Department of Public Health

MMS Prescriber Education: 17,063 courses, 5,905 individuals

Posted in Department of Public Health, Drug Abuse, opioids on August 5th, 2016 by MMS Communications – 1 Comment

MMS has engaged in many efforts to address the opioid epidemic in the Commonwealth, from creating prescribing guidelines to public information campaigns for patients.  One of the major contributions of the Society – and one of the critical steps in alleviating the crisis as MMS President James S. Gessner, M.D. has noted — has been prescriber education.

MMS began offering free continuing medical education courses in opioids and pain management to all RXMonitoringprescribers beginning in May of last year, and demand for the courses has been high.

Over the 14-month period from May 26, 2015, when the free courses were first offered, through August 1, 2016, a total of 17,063 courses have been completed by 5,905 individuals. Currently, 18 courses are offered.

The courses appear to be having a positive impact, as multiple studies show that opioid prescribing has declined significantly in the state.

A study by athenahealth showed that the number of patients in Massachusetts who were prescribed opioids between the first and second quarter of 2016 dropped 14 percent, compared to an 8 percent decline for the rest of the nation.  Another study, released in June by the Cambridge-based Workers Compensation Research Institute, recorded decreases in the amount of opioids prescribed per worker’s compensations claims in the Commonwealth as well as many other states.

Finally, a Massachusetts Department of Public Health report, issued on August 3, noted that data from the state’s Prescription Drug Monitoring program showed that the total number of opioid Schedule II prescriptions and the number of individuals receiving Schedule II prescriptions were both at their lowest levels since the first quarter of 2015.  DPH said that the number of individuals who received one or more prescriptions for opioids dropped 16 percent from the first quarter of 2015 to the second quarter of 2016.

Despite the decline in prescription medications, deaths from opioid overdoses continue to rise, fueled by the synthetic opioid, fentanyl.  DPH reported that 66 percent of confirmed opioid-related overdoses deaths so far in 2016 involved fentanyl, an increase over  2015, when the rate was 57 percent.

The President’s Podium: A Step Forward in the Opioid Battle

Posted in Department of Public Health, Drug Abuse, opioids, Public Health on July 22nd, 2016 by MMS Communications – 1 Comment

by James S. Gessner, M.D., President, Massachusetts Medical Society

Congress has helped Massachusetts and the nation take another step forward in the battle against prescription drug abuse. The Comprehensive Addiction and Recovery Act (CARA), a bipartisan effort incorporating several pieces of legislation targeted at opioid abuse, has been passed overwhelmingly by the House and Senate, and President Obama has signed it into law.

A compelling need to fund some of the law’s provisions still remains, but the symbolism and substance of its passage, like the enactment of Governor
Dr. James S. Gessner, MMS President '16-'17_editedCharlie Baker’s opioid bill in March, is hard to overstate.  According to the Centers for Disease Control, drug overdose deaths in the U.S. hit record numbers in 2014.  While heroin and fentanyl certainly claim their share of lives, prescription opioids continue to fuel the epidemic: at least half of all opioid overdose deaths involve a prescription opioid, and in 2014, more than 14,000 people died from overdoses involving prescription opioids. In Massachusetts alone, more than 1,500 opioid-related deaths occurred in 2015.

CARA includes several important provisions, including greater access to the life-saving therapies of naloxone and buprenorphine, help for infants and veterans, and the reauthorization of the National All Schedules Prescription Electronic Reporting Act, or NASPER, which provides for prescription monitoring programs that have proven to reduce opioid prescribing and overdose deaths.

One provision of CARA, however, can make a big difference: partial-fill prescriptions that will help patients balance the need to relieve pain with an adequate supply of medication by only filling part of a prescription.

The importance of a partial-fill prescription is that it can help to cut drug diversion – something that makes up a significant part of the opioid abuse crisis.  Estimates from the National Institute on Drug Abuse indicate that the majority of individuals – up to an astonishing 70 percent – who misuse or abuse pain medications get them from prescriptions written for someone else, such as family or friends.

