Transcript: Mayor de Blasio, First Lady Chirlane McCray Launch New Initiative to Combat Opioid Epidemic

March 13, 2017

Mayor Bill de Blasio: Good afternoon, everyone. I want to start by talking about the weather situation for tomorrow, then we’ll go into everything we want to talk about related to today’s announcement. But first this weather situation really needs to be addressed. We – as you know – we get regular updates from the National Weather Service. We’ve seen a very consistent pattern so far with this storm – that this should be a very serious blizzard – one that everyone should take seriously. I'm asking all New Yorkers to recognize that the next day or two are going to be very challenging. I want everyone to hear this information early, so you can take full precautions. I'll say at the outset, we have seen weather patterns change before. Sometimes they get better, sometimes they get worse. We are judging on the information we have at this moment from the National Weather Service, and it has been pretty consistent over the last day or so. So that is why I think we have enough information now to announce a series of measures.

We are tracking a major storm with blizzard conditions. Snow will begin after midnight tonight, and then will intensify. The worst period of the snow at this moment is projected to be from 6:00 a.m. tomorrow through noon tomorrow with intense accumulation. At this moment we believe it could be at the rate of 2 to even 4 inches per hour at times. And you'll remember from previous storms, 2 inches per hour is pretty intense to begin with. You get up toward 3 or 4 inches of accumulation an hour – that is very difficult to deal with, particularly for folks on the roads. We should be ready for the potential of whiteout conditions during that period of time. So obviously I'll give you more facts, but I'll be saying repeatedly I'm going to urge people to make plans to not be on the roads tomorrow. 

Overall at this moment, based on the National Weather Service report we got just over an hour ago – 16 to 20 inches of snow expected. And I will say consistently again that could change. It could go up or down at any point. But right now, 16 to 20 inches of snow expected. High end could be as much as 24 inches, which would, therefore, put this in the category of one of the biggest snowstorms in recent memory. We do expect some coastal flooding, tomorrow morning and evening, at high tide. And this kind of snow coming down this intensely, again it’s dangerous. It will be dangerous to be on the roads. I want to urge everyone now to make plans to not be out on the roads tomorrow. First and foremost, for your own safety, but second and very important, so that all of the good people at the Sanitation Department can do their job and clear the roads. That is going to be very, very difficult work for Sanitation. They’re going to need all the support they can get. The number one thing you can do to help them is stay off the roads.

On top of the snow situation, we have a wind situation, which should not be taken lightly at all, either. We expect very strong winds with gusts as high as 40 to 50 miles per hour tomorrow. That will make travel conditions even more difficult, particularly during the morning hours going into the early afternoon. The Department of Sanitation, as always, is ready. And I want to say to all of our Sanitation workers, you have done an outstanding job in the recent snowstorms, I am sure you are ready again to excel. Our sanitation teams will start on 12-hour split shifts starting at 7:00 p.m. this evening. Twenty-four hundred Sanitation workers per shift, 689 salt spreaders will be pre-deployed. The Plow NYC system will be activated as soon as 2 inches of snow have accumulated. That is when the plows can go into action. We'll have 1600 plows out. The Department of Transportation will play a major role in this with personnel and 80 additional plows. Because up to now we have not had too bad a winter, we have an ample supply of salt – 283,000 tons of rock salt on hand. So we are ready with salt.

Major announcements. Due to the fact that we have such a high amount of snow, such a large amount of snow being predicted, particularly with intensive accumulation during the early morning hours, I have made the decision to close school tomorrow. This is an unusually early call. But we are seeing this snowstorm hitting exactly at the time when parents will be trying to move around with their children and with this kind of intense activity, 2 to 4 inches an hour, I don't think it will be safe enough, so we are going to close school tomorrow. I wanted to give everyone very early notice. I know for a lot of parents and caregivers this takes – it is a real challenge to come up with alternative options for children. I wanted to give people as much notice as possible. Based on what we know now, yes it could change, but based on what we know now this one is a straightforward decision. There will be no alternate side parking on Tuesday and Wednesday. So more incentive for people to leave their vehicles in place, and if you can, just stay home. If you need to move around, take mass transit. But the last thing you should be doing is moving your car if there is anyway on earth you can avoid doing that. So we are canceling alternate side to make that easier.

I want to remind people, even if you are out on footed, it will be very slippery conditions. Obviously the wind on top of that. So even those who go outside on foot should take caution. Be out as little as possible. Anyone who has a heat and hot water problem, even if you have it now, call it in to 3-1-1 so we can get to work on it. The minute you have a heat and hot water problem we need to hear about it. Please, as always, get ready to check in on senior citizens and neighbors. Make sure they are okay. We will have our normal Code Blue effort in effect. Anytime the temperature goes below 32 degrees we'll be doing our outreach to make sure folks who are on the street come in. And want to remind people you can call 3-1-1 for information throughout the day and tomorrow, but if you see an emergency situation where lives are in danger that is when you call 9-1-1. We will be giving you regular updates. There will be a lot more to know, but these are the basics. Let me say a few words in Spanish, and then we'll open up to see if there’s any media questions related to the storm, and then we'll go on to the other matters at hand.

[Mayor de Blasio speaks in Spanish]

With that, I want to see if there are any media questions related to the storm before we go on. Yes?
Question: Is there any chance that you would reverse the decision to close schools?

Mayor: No

Question: Mr. Mayor, do you think that the buses and subways will be offering [inaudible]? 

Mayor: I think it is too early to tell, Marcia. I'm going to be talking to the governor later on to compare notes on that very fact given the magnitude of the storm. I think the intensity I talked about in the morning is obviously going to create a challenge for both buses and certain subway lines. Too soon to tell, obviously the goal of all of us is to keep those subways running as much as possible, keep the buses running. But I think we need to get closer to know for sure. 

Question: what about construction sites? Cranes? 

Mayor: Yes, given these wind levels, cranes, obviously, will be shut down. Construction sites, I can't speak to all of them, but I think it will be very, very hard for any construction to happen tomorrow. 

Any other questions?

Question: Do you have any information [inaudible] buses and subways will be closed?

Mayor: [Inaudible] it’s too soon to tell, but we are hopeful to keep everything going. I'll be comparing notes with the governor later. 

Question: what about city offices and agencies? Will they be open tomorrow? 

Mayor: So it is the same standard we hold in any situation. City employees are supposed to report unless they get different instructions and that is because, of course, city employees will be part of this response, whether it is at Fire, Sanitation, Police or Health Department. So many agencies are necessary to respond in a crisis situation. So the working assumption, and city employees know this, you report as usual unless you get alternative information. 

Question: Mr. Mayor, are there specific areas of the city where you are directing your administration to pay special attention to given prior snowstorms? 

Mayor: I think the Sanitation Department, because of the new equipment that they have put in play showed in this last storm much more ability to get at some parts of the city that had smaller, more narrow streets. I think we did pretty well in the last storm. We will continue to watch carefully. If there are any areas that need special attention. I don't know enough yet from National Weather Service about geographical variations in terms of snowfall and things like that – some areas might get harder hit. But I think the last storm, meaning weeks ago, was handled well, and I look to see continued progress with those new approaches and new equipment. 

Question: Mr. Mayor, given the conditions that you anticipate tomorrow morning, will you stay over at Gracie Mansion, or you going to stay over at City Hall? 

Mayor: I don't have any – you know, I have been through these many times as you know, Rich. I assume I will be staying at Grace Mansion and then going out and checking on situations around the city in the early morning. I expect to be briefing all of you at some point later in the morning. 

Question: From what you have been told how bad do you think the coastal flooding will be? 

Mayor: Amongst the many challenges we are going to face in the next day or two, coastal flooding seems to be an issue but nowhere near as much of an issue as the accumulation of snow, the pure intensity - you know the intensity of the snow accumulation – and the wind situation. So we'll be ready to address flooding issues and folks in coastal areas should be ready for challenges around high tide. But it seems to me, based on what we are hearing so far from the national weather service, the snow and the wind are bigger problems right now. 

Let’s see if there’s any more before we continue. Once, twice – is that a question on this? Go ahead. 

Question: [Inaudible] Are you guys going to ban travel? 

Mayor: We're not there yet. Again, this is, I always remind you guys, these reports change up and down. So at this moment we are not in that scenario, but that could change. I think, knowing that we are giving people a very early message of changing your plans, get off the streets, obviously closing schools, that is going to take a lot of pressure off the roads right there, we believe. But as we see this develop, you know, we had last winter, the biggest snowstorm in the history of New York City. The final total I believe was 27, 28 inches or more. The original report we got on that storm from the weather service was 8 to 10 inches, and it grew intensely from that point on. This one we are already up at a very high level. That could go up, or that could go down. We just need to be aware of that. So that travel ban occurred when we were dealing with one that was obviously verging on being the greatest snowstorm in city history, it then became the number one in all time, dating back 150 years. This one is in striking range, but it is too soon to tell if we are talking about something like that. Last call – yes? 

Question: Mr. Mayor, in light of what we’re expecting what is being done for the homeless population? 

Mayor: Sure, that is the Code Blue I referred to earlier. There will be a full outreach effort with the Department of Homeless Services and our HOME STAT initiative. But also the NYPD, FDNY, MS etc. all will be out. As you saw in previous storms, when they encounter someone on the street, the typical situation is that person comes in voluntarily. From time to time we need to bring someone in, involuntarily, but generally speaking in these kinds of conditions, people decide to come in and accept the offer of help. Last call on anything related to the storm? Going once, twice? Okay.

