2023-09-18 00:00:00 - Joint Committee on Mental Health, Substance Use and Recovery
2023-09-18 00:00:00 - Joint Committee on Mental Health, Substance Use and Recovery
SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Alrighty. Good morning, everyone, and welcome to the joint committee on mental health substance use and recovery's 3rd public hearing of the 2023, 2024 legislative session. My name is John Villas. And I'm the senate chair of the committee, and I'm joined by my friend and colleague chair Adrian Madero, the house chair of this committee. Wanna thank all those present? Both in person and virtually for being here today, and we are now calling this hearing to order. Today's hearing focuses on legislation related to opiates. I wanna take a moment to recognize that here we are more than 30 years into this opioid epidemic, and we are still talking about these painful issues When we talk about the challenges that our Commonwealth faces in terms of substance use disorders and addiction, it's important to remember that for many people, These problems started first with the trip to their doctor. While we have come a long way with the prescription monitoring program and other measures,291 opioid pain killers continue to be 1 of the first ways that individuals in our commonwealth get introduced to addictive substances, specifically opiates. This has to be a continued focus of ours, and that's why I'm grateful this for this hearing today where we will be hearing testimony on several bills focused directly on Christian opiates, patient and prescription edging prescription education requirements, non opiate alternative forms of care, and other related matters. And now I wanted319 to turn it over to my friend and co chair.
SPEAKER2 - They accept
SPEAKER3 - Yeah. Vice chair, Michelle Duvois, representative of Bla. We have Representative Wipps,340 Representative Cushy America. I believe he's here in person. Representative Exxaro is here in person. Representative Donahue went down to my right. And Representative Cameron is also
SPEAKER2 - in person. As Senator B said, today's hearing is not about opioids. This is notable given that August was overdose prevention month and August 31st was overdose awareness day. These important milestones are an opportunity to honor the lives, far too many, been lost to overdose stay united with those who continue to grieve, the loss of loved ones, and379 renew our commitments they overdose in its consequences, and our commuter is383 just to put some numbers, too, what I just said, nearly 110,000 lives were lost due to overdose in 2022. The number of opioid-related deaths increased by 2.5% in the commonwealth with over 2000 lives lost. So, this is an incredibly important matter and, I'm glad that coming back after406 recess, in September, this is the first year. So we could start to tackle411 these issues from here from you all. So I do want to just note, that we have a custom here, there's one committee that's called institutional recovery to take a short mental health break about halfway through the hearing. I want to thank LIS and the system's starting to launch with facilitated hybrid hearing. I want to thank our committee staff, Senator, for being able to staff, my staff, but it dealt with your work in setting today's hearing up. Finally, I want to thank all of you who signed up to testify. Virtually and in person for your time and perspective on these critical issues we look forward to hearing from you all. Thank you.
REP MADARO - Thank you, Mr. Chairman. I would now like to recognize the other senate members of this committee. The vice chair, Senator Seer, Senator Collins, Senator Kreitan, Senator Keenan, who has joined us, Senator Kennedy, and Senator O'Connor. Few other housekeeping details before we get started. This is a hybrid hearing with participation both in person and virtually testimony will be limited to 3 minutes per person at the discretion of the chairs. As is customary, the committee may take elected officials out of turn to testify. If you are here today in person and have not yet registered to testify, you may do so by filling out the signing sheet with committee staff at the back of the hearing room. Written testimony will also continue to be accepted by the committee and could be submitted via email. For members of the committee participating virtually. If you have a question, please use the raised494 hand feature on teams or communicate via the chat to committee staff. I know that several of our legislative colleagues are with us today to testify in legislation. So without further ado, I would like now like to recognize representative Jim Arciero. Representative, are you here?
REP ARCIERO - HB 1962 - Thank you, Mr. Chair. Appreciate it. Typically I'd be here in person. The COVID virus went through my family, so I've been kind of, out, as they will be at home, recovering here. So, normally it'd be my testimony would be in person, but, thank you for taking me out of turn. Chair Madaro, Senator Villas, and members of the joint committee on mental health and substance abuse. I'm testing 5 before you today and I strongly support, House Bill 1962 and act relative to nonopioid alternatives and pain treatment. Legislation I filed with several of553 my legislative colleagues and filed also555 with Senator Timothy, who I assume will be testifying today as well. To address the use of non-opioid alternatives in pain management. I don't have to tell you the devastating impact that the use of opioids has had in our nation in the state in last 2 decades. Addiction and death have become all too common as these very dangerous drugs have gone from our hospitals and doctors' offices to our streets and vulnerable populations.
