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Baker On Opioids: 'Still Far Too Many Overdoses'

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Massachusetts Secretary of Health and Human Services Marylou Sudders, and Governor Charlie Baker.
Meredith Nierman/WGBH News
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180111_baker_sudders_web.mp3

The opioid epidemic has taken hold in Massachusetts with a vengeance. According to state statistics, opioid-related deaths in the state were more than four times higher in 2015 than in 2000. The Massachusetts Department of Public Health says that between January and September 2017, there were nearly 1,500 confirmed and estimated opioid-related overdose deaths statewide.

But there is some good news. These numbers have been declining — the number of opioid-related overdose deaths in the first nine months of 2017 is a decrease from the same time period of 2016. And, the state says, the percentage of overdoses that have resulted in death has also decreased in the last several years.

WGBH News hosted a special discussion about the opioid epidemic in Massachusetts, examining past efforts to combat the crisis and initiatives moving forward.

The conversation with Gov. Charlie Baker and Mass. Health and Human Services Secretary Marylou Sudders focused on a range of issues, including Massachusetts programs that are being adopted nationally and new efforts to help addicts after recovery. The President's Opioid Commission, of which Baker is a member, has recommended to Congress that the country adopt new training for medical, dental, and nursing school programs, which was first implemented in Massachusetts. The state's prescription monitoring program is also being adopted nationally.

Below is a video of Gov. Baker discussing the frustrations that first responders face and what the administration can do to support them and a partial transcript of the entire interview.

 

 

Joe Mathieu: Governor, you are the first to say that people are dying every day. You remind us of this — well over 2,000 in the last official recorded year. And you said to me two years ago that this crisis would get worse before better and I wonder if you still feel that way?

Governor Charlie Baker: Well I certainly believe that we are doing things that are making a difference. For the first time in 15 years, we actually had a reduction in deaths in 2017 over 2016 after literally 15 years of double-digit increases every year. But as you note, that's still five or six people a day, which is far too many. And the other issue that's important and positive is we've seen a significant decline in the number of opioid prescriptions that are being written in Massachusetts. And that has a lot to do with the work that we've done to step up the way we educate prescribers and the development of a far more modern and easy to use prescription monitoring program. But there are still far too many overdoses. If you talk to anybody in the first responder community, in the EMT community, in the emergency rooms of hospitals in Massachusetts, they’ll all tell you that part of the reason that thankfully fewer people are dying, has as much to do with the fact that we've worked very hard to expand the availability of Narcan, which is the overdose reversal drug.

I think the big challenge we and others face going forward is going to be — it's going to be built around some of the legislation we currently have pending on Beacon Hill, which is to do a much better job with community-based and aftercare support services for people who are dealing with opiate addiction, because all the research basically says you really need to come up with strategies that can support people for probably a year before they're really going to get sort of their head back on straight, given the significant grip that this particular addiction puts on people.

Joe Mathieu: We're going to be digging into a lot of this legislation that you've proposed. I wonder, Secretary Sudders, how you feel about this trend line. Is this changing, are we are we finally moving into a period of improvement, or is it too early to tell?

Secretary Marylou Sudders: Well, I think as the governor has said, while there are positive trends that we see, we know that there is so much suffering by individuals who have addictions. And, you know, the pain of their loved ones. So we are pleased to see a decline in death for the obvious reasons, but we know that there's just so much more work to be done. And it means that our early, early work seems to be now having positive impact, but we really want to expand the access to treatment. We really want to help people find that long-term path to recovery and continue the momentum that we started several years ago. So this is, you know, full speed ahead building upon the momentum that started.

JM: Well, let's get into this. Your administration is proposing a new piece of legislation following on a major bill passed in 2016. And I'd like to ask you both about a couple of components that seeks to do a lot from changing the way we teach kids about this in schools, to going after doctors who over-prescribe, and some more controversial components like involuntary hospitalization. And I want to be careful with that because I know this has evolved over the last year. Secretary Sudders, there are critics who say holding people against their will is inhumane and ineffective as treatment, but there are also families who say it must happen.

MS: So, Massachusetts has involuntary treatment already called Section 35. And I won't talk too much jargon, I promise. And the reality is you have to go through the courts in order to seek involuntary treatment. And we're not taking away that path. But that is actually stigmatizing. And as we know, courts are only open Monday through Friday from about 8:00 in the morning to about 3:30 in the afternoon. And if someone is at imminent harm and needs immediate hospitalization for their addictions, you know, we're talking a rare situation that happens on nights and weekends that the person, we believe, should not be released from an emergency room but in fact transported to an addiction treatment facility. We understand that it should be used judiciously and rarely but that people's addiction and crises don't just occur during the same hours as court time.

JM: There are some exceptions and some changes to the way this will be handled, governor.

