Brian Lehrer: Brian Lehrer on WNYC. October, as you may know, is Substance Abuse Awareness Month. The issue of substance abuse, particularly of fentanyl, has become alarmingly prevalent in our city. Last month, we were all shocked by the devastating death of one-year-old Nicholas Domenici. The child, along with two others, was exposed to fentanyl stored under the mats used for naptime at a Bronx daycare center where the incident took place.

Now, this is not an isolated incident, even though it's an extreme example. Just a block from an elementary school in the Bronx, another fentanyl operation was recently unearth, a stark reminder of the drugs pervasive presence in our communities. The unsettling reality is that in 2022, New York City witnessed a record breaking 3,026 overdose deaths. It's clear the war on drugs has faltered leaving us grappling for effective solutions.

One solution that activists and some politicians are calling for is the protection and expansion of overdose prevention centers in New York. A stalwart advocate for this cause was Ryan Carson, a name many might recognize from the tragic circumstances of his death last week, which has been in the news. Maybe you've even seen the viral footage of his murder broadcast on local news, or seen it online, or heard the descriptions of how he died in the arms of his girlfriend. Instead of focusing on that, however, we thought we would highlight his work on this issue.

In 2021 as a founder of the No OD NY group, Carson ran a campaign in which he walked from City Hall, that's downtown Manhattan, obviously, up to Albany, and then all the way to Buffalo to call on then Governor Cuomo to authorize a pilot for overdose prevention sites. As of now, two of these sites exist in New York City, but are currently at risk of being shut down under political pressure.

Let's learn more about overdose prevention centers and the threat to their existence here in New York. Joining us, Gustavo Rivera, New York State Senator from the Bronx, chair of the Senate Health Committee, as well as Joyce Rivera, founder and CEO of St. Ann's Corner of Harm Reduction. Joyce Rivera and Senator Rivera, you can tell me if you're related or not, welcome to WNYC. Senator, welcome back.

Gustavo Rivera: It's a pleasure to be back, and no, Rivera is like the Smith of the Puerto Ricans, Brian. Even though I have a lot of respect and admiration for my sister, we are not related.

Brian Lehrer: I got you.

Joyce Rivera: Good morning, Brian. Good morning, Gustavo.

Brian Lehrer: Joyce, can you start us off by explaining what exactly is an overdose prevention center? Joyce?

Joyce Rivera: Good morning, Brian, Gustavo and everyone. An overdose prevention center is a-- it's a health facility. It's a facility wherein individuals can come in, and under supervision, inject safely. These centers are portals to referral to medical care, social services. It engage individuals first of all to surpass barriers and care, but also to live safely and live as optimally healthy as they possibly can. It's very simple. It's just simply a place where individuals can come in, get engaged, receive care that is respectful, and treats them with dignity, and ensures that as they progress through their journey, they'll stay healthy and that they can restore, if they need to, their relationships with family and friends, and really reintegrate into the system.

Brian Lehrer: We'll get back to the overdose prevention centers and the politics around that, but Senator Rivera, can you talk to the overdose death of the one-year-old at the daycare center, which probably all our listeners have heard about? How did that happen, or more precisely, was the way that that happened an expression of anything that's more systemic, that can be putting other babies and children and innocent people, not even trying to use fentanyl, at risk?

Gustavo Rivera: Well, first of all, I would say, thank you for having me here this morning. That happened in my district. I've talked with the family. I'm in communications with them. My heart goes out to them and to the children who were also hurt but did not actually perish, thankfully. I should tell you that I'm also working along with Council member Pierina Sanchez, it is her district, and we are working, potentially, just to look at things legislatively that potentially could be done as it relates to daycare centers and how they're inspected, et cetera. We're figuring out how best to respond to this.

I think that what we need to just think about for a second to backup is we have to start with the fact that criminalization has not worked. You talked about the drug war faltering. I would say it has failed. The fact is that we cannot arrest our way out of this crisis. We cannot criminalize our way out of this crisis.