This legislation simply seeks to give non-opioid alternatives equal weight to the use of opioids for pain management and strengthen addictiveness posed such a dangerous risk to some of our citizens. Specifically, the595 bills this bill simply seek to establish a program to develop and distribute an educational pamphlet regarding the use of non-opioids as an alternative strategy to deal with a treatment of pain. This information would explain the non-opioid medications that are available as well as non-pharmacological therapies that could be utilized by a patient. This critical healthcare information will allow patients and or their representatives to make informed important choices about treatment options, medications, and therapies, and will be especially helpful to those who deem themselves as being at risk for drug addiction and abuse. Thank you for taking me out of turn today. Members of the community, certainly we'll take any questions. Again, thank you, for taking me out of turn. Appreciate the time. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Representative. Thank you for your testimony today. I've known you for many years and your dedication this650 issue. This is something that you've been652 talking about for years, and that's not lost on anyone on this committee. So thank you for your time today. Members of the658 committee questions,
Seeing none. Thank you, Representative.
SPEAKER4 - Thank you, Senator. Thank you, Jim.
SPEAKER1 - Representative Cataldo. Please.
REP CATALDO - Mr. Chairman, good morning. I'm here, just in my capacity as a member of the703 committee. Sorry to be joining a few moments late.
SEN VELIS -COMMITTEE CHAIR - No. We just want to give you the proper the proper greeting. Thanks for Thanks for joining us today. So, yeah, good to see you, representative, and next up in person, likewise. Yes Course. We have Middlesex County district attorneys Mary and Ryan here to talk about House Bill 1969 and SB 1259. Thanks so George. Thank you so much for joining us today.
MARIAN RYAN - MIDDLESEX COUNTY - HB 1969 - SB 1259 - Thank you to the tune, members of the committee for having me today to talk about this Bill. I would suggest that this Bill addresses something that you made a reference to in terms of how long we've been dealing with this struggle. We all know that naloxone has been a game-changer in many settings. In Middlesex County, right now, over 50% of the overdoses that are troopers and local departments respond to. Someone, a civilian, either a family member or someone in a, perhaps, has already administered Aloxo. That has made an enormous difference in terms of our numbers. What we tend to forget is the struggle that still exists for many people just to be able to afford Neulasta. The more common street version of Neulasta on the NARCAN, which is now available pretty much everywhere. It's available in CVS789 and other pharmacies.
Just a couple of weeks ago, Blue Cross Blue Shield became the first big insurance company to say that they would cover the cost without the co-pay, but there remain a number of insurance companies that are not doing that. What we have repeatedly seen, and what was really806 the impetus for this Bill is someone who needs naloxone either for themselves or a family member. They use it, which we encourage them to do. Once you use it, it's gone, and then because of the cost of the co-pay. They can't, maybe at that moment, maybe they are between receiving some payments or something. They can't replenish and then they need it again, and they don't have it. I think if you consider for one second, the prospect of having a family member or someone you love, needing it, not having it, and knowing you don't have it because you were maybe waiting a little bit until you had the $30 or the up to $50 for the co-pay. You see the importance of this Bill. This Bill is modeled on a fund created in the state of New York, where everyone either manufactures cells or delivers opioids in Massachusetts. Would be required to pay a very small, essential tax on the drug, and that would go into a fund to be administered by DPH. To cover the cost.
The Bill does need some redrafting because of the change around the status of naloxone and Narcan, and also because I think this, again, speaks to the crisis as we are seeing it evolve. You may have seen just in the last couple of weeks, the number of prescription opioids being sold has declined pretty dramatically and steadily over the last 9 years. What it is showing now is that people are using those and very quickly transitioning to cheaper street drugs. So there continues to be901 this need. I think this is a common sense, very practical way to look at people who may not want to go to one of the social910 service agencies. I know there's a response that people who want the Lobst1 can get it. For many people, there is still a signal. They are not going to walk into some place and ask for it. They'd rather go to the pharmacy, use their insurance coverage pay for it, and have some privacy in that transaction. This just levels the playing929 field for them in terms of being able to address that family. Thank you for allowing me to testify. I'm happy to take any questions.
