Massachusetts, often called the Bay State, is a picturesque historical state situated on the East Coast of the United States. Overall, residents of Massachusetts struggle with drug and alcohol abuse and addiction at rates similar to the rest of the nation with a few exceptions.
The Behavioral Health Barometer, Massachusetts 2015 reports that youths and young adults between the ages of 12 and 20 binge drink alcohol at rates higher than national averages indicate; data collected for 2013 and 2014 suggest a past-month binge drinking rate of 17.7 percent for Massachusetts underage residents compared to a national underage past-month binge drinking rate of 14 percent. Rates of illicit drug dependence or abuse for Massachusetts residents were a little higher than national averages as well; 3 percent of Massachusetts residents struggled with drug abuse each year for 2013 and 2014 versus a national average of 2.6 percent. Massachusetts is also facing serious issues related to opioid abuse, addiction, and overdose, as the Boston Patch publishes that Massachusetts ranked sixth in the United States for number of overdose deaths in 2015.
The Massachusetts Department of Public Health (DPH) reports that for the fiscal year (FY) 2013, there were more than 40,000 people served by public state-regulated acute treatment services (ATS) or detox programs. The Behavioral Health Barometer further states that treatment for mental health was slightly better in Massachusetts than the rest of the country. More adult residents in Massachusetts received treatment for any mental illness (AMI) with 53.8 percent receiving care between 2010 and 2014; the national average was 42.7 percent. More youths battling major depressive episode (MDE) were treated between 2010 and 2014 in Massachusetts at 50.5 percent than the national average of 38.6 percent.
Both addiction and mental health are considered to be behavioral health concerns, and they often go hand in hand. Behavioral healthcare is provided through both public and private providers in Massachusetts. Care is generally provided on a local level by community-based providers. The Office of Senator Elizabeth Warren publishes that there are over 50 community health centers (CHCs) in over 300 locations in Massachusetts, serving one in seven residents with a full continuum of care for behavioral health needs.
Opioid Abuse and Overdose Issues in Massachusetts
The National Review reports that close to one out of every four residents of Massachusetts has been directly impacted by the opioid overdose epidemic; 25 percent of residents of the Bay State have lost a loved one to a fatal opioid overdose. Seventy percent of residents surveyed report the opioid crisis as one of the most serious problems the state faces, and nearly everyone knows someone battling opioid addiction.
The Massachusetts DPH publishes that close to 2,000 residents died from an opioid overdose in 2017, most of which (83 percent of confirmed opioid overdoses recorded where a toxicology screen was available) involved the drug fentanyl. Fentanyl is an extremely potent synthetic opioid that has been invading the streets of the United States, especially the Eastern Seaboard recently. Over 50 times more potent than heroin and absorbable through skin contact, fentanyl is being manufactured in illicit laboratories, and it often used to “cut” and stretch other drugs, such as heroin, cocaine, and counterfeit prescription medications. The 2017 National Drug Threat Assessment reports that Massachusetts had the second highest number of fentanyl reports in the United States for the calendar year (CY) 2016 at close to 4,000 law enforcement encounters and incidents.
The Boston University (BU) School of Public Health publishes that there were nearly 12,000 people treated by emergency personnel for opioid-related causes in 2015. Many of these incidents were overdoses and required the administration of the opioid antagonist naloxone to reverse them. In around one-third of all cases where naloxone was administered, it had to be given more than one time, largely due to the presence of fentanyl and its elevated potency requiring more of the reversal drug to be effective.
In 2014, the Massachusetts DPH reports that over half (53.1 percent) of all addiction treatment admissions to programs contracted under the Bureau of Substance Addiction Services (BSAS) cited heroin as the primary drug of abuse. More than 100,000 Massachusetts residents were served by BSAS-contracted substance abuse programs for FY 2014. The second most cited primary substance of abuse was alcohol at 31.9 percent of treatment admissions followed by all other opioids at 5.8 percent, marijuana at 4 percent, cocaine and crack cocaine at 3.4 percent, and other drugs at 1.7 percent.
Addiction is a disease with far-reaching implications. It impacts individuals, families, and the community at large.
Turning the Tide
There is some news to suggest that efforts to address the opioid crisis in Massachusetts may be working, as the Boston Globe publishes that opioid overdose deaths actually fell by just over 8 percent from 2016 to 2017 in the Bay State; this is the first decrease in half a decade. Some counties in Massachusetts are not following the same trend, however, as Mass Live reports that several cities and counties are still recording increases in opioid overdose deaths. Middlesex County ranked number nine in the United States out of all 44 counties home to 1 million residents or more for opioid overdose fatalities between the years 2000 and 2016. Rural counties also seem to be hit hard.
Legislation is aiming to control prescription patterns of controlled painkillers in an effort to reduce opioid diversion and medication misuse. It is well known that many people who battle heroin addiction began misusing prescription medications before turning to the cheaper and often easier to get illegal opiate heroin (and now fentanyl or its analogues). The National Institute on Drug Abuse (NIDA) explains that around 80 percent of people struggling with heroin abuse began by abusing prescription opioids. If prescription medications can be more tightly controlled and regulated, then perhaps abuse of other opioids such as heroin and illicit fentanyl will be prevented.
