The partnership was founded as an intergovernmental data-sharing vehicle and part of the Bloomberg Administration’s Mayoral Task Force on Prescription Painkiller Abuse. As an intervention, RxStat has not remained static, but has evolved alongside the overdose epidemic (Table 1). RxStat was formed and convenes voluntarily the group is not guided by a policy or legislative mandate, nor is membership and attendance mandated within agencies. With respect to the analysis of disparate data sources and implementation of collaborative programming, RxStat aimed to adhere to a public health framework, with interventions focused at the population level and analyses conducted using epidemiologic methods (Heller et al., 2014). As a partnership, RxStat aims to integrate data-driven policing with actionable public health interventions and data (Heller et al., 2014). While primarily a local-level strategy, RxStat engages and leverages the capacities of state and federal authorities in addition to local government agencies. In addition to programmatic interventions, in 2012 NYC established the NYC RxStat initiative (referred to hereafter as RxStat), the US’s first public health and public safety partnership (PHPSP) implemented as a key strategy to reduce overdose deaths (Heller et al., 2014). Local-level initiatives have included: expanded naloxone distribution in community, pharmacy, harm reduction, law enforcement, and social service settings (Dolatshahi et al., 2019) access to low-threshold buprenorphine treatment for opioid use disorder (Kaplan-Dobbs et al., 2021) targeted public awareness regarding the risks of fentanyl (Allen et al., 2020) and enhanced investigation and enforcement of overdose scenes (Goodman, 2018). Since 2012, overdose prevention has been a cornerstone of NYC’s health and safety policy (Office of the Mayor of the City of New York, 2017). In 2021, 2668 New Yorkers died from overdose, the highest number since records began in 2000, and a 27% increase from 2020 (Askari et al., 2023). Recent increases in stimulant- and fentanyl-involved overdose deaths in the time during and since the COVID-19 pandemic have led some researchers to identify a “fourth wave” of the overdose epidemic centered on polysubstance overdose (Ciccarone & Shoptaw, 2022). Likewise, the COVID-19 pandemic compounded the harms of the overdose epidemic and accelerated mortality (Cartus et al., 2022). Since 2014–2015, fentanyl, a highly potent synthetic opioid, has driven the increases in overdose death nationally and in NYC, (Colon-Berezin et al., 2019) with precipitous increases among Black and Latinx populations (Wilson et al., 2020, Allen et al., 2019). Overdose deaths in New York City (NYC) more than tripled between 20, (Askari et al., 2023) mirroring the epidemic across the United States (US) (Spencer et al., 2022). Findings can inform efforts to implement and scale cross-sector partnerships. Cross-sector partnerships offer a promising strategy to integrate the public health and safety sectors, but disciplinary tensions in approach may hamper implementation. Findings informed 12 strategies to improve RxStat and partnerships in its model, organized into three opportunity areas: (1) ensure stakeholder and agency accountability (2) build secure and mutually beneficial data systems and (3) structure partnerships to facilitate equitable collaboration. Stakeholders reported certainty about the need for cross-sector collaboration and described cross-disciplinary tensions, challenges to collaboration and implementation, and opportunities for partnership optimization and growth. Interview data were iteratively coded and thematically analyzed. Interviews probed stakeholder perceptions of RxStat’s successes, challenges, and opportunities for growth. We conducted in-depth, semi-structured interviews with 25 current and former RxStat stakeholders. To inform partnership replication efforts, we conducted a stakeholder evaluation of RxStat. With federal support, jurisdictions nationally have implemented public health and public safety partnerships modeled on RxStat. The partnership aimed to integrate data-driven policing with actionable public health interventions and surveillance to develop and implement cross-sector overdose responses. NYC RxStat, the United States' first public health and public safety partnership aiming to reduce overdose deaths, began in 2012 and established a national model for cross-sector partnerships.
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