Drug seizure data indicate the presence of fentanyl in the cocaine supplies nationally and in New York City (NYC). In NYC, 39% of cocaine-only involved overdose deaths in 2017 also involved fentanyl, suggesting that fentanyl in the cocaine supply is associated with overdose deaths. To raise awareness of fentanyl overdose risk among people who use cocaine, the NYC Department of Health and Mental Hygiene pilot tested an awareness campaign in 23 NYC nightlife venues. Although 87% of venue owners/managers were aware of fentanyl, no participating venues had naloxone on premises prior to the intervention. The campaign's rapid dissemination reached people at potential risk of opioid overdose in a short period of time following the identification of fentanyl in the cocaine supply. Public health authorities in states with high rates of opioid-involved overdose death should consider similar campaigns to deliver overdose prevention education in the context of a drug supply containing fentanyl.

In low-income, urban corner store settings, 87% of purchases did not include tobacco; most tobacco purchases did not include the sale of non-tobacco items and spending on non-tobacco items was similar whether or not tobacco was purchased. These findings can help inform retail-level tobacco sales decisions, such as voluntary discontinuation of tobacco products or future public health policies that target tobacco sales. The results challenge prevailing assumptions that tobacco sales are associated with sales of other products in corner stores, such as food and beverages.

Background: Fentanyl has become increasingly present in the illicit drug supply, including in cocaine. Interventions that target non-opioid use are a necessary component of overdose prevention due to the increased presence of fentanyl. Objectives: To assess management and staff reception to overdose prevention messaging and access to naloxone in New York City nightlife venues. Methods: Between June and August 2019, we conducted a public awareness intervention in 75 nightlife venues (bars, nightclubs and music venues) to visibly display coasters and posters containing overdose prevention messaging for 6 weeks. As part of the intervention, staff were offered overdose education and a naloxone kit. A post-intervention survey assessed reception of intervention materials, staff and patron responses to intervention messaging and staff awareness of fentanyl, naloxone and access to naloxone. Results: Forty-one venues displayed posters and coasters and staff at 28 of these venues (68%) completed naloxone training. Respondents reported learning about naloxone and fentanyl through the intervention, and a majority of staff (92%) were receptive to the intervention’s messages. Partnerships with community-facing stakeholders and earned media facilitated the reach of the intervention. Conclusion: Venue management and staff were receptive to the intervention, its messaging and keeping a naloxone kit on the premises. Overdose prevention efforts in nightlife venues should consider low-cost strategies such as disseminating intervention materials through television, print and social media, collaborating with community partners to enhance venue recruitment and providing venues with naloxone training and communal kits. Further research is needed to explore retention of overdose prevention messaging and subsequent short- and long-term behaviour change.

