With substance use legislation hung up on Beacon Hill, state health officials are working on a separate track to bolster harm reduction services across Massachusetts and emphasizing that providers will not be disciplined for distributing supplies like drug tests strips.
BOSTON, Mass. (SHNS)–With substance use legislation hung up on Beacon Hill, state health officials are working on a separate track to bolster harm reduction services across Massachusetts and emphasizing that providers will not be disciplined for distributing supplies like drug tests strips.
In a Sept. 24 memo, the Department of Public Health urged providers to integrate harm reduction services into care settings, offering new guidance surrounding naloxone, syringe service programs, fentanyl test strips, wound care, and “safer consumption materials” like cookers to mix or heat drugs before being used.
DPH appears to be taking its own measures to address an opioid crisis that has taken the lives of thousands of Massachusetts residents.
The memo in bold font says “no licensed healthcare professional should be subject to professional disciplinary action solely for the provision of harm reduction supplies or services to patients.” Department of Public Health Commissioner Robbie Goldstein “has instructed all boards they may not discipline a healthcare professional solely for the provision of harm reduction supplies to a patient.”
“Direct provision of harm reduction supplies or services by health care providers and referral to harm reduction services in community settings are lifesaving actions that are appropriate to clinical settings,” the memo, which was circulated by the Massachusetts Health and Hospital Association on Monday and obtained by the News Service, says.
DPH identified nearly 20 safer injection supplies, including syringes of “appropriate gauge,” tourniquets, wound care tape, sterile gauze, non-stick gauze pads, Bacitracin antibiotic ointment, hot packs, cold packs and bleach kits. The uptick in xylazine in the state’s drug supply has led to more ulcerated wounds among people who use drugs, and DPH “recommends providers be prepared to address wounds and offer wound care supplies.”
Officials listed nine “safer smoking” supplies such as scrubbing pads, plastic razor blades, scooper straws and sharps containers.” The memo also outlined “safer sex” supplies, such as condoms, and hygiene supplies like baby wipes, sunblock and hand sanitizer.
A DPH spokesperson, asked why officials released the guidance on Sept. 24, said there was “no particular reason,” and that was when the document was ready and approved. MHA said the association and its Equity and Addiction Workgroup collaborated with DPH “to address implementation of harm reduction principles and practices across healthcare settings.”
The Massachusetts Medical Society praised DPH’s “timely” guidance and pressed the Legislature to pass the stalled opioid bill.
“We appreciate and support the DPH’s position opposing professional discipline for the provision of harm reduction supplies and services, which should encourage physicians and health care teams to deploy all evidence-based and proven harm-reduction tools without risk of penalty,” Dr. Hugh Taylor, MMS president, said in a statement. “As health care professionals work to employ all the tools and resources at their disposal, we encourage passage of substance use disorder legislation under consideration to build upon existing harm-reduction tools and alleviate the crises of addiction and overdose in the Commonwealth. With the recent decline in overdose deaths, we have an opportunity to further this progress, helping more patients prevent and survive overdoses, and access the treatment and recovery they need.”
Health officials in the memo stressed harm reduction efforts can staunch the “persistently high rates of fatal opioid overdoses” — which have claimed more than 2,000 lives annually in Massachusetts since 2016 — and prevent the spread of diseases like hepatitis C and HIV.
DPH said its guidance, which also outlines resources for providers, builds upon a July advisory from the Board of Registration in Nursing, which said licensed nurses “shall not be subject to professional disciplinary action solely for the provision of harm reduction supplies or services to patients, regardless of setting.”
BORN’s former executive director, in a December 2018 letter to then-Health and Human Services Secretary Marylou Sudders, detailed the challenges of having nurses working or volunteering at harm reduction sites without installing legal protections.
Those nurses, for example, would risk their Massachusetts Controlled Substances Registration, which authorizes people to dispense, possess, prescribe or administer controlled substances. The letter said nurses could also “be deemed to be aiding unlawful activity by simply standing by and observing, ready to render aid as needed.”
Overdose prevention centers, another strategy where trained health professionals can intervene as people take pre-acquired drugs, face an uncertain future on Beacon Hill. DPH has said it supports the centers, also known as safe injection sites, with liability protections in place.
In a major departure from the House substance use addiction and disorder bill, the Senate in late July passed legislation that would allow cities and towns to open the centers, which are also intended to connect people to treatment. The Senate bill provides legal and professional liability protections for health care workers, volunteers and people who use services at harm reduction facilities.
The bills also look to expand access to overdose reversal drugs, and establish a licensing process for alcohol and drug counselors and recovery coaches.
At a memorial with more than 22,000 purple flags on Boston Common ahead of International Overdose Awareness Day, Goldstein had said Massachusetts needs policymaking “that is going to support people in recovery and support people who are actively using.”
“And there are ways to do that through the State House, and I think we continue to want to work with our colleagues in the Legislature to get a bill over the finish line and get that out,” Goldstein told the News Service in late August. “But our Bureau of Substance Addiction Services is doing this work every day, and we’re going to continue to do the work and push forward with the policy that we know is going to save lives, and protect people, and get people into care.”
The DPH memo came from Deirdre Calvert, director of the Bureau of Substance Addiction Services; Antonio Sousa, acting director of the Bureau of Health Care Safety and Quality; James Lavery, director of the Bureau of Health Professions Licensure; and H. Dawn Fukuda, assistant commissioner and director of the Bureau of Infectious Disease and Laboratory Sciences.
“To ensure the safety of PWUD [people who use drugs], including patients with opioid use disorder (OUD) and/or presenting after an overdose, healthcare facilities should develop and implement policies to provide harm reduction supplies to patients,” the memo says. “DPH recommends that supplies include: naloxone (two to four doses); rescue breathing masks; safer consumption materials; and fentanyl test strips.”
DPH says it has also issued a statewide pharmacy standing order that authorizes licensed pharmacists to dispense naloxone rescue kits to individuals who are at risk of overdosing, family members, friends or others who are in “a position to assist a person at risk of experiencing an opioid-related overdose.”
“Healthcare providers should develop familiarity with local pharmacies and facilitate access to naloxone for their patients, and patients should be provided with education on how to recognize and respond to an overdose and how to access naloxone from retail settings, pharmacies, and community-based programs,” the memo says.
“DPH also recommends that prescribers issue standing orders for naloxone dispensing within their healthcare facility or practice setting (such as a clinic, acute care hospital, or emergency department) for individuals with opioid use disorder and those presenting after an overdose,” the memo continued. “It is also recommended that facilities allow patients to retain possession of naloxone rescue kits while receiving services.”