Fentanyl, the illegal synthetic opioid, is present in almost 90 percent of cases of opioid overdose in Massachusetts today and more commonly associated with cocaine or a benzodiazepine than heroin.
Public health officials say the numbers in the last state quarterly report, Friday, should serve as a warning to all drug users.
"If a person in Massachusetts consumes illegal drugs, there is a high likelihood that fentanyl, which is so deadly, could be present," Dr. Monica Bharel, the state public health agency. "Those who consume illegal drugs should understand the risks, wear naloxone and have access to treatment."
Bharel says the friends and family members of those who consume cocaine or other illicit drugs must also be prepared for an overdose.
For prescribers, the Ministry of Public Health issues a recommendation on the concurrent use of cocaine and fentanyl, sometimes mixed into powdered drugs or pressed into tablets without the knowledge of low-ranking traders or their buyers. The Advisory includes this reminder for vendors and patients: "[P] Olyposite use may not be a reason for refusing admission into the treatment system."
Overall, opioid overdose deaths in Massachusetts, decline of 4 percent from 201
It is not clear why Massachusetts rejects this national trend, but the use of naloxone, the drug that reverses opioid overdose, has steadily increased among state EMTs, and the Baker administration has more than 1,200 treatment beds The administration also points to a 30 percent decline in opioid prescriptions over the past two years – although it may be too early to see that this change will affect fewer overdose deaths.
"In Massachusetts we have a multi-pronged approach," said Bharel. "This is about prevention, raising awareness in our communities and sensitizing our prescribers."  Bharel says the epidemic remains a top priority. With between five and six residents still dying every day after an overdose, some doctors and activists are urging the Baker government to take further steps, such as opening at least a few supervised injection facilities.
The broad downward trend masks some disquieting disparities. Fatal overdose among black men is still rising and Hispanics represent a disproportionate share of deaths.
"While the results of our efforts are effective, we must redouble our efforts to implement treatment strategies that meet the needs of the most vulnerable individuals and communities "Double," said Marylou Sudders, Minister of Health and Social Affairs.
The highest risk group overall is still men, accounting for 74 percent of all opioid deaths in Massachusetts.
One quarter of all EMS overdose responses are for young men aged 25 to 34 years.