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From YouTube: CI WG demo: Massachusetts Responds to the Opioid Epidemic Using Data to Inform Policy and Programs
Description
Date: 1/11/2019
Presenter: Commissioner Monica Bharel
Institution: Massachusetts Department of Public Health
Northeast Big Data Hub
A
Okay,
why
don't
I?
Why
don't
we
get
started
as
most?
You
know,
we've
got
two
parts
to
the
meeting.
First
is
Commissioner
Monica
Burrell
from
the
state
of
Massachusetts
Department
of
Public
Health,
we'll
be
we'll
be
speaking,
and
then
we
have
a
little
bit
of
business
related
to
the
hubs
that
we
will
do
after
she's
done
and
after
we've
we
finished
up
with
with
questions
so
I'll
start.
They
was
a
brief
introduction
on
these
calls
and
a
lot
of
other
forums.
A
We
often
talk
about
the
power
of
data
sharing
and
how
difficult
it
can
sometimes
be
to
kind
of
navigate
the
barriers
to
stand
in
the
way.
I
thought
this
talk
would
be
interesting,
because
several
years
ago
the
commissioner
and
the
governor
and
the
state
legislature
did
what
I
think
we
would
recognize
is
a
truly
remarkable
thing:
I'm
going
to
oversimplify
it
a
bit,
but
in
essence
they
passed
a
law
that
said
for
opioid
abuse.
The
data
sharing
will
be
that
a
fault,
as
opposed
to
the
exception,
which
really
opened
some
some
interesting
doors.
A
A
few
years
ago,
when
I
heard
the
Commissioner
speak
at
a
workshop,
I
found
myself
at
a
table
with
someone
representing
the
local
county
jail
literally,
the
state,
the
statewide
community
health
system
and
insurance
carrier
and
a
data
scientist
kind
of
all
mixed
mixed
together,
which
is
a
really
assistant
crew
people
to
apply
to
a
really
difficult
problem.
So
a
couple
of
years
have
passed
since
then
as
interested
as
called
the
rest
of
you
that
to
hear
how
things
have
gone
since
then,
so
I
will
turn
it
over
now
to
the
commissioner.
B
Thanks
so
much
for
the
introduction-
and
thank
you
for
your
interest
in
this
topic,
when
you
talk
about
the
power
of
data
and
what
we
can
do
with
it,
and
how
we
can
use
data
to
inform
policy
and
programming
and
I
can't
think
of
a
better
example
that
I've
been
involved
in
so
I
really
appreciate
the
opportunity
to
share
our
work
here.
What
I'll
do
is
I'll.
B
As
you
alluded
to
the
opioid
epidemic,
is
a
complex
medical
illness
and
there
are
multiple
different
ways.
It
could
be
approached
in
terms
of
what
way
to
make
impact.
When
Governor
Baker
was
elected
in
2015
and
our
administration
began,
he
declared
the
opioid
epidemic
his
number
one
health
priority.
B
B
So
here's
an
example
of
the
data
that
we
present
in
our
quarterly
reports,
and
what
you
can
see
here
is
the
annualized
data
up
to
2017
and
you'll,
see
that
the
red
bars
at
the
end
on
2016
and
2017
are
the
data
that
we
achieve
through
that
predictive
model.
That
I
spoke
to
you
about,
and
what
this
clearly
shows
is
that
from
about
2013,
we
really
have
this
unbearable
spike
in
deaths
related
to
the
opioid
epidemic.
B
What
this
also
shows
us
is
that
we
have
seen
really,
if
you
go
back
to
2000,
of
really
remarkable,
almost
500%
increase
over
the
16
month
period,
and
we
wanted
to
investigate
further
this
spike
from
2013
to
2016
to
understand
it
better
enough.
Note
I'll
come
back
to
this
at
the
end,
but
you
do
see
a
flattening
or
a
decrease.
B
If
you
will,
in
some
of
those
deaths
between
2016
and
2017
and
I,
believe,
were
one
of
only
a
few
states
who
are
seeing
that,
but
let
me
delve
further
into
it
with
you
into
this
opioid
overdose
deaths
report.
