Local Opioid Legislation: What’s Done, What’s to Come?
In a region known for its intellectuals, natural beauty, strong economies and tight knit communities, a quiet epidemic has spread over the past five years. Opioids, once a drug thought of as reserved for rock stars, those struggling with poverty and other social pressures have shaken hundreds, if not thousands of individuals across New England. But that false conception has been proved horribly wrong in communities all over Massachusetts and New Hampshire. Drugs like heroin, fentanyl, and prescription painkillers are ravaging towns, schools, and families in every class level across the states. The epidemic has caused a sharp response at every political level. A look into the legislation passed and methods applied in different municipalities helps comprehend the severity and the very personal effect the epidemic has had throughout the region.
On March 14, Massachusetts Governor Charlie Baker signed Chapter 52-Acts of 2016, An Act Relative to Substance Use Treatment, Education and Prevention. Some notable highlights of the bill are a seven-day limit on first time prescriptions of opiates to patients. The legislation also allows patients to request a partial filling of their prescription, and this is hoped to prevent overprescription, which leads to overexposure. The legislation puts some burden on drug companies, of which Massachusetts is a global hub, to provide education programs for patients and provide greater opportunity for drug disposal. In addition, a connection is made between mental health and the use of these drugs, as overdose and narcan patients in emergency rooms must undergo a mental health evaluation within 24 hours of their admission. Through police training and engagement, community leaders are being taught to recognize the signs of addiction and drug abuse and to treat victims in a manner that leads them to care and treatment rather than harsh prosecution.
These methods are essential in a state facing drug exposed childbirth rates three times the national average. Every 16 in 1,000 births in the state are facing symptoms of withdrawal from having opioid-using mothers. In addition, the utilization of these substances is not subject to economic boundaries. Policy makers have no reason to create disparaging legislation in this area because rich whites are being harmed in nearly equally proportions as other demographics. In fact, the statistics surrounding this epidemic have set the stage for a bipartisan movement in both New Hampshire and Massachusetts. The recently passed legislation signed by Baker is just one example of efforts made across party lines to address curbing accessibility to opioids and methods for rehabilitation and community safety.
In New Hampshire, a state suffering from the third highest per capita overdose death rate in the U.S., Democratic Congresswoman Annie Kuster and Republican Congressman Frank Guinta have come together to shed mutual light on how the issue is affecting their constituents. In October 2015, they created a Bipartisan Task Force to Combat the Heroin Epidemic. They hope to raise awareness on the national implications of these local issues and shift federal attention to the needs of residents in struggling cities, smaller at-risk towns and more economically isolated counties. Republican Senator Kelly Ayotte and Democratic Senator Jeanne Shaheen have spoken out in a bipartisan manner. They have called for comprehensive policy to raise funding and provide police officers and EMTs with narcan and other life saving overdose reversals.
In Massachusetts, Senator Elizabeth Warren has proposed legislation in conjunction with Republican Senator Shelly Moore Capito of West Virginia. Similar to the Massachusetts bill, the Reducing Unused Medications Act aims to minimize the amount of unused painkillers that are frequently cited as an addict’s first introduction to opioids. Senator Warren said, “[t]his bipartisan bill will empower patients and doctors to work together to determine appropriate pain treatment, while limiting the number of unused pills left in family medicine cabinets.” Senator Capito echoed this message. What has not been addressed are the ways and means of preventing the production and transportation of heroin. Massachusetts sources much of the heroin for New Hampshire users, and this is just a small part of the drug trafficking that occurs. Legislators will continue to struggle in defining punishment for dealers versus rehabilitation for addicts. Currently, both states attempt to draw a line between the two, but issues of petty and serious crime are rising as addicts try to source funds for their habits.
While much of the debate surrounding solutions to the epidemic have been bipartisan and cooperative, there are a few issue areas that are still contentious and remain to be answered. One difference between Vermont, a state that was seen as the starting point for the epidemic, and its New England counterparts is social acceptance of the epidemic and solutions. Vermont has many semi-private needle exchanges that enable users to properly dispose of their dirty needles and acquire clean ones. This is seen as a positive in a few ways. First, it limits diseases such as Hepatitis B and HIV that are commonly transmitted through needle sharing. Second, it allows facility coordinators and drug specialists to assist addicts and work with them to curb their addiction. Lastly, it allows addicts using the exchanges to distribute clean needles within the opioid community and encourage others to seek help through exchanges and other clinics.
In New Hampshire and Massachusetts, this policy is highly contentious as many constituents and legislators see needle exchanges as trying to put out a fire with more fire. The debate is very personal and will continue to play out in the coming months as New Hampshire state legislators hear a bill to establish needle exchanges. One large technicality would need to be addressed: Under current New Hampshire law, a user who had heroin residue on a needle and was transporting it to a needle exchange facility would be charged for a felony if pulled over or stopped by the police. Massachusetts currently has exchanges, but many complain they are inadequate to meet demand. Tight budgets and varying opinions also leave exchange programs vulnerable to budget cuts. Lastly, similar to needle exchange facilities are rehabilitation centers. In both states, public facilities are overburdened. Those seeking assistance have wait times and fear they will receive inadequate treatment. This is yet another question that state and federal legislatures need to address.
The opioid epidemic has consequences even beyond the trauma of lost lives. It has potential to lower GDP by harming tourism attraction, decreasing worker productivity, and sending government money to unproductive sectors. And the epidemic is currently setting the tone in communities that were already hurting post-recession. Much of the proposed and passed legislation stands to assist those facing a spiral of addiction and pain, but more hard debates loom in the future to help the people of Massachusetts and New Hampshire recover and prosper.