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Globe Staff
The crisis of opioid addiction in Massachusetts, known for a long time to be serious, could even be worse than we thought – four times more, according to new research.
A Boston Medical Center study released Thursday indicates that 275,000 Massachusetts residents, or 4.6% of those over the age of 11, had opioid-related disorders by 2015. According to earlier estimates based on national surveys, the number was slightly above 1%.
More than half of the opioid addicts had never been identified because they had not obtained health services related to opioid abuse, the researchers said.
The study, published in the American Journal of Public Health, also revealed that the percentage of people suffering from opioid addiction had almost doubled in four years.
"It's a good wake up call," said Dr. Joshua A. Barocas, infectious disease physician at the Boston Medical Center, who led the study. "Our pool of people at risk of overdose is potentially higher than we thought."
The study adds a new dimension to an epidemic up to now, measured primarily by the number of overdose deaths, said Dr. Michael F. Bierer, president of the Massachusetts Society of Addiction Medicine, which n & # 39; 39, did not participate in the research. He suggests that rising drug addiction may play a significant role in the high mortality rate as a prevalence of fatal fentanyl,he said.
"The problem of overdose is not just due to a bad batch of illicit drugs," said Bierer, a primary care physician at Massachusetts General Hospital. "We are going to have people with opioid use disorder for years and we need to be prepared to take care of them."
But one specialist expressed skepticism about the figures put forward by the Boston group. Silvia S. Martins, Director of the Epidemiology Unit for Psychoactive Substance Abuse at the Mailman School of Public Health at Columbia University, said the researchers had used a definition too wide of the disorder of the use of opioids, which could have lead to overestimate the incidence.
"The analysis could have been done more precisely," she said.
Martins however agreed that the prevalence of opioid dependence has been underestimated. "We know that most people with this disorder are not seen by a doctor," she said.
By searching a single data source in Massachusetts, researchers identified people suspected of having a health system-related opioid disorder – 119,000 people in 2015, or 2% of the population over 11 years of age .
Next, they used statistical methods using the probability laws to estimate the number of Massachusetts residents with the disorder but remaining undiagnosed – an additional 156,000 or 2.6%.
In 2011, researchers found that opioid addiction was the most prevalent among people aged 11 to 25 years (from a third of 1% in 2011 to 1.7% in 2015).
They also noted geographical differences, with rural areas being the most affected.
The proportion of opioid-addicted residents was 6% in Berkshire County, 5.8% in Bristol County, 5.3% in Hampden County and 5% in Barnstable County. For Suffolk County, which includes Boston, the prevalence was 3.4%, lower than the state average.
Funded by the National Institute on Substance Abuse, the National Institute of Allergy and Infectious Diseases and the School of Medicine at Boston University, the study was motivated by feeling among clinicians that the magnitude of the addiction problem was underestimated, Barocas said.
Previous prevalence studies were based on interviews, reaching only those who interacted with the health system and leaving out those who did not admit to drug use.
To get a better idea of what's really going on, the researchers looked at the Massachusetts Public Health Data Warehouse, a legacy established by a 2015 law that links data from 16 state agencies.
The data contains patient-specific information about events such as hospital and emergency room visits, ambulance trips, insurance claims, opioid-related deaths, and more. prescriptions. Patients are not identified, but each person has a unique number. It is therefore possible to say, for example, that a survivor of an overdose was the same person who was admitted later to the hospital.
The researchers were able to count the number of people who had experiences of opioid addiction, such as receiving methadone. Then, using a method used by wildlife scientists to estimate animal populations, they extrapolated the number of people who were addicted, but did not receive health care or died of an overdose.
Stoddard Davenport, a health care management consultant at Milliman, a leading actuarial and consulting firm, applauded efforts to estimate "unknown" patients.
"It's great to see work on this front," said Davenport, who read the study but did not participate. "There are many more people with opioid use disorder than the health system has seen."
The Boston group's methodology for estimating "unknowns" has been used in other public health research, but Davenport said he has never seen it apply to the current opioid epidemic. He described the results as plausible and indicated that they went in the direction of his own research, showing that only a fraction of people who consume large amounts of opioids have been diagnosed with a disorder of the eye. Use of opioids.
Felice J. Freyer can be contacted at [email protected]. Follow her on Twitter @felicejfreyer
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