Sunday, July 29, 2012

Update on prescription drug bill: Please help

UPDATE: July 29, 2012
My latest info is that a rally will take place at 10am at the Statehouse tomorrow (Monday). As soon as I have a location, I'll let you know.

I understand that most of you cannot attend the rally, but you can help us out by sending an appeal to release this bill from committee via email to the House Way & Means chairman, Brian Dempsey. Original letters are best and most effective if they are short and concise.

Below, I've reproduced an example letter and bullet points about the bill that Kate McHugh put together.


[Sample Email]

Addressee list: brian.dempsey@mahouse.gov; stephen.kulik@mahouse.gov; marty.walz@mahouse.gov

Honorable Chair Brian Dempsey
Honorable Vice Chair Stephen Kulik
Honorable Asst. Vice Chair Martha Walz

House Committee on Ways and Means
State House, Room 237
Boston, MA 02133

I am respectfully asking you to release S.2125 (An Act Relative to Prescription Drug Diversion, Abuse and Addiction) from the House Way & Means Committee for a floor vote before the end of legislative session on July 31.

Ten Massachusetts residents a week die from prescription drug abuse. Hundreds more overdose and require emergency care.
More Massachusetts residents now die from opiate-related overdoses than car accidents.

Alarmingly, the prescription pill epidemic is out of control, devastating wonderful families and our children.

We need a strong law that better educates parents and children about the dangers of prescription drug abuse, reduces doctor-shopping and pill theft, and provides more help to our loved ones, friends, and neighbors in need.

The time is now for strong, practical and common-sense legislation that will combat this growing epidemic.

S2125 will save lives. Please pass it now.

Thank you for your consideration in this matter.

Sincerely,

[PROVIDE YOUR NAME, ADDRESS AND PHONE NUMBER]




[Additional information for composing your own email]:

FACTS:
* More Massachusetts residents now die from opiate-related overdoses than car accidents.

* Opiates kill more people than heroin and cocaine combined.

* As many teenagers are now experimenting with prescription painkillers as experiment with marijuana.

* Ten Massachusetts residents a week die from prescription drug abuse. Hundreds more overdose and require emergency care.


About S2125: This bill takes a number of important steps to address the prescription drug abuse epidemic gripping our communities. Specifically, S2125:

* Requires prescription painkillers come with an easily-understood pamphlet explaining the dangers of prescription drug abuse, where to turn for help, and how to safely store and dispose of the medications.

* Ensures that prescriptions for painkillers are written on secure, tamper-resistant prescription pads to discourage tampering.

* Requires doctors, dentists and other practitioners to simply check a new patient's drug history through an existing database once before prescribing painkillers, while providing exemptions for emergency situations.

* Forms a working group of doctors, nurses, and other health care providers to establish best practices for the prescribing of painkillers.

* Increases opportunities for pharmacists to check patient drug histories to prevent fraud.

* Ensures parents or guardians are notified when their child is treated in the emergency room for an overdose.
* Bans the sale, manufacture and use of "bath salts."

* Strengthens the State's Medicaid prescription drug fraud program.

* Establishes new professional substance abuse training for court personnel and attorneys.

* Provides for a pilot substance abuse education curriculum for five school districts with high prescription painkiller abuse rates.

* Provides for a Good Samaritan Policy, allowing for certain immunity to persons calling 911 during an overdose. It would also increase access to Naloxone or Narcan, a medication that can reverse a potentially fatal opioid overdose. This bill allows for expanded legal protection to prescribe, possess and administer Naloxone or Narcan to someone appearing to have an opioid overdose.


ORIGINAL ARTICLE: February 7, 2012
A key piece of legislation designed to combat multiple issues related to prescription drugs and "bath salts" is working its way through the process on Beacon Hill. A consolidation of a number of free standing bills, massaged and enhanced by the Joint Committee on Mental Health and Substance Abuse, the omnibus bill takes up where previous legislation left off after the report of the OxyContin and Heroin Commission several years ago.

