The Massachusetts opioid epidemic is growing rapidly, but resources may not be appropriately distributed across the state to help address the issue, according to an analysis from the commonwealth's Health Policy Commission.
The commission found opioid-related hospital visits — including inpatient admissions, observation stays and emergency department visits — nearly doubled between 2007 and 2014 to more than 55,000 annually. Most of these visits are related to non-heroin opioids. However, the small fraction of heroin-related hospital visits is growing fast. The analysis shows a sharp uptick of 201 percent in heroin-related visits between 2007 and 2014, indicating more Massachusetts residents are turning to a less expensive alternative to prescription opioids.
The analysis shows the severity of the issue varies widely across the state. Some of the worst regions in terms of opioid-related hospital visits include East Merrimack, Metro South, New Bedford and the Berkshires, but there are hot spots located all over the state, including Boston and Worcester.
Part of the issue is that medication-assisted treatment — which has been shown to reduce inpatient admission rates, addiction and infectious disease transmission — is not widely accessible across the state and patients frequently must travel more than five miles to access it, according to the HPC analysis. It also shows the availability of such treatment varies by region of the state, but not necessarily in proportion to the magnitude of the epidemic.
For example, the Berkshires region, which has a 70 percent higher rate of opioid-related hospital visits than the state average, also has comparatively long travel times for patients seeking treatment. There are three types of medication-assisted treatment: naltrexone, buprenorphine and methadone. The Berkshires region has no naltrexone providers, while 33 percent of patients have to travel more than five miles to a buprenorphine provider and 39 percent must travel more than five miles for a methadone provider.
Without these programs in areas where they are needed most, patients are left to turn to the hospital for opioid-related issues. The majority of the bill for these inpatient admissions — 75 percent — is footed by the federal and state governments through Medicare, Medicaid and other government programs.
In particular, infants born with neonatal abstinence syndrome due to exposure to opioids in the womb puts a significant financial strain on hospitals, according to the report. Infants born with NAS has increased more than five-fold between 2004 and 2013. The mean hospital charge for an infant with NAS is $66,700, compared to the $3,500 national average total cost of care for uncomplicated term infants, according to the report. Mean hospital charges for infants with NAS that are pharmacologically treated soar to $93,400, according to the analysis.
Based on these findings, the HPC is issuing a report focusing on the availability of medication-assisted treatments, best practices to treat infants with NAS, and recommendations to address Massachusetts' opioid crisis.
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