In March, Governor Baker signed An Act Relative to substance use, treatment, education, and prevention into law. Its ultimate goal is ending the opioid epidemic that currently plagues Massachusetts. The bill unanimously passed both chambers of the legislature.
It is clear that both the Governor and the legislature see the imperative to act immediately on this issue. Just three years ago, there were fewer than 700 opioid-related deaths. According to the Department of Public Health, there were 1,526 opioid-related deaths in Massachusetts. Current estimates lead legislators to believe that there were nearly 12,000 incidents that emergency responders responded to regarding opioid use , with as many as 12,982 units of naloxone (Narcan) being used to treat those cases. Currently, Massachusetts has an average of 4 opioid-related deaths every day. This is a serious problem in Massachusetts that must be addressed before more preventable deaths occur.
The legislation passed in March takes important steps. First and foremost, the law now limits the number of opiate pills a first-time adult patient or child can receive—up to a week’s supply. The bill also allows patients to voluntarily reduce the amount of opiate medication prescribed to them. Additionally, the law creates a statewide prescription monitoring program designed to track the amount of opiate medication people are prescribed and to prevent addicts from seeking different doctors to obtain multiple prescriptions. It aims to increase awareness about opiate abuse in schools and other public institutions by mandating that all schools verbally screen students who may be at risk of substance abuse, and by adding more educational awareness programs. Before being released, all people hospitalized for opiate abuse must now: (1) receive any and all information related to FDA-approved recovery efforts, and (2) for those checked into a hospital for 24 or more hours, they must now be given a substance abuse evaluation before being released. The bill also sets new training requirements for physicians to be able to prescribe opiates to patients given that historically patients have been overprescribed opiate medication.
While the legislation makes extraordinary leaps and bounds towards curbing opiate abuse in Massachusetts, there are still areas beyond the legislation that need to be addressed. For one, nothing is mentioned about future efforts to reduce the stigma surrounding opiate abuse. Many people believe that it is easy to identify people who suffer from drug addiction, but as the opioid crisis has demonstrated, that is not always the case. People from all economic and social classes have succumbed to opiate overdoses. However, many people still have the idea that all addicts are “junkies”, and that all victims have made themselves into addicts. Last year, Governor Baker, using an $850 thousand federal grant, launched the “State Without StigMA” campaign. While the campaign seeks to address the gross mischaracterization of small stereotypical subsect of people being the only ones affected by opioids, it appears the message has become lost in the mass media market that exists today. The extreme dearth of op-eds and other forms of media attention focused on this element of the opiate issue reflect this problem. As a result, the state should look further into increasing the attention this campaign receives, as well as assessing how it can be made more effective before making necessary changes.
Similarly, while the law allows municipalities to take action on a local level, municipalities must also be willing to take action. While units of Naloxone – the only drug that reverses the effects of an opiate-induced overdose – are continuously used, and are readily available to cities and towns, presently only 111 municipalities of the roughly 350 are actively using Naloxone. While some may say that the administration of Naloxone is outside the purview of local government, the pervasiveness of the opiate crisis requires that towns act with more intense engagement with their residents. At the local level, residents and town administrators can best examine and highlight just how it is that opioids are affecting their communities, and then take the necessary measures to provide opiate addicts and their families with outlets they feel they can go to in order to receive help. This relates to the administration of Naloxone in that since many cities and towns pay for their own fire and police departments—why would municipal civil servants not want to carry Naloxone given that they will be first responders at the scene of the next overdose? In a medical situation, any additional time that someone has to wait to receive a drug that will reverse their overdose means that they are that much closer to death, and becoming another grim statistic. By further involving cities and towns in addressing this state-wide epidemic, the state government can also reduce the burden put upon it to resolve the problems given its sheer size and lack of ability to handle every single drug overdose, which could in all likelihood be better handled at the local level.
In addition, the lack of housing readily available to recovering addicts has worsened the epidemic. In New England, homeless adults between the ages of 25 and 44 are nine times more likely to die of an opiate overdose than addicts with a stable source of housing. The legislation passed in March does not address this issue. For a firsthand look at the damage the opiate crisis is causing, one need only travel to “the Methadone Mile” near Boston Medical Center. It is ironic how, just outside one of the best hospitals in the state, people are able to get high while simultaneously running the risk of ending their own life.
In order to combat opiate addiction, we need not only better treatment options, but improvements in the housing system and other areas. For instance, the state should look into reforming its Bureau of Substance Abuse Services (BSAS) by potentially merging some of its recovery treatments that last for less than 30 days with some that last for more than 30 days. An example would be if legislators could pursue the creation of more programs like the Tewksbury Stabilization Program, where homeless, uninsured men, after detoxifying, receive case management, psycho-educational groups, and other self-help groups designed to help them cope with their present situation. In conjunction, if after someone has detoxified, the state could provide them with some type of career and job counseling by helping them try to find a job by potentially partnering with businesses who would be willing to hire recovered addicts, the state could attempt to incorporate them back into society if it also provides shelter long enough for someone to get a stable source of income before they can go out and get a place of their own.
One model that could drive meaningful reform on this issue is the Beth Israel Deaconess – Plymouth’s (BID-Plymouth) Integrated Healthcare and Substance Use Collaborative. Partnering with the Plymouth Police Department, the Plymouth school system, and the Massachusetts Mental Health and Drug Court in Plymouth, BID-Plymouth has been able to significantly curb the number of opiate overdoses on the South Shore. The central mission of the collaborative is to provide assistance and guidance to recovering addicts and their families. One of the first steps they have already taken is staffing their emergency department with psychiatrists, social workers, and mental health clinicians, which most hospitals do not. BID – Plymouth has also come up with a solution for people to dispose of unused medication, regardless of type, by creating a “MedSafe” drop box location on its premises.
Law enforcement plays a key role in this dynamic as well. Last December, the Plymouth Police Department launched Project OUTREACH (Opioid User Taskforce to Reduce Epidemic and Care Humanely). This program is an outreach program directed towards victims of an overdose and their families within 24 to 48 hours post-overdose. The program’s central goal is to provide victims with a method to enter treatment without the pain or humiliation that often comes when someone admits themselves to drug rehabilitation.
While not all-encompassing, the legislation passed by the legislature and signed by the governor this past March was still a large step forward in the Commonwealth’s efforts to end the ongoing opioid epidemic. However, much more needs to be done to improve the lives of those most vulnerable to opiate addiction. At the local level, municipalities must step up and accept their responsibility in helping to solve to the crisis, much like stakeholders in Plymouth have, as embodied in the BID–Plymouth initiative. The state can also intensify its de-stigmatization campaign, while supporting those addicts who may be homeless with resources for as long as they need before they are financially stable to work themselves back into society. Together, the state and local governments along with hospitals and good Samaritans alike, can help curb the opioid epidemic in Massachusetts, and one day, maybe even end it.