Committee on Mental Health and Substance Use

Good afternoon and welcome to the New York City hybrid hearing on the Committee on Mental Health and Substance Use. Please silence all electronic devices at this time. Also, if you have not yet filled out a testimony slip, please do that, do that with the sergeant-at-arms in the back of the room or outside in the foyer. Also, please do not approach the dais.

Thank you very much for your kind cooperation. Chair? Thank you, Mr. Chairman. We are ready to begin.

Good afternoon. I'm Councilmember Tiffany Caban, chair of the New York City Council's Committee on Mental Health and Substance Use. Thank you all for joining us at this oversight hearing on syringe litter management and related support services. We will also be hearing 3 pieces of legislation. Intro 67, sponsored by Councilmember David Carr, establishing a public outreach and education campaign regarding the availability and use of fentanyl test strips.

Reso 262, sponsored by Councilmember Linda Lee, calling on the New York State— calling on New York State to mandate basic training in addiction treatment as a requirement for medical schools that receive state funding. And Reso 263, also sponsored by Councilmember Lee, calling on the federal government to mandate basic training in addiction treatment as a requirement for medical schools that receive federal funding.

We have been joined by Councilmembers Felder, Aldawal, Hankerson, Wilson, Lee, and Carr.

Now, there are very real public health concerns from discarded syringes that should be recognized, especially in a place as dense as New York City. The risk that they pose shouldn't be minimized. Parents shouldn't have to sweep a playground before their kids can play. Workers shouldn't fear a needle stick on the job. In 2024 alone, outreach teams picked up nearly 200,000 syringes up off of our streets.

But today's hearing is about much more than litter. It's about the story that is told behind each syringe and discarded needle and the very real humans behind them. Because behind every syringe use is a person. It's someone's child, parent, or neighbor, and often someone whose substance use disorder began with a prescription, with trauma, with pain that our systems left untreated.

And too often we met them with handcuffs instead of help. Arrests, evictions, lost jobs, lost children, weeks-long waits for treatment. and so much shame that people hide. Nearly half of all deaths among homeless New Yorkers in the most recent reporting year were caused by drugs or alcohol. And that's not a personal failing. It is a policy failure.

And that failure does not fall on everyone equally. We've made some real progress. Overdose deaths fell from 2023 to 2024, but still 6 New Yorkers die every single day. Black and Latino New Yorkers die of overdose at twice the rate of white New Yorkers. Black New Yorkers have the highest overdose death rate of any group in our city.

And the highest rates are among Black New Yorkers in their late 50s and early 60s, which is quite frankly a group that's too often left out of how we talk about this crisis. Men die at roughly 3 times the rate of women. And the Bronx has the highest overdose death rate of any borough. And Hunts Point-Mott Haven, Highbridge, Morrisania, and Crotona-Tremont have among the highest rates in the city.

In 2023, the rate in Hunts Point-Mott Haven Mott Haven was more than triple the citywide average. And these aren't accidents of geography. They're the result of decades of disinvestment, overpolicing, and structural racism in the very neighborhoods where the crisis is now the worst.

The Community Syringe Redemption Program was built to meet both of those realities. It was created by local law through this council and launched in 2025. It trains participants to safely collect used syringes and return them to mobile vans in 8 high-need neighborhoods for $0.20 a syringe, up to $10 a day. More than 2 million syringes have now been safely collected and disposed of.

Just as important, the program brings people into contact with care. Every participant is trained not only in safe syringe handling, but in how to respond to an overdose and administer naloxone so that the people who are out on our streets every day are equipped to save a life. Because participants come back to the vans week after week, the program builds something our system too often lacks: a regular, trusted, low-barrier point of contact with people who may never walk into a clinic.

And so at each visit, staff can connect people to nearby syringe service programs, which offer naloxone, HIV and hepatitis C testing, drug testing, drug checking, counseling, and pathways to treatment and other health and social services. And for someone who has been failed by every system that they have touched, a relationship that starts with $10 and a conversation can be the first door back to care.

Clean streets and saved lives are not competing goals. A city that is serious about public health has to be serious about public space and serious about the people that we have failed. I want to thank the administration for being here, as well as the committee staff and my staff who— that helped prepare for this hearing. And I look forward to today's testimony.

And actually, with that, I'm going to turn it over to Councilmember Carr, who has a statement. Thank you, Madam Chair. statement. Thank you, Chair, for your leadership on these issues, and of course this committee. It's an important, very important issue facing every one of our boroughs. An average person, an average one person dies every 5 hours from a drug overdose in our city, and the vast majority of these, nearly 80%, are caused by fentanyl.

Fentanyl is not only mixed in with other illicit drugs to increase potency, it's also sold as powders and nasal sprays, and and increasingly pressed into pills to make it look like legitimate prescription drugs. Not just opioids, but also anti-anxiety and antidepressants like Xanax and Ativan. A lethal dose of fentanyl can be the equivalent to just a few grains of table salt, and this minute amount can be detected by test strips that our city already distributes for free.

This legislation would simply require a public education campaign to take place to make people aware that these fentanyl test strips are available and to use them. We need to do much more to stop the scourge of addiction that is afflicting our city and to encourage people to get the treatment that they need. But we can't help them unless we keep them alive.

And we need these test strips to help do just that. And, you know, the chair was talking about the numbers in the Bronx. And the reality is, is that this is a scourge that is affecting every community in our city, every borough, and frankly, the nation. There's no part of this country that's been left untouched, and we need to do everything that we can to tackle this crisis together.

I want to thank the chair again for hearing this bill today. I want to thank Majority Leader Abreu and Councilmember Lewis for already signing on as co-sponsors. And I also want to thank our former colleague, now State Senator Eric Boettcher, who was the original prime sponsor of this bill last term. And I urge my colleagues to support it.

Thank you. Thank you. Okay, thank you. Now I'm going to turn it over to the committee counsel to administer the oath to the representatives from the administration. Thank you. Now, in accordance with the rules of the council, I will administer the affirmation to the witnesses from the mayoral administration. Please raise your right hand. Do you affirm to tell the truth, the whole truth, and nothing but the truth in your testimony before this committee and to respond honestly to councilmember questions?

You may begin when ready.

All right, thanks. Let's see if I can handle both looking at this and then looking at all of you. Okay. Good afternoon, Chair Caban and members of the committee. I'm Dr. Rebecca Lynn Walton, Assistant Commissioner for the Bureau of Alcohol and Drug Use at the New York City Department of Health and Mental Hygiene, the Health Department. On behalf of Commissioner Martin, I thank you for the opportunity to testify today about our efforts to safely collect and dispose of syringe litter, our contracted syringe service providers, and the outreach and syringe litter teams that connect individuals to the support services they may need.

I'm joined by Assistant Chief Frank Latera from the New York City Department of Sanitation, DSNY. Overdose deaths decreased by 28% in New York City from 2023 to 2024. While this sustained decrease is promising, overdose continues to be a public health emergency, and there are substantial inequities in overdose deaths across demographic and geographic groups in New York City.

In particular, overdose deaths remain disproportionately high among Black and Latino New Yorkers, residents of the Bronx, and residents of neighborhoods with very high levels of poverty. The decline in overdose deaths that we have seen reflects persistent but often unseen efforts by community advocates, harm reductionists and care providers and follows significant city investments across the substance use care of continuum— continuum of care.

Syringe service providers, SSPs, are a critical component of New York City's overdose response strategy and are an invaluable resource for the safe collection and disposal of syringes. SSPs are community-based organizations designated as New York State licensed syringe exchange programs, SEPs. To fulfill their duties as state-licensed SEPs, SSPs offer access to sterile syringes and safe syringe disposal. Some have dedicated teams to collect and safely dispose of used syringes found in the communities they serve.

The Health Department contracts with all 14 syringe service programs in New York City. They provide syringes and reduce community spread of infectious disease, along with a myriad of other essential services. I'll refer to this network of 14 community-based organizations as SSPs going forward. SSPs also provide a range of health services including referrals to onsite physical and mental healthcare, opioid use disorder treatment with buprenorphine, naloxone distribution, overdose education, HIV and hepatitis C testing and counseling, drug treatment counseling, support groups, drop-in centers, and in some cases outreach and syringe litter teams.

Harm reduction services offered by SSPs provide key opportunities for connections to care and work in tandem with other components of substance use care spectrum, such as treatment and recovery services. The Health Department remains committed to the safe collection and disposal of syringes. To date in 2026, January through August, outreach and syringe litter teams safely collected and safely disposed of more than 46,000 ground syringes provided syringe disposal education and materials in over 8,200 encounters, distributed over 7,800 naloxone kits, initiated over 18,000 participant engagements, and made more than 8,300 referrals to additional care services.

