Massachusetts Sees Encouraging Decline in Overdose Deaths

April 05, 2018|10:25 a.m.| ASTHO Staff

Monica Bharel, MD, MPHOpioid-related overdose deaths in Massachusetts declined in 2017 by an estimated 8.3 percent compared to 2016. This is encouraging news, since it’s the first time in several years that Massachusetts has seen a year over year decline in overdose deaths. ASTHO spoke with Monica Bharel, MD, MPH, commissioner of the Massachusetts Department of Public Health, about how the state is reducing overdose deaths in underserved populations, training medical students on preventing and managing substance use disorders, and navigating the continuing challenges associated with this epidemic.

For the first time in seven years, the opioid-related overdose death rate is decreasing in Massachusetts. You’ve said it’s important to stay ahead of the epidemic. As state health commissioner, how do you plan to do that and motivate others to remain vigilant?

I am hopeful and encouraged that for the first time since the start of the current opioid epidemic we saw a decrease in the number of opioid deaths in 2017. Our administration views the opioid epidemic as a top public health priority and we are addressing the problem through a public health lens, with a focus on prevention, education, treatment, and recovery. We have worked with communities through schools and with other agencies to raise awareness, increase prevention through education, and eliminate the stigma of this disease. We have worked to bring naloxone access to more communities across Massachusetts through our family and friends programs, through first responders, and through prescribers and pharmacists. We have increased the number of treatment beds in our system and increased access to medications to treat opioid use disorder.

These interventions have been driven by our public health approach, which involves synthesizing data collected across multiple state agencies to help us better understand this epidemic and target resources more effectively. However, there is still much work to do. It took us a long time to get to this stage of the epidemic and it will take our persistent focus and commitment to improve the treatment and recovery options for those who suffer from this devastating disease. We are committed to this. 

Massachusetts has focused its efforts on those disproportionally impacted by the opioid epidemic, such as incarcerated individuals and Latino communities. How have various public health strategies been tailored to serve the needs of these distinct populations?

Our data analysis has enhanced our ability to understand who is at greatest risk of an opioid overdose death in Massachusetts. Unfortunately, for those with a history of incarceration, risk of overdose death is 120 times higher. This finding has opened up new opportunities for us in public health to talk with our colleagues in criminal justice in new and important ways. It has also led to concrete program and policy changes. For example, we recently awarded grants to six houses of corrections to begin making available medication-assisted treatment and recovery services to incarcerated individuals with an opioid use disorder before their release and to connect them to community services upon discharge, thus increasing the likelihood of successful treatment and recovery.

Unfortunately, we also found that among the Latino population, between 2014 and 2016, there was a 100 percent increase in overdose deaths. We are partnering with local communities to improve awareness of the disease among Latinos and have launched a new public awareness campaign in both English and Spanish called Stop Addiction Before It Starts to help parents understand how to talk with their children about opioids.

What changes or shifts in thinking have occurred since establishing cross-institutional core competencies for medical students a few years ago? Do you believe medical students are now better equipped to prevent and manage substance misuse?

Last fall, we had a follow-up meeting with all four medical school deans in Massachusetts and it was remarkable how much progress they have made in such a short time. Now all four medical schools cover the 10 core competencies before graduation, giving students the tools they need to balance pain management with potential for opioid misuse. The best evidence for this comes from medical students, who say they can see a difference in what they are learning and believe it is a change that will aid them in future work. 

What targets or outcomes do you hope to see in the next quarterly data report on opioids?

There are still too many people dying from this devastating and preventable disease. Our goal remains the same: bend the death curve of this epidemic and engage more individuals in treatment and recovery services. This includes Massachusetts’s response to the opioid epidemic, the Stop Addiction Before it Starts campaign, as well as the core competencies.