Senate Reaches Compromise On Partial-Fill Prescriptions

Hours of backroom deliberations resulted in an agreement in the Senate Thursday that would permit pharmacists to dispense a lesser amount than prescribed of a schedule II prescription drug, a category that includes the most dangerous painkillers.

The provision was included in a Senate bill (S 2020) aimed at preventing substance abuse and curbing the scourge of heroin and other opiates, which the Department of Public Health blamed for 1,256 accidental deaths last year in a state of 6.7 million people.

After passage of a law last year focused on expanding access to treatment for addiction, senators in the bill approved Thursday zeroed in on education and prevention tools, including mandatory screenings by trained school staff for signs of risk or substance abuse in students, additional training for doctors on best-prescribing practices and alternative pain management methods and unused-drug collection programs.

Worked out over hours while the chamber stood idle, the partial-fill provision backed by Sen. John Keenan differed from an earlier version that would have allowed individuals to take out their prescriptions for schedule II narcotics, which includes drugs like Oxycontin, in smaller batches over time, but still adding up to the total prescription size.

The new language allows for a one-time smaller fill and requires the prescriber to talk to the patient about the danger of opiates, Keenan said. If a patient requires additional medication, they would have to go back to their doctor and receive another prescription.

"It's just a whole new area of rule-making and that was the robust discussion," Senate President Rosenberg told the News Service after the bill passed on a unanimous 38-0 vote Thursday night.

The Keenan amendment was adopted without floor debate.

Keenan's original proposal had sparked concerns within the Senate Ways and Means Committee that it would run afoul of federal law. Ways and Means Chairwoman Karen Spilka said the final version "better protects the pharmacists," and avoids a conflict in state and federal law.

The final version of the Senate bill also charges state health and education officials with determining what grades to verbally screen schoolchildren for substance usage. The initial version specified screenings for seventh and 10th grade students.

Insurance coverage for non-narcotics pain management was one of the other aspects of the bill that hit the floor midday Thursday.

The Senate adopted a Sen. Michael Moore amendment banning the sale, manufacture or possession of powdered alcohol, fining offenders between $100 and $1,000.

The Senate also adopted a Senate Majority Leader Harriette Chandler amendment creating a commission of leaders from the state's medical schools to work on incorporating safe prescribing and pain management education into their curriculum. Last month, the medical school deans met with Gov. Charlie Baker to discuss the establishment of cross-institutional best practices around opioids.

Democratic presidential candidate Hillary Clinton was in Dorchester Thursday to talk about substance abuse, while Speaker Robert DeLeo had a visit scheduled to discuss substance abuse in Plymouth on Thursday, and U.S. Attorney General Loretta Lynch on Friday plans to address a summit in Waltham on opioid misuse and addiction co-hosted by U.S. Attorney Carmen Ortiz and the Massachusetts Medical Society.

The Senate adopted a Sen. Eileen Donoghue measure that calls for doctors prescribing opioid medication to minors to explain the risks of addiction and overdose, then obtain informed written consent from the parent or guardian, except in emergencies.

"It's shocking that last month the FDA said you can prescribe OxyContin to children as young as 11 years old, and when they get that type of powerful drug, oftentimes parents or guardians are unaware of the physical effects " Donoghue told the News Service. "These are awareness tools, and for making sure that we're protecting people out there. This bill is chock full of many things for getting that done."

Also included in the final version is a commission to look into the possibility of expanding "implied consent" for roadside intoxication tests from alcohol to other substances. The chemical breath-test for alcohol is far more developed than tests for marijuana, cocaine or other intoxicating substances, according to those skeptical of adopting new roadside tests for drugs.



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