The recent overdose deaths, combined with general statewide statistics that show a steady increase in even nonfatal overdoses over the last decade, are the latest evidence that opiate abuse is hitting not only in the state’s urban centers, but also in rural communities from Cape Cod to the Berkshires.

The tally, compiled by the State Police, does not include the state’s three largest cities: Boston, Springfield, and Worcester. The number of heroin-related deaths in those cities was not readily available Tuesday, but would probably significantly increase the total.

At least 185 people have died from suspected heroin overdoses in Massachusetts in less than four months, a death toll that has magnified concerns of a growing public health crisis in the state and the region.


“It’s not just your back alley junkie doing heroin anymore,” said Franklin County Sheriff Christopher J. Donelan. “It could be any kid, in any neighborhood, in any demographic.”

Though the data is limited — and there were no figures for fatal overdoses during the same period of time last year — a State Police spokesman said the 185 deaths since November clearly represents an increase.

“Our experience and accumulated knowledge . . . indicates that these numbers absolutely represent an increased rate of fatal heroin overdoses,” said David Procopio, a State Police spokesman.

According to the state Department of Public Health’s annual statewide figures, the number of opiate-related deaths increased from 363 in 2000 to 642 in 2011, the most recent year that data was compiled.

The deaths over the last few months are occurring at a much faster rate than even car crash deaths. A total of 349 people died in car accidents in all 2012, the most recent year that data is available, according to the figures from the National Highway Traffic Safety Administration.


Nonfatal overdoses are also on the rise: In Boston, the Public Health Commission reported that accidental drug overdoses increased by 39 percent between 2010 and 2012.

Nonfatal heroin overdoses increased 76 percent in that time frame, and prescription drug overdoses rose by 38 percent from 2009 to 2012.

By the first week of this month, Boston Emergency Medical Services administered Narcan, a medication to counter the effects of an opiate overdose, 52 times since the beginning of the year, compared with 41 times by the same date in 2013.

Procopio and other law enforcement and public health officials have attributed the rise in overdose deaths to several possibilities.

A potent strain of heroin could be making its way into the region. Suppliers could be cutting heroin, or mixing it to increase profits and potency, with a synthetic substance, possibly the painkiller fentanyl. A third possibility is that drug users could be taking heroin simultaneously with other drugs, specifically prescription drugs such as Percocet.

“Add to those one more probable factor, the fact that heroin is more readily available and easier for users to obtain than other opiates or prescription drugs,” Procopio said.

Authorities continue to investigate and analyze the overdoses, Procopio said, but added, “We firmly believe that it is a problem that cannot be solved solely by arrests. . . . Treatment and public education components are equally essential.”

The increase in overdoses has triggered responses in Greenfield and Taunton, where public forums on opiate abuse have been held and where officials agreed with the need to increase the number of special drug courts that could quickly handle drug abuse cases.


Officials agree there is a need for more beds at rehabilitation clinics.

Governor Deval Patrick has requested $2.7 million to create five more drug courts and three other courts to deal with mental health issues.

The state has 21 drug courts, which are used to aggressively and swiftly address a defendant’s underlying drug addiction by ordering treatment and evaluation as alternatives to prison.

Meanwhile, the state Senate has launched a special commission to hear public testimony on what officials have called a public health crisis, with the goal of formulating recommendations by the time the Legislature debates the state’s annual budget.

Cheryl Bartlett, the state public health commissioner, said that the growing concern across Massachusetts illustrates a worry that public health officials have long held: That heroin and other opiate abuse is not only a problem in urban areas, but is making its way across the commonwealth’s rural communities as well.

The state began the Opiate Overdose Prevention Program campaign in 2007, with ads and pilot programs to train first responders to deal with overdoses.

One program has increased the number of community distribution sites for Narcan from seven sites to 27.

But the state and individual communities can do better, Bartlett said.

“I think it’s a major concern to us, and I think the fact that there’s more awareness, that we can come together to call attention to this concern, can only help us as we move forward,” Bartlett said.


Last month, the governor of Vermont focused his entire State of the State address on opiate abuse in that state.

Donelan, the Franklin County sheriff, worried that the response to the epidemic has been too slow and that heroin and opiate abuse is already intractable.

“We need to completely reevaluate how we treat addiction,” Donelan said.

“The old infrastructure we have for alcoholics, or marijuana or cocaine abusers, isn’t what’s needed for heroin addiction.”

Evan M. Allen of the Globe staff contributed to this report. Milton J. Valencia can be reached at MValencia@

globe.com. Follow him on Twitter @MiltonValencia.