Advocated by Massachusetts physicians, the partial-fill legislation was championed by Senator Elizabeth Warren and Congresswoman Kathrine Clark, who co-sponsored the Reducing Unused Medications Act of 2016 that became part of CARA. With few exceptions, U.S. Drug Enforcement Administration regulations had previously prevented partial-fill prescriptions.

While state law also now permits partial-fills, passed as part of the Governor’s opioid bill due to the efforts of Senator John Keenan of Quincy, the Federal law goes a step further by allowing the patient to fill the unused portion of the prescription, should patients need more relief.  State law currently does not.  This new provision in CARA will enable Massachusetts to change its law to become aligned with the new Federal law, as well as give other states the ability to pass partial-fill legislation.

In prescribing pain medicines, physicians are challenged with balancing the risk of addiction versus ensuring adequate pain relief for their patients. In efforts to reduce patients’ pain, however, too many prescriptions have been written, and prescription opioids have played a major role in driving this epidemic. Partial-fill prescriptions have the potential to shrink the amount of drugs susceptible to abuse and misuse or theft from unsecured locations such as family medicine cabinets – the place where Director of the White House Office of National Drug Policy Michael Botticelli has said the epidemic starts.

The law permitting partial-fill prescriptions is another in a long list of substantive efforts taken to address the opioid epidemic.  Here in Massachusetts, we perhaps have had more actions taken much sooner than elsewhere to fight opioid abuse. Governor Baker’s Opioid Working Group that led to bipartisan landmark legislation, law enforcement programs such as Gloucester’s Angel Program and the Middlesex County Sheriff’s Office MATADOR program for inmates, prescribing guidelines and prescriber education offered by our state medical society, and public information campaigns are among endeavors contributing to prevention, education, treatment, recovery.  These efforts, underway for more than a year now, are now beginning to see some results in recovery and reduced prescribing rates.

Another major step will be taken in August, when the Department of Public Health launches its new prescription monitoring program, offering enhanced searching capability along with access to data from other states.

These actions provide encouragement and hope. Yet despite this momentum, the rate of opioid-related deaths in the Commonwealth continues to climb  – a stark reminder of the human cost of this epidemic.  And those rising numbers keep sending us an important message: that’s there’s no room for complacency, a need for even more vigilance, and a long, long way to go before we can claim real progress.

The President’s Podium appears periodically on the MMS blog, offering Dr. Gessner’s commentary on a range of issues in health and medicine. 


Q&A with Dr. Catherine Brown of the Massachusetts DPH: What Physicians and Patients Should Know About Zika

Posted in Department of Public Health, Public Health on June 8th, 2016 by MMS Communications – Comments Off on Q&A with Dr. Catherine Brown of the Massachusetts DPH: What Physicians and Patients Should Know About Zika

Editor’s Note: Last week, the Massachusetts Department of Public Health posted new clinical guidance for physicians about the Zika virus on its website, which also includes handouts in multiple languages about the virus and travel advice for patients.

MMS spoke with Catherine Brown, D.V.M., M.S., M.P.H., Deputy State Epidemiologist and State Public Health Veterinarian at the Massachusetts Department of Public Health, about the potential for contracting Zika in the Commonwealth and what physicians and patients need to know.

We’ve seen a lot in the news about the Zika virus.
Should we be concerned about Zika virus in Massachusetts?
It’s extremely unlikely that we’ll see mosquito-borne Zika virus in Massachusetts.  The conditions in Massachusetts are not conducive to mosquito transmission of the virus here. In order for the Zika virus to spread, there needs to be widespread established populations of mosquitos and a significant number of people actively infected with that widespread population of mosquitoes.

