Spike in Opioid Overdose Deaths Due to Increase in Illicitly Manufactured Fentanyl: New Report

DASHNY Advocacy & Policy, Clinical and Community Linkages, Emerging Evidence, Prevent Substance Abuse Leave a Comment

Image credit: PBSS issue brief, page 2

By Ellie DeGarmo, B.A., Junior Policy Associate

Opioid overdose deaths are on the rise in the United States, with over 52,400 in 2015 and recent estimates indicating that 2016 saw the steepest annual increase to date, and reaching a record annual death count of over 59,000. There are many different kinds of opioid drugs and new research reveals that there are certain types that have led to sharp increases in overdose deaths. A recently released Prescription Behavior Surveillance System (PBSS) issue brief reports that overdose deaths specifically involving a narcotic called fentanyl have increased significantly. The infographic accompanying this post is an image from this issue brief and can be found on page two.

Fentanyl can be manufactured and prescribed legally, but can also be produced illicitly and sold illegally as heroin or combined with heroin. The PBSS brief analyzes data from five states (Maine, Ohio, Virginia, Washington, and West Virginia) and explores how trends in fentanyl related deaths compare to trends in legally prescribed fentanyl. Four out of the five states demonstrated their greatest number of fentanyl overdoses in 2015 (the final year in the study’s 2010 to 2015 timeframe), yet prescribed fentanyl rates remained stable or had fallen during this time.

This means that the increase in fentanyl overdoses can be attributed to an increase in illicitly manufactured fentanyl (IMF). The PBSS issue brief insists that this reality “highlights the need for close collaboration between public health and public safety in order to optimize the response to the ongoing opioid overdose epidemic.”

To this end, the PBSS brief concludes with two main recommendations. One concerns improving surveillance of fentanyl outbreaks, while the other calls for expanding access to naloxone, an antidote that counteracts the effects of opioids, and ultimately prevents overdose deaths. The recommendations offer guidelines for health care providers and harm reduction organizations that are specific to their capacity and expertise. For example, they suggest that health care providers supply more naloxone to first responders like EMS personnel, while they encourage harm reduction organizations to make available take-home naloxone kits.

The New York State (NYS) Prevention Agenda (NYSPA), on the other hand, did not mention naloxone in its original version that was published in 2013. Since then, however, naloxone has found its way into the language of updated NYSPA publications. Most notably, in December of 2015, the NYS Department of Health released an Action Plan Re-Fresh Chart, incorporating recent information generated from their Update Survey. On page 22 of this document, “harm reduction including Naloxone training” is listed as one of the eight recommended interventions for overdose prevention.

The Academy commends the NYSPA’s addition of naloxone and encourages stakeholders to consult the PBSS brief’s recommendations for more detailed guidelines about how to implement this crucial safeguard against overdose deaths.

Perhaps the most promising solution for combatting the opioid epidemic, however, is through the implementation of supervised injection facilities (SIFs), legally safe spaces in which users can inject drugs with medical supervision. A previous Promoting Prevention blog post discusses, in detail, the controversial measure that exists in over 60 cities in ten countries, curbing the epidemic and preventing overdose deaths. In fact, over the course of 30 years and millions of injections in SIFs around the world, not a single overdose death has occurred in a SIF.

Despite this proven success, mention of SIFs is completely absent from both the original and recent updates to the NYSPA. This is probably because there are no SIFs in NYS. New York City, along with Seattle, San Francisco, Baltimore, Ithaca, NY and other municipalities are examining the issues surrounding implementation of this strategy. In New York City, the Academy is currently engaged in research aimed at advancing SIF implementation in New York. The ongoing SIF Feasibility Study is gathering opinions from local stakeholders – people who use drugs, health care providers, the faith and business communities, law enforcement – on the topics of drug use and SIFs, in order to better understand and maximize the benefits of establishing SIFs in NYS.

In addition to this, the Academy joins over 30 organizations and over 100 health care professionals in support of the SIF NYC coalition, a coordinated effort to advocate for SIF implementation. Spurred into action by a letter of support signed by the 100 health care professionals, bill A. 8534, which would authorize the implementation of SIFs in NYS, was introduced to the New York State Senate by Assemblymember Linda B. Rosenthal (D – Manhattan).

