THE STATE WAS already swimming upstream against the opioid epidemic, but new numbers showing record high opioid-related overdose deaths brought an undercurrent of despair to Healey administration discussion of how to stem the toll.

There were 2,357 confirmed and estimated fatal opioid-related overdoses in Massachusetts last year, or 33.5 deaths per 100,000 residents, according to the Department of Public Health. The figure marks a 2.5 percent increase from 2021 and a 9 percent jump from 2016’s pre-pandemic peak, which itself capped a startling rise in deaths over the prior five years. Populations of color and rural areas have seen the largest jumps in opioid overdose deaths.

“Every time we look at these data, I feel so hopeless and I feel like we’re just not making an impact. We’re not turning the tide,” said Secretary of Elder Affairs Elizabeth Chen at a meeting of the Public Health Council on Thursday afternoon. She acknowledged the many efforts being made to address the issue, but said the crisis “just feels so intransigent.”

Department of Public Health Commissioner Robbie Goldstein said the figures in the new report were going in the wrong direction. “These numbers are devastating. These numbers are tragic,” he said. “I think we would all would hope to see a reversal in this trend.” 

Public health officials warn that drug dealers mixing synthetic opioids like fentanyl and other substances into their offerings have created an extremely dangerous cocktail. 

“We have a toxic drug supply,” said Deirdre Calvert, director of the Bureau of Substance Addiction Services. “And it doesn’t matter if you’re using opiates or not. You’re at risk if you’re using drugs that are bought illicitly.”

Mixed substances, especially fentanyl, have contributed to the rising death rates, public health officials said. Fentanyl was present in 93 percent of opioid-related deaths where a toxicology screen was available, Goldstein said. Cocaine was present in 53 percent of cases, alcohol in 28 percent, benzodiazepines in 27 percent, prescription opioids in 11 percent, amphetamines in 9 percent, and heroin in 6 percent. 

Xylazine, a long-acting veterinary sedative, is increasingly being detected in the drug supply, Goldstein said. It was present in 5 percent of the opioid-related overdose deaths in the 2022 data. 

“While the presence of xylazine is relatively low among opioid related overdose deaths, it’s important for the public to be aware – especially as all people including first responders should continue to give naloxone and oxygen for suspected opioid overdoses – that naloxone alone will not reverse the effects of xylazine,” Goldstein said.

The state has distributed nearly 300,000 naloxone kits since 2020, with about 50,000 doses of the overdose-reversing drug distributed since this January. 

The epidemic’s impacts are being unevenly felt, according to new state data. Non-Hispanic Black residents experienced the greatest rise in opioid overdose death rates, which increased by 42 percent between 2021 and 2022, from 36.4 to 51.7 deaths per 100,000 residents. While the majority of opioid-related deaths are non-Hispanic White residents, making up almost 70 percent of all such deaths, non-Hispanic Black residents and Hispanic residents make up a much larger share of opioid deaths than overall drug-related deaths, according to the data.

“When we look at opioid-related overdose deaths by race and ethnicity, we see concerning data that underscored the ongoing obligation to meet the needs of people of color across the Commonwealth,” Goldstein said. “Underlying these data are known disparities in access to treatment and the impacts of social determinants of health.”

Public health officials classified overdose rates in urban and different types of rural communities for the first time in this report, finding the highest death rates in the most rural areas of the state – 36.1 deaths per 100,000 residents. 

Goldstein highlighted areas of the state where some intervention and response strategies are working, but he acknowledges those tools are “not universally accessible.”

Most counties in Massachusetts saw overdose deaths rise from 2021 to 2022, with Worcester County’s deaths jumping by about 18 percent, Plymouth County by 14 percent, and Barnstable County by 7.5 percent. Notably, Franklin, Berkshire, and Hampshire counties all saw substantial decreases in deaths, dropping between 16 and 25 percent over the year.

On top of the roughly $600 million for substance addiction prevention and treatment programs proposed in Healey’s fiscal year 2024 budget, the administration says it will be rolling out a statewide overdose prevention hotline through the Bureau of Substance Addiction Services. 

The state is working to determine the best evidence-based placement for “harm reduction vending machines,” which target common causes of opioid death by dispensing items like clean syringes, hand sanitizer, safe disposal kits, and overdose reversal drugs. The first three vending machines will be in service this fall in Western Massachusetts through Berkshire Harm Reduction, Goldstein said. 

The Department of Public Health is also tasked with creating a “comprehensive plan” to address overdoses. By the end of the year, Goldstein said, the department will release a feasibility report on overdose prevention sites, sometimes called supervised consumption sites, where people can consume otherwise illegal drugs they have already obtained in a monitored setting with medical staff present and without the risk of legal repercussions.

The report will be “looking at the federal legal barriers that may be in place, looking at the funding that may be necessary to get them open, and especially working with municipalities and the State House to figure out how we might be able to move forward,” Goldstein said.

Proposals for supervised consumption sites have prompted fierce debate across the country, and the legal liability for operators and medical staff remains murky after the US Supreme Court declined to take up the issue in 2021. 

The Department of Justice under former President Donald Trump won a ruling from a federal appeals court in Pennsylvania declaring that such facilities run afoul of federal drug laws, but the Biden administration has opted not to prosecute New York overdose prevention centers. Rhode Island and Minnesota have legalized the practice, with Connecticut also making moves to authorize these sites. 

Four years after a Massachusetts state task force recommended a supervised consumption center pilot, legislators are pushing new bills to launch a 10-year pilot program. Massachusetts for Overdose Prevention Centers, a coalition supporting the practice, rallied at the State House on Thursday afternoon and cited New York’s centers as promising.

“The overwhelming evidence shows that overdose prevention centers are an intervention that saves lives,” said Sen. Julian Cyr, who co-filed the legislation with Rep. Marjorie Decker and Rep. Dylan Fernandes, in a statement. “This harm reduction tool provides immediate help in the event of an overdose. With the fentanyl crisis continuing unabated, we cannot count out a proven and effective resource. Overdose prevention centers could serve as one of the game changers in Massachusetts in our efforts to end this epidemic.”

Former governor Charlie Baker was publicly leery of the concept and its legality, calling supervised injection sites “extremely controversial within the addiction community.” 

Healey’s stance on safe injection sites has been consistent throughout her gubernatorial run and early tenure in office. “Harm reduction strategies are an important part of mitigating the opioid crisis,” she said in 2022 when Somerville began moving toward a supervised consumption clinic. Somerville expects to vote soon on a budget proposal to fund consultants to get the consumption site process moving, WBUR reported, with municipal leaders in Cambridge and Worcester joining the call to consider safe consumption sites. 

The governor released an identical statement this week, reiterating that she “supports allowing communities to decide what’s best for their residents, including the option of setting up safe consumption sites, given the urgent need to help connect people with treatment services, address stigma, and save lives.”