Pubdate: Fri, 16 Oct 2015
Source: Boston Globe (MA)
Copyright: 2015 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Joshua Miller

FACING EPIDEMIC, BAKER SEEKS TO LIMIT OPIOID PRESCRIPTIONS

Governor Charlie Baker, facing a deadly scourge of prescription drug 
and heroin abuse, proposed Thursday to place new limits on how many 
opioid painkillers doctors and dentists can prescribe to a patient.

Looking to help stanch addiction where it often begins, the 
wide-ranging bill would limit practitioners to prescribing no more 
than a 72-hour supply of opioids to patients the first time they 
prescribe an opioid to them, with exceptions only for certain limited 
emergencies.

At a State House news conference, Baker said he has heard far too 
many stories in recent years of people who come from a doctor's 
office, a dental visit, or the hospital with 30 or 60 or 80 tablets 
of an opioid drug, when a handful would do. "This has got to stop," he said.

Administration officials said they did not know of any other state 
that has enacted a similar measure.

Legislative leaders reacted positively to the proposal, but the Baker 
plan immediately drew concern from the medical community in 
Massachusetts, underscoring the tension between the government's 
latest effort to stem the epidemic and doctors' belief that they know 
their patients' needs best.

"It doesn't necessarily allow for the clinical judgment of physicians 
- - to adjust their prescriptions for different patients with different 
situations," said Dr. Dennis Dimitri, president of the Massachusetts 
Medical Society, which represents more than 25,000 physicians and 
medical students.

Dr. David P. Lustbader, an oral and maxillofacial surgeon who is vice 
president of the Massachusetts Dental Society, said the effort is a 
simplistic approach to a complex problem.

"For me to tell a patient, 'I'm sorry, you can only have 72 hours of 
pain medication,' it's not fair and it's not realistic," he said. 
"You're having attorneys trying to fix health care, and you're 
throwing the baby out with the bathwater."

The powerful American Medical Association also expressed worry. The 
group's chairwoman-elect, Dr. Patrice A. Harris, said in a statement 
the AMA shares local doctors' "concerns over sections of the bill, 
including universal mandates that may be well-intentioned, but may 
have unintentional consequences to the patient-physician relationship."

But Dr. Sarah Wakeman, a Massachusetts General Hospital physician who 
served on Baker's Opioid Working Group, which delivered a lengthy set 
of recommendations in June that helped form the basis of the bill, 
described a rationale for the prescribing limit push. She said drug 
addiction is a disease and, as in dealing with other diseases, 
prevention works.

"We prevent diabetes by limiting exposure to foods and beverages. We 
prevent lung cancer by limiting exposure to tobacco smoke," she said 
at the news conference. So the proposed opioid prescription limit 
"will help to minimize excessive exposure to opioids."

Baker, a former health insurance company executive, explained he has 
lots of friends and colleagues in the health care world. "I am 
astonished," the Republican governor said, "by the casual nature and 
the casual attitude that I find when I talk to them about these 
medications and these issues. And that has got to change. Period."

The governor's legislation would also strengthen a prescription 
monitoring program, requiring every practitioner to check a database 
before writing an opioid prescription; increase education about the 
drugs for athletic coaches, parents, and physicians; and give 
hospitals new power to force treatment on substance abusers who pose 
a danger to themselves or others.

Early reviews of the bill from several powerful figures in the state 
were positive. Senate President Stanley C. Rosenberg and House 
Speaker Robert A. DeLeo, both Democrats, released warm statements 
about the legislation.

And in a clear nod to the bipartisan effort to tackle the crisis, 
Steven A. Tolman - the president of the Massachusetts AFL-CIO, a 
former Democratic state senator, and a sometimes Baker antagonist - 
stood directly to Baker's right during the news conference. In 
remarks, Tolman, a longtime advocate on issues of substance abuse, 
underscored his support for the governor's effort to address the scourge.

In another boost for the bill, Lora M. Pellegrini, president and 
chief executive of the Massachusetts Association of Health Plans, 
which represents 17 health insurers in the state, praised Baker for 
leading on the issue of opioid addiction.

Pellegrini said the data show a lot of heroin users start with opioid 
prescription drugs, and the prescription-limiting effort might help 
reduce the amount of those drugs on the street.

The governor also proposed ending the practice of sending women 
struggling with addiction - who are found by a court to pose an 
immediate risk of harm to themselves or others - to a Framingham 
prison when treatment beds are full.

Jessie Rossman, a staff lawyer with the American Civil Liberties 
Union of Massachusetts, which has brought a lawsuit on behalf of 
women civilly committed to the prison, said she is reviewing the 
legislation and hopes any bill that becomes law will actually 
accomplish the goal of ending the practice.

She also said the ACLU is carefully reviewing Baker's push to give 
hospitals new power to force treatment on substance abusers who pose 
a danger to themselves or others for up to 72 hours - and offered a 
note of concern about any effort that can deprive people of their liberties.

Baker's proposal mirrors existing law that permits a 72-hour period 
of involuntary treatment when a physician determines a person suffers 
from mental illness and poses a serious risk of harm.

Massachusetts has suffered from a grim rise in unintentional opioid 
overdose deaths. The state Department of Public Health said this year 
that an estimated 1,256 Massachusetts residents died from opioid 
overdoses in 2014, a sharp increase from 2013 and 2012.

The Senate has already passed its own bill this fall, focused on 
steering people away from addiction through education and prevention. 
Baker's bill, along with efforts by the House, may be melded into a 
single legislative package in the months ahead.

The governor has made a wide-ranging state government response to the 
crisis a centerpiece of his agenda. Aides said he is deeply committed 
to getting a comprehensive bill to address opioid abuse into law and 
is willing to use his political capital to get it done.
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MAP posted-by: Jay Bergstrom