Massachusetts Medical Society Testifies on Governor's Opioid Bill

Urges 7-day limit on opioid prescriptions with sunset provision in law; encourages consideration of partial-fill prescriptions; warns about possible consequences of involuntary confinement 

Contact: Richard Gulla
781-434-7101
rgulla@mms.org 

Waltham / Boston – Nov. 16 – Declaring that physicians “remain our patients’ best allies in addressing the consequences of opioid abuse,” the president of the Massachusetts Medical Society today testified before the legislature’s Joint Committee on Mental Health and Substance Abuse on House Bill 3817, An Act Relative to Substance Use Treatment, Education and Prevention, legislation proposed by Governor Charlie Baker to address the opioid abuse epidemic in Massachusetts. 

In beginning his remarks, Dennis M. Dimitri, M.D. applauded the Governor for his leadership in attacking the crisis and commended and thanked the legislature for its “thoughtful, multi-pronged approach to addressing this crisis,” including significantly increased funding for addiction services, insurance coverage, and enhancements to the state’s Prescription Drug Monitoring Program.  “We strongly support these and other measures,” Dr. Dimitri said. 

Declaring that the Medical Society supports many of the Governor’s proposals, Dr. Dimitri specifically addressed sections of the bill regarding prescribing limits, involuntary commitment, and the use of the Prescription Monitoring Program.    

Recommends seven-day limit on prescribing with sunset provision
Addressing prescribing limits, and recognizing that exceptions are being made for the needs of chronic and hospice care patients, Dr. Dimitri urged the committee to consider a seven-day limit for prescribing and to incorporate a sunset provision in law.  The sunset provision would take effect when the crisis has abated, prevent a “one-size-fits-all” approach to prescribing from being established in statute, and allow prescribers to care for their patients on an individual basis according to accepted standards of care.   

Dr. Dimitri noted that the Society’s guidelines developed in June already urge physicians to prescribe to patients with acute pain the minimum dosage necessary for the shortest needed time to minimize risk.

“We understand that there will be exceptions addressing end-of-life and cancer care,” Dr. Dimitri said, “and we continue to support incorporation of clinical judgment, fully understanding the severity of the significant challenges confronting the Commonwealth and our patients.” Dr. Dimitri said physicians look forward to working with other stakeholders to develop additional clinical exceptions allowed for in regulation.  

In recommending a seven-day limit, Dr. Dimitri called attention to practical considerations in deciding prescribing limits. He noted that opioid prescriptions cannot be phoned into a pharmacy and that only 2 percent of physicians have the capability of electronically prescribing opioids as they might a standard antibiotic prescription. 

“A patient with acute pain beyond the proposed initial 72-hour treatment period,” Dr. Dimitri said, “would have to return to their physician’s office, obtain a paper prescription, bring it to the pharmacy and wait for it to be filled. An elderly or disabled or poor patient, especially one without a helping caregiver or transportation, could be left to suffer.” 

Urges consideration of “partial-fill” prescriptions
Acknowledging extreme concern about the risk of unused opioids being diverted and the Society’s goal of reducing the overall number of opioids that are prescribed, Dr. Dimitri encouraged the lawmakers to consider allowing “partial-fill” prescriptions.  Allowing “partial-fill” prescriptions, he said, would help patients “balance the need to relieve pain with an adequate supply of pain medications by only filling part of their prescription, with the ability to later go back if necessary to fill the rest.”

The Medical Society has supported an effort by Massachusetts Congresswoman Katherine Clark, backed by 47 members of Congress, urging the Drug Enforcement Administration to allow partial-fill prescriptions.  Current DEA regulations prohibit partial-fill prescriptions. 

Involuntary commitment: May raise risk of overdose without support and worsen emergency department overcrowding, boarding, and diversion
Commenting on the involuntary confinement section of the proposed bill, Dr. Dimitri said “the addiction medicine colleagues that I have heard from have raised concerns that such commitment cannot work without access to treatment resources and post-hospitalization care.” 

“There is a paucity of evidence,” Dr. Dimitri continued, “that forcing hospitalization on patients not ready to make a change will be successful, and there is evidence that addicted patients released from hospitalization with no plans to pursue aftercare are at higher risk for opioid overdose.”

