Full extent of the opiate crisis in Mass. unknown

Overdose, death, location data lacking

Massachusetts is under siege from a frightening surge of heroin overdoses, Governor Deval Patrick said last month in declaring a state of emergency. That grim view has become unquestioned consensus among law enforcement, health workers, and devastated families.

But even as officials from Beacon Hill to town halls rush to respond to the crisis, its full scope remains unknown. No real-time data are collected by state health officials to show how many overdoses are occurring, how many deaths are resulting, and where the toll is greatest.

As a result, police and health officials in large cities and small communities are scrambling on their own to map and react to the crisis rather than wait for data from the state Department of Public Health, which only last week released its count of opiate-related deaths for 2012, reporting 668 such fatalities, an 11 percent increase from the previous year.

“The lag time is a disgrace. It’s a combination of indifference and ineptness on DPH’s part,” said David Sullivan, the Northwestern district attorney, whose office serves Hampshire and Franklin counties.

By contrast, he said, federal officials keep up-to-date records on disease outbreaks. “If I call the Centers for Disease Control and Prevention, they can tell me how many people died of the flu last week.”

State officials said the health department is hampered by a labor-intensive system in which death certificates are still recorded on paper by the state medical examiner, whose office generally takes three months to confirm a fatality as opiate-related. Then, staff members from the Department of Public Health must review all those certificates every year, enter the information into an electronic system, and code the data.

“DPH is working with cities and towns to improve data collection to better track and understand these emerging trends,” said Anne Roach, department spokeswoman. Roach declined to provide details of those improvements.

Whatever the state agency is doing, Sullivan said, the work needs to be expedited to help local officials grasp the extent and location of the opiate problem. “This isn’t complicated,” said the district attorney, who suggested that the health department create a website portal to allow every first responder in the state to record suspected overdoses immediately.

“Nobody really took responsibility for this public health crisis. With this spike in opiate overdoses, they just didn’t recognize that you need good data to make good decisions,” Sullivan said.

Since Feb. 25, news media and public officials trying to gauge the impact of heroin and other opiates have relied almost exclusively on a State Police report that counted 185 overdose deaths in Massachusetts since November. But even that figure is understated — and possibly substantially so — because the report did not include deaths in Boston, Worcester, and Springfield, where local police lead their own investigations into suspicious and unattended fatalities. Elsewhere in Massachusetts, the State Police assign homicide detectives to each county’s district attorney’s office to investigate deaths. Those detectives combed their records since November to arrive at the 185 figure, but that number is speculative. In a change from their original statement, State Police now say that many of those deaths are suspected to be opiate-related but have not been confirmed.

That review was conducted by the State Police as an independent response to the intense public interest in the overdose surge, said David Procopio, the State Police spokesman. Although State Police do not routinely compile overdose numbers, Procopio said the agency thought it was important to provide up-to-date statistics.

“We’re of the mind that the more information the public has, the better, both for the public and the policy makers, to make informed decisions,” Procopio said. “I would expect more of it. Hopefully, this won’t be a one-time thing.”

Adding suspected fatalities from Boston, Worcester, and Springfield probably would swell the State Police tally by dozens. But there is little uniformity in the release of those numbers. In Boston, the latest state figures are from 2011; in Worcester, they date from August.

The state Public Health Department did not make any officials available to discuss the data. In Boston and Worcester, officials have moved to track overdoses and suspected fatalities on their own. In Boston, the city’s emergency medical crews recorded 137 possible overdoses — some of which resulted in death — from Jan. 1 to April 6, an increase of 20 percent over the same period last year, said Rita Nieves, director of the addictions bureau of the Boston Public Health Commission.

That figure represents the number of times emergency crews administered Narcan, a synthetic drug used to reverse heroin overdoses, Nieves said.

The city’s Public Health Commission began tracking overdoses in 2007 to look for patterns and to plan its response. As part of that effort, Nieves said, city EMS crews notify her office electronically within 30 minutes of every suspected overdose.

“It became clear that we needed to have more real-time data and a better sense of what was going on in the streets,” Nieves said. “We need to know right away when activity is increasing in any specific area.”

Otherwise, she said, “it doesn’t allow me to respond in a timely way.”

The number of Boston overdoses that ended in death this year has not been confirmed, and Nieves would not disclose the suspected number. But she said the figure is running close to the 2013 pace, which also has not been confirmed and released. Boston’s latest official figures are from 2011, when the state reported 59 unintentional overdose deaths.

In Worcester, police said they had received confirmation for heroin-related deaths that occurred during much of 2013 — 12 until August. In 2014, Worcester has recorded 46 overdoses, said Sergeant Kerry Hazelhurst. He did not break out suspected deaths from that figure, pending state confirmation. Farther west, data collection in Springfield appears to be left exclusively to the state health department, which could mean that 2014 trends will not be available for years. Helen Caulton-Harris, the city’s commissioner of health and human services, said she has no overdose data and does not track drug fatalities.

“We don’t have any recent data, I’m sorry,” Caulton-Harris said. “Obviously, the more data we have, the better prepared we can be to do intervention and prevention.”

Terrel Harris, spokesman for the state Executive Office of Public Safety, said improvements in data collection are nearing. According to Harris, the Registry of Vital Records and Statistics is working on an electronic death-certificate system that is scheduled to be running in June. “This means medical examiners as well as physicians in the community will be using this system. It will eliminate the paper death certificates,” Harris said.

In Taunton, which has been hit hard by heroin overdoses, a city worker who is helping lead the fight against drugs said she would welcome faster statewide data.

“I would like to know whether the areas around us are seeing it, whether the smaller towns also are seeing overdoses,” said Jennifer Bastille, program adviser for the city’s Safe Neighborhood Initiative. “I can’t say it would make the job easier. But it certainly could show a trend — that we are seeing more overdoses in this area, and we could focus our efforts there.”