Massachusetts Medical Society: MMS Testimony on Governor Baker’s Opioid Legislation (The CARE Act)

MMS Testimony on Governor Baker’s Opioid Legislation (The CARE Act)

Good Afternoon, I am Dr. Hank Dorkin, the president of the Massachusetts Medical Society and a physician at Children’s Hospital. The Medical Society applauds Governor Baker, his administration, and all of you here today, on continued leadership on this issue, and on this important piece of legislation. 

The Medical Society strongly supports several important provisions. Providing evidence-based education to children and young people regarding substance use disorder will be essential to bending the opioid overdose curve and stopping this epidemic. 

With regard to harm reduction, while the existing naloxone standing order policy has served the state well, the revisions proposed here would ensure that more patients would have access to naloxone without a prescription from their doctor. We urge adoption.

In addition, the Medical Society also supports the “partial fill” provisions, which would clarify that a patient may return to a pharmacy after receiving a partially filled prescription to receive the remainder of the prescribed medication, if the patient feels it necessary. We hope that this revision will significantly increase the uptake of this option to receive a partially filled medication - thereby reducing the diversion of extraneous opioids left over when the pain is gone.

The Medical Society shares the Governor’s goal to increase electronic prescribing of controlled substances. To be clear, the Society believes that e-prescribing holds the promise to improve the process for patients and physicians alike and to increase security. We are working to further improve the underlying federal requirements and regulations. Once DEA regulations are updated, e-prescribing can be encouraged with less disruption to clinical workflows, and at less expense. We must, however, have simple, working systems that do not further impede already over-burdened physicians. Our submitted written testimony notes some of our remaining concerns about this mandate, and includes improvement suggestions.

The Medical Society takes issue with the provisions that would establish a Prescribing Oversight board, for the purposes of both “prescribing enforcement,” and to dictate prescribing doses or limits. We have long promoted the importance of assuring best prescribing practices, and we hold that those who prescribe inappropriately should be held accountable in order to protect patients. We believe, however, that professional licensing boards and the DPH’s Medical Review Group are the most appropriate path toward achieving these aims, and that additional bureaucracy should be avoided. 

The MMS also wishes to note concerns regarding the provisions that would expand the scope of civil commitments. We continue to worry that data do not support this, and that the present lack of treatment infrastructure would lead to boarding involuntarily committed patients in emergency departments.

In conclusion, the Society hopes to continue working with the Governor, the legislature, and fellow stakeholders to combat the opioid crisis. We hope, in recognition of crisis severity, to see additional evidence-based interventions promoted in this legislation. One such intervention would be the provision of Medication-Assisted Treatment provided to eligible patients onsite in emergency departments; another would be the establishment of a pilot supervised injection facility, under the auspices of and following a study by the Department of Public Health. We are eager to discuss any of the above comments, and we look forward to collaborating on these and other efforts.

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