# data[].attributes.body
This article explains and shows how the drug industry feeds the vulnerable and most likely to use their drugs, many of which have a lower income which drives them into homelessness. This is a major problem in a large cities where they cant control everything.

# data[].attributes.attachment_link.readable_text
The drug overdose epidemic continues to worsen in the United States.

Drug overdoses, both fatal and nonfatal, continue to impact our nation.

Overdose deaths remain a leading cause of injury-related death in the United States. The majority of overdose deaths involve opioids. Deaths involving synthetic opioids (largely illicitly made fentanyl) and stimulants (such as cocaine and methamphetamine) have increased in recent years. In addition, overdose deaths accelerated during the COVID-19 pandemic.

For every drug overdose that results in death, there are many more nonfatal overdoses, each one with its own emotional and economic toll. This fast-moving epidemic does not distinguish among age, sex, or state or county lines. People who have had at least one overdose are more likely to have another. If a person who has had an overdose is seen in the ED, there is an opportunity to help prevent a repeat overdose by linking an individual to care that can improve their health outcomes.

Timely data help improve coordination and promote readiness among health departments, community members, healthcare providers, public health, law enforcement, and government agencies, for regional or multiple state overdose increases.

Featured Topics on Drug Overdoses and Deaths

# data[].attributes.attachment_link.description
Drug overdoses, both fatal and nonfatal, continue to impact our nation. Overdose deaths remain a leading cause of injury-related death in the United States. The majority of overdose deaths involve opioids. Deaths involving synthetic opioids (largely illicitly made fentanyl) and stimulants (such as cocaine and methamphetamine) have increased in recent years.

# data[].attributes.body
As Philadelphia deals with poverty and homelessness the opioids shine through. They have one of the highest overdose rates in homeless community nearly 18% of their homeless community are dealing with or dealt with drugs (out of who they researched).

# data[].attributes.attachment_link.readable_text
The City of Philadelphia is working to save lives, improve access to help, and reverse the effects opioids have had on our community. Every neighborhood in the city is being hit hard by an epidemic of opioid use and overdose. Across all racial and ethnic groups, the number of deaths from drug overdose is higher than the number of deaths from homicide. Of the 1,217 overdoses in 2017, 1,074 involved an opioid. Check out the City's Opioid website.

The Philadelphia Resilience Project: Our response to the opioid crisis

"On October 3, 2018, Mayor Jim Kenney signed Executive Order 3-18 declaring a citywide emergency and empowering City agencies to come together to immediately solve the problem."

"What the Resilience Project does

It focuses on seven critical mission areas:

Clearing major encampments.

Reducing criminal activity.

Reducing the number of unsheltered individuals.

Reducing trash and litter.

Reducing overdoses and the spread of infectious diseases.

Increasing treatment options.

Mobilizing community response."

Encampment Resolution Pilot Update - May 17, 2018

Opioid-related homeless encampments present one of the most complex situations Philadelphia has encountered in recent history. The existing encampments are in a densely residential neighborhood, which not only creates an unsafe and unhealthy environment for residents but creates tension. Making matters more complex is that the affected Kensington "community" is not at all unified in its reaction to the encampments, which is common and understandable. Factions want the camps gone at all cost; they are especially concerned about illicit drug use, trash, crime and the constant feeling that illegal activity is being tolerated. Others are providing tents, food and other necessities to campers. Harm-reduction groups are advocating for the protection of campers and getting additional services to them to save lives and provide easier access to treatment.

The Office of Homeless Services (OHS) and the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) launched a pilot on April 30, 2018 engaging in intensive daily outreach to those living at two Kensington encampments, one at Tulip and Lehigh and another at Kensington and Lehigh. The purpose of the pilot offers services and emergency housing to campers in these two sites, ultimately clears the two camps and pioneers a new service model tailored to this new problem.

The purpose of this document is to provide an update on the progress of the pilot and context surrounding the severity and complexity of the problem it aims to address.

Impact of the pilot program at mid-way point:

The pilot outreach team has engaged many who were camping under the two identified bridges for this pilot, created a by-name list of occupants and obtained information regarding individual needs, interests, and barriers and referred individuals to treatment and more stable housing options.

There is a multidisciplinary team on site daily: homeless outreach, nurse, doctor, mobile medical care several days a week, assessors and authorizers for insurance.

On-site assessment, transportation, and coordination for ease of access to these services have been successful strategies so far.

Many aspects of the plan are working:

People are accepting services. Nearly 100 people have accepted services so far;

About three dozen people have entered treatment, more in the first two weeks of the pilot than in the prior six months;

We are getting closer to treatment on demand by bringing services on-site to people, breaking down barriers to accessing treatment: ID, transportation, assessment and referral and insurance authorization. No one has been turned away who teams have referred for treatment. This success has implications for changing the way we provide access to treatment.

More than two dozen people have gotten an ID card which nearly half of those surveyed identified as a barrier to leaving the camps;

About 40 percent have been homeless for more than a year, most are newly homeless;

Daytime encampment numbers are much higher than night time numbers, which are going down. People are accessing the respites including, slowly, the ones further away. This demonstrates that the City's low-barrier approach is working;

The clear majority have a work history and would like to return to work;

Prevention Point has been piloting suboxone induction on the street under medical supervision. This is promising because it has been found to be effective elsewhere in helping people think more clearly about their future;

We have secured an outside evaluator who is tracking progress from camper and neighbor perspectives;

People are using the daytime services. Now they can go directly from the respites to daytime services at Prevention Point Philadelphia.

Anyone who is still camping will be offered services again and then, if they refuse, asked to leave.

Anyone who remains will have their belongings removed. The campers can put their things in a large crate which they will close and label; L&I will transport possessions to the Prevention Point Respite at 3247 Kensington Avenue where it will be stored until July.

Anyone who does not leave will be issued a CVN or Ticket for $20 by the Police.

Police will enforce the camp closure. Homeless outreach and access to treatment will continue to be available on site.

The Problem Itself

The opioid epidemic is a public health crisis - the worst we have seen in over a century:

Four times as many people died from drug overdoses in Philadelphia than from homicides in 2017:

Opioid Use Disorder is a chronic, relapsing brain disease that can lead to disability and death;

Drugs change the brain creating cravings, inability to abstain, and impairment in self-control;

There is an increased risk of HIV, Hepatitis C, and skin infections associated with the harmful effects of drug use;

Both the disease and the people suffering from the disease are highly stigmatized and socially isolated;

Medication Assisted Treatment is an effective evidence-based treatment and there are multiple pathways to recovery.

Poverty and homelessness are both contributing factors to the problem:

The opioid epidemic and associated drug trade is centered in a low-income neighborhood that residents believe would not be tolerated elsewhere;

Economic opportunity is a significant part of what drives the commerce of selling drugs;

Blight and vacant property make the sale and use of drugs more open and accessible;

Poverty drives people who have addiction to panhandling and homelessness and makes it harder for them to escape.

We don't know if the epidemic has peaked. The reality is that we could do everything right and still see the numbers of active opioid users, homeless people and overdose victims grow along with new encampments.

"Supply-side" solutions are not enough.

We can't arrest our way out of this situation. If we learned nothing else from the "war on drugs," we learned that it can become a war on low-income people that leaves them worse-off than they were before;

Nonetheless, we can't condone lawlessness so police are enforcement laws against drug sales while piloting pre-arrest diversion which they plan to expand, budget allowing.

"Demand-side" solutions are not enough:

Access to treatment has not always been easy; treatment on demand is essential;

People enter treatment when and how they are ready. They must believe that there is hope and must feel welcomed to access addiction services at their own pace;

Need to promote wellness to help people shift from an illness track to a wellness track;

Substance use disorder is more prevalent in impoverished areas;

State and federal regulations such as a need for ID and barriers to supervised injections are obstacles that systemically need to be navigated and negotiated. These challenges are being addressed by DBHIDS, the City of Philadelphia and the State of Pennsylvania, including a declaration by Governor Wolf that may help to pave the way.

The City is is trying to balance these needs and interests in a legally appropriate and humane way. Specifically, we must:

Make the community safer and healthier for all residents, which includes removing needles, trash, human waste, potential sources of Hepatitis C, HIV/AIDS and blood-borne pathogens;

Learn from previous public health challenges that have affected behavioral health and medical health to determine the most effective ways to get treatment to people in need meeting them where they are;

Uphold the human rights of all, even those who are stigmatized by addiction and homelessness;

Enforce the law to the greatest extent possible;

Solve a newly emerged problem that has never been solved before with limited resources and in a highly visible way.