[…]

First Lady Chirlane McCray: Thank you so much, Hector. We really appreciate you sharing your story with us today; because you are living proof that one person can make a huge difference in the fight against opioids. That’s not to say that everyone needs to save 26 lives. Hector has gone above and beyond with his heroism, but we all have a role to play in combatting a crisis that has taken far too many lives.

In 2016, some 1,300 New Yorkers died of a drug overdose. That is nearly four deaths per day. And let’s think a moment about what that number really means; it means four lives cut short by a disease with a cure, four families that will never again be whole, four missed opportunities to save a fellow New Yorker. Four deaths per day also add up to more deaths due to overdoses than any year on record.

So how and why are we losing so many New Yorkers? The broad answer is opioids. Of the 1,300 people who suffered fatal overdoses last year almost 1,100 or 11 percent were traced back to opioids. That means opioids killed more New Yorkers than car crashes and homicides combined. The South Bronx and Staten Island have lost the largest number of loved ones. But make no mistake this is a citywide problem and no neighborhood is immune.

One particular drug – a synthetic opioid known as fentanyl – has been especially deadly. During the second half of last year it was involved in approximately half of all overdoses in the City. And that is up from less than five percent in prior years. This is a new drug; one that is similar to morphine but 50 to 100 times more potent. But what is not new is the disease that is at the root of this crisis and that is addiction. Addiction is a disease, not a moral weakness not a lack of will power. So we need to address addiction the same way we would any other public health disorder – any other health disorder with a public health initiative that engages every sector of our City. That is why we are launching Healing NYC to prevent overdoses and save lives. Our goal is to reduce opioid overdose deaths by 35 percent over the next five years. That is an ambitious target, no question but it is important to understand that every single overdose death is preventable. Let me say that again in Spanish because it is so important.

[First Lady speaks in Spanish]

Because when it comes to treating opioid addiction and overdose we know what works and we have better tools than ever before.

Now, with Healing NYC we have a five-borough plan to bring our knowledge and tools to those who need them most. The good news is that New York City already leads the nation when it comes to reducing over prescribing. In fact, our model of educating doctors was adopted by the Center for Disease Control. We are helping doctors understand the importance of prescribing less often and at lower doses. And we have gone door to door in Staten Island and the Bronx providing information to more than 1,500 physicians. This work will continue because doctors are natural allies in the campaign to stop this crisis at the source. And thanks to Thrive NYC, which launched in November of 2015, we have a running start and a strong foundation when it comes to helping people survive and recover. With Healing NYC we’re building on Thrive’s success and taking an innovative public health approach to treating substance misuse.

For too long our nation’s strategy on addiction has been built around detox beds. These beds are a short term high cost fix that don’t address the root challenges that may lead someone to overdose. They are all about survival. Well, we don’t think survival is enough. Our goal is to give people the support they need to thrive. Medication-assisted treatment is a great example. As with other serious chronic diseases, the most effective treatment for overcoming opioid addiction often includes safe and proven medications along with counseling and lifestyle changes. That is why Thrive includes a commitment to enlist 1,000 new providers to prescribe Buprenorphine, which we refer to as ‘Bupe’ for short. ‘Bupe’ stops opioid cravings and prevents withdrawal symptoms. It doesn’t make people high and it could be prescribed by general physicians, nurse practitioners, and physician assistants. Enlisting help from primary care providers is important because people are more likely to seek help from a trusted health provider, someone they already have a relationship with. Through Healing NYC we will connect 20,000 more New Yorkers to medication-assisted treatment by 2022 because with the right support anyone can recover from addiction.

The other medication every New Yorker needs to know about is naloxone. As Hector’s story makes clear Naloxone is a true lifesaver – a simple and effective way to reverse opioid overdoses. Last year, through NYC we distributed more than 15,000 of these kits. We also led the charge to make naloxone available without a prescription at nearly 750 pharmacies including all major chain pharmacies in New York City. And that is a game changer because you don’t have to be an expert like Hector to use naloxone. Let’s say someone has a son who is struggling with opioid addiction; to be prepared for the worse the parent goes to the local CVS, gets trained by the pharmacists, and goes home with a kit. Now, one day the parent walks into a room and finds the son passed out with a syringe on the floor. After calling 9-1-1 the parent grabs the kit and sprays the naloxone up the son’s nose. Now he is alive again. Now he has another chance at recovery.

[First Lady speaks in Spanish]

We need to get naloxone into the hands of more New Yorkers especially in neighborhoods like the South Bronx. That is why through Healing NYC we will distribute 100,000 kits citywide. We will work with city agencies and community partners to get them in the hands of those New Yorkers who are living and serving on the front lines of this crisis. And we will increase the number of pharmacies that stock naloxone to 1,000. It just makes sense. Think about a disease like asthma; if you or someone in your life has severe uncontrolled asthma then you are likely to carry a rescue inhaler at all times. Am I right? Right, because you never know when or if you’ll be confronted with a life or death situation. The same logic applies to naloxone. All of us can do something to help overcome the opioid crisis. Doing something could mean picking up one of these naloxone kits. Doing something could mean urging our leaders in Congress to protect the affordable care act. Under the recent Republican proposal to replace ACA, Medicaid would no longer be required to cover life-saving mental health and substance misuse treatment. That is unconscionable. And leaders on both sides of the aisle are taking a stand. Last week, I was in Washington and met with Senator Shelly Moore Capito – a Republican from West Virginia. She has concerns about the rollback to Medicaid – to the Medicaid program and so do a number of other Republican lawmakers. So our voices are being heard, but we need even more people to speak up.

And doing something could mean telling your friends and family about NYC Well, our central access point for connecting New Yorkers to mental health care. When someone who is struggling with opioid reaches out our counselors are trained to ask the right questions and guide them to the right care, whether that means helping them find naloxone, get connected to medication-assisted treatment or to make an appointment with a therapist. If they need follow up we can provide follow up and provide more help if needed because recovery takes time.   I want you all to know the phone number for this central access point is 1-888-NYC-WELL – again, that is 1-888-NYC-WELL. Please help us spread the word because when all of us do our part – when all of us look out for each other we can alter the trajectory of so many lives. More of our children will grow up with parents; more of our parents will get to watch their children graduate, grow up. And more of our families will stay together and thrive. This is how we will heal NYC; one life, one family, one neighborhood at a time.

It is now my pleasure to introduce the man who fights every day to protect New Yorkers, our mayor, Bill de Blasio.

Mayor Bill de Blasio: Thank you very much, Chirlane. [Inaudible] this approach because it is all about reaching people who have not been reached. It is all about breaking through the stigma and putting the tools in the hands of family members and loved ones and friends who can save lives. And I just want to say that this – everything that we’re doing here would not be possible if our first lady had not paved the way with Thrive NYC, so we actually had a way to break through the stigma to get people talking about mental health challenges and substance misuse challenges in a different way; to end the fear of coming forward. And end the stigma that family members feel when they see one of their own in pain and in danger. We need to put aside all those unfortunate things we were taught and just talk about saving lives and helping people turn their lives around. And that is what our First Lady’s work has done. So, Chirlane thank you from the bottom of my heart on behalf of all of us.

And I also have to just say Hector you have done something amazing; and you know I can only imagine what it felt like in those moments of crisis. And you knew that that person’s life was in your hands and you had to stay cool and you had to stay focus, but that you have done it time and again – you have saved lives is such an extraordinary thing. And I want you to know, again, from the bottom of my heart but on behalf of all eight-and-a-half million New Yorkers and certainly for the loved ones of those 26 people, God Bless you for all you have done and thank you for being an example today of the everyday heroes who are out there saving lives. Let’s give Hector a big round of applause.

[Applause]

Before I go into a couple of other points, I want to mention some of those who are with us. This plan that we are going to talk about today has been in the works for months. It has taken a lot of work and I want to thank everyone who has been a part of it starting with our Deputy Mayor for Health and Human Services, Dr. Herminia Palacio. All of the leadership of the NYPD, you’re going to hear from Commissioner O’Neill in a moment, but I want to thank First Deputy Commissioner Ben Tucker and all the other leadership of the NYPD present has worked so hard on this. Stan Brezenoff, the CEO of the Health and Hospitals Corporation, thank you to you and your team for all of your work. I want to thank our budget director Dean Fuleihan and I want to thank the Chair of the committee on mental health in the City Council. He has been a crucial ally in so much of this work, Councilmember Andy Cohen of the Bronx thank you so much. And if I have missed anyone they will hand me a note.

[Laughter]

Let me talk about this challenge. And again – we’re going to hear from Mary. We’re going to hear from Mary; we’re going to hear from Commissioner O‘Neill, we’re going to hear from the D.A.

Chirlane mentioned that she met with the United States Senator from West Virginia. There is a reason she met with that Senator. West Virginia is going through a horrible opioid epidemic. And we’re seeing this now tragically all over this country. We are focused on the people of New York City, but it is impossible to ignore the fact that we now have a national problem on our hands. And it is cutting across regions, socio-economic backgrounds. It is an urban problem; it is a rural problem simultaneously. One thing that we all have in common, we’re losing loved ones; we’re losing too many people each day. So, we have to do something very different.

