The current opioid epidemic has reached staggering heights in Massachusetts. An estimated 2,290 people died from an opioid-related overdose in 2021, an 8.8% increase from 2020. These numbers, compiled and released by the Massachusetts Department of Public Health in June, show that while overdose deaths increased for all racial and ethnic groups amid the pandemic, there was the most extreme escalation of overdose deaths in 2020 for Black Americans. The reason for the spike is a complex one. One that will require a multi-pronged, racial justice-focused approach.
What’s causing the current opioid overdose crisis?
Chief among the factors leading to the increase in opioid overdose deaths is the rise of fentanyl, a synthetic opioid that is prescribed for severe pain but now dominates the supply of opioids available on the street, and is very lethal, even in minuscule quantities. Further, other drugs like cocaine, ecstasy, other opioids, and even marijuana are increasingly laced with fentanyl. That makes it particularly dangerous because people may not even know that they are consuming fentanyl, and there is a high risk for opioid-naïve individuals to overdose.
There are some ways to combat this: Widespread distribution of the opioid-blocking drug is very important, since it can be used in medical or non-medical settings to reverse an opioid overdose that would otherwise be fatal. Another strategy is fentanyl test strips, which can help identify the presence of fentanyl in drugs. Both of these strategies are lauded by public health officials, clinicians, and the harm reduction movement as a way to prevent death due to overdose. As a clinician, I think these are useful, life-saving tools. However, for them to be extremely effective, we need to amplify outreach and education to ensure these tools will be available and used by our most vulnerable populations.
Another reason for this recent increase in overdose deaths is multi-layered: the fallout from the ongoing COVID-19 pandemic and the rippling mental health effects of isolation and fear of disease. Anxiety and depression increased significantly during COVID and, though, we’re certainly in a better place with the pandemic than we were in the early days of 2020 or even 2021, we’re still steeped in uncertainty as new variants continue to emerge and infections increase.
People are also reeling from grief caused by the COVID-19 pandemic. A 2021 Vox article estimates that, at the time, nearly 5 million people worldwide were grieving the loss of a loved one due to COVID. Grief and despair are powerful factors in the latest surge of deaths among people with active substance use disorders (SUDs).
How race and racism intersect with opioid overdose deaths
Over the last few years, the media’s framing of the current opioid overdose epidemic as a “white” issue drew sharp criticism from news outlets and public health experts, as data has continued to show opioid-related overdose deaths increasing for members of the Black community. Further, the shift in framing this particular overdose crisis as one we must meet with compassion and treatment rather than personal blame and incarceration was not lost on many who remember the punitive actions taken against Black Americans struggling with crack cocaine addiction in the 1980s.
Our responsibility moving forward is to center the human suffering at the heart of the overdose crisis and address that suffering with psychosocial interventions alongside medical interventions for SUDs.
We cannot and must not go backward. What happened in the 1980s was a brutal, cruel, and racist response to a humanitarian crisis. Our responsibility moving forward is to center the human suffering at the heart of the overdose crisis and address that suffering with psychosocial interventions at the same time that we offer medical interventions for substance use disorders. In addition, our approach must emphasize racial justice through outreach and access to treatment.
Boston Medical Center has an incredibly diverse patient population. As such, it is a priority for our hospital to center racial justice in healthcare. We saw that many people who came into our emergency department with an addiction-related health crisis did not subsequently engage in treatment for their SUD. In many cases they disappeared from our healthcare system. Our internal data indicates that this is an even more common outcome for Black patients than it is for white patients.
We knew that we needed to do something to repair this. So we, at BMC’s Grayken Center for Addiction,created Rapid ACCESS, a program connecting recovery coaches with people who have just come through our emergency department with an addiction-related crisis. Recovery coaches — who are, by definition, in recovery themselves — are integral in the recovery process for many who struggle with substance use. Coaches work with people in every phase of their recovery journey and act as a guide through the recovery process. We’ve made a concerted effort to hire a diverse group of recovery coaches to ensure that patients of color struggling with substance use disorders feel represented and comfortable when they seek support.
In addition, for the past year, the Grayken Center has been leading an initiative to learn how to make addiction treatment more accessible for Black people. We started with a series of six focus groups, conducted in the neighborhoods surrounding BMC, among people who have lived experience. This fall, we will launch four day-long convenings with clinicians, researchers, and people who have lived experience to assess the information that we have gathered, and define what we know — and do not know — about how to improve addiction treatment for Black people. This convening will produce a list of actions that we can implement in our addiction treatment programs, as well as a list of unanswered questions that we will use to define our future research agenda. We plan to share our findings broadly to help to improve access to addiction treatment for Black people.
Policy solutions to the opioid overdose crisis
Health systems, policymakers, and community groups must come together to combat opioid overdose deaths. It’s essential that we increase harm reduction education among primary care providers. In an ideal world, primary care providers would be asking all patients about their substance use, then provide information — without judgment — about ways to protect oneself against infection, overdose, and death.
Increasing education around harm reduction includes, but is not limited to:
- providing patients with sterile injection equipment or putting them in touch with syringe exchange programs and education about preventing infection and overdose while using drugs;
- reducing the stigma around medication for opioid use disorder (MOUD);
- and peer support.
Another important tool in combating opioid overdose deaths is implementing supervised consumption sites (also known as harm-reduction sites), which are clinical settings where individuals can consume previously obtained non-prescribed substances in a safe, non-judgmental space. These individuals are under the supervision of clinical staff who will monitor for signs of overdose and can test the drug supply for fentanyl. The data are clear. Supervised consumption sites are an effective tool for reducing harms of drug use and engaging people with treatment services. Studies also show that trash and discarded syringes decrease in areas served by a supervised consumption site. We hope that Boston can become an early-adopter of this important strategy to reduce harm, suffering, and death.
It’s essential that we increase harm reduction education among primary care providers.
As we’ve seen with the ongoing humanitarian crisis on Mass and Cass, the need is immediate. In January, The Grayken Center worked with the Wu Administration to utilize the Roundhouse Hotel as a low-threshold site for individuals still grappling with their addictions to opioids and other drugs, and living in street encampments. This plan was implemented with a harm reduction and racial justice focus. Roundhouse housing is not contingent on abstinence from substance use and is welcoming to people who are experiencing homelessness no matter where they may be on the spectrum of engagement with addiction treatment services.
Among the 60 patients who entered the facility when it opened, none have chosen to return to living unhoused, and only one life has been lost to overdose over a 6-month period. Residents are engaging with housing case management and addiction treatment services, and one by one, they are moving on to permanent supportive housing. Our work at the Roundhouse, while not a perfect solution, showcases what happens when community groups, clinicians, and policymakers work together to address a complex crisis while maintaining a human-centered approach.
