The Massachusetts Legislature passed substance addiction legislation that enhances intervention, prevention, and education efforts, including the creation of a framework to evaluate and treat patients who present in emergency rooms with an apparent overdose.
This new practice, which will be covered by insurance, is designed to ensure the proper assessment and discharge of patients who seek voluntary treatment. If a patient refuses treatment, information on health and community resources will be provided. This framework reflects the 2012 University of Miami Medical School findings that voluntary treatment is more effective and affordable than involuntary commitment.
“Substance abuse and opioid addiction in our communities are tragedies playing out in real-time, but it is heartening that policymakers have made this issue a top priority,” said Senator Jason Lewis. “This urgently needed legislation will build on the steps we’ve taken in recent years and match political will with unprecedented budget investment in strengthening continuity of care and prevention.”
The bill limits first-time opiate prescriptions to seven days for adults and all opiate prescriptions for minors to seven days, with exceptions for chronic pain management, cancer, and palliative care. Practitioners must now check the prescription monitoring program (PMP) each time they prescribe any opiate and correspondingly note that in the patient’s medical records.
From its discussions with numerous stakeholders and recovery groups, the Legislature recognizes the importance of empowering individuals as they grapple with addiction. As a result, this bill establishes a non-opiate directive form, allowing patients to include a notation in their records that they shall not be offered opiates. It also provides the option of a “partial fill” which allows patients, in consultation with their doctor, to request a lesser amount than indicated on the script; however, this language is permissive and pharmacists may use their discretion.
In an effort to build upon current prevention efforts, the legislation updates current law – which requires all public schools to have a policy regarding substance abuse education – by directing schools to report their plans to the Department of Elementary and Secondary Education (DESE). DESE will then consult with the Department of Public Health (DPH) to provide recommendations that will assist schools and ensure they are providing effective and up-to-date education. Additional education materials will be provided to all student-athletes.
Schools will annually be required to conduct a verbal substance abuse screening in two grade levels. These screenings are subject to appropriate ages and include an opt-out provision for students and parents. Additionally, school districts implementing alternative substance use screening policies may opt out of the verbal screening tool requirement.
To ensure that unused medications are safely collected and disposed of, this legislation requires manufacturers of controlled substances in Massachusetts to participate in either a drug stewardship program or an alternative plan as determined by DPH.
Over the past few years, the Legislature’s efforts related to substance addiction have focused on behavioral health and the prevalence of co-occurring disorders. This legislation requires the Health Policy Commission to conduct a study on access to dual-diagnosis treatment in the Commonwealth for children, adolescents and adults. To help ensure parity between behavioral and physical health care, the legislation also requires insurance companies to report annually on their denied claims.
This bill also:
• requires that contact information for all insurers be posted on the bed-finder tool website and updates the law to ensure the site is available 24 hours a day;
• requires that patients being discharged from substance addiction receive information on all FDA-approved medication-assisted therapies;
• ensures civil-liability protection for individuals who administer Narcan; and,
• updates the training guidelines for all practitioners who prescribe controlled substances.
This legislation follows a 65.2% increase in substance addiction funding since FY12 and the landmark substance addiction law passed in 2014 which, for the first time, mandated detox and stabilization insurance coverage. The two bills are intended to complement each other and reflect a consensus-driven approach.