By Susannah Sudborough
BU News Service
BOSTON – “People show up for treatment on Friday, don’t come on Tuesday, and then we find out later they died over the weekend,” said Dr. Genie Bailey, a psychiatrist who heads both the research department and medication-assisted treatment services at Stanley Street Treatment and Resources in Fall River.
Though Massachusetts has made significant strides in enacting legislation and other programs to help people and communities struggling with addiction, there is still a long road ahead. With so many people becoming addicts through use of prescription painkillers, and thousands dying from overdoses of the powerful drug fentanyl, the opioid crisis remains a top priority for many legislators.
In the beginning
According to Massachusetts Attorney General Maura Healey’s lawsuit, as well as doctors, lawmakers and other experts, the crisis started in the 1990s with Purdue Pharmaceuticals’ introduction of the drug OxyContin.
At the time, the medical community was undergoing a shift in attitude towards pain management. In the past, it had not been a priority, but it became recognized as an important aspect of medical care.
Purdue and the Sackler family who owns the company pushed the idea that OxyContin was an effective painkiller that was not addictive for most people, which was later found to be untrue.
As a result, the drug started being prescribed widely for chronic pain, often to laborers who were hurt on the job, or to athletes for their injuries. Sometimes these athletes were high schoolers.
“Young people who have a lot of potential don’t realize that using one more time could result in death,” said Bailey.
Children also became exposed to opioids through simply finding prescribed drugs in a bathroom cabinet and experimenting with them, not understanding how dangerous that is.
“You can do everything right and your kids can still get exposed to this,” said Pat Emsellem, SSTAR’s chief operating officer.
Luis Perez, a recovery coach at SSTAR, said for a long time he thought he was different from other addicts because he had a good childhood, went to college and worked as an accountant. For a while, this kept him from seeking treatment. But addiction can affect anyone, he said.
“It’s about the feelings, not the situation,” said Perez, who is 3 ½ years clean after completing a SSTAR recovery program for opioid addiction.
Unaware of the drug’s potency, patients would become addicted, and when doctors would no longer prescribe them opioids, they would turn to the streets for drugs, starting with prescription pills. But as their tolerance grew and their money waned, they would start using heroin, and later, fentanyl.
According to the DEA, fentanyl is 80 to 100 times stronger than morphine. One can overdose even when using small quantities, and a dose as little as .25 milligrams can be fatal.
Emsellem said she has seen people relapse with fentanyl after years of sobriety and die.
“It’s killing people,” said Emsellem. “They don’t know how to adjust to the dosage and can die in just a few days.”
Fentanyl is often laced with cocaine and heroin on the street. Users may not even be aware that what they are using contains the drug. Because of its potency, fentanyl is very profitable for drug traffickers.
The number of Massachusetts residents who died due to opioid overdose peaked in 2016 with nearly 2,100 deaths that year. Between 70 and 80 percent of those deaths involved fentanyl.
These statistics are seen in their day-to-day lives, Emsellem said. And there are more people looking for in-patient care than they can help.
“We used to turn away people who weren’t ‘ready’ for treatment and tell them to come back when they were, but that could be signing a death warrant now,” said Bailey.
Since 2016, the number of opioid-related deaths in Massachusetts has started to decline. This could be due to the state’s efforts to make Narcan, a life-saving drug that reverses opioid overdoses, affordable for communities to purchase for first-responder use. But both lawmakers and doctors say that the problem is not over yet.
“The numbers are going down, but I caution against people patting themselves on the back,” said Rep. Tami Gouveia, D–Acton. “People in our communities are saying their friends and family are still dying left and right.”
“This crisis is affecting every single community in Massachusetts,” said Gouveia, a member of the Legislature’s Committee on Mental Health, Substance Abuse and Recovery. “We lost two young moms in Carlisle last year.”
Jessica Eagles, the treatment center director at Health Care Resources Center in New Bedford, wrote in an email that addiction strains resources in the community in every imaginable way, from health care and treatment to law enforcement to public assistance and services.
“There’s a bottleneck effect happening between the need and the treatment resources available,” wrote Eagles.
Sen. Julian Cyr, D-Truro, and Senate chair of the mental health, substance abuse and recovery committee, said the opioid crisis has taken a huge toll on Cape Cod, Martha’s Vineyard and Nantucket for a long time. He said that many of the people who have died from overdoses there were in the service, construction, and fishing industries.
In Massachusetts, Cyr said, the crisis has manifested in communities lacking opportunities for young people. He said that in places like Cape Cod and the islands, the seasonality of work can also have a big impact.
Rep. Paul Schmid, D-Westport, and member of the Legislature’s Committee on Public Health, said that the opioid crisis has reduced the number of people able to work in the SouthCoast and that employers say they are struggling to fill open positions.
Rep. Alyson Sullivan, R-Abington, and member of the mental health, substance abuse and recovery committee, said that she had to watch a mother from her district bury her 23-year-old son. She said that tragedies such as this deeply affect both her and her constituents, as they wonder if there is more they could have done to prevent them.
