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Compromise Opioid Bill Caps First-Time Prescriptions At 7 Days

Update March 9 at 3 p.m.: The House has unanimously passed the compromise bill (PDF). The Senate is expected to take it up Thursday.

Our original story:

BOSTON — A Massachusetts House and Senate compromise bill on how to tackle the state’s opioid epidemic includes new limits on first-time opioid prescriptions, a push to evaluate patients after an overdose and addiction screening for middle and high school students.

The provisions are not as dramatic as those proposed by Gov. Charlie Baker, but a spokeswoman said the Legislature is taking a strong step in the right direction.

Baker ignited controversy last fall when he proposed a three-day limit on first-time opioid prescriptions. The House took a step back and suggested seven days, and seven is the number in the compromise bill House members are expected to vote on Wednesday.

Liz Malia, chair of the House Mental Health and Substance Abuse Committee, said this restriction, coupled with the expectation that doctors and dentists will talk to patients about the dangers of addiction, will shift the thinking about opioids.

“We’re changing some of the culture, and in my mind that’s of the things that really has needed to to happen,” she said.

The seven-day limit includes an exception for adults with chronic pain. It has the support of the Massachusetts Medical and Dental societies.

“I think seven days is a lot more reasonable than the original three days,” said David Lustbader, an oral surgeon who is also vice president of the dental society. “That generally is enough time to get people through the acute period of pain, post surgically.”

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Eva Gets A Mammogram: A Primer On Finding Quality In Mammography

Eva Kennedy gets her annual mammogram at the Beth Israel Deaconess Medical Center clinic in Lexington. Ethel Waite, a radiologic technologist, is at her side. (Jesse Costa/WBUR)

Eva Kennedy gets her annual mammogram at the Beth Israel Deaconess Medical Center clinic in Lexington. Ethel Waite, a radiologic technologist, is at her side. (Jesse Costa/WBUR)

Eva Kennedy walks out of a dressing room clutching the strings of her pink and white johnny. Her face is calm, but her eyes flick nervously from person to person.

“I’m ready, I guess,” says the 43-year-old mom from Harvard, Massachusetts. “It’s kind of strange to have someone manhandling your breasts, smushing, just weird.”

For the next 30 minutes this elementary school teacher will follow, not give, instructions. It’s time for Kennedy’s annual mammogram.

Millions of women across the country stand with Kennedy every year, in a johnny, in front of a machine that will compress their breasts and X-ray the pancaked tissue.

Most women assume a mammogram’s a mammogram — you just get through it. But in fact the quality — as with most things in medicine — does vary.

Here, for the first time, you can compare the quality of a mammogram at some of the larger hospitals and medical practices in Greater Boston and Worcester. Continue reading

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The Opioid Treatment Business Is Booming

Recovery Centers of America is spending some $20 million to renovate the former Hunt Hospital in Danvers into what will eventually be a 210-bed substance use treatment center. (Jesse Costa/WBUR)

Recovery Centers of America is spending some $20 million to renovate the former Hunt Hospital in Danvers into what will eventually be a 210-bed substance use treatment center. (Jesse Costa/WBUR)

Ray Tamasi, the president and CEO of Gosnold on Cape Cod, has been working in addiction treatment for more than four decades. But he’s never seen anything like what he’s seeing now: private equity investors lining up to get into the treatment business.

“I’ve been doing this for 40 years, and I’ve been doing presentations at private equity firms [that] want to understand behavioral health because they want to understand and invest in it,” Tamasi said. “I’ve done more of those in the past year than I’ve done in my entire career.”

Tamasi says several things are fueling this interest — the biggest of which is the opioid epidemic.

Only 10 percent of the estimated 700,000 Massachusetts residents who could use substance treatment actually are able to get it. There are also state and national legislative and insurance changes that have made substance use treatment a projected $35 billion-a-year business in the United States.

Hundreds of new treatment beds are being created in New England this year alone. One of the largest projects — which also represents one of the biggest private equity investments in addiction treatment — is now under construction in Danvers. Recovery Centers of America (RCA) is spending some $20 million to renovate the former Hunt Hospital into what will eventually be a 210-bed substance use treatment center. It’s set to open Aug. 1. Brad Greenstein, CEO of Recovery Centers of America, Danvers, says the center will help with the state’s opioid crisis. Continue reading

With Brookline Dispensary, A Trial Opening For Medical Marijuana On Boston’s Border

At New England Treatment Access in Brookline, patient service associate Ashley Cabana dispenses 14 grams (1/2 oz) of Facewreck marijuana flower for patient Sam Brown. (Jesse Costa/WBUR)

At New England Treatment Access in Brookline, patient service associate Ashley Cabana dispenses 14 grams (1/2 oz) of Facewreck marijuana flower for patient Sam Brown. (Jesse Costa/WBUR)

Under the teal dome of a former bank lobby, Ashley Cabana pulls the top off a plastic storage box labeled “Facewreck.” Cabana rests the box on a glass counter and flaps the lid, sending the aroma of marijuana toward Sam Brown.

