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The number of older black New Yorkers dying of cocaine-involved overdose deaths has tripled in recent years, a trend city health officials are struggling to understand.
Between 2010 and 2015, the number of non-Latino black New Yorkers age 55 to 84 who died over overdoses where cocaine was at least one of the drugs in their system went from 33 to 43. In 2016, that number jumped to 93 and has continued to climb, reaching 133 last year, city health data show.
A majority of the deaths involving cocaine last year among older black New Yorkers did not involve heroin or fentanyl, city Department of Health and Mental Hygiene data reveal. The cocaine-related deaths that did involve fentanyl — the potent opioid implicated in 60% of all city drug-related fatalities last year — frequently included heroin.
Cocaine and other “stimulant-related” deaths also have been on the rise nationally in recent years, and rose 88% in the city overall across demographics between 2015 and 2018. When looking at people who lethally overdosed with cocaine in their system, the death rate in the city for older black New Yorkers last year was 27.5 per 100,000 people, compared with 10.7 for the total population across the five boroughs, according to the Health Dept.
Dr. Guohua Li, professor and director of the Center for Injury Epidemiology and Prevention at Columbia University, says the abrupt increase in deaths where cocaine may be a factor, beginning in 2016, should shift how the public thinks about fatal overdoses.
“It should no longer be called the opioid epidemic,” Li said. “Rather, we should call this public health crisis the drug overdose epidemic.”
Who and Why?
Patterns, such as method of use — snorting or injecting cocaine as opposed to smoking crack, for example — in these cases remain unknown. And deeper information on who might be most at risk, such as longtime frequent users versus more casual ones, is also scarce.
“We’re in a cycle right now where we’re seeing this uptick in cocaine use and cocaine-involved overdose deaths. And it’s national, it’s not just New York City,” said Denise Paone, director of research and surveillance in the Bureau of Drug and Alcohol Use at the Department of Health and Mental Hygiene.
People with cardiovascular issues may be especially vulnerable to cocaine-related death because the drug can overwork the heart, Paone noted.
That black New Yorkers in this age group seem to be at higher risk for cocaine-related death than their white counterparts might reflect health care disparities, said Daliah Heller, director of drug use initiatives at health nonprofit Vital Strategies.
“We’re talking about a population group who are very likely to have experienced poor or low access to quality primary care over their life course because of the color of their skin,” said Heller, a former assistant commissioner at the Health Department.
The Health Department plans in the coming year to focus on education efforts with primary care doctors and a public awareness campaign around cocaine, Paone said.
“We don’t have the tool like naloxone like we do for opioids,” she said, referring to the overdose-reversing antidote.
Keith Brown, director of health and harm reduction at the Katal Center for Health, Equity and Justice, said the city and state should focus on addressing the forces that hamper access to care and make drug use more dangerous.
“We keep doing this policy shifting around specific substances, and it’s incredibly misguided,” he said. “If we had a comprehensive public health strategy, we would be prepared regardless of what substances people were using.”
To Brown, such a strategy means dealing with needs such as housing, health care and poverty, and turning away from criminalization of drugs.
Growing Search for Answers
Public health officials often work with limited information, even as fatal overdoses are increasingly the subject of law enforcement-backed investigations.
Staffers funded by the High Intensity Drug Trafficking Area, a federal law enforcement program, are teaming with the city medical examiner’s office to examine drug deaths. An epidemiologist housed at the medical examiner’s office, paid by the federal program, creates daily reports on suspected overdose deaths that go to the NYPD, according to local HIDTA director Chauncey Parker.
The HIDTA also funds two social workers at the medical examiner’s office who call family and friends of someone who has likely died of an overdose. They ask about the person’s treatment history, among other information.
The details are used to create monthly reports on data about where and how people died, and other factors. The reports go out to law enforcement, health and social service agencies in the city and state, Parker said.
NYPD Plays a Role
The city’s overdose response plan, known as HealingNYC, also has designated millions of dollars for the Police Department to immediately investigate drug overdose scenes. The information gathered there goes toward criminal investigations, an approach advocates have criticized.
“If Mayor de Blasio really believed in a public health and compassionate approach to overdose and substance misuse, he would take every dollar of HealingNYC that went to the NYPD and give it to the Department of Health,” said Jeremy Saunders, co-director of the activist group VOCAL-NY.
Saunders said the money should go to public health investigations of the deaths “so we can understand how they happened and can be avoided in the future.”
The NYPD said it shares information on overdose death cases with city health agencies at a quarterly meeting at police headquarters called RxStat.
“As part of its groundbreaking effort to fight narcotics, help those in need and foster public health awareness, the NYPD shares its intelligence on drug overdoses, and overdose deaths, with an array of stakeholders, including health and law enforcement partners,” said Al Baker, an NYPD spokesperson.
“These efforts together have helped build an increasingly coordinated, and effective, response to address the tragic scourge of drug overdoses.”
Avery Cohen, a spokesperson for the mayor, wrote in an email that HealingNYC had “bent the curve on substance misuse” and helped to decrease overall fatal overdoses in the city for the first time in eight years.
“We will continue to build on this progress, and work across agencies to ensure we are doing everything we can to tackle this public health crisis head on,“ she said.
Medical intakes at city jails last year showed that more than a quarter of people locked up likely have cocaine-use disorders — a greater share than those with likely opioid-use disorders, according to Correctional Health Services, although the two categories are not exclusive.
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