Heroin overdoses and deaths in Massachusetts surged last month after a decline over the summer, a sign that the wave of opioid addiction is overwhelming some efforts to curb the crisis.
Ten months after then-governor Deval Patrick declared a public health emergency, State Police recorded 114 suspected opioid fatalities in December, nearly double the 60 that were tallied in November.
The authorities believe one reason for the sharp increase is a return of heroin that is mixed with potentially deadly additives to produce an explosive high. Early last year, heroin tainted with fentanyl — an opioid used in end-of-life care that is up to 100 times stronger than morphine — was blamed for a spike in overdoses that took hundreds of lives in Massachusetts in only a few months.
Another reason could be that tighter restrictions on prescription opioids are pushing more buyers to gamble with heroin, which generally is cheaper and more accessible, medical officials said.
Whatever is driving the surge, its toll has stunned workers in addiction treatment and prevention.
“The month of December was like nothing I have ever seen,” said Joanne Peterson, executive director of Learn to Cope, a support organization for families afflicted by drug abuse. “It’s like a live horror movie, like there’s this monster plucking people away from their families. Not only do you hear about one a day, you hear about several a day.”
Monday brought a new reminder of the lethal trend, when two women were found dead in Lowell of suspected heroin overdoses.
Earlier, police and health care workers were startled by a string of overdoses during the holidays. Among the victims was Keith Cordaro, a 26-year-old Brockton man who overdosed Dec. 23 in a bedroom in his grandmother’s house.
Like many other heroin users, Cordaro had been in and out of treatment facilities, spent time in jail, and stolen repeatedly from his family, his mother said. But Cordaro enjoyed enough sober time that his mother retained hope he would beat addiction.
“He was a good guy when he wasn’t near this stuff,” said Terri Cordaro, sobbing as she visited the home of Christine Hedding, a Brockton woman who lost her 24-year-old daughter, Kerri, to fentanyl-laced heroin in February. “Everything spiraled out of control so fast,” Cordaro said.
In Westminster, Gwen Phelps told a similar story of struggle, frustration, and tragedy. She took her son Jacob off life support Dec. 10, the day after the 24-year-old had overdosed in a Fitchburg pizza shop.
“We’re an average, middle-class, little-town family,” Phelps said. “Never in my wildest dreams did I think it would happen.”
Across the state, the toll has been broad, deep, and unsparing.
In Essex County, 33 suspected opioid-related deaths were recorded in November and December, compared with 13 in July and August.
In sparsely populated Franklin County, 21 overdoses were reported in November and December, compared with three in October.
And in Taunton, where overdoses plunged to near zero last summer, a combined 37 overdoses and three deaths occurred in November and December.
State Police numbers don’t include suspected deaths in Boston, Worcester, and Springfield, where local authorities collect the fatality figures, which often are not confirmed by the state for a year or more.
However, emergency workers in Boston used the medication naloxone, also known by the trade name Narcan, to reverse 138 opioid overdoses in December, compared with 92 in November and 69 in October. Without Narcan, many of those survivors might have died, health officials said.
Another trait of the resurgence is that more overdoses are occurring in “someone’s home, in the bathroom and kitchen,” said Rita Nieves, director of addiction services for the Boston Public Health Commission.
“They end up in trouble by themselves, and there’s no one to rescue them with Narcan,” Nieves said.
Yet another change is the frightening speed of death. Many users are dying within minutes of taking heroin instead of hours later, health workers said.
“Something’s different,” said Colleen LaBelle, who directs the outpatient addiction-treatment program at Boston Medical Center and state-funded community health centers. “Is it people are less street-savvy and don’t really know what they’re getting, or are they not sticking with the same suppliers?”
Dr. Daniel Alford, who oversees the Clinical Addiction Research and Education Unit at Boston Medical Center, said some patients are reporting changes in the texture and composition of their heroin.
“Whether it’s fentanyl again is unclear — and there are rumors it’s being cut with methamphetamine — but it looks different,” said Alford, who added that some patients are seeing unfamiliar crystals in the drugs they are using.
State Police plan to release a report soon on the composition of all narcotics tested by its lab in the last six months of 2014, said David Procopio, a spokesman. Meanwhile, questions about the spike are being asked by authorities at every level.
“We believe there is a strong likelihood that the increase in overdoses is due to a strong batch of the drug,” said Rachel McGuire, a Boston police spokeswoman. “Our drug-control unit continues to make controlled purchases of the drug throughout the city in an effort to find the source or sources.”
The federal Drug Enforcement Administration is also unsure of the answer.
“It could be fentanyl mixed in, it could be pure fentanyl, it could be no fentanyl. It could be any number of factors,” said Anthony Pettigrew, spokesman for the New England division of the DEA. “When people are using heroin, it’s a crapshoot. People don’t know what’s in it.”
Dr. Jeff Baxter, chief medical officer for Spectrum Health Systems, a Worcester-based network of addiction-treatment providers, said the most recent spike reflects the cyclical nature of the criminal drug business.
“There’s absolutely no predictability to the production, delivery, and processing” of heroin, Baxter said. The drug could be coming from places as far-flung as Pakistan, Burma, Mexico, or “some guy who’s experimenting in New York City and cutting it with A, B, or C to see it if drives up his profits.”
As a result, Baxter said, the numbers of overdoses and deaths will rise and fall.
Governor Charlie Baker has signaled that the fight against opioid addiction, particularly the over-prescription and misuse of narcotic painkillers, will be a top priority of his new administration. But tighter restrictions on prescription opioids such as Percocet and Vicodin might be making heroin more attractive.
“It’s one of those unintended consequences,” said Carl Alves, the executive director of Positive Action Against Chemical Addiction, based in New Bedford. “The alternative becomes more of an access to street drugs.”
An increasing number of prescription opioids are difficult to crush into powder and snort. In addition, more physicians and pharmacists are using a central database to track the drug histories of their patients.
Dr. Philip Bolduc, assistant professor of family medicine and community health at the University of Massachusetts Medical School, said he recognizes the danger that some users might switch to heroin for convenience and cost.
“I absolutely agree that is happening, but it doesn’t mean we shouldn’t be tightening the reins” on prescription painkillers, Bolduc said.
In the meantime, any cautious optimism created by the summer’s decline in overdoses has dissipated. Boston Mayor Martin J. Walsh, who described the overdose numbers as staggering, said he is close to opening a city-run Office of Recovery Services.
“We have to do more as a society, more as a government, around education and drug addiction,” Walsh said.
But finding the most effective response remains frustratingly elusive.
“There was a tremendous amount of awareness and sensitivity that led to numerous task forces” last year, Alves said. “I think that’s simmered down over time, and I think we need to double down.”