Massachusetts Bill Would Limit First Opioid Supply to 7 Days

BOSTON — Patients prescribed opioids for the first time would be limited to a seven-day supply and any individual admitted to the emergency room with an apparent drug overdose would be required to undergo a substance abuse evaluation within 24 hours, under a redrafted House bill.

Setting the ball in motion for what House Speaker Robert DeLeo hopes will be a full debate in the House in January, the Mental Health and Substance Abuse Committee on Monday released a redrafted version of Gov. Charlie Baker’s opioid abuse prevention bill.

The bill, which is being polled through the committee, does not go nearly as far as Baker who proposed a 72-hour supply limit on first-time opioid prescription and recommended allowing doctors to hold patients involuntarily for up to 72 hours if deemed a threat to themselves due to substance abuse.

While the limit on prescriptions for adults would apply to first-time patients, the House bill also calls for all opioid prescriptions for minors to be limited to a seven-day supply.

“This bill is a significant step forward as we continue to address the rise in substance addiction that is so tragically devastating lives across the Commonwealth...,” said Rep. Elizabeth Malia, chair of the committee, in a statement. “I believe this proposal is a balanced approach that will improve our efforts at prevention and increase patients’ access to treatment.”

About an hour before the committee released the bill to its members for a vote, DeLeo said the committee was putting the finishing touches on the opioid abuse prevention bill in the hope of prepping the legislation for a full debate later in the month of January.

Members of the committee have until 4 p.m. on Wednesday to vote on the legislation, and DeLeo said that if it clears the committee it will likely have to go through the Health Care Financing Committee and Ways and Means before surfacing on the floor for a debate.

Baker, in a statement, said he is “eager to work with the legislature to bend the trend on opioid misuse and we appreciate the leadership of House Speaker DeLeo, Senate President Rosenberg and the committee to quickly produce legislation and we look forward to reviewing the bill.”

The bill, a redrafted version of Baker’s bill would require insurance coverage of the substance abuse evaluations mandated by the bill, and would update prescriber training guidelines for all physicians who prescribe controlled substances.

Doctors would be required, under the legislation, to check the state’s Prescription Monitoring Program every time a patient is prescribed a high risk opiate and note in their records the reasons for the medication, and patients could voluntarily put a note in their medical records informing prescribers that they should not be prescribed opioids. c

Baker two weeks ago invited lawmakers, including DeLeo and Rosenberg, to a screening in downtown Boston of a new HBO documentary on the scourge of opioid addiction of Cape Cod to drive home his desire to take comprehensive action soon to improve the state’s response to the crisis.

That film — “Heroin: Cape Cod, USA” — was to premiere on the cable network tonight Monday night.

So far this year, the Legislature has voted to pump additional resources into treatment beds and other prevention programs, and passed a law making trafficking in the powerful synthetic opioid fentanyl a specific crime.

The Senate passed legislation calling for safer prescribing practices and more physician training, insurance coverage for non-narcotics pain management, the ability of patients to request only partial-fills of opioid prescriptions and verbal substance abuse screenings of high school students.

A study led by Boston Medical Center and released late Monday afternoon found that most patients with chronic pain who are hospitalized after a non-fatal opioid overdose continue to receive prescription opioids after the overdose and are at high risk for experiencing a repeated overdose. The findings were published in the Annal of Internal Medicine based on an analysis of a national commercial insurance claims database with data from 50 million Americans over a 12-year period.

Researchers identified 3,000 individuals who had been treated in an emergency or inpatient setting for a non-fatal opioid overdose after being prescribed the drugs for chronic pain, and 91 percent of those patients continued to be prescribed opioids after their overdose, including 70 percent from the same provider.