Now, to be clear, the people who are responsible for keeping these materials so close to children should absolutely be held accountable, because these are dangerous drugs that could, obviously, harm people. It was in a daycare center, they should absolutely be held accountable, but we have to think about the fact that the reason why they were there was because there is a market in it, and criminalization over the last generations has not worked in making it go away.

As a matter of fact, as far as overdoses are concerned and deaths from overdoses, the city just break records every frigging year. In 2021, almost 2,700 people died from overdose deaths. Based on the data from the first half of 2022, it looks like that number increased last year. We have to think about other ways to deal with this issue, and OPCs, which I am an enormous believer in, are absolutely a way to do it.

Brian Lehrer: Overdose Prevention Centers.

Gustavo Rivera: Yes, sir.

Brian Lehrer: Joyce, could I ask you, and Senator, I'll ask you next, why you think the number of fentanyl overdose deaths is increasing in New York City? I think there was a time, not that long ago, when opioid use and opioid overdoses were considered more of like a white working class plague. Maybe other drug issues plagued cities more, but why, however you want to contextualize it, are fentanyl deaths increasing in New York City right now? Joyce?

Joyce Rivera: Sure. We're in the third wave of opioid overdoses. They have been driven mainly into other communities by the prescribers who have been allowed, who wantonly have prescribed drugs for everything. You go to your dentist, you get Vicodin. There isn't any little pain that you go to a doctor for that they don't immediately prescribe you an opioid, and then folks get reliant on them. When they can't shop for doctors and prescriptions any longer because the system realizes we have a problem, there is no solution, and so they are displaced into the illicit market.

That is why we have for 2021, over 100,000 overdoses. States like West Virginia have a prescription rate that is like, what, 200 to 1 of opioid prescriptions for every citizen in that state. What we have across the nation is an unregulated system, both a legal indifferent system, and of course, in the illicit system, which is a huge market largely been fed by people who innocently were driven to addiction or dependence by a legal prescriptions there.

Brian Lehrer: You think it should be harder for patients in pain to get prescription meds from their doctors?

Joyce Rivera: I won't say that. I think that people who need pain medication should receive it. Do I think that doctors need to be educated on the variety of ways that they can be responsible prescribers? Yes.

Brian Lehrer: Senator Rivera, let me bring you in on the illicit market. One of the reasons that people calling to control the southern border better say to do so is to stop as much fentanyl as is coming in from south of the border. Do you agree that that's an issue that needs to be addressed no matter what we think about the asylum seekers?

Gustavo Rivera: Two things. First of all, that's a red herring used by the same southern-- not southern, but racist administrations in places like Texas and other conservative Republicans in different places just try to make us fear people that are coming over the border. That's one thing, but to go back for a second to what Joyce was saying, let's not forget here the responsibility of the pharmaceutical companies who lied about the addictive nature of these painkillers. They basically, because they could make a buck, and they made many billions of bucks, they lied to the public. They lied to doctors about the addictive nature of opioids. As opposed to they sold it around like it was a Tylenol that you have to get a prescription. It was basically just something that could deal with your pain.

Ultimately, when that was no longer available as far as prescription, then that's where the illicit market grew. As far as where fentanyl is entering the country, it is my understanding that most of it actually comes from overseas and not over the border, but from China. Regardless, the connection that has been made in the last couple of months between fentanyl and migrants is, again, a red herring meant to make us be scared of these people who, I remind you, are coming to this country-- Well, I won't remind you, I'll remind the folks who say that, that these are folks who are coming here trying to seek asylum, trying to seek solace from situations back in their home countries and we have to [crosstalk].