CB: Yeah, I mean one of the things we worked hard on was to create a series of voluntary paths to treatment as well. And those under the legislation that's being proposed would be, sort of, what I would call the first alternatives. The second thing I would say is that the secretary and her team do a lot of work working with hospitals, emergency rooms, EMT's and the other folks who in many cases are the frontlines for people who are overdosing. And I think at this point the fact that we've added 1,100 treatment beds over the course of the past several years, the involuntary pieces associated with this, which as the secretary pointed out is very consistent with the current standard we have in Massachusetts for a judicial decision made based on an immediate potential to harm themselves or someone else doesn't become effective until 2020.

I think under the legislation, by which time we will have additional capacity. But the notion that you should just board somebody in an E.R. doesn't make a heck of a lot of sense either. And truthfully, one of the things I hear over and over again from folks in the addiction community is you don't always know when the path to treatment is going to work for someone.

And I've had people who have come through this terrible addiction and have come out the other side and said to me you know I never would have expected at the moment that I actually got into treatment that A, it would happen, and B, that it would stick. And I think the more past the treatment that we can make available for people who are dealing with this issue and for their families, the better off in the long run we're going to be.

JM: I'd like to talk to you both about the doctors. WGBH News has done a lot of reporting on this the past year and since before that including some of the challenges that doctors face. And we talked about the curriculum that you've created to help doctors understand prescribing and to not over-prescribe. We spoke, as we hear in this clip, with a doctor who struggled with what to do after a 23-year-old patient who is already recovering from an opioid addiction demanded pain meds after surgery. We have all heard stories like this one. This is what he said.

Audio Clip: It was horrible, because you're a doctor —  you don't want people to be in pain. But my fear is that this kid is going to go back to his life is going to be altered because of what we're doing in a bad way.

JM: He ended up relapsing and died weeks later of a heroin overdose. One of the ways that you've tried to get to this in the past is by going to medical schools and starting at the beginning, right, to change the way that doctors are trained to prescribe. And it's included in recommendations from the President's Opioid Commission sent to Congress. Governor Baker, is it making a difference?

CB: Well, what I would say, a couple of things about this. The first is, the fact that you could graduate from medical school, dental school, pharmacy school and nursing school in Massachusetts without ever having taken a course in opioid therapy or pain management, was kind of a surprise to me. And given the fact that we write over 220 million opioid prescriptions in the United States every year, in a nation with only 300 million people, indicates just how prevalent this stuff is to begin with. And the fact that four out of five people who become addicted to heroin start on prescription pain meds, according to the national substance abuse mental health agency. This is a big statement about how important it is to manage this issue associated with opioids on the prescribing side as intelligently as possible.

And I'm pleased that all the schools here in Massachusetts adopted that core curriculum. You can't graduate anymore without taking and passing a course in that. But the other thing we put in our legislation was if you’re prescriber, when you go to get your license renewed, you're going to have to take him pass a course in opioid therapy and pain management to get your license renewed. And I think from our point of view, there are three important issues here and the doctor you had on the on that clip pointed to one of them, which is three, four, or five years ago there weren't that many people in the visiting community who were even thinking about the question that he was wrestling with and trying to solve.

CB: The second is the prevalence of available information through the prescription monitoring program that secretary Sudders and her team put together is so much better than it was even three years ago. If you're, if you're a prescriber, you know, of access to a lot of really good data, not just on the person who's in front of you but on your own patterns and how they relate to the prescribing patterns of others. And I do believe that this, over time, will become a big part of how states and the federal government deal with this. When we put our program out originally, I was the co-chair of the Health and Human Services Committee for the National Governors Association. And something happened that had not happened before, which is 46 governors signed on to that particular blueprint as an approach to dealing with this issue in their states. I'm a big believer that states on their own can play a big role in this space, and having so many states basically say the prevention education treatment or recovery approach that Massachusetts is pursuing is the right way for us to think about this was gratifying.

And my hope is that once we have a new Health and Human Services secretary at the federal level, that he will take the recommendations of that opioid commission, one of which involves this whole issue around educating prescribers and run with an aroma that hard because the feds obviously have a very big footprint.

JM: We're joined exclusively on WGBH Radio by Governor Charlie Baker and the Secretary of Health and Human Services Mary Lou Sudders. Secretary you spent your career before now as a social worker in the mental health space. What's the reaction from the medical community been like to right the ship in this way?

MS: Well, what I would say is in the past three years in this administration we have really worked quite collaboratively, particularly now with the Massachusetts Medical Society, for example. And to just pick up on something the governor said, the Massachusetts Medical Society now offers free courses for their physicians, potentially for, like the gentleman we just heard from. Really on understanding opioids, how to work with patients, how to really understand their own practices and working with individuals who may have addictions may be asking for pain medications and the like. So I think we've really seen a sea change with the medical profession in Massachusetts, not just with the deans at the medical schools, as the governor talked to about adopting core curricula for our future prescribers. But with the existing community to really, you know, up their game if you would, their clinical game, to understand addictions, the hidden side of addictions that people may come to them as seeking medications that's really trying to feed an addiction. So I think we're working quite collaboratively with the medical profession, and really understanding all of us have so much more work to do.

This article has been updated with more detail and a partial transcript of the conversation. 

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