Thanks to the City Council, the Health Department launched our Community Syringe Redemption Program last spring. This was a novel addition to our layered approach to addressing syringe litter in parks and other spaces in New York City where complaints were highest. The redemption program is designed to reduce syringe litter by allowing participants to return used syringes to the program for a small financial incentive.

This encourages proper disposal and simultaneously serves as a low-threshold engagement opportunity for people who use drugs to be connected to services. This program also refers participants to SSPs and other services. Since its launch in March 2025, the Community Syringe Redemption Program has collected over 3.5 million syringes enrolled over 2,400 participants across just 8 sites in Queens, Manhattan, Brooklyn, and the Bronx.

The Health Department recognizes the public safety and quality of life issues associated with syringe litter. This is a growing concern that the Mondani Administration takes seriously. We are working closely with our partners in Parks Department, DSNY, and other city agencies to address syringe litter. DSNY provides needle collection in high-need areas, and particularly around schools, transit stops, and public spaces.

This collection is done during daily needle patrols, responding to 311 complaints, and through interagency encampment cleanups. DSNY services certain hotspots daily or multiple times a week and has collected nearly 40,000 needles so far this year. Many people use syringes for a range of medical and health needs. It is important for New Yorkers to know how to properly dispose of needles.

And we will use this opportunity to educate everyone tuning in. Needles and other sharps should be placed in sharps containers or other leak-proof, puncture-resistant containers such as laundry detergent bottles and sealed and labeled with home sharps, not for recycling. These containers can be brought to a collection site— a map can be found on DSNY's website— or discarded as trash.

Unfortunately, there has been an increase in the number of sanitation workers struck by needles in recent years. DSNY recently finalized a rule to increase the penalty for improper disposal of needles from $100 to $250 to discourage this dangerous practice. Before I answer your questions, I'd like to briefly discuss the legislation being heard today. Introduction 67 will require the Health Commissioner to establish an ongoing public outreach and educational campaign regarding the use and availability of fentanyl test strips.

The Health Department supports this legislation and currently provides extensive public outreach and education on the availability and use of fentanyl test strips. The department offers regularly scheduled virtual public trainings twice a month and multiple resources on fentanyl test strips on our website. These resources include an instructional video, brochure, and poster available in multiple languages, and also includes information on locations where the public can access fentanyl test strips.

In 2026, thus far, the Health Department has already distributed over 118,000 fentanyl test strips to community-based providers. More information in our efforts to engage the, the public and educate individuals around the accessibility of fentanyl test strips is available on NYC Health's Alcohol and Drug Use Services page. There are a few points within the bill language we would like to clarify, and we look forward to discussing the bill further.

The Health Department remains committed to partnership with the council and other community stakeholders to find more solutions for the safe collection and disposal of syringe litter and its impact on community quality of life. Thank you for the opportunity to testify today, and I look forward to answering your questions.

Sorry, thank you so much. Does sanitation have separate testimony? Great, we'll dive in. I just want to acknowledge that we've been joined by Councilmember Areola on Zoom. I'm going to start with just a few questions, give it to my colleagues, and then I'll come back. But we'll start sort of on the basics. I want to know, you know, the scale of the problem, how it's currently being measured.

How do you currently measure the amount of syringe litter in public spaces? So, for example, is it through a combination of 311 complaints? Is it through DOHMH outreach and litter team counts? Is it through CSRP returns? Where are you guys getting that number from?

So I'll start with 311s. 311s primarily come to Sanitation. We have our needle crews out there 24 hours a day, 7 days a week. So when the 311s come in, and let me just clear that up, it's 311s for all city streets, sidewalks. We handle everything except inside a park. Inside a park, we will reroute that to the Parks Department.

We have crews 24/7, 7 days a week. We try to expedite, especially if it's near a school or near, if there's other homeless encampments around there, we're going to try to expedite and get there a little bit quicker. We usually are out there within 4 to 5 hours, sometimes even quicker, but we respond to every 311 within hours.

We also keep track of every single needle we pick up. And then do you take those numbers and combine them with a different set of numbers were collected from different places. Oh, and before you answer, I just want to say, one, it's nice to have you here. Obviously you're not a regular player in, in our committee's, um, you know, testimony.

And Councilmember Gutierrez says that your folks do a really great job doing syringe pickup before school starts, um, nearby. So I just wanted to, to say thank you on her behalf. Appreciate that. There's many schools that we, we are out there before, schools that have a needle epidemic around them. where we try to get out there before the kids arrive.

Thank you. Yeah, and how the Health Department adds to that is through a wide variety of our syringe abatement programs. So we have the syringe service, the syringe redemption program. We also work with Parks very closely because they have their kiosks and then we have the syringe service programs service them. And so they add that to their needle collection figures that they're sharing out as well.

And we collect both information about the syringe service programs, how much they're collecting on site, but then also the outreach syringe litter team. So only 5 SSPs right now have it, and from those, they're able to pick up hundreds of thousands of syringes a year. And as a follow-up to that, out of all of the areas that you're getting data or numbers in terms of syringe pickup, is there anybody doing pickup that you're currently not able to get the numbers from?

Yeah, so we also— so across— sorry, my kid gave me a cold like 3 weeks ago, and I'll be coughing for the rest of my life. If you need tissues, we can We can get you tissues, let us know. Nope, I'm just gonna be coughing for the rest of the season. So we also work with, so we have 14 syringe service programs across all 5 boroughs, so they don't cover all of New York City.

And so we regularly are talking to people at OCMH, we'll be talking to community partners and talking about how they can safely pick up syringes. So maybe we don't get a syringe count from them, but we're understanding and elected share with us hotspots that they're noticing. And so from all of that, we're trying to get a picture of where we should put our efforts.

So maybe it won't be like I'll have a number In Sunset Park, for example, they have this many syringes. But we know it's an issue, and so we're working together with our sister agencies to address it.

The hotspots, which neighborhoods are carrying the heaviest syringe litter, and then how does that correspond with where harm reduction services are concentrated? Yeah. So how we picked the 8 sites for the syringe redemption program is we looked at 311 complaints, and we're really grateful for open data, and then also complaints we were getting from councilmembers. sites are actually the highest volume of syringe litter we're noticing.

So like the Hub in the South Bronx, Echo Park, St. Mary's Park, although I have to say St. Mary's Park is tremendously much cleaner now as a result of all of the efforts going on, but still a long way to go. And so we also— Walter Gladwin Park. So it's the South Bronx, it's Upper Manhattan, Midtown is an issue as well.

But also then we'll notice other neighborhoods. I keep mentioning Sunset Park just because that hasn't historically been an area that we've had these services in, but that's one of the areas that we had outreach from council members in the community, and so that's where we're working with the community. The hotspots are going to be familiar to all of you because it's often where public drug use is highest and the overdose rates are highest, and so that's where we've really been focusing our efforts as the Health Department and then in partnership with other agencies.

Awesome, thank you.

And then Can you tell me how needlestick injury reports compare with actual infection risk and how that risk is communicated to the public? I think just making a record, obviously, of— we need to accurately tell people what the danger is or isn't because that's an issue that comes up. Yeah, do you want to take the needlestick injuries since you're— I can only speak on needlestick injuries for sanitation workers.

They are definitely on the rise. I could give you our numbers for the last few years. This year, I mean, we're up to 69 and we're only in October, mid-October. We're up to 69 where last year we were at 50 total for the year, 40 the year before. And every time a sanitation worker gets stuck, it's an extensive process.

There's a lot that goes along with it. He's out of work. Obviously, he's being paid low-dive, but there's other— Well, it's traumatic. It's very traumatic. It is mentally, yeah. You know, they miss out on a lot of other details of the job that they would normally have. And then obviously the health risk. of the medication and being sick from the medication.

They take a certain kind of cocktail, they're getting shots, they have to follow up with our healthcare facility for 28 days. So there's a lot that goes with it. So our needle sticks are on the rise. Okay, so thank you. I guess you guys might not be the best people to ask about what actual infection risk is.

Is that sort of correct? We can follow up with more information. But I will say that of the programs that we have and the strategies we have, People are not getting needlestick injuries. And so we have a sort of different view of it because we're training everyone to do it safely. Great. Okay, so, oh, sorry, were you gonna say something?

All right.

