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

Source: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

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. 

Source: https://www.mass.gov/files/documents/2017/11/13/sec4-od%20deaths%20demo%20Nov-17.pdf

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. 

Source: https://www.mass.gov/files/documents/2017/11/13/sec2-od%20deaths%20by%20county%20Nov-17.pdf

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

Sources:

1: https://www.cdc.gov/drugoverdose/epidemic/index.html

2: https://www.nytimes.com/2017/10/26/us/opioid-crisis-public-health-emergency.html

3: http://www.mass.gov/chapter55/

4: https://www.mass.gov/files/documents/2017/11/13/sec4-od%20deaths%20demo%20Nov-17.pdf

5: https://www.mass.gov/files/documents/2017/11/13/sec2-od%20deaths%20by%20county%20Nov-17.pdf

6: https://www.cdc.gov/media/releases/2017/p0905-opioid-funding.html

7: http://www.mass.gov/chapter55/

8: http://www.wbur.org/commonhealth/2017/11/13/opioid-state-snapshot-third-quarter 

ICH Supports Community-Based Approaches to Opioid Abuse Prevention

By Lynn Ibekwe

Although opioid abuse has been a growing problem over the past decade, public awareness has only recently peaked due to opioid deaths around the country reaching epidemic proportions and the deaths of celebrities like Phillip Seymour Hoffman and Cory Monteith. Opioids are highly addictive substances that include heroin and prescription pain medication such as morphine, codeine, oxycodone, and buprenoprhine. Characterized as an “urgent public health crisis” by U.S. Attorney General Eric Holder, rates of fatal heroin overdose, opioid drug trafficking, and prescription drug misuse and abuse have sharply increased in recent years. According to Drug Administration Enforcement (DEA) officials, the growing use of heroin stems from the corresponding growth in prescription painkiller abuse. In 2010, about 12 million Americans reported using prescription painkillers for non-medical purposes in the past year. Today, four out of five adults (ages 12 and older) who recently began using heroin had previously abused painkillers.

Past Month & Past Year Heroin Use among Americans Aged 12 or Older: 2002-2012 [1]  

Massachusetts communities have not been immune to the opioid epidemic. With many New England cities and towns now reporting dramatic increases in opioid overdoses and death, communities and stakeholders across MA are mobilizing to address this growing problem. ICH has been engaged in a number of these efforts over the past few years, including the current Massachusetts Opioid Abuse Prevention Collaborative (MOAPC) and the Partnerships for Success II (PFS II) initiatives.

MOAPC is a Massachusetts Department of Public Health Bureau of Substance Abuse Services (BSAS) funded project that aims to increase both the number and the capacity of communities across Massachusetts addressing opioid misuse and abuse. ICH works with the MOAPC Cambridge cluster, consisting of Cambridge, Everett, Somerville, and Watertown and lead by the Cambridge Public Health Department (CPHD). The mission of this collaborative is to employ systems-level approaches to prevent opioid misuse and reduce unintentional deaths and hospital events associated with opioid poisonings. Cluster members are currently strategizing around activities and initiatives to address key factors associated with opioid abuse, overdose, and death in their communities, such as access to opioids, low provider knowledge around prescription drug misuse, and misconceptions around the safety of non-medical use of prescription drugs.

ICH also collaborates with the cities of Quincy and Worcester on the three-year PFS II project funded through BSAS. Impact Quincy and the City of Worcester’s Division of Public Health (WDPH) were two of the many community-based prevention programs in MA awarded PFS II dollars to address prescription drug misuse and abuse in their communities. Both organizations have spent the past year identifying a number of prevention strategies to address misuse among youth, including:

•  Increasing the number of locations for safe disposal of prescription drugs
• Developing mass media and educational campaigns aimed at raising awareness among parents and community members
• Conducting trainings and professional development workshops to educate physicians and other medical providers around the non-medical use of prescription drugs (NMUPD)
• Developing social norms/marketing campaigns and a health curriculum for youth around misperceptions of peer use and safety of NMUPD

As the local evaluator for these initiatives, ICH assists these multi-sectoral groups in identifying evidence-based strategies for opioid abuse prevention, soliciting and analyzing community input, and documenting and understanding their impact. Our participatory approach values local knowledge and encourages capacity building so that our communities are well equipped to curb this disastrous epidemic. 

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[1] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

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