It’s also become bluntly clear that there is something fueling this crisis that makes it different from some other public health crisis. And that unfortunate factor is corporate greed. The pharmaceutical industry for years has encouraged the overuse of addictive painkillers. And that has unfortunately poisoned our entire society. The painkillers that have become all too common are some of the most addictive drugs on the planet. And let’s be clear, the pharmaceutical industry has peddled them in the name of profit. One example, in 2010 sales for OxyContin alone topped $3 billion in this country. And according to the Center for Disease Control, sales of prescription opioids in the U.S. nearly quadrupled over 15 years from 1999 to 2014. The overuse of these drugs was planned by the pharmaceutical industry. And the results have been devastating. And now this is a problem being felt in households all over this City and all over this country. According to the American Society of Addiction Medicine – this is a shocking figure – in 2012 there were 259 million prescriptions written for opioids in the United States of America – 259 million prescriptions in one year alone. That is enough for every adult American to have their own bottle of dangerous pills. Four – according to the same study – four in five heroin users nationally started on the pathway to addiction through the misuse of prescription painkillers. This is a different reality then what we used to face years ago. It is not that heroin has not been available over the years, but heroin usage had leveled off before the prescription painkillers became so readily available. We literally have a reality now where more and more people get hooked on heroin because first they went through the overuse of a legally prescribed drug. 2014 national survey of people in opioid treatment showed that 94 percent started using heroin because it was cheaper and easier to get then the prescription pills they had first gotten hooked on. So it is a direct gateway from these prescription drugs straight through to illegal drugs like heroin.

We know this is a particularly challenging crisis to address because it is happening, in so many cases, behind closed doors – happening in our homes where people often silently deal with addiction or family members feel again feel the weight of that stigma and don’ t come forward. 

Chirlane talked about the painful number – we have lost 1,075 New Yorkers to an opioid overdose last year, which was much more than the year before. But – as Chirlane said, as Hector said each one of these was an individual, a person, a family was affected. And a huge number of people to lose when you think about the fact that if we could have only had reached them we could have saved those lives. Well, Hector did 26 times. Someone could have done for each and every one of those 1,075 individuals. We have to change our approach and deepen our approach to protect people who are dealing with this painful crisis.

Chirlane talked to you about the elements of our new plan. We’re going to use every tool we have and we will be making an additional investment in the City budget to achieve the outcomes we need – $38 million investment will deepen, immediately, a series of efforts that are already under way. And this plan will be active in all five boroughs with the key point of availability being NYC Well as you heard 1-888-NYC-WELL. Think of that as the portal through which anyone can reach the help they need. Think of that as the air traffic control. Anybody trying to get help for a loved one – anybody trying to get help for themselves can now call one phone number and get connected to treatment. It is as simple as that. I think in in the past it was clear that many people didn’t know where to turn. Now, 24 hours day you call 888-NYC-WELL and begin the process of getting the support and help that you need or that your loved one needs.

Our Health and Hospitals system will play a crucial rule with centers of excellence at H&H hospitals in four boroughs and at the treatment facility at the new Vanderbilt Clinic in Staten Island that is opening up later this year. And as you heard, one of the crucial elements of this is the distribution of naloxone citywide. So this crucial, crucial medication will be available to more and more people in all five boroughs.

Now Commissioner O’Neill is about to speak to us and he is going to talk about another key piece of this plan which is the increasing role of the NYPD in stopping the flow of opioids into our City and into the hands of those who would be endangered. More and more efforts are going to be made to disrupt distribution networks for opioids and to arrest those involved and intercept dangerous drugs before they ever come into our City. This is work the NYPD will do, but also work we crucially rely on other partners of law enforcement to work with us on. And the NYPD has already pioneered crucial methodologies for addressing the opioid crisis including the RX-Stat operations group and the overdose response initiative. Both of those having an immediate impact already and the Commissioner will speak to them.

All of our agencies are going to be a part of the fight against opioids. But the work of all of these agencies alone won’t be enough. Every New Yorker needs to be a part of winning this battle. Again, because so often this is a crisis that happens behind closed doors and one where we don’t get a warning that someone is in danger. Only a loved one can come forward or a friend could come forward to connect that individual to the help they need and to help us address a problem before it is too late. So, 1-888-NYC-WELL is the way that we know that anyone who wants to help – anyone who needs help has it at their fingertips.

The stigma I mentioned earlier has held us back, but it is up to all of us to defeat it. And Chirlane’s work and everyone who has been involved in Thrive NYC, as I said at the beginning, has been meant to undercut the stigma that stops people from getting help. What a painful reality that for those reasons we lose lives we don’t need to lose. Well, we’re going into houses or worship; we’re going into community organizations, we’re going into schools. Everywhere we go we’re sending a message that if you have an addiction problem it is part of human life. Some people tragically become addicted; some people have a propensity to addiction. The important thing is that they need to come forward and get help. And that help will now be more available than ever before in the history of this city.

A few words in Spanish.

[Mayor de Blasio speaks in Spanish]

Before I introduce the Commissioner I just want to thank also for being present the New York City Special Narcotics prosecutor, Bridget Brennan. We thank her for the work she does and for her partnership in these efforts. And with that, a crucial role will be played by the NYPD already doing this work, but now expanding their efforts. It is my honor to introduce our Police Commissioner, Jimmy O’Neill.

Police Commissioner James O’Neill: Thank you, Mr. Mayor and good afternoon everyone. It is really important that we are all here in this room, so thank you.

As the Mayor said, this is a national crisis we’re facing and the NYPD is proactively facing it head on. Here in New York City, it is in every borough. It is affecting people from all walks of life, all races, ages, financial backgrounds, and in every neighborhood. No facet of our society is immune. We guess that by everybody sitting in this room has some relative or friend that is affected by this problem. It is not going to go away; it’s not going to get better unless we all take affirmative steps here.

Again, this change is in the way the men and women of the NYPD do their jobs. What is making matters worse is that illegal drugs commonly taken like heroin are increasingly being cut with fentanyl; a powerful synthetic opioid 50 to 100 times stronger than the painkiller morphine. As you know, in 2013 the NYPD started a pilot program on Staten Island with our officers carrying naloxone; a drug that can reverse an opioid overdose. That program was expanded citywide in 2015. We now have more than 13,000 naloxone kits deployed to our officers in all five boroughs. To date, the NYPD alone – this is just us – has recorded 141 saves, with 51 last year and 17 already this year. Those numbers don’t include hospitals and other places where people have been saved and the NYPD wasn’t involved, like Hector. Thank you, Hector. If you do the math you can see we’re on track to perform more saves this year than last year. The NYPD currently trains about 220 officers per week in the use of naloxone. In that training they also receive refresher for CPR and the use of automated external defibrillators or AEDs.

We need to do more. The NYPD will now investigate all cases of overdoses that we are made aware of both fatal and non-fatal. That is a massive manpower issue as you can imagine. In order to accomplish this we are specifically assigning 84 NYPD investigators to tackle the problem. 64 off these investigators will be assigned to our borough narcotics squad citywide and the remaining 20 will be assigned to our criminal enterprise division where they will work with our federal law enforcement partners to handle complex long-term casers. This is being done already; we’re just adding people to this. We already have the drug enforcement taskforce – the strike force. Each borough has major case teams. Each borough also has buy and busts teams. But we’re doing this on an international level, a national level, a regional level, and, of course, a New York City.

In addition, we’re bringing 50 new technicians to the NYPD lab specifically to test the heroin we cease. We used to test heroin in the field at the location of an incident, but because of fentanyl it has become so potent these days that it is potentially deadly for our people to be around it in an unsecured area. You have seen cases all across the nation. We’re going to continue our participation with the valuable RX-Stat operations group, which is a regular meeting of more than 25 public health and public safety agencies that share information and best practices with the aim of reducing overdose deaths. We’re studying the possible expansion of other initiatives already in place including the HOPE program – we’ll work with the Staten island DA. It’s an early diversion pre-arraignment effort on Staten Island for people charged with low level drug arrests. Those who successfully complete that drug treatment program will not have to appear in court on the date of their desk appearance ticket. Prosecutors will agree to decline to prosecute those cases and the arrest will be sealed. Like all of our crime fighting efforts this is a shared responsibility. Government is willing to do its part to help keep people’s records clean. The individual also need to do their part following through on treatment services.

Further moving beyond traditional policing is prevention and education. We continue our school safety division heroin and opioid drug presentations. We helped to expand the Too Good for Drugs program currently in schools on Staten Island. The bottom line is this; you can’t arrest your way out of this problem. When we interview those who have been fortunate enough to not die after an overdose we won’t lock them up. This is about teaching everyone from school age kids [inaudible] to adults with major substance abuse problems to make good decisions, to resist peer pressure, and to live their lives in a positive, healthy, and productive way. I’m confident New York City can lead the way in this. Thank you very much, Mr. Mayor.

Mayor: Thank you, Commissioner.

Now, I want you to hear from our Health Commissioner. She has been at the frontline of addressing this problem over these last years – Dr. Mary Bassett.

