Witnesses Tuesday told state lawmakers they must permit New York paramedics to administer opioid drugs that ease the pain of withdrawal as lethal drug contaminants spur a new wave of the opioid epidemic. 

New York overdose deaths declined almost 30% in the last year, but drug experts at an Assembly hearing in Albany told lawmakers the prevalence of synthetic opioids like fentanyl, betadine and the horse tranquilizer xylazine are presenting new roadblocks to recovery. 

"We're not anywhere near close to the end of the overdose epidemic, and it's more than just opioids," said Rob Kent, president of Kent Strategic Advisors LLC who served as the general counsel with the White House Office of National Drug Control Policy. 

Kent was one of several people to testify Tuesday, telling lawmakers that the state must take action with the newest shift in the opioid epidemic, and synthetic opioids being used to enhance the drug's effects at a cheap price. 

And panelists warned, there's no direct overdose reversal agents for fatal contaminants infiltrating the illicit drug supply. 

"What we are used to seeing with naloxone given for opioid overdoses, those effects are different now because there are other drugs, typically, in the system," said Dr. Joshua Lynch, clinical associate professor in the University at Buffalo's Department of Emergency Medicine. 

A bill became a focal point of the hearing that would enable paramedics to issue buprenorphine after distributing an overdose reversal drug. The opioid medication eases pain and the withdrawal symptoms a person experiences. 

"It's been working for years in Camden, New Jersey, and other parts of the country — why not New York?" Assembly sponsor John McDonald said. 

It would also connect patients with substance use disorders to treatment programs, the Cohoes Democrat added. 

"We think it means something — we think it's going to save lives," McDonald said. "It's also going to reduce demand on our EMS provider community...I think will make a difference in cutting down on repeat overdose calls, but more importantly, letting people get on the road to treatment." 

Gov. Kathy Hochul and the state Health Department back the proposal, which was included in the governor's budget. It fell out of the final spending plan after being crowded out by other policy items. 

McDonald said Assembly leadership has concerns about changing the scope of a paramedic's medical training and practice, but conversations are ongoing until the lower house concludes session for the year on June 17. 

"Time is running out, and there's still plenty of time," he said. 

But with less than two weeks left on the session calendar, Assemblyman Phil Steck told Spectrum News 1 it's unlikely significant opioid bills will clear both houses this year. 

"There will be other things, but not this year," he said after Tuesday's hearing. 

Steck added he plans to work on legislation to expand treatment and resources for opioid and substance abuse and aim for passage next year. 

Kent is pushing for legislation to expand treatment for substance use disorders and limit an insurer's ability to take back money from patients who were suspended from employment while getting help for addiction. But he said state lawmakers often get more accomplished in significant election years. 

"If we can't get stuff done this year, we're setting it up for next year, and people will be pushing," he said. 

Steck carries a bill to require the state Health Department to consider all opioid antagonists approved by the U.S. Food & Drug Administration that's also unlikely to advance. 

The department is currently accepting bids from other companies to buy opioid antagonists and reduce overdose deaths before its longstanding $40 million contract to purchase Narcan expires at the end of July. 

New York currently only buys 4-mg doses of Narcan nasal spray, or the brand name for the overdose reversal drug naloxone, to give to first responders as part of its Opioid Overdose Prevention Program. 

"It doesn't make any sense from an economic standpoint because competition will lead to better products and lower costs," Steck said. 

Steck said the department's open request for bids is discriminatory as it mandates companies to have at least two years of experience providing and manufacturing opioid antagonists — a requirement he added is atypical for other drug manufacturers.  

McDonald agrees the department's request for bids will restrict the ability of certain providers to apply and could give Emergent Devices an advantage in continuing the contract.  

The department will award one contract to the bidder who offers the lowest total bid price, and including mandatory bid qualifications is a standard best practice, according to DOH. 

“The New York State Department of Health has issued an Invitation for Bid to purchase naloxone nasal spray and fentanyl test strips for the department’s registered opioid overdose prevention programs statewide," DOH spokesperson Cadence Acquaviva said in a statement. "The landscape has changed since 2022 when the state Department of Health initiated the original competitive contract. There are now multiple manufacturers of 4-mg naloxone intranasal kits, so we are initiating the IFB to ensure that we are getting the best service for this product at the best price.” 

The department will choose a company that demonstrates it can fulfill between 20,000 to 45,000 units per month to about 1,300 registered programs at nearly 5,800 affiliate locations statewide. The approved contractor must include fentanyl testing strips to validate the accuracy of tested drug samples. 

The department continues to recommend a 4-mg dose of naloxone as the most effective opioid antagonist.