sellers Stymie Public Health

This article was published by GayCityNews.Com on Nov. 30, 2017

BY NATHAN RILEY | Drug law reformers are pushing back against a new wave of counterproductive cruelty from prohibition-minded law enforcement seeking to prevent drug use with harsh sentences.

Drug users and low-level sellers are being accused of drug-induced homicides (DIH) in ever-greater numbers, according to a new report by the Drug Policy Alliance (DPA). Comprehensive statistics are not available because prosecutors are usually locally elected, but the organization’s researchers report a staggering 300 percent increase in newspaper reports about DIH prosecutions. Prosecutors are not required to report statistics on such cases or prove the interventions are effective.

In 2011, there were 363 reports of drug-induced homicides nationwide, but five years later 1,200 mentions were uncovered. Opioid-related deaths during that period soared, reaching 64,000 last year, more than all US deaths in the Vietnam War or the deaths from AIDS in 1995, the peak year of HIV-related fatalities. In Ohio, 10 officers pursued 53 DIH cases, yet the state still recorded 100 more OD deaths in 2016 than 2015.

PERSPECTIVE: The Long View

On a November 7 teleconference, Lindsay LaSalle, a senior counsel for DPA, said prosecutors expect that their actions impact the rate of drug overdoses only indirectly. The law enforcement theory is that arrests reduce sales and thereby curb use, which might in turn reduce overdoses. In fact, LaSalle asserted, these policies kill drug users by nullifying Good Samaritan laws that encourage calls for emergency help. The caller and victim risk charges of drug possession and even sales. The Good Samaritan laws are usually limited in scope, protecting users only from low-level offenses like possessing needles or small amounts of drugs. Should an overdose victim die, the caller could be subject to a murder charge. LaSalle deadpanned, “When a person knows they are going to be charged with something as extreme as murder of course they are going to hesitate before calling for help.”

In January 2015 in suburban Chicago McHenry County, Danielle Barzyk overdosed and was having trouble breathing. After her boyfriend, Cody Hillier, called 911 and police showed up, he got rattled and said she was having an asthma attack. Naloxone, which is effective in reversing overdoses, was never administered and she died. The police then prevailed on Hillier to make a second buy from James Lindner, an unemployed black man recently released from prison who had never met Danielle or had any dealings with her. He was accused of homicide although he had no role in making the product and never lied to emergency responders. He refused to plead guilty, was convicted by an all-white jury in a county whose population is 94 percent white, and was sentenced to 28 years in prison. Hillier, who is white, testified for the state and was charged with delivery and sentenced to time served and probation.

The DPA’s new report, “An Overdose Death Is Not Murder: Why Drug-Induced Homicide Laws Are Counterproductive and Inhumane,” said the surge in prosecutions is a fatally flawed approach. Justified as going after drug kingpins, such prosecutions almost never reach those high in the supply chain. LaSalle stressed that DIH charges are often made against the last person to touch the drug — a friend, another user, or the guy on a street corner selling bags.

“What we lose by pointing the finger of blame at a single person is to ignore all the other structural factors,” she explained. “We ignore our failed public health infrastructure. What we know from the history of the drug prosecution is that when we point the finger of blame at a particular person very often it is pointed at communities of color.” Racially coded terms like pusher and drug peddler are often used in DIH prosecutions.

These prosecutions undermine public health efforts to prevent overdose deaths, DPA maintains, because that approach relies on friends and fellow users administering Naloxone and calling an ambulance. Naloxone is an easy-to-use nasal spray that restores normal breathing promptly, and its proper use is taught in one short training session. Had Hillier been trained, Barzyk would still be alive and Lindner would be a free man. All this should be among the goals of effective public health strategy.

At DPA’s recent biennial conference, prosecution of drug sellers was identified as a particularly troubling aspect of mass incarceration, where low level sellers get lengthy prison sentences — one more inhumane aspect of the criminalization of poverty.