The afternoon before Thanksgiving, David Terry stood outside OnPoint NYC’s East Harlem safe-injection site, thinking about a friend who had recently died of an overdose. Later that week, he would attend their funeral.
For the 60-year-old Terry, a poet and member of New York Harm Reduction Educators, having access to a harm reduction service is deeply personal.
“Many, many people come from the Bronx over here because they can use safely,” said Terry, who relies on the East Harlem service himself. He pointed out that its range of services makes the commute worthwhile for residents of the Bronx, where the rate of fatal overdoses is the highest of the five boroughs.
But local harm reduction advocates say the city allocates less money to the Bronx from opioid settlement funds than the other boroughs.
“As someone who has worked for 34 years in the trenches of the South Bronx providing lifesaving resources to all of its residents, I am disappointed,” said Joyce Rivera, executive director at St. Ann’s Corner of Harm Reduction in a statement following a Sept. 14 presentation by representatives of the city’s health department to the Opioid Settlement Fund Advisory Board. “One can argue that [the city] is a complicit variable in overdose deaths continuing to increase in [the South Bronx].”
So far, the city has received $90 million from a $520 million opioid settlement fund allocation scheduled to be paid out through 2040. The city’s share is one fifth of a $2.6 billion dollar total the attorney general’s office won for New York State in settlements with companies involved in “manufacturing, distributing, and selling opioids.”
Just two overdose prevention centers have received money from the settlement, both of them located in Manhattan—one in East Harlem and the other in Washington Heights–where patients can inject controlled substances. Both were allowed to open and operate under an executive action by then-Mayor Bill de Blasio.
St. Ann’s board member Ashley Livingston noted that St. Ann’s is “the oldest syringe service program in our state. The fact that the city didn’t consult with [Rivera] is crazy.” Fellow board member Ann Constantino said the city is “recreating services and resources that exist instead of partnering” with non-government providers.
Dr. Rebecca Linn-Walton, assistant commissioner of the Bureau of Alcohol and Drug Use Prevention, Care & Treatment at the city health department, countered that the health department has recently put out a procurement request for syringe service programs to submit bids for contracts that would be paid from the opioid settlement funds.
“We are focused on all of the areas of high overdose deaths and are focused on figuring out how to get those dollars into those communities,” said Linn-Walton.
Advisory board member Dr. Justine Waldman called the Department of Health and Hospital’s “Virtual ExpressCare” program “a complete failure,” noting that it gave out only 32 buprenorphine prescriptions citywide between June 2023 and June 2024. “I give out 30 buprenorphine prescriptions in a day,” Dr. Waldman said.
Constantino criticized the health department for an “appalling lack of substantial data” in its reports on how it is spending settlement money.
The health department’s most recent quarterly report notes broad spending categories of spending. In an interview, Alexis Pleus, the executive director of anti-substance abuse activist organization TruthPharm, said it would be more helpful for expenditures to be listed for specific programs.
A statewide problem
Concerns about misuse and lack of transparency over how opioid settlement funding is being spent are not restricted to New York City. The money flows down from the state to a plethora of agencies and county governments, all of which have different reporting and spending standards.
The scheme is so complicated that it continues to stymie Opioid Settlement Advisory Board members. In the board’s Sept. 12th meeting, two years after it first convened, a nearly 10-minute discussion about one of the finer points of how money is distributed to counties concluded with board Chair Pantin saying “There needs to be a design of a course called Opioid Funding 101.”
Board members have expressed particular concern about the tranche of funds that flows directly to elected county executives. On September 12th, board member Stephanie Marquesano said “There are counties that I’ve heard about that have slipped through the cracks.” The spending of the funds that counties receive directly, known as “direct share subdivisions” are subject only to self-imposed public reporting requirements like that done by the NYC Health Department. The Appalachia Opioid Remediation project collects some of that patchwork county reporting in its spending tracker.
Allegations of misused funding have started to surface around the state. Nassau County executives have faced scrutiny from county legislator Delia DeRiggi-Whitton for dispersing less than 10% of the $85 million in settlement funds it received from the state, choosing instead to collect interest on the money and to use the capital to “improve its bond rating.”
Suffolk County’s comptroller launched an audit of $57 million of its opioid settlement spending in April, after a Newsday report about a county official who chaired the committee that dispersed funds taking a top job at a non-profit that received $1.8 million.
Board members are not concerned about all of the tranches of funding. Chair Debra Pantin praised OASAS, which operates a program-level funding dashboard, for its transparency, and the requirements it places on recipients to report back on how funds are used.
For David Terry, the continued lack of support for harm reduction services in the Bronx and in the state is baffling.
“It’s mind boggling to me that we have so much controversy about these safe injection sites,” said Terry. “They cut the death rate in half. In Amsterdam and other countries, Sweden, France, they have them so that people can use safely because drugs are not going anywhere.”
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