Massachusetts has taken many measures to try to combat the opioid crisis. As far back as 2006, the Governor’s Interagency Council on Substance Abuse and Prevention used the Strategic Prevention Framework State Infrastructure Grant to reduce unintentional fatal and non-fatal opioid overdoses.
In 2016, Massachusetts started a prescription monitoring program that requires doctors to report every time they prescribe certain controlled substances, including opioids. The state said this has caused a 30 percent decrease in opioid prescriptions. Additionally, the state passed a law that year that restricts opioid prescriptions for first-time users and minors to a seven-day supply.
Since the 2015 fiscal year, the Baker-Polito administration has increased funding for addiction treatment, counseling, education, and other services by $147 million, an increase of 123 percent.
In 2018, Baker signed the STEP Act which strengthened the commonwealth’s education and prevention efforts, intervention and harm reduction strategies, and increased access to addiction treatment. He also signed a bill that year that allowed pharmacies to dispense naloxone, the generic name for Narcan, without a prescription and funded a program to help prevent and treat substance abuse in Native-American youth.
Many bills that would help those struggling with opioid addiction are currently passing through the Legislature.
Baker’s proposed budget recommends $266 million in funding across several state agencies for substance misuse treatment and services. It also includes a 15 percent excise tax on sales of prescription opioids in Massachusetts that would generate an estimated $14 million to fund programs and efforts to combat the opioid crisis.
“The governor’s proposed tax is bold and encouraging,” said Cyr. “We need to throw the kitchen sink at it (the opioid crisis) in terms of resources.”
Gouveia has introduced a bill to create a pilot program where the Department of Public Health would authorize harm reduction sites (also known as safe injection sites). While there, a person struggling with addiction may consume drugs that they obtained themselves under the supervision of medical professionals who would be ready to stop a fatal overdose. The site would also have counseling, referrals to treatment and other services available.
“Harm reduction sites keep people connected to health care,” said Gouveia. “They treat addiction as a patient issue instead of through law enforcement.”
Both SSTAR’s Bailey and Emsellem support harm reduction sites. Baker and Andrew Lelling, the US Attorney for Massachusetts, do not.
“People think it is condoning drug use, but it’s not,” said Bailey. “It’s an entryway into treatment.”
Another important bill by Gouveia would create a pilot program to test the efficacy of fentanyl testing strips. This would allow users to test their drugs to see if fentanyl is present.
Sen. John Keenan, D-Quincy has introduced a measure that would make permanent a bill set to expire in 2021 that requires drug manufacturers to create or fund a safe drug disposal program.
“There are lots of pills out there in drawers that are ripe for being used for the wrong purpose,” said Keenan. “We have to make sure they are disposed of safely.”
Keenan, who is vice chair of the mental health, substance abuse and recovery committee, has also sponsored a bill that would extend private insurance coverage of addiction treatment from 14 to 30 days.
Keenan said this is a modest request given that MassHealth currently covers 90 days of treatment.
“People shouldn’t have differences in access to treatments because of what insurance they have,” said Keenan.
Lastly, Keenan is sponsoring a bill that would remove the requirement of prior authorization for insurance coverage of non-opioid pain treatments such as physical therapy. He said that this will help shift providers’ focus away from opioids and towards other options.
Further policy ideas may yet bloom into legislation in the near future.
Bailey, Cyr and Gouveia all agreed that there is a great need to make medically-assisted treatment more available.
“We shouldn’t need prior authorization to prescribe these life-saving medications,” said Bailey.
Lawmakers and doctors are also concerned about the lack of insurance coverage of these medications.
Sen. Edward Kennedy, D-Lowell and former mayor of the city, said that more education on the dangers of opioids is needed in Massachusetts schools and hospitals. He said doctors need further instruction on how to prescribe opioids safely.
Sullivan said that her district has seen effective outreach through the Plymouth County Task Force, which works with both law enforcement and healthcare professionals to respond effectively to overdoses, offers safe medication disposal, and educates the community on the role of childhood trauma in the opioid crisis.
She said she would like to see programs like this expanded throughout the state.
Cyr said there also needs to be greater parity in access to mental health treatment.
“Mental health is inextricably linked to addiction and we don’t provide adequate mental health resources in our communities,” said Cyr.
Still, he was clear that there is no silver bullet for solving the opioid crisis.
Cyr said that he hopes the crisis will soon move from the epidemic to the endemic phase, where the number of people affected is not increasing. There will be new baseline of people who need services for the course of their lives. The state will then have to find ways to support people in long-term recovery, Cyr explained, which will mean ensuring housing, healthcare and employment.
Thankfully, some positive effects have come out of dealing with this crisis. Cyr said that there has been a reduction in the stigma surrounding addiction and recognition that it is truly a disease.
The issue has brought communities together, said Keenan, and people are stepping up to help educate the community on addiction, offer support to others and reach out to direct people towards treatment.
This article was previously published in South Coast Today.