Greater Harlem Coalition has published this Op-Ed on New York Daily News describing the impact of excessive number of methadone clinics in Harlem. Please help forward to your neighbors and elected officials to raise awareness
Although the opioid epidemic led to a 200% increase in overdose deaths in New York State from 2010-17, even before the sharp rise last year during the COVID pandemic, medical strategies to address Substance Use Disorder (SUD) haven’t substantially changed in decades. In New York City, the state Department of Addiction Services and Supports (OASAS) relies on approximately 70 Opioid Treatment Programs (OTPs) that primarily dispense methadone.
National Institutes of Health research shows that opioid treatment is most successful when it is available locally, but OASAS data on the distribution and attendance of treatment programs in New York City show a systemic overconcentration of OTPs in majority Black and Brown neighborhoods. Harlem is particularly oversaturated, with eight OTPs in a five-block radius of 125th St. and Park Ave. More than 75% of patients being treated in Harlem live elsewhere and commute into the neighborhood from elsewhere in the city, and even from Long Island and Upstate New York. Since successful treatment negatively correlates with distance from a treatment site, OASAS’s decision to concentrate treatment centers in Harlem is clearly not based on patient welfare.
Profit margins, instead, seems to be the major factor that has led to Harlem becoming the city’s “methadone hub,” primarily through three OTP providers: Mount Sinai (which absorbed Beth Israel’s many OTPs during their merger), Kaleidoscope and START, who benefit from Harlem’s relatively inexpensive real estate. And given the economic and political advantages that accrue from expanding an existing facility, OTP capacity in Harlem has continued to increase over the years, leading social services to refer more patients to Harlem, leading to more increases, and so on, with full approval from OASAS.
This hyper-concentration of drug treatment resources in Harlem unfairly burdens the patients who have to travel up to six days a week to get their medication. It also burdens area residents and businesses. Along much of 125th St., used needles lie in gutters and on the sidewalks; people nod out and use doorways as toilets. Drug dealers operate openly, taking advantage of this concentration of vulnerable patients. Small businesses suffer from a lack of foot traffic and high rates of shoplifting. Restaurants note that customers often report being uncomfortable and do not return. New businesses are reluctant to open in the neighborhood when they see the street drug dealing and use.
And Mount Sinai is now planning to relocate its CARES program, an education program for at-risk kids (with mental and addiction issues), from Morningside Heights into the middle of this methadone hub — another decision that seems unlikely to benefit the clients.
Some believe that this kind of oversaturation is part of Harlem’s identity. In reality, the neighborhood’s history of compassion for people who are working through difficulties is being exploited. OASAS and Mount Sinai’s relentless concentration of treatment facilities in this neighborhood of color is simply medical redlining. Wealthier and frequently whiter communities are rarely asked to shoulder their fair share of vulnerable OTP patients.
It’s past time that this problem be addressed. While the Mainstreaming Addiction Treatment Act currently under consideration at the federal level would increase Medicaid reimbursement for helping those struggling with drug abuse and make alternative forms of treatment more readily available, it is expected to do little to alleviate Harlem’s burden unless more direct actions are taken.
New York State must take responsibility for the oversaturation and adopt measures to address it without further delay.
First, to allow a systematic assessment of whether treatment programs are being fairly situated, OASAS should publish data on addiction and overdose rates, capacities, services, locations of drug treatment centers in each district, and audit reports and verified complaints should be made publicly and easily available.
Then, the state should move OTPs that exceed the demonstrable need of the neighborhood into other, less serviced, neighborhoods in each renewal cycle. When homeless shelters or environmental hazards are unfairly clustered in relatively poor and powerless parts of the city, we call it racism.
Input from community organizations, local government officials and government agents such as police and social workers regarding the impact of OTPs on their neighborhoods should also be made public and included when considering license renewal.
And more weight in OTP placement decisions should be given to New York City officials. The mayor’s office and the City Council, in turn, must commit to redressing this inequity.
If the officials of New York State and New York City are committed to rooting out systemic racism, they must also commit to distributing social services equitably. No community should be asked to do more than its fair share — or allowed to do less — regardless of its economic, political or racial make-up. We should have tremendous compassion for those struggling with drug addiction, and part of that compassion should be ensuring that services designed to help them are close to their homes.
Hill and Asberry-Chresfield are founders of The Greater Harlem Coalition, a grassroots organization focused on improving quality of life.