This
shows
this
is
looking
at
that
same
information
looking
at
the
death
rate
and
gives
you
a
clear
picture
of.
As
with
many
epidemics,
we
see
this
rise
and
hopefully
was
really
hopeful
that
we're
beginning
to
see
a
leveling
off
what
you'll
see
here
is
that
we
began
to
say
we
understand
that
people
are
dying.
B
We
understand
that
more
individuals
are
dying.
We
really
want
to
dig
deeper
to
understanding
these
deaths
so
that
we
can
prevent
them.
So
what
this
shows
here
is
a
really
collaborative
effort
that
we
had
across
different
Secretariat,
so
working
across
both
health
or
the
Department
of
Public
Health
says,
and
the
Office
of
Public
Safety,
where
the
office
of
the
chief
medical
examiner
says
to
be
able
to
really
analyze
each
day,
even
confirmed
or
predicted
from
opiates
to
look
at
the
component
of
that.
B
So
what
you
see
here
in
front
of
you
is
what
was
really
important
if
the
for
us
to
find
out,
which
is
the
unfortunate
presence
of
Sentinel
in
individuals
who
have
overdose
deaths.
The
reason
it's
important
to
understand
that
fentanyl
is
present
is
that
when
individuals
use
illicit
fentanyl,
that
fentanyl
is
fifty
or
a
hundred
times
more
potent
than
heroin
or
other
opiates
and
therefore
has
a
much
higher
chance
of
causing
death.
So
this
begins
to
unpack
for
us
the
rising
numbers
of
deaths
that
we're
seeing
you
can
see.
B
This
data
goes
out
to
the
second
quarter
of
2018
and
you
can
actually
see
the
cross
over
the
red
line
is
heroin
and
the
blue
line
is
fentanyl.
You
can
see
that
crossover
point
where
we
begin
to
see
that
there's
more
deaths
associated
with
fentanyl
the
percentage
is
higher
up
to
ninety
percent
now
in
Massachusetts
than
heroin.
Much
of
this
data
also
helps
us
understand
what
we're
hearing
from
the
field
and
from
frontline
individuals
and
providers.
Saying
that
you
know
don't
forget
about
benzodiazepines.
B
That's
the
Green
Line
here,
that's
still
an
issue
we're
still
seeing
a
lot
of
cocaine.
That's
the
purple
line
here.
This
helps
us
again
begin
to
see
what
individuals
are
dying
from
thinking
further
into
their
opioid
deaths.
Later
we
were
able
to
see
that
the
majority
of
individuals,
73
percent,
were
male
and
about
27%
female
looking
at
it
another
level.
We
often
talk
about
individuals
and
how
the
opioid
overdose
is
taking
the
life
of
our
young
people
in
premature
death,
and
what
you
can
see
here
is
when
we
looked
at
the
deaths
by
all
ages.
B
Four
percent
decrease
in
the
white
non-hispanic,
the
10%
decrease
and
in
the
Hispanic,
a
decrease
as
well,
but
unfortunately
we
see
that
in
our
black
non-hispanic
communities
we
it's,
the
only
group
are
still
seeing
rising
numbers
and
in
fact
again
one
for
the
first
time
we
broke
that
down
by
gender.
We
see
that
the
you'll
see
in
the
blue
circled
area.
That's
a
high
rates
are
really
related
to
black
non-hispanic,
males,
an
information
like
this.
B
If
we
had
only
looked
at
that
highest
level
of
data
and
not
stratified
in
this
way,
we
wouldn't
be
able
to
see
that
this
is
a
group
among
us
that
we
have
to
target
intervention
and
make
sure
that
all
of
our
policies
that
are
bringing
down
the
deficit
are
also
getting
to
all
populations.
I
move
now
to
talk
about
the
chapter
55
report
that
you
heard
a
little
bit
about
in
the
introduction,
so
the
quarterly
reports
have
really
helped
us
provide
timely
information.
