Wednesday, December 30, 2020

Overdose Uptick Leads to More Outreach in NYC

Overdose Uptick Leads to More Outreach in NYC



The Health Department released new data on drug overdose deaths in New York City. Consistent with nationwide trends, overdose deaths rose during the first quarter of 2020. 


From January - March 2020, there were 440 overdose deaths, 41 more deaths than the previous highest quarter. To address the recent uptick, the City has pledged an additional $2 million in outreach and overdose prevention resources that includes expanding access to buprenorphine treatment, increasing naloxone distribution through community-based organizations, and establishing harm reduction vending machines to make naloxone readily available.

To ensure New Yorkers can access life-saving, overdose prevention resources throughout the pandemic, the City has continued to invest in innovative strategies, ranging from methadone home delivery to launching a pilot program that makes naloxone freely available in 16 pharmacy locations across the five boroughs.

 

The full 2019 Epi Data Brief and 2020 first quarter report can be found here and here.

 

“Even before the COVID-19 pandemic gripped New York City, overdose deaths were at record levels, consistent with national trends,” said Health Commissioner Dr. Dave A. Chokshi. “This has been a tragedy leading into a crisis. Every fatal overdose is preventable and we will continue our work to keep our fellow New Yorkers alive.”

 

The provisional Epi Data Brief shows that drug overdose deaths in New York City remained at epidemic levels in 2019, with evident disparities. There were 1,463 drug overdose deaths in 2019, an increase of 11 deaths from 2018. Fentanyl— an opioid 50 to 100 times stronger than morphine —was detected in 68% of drug overdose deaths in 2019 compared with 60% in 2018. For the third consecutive year, fentanyl was the most common substance identified in overdose deaths. NYPD laboratory testing has identified an increased presence of fentanyl in heroin, cocaine, ketamine and methamphetamine, as well as in benzodiazepines and opioid analgesics acquired from non-pharmaceutical sources.

 

2019 Epi Data Brief highlights:


The rate of overdose death remained the same in 2019 as 2018 (21.2 per 100,000 residents).


In 2019, opioids were involved in 83% of overdose deaths.

For the third year in a row, fentanyl was the most common substance involved in drug overdose deaths, present in 68% of overdose deaths in 2019.


Mixing substances remains an issue of critical concern. Half (51%) of all overdose deaths involved multiple central nervous system depressants, such as alcohol, benzodiazepines, and opioids. 


The Health Department advises New Yorkers who use drugs to avoid mixing substances.

For the second consecutive year, Latino/a New Yorkers had the highest rate of drug overdose death. 


From 2018 to 2019, rates of overdose death increased among Latino/a New Yorkers (25.5 to 26.1 per 100,000 residents) and Black New Yorkers (22.5 to 23.0 per 100,000 residents). Among White New Yorkers, the rate of overdose death decreased for the third consecutive year, to 23.2 overdose deaths per 100,000 residents.


The neighborhoods with the top five highest rates in 2019 (Hunts Point-Mott Haven, Highbridge-Morrisania, Crotona-Tremont, Fordham-Bronx Park, East Harlem) are consistently among the neighborhoods with the highest overdose rates in New York City.

 

“These data tell a consistent story,” said Senior Director of Research and Surveillance Dr. Denise Paone. “Year after year, residents of the South Bronx and East Harlem have among the highest rates of drug overdose death in New York City. Although we eagerly await overdose mortality data from the second quarter of 2020 to understand the impact of the COVID-19 pandemic on overdose deaths, we have already implemented several interventions, including work focused in neighborhoods that are disproportionately impacted, to help address the unique impact this pandemic has on overdose risk.”

 

In recognition of the challenges the COVID-19 pandemic presents for people who use drugs or have a history of substance use, the Health Department has implemented several new interventions aimed at reducing overdose risk, including:


Launched a methadone delivery system in partnership with the New York State Office of Addiction Services and Supports (OASAS) after pandemic-related changes in federal regulations around methadone. The program helps ensure patients can access their life-saving medication without putting themselves or the community at risk for COVID-19. As of September 30, the MDS program has made 1,755 deliveries. 


Secured personal protective equipment and cleaning supplies for Syringe Service Programs (SSPs) to safely operate as an essential service during the pandemic. SSPs serve communities that experience health inequities including disproportionate impact of COVID-19.


Launched targeted messaging to inform New Yorkers at risk of overdose options for accessing Medication for Opioid Use Disorder (MOUD) including a targeted postcard mailing campaign detailing ways to access methadone and buprenorphine during the COVID-19 pandemic.


