Like so much of the country, Massachusetts has been ravaged by the opioid epidemic. Since 2000, annual overdose deaths involving opioids have increased fivefold in the state, with a dramatic spike over the past five years driven by the spread of the highly lethal opioid fentanyl. In a recent survey, more than 1 in 4 Massachusetts residents reported knowing someone who had died from an opioid overdose.
The death toll is even more tragic in light of the many effective treatments for opioid use disorder that exist. The overdose-reversal drug naloxone and the FDA-approved medications for opioid use disorder — buprenorphine, methadone, and naltrexone — have all been shown to reduce overdose deaths, but they aren't consistently getting into the hands of the individuals or the communities that need them most. Only 20% of people with opioid use disorder are taking a medication.
The National Institute on Drug Abuse (NIDA) has responded to this treatment gap with a $350 million study, known as HEALing Communities, designed to accelerate our understanding of effective interventions and create a national model aimed at curbing the national opioid crisis. The study is headquartered at four sites: Boston Medical Center (BMC), Columbia University, the University of Kentucky, and Ohio State University.
Jeffrey Samet, MD, the chief of general internal medicine at BMC and a professor of medicine at the Boston University School of Medicine, is the lead investigator for Massachusetts. In collaboration with several state agencies, numerous partner organizations, and 16 communities highly impacted by the opioid crisis, Samet and his colleagues will study a broad range of treatment interventions with the goal of reducing opioid overdose deaths by 40% in those communities over three years.
HealthCity met with Samet following the grant announcement to talk about the opioid crisis in Massachusetts, the HEALing Communities study, and where he sees hope.
HealthCity: How does this crisis compare to other public health crises you've seen in your career?
JS: It's about as bad as we've seen in this country. I trained in the period when HIV arrived in the U.S. and overwhelmed hospitals, families, and communities. When the opioid overdose deaths surpassed the number of deaths from HIV/AIDS in a single year in this country, that was shocking. Those are the two greatest epidemics that have hit the country in my lifetime, and they're of similar magnitude.
How has the opioid epidemic affected Massachusetts?
The opioid crisis in Massachusetts has been devastating for families. Many people have died. Young people and older people alike are being lost. Children are losing parents, and it shouldn't be happening.
No community has been spared. I've seen it in my own community, with families ripped apart. And it happens in communities all across the commonwealth. You can't talk to anyone who doesn't understand this on a visceral level.
Is this the biggest opportunity we've had in Massachusetts to date to reverse this epidemic?
Lots of work has happened in Massachusetts over the last 20 years to address the opioid use disorder epidemic. This is a major step forward, which will help us apply what we've learned, from the creation of office-based addiction treatment programs to the distribution of naloxone to reduce overdose deaths, to the creation of programs in police stations to help people with addiction, to the willingness of jails and prisons to address this issue.
This opportunity brings many of those initiatives together, to see if we can make a dent — a serious dent — in the overdose death rate, by learning from everything we've done in the past, implementing it going forward, and learning from what we're implementing.
Who are some of the other partners involved in this effort?
The state Department of Public Health is a key partner in this. They deserve tremendous credit for pulling together the data in a way that can inform how we deliver the intervention.
There's great expertise in Massachusetts in addressing addiction in general and opioids in particular, and we reached out to partners including Boston Children's Hospital, McLean Hospital, Mass General, Baystate Medical Center, UMass Medical School, Tufts University, the Boston University School of Public Health, and Brandeis University. No one said no. Everybody was enthusiastic, wanted to know how they could help, and wanted to give their particular talent to try to make this move forward.
Daunting? Yes. Possible? We believe so. But it means pulling out all stops.
This is a field where people work together and are pretty passionate about trying to make progress. When the grant opportunity was announced back in September, that's when the contemplation about the potential began. We put our heads together to say, "What can we do? What can we try to do in a big way to make a dent in this epidemic?" And a 40% reduction in overdose deaths is a bold dent. I think it's energized everybody that's signed on to this.
Reducing overdose deaths by 40% in the targeted communities is an ambitious goal. Does it feel daunting?
Daunting? Yes. Possible? We believe so. But it means pulling out all stops. It means looking at everything that has worked, it means looking at the data and deciding where the best opportunity to make progress is, and it means getting the best crew together, both here at Boston Medical Center, across the city of Boston, at other medical institutions, and across the state.
HEALing Communities comprises 16 communities and more than a dozen partner institutions in Massachusetts.
How will the HEALing Communities study be implemented in Massachusetts?
We want to bring the best, proven, evidence-based treatments for opioid use disorder and the prevention of overdose deaths to these communities and implement them in a community-engaged fashion.
Medications to treat opioid use disorder and prevent overdose deaths are at the core. We know the medications decrease mortality, and hence getting people on medications is a core strategy. Also at the core are elements to communicate the fact that the stigma associated with the disease has to be faced head-on, and people need to be congratulated for getting into recovery.
What do you mean by "community-engaged fashion"?
We're presenting a menu of options to communities. We're not saying, "You do this," or "You do that." We're saying, "These are all the things that we know works, or we think works, and we want to show them to you and have you decide what works for your community."
If you don't have a prison in your community, or people coming home from prison, then a program dealing with medications for people leaving prison probably isn't what you want. But it may be that you have an emergency department or a hospital that's seeing a lot of people overdose. The interventions can be tailored to communities. The idea is that many doors might be a pathway to treatment.
How replicable are the interventions that will be used in the study? Are you hoping that other states and communities will learn from your experience in Massachusetts?
The hope is that we'll learn many things that can be used in communities around the country. We may learn what works best in one community with certain characteristics, compared to another. We may learn what works best to get a community to adopt treatments that they hadn't previously adopted. We may learn the economics of going about it one way versus another way. There is tremendous opportunity, once we get it up and running and then evaluate it. There are lots of dimensions from which to learn.
The headlines about the opioid crisis have been so grim, but this study seems to offer some hope and inspiration. What would you say to someone who's looking for the light at the end of the tunnel of this epidemic?
The inspiration that there's hope to address the opioid use epidemic is everywhere. It's among those people who are in recovery. And there is no place in this country where there are not people who are in recovery, people who have suffered, struggled, embraced treatment, and changed their life around. And what really inspires clinicians — physicians, nurses, social workers — is that we see those people.
The challenge is those people are often invisible. They're right among us, and we don't recognize the successes that are possible. Sharing some of those successes may help people feel as inspired as the team does, that this is something we can make progress with.
This interview has been edited and condensed.