Today the Senate passed a bill to strengthen the state’s response to prescription drug addiction.
This legislation builds on the tireless work of my predecessor, Steven Tolman, on this issue. Click here for former Senator Tolman’s Commission Report. The statistics are stunning — overdoses from prescription drugs now exceed both heroin overdoes and auto accidents as a cause of death. The problem touches every community in the state.
The center of the bill is an effort to strengthen the monitoring program that will help doctors identify patients involved in “doctor shopping.”
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BOSTON – With the abuse of prescription pain killers having reached epidemic levels in Massachusetts, the Senate on Thursday unanimously passed legislation for strict oversight of the drugs. The bill will reduce the excess supply of pills and require physician registration in the state’s Prescription Monitoring Program to prevent patients from “doctor shopping” for highly addictive medications such as OxyContin and Vicodin.
“When drugs like these are responsible for more accidental deaths in Massachusetts than motor vehicle accidents, you know we’ve got a problem,” Senate President Therese Murray (D-Plymouth) said. “I said at the beginning of this legislative session this would be a top priority. The abuse of these drugs has devastating effects on individuals and families of every socio-economic background. The costs are high, both to families and the economy, not to mention the significant impact on public safety. This bill will help save lives and keep us all safer.”
“This bill recognizes the quiet epidemic that has struck families all across this Commonwealth, and with practical, cost-effective measures steps up our fight against one of the main causes of the epidemic – prescription painkillers,” said Senator John F. Keenan (D-Quincy) lead sponsor of the bill.
A report released by the OxyContin and Heroin Commission in 2009 found that Massachusetts has one of the highest rates of opiate abuse in the nation, causing 3,265 deaths from 2002 to 2007 and 23,369 hospitalizations in 2006 alone.
The Drug Enforcement Agency reports that Vicodin is the second-most abused drug by high school seniors, behind marijuana, and opiate addiction is the leading cause of property crime. Meanwhile, taxpayers are spending hundreds-of-millions of dollars annually in costs associated with the epidemic – including hospital visits, court appearances, jail time and social services.
The bill increases prescription drug security by making enrollment in the state’s Prescription Monitoring Program mandatory. The top 30 percent of prescribers, who provide 90 percent of all controlled substances, are required to enroll immediately. All others would be phased-in over three years. Currently, participation in the program is voluntary, with only 1,700 out of 40,000 prescribers signed up.
To promote awareness, the Department of Public Health will be required to produce informational pamphlets explaining addiction risks, signs of dependency, where to go for treatment, and ways to safely store and discard drugs. The pamphlets will be distributed by pharmacies with each prescription filled.
Pharmacies, drug manufacturers and other relevant parties will also be required to alert local police when reporting missing controlled substances to the Drug Enforcement Administration. Under the bill, doctors and hospitals will be required to notify a parent or guardian of any minor treated for drug overdose. Information on substance abuse treatment options must also be provided, and a social worker will be available for counseling prior to hospital discharge.
The legislation also requires all prescriptions for controlled substances to be written on “secure” forms, using special watermarks, serial numbers or micro-printing to be determined by the Department of Public Health. The bill also forms a working group of practitioners to draft “best practices” for prescriptions that treat acute and chronic pain.
The bill also does the following:
• Bans the possession, distribution and manufacturing of synthetic over-the-counter recreational drugs known as “bath salts” which are smoked, inhaled or injected and linked to serious physical and mental problems;
• Prohibits pharmacists from filling certain narcotic prescriptions from doctors in non-contiguous states;
• Restricts MassHealth enrollees with a history of excessive use to one pharmacy;
• Provides limited immunity from drug possession charges for those who seek medical assistance for an overdose, but does not extend to drug trafficking cases;
• Allows sheriffs to enter into a study on the effectiveness of medication-assisted treatment for the successful transition of inmates back into society;
• Commissions a study on substance abuse among seniors; and
• Mandates professional training for court personnel and legal counsel on substance abuse services available for those facing criminal charges.
