With mixed record on opioids, Baker joining task force

With mixed record on opioids, Baker joining task force

Prescriptions have slowed, but overdose deaths rising

GOV. CHARLIE BAKER IS JOINING a White House task force on opioids, to be chaired by fellow governor Chris Christie, whom Baker endorsed in the Republican presidential primaries. Baker is bringing with him a reputation for action on the issue, both here in Massachusetts and leading his fellow governors. Yet despite these efforts, opioids remain a tragic problem in the Commonwealth. Baker’s initiatives may have slowed the pace of opioid prescriptions, but they have not stopped the steady rise in overdose deaths.

The opioid crisis was raging when Baker took office. In 2014, unintentional opioid overdose fatalities in Massachusetts were more than double the national average and had been climbing every year since 2000. According to the CDC, between 2014 and 2015 the opioid overdose death rate in Massachusetts increased by 35.3 percent, the second highest percentage increase in the country. The spike affected communities across the state; opioid deaths occurred in two-thirds of all cities and towns between 2013 and 2014.

Baker’s initial response in October 2015 was a hardline legislative proposal that would have limited opioid prescriptions to a three-day supply. After pushback from doctor’s groups, he and the Legislature settled on a seven-day limit. That March 2016 law also required the review of all opioid prescriptions by a monitoring system, public school screenings, education on opioids in drivers’ education courses, emergency room evaluations, and a “Good Samaritan” policy to encourage the reporting of drug overdoses. Other states have followed Massachusetts’ lead; Connecticut, New York, Maine, Rhode Island, and most recently New Hampshire have instituted seven-day supply limits. In April 2016, Baker spearheaded the National Governors Association’s compact on opioids, which was signed by 44 state chief executives.

Baker’s track record on the issue is not perfect. He was criticized late last year for cutting nearly $2 million in substance abuse funding as part of a mid-year attempt to balance the budget. Baker’s communications team argues,that the cuts were earmarks that had been previously vetoed and restored by the Legislature, that they were more than outweighed by other increases in spending since he took office.

Since the law was signed, Massachusetts has seen a steady monthly decrease in opioid prescriptions. As of January 2016, before the law was signed, 6.2 percent of the state population was being prescribed opioids, according to state reports. That has dropped steadily to 4.2 percent as of February 2017. Prescription opioids are also turning up in a smaller share of toxicology reports, dropping from 24.8 percent in 2014 to 16.2 percent at the end of 2016.

The new law is probably contributing to this decline, but other factors may be at work as well.  A study published in Drug and Alcohol Dependence, for example, shows that states with legal medical marijuana are seeing a decrease in opioid-related hospitalizations and overdoses; in Massachusetts, medical marijuana was approved in 2012, and dispensaries have been running for the past 3 years. Doctors may be prescribing fewer opioids because of the new law, or because they have an alternative they can turn to, or both.

Prescription opioids use may be down, but the most important metric — overdose deaths — is still climbing. In 2016, the raw number of fatalities increased for the sixth year in a row; estimates place the final toll at nearly 2,000 deaths. The most likely culprit is the powerful synthetic opioid fentanyl, which now shows up in  75 percent of overdose toxicology reports. Fentanyl can be prescribed for severe pain, but, according to a 2015 DEA investigative report, much of the fentanyl in Massachusetts is produced illegally and illicitly.

The rapid rise of fentanyl underscores the whack-a-mole nature of the crisis: cut off one source of drugs and another takes its place, with even more devastating effects. That is not to say that the governor’s efforts haven’t helped, at least with the prescription-drug side of the problem. But the ultimate goal of reducing deaths from opioids remains elusive in Massachusetts.

It will likely prove even harder on the national stage, especially in light of other federal initiatives. The Trump administration’s budget proposal cuts $100 million in substance abuse funding while trying to take credit for a $500 million more carried over from an Obama-era law. And the Republican health care plan would have stripped mandates that insurance cover substance abuse put in place by Obamacare. Maybe Rep. Katherine Clark had a point when she questioned whether Baker should get involved with Trump’s panel. Opioids activists are also displeased with Trump’s decision to study the issue further through a commission, instead of taking more direct action. As the Massachusetts numbers show, tackling opioids is hard enough with increased funding and everyone pulling together; it will be near impossible otherwise.

Meet the Author

Richard Parr

Research director, MassINC Polling Group
Meet the Author

Hannah Chanatry

Research associate, MassINC Polling Group
Richard Parr is research director and Hannah Chanatry is research associate at the MassINC Polling Group.