H.4033. An Act relative to combatting addiction, accessing treatment, reducing prescriptions, and enhancing prevention

Massachusetts House of Representatives
Last action a year ago
Polls (open):


Charles D. Baker


                    An Act relative to combatting addiction, accessing treatment, reducing prescriptions, and enhancing prevention.

Whereas, The deferred operation of this act would tend to defeat its purpose, which is to continue the Commonwealth’s efforts to mitigate of the effects of the ongoing opioid crisis in Massachusetts, therefore, it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience.

Letter from the Governor:

To the Honorable Senate and House of Representatives, I am filing for your consideration a bill entitled “An Act Relative to Combatting Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention.” This legislation continues our commitment to mitigate the impacts of the ongoing opioid addiction crisis in Massachusetts. One of the major first steps in this effort was the enactment of Chapter 52 of the Acts of 2016, an Act Relative to Substance Use, Treatment, Education and Prevention (the STEP Act), which created important new tools for expanding treatment for people who suffer from opioid addiction, reducing the overuse of prescription opioids in the Commonwealth, and improving education for young people, educators, and medical professionals on the risks of opioid misuse. Today, eighteen months later, we are seeing early signs of progress in fighting this terrible epidemic, and we know much more about what works in the fight. The legislation I am filing today builds upon the foundational work of the STEP Act and continues the Commonwealth’s comprehensive approach to addressing the problem of opioid addiction.
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                    Improving Access to Treatment The first priority of this legislation is to ensure that people who are suffering from opioid addiction receive the specialized treatment they need. The STEP Act introduced a requirement that medical staff in an emergency department conduct a substance abuse evaluation and provide information on addiction treatment for any patient treated for an opioid overdose. This bill aims to improve the effectiveness of these consultations by expanding the range of medical professionals authorized to perform the evaluation and by requiring that the emergency department affirmatively connect the patient with the appropriate level of care.

The bill also permits medical professionals or police officers to authorize the transport of a patient to a substance use treatment facility for emergency assessment and treatment when the patient presents a risk of serious harm due to addiction and the patient will not agree to voluntary treatment. A treatment facility receiving a patient transported under this provision would then be required to attempt to engage the patient in voluntary treatment for a period of up to 72 hours. In cases where a patient poses an immediate risk of harm but remains unable to engage in voluntary treatment, medical professionals at the treatment facility would be required to petition a court to commit the patient for involuntary treatment under section 35 of chapter 123, the existing civil commitment statute. Other provisions in the bill call for the development of a set of consistent, state-wide standards for the medical evaluation of any person who is the subject of a section 35 petition and the inclusion of medical professionals other than physicians among the persons who are authorized to initiate a court petition for commitment under the statute.

In order to ensure that the right kind of treatment facilities will be available to serve every patient who needs treatment, the legislation enhances the oversight authority of the Department of Mental Health (DMH) and the Department of Public Health’s Bureau of Substance Addiction Services (DPH/BSAS), the two agencies that license facilities that provide treatment for addiction and mental illness. Under the legislation, before licensing new treatment programs or approving the transfer of license for an existing program, DMH and DPH/BSAS will require that a facility demonstrate that it provides the range and quality of services necessary to meet the current critical treatment needs of the Commonwealth’s patients. One important component of the evaluation will be a requirement that these facilities make treatment available to patients with public health insurance on the same basis as patients with private insurance.

The bill recognizes the important role that recovery coaches play in successful long-term addiction treatment by creating a commission to recommend standards for establishing a professional credential for recovery coaches as an important step toward formalizing the role of recovery coaches in the regimen of long-term addiction treatment.

Even now, years into the opioid crisis, there is still far too little high quality data guiding decision making about the most effective forms of treatment for addiction. To address this gap, the bill creates a commission to review evidence-based treatment approaches to substance use disorders and mental health conditions. The bill directs the commission to produce findings in 180 days to help insurers and patients to identify the most effective addiction and mental health treatments offered across the full range of licensed behavioral health clinician specialties so that each patient can find the specific treatment that best meets the patient’s needs.