May, 2018

CITY OF PHILADELPHIA

ENCAMPMENT RESOLUTION PILOT

The City of Philadelphia announced the launch of a pilot encampment action plan for the Kensington area as part of the City's latest efforts in combating the opioid crisis in Philadelphia. The City and partners researched best practices from around the country in addressing addiction related homelessness.

What will this look like?

This pilot intensively engages individuals living under the Kensington and Tulip Street bridges.
Ongoing outreach, engagement, coordinated services, and supports are being provided to individuals living in the encampments every day for 30 days (April 30th-May 30th).

Where will people go?

People have options to access residential and treatment services-options can include:

Prevention Point Respite

One Day At A Time (ODAAT) Respite

Prevention Point Navigation Center

Northeast Treatment Center (NET) Assessment Center
for access to these sites, please contact Homeless Outreach at 215-232-1984

Substance abuse treatment services

Mental health treatment services

Safe Havens

Medical treatment options

Case management

Identification assistance

Crisis Response Center

What services are available?

In addition to the on-site outreach efforts at the Kensington and Tulip Street bridges, the following places - always available through DBHIDS and the Office of Homeless Services - are able to help people living in the encampments to get back on a path to wellness.

Those who are currently enrolled in Medicaid can call: Community Behavioral Health's (CBH) 24/7 Member Services at 888-545-2600

Those who are uninsured and wishing to access services can call the Department of Behavioral Health and Intellectual disAbility Services' (DBHIDS) Behavioral Health Special Initiatives Unit (BHSI) at 215-546-1200, Monday-Friday, 8:30am - 5:00pm

Engagement and connection to homeless services will occur through Homeless Outreach and can be contacted 24/7 at
215-232-1984

Individuals wanting to immediately be assessed and access substance abuse treatment services can walk- in 24/7 at Northeast Treatment Center, 499 N. 5th Street (5th and Spring Garden)

For more information or support, please contact Centralized Homeless Intake Services
802 N Broad St, Philadelphia, PA 19123 (Monday - Friday, 7:00 a.m. - 5:00 p.m.), 215-685-3700
2601 N Broad St, Philadelphia, PA 19132 (after 5:00 p.m. on Weekdays or on Weekends), 215-225-9230
Download the flier Español
March 12, 2018

Liz Hersh's testimony before City Council on Resolution #180037 to assess the City of Philadelphia's efforts to prevent and treat abuse, addiction, and disease related to the use of opioids

Good morning Councilwoman Bass and other members of the Committee. My name is Liz Hersh and I am Director of the Office of Homeless Services. Thank you for the opportunity to testify today.

Using the Kensington Counts plan as the basis, the Office of Homeless Services established a 23-bed respite with Prevention Point last winter. Based on its high utilization, we then expanded it to 40 beds this winter. It has been an overwhelming success. Our method has been to listen to the people on the ground closest to the problem and support their efforts in addressing the problem to the best of our ability.

Similarly, we added 15 dedicated beds to the 60 already being provided by Pathways to Housing, the first-in-the nation street to home program for people with Opioid Use Disorder. To date they have a 100% housing retention rate and half have entered treatment or are practicing abstinence. Again, a remarkable success rate and an approach that we hope to expand in the next fiscal year if the dollars proposed by the Mayor are made available.

Despite this expansion of investments, the growth of homeless encampments driven by the opioid crisis is plaguing Kensington. It is a humanitarian crisis that presents a health and safety threat not only to be the people living there, but to the neighbors who live nearby. We must acknowledge this reality. Our January Point in Time Count found that the number of people experiencing street homelessness in Kensington (zip codes 19133, 19125, 19134) had gone down from 227-210. Yet, Kensington has the second highest concentration of homeless people in the City after Center City.

The homeless encampments in the Kensington area, specifically under the tunnels north of Lehigh Avenue on Tulip, Kensington, Frankford and Emerald streets, have an estimated population of 200 people.

Encampments are a national and growing problem. National Law Center on Homelessness and Poverty found a 1,342% increase in the number of homeless encampments from 19 in 2007 to a high of 274 in 2016 (the last full year for data). https://www.nlchp.org/Tent_City_USA_2017.

And yet, the new budget proposed by the White House slashes all forms of evidence-based housing assistance leaving communities on our own.

Working in a coordinated effort with partners throughout the City, we have taken a number of steps to manage this dire situation so far:

Under the leadership of Eastern Division Police Inspector Ray Convery, established a Homeless Detail, a small group of officers dedicated entirely to the homeless encampment. They do a nightly count of people sleeping, weekly clean-ups and have a constant presence in the community. Deploying the combined "push and pull" of the police officers and homeless outreach teams, the people in the encampments were asked to move to one side of each street to allow for safe passage. This arrangement was the suggestion of Somerset Neighbors for Better Living (SNBL) to enable neighbors to walk through without going into the street. While it is progress, it is far from the resolution needed.

The Streets Department has increased to twice weekly trash pick-ups and the encampment residents have been provided with trash containment supplies. At the neighbors' request, L&I has also inspected all the local scrap metal collectors and one has closed. Scrap metal is a source of income often used for drug purchase that leads to petty theft in the neighborhood and has been the cause of considerable concern.

The Office of Community Engagement under the direction of Joanna Otero-Cruz, in coordination with the police has distributed kits to neighbors that include sharps containers, grabbers, no trespassing signs and blue light bulbs to add to empower residents to take back their streets by containing and minimizing the harm of needles on the street and discouraging intravenous drug use in front of their houses. This also enables the police to enforce no trespassing laws.

In addition, our office is aggressively pursuing additional actions:

A respite is a small, low-barrier place in the community for people experiencing homelessness to come in and be cared for. ID and drug testing are not required for entry. It is come as you are. It is based loosely on the model of a Safe Haven pioneered in the 1990s by Project HOME and supported by DBHIDS. In its first year of operation Prevention Point's respite served 160 people of whom nearly 40% entered treatment and/or got permanent housing. This is a tremendous success.

The respite uses a housing first model. While many of us on the outside wish that those in the encampments would seek treatment first, experience is showing us that providing housing first is working well. We have found that when people have a place to come into to get clean, warm (or cool), fed, get medical care, feel safe and comfortable, THEN they can start to make plans and think about their future.

Based on the success of this model, we have aggressively pursued a second respite in the neighborhood. It has taken several months to identify a site as the community is quite divided. Some believe that Kensington is already a magnet and that any new respite should be sited elsewhere while others are clamoring for more beds. We analyzed the number of homeless facilities in the neighborhood and found that it is quite under-served. There is one shelter the one we established last year.

Today we are pleased to report that Impact Services is in the final stages of negotiating a lease at 3247 Kensington Avenue to provide 40 more respite beds and be operated by Prevention Point.

Encampments require a new strategy. The Office of Homeless Services researched other cities to better understand how best to address the encampment problem. San Francisco is the model that looks most promising. With over 1000 tents on the streets throughout the City, they have deployed an encampment resolution team, a multi-disciplinary team that engages and helps resolve the homelessness of the residents.

They use what I will simplistically refer to as a carrot and stick approach. They first develop a by-name list of people in the encampment and assess what they need systematically. They then begin the resolution process of helping people who can go home, do so, of getting ID, access to treatment or entry into a respite which they call a Navigation Center. They go so far as to begin Medication Assisted Treatment on the street and have found that with medication like Suboxone that some people are able to think more clearly about and make better choices. Outreach teams make clear that the encampment will be closed completely at 30 days.

The Navigation Center offers a range of services with easy access. It also offers beds for people finding as we have, that a good night's sleep, meals, safety and care enables better problem solving. Finally, within the final 72 hours the police notify people that the encampment will be permanently closed and that they will have to move. They have found that generally there are few people left at that time if the outreach and engagement has been successful.

As a result, they are seeing about a 65% success rate in people accepting safety off the street, 25% have exited homelessness and an 85% reduction in tents. To date they have resolved 23 encampments comprised of 944 people. Obviously, additional resources have been deployed to achieve this success.

We are working with our partners at DBHIDS, the police and MDO to establish an Encampment Resolution Team and deploy the new Prevention Point site as our Navigation Center.

We have a preliminary plan that we will shortly be sharing with representatives of the neighborhood associations in the area to get their input. We cannot move ahead without their being informed and involved in the plans. And, we need their help.

