Shortly before vowing last month to control the growing opioid epidemic, Massachusetts Governor Charles Baker eliminated $500,000 in funding for a program designed to curb the inappropriate prescribing of such drugs by physicians.
The legislature had appropriated the funds for Alosa Foundation to distribute clinical information and best prescribing practices to physicians. But the governor took away the money amid $50 million in midyear budget cuts.
The Boston-based non profit runs academic detailing programs, which emerged more than a decade ago as a counterbalance to the commercially driven sales calls made to doctors’ offices. Industry critics complained drug makers are motivated to distribute self-serving medical literature that highlights the uses of their medications, but may not fully incorporate other information that physicians need for providing treatment.
By contrast, academic detailing programs receive government funding in order to provide a more even-handed spectrum of evidence-based material to doctors. A 2007 study by the Cochrane Collaboration, which is an independent network of researchers, health care professionals, and patients, found that academic detailing programs can be effective in improving physician practices in most circumstances.
Baker’s decision to cut the funding to the Alosa program came less than two weeks before the governor singled out physicians for reckless prescribing, noting that doctors wrote more than 4 million opioid prescriptions for 200 million pills in 2014. “Prescribers in Massachusetts — and across this country — are far too casual about the addictive consequences of these medications,” he said during his State of the Commonwealth speech.
During his address, the governor also pointed to several proposed initiatives to combat the problem, including a bill to limit the number of prescriptions doctors can write, and a program to train medical students to assess the use of opioids as pain treatments.
As a result, the cut to Alosa’s program left one of its board members puzzled.
“Here we have a proven program that is able to deal with a widely abused medicine and it was deep-sixed by the executive branch,” said Dr. Jerry Avorn, a Harvard Medical School professor who helped create the Alosa Foundation. “It doesn’t make any sense.”
A spokesman for the Department of Public Health, which was to have administered the program, did not explain why the funding for the Alosa program was targeted.
He noted, however, that the state has provided $1.3 million to Alosa over the past two fiscal years for the opioid program and another for improving antipsychotic use in nursing homes, where these medicines are sometimes prescribed inappropriately. The state, he added, is renegotiating a contract with Alosa to renew a separate antipsychotic program.
Unlike the opioid program, funding for the antipsychotic program came from a 2013 settlement in which Johnson & Johnson agreed to pay the state $62.5 million to resolve allegations of illegal marketing of two antipsychotics, Risperdal and Invega. Of that, $2 million was earmarked for state Department of Public Health grants that would reduce inappropriate use of antipsychotics in nursing homes.
“Investing in education and treatment, overall, not just one program, and in ways beyond academic detailing is a priority,” said the spokesman. The antipsychotic program, he explained, may be used as a test model for others.
However, Avorn said the Alosa program had value. “Most people understand that doctors want and need education about managing pain without relying so much on opioids, since this information is not covered well enough in the medical training most of us have had,” said Avorn, who does not receive compensation from Alosa. The nonprofit provides academic detailing material or training in Maine and Pennsylvania, among other locales.
Avorn further maintained that talks have not been held to renew the antipsychotic detailing program, which was originally envisioned running four years. “Both programs are now dead as a doornail,” he said.
The Baker administration, which took office in January 2014, last spring signaled that funding for the opioid program would not be continued, according to Avorn. In fact, the governor vetoed funding for the program for the current fiscal year. Last summer, the legislature overrode his veto and reinstated the funding, but the Department of Public Health did not follow through and provide the funds to Alosa.
“The new administration has not been as big a supporter of noncommercial drug information as the old administration,” said Avorn.
Meanwhile, Alosa last month hired Cheryl Bartlett, who was the Department of Public Health commissioner in the Deval Patrick administration, as its new chief executive. She arrived four days after Baker deleted the Alosa funding from the budget. Prior to taking the job with Alosa, Bartlett was executive director of the Cape Cod Regional Substance Abuse Prevention Initiative.
A consumer advocacy group criticized the state’s decision to eliminate funding for the programs such as Alosa’s.
“These programs provide a good counterbalance to industry marketing and help doctors make good choices about prescribing for patients,” said Brian Rosman, research director at Health Care For All, which is based in Boston. “In the scheme of things, it’s not a lot of money. It seems foolish and counterproductive to have cut it” from the budget.
An earlier version of this story incorrectly spelled the name of former Massachusetts Governor Deval Patrick.
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