Massachusetts Medical Society: Fact Sheet: An Act Relative to Substance Use Treatment, Education and Prevention

Fact Sheet: An Act Relative to Substance Use Treatment, Education and Prevention

Chapter 52 - Acts of 2016

The MMS shares the Commonwealth’s concern with drug abuse and has put forth a variety of initiatives to address the opioid crisis. We commend Governor Baker, his administration and the State Legislature in crafting a law that offers a number of helpful measures to reduce prescription drug and opioid abuse. We also appreciate the significantly increased funding for addiction services, expanded insurance coverage, and enhancements to the state’s Prescription Monitoring Program (PMP).

Unless otherwise noted, these provisions became effective March 14, 2016.

Highlights related to the practice of medicine:  

  • Imposes a seven-day limit on prescribing of opiates to a patient for the first time. Provision applies to minors for every such prescription, with parental notification. For outpatient cases only. Exceptions for acute medical conditions, chronic pain, cancer and palliative care. (Section 24)
  • Prescribers must check the Prescription Monitoring Program (PMP) every time for a Schedule II and III narcotic is prescribed. Maintains current statutory language requiring regulations to recognize circumstances under which such narcotics may be prescribed without first utilizing the PMP, and permits delegates to use the PMP on behalf of the prescriber. Effective Oct. 15, 2016. (Section 27)
  • Allows patients to request a partially filled opioid prescription. The pharmacist must notify the prescriber within seven days. Prescribers must discuss with the patient the quantity of the prescription and the option to partial fill. Remainder of the prescription becomes void. (Section 21)
  • All prescribers must complete appropriate training in pain management and addiction, to be determined by boards of registration.  (Section 22)
  • Prior to issuing an extended-release long-acting opioid in a non-abuse deterrent form for outpatient use for the first time, a practitioner must evaluate the patient’s current condition, risk factors, history of substance abuse, if any, and current medications; and inform the patient and note in the patient’s medical record that the prescribed medication, in the prescriber’s medical opinion, is an appropriate course of treatment based on the medical need of the patient. (Section 23)
  • Prescriptions for extended-release long-acting opioids require the prescriber and patient to enter into a written pain management treatment agreement.  (Section 23)
  • Requires the Department of Public Health to establish a voluntary non-opiate directive form, indicating to all practitioners that an individual shall not be administered or offered a prescription or medication order for an opioid. Directive may be revoked at any time, in writing or verbally. Directive to be recorded in patient’s medical records. Exemptions for emergencies. Liability protections for prescribers and pharmacists.  Effective Dec. 1, 2016. (Section 23)
  • Establishes a benchmarking mechanism for prescribers. The Department of Public Health determines mean and median quantity and volume of prescriptions for opiates, within categories of similar specialty or practice types. Prescribers who exceed mean or median will be sent notice. Rankings are confidential, are not admissible as evidence in a civil or criminal proceeding and are not to be used as the sole basis for an investigation by the board of registration. Effective Dec. 1, 2016. (Section 29)
  • Requires the establishment of a drug stewardship program to be paid for by drug companies that makes it easier for patients to safety dispose of unwanted and unused medications. Effective Jan. 1, 2017 (Section 31)
  • Requires overdose and naloxone patients in emergency departments to undergo a substance abuse evaluation by a licensed mental health professional or through an emergency service program within 24 hours. Can’t be discharged before 24 hours or before evaluation, whichever comes first. Clinicians cannot be held liable in a civil suit for releasing a patient who does not wish to remain in the emergency department after stabilization but before a substance abuse evaluation has taken place. Parents of overdose minors must be notified. Emergency departments must notify a patient’s primary care provider, if known. Private insurers must pay for substance abuse evaluations without prior authorization. Effective July 1, 2016. (Section 32)
  • Requires the Mass. Behavioral Health Access website to post contact info for all insurers, including 24/7 phone number. (Section 61)
  • The Division of Insurance must develop a universal intake form for intake of behavioral health and substance abuse patients. (Section 67)
  • Insurers must report on medical/surgical, mental health and substance abuse disorder claims.  (Section 53)
  • Health Policy Commission, Department of Public Health and Department of Mental Health directed to study availability of services for dual diagnosis patients.  (Section 57)
  • Special commission on incorporating pain management and safe prescribing into student training. Commission members include MMS. (Section 58)
  • Special commission to study the feasibility of establishing a pain management access program. Commission members include MMS. (Section 59)
  • Prohibits the sale, manufacture or possession of powdered alcohol.  (Section 41)

Other highlights:

  • Authorizes the municipal police training committee to establish a training course on drug-related overdoses. (Section 1)
  • Requires drivers education programs to have courses on addiction and addictive substances. (Section 14)
  • Requires public schools to educate students about substance abuse prevention. Schools must develop and utilize a verbal screening tool to screen pupils for substance abuse disorders, at two different grade levels. The parent or guardian may opt out of the screening. (Section 15)
  • Those who administer naloxone in good faith are not liable for acts or omissions from attempting to administer the drug to anyone believed to be experiencing an overdose (Section 37)
  • The Board of Registration in Pharmacy must establish a rehabilitation program for pharmacists, pharmacy interns and pharmacy technicians who have a substance abuse issue. (Section 38)
  • Insurers, HMOs, behavioral health management firms and third party administrators under contract to Medicaid must cover substance abuse evaluations without preauthorization. Effective July 1, 2016. (Section 39).                 
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