Commissioner Mary Bassett, Department of Health and Mental Hygiene: Thank you, Mr. Mayor and thank you First Lady. I am so very proud to be part of Healing NYC. As you have heard, the numbers of overdose deaths are increasing in New York City and the entry of fentanyl into our street drugs has made these drugs more lethal than ever. We expect when we close the books for 2016; the number of overdose deaths will be over 1,300. This is the highest ever recorded and 90 percent of the increase is related to heroin and fentanyl. That is the bad news. The good news is that these deaths are preventable. And it will take the all hands approach that we are describing to you today. It will take the NYPD; it will take our public hospital system. And I’d like to thank Stan Brezenoff who is here from Health & Hospitals for what has been a really great public health, public hospital collaboration. And thank our Deputy Mayor, Herminia Palacio who has helped to knit together the whole health and human services portfolio to take this public health approach.

New York City has led the country in tackling overprescribing of highly addictive painkillers. The prescription painkillers are exactly the same biologically and just as addictive as illegal street drugs. And reducing this source by changing prescribing patterns along with efforts at [inaudible] that Police Commissioner O’Neill has described is key to prevention. As part of Healing NYC, we’re going to continue to focus on what we call judicious prescribing. This means encouraging doctors and other health workers to prescribe non-opioid painkillers; when they prescribe opioid painkillers to have them prescribed for shorter durations, lower doses. And we also are going to continue our door to door campaign of talking face to face to prescribers. And we have done this in the Bronx, we’ve done it in Staten Island and this spring we will be extending to Brooklyn. Our priority here is to stop preventable deaths, to keep people alive, and to connect them to care.

I want to take a moment to focus on what is really a new strategy, which will be targeting communities at highest risk with prevention messages in care. We’re going to follow the model that we have used for infectious diseases and outbreak investigations and using the wealth of data that we collect with RX-Stat and our own Health Department data. The Health Department is deploying field staff to neighborhoods which show emerging drug issues. This means when we see a large increase in fentanyl-related deaths or an increase in overdose visits to emergency departments, our brand new team of public health workers will rapidly enter these communities; bring essential information, and resources to reach people at risk. They will educate people about the risk associated with opioids. People who use fentanyl often have no idea that it is mixed in the drugs that they are using. And we’re importantly going to ensure that people know about and know how to use naloxone. Overdose deaths are showing up in neighborhoods that haven’t seen this before. They may not be paying attention when we talk about naloxone. When we see an uptick in overdose deaths we will deploy people and make sure people have information about how to reverse overdoses; understand how treatment is available, access to harm reduction services is available. And again, I want to repeat the number that all of us – I want to be sure everyone in this room learns it is 1-888-NYC-WELL. And for those of you who like numbers better, that number is 1-888-692-9355 – the Thrive NYC open portal.

So, thank you again Mr. Mayor, First Lady for prioritizing public health and for creating the right response to this terrible epidemic that has cost too many lives.

Mayor: Thank you, Dr. Bassett.

Finally, I want to call upon the District Attorney of the Bronx who is a crucial partner in this effort, District Attorney Darcel Clark.

[…]

Mayor: Thank you very much, District Attorney.

I want to – before we open up to questions – just thank everyone at Lincoln Hospital. We are here at Lincoln Hospital because this is literally one of the epicenters here in this community – one of the epicenters of the opioid crisis in this City. But also, Lincoln Hospital is one of the facilities that is doing the most to address this crisis and has innovated some of the most effective approaches. So, we wanted to be here to thank everyone at Lincoln Hospital for being on the frontline of this fight.

We’re going to take questions on this plan, and then we'll be taking questions on other topics. Yes?

Question: In the report, you talk about the success of the program in Staten Island – the pre-arraignment program and also, the program that treats every overdose case like a murder. I'm wondering if you can quantify, in terms of arrests, cases, and convictions probably, the successes of that program and how much it's going to cost to rule that out citywide? 

Commissioner O’Neill: Sure. In Staten Island, the HOPE program recently started. I think we have a couple months under our belt. We have 78 people that qualified for the program; 73 of them are still in the program. I think there were five people that made the decision not to participate. But so far, I think we're in fairly good shape. People are enthused. Again, these are people with not significant criminal histories. They go into the program after we arrest them. There's a DAT date that's set and if they maintain their treatment, the District Attorney out in Staten Island will seal that record and not charge them.

And then, just move it across – move it across the city, we are investigating every overdose now, every overdose death. In 2016, we investigated 381 overdose incidents. With the additional personnel that we'll be getting, that number will, of course, will increase. We did 56 in Staten Island, 90 in Brooklyn, 61 in Manhattan, 77 in the Bronx, and 97 in Queens. And out of that, we're working on 64 long-term cases. We do have a number of arrests, but I don't want to give that number out. 

Mayor: All right. David? 

Question: I've got two questions. One is – does anyone on the panel see an inflection point with the moment when the State implemented its I-STOP program? This is a program that's meant to prevent the improper prescribing and really get ahold of how these pills are getting out there. A lot of addicts talk about how, when the sort of supply of pills dried up, they moved to heroin. You see in the chart there's actually a pretty large jump right there. It goes into effect in 2014. And then you have a, it's very advanced, but [inaudible] – 

Mayor: You'll get the second one, let me just have him speak to Dr. Palacio or Dr. Bassett – you want to speak to that? 

Deputy Mayor Palacio: Sure. I'll begin just by crediting the New York Department of Health and Mental Hygiene that actually served as a national leader for judicious prescribing of opioids for healthcare providers. In fact, it was New York City's plan that was adopted by the CDC as a template for the national plan.

In terms of the change from opioids to heroin, I think there are multiple factors in play. One is more judicious prescribing. Some of it is actually just economics. Right now, heroin is much cheaper. It is once people are addicted, and they really continue to need to find opioids to sustain that addiction because withdrawal feels physically – physically terrible. Not just emotionally terrible, it is a physically very painful condition. Buying heroin is a much more economical way.  
Commissioner Bassett: In terms of our data, we saw – we saw heroin begin to increase before we saw – as prescription drugs were continuing to increase. So there is a concern about the displacement question that you asked, but the problem has just been a rise in opioid dependence. And that's what we're seeking to address, regardless of the type of drug. 

Mayor: What's your second question? 

Question: [Inaudible] panel, someone asked you a question at a town hall about homelessness. They said it had been three years and change. What took so long? If this is a problem, as you can see from the chart and as people were saying in 2013 and 2014, it's already evident to a lot of people in the Bronx and Staten Island – why did it take you so long to do this?

Mayor: Well, I'll start and then – I'm sorry, Chirlane will start and I'll follow.

[Laughter]

First Lady McCray: HealingNYC is a –

Mayor: [Inaudible]

First Lady McCray: Better. All right. HealingNYC is a new phase of efforts that were already underway to address this problem. It builds on steps that Thrive was taking to address the root causes of addiction, to expand access to naloxone, and to educate doctors about buprenorphine and get them to prescribe it. This is something we've been monitoring very carefully, and the presence of fentanyl really was a game changer. 

Mayor: I'll pick up on that before either commissioner wants to speak to it, but my argument here would be – a lot of the pieces were in place and moving, but the last year has been very sobering. You see that difference between the 2015 fatalities and 2016. It's shocking. And yes, it's largely because of fentanyl, but it also is a wake-up call to us that we had to deploy a whole new range of tools to address this.

Commissioner O’Neill: We started our naloxone program back in 2013, David. As you know, the NYPD has historically engaged in narcotics enforcement efforts. Just last year in 2016, we seized 835 pounds of heroin in New York City. And then that's up 90% from 2015 where we seized 439. And in 2016, we seized 160 pounds of fentanyl.  

Mayor: Okay. Yes?

Question: My question is one for Director Fuleihan. Can you provide us with a line-item breakdown of where the 38 million dollars in costs are coming from? And for Commissioner O'Neill, where is the heroin coming from?

Director Dean Fuleihan, Office of Management and Budget: Sure, we’ll be happy to give you a breakdown between the agencies. We can do that after. We'll make sure you get the breakdown of both the PD and DOHMH and Health + Hospitals as well.

Question: And then Commissioner – the heroin and fentanyl, where are they coming from?

Commissioner O’Neill: Yeah, most of the heroin is coming from Mexico. Some of it is coming from Asia. And the fentanyl we see coming from overseas.

Question: How is it getting here?

Commissioner O’Neill: All different ways. By boat, over the border, through tractor trailers, in airplanes. So there's many different ways to bring it here.

Mayor: Okay. Marcia?

Question: This is actually a question for the Police Commissioner. You said that you're going to investigate every overdose. Does that mean that really what you're trying to find out is how the person got the illegal drug? And what will you do, are you going to go after the person that sold it to them, a bigger distributor? I mean what's the goal here?

Commissioner O’Neill: So the goal here is we're gonna work from the top down. That's how we – Drug Enforcement Task Force, with the DEA, Strike Force – everything I spoke about. But we also have an obligation to do that from the ground up also. So, on every overdose, whether it's a death, or whether it's a save, or somebody that we find out subsequently to the OD, we're gonna conduct an interview. And then work our way up the food chain. And we're not looking to lock up the person that OD'd, or even the person that might have been with them. Because there’s a – I talk about everybody has an obligation to assist here, so we're not looking to penalize anyone that helps save someone that ODs.

Question: [Inaudible] looking to arrest – 

Commissioner O’Neill: To go further up the food chain. We'll interview the people involved and we'll see if we can bring ourselves up that food chain to see if we can identify a major dealer. And also just to – Marcia, just to answer that, we're adding the 50 people to the lab, so we'll be able to better analyze all the drugs that we seize and we'll see which has fentanyl.

Mayor: Yeah?

