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Report outlines why WMass struggles to combat opioid crisis

  • Containers depicting OxyContin prescription pill bottles lie on the ground in front of the Department of Health and Human Services’ headquarters in Washington on April 5 as protesters demonstrate against the FDA’s opioid prescription drug approval practices. AP



Staff Writer
Saturday, September 07, 2019

AMHERST — The opioid crisis in western Massachusetts continues to grow, fueled by a range of factors including an increase in fentanyl in the region, a large number of doctors prescribing opioids, a lack of access to treatment and federal regulations some say make it hard to help people with addiction.

An increase in the number opioid-related deaths in the state’s four western counties in 2018 — even as deaths dropped statewide — is also having a ripple effect in the region, as more grandparents are raising their grandchildren and the number of children in foster care has shot up.

These findings and more are outlined in a new report from the Massachusetts Health Policy Forum, an organization based at Brandeis University. The report, “Addressing the Opioid Crisis in Small and Rural Communities in Western Massachusetts,” was unveiled Friday during a forum at the University of Massachusetts Amherst that drew hundreds of people.

“There truly are unique challenges in western Mass ... but I think that is widely recognized here and we’ve recognized the unique opportunity that western Mass has to come together to solve this problem,” said Constance Horgan, director of the Institute for Behavioral Health at the Heller School for Social Policy and Management at Brandeis.

Last year, opioid-related deaths met or topped previous records for all four western Massachusetts counties, according to thedata. In Hampden County, deaths nearly doubled, jumping from 113 in 2017 to 208 in 2018.

Challenges

The report looks at issues that western Massachusetts faces in addressing the opioid epidemic — what U.S. Sen. Ed Markey called “the most devastating public health crisis facing our country” in a videotaped address shown at Friday’s forum.

The report included a literature review, data analysis, and 24 “stakeholder interviews” that included medical providers and community coalitions. The team did not interview anyone with opioid use disorder, according to Robert Bohler, a Ph.D. student at Brandeis and the report’s lead author.

Bohler explained some of the struggles western Massachusetts faces in addressing the crisis.

“We think a significant factor here is the recent increase in fentanyl in the drug supply,” he said.

Fentanyl is a synthetic opioid that can be 50 to 100 times stronger than morphine. Opioid-related deaths involving fentanyl are climbing faster in western Massachusetts compared to the rest of the state, the report says.

There also are more opioids prescribed in the region, Bohler said. U.S. Drug Enforcement Administration data showed that between 2006 and 2012, Hampden County had the second-highest number of opiate prescriptions per capita in the state, while prescriptions per capita in Berkshire County were the third highest, the report says. One Greenfield pharmacy got more prescription opioids than any other pharmacy in the state.

Another challenge is a lack of public transportation to access methadone clinics and other treatment. Some people have to spend hours to get to a clinic and some clinics have waiting lists, the report says. The North Quabbin and the southern part of Berkshire County are considered “methadone deserts,” an area where there is “impractical traveling distances severely restricting access to clinics,” the report says.

From the Quabbin area, for example, getting methadone might mean a 50-minute drive, said Dr. Ruth Potee, director of Addiction Services Behavioral Health Network.

“It is unacceptable,” she said.

Drugs such as methadone and buprenorphine are effective medication-assisted treatments for addiction, Potee said. They’re just as effective as blood pressure medication and, “they work a hell of a lot better than antidepressants do,” she said.

Yet the medications can be difficult to get. She sees some federal government regulations as a barrier in making methadone accessible and establishing overdose prevention sites, places where people can safely use drugs. Those who need methadone for opioid addiction treatment have to get it from an opioid treatment program certified through the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The barriers to accessing this drug are so crazy — we need to call SAMHSA on a daily basis, and we need to be advocating with our legislators saying this has to go,” Potee said.

Although a lot of work has been done to address the opioid crisis in western Massachusetts, she said, “I would argue that we have hit a giant 3-foot-thick, mile-high brick wall. And that brick wall is the federal government and regulations to help get people the treatment we need.”

Stigma is also a barrier.

“We still have a huge issue with stigma in medical professionals,” Bohler said. A 2019 survey in Massachusetts showed that half of family medicine, internal medicine and emergency room doctors “thought opioid use disorder was not a treatable condition,” he said.

And in small communities, including parts of western Massachusetts, “It’s hard to maintain anonymity,” Peter Friedmann, chief research officer for Baystate Health, said at the forum.

Ripple effects

Bohler also spoke about the effects of the opioid crisis in western Massachusetts. In the report’s interviews, he said researchers heard many cases of grandparents raising their grandchildren because of opioid addiction.

Across the state, the number of children in foster care increased by nearly 20 percent over the last five years, Bohler said. The report says that statistic is “largely attributable to the opioid crisis.”

Economically, the cost of the crisis in western Massachusetts — a number that includes account health care, public safety and criminal justice costs — totals an estimated $1.8 billion, Bohler said.

Despite the challenges, “We have reasons for optimism here in the west,” Friedmann said. “We have very strong community coalitions.”

Both the report and the forum speakers pointed to local coalitions, including The Opioid Task Force of Franklin County and the North Quabbin Region, Hampshire Hope, and Hampshire County’s Drug Addiction and Recovery Team, “an innovative program where a team comprised of police officers, recovery coaches, and harm reduction specialists follows up with people after a nonfatal overdose, substance-related incident, or referral,” the report says.

The report also points out efforts at Franklin County jail. For example, last month, the facility became one of the first jails in the country to get a federal license to dispense methadone to inmates, many of whom have opioid-.

Greta Jochem can be reached at gjochem@gazettenet.com.