You talked about the locations that CSRP is currently operating and how the redemption sites were chosen, but can you talk a little bit about how the weekly schedule is chosen? Yeah, we can follow up. We have on our website, we have the actual weekly schedule. And so that's based on, I mean, it's a model where you have to be within 1 hour of another location to make sure they're not spending their whole day in transit.

And so they'll start, they'll do, each van will do 2 to 3 sites per day where they're there for several hours. We're also working very, they work very closely with community providers as well so that people don't show up at a time when the van is not there because that's not helpful and that's gonna frustrate New Yorkers and we don't want that.

And so we work very closely with community programs and make sure that people are aware of the schedule. And then sometimes we have adapted the schedule because we're noticing an uptick at a different time in a location, and so we try to work with the program as well to make sure that the schedule is there when people need the services so that we can reduce ground syringes.

Great. And are there plans to add more, like add more sites, more days, more hours, more neighborhoods? As an example, Queens only has one site. I'd love to see more. And Queens, you know, disproportionately has less overdose prevention resources and harm reduction resources compared to the deaths that we're seeing. And then I'm sure my colleague Councilmember Carr would want to know about getting one in Staten Island because there are no— there are none there.

Yeah, so I defer to City Hall around any plans to expand. I can say I love this program very much. It's one of my favorite parts of my job, and it has been a joy to be part of it because I I got to start right as we were starting to launch it. So I love this program.

And I will say the only reason Staten Island doesn't have it is because of that 1 hour. We just couldn't— we tried really hard and just couldn't figure out how to get them from there to Upper Manhattan in the right amount of time. And the same with Queens. Sometimes you can't get from Western Queens to Brooklyn in an hour, so I feel you.

So we tried, but we will keep trying. And we are constantly figuring out, you know, have we done enough in this community that we should move it, and we're just trying to work with communities and figure out. And there have been a couple times where we thought, oh, maybe we've fixed the problem, and the community said, no, no, please stay.

And so we just want to be responsive to the communities where they are right now. So you would be, you would be happy if you got more resources to expand locations, hours, etc.? I'm gonna defer to City Hall, but I love this program. Can you tell us so far how many syringes you've collected, CSRP has collected to date?

And could you break those down by month, borough, and redemption site? Yes, we will make sure you get a copy of the report because it does exactly that. So we've picked up— And that was released yesterday, I think, right? Is that correct? There was one that was published yesterday? Yeah. Okay. And so it was only through February.

So through that time, we had a total of about 1.5 million syringes picked up. And then the highest areas of pickup were Echo Park, St. Mary's Park, and a tie between Walter Gladwin Park and then Highbridge Park. So all the South Bronx sites were actually the highest amount of it.

Great. And I know the committee staff and our team has the report. I haven't been able to dig into it as closely since it was released yesterday. But since CSRP was launched, the city has seen declines in syringe litter in the neighborhoods it serves. obviously being measured by 311 complaints, as you said. Or I guess my question is, have you seen declines in the syringe litter as measured by the 311 complaints?

Yes, but also I would— I just always love sharing the story of St. Mary's Park because— and there was a really wonderful News 12 piece on it the other day. And so when we started, it was the highest frequency of ground syringes noticed. And one time when I went, it was like 100 degrees over the summer, and I went out there for the day, and there were no syringes nearby.

And also there was a group of kids from the local camp learning how to ride bicycles. So that is a sign of what I love about public health in New York City government. Yeah, I, I like going over to On Point and just having them— getting to see the bins and bins filled up of the syringes. How do Parks Department weekly syringe collections compare with CSRP's, and which You mentioned the parks already that have the highest, but yeah, how are they comparing with the CSRP pickups?

Yeah, so we can follow up with the kiosk data, but I will say, I mean, the kiosks are smaller, and so you're going to have a— there is a much smaller volume. That's why we have the kiosk partnered with— I think it was something like 40,000 syringes in the kiosk. But I will say that's why we have it partnered with the outreach and syringe litter teams. so that people are, maybe people are in that park but didn't know the kiosk is at one end of it.

And so when we're doing outreach, our outreach workers who are really wonderful people and generally have lived experience and are from that community, that's why it's such a helpful and effective model. So they will go out and if they notice someone has left a syringe by, they can have a conversation with the person, make sure they have a safe disposal piece of material, and then also let them know about the kiosk.

And so we really try to add it together that it's the kiosk, plus the outreach and syringe litter teams, because it's really the same people.

Okay. I want to ask you some specific questions about the report that was released, and then I'll pass it over to colleagues. But over 12 months, the report lists 9 referrals, 4 for detox, 4 for MOUD, and 1 harm reduction. And that was across a little over 1,700 enrollees and over 30,000 transactions. So I want to get a sense of, obviously, it's in its infancy.

We're learning a lot. But can you talk to me about why so few referrals and what the referral target would be, should be going forward, or will be going forward? Yeah. So yes, absolutely. It was a pilot program. And so what we often do when we're going through a pilot program is realize, oh, we were calculating that incorrectly.

And so I will say without a doubt that every single individual who is engaged through this program someone has a conversation with them about what services they're accessing and if they need it. And so what we found was the program wasn't maybe collecting that data and that maybe they don't, you know, sometimes my conversations, I'll notice someone has, you know, someone will come to us with wounds and when I'm doing outreach and I'm seeing the same person, or I know that the syringe redemption folks have said they'll see the same person every day and they check on their wound and they say, did you go to the show van down the block?

And so maybe it doesn't get counted as a formal referral. Yeah. But it's happening. They're important touches. If we're doing wound care, if they're following up on wound care, are you guys going to make adjustments to what kind of data you're collecting then? Like, what are you thinking about collecting? Absolutely. Yeah. We have our sort of 1-year talk in a couple of weeks, and we were just like, can you just download to us what has been a challenge?

Sometimes it's challenging for people to mark off that they've done a referral, that, you know, some of the— some former participants are now working for the program because it's been so successful. And so maybe, you know, whenever I work with people who haven't been doing data collection. You know, we have this with the relay peers who go to emergency departments and do bedside overdose response.

They may not be, you know, counting it the way that it gets measured, and so how do we do that work one-on-one? So absolutely, we want to be improving this, and so that we can capture things like, I walked you down the block, or maybe for 3 months, you just wanted to hand me your syringes and not talk to me, but maybe in month 4, you were willing to have a 5-minute conversation, and then maybe in month 5, I got to know that you were going to St.

Ann's Corner of Harm Reduction down the block. I also will say that On Point has been great and they park their Winnebago right next to the van. And so that's a great natural example of how maybe it doesn't get counted as a referral because they're just going next door and getting acupressure. I'd be really curious to see what adjustments y'all make to better capture the impact of the programming and also to better capture even based on that what gaps there might be.

The 5 Bronx sites, they account for 84% of syringes and 77% of enrollments. And then the Queens and Brooklyn sites together collected under 1%. And Borinquen Place enrolled 7 people. How can— what can we do to increase enrollment in Queens and Brooklyn? Because we know people are using. Like, what can we do there? Yeah, so one thing that we have noticed was that rollout has been a little slower because it was something so new for the area.

And so there's been a lot more more adjustment in where the van is, which community providers we should be working with. And I will say it's starting to tick up and doing better. Happy to work with you about other strategies. I will say electeds have been incredibly helpful in talking to us about— we were able to move the Brooklyn van, I think it was like around the corner, same park but a different corner of it, and that dramatically increased the ability to be effective.

And then had better partnerships because it was right near some social service organizations, but very much open to continuing to improve. And Queens and Brooklyn, who are you working with there? I will get the list for you all. All right. Thank you.

I'm going to ask one more question and then I'll hand it over to colleagues. New enrollments, they peaked in— I mean, I have like— there seems to be one obvious answer to this, but I wonder what else is— we can— how we can account for this. But new enrollments, they peaked at 239 in September 2025, and then they fell to 105 in February 2026.

How the program— like, has the program reached the people it can reach at current sites? How are you going to find new participants? How do you account for that change? Yeah, it was very cold and there was a lot of snow. So it was as simple as there were just fewer people out and we were trying as much as possible to encourage people to be inside.

And so maybe not stopping by the van that day, but just going to the drop-in center at OnPoint or Boom Health or another one of our SSPs or VOCAL in Brooklyn. And just going back to the enrollment increases in Queens and Brooklyn, are, as part of those plans to increase enrollment in those boroughs, are you contemplating or planning out a public education campaign?

What does that look like? What resources do you anticipate being behind that? Well, we're in a really exciting startup phase of we are going to be expanding additional outreach folks to all 14 of the syringe service programs, and then we're also going to be able to add a clinician. So that's coming in the next year, just working through all the fun contracting.

