Testimony to the NY State Senate Opioid Overdose Task Force
Myname is Chinazo Cunningham, and I am a physician and researcher at Montefiore Health System and Albert Einstein College of Medicine in the Bronx. As a physician who is board certified in internal medicine and addiction medicine, I have personally been caring for patients in the Bronx with substance use disorders for over 20 years, and I have developed programs at
Montefiore that serve as models for integrating opioid use disorder treatment into primary care. I have also been conducting research funded by the National Institute of Health and other federal agencies for nearly two decades. Myresearch focuses on how to improve access to care and improve the health of people who use drugs. Much of my work has focused specifically on opioid use disorder.
I appreciate this meeting occurring here in the Bronx, where I care for patients in a federally qualified community health center. While attention to the opioid epidemic is fairly new, in the
Bronx community where I work, opioid use disorder is not new. It has been a problem in the Bronx for decades. In fact, in 2017, the Bronx had the most overdose deaths and the highest overdose death rate of all 5 boroughs in New York City. In addition, among all counties in NY, the Bronx had the 4th largest number of opioid overdose deaths. While the statistics are startling, the devastation that has been experienced by individuals, families, and the community is unprecedented.
Attention to the opioid epidemic increased as the epidemic changed. When the opioid epidemic occurred mostly in poor communities and among people of color, the response was incarceration. When the epidemic changed to include affluent communities and white people, the response was softened and we focused on medical treatment. While it is critical to address opioid use disorder as a medical condition that requires treatment, the path to realizing this has been bittersweet.
In addition, most of our response to the opioid epidemic has focused on reducing opioid prescribing. And, overdose deaths from prescription opioids have plateaued. However, there have been unintended consequences. Now, overdose deaths from heroin and synthetic oploids, like fentanyl, have increased dramatically. Therefore, it is clear that the opioid epidemic has changed. Previously, it was driven by prescription opioids for pain management, and now it is driven by heroin and fentanyl from opioid use disorder.
Given these changes in the epidemic, we must focus on addressing opioid use disorder. Our health care system is broken, especially when it comes to substance use disorders. Good evidence-based treatment for opioid use disorder exists, but only 10-20% of people who need treatment receive treatment. In addition, although the focus today is on opioids, the epidemic is not just opioids. We need a broader conversation about how we treat substance use disorders in NYand the US.
Addressing today’s epidemic is a complex and multi-faceted problem, and therefore, requires a complex and multi-faceted solution. No single policy or intervention willsolve this crisis. Iwill outline 7 key steps that are based on data and science that must occur to address this epidemic.
1. First, we must truly commit to treating opioid use disorder. The sad reality is that 80-90% of people with opioid use disorder do not receive any treatment. This MUST change. We need to ensure that people have access to evidence-based treatments including the 3 FDA-approved medications for opioid use disorder — methadone, buprenorphine, or naltrexone.
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