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Charlie Baker, Governor of the Commonwealth of Massachusetts, has issued 110 recommendations for government, healthcare and educational institutions, to help combat opioid addiction from multiple directions. We've compiled the recommendations into eleven different categories, which we are comparing with the efforts being made by other states.
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##Treatment
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| ID | Name | Description |
|---|---|---|
| TR01 | Realign Treatment | Realign Treatment System to Reflect Nature of Opioid Use Disorder as a Chronic Disease with Periods of Acute Needs and Periods of Stability |
| TR02 | Increase points of entry | Increase points of entry to treatment, eliminating the need for individuals to access other levels of care only through acute treatment services (ATS) and clinical stabilization services (CSS) |
| TR03 | Continuum of care | Establish and promote a longitudinally based treatment system and continuum of care |
| TR04 | Increase Treatment Access | Increase Treatment Access by Matching Demand and Capacity |
| TR05 | Database of services | Develop a real-time, statewide database of available treatment services, making information available via phone and the internet |
| TR06 | Increase post-ATS beds | Increase the number of post-ATS/CSS beds (transitional support service, residential recovery homes) |
| TR07 | Patient navigators | Fund patient navigators and case managers to ensure a continuum of care |
| TR08 | Access to assessment | Pilot a program that provides patients with access to an emergent or urgent addiction assessment by a trained clinician and provides direct referral to the appropriate level of care |
| TR09 | Revise recovery homes rates | Establish revised rates for recovery homes, effective July 1, 2015 |
| TR10 | Access to MAT | Increase Access to Evidence-Based Medication-Assisted Treatment |
| TR11 | Office-based treatment | Increase the number of office-based opioid treatment programs and the number of practitioners prescribing buprenorphine and naltrexone |
| TR12 | Opioid agonist therapy | Enforce and strengthen the requirement that all licensed addiction treatment programs accept patients on an opioid agonist therapy |
| TR13 | Integrate care & treatment | Promote Integration of Mental Health, Primary Care, and Opioid Treatment |
| TR14 | Review licensing regs | Create a consistent public behavioral health policy by conducting a full review of all DPH and DMH licensing regulations for outpatient primary care clinics, outpatient mental health clinics, and BSAS programs removing all access barriers |
| TR15 | Health Homes | Explore state mechanisms to establish opioid treatment programs as Health Homes |
| TR16 | "Deemed Status" | Conduct a review of the license renewal process for programs accredited by The Joint Commission or Commission on Accreditation of Rehabilitation Facilities (CARF) and evaluate whether Massachusetts should implement a “deemed status” for BSAS license renewals |
| TR17 | Holding individuals | Permit clinicians to hold an individual with a substance use disorder involuntarily in order to conduct an assessment of whether release poses a likelihood of serious harm |
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##Education
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| ID | Name | Description |
|---|---|---|
| ED01 | Substance use criteria | Support the implementation of substance use prevention curricula in schools. School districts should have the autonomy to choose the evidence-based curricula and the grade level that it is implemented in their district. Programs must be proven to reduce nonmedical opioid use. Examples of programs include: LifeSkills and All Stars |
| ED02 | Info at athletic meetings | Integrate information about the risks of opioid use and misuse into mandatory athletic meetings and trainings for parents, students, and faculty |
| ED03 | Increase screenings | Increase the use of screenings in schools to identify at-risk youth for behavioral health issues |
| ED04 | Info for parents | Develop targeted educational materials for school personnel to provide to parents about closely monitoring opioid use if their child is prescribed opioids after an injury, as well as, signs and symptoms of drug and alcohol use |
| ED05 | Partner with universities | Partner with state universities that have strong education programs to develop substance use prevention curricula for school districts throughout the Commonwealth |
| ED06 | Screenings at universities | Require state universities that educate teachers to integrate screening and intervention techniques as well as substance use prevention education into the curriculum |
