Senator Tackling Opioid Crisis, an Interview with Jen Flanagan (D-MA)

Senator Flanagan has been a leading proponent and champion in her state on issues that involve setting mental health policies and more recently in passing two key bills on the opioid crisis. The first, An Act to Increase Opportunities for Long-Term Substance Abuse Recovery, provides people with an opportunity to access treatment. As well as An Act Relative to Substance Use Prevention, which seeks to avert people away from substances.

Q.  Tell us a little bit about yourself and what has driven your passion around the issue of opioid use? Is there a personal connection that has inspired you to work on the opioid epidemic?

A.  There is no personal issue per se, I get asked that a lot. I actually came about it from a side door. Growing up, I am the daughter of an ER Nurse and witnessed first hand the impact of accidents involving drugs. I knew I couldn’t be a nurse, I just can’t handle blood and guts, but I wanted to be on the recovery side of mental health. I specifically recall a story of a 14-year-old cocaine addict. Her mom was her supplier, whereas my mom was a nurse helping people, what a contrast! I then thought about becoming an attorney, to learn more about the law and go after those that abuse children. I eventually graduated from college with a degree in political science and began as a legislative aide for the Massachusetts’s House of Representatives.   This was followed by my obtaining a master’s degree in mental health counseling while remaining in public service. It’s just my passion to help people!

Let’s move into some background on what’s happening in Massachusetts. Unintentional opioid-related deaths continue to increase. The estimated rate of 17.4 deaths per 100,000 residents for 2014 is the highest ever for unintentional opioid overdoses & represents a 228% increase from the rate of 5.3 deaths per 100K in 2000. Since 2004, 6600 members of your communities have died of an opioid overdose.

Q.  What is driving this trend from your perspective in MA? And do you view the issue within your state any different than neighboring states in this regard?

A.  Our state has had a Mental Health & Substance Abuse Committee in place for over 10 years. The problem is that it only addressed chronic disease. People that needed help with addiction and detox couldn’t get into treatment, many were dying. So in 2014, we made access easier.  Insurance did not want to cover 5 days of detox or post detox but the problem is that tolerance goes down after detox then overdose can happen when they go back to using drugs again.   So we began allocating money in our budget for more open beds for addiction treatment even though insurance was saying no way. The legislature basically walked over them, forcing them to understand we were talking pennies to make this work! By addressing addiction treatment head on, there are immediate savings in reduction of treatment costs associated with Hep C as an example. Yes, we do have 99% insured in our state and now insurance does cover some of the cost. But with more beds and treatment coverage, inpatient is much safer as the patient is under observation and assistance. We also have a $5M substance abuse trust to help cover costs, but individuals must apply for it.

Over $250M has been allocated toward opioid epidemic substance use disorders, education, prevention & treatment, increased bulk purchasing of Narcan and also changes to the PDMP including 24 hour reporting, not 7 days. 200 substance use treatment beds have been opened. We continue to invest in major programs, i.e. beds, treatment, expert training & screening for $1.4M per year. We gave a lot of attention and dollars for the treatment side of this epidemic. But we also now have prevention programs to assess risky behaviors for teens for example. Streamlining use for all of these programs is our next goal.

However, we are now faced with increasing use of heroin. What is more concerning is that heroin is being cut with fentanyl which is leading to higher rates of overdoses. Our first responders must wear gloves when treating overdosed patients because they could get sick from even minimal contact with the patient. Our police and firefighters carry Narcan as a matter of routine. Just when you think you have one spoke of the wheel fixed (making it harder to get opioids), you realize you need another spoke for something else (increased use of heroin).

In May 2016, Governor Baker signed landmark legislation to address the deadly opioid and heroin epidemic which was supported by a large contingency including HHS Secretary, Senate President, House Speaker, Attorney General, Auditor and members of the legislature, law enforcement, health care providers, community leaders, individuals in recovery and others. The bill, titled an Act relative to substance use, treatment, education and prevention passed with unanimous votes in both legislative chambers and included numerous recommendation from the Governor’s opioid working group as well as the first law in the nation to establish a 7 day limit on first time opioid prescriptions.

Q.  How was the legislature able to get on the same page and agree to the terms in the bill?

A.  The key word here is Honesty. We have a Republican Governor with a Democratic majority in the legislature. When the Governor began his term, it wasn’t part of his agenda to deal with the opioid crisis. That changed quickly, substance abuse impacts everyone no matter what side of the aisle you’re on. There was a lot of proactive work in the legislature with respect to the problem, the Governor supported our efforts, and all sides and stakeholders were included. Trust was also a big factor.

Back in June 2015, the Governor’s Opioid Working Group released its recommendations including 65 actionable recommendations with an Action Plan for the administration to consider for implementation.   I appreciate how the recommendations were broken down from short-term goals (0-6 months) with long terms goals (3+ years) by 4 categories: Prevention, Intervention, Treatment & Recovery. According to the Governor’s website, approximately 90% of the initiatives in the Governor’s Action Plan are complete or underway, impressive!

