Authors: Zachary Richard & Eric Andrade, students in Professor Gloria de Sa’s SOC/ANT 350, ‘Urban Issues in Public Policy’ (learn more about their collaboration with the UI by reading this post)
Editor’s note: Zach and Eric also produced an excellent presentation which you can view here: Opioid addiction presentation – PDF.
Recent Opioid Discussion & Trends
Opioid abuse and overdoses have become central topics of discussion both locally and nationally in recent months. The heroin related death of actor Philip Seymour Hoffman stoked these discussions and brought them to the forefront of public discourse via media coverage and public officials. Vermont Governor Peter Shumlin dedicated nearly his entire state of the state address back in January to discussing the heroin / opioid problem in his state. Massachusetts Governor Deval Patrick declared a “public health emergency” in Massachusetts in March resultant of heroin /opioid abuse in the commonwealth. Attorney General Eric Holder even weighed in to the discussion earlier this year calling it an “urgent public health crisis.”
Here in Massachusetts Governor Patrick has implemented a policy to make Narcan, a drug used to reverse the effects of opioid overdoses, available to police officers and first responders to combat opioid overdoses; which are believed to be increasingly resultant of the incorporation of fentanyl in opioids, primarily heroin. Governor Patrick recently even tried to ban ‘Zohydro’ in the commonwealth; a new FDA approved prescription opioid. Federal courts quickly rejected the ban and overturned it; much to the dismay of Governor Patrick. Zohydro sparked a firestorm amid already opioid weary politicians and citizens both in Massachusetts and beyond. Locally Mayor William Flanagan of Fall River (one of the most opioid afflicted cities in Massachusetts) beseeched President Obama to weigh in and speak on behalf of those trying to ban Zohydro. This discussion has landed on the national stage where senators have also expressed concern over the new potent opioid which some have called, “heroin in a capsule.” According to the National Institute on Drug Abuse “Prescription opioid pain medications such as Oxycontin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and research now suggests that abuse of these drugs may actually open the door to heroin abuse.” With the rising prevalence of prescription opioids in the U.S one can infer that this is having a substantial effect on opioid abuse and is a leading cause of addiction.
Statistically speaking Massachusetts has, overall, seen in increase in opioid related overdoses over the past decade. “The rate of unintentional opioid-related overdose deaths, which includes deaths related to heroin, reached levels in 2012 previously unseen in Massachusetts. The rate of 10.1 deaths per 100,000 residents for 2012 (the most recent full year of data available) was the highest ever for unintentional opioid overdoses and represents a 90% increase from the rate of 5.3 deaths per 100,000 residents in 2000. In 2012, 668 Massachusetts residents died from unintentional opioid overdoses, a ten percent increase over the previous year. While data are still preliminary, unintentional overdose deaths for the first six months of 2013 point to even higher numbers than 2012.” (Mass.gov) Nationally the figure is up as well.
According to the National Institute on Drug Abuse’s National Survey on Drug Use and Health (NSDUH), “in 2012 about 669,000 Americans reported using heroin in the past year,a number that has been on the rise since 2007. This trend appears to be driven largely by young adults aged 18–25 among whom there have been the greatest increases. The number of people using heroin for the first time is unacceptably high, with 156,000 people starting heroin use in 2012, nearly double the number of people in 2006 (90,000).” The report goes on to state that “Heroin use no longer predominates solely in urban areas.” This information correlates with Massachusetts data which states that “In addition to the burden in major cities, many smaller communities saw increases” in opioid abuse and overdoes between 2003 and 2012, according to the most recent information from the Massachusetts Department of Public Health.
As far as New Bedford and Fall River are concerned opioid overdoses haven’t changed too much. Though yearly fluctuation does occur, fatal overdoses in these cities are continuously higher than others in Massachusetts. Due to its much larger population, Boston had the most opioid overdoses each year between 2000 and 2012. However it is quite clear that opioid abuse is particularly high in the South Coast due to the fact that New Bedford and Fall River literally alternate between 2nd to 4th place for opioid overdoses each year, despite the fact that these cities are currently the 6th and 10th most populated cities in Massachusetts, respectively. (2010 census data) In 2012 New Bedford had the second most opioid overdoses in Massachusetts with 25. New Bedford also came in second in the years 2010 and 2008. In 2011 Fall River was tied for second with Lowell with 25. It was also in second in 2009. These numbers have remained largely similar in the South Coast since the year 2003 (Mass.gov statistics, refer to table 1) Another telling fact is that according to the Herald News, which cites the Massachusetts Prescription Monitoring Program, 72% of prescriptions given to Fall River residents were opioid based, while in New Bedford that number is 70%. Both cities are well above the Massachusetts prescription rate of 40%. It is clear that opioid abuse is a serious and sustained problem in the South Coast.
From Criminal Justice to Public Health
Unquestionably the topic of opioid abuse has been at the forefront of much discussion. Whether or not there is a full-fledged epidemic, as is claimed by many, remains to be seen – as data for 2014 and the second half of 2013 is not yet available. However, one may agree that irrespective of the semantics of whether or not opioid abuse constitutes an epidemic something should be done to alleviate and resolve this problem. Opioid abuse is a serious and troubling affliction that should most certainly be addressed and discussed by lawmakers, media outlets, and the public at large. We must also, and most importantly, adjust our understanding of drug addiction and remove it from the realm of criminal justice; shifting it to the jurisdiction of public health where it rightfully belongs. Persecution has arguably gotten us nowhere. Let us heal and not condemn. Also we should critically examine the role of the pharmaceutical industry in potentially stoking this surge in opioid abuse and overdoses. As a society we should begin the debate as to whether or not the benefits of prescription opioids outweigh the costs.
Table 1. Cities/Towns with Over 7 Unintentional Opioid Overdose Deaths in 2012, MA Residents
Figure 1. Rate of Unintentional Opioid Overdose Deaths, MA Residents, 2000-2013
Source: Registry of Vital Records and Statistics, MDPH
Figure 2. Number of Unintentional Opioid Overdose Deaths, MA Residents, 2000-2013