New York is one step closer this month to putting to use millions of dollars procured through legal settlements with pharmaceutical companies that have been accused of stoking the opioid crisis.

After months of deliberation, the state’s Opioid Settlement Fund Advisory Board submitted recommendations for how to spend the money on Nov. 1.

The state’s overall windfall now tops $2 billion. About $129 million of that will be allocated through the state this fiscal year to address issues related to opioid use, which has driven record numbers of overdose deaths in recent years. The board, which was convened in June, includes government officials, people who work in health care and substance use treatment, people in recovery from drug use, and family members of those who have died from opioid overdoses.

The advisory board is recommending spending on programs to reduce the harms of opioid use as well as investments in services such as treatment, housing and prevention. The report suggests prioritizing programs that integrate services for mental health and addiction, since the two frequently go hand in hand.

But some of the recommendations are controversial, according to harm reduction groups serving drug users across the state. They are pushing back on a proposal to set aside $8 million for New York MATTERS, an electronic treatment referral network that was founded by a member of the Opioid Settlement Fund Advisory Board.

Although the service would be jointly operated by the state Department of Health, it’s the only non-government organization the board is allocating money to directly. Other private service providers will have to go through a procurement process. NY MATTERS represents about 28% of the funding the board designated for harm reduction services — with some questioning whether it should even fall into that category because it is more focused on connecting people with treatment versus safer drug use.

Pouches of confirmed fentanyl are displayed at the Drug Enforcement Administration Northeast Regional Laboratory on October 8, 2019, in New York.

Under the harm reduction category, the advisory board also specified that funding should go to overdose prevention centers, which allow people to use illicit drugs under staff supervision so they can intervene in the case of an overdose. Although two such centers are already operating in New York City with the blessing of Mayor Eric Adams, these facilities still violate federal law and have not yet received any city or state funding. Gov. Kathy Hochul — who now has an opportunity to weigh in on the advisory board’s recommendations, along with the state Assembly and Senate — has yet to lend her support to these safe injection sites.

The report also goes a step further by calling to fund a pilot program that would allow some people who are opioid dependent to receive access to state-sanctioned heroin through an overdose prevention center. Under the current model, people bring their own street drugs into these centers, and the illicit substances can often contain the more powerful and dangerous opioid fentanyl or other unknown compounds. Other countries, such as Canada and the United Kingdom, have implemented heroin maintenance programs, but the U.S. isn’t among them.

The Debate Over NY MATTERS

New York MATTERS was initially launched in Buffalo in 2017 to make it easier for hospitals and doctors’ offices to connect heavy opioid users to treatment providers that follow best practices — including offering opioid replacement medications such as buprenorphine.

Working with the state Department of Health, the organization has expanded its network to include hospitals, jails and community-based providers across the state. It offers patients vouchers for buprenorphine in partnership with pharmacies such as Walgreens and CVS, as well as transportation for those who need help getting to their first appointment for a prescription. NYC Health + Hospitals opted into the network earlier this year.

Dr. Joshua Lynch is the founder and medical director of NY MATTERS and also sits on the opioid advisory board. He said he is eager to expand the program but never anticipated getting funded in this way.

“That was not anything I ever asked for or would've even considered,” Lynch told Gothamist.

Those who have objected to funding the program — including some members of the opioid settlement board — don’t oppose NY MATTERS' underlying premise. Rather, they say the organization needs to justify how it will use the money in more detail and have clear benchmarks.

The New York State Harm Reduction Association, which represents organizations serving drug users, outlined their concerns in a letter to Hochul and state legislators last week.

“Without a [Request for Applications] process, we risk designating funds to programs without proper evaluation of the program’s ability to deliver significant results with equitable outcomes across disparate communities,” read the letter, which was shared with Gothamist.

As of late September, 70 hospitals and 177 clinics existed in the MATTERS network, according to a presentation the state health department made to the advisory board on the program. At the time, 77 participating sites had made more than 1,400 referrals to 122 participating clinics.

But even after the presentation and a vote in favor of funding the program, some board members said they still had misgivings.

Right now, it’s an $8 million allocation without a lot of specificity about what it’s going to go towards.
Stephanie Marquesano, The Harris Project

“Right now, it’s an $8 million allocation without a lot of specificity about what it’s going to go towards,” Stephanie Marquesano, founder and president of a Westchester organization called the Harris Project, said at the Board’s Oct. 31 meeting — the last time it convened before releasing the funding recommendations. “Is it expanding what it will be doing geographically? Is it moving into the space of integration and co-occurring [disorders]? … All those things I think in a traditional RFA process would be covered.”

Other members voiced support and said they were confident in the investment.

“I’ve had personal experience with the MATTERS program, so I feel strongly about that type of intervention,” Anne Constantino, president and CEO of Horizon Health, said at the same meeting. She added that she wasn’t sure there were other organizations that could provide a similar service even if there was a competitive procurement process.

Lynch pushed back on the idea that New York MATTERS has not been proven effective.

“We're ready to get to work to continue to help as many people around New York State as we possibly can,” Lynch said. “I'm sad that there's a certain degree of controversy surrounding the support.”

The funding for New York MATTERS was initially presented to the advisory board in a scorecard outlining the spending priorities the governor and state legislature had for the Opioid Settlement Fund — which the board members would then have a chance to weigh in on and expand upon.

The state Department of Health, the Office of Addiction Services and Supports and the governor’s office all declined to comment on the controversy.

Funding supervised drug use

The two overdose prevention centers that opened in Upper Manhattan late last year have already intervened in more than 500 potentially fatal overdoses and the advisory board noted their life saving potential and the need to replicate the program in its spending recommendations.

Although Hochul has yet to lend her support to the model, some said they are optimistic that she will approve the funding. Charles King, CEO of Housing Works, noted that the U.S. Department of Justice could soon issue guidance allowing this type of supervised drug use, despite the fact that it violates the so-called Crackhouse Statute once supported by President Joe Biden.

Staff stay nearby while a client uses drugs behind a privacy screen at the OnPoint NYC center in Harlem.

“If that’s what [Hochul] is hiding behind [to avoid supporting overdose prevention centers], then something coming out of the Justice Department is going to take that justification away from her,” King said. Housing Works has been planning to open two overdose prevention centers in Manhattan, but King said the organization will not do so without public dollars.

Despite touting the success of the existing centers, which are run by the nonprofit OnPoint NYC, the Adams administration has also said it won’t fund the model until it receives state or federal support. New York City also has discretion over a separate pot of opioid settlement funds.

As far as the heroin maintenance pilot program — a model that falls under the concept of a “safe supply” of drugs – King said he thought funding that was “unrealistic.”

“While I very much believe in safe supply, right now there is no evidence the federal government will change the law to allow it,” King said.

Clients use drugs at supervised booths in the overdose prevention center in Harlem. Mirrors make it easier for staff to keep an eye on the clients in case they need overdose treatment.

Speaking to Gothamist, Marquesano said some things were included in the advisory board’s recommendations to indicate they were important.

“We were very mindful of the larger landscape and so where we could provide guidance on things that we thought should be priorities moving forward, we wanted to make sure that voice was heard,” Marquesano said.

The state Assembly, Senate and governor’s office will now have an opportunity to review the board's proposal. If state officials decide they do not want to follow any of the recommendations, they will have 14 days after issuing that decision to publicize their reasoning, and the advisory board then has 14 days to respond. There is no set deadline for finalizing the spending priorities, but the advisory board plans to hold its next meeting on Dec. 9.