Dr. Catherine Brown, Massachusetts Department of Public Health

Dr. Catherine Brown, Massachusetts Department of Public Health

The primary vector of Zika virus, not just in this current outbreak, and in almost all outbreaks, has been the yellow fever mosquito Aedes aegypti. This mosquito is more likely to spread disease because it breeds successfully in urban environments, and bites, almost exclusively, people–it doesn’t feed on other mammals—and unlike other types of mosquito, it takes multiple blood meals. Most mosquitoes take a single blood meal, so are less likely to transmit disease. The Aedes aegypti mosquito has not been found in Massachusetts.

The secondary vector is the Asian tiger mosquito Aedes albopictus. This is a non-native introduced species that is well established in the southern tier of the U.S. It feeds on humans as well as other mammals. There is some evidence, from Massachusetts mosquito surveillance, that we have geographically isolated and sporadic findings of Aedes albopictus. However, as with Aedes aegypti, there would need to be widespread established populations as well as significant numbers of actively infected people in contact with that widespread population of mosquitoes in order to spread the virus.  The people in Massachusetts who have been infected with the virus are travelers returning from affected areas; they don’t carry the virus in their blood for very long.

So the risk for people in Massachusetts relates to those traveling to or from an affected region.  What regions in and out of the U.S. are affected?
As of [this interview], there have been no cases of locally acquired, mosquito-borne transmission anywhere in the United States.  The areas involved in the current epidemic of Zika virus are most of Central and South America and the Caribbean, as well as Cape Verde and Papua New Guinea. The U.S. Territory of Puerto Rico has been particularly hard hit. This is the largest outbreak of Zika virus ever documented, both in terms of number of people infected and the geographic range of the outbreak. Because infection with Zika virus likely confers long-term immunity, previous outbreaks have waned relatively quickly as the percentage of susceptible people in the population declines.

Travelers concerned about the status of the Zika virus should check the CDC website for the most updated information on currently affected areas.

What are the symptoms of Zika?
Eighty percent of people infected with Zika virus will never develop symptoms. For those that do become symptomatic, the most common complaints are fever, a rash, joint pain and non-purulent conjunctivitis. Headache and pain behind the eyes have also been reported. For the vast majority of people, the illness lasts between two to seven days and is self-limiting. No specific treatment exists. Hospitalizations associated with Zika virus infection are rare but have been associated with Guillain-Barré, meningoencephalitis, and other neurologic problems.

It is not known if there are particular groups of people that are more likely to develop disease, or who are more likely to develop severe disease, including Guillain-Barré.  No evidence exists that pregnant women, infants, or children are at greater risk for developing disease and information about risk in immune-compromised patients is limited.

What is the risk from Zika to humans?
The most significant concern from Zika virus infection is for pregnant women who can transmit the virus to a developing fetus.

Right now, there are still more questions than answers about Zika virus.  We do know that women infected with Zika virus during pregnancy are more likely to give birth to an infant with birth defects or some other poor birth outcome. Exactly how much risk is associated with infection is not known. There is some information that infection with Zika virus during the first trimester, as opposed to later trimesters, is more likely to cause microcephaly in the developing fetus, but poor birth outcomes and other types of birth defects have been reported associated with infection during all trimesters of gestation. Microcephaly has received much of the attention; fetal loss, intracranial calcifications, and hearing and vision defects have also been reported.  It is not known how often vertical transmission –a mother with the virus transmitting it to a fetus—occurs, or how often this results in problems with the developing fetus or the pregnancy.

How should physicians counsel their patients?
Physicians should counsel pregnant women or those who want to become pregnant in the next two months that they really should not travel to areas where there is a reported threat of Zika virus transmission. If they do travel to those areas, they should wait eight weeks after returning before attempting conception.

Sexual transmission from symptomatic males has been documented, so male patients who have been symptomatic for Zika should use condoms consistently and correctly for all sexual contact for six months as a precaution to avoid transmitting the virus to a woman who may be, or may wish to become, pregnant.

What if the male traveled to an affected region, but has not been symptomatic for Zika?
Males who have traveled to an affected region but did not develop characteristic Zika signs and symptoms should use condoms consistently and correctly for all sexual contact for eight weeks after their last possible exposure.