According to Centers for Disease Control, more people are overdosing on prescription pain killers (approximately 12,000 nationally in 2007) than on cocaine and heroin combined, with the number of people needing emergency treatment for overdoses having tripled in the last decade. Of the nearly 2 million emergency room visits nationally in 2009, almost half involved prescription drug abuse.
For an explanation of drug classifications, knows as schedules, under the U.S. Controlled Substances Act, please see this website: http://nationalsubstanceabuseindex.org/drugclass.htm.
The bill now goes to the House of Representatives for further action.
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Will, three comments/questions:
Are services for opiate addicts widely available? I recall reading that there were alternatives to methadone (buprenorphine, I’m pretty sure) that were better in many ways, but that was difficulty in licensing enough doctors to prescribe to enough people to cover the need.
I’m a little concerned about people who need opiates for pain; will they be able to get what they need? Cases like that of Richard Paey in Florida would be good to avoid (I met his wife; my Dad is active in attempting to reform drug laws down there).
As always, I’m a little concerned about the blanket discussion of “drugs”. Some illegal drugs are relatively harmless (compared to both opiates, and even to legal drugs like alcohol). If we treated them less aggressively in the legal code and enforcement, we’d save money, with little or not social harm. Portugal has apparently done relatively well with blanket decriminalization; some of the money saved on enforcement and prison could instead be directed to treatment.
Thanks, David. We also need to expand treatment, including use this of drugs like Buprenorphine that suppress craving and/or reduce the high available through opioid drugs. That is mainly a budget issue — we’ll be doing the budget later in the session.
Your point about availability of pain drugs is well taken. Sometimes they are absolutely necessary. The legislature does not presume through this bill to directly regulate the practice of medicine. The bill instead creates a consultative panel including physicians, dentists, etc. That panel will make best practice recommendations which will then be included in regulations. Our expectation is that the regulations will be well-informed by practical and clinical considerations. The bill is explicit that regulations should identify kinds of cases in which a check of the prescription monitoring program is not required — for example, physicians shouldn’t need to check for evidence of prescription abuse before administering pain blocking drugs in emergency procedures.
This isn’t a blanket bill — it is about the problem of prescription pain-killer abuse, which unfortunately has become epidemic in Massachusetts at this time. The bill is not primarily about punishment and, in fact, includes an important “harm reduction” measure — protecting good samaritans who assist persons who are overdosing from getting prosecuted for drug possession themselves.
Hi Will-
While I agree that prescription drug abuse seems to have increased in the last decade, I fear that one of the side effects of legislation like this can have a detrimental effect on legitimate doctor/patient relationships. What happens is Doctors become fearful of prescribing pain medications, and hence you are left in many instances with needlessly suffering patients. Let me share one anecdote from my own personal experience:
About 2 years ago, I had major oral surgery (specifically, my gums were cut open to prep for dental implants.) As the novocaine began wearing off, I was in quite a bit of discomfort, but the oral surgeon refused to give me anything stronger than Ibuprofen. I complained to her, to no avail. When I left the dentist’s office, I went straight to see my primary care physician to see if she would prescribe me enough pain medication to get through a 24-hour period, however, she was away, and the nurse practitioner covering for her also refused to prescribe me pain medication, also out of fear of the laws. Several hours later, I was actually reduced to holding a small, “medicinal” amount of whiskey in my mouth to numb the throbbing in my gums from the surgery. Later, at about 2AM that night, I was awoken by the pain, and wound up having to go to the ER (Mt. Auburn Hospital) where the physician who saw me there had sympathy for my situation after I described what had happen, and prescribed me 6 tablets of a common narcotic pain reliever to get me through the majority of the post-operative pain. Bottom line, that day was a waste of time, money (ER costs), and I think highlights what legislators should be aware of when they put forth laws like this. I wound up filing a formal complaint to the Mass. Board of licensure for Dentists.
I write this to make you, and other lawmakers, aware of what can happen when these laws are enacted. I understand you want to help curb the growing problem of prescription drug abuse, but it shouldn’t come at the cost of causing legitimate sufferers of pain to be denied adequate medical care. Be aware that you may be opening the door to malpractice suits for underprescribing for pain because good, honest doctor’s are living in fear of byzantine laws.
