By TOM RELIHAN
Friday, January 15, 2016
(Published in print: Saturday, January 16, 2016)
GREENFIELD — A comprehensive bill to address various aspects of the state’s opioid abuse crisis headed to a conference committee after passing in the state House of Representatives this week.
The bill, with the conference panel crafting a final version agreeable to both the House and Senate, focuses primarily on prescription opioid painkillers — considered by many as a gateway to addiction and use of illegal street drugs like heroin.
Dr. Ruth Potee, a Greenfield family physician who specializes in addiction treatment and recovery, says she’s pleased to see a provision in the bill that would require school nurses to screen students for substance-abuse problems and refer them to treatment if necessary.
The House version of the bill, Potee said at a substance abuse prevention conference Friday in Hadley, removed two provisions from the Senate version that she found problematic. The first is a mandatory three-day hold of emergency-room patients at risk of substance abuse or overdose. The House bill only requires those patients to be evaluated within 24 hours of being discharged. Whether to pursue further treatment would be left up to the patient.
“We actually need to get people access to treatment fast who want it,” she said, in a way “that doesn’t involve withdrawing under lock and key in an emergency room. That is now not part of the legislation, and that’s a good idea.”
House Republicans attempted to reinsert the three-day hold as an amendment, but it was shot down. Opponents of the provision called it unconstitutional.
The second problem provision, she said, would have limited new patients to a three-day supply limit on their first prescription for opioids. That limit would be expanded to seven days in the House measure.
“Seven days seems like an easier number to work with,” she said. “If you’re seeing someone on a Thursday, they’re going to run out on a Saturday. With seven days, you can see them on a weekday, so it’s better than three. It gives a provider time to get old medical records and check the prescription monitoring program to make sure things are where they are.”
Potee said the legislation would represent another step toward creating a “partial-fill” prescription program to allow pharmacies to fill patients’ prescriptions in small increments at their request instead of all at once. That would allow patients to self-limit their access to the drugs.
“It’s the notion that you could go to a pharmacy with a prescription and fill just a little bit of it, leaving the rest there,” she said.
Potee said she doesn’t feel that the proposed legislation goes far enough in improving access to treatment programs. Most of what has been done there so far, she said, has consisted of opening up acute, short-term detox beds, which typically allow for a minimum stay of 14 days under new state laws.
Such a short-term facility is planned for Greenfield this spring.
“Detox beds for opiates don’t really help people truly get better,” Potee said, noting that short-term detox has the chance to put a person back on the streets with a higher risk of overdose. “What it does do is give you a chance to breathe and get a real plan in place.”
She said she’d like to see legislation expanding access to long-term therapeutic treatment options instead.
“That costs money. From a state level, that conversation is just not happening,” said Potee, a member of the Franklin County Opioid Task Force.
She said one of the few options for that sort of long-term, sober-living treatment in the state involves becoming incarcerated at the Franklin County Jail and House of Correction, which offers treatment programs for inmates.
“If you want to be locked up for treatment, you want it to be there, and you want it to be longer than three months,” she said. “I don’t want anyone to be locked up, but what I do want is for people to go to a place for nine to 12 to 15 months, where they can actually get that type of treatment. (The jail) is the only place being funded, but couldn’t you imagine it being on a farm? There are models for this in the world that work.”
Task Force Director Marisa Hebble agreed with Potee on many points, noting that the bill includes many provisions that would enhance efforts to prevent drug use.
“To be honest, it looks very good,” said Hebble. “It looks like they included a lot about prescription medication, which is good, particularly for prevention, and it does include some important pieces on the assessment side.”
She said she, too, would liked to have seen to see more support for long-term treatment and recovery options.
“I think we still have a lot of work to do on the treatment and recovery support sides, particularly when it comes to sober housing and supporting long-term recovery,” she said. “But as a first step, this makes headway.”
The bill would also require schools to develop and implement substance-abuse prevention and education policies, prohibit sending to jails women ordered to treatment, and require doctors use the prescription-drug monitoring system and explain their reasons for prescribing opioids in a patient’s medical records instead of other pain management.
State Rep. Paul Mark, D-Peru, said he thinks the seven-day limit on first time prescriptions is a positive step toward reining in the trend of over-prescribing powerful painkillers.
“What we’re seeing more and more is that a lot of people are getting hooked because of over-prescription of opioid medicines,” he said. “There used to be too much of an emphasis maybe on making sure pain goes away at any cost, and it’s saturated the market with these pills. It’s either that people think it’s safe because it’s prescription, so they should take it but it’s leading to people getting hooked.”
He also expressed support for the increased focus on requiring use of the prescription monitoring system for the same reason.
Mark, who represents 2nd Berkshire District, noted that the Task Force held meetings with other state agencies and leaders while the bill was being formulated, which he believes helped shape its overall direction.
Mark said the controversial three-day hold provision was rightfully jettisoned from the legislation. He said hospital emergency rooms would essentially be turned into short-term detox centers under that measure.
“Detox is painful to go through and watch,” he said. “When you have your kid in there maybe for a broken bone, and have gurney after gurney of people handcuffed down, it’s just not appropriate at this time.”
Franklin County Sheriff Christopher Donelan said he’s pleased to see a bill designed to make mandatory throughout the state a series of initiatives that he and other Task Force members have been implementing voluntarily. He’s particularly excited about the monitoring system and first-prescription limiting provisions.
“To have it required statewide is certainly more effective,” said Donelan, a former legislator. “When they blend it together with the Senate version, we’re hoping the conference committee will produce something comprehensive and great for all of us.”
Moving forward, Donelan said he’d like to see some future legislation increasing support for jails to help incarcerated people battle addiction.
“I think these bills are missing opportunities to help incarcerated people and give us more resources to dig into the hard-core heroin addiction we’re seeing” in the jail, he said.
The bill would also create a variety of committees to continue studying the epidemic.
You can reach Tom Relihan at: firstname.lastname@example.org or 413-772-0261, ext. 264 On Twitter, follow @RecorderTom