Massachusetts Medical Society: MMS Comments to the Legislature on the Reconciliation of the CARE Act

MMS Comments to the Legislature on the Reconciliation of the CARE Act

The Massachusetts Medical Society commends both branches of the legislature on their advancement of the Governor’s CARE bill. As the opioid epidemic continues, we as physicians are fighting on the front lines to keep our patients alive, and we deeply appreciate all that the Governor and the legislature have done and continue to do to fight alongside us. We applaud the legislature for developing bills that would address many areas of dire need in the Commonwealth’s response to this epidemic. In particular, we commend the provisions of these bills that would shore up the statewide standing order for Naloxone, improve the process allowing for the partial fill of opioid prescriptions, and develop and fund innovative peer-to-peer physician education programs for both pain management and opioid use disorder. The Medical Society is proud to have partnered closely with the legislature on both the partial fill and the peer-to-peer education programs included in these bills, and we look forward to continuing to serve as a resource for evidence-based legislative solutions to the opioid epidemic, as well as to future public health crises. 

As the legislature moves to finalize the CARE Act, the Medical Society wishes to indicate support for two proposals included in the Senate’s version of the bill.

Electronic Prescribing

The Medical Society supports the Senate’s provisions on the electronic prescribing of controlled substances, as they add necessary flexibility for the Department of Public Health to promulgate regulations. The Medical Society has long promoted electronic prescribing, but has also cautioned the legislature that some flexibility will be needed to ensure that the transition to electronic prescribing does not inadvertently result in losses to access to medical care. 

We have been very pleased to work with the legislature to build in much of that flexibility, but one gap still needs to be addressed: the technical limitations of electronic prescribing are such that certain categories of prescriptions, such as compounded drugs, prescriptions written for third parties, and prescriptions with complex instructions, cannot be electronically prescribed because of limitation in the federal regulations controlling this practice.

Supervised Injection Facilities

The Medical Society also urges the legislature to adopt the Senate’s provisions on Supervised Injection Facilities (SIFs). As stated in the Medical Society’s 2017 Report on Establishment of a Pilot Supervised Injection Facility in Massachusetts,[1] the literature on SIFs shows that they are an evidence-based harm reduction strategy that has saved lives around the world, and that would save lives if implemented here in the Commonwealth. We therefore strongly supported the provision on SIFs that was contained in the Senate’s version of the CARE Act prior to the amendment process, which would have authorized DPH to promulgate regulations for the establishment of a SIF. However, we support the Senate’s current SIF provisions as an important step towards our shared goal. We are confident that a study of this issue will conclude with the same results that we found in our report, and that DPH taking up the question of establishing a SIF in Massachusetts will allow for further exploration of siting and for the state to contend with the legal questions it will need to answer prior to opening a SIF.

Medication Assisted Treatment in Jails and Prisons

The Medical Society strongly supports legislative proposals to assure the full spectrum of evidence-based medication assisted treatment for all persons with substance use disorder in jails and prisons. We therefore support the Senate version which takes an incremental approach across the entire system while also recognizing the life-saving value of MATs. This approach prioritizes serving individuals who are already receiving these life-saving medications so that they can continue treatment upon incarceration and also prioritizes individuals pre-release by ensuring they have access to these same medications at least 30 days before they are released to the community. Importantly, the Senate also creates a working group of state agencies, county sheriffs and the treatment community to ensure that the Senate provisions are implemented in a responsible manner that addresses the concerns of corrections staff and health care advocates. Taken together, this legislation puts Massachusetts on a more certain pathway to treating incarcerated individuals with treatment that best meets the need of that individual. 

The Medical Society is proud to partner with the legislature in the essential work of fighting the opioid epidemic in our Commonwealth. We look forward to the passage of a bill that will make vital strides in that effort, and to our continuing work with the legislature in the future.

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