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##Neonatal Care
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| ID | Name | Description |
|---|---|---|
| NC01 | Training for prenatal providers | Outreach to prenatal and postpartum providers to increase training about: screening, intervention, and care for women with a substance use disorder |
| NC02 | Raise awareness of NAS | Promote early identification and proper treatment, raise awareness of Neonatal abstinence syndrome (NAS) within the public health and medical communities |
| NC03 | CBA of in utero testing | Review the costs and benefits of mandating testing for in utero exposure to alcohol and drugs at every birth |
| NC04 | Pregnant women treatment | Ensure adequate capacity for pregnant women in the treatment system |
| NC05 | NAS treatment for DCF staff | Develop and institute a training program focused on NAS and addiction for Department of Children and Families staff |
| NC06 | NAS early intervention | Work with health care providers to ensure all infants with NAS are referred to early intervention by the time of hospital discharge |
| NC07 | Early intervention study | Partner with early intervention (EI) leadership and developmental experts to study the value of increasing automatic EI eligibility for infants with NAS from one year to two years |
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##Safe Disposal
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| ID | Name | Description |
|---|---|---|
| SD01 | Pain management training | Mandate pain management, safe prescribing training, and addiction training for all prescribers as a condition of licensure (physician assistants, nurses, physicians, dentists, oral surgeons, and veterinarians) |
| SD02 | Partial refills | Allow partial refills across all payers with a one-time co-payment |
| SD03 | Eliminate refills by mail | Eliminate prescription refills by mail for schedule II medications |
| SD04 | Improve PMP | Improve the Prescription Monitoring Program (PMP) |
| SD05 | PMP ease of use | Increase utilization by improving ease of use and expanding abuse alerts from the PMP to prescribers |
| SD06 | PMP data compatibility | Ensure data compatibility of the PMP with other states & interface the PMP with electronic health records |
| SD07 | PMP mandatory use | Enforce mandatory use of the PMP |
| SD08 | PMP 24 hours submittal | Require PMP data to be submitted within 24 hours by pharmacies |
| SD09 | PMP data analytics | Improve data analytics and educate prescribers about how to utilize the information |
| SD10 | Electronic prescribing | Implement electronic prescribing for opioids |
| SD11 | Safe prescribing education | Partner with the medical and provider community to improve and increase educational offerings for prescribers and patients to promote safe prescribing |
| SD12 | Alternate pain therapies | Promote awareness and support for alternate pain therapies |
| SD13 | Addiction experts on Med Bd | Appoint individuals with expertise in addiction to the medical profession licensing boards |
| SD14 | Safe use info at pharmacies | Develop universal distribution of easy to read materials at pharmacies on the safe use of medications |
| SD15 | Promote take-back days | Expand and promote drug take-back days and permanent drug take-back locations, financed by pharmacies and manufacturers |
| SD16 | Require patient education | Require practitioners, including dentists, to educate patients on the risks and side effects associated with opioids and document such discussions at the point of prescribing |
| SD17 | Screening for substance use | Increase screening for substance use at all points of contact in the medical system |
| SD18 | Drug Formulary appointments | Appoint members to the drug formulary commission established under Chapter 258 of the Acts of 2014 |
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##Stigma
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| ID | Name | Description |
|---|---|---|
| ST01 | Stigma public awareness | Create a public awareness campaign, with messaging that targets various ages, focused on: |
| ST02 | Stigma as a medical disease | Reframing addiction as a medical disease |
| ST03 | Promote med safety practices | Promoting medication safety practices |
| ST04 | Good Samaritan Law | Promote the Good Samaritan Law |
| ST05 | Reduce stigma w/med pros | Reduce stigma among medical and treatment professionals |
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##Improve Transparency & Accountability
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| ID | Name | Description |
|---|---|---|
