Opioid compromise passes House, heads to Senate

Printed from: http://newbostonpost.com/2016/03/09/opioid-compromise-heads-for-final-votes/

BOSTON – A compromise measure to rein in the opioid abuse crisis passed unanimously in the state House of Representatives Wednesday and is expected to face a final vote in the Senate Thursday.

The measure would put limits on first-time prescriptions of synthetic opiate painkillers like oxycodone and use additional screening of students and emergency room patients for signs of addiction as part of the effort to curb the substance abuse epidemic ravaging the state. But it falls short of key features sought by Gov. Charlie Baker, by limiting initial prescriptions to a seven-day supply instead of three and leaving out giving doctors the power to involuntarily commit suspected drug addicts for up to three days.

Baker, who is vacationing in Utah, signaled his support for the bill Tuesday night.

The agreement struck by a six-member conference committee after nearly seven weeks of negotiation comes as Baker has been ramping up his encouragement for lawmakers to finalize a substance-abuse prevention bill before their focus turns to the budget.

Senate Ways and Means Chairwoman Karen Spilka said the compromise bill (H 4056) blends approaches taken by both branches to produce legislation that she said “might be a landmark” for other states battling addiction to painkillers and heroin.

“It should be on the governor’s desk before the week is out,” Spilka said Tuesday.

The conference report adopts House-backed measures to limit first-time prescriptions of powerful painkillers to seven days, and would require emergency room patients with symptoms of an overdose to be screened within 24 hours for signs of addiction before being discharged.

“We agreed with both of those. We thought they were good constructs. The governor started that process. The House improved it,” Senate President Stanley Rosenberg, an Amherst Democrat, said during an interview Tuesday night on WGBH’s “Greater Boston” show.

Baker had initially proposed a three-day supply limit on pills, and a controversial expansion of the civil commitment law that would have allowed doctors to hold overdose victims involuntarily for up to 72 hours.

The bill also incorporates a Senate provision that would allow patients to request that only a portion of their opioid prescription be filled in order to discourage overuse of painkillers or the proliferation of unused medicines that can get into the hands of people struggling with substance abuse.

Baker, who planned to be in Utah for the rest of the week, could return home to find one of his top priorities on his desk awaiting his signature. In a statement, a spokeswoman said the governor views the bill as “a strong step in the right direction.”

“Governor Baker has acted to increase access to treatment and invest in prevention efforts, and believes this bill contains many important provisions, including prescription limits for highly addictive pain pills. Moving forward, the administration is committed to collaborating with the legislature, law enforcement and treatment providers to continue fighting this public health crisis,” spokeswoman Lizzy Guyton said.

Another Senate idea that found its way into the bill is a proposed requirement that schools conduct voluntary screening of students for signs of addiction or substance abuse.

Spilka and her House counterpart, Rep. Brian Dempsey, the two lead negotiators on the conference, issued a joint statement Tuesday night saying the compromise language “focuses on intervention, education and prevention, and incorporates the best ideas from both versions of the bills.”

The conference report sets a requirement for drug companies to participate in a “drug stewardship” program, according to Spilka, who added that if the pharmaceutical companies decide to participate in a Department of Public Health stewardship program the health department would set the cost for participation.

The bill would also require training in substance abuse disorders for medical licenses, Spilka said. Earlier this year medical and dental schools worked with Baker to make addiction education part of their core curriculum.

“We want it codified that this has to be a part of their education and training,” Spilka said.

The legislation has been in the works for months and is aimed at slowing the explosive growth in deaths associated with heroin use and prescription painkiller abuse, which officials say claim four lives a day on average across Massachusetts.

House Speaker Robert DeLeo, a Winthrop Democrat who appeared with Rosenberg on “Greater Boston” Tuesday night, said that while he wished it could have been done sooner, the task of finding the right approach was more complicated than it appeared.

“Although it may have seemed like an easy situation because of course everyone said we have to something about substance abuse, it wasn’t so easy in terms of the particular parameters of the bill,” DeLeo said.

Rosenberg said that Baker told the Democratic leaders – upon returning from a conference last month in Washington, with fellow governors – that if enacted the proposals being debated in Massachusetts would be the “most aggressive program of fixes and assistance in the whole country” and would likely be replicated in other states.

A major state organization representing doctors praised the measure. Dr. Dennis Dimitri, the lobbying group’s president, singled out the seven-day limit, saying “this provision in the bill should reduce the amount of prescription drugs that can be diverted to abuse or misuse, and at the same time allow a reasonable time for prescriptions for those patients who truly need pain relief,”  in a statement Wednesday.

U.S. Sen. Elizabeth Warren and U.S. Rep. Katherine Clark have already filed legislation in Congress to clarify the rules around partial-fill prescription of powerful narcotics based on the debates on Beacon Hill.

The agreement requires doctors to check the prescription monitoring program database each time before writing a prescription for a Schedule 2 or Schedule 3 narcotic and talk to patients about addiction each time an opioid prescription is written, Spilka said. She said under the bill patients who do not want to take opioid medications would be able to list on their electronic health records a directive not to administer or prescribe them opioids.

School districts would be required to conduct “some sort of screening,” including one called Screening, Brief Intervention, and Referral to Treatment, known as SBIRT for short, or an alternative program, according to Spilka. The Ashland Democrat said the Department of Elementary and Secondary Education would determine the two grade-levels where that screening would be performed.

She said many schools already perform SBIRT screenings. Driver education courses would also include some addiction training under the legislation.

Written by Matt Murphy and Andy Metzger