Opioid Addiction Is a National Crisis and Its T wice as Bad in - - PowerPoint PPT Presentation

Opioid Addiction Is a National Crisis… and It’s T wice as Bad in Massachusetts.

Luc Schuster Director, Boston Indicators March 6, 2019

8,407 47,600

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Opioid-related deaths in the US have quintupled since 2000.

Opioid-related deaths. United States.

Putting the scale of the opioid crisis in context:

• There were more opioid-related deaths in 2017 than deaths

from car crashes.

• Driven by the opioid epidemic, American deaths from drug
• verdoses in 2017 were greater than American deaths from the

entire Vietnam war.

• There were roughly the same number of opioid-related deaths

in 2017 as HIV/AIDS deaths in 1995, the height of the epidemic.

4.8 28.2 3 14.9

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Massachusetts’s opioid-related death rate is roughly 2x the US average.

Age-adjusted opioid-related death rate (per 100,000).

Massachusetts United States

379 506 526 614 514 575 660 642 622 638 560 656 742 961 1,362 1,704 2,099 1,945 1,617 2,056 1,974

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Estimated Deaths Confirmed Deaths

While we made some very modest progress over the last 2 years,

• pioid-related deaths remain extremely high in Massachusetts.

Opioid-related deaths. Massachusetts residents.

Source: Massachusetts Department of Public Health, November 2018 update.

U.S. (all races), 14.9 MA Hispanic, 29 MA Black, 20 MA White, 31.9 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

90% 83% 89% 89% 10% 17% 11% 11%

White Black or African-American Hispanic Total

All other drug- related deaths Opioid-related deaths

The vast majority of drug deaths in Massachusetts are opioid-related, regardless of race or ethnicity.

Share of drug overdose deaths related to opioids. Massachusetts. 2016.

5 10 15 20 25 30 35 2010 2011 2012 2013 2014 2015 2016 2017

Our state’s opioid crisis spiked...

Age-adjusted opioid-related death rate (per 100,000). Massachusetts. 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% 10.0% 2010 2011 2012 2013 2014 2015 2016 2017 2018

…even as our economy improved.

Unemployment rate, seasonally adjusted. BLS. Massachusetts.

121.0 47.1

AL AR TN MS LA OK KY WV SC MI IN NC NV MO DE GA ID KS OR OH WY UT AZ MT PA ME FL NM WA NH IA VA NE WI RI CO AK MD VT TX IL CT SD NJ ND MA MN CA NY HI DC

Massachusetts prescribes lots of opioids, but less than most states.

Opioid prescriptions per 100 people. 2016.

Fentanyl and other synthetic opioids, 1,649 Heroin, 466 Opioid painkillers, 254 500 1,000 1,500 2,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Fentanyl is now the number one cause of opioid-related deaths in Massachusetts.

Number of deaths by opioid type.

14.9 27.7 29.9 28.2 34 26.9 20 US CT ME MA NH RI VT

Opioid-related death rate

Age adjusted death rate (per 100,000 people). New England states. 2017

Rank State Fentanyl-related death rate per 100k (age-adjusted), 2016 1 New Hampshire 30.3 2 West Virginia 26.3 3 Massachusetts 23.5 4 Ohio 21.1 5 D.C. 19.2 6 Maryland 17.8 7 Rhode Island 17.8 8 Maine 17.3 9 Connecticut 14.8 10 Kentucky 11.5 11 Pennsylvania 10.9 12 Vermont 10.1 13 Michigan 9.8 14 Delaware 8.7 15 Florida 8.3

There’s likely a regional effect at play, with New England states having high opioid-related death rates.

