Lost lives have become the defining measure of the opioid crisis in Massachusetts. More than 2,000 dead last year, approximately 1,800 the year before. So when Governor Baker noted “some signs of progress” in this battle, the reason was a slight decline in opioid deaths between early 2016 and early 2017.
That’s undoubtedly a good thing, but it’s risky to focus too narrowly on this one variable. Death isn’t the best measure of the opioid crisis.
One reason we’re so focused on the opioid-related death rate is because there’s an existing system to track it, using death certificates to register and record the cause of nearly everyone’s last breath. But tallying up these deaths presents a very limited view.
It’s possible, for instance, that addiction is spreading even as overdoses decline. That might sound counterintuitive (why wouldn’t more addiction lead to more overdoses?), but it does sometimes happen, especially when there’s an emphasis on treating near-death patients.
The wide deployment of naloxone, which can reverse overdoses, is an example. People who would have died in the past now survive because emergency personnel have a life-saving injection ready at hand.
But in theory, this could distort our sense of what’s actually going on in Massachusetts, lowering the opioid-related death rate even if heroin and fentanyl are still expanding their reach.
It’s impossible to know whether this is really happening. Use of naloxone, sold under the name Narcan, has been going up. But the state’s publicly released information about EMS incidents is too spotty to say whether there’s been a naloxone-fueled rise in nonfatal overdoses.
Plus, there’s another problem with focusing on opioid deaths alone. We don’t actually care about opioids. If drug users in Massachusetts suddenly switched to cocaine, there would be no opioid crisis — but that would hardly be a reason to celebrate.
This isn’t just an idle thought. In the whack-a-mole world of drug interdiction, it often happens that a crackdown on one class of drugs leads users to try something else.
Opioids have become the leading killer for a variety of reasons: misleading marketing from prescription drug companies, overprescription by doctors, new heroin smuggling routes, and the mass-production of synthetic fentanyl. But mostly they’re cheap, available, and ready to soothe away pain.
However, as pill mills fall to law enforcement and fentanyl gets more attention, that could create room for something new — or a resurgence of something old.
Already, there are signs of a return to other drugs. Preliminary data from the Centers for Disease Control show a huge jump in cocaine overdoses nationwide in 2016, along with a smaller but still substantial increase in methamphetamine-related deaths. It’s a reminder that the enemy here is addiction, not necessarily opioids.
Again, however, we don’t have the data to say whether this uptick in nonopioid overdoses is also happening here in Massachusetts. Or what role it might be playing.
To address the addiction crisis, we need timely, reliable information that reaches beyond mortality. And that’s lacking. The latest comprehensive report, issued by the state’s Department of Public Health last month, only covers the period through 2015, with estimates of addiction that are partly derived from the death data, rather than gathered from surveys or collected at mental health facilities.
Getting such information wouldn’t be easy; part of the virtue of focusing on the death count is that we already track deaths. But it’s like a tragic version of the joke about the researcher looking for his keys by the lamppost, even though he lost them down the street. That’s where the light is best, he tells his perplexed friend.
Sometimes, the things that are easiest to track aren’t the most important.Evan Horowitz digs through data to find information that illuminates the policy issues facing Massachusetts and the United States. He can be reached at firstname.lastname@example.org. Follow him on Twitter @GlobeHorowitz.