Opioid Policy Issues Continue to be Center Stage at the State House

By: Chris Niles

The recent announcements of two major private initiatives, RIZE Massachusetts and the Grayken Center at Boston Medical Center, focused on the treatment and prevention of substance use disorders are welcome additions in the fight against opioid addiction in Massachusetts. The misuse of opioids continues to take lives at a frightening pace in the Commonwealth and presents a complicated challenge to elected officials and policy makers across the United States.

Early data from the Massachusetts Department of Public Health indicate that 2016 was another devastating year as opioid overdose fatalities will approach or exceed 2,000 deaths, the deadliest year thus far. As of now, 1,465 deaths are confirmed with another 469 to 562 estimated to be designated as an overdose fatality. Equally shocking is that these numbers would have been much worse if not for the availability of the drug naloxone, used to reverse an overdose, which was administered approximately 12,000 times in 2015 (the last year data was available). Most recently, a report by the US Office of Health and Human Services found that the Commonwealth had the highest rate of opioid related Emergency Room visits among 30 states included in the study.

The sheer scope of the opioid epidemic in Massachusetts will require a sustained effort over many more years to bring under control. For over a decade the Commonwealth has increased resources, made significant policy changes and raised awareness about stigma in an effort to curb the epidemic. The Legislature has passed a series of omnibus bills over the last several legislative sessions to address different but interrelated aspects of the epidemic. Laws and regulations have been strengthened to mandate prescriber education, to encourage regular queries of the Prescription Monitoring Program by prescribers, to provide education to students, to improve access to quality treatment and to supplement treatment capacity. The implementation of the Commonwealth’s 1115 Medicaid waiver will add new resources and capacity in critical areas of the continuum of care and the system of five Recovery High Schools offer students with substance use disorders a safe and supportive environment to continue their education.

The Legislature also authorized a study, the Chapter 55 report, by the Department of Public Health in cooperation with other state agencies that utilizes pooled state data to try to identify patterns and gain a more comprehensive understanding of the underpinning issues of opioid misuse in Massachusetts.  For many years, hard data about the opioid epidemic was hard to come by, either siloed in agencies across state government or simply not collected. The data and analysis in the Chapter 55 report confirms that we are not facing an epidemic of misuse of only one class of drug, rather an evolving epidemic of misuse of many substances. The surge of fentanyl use in particular, identified in 75% of overdose fatalities in one set of recent data, combined with the emergence of carfentanil and the presence of benzodiazepines in postmortem overdose reports all illustrate the dangerous mix of chemicals that are being misused and are a driving factor in these fatalities. The changing nature of the epidemic over time has made it a moving target for providers, regulators and law enforcement.

As the Legislature considers its next policy priorities on opioids, we’re likely to see an emphasis on adding tools to sustain a client’s long term recovery in their community, one of the more elusive and frustrating aspects of this chronic disease. In many ways, policy makers have worked through many of the immediate challenges but the buildout of a comprehensive response is not yet complete. While many of the pieces are in place or coming online, pulling all of the components of treatment together to create a streamlined continuum of care that will be evidenced based, efficient and effective for clients remains a work in progress. The workforce challenges faced by the provider community could also present a chilling effect to the state’s response. As new programs open or expand  the demand for qualified professionals in the field is a pressing need across the state and attracting significant numbers of new staff will be critical to building a sustainable network. Additionally, training more medical professionals in addiction medicine and training existing staff in the latest advances in the field will help improve provider capacity. While much was done through the STEP Act around prevention, research and policy continues to develop around how to best identify opioid misuse at the earliest stages. The use of data to target resources and analyze trends is a new and important resource and some hope the application of mobile technology could be part of the solution.

Many of the remaining opioid policy issues are also intertwined with other challenges we face in Massachusetts but are crucial to the opioid epidemic as well. Affordable housing and homelessness, gaps in education, lack of job skills or work experience, complicated family dynamics, criminal records, co-occurring disorders and collateral health issues can all face clients as they work to sustain recovery. With the additional attention and resources that have now been brought to bear, perhaps we’ve reached a critical mass and a more robust understanding of what it will take to treat this public health crisis.