Three Questions with Christopher Tracy, Senior Director


Proposal Boston Sky Line

Christopher Tracy, Senior Director

What are you seeing right now in real estate development in Greater Boston?

It’s pretty clear that there’s tremendous growth taking place. You see it every day with more people and new structures. We can now add Amazon to the growing list of companies calling Boston home. Amazon expects to bring 900 new jobs to Fort Point channel, where GE is relocating its world headquarters. And according to census reports in May, Boston has seen an 8.4 percent rise in population since 2010 and is now the 22nd largest city in the United States. In the City of Boston and surrounding municipalities, housing and planning agencies are continuing to work with developers to approve residential housing proposals and increase the housing stock, which will hopefully soften housing prices.

What strategies does O’Neill and Associates employ to support real estate development clients?

We use a multi-pronged approach to help clients successfully navigate the arduous processes of permitting approvals to expedite their ability to get shovels in the ground. When I say multi-pronged, I mean that we combine our grassroots community outreach strategies with our experience, relationships, and understanding of relevant government agencies involved in permitting and use, along with public relations and social-digital media tools to close gaps and meet any audience in any venue. It used to be that you reached people at an address. Today, you need to reach people digitally. O’Neill and Associates is uniquely qualified as a development partner because we can capably guide clients through these often confusing approval processes. We have an experienced team from the public sector with first-hand knowledge of the goals that cities and towns hope to achieve when considering smart growth opportunities.

What excites you most/do you enjoy most about your sector?

Boston is absolutely booming and thriving with energy, opportunity and community right now. When this building boom is complete, it will be the largest in Boston’s history, bypassing the infilling of the Back Bay and the construction of the high spine corridor. The City has never been cleaner, more active and exciting. I like being a part of this chapter. O’Neill and Associates and our clients are making an impact by increasing housing, including affordable units, enhancing vibrancy and activity in communities and improving neighborhoods in and around Boston. I have the ability to help clients make a tangible impact on the city and its future.

Grassroots Social Media and Digital Engagement

A Q&A with Shakeir Gregory, Senior Account Executive Digital and Social Engagement, on how social and digital platforms are used to support clients’ initiatives

How do you assess a client’s social media capabilities?

I think correct and comprehensive utilization of a platform is most important. Is the client’s content compelling? Are they on message? Are they using the platform the way it’s meant to be used? And are they using it regularly? I think those are core factors that determine whether somebody is doing social media well. Posts should occur regularly—most people would say daily, multiple times daily, but the rules vary depending on the client’s resources and objectives. If target audiences are not seeing your content, then you’re not using the platform correctly. You need to post things that are relevant to both what you do as an organization and that are meaningful to your audience.

One advantage I think about when it comes to social media is that it is instantly measurable and can be easily recalibrated. If audiences are not liking or commenting on your content, or you have a lot of followers but little response to your call to action, then what’s going wrong? It probably is that your audience does not feel compelled to engage with your content. Social media fosters two way communication as with an everyday conversation, so what do you have to offer as a company, nonprofit or a membership organization like a union that will move your audiences to act? What are your objectives for your audiences and what can you communicate to achieve those objectives?

What objectives might an organization have in its social media strategy?

Let’s take a union as an example. Internally, a union might want to foster better communication among its membership or better explain union benefits, contract details or to activate members around a legislative issue. Externally, a union may want to rally the general public around a cause that is important to workers such as pushing back on things like privatization and the destabilization of programs that protect union workers and their interests. And, you want to call out worker exploitation wherever it’s seen. Social media’s two-way communication and mobile reach is the union’s modern day organizing and activation tool. Most people today in every age group are reachable in some way shape or form online. Even at the oldest age group 65+ use some form of social media.

What steps are often successful as an organization tries to increase its social media presence?

