A bipartisan group of lawmakers will prioritize legislation in the 18 remaining days of session to require the state to purchase more potent overdose reversal drugs for first responders and the public in efforts to reduce the number of New Yorkers who die by overdose.

More than 6,300 people died by overdose in the state in 2022 — peaking due to the prevalence of fentanyl-laced drugs, synthetic opioids and an increase in substance use.

Republican and Democratic lawmakers each introduced bills in the last week to strongarm the state Health Department to expand the types and potency of opioid antagonist medications it distributes through the state Opioid Overdose Prevention Program.

"We need all tools in the toolkit," said Lisa Alteri, president & CEO of Capital Health Consulting. "It's a problem that you have to look at holistically."

The state Health Department has bought Narcan, or the brand name for the overdose reversal drug naloxone, for years from pharmaceutical manufacturer Emergent Devices Inc. Its current two-year, $21 million contract with the company expires July 31.

The state purchases a 4-mg dose of Narcan nasal spray for its Opioid Overdose Prevention Program at no cost to first responders and registered opioid overdose prevention programs. But because of fentanyl, law enforcement say many overdoses require two or three doses to prevent death. Time is of the essence when administering the life-saving drug, but subsequent doses must be administered a few minutes apart while a person risks losing brain function.

Sen. Pete Harckham introduced legislation with Assemblyman Phil Steck last week to require the state Health Department to consider all opioid antagonists approved by the U.S. Food & Drug Administration.

"The [U.S.] Centers for Disease Control & Prevention says that all approved medications should be part of the toolkit, and that's all this legislation says," Harckham said.

The senator said the Legislature cannot leave Albany without ensuring the state will expand the type of overdose reversal medications offered to emergency responders and the public.

"We're not saying this must be the tool of choice, that is up to the first responders — that is up to the harm reduction specialists — but it just needs to be an allowable tool," he added.

Republican Assemblyman Keith Brown introduced a similar bill Tuesday he argues would be easier to get over the finish line.

"My bill was designed as a compromise bill," he said.

It would broaden the state definition of opioid antagonists to include all FDA-approved medications beyond naloxone and Narcan, and likely avoid hurdles in the other bill that Brown says would likely stall its passage this year.

"It'd be better if we just had the different products from different manufacturers so first responders can their judgment in the field and determine 'OK, the 4 mg didn't work, let's give it a minute and try the 6,' " Brown said.

The Long Island assemblyman pointed to a recent Frontiers in Public Health study that recommends higher-dose naloxone options to reverse deadly fentanyl overdoses.

State Comptroller's Tom DiNapoli's office is reviewing the legislation and has not taken an official position. The Health Department determines the overdose reversal drug needed for state programs. The comptroller's office reviews the contract to ensure the agency followed the law with a proper bid process.

A standing order for naloxone in pharmacies signed by Health Commissioner James McDonald includes any FDA-approved single-dose 4 mg naloxone nasal spray or injectable 0.4mg/cc product and is separate from the Opioid Overdose Prevention Program, according to DOH.

"While the department is open to considering all FDA-approved opioid antagonists, final determinations are guided by medicine and science," according to the department. "Based on current science and clinical judgment, we believe that the products available under the standing order and through Opioid Overdose Prevention Programs are the appropriate formulations to keep New Yorkers safe."

The state Health Department released a report in February citing law enforcement data to show 4 mg doses of naloxone continue to be the most effective.

Health officials have warned the higher doses lead to more side effects of withdrawal.

Albany resident Chris Assini, who is in recovery from opioid use, argues withdrawal symptoms are better than death.

"New York's overdoses are roughly rising by 10 to 12% year over year ... we lose roughly 19 individuals per day," Assini said. "...And this is all preventable. We need to save lives, and currently we are failing in every sense of the word."

Several lawmakers and recovery advocates Wednesday questioned the report's credibility, and said they're skeptical that it hasn't been peer-reviewed and its small sample size.

DOH stands by the findings of its field test study, which was published in the CDC's Morbidity and Mortality Weekly Report.

"Studies published in CDC’s MMWR are not peer-reviewed as they undergo a rigorous review process at the CDC, and this does not mean that the study was not rigorous," according to the department.

The department pointed to other studies published in the CDC's weekly morbidity and mortality report that are not peer-reviewed.

Assini and lawmakers said they are concerned the argument about withdrawal symptoms will pose the greatest challenge to get legislative leaders to make the issue a priority.

New Yorkers can obtain any FDA-approved opioid antagonists available to individual patients with a patient-specific prescription.

“The opioid epidemic continues to impact every community across New York and fighting the epidemic includes equipping individuals, communities, organizations, and agencies with the right tools," the Health Department said in a statement Wednesday. "The state Department of Health whole-heartedly agrees that we must work together to develop programs, services and strategies to treat opioid use disorder and prevent overdose deaths. The department remains committed to harm reduction by making lifesaving overdose reversal medications like naloxone available to the public, increasing access to fentanyl testing strips, funding drug user support programs and supporting community-based organizations that work directly in communities impacted by the opioid epidemic.”

Lawmakers said they noticed overdose prevention and addiction treatment strategies have been absent from conversation this session, including the budget.

Brown said the word "opioid" was said on the Assembly floor for the first time this session two weeks ago.

"I was critical during the budget hearings and budget bills that we weren't doing enough," he added.

The $237 billion budget included $90 million in opioid settlement funds to support recovery and prevention efforts as prioritized by the Opioid Settlement Fund Advisory Board.

Several lawmakers and advocates said the settlement funding cannot replace other state investment to successfully combat the opioid crisis and overdose deaths.

*Editor's note: An earlier version of this story misidentified Health Commissioner James McDonald as John McDonald.