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The "big three" leaders on Beacon Hill are unanimous in their support for taking some type of action to address the rise of opioid addiction and related deaths in Massachusetts, but it will be the Senate that takes the first crack at a new menu of options to strengthen prevention and education.
Nearly nine months into a session where drug treatment was identified early on as a priority, Senate leaders are planning a vote for next Thursday on a comprehensive opioid addiction prevention bill that is expected, among other things, to require schools to screen students for signs of addiction, encourage alternatives to opioids for pain management, and allow patients to limit their own access to the addictive drugs.
"We're really trying to put forth a robust piece of legislation that we're hoping is going to make a direct impact to not only those who are actively using, but those who have yet to touch a substance and that we hope never, never do," said Sen. Jennifer Flanagan, a Leominster Democrat.
The focus on education and prevention comes after the Legislature last year passed a major bill aimed at improving access to treatment, including requirements that insurers reimburse patients for addiction treatment from licensed counselors and guarantee coverage for up to 14 days in an inpatient setting. Those mandates go into effect starting Oct. 1.
Flanagan chairs a special Senate committee focused on opioid addiction. Earlier this month, the committee issued recommendations that were packaged into a bill (S 2010) currently being reviewed by Senate counsel and the Senate Ways and Means Committee.
The Senate on Thursday will adopt an order directing Senate Ways and Means to report out a finalized bill on Friday, and set a deadline for amendments to be filed at 5 p.m. next Tuesday with the intention of debating the bill next Thursday.
The rise of addiction to powerful prescription and non-prescription drugs like Oxycontin and heroin has commanded attention from political leaders at the State House who have all shared stories of individuals and families they've met in their own communities ravaged by addiction. The Department of Public Health has estimated 1,256 people died of unintentional opioid overdoses in 2014.
After convening a task force that made a number of recommendations, Gov. Charlie Baker included $27.8 million in an end-of-year spending bill that would be used for opioid-abuse prevention and treatment, including $5.8 million to move addiction treatment for women out of a correctional facility. The bill is pending in the House.
Baker has said he intends to file additional legislation this fall, and Senate leaders said they would be open to considering the governor's recommendations as the bill moves through the process.
While the details may change over the next day, both Flanagan and Sen. John Keenan, a Quincy Democrat and vice-chair of the special Senate committee, expect the final bill to be released Friday to largely reflect the work of their committee.
Among the recommendations, Flanagan and Keenan are calling for schools to be given new resources to train nurses, teachers and guidance counselors to perform Screening, Brief Intervention, and Referral to Treatment (SBIRT) sessions with students in the seventh and tenth grades to identify signs of addiction and potentially get them help.
While the screenings would become part of the mandatory health checks school are required to perform, along with vision and hearing, students or parents could decline participation. Flanagan said the hope is to expand the use of SBIRT screening from 10 schools to 440 districts across the state with additional funding to be included in a supplemental budget later this fall.
"To make it very clear, it is not a drug test," Flanagan said, explaining that parents would not be immediately notified of results and there would be no criminal or disciplinary repercussions.
Gov. Charlie Baker has already voiced skepticism toward the drug screening idea, and House Speaker Robert DeLeo said he worried it could raise constitutional concerns. Flanagan, however, said the screenings would only be in place to help those who want help. "You can't force them into treatment," she said.
The bill currently being redrafted and refined would also seek to encourage the use of alternative pain management tools by putting non-opioid pain products on the drug formulary to familiarize doctors with available treatment options.
Insurance companies would also be required to work with physicians, as part of their accreditation, to understand other pain management alternatives such as chiropractors, physical therapy or acupuncture.
"My feeling is that we should be asking insurance companies to do more," Keenan said. Officials said the bill is unlikely to include a coverage requirement for alternative therapies.
The senators are also recommending that patients be allowed to list themselves in their medical records as someone who should not be prescribed opioids, and doctors would be required to list the reasons in medical records why a patient has been prescribed certain types of highly potent opioids, such as Zohydro.
"It's just to make a practitioner or physician stop and think," Keenan said.
While acknowledging that the insurance industry has concerns about implementation and administrative oversight, Keenan said the bill could also include a measure to allow patients to request partial fills of opioid prescriptions to self-limit access to powerful narcotics or the diversion of drugs into the wrong hands.
Flanagan said she's pushing for the bill to include an update to the Good Samaritan law shielding first responders, many of whom now carry the overdose-reversal drug Narcan, from civil liability. Flanagan is also looking for additional training for first responders on the details of the law that protects those who call for help in cases of drug overdoses from criminal prosecution.
Other key provisions expected to be included in the bill are a requirement for insurers to report annually to the Health Policy Commission on the number and reason for denials of addiction and behavioral health services, physician notification of their prescribing habits compared to other doctors in the same field and a directive for pharmaceutical companies to come up with "drug stewardship" plans to help people dispose of unused drugs.
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