Massachusetts Becomes First State to Pass Statewide Cap on First-Time Opioid Prescriptions

Earlier this year, Massachusetts Governor Charlie Baker discussed his state’s opioid epidemic during his State of the Commonwealth Address. Less than two months later, on March 14, he signed omnibus legislation designed to tackle the epidemic head-on.

Chapter 52 of the Acts of 2016 contains a wide range of provisions, however one specific provision is making headlines: a seven-day limitation on first-time opioid prescriptions (Note: There are exclusions for pain associated with a cancer diagnoses and for individuals receiving palliative care). The final language reflects a compromise between the Governor, the House, and the Senate. Governor Baker’s original bill limited first-time opioid prescriptions to three days, which the House amended to seven days. In the Senate version, there was no cap; rather, they introduced language requiring that pharmacists only dispense the amount requested by a patient, up to the full amount prescribed. The final bill includes both the House’s seven-day limit on first-time prescriptions as well as modified version of the Senate’s language authorizing partial-fills. Interestingly, the Massachusetts Hospital Association recommends no more than a five-day course for acute pain seen in emergency departments.

In addition to the seven-day cap, the Massachusetts law:

  • Requires the state’s boards of professional licensure to develop standards for pain management training programs that will be required to obtain or renew professional licenses;
  • Requires providers to consult the state’s prescription monitoring program before writing any schedule II or III prescription narcotic (most opioids);
  • Requires emergency departments to, within 24 hours of providing services, conduct a substance abuse evaluation on any person believed to be experiencing an opioid overdose, including individuals who have been administered naloxone;
  • Provides liability protections to individuals attempting to provide emergency care by administering naloxone or any other opioid antagonist to reverse the effects of an opioid overdose; and
  • Requires schools to verbally screen pupils for substance use disorders at two different grade levels (to be determined by the Department of Elementary and Secondary Education, in consultation with the Department of Public Health).

Notably, Gov. Baker’s controversial proposal to expand certain providers’ authority to involuntarily hold and evaluate individuals for up to 72 hours did not make the final bill.

Massachusetts is not the only state pursuing stronger limitations on opioid pain medications. Maine Governor Paul LePage recently filed legislation that would limit opioid prescriptions to a 15-day supply for chronic pain and a three-day supply for acute pain. A second bill filed in the Maine Senate this week would instead require the state’s licensing boards to review the limitations for MaineCare enrollees (passed in 2012) to determine whether the policies should be expanded beyond the state’s Medicaid program.

Other states’ efforts to reduce opioid misuse and abuse have been successful in reducing overdose deaths. In 2010 and 2011, the State of Florida strengthened regulations for pain clinics, prohibited physicians from dispensing opioid analgesics from their offices, and set reporting requirements for the state’s prescription drug monitoring program. Between 2010 and 2012, the rate of opioid analgesic overdose death dropped by 27 percent. However, it is important to note that the rate of heroin overdose death in Florida increased by 122 percent during the same time period. Florida’s experience underscores the importance of comprehensive approaches that also increase access to non-opioid pain management services and substance use disorder treatment services.

The Federal Government is working to support states in this mission. In his fiscal year 2017 budget, President Obama called for $1.1 billion in new funding to address the opioid epidemic. Most of that funding would be given to states to expand access to medication-assisted treatment services. Also of note for states this week, the United States Senate passed Senate Bill 524, known as the Comprehensive Addiction and Recovery Act of 2016. If passed as written, one section of the bill would authorize up to $5 million annually through fiscal year 2020 for grants to states to support comprehensive initiatives addressing prescription opioid and heroin abuse.

In addition to Gov. Baker, twelve other governors discussed prescription drug and heroin abuse during their 2016 State of the State Addresses. NASHP will continue to monitor and write about how these states – and the rest of the country – are working to reduce opioid misuse and abuse and strengthen their substance use treatment systems.

See our blog on legislation recently passed in Maine.