Combatting Massachusetts's Opioid Epidemic: Reducing the Social Stigma of Addiction Through Increased Access to Voluntary Treatment Services and Expansion of Mandatory Clinician Education Programs.

INTRODUCTIONThe opioid epidemic is a significant global health problem affecting the health and economy of our nation.1 Massachusetts currently faces an increasing prescription opioid crisis, resulting in addiction, heroin use, and accidental overdose deaths.2 While other states are certainly experiencing this same problem, former Massachusetts Governor Deval Patrick declared the problem a Public Health Emergency in 2014.3 By declaring the opioid epidemic a Public Health Emergency, Governor Patrick took "extraordinary legal action[]," which is normally only invoked for public health issues such as acts of terrorism, epidemics of serious, contagious diseases, and natural disasters.4 Massachusetts does not define a public health emergency, granting the governor discretion in deciding when to declare such an event.5The National Institute on Drug Abuse estimates that in 2012 approximately 2.1 million people in the United States abused opioid painkillers.6 Between 2004 and 2015, approximately 6,600 Massachusetts residents died from opioid-related overdoses.7 And in 2014 alone, there were 1,089 opioid-related overdose deaths in Massachusetts.8 "Experts cite a number of contributors to the exponential increase in the amount of patients treated with opioids, including providers' inappropriate prescribing or inadequate counseling and monitoring, patients' misuse or abuse of drugs, sharing of pain pills with relatives or friends, [and] 'doctor shopping' to obtain multiple prescriptions . . . . "9 While treatment can be an effective means of preventing death in many cases, the majority of people suffering from substance addiction do not receive the treatment that they need.10 In fact, fewer than twelve percent of those Americans who were addicted to opioids in 2014 received treatment.11 According to the Massachusetts Department of Public Health, 89% of individuals addicted to opioids do not receive treatment for their addiction, while close to 95% of those surveyed indicated that they personally believed they were not in need of treatment.12In the fall of 2015, Massachusetts Governor Charles Baker proposed a bill to limit the amount of prescription opioids that medical professionals could prescribe to their patients.13 Specifically, Baker proposed limiting the supply of prescription painkillers to a three-day supply, with few exceptions.14 On January 13, 2016, the Massachusetts House unanimously passed a bill to address the opioid-crisis, which was similar to Baker's proposal but contained several important differences.15 Notably, the House's proposal limited the supply of prescription painkillers to seven days, rather than Baker's proposed three-day limit.16 On March 14, 2016, Baker signed the bill (commonly called "Baker's Bill") into legislation, which adopted the House's sevenday limit for first-time opioid prescriptions, among other provisions designed to improve prevention, treatment, and education of opioid abuse.17The discussion surrounding this legislation has emphasized the "tension between the government's latest effort to stem the epidemic and doctors' belief that they know their patients' needs best."18 This balance between governmental regulation and individualized medical concerns is certainly not novel, but given the widespread problem of painkiller addiction, many believe this bill is crucial to solving the urgent opioid crisis in Massachusetts.This paper proceeds in four parts. Part I defines the problem of opioid addiction, examining the underlying causes as well as the significance of the epidemic. Part II discusses the reasons for current attention to the opioid epidemic. Since some argue this is largely due to an increase in the number of white addicts dying, part II considers the possibility of racially motivated reporting. Part III identifies the main provisions of Baker's Bill.19 Part IV critiques Baker's Bill and proposes two modifications designed to remedy potential problems with the Act: (a) increasing access to voluntary treatment programs, and (b) expanding education and awareness about opioid misuse, particularly for clinicians and those prescribing opioids. …