Bridging the Gap: Connecting Behavioral and Public Health


health care mental health group session


Like many other states across the country, Massachusetts has seen an alarming increase in opioid overdose deaths since 2000. In fact, opioid-related deaths in Massachusetts increased more than 350% between 2000 and 2015, spiking abruptly in 2010 and far surpassing the national average.

In response, the Massachusetts legislature passed, and the governor signed into law, Chapter 55 of the Acts of 2015. The legislation was an innovative and large-scale effort to study opioid-related deaths in the state. The legislation instructed the Massachusetts Department of Public Health to consider the available data across multiple state agencies and private partners in the public health and behavioral health sectors in order to understand what was driving the epidemic.

The result was a report that gave lawmakers a comprehensive picture of all opioid-related deaths in Massachusetts, along with a detailed description of the causes of deaths and the populations most at risk of dying. This allowed the department to recommend public health interventions to the legislature, which would not have been possible without intentional efforts to connect public health and behavioral health agencies’ information and systems.

By combining death records from the Registry of Vital Records and Statistics with death and toxicology reports from the Office of the Chief Medical Examiner, for instance, the department’s analysts were able to identify the causes of deaths. It concluded that most opioid-related deaths in the state were due to illicit opioids like heroin and not prescription opioids. This allowed the department to recommend expanding and enhancing harm reduction programs that focused on addressing heroin, fentanyl and polysubstance use. Combining the information with data from the state’s prescription drug monitoring program (PDMP), analysts also concluded that women were much more likely than men to die of an overdose related to prescription opioids. This resulted in the department recommending that providers use the PDMP database to identify any active or past prescriptions for their patients, particularly women.

In their role as policymakers, state legislators are uniquely positioned to align behavioral health and public health systems where they believe it is beneficial. They can strengthen and use statewide data systems, promote cross-sector engagement and partnerships, determine spending levels and coordinate funding sources.