The Committee has scheduled a public forum on the various aspects of this bill along with a discussion by doctors on new methods for detection and treatment of drug abusers, including a pilot program at the Barnstable County Correctional Facility using Vivitrol (extended release naltrexone).


Joint Committee on Mental Health and Substance Abuse Public Forum

An Evening of Solutions for the Problem of Prescription Drug Abuse

Monday, March 5, 2012 at 7pm
Sandwich High School Auditorium
Exit 3 off Route 6
365 Quaker Meeting House Road, East Sandwich, MA 02537



An Act Relative to Prescription Drug Diversion, Abuse and Addiction
S.2125 Section Summary
Prescription Monitoring Program
(Section 1,6,16,18A,21)
·        Requires a practitioner (not including a veterinarian), who prescribes controlled substances register as a participant in the Prescription Monitoring Program (PMP) when obtaining or renewing their Massachusetts Controlled Substances Registration.
·        Requires the Department of Public Health (DPH) to promulgate rules and regulations relative to the use of the PMP by registered participants that includes requiring participants to utilize the PMP prior to the issuance of a prescription for a narcotic drug contained in Schedule II or III to a new patient.
·        DPH shall specify the circumstances under which narcotics may be prescribed without first utilizing the PMP. 
·        DPH may also specify the circumstances under which licensed support staff may use the PMP on behalf of a registered participant.
·        Directs DPH to require pharmacists be trained in the use of the PMP as part of the continuing education requirements mandated for licensure by the board of registration in pharmacy.
·        Requires DPH to study the feasibility and value of expanding the PMP to include Schedule VI prescription drugs.
·        Requires DPH to notify pharmacists of the opportunity to use the PMP when conducting a prospective drug review.
·        Directs the DPH Commissioner to work with a nationally recognized entity specializing in prescription monitoring programs to establish interstate compacts between the commonwealth and other states that have programs and with those states that do not to securely share prescription data to improve public health and safety.
·        Requires a practitioner who is not registered with the PMP and who is identified by the PMP as within the top 30% of prescribers of controlled substances in the preceding 12 months to register as a participant in the prescription monitoring program not later than January 1, 2013. 

Report theft or loss of controlled substances
(Section 2)
·        Requires a person registered to manufacture, distribute, dispense, or possess controlled substances that discovers a theft or loss of controlled substances that requires the filing of a DEA Form 106 with the federal Drug Enforcement Administration must simultaneously file a copy of that form with local law enforcement and the state police.

Issuance of Schedule II prescription for a narcotic by an out of state physician
(Section 2B)
·        In addition to a Massachusetts practitioner, a prescription for a Schedule II narcotic may only be issued by a licensed physician in a contiguous state.

Naloxone (Narcan) prescriptions
(Section 2C)
·        Allows Naloxone (Narcan) or other opioid antagonist to be prescribed and dispensed for a legitimate medical purpose in the usual course of professional practice to a person at risk of experiencing an opiate related overdose or to a family member, friend or other person in a position to assist a person at risk of experiencing an opiate related overdose. 

Consumer education
(Section 3)
·        Requires the Department of Public Health to produce a pamphlet for distribution by  pharmacists with every Schedule II or III prescription that includes educational information on misuse and abuse for adults and youth, risk of dependency and addiction, proper storage and disposal, and addiction support and treatment resources.

Lock boxes for securing prescription drugs 
(Section 4,13)
·        A pharmacy registered in the Commonwealth to dispense Schedule II, III, IV or V prescription drugs shall make available prescription lock boxes for sale at each store location.
·        Pharmacies shall make customers aware of the availability of the lock boxes by displaying a sign on or near the pharmacy counter that: (i) is at least 4 inches by 5 inches; and (ii) includes the following statement in legibly printed font: “Lock boxes for securing your prescription medications are available at this pharmacy.”
·        Section 11 of chapter 283 of the acts of 2010 is repealed.

Tamper resistant prescription form
(Section 5,14)
·        Requires a written prescription for a controlled substance be written on a secure form.
·        Requires the Department of Public Health Commissioner to promulgate regulations concerning the security standards for written prescription forms.