Q.  Was it important to develop the recommendations and action plan? How are you measuring its success?

A.  First we had to figure out how we could move around money and not increase taxes. Next, we needed a roadmap. I traveled from the corner of our state to the Cape. We brought in all stakeholders while working on the issue in the Senate and the Governor’s plan mirrored our plan. Absolutely it has been important to have these documents. We may not have gotten everything we wanted or asked for, but the roadmap sets the pathway for what we have agreed to work on together.

Use of data will be necessary to measure success; this is still new for us. Most likely our Department of Public Safety will be the ones that aggregate and create the metrics for quantitative and qualitative analysis of the impact of our roadmap’s initiatives.

In December 2016, the Governor joined Secretary of Labor & Workforce Development Ronald Walker, II and Secretary of HHS Marylou Sudders to announce a new 2 year voluntary workers compensation pilot for opioid-related cases to assist injured workers who have settled workers’ compensation claims get treatment for pain management, aimed at limiting the use of opioids or other narcotics. The program assigns a care coordinator to mediate treatment options between an injured worker and the insurance company paying for medical care.

Q.  May be too soon to tell, but what are your thoughts on this voluntary, work comp program for opioid-related cases?

A.  I was not involved with this latest initiative however I feel that people on opioids just want to find some sort of balance. So for example, how do we utilize alternative therapies (yoga or acupuncture) versus use of opioids? How can we do a better job of having a conversation on do you want to spend the next 60 years of your life on drugs or having a quality of life?   Education matters, let’s be open to trying other things. Doctors need to be part of the conversation in helping to change the disability mindset of patient. It has helped that younger doctors today are getting trained in school on addiction.

Q.  Last, what more needs to be done with respect to the opioid crisis? What are some of the items you’ll be working on?

A.  More transitional housing needs to be addressed. When addicts get out of detox, they are stuck…they have a record, background of drug use, they cannot get into public housing, “sober homes” aren’t always sober and most can’t go home. I want to encourage more public/private partnerships, dorm-style or apartment living to help with recovery and gainful employment.

Additionally, we need to educate employers that the best thing they can do for an addicted worker is to allow them to remain employed while seeking treatment. Employers can put posters in the bathroom on available resources for treatment help for example. Involving the Chamber of Commerce to support this issue would help. It doesn’t cost any money to educate workers on available resources and workers can’t pay taxes if they aren’t working!

Senator, thank you for taking time out of our busy schedule for our discussion on the opioid epidemic and for your tireless efforts to make a difference.



Thursday Thought Leader: Rx Professor Mark Pew

Love to see great recognition for my friend Mark Pew, Senior Vice President at PRIUM, aka Rx Professor!  His tireless passion for educating our work comp industry on chronic pain and appropriate treatment is exemplary.  Read more about him in LegalNet’s Thursday Thought Leader series!

Major Insurer Removes Barriers to Addiction Treatment

Health insurer Cigna announced last week it has discontinued its policy of requiring docs to seek pre-authorization and approval before treating opioid addicts.  This is GREAT news for many suffering from dependency and addiction to these dangerous drugs.

New York’s Attorney General Eric Schneiderman made the CIGNA announcement and has been a leading proponent on the opioid abuse front.  Schneiderman’s passion and conviction fighting this epidemic led to the passage of NY’s I-STOP legislation.  That legislation also included a provision to reclassify hydrocodone as a Schedule II controlled substance, the first state to do so with the Federal government following suit shortly thereafter.

Lawmakers across this nation are seeking ways to stem the epidemic.  Nevada’s Governor Brian Sandoval held a 2-day Prescription Drug Summit comprised of key stakeholders that included medical and pharmacy state boards, law enforcement and policy makers.  As part of the pre-planning session, Governor Sandoval also asked two recovering addicts to discuss their stories…their presentations were moving and powerful.  Vermont’s Governor Peter Shumlin has been recognized for his efforts confronting opioid addiction by making naxolone more widely available to law enforcement & EMS, and strengthening its PDMP as a tool to promote appropriate use of controlled substances and deter misuse.

California’s SB482 is now law and requires a prescribing health care practitioner to consult the CURES prescription drug monitoring database to review a patient’s controlled substance history prior to prescribing any Sch II, III or IV controlled substance, with limited exceptions.  What remains to be seen is when this mandate will go into effect and enforcement of this provision, but certainly another step in the right direction on controlling opioid utilization.

What makes the Cigna announcement so significant is that Cigna likely understands the potential for dollars saved, but made a moral judgment to try to save lives as well.  I would be surprised if Cigna did not investigate the continued costs of paying for health care for struggling addicts (higher ER visits, continued costs of prescribed opioids, co-morbidities from long term use) over the cost for treating opioid addiction then determined it made economic sense to get people into treatment.  However, the bigger message here is that all insurers, including workers’ compensation payers, should follow suit and remove barriers to allow expedited access to addiction treatment.  You see, when an addict finds a moment of clarity and asks for help, that door only opens for so long…waiting days for authorization may likely cause it to close permanently.

Work comp payers, unwittingly, may have helped to create an opioid dependent population of disabled workers…shouldn’t we have a moral and financial obligation as well to provide a pathway for treatment of addiction?  Treating addiction is complex and difficult, there’s no simple solution, but not trying is a failure on our part.  Removing barriers to treatment is the right thing to do, clearly Cigna agrees.