2016: A Year of Promise in the Fight Against Opioid Addiction
When it comes to addressing opiate addiction, it’s all beginning to come together. Within mere days of each other, Massachusetts Gov. Charlie Baker signed a historic law holding great promise to curb the Commonwealth’s opioid epidemic; the Centers for Disease Control and Prevention (CDC) released new guidelines for prescribing opioids; and the U.S. Senate passed the Comprehensive Addiction and Recovery Act of 2016 (CARA) by a near-unanimous vote. All this, just a matter of weeks following President Obama’s fiscal 2017 $1 billion budget proposal in new mandatory funding over two years to expand treatment access for prescription drug and heroin addiction. These changes represent significant momentum in addressing addiction, as it trends to claim even more lives in the next several years than the 165,000 cited by the CDC in the five-year period prior to 2014.
What’s not new is that Massachusetts is again charting new territory; many of the law’s provisions are regarded as the first in the nation. Further, the historic law addresses treating opioid addiction as a chronic disease, much like diabetes or asthma, as described in Beacon Health Options’ white paper, “Confronting the Crisis of Opioid Addiction,” released last summer.
The Massachusetts measure, most of which is effective immediately by declaration as an emergency law, includes limits on opioid prescribing, school-based screening, substance misuse evaluation and treatment in hospital emergency departments (EDs). It also significantly broadens education regarding the risks of opioid use and addiction – for elementary and secondary students, police, prescribers, junior motor vehicle operators, and patients receiving an opiate prescription at an outpatient pharmacy. Highlights include:
- Limits to a seven-day duration for first-time opioid prescriptions for adults and children, outside of cancer treatment, chronic pain management, end-of-life care, and palliative care
- Requires prescribers to check the Prescription Monitoring Program with each new opioid prescription
- Permits patients to fill a lesser quantity at the pharmacy than was prescribed, and to create a non-opioid directive in their medical record
- Requires substance misuse and prevention education policies in all public schools
- Requires that a substance misuse evaluation be performed on a patient suffering an opiate-related overdose within 24 hours of arriving at an acute hospital ED
- Requires that all patients be informed about the availability of medication-assisted treatment, upon discharge from a substance use disorder treatment center
It takes a village to make policy change
The level of public commentary that informed the CDC guidelines is illuminating. The more than 4,300 public comments submitted to the CDC on the draft recommendations included patients and families affected by addiction, as well as health policy experts and clinicians. Such a level of patient engagement and advocacy is the cornerstone of the education and prevention movement to counter the increasing prevalence of opiate addiction.
In brief, the guidelines, which cover opiate prescribing for pain management in adults but not children or adolescents under 18, include dosing limits and patient counseling. Targeting primary care clinicians, prescribers of close to half of all opioid prescriptions, the recommendations also address the collaboration between primary care clinicians and other providers, such as behavioral health clinicians.
Finally, at the federal level, before Congress now, the CARA proposes to fund treatment, recovery services, and education, as well as to expand availability of naloxone. Having passed the Senate, it has yet to be raised for a vote in the House.
Beacon Health Options joined many legislators, patient advocates and other health care stakeholders at the ceremonial bill signing at the Massachusetts State House. Feelings were palpable as Gov. Baker, at one point unable to speak through his emotion, expressed the despair we all feel over the lives lost but also the hope that this landmark legislation brings as a crucial step in saving lives.
If you or a loved one is grappling with addiction, go to Beacon’s Opioid Treatment Resources page on our website to learn more about the treatment options available to you.