Boston’s Opioid Overdose Death Rose Notably in 2020

It came as no surprise to recovery community advocates this week, but the state did confirm this week that opioid-related deaths increased by 5 percent statewide in 2020, with notable increases logged in Boston.

Opioid-related overdose deaths in Massachusetts increased by 5 percent in 2020 compared to 2019, with rates among Black non-Hispanic males making up the largest increase, according to preliminary data released Wednesday by the Massachusetts Department of Public Health (DPH). 

There were 2,104 confirmed and estimated opioid-related overdose deaths in 2020, an estimated 102 more than the prior year and slightly above the previous peak of 2,102 in 2016. This is the first increase in annual opioid-related deaths in Massachusetts in three years and coincides with the extraordinary public health challenges stemming from the COVID-19 pandemic. Among Black non-Hispanic males, the confirmed opioid-related overdose death rate increased the most – by 69 percent – from 32.6 to 55.1 per 100,000 people, the highest increase of any ethnic or racial group in 2020.

In Charlestown, Shannon Lundin White of the Charlestown Coalition – who is very active in the recovery community – said the isolation of social distancing and not being able to meet has taken its toll on those trying to stay sober.

While some have been successful, she said too many have lost their lives quietly as the pandemic evolved.

“While most attention and resources have been focused on the COVID-19 Pandemic, the overdose crisis has exacerbated as people struggle with financial difficulty, job losses, isolation and the loss of loved ones brought on by the pandemic,” she said. “I believe the high increase in overdose deaths is connected to social isolation due to social distancing, temporary closures of treatment facilities and in-person meetings which have brought on deadly side effects. 

“As we continue to worry about the coronavirus and possible reactions of the COVID-19 vaccines, we shouldn’t forget about the deadly unintended consequences of other actions taken to control the pandemic,” she continued. “Addiction doesn’t care or stop because we are in a global pandemic, we must continue to make this public health crisis a top priority.”

Shockingly, Massachusetts is actually on the low-end of the spectrum for overdose deaths nationally, as the occurrence was way up.

Preliminary data released last month from the Centers for Disease Control and Prevention (CDC) show drug overdose deaths surged by 29 percent nationally in the year between September 2019 and September 2020, with Massachusetts showing a smaller increase in the single digits.

“Both the COVID-19 pandemic and the opioid epidemic have underscored the importance of supporting disproportionately impacted communities, and as we address both issues, our Administration has continued to focus on equity as a core component of our response,” said Governor Charlie Baker. “While Massachusetts experienced a smaller increase in drug-related deaths compared to the rest of the country, these trends make clear we have to redouble our efforts. That’s why we have continued to ensure access to life-saving tools like naloxone, focus on prevention strategies especially in communities of color, and provide pathways to treatment and supports for those struggling with addiction. We remain focused on fighting the opioid epidemic even as we continue to battle COVID, and are committed to funding new and innovative programs to support our residents.”

Since the start of the pandemic, the Administration has continued to expand existing overdose-targeted initiatives and implement innovations to ensure uninterrupted substance use treatment and support. DPH has distributed more than 110,000 naloxone kits to opioid treatment programs, community health centers, hospital emergency departments, and houses of correction since March 2020. Designated units to treat COVID-positive individuals were created to counteract the fear of exposure and allow facilities to safely transfer or refer patients to treatment service settings. With a blanket exception from the Substance Abuse and Mental Health Services Administration (SAMHSA), 49 percent of Massachusetts opioid treatment program patients have been receiving take-home doses of medication for opioid use disorder (MOUD) as of December 2020, compared to the pre-pandemic average of 16 percent in December 2019.

The occurrence of opioid-related deaths was greatest by and large in Boston, where in 2020 there were 311 occurrances – with 245 of those being by people who listed themselves as residents of the city. Some 66 in 2020 died of an overdose in Boston, but were not residents.

The 2019 numbers listed 258 occurrances in Boston, with 173 being listed as residents. In 2018, there were 247 occurrances of overdose death, and 197 were listed as residents.

The Baker-Polito Administration continues to invest millions of dollars in federal grants toward new substance use treatment, support, intervention, and education programs, primarily for residents experiencing the highest burden of this epidemic, including those in communities of color and individuals with a history of homelessness or incarceration. Most recently, this includes a combined $9.4 million for high school substance use and mental health response teams, youth substance use prevention programs, and support services for young adults in recovery. Additionally, $2.3 million in federal grants will fund a reentry pilot to provide recovery-based wraparound services for incarcerated Black and Latino men with a history of substance abuse who are at risk of fatal overdoses upon release.

“The unprecedented challenges created by the COVID-19 pandemic did not slow down our aggressive fight against the opioid epidemic,” said Health and Human Services Secretary Marylou Sudders. “We will continue to target critical resources and develop innovative solutions to reduce opioid addiction and overdose deaths.”

The powerful synthetic opioid fentanyl continues to be the main driver of opioid-related overdose deaths in Massachusetts. The rate of fentanyl present among opioid-related overdose deaths where a toxicology report was available was 92 percent in 2020, preliminary data show. The rate of heroin or likely heroin present in opioid-related overdose deaths was 14 percent, continuing a downward trend since 2014. After fentanyl, cocaine continues to be the next most prevalent drug among opioid-related overdose deaths, present in toxicology reports at a rate of 46 percent in 2020. 

The presence of benzodiazepines, amphetamines, and prescription opioids in opioid-related overdose deaths have remained stable, toxicology screens show.

Several communities outside of Boston experienced a notable decrease in opioid-related overdose deaths from 2019 to 2020, including Lawrence, Lowell, Lynn, and New Bedford. There were 28 communities that experienced a notable decrease in opioid-related incidents responded to by Emergency Medical Services (EMS) from 2019 to 2020, including Chelsea, Framingham, and Worcester. Meanwhile, Middlesex County marked its fourth consecutive year of declining opioid-related overdose deaths from its peak of 402 in 2016 to 299 last year, a 26 percent decrease.

Among the other findings of the latest opioid report:

•Males comprise 73 percent of all opioid-related overdose deaths occurring in 2020.

•55 percent of opioid-related deaths occurred in people who were between 25 and 44 years old, while 36 percent were between 45 and 65 years old.

•Approximately 209,000 individuals in Massachusetts received prescriptions for Schedule II opioids in the first quarter of 2021, a 46 percent decrease from 390,532 in the first quarter of 2015.

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