Tuesday, January 16, 2018

What is being done about the opioid epidemic at a national, state, and local level

Elaine Zhang, BS
Research Associate 

The rise in pain killer prescriptions from doctors combined with aggressive marketing campaigns from large pharmaceutical companies in the 1990’s awakened a tsunami of addiction that has swept through the US resulting in significant increase in opioid drug overdose death rates. From 2000 to 2015 more than half a million people died from a drug overdose.1  Since 2011, the rate of drug overdose deaths due to opioid prescriptions started to level out while death rate due to heroin overdose experienced a sharp increase, see graph below. In 2016, roughly 64,000 people died due to drug overdoses making it the leading cause of death for Americans under 50 years old.2

Massachusetts is experiencing the opioid epidemic at a much higher rate than the rest of US. In 2014, Massachusetts’s age adjusted overdose death rate was 23.3 per 100,000 which is more than doubled the national rate of 9.6 per 100,0003. In 2017, there were 932 confirmed opioid related deaths in Massachusetts; 76% of deaths were male and 24% were female.4 The opioid epidemic also affects the white non-Hispanic population at a much higher rate than any other race. Of the 932 confirmed opioid-related deaths in 2017, 81% or 753 of those deaths were of people of white non-Hispanic race/ethnicity. This group has historically had higher death rates than any other race/ethnic group in the past three years4, see graph below. 

At a county level, certain counties are experiencing higher opioid overdose death rates than other ones. Barnstable, Berkshire, Bristol, Duke, Essex, Norfolk, Plymouth, and Worcester counties currently have the highest opioid overdose death rate,5 see map below. 

In October 2017, the president declared the opioid epidemic a national public health emergency. The Department of Health and Human Services has outlined a five-point strategy to combat the opioid epidemic:
1.       Improving access to treatment and recovery services
2.       Promoting use of overdose reversing drugs
3.       Strengthening our understanding of the epidemic through better public health surveillance
4.       Providing support for cutting edge research on pain and addiction
5.       Advancing better practices for pain management.
The Center for Disease Control and Prevention (CDC) awarded $28.6 million in funds to 44 states and the District of Columbia to help strengthen prevention efforts and better understand the epidemic through public health data6, which aligns with part of the HHS five point strategy.

In 2015, Massachusetts Governor Charlie Baker signed Chapter 55 into law in response to the opioid epidemic. The new law allowed different government data sets to be analyzed to help guide policy decisions and better understand the opioid epidemic.7 The Baker administration also allocated $34.5 million to combat the opioid epidemic through raising awareness, increasing prevention, and providing education. Recent data shows that in the first 9 months of 2017 there were 167 fewer opioid related overdose deaths when compared to the first 9 months of 2016, a 10% drop in deaths.8 Along with the decrease in deaths, there has also been a 30% decrease in the number of patients who were prescribed an opioid in the third quarter of 2017 when compared to the first quarter of 2015.8

At ICH, we work on several projects that focus on the opioid substance use disorders. SUSTAIN Communities Evaluation is an initiative funded by the GE Foundation with support from Partners HealthCare. SUSTAIN Communities provide grants and technical assistance to community health centers to build capacity for Medication Assisted Treatment (MAT) for patients with opioid use disorder.  ICH Assistant Director of Research, Leah Zallman, MD, MPH, works on a project funded by a small foundation (McManus) that uses electronic health record data to understand the relationship between opioid prescriptions and the development of opioid abuse disorder. ICH is looking into Cambridge Health Alliance data among patients who have ever been prescribed opioids and tracking how many developed opioid use disorders, how long it took, and what are the clinical predictors. Promoting Older Women’s Engagement in Recovery (POWER) is a collaborative project aimed at the prevention of opioid misuse in older women ages 55 or older in Cambridge and Somerville. The Institute for Health and Recovery received the grant and works alongside with Cambridge Health Alliance, Somerville Cambridge Elder Services, and the Cambridge Council on Aging to address the risk factors of opioid misuse among older women through technical assistance for partnership sites and direct support groups for women 55+. ICH is the evaluator on the project.

