Massachusetts and the Opioid Epidemic: From Purdue Pharma to Fentanyl

Massachusetts has the distinction of being both a state deeply wounded by the opioid epidemic and a state that has been among the most aggressive in responding to it. The Commonwealth was one of the first states to sue Purdue Pharma over the marketing of OxyContin — a lawsuit that eventually helped expose the deliberate deception behind the prescription opioid crisis. Massachusetts also developed one of the most robust public health responses to the epidemic in the nation: expanded naloxone access, low-threshold MAT, harm reduction programs, and significant investments in treatment capacity.

And yet the deaths continue. The Massachusetts Department of Public Health (DPH) has documented overdose death tolls exceeding 2,000 per year in recent years — devastating numbers for a state of approximately 7 million people. The opioid crisis in Massachusetts is not over. Understanding its history, its current shape, and the resources that exist to address it is essential for anyone affected by it.

The Roots of Massachusetts’s Opioid Crisis

Purdue Pharma and the Prescription Opioid Wave

In 1996, Purdue Pharma — owned by the Sackler family — introduced OxyContin, a time-release formulation of oxycodone, with aggressive marketing claims that its controlled-release mechanism made it less prone to abuse than immediate-release opioids. This claim was false, as subsequent litigation and regulatory action established.

Massachusetts was among the states hit hardest by the resulting prescription opioid epidemic. The Commonwealth’s well-educated workforce, employer-sponsored health insurance penetration, and large number of physicians in a small geographic area meant that opioid prescriptions reached enormous volume during the peak years. Pain clinics proliferated. OxyContin was prescribed for back pain, dental pain, sports injuries, and post-surgical recovery at doses and durations that created physical dependence in patients who had no history of addiction.

The Massachusetts Attorney General’s Office became one of the first to pursue major litigation against Purdue Pharma, ultimately winning a settlement — after years of litigation — that held members of the Sackler family personally liable for their role in fueling the crisis. The Massachusetts AG’s complaint, released publicly, provided some of the most detailed documentation available of Purdue’s deceptive practices.

The Heroin Bridge

When access to prescription opioids tightened — through regulatory action, prescription drug monitoring programs (PDMPs), and physician education — many people who had developed opioid use disorder transitioned to heroin. The CDC documented this transition as a national phenomenon, and Massachusetts experienced it acutely.

Cities like Springfield, Lawrence, Lowell, New Bedford, and Brockton — post-industrial communities already facing significant economic and social stress — saw heroin flooding the supply chain. Boston’s urban neighborhoods, particularly those in neighborhoods like Methadone Mile (now referred to as the Mass and Cass corridor), became visible centers of open drug use.

The Fentanyl Escalation

Beginning around 2014–2016, illicitly manufactured fentanyl began appearing in the Massachusetts heroin supply. The Massachusetts DPH was among the first state health departments to comprehensively document and report on fentanyl contamination in the drug supply.

The impact on overdose deaths was immediate and severe. Massachusetts DPH data shows that fentanyl involvement in opioid overdose deaths increased dramatically starting in 2016 and now accounts for the vast majority of opioid deaths in the state. This is consistent with national CDC data showing synthetic opioids as the primary driver of opioid overdose deaths.

A particularly troubling trend in Massachusetts, documented by DPH and the National Institute on Drug Abuse (NIDA): fentanyl has increasingly contaminated cocaine and other stimulants, leading to opioid overdose deaths among people who did not intend to use opioids at all.

Current Data: What the Numbers Show

The Massachusetts Department of Public Health publishes quarterly and annual overdose surveillance reports — among the most detailed state-level reporting in the nation.

Key findings from recent DPH reports:

More than 2,000 confirmed or estimated opioid-related overdose deaths annually in recent years
Fentanyl is detected in the overwhelming majority of opioid overdose deaths
Men account for approximately 70 percent of opioid overdose deaths
Deaths are increasing among Black and Latino Massachusetts residents, reflecting both the fentanyl contamination of stimulants and disparities in treatment access
Western Massachusetts — including Hampshire, Hampden, and Franklin counties — has particularly high overdose death rates relative to population
The Mass and Cass corridor in Boston remains a visible and concentrated area of drug use and overdose

SAMHSA’s national surveys consistently rank Massachusetts among the states with the highest rates of opioid misuse, though the state also has among the highest treatment access rates in the country.

Massachusetts’s Public Health Response

Massachusetts has implemented some of the most aggressive opioid response policies in the nation:

Expanded Naloxone Access: Massachusetts was an early adopter of standing order prescribing for naloxone — meaning any pharmacist can dispense it without a patient-specific prescription. The MDPH Bureau of Substance Addiction Services (BSAS) has funded extensive naloxone distribution. Massachusetts Good Samaritan Law provides limited legal protection for people who call 911 to report an overdose.

Mandatory Prescriber Education: Massachusetts requires prescribers to complete opioid-specific CME training and mandates a seven-day maximum for initial opioid prescriptions for acute pain (with exceptions for cancer pain, palliative care, and substance use disorder treatment).

PDMP (Prescription Monitoring Program): Massachusetts has a mandatory PDMP with real-time reporting, among the most robust in the country, helping prescribers and pharmacists identify problematic prescribing patterns.

Opioid Use Disorder Treatment Hub and Spoke Model: Massachusetts developed a hub-and-spoke system to expand access to buprenorphine treatment, connecting specialty addiction treatment “hubs” with primary care “spokes” to dramatically increase MAT prescribers statewide.

Harm Reduction: Massachusetts has authorized and funded syringe service programs throughout the state, decriminalized fentanyl test strips, and expanded access to low-barrier MAT.

Mass and Cass Response: The Commonwealth and Boston have invested significantly in services for people experiencing homelessness and substance use disorder in the Mass and Cass corridor, though this remains a deeply challenging situation with no easy solutions.

Who Is Affected in Massachusetts

The Massachusetts opioid crisis cuts across demographics:

Young adults 25–44 account for the largest share of overdose deaths
Rural communities in Western Massachusetts, including the Connecticut River Valley, have high rates of use and limited treatment access
People with co-occurring mental health conditions: SAMHSA data shows high rates of co-occurring disorders among people with OUD in Massachusetts
Racial disparities: DPH data documents growing racial disparities in overdose deaths, with Black and Latino residents experiencing disproportionate increases during the fentanyl era
People who are homeless: Massachusetts’s large homeless population has disproportionately high rates of substance use disorder and overdose

The Role of Stigma

Despite Massachusetts’s sophisticated public health response, stigma remains a significant barrier to treatment. Research from Harvard Medical School and Boston Medical Center — both located in Massachusetts — has documented how stigma in healthcare settings, workplaces, and communities delays treatment seeking and reduces care quality for people with substance use disorders.

Recognizing addiction as a brain disorder — as SAMHSA, NIDA, and the Massachusetts DPH all do — is the foundation for a stigma-reduction approach that can improve treatment access.

Get Help Today

Massachusetts has invested significantly in opioid treatment and recovery — more resources are available here than in most states. If you or someone you love is struggling with opioid use disorder, our Massachusetts Addiction Hotline can connect you with treatment programs, naloxone access, and recovery support.

Call our Massachusetts Addiction Hotline today. Available 24/7, free, and completely confidential. Help is available right now.