House Dems hold line on seven-day Rx limits

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STATE HOUSE — House Democrats put up a unified front on Wednesday against Republican-led efforts to reinsert into a major opioid abuse prevention bill controversial measures backed by Gov. Charlie Baker to limit opioid prescription sizes and allow hospitals to hold overdose patients involuntarily.

The House voted unanimously 149-0 on Wednesday evening to pass a substance abuse treatment and prevention bill, but not before a passionate debate over the length of time doctors should be allowed to hold a patient who has recently overdosed.

The bill, which now moves to the Senate and will have to reconciled with competing proposals adopted last year in that branch – gives physicians a 24-hour window to conduct a substance abuse evaluation on patients who show up in an emergency room with symptoms of an opioid overdose.

Doctors would be required to both discuss that evaluation with the patients and log it into their medical records. Insurance coverage for the evaluation period would be mandated.

The evaluation “puts the responsibility not on the diseased individual who may not be ready to ask for help but it puts the responsibility on the hospital,” Rep. Ruth Balser, a Newton Democrat, said. “How often has someone who just had an overdose been sent out the door without trying to connect even that person, or how often did the hospital try to connect the person, but the insurance company wouldn’t cover it?”

Other measures in the House bill include a requirement that all public schools have a substance abuse education policy, a prohibition on sending women civilly committed for drug or alcohol treatment to the Framingham state prison, and a requirement that practitioners check the state’s prescription monitoring database each time they prescribe opiates.

The House and Senate have taken varying approaches to limiting individuals’ access to prescription painkillers, with the House opting for only a seven-day supply for initial opioid prescriptions. In legislation it passed in October, the Senate opted to allow pharmacists to dispense a lesser-than-prescribed amount of the most dangerous painkillers.

House Republicans attempted to bring the initial prescription supply down to five days, filing an amendment that was rejected on a 33-114 vote. Baker had proposed a more restrictive three-day supply limit.

Rep. Claire Cronin, of Easton, also withdrew her amendment to sunset the prescription limits after three years, which the Massachusetts Medical Society had advocated for, but was opposed by both Baker and House leadership.

With 1,256 accidental opioid overdoses tallied in 2014, scrutiny and some blame has fallen on the legal prescription of painkillers, which can serve as a gateway to drug abuse and addiction or be shuttled into the illicit drug market.

Despite efforts backed by Republicans, the Democrat-dominated House declined to include a measure proposed by Baker that would allow physicians to hold people at immediate risk of harming themselves with drugs for three days.

Supporters of that measure argued that addicts often leave the hospital after an overdose looking for another fix. Critics said there are capacity issues already at hospitals, and the idea failed to gain wide purchase among doctors.

Describing himself as a “defender of community hospitals,” Majority Leader Ron Mariano, of Quincy, criticized the three-day hold as an unfunded mandate. Rep. Paul Frost, an Auburn Republican, countered that claim, arguing the measure would give doctors the ability to keep a patient for the extra time, but not require them to do so.

Filed by Rep. Jim Lyons, an Andover Republican, the amendment to add the 72-hour hold was rejected on a 34-113 vote. Lyons and others who spoke in support of the measure suggested that more time to intervene could translate to more lives saved.

“People are dying every day because they are being sent home,” said Rep. Shawn Dooley, a Norfolk Republican who serves as an on-call firefighter and EMT. “It is getting worse.”

Opponents of the amendment argued that no one could force someone to seek treatment if they did not want it or were not ready

“This a very, very personal and individual disease,” said Rep. Jeffrey Sanchez, a Jamaica Plain Democrat. “Imagine this person that gets held once…will probably go back to the emergency room if they’re in the early throes of the disease. We want to make sure the emergency rooms themselves are always seen, by anyone who comes in, as a place of healing.”

The amendment’s backers said that part of reducing the stigma around addiction would be making the same level of care available as for other medical conditions.

“Please don’t call this an epidemic if you’re not willing to treat it like an epidemic,” Rep. Geoff Diehl, a Whitman Republican, said, arguing in favor of a 72-hour hold on addicts at risk of harming themselves.

A Republican-backed attempt to salvage some aspect of an involuntary medical hold on drug addicts went down on a 38-108 vote. The amendment would have created a procedure allowing an attending physician to restrain and treat a person involuntarily for three days if that person suffered another opioid overdose within a week of receiving overdose treatment and a substance evaluation.

While Sanchez argued involuntary treatment was not conducive to recovery, Rep. Sheila Harrington, a Groton Republican, noted the state’s so-called Section 35 law – where loved ones can petition a court to authorize forced substance abuse treatment – can save lives.

Democratic Reps. Paul Brodeur, Thomas Calter, Diana DiZoglio, James Dwyer and Colleen Garry voted with Republicans in favor of the failed amendment.

A provision adopted by the House that had been filed by Rep. Linda Dean Campbell, a Methuen Democrat, would require hospitals to notify the primary-care physician, when possible, when discharging a patient after an opiate-related overdose.

Rep. David Muradian, a Grafton Republican, spoke for the first time on the House floor, warning of the dangers of a drug called flakka, that he called “bath salts on steroids.”

Though Muradian withdrew an amendment that would have included the dangerous chemical in the state’s drug code, he told the News Service he has filed separate legislation to that effect.

The House adopted a provision sponsored by Methuen Democrat Rep. Diana DiZoglio, which would direct the Department of Public Health to regulate the advertising of certain drugs, including opiates, within doctors’ offices.

— Written by Katie Lannan and Andy Metzger

Copyright State House News Service