Question: In terms of the enhanced prosecution, is the idea to prosecute suppliers or dealers in those cases as attempted murders or murderers? There’s been some talk about?

Commissioner O’Neill: I don't think we've gotten to that point yet, but if Darcel – I don't know if you want to talk about that.
Bronx District Attorney Darcel D. Clark: We are looking into that possibility. I know some of the federal authorities have tried it, of course, their laws are a little different than ours. But, we're gonna try to be as creative as possible to do whatever we can to eliminate those drug traffickers that are doing it. And if we can make a connection between the dealer or the trafficker and the person who has been harmed, by all means, we're gonna use every possible tool we have to make sure that we prosecute them to the fullest extent of the law. 

Question: To follow up on that, New York has a Good Samaritan Law that protects people. I'm wondering if maybe the Health Commissioner can weigh in to try to encourage people to call 9-1-1. Is there any concern that the fear of punishment will actually dissuade people from calling 9-1-1?

Commissioner O’Neill: Let me just jump first – that's exactly what we don't want to happen and I think the City is going to do a public information campaign about the Good Samaritan Law, so everybody knows that if you make a phone call, you're not in jeopardy of being arrested.

Question: Often times [inaudible] suppliers like friends, you know, people talk together and then one person, a friend, is charged with murder. Is that something people here should start to worry about?

Commissioner O’Neill: No, we're looking to, as I said, we're looking to go further up the food chain.

Commissioner Bassett: No, I think it's really important to remind people about the Good Samaritan Law and the Police Department, as I understand it, is going to do a public information campaign to let people know. We want also to make sure that everyone is aware that they should – if they know someone who uses, if they use, that they should have naloxone. And that they can get naloxone because if you carry naloxone, you can save a life. And that should be completely clear that that is legal and, in fact, life-saving behavior.

Mayor: Before we take other questions, just since the Special Narcotics Prosecutor is here, I want to emphasize, and I'll turn to her to that. What the Commissioner keeps saying is we're trying to get to where the supply is coming from. And again, this is a complicated web. But the more we can find the serious players in this equation and stop them, the more lives we can save. So I want to see if you'd like to add to that. 

Special Prosecutor Bridget Brennan, Office of the Special Narcotics Prosecutor: Thank you very much. The goal in any narcotics investigation is to shut off the supply chain as high up as possible. And to prevent use by preventing availability. And so when we get one of these cases, we take it as far as we can, in terms of identifying the most significant suppliers or, ultimately, the international source. Thank you.

Mayor: Thank you. Anna?

Question: So most of this [inaudible] like a lot of it, at the very least, is stuff that the City has been doing or other people have been doing for several years, and you guys have mentioned a lot of programs on Staten Island that have worked and are already in place. I'm just wondering, do you guys see this as really a new plan? Or – 

Mayor: Absolutely. It's a new plan with a host of new elements. It obviously is building upon some pieces that worked before. In some cases, expanding them. This is how you build out something that can have a true citywide impact. But one of the things – and the two doctors, Dr. Bassett and Dr. Palacio, can speak to this – is we know that there are many people who need treatment, who aren't getting it. That is true in all five boroughs. And one of the things we have to do better is make contact with them and their loved ones and get them into the treatment programs that work, that there are spaces available in right now. That's something that there hasn't been enough success at previously, so this is a much more focused effort to achieve that.
But as we get more and more people connected to treatment, we're gonna expand the amount of treatment to the tune of 20,000 more people who can be served ultimately in this city. So that is a whole different approach to what was taken previously. And once again, I believe, the First Lady is going to weigh in first.

Commissioner Bassett: She’s the honorary doctor. 

First Lady McCray: One of the tools we did not have before was our central access point – NYC Well, 1-8-8-8-NYC-WELL. Remember that this number is just not for someone who's addicted, a loved one can actually call that number and ask for guidance about how to talk to the person that they know who is using these opioids. So, NYC Well is a very important tool to be able to connect people to care. We did not have that before and is a very powerful tool in this arsenal.

Mayor: And just – let me just add and pass it back to the doctors that – so again, there are methadone programs right now that have space that could be helping people. There are doctors who can prescribe buprenorphine right now who are not being connected to those who need it, so this is why I describe NYC Well as air-traffic control. Get a call from someone in need, that person gets connected to a doctor or to a treatment program, that right now there's a total disconnect. While simultaneously, we're increasing the supply of treatment all along.

Deputy Mayor Palacio: I just wanted to add – what this plan does is, as the Mayor said, it not only builds on streams of work and effort and initiatives that the City has been putting in place that work, but it really ties together a number of things – things that we were already doing that work. It puts new things in place, some of which we know work, some of which are, frankly, cutting-edge and we hope will really contribute not just to a reduction of opioids deaths here, but will really demonstrate to the nation different paths that they can take in terms of best practice.
And we're not just here to say very loudly and clearly that addiction is a disease, it's important, with all of the First Lady's work, to de-stigmatize mental health issues and substance abuse issues, but we also want to de-stigmatize treatment. It is really important to understand that these are effective medications – methadone and buprenorphine are effective medications to treat a chronic illness. And they should not carry any stigma for people who are choosing to take the most effective medications we have available to us to allow them to sustain good jobs, to allow them to function, to allow them to live, to, in fact, allow them to thrive. And Health + Hospitals is positioned to be a leader in providing these kinds of – and expanding these kinds of treatment and doing comprehensive addiction treatment.

Mayor: Yeah?

Question: Where did the 35 percent number come from? You said you want to reduce it by 35 percent. And, wouldn't that just get you back to 2015?

Mayor: So, first of all, every life we're saving as we arrest this trend and turn it downwards. Now remember, each year we're going to be saving more and more lives. We start every one of these plans with the question: how far can we go, how quickly? Given that this is a problem that's too often in the shadows, this is what we think is the realistic, initial – hold on, we’re having a technology problem over there, Juliet; it’s all right – this is what we think is realistic, beginning of this effort. Everything we do, we want to do more and faster, but we're trying to level with people about what we think can definitely be done over these next few years. But, it's going to take participation of New Yorkers who are dealing with these challenges in their families and with their friends. I mean we have to get people engaged in treatment if we're going to turn this around. And that's the crucial piece here. We are building out the tools to treat more and more people, but we have to find the people who need the help. So this is our assessment of what can be done, what's realistic, but we're gonna take every opportunity to go beyond it.

Juliet?

Question: Yes, a question for DA Clark, when you conduct the investigation in the tractor trailers, were you able to tie any of that cartel into homicides [inaudible]?

Bronx District Attorney Clark: No, not that particular investigation, but it's still under investigation as well. So at this time, no information there, but we're continuing to investigate that case and many others.

Mayor: Yeah?

Question: The people who work with the recovery community – an issue that they expressed is that there's a limited number of outpatient treatment beds, for example. [Inaudible] which has the highest number of drug and alcohol-related hospitalizations in the borough, doesn't have any outpatient treatment beds. Detox center closed after the hurricane, and then the only hospital there actually closed their beds as well. Is there a plan –

Mayor: No, wait, there is still a hospital. Let's be clear.

Question: No, I said, the only hospital there closed their beds.

Mayor: Oh okay, fair enough, right, right.
Question: Within this plan – I didn’t read it in the plan – is there an actual plan or a second part to add more treatment beds?

Mayor: I want the two doctors to talk about the approach that we think that works, which is about real treatment.

Commissioner Bassett: So the backbone of treatment is outpatient treatment, which is both methadone, which we're all familiar with, and buprenorphine, which has been hugely underutilized and is poised to expand in New York City because of our commitment to training people and supporting people in prescribing buprenorphine. And also, because of changes at federal level, which are allowing different classes of health workers: nurse practitioners, physician's assistants, to under the CARA, the Comprehensive Addiction Recovery Act, to prescribe. So that just started in February.

The whole issue of inpatient beds is really not, in our view, the backbone of treatment, but we're aware that there is a need for inpatient beds. These are handled by the State by OASIS, and our main goal – because people have to go home, they can't stay in a bed forever – is to ensure that the people have access to comprehensive medication-assisted treatment on an outpatient basis.
Now, all thought city, and Mr. Mayor, you tell me when I go on too long –

Mayor: You're doing good, you’re doing good, go with it.

Commissioner Bassett: All through the city, we know that we have an underutilization of available methadone treatment slots. There are – anyone in any borough can find a treatment slot in the methadone program. Further, should those all be used, then OASIS, the State agency, responsible for addiction services will certify an expansion of that treatment.

Buprenorphine is a much more flexible treatment program because it can be available in primary care settings. And as you've heard from the First Lady, there are going to be additional training opportunities for healthcare workers in being certified for buprenorphine with a goal of 1,000 to 1,500 new prescribers. Our goal is to have another 4,000 people on treatment in the coming fiscal year.

Question: Can you just talk a little about how SUBOXONE, which is used for a lot of opioid?

Commissioner Bassett: That's buprenorphine – same thing. It's the brand name for buprenorphine.

Mayor: Okay, Rich?

Question: Mr. Mayor, you made some pretty – seemed to me – serious allegations about the pharmaceutical industry here. I think you said they encourage overuse of painkillers, that they peddle them in the name of profit, that the overuse was planned by pharmaceutical industry. And now you've got the – I don't know who produces the drugs that undo this – but it seems to me it probably is a pharmaceutical industry as well. So do you think they're criminally liable in any way here? Or is this?