If you or someone you know is struggling with addition, there are some resources available to help. The Massachusetts SubstanceAbuse Information and Education Helpline provides free and confidential information and referrals for alcohol and other drug abuse problems. The Institute for Health and Recovery helps families and youth with substance abuse issues access publicly funded services. The Suboxone Hotline Office Based Opioid Treatment Program at Boston Medical Center provides referrals and information on opiate and heroin treatments available at doctor’s offices statewide. Cambridge Health Alliance offers an outpatient addiction service which helps adults to and maintain sobriety. The Fresh Start Alcohol and Drug Recovery Group is an anonymous peer support group that meets on Thursday evenings at CHA Revere Care Center. Smart Recovery is a scientifically tested program for adults who want to manage their addiction and is held every Tuesday evening at CHA Everett Care Center.

Below are the numbers for each helpline:
The Massachusetts Substance Abuse Information and Education Helpline:
Phone Toll Free: 1-800-327-5050
TTY: 1-888-448-8321

The Institute for Health and Recovery:
Phone: 1-866-705-2807
TTY: 1-617-661-9051

Suboxone Hotline Office Based Opioid Treatment Program at BMC:
Phone: 1-866-414-6926 or 1-617-414-6926


Wednesday, January 3, 2018

The Heart of ICH

Luisa Raleza 
Executive Assistant 

During this holiday season of giving and blessings, I am reflecting on how blessed I am.  I am fortunate to have good health, great family, friends, and colleagues.  The biggest blessing of all is that I am working for the Institute for Community Health (ICH).  ICH is a nonprofit consulting organization that provides participatory evaluation, applied research, and assessment and planning to help the helpers and, ultimately, assist local communities to create sustainable health.  Since the inception of ICH, it has contributed to communities, creating engagement and a chain of giving, which leads to a gratefulness for both the giver and the recipient alike.  The work ICH does leads to improved health, happier living, and better communities.

According to one of our founding fathers, Dr. David Bor, “ICH was created in response to the growing AIDS epidemic in the 1980's: David Bor, Marshall Forstein and Paul Epstein started the Cambridge AIDS Task Force. The task force considered health care to be the fourth priority after housing, work place anti-discrimination policies, and education about contagion -- a surprise to many health practitioners. That model of community engagement formed the basis for the ‘Cambridge-Harvard Health of the City Program (HoC)’, with funding from the Rockefeller Foundation and Pew Charitable Trusts. The co-directors of HoC included David Bor, representing the public hospital (CHA), Ron Arky, representing the private hospital (Mt. Auburn), and Frank Duehay, representing the city of Cambridge. The organization spawned the Men of Color Task Force, Healthy Children's Task force, and a "health information unit" whose purpose was to collect data to inform the public about local health and health needs. When funding ran out, the Cambridge Health Alliance, Mt. Auburn, and Mass General Hospital agreed to co-sponsor a new organization, The Institute for Community Health, based upon the same principles.”

The cosponsoring of ICH started this chain of partnership, involvement, caring, and giving to the communities.  My colleagues take this caring and giving to their partner organizations, who in turn pass it on to the communities they serve.  ICH assists our partners, for example, to help educate new parents on how to care for their children, and to improve the lives and health of folks that have health problems such as HIV, mental health, and/or substance use disorder.  ICH also assists our partners to prevent violence such as gang violence, domestic violence, and other relationship violence. And these are just a few of the areas in which we assist.  Overall, ICH creates better communities, especially for the underserved.  Best of all, ICH helps these foundations and programs work with the resources they do have and use them to the fullest. 

With great care, passion, and devotion, my colleagues assist ICH’s partners with creating safe and healthy environments.  Safe healthy environments then lead to greater prosperity and health equity, and in turn it gets passed on and given to others, who are able to make better lives for themselves.  I have always wished to work in an organization like this one and have been blessed.

Happy New Year to all!