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Why Was Boston Harder Hit By The Opioid Epidemic?

The number of opioid-related deaths in Greater Boston has increased over five-fold since the end of the 1990s, with a new peak reached during the COVID-19 pandemic. Compared to the rest of the United States, opioid overdose deaths in Boston are now twice the national average. Some areas are seeing up to 10 times more deaths and emergency room visits since the start of the 2000s.

Though we now have a fairly good idea why this is, this major discrepancy in opioid overdose deaths in Boston compared to the rest of the country could not yet be definitively isolated to just a few causes. But while we may not know the full extent and causes of the crisis for several years, we listed some of the likeliest major contributory factors below.

If you or someone close to you has a problem with opioids or other habit-forming substances, get in touch with a mental health professional immediately. You can also contact us at Boston Drug Treatment Centers to discuss your options.

The availability of newer, powerful, cheaper illicit opioids

Black tar heroin was previously considered to be the biggest opioid threat in Boston. However, fentanyl, a much more powerful synthetic opioid, has started becoming more and more available throughout Massachusetts, with most of it concentrated in the Greater Boston area, where there was and still is a larger baseline demand for opioid drugs.

In addition to being more powerful than heroin per gram, the fentanyl coming into Boston is also much cheaper. Even drug users that prefer heroin or other opioids are likely to also inadvertently consume fentanyl, as the drug is also used by dealers to “cut” or adulterate other drugs.

Today, fentanyl is implicated in between 80 and 90 percent of all local drug overdose deaths. While other factors might be at play, the wide availability of fentanyl is likely the be the biggest so far in contributing to Boston’s opioid problem.


New England has long been a favored transshipment point for transnational criminal enterprises. While most of the drugs in New England may go to different parts of North America, offloading cheap opioids in nearby major urban centers like Boston can reduce the risk of seizure for these gangs. This means dangerous illicit opioids are more likely to be found here than they are in cities further away from New England and other prime transshipment points.

Economic and social reasons

Systemic neglect from the mainstream may be playing a key role in the worsening of Boston’s opioid problem. While opioids were, for a time, a primarily white middle and working-class crisis, individuals from relatively poorer minority communities are now bearing the brunt of Boston’s current opioid crisis. Today, Boston’s African-American and Hispanic communities are facing the problem without the benefit of the support that allows wealthier communities to avoid both drugs and their consequences.

Doctor-prescribed opioid medications

The CDC and NIDA both blame the liberal prescribing of painkillers in the 2000s as a major contributor to the current opioid epidemic. While this particular factor is not particularly strong in Boston (local doctors were not more likely to hand out opioid painkiller prescriptions than in other places in the US) it has, regardless, made more people vulnerable to street fentanyl and deadly overdoses.

An increase in mental health issues during COVID-19

The loss of life, social isolation, and economic devastation of COVID-19 were, in some ways more acutely felt in dense, highly urbanized areas like Boston. These all contributed to a large uptick in mental health problems like depression and anxiety. The use of drugs and alcohol is a common coping mechanism among people experiencing these issues. The once-in-a-century health crisis has pushed many Bostonians and other Americans to the breaking point, leading to an increase in substance misuse across the board.

Combination drug and alcohol use

Boston has had a long-running problem with alcohol misuse that stems from historical and cultural factors. The presence of several major universities and colleges in the area also serves to drastically bump up the rates of alcohol misuse, including underage drinking.

Boston already had some of the highest rates of alcohol misuse in the US even before illicit fentanyl started hitting the streets. Unfortunately, opioids and alcohol have an extremely strong synergistic effect that serves to drastically raise the odds of a fatality during an overdose. When a person consumes both opioids and alcohol, only relatively low doses are needed to stop their breathing, often leading to asphyxiation and death in short order.

A similar issue also exists with the concurrent consumption of benzodiazepines, a commonly-prescribed class of anti-anxiety and anti-epilepsy drugs with their own risks for substance use disorder. As with alcohol, benzodiazepine drugs like Klonopin, Xanax, Librium, and others have synergistic effects with opioid drugs that can easily over-depress the central nervous system and lead to asphyxiation and death.

This type of combination drug use is, unfortunately, more difficult for emergency room personnel to treat, as it may not be immediately obvious that affected individuals took multiple substances. This can easily complicate critical early treatments and raise the odds of a fatality, even after medical intervention is given.


The data suggests that Greater Boston is suffering a great deal more from the opioid crisis than the rest of the nation. While we may not yet be completely sure about the primary reasons for this, we can make some very educated guesses. If you or a loved one have problems with opioid drugs, get in touch with Boston Drug Treatment Centers for a comprehensive discussion of your treatment options. Good luck, and be well!

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