If a patient has traveled to an affected area, what does the physician need to know?
Anyone who was pregnant when they traveled, or who became pregnant within eight weeks of returning, should be tested for Zika virus infection whether or not they developed symptoms of Zika.  If the male partner of a pregnant woman traveled to an affected area, testing of the pregnant woman (and sometimes her male partner), is indicated if either one of them develops symptoms of Zika virus infection.

Patients who develop Guillain-Barré syndrome following a Zika-like infection should also be evaluated for testing.

Why shouldn’t everyone who has traveled be tested?
Testing is not as simple as marking a checkbox on a lab test order. There are two types of testing: antigen-based and antibody-based. Whether the patient is symptomatic or asymptomatic, and the timing of specimen collection, determine what type of testing needs to happen. Right now, the commercially available, antigen-based test is only good for three to four days after the onset of symptoms, so this test is completely inappropriate for patients who have no symptoms. The Massachusetts State Public Health Laboratory has the ability to run both the antigen- and antibody-based tests; preliminary positive results from the antibody test require confirmation which is currently being done by CDC. Clinicians should check the Mass. Department of Public Health clinical advisory (found under the section, “Information for Health Care Providers” on the MDPH’s Zika website) to ensure they’re ordering the appropriate test for the patient.

Physicians should also keep in mind that it’s possible that pregnant women returning from the affected regions to Massachusetts to deliver their babies here have received virtually no prenatal care, and probably haven’t been tested previously for Zika. The pediatrician may be the first health care provider to recognize that Zika is involved. Physicians should call the MDPH Epidemiology Line at 617-983-6800 to determine if testing is recommended.  When Zika virus testing is appropriate, the results can help to inform the provider’s clinical decision-making and help to provide answers to parents.

Is the Department of Public Health tracking these cases?
Yes. While no single state is going to have enough data to draw all conclusions that we need to draw in order to guide clinical and prevention practices, individual states are collecting de-identified data from OB/GYN providers on pregnant moms with lab verified exposure to Zika virus. Additionally, states are working with pediatricians to follow the infants for 12 months after birth as part of participation in the U.S. Zika Pregnancy Registry being operated by CDC. Most information on the pregnant women can be collected during routine phone calls with OB/GYN providers to discuss laboratory testing and to share results. The Massachusetts Center for Birth Defects Research and Prevention within MDPH is aiding this effort by providing information on both the mother and the initial neonatal assessment as part of their routine work identifying infants with birth defects.  MDPH will work with individual pediatricians to gather the requested data in as unobtrusive a manner as possible. We have been delighted by the positive relationships being developed with providers who understand the importance of collecting this information. By collecting information on the progress of pregnancies and serial assessments of infants’ health, we hope to rapidly and completely identify both the risks of infection during pregnancies and the spectrum of possible effects to infants that might include more subtle developmental problems.


April Physician Focus: The Opioid Crisis

Posted in Department of Public Health, Drug Abuse, opioids, Physician Focus, Public Health on April 14th, 2016 by MMS Communications – Comments Off on April Physician Focus: The Opioid Crisis

The Massachusetts Medical Society, in cooperation with the Department of Public Health, has taken another step in its efforts to address the publicOpioids_edited health crisis of opioid and prescription drug abuse affecting residents of the Commonwealth.

The April edition of Physician Focus, Crisis in the Commonwealth: Opioid and Prescription Drug Abuse, examines multiple aspects of the opioid epidemic with MMS President Dennis M. Dimitri, M.D. (photo, center) and DPH Commissioner Monica Bharel, M.D., M.P.H., (right), two physicians who have been at the forefront of addressing the problem over the last year.

Hosted by Lynda Young, M.D., (left) Professor of Pediatrics at UMass Medical School and a past president of MMS, the program represents another initiative by the physician community and seeks to educate prescribers, patients, and citizens about the crisis and what steps they can take to help to curtail the abuse.