B
Many
times
a
complaint
of
information
that
comes
from
big
data
or
from
state
based
data
is
the
timeliness.
Another
complaint
is
that
we
look
at
data
in
their
silos.
If
you
will
so
what
we
did
was
working
through
the
governor's
administration
and
with
our
legislative
partners,
it
really
did
take
law
to
be
changed
in
order
for
us
to
look
at
this
data
in
this
way.
B
So
what
we
did
is
the
law
required
us
to
answer
seven
specific
questions
that
was
based
on
what
could
be
actionable
and
that
we
would
have
specific
databases
that
we
brought
to,
and
that
would
overcome
legal
barriers
for
this.
If
you
look
at
this
slide
here,
you'll
see
what
some
of
the
data
mapping
entails.
There's
a
code
to
say
where
the
data
sources
were
I
want
to.
C
B
Your
attention
for
a
minute
to
the
gray
bucket,
because
those
are
buckets
of
data
that
sit
within
the
Department
of
Public
Health,
but
we
sometimes
compartmentalize
big
data.
It's
interesting,
because
if
you
look,
for
example,
at
the
prescription,
monitoring
program
data
and
the
be
fast
data,
which
is
our
addictions
data
and
you
look
at
the
death
record,
these
all
fit
within
the
Department
of
Public
Health.
But
because
of
the
way
the
legal
structures
were
set
up,
even
as
the
Commissioner
of
Health
I
couldn't
bring
together.
B
Those
different
data
sets
to
try
and
answer
some
of
these
very
challenging
questions
about
how
to
care
for
individuals
dying
from
the
opiate
epidemic.
So
what
the
law
did
is
it
allowed
us
across
these
different
buckets
within
the
Department
of
Public
Health
across
the
executive
office
of
Health
and
Human
Services
and
throughout
the
governor's
administration,
to
look
at
different
pieces
of
information?
B
Do
that
I
always
put
this
slide
and
when
I
talk
about
this,
so
there's
a
really
important
piece,
as
we
were
looking
at
our
state
response
to
this
problem,
the
the
data
analytics
that
you
see
bringing
all
of
this
data
together.
There
was
no
additional
funding
that
could
be
put
to
this,
because
we
had
to
put
the
funding
that
was
coming
in
to
the
services
that
the
individuals
needed
suffering
from
the
disease.
B
So
we
arm
we
undertook,
for
the
first
time
a
very
innovative
private
public
partnerships
with
the
members
you
see
on
this
slide
and
there
were
others
as
well.
This
is
a
representative
sample
came
together
in
private
public
partnerships
to
offer
us
voluntary
resources,
such
as
data
analysts,
epidemiologists
data
scientists,
AI
expertise,
etc.
To
help
us
complete
this
project.
B
So
here
are
some
of
the
findings,
see
two
things
so.
First
of
all,
this
looks
at
the
prevalence
of
opioid
use
disorder
and
we
see
in
Massachusetts
in
2015
about
four
point.
Four
percent
of
the
population
suffers
from
opioid
use
disorders.
Now
this
may
actually
just
published
in
the
American
Journal
of
Public
Health
at
the
end
of
last
year,
and
this
may
seem
like
well.
How
would
this
help
with
the
care
that
we're
providing?
B
You
know
this
is
really
critical,
because
if
we
look
at
other
medical
diseases,
when
I
was
on
a
general
internal
medicine
physician
when
I
was
in
my
clinic,
if
I
was
trying
to
take
care
of
my
patients
with
diabetes,
really
important
to
know
how
many
of
them
there
were
I
can
understand
what
resources
are
needed
and
what
I
need
to
do
for
them.
By
bringing
together
all
these
different
data
bases,
we
were
able
to
get
a
better
estimate
of
the
true
prevalence
and
how
it's
been
rising
and
it
actually,
this
estimate
is
more
than
double.
B
What
was
previously
thought.
I
should
note
that
the
data
I'm,
showing
you
now
is
all
from
2011
to
2015.
