Governor Baker announcing his “every tool in the toolbox” legislation to fight opioid addiction. (the man to his left is the sign language interpreter)

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Last week Governor Baker filed his legislative response to the opioid addiction epidemic that claimed more than 1,000 lives in Massachusetts last year, Much of it breaks new ground; some of it seems drastic. Chiefest of these parts is its allowing civil commitment of addicts, against their will if need be, similar to the civil commitment law that already allows it for the suicidal.

Before I discuss Baker’s legislation further, I suggest that you read his office’s synopsis of significant provisions:in what Baker calls “The Act Relative to Substance Use Treatment, Education and Prevention (STEP)”:

•Limits Prescribing Practices for First-Time Opioid Prescriptions: ◾The first time a patient obtains a prescription for an opioid or when they see a new doctor, the patient will be limited to a 72-hour supply.
◾This section provides an exception for emergency situations and permits the Department of Public Health to identify additional exceptions to the 72-hour limit.

•Allows Clinicians to Treat and Assess Patients for 72-hours: ◾Creates a new pathway for treatment of individuals with substance use disorder by allowing clinicians to retain a patient for 72-hours so they can attempt to engage the patient in voluntary treatment or seek court ordered involuntary treatment.
◾Instead of limiting the “front door” to obtain involuntary treatment for a substance use disorder to the court system, the bill makes hospitals as a new “front door” that can provide access to involuntary emergency treatment for an initial 72-hour period. This provision parallels existing law that permits a 72-hour period of involuntary treatment where a physician determines that a person suffers from a mental illness and poses a serious risk of harm.

•Strengthens the Prescription Monitoring Program (PMP): Requires every practitioner, including emergency room clinicians, to check the prescription monitoring program (PMP) prior to prescribing an opiate.

*Mandates Controlled Substance Training for Practitioners: Requires that practitioners who prescribe controlled substances receive five hours of training every two years related to effective pain management and the identification of patients at high risk for substance use disorder.
•Requires Educational Training on Substance Misuse for Coaches and Parents: All public schools subject to the Massachusetts Interscholastic Athletic Association rules are required to provide training for parents, coaches, trainers and parent volunteers, physicians and nurses on the dangers of opioid use during the annual mandatory head injury safety training program.
•Amends the Civil Commitment Statute (Section 35 of Chapter 123 of the General Laws): ◾Removing the provision allowing the civil commitment of women to MCI-Framingham for substance disorder treatment.
◾Requiring the department of public health to identify for the court the facility where a bed is available for the treatment of an individual committed under section 35;
◾Expanding access to treatment beds by authorizing the department of mental health to identify DMH licensed beds, with enhanced security comparable to that now maintained at the Men’s Addiction Treatment Center, in Brockton, and the Women’s Addiction Treatment Center, in New Bedford, that are available to treat individuals with a substance use disorder who have been committed under section 35;
◾Clarifying the executive branch’s existing authority to transfer patients between facilities while the patient is committed under section 35 and receiving treatment services.

•Requires Insurers to File Opioid Management Policies: Mandates insurers regulated by the Division of Insurance (DOI) to file policies annually to encourage safe prescribing practices.
•Improve Access to Recovery High Schools: Recovery high schools (RHS) provide a safe, sober and supportive learning environment for students who have been diagnosed with a substance use disorder. Currently, students attending a RHS do not receive funding from the Commonwealth to cover transportation costs. This act requires the Department of Public Health and the Department of Elementary and Secondary Education to develop a transportation plan for students who attend a recovery high school.

13 steps, some controversial, deliver a full frontal attack on a crisis that Baker, as a health care guy, has embraced as a state service priority. Certainly addicts (and addict advocates) will be glad to see that female addicts will no longer be committed to the Women’s Prison in Framingham. This alone makes Baker’s legislation a godsend. The 72-hour period, prescription limitation makes solid sense as well : do NOT prescribe more pain killer pills than a patient absolutely needs, short term. Baker, at his press conference, cited cases where prescriptions for up to ninety (90) opiate pills were given. He’s right; that’s way too much. In many cases the majority of those pills end up on the street, sold for cash and bartered illegally from there; and if not ? 900 pills is more than enough to shanghai an addict.

Expanding the number opf treatment beds, so that addicts can be cared for rather than  made criminals, is something that addiction voices are pleasing for. One of the most prominent of such voices, Jack Kelly of Charlestown (whom I often consult on this issue), a former City Council candidate and recovered addict, also says he thinks the forced commitment of addicts — the bill’s most controversial part — is a good idea.”You have to start somewhere,” he said to me. Kelly also likes the entire legislation : “it’s not perfect, but it’s good and it’s a start,” were his words.

The Governor baker noted, at his press conference, that he hears addict stories all the time. Kelly’s is one such. He and the Governor have conversed at length about the addict situation and about recovery. Chris Herren, too, whose promising NBA career was erased by addiction, has the Governor’s ear when addiction is on his agenda. With Kelly and Herren as advisors, or sources of first hand information about what the addict life is like, Baker is well positioned to get this challenge right and to see a response through to success.

—- Mike Freedberg / Here and Sphere