And so that's something that those programs have been asking for us for a very long time. And we're really proud that this administration has made it possible that we can fund that and do that work. And so part of the rollout is working with each program. For example, ACQC deals with a lot more alcohol than the other SSPs are.

And so what is, you know, more of like a car-based outreach model since they cover more ground? Right. And it's all of this really exciting and enjoyable work that we get to do with our technical assistant folks, and we get to really sit down with those programs. And then also part of that outreach is to electeds in the area and making sure that we are responsive to them and just really sort of thoughtful work about how do we approach this problem so it both meets the needs of the community and then also serves effectively.

So if alcohol outreach is something that we're seeing rather than like, say, K2 or stimulant use in East Harlem, for example, what is the different response that's needed in, in that moment? Well, thank you.

I will pass it over to Councilmember Hankerson, and then I'll have the ball. Thank you, Chair, and thank you all for being here. Thank you for the information that you shared. I remember earlier this year we held a hearing on the Parks Committee, and I was astonished by the number of syringes that are picked up within our public parks.

I know in the upper— I think in Upper Manhattan alone in 2023, they recovered 160 73,000, and that's just in that area. Can you— I'm going to kind of leave this question open-ended. Can you talk about the relationship with the Parks Department and your agency? Yeah, we love working with Parks. We just sent our data over to Julian the other day, and yeah, we regularly meet with them.

We've brought them on tours with OnPoint so that they could see what the services were looking like. We have regular conversations with them to identify, are there new parks that maybe weren't on our radar that we should know about, and some Sometimes we also include sanitation. I don't know if you have anything else to add, but yeah, I would say it's a great partnership and really necessary too.

The training that the parks workers receive in terms of pickup, does that come from your agency? We really try to have the model— I mean, when I asked the state, how do I do the formal syringe pickup training, they were like, don't do it by hand. Wear gloves or use a grabber and be safe. And so it's really intuitive.

And so we try to make it as much as possible that I believe Parks does it as part of their onboarding, that we don't want to wait for like, is, you know, Ian from the health department available that day to come do training? We really want it. Same with naloxone that when I was at Health and Hospitals, we wanted your first day on job as a security officer for Health and Hospitals, like you were getting naloxone training.

We really want it to be happening as part of the natural onboarding that people are doing. So we train, we usually train folks to be doing it themselves because we don't want to gatekeep any of this information and access. Is there data on accidental, accidental, I guess, punctures with it, with parks workers? We'd have to defer to Parks Department on that.

Okay. Well, just across the board, do you all keep that data? I will find out. It's not my bureau, so I will find out who has it.

Sanitation gave us their, like, stick numbers. Just sanitation. Okay. Yeah. Can you, can you share? Absolutely. So this year, hold on one second. Let me just get— I think we had 60 this year. Yeah, calendar year '26, we're at 69 right now. Calendar year '25, we're at 50. Calendar year '24, we were at 40. Calendar year '23, we were at 23.

Calendar year '22, we're at 25. And calendar year '21, we were at 29. So we're up significantly with you know, 2 full months to go. Okay, thank you. That's all the questions I had. Thank you, Chair. Thank you. Um, you know, obviously we want to— oh, I have a quick follow-up and then I'll go to Councilmember Aldawalla on that.

But, you know, obviously we want to reduce the, the number of syringes on the street so that there isn't an opportunity to get stuck. Um, in the meantime, while you're seeing this increase, have you— will there be adjustments to maybe more frequent training on proper and safe disposal, things like that, to reduce the number of sticks that you're seeing in the department?

Yeah, so Commissioner Anderson has done some social media campaigns with the Health Commissioner, I believe, and other people from City Council getting out there doing some social media campaigns on how people could properly dispose of. We're doing some mailouts and other follow-ups.

Councilmember Aldawell. Good afternoon. Thank you for being here today. According to your 3rd quarter report, fentanyl— and you, and you mentioned it in your, in your statement— fentanyl consistently remains involved in the majority of overdose deaths citywide. The Bronx has remained the most susceptible of all 5 boroughs. Since you issued your report, Have you altered your mode of operation in these particularly vulnerable communities, and how are you using your data collection tools to decide where to place naloxone distribution, for example?

Yeah, that's a great question, and I would say we use every quarter data to see how we need to adjust it. We absolutely agree, and we really try to take a zero overdose approach. approach because we don't want any single overdose. So one of the programs we're really proud of that we launched over the summer was a community ambassador program.

We looked at the 10 highest zip codes of overdose deaths, and we had people hired from the community to go do naloxone training. And many people said that they had heard of naloxone but had never received a kit. And so we really were trying to reach the people who, you know, we initially blanketed the city with naloxone as much as possible, but then you have to do targeted in-reach to communities.

Happy to work with you and your community as well. Thank you. And we really rely on electeds and community folks to let us know there's an issue in my neighborhood. That's why we wound up doing naloxone training for home health workers as well. And we really do try to constantly be changing our approach in terms of what's evidence-based to better in-reach to communities that we haven't hit before, because we don't want any New Yorkers to be dying of an overdose.

And what existing outreach models does the department have to reach those who may be hesitant to look for help? Yeah, so we have a bunch of different outreach techniques because we recognize that we want it to be a lot of different ways. So we have— I have a couple really, or a few really fabulous folks in my community, in my department who are going out.

We also— that's why we engage with the syringe service programs, because they have a lot of people with very deep lived experience in a wide variety of ways to be going out into their own communities to be doing outreach. and then doing things like driving someone back to On Point or Satcher or Harlem United or any of them with a drop-in center so that they are not in public using and they are able to access supports.

And we also work with a tremendous number of treatment providers as well, as well as work very closely with Oasis so that we can recognize that, you know, I'm an example of someone who was sent to treatment and it was incredibly effective, but I was also told at this incredibly effective treatment that within a year, only 2 of us would still be in recovery, and within 5 years, half of us would be dead.

And so I always use that as an example of if it doesn't work, if that doesn't work for you, you could be dead. And so we always want to make sure we're having as many doors as possible for people to get into. And so that's why the syringe service programs have been great about getting people on medication for opioid use disorder and also traditional treatment.

And that's why OASAS and we have rolled out additional funding for recovery centers as well. How much of your budget is allocated towards the OSL and SSPs? So I can get back to you with the actual figures. I will say that we provide a wide range of both traditional treatment funding. I would say it's evenly spread for the number of programs across the city.

And then we also work with the state to make sure they have resources.

One more? I know I have a lot of time. I just want— yeah. So the fiscal management, the 2026 fiscal management reports, the mayor's management report indicates that needles removed by DSNY fell 49% after 3 consecutive years of increases. In fiscal year 2026, DSNY attributed this loss to the decline in interagency cleanup operations. Staff was appropriated to address other operations.

Is there any outreach or interagency cooperation happening now to confront this decline? I think the decline can be— it can be— there's a lot of different factors. I think Department of Health is out there a lot more than they've ever been. I think they picked up over 3.5 million syringes. I think you have a lot of these little pop-up agencies.

I know last year when we started in the hub, It seemed like there were little pop-up agencies coming out of the woodwork to help us with syringe pickup. They were there around the clock, so I think they had a big part in it. I think the winter weather of 3 months of not being out there— January, February, and almost most of March— had a lot to do with the decline.

So I think there's a lot of factors. I know that DHS and DSS is out there every single day assessing every single homeless New Yorker. So I think the decline is really about what happened in the past months. I think you'll see the, you'll see the increase come again. Thank you. Appreciate that. We can talk offline about the East Bronx.

Councilmember, do you have any questions? You good? All right. I just want to go back to the, the report for a few minutes. So the report, it doesn't have participant demographics, right? It's not including race, ethnicity, gender, housing status, prior SSP enrollment. Is DOHMH collecting this, and if so, will you share it? So we don't for this program, and it's because the way it is designed is to be the lightest touch of all of our interventions.

And so I I honestly can tell you that for many months, some people will not talk to us during an exchange. And so we don't want to do anything to deter them from being willing to come and hand in syringes. I will say that over time, people then do talk to us. And I was out at Walter Gladwin Park on Monday, and so someone was sharing that they love this.

And then we had like a crowd of people coming to tell me that they love this program. And so those are folks that— And then one of the people was interviewing for a job that day, and he had been a participant. participant. And so, you know, I think it's really important to have information about the people we're serving unless it's going to stop them from coming for those services.

And so while we try to— the same for syringe service programs, that they— that's also a lighter touch. And so if you want someone to access treatment for infectious disease, then you have to make it as easy as possible. That's why we have a lot more data on the traditional treatment setting type because that's much higher— barriers to get into and/or takes more to access that system.

