Worcester Reports 37 Suspected Drug Overdose Deaths in 2014

Thursday, February 27, 2014

Zeke Wright, GoLocalWorcester Contributor

One in 200 Worcester County residents checked into substance abuse treatment for an injected drug addiction in the latest year that data was available — and the number is on the rise according to local treatment providers.

Between the beginning of this year and Wednesday, the number of suspected drug overdose deaths in the city of Worcester totaled 37 according to reporting by the city police department available on CrimeReports.com.

Concern is for heroin combined with Fentanyl

“The heroin problem in Massachusetts is not new,” said Constance Peters, vice president for addiction services at the statewide Association for Behavioral Healthcare. “Both fatal and non-fatal overdoses are long standing problems. However, at this time, there is a new trend developing where heroin is mixed with Fentanyl (a pain medication) that is possibly behind this most recent rash of overdose deaths.”

Michael Stuart, the executive director of inpatient and residential services for Spectrum Health Systems, called Fentanyl-laced heroin the “most significant factor” contributing to the recent, dramatic increase in fatal overdoses.

“Illicit opioid use, including heroin and prescription medications, has significantly increased in our region. Our treatment programs are seeing not only an increase in volume of persons seeking help, but also a downward trend in the ages of these people,” Stuart said.

Worcester County Sheriff Lewis Evangelidis pointed to youth health surveys that show greater abuse of prescription painkillers than marijuana.

In central Massachusetts in 2011, 18.6 percent of high school seniors between eight school districts reported abusing prescription drugs.

Heroin cheaper than prescription painkillers

“The perception is that these aren't 'real drugs', they're prescriptions,” Evangelidis said, in speaking to high school students through an education program run by his office. “Now we're seeing what's the effect. ... They're leading to real dependency.”

Given the high cost of prescription pills on the street, heroin becomes a cheaper alternative. “I see a lot of the end results in our prisons,” Evangelidis said.

The overdose figure in Worcester includes all deaths that were preliminarily ruled as drug-related, but the number is always subject to change following official medical examinations.

“We're not making that assessment,” said Detective Sergeant Glenn Fossa of the Fitchburg Police Department. Recounting the cocaine craze of the 1970s and early 1980s giving way to heroin during his three decades in law enforcement, Fossa attributed heroin use partly to people initially prescribed pain medication and partly to experimental recreational use.

Paradoxically, he said news of more lethal strains drove users to seek it out. “They don't care about overdosing, they want the high,” Fossa said.

“There's this poisonous level of heroin on the street — and they go and seek it out.”

Overdoses across Massachusetts on the rise

Since state police implemented a new case management and tracking system Nov. 1, 2013, they've recorded 185 fatal heroin-related overdoses. That number reflects the entire state minus the three largest cities: Boston, Worcester, and Springfield, which each handle their own investigations.

In Worcester County outside of the city, state police reported 12 fatal overdoses over that timespan. (In Worcester, police reported 42 suspected overdose deaths in November and December of last year, not specifying the type of drug.)

State police spokesperson David Procopio said the numbers “absolutely represent an increased rate of fatal heroin overdoses.”

Procopio said possible contributing factors included a more potent strain of heroin, Fentanyl increasing the drug's toxicity, and frequent poly-drug use, combining heroin with other drugs like Percocet.

Across the state, the alarm has been raised over opiate deaths and overdoses this week. On Monday, at a conference with lawmakers and the White House director of drug control policy, U.S. Sen. Edward Markey called the increase in deaths a “scourge”.

“Like so many other states, here in Massachusetts there can be no doubt that the use of opioids has reached epidemic proportions,” said Massachusetts Department of Public Health Commissioner Cheryl Bartlett in a blog post Wednesday . “The evidence is clear and compelling, as seen in terms of rising rates of fatal and non-fatal overdoses as well as trends in substance abuse treatment.”

In 2013, Bartlett said fully half of all individuals participating in treatment programs reported opiates as their primary or secondary drug of choice.

How can communities respond?