Bath Salts
(Section 7)
·        Adds 16 chemical compounds commonly known as “Bath Salts” to the list of Class C controlled substances.

Good Samaritan
(Section 8)
·        Provides limited immunity from drug possession charges and prosecution when a drug related overdose victim or a witness to an overdose seeks medical attention.
·        Allows a person to receive and possess a Naloxone (Narcan) prescription and to administer it to a person appearing to experience an opiate related overdose.

Overdose notification and prevention for minors
(Section 9)
·        Requires the Department of Public Health (DPH) to produce a pamphlet with contact information for its Bureau of Substance Abuse Services, information on the benefits and availability of addiction treatment and on the prevention of future overdoses.
·        Requires any physician, nurse practitioner or hospital that treats a person under 18 years of age for a drug or alcohol overdose as defined by DPH to: (i) notify the minor’s parent, legal guardian or other person having custody or control of a minor child of the overdose as part of the discharge planning process; (ii) provide the pamphlet to the parent, legal guardian or other person having custody or control of a minor child and to the minor child; and (iii) provide access to a social worker, if available.

MassHealth Controlled Substance Management Program
(Section 10,17)
·        Requires MassHealth to establish a controlled substance management program for MassHealth enrollees who use excessive quantities of prescribed drugs.
·        Enrollees shall be restricted to obtaining prescription drugs only from the provider that the MassHealth designates as the enrollee’s primary pharmacy.
·        MassHealth must promulgate rules and regulations relative to the program, including criteria for participation, service restriction, responsibilities of primary pharmacy, change in primary pharmacy and participation status, utilization review, and enforcement.

Substance abuse training for Courts and CPCS
(Section 11,12)
·        Requires the Judicial Institute, in consultation with the Bureau of Substance Abuse Services, to provide substance abuse training for judicial and non-judicial personnel of the trial court, the appeals court and the supreme judicial court.
·        Requires the Committee for Public Counsel Services, in consultation with the Bureau of Substance Abuse Services, to provide substance abuse training for both private counsel who accept assignments and salaried public counsel.

Substance abuse education in schools
(Section 13A)
·        The study authorized by section 14 of chapter 283 of the acts of 2010 shall also include a cost estimate for a pilot substance abuse education program in 5 school districts that have surrounding communities with high rates of opioid drug abuse. 
·        The pilot program shall include evidence based curricula to decrease experimentation and provide skills for using prescription drugs appropriately.

Opioid prescribing practices
(Section 18)
·        Requires the Department of Public Health Commissioner to convene a joint policy working group consisting of 14 members to investigate and study best practices to promote safe and responsible opioid and other abused prescription drugs prescribing practices with the goal of reducing diversion, abuse and addiction.
·        Based on the working group’s report and recommendations the Commissioner shall promulgate rules and regulations relative to safe and responsible opioid prescribing practices with the goal of reducing diversion, abuse and addiction.

Medication assisted treatment on pre-release opioid dependent offenders
(Section 19)
·        Requires the Department of Public Health (DPH), in collaboration with the Department of Correction and the Massachusetts Sheriffs' Association, to study the use of FDA approved medication assisted treatments, including nonnarcotic, opioid antagonist therapies, for opioid dependent offenders leaving correctional facilities and transitioning to community based treatment programs. 
·        Allows DPH to enter into pilot programs to provide voluntary treatment for opioid dependent offenders with sheriff's offices that choose to participate with the goal of improving treatment outcomes and reducing recidivism.

Reschedule of a controlled substance from Schedule III to Schedule II
(Section 19A)
·        Directs the Department of Public Health Commissioner to reschedule the controlled substance hydrocodone combination product <15 mg/du (DEA Number 9806) from Schedule III to Schedule II.

Substance abuse treatment in the Massachusetts correctional system 
(Section 19B)
·        Requires the Department of Public Health, in collaboration with the Department of Correction and the Massachusetts Sheriffs' Association, to study the treatment programs and services available within the Massachusetts correctional system for offenders dealing with substance abuse and opioid dependency issues. 
·        The study shall focus on the accessibility and adequacy of those programs and services that currently exist within the department of corrections, and shall attempt to identify any gaps within the existing system and ways to improve upon the delivery and effectiveness of these treatment programs and services, including, but not limited to, the use of FDA approved medication assisted treatments. 