“My colleagues in emergency medicine and hospital leadership are concerned that this proposal could create a new standard of care requiring all patients who are suspected of having the potential to overdose to be involuntarily hospitalized. This will result in new demands on hospital medical and psychiatric beds that are already severely strained.” 

“The Commonwealth has spent a tremendous amount of time and resources in trying to resolve the issue of emergency department overcrowding, boarding, and diversion. This could further exacerbate that problem without actually benefiting patients.  New funding has become available to expand capacity; let’s see what progress we can make before adding more stress to our system.”    

Prescription Monitoring Program: Alerting physicians; Use already mandated
In addition to allowing “partial-fill” prescriptions to reduce the number of opioids prescribed, Dr. Dimitri also suggested enabling the Prescription Monitoring Program to "push" information to physicians, indicating how their prescribing patterns compare to their peers.  “Programs such as this have successfully reduced opioid prescribing in other states,” Dr. Dimitri said, “and we welcome the opportunity to work with you on developing language to allow for these concepts.”

In commenting on the proposal that the Prescription Monitoring System be used every time an opioid is prescribed, Dr. Dimitri called the lawmakers’ attention to the legislature’s recent law mandating the use of the PMP the first time an opioid or benzodiazepine is prescribed.  “We believe it would be prudent to keep the existing law in place without modification at this time,” he said. “As improvements are realized with the new PMP, we can better determine optimal use.” 

Restated the Medical Society’s multiple efforts
While recognizing that more needs to be done, Dr. Dimitri also reminded lawmakers of  the Society’s multiple efforts in combatting the opioid epidemic, among them new prescribing guidelines issued in June and adopted by the Massachusetts Board of Registration of Medicine, integrated into the practice of medicine, and disseminated to every practicing physician in the Commonwealth; free continuing medical education programs on opioids and pain management available to all prescribers in the Commonwealth; and the Society’s collaboration with the Commissioner of Public Health and the Secretary of  Health and Human Services to bring together the deans of  the state’s medical schools in developing  a first-in-the-nation set of medical education core competencies for medical students in the prevention and management of prescription drug misuse. 

Dr. Dimitri closed his testimony with a personal perspective.
“I am a family physician treating patients of all ages and circumstances across the entire socio-economic spectrum,” he told the lawmakers. “I take care of patients with cancer and end-of-life issues.  I take care of patients and families with addiction issues and chronic pain issues. I understand how complex this is and how much of a crisis it has become. I have re-examined by own prescribing patterns, and I have called upon my colleagues across the Commonwealth to do the same.”

“Addiction is a chronic disease,” he continued, “which is difficult to overcome. Reversing this epidemic will not be easy, but I am committed, as is the Medical Society, to do everything necessary to continue our efforts and increase our outreach for the benefit of our patients.”

“We look forward to working with you, your colleagues in the House of Representatives and Senate, Governor Baker, his administration, Attorney General Healey and other stakeholders in creating a multidisciplinary solution to this horrible problem affecting our Commonwealth and our country.”  

Complete testimony of the Medical Society may be viewed at www.massmed.org/testimony.  


The Massachusetts Medical Society, with more than 25,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society, under the auspices of NEJM Group, publishes the New England Journal of Medicine, a leading global medical journal and web site, and Journal Watch alerts and newsletters covering 13 specialties. The Society is also a leader in continuing medical education providing accredited and certified activities across the globe for physicians and other health care professionals.  Founded in 1781, MMS is the oldest continuously operating medical society in the country. For more information please visit www.massmed.org, www.nejm.org, or www.jwatch.org.   

Share on Facebook

New: Advertise With MMS

Increase your brand awareness and visibility to physicians and the general public through advertising space on the MMS website and several MMS email newsletters.

Read More »

Subscribe to e-Newsletters

Stay on the cutting edge of medicine by subscribing to free MMS e-newsletters. Choose from up to ten subject areas including physician and patient advocacy, public health, CME, daily health care news, and more. 

Sign Up »

NEJM Resident 360  Ad

MMSMediaWatch

FacebookTwitterLinkedInYouTube

Copyright © 2017. Massachusetts Medical Society, 860 Winter Street, Waltham Woods Corporate Center, Waltham, MA 02451-1411

(781) 893-4610 | (781) 893-3800 | Member Information Hotline: (800) 322-2303 x7311