Boston: Public Health Commission Increased Prevention Services as Latest Data Highlights Major Racial Inequities in Overdose Deaths

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New data shows opioid-related overdose deaths increased by 12% in Boston from 2022-2023 even though there is a 10% decrease statewide, according to the Massachusetts Department of Public Health's latest report. In Boston and throughout the state, there has been a notable increase in fatal drug overdoses for Black and Latinx residents. In Boston the drug overdose mortality rate increased by 27.9% and the opioid mortality rate increased by 27.3% for Black residents, and for Latinx residents the drug overdose mortality rate increased by 5.6% and the opioid mortality rate increased by 15.7%. The drug overdose mortality rate includes deaths due to the combination of cocaine and opioids (primarily fentanyl), which can be ingested knowingly or unknowingly. These data underscore the urgent need to address racial and ethnic inequities in the substance use crisis. To bolster current efforts, the Boston Public Health Commission (BPHC) is using $7.5 million in new funding to increase substance use services, support low-threshold housing, train more people in overdose rescue, and build citywide infrastructure to support individuals living with substance use disorder.

"The increase in drug overdose deaths in Boston, particularly among Black and Latinx residents, emphasizes the urgent need for interventions across the city in overdose prevention and substance use treatment," said Dr. Bisola Ojikutu, Commissioner of Public Health and Executive Director of the Boston Public Health Commission. "As the Commission uses new investments to address this crisis, residents need to understand the dangers of all drug use. If you are a person living with substance use disorder, check your supply, do not use alone, and have naloxone on hand to prevent fatal overdose."

The Commission's newly published Health of Boston 2024 Substance Use and Disorders Report highlights trends in substance use in Boston. It found that since 2017, drug overdose deaths have been increasing throughout the city. Reasons could include the impacts of social determinants of health; a lack of awareness that fentanyl is in the cocaine supply; and COVID pandemic disruptions that led to changes in drug use patterns, decreased access to services, and increased stress and isolation, limiting interventions that reverse overdose.

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BPHC's report data show:
  • Drug overdose mortality associated with use of fentanyl in combination with cocaine increased significantly from 2017 to 2022 from 6.6 deaths per 100,000 residents to 16.9 deaths per 100,000 residents.  
  • Cocaine was present in more than half of all overdose-related deaths associated with fentanyl in 2022, and over 60% involved some combination with other opioids and/or cocaine.
  • Substance use-related hospitalizations and emergency department visits slightly decreased from 2017 to 2021.
  • In 2021, Black residents experienced higher rates of non-fatal opioid and cocaine overdoses, and Latinx residents experienced higher rates of non-fatal opioid overdoses, compared to white residents.
  • From 2017 to 2021, treatment admissions for all major substance types (alcohol, cocaine, opioids, and marijuana) decreased for Boston residents overall, and across all racial/ethnic groups.

The report also highlighted that the affordable housing crisis and the COVID-19 pandemic exacerbated the opioid epidemic and unsheltered status in Boston. The City and BPHC responded by working with the State to provide low-threshold sites, which have played a critical role in providing a stabilizing environment for people, connecting them with treatment and other services, and transitioning them to permanent housing. Through a federal grant from the Office of Minority Health, BPHC will continue to ensure racial equity in access to low threshold shelter and services for people living with substance use disorder.

In addition, the Commission is using new federal funding to expand current overdose prevention services and improve data collection so a wide array of service providers, local nonprofits, and Boston residents have resources and training to play an active role in overdose prevention and response, building a citywide support system with different avenues of care. The Commission's $6.5 million from the CDC's Overdose Data to Action (OD2A) grant will be used to create a dashboard to track fatal and nonfatal overdoses to enhance targeted prevention strategies across the city. This funding will also embed substance use navigators in community health centers to keep active drug users in the healthcare system, and it will train medical staff on harm reduction techniques and best practices. Boston's opioid remediation funding will give community-based organizations $1 million dollars to increase access to naloxone, a life-saving medication that can reverse an opioid overdose. Through more access and training on how to use naloxone, Boston residents will be empowered to reverse overdose and encourage others to perform overdose rescues in their communities.

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BPHC is at the forefront of the City's response to the substance use crisis. BPHC's Recovery Services Bureau operates a continuum of care, spanning outreach, harm reduction, treatment, and community-based programs. The Bureau's outreach workers regularly reverse up to five overdoses per day and host free trainings on how to respond to overdoses and administer naloxone. In 2023 the Bureau distributed over 23,000 doses of naloxone to residents and community partners and made 2,389 referrals for substance use treatment.

Harm reduction and treatment referrals are available through BPHC's AHOPE and PAATHS programs. AHOPE offers lifesaving harm reduction services including syringe exchange; drug checking to identify the presence of fentanyl and xylazine; naloxone distribution; and screening for HIV, hepatitis, and other bloodborne illnesses that can be spread through intravenous drug use. The PAATHS program connects people to a variety of treatment services including detox, medication for opioid use disorder, and outpatient treatment programs. For support with substance use disorders, contact the PAATHS program at 1-855-494-4057 or call 3-1-1. For more information, visit boston.gov/recovery.

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