Massachusetts passes new law to combat opioid abuse
Friday, July 27, 2018
On July 19, the Massachusetts Senate unanimously passed a new package of legislation aimed to combat the persistent problem of opioid addiction, abuse and overdose in the state.
Referred to as the "CARE Act" (an act for prevention and access to appropriate care and treatment of addiction), this 50-page, 97-section, piece of legislation hopes to address an issue that is said to be taking the lives of five people per day in Massachusetts.
Rep. Ryan Fattman (R-Sutton) called it "…a great initiative designed to help combat the opioid addiction crisis, and I hope this is a right step in helping those who need it and provides the resources to do that."
As a Massachusetts pharmacist myself, I’m encouraged to see that this issue remains a high priority. Some of the provisions make perfect sense and clearly build upon previous legislation to address our opioid problem.
For example, previous legislation required prescriptions for Schedule II controlled substances to indicate in writing that they may be "partially filled" by the patient. This has always been the case, but the laws helped to promote this fact both to patients and providers.
But a patient choosing to "partially fill" their prescription was left at risk of needing the balance and being unable to fill it since a Schedule II prescription cannot be refilled.
The new legislation would allow, with certain restrictions, a patient to fill the balance of their partially filled prescription. The new language states that "the remaining portion may be filled upon patient request in accordance with federal law; provided, however, that only the same pharmacy that originally dispensed the lesser quantity shall dispense the remaining portion."
I believe this law helps us, as pharmacists, to encourage patients to obtain a partial fill if the amount written by the provider is likely to be more than needed.
Another example of how this new law builds on prior legislation is the establishment of a statewide standing order for naloxone rescue kits. Previous legislation required pharmacies to obtain such a standing order, but left each pharmacy to find a willing physician to sign it.
But now we can anticipate that "the department shall ensure that a statewide standing order is issued to authorize the dispensing of an opioid antagonist in the commonwealth by any licensed pharmacist."
Personally, I wish this legislation would take a further step and require that all insurance plans licensed in the state would be required to a no-copay option for patients to obtain either a naloxone rescue kit or Narcan. While a standing order is helpful, it doesn’t address the cost-to-carry issue which may be significant for those who want to be ready to help.
Additionally, the new legislation moves toward requiring all prescriptions for controlled substances be transmitted electronically, rather than being hand-written. Section 32 states, "Prescribers shall issue an electronic prescription for all controlled substances and medical devices."
Hand-written prescriptions have the potential to be altered easily by either patients or pharmacists, and therefore the move toward electronic prescribing would make such alterations more difficult.
The legislation about electronic prescribing does contain clauses to allow hand-written prescriptions or oral prescriptions under certain situations where the health of the patients depends upon it.
There are also provisions in the new laws to promote treatment programs to help patients who are struggling with addiction. Incarcerated criminals will have the opportunity to obtain treatment for addiction prior to release.
According to Section 62, "A state or county correctional facility shall make treatment under this section available not less than 30 days prior to release of any person in the custody of a state or county correctional facility for whom such treatment is determined to be medically appropriate…"
I, for one, appreciate the effort made by this current piece of legislation. But laws alone cannot fix the problem. We need tougher enforcement and penalties, in my opinion, on those who are willingly involved in the profitable diversion of drugs in our state. I believe, for example, we must insist that payers collaborate with pharmacists to provide tapering services to help patients reduce their dependence on these drugs and transition to non-addictive options that often work better.
But the current laws are a step in the right direction. For the sake of our patients, we cannot let this issue go.
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