We will also need everyone's help in redirecting their generous contributions away from the encampments and helping provide food, move-in kits, furniture, etc. to help people transition to more stable housing situations. We are developing a list of what our providers can use with the hope that neighbors can help. It is abundantly clear that we cannot solve this problem alone.

That concludes my testimony. I will be available to answer any questions.

"The opioid epidemic has been taking lives, destroying families and undermining the quality of life of Philadelphians across the city." Mayor Jim Kenney.

Read the Mayor's Opioid Task Force Report.

The opioid epidemic appears to be driving last year's increase in unsheltered persons, even while the total number of people experiencing homelessness decreased. See the table below from the 2017 PIT Count.

Estimated Magnitude of the Opioid Problem in Philadelphia: Type

Numbers

Fatal overdoses (2016)
Source: Medical Examiner

900

In publicly-funded treatment for opioid dependence
Source: Community Behavioral Health/ Behavioral Health Special Initiative

14,000

Misusing/abusing prescription opioids (2016)
Source: National Survey on Drug Use & Health

55,000

Using heroin (2016)
Source: NSDUH, BHSI

55,000

Adults receiving more than 1 opioid prescription in a year
Source: PA DHS, Aetna, US Census

150,000

City's Behavioral Health Department Offering Free Narcan Trainings to the General Public in Effort to Curb Skyrocketing Opioid Overdose Deaths

With the city on pace to record more than 1,200 drug overdose deaths this year - far surpassing last year's count of 907 - and with an estimated 70,000 people in Philadelphia currently using heroin daily while thousands more are abusing other opioids, the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) is offering free trainings to the general public on how to administer the life-saving opioid overdose antidote Narcan (Naloxone).

The DBHIDS Narcan overdose prevention trainings will take place at 801 Market Street from 10:00 am to Noon on September 20th, October 18th, November 15th and December 13th. Registration is required. Download Free Narcan Trainings Flyer.

The opioid crisis increases the risk of homelessness for many Philadelphians. The following article in the philadelphiaweekly details what is happening in the Kensington neighborhood.

Highlights of Progress in Kensington/Fairhill

Read "Responses to Gurney Street"

Addressing the Opioid Epidemic - How the Opioid Crisis Affects Homeless Populations

National Health Care for the Homeless Council - Fact Sheet | August 2017
America is facing an opioid epidemic that has reached nationally recognized crisis levels. Currently the Center for Disease Control and Prevention cites that 142 Americans die from opioid overdose every day. Since 2000, deaths due to drug overdose in general have been steadily increasing.Read the Fact Sheet

Hank's Take: Down and out on Market Street

Fox29 Hank Flynn

Philadelphia's homeless numbers are on the rise, thanks to opioid abuse .... Read the story

Max Marin June 28, 2017

Gabby Dean . . . . under the Emerald Street bridge, was living on the streets until she recently secured a bed at a women's shelter. On the 2700 block of Emerald Street, a gaunt, bone-thin man named Michael sweeps the sidewalk under the railroad tracks where he's been sleeping on and off for two years. He tugs at his sweatpants to show that he's not wearing any underwear or socks.

Two days ago, the Streets Department came through and cleared out the belongings of the homeless drug addicts who had claimed space under the bridge. "They took all my clothes," Michael says.

In Kensington, the opioid crisis and homelessness go hand in hand. The neighborhood has the largest homeless population outside of Center City, and the dozen people huddled in this tunnel, most of whom asked for their last names to be withheld, are just a fraction of the whole.

Before the Streets Department cleaned out the underpass, about 40 others had set up camp there.

Just a few blocks away, the city and railroad giant Conrail have agreed to clean up and fence off a far more notorious encampment, which stretches bleakly along the same train line that traverses Emerald Street.

For more than two decades, thousands of addicts have been frequenting the out-of-site injection space known as "El Campamento." Dozens currently live in squalid conditions at the site. With impending closure, many are concerned about where the unstably housed denizens of Kensington will go to continue fueling their addictions.

"If we looked at a map, people are going to continue their behavior," says Casey O'Donnell, a psychologist and CEO of Impact Services, a Kensington nonprofit that provides housing assistance. "They're going to find more bridges, more vacant homes, and the people that want to be out in the open because they feel safer, like at McPherson [Square], they're going to find more open space."

Once a month, the Streets Department clears out the tent city that begins to appear under Emerald Street between Lehigh and Somerset.

Locales such as El Campamento and McPherson Square park, where librarians are trained to administer overdose-reversing medicine, have garnered national attention in recent months. The city has stepped up its response. Harm-reduction advocates have been pitching to bring a safe injection site to the neighborhood.

Meanwhile, lesser-discussed places such as the Emerald Street tunnel underscore the sheer scope of problem.

When the warm weather strikes, this thoroughfare north of Lehigh Avenue evolves from a small refuge for regular mainstays like Michael into a full-blown shantytown, packed with mattresses and battered furniture and makeshift shelters.

Once a month, the Streets Department comes in and clears off the sidewalks during what are called "service days," which are coordinated with the city's Office of Homeless Services.

Lisa, whose last name is being withheld, leans against the grafittied concrete wall next to two other women. These thirty-somethings are regulars on Emerald Street. Sleeping and getting high in close quarters out in the open is far safer than staying inside a vacant house, they say. Save for when people throw objects at them from moving cars, Lisa says they feel more secure here. They can look out for each other.

"Whether you call it a community or not ... whether it's adaptive or maladaptive, there is a network and a community of people that are in their addiction," O'Donnell says. "And they haven't stopped being human just because they use drugs to manage pain."

In a few weeks time, dozens of others will likely join the crowd. Complaints will arise from neighbors. Cleaning crews and police officers will disperse the burgeoning tent city once again before it gets out of control.

"There's a core group of us," Lisa says. "We do our best to try to keep it clean and safe, but then it gets to be too many people."

The Streets Department gives the homeless and addicted a chance to move their belongings before they service the underpass. (Some, like Michael, say they missed that opportunity last week.) An outreach team from the Department of Behavioral Health and Disability Services also intervenes to offer pathways to social services and housing.

"And when they say yes, we move heaven and earth" to help them, says Liz Hersch, director of the city's Office of Homeless Services.

But the city's emergency housing facilities operate at 90 to 120 percent of capacity most of the time, Hersch added, and there are not enough permanent housing units to meet the need for the at-risk homeless population. "We have kind of a clogged pipe system," she said. "People come in but we don't have the housing on the other end for them to get to."

Michael sweeps up the remaining debris and used needles on Emerald Street.

At least 241 street homeless or unstably housed individuals reside on the streets Kensington, according to a 2015 survey conducted by multiple neighborhood organizations. Some who work in the neighborhood believe the number to be much higher. Under Emerald Street bridge, they hail from as close as Fishtown and as far as Florida.

Access to treatment remains the most daunting problem in Philly, especially coming off a year that saw 907 fatal drug overdoses. In the last 18 months, the city has expanded publicly funded outpatient and residential substance abuse treatment slots from 500 to 1,000, said a spokesman for DBHIDS. For those under Emerald Street, however, it's not always as simple as wanting help. One woman, who declined to give her name, said she couldn't get into treatment because she doesn't have the proper identification. Others said they have gone into treatment programs, but they wound up back on the streets where they inevitably relapsed. Non-English speaking addicts, many of whom come to Philly from Puerto Rico for drug treatment through a practice known as "air bridge," face even more hurdles.

In a matter of weeks, those living and using drugs in the railroad gulch at El Campamento may be searching for new surroundings - whether in treatment or in a new part of the neighborhood.

To stymie displacement, outreach teams are providing on-the-ground intervention near the site to connect drug users with social services, whether it be referring them to Prevention Point for medical care or to rehab facilities for longer-term treatment.

Since May, outreach teams have engaged 259 individuals near El Campamento, says DBHIDs, which is orchestrating the effort with neighborhood organizations like Impact Services and Prevention Point. Nine people have since been placed in treatment, one woman in a Safe Haven, a woman's shelter. Two people are now being processed for by Pathways to Housing, which connects at-risk homeless to permanent housing.

Back on Emerald Street, Lisa wonders who's next from her crew to leave the streets for help or housing. Inevitably though, some will continue to find places to sustain their drug habit, whether in a vacant lot, an abandoned house or under I-95.

Michael is still sweeping up a stretch of the sidewalk, using his broom to unclog trash from sewer drain. There are crumpled beer cans, cigarette butts, and food wrappers, but he's more concerned about the used hypodermic needles. Every time he talks to neighbors, he says he offers an apology and promises to keep the sidewalk clean.

