OD deaths down, thanks to Narcan

Boston Herald - - NEWS - — lind­say.kalter@boston­her­ald.com

Fa­tal opi­oid over­doses in Mas­sachusetts fell by 8 per­cent in 2017 after sev­eral years of steadily ris­ing death tolls, ac­cord­ing to new state data.

But lo­cal ad­dic­tion spe­cial­ists say grow­ing use of over­dose-re­ver­sal agent nalox­one, com­monly known as Narcan — not a de­crease in opi­oid use — is likely a ma­jor fac­tor.

“I think the rea­son is, there’s no ques­tion, the ex­pand­ing of ac­cess to Narcan amongst all peo­ple,” said Dr. Laura Ke­hoe, med­i­cal di­rec­tor at the Mas­sachusetts Gen­eral Hospi­tal Sub­stance Use Dis­or­der Bridge Clinic. “There’s still a num­ber of peo­ple with un­treated, se­vere opi­oid use dis­or­der.”

The to­tal num­ber of es­ti­mated and con­firmed opi­oid-re­lated over­dose deaths in 2017 was 1,977 — 178 fewer deaths than the 2,155 es­ti­mated and con­firmed fa­tal­i­ties in 2016.

This con­trasts with the trend seen in the Bay State since 2013. The es­ti­mated over­dose death rate in 2016 in­creased by 22 per­cent from 2015; 30 per­cent in 2015 from 2014; and 39 per­cent in 2014.

The preva­lence of the deadly syn­thetic drug fen­tanyl con­tin­ues to rise — it was present in the tox­i­col­ogy of 83 per­cent of opi­oidrelated over­dose deaths in 2017.

Ke­hoe said the clinic gives nalox­one “to any­one who walks through the doors,” and nearly all of her pa­tients have used it to re­verse over­doses. Pa­tients are given mul­ti­ple rounds of the agent be­cause fen­tanyl re­quires more doses for a suc­cess­ful re­ver­sal, she said.

“The Narcan keeps them alive, but they still have the un­der­ly­ing ad­dic­tion,” Ke­hoe said.

Bos­ton EMS num­bers re­flect a sig­nif­i­cant in­crease in nalox­one use over the years.

The med­i­ca­tion was used a to­tal of 11,134 times for the first three quar­ters of 2015, com­pared to 13,785 times for the first three quar­ters of 2017. Fourth-quar­ter data is not yet avail­able for last year.

Dr. Marc Larochelle, ad­dic­tion spe­cial­ist at Bos­ton Med­i­cal Cen­ter’s Grayken Cen­ter for Ad­dic­tion, called nalox­one “a re­ally im­por­tant tool in the toolkit,” and said pa­tients are en­cour­aged to carry it and never use alone.

“You can’t en­gage some­one in treat­ment who dies be­fore they’re will­ing to en­gage,” Larochelle said.

An­other fac­tor con­tribut­ing to the drop in deaths, Larochelle said, is a 30 per­cent de­crease in pre­scrip­tions for Sched­ule II opi­oids. This in­cludes oxy­codone, fen­tanyl and methadone.

From a hospi­tal stand­point, there haven’t been no­table changes in the num­ber of pa­tients with sub­stance abuse dis­or­der on the emer­gency or in­pa­tient units, said Dr. Saul Wein­gart, chief med­i­cal of­fi­cer at Tufts Med­i­cal Cen­ter.

Though doc­tors are “tight­en­ing up their prac­tices” when it comes to pre­scrib­ing, the real chal­lenge is get­ting help for the peo­ple who are bat­tling ad­dic­tion, Wein­gart said.

“I’m cau­tiously op­ti­mistic,” he said. “But I worry about the peo­ple who are still deeply com­mit­ted to their ad­dic­tion. It’s a mat­ter of how you pen­e­trate that very hardto-reach pop­u­la­tion.”

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