Massachusetts reports largest single-year decline in opioid-related overdose deaths in two decades

Massachusetts experienced a 10% drop in opioid-related overdose deaths from 2022 to 2023, the largest single-year decline over the past two decades and a trend that is expected to continue based on early data from 2024, according to a report released June 12.

But even as experts with the Department of Public Health signaled a victory lap was in order because of the decrease, officials warned of "concerning data" on opioid-related overdose deaths when statistics were broken down by race and ethnicity that could temper any celebrations.

While opioid-related overdose death rates among among white, non-Hispanic males decreased by 16% from 2022 to 2023, the rate actually increased among Black non-Hispanic men, according to the report.

"I want to state this clearly, this is yet another example of racism as a serious public health threat, and it reflects the decades of racism inherent to the war on drugs," Department of Public Health Commissioner Dr. Robert Goldstein said during a briefing ahead of the release of the report.

But the overall drop in the number of opioid-related overdose deaths could mark a significant turning point in Massachusetts' fight against highly addictive drugs that have plagued the state for decades and cut short the lives of many.

The confirmed and estimated opioid-related overdose death rate in 2023 was 30.2 per 100,000 people, a drop from 33.5 people per 100,000 people in 2022, which itself was a 2.5% increase over 2021, according to state data.

There were 2,125 confirmed and estimated opioid-related overdose deaths in 2023, or 232 fewer than in 2022, when Massachusetts had a record 2,357 deaths.

Goldstein said fentanyl is still a driver of deaths here and "there's increasing identification of multiple substances in toxicology screening done following death, highlighting, yet again, our poisoned and lethal drug supply in the state."

It is almost "impossible" to attribute the drop in deaths from 2022 to 2023 to one single factor but pointed to "one of the best naloxone distribution programs in the country," Goldstein said.

"We have naloxone everywhere in every community so that people can use it. We have really pioneered the use of certain service programs in this state, and to use a harm reduction lens in everything that is being done, and I think that has brought a lot of visibility and has brought resources to people," he said while also ticking off a drug-checking program and an overdose prevention hotline that has so far detected 13 overdoses and 2,591 "use events."

Opioid-related overdose death rates among males decreased from 2022 to 2023, a change driven by a 16% decrease in the death rate among white, non-Hispanic males, the only race and ethnicity to see a significant change, according to the report.

"In comparison, opioid-related overdose death rates increased since 2022 among Black non-Hispanic men. And although this was not a statistically significant change, the rate remains historically high, and the trend continues to increase," Goldstein said.

American Indian males have consistently led the pack with the highest rate of opioid-related overdose deaths in Massachusetts, according to Goldstein.

"Similar trends are seen in the data for women in Massachusetts, with inequities growing over time. In 2023, rural level two communities, our most rural communities, have the highest age-adjusted opioid-related overdose death rate at 35.6 deaths per 100,000 residents," Goldstein said.

The death rate in 2022 was one of the worst on record as fentanyl, a deadly drug, was found in most fatal opioid-related overdoses. Deaths had already been steadily increasing year-over-year before the spike that year, Goldstein said.

"Looking at the data, we can see that the increases in opioid-related overdose deaths from 2020 to 2022 were mainly attributed to Black, non-Hispanic and Hispanic males, with the rates decreasing in white, non-Hispanic males during this time," he said.

After deaths mounted in 2022, the Department of Public Health released a report backing supervised injection sites, arguing they were an "evidence-based, life-saving toll that is aligned with a comprehensive, public health approach to substance use and overdose risk."

Municipalities in Massachusetts have worked in previous years to obtain funding and set up pilot sites and they have been used in Europe, Australia, and Canada for decades. Health officials also argued that lawmakers here needed to put in place legal liability protections for providers.

"We continue to work with our colleagues in the Legislature to try to get those legal liability protections passed codified into law so that we can move forward and support communities as they want to open up overdose prevention centers," he said.

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