With the support of area state senator Mike Barrett (D-Lexington), Massachusetts Senate has passed major legislation to tackle the opioid crisis. Provisions of the bill increase access to medication-assisted treatment (MAT), explore tools to reduce harm and save lives, expand education and prevention efforts, and address the high rates of co-occurring conditions of substance use disorder (SUD) and mental illness.
The legislation draws on extensive new research into evidence-based best practices and accents collaboration among healthcare researchers and clinicians, hospitals, behavioral health providers, law enforcement officials, patient advocates and individuals with lived experience, to develop policies to address the opioid epidemic.
“There’s help here for addicted people whether in the community, the emergency room, or in prison,” Sen. Barrett said. “Whether they’re in long-term recovery or the immediate throes of an overdose, we’re bringing a determined effort and the latest thinking to every link in the addiction chain.”
“Despite efforts to suppress the opioid crisis, families across the Commonwealth continue to lose their loved ones to substance use disorder,” said Senator Cindy F. Friedman (D-Arlington), Senate Chair of the Joint Committee on Mental Health, Substance Use and Recovery. “This legislation builds upon the work the state has done around opioid misuse and prevention and provides another set of tools to reduce harm, save lives, and increase access to evidence-based treatment. We have a major epidemic on our hands and we have to use everything at our disposal to cure this disease.”
Under this bill, someone who receives treatment in an emergency department (ED) for an opioid overdose will now have the opportunity to begin treatment for their SUD before they leave the ED. The bill requires that all EDs and all satellite emergency facilities have the capacity to initiate voluntary SUD treatment, including opioid agonist treatment, after treatment for overdose.
Opioid agonist treatment commonly includes the use of Buprenorphine, also known as “Suboxone,” which is an evidence-based treatment that eases the symptoms of withdrawal and relieves opioid cravings. It can be administered as early as 8 to 24 hours after a patient’s last exposure to an opioid. This timetable allows treatment to begin in the ED soon after an overdose, when someone with an SUD may be most willing to consider treatment. They will also receive, under the legislation, a direct referral from the ED to a provider in the community who can continue their treatment regimen after they return home.
In 2017, opioid-related overdose deaths fell by 8% according to the Department of Public Health (DPH). The reduction in deaths is partially accredited to the widespread use of the life-saving drug Naloxone, commonly known as “Narcan,”which blocks the effects of opioids and reverses an opioid overdose. Under the legislation, the DPH is directed to issue a statewide standing order authorizing every pharmacy in the state to dispense naloxone, eliminating the current requirement that each pharmacy obtain an individual authorization.
The bill also brings Massachusetts in line with other states by providing liability protections, including protection from criminal or civil liability, for practitioners who prescribe and pharmacists who dispense naloxone in good faith.
In Massachusetts, nearly 1 out of every 11 individuals dying from opioid-related overdoses has a history of incarceration in state jails and prisons, and in 2015 alone, nearly 50% of all deaths among those released from incarceration were opioid-related. In response, this bill makes significant strides towards extending access to medication assisted treatment in correctional facilities.
The bill also includes several provisions to address dual diagnosis and the high rates of co-occurring SUD and mental illness in the Commonwealth. According to the National Association on Mental Illness-Massachusetts, over 50% of individuals seeking treatment for SUD also suffer from a mental health condition. To ensure that the right kind of treatment facilities will be available to serve every patient who needs treatment, the bill enhances the oversight authority of the Department of Mental Health (DMH) and the DPH’s Bureau of Substance Addiction Services (DPH/BSAS) – the two agencies that license facilities that provide treatment for mental illness and addiction.
In addition, the bill recognizes the important role that recovery coaches and peer specialists play in successful long-term addiction and mental illness treatment by creating two commissions to recommend standards for establishing a professional credential for recovery coaches and peer specialists as an important step toward formalizing the role that each play in the pathway to treatment and recovery
Numerous studies and years of experience in Canada and Europe show that supervised injection sites save lives and provide public health benefits, such as reducing the transmission of HIV, hepatitis C, and other blood-borne diseases and reducing complications of injection site infection. They also aid in building trusting relationships between clients and health care providers, which can lead to the initiation of treatment for SUD. The bill creates a special commission to study the feasibility of establishing such sites here in Massachusetts.
To reduce fraud and drug diversion and improve tracking and data collection, the bill requires by 2020 that all prescribers convert to electronic prescriptions for all controlled substance prescriptions.
In an attempt to ensure that those experiencing chronic pain have access to the medications they need, the bill establishes a MCPAP for Pain program to provide remote consultations to primary care practices, nurse practitioners and other health care providers who are caring for chronic pain patients.
The House of Representatives has passed its own legislation on the issue. The two different versions of the bill now need to be reconciled.