Shared Responsibility: Massachusetts Legislators, Physicians, and An Act Relative to Substance Use Treatment, Education, and Prevention

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Abstract

Recent passage of the Massachusetts law, An Act Relative to Substance Use, Treatment, Education, and Prevention, represents an admirable public health approach to substance use disorder (SUD), a stigmatized chronic disease that affects some of society's most vulnerable people. With its seven-day supply limit on first-time opioid prescriptions, this legislation takes an unusual approach to state government involvement in health care. By intervening in individual physicians' practices, state legislators have entered a space traditionally reserved for clinical teams. The seven-day supply limit and the process through which it was developed highlight competing priorities and dialogue between physicians and legislators, limits of physician self-regulation, and standards of evidence in policy making and health care. Addressing these issues requires both physicians and legislators to recognize and fulfill new responsibilities in order to better assist the populations they serve. Shared Responsibility: Legislators, Physicians, and Massachusetts' An Act Relative to Substance Use, Treatment, Education, and Prevention SUD is a stigmatized chronic disease that affected some 20.2 million adults in the United States during 2014 and carries with it a substantially increased risk of morbidity and death [1, 2]. In Massachusetts, opioid misuse, in particular, has been on the rise. In 2015, the estimated rate of unintentional opioid-related overdose deaths rose to 22.6 deaths per 100,000 residents, representing a more than 400 percent increase from the rate of 5.3 deaths per 100,000 residents in 2000 [3]. The rising death rate has captured the attention of many, including Governor Charlie Baker and the Massachusetts state legislature, which, in March 2016, passed An Act Relative to Substance Use, Treatment, Education, and Prevention in an effort to control the epidemic [4]. The causes of and potential policy responses to the opioid epidemic are myriad. A central part of the act—and this commentary—is the decision to limit opioid supply by regulating physician practice. It is noteworthy, however, that the act also allows patients to request smaller quantities of opioids than were prescribed, mandates substance use evaluations for patients who present to the emergency department after an overdose,

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APA

Shared Responsibility: Massachusetts Legislators, Physicians, and An Act Relative to Substance Use Treatment, Education, and Prevention. (2016). AMA Journal of Ethics, 18(9), 950–959. https://doi.org/10.1001/journalofethics.2016.18.9.pfor2-1609

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