Opioid overdose deaths up by 9 percent last year
Highest fatality rate among Native Americans
THE NUMBER OF OPIOID overdose deaths in Massachusetts rose by 9 percent in 2021, a worrying number in a state that had started seeing some success in addressing the opioid epidemic when COVID-19 hit and reversed that progress.
“These are sobering and devastating statistics,” said Deirdre Calvert, director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health.
The new data, released Wednesday by the Department of Public Health at a meeting of the Public Health Council, also found worrying signs among particular demographic groups – including, for the first time, Native Americans. While previous reports have identified overdose death increases among Black and Hispanic residents, this report breaks out Native Americans for the first time. There were only 13 opioid overdose deaths among Native Americans last year, but due to their small numbers in the state overall, the 13 deaths actually reflect the highest opioid overdose death rate among all populations, more than three times the state average.
The death rate from opioid overdoses in Massachusetts was 32.6 per 100,000 people in 2021, but 118.6 per 100,000 for residents classified as American Indian.
Overall, the report identified 2,234 confirmed opioid overdose deaths in Massachusetts in 2021, with another 42 to 71 that have not yet been confirmed. That compares to 2,105 opioid overdose deaths in 2020. The numbers have started decreasing in 2022, with a 4 percent drop compared to the same time last year.
Overdose deaths had been steadily rising from around 2010 to 2016, at which point state policymakers made a major effort to slow down the epidemic through policies that ranged from mandating insurance coverage for substance abuse treatment to expanding access to the anti-overdose drug Naloxone to running anti-stigma campaigns. The numbers began leveling out and dropping for the next few years, until the pandemic hit. CommonWealth previously reported that factors related to the COVID-19 pandemic contributed to the increases in opioid-related deaths. People had a harder time accessing support services and treatment, and social isolation can lead to worsening dependence on drugs and alcohol.
The latest report found that the use of fentanyl – and the contamination of the drug supply with the dangerous opioid – remains a huge factor, with fentanyl present in 93 percent of deaths. Calvert announced at the Public Health Council meeting that the Department of Public Health plans to create a “clearing house” this July through which the state will distribute fentanyl test strips, so that people who want to test their drugs for fentanyl can do so. Details of that initiative were not immediately available.
“Today’s report underscores the harmful impact that the COVID-19 pandemic and the scourge of fentanyl have had on those struggling with addiction, and we are committed to continuing our work with the Legislature and our colleagues in the addiction and recovery community to boost access to services and treatment,” Gov. Charlie Baker said in a statement.
Demographically, the rate of overdose deaths fell slightly in 2021 for Blacks, while rising for White and Hispanic residents. Nearly three-quarters of overdose deaths were among men, and half were between the ages of 25 and 44.
Public Health Commissioner Margret Cooke flagged the number of Native American deaths in her presentation to the public health council, noting that the age-adjusted rate of death from overdoses among American Indian men is three times the state average and statistically higher than any other racial or ethnic group. Since 2014, the most overdose deaths among Native Americans occurred in Bristol and Barnstable counties. Barnstable County is home to many members of the Mashpee Wampanoag tribe.
Cooke said the Bureau of Substance Abuse Services has partnered with UMass Boston’s Institute for New England Native American Studies to conduct needs assessments in tribal communities, offer trainings on stimulant use, provide prevention and treatment resources at powwows and other events, develop culturally sensitive educational materials, and train substance use providers on culturally sensitive ways to serve Native Americans.
Brewer-Lowry said Native American communities are dealing with “generational hurt,” and residents are often being overlooked. Many communities are struggling with poverty, hunger, and housing. “A way to deal with it is through drug abuse,” she said. She said there also remains stigma about seeking treatment.
Harvard professor and psychologist Joseph Gone, the faculty director of the Harvard University Native American Program and an enrolled member of the Aaniiih-Gros Ventre tribal nation of Montana, said the Massachusetts numbers are in sync with what he has seen nationally.
One national study of overdose deaths among high school-age adolescents, published in the American Medical Association journal JAMA in April, found that American Indian and Alaska Native youth had an overdose death rate of 11.79 per 100,000 population. The next highest rate was among Latino youth, with a death rate of 6.98 per 100,000, while the national rate among all adolescents was 5.49 per 100,000. That report found the rates among American Indian youth skyrocketing disproportionally since 2016.
Gone said Native American communities typically have high rates of substance use disorders, and also higher than average rates of abstinence, as people see the toll that drug and alcohol use can take.Gone said it is not clear whether the higher rates of overdoses are due solely to accidental overdoses or deaths by suicide. But he said what is clear is that the rates of drug use are influenced by sociological and historical factors related to a “legacy of colonial subjugation” that left communities impoverished.
“Any community that suffers from long histories of racism and discrimination, subjugation and oppression, and which tries to live with contemporary conditions of impoverishment turns to these sorts of things to cope and escape,” Gone said. Gone said colonial oppression tried to eradicate native cultural practices and ways of life, which led to Native Americans losing their sense of self. Native Americans also face racism and discrimination that prevents them from fully melting into American life. “It leads to a crisis in purpose and meaning that in turn triggers demoralization that spirals into substance use, mental health problems, even suicide,” Gone said.