Among the topics of conversation are the origins of the opioid crisis; the roles of prescribers and patients; actions taken by medical, state, and public health agencies to reduce the abuse; and the provisions of a new state law created specifically to fight the epidemic.  The video also contains a public service announcement recorded by the guests and a list of local and national resources about substance abuse, opioids and pain medicines, and prevention and treatment options.

Physician Focus is distributed to public access television stations throughout Massachusetts, reaching residents in more than 275 cities and towns. It is also available online at,, and on YouTube.

The President’s Podium: Engaged in the battle? Yes!

Posted in Department of Public Health, Drug Abuse, Health Policy, opioids, Public Health on November 3rd, 2015 by MMS Communications – 1 Comment

by Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

The voices of the media are becoming more frequent and more pointed about the nation’s opioid epidemic, and the Dr. Dennis Dimitri, MMS Presidentnarrative that physicians are part of the problem continues.

The suggestion that physicians are lax in addressing the opioid epidemic or are reluctant to work toward solutions has been espoused by national and local media. A November 2 editorial in The Boston Globe takes our medical society to task, suggesting that we are reluctant to work with public officials and are even obstructing progress because we believe there needs to be more flexibility in the Governor’s proposed limit of a 72-hour supply of opioids for first-time prescriptions.

The idea that physicians are standing on the sideline or hindering progress toward solutions to the opioid epidemic is simply wrong. The fact is that MMS officers and staff have been meeting and working with Governor Baker, Health and Human Services Secretary Sudders, Attorney General Healey, and Public Health Commissioner Bharel for some months in order to address this crisis and develop strategies and responses. There has been nothing casual about the MMS response to this crisis.

Our opioid prescribing guidelines, issued in May, were in fact a response to the Governor’s request for assistance in addressing the epidemic. Our guidelines outlining use of the lowest effective dose for the shortest time presaged the Governor’s opioid bill by several months, and were subsequently adopted by the Massachusetts Board of Registration in Medicine and incorporated into its comprehensive advisory to physicians on prescribing issues and practices.

Additionally, the MMS has called for every physician to rethink their prescribing practices with the goal of reducing the number of opioids prescribed. We ‘own’ that part of the problem.

We have worked with members of the Baker administration on several initiatives and have invited them to work with us as we reach out to physician leaders for help. Physicians are firmly committed to working with government leaders, public health officials, and others in the medical community to stem the tide of opioid and prescription drug abuse.

Our other actions speak to that, as well.

Our continuing medical education courses on opioid prescribing and pain management have been taken by nearly 2,000 individuals since we began offering them free in May. Nearly 5,000 courses have been taken.

We have reached out to the medical community and beyond with our annual public health forum and our Opioid Misuse and Addiction Summit, which brought together physicians, pharmacists, law enforcement officials, and government officials to create awareness and discuss strategies to reduce opioid abuse.

We have been engaged for several years in efforts with the Department of Public Health to improve the state’s Prescription Monitoring Program and are now collaborating with the DPH and the deans of the four Massachusetts medical schools to improve education on opioids and pain management for medical students.

Our dedicated website and public service advertising campaign speak to the importance of safe storage and disposal by patients, two critical elements in curbing abuse.

Physician activity in addressing the opioid crisis by the MMS is not something new in 2015. MMS efforts in alerting patients about prescription drug abuse go back nearly five years, and my predecessors Dr. Ron Dunlap and Dr. Rick Pieters were instrumental in bringing the urgency and importance of opioid abuse to our members and the patient population.

As I wrote back in July, physicians have made the commitment to be part of the solution. We will remain so and will continue to work with government and public health officials, our colleagues in the medical community, and our patients to attack this crisis.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dimitri’s commentary on a range of issues in health and medicine.

MMS, Medical Schools, Governor Join in Opioid Abuse Battle

Posted in Department of Public Health, Drug Abuse, opioids, Public Health on September 3rd, 2015 by MMS Communications – Comments Off on MMS, Medical Schools, Governor Join in Opioid Abuse Battle

MMS President Dennis M. Dimitri, M.D.