"I may shoot dope, but if it was my kid who got poked with a needle I'd want to kill every addict down here," he said.

# data[].attributes.attachment_link.description
City of Philadelphia's Opioid website The City of Philadelphia is working to save lives, improve access to help, and reverse the effects opioids have had on our community. Every neighborhood in the city is being hit hard by an epidemic of Read More ...

# data[].attributes.headline
What fuels an Addiction; and how to prevent one. 

# data[].attributes.subject
What fuels an Addiction; and how to prevent one. 

# data[].attributes.body
NYU’s Stephen Morris explains how the main way addictions are fueled is constant cravings and the one thing different is many of the drugs make you brain think it is a need like water and you will die if it does not have it.

# data[].attributes.attachment_link.readable_text
An Addiction Specialist Explains the Deadly Link between Prescription Opioids & Heroin Abuse

In February, the federal government announced it would seek more than $1.1 billion to fight the spiraling epidemic of prescription painkiller abuse. Today, more than 2 million Americans are dependent on or abuse prescription opioids, a widely prescribed class of painkiller that includes oxycodone, hydrocodone, and morphine. In 2014, overdoses from such drugs killed an estimated 14,000 people in the U.S.-triple the number in 1990. Stephen Ross, MD, director of Addiction Psychiatry at NYU Langone's Tisch Hospital, and director of the Division of Alcoholism and Drug Abuse and the Opioid Overdose Prevention Program within the Psychiatry Service of Bellevue Hospital Center, shares his thoughts about this unprecedented epidemic and its link to a resurgence of heroin addiction.

What's Behind This Alarming Trend?

In 2001, The Joint Commission on Accreditation of Healthcare Organizations issued its pain management standards, which propagated the notion that pain is a "fifth vital sign." It required healthcare providers to ask every patient about their pain, since the perception at the time was that pain was undertreated. This led to the unintended consequence: prescription opioids went from a treatment of last resort to a first-line therapy for chronic, nonmalignant pain syndromes. Yet there was little or no evidence that long-term use of opioids could successfully manage pain in this patient population. In the late 1990s, pharmaceutical companies had begun to aggressively market opioids for pain, downplaying their addictive liability. Because doctors typically have minimal training in addiction, many began to prescribe opioids to treat chronic pain syndromes without screening for current addiction or risk factors associated with opioid addiction. Soaring prescriptions for opioids have caused an alarming increase in the incidence of addiction, treatment for addiction, and overdose fatalities. Today, opioids are the most commonly prescribed class of any medication. The other big issue is perception. When heroin is essentially packed into a pill, made and marketed by a pharmaceutical company, prescribed by a physician, and dispensed by a pharmacist, it doesn't seem so dangerous. But the brain doesn't differentiate heroin from a prescription opioid.

How Have Prescription Opioids Fueled the Rise in Heroin Abuse?

Someone who becomes addicted to a prescription opioid needs to keep taking more and more of the drug to relieve pain or get high and prevent withdrawal symptoms. But these are controlled substances that are legally available only by prescription, and they're expensive. To an addict, heroin offers an attractive alternative. It's very cheap and more potent than just about every prescription opioid, with the notable exception of street fentanyl, which is alarmingly becoming an opioid epidemic in and of itself. From 2010 to 2012, the mortality rate from heroin overdose doubled in 28 states.

So How Do We Combat These Intertwined Epidemics?

By developing abuse-resistant painkillers and creating more prescription-monitoring programs. Our biggest weapons, though, are public education and professional training. The recent CDC guidelines around opioid prescribing, and the involvement of the White House in combating opioid addiction are very important developments. Addiction is arguably the number one public health threat in the U.S., in terms of prevalence, morbidity, mortality, and societal cost. Very few physicians receive adequate training in addiction prevention and treatment. I'm proud to say that this is one of our areas of expertise at NYU Langone and that we offer fellowship training in addiction psychiatry. Only recently have hospitals begun to routinely screen for addiction and help people obtain proper care. This policy shift should help change behavior, but it will take time.

Related Articles

Research, Press Releases

This study compares overdose risk among two patient populations in treatment across an entire state.

Research

New studies investigate the efficacy of psilocybin, cannabidiol, MDMA, and topiramate.

# data[].attributes.attachment_link.title
An Addiction Specialist Explains the Deadly Link between Prescription Opioids & Heroin Abuse

# data[].attributes.attachment_link.description
An Addiction Specialist Explains the Deadly Link between Prescription Opioids & Heroin Abuse In February, the federal government announced it would seek more than $1.1 billion to fight the spiraling epidemic of prescription painkiller abuse. Today, more than 2 million Americans are dependent on or abuse prescription opioids, a widely prescribed class of painkiller that includes oxycodone, hydrocodone, and morphine.

# data[].attributes.body
Most of the time Illegal drugs start with opioids and work themselves up. Most of the time painkillers are prescribed that in the beginning give a feeling of relief in that part of the body. Once it is healed you want the feeling in the rest of your body and to get better feelings of the opioids heroin and illegal drugs can give you that.

# data[].attributes.attachment_link.readable_text
What is heroin?

20% of 12th graders said they could easily get heroin if they wanted to.

Heroin is made from morphine, a natural substance taken from the seed pod of opium poppy plants in Southeast and Southwest Asia, Mexico, and Colombia. Heroin can be injected, sniffed, snorted, or smoked.

Common names for heroin include Big H, Horse, Hell Dust, and Smack.

What is the connection between opioids and heroin?

Heroin is a type of opioid. Prescription pain relievers and heroin are chemically similar and can produce similar effects.

In some communities, heroin is cheaper and easier to get than prescription opioids. Because of this, people who are addicted to prescription opioids sometimes switch to using heroin instead.

Data from 2011 showed that an estimated 4 to 6 percent who misuse prescription opioids switch to heroin and about 80 percent of people who used heroin first misused prescription opioids. More recent data suggest that heroin is frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported heroin as the first opioid they used regularly to get high.

Some people who get addicted to opioid pain relievers switch to heroin because it's cheaper and easier to get. However, only a small fraction of people who misuse pain relievers switch to heroin. Less than 4 percent of people who had misused prescription pain medicines started using heroin within 5 years. Preventing opioid misuse and ensuring people with opioid addictions get the treatment they need will also reduce the number of people using and addicted to heroin.

How many people use heroin?

Heroin use has been increasing in recent years. The number of people using heroin in the past year has more than doubled in the past 15 years, to nearly one million in 2016, including 13,000 12- to 17-year-olds.

What are the effects of heroin on the brain and body?

Just like other opioids, heroin binds to the opioid receptors in the brain and body that send a rush of dopamine and extreme happiness through your body. Other short-term effects include dry mouth, nausea and vomiting, severe itching, and clouded thinking. If the dose is too strong, it can cause you to stop breathing, resulting in death.

Long-term effects include insomnia, heart infections, liver and kidney disease, collapsed veins in people who inject heroin, depression, and addiction.

People who inject drugs are at an increased risk of getting HIV or hepatitis C. Both of these diseases are transmitted through blood and other bodily fluids. When people share needles or other drug equipment, they can come in contact with these fluids. HIV, and less often hepatitis C, are also spread through unprotected sex, which drug use makes more likely.

# data[].attributes.attachment_link.title
Opioids and Heroin | National Institute on Drug Abuse

# data[].attributes.attachment_link.description
What is heroin? 20% of 12th graders said they could easily get heroin if they wanted to.7 Heroin is made from morphine, a natural substance taken from the seed pod of opium poppy plants in Southeast and Southwest Asia, Mexico, and Colombia. Heroin can be injected, sniffed, snorted, or smoked.

# data[].attributes.body
Portland’s overdose rate is 8%, the highest in the U.S. and in North America. Portland’s illegal drug trade in 2016 was higher than the drug trade in the late 90s (per capita). Portland as of now is in a better place but there overdose deaths as of now account of 13% nation wide.

# data[].attributes.attachment_link.readable_text
Drug-Involved Overdose Deaths

In the U.S., there were 67,367 drug overdose deaths reported in 2018, 4.1% fewer deaths than in 2017.

The age-adjusted rate declined by 4.6% to 20.7 per 100,000 standard population.¹ The decline follows an increasing trend in the rate from 6.1 in 1999 to 21.7 in 2017.

Opioids were involved in 46,802 (a rate of 14.6) overdose deaths in 2018-nearly 70% of all overdose deaths.

