Mass. House bill would limit first-time opioid supply, require post-OD evaluations
BOSTON — Patients prescribed opioids for the first time would be limited to a seven-day supply and any individual admitted to the emergency room with an apparent drug overdose would be required to undergo a substance abuse evaluation within 24 hours, under a redrafted House bill.
Setting the ball in motion for what House Speaker Robert DeLeo hopes will be a full debate in the House in January, the Mental Health and Substance Abuse Committee on Monday released a redrafted version of Gov. Charlie Baker's opioid abuse prevention bill.
The bill, which is being polled through the committee, does not go nearly as far as Baker's, which proposed a 72-hour supply limit on first-time opioid prescription and recommended allowing doctors to hold patients involuntarily for up to 72 hours if deemed a threat to themselves due to substance abuse.
While the limit on prescriptions for adults would apply to first-time patients, the House bill also calls for all opioid prescriptions for minors to be limited to a seven-day supply.
"This bill is a significant step forward as we continue to address the rise in substance addiction that is so tragically devastating lives across the commonwealth," said Rep. Elizabeth Malia, chairwoman of the committee, in a statement. "I believe this proposal is a balanced approach that will improve our efforts at prevention and increase patients' access to treatment."
About an hour before the committee released the bill to its members for a vote, House Speaker Robert DeLeo said the committee was putting the finishing touches on the opioid abuse prevention bill in the hope of prepping the legislation for a full debate later in the month of January.
Members of the committee have until 4 p.m. Wednesday to vote on the legislation, and DeLeo said that if it clears the committee it will likely have to go through the Health Care Financing Committee and Ways and Means before surfacing on the floor for a debate.
Baker, in a statement, said he is "eager to work with the legislature to bend the trend on opioid misuse and we appreciate the leadership of House Speaker DeLeo, Senate President Rosenberg and the committee to quickly produce legislation and we look forward to reviewing the bill."
While DeLeo would not discuss the details of the House draft before it was released, the timetable identified by the Winthrop Democrat could allow the House to put the debate on substance abuse prevention behind the chamber before talk of the fiscal 2017 budget starts to consume discussions on Beacon Hill.
"I can tell you that the committee has been working on this throughout the month of December," DeLeo said after meeting for close to two hours with Gov. Charlie Baker and Senate President Stanley Rosenberg.
The bill, a redrafted version of Baker's bill (H 3817), would require insurance coverage of the substance abuse evaluations mandated by the bill, and would update prescriber training guidelines for all physicians who prescribe controlled substances.
Doctors would be required, under the legislation, to check the state's Prescription Monitoring Program every time a patient is prescribed a high risk opiate and note in their records the reasons for the medication, and patients could voluntarily put a note in their medical records informing prescribers that they should not be prescribed opioids.
The Senate in October passed legislation aimed at improving education and prevention efforts to fight opioid addiction. That bill is now pending before the House Ways and Means Committee. Separately, Baker filed his own legislation weeks later in October that was heard by the Joint Committee on Mental Health and Substance.
The decision by House leaders to use the governor's bill as a vehicle for its recommendations could impact how quickly a bill can advance into conference committee.
"The governor votes for whichever version gets it most quickly through both branches and back to the governor's office," Baker said while speaking with reporters after his Monday meeting with DeLeo and Senate President Stanley Rosenberg.
After it was suggested that the Senate bill provided the cleanest path forward for opioid abuse prevention legislation because that bill has already been debated by the Senate, Baker said, "I know that. This is not a pride of authorship issue. This is one where I think all of us are anxious to see something happen. Four people a day are dying in Massachusetts of opioid overdoses and the more we can do to move quickly on our shared agenda on this the better off we're all going to be."
Rosenberg said no matter what the House decided to do, his branch will be ready to advance a bill into conference committee "as quickly as possible," suggesting he could avoid a repeat of the process that led to a minimum wage increase last session that required the Senate to debate and pass two distinct versions of the wage-hike bill.
"We don't necessarily have to do it again," he said. "There are procedural mechanisms we can use so we don't have to have a full-fledged additional debate."
Baker two weeks ago invited lawmakers, including DeLeo and Rosenberg, to a screening in downtown Boston of a new HBO documentary on the scourge of opioid addiction of Cape Cod to drive home his desire to take comprehensive action soon to improve the state's response to the crisis.
That film, "Heroin: Cape Cod, USA," premiered on the cable channel on Monday.
So far this year, the Legislature has voted to pump additional resources into treatment beds and other prevention programs, and passed a law making trafficking in the powerful synthetic opioid fentanyl a specific crime.
The Senate passed legislation calling for safer prescribing practices and more physician training, insurance coverage for non-narcotics pain management, the ability of patients to request only partial-fills of opioid prescriptions and verbal substance abuse screenings of high school students.
Baker's bill proposes, among other things, to limit the quantity of opioids that can be prescribed by a doctor for a first-time patient to a 72-hour supply and to allow emergency rooms doctors to hold substance-addicted patients for up to 72 hours against their will to help them get treatment.
The Massachusetts Medical Society and others had raised concerns about how Baker's proposal would limit doctors' discretion to treat their patients.
Speaking to the section of her bill that calls for substance abuse evaluations instead of involuntary commitments, Malia, a Jamaica Plain Democrat, said, "This legislation creates a new standard in acute-care settings by requiring a substantive evaluation be administered by a licensed medical professional to anyone who presents in an emergency department with an opiate-related overdose. This new best-practice is designed to ensure the proper assessment and discharge of patients who seek voluntary treatment."
The House bill would also require schools to include educational materials on opioid misuse and abuse through an already established program for student athletes on head safety.
With the support of both the Senate and Baker, it would also update the Section 35 civil commitment law to prevent women with alcohol and substance abuse disorders from being remanded by a court to MCI-Framingham, instead placing women in a hospital setting.
A study led by Boston Medical Center and released late Monday afternoon found that most patients with chronic pain who are hospitalized after a nonfatal opioid overdose continue to receive prescription opioids after the overdose and are at high risk for experiencing a repeated overdose. The findings were published in the Annal of Internal Medicine based on an analysis of a national commercial insurance claims database with data from 50 million Americans over a 12-year period.
Researchers identified 3,000 individuals who had been treated in an emergency or inpatient setting for a nonfatal opioid overdose after being prescribed the drugs for chronic pain, and 91 percent of those patients continued to be prescribed opioids after their overdose, including 70 percent from the same provider.
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