Continued strong support for SIFs is needed to ensure that this crucial bill becomes law. New York has an incredible opportunity to become the first state in the country to authorize SIFs. Hopefully, this would encourage other states to follow, so that overdoses can be prevented and lives can be saved nationwide.

Breastfeeding Awareness Every Month – Not Just August

DASHNY Advocacy & Policy, Clinical and Community Linkages, Prevent Chronic Disease Leave a Comment

By Ellie DeGarmo, B.A., Junior Policy Associate

August is National Breastfeeding Month, and New York State (NYS) is dedicated to promoting breastfeeding as a part of the NYS Prevention Agenda (NYSPA). Specifically, the NYSPA identifies the goal of “increas[ing] the proportion of NYS babies who are breastfed” as one of the ways to accomplish the Promoting Healthy Women, Infants and Children Action Plan.

Breastfeeding is important because there are many proven benefits to both mothers who breastfeed and to their babies. For example, breastfed babies are more likely to have stronger immune systems and are less likely to develop childhood obesity, while mothers who nurse are also likely to have positive effects on their immune systems and will have a reduced risk of developing breast cancer.

When in the hospital, after giving birth and before discharging, mothers typically make the crucial decision of whether to breastfeed or to use formula. This is why the position that hospitals take plays a crucial role in informing this decision.

The NYSPA recognizes this influence. To this end, as a part of its suggested interventions, the NYSPA emphasizes the expansion of Baby Friendly Hospitals, calling on various stakeholders to support this effort. To acquire the designation of being a Baby Friendly Hospital, birthing facilities must implement the Ten Steps to Successful Breastfeeding and abide by the International Code of Marketing Breast-milk Substitutes.

In addition to breastfeeding being a part of the NYSPA, there is relevant information that, if equipped with, New Yorkers can become aware about breastfeeding in NYS. Two examples of this are by understanding (1) the relevant legal framework in NYS; and (2) the resources available to breastfeeding mothers.

The most important piece of NYS legislation to know is the “right to breast feed,” found in Section 79-E within the 1994 New York Civil Rights Law. This law provides the most explicit and comprehensive protection to nursing women, allowing mothers to nurse wherever they want, regardless of whether they are in a public or private space. The New York Civil Liberties Union expands upon this by highlighting the fact that and the ways in which the right to breast feed protects women in specific settings like at hospitals and in the workplace.

Despite these protections, prevailing stigma towards breastfeeding in public can deter women from exercising their right to do so. To address this, baby cafés, which are places that “offer support on all aspects of breastfeeding,” have sprung up across the country. There are currently 17 baby cafés operating in NYS alone, six of which recently opened.

Nursing mothers in New York City (NYC) also have the option of using public “lactation pods” to pump milk or breastfeed their babies. These 4 foot by 8 foot pods are enclosed spaces that can be locked and are equipped with an electrical outlet for breast pumps. There are dozens of these units located throughout NYC, five of which were unveiled at the beginning of this month.

Although the official National Breastfeeding Month is coming to a close, our dedication to this issue is far from over. It’s important to ensure that awareness and advocacy extends beyond August, and continues throughout the year.

Accomplishing this requires sustained attention to both the institutional level and the individual level. Specifically, relevant professionals and hospitals must adopt the guidelines delineated in the NYSPA to become baby friendly, while mothers must be provided with necessary information about the protections and services that are available to them. For more material and resources to help guide this process, please refer to the breastfeeding factsheet that was assembled by the Academy’s Designing a Strong and Healthy New York (DASH-NY) project team.

Children’s Menus Offer Fewer Sugary Drink Options but There is Still Room for Improvement: New Report

DASHNY Advocacy & Policy, Food Policy, Prevent Chronic Disease, Promoting Prevention News Leave a Comment

By Ellie DeGarmo, B.A., Junior Policy Associate

Research reveals that children’s chain restaurant meals have gotten healthier. More specifically, children’s menu items are less likely to offer sugary drinks and more likely to offer low-fat milk now than they did four years ago. The Center for Science in the Public Interest (CSPI) recently released a report examining 38 of the country’s largest restaurant chains like McDonald’s, Chipotle Mexican Grill, and Panda Express. The image accompanying this post is a figure from this report and can be found on page two.