One of the biggest first steps is to look at what platform is being used and whether it effectively intersects with the target audience. For example, if I’m doing a campaign to raise awareness on the cost of credit card debt and the rising burden it is placing on young people across our country, who am I going to talk to? Probably people below the age of 25. What social media platform do people below 25 use? They are Reddit, Snapchat, Instagram, Pinterest and Tumblr. They may also have a Facebook, but is that their preferred platform for content? All of these answers are measurable. These metrics are attainable so you have to choose your outlets first and foremost when making a calculated decision about who you’ll be talking to.

And then it’s a matter of format. What messages are going to be most compelling to your target audience and is your message properly formatted for the medium you’ve chosen? For example, if you have a multi-paragraph long statement to share, Snapchat may not be the right place to distribute it. If you have a chart it may not be the best idea to post that to Pinterest. So it really just boils down to these three things: Who are you talking to? Where are they? What should you be saying to them and how?

Teamsters Labor Union: An O’Neill and Associates Case Study

For the Teamsters we were engaged to help rally membership and raise awareness of right to work legislation that was being considered in the NH legislature and heavily advocated for by the governor. The Teamsters realized was that their membership wasn’t fully engaged, and so we looked at their membership’s age range and noticed that it skewed older. They had a larger audience on Facebook and not as much on Twitter. Therefore we made sure we were doing everything we could to activate their members via Facebook, including using paid advertisements, publishing videos, placing content that was visually appealing with pull quotes, and complementing this with a traditional earned media PR strategy. If members skew older, they probably still subscribe to and read their local paper whether that is online or in print. We made sure to share that PR content online and extend the lifetime of that content through regular posting on Facebook. This might sound simple and straightforward, but every campaign has a lot of variables to consider.

Ultimately members were commenting on posts and saying “I was definitely against this right to work legislation– I might have been aware of it but I started seeing some of your posts” or “My spouse shared it.” Really the goal of a grassroots movement is getting to that word of mouth stage where people are so aware of what the issue is that they start to form an opinion on it, they start talking about it, and they take action. The goal is to get an audience to see it numerous times and get them thinking about the cause for which you’re advocating.

A Look Ahead at What Congress is Addressing This Summer

By: AmyClaire Brusch, Vice President

Even as Congress remains divided on many important issues that will dominate the news this summer (health care, budget, homeland security…), there are also areas in which Republicans and Democrats are working together as their constituents expect. The average American only has time for short snippets of news a day which is dominated by these divisive, if important issues. We all know that the level of political discourse has grown more heated, as displayed in the recent violent attack on Members of Congress practicing for a charity ball game. But below the surface, aired on CSPAN for those who may have more time, House and Senate committees have held several hearings and legislative markups this month that are surprisingly devoid of partisan divide.

One such measure passed both houses of Congress with broad support and was signed into law on June 23rd.  The VA Accountability and Whistleblower Protection Act will give the Department of Veterans Affairs more resources to help restructure the department to better serve the needs of our nation’s veterans. All Americans have been upset by the long waits veterans face for health care and the inability to swiftly respond to the need for other services. The public has pressured Congress and recent administrations to better support veterans and public officials have answered the call. There is still more to do for veterans, but the enactment of this bill in the midst of a negative political climate gives one hope that Congress and the administration will continue to make progress on improving VA service.

Another issue that also affects people in every state and of every demographic is access to broadband services. From education and communication to telemedicine and economic development, broadband access is essential to meeting the needs of 21st century Americans. Both the House and Senate have held hearings this month examining the challenges to full nationwide broadband access. Listening to the Senators and Representatives, one was struck by the number of bipartisan bills they referenced to achieve this goal and it was hard to know their political affiliation from their comments and questions.

Similarly, both the House and Senate have been considering reauthorization legislation of the Federal Aviation Administration. There are some controversial issues in these bills, but they do not fall into partisan categories. Instead, there are Republicans and Democrats on both sides of drone policy, privatization of air traffic control, and financing issues to name a few. As I monitored these hearings and then the markups for clients, it was heartening to see a robust debate that lacked partisan edge.