And so that's why we have more robust information about them. Related to being as low-touch as possible, right now participants, they sign a liability waiver covering AR, DOHMH, and all the partners. Why is the waiver required? And do you sense that it discourages anybody from enrolling at all? It really doesn't because we're doing so much education around safe pickup.

And once you get the hang of safely picking up, like, I've never injured myself, and ARR, the people who've been operating it for years in Boston, and now we're lucky enough to work with them, they've never had needlestick injuries. And so that's why it's so important to be handing out those materials. And they hand out the disposable cups so that people can— it fits about 50 syringes.

And so people are just putting it in there, and then they know to hand that in. Wow. And then we're really trying to avoid as much opportunities to get hurt as possible. So we haven't found it to be a deterrent.

You spoke about this a little bit in terms of conversations that happen. Sometimes they do, sometimes they don't, sometimes it takes time. What is the scope of the things that can happen at a redemption visit beyond the exchange? I know you said that for a little while, like, a lot of people might not want to engage at all, but is every participant at least offered a service conversation?

Or offered naloxone or test strips or anything else? Very much so, and I've watched people walk up and say, can I have that? They'll have like a bunch of naloxone hanging, and they'll say, can I have that kit? And then they're really happy they get to choose, and so it's all about agency. So I will say, while someone may not want to talk at first, they generally do if you say that, you know, it's like neighbors.

When I see the guy who owns the corner store, Mike, on my corner, I'm like, I know him because I've been coming there with my kid for years. And so we get to know people over time, and it's the same for Syringe Redemption. And so we do build those relationships. And that's why, you know, one time I was there and it was like 8 degrees out, and there was a woman who was a participant who didn't have a maternity coat.

And so we were able to say, have you been going to Santa's Corner? Harm reduction is right down the block, and they tend to have the most materials for women of any of the SSPs. And so she said no. Oh, she said they'd already ordered her a coat and they were going to have it for her the next And so that was because of those ongoing conversations.

And is that typically how a participant ends up moving from Redeeming Syringes to an ongoing relationship with an SSP, a drop-in center, or another provider? It sounds like there are opportunities for these warm handoffs. Absolutely, very much. And it always reminds me of my clinical work and like the kid who would come into my office and sit down and say, I don't want to be here.

And maybe it would be that way for 3 months. And then in the 4th month, he'd suddenly have something he wanted to tell me about his day. And so having these repeated interactions where people are getting looked at in the eye and getting treated with respect and dignity and interest in who they are and what their lives are really does make it a unique program in terms of being able to engage.

And I would say that of all the harm reduction programs. Yeah, there's a, a story that Sam from On Point, like, likes to tell about a participant who who he called by his actual name and hadn't heard his name uttered in years. And that is a story that has stuck with me, and it's something that kept him coming back to On Point.

So that resonates. Can you— do you have a sense of what share of participants are new to the harm reduction system as opposed to people who are already enrolled at an SSP? Like, is the CSRP program an effective way to connect with these individuals? What's your sense there? I would say it varies. I don't know the exact breakdown, but I would say, you know, just from working with New Yorkers that would use programs like this, many of them have been in and out of the system so many times, and maybe they've been referred to substance use treatment 12 times.

And so each time, you know, for that type of service, there's a barrier of you have to do this in order to come or else your case gets closed. And so they're used to cycling through. And then slowly becoming someone like that story that Sam tells so eloquently, who no one uses your name. And so they will know about the programs usually, and people also have networks and communities.

And so they were hearing about it from the local SSP. And one of the participants on Monday was sharing that he has been sharing safe disposal information with his neighbors as part of being a participant, that he then was able to go out and educate. So I would say people tend to be aware of the networks. But maybe aren't accessing it.

Maybe they're scared that since they, you know, maybe they had an outburst last time they were in a drop-in center, they may not be welcome back, even though I can say every SSP is fabulous about welcoming you back. And so maybe they just needed another person to say, hey, do you want to walk down the block with me to St.

Ann's Corner of Harm Reduction or Harlem United or whichever the local or vocal, so that they can feel that they can rejoin that community.

I want to ask a little bit about how some of the other administration's initiatives kind of interplay with DOHMH's strategy to reduce public injection, right? Like, I talked about this in my opening, the reduction of public injection. Sure, we don't want the litter on the streets, but it's a larger issue that we're trying to address when it comes to people and their needs not being met.

So do you know if the Housing First initiative is part of DOHMH's strategy to reduce public injection? And also, how is— how are you guys working with DHS and HPD to get people indoors? Yeah, we work incredibly closely with both of those agencies. I would say regardless of administration, the goal of the Health Department is to do good public health for New Yorkers.

And so that absolutely means making sure people are getting housing as they need it, making sure we're working with every agency that has access to housing, making sure we're working with the state to figure out are there some additional— like when I started at the health department, there had been a rash of overdose deaths in some supportive housing sites.

And so, you know, it was just a natural thing where some people in my bureau were talking to the Bureau of Mental Health and they were figuring out like what are the things we need to do and do we need to, you know, pilot having one of the peer corps trainees go work in supportive housing. And so everyone's trying to use public health to fix the problem.

And so I would say while it's— this administration has been incredibly supportive, also we're just continuing to do public health. And so we will always be doing public health. Totally. Capacity always ends up being an issue, obviously. When CSRP refers to services, do you find that, you know, like those services have the capacity to take people promptly?

Like where are the gaps? Are people waiting for treatment slots or shelter beds or appointments in particular places? Can you kind of break down how that's working across different supports or interventions? Yeah, so we're always trying to prioritize the supports where it's, can I walk you down the block or is it next to you and that's how I get you to it?

Because this is a population where we really can't be saying, you know, a month from now you can go upstate to this rehab and get a bed. And maybe if they want that, what are the things I can do with you in this month to help you keep going and keep you safe and alive during this time?

And that's how it operates. And so I would say that people generally get referrals in that moment because that's the type of referral we need. But is it— how often is that successful? How often are you able to say, well, we have an opening, we have an opportunity here, the person is very willing, they want to be connected to something.

How often is that happening, understanding that you're looking for something that's geographic? close that you can do in the moment? And how often are you like, ugh, missed opportunity because that thing wasn't available because we need more of it? Yeah. More capacity. Yeah. So the missed opportunities are more like maybe you showed up at Tuesday at 3 PM when the schedule was Monday at 11 AM, and then we're trying to do more outreach.

So I would say that's why we've partnered so much with the syringe service programs. because they have drop-in centers and it's so easy to just walk over and access it. And so that's why we try to make— so I would not say that if someone wants help, they're not going to get it in this program. Also, it's a small program, and so it's easier to find slots for a small number of people that are right near the thing that they want to access.

Thank you.

I'd love to ask you a little bit about workforce and training. Redemption site staff, there are Are any of them trained as peer or outreach workers? So they, I would have to check. I don't think they are certified because the model is trying to offer an access to employment for folks that sometimes, you know, so we work, I would say all the programs add up to workforce support.

And so some workforce support for people is that they are ready to go to the OASAS or OMH training. And so we send them there and they can get training for that and we can get them certified. But sometimes, They don't want that yet, or they want to see, like, what would it be like if I did outreach with Harlem United one afternoon a week?

That is something they can do with that organization as well. We try to offer as many opportunities. Also, the peer corps that we have is so that people can do— sometimes people have a hard time getting through the certification programs in the time that's set by the state, and so we have this program where you can take a little longer to get through it.

We're trying to create as many opportunities, whether it's a community health worker or a certified peer. And then sometimes people start as a community health worker and then find out about a certified peer training program, and then they do that too. And then we had someone leave Peer Corps to go to social work school. And so we wanna make as many opportunities as possible.

What training do redemption site staff receive? So they're doing a combination of safety and how to use, say, the microscope to make sure it's a used syringe, because we don't want people taking sterile syringes from the pharmacy or wherever they're getting it and then bringing it over to the van. And then also they get coaching from the people, you know, they'll have someone who works there who's been there longer work with someone who hasn't been there as long.

And in the harm reduction programs, use this model too. So you can do on the job, it may not be a formal like motivational interviewing training, but you're learning how to do that on the job, which was frankly much more useful to me was getting supervision around how I was going to use tools. What's the staff to participant ratio and how much time per visit is available for engagement beyond I had a feeling you were going to ask that.

So the model is a van and 2 workers. Okay. But I will say that they can spend 0 seconds with the person who doesn't want to talk to us, or they will spend an hour with someone. And so there are regular peoples who want to talk and tell you how their life is going and what they did yesterday.