VELIS - Thanks so much for your time today. I think I couldn't agree with you more. I mean, the prevalence and dissemination as far as why did can, Alexa, and I think is the game changer that we have yet to fully do as a commonwealth951 yet. We've taken many great strides, but I think there are opportunities for more. Just really curious, you know, obviously, as you already referenced in the past couple959 of weeks, we've kind of seen the the961 policy of the FDA now making NARCAN over the counter. Your thoughts on that as it relates to kind of increasing access, but also the stigma that you could just walk into a CVS or a975 wall?
RYAN - Thank you. That's a great question. I977 think it's 3 pieces, really. It is the stigma that you could now just walk in and get this. You don't have to go somewhere else. You don't have to be embarrassed about raising it. I think it encourages people to use it. We make it very widely available. I buy about 60,000 doses a year that I distribute across our county. Sometimes people have a reluctance. What if I use it and it doesn't work? The research shows that there are no ill effects from using this. We have had in our county, it is used when someone is young as a 9-month-old baby. That baby has been tracked. It's been a number of years with no known harmful effects. So I think make your point, that making it that much more available, making it really much more mainstream will increase people's willingness to take it to use it. The Globe ran an article this week, just really talking about the fact that essentially everybody should have it. It should be in everybody's car. It should be in everybody's pocket because even if you don't use drugs and you think what you're probably wrong, but you think you don't know anyone who does you certainly could find yourself in a situation where using it would make an incredible difference. That all of this change Blue Cross covering it, I think, makes it much more mainstream.
VELIS - Just to your point, EA, and then I'll move on to the ick tragedy in the Bronx over the weekend I believe it was a 1-year-old who passed away, but Narcan bringing others back to life. So it can truly have if it could happen at a daycare, you know,1070 I think it can happen anywhere to1072 your point. So thank you very much. Members of committee questions.
RYAN - As I said, we've been able to use a lot of our funds to provide it. I think there were a number of social service agencies that provided. There are still people who struggle to make this something that they can have readily1130 available. You know, in a perfect world,1132 somebody would have it in their house. They'd have it in their car, especially if they're dealing with somebody they love who's struggling. The cost of you're paying $50 a co-pay for each box, that's a real struggle and a real impediment for some people. So this Bill really seeks to level that access piece, which in a way that I think will make an incredible difference. It's not that people don't know1156 they need it. It's not that they don't know how to use it, but you use it and it's gone. You can't save it and say, maybe I'll need it again this month. So when you take it's one dose. You, use it, and then it's gone. Then until you replace it, you are without it. So we know, for instance, sometimes people are revived and the opioid has not left their system.
So they may overdose again two hours later. You might not have it if you haven't been able to replace that. You know, in a perfect world, we'd want somebody who's been in that situation to have 2 boxes in their house. It is not going to go to waste. It's not something that's got such a short shelf life that people won't be able to use boxes that are not canned everywhere. They tried that in Cambridge. They tried having them in sort of like a, almost like a defibrillator. So you'd unlock the box. There was, I think, and then this goes in part to your point about assuming there was a lot1234 of issue about whether we should have those things on the street and when kids get into them and all of those issues. I think we need to do an even better job of educating people about how important it is. You know, even in a building like this, we should have it available in a building like this. There certainly could be anybody who would come into the building and might have a need. We have seen, for instance, that in a number of elementary schools someone who might be driving with somebody they love who's overdosing. They know there's usually a school nurse. They'll go to the school and use it. So we now provide it. I provide to libraries. I provided soup kitchens to any place that someone might go and then experience an overdose. In the quest. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, sir. Any other questions? Thank you, D. A. Thanks.
Alrighty. Next up, we have a panel, the Massachusetts Cairo Practices chiropractic society on h1970ands1254and1971and1255.
Welcome.
