BACKGROUND: In 2012, in response to growing opioid analgesic-related mortality in New York City, the NYC Department of Health and Mental Hygiene and the New York/New Jersey High Intensity Drug Trafficking Area formed a public health/public safety partnership, RxStat. The distinct roles played by health and safety agencies means that collaboration between these entities is not routine, and divergent methods and ideologies exists. As drug policy sits at the nexus of health and safety, collaboration is essential to effectively combat the current opioid epidemic.
METHODS: Modeled on CompStat, the NYC Police Department’s system of real-time metrics to assess crime patterns and target resources, RxStat is a data-driven initiative to inform policy and program interventions to reduce overdose mortality. Group membership to date includes 37 municipal, state, and federal agencies representing greater New York and New Jersey. Conceived as a data-sharing mechanism, the partnership has shifted since inception toward furthering overlapping policy goals and developing programs at the intersections of the fields. We will highlight challenges faced while building RxStat and discuss how these difficulties were addressed and overcome.
RESULTS: While the central goal of Rx Stat is to reduce overdose deaths, differences exist between health and safety partners stemming from the disciplines’ divergent missions and methods. Public health works to reduce risk, public safety to reduce crime. While not diametrically opposed, each mission necessarily employs different methods. Public health operates at a population level, public safety at a caselevel. The challenge lies in finding shared points of intervention. In NYC, RxStat agencies have used prescription drug monitoring program (PMP) data to accomplish complementary goals. Public health used PMP data to tackle risky prescribing through education and guidelines targeting the widest possible range of prescribers. Public safety used PMP data to identify the narrow segment of prescribers and patients engaged in criminal distribution of controlled substances. Collectively, our actions demonstrated a measurable decrease in prescription opioid-involved mortality in geographic areas targeted. Further complementary goals were achieved through the shared use of emergency department and emergency medical services data, prosecution and drug seizure data, and laboratory and toxicology data.
CONCLUSIONS: While the goals of health and safety organizations might at times be difficult, even insurmountable, engaging in frequent and open dialogue, as well as facilitated discussion between practitioners at all levels, is crucial to developing and deploying effective interventions toward shared ends.