And so it is a very flexible model, and that's why we've been a little less like, you know, did you categorize— catalog that referral quite correctly because we really want them to be focusing on, if I needed to spend half an hour with you, was I able to spend half an hour with you? And in year 2 of the program, then we'll figure out the data stuff.

Yeah, totally. I think the tension with that continually that comes up is the ability to keep data that makes the case for scaling a program, especially in the face of naysayers. But that's been the area that we're talking about. Peer workers and cleanup teams, they carry a lot of the work. What are they paid? Like, what's the pay?

Do they have benefits? Is there a path to full-time employment? Do city contracts require a living wage for these roles? So different harm reduction programs pay different salaries, but we work with them on their budget so that we can work toward parity and make sure people are paid. I know that everyone is struggling with funding, and health service workers of all types are struggling with salaries.

And so I will say that, yes, you can be fully employed. We have a number of folks who started out as outreach workers part-time and were participants of SSPs that are now the director of the outreach team. And so there absolutely is opportunity for growth. And then some people then wind up joining our relay team, and then being senior directors in the, or being senior supervisors in the relay team.

There are opportunities for people to have advancement. Can you talk about range though of compensation? I know you're saying it's not consistent across the board and people are moving into these different roles, but generally sort of what's the floor of what people are making? What's their earning opportunities? Yeah, I would have to follow up with that. I will say that the health department, we are able to pay our peers for relay programs very well.

One moment, please. Your training, can we talk about the accessibility of it? How long is it? Who delivers it? What languages? Are there opportunities for people with low vision or who are hard of hearing or have other accessibility needs? Which training? The CSRP enrollment training. Oh, yeah. So that is done one-on-one with someone working there, and we try to hire bilingual folks.

We don't have it right now in, say, 14 languages, for example, but we can also train someone who has vision issues because we're doing it right there one-on-one, and they can say, like, oh, that doesn't work for me. And then we can say, oh, what about if you did it this way? Or what if you do it in a pair, for example?

Thank you.

What are participants taught about reporting litter and finding disposal options? Is that information that's shared also with people who aren't enrolled? Yeah, absolutely. So people are taking this— that's what we're hearing from participants, that they're taking back this education they've learned to their community members. And so someone was showing me how he was showing his neighbor how to pick up syringes safely and how to use a grabber and things like that.

And so we always— That's part of what we love about how our public health model works is that we're always trying to share information with people in a way that they are able to take it in, make it their own, and then teach it to their neighbor. The best naloxone training I ever did was with someone on the street, and they said, no, no, no, I know how to do it, and they showed it to the person next to them.

Thank you.

Okay, oversight, and also evaluation and metrics and all those kinds of things, right? The program, it's permanent, we love that. I think baselined at $3 million a year. What changes from the pilot? We talked a little bit about thinking about metrics and how data is being collected, but like what else? What changes? And will future contracts be competitively procured?

So this was a unique contract because there was one person doing it in the country, ARR. And so that's why we worked with them and they have been fabulous, but they also would like other people to be doing it. So it would, if there were more, we would be doing it competitively. Got it. And I will say we absolutely do constant technical assistance with all of the programs that we're in contract with.

We do performance evaluations of them. We're making sure that they are meeting the goals of the contract. And so, and I will say about referrals, that the purpose of syringe redemption is really about that, getting the syringes from folks. And so that's why maybe we didn't focus in the first year about the referrals. Mm-hmm. And so maybe we just need to categorize it differently, knowing that really every person is talked to about what referrals would be helpful.

But yeah, so we are constantly talking to them. One of the— some of the things we're talking about for year 2 is, are there different times of day that might be more effective for a site? Should it shift to a slightly different location in the community? And that's where electeds are so important to talk to about this if they're noticing it in a different part of their community.

And you've said we in a lot of this, so I just want to get super specific about who the we is. Is CSRP being independently evaluated, or is the operator reporting on its own? performance? We don't have an independent evaluation, but I will say it's a combination of them reporting on it, but then I also have a team who manages their contracts.

And so they, for every program they manage the contracts of, we're evaluating to make sure that they are meeting their deliverables. Okay. And here's the big question. The— I guess the rivalry is going to extend. There's only one other. How do New York City's results compare With ARR's program in Boston? I would like to say New York is always doing the best of everything.

They would say that it has been tremendously well received by the community, and so that has been what's made it so successful. I will say, having worked in research for years, that independent evaluations are incredibly expensive, and so one of the things we're always trying to balance at the health department is do we want to spend our resources there, or do we want to spend our resources in the community, in the program?

Thank you.

Yeah, go for it. So syringes, you know, collect on land that's like embankments, medians that are shared. Like, it's DOT on one side, parks on the other side. I have an example where we have land that's, you know, Pelham Bay Little League, part of it is Parks Department, another part of it is DOT, then you have MTA right there.

It's everybody's responsibility and nobody's responsibility. And there have been, you know, more recently, you know, needles found in the vicinity. How does DSNY coordinate with the different agencies to collect the needles? Yeah, so obviously with the social media posts from a few weeks ago, right, with Pelham Bay Little League and everything that's going on, we work very closely We went down there and on their Saturday cleanup, we went in and we just cleaned.

We took every needle. It didn't matter where it was. We went behind the fence, on the side of the Hutch, around the baseball field. We worked very closely with the community organizers who were doing it. I was in contact with them the whole time. We try to be an agency that's never going to pass the buck, right?

Especially when it comes to syringes. This is something that's— it's a health issue. It's a public health issue. You have Lehman High School across the street. The other school that's right on Ward is placed on the block. Right across the street from the ball field. Yep. So when it comes to something like that, there's no passing the buck.

We went out there, we cleaned every single thing there was. We, we, I don't have the needle numbers, but I know there was a large needle collection, I think, especially coming down the embankment of the Hutch. Yeah. Um, we, we try to just go out there and clean. If it's in a park, we refer to Parks. If Parks needs assistance, we're always there.

We, we, last year, again, going back to the Hub, we, we were very instrumental in cleaning up St. Mary's Park with all the the needles. So when it comes to something like this, I know sometimes with litter and everything, there are some interagency back and forth. When it comes to needles, our team goes out there. It's a public health issue.

We clean it. And is DOHMH going to expand your programs to other parts of the Bronx or other boroughs? The syringe redemption program? Yeah. So I would have to defer on City Hall about that. I will say it's been tremendously effective where it is, but it's also a baby program that's just started. Thank you.

Thank you. I also have a couple of sanitation questions. When sanitation crews find the syringes during street cleaning or litter basket collection or vacant lot cleanup, Can you just walk us through the protocol? Do crews collect them, flag them for another— I mean, I know that you have your guys pick them up, but can you just— yeah, can you walk us through what the protocol is?

I know that you then do track the collections, you share the counts. Sure. So if it's just a regular basket crew, regular collection crew, or we get a call, we call our environmental police They are the ones who are trained on picking this up. They come out with their protective gear on, their pickers, they pick it up the right way, put it in a sharps container, document everything, where it is.

They also try to find the source of the needle. It's not just that we pick it up and leave, especially if it's in a bag. We try to open up the bag, see if we can find a piece of mail. We want to see where it's coming from so we could prevent that from coming. Could I ask a quick question about this too?

Do you, for the number of Sticks reporting, do you have that broken down between environmental team folks and then other folks? So for us right now, it's really just the environmental team. Just the environmental team. Yeah. We do have, about 10 years ago, we were, when lot cleaning, before lot cleaning was disbanded, we were finding a lot of needles at abandoned lots.

So we decided we were going to train our lot cleaning personnel. So our lot cleaning and our highway personnel are trained in picking up syringes. They're not the ones that are called to the sites. They're more of on-site. If we're cleaning a lot, they're going to pick up the one or two that are in there. If they're on a highway, it just saves us time so we don't have to call the environmental team in.

That makes sense. So they are trained, but really— Or like if there's a couple, but it's not something that you need to bring a crew in for. Correct. So mostly it's our EPU team that comes in. Sorry. Thank you. Yeah, no problem.

Has DSNY considered sharpsafe receptacles on or near litter baskets in high litter areas? Obviously some parks have them, but I just wonder if that's ever been considered. I don't think it's been considered, but I mean, we have dog poop dispensers on litter bags now, litter baskets, so maybe that's something we can actually think about. It's not far-fetched.

