State governments strive to curb epidemic of fatal opioid abuse

Abuse of opioids such as heroin, oxycontin and methadone led to 28,000 deaths last year, according to federal agencies. Many states are taking steps to combat the epidemic, but proposed solutions have attracted their own share of controversy and criticism. Judy Woodruff talks to Gov. Charlie Baker of Massachusetts for more on the fight against opioid abuse in his state.

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    Now to the problem of opioid abuse and proposals by governors to tackle it.

    Judy Woodruff has the story.


    The dimension of the problem is becoming ever larger. The federal government reported that opioids, which includes prescription painkillers and heroin, were involved in more than 28,000 deaths in the U.S. in 2014.

    This past week, leading voices at the National Governors Association called for new limits for some painkillers like OxyContin and for greater drug monitoring of those prescription drugs.

    The epidemic has hit a number of states very hard, including Massachusetts, where more than 1,200 people died of opiate overdoses in 2014.

    Governor Charlie Baker has proposed legislation that would limit practitioners from prescribing more than three days' worth of opiates to patients when they're using them for the first time. Governor Baker also is the head of the Health Committee for the Governors Association, and he joins me now.

    And thank you for being here.

    How did this get to be such a high priority for you, Governor Baker?

    GOV. CHARLIE BAKER (R), Massachusetts: Well, when I was campaigning for governor in 2014, I literally couldn't go anywhere without somebody having a story to tell me about this.

    And all the stories were for the most part stories that ended tragically, in the death of a family member or a close friend or a co-worker.

    And you hear this enough over and over and over again, and you start to realize that it's just everywhere. And I — when I took office, I talked about this in my inaugural address and said, you know, we have more people dying of opioid overdoses in Massachusetts than car accidents and gunshots combined, four people a day. There has to be a better way here.


    And you're proposing a number of things to do about this in your state and through the Governors Association.

    A big part of that is this — what we just mentioned, limiting to three days the prescription. How did you decide on three days vs. two days or four days or more?


    Well, the — first of all, the overall proposal — and we have a good working relationship with our legislature on this.

    And I think they have already done two separate bills on this, and I believe they will do a third. But it's a prevention and education piece, an intervention piece, a treatment piece, and recovery piece. You got to — our view is, you got to do all of them.

    But on the prevention and education piece, we picked three days for first prescriptions, sort of acute pain, you have a wisdom tooth out, you break a finger, something like that. Our approach to this was to take the CDC preliminary recommendation, which was three days.

    Now, the Mass Medical Society, after we proposed three days, proposed seven.


    This is your state society.



    And that seven-day proposal ended up in the House version of the bill. They're now conferencing the two of them. But my guess is, we will end up with some sort of a limit on first prescriptions, which I think is a good thing.


    Then, I saw the American Medical Association, which is the national organization, is saying — I read their statement today. They're saying it's arbitrary, and surrounding circumstances are clinically vague. They say, how do you define major surgery?

    In other words, they're raising some questions about the three days.


    Well, I think whether it's the CDC three days or the seven days, Mass Medical Society, my view on this is, we need to separate acute pain from chronic pain.

    There's no reason to give somebody who has their wisdom teeth out 30 pills. There's no reason to give somebody who has a minor procedure 60 pills. The stories about this that I heard as I travel, still, as I travel around the commonwealth are overwhelming. It's like an avalanche.

    Remember, 5 percent of the world's population in the U.S. We consume 80 percent of the world's opioids. There's something that is inherently not right about that.


    What are you hearing back right now from the pharmaceutical industry and from the medical community broadly?


    Well, the interesting thing is, you know, most of the practicing docs I talk to — and I talk to a lot of them — tell me that they believe having some limit on first prescriptions is a good idea.

    The dentists I know feel the same way. And, in fact, we got the medical schools in Massachusetts and the dental schools to incorporate for the first time a core requirement that, for graduation, you have to pass a class in pain management and addiction, which has never been true before.

    There's a lot of interest in this issue and a lot of belief that something needs to be done on the part of the health care community.


    I saw that President Obama, that the White House said that the president had declined to endorse the Governors Association proposal. He said words to the effect, limiting prescriptions should be part of a comprehensive approach, that, sometimes — painkillers are sometimes, he said, the only realistic treatment option for people in rural communities.

    What about that?


    Well, I think his overarching notion of it being part of a comprehensive plan is correct.

    Ours is prevention, education, intervention, treatment, and recovery. I think you got to play with all those. But he also said at this meeting — and I thought this was an interesting perspective as well. He said, states are many times the laboratories of democracy. You folks should try a variety of different solutions, and if you come up with something that ends up becoming kind of the standard around the country and a whole bunch of states, then we, the federal government, might choose to just follow you, which I think is fine.


    You mentioned other legs to the stool.

    What about the provisions to educate and train doctors, physicians, differently?


    I think that's a big part of it.

    I hear from doctors all the time who tell me that they don't necessarily feel they have had the training that they should have on this. And most — you know, the three biggest prescribing groups currently can graduate from medical school without ever taking a course in pain management.

    There is no requirement that you take a course in pain management as an in-service part of your continuing education as a physician. We're trying to change that in Massachusetts. I mean, this is a very complicated issue. I get that. But I think the more we can do to create an opportunity for both existing soon-to-be doctors and dentists and nurses and physician assistants and current ones to get smarter about this, we should take.


    What about the other part of the argument, Governor Baker, that so much of narcotic abuse, opiate abuse is on the part of people who just are stealing drugs, who just are addicts, and they didn't get into it because of a bad prescription, but they have fallen into it and there need to be other methods to get to them?


    Well, I certainly think treatment and recovery are a big part of this, and that we need to treat this as a public health issue, and in many cases for the disease that it is.

    And there are a whole series of elements in what we're doing already in Massachusetts and what we're proposing to do going forward that factor into that as well.

    We're also working with a bunch of the local pharmacies to make sure that they have drop boxes and where people can take unused medicine back and deposit it safely.

    There's no silver bullet to this, but I also believe that we will never change this 25 percent per year increase in deaths, prescriptions and overdoses unless we do some things to disrupt this trend line. And I think you got to bring every tool to the table here, prevention, education, treatment, recovery, and intervention.

    And if you're not willing to chase all that stuff in a pretty serious way, it's probably not going to get any better. I know I'm not going to consider success to be taking the increase in deaths from 25 percent to 20. I want to take that number. I want to flatten the number out and start to drive it in the opposite direction.

    Too many people are losing too many people.


    Massachusetts Governor Charlie Baker, we thank you.


    Thank you.


    And you can tune in later tonight for "Frontline"'s two-hour documentary "Chasing Heroin." It paints a larger picture of opioid abuse, from pharmaceutical companies' push to popularize painkillers, to personal stories of heroin addiction. Check your local listings for the time.

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