On March 9, I joined my colleagues in the Massachusetts Legislature to pass substance abuse legislation that enhances education and prevention initiatives and increases intervention and treatment options statewide.
This opioid epidemic has killed too many of our loved ones. The numbers are staggering. According to the Department of Public Health (DPH), the 1,099 confirmed cases of unintentional opioid overdose deaths in 2014 – or four people every day – represent a 65% increase over the 668 overdoses in 2012, and a 21% increase over the 911 overdose cases in 2013. In 2014, there were 4.4 million prescriptions written in Massachusetts, yielding 240 million opioids for a total population of 6.7 million people.
While this new law contains a wide range of provisions aimed at preventing addiction and educating students and doctors, it will take time for things to turn around. The good news is we were able to craft these solutions by involving everyone – families, educators, health care providers and prescribers, insurers, drug manufacturers, public health departments, and law enforcement. And I’m proud that the law’s policies end our decades-long error of treating substance abuse and the disease of addiction as criminal justice matters instead of the public health issues that they are. We will be a healthier Commonwealth for choosing treatment over punishment.
The legislation requires hospitals to conduct a comprehensive substance abuse evaluation for individuals who present in the emergency room because of an apparent opiate overdose, and provide connections to treatment if necessary. This new practice, covered by insurance, is designed to ensure the proper assessment and discharge of patients who seek voluntary treatment. If a patient refuses treatment, evaluators must offer information on health and community resources.
The new law limits first-time opiate prescriptions for adults and all opiate prescriptions for minors to seven days, with exceptions for chronic pain management, cancer, and palliative care. Medical staff must now check the prescription monitoring program (PMP) each time they prescribe a Schedule II or III narcotic. Additionally, when an extended-release, long-acting-opioid is prescribed for the first time in an outpatient setting, a note will be made in the patient’s medical record.
The plan gives individuals grappling with addiction another tool for recovery. With the non-opiate directive form, patients may include a notation in their records that they cannot be offered opiates. It also provides the option of a “partial fill” that allows patients to request fewer doses than indicated on a Schedule II prescription, which the pharmacists may do at their discretion.
In an effort to build upon current prevention efforts, the legislation updates current law - which requires all public schools to have a policy regarding substance abuse education - by directing schools to report their plans to the Department of Elementary and Secondary Education (DESE). In consultation with the Department of Public Health (DPH), DESE will then provide recommendations to assist schools and ensure they are providing effective and up-to-date education. Additional educational materials will be provided to all student-athletes.
Under the new law, schools will conduct an annual verbal substance abuse screening in two grade levels. These screenings are subject to appropriation and include an opt-out provision for students and parents. Additionally, school districts implementing alternative substance use screening policies may opt out of the verbal screening tool requirement.
Achieving parity between behavioral and physical health care was a goal we set in landmark 2014 legislation, and we sought to maintain that focus in this most recent bill. The prevalence of co-occurring disorders informed the requirement for a Health Policy Commission study on access to dual-diagnosis treatment in the Commonwealth for children, adolescents and adults. This law also requires insurance companies to report annually on their denied claims to the Office of Patient Protection in the Health Policy Commission.
To ensure safe collection and disposal of unused medications, the legislation requires manufacturers of controlled substances in Massachusetts to participate in either a drug stewardship (i.e. drug take back) program or an alternative plan as determined by the DPH.
• Requires that contact information, including a phone number which will be accessible 24 hours a day, for all insurers be posted on the bed-finder tool website;
• Requires that patients being discharged from a licensed substance use disorder treatment program receive information on all FDA-approved medication-assisted therapies (MATs);
• Ensures civil-liability protection for individuals who administer Narcan; and
• Updates the training guidelines for all practitioners who prescribe controlled substances.
This legislation follows efforts since FY12 to increase funding for substance abuse education and prevention, intervention, and treatment, and the landmark access to addiction treatment law passed in 2014 that mandated – for the first time – 14 days of insurance coverage for detox and stabilization services. The two plans complement each other and reflect creative and compassionate solutions that will continue to pave a path for the recovery of our loved ones.
Liz Malia, a Jamaica Plain Democrat, is a Massachusetts state Representative for the 11th Suffolk district and currently serves as House Chair of the legislature’s Joint Committee on Mental Health and Substance Abuse.