Taking another step in the battle against opioid abuse in the Commonwealth, the Massachusetts Medical  Society, along with representatives from the state’s four medical schools, met yesterday with Governor Charlie Baker and Commissioner of Public Health Monica Bharel, M.D., to discuss a physician-led approach in developing training and best practices for medical students on pain management and safe opioid prescribing.

Providing physicians with additional training on opioids was part of the comprehensive set of 65 recommendations released in June by the Governor’s Opioid Working Group. Yesterday’s meeting was a collaborate effort by the Governor, the Department of Public Health, and the state’s leading physicians to develop that recommendation.

MMS President Dennis M. Dimitri, M.D. described the meeting as one filled with a “spirit of cooperation and positive energy about what we can do working together” to continue the battle against opioid abuse.

Continuing medical education on opioids and pain management has been a prime focus of MMS in its efforts to help curb opioid abuse. In May, MMS issued its Opioid Therapy and Physician Communication Guidelines, offering evidence of best practices for prescribing and made its continuing medical education courses on opioids and pain management free to all prescribers. These courses have been accessed more than 3,200 times.

In a press conference following the meeting, Governor Baker said he was “pleased with the quality of the dialogue” and saw the meeting as the first of several discussions with physicians about their role in addressing the opioid epidemic. “Everybody’s got a role to play,” said Baker, “and we can’t move fast enough” in the fight.

DPH Commissioner Bharel said the meeting resulted in agreement to develop core competencies to educate future doctors on safe prescribing and pain management.

In offering the physicians’ perspective, Dr. Dimitri said physicians constantly face the “challenge of patients with ongoing pain, but the pressure of time, inadequate systems to help the physician and patient deal with pain, and the lack of alternative methods of pain relief covered by insurance put physicians in a tight box” where options to relieve pain were limited and the choice of opioids seemed the most appropriate one.

Dr. Dimitri added that doctors now recognize the impact of the number of opioids in the community and that too many have been allowed to be prescribed. Pledging MMS support of the Governor’s effort, Dr. Dimitri said “we’re very glad to participate in this process.”

MMS commitment to the effort was evidenced by the presence at the meeting of its top three officers – Dr. Dimitri, President-Elect James Gessner, M.D., and Vice President Henry Dorkin, M.D. – and Executive Vice President Corinne Broderick. The medical schools were represented by Karen Antman, M.D., Dean of the Boston University School of Medicine; Harris A. Berman, M.D., Dean of the Tufts University School of Medicine; Terence R. Flotte, M.D., Dean of the University of Massachusetts Medical School; and Todd Griswald, M.D., Director of Medical Student Education in Psychiatry at Harvard Medical School.

Selected press coverage is available here: Boston Herald, Republican, WCVB-TV.

The President’s Podium: Reducing Opiate Abuse

Posted in Department of Public Health, Health Policy, Medicine, opioids on February 18th, 2015 by MMS Communications – Comments Off on The President’s Podium: Reducing Opiate Abuse

By Richard Pieters, M.D., President, Massachusetts Medical Society

Governor Charlie Baker and Attorney General Maura Healey have each made opiate abuse one of their top priorities, and this week they will announce steps they will take to fight this public health crisis. That the state’s top elected official and top law enforcement officer have put this issue at the forefront of their agendas is good news, because even as Massachusetts ranks as one of the top four states in adopting strategies to curb prescription drug abuse by the Trust for America’s Health, prescription and opiate abuse remains a crisis in the Commonwealth.

MMS has reached out to both the Governor and Attorney General to offer our assistance as they address the problem. Their initial responses have been encouraging, and we look forward to hearing the specifics of their plans and working with them.

One of the keys to reducing the abuse, however, is a sustained effort in raising public awareness about the issue, and the Massachusetts Medical Society has long recognized the importance of communicating to both physicians and patients about prescription drug abuse.

