By Robert Booth, Executive Director, Center for Clinical Social Work

In 2017, 2100 citizens of Massachusetts died from accidentally overdosing on opioid substances. A larger number overdosed but did not die. The disordered use of these chemicals continues there, as throughout the U.S., at the level of an epidemic, despite the concerted efforts of state authorities. In Massachusetts, where the crisis had been met with intensive programs, 10% fewer people died of overdose than in 2016, while in the U.S. at large, about 63,000 people died of drug ODs—a 17% increase.

Massachusetts declared a public health emergency over the opioid-use crisis in 2014, two years before any other state. In March, 2016, Mass. Gov. Charlie Baker (R), signed into law a comprehensive bipartisan bill, An Act Relative to Substance Use, Treatment, Education and Prevention, which built on extant opioid-related legislation. Tracking the appalling OD death-rate in the next 20 months, Baker submitted new legislation in November, 2017, inter alia to commit at-risk but unwilling citizens to 72 hours in a treatment facility and to improve addiction treatment (especially follow-up treatment, hitherto provided by unaccredited individuals and largely going un-monitored by state health authorities). This legislation will probably be enacted by the legislature soon.

Despite Pres. Trump’s declaration of an opioid-related national “public health emergency” in October, 2017, the national-level (federal) response is non-existent: Congress is not considering meaningful legislation or revision of regulations of the sort adopted in Massachusetts and some other states. The nine-year-old Mental Health Parity and Addiction Equity Act (2008) was the most recent federal law addressing substance use disorders. Many states refused to implement its key provisions, some of which are covered under the Affordable Care Act of 2010.

At the federal level, the specific crisis of opioid addiction is met with just one program: not a law but a federal regulation, 42 CFR Part 8, “Certification of Opioid Treatment Programs” administered by SAMHSA’s Center for Substance Abuse Treatment and providing for accreditation of opioid treatment programs—an effort subsumed in states like Massachusetts, which, in the absence of federal help, have already funded the setting and enforcing of higher standards of treatment and better access for the public to ensure the proper prescription, use, and efficacy of opioids, which can be extremely effective in ameliorating pain.

Regardless of current attitudes—federal-level indifference or the concern of a few state governments—this epidemic, which is killing people at a horrifying rate, did not have to happen. For one look at its origins, consider reading the piece by Patrick Radden Keefe, published in The New Yorker magazine, issue of Oct. 30, 2017, “The Family That Built an Empire of Pain,” about the multi-billionaire Sackler family and their oxycontin exploits.

Your clients rely on you to be knowledgeable and helpful about the problems that overwhelm them. Pain causes great suffering, and, in some cases, the treatment can cause even more suffering. With regard to disordered use of opioids, you may wish to familiarize yourself with best practices and to review the actions being taken in Massachusetts, and a few other states, with regard to social justice and matters of life-or-death.


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