The
data
linkages
were
made
over
that
time
period
and
we're
working
now
to
go
on
beyond
from
2016
and
beyond.
This
next
slide
that
you're
looking
at
is
a
survival
curve.
We
usually
we
use
this
a
lot
in
medicine,
but
we
haven't
had
something
like
this
before
to
look
at
our
opiate
epidemic.
B
It
really
becomes
a
call
to
action,
but
all
of
us
in
our
programming
and
policy
work
to
work
next
I
want
to
show
you
on
some
information
that
I
found
very
helpful
in
speaking
to
my
clinical
colleagues.
You'll
see
their
arm
on
the
left
side
of
your
screen,
individuals
who
are
engaged
in
Oh
18
and
that's
opiate
agonist
treat
so
that's
medication
that
work
to
assist
individuals
who
are
suffering
from
opiate
use,
disorder,
methadone
or
buprenorphine.
B
B
When
I
talk
to
my
colleague
my
clinical
colleagues-
and
they
say
what
can
we
do
to
address
the
opiate
advancing
well
look
here,
people
are
not
getting
the
medication
they
need
and,
in
fact,
if
we
really
want
to
decrease
the
number
of
the
rapidly
rising
deaths,
treating
people
with
these
medications
will
decrease
that
risk
by
50%
as
good
as
medications.
We
use
for
diabetes,
high
blood
pressure
better
than
some
chemo
therapies.
We
have
available.
So
really.
This
has
been
really
powerful
to
help
us
spread
the
use
of
medications
throughout
our
system
in
Massachusetts.
B
B
So
this
is
both
history
of
jail
and
prison.
Some!
What
you
can
see
here
that,
unfortunately,
the
opioid
death
date
a
hundred
and
twenty
times
higher,
if
someone
has
any
history
of
incarceration
and
will.
Furthermore,
we
found
that
some
of
the
highest
risk
is
right
when
they're
released
from
jail
or
prison,
and
this
fact
alone
and
the
data
pieces
that
are
behind
it,
have
opened
the
doors
for
us
to
speak
with
our
criminal
justice.
B
Colleagues
in
ways
we
have
never
been
able
to
do
before
and
understanding
this
risks
our
individuals
have
they
leave
incarceration,
has
been
a
real,
powerful
motivator
for
our
colleagues
in
criminal
justice
and,
in
fact,
in
our
open
law
that
the
governor
just
signed
last
August.
There
is
now
pilots,
where
several
of
our
houses
of
Correction
are
working
directly
with
the
department
to
prevent
ways
to
get
treatment
for
individuals
while
they
are
still
incarcerated.
B
This
next
slide
looks
at
individuals
with
any
experience
of
homelessness.
Of
note,
I
will
say
that,
from
a
data
point
of
view,
it
was
very
challenging
at
the
state
data
level
to
be
able
to
identify
someone
right,
a
period
period
of
homeless
month,
less
much
less
housing
and
stability.
So
we
developed
our
own
model
in
order
to
predict
who,
in
the
database,
had
an
experience
with
homelessness
and
saw
that
the
risk
was
30
times
higher.
B
This
looks
at
the
intersection
of
serious
mental
illness
with
fatal,
opioid
overdoses,
and
we
see
individuals
with
serious
mental
illness
have
a
higher
risk
of
fatal
opiate
overdose,
and
that
includes
SMI,
which
is
includes
in
include
illnesses
such
as
psychosis
and
schizophrenia,
and
what
this
data
point
is.
Plus.
B
Some
of
the
data
that
I'm
describing
to
you.
We
then
visualized
so
that
individuals
in
communities,
whether
it's
individual
community,
members,
friends
and
families
of
those
with
open
use,
disorder
or
individuals
who
are
working
on
the
opiate
epidemic
at
the
community
level,
could
look
at
their
data
and
I
urge
you,
when
you
have
a
chance
just
to
take
a
look
at
the
link
below
there's
some
basic
videos
and
description
of
what
opiates
are
and
what
the
epidemic
is.