We highlighted the topic in 2011 with our patient education television program that reaches communities across the state, and in subsequent shows addressed the topic of substance abuse in young people and how they can be treated.

Our current program revisits the subject of prescription abuse with experts in addiction medicine. Additionally, we have distributed articles to local media, to outline what both physicians and patients can do to prevent prescription abuse. This is especially important, as more than three out of four people who misuse prescription pain medicines use drugs prescribed to someone else.

My predecessor Dr. Ronald Dunlap last year outlined the physician’s perspective on prescription drug abuse and recommended additional steps that can be taken to reduce the abuse.

I have since provided my views and recommended improvements in the state’s prescription monitoring program, which the Society helped to create more than 20 years ago. We believe a well-run, real-time, robust monitoring program is a key element in the fight against prescription abuse and one in which every physician should participate.

MMS will continue its educational effort on opioids and prescription abuse on April 8 with our Annual Public Health Leadership Forum for physicians and health care providers. The Opioid Epidemic: Policy and Public Health, featuring local and national leaders in substance abuse and addiction medicine, will discuss a range of issues, including the basics of pain management, alternatives to opioids, communicating with patients about pain management and treatment, and advocacy for treatment programs for those with addictions. This forum will offer important information for those who prescribed opioids and treat pain and addiction, and I urge those who do so to attend.  Also, the MMS Ethics Forum at our annual meeting in May will explore the ethical and legal considerations in pain management by physicians.

As government and public health officials seek remedies to the opiate crisis, we urge them to recognize that physicians and their patients – the ones who treat the pain and take the medicines – can play critical roles in reducing the abuse.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine.

New Medical Marijuana Registration Rules Take Effect Feb. 1

Posted in Department of Public Health, Medical Marijuana on January 30th, 2015 by MMS – Comments Off on New Medical Marijuana Registration Rules Take Effect Feb. 1

marijuanaEffective February 1, 2015, patient certifications from physicians for the medical use of marijuana must be submitted electronically. Paper certifications are no longer sufficient to comply with state law or regulations.

Patients must now obtain their certifications electronically and be registered with the Medical Use of Marijuana Program to possess marijuana for medical use. Paper certifications will no longer be valid. Patients who previously had a paper certification must get a new electronic certification from their physician.

Physicians who wish to certify patients for medical marijuana must now do so electronically. Paper certifications will no longer be valid. Before certifying patients electronically, physicians must register with the state, after earning at least 2 CME credits relating to medical marijuana.

 Additional Resources

Ebola: New Health Care Worker Guidance on Equipment, Testing, and Personal Protection

Posted in Department of Public Health, Ebola, preparedness on October 21st, 2014 by Erica Noonan – Comments Off on Ebola: New Health Care Worker Guidance on Equipment, Testing, and Personal Protection

MMS has updated its website with new guidance for health care workers related to Ebola Virus Disease from the Massachusetts Department of Public Health and the Centers for Disease Control and Prevention.

Ebola Virus

New guidance from the CDC for Personal Protective Equipment  for health care workers treating Ebola patients:

Both the CDC and MDPH guidance reflect one change to the clinical criteria for a patient under investigation for Ebola Virus Disease having a fever of >100.4 °F. Previous guidance for fever was 101.5°F. (Guidance regarding additional symptoms remains: the patient must also exhibit additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage, AND within the 3 weeks prior to the onset of symptoms, either having contact with the bodily fluids of a patient suspected to have EVD, or having traveled from an EVD-endemic region.)

Links to these resources are available at, which is updated as new information and guidance is released.

— Robyn Alie

The President’s Podium: Tracking Prescription Drug Abuse

Posted in Department of Public Health, Drug Abuse, opioids, Public Health on July 17th, 2014 by MMS Communications – Comments Off on The President’s Podium: Tracking Prescription Drug Abuse

By Richard S. Pieters, M.D., President, Massachusetts Medical Society

The Centers for Disease Control’s just-released state-by-state report on opiate abuse has cast a bright new light on this serious and potentially deadly problem.

