Charlie Baker, Governor of the Commonwealth of Massachusetts, has issued 110 recommendations for government, healthcare and educational institutions, to help combat opioid addiction from multiple directions. We’ve compiled the recommendations into eleven different categories, which we are comparing with the efforts being made by other states.

Categories:

##Treatment

ID	Name	Description
TR01	Realign Treatment	Realign Treatment System to Reflect Nature of Opioid Use Disorder as a Chronic Disease with Periods of Acute Needs and Periods of Stability
TR02	Increase points of entry	Increase points of entry to treatment, eliminating the need for individuals to access other levels of care only through acute treatment services (ATS) and clinical stabilization services (CSS)
TR03	Continuum of care	Establish and promote a longitudinally based treatment system and continuum of care
TR04	Increase Treatment Access	Increase Treatment Access by Matching Demand and Capacity
TR05	Database of services	Develop a real-time, statewide database of available treatment services, making information available via phone and the internet
TR06	Increase post-ATS beds	Increase the number of post-ATS/CSS beds (transitional support service, residential recovery homes)
TR07	Patient navigators	Fund patient navigators and case managers to ensure a continuum of care
TR08	Access to assessment	Pilot a program that provides patients with access to an emergent or urgent addiction assessment by a trained clinician and provides direct referral to the appropriate level of care
TR09	Revise recovery homes rates	Establish revised rates for recovery homes, effective July 1, 2015
TR10	Access to MAT	Increase Access to Evidence-Based Medication-Assisted Treatment
TR11	Office-based treatment	Increase the number of office-based opioid treatment programs and the number of practitioners prescribing buprenorphine and naltrexone
TR12	Opioid agonist therapy	Enforce and strengthen the requirement that all licensed addiction treatment programs accept patients on an opioid agonist therapy
TR13	Integrate care & treatment	Promote Integration of Mental Health, Primary Care, and Opioid Treatment
TR14	Review licensing regs	Create a consistent public behavioral health policy by conducting a full review of all DPH and DMH licensing regulations for outpatient primary care clinics, outpatient mental health clinics, and BSAS programs removing all access barriers
TR15	Health Homes	Explore state mechanisms to establish opioid treatment programs as Health Homes
TR16	“Deemed Status”	Conduct a review of the license renewal process for programs accredited by The Joint Commission or Commission on Accreditation of Rehabilitation Facilities (CARF) and evaluate whether Massachusetts should implement a “deemed status” for BSAS license renewals
TR17	Holding individuals	Permit clinicians to hold an individual with a substance use disorder involuntarily in order to conduct an assessment of whether release poses a likelihood of serious harm

##Education

ID	Name	Description
ED01	Substance use criteria	Support the implementation of substance use prevention curricula in schools. School districts should have the autonomy to choose the evidence-based curricula and the grade level that it is implemented in their district. Programs must be proven to reduce nonmedical opioid use. Examples of programs include: LifeSkills and All Stars
ED02	Info at athletic meetings	Integrate information about the risks of opioid use and misuse into mandatory athletic meetings and trainings for parents, students, and faculty
ED03	Increase screenings	Increase the use of screenings in schools to identify at-risk youth for behavioral health issues
ED04	Info for parents	Develop targeted educational materials for school personnel to provide to parents about closely monitoring opioid use if their child is prescribed opioids after an injury, as well as, signs and symptoms of drug and alcohol use
ED05	Partner with universities	Partner with state universities that have strong education programs to develop substance use prevention curricula for school districts throughout the Commonwealth
ED06	Screenings at universities	Require state universities that educate teachers to integrate screening and intervention techniques as well as substance use prevention education into the curriculum

##Neonatal Care

ID	Name	Description
NC01	Training for prenatal providers	Outreach to prenatal and postpartum providers to increase training about: screening, intervention, and care for women with a substance use disorder
NC02	Raise awareness of NAS	Promote early identification and proper treatment, raise awareness of Neonatal abstinence syndrome (NAS) within the public health and medical communities
NC03	CBA of in utero testing	Review the costs and benefits of mandating testing for in utero exposure to alcohol and drugs at every birth
NC04	Pregnant women treatment	Ensure adequate capacity for pregnant women in the treatment system
NC05	NAS treatment for DCF staff	Develop and institute a training program focused on NAS and addiction for Department of Children and Families staff
NC06	NAS early intervention	Work with health care providers to ensure all infants with NAS are referred to early intervention by the time of hospital discharge
NC07	Early intervention study	Partner with early intervention (EI) leadership and developmental experts to study the value of increasing automatic EI eligibility for infants with NAS from one year to two years

##Safe Disposal

ID	Name	Description
SD01	Pain management training	Mandate pain management, safe prescribing training, and addiction training for all prescribers as a condition of licensure (physician assistants, nurses, physicians, dentists, oral surgeons, and veterinarians)
SD02	Partial refills	Allow partial refills across all payers with a one-time co-payment
SD03	Eliminate refills by mail	Eliminate prescription refills by mail for schedule II medications
SD04	Improve PMP	Improve the Prescription Monitoring Program (PMP)
SD05	PMP ease of use	Increase utilization by improving ease of use and expanding abuse alerts from the PMP to prescribers
SD06	PMP data compatibility	Ensure data compatibility of the PMP with other states & interface the PMP with electronic health records
SD07	PMP mandatory use	Enforce mandatory use of the PMP
SD08	PMP 24 hours submittal	Require PMP data to be submitted within 24 hours by pharmacies
SD09	PMP data analytics	Improve data analytics and educate prescribers about how to utilize the information
SD10	Electronic prescribing	Implement electronic prescribing for opioids
SD11	Safe prescribing education	Partner with the medical and provider community to improve and increase educational offerings for prescribers and patients to promote safe prescribing
SD12	Alternate pain therapies	Promote awareness and support for alternate pain therapies
SD13	Addiction experts on Med Bd	Appoint individuals with expertise in addiction to the medical profession licensing boards
SD14	Safe use info at pharmacies	Develop universal distribution of easy to read materials at pharmacies on the safe use of medications
SD15	Promote take-back days	Expand and promote drug take-back days and permanent drug take-back locations, financed by pharmacies and manufacturers
SD16	Require patient education	Require practitioners, including dentists, to educate patients on the risks and side effects associated with opioids and document such discussions at the point of prescribing
SD17	Screening for substance use	Increase screening for substance use at all points of contact in the medical system
SD18	Drug Formulary appointments	Appoint members to the drug formulary commission established under Chapter 258 of the Acts of 2014

##Stigma

ID	Name	Description
ST01	Stigma public awareness	Create a public awareness campaign, with messaging that targets various ages, focused on:
ST02	Stigma as a medical disease	Reframing addiction as a medical disease
ST03	Promote med safety practices	Promoting medication safety practices
ST04	Good Samaritan Law	Promote the Good Samaritan Law
ST05	Reduce stigma w/med pros	Reduce stigma among medical and treatment professionals

##Improve Transparency & Accountability

ID	Name	Description
TA01	Timely reporting of deaths	Require and support universal and timely reporting of overdose deaths, through a partnership between the Department of Public Health, the Attorney General’s Office, the Massachusetts State Police, the District Attorneys, local police departments, emergency medical services, hospitals, and others
TA02	EMS overdose data	Make EMS overdose data available
TA03	Hot spot with overdose data	Utilize overdose reports to identify geographical hot spots for targeted intervention and to alert law enforcement, public health entities, community coalitions, and the public
TA04	EOHHS process to share data	Create a unified EOHHS privacy policy and implement a process for sharing confidential data
TA05	Dir of Addiction & Recovery	Establish a single point of accountability for the Commonwealth, Director of Addiction and Recovery Policy
TA06	Treatment program reporting	Enhance provider accountability by requiring treatment programs at all levels (inpatient and outpatient) to report on outcomes
TA07	New treatment approaches	Incentivize and support providers to develop and test innovative treatment approaches
TA08	rewards for reducing re-adm	Create provider accountability for the successful transition from one level of care to the next and incentivize providers to reduce re-admissions; the current “system” inadvertently “rewards” providers for repeat detoxes and rehabs
TA09	Establish industry benchmarks	Require the Department of Public Health to advance standards of care by establishing industry benchmarks

##Courts & Jails

ID	Name	Description
CJ01	Increase drug court capacity	Increase drug and specialty court capacity
CJ02	More beds for Sec 35 ch 123	Increase access to beds for patients who are civilly committed under section 35 of chapter 123 of the General Laws and provide a roster of currently available beds to judges for section 35 commitments
CJ03	Revise discharge policies	Review and revise discharge policies for section 35 patients; facilities must be required to follow the law and issue a written determination that release will not result in a likelihood of serious harm when individuals are discharged from the facility
CJ04	Improve continuum of care	Improve the continuum of care for patients committed under section 35
CJ05	Notification for escapees	Ensure notification to the Court when a section 35 patient escapes from treatment
CJ06	DoC->EOHHS responsibility	Transfer responsibility for civil commitments from the Department of Corrections to the Executive Office of Health and Human Services
CJ07	Do not terminate MassHealth	Suspend, rather than terminate, MassHealth coverage during incarceration
CJ08	Partner for treatment	Partner correctional facilities with community health centers to ensure individuals can access treatment upon release
CJ09	Analyze treatment spending	Analyze treatment spending in correctional facilities
CJ10	MAT while incarcerated	Inmates should be able to continue medication-assisted treatment while incarcerated
CJ11	Begin care while incarcerated	Inmates should be able to begin treatment while incarcerated and be connected to treatment upon release
CJ12	Alternatives to arrest	Encourage and support alternatives to arrest, making police a partner in obtaining treatment for individuals
CJ13	Narcan for county corrections	Bulk purchase opioid agonist and naltrexone therapies for county corrections

##Recovery

ID	Name	Description
RE01	Community coalitions support	Leverage and increase support for community coalitions to address the opioid crisis
RE02	Online repository of resources	Create an online repository of resources and best practices for community coalitions
RE03	Coordination among coalitions	Improve statewide coordination and information sharing among coalitions
RE04	Expand family support	Expand peer and family support organizations such as Learn to Cope
RE05	Recovery coaches in ERs	Pilot recovery coaches in emergency rooms and hot spots
RE06	Certify drug free housing	Implement a process to certify alcohol and drug free housing to bring accountability and credibility to this recovery support system
RE07	Remove employment barriers	Partner with businesses to remove employment barriers that recovering individuals experience, specifically review regulations related to CORI checks
RE08	Hire individuals in recovery	Incentivize employers to hire individuals in early recovery
RE09	Issue certificates of recovery	To improve outcomes for recovery, explore the benefits and costs associated with issuing certificates of recovery

##Naloxone

ID	Name	Description
NA01	Narcan in public spaces	Investigate the feasibility of having Naloxone in public spaces
NA02	Narcan affordability	Improve affordability of Naloxone
NA03	Narcan bulk purchasing	Through bulk purchasing agreements
NA04	No copay for Narcan	By eliminating all copayment requirements
NA05	Co-prescribe Narcan	Encourage Naloxone to be co-prescribed with opioids

##Insurance

ID	Name	Description
IN01	Implementation of Chapter 258	Require the Division of Insurance to implement guidance for commercial insurers about the implementation of chapter 258 of the acts of 2014 prior to October 1, 2015
IN02	eliminate insurance barriers	Eliminate insurance barriers that impede integration of addiction and mental health care into the primary care setting
IN03	Require consistent coverage	Require consistent coverage and prior authorization practices and policies throughout all MassHealth programs
IN04	Enforce behavioral health parity law	Bring meaning to federal and state behavioral health parity laws through enforcement actions to remove inappropriate barriers to treatment
IN05	Support non-opioid pain therapies	Encourage insurers to support non-opioid pain therapies
IN06	Coverage for non-pharma treatments for pain	Prepare a public report on what non-pharmacological treatments for pain are covered by all private and public insurers
IN07	Support for recovery coaches	Encourage insurers to support recovery coaches for individuals with a substance use disorder
IN08	Support new pathways to treatment	Encourage insurers to support new pathways to treatment

##Federal-State Partnership

ID	Name	Description
FS01	Pain management reqs for residency programs	Partner with federal leaders to recommend that the American College of Graduate Medical Education adopt requirements for pain management and substance use disorder education for all medical and residency programs (i.e. surgical, pediatrics, internal medicine, family medicine, obstetrics, and gynecology)
FS02	Safe prescribing for dentists	Partner with federal leaders to recommend that the Commission on Dental Accreditation adopt requirements for education on safe opioid prescribing practices for all dental programs
FS03	Safe prescribing for veterinarians	Partner with federal leaders to recommend that the American Veterinary Medical Association adopt requirements for education on safe opioid prescribing practices for all veterinary programs
FS04	Support for Vets	Partner with federal leaders to increase support for substance use prevention, intervention, treatment, and recovery efforts uniquely tailored for our Veterans
FS05	Residents prescribe buprenorphine for MAT	Request the Drug Enforcement Agency (DEA) to permit medical residents to prescribe buprenorphine under an institutional DEA registration number, thus allowing residents to learn how to manage patients with an opioid addiction
FS06	National take back program standards	Implement nationwide standards for pharmaceutical take back programs
FS07	Drug makers fund med disposal	Require manufacturers and pharmacies nationwide to finance the disposal of unused prescription medication
FS08	Update laws for prescribing buprenorphine	Change the laws and regulations related to prescribing buprenorphine
FS09	Increase MAT cap	Increase the cap - the number of patients a physician can treat - or remove it entirely
FS10	More buprenorphine prescribers	Permit nurse practitioners and physician assistants to prescribe buprenorphine
FS11	PDMP interoperability	Facilitate the interoperability of prescription monitoring programs nationwide
FS12	Review 42 CFR Part II to avoid stigma	Review 42 CFR Part II to ensure that it facilitates integrated care and the use of electronic health records and does not exacerbate the stigma associated with a substance use disorder
FS13	Separate Pain Mgmt Query from reimbursement	Request that the Pain Management Question from the HCAHPS not be linked to hospital reimbursement