Deaths involving synthetic opioids other than methadone (including fentanyl and fentanyl analogs) continued to rise with more than 28,400 (a rate of 9.9) overdose deaths in 2018.

The number of deaths involving prescription opioids declined to 14,975 (a rate of 4.6) in 2018 and those involving heroin dropped to 14,996 (a rate of 4.7).²

Figure 1. Number of drug and opioid-involved overdose deaths in Oregon, by opioid category. Drug categories presented are not mutually exclusive, and deaths may have involved more than one substance. Source: CDC WONDER, 2020.

In Oregon, drug overdose deaths involving opioids totaled 339 (a rate of 8.0) in 2018 and have remained level since 2012.

Deaths involving prescription opioids or heroin remained steady with a respective 151 (a rate of 3.4) and 154 (a rate of 3.7) in 2018 (Figure 1).

Deaths involving synthetic opioids other than methadone (mainly fentanyl and fentanyl analogs) trended up to 97 (a rate of 2.4) in 2018-more than twice the 43 deaths (a rate of 1.1) reported in 2016.³

Opioid Prescriptions

In 2018, Oregon providers wrote 57.3 opioid prescriptions for every 100 persons in 2018, compared to the average U.S. rate of 51.4 prescriptions. This is the lowest rate in the state since 2006 when data became available. ⁴

Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS)

NAS or NOWS may occur when a woman uses opioids during pregnancy. To date, there is no standard in NAS/NOWS provider and hospital coding practices. 5 As a result, there is variability in the rates reported by states.

The national incidence rate of NAS/NOWS in 2016 was 7 cases per 1,000 hospital births.6-7

The highest rates were reported among American Indian/Alaska Native (15.9 per 1,000 births) and White Non-Hispanic (10.5 per 1,000 births) individuals.

In 2016, hospital costs for NAS/NOWS births totaled $572.7 million, after adjusting for inflation.⁸

The incidence rate of NAS/NOWS in Oregon in 2018 was 6.2 cases per 1,000 hospital births and is the most recent data available.⁶⁻⁷

Figure 2. Oregon: Estimated percent of male vs. female with new HIV diagnoses, by transmission category, 2017. Percentages may not add up to 100% due to rounding. Source: CDC NCHHSTP, AtlasPlus.

New HIV Diagnoses⁹ and Prevalence Attributed to Injection Drug Use (IDU)

U.S. New Diagnoses: In 2017, 9.7% (3,690) of the 38,226 new HIV diagnoses were attributed to IDU. Among males, 8.6% (2,655) of new diagnoses were transmitted via IDU or male-to-male sexual contact and IDU. Among females, 14.2% (1,035) of new diagnoses were transmitted via IDU.¹⁰

U.S. Prevalence: In 2017, more than 1 million Americans were living with a diagnosed HIV infection-a rate of 367.7. Among males, 16.4% (125,274) contracted HIV from IDU or male-to-male sexual contact and IDU. Among females, 20.8% (49,288) were living with HIV attributed to IDU.¹⁰

State New Diagnoses: : Of the new HIV diagnoses in 2017, 203 occurred in Oregon-a rate of 5.8. Among males, 20.2% of new HIV diagnoses were attributed to IDU or male-to-male sexual contact and IDU. Among females, 31.4% were attributed to IDU (Figure 2).¹⁰

State Prevalence: In 2017, 6,879 persons were living with a diagnosed HIV infection in Oregon-a rate of 195.5. Of those, 18.0% of male cases were attributed to IDU or male-to-male sexual contact and IDU. Among females, 27.3% were living with HIV attributed to IDU.¹⁰

Hepatitis C (HCV) Incidence and Prevalence Attributed to IDU¹¹

U.S. Incidence: In 2017, there were an estimated 44,700 new cases of acute HCV. Among case reports that contained information about IDU, 86.6% indicated IDU prior to onset of acute, symptomatic HCV.¹²

U.S. Prevalence: An estimated 2.4 million Americans are living with HCV (based on 2013-2016 annual average).¹²

State Incidence: There were approximately 35 new cases of acute HCV (a rate of 0.8) reported in Oregon in 2017.¹⁰

State Prevalence: In Oregon, there are an estimated 48,700 persons living with HCV (a rate of 1,560 based on 2013-2016 annual average).¹³

References

1. Rates are age-adjusted per 100,000 standard population unless otherwise noted.

2. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999-2018. NCHS Data Brief, no 356. Hyattsville, MD: National Center for Health Statistics. 2020.

3. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2018 on CDC WONDER Online Database released in 2020. Data are from the Multiple Cause of Death Files, 1999-2018, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. (2020 February 14) Retrieved from http://wonder.cdc.gov/mcd-icd10.html

4. Centers for Disease Control and Prevention. U.S. Opioid Prescribing Rate Maps. (2019, October 3). Retrieved from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

5. Lind JN, Ailes EC, Alter CC, et al. Leveraging Existing Birth Defects Surveillance Infrastructure to Build Neonatal Abstinence Syndrome Surveillance Systems-Illinois, New Mexico, and Vermont, 2015-2016. MMWR Morb Mortal Wkly Rep 2019;68:177-180.

6. Healthcare Cost and Utilization Project (HCUP). Neonatal Abstinence Syndrome (NAS) Among Newborn Hospitalizations. (2019, December 12) Retrieved from https://www.hcup-us.ahrq.gov/faststats/nas/nasquery.jsp?

7. Comparisons with earlier estimates are difficult because of the ICD-10-CM transition in 2015.

8. Strahan AE, Guy Jr. GP, Bohm M, et al. Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016. JAMA Pediatrics. 2020;174(2):200-202.

9. The term refers to people diagnosed with HIV infection, regardless of the stage of disease at diagnosis.

10. Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) AtlasPlus. (2020, January 30). Retrieved from https://gis.cdc.gov/grasp/nchhstpatlas/main.html.

11. Not all states collect or report data on the incidence or prevalence of Hepatitis C or on how Hepatitis C is transmitted. When available, the data will be included.

12. Centers for Disease Control and Prevention. Surveillance for Viral Hepatitis-United States, 2017. 2019, November 14. Retrieved from https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm

13. HepVu. Local Data: Oregon. Retrieved from https://hepvu.org/state/Oregon/

# data[].attributes.attachment_link.title
Oregon: Opioid-Involved Deaths and Related Harms | National Institute on Drug Abuse

# data[].attributes.attachment_link.description
In the U.S., there were 67,367 drug overdose deaths reported in 2018, 4.1% fewer deaths than in 2017. The age-adjusted rate declined by 4.6% to 20.7 per 100,000 standard population.1 The decline follows an increasing trend in the rate from 6.1 in 1999 to 21.7 in 2017.

# data[].attributes.body
The reasons opioids are so addictive is because the opioid receptors react more strongly with the opioids then endorphins (the body’s way to cope with pain) . And because of that the body wants more and more of it because it thinks it is endorphins. Once the addiction starts it could take months to fix.

# data[].attributes.attachment_link.title
What causes opioid addiction, and why is it so tough to combat? - Mike Davis

# data[].attributes.body
Opioids are usually painkillers that deal with relaxation. On the other hand stimulants such as cocaine gives you hypers and more reactive to the world around you. Hallucinates such as weed, give you a false sense of reality, space, and time. All of these are addicting because they can trick your mind into giving something it can’t produce their for thinking it needs it and it can produce it.

# data[].attributes.attachment_link.readable_text
Overview

Illicit drugs are those that are illegal to make, sell, or use. They include:

Many illicit drugs are highly addictive and pose serious risks. Using these drugs usually begins as an experiment or because of curiosity. Other times, it may start from using prescription pain medication prescribed to treat an illness or injury.

Over time, a user may become hooked on the mental or physical effects of the drug. This leads to the user needing more of the substance to get the same effects. Without help, a person with an illicit drug addiction will often put their health and safety in danger.

It's important to remember that addiction isn't a weakness or choice. According to the American Society of Addiction Medicine (ASAM), addiction is a chronic disease that causes people to seek reward or relief through substances or other behaviors.

The effects of illicit drugs depend on the type of drug. Drugs are grouped into categories based on their effects:

Stimulants

Stimulants include cocaine or methamphetamines. They cause hyperactivity and increase heart rate and brain activity.

Opioids

Opioids are painkillers that also affect chemicals in the brain that regulate mood. They can also depress or slow down the central nervous system and affect breathing.

Hallucinogens

Marijuana, psilocybin mushrooms, and LSD are all considered hallucinogens. They alter the user's perception of space, time, and reality.

