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Boston, Massachusetts 02108-3002

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More Substance Abuse Treatment Beds Needed to Take on Opioid Crisis - Boston, MA

Wednesday, November 18, 2015

By Thomas Kenney and Brandon Saunders

If the image of the crumbling state hospital in the Leonardo DiCaprio film Shutter Island seems eerily familiar, it may be because the building used in the film was the former Medfield State Hospital, itself shuttered along with most state hospitals as the Commonwealth moved away from institutional care in favor of a community-based treatment model several decades ago.

While that image might spark a debate about the wisdom of deinstitutionalization, it also may provoke dialogue about how these facilities could be restored to productive use as addiction treatment centers to grapple with a rising opioid crisis that will likely get worse before it gets better.

Much of the current debate over a comprehensive legislative proposal by Governor Charlie Baker focuses on limiting prescriptions physicians may write for these highly addictive drugs, and a measure that emergency room medical staff be permitted (or even required) to place a 72-hour hold on an addict who appears in the ER if the treating physician judges that person to be a danger to him or herself or others.

What hasn’t received as much attention is what occurs after that patient is released – whether it is the same day they appeared in the ER or 72 hours later. What happens next?

There is much that should be done on the front end of the addiction crisis, but little will change unless we also expand treatment beds in a system that is already beyond capacity.

What is also undermining the effort to get addicts into treatment, according to Health Policy Briefs, is a pattern of insurer denials of mental health and substance abuse treatment claims as compared to other medical claims, despite efforts by Congress to close that inequity.

The drug addiction crisis in Massachusetts goes beyond the 1,200 accidental opioid deaths reported in 2014. The state’s Bureau of Substance Abuse Services (BSAS) reports that 107,358 people in Massachusetts were admitted into an alcohol or drug substance abuse program in fiscal year 2014.

Under existing Massachusetts law, those suffering from severe drug or alcohol addiction can be involuntarily committed to a treatment program for up to 90 days by a district court judge when all other efforts have failed.  The state’s highest court has recently ruled that hearings on these so-called “Section 35” commitments require a lower burden of proof, with hearsay evidence allowed, and a “clear and convincing” standard applied, as opposed to the stricter “beyond a reasonable doubt” standard utilized in criminal proceedings.

As attorneys who obtain and enforce involuntary commitments of those with alcohol and drug addictions, we see the impact of an acute shortage of treatment beds. We have successfully petitioned the courts for the involuntary commitment of those so afflicted with a drug or alcohol addiction that they are in danger of significant harm to themselves or others, only to see them leave the treatment facility within a few weeks and then reappear at hospital emergency rooms. Local emergency medical leaders are rightfully concerned that short stays in ERs after commitments may do more harm than good to access to care in many instances.

The state’s two facilities for treating addicts are chronically overcrowded and underfunded and can barely cope with alcohol addiction, never mind a rising narcotic and opioid addiction crisis. Those in treatment under an involuntary commitment are typically discharged after as little as 20 days in what amounts to a “spin dry” detox that has little chance of curing the addiction.

In our opinion, the Commonwealth’s plan to open new secure treatment facilities at Taunton State Hospital and Lemuel Shattuck Hospital in early 2016 will not be nearly enough to handle the overwhelming increase in the demand for substance abuse treatment beds.

One promising approach, developed by Beth Israel Deaconess in Plymouth and other key local stakeholders, is broader in scope. BID Plymouth CEO Peter Holden recently argued that this pandemic needs to be addressed with a community-based approach that includes local hospitals, police and the courts, in a coordinated approach and doesn’t just rely on hospitals treating the opioid crisis simply as a medical issue.

There is no panacea, and none of these well-meaning measures alone will change the arc of this crisis unless they are pursued together with longer-term substance treatment resources - inpatient beds, residential programs and specialty treatment centers to treat addicted patients and keep them long enough to provide meaningful treatment and a reasonable chance for recovery.

Thomas Kenney and Brandon Saunders are attorneys at Pierce & Mandell, P.C., Boston, who specialize in involuntary commitment proceedings.

Addiction Treatment Centers in Massachusetts Being Overrun By Epidemic

Tuesday, May 05, 2015

By Brandon Saunders

Governor Charlie Baker’s recent description of drug addiction in Massachusetts as a “public health emergency” is a welcome acknowledgement of a crisis that is swamping treatment centers, hospitals and the criminal justice system. The Governor is asking a task force he assembled to come back with strategies for dealing with addiction, treatment and recovery. Those recommendations are expected soon.

Governor Baker’s Secretary of Health and Human Services, Marylou Sudders, describes the problem in stark terms: "The costs associated with treating opioid addiction are great, however inaction or not labeling it for what it is - which is an epidemic - is actually much greater," Secretary Sudders said, as the Baker task force held public meetings to better understand the threat. "I recognize that there are no quick fixes and that we have lots to do."

The scale of this crisis is unprecedented. In 2014, there were more than 1,000 accidental opiod-based drug overdoses in Massachusetts, and 868 confirmed opiod overdoses the year before that. The state Department of Public Health’s Bureau of Substance Abuse Services (BSAS) reports that 107,358 people in Massachusetts were admitted into a substance abuse program in fiscal year 2014, 44 percent of whom reported prior mental health treatment, and nearly 60 percent self-reported heroin use. Those numbers reflect only those who were admitted to rehabilitation centers.  A large number of addicts refuse treatment.

These individuals repeatedly present themselves to the emergency department of acute care hospitals, putting an even greater strain on an already overrun system.  Once their acute conditions are treated, physicians at the facilities prescribe substance-abuse treatment, but often to no avail.  In my representation of a large, Boston-based acute care hospital, I have dealt with individuals who had presented themselves to the ER more than a hundred times in one year for substance-abuse related conditions.

Under existing Massachusetts law, those suffering from severe drug or alcohol addiction can be involuntarily committed to a treatment program for up to 90 days. The law that enables interested parties to commit someone to a treatment center (Chapter 123, Section 35) establishes a process by which family members, a physician, or legal guardian can petition a district court judge to order that commitment when all other efforts have failed.

The reality, however, is that Section 35 cannot cope with the rising tide of addiction, particularly for the uninsured or MassHealth recipients who are invariably sent to the Massachusetts Alcohol and Substance Abuse Center (MASAC) at the Bridgewater State Hospital for men, and MCI Framingham for women under an involuntary commitment. Both of those facilities are chronically overcrowded and underfunded, resulting in a “spin dry” detox that often sends them out on the streets after just 10 days without a real opportunity for a meaningful change or lasting sobriety that the 90-day commitment might have afforded. And then the cycle repeats itself.

Acute care hospitals are not the only system choking under the pressure of untreated addiction.  The systemic failure to successfully treat addiction is also swamping our criminal justice system. Those who continue down the path of addiction are often arrested and prosecuted for drug- or alcohol-related offenses, contributing to overcrowded conditions in state and county correction facilities when they might have been more successfully, and more appropriately, treated in a substance abuse or mental health facility.

Governor Baker is to be commended for taking this issue on, but it will take the leaders of our healthcare and legal systems, together with our elected officials, to get ahead of what is still a rising tide of needless deaths and hopeless addiction. We need to solve the ineffective and often wasteful ways we handle substance abuse and addictions in the Commonwealth and hopefully these most recent initiatives will move us in the right direction.

Brandon Saunders is an associate attorney at Pierce & Mandell LLC in Boston and specializes in guardianships, incapacitated adults and civil commitments


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