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Gov. Baker gets it right on opioids, we got it wrong on crack

On opioids, Massachusetts Governor Charlie Baker (R) has been in the forefront, working with the Democratic-led legislature on intelligent, comprehensive legislation designed to save lives, assign accountability, and reduce costs. The passage and adoption of HB4056 shows what can be done – and what should be done – by every state.

Yet there’s something unsettling about this – for me and for many others.  More on that in a minute.

Friend and colleague David Deitz MD, also a member of the Mass Healthcare Services Board, was involved in this process; here’s his take:

Gov. Baker and his administration have shown real leadership in addressing this issue, and it’s important to note that other groups within the Commonwealth, notably the Department of Industrial Accidents and the Massachusetts Medical Society, have also acted in concert to address problematic opioid prescribing.  The MA Healthcare Services Boards’ guidelines have been updated to reflect the new legislation so there are no inconsistencies.  Much work remains to be done, but this is a good step forward that puts important protections in place for injured workers, in particular.”

Key components of the bill include:

  • a seven-day limit on first-time opioid prescriptions,
  • new efforts to evaluate patients within 24 hours after an overdose,
  • addiction screening for middle and high school students.
  • requires doctors to check a state Prescription Monitoring Program each time they prescribe an addictive opioid to prevent someone from getting prescriptions from multiple doctors;
  • incorporates education about opioid addiction into high school sports training; and
  • establishes a drug stewardship program to dispose of unneeded drugs.

The other 49 states would do well to consider similar legislation.

What bothers me about my/our focus on opioids is that the victims of opioids are generally white, with many middle-class.  Did we – me, you, the powers-that-be, legislators, governors – handle this differently than the crack or “pre-opioid” heroin crisis?

Yes.  And that’s just wrong.

Back when crack and heroin were predominantly a poor and minority issue, it was a crime problem.  Policing, criminal prosecutions and jail time were the approach.  Just contrast the sentencing guidelines passed by Congress and signed into law in the eighties with the legislation pending before Congress today. Crack sentences were 100 times longer than those for powder cocaine.  Today, the bills are all about naloxone, buprenorphine, and addiction treatment, brought to our attention by weeping elected officials.  Back then, it was quite a bit different.

Now that it’s affecting a wealthier and whiter population, the solution is education, prevention, compassion, a disease model of addiction.  Abusers are victims, not criminals.

What does this mean for you?

There are lessons to be learned here, some of them uncomfortable indeed.


9 thoughts on “Gov. Baker gets it right on opioids, we got it wrong on crack”

  1. Seven day first fill is a great idea. After wrist sx, my wife got a 35 day supply. She never used one pill, which created a new problem—how to dispose of them

  2. That is a very important question; why does the model reflect education and prevention for middle class whites addicted to pain pills and then moving to heroin due to cost, when the model was based on jail for lower class minorities?

  3. Don’t just jump into why they didn’t do something about completely different source of drugs, one of which is not legal. They have education and screenings about those drugs in the education system. No one has a handle on that supply chain. Heroin and crack are not dispensed by doctors. 4 of the 6 changes above are specifically related to the prescription arena with which they have control. The other two areas are addressed, we are just numb to it. Doesn’t anyone remember “Just say no”?? I completely agree this area should have been addressed a looooong time ago.

    1. Phillip – thanks for the observations.

      With respect, I’d suggest that no one is just “jumping into” what happened then vs. now. The url link in the post provides a chilling historical perspective on exactly what happened then vs now.

      I’m not sure I follow the rest of your comment, however the supply chain for illicit drugs is fairly well understood by law enforcement albeit it’s clear law enforcement has been unable to control supply. That is likely because demand is so high – and we must do a much better job on that end – as we should have with crack and heroin decades ago.

  4. I am a retired case manager with my own chronic pain issues. I have seen first hand the kinds of problems created by prescription opioid medications. What I am not hearing are alternatives are to be offered to long term pain patients. I am over 65, on Medicare, with significant arthritis in my spine and knees. On bad days pain meds make the difference between being able to enjoy life, take care of my home, spend time with friends and family versus sitting at home with ice packs and taking too much ibuprofen or other OTC meds to try to get at least some relief.

  5. Is it possible that we have moved to a more enlightened view on how to treat drug dependance issues? Back in the 80s we that passing tough laws would address the “problem” . Fail. Crack is still a scourge on society. I would also like to challenge the idea that opioid abuse is a white mans decease. The data I have seen and claims that I have dealt with indicate that opioids do not discriminate. Abuse is real in every social economic and racial category. Hurray for Mass leading the charge to stem the tide. Substance abuse is the symptom how are we dealing with the problem ? Joe I could be wrong my data is California based and primarily antidotal ,but please consider substance abuse as more than an opioid .

    1. John -great as always to hear from you.

      My take is opioid abuse is not ONLY a white disease, it certainly affects every race/ethnic group. What’s different is crack and inner-city heroin use disproportionally affected minorities, while opioid abuse affects whites.

      I’m not sure substance abuse is the “symptom”; it looks like the problem from here.

      Lastly, if I understand your point correctly, I wholeheartedly agree that substance abuse is more than opioids – there’s no question about that.

  6. I agree with much of this post. However, regarding the difference between the crack phenomenon in the ’80s and opioids, I don’t believe we have as much of an issue with violent suppliers and sellers.

    1. Thanks for the comment Steven. Your observation is correct however the legal penalties noted in the post as for possession or distribution; there are different penalties for violence independent of the drug charges.

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Joe Paduda is the principal of Health Strategy Associates



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