New data analysis point to illegally obtained opioids as 'driving force' behind epidemic

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BOSTON >> Authorized by a law signed last year to collect information from health care agencies, law enforcement departments, the court system and other state agencies, the Department of Public Health is working to demystify the data and identify previously unseen trends in the state's opioid crisis.

In a preliminary report filed with the Legislature this month, DPH Commissioner Monica Bharel wrote that other states have already called Massachusetts to learn more about its approach to using data analytics to inform the state's response to the scourge of opioid misuse and overdose.

"The ability to look as broadly and as deeply at public health data has been a unique challenge, but one that has given us a much greater understanding of the current opioid epidemic," Bharel wrote. The approach "has enabled Massachusetts to serve as a national example for the possibilities of public health's ability to leverage data warehousing to respond to pressing policy and health concerns by allowing existing data to be used in new and innovative ways to support policy and decision making."

Working with the Center for Health Information and Analysis, MassIT, the Office of the Chief Medical Examiner, MassHealth, the Department of Correction and others, DPH has developed a model that allows for "simultaneous analysis of 10 data sets with information relevant to opioid deaths."

The collaborative effort to link data sets has allowed DPH to dig into questions like, "Does an abnormally high number of prescribing physicians increase a patient's risk of fatal overdose?"

The preliminary answer, DPH reported, is yes. The agency reported that the risk of a fatal opioid overdoses is seven times greater for individuals who use three or more prescribers within three months. DPH also reported that the concurrent use of opioids and benzodiazepines is associated with a four-fold increase in risk of a fatal opioid overdose.

The data analytics approach was also used to better understand the link between opioid overdose deaths and the legal use of prescribed opioids. DPH reported that "at least" two out of every three people who died of an opioid overdose had been prescribed an opioid between 2011 and 2014.

But just 8.3 percent of those decedents had an active opioid prescription in the same month as their death, DPH said, and in 83 percent of opioid overdose deaths that had a toxicology report completed the person who died had "illegally-obtained or likely illegally-obtained substances" in their system at their time of death.

In its report, DPH points to the information on illegally-obtained substances as "evidence to support an emerging hypothesis that illegally-obtained substances are the driving force behind" the state's epidemic.

Since 2000, Massachusetts has seen a 350 percent increase in opioid-related deaths — from 338 in 2000 to an estimated 1,526 in 2015 — including record-setting numbers of deaths in each of the last four years, according to DPH.


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