Regional, national opioid responses discussed at Boston forum

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BOSTON — Across New England, efforts to tackle opioid abuse and curb rising overdose rates involve a focus on working with doctors on both how the drugs are prescribed and how addiction is treated, political and public health leaders from four states said Monday.

The week before Massachusetts lawmakers hear testimony on substance abuse legislation and their peers in New Hampshire debate the same issue, officials gathered at a multi-state conference to discuss their approaches to fighting drug addiction and misuse, calling it a crisis that needed to be addressed immediately.

“It’s everywhere, and there are things we can do about it,” Gov. Charlie Baker said at the forum, held by the New England Council at the Seaport Hotel. “To truly disrupt this, we are going to have to have the will to disrupt this, and I get the fact that for a lot of people, that’s a little complicated. That’s what it’s going to take.”

Baker’s opioid bill will come before the Joint Committee on Mental Health and Substance Abuse on Monday, one in a series of legislative efforts at addressing drug abuse. The Senate has passed a bill focusing on addiction treatment and prevention, while the House has passed legislation that would make it a crime to traffic in fentanyl, a powerful synthetic opiate sometimes added to heroin.

A crackdown on fentanyl is among the provisions in a substance abuse bill soon to be taken up by the New Hampshire Legislature, Gov. Maggie Hassan said. Hassan has called New Hampshire lawmakers in for a special session on Nov. 18 to deal with opioid legislation.

“We still have much more work left to do in New Hampshire and across our region to save lives and to reverse the tide of addiction,” Hassan said.

Efforts are underway in New Hampshire to end over-prescribing of opioids through training for health care providers and new emergency rules adopted by the state’s board of medicine that require informed consent from patients receiving opioid prescriptions, Hassan said.

Hassan said she signed legislation earlier this year to strengthen her state’s prescription drug monitoring program, a database that confrence speakers said proves an important tool in the fight against drug misuse.

Baker told reporters at the State House that regional prescription monitoring is an area where New England leaders “really have the biggest opportunity to work together.” Massachusetts is seeking to updrage its program, in part so that it can be better integrated into clinical practice, Department of Public Health Commissioner Monica Bharel said.

“Several of the states have them, and a couple of them don’t,” Baker said of the programs. “They don’t all. The ones that do have them don’t all talk to each other, and one of the things we’re hoping to do with our upgrade, which should be in place by the end of the year, and some of the other folks are trying to do with their updates as well is to get to the point where all of us are in the position where our data is crossing borders so that people won’t be able to basically drug shop from state to state.”

Elsewhere in New England, Connecticut is now offering increased education and continuing education for prescribers on safe practices and the dangers of opioid addiction as well, said Dr. Miriam Delphin-Rittmon, the commissioner of the state’s Department of Mental Health and Addiction Services.

“That’s been a significant initiative,” she said. “What we’re hearing back is some prescribers weren’t aware of some of the long-term behavioral health consequences that individuals can experience quickly.”

Rhode Island officials are trying to engage with physicians not just around prescribing but also to expand access to medication-assisted treatment, said Maria Montanaro, director of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Medication-assisted treatment combines behavioral therapy with medicines like methadone or buprenorphine to treat substance abuse disorders.

“Primary care physicians really need a great deal of support to change practices around the use of medication-assisted treatment,” Montanaro said. “It’s not just prescribing. They need to be linked to opiate addiction specialists. They need systems they can tap into. They need access to recovery supports for their patients.”

In an effort to better control prescribing practices, Baker’s bill includes a provision limiting patients to a 72-hour supply for a new opioid prescription. Some health care professionals, including the Massachusetts Medical Society, have pushed back against this limit, saying it could impede pain management.

“When I start talking about limiting first prescriptions to a few days, because there’s a big difference between acute pain and chronic pain, I find it interesting that people consider that to be a controversial proposal,” Baker said.

Baker said that he’s happy to debate the appropriate number of hours or days where the cap should fall, but that there is “no medical positive justification” for giving someone a month or more worth of opioid pills for an acute pain like that caused by wisdom teeth removal or a sprained ankle.

The governor said controversial ideas are at times necessary to start discussions and get people to “start thinking differently about whether the status quo should be allowed to stand.”

Baker addressed the conference after meeting with sheriffs from eight counties who support his opioid bill, and after his office announced a coordinating set of principles the state’s medical schools will use in teaching students about safe prescribing and pain management.

The Massachusetts Medical Society, which worked with the medical schools to develop the principles, has made it “absolutely a top priority” to avoid prescription drug overuse and addiction, society president Dr. Dennis Dimitri said during the conference.

The society published guidelines this year for prescribing opioids, Dimitri said, including discussion of assessing a patient’s addiction risk and starting with low doses over short periods of time.

Dimitri also said that physicians in Massachusetts have been required “for quite a few years now” to receive education on safe prescribing in order to renew their licenses.

U.S. Sen. Edward Markey called for such education to become a national requirement, saying he also wants to see the implementation of a national prescription monitoring program and for overdose reversal drugs to become more readily available.

“If we don’t act now, we could lose an entire generation of people,” Markey said during the forum.

Markey recognized Baker and Hassan for the attention they’ve brought to the issue in their respective states and said the time has come for federal legislation that would incorporate strategies similar to those introduced locally.

“There’s no one silver bullet, but we have to act across state lines,” Markey said. He said Congress needs to “dramatically increase” the federal budget to give states more resources to expand treatment and recovery programs.

“It’s got to be much more aggressive than best practices, ‘Try to do your best, here’s some money for a study,'” Markey said. “We’re way past that already.”

— Written by Katie Lannan

Copyright State House News Service