Saying that an “increase in painkiller prescribing is a key driver of the increase in prescription overdoses,” CDC noted that prescribers wrote 259 million prescriptions for painkillers in 2012, and that 46 people die from prescription overdoses every day. That prompted CDC Director Dr. Tom Frieden to capture the paradox: “All too often, and in far too many communities, the treatment is becoming the problem.”

Massachusetts ranked in the top 10 in prescribing long-lasting painkillers, but 41st in overall prescribing of opioids.  Rankings, however, are only a reference point, as volume itself is insufficient to indicate whether overprescribing or under prescribing is occurring.  And rankings matter little when counting the human toll: in Massachusetts alone, 688 residents died from opiate overdoses in 2012, and more than 200 additional lives have been lost since November 2013, according to the Massachusetts Department of Public Health (DPH).

Multiple responses are under way in the Commonwealth: The Governor has formed an Opioid Task Force, the legislature has filed bills, DPH launched Opioid Overdose Education and Naloxone Distribution Program, and police and fire departments are now carrying naloxone.

Regionally, five New England governors agreed to collaborate, and nationally, the U.S. Senate has announced the formation of a Prescription Drug Abuse Working Group.

Physicians are adding their voices as well. MMS immediate past president Dr. Ronald Dunlap offered his perspective in April, and American Medical Association President Dr. Robert M. Wah, following the New England governors’ announcement in June, shared a five-point proposal to combat prescription drug abuse.

The CDC is focusing attention on overprescribing by healthcare providers, and while others continue to see physicians as part of the problem, thefts from pharmacies and diversion from families and friends remain major contributors to the problem, as is the influx of heroin into Massachusetts and New England.

A critical need in responding to this crisis is getting better data. We should know the sources of the drugs – how many come from prescriptions, how many from thefts, how many are diverted from home medicine cabinets – to develop responses.

Better data is available through the state’s Prescription Monitoring Program (PMP), a program MMS helped to establish more than 20 years ago.  It’s one of the best tools we have to track prescription use, and one CDC urges all states to use.  The experiences of New York and Tennessee are testimony to the effectiveness of such programs.

In Massachusetts, however, the program has yet to fulfill its promise.

A well-run PMP has four purposes: (1) identifying patients who get schedule II and III prescriptions from multiple doctors; (2) identifying prescribers who inappropriately write many prescriptions or write prescriptions for high dosages; (3) providing a clinical review of those patients and prescribers, to determine what interventions might be necessary; and (4) facilitating research in discovering trends, practices, and problems.

To achieve the program’s full benefit, two things must occur: (1) the PMP must allow all prescribers and dispensers access to up-to-the-minute data on individual patients, and (2) the state must reform its structure to devote resources to the clinical analysis of data and to streamline outreach to providers.

Further, a re-energized medical review board, created as part of the original PMP but subsequently reduced in its role, will give an added boost to the effort.  The board can determine patterns of abuse, propose needed interventions, and should be charged with responsibility for referral of such activity to licensing boards or law enforcement authorities.

For the individual clinician, the monitoring program should be a tool seamlessly incorporated into clinical decision making, but it should never impede appropriate patient care.  One of the most difficult tasks for physicians in patient care is balancing the alleviation of pain and the risks of addiction, and we must recognize that patients who experience severe pain will always require treatment and should be able to get relief.

An improved PMP, with real-time data, with all prescribers participating, and with accurate and timely data analysis, should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.  It’s time for that to happen, and physicians stand ready to help.

Addiction is a major public health problem that needs prevention and treatment. Prevention requires the use of all pain management tools, including such methods as physical therapy and acupuncture. We should use the PMP as a starting point to engage other stakeholders to develop a comprehensive strategy for chronic pain management, with the hope of less need for opioids and thus less addiction. Such actions should also lead to more compassionate and enlightened treatment of addiction.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine.