BOSTON — Gov. Charlie Baker on Tuesday unveiled a sweeping proposal aimed at curbing opioid abuse that would set new standards for prescribers, expand the use of recovery coaches, and give emergency room clinicians authority to commit suspected addicts for treatment.
Baker, a Republican, said the proposal is largely aimed at expanding and improving access to long-term treatment for opioid addiction while cracking down on overprescribing of painkillers.
"We need to focus more of our efforts on aftercare," he told reporters at a Statehouse briefing. "We need to create more uniform processes for providers and insurance companies so patients and their families can better navigate the system more effectively."
The plan would create a new professional credentialing program to license people such as recovery coaches to work with addicts and health plans. It would provide additional resources to schools to educate students about the dangers of opioid abuse.
The proposal, estimated to cost about $120 million, also calls for new standards for prescribers to curb abuse of Oxycontin and other painkillers.
Separately, Baker said he plans to petition the Trump administration to give the state more flexibility through its Medicaid programs to dispense the overdose-reversing drug naloxone, identify fentanyl abuses, and expand access to medication-based treatment of addiction.
Baker's initiative comes as the latest state data show the number of opioid-related overdose deaths trending downward for the first time in 15 years.
On Monday, the state Department of Public Health released figures showing that the 1,470 estimated and confirmed overdose deaths in the first nine months of 2017 represented a decline of about 10 percent from the 1,637 deaths reported in the first nine months of last year.
Likewise, opioid prescriptions have dropped 29 percent since the state overhauled a prescription monitoring tool, MassPAT.
"These numbers, while positive, remind us of how much suffering continues and how we must continue to double down on our efforts," Mary Lou Sudders, secretary of the state Department of Health and Human Services, said Tuesday.
Baker said too many doctors still overprescribe opioids, and he wants to create a commission to recommend prescribing levels for common procedures.
"Some of the haunting stories of addiction start with our own trusted clinicians prescribing a highly addictive opioid in large quantities to ease pain after routine surgery, such as getting your wisdom teeth out," Baker said Tuesday. "This can quickly lead to addiction and turmoil for many people."
In the past six years, opioid-related emergency department visits in Massachusetts have increased 87 percent from 17,897 visits in 2011 to 33,444 visits in 2015, according to the Baker administration. More than half of those patients declined a voluntary screening for substance abuse, officials said.
Baker said his proposal adds "medical professionals" to the list of people authorized to petition courts to commit a person suspected of opioid abuse under the Section 12 and 35 laws. Only police, physicians, spouses, relatives or legal guardians may now make such a request.
"If the patient presents a risk of serious harm due to addiction, clinicians can authorize their involuntary transport to a treatment facility," Baker said.
His proposed bill also requires prescribers to use all-electronic prescriptions for controlled substances by 2020.
More than 2,000 people died from opioid-related overdoses in Massachusetts last year. Essex and Middlesex counties have been hit particularly hard.
The new data suggest that fentanyl, a synthetic drug considered more potent than heroin, continues to be a major factor contributing to opioid abuse.
Public health officials said the portion of cases involving fentanyl continues to rise — accounting for about 80 percent of all deaths — even as deaths from prescription opioids and heroin continue to decline.
In 2014, fentanyl was responsible for about 15 percent of opioid-related deaths.
"If you go back four or five years, fentanyl wasn't even part of the conversation," Baker said. "Now, it accounts for four out of every five deaths."
Lt. Gov. Karyn Polito said the Baker administration’s plan includes separate administrative actions expanding prevention education in schools, training for school nurses to recognize signs of opioid addiction, and requiring incoming college students to take an opioid awareness class. A grant program will help fund the initiative.
"Just as we have worked through our school system to educate our children, from elementary school to college, about the dangers of alcohol and drugs, it is imperative that we increase addiction awareness for opioids," she said. "We need a whole new line of defense to prevent addiction before it starts."
Baker and Polito have made fighting opioid addiction a key part of their administration.
Last year, Baker signed legislation mandating a seven-day limit on first-time prescriptions for opiate painkillers and expanding the use of naloxone. His administration has also increased state spending on addiction prevention and treatment by 50 percent.
Substance abuse treatment experts credit the state’s full-throttle response with bending the upward trajectory of opioid-related fatalities.
Meanwhile, state lawmakers are considering a number of proposals aimed at curbing opioid abuse as part of a sweeping criminal justice bill.
House lawmakers were expected Tuesday to approve the legislation that stiffens penalties for people who traffic fentanyl and carfentanil.
The Senate approved its own version last month, meaning the two bills would have to be reconciled before a final version is sent to Baker for consideration.
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at firstname.lastname@example.org.