The Massachusetts Medical Society (MMS) wishes to be recorded in support of House bill 1343 and Senate bill 937
The MMS is a professional association of over 25,000 physicians, residents, and medical students across all clinical disciplines, organizations, and practice settings. The Medical Society is committed to advocating on behalf of patients, for a better health care system, and on behalf of physicians, to help them provide the best care possible. The Medical Society thus supports this legislation, which ensures that when persons on probation are engaged in active treatment for their substance use disorder, they are not incarcerated solely for a positive toxicology screen. The Medical Society believes this legislation will offer critical alignment between court policies and best medical practices for persons with substance use disorder, a population that is at high risk for overdose death.
Underlying this call for policy change is the reality that substance use disorder is a chronic brain disease, a common symptom of which is relapse. Relapse is part of the natural course of this disease, just as remission is for cancer or as a seizure is for epilepsy. When a patient in recovery experiences a sudden period of substance use, the standard of care is for the patient and physician to come together to discuss the occurrence and to reevaluate aspects of the care plan, such as medication dosage or behavioral health supports. The patient and physician together devise a modified plan to best treat the disease moving forward. Collaborative planning at this critical juncture in clinical care occurs at a vulnerable and dangerous time for the patient and cannot occur properly—or at all—if a patient is incarcerated.
In Massachusetts, persons with a history of incarceration are at a 120-times higher risk of overdose death than the general population. For individuals with substance use disorder, incarceration at the moment of relapse is actually worse than withholding treatment and can have a detrimental impact. The stress of incarceration, the disruption from family support, and the discontinuity in clinical care all increase risks of overdose and death—even despite the ongoing efforts to improve access to care for treatment of substance use disorder in correctional institutions.
Importantly, the concept of this legislation is conditioned upon a patient being engaged in active treatment, which can be a high bar for patients that is not easily met, as unfortunately many individuals are unable to remain successfully engaged in such treatment. While we believe all people with substance use disorder deserve compassion and a meaningful opportunity for treatment and recovery, it is especially critical for those in active treatment to main continuity in their care. It is in the patient’s best interest, from both a recovery and overall health perspective, not to be incarcerated, particularly for patients who—despite the fear and trauma that a relapse can provide—are committed to their recovery and are actively engaged with their physician in active treatment.
The state has made great strides in moving toward a humane, treatment-based approach to addiction. We have undertaken great efforts to increase access to low-barrier treatment and to promote life-saving harm-reduction efforts. Many remaining policy avenues to address the opioid crisis require significant state resources and capacity. This legislation requires neither; it ensures that patients on probation who are actively engaged in a treatment program can continue with their treatment, uninhibited by the disruption of incarceration, and have the best opportunity possible for recovery.
Thank you for your consideration of this matter. For the foregoing reasons, the Massachusetts Medical Society respectfully urges a favorable report on House bill 1343 and Senate bill 937.