There are several things that leaders in Massachusetts are doing to combat opioid abuse and overdose. A few of these include:
- Hosting a Prescription Monitoring Program (PMP): This helps to track the dispensing of controlled prescription medications, alerting prescribers to potential concerns and misuse patterns. It also helps to crack down on “doctor shopping” and other methods of obtaining medications for recreational use.
- Passing legislation, such as An Act Relative to Substance Use, Treatment, Education, and Prevention: This law enacts a seven-day limit on new opioid prescriptions, improves the PMP, increases preventative educational measures statewide, and mandates drug disposal programs.
- Providing prescription drop box locations and kiosks: These boxes and disposal sites are located all throughout the Commonwealth, allowing residents to dispose of unwanted prescription medications to keep them from being diverted and misused.
- Forming the Massachusetts Opioid Abuse Prevention Coalition (MOAPC): This is a grant program funding local community-based coalitions, preventative programs, and educational services designed to reduce opioid abuse.
- Passing a Good Samaritan law: This protects individuals who report an overdose from drug-related charges and also allows bystanders to administer naloxone to try and reverse an overdose.
- Holding a standing order for naloxone dispensation: This allows local pharmacies to dispense naloxone to those impacted by opioid addiction and face potential opioid overdose.
- Launching the Overdose Education and Naloxone Distribution (OEND) program: This trains individuals and first responders on the use of naloxone (Narcan) to help overturn an opioid overdose as well as provides information on how and where to obtain it.
Prescriptions for opioid drugs in the state of Massachusetts have decreased about 25 percent from the first quarter of 2015 through the second quarter of 2016, BU reports, which is better than national trends where the dispensing of opioid prescriptions has declined 13 percent. Coupled with decreasing opioid overdose fatalities, Massachusetts legislation and preventative efforts seem to be at least slightly turning the tide on opioid abuse in the Commonwealth.
Drug Courts and Mandated Treatment Programs
Massachusetts is one of 37 states where a person can have another involuntarily committed when they are concerned about their drug and/or alcohol use, WBUR publishes. There are five locations in the state of Massachusetts where individuals can be sent for civil commitment under Section 35, including the Massachusetts Alcohol and Substance Abuse Center (MASAC) at Plymouth. This program provides treatment in a minimum-security facility where residents stay for 30-90 days, meeting with drug and alcohol abuse counselors and receiving addiction recovery services.
Massachusetts also operates 27 adult and three juvenile drug courts as specialty courts designed to help individuals battling addiction who are arrested for drug-related and nonviolent offenses get treatment instead of facing prison or jail time. When a person completes the mandated treatment program, they may be able to have their charges dropped or sentences reduced. Many times, crimes are committed due to a drug problem, and mandated treatment and diversion programs can manage the root of the issue.
The Massachusetts BSAS, as a division of the DPH, provides oversight and licensing for providers and helps to design and implement substance abuse and addiction treatment services in the Commonwealth. The Department of Mental Health (DMH) does the same for mental health treatment services across the state. The DMH has 27 offices throughout the Commonwealth, four continuing care facilities, and six community health centers (CHCs).
Both addiction and mental health services are offered based on where a person lives, often through community-based providers. Residents can use this table to find the local DMH office that supports their area. The DMH Resource Guide also provides residents with current listings of providers. To find a local addiction treatment provider, Massachusetts residents can call the free and confidential Massachusetts Substance Abuse Helpline or use their web-based interactive tool. State-regulated services can also be located using the national Behavioral Health Treatment Services Locator operated by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The Office of Senator Elizabeth Warren publishes that treatment providers in Massachusetts offer the following services
- Acute treatment services (ATS), including detox and medical detox
- Clinical stabilization services (CSS), step-down and post-detox
- Structured outpatient addiction programs (SOAP)
- Transitional support services (TSS)
- Residential recovery homes
- Medication-assisted treatment (MAT), provided in both outpatient and inpatient settings
Substance abuse and addiction prevention, treatment, and recovery services and programs are offered by nonprofit, private, public, and state-funded agencies and coalitions throughout Massachusetts. These include:
- Massachusetts Organization for Addiction Recovery (MOAR): This initiative is statewide and supports residents in recovery while also providing educational and preventative measures and information on obtaining treatment services.
- End Mass Overdose: This nonprofit organization aims to minimize and prevent opioid overdose deaths through education, policy, and wider dispensation of naloxone.
- Learn to Cope: This organization strives to support families of individuals battling addiction and those in recovery.
- New England Region of Narcotics Anonymous (NERNA): This peer-support organization helps members to work through the 12-Step program through fellowship and encouragement from each other in recovery.
- Massachusetts Clubhouse Coalition: This nonprofit agency helps to improve quality of life for families and individuals battling long-term mental illness.
- Magnolia New Beginnings: This nonprofit organization supports individuals and families struggling with substance abuse and addiction and provides educational and preventative measures and services.
- National Institute on Mental Illness (NAMI) Massachusetts: This organization provides advocacy to reduce the stigma of mental illness, improve policy, and offer resources for obtaining local behavioral healthcare services.
- Alcoholics Anonymous (AA) in Massachusetts: This is a listing of local AA chapters for individuals seeking sobriety and support in recovery.
Different municipalities, regions, counties, and communities throughout the Commonwealth will also have community-based providers, coalitions, and agencies working to improve the wellbeing of their immediate neighborhoods with drug abuse and overdose education and prevention measures, treatment programs, and recovery support services.