Pubdate: Wed, 29 Apr 2015
Source: Boston Globe (MA)
Copyright: 2015 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Kay Lazar

MASS. OPIOID DEATHS TOPPED 1,000 IN 2014

Baker, Aides Discuss Strategies for Crisis

More than 1,000 people died from overdoses of heroin and other 
opioids last year in Massachusetts, according to figures released 
Tuesday that provide the sharpest portrait yet of an epidemic that 
has devastated families across the state.

The data, released at an event that included Governor Charlie Baker 
and the nation's top health official, show that opioid-related deaths 
increased 3.3 percent in 2014 compared with 2013. More striking, the 
number of such deaths last year was 33 percent higher than in 2012.

The state's report found that in 2014, 600 deaths were confirmed as 
opioid-related with an additional 408 expected to be linked to the 
powerful drugs. The total of 1,008 would appear to be the highest 
ever recorded in Massachusetts.

Stories and data shared Tuesday at a roundtable discussion convened 
by Baker on opioid-fighting strategies suggest that despite efforts 
by regulators, law enforcement, and health leaders, every corner of 
the state is contending with the crisis in abuse of opioids, 
especially prescription painkillers.

"This issue doesn't care about geography. It doesn't care about 
race," the governor said. "We have much work to do."

Evan Horowitz: It's a heroin crisis

While prescription-type opioids still lead to more overall deaths, 
heroin-related deaths have increased by 172 percent between 2010 and 2013.

While every county in the state witnessed at least one opioid-related 
overdose death last year, a few experienced significant spikes, 
including Middlesex County, which saw an increase of more than 30 
percent, from 154 deaths in 2013 to 212 last year, according to the 
state's data.

"We have seen places in our county where the dealers are doing free 
Sundays, where they are giving away heroin because it's so cheap and 
so addictive," said Middlesex District Attorney Marian Ryan, whose 
county includes communities west and north of Boston.

She said her office has been encouraging residents to bring unused 
prescription painkillers to police station drop boxes for safe 
disposal. And the district attorney is working with realtors to 
encourage people to remove painkillers from medicine cabinets before 
strangers stroll through during an open house.

State data show that in Essex County, overdose deaths jumped from 120 
in 2013 to 146 last year, an increase that is "deeply concerning," 
said Essex District Attorney Jonathan Blodgett.

"Local law enforcement officials are working hard to identify major 
drug traffickers and dealers in an effort to get this poison off of 
our streets," Blodgett said in a statement.

He said he supports programs that allow low-level offenders to seek 
treatment instead of facing prosecution.

"Simply put, we need more treatment options for people trapped in the 
vicious cycle of addiction," Blodgett said.

The report said Suffolk County, which includes Boston, saw a drop in 
opioid-related deaths, from 115 in 2013 to 98 in 2014. But a Boston 
health official cautioned that the state's figures, which rely on 
projections for the last three months of the year, may be more 
optimistic than final figures will show.

Baker cited research showing that four out of every five heroin 
addicts got hooked on opioids through pain medications, many starting 
with legally prescribed medicine. At the start of his administration, 
the governor appointed a 16-member working group to submit specific, 
tangible recommendations to tackle the opioid crisis, with a report 
expected in early June.

The state's largest private health insurer, Blue Cross Blue Shield of 
Massachusetts, began an initiative two years ago to craft better 
practices for treating patients' pain, including prescribing drugs 
that are not narcotics. And it more closely tracked prescriptions for 
painkillers.

The program has reduced prescriptions for some of the most potent 
opioids, but the insurer is still detecting problems, said Dr. Tony 
Dodek, Blue Cross vice president of medical quality and strategy.

"We are providing reports for providers on patients who are getting 
medications from multiple providers," Dodek told the gathering at 
Boston Medical Center. "We have 6,000 letters going out next week to 
providers, most of whom don't realize their patients are getting 
medications from other providers. Some are going over the border to 
New Hampshire."

When first prescribing pain medication for a patient, health 
professionals - including doctors, dentists, and nurse practitioners 
- - must consult the state's Prescription Monitoring Program, a 
database that reveals if a patient is obtaining drugs from more than 
one pharmacy or prescriber.

Even though that initial check is required under state law, figures 
indicate many health professionals are not checking the database, 
probably because it is too "cumbersome," requiring users to click 
through various computer screens at least 11 times, said Dr. Monica 
Bharel, the state's health commissioner.

The state is working on an upgrade, she said.

Yet even when health care providers receive the information, they 
often are not sure how to use it, balancing the need to treat pain 
with not over-prescribing powerful medications, said Dr. Sarah 
Wakeman, medical director of the substance use disorder center at 
Massachusetts General Hospital and a member of the governor's opioid 
working group.

"We haven't helped doctors have a rational approach," Wakeman said.

The state's top health official, Marylou Sudders, illustrated that 
conundrum for the group, sharing how she was prescribed in February a 
60-day supply of Percocet, a powerful, opioid after outpatient 
surgery. All she wanted to help her sleep that night was two tablets 
of Ativan, a much milder antianxiety medication. "I was stunned," Sudders said.

For 21-year-old Rebecca Reilly, the road to heroin from prescription 
painkillers was swift and surprisingly easy, she told the group. "We 
could buy them off people who had prescriptions," said Reilly, who 
grew up in Wayland and has been in recovery since October 2012.

Reilly said she was also able to "doctor shop," feigning the need for 
other types of prescription drugs while visiting psychiatrists' offices.
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MAP posted-by: Jay Bergstrom