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The State of Boston’s Opioid Crisis


COVID is not the only public health crisis sweeping America. The opioid crisis, which has been going on for its second decade, has continued to be a serious threat even though the coronavirus pandemic, being one of the largest causes of premature death in America today.

Boston has been especially hard-hit by the opioid epidemic, with the powerful synthetic opioid fentanyl being cited by authorities as one of the biggest threats to public safety in Boston. However, opioids are not the only serious substance misuse issue in Greater Boston. Boston Drug Treatment Centers has seen alcohol-related rehab admissions remain steady.

The Greater Boston area has one of the highest rates of underage drinking and binge drinking in America. Prescription drug misuse, not only of opioid drugs but also other habit-forming drugs like benzodiazepines are also higher in the Greater Boston area than they are nationally as well.

Substance misuse by young adults contributes significantly to Bostons’ relatively high rankings. This other substance misuse is also linked to combined drug use, another factor in Boston’s high opioid OD rates.

One major reason for this is a culture of binge drinking and drug experimentation in the area’s universities. This specific factor may no longer apply as much due to the coronavirus. However, alcohol and drug use throughout the United States has also risen across the board during the pandemic, which has likely more than offset this.

Opioid use in Greater Boston

Massachusetts is one of the states most hard-hit by the ongoing opioid epidemic. In 2018, the National Review reported that about one in four Massachusetts residents have felt the direct impact of an opioid overdose, having lost a loved one to a fatal OD. Virtually everyone surveyed reported knowing someone with an opioid problem. About seventy percent also considered opioids to be the most serious crisis facing Massachusetts.

The effects of the crisis have been more acute in Boston proper, especially among minorities, who often have a more limited support network. There was reason to be optimistic before the pandemic, as deaths had been on a year over year decline by 2019. However, the pandemic’s effects on mental health as well as its disruption of vital rehab and aftercare services caused opioid-related fatalities to rise again.

Most of these opioid deaths – about 4 in 5 – are attributed to fentanyl, a synthetic opioid drug that, in its pure form, is 50 times more potent than heroin. The relatively cheap drug is often used to cut more valuable drugs like cocaine and heroin, and it’s also used to make illicit painkillers. Today, while some progress has been made since the mid-2010s, Massachusetts still has some of the most fentanyl-related law enforcement cases in the nation.

The threat of mixed drug use

It’s fairly common practice to combine the use of opioids with other drugs like cocaine, benzodiazepines, alcohol, and cannabis. 

There may be several reasons for this. For instance, some opioid users may use stimulants like methamphetamines or cocaine to help offset the sedative effects of opioids. Others may combine opioids with a sedative drug like benzodiazepines to get a stronger high out of a smaller amount of drugs. Others simply enjoy the unpredictable effects of combined drug use.

However, the data shows that combining opioids with other drugs can be deadly. Combining opioids with alcohol or common anti-anxiety medications like Xanax and Valium can depress the central nervous system to the point that the individual can no longer breathe, leading to asphyxiation. This kind of combined drug use is responsible for a disproportionate number of deaths attributed to opioids.

What’s being done to fight opioids

Local authorities have, over the past decade, stepped up the control of prescription opioid drugs. The overprescription of opioid medications in the 2000s and 2010s has been largely blamed for the subsequent rise in illicit opioid use. The high prescription rates opened up avenues for chronic misuse and also allowed more opportunities for unauthorized use. Many people who were previously hooked on prescription medications also subsequently turned to illicit opioid drugs like heroin to prevent uncomfortable withdrawals.

Aside from legislation, other steps include increasing the availability of drop sites for unwanted drugs, increased funding for local initiatives that combat drug use, and a prescription medication monitoring program that helps prevent “doctor shopping” and tracks unusual use patterns. 

Notably, a Good Samaritan law was passed to encourage individuals to report overdoses. The law protects individuals reporting overdoses or attempting to help people who are overdosing from being charged with drug crimes. The threat of criminal charges had previously been a major factor in preventing early intervention for fatal opioid overdoses.

More individuals throughout the state have also received specific training to administer lifesaving medication to people amid an overdose. This followed several cases where fatalities occurred because responders had no special training for handling overdoses.


Thanks to prompt action, Boston has probably already seen the worst of the opioids epidemic, though the aftereffects are likely to linger for the rest of the decade. If it continues and improves on the strategies that it implemented before the COVID pandemic, it may soon be on track to effectively reduce the problem. However, this may bring little comfort to those who already lost someone or are continuing to deal with an opioid use disorder today.

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