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.”
- 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.