While Massachusetts is reporting a decrease in opioid-related overdose deaths statewide in 2019, the western half of the state is still seeing those numbers rise. Jennifer Kimball of the Berkshire Opioid Addiction Prevention Collaborative says there are difficulties in tracking overdose deaths in smaller communities. She spoke with WAMC Berkshire Bureau Chief Josh Landes about why rural portions of the state struggle more than urban areas, and how better data collection can inform efforts to prevent the state’s 2,000 yearly deaths from opioid-related incidents.
KIMBALL: At the state level, what we finally started to see, as of 2017, was a leveling off, a slight decline, at the state level. And on the state level, again, it looks like the declines are continuing, although, you know, it's at a very, very miniscule rate. And, for example, in 2017, we had 2,050 deaths and then went to 2,031. And then they show in 2019, 2,015 deaths. I think the most important things that I glean from this data is that we're still seeing over 2,000 deaths per year in the state of Massachusetts related to opioid use disorder, and that is is too many. The other thing I think that needs to be noted is a lot of this data, lags in time and is still quite preliminary and can be adjusted in that, you know, for 2018 and 2019. And from my experience, these numbers tend to when they get adjusted, adjust up, not down. So on the state level, we're we're happy to see the decreases, you just need to know that there's still way too many opioid overdoses and overdose deaths in the Commonwealth. And that we don't have a lot of information as to who, what, why on the local level, that would make addressing opioid use disorder in Berkshire County so much more easy to do.
WAMC: Looking here at the county, what are the trends like here? Do they differ from that slight decline you're seeing at the state level?
I think it's important to note, and it has been noticed now at the state level and by researchers, say, at Brandeis University or whatever, there was a policy brief about opioid use disorder in Western Massachusetts that kind of showed how Western Massachusetts is an outlier compared to the rest of the state, and was really absent from the state discussions, and state, I guess, line, if you will, that opioid use disorder related overdoses and deaths, deaths, specifically, were on the decrease. That was not mirrored in Western Massachusetts, and I think we discussed this last year, that in 2018, that was a 48% increase in opioid overdose deaths. We're still around the same number preliminarily, for 2019. In 2018, they said 41 deaths for Berkshire County. In 2019, preliminary numbers are 40, so we're holding steady. Locally, what we do see, what we are allowed to see that's not, I guess- Because some of our towns are smaller, data gets suppressed. So you will get information that you have between one and four deaths or whatever, so suppressed information is an issue. It doesn't give us as clear of a picture in Western Massachusetts as we'd like to have. But what we do see in the number of opioid-related overdose deaths, they do a report on the Massachusetts Department of Public Health website and the latest one posted in June has us through 2019, and we do see the cities of North Adams and Pittsfield significantly up for 2019 deaths. A lot of towns are holding steady, but we do have towns like Great Barrington, and Lenox, and Pittsfield, and North Adams that have shown some notable increases in overdose deaths.
So, why why would that be? Why are these population centers in the Berkshires still trending upwards?
Well, I think that is the big question as we try to dig down on why we're seeing these increases. Not just here, but in Hampshire, Hampden, and Franklin Counties, as well. And that's not to say parts of Eastern Mass aren't also seeing increases in overdose deaths, I think. But, what we're hearing in the news a lot is just the state level data, and that doesn't necessarily translate to here. There's a number of reasons why rural health outcomes, opioid use disorder related outcomes, as well, don't fare as well in as those in other areas. We have rural isolation. We have more of a stigma, a history of stigma, of drug use, perhaps than other areas. We're just, you know, in the last few years gotten more harm reduction units to open up in North Adams and Pittsfield. And also, I think one of the major reasons why we're seeing more overdose deaths in Western Massachusetts, as we are later to the game, if you will, not a whole lot later, but later in getting higher amounts of fentanyl and other synthetic opioids in our drugs here that are in in Berkshire County. So before, when we might have had more heroin, in the heroin, we're seeing a huge amount of synthetic opioids, which are by far more potent, in the drug supply here. So that is an element of it. We do have many rural areas, many areas with rural EMS or volunteer EMS. So sometimes getting to these more rural parts of the county results in more time getting to the scene of an overdose, which of course, time is of the essence. And that can result in poorer outcomes as well. So, we have a lot of different dynamics going on. And that isn't even to touch, scratch the surface of what we call systems of oppression: institutionalized racism, lack of access to health care, lack of access to housing, good paying jobs. All those things also factor in to what I call kind of a "cocktail" of something that would create poor health outcomes, and one of those being overdose deaths. So there's a lot, I think there's a lot going on here. And I just think when we, when we're looking to the state for our data, although I have to say that I think they do a pretty good job with data at the state level, but if you really wanted to unpack it and look at it for local level, it doesn't communicate well to local information, and local information that people can really build interventions around, to strategize to address the increase in deaths. So that's some of the work I do with Berkshire Opioid Addiction Prevention Collaborative is trying to improve the data system that will tell us the who’s, what’s, and why’s of why these overdoses are increasing so greatly.
So as far as those key data points, what are you looking for to make sure that you can track this information with the most accuracy for Berkshire County?
Well, I think, one of the best ways we can do it, although it's harder to clean the data, is to build upon relationships that we have with EMS and other first responders in Berkshire County, to send us reports on a monthly basis, of what they're seeing: relative locations of overdoses, how many NARCAN units filled, that kind of thing. Some more rapid responses. Because as you see, this is June and we're just getting 2019 data, and we still don't really have the updated data which CPH was referencing, the first number of months of 2020. When we get those reports, if we see them this month, we don't see those first three quarters. So we really have to work with our building relationships with our local partners and regional partners, and strategize ways around getting better data. And I think one of the things that's most exciting around the data that will help us, is with our other Western Mass partners in Franklin, Hampshire, Hampden County. We're building in partnership with a grant that Franklin County Sheriff's Office got, what's called the World Opioid Data Collaborative, which is going to be a database that will look at a whole bunch of different data sets, not just overdose, but we're going to look at, be able to look at: housing status, or if someone was justice involved, or someone, you know, has other law enforcement touches in their past, if they have a DCF record. There's going to be a database that the Northampton Health Department is currently using, that, for their post-overdose engagement case management- That this will be built out into Berkshire County, and we'll be able to really look at all these datasets. And kind of see what really is happening, really kind of try to drill down on the whys. And so that is also a three year grant that we have a partnership on, that will help us get better data, faster, to our community partners.