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East Harlem’s Share of Treatment Capacity is 4 Times Higher Than Can be Justified by Overdose Rates

The over-saturation of opioid treatment programs in Harlem and East Harlem could only be justified by the city if Harlem was also disproportionally affected by the opioid epidemic.

The city primarily considers overdose deaths in an area to determine the need for treatment services, based on the city’s own 2018 report on the viability of supervised injection sites.

(The nation’s first Supervised Injection Site was opened in East Harlem in 2021, just as Mayor de Blasio was leaving office—see GHC’s response here.)

But the allocation of opioid treatment in the city is completely out of proportion to the actual prevalence of overdose deaths! In particular, Queens and Staten Island are dramatically under-served by treatment programs relative to the overdose deaths in those boroughs, and Manhattan has far too many.

And in fact, nearly half of Manhattan's treatment capacity is concentrated in Harlem in particular!

is there any other argument that could justify the concentration in Harlem? Overdose deaths are not necessarily the best way to gauge the need for addiction services in an area, so GHC has tried to locate other sources of data on the severity of the epidemic. Much of the data on drug usage is too sensitive for the city to share publicly, so the FOIL requests GHC has made to the Office of Addiction Services and Supports (OASAS) only supply aggregated and redacted data, and only after long delays. Much of the resulting data is too coarse-grained to effectively compare Harlem to other areas of the city—but a few datasets can give a sense of the severity of the need for addiction treatment services in different neighborhoods:

Opioid Epidemic Data Sources

  1. The DOHMH has published a dataset of overdose deaths by city neighborhood in 2020. (PDF)
  2. A New York State Department of Health website publishes a number called "opioid burden" at the granularity of zip codes, representing "opioid overdose deaths, non-fatal outpatient ED visits and hospital discharges involving opioid abuse, poisoning, dependence and unspecified use." (Excel FileSource WebsiteDocumentation)
  3. Data obtained from our own Freedom-of-Information requests to OASAS supplies an estimate of the opioid treatment patient population claiming residence in each zip code. It should be noted that this represents what patients report on check-in as their last zip code of residence, and only accounts for those patients who are enrolled in treatment, which is disproportionately the lower income drug users who do not have access to treatment through the healthcare system. (PDFOCR and Analysis, more information here)

Below, all three of these datasets are displayed side-by-side with the populations and opioid treatment capacity by neighborhood. Each quantity is displayed as a fraction of the city's total to make the (lack of) proportionality visible.

East Harlem stands out starkly as the neighborhood whose opioid treatment capacity is most out of proportion to the severity of any of its opioid statistics. East Harlem has over 12% of the city's OTP capacity but less than 3% of its overdose deaths, differing by a a factor of more than 4! And the other statistics, opioid burden and the population of OTP patients, also come up short, each by a factor of about 3.

Other neighborhoods in Manhattan are experiencing a similar lack of proportionality—the only remaining explanation for the concentration of treatment programs is the centrality of these location, and accessibility by transit, but that comes up far short when considering the far better option of allocating treatment programs to the places they're needed most.

The chart above also shows that East Harlem's treatment capacity is overwhelms its resident population even more dramatically—by a factor of 6! It's the local residents who have to bear many of the negative consequences of having these treatment programs in their communities—and without any adequate justification, as is plain to see.

At the same time, other neighborhoods are evidently underserved, and their own residents have to have to go far out of their way to access necessary treatment. The answer may be to dramatically expand treatment programs—considering that, based on FOIL data, the city has scaled down these OTP programs even as the opioid crisis has exploded.

The Greater Harlem Coalition asks that the city redistribute these addiction services in accordance with the Fair Share criteria already agreed upon—with an eye towards racial and economic equity, in a fashion justified by need and not political expedience, and with a consideration of their total impacts, both positive and negative—not idealizing away the negatives, and not ignoring the fact that a concentration of negative consequences in excess of what is justified can do real harm.

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