Tackling the Opioid Epidemic
The state of Massachusetts has instituted a multi-faceted strategy to curb the opioid epidemic. On March 14, 2016, Massachusetts Governor Charlie Baker signed Chapter 52 - Acts of 2016, An Act Relative to Substance Use, Treatment, Education and Prevention, into law. This is a comprehensive law addressing the opioid epidemic, focusing on prescriber education and prevention.
There are many aspects to this legislation that helps addicts as well as clinicians have better resources and a framework that fosters responsible pain management. For clinicians, the law requires them to implement the following new requirements into their practices including and for:
- Outpatient prescribing of all opiates
- Make special provisions for minors under the age of 18 limiting it to a seven-day supply with some exceptions
- Schedule II opioids
- Extended-release, long-acting opioids in non-abuse deterrent form
- Long-term pain management with extended-release long-acting opioids in non-abuse deterrent form
Statistics Show Rise in Opioid-Related Deaths
In 2015, the estimated rate of unintentional opioid-related overdose deaths was 22.6 deaths per 100,000 residents. This represents a 12.4% increase from the rate of 20.1 deaths per 100,000 residents in 2014 according to the Massachusetts Department of Public Health.
Rate of Unintentional/Undertermined Opioid-Related Deaths Among MA Residents from 2000-2015
Governor Baker described the legislation as basically prevention and education, including better training of prescribers. He continued, "Until very recently, you could practice medicine, you could be a dentist, you could be a nurse or physician's assistant and never take a course in pain management or opioid therapy. In Massachusetts, you have to take a course and pass it now to graduate from any of those schools."
Another example how this legislation is impacting clinical education was held in February, 2016, when Governor Baker announced along with the Massachusetts Dental Society, the first in the nation set of dental education core competencies for the prevention and management of prescription drug misuse. Undergraduate and advanced graduate dental students will receive enhanced training in primary, secondary and tertiary strategy for the prevention and management of prescription drug misuse.
Support for Workers' Compensation Patients
At the end of 2016, Governor Baker announced a new voluntary program to assist injured workers who have settled worker's compensation claims get treatment for pain management, and is aimed at limiting the use of opioids or other narcotics. An insurance company can seek to discontinue payment for patients who are still being treated with opioids after settling their claim. In this pilot program, injured workers receive a care coordinator who is a specialized nurse, who acts to shorten the length of court proceedings and mediate treatment options between the injured worker and the insurance company that's paying for care. This is to help provide workers who get injured on the job get the help and care they need while reducing the risk of opioid addiction.
Changes in Drug Policy, Changes in Abuse-Related Deaths
Although there has been a rise in unintentional opioid-related deaths in Massachusetts and is at a record high, heroin-related deaths are declining and less the cause than fentanyl. Fentanyl is a synthetic opioid with effects similar to heroin and is prescribed for severe pain. Illicitly-produced fentanyl, not diverted pharmaceutical fentanyl, is responsible for the majority of overdose-related deaths. Other drugs included in toxicology reports that fall into the opioid-related death statistics include heroin, benzodiazepine, cocaine, and the more commonly prescribed hydrocodone, hydromorphone, oxycodone, oxymorphone and tramadol.
Despite Governor Baker's December 2016 $98 million mid-year budget cuts—which impacts opioid abuse relief funding—the state remains committed to having an impact on opioid-related abuse and deaths.