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Press Release Massachusetts Rate of Opioid-Related Overdose Deaths Increased 8.8 Percent in 2021 Compared to 2020

Fentanyl continues as a major factor driving opioid-related deaths; rates among Black residents decreased
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Media Contact for Massachusetts Rate of Opioid-Related Overdose Deaths Increased 8.8 Percent in 2021 Compared to 2020

Katheleen Conti, Assistant Director of Media Relations

BOSTON — The rate of opioid-related overdose deaths in Massachusetts increased by 8.8 percent in 2021 compared to 2020, according to preliminary data released today by the Massachusetts Department of Public Health (DPH). Drug overdose deaths in Massachusetts continue to trend lower than the nationwide figures. The rise in death rates reflects effects of the COVID-19 pandemic and an increasingly poisoned drug supply, primarily with the powerful synthetic opioid fentanyl.

There were 2,290 confirmed and estimated opioid-related overdose deaths in 2021, an estimated 185 more deaths than the prior year. Preliminary data from the first three months of 2022 show there were 551 confirmed and estimated opioid-related overdose deaths, a 4 percent decrease (an estimated 24 fewer deaths) than the same time last year.

Fentanyl remains a persistent factor in opioid-related overdose deaths in Massachusetts. Preliminary data show fentanyl was present at a rate of 93 percent where a toxicology report was available. The presence of fentanyl has increased about 1 percent per quarter since 2016, including in the pre-pandemic period from 2017 to 2019 when opioid-related overdose deaths in Massachusetts were on the decline.

The Baker-Polito Administration remains focused on the opioid epidemic and continues to invest millions of dollars to expand a wide range of harm reduction, substance use awareness, treatment intervention, and recovery services. The Administration’s Fiscal Year 2023 (FY23) budget proposal invests $543.8 million in total funding for a wide range of harm reduction, treatment, and recovery programs that support individuals struggling with substance addiction and programs that work to prevent substance addiction through education, prescription monitoring, and more. This builds on the work done by the Administration and the Legislature to nearly quadruple state funding to tackle the addiction crisis since 2015.

“Tackling the opioid epidemic remains an urgent priority for our Administration, which is why we have worked with the Legislature to quadruple funding for substance addiction treatment and prevention, but we know there is more work to do,” said Governor Charlie Baker. “Today’s report underscores the harmful impact that the COVID-19 pandemic and the scourge of fentanyl have had on those struggling with addiction, and we are committed to continuing our work with the Legislature and our colleagues in the addiction and recovery community to boost access to services and treatment.”

“Over the past several years, our Administration has focused on addressing the opioid epidemic and the ways in which it intersects with the challenges of the COVID-19 pandemic, by strengthening pathways to treatment and recovery services, and education and prevention tools,” said Lieutenant Governor Karyn Polito. “We will continue our comprehensive efforts while working with local public health officials to expand access to programs and services for those struggling with addiction.”

In 2021, the opioid-related overdose death rate in Massachusetts increased to 32.6 per 100,000 people as compared to 29.9 per 100,000 in the prior year. When comparing 2021 to 2020, the opioid-related overdose death rate among race and ethnic groups as a whole or by gender remained relatively stable, with Black non-Hispanic and Asian/Pacific Islander populations seeing small decreases and white non-Hispanic and Hispanic populations seeing small increases. One exception is American Indian/Alaska Native residents. The 2021 opioid-related overdose death rate for American Indian/Alaska Native residents was 118.6 per 100,000. While this population accounts for a small number of opioid-related overdose deaths (13 out of 2,234 confirmed deaths), American Indian/Alaska Native residents statistically had the highest opioid-related overdose death rate among all race/ethnicity groups last year.

There is clear evidence that the COVID-19 pandemic has had a profound impact on mental health and has led to increased substance use across the Commonwealth. A preliminary analysis of DPH’s COVID-19 Community Impact Survey, conducted to better understand the layered impacts of the pandemic, saw an increase in poor mental health and substance use since the pandemic began, especially among Black, Indigenous, people of color (BIPOC) and LGBTQ+ individuals.