Researchers explored beverage options found on the children’s menus at these restaurants and grouped each drink into five categories: sugary drinks, high-fat milk, low-fat milk, juice, and bottled water/seltzer. Findings related to two of these groups were significant. First, sugary drinks, like soda and sports drinks, were offered by 74 percent of restaurant’s children’s menus, a drop from 83 percent in 2012. Second, low-fat milk, characterized by being fat free or 1 percent, was offered by 69 percent, a sharp increase from 40 percent in 2012.

Information about drink options in restaurants is increasingly important as Americans are eating out more now than ever before. According to CSPI, over half (50.1 percent) of the money used for food is spent at venues away from the home, like restaurants and cafeterias. This is nearly double the 1970 rate of 26 percent.

As sugary drinks continue to be a part of children’s meals at restaurants, kids remain at a greater risk for developing health issues like obesity, type 2 diabetes, and dental disease. Although trending in the right direction, additional restaurants need to trade unhealthy drinks for healthier ones in order to minimize rates of childhood obesity and prevent the onset of associated chronic health conditions.

The 26 percent of restaurants that do not offer sugary drinks comprise nine restaurants that decided to remove these kinds of beverages from their children’s menus. While complete elimination of sugary drinks is ideal, CSPI offers alternative measures that can be taken. The report’s three recommendations involve making healthy beverage options the default, ensuring that nutrition guidelines are met, and restricting advertising to feature children’s meals that are healthy.

Setting healthy options as the default in children’s menus is an action that is overwhelmingly supported by New York City residents. A recent poll by the American Heart Association found that “87% of New Yorkers agree: restaurants should make healthy drinks the default option on kids’ menus.”

This sentiment is also reflected in the goals of the New York State (NYS) Prevention Agenda (NYSPA), which calls upon state and local actors to “create community environments that promote and support healthy food and beverage choice and physical activity.”

As a part of the Academy’s commitment to the NYSPA, our Advancing Prevention Project and Designing a Strong and Healthy New York project teams support the NYS recommendations and strongly encourage restaurants to either remove sugary drinks from their children’s menus or implement CSPI’s suggestions.

Beyond this, there is opportunity for action in the legislative arena as well. The Academy recommends amending and passing Introduction 442 to promote children’s health by ensuring that healthy drinks are the default option in kids’ meals in every New York City restaurant. Permissible beverages to be sold with a children’s meal include (1) water, sparkling water, or flavored water, with no added natural or artificial sweeteners; (2) milk or non-dairy milk alternatives; and (3) 100% juice. This bill was introduced to by Council Member Ben Kallos (D-Manhattan) to The New York City Council in 2014, yet it remains undecided.

Most recently, the bill, which has 16 co-sponsors, was discussed in a committee hearing in January of 2016. Introduction 442 was laid over in committee at this hearing, and has not been revisited since. The Academy urges New York City Council Members to use the momentum generated from CSPI’s recent, promising findings to move forward with this legislation. We must hold our local lawmakers accountable to ensure that they take this crucial step towards making children’s meals healthier, ultimately reducing both the rate of childhood obesity as well as the risk of developing chronic conditions like type 2 diabetes and heart disease.


New Yorkers Need to Get Serious about Getting Active: New Report

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New Yorkers are exercising less than they did five years ago and at a rate below that of the average American. That’s what a newly released Behavioral Risk Factor Surveillance System (BRFSS) report tells us. BRFSS, an annual nationwide survey, assessed physical activity among American adults by measuring Leisure-Time Physical Activity (LTPA)—a fancy term used to encompass a broad range of activities like gardening, swimming, and golf.

The survey findings are particularly important tools for evaluating the progress made towards the New York State (NYS) Prevention Agenda (NYSPA). The NYSPA identifies increasing physical activity, as a way to prevent chronic disease, as one of five core goals. Unfortunately, this goal has not been met. The NYSPA calls for increasing exercise rates by 5 percent, from 73.7 percent in 2011, to 77.4 percent by the end of 2018.

So far, New Yorkers have failed to hit this target and are now farther from it than in 2011. By 2015, the percentage had actually dropped 3 percent, to 70.7, the lowest it had been for five years, slipping below the national average of 73.8 percent.

