More than 2,300 people in Massachusetts died of opioid-related overdoses in 2022, the highest number ever recorded, as the scourge of addiction and a contaminated drug supply continue to take lives throughout the state.
The bleak figures appear in the state Department of Public Health’s semiannual opioid report, released Thursday, which shows that opioid-related overdose deaths in 2022 went up 2.5 percent from 2021 and 9.1 percent from the pre-pandemic high in 2016.
Dr. Robert Goldstein, state commissioner of public health, blamed the increase on “a poisoned drug supply” in which nearly all street drugs are tainted with the powerful opioid fentanyl.
More people are dying because the drugs have become more dangerous, not because more people are using them, said Dr. Miriam Komaromy, medical director of the Grayken Center for Addiction at Boston Medical Center. “Even if someone is trying to be careful, the drug supply is so mixed now that people can’t escape the huge risk of overdose and death,” she said.
The report also reveals stark disparities among different groups and localities. Death rates were higher in the state’s most rural areas. Overdose death rates among white people declined slightly, to 33.3 per 100,000 residents, from 36.5 in 2021. But the death rate among Black and Hispanic people, already much higher, increased in 2022. In particular, the overdose death rate of Black men was 79.6 per 100,000 in 2022, the highest among males of any racial or ethnic group, 41 percent higher than the previous year.
“It’s incredibly discouraging that overdose rates have risen for yet another year,” Komaromy added. “We’re not only continuing to have rising deaths, we’re actually seeing widening disparities by race, which is so disturbing.”
Preliminary data from the first three months of this year suggest that the overall trend might be starting to improve: There were 522 estimated opioid-related overdose deaths in the first quarter, down 7.7 percent from the same period in 2022.
Goldstein, the public health commissioner, said the Healey administration has proposed spending $600 million on substance addiction prevention and treatment programs in the fiscal year that starts July 1. Additionally, the state plans to draw $26.5 million from the legal settlements with opioid manufacturers to forgive educational loans of workers involved in addiction treatment and to support treatment and harm reduction programs.
In a significant break from the previous administration, Goldstein seemed open to establishing overdose prevention centers, places where people can use illicit drugs within view of clinicians trained to rescue them if they overdose. The Massachusetts health department will conduct a feasibility study on the controversial proposal, to be completed by the end of the year, Goldstein said.
Illicit fentanyl, a powerful opioid, continues to drive the high rate of deaths. It is mixed with most street drugs and was involved in 93 percent of deaths in which a toxicology screen was performed. Most people who died of overdoses had used multiple substances. A concerning new drug, xylazine, or “tranq,” has also entered the picture; the highly sedating animal tranquilizer was present in 5 percent of those who died.
“It is not just that people are using fentanyl alone, it is that fentanyl is in the supply of other drugs,” Goldstein said. “The message here is that the drug supply itself is not safe at this moment.”
The report shows striking geographic differences. Worcester and Plymouth counties experienced dramatic increases in opioid deaths, 18 percent and 14 percent respectively. But six counties and five municipalities logged a reduction in deaths.
Goldstein said those isolated improvements are evidence that the state’s efforts so far have not been in vain. “We have an incredibly dedicated workforce that has worked really hard over the past few years to address substance use, and to address the opioid-related overdose deaths,” he said. “And I think that we have had some success while we aren’t necessarily seeing it play out in the numbers.”
Still, he said, “We need to look at new and bold strategies.”
Goldstein listed several novel initiatives.
Starting this fall in Berkshire County, vending machines with drug paraphernalia such as syringes and hand sanitizer will be established so people can access clean equipment during the hours when the syringe service programs are closed.
A hot line will be established to connect people taking drugs with someone who will stay on the line and summon emergency services if the caller becomes unresponsive. The health department is seeking proposals for an agency to run the hotline, which would serve the state and be similar to the national Never Use Alone line.
The state will aim to identify and pour resources into “opioid treatment program deserts” where there are few services available for those seeking recovery.
And the state will work to ensure that all professionals licensed by the Department of Public Health, which includes nurses, pharmacists, dentists and dozens of other professions, have received training in addiction care. Such training is already required for physicians.
The move toward opening an overdose prevention center is also a “bold strategy,” Goldstein said. The department’s feasibility study will not duplicate the work of a legislative commission that in 2019 recommended piloting such centers, he said. Instead it will update that work and examine such issues as legal barriers at the federal level, the funding required, experiences of such centers in Rhode Island and New York City, and how to work with municipalities that might host an opioid prevention center.
Komaromy, of the Grayken Center at BMC, said the feasibility study is “a fine idea” but should happen simultaneously with taking steps to establish the centers, she said.
“We don’t have to stand back and study the issue as more and more people die,” she said.
Coincidentally, a coalition of groups advocating for overdose prevention centers held a State House event Thursday afternoon promoting legislation to launch a 10-year pilot program of the centers.
Among other measures to address opioid use, MassHealth, the state’s Medicaid program, has already dedicated $67 million for higher reimbursement rates for addiction treatment services, said Emily Bailey, chief of behavioral health for MassHealth. Additional rate increases ranging from 20 percent to 50 percent are planned, she said.
Lisa Blanchard, chief clinical officer at Spectrum Health Systems, a large treatment provider based in Central Massachusetts, said increased reimbursement is always welcome but the state also needs to rethink the way it pays for services.
Typically, providers collect reimbursement only after meeting with a patient and starting care. But services are needed long before that with, for example, community health workers and case management teams going into neighborhoods to connect with those who may not be ready for treatment or don’t know their options. Such programs exist — including Spectrum’s “road to recovery” van, funded by the state — but they’re limited in scope, Blanchard said.
Julie Burns, chief executive of RIZE Massachusetts, an independent nonprofit foundation working to end the opioid epidemic here, praised the state’s efforts but said it’s also necessary to look more deeply at the root causes of this unending crisis — what draws people into drug use and what can be done to prevent it.
Additionally, Burns said, “we need to examine the systems and beliefs that are hampering progress.” Stigma continues to deter people from seeking help, and addiction treatment programs remain separate from the rest of the health care system. “It doesn’t make sense,” she said.