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!DOCTYPE html>html langen-US>head>    !-- title and meta -->    meta charsetutf-8>    meta http-equivX-UA-Compatible contentIEedge>    meta contentwidthdevice-width,initial-scale1.0 nameviewport>    title>Opioid Epidemic/title>    !-- css -->    link relstylesheet hrefhttp://fonts.googleapis.com/css?familyRoboto+Slab>    link relstylesheet hrefcss/jquery-ui.css>    link relstylesheet hrefcss/bootstrap.css>    link relstylesheet hrefcss/main.css>    script srcjs/dist/vendor.js>/script>    script typetext/javascript async srchttp://www.google-analytics.com/ga.js>/script>    script typetext/javascript>    // ga tracking    // initiate google analytics queue    var _gaq  _gaq || ;    // global tracking code    _gaq.push(        b._setAccount, UA-12471675-2, b._setDomainName, mass.gov, b._trackPageview    );    (function() {        var ga  document.createElement(script);        ga.type  text/javascript;        ga.async  true;        ga.src  (https:  document.location.protocol ? https://ssl : http://www) + .google-analytics.com/ga.js;        var s  document.getElementsByTagName(script)0;        s.parentNode.insertBefore(ga, s);    })();    /script>    !-- Facebook Open-graph metadata -->    meta propertyog:title contentChapter 55 Data Visualization />    meta propertyog:description contentThere is a deadly #OpioidEpidemic in Massachusetts. View the interactive #Chapter55 report to find out what’s causing this public health crisis and what can be done to solve it. />    meta propertyog:type contentwebsite />    meta propertyog:url contenthttp://www.mass.gov/chapter55 />    meta propertyfb:admins content1266533259 />    meta propertyog:image contenthttp://www.mass.gov/chapter55/img/chapter55-cover.jpg />    !-- Twitter card metadata -->    meta nametwitter:card contentsummary_large_image />    meta nametwitter:site content@massgov />    meta nametwitter:title contentChapter 55 Data Visualization />    meta nametwitter:description contentA data visualization of findings from the Chapter 55 report />    meta nametwitter:creator content@iamclairesun />    meta nametwitter:image contenthttp://www.mass.gov/chapter55/img/chapter55-cover.jpg />/head>body>    div classwrapper>        main>            div classannouncement>                p>                    This data visualization is now an strong>archive/strong> from 2016.                    Updated Chapter 55-related files are now being maintained on                    span classannouncement-link-wrapper>                        a classannouncement-link hrefhttps://www.mass.gov/lists/public-health-data-warehouse-phd-publications>                            Public Health Data Warehouse: Publications                            svg                              classannouncement-link-arrow                              aria-hiddentrue                              xmlnshttp://www.w3.org/2000/svg                              width1em                              height1em                              viewBox0 0 16 18                            >                                path                                  dM12.721 6.28L15.423 9l-2.702 2.72-5.403 5.45-2.701-2.72 3.498-3.53H.443V7.07h7.66L4.617 3.55 7.318.83z                                >/path>                            /svg>/a>/span>                /p>            /div>            section classmodule parallax parallax-1 target idtop>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-6 pull-right hidden-xs hidden-sm header-vid-space>                            video autoplay loop>                                WCAG general accessibility recommendation is that media such as background video play through only once. Loop turned on for the purposes of illustration; if removed, the end of the video will fade in the same way created by pressing the Pause button                                source srcvideo/opioid.mp4 typevideo/mp4>                            /video>                        /div>                        div classcol-xs-12 col-md-6 neg-space-col-md>                            h1>span classh1-sm>The Massachusettsbr />/span>Opioid Epidemic/h1>                            h2>A data visualization of findings from the 2016 Chapter 55 report/h2>                            a hrefhttps://www.mass.gov/lists/public-health-data-warehouse-phd-publications stylemargin: -15px 0 15px; typebutton classbtn btn-primary btn-lg onclick_gaq.push(b._trackEvent, button, clicked, new-data)>View latest report i classglyphicon glyphicon-arrow-right aria-hiddentrue>/i>/a>                            !-- Social Media Buttons BEGIN-->                            div stylepadding: 10px 0;>                                !-- Facebook -->                                div classfb-share-button stylevertical-align: top; data-hrefhttp://www.mass.gov/chapter55 data-layoutbutton_count>                                /div>                                !-- Twitter -->                                a classtwitter-share-button hrefhttps://twitter.com/intent/tweet?textLearn%20about%20the%20#MA%20#OpioidEpidemic%20and%20what’s%20being%20done%20to%20stop%20it%20with%20the%20interactive%20#Chapter55%20report>Tweet/a>                                !-- Linkedin -->                                script src//platform.linkedin.com/in.js typetext/javascript>                                lang: en_US                                /script>                                script typeIN/Share data-urlhttp://www.mass.gov/chapter55 data-counterright>/script>                                !-- Github -->                                a classgithub-button hrefhttps://github.com/massgov/chapter55 data-count-href/massgov/chapter55/watchers data-count-api/repos/massgov/chapter55#subscribers_count data-count-aria-label# watchers on GitHub aria-labelWatch massgov/chapter55 on GitHub>Watch/a>                            /div>                            !-- Social Media Buttons END -->                        /div>                    /div>                /div>                div classtarget idintro data-indexIntro>/div>            /section>            !-- Navigation -->            nav classnavbar navbar-inverse rolenavigation idnavigation>                div classcontainer>                    div classnavbar-header>                        span classnavbar-brand idcurrent-section>Home/span>                        button typebutton classbtn btn-danger navbar-toggle data-togglecollapse data-target.navbar-main-collapse onclick_gaq.push(b._trackEvent, menu, clicked, menu-mobile)>Menu i classglyphicon glyphicon-menu-hamburger aria-hiddentrue>/i>                        /button>                    /div>                    !-- Collect the nav links, forms, and other content for toggling -->                    div classcollapse navbar-collapse navbar-main-collapse>                        ul classnav navbar-nav>                            li idtop1 classactive>a href#top onclick_gaq.push(b._trackEvent, menu, clicked, menu-top) classpage-scroll>Home/a>/li>                            li idintro1>a href#intro onclick_gaq.push(b._trackEvent, menu, clicked, menu-intro) classpage-scroll>Intro/a>/li>                            li idchapter551>a href#chapter55 onclick_gaq.push(b._trackEvent, menu, clicked, mobile-menu) classpage-scroll>Chapter 55/a>/li>                            li idprescriptions1>a href#prescriptions onclick_gaq.push(b._trackEvent, menu, clicked, menu-prescriptions) classpage-scroll>Addiction/a>/li>                            li idaddictions1>a href#addictions onclick_gaq.push(b._trackEvent, menu, clicked, menu-addiction) classpage-scroll>Substance Use/a>/li>                            li idpopulations1>a href#populations onclick_gaq.push(b._trackEvent, menu, clicked, menu-population) classpage-scroll>Demographics/a>/li>                            li idfuture1>a href#future onclick_gaq.push(b._trackEvent, menu, clicked, menu-future) classpage-scroll>The Future/a>/li>                        /ul>                    /div>                    !-- /.navbar-collapse -->                /div>                !-- /.container -->            /nav>            !-- NAV -->            !-- intro -->            section classmodule content>                div classcontainer>                    div classrow>                        div classcol-md-12>                            h2>A Deadly Problem/h2>                            p>Massachusetts is currently experiencing an epidemic of opioid-related overdose and death./p>                            p>These overdoses are driven by the underlying chronic disease of opioid addiction or opioid use disorders. People with opioid addiction are at high risk of overdose and death./p>                            p>Opioid-related deaths in the state were more than four times higher in 2015 than in 2000. This recent rate of increase is several times faster than anything seen here before. In 2013–2014 alone, opioid-related deaths occurred in two-thirds of the cities and towns in Massachusetts. /p>                            p>/p>                        /div>                    /div>                /div>                div classcontainer>                    div classrow>                        div classcol-md-12>                            h3 classtitle>Average Annual Opioid-related Death Rate per 100,000 Peoplea href#footnote-1 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>1,/sup>/a>a href#footnote-2 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>2,/sup>/a>a href#footnote-3 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>3,/sup>/a>a href#footnote-4 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>4,/sup>/a>a href#footnote-5 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>5/sup>/a>/h3>                            h4 classsubtitle>The maps below, representing average annual rates of opioid-related deaths across five-year spans, demonstrate the increase in both the spread and intensity of the problem across Massachusetts./h4>                            div idbinaryMaps data-active-date2005 stylepadding-bottom: 5%; roleimg aria-labelThree maps showing opioid-related deaths in Massachusetts in 5-year intervals from 2001 to 2015.>                                div classbtn-group btn-group-justified>                                    div classbtn btn-sm btn-default js-toggle-binary-map active onclick_gaq.push(b._trackEvent, 5yrmap, clicked, mobile-2001-2005) data-date2005>2001-2005/div>                                    div classbtn btn-sm btn-default js-toggle-binary-map onclick_gaq.push(b._trackEvent, 5yrmap, clicked, mobile-2006-2010) data-date2010>2006-2010/div>                                    div classbtn btn-sm btn-default js-toggle-binary-map onclick_gaq.push(b._trackEvent, 5yrmap, clicked, mobile-2011-2015) data-date2015>2011-2015/div>                                /div>                                div idbinaryMaps_legend classvis-legend>/div>                                div idbinaryMaps_maps>/div>                                div classsource>a hrefjs/data/csv/Introduction_MassMuni_5yrOpioidDeathRate.csv onclick_gaq.push(b._trackEvent, download, clicked, average-annual-opioid-related-death-rate) downloadAverageAnnualOpioidRelatedDeathRateper100,000People.