Depressants or sedatives

These drugs aren't always illicit. But people may get addicted to prescription medications of all kinds. If drugs are used in ways they weren't prescribed by someone addicted to illicit drugs, they may end up stealing to maintain their supply.

Some people addicted to illicit drugs might mix several different substances together. They may also alternate between taking different drugs. But no matter how the drugs are taken, there are certain behaviors that may indicate an addiction:

significant, unusual, or sudden changes in energy level

aggressive behavior or violent mood swings

preoccupation with getting and using drugs

withdrawal from friends and family

new friendships with other users

attending social events where the drug will be present

chronic health problems or continued use of the drug despite physical risks

behavior which violates one's personal morals or values in order to obtain the drug

legal or professional consequences from illicit drug use, such as an arrest or loss of a job

There are also specific symptoms associated with certain categories of illicit drugs.

Stimulants

Signs of stimulant drug abuse include:

increased blood pressure or body temperature

weight loss

diseases related to vitamin deficiencies and malnutrition

skin disorders or ulcers

insomnia

depression

consistently dilated pupils

Opioids

Opioid addiction can cause:

immune system weakness through malnutrition

infections passed through blood

gastrointestinal issues

difficulty breathing

Drugs like heroin make you drowsy, so abusers will seem like they are extremely tired. Also, when a user doesn't get enough of a drug, they can experience:

Hallucinogens

Hallucinogen abuse is more common than hallucinogen addiction. Signs of abuse can include:

dilated pupils

uncoordinated movements

high blood pressure

dizziness

vomiting

In some cases, there may also be suicidal or violent moods.

Treatment for illicit drug addiction could involve inpatient or outpatient treatment and then maintenance treatment. Often it can be difficult for someone addicted to drugs to stop using them and stay sober without professional help.

The withdrawal process can be dangerous and damaging to the health of the user. Many people need to be under a doctor's supervision for the first few weeks of sobriety so they can detox safely. A combination of the following treatment options may be necessary:

Inpatient rehabilitation program

An inpatient program is often the best start for a person with an addiction to illicit drugs. Doctors, nurses, and therapists monitor the person to make sure they're safe.

In the beginning, the person may have several negative physical symptoms as their body adjusts to not having the drug.

After the physical withdrawal, they can focus on staying clean in a safe environment. The length of inpatient programs can vary. It depends on the facility, situation, and insurance coverage.

Outpatient rehabilitation program

In an outpatient program people attend classes and counseling at a facility. But they continue to live at home and attend daily activities like work.

12-step programs

Programs like Narcotics Anonymous (NA) and Drug Addicts Anonymous (DAA) follow the same recovery method as Alcoholics Anonymous (AA).

These programs are centered on principles known as the 12 steps. A person is confronted by their addiction and will learn to develop new coping behaviors. These programs also act as support groups by involving other people with addictions.

Psychotherapy or cognitive behavioral therapy

A person with addiction may benefit from individual therapy. Drug addiction often involves emotional issues that need to be dealt with in order to change self-destructive patterns.

Also, a therapist can help someone with a drug addiction cope with the emotions involved in recovery. A person with addiction may have to deal with depression, guilt, and shame.

Medication

In some cases, medication is necessary to help overcome cravings or urges. Methadone is a drug that can be used to help heroin addicts beat addiction. Also, buprenorphine-naloxone is available to help people with opiate addictions manage cravings.

Sometimes people self-medicate. They turn to drugs to deal with mental health issues. In this case, antidepressants can help the recovery process.

Illicit drugs can often alter brain chemicals. This could complicate or uncover preexisting mental health conditions. Once the regular substance abuse has stopped, these mental health conditions can often be managed with the right medication.

There are some organizations that help with illicit drug addiction and treatment. These include:

People close to the person with the addiction often deal with stress of their own during a loved one's addiction or recovery. Programs like Al-Anon can help the families and friends of someone with an addiction find support.

Illicit drug addiction can be treated. But it can be a difficult process, physically and emotionally. People with addiction often say they are never "cured." They learn to cope with their disease.

Relapses can occur but it's important that the person seeking treatment gets back on track and continues treatment.

It's also important to develop a strong support system that includes sober people to help with long-term recovery.

# data[].attributes.attachment_link.title
Illicit Drug Addiction: Symptoms and Resources for Help

# data[].attributes.attachment_link.description
Overview Illicit drugs are those that are illegal to make, sell, or use. They include: Many illicit drugs are highly addictive and pose serious risks. Using these drugs usually begins as an experiment or because of curiosity. Other times, it may start from using prescription pain medication prescribed to treat an illness or injury.

# data[].attributes.body
New York’s senate is trying to figure out its state emergency and the opioid crisis. Much of the crisis is in the city but the crisis has spread to other parts of the states. The first step made was a multi billion dollar plan but was delayed, leaving lives on the line.

# data[].attributes.attachment_link.readable_text
(Albany, NY) The Senate today will pass a series of legislation to combat the opioid epidemic affecting communities across New York State. The series of bills will fight opioid abuse and addiction by providing additional resources to those fighting and recovering from this disease. Specifically, the legislation will encourage and monitor the distribution and use of opioid antagonists, expand Medication Assisted Treatment Programs, increase access to abuse-deterrent drugs, and establish a pilot program for Infant Recovery Centers.

"Across New York State, communities have been impacted by the opioid epidemic and families have faced its tragic effects. The fight against opioid abuse is a long one but the Senate Majority remains committed to finding solutions that will end this crisis," Senate Majority Leader Andrea Stewart-Cousins said. "The bills advanced by the Senate Democratic Majority will support New Yorkers affected by opioid abuse by establishing recovery programs and expanding treatment options. I applaud Senator Pete Harckham, the bill sponsors, and all of my colleagues for supporting those fighting against opioid abuse."

The legislation to be passed by the Senate Democratic Majority includes:

Administering of Opioid Antagonist: S.5457, sponsored by Senator Pete Harckham, will expand the entities authorized to possess, distribute, and administer an opioid antagonist to reverse an opioid-related overdose to include public accommodations.

Online Directory of Opioid Antagonist Distributers: S.4499, sponsored by Senator Pete Harckham, will establish an online directory for distributors of opioid antagonist.

Opioid Risk Awareness: S.4277-A, sponsored by Senator Pete Harckham, will require health practitioners to discuss with patients the risks associated with certain pain medications before prescribing them, as well as alternative prescriptions available to them.

Expand Access to Medication Assistance Treatment: S.5935, sponsored by Senator Pete Harckham, will expand access for eligible Medicaid individuals to medications that treat substance use disorders.

Medication Assisted Treatment Program: S.2161, sponsored by Senator Jamaal Bailey, will establish a voluntary medication-assisted treatment program at all state correctional facilities and local jails and will be offered to those fighting opioid addiction.

Access to Abuse Deterrent Formulations: S.6397, sponsored by Senator David Carlucci, will ensure that abuse-deterrent drugs approved by the FDA are accessible to patients and that insurance coverage does not disadvantage access for patients to drugs approved by the FDA as abuse-deterrent.

Infant Recovery Centers: S.5480, sponsored by Senator Gustavo Rivera, will require the Dept. of Health and The Office of Alcoholism and Substance Abuse Services, to establish a pilot program of infant recovery centers for infants experiencing opioid or other drug withdrawal symptoms.

Chair of the Alcoholism And Substance Abuse Committee and Bill Sponsor, Senator Pete Harckham said, "With opioid addiction at epidemic levels in New York, I'm proud to sponsor a package of four bills that will expand access to medications that treat substance use disorder, ensure that physicians discuss risks of opioid use with patients and make it easier to save the lives of opioid overdose victims. No single bill can bring a halt to the epidemic. But, today's package, as well as other substance use disorder bills passed earlier in session, are making a huge difference in the lives of substance users and their families."

Chair of the Senate Health Committee and Bill Sponsor, Senator Gustavo Rivera said, "Every day the opioid crisis is claiming the lives of many New Yorkers. We need to take action now and employ every tool at our disposal to fight this epidemic and save lives. By including my bill to establish recovery centers for infants suffering from opioid or other drug withdrawal symptoms, New York is taking the necessary steps to ensure we win this battle against such a devastating public health crisis."

