Massachusetts Leads the Way on Opioid Overdose Fight, but Will Pain Patients Suffer?
Boston—Massachusetts Gov. Charlie Baker has signed into law new legislation that will significantly regulate how opioid analgesics are prescribed and how the widespread problem of opioid abuse is addressed within the state.
Although the pain care community generally welcomes the changes, there are concerns that the new regulations—and other initiatives recently implemented within the state—will have negative implications for people with chronic pain who have a legitimate need for the powerful drugs. However, political leaders in the state believe a legislative response was needed after a state report issued in 2014 revealed that 668 Massachusetts residents died from unintentional opioid overdoses in 2012 (the number of fatal overdoses reported in the state increased by 90% between 2000 and 2012).
According to data from the Centers for Disease Control and Prevention, 1,162 state residents died as a result of opioid overdose in 2014, the most recent year for which data are available (an 18.8% increase over 2013). To put that in perspective, Massachusetts had more than three times as many opioid-related fatalities as car accident deaths in 2014.
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“Thanks to input and support from medical and law enforcement professionals, I was pleased to file landmark substance misuse legislation, and look forward to working with the legislature around further efforts to stem the flow of addictive prescription opioids,” Gov. Baker said in a statement issued to Pain Medicine News.
The bill approved by the state House represents a compromise between the legislature and the governor’s office, after the latter had submitted a proposed bill to both houses of the state legislature late last year. According to media reports, Gov. Baker’s proposal, called STEP (Substance use Treatment, Education and Prevention), would have limited initial opiate painkiller prescriptions to three days and allowed physicians to commit a person involuntarily to a drug treatment facility for up to 72 hours if he or she is considered an immediate danger to himself or herself, or others.
The state House version, however, limits initial opiate painkiller prescriptions to a seven-day supply and requires anyone who shows up in an emergency room with an opiate-related overdose to undergo an in-depth evaluation by a licensed medical professional. According to sources in the field, the state House bill reflects changes proposed by pain management specialists and other clinicians, who have acted as de facto advocates for chronic pain sufferers with legitimate needs for opioid treatment.
When contacted by Pain Medicine News, Bob Twillman, PhD, FAPM, executive director of the American Academy of Pain Medicine (AAPM), acknowledged that the group had concerns about the governor’s original proposal, but called the revised legislation “much improved.” Still, he added that there are “a couple of things” the AAPM would like to see changed, among them a provision that “could lead to … involuntary commitment for treatment of a substance use disorder, based on somewhat vague criteria and with the note that, if there is inadequate room in hospitals, those individuals undergoing such treatment can be moved to a correctional facility.
“We think that goes a few steps too far. On the whole, however, we think the hard work of Massachusetts pain management advocates shows in the latest bill, and we’re grateful that legislators have listened to our concerns,” said Dr. Twillman. “[We are] a big supporter of efforts to prevent and treat opioid addiction, provided those efforts are appropriately designed so that they don’t produce a harmful outcome for people with pain.”
If Gov. Baker ultimately gives the state House bill his formal stamp of approval, it will mark only his latest legislative action aimed at curbing the effects of opioid abuse. Last year, his administration committed more than $7 million in grant funding toward educational initiatives and efforts to prepare first responders to treat victims of opioid overdose.
Scott Sigman, MD, chief of orthopedic surgery at Lowell General Hospital, in Lowell, who has met with Gov. Baker several times to offer his perspective on the problem, told Pain Medicine News, “I have expressed my personal opinion that physicians need to be better educated on prescriptive practices. We must also educate our patients to the dangers of prescriptive medications and the possibility of substance abuse. Our local community continues to be overwhelmed with narcotic overdoses. Our emergency rooms and emergency responders are not able to keep up with this epidemic.”
Meanwhile, with more than 80 opioid-related deaths in his city in 2014 alone, Boston Mayor Martin J. Walsh has made prevention and treatment a cornerstone of his public health platform as well. Last year, his office established an Office of Recovery Services, the first known municipality-based office in the United States dedicated to the prevention and treatment of substance abuse. In November 2015, his office held its first-ever Fighting Addiction In The Hub (FAITH) program (the name refers to a nickname for the city of Boston). According to city officials, the goal of FAITH is to educate the public on the extent of opioid abuse in the community and to provide the tools to combat the problem. In addition, the Walsh administration has taken steps to ensure that first responders in the city are equipped with the opioid overdose drug naloxone in order to provide emergency treatment to overdose victims. Due in large part to efforts such as these, Mayor Walsh was appointed chair of the U.S. Conference of Mayors Task Force on Substance Abuse, Prevention and Recovery Services in October.
“I know from personal experience that to get people the help they need, we have to meet them where they are: whether that’s on the street, in the hospital, at home, at work or in school,” Mayor Walsh said in a statement issued to Pain Medicine News and other media outlets. “We need to work together toward a comprehensive continuum of care; we need to tackle this crisis on all fronts.”
How these efforts will ultimately affect the treatment of chronic pain remains to be seen.
Filed under: General Problems
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