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                                div classsource>Sources: a target_blank hrefhttps://www.mass.gov/orgs/registry-of-vital-records-and-statistics>Massachusetts Registry of Vital Records and Statistics/a>, a target_blank hrefhttps://www.mass.gov/orgs/department-of-public-health>Massachusetts Department of Public Health/a>./div>                            /div>                        /div>                    /div>                /div>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-6>                            p classhidden-xs hidden-sm>/p>                            p>The opioid-related death rate in Massachusetts has surpassed the national average, with an especially sharp rise in the last two years./p>                            p>In fact, 2014 marked the first year since 1999a href#footnote-6 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>6/sup>/a> that the fatal overdose rate in the Bay State was more than double the national average. While opioid-related deaths have been on the rise across the country during that period, the situation in the Commonwealth has become especially worrying./p>                            p>In one way or another — through deaths, nonfatal overdoses, or disruptions to jobs, marriages, families, and neighborhoods — every community in Massachusetts has been impacted by this growing crisis./p>                        /div>                        div classcol-xs-12 col-md-6>                            h3 classtitle>Age-Adjusted Opioid-related Death Rate by Yeara href#footnote-4 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>4,/sup>/a>a href#footnote-7 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>7/sup>/a>sup>,/sup>a href#footnote-8 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>8/sup>/a>/sup>/h3>                            h4 classsubtitle>Comparing the opioid-related death rate of Massachusetts to the nation overall./h4>                            div iddeathLines roleimg aria-labelLine chart showing annual age-adjusted opioid death rates per 100,000 people for Massachusetts and the United States from 2000 to 2015.>/div>                            div classsource>a hrefjs/data/csv/Introduction_USA_vs_MA_OpioidDeathRate.csv onclick_gaq.push(b._trackEvent, download, clicked, usa-ma-opioid-death-rate) downloadAgeAdjustedOpioidRelatedDeathRateByYear.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                            div classsource>Sources: Centers for Disease Control and Prevention, National Center for Health Statistics. a target_blank hrefhttp://wonder.cdc.gov/mcd-icd10.html>Multiple Cause of Death 1999-2014 on CDC WONDER Online Database/a>, released 2015. a target_blank hrefhttps://www.mass.gov/orgs/registry-of-vital-records-and-statistics>Massachusetts Registry of Vital Records and Statistics/a>, a target_blank hrefhttps://www.mass.gov/orgs/department-of-public-health>Massachusetts Department of Public Health/a>./div>                        /div>                    /div>                /div>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-12>                            p>/p>                            p>Understanding the causes and deadly effects of this issue can be a challenge. It’s a complex problem that has many layers and no single solution. It often raises more questions than answers. a classcontrols controls-video js-play-video onclick_gaq.push(b._trackEvent, intext, clicked, video-intro) data-targetLukas>span classglyphicon glyphicon-facetime-video hidden-sm hidden-xs  aria-hiddentrue>/span> Why do people start — and why do they continue – taking opioids?/a> How many people does this affect? What can be done about it and what steps are being taken? What is an opioid, anyway? /p>                        /div>                    /div>                    div classrow>                        div classcol-xs-12 col-md-6>                            !--tabs -->                            div classsr-only>                                dl>                                    dt>Definition/dt>                                    dd>The term opioid means “opiate-like.” It generally refers to a family of substances that include natural opiates (like Morphine and Codeine), as well as synthetic and semi-synthetic opioids like Heroin, Oxycodone, and Fentanyl./dd>                                /dl>                                dl>                                    dt>Uses/dt>                                    dd>The most common medical use of opioids is in the treatment of pain across a broad spectrum, from acute post-surgical pain, to chronic pain in cancer patients, to end-of-life care. Opioids can also be misused, like taking a higher dosage of a painkiller than what a doctor prescribed. Other types of misuse can be unlawful, including taking heroin — which is illegal in all instances — or taking Oxycodone that has been legally prescribed to another person. This latter behavior, transferring drugs prescribed for one person to be used by someone else, is known as “diversion”./dd>                                /dl>                                dl>                                    dt>Side Effects/dt>                                    dd>                                        Short-term side effects include drowsiness, depressed breathing, and euphoria. Long-term usage can trigger the body to develop tolerance, dependence, and addiction.                                        ul>                                            li>Tolerance is the body’s natural response to the regular presence of a substance, requiring higher doses to achieve the same effect./li>                                            li>Dependence occurs when the body becomes so accustomed to the presence of a substance that its sudden absence causes withdrawal. For an opioid user, that could also mean that a prescription to address localized pain (a shoulder, a knee, a back) could cause pain all over the body if the prescription ends without tapering off./li>                                            li>Addiction is a complex brain-body disease, where brain and body responses have changed to negatively and drastically affect behavior. This often includes an irresistible compulsion for short-term relief even in the face of both immediate and long-term risk./li>                                        /ul>                                        Each side effect is independent of the others, meaning that any, all, or none may occur in any individual.                                    /dd>                                /dl>                            /div>                            div classaria-hidden aria-hiddentrue>                                p classhidden-xs hidden-sm>/p>                                h3 classtitle>Learn More About Opioids/h3>                                hr classhidden-xs hidden-sm />                                ul classnav nav-tabs classpills-first>                                    li classactive>a href#tab_a onclick_gaq.push(b._trackEvent, learn-more, clicked, definition) data-toggletab> Definition /a>/li>                                    li>a href#tab_b onclick_gaq.push(b._trackEvent, learn-more, clicked, uses) data-toggletab> Uses /a>/li>                                    li>a href#tab_c onclick_gaq.push(b._trackEvent, learn-more, clicked, side-effects) data-toggletab>Side Effects/a>/li>                                /ul>                                div classtab-content aria-hidden>                                    div classtab-pane active idtab_a>                                        h4>What are opioids?/h4>                                        p>The term opioid means “opiate-like.” It generally refers to a family of substances that include natural opiates (like Morphine and Codeine), as well as synthetic and semi-synthetic opioids like Heroin, Oxycodone, and Fentanyl./p>                                    /div>                                    div classtab-pane idtab_b>                                        h4>What do opioids do?/h4>                                        p>The most common medical use of opioids is in the treatment of pain across a broad spectrum, from acute post-surgical pain, to chronic pain in cancer patients, to end-of-life care. Opioids can also be misused, like taking a higher dosage of a painkiller than what a doctor prescribed. Other types of misuse can be unlawful, including taking heroin — which is illegal in all instances — or taking Oxycodone that has been legally prescribed to another person. This latter behavior, transferring drugs prescribed for one person to be used by someone else, is known as “diversion”./p>                                    /div>                                    div classtab-pane idtab_c>                                        h4>What are the side effects of using opioids?/h4>                                        p>Short-term side effects include drowsiness, depressed breathing, and euphoria. Long-term usage can trigger the body to develop tolerance, dependence, and addiction./p>                                        ul classneg-space-col>                                            li>strong>Tolerance/strong> is the body’s natural response to the regular presence of a substance, requiring higher doses to achieve the same effect./li>                                            li>strong>Dependence/strong> occurs when the body becomes so accustomed to the presence of a substance that its sudden absence causes withdrawal. For an opioid user, that could also mean that a prescription to address localized pain (a shoulder, a knee, a back) could cause pain all over the body if the prescription ends without tapering off./li>                                            li>strong>Addiction/strong> is a complex brain-body disease, where brain and body responses have changed to negatively and drastically affect behavior. This often includes an irresistible compulsion for short-term relief even in the face of both immediate and long-term risk./li>                                        /ul>                                        p>Each side effect is independent of the others, meaning that any, all, or none may occur in any individual./p>                                    /div>                                    hr classhidden-xs hidden-sm />                                /div>                            /div>                            !