Brian Lehrer: About law enforcement's role, which one of you said earlier is not the solution to the overdose crisis. I'm going to read from a New York one story from just the other day, just from Friday. It says, "For the third time in less than a month, local and federal law enforcement officials have busted an alleged major fentanyl drug operation in the Bronx. Around 4:00 PM Thursday, this says a home on Beaumont Avenue in the Belmont section was raided as a suspected pill mill. A neighbor said two smoke bombs went off before officials from multiple agencies entered the home." It goes on from there to describe more of the details. That lead that for the third time in less than a month, local and federal law enforcement officials have busted an alleged major fentanyl drug operation in the Bronx. Senator, do you think they have no role to play?

Gustavo Rivera: That's not what I said. What I said is, certainly, if something is illegal, then law enforcement should certainly act to intercede and find this and get it out of the marketplace. My statement still stands, if criminalization worked, we would no longer have a drug problem, Brian. If criminalization worked, if just putting people who use drugs in jail would work, then we would have no overdose crisis. We would have no deaths, record deaths in the last couple of years. We have to think about this differently. Now, there is absolutely a role for law enforcement, but it cannot be the primary way that we approach this.

Certainly, as it relates to people who use drugs, let's start thinking about them as people and think about why drug use occurs in the first place. Let us remember that it is a way to self-medicate. The perfect storm that we've had, not only of what we just described, what I just described earlier, of pharmaceutical companies benefiting from lying about the addictive nature of opioids, but also the pandemic that we had a few years back, this major trauma that impacted the entire world. All of these things together are perfect storm of a place where people are self-medicating and they're doing it in an environment in which there is an incredibly addictive and strong drug that can actually kill you. This is not the first time that this has happened. Bottom line, if criminalization worked, if the drug war worked, we would have won it by now.

Brian Lehrer: We have people calling in on--

Joyce Rivera: May I add?

Brian Lehrer: One second, Joyce. Just want to acknowledge that people are calling in and our lines are almost full. We will take some phone calls on fighting fentanyl in the Bronx as well as the region generally, but the Bronx is our specific focus now with Bronx State Senator, Gustavo Rivera, and Joyce Rivera, founder and CEO of St. Ann's Corner of Harm Reduction which is an overdose prevention center. Joyce, I wonder if you would take a minute and take people step by step through what happens when someone goes to visit an overdose prevention center or a harm reduction center, if we want to call it that, like yours since they are under political attack, the very few that we have even. I wonder if you could just describe to listeners who've never experienced anything like this, what happens?

Joyce Rivera: Yes, of course, I will. I just want to add that we should ask ourselves that, how is it that these drugs are sitting in our neighborhoods and in large quantities? How did they get there? They come by plane. I think that law enforcement has a role to play, and it has a big role to play in looking at the profit in it, and who is profiting from the tow transit point, of the point of departure to the point of arrival. Because drugs are going all the way up and down and across America to the most rural points. That said, SACHR is a harm reduction agency for 33 years, but we are not yet an OPC. We are in line to become one, but we are a harm reduction center.

Overdoses still occur in our agency because people can consume a drug not just by injecting, but by snorting. We, in fact, this week, we had to revive-- I think we had three or four overdoses at our agency that we had to revive. When you come into one of our centers, an intake is performed, but it is all anonymous. We want to know who you are, and we want to know-- we're really concerned about the state of your health and the state of your social resources so that we can create a plan for you that keeps you healthy, and it puts you in a stream of services to get everything that you need. We're a one-stop shop.

If you need pain management, for instance, or have an experience with alternate ways of reducing stress, we have an inner sanctuary where we offer acupuncture and other stress reduction modalities. Our approach is more like a therapeutic menu. We develop therapeutic alliances with every participant that we engage with. Your visit can be a short visit, so you can pick up palliative supplies that you may need, whether condoms or syringes or antibiotic ointment or wound care. There's not just fentanyl that's out there, but there's also xylazine. We have seen an epidemic of wounds that require lots of wound care before they become really toxic for the system.