“Yeah,” says Brown, breathing deeply. “Smells good.”

Brown, 32, will inhale more than just the smell through a vaporizer, to relieve insomnia and anxiety. “I’m using it to treat lifelong issues that I’ve treated through psychotherapy and medication at various points,” Brown says. “This is another avenue like that.”

New England Treatment Access is located in a former branch of Brookline Bank. (Jesse Costa/WBUR)

New England Treatment Access is located in a former branch of Brookline Bank. (Jesse Costa/WBUR)

Brown is among the first wave of patients to shop at the New England Treatment Access (NETA) dispensary in Brookline. It’s open by appointment only for two weeks, a condition set in agreement with the town, where the main concern is crowds. This dispensary, just 300 paces from Boston, is the first within easy reach of the city and could be overwhelmed by patients. Brookline Public Health Director Dr. Alan Balsam says he and the chief of police are monitoring the situation. Continue reading

How Community Health Workers Act As A ‘Bridge’ For Patients Needing Extra Help

Guissela Mariluz, left, a community health worker at Rosie's Place in Boston, translates and negotiates a new plan for diabetes treatment for patient Luciana Joaquin with endocrinologist Dr. Devin Steenkamp. (Martha Bebinger/WBUR)

Guissela Mariluz, left, a community health worker at Rosie’s Place in Boston, translates and negotiates a new plan for diabetes treatment for patient Luciana Joaquin with Dr. Devin Steenkamp. (Martha Bebinger/WBUR)

When Guissela Mariluz calls every day, Luciana Joaquin remembers to take her pills for diabetes, anxiety and paranoia. When Mariluz doesn’t call and Jaoquin forgets to take her medication, she hears voices inside her head, reacts, and gets in trouble.

Like the time last year when Joaquin heard a threat: People were coming to invade the building, owned by the Boston Housing Authority, where Joaquin rents a one-bedroom apartment. Joaquin rushed into the hall to alert her neighbors.

“She started knocking on everyone’s doors, at 3 or 4 in the morning, so everyone could get out,” Mariluz recounted. “She was throwing things from her building down the stairs, things you can’t do in housing, but in her head she was doing it because she wanted to help.”

Joaquin’s misguided warnings almost got the generally demure, middle-aged native of the Dominican Republic evicted.

But Mariluz intervened, in her role as a community health worker. She’s one of at least 3,600 men and women in Massachusetts who help patients pay bills, arrange pet or child care so the patient can have surgery, or sit with them at an AA meeting. It’s a job that’s been taking shape for decades but is just now becoming a more formal profession. Massachusetts is finalizing rules that are expected to establish the first voluntary community health certification. Continue reading

Calling 911 From Your Cellphone? Don’t Assume They’ll Know Exactly Where You Are

Trainer Kevin Lewis (Carey Goldberg/WBUR)

Training specialist Kevin Lewis of the Massachusetts 911 department at a call center training screen. (Carey Goldberg/WBUR)

One afternoon this fall, as Dr. Ian Sklaver was coaching his 13-year-old daughter’s soccer team, one of the players suddenly collapsed and stopped breathing. Her skin took on a blue pallor, and her pulse was thready, barely there.

Sklaver, who practices at Garden City Pediatrics in Beverly, Massachusetts, immediately started CPR and called 911. We need an ambulance, he told the dispatcher urgently, giving the name of the school he was at and the street it was on.

The dispatcher asked him a question or two, he recalls, “and then asked me the bewildering question of ‘What town are you in?’ And I told them, and then they reconnected me to another person to re-tell the same story again — which seemed to be taking a lot of time away from doing CPR.”

Fortunately, the player was fine — but Sklaver was left mystified.

He has Google Maps, Find-My-iPhone and other free apps, he said, “that can find me to the exact street address. And I call 911, the most important call one could potentially make,” and he’s asked what town he’s in.

Our goal is to bring the 911 system into the 21st century.

