Opioid overdose deaths are down in Massachusetts. The latest quarterly data from the Baker administration show 4 percent fewer fatalities in 2018 as compared to 2017. That's 82 fewer men and women who could not be revived after an overdose, according to preliminary estimates.
"The decrease in overdose deaths provides some hope that our approach to combating the opioid epidemic is having an impact," Health and Human Services Secretary Marylou Sudders said in a statement. "We must maintain an intense focus on this crisis and continue to expand opportunities to increase harm reduction initiatives and expand treatment and recovery services."
While the number of deaths dropped in 2018, overdose-related 911 calls increased. There were 821 more such calls in the third quarter of 2018 as compared to the first. That 18 percent increase may be an underestimate, the state says, because it doesn't include reports from all ambulance services.
So it looks like more people are overdosing but fewer are dying. Why might that be the case?
Public health experts who've weighed in on the state of the epidemic in Massachusetts say the reasons are complex. But they say increased access to naloxone, common brand name Narcan, is certainly making a difference.
Take the experience of Dr. Kavita Babu, the chief opioid officer at UMass Memorial in Worcester. Babu says UMass may be seeing the same or fewer overdoses in the emergency department, but that doesn't mean there are fewer overdoses in the Worcester community.
"There is more bystander naloxone," which Babu says is great, but also raises concerns. "Unfortunately, we'll have cases where patients are reversed after their overdose and they decline EMS transport, or they've left the scene before the EMS crew arrives. That's a missed opportunity."
Doctors in the UMass Memorial emergency room can begin treatment for an opioid addiction with a prescription for buprenorphine, often more commonly known by the brand name version Suboxone. This spring, the hospital plans to open a bridge clinic where patients can receive follow-up treatment immediately after an overdose.
Traci Green, an epidemiologist at Boston Medical Center, says the increase in 911 calls suggests that people who use drugs realize that fentanyl, which was present in 89 percent of deaths in 2018, can kill someone within minutes. She's encouraged by the rise in EMS calls and the decrease in deaths. But Green says a 4 percent drop is not good enough.
"We have not fully explored the many things we could be doing on harm reduction, on treatment and treatment access, and we don't yet completely understand how to reach some of the people at greatest risk," Green said.
She says Massachusetts and other states must consider other options, like supervised consumption spaces, flooding the drug user community with naloxone, mobile syringe exchange and treatment vans, and treatment in community health centers. A state commission considering ways to increase harm reduction services is expected to issue its report in March.
The state data point to the people in greatest need for additional services. Seventy-three percent of those who die after an overdose are men, with the highest concentration in 25- to 34-year-olds. Death rates are still climbing among blacks even though they are down, modestly, overall. And deaths involving cocaine and amphetamines are on the rise while those involving prescription opioids dipped toward the end of 2018.
The data show a 35 percent decrease in opioid prescriptions since 2015, which state leaders say may help slow the epidemic. But a recent study forecasts little impact on overdose deaths.
The Baker administration stands out among states in this tracking of the opioid epidemic. Gov. Charlie Baker's proposed budget includes $266 million for substance use treatment. The governor is also asking the state Legislature for $5 million to help fund a regional effort to stop the flow of fentanyl into Massachusetts and nearby states.