OD deaths down, thanks to Narcan
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.”