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How Staten Island’s ‘hotspotting’ program is helping curb drug overdose deaths
By
Caroline Lewis
Published Nov 6, 2025
Modified Nov 7, 2025
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Spencer Platt/Getty Images
By
Caroline Lewis
Published Nov 6, 2025
Modified Nov 7, 2025
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When Matt Germoso cold calls someone he knows might be at risk of a drug overdose, he says, “ We won't necessarily lead with, you know, ‘Hey, I’m calling you about substance use.’”
Instead, Germoso, who once struggled with addiction himself and is now a peer recovery advocate at Staten Island University Hospital, will talk about a range of social services he can connect the person with and try to get a sense of what they need.
Germoso’s outreach is part of a novel program known as “hotspotting,” which uses a combination of data, artificial intelligence and old-fashioned human connection to home in on and help the people at highest risk of a drug overdose.
Those who work with drug users on Staten Island say the program, which launched in 2022, could be one factor contributing to the borough’s recent decline in overdose deaths, which has outpaced the rest of the city, and the data so far show promising results.
The number of overdose deaths per 100,000 residents on Staten Island last year fell by nearly 50%, compared with 28% citywide, according to a city health department report released last week. The borough was once known for the highest rate of overdose deaths in the city, before being outpaced by the Bronx. Its overdose rate is now the second lowest.
With just under 500,000 residents, Staten Island is dealing with an overall smaller population of drug users than other boroughs. On Staten Island, 81 people died of overdoses last year, down from 157 in 2023. Overdoses killed more than 2,000 residents last year citywide.
Hotspotting was developed as a partnership between MIT and a coalition of Staten Island health care providers. It uses an AI-driven algorithm to help identify individuals at the highest risk of overdosing based on their medical history, justice involvement and a wide range of other factors. The district attorney’s office and local health organizations can also refer people to the program.
Peers with their own history with substance use then actively reach out to those identified to ask about their needs — whether that’s housing, treatment, Narcan or anything else — and help coordinate care. The program uses regular check-ins and an app with monetary incentives to help keep clients on track.
More than 2,000 drug users have been engaged in the program so far, according to reports published by the Staten Island Performing Provider System, the health care coalition that runs the program. Between April 2022 and April 2024, four of those clients died of overdoses, compared to 25 individuals in a control group, according to the reports. There was also a dramatic drop in emergency room visits among those who participated.
Drug policy researchers haven’t definitively identified what is behind the nationwide drop in overdose deaths, or why some areas are seeing bigger improvements than others, though they say investments in programs to reduce the harms of drug use and connect people to care are likely helping to move the needle.
Joseph Conte, executive director of the Staten Island Performing Provider System, called the proactive outreach baked into the hotspotting program a “paradigm shift” on Staten Island.
Others working on the program said it has also been part of a broader effort to coordinate among different health care providers and agencies that might come into contact with people at risk of overdosing and address gaps in care.
Germoso said he is sometimes connected to people who are already in an outpatient drug treatment program but are still using illicit drugs and may need a connection to mental health care or other services to really turn things around.
Staten Island has its own challenges when it comes to addressing the overdose crisis, including the fact that many people are more isolated from services than in other parts of the city, said Donna Demarest, the director of harm reduction at Community Health Action of Staten Island, which participates in the hotspotting program.
But she said the island’s insular nature also makes it easier for different organizations to unite around a single initiative like hotspotting.
The program is now expanding. NYC Health and Hospitals announced earlier this year it would try it out as part of a new pilot program at Lincoln Hospital in the Bronx — the borough that currently has the highest rate of overdose deaths in the city — with the help of $600,000 in funding from the Robin Hood Foundation.
This story was updated with new data from the Staten Island Performing Provider System.
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Health and Science
staten island
Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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