Massachusetts is a national leader in providing access to high quality healthcare, yet our state opioid epidemic continues to be among the worst in the nation. According to newly released data from the Massachusetts Department of Public Health (DPH), we set another record high in 2022, losing 2,357¹ people to opioid-related overdoses. In this research brief we analyze these newly released data to provide a quick update on where we stand.

After a period of slight declines from 2014 to 2018, opioid-related deaths again increased in Massachusetts for four years straight. Over the year from 2021 to 2022, age-adjusted deaths per 100,000 increased by 2.5 percent. In response to our high rates, the state of Massachusetts has invested in expansion of substance use disorder treatment and overdose prevention initiatives, yet deaths are still trending upwards.

The national trend looks like our state trend, except the rate of increase nationally has been even faster in recent years. Several years ago, Massachusetts had an opioid-related death rate almost two times the national rate. As of 2021 (the most recent year for which we have national data), it was 8 percentage points greater.

During the early years of the opioid epidemic, White death rates were consistently higher than Black and Latino death rates. Unfortunately, the Black and Latino rates increased quickly over the past 10 or so years, and these new data show Black and Latino death rates now consistently outpacing White death rates. Between 2021 and 2022, opioid-related overdose death rates increased by a staggering 42 percent among Black residents and 14 percent among Latino residents.

It’s important to stress that death rates among American Indian residents are the highest of any racial group and have been all along. In 2022, at an age-adjusted rate of 143.6 per 100,000, American Indian death rates exceed any other group. They are not represented in the chart due to small total numbers, but these high opioid-related overdose death rates indicate we have more work to do to counteract decades of racist policies that use punitive rather than treatment based approaches and to make sure interventions are reaching these groups.

White death rates in Massachusetts have largely leveled off since 2016, albeit at levels still meaningfully above the national rate for all racial groups. Notably, the death rate among Asian residents of Massachusetts has remained dramatically lower than all other groups.

Men continue to make up the majority of opioid-related deaths, comprising 72 percent of all opioid-overdose deaths in 2022. Looking at gender and race together, Black and Latino men face the highest rates of overdose. Opioid-related overdose death rates increased from 2021 to 2022 by 41 percent among Black men and by 12 percent among Latino men.

Typically, we expect to see higher death rates among older populations, but that’s not the case for opioid-related deaths. In 2022 the vast majority of opioid-related deaths occurred between the ages of 25 and 64. As we would expect, 25–44 year-olds made up only 5 percent of all deaths in Massachusetts, but they made up 47 percent of opioid-related deaths.

In 2022, a striking 93 percent of overdose deaths involved fentanyl, a powerful synthetic opioid. You can reference our 2021 update on the opioid epidemic to see how the presence of fentanyl has increased drastically since 2013. Its growing presence is one of the reasons that opioid-related overdose deaths have increased so rapidly. Because other drugs like heroin and cocaine are often laced with fentanyl, at times people using these drugs don’t even know they’re taking this potent opioid.

After seeing more and more deaths involving xylazine, Massachusetts DPH included xylazine in its data release for the first time in 2022. Xylazine was present in 5 percent of Massachusetts overdose deaths in 2022. Xylazine is not an opioid but a veterinary tranquilizer not approved for human consumption that in 2020 to 2021 started appearing mixed with opioids in street drug tests. Concerningly, naloxone, the lifesaving medication that can reverse the effect of any opioid, will not reverse the effects of xylazine, making overdoses that involve both substances more complicated to respond to.

Research points us to evidence-based strategies that can help reduce opioid-related overdose deaths—this includes medications for opioid use disorder, broad distribution and availability of naloxone, and other interventions that reduce the negative impacts of drug use, known as “harm reduction.” And while the state of Massachusetts and some municipalities have already begun expanding these strategies, unfortunately, they haven’t been enough to curb the upward trend.

1. Includes confirmed and estimated.