Alcohol and Drug Use: Provider Information and Resources

Health care providers are an essential part of addressing the overdose crisis and substance use-related health problems. People who use drugs and alcohol face structural, institutional, and interpersonal stigma, which can serve as a barrier to seeking, accessing, and receiving health care. Providers help overcome these barriers by providing evidence-based and compassionate care rooted in harm reduction.

Alcohol and Drug Use in NYC

Overdose deaths and substance use-related harms continue to be a public health crisis in NYC, largely driven by the increased presence of fentanyl in the unregulated drug supply. Overdose deaths have increased sharply since 2016 and demonstrate disparities by race and ethnicity, age, and neighborhood of residence. Structural racism and long-term disinvestment in communities drive inequities in overdose death and other adverse health outcomes.

• Unintentional Drug Poisoning (Overdose) Deaths in New York City in 2023 (PDF)

Harm Reduction

Harm reduction is a set of practical strategies and ideas aimed at reducing the negative consequences associated with drug use. Harm reduction is rooted in recognizing that all people deserve safety and dignity. Harm reduction acknowledges that drugs are widely available in our society and are used for a variety of reasons, and aims to empower people to reduce the risks of drug use and protect their health.

Health care rooted in harm reduction is non-judgmental and person-centered. It incorporates strategies such as the distribution of naloxone to people at risk of overdose and their communities and the provision of low-threshold health care like syringe services, safer use supplies, and medications for addiction treatment.

Decades of research demonstrate that harm reduction strategies provide significant public health benefits, including preventing overdose deaths, reducing emergency department visits, and increasing opportunities to connect people to substance and alcohol use treatment and other health care services. For more information visit:

• Johns Hopkins University: What is Harm Reduction?

Health Care for People Who Use Drugs and Alcohol

Reduce Stigma

Drug use-related stigma is a major barrier to health care access. Stigma is perpetuated by harmful language and stereotypes, and causes negative health care encounters and adverse health outcomes among people who use drugs and alcohol. Stigma and its negative effects are compounded among people who have additional marginalized identities.

The resources below support providers to enhance their understanding of stigma and include best practices to reduce stigma and improve health outcomes:

• Watch: Exploring substance use stigma and its impact on patient engagement and care
• Watch: Reducing stigma in healthcare: why language matters
• E-learning: Addressing substance use stigma

Overdose Prevention and Response

Naloxone (Narcan) is a safe medication that can save someone’s life by reversing the effects of an opioid overdose. Providers can prescribe naloxone to patients as well as educate patients on how to access naloxone without a prescription. For more information, including naloxone prescribing guidance, visit Overdose Prevention Resources for Providers.

• Talking to Patients About Naloxone (PDF)

Harm Reduction Services

Providers can refer patients who use drugs to syringe service programs, Overdose Prevention Centers, and other harm reduction services to connect them with safer use supplies, drug-checking services, harm reduction counseling, and other resources to reduce the risk of overdose and other drug-related harms. For more information, visit Alcohol and Drug Use Services.

• SAMHSA Advisory: Low Barrier Models of Care for Substance Use Disorders (PDF)

Medications for Opioid Use Disorder

Buprenorphine (bupe) and methadone are the most effective treatments for opioid use disorder. They are the only medications demonstrated to reduce the risk of fatal overdose. Extended-release injectable naltrexone is another option for treating opioid use disorder, but it is not associated with a reduction in overdose risk. For more information on medications for opioid use disorder, visit Treatment for Opioid Use Disorder.

Prescribing Buprenorphine

Following federal regulation changes, any provider with a valid state license and a current Drug Enforcement Administration registration that includes Schedule III authority can prescribe buprenorphine to treat opioid use disorder. Providers can also connect patients to opioid treatment programs to receive methadone.

The resources below support providers in buprenorphine prescribing:

• Dear Colleague: Buprenorphine Rx (PDF)
• American Society of Addiction Medicine’s Buprenorphine Mini Course
• Providers Clinical Support System
• New York State Department of Health: Buprenorphine Resources
• New York State Department of Health: Clinical Education Initiative Online Courses
• MATTERS: DEA Training Requirements
• Buprenorphine: Information for Patients and Families (PDF)
• Myths and Facts About Buprenorphine (PDF)
• For more information about buprenorphine prescribing or technical assistance to start prescribing, email buprenorphine@health.nyc.gov

Providers can also connect patients to opioid treatment programs to receive methadone. For more information, visit OASAS: Opioid Treatment.

Alcohol Use and Alcohol Use Disorder

Excessive alcohol consumption contributes to multiple leading causes of premature death including chronic liver disease and cirrhosis and certain types of cancer. Alcohol use also increases the risk of fatal overdose. Alcohol-related morbidity and mortality disproportionately impact older adults, males, Latino people, and people who live in high poverty neighborhoods.

Providers can help reduce alcohol-related morbidity and mortality by talking to their patients about their alcohol use and prescribing evidence-based treatment for patients with alcohol use disorder.

• When asking patients about their alcohol use, use reflective, collaborative, and person-centered language.
• Work with patients to explore their personal relationship with alcohol, including their motivations for use and any associated harms.
• Offer patients harm reduction strategies, such as learning how to drink more safely.
• Understand pharmaceutical and nonpharmaceutical treatment options and inform patients of treatment options for alcohol use disorder.

Medications for alcohol use disorder are effective at reducing heavy drinking and associated morbidity, but are vastly underutilized. There are three FDA-approved medications to help people stop or reduce alcohol use: naltrexone, acamprosate, and disulfiram. Medications may be used with or without other treatment such as behavioral health interventions and counseling. Providers should talk to their patients about medication options and prescribe when appropriate.

