DEATHS FROM OPIOID OVERDOSES increased in Massachusetts during the pandemic, after three years of a steady decline.
The rise in deaths is an alarming sign and one that experts say is likely indicative of the harmful impacts the pandemic is having on people with substance use disorder.
“The way we looked at it is we had an epidemic within a pandemic,” said Julie Burns, president & CEO of RIZE Massachusetts, a nonprofit working to address the opioid epidemic through research and funding.
According to data released by the Department of Public Health on Wednesday, there were 2,104 confirmed and estimated opioid overdose deaths in 2020, the highest number ever recorded in Massachusetts. The previous peak was 2,102 deaths in 2016.
Since 2016, an enormous state effort at addressing opioid addiction had led to decreases in overdose deaths in each of the last three years, with the number of opioid overdose deaths hovering around 2,000 annually. The 2020 figure represents an increase of 102 deaths, or 5 percent, over 2019.
The rate of opioid overdose deaths skyrocketed in particular among black men, from 32.6 to 55.1 per 100,000 people. Hispanic men continue to have the highest rates of opioid-related deaths at 57.9 per 100,000 people.
Gov. Charlie Baker said in a statement that the opioid epidemic and the COVID-19 pandemic “have underscored the importance of supporting disproportionately impacted communities.” “We remain focused on fighting the opioid epidemic even as we continue to battle COVID, and are committed to funding new and innovative programs to support our residents,” Baker said.
There were some communities, particularly in Gateway Cities, that saw the number of deaths decline, including Lawrence, Lowell, Lynn, and New Bedford. Boston, however, saw a large increase in deaths, from 258 in 2019 to 311 in 2020. The next most populous cities – Worcester and Springfield – also saw increases. Several Western Massachusetts communities had more deaths this year than last year, including Agawam, Holyoke, Chicopee, and North Adams. There were also increases in Fall River, Haverhill, Malden, Marlborough, Salem, Saugus, and Stoughton.
Caitlin McLaughlin, a spokesperson for the Boston Public Health Commission, called the report “troubling.” “It reinforces the evolving nature of the opioid epidemic and the need to double down on equitable efforts to support our most vulnerable neighbors,” she said in a statement, noting that just as with the pandemic, substance use disorder disproportionally impacted communities of color.
McLaughlin said during the pandemic, city residents who were already struggling with substance use disorder, mental health issues, and homelessness were hurt by the increased social isolation. The drug supply has become more unpredictable and lethal. While city-run services remained operational, and city officials have been responding to calls and placing people in treatment facilities, there was a reduction in access to treatment as many daytime services closed and shelters, court services, and public safety interventions all became more limited. Meanwhile, more people were released from jails.
Massachusetts’ increase in deaths comes amid a national rise in overdose deaths. According to CDC data, Massachusetts actually has among the lowest increases in the country. Between September 2019 and September 2020, opioid-related deaths nationally surged by 29 percent.
State officials have been working to address the issue. Since the pandemic started, the Department of Public Health distributed 110,000 kits containing the anti-overdose drug naloxone to opioid treatment programs, community health centers, hospitals, and jails. It has created designated treatment units for COVID-positive individuals who need treatment for substance use disorder.
While methadone, a medication used to treat addiction, is usually administered in a clinic, the federal government authorized take-home medication for certain individuals during the pandemic. Under this exception, 49 percent of Massachusetts opioid treatment program patients have been receiving take-home doses of medication as of December 2020, compared to 16 percent in December 2019.
The state has used federal grants to run drug prevention programs in schools. Another grant is being used for a pilot program to provide recovery-based services to black and Latino men who have a history of substance abuse when they are released from jail.
But experts say the increase in deaths in Massachusetts is a worrying indicator that the pandemic has worsened an already dire epidemic.
Lydia Conley, president and CEO of Association for Behavioral Healthcare, which represents community-based providers, called the numbers “really discouraging and demoralizing.”
Burns noted that isolation is one of the greatest drivers of addiction. “With COVID, there was just an unprecedented, unmanageable degree of isolation,” she said. She added that people using drugs alone are at increased danger for a fatal overdose compared to people using drugs in a group or in a place where someone will check on them.
Conley and Burns both said the pandemic contributed to a massive disruption in addiction treatment services. Group therapy and meetings were cancelled. Individual counseling was delivered via video or telephone. Some people, such as homeless individuals, may not have had access to the technology they needed to continue counseling.
Conley said the number of available inpatient beds for treatment, which includes residential recovery homes, dropped as facilities had to accommodate social distancing and quarantine requirements. Some people hesitated to seek treatment out of fear of virus exposure, and persistent staffing problems got worse with COVID.
Asked about the large increase in deaths among black men, Conley said it is clear that treatment providers need a new strategy for reaching that population. “We’re not engaging black men. What is there that can we be doing differently?” she said.
Burns said there needs to be a continued attempt to reduce the stigma of opioid use and put in place the support services people need to recover. “The immediate reaction often is to look away,” Burns said. “You see someone on a corner experiencing an overdose or using drugs or intoxicated, your gut reaction is to look away. We can’t look away from this problem. It’s too big, it’s too deep, it’s too entrenched.”