Bill Sponsor, Senator Jamaal Bailey said, "Every person deserves to be treated in a humane manner, whether they are incarcerated or not. New Yorkers that are incarcerated should have access to adequate medical treatment- especially in such a time when we are suffering through an opioid crisis. It is unfortunate that instead of rehabilitating those that suffer from drug abuse, in New York's prisons, individuals have been allowed to suffer on their own, often times leading to their death. I want to thank Majority Leader Andrea Stewart-Cousins, Assembly Member Linda Rosenthal, and my colleagues in government for passing the Medical Assisted Treatment Bill and other pieces of crucial legislation that will save the lives of many New Yorkers."

Bill Sponsor, Senator David Carlucci said, "It's time we look at how the Opioid crisis is starting and address it with doctors and insurance companies. 1 in 5 people receive prescription opioids long-term for non-cancer pain. To curve this dependency, I sponsor a bill to require insurance companies cover the cost of alternative abuse-deterrent drugs, which will help reduce addiction and allow people with a past drug history to safely receive pain relieving medicine."

Bill Sponsor, Senator James Sanders, Jr. said, "While often prescribed legally as a pain reliever, the overuse or misuse of opioids can lead to addiction and even death. It is so important that we put into place measures to combat this crisis, which affects the public's health as well as the social and economic welfare of all New Yorkers. Every day, more than 130 people in the United States die after overdosing on opioids, according to the National Institute on Drug Abuse. We need to take action to stop this madness, and I believe the bills we are introducing today are an important step in that process."

Senator Joseph P. Addabbo, Jr. said, "I am pleased to join my colleagues in passing this comprehensive legislative package aimed at combating opioid abuse. We must continue to do all we can to fight the opioid epidemic that affects millions of families regardless of race, age, sex, or economic status; it simply does not discriminate. This legislation is an important step forward in helping all of our communities fighting on the front lines of the crisis."

Senator Alessandra Biaggi said, "District 34 is no stranger to the grip of the opioid crisis that strangles all communities across the state. The number of lives lost necessitates bold action, and this package of bills achieves that aim. New York is attacking this epidemic by creating and expanding access to recovery treatment, and providing New Yorkers with the necessary support to heal."

Senator John Brooks said, ""I am proud to stand with my colleagues in the New York State Senate in taking essential action to combat the deadly and pervasive opioid epidemic that this state is currently facing. This legislation takes groundbreaking new steps to raise awareness of the risks of addiction and, most importantly, to ensure equitable and affordable access to all types of addiction treatment. This epidemic has taken far too many American lives and the legislation passed today is a great step towards addressing this critical problem. I commend my colleagues in the Senate for making this a priority and putting the lives of all New Yorkers first."

Senator Jim Gaughran said, "The opioid crisis has ravaged communities across New York, destroying countless families and lives. These bills are important protections to help address this epidemic and provide assistance to those struggling with opioid addiction. I thank Leader Stewart-Cousins and the bill sponsors for prioritizing New York families today with this package of bills."

Senator Andrew Gounardes said, "The opioid epidemic has devastated our communities. We lost 359 Brooklynites to drug overdoses in 2017, and no neighborhood has been spared this tragedy. The vast majority of us know someone whose life has been turned upside down by addiction--their own, a friend's or a family member's. The bills we are passing in the NY State Senate today treat addiction as a medical issue. Expanded access to Medication Assisted Treatment and opioid antagonists has been shown to save lives. We owe it to those we have lost and their family members to pass this essential legislation."

Senator Tim Kennedy said, "As the opioid crisis continues to persist, it is rare to find a New Yorker who has not been impacted by this epidemic. We cannot be discouraged. With the passage of these bills, New York has once again stepped up to support both treatment and prevention programs, and ensure that those suffering have access to critical resources needed to successfully navigate the recovery process."

Senator Rachel May said, "The opioid crisis continues to ravage our communities, with no end in sight. We are finally seeing action against those responsible for the crisis, but we must expand access to assistance for all those suffering from opioid use disorder. Central New York has been hit especially hard by the opioid crisis, which is why it is so important that the Senate is advancing this slate of legislation that expands access to treatment for individuals of all walks of life."

Senator Shelley B. Mayer said, "The opioid public health crisis has destroyed the lives of too many people and hurt too many families in Westchester, throughout the state, and our nation. I am pleased to vote for a package of legislation that strengthens addiction prevention strategies, expands access to addiction treatment, and makes finding opioid antagonists easier. I am also proud to work with colleagues who are committed to finding a path forward in the fight against the opioid epidemic."

Senator Jen Metzger said, "The opioid crisis has hit the communities in my district particularly hard. Ulster, Sullivan, Orange, and Delaware counties are all faced with rates of opioid deaths that exceed the state average--in the case of Ulster County, it's nearly double--and our hospitals are dealing with more overdose cases than we see in other parts of the state. The package of legislation we passed today will help our communities address this crisis by expanding access to prevention, treatment and recovery services."

Senator Kevin Parker said, "This package of legislation proposed by my colleagues in the Senate Democratic Majority will create access to effective, community-based care and provide much-needed education as it relates to opioid usage and overdose. I look forward to supporting and passing this forward-thinking legislation."

Senator Roxanne Persaud said, "New York's opioid epidemic remains unyielding; too many are being affected and deeply suffering due to the consequences substance abuse has on individuals and their loved ones. We must prevent this by doing as much as possible to eliminate the possibility of addiction in the first place, and help those fighting, as well as their families, on their road to recovery."

Senator Luis Sepúlveda said, "I commend my colleagues for leading on these set of legislation that will combat our current opioid crisis and change the outcome for millions of people who are suffering from opioid addiction. Our communities are currently facing devastating consequences from the opioid epidemic; therefore, it is crucial for us to raise opioid risk awareness and provide accessible treatment for those in need and prevent future opioid misuse and overdoses."

Senator Kevin Thomas said, "Too many families on Long Island and throughout New York have suffered from the devastating consequences of the opioid epidemic. We must work vigilantly to promote access to education, prevention, and treatment across our communities. This package of legislation takes a proactive and comprehensive approach that will expand access to life-saving medication assisted treatment options. I commend my Senate colleagues for their leadership and continued efforts to combat this epidemic."

# data[].attributes.attachment_link.title
Senate Empowers New Yorkers To Combat Opioid Abuse And Overdoses

# data[].attributes.attachment_link.description
(Albany, NY) The Senate today will pass a series of legislation to combat the opioid epidemic affecting communities across New York State. The series of bills will fight opioid abuse and addiction by providing additional resources to those fighting and recovering from this disease.

# data[].attributes.body
The public health committee of UCLA showed how the crisis is thriving in their community. They account for 12% percent of overdose deaths in the country and 45% of overdose deaths in the state. They are making pushes to have illegal drugs checked on the Canadian border harder due to the fact most come from the north and smaller doses for painkillers.

# data[].attributes.attachment_link.title
Wesley Ford: "The Opioid Addiction Epidemic: A Public Health Crisis"

# data[].attributes.body
Matt Ganem describes it as ‘you are living in hell.’ The symptoms are vomiting or diarrhea, extreme pain, you can either feel extreme hot or cold, and the worst anxiety.

# data[].attributes.body
The Brain reacts very differently to opioids than any other thing you can consume. Opioids as I said trick the brain to pain relief but one way it is different is it causes the brain into a hibernation state. When you are born you crave water and food from your DNA. But when you have Opioids the relief makes you think that the painkiller is saving you and you start to believe you cant live without them.

# data[].attributes.attachment_link.readable_text
Introducing the Human Brain

The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity-you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. The brain regulates your body's basic functions, enables you to interpret and respond to everything you experience, and shapes your behavior. In short, your brain is you -everything you think and feel, and who you are.

How does the brain work?

The brain is often likened to an incredibly complex and intricate computer. Instead of electrical circuits on the silicon chips that control our electronic devices, the brain consists of billions of cells, called neurons, which are organized into circuits and networks. Each neuron acts as a switch controlling the flow of information. If a neuron receives enough signals from other neurons that it is connected to, it fires, sending its own signal on to other neurons in the circuit.

The brain is made up of many parts with interconnected circuits that all work together as a team. Different brain circuits are responsible for coordinating and performing specific functions. Networks of neurons send signals back and forth to each other and among different parts of the brain, the spinal cord, and nerves in the rest of the body (the peripheral nervous system).

To send a message, a neuron releases a neurotransmitter into the gap (or synapse) between it and the next cell. The neurotransmitter crosses the synapse and attaches to receptors on the receiving neuron, like a key into a lock. This causes changes in the receiving cell. Other molecules called transporters recycle neurotransmitters (that is, bring them back into the neuron that released them), thereby limiting or shutting off the signal between neurons.