• NYC Health: Alcohol
• CDC: Alcohol

Stimulant Use Disorder

Stimulant use disorder can cause a range of serious health effects. Providers can help assist patients who use stimulants by understanding the clinical impact of stimulants on a person’s health and working with their patients to reduce the harms associated with stimulant use.

• American Society of Addiction Medicine: Clinical Guidelines for Stimulant Use Disorder

Wound Care

Injection-related wounds and soft tissue infections are increasingly pervasive among people who use drugs. The veterinary sedative xylazine, which is increasingly present in the unregulated opioid supply, causes extensive ulcers and skin wounds. Effectively treating drug use-related wounds and soft tissue infections is imperative as these infections can lead to serious conditions such as sepsis and endocarditis, and can harm social and employment status. Early and routine screening are essential to facilitating timely wound care. Providers can provide patients with basic wound care education and supplies, provide basic wound care on site, and refer them to a higher level of care when necessary.

Viral Hepatitis Screening, Testing, and Diagnosis

Hepatitis is inflammation of the liver, and can lead to serious liver disease, liver cancer, or premature death. It can be caused by alcohol use, viral infection, or buildup of fat in the liver. People who use drugs and alcohol are at increased risk for viral hepatitis. Providers can provide testing, prevention, and treatment for all forms of viral hepatitis.

• NYC Health: Hepatitis
• SAMHSA: Addressing Viral Hepatitis for People with Substance Use Disorders

PEP and PrEP to Prevent HIV and Promote Sexual Health

Pre-exposure prophylaxis (PrEP) is safe and effective medication that prevents HIV. Emergency post-exposure prophylaxis (PEP) is emergency medication that can prevent a new HIV infection after exposure. Providers can provide HIV testing, and offer PrEP to people at risk of HIV or PEP to prevent infection.

• PrEP and PEP: Information for Medical Providers
• HIV PrEP and PEP Action Kit

Chronic Pain Management

Pain is one of the most common reasons adults seek medical care in the United States. Pain management strategies should balance the need to reduce the burden of suffering from pain while reducing the harms associated with the use of opioid analgesics.

The availability of safe and effective pain management is crucial for all New Yorkers. Providers can learn about current recommendations and guiding principles for pain management, and adopt this guidance into their practice.

• Dear Colleague: Opioid Rx (PDF)
• CDC: Overdose Prevention Guideline Recommendations and Guiding Principles

Treating Patients with Chronic Pain and Optimizing Provider Use of Prescription Drug Monitoring Programs

This e-learning series offers guidance for healthcare providers treating patients who are on or in need of opioid therapy. The modules present best practices for pain assessment, treatment planning, medication management and caring for patients with co-occurring health conditions, with a focus on utilizing Prescription Drug Monitoring Programs in clinical care.

1. Optimizing Provider Use of Prescription Drug Monitoring Programs
2. Patient Assessment and Pain Management
3. Pain Management for Patients with Complex Co-occurring Conditions
4. Managing Pain in Special Populations
5. Medication Management: Opioid Tapering and Reducing Polypharmacy

Additional Resources

Referral Resources

• NYC HealthMap: Buprenorphine treatment in primary care sites, naloxone in pharmacies, and syringe service program locations.
• Office of Addiction Services and Supports (OASAS) Treatment Locator: Opioid treatment programs, outpatient services, residential services, inpatient treatment services, and crisis services
• New York State Department of Health AIDS Institute Provider Directory: Buprenorphine treatment, opioid overdose prevention programs, sexually transmitted infection care and services, and more
• To find harm reduction services: Alcohol and Drug Use Services
• Mutual aid groups can be a helpful resource for some people. Some mutual aid groups include Recovery Dharma, Refuge Recovery, SMART Recovery, and 12-step groups (PDF).

Education Resources for Providers

• New York City Emergency Department Learning Community on Opioid Use: A citywide forum to learn about and exchange best practices for addressing opioid use in EDs and create an interactive network of colleagues engaged in similar work, with the ultimate goal of decreasing opioid overdose deaths in NYC. Any ED staff involved in opioid-related efforts, including medical directors, administrators, quality improvement specialists, front line providers, nursing leadership, can contact buprenorphine@health.nyc.gov to learn about upcoming events.
• Buprenorphine treatment information, clinical mentorship, or technical assistance, as well as wearable pins that say Ask Me About Bupe, contact buprenorphine@health.nyc.gov.
• Naloxone staff training or technical assistance, visit Naloxone or email naloxone@health.nyc.gov.
• Opioid Crisis Response Online Trainings: This e-learning series offers local health departments and community partners guidance and resources on evidence-informed public health responses to the opioid crisis using a harm reduction approach.
1. Local Health Departments and Public Health Emergencies
2. Mortality Surveillance and Prescription Drug Monitoring Programs
3. Lower-Threshold Access to Medications for Opioid Use Disorder
4. Syndromic Surveillance and Rapid Assessment and Response
5. Recovery-Oriented Systems of Care and Peer-Delivered Services
6. Addressing Substance Use Stigma
7. A Systematic Approach to Public Health Communications
• Wound Care
• Wound Care and Medical Triage for People Who Use Drugs and Programs that Serve Them
• Wound and Abscess Care for People Who Use Drugs
• Wound and Abscess Care for People Who Use Drugs (in Spanish)
• Skin & Soft Tissue Infections: When to Seek Medical Care (& Why)

Publications