--tabs -->                        /div>                        div classcol-xs-12 col-md-6>                            p>/p>                            div classembed-responsive embed-responsive-16by9 >                              div classembed-responsive-item idlukas>/div>                            /div>                        /div>                    /div>                    !--row -->                /div>                !--container -->            /section>            !-- /intro -->            !-- Chapter55 -->            div classmodule parallax parallax-1-1 target idchapter55 data-indexChapter 55>                div classcontainer>                    h1>Chapter 55/h1>                /div>            /div>            section classmodule content>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-6>                            p>In the face of this emergent public-health issue, the Commonwealth of Massachusetts took an unprecedented deep dive into available data on opioid-related deaths to investigate the crisis. As part of a multi-faceted effort to combat the epidemic, a target_blank onclick_gaq.push(b._trackEvent, intext, clicked, ref-chpt55-law) hrefhttps://malegislature.gov/Laws/SessionLaws/Acts/2015/Chapter55>Chapter 55 of the Acts of 2015/a> was passed by the Legislature and signed into law by a classcontrols controls-video js-play-video onclick_gaq.push(b._trackEvent, intext, clicked, video-governor) data-targetGovernor>span classglyphicon glyphicon-facetime-video hidden-sm hidden-xs  aria-hiddentrue>/span> Governor Baker/a> in August 2015. /p>                            div classembed-responsive embed-responsive-16by9 >                              div classembed-responsive-item idgovernor>/div>                            /div>                            p>/p>                            p>This new law permits the analysis of different government datasets to guide policy decisions and to better understand the opioid epidemic. Recently, a groundbreaking report highlighting the current state of the crisis was released as part of this effort./p>                        /div>                        div classcol-xs-12 col-md-6>                            p>Led by the Department of Public Health (DPH), the Chapter 55 analysis involved a target_blank onclick_gaq.push(b._trackEvent, intext, clicked, ref-chpt55-datasets) hrefhttps://www.mass.gov/doc/chapter-55-overdose-study-dph-leg-report-0/download#page58>10 datasets/a> from five different government agencies. In total, a target_blank onclick_gaq.push(b._trackEvent, intext, clicked, ref-chpt55-partners) hrefhttps://www.mass.gov/doc/chapter-55-overdose-study-dph-leg-report-0/download#page95>29 groups/a> from government, higher education, and the private sector provided information and expertise. This level of partnership is what makes the a target_blank onclick_gaq.push(b._trackEvent, intext, clicked, ref-chpt55-report) hrefhttps://www.mass.gov/doc/chapter-55-overdose-study-dph-leg-report-0/download>Chapter 55 report/a> a milestone achievement in Massachusetts. Before this legislation was passed, such a comprehensive look at the opioid epidemic in the Commonwealth would not have been possible./p>                            p>In addition to providing significant insights into the opioid crisis by answering a target_blank onclick_gaq.push(b._trackEvent, intext, clicked, ref-chpt55-7questions) hrefhttp://www.mass.gov/eohhs/docs/dph/stop-addiction/dph-legislative-report-chapter-55-opioid-overdose-study-9-15-2016.pdf#page41>seven key questions/a>, this project demonstrates how private and public organizations can collaborate to answer complex public-health questions. This model of cooperative data analysis has the potential to become the standard in Massachusetts and across the United States. The Chapter 55 project represents a process that should be continued, adapted, and refined as new public health challenges and new collaborators step forward./p>                            p>Below are examples of opioid use trends that were uncovered by Chapter 55 analysis. Real, actionable steps to curb the epidemic can be taken as a direct result of this innovative data effort./p>                        /div>                    /div>                /div>            /section>            !-- /Chapter55 -->            !-- addiction -->            div classmodule parallax parallax-2 target idprescriptions data-indexAddiction>                div classcontainer>                    h1>Addiction and Substance Use Disorder /h1>                /div>            /div>            section classmodule content>                div classcontainer>                    div classrow>                        div classcol-xs-12>                            p>Similar to diabetes or cancer, a classcontrols controls-video js-play-video onclick_gaq.push(b._trackEvent, intext, clicked, video-addiction) data-targetWakeman>span classglyphicon glyphicon-facetime-video hidden-sm hidden-xs aria-hiddentrue>/span> addiction is a complex disease/a> impacted by certain risk factors like behavior and family history. Compulsive substance abuse, cravings, and continued use despite known harmful consequences are hallmarks of the condition. This disease is also more widespread than some may realize — according to a a hrefhttp://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf#page6 onclick_gaq.push(b._trackEvent, intext, clicked, ref-addiction-SAMHSA) target_blank>study from the Substance Abuse and Mental Health Services Administration (SAMHSA)/a>, nearly 1 in 12 Americans over the age of 12 have a substance abuse disorder./p>                            h2>Cost of Addiction/h2>                        /div>                        div classcol-xs-12 col-md-6>                            p>Economically, addiction is more costly than other brain conditions like Alzheimer’s disease, Parkinson’s disease, and stroke. In fact, a hrefhttps://www.drugabuse.gov/related-topics/trends-statistics onclick_gaq.push(b._trackEvent, intext, clicked, ref-addiction-NIH) target_blank>data from the National Institutes of Health (NIH)/a> shows that costs related to substance abuse top more than $700 billion annually in the United States./p>                            p>However, economic impact is hardly the most negative aspect of addiction and, more specifically, the opioid epidemic. Addiction to opioids can put people at greater risk for infectious diseases like HIV or hepatitis, deteriorating conditions like cirrhosis or cognitive decline, family disruption like domestic violence or child abuse, job loss, exposure to criminal behavior, overdose, and death./p>                            p>/p>                        /div>                        div classcol-xs-12 col-md-6>                          div classembed-responsive embed-responsive-16by9 >                            div classembed-responsive-item idwakeman>/div>                          /div>                        /div>                    /div>                    p classhidden-xs hidden-sm>/p>                    p classhidden-xs hidden-sm>/p>                    div classrow>                        div classcol-xs-12 col-md-5 pull-right>                            p classhidden-xs hidden-sm>/p>                            h2>Growth of Addiction in Massachusetts/h2>                            p>Data from the DPH Bureau of Substance Abuse Services (BSAS) shows an increasing need for opioid-related treatment in Massachusetts. In 2000, a idtoggleOpioidsY2000 onclickopioidsY2000(); _gaq.push(b._trackEvent, intext, clicked, vis-lines-bsas-onethird) classbtn-bsas data-valmassachusetts>about one third/a> of admissions to substance abuse treatment centers and programs were opioid-relateda href#footnote-9 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>9/sup>/a>. By 2015, that figure had increased to a idtoggleOpioidsY2015 onclickopioidsY2015(); _gaq.push(b._trackEvent, intext, clicked, vis-lines-bsas-half) classbtn-bsas data-valmassachusetts>more than half/a>, overtaking alcohol as the most prevalent substance recorded by BSAS at treatment intake. a hrefhttps://www.mass.gov/media/909801/download target_blank>The Health Policy Commission (HPC)/a> recorded similar numbers for emergency room visits and hospitalizations during that time./p>                            p>Along with the rise in demand for opioid use treatment, nationally and in Massachusetts, there has been an increase in opioid-related overdoses, both fatal and nonfatal./p>                        /div>                        div classcol-xs-12 col-md-7>                            p>/p>                            div classbsas-controls>                                h3 classtitle>Primary Substance of Use When Entering Treatment by Towna href#footnote-9 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>9,/sup>/a>a href#footnote-10 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>10,/sup>/a>a href#footnote-11 classpage-scroll>span classsr-only>see footnote/span>sup>11,/sup>/a>a href#footnote-12 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>12,/sup>/a>a href#footnote-13 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>13/sup>/a>/h3>                                h4 classsubtitle>At admission, clients identify a primary substance of use for which they are seeking treatment. Below, view the changes in the percentage of primary substances identified at admission from 2000 to 2015./h4>                                hr>                                span> Filter by town name /span>                                input typetext titleTags idtags placeholdere.g. Arlington onclick_gaq.push(b._trackEvent, lines-bsas, clicked, entered-town) /> span> or /span>                                button classbtn btn-primary btn-sm btn-bsas onclick_gaq.push(b._trackEvent, lines-bsas, clicked, mass) data-valmassachusetts>view all of Massachusetts/button>                            /div>                            div idlines-bsas roleimg aria-labelLine chart sortable by town showing the annual percentage of people who listed opioids, alcohol, marijuana, other, or none as the primary substance of use from 2000 to 2015.>/div>                            div classsource>a hrefjs/data/csv/Addiction_BSAS-LineChart.csv onclick_gaq.push(b._trackEvent, download, clicked, primary-substance-treatment-by-town) downloadPrimarySubstanceofUseWhenEnteringTreatmentbyTown.