Black residents accounted for the largest increase in opioid overdose death rates

Opioid-related overdose deaths in Massachusetts increased by 2.5 percent in 2022 compared to 2021, with rates among Black, non-Hispanic residents making up the largest increase, according to preliminary data released today by the Massachusetts Department of Public Health (DPH).   

There were 2,357 confirmed and estimated opioid-related overdose deaths in 2022, surpassing the previous peak in 2021 by an estimated 57 deaths. Preliminary data also show there were 522 confirmed and estimated opioid-related overdose deaths in the first three months of 2023, a 7.7 percent decrease (an estimated 44 fewer deaths) from the same time period in 2022. 

Among non-Hispanic Black residents, the opioid-related overdose death rate increased by 42 percent, from 36.4 to 51.7 deaths per 100,000 residents from 2021 to 2022. When broken down by sex, the data show that non-Hispanic Black men had the highest opioid-related overdose death rate increase among males in all race/ethnicity groups, from 56.4 to 79.6 per 100,000 (a 41 percent increase). The rate for non-Hispanic Black women increased by 47 percent, from 17.4 to 25.5 per 100,000. 

The Healey-Driscoll Administration’s opioid prevention efforts are focused on providing communities with the resources needed to support a wide range of substance use programs, including those centered on behavioral health and homelessness. The Administration’s Fiscal Year 2024 (FY24) budget proposes investments of more than $600 million for substance addiction prevention and treatment programs, including critical funding for expanding outpatient services, increasing access to crisis stabilization services in communities and emergency departments, and strengthening the continuum of care in inpatient settings. 

“As Attorney General, I made combatting the opioid crisis a top priority, and that commitment continues as Governor while we work to provide individuals and communities with the support they need for treatment, prevention and recovery,” said Governor Maura Healey. “Too many Massachusetts families, particularly families of color, have been impacted by this crisis, and in order to effectively respond, we need to address the gaps in the system by advancing long-term solutions that include housing, jobs, mental health care and more resources for our cities and towns.” 

 “We know that the opioid crisis impacts communities across Massachusetts and requires a collaborative response between the state and municipalities,” said Lieutenant Governor Kim Driscoll. “By investing in supports at the local level, including increasing access to crisis stabilization services in the community, we will be able to support people where they live, and where their families and communities can support them in their treatment.” 

The Commonwealth continues to expand existing substance use disorder treatment and overdose prevention initiatives, including increasing access to the overdose-reversal drug naloxone. Massachusetts has already exceeded, and plans to expand upon, federal naloxone “saturation” goals, providing communities with enough naloxone to prevent overdose deaths that may occur from a lack of medication access. Since 2020, DPH has distributed nearly 300,000 naloxone kits to harm reduction programs, opioid treatment providers, community health centers, hospital emergency departments, and county houses of correction, with distribution increasing about 40 percent each year. DPH has increased its investment in naloxone by more than 140 percent in recent years, from $2.9 million in 2018 to $7 million in 2022. Through these investments, DPH launched the Community Naloxone Purchasing Program in May 2022 to increase distribution of free naloxone through organizations to community members across Massachusetts.  

In response to the rise in opioid-related overdose deaths, DPH issued an advisory last month urging all providers to increase availability of naloxone kits and train staff to dispense and administer naloxone to anyone who may need it. Retail pharmacies in Massachusetts should continue to dispense naloxone without a prescription as part of a statewide standing order. Everyone, especially those around people at high risk for overdose, should carry and know how to use naloxone, which can prevent serious harm and death from overdose. Those at high risk include people taking high doses of prescription opioids, people misusing prescription opioids, and people using illicit opioids or other drugs, which can be contaminated with the powerful opioid fentanyl. 

“We understand that to address the opioid crisis, we need to prioritize overdose death prevention while simultaneously investing in comprehensive supports for those dealing with substance use disorder, to ensure they have every opportunity for recovery,” said Secretary of Health and Human Services Kate Walsh. “We have to lean into the disparities we see in impacts on Black residents and target our interventions accordingly. Challenges like housing, hunger, and accessing education, behavioral health treatment and transportation need to be addressed in concert with substance use treatment in order to turn the tide of this epidemic.” 

 “The increase in opioid-related overdose deaths is a tragedy and alarming,” said Department of Public Health Commissioner Robert Goldstein, MD, PhD. “We know overdose deaths are preventable. The pandemic has had a devastating impact on mental health and substance use, especially among marginalized communities. We are working to reverse these troubling trends by continuing to build on our data-driven and equity-based approaches toward responsive support and treatment.”     

Key Points and Interventions:  

• The opioid-related overdose death rate in Massachusetts increased to 33.5 per 100,000 people in 2022, 2.5 percent higher than in 2021 (32.7 per 100,000) and 9.1 percent higher than the pre-pandemic peak in 2016. 

• Since August 2022, DPH has distributed about 275,000 rapid fentanyl test strip kits at no cost to providers and community organizations and plans to expand distribution in the coming year. Single-use fentanyl test strips help reduce the chances of overdose by allowing people who use drugs to test their supply prior to consumption to determine if it is tainted with fentanyl.   

• Fentanyl was present at a rate of 93 percent of fatal opioid overdoses in 2022 where a toxicology report was available. Cocaine was present in 53 percent of toxicology reports, a 4 percent increase over 2021. Alcohol was present in 28 percent, benzodiazepines in 27 percent, prescription opioids in 11 percent, amphetamines in 9 percent, and heroin in 6 percent. Xylazine was present in 5 percent of opioid-related overdose deaths from June to December 2022 where a toxicology screening was available.  

• 47 percent of all opioid-related overdose deaths were between 25 and 44 years old; 43 percent were between 45 and 64 years old.  

• Males comprise 72 percent of all opioid-related overdose deaths in 2022.   

• In the first three months of 2023, males aged 35-44 accounted for the greatest number of suspected opioid-related incidents with a known age and sex treated by Emergency Medical Services (EMS) at 19.4 percent. This marks a shift from prior years where the greatest number of incidents occurred among males aged 25-34.  

• Naloxone was administered in 97 percent of acute opioid overdoses occurring in the first three months of 2023.

• Using federal funds, DPH continues to increase investment in 29 opioid addiction treatment programs across the Commonwealth to expand services aimed at reaching historically underserved or hard to reach populations, including those in the hardest-hit communities like Boston, Lawrence, Lynn, Springfield, and Worcester.  

• DPH’s ongoing investments in temporary and permanent low-threshold housing for homeless or housing unstable individuals struggling with substance use disorder have led to the placement of more than 400 people so far. Using funds from the state’s Opioid Recovery and Remediation Fund, DPH expects to increase low-threshold housing units statewide from 394 to 761 and is on track to house more than 500 people by the end of FY24.  

• The largest overdose death increases in 2022 were seen in Worcester County (18 percent, from 281 to 331) and Plymouth County (14 percent, from 167 to 190).  

• The most rural communities had the highest opioid-related overdose death rate in 2022 at 36.1 deaths per 100,000 residents.   

• The following cities and towns experienced a notable decrease in opioid-related overdose deaths in 2022 compared with 2021: Gloucester, Haverhill, Norton, Salem, and Taunton.   

• The following cities and towns experienced a notable increase in opioid-related overdose deaths in 2022 compared with 2021: Lawrence, Leominster, Lynn, Springfield, Waltham, Weymouth, and Worcester

— Massachusetts Department of Public Health (DPH)