More people died of opioid-related overdoses in Massachusetts last year than in any previous year, according to a grim new report out Wednesday that reflects both the mental health toll of the pandemic and the pervasiveness of fentanyl-contaminated drugs.
The Massachusetts Department of Public Health’s twice-yearly opioid report showed that opioid-related deaths surged by 9 percent in 2021, to an all-time high of 2,290 lives lost. That is lower than the 15 percent increase seen nationally. But Massachusetts continues to have a high rate of overdose deaths compared to other states, the 17th highest in 2020, the most recent year for which state-by-state comparisons are available.
“There’s been a lot of attention and concern around the overdose crisis, and yet we’re still seeing the numbers get worse,” said Dr. Sarah E. Wakeman, medical director for substance use disorder at Mass General Brigham. “That tells me we have not taken it to the scale it needs to be at. . . . The system is still very broken.”
Governor Charlie Baker said in a statement that tackling the opioid crisis “remains an urgent priority for our administration, which is why we have worked with the Legislature to quadruple funding for substance addiction treatment and prevention, but we know there is more work to do.” Baker’s fiscal year 2023 budget proposal invests $543.8 million in harm reduction, treatment, and recovery programs.
In a small glimmer of hope, preliminary data suggest that the number of deaths declined by 4 percent in the first quarter of this year. These early data for January through March show 551 confirmed and estimated opioid-related overdose deaths, 24 fewer deaths than in the first three months of 2021.
Overdose deaths in Massachusetts quadrupled between 2010 and 2016, when they reached the previous high of 2,110. Then deaths dipped slightly and leveled off for a few years, until the pandemic brought a 5 percent increase in 2020, followed by the 9 percent leap last year.
However stunning the 2021 death toll, addiction treatment providers were not surprised, saying the numbers here align with national trends. But it’s not entirely clear whether the increase is driven by people taking more drugs or by the fact that the drugs they’re taking are more deadly. Nearly all street drugs are contaminated with fentanyl, a potent synthetic opioid.
Fentanyl has been found not just in heroin but in cocaine, methamphetamine, and even marijuana. As a result, people who are not opioid users and have little tolerance for such drugs can unknowingly overdose on fentanyl by taking another, contaminated drug. In Massachusetts, fentanyl was found in 93.3 percent of deaths in which toxicology tests could be performed.
Wakeman said national studies show no increase in people initiating drug use, and she suspects the same is true in Massachusetts.
“It’s not that there’s new people using drugs,” Wakeman said. “There’s an ongoing complete poisoning of the drug supply.”
But the pandemic still plays a role in the death rate because for some people, it has changed the context of their drug use. Stress and trauma, such as the loss of housing, economic despair, or boredom, have led to more “chaotic use” and isolation, leading people to overdose alone, she said.
Dr. Miriam Komaromy, medical director of Boston Medical Center’s Grayken Center for Addiction, said she’s struck by the high stress levels among her patients.
“We continue to see people very disconnected, stressed, anxious in the face of the pandemic,” Komaromy said. “People are not back on their feet. They’re struggling with death, loss, ongoing fear of infection,” all of which can contribute to drug use and addiction.
And authorities have a hard time stopping the trafficking of fentanyl, which is highly potent in small amounts and can be easily shipped in an envelope, she added. “It’s pretty terrifying, honestly,” Komaromy said.
Kristin Nolan, chief behavioral health officer for Spectrum Health Systems, the largest addiction treatment provider in the state, said her company has not seen a significant increase in people seeking services. Instead, many patients seeking treatment for use of drugs other than opioids are testing positive for fentanyl.
“Fentanyl is the main theme here and why we’re seeing this increase,” Nolan said.
But she agreed that the stress from the pandemic has affected drug use, leading more people to use alone. Additionally more people are choosing stimulants such as cocaine and methamphetamine and deliberately mixing them with opioids.
“As a person using illicit substances, you’re always looking for a different kind of high,” she said, and such wishes only intensify at times of high stress.
Wakeman said the state should do more to enable people to use drugs safely, such as easier access to clean supplies and opening safe consumption sites, where people can take drugs in the presence of medical staff who can revive them if they overdose. Komaromy agreed that it’s time to “get real” about the need for such a site.
Treatment is “still far too hard to access,” Wakeman said, especially for people who would benefit from methadone, which can be obtained only at highly regulated clinics.
The state data report shows that Franklin, Hampshire, Middlesex, and Bristol counties experienced increases in the number of deaths in 2021, and that no county saw a decrease.
Black and Hispanic people remain disproportionately affected. And new data on the American Indian population reveal that, while they are a small proportion of the state’s population, they carry a high burden of overdose deaths. There were 13 overdose deaths among the American Indian community. But, calculated as a rate per 100,000, American Indians had a rate of 118.6 deaths per 100,000, compared with 31.9 for the entire population.
Leigh Simons Youmans, senior director for health care policy at the Massachusetts Health & Hospital Association, called the overall increase in deaths “a solemn reminder of a crisis that is affecting more lives than ever before.”
“Health care providers continue to report that the pandemic has fast-tracked many of the stressors and environmental factors that often lead to substance use disorder — especially among people of color,” Youmans said in a statement.
“We are asking people to use this news as a call to action: please check in with those in your lives who are trying to overcome addiction and help them find the resources they need.”
The report on Wednesday contrasts sharply with the trends seen in the health department’s previous report, released in November. That report found only a 1 percent increase in overdose deaths in the first nine months of 2021 compared with the same period in 2020. But a spokeswoman said that those numbers were estimates; the actual numbers for July through September turned out to be higher than estimated, and the last quarter numbers were also high.