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                            div classsource>Sources: a target_blank hrefhttp://www.mass.gov/eohhs/gov/departments/dph/programs/substance-abuse/>Massachusetts Bureau of Substance Abuse Services/a>, a target_blank hrefhttp://www.mass.gov/eohhs/gov/departments/dph/>Massachusetts Department of Public Health/a>/div>                        /div>                    /div>                    div classrow>                        div classcol-xs-12 col-md-12>                            p>/p>                            h3 classtitle>Percentage of Patients in Treatment Listing Heroin as their Primary Substance of Usea href#footnote-11 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>11,/sup>/a>a href#footnote-12 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>12,/sup>/a>a href#footnote-13 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>13/sup>/a>/h3>                            h4 classsubtitle>At admission, clients identify a primary substance of use for which they are seeking treatment. Below, view maps at five-year intervals which show the increase in the percentage of admissions identifying heroin as their primary substance of use./h4>                            hr>                            div idtreatmentMaps data-active-date2000 roleimg aria-labelFour maps showing the percentage of people by town seeking substance use treatment who listed heroin as the primary substance of use in 2000, 2005, 2010, and 2015.>                                div classbtn-group btn-group-justified>                                    div classbtn btn-sm btn-default js-toggle-treatment-map active onclick_gaq.push(b._trackEvent, maps-bsas, clicked, 2000) data-date2000>2000/div>                                    div classbtn btn-sm btn-default js-toggle-treatment-map onclick_gaq.push(b._trackEvent, maps-bsas, clicked, 2005) data-date2005>2005/div>                                    div classbtn btn-sm btn-default js-toggle-treatment-map onclick_gaq.push(b._trackEvent, maps-bsas, clicked, 2010) data-date2010>2010/div>                                    div classbtn btn-sm btn-default js-toggle-treatment-map onclick_gaq.push(b._trackEvent, maps-bsas, clicked, 2015) data-date2015>2015/div>                                /div>                                div idtreatmentMaps_legend classvis-legend>/div>                                div idtreatmentMaps_maps>/div>                            /div>                            div classsource>a hrefjs/data/csv/Addiction_HeroinAbuseMap.csv onclick_gaq.push(b._trackEvent, download, clicked, heroin-primary-substance-use) downloadHeroinAsPrimarySubstanceOfUse.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                            div classsource>Sources: a target_blank hrefhttps://www.mass.gov/orgs/bureau-of-substance-addiction-services>Massachusetts Bureau of Substance Abuse Services/a>, a target_blank hrefhttps://www.mass.gov/orgs/department-of-public-health>Massachusetts Department of Public Health/a>/div>                        /div>                    /div>                /div>            /section>            !-- /addiction -->            !-- prescriptions -->            div classmodule parallax parallax-3 target idaddictions data-indexSubstance Use>                div classcontainer>                    h1>Substance Use/h1>                /div>            /div>            section classmodule content>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-12>                            p>Opioids are incredibly powerful drugs that have transformed the way the health care world treats and manages pain. However, because they are so potent, they can be dangerous if misused. To understand the opioid epidemic, it’s important to realize how both legal prescription medications and illegal substances impact the crisis in Massachusetts. To investigate the scope of the problem, the entire population of adultsa href#footnote-14 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>14/sup>/a> was analyzed./p>                        /div>                        div classcol-xs-12 col-md-6>                            p>/p>                            h2>Prescriptions/h2>                            p>The number of opioids prescribed to residents of Massachusetts has increased roughly 7% annually since 2000. In 2015, nearly one in six Massachusetts residents obtained an opioid prescription from a health care provider. Those receiving prescriptions obtained more than three filled prescriptions on average./p>                            h3 classtitle center>Prescription History for Fatal Overdoses/h3>                            div classsr-only>                                p>About 8 in 12 people who died from opioids in 2013 and 2014 had an opioid prescription at some point from 2011–2014/p>                                p>Only about 1 in 12 people who died from opioids in 2013 and 2014 had an active opioid prescription in the month before they died/p>                            /div>                            div classaria-hidden aria-hiddentrue>                                hr>                                div classcenter>                                    button classbtn btn-sm btn-primary btn-svg onclick_gaq.push(b._trackEvent, rx-history, clicked, 2011-2014) value2/3>2011 – 2014/button>                                    button classbtn btn-sm btn-primary btn-svg onclick_gaq.push(b._trackEvent, rx-history, clicked, 1monthdeath) value1/12>1 Month Before Death/button>                                /div>                                hr>                                div idodInfographic classcenter rolepresentation>/div>                                div classcol-xs-12 col-md-1>/div>                                div classcol-xs-12 col-md-11>                                    p idodInfographic_details>/p>                                    p>/p>                                /div>                            /div>                            div classsource>Sources: a target_blank hrefhttps://www.mass.gov/orgs/registry-of-vital-records-and-statistics>Massachusetts Registry of Vital Records and Statistics/a>, a target_blank hrefhttps://www.mass.gov/orgs/prescription-monitoring-program>Massachusetts Prescription Drug Program/a>, a target_blank hrefhttps://www.mass.gov/orgs/department-of-public-health>Massachusetts Department of Public Health/a>/div>                            p>/p>                            p>Whether using them for legitimate medical reasons or not, anyone can become dependent on or addicted to opioids. When this happens, the body’s craving for an opioid continues even if a prescription runs out. In these cases, many people keep using opioids, but illegally. More than a classcontrols controls-svg onclick_gaq.push(b._trackEvent, intext, clicked, rx-history-2thirds) data-select2/3>two-thirds/a> of people who died from an opioid-related overdose had a legal opioid prescription at some point from 2011–2014. However, only about a classcontrols controls-svg onclick_gaq.push(b._trackEvent, intext, clicked, rx-history-1twelve) data-select1/12>1 in 12/a> of those who died had an opioid prescription in the month before their death./p>                            p>It should be noted that opioid-related deaths began increasing sharply in 2012, no similar increase in opioid prescriptions was recorded. This suggests that no single substance or health care practice is solely responsible for the current opioid crisis. Rather, it’s a complex issue with a number of contributing factors./p>                            p>/p>                        /div>                        div classcol-xs-12 col-md-6>                            div classspace-col>/div>                            div classcallout>                                h3 classh3-sm>Deadly Trend: Switching from Legal to Illegal Opioids/h3>                                p classhidden-xs hidden-sm>/p>                                p>Some people make the transition from legal to illegal opioid use, driven by the disease of addiction. This becomes clear by looking at the amount of people who had a prescription six months, three months, and one month before death. This is found regardless of the substance that caused a fatal overdose./p>                                div classsr-only idsr-blocks-bar>/div>                                div classaria-hidden aria-hiddentrue>                                    h4>span idtotal classred>154/span> people had a positive toxicology screen for b>span classsubstance-type>prescription opioidsa href#footnote-15 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>15/sup>/a>/span>/b>  from 2013-2014/h4>                                    div classleft>                                        button classbtn btn-primary btn-substance btn-sm onclick_gaq.push(b._trackEvent, call-rx-history, clicked, heroin) value0>Heroin/button>                                        button classbtn btn-primary btn-substance btn-sm onclick_gaq.push(b._trackEvent, call-rx-history, clicked, fentanyl) value1>Fentanyl/button>                                        button classbtn btn-primary btn-substance btn-sm onclick_gaq.push(b._trackEvent, call-rx-history, clicked, heroin-fentanyl) value2>Both Fentanyl & Heroin/button>                                        button classbtn btn-primary btn-substance btn-sm active onclick_gaq.push(b._trackEvent, call-rx-history, clicked, rx-opioid) value3>Precription Opioids/button>                                        button classbtn btn-primary btn-substance btn-sm onclick_gaq.push(b._trackEvent, call-rx-history, clicked, meth) value4>Methadone/button>                                    /div>                                    p>/p>                                    div idbar rolepresentation>/div>                                    p classhidden-xs hidden-sm>/p>                                    hr>                                    h4 classleft>Of those with a positive toxicology screen for b>span classsubstance-type>prescription opioidsa href#footnote-15 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>15/sup>/a>/span>/b>, b>span idpercentage classred>83%/span>/b> had a legal opioid prescriptiona href#footnote-17 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>17/sup>/a> span idtime-period>at some point from 2011-2014/span>/h4>                                    div idbuttons-pie>                                        button classbtn btn-primary btn-time btn-sm active idstudyperiod onclick_gaq.push(b._trackEvent, call-rx-history, clicked, 2011-2014) value0>2011–2014/button>                                        button classbtn btn-primary btn-time btn-sm id6month onclick_gaq.push(b._trackEvent, call-rx-history, clicked, 6month) value1>6 Month Before Death/button>                                        button classbtn btn-primary btn-time btn-sm id3month onclick_gaq.push(b._trackEvent, call-rx-history, clicked, 3month) value2>3 Month Before Death/button>                                        button classbtn btn-primary btn-time btn-sm id1month onclick_gaq.push(b._trackEvent, call-rx-history, clicked, 1month) value3>1 Month Before Death/button>                                        p>/p>                                        p>/p>                                    /div>                                    div classpeople-blocks>                                        div idtable_substance>/div>                                        div idlegend>                                            img srcimg/person.svg altperson icon width25px height25px /> span> 1% of people with a positive toxicology screen for span classsubstance-type>prescription opioids/span>/span>                                        /div>                                        div classblock-chart idpeople rolepresentation>/div>                                    /div>                                /div>                                div classsourcecallout>a hrefjs/data/csv/SubstanceAbuse_RxHistory.csv onclick_gaq.push(b._trackEvent, download, clicked, opioid-decedents-prescription-history) downloadProportionDecedentsWithRxHistorybyToxicologyScreen.