In response to a record surge in drug overdose fatalities, New York City Mayor Eric Adams announced Thursday a plan to expand intervention services in neighborhoods hit hardest by the crisis.

Along with distributing free overdose kits using the medication naloxone and offering a wide array of services to drug users, city health officials will seek to expand the number of overdose prevention centers — which offer supervised injection as well as counseling — from two to five by 2025. The city did not specify where the new sites would be, but cited the South Bronx as a community in need of more overdose intervention services.

The mayor said the goal would be to reduce overdose deaths by 15% over the next three years.

“Too many New Yorkers are lost to overdose, and it's clear that we cannot allow this crisis to continue taking lives and tearing apart communities,” Adams said in a statement.

The overdose death rate has skyrocketed in New York City, more than quadrupling in the last decade. The pattern reflects a national trend, which experts and data say is driven by the growing use of opioids like fentanyl and increased isolation and financial hardship during the pandemic. The drug overdose fatalities are highest among Black residents, but have risen across ethnicities. Rates are most severe in parts of northern Manhattan and the South Bronx, but hot spots also exist in sections of Brooklyn and Staten Island.

The mayor announced his plan – which was shared with Gothamist in advance – during an address on mental health at City Hall. Adams also said the city would expand care for New Yorkers with mental illness by increasing the number of so-called clubhouses, a growing model that offers a social support network for those with serious psychiatric conditions.

News of the mental health and overdose prevention plan was first reported by Politico.

New York City currently has two overdose prevention centers in Harlem and Washington Heights, the first such sites to operate with government approval in the country.

Since the centers' opening, their staff have provided care to those overdosing more than 700 times, according to the city health department.

“We know, after a year of work, that they save lives,” said Dr. Ashwin Vasan, the city's health commissioner.

As with many of the mayor’s new policies, questions exist around funding and implementation. City health officials said the overdose plan will draw money, in part, from settlements with pharmaceutical companies accused of contributing to the opioid crisis, including $150 million in settlement dollars the city already has in hand.

The mayor’s plan notably did not include a breakdown of how the funding will be allocated.

Patrick Gallahue, a city health department spokesperson, did not provide an exact number on total spending, saying only that the city will set aside an additional $20 million for the plan, adding to “hundreds of millions in existing investments by the administration.”

He added that the plan also applies money from the state.

Additional funding could be allocated in the city budget, which is due out at the end of June. New York City first began receiving opioid settlement dollars in April of last year, but has not released details about how that money will be spent until now.

Community opposition may represent a challenge for opening new overdose prevention centers. Although such facilities have been proven to reduce the risk of fatal overdoses, the centers and other opioid clinics have drawn criticism from some residents who object to the facilities being located in their neighborhoods.

Yet for some health advocates, the city’s strategy may not be bold enough, considering the gravity of the crisis.

Vasan acknowledged that the plan largely calls for expanding existing services geared toward reducing the harms of drug use among New Yorkers, rather than splashy new ideas. For instance, the plan aims to expand the city’s Relay program, in which peers with their own past experiences with substance use meet people who have had non-fatal overdoses in emergency rooms and offer safer drug use information and connection to services such as buprenorphine, a medication used to treat opioid addiction.

“I know that innovation sells, but this is about the hard, dirty work of investing in the things that we know save lives and scaling those up,” said Vasan. “That's the core of public health.”

In New York City, harm reduction work is performed mostly by community organizations, such as those running syringe service programs. These groups distribute clean needles and information on how to use drugs more safely, while connecting New Yorkers who use drugs to additional resources, such as housing, basic health care, and addiction treatment for those who want it. The mayor’s new plan pledges to help these groups ramp up their efforts and offer additional services.

Although the Adams administration aims to help more of these groups open overdose prevention centers, Vasan confirmed the city is not committing any funding to current or future overdose prevention centers at this time.

“We're obviously extremely proud to have the first two [overdose prevention centers] in the country,” Vasan said.

Groups such as Housing Works that have expressed interest in opening overdose prevention centers have previously cited a lack of public funding as a hurdle – and the nonprofit operating the existing centers, OnPoint NYC, has said they need more funding to expand their hours.

Former Mayor Bill de Blasio helped the two existing centers get off the ground in November 2021, despite a lack of state or federal support. They operate in violation of federal law known as the Crackhouse Statute, which prohibits anyone from knowingly providing a space for people to use drugs. But despite this act of defiance – and Adams’ vocal support for the centers since then – City Hall has stopped short of providing financial support.

Asked specifically what consequences the administration would face if it did provide public dollars to overdose prevention centers – which have been operating for over a year without any enforcement action against them – Vasan said, “We're working through a number of different questions with state and federal authorities on how to make this happen.”

The report itself notes that in the future, the city aims to “create legal pathways to operate and fund overdose prevention centers.”

In the meantime, Vasan said, the city would fund all the wraparound services that organizations operating overdose prevention centers provide. He said these services include “onsite mental health care, medication-assisted therapy, physical health care and primary care, basic needs like food and laundry, social supports, connections to housing.”

Vasan said this plan builds on Healing NYC, an initiative launched to reduce overdose deaths in 2017. A large chunk of the money from that plan went to the NYPD – partly to distribute naloxone, but also to ramp up enforcement efforts against drug dealers and give the police more resources to test the drugs they seize.

Asked about the NYPD’s role in this current effort to reduce overdose deaths, Vasan said, “Obviously, we have ongoing partnerships with the NYPD, but as you can see, our focus here is really on harm reduction, it's on prevention, it's on saving lives.”

He added that instead of relying exclusively on the police to inform the public about what’s in the illegal drug supply, the city health department aims to ramp up its own drug checking pilot program. That program gives public health workers and harm reduction groups the tools to test drugs brought in by consumers and tell them exactly what they’re taking.

Vasan was not able to say how much the city plans to expand the program, but the mayor’s plan calls for investing in drug checking services in the neighborhoods with the highest rates of overdose deaths.