Prescription drug abuse bill hits the governor's desk

Will reduce doctor-shopping, fraud and increase treatment

BOSTON – August 9, 2012 – With a new state report finding that 12 Massachusetts residents die every week from opiate-related overdoses serving as a backdrop, the House and Senate today gave final approval to legislation that will reduce the number of people abusing or selling prescription painkillers, while increasing opportunities for those battling addiction to receive treatment.

The bill requires, among other steps, that doctors, dentists and other practitioners conduct drug history screens for new patients. It also creates a professional working group to recommend new prescribing standards for painkillers, and requires all prescriptions for painkillers -- such as OxyContin, Percocet and Vicodin -- be written on tamper-resistant pads.

“This bill recognizes the role everyone has to play in battling this epidemic, from doctors and pharmacists, to parents and patients,” said the bill’s lead sponsor, Sen. John F. Keenan (D-Quincy), co-chairman of the Joint Committee on Mental Health and Substance Abuse. “It consists of practical, common-sense strategies that will have a real, positive impact.”

 “You know we’ve got a problem when drugs like these are responsible for more accidental deaths in Massachusetts than motor vehicle accidents,” said Senate President Therese Murray (D-Plymouth). “This was one of our top priorities and I’m glad that we got this bill done. The abuse of these drugs has devastating effects on individuals and families of every socio-economic background. The costs are high, both to families and the economy, not to mention the significant impact on public safety. This bill will help save lives and keep us all safer.”

“This legislation is a big step forward in dealing with the epidemic of prescription drug abuse in the commonwealth,” said Rep. Liz Malia (D-Jamaica Plain), the committee’s House chairwoman. “Too many lives have been lost and too many families have been destroyed. We are fortunate in Massachusetts to have the leadership of Governor Patrick, Speaker DeLeo and Senate President Murray, who truly appreciate how important it is for us to rise to the challenges we have before us. Hopefully this legislation will open the door to a better understanding of addiction and more effective ways of education and prevention.”

“This bill may well be the most important, life-saving legislation we've passed this session," observed Rep. Randy Hunt (R-Sandwich). “My thanks go out to all of the people who worked so hard to pull this together, most especially to our committee chairmen and staff, those who work in the field of addiction recovery, and individuals whose family members have been affected by the nightmare of prescription drug addiction.”

“This is the biggest step we have taken to combat the abuse of prescription drugs,” said Rep. Marty Walsh (D-Dorchester). “I want to thank the leadership of the House and Senate for pushing this legislation, and I would like to commend all of the advocates who worked tirelessly to pass this bill.”

The legislation includes a ban on synthetic stimulants known as “bath salts.”

“I am pleased that the House and Senate have acted upon this important piece of legislation,” said Rep. George Ross (R-Attleboro), who filed the original bath salts ban. “The ingredients found in this hallucinogen produce a potentially dangerous narcotic that is now readily available to anyone in Massachusetts. In passing this legislation, the Commonwealth has taken a proactive approach to eliminating this growing epidemic.”

A report released by the OxyContin and Heroin Commission in 2009 found that Massachusetts has one of the nation’s highest rates of opiate abuse, causing 3,265 deaths from 2002 to 2007 and 23,369 hospitalizations in 2006 alone. Last month, the state Department of Public Health released a study that found that 627 Massachusetts residents had died from opiate-related overdoses in 2009, the last year data was available.

The Patriot Ledger of Quincy reported last month that 93 people from 10 small South Shore communities had died from opiate-related overdoses between 2007 and 2011, and that 99 people had died in Quincy, Braintree and Weymouth alone between 2009 and 2010.

The Drug Enforcement Agency reports that Vicodin is the second-most abused drug by high school seniors, behind marijuana. Local police chiefs estimate that opiate addiction is the leading cause of property crime. Meanwhile, taxpayers are spending hundreds-of-millions of dollars annually in costs associated with the epidemic – including hospital visits, court appearances, jail time and social services.

Prescribers would automatically be enrolled in the state’s Prescription Monitoring Program when they renew their controlled substance prescribing license. They will then be required to use the PMP to review a new patient’s drug history to ensure the patient is not doctor shopping for painkillers. Limited exemptions from this requirement will be granted for emergency treatments, or if the PMP system is inoperable. Currently, participation in the program is voluntary, with only 1,800 out of 40,000 prescribers signed up. The bill also allows licensed professional staff in the practitioner’s office to conduct the screens, thereby not taking time away from patient visits.

To promote awareness, the Department of Public Health will be required to produce informational pamphlets explaining addiction risks, signs of dependency, where to go for treatment, and ways to safely store and discard drugs. The pamphlets will be distributed by pharmacies with each prescription filled.

Pharmacies, drug distributors and other relevant parties will also be required to alert local or state police when reporting missing controlled substances to the Drug Enforcement Administration. Under the bill, doctors and hospitals will be required to notify a parent or guardian of any minor treated for drug overdose. Information on substance abuse treatment options must also be provided, and a social worker will be available for counseling prior to hospital discharge.

The legislation also requires all prescriptions for controlled substances to be written on “secure” forms, using special watermarks, serial numbers or micro-printing to be determined by the Department of Public Health. This requirement is already in place for Medicare and Medicaid recipients.

In addition, the bill forms a working group of practitioners, nurses, and pain advocates to draft “best practices” for the use of prescription painkillers in the treatment of acute and chronic pain. The commission of the Department of Public Health can then turn those recommendations into regulations.

The bill also does the following:

•Restricts pharmacists from filling out-of-state prescriptions for narcotics unless the prescriptions were written by practitioners in the five contiguous states, plus Maine;

•Requires professional training for pharmacists on using the PMP as part of their relicensure process;

•Restricts MassHealth enrollees with a history of excessive use to one pharmacy;

•Allows sheriffs to enter into a study on the effectiveness of medication-assisted treatment for the successful transition of inmates back into society;

•Commissions a study on substance abuse among seniors; and

•Mandates professional training for court personnel and legal counsel on substance abuse services available for those facing criminal charges.

According to Centers for Disease Control, more people are overdosing on prescription pain killers (approximately 12,000 nationally in 2007) than on cocaine and heroin combined, with the number of people needing emergency treatment for overdoses having tripled in the last decade. Of the nearly 2 million emergency room visits nationally in 2009, almost half involved prescription drug abuse.

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