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                                div classsourcecallout>Sources: a target_blank hrefhttps://www.mass.gov/orgs/office-of-the-chief-medical-examiner>Massachusetts Office of the Chief Medical Examiner/a>, a target_blank hrefhttps://www.mass.gov/orgs/registry-of-vital-records-and-statistics>Massachusetts Registry of Vital Records and Statistics/a>, a target_blank hrefhttps://www.mass.gov/orgs/prescription-monitoring-program>Massachusetts Prescription Drug Program/a>, a target_blank hrefhttps://www.mass.gov/orgs/department-of-public-health>Massachusetts Department of Public Health/a>/div>                            /div>                        /div>                    /div>                /div>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-12>                            p>/p>                            h2>Multiple Prescribers/h2>                            p>One risk factor for fatal overdose that was identified was the number of opioid prescribers for an individual. There are legitimate reasons why someone might have multiple prescribers — primary care plus specialistsa href#footnote-18 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>18/sup>/a> or multi-provider practicesa href#footnote-19 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>19/sup>/a> — but there is an elevated risk for this group. The fatal opioid-related overdose rate for individuals with three or more opioid prescribers is seven times higher than the rate for other people./p>                            h2>Multiple Substances/h2>                            p>Using multiple substances at the same time is also a risk factor. For example, Cocaine showed up in 30% of toxicology screens for opioid-related deaths from 2013–2014. Nearly 60% of post-mortem toxicology screens were positive for benzodiazepines. Benzodiazepines are a type of tranquilizer, including drugs like Valium, Xanax, and Ativan, and are typically used to treat anxiety./p>                            p>While Cocaine is always illegal, benzodiazepines are legally available but might be used outside a prescription. Although benzodiazepines were present in nearly 1,000 toxicology screens from 2011–2014, only about half that many people ever had a prescription for one during that period. Fewer than 200 had a benzodiazepine prescription within a month of death. This suggests that the supply of benzodiazepines involved in overdoses includes both prescribed and diverted pills./p>                        /div>                    /div>                /div>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-6 pull-right>                            p>/p>                            p>/p>                            h2>Illegal Drugs/h2>                            p>When it comes to illegal opioids, Massachusetts is facing a dangerous combination of trends. Some individuals are transitioning from legal to illegal opioid use, perhaps due to dependence and addiction developing beyond prescribed thresholds. At the same time, the availability of illegal drugs is strengthening across the region. The Drug Enforcement Administration (DEA) surveyed law enforcement officials about the availability of Heroin in eight regions across the country from 2007 to 2014a href#footnote-20 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>20/sup>/a>. Each year, New England led all regions in the percentage of respondents who reported high Heroin availability/p>                            p>Heroin, perhaps expectedly, is commonly found in toxicology reports for opioid-related deaths. Data from 2013–2014 shows Heroin was likely or definitely in the individuals system at the time of death in more than 60% of opioid-related overdose deaths. What might be surprising is the increasingly deadly role Fentanyl is playing in the crisis./p>                            p>While Fentanyl can be available as a legally-prescribed medication, it is most often used illegally. Only about 3% of people who died from an opioid-related overdose and had Fentanyl present in their toxicology screen during the study period had a prescription for Fentanyl at the time of death. However, toxicology data shows Heroin, Fentanyl, or both substances were present in 85% of cases./p>                        /div>                        div classcol-xs-12 col-md-6>                            p>/p>                            p>/p>                            div classcallout>                                h3>Fentanyl: Legal and Illegala href#footnote-16 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>16/sup>/a>/h3>                                hr classhidden-xs hidden-sm />                                p>Fentanyl is an opioid that can be prescribed for pain management. However, it’s also used illegally either on its own or combined with Heroin, often without the users knowledge. According to the DEA, illegally produced Fentanyl can be up to 50 times more potent than Heroin. Fentanyl is increasingly recognized as a problem across the United States, and particularly in Massachusetts. Toxicology data from recent post-mortem cases indicates span classfentanyl_>Fentanyl/span> is adding to the state’s deadly epidemic more than span classheroin_>Heroin/span>. In 2015, more than 60% of toxicology samples tested positive for Fentanyl. In the previous year, that mark was about 40%./p>                                div idfentanyl-lines roleimg aria-labelLine chart showing whether both Fentanyl and Heroin, only heroin, only fentanyl, or only methadone were found in quarterly toxicology reports from the start of 2014 through the first quarter of 2016. >/div>                                div classsourcecallout>a hrefjs/data/csv/SubstanceAbuse_FentanylTox.csv onclick_gaq.push(b._trackEvent, download, clicked, percent-opioid-death-by-substance) downloadPercentageOpioidDeathBySubstance.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                                div classsourcecallout>Sources: a target_blank hrefhttps://www.mass.gov/orgs/office-of-the-chief-medical-examiner>Massachusetts Office of the Chief Medical Examiner/a>/div>                            /div>                        /div>                    /div>                /div>            /section>            !-- /prescriptions -->            !-- populations -->            div classmodule parallax parallax-4 target idpopulations data-indexDemographics>                div classcontainer>                    h1>Demographics/h1>                /div>            /div>            section classmodule content>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-12>                            p>Opioid addiction doesn’t discriminate. The crisis in Massachusetts affects people from all backgrounds. The widespread nature of the epidemic makes addressing it an especially challenging task, because the path to opioid addiction has different starting points from person to person. While definite solutions might still be a mystery, knowing how the epidemic plays out among different sections of society can help Massachusetts find ways to strongly and effectively address this problem./p>                            div classrow>                                div classcol-xs-12 col-md-12>                                    h2>Male and Female/h2>                                    p>Despite the fact more men die from opioid overdoses than women, both genders are at risk, yet in different ways. Toxicology reports show men are more likely than women to have a classcontrols controls-block onclick_gaq.push(b._trackEvent, intext, clicked, demo-mf-heroin) data-selectheroin>Heroin/a> in their systems, while a classcontrols controls-block onclick_gaq.push(b._trackEvent, intext, clicked, demo-mf-rx) data-selectprescription>prescription opioids/a> are more likely to be found in women than in men at the time of death. Part of this discrepancy may be down to a simple fact — women are more likely to use the health care system. This could present a particular risk for women because they are also more likely than men to have a classcontrols controls-block onclick_gaq.push(b._trackEvent, intext, clicked, demo-mf-multi-rx) data-selectmulti>multiple prescribers/a> for opioids, which is a risk factor as mentioned above. /p>                                /div>                                div classcol-xs-12 col-md-7>                                    p>/p>                                    h3 classtitle>Prescriber and Opioid Use Trends by Gendera href#footnote-21 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>21/sup>/a>/h3>                                    hr>                                    div classpeople-blocks>                                        img srcimg/person.svg altperson icon width25px height25px />span> 1% of strong>1,692/strong> Opioid-related Deaths from 2013-2014 /span>                                        div classgroup>                                            div classblock-chart idgender>                                            /div>                                        /div>                                    /div>                                /div>                                div classcol-xs-12 col-md-5>                                    div classspace-col>/div>                                    div idbuttons-blocks classcenter>                                        button rolebutton classbtn btn-sm btn-primary btn-blocks idprescription onclick_gaq.push(b._trackEvent, demo-mf, clicked, rx) value0>Prescription Opioids/button>                                        button classbtn btn-sm btn-primary btn-blocks idheroin onclick_gaq.push(b._trackEvent, demo-mf, clicked, heroin) value1>Heroin/button>                                        button classbtn btn-sm btn-primary btn-blocks idmulti onclick_gaq.push(b._trackEvent, demo-mf, clicked, multi-rx) value2>Multiple Prescribers/button>                                    /div>                                    p>/p>                                    !-- /select> -->                                    div idtable_gender>/div>                                    hr>                                    div idtable_gender_legend>                                        div classsource>a hrefjs/data/csv/Demographics_TrendsGender.csv onclick_gaq.push(b._trackEvent, download, clicked, prescriber-opioid-use-trends-gender) downloadPrescriberAndOpioidUseTrendsByGender.