Ruth Bass: State deserves applause for stance on opioids

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RICHMOND — Once Massachusetts had the bit in its teeth, it trotted rapidly into the arena of opioid addiction, overdoses and misuse of prescription drugs. On March 14, the commonwealth became the first state in the nation to put a 7-day limit on first-time prescriptions for opioid drugs. Exceptions are made for cancer patients and others who suffer chronic pain.

It's okay to take a pat on the back for being out in front of the other 49 states on this. Those who like the feeling of well-being that came with an oxycodone prescription won't have leftovers after the wisdom tooth surgery or other pain source is healed. Research has indicated that too many of those little brown bottles in the medicine cabinet were leading to bigger problems by the year, including being taken by other members of the family.

But two pats on the back would be overdoing it. Welcome as the law is, it only happened after hundreds of people upped the ante and either became addicted to prescription opiods or moved on to the much cheaper heroin. The National Institute on Drug Abuse (NIDA) says deaths from overdoses of prescription opiods have tripled in the past 20 years. The link between the office visit and addiction has been established.

As a corollary, the institute told the U.S. Senate less than two years ago that the number of prescriptions for opioids in this country went from 76 million in 1991 to 207 million in 2013.

Whether they traveled from a pill bottle to heroin or started directly on the heroin road, the users are legion in this country now. Because of their addictions, some of them lose their businesses, some lose their families, some lose their freedom, some lose their lives. Many turn to robbery for the cash their habit requires.

The Massachusetts law was crafted with care. The work began last fall, and it was not until this month that the House and Senate reached agreement on its provisions, which are extensive. First is the limit on how many days you can take an opioid after you break your leg before you have to go back to your doctor for renewal. Second, public school students seen to be at risk will be interviewed and evaluated in terms of drug use. And other parts of the law deal with education, prevention and treatment. Those who arrive at the emergency room because of an overdose will be seen by a mental health professional before they are discharged — if, of course, they've survived.

Progress continues. This week the Centers for Disease Control issued new guidelines for physicians who prescribe opiods for chronic pain, the kind that persists for three months or more. Again, cancer and end-of-life care are excluded from the recommendations.

In an interview on the BBC, an American pharmacist described his countrymen (and women) as "wussies." Certainly we're winners on pills — Americans take 80 percent of the world's painkillers. Way back, before we were wussies, the medical world often did little about pain. The grin-and-bear-it philosophy was the "in" thing. But now we've been encouraged and nowhere more than when lying in a hospital bed. Nurses ask their patients several times a day about their pain level on a scale of one to ten, and they're often advised to take a pill to "stay ahead of the pain." After all, the record in the computer says it's okay.

Perhaps we need a little Nancy Reagan advice: "Just say no." Substitutes can be found, even if they don't produce the same sense of well-being. Our grandparents just gritted their teeth.

Ruth Bass is author of two historical novels. Her web site is www.ruthbass.com.


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