December 9th, 2016
Earlier this week, The Influence reported on a forward-thinking fentanyl outreach project in New York City. Thousands of flyers produced by the NYC Health Department’s Bureau of Alcohol and Drug Use Prevention, Care and Treatment were set to be distributed on December 9 and 10 in all five boroughs by Medical Reserve Corp volunteers.
But the volunteers were suddenly told that the project was cancelled, at short notice and with no further explanation. Why could this be?
The flyers (you can see an example below) contain sensible, harm reduction-oriented advice to help people who use drugs keep themselves safer, given the common presence of fentanyl in what’s sold as heroin, cocaine or Xanax. Tips include not using alone, carrying naloxone, taking small “tester” amounts, and avoiding mixing drugs. It’s vital information for a city where 725 fentanyl-related deaths were confirmed between January and October this year.
However, on December 8 dozens of NYC Medical Reserve Corp (MRC) volunteers received calls from organizers and an email titled “FENTANYL OUTREACH CANCELLED” from Betty Duggan, MRC’s director. The Influence obtained a copy.
“I am very sorry to inform you that the MRC Fentanyl Outreach Project is cancelled,” Duggan wrote. “Due to circumstances beyond our control, we will not be able to do outreach on Friday, Dec. 9 and Saturday Dec. 10.”
After praising the volunteers’ commitment (“This cancellation is not a reflection on NYC MRC”) and acknowledging the time they had spent attending a training session, Duggan added: “Please don’t distribute any of these flyers on your own. We will need to collect the flyers and the vests.” She shared arrangements for dropping the supplies off and thanked everyone again.
I called Betty Duggan to ask about the reason for the cancellation. However, working at a city-run organization, she is not permitted to speak with the media, so she referred me to the NYC Health Department press office.
I called the press office and asked why the event was cancelled. I later received an email stating: “The outreach event was postponed and will be rescheduled. We are committed to educating New Yorkers about the risks associated with fentanyl.”
I asked again for the reason for the event not being held, and whether the content of the flyers had anything to do with it. “Just postponed,” was the response. “And as background, that flyer is on our website along with tons of other material.”
One of the MRC volunteers who was called and emailed was Helen Redmond, a licensed clinical social worker who has worked with drug users for many years, and who contributes to The Influence. She told me about the preparations that had gone into the project.
“I attended a two-hour training called ‘Emergency Response to Fentanyl and Opioid Overdose in NYC’ at CUNY Law School in Long Island City,” she said. “It was a ground-breaking training because the outreach messaging was completely based on the principles of harm reduction. Finally, I thought, after 20-plus years of harm reductionists fighting with public health officials, here was a flyer that encapsulated pragmatic ideas for people who use opiates. The flyer contained no scary, shaming messages. This was a first!”
“At the end of the training we all signed up for shifts, got a cache of 500 flyers and were thanked for our commitment,” she continued. “We were excited to hand out these well crafted flyers and engage with the public about a pressing public health issue. So imagine my surprise when I got a call and an email two days later saying the outreach was cancelled.”
Part of the training, Redmond said, had concerned how to respond to members of the public who questioned the flyers’ approach. “We were told people might ask: ‘Why is the Health Department telling people to use drugs?‘; ‘Don’t these tips send the message that it’s okay to use drugs?‘; ‘Why don’t people just go to treatment?‘”
And according to Redmond’s information, NYC Mayor Bill de Blasio’s staff could themselves have benefited from the answers to those questions.
“I was told that the mayor’s office was concerned that the flyer ‘sent the wrong message,’ and ‘could encourage drug use,'” she said.
The possibility that the mayor’s office postponed the project due to a belief that the existing flyers could encourage drug use remains unconfirmed, but I put the scenario to Daniel Raymond, policy director at the Harm Reduction Coalition.
“We rely on the health department to provide clear, concise and compelling messaging to people who use drugs at risk of overdose, and these posters are a strong example of how to do that,” Raymond said. “These flyers are consistent with similar messaging from the Baltimore City Health Department, and I’ve shared New York City and Baltimore City health department materials with other health departments looking for good messaging directed at people at high risk of a fentanyl overdose.”
“I hope that the city quickly reviews and resumes this campaign,” he continued, “because it’s an urgent health problem and the messaging complements the administration’s broader initiatives around overdose, harm reduction and treatment.”
“We’re in the midst of a crisis with fentanyl-involved overdoses, and there’s a clear role for public health in crisis communications,” he concluded. “Just like the city health department has done for Zika, Legionnaire’s Disease and Ebola, it’s vital to be able to communicate effective, evidence-based risk messages to the people and communities in greatest danger.”
Read more from The Influence:
Volunteers like Redmond, who were all set to go out in the cold to help keep their fellow New Yorkers safer this weekend, are left frustrated.
“This is 2016!” she said. “Harm reduction-based public health outreach campaigns are mainstream in many countries in Europe. They don’t encourage or condone drug use, they simply meet people where they are at. But apparently Mayor de Blasio’s people are upset.”
“They used to say this about needle exchange,” Redmond noted. “That if you gave drug users clean needles, you were ‘encouraging’ them to use drugs. We’ve finally won that battle. No, it doesn’t increase drug use—as a mountain of studies have proved. Nor does recommending that people carry naloxone, don’t use alone or test their drugs.”
It remains to be seen whether any reason will be confirmed for the event’s cancellation, when it will be rescheduled for, and whether the materials used for any rescheduled event will be different. In the meantime, fentanyl-related deaths remain an urgent problem for New York City.
[One of the flyers that will not now be given out to New Yorkers this weekend.]