Addiction progress slowed by pandemic
The increase wipes out five years of progress, with a toll much higher among Black and Hispanic people.
By Felice J. Freyer, Globe Staff

Opioid-related overdose deaths increased by 5 percent in Massachusetts last year and rose dramatically among non-Hispanic Black men, as the pandemic erased the state’s recent progress in combating the addiction crisis.

In its semiannual report, released Wednesday, the state Department of Public Health revealed that there were 2,104 opioid deaths in 2020 — 102 more than 2019 and two more than the peak year of 2016.

The state also released numbers for the first quarter of 2021, which showed a continued increase. There were 507 overdose deaths, 2 percent more than in the same period in 2020.

“Massachusetts was in a steady decline in opioid overdose deaths before the pandemic hit,’’ Dr. Monica Bharel, state public health commissioner, told the Public Health Council on Wednesday. “Despite all the effort and resources we poured into it, the pandemic has set back that progress.’’

The pandemic brought isolation, stress, and fear, said Dr. Miriam Komaromy, medical director of the Grayken Center for Addiction at Boston Medical Center.

“It’s a natural part of addiction that when people have increased stress, that triggers drug use,’’ Komaromy said. In addition, the advice to socially distance to avoid COVID-19 prompted more people to use drugs alone and risk overdosing with no one nearby to rescue them. And fear of infection kept people away from treatment centers.

Given all these challenges, Dr. Peter Friedmann, immediate past president of the Massachusetts Society of Addiction Medicine, said he was surprised the death rate wasn’t even higher. Friedmann credited state initiatives that eased access to medications to treat addiction, and he called for even bolder efforts in the future, such as offering doctors incentives to treat addiction and defying federal rules that limit access to methadone.

The toll struck state residents unevenly. When looking at the rate per 100,000, deaths actually declined from 2019 to 2020 among non-Hispanic white men, but it increased among Blacks, Asian and Pacific Islanders, Hispanics, and non-Hispanic white women.

The death rate per 100,000 among Black men surged the most, up 69 percent. (In contrast, the statewide increase per 100,000 was a modest 5.2 percent.) And while their increase wasn’t as steep, Hispanic men continued to have the highest rates of overdose deaths in Massachusetts.

“This is unacceptable and deeply troubling,’’ Bharel told the Public Health Council, an appointed board of physicians, academics, and consumer advocates. She noted that the same populations experiencing high overdose death rates were also hit hard by COVID-19.

The state is shifting its focus from diseases to populations, looking to address the underlying social factors that lead to a host of health problems, she said.

“We’re looking at racism as a public health crisis and something that should be addressed through the eyes of public health,’’ Bharel said.

Komaromy said that opioid addiction was increasing among Black people even before the pandemic. But that trend may have accelerated because of the extraordinary stresses on them during the past year, she said — the high rate of COVID-19 sickness and death, as well as the national focus on police violence against Black people.

There were also geographic differences. Several communities, including Lawrence, Lowell, Lynn, and New Bedford, experienced notable decreases in opioid-related deaths. But others, including Boston, Brockton, Holyoke, and Salem, saw deaths go up significantly.

Middlesex County has seen opioid-related deaths decline steadily over four years, from 402 in 2016 to 299 last year, a 26 percent decrease. The number of deaths in Suffolk County, in contrast, bounced up and down over the past four years and in 2020 was about 15 percent higher than in 2017.

Governor Charlie Baker said in a statement that both the pandemic and the latest data on drug deaths “have underscored the importance of supporting disproportionately impacted communities, and as we address both issues, our administration has continued to focus on equity as a core component of our response.’’

Baker’s fiscal year 2022 budget proposal includes $375.3 million to address substance misuse, a 7 percent increase over last year.

As in the past, illicit synthetic fentanyl was the main factor in overdose deaths, found in 92 percent of people in whom toxicology analyses were performed. Cocaine remains the next most prevalent drug, present in 46 percent of toxicology reports in 2020.

Lydia Conley, executive director of the Association for Behavioral Healthcare, the trade group for treatment providers, called the overdose data “disappointing but not surprising.’’ Association members have seen fewer people coming in for treatment, perhaps because of infection fears or the general disruption of society, Conley said.

“People were afraid to come into congregate care settings. There were good reasons for that,’’ said Emily Stewart, CEO of Casa Esperanza, which provides addiction recovery supports for the Latino community in Boston.

Casa Esperanza’s offerings include residential programs with people living in tightly packed quarters and open-access, walk-in outpatient care, both difficult to operate safely in a pandemic. As a result, Stewart said, overall the number of clients dropped by 25 percent to 40 percent — and those empty slots meant fewer people getting care and more left at risk of overdose.

Despite the discouraging numbers, Massachusetts suffered less when compared with the nation as a whole. The Centers for Disease Control and Prevention reported last month that drug overdose deaths nationwide soared by 29 percent between September 2019 and September 2020, but the increase in Massachusetts was in the single digits.

Massachusetts would have seen increases similar to those nationwide, Conley said, if the state had not moved quickly to ease access to services and provide financial support to prevent treatment programs from shutting down.

The state increased distribution of the overdose-reversing drug naloxone and loosened regulations so that nearly half of methadone recipients could take their doses at home, and others could get prescriptions for the other antiaddiction medications over the phone.

Those initiatives were enormously helpful, said Boston Medical Center’s Komaromy. But now, she said, the state needs to open more syringe services programs, where drug users can get clean equipment and other services, and authorize the controversial “harm reduction sites’’ or “safe injection facilities,’’ where people can use drugs under medical supervision. No such program is currently sanctioned in the United States, but other countries have found them to be life saving.

“If you look at the magnitude of the deaths, all the lives lost, we have a public health disaster going on in parallel with the COVID epidemic,’’ Komaromy said. “We need to take it just as seriously and be just as aggressive in trying to solve it.’’

Felice J. Freyer can be reached at Follow her on Twitter @felicejfreyer.