Opioid-related ER visits decline in Mass. — but not everywhere
The number of emergency department visits by people with opioid-related conditions dropped by nearly 6 percent in Massachusetts from 2016 to 2017, according to data providing another hint that the state may be getting some traction in its efforts to halt the opioid crisis.
But the findings, to be released Wednesday by the Health Policy Commission, a state agency that monitors health care spending, also show that Massachusetts still has a long way to go. In 2017, the state had by far the country’s highest rate — more than double the national average — of emergency department use by patients diagnosed with opioid-related disorders.
The improvement is not being enjoyed equally by all. Hospitals in Lowell and Haverhill saw increases in emergency visits related to opioids in 2017. And people who live in low-income areas constitute a large and growing proportion of those afflicted.
“For the first time this decade, Massachusetts is starting to make some progress in reducing the impact of the opioid epidemic,” said David Seltz, the commission’s executive director. “Not all populations are experiencing the moderation. Older adults, African-American males — the rates of use among those populations continue to increase.”
Drawing from a state database of hospital discharges up to 2017, the most recent available, the commission analyzed emergency department visits — and inpatient hospital stays — for people who have an “opioid-related diagnosis,” such as opioid dependence, misuse, or overdose. People who had such diagnoses often came to the hospital for other ailments, including mental health disorders, diseases of the skin, respiratory system and digestive system, or a host of other medical conditions the commission did not enumerate.
Nearly 68,000 opioid-related hospital visits occurred in 2017. Inpatient stays linked to opioids rose slightly even as emergency room visits dropped, for reasons that are unclear.
Combined, inpatient and emergency visits increased sharply from 2010 to 2016, and then fell 2.3 percent in 2017. This pattern tracks closely with the trend in opioid-related overdose deaths, which dropped 3 percent in 2017 after years of stunning increases.
Such progress owes to “the confluence of everything that we’re doing,” said Dr. Scott G. Weiner, an emergency physician at Brigham and Women’s Hospital and immediate past president of the Massachusetts College of Emergency Physicians.
He mentioned the widespread availability of the opioid-reversing drug naloxone, reduction in opioid prescribing, and hospital “bridge clinics” that provide immediate access to addiction treatment.
“Anecdotally, and also speaking with colleagues in Boston, we feel like we’re seeing a lot fewer overdoses. I really do think we’re starting to move the needle,” Weiner said.
Dr. Jeffrey Samet, chief of general internal medicine at Boston Medical Center, hypothesized that both the improvement and the disparities can be attributed to the availability of medications to treat opioid addiction — buprenorphine, methadone, and naltrexone.
“When you’re on medication it’s a pathway to stabilizing your life and not getting sick,” he said.
Overall, Samet said, the state has done a good job getting people access to the medication — but the access may vary depending on where one lives.
“Communities are affected by this to varying degrees and have made efforts to address it to varying degrees,” Samet said. And, he added, each community will have to find its own solutions.
The Health Policy Commission has made it easier for communities to identify their particular challenges by providing interactive maps with highly localized data.
Among the commission’s other findings:
■ Residents of the lowest income areas accounted for 40 percent of opioid-related hospital visits, and that rate leapt by 80 percent since 2012 among this population. In contrast, people who live the richest areas accounted for only 11 percent of such visits.
■ From 2012 to 2017, opioid-related emergency and inpatient hospital use declined among people under age 25 but increased substantially in all other age groups.
■ While whites have the highest rate of opioid-related hospital use, blacks have been steadily closing that gap.
■ The rate of babies born exposed to drugs in the uterus has followed a similar pattern as emergency department use, increasing markedly until 2016 and then dropping 6 percent in 2017. The hospitals with the highest rates of substance-exposed newborns were Tufts Medical Center, Cape Cod Hospital, Berkshire Medical Center in Pittsfield, and Southcoast Health’s Charlton Memorial Hospital in Fall River.
■ Looking at inpatient hospital stays, people with opioid-related diagnoses accounted for 4 percent overall. But certain hospitals saw much higher rates. At Cambridge Health Alliance’s Everett Hospital and MetroWest Medical Center’s Leonard Morse Hospital in Natick, the proportion of patients with opioid-related diagnoses was more than 10 percent and increased substantially in 2017.
■ Among emergency department visits, opioid-related problems accounted for 1.4 percent. But at Boston Medical Center and North Shore Medical Center Union Hospital, more than 3.5 percent of emergency visits involved people with opioid problems. And Holy Family Merrimack Valley Hospital in Haverhill and Lowell General Hospital Saints campus saw increases in opioid-related emergency visits in 2017.
Leigh Simons Youmans, director of behavioral health and health care policy for the Massachusetts Health & Hospital Association, said the commission’s new data bring into sharper relief trends that hospitals’ officials had suspected. “These numbers will help focus our work as we address the crisis,” she said.