A bold plan to tackle the opioid crisis in Massachusetts is fueling a debate over how far to go to stop the flow of potent painkillers that bring relief to some ailing patients but pave a path to addiction for others.
The legislative proposal from Republican Governor Charlie Baker would restrict doctors’ power to prescribe painkillers — while giving them new authority to force drug addicts into immediate treatment.
“This is an issue that is a public health epidemic. And you don’t solve problems like that by nibbling around the margins,” Baker told STAT in a recent interview.
Baker’s plan goes farther than any other state. It has drawn strong bipartisan support; law enforcement agencies have lined up behind it, too. But doctors, dentists, and civil liberties advocates have raised concerns.
The proposal would limit doctors to prescribing a 72-hour supply the first time they issue opioids to any patient. That’s meant to address heart-wrenching testimony from patients who got addicted after receiving an opioid supply of a month or more for a routine medical procedure.
There is some flexibility: Doctors can write refills for longer than three days. And the bill is expected to provide exemptions for certain conditions, such as cancer or end-of-life treatments. But that doesn’t satisfy critics.
“The problem is that it’s really hard to create a comprehensive list of exemptions that’s going to meet every potential scenario that comes along,” said Dr. Dennis Dimitri, president of the Massachusetts Medical Society and a practicing doctor. He supports Baker’s overall approach to the crisis but says this provision goes too far.
Baker’s not the only politician targeting the issue. Both Republican and Democratic presidential candidates have called for reining in painkiller prescriptions. GOP candidates Jeb Bush and Chris Christie have spoken about the destruction that addiction has wrought in their own families and social circles.
Some patient advocates fear that this kind of rhetoric, paired with some policy proposals to regulate opioid prescriptions, risks putting patients who desperately need relief in the same category as drug addicts buying pain pills — or heroin — on the street.
“They’re two very, very different [illnesses], and they’re two very, very different populations of people,” said Cindy Steinberg, an advocate for patients in pain who is herself a chronic-pain patient. “It’s a total misunderstanding.”
Every day, 44 people in the US die from a prescription painkiller overdose. Overdose deaths from prescription opioid pain relievers have increased threefold between 2001 and 2013.
But a recent government survey found 78 percent of those who misused prescription painkillers got them from sources other than a doctor. And numerous studies have found that only a small fraction of patients who get opioid prescriptions ultimately become addicted.
Baker, however, says legal opioid prescribing has gone too far in Massachusetts. Last year, providers in the state wrote 4.4 million opioid prescriptions, averaging nearly 36 pills, capsules, and tablets for every man, woman and child in the state.
That’s helped drive a grim death toll: In Massachusetts, opioid overdoses killed 684 people in the first half of this year, on track to outpace last year’s total. The state’s death rate from opioids and all other drug poisoning is classified as significantly higher than the overall US rate by the Centers for Disease Control and Prevention.
“The challenge we face on this one is creating a sense of urgency in the provider community, not so much about the upside benefit of pain medication but about the downsides associated with addiction on this stuff,” Baker told STAT.
Baker’s proposal also targets patients who might start out with prescription drugs and later become addicted to heroin. The governor says he’s motivated in part by stories he’s heard about addicts who overdose and are revived on the brink of death with the antidote Narcan — only to walk right out of the hospital and inject again within minutes.
That’s why he wants to create a new 72-hour window in which addicts could be held against their will for treatment.
The provision would apply only to addicts deemed a danger to themselves or others. The patients would be able to legally challenge the decision. And doctors, police, and family members would still have to go through the courts, as they do now, to seek a longer period of involuntary commitment.
Another governor who has tried to lead on the opioid abuse issue warns that it’s tough for states acting alone to overcome what’s become a nationwide crisis.
“If we don’t get a federal FDA that’s going to work with us, we can keep beating our heads against the wall, spending more money, spending more resources to try to be creative, but we will continue to fail until we really have a significant national conversation about our approach to painkillers,” Governor Peter Shumlin of Vermont told STAT in a recent phone interview.
Shumlin, a Democrat, has criticized the FDA for approving the use of the narcotic painkiller OxyContin by children with unremitting pain.
He told STAT he thinks Baker’s proposal to restrict opioid prescriptions is “a great idea” and said he’s “looking at anything that works.”
In Missouri, where drug overdose deaths are also classified as significantly above the national average, mental health department chief Mark Stringer said he’ll also be watching Baker’s bill closely. “I’ll just be looking for ideas,” Stringer said.
Maybe it’s worth mentioning that at one time the Joint Commission on Accreditation of Healthcare Organization had as one of their standards for hospitals and emergency rooms that every patient be asked about their level of pain and that this be charted. If doctors did not address patients pain they could be reported to their state board and if a review by the board found that the doctor did not address the patients pain disciplinary action would and did occur
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