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

Opioid-related deaths in the US have quintupled since 2000. Opioid-related deaths. United States . 47,600 8,407 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

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 overdoses 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.

Massachusetts’s opioid-related death rate is roughly 2x the US average. Age-adjusted opioid-related death rate (per 100,000). 28.2 Massachusetts 14.9 United States 4.8 3 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

While we made some very modest progress over the last 2 years, opioid-related deaths remain extremely high in Massachusetts. Opioid-related deaths. Massachusetts residents. 2,056 1,974 2,099 1,945 Estimated Deaths 1,704 1,617 Confirmed 1,362 Deaths 961 742 660 656 642 638 622 614 575 560 526 514 506 379 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Source: Massachusetts Department of Public Health, November 2018 update.

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

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. 10% 11% 11% All other drug- 17% related deaths Opioid-related deaths 90% 89% 89% 83% White Black or African-American Hispanic Total

Our state’s opioid crisis spiked... …even as our economy improved. Age-adjusted opioid-related death rate (per 100,000). Massachusetts. Unemployment rate, seasonally adjusted. BLS. Massachusetts. 35 10.0% 9.0% 30 8.0% 25 7.0% 20 6.0% 15 5.0% 10 4.0% 5 3.0% 2.0% 0 2010 2011 2012 2013 2014 2015 2016 2017 2010 2011 2012 2013 2014 2015 2016 2017 2018

Massachusetts prescribes lots of opioids, but less than most states. Opioid prescriptions per 100 people. 2016. 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

Fentanyl is now the number one cause of opioid-related deaths in Massachusetts. Number of deaths by opioid type. 2,000 Fentanyl and other synthetic opioids, 1,649 1,500 1,000 500 Heroin, 466 Opioid painkillers, 254 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

There’s likely a regional effect at play, with New England states having high opioid-related death rates. Opioid-related death rate Fentanyl-related death rate Age adjusted death rate (per 100,000 people). New England states. 2017 Fentanyl-related death rate per Rank State 100k (age-adjusted), 2016 34 1 New Hampshire 30.3 29.9 2 West Virginia 26.3 28.2 27.7 26.9 3 Massachusetts 23.5 4 Ohio 21.1 5 D.C. 19.2 20 6 Maryland 17.8 7 Rhode Island 17.8 14.9 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 US CT ME MA NH RI VT

Major drug trafficking routes run through New England.

www.bostonindicators.org

1

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 2

The opioid epidemic is far from over and it will probably get worse U.S. Deaths from Other Synthetic Opioids – Principally Fentanyl 3

Massachusetts at the epicenter of the epidemic – opioid-related deaths per 100,000 population 4

Another metric: incidences of Neonatal Abstinence Syndrome per 1,000 Births 20 17.0 18 16 14 12 10 7.7 8 6 4 2 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 MA 28 State Average 5

People in the workforce: absenteeism, presenteeism, and excess health care costs businesses ~ $4.8 billion Excess Health Studies 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) 6

People out of the workforce: the U.S. labor force participation rate is demonstrably lower than other countries in the developed world 7

Since 2011, MA has averaged 33,700 people unable to work due to opioid misuse 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 -5,000 8

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 10

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 our 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. 11

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

Assessing a Public Health Crisis 2016 Boston Area Narcotic Related Incidents: N. Station • Nearly every Boston neighborhood affected by the opioid epidemic. MGH • Fentanyl present in the majority of deaths. Downtown Court St / DT Crossing • A significant number of OUD victims were Chinatown homeless. South Station Copley • 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  South End range of harm reduction services. BMC South Boston Roxbury Substantial need for access to low-threshold Andrew Dorchester Square treatment & harm reduction services for the Dudley most marginalized populations 2

The Care ZONE Model Discussion Document - Not for Public Release Care ZONE uses data driven hotspotting to bring low- threshold, on-demand addiction care & harm reduction services to populations at highest risk of near-term death. Harm Reduction Hotspotting Mobility Partners Target areas with Clinical Partners Customized Needle Exchange largest number of opioid Community Health Centers Medical Vans Programs, Nonprofits overdose deaths 3

A Day on the Van • 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 Weekly Clinical Sites Downtown –West End on Haverhill Street and the other in • Outreach workers walk patients to nearby Downtown Crossing on Chauncy Street. pharmacy to fill MAT prescription Roxbury – The van holds clinics in Dudley Square. immediately Fenway – The van holds clinics in The Fens. • Facilitate access to OBAT program; weekly follow up on van until warm handoff made

Proof of Concept Results, January-October 2018 *Note: AHOPE, the mobile health program’s harm reduction team from the Boston Public Health Commission, on average takes 112 syringes off the street for every 100 syringes distributed, meaning their syringe exchange program results in fewer needles in circulation