State Sen. Flanagan says hospitals ill-equipped for involuntary addiction admissions

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BOSTON — The Senate's point-woman on substance abuse said the decision to omit a key section of Gov. Charlie Baker's opioid abuse prevention bill in a redrafted version of the legislation had to do with the limited capacity of hospitals to handle an influx of patients battling addiction.

Baker filed legislation in October that proposed to allow doctors to hold patients with substance abuse issues involuntarily for up to 72 hours for treatment, similar to the civil commitment law for mental health patients.

That controversial section, however, was left out of the redrafted bill currently being polled through the Mental Health and Substance Abuse Committee. House Speaker Robert DeLeo hopes to move that bill to the floor for a vote in January.

"I know there's going to be some people who are disappointed by the fact that the 72-hour hold is not in there and we have an altered version, but I think it's very important that we have to work with what we have right now," said Sen. Jennifer Flanagan, the lead author of the Senate's substance abuse prevention bill and the co-chair of the House-controlled committee that rewrote Baker's bill.

After speaking with hospitals and emergency room heads, Flanagan said, "I'm not convinced there's a capacity to do that, the 72-hour hold."

House committee Chairwoman Rep. Elizabeth Malia released a copy of the new opioid bill Monday evening after it was sent to committee members for their review. Despite the Senate having already acted on their own substance abuse bill, Flanagan said she and her staff played an active role in helping to write the new bill.

Rep. Tricia Farley-Bouvier, D-Pittsfield, said in an email to Malia in response to the current bill language, "I appreciate the thought and work that has gone into it, but I feel that it is not strong enough. I am particularly concerned that we are not giving our medical professional all the tools they need to save lives when we are not giving the authority to hold overdosed patients. I will point out that giving the doctors the authority to hold a patient does not mean that have to hold everyone of them.

"My other concern," Farley-Bouvier said, "is in reference to the limit on prescriptions to minors. After to listening to many hours of testimony and spoken to local experts, no one has been able to convince me that a child, except those under very special circumstances, need anything close to a seven-day supply from a first time prescriber. I will be preparing amendments as this bill moves further through the committee process and onto the House floor."

Flanagan suggested provisions included in the Senate version, which passed in October, could be added onto the House bill, including her proposal to require schools to verbally screen students for signs of addiction.

"When the bill gets debated, who knows. Maybe someone in the House will add it. I think having both bills in play now is a positive sign," she told the News Service.

If the bill passes the House, the Senate would have an opportunity to make its own changes.

Instead of the 72-hour hold provision, the committee bill released by Malia recommended that all patients admitted for opioid overdoses undergo a mandatory substance abuse evaluation within 24 hours prior to discharge.

Flanagan suggested that the availability of licensed mental health physicians in emergency settings can vary from hospital to hospital, and the evaluation requirement would ensure that those who end up in an acute care setting are properly diagnosed.

"Not everyone who presents is an addict. The majority might be, but not everyone," Flanagan said. "Is it a single episode, did someone mistakenly take more of their prescription than they were supposed to, substance abuse, a mental health problem? Putting someone in detox who has a mental health issue isn't necessarily going to fix them," she explained.

The Leominster Democrat also said that committee leaders decided to recommend a seven-day supply limit on opioid prescriptions to first-time patients as a compromise to Baker's call for 72-hour limits, in part, due to concerns over accessibility for patients in more rural parts of the state to doctors and pharmacies.

"We're all working toward the same goal. We're all working to eradicate this epidemic and make sure the next generation of kids don't become the next addicts. But we have to continue to have the hospitals, the providers, law enforcement, the Legislature and the governor at the table."


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