B
But
it
also
goes
through
and
you
can
town
by
town
look
at
what
what
drugs
the
drugs
that
are
used
in
those
town
and
some
way
at
some
places.
You
can
see,
for
example,
where
there
are
first
most
popular
drug
use,
used
to
be
alcohol,
and
now
it's
opiates.
It's
meant
to
give
community
members
more
information
in
a
very
tangible,
interactive
way
and
again
for
the
first
time,
because
we
know
solutions
to
the
opioid
epidemic
start
in
the
community
and
the
communities
looking
at
what
they
need.
B
I
want
to
just
end
my
formal
part
of
talking
with
a
couple
of
things
about
how
we
went
about
in
our
opiate
working
group,
and
you
can
see
how
it
relates
to
some
of
the
data
points.
I
gave
you,
as
I
mentioned,
the
governor
had
a
multi-sector
group
come
together,
including
myself
and
my
boss,
secretary
stutters,
in
an
opiate
working
group,
and
we
came
up
with
an
action
plan
with
dozens
of
actionable
steps
on
how
we
would
address
the
opiate
epidemic.
B
The
areas
included
looking
at
prevention,
both
in
the
area
of
safe
prescribing
and
prevention
of
opioid
use
among
youth
and
individuals,
and
then
interventions
and
treatment
recovery
so
in
the
area
of
safe
prescribing
legally
in
Massachusetts,
was
one
of
the
first
States
to
put
a
seven-day
limit
on
first-time
prescriptions,
a
requirement
to
check
that
prescription,
monitoring
tool
that
I
mentioned
to
you
earlier
and
then
prescriber
education
and
in
prescriber
education.
We
were
the
first
state
to
bring
together
all
of
our
prescriber
schools,
along
with
our
association
and
state
government,
to
come
together
and
say.
B
We
understand
that
we
need
to
do
more
teaching
around
how
to
balance
pain
management
with
the
potential
for
open
misuse.
So
we
came
together,
as
is
published
in
academic
medicine.
If
you
want
to
see
the
details
and
our
medical
schools,
dental
schools,
NPA's
community
health,
centers
and
social
workers
have
now
adopted
this
actually,
as
well
as
our
physician,
physical
therapists,
so
there's
more
education
in
this
area.
This
is
a
sample,
so
you
can
see
what
our
parent
campaign
looks
like.
B
We've
launched
it
on
to
multiple
different
communities,
and
it's
really
about
talking
to
ended
talking
to
the
children
about
the
potential
for
misuse
of
prescription
payments.
Here,
I
showed
you
some
of
that
race,
ethnic
ethnicity
breakdown.
In
the
beginning
of
my
talk,
here's
just
a
sample
of
our
same
add
on
stop
addiction
before
it
starts
in
Spanish.
B
B
So
there's
there
more
treatment,
beds
and
expanded
our
availability
of
medications,
which
I
mentioned
to
you
earlier,
as
well
as
targeted
I,
give
you
some
examples.
Some
of
these
highest
risk
routes
that
we're
finding.
We
also
revamped
our
helpline.
What
individuals
can
call
in
and
now
do
a
live
chat
with
someone.
B
I
do
want
to
recognize
that
having
done
this
work
clinically
for
a
long
time
we're
talking
about
almost
2000
individuals
over
2000
individuals
losing
their
lives
prematurely
behind
each
one
of
those
individuals
is
a
family,
member
or
community
and
really
devastating
impact
of
disease.
So
using
the
data
in
this
way,
really
it's
a
call
to
action
for
all
of
us
to
take
part
in
solutions
and
to
make
sure
all
the
questions
that
we
are
asking
and
answering
really
can
impact
these
individuals
and
the
last
thing
from
a
data
point.
B
If
you
I'll
show
you
is
I
mentioned
our
prescription.
Monitoring
program
is
now
required
and
you
can
see
from
here.
The
Green
Line
is
the
number
of
searches
by
prescribers
and
pharmacists,
and
you
can
see
how
that
has
that
bump
right.
