Governor Andrew M. Cuomo today unveiled the 2nd proposal of his 2020 State of the State agenda: legislation banning fentanyl analogs — a deadly synthetic opioid that is 50 to 100 times more potent than morphine — by making them subject to the same criminal sale or possession penalties as other controlled substances. The legislation will also empower the New York State Health Commissioner to ban any new fentanyl analogs that have been added to the federal schedule of controlled substances, allowing the State to deal with these deadly substances in real time rather than play catch up. The Governor will also propose a series of actions to expand access to medication assisted treatment for opioid use disorder in hard to reach communities. Medication assisted treatment entails using medications in combination with education and counseling to treat substance use disorders.
"The opioid epidemic is a public health crisis that continues to ravage too many communities across this country. In New York we have taken aggressive action to combat this disease, and we are seeing results with the first reduction in opioid deaths in 10 years," Governor Cuomo said. "Despite this progress, drug dealers have turned to lacing opioids and other illicit drugs with fentanyl analogs — a deadly synthetic opioid that current law does not ban. This two-pronged proposal will tackle that problem by banning these dangerous fentanyl copycats and providing treatment to people suffering from opioid addiction before it's too late."
Scheduling Fentanyl Analogs
Although the overall number of overdose deaths is declining in New York State, there has been a dramatic increase in overdose deaths due to fentanyl and its analogs. Fentanyl is a very powerful synthetic opioid that is 50 to 100 times more potent than morphine. Compared to 30 milligrams of heroin, just three milligrams of fentanyl can be fatal.
Overdose deaths involving fentanyl and its analogs among New Yorkers outside of New York City increased 124 percent in 2016 and again by another 28 percent in 2017. Fentanyl analogs are not illegal in New York State. This is because although some analogs are prohibited by the federal government's controlled substances schedule, they are not listed in the State schedule. This loophole creates a nightmare for prevention and prevents prosecution. Currently, selling an unscheduled fentanyl analog is not against New York State law, unless the fentanyl analog is mixed with a banned substance.
In response to this crisis, the Governor will advance legislation to ban illicit fentanyl analogs. This action will close a prosecutorial loophole and make fentanyl analogs subject to the same criminal sale or possession penalties as other controlled substances. Giving law enforcement the ability to arrest and prosecute drug traffickers who deal in emerging fentanyl analogs. These new rules will give police and law enforcement the authority to prosecute the manufacturing, sale, and distribution of these drugs to the fullest extent of the law.
The proposed legislation will also give the State Department of Health commissioner the authority to add additional analogs to the list of controlled substances, allowing the State to stay in front of these deadly substances as they appear on the market.
Expand Access to Medication-Assisted Treatment in Hard to Reach Communities
Under Governor Cuomo's leadership, more New Yorkers than ever have access to medication assisted treatment - or MAT - for Opioid Use Disorder. Governor Cuomo has launched initiatives to aggressively expand access to MAT both by increasing the number of medical professionals who are designated to prescribe and by expanding the number of settings in which MAT can be prescribed. In 2019, the Governor directed the NYS DOH to require all hospitals statewide to develop protocols for their EDs to address Opioid Use Disorder based on the standard of care for treatment or referral for treatment.
Under Governor Cuomo's leadership, OASAS has also expanded access to medication assisted treatment through the use of innovative care delivery models such as telehealth and the deployment of mobile clinics. These services have expanded access to addiction treatment services for people that may not otherwise engage in care because of transportation and other barriers to accessing treatment. However, more can be done to expand access to MAT in these hard to reach communities.
This year, Governor Cuomo is proposing a series of aggressive actions to expand access to medication assisted treatment, including:
- Expansion of the Medication Assisted Treatment and Emergency Referrals (MATTERS) Program: Governor Cuomo proposes expanding a pilot that provides MAT to patients identified with Opioid Use Disorder in Emergency Departments. These individuals will rapidly be transitioned into long-term treatment at a community clinic of their own choosing, all within 24-48 hours.
- MAT Telemedicine Program: The Governor proposes improving access to MAT by connecting emergency departments with doctors who can prescribe buprenorphine through telehealth.
- Expanding Access to Telehealth and Mobile Clinics: The Governor will direct OASAS to continue to expand access to these resources in underserved communities across the state by adding 10 new mobile clinics, one in each economic development zone statewide. In addition, in order to ensure access to addiction treatment in every region of the state, the Governor will direct OASAS to develop telehealth capacity by funding equipment for at least one addiction treatment program in each county across the state.
- Expanding Access to Medication Assisted Treatment in Correctional Settings: Governor Cuomo will direct DOCCS to expand access to Medication-Assisted Treatment by providing buprenorphine in the 7 facilities currently offering methadone. In addition, the Governor will direct DOCCS to seek national certification and accreditation to operate an Opioid Treatment Program, creating the Nation's first state corrections-operated OTP in the country.
Leading the Fight Against Opioid Addiction
Since taking office, Governor Cuomo has instituted an aggressive, multi-pronged approach to address the opioid epidemic and has created a nation-leading continuum of addiction care with harm reduction, prevention, education, treatment, and recovery services. To combat this epidemic, the Governor has worked to expand access to traditional services, including crisis services, inpatient, outpatient, and residential treatment programs, as well as medication-assisted treatment, telehealth expansion and mobile treatment and transportation services.
In 2016, Governor Cuomo's Heroin Task Force recommended new, non-traditional services, including recovery centers, youth clubhouses, expanded peer services, Centers of Treatment Innovation, drug user health hubs and 24/7 open access centers, which provide immediate assessments and referrals to care. These services have since been established in numerous communities around the state and have helped people in need access care closer to where they live.
The Governor has advanced legislative and regulatory reform to enable people to get treatment faster by eliminating many insurance restrictions, as well as advanced legislation to reduce opioid prescriptions for the initial treatment of acute pain from 30 days to seven days, and legislation to increase training and education for prescribers. Governor Cuomo has also taken action to combat patient brokering and fraudulent addiction treatment services.
The Governor has also worked to increase training on administration and availability of naloxone, resulting in more than 420,000 individuals in New York State being trained and equipped with the opioid overdose reversal medication. Through Governor Cuomo's actions, over 2,600 pharmacies around New York State are now able to dispense naloxone without individuals needing a prescription from their health care provider.
Due to these efforts, opioid overdose deaths in New York State are decreasing for the first time in a decade, down 13.46 percent in 2018. Opioid-related overdose hospitalizations are also down by 7.1%.