Overdose deaths, Hep-C climbing steadily on Cape

A report on health trends in Massachusetts released Tuesday takes Cape Cod to task for high youth rates of hepatitis C, opiate overdoses, a dearth of physicians for lower-income patients — and barely a trickle of fluoridated water.

The nonprofit Massachusetts Health Council takes a look at health indicators including obesity, tobacco smoking, asthma and access to care in its biennial report, “Common Health for the Commonwealth.”

“The focus is on prevention and wellness,” said Susan H. Servais, executive director of the Massachusetts Health Council.

Most of the report’s statistics, which are drawn from a number of health and human service agencies, were for the state as a whole. But there was room for improvement in the few instances in which Barnstable County or towns on Cape Cod were mentioned specifically.

For one, the report says the town of Bourne is experiencing some particularly heavy fallout from the opiate addiction epidemic raging across the state.

Bourne was among several towns including Attleboro and Holyoke where the number of unintentional opioid overdose deaths more than doubled from the five-year period extending from 2003-2007 to the period from 2008-2012, according to the report.

The fatal overdose rate in Bourne went from three in the first five-year period to 12 in the next five-year period, according to a table accompanying the report.

“The overdose rate in Bourne is absolutely ridiculous,” said recovering addict Ryan Beers, a 25-year-old Bourne resident.

But it’s not all local residents overdosing in the town, he said

People coming from Hyannis or Brewster to meet a dealer from off-Cape in Bourne “will take their drug there. You don’t wait,” he said. “You go to the closest store and park somewhere. You’re so sick you don’t care.”

“Bourne is obviously the first town on the Cape,” Bourne police Detective John Doble said. He said it’s convenient for dealers from Brockton and other urban areas to make their deliveries in busy parking lots off Route 3 or Route 25.

“They can make arrangements to meet someone from the town of Bourne or to meet someone from the Lower Cape,” Doble said. And “as soon as they receive the package, they are going to do it” — leading in some cases to fatal overdoses.

The epidemic of opiate use including heroin is a statewide plague, Servais said. “The opioid death (rate) is the highest that’s ever been reported in our state,” she said. “It crosses all socioeconomic boundaries.”

Statewide there’s been a 90 percent increase in fatal opiate overdoses between 2000 and 2013, and Massachusetts has triple the national rate of babies born with opiates in their system, according to the MHC report.

Hepatitis C on the rise

The report also notes that Barnstable County has the highest rate of hepatitis C cases among 15- to 25-year-olds in Massachusetts, with a rate of 519 confirmed and probable cases per 100,000 people in the population.

“It’s not surprising that opiate overdoses and hepatitis C are both on the list because they are so related,” said Heidi Nelson, CEO of the Duffy Health Center, which provides a substance abuse treatment program for patients.

The liver-destroying disease “is more prevalent among IV drug users,” she said.

The MHC report says that while HIV rates are going down, hepatitis C rates are rising.

Hepatitis C is more easily transmittable than HIV and injection drug users can contract the virus from different paraphernalia including needles, syringes, cookers and even contaminated cotton and water, said Valerie Al-Hachem, manager and grants administrator for Infectious Disease Clinical Services at Cape Cod Healthcare.

Other factors contributing to the high rates of youthful hepatitis C on Cape Cod are the fact that Cape Cod Healthcare, the AIDS Support Group of Cape Cod and the state Department of Public Health have teamed together to aggressively screen for the disease, Al-Hachem said.

Health care workers go to treatment centers, the methadone clinic in Yarmouth and the jail to talk to people about getting testing for the virus, she said. The agencies are looking for cases, and “we’re finding them,” Al-Hachem said.

She also said that Cape Cod Healthcare’s laboratory uses an electronic record system to report hepatitis C cases directly to the state. “The reporting is also good,” Al-Hachem said.

In addition, she said, the population of the Cape is older “so anything seen among a younger population is going to get skewed.”

Primary care hard to find

While more people than ever have health insurance coverage, Barnstable is one of three counties in the state in which 50 percent or fewer physicians in internal medicine accept MassHealth, a government-subsidized insurance program. The other two counties were Essex and Worcester.

Barnstable is also one of two counties in which fewer than half of family medicine practitioners accepted MassHealth. In Barnstable 40 percent of family medicine doctors accepted MassHealth; in Plymouth the acceptance rate among that specialty was only 30 percent.

That means people on subsidized health insurance have more trouble finding primary-care practitioners, Servais said. “Having insurance isn’t going to do you a lot of good” if you don’t have a doctor, she said.

“People who have chronic medical issues and are on MassHealth and need mental health (care) or substance abuse treatment — they really struggle to find someone who is going to take care of them,” Nelson said.

The Cape’s four nonprofit community health centers are picking up the slack by expanding programs and services with the help of funding from the Affordable Care Act, she said. “That’s why we’re here.”

She said Duffy Health Center, which focuses on patients at risk of homelessness, served 3,000 patients last year.

Fluoridation lacking

The Massachusetts Health Council report also criticized the lack of fluoridated water in several communities, including communities on Cape Cod.

The report says all 25 of the largest cities and towns in Massachusetts have community water fluoridation programs except five: Barnstable, Brockton, Chicopee, Worcester and Springfield.

“(Fluoridation) improves the oral health of everyone in the community,” Servais said. “It’s cost effective.”

Her organization recommends the state appoint a dental health director to work with local boards of health on community fluoridation programs.

The Otis base in Bourne is the only community on the Cape with fluoridated water, according to the Massachusetts Dental Society website.

Karen Gardner, CEO of the Community Health Center of Cape Cod in Mashpee, said fluoridation is a political issue for towns.

She said the Cape’s nonprofit health centers have worked with the Oral Health Excellence Collaborative and “tremendously improved access to oral health regardless of insurance coverage.”

Among other initiatives, the Community Health Center of Cape Cod has a mobile dental unit it takes to senior centers to do cleanings, evaluations and X-rays, Gardner said.

MassHealth coverage also is improving. After dropping all adult coverage except for cleanings and extractions in 2010, MassHealth started adding benefits in 2012. As of July of this year the subsidized insurance program provided coverage for fillings in all teeth; by May of next year it will offer complete coverage for dentures, according to the Massachusetts Health Council report.

“There were really no surprises here,” Gardner said. She said the problem areas highlighted in the report are issues “Barnstable County already is addressing.”

Local initiatives to fight opiate abuse include a new Cape program offering education and healthful alternatives. The Cape Cod Regional Substance Abuse Prevention Initiative will be led by Cheryl Bartlett, who is resigning from her position as DPH commissioner in mid-December to kick start the program under the auspice of Cape Cod Healthcare.

The health care organization — parent company of Cape Cod and Falmouth hospitals — also is working with her organization to recruit a psychiatrist for Duffy, Nelson said.

“All the health care organizations are pulling together to bring more providers to the Cape,” she said.

Cape Cod Times October 29, 2014

Cynthia McCormick on Twitter: @CmccormickCCT