DPH head urges Islanders to rethink addiction assumptions

On Martha’s Vineyard, Department of Public Health commissioner Monica Bharel said addiction must be treated as a medical disease.

Dr. Monica Bharel, commissioner of the Massachusetts Department of Public Health. – Stacey Rupolo

“If you remember anything from tonight, I hope it is that you see substance abuse disorder as a medical disease that deserves prevention, intervention, and treatment, just like diabetes, just like heart disease,” Dr. Monica Bharel, Massachusetts Department of Public Health (DPH) commissioner, told a Vineyard gathering last Wednesday night. “Until we get over that stigma as a society, it will be very difficult to bring down our opiate overdose death toll.”

Dr. Bharel delivered that message to more than 100 Vineyarders at a forum titled “De-Stigmatizing Substance Use Disorder,” held in the Martha’s Vineyard Regional High School Performing Arts Center Wednesday. It was the last event of a whirlwind Island day for Dr. Bharel, organized by the Martha’s Vineyard Substance Use Disorder Coalition (MVSUDC).

Dr. Bharel described “State Without StigMA,” a public outreach campaign, under the auspices of the DPH, aimed at reducing the barriers standing in the way of people getting proper addiction treatment because of the stigma often attached to substance use disorder (SUD).

.Data-driven approach

As DPH commissioner, Dr. Bharel is also in charge of the state’s response to the opioid crisis, which Gov. Charlie Baker said is his No. 1 health priority.

Chapter 55 of the Acts of 2015, passed by the legislature and signed into law by Governor Baker in August 2015, called for a concerted effort to compile the most recent data from a wide range of state sources, so an accurate assessment of the crisis could be made.

“We want to make sure we understand everything we can about the current opioid epidemic, in order to intervene appropriately,” Dr. Bharel said.

The Chapter 55 Report, a data compendium on the Massachusetts opioid crisis, was the springboard for Dr. Bharel’s presentation. Available online, the report contains information from a wide range of sources, as well as compelling graphics that show the increasing severity of the disease and even the drug of choice in different communities.

The data also show that Massachusetts is one of the states hit hardest by the opioid epidemic, in particular eastern and southern Massachusetts.

“There has been a 400 percent increase in the deaths that we’re seeing from opioids over the past 15 years in Massachusetts,” she said. “The number of deaths in Massachusetts has become unbearable. Almost five people overdose every day in Massachusetts.”

Dr. Bharel said the spike of opioid deaths in the past two years is directly attributable to the rise of fentanyl, a synthetic opioid that is much more potent than heroin.

The data show that gender plays a role. While the ratio of Massachusetts residents in treatment is evenly divided, 75 percent of opioid deaths are men. Roughly two-thirds of opioid fatalities are under the age of 44.

“We’re losing very young individuals,” Dr. Bharel said.

Dr. Bharel said the data from a Boston Globe/Harvard School of Public Health survey show that roughly half the people in the state believe opioids are too readily available, and that their addictive properties are not well explained by prescribers.
“One of the striking things that I found is that nationally, about 60 percent of the people polled said their physician explained the risks and benefits of painkillers,” she said. “But here in Massachusetts, it’s closer to 30 percent.”

Dr. Bharel said the survey prompted the formation of opioid prescribing classes in every medical, dental, and nursing school in the state.

Some good news

Dr. Bharel said she believes the overdose death toll can also be reduced if more people know about the Good Samaritan Law, which shields people from prosecution if they call 911 when someone overdoses, even if they are using at the time.

“We really want people to stay with the person who is overdosing, even after they call 911,” she said.

There was also some good news from the front lines of the battle against SUD. “In the last couple years we’ve added over 400 new [inpatient treatment] beds,” Dr. Bharel said. “Insurance must now cover the first 14 days of treatment — it’s the law in Massachusetts. We really have strengthened our commitment to make sure individuals in recovery have safe places to go.”

Nonfatal overdoses are an ideal time to intervene, Dr. Bharel said, in particular with either methadone or buprenorphine (Suboxone) treatment.

“The risk of death to people treated with one of these drugs goes down by about half,” she said. “This is following many, many years of peer review and national data on this topic. This is really powerful information. If we had this information about a blood pressure medicine or a diabetes medicine, it would be used throughout the state, no question. We know these medications work. Even though we know this, we found that less that 5 percent of individuals who come in with a nonfatal overdose actually get this treatment …There is a wide variety of treatment available under medical supervision. I believe all of those should be available to everybody.”

Before leaving to catch her 7:15 boat, Dr. Bharel praised the degree to which Islanders have become involved in the opioid battle. “I have really been impressed with how much is happening here,” she said. “It’s very reassuring to see such a strong local commitment.”

Statistics, testimonials, information on addiction treatment and prevention, and a pledge to become a “Champion” to destigmatize addiction can be found at the State Without StigMA website,(bit.ly/1NQm3l6) and on Twitter at #StateWithoutstigMA.