By Colleen Quinn
STATE HOUSE NEWS SERVICE
STATE HOUSE -- Bills aimed at curbing the Massachusetts opioid epidemic in part by making substance abuse services more easily accessible are still being ironed out by lawmakers who think they can reconcile the differences within the next two weeks.
Sen. Jennifer Flanagan (D-Leominster), who chaired a special task force that looked at the opioid epidemic, said Wednesday that lawmakers are trying to work out differences between bills approved by the House and Senate, and hope to do it without appointing lawmakers to a conference committee.
"We are trying, because the differences are so few, we are trying not to appoint a conference committee. I think we will be able to negotiate a compromise with the House," Flanagan told the News Service Wednesday. "That is where it stands now. There are no major differences."
Meanwhile, a national association of doctors who treat drug addictions has concerns about a provision in the bill that would require insurance providers to cover in-patient detox treatment up to 10 or 21 days, without prior authorization from insurers.
The American Society of Addiction Medicine wrote to Speaker Robert DeLeo and Senate President Therese Murray last week, urging them to remove that provision in the bills (H 4236/S 2142).
The president of the American Society of Addiction Medicine, based in Chevy Chase, Maryland, said he is concerned the provision endorses in-patient detoxification as a preferred treatment for opioid addiction over other less costly treatments he says are often more effective.
"Very few people require twenty-four hour care to detoxify from opioids," Dr. Stuart Gitlow, president of the ASAM wrote in a letter to legislative leaders.
Bill proponents accused the association of launching a "last-ditch effort" to derail the bill.
Vic DiGravio, president of the Association for Behavioral Healthcare, said the organization criticizing the drug abuse treatment legislation misread it, and the bill does not create mandates for in-patient care.
The bill requires access to services, but it does not say everyone should be treated in-patient, DiGravio said, with the decision made in consultation with a health care provider. "That is different than everyone has to have detox services," he said.
During hearings held around the state, lawmakers heard stories from family members and drug addicts about the difficulty in getting insurance companies, including the state-run MassHealth, to approve coverage for in-patient detox care.
"A lot of what we've heard from across the state, and we've been from North Adams to Hyannis and everywhere in between, and it was 'okay when I called to go in they would tell me that I hadn't used enough or they told me to try outpatient first, and it's not working for me,' " Flanagan said.
Another aspect lawmakers focused on when crafting the bill was the increasing number of deaths related to opioid addiction.
"The number of deaths, not only in Massachusetts but nationwide, is escalating to the point that if we do not look at what some of those real obstacles are and try to get beyond them, we are going to continue to lose lives," Flanagan said.
Nancy Paull, chief executive officer of SStar - a drug treatment care provider - also wrote a letter to DeLeo, countering the concerns raised by the ASAM. Since January 2014, her organization has seen in increase in insurance coverage denials for detox-level care.
Gitlow said the vast majority of patients can detoxify in an outpatient setting, and maintain abstinence from opioids using drug treatments such as methadone, naltrexone or buprenorphine.
"Patients prescribed medication-assisted maintenance pharmacotherapies are associated with better treatment retention and lower rates of illicit drug use and mortality, compared to patients who are detoxified as their primary or sole management approach," Gitlow wrote.
Gitlow, in a telephone interview with the News Service, said the organization is concerned that in-patient detox will become the preferred treatment option.
"Let me preface this by saying, we are on a different side then we would be expected to be on this issue," Gitlow said. "The expectation is we would fight for parity. Therefore, we should be in favor of a bill that would make that easy."
The problem, Gitlow said, is each patient with addiction needs to be treated individually. Frequently, patients do not require a high-level of detox care and would do better with outpatient drug treatment, he said.
In addition, there are a limited amount of detox beds, and if everyone with an addiction seeks in-patient care "some people who really need to get in aren't going to get in because there is no space," Gitlow said.
Flanagan said lawmakers are not endorsing any one method of treatment over another.
"There isn't a mandate for in-patient, and I think that's where the letter is wrong, saying we're endorsing the mandate," Flanagan said. "I think what's happening is we're saying it's an option for treatment. In no way is the Senate telling someone how to handle their recovery, or how to go about their recovery."
Some people need to start recovery at the detox level, and some do not need detox but need intensive outpatient, she said.
"What we are saying is the doctor and the patient are going to decide what needs to happen," Flanagan said.