| TA01 | Timely reporting of deaths | Require and support universal and timely reporting of overdose deaths, through a partnership between the Department of Public Health, the Attorney General’s Office, the Massachusetts State Police, the District Attorneys, local police departments, emergency medical services, hospitals, and others |
| TA02 | EMS overdose data | Make EMS overdose data available |
| TA03 | Hot spot with overdose data | Utilize overdose reports to identify geographical hot spots for targeted intervention and to alert law enforcement, public health entities, community coalitions, and the public |
| TA04 | EOHHS process to share data | Create a unified EOHHS privacy policy and implement a process for sharing confidential data |
| TA05 | Dir of Addiction & Recovery | Establish a single point of accountability for the Commonwealth, Director of Addiction and Recovery Policy |
| TA06 | Treatment program reporting | Enhance provider accountability by requiring treatment programs at all levels (inpatient and outpatient) to report on outcomes |
| TA07 | New treatment approaches | Incentivize and support providers to develop and test innovative treatment approaches |
| TA08 | rewards for reducing re-adm | Create provider accountability for the successful transition from one level of care to the next and incentivize providers to reduce re-admissions; the current "system" inadvertently "rewards" providers for repeat detoxes and rehabs |
| TA09 | Establish industry benchmarks | Require the Department of Public Health to advance standards of care by establishing industry benchmarks |
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##Courts & Jails
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| ID | Name | Description |
|---|---|---|
| CJ01 | Increase drug court capacity | Increase drug and specialty court capacity |
| CJ02 | More beds for Sec 35 ch 123 | Increase access to beds for patients who are civilly committed under section 35 of chapter 123 of the General Laws and provide a roster of currently available beds to judges for section 35 commitments |
| CJ03 | Revise discharge policies | Review and revise discharge policies for section 35 patients; facilities must be required to follow the law and issue a written determination that release will not result in a likelihood of serious harm when individuals are discharged from the facility |
| CJ04 | Improve continuum of care | Improve the continuum of care for patients committed under section 35 |
| CJ05 | Notification for escapees | Ensure notification to the Court when a section 35 patient escapes from treatment |
| CJ06 | DoC->EOHHS responsibility | Transfer responsibility for civil commitments from the Department of Corrections to the Executive Office of Health and Human Services |
| CJ07 | Do not terminate MassHealth | Suspend, rather than terminate, MassHealth coverage during incarceration |
| CJ08 | Partner for treatment | Partner correctional facilities with community health centers to ensure individuals can access treatment upon release |
| CJ09 | Analyze treatment spending | Analyze treatment spending in correctional facilities |
| CJ10 | MAT while incarcerated | Inmates should be able to continue medication-assisted treatment while incarcerated |
| CJ11 | Begin care while incarcerated | Inmates should be able to begin treatment while incarcerated and be connected to treatment upon release |
| CJ12 | Alternatives to arrest | Encourage and support alternatives to arrest, making police a partner in obtaining treatment for individuals |
| CJ13 | Narcan for county corrections | Bulk purchase opioid agonist and naltrexone therapies for county corrections |
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##Recovery
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| ID | Name | Description |
|---|---|---|
| RE01 | Community coalitions support | Leverage and increase support for community coalitions to address the opioid crisis |
| RE02 | Online repository of resources | Create an online repository of resources and best practices for community coalitions |
| RE03 | Coordination among coalitions | Improve statewide coordination and information sharing among coalitions |
| RE04 | Expand family support | Expand peer and family support organizations such as Learn to Cope |
| RE05 | Recovery coaches in ERs | Pilot recovery coaches in emergency rooms and hot spots |
| RE06 | Certify drug free housing | Implement a process to certify alcohol and drug free housing to bring accountability and credibility to this recovery support system |
| RE07 | Remove employment barriers | Partner with businesses to remove employment barriers that recovering individuals experience, specifically review regulations related to CORI checks |
| RE08 | Hire individuals in recovery | Incentivize employers to hire individuals in early recovery |
