The number of people who died from opioid-related overdoses in Massachusetts dropped by 4 percent in 2018, the second consecutive year to show a slight drop-off and a sign that the state may have begun to get a handle on the devastating epidemic.
But the death toll remains staggeringly high, with nearly 2,000 lives lost in 2018 — more than double the number just five years earlier, according to data released Wednesday.
“We still have far to go,” said Dr. Tracey Cohen, chief clinical officer for CleanSlate Outpatient Addiction Medicine, a national chain with 15 offices in Massachusetts. “Thank goodness it’s not worse. But a decrease of 4 percent means we have a lot more work to do.”
The decrease was attributed to a variety of factors, including improved access to treatment and widespread use of the overdose-reversing drug naloxone, or Narcan.
The Department of Public Health’s quarterly opioid report is the first to provide counts for all of 2018. Revised figures for 2017 show that opioid-related overdose deaths declined by 2 percent compared with 2016.
Nationwide, preliminary figures suggest a 1.3 percent decrease in opioid-related deaths in the first half of the year.
The two-year decline in Massachusetts deaths sparks optimism, “but we know that this is going to really take a sustained attention for years to come,” said Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center.
Botticelli said the state is not only preventing deaths but also ameliorating addiction itself.
Massachusetts is reaping the benefits of near-universal health insurance, which allows access to treatment, as well as state efforts to expand treatment programs and distribute naloxone, he said.
In particular, Botticelli said, people today have better access to the medications that treat opioid use disorder and also prevent overdoses — buprenorphine, methadone, and Vivitrol.
In a statement, Governor Charlie Baker said he was “encouraged” by the news but added that “the opioid epidemic continues to present a very serious challenge that is made more difficult due to the presence of fentanyl.”
Illicit synthetic fentanyl (not the drug prescribed by physicians) was found in toxicology tests of 89 percent of those fatal overdose victims screened, indicating that the powerful drug remains pervasive. Heroin was found in about 34 percent of those tests, continuing a two-year decline. Only 15 percent of the victims had taken prescription opioids.
The data also suggest that fentanyl is getting mixed with cocaine and methamphetamine, putting people who use those drugs at risk as well.
In 2018, preliminary estimates showed 1,974 confirmed and estimated opioid-related overdose deaths or 82 fewer than in 2017. There were 2,099 confirmed deaths in 2016. Three-quarters of those who died in 2018 were men, and 58 percent were between the ages of 25 and 44.
Despite the overall decline, for black males the opioid-related overdose death rate increased 45 percent from 2016 to 2017. More recent data broken down by race were not available, but state officials said they have taken several measures to address opioid addiction in minority communities.
Dr. Monica Bharel, Massachusetts public health commissioner — who has long resisted declaring victory based on the mortality data —
on Tuesday said: “It is quite possible that we’ve reached the point that we can acknowledge that yes, we’re making some progress.”
Bharel said there’s no single factor driving the decline in deaths; she attributed it to the combined force of prevention, education, treatment, and access to naloxone.
“The way that we’re looking at this disease is profoundly different
,” she added. “We’ve taken addiction out of the shadows, and we’ve kept the spotlight on this medical disease.”
Daniel S. Mumbauer, chief executive of the High Point treatment centers, agreed. He said that until recently, people with addiction and those who served them were ignored or scorned by the health care system and law enforcement. Today, he said, police officers visit overdose survivors and help them find treatment.
“Now they’re one of our stronger partners,” he said. “It’s a remarkable change in the way folks are looking at the issue and the population with an addiction problem.”
Going forward, Mumbauer said, more work needs to be done to make medication-assisted treatment more widely available through doctor’s offices. Also, people recovering from addiction have a great need for safe, stable housing.
Cohen, the CleanSlate executive, said that Massachusetts “is a national leader in some aspects,” such as removing insurance barriers to addiction treatment. But she faulted state officials for failing to take “clear, crisp action” to enforce a new law requiring hospital emergency departments to provide antiaddiction medication to overdose survivors or else connect them directly with treatment.
“It’s still not catching on the way it needs to,” Cohen said. “We need to really push to make sure this becomes more than a good idea.”
Massachusetts has also overemphasized inpatient treatment, adding detox beds, when addiction is a chronic illness that requires ongoing care in the community, Cohen said.
Cohen, who sees patients in New Bedford, said stigma remains an issue for many of her patients, who are uncomfortable telling their family doctors or obstetricians that they’re taking medication to treat addiction or face pressure from family members to stop the medication.
Dr. Matilde Castiel, Worcester’s commissioner of health and human services, said the city’s data from 911 calls show an increase in reported overdoses overall, and little change in fatal ones, from 2017 to 2018. Although such a tally is not comprehensive, it indicates that the opioid problem persists in Worcester.
Castiel said she was heartened by several antiaddiction projects in her city that didn’t exist even two years ago, including a 24-hour urgent care center that links walk-in patients with treatment; a recovery coach who works to coax homeless people and others into treatment; and a school task force seeking to address the childhood trauma that often leads to addiction.
But then she pointed to the work that remains: getting more doctors to understand and treat addiction; improving mental health services, especially for young people; taking better care of addicted inmates; and keeping people safe from illness and death when they continue to use drugs.
“Things are getting better,” Castiel said. She added, “We have a long ways to go.”
Also on Tuesday, the American Medical Association announced that it had awarded Baker the Dr. Nathan Davis Award for Outstanding Government Service for his work addressing the opioid crisis. The association’s board chair, Dr. Jack Resneck Jr., called Baker “one of the most innovative, forward-thinking, results-oriented leaders in confronting this challenge.”
For more information, visit www.mass.gov/opioidresponse.
To get help for a substance use disorder, visit www.helplinema.org or call the Massachusetts Substance Use Helpline at (800) 327-5050.