Disseminated low tolerance guidance to provide information about how changes in tolerance impacts overdose risk and provide steps people can take to reduce the risk of overdose. The guidance can be found here.


Published a fentanyl fact sheet to provide information about the drug's potency, its role in increasing overdose risk, signs of a fentanyl-involved overdose, and overdose prevention strategies for people who use drugs. The fact sheet can be found here


Issued several public and provider facing guidance documents addressing overdose, changes in tolerance, and access to treatment and services during the pandemic that can be found here


Re-launched the “I Saved A Life” campaign which encourages New Yorkers to have naloxone, a life-saving medication to reverse an opioid overdose.


Since the launch of HealingNYC in March 2017, the Health Department has:


Distributed 395,509 naloxone kits throughout the city. 156,836 kits were distributed to Opioid Overdose Prevention Programs (OOPPs) in 2019. To increase access to naloxone during COVID-19 in neighborhoods with high overdose rates, the Health Department recently launched a pilot program to make naloxone available for free at 16 pharmacy chain locations across all five boroughs, including four of the top five neighborhoods with the highest overdose rate.


Launched Relay, a nonfatal overdose intervention, currently at 13 emergency departments. Following a nonfatal overdose, Relay sends a peer advocate to emergency department sites to provide naloxone, overdose risk reduction support, and connections to other services and care. From launch through June 30, 2020, Relay has received 2,581 eligible referrals, of which 1,748 (68%) accepted Relay services, and distributed 2,687 naloxone kits.


Conducted targeted overdose prevention and education outreach through the Rapid Assessment and Response (RAR) initiative. RAR has interacted with and provided supplies, education and resources to people at community venues, substance use treatment centers, pharmacies, and shelters in Washington Heights – Inwood, Central Harlem – Morningside Heights, East Harlem, and the Lower East Side – Union Square in Manhattan; Hunts Point – Mott Haven, Highbridge – Morrisania, and Crotona – Tremont in the Bronx; and Downtown – Heights – Park Slope, Bedford Stuyvesant – Crown Heights, East New York, and Williamsburg – Bushwick in Brooklyn.


Expanded funding to 14 syringe service programs across the city who provide critical services to people who use drugs including sterile drug use supplies, overdose prevention education and harm reduction counseling.


Expanded access to effective treatment for opioid use disorder by training 1,817 new buprenorphine providers from launch through June 30, 2020; implementing a Buprenorphine Nurse Care Manager Initiative at 27 federally qualified health care center sites; and establishing buprenorphine induction at 14 emergency departments. From 2018 to 2019, the number of NYC residents who filled at least one buprenorphine prescription increased by 8% (15,174 to 16,383).


Disseminated several citywide public awareness campaigns in print, social media, and on TV: “Fentanyl,” “Overdose is Preventable,” “I Saved a Life,” and “I am Living Proof that Buprenorphine and Methadone Work.”


Launched Health Engagement and Assessment Teams (HEAT) to provide a public health-focused approach to serving New Yorkers presenting with substance use and mental health concerns to reduce the footprint of these persons in the criminal justice system.

 

New Yorkers can find more information about substance use and their health here. Individuals seeking support or treatment for substance use issues for themselves or their loved ones can contact NYC Well by calling 1-888-NYC-WELL, texting “WELL” to 65173, or going to nyc.gov/nycwell. Free, confidential support is available at any hour of the day in over 200 languages.

Monday, December 28, 2020

Fundraising Campaign Launched for Doctor Struck by Tragedy


Fundraising Campaign Launched for Doctor Struck by Tragedy



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Although it is being done with a great deal of reluctance, Dr. Ernest Patti, who has been a familiar and caring figure at St. Barnabas Hospital for generations of emergency room victims, is asking the community for help.

 

This summer, his 19-year-old son Ernest had just started his freshman year at the University of Miami when he dove into a wave at a local beach and hit his head on a sandbar. He sustained a paralyzing C6 spinal cord injury that in an instant forever changed his life and that of his family.

 

Dr. Patti has long been a beloved physician at SBH, having completed his emergency medicine training here in the 1990s before becoming an attending.  


He is often called the face of the institution for not only showing excellent and compassionate care for thousands of patients over this time, but for representing the hospital on many television news shows in discussing a range of medical issues.  


This was most evident during the spring when he spoke movingly about the hospital’s Covid-19 battle. His students at the CUNY School of Medicine, the hospital’s clinical affiliate, recently selected him “teacher of the year.” 

