Builds off 2014 landmark law and unprecedented budget investments
(BOSTON) – Representative Sánchez joined his colleagues in the Massachusetts Legislature to pass substance addiction legislation that enhances intervention, prevention and education efforts, including the creation of a framework to evaluate and treat patients who present in emergency rooms with an apparent overdose.
This new practice, which will be covered by insurance, is designed to ensure the proper assessment and discharge of patients who seek voluntary treatment. If a patient refuses treatment, information on health and community resources will be provided. This framework reflects the 2012 University of Miami Medical School findings that voluntary treatment is more effective and affordable than involuntary commitment.
“We are in the midst of a public health crisis that is draining vitality from our hometowns, extinguishing lives and stealing souls,” said House Speaker Robert A. DeLeo (D-Winthrop). “Our focus on workable solutions, consensus-building and legislation that complements our budget investments has set a foundation for continual improvement. I wholeheartedly thank my colleagues for their creative, unassuming and compassionate commitment to paving a path for the recovery of thousands of our loved ones, and in fact, a path for our wounded Commonwealth.”
“This legislation provides a meaningful framework for how we address the prevention and treatment of substance abuse disorder in the Commonwealth,” said Representative Jeffrey Sánchez (D-Jamaica Plain), Chair of the Joint Committee on Health Care Financing. “We are now another step closer in helping patients, families, and communities tackle this challenging issue.”
"This conference report includes significant new policies that will help to fight the opioid epidemic impacting all corners of the Commonwealth”, said Representative Brian S. Dempsey (D-Haverhill), Chair of the Joint Committee on Ways and Means. “The seven day limit on first time opiate prescriptions and required substance abuse evaluations in emergency rooms are innovative new initiatives that will have a real impact on the lives of our constituents struggling with opioid addictions."
“The bipartisan compromise bill we passed today represents the strong commitment of the Legislature and Administration to addressing the opioid crisis by developing specific systems of education and prevention, intervention, and treatment,” said Representative Liz Malia (D-Jamaica Plain), House Chair of the Committee on Mental Health and Substance Abuse. “Among many key provisions, it creates a new standard in acute-care settings by requiring a licensed medical professional to conduct a substantive evaluation of individuals who present in an emergency department with an apparent opiate overdose. This new best-practice is designed to ensure the proper assessment and discharge of patients who seek voluntary treatment and provides for insurance coverage of the evaluation, arming providers with the necessary resources. I thank the Speaker for his leadership and support for this change in how we view and treat those suffering from the disease of addiction, and our Senate colleagues for prioritizing proposals to disrupt the status quo and stem the tide of this public health crisis. Change requires starting where we are and progressing incrementally, and I think this comprehensive piece offers that opportunity.”
“This legislation works hand-in-glove with the governor's opioid task force recommendations as well as recent significant funding increases to provide education, identification of persons at-risk, and smart ways to reduce the volume of opioid medications that can lead to illicit use,” said Representative Randy Hunt (R-Sandwich), member of the conference committee.
The bill limits first-time opiate prescriptions to seven days for adults and all opiate prescriptions for minors to seven days, with exceptions for chronic pain management, cancer, and palliative care. Practitioners must now check the prescription monitoring program (PMP) each time they prescribe any opiate and correspondingly note that in the patient’s medical records.
From its discussions with numerous stakeholders and recovery groups, the Legislature recognizes the importance of empowering individuals as they grapple with addiction. As a result, this bill establishes a non-opiate directive form, allowing patients to include a notation in their records that they shall not be offered opiates. It also provides the option of a “partial fill” which allows patients, in consultation with their doctor, to request a lesser amount than indicated on the script; however, this language is permissive and pharmacists may use their discretion.
In an effort to build upon current prevention efforts, the legislation updates current law - which requires all public schools to have a policy regarding substance abuse education - by directing schools to report their plans to the Department of Elementary and Secondary Education (DESE). DESE will then consult with the Department of Public Health (DPH) to provide recommendations that will assist schools and ensure they are providing effective and up-to-date education. Additional education materials will be provided to all student-athletes.
Schools will be required to conduct an annual verbal substance abuse screening in two grade levels. These screenings are subject to appropriation and include an opt-out provision for students and parents. Additionally, school districts implementing alternative substance use screening policies may opt out of the verbal screening tool requirement.
To ensure that unused medications are safely collected and disposed of, this legislation requires manufacturers of controlled substances in Massachusetts to participate in either a drug stewardship program or an alternative plan as determined by DPH.
Over the past few years, the Legislature’s efforts related to substance addiction have focused on behavioral health and the prevalence of co-occurring disorders. This legislation requires the Health Policy Commission to conduct a study on access to dual-diagnosis treatment in the Commonwealth for children, adolescents and adults. To help ensure parity between behavioral and physical health care, the legislation also requires insurance companies to report annually on their denied claims.
This bill also:
- Requires that contact information for all insurers be posted on the bed-finder tool website and updates the law to ensure the site is available 24 hours a day;
- Requires that patients being discharged from substance addiction receive information on all FDA-approved medication-assisted therapies;
- Ensures civil-liability protection for individuals who administer Narcan;
- Updates the training guidelines for all practitioners who prescribe controlled substances;
This legislation follows a 65.2% increase in substance addiction funding since FY12 and the landmark substance addiction law passed in 2014 which, for the first time, mandated detox and stabilization coverage. The two bills are intended to complement each other and reflect a consensus-driven approach.