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Briefing: Battling the Opioid Epidemic in Massachusetts

Battling the Opioid Epidemic in Massachusetts Recap
March 6, 2019 at The Boston Foundation
Presented in collaboration by The Boston Foundation, Philanthropy Massachusetts, RIZE Massachusetts, and Boston Indicators
View the PowerPoint Presentation of Battling the Opioid Epidemic

5 people die every day from opioid related overdoses in MA. The partnership of this program is emblematic of the kind of collaborative work necessary to address this epidemic.

Data Behind the Epidemic

Luc Shuster, Director, Boston Indicators

Andrew Bagley, VP for Policy and Research, Massachusetts Taxpayer Foundation

Boston Indicators

  • Opioid deaths in the US have quintupled since 2000, up to 47,600 in 2017
  • Putting the crisis in context
    • More opioid-related deaths in 2017 than deaths from car crashes
    • Driven by the opioid epidemic, American deaths from drug overdoses in 2017 were greater than American deaths from the entire Vietnam war
    • Roughly the same number of opioid-related deaths in 2017 as HIV/AIDS deaths in 1995, the height of that epidemic
  • MA’s opioid-related death rate is roughly 2x the US average
  • Have made some very modest progress over the last 2 years, but deaths remain extremely high in MA – estimated 1,974 deaths in 2018
  • Black and Hispanic opioid deaths have increased rapidly since 2011. And their death rates in MA are higher than the national rate for all races.
  • Vast majority of drug deaths in MA are opioid-related regardless of race or ethnicity
  • Our state’s opioid crisis spiked even as our economy improved which tells us that harsh economic conditions were not the cause for the spike
  • Fentanyl is now #1 cause of opioid-related deaths in MA (1,649 in 2017)
  • There’s likely a regional effect at play, with New England states having high opioid-related death rates
    • Major drug trafficking routes run through New England
    • It is extremely potent in small amounts, so drug enforcement is not an effective way to keep it out of communities

Massachusetts Taxpayers Foundation

  • Report was meant to provide a comprehensive picture of the size and scope of the epidemic in Massachusetts to motivate greater involvement among business leaders
  • MA is at the epicenter of the epidemic and it is virtually impossible to stop the flow of drugs into MA
  • People in the work force who use opioids experience absenteeism, presenteeism (working while sick), and excess health care which cost businesses ~$4.8 billion
  • The US labor force participation rate is demonstrably lower than other countries in the developed world
  • Since 2011, MA has averaged 33,700 people unable to work due to opioid misuse
  • MA economy has lost $7 billion due to lost productivity and foregone income- has lost about 12% of potential growth over the past 10 years
  • Crisis touches every system in Commonwealth – sizable impacts on economy, business, health care providers, the state and municipalities


Scope of the Crisis

Julie Burns, Executive Director, RIZE Massachusetts, Moderator

Dr. Myechia Minter-Jordan, MD, MBA, President & CEO, The Dimock Center

Marty Martinez, Chief of Health & Human Services, City of Boston

Opioid Addiction is classified as a chronic disease

  • Opioids are chemicals that naturally occur in your body
  • Manufactured opiates attached to MU receptors in the brain creating a full on reward experience, which becomes an addictive feeling
  • Conversation is moving away from the term “abuse” towards  “disease” because of the impact of opioids on the brain and its addictive nature
  • Need for better research in this space, other treatments
  • Important to first get on the same page that it is a disease and then work together to find the ways we can treat it

The City of Boston is addressing this crisis by making sure there are as many first responders as possible, everyone can be a first responder eg police officers, case managers etc

  • While dealing with disease, neighborhoods dealing with different issues related to epidemic so it is important to put more resources into the hands of folks
    • Widespread availability of Narcan (Naloxone) – nasal spray that can treat overdose in an emergency situation
    • EMS administered Narcan roughly 2000 times last year, 5 or 6 years ago that number was in the hundreds
    • The more Narcan is available, more people are trained to use it, the more successful it will be
  • No single strategy, City of Boston in putting everything on the table


  • How it works: displaces opioid from receptor, immediate response, not a treatment methodology but used to prevent opioid overdoes from becoming death
  • Everyone should know how to use and administer
    • Eg librarians, parents with teens
  • City of Boston has overdose prevention training with the City Bureau of Recovery Services through which they have distributed 18,000 or so kits related to the training with Narcan
  •  It is important to get out of the notion that we can only have it at health centers or in certain neighborhoods, it is a tool for survival

Why is Fentanyl so hard to track?

