‘Long way to go’ on opioid crisis
National expert speaks in city
WORCESTER — The U.S. must do a better job of investing in long-term treatment and recovery services to tackle the nation’s opioid crisis, said a national expert who made a stop in Worcester. It’s a crisis that has hit
Worcester hard, with 141 opioid-related overdose deaths in 2022.
Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse of the National Institutes of Health, told an audience Thursday night at Worcester Technical High School that detox to remove drugs from the body is an essential medical procedure.
But it’s not enough.
“(Detox) is a first step to longer-term treatment and recovery support services. We need a comprehensive system of care, and there’s a long way to go to bring that together,” he said.
Compton came to Worcester at the invitation of Worcester County District Attorney Joseph D. Early Jr. Early told the audience more urgency is needed to save lives, adding that opioids are responsible for hundreds of thousands of deaths in the U.S.
“If there was not a stigma (tied to substance use), then it would be a lot better in regard to this whole problem,” said Early, a reference to the need for more investment in prevention, treatment and recovery services.
Besides the 141 deaths in 2022, Worcester Country experienced a 17.8% spike from 2021 to 2022 in opioid-related overdose deaths, from 281 deaths in 2021 to 331 in 2022.
In addition, Worcester’s rate of deaths (79.62 per 100,000 people from 2015 to 2022) exceeds Boston’s rate (54.09 per 100,000 people from 2015 to 2022).
Fentanyl more potent, a killer
Compton noted a shift in the illicit drug market, from heroin to fentanyl.
The synthetic opioid has the same internal effects of heroin, said Compton, but is more potent.
He explained that fentanyl contributed to a surge in the counterfeit market, as it’s pressed into pills that mimic the look of Xanax for anxiety disorders and Adderall and Ritalin to treat attention deficit hyperactivity disorder. Users often don’t know the drugs they’re taking contain fentanyl.
“There’s been an explosion in counterfeit pills,” said Compton. “Teenagers tend to experiment with pills, and a single dose can be fatal. The potency of fentanyl is exceptional.”
Doctors overprescribing pain pills contributed to the crisis, said Compton, who said he was once prescribed 16 pills for a thumb injury and only needed to take one.
“Most people don’t need so many pills,” he said.
Some overprescribing of opioids was driven by the pharmaceutical industry’s desire for profits, said Compton, and efforts over the past decade focused on changing how doctors prescribe opioids. One example, noted Compton, are CDC guidelines established in 2016 for prescribing opioids for chronic pain.
The guidelines state: “When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose.”
Solution: many approaches
Supportive environments at home and school are important aspects of drug prevention, said Compton. So are harm-reduction strategies, like naloxone, the nasal spray that immediately reverses a drug overdose.
Medication-assisted treatment, using drugs like buprenorphine and methadone to combat severe withdrawal with the goal of getting users into treatment, is another avenue.
However, Compton said, long-term support is essential, because it takes “years to unlearn and develop new ways to live . ... We need to think treatment over an extended number of years.”
Potential breakthroughs
On the research front, Compton noted several possibilities that need further study. One is vaccines that could shield the brain from the harmful effects of opioids. Brain stimulation is another. It’s already being used with magnets to manipulate brain circuitry to help patients suffering with depression.
GLP-1 Agonists are another possible application. These drugs lower blood sugar levels and promote weight loss. Preliminary studies indicate the drugs that cut appetite could also reduce habit-forming behaviors, including drug addiction.
End the stigma
Like Early, Compton said society must end the stigma of drug addiction. Respect those struggling with opioid disorders, give them the treatments they need, and recovery is not only possible, it’s the typical outcome, said Compton.
Early ended the night with a message to those in attendance — the community must come together to fight the opioid crisis.
“Partnerships. It’s the partnerships,” said Early.