Mayor: I'm not going to speak to the criminal element; we have experts on that. We know it – folks around me will explain the history. But what's abundantly clear is that these super-addictive drugs were promoted – by the way, remember when we learned years ago, that cigarettes had been promoted with messages from doctors saying it wouldn't hurt you, and the industry went to a lot of trouble to put out those messages and find doctors who would say that, and to make sure that the doctors who wouldn't say that wouldn't get heard? I mean we need to look in the face the extent of human greed. So here, a bill of goods was sold to people that these drugs were not dangerous and didn't lead to long-term addiction, when in fact, it was well known that they did.
Anyone want to add?

Special Prosecutor Brennan: If you want me to – 

Mayor: Please, go ahead. Line up.

Special Prosecutor Brennan: There actually was a federal prosecution of top executives from Purdue Pharma – I believe it was in the early 2000s – and three of the executives took pleas to misdemeanors, related to the misbranding of the drugs, which was actually misrepresenting what the drugs would do. Purdue Pharma took a fine of – I think – $637 million. So, there actually was a criminal prosecution at one time. There were consequences for those who manufactured one of the original drugs, which was Oxycontin, the first one that kind of broke through that barrier to opioid prescribing.

Thank you.

Mayor: Okay, we're good? Okay, who has not gone yet? Over there.

Question: You mentioned West Virginia, and I was wondering if carfentanyl has showed up? It's been responsible for hundreds of ODs in West Virginia, Indiana, Kentucky –

Commissioner Bassett: No, it's like fentanyl. I mean, I know that – if one of the challenges we face is that these synthetic narcotics or opioids are being produced in illegal labs, many of them outside the United States, and they're coming up with different formulations, some of which are difficult to detect. I don't know that we've found that here in New York City. I haven't heard that we have, but I know that the Medical Examiner's Office has a laboratory that is working hard on keeping up with these synthetic opioid lab formulations. Sometimes they find metabolites, but they don't find the original product, so we are concerned with our ability to continue to detect these formulations. That's why it's so important that people understand that street drugs are more lethal than ever.

Mayor: Hold on, just one ground rule. Anyone who has not asked first. We want to take all the questions on this topic, but I want to let Dr. Palacio finish and then first folks who haven't asked at all, and then we'll come around on others.

Deputy Mayor Palacio: Your question just goes to the importance of really the multi-agency work that's being done here. As Dr. Basset indicated, the office of the Chief Medical Examiner is providing lots of evidence to help us understand this epidemic. That is in fact one of the reasons that we know that over 50 percent of the overdose deaths in the last year were because of Fentanyl. As we uncover new trends, we will respond accordingly. This is a plan that evolves based on the data from multiple initiatives here across the city.

Mayor: Okay, who has not gone yet? Brigid?

Question: It sounds like there's an important awareness component of this program. I'm wondering is part of that going to actually be in the schools? I know you have a lot of agencies involved here, but what's happening for some of the younger folks who are encountering some of this?

First Lady McCray: There is an effort in the schools, and we're working to make sure that young folks are aware of this. The users though, tend to be much older – 25 to 35 to 50 or so. But we do want to make sure our children, our young people, are making good choices, are not succumbing to peer pressure because often what happens is they'll use something that will be a gateway to using opioids later on. We have social, emotional training for our teachers in our schools. We have mental health support in all of our schools now, which we've never had before, and we're working to make sure that there is this greater awareness of the dangers of addiction. Greater access to treatment and awareness that we do have numbers that we have like 888-NYC-WELL that people can call for themselves or if they know someone else who is using.

Commissioner O’Neill: We do have – in Staten Island, we have police officers, and neighborhood policing commands, NCOs, going into schools and speaking to the fifth grades, called Too Good for Drugs. We're looking to possibly expand that citywide.

Mayor: Grace?

Question: What's the cost if you buy Naloxone over the – at a pharmacy? Is there any discussion about subsidizing that or trying to lower the cost?

Commissioner Bassett: The latest information that I have is that the Naloxone over the counter costs about$50. It is for a kit, which is two doses. It is covered by many insurance plans, but that's something that a person would have to discuss directly with a pharmacist. When we're making it available, we're making it available at no cost.

Mayor: Right, so I want to emphasize that. Everything that's being given out currently, plus the commitment to 100,000 more, those are all free distribution. That's obviously going to reach a lot of people.

Okay, who has not gone yet? Way in the back?

Question: Is the theme of the addiction starting with painkillers, and that leading to heroin, Fentanyl? Is that consistent in all parts of the city? Would you say that's the number one contributor no matter what borough you're in? And, I guess, a follow up, or another way of saying that is – the factors that have contributed to this epidemic in the Bronx, do you see anything different in the Bronx than in Staten Island?

Commissioner Bassett: That's a really good question, and it's true that the Bronx, where we are right now, has been the heartland for heroin addiction in the city for many, many years. But this – the current epidemic has been affected by opioid prescription drugs across the city. This opened up a new pathway to opioid addiction that we didn't have in every single borough. There are – two decades ago, if you asked somebody going into treatment, ‘how did you start out using heroin?’ They'd say, ‘I started out using heroin. Now I'm trying to get treatment.’ Now, as you've heard, four out of five people start out using opioid prescriptions.

Mayor: Just as the layman here on the panel because I was asking these very same questions as we prepared, I think one way to think about it is – we had a heroin problem for decades. It was leveling off. Unfortunately, because of these prescription drugs, we ended up with a much bigger heroin problem than we've had in a long, long time. That has happened in many parts of the city.

First Lady McCray: The advent of Fentanyl is what made it so deadly. Most of the overdose – not most – but at least half of the overdose deaths last year were due to the addition of Fentanyl. That's important to remember.

Mayor: Who has not gone first? Yes sir?

Question: Hi, so, what's being done against the doctors and pharmacists who are over prescribing these medications to patients? Is there any action being taken on them, or more investigations?

Deputy Mayor Palacio: In general, sort of prescribing – physicians are regulated by the state. Part of what we're doing is to make sure that physicians really understand – is training. That physicians better understand the risk of overprescribing, that they get the tools that they need to think critically around first using a non-opioid medication as the first line of treatment for pain. And if opioid treatment is in fact medically appropriate to think about using the least dosage that is required, to not prescribe an excess number of pills and to prescribe less frequently.

Special Prosecutor Brennan: For those doctors who are involved in basically pill mills, whose conduct is far beyond, just perhaps, a little bit careless, we have prosecuted them. In fact, we convicted one doctor of manslaughter in connection with the death of a couple of his patients. And we have a whole unit that's devoted to that kind of prosecution.

Mayor: Okay, I'll call one more time, who has not gone?

Question: Do you hear of any cases of teenagers having parties using these kinds of drugs?
Mayor: I'm sorry, of –

Question: I hear cases of teenagers –

Mayor: Teenagers –

Question: Having parties, using these kinds of drugs, and they have somebody in charge of the Naloxone in case somebody have an overdose the same way somebody have a designated driver.

Mayor: Please, let's let Hector give some insight.

Mata: I believe this is why – the reason why the First Lady's making sure that we're having these conversations because if we don't have these conversations, then we're not going to know that our kids are using drugs. We have to get to the part of our community that's not willing or that's not talking about drug use. Because yes, it does happen, but if we don't speak about it, if we're not aware how to like recognize or how to like reverse an overdose, then we're not going to find out until it's too late. Once somebody's dead, nobody can recover from that.

Mayor: Thank you. Dr. Basset?

Commissioner Bassett: I think what we want to be careful about is a misconception that having a Naloxone available, which can reverse an overdose, makes people more likely to use these drugs. As you've heard, the drivers behind rising use of opioids are multifold, importantly tied to the prescription drugs, which were given to them by physicians, legally prescribed. But people should understand that when you’re reversed with Naloxone, that's no party. It is an immediate, throwing that individual into withdrawal. They feel terrible, am I right, Hector?

Hector: 100 percent.

Commissioner Bassett: You want to say more about that? This is not something that people to look forward to. We need people to be safe. It is important to carry Naloxone so that we can save a life.

Mayor: Go ahead.

Question: [Inaudible] specifically for all of the NYPD patrol officers to receive them?

Mayor: When do start off on the patrol officers?

Commissioner O'Neill: We're going to transition to Narcan, so all of our patrol officers will have 25,000 kits available to them. We're just working on finalizing the funding for the roll-out plan. 

Mayor: And Narcan is just a version of Naloxone. But the timeline?

Commissioner O'Neill: I can't give you a definitive.

Mayor: Okay, so-

Commissioner O'Neill: Right now, we have 13,000 kits out there with 17,000 people trained.

Mayor: Okay. Go ahead on the 100,000 timeline.

Deputy Mayor Palacio: Overall, the plan calls for a hundred thousand by the year 2019, over the life of the plan. We are increasing that in very rapid order as we get there in a variety of distribution mechanisms.

First Lady McCray: We're doing trainings on how to use it all over the city. We've already started.

Mayor: Okay, who has not gone – Okay, Mary, you want to add on the distribution to police?

Commissioner Bassett: The Police Commissioner is absolutely the best qualified to speak to this, but the police already are distributing 13,000. So taking it up to their entire patrol force is basically a doubling of the distribution of Naloxone. The formulation is what's under discussion. Just getting an easier to use kit, but as you saw, the kit the First Lady demonstrated to us all, is pretty easy to use. So this means that every person on patrol will have the ability to reverse an overdose. It doesn't mean that it will always be used. Last year, I think the Police Department reversed about 50 individuals. Going forward, we'll have every patrol officer in the position to reverse.