– David Furth, FCC

So — if apps like Google Maps and Uber seem to know just where your phone is, why doesn’t the 911 system?

The answer is sadly simple. The 911 system “is based on technology that was developed almost 40 years ago,” said Brian Fontes, CEO of the National Emergency Number Association, a nonprofit that focuses on 911 issues.

“And it was designed for a wired-only world where you have your wired phone tethered to a fixed address,” he explained. “Much has changed, obviously, over the years, and today roughly 75 or 80 percent of 911 calls come in from wireless devices.”

Back when cellphones were new, the 911 system could only map which tower had relayed a given call. In recent years, with GPS, the system has gotten much better at locating cellphone calls. But it is still behind commercial apps. Continue reading

Dr. Donald Thea On What We Know About The Zika Virus

For the first time, a Massachusetts resident has been diagnosed with the Zika virus.

He or she is from Boston and traveled in a country where the virus is being transmitted. The symptoms were mild, the patient did not have to be hospitalized, and is expected to make a full recovery.

Dr. Donald Thea, professor of global health and director of the Center for Global Health & Development at Boston University, joined WBUR’s Morning Edition to discuss the virus and this case in Boston.

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Salisbury Woman’s Death Shows The Complications In Responding To Opioid Crisis

Anna Jaques Hospital in Newburyport is seen on Friday. (Jesse Costa/WBUR)

Anna Jaques Hospital in Newburyport is seen on Friday. (Jesse Costa/WBUR)

The death of a Salisbury woman this month shows how difficult it can be to coordinate the response to the opioid addiction crisis.

Gretchen Fordham received the opioid overdose reversal drug Narcan in an emergency room. But she still left the hospital with a prescription for opioid pain pills.

Hours later, police say Fordham was found unresponsive in her home.

Here’s what happened:

It was shortly after 6 a.m. on Jan. 10 when police received a 911 call from the boyfriend of 44-year-old Fordham saying she was unresponsive.

“She was transported to the hospital but was pronounced dead at the hospital,” Salisbury police Chief Tom Fowler explained. “My detective speculates that it could possibly be an accidental overdose.”

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Health Insurers Step In To Help Stem Opioid Crisis In Mass.

For some health insurers, there are critical costs to helping members struggling with drug addiction succeed at staying healthy and off drugs. As a result, these insurers are trying new ways to offer support to those at risk. (Toby Talbot/AP)

For some health insurers, there are critical costs to helping members struggling with drug addiction succeed at staying healthy and off drugs. As a result, these insurers are trying new ways to offer support to those at risk. (Toby Talbot/AP)

For many people struggling with opioid use, a key to their success in recovery is having support. Some are getting that support from an unlikely place: their health insurer.

Amanda Jean (or “A.J.”) Andrade, 24, has been drug- and alcohol-free since October, the longest amount of time she’s been off substances in a decade. She gives a lot of the credit for that to her case manager, Will, who works for her insurance company. He’s helped her find the sober house where she moved after inpatient treatment, and he’s helping her figure out where she’ll go from there.

“Having Will is the best thing in the world for me. If I have the slightest issue with anything to do with my insurance, that included like prescriptions, even when I had a court issue, I know that I can call him,” Andrade said.

Her insurer, CeltiCare Health Plan, is one of several health insurance companies taking new steps to deal with the nation’s growing opioid epidemic. CeltiCare has about 50,000 members in Massachusetts and mostly manages care for low-income patients on Medicaid. Continue reading

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Patient Demand Surges In Opening Year Of Medical Marijuana Dispensaries In Mass.

In 2015, medical marijuana took root in Massachusetts, with four dispensaries now open in Salem, Brockton, Ayer and Northampton more than two years after voters approved a ballot question on the issue. (Jesse Costa/WBUR)

In 2015, medical marijuana took root in Massachusetts, with four dispensaries now open in Salem, Brockton, Ayer and Northampton more than two years after voters approved a ballot question on the issue. (Jesse Costa/WBUR)

By the numbers, the first year of medical marijuana dispensaries in Massachusetts looks pretty dramatic.

The latest data released by the Department of Public Health shows that 16,510 patients had obtained a certificate from a physician and registered through the state as of Nov. 30.

That’s up from 1,423 in January, a nearly 12-fold increase.

This chart shows the sharp increase in both active and certified medical marijuana patients since October 2014. (Screenshot via DPH)

This chart shows the sharp increase in both active and certified medical marijuana patients since October 2014. (Screenshot via DPH)

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