Gov. Charlie Baker criticized what he considers a blase attitude among some health professionals about addictive painkillers as he introduced legislation Thursday as part of his strategy to curtail a deadly surge in drug overdoses in Massachusetts.
Baker called for a 72-hour limit on first-time prescriptions for opioid painkillers and a change in the state's civil commitment law.
The legislation would restrict patients to a three-day supply of painkillers the first time they are prescribed an opioid drug, or when they receive a prescription from a new doctor. Patients could seek refills after the three-day period and exceptions would be made for certain chronic conditions and hospice care.
Baker's proposals, which prompted concerns from a leading physicians' group and civil libertarians, came in response to state figures that showed an estimated 1,250 deaths from opioid overdoses in 2014, about triple the number of deaths five years ago.
The governor has been highly critical of overprescribing painkillers, which can lead to addiction to opioids, including heroin.
"I'm a health care guy," said Baker, a Republican and the former head of Harvard Pilgrim Health Care. "I have lots of friends and lots of colleagues in the health care world, and I am astonished by the casual nature and the casual attitude I find when I talk to them about these medications. That has got to change."
The bill would also allow doctors and other medical professionals to commit a person involuntarily to a drug treatment facility for up to 72 hours if they're considered an immediate danger to themselves or others. Currently, a judge's order is required for a civil commitment and such orders can be difficult to obtain at night or on weekends.
Baker referred anecdotally to people who go to emergency rooms, receive an injection of the overdose reversal drug Narcan, and are then released - only to turn up days later in the same ER.
"In many cases, these are stories that end badly several weeks or several months later," he said.
Dr. Dennis Dimitri, president of the 25,000-member Massachusetts Medical Society, said a hard-and-fast 72-hour supply limit on first-time prescriptions could limit treatment options and interfere with the clinical judgment of experienced doctors. The organization already has guidelines that urge physicians to prescribe the lowest effective doses of opioid drugs in the smallest possible quantities, he added.
While praising the governor's determination to stem the addiction crisis, Dimitri also cited challenges with allowing doctors to authorize civil commitments.
"I think that is something that would be very difficult for most physicians to make a judgment call on," he said, adding that there are not enough substance abuse beds available for patients in the state.
Jessie Rossman, staff attorney for the American Civil Liberties Union of Massachusetts, called for a careful review of the civil commitment provision.
"Depriving people of their liberties even with the intent of helping them is a very serious undertaking," said Rossman.
Baker acknowledged the controversial aspect of the proposals but said he hoped it would lead to a wider discussion of issues surrounding addiction.
The state Senate recently approved its own wide-ranging bill that includes screening of public school students for potential substance abuse and encourages doctors to consider alternatives to opioids for pain management.
Senate President Stan Rosenberg and House Speaker Robert DeLeo, both Democrats, issued statements Thursday pledging legislative action on opioid abuse in the current session, though neither immediately endorsed the governor's bill.
Rosenberg did praise the administration's previously announced intention to end a longstanding policy of placing women with civil commitments for substance abuse - but who have not committed crimes - into the state prison for women in Framingham. The ACLU has filed a lawsuit to end the practice.