Prescription drug abuse among seniors
(Section 20)
·        Requires the Executive Office of Elder Affairs, in conjunction with the Bureau of Substance Abuse Services, to conduct a study of prescription drug abuse among seniors.

9 comments:

  1. Thanks for this information Randy. I've already send it out to the Substance Abuse Prevention Task Force. It is wonderful that the forum is coming here. As you know the Substance Abuse problem on the Cape is huge. Numbers keep going up and up. I'm sure this will be well attended. It is a great location!

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  2. Concerned in East SandwichFebruary 9, 2012 at 5:04 PM

    Randy, I would like to contact the Abuse Prevention Task Force. I feel that they are not doing much. I have neither heard nor read of anything they have accomplished and have not seen that there have been any meetings. Could you tell me who I should call to suggest that they either get new leadership or start doing something.

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  3. Linell Grundman frequents this blog and has commented on the committee's plans very recently. I'm not sure who else is on the committee, but I would imagine that the town clerk has the listing. 508-888-0340

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    Replies
    1. Randy,

      I am very well aware of the problem of drug abuse - especially here on the cape.

      But, honestly, is this bill really necessary? I ask this not suggesting that the problem not be addressed. I am asking because the solution being proposed in this bill will probably not do what is intended while doing a lot of collateral damage.

      Firstly, this bill seems to create a major bureaucracy and seems to force a lot of extra work on pharmacies and medical providers. This has got to cost something and that cost has got to be passed on to everyone = raising the already "highest in the country" cost of medical care here in Massachusetts.

      I personally don't want to pay more for paperwork. Especially since, in the age of computers, we can get this same information (it is already collected). The State already knows who's giving and getting prescriptions. If there are doctors abusing the system, there are many ways of finding that out and the medical board can fix that easily. If there are patients over prescribed, we know who's getting these prescriptions. Matching the doctors with the prescriptions can highlight what needs to be fixed. Do we really need hundreds of paperpushers added to the mix.

      Since this is one of the most stringent states, there is a massive hole here: drugs coming over our borders. If someone believes that the "street pharmacists" are selling mostly drugs prescribed here in Massachusetts - they're living in fantasyland.

      Is the object of the bill to grab abusers and put them into treatment facilities? If so, don't we have a way of doing this already?

      But the thing about this bill that bothers me most is the impact it's going to have on Hospice patients - Are we trying to cut down on the Oxy given to the 95 year old bone cancer terminal patient? Or are we just going to have her, her doctor and her pharmacy spend a lot of time and money on paperwork rather than her care?

      I know a 75 year old guy who got run over by a tractor a year ago (Don't ask - long story). He NEEDS 6 Oxycontin a day to get about 4 four hours of level 7 pain. Without the pills he would suffer tremendously. Is he addicted? Absolutely, probably. But what is the solution? Let him suffer to death?

      I feel the intent of this bill is great but it's throwing an atomic bomb of a solution and, I feel, is missing the real target and intent of the bill.

      Delete
    2. Steve, it's easiest if I comment on your remarks by embedding my responses. Mine are within [ ] marks.

      Randy,

      I am very well aware of the problem of drug abuse - especially here on the cape.

      But, honestly, is this bill really necessary? I ask this not suggesting that the problem not be addressed. I am asking because the solution being proposed in this bill will probably not do what is intended while doing a lot of collateral damage.

      [This is a legislative solution to help address a serious problem. Absent divine intervention, I believe a legislative solution is both proactive and reasonable. I'm under the impression that that’s why I was elected to this position: to find solutions to problems.]

      Firstly, this bill seems to create a major bureaucracy and seems to force a lot of extra work on pharmacies and medical providers. This has got to cost something and that cost has got to be passed on to everyone = raising the already "highest in the country" cost of medical care here in Massachusetts.

