1015-DEEHAN-GBH-baker_opiates_bill-WRAP.mp3

Gov. Charlie Baker wants to crack down on opiate painkiller abuse with new rules on how doctors prescribe addictive drugs and deal with addicted patients.

Baker filed a bill with the Legislature that would allow doctors to prescribe only a 72-hour supply of opiates the first time a patient came to them for painkillers.

"I and many others have listened to far too many stories of people who come home from the doctor's office, the dentist or the hospital with 30, 40, 50, 60, 80 tabs of all kinds of opioids when a handful would do. This has got to stop," Baker said at a Thursday press conference rolling out his new legislation.

The proposal increases education on pain treatment for clinicians and would also allow them to hold patients for 72 hours, without a court order, to try to guide a patient toward addiction treatment.

Baker's plan would create "a new pathway for treatment of individuals with substance use disorder," according to a release on the bill, by letting clinicians retain a patient for up to 72 hours so they have the time to engage the patient and go over voluntary treatment options. The new time frame would also allow clinicians to pursue orders from a judge for commitment for the patient.

Baker wants to make hospitals, instead of the legal system, the new “front door” for supplying involuntary emergency treatment for opiate addicts for the initial 72-hour period. Baker says the new detention period would parallel existing law that allows doctors to commit patients to involuntary treatment for mental disorders.

Dr. Dennis Dimitri, the president of the Massachusetts Medical Society, cautions that some of Baker's preferred changes, including the 72-hour hospitalization, could be problematic.

"I think that we should have the specialists in addiction and pain treatment weigh in very carefully on that, because we don't want to have a mandate out there for involuntary commitment if there's little evidence that it would be a useful approach," Dimitri said.

"What we don't want happening is that people won't want to ask for help for fear that they would be detained," said Dr. Laura Kehoe, an internist and addiction medicine specialist at Massachusetts General Hospital.

Kehoe sees the 72-hour detention plan as controversial, but thinks it could work if done thoughtfully and with the right resources for addicts.

"We have to have places to send people to get into long term care," Kehoe said. "Those are the challenges."

The Massachusetts branch of the American Civil Liberties Union also has concerns about how the 72-hour hospitalization plan would work.

"We need to take a very careful look at that portion of the proposed legislation because depriving people of their liberty, even with the intent of helping them, is a very serious undertaking," said

Baker said at his press conference that the casual attitude some doctors have about prescribing addictive drugs has to end:

"I'm a health-care guy. I have lots of friends and lots of colleagues in the health-care world," Baker said. "I am astonished by the casual nature and the casual attitude that I find when I talk to them about these medications and these issues, and that has got to change. Period."

The bill would also tighten rules governing how often doctors check a patient's prescription data, forcing them to check with the statewide prescription monitoring program each time a script is written.

Many of the proposals in the governor's bill originated in a wide-ranging task force report Baker commissioned when he entered office in January.

The Legislature has already begun debating different opiate plans this session and Baker hopes his proposals can become law this session.

In a statement on Baker's proposal, House Speaker Robert DeLeo thanked the governor for his "thoughtfulness and thoroughness" in drafting the bill.

"In my visits to hospitals, specialty courts and treatment centers this year, I’ve had the opportunity to discuss many ideas related to combatting substance misuse, including proposals to Section 35, the state’s civil commitment law. Those very specific and frank conversations will inform our work on this bill and future efforts," DeLeo wrote in the statement.