 

In addition to the personal tragedy, the Patti family faces the staggering cost of Ernest’s care and recovery. Estimates from the Christopher & Dana Reeve Foundation place Ernest’s first-year spinal cord injury expenses at over $700,000 with an additional $120,000 in every subsequent year. Many costs, including rehabilitation, home modifications, and caregiving, are only partially covered by insurance.

 

Friends and family have started a verified fundraising campaign with the national nonprofit Help Hope Live to lift the financial burden. You can make a tax deductible donation in honor of Ernest Patti and his family at https://helphopelive.org/campaign/18135/ or by calling 800-642-8399. 


All funds raised will be managed by the nonprofit to cover only verified expenses, including the cost of an accessible van. Help Hope Live verifies medical and financial need for every patient.

 

Help Hope Live is a national nonprofit that specializes in engaging communities in secure, tax-deductible fundraising campaigns for people who need a transplant or are affected by a catastrophic injury or illness. Since 1983, campaigns organized by Help Hope Live have raised over $145 million to pay patient expenses.

Wednesday, December 23, 2020

Health Insurer Helps Restaurants Feed Essential Workers, Needy




By David Greene

December 23, 2020


One of the most miraculous things to come out of the coronavirus pandemic has been the coming together of the private sector in filling a vacuum created by a lack of government assistance, Now health plan provider Fidelis Care has teamed up with Rethink Food and have joined in a partnership with Essen Health Care and on Monday's in December have been providing free gourmet meals and free rapid COVID testing to the general public and local healthcare professionals.


Having kicked off on December 4, the coalition hopes to distribute 2,400 meals before the end of the month, with 300 meals distributed at two Essen Health Care locations in Mott Haven and in the Melrose sections on each day of the four Monday's of the month.


According to Maria Ramirez of Fidelis, Fidelis provided a small grant to both "Taste So Good" and the "Mott Haven Bar and Grill" to provide the meals, but concedes, "They did a lot of the heavy lifting." 


Ramirez added, "We're promoting them as much as possible because they're both local Bronx restaurants that we're supporting for the community they serve."


On December 14, Termisha Henry, who owns the Taste So Good restaurant on Lafayette Avenue in the Soundview section, was outside of Essen Health Care on East 138 Street and St. Ann's Avenue as she passed out her specialty Carribean soul dishes. Since the pandemic, Henry said, "Business has been good, I can't complain."


Henry continued, "Today I'm here to support Rethink as a partner with them. What we do is give back food and we help the Bronx community and I love to cook and I love to give back." She added that local residents had grabbed the free meals to go, but many would later leave positive reviews on the restaurant's website.


Rosa Garcia, owner of the Mott Haven Bar & Grill which is located at 1 Bruckner Boulevard, is also a member of the Rethink Program and was also passing out meals to passersby on December 14. Garcia explained, "They pretty much hired restaurants like ours, to make these meals where they're able to distribute them to essential workers throughout the Bronx."


On that day Garcia helped distribute 250 flounder dinners with brown rice and vegetables and an additional fifty vegetarian meals. Asked how many cooks, Garcia responded with a laugh, "One person cooks everything, my mama."


According to a press release, Rethink Food is a non profit founded in 2017, whose mission had been to reduce food insecurity, but since the COVID outbreak, has been to "feed communities and keep restaurants in business." 


Since its launch in April, the program has invested $10 million in more than 35 independent restaurants, who have provided over 2 million meals.


Essen Health Care was founded in 1999 and currently has 40 offices across the Bronx that employs 150 physicians and over 100 clinicians, who provide care to 150,000 vulnerable and under-served residents of the borough annually.


Fidelis Care is a health care plan with over 2.1 million members across New York State.


Anyone interested in a free meal from Taste So Good or the Mott Haven Bar & Grill, the last 600 meals will be distributed on Monday, December 28, between 11 a.m. and 2 p.m. at two Essen Health Care locations: 542 East 138 Street and 899 Elton Avenue. The 300 meals and free rapid COVID testing will be available at both sites.   

Tuesday, December 8, 2020

Enroll in Health Insurance Today

Health Insurance Enrollment Ends Soon


Stay healthy in 2021 




By Melissa Cebollero, Senior Director, Office of Government & Community Relations at Montefiore Health System and New York State of Health

Bronx Voice

December 8, 2020


The COVID-19 pandemic brought health into the spotlight this year. If you haven’t already, take time to enroll in a 2021 a health plan through New York State of Health, the state’s official marketplace. 


Open Enrollment is happening now. You can enroll until December 15 for coverage that begins January 1, 2021. The December 15th deadline guarantees your coverage begins on Jan 1.


