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In the midst of an opioid addiction crisis that has claimed over 1,200 deaths in 2014 and thousands more in the preceding decade, the state Senate has passed a bill intended to help prevent opioid addiction. There's more to it than most have realized.
You’ve probably read about the proposed expansion of so-called Screening, Brief Intervention and Referral to Treatment (SBIRT) programs in public schools — a proposal initially deemed controversial, with people believing it involved blood samples and lab testing. Even my mother called to report her concerns, and conveyed that my 88-year-old aunt was also opposed. For the record, the Senate bill does not include any drug testing. It does include a verbal survey and assessment, of students, to gain a better understanding of trends and risks among youth.
Lost in the misunderstanding on the screening proposal was that the entire bill comprises more than a dozen distinct policy initiatives. Much more than a haphazard assortment of mandates and prohibitions, it is a determined effort to rein in our over-reliance on the pharmaceutical products that create addiction.
And we need this change. Our health care systems push unconscionable quantities of opioid pills into our communities, not by malicious intent (though some of that exists), but due largely to simple inertia and complacency. The bill requires pharmaceutical manufacturers, prescribers, pharmacists, insurance companies and patients to all take an active role in not only combating the epidemic, but also in promoting more affordable health care with better outcomes.
Consider the noteworthy changes in areas described below:
Pharmaceutical manufacturers must be responsible for the safe use and disposal of their products, not merely through passive labeling and warnings, but through tangible stewardship steps such as funding and operating mail-back and take-back programs. Similar programs, allowing patients to safely turn in their unused pills, have previously been funded solely by government agencies. With this bill we could become the first state in the nation to make manufacturers responsible for their products, not by litigation and prosecution, but by the assertion as a Commonwealth that responsible corporate behavior is a minimum condition of the manufacturers’ licenses to do business with us.
Prescriber Trend Notification
Prescribers would regularly be compared against their peers, and informed (not warned or penalized, only informed) when their prescribing numbers exceed the average among their peers of a similar specialty, practice setting and geography.
This shifts, in a subtle but important way, one of the primary purposes of the Prescription Drug Monitoring Program (PMP). By gathering data on prescription trends, then making that data personal to each prescriber, we are nudging high prescribers to consider their choices thoroughly. This will make the PMP a powerful tool for education and best practices, not a tool solely for monitoring and enforcement. The information we can distribute to prescribers will also be, in many cases, the only counterbalance to marketing efforts by pharmaceutical sales teams.
Access To Pain Management
A three-fold approach would encourage the use of non-opioid pain management drugs, demand more coordinated and comprehensive insurance coverage of non-opioid pain management alternatives, and test a model that allows primary care providers to quickly access pain management specialists for consultation.
With this change we are rejecting the old notion of a zero sum game between prescription safety and pain management. We are balancing the push to reduce our consumption of pills, with a push to replace those pills with real treatment. We are making information, expertise and reimbursement more readily available to primary care providers, so that they do not face the limited choice of either prescribing dangerous pills or leaving their patients without any treatment for their pain.
The Senate’s bill also makes opioid safety a patient-driven priority. For all the time and effort we’ve spent educating the general public on the risks of opioid addiction, we’ve given the average patient and family very little say about their exposure to these drugs. We are changing that, completely. The patient would be in control, not only in the doctor’s office, but also before arriving at the office (non-opiate directive), after leaving the office (choosing the fill quantity), and in their own neighborhoods and homes (stewardship programs).
Massachusetts patients would be empowered to register their desire not to be administered or offered an opiate, not as a request that may or may not be honored by their provider, but as a legally binding medical directive, with appropriate safeguards for emergency situations.
Patients would be authorized, after consultation with prescribers, to receive their opioid prescriptions in any quantity up to a prescribed maximum, rather than directed to receive the fixed amount written by the prescriber. Those patients who may want far fewer pills than their prescription calls for would face no obstacles to receiving the lesser quantity. Massachusetts would be the first state in the nation to provide for such a degree of patient choice in filling prescriptions.
I have been proud to work on this legislation, and hope to see it passed without delay.
John Keenan, a Democrat, is the Massachusetts state Senator for the Norfolk and Plymouth district and currently serves as vice-chair for the Senate Special Committee on Opioid Addiction Prevention, Treatment and Recovery Options.
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