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One day after announcing that fewer Massachusetts residents have died from opioid overdoses this year than last, Gov. Charlie Baker delivered a slate of proposals to combat the epidemic, including reforms for prescribing and treatment, at a press conference Tuesday.
The CARE Act would fill gaps the administration missed when crafting legislation during Baker's first year, and calls for dozens of provisions that would overhaul treatment, tighten restrictions on prescribing, and focus on educating children, teenagers and college students on the dangers of opioids.
The bill focuses heavily on the difficulty many drug users have finding meaningful treatment.
"One of the biggest problems we have right now is people get detoxed and then they’re kind of on their own for everything that happens after that," Baker said.
Treatment for addiction can vary and patients typically stumble from one program to the next, trying to find the solution that helps — or eventually give up.
Baker's proposal would create a commission to review the evidence and protocols for addiction treatment.
"We should be providing you with access to treatment that actually makes sense and will work for you," he said.
The governor, a former health insurance executive, pounded the podium again and again when describing the many ways addiction treatment falls short of general medical care.
"It’s not credentialed properly, it’s not certified properly, it’s not paid for, and we don’t collect data on it," Baker said. "We would never accept that in cancer or heart disease or congestive heart failure or diabetes or other forms of chronic illness, yet we accept it here."
In addition to treatment reform, the act would issue a standing order for naloxone, building on the option at some chain pharmacies for anyone to buy the drug, which can reverse an overdose.
The act calls for steps to limit prescribing and set up a process for reporting doctors suspected of violating the state's seven-day limit for first-time opioid prescriptions.
It would require all doctors to convert to electronic prescriptions by 2020, and it would create a commission to look at prescribing guidelines.
"More and more we’re learning that patients do not need large prescriptions and numerous refills to manage this pain," Baker said, remarking that some patients are still receiving large, and perhaps unnecessary, amounts of opioids after surgery.
"In fact, they may not need opioids at all."
The act would also create a $2 million trust fund for prevention education.
The Massachusetts Medical Society said it supports the bill overall and particularly a provision that would merge the state and federal law on partial-fill prescriptions. Those let patients fill less than their full opioid prescription initially, and permits them to go back to the same pharmacy for the balance within 30 days.
“The partial-fill approach to opioid prescribing remains a vital component in reducing opportunities for unused pain medication to be transferred from a patient to those who suffer from opioid abuse disorder or may be at risk of developing an opioid use disorder," said MMS president Dr. Henry Dorkin.
Two veteran addiction treatment advocates who heard Baker outline his bill were impressed.
"What I heard really is almost revolutionary, in terms of what it can do to bring addiction treatment into the mainstream of how medicine is practiced," said Gosnold Innovation Center president Ray Tamasi.
"It’s clear that with this level of addiction, one size doesn’t fit all," said Massachusetts AFL-CIO president Steve Tolman. "They’re trying to build some sort of mechanism to determine what is best."
But some advocates say Baker has conflicting strategies about how to address the opioid epidemic. The CARE Act may emphasize treatment for a disease, but amendments to existing law filed in August 2017 would establish a minimum five-year manslaughter charge for anyone who supplies an opioid that results in death. Drug users say that could mean jail for anyone who buys or shares heroin or fentanyl with friends.
"Providing better care for people with addiction is commendable and I applaud the investment," said Northeastern University law professor Leo Beletsky. But "that investment cuts at total cross purposes with simultaneous efforts to ramp up the criminal justice approaches."
Beletsky points to Baker’s proposal to let emergency room doctors and other providers send drug users they revive after an overdose to a detox facility, where the patient could be held for up to 72 hours against their will. It’s a controversial idea because, according to some studies, involuntary treatment is generally less effective than a voluntary admission.
Detox facilities have not said whether they support the idea of a three-day involuntary hold. Dr. Melisa Lai-Becker, president of the Massachusetts College of Emergency Physicians, says it’s worth a try.
"Think of this as the fire extinguisher," she said. "Even if it can save one life, I think if you ask the friends and family of the one life that is saved, they will say that it is well worth it."
If the goal is saving one life at a time, many in the addiction community say the proposals fall short.
"Safe injection/consumption is the critical component in any response to the current opioid crisis," said Jim Stewart, with the advocacy group Supervised Injection Facilities in Massachusetts NOW, "because it reaches out to engage opioid users where they are and offers proven and effective engagement that preserves their lives."
There's no word yet on whether the House and Senate agree with Baker’s evolving strategy for stopping the opioid epidemic. It would cost about $120 million over four years, using a combination of state and federal dollars.
Correction: An earlier version of this digital story said patients could be held at a detox facility for 24 hours. It's 72 hours, per Baker's bill. We regret the error.
This segment aired on November 15, 2017.
- Some Experts See Opioid Addiction Stemming From Prescriptions As A Medical Error
- The Opioid Addiction Crisis
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