“Heroin and prescription drug addiction is an equal-opportunity destroyer of lives,” Markey said on Monday, calling for a three-pronged plan that includes an expansion of naloxone (an opiate overdose-reversing drug) for first responders, greater access to treatment, and improving on that treatment system.

“We have seen a steady increase in our census over the last year,” said Kristin Nolan, executive director of outpatient services for Spectrum. “Access to treatment services to individuals addicted to heroin and other opiates is critical in overdose prevention.”

In 2012, the DPH reported 48,092 heroin-related substance abuse treatment admissions statewide — 330 of which were under the age of 18.

Nolan said discussion among community leaders and lawmakers was important, while educating youth, parents, and the community as a whole was crucial.

“Easily available and accessible treatment is the answer to deal with this epidemic,” according to Stuart. “The reality is that these persons want to get help and are often confronted with barriers to getting into treatment and remaining in treatment.”

“It's not a new problem, I think people are finally acknowledging the problem,” said Leominster Mayor Dean Mazzarella, who said city officials responded in a “100 different ways” including education, treatment, law enforcement, and rehabilitation. “It's complex and comprehensive. And it's not just heroin.”

Mazzarella said fatal heroin overdose numbers didn't begin to touch on deaths from all drugs, or nonfatal overdoses. “It's been going on for a long, long time,” he said, impacting not just cities by smaller towns and communities.

“It's made its way to Main Street, USA.”

Many admissions in Worcester, but below state average

In county-by-county reports last year, the state health department reported admissions to DPH-funded substance abuse treatment programs at 10,620 in Worcester County for 2011, the most recent year that data was available.

Of which, the state reported 4,156 injection drug (heroin) user admissions. That number was down from 4,230 in 2010.

Comparatively on a per capita basis, Worcester County was below the statewide average in drug treatment admissions.

For overall admissions, the county's “crude rate” (per 100,000 persons) was 1,347.8 compared to the statewide average 1,532.4. For injection drug user admissions, Worcester was 527.4 compared to 621.2 across the state.

Worcester's community health plan

Much of the county's substance abuse services are handled by Spectrum (their 182-bed Westborough treatment center is the largest such facility in New England) and Community Healthlink, which operates seven smaller recovery centers.

City and health officials met Wednesday to report on progress with the region's Community Health Improvement Plan (CHIP), a collaborative effort involving six local communities — a regional grouping of more than a quarter-million residents called the Central Massachusetts Regional Public Health Alliance.

Reducing the incidence of prescription drug and other opiate overdoses like heroin was one key behavioral health objective in the initial CHIP report last year. Behavioral health was ranked the top priority in assessments conducted in October 2012.

Reported heroin use rises and falls in waves

Across the state, admissions for heroin have risen and fallen by thousands on a year-to-year basis.

In 2012, adult admissions totaled 47,762 — the highest number since 2002, when there were 51,445 admissions statewide. The lowest recent reported number came in 2008, at 41,503.

Of those admitted for treatment for heroin use in 2012, two-thirds were men, 83 percent were white, and 90 percent were unemployed.

More than a quarter were homeless, and nearly half had received prior mental health treatment. Nearly three-quarters were between the ages of 21 to 39 (the mean age was 31.6).

“Over the past 10 or so years a significant shift has occurred in the addiction treatment system,” according to Peters, “younger individuals are seeking treatment and the primary reason is opioid addiction. They often started using alcohol and legal prescription and illicit drugs at 10, 11, or 12 years of age and now have chronic health care needs including infectious diseases and mental health needs due to histories of trauma and abuse. They are often unemployed and homeless, have criminal records, and are disenfranchised from their families and society.”

Peters said the health community needed to do more prevention work at an earlier age, beginning in the 4^th and 5^th grades. “We need to stop the trend of kids thinking it is a rite of passage and not a problem to be drinking and drugging at an early age.”

“Research shows that the younger a person is when they start using alcohol and drugs, the more likely they will have a lifetime addiction. There are both genetic and environmental factors involved (both nature and nurture) and we need more parents to become educated about addiction and its consequences. Addiction is a chronic brain disease and we need to treat it as such.”