SPEAKER5 - Thank you.1304
SPEAKER2 - Thank you.
SPEAKER8 - Go and talk.
HOWARD EWERT - MASS CHIROPRACTICS SOCIETY - HB 1970 - HB 1971 - SB 1254 - SB 1255 - Thank you. Please. So I'm Howard Ewert. I'm a chiropractor, and I'm speaking on behalf of the Chiropractic Society in support of House Bill 1970 and House Bill 1971. As well as Senate Bill 1254 and SB 1255. These Bills would require that the Department of Public Health and Various boards in the process of writing opioid training programs consult with the Mass Chiropractic Society to ensure the inclusion of accurate information about chiropractic in their documents. That's important because those documents guide prescribers on how to inform their patients. What is the message the chiropractic profession wants to share? Many patients who have common pain conditions like back pain and neck pain have historically been treated with prescription opioids. Those patients could be cared for instead by effective forms of nonfarm care specifically including chiropractic That is far safer than opioids. While prescription opioids have a role in pain care, we know that they're very deadly, addictive, and dangerous. I quote from the New England Journal of Medicine where they say, we know of no other medication routinely used for a non-fatal condition. That kills patients as frequently.
That's pretty startling. Opioids are well known. Even though opioids have been prescribed less in recent years than before, the most recent stats for the mass prescription monitoring programs say that in the first quarter of 2020, 201,000 individuals received opioid prescriptions. 201,000. Now that's a statistic, but it's also individuals. It's about people. 201,000 people who are now at higher risk and who are now on the trajectory so common with opioids. That often leads to death. So we want to implore you to enact these Bills because we think the health care system would be safer and more effective if chiropractor input were more integrated into the system. If we had more time, we would talk about primary prevention programs . We talk about initial care providers that chiropractors are prepared to do this. The chiropractors could treat most of those people triage them and send them for care to other providers if needed. This idea is well documented by many clinical guidelines, especially the1473 CDC 2022 guideline. The next step is for all of1477 us to work together to get this done. It's been 30 years, as you say and, we're here to help at the MCS. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you very much. And keep in mind, you we would love1489 to have the the remainder of your testimony or anything else you wanna say, please feel free to submit that via written testimony as well. Which we will obviously take a look at. And then do we have, miss Tracy Lane?
SPEAKER9 - Hi. Hi, everyone. Thank you for having us today.
SPEAKER1 - Thanks for being here.
TRACY LANE - MASSACHUSETTS CHIROPRACTIC SOCIETY - HB 1970 - HB 1971 - SB 1254 - SB 1255 - Thank you very much. My name is Tracy Lane, and I'm an executive director of the Massachusetts Chiropractic Society. I'm here today to share the testimony on the crucial role that chiropractic care can play in reducing opioid addiction in our community. Our support for House Bill 1970 and HB 1971 and SB 1254, SB 1255, and to inform prescribers of non-opioid alternative care by incorporating chiropractic care into our healthcare system and promoting equitable access to it. We can offer patients a very safe and effective alternative to opioids, potentially preventing many from ever resorting to prescription opioids in the very first place. It is evident that we need comprehensive and innovative solutions. Opioids have long been prescribed as a primary means of managing care in managing pain. But the consequences of this approach have been dire. Addiction overdose and fatalities have become far too common and it is our duty to explore alternative therapies, not only to alleviate pain but also to safeguard the well-being of our patients who are addicted to opioids and furthermore, the ones who are faced with the challenge of managing pain and are making decisions to possibly start even taking an opioid.
Chiropractic care offers a non-pharmacological approach to pain management that has been shown to have been both effective and very safe by integrating chiropractic care and other non-pharmacological treatments into our healthcare system, we have the opportunity to make significant strides in combating the opioid crisis. One crucial aspect of utilizing chiropractic care to reduce the opioid epidemic is to improve access and encourage patients to consider it as their first line of treatment option for common pain syndromes, conditions such1610 as back pain joint pain, spine-related pain, and headaches are widespread and often led individuals down the path of opioid use in the first place. When traditional medical interventions have fallen short. However, patients who seek1625 care from chiropractic providers experience significantly reduced odds of initiating opioids, whether short-term or long-term, often experiencing reductions in the range of 50 to 90%.
