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