With Massachusetts in the midst of a deadly drug epidemic, health officials are fighting to curb the loss of lives. The greatest challenge they face, however, may be bringing public awareness to the same high level as the danger.
"Stigma's really the biggest hurdle," Dr. Alexander Walley, the director of the Addiction Medicine Fellowship at Boston Medical Center, told NBC Boston. "It's a stigmatized problem at all levels. I think with the general public, it's not the first thing they choose to think about when they are thinking about what news they're going to watch."
BMC received a $25 million gift on March 6 with the goal of fighting what it calls "the most pressing public health crisis of our time." Eilene and John Grayken made the donation, which will fund the creation of the Grayken Center for Addiction Medicine. Walley says the plans for the center provide "a tremendous opportunity, and with it brings a renewed challenge" to make a difference.
After the announcement, public officials like Massachusetts Gov. Charlie Baker, Boston Mayor Marty Walsh and Sen. Ed Markey agreed that the opioid problem is widespread, and noted the importance of raising awareness of addiction as a major health issue.
"We have a problem that Weston and Wellesley has, and that Worcester and Waltham has," Markey said. "There is no geographic, there is no income barrier whatsoever. It's destroying the lives of tens of thousands of people on an ongoing basis."
"The opioid crisis that's happening, it's not a Democrat or Republican issue, it's not a black or white issue, it's not a man or woman issue, it's not a rich or poor issue. It's all of us," Walsh said. "This gift is going to help raise awareness. This gift is going to help increase understanding. This gift is going to bring hope. And probably the most important thing, this gift is definitely going to save lives."
"[The Graykens'] decision to make such a major contribution to research and treatment and prevention, and to put a big stamp on the notion that this issue deserves the same sort of clinical inquiry that so many others get, especially in this town, is a major statement," Baker said.
The governor's administration has focused heavily on drug addiction. The Department of Public Health's Chapter 55 report – featuring interactive maps and graphs – highlights the severity of the crisis, analyzing drug information from all the commonwealth's cities and towns to paint a more vivid picture.
"When you present it in a different way, people really take notice," DPH Communications Director Tom Lyons said, explaining that the actual information was released the month prior to its interactive presentation. "It really allows people to kind of delve into the issue, to learn more about addiction and opioids in general, but also to localize the story."
The above maps show the number of deaths in each Massachusetts municipality from 2001 to 2005, from 2006 to 2010 and from 2011 to 2015. Hovering over each city and town will reveal the death count in each date range.
The cities and towns in the darkest shade of blue had more than 17.1 opioid-related deaths per 100,000 people. Between 2001 and 2005, there were nine municipalities in that shade. The stretch from 2011 to 2015 is much more troubling – 98 cities and towns are in dark blue.
The number of deaths in Boston climbed from 339 in the first five years analyzed to a shocking 468 deaths in the last five years.
One of Brockton's 118 deaths in the most recent span was particularly difficult for Stephen Marciano. The nephew of world heavyweight champion boxer Rocky Marciano lost his brother to addiction in 2015.
"Peter changed so much over the years, and [went] from this vibrant kid to really becoming a shell of himself," he said. "In today's day and age, if you don't understand the effects painkillers can have on you, then I think you are living under a rock."
After being prescribed 100 Percocet pills, Peter Marciano became friends with his pharmacist, who Stephen says began giving him more drugs.
"All of a sudden, that led to Oxycontins, where he would crush up an eight-hour time release on the Oxycontin and snort them," Stephen recalled. "The Oxycontin became too expensive and he went to a $4 bag of heroin."
Peter passed away from an overdose in December of 2015. He was 48. Stephen now fights to raise awareness for addiction – a cause with which the DPH can sympathize.
"Public awareness of the opioid epidemic has increased as the epidemic has grown," DPH Commissioner Monica Bharel told NBC Boston. "I think there is a greater understanding now than there was a year ago given the work that has been done to address the crisis, but also because the problem has become so widespread – touching nearly every community in the commonwealth."
Bharel says public perception of addicts has been a major obstacle.
"Seeing substance use disorders as a disease and not some moral failing is a major challenge, and one that the administration has moved to address through our #StateWithoutStigMA campaign," she explained.
After the Grayken Center's announcement, Baker also noted the importance of removing that stigma.
"You can't underestimate how important it is for the family members who are dealing with this stuff, and for the people themselves who are dealing with these issues, to be able to believe there's a community out there that's trying to help them work their way through this," Baker said. "That they're not all by themselves, and they're not alone, and that people are putting the shoulder to the wheel on this issue the same way we do on so many others."
"Substance use disorders or addiction – it's a brain disease that's often conflated with moral failing. I think there's big strides being made in that area to de-stigmatize addiction, but I think it's still a legacy we'll be faced with," Walley said. "People often don't want to talk about it, and they don't want to address it, until it's really bad or too late."
A graph featured in the Chapter 55 report compares age-adjusted opioid-related deaths each year in Massachusetts against the national average. Since 2000, Massachusetts has consistently held a higher death rate than the U.S. as a whole. But over the last several years, the Bay State has seen a sharp spike and pulled away from the average.
This century, Massachusetts' rate (8.5 deaths per 100,000 people) was closest to the national one (7.6) in 2010. While both rates have been on the rise since then, in 2015, the commonwealth's rate (23.3, as seen in the Chapter 55 report) was more than double the national rate (10.4, according to the Centers for Disease Control).
The report, which Bharel says is "groundbreaking in its depth," also presents an extensive array of data about the correlation with medications, like the ones Peter Marciano was prescribed.
"As opposed to just seeing words and numbers on paper, it's an interactive tool," she explained. "People can understand the issue and work toward making improvements."
Those improvements often involve rehabilitation programs for people in the throes of addiction.
"The stigma of opioid addiction keeps many people from seeking treatment that can save their lives," Bharel said. "Our anti-stigma efforts aim to educate the public that addiction is a disease, not a choice – and that treatment is available."
While Stephen Marciano says treatment programs for addicts are well-intentioned, he doesn't believe they get to the root of the problem.
"It needs to start sooner than that. It needs to start with the kids before they get to that," he said. "It needs to start with doctors being held accountable for over-prescribing painkillers."
Marciano saw the progression from the pharmacy to the needle over the course of his brother’s addiction, and he doesn't believe rehabilitation is as effective as prevention.
"We have come up with so many different programs for people after the fact. I just believe that after that point in time, it is too late for people," he said. "It's almost as if they have been dying for years."
Walsh echoed that priority after thanking the Graykens for their donation.
"Today is not about beds," the mayor said. "Today is about coming up with a continuum of care, and coming up with a system that works. And I think beds are great, but what we have to do is figure out, 'How do we prevent people from needing the bed in the first place?'"
For those who do need help, Walley knows first-hand that they can get better.
"If it were hopeless, if people didn't get better, if it were a death sentence – I don't think I'm personally strong enough to keep taking care of people. But it's the opposite. Most people get better. The treatments are effective," he said.
Still, he says, the tragic number of lives being claimed by addiction does yield one positive result – this crisis can no longer be ignored.
"The overdose numbers really raise the stakes on the issue," said Walley. "It is helpful, in some ways, for increasing understanding and recognition about the problem. You can't just walk around and pretend like it's not there."