The reduction in opioid initiation is of paramount importance because it disrupts the trajectory that leads to long-term opioid use. Addiction and tragically overdose, and the main point is death. By encouraging patients to explore chiropractic care as their first choice of pain management, we can make a substantial alternative to opioids, but it also empowers a patient to actively participate in their own well-being. Chiropractors focus on holistic, patient-centered care, providing education and tools to manage their1678 pain and improve overall health and well-being. In conclusion, I implore this committee to consider the wealth of evidence supporting the integration of chiropractic care and non-pharmacological treatment. The Massachusetts Chiropractic Society is dedicated to enhancing patient education on non-opioid alternative care. We also remain diligent about enhancing patient education so that patients are fully aware and have been fully informed on alternatives before they're ever issued an opioid in the first place. I thank you for allowing us to be here today1709 representing the Massachusetts chiropractic society and being a part of the health care1713 system. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Well, thank you very much for your testimony today. But you want questions for any members. Alright. And we also have on the same panel Steve Panjiatakis. Senator Panjiatakis. Welcome.
STEVE PANAGIOTAKOS - HB 1970 - HB 1971 - SB 1275- SB 1254 - Thank you very much, Mr. Chairman, and members of the committee. Doctor Euert and, Tracy Lane have certainly made a strong case, in favor of HB 1970 HB 1971, Senate Bill 1254 SB 1275. As our communities, families, and individuals continue, to be battered by the effects of drug addiction, we need to have all hands on deck, and one of those groups of hands, especially in the area of opioid addiction is our chiropractors. During the COVID, crisis were called upon by the Commonwealth as essential medical providers to stay open and treat patients so as to lessen the demand on our hospitals.
Chiropractors regularly treat some of the largest opioid treatment diagnoses, such as chronic pain in the lower back, neck, shoulder, and other joints, in a pharmacological, non-pharmacological, non-opioid manner. With studies showing high-quality outcomes. But in many cases, this weapon in our battle against opioid addiction is not being called upon. Who is a lack of knowledge about it? These Bills would simply educate and inform patients about the benefits and alternatives of this non-opioid treatment for pain. As well as educate and inform medical providers of prescribers as to its availability as a non-opioid alternative. I hope that this committee will take advantage of this resource that is available in every community across this Commonwealth and pass these Bills out favorably, or use this language in any future health care or substance abuse Bill that is moving forward. Thank you for your time, your energy, your work, and your consideration. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you for your time and your advocacy on this issue and so many others. Members of committee questions on any of these panel. Thank you very much.
SPEAKER2 - You. I wanna recognize that representative when member of the committee is joining us. Thank you.
SPEAKER1 - Alrighty. Next up, we have the another panel, the Massachusetts Pain Initiative, the steering council. If you were here, the floor is yours.
CINDY STEINBERG - MASSACHUSETTS PAIN INITIATIVE - HB 1962 - Yes. Thank you very much. Good morning, chairman, and1867 honorable members of the committee. My name is Cindy Steinberg, and I am the policy council chair for the Massachusetts Pain Initiative or mass PI, a non-profit statewide organization whose members are primarily expert pain management clinicians. Doctors, nurses, and psychologists who treat pain patients throughout our state. We applaud the work of this committee now, and over the past decade, aiding patients suffering from substance use disorder. But we also need this committee to understand that there is another important side to the opioid crisis that does not get the attention it deserves. That is the thousands of Massachusetts residents suffering with debilitating, relentless chronic pain, from a myriad of serious diseases, conditions, and injuries, who over the past several years have found themselves in a frightening predicament. They have been forced off opioid pain medication that has helped them to live a functional life . In many cases for years and even decades without problems and with minimal side effects.
Opioids do not help everyone with chronic pain. But they do help many with moderate to severe pain. Even when they help, it's best to combine them with other therapies. Current best practice in pain management is an individualized multimodal treatment plan that combines a number of different pharmacological and non-pharmacological approaches. That is why we support HB1962 which calls for patient education on a wide range of nonopioid medications and nonpharmacological therapies for pain. Although this Bill requires an edit to exclude acute inpatient situations requiring anesthesia. MassPI specializes in pain education and would be pleased to offer our expertise to the legislative sponsors of this Bill. We opposed HB 1970 and HB 1971, which pulled for chiropractic to be used instead of opioids. While chiropractic might be appropriate for certain kinds of musculoskeletal pain.
