How Bad Is Massachusetts’ Opiate Epidemic?

No one really seems to know (boldface mine):

Massachusetts is under siege from a frightening surge of heroin overdoses, Governor Deval Patrick said last month in declaring a state of emergency. That grim view has become unquestioned consensus among law enforcement, health workers, and devastated families.

But even as officials from Beacon Hill to town halls rush to respond to the crisis, its full scope remains unknown. No real-time data are collected by state health officials to show how many overdoses are occurring, how many deaths are resulting, and where the toll is greatest.

As a result, police and health officials in large cities and small communities are scrambling on their own to map and react to the crisis rather than wait for data from the state Department of Public Health, which only last week released its count of opiate-related deaths for 2012, reporting 668 such fatalities, an 11 percent increase from the previous year

State officials said the health department is hampered by a labor-intensive system in which death certificates are still recorded on paper by the state medical examiner, whose office generally takes three months to confirm a fatality as opiate-related. Then, staff members from the Department of Public Health must review all those certificates every year, enter the information into an electronic system, and code the data…

Since Feb. 25, news media and public officials trying to gauge the impact of heroin and other opiates have relied almost exclusively on a State Police report that counted 185 overdose deaths in Massachusetts since November. But even that figure is understated — and possibly substantially so — because the report did not include deaths in Boston, Worcester, and Springfield, where local police lead their own investigations into suspicious and unattended fatalities. Elsewhere in Massachusetts, the State Police assign homicide detectives to each county’s district attorney’s office to investigate deaths. Those detectives combed their records since November to arrive at the 185 figure, but that number is speculative. In a change from their original statement, State Police now say that many of those deaths are suspected to be opiate-related but have not been confirmed.

It goes without saying that addiction is a horrible problem, regardless of whether it’s increasing, decreasing, or staying constant. That said, in the course of the War on Some People Who Use Certain Drugs Drug War, there has been a lot of hysteria. It’s telling that the Massachusetts State Police are backing off their numbers a bit. The real issue is if this is a transient phenomenon: if there was a short-term surge (perhaps due to new product, or switching from pills to heroin), that surge might be over by now–we simply don’t know. While a ten-percent increase is still awful, that’s not exactly an epidemic, but a constant problem that has become somewhat worse–potentially, the public health and law enforcement responses to a dramatic increase versus an uptick could be very different, especially if this reflects changes in drug use habits.

We desperately need better data, but, at the same time, we should realize that, right now, we don’t really understand what is happening or how bad it really is.

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