      [Not sure what major bureaucracy this bill will create. The PMP (prescription monitoring program) will be expanded. Disagree that pharmacies will be overburdened. Basically the pharmacist will have to staple an extra piece of paper to a script and send a copy of a theft form to local & state law enforcement. Does not strike me as “a lot of extra work.” The bill does ask controlled substance prescribers to run a PMP search on a patient the first time that patient is prescribed a narcotic. Consider that a best practice and not “extra work.” There is a cost to the bill, but it is minimal and should not raise health care costs; it is more likely that the reverse will happen and money will be saved by reducing RX drug diversion & abuse.]

      I personally don't want to pay more for paperwork. Especially since, in the age of computers, we can get this same information (it is already collected). The State already knows who's giving and getting prescriptions. If there are doctors abusing the system, there are many ways of finding that out and the medical board can fix that easily. If there are patients over prescribed, we know who's getting these prescriptions. Matching the doctors with the prescriptions can highlight what needs to be fixed. Do we really need hundreds of paperpushers added to the mix.

      [Not sure where you think extra paperwork will be generated. Most, if not all, is electronic already. The state already knows who’s giving and getting prescriptions. It’s called the PMP, which this bill seeks to enhance and improve--not create.]

      Delete
    3. Part 2 of Randy's response to Steve:

      Since this is one of the most stringent states, there is a massive hole here: drugs coming over our borders. If someone believes that the "street pharmacists" are selling mostly drugs prescribed here in Massachusetts - they're living in fantasyland.

      [I disagree this is one of the most stringent states. You are correct that scripts and RX drugs are making their way here and this bill seeks to reduce that pipeline.]

      Is the object of the bill to grab abusers and put them into treatment facilities? If so, don't we have a way of doing this already?

      [This bill says nothing about “grabbing abusers” and putting them in treatment.]

      But the thing about this bill that bothers me most is the impact it's going to have on Hospice patients - Are we trying to cut down on the Oxy given to the 95 year old bone cancer terminal patient? Or are we just going to have her, her doctor and her pharmacy spend a lot of time and money on paperwork rather than her care?

      [This bill will not affect those people who are using RX drugs for their medically intended purpose prescribed by a licensed practitioner in the normal course of practice. Don’t see in this scenario where any extra time, money or paperwork would be expended if this bill were to pass.]

      I know a 75 year old guy who got run over by a tractor a year ago (Don't ask - long story). He NEEDS 6 Oxycontin a day to get about 4 four hours of level 7 pain. Without the pills he would suffer tremendously. Is he addicted? Absolutely, probably. But what is the solution? Let him suffer to death?

      [This bill will not take this man’s pain meds away from him.]

      I feel the intent of this bill is great but it's throwing an atomic bomb of a solution and, I feel, is missing the real target and intent of the bill.

      [I'm glad you acknowledge the intent of the bill. Wrong analogy though. This bill is more like a laser guided missile of a solution that will hit its intended target and bring positive results to the Commonwealth in our war on RX abuse.]

      Delete
  4. The Task Force will be meeting Wednesday Feb.15th at 4:00 pm at Sandwich High School. Please feel free to contact me at 508.888.2601. There are minutes on file at the Town Clerks office covering the meetings that have taken place since. There will be new leadership in place after Monday when the Executive Board meets. You will hear more about the Task Force at this coming Thursday's BOS meeting.

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  5. Good discussion, and good initiative. I have felt for years that much more drug treatment could and should be done in the local jails. This has worked for severe alcoholics for years, just to get centered and dried out. Putting people up in rehabs is not better than putting them up in jail. Jail can and should be a good and spiritual place to be. Correctional facilities should be just that. Also, in the future I hope individual pills will be marked and tracked. There are just unbelievable shenanigans going on with the pharmaceuticals now, assume this is all blessed by the folks getting a cut of the profits. Branding pills is the way to go, as it's all automated, and nothing can get by the system. Keep up the good work.

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    Replies
    1. I find your comment on branding pills to be of interest. Exactly how would pills be branded. If they are, exactly how can they be traced.

      Thank you

      Delete

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