BOB SALSBERG, Associated Press
BOSTON (AP) — Gov. Charlie Baker criticized what he considers a blase attitude among some health professionals about addictive painkillers as he introduced legislation Thursday as part of his strategy to curtail a deadly surge in drug overdoses in Massachusetts.
Baker called for a 72-hour limit on first-time prescriptions for opioid painkillers and a change in the state’s civil commitment law.
The legislation would restrict patients to a three-day supply of painkillers the first time they are prescribed an opioid drug, or when they receive a prescription from a new doctor. Patients could seek refills after the three-day period and exceptions would be made for certain chronic conditions and hospice care.
Baker’s proposals, which prompted concerns from a leading physicians’ group and civil libertarians, came in response to state figures that showed an estimated 1,250 deaths from opioid overdoses in 2014, about triple the number of deaths five years ago.
The governor has been highly critical of overprescribing painkillers, which can lead to addiction to opioids, including heroin.
“I’m a health care guy,” said Baker, a Republican and the former head of Harvard Pilgrim Health Care. “I have lots of friends and lots of colleagues in the health care world, and I am astonished by the casual nature and the casual attitude I find when I talk to them about these medications. That has got to change.”
The bill would also allow doctors and other medical professionals to commit a person involuntarily to a drug treatment facility for up to 72 hours if they’re considered an immediate danger to themselves or others. Currently, a judge’s order is required for a civil commitment and such orders can be difficult to obtain at night or on weekends.
Baker referred anecdotally to people who go to emergency rooms, receive an injection of the overdose reversal drug Narcan, and are then released — only to turn up days later in the same ER.
“In many cases, these are stories that end badly several weeks or several months later,” he said.
Dr. Dennis Dimitri, president of the 25,000-member Massachusetts Medical Society, said a hard-and-fast 72-hour supply limit on first-time prescriptions could limit treatment options and interfere with the clinical judgment of experienced doctors. The organization already has guidelines that urge physicians to prescribe the lowest effective doses of opioid drugs in the smallest possible quantities, he added.
While praising the governor’s determination to stem the addiction crisis, Dimitri also cited challenges with allowing doctors to authorize civil commitments.
“I think that is something that would be very difficult for most physicians to make a judgment call on,” he said, adding that there are not enough substance abuse beds available for patients in the state.
Jessie Rossman, staff attorney for the American Civil Liberties Union of Massachusetts, called for a careful review of the civil commitment provision.
“Depriving people of their liberties even with the intent of helping them is a very serious undertaking,” said Rossman.
Baker acknowledged the controversial aspect of the proposals but said he hoped it would lead to a wider discussion of issues surrounding addiction.
The state Senate recently approved its own wide-ranging bill that includes screening of public school students for potential substance abuse and encourages doctors to consider alternatives to opioids for pain management.
Senate President Stan Rosenberg and House Speaker Robert DeLeo, both Democrats, issued statements Thursday pledging legislative action on opioid abuse in the current session, though neither immediately endorsed the governor’s bill.
Rosenberg did praise the administration’s previously announced intention to end a longstanding policy of placing women with civil commitments for substance abuse — but who have not committed crimes — into the state prison for women in Framingham. The ACLU has filed a lawsuit to end the practice.
“Combatting the devastating epidemic of addiction remains my top priority, and I am proud of the thoughtful work undertaken on this issue by the House – particularly last year’s landmark substance addiction bill which significantly increases patients’ access to care. The insurance provisions of that bill went into effect two weeks ago, and I wholeheartedly believe that it will save lives,” said DeLeo in a statement. “In my visits to hospitals, specialty courts and treatment centers this year, I’ve had the opportunity to discuss many ideas related to combatting substance misuse, including proposals to Section 35, the state’s civil commitment law. Those very specific and frank conversations will inform our work on this bill and future efforts.
“I thank Governor Baker and Secretary Sudders for their thoughtfulness and thoroughness in drafting this bill. While we review the legislation in its entirety, I am pleased to say that the House’s supplemental budget funded the recommendations made by the Governor earlier this year,” he said.”I look forward to collaborating with my colleagues in the House, the Baker Administration and all stakeholders to ensure that addiction is treated as a disease rather than a choice, and that we are providing the most effective support for individuals battling substance addiction.”
“Our administration is utilizing every tool in the toolbox to fight the opioid crisis tainting every corner of the Commonwealth,” said Lt. Governor Karyn Polito. “Filing today’s bill serves as the latest call to action to execute a dynamic strategy and we look forward to working with the legislature to enact meaningful laws to help our citizens.”
Baker and Health and Human Services Secretary Marylou Sudders announced the landmark legislation at a State House press conference, joined by Department of Public Health Commissioner Monica Bharel and members of the Working Group, including Dr. Sarah Wakeman.
“Since the Working Group’s Action Plan was made public in June, we have expanded treatment services, eliminated insurance barriers and worked to increase education for students, parents, and faculty, broadened public awareness of the crisis and expanded access to life-saving Narcan,” said Sudders, who is also chairwoman of the Opioid Working Group. “This legislation will allow us to continue progress in order to bend the trend of overdoses and addiction that is devastating individuals, families and our communities.”
“Addiction is a disease that is caused by a mix of genetics and exposure,” said Wakeman. “As physicians, legislators and community members we cannot change people’s genetics but we can begin to work on the exposures that leave individuals vulnerable to this deadly disease.”
Senator Edward J. Markey (D-Mass.) applauded Baker’s new legislation to address substance abuse and addiction. The Senator has pledged his support for solutions at the local, state, and federal levels and previously commended Baker for launching the Opioid Working Group led by the Attorney General and the Health and Human Services Secretary.
“I commend Governor Baker for this important legislation and his ongoing commitment to address the devastating epidemic of prescription drug and heroin addiction. The Governor understands that it will take a comprehensive strategy to prevent addiction before it takes hold and provide treatment where it is needed, and today’s legislation is a critical component. It will take a massive effort at the local, state and federal effort to combat this crisis, and I will continue to fight for the resources necessary to interrupt the cycle of addiction and help heal our neighborhoods,” Markey said.
Markey has introduced the Safe Prescribing of Controlled Substances Act, which would require prescribers of opioid pain medications and other controlled substances to undergo mandatory training on safe prescribing practices and the identification of possible substance use disorders.
Markey has called on the Veterans Administration, Department of Defense and Indian Health Services to require its providers to participate in state Prescription Drug Monitoring Programs (PDMPs). PDMPs are a critical front line tool to help state law enforcement and public health officials better monitor drug-dispensing practices, ultimately helping identify potential abuse and misuse.
Markey has introduced the Treatment and Recovery Investment Act to increase funding for states so they can better assist individuals with substance use disorders, including pregnant or parenting women and adolescents.
Last year, Markey released a comprehensive plan to address the opioid epidemic. The plan outlines the broad range of actions – prevention, treatment and enforcement – that must work in unison to address the crisis.
