Madeline McGill
On the Road to Recovery: The State of the Opioid Crisis in Massachusetts
Most heard the news when it broke, even if only via a headline on a Facebook page: "Opioid deaths in Massachusetts top 1,000 in 2014." This number, a tragic record for the Commonwealth, was as heartbreaking as it was alarming. A 63% increase over 2012 and 20% increase over 2013, the issue could no longer be denied and could certainly not be ignored.
Even this month as Governor Baker proposes a bill to address the crisis, politicians and residents are still struggling to understand the issue and where it came from. Sometimes misunderstood as a heroin epidemic alone, opioids include medication prescribed to relieve pain, and include common prescriptions such as Vicodin, OxyContin, Demerol, and also morphine. It could affect anyone.
Why are opioids so prevalent in Massachusetts? We have one of the top health systems in the world with unparalleled doctors. However, the Centers for Disease Control (CDC) found in 2012 that Massachusetts was in the top 10 states when it came to prescribing long-acting and high-dose opioid pain relievers. Furthermore, only 36% of those who were prescribed an opioid in Massachusetts said the doctor explained the risk of addiction – compared to 61% nationally.
The crisis is costing both lives and tax dollars. Every day, four people in Massachusetts die from drug overdose. In 2014 alone, the Commonwealth spent an estimated $584 million on health care costs from Opioid-abuse related costs (the 15th largest dollar amount in the nation). Even taken responsibly, opioids can be extremely addictive. The CDC states that once addicted, patients are 40 times more likely to become addicted to heroin.
In an interview for the Boston Political Review, Rhonda Mann, Director of Communications for the Massachusetts Office of Health and Human Services, detailed why the addictive drugs have such a potent effect on residents, and why they're treated differently than other prescribed controversial drugs, such as marijuana.
"Opioids are extremely powerful drugs that are highly addictive in nature," Mann said. "I'm not a doctor or a researcher, but if you look at brain images after taking opioids for a period of time, there are actual changes that show up on a brain scan. Opioids are also legal, by prescription. While marijuana is now legal by prescription in Massachusetts… the number of those prescriptions is extremely small in comparison."
Given the damaging impact opioids have had on the Commonwealth, many believe they are right to be treated differently. The question that remains is how to address them in a manner that makes communities safer while still allowing those with injuries and chronic pain to be properly treated.
In February, Governor Baker put together an Opioid Working Group, made up of 18 experts including clinicians, sheriffs, court judges, social workers, public health experts and treatment center heads. From this working group, 65 recommendations were made. Mann explains that these recommendations were broad in scope, while addressing a common issue.
"Recommendations spanned from increasing the number of treatment beds, to making wider access to community based outpatient services, placing recovery coaches in hospital emergency rooms, and mandating that insurance cover up to 14 days of medically necessarily acute treatment," she said.
These recommendations came after hosting listening sessions and hearing from more than 1,100 individuals across the Commonwealth. To achieve these recommendations, the working group composed of 10 key strategies, including: Utilizing data to identify hot spots and deploying appropriate resources, encouraging substance use prevention education in schools, increasing distribution of Naloxone to prevent overdose deaths and acknowledging that punishment is not the appropriate response to substance abuse disorders.
Based on these strategies for reducing abuse and misuse, this working group was followed by a bill proposal from Governor Baker in mid-October. The bill proposes two regulations that were met with some controversy. The first, reducing the changes of addiction by capping all first-time opioid prescriptions at a three-day supply. Although there would be exceptions for emergency medical conditions and palliative care, many critics argue that under this rule many in need of medication will be forced to go without. The second controversy rests in allowing hospitals to hold addiction patients against their will for up to three days while trying to place them in treatment. Relying on an involuntary commitment system already in place for people deemed a danger to society and themselves, Baker hopes to stop the cycle of emergency room overdose patients who arrive some days later for the same treatment.
"If you overdose, to the point where you are on the verge of death or you have died and Narcan [a drug that blocks the effects of opioids and reverses an overdose] brings you back to life, we don't have a standard in place that says you are a immediate danger to yourself," Baker said at a press conference following the announcement of the bill. "Seriously?"
This aspect of the bill has been met with some pushback from the ACLU and the Massachusetts Medical Society. Some fear that doctors may find themselves in a gray area of when to commit patients, and potentially threaten to deprive an addict of their liberty, potentially resulting in legal challenges. Furthermore, the state already faces a shortness of treatment beds, which will not be alleviated by involuntary committals. From a patient's perspective, some fear that the involuntary holding period will act as a deterrent for addicts to seek treatment at all.
There is much that can be done to lessen the impact of the opioid crisis outside of hospitals. A larger proponent of the bill focuses not only on reducing excessive prescribing practices and creating new emergency pathways to treatment – but on education. This includes education for practitioners but also for athletes and their parents, especially on college campuses. The bill suggests that opioid training for any and all schools that belong to the Massachusetts Interscholastic Athletic Association. Mann argues that this is only the beginning of what college campuses can do to address the opioid crisis.
"One of the biggest things college campuses can do is to educate students about the dangers of opioids," she said. "They can also make sure Narcan, a drug that when administered can reverse an overdose, is available near dormitories."
Furthermore, Police departments across Massachusetts have been dealing with the crisis in the own right. To fill gaps in treatment, many departments have been creative in their approach to handling addiction in their towns.
"In Gloucester, police started a program, funded by local donors, that allows anyone with a drug problem to show up at the police station, no questions asked, and get treatment," said Mann. "In Worcester County, the Sheriff has designed a 1-hour education program for high school kids that starts with a photo of a jail cell and has incredible stats about high numbers of kids who end up in jail because of addiction. Law enforcement has been really out in front on this issue. Finally, many town police departments allow officers to carry Narcan in their cruisers in case it is needed."
In the fall, the Senate had already passed its own bill focused on education and prevention related to the opioid crisis. In the coming months, it is expected that Baker will be working with the House to create a legislative package to address the crisis. In order for this to be successful, Baker must win over the medical community, many of whom oppose outright or worry that the bill would limit their ability to treat patients fully. However, beyond this disagreement, everyone agrees that some action must be taken. The issue can neither be handled by the medical community, law enforcement, nor the government alone, and must come as a collective effort from all departments, agencies and residents of the Commonwealth. A bill will change little unless residents are able to work on reducing the stigma that surrounds mental health and addiction and acknowledge that punishment will do little to solve the problem. From there, Massachusetts might be able to work together to reduce a preventable crisis that has already taken thousands of lives too many.
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