As New Yorkers spend more time sitting and less time walking, running, riding bikes or otherwise on the move, their chances of developing chronic diseases, like type 2 diabetes, increase. To improve this situation, the NYSPA offers several suggestions, such as investing in community-based organizations dedicated to increasing physical activity, as well as creating safe public spaces for exercise.

Communities across the state are also working toward the goal. For example, David Sandman, PhD, president and CEO of the New York State Health Foundation, discusses the revamping and renaming of the Corning Riverfront Park in Albany as a successful way of attracting more visitors to the site.

The survey also revealed that some NYS residents were more likely to get a healthy amount of physical activity than others. People living with disabilities or struggling with obesity spent less time engaged in physical activity. Rates were also lower in some ethnic groups, such as Hispanic adults, and among people with less than a high school education.

In an ongoing effort to address disparities, the NYSPA‘s mission includes a commitment to improving these discrepancies: “reduce health disparities for racial, ethnic, disability, and low socioeconomic groups, as well as other populations who experience them.”

Specifically tailoring interventions to certain groups has also proven to increase physical activity among individuals in communities facing greater health disparities. Another article by Sandman demonstrates this by explaining the success of the Citi Bike program in the Brooklyn neighborhood of Bedford-Stuyvesant. Making Citi Bikes available in Bedford Stuyvesant adds to local resources like the YMCA and may help residents address high rates of obesity and diabetes.

As part of the Academy’s dedication to improving health in New York City and State, our Advancing Prevention Project and Designing a Strong and Healthy NY project teams energetically support the BRFSS report’s call to increase opportunities for physical activity for all New Yorkers.  Continuing to turn NYSPA objectives into action is one of the best ways to help all New York communities get moving.

Paving the Road for Expansive Policies, the Complete Streets List is In

DASHNY Active Communities, Advocacy & Policy, Prevent Chronic Disease Leave a Comment

People everywhere are demanding safer, innovative streets for their towns. One of the ways to go about this is to come up with new transportation policies that will accommodate every citizen, regardless of race, ethnicity, socioeconomic status, and ability. The top 15 best policies to enhance localities’ roads for 2016 were named earlier this month.

In 2004, the community planning and advocacy organization Smart Growth America launched the National Complete Streets Coalition. The coalition was a call for localities across the country to draft policies for that Smart Growth calls Complete Streets, which are “for everyone,” meaning that they should be accessible to pedestrians, bikers, and people of all ages and abilities. A Complete Street includes sidewalks, special lanes for public transit, more median islands in crosswalks, and curb extensions. 2016 saw more than a thousand towns in the United States draft policies towards safer and more accessible streets. 2016 saw the most policies than any other year of the coalition existing, with a whopping 222 new policies drafted. They were also the strongest ever, many of them achieving scores of 90 or higher. Among them was our own Binghamton, NY, whose policy included adding more walkways for access to public transit, bike racks on buses to allow for more travel destinations for bikers, and add greenways in parks. These simple additions will improve air quality, increase physical activity, and will overall enhance quality of life for Binghamton’s residents.

On a national scale, the promises of safe streets are an immensely positive step, as these localities are leading the way in equitable and safe roads. The United States is steadily improving to avoid accidents and harm coming to pedestrians. A Smart Growth report called Dangerous by Design 2016 highlighted alarming statistics of disparate pedestrian accidents and deaths. It reported that the aging, low-income, and communities of color were the most susceptible to pedestrian deaths because of roads being more catered to cars. For example, Non-White populations make up 34.9 percent of the national population, but make up 46.1 percent of pedestrian deaths. At the same time, individuals that are 65 years or older are 50 percent more likely to be hit and killed by a car while walking. It also stated that many individuals in those communities do not have access to a car and must walk, putting them at risk of injury or death.

Not only is the sheer number of new policies monumental, it also shows a shift in the nation’s thinking. More and more, localities and states are implementing projects and policies to make their landscape more equitable and safe, taking the first steps to lessen the disparities between communities, building crosswalks instead of road blocks. We hope the results of Complete Streets will start a trend for even more localities to make their spaces more accessible and safe for everyone. The Advancing Prevention Project (APP) and DASH-NY are proud to support Complete Streets initiatives, which is part of our ongoing support to Local Health Departments’ Prevention Agenda plans and our advocacy for Active Communities around New York State.

Congratulations to all the ranking towns on their policies, keep paving the road for equity and justice.