It's not a bad idea. But no, we haven't, but we could bring that back and see if if that's something we'd be interested in doing. Okay, yeah, we'd love to have a conversation about it. Does DSNY change cleaning routes frequency or staffing in neighborhoods with the most syringe litter? Like, we've said this a lot, South Bronx, East Harlem.

And how do you use the 311 data, the DOHMH hotspot maps, or any other input that might come from like the SSP cleanup teams to target, to figure out where you're targeting your work? Yeah, so obviously 311 is for us, whether it's cleaning, collection, needle pickup. We're always going to focus our attention to where the highest number of 311s are coming in.

We always evaluate our numbers based on our needle patrols. We have needle patrols in several neighborhoods. There are some neighborhoods that unfortunately we can never just get out of. There are some neighborhoods that have gotten better over time and we reduce it, but we constantly throughout the year evaluate what is our collection status, how many syringes we're picking up, do we need to pay special attention to them.

And then there's always new sites coming in from a lot of Councilmembers that are coming in now. Like I mentioned earlier in my testimony with the schools, a lot of Councilmembers right now are calling about a problem around schools. It seems like schools is a hotspot overnight right now, so we're constantly evaluating that data and getting out there.

And yeah, like I said before, Councilmember Gutierrez had high praise for the preschool pickups. When the syringe is reported through, through 311, what's the average response time, and does that change depending on where the syringe is, whether it's, you know, park, sidewalk, school? Sure, so I could say it definitely changes when there's a school involved. We have protocol where our officers will call it out over our internal radio system, and one of the questions, one of the first questions they're asked by whoever, whatever Borough Command they're calling that out to, Is this by a school?

Is the school open? Are there children nearby? That's going to always expedite it. But even when it's not in a school, we try to keep our response time to 3 to 4 hours. Obviously, New York City traffic with a certain amount of teams out there, we can't always keep to that, but we do our best to do it within 3 or 4 hours.

And I would say schools, probably within the hour most times. Thank you.

There are a lot of different people picking up syringes in a lot of different places. Is there a single map that you're all populating or a schedule showing who's covering what? There is not. Something that we're trying to figure out for outreach folks is there— you're going to be shocked— there isn't a shared platform where people can put in all of their schedules so that it's helpful in a way that— We need that.

I know. So we're working— so absolutely heard. Like, we do outreach summits with all of the folks we do outreach with. And this is something we've been asking for, like, who could create that tech? So if you know of a developer, they should be working on that because people want to be able to have it be dynamic.

So if I'm shifting today, and maybe I got into work late because there was like a subway delay, and I'm supposed to go out 10 to 1, but instead I'm going out like 11 to 2, I want to make sure that we're not having the same 2 people interact with someone on a corner, but you could be 5 blocks over and then I know that.

Yeah, that seems super imperative. Okay. So an area where we need some advancement.

I also want to talk a little bit about sort of how policing or enforcement can impact participation in specific areas where the CSR Have any of the SSP, CSRP sites, or peer cleanup teams reported NYPD activity near their sites while they're out there? So they try to go to roll call so that they can get to know— all of the harm reduction programs do try to go to roll calls and then get to know the folks in the precinct around.

And so, yeah, like On Point's a great example. Like, they were the first to do this and they do a great job of doing that. And so it'll be more of a relationship. I also will say when the hub stuff started a couple summers ago, that super hot summer, we were all out there trying to figure out.

And so that was all of the agencies together figuring it out, plus all of the outreach folks in the community from DHS, from the substance use treatment programs, from the harm reduction programs. And we were all trying to figure it out together. And so that's where that came from, is if I park on the hub, is that going to help?

Yeah. So, so if they're going to roll call, is it to let the precinct know, this is where we're going to be, can you steer clear? Or are they going to roll call? What is happening when they're going to— what is the purpose of going to the roll call and what is happening post-roll call? Yeah. So it's going to be a bunch of different things.

It may be, I work on this corner, and so then you know me. I'm Rebecca. I'm going to be on this corner or I'm going to be doing this route. And if you see me in the community, come say hi. If you've noticed someone on your walkthrough that you think could benefit from my services, please, please, please bring them to me.

Also, if maybe there's someone who is skittish about talking, maybe it would be better for the harm reduction folks to interact with that individual because they're really amazing at doing this. And so they'll work with NYPD and the officers will say, great, that's fantastic. And so all together we're able to figure out what is the approach that's gonna help the person.

I mean, yeah, 'cause the question ultimately is, where the concern ultimately is that if there are police officers hanging around a site, that folks are going to be discouraged from participating. Obviously, there's the other part of this that's like, yeah, you would want a good enough relationship where if a police officer was out, they would proactively reach out to an outreach worker or something and say, hey, you guys go deal with this.

But yeah, I just did— I don't know that it's totally answered my question about kind of— And like, police activity near the sites or whether that has an impact on participation. And this is an extreme example. I'm not saying that this is what's happening, but I'm a former public defender. Like, unfortunately, I've seen cops hang out of methadone clinics, and not only did it discourage participation, but actually it was even worse because they would, like, pretend to be dope sick and then entrap people into arrests.

And we saw that a lot. So I just— yeah, I'm just trying to get a clearer sense of kind of, are they hanging back enough for folks to be able to engage with these teams? Yeah, so that's something that we talk about in our RxStat work that we do across the city and with city and state folks, and we have NYPD as a participant in it.

And so stigma's there in every field, whether it's substance use treatment or harm reduction or law enforcement. And so we recognize that there's always going to be additional support needed so that someone can be able to see what's the way that's actually going to help in this moment to help this individual rather than like, what are my biases and then how am I acting as a result of that?

And so we do do work with all the agencies we talk to to talk about sort of how is my stigma getting in the way of my being able to effectively engage with someone? So I know that didn't fully answer your question, but I would say that's why I'm here and that's why we're all here trying to work on this together.

And do you have a sense of whether other kind of enforcement policies affect or undermine efforts to connect people to the services, like encampment sweeps, for example? I would have to defer to other agencies on that. I don't work with them.

How effective do you think— do you consider kiosks in reducing syringe litter? I know I jumped entirely to something else, but I'm curious about that. Got it, okay. So sometimes they're incredibly effective, and then sometimes we'll notice there hasn't been a single syringe in a kiosk. And so we're talking to Parks, and we're talking to the community folks, and we're talking to the SSP, and then we're doing education around, hey, did you notice that kiosk?

I've also been in conversations with Parks where they said, oh, we will say to them, you know, no one has been, 'cause we have their data, and we'll say, you know, no one has been accessing this, and then they go find out, Oh, it's been covered up by like a bush has grown over it. And so then they cut back the bush and then suddenly people are using it again.

And so I will say it's a dynamic thing in a conversation rather than how effective— they're tremendously effective overall. We just need to make sure people know about them and are using them.

At the beginning of the hearing, we talked a bit about just the racial disparities. Overdose deaths are rising fastest among Black and Latina New Yorkers. How are CSRP and the related services, how are they designed to specifically reach those communities? Yeah, so I'm always conscious of my, my background, and that's why it was easier for my privilege for me to access the help I needed.

And so that's why we're always trying to make sure that the people we're hiring are representative of the communities they serve. And so I think that's why government and nonprofit has been so great because we're able to make sure the workforce looks like the people that we're helping. And so I would say that's why we rely on people who have that lived experience to help counsel us on, you know, talking to like National Black Harm Reduction Network and other organizations about like, what are we missing in this approach that we've had?

And then how do we improve things? Do you have the demographics of the workers? We would have to— I mean, they're going to be predominantly looking like the people they're served. And so that's what's great about it. Okay, so Bronx, highest overdose death rate in New York City. They die at more than twice the rate of Manhattan residents.

How is the city ensuring that individuals are being connected to continuing services? Yeah, so that's why our opioid settlement funds and other investments we've made have been targeted in communities. Every RFP we put out was saying you had to be working and serving communities that were in the highest overdose rate communities. Because we want to make sure that every dollar we're spending is going to the communities that need it most.

You're absolutely right, it is heartbreaking, but also there's a lot of work to be done. And so that's why we keep layering on new strategies like adding syringe redemption, adding on additional outreach folks, adding on the recovery centers, adding on additional workforce opportunities for all of those programs as well. And so we're constantly trying to layer on for the community.

And in terms of having that workforce represent the community or also just have cultural competency and training in being able to refer to certain types of services, can you talk a bit about services for women, services for trans and gender nonconforming folks, services for sex workers? Or like, what are the opportunities there for those folks at redemption sites and SSPs?

