An Assessment of Opioid-Related Deaths in Massachusetts (2013 2014)

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

DRAFT

The Commonwealth of Massachusetts

Executive Office of Health and Human Services

Department of Public Health

250 Washington Street, Boston, MA 02108-4619

CHARLES D. BAKER

Governor

KARYN E. POLITO

Lieutenant Governor

MARYLOU SUDDERS

Secretary

MONICA BHAREL, MD, MPH Commissioner

Tel: 617-624-6000

www.mass.gov/dph

September 15, 2016

Steven T. James

House Clerk

State House Room 145

Boston, MA 02133

William F. Welch

Senate Clerk

State House Room 335

Boston, MA 02133

Dear Mr. Clerk,

The Massachusetts Department of Public Health (DPH) is pleased to submit the attached initial report on the opioid overdose study authorized by Chapter 55 of the Acts of 2015.

The current opioid epidemic affecting our Commonwealths communities has taken a record number of lives in each of the last four years. Opioid Use Disorder is a complex chronic disease, and this opioid epidemic is a complex and persistent problem that will not be solved through a single solution. Analytic work is ongoing, and much is yet to be learned from this effort, however, the findings of this initial report can immediately inform our collective work with new insight into overdose-related deaths and the relative risks faced by different populations.

I would like to acknowledge that this work has required a significant collaborative effort from many government agencies. To this end, we are truly grateful to the many partners which have assisted DPH in this work so far. This effort highlights governments ability to work collaboratively towards efficiently solving complex and urgent problems. With the effort of legal, technical, and analytical teams across seven state agencies (Department of Public Health, EOHHS IT, the Office of the Chief Medical Examiner, the Department of Correction, MassHealth, the Center for Health Information and Analysis, and MassIT), Massachusetts has been able to develop a novel data model that allows for simultaneous analysis of 10 datasets with information relevant to opioid deaths. The goodwill of all parties has been a hallmark of this ongoing work.

I would also like to express my appreciation for the continued opportunity the Legislature has provided the Department of Public Health. The analytic approach authorized by Chapter 55 has enabled Massachusetts to serve as a national example for the possibilities of public healths ability to leverage data warehousing to respond to pressing policy and health concerns by allowing existing data to be leveraged in new and innovative ways to support policy development and decision making, and to allocate resources more efficiently and effectively. To this end, other states have already engaged the Department in discussions about the technical aspects of this project, and I hope that this will serve as a model for how complex problems can be tackled in the future.

Let me once again express how grateful I am for the Legislatures commitment to better understanding the root causes of this opioid epidemic by allowing us to continue this important work. I look forward to continuing to share the results of our analyses, and to our continued partnership in addressing this opioid epidemic.

Sincerely,

Monica Bharel, MD, MPH

Commissioner

Department of Public Health

An Assessment of Opioid-Related Deaths in Massachusetts (2013 2014)

September 2016

Table of ContentsLegislative Mandate6Executive Summary8Introduction12Report Organization18Key Findings from the Across Chapter 55 Datasets19Analysis #1 (Toxicology & PDMP): Key Findings and Recommendations20Analysis #2 (Nonfatal Overdoses and Opioid Agonist Treatment): Key Findings and Recommendations28Analysis #3 (Gender Differences and the PDMP): Key Findings and Recommendations31Analysis #4 (Post Incarceration Risk): Key Findings and Recommendations36Conclusions41Appendix A: The Seven Chapter 55 Statute Questions42Appendix B: Dataset Descriptions59Appendix C: Additional Single Table Discussion67Appendix D: Data Linkage73Appendix E: Data Quality and Strategies for Handling Missing Data75Appendix F: Data Privacy and System Architecture79Appendix G: Legal Agreements85Appendix H: Cross-tabulations of Chapter 55 Datasets with Death File Demographics86Appendix I: Background on Addiction & the Bureau of Substance Abuse Services93Appendix J: Partnerships96

Legislative Mandate

The following report is hereby issued pursuant to Chapter 55 of the Acts of 2015, as amended by Chapter 133 of the Acts of 2016 as follows:

Notwithstanding any general or special law to the contrary, the secretary of health and human services, in collaboration with the department of public health, shall conduct or provide for an examination of the prescribing and treatment history, including court-ordered treatment or treatment within the criminal justice system, of persons in the commonwealth who suffered fatal or nonfatal opiate overdoses in calendar years 2013 to 2015, inclusive. Any report or supplemental reports resulting from this examination shall provide any data in an aggregate and de-identified format.

Notwithstanding any general or special law to the contrary, to facilitate the examination, the department shall request, and the relevant offices and agencies shall provide, information necessary to complete the examination from the division of medical assistance, the executive office of public safety and security, the center for health information and analysis, the office of patient protection and the chief justice of the trial court, which may include, but shall not be limited to: data from the prescription drug monitoring program; the all-payer claims database; the criminal offender record information database; and the court activity record information. To the extent feasible, the department shall request data from the Massachusetts Sheriffs Association, Inc. relating to treatment within houses of correction.

Not later than 1 year from the effective date of this act, the secretary of health and human services shall publish a report on the findings of the examination including, but not limited to: (i) instances of multiple provider episodes, meaning a single patient having access to opiate prescriptions from more than 1 provider; (ii) instances of poly-substance access, meaning a patient having simultaneous prescriptions for an opiate and a benzodiazepine or for an opiate and another drug which may enhance the effects or the risks of drug abuse or overdose; (iii) the overall opiate prescription history of the individuals, including whether the individuals had access to legal prescriptions for opiate drugs at the time of their deaths; (iv) whether the individuals had previously undergone voluntary or involuntary treatment for substance addiction or behavioral health; (v) whether the individuals had attempted to enter but were denied access to treatment for substance addiction or behavioral health; (vi) whether the individuals had received past treatment for a substance overdose; (vii) whether any individuals had been previously detained or incarcerated and, if so, whether the individuals had received treatment during the detention or incarceration.

The report shall be filed with the clerks of the senate and house of representatives, the house and senate chairs of the joint committee on mental health and substance abuse, the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means. The secretary of health and human services may publish supplemental reports on the trends identified through its examination; provided, however, that any supplemental report shall be filed not later than July 1, 2017 and shall be filed with the clerks of the senate and house of representatives, the house and senate chairs of the joint committee on mental health and substance abuse, the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means.

Notwithstanding any general or special law to the contrary, the executive office of health and human services may contract with a non-profit or educational entity to conduct data analytics on the data set generated in the examination, provided that the executive office shall implement appropriate privacy safeguards.

Executive SummaryBackground

Since 2000, opioid-related deaths have increased in Massachusetts by 350%. The recent rate of increase is several times faster than anything seen before[footnoteRef:1] with every community in Massachusetts impacted by the current opioid epidemic. However, beneath this statewide impact, data indicates that some areas of the Commonwealth have been disproportionately impacted by this opioid epidemic. In particular, southeastern Massachusetts and Essex County have been inordinately affected. Just as communities are differentially impacted by the current opioid epidemic, population groups are also differently burdened. Opioid-related death rates are highest among younger males a fact that is similar in all states.[footnoteRef:2] Opioid-related death rates are also higher among those who have recently been released from Massachusetts prisons, those who have obtained opioid prescriptions from multiple pharmacies, and those who have obtain