When
we
put
a
new
system
in
place
and
then
it
became
a
legal
requirement
to
use
the
system,
so
you
can
see
that
bump
up
and
then
steady
usage,
and
importantly,
you
could
see
that
the
blue
line
is
the
total
number
of
opiates,
the
schedule
to
opiates
that
are
prescribed.
B
So
you
can
see
that
going
down
to
about
37
percent
decrease
since
the
beginning
of
2015,
so
37
percent
less
opiates
out
in
your
community
and
along
with
that,
we
know
that
the
rate
of
individuals
of
concern
so
potentially
individual,
maybe
misusing
those-
has
also
gone
down
along
with
that
rate.
So
we
see
slowly,
you
know
progress
in
this
area.
I
gave
you
a
lot
of
data
and
facts.
If
you're
interested
in
some
of
the
more
information
on
our
helpline,
you
can
see
that's
up
there.
B
The
boat
was
the
link
at
the
bottom
is
to
that.
Stop
addiction
campaign.
If
you'd
like
to
see
that
link
in
the
middle,
it's
really
where
I
would
send
you.
If
you'd
like
to
look
more
in-depth,
I
gave
you
snapshots
of
some
of
our
findings.
If
you
go,
there,
you'll
see
much
more
detail
about
how
we
put
the
chapter
55
reports
together
and
all
of
the
data
details
behind
what
I
deeply
presented
to
you
today.
I
really
thank
you
for
allowing
me
to
be
here
with
you.
B
C
I
this
is
Renae
Bastogne.
Thank
you,
I'm,
the
executive
director
of
the
Northeast
big
data
innovation
hub.
Thank
you
very
much
for
the
presentation
that
is
amazing,
work
and
I'm
very
interested
in
the
possibility
of
following
up
with
you,
I'd
love,
to
learn
a
little
bit
more
about
whether
other
states
are
starting
to
look
at
Massachusetts,
particularly
in
the
Northeast
to
to
try
to
model
what
you
have
done
and
create
similar
programs
and
and
see.
If
there
are
ways
that
we
may
be
able
to
help
in
trying
to
replicate
your
fantastic
work.
C
B
You
and
I
appreciate
you
listening
in,
you
can
feel
free
to
email
me.
It's
Monica,
dot,
Burrell,
my
name
at
state,
dot,
M,
a
dot
us
and
I
will
say
that
you
know
I
can't
speak
in
detail
about
other
states,
but
I
do
know
in
Massachusetts.
I
know
on
these
calls.
You
often
speak
about
barriers,
and
one
of
the
barriers
was
around
really
figuring
out
a
way
to
bring
this
data
together
in
a
way
that
complies
with
our
legal
requirements.
B
We
all
take
the
security
of
our
data,
as
we
should
extremely
seriously
and
one
of
the
innovative
things
about
the
way
we
brought
this
data
together
is
that
we
were
bringing
different
silos
of
data
together,
but
only
temporarily
linking
it
in
order
to
answer
specific
questions
behind
a
privacy
shield
and
then
be
linking
and
decoupling
the
data.
That
was
a
really
important
part
for
us
and
it
really
helped
our
legal
teams
across
these
different
data.
B
Silos
feel
more
comfortable
and
I
should
add,
though,
for
our
researchers
and
our
partners
we
saw
the
list
of,
it
did
add
an
increased
burden,
but
we
wanted
to
be
so
careful
when
they
physically
have
to
come
to
the
Department
of
Public
Health.
To
do
any
add
the
analytics.
So
we
weren't
sharing
data
in
any
way
and
all
of
those
pieces
really
helped
us.
Oh.
A
A
I
wondered
also,
if
you,
if
you
now,
might
be
able
to
use
this
framework
that
you've
developed
for
for
other
challenges,
not
just
the
opioid
crisis,
but
possibly,
if
you're
looking
at
using
some
of
the
infrastructure
that
you've
created
some
of
the
culture
that
you
created
around
this
to
address
other
challenges.
