OnPoint NYC made history in November 2021 when it opened the nation’s first “overdose prevention centers” (OPCs), where people can consume illicit drugs under medical and/or peer supervision.

Since then, more than 2,300 participants have visited Manhattan’s East Harlem and Washington Heights facilities more than 55,000 times, and the nonprofit’s staff has intervened in more than 700 overdoses that may have otherwise been fatal.

Despite those results, the OPCs—which operate in a legally gray area due to the federal 1986 Anti-Drug Abuse Act (sometimes called the “crack house” statute)—have struggled to maintain their overdose prevention services. The statute prohibits public funding for that work, forcing OnPoint to rely on private fundraising.

That could all change, though, if the Department of Justice drops its opposition to OPCs in a pending federal lawsuit.

Still, OnPoint Executive Director Sam Rivera argues there’s another way to ensure the nation’s only OPCs can keep their doors open: funding them with dollars secured through national opioid settlements. New York Attorney General Letitia James secured more than $1.6 billion from settlement agreements with companies that manufacture, distribute, and sell opioid painkillers. The money must be used to help communities hit hardest by the overdose crisis.

New York leaders have declined to allocate some of the opioid settlement funds to support OPCs—even as Rhode Island prepares to use more than $2 million in its own settlement dollars to support a forthcoming safe consumption site.

Rivera spoke with Healthcare Brew about the financial challenges facing OnPoint’s OPCs, and why he’s fighting to use opioid settlement dollars to operate the New York City sites. Keep reading here.—SY

Do you work in healthcare or have information about the industry that we should know? Email Shannon at [email protected]. For completely confidential conversations, ask Shannon for her number on Signal.

Opioids, particularly fentanyl, are increasingly laced with an animal tranquilizer called xylazine—a drug that public health experts fear will worsen the opioid crisis.

The drug is colloquially called “tranq” and is mostly found in the Northeast—with Philadelphia as the epicenter in this region, Philippe Bourgois, a professor of social medicine and anthropology at UCLA who researches xylazine usage trends, told Healthcare Brew.

Due to a lack of testing, xylazine “will catch the country by surprise as it continues to rapidly spread to new cities,” Bourgois said.

Though xylazine use became prominent in 2015, there’s not much data quantifying how much money health systems have spent to treat patients for its side effects, such as severe skin ulcerations and withdrawal that can put users at risk for seizures.

But just looking at the costs of treating a couple of those common symptoms can show the financial effect on health systems.

Xylazine use symptoms are expensive to treat: A common symptom of xylazine use is pressure ulcers (bed sores), as xylazine often makes users go unconscious for many hours at a time, Bourgois said. Bed sores can be extremely expensive to treat, with severe cases costing an average of $124,327, according to a 2011 New York University study from New York University.

Xylazine dependence can result in such severe skin ulcerations that require amputation. Bourgois said it’s “shocking” how often people are losing limbs as a result of xylazine usage. The economic burden of hospitalizations after amputation is “considerable,” according to a 2018 study from Qatar that estimated the overall per-patient cost for an amputation to be $89,808. Keep reading here.—MA

Do you work in healthcare or have information about the industry that we should know? Email Maia at [email protected]. For completely confidential conversations, ask Maia for her number on Signal.

This week’s Making Rounds spotlights Rachel McCrickard, a licensed marriage and family therapist who co-founded Motivo Health in 2018 to help therapists with the licensure process.

McCrickard, who is also the company’s CEO, spoke about the challenges therapists face in becoming licensed—which contributes to the ongoing shortage of mental health providers—and how her startup is trying to make the process easier.

This interview has been lightly edited for length and clarity.

What’s the problem you want to solve with Motivo Health?

The licensure process is harder than it should be—65% of therapists who get a master’s degree in counseling never make it through the licensure process [according to internal Motivo research], so we’re losing over half of the supply of available therapists just from the licensure process itself.

Motivo is a platform that connects therapists with clinical supervisors. You need about 200 hours of clinical supervision to become a therapist [though requirements vary by state]. A new therapist gets a master’s degree in counseling or psychology, and then they have to work under the supervision of another therapist for [about] two years. Historically, it’s been in-person meetings with your supervisor once a week. I’m from a rural area of north Georgia, and when I was working toward my license, the closest supervisor was two hours away in Atlanta. The idea for Motivo came about when I saw that states had started passing laws saying you could do your supervision virtually. We’ve helped move that process online so that it’s more accessible.

What are some other barriers in the licensing process?

It’s oftentimes cost prohibitive. Entry-level wages as a therapist are often quite low. You’re serving mostly the Medicaid population. You make $30,000–$40,000 a year as a new therapist, and you have student loans coming due. Keep reading here.—MA

Today’s top healthcare reads.

Stat: President Joe Biden’s near 7,300-word State of the Union speech mentioned abortion 72 times. (the 19th)

Quote: “The court order is in place ordering isolation and quarantine.”—Nigel Turner, director of the communicable disease control division of the Tacoma-Pierce County Health Department, on a mandate requiring a local woman to receive medical treatment (NBC News)

Read: The UN warned in a new report that “climate change and antimicrobial resistance” are the top two greatest threats to public health. (CNN)

Catch up on the top Healthcare Brew stories you may have missed:

• Debate over nurse-patient ratios heats up
• New guidelines aim to weed out surgery risks for cannabis users
• Why NYU Langone screens its ER patients for diabetes