Mayor: Last call for who has not gone, and then the patient. Anna Sanders will be next. Anyone not gone? Okay, Anna Sanders.

Question: So from my understanding with Fentanyl, you often have to use more than one dose of Naloxone. So as more people are using heroin laced with Fentanyl, you might have more instances where Naloxone has to be used two doses at a time, versus one. With the deal that the Attorney General has against pharmaceuticals running out at the end of the year.

Mayor: Okay, you better look that way, because I don't know the details. Look at the doctors on this one.

Question: You guys had a deal with the pharmaceutical companies to provide Naloxone to the city, only to the end of this year to get a cheaper – like a rebate of some kind. Is this huge investment in raking up how much Naloxone you guys are using and increasing the reliance on Naloxone – is there a concern about the funding for this running out, or not having enough, or the price skyrockets –

Commissioner Bassett: We're in active negotiations about the price of the kits, and we are adequately funded to purchase the kits to distribute 100,000 doses that have been described. You're quite right that Fentanyl means that some people will need to receive both doses of Naloxone. Of course, we always tell people to call 911 first. You notice that the First Lady said, call 911, then administer Naloxone. Everybody who's reversed should be taken to a hospital because we don't know what they have on board. Almost all of our drug overdose deaths are related to mixed drug use that includes opioids, but may not be limited to that.  So, we want anyone who's overdosed to be taken to hospital and to be assessed, and be sure that they are, in fact, safe.

Question: Have you ever come across a situation where someone needed three doses of Naloxone or Narcan?

Commissioner Bassett: I haven't. I should turn to Dr. Hillary Kunins who may speak to that. I believe that it's possible, so let's hear from her.

Mayor: Doctor, just announce your title and all, so people know.

Assistant Commissioner Dr. Hillary Kunins, Department of Health and Mental Hygiene: I'm Dr. Hillary Kunins, Assistant Commissioner at New York City Department of Health and Mental Hygiene.

So we are – we have heard reports of more than one dose being required to reverse an overdose. Often, we don't know at the time whether that is because of the presence of Fentanyl because testing is not typically available on the spot. All of our kits have two doses of Naloxone, and the instructions are to give a second dose after approximately two to three minutes, which can feel like an awfully long time when you're the person doing the reversal. In that time emergency medical services usually arrives with additional Naloxone. So if additional doses are needed, they can administer them at that time. So we certainly have heard reports of additional dosing that are needed. Sometimes we don't know, whether because people in the heat of the moment go to administer a third dose or fourth dose because they're nervous about waiting the sufficient amount of time. We believe the two doses will by and large be adequate to respond in most cases.

Mayor: Okay, go ahead.

Question: Where the 20,000 number came from in terms of getting people on Suboxone, and if you have an estimate for the number of regular heroin users in the city? And then the second –

Mayor: Wait, wait, stay on that first.

Go ahead, so you got those?

Commissioner Bassett: The 20,000 is people on medically assisted treatment, so it means fully utilizing our methadone treatment slots, as well as expanding Buprenorphine, and this is really based on an ambitious goal that we think is doable. On your question, which the Mayor just asked us recently about how many people are there who are opioid users in New York City, and opioid-dependent. That's an estimate that we can only guess at, but it runs as high as 85,000. 

Mayor: Let me just speak to that. So again, you can imagine, since so much of this problem is in the shadows, we don't have a perfectly verifiable way of knowing how many people are addicted. But, let's take that number as what we think is the high end of 85,000. We're in the process of getting treatment available at any given moment for 58,000. That is what we believe is the realistic stretch-goal to get treatment online quickly. Then I ask the obvious question, what's that gap? And the answer was – there are always going to be a number of people who are addicted who have not yet come forward, and we don't even know to be able to connect them to treatment, or not willing to come to treatment, or their family members and friends have not told us they need treatment. We think with a strength of 58,000 people that we can reach at any given time that that's the number that will actually serve the realistic need.

Did you have a follow-up?

Question: Yeah, I wanted to know if there's been a campaign for a safe injection facility, if you guys looked at that and what [inaudible]?

First Lady McCray: There's no plan for a safe injection site at this moment, but there is a study. Through – the City Council is working with DOHMH to do the study, and we'll take a look at whatever proposals come out of it.

Question: I have 20 questions -

[Laughter]

Mayor: That's too many. 

Question: In each kit, how many doses are there and how many kits can a civilian purchase from a pharmacy-

Mayor: Stay there, let's do in sequence.

Dr. Bassett: Two doses, no limit.

Question: Okay, and Mayor, when you say that you're going to reduce overdose deaths by 35 percent, is that from 1300 to about 850, 930 to about 600? I mean, what's the number you're –

Mayor: I want the Deputy Mayor and the Commissioner to talk about how we are defining that specifically, but I want to remind you we're talking about a goal over a series of years, but each year, we're driving down the number. So, don't just think about where we are now and where we are five years from now. Every single year, that number should be going down along the way, so we're saving hundreds of lives along the way, and then establishing a much lower level and then obviously again want to drive it down past that.

Question: So again, the 35 stretch-goal, where we are now, is about 1,075, slightly about 1,100 opioid-related overdose deaths. The 1,300 was all overdose deaths. Our 35 percent over five years is a target that we believe is achievable by putting many of these things in place. As the Mayor said, we're always trying to achieve more. This is a process where we will continue to learn. We will chase down initiatives that are working. We may need to do some mid-course corrections for initiatives that are not working as fast as we would like them to. And while the Naloxone that we've been spending so much time, as the sort of very up close for somebody who has already overdosed, many of these initiatives build on each other to try to get people from ever getting to the point of an overdose. Getting people into treatment reduces their risk of getting to an overdose. Getting people into prevention services reduces their risk of an overdose. So these are additive strategies that we're putting in place with a fairly aggressive goal in the face of an epidemic. Right? We've got forces that are working against us. We see an increase in the number of drugs being cut with Fentanyl as you've heard from the police commissioner, so we are really trying to combat – we're swimming upstream here and working very aggressively to make sure that we can protect people and families.

Mayor: To add to the point, so again, the base number we're dealing with is almost 1,100 opioid-related deaths, and that's the base from which we will reduce 35 percent. But I do want to parallel this to the other two big crises we face in terms of protecting human life. For years and years in this city, the number of people murdered was extraordinary and the human impact was horribly painful. Now, over almost a quarter century, the NYPD working with people in the community level has driven down the murder rate to now almost an all-time low. That took steady effort to keep driving it down. What we're doing with Vision Zero, which was initiated because we saw the number of traffic fatalities almost approaching the number of murders in a given year that has shown an immediate impact in reduction. The goal is to keep driving it down. In percentage terms – and when I talk about percentages, it's important to do it – but again, every single case is a human life we're talking about. We can reduce 35 percent in the course of five years that's an even faster rate than we're talking about the ways we have addressed some of these other problems historically. We want to go as fast and as far as with can. This one, we have the problem that we don't know about so many of the people in need. But we also have the treatment available right now. So if we can start to create some momentum where people come forward and receive treatment, this is something we can turn around, in some ways, faster than some of the other crises if we can connect the dots. If we can get people to come forward and get the treatment they need. 

Anything that's left on this, and then we'll go to other topics, David?

Question: I do want to go to the off topic, so I'll ask very simply-

Mayor: Well, we appreciate that.

[Laughter]

Question: Was the DA for Staten Island invited to this event?

Mayor: We talk to him all the time. This is obviously an event in the Bronx, so that's why the DA from the Bronx is here. 

Question: Was he not invited?

Mayor: I don't know if he was invited. I don't know who gets invited. I'm saying we work very closely with him.
Yes?

Unknown: I think the people should know that as soon as you change the programs, you're also training people and providing a Naloxone to those that are in need.

Mayor: Thank you. 

Okay, last call on questions from the media before we turn over?

Question: Is there going to be an effort to make more detox programs and recovery programs for people who don't have a lot of money? There are plenty of rehabs that cost a lot of money, but there are also plenty of people that don't have that kind of money. So is there going to be –

Mayor: I think the answer, again as the layman, is the answer is the kind of treatment programs, which the doctors will reiterate that are available right now – I don't know the financing dynamics, you can describe that, but not the detox, the treatment.

You need to have your microphone on, and talk about if insurance covers and that sort of thing.

Deputy Mayor Palacio: Again, the linchpin to our plan is focusing on what we know the science tells us are the most effective treatment modalities, which are the medication assisted treatment rather than the shorter term detox modalities. The methadone clinics are funded by the state. Buprenorphine, we can – people can receive in the same way they receive other services at Health and Hospitals based on ability to pay is what they're charged, and in private providers it will depend on what the provider's insurance status is. But there will be treatment available for people of all economic status. 

Mayor: Last call on this topic, going once, going twice. Other topics.

Question: [Inaudible] bag check on the Staten Island ferry [inaudible].

Mayor: I had not heard that allegation previously, and a bag check by who?

Question: The NYPD.

Mayor: Okay, Commissioner are you familiar with this one?

Commissioner O’Neill: No, I’m not. I’m going to have to get back to you on that.