A
lot
of
us
here
on
this
call
are
what
we
call
cyber
infrastructure
engineers
and
we
love
to
be
able
to
recycle
or
to
point
to
cases
that
we
might
be
able
to
use
to
to
address
other
challenges.
A
B
A
great
point,
and
one
of
the
reasons
I'm
happy
to
share
this
is
I-
do
think
it
can
be
translated
for
other
issues
as
well.
So,
as
I
mentioned,
when
we
first
asked
for
the
chapter
55
we
perfectly
because
it
was,
it
was
new
territory
for
Massachusetts
to
be
entering,
and
we
it
purposely.
It
was
a
one
year
that
we
could
answer
the
seven
questions,
and
then
we
again
asked
for
another
year
to
continue
to
ask
the
questions
and
those
were
specific
around
opens.
B
What
we
have
now
accomplished
is
the
capacity
without
an
end
date
to
do
a
public
health
data
warehouse
and
the
way
that
that
legislature
is
written
and
I'm
happy
to
share
it
smoothly,
organizes
anyone
who's
interested
in
having
it.
The
way
that
legislation
is
written
is
that
the
questions
that
are
asked
and
the
priorities
are
based
on
the
priorities
that
the
Commissioner
of
Public
Health
set.
So
we're
looking
at
opiates
right
now
and
we're
now
specifically
looking
at
opioid
related
to
maternal
child
health.
B
But
we
will
then
also
look
at
other
issues
related
to
maternal
child
health
and
then,
whatever
issues
come
next
I
will
tell
you
that
I
mentioned
that
the
data
is
was
linked
from
2011
to
2015
and
now
we're
going
on
2016
to
2018.
So
you
know,
continuous
capacity
to
link
is
something
that
can
be
a
barrier
as
well,
because
at
this
point,
when
we
started
using
this,
it
wasn't
old,
but
now
it's
becoming
old
data
and
all
of
the
work
that
our
administration
has
done
has
been
2015
on.
C
B
That's
a
good
question,
so
the
if
you,
if
you
go
to
that
link
and
toggle
over
it,
you
can
see
all
351
towns
and
cities
in
Massachusetts
and
if
you
go
to
our
link,
I'll
put
it
back
up.
There
I
sent
the
mass.gov
backslash
OB
response.
You
can
get
our
quarterly
reports
there
and
we
report
the
deaths
by
every
single
town
and
city.
We
just
suppress
if
it's
small
numbers,
but
even
the
you
know,
towns
of
150
individuals,
it's
all
in
there.
Oh
that's.
B
B
A
Well,
this
is
John
I'll
get
a
try.
You,
you
listed
quite
a
few
academic
institutions
being
part
of
the
initiative.
Since
this
this
group
represents
academic
institutions.
Nationwide
I
was
wondering
if
you
could
just
say
a
few
words
about
how
you
think
that
could
Emma
can.
The
research
community
was
able
to,
uniquely
or
especially
helpfully
contribute
to
the
effort.
B
It's
a
great
point:
we
could
not
have
done
this
work
without
our
colleagues
in
academics
and
research.
The
way
that
we
approach
this
because,
as
I
mentioned,
we
really
wanted
to
develop
these
relationships,
and
I
must
say
that
our
academic
and
research
colleagues
around
the
state
of
Massachusetts
wanted
to
contribute
to
answering
questions
and
helping
with
the
opioid
epidemic
cuz
of
that
Alliance
and
then
really
based
on
you
know,
relationships
and
a
notice
of
intent
that
we
put
out
that
these
are
the
questions
we
wanted
answered.
B
We
were
able
to
bring
in
individuals
to
do
this
work
I
will
say
having
been
on
the
academic
side
of
it.
One
thing
that
was
different
is,
as
you
all
know,
many
times
we
apply
as
an
academic
for
our
grants,
and
we
have
specific
questions
in
mind
and
then
we
go
to
a
big
data
set
to
answer
them
right
and
what
we
did
here
was
we
kind
of
flicked
flips
that
relationship
and
said
as
the
state
of
Massachusetts
Department
of
Public
Health.
We
need
to
answer
these
seven
questions.