There are many types of chronic pain such as neuropathy, cancer pain, endometriosis, and trigeminal neuralgia, and I could go on for many conditions where chiropractic is not appropriate. We have posed HB 1990 HB 1998 HB 1983 because they go too far into dictating a medical practice in law. With inaccurate, inappropriate divisions that are redundant to existing law, such as such as HB 1990. Or they will make it impossible for physicians and nurse practitioners to make the best medical judgments for their patients. My SPI welcomes this committee to consult with us on the many aspects of your work that pertain to pain management. To ways in which to improve and strengthen HB 1962 before reporting it favorably. We respectfully urge the committee to not report the other 5 Bills we've discussed. Thank you for listening. My colleague, Jackie Nathan will speak next, and then Debbie Page and Becky West. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you. Thank you.
JACKIE NATHAN - MASSACHUSETTES PAIN INITIATIVE - HB 1970 - HB 1971 - HB 1962 - HB 1998 - HB 1999 - HB 1990 - Hello, and good afternoon. My name is Jackie Nathan. I'm a nurse practitioner. I specialize in pain management. I've been doing this for the past 50 years. I'm also on the steering council of the Mass Payne Initiative. I would like to add some comments on some of the Bills from my perspective as a paid management provider. On House Bill's 1962. I agree with Cindy that we would enthusiastically support section one of the Bill2099 and encourage you to take advantage of the parties that MSPI has to offer when creating the educational pamphlet. Section 2 of the Bill, however, seemed very problematic to me.
As written before providing hair regarding the administration of anesthesia involving the use of an opioid drug, the practitioner shall inform the patient on the patients or the patient's representative of available non-opioid alternatives for the treatment of pain. I'll give you a quick example of the absurdity of this section. If passed prior to your routine colonoscopy procedure, it would be mandated by law that you must be informed of available non-opioid alternatives for the treatment of your pain. That would be for your colonoscopy procedure. Hopefully, you can see that the intent of this part of the Bill will not be realized due to errors in the writing. Regarding House Bills 1970, and 1971, as a provider, I'm frankly2148 baffled as to why the boards would be mandated to consult with a carbonatic society.
While chiropractic care has been shown to have an effect2152 on musculoskeletal pain, there are many other types of pain, and there's good empirical evidence that other therapies such as mindfulness, osteopathy, acupuncture, interventional, and even yoga are also effective. If you're going to mandate that the mass Chiropractic Society has consulted, and you should also be mandating that experts in all forms of alternative treatments for pain be consulted as well. I agree with Cindy in opposing House Bill 1990 in HB 1993 in HB 1998 due to the following reasons. Oftentimes good-intentioned lawmakers propose legislation that creates unintentional results. Here's a good example. After the CDC published the guidelines for opium prescribing in 2016, at least 33 states turned what was supposed to be guidelines into laws. These laws frighten providers and many stop prescribing opioids to patients who rely on them to function. This became so problematic that the FDA had to step in and require changes stating that rapid discontinuation is not advised.
Many patients had nowhere to turn, and then the FDA suggested and I would agree that these laws intended to address the opioid crisis, but instead led to a worsening of the opioid crisis. I can attest that many providers are afraid of treating pain, even acute pain. They just won't take the risk due to laws that have made prescribing any opioid pain medication onerous and fraught with potential legal consequences. That has become scary to take care of the patients who need us the most. The Mass Medical Society, boards of Medicine, And Nursing, along with other specialty societies, are doing a great job of ensuring that providers are properly trained on all that they are attempting to man and that is responsible opioid prescribing informing patients on the risks of addiction and dependence. The risk of combining opioids with alcohol and adiazepines and the use of naloxone to treat unintentional overdose. These highly skilled medically trained members of the regulatory bodies are better equipped to provide guidelines for evidence-based standard-of-care practices for the management of a very complex problem, such as pain. Thank you very much. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you very much.
