Lawmakers to debate opioid bill

Lawmakers to debate opioid bill legislators reject one proposal by Gov. baker, revising another

STATE HOUSE - The Legislature will debate an opioid bill starting this month that follows up on proposals made by Gov. Charlie Baker, which aimed to enhance addiction treatment and reduce prescription opioid abuse. “This is going to be the big substance abuse bill that has been in the works for a while,” said state Rep. Jon Zlotnik, D-Gardner. State Sen. Jennifer Flanagan, D-Leominster, is the Senate chair­woman for the Joint Committee on Mental Health and Substance Abuse, which has members from the Senate and House. After Mr. Baker filed his bill in October, the committee reviewed the proposal and made some changes that will be debated by House members this month. If the House approves its own version of the bill, it will then go to the Senate and the two chambers would have to come together to vote and compromise on a single bill. “Everyone around me knows I don’t want to wait for this. I’m very anxious to do this. I don’t want this getting caught up in politics,” said Ms. Flanagan. As of now, legislators are rejecting one key provision laid out by Mr. Baker and revising another. He proposed that medical professionals be allowed to involuntarily commit an individual to substance abuse treatment for 72 hours if they were deemed to pose a danger to themselves or others. Normally, such authority is restricted to the courts and not given to medical professionals. Citing a lack of capacity at hospitals to involuntarily hold patients, Ms. Flanagan and her committee rejected that provision. She said hospitals across the state, such as Heywood Hospital in Gardner, have expressed to her that they do not have enough beds to house patients for 72 hours. “I’m not someone who is going to give false hope and say we can do this,” she said. However, while not approving the proposal, Ms. Flanagan said she “does not disagree with the governor,” adding that it makes sense for medical professionals to be able to decide in an emergency situation if they need to hold a patient to protect their safety. She said having the courts make such a decision is treating substance abuse like a crime when it is foremost a medical issue. Instead of the 72-hour involuntary hold, the joint committee is proposing that patients who are considered a threat to themselves or others be given an evaluation that will diagnose them and discuss treatment options. Mr. Zlotnik said that “it is a tough balance to strike” between strengthening laws to ensure effective treatment while maintaining the privacy and civil rights of patients. “In general, I’m opposed to involuntary holds,” he said. Ms. Flanagan said that with opioid use reaching a level of crisis, the state has a “responsibility to take some kind of action,” but noted that the difficulty in doing so is “breaking through the irrational thinking” of addicts who put their lives in danger. In the bill proposed by Mr. Baker, patients would have been limited to a 72-hour supply of opioids the first time they were prescribed or the first time they were prescribed by a new doctor. Ms. Flanagan said the joint committee lengthened that limitation to a week-long supply to accommodate patients who live far away from their doctor and have a legitimate need for an additional prescription. Mr. Zlotnik said limiting prescription opioid abuse is a key to curbing the tide on the overall issue of addiction and overdoses. In particular, he said, many addicts start with a legitimate pain need for which they receive a prescription, but they can quickly become addicted and sometimes turn to heroin over time. “I think there are a lot of people who become addicts almost against their will. It’s a chemical reaction that takes place at that point and you don’t have much control over it. They call it prescription strength for a reason. There’s a reason you can’t just get these things. It’s a highly refined substance,” he said. “You don’t know when you take one how you’re going to react,” said Ms. Flanagan. She added that she tells people the difference between an addict taking a prescription opioid vs. heroin is money, being that their effects are similar but heroin is a cheaper option. She cites the over-prescribing of opioids, such as doctors giving a 30-day supply after a surgery or minor injury, as a significant reason for the rise of opioid use in recent years. Mr. Zlotnik said he thinks the issue of opioid abuse is largely economic-driven, as the cost of drugs has gone down in recent years, making them more available and easier to obtain in large quantities. In this way, the issue is affected by both the economics behind the legal and illegal drug markets. The joint committee is also proposing that an opioid bill include a provision to create a group called the Council on Substance Use Disorder Prevention and Treatment. The group would operate separate from the Massachusetts Department of Public Health and be comprised of 21 different members from various sectors of the health care industry. They would meet quarterly to brainstorm ways to deal with opioid use and how it relates to other mental health issues. “Our infrastructure (with these issues) has never really been expanded on as much as the other health care systems have. The goal is to get to where are we and how can we move forward,” said Ms. Flanagan. According to a report released by the Department of Public Health in October, there were 1,089 confirmed opioid-related deaths in 2014 in Massachusetts, which is a 20 percent increase from 2013 and a 63 percent increase from 2012. Both Ms. Flanagan and Mr. Zlotnik said that when the Legislature comes up with the budget in the spring, increasing funding for substance abuse treatment will be discussed, such providing more detox beds for facilities.