A bill to address the opioid addiction crisis in Massachusetts is on Gov. Charlie Baker’s desk. Passed in the final hours of the legislative session, it includes a provision that would allow some jail inmates to be given drugs to ease their cravings for heroin.
One of the last provisions legislators agreed upon before taking a final vote on the bill creates a three-year pilot program at five county jails where inmates who had a prescription before being arrested will continue to be provided their medications including methadone and buprenorphine that treat opioid addiction.
It is a controversial approach – to give drugs to a person who is addicted to drugs – but State Rep. Carlos Gonzalez, a Springfield Democrat, believes the pilot program in county jails is an important step in the state’s overall strategy to reduce the opioid death rate.
" Trying to look at this as a mental health issue as opposed to a criminal issue and I think that is overall what the legislation was able to do," said Gonzalez.
The Franklin County jail began a program in 2016 to give daily doses of buprenorphine, which is commonly known by the brand name Suboxone, to heroin-addicted inmates. Sheriff Christopher Donelan said it has been very effective.
"When they leave here they are still on their medication, stable, and we make sure they have a doctor's appointment and a counseling appointment," explained Donelan. " It is much improved over forcing someone to detox and then sending them out of here like a drug-seeking missle."
He believes the medication-assisted treatment program at the jail was partly responsible for a 60 percent drop in opioid-related deaths in Franklin County in 2017.
The pilot program, which is to start in September 2019, will include Franklin, Hampden and Hampshire counties in western Massachusetts along with Middlesex and Norfolk counties.
Corrections officials have historically opposed providing methadone and Suboxone because these are opioids that are often smuggled into jails.
"Trying to wrap you arms aroud this change from viewing this as contraband versus viewing it as an appropriate treatment for some people whose addiction is so severe they can't stay away from heroin or opioids without the help of medication-assisted treatment is a stretch for some folks, but we are getting there," said Donelan.
Another concern is the costs. Donelan said expenses for the medication-assisted treatment program in Franklin County come out to roughly $12,400 per inmate per year.
The opioid bill also includes a requirement that hospital emergency rooms begin medication-assisted treatment of people treated for overdoses. Experts in substance use, behavioral health, and chronic pain will be added to the Board of Registration in Nursing. By 2020, all prescriptions for controlled substances will have be done electronically.
There would be a program where physicians consult with experts on pain management. Insurance companies would be required to cover many non-opioid treatments for pain such as acupuncture and physical therapy.
Debra McLaughlin, director of the Opioid Task Force of Franklin County and North Quabbin Region, said the bill has a lot of progressive features.
" The bottom line for all of this is we need vigilence on all fronts, prevention, intervention, treatment, and recovery to do everything we can to save lives," she said.
Legislators rejected Gov. Baker’s proposal to empower medical professionals to hold a patient for 72 hours for substance use treatment. Included was a provision championed by the governor to create a commission to recommend licensing standards for recovery coaches.
Advocates for so-called “safe injection sites” lost a bid for a pilot program in Massachusetts. Instead, the bill creates a commission to look at the idea of sites where medical professionals would supervise illegal drug use to prevent overdoses.
As the legislature was considering the opioid bill, the Massachusetts U.S. Attorney Andrew Lelling issued a statement that safe injection facilities would violate federal law and people using one, or working at one, could face criminal charges.