ObjectiveDescribe the development of an individual-level tracking system for community-based naloxone dispensing as part of New York City’s (NYC) comprehensive plan to reduce overdose deaths. We present data from the first year of the initiative to illustrate results of the tracking system and describe the potential impact on naloxone dispensing program.IntroductionThe number of unintentional overdose deaths in New York City (NYC) has increased for seven consecutive years. In 2017, there were 1,487 unintentional drug overdose deaths in NYC. Over 80% of these deaths involved an opioid, including heroin, fentanyl, and prescription pain relievers.1 As part of a comprehensive strategy to reduce overdose mortality in NYC, the NYC Department of Health and Mental Hygiene’s (DOHMH) Overdose Education and Naloxone Distribution (OEND) Program makes naloxone kits available to laypeople free-of-charge through registered Opioid Overdose Prevention Programs (OOPPs). Naloxone kits contain two doses of naloxone and educational materials. The OEND Program distributes kits to registered OOPPs, which then dispense kits to individuals via community-based trainings. In this context, distribution refers to kits shipped to programs, whereas dispensing refers to kits given to individuals. Increased NYC funding has enabled recruitment of more OOPPs—including syringe exchange programs, public safety agencies, shelters, drug treatment programs, health care facilities, and other community-based programs—and greater dispensing of naloxone kits to laypeople. Naloxone distribution has undergone a dramatic expansion, from 2,500 kits in 2009 to 61,706 kits in 2017.2 In 2018, DOHMH aims to distribute more than 100,000 kits to OOPPs.In order to target naloxone dispensing to neighborhoods in NYC with the highest overdose burden, we developed a tracking system able to capture individual-level geographic data about naloxone kit recipients. Prior to the development of the tracking system, DOHMH collected quarterly, aggregate-level naloxone dispensing data from OOPPs. These data included only the OOPPs’ ZIP Codes but not recipient residence. OOPP ZIP Code was used as a proxy for kits dispensed to individuals. Without individual-level geographic information, however, we could not determine whether naloxone kit dispensing reached people in neighborhoods with high overdose mortality rates. To overcome these barriers, DOHMH developed a comprehensive but flexible individual-level data collection method.MethodsTo both capture individual-level data from each naloxone recipient in NYC and meet the needs of OOPPs’ varying capacities, dispensing settings, and any existing organizational data requirements, DOHMH devised a two-pronged data collection system. The Naloxone Recipient Form (NRF) system, launched January 1, 2018, primarily employs a short paper form (or NRF) to collect dispensing data. The NRF is a one-page document designed with the OpenText™ TeleForm processing application. It captures individual data and OOPP information. Individual data include: reason for obtaining a kit, whether first-time receipt of a kit, age, and ZIP Code of residence. OOPP information includes: program name and ZIP Code of dispensing location. Forms are completed by OOPPs and recipients at OEND trainings, compiled by the OOPP, then scanned back to DOHMH. We then import forms into TeleForm, which reads the NRF data directly into a database without need for manual data entry and only moderate need for data verification. The second component of the NRF system allows larger organizations and dispensers in clinical settings with electronic health records to submit data extracts to DOHMH that are pulled directly from organizations’ data systems. Together with these organizations, we customized these data extracts for direct importation into the master NRF database.To demonstrate improvements in our tracking of naloxone dispensing after the development of the NRF system, we mapped the geographic spread of naloxone kits in NYC during the first three months of 2018 (Q1 2018) by recipients’ ZIP Code of residence and OOPPs’ ZIP Codes.ResultsA total of 138 OOPPs2 reported any dispensing from January to June, 2018, of which 107 reported individual-level data using the NRF system, accounting for 27,899 kits dispensed to 23,610 individual recipients.3 Logistical barriers to implementing the NRF system varied among OOPPs, thus the data underestimate citywide dispensing during this time period. Some OOPPs experienced delays in reporting recipient-level data until a more-tailored data collection strategy was devised. Visual inspection of OOPP-level distribution and individual-level dispensing maps using Q1 2018 data (See Figures 1 and 2) demonstrate the difference between OOPP-level distribution data and individual-level dispensing data. Mapping data indicate that the largest numbers of naloxone kits were dispensed to people in neighborhoods with the highest burden of overdose in NYC.ConclusionsThe NRF system provides DOHMH, as well as OOPPs in NYC, with individual-level data to more accurately track naloxone dispensing citywide. The simplicity and flexibility of the NRF system allows for timely and geographically precise data collection from dozens of organizations across NYC with little or no additional cost to OOPPs. As new organizations have registered as OOPPs, particularly large health care or human services systems, DOHMH has developed new methods for incorporating dispensing data into the NRF system. Ongoing communication with OOPPs of all types and an iterative data collection improvement process have ensured that the system remains comprehensive while also being responsive to individual program’s capacities and data needs.References1. Nolan ML, Tuazon E, Blachman-Forshay J, Paone D. Unintentional Drug Poisoning (Overdose) Deaths in New York City, 2000-2017. New York City Department of Health and Mental Hygiene: Epi Data Brief (104); September 2018.2. NYC DOHMH Opioid Overdose Prevention Program (OOPP) Database. All data is provisional.3. NYC DOHMH Naloxone Recipient Form (NRF) Database. All data is provisional.

Background: Naloxone is an opioid antagonist medication that can be administered by lay people or medical professionals to reverse opioid overdoses and reduce overdose mortality. Cost was identified as a potential barrier to providing expanded overdose education and naloxone distribution (OEND) in New York City (NYC) in 2017. We estimated the cost of delivering OEND for different types of opioid overdose prevention programs (OOPPs) in NYC. Methods: We interviewed naloxone coordinators at 11 syringe service programs (SSPs) and 10 purposively sampled non-SSPs in NYC from December 2017 to September 2019. The samples included diverse non-SSP program types, program sizes, and OEND funding sources. We calculated one-time start up costs and ongoing operating costs using micro-costing methods to estimate the cost of personnel time and materials for OEND activities from the program perspective, but excluding naloxone kit costs. Results: Implementing an OEND program required a one-time median startup cost of $874 for SSPs and $2,548 for other programs excluding overhead, with 80% of those costs attributed to time and travel for training staff. SSPs spent a median of $90 per staff member trained and non-SSPs spent $150 per staff member. The median monthly cost of OEND program activities excluding overhead was $1,579 for SSPs and $2,529 for non-SSPs. The costs for non-SSPs varied by size, with larger, multi-site programs having higher median costs compared to single-site programs. The estimated median cost per kit dispensed excluding and including overhead was $19 versus $25 per kit for SSPs, and $36 versus $43 per kit for non-SSPs, respectively. Conclusions: OEND operating costs vary by program type and number of sites. Funders should consider that providing free naloxone to OEND programs does not cover full operating costs. Further exploration of costeffectiveness and program efficiency should be considered across different types of OEND settings.