“We continue to be relentless in our commitment to increase access to harm reduction services, low threshold housing and treatment,” said Health and Human Services Secretary Marylou Sudders. “By working to destigmatize addiction and meeting people where they’re at, including with an expanded array of harm reduction tools, we can reverse this negative trend.”

“We recognize the disproportionate burden of the opioid epidemic on historically marginalized communities, which have also borne the brunt of the ongoing pandemic and its destabilizing impacts on mental health and substance use,” said Public Health Commissioner Margret Cooke. “We continue to use a data-driven approach to identify new solutions and expand on existing programs at the community level to increase much-needed outreach, especially among communities of color.”

Since the start of the pandemic, the Administration has aggressively expanded existing substance use disorder treatment and overdose prevention initiatives, investing $120 million in prevention programs from fiscal years 2016 to 2022. DPH has distributed more than 143,000 naloxone kits since March 2020 to opioid treatment programs, community health centers, hospital emergency departments, and houses of correction. Exemptions for federal requirements for take-home doses of medication for opioid use disorder have allowed 34 percent of Massachusetts opioid treatment program patients to access this life-saving treatment as of January 2022, compared to the pre-pandemic average of 16 percent in December 2019 (with a high of 52 percent in June 2020).

DPH has also expanded harm reduction programs as part of its overall overdose prevention efforts, including low-threshold housing (transitional and permanent), post-overdose support teams for overdose survivors, and mobile addiction services to improve access to treatment for individuals.

After fentanyl, cocaine continues to be the next most prevalent drug among opioid-related overdose deaths, present in toxicology reports at a rate of 51 percent in 2021 – a 5 percent increase over 2020. Benzodiazepines were present in 31 percent of opioid-related fatal overdoses. The percentage of benzodiazepines has been declining since the last quarter of 2017.

Alcohol, a newly reported toxicology data point, was present in 29 percent of opioid-related overdose deaths. This was followed by prescription opioids in 13 percent, and heroin or likely heroin and amphetamines present in 10 percent. The rate of heroin or likely heroin present in opioid-related overdose deaths has been declining since 2014.

Among the other findings of the latest opioid report:

  • The confirmed opioid-related overdose death rate for all Black non-Hispanic residents fell from 37.5 to 35.1 per 100,000 between 2020 and 2021. The death rate for Asian/Pacific Islander non-Hispanic residents was relatively constant, going from 3.4 per 100,000 in 2020 to 3.3 per 100,000 in 2021.
  • Both white non-Hispanic and Hispanic residents experienced death rate increases, with white non-Hispanic rates rising from 33.8 to 35.9 per 100,000 and Hispanic rates from 35.4 to 38 per 100,000 between 2020 and 2021.
  • Males comprise 73 percent of all opioid-related overdose deaths occurring in 2021.
    • 50 percent of opioid-related deaths occurred in people who were between 25 and 44 years old, compared to 5 percent of all deaths
    • 41 percent were between 45 and 64 years old, compared to 17 percent of all deaths
  • In 2021, males ages 25-34 once again represented the greatest number, accounting for 21 percent of suspected opioid-related incidents with a known age and sex treated by Emergency Medical Services (EMS).
  • Naloxone was administered in 96 percent of acute opioid overdoses occurring in 2021. Of all opioid-related EMS incidents in 2021, 55.3 percent were categorized as acute opioid overdoses.

The following cities and towns experienced a notable decrease in opioid-related overdose deaths in 2021 compared with 2020. (Residence is the city/town where the decedent lived, and occurrence is where the death occurred.)

Towns Experiencing a Notable Decrease in Opioid-Related Overdose Deaths from 2020 to 2021 that Meet Criteria*
















The following cities and towns experienced a notable increase in opioid-related overdose deaths in 2021 compared with 2020.

Towns Experiencing a Notable Increase in Opioid-Related Overdose Deaths from 2020 to 2021 that Meet Criteria*
Town Residence Occurrence Both


















New Bedford















* Criteria are the difference in the number of deaths between 2020 and 2021 is 10 or more higher in absolute number and 20% or higher in percent change.


Media Contact for Massachusetts Rate of Opioid-Related Overdose Deaths Increased 8.8 Percent in 2021 Compared to 2020

Department of Public Health 

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