Fentanyl-related death rate

Major drug trafficking routes run through New England.

www.bostonindicators.org

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Purpose of this report

• Provide a comprehensive picture of the size and

scope of the epidemic in Massachusetts

• Motivate greater involvement in this crisis among

business leaders

• Demonstrate methodology and data sources for

future studies here and in other states

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The opioid epidemic is far from over and it will probably get worse

U.S. Deaths from Other Synthetic Opioids – Principally Fentanyl

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Massachusetts at the epicenter of the epidemic – opioid-related deaths per 100,000 population

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Another metric: incidences of Neonatal Abstinence Syndrome per 1,000 Births

5 17.0 7.7 2 4 6 8 10 12 14 16 18 20

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

MA 28 State Average

People in the workforce: absenteeism, presenteeism, and excess health care costs businesses ~ $4.8 billion

6 Studies Excess Health Care Costs / Employee Birnbaum et al, 2006 13,363 Councial of Economic Advisors 15,474 FairHealth, 2016 15,898 Florence et al, 2016 16,257 Kirson et al, 2016 14,810 Rice et al, 2014a 10,627 Rice et al, 2014b 11,376 White et al, 2005 14,054 White et al, 2011 20,546 Average 14,712 143,000 (2,103,768,333)

People out of the workforce: the U.S. labor force participation rate is demonstrably lower than

• ther countries in the developed world

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Since 2011, MA has averaged 33,700 people unable to work due to opioid misuse

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• 5,000

5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Massachusetts economic impact from lost productivity and foregone income

9

Breadth of the crisis: sizable impacts on the economy, business, health care providers, the state and municipalities

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Conclusion: It is time to talk

• MTF hopes this report catalyzes greater urgency and

engagement from all segments of our society in the battle against the scourge of this epidemic – particularly among Massachusetts employers

• For the future of our Commonwealth and the sake
• ur children, we must ALL fully engage in the

struggle to curtail this crisis. It is a fight for their lives – and the fight of our lives.

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CareZONE Program

Elsie M. Taveras, MD, MPH Executive Director, Kraft Center at MassGeneral Hospital Professor, Harvard Medical School

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2016 Boston Area Narcotic Related Incidents:

• Nearly every Boston neighborhood affected

by the opioid epidemic.

• Fentanyl present in the majority of deaths.
• A significant number of OUD victims were

homeless.

• Increasing availability of office-based

addiction treatment (OBAT) programs but:



Few buprenorphine-waivered clinicians & OBAT programs in community-based health centers;



Few OBAT programs offering the full range of harm reduction services. Substantial need for access to low-threshold treatment & harm reduction services for the most marginalized populations

Downtown Roxbury South End South Boston Dorchester

South Station Chinatown Court St / DT Crossing MGH

• N. Station

Copley Dudley BMC Andrew Square

Assessing a Public Health Crisis

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Discussion Document - Not for Public Release

CareZONE uses data driven hotspotting to bring low- threshold, on-demand addiction care & harm reduction services to populations at highest risk of near-term death.

Clinical Partners

Community Health Centers

Mobility

Customized Medical Vans

Harm Reduction Partners

Needle Exchange Programs, Nonprofits

Hotspotting

Target areas with largest number of opioid

• verdose deaths

The CareZONE Model

• Currently staff 4 sessions/week;
• Van parked in same spot each week; team

disperse by foot to engage potential patients

• Offer new syringes, collect used syringes,

and distribute naloxone

• Interested patients brought back to the

van to meet clinicians

• Can receive primary care or MAT
• Outreach workers walk patients to nearby

pharmacy to fill MAT prescription immediately

• Facilitate access to OBAT program; weekly

follow up on van until warm handoff made

Weekly Clinical Sites

Downtown –West End on Haverhill Street and the other in Downtown Crossing on Chauncy Street. Roxbury – The van holds clinics in Dudley Square. Fenway – The van holds clinics in The Fens.

A Day on the Van

*Note: AHOPE, the mobile health program’s harm reduction team from the Boston Public Health Commission, on average takes 112 syringes

• ff the street for every 100 syringes distributed, meaning their syringe exchange program results in fewer needles in circulation

Proof of Concept Results, January-October 2018