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Opioid fatalities decline but challenges lie ahead

Eagle-Tribune - 9/4/2017

Sept. 04--BOSTON -- For the first time in years, opioid-related overdose deaths are declining in Massachusetts, according to newly released state data. But public health officials and substance abuse counselors are warning the state isn't out of the woods yet.

Department of Public Health officials say the number of opioid-related deaths fell about 5 percent in the first six months of 2017 compared to the same period last year.

There were an estimated 978 confirmed deaths in the first half of 2017, compared to 1,031 estimated and confirmed deaths during the first half of 2016, according to state data.

But the data, released in quarterly report, lays bare the extent of the deadly opioid crisis.

In 2016, there were 2,107 suspected fatal overdoses, the highest level ever and at least three times the number reported in 2013.

Meanwhile, deaths from the powerful synthetic drug fentanyl continue to increase, even as the presence of heroin in opioid-related fatalities has declined.

Gov. Charlie Baker, who has spent much of his first term wrestling with the opioid crisis, said the decline in fatalities is "positive" but warned that more work lies ahead.

"Progress in this arena is going to be long and hard-fought," Baker said at an event in Boston this week. "There are still far too many people who are dealing with addiction issues, far too many people overdosing and far too many families and individuals dealing with the fact that they have lost someone they love and care about to this terrible disease."

Last year, Baker signed what his administration called the most comprehensive law in the nation to fight opioid addiction, including a seven-day limit on first-time prescriptions for opiate painkillers. Baker has also increased state spending on addiction prevention and treatment by 50 percent since he took office in 2015, according to budget figures.

Substance abuse treatment experts credit the state's full-throttled response -- and the widespread availability of the overdose reversing drug naloxone among first responders and laypeople -- with helping to alter the upward trajectory of opioid-related fatalities.

Naloxone, which is known by the brand name nasal spray Narcan, reverses the effects of an opioid overdose. As America's opioid epidemic has exploded in recent decades, it has become a frontline defense tool for individuals with little or no medical training.

The drug is made available to the public as an injectable product or a nasal spray sold by pharmacies. In addition to police and firefighters, school districts, community centers, health clinics and hospital emergency rooms have also stocked up on the medicine.

"Narcan is much less stigmatized," said Mark Kennard, director of community services at Lynnfield-based Bridgewell, which provides substance abuse treatment services. "It's become widely accepted by the public as the number one antidote for saving lives."

Still, patients who've overdosed on substances laced with fentanyl often require multiple doses and have less chance of survival, he said, because of the drug's higher potency.

"Death can come quick with fentanyl," Kennard said. "It's such a dangerous product."

A bulk-buying program was created by lawmakers two years ago makes the purchases then sells the naloxone to communities at a cost lower than they would otherwise get.

The state program charges local first-responders $20 per dose. Local governments, schools and others pay the price negotiated by the state, now about $35 a dose.

Naloxone doses bought commercially run between $75 and $100. Auto-injectors made for laypeople can run upward of $4,000 a dose without insurance coverage.

Kennard said the expansion of medication-assisted treatments such as methadone and buprenorphine, known by the brand name Suboxone, is also saving more lives.

But myriad challenges remain, Kennard said, from expanding the number of beds in long-term recovery centers and reducing barriers for medication-based treatment to improving how addicted individuals are treated by the larger medical community.

"We're not out of the woods yet, by any means," he said. "We've a long way to go."

While deaths are declining, it's not clear from the newly released data whether fewer people are overdosing.

A separate report on opioid abuse, released by the Baker administration two weeks ago, found non-fatal overdoses in Massachusetts soared by nearly 200 percent from 2011 to 2015, with the total number of non-fatal overdoses during that period exceeding 65,000.

John Rosenthal, co-founder and chairman of the Police Assisted Addiction and Recovery Initiative, said despite the ongoing challenges he is encouraged by the decline in overdose fatalities and attributes it largely to the increased use of naloxone among first-responders.

His group, founded by former Gloucester police Chief Leonard Campanello, has collected tens of thousands of donated doses of naloxone and distributed them to police and fire departments.

"If it weren't for this life-saving medicine being in the hands of first-responders and family members," he said," I have no doubt the death toll would be even more staggering."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group's newspapers and websites. Email him at cwade@cnhi.com

READER BOX

Highlights of latest Massachusetts opioid data

* Heroin and prescription painkillers are declining in opioid-related deaths.

* Fentanyl was present in 81 percent of overdose deaths in the first quarter of 2017, up from only 19 percent in the third quarter of 2014.

* In the second quarter of 2017, prescriptions for opioid painkillers fell nearly 28 percent from the first quarter of 2015.

* While 82 percent of opioid-related fatalities were among white residents, the death rate among Hispanics increased significantly between 2015 and 2016.

* Nearly one-third of people who overdosed in the first quarter of 2017 required more than one dose of naloxone.

Source: Massachusetts Department of Public Health, quarterly report, August 2017

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(c)2017 The Eagle-Tribune (North Andover, Mass.)

Visit The Eagle-Tribune (North Andover, Mass.) at www.eagletribune.com

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