SPEAKER12 - Do I go next?
SPEAKER10 - Yes, Debbie.
SPEAKER1 - Yes, please. Thank you.
SPEAKER12 - Okay.
SPEAKER1 - Debbie Page. Thank you very much.
DEBBIE PAGE - RESIDENT - Thank you. My name is, Debbie Page, and I currently live in Lincoln in a condo here, where I grew up, and I'm a person living with severe chronic pain. And this started in 1984.2299 That was about 30, 40 years ago. For 10 years, I had no opiates I made every kind of alternative, and medical, attempt and then, 10 years later, my doctor, my PCP, I said to try OxyContin. I did, and I got my life back. It was like a magic pill. It was incredible. I could finally go to work. I could sit through church. I could properly care for my children and be a good friend and wife and all kinds of stuff be, you know, I'm a very active person. Without OxyContin, I can't do a lot of the2342 exercise I have a horrible life, and I don't want to go back to that. I'd rather die. Seriously and so I also, for years, have successfully used Zana at night to help me sleep and valium at night when I have severe spasms and in order to go on a long, trip. In a plane where I have to sit. It's extremely helpful. I've also had two major spine surgeries.
The first one was incredibly, painful neck surgery, and I was refused valium. If I'd had it, it would have really helped So I don't have side effects from it because I have good, you know, I have good tolerance to opiates, or OxyContin and, the same dose for many, many years, 25 years, and no side2403 effects whatsoever. So I will mention real quick I saw a chiropractor in the and it was very damaging. It made the pain worse. So, I would like to say that I'm speaking for many people, and I also have to go to my doctor 90 miles away because I can't find anybody else who treats this. I'm really afraid 1. He retires that I'll really be it. I'm also having a lot of trouble getting OxyContin it's become extremely expensive, and, they've cut back on the generic, which is really scary. So sometimes I have to go to several pharmacies, and it hurts to drive for a long time. It hurts to sit and stand because of the severe muscle damage that2454 I have from an injury2456 way back. Please don't make it harder, even harder than it is for legitimate patients. Thank you. I think I'm out of time. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you, miss Paige, and we really appreciate your lived experience on this matter. Thank you very much, miss Becca West.
REBECCA WEST - RESIDENT - Hi. My name is Rebecca West. I live in the East of Mass with my husband of 12 years. I have been living with chronic pain due to endometriosis I'm lupus for the last 19 years, which is almost 2 thirds of my life, I have been spent living with chronic pain that keeps me from my loves loved ones and the activities I enjoy. I've had 4 lap eroscopies, 2 endoscopy colonoscopies, numerous nerve blocks and epidurals, and lidocaine infusions. I have tried yoga acupuncture, chiropractor, chiropractor, practices, and physical therapy. Obtained a coaching program, and countless different medications, including muscle accidents and NSAIDs. I meditate daily and go to a support group. I see a pain psychologist for every single thing that the state legislature keeps proposing that patients do as an alternative to opioids I have already done and continue to do.
Some of the things I have tried to failed and some of them have helped2551 me partially, but what has helped2553 me the most has been opioids. Despite all my efforts at the age of 33, I am unable to work. I cannot keep up with my parents who are in their sixties. I am unable to take my dog out for a walk. Despite desperately wanting to have a child, I am facing the decision of having a hysterectomy. I've had to reassess what my life would look like and the things. I would be able to accomplish it, by only putting my energy into things that are most important to me in my life. I used to spend every day painting and going to school. I wanted to be a doctor, and now I spend my days in doctor's offices begging for help. You have little to no rights as a pain patient and are not treated only badly, but inhumanely. It has become increasingly difficult for me to get the medications.
I need such as buprenorphine and the benzodiazepine Xanax, which I use to treat the PTSD that I have from all the negative, treatments. I have had my doctors, including a sexual assault by an ER doctor, and painful treatments. I've gone through doctors who told me they legally needed to perform them in order to give me the medication I needed. I do not abuse them. I have no2646 personal or family history of addiction, and I've been on the same dosage for many years. It has now become the Pendulum that has swung so far. It has become to a point where legitimate pain patients can no longer get the medications they need. Thank you. Please do not take me away from my family. Wes, thank you. Thank you so very much for your heartfelt testimony today.
