Working group offers plan to combat opioid crisis
Clear in his aim to reframe substance abuse as a public health crisis that can't be solved by law enforcement alone, Gov. Charlie Baker on Monday detailed a suite of options to reverse the trend of opioid addiction that last year claimed the lives of over 1,000 residents across the state.
Baker, who was joined at a press conference by Attorney General Maura Healey, Health and Human Services Secretary Marylou Sudders and a Cape Cod family impacted by substance abuse, spoke of investing in new beds for treatment, providing resources for schools to educate students on the dangers of painkillers and reforming the way the criminal justice system handles addicts.
The governor's task force on substance abuse produced a report with 65 action items that include making the state's prescription monitoring program easier for physicians to use and more efficient at producing real-time data that can be used to target treatment and intervention programs.
"Let me make one thing perfectly clear here. Opioid addiction is a health care issue that knows no boundaries across age, race, class or demographics," Baker said. "From the Berkshires to Boston to Cape Cod, too many people have heart-wrenching stories of loved ones and friends that battled with addiction and in some cases lost their lives."
Unintentional opioid overdoses claimed an estimated 1,008 lives in Massachusetts in 2014, an increase over the prior year and more than three times the number of lives lost to automobile accidents.
The report calls for the creation of nearly 200 new treatment beds by July 2016, state funding for school prevention programs to be designed at the local level, a partnership with a chain pharmacy to pilot a drug take-back program, and amendments to the civil commitment statute to include substance abuse disorders.
The 18-person group also recommended that women civilly committed for substance abuse problems be removed from MCI-Framingham and placed in a hospital operated by the Executive Office of Health and Human Services.
Sudders told reporters that up to about 20 civilly committed women housed at MCI Framingham would instead be treated at Taunton State Hospital under the plan. Men are currently civilly committed at a treatment facility on the grounds of Bridgewater State Hospital, she said.
According to Health and Human Services the plan is also to add 64 treatment beds in Greenfield at Behavioral Health Network; 27 new beds in Westborough at Spectrum Health; 34 new beds in Natick at Metrowest Medical Center; 24 new beds in Dartmouth at Acadia Health; and 43 new beds in Haverhill at Summit Behavioral Health.
"It can't just be law enforcement, and it can't just be Health and Human Services," Sudders said.
Baker's task force recommended a process to certify and register drug-free housing for recovery addicts, to require prescription monitoring data to be entered into the system within 24 hours by pharmacies instead of within 7 days, and to improve the affordability of the overdose reversing drug naloxone, also known as Narcan, through bulk purchasing.
Baker said he intends to file legislation "shortly," perhaps within the next 10 days, to begin implementing some recommendations, and will seek $27.8 million in new funding from the Legislature in fiscal 2016. Sudders said that the administration will also repurpose $6.7 million in existing funds to bring the total investment next year to $34.5 million.
Senate President Stanley Rosenberg said he's hopeful that the House and Senate can accomplish some goals quickly through the budget process. Both the House and Senate passed measures geared toward combating substance abuse that overlap with the governor's recommendations, including the Senate's proposal for bulk purchasing of Narcan.
House Speaker Robert DeLeo also said he would be amenable to making additional financial resources available to Baker.
"I don't think there's a person in this building that doesn't feel that opioid addiction is one of the major issues facing us as a commonwealth and as such maybe some of the stuff we can do through the budget process. But having said that, I think that whatever resources are necessary to combat this issue I think we have to use," DeLeo said.
The governor also said he was in discussion with other governors in the region about how to make the state's prescription monitoring data compatible across borders to stop patients from doctor shopping in New Hampshire, Rhode Island, Connecticut and other nearby states.
Baker was joined at the press conference by Janis McGrory, of Harwich, and her daughter Amy, both of whom appear in one of two new public service announcements that began airing on television last week telling the story of her late-daughter Liz, a one-time honor student who became addicted to painkillers and died of an accidental heroin overdose four years ago.
"Parents, be vigilant, addiction is a disease, and don't be fooled. It can happen to you," Janis McGrory said.
Healey said she will use her office to help the administration implement some of the new policies, including making sure Narcan is affordable and accessible for local first responders and promoting the state's "Good Samaritan" law that protects anyone who reports an overdose from criminal charges.
"We are not going to arrest or incarcerate our way out of this. It is a disease," Healey said.
The attorney general also said she will enforce behavioral health parity laws and go after doctors and pharmacists that recklessly prescribe addictive painkillers.
Noting that nearly 80 percent of people who turn to heroin started by abusing prescription opioids, Baker said the deans of the state's medical schools should expect to hear from him about incorporating more than a few hours of training on pain management into the medical school curriculum.
The task force also recommended that pain management, safe prescribing training, and addiction training be required for all prescribers as a condition of licensure and that addiction specialists be appointed to state medical boards of registration for medicine, nursing, physicians assistants and dentistry.
Vic DiGravio, head of the Association for Behavioral Health, commended the Baker administration and the task force for recognizing the multi-faceted nature of the addition problem.
"The recommendations acknowledge the scope of the problem and outline a holistic approach to battling the current epidemic through prevention, intervention, treatment and recovery supports," DiGravio said.
Lora Pellegrini, president of the Massachusetts Association of Health Plans, said insurers are committed to expanding coverage for inpatient and outpatient treatments, including medication-assisted treatment such as Suboxone and Vivitrol. Many plans will begin offering Methadone coverage on July 1, Pellegrini said.
Doctors also said they welcomed the governor's focus on reforming prescribing practices to reduce incidences of prescription drugs being abused by patients or others accessing legally prescribed drugs.
"We agree that because of the opioid crisis, we need a different approach to the prescribing and management of opioid medications. That is why we've taken a proactive approach to the issues, and launched a comprehensive program to educate physicians, other prescribers and the public last month," said Dr. Dennis Dimitri, president of the Massachusetts Medical Society.
A Massachusetts Medical Society working group recommended improvements to the state's online prescription monitoring program, co-prescribing naloxone with opioid medications, allowing the partial filling of opioid prescriptions without additional co-payments, and more education for prescribers and the public.
Sean Kelley, a Beth Israel Deaconess Medical Center emergency room physician and chief medical officer at Imprivata, said it was important that the governor's group recommended the use of electronic prescribing of controlled substance to fight prescription theft and forgerym, which he described as a "significant driver" of abuse.
"EPCS eliminates paper prescriptions that are so vulnerable to abuse and creates a secure, transparent and auditable chain of trust between prescribers and providers. We look forward to working with providers and policymakers to increase the use of EPCS in Massachusetts, where the EPCS utilization rate is only 2.7 percent," Kelley said.
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