If we talk to our friends, family and neighbors we can help families get the coverage they need to take care of their health.


Why use NY State of Health?


The digital marketplace allows anyone to shop and compare quality affordable health plans – once you make your decision you can enroll on the site, too! All plans offered through NY State of Health are Qualified Health Plans, meaning they provide essential health benefits or more, follows established limits on cost-sharing.


Medicare recipients


If you have Medicare, you need to review and renew your benefits for the 2021 year before December 15. 


Need help with the cost of health insurance?


NY State of Health is the only place you can see the options for financial assistance and find out if you qualify. If you meet the requirements for Medicaid, Child Health Plus or the Essential Plan due to loss of income/employment or reduced wages, you can enroll all year long. If you are not sure if you qualify for these benefits our navigators can help you find out; contact them by visiting www.montefiore.org/nys-health-benefits-exchange-help. 


COVID-19 Health 

Coverage Enrollment


NY State of Health continues to serve as a safety net during the pandemic. In March 2020, a Special Enrollment Period opened allowing people to continue their insurance coverage into 2021. Those who needed emergency health coverage won't have to worry about a break in their health insurance or avoid seeking COVID-19 related testing or medical care. 


Need help figuring out what’s right for you?


Montefiore Health System and NY State of Health are working together to share this information with the community via webinars to help you select the best coverage for you and your family. Join an upcoming web meeting to connect with local health navigators who can help you with questions and enrollment. 


For more information on upcoming virtual events visit  www.montefiore.org/events. NY State of Health can be reached at www.nystateofhealth.ny.gov and by phone at 1-855-355-5777. 

Flu Shot- Where to Get It

Flu Shot Needed More than Ever in Light of Covid

Flu Shot- Where to Get It

2020 is Almost Over, but Flu Season Isn’t!



By Dr. Margaret E. McCort, Montefiore Health System 

Bronx Voice

December 8, 2020


2020 is almost over, but don’t worry - it’s not too late to get your flu shot. In fact, it’s still helpful! 


Each year, a new version of the flu shot is introduced around September, aimed at protecting against the flu strains that will circulate during that year’s flu season. Typically, the flu season runs from September until March. Even in December, the flu shot is still very effective and very important. 


As we continue to fight the COVID-19 pandemic this year, getting your flu shot is more important than ever. Like COVID-19, influenza spreads easily through close casual contact and can be spread before you realize you’re sick. Symptoms of the flu are similar to those of COVID-19, so if you develop a cough or fever, you should talk to your doctor about getting tested for both.


A flu shot could help you avoid long lines for testing and long waits in urgent care or emergency departments due to an influx of people with COVID-19. Plus, getting the flu shot also protects others around you, like your elderly neighbors, a family member with cancer, and young children in your community.


As an infectious disease specialist, I often hear “myths” about the flu shot. Sometimes I meet people who say they don’t usually get the shot: they don’t usually get sick and they don’t need one this year. While you may not have gotten sick with flu in the recent past, there’s no guarantee you won’t get ill this year. It would be better to have the flu shot, which is scientifically proven to reduce your chance of hospitalization from the flu.


Another myth I hear often is that the flu shot makes you sick. The flu vaccine does not contain any live virus, so you cannot catch the flu from the vaccine. Some people may have a mild reaction with aches and fever for about 24 hours after vaccination. This is a sign that the immune system is responding appropriately to the vaccine and is a much milder reaction than the actual flu.


Years of research show that the shot is extremely safe and effective. Serious reactions to this shot are exceedingly rare. The vaccine has been shown to reduce your risk of dying from the flu, if you do get sick during that season. For these reasons, the seasonal influenza vaccine is recommended for every person over the age of 6 months old, every year. Due to its safety profile, the flu shot is recommended for pregnant women, organ transplant patients, and people with weakened immune systems from cancer.


With so many reasons to stay healthy this year, make time this December to get your flu shot!

Tuesday, December 1, 2020

Aging with HIV/AIDS: A Mental Health Dialogue for 2020

Aging with HIV/AIDS: A Mental Health Dialogue for 2020



On World AIDS Day 2020, this conversation between Arthur Fitting, RN, LGBTQ Program Director at the Visiting Nurse Service of New York and Mark Brennan-Ing, PhD, senior research scientist at Hunter College’s Brookdale Center for Healthy Aging examine what people with HIV, partners, caregivers, communities and the health care industry can do to help expand knowledge, reduce HIV stigma and promote healthy aging. 


Arthur Fitting: For people with HIV looking to maintain their health as they get older, what are the key health challenges they face?


