Q&A: State commissioner of addiction services on the
rollout of opioid settlement funds
Amid a raging overdose crisis, New York state is about a year into distributing its opioid settlement funds, which will amount to $2.6 billion over the next two decades. A majority of the funds, which were obtained through litigation with major opioid companies over their role in an epidemic that has killed hundreds of thousands, flow through the Office of Addiction Services and Supports. So far, OASAS has procured around $190 million to local governments and organizations providing substance use disorder services. But the process has not been without criticisms, as providers have called attention to bureaucratic hurdles that have bogged down the flow of cash.
Dr. Chinazo Cunningham, commissioner of the OASAS, spoke to Crain’s about the urgency of the overdose crisis, the office’s harm reduction approach and lessons from the first year of distributing opioid settlement funds.
We consistently hear that the overdose crisis is the most pressing public health issue in New York. What is the state of the crisis?
We are experiencing the worst overdose epidemic ever on record in this country and in the state. Right now, over 6,000 [New Yorkers] have died from drug overdose annually—that’s one person every 90 minutes.
What do you think has gotten us to this point?
If it were one thing, then it would be much easier to solve. Certainly a big part of why we’re here now has to do with the unregulated drug supply—fentanyl and xylazine are incredibly risky like never before. Fentanyl is everywhere. It’s in heroin, it’s in cocaine, it can be in methamphetamine and counterfeit pills. Then through the Covid pandemic, people had disruption in their routines, and then their health care. People were isolated, people had worsening mental health symptoms. All of those things have also contributed.
What is the agency’s approach to mitigating the crisis?
We have a new division of harm reduction, and we have really tried to embrace more harm reduction approaches throughout our system—in prevention programs, treatment programs and recovery programs, and also in expanding supplies such as naloxone, fentanyl test strips and now xylazine test strips. It’s really a comprehensive approach.
What is the role of the opioid settlement funds to aid the agency’s efforts?
It’s really important to hold the pharmaceutical companies and distributors accountable. This is an important step in that, because there’s been a lot of harm done to families and communities. For us, hearing from experts who are members of the opioid settlement fund Advisory Board was also really important. A lot of their priorities are our priorities. I think we are actually highly aligned in terms of thinking about what we need to do and how these dollars should be used.
Some board members have been critical of how funds have been distributed. How has the state been handling this?
There’s three reviews that have to happen for a procurement—whether it’s a competitive procurement or not—and that’s just part of state finance law. We don’t have the power to change that. But when we heard that the board wanted the money out quicker, we recalibrated our approach and worked within existing structures to expand and enhance services. One example is recovery centers. We provided additional funding so that you could hire more staff, more peers, expand their hours so that they could be open 12 hours a day instead of eight. Those kinds of things, in addition to a more competitive approach.
What have you learned from the first year of distributing the opioid settlement funds?
I’ve appreciated really hearing from the public about what they feel is needed. We started doing things a little differently, because we heard the criticisms and we want to be responsive. We also heard from organizations that don’t typically get funding by the state and are in the process of thinking about how we can provide support to them through a different mechanism. We have to work within state finance law, but if we do a smaller dollar amount, then some of these requirements are not necessary. That’s something that we’re discussing now.