Massachusetts Legislature Passes Bill to Combat Opioid Crisis Bills moves to the Governor’s desk

BOSTON – On July 31, the Massachusetts Legislature passed H.4742, providing an additional set of tools to address the opioid crisis and establishing the Commonwealth as a national leader in the fight against this epidemic. Among the provisions included in the bill are increasing access to medication-assisted treatment (MAT), exploring tools to reduce harm and save lives, expanding prevention efforts, and addressing the high rates of co-occurring conditions of substance use disorder (SUD) and mental illness.

The bill, An Act for prevention and access to appropriate care and treatment of addiction, is the result of extensive work researching evidence-based best practices and collaborating with healthcare researchers and clinicians, hospitals, behavioral health providers, law enforcement officials, patient advocates and individuals with lived experience, to develop policies to address the opioid epidemic.

“This comprehensive legislation is a vital next step in Massachusetts’ ongoing fight against the opioid epidemic,” said Senate President Karen E. Spilka (D-Ashland). Among other accomplishments, we are ensuring those facing the illness of substance use disorder will be able to get the medicine and treatment they need quicker, more efficiently, and in a more sustained way. We are taking steps to address the high rates of co-occurring mental illness, and ensuring that those who provide naloxone are better protected under the law.”

“Despite efforts to suppress the opioid crisis, families across the Commonwealth continue to lose their loved ones to substance use disorder,” said Senator Cindy F. Friedman (D-Arlington), Senate Chair of the Joint Committee on Mental Health, Substance Use and Recovery. “This legislation builds upon the work the state has done around opioid misuse and prevention and provides another set of tools to reduce harm, save lives, and increase access to evidence-based treatment. We have a major epidemic on our hands and we have to use everything at our disposal to cure this disease.”

“The Commonwealth of Massachusetts has advanced its commitment to combating the opioid epidemic today with the passage of this legislation. I want to thank Senator Cindy Friedman and Representative Denise Garlick, whose leadership led to the success of this legislation. Among its many important provisions, this bi-partisan effort takes steps towards developing proper addiction treatment for incarcerated individuals, provides a pathway to evidence-based care through hospitals and emergency departments, and requires insurance companies to provide better access to alternative pain management services,” said Senator John Keenan (D-Quincy), Senate vice chair of the Joint Committee on Mental Health, Substance Use and Recovery.

“The rapid and penetrating seriousness of the spread of heroin, fentanyl, and the over use of prescription drugs across Massachusetts is not only alarming, it is action provoking,” said Senate Minority Leader Bruce Tarr (R-Gloucester).  “This legislation represents an important contribution to expanding the available paths to treatment and the prevention of addiction.

Under this bill, someone who receives treatment in an emergency department (ED) for an opioid overdose will now have the opportunity to begin treatment for their SUD before they leave the ED. The bill requires that all EDs and all satellite emergency facilities have the capacity to initiate voluntary SUD treatment, including opioid agonist treatment, after treatment for overdose.

Opioid agonist treatment commonly includes the use of Buprenorphine, also known as “Suboxone,” which is an evidence-based treatment that eases the symptoms of withdrawal and relieves opioid cravings. It can be administered as early as 8 to 24 hours after a patient’s last exposure to an opioid. This timetable allows treatment to begin in the ED soon after an overdose, when someone with an SUD may be most willing to consider treatment. They will also receive, under the legislation, a direct referral from the ED to a provider in the community who can continue their treatment regimen after they return home.

In 2017, opioid-related overdose deaths fell by 8% according to the Department of Public Health (DPH). The reduction in deaths is partially accredited to the widespread use of the life-saving drug Naloxone, commonly known as “Narcan,”which blocks the effects of opioids and reverses an opioid overdose. Under the legislation, the DPH is directed to issue a statewide standing order authorizing every pharmacy in the state to dispense naloxone, eliminating the current requirement that each pharmacy obtain an individual authorization.

The bill also brings Massachusetts in line with other states by providing liability protections, including protection from criminal or civil liability, for practitioners who prescribe and pharmacists who dispense naloxone in good faith.

In Massachusetts, nearly 1 out of every 11 individuals dying from opioid-related overdoses has a history of incarceration in state jails and prisons, and in 2015 alone, nearly 50% of all deaths among those released from incarceration were opioid-related. In response, this bill makes significant strides towards extending access to medication-assisted treatment in correctional facilities, making medication-assisted treatment available in the state correctional system and establishing a medication-assisted treatment pilot program at 5 county correctional facilities.

“This pilot program will expand upon the innovative and nationally recognized work of Massachusetts Sheriffs. We are proud to have collaborated with Senator Cindy Friedman and Representative Denise Garlick on this important step forward for corrections,” said Massachusetts Sheriffs’ Association President Peter J. Koutoujian. “This approach is balanced, thoughtful and will provide data to drive best practices for us and our colleagues not just locally, but nationally.”

The bill also includes several provisions to address dual diagnosis and the high rates of co-occurring SUD and mental illness in the Commonwealth. According to the National Association on Mental Illness-Massachusetts, over 50% of individuals seeking treatment for SUD also suffer from a mental health condition. To ensure that the right kind of treatment facilities will be available to serve every patient who needs treatment, the bill enhances the oversight authority of the Department of Mental Health (DMH) and the DPH’s Bureau of Substance Addiction Services (DPH/BSAS) – the two agencies that license facilities that provide treatment for mental illness and addiction.

Under the bill, a center for police training in crisis intervention is established to serve as a clearinghouse for best practices in police response to people with mental illness and substance use disorders. The center would also implement crisis intervention training for all municipal police officers and provide technical assistance to cities and towns to form collaborative partnerships between law enforcement and human service providers to maximize referrals to treatment services.

In addition, the legislation recognizes the important role that recovery coaches play in successful long-term addiction and mental illness treatment by creating a commission to recommend standards for establishing a professional credential for recovery coaches as an important step toward formalizing the role that they play in the pathway to treatment and recovery.

The bill also creates a Community-Based Behavioral Health Promotion and Prevention Trust Fund to promote positive mental, emotional and behavioral health among children and young adults and to prevent substance use disorders among children and young adults.

Numerous studies and years of experience in Canada and Europe show that supervised injection sites save lives and provide public health benefits, such as reducing the transmission of HIV, hepatitis C, and other blood-borne diseases and reducing complications of injection site infection. They also aid in building trusting relationships between clients and health care providers, which can lead to the initiation of treatment for SUD. The bill creates a special commission to study the feasibility of establishing such sites here in Massachusetts and to explore other harm prevention measures.

To reduce fraud and drug diversion and improve tracking and data collection, the bill requires by 2020 that all prescribers convert to electronic prescriptions for all controlled substance prescriptions.

The bill also updates the state’s partial fill law by clarifying that any patient who decides to partially fill a prescription for a Schedule II controlled substance will not have to pay a duplicate co-pay at the pharmacy if they decide to fill the remainder of the prescription later.

In an attempt to ensure that those experiencing chronic pain have access to the treatments they need, the bill establishes a MCPAP for Pain program to provide remote consultations to primary care practices, nurse practitioners and other health care providers who are caring for chronic pain patients.

The bill also establishes a similar MCPAP for SUD program to provide remote consultations for clinicians providing care to those with SUD.

The final bill, H.4742, was signed into law on August 9, 2018.