The House has now produced its own substance abuse bill. It takes a very sensitive approach to the issue of coercion of treatment by hospitals. The Senate Chair of the Mental Health and Substance Abuse Committee has commented favorably on the proposal and was involved in its development, so, while there are more steps to the process, the legislature seems to headed in a good direction.
Many of the commenters on my post about the original proposal shared my concerns about making hospitals a place where persons with addiction could end up getting detained. The House approach is sensitive to those concerns, while, at the same time, making it more likely that people with addictions will get treatment that they need.
- It does not allow physicians to physically detain people with addictions and force them into treatment.
- It does prohibit them from affirmatively discharging a person admitted for an opioid overdose without evaluating them and offering them treatment — patients would remain physically free to leave “against medical advice.”
- If an evaluation doesn’t get done within the first 24 hours, perhaps because the patient does not wished to be evaluated, the hospital can discharge the patient.
I am much more comfortable with this approach. I am profoundly sympathetic with people who are struggling with the destructive substance abuse disorder of a loved one, and I understand that some would like to see the system take over and force change, but I think we have to be realistic about what is possible. Making hospitals into places that are scary for people with addictions will lead to more deaths, not less. The new proposal does the right thing — it requires hospitals to offer more to people with addictions, without turning doctors into police.
The specific proposed language appears below. Would very much appreciate your further comments.
SECTION 17. Chapter 111 of the General Laws, as so appearing, is hereby amended by inserting after section 51 the following new section:-
Section 51½: Substance Abuse Evaluations in Acute-Care Hospitals
(a) For the purposes of this section, the following words shall have the following meanings:-
“Acute-care hospital”, any hospital licensed under section 51 of chapter 111, and the teaching hospital of the University of Massachusetts Medical School, which contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the department.
“Licensed mental health professional” , a licensed physician who specializes in the practice of psychiatry or addiction medicine, a licensed psychologist, a licensed independent social worker, a licensed mental health counselor, a licensed nurse mental health clinical specialist or a licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J.
“Substance abuse evaluation”, an evaluation ordered pursuant to subsection (b) that is conducted by a licensed mental health professional which shall include, but not be limited to, collecting the following information: history of the use of alcohol, tobacco and other drugs, including age of onset, duration, patterns and consequences of use; the use of alcohol, tobacco and other drugs by family members; types of and responses to previous treatment for substance use disorders or other psychological disorders; an assessment of the patient’s psychological status including co-occurring disorders, trauma history and history of compulsive behaviors; and an assessment of the patient’s Human Immunodeficiency Virus, Hepatitis C, and Tuberculosis risk status.
(b) Each person presenting in an acute-care hospital who is reasonably believed by the attending physician to be experiencing an opiate-related overdose shall receive within 24 hours of admission a substance abuse evaluation. A substance abuse evaluation shall conclude with a diagnosis of the status and nature of the client’s substance use disorder, using standardized definitions established by the American Psychiatric Association, or a mental or behavioral disorder due to the use of psychoactive substances, as defined by the World Health Organization. Each patient shall be presented with the findings of the evaluation in person and in writing, and such findings shall include recommendations for further treatment, if necessary, with an assessment of the appropriate level of care needed. Findings from the evaluation shall be entered into the patient’s medical record. No acute-care hospital licensed pursuant to section 51 of this chapter shall permit early discharge, defined as less than 24-hours after admission or before the conclusion of a substance abuse evaluation, whichever comes sooner. If a patient does not receive an evaluation within 24 hours, the attending physician must note in the medical record the reason the evaluation did not take place and authorize the discharge of the patient.
(c) After a substance abuse evaluation has been completed pursuant to subsection (b) a patient may consent to further treatment. Such treatment may occur within the acute-care hospital, if appropriate services are available; provided, however, that if the hospital is unable to provide such services the hospital shall refer the patient to treatment center outside of the hospital. Medical necessity for such treatment shall be determined by the treating clinician in consultation with the patient and noted in the medical record. If a patient refuses further treatment after the evaluation is complete, and is otherwise medically stable, the hospital may initiate discharge proceedings. All persons receiving an evaluation under subsection (b) shall receive, upon discharge, information on local and statewide treatment options, providers, and other relevant information as deemed appropriate by the attending physician.
(d) If a person has received a substance abuse evaluation within the past 3 months, further treatment and evaluation determinations shall be made by the attending physician according to best practices and procedures.
(e) If a person under 18 years of age is ordered to undergo a substance abuse evaluation, the parent or guardian shall be notified that such an evaluation has been ordered. The parent or guardian shall consent to the evaluation and may be present when the findings of the evaluation are presented and may authorize further treatment for the minor if such treatment is recommended by the evaluator.