These are just three of the issues Congress is addressing in a bipartisan way this summer. While they may not be as dramatic as the scene of unity on the baseball field, they are a more significant sign that the legislative body is still working. There will be more vigorous debates on top line issues, as there should be. That debate will dominate the national news. For a look deep into the process, sneak a peak at CSPAN every so often to remind yourself that public officials haven’t completely lost their ability to work together.

Demystifying the Facebook algorithm: A guide to reaching your audience

In the span of an internet minute, the content your organization shares online competes for the attention of millions of users—and for the assistance of the Facebook algorithm.

To provide an individual experience to each of its users, Facebook employs a complex algorithm, formerly known as EdgeRank, that ensures the content displayed in your news feed is interesting to you, specifically. Facebook wants to put engaging and entertaining content in your timeline. The company’s goal? To increase the time you spend on its website—and to up its share of the internet minute. While the algorithm and the tactics Facebook uses may change, that fundamental motivation is here to stay.

For companies and organizations, this means that simply posting content cannot guarantee reach. Having 5,000 likes on your page does not mean those 5,000 people are regularly seeing your posts in their News Feeds.

While the intricacies of the algorithm remain a mystery to those outside Facebook, we know the algorithm at its most simple follows three main tenets—affinity, weight, and time decay. Affinity determines how relevant certain content is to you based on your previous activity, while weight and time decay prioritize posts based on post type (photos, videos, text posts) and relevancy (how old is your content?).

So, how do you compete for space on the news feeds of your audience? Following the algorithm, it is essential to generate original content that is relevant to the people who like your page. It must be easy to absorb, encourage user engagement through likes, shares and comments, and should be timely. For example, natively uploaded videos (which keep users on Facebook rather than redirecting them to other sites like YouTube) are much more likely to show up on your audience news feeds, as are photos that encourage user engagement and discussion in the comments section.

Engaging with hot-button issues, current news in your industry, or local trends are all ways to increase your exposure on the site.

If the message and content you send through Facebook is not going to be important or interesting in the eyes of your audience, you cannot expect reach or engagement.

American Hotel & Lodging Association Legislative Action Summit 2017

By: Jennifer Krowchun

Last week members of Massachusetts Lodging Association (MLA) attended the Annual American Hotel & Lodging Association (AH&LA) Meeting.  The summit concluded with a day on Capitol Hill advocating and lobbying for important issues both federally and in the state of Massachusetts.  The theme of this year’s AH&LA summit was “Dreams Happen Here”, a national awareness campaign to showcase the career advancement opportunities, community commitment, and economic importance of the hotel and lodging businesses.  The chance to have a lifetime career in a fast moving and exciting industry was evident by our group which included a number of folks who first started out in hotel restaurants or back of house operations before moving up the corporate ladder.  The key issues the group focused on during the Legislative Action Summit were short term rentals, drive-by lawsuits, protecting consumers from online booking scams and H2B visas.


Figure 1 MLA members meeting with legislative staff.

The MLA asked offices to support and cosponsor the Stop Online Booking Scams Act (S.1164/ HR 2495).  The bill will help protect consumers from online hotel booking scams by prohibiting websites from pretending to be the hotel and requiring these websites to prominently display that information. In meetings arranged by O’Neill and Associates, the MLA asked members of the Massachusetts Delegation to consider signing on as co-sponsors of the ADA Education and Reform Act of 2017 (H.R. 620) which would provide a “Notice and Cure” provision that would give small business owners time to address an ADA violation before any legal proceedings can move forward. Paul Sacco, President of MLA, led our largest group by far which included Chris Burgoyne, Director Political and Government Affairs at AH&LA and 6 other members.


Figure 2 MLA members meeting with Congressman Bill Keating.

Included in the 10 meetings scheduled, the group met with Congressman Keating (see Figure 2), a long time champion and leader for MLA regarding H2B visas. As the representative for the Cape and Islands and member of the House Committee on Homeland Security he is well aware of the challenges facing many hotels this year in MA and nationally as they scramble to fill seasonal positions with limited visas. The Congressman was able to share his own personal frustrations with short term rentals as homes near his residence on the Cape are often rented out, becoming a neighborhood annoyance and presenting real safety concerns. As well as the impact short term rentals have on the rental market on the Cape, hard enough to get seasonal employees, and often they are unable to find affordable housing.

Overall the 10 meetings on the Hill were a success as they were extremely informative and educational for both attendees, staff and members of Congress.


Figure 3 Members of MLA meeting with Patrick O’Connor, Office of Congressman Neal in the halls of Congress.


Figure 4 members of MLA in front of Capitol Building.

CEDAC Commits $8.5 Million to Preserve Affordable Housing in Boston’s Fenway Neighborhood

Massachusetts notched another win this month in its continued efforts to preserve affordable housing.  On April 10th, the Community Economic Development Assistance Corporation (CEDAC) announced that it had committed over $8.5 million in financing to Fenway Community Development Corporation (Fenway CDC) to purchase and preserve Burbank Gardens, an existing affordable housing development located in the Fenway neighborhood of Boston. This residence is one of many 13A properties whose 40 year mortgage will reach maturity in March 2018, risking tenant displacement and loss of affordable housing. Fenway CDC closed on the purchase of the property on the same day.

In 2009, the Massachusetts legislature passed into law Chapter 40T. This law has given the state’s Department of Housing and Community Development (DHCD) and CEDAC tools to monitor and address the expiring use challenge. Among the most important provisions of Chapter 40T are purchase rights to allow DHCD or its designated agent to acquire and preserve these expiring affordable housing projects if an owner offers to sell a building.

When the seller of Burbank Gardens put the property on the market in early 2016, Fenway CDC was designated by DHCD through Chapter 40T to purchase and preserve the 52-unit residence. The seller accepted Fenway CDC’s offer in September 2016.

“Preserving Burbank Gardens is an important step in the Commonwealth’s ongoing efforts to maintaining affordable housing,” said CEDAC’s Executive Director Roger Herzog. “It demonstrates once again that the innovative Chapter 40T law remains an effective tool and is a national model for preserving quality affordable housing.”

Fenway CDC, established in 1973, is a membership organization that builds and preserves affordable housing and champions local projects to protect the neighborhood’s economic and racial diversity as well as its long term vibrancy. The organization also provides social services, workforce development programs, financial literacy assistance, health programs, and adult education. They have developed nearly 500 affordable homes that house about 1,500 people, including seniors, families, and people living with disabilities.

With the acquisition of Burbank Gardens, Fenway CDC plans to ensure that 51 of the 52 apartments remain affordable for low and moderate income households. The property currently consists of 52 studio, one- and two-bedroom apartments. CEDAC provided a $313,000 predevelopment loan and, with participation by Eastern Bank, an $8,268,525 acquisition loan to Fenway CDC for this important preservation effort.

“CEDAC was thrilled to work with a mission-driven non-profit to preserve this crucial affordable housing resource,” said Bill Brauner, CEDAC’s Director of Housing Preservation and Policy. “The involvement of public sector agencies, including MassHousing, the City of Boston’s Department of Neighborhood Development and DHCD, was crucial to this transaction.”

Click here to read more about the expiring use challenge and CEDAC’s work in producing and preserving affordable housing.

The Path to Tax Reform Will Go Through Massachusetts

By: Anthony DeMaio

Washington is working overtime this week to characterize the president’s first 100 days following the April 29th milestone. With the spotlight on the White House, it is easy to ignore Capitol Hill. As the 115th Congress reconvenes after a two-week recess, many Members will be smarting from tough town halls and other public appearances back in their districts. Pressure on Speaker Paul Ryan and Majority Leader Mitch McConnell to pass legislation is mounting. With the president having outlined his vision for tax reform, it looks like a much-anticipated tax bill will be the next policy item on Congress’ agenda.

If the goal of re-writing the federal tax code seems ambitious, it’s because it is. The last time a tax reform bill was enacted was 1986 – three days before the ball rolled through Buckner’s legs – a lifetime ago (in both politics and sport). Despite a divided government then, Washington was less polarized. Democrats in the House including Speaker Tip O’Neill and Ways and Means Chairman Dan Rostenkowski worked with Republicans like Senate Majority Leader Bob Dole, Finance Chairman Bob Packwood, and President Ronald Reagan to pass the first comprehensive changes to the tax bill code in 32 years.

There is no doubt that politics is more partisan today than during the Reagan-O’Neill era. And with Republicans in control of Congress and the White House, one would expect the Democrats’ role to be insignificant. But as we learned during the recent attempt to repeal and replace the Affordable Care Act, House Republicans are deeply divided. So if congressional leadership is serious about passing a tax bill, they will need rank and file Democrats to support it, especially Congressman Richard Neal of Massachusetts.

Mr. Neal has served on the House Ways and Means Committee, which has jurisdiction over the tax code, for over 20 years. He is now the top or Ranking Democrat on the panel. It will be up to Mr. Neal and Chairman Kevin Brady (R-Texas) to hash out the details of a viable tax bill.

Among President Trump’s campaign promises and early proposals was a border adjustment tax, or BAT, which would impose a steep tax on goods coming into the United States from abroad. In theory, the BAT would encourage corporate investment at home and create jobs in the manufacturing sector. But as the president found out, tax proposals often make strange bedfellows and while the BAT has some bipartisan support, it also has bipartisan opposition. It appears that the vocal opposition from key Republican senators prompted Trump to shelve the BAT proposal. As other suggestions are considered and tweaked, Mr. Neal will be responsible for determining their viability within his caucus.

In recent history, the medical device tax has been the key tax issue for Massachusetts, thanks to the booming medtech industry. But with a comprehensive bill up for consideration, and a critical seat at the table, Massachusetts interests will play a more central role. Changes to the corporate tax rate will not only affect the 13 Fortune 500 companies based in Massachusetts, but the thousands of small businesses and startups in bio, tech, and other sectors. Consolidating tax brackets and changing eligible deductions should get the attention of the state’s growing millionaire class and the thriving middle class alike. And if Congress is serious about paying for lower taxes by creating savings in the healthcare system, Massachusetts’ research facilities and its dominant healthcare sector will need to sit up and take notice.

While not the low-hanging legislative fruit that would count as an easy win, tax reform is certainly high on Speaker Ryan’s agenda. As the focus turns to legislative action, and the Speaker seeks a win after an early failure on healthcare, we expect to see a tax bill move. There is a narrow political path for the legislation to tread, and it goes right though the Commonwealth.

April Showers bring….government shutdown?

By: AmyClaire Brusch

The end of this week is not only the end of President Trump’s first 100 days in office (Saturday), but also a looming federal funding deadline (Friday).  While the current fiscal year ends on Sept. 30, due to the lack of agreement last fall on FY17 appropriations bills, the government has been under a short term Continuing Resolution (CR) that ends on Friday.  Without a new Continuing Resolution or approval of the FY2017 appropriations, the government will not be allowed to spend money and non-essential functions will be forced to shut down. Threats of a government shutdown have Washington and media outlets in a spin zone, transforming the news cycle to a traditional administration vs. Congress dispute.

Though the formal appropriations process doesn’t usually get the attention and appreciation it deserves from the media, when it comes to a funding deadline everyone pulls out some of their favorite phrases: “Shutdown Showdown”, “CROmnibus” (the CR combined with omnibus for one big funding bill), and disputed “riders” of the day (as in policy language “riders” attached every year to appropriations bills that become bargaining chips, or poison pills, in the days leading up to a deadline).

