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^ Governor Baker accompanied by major medical leaders : heavy artillery rather than small scale platoons of infantry

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When last year Charlie Baker made fighting the opioid crisis a top campiagn priority, the only question was How, not If. Baker spent several years guiding Harvard Pilgrim Health Care through hard times into good, till it became maybe Massachusetts’s numnber one helath organization. Health care was and still is his roots. The opioid addiction epidemic was a natural for him to take on. And that he has done.

Today, at a major press conference, Baker was joined by the Deans of the Boston area’s top four medical schools — Harvard, Tufts, Boston University, and UMass — and by Dr. Dennis Dimitri, President of the Massachusetts Medical Society as well as by his own Department of Health Commissioner, Dr. Monica Bharel. said baker, “the number of opioid deaths is going up steeply” — he made a steep-slope gesture with his arm — ‘and we can’t move fast enough to deal with it.” By which he meant, “we can’t possibly move too fast because the death incidence is rising that steeply.”

Baker is right. The statistics show it. Last year there were some 2500 opioid deaths In Massachusetts. This year’s number will surpass that. So Baker is correct : no matter how fast the State moves to head the opioid epidemic off, it might not be fast enough.

The assembled Deans and organizational Doctors all agreed that there are too many opioid prescriptions written; too many opioid pills abounding in the community. Yet, as Dr. Dimitri eloquently noted, there so far isn’t an easy alternative for dealing with patients in severe pain; and to not deal with grave pain is not an option.

What, then, will the Doctors, Deans, and Baker do ? Baker explained that he’s expecting these high-level medical advisors to give him a kind of best practices user manual.

But why them ? Why not entrust the opioid crisis fight to actual opioid addicts, who have been there, done that and who communicate remedy option among themselves ? Why adopt such an institutional approach to a crisis that mostly plays out on the streets in settings improvisational, difficult to rank on a best practices scale ?

I ask this question because there is a large communhity of opioid addicts who do meet and do discuss and who forge large networks of their own, addict to addict, exchanging information, emergencies, and solutions.

As I see it, the reason that Baker has chosen to fight opioid addiction with instititional weapons, instead of street level search and destroy, is that street level addict experience may involve too much gamble : which anecdotes to support, which not ? Truthfully, who really can tell ? There may be genius in some direct addict response, but just as likely there is a dead end. Do, fat safer, as I see Baker thinking, to entrust battle to institutiions that can process thousands of addiction narratives and compute the best fair odds of doing some good.

It’s a “take as few chances as feasible”” approach rather than a bold ambush; but Baker has said, about voters, that “at the end of the day, what people want is effcetive delivery of ssvices.” This is a motto of caution; and caution has been Baker’s basic gait since day one of taking office. “Do more of what works and less of what doesn’t.” he has said at meet and greets.

That’s certainly a wise tactic, usually, and in the “Fix the T” struggle it makes precise sense.

But perhaps when fighting opioid deaths, csutiin hasn’t the same clout ? Activists in the addict commnity passionately believe they, not the institutions, know the iopioid devil best and how to fight it.

But what if they don’t ? Baker will be up for re-election, not the addict community. He will be judged, not they. Thus the decision to entrust the Baker administration’s opioid fight to the biggest, most experienced, highest prestige organizations he can bring to bear.

How quickly can such heavy artillery be deployed in the fight ? the addict community is already in it, fighting it at platoon level in the jungles where opioid drugs lurk and seduce. It may take the institutional people a year to get its opioid combat boots on. Does that support Baker’s assertion that “we cannot move fast enough to fight the (death curve) momentum” ? I guess it will have to.

—– Mike Freedberg / Here and Sphere