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Opioid-related overdose deaths fall in Mass., but remain near record highs

The mixing of drugs like fentanyl and cocaine is driving the deadly scourge and making treatment more difficult.

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Deaths from opioid-related drug overdoses in Massachusetts have dipped but remain near record highs —stark evidence that the state is still deep in the throes of a devastating opioid crisis that has killed 25,000 residents since 2000.

Approximately 1,718 people statewide died of opioid-related overdoses during the first nine months of this year, down 1.8 percent from the same period last year when the state recorded the highest number of such deaths on record, according to preliminary data released Wednesday by the state Department of Public Health. The staggering death toll continues to be driven by an increasingly toxic drug supply and the rapid spread of fentanyl, the highly potent synthetic opioid that is deadly even in small quantities.


“It’s hard to find hope in these numbers,” said Dr. Robert Goldstein, state commissioner of public health. “[Deaths are] leveling off, but they are leveling off from the highest number of opioid-related overdose deaths that we’ve ever seen in the Commonwealth. And that is a really jarring, sobering number to have to report.”

Policymakers, clinicians, and outreach teams that work to prevent overdoses say the decades-long opioid epidemic has entered a perilous phase ― one that is more difficult to counteract.

More dangerous substances like fentanyl, a synthetic opioid, and xylazine, an animal tranquilizer known as “tranq,” are spreading through an ever-growing portion of the illicit drug supply. In many cases, people using stimulants such as cocaine or pills that resemble prescription painkillers are overdosing because they do not know they are laced with deadly amounts of fentanyl, treatment specialists and outreach workers say.

As the illicit drug supply becomes more contaminated, people seeking help to break their addictions face fewer treatment options. Medications like methadone and buprenorphine, which help reduce opioid cravings, are not effective for treating the use of stimulants like cocaine and methamphetamine. And xylazine, which poses dangerous side effects including skin ulcers and depressed breathing, is resistant to fast-acting opioid-reversal drugs like Narcan.


The deadly drugs have become alarmingly easy to make – and to hide. Last month, investigators seized more than 220 pounds of drugs – many of them laced with lethal amounts of fentanyl – from the basement of a multifamily home in Lynn. Many of the seized pills were molded to resemble pink Valentine’s Day candies.

“Now amateur chemists are mixing these ultra-deadly agents with every drug — with counterfeit Adderall, with adulterated cocaine... and no one knows for sure what they’re taking,” said Dr. James Baker, president of the Massachusetts Society of Addiction Medicine and a professor at Tufts School of Medicine. “These agents can be produced anywhere.”

The dangerous trend of combining illicit drugs, sometimes referred to as “polysubstance use,” is reflected in toxicology screenings done on people who die of opioid overdoses. Cocaine was present in a record 60 percent of opioid-related overdose deaths statewide in the first three months of the year. Anti-anxiety medications known as benzodiazepines were present in 24 percent of those who died, and prescription opioids were found in 11 percent of deaths. Xylazine was present in 7 percent of deaths, state researchers found.

Most of these drugs were combined with fentanyl, which is the driving force behind the relentless death toll, showing up in 93 percent of opioid-related deaths in the first three months of the year.


The ever-fluctuating blend of dangerous substances making their way into the illicit drug supply poses challenges for drug treatment counselors and others on the front-lines of the epidemic.

Ashley Oliveri, a clinician at an outpatient drug treatment clinic in Worcester operated by Spectrum Health Systems, said people seeking to wean themselves off opioids are needing ever-higher doses of methadone because illicit street drugs have become so potent. Often, the initial methadone dose prescribed by a doctor is too small, she said, to prevent painful withdrawal symptoms, which increases the risk of relapse.

Every few months, Oliveri has to update the information she shares with clients in group therapy sessions to keep pace with the growing risks and evolving nature of the illicit drug supply. “Maybe 10 years ago, if you were going to pick up heroin, you knew you were getting heroin,” she said. “It wasn’t safe but it’s a lot safer than what’s on the street now.”

The Commonwealth has poured $1.2 billion into addiction prevention, treatment, and harm reduction programs since 2015, yet state officials acknowledged they need to do more to reverse the trend in overdose deaths and keep pace with the evolving epidemic.

In a significant break from past administrations, the Healey administration is publicly embracing supervised consumption sites.

These are special centers where people can use illicit drugs under the watchful eye of trained professionals, who can step in and rescue anyone who overdoses. Also known as overdose prevention centers, or OPCs, such sites have operated in Europe and Canada for more than 30 years, and a chorus of research studies has found they save lives, prevent infectious diseases, and reduce harmful behaviors such as needle sharing. Because of legal barriers, there are only two supervised drug consumption sites in the country, both in New York City, though another is scheduled to open early next year in Providence.


The Department of Public Health released a report Wednesday describing supervised consumption sites as “feasible and necessary” and recommended the state pass legislation that would shield supervised consumption providers, their staff, and clients from criminal liability. “It is [the Department of Public Health’s] position that OPC activities are a life-saving intervention and a component of healthcare, and that these activities should be protected as such,” the agency concluded in its report.

The Healey administration unveiled several other initiatives. These include a new public health campaign targeted at night-life venues and focused on the risks of unintended exposure to fentanyl, more funding for mobile addiction programs, and a research effort to identify so-called “opioid treatment program deserts,” or areas where people have limited access to methadone and other treatment services.

In September, Massachusetts became the first state to fund a 24-hour overdose prevention hotline. The hotline allows people taking drugs alone to be monitored during a phone call, and receive emergency medical care if they become unresponsive. From January to November, helpline staff supervised more than 1,000 episodes in which people used drugs and helped prevent at least 9 overdoses, state officials said.


Yet such government-funded initiatives need to be combined with a broader campaign to educate the public and medical community about the life-saving benefits of addiction medicine, Baker argued.

Two days before Christmas in 2016, Baker lost his 23-year-old son Max, who was addicted to heroin, to a fatal overdose. He partly blames his son’s doctors for not educating him about the nature of addiction and the availability of medications like buprenorphine, which bind to the brain’s opioid receptors long enough to prevent cravings. In his view, Massachusetts will not turn the corner on overdose deaths until the question, “Are you or anyone else in your family suffering from addiction?” becomes a standard question asked of every patient admitted to a clinic or hospital.

“No one asked that about my son, and he was naked to the world,” Baker said. “It’s a very hard thing to accept, at this stage, that there are still people out there who are dying without any help.”

Chris Serres can be reached at chris.serres@globe.com. Follow him @ChrisSerres.