How do drugs work in the brain?

Drugs interfere with the way neurons send, receive, and process signals via neurotransmitters. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter in the body. This allows the drugs to attach onto and activate the neurons. Although these drugs mimic the brain's own chemicals, they don't activate neurons in the same way as a natural neurotransmitter, and they lead to abnormal messages being sent through the network.

Other drugs, such as amphetamine or cocaine, can cause the neurons to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals by interfering with transporters. This too amplifies or disrupts the normal communication between neurons.

What parts of the brain are affected by drug use?

Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug use that marks addiction. Brain areas affected by drug use include:

The basal ganglia, which play an important role in positive forms of motivation, including the pleasurable effects of healthy activities like eating, socializing, and sex, and are also involved in the formation of habits and routines. These areas form a key node of what is sometimes called the brain's "reward circuit." Drugs over-activate this circuit, producing the euphoria of the drug high. But with repeated exposure, the circuit adapts to the presence of the drug, diminishing its sensitivity and making it hard to feel pleasure from anything besides the drug.

The extended amygdala plays a role in stressful feelings like anxiety, irritability, and unease, which characterize withdrawal after the drug high fades and thus motivates the person to seek the drug again. This circuit becomes increasingly sensitive with increased drug use. Over time, a person with substance use disorder uses drugs to get temporary relief from this discomfort rather than to get high.

The prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulses. This is also the last part of the brain to mature, making teens most vulnerable. Shifting balance between this circuit and the circuits of the basal ganglia and extended amygdala make a person with a substance use disorder seek the drug compulsively with reduced impulse control.

Some drugs like opioids also disrupt other parts of the brain, such as the brain stem, which controls basic functions critical to life, including heart rate, breathing, and sleeping. This interference explains why overdoses can cause depressed breathing and death.

How do drugs produce pleasure?

Simple activities in everyday life can produce small bursts of neurotransmitters in the brain bringing pleasurable feelings. Drugs can hijack that process.

Pleasure or euphoria-the high from drugs-is still poorly understood, but probably involves surges of chemical signaling compounds including the body's natural opioids (endorphins) and other neurotransmitters in parts of the basal ganglia (the reward circuit). When some drugs are taken, they can cause surges of these neurotransmitters much greater than the smaller bursts naturally produced in association with healthy rewards like eating, hearing or playing music, creative pursuits, or social interaction.

It was once thought that surges of the neurotransmitter dopamine produced by drugs directly caused the euphoria, but scientists now think dopamine has more to do with getting us to repeat pleasurable activities (reinforcement) than with producing pleasure directly.

How does dopamine reinforce drug use?

The feeling of pleasure is how a healthy brain identifies and reinforces beneficial behaviors, such as eating, socializing, and sex. Our brains are wired to increase the odds that we will repeat pleasurable activities. The neurotransmitter dopamine is central to this. Whenever the reward circuit is activated by a healthy,

pleasurable experience, a burst of dopamine signals that something important is happening that needs to be remembered. This dopamine signal causes changes in neural connectivity that make it easier to repeat the activity again and again without thinking about it, leading to the formation of habits.

Just as drugs produce intense euphoria, they also produce much larger surges of dopamine, powerfully reinforcing the connection between consumption of the drug, the resulting pleasure, and all the external cues linked to the experience. Large surges of dopamine "teach" the brain to seek drugs at the expense of other, healthier goals and activities.

Cues in a person's daily routine or environment that have become linked with drug use because of changes to the reward circuit can trigger uncontrollable cravings whenever the person is exposed to these cues, even if the drug itself is not available. This learned "reflex" can last a long time, even in people who haven't used drugs in many years. For example, people who have been drug free for a decade can experience cravings when returning to an old neighborhood or house where they used drugs. Like riding a bike, the brain remembers.

Why are drugs more addictive than natural rewards?

For the brain, the difference between normal rewards and drug rewards can be likened to the difference between someone whispering into your ear and someone shouting into a microphone. Just as we turn down the volume on a radio that is too loud, the brain of someone who misuses drugs adjusts by producing fewer neurotransmitters in the reward circuit, or by reducing the number of receptors that can receive signals. As a result, the person's ability to experience pleasure from naturally rewarding (i.e., reinforcing) activities is also reduced.

This is why a person who misuses drugs eventually feels flat, without motivation, lifeless, and/or depressed, and is unable to enjoy things that were previously pleasurable. Now, the person needs to keep taking drugs to experience even a normal level of reward-which only makes the problem worse, like a vicious cycle. Also, the person will often need to take larger amounts of the drug to produce the familiar high-an effect known as tolerance.

Long-term drug use impairs brain functioning.

# data[].attributes.attachment_link.title
Drugs and the Brain | National Institute on Drug Abuse

# data[].attributes.attachment_link.description
The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity-you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities.

# data[].attributes.body
The highest used drug in the graph is prescribed opioids. These drugs are legal making it harder for the government to stop their use unlike meth or cocaine.

# data[].attributes.body
The MRI shows how the frontal lobe has more action on drugs than not. This explains terrible decision making and the cases of being unaware of their surroundings.

# data[].attributes.body
Illegal drugs are usually much harder to get and barely have enough to overdose. But Opioids such as coughing medicine are the most abused because they are the easiest to get. Although with a prescription pharmacy’s cannot deny pills or syrup.

# data[].attributes.attachment_link.readable_text
Many people think that abusing prescription drugs is safer than abusing illicit drugs like heroin because the manufacturing of prescription drugs is regulated or because they are prescribed by doctors. That's true, but it doesn't mean that these drugs are safe for someone who was not prescribed the drug or when they are taken in ways other than as prescribed.

Prescription drugs can have powerful effects in the brain and body, and they act on the same brain sites as illicit drugs. Opioid painkillers act on the same sites in the brain as heroin; prescription stimulants have effects in common with cocaine. And people sometimes take the medications in ways that can be very dangerous in both the short and long term (e.g., crushing pills and snorting or injecting the contents). Also, abusing prescription drugs is illegalâ€"and that includes sharing prescriptions with friends.

Why Don't People Who Take Prescription Drugs for Medical Conditions Become Addicted?

On rare occasions they do, which is why a person must be under a doctor's care while taking prescription medications and sometimes when stopping their use. A doctor prescribes a medication based on an individual's needâ€"each patient is examined for symptoms and receives a dose of medication that will treat the problem effectively and safely. Typically, prescription drugs are taken in a form (e.g., a pill) that doesn't allow for rapid absorption of the drug by the brain and at a dosage that treats the problem but doesn't overwhelm the systemâ€"both of which reduce the likelihood of addiction.

Long-term medical use of certain prescription drugs can, however, lead to "physical dependence," because the brain and the body naturally adapt to chronic drug exposure. A person may need larger doses of the drug to achieve the same initial effects (tolerance), and when drug use is stopped, withdrawal symptoms can occur. Dependence is not the same as addiction. It is one of the many reasons why prescription drugs need to be taken and stopped under a physician's guidance.

What About Over-the-Counter Drugs, Like Cough Medicine? Aren't They Safer Than Prescription Drugs?

Cough and cold medications are some of the most commonly abused over-the-counter (OTC) medications. Many contain an ingredient called dextromethorphan (DXM). However, to get the "high" or "dissociative" state craved by people who use drugs, large quantities are needed. At high doses, DXM causes effects similar to that of the drugs ketamine or PCP by affecting similar sites in the brain. Ketamine and PCP are considered "dissociative" drugs, which make people feel disconnected from their normal selves. They affect memory, feelings, and thoughts. DXM is similar, and its abuse can affect control over movement; cause numbness, nausea, and vomiting; and can increase heart rate and blood pressure.

When taken as directed, OTCs are safe and effective, but high doses can cause problems. And, some OTC medications can produce dangerous health effects when taken with alcohol. It is important to understand these risks, read the bottle labels, and take OTC medications only as directed.

# data[].attributes.attachment_link.description
Many people think that abusing prescription drugs is safer than abusing illicit drugs like heroin because the manufacturing of prescription drugs is regulated or because they are prescribed by doctors. That's true, but it doesn't mean that these drugs are safe for someone who was not prescribed the drug or when they are taken in ways other than as prescribed.

# data[].attributes.body
The graph shows how much treatment is given once entered a help facility. It clearly shows not enough is not being done to heal people with their problems. The key is once someone is brought in, is to treat them. If not done properly it can cause a much worse addiction.