Again, with that lived experience, I guess, so I would just point out in the form of a question. But also a comment that we know with absolute certainty that Prescription pain killers were a big part of2697 this driving part of the opioid epidemic. That we still find ourselves to this day2703 but we also know, and I would argue that it's irrefutable in many respects. One of the voices the main voice, I would argue was left out of many discussions. In many instances, the detriment of folks was, people like members of the previous panel who spoke about, you know, the need, being in pain, and some of the conditions where these medications are still needed. So finding that balance It's absolutely critical. So thank you very much today for your time.
WEST - I would like to say, that I do have experience with addiction on my husband's side of the family. None of the people that I know who have abused these medications have ever gotten them from a doctor with a legitimate prescription. The CDC has actually come out with many articles talking about pill mills being the driving. A place for these medications to be gotten via prescription. But that's obviously not a legitimate prescription when it's coming out of a place like that. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Fortunately, I think It's a little bit all of the above. But, again, thank you so very much for your courage, for your testimony, if you lived experience, and members of the committee questions,
Thank you so very much,2798 Pamela, for all of your testimony today. Very helpful.
SPEAKER13 - Thank you.
SPEAKER1 - Representative Dom here on in person, House Bill 19 98 welcome representative.
SPEAKER7 - We got each other, Western Minas. Indeed.
SPEAKER3 - We do want, Fran. Good to see you.
REP DOMB - HB 1998 - Members of the committee. I'm here to speak in favor of the Advancing Representative of Labuffs bill. I want2834 to get the number correct, HB 1998. Enact relative to reducing the risk of unintended fatal opioid overdose. This Bill is actually pretty simple. It just requires informed consent when a physician prescribes an opioid to a patient. It doesn't say you can't prescribe an opioid. It just says if you're going to prescribe an opioid, you need to get informed consent, and part of that informed consent needs to be the risks of unintended fatal overdose. Particularly the risks of combining medications.
One of the reasons why this is important is early on in the opioid epidemic the risk of unintended overdose as a result of mixing and combining medications was extremely high. People who would be getting benzodiazepines would also be getting prescribed opioids and never be told that if you combine the two, there's a risk for unintended, overdose or weren't asked, do you consume alcohol and be able to have that conversation that alcohol mixed with a prescribed opioid can increase and generate a risk for unintended overdose. So this Bill looks to try to stimulate that conversation between a physician and their patient, and also the awareness on the part of the patient. If they're taking other kinds of medication, particularly benzodiazepines.
People who are on prescribed opioids take, as well as a gang the opioid, there's got to be an awareness that mixing can create a risk so that there can be a conversation about how to reduce the risk. That conversation can be anything from, let's reduce the dosage of the benzodiazepine, or let's make sure you have an ARC Hand in the house. Then talk about how someone might have an overdose and be able to be revived. But right now, the conversation may not be happening. So I just want to give a little bit of a curve, and I know you probably know this better than me. The beginning of the opioid epidemic was very much rooted in these prescribed painkillers. Right now, it's not so much rooted in that because people who became addicted to prescribed opioids found that if they got street opioids. It was cheaper and they could move from pills to treat opioids, particularly heroin. But we're seeing this upsurge in the epidemic right now in opioids, and we know that people are continuing to get prescribed benzodiazepine. So we should be sort of thinking. Let's try to make sure that we can do everything we can to reduce unintended fatal opioid overdose, particularly through the mixing and combining of other medications with prescription opioids. Who better to have that conversation? The person who's probably making the prescription for all the medicines is the person's doctor. So thank you, and I'm happy to take questions. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Representative. Thank you so much for your testimony here today. What a critical issue. Questions. Members of the committee.
SPEAKER7 - Thank you so much for your opportunity to talk about this.
SPEAKER1 - Thank you.
SPEAKER7 - And for your very wonderful, compassionate ears and eyes on all your hearings. Thank you. Your public service is really but grateful for it.
SPEAKER1 - Is there anyone else signed up in person or virtual that's here to testify that we missed? We are showing that we've heard everybody
Stowing lunch, going twice, ocean to adjourn. We are adjourned.
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