Massachusetts lawmakers heard testimony on Monday regarding Governor Charlie Baker’s proposed legislation to combat the opioid crisis in the commonwealth.Governor Baker went before the Joint Committee on Mental Health and Substance Abuse to explain why he thinks the bill will help Massachusetts get a handle on the opioid epidemic.Baker outlined the initiatives in October, one of which would limit first- time opioid prescriptions to a 72-hour supply with exceptions for emergency situations as well as chronic and hospice care patients.
“I understand that some of our proposals disrupt the status quo,” Baker said. “They’re supposed to. In 2014, Massachusetts clinicians wrote over 4.4 million schedule-2 and 3 prescriptions worth over 240 million pills.”
There are about 6.5 million people in the commonwealth.
The Massachusetts Medical Society recommends a seven-day supply with a sunset provision to take effect when the need for pain medication ends. MMS says this eliminates a one-size fits all approach, allowing doctors to care for patients on an individual basis. The group is also calling on the state to consider partial-fill prescriptions. Earlier this month, the Massachusetts District Attorneys Association came out in support of Governor Baker’s proposals. The Association’s President-elect and Berkshire DA David Capeless had harsh words for the medical community.
“Unfortunately the case is that they have completely failed in their responsibility to do this properly,” Capeless said. “Over the past 20 years, they have gone through this initiative in order to reduce pain. They did not foresee the consequences, but now that they are here they are not facing up to them. Doctors still want to go about doing things the way they are doing it and unfortunately we’ve learned we can’t do that.”
Since unveiling his plan, Baker has met publicly with law enforcement, behavioral health and medical school leaders to showcase support for his proposed legislation. If enacted, medical professionals would have the authority to commit substance abusers to treatment for 72 hours if they pose a danger to themselves or others.
“This is not a new standard,” said Paul Summergrad, chairman of psychiatry at Tufts University School of Medicine. “We already have the capacity to commit people under Section 35. This is just working through the process of what this will look like so that physicians and others in the emergency room or other settings can respond to the clinical circumstances in front of them.”
The Massachusetts Medical Society is concerned involuntary commitment authority will create a new standard of care requiring all patients suspected of having the potential to overdose to be hospitalized leading to new demands on hospitals. The Massachusetts branch of the ACLU also expressed reservations about involuntary commitment, according to political director Whitney Taylor.
“Our huge fear, not only on the civil liberties of individuals, but also what coercion will mean,” Taylor said. “Coerced treatment very honestly, there are studies on both sides of that issue and there is a grey area as to whether or not that works. To put all of our eggs in this basket when we don’t have the basic system set up is where we see a big problem.”
The Massachusetts Nurses Association calls the involuntary commitment provision "alarming."
“Our emergency departments are already overcrowded with patients suffering from mental health conditions due to the lack of beds and services in the system,” Massachusetts Nurses Association President Donna Kelly-Williams said. “In fact, one study, conducted by the state’s Mental Health Advisory Committee in 2013 found that more 40,000 patients with mental health conditions are boarding in our hospital EDs each year, waiting for several hours to several days for appropriate care and services. The addition of thousands of patients suffering from addiction will only exacerbate this crisis.”
Boston Mayor Marty Walsh testified in support of the bill Monday.
“You might hear people come up to this microphone and say ‘We’re not equipped for that,’” Walsh said. “Well the addicts and the families who are losing loved ones aren’t equipped to go to the funeral home to bury their loved ones either. We can figure it out. This is the greatest state in the country. We can figure out a system inside an emergency room which would give a family member the opportunity to take further action. That’s what this is about.”
Berkshire County DA Capeless expects a legal challenge.
“I think that it’s been very carefully crafted,” Capeless said. “I think it will be upheld particularly under these circumstances.”
The proposals reflect the recommendations of an 18-member working group tasked by Governor Baker to suggest how the state could combat the crisis that killed more than a thousand Massachusetts residents last year and has been identified as a national scourge.
