New York Attorney General Letitia James has secured about $1.5 billion from settlements with opioid manufacturers to help the state combat its worsening overdose crisis, and New York City is set to receive $256 million from this pot. The first installment of $11.5 million arrives this week, James announced Thursday at a press conference with Mayor Eric Adams and city health officials.

The money is undoubtedly arriving at a time when it’s urgently needed. New York City data show fatal drug overdoses in the five boroughs reached a record high of 2,062 in 2020, driven by the powerful opioid fentanyl. Preliminary data show 2021 may be on track to exceed that figure.

“We are in the midst of a five-alarm public health fire that few are talking about because of the other pressing public health challenge we’ve been facing over the past two years,” New York City Health Commissioner Dr. Ashwin Vasan said at the press conference. “Every four hours a New Yorker dies of an overdose in New York City.”

But despite this sense of urgency, Vasan and other officials weren’t able to share concrete details Thursday of how the money would be allocated.

Every four hours a New Yorker dies of an overdose in New York City.

Dr. Ashwin Vasan, NYC Health Commissioner

About 10 months have passed since former Gov. Andrew Cuomo signed a law requiring all the settlement money to be placed into a statewide Opioid Settlement Fund and establishing an Opioid Settlement Board to determine how it will be used.

Asked Thursday what the New York City health department’s role will be in deciding how the money is distributed, spokesperson Patrick Gallahue noted that Vasan was appointed to the Opioid Settlement Board by Mayor Adams earlier this month. Gallahue did not provide an update on the decision-making process.

Still, officials did offer some ideas for how the money could be used. Dr. Machelle Allen, chief medical officer at NYC Health + Hospitals, said the public health care network is working on a new, family-centered approach to addressing substance use that involves timely interventions. Examples include services for when pregnant people who are struggling with addiction seek prenatal care, as well as early childhood interventions that recognize a parental addiction can have lifelong consequences for children.

“In pregnancy, there may be that crucial moment to engage a person in health care and get them into the vital substance use disorder services they need,” Allen said.

Officials also talked about the need to expand access to medication for those with opioid use disorder as well as the use of peer counselors who have their own experience with substance use to engage patients throughout the NYC Health + Hospitals system.

“Our workforce can welcome patients into bright and shiny rooms, get them their medication quickly and easily – and we can provide our workforce with the training to match their dedication and passion,” said Rebecca Linn-Walton, senior assistant vice president in the Office of Behavioral Health at NYC Health + Hospitals, who previously struggled with opioid addiction herself. “Everything we need to provide cutting-edge and evidence-based care.”

Asked whether some of the funds would be used to establish more overdose prevention centers that allow people to use drugs onsite in a supervised manner, Adams said his administration is looking into it. But he added that “what we can’t do is saturate just one community with them like we’re seeing in Harlem.”

Harlem only has one overdose prevention center and there are only two citywide so far, but state data show the neighborhood has an outsized concentration of services for drug users in general. Vasan made a point of lauding the success of the two centers, operated by the nonprofit OnPointNYC, which he said have prevented nearly 250 fatal overdoses since opening in November.

New York City will receive $88.9 million of the settlement funds this year.