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                                        div classsource>Sources: a target_blank hrefhttps://www.mass.gov/orgs/office-of-the-chief-medical-examiner>Massachusetts Office of the Chief Medical Examiner/a>, a target_blank hrefhttps://www.mass.gov/orgs/registry-of-vital-records-and-statistics>Massachusetts Registry of Vital Records and Statistics/a>, a target_blank hrefhttps://www.mass.gov/orgs/prescription-monitoring-program>Massachusetts Prescription Monitoring Program/a>, a target_blank hrefhttps://www.mass.gov/orgs/department-of-public-health>Massachusetts Department of Public Health/a>                                        /div>                                    /div>                                /div>                            /div>                        /div>                    /div>                    div classrow>                        div classcol-xs-12 col-md-4 pull-right>                            p>/p>                            h2>Young People/h2>                            p>The fight to curb the opioid epidemic in Massachusetts is also a battle to protect future generations. The percentage of opioid-related deaths for different age groups shows the young people of Massachusetts are especially at risk. From 2013–2014, opioids accounted for more than a quarter of all fatalities in the a idage18to24 onclick_gaq.push(b._trackEvent, intext, clicked, demo-age-18-24)>18–24/a> age group. For individuals from a idage25to34 onclick_gaq.push(b._trackEvent, intext, clicked, demo-age-25-34)>25–34/a>, opioids were responsible for more than a third of all deaths, rising to more than 40% for men in this group. In 2015, roughly two out of every three people who died from opioids were younger than 45./p>                        /div>                        div classcol-xs-12 col-md-7>                            p>/p>                            h3 classtitle>Fatal Opioid Overdoses by Age and Gendera href#footnote-21 classpage-scroll aria-describedbyfootnote-label>span classsr-only>see footnote/span>sup>21/sup>/a>/h3>                            hr>                            div idbuttons-bar>                                button classbtn btn-primary btn-sm idPOD onclick_gaq.push(b._trackEvent, demo-age, clicked, percent)>Percent of Opioid Deaths/button>                                button classbtn btn-primary btn-sm idDR onclick_gaq.push(b._trackEvent, demo-age, clicked, rate)>Opioid Death Rate per Year/button>                                button classbtn btn-primary btn-sm idNOD onclick_gaq.push(b._trackEvent, demo-age, clicked, number)>Number of Opioid Deaths/button>                            /div>                            hr>                            div idchanging_bars>/div>                            div classsource>a hrefjs/data/csv/Demographics_AgeGender.csv onclick_gaq.push(b._trackEvent, download, clicked, fatal-opioid-overdose-age-gender) downloadFatalOpioidOverdosesByAgeAndGender.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                            div classsource>Sources: a target_blank hrefhttps://www.mass.gov/orgs/registry-of-vital-records-and-statistics>Massachusetts Registry of Vital Records and Statistics/a>, a target_blank hrefhttps://www.mass.gov/orgs/department-of-public-health>Massachusetts Department of Public Health/a>/div>                        /div>                    /div>                    div classrow>                        div classcol-xs-12 col-md-12>                            p>/p>                            h2>Race and Ethnicity/h2>                            p>In 2000, the rate of opioid-related fatal overdose was 5.8 per 100,000 people in Massachusetts, according to DPH data. That rate has increased steadily since then, with the figure hitting 11.1 per 100,000 in 2012. However, the increase in the last three years has been especially sharp. By 2015, there were 23.3 fatal overdoses for every 100,000 residents./p>                            p>While the death rate within Massachusetts differs for various racial and ethnic groups, people from all backgrounds in the Bay State are caught up in the deadly epidemic. In the adjoining graph, we can see the overdose rates of three of the state’s largest groups for the last two years. By comparison, the national average was 9.7 per 100,000 in 2014. As seen in the graph, the age-adjusted, normalized data reveals that the epidemic is hitting the White non-Hispanic population at a rate around twice that of Black non-Hispanic population for the last two years, and roughly 50% more than the rate for the Hispanic population over that time./p>                        /div>                    /div>                    div classrow>                        div classcol-xs-12 col-md-4>                            p>/p>                            h3 classtitle>Opioid-related Deaths by Race and Ethnicity/h3>                            hr>                            div idrace_ethnicity_chart roleimg aria-labelBar chart showing the opioid-related death rate per 100,000 people in 2014 and 2015 in Massachusetts for the overall population and three racial and ethnic groups including white non-Hispanic, black non-Hispanic, and Hispanic. >/div>                            div classsource>a hrefjs/data/csv/Demographics_RaceEthnicity.csv onclick_gaq.push(b._trackEvent, download, clicked, opioid-related-death-by-race-ethnicity) downloadOpioidDeathsByRaceAndEthnicity.csv>View the dataset powering this visualization i classglyphicon glyphicon-download-alt aria-hiddentrue>/i>/a>/div>                            div classsource>Sources: a target_blank hrefhttps://www.mass.gov/orgs/registry-of-vital-records-and-statistics>Massachusetts Registry of Vital Records and Statistics/a>, a target_blank hrefhttps://www.mass.gov/orgs/department-of-public-health>Massachusetts Department of Public Health/a>./div>                        /div>                        div classcol-xs-12 col-md-7 pull-right>                            p>/p>                            div classcallout>                                h3 classtitle>Interpreting Data/h3>                                hr classhidden-xs hidden-sm />                                ul classnav nav-tabs classpills-first>                                    li classactive>a href#tab_d onclick_gaq.push(b._trackEvent, interp-data, clicked, age-adjusted-rates) data-toggletab>Age-Adjusted Rates/a>/li>                                    li>a href#tab_e onclick_gaq.push(b._trackEvent, interp-data, clicked, confidence-intervals) data-toggletab>Confidence Intervals/a>/li>                                    li>a href#tab_f onclick_gaq.push(b._trackEvent, interp-data, clicked, normalizing-rates) data-toggletab>Normalizing Rates/a>/li>                                /ul>                                div classtab-content aria-hidden>                                    div classtab-pane active idtab_d>                                        p>/p>                                        p>Using age-adjusted data is important because different groups have different age distributions, whether those groups are broken out by racial/ethnic, gender, or geographic lines. For example, the Hispanic population in Massachusetts is relatively younger than other racial/ethnic groups in the state. Without taking age distribution into account, the fact that younger people are more likely to die from opioid-related overdoses could result in an over-estimated death rate for the Hispanic community as a whole. We might experience similar mischaracterization when looking at cities and towns that skew older or younger than the rest of the state. In these ways and others, age-adjusting population data helps public health officials get a more accurate picture of the crisis and better target the most problematic areas and populations./p>                                    /div>                                    div classtab-pane idtab_e>                                        p>/p>                                        p>Statisticians use confidence intervals to indicate the level of certainty of a measurement by showing a range of likely results. Analyzing a population is often done by looking at samples that are intended to be representative of the whole group. It is easier to assess whether that representation is accurate when the sample size is larger. For example, it is easier to trust the results of a survey with thousands of respondents than a survey with only a dozen respondents. So, adjusted for different sample sizes, confidence intervals show the precision of different results. /p>                                        p>When counts are smaller, rates are less precise and confidence intervals are wider. Larger samples have narrower ranges. Note that the confidence intervals on the rates for the Black non-Hispanic category are much wider than those around the rates for the White non-Hispanic category. This is because fewer non-Hispanic Blacks are dying from opioid-related overdoses than non-Hispanic Whites, so their sample size is smaller./p>                                        p>When comparing two results, you can only be sure that there is truly a difference when the confidence intervals do not overlap. An example of this is seen in the death rates for the Black non-Hispanic and Hispanic populations. While the projections look higher for 2015, since the confidence intervals overlap, we can’t be sure that the numbers are significantly different from 2014 because the results could fall anywhere within either overlapping range./p>                                    /div>                                    div classtab-pane idtab_f>                                        p>/p>                                        p>When doing population analysis, statisticians will often use a rate per sample size (example: rate per 100,000), rather than just a raw count. Densely populated areas are more likely to show many types of behavior, whether good or bad, because there are simply more people. Using raw count, the largest cities would always show up as hot spots and probably draw the most focus and resources. By contrast, a raw count change from 100 to 200 in a city of 1 million (was 0.01%, now 0.02%) might not seem as significant as the same change in a town of 2,000 (was 5%, now 10%)./p>                                        p>For example, since the White non-Hispanic population is larger in Massachusetts than other similar groups, if we just went by raw count, we couldn’t be sure whether the higher number of opioid-related deaths reflected a larger problem, or just a larger sample. By normalizing all the rates to the same sample size, we can properly compare