BOSTON (State House News Service) — The already-devastating opioid crisis is getting worse.
Massachusetts experienced 2,357 confirmed and estimated fatal opioid-related overdoses in 2022, a new record high, according to data the Department of Public Health published Thursday. The fatality rate of 33.5 per 100,000 people reflects a 2.5 percent increase over 2021 and a 9.1 percent increase from 2016, the pre-pandemic peak.
The crisis was especially pronounced among non-Hispanic Black residents, for whom overdose deaths increased 42 percent. The most rural areas of the state had the highest overdose death rate, compared to more densely populated regions.
State public health officials said a major factor driving the jump in fatalities is the increasingly common presence of multiple substances, especially fentanyl, contaminating the drugs a person might use.
DPH plans to release the latest opioid report at a Public Health Council meeting Thursday afternoon. Goldstein and other Healey administration officials briefed media beforehand about the trends and their response efforts.
The Healey administration signaled it will pursue several strategies to try and limit the damage, including the creation of a statewide overdose prevention hotline and instructions for the DPH to craft a "comprehensive plan" to prevent overdoses.
That plan will analyze the "feasibility" of overdose prevention sites, where individuals can use pre-acquired drugs free of legal consequences under the supervision of medical professionals, who can intervene to prevent an overdose from turning fatal.
DPH Commissioner Robbie Goldstein stopped short of outright endorsing those facilities, which are also known as supervised consumption or safe injection sites. Such locations have been hotly debated for years and drawn threats of federal prosecution.
"We want to understand the feasibility of overdose prevention sites here in the state of Massachusetts. There are, as I said before, complicated issues here that include understanding the federal legal landscape and, very importantly, understanding the engagement that is necessary with municipalities and with the state Legislature to make sure that these truly are a feasible harm reduction strategy to roll out across the state," Goldstein told reporters. "This study and this comprehensive plan will look specifically at the feasibility of overdose prevention sites in the state."
The administration's new study could give hope to advocates who have long pressed state policymakers to embrace the approach. Supporters say the facilities would limit the toll of drug use that is already happening, given how quickly fentanyl in particular can make an overdose deadly, and connect users to resources.
New York City is operating two overdose prevention centers, which so far have not drawn any enforcement response from federal officials.
Some Massachusetts municipalities have been working to stand up overdose prevention sites despite the lack of a regulatory framework or support from legislative leaders. In Somerville, city officials are working to approve funding for a mobile clinic, and some city leaders in Cambridge and Worcester are exploring options, according to WBUR.
"We are certainly not telling anyone to hold off on moving forward, but we are publicly saying that we would like to be their partner in this process and we would like to be part of the conversation," Goldstein said when asked about the approach in communities like Somerville. "We can hopefully bring the data that we will bring to the report and a comprehensive statewide plan to think about the best utilization of these services."
In 2019, a state commission tasked with studying ways to reduce the harm of substance use disorder concluded that Massachusetts should pilot "one or more" safe drug consumption sites, even as its members -- including then-Public Health Commissioner Monica Bharel, Boston Mayor Martin Walsh, and Health and Human Services Secretary Marylou Sudders -- cautioned that doing so could carry legal risks.
Goldstein said DPH will "lean heavily" on that panel's report but will not "repeat all of those efforts again."
"We are going to add to it by making sure that we have up-to-date data as well as conversations with other municipalities and jurisdictions that have moved forward with safe injection facilities or overdose prevention sites," he said. "Those include neighbors to our south in Rhode Island, where they're thinking through this process, folks down in New York City, where there's something that's active, and others across the country and really across the world."
"We are hoping to move quickly on this," he added. "As you heard me say, we are committed to having a report ready by the end of the year so that we can make sure that we're presenting the evidence-based plan to the governor and to others across state government."
Supporters of legislation (H 1981 / S 1242) that would launch a 10-year pilot program involving overdose prevention centers plan to gather for a State House briefing later Thursday afternoon. They include Sen. Julian Cyr, and Reps. Marjorie Decker and Dylan Fernandes.
Gov. Maura Healey has signaled that she is open to municipalities deciding for themselves whether to open authorized drug use sites, a contrast from her predecessor, Gov. Charlie Baker, who repeatedly warned about the threat of federal prosecution.
"Governor Healey believes harm reduction strategies are an important part of mitigating the opioid crisis," Healey spokesperson Karissa Hand said in a statement. "She supports allowing communities to decide what's best for their residents, including the option of setting up safe consumption sites, given the urgent need to help connect people with treatment services, address stigma and save lives."
There are bills pending before the Legislature to address such sites, but the governor and Democratic legislative leaders have not lined up behind them.
Since 2012, more than 20,000 people have died of opioid-related overdoses in Massachusetts, roughly equivalent to the population of mid-sized towns such as Hudson or Marblehead.
Despite hitting a new record high, the jumps in 2022 were not uniform across Massachusetts.
Worcester County experienced nearly 18 percent more deaths in 2022 than it did in 2021, followed by a roughly 14 percent increase in Plymouth County and a 7.5 percent increase in Barnstable County. Overdose deaths fell 25 percent in Franklin County, 22.6 percent in Berkshire County and nearly 16 percent in Hampshire County.
Law enforcement officials regularly announce arrests of alleged drug dealers who have mixed fentanyl, a powerful synthetic opioid, and other substances into the supply they sell to users, but enforcement efforts are not capturing all of the supply. Most fentanyl in Massachusetts is "illicitly produced," not diverted from authorized pharmaceutical uses, according to DPH.
Fentanyl was present in 93 percent of the fatal opioid overdoses last year where a toxicology screen took place, according to the latest report. Cocaine was present in 53 percent of those deaths, followed by alcohol in 28 percent, benzodiazepines in 27 percent, prescription opioids in 11 percent, amphetamines in 9 percent, heroin in 6 percent and xylazine in 5 percent.
"We have a poisoned drug supply, and that poisoned drug supply is resulting in an increase in overdose deaths," Goldstein said.
DPH first began tracking xylazine in its last biannual overdose report published in December. The substance, a sedative sometimes referred to as "tranq," has been receiving national attention as it appears in more and more overdose case and makes overdoses more difficult to reverse.
"We know that we're starting to see xylazine in overdose-related deaths, and that may be playing a role here," Goldstein said. "One of the biggest messages we have from the Department of Public Health is to make sure that first responders, those on the scene, are providing naloxone and also providing oxygen because we know there's xylazine in the drug supply and naloxone alone will not reverse the effects of xylazine."
Goldstein said the state has distributed 50,000 doses of naloxone to 10,000 people since Healey took office in January, adding that "we estimate that we have prevented at least 700 overdose deaths because of that."
The administration is investing $100 million in MassHealth reimbursement rate increases for substance use disorder treatment and working to use DPH funding to stand up "harm reduction vending machines," which will dispense clean syringes, hand sanitizer and other items that can decrease the risk of overdose deaths. The first three vending machines will be in service in the fall through Berkshire Harm Reduction, according to DPH.
This summer, the department's Bureau of Substance Addiction Services plans to kick off an effort to launch a statewide overdose prevention hotline.
DPH will also be tasked with identifying "deserts" where Bay Staters face the biggest obstacles accessing opioid treatment programs, especially on the Cape and islands and in rural areas.
Written by Chris Lisinski/SHNS