Massachusetts Medical Society: Dr. Alain A. Chaoui, President, Massachusetts Medical Society, Comments on CARE Act Revisions

Dr. Alain A. Chaoui, President, Massachusetts Medical Society, Comments on CARE Act Revisions

“The Massachusetts Medical Society supports the intent of the revised CARE Act and is thankful for the opportunity to have worked with Chairwoman Garlick and others as they take carefully measured yet urgent action to strive toward means to curtail the loss of life and loss of hope resulting from our state’s indiscriminate opioid epidemic.

“We are pleased at the commitment to streamline the process for securing naloxone statewide, particularly for those who may be at increased risk of overdose or who are likely to encounter an overdose. 

“The Medical Society has long held that increasing capacity for all forms of evidence-based treatment will save lives, and therefore commends the House for proposing a novel program to support prescribers of medication assisted treatment.

“The partial-fill provision is wise policy and is firmly endorsed by the Massachusetts Medical Society. In addition to giving the patient a stronger voice in managing their medically appropriate pain medication, partial-fill lessens the likelihood that unused opioid-based pain medication will be ingested by anyone other than the patient for whom it was prescribed.

“While the Massachusetts Medical Society is in support of the intent of the CARE Act, we take issue with some of the provisions contained within the revised bill. The incorporation of language on electronic prescribing is no doubt included with the noble intent of increasing patient safety, but we have concerns that the proposed rigid and broad implementation of e-prescribing guidelines could hinder work flow and patients’ timely access to prescription medications.

“We take issue with the 72-hour involuntary commitment of patients with substance use disorder, primarily because there continues to be uncertainty as to whether appropriate beds exist to care for these patients. In addition, the lack of appropriate facilities to take care of committed patients will exacerbate problems of overcrowding in hospital emergency departments that already exists.  Infrastructure must be created that will include the clinical bandwidth to support medically appropriate treatment when and if the patient is able to find an available bed. Finally, there is no good evidence that involuntary commitment of those not yet ready to commit to treatment results in better outcomes. 

“Evidence from the Massachusetts Department of Public Health compiled last August tells us that the opioid-related overdose death rate is 120 times higher for inmates released from Massachusetts prisons and jails, and, in 2015, nearly 50 percent of all deaths of among those who were released from incarceration were opioid-related.  We hoped that those unfortunate statistics would have compelled the Legislature to include a provision or provisions that would make available in Massachusetts prisons and jails medication-assisted treatment (MAT) for inmates in an effort to save lives and increase the opportunity for recovery from substance use disorder among one of our most vulnerable populations.

“Solving the opioid crisis is by no means simple nor can it be accomplished without collaboration from a multitude of concerned parties, including physicians and those in the health care realm who can most directly affect outcomes for those with substance use disorder. We stand by readily to continue our work with the Legislature to work toward policy based in the latest evidence and to discuss innovative measures to improve public health and to foster harm reduction.”

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