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.
