DataBrief:Opioid1RelatedOverdose

DeathsAmongMassachusettsResidents
MassachusettsDepartmentofPublicHealth POSTED:NOVEMBER2017

ThisreportcontainsbothconfirmedandestimateddatathroughSeptember2017.

Figure1.Opioid1RelatedDeaths,AllIntentsbyMonth
MassachusettsResidents:January 2016 September2017
Confi rmed Estimated
250

200
Numberofdeaths

7 11 20
7 7 159
5 6 6 6 7
4 10 15 24
150 23 163
23
32 67
32
100 189 181 195 185
175 172 174 169 166 178
157 153 153 141 148
130 114
50 107 97
37
5
0
January February March April May June July August September October November December January February March April May June July August September

2016 2017

Thechartaboveshowsmonthbymonthestimatesforfatalopioidrelatedoverdoses,allintentsfromJanuary2016
throughSeptember2017.Forthefirst9monthsof2017,thereare932confirmedopioidrelatedoverdosedeathsand
DPHestimatesthattherewillbeanadditional491to582deaths.

Figure2.Opioid1RelatedDeaths,AllIntents
MassachusettsResidents:2000 2016
Conf irmed Estimated
2,400
2,190
2,200
2,000 1,811
Numberofdeaths

1,800 2,094
1,600 1,687
1,400
1,200 1,364
1,000
800 961
600 742
614 660 642 622 638 656
400 506 526 514 575 560
200 379
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Thefigureaboveshowsthenumberofconfirmedcasesofallintentsopioidrelatedoverdosedeathsfor2016(n=2094).
Thisrepresentsa24%increaseoverconfirmedcasesin2015(n=1687)anda54%increaseover2014.Inordertoobtain
timelierestimatesofthetotalnumberofopioidrelatedoverdosedeathsinMassachusettsconfirmedandprobable
DPHusedpredictivemodelingtechniquesforallcasesnotyetfinalizedbytheOfficeoftheChiefMedicalExaminer
(OCME).BasedonthedataavailableasofOctober12,2017DPHestimatesthattherewillbeanadditional116to132
deathsin2015,andanadditional89to103deathsin2016,oncethesecasesarefinalized.

1

OpioidRelatedOverdoseDeathRates,AllIntents

Theincreaseinestimateddeathratesisslowingyearoveryear:in2014,therewasa40%increasefromtheprioryear;in
2015,therewasa32%increasefromtheprioryear;andin2016,therewasa21%increasefromtheprioryear.
Figure3.RateofOpioid1RelatedDeaths,AllIntents
MassachusettsResidents:20002016
35
32.2
30
per100,000 Residents

25 26.7
Rate

20 20.2

15
10.3 10.0 14.4
10 9.6 9.7 11.2
7.9
8.9 10.0
8.2 9.6 8.0
8.0
5
6.0

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

1

Opioidsincludeheroin,opioidbasedprescriptionpainkillers,andotherunspecifiedopioids.

TechnicalNotes

BeginningwiththeMay2017report,DPHstartedreportingopioidrelateddeathsforallintents,whichincludes
unintentional/undeterminedandsuicide.Thisreporttracksopioidrelatedoverdosesduetodifficultiesinidentifying
heroinandprescriptionopioidsseparately.TheDepartmentregularlyreviewsprojectionsasmoreinformationbecomes
available.InformationfromtheOfficeoftheChiefMedicalExaminerandtheMassachusettsStatePolicearenow
incorporatedintothepredictivemodel.Thisadditionalinformationhasimprovedtheaccuracyofthemodelsthat
predictthelikelihoodthatthecauseofdeathforanypersonwasanopioidrelatedoverdose.DPHappliedthismodelto
deathrecordsforwhichnoofficialcauseofdeathwaslistedbytheOCME.Themodelincludesinformationfromthe
deathcertificate,MedicalExaminersnotes,andthedeterminationbytheStatePoliceofasuspectedheroindeath.DPH
addedthisestimatetothenumberofconfirmedcasesinordertocomputethetotalnumberofopioidrelated
overdoses.Shouldnewinformationbecomeavailablethatchangestheestimatestoanysignificantdegree,updateswill
beposted.Pleasenotethatthereisroundingofcountsfor20152017.

2
ToxicologyAnalysis:FentanylandOtherDrugs

Fentanylisasyntheticopioidthathaseffectssimilartoheroin.Itcanbeprescribedforseverepain. Accordingtothe
U.S.DepartmentofJustice,DrugEnforcementAdministrations2015InvestigativeReporting,whilepharmaceutical
fentanyl(fromtransdermalpatchesorlozenges)isdivertedforabuseintheUnitedStatesatsmalllevels,muchofthe
fentanylinMassachusettsisduetoillicitlyproducedfentanyl,notdivertedpharmaceuticalfentanyl.

ThestandardtoxicologyscreenorderedbytheOfficeoftheChiefMedicalExaminerincludesatestforthepresence
offentanyl. Amongthe747individualswhosedeathswereopioidrelatedin2017whereatoxicologyscreenwasalso
available,603ofthem(81%)hadapositivescreenresultforfentanyl.Inthesecondquarterof2017,heroinorlikely
heroinwaspresentinapproximately48%ofopioidrelateddeathsthathadatoxicologyscreen.Cocainewaspresent
inapproximately39%ofthesedeaths;andbenzodiazepineswerepresentinapproximately68%.

Whilescreeningtestscanbeusedtonotetherateatwhichcertaindrugsaredetectedintoxicologyreports,theyare
insufficienttodeterminethefinalcauseofdeathwithoutadditionalinformation. Thecauseofdeathisaclinical
judgementmadewithintheOfficeoftheChiefMedicalExaminer.

Figure4.PercentofOpioidDeathswithSpecificDrugsPresent
MA:20142017
100
90
80 Fentanyl
70
LikelyHeroin
60
Percent

50 PrescriptionOpioid
40 Benzodiazepine
30
Cocaine
20
10
0
1 2 3 4 1 2 3 4 1 2 3 4 1 2
2014 2015 2016 2017

YearandQuarter

1.Thisismostlikelyillicitlyproducedandsold,notprescriptionfentanyl
2.Prescriptionopioidsinclude:hydrocodone,hydromorphone,oxycodone,oxymorphone,andtramadol
PleasenotethatpreviousestimatesmaychangeslightlyasDPHroutinelyreceivesupdatedtoxicologydatafromtheOfficeoftheChiefMedical
ExaminerandtheMassachusettsStatePolice.

Thepercentageofopioidrelatedoverdosedeathswhereprescriptiondrugswerepresenthastrendeddownwardsince
thebeginningof2014,whenapproximatelyaquarterofdeathswithatoxicologyscreenshowedevidenceofa
prescriptionopioid.Inthesecondquarterof2017,prescriptionopioidswerepresentinapproximately16%ofopioid
relatedoverdosedeathswhereatoxicologyresultwasavailable.Alsonotable,therateofheroinorlikelyheroinpresent
inopioidrelateddeathshasbeendecreasingwhilethepresenceoffentanylisstilltrendingupward.