  • It is manufactured, created, and then cut with other drugs, which forces people to use more frequently than if there weren’t fentanyl in it 
  • In Canada, they can actively test people’s drugs for Fentanyl so people know what they’re taking
  • It is odorless and a small amount is very potent so it is hard to detect

Harm Reduction Focus

  • Harm reduction – strategy to help people avoid dangerous behavior when using, strategy to keep people alive
  • State Harm Reduction Commission established in August 2018 to establish culture of harm reduction. Report recently submitted to Governor
  • Harm reduction can often be viewed as controversial, but the only way to help folks to the path of recovery is if they are alive
  • Opioid Use Disorder knows no bounds and affects vulnerable populations because of stigma, lack of access to care, and various other social determinants of health
    • Necessary to create individualized comprehensive care plans for those with substance use disorder (like they do at The Dimock Center)
  • Need to meet people where they are and address the gaps in service opportunities to those who need care
    • Diversity of responders eg supporting Spanish speaking providers
    • Using substances is one issue for those experiencing homelessness or other issues and so it is important  to take every facet into account
  • The City plans to rebuild the bridge to Long Island in the Boston Harbor to serve as a recovery campus

Innovative Solutions and Funding Needs

Nineequa Blanding, MPH, Director, Health and Wellness, The Boston Foundation, Moderator

David Barash, MD, Executive Director, GE Foundation

Brendan Little, Policy Director, Office of Recovery Services, City of Boston

J.J. Bartlett, President, The Fishing Partnership

Elsie Taveras, MD, MPH, Executive Director, Kraft Center for Community Health, MGH

GE Foundation’s Community Involvement in MA

  • Have given $15 million to address opioid crisis because 1) GE see itself as part of the community and so they can step up with their resources, and 2) this epidemic is important to its employees and so it’s important to GE.
  • Support capacity building over direct service ie they support trainings for the providers and community health centers to be better equipped to address the crisis. Strategies include:
    • Sustain- increase provider capacity with partners already within state
    • Support for Boston Medical Center as hub to train community health centers
    • Building a pipeline from stigma to awareness through support of activities like CareZone, Hackathon, AG office’s Project Here – Substance Use Prevention Education

Kraft Center for Community Health

  • CareZONE – mobile health program that brings together partners in preventive care, addiction services, and harm reduction to serve individuals not well-connected to health care, experiencing homelessness and/or living with addiction
    • Low-threshold, on demand addiction care that is data-driven, has been very successful in its pilot program – made contact with over 3400 people who inject drugs, prescribed over 130 buprenorphine prescriptions 
    • Abstinence shouldn’t be a precondition for care so they offer services like needle exchanges to address harm reduction
    • Van is movable and parks in same location on same day every time so community can access it easily

Office of Recovery Services

  • One of the only municipal offices of its kind in the US - supports substance use disorder and addiction recovery strategies in the City through various programs
    • Eg PAATHS program, the City’s access to care program, Access, Harm Reduction, Overdose Prevention and Education (AHOPE) is a harm reduction and needle exchange site, Narcan Education Program, 24 hour support line
  • Focus on building a life of purpose – how can we make sure meaning is put back into people’s lives when they’re in recovery
  • Learn how each community defines substance abuse and what kind of support they seek to minimize stigma and maximize care
  • So far more acute services have been launched like detox beds, gap is in next levels of care, support people in recovery through residential programs etc
  • Support young people experiencing or at risk of Opioid Use Disorder- connecting them with a strong adult and working on why they do what they do through an equitable lens

The Fishing Partnership

  • Supporting the health, safety, and economic security of commercial fishermen and their families since 1997
  • Opioid Related Deaths are higher in MA than national rate, many of these are fisherman and other physical labor professions
  • Workers in occupations with high pain and injury rates, fewer days off, and less job security are more likely to die
  • Fishing is a low-income job (about $24,000 a year) – for scalloping they will be at sea for 10-15 day period and invest their own money to go out which gets paid back based on how much they catch – only limiting factor is how intensely you’re willing to work your body, which often means 18-20 hours/day and a lot of physical labor
    • This can lead to an addiction to painkillers; ambulances don’t go out to fishing boats so an overdose at sea can be a death sentence
  • Losing a generation of workers and treating this disease very differently than we would treat any other one due to stigma
  • Focused on education efforts to make sure everyone knows about the disease and what to do
    • Narcan training for fisherman, Coast Guard, MA Environmental Police, etc


What is the long term financial sustainability – cost to insurance providers?

  • At this point, many of these services are not reimbursable and are considered charity. But if access to drugs is easier than access to treatment, we have a responsibility to address that problem

How do we develop a culture of harm reduction for young people?

  • Connect with adults to answer why young people are using over what the substance is. Important to equip adults to have conversations with young people about how they’re dealing with pain and stress
  • Strong social networks help those in recovery

Together through collaboration and empathy we can address this crisis.


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