Finally, the bill increases access to naloxone—a front-line treatment for overdoses—by directing the Department of Public Health to issue a state-wide standing order that will authorize every pharmacy in the Commonwealth to dispense naloxone. The bill also encourages broader use of naloxone by guaranteeing that practitioners who prescribe and pharmacists who dispense naloxone in good faith will be protected from criminal or civil liability.

Preventing Opioid Misuse The Commonwealth has seen a 29% decline in opioid prescriptions since the STEP Act introduced new tools to monitor and limit the use of opioid prescriptions. This legislation introduces a number of initiatives aimed at continuing this positive, downward trend.

In order to reduce fraud and drug diversion and improve tracking and data collection, the bill mandates that by 2020 all prescribers must convert to secure electronic prescriptions and cease the use of oral and paper prescriptions when prescribing regulated drugs.

The STEP Act introduced a 7-day limit on initial prescriptions for opioids and enforced accountability by requiring practitioners to use the Commonwealth’s Prescription Monitoring Program (PMP) before issuing any prescription for opioids. The bill creates a commission to develop standards for the Department of Public Health to apply in referring prescribers to professional licensing organizations for potential disciplinary action when they do not check the PMP as required by law or violate the 7-day rule or other legal or professional standards limiting the prescribing of opioids. The bill also creates a commission that will develop recommendations on appropriate prescribing practices for the most common oral and advanced dental procedures including recommendations on approving the use of standardized, prepackaged doses of commonly issued prescription drugs to reduce the likelihood of overprescribing.

We know that, for too many people, an opioid prescription issued to treat a serious injury can put them at risk of developing an addiction. To address this danger, the bill authorizes the Department of Industrial Accidents, which administers the Commonwealth’s workers compensation insurance program, to develop an approved drug formulary to regulate the use of opioids in treating workplace injuries. Following a change in Federal law, the bill also improves on the “partial fill” provision of the STEP Act so that patients will now be able to receive a portion of their full opioid prescription without invalidating the remainder of it. More patients may choose the “partial fill” option if they know they can go back to the same pharmacy within 30 days to fill the rest of the prescription if needed.

Expanding Educational Efforts In the long run, our ability to meaningfully reduce the problem of opioid addiction will depend on better and wider education about the larger problem of substance misuse. The STEP Act introduced requirements that every school district in the Commonwealth develop effective 4 of 32 substance use prevention and misuse education programming and that schools adopt an individualized assessment tool to screen students for substance use disorders.

This legislation creates a trust fund to help finance the expansion of educational and intervention programs, to support the development of information systems that can help identify students at risk and track outcomes, and to support the implementation of new, school-based models for coordinated support of students in need. I intend to include a request for an appropriation of $2 million in the fiscal year 2019 budget to provide a first year of funding to the trust.

I urge your prompt enactment of this legislation.


Charles D. Baker,


In an effort to be an unbiased source of information, all text in this summary comes directly from government resources.


  • Accompanied a new draft, see H4470

    Mon, May 7th 2018
  • Senate concurred

    Thu, Mar 22nd 2018
  • Reporting date extended to Monday May 7, 2018, pending concurrence

    Wed, Mar 21st 2018
  • Amendment (changing reporting date to Friday May 4, 2018) adopted, pending concurrence

    Wed, Mar 21st 2018
  • Senate concurred

    Wed, Feb 7th 2018
  • Reporting date extended to Tuesday March 20, 2018, pending concurrence

    Tue, Feb 6th 2018
  • Hearing scheduled for 01/16/2018 from 01:00 PM-05:00 PM in Gardner Auditorium

    Wed, Jan 3rd 2018
  • Senate concurred

    Mon, Nov 20th 2017
  • Referred to the committee on Mental Health, Substance Use and Recovery

    Wed, Nov 15th 2017