Drug overdose fatalities surged during the COVID-19 pandemic in New York state, with opioid-related overdose deaths increasing by 68% to nearly 5,000 individuals from 2019 to 2021, according to an analysis released today by New York State Comptroller Thomas P. DiNapoli. The surge is largely due to a sharp increase in deaths from opioids related to illicit fentanyl and similar synthetic opioids. Overdose deaths statewide from opioids and all drugs (5,841) in 2021 surpassed the previous 2017 peak by more than 1,700 fatalities.

“Too many New Yorkers have died from the misuse of drugs, but the jump in these numbers is alarming. It is a tragedy that devastates families and impacts our communities in countless ways,” DiNapoli said. “The data shows our battle against drug overdose deaths is far from over. State leaders must ensure an ongoing commitment of public resources and strategies, including new funding from legal settlements, and innovative, evidence-based solutions for the fight against this deadly epidemic to be effective.”

DiNapoli’s report found:

• The share of drug overdose deaths in the state involving opioids increased to 85% in both 2020 and 2021 from 69% in 2010.
• In 2021, 30 New Yorkers per 100,000 died from drug overdoses and 25 per 100,000 New Yorkers died from opioid overdoses, compared to five in 2010. New York’s opioid overdose death rates exceeded national rates in both 2020 and 2021.
• Fatalities grew across all racial and ethnic groups. Death rates increased five-fold for Black New Yorkers, quadrupled for Hispanic or Latino New Yorkers, and nearly tripled for White New Yorkers. In 2020, death rates were highest for White New Yorkers at 28.7 per 100,000 people.
• In 2020, drug overdose death rates were higher than the statewide average (25.4 per 100,000) in 10 of the 15 counties for which Centers for Disease Control and Prevention (CDC) data is available. Due to low death counts in most counties resulting in privacy and statistical reliability concerns, CDC data is only available for certain counties. The highest rate was in Dutchess County, where over 43 per 100,000 people died of drug overdoses, followed by Niagara County, the Bronx, and Monroe County.

“The shocking news in State Comptroller DiNapoli’s report on overdose deaths between 2019 and 2021 simply reconfirms the need for an all-out effort to mitigate this crisis,” said State Senator Pete Harckham, chair of the New York State Senate Committee on Alcoholism and Substance Abuse. “That means giving proper resources and support to stakeholders and those on the frontlines of Substance Use Disorder treatment, recovery, overdose prevention and harm reduction, so we can work together and save the lives of our loved ones and neighbors.”

“The first step in addressing a problem is understanding it, and thanks to State Comptroller DiNapoli’s new report on the overdose crisis in New York, we have a road map for how to better support New Yorkers who are struggling so that we can stop the senseless tragedies that are impacting far too many families in our community,” said State Senator Anna Kaplan. “I look forward to working with my colleagues in the coming legislative session to implement the Comptroller’s recommendations and continuing our effort to attack this crisis from all sides.”

"I commend State Comptroller DiNapoli’s dedication in the fight against opioid abuse,” said Assemblymember Charles Lavine. “While I am deeply disturbed by this report showing the worsening of an epidemic which has already claimed the lives of so many Americans, including thousands from here on Long Island, I look forward to working together at the state level to prevent opioid-related overdose deaths.”

“Overdoses continue to wreck families and communities across New York, and the recent post-COVID increase in fatalities creates even more urgency that we do more,” said Dr. Jeffrey Reynolds, Family and Children’s Association President/CEO. “At the same time, it's critical that we recognize this crisis has moved steadily into communities of color and future funding decisions should reflect that fact. We are grateful for State Comptroller DiNapoli's continued focus on New York's opioid crisis, his thoughtful analysis of the current challenges and his willingness to ensure that prevention, access to treatment and support for people in recovery remains a priority.”

Trends in Drug Overdose Deaths

For the better part of a decade, drug overdose deaths were on the rise both in New York and across the country, growing 152% in the state between 2010-2017 compared to 83% nationally. Deaths in New York had peaked at almost 4,000 in 2017, when the federal government declared a nationwide opioid public health emergency.

The majority of overdose deaths were from opioids, both in New York and across the nation during this time period. Opioids include different classes of drugs, such as painkillers prescribed by doctors, as well as heroin and other illicit drugs. Nationally, opioid-related deaths grew from 55% to 68% of all drug overdose deaths between 2010 and 2017. In New York, the proportion of opioid-related drug overdose deaths was greater, growing from 69% to 82% in that time period. Opioid overdose deaths surged by 200% in New York between 2010 and 2017. Opioid deaths then declined in New York for two consecutive years after the emergency declaration, only to increase again during the pandemic by 68%.

Synthetic opioids like fentanyl and tramadol – often mixed with other drugs – account for much of the increase in drug overdose fatalities in the state, growing from 11% of all drug overdose deaths in 2010 to 78% in 2021. The CDC reports that most recent cases of fentanyl-related overdose are linked to illicitly manufactured fentanyl, which is distributed through illegal drug markets for its heroin-like effect and often added to other drugs because of its extreme potency, making the drugs cheaper, more powerful, more addictive, and more dangerous.

Significant increases in mental illness over the past decade, particularly among young adults, are a contributing factor to the growing incidence of substance use disorder and drug overdose deaths. In 2020, 9.7% of young adults aged 18-25, or 3.3 million individuals nationally, experienced serious mental illness, with less than 60% of affected individuals receiving treatment.

State Actions to Address the Opioid Epidemic

New York has invested hundreds of millions of dollars in state and federal funding in prevention, treatment, recovery, harm reduction and education programs to address the opioid epidemic. According to the Division of the Budget, opioid-related spending by the State Office of Addiction Services and Supports (OASAS) grew from $187.2 million in SFY 2011-12 to $246.2 million in SFY 2020-21.

The Executive projects that current year opioid-related spending will exceed $500 million, including $209 million in resources from an opioid tax, and litigation settlements with pharmaceutical manufacturers and distributors. A portion of settlement funds secured by State Attorney General Letitia James will be deposited into an Opioid Settlement Fund, and an advisory board is required to provide recommendations by Nov. 1 annually on how those funds are allocated by the Legislature. Along with effective use of additional funds, DiNapoli noted workforce challenges facing treatment providers must also be addressed in order to overcome employee shortages, low morale and high rates of turnover.

OASAS finalized a plan in Jan. 2020 that established a series of priorities to address the state’s opioid crisis which included expanding access to medication-assisted treatment and enhancing treatment capacity for opioid addiction; using federal funding to implement treatment innovations in high-need counties; and providing overdose reversal training. Aside from using outcome studies to document the effectiveness of evidence-based programs and strategies, the comprehensive plan proposes few metrics for tracking implementation of its priorities for containing the state’s opioid epidemic.

Recommendations
DiNapoli’s report recommended that policymakers:

• Seek continued improvements to care systems by improving coordination across state agencies, such as OASAS, the state Office of Mental Health and the state Department of Health.
• Bolster interventions to stem the tide on drug overdose deaths using evidence-based practices to achieve the most effective prevention, treatment and recovery outcomes.
• Improve efforts to track funding, as current financial reporting does not clearly identify total state, federal and local resources dedicated to addressing the opioid crisis.
• Establish clear performance targets and regular reporting of metrics, program evaluations, and outcomes.
• Direct funding and support toward communities facing the greatest challenges.

Report
Continuing Crisis: Drug Overdose Deaths in New York

Track state and local government spending at Open Book New York. Under State Comptroller DiNapoli’s open data initiative, search millions of state and local government financial records, track state contracts, and find commonly requested data.