Bill improves access to evidence-based treatment and expands education and prevention efforts
BOSTON – On July 19th, State Senator Jamie Eldridge joined his colleagues in the Massachusetts Senate to pass S.2609, providing an additional set of tools to address the opioid crisis and establishing the Commonwealth as a national leader in the fight against this epidemic. Among the provisions included in the bill are increasing access to medication-assisted treatment (MAT), exploring tools to reduce harm and save lives, expanding education and prevention efforts, and addressing the high rates of co-occurring conditions of substance use disorder (SUD) and mental illness.
The bill, An Act for prevention and access to appropriate care and treatment of addiction, is the result of extensive work researching evidence-based best practices and collaborating with 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.
“Massachusetts is in one of the worst health crises since the AIDS epidemic, and no community has been spared from the heartbreak and loss of opiate addiction,” said Eldridge. “As Senate Chair of the Harm Reduction and Drug Law Reform Caucus, I work with my colleagues, advocates, and people with lived experience to fight this epidemic with proven public health and policy solutions. We need to use every weapon in our arsenal to beat this fatal disease, and I am proud of the Senate for passing legislation that will save lives, expand education and prevention efforts, and bring more harm reduction programs to the Commonwealth. I want to thank Senator Cindy Friedman for her work on this bill as chair of the Committee on Mental Health, Substance Use and Recovery, and Senate President Chandler for bringing this life-saving legislation to the floor for a vote.”
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
The bill also creates a Substance Use Prevention, Education, and Screening Trust Fund. The fund will help finance the expansion of school-based programs that educate children and young persons on alcohol and substance misuse, and that identify and support children and young persons at risk of alcohol or substance misuse.
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.
The bill also updates the state’s partial fill law by clarifying that any patient that decides to partially fill a prescription for a Schedule II controlled substance will not have to pay a duplicate co-pay at the pharmacy if they decide to fill the remainder of the prescription later.
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 passed their version of this bill, and the two chambers will now reconcile their differences in a conference committee.