| RE09 | Issue certificates of recovery | To improve outcomes for recovery, explore the benefits and costs associated with issuing certificates of recovery |
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##Naloxone
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| ID | Name | Description |
|---|---|---|
| NA01 | Narcan in public spaces | Investigate the feasibility of having Naloxone in public spaces |
| NA02 | Narcan affordability | Improve affordability of Naloxone |
| NA03 | Narcan bulk purchasing | Through bulk purchasing agreements |
| NA04 | No copay for Narcan | By eliminating all copayment requirements |
| NA05 | Co-prescribe Narcan | Encourage Naloxone to be co-prescribed with opioids |
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##Insurance
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| ID | Name | Description |
|---|---|---|
| IN01 | Implementation of Chapter 258 | Require the Division of Insurance to implement guidance for commercial insurers about the implementation of chapter 258 of the acts of 2014 prior to October 1, 2015 |
| IN02 | eliminate insurance barriers | Eliminate insurance barriers that impede integration of addiction and mental health care into the primary care setting |
| IN03 | Require consistent coverage | Require consistent coverage and prior authorization practices and policies throughout all MassHealth programs |
| IN04 | Enforce behavioral health parity law | Bring meaning to federal and state behavioral health parity laws through enforcement actions to remove inappropriate barriers to treatment |
| IN05 | Support non-opioid pain therapies | Encourage insurers to support non-opioid pain therapies |
| IN06 | Coverage for non-pharma treatments for pain | Prepare a public report on what non-pharmacological treatments for pain are covered by all private and public insurers |
| IN07 | Support for recovery coaches | Encourage insurers to support recovery coaches for individuals with a substance use disorder |
| IN08 | Support new pathways to treatment | Encourage insurers to support new pathways to treatment |
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##Federal-State Partnership
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| ID | Name | Description |
|---|---|---|
| FS01 | Pain management reqs for residency programs | Partner with federal leaders to recommend that the American College of Graduate Medical Education adopt requirements for pain management and substance use disorder education for all medical and residency programs (i.e. surgical, pediatrics, internal medicine, family medicine, obstetrics, and gynecology) |
| FS02 | Safe prescribing for dentists | Partner with federal leaders to recommend that the Commission on Dental Accreditation adopt requirements for education on safe opioid prescribing practices for all dental programs |
| FS03 | Safe prescribing for veterinarians | Partner with federal leaders to recommend that the American Veterinary Medical Association adopt requirements for education on safe opioid prescribing practices for all veterinary programs |
| FS04 | Support for Vets | Partner with federal leaders to increase support for substance use prevention, intervention, treatment, and recovery efforts uniquely tailored for our Veterans |
| FS05 | Residents prescribe buprenorphine for MAT | Request the Drug Enforcement Agency (DEA) to permit medical residents to prescribe buprenorphine under an institutional DEA registration number, thus allowing residents to learn how to manage patients with an opioid addiction |
| FS06 | National take back program standards | Implement nationwide standards for pharmaceutical take back programs |
| FS07 | Drug makers fund med disposal | Require manufacturers and pharmacies nationwide to finance the disposal of unused prescription medication |
| FS08 | Update laws for prescribing buprenorphine | Change the laws and regulations related to prescribing buprenorphine |
| FS09 | Increase MAT cap | Increase the cap - the number of patients a physician can treat - or remove it entirely |
| FS10 | More buprenorphine prescribers | Permit nurse practitioners and physician assistants to prescribe buprenorphine |
| FS11 | PDMP interoperability | Facilitate the interoperability of prescription monitoring programs nationwide |
| FS12 | Review 42 CFR Part II to avoid stigma | Review 42 CFR Part II to ensure that it facilitates integrated care and the use of electronic health records and does not exacerbate the stigma associated with a substance use disorder |
| FS13 | Separate Pain Mgmt Query from reimbursement | Request that the Pain Management Question from the HCAHPS not be linked to hospital reimbursement |
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