Public forum examines opioid overdose prevention

  • Liz Whynott, left, Dr. Robert J. Roose and Jess Tilley chat before a forum Thursday evening, titled “Reducing Opioid Overdose Deaths-What Works?” at Baystate Medical Center in Springfield. All spoke during the event, which was organized by Dr. Peter Friedmann, a nationally-recognized addiction specialist who is the chief research officer for Baystate Health and president-elect of the Massachusetts Society of Addiction Medicine. Gazette Photo/Jerrey Roberts

  • Dr. Peter Friedmann speaks during a forum titled “Reducing Opioid Overdose Deaths-What Works?” Thursday at Baystate Medical Center in Springfield. Friedmann is a nationally-recognized addiction specialist who is the chief research officer for Baystate Health and president-elect of the Massachusetts Society of Addiction Medicine. Gazette Photo/Jerrey Roberts

For The Recorder
Saturday, December 02, 2017

SPRINGFIELD — A public forum held at Baystate Medical Center brought together experts fighting the opioid crisis to discuss innovative and at times controversial solutions to keep people safer and lower opioid overdose deaths.

Dr. Peter Friedmann, president-elect of the Massachusetts Society of Addiction Medicine and Baystate Health’s chief research officer, started off the forum Thursday night with a moment of silence in reverence for the people who have died or had their lives altered by the opioid crisis, some 58,000 of them each year.

“More Americans died last year of overdose than in the entire Vietnam War,” Friedmann said. “The epidemic of overdose deaths does not discriminate, and experts, some of which are here, are clear about what we need to do. The controversy is ideological, political, economic, and perhaps practical, but it is not scientific.”

After discussing treating addiction as a disease, Friedmann opened up the forum to experts to discuss the treatment solutions they have seen work.

One solution that has begun to gain wider acceptance in Massachusetts and across the country is the distribution and availability of naloxone, a drug that can reverse opioid overdoses.

Dr. Alex Walley, an associate professor at Boston University School of Medicine, arrived just off a plane from Norway where he had been attending the second international naloxone conference.

He said that naloxone is “important, but not enough” in the fight against the opioid crisis. The increasing presence of fentanyl, a strong and fast-acting opioid, has caused the response window where naloxone can work to shrink, and Walley stressed that it is imperative to respond as quickly as possible.

Through observational evidence, Walley said he has seen overdose education and naloxone distribution lower the overdose rates of communities by 27 to 46 percent.

Dr. Robert J. Roose, who served on Gov. Charlie Baker’s opioid addiction working group, shared another solution — medically assisted treatment or MAT, which he called the “gold standard of treatment of opioid disorders.”

MAT is when someone who is addicted to opioids uses weaker, synthetic opioids that don’t produce a high to lessen withdrawal and slowly wean himself off opioid use. Roose compared it to the treatment plans for hypertension, diabetes and asthma, all of which have expected relapses and require ongoing care, and he presented numerous studies to show the effectiveness of MAT overall in reducing opioid overdose deaths.

“Expanding access to evidence-based medication treatment is an essential component of a comprehensive response,” he said.

In general, the panelists agreed that one of the biggest problems facing medically assisted treatments and the distribution of naloxone is stigma that the solutions will only create a bigger drug problem.

This is something Liz Whynott, director of HIV health and prevention at Tapestry Health, spoke of also as she detailed the slow progress in establishing needle exchange programs in Massachusetts since the first one opened in Boston in 1993. There are now five in the state.

A syringe, she said, costs 19 cents. The lifetime cost of HIV averages about $380,000.

Still, towns have been slow to create syringe service centers, even in places with statistically high rates of HIV attributable to drug use. Whynott ended her presentation with an impassioned plea.

“We need a needle exchange in Springfield now,” she said.

Supervised injection site

One of the more controversial solutions was presented by Brandon Marshall, associate professor at Brown University School of Public Health. Marshall was a part of the scientific team that evaluated the first supervised injection site, or SIF, in North America.

Located in Vancouver, Canada, the SIF is a medical clinic where people can use illegal drugs like heroin under the supervision of medical professionals to lower the risk of overdose and practice safer, cleaner use.

He said it was very controversial when it first opened, with people concerned about the “honeypot effect” — that the site would draw drug users into the area to use it. However, his team found the site reduced public injection and injection-related litter and decreased fatal overdoses. Having a treatment facility onsite as well resulted in more people seeking treatment.

“If there’s anything you take away from my talk,” Marshall said, “it’s that overdoses can 100 percent be prevented.”

New data released by the Massachusetts Department of Public Health this month showed that opioid overdose deaths have decreased by 10 percent when compared to the same period in 2016, maybe indicating the success of some of the solutions discussed. However, there still have been some 1,470 fatal overdoses so far this year, showing that Massachusetts has a long way to go.

Jess Tilley, the executive director of the New England Users Union, an outreach organization for drug users, said that from her position on the front line, doing outreach work in the street to users who are unable to access bricks-and-mortar services and providing fentanyl testing strips, the solutions are helping but there are still a lot of people who aren’t being reached.

“I am tired, I am burnt out, I am stymied by overdose rates,” she said. “Still, the biggest challenge we face is stigma.”