Mayor: We’ll have to find out.

Okay, other questions? Yes?

Question: Health Department made [inaudible] new case of neonatal herpes linked to metzitzah b’peh. The Health Department said it was reconsidering the deal that you had talked about a couple of years ago. Can you tell us where your thoughts are on this and if the deal with the Hasidic community that you made still in effect or if you’re going back to the drawing board considering [inaudible]?

Mayor: We are evaluating the situation. We now have enough experience to look at the situation and decide if the current policy is working effectively or not. Number one goal is to protect children, so we’ll have an evaluation soon, and then we’ll determine a course of action.

Question: When do you expect to have that evaluation?

Mayor: I think in a matter of weeks.

Brigid?

Question: Mr. Mayor, WNYC’s been reporting about outside income for members of the NYPD. The latest report today talked specifically about a commander from – excuse, a chief from – Staten Island with outside income that seemed to also have some links to organized crime. A question for you and for the commissioner, are you going to do any investigation to follow up on those reports and also do you think that the city’s Conflict of Interest Board does enough – can oversee enough – when it comes to the outside income that those folks are declaring?

Mayor: Well, I had not heard the specific report. I’m obviously concerned about it. I don’t have a good enough sense of how many specific situations are looked at by the Conflict of Interest Board in terms of the NYPD. I think the Conflict of Interest Board is a very high functioning agency in the sense of being able to provide very specific guidance, but I don’t know what volume of those requests is coming from the PD, so I’ll turn to the commissioner.

Commissioner O’Neill: So I read the article today in the Daily News that was originally put forth by Rob Lewis from WNYC. And based on that I think we knew about it a little bit beforehand. We – I mean I had a discussion with Joe Reznick our Deputy Commissioner of Internal Affairs, so he opened  up an investigation.

Mayor: Melissa?

Question: Mayor, your reaction to the ousting of U.S. Attorney Preet Bharara. Do you feel like this is a loss for NY and does the investigation into City Hall and all that’s been going on color your view about his departure in any way?

Mayor: Melissa, I’m just not going to comment on it. Obviously there’s an ongoing investigation, so it’s not appropriate to comment on it.

Marcia?

Question: This is sort of a follow up question. I wonder – given the fact that whoever becomes the U.S. Attorney will be a Republican, I wonder if you think that politics could suddenly play a role in the investigation of you administration especially in light of the fact that you’ve been an ardent and enthusiastic critic of President Trump?

Mayor: That last part is accurate, but again I’m not going to comment on the situation involving the U.S. Attorney.

In the back?

Question: Mr. Mayor, on Friday on the Brian Lehrer show you seemed to indicate that media outlets shouldn’t be trusted to report on the budget. Do you stand by that claim?

Mayor: I was referring to a specific article that I think failed clearly to look at the adopted budget of the last three years, which I thought was an omission that went beyond, you know, ignorance. It’s really disingenuous to suggest – and I have a witness here in the Budget Director – to suggest that we haven’t fully funded emergency food programs. This is an issue I worked on for 15 years going back to when I started being general welfare chairman in 2002. And every time there’s been a need for additional funding for emergency food, we fulfilled it. So the notion at the beginning of a budget process you start with a baseline number and then adjust according to need – and according to negotiation. Anyone who’s paying serious attention knows that’s what happens. The question is what was the final result? The final result has been absolutely consistent.

Question: You said ‘I encourage, you know, any New Yorker who wants to know about the budget to look at the budget’ –

Mayor: Yes.

Question:  [Inaudible]

Mayor: No, no, I don’t think that’s an accurate statement. I’ll gladly get the transcript. I encouraged people to look at direct sources. With all due respect to the media you are the middle people, and we actually put the budgets online, and people can see year after year how we funded emergency food programs and see for themselves how consistent that funding has been and when it’s increased according to need. So my concern was actually – with deepest respect for Brian Lehrer – that Brian Lehrer was not working from original source materials. He was working from someone else’s interpretation, which I believe was an inaccurate interpretation. So I appreciate the breadth of your attempt to interpret, but I think this was very straightforward.

Question: [Inaudible] anyone listening who wants to actual understand the budget to look at the budget and not go through a journalistic outlet to understand the budget.

Mayor: I think [inaudible] encouraging people to look at the budget directly is really smart.

Yes?

Question: Mayor, I just wanted to follow up on the metzitzah b’peh. I’m just curious what the need to evaluate the situation. From my understanding, there’s been six cases since the city made the deal with the community, and they haven’t fully complied in any of those cases. So isn’t it clear that the community hasn’t lived up to its side of the deal?

Mayor: Again, we’ve made very clear what we expect from the community. We’re evaluating the situation, and when we get through with that evaluation we’ll have an update. It’s as simple as that.

Yes?

Question: You told us before that you don’t believe that you are personally the target of any of these investigations of the federal investigation. The WSJ reported this weekend that your top aide Emma Wolfe was interviewed by federal prosecutors. Can you tell us whether or not you believe she isn’t?

Mayor: I’m not going to comment. Again, guys, I think it’s been really clear for weeks now I’m just not going to comment on any details of this investigation.

Question: Do you feel confident that she has done –

Mayor: I feel confident that she and every other member of my team have handled things appropriately. I’ve said that more times than I could count. Absolute total faith in her, but I’m not going to comment on anything specific about the investigation.

Yes?

Question: For the commissioner, actually. Two questions for you – are there any updates regarding the investigation into the bomb threats that have been made throughout the nation. I know John Miller said last week that this person was using technology to distort his voice and then just a follow up to that – or a separate question – with the firing of Preet Bharara –

Mayor: Can you just stay on the first one first? Just let him speak to that.

Commissioner O’Neill: I was following him.

[Laughter]

Mayor: I’m trying to – I’m trying to help everyone help us answer one topic at a time, so we can give them good answers.

Go ahead.

Commissioner O’Neill: As far as the bomb threats, I think John and I both spoke about there was one person – and you wrote about one person locked up out in St. Louis that was responsible for about eight and two of them being in New York City. We haven’t – of course we continue to investigate, but we have no further arrests.

Question: And the second one was just, you know, you – the NYPD has worked with Preet Bharara on numerous gang takedowns in recent years, also Chelsea bombing. With, you know, with what happened over the weekend, how does this affect the NYPD’s work going forward?

Commissioner O’Neill: Just – Preet and the NYPD and Southern District along with the FBI and a couple other federal agencies, they’ve done tremendous work. A lot of local impact. They had that huge case takedown in the Bronx. I think that was in the 4-7 and the 4-9. I think that was probably the big gang case takedown that we’ve had. They also did a case takedown in the 2-3 in the East River Houses. Remember after Randolph Holder was murdered on October 20, 2015. So Preet and his people did a tremendous job for this city. Going forward, we’ll just have to see who gets the job. I know Joon. I’ve worked with him. He’s the acting, so I’m sure we’ll continue to keep this city safe.

Question: One more follow up just to the first question, you know, when somebody’s using technology like this I mean what really can law enforcement do to track this person?

Commissioner O’Neill: We have pretty good people and technology that are – that have great technological abilities. But it takes time. It takes time.

Mayor: That’s why they caught the gentlemen in St. Louis obviously.

David?

Question: Preet Bharara has been described as aggressive an independent prosecutor. What sort of prosecutor do you hope to see for the people of the Southern District of New York being named by president trump, and then as a follow up quote – where were you when you heard about this firing?

Mayor: I’m not going into the where was I. I just don’t think – again, I’m not going to be commenting on anything related to the Southern District of New York.

Question: [Inaudible.]

Mayor: Same thing. I’m just not commenting at this point.

Go ahead, Grace.

Question: There’s been some speculation and discussion that Preet Bharara might run for political office. I’m wondering – I know you’ve said in the past when different challengers have suggested they might run against you, you’ve said you welcome them into the race. Would that be the same if he decided to run –

Mayor: Because of the ongoing investigation, I’m not going to comment on that.

Question: Paul Massey officially launched his campaign for mayor – a Republican running against you. I wonder if you have any response to that, and he released a video, which was very critical. I think the tagline is that New York City is a fulltime city that deserves a fulltime mayor. Suggesting that…

Mayor: He can suggest whatever he wants. I’m very proud of the work we’re doing, and today is evidence of it. This is the biggest response to the opioid crisis ever mounted in this city on top of, you know, three years of driving down crime; on top of improved graduation rates and test scores. This is going to be about the things that actually affect people’s lives, and I will put that record up against anyone.

Question: Mr. Mayor back to the budget for a second. When people want to understand the budget or news outlets are supposed to report on it or are going to report on it. Are you saying that we should not compare –

Mayor: I think your line of question is getting a little abstract, my friend. It’s fine if – people should look at anything and everything. I simple am saying look at the original source material too because it is the thing that tells you the facts. Look at the budget.

Question: So when we look at the November modification or the adopted budget and then you release the preliminary budget, it’s not fair to note the reduced amounts?

Mayor: I think to the specific case of emergency food, which is what I was talking about – if you look at the pattern every year, it’s really consistent that we fully funded emergency food. It’s just as simple as that. To suggest there was a cut when there’s been an exceedingly consistent pattern – I think if the question had been ‘what’s your view on emergency food?’, it would’ve been ‘we’re going to do whatever is necessary.’ So I just think that the question did not look at the obvious history, and I think it’s good to look at the obvious history.

Thank you, everyone.

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