We provide food. Most of our people-- There is such food insecurity in the Bronx that we are compelled to offer, not just breakfast, but lunch and dinner. We go out on the streets because some of the folks that are relying on our service can't even get to our shops. We are out on the street providing the same services, bringing food and supplies to the community. We're also a drug user health hub, so that you can get buprenorphine at our shop. You could also get-- we've become a vaccination site, not just for COVID, but we do a vaccination and treatment for Hepatitis and STIs. We are a small-medium sized one shop for everyone.

We're a women's service center. Women who are at high risk, women who experience the social stigma of poverty and bad healthcare, bad medical care, bad mental healthcare can come to our organization and receive all of these women centric care. It's a woman-founded agency. When any woman that walks in through our doors receives immediate care, because we know that over time, poor women, especially women who have had use histories just drop out of services. That's not who we are. Not just SACHR, but Brian, we as a society can do much better for everyone. The old outdated practices that punish people are just simply unacceptable.

Brian Lehrer: Let me jump in for a second, because with everything you've just described in terms of the services that you offer at St. Ann's Corner of Harm Reduction, why don't you tell everybody where it is, or how to get in touch with you? Because I imagine there might be a couple of people listening right now who think that could be helpful to them or someone they love.

Joyce Rivera: You could take the 2 or the 5 train to Prospect Avenue. We're a block and a half. We are at 886 Westchester Avenue. You can reach us by website at www.sachr.org. If you have any needs, you can just ask us and we will respond within 24 hours for any needs that you may have. We're open from 7:00 AM to 9:00 PM, and with greater resources, we'll open up longer. We are out on the streets five days a week. We can prescribe buprenorphine, and for women who need women-specific care, we are there for them. We have specific funding for women. Women, if you need our care, if you're afraid, reach out to me, reach out to us, and we will absolutely prioritize your needs and satisfy your needs.

Brian Lehrer: Let's take a phone call. Craig in the Bronx, you're on WNYC. Hello, Craig.

Craig: Hey, how you doing? These places are awesome. I wish there were more of them. However, a lot of these times things spill over into other areas. Have you guys been to San Francisco lately? It's disgusting. I hope that we don't end up like that. There's more of a problem here also with law enforcement. I know someone who used to work with the Marines, used to work with US customs and DEA, when they confiscate drugs, they don't burn them or destroy them, they just take custody of them. There's too much money involved. They really wanted to stop the drugs when they take these drugs in, you burn them, you destroy them. That doesn't happen. You guys got to think about that. This is a far more esoteric, more angled problem than just giving out help. It's how you give out help. My father used to be a doctor and he never gave out painkillers.

Brian Lehrer: Craig, thank you very much for your call. Senator Rivera, I know you're concerned that these harm reduction centers may be legally forced to shut down in the near future. That's not what the caller is calling for. He sees San Francisco as a cautionary tale. I wonder if you do too in any way, and what are the politics of this right now that you're having to fight?

Gustavo Rivera: Two quick things that I'd want to mention. First of all, when we think about drug use, we're talking about supply and demand. I certainly want to make very clear that, obviously, folks that are preying on individuals who are addicted, they certainly should be held accountable. If we decrease demand, we will actually cut off the market. That's what we have to think about. How do we deal with demand? The way that we create public safety, the reason I am so supportive of these centers is because creating public safety is a comprehensive thing that requires services, that requires these types of facilities so that we can actually treat people where they are.

If you have an understanding of addiction, you can't just turn it off. Some people can, but very few folks can. It is a spectrum, and meeting people where they are in a non-stigmatized place, which is what these places are, means when someone is ready for treatment, it is available to them, and that is how they work. Now, as far as the politics here, it is true. When I grew up, the way that we talked about drug addiction, certainly, the way that we talked about people who use drugs as if though they were these aliens or these foreign things that we needed to be away from, junkies or crackheads.

These are words that are ultimately meant to dehumanize what is ultimately a person with a medical problem. The resistance, and some of my colleagues on both sides of the aisle, a lot of the resistance, I believe, comes from the stigma that is still attached to the idea that drug use is a moral failing. Drug use is not a moral failing. Addiction is not a moral failing. It is a medical problem, and we can't solve it by arresting our way out of it. What I've been trying to do over the last year and a half that the center's been operational, is that I've invited colleagues for tours, and there's many of them that have gone, and they can see firsthand what it is that happens there.

I'm in constant communications both with my conference as well as the governor since there is a bill that I have that would authorize and regulate these centers and would allow them to exist in other places, not just in the city of New York. It could be done by an executive order. We don't need to pass my bill. The governor could do it by an executive order. Lastly, the two centers that are operational now, operated by OnPoint in Manhattan, the two centers, there is a bill that I passed a few years ago called the Opioid Settlement Fund. What this did, was it created a fund of money when we reach settlements with pharmaceutical companies which could be $1 million, could be $10 billion. Right now, there's over $2 billion in this fund.

That money is to be used strictly for treatment, recovery, and harm reduction. I'm trying to convince the governor to take a little bit of that money, $40 million worth of the $2 billion that is in there to actually support the services of the two centers that are already working. I should tell you, in those two centers, in the last couple of years, over a thousand people have overdosed, but not a single human being has died. I want to underline that for anyone that might have an issue with the perception that this is enabling drug use. As opposed to having people overdose in a bathroom, in a McDonald's or in a park, or in a subway station and die, people who overdose in these centers are taken care of, and not a single one of them has died in over 30 years of these centers existing [crosstalk].

Brian Lehrer: Governor Hochul, should I take it, is undecided on your request for that funding?

Gustavo Rivera: That's correct. She has not yet done it. We are asking for her, we're pleading for her to follow the-- The bill created a board. For clarity's sake, Joyce is on this board as an expert on harm reduction. We have, it is populated by experts from all over the state that are experts in harm reduction and treatment, et cetera, and they provide recommendations to the executive. In these recommendations, the governor has accepted most of them, and I'm thankful for that, we are, but the one that she has not accepted yet is to use $40 million to support the work of the centers that are already operational.

Brian Lehrer: We just have about 90 seconds left in the segment, but I want to squeeze in one more caller because a number of people are calling to make the same basic point. I'm going to let Bill in Beacon do it. Bill, you're on WNYC. We've got about 20 seconds for you. Hi.

Bill: Hi. I totally endorse the senator's point of view. It's just that there are also people who have a chronic pain condition and they need pain meds and it's getting very, very difficult to get those meds. That's all.

Brian Lehrer: Thank you. Joyce, the point that three different callers are waiting to make is, there's such a backlash because of opioid addiction and overdoses that it's hard to get pain medications now. Doctors are so reluctant to prescribe it for people who actually need it. Can we thread the needle? 30 seconds.

Joyce Rivera: Absolutely. People should get pain meds and they should get the kind of pain meds that they need. Doctors should, in fact, be required to know more about the prescriptions that they are writing instead of focused on some salesperson pushing any particular drugs. Drugs are specific to specific symptoms, and everyone who has a real system-- that has a problem, should be able to go to a doctor, and they should not be discriminated against or experience any stigma because they are in pain. That's not what we were talking about. That is not what has driven the fact. It is disdain or the irresponsibility of the pharmaceutical industry as Gustavo pointed out, as well as doctors who are not really paying attention to prescription, to the needs of patients like geriatric patients who are--

Brian Lehrer: When they actually need it or not.

Joyce Rivera: We don't have the kind of care in this country. Even as expensive as it is, there's really no nuance in the care and the focus on the individual needs and even the collective needs of us as a society.

Brian Lehrer: Thank you, Joyce. Joyce Rivera, founder and CEO of St. Anne's Corner of Harm Reduction, and State Senator Gustavo Rivera from the Bronx, who is chair of the Senate Health Committee. Thank you both so much for joining us on this vitally important topic.

Joyce Rivera: Thank you, Brian.

Gustavo Rivera: Thank you for having us.

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