Compromise Opioid Bill Caps First-Time Prescriptions At 7 Days

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Update March 9 at 3 p.m.: The House has unanimously passed the compromise bill (PDF). The Senate is expected to take it up Thursday.

Our original story:

BOSTON — A Massachusetts House and Senate compromise bill on how to tackle the state’s opioid epidemic includes new limits on first-time opioid prescriptions, a push to evaluate patients after an overdose and addiction screening for middle and high school students.

The provisions are not as dramatic as those proposed by Gov. Charlie Baker, but a spokeswoman said the Legislature is taking a strong step in the right direction.

Baker ignited controversy last fall when he proposed a three-day limit on first-time opioid prescriptions. The House took a step back and suggested seven days, and seven is the number in the compromise bill House members are expected to vote on Wednesday.

Liz Malia, chair of the House Mental Health and Substance Abuse Committee, said this restriction, coupled with the expectation that doctors and dentists will talk to patients about the dangers of addiction, will shift the thinking about opioids.

"We’re changing some of the culture, and in my mind that's of the things that really has needed to to happen," she said.

The seven-day limit includes an exception for adults with chronic pain. It has the support of the Massachusetts Medical and Dental societies.

"I think seven days is a lot more reasonable than the original three days," said David Lustbader, an oral surgeon who is also vice president of the dental society. "That generally is enough time to get people through the acute period of pain, post surgically."

Lustbader said dentists and doctors will have to coach patients about how to manage pain with fewer opioids. He warns that taking too much Tylenol, for example, can damage a patient’s liver.

Lustbader also added that health care providers will have to monitor the effects of reducing prescription opioids.

"There is no easy solution to this," he said. "You can get heroin on the streets of Boston cheaper than you can get illegal Vicodin, so you don’t want to push people in that direction either."

There are a number of new opioid addiction prevention and treatment programs in the compromise bill.

The Department of Public Health will establish a verbal screening program for middle and high school students to assess their risk for addiction or current problems. A student or parent or guardian can opt out of the screening by written notification.

Senate Ways and Means Committee Chair Karen Spilka said the bill aims to bring everyone to the fight. "From prescribers, to pharmaceutical companies, to insurance companies, to patients, to children, to schools, you know, to really aid in the education and prevention, because I believe it’s the only way we are going to reverse the course of this horrible epidemic," she said.

Emergency room physicians are relieved they will not be required to hold overdose patients for up to 72 hours, as proposed by Baker. Many, like the governor, are frustrated by the cycle of patients overdosing and fleeing an ER in search of their next high.

Melisa Lai Becker, emergency room director at Whidden Hospital in Everett, which is part of the Cambridge Health Alliance, prefers the compromise bill that requires that doctors attempt to conduct an evaluation of patients within 24 hours of an overdose.

However, Lai Becker said it's likely some patients will instead choose to leave the hospital before being evaluated. In those cases, doctors would not be held liable.

"But every relapse is at least another opportunity to help save the patient," Lai Becker said.

She read the bill late Tuesday night, an antidote after an eight-hour shift during which she revived three overdose patients.

"It’s sad to continue to see the prevalence of this illness at the rate that we do, but I’m hopeful," she said.

In a statement, a spokeswoman said Baker “believes this bill contains many important provisions” and is pledging to continue fighting this public health crisis.

This story was updated at 9:50 a.m. on Wednesday, March 9.

This article was originally published on March 08, 2016.


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Martha Bebinger Reporter
Martha Bebinger covers health care and other general assignments for WBUR.



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