Health

10 HE ALTH • Summer 2019 A report in May brought troubling news for Worcester: In 2018, 97 city residents died from opioid overdoses, the highest number ever recorded, up from a previous high of 82 in 2015. Worcester County also hit a new high of 283 deaths from overdoses of the drugs. In contrast, the report – produced by the Massachusetts Executive Office of Health and Human Services – found the statewide numbers declined slightly for the second year in a row, from a high of 2,100 in 2016 to 2,033. In a city of close to 200,000 people, an additional 15 deaths could be chalked up to a couple of unusually strong batches of drugs hitting the area, or just random chance. But to Dr. Matilde Castiel, the city's commissioner of Health and Human Services, the numbers suggest improvements in local institutions' approach to the problem haven't yet accomplished enough. "We overall have done some impressive things over the past number of years, but it takes some time to change," Castiel said. Initial efforts When the city hired Castiel, a doctor with a background addressing substance use disorders, in 2015, it was part of a broader effort to focus resources on the opioid problem. Already, she said, the city had a task force working with homeless people in encampments, many of whom deal with addiction. UMass Memorial's Community HealthLink now offers 24-hour urgent care support for people with drug use problems. New recovery homes are opening up in Worcester. And the city in May rolled out the new app Stigma Free Worcester, created in partnership with Worcester Polytechnic Institute, to help residents find resources like housing, clothing, mental health support and addiction treatment. Dr. Pamela Tsinteris, director of Office-Based Addiction Treatment and the Chronic Pain Program at Family Health Center of Worcester, said she's seen a big improvement in recent years in medical providers' attitudes toward substance use treatment. "A few years ago, just a few people were willing to treat addiction," she said. "We've really had an increase in the number of people providing this care." Tsinteris said, in the past, practitioners' only experience with addiction was encounters with people who tried to hide their drug problems in order to seek opioid pain prescriptions. Those encounters are often confrontational and uncomfortable, Tsinteris said, but when practitioners demonstrate they see addiction as a disease rather than a moral failing, they often find people in recovery are eager to work with them. Fighting addiction with drugs In both community settings like Family Health Center and larger institutions like the UMass Memorial Health Care system, increasing numbers of doctors, nurse practitioners, and physician's assistants are getting trained and receiving federal waivers allowing them to prescribe buprenorphine. The drug, often combined with another medication called naloxone and sold under the brand name Suboxone, helps people avoid withdrawal symptoms and physical cravings when they stop using drugs like heroin or fentanyl. "It's kind of a miraculous drug in some ways," said Dr. Christopher Kennedy, chief of psychiatry at UMass HealthAlliance Hospital in Leominster. "It Opioid deaths in Worcester and Worcester County increased last year, while the statewide death toll dropped • By Livia Gershon Fighting a rising problem Stephen Smith waits on tables at Cafe Reyes on Shrewsbury Street in Worcester, a business set up with the Hector Reyes House to provide employment for Latino men in recovery. Dr. Pamela Tsinteris, director of Office-Based Addiction Treatment and the Chronic Pain Program at Family Health Center of Worcester

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