- Office of State Auditor Suzanne M. Bump
Media Contact
Mike Wessler, Communications Director
Boston — Good morning, Chairwoman Flanagan, Chairwoman Malia, and members of the committee. Thank you for the opportunity to testify relative to the substance abuse legislation before you. There are good ideas relative to education, reporting, Narcan, administration, and the establishment of a women’s treatment center as an alternative to MCI Framingham in the legislation you have bene considering. The apparent consensus around these ideas suggests their easy passage into law, and I certainly urge you to do that.
What I would like to focus on today are a few elements of Governor Baker’s bill, HB3817, about which there is less consensus.
Ten and more years ago, I was often in this building seeking support for the treatment of alcohol and other drug abuse. I was then a recent co-founder and board member of a Brockton residential recovery home for 21 women. I was also a lawyer and lobbyist for the Recovery Homes Collaborative. I was always grateful for the support we received from the Committee.
When I first because involved with the Edwina Martin House a dozen years ago, most of our residents were addicted primarily to alcohol and they were mostly in their 30s and 40s. In the span of less than a decade, the residential profile changed. More women in recovery there now are in their 20s, and their drugs of choice are opiates. They got hooked more quickly and at a younger age than the house’s original residents. In many cases, it happened before they had learned how to navigate the normal ups and downs of adult life, never mind wrestle with a life-threatening disease. This phenomenon, repeated across the genders and the Commonwealth, demands that we bring new strategies to the fight against addiction and to its treatment.
There are 3 aspects of the Governor’s bill I would like to address. Two provisions impose what I understand physicians regard as intolerable limitations on their professional practice since they add restrictions to their prescription-writing authority. I respectfully disagree with their view. I believe the curbs are warranted, not as a matter of my personal philosophy or political expediency but as a reasoned position based on my office’s analysis of patterns of opioid prescription practice.
I would like to share two slides that are products of our burgeoning data analytics capabilities, which we will be bringing to more of our audit work. We have been testing our new data engine on MassHealth data, to which we have real time access. In an effort to determine whether we might be a resource to state agencies grappling with the opioid addiction problem, we have made numerous queries of this data, two of which are highly relevant to this discussion.
The first slide, filled with what appear to be star bursts, depicts something far more ominous. The center of each star represents an individual, opiate-prescribing physician. The surrounding blue dots represent MassHealth members to whom they have prescribed opiates at least 10 times AND who live more than 75 miles away. While only further investigation will determine if these doctors are part of the supply chain feeding our epidemic, this and other queries we have run certainly support the contention that some limits are warranted, even on the practice of legitimate physicians, in order to curb dangerous access and abuse.
The second slide looks like a web. At its center, however, is not a victim, but a perpetrator. In this case, we tested an algorithm much like Amazon’s product recommendation feature. You know - if you like Product A or Product B, you are apt to like Product C. In this case though, if you got opiates from Doctor A or Doctor B, you were likely to also get them from Doctor C. Unlike the first test I just shared, Doctor C wasn’t a theoretical risk – he was in fact high-risk, had already been kicked out of MassHealth, and is now being prosecuted.
The results of analytics like this cause me to support the Governor’s call for prescribing limits. Restricting first-time opiate patients to a few-day supply after determining that non-opiate pain-killers will not suffice and requiring that prescribing physicians first check the prescription monitoring program database will benefit not just patients who may be susceptible to abuse or addiction, they’ll also protect physicians from drug-seeking individuals who are feeding a habit or a supply chain.
With specific reference to the PMP, it must first be developed into the accessible and useful tool it was meant to be. Several years ago, my auditors found it unable to provide all the information one would expect of such a resource. Specifically, while it tracked the pharmacies which filled prescriptions, it did not track the doctors who were writing prescriptions. This is an obvious deficiency which we have been told is being remedied. This, as well as other practical matters, including who in a prescriber’s office can have access to the PMP, are issues that must be resolved before this provision of the bill can be implemented, but I urge you to work through them and include this in any bill you pass.
The third and last provision of the bill that I will address is the one allowing certain medical professionals to call for an involuntary three-day substance abuse disorder evaluation. On this matter, I have no analytical data to support my position, just the firm conviction that it will save lives.
Addiction is a three-fold disease affecting the body, the mind, and the spirit. There is the physical compulsion, the mental obsession, and the loss of spiritual values, by which I do not mean a loss of religious faith. I mean that their addiction, whether to alcohol, cocaine, meth, oxycodone, or heroin, overrides their commitment to truth, loyalty, honesty, the welfare of others, and even their own long-term best interests.
Pumping out a stomach or squeezing Narcan into a nose may stave off death for a day. But it doesn’t restore the addict to health or even to a state of rational thinking. They are still in the throes of a life-threatening disease which renders them unable to apprehend their own peril. Enabling a medical professional to make an informed determination when an in-patient evaluation and the development of a treatment plan are warranted is surely more humane, more respectful of human life than simply releasing them into the streets after an emergency treatment.
If you believe this, then surely we can find the ways and the means to accomplish this, without overburdening our hospital emergency departments or holding out false hope to the addicts and their families.
My final point is that we all share responsibility for solving this problem – not just us in government, but treatment providers, family members, and ordinary citizens. The problem of addiction requires us ALL to rethink our attitudes toward the disease and those sick, sometimes undesirable people we encounter. Just because we can’t find a home run solution doesn’t mean we can’t win the game with a lot of singles and doubles.
And this applies to those in recovery. In fact, they know better than the rest of us that if you can put together single days of sobriety, you can make a heck of a beautiful life.