groups to see that the problem is truly more prevalent among non-Hispanic Whites than among other groups./p>                                        p>Comparing apples to apples by standardizing to a normalized rate helps public health officials get a more accurate picture so they can develop the right strategies to combat the epidemic./p>                                    /div>                                    hr classhidden-xs hidden-sm />                                /div>                            /div>                        /div>                    /div>                    div classrow>                        div classcol-xs-12 col-md-12>                            p>/p>                            h2>Incarcerated Population/h2>                            p>When an inmate is released from prison in Massachusetts, their ability to re-enter society is being threatened by the opioid crisis. The risk of opioid-related death following release from incarceration is more than 50 times greater than for the general public. What’s more concerning is that the threat is immediate. Fatal overdoses during the first month after release are six times higher than for all other post-incarceration periods. /p>                            p>Among inmates who both were released and died between 2013 and 2014, opioid-related overdose was the cause of death for 40% of these people. Following the age trend noted above, the risk of death for people aged 18–24 in this group is roughly 10 times higher than for individuals 45 or older. While some inmates receive substance use treatment while incarcerated, the data from this study does not include how, when, or for how long that treatment takes place./p>                        /div>                    /div>                /div>            /section>            !-- /populations -->            !-- future -->            div classmodule parallax parallax-5 target idfuture data-indexThe Future>                div classcontainer>                    h1>The Future/h1>                /div>            /div>            section classmodule content>                div classcontainer>                    div classrow>                        div classcol-xs-12 col-md-6>                            p>The opioid epidemic won’t be solved overnight, and there’s no easy solution to make this problem disappear. However, there are signs of hope and a turning tide./p>                            p>The state has recently taken a number of important steps to address the crisis. From campaigns aimed at shifting the culture around how the public views addiction, to giving our health care professionals the tools they need to responsibly prescribe opioids and monitor prescriptions, Massachusetts is working to end the epidemic./p>                            p>While there is still a lot to do, findings from the Chapter 55 report have helped elected officials and public health leaders determine what should be done next./p>                            !--tabs -->                            div classaria-hidden aria-hiddentrue>                                p classhidden-xs hidden-sm>/p>                                ul classnav nav-tabs classpills-first>                                    li classactive>a href#tab_g onclick_gaq.push(b._trackEvent, learn-more, clicked, done) data-toggletab>Recent Steps Taken/a>/li>                                    li>a href#tab_h onclick_gaq.push(b._trackEvent, learn-more, clicked, to-do) data-toggletab>What to Do Next/a>/li>                                /ul>                                div classtab-content aria-hidden>                                    div classtab-pane active idtab_g>                                        p>/p>                                        ul>                                            li>strong>Stopping Stigma/strong> — Shifting the way that people view addiction and individuals with substance use issues is a top priority. DPH launched the a hrefhttps://www.mass.gov/statewithoutstigma target_blank>State Without StigMA/a> campaign to encourage the public to rethink how they perceive and treat people with addiction. Stories from people in recovery — like a classcontrols controls-video js-play-video onclick_gaq.push(b._trackEvent, intext, clicked, video-sue) data-targetSue>span classglyphicon glyphicon-facetime-video hidden-sm hidden-xs  aria-hiddentrue>/span> Sue and Stephanie/a>, and a classcontrols controls-video js-play-video onclick_gaq.push(b._trackEvent, intext, clicked, video-cotto) data-targetCotto>span classglyphicon glyphicon-facetime-video hidden-sm hidden-xs  aria-hiddentrue>/span> Cotto/a> — have helped reframe addiction as the disease it is./li>                                            li>strong>Promoting the Good Samaritan Law/strong> — Another state campaign, a hrefhttps://www.mass.gov/maketherightcall target_blank>Make the Right Call/a>, has helped spread awareness about the state’s Good Samaritan Law. It ensures a person won’t be charged with possession of a controlled substance if they call 9-1-1 to report an overdose./li>                                            li>strong>Prescription Monitoring Reforms/strong> — To help pharmacists and doctors better monitor active opioid prescriptions, DPH launched the a hrefhttps://mass.gov/masspat target_blank>Massachusetts Prescription Awareness Tool (MassPAT)/a>. This new online system is more efficient and user-friendly than older technologies./li>                                            li>strong>Expanding Prescription Drug Training/strong> — More resources and programs have been offered to dental schools and nursing and physician assistant programs to train students and professionals on how to prevent prescription drug misuse./li>                                        /ul>                                    /div>                                    div classtab-pane idtab_h>                                        p>/p>                                        ul>                                            li>strong>Expand OAT Treatment/strong> — One of the findings from Chapter 55 was that opioid agonist treatment (OAT) can lower the ongoing risk for opioid-related death if it follows a non-fatal overdose. Developing a strategy to effectively deliver OAT could reduce the number of opioid-related deaths in the state./li>                                            li>strong>Consider Gender/strong> — Substance use trends differ depending on gender. This information can be used when developing prevention programs for both men and women. For example, working with pharmacists to create education and coordinated care strategies targeted at female patients could reduce the percentage of women who have multiple prescribers./li>                                            li>strong>Develop Post-incarceration Treatment Plan/strong> — The short-term risk for opioid-related death is much higher for individuals who were recently released from prison. Creating treatment programs that target this population may help curb the epidemic./li>                                            li>strong>Continue Using Data/strong> — The Chapter 55 legislation itself is an incredible tool. By continuing to share and look at different datasets, Massachusetts can gain even more insight into the epidemic and how it is changing. Public health leaders can then develop solutions based on the latest trends, enabling the state to stay ahead of the problem./li>                                        /ul>                                    /div>                                /div>                                hr classhidden-xs hidden-sm />                            /div>                            !--tabs -->                        /div>                        div classcol-xs-12 col-md-5 col-md-offset-1>                            p>/p>                            div classembed-responsive embed-responsive-16by9 >                              div classembed-responsive-item idsue>/div>                            /div>                            div classclearfix>/div>                            p>/p>                            aside classcallout>                                h3 classtitle>Opioid Addiction and Use Resources/h3>                                p>/p>                                ul>                                    li>a hrefhttps://helplinema.org/ target_blank>Massachusetts Substance Use Helpline/a>                                        br />a hreftel:8003275050 aria-labelMassachusetts Substance Abuse Helpline phone number>i classglyphicon glyphicon-earphone aria-hiddentrue>/i> (800) 327-5050/a>/li>                                    li>a hrefhttps://findtreatment.samhsa.gov/locator/home target_blank>Substance Use Treatment Services Locator i classglyphicon glyphicon-arrow-right>/i> /a>/li>                                    li>a hrefhttps://www.mass.gov/service-details/prescription-dropbox-locations target_blank>Prescription Dropbox Locations i classglyphicon glyphicon-arrow-right aria-hiddentrue>/i> /a>/li>                                    li>a hrefhttps://www.mass.gov/protect-your-kids-from-prescription-drug-use target_blank>Parents: Talk to Your Kids about Opioids i classglyphicon glyphicon-arrow-right aria-hiddentrue>/i> /a>/li>                                /ul>                            /aside>                            p>/p>                            div classembed-responsive embed-responsive-16by9 >                              div classembed-responsive-item idcotto>/div>                            /div>                            div classclearfix>/div>                        /div>                    /div>                /div>            /section>            !-- /future -->        /main>        !-- /main -->        footer>            div classcontainer>                div classrow>                    div classcol-xs-12 col-md-6>                        div classlogo>                            img srcimg/DPHLogo_White.png classimg-responsive altDPH logo />                        /div>                        address>                            strong>Massachusetts Department of Public Health/strong>                            br>                            i classglyphicon glyphicon-map-marker aria-hiddentrue>/i> 250 Washington St, Boston, MA 02108                            br>                            a hreftel:6176246000 aria-labelMassachusetts Department of Public Health phone number>i classglyphicon glyphicon-earphone aria-hiddentrue>/i> (617) 624-6000/a>                            br>                        /address>                    /div>                /div>            /div>            !--             div classasides clearfix>        aside>          nav>          /nav>        /aside>      /div> -->        /footer>        !