Thanks for your time, and hope you will consider the points I have outlined here.
Thank you, Chris.
Your story and your points are very well taken. You are not alone in these concerns and a key idea in the bill is to have practitioners involved in designing the regulations.
In Lowell, the Health Department has done tireless work around this issue. The city has one of the higher rates of deaths from opioid overdoses in the state (prescription drugs). Several years ago they were surprised to find that most of these victims are adults – often white, English-speaking, building trades workers who were badly injured on the job. When their workers’ compensation benefits ran out they could not longer afford the pain medication, but even though the comp system said they had completed their recovery, they had not. So, the health department discovered that what can happen is that these men learn that they can get the drugs on the street. Then, something happens and they overdose.
So, although teenage substance abusers are using these prescription drugs, which is problematic, we should not assume that this problem is only about substance abuse. It also represents failures in our healthcare and health insurance systems. As we shift more of the costs of healthcare spending onto those in need of healthcare services – in order to control costs to the payers (as was done by the legislature this past year by removing the right of municipal workers’ unions to negotiate their health insurance benefits – a cost-shifting measure)we establish the basis upon which these other problems will build.
Thanks, Craig. Interesting angle, which I haven’t heard suggested before in this context.
Like Christopher Pearson, I have been denied pain medication when I needed it by a physician who was afraid of the old drug laws. Fortunately, my long-time internist knew I wasn’t a drug abuser and prescribed me some. I do worry that this change will make the situation for patients even worse.
Will, with 2x drug overdose deaths as traffic deaths and more deaths from dirty hands in hospitals than traffic deaths, reason implies that law enforcement should stop wasting resources writing speeding tickets and buying laser speed guns? They would save more lives by monitoring hand washing in hospitals, checking scripts, and getting reports from the DEA and other LE. Likewise, intersection and bus cameras seem like a huge waste of money, especially when they don’t catch bicyclists who are the ones most often running red lights.
I’ve had a number of sport/exercise related knee injuries and laws inducing doctor paranoia have been the biggest problem I’ve experienced, not addiction despite having taken 300 Percocets, often with alcohol for enhancement, over a few months recovering from my last open surgery. For an earlier arthroscopic surgery when much younger, my parents were given only 3 Percocets on day surgery discharge with instructions on the bottle to take 1 every 4 hours and NEVER EVER with alcohol. My mother, thus would not give me any, and I couldn’t go get it. So, I was in excruciating pain after the local anesthetic in my knee wore off and swelling continued (they didn’t ice my knee in the recovery room while waiting for my nausea to stop). After a sleepless night, my father was finally able to spend hours getting and filling for me another script – in person because the law doesn’t allow calling in vital scripts like these. On hindsight, him being given my schedule 1 script by a pharmacist must have broken some laws.
I’ve never smoked cigarettes, but understand nicotine is far more addictive than opiates where under 10% of the population may be susceptible to addiction. I see that this bill only makes the problem worse, not better. Also, because the DEA communicates poorly with other government law enforcement, the solution is putting more burden on the private sector to bridge the communication gaps? With the ever more obscene prices of medications at pharmacies, legislators want to make them even more expensive?
The bill could be written for the 21st century and encourage secure electronic prescription delivery from the doctor’s computer to the pharmacy, with all the various government agencies getting carbon copied (by the pharmacy upon receipt). A doctor I have uses this amazing new technology on his desktop computer, and there might even be an iPad or iPhone app for that! Isn’t this better than hand delivered pieces of (secure) paper?
Thank you, Mark, I am under the impression that moving towards more secure prescription delivery is one of the measures we are hoping that DPH will facilitate. But I will check into this.
A constituent sent me an email recounting a story showing why we need to make sure that the regulations that emerge under this legislation are reasonable and practical — many people need pain medication. She didn’t feel comfortable posting under own name, but I’ve quoted from her email here:
Another comment from a patient: