Massachusetts report outlines ideas from those working to fight addiction


BOSTON >> In addition to touting the pivotal work of community coalitions in the fight against heroin and opiate addictions, the Massachusetts Health Council in a report released Friday described opposition to legalizing marijuana for recreational use and called for tighter regulations on medical marijuana facilities and a ban on medical marijuana edibles.

The Needham-based council's report, based on interviews during February and March with coordinators of 21 substance abuse prevention coalitions, recommended developing prevention curricula for students and parents, providing more resources to address an inadequate treatment system, and changing pain medication prescribing practices.

The council is a non-profit group of more than 150 health and public policy related organizations in Massachusetts. Gov. Charlie Baker has tasked a working group with examining the opiate crisis and that panel is expected to release its conclusions in June. Council officials plan to submit to the working group their recommendations, which are drawn from survey respondents and interviews and from the council based on its analysis of respondent data.

In addition to mandating and enforcing usage of the Prescription Drug Monitoring Program by all prescribers, the council report recommends establishing prescriber guidelines for hospital emergency departments, and one respondent called for the removal of patient satisfaction ratings from prescriber compensation structures, saying the ratings "create an inherent 'perverse incentive' by financially motivating doctors to appease patients seeking prescription pain relief."

Jeffrey Stone, the report's principal researcher and the council's director of programs, said busy physicians, including those in emergency rooms, need to be judicious about authorizing opiate-based painkillers and mindful of all options available to treat pain.

Hospitals are eager to please patients and give consideration to patient satisfaction surveys, Stone said, and physicians are often pressed for time. "Sometimes they may be likely to prescribe pain-killing medication because their patient convinces them that they ought to have it," he said.

Massachusetts public health officials in April estimated a total of 1,008 unintentional opioid-related deaths in Massachusetts during 2014, up from 967 in 2013.

Politicians should also take steps to better inform themselves about marijuana legalization, an idea that activists hope to bring to a statewide ballot vote in 2016, the report said. Activists used the ballot in 2008 to decriminalize possession of less than an ounce of marijuana and in 2012 to legalize medical marijuana.

"For example, politicians need to know how legalization will affect our youth. They should study reports documenting the impact of legalization in Colorado, some of which include upsetting and frightening impacts on youth," the report said. According to the report, one unnamed respondent told the council, "I would like to see legislators in that case [passage of such a referendum] REFUSE to allow it to take effect until the research has been done. I think laws should not be passed by the vote of an uneducated public who are not experts in the topic under consideration."

Several top state officials have come out against legalizing marijuana for recreational use while supporters of that idea express confidence that Massachusetts voters will pass a ballot law.

Stone said the council has not officially staked out a position on legalizing recreational marijuana, but said those involved in coalitions working to fight addiction expressed opposition to the idea during interviews.

"They are trying to convey that it's not okay to try dangerous substances. We heard it directly from the mouths of some very committed, passionate people," said Stone, who has a master's degree in health care management and previously worked in public health and at health maintenance organizations.

The report also recommends banning powdered alcohol and making 21 the legal age to purchase tobacco, while monitoring other substances such as "steroids, MDMA (ecstasy or 'Molly'), Flakka, bath salts, spice, K2, Scooby Snax, N-Bomb, Kryptonite, Cloud 9, Bliss, and Adderall."

Community coalitions often include police, district attorneys, drug courts, high schools, middle schools, elected officials, parent groups, treatment centers, houses of worship, support groups, prescribers and pharmacies, the business community, councils on aging, civic groups and others, according to the report.

"Many of our substance use prevention coalitions have existed for a long time, usually targeting youth and usually focusing on alcohol and marijuana, rather than heroin and other opioids," the report said. "In the past two or three years, they have responded to the dramatic increase in heroin use and overdoses."

Calling peer pressure "enormous," Stone said coalition officials make use of data submitted anonymously by students regarding what substances they say they are using and what they believe other young people are using. "The kids usually think that more of their peers are using things than is true," he said.

Coalition officials also try to get the word out about heroin use and prescription drug abuse, Stone said, asserting that some people who become addicted to prescription painkillers find the expense too cumbersome and eventually turn to heroin as a cheaper alternative.

"We respect really the people who are doing this work," Stone said. "They are struggling to get parents to listen."

Some coalitions are unfunded, the report said, "and this is not the kind of work that unpaid volunteers can shoulder for very long."


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