Yes to all of it. And as a bisexual New Yorker and a parent of a gay 13-year-old, like, it's really important for me to make sure that people are taken care of. And it honestly wouldn't even matter if I were representative or not. Like, these are all New Yorkers. And so, for example, like, Streetwork Project is part of Safe Horizon.

And so they are special— their specialty is working with youth who are LGBTQ. And so we want to make sure we have both specializations. And OASAS has a really good designation for treatment programs who are affirming for not just the of folks who are coming to see them, but then also for the workforce as well, because that's the key to it really being not stigmatizing.

And so there's lots— there's a long way to go, but I would say we have both trying to make sure the whole workforce is receptive and then also have those specialization programs that someone just immediately feels safe walking through the front door. Thank you.

Well, thank you for taking the time to testify today. Thank you. Okay. I am now going to be opening the hearing for public testimony. I want to remind members of the public that this is a government proceeding and that decorum shall be observed at all times. As such, members of the public shall remain silent at all times.

The witness table is reserved for people who wish to testify. No video recording or photography is allowed from the witness table, and further, members of the public may not present audio or video recordings as testimony but may submit transcripts of such recordings to the sergeant-at-arms for inclusion in the hearing record. If you wish to speak at today's hearing, please fill out an appearance card with the sergeant-at-arms and wait to be recognized.

When recognized, you'll have 5 minutes to speak on the oversight topic or on any of the legislation on today's agenda. If you have a written statement or additional written testimony you wish to submit for the record, please provide a copy of that testimony to the sergeant-at-arms. You may also email written testimony to testimony@council.nyc. Thank you. within 72 hours of this hearing.

Audio and video recordings will not be accepted. And we have Ann Marie Foster. Yeah. You don't even have to run the clock. It's fine. Don't— don't— Floor is yours. I know.

Good afternoon. Good afternoon to the Committee on Mental Health and Substance Use and to our chair. My name is Annemarie Foster, the president and CEO of Phoenix House of New York and Long Island. I am submitting the following testimony for the council's oversight hearing, syringe litter management and related support. Since 1967, Phoenix House has been around helping thousands of individuals overcome substance use and alcohol use in order to lead healthy and productive, rewarding lives.

Phoenix House offers a variety of behavioral health services for those with co-occurring mental health disorders, substance use disorders, and that includes residential services, outpatient service, recovery services, and peer driver programs. And our services are designed to meet the individual needs of adults at various stages of their recovery, and that includes our veterans. Phoenix House also additionally provides educational and supportive services to the family members, friends, and significant others, and those in the community.

And so with Phoenix House working on the front lines of the substance use and mental health crisis, I urge the committee to advance Councilmember Carr's introduction bill of 0067-2026 to a full council vote. And I am testifying in support of Councilmembers Lees' Resolutions 262 and 263. According to the New York City Department of Health and Mental Hygiene, and we heard them speak earlier, 2,192 residents died from an overdose in 2024, and Black and Latino New Yorkers died of an overdose rate about twice that of white New Yorkers.

And recent data and news tell us that this crisis is far from over. About a week and a half ago, prosecutors indicted 2 suspects for fatally dosing 2 New York City college students with fentanyl. Fentanyl test strips can accurately identify the presence of fentanyl in drugs and help individuals spot danger from an overdose. But test strips only save lives when people know they exist and where to get them and how to use them.

And Councilmember Carr's bill would require DOHMH to develop an ongoing public health campaign that does exactly that. This matters most for community members living in neighborhoods hit hardest, where trusted, accessible outreach and education is often out of reach at times. Passing this legislation represents a crucial opportunity to help close the gap and arm New Yorkers with the tools they need to protect themselves and their neighbors.

I would also share that there is a cost-effective and efficient means to bring these services to neighborhoods that are hardest hit, something we did during the COVID the dark days of our COVID pandemic. For those communities that were testing and vaccine resistant, the city brought the services to the communities by way of mobile vans. We have an opportunity to do just that with fentanyl test strips, naloxone, and recovery services, and collect syringes in these vans.

With opioid settlement dollars, Phoenix House received their first mobile unit about earlier this summer, July, the first of its kind, and we would love to see this expanded citywide. Her name is Phoebe, Phoebe Phoenix. Phoenix House also has a Narcan and fentanyl test strip vending machine in Long Island City adjacent to our residential program across from Rainey Park.

It is used quite frequently, and we have to fill it up. Councilmember Lee's resolutions are another welcome part of a multifaceted addiction treatment and overdose prevention strategy. Many people with substance use disorder first encounter the healthcare system through a primary care office, an ER, a specialist, rather than a treatment program. And so what happens in that first encounter shapes whether they are recognized, treated with dignity, and connected to care.

Yet too many physicians, finish medical school with little or no formal training in identifying treatment— treating addiction. Resolution 262 and 263 call on New York State and the federal government to require basic addiction treatment training at medical schools that receive public funding. This is a reasonable condition for public dollars. It would help ensure that the next generation of doctors can better recognize substance use disorders reduce stigma, offer evidence-based treatments such as medication for opioid use disorder, and make timely referrals to providers like Phoenix House.

Earlier, better-informed intervention means fewer people reaching crisis and fewer syringes, overdoses, and emergency calls on our streets and in our hospitals. Now more than ever, New York City needs to deploy every available tool. The health and the future of our community depend on what we do now. Prevention, education, better-trained health workforce all help accomplish this and allows providers like Phoenix House to save more lives.

So I urge the committee to advance Introduction Bill 007-2026 and to support Resolution 26 and 23. But I'd be remiss if I left this hearing and not say that distributing Narcan and fentanyl test strips is the floor. We need— we can rescue people in the city all day long, We'd love to shift the conversation for how we help people live a life of recovery.

Thank you for considering my testimony.

Thank you so much. I'd love to come visit Phoebe. Yes, yes, yeah. Actually, we want to do a ride-along with Phoebe. I would be so down. Yes. Okay. I have a follow-up question. Obviously, y'all are doing incredible work. Continue to do that work. You know, the Bronx and Queens. Like, there's an outsized impact, and that's not reflected in the resources that especially Queens receives.

So where do you identify some of the gaps? What do we need more of? Right. As I said in my testimony, we have to bring the services to the people. We know the hotspots. And when we— I heard your question earlier when you talked about law enforcement. There is a shift with some of our law enforcement agencies.

I work very closely with the DEA. They're on the record as saying that we're not going to law enforcement our way out of this problem. And so in collaboration, we were trying to figure out the funding that they go in and they do an action or they take down what they call the bad actors. What are we replacing it with?

All we're doing is 2 things. One, the community has been relying on that drug dealer is now susceptible to someone else coming in and bringing— and we know our drug supply is tainted with fentanyl. Yep. risk of overdoses going up in that community. We would love to see that in partnership, we now show up there, as I said, similar to what we did with COVID When people in communities did not want to take the vaccine, we had vaccine equity issues.

We knew the areas where those problems were, and we dispatched that. We need to do the exact same thing with substance use. Yes. We can have the brick-and-mortar buildings, but there's going to be a subset of our population Just left a hearing earlier where we were talking about homelessness, that are not going to come out, they're not going to walk into our buildings, so we need to go to them.

And when we're going to them, not only are we going with Narcan, fentanyl test strips, and recovery coaching, we're going with food, we're going with a warm coat. And so we're building trust in the community and they get to rely on us, and then we can move those individuals into our treatment facilities or any of the other treatment facilities that exist in the city.

Well, a reminder for nonprofits who are contracted to do business with the city is that these are capital projects that you can— like, the vans are capital. Yes. And I just encourage organizations to make those capital requests of all of us in the council. I feel like we don't get enough of them. And to your point on the enforcement too, it's like, yeah, you have these big actions at the federal level, and then what fills that void.

And then also sometimes you have the overenforcement of low-level where you're picking up somebody from a corner who's dealing a little bit just to support their own use, and you're just replacing the person on the— and that's not doing us any good either. So that makes a ton of sense. Absolutely. Yeah. Well, anything else you'd like to add that you didn't say?

I mean, the floor is yours. I don't think we have anybody else signed up at the moment. Well, we welcome you for a visit and definitely a ride along with our van. We will reach out to the office and we can set that up. I'd love to. I'll bring the coffee. Awesome. Thank you so much. Thank you.

All right. Thank you for testifying. If there is anyone present in the room or on Zoom that has not had the opportunity to testify, please raise your hand. All right. Seeing no one else, I would like to note that written testimony, which will be reviewed in full by the committee staff, may be submitted to the record up to 72 hours after the close of this hearing by emailing it to testimony@council.nyc.gov.

And with that, this hearing is adjourned. We're closed. Thank you. Thank you.