No good data on heroin epidemic

Everyone is convinced there is a public health emergency, but there’s no numbers to prove it

A correction has been made to this story and the accompanying chart. Information on the correction is available at the bottom of the story.

Gov. Deval Patrick declared it a public health emergency. Senate President Therese Murray is calling it an epidemic. Everywhere you turn there are reports that opiate addiction and overdoses are out of control. Only one thing is missing: good, current data.

The data on the state’s opiate problem are old, geographically incomplete, and inconclusive. None of the media reports about growing heroin use cite recent, authoritative sources, and calls to the Massachusetts Department of Public Health produced only dated information. 

Does the state government have a better understanding of the problem than the news accounts suggest? If so, the information should be shared so all of us can understand the nature of the public health emergency. If not, we are attacking a big and serious problem without a data-driven, real-time understanding of what we are facing.

The Globe reported in February on State Police statistics showing 185 heroin deaths since November 2013, a number that clearly understated the problem because data from Boston, Springfield, and Worcester were not available and not included in the total.  The state’s three biggest cities account for a third of violent crime in Massachusetts, and almost certainly represent a huge share of opiate use and overdoses. Looking at DPH data on hospitalization rates (also old, FY2012), the three cities account for about a quarter of all substance abuse-related hospitalizations, though the exact figure is frustratingly difficult to calculate given the imprecise way these figures are reported.

Even though a State Police spokesman said no data on heroin deaths for the corresponding four-month period from a year ago was available, he said the 185 deaths between November and February represented an increase. “Our experience and accumulated knowledge…indicates that these numbers absolutely represent an increased rate of fatal heroin overdoses,” David Procopio, the  State Police spokesman, told the Globe.

Opiates are a problem that has been on a steady rise for years, decades even. But the state’s understanding of the problem is at least several years old at any given moment. Statistics provided by DPH show a steady, long-term growth in the number of opioid-related poisoning deaths, but the most recent information is from 2012. Further, the data reveal an apparent calculation error in the public health advisory which announced the public health emergency. The advisory said: “In 2012, 668 Massachusetts residents died from unintentional opioid overdoses, a 10 percent increase over the previous year.” DPH data from 2011 show 642 deaths, meaning 668 deaths in 2012 would represent a 4 percent increase, not 10 percent.

DPH is not alone in referring to dated information on this issue. Per the Statehouse News, Senate President  Murray testified before a panel in her hometown of Plymouth that since 1999 the state has seen a 47 percent increase in overdose deaths. That sounds bad, but the number is four years old, representing the increase between 1999 and 2010, not between 1999 and 2014.

The increase is also smaller than most states across the country have experienced. The increase in Massachusetts was the sixth lowest of any state in the country, according to a Trust for Americans Health Report that included the 47 percent figure. 

Confronting an issue of this magnitude with old and incomplete data leaves both policymakers and frontline responders with less than a full toolkit. Where should resources be directed? Is incidence of opiate abuse trending up in 2014, meaning we will need more resources next year? Is it staying flat? Or is it declining somewhat? Where are the worst problems, and where are problems getting worse the fastest? Answers to any of these questions would allow for a more targeted response than is possible with old and incomplete information.  

Due to a reporting error, the number of opioid-related poisoning deaths for 2012 was misstated in the story and accompanying chart. DPH initially provided CommonWealth with data on opioid-related poisoning deaths for 2000 through 2011. It also issued a press release announcing a public health emergency saying the number of unintentional opioid overdoses was 668 in 2012. CommonWealth assumed the 2012 number was an extension of the earlier numbers, but DPH says the number represented only those who overdosed unintentionally. Another 43 people died from intentional overdoses, or suicides. The fact remains the latest complete-year data available are for 2012.

Steve Koczela is president of the MassINC Polling Group.