A new report from Columbia’s School of International and Public Affairs and the Staten Island district attorney’s office outlines the impact and extent of the opioid crisis in the New York City borough. The report revealed treatment gaps and debunked some commonly-held beliefs about the crisis.

In 2016, the borough had 116 drug overdose deaths.

Though Staten Island is technically part of New York City, its location gives it a distinctly suburban feel. The borough has the lowest population density of any of the boroughs. The island is colloquially divided into the North Shore—which is closer to Manhattan via the ferry and is more ethnically diverse—and the South Shore, which is predominantly white. Sometimes the area between the two is called “Mid-Island.”

The report, titled the Staten Island Needs Assessment, identified Mid-Island as having the highest occurrence of overdoses.

The report was able to show through mapping overdose deaths that—despite media portrayals disproportionately showing white youth from the South Shore as being affected by the crisis—it is a borough-wide problem.

“When we went into this, it was presented as a white middle-class problem that hit Staten Island,” Patricia Wendt, one of the researchers, told the New York Times. “But it didn’t take us long to learn that it’s affecting people across all demographics in the island. I think the important thing is that addiction doesn’t discriminate.”

Furthermore, their mapping determined that opioid addiction is not a “youth” problem—showing that the "median age of overdose" in 2016 is actually 37 years old. 

Another alarming finding of the report was that the zip codes with the highest rates of overdoses are also the most underserved in terms of treatment options. In fact, the zip code with the highest overdose rate per 100,000 people doesn’t have a single inpatient clinic or outpatient clinic providing medication-assisted treatment (MAT). “There was this separation between overdose counts and treatment clinics,” said Myrela Bauman, one of the researchers. “That was quite surprising. Basically we found that these areas with the highest counts were the most underserved.”

The report recommends that services be provided where they are most needed.

Interestingly, in the South Shore, where buprenorphine prescriptions are highest, overdoses are lowest. It’s not possible to draw a causal relationship between the two, but the correlation is worth noting especially since research has shown that people on maintenance therapy have a lower death rate.