Opioid bill’s commitment power, prescription caps draw objections

Printed from: http://newbostonpost.com/2015/11/16/opioid-bills-commitment-power-prescription-caps-draw-objections/

BOSTON – Lawmakers grappling for responses to the drug-abuse epidemic that has killed hundreds of Bay State residents heard Monday from Gov. Charlie Baker and Boston Mayor Martin Walsh in support of Baker’s proposal to let doctors order involuntary three-day commitments of addicts and to limit initial prescriptions for addictive painkillers.

But a major physicians’ association, the Massachusetts Medical Society, objected to those key provisions of Baker’s proposed measure, in a hearing before the Joint Committee on Mental Health & Substance Abuse at the State House.

Dr. Dennis Dimitri, a family physician in Worcester and president of the medical society, which represents 25,000 doctors and medical students, said holding someone against their will for three days and then releasing them without follow-up treatment can elevate the risk of that person overdosing on heroin or a synthetic opioid.

“There is a paucity of evidence that forcing hospitalization on patients not ready to make a change will be successful,” Dimitri said in his prepared remarks. “There is evidence that addicted patients released from hospitalization with no plans to pursue aftercare are at higher risk for opioid overdose.”

Dimitri cited an additional concern that the measure may create a new standard that would lead to three-day commitments of everyone suspected of being at risk of overdosing. He cautioned that a trend of that sort would put new demands on an already “severely strained” hospitals and psychiatric care facilities.

Currently, more than thirty other states have involuntary commitment for addictions, according to the statement from Baker’s office.

As for limits on initial prescriptions for painkillers, Dimitri said poor and disabled patients with acute pain may be “left to suffer” because of an inability to get to a pharmacy to renew a needed supply of drugs. And he said it could lead to some unnecessary discomfort for many patients, because of current restrictions on how painkillers are prescribed and distributed.

“A patient with acute pain beyond the proposed initial 72-hour treatment period would have to return to their physician’s office, obtain a paper prescription, bring it to the pharmacy and wait for it to be filled,” Dimitri said. “We urge the committee to consider a seven-day limit and incorporate a sunset provision.”

Many of the state’s district attorneys and police chiefs have come out in support of Baker’s bill, and the governor pressed his case for the measure at Monday’s hearing.

“Addiction is a chronically relapsing disease, and too often, we have relied on our courts and jails as the primary or only treatment option,” Health and Human Services Secretary Marylou Sudders told the hearing Monday.

“I understand that some of our proposals disrupt the status quo. They are supposed to,” Baker said., reiterating comments to reporters last week. “Our legislation aims to bend the trend on opioid misuse and provide much needed prevention and education programs, while continuing to expand access to treatment and recovery programs.”

When he introduced the measure Oct. 15, Baker pointed to the hundreds of deaths tied to heroin and synthetic opiates in recent years, a trend that took 1,256 lives in 2014, up almost 40 percent from 2013. The numbers suggest 100 people die in Massachusetts each month from opioid overdoses.

Some steps have been taken to help prevent more deaths, such as distributing Narcan, or naloxone, a drug that counteracts the narcotic effects of heroin and opioids and can revive an addict who may be expiring from an overdose. Supplies of Narcan have been delivered to municipalities around the state to help first-responders revive addicts who have overdosed.

But what’s been done so far is inadequate, according to supporters of Baker’s measure.

“I support this bill because 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,” Walsh said at the Monday hearing. “We need to tackle this crisis on all fronts.”

Speaker Robert DeLeo (D-Winthrop), whose position leading the House of Representatives gives him control of the agenda in the chamber, has said he doesn’t envision the House voting on Baker’s bill before a seven-week break that begins Nov. 19.

In the meantime, the Senate may vote Wednesday on a related measure, making trafficking in fentanyl, an addictive opioid, a crime. The House passed the measure (H 3798) in October. The bill would stiffen penalties for illicit sales of larger quantities of the drug, which is sometimes mixed with heroin to increase its potency and has been linked to the rising tide of overdose deaths in Massachusetts. The State House News Service said one version of the measure would call for 20-year prison terms.

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