The Opiate Crisis: Past Steps and Next Steps

The Massachusetts Department of Public Health has released preliminary figures for the number of opioid overdose deaths in 2016: 1,465 confirmed overdose deaths, and an estimated total of 1,979, a startling increase of 228 over the 2015 figure.

The Commonwealth has been leading the fight against the opioid epidemic, passing first in the nation laws that are now being implemented, but clearly we need to do more.

On the prevention front, we have introduced school screenings and education, require practitioners to receive continuing education on proper prescribing, are teaching our future doctors as to the dangers of over-prescribing, and are requiring the use of our now robust prescription-monitoring program. We prohibit the filling of opiate prescriptions from states outside of New England. We are giving patients a voice by allowing them to refuse an opioid prescription simply by filing a non-opioid directive, or by allowing them to fill a prescription only in the quantity they feel they need. We will soon begin notifying prescribers when they are issuing opioids in quantities exceeding their peers in similar practice settings. We are also making drug manufacturers responsible for the safe collection and disposal of their unused pills.

As for harm reduction, i.e. efforts to keep active opioid users alive, we have established a “Good Samaritan” law allowing people to seek help for overdose victims without fear of legal repercussions, made Narcan more widely available, and have created licensure and quality standards for large suboxone providers.

To improve access to treatment, we now require all insurance carriers to cover up to 14 days of detox and crisis stabilization treatment whenever it is deemed medically necessary. We are advancing efforts to centralize treatment intake, and have removed all preauthorization requirements for substance abuse treatment services, including Medication Assisted Treatments. We have funded addiction counselors in our schools, and we have increased the number of beds funded through the state budget. People arrested for drug offenses are being diverted to treatment, rather than being incarcerated, and “Drug Courts” are effectively leading people down the path to recovery.

On the recovery front, funding rates for state licensed recovery homes have increased, sober homes are now being certified, and increased funding has resulted in the opening of additional recovery high schools.

Many of these changes have been codified in law but are not yet implemented, and new programs have been in place for only a short time. Their long term impacts are not yet apparent, but we have good indications of progress. Health practitioners are taking a lead in establishing safer prescribing practices, responsibly satisfying pain relief needs while decreasing the number of unnecessary opioid prescriptions, which have fueled this epidemic. Harm reduction efforts are keeping thousands of people a year alive, more people are receiving treatment than ever before, and there are better and more numerous long-term housing options for those in recovery.

Some believe we should fully implement the programs and models that we have introduced before pressing on – particularly when it comes to paying for more treatment access.

We cannot wait. We need to do more.

We must require private insurers to increase their coverage from 14 days up to 30 days, whenever the treating clinician determines it to be medically necessary. A person struggling with addiction should have access to all treatments and combinations of treatments recommended by their health provider, and all of them should be covered by insurance. I filed a bill last session to ensure such coverage. It passed in the Senate but failed in the House of Representatives. I have filed it again, with 87 cosponsors. It is imperative that the Senate and House take action on the bill as soon as possible. We need to accelerate efforts to promote evidence-based pain management options rather than rely on pills. Physicians and other practitioners I’ve met with at the South Shore Health System are showing that it can be done, with great outcomes. On the harm reduction front, we have to ensure that medication assisted treatments are subject to appropriate oversight to ensure patient compliance.

Finally, as our efforts are showing results in prevention, harm reduction, treatment and recovery, there are untold thousands still struggling with addiction. Many have transitioned from prescription pills to heroin use. Use of fentanyl, an even more powerful synthetic opioid, is rising and has been a large factor in the sharp increase in overdose deaths. Those producing and trafficking fentanyl and similar derivatives have sensed an opening in the market and are exploiting people driven to a less expensive, often lethal high. Traffickers know that current penalties are less punitive for fentanyl than they are for heroin, despite fentanyl’s much higher potency. I have introduced a bill that will close this loophole and hold them accountable. Here too, it is imperative that the Senate and House take action on this bill as soon as possible.

While I am confident that our efforts to date, once fully implemented, will lead Massachusetts out of this epidemic sooner than other states, we must keep fighting it on all fronts and at all levels. The Legislature and Governor must continue working together, and must accelerate our progress by requiring insurers to cover all forms of treatment for up to 30 days, holding fentanyl traffickers responsible for the despair and death they are peddling, and acting on the various other opioid bills before the legislature.