Mark Brennan-Ing: Long-term survivors are really challenged trying to figure out what’s happening because of HIV and what’s happening because of normal aging. The default is to blame everything on HIV, because for so long, managing their HIV has been the source of their major medical issues.


There’s evidence that the onset of multiple chronic illnesses, which can happen to anyone as they age, happens at an earlier age when people have HIV. People should know about that, but, at the same time, try not to internalize ageist beliefs.


As part of aging, people with HIV are going to get symptoms of different chronic conditions, and they should address them with their healthcare provider, just as they do with their HIV.


One important area of care is poly-pharmacy [multiple medications]. People with HIV already have a high pill burden. When you add medications for diabetes, high blood pressure, or other illnesses on top of that, that can be a lot to manage.


The bottom line is that people need to make sure they take charge of their health. You don’t have to do it alone — involve family and other caregivers, and health care providers, as part of a team that’s going to help you manage your health.


AF: How do we make sure that people become advocates for their own health, in a comprehensive and holistic way?


MBI: First, make sure you have your mental health needs adequately addressed — which many people aging with HIV do not. There’s still a stigma attached to mental health, which prevents people from seeking care. I always try to normalize behavioral health issues and encourage people to seek mental health care because it can have a lot of ripple effects. For instance, we know that depression is one of best predictors for being non-adherent to medication.


It’s particularly important now because so many people have been isolating, which exacerbates any kind of mental health problem. Living through another pandemic has been very triggering for a lot of people with HIV, and I encourage people to be extra vigilant about their mental health. If you are depressed or anxious, if the pandemic or social isolation is exacerbating substance misuse or causing a relapse, bring up these issues with your provider. These feelings are normal at this time, but don’t ignore them. Try to get some help.


There’s also burnout. For people with HIV and other longstanding chronic illnesses like diabetes, you just get worn out over time trying to manage it.


AF: You even see that now, with COVID, there’s a sense of burnout — people tired of taking the precautions they’re supposed to take.


MBI: Yes. For people with chronic illnesses, that sense of burnout means the care has to become psychosocial in addition to medical. It helps to have friends, family and others in the community help people manage chronic illness — not necessarily through direct care, but it can help people cope with their own health if they know they have support.


AF: Even before COVID, there were demands for behavioral health care that were not being met.


MBI: There was certainly a lack of capacity in the system to begin with, especially with Medicaid and Medicare — there’s a real lack of providers. We are never going to meet the targeted goals of Ending the Epidemic and Getting to Zero unless we expand capacity and reduce barriers to behavioral health care.


Fortunately, telehealth is now more accessible and reimbursable. I recently saw a news program about a physician doing work with opioid users through telehealth. That can reduce barriers to getting care, in terms of transportation and fitting it into your schedule.


AF: That brings me back to my earlier question, about the best ways to get people involved in their own care as they age. Should people seek out the care of a geriatrician as they get older, who may have a more holistic approach to health?


MBI: It’s not easy to find a geriatrician. But you can manage your care successfully with your primary care physician if you stay on top of your health, make sure you’re getting all the age-appropriate care you need, get screenings when you’re supposed to get screenings, and make sure your physicians are talking to each other.


There are only about 7,000 certified geriatricians in the whole of the United States, so it’s not realistic to think we’re going to be able to refer every older person with HIV to a geriatrician. I’ve been working with colleagues across the country on solutions that include diffusing models of geriatric care into HIV clinical practice. That means taking a holistic view of health, having an integrated care team to manage comorbidities, having the family/significant other caregiver involved in developing the care plan, focusing on function, and asking, “What’s important to the patient?” Is it getting out every morning to walk, being able to travel to a grandchild’s graduation (in the pre-pandemic world), being able to read the newspaper? And you gear your care toward those functions. It’s a different way of thinking about patient care.


AF: How about for an older person who’s newly diagnosed with HIV? How would you start that conversation?


MBI: it would need to be a gradual conversation. Getting an HIV diagnosis, even now with effective treatments, it’s overwhelming. There’s so much baggage that comes with it, and older people may be thinking of it as a death sentence, like it was back in the 80s. But it’s definitely not. You can have a life expectancy that’s nearly normal if you stay in care, if you take your antiretroviral medications and control your viral load — and if you take good care of yourself.


AF: Thank you Mark for taking this time to give us more information on this very important health topic and thank you for supporting our LGBTQ Health program at VNSNY.


To learn more about LGBTQ Community Outreach efforts at the Visiting Nurse Service of New York, visit VNSNY.org, or dial: 1-800-675-0391.

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