Opiates are an insidious, shapeshifting foe, and the leading cause of accidental death in Massachusetts. More than 1,000 people died of opiate overdoses last year in the Bay State. As the supply of pharmaceutical painkillers has diminished with increased oversight, heroin, a cheaper, stronger and more plentiful alternative, has filled that void, and its rapid ascendance is sending more and more people to the hospital, and to their graves.
The Centers for Disease Control (CDC) released a study in October last year that examined opiate addiction in 28 states, including Massachusetts, and found that heroin deaths doubled between 2010 and 2012. The Northeast and South had much larger heroin-overdose death increases — 211.2 percent and 180.9 percent, respectively.
Massachusetts State Police estimate there were at least 220 fatal heroin overdoses in the first three months of 2015. By mid-May of this year, Plymouth averaged an overdose a day, and had had at least 10 overdose deaths.
On Martha’s Vineyard, people on the front lines have seen a definite spike in heroin overdoses and the number of overdose deaths.
“I’d say in the past month or so, I’ve seen a threefold increase in the amount of [overdose] presentations that we’re seeing in emergency services,” Dr. Jeffrey Zack, director of emergency services at Martha’s Vineyard Hospital, told The Times. “Most of the time it’s because people are cutting it with something.”
On June 8, after a weekend with multiple overdoses and one death in Provincetown, police issued a warning that tainted heroin was being distributed. Police also reminded people that Massachusetts has a Good Samaritan law, which says a person seeking medical help for someone having a drug-related overdose will not be charged or prosecuted for possession.
“Last year, on average, there was an overdose death here every other month,” Dr. Charles Silberstein, psychiatrist and board-certified addiction specialist at Martha’s Vineyard Hospital, told The Times. “Since the beginning of this year, we’ve averaged one death per month. That’s counting Islanders who go off-Island, where heroin is less expensive and more available. There’s no doubt in my mind that the state statistics are a gross underestimation of the number of overdose deaths. It’s hard to prove overdose as the cause of death, and it’s often not recorded that way.”
A study by the Barnstable County Regional Substance Abuse Council (RSAC), released three months ago, reported deaths from heroin and prescription opiates had more than doubled on Cape Cod since 2012. Seventy-four percent of people said they knew someone who abused prescription drugs. The study estimated that the direct cost of substance abuse in 2013 was $110,085,000.
A Boston Globe/Harvard School of Public Health survey released last month asked Massachusetts residents about their attitudes toward opiate addiction, and compared those results with national averages. The study found 71 percent of Massachusetts adults believe heroin use is an extreme or very serious problem, compared with 45 percent nationally.
Robert Blendon, professor of health policy at the Harvard School of Public Health, said he was “staggered” that 39 percent of Massachusetts adults reported knowing someone who has abused prescription drugs. He was also struck that only 36 percent of Bay State respondents said their doctor told them about the risks of taking opiates, less than half the national average of 61 percent. “For some reason in the Commonwealth, people who are taking painkillers do not have this conversation,” he said.
The Boston Globe/Harvard study also found that Massachusetts is also a progressive state when it comes to addiction treatment, stating, “Massachusetts residents are more aggressive than the rest of the country in pushing for tools to help addicts, both at the time of overdose and in treatment afterward…Massachusetts adults showed greater support for making naloxone, a drug that reverses opioid overdoses, available to the public, and a greater willingness to require insurers to cover treatment for drug addiction.”
Massachusetts adults, by 58 percent to 36 percent, also favored requiring insurers to cover drug treatment, even if it raises their premiums, the study said.
In February, newly elected Gov. Charlie Baker appointed a 16-member working group to hold public meetings, assess the resources devoted to the problem, and submit “specific, targeted, and tangible recommendations” by May. “Opioid addiction is a problem that has touched far too many people in the Commonwealth,” he said at the press conference. “We are taking aggressive action on this issue, and have made it a top priority to get people the resources and education they desperately need to prevent and treat this disease.”
This Tuesday, Governor Baker delayed the release of the report until next week, when Attorney General Maura Healey will be back in the state from an Attorneys General conference in California. During her campaign, Ms. Healey, now the state’s top law enforcement officer, advocated reforming the criminal justice system to focus on substance abuse and mental health treatment, and not incarceration. Last month, Ms. Healey called for cheaper access to the anti-overdose drug Narcan, also known as naloxone, which has gone up in price concurrently with its rapid rise in demand. Narcan can reverse the effects of potentially fatal opioid overdoses, and has become de rigueur for many EMS crews.
Massachusetts Public Health Commissioner Dr. Monica Bharel, responding to the Boston Globe/Harvard School of Public Health study, said state government needs to do a better job informing people about treatment successes. She also said that health officials must help combat the stigma of addiction so that more users, and their families, will seek help.New tactics
Beginning this month, Gloucester Police Chief Leonard Campanello initiated a groundbreaking approach to battling the opiate scourge — the Police Assisted Addiction and Recovery Initiative (P.A.A.R.I.). “Addicts who ask the police department for help are be immediately taken to a hospital and placed in a recovery program. No arrest. No jail,” the Gloucester Police Department Facebook page states. The program is also known as the “Angel Program,” because police arrange for an “angel,” a volunteer with experience in recovery, to help guide the addict, and his or her family, through the first steps of recovery.
The program had its skeptics, especially after no one showed up at the police station on the first day, June 1. But this Tuesday, a post on the Gloucester Police Facebook page read, “We’ve done it 17 times in 15 days, and we are batting 17 for 17!”
The Boston Globe/Harvard survey showed that while most Massachusetts adults favor expanded coverage, only 33 percent believe that long-term treatment works.
“The tragedy [of that perception] is that people do get better,” Dr. Silberstein said. “When they get treatment, many become healthy members of society who lead productive lives.”
Although the relapse rate for opiate addicts is about 90 percent, according to the National Institute of Health, Dr. Silberstein said treatment programs that incorporate Suboxone significantly reverse that trend. Suboxone—buprenorphine—is a drug that blocks opiate receptors, making it nearly impossible for the recovering addict to get high. “The national average for staying sober on Suboxone is about 60 percent. But my experience is much higher here,” he said.
Suboxone is opiate-based, and therefore controversial in some circles.
“People report minimal or no craving with Suboxone,” Dr. Silberstein said. “Sometimes they taper off completely, and lead sober lives. Once they’re stabilized, the success rate is higher. I’ve never had anyone on Suboxone overdose.”
There are two doctors on the Vineyard who can prescribe Suboxone, Dr. Silberstein and Dr. David Gorenberg. Dr. Silberstein said that his practice accepts Harvard Pilgrim, Medicare, some private insurances, and some Blue Cross and Blue Shield policies. For those without accepted health insurance, an initial consult with Dr. Silberstein is $350. Follow-up sessions are $100. Patients must be active in their recovery, and submit to urine screens. Dr.Silberstein’s group therapy is free.
“Most [insurance plans] cover the cost of urine screens and other lab work. It’s much less expensive than maintaining a habit,” he said. “Suboxone is easier to access here than many other places, and it’s affordable to most people. All health insurance plans, including MassHealth, cover it.”
Dr. Gorenberg could not be reached for comment.
Dr. Silberstein stressed that Suboxone is only prescribed after the addict undergoes a thorough psychiatric evaluation and is active in his or her recovery. “It has to accompany other tools, like 12-step meetings, group therapy, social support, often psychotherapy,” he said. “We’re fortunate here on Martha’s Vineyard; we have some great options. New Paths is a fabulous intensive outpatient program.”