On Tuesday, August 7, candidates running for the Massachusetts 7th Congressional District debated at the University of Massachusetts Boston. Incumbent congressman, Michael Capuano (D), squared off against Boston City Councilor At-Large Ayanna Pressley (D). The two candidates touched on a number of subjects; from race relations and immigration, to transportation and equity, to age and experience, but noticeably absent from the discourse were the topics of substance use and mental health, in particular the opioid crisis.

That is not to say matters like race, transit, and experience do not matter in this contest; they most certainly do. The 7th Congressional District is noted for its vibrant cultural and economic diversity.

More than half the population identifies as non-white, according to U.S. Census data. For 20 years Capuano, a Dartmouth College graduate with a law degree from Boston College and an attorney by trade, has represented the district and is highly popular with residents. Pressley, the first woman of color on the Boston City Council and former aid to John Kerry and Joseph P. Kennedy II, aims to unset Capuano on a platform of change, energy, and grassroots-level organization. She says her perspective is fresh and aligns with the diversity of the district.

The District is composed of the cities of Chelsea, Everett, Randolph, Somerville, and large portions of Boston, Cambridge, and Milton.

Opioid Crisis & Minority Populations

For minorities in particular, the opioid epidemic has been nightmarish. From 2014–2017 opioid-related deaths among Hispanics more than doubled in Massachusetts, a rate higher than any other demographic. In some of the district’s communities, as seen in the chart above, overall overdoses also doubled from one year to the next.

Boston EMS respond to dozens of thousands of incidents every year, and in 2015, 2016, and 2017 overdoses constituted just 1.3%, 1.4%, and 1.5% of those incidents. But, as you can see in the chart below, those small percentages actually represent a growing rate of overdose responses; from 1,544 to almost 2,000 in just three years. (Remember: not all of Boston is part of the district, though the majority of its land area and population are).

Data via Boston EMS 2017 Vital Statistics

Data via Boston EMS 2017 Vital Statistics

Still, there is reason to be optimistic. Data from the Massachusetts Department of Public Health indicates overdose deaths and opioid-related incidents are beginning to slow down across the state. This is likely due in part to the growing accessibility of the overdose prevention drug known as Narcan. In Boston, for example, calls in which Narcan was administered were up 30% in 2017.

In addition, the state legislature has pushed multiple bills that target the crisis while Gov. Charlie Baker’s (R) budget allocates ” $203 million across multiple agencies (not including MassHealth) for treatment and services for individuals with substance use disorder, an approximately 70% increase since 2015,” according to his press office. It also calls for a $109 million increase in funding for the Department of Mental Health and a $1 billion in the Department of Children and Families.

Further, a recent study led by the Harvard T.H. Chan School of Public Health looked at the rate opioids were prescribed in congressional districts in 2016. It found that rates in districts concentrated near urban centers, including Boston and the 7th District, have the lowest prescribing rates and have been on the decline for years.

But this fight is a long way from over. That is why it was so striking that neither Capuano or Pressley used this opportunity to speak directly to their constituents about their plans to increase efforts to combat substance use and stigma, and support mental health initiatives. All of the topics discussed are in some way connected to the crisis and both candidates could have used those opportunities to nudge the conversation toward that subject.

Pressley’s campaign website has sections dedicated to substance use disorders, mental health, and public health. Capuano’s campaign website has a section dedicated to universal healthcare and improving community health centers.

The primary election is schedule for September 4. As of now, no Republican challengers have declared their candidacy.