-- /footer -->        div classsources-section>            div classcontainer>                h1 idfootnote-label classsr-only>Footnotes/h1>                ol>                    li idfootnote-1>The confirmed opioid-related death rate was suppressed in towns that were detected as strong outliers using Tukey’s outlier filter. All values that fell outside of the upperbound, calculated using three times the interquartile range, were considered strong outliers. Rates for Provincetown, Cummington, and Granville were suppressed from 2001 to 2005. Rates for Aquinnah, New Ashford, and Tyringham were suppressed from 2011 to 2015./li>                    li idfootnote-2>In both 2014 and 2015, there was one death of a Massachusetts resident whose city/town of residence was not known./li>                    li idfootnote-3>Please note that data for 2000-2013 have been updated following a review of cases that did not receive an official cause of death at the time the file was closed. Death data for 2014-2015 are preliminary and subject to updates. Case reviews of deaths are evaluated and updated on an ongoing basis. A large number of death certificates have yet to be assigned final cause-of-death codes. These counts are based on the estimates rather than confirmed cases./li>                    li idfootnote-4>Cases were defined using the International Classification of Disease, Tenth Revision (ICD-10) codes for mortality. The following codes were selected from the underlying cause of death field to identify poisonings/overdoses: X40-X49, Y10-Y19. All multiple cause of death fields were then used to identify an opioid-related death: T40.0, T40.1, T40.2, T40.3, T40.4, and T40.6./li>                    li idfootnote-5>The average annual opioid-related death rate was calculated in five-year intervals. The death rate displayed is the crude, non age-adjusted rate./li>                    li idfootnote-6>In 1999, the International Classification of Diseases, Tenth Revision (ICD-10) replaced the International Classification of Diseases, Ninth Revision (ICD-9) for coding all mortality data. Because there were changes made in the codes that are assigned to causes of death, changes to the rules used to determine the underlying cause of death, and changes in the codes that comprise the leading cause of death categories, direct comparisons of causes of death between 1999 and previous years cannot be made./li>                    li idfootnote-7>The Massachusetts age-adjusted opioid-related death rate was provided by the Massachusetts Department of Public Health./li>                    li idfootnote-8>The national level data was extracted from the Centers for Disease Control and Prevention, National Center for Health Statistics Wonder Databases./li>                    li idfootnote-9>Opioids includes Heroin and Other Opioids. Other Opioids includes non-prescription Methadone, Oxycodone, non-prescription Suboxone, prescription opiates, non-prescription opiates, and other opiates./li>                    li idfootnote-10>Other includes Crack/Cocaine, PCP, other hallucinogens, Methamphetamine, other amphetamines, other stimulants, benzodiazepines, other tranquilizers , barbiturates, other sedatives, inhalants, OTC, club drugs, and other./li>                    li idfootnote-11>All out-of-state enrollments and Massachusetts County Correction Facility enrollments are excluded./li>                    li idfootnote-12>Data were prepared on Sep 12, 2016 with data as of July 15, 2016./li>                    li idfootnote-13>To protect client confidentiality, categories with 5 or fewer admissions are supressed./li>                    li idfootnote-14>For the purposes of the study, adults is defined as the nearly 3.5 million residents aged 11 and older./li>                    li idfootnote-15>Prescription opioids includes Hydrocodone, Hydromorphone, Oxycodone, Oxymorphone, Codeine, and Tramadol./li>                    li idfootnote-16>Both Fentanyl and Heroin includes Fentanyl, Heroin, and Morphine (likely Heroin)./li>                    li idfootnote-17>Legal opioid prescription includes any prescription for Fentanyl, Methadone, Hydrocodone, Hydromorphone, Oxycodone, Oxymorphone, Morphine, or Codeine./li>                    li idfootnote-18>Some individuals may see a primary care physician who then directs them to a specialist, depending on the medical issue. In some cases, both the primary physician and specialist may provide opioids to the patient for various reasons, including for immediate pain relief. Emergency room visits might also fall under this category.                    /li>                    li idfootnote-19>Some health centers or clinics could have a pool of multiple physicians who collectively treat all patients. This could result in one patient receiving multiple opioid prescriptions from different physicians on separate visits for various reasons, including for immediate pain relief./li>                    li idfootnote-20>Data from the National Drug Threat Assessment Summary. Sources: a hrefhttps://www.dea.gov/resource-center/DIR-017-13%20NDTA%20Summary%20final.pdf#page15 target_blank aria-label2013 National Drug Threat Assessment Summary PDF>2013/a>, a hrefhttps://www.dea.gov/resource-center/dir-ndta-unclass.pdf#page53 target_blank aria-label2014 National Drug Threat Assessment Summary PDF>2014/a>. Data is not available for 2012./li>                    li idfootnote-21>Data from 2013-2014./li>                /ol>            /div>        /div>    /div>    !-- /#wrapper -->    !-- js -->    script srcjs/dist/main.js>/script>    !-- facebook -->    script>    (function(d, s, id) {        var js, fjs  d.getElementsByTagName(s)0;        if (d.getElementById(id)) return;        js  d.createElement(s);        js.id  id;        js.src  //connect.facebook.net/en_US/sdk.js#xfbml1&versionv2.8&appId873502176006096;        fjs.parentNode.insertBefore(js, fjs);    }(document, script, facebook-jssdk));    /script>    !-- twitter -->    script>    window.twttr  (function(d, s, id) {        var js, fjs  d.getElementsByTagName(s)0,            t  window.twttr || {};        if (d.getElementById(id)) return t;        js  d.createElement(s);        js.id  id;        js.src  https://platform.twitter.com/widgets.js;        fjs.parentNode.insertBefore(js, fjs);        t._e  ;        t.ready  function(f) {            t._e.push(f);        };        return t;    }(document, script, twitter-wjs));    /script>    !-- github -->    script async defer srchttps://buttons.github.io/buttons.js>/script>/body>/html>

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criminaljustice360.mass.gov	2025-01-06	35.212.63.212
elicensing21.mass.gov	2024-11-25	44.220.113.27
eplace.eea.mass.gov	2024-05-13	52.207.48.38
reports.dppc.mass.gov	2024-12-26	3.231.43.193
dashboard-data-upload.hed.mass.gov	2024-11-25	35.175.77.102
stage.mass.gov	2024-12-14	23.41.4.80
edit.stage.mass.gov	2024-03-13	184.28.93.99
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ara.anf.mass.gov	2024-02-21	54.237.123.252
cthruquasispending.mass.gov	2024-07-04	52.206.140.199
mematraining.mass.gov	2024-10-14	54.84.33.43
elicensing.mass.gov	2024-11-25	44.220.113.27
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agis.elicensing.mass.gov	2024-06-10	3.212.52.186
search.mass.gov	2024-11-02	13.224.14.33
epia.dmh.mass.gov	2023-10-04	44.196.132.25
elr4.dph.mass.gov	2024-06-10	23.22.214.210
infectious-disease-reporting.dph.mass.gov	2024-07-30	52.7.53.216
datavisualization.dph.mass.gov	2024-12-21	52.45.85.1
miis.dph.mass.gov	2024-06-09	3.92.98.254
resourcecenter.miis.dph.mass.gov	2025-01-05	184.73.232.184
edss.dph.mass.gov	2024-11-25	44.209.223.31
apex.dph.mass.gov	2024-05-13	3.216.98.59
www.sfi.eth.mass.gov	2024-09-07	34.205.249.23
paidleave-api.mass.gov	2024-12-29	204.246.191.80
chapter55.digital.mass.gov	2025-01-13	18.238.238.44
hlc-nonprod.site.secure.digital.mass.gov	2024-06-28	18.161.6.82
dev-learn-to-earn.secure.digital.mass.gov	2024-06-03	184.72.157.137
devsearch.digital.mass.gov	2024-07-20	99.84.66.104
etl.digital.mass.gov	2024-03-16	99.84.66.44
arcgisserver.digital.mass.gov	2023-08-16	52.202.57.211
mayflower.digital.mass.gov	2024-01-08	204.246.191.9
calculator.digital.mass.gov	2024-06-27	3.163.24.13
docs.digital.mass.gov	2019-11-26	13.226.15.102
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budget.digital.mass.gov	2024-09-08	204.246.191.53
chatbot.digital.mass.gov	2024-08-05	3.163.24.19
diasafetygrants-uat.dia.eol.mass.gov	2024-11-24	35.174.32.154
ais.dls.eol.mass.gov	2024-11-25	44.198.113.19
ais-uat.dls.eol.mass.gov	2024-06-03	34.194.231.208
applyhousinghelp.mass.gov	2024-03-22	52.61.134.52
vaxfinder.mass.gov	2024-09-19	44.221.35.239
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iee-qa.ehs.mass.gov	2024-12-26	44.196.75.129
mhesubmission-qa.ehs.mass.gov	2024-06-10	3.216.39.217
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alation-ad.ehs.mass.gov	2024-12-26	3.212.117.102
alation-test-ad.ehs.mass.gov	2024-05-03	3.83.62.72
ehs-hie-dash.ehs.mass.gov	2025-01-09	98.82.62.49
dta-finder.ehs.mass.gov	2024-12-27	3.163.24.118
dta-path-test.ehs.mass.gov	2024-08-04	3.163.24.95
iee-dev.ehs.mass.gov	2024-06-03	52.55.85.135
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logportal.hhs.mass.gov	2024-11-25	34.228.164.40
criminaljustice360-stage.eps.mass.gov	2025-01-09	35.212.123.171
crosstracking-stage.eps.mass.gov	2024-11-13	34.49.142.255
my.stage.tss.mass.gov	2024-11-24	108.138.94.95
api.my.stage.tss.mass.gov	2024-11-24	13.224.14.87
vets.mass.gov	2024-12-26	13.248.240.197
paidleave-uat.mass.gov	2024-10-07	18.238.238.30
vets.test.vet.mass.gov	2024-12-26	3.33.130.122
edit.mass.gov	2024-06-26	23.41.4.76
feature1.edit.mass.gov	2024-08-19	23.192.230.70
feature2.edit.mass.gov	2024-09-19	23.54.19.88
feature3.edit.mass.gov	2024-08-30	23.192.230.86
feature4.edit.mass.gov	2024-08-19	23.54.19.107
feature5.edit.mass.gov	2024-12-26	23.41.4.71
cd.edit.mass.gov	2024-08-21	23.192.230.86
dev.edit.mass.gov	2024-11-24	23.41.4.80
workplacesafetygrant.mass.gov	2024-12-26	15.197.147.172
unemployment.mass.gov	2024-12-26	170.10.106.79
admin-apps.crashdata.dot.mass.gov	2025-01-09	104.45.129.178
admin-api.crashdata.staging.dot.mass.gov	2025-01-11	4.236.243.250
vpn.crashdata.staging.dot.mass.gov	2024-12-30	40.114.125.227
services.crashdata.staging.dot.mass.gov	2025-01-06	4.236.243.250
apps.crashdata.staging.dot.mass.gov	2025-01-10	4.236.243.250
admin-apps.crashdata.staging.dot.mass.gov	2024-11-24	4.236.243.250
reports.crashdata.staging.dot.mass.gov	2024-12-21	168.62.36.137
drivercitationdata.staging.dot.mass.gov	2025-01-07	4.236.243.250
api.drivercitationdata.staging.dot.mass.gov	2024-12-26	4.236.243.250
admin-api.drivercitationdata.staging.dot.mass.gov	2025-01-09	4.236.243.250
admin-apps.drivercitationdata.staging.dot.mass.gov	2025-01-12	4.236.243.250
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www.mass.gov	2015-04-06	184.27.202.106
virtualgateway.mass.gov	2024-11-24	100.27.85.55
api.my.mass.gov	2024-11-24	18.172.170.58

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