April 21, 2015

Fighting Opioid Abuse, Community by Community

In Massachusetts, working together to confront heroin use and abuse

EDC’s Gary Langis has made it his mission to reduce heroin deaths in Massachusetts. But for much of the past two decades, attitudes toward addiction and abuse have been as much an obstacle to this goal as the drug itself.

Few people wanted to admit that heroin could be present in their community. Law enforcement often dealt with addiction through incarceration. Public health campaigns were more likely to focus on less stigmatized issues, such as reducing teen alcohol abuse.

But in 2005, the number of fatalities in Massachusetts due to opioid overdoses eclipsed the number caused by motor vehicle accidents for the first time, thrusting the issue into the public eye. And as the state’s opioid abuse crisis deepened, Langis noticed a shift in attitude: law enforcement personnel were asking him more about prevention than punishment.

“I remember talking to an officer from Quincy who used to dismiss addicts as junkies,” says Langis. “Then he started seeing people from his own community, people he knew, overdosing and dying. That changed his opinion.”

With more than 900 opioid-related deaths in 2013, Massachusetts is now engaged in a full fight to save lives at risk of being lost to opioid abuse—and EDC is a critical partner. Through the Massachusetts Technical Assistance Partnership for Prevention (MassTAPP), Langis and other technical assistance experts are helping the state develop a strategic, community-level response to the crisis.

Reaching out across lines

MassTAPP is providing technical assistance to 18 Massachusetts opioid abuse prevention collaboratives (called MOAPCs), which are funded by the Commonwealth’s Department of Public Health, Bureau of Substance Abuse Services (BSAS).

Each MOAPC grant funds a lead municipality to bring together neighboring communities in an effort to share resources and knowledge and collectively plan prevention strategies. This “cluster” approach is a change in direction for Massachusetts, which used to award substance abuse prevention grants only to individual cities and towns.

MassTAPP’s Tracy Desovich says that a regional prevention effort builds the capacity of several communities at once. This is key because the impact of opioid abuse crosses town lines.

“The idea is to share expertise across communities and across roles,” she says. “We want law enforcement, public health professionals, and people who are in recovery all working together to make a difference.”

Desovich says cities and towns may often lack data about when and where opioid overdoses have occurred, especially if victims are rushed to a hospital in a neighboring community. Working in clusters can give communities a more accurate picture of how opioid abuse is playing out at the local and regional levels. MassTAPP supports communities by helping them build data-driven prevention strategies that address areas of critical importance.

“You need that data to plan prevention—plain and simple,” says Desovich. “Otherwise you might be putting a band aid on a broken leg.”

Penny Funaiole, the coordinator of the Mystic Valley MOAPC—a coalition comprising the communities of Malden, Medford, Melrose, Stoneham, Wakefield, and Reading—believes that MassTAPP’s technical assistance has played a significant role in facilitating conversation and coordination among communities.

“The lines of communication are tremendous right now,” she says.

Taking steps forward

For many young people in the Mystic Valley, says Funaiole, the road to opioid abuse often begins with painkillers prescribed for sports injuries. Prescription drug abuse has become so severe that many schools are beginning to educate parents about the dangers and warning signs.

She credits the MOAPC grant with helping the Mystic Valley region develop a coordinated plan and says that MassTAPP has helped connect people engaged in the same fight across the state.

“Everybody is talking about opioid abuse now, and it can become disorganized when everybody wants to do their own thing,” says Funaiole. “Having Tracy there at our cluster level has helped open lines from state to regional to local prevention efforts.”

Turning around the state’s epidemic will not be a short, or easy, process. But there are indications that barriers to prevention are shrinking.

Desovich recalls a recent request from one local police department. They were considering whether to equip all of their first responders with naloxone, the overdose-reversal drug commonly known as Narcan. Did she know anybody who could answer some questions for them?

“I called Gary, and he went there the next day to do a training,” she says.

Langis showed the officers how to administer the drug and talked to them about why it worked. During the training, the officers asked Langis a question that he has grown used to hearing during his career in prevention work: Isn’t administering Narcan to an overdose victim just enabling the addict?

“I ask how many heart attacks a person has to suffer before they shouldn’t be resuscitated by a defibrillator,” Langis says. “When do you say, ‘I’m not going to save a life?’“