Without agreement, non-essential government functions (as determined by OMB) cease. Many non-essential federal employees will be furloughed and certain federal government locations such as national parks will be closed. Essential personnel can vary from administration to administration but typically active military, law enforcement/homeland security, medical personnel in federal hospitals, air traffic controllers remain on duty. Mail will still be delivered and social security checks will still be processed. The length of shutdown determines how quickly non-federal employees feel the impact on their daily lives. Politically, the White House and Congress will feel the impact immediately. Constituencies on all sides will be angry and let their elected officials hear it.

There are indications that an agreement is in sight. One of the high profile obstacles to agreement on the FY17 spending bills has been funding for a border wall with Mexico. In order to reach agreement, President Trump has indicated that he will not insist that it be part of the FY17 package and instead look to FY18 for funds. An agreement, or even a CR through September 30th, would free Congress and the Trump Administration to focus on FY18 funding and other large policy areas such as infrastructure. Though it looks at the moment like a shutdown will be avoided, that could change at any time. We have learned in the past 100 days that conventional wisdom rarely applies to the interactions between the Trump administration and Congress.

Is Your Crisis Plan Ready for 2017 Realities?

By Anthony DeMaio

Running a network enterprise is exceedingly complicated. The global network of an airline like United makes the business particularly fraught. Industry pressures exacerbate problems and translate to frustration for passengers. What happened two weeks ago in Chicago was an unmitigated reputational disaster. Given the nature of the airline business today, passengers are well aware that operational disruptions can happen. However, this incident was extreme in every way. Today’s media landscape dictates that carriers need to be prepared with much better protocols than those employed at O’Hare.

First things first – flying is more affordable and more popular than it has ever been. Since the federal government deregulated the airline industry in 1978, fares have fallen by nearly 50 percent and passenger traffic has tripled. As much as we the flying public like to complain about the flying experience, the fact that it is uniquely accessible in the United States today can’t be denied.

Among the factors that keep ticket prices down is the practice of “capacity discipline,” an industry buzzword which roughly translates to “fuller flights.” In order to keep costs down, airlines do their best not to have more seats on a route or frequency than the market demands. In the United case ORD > SDF, that was 70 seats, as evidenced by the full flight. And while full flights can sometimes lead to boarding denials, most passengers would rather have a lower fare and take a chance on getting bumped than subsidize a bunch of empty seats. In rare cases, passengers need to be “re-accommodated.”

Other, external factors further complicate matters. While much has been made about United’s overbooking procedures, the flight in question was not technically oversold. Rather, a crew of four needed to be repositioned at the last second in order to work another flight out of Louisville. Any number of factors could have necessitated the deadheading crew including weather, a mechanical failure, poor scheduling or a growing and soon-to-be cataclysmic shortage of pilots.

The airlines remain a mystique industry. There is a certain amount of magic involved in hurtling through the sky at 500 miles per hour and ending up on the other side of the continent, the ocean, or the world in a matter of hours. The airlines need to do a better job of explaining that it isn’t magic, but rather the product of tens of thousands of employees constantly solving a giant and color-changing Rubik’s cube which get passengers to their destinations quickly, safely, and affordably.

So, too, do the airlines need to improve their communications and protocols. In the aftermath of this disgraceful episode, consumer advocates are rushing to push for improved federal regulations and lawmakers in Congress are introducing legislation. But certain problems are never going to go away. That means all carriers, not just United, need to take a hard look not only at what they’re doing but how they’re explaining their decisions. Social media has transformed the media. United’s bad month (including the “leggings incident” before the infamous “re-accommodation”) was made terrible by the wall-to-wall coverage provided by Twitter, Facebook, YouTube, and other channels. Social Media means there’s a reporter in every seat today, and their content can go viral in minutes. Book-aways, a plunging share price, and irreparable brand damage can result. The once iconic “Fly the Friendly Skies” is now and forever a punch line to a bad joke. All carriers would be wise to examine their crisis plans and employee training manuals to ensure they are up to 2017’s standards.

Opioid Policy Issues Continue to be Center Stage at the State House

By: Chris Niles

The recent announcements of two major private initiatives, RIZE Massachusetts and the Grayken Center at Boston Medical Center, focused on the treatment and prevention of substance use disorders are welcome additions in the fight against opioid addiction in Massachusetts. The misuse of opioids continues to take lives at a frightening pace in the Commonwealth and presents a complicated challenge to elected officials and policy makers across the United States.

Early data from the Massachusetts Department of Public Health indicate that 2016 was another devastating year as opioid overdose fatalities will approach or exceed 2,000 deaths, the deadliest year thus far. As of now, 1,465 deaths are confirmed with another 469 to 562 estimated to be designated as an overdose fatality. Equally shocking is that these numbers would have been much worse if not for the availability of the drug naloxone, used to reverse an overdose, which was administered approximately 12,000 times in 2015 (the last year data was available). Most recently, a report by the US Office of Health and Human Services found that the Commonwealth had the highest rate of opioid related Emergency Room visits among 30 states included in the study.

The sheer scope of the opioid epidemic in Massachusetts will require a sustained effort over many more years to bring under control. For over a decade the Commonwealth has increased resources, made significant policy changes and raised awareness about stigma in an effort to curb the epidemic. The Legislature has passed a series of omnibus bills over the last several legislative sessions to address different but interrelated aspects of the epidemic. Laws and regulations have been strengthened to mandate prescriber education, to encourage regular queries of the Prescription Monitoring Program by prescribers, to provide education to students, to improve access to quality treatment and to supplement treatment capacity. The implementation of the Commonwealth’s 1115 Medicaid waiver will add new resources and capacity in critical areas of the continuum of care and the system of five Recovery High Schools offer students with substance use disorders a safe and supportive environment to continue their education.

The Legislature also authorized a study, the Chapter 55 report, by the Department of Public Health in cooperation with other state agencies that utilizes pooled state data to try to identify patterns and gain a more comprehensive understanding of the underpinning issues of opioid misuse in Massachusetts.  For many years, hard data about the opioid epidemic was hard to come by, either siloed in agencies across state government or simply not collected. The data and analysis in the Chapter 55 report confirms that we are not facing an epidemic of misuse of only one class of drug, rather an evolving epidemic of misuse of many substances. The surge of fentanyl use in particular, identified in 75% of overdose fatalities in one set of recent data, combined with the emergence of carfentanil and the presence of benzodiazepines in postmortem overdose reports all illustrate the dangerous mix of chemicals that are being misused and are a driving factor in these fatalities. The changing nature of the epidemic over time has made it a moving target for providers, regulators and law enforcement.

As the Legislature considers its next policy priorities on opioids, we’re likely to see an emphasis on adding tools to sustain a client’s long term recovery in their community, one of the more elusive and frustrating aspects of this chronic disease. In many ways, policy makers have worked through many of the immediate challenges but the buildout of a comprehensive response is not yet complete. While many of the pieces are in place or coming online, pulling all of the components of treatment together to create a streamlined continuum of care that will be evidenced based, efficient and effective for clients remains a work in progress. The workforce challenges faced by the provider community could also present a chilling effect to the state’s response. As new programs open or expand  the demand for qualified professionals in the field is a pressing need across the state and attracting significant numbers of new staff will be critical to building a sustainable network. Additionally, training more medical professionals in addiction medicine and training existing staff in the latest advances in the field will help improve provider capacity. While much was done through the STEP Act around prevention, research and policy continues to develop around how to best identify opioid misuse at the earliest stages. The use of data to target resources and analyze trends is a new and important resource and some hope the application of mobile technology could be part of the solution.

Many of the remaining opioid policy issues are also intertwined with other challenges we face in Massachusetts but are crucial to the opioid epidemic as well. Affordable housing and homelessness, gaps in education, lack of job skills or work experience, complicated family dynamics, criminal records, co-occurring disorders and collateral health issues can all face clients as they work to sustain recovery. With the additional attention and resources that have now been brought to bear, perhaps we’ve reached a critical mass and a more robust understanding of what it will take to treat this public health crisis.