More data needed in the fight against Island substance abuse

Rural Scholars seek clearer data to better manage an increasing problem.

The chart shows that the majority of substance use disorder related deaths are caused by alcohol and opioids. — UMASS Medical School

According to a 10-day study conducted by medical students in the Rural Scholars program from the University of Massachusetts (UMass), there’s still more work to be done in combating substance abuse and addiction on the Vineyard.

The scholars found that there were approximately 1,450 people dealing with substance use disorder (SUD) on the Island, and that an average of one person under age 30 is dying each month because of SUD.

Rural Scholars is an educational program cofounded by Suzanne Cashman, and is part of a UMass population health study for medical students and students from the Graduate School of Nursing.

The program has aligned with the Dukes County Health Council, an organization of healthcare providers and community members who have accumulated information to try to better serve the Island population regarding health care. The Rural Scholars committee is part of the health council.

Dr. Daniel Pesch serves on the Dukes County Health Council, and is the chair of the Rural Scholars committee. He is an obstetrics and gynecology physician at Martha’s Vineyard Hospital. Dr. Pesch said the Rural Scholars committee serves as a liaison between the students and the community, soliciting projects that address various needs on the Island.

Dr. Pesch said the Rural Scholars project had the goal of trying to quantify the problem of addiction and substance abuse on the Island — something that even as the community struggles to get a grasp on it, continues to be incredibly complex.

“When I became chair of the Rural Scholars committee and we took this on, I thought I had a pretty good idea of what addiction services looked like on the Island,” Dr. Pesch said. “By the end of that day, I can tell you my knowledge base was not what I thought it was.”

In the past five years, hospital admissions related to SUD have doubled, he said. “We have seen a steady increase through our ER admissions of the people that are affected by substance use disorder,” Dr. Pesch said. “It’s gone up from 5 percent to 10 percent of admissions over 2010 to 2015.”

Eighty percent of the admissions are alcohol-related, and 20 percent are what the hospital deems as “other,” and likely drug-related.

In addition to substance and addiction issues, Rural Scholars have investigated tick-borne illnesses, Youth Task Force initiatives, and dementia on the Island.

But the need for data on substance and addiction issues on the Island is clear — Rural Scholars have investigated SUD in 2007, 2008, 2011, and again this year.

In a 10-day period, students interviewed law enforcement, healthcare providers, and people in recovery. They also visited various programs and services put in place to deal with SUD. Students collected data from the six police departments, from Martha’s Vineyard Hospital, from death certificates, from Martha’s Vineyard emergency medical services (EMS), and from the Dukes County Jail.

Rural Scholars data found there were 19 Narcan administrations by EMS from Jan. 1 to May 31 of this year. Narcan is a medication that blocks the effects of opiates, and is used on people who are overdosing. The statistics showed that there were 14 males and three females who were given Narcan. There were also two administrations unrelated to SUD. The average age for males who got the medication was 38, while it was 39 for women.

From hand-collected death certificate data, 46 deaths were found to be related specifically to SUD between 2010 and 2015: 33 males and 13 females. Of the 46 deaths, 28 were related to alcohol, 14 to opioids, and four to “other.”

There’s a great deal of ambiguity in interpretation of the data, because of how it’s collected and the different parties involved, be it healthcare providers or police officers. Other discrepancies in data collection were that there were potential overlaps that couldn’t be determined. For example, Narcan numbers could be skewed because one person might have received multiple administrations. ER admissions could also be misleading because of duplicate admissions, where an individual could be admitted 15 times, Dr. Pesch said.

“We always say that getting the denominator for this is a really hard thing,” he said. “Every community deals with it.”

Other goals of the project were to look at the experience of patients, participants, and family members in accessing care, find the shortcomings, and make recommendations to move forward.

Although there are a lot of services on the Island, trying to align all of the different services proved difficult: “We have a lot of services on the Island, but we don’t have a great way to interconnect them,” Dr. Pesch said.

Addiction on the Island is a big problem, and a daunting task to come to grips with. It’s estimated that there are 130 admissions to the hospital a year from SUD.

The students in the Rural Scholars program provided a map for the community as to what work still needs to be done, and where we should go from here.

Is it a problem that can be fixed? Dr. Pesch believes that communities are always going to have SUD as an issue, but that it will come down to how we, as a community, manage it.