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Opioid overdose deaths in Massachusetts declined 10% in 2023

Creative Commons / flickr.com/photos/armydre2008

Massachusetts recorded a significant drop in opioid-related overdose deaths in 2023, forging a potential turning point after the state's fatality count hit a record high the previous year.

State officials say there were 2,125 confirmed and estimated opioid-related overdose deaths last year, or 30.2 per 100,000 residents. That marks a 10% decline compared to 2022, when the epidemic claimed the lives of 2,357 Bay Staters, at a rate of 33.5 per 100,000.

The Public Health Council reviewed the data during its meeting Wednesday morning.

The state said the fatality rate decrease represents the largest single year decline in opioid-related overdose deaths in 13 years. The trend is expected to continue this year, based on initial data from the first three months of 2024, officials say.

But not all groups and regions shared in the drop. The biggest improvement was among white men — with a 16% drop in deaths.

But deaths went up slightly among Black men, as they did in some rural areas like Franklin County, which had 32 fatal overdoses in 2023 compared to 28 the year before.

Franklin County Sheriff Chris Donelan, who is on that region's opioid task force, said it's harder to access treatment and medical care in rural areas. But after years of work bringing in detox beds and community services to the county, Donelan said, fewer people are dying than they used to.

"It's an ever evolving and changing statistic," Donelan said. "And some years it's discouraging. Other years it's encouraging. But we have to keep doing the work."

In addition to addiction treatment, the sheriff said the task force members try to address the problem by helping vulnerable people with housing, mental health care, employment and other services to stabilize their lives.

Donelon said the actual number of overdoses often comes down to which drugs are on the street and how toxic they are.

In Hampshire County, officials reported a drop in overdose deaths that mirrored the state's trend — from 37 in 2022 to 29 in 2023.

But Taylor McAndrew of the Hampshire Hope coalition, in the Northampton Department of Public Health, said it is important to be cautious with their optimism.

"This should not serve as a reason to slow down in our community-wide interventions and harm reduction messaging," she wrote in an email. "There are still too many losses, and especially in populations that have been historically marginalized."

In Springfield, city health director Helen Caulton-Harris said there was a slight decrease in overdose deaths in 2023 - from 122 to 117 - but she did not consider that statistically significant. More worrisome, she said, is that Springfield's fatal overdose rate is still much higher than in 2016, when 75 people died.

"I hope we continue to see a downward trend," said Caulton-Harris.

Opioid-related overdose fatalities in Massachusetts have exceeded 2,000 since 2016. The number of deaths in 2023 is greater than the 2,092 deaths in 2020; 2,007 deaths in 2019; 2,015 deaths in 2018 and 2017; and 2,111 deaths in 2016, according to state data.

"Every overdose death is tragic, preventable and unacceptable," Secretary of Health and Human Services Kate Walsh said in a statement. "While we are proud and encouraged that fewer Massachusetts residents were lost to overdose last year, we know that inequities persist, and our work is not done. Our understanding of where gaps in treatment and services occur, and the people who we are not yet reaching, drives our work and helps focus our efforts."

Health officials said 48% of all opioid-related overdose deaths in 2023 occurred among individuals ages 25 to 44 years old, and 43% of deaths were among those ages 45 to 64. Men accounted for 72% of deaths.

Among cities and towns with "notable" decreases in deaths in 2023 compared to the prior year, DPH identified Brockton, Cambridge, Falmouth, Lawrence, Leominster, Lynn, Pittsfield, Randolph, Waltham, and Wareham. But Holyoke and Taunton saw notable increases.

Goldstein attributed the declining fatality rate in 2023 to the state's distribution of naloxone, a medication that reverses overdoses, as well as syringe service programs, an overdose prevention hotline, and a drug-checking program that allows officials to understand the lethality of the drug supply here.

"We have one of the best naloxone distribution programs in the country, and we have naloxone everywhere in every community, so that people can use it," Goldstein said. "We have really pioneered the use of syringe service programs in this state, and to use a harm reduction lens in everything that is being done."

DPH said it has distributed more than 196,500 naloxone kits, with each kit containing two doses, since 2023. The effort has led to at least 10,206 overdose reversals, officials said.

DPH said it has also distributed more than 504,000 free fentanyl test strip kits to providers and community organizations.

DPH in December released a report saying health officials were in support of overdose prevention centers, also known as supervised injection sites, where medical professionals are on hand to intervene in potential overdoses. Legislation creating a path for municipalities to open the centers is before the House and Senate Ways and Means committees.

Goldstein referenced the department's report when asked about how legalizing the sites would impact the state's overdose fatality rate.

"We highlighted in the report some very specific concerns we have about opening an OPC right now, and that was absent legal liability protections for providers, for those who use the services, and for those who maybe are operating around the services, things like landlords and other people who are in this space," Goldstein said. "And so we continue to work with our colleagues in the Legislature to try to get those legal liability protections passed, codified into law, so that we can move forward and support communities as they want to open up overdose prevention states."

Mobile clinics that provide methadone in the Quabbin, Greater Springfield, Greater Boston, Worcester and Wellfleet regions have been another critical tool in curbing overdose deaths, said Deirdre Calvert, director of DPH's Bureau of Substance Addiction Services. She also mentioned the importance of investing in low-threshold housing.

Calvert fought back tears as she noted how much work must still be done to continue combating the opioid epidemic.

"I know I say this all the time, and it's not just for a headline. But these are people's children and family members, and they deserve all of the treatment and respect that we can give them," Calvert said.

Goldstein said DPH's efforts to address the maternal health crisis, including increasing the use of birth centers and growing the doula workforce, is connected to substance abuse work.

"Over 40% of severe maternal morbidity events in the state are related to substance use disorder. It's the single largest driver of maternal morbidity in the state," he said.

The state's progress in tackling the opioid epidemic, despite gains that officials touted in 2023, is more nuanced when factoring in racial and ethnic disparities in DPH's latest biannual report, Goldstein signaled.

While the overall rate of fatalities among men decreased from 2020 to 2023, only white non-Hispanic males saw a "significant change," or a 16% decrease, in the fatality rate, Goldstein said. The fatality rate among Black non-Hispanic males is persistently high, he said.

"So I want to state this clearly, this is yet another example of racism is a serious public health threat and reflects the decades of racism inherent to the war on drugs," Goldstein said. "When you look at the data, you'll see that in 2020, the rate of opioid-related overdose death was nearly equivalent for white non-Hispanic, Black non-Hispanic males and Hispanic males. But by 2023, the rate was two times higher for Black non-Hispanic males, and one and a half times higher for Hispanic males, compared to white non-Hispanic males."

Officials said that among racial and ethnic groups, American Indians, as well as Black men and women, had the highest opioid-related overdose death rates. Goldstein said the commonwealth's most rural communities have the highest age-adjusted, opioid-related overdose death rate of 35.6 deaths 100,000 residents.

Goldstein and Calvert are in Greenfield Wednesday to meet with the Opioid Task Force of Franklin County and the North Quabbin Region, as officials are scheduled to discuss challenges and successful outcomes of implementing public health interventions.

"Since September 2013, the task force has worked diligently with its partners to address the devastating impacts of opioid misuse through prevention, intervention, treatment, and recovery support," Goldstein said. "And it's consistently championed effective, evidence-based solutions to prevent opioid-related overdoses, becoming a national model for delivery of substance use care in rural communities."

NEPM's Karen Brown contributed.

Updated: June 14, 2024 at 11:35 AM EDT
Updated: June 13, 2024 at 9:00 AM EDT
This story has been updated to include statistics and reaction from western Massachusetts.
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