The Opioid Epidemic continues to sweep through major cities, increasing fatality rates and greatly impacting the lives of millions. The Massachusetts Department of Public Health released data in June 2024, revealing that while opioid-related deaths have decreased 10% statewide, deaths have increased 12% in Boston. The Boston Public Health Commission uses a $7.5 million grant to improve and expand knowledge and access to harm reduction strategies. Given this, Boston officials are working to change and redirect their approach to addiction.
The Opioid Crisis has been a prevalent issue in society since the early 1990s, when the first wave of natural and semi-synthetic methadone was fed by aggressive marketing from pharmaceutical companies and an increase in written prescriptions from physicians. A second wave followed shortly after from 2010 to 2013, consisting of a spike in heroin-involved deaths. This was later followed by a dramatic third wave that has been prevalent since 2001, the rapid increase in deaths due to synthetic opioids including fentanyl, fentanyl analogs, and tramadol.
More recent data reported by the American Psychological Association shows the presence of 81,806 opioid overdose deaths in 2022, 90% of which involved synthetic opioids other than methadone. Since the third wave, access to these drugs has increased as well. Not only has the illicit street drug market increased, but the rate of prescriptions written has skyrocketed, so much so that 19% of people who developed an opioid addiction were initially introduced to them in a physician's office.
With these statistics publicly released, pharmaceutical companies have rewritten their bylaws. Most prescriptions now are initially set to a seven-day limit unless overridden by the prescriber.
While this may seem like a preventative measure, the Center for Medicare and Medicaid Service reports that most opioids only require a five-day use to become addicted, so that a prescription may be just enough to potentially trigger dependence. However, the overprescription of medication is not the only start of addictions.
A multitude of factors and social determinants of health contribute to a person's susceptibility to addiction. These include having low educational attainment, low socioeconomic status, mental health disorders, genetic predisposition, and being of a certain marginalized community. The Boston Public Health Commission reports that the opioid mortality rate has increased 27.3% for Black residents and 15.7% for Latinx residents. In 2021, Black residents experienced higher rates of nonfatal opioid and cocaine overdoses, and Latinx residents experienced higher rates of nonfatal opioid overdoses as compared to white residents.
The Alcohol and Drug Foundation states that it can take five to six attempts for a person to successfully maintain sobriety. In between these attempts people often relapse due to lack of mental health resources, sobriety support, financial struggles, lack of support from families, child care, and many other factors. Each of these branches dramatically contributes to why addiction is so prevalent and why sobriety is so challenging to maintain. Lack of understanding of drug use greatly contributes to this. Data reported from 2017 to 2022 shows that there was an increase in drug overdoses from 6.6 deaths per 100,000 residents to 16.9 deaths per 100,000 residents. There was also decreased access to services and increased stress and isolation, all of which limiting intervention which could reverse overdose. In fact, cocaine was present in more than half of all overdose-related deaths associated with fentanyl in 2022, and over 60% involved some combination with other opioids and/or cocaine.
Awareness and understanding of the severity of addiction is just half the battle; treatment plans and affordability present themselves as a separate issue. In Boston, there are 56 inpatient drug and alcohol rehabilitation centers, 126 outpatient centers, and 32 detox centers, with only 15 free treatment programs. While patients may be able to seek detox treatment, the longevity of these programs are fairly short, typically 28 to 30 days, and then patients are released without offering much post-treatment care or support of any kind.
As of June 2024, the BPHC has been using $7.5 million in new funding to increase substance use services, support low-threshold housing, train more people in overdose rescue, and build city-wide infrastructure to support individuals living with substance use disorder. The Massachusetts State Government as well as the Office of Minority Health, the BPHC is using its recent federal grant to expand current overdose prevention services and improve data collection so that service providers, local non-profits, and Boston residents have resources and proper training to play an active role in overdose prevention and response, in hopes of educating and uniting a city in current struggle. Additionally, the BPHC has received a federal grant from the Office of Minority Health, which will help ensure that the BPHC enforces racial equity in access to low threshold shelter and services for people living with Substance Use Disorder.
The commission's $6.5 million grant for the CDC’s Overdose Data to Action (OD2A) will be used to create a dashboard to track both fatal and nonfatal overdoses to encourage these strategies across the city. The CDC will use this funding to keep active drug users in the health care system and train medical staff on reduction techniques and practices in hopes of teaching, decreasing, and preventing these numbers from rising.
In addition to the federal grant, the BPHC also received $1 million in Opioid Remediation Funding to increase training and access to naloxone, a drug that can be administered to reverse an overdose. Current data shows that the BPHC Recovery Services Bureau workers regularly to reverse up to 5 overdoses per day and can confidently report that this fund has delivered 2,389 referrals for substance use treatment.
Further outreach programs include the BPHC’s Access, Harm Reduction, Overdose Prevention and Education (AHOPE) program and the Providing Access to Addictions Treatment, Hope and Support (PAATHS) program. These offer harm reduction services, including fentanyl testing strips, syringe exchanges, and screening of drug transmitted diseases such as HIV and hepatitis.
Addressing the opioid epidemic in Boston requires a balanced, community-driven approach that emphasizes harm reduction, improved access to treatment, and support for those affected by addiction. By fostering collaboration between public health officials, local organizations, and residents, as well as state and federal grants and assistance from non-profits, the city has the proper support and resources to make meaningful strides toward alleviating the crisis while prioritizing the well-being of its population, for everyone involved.
Comments