1. Memorandum
To: David T. Vieria
From: Tyler Flanigan
Subject: Opioid Crisis in Massachusetts
Date: 11/19/15
Massachusetts has a growing epidemic in the commonwealth: the abuse of Opioids. It is one of
the leading causes of death among the residents. It is an extremely critical issue threat to the
Public Health. Opioids reduce the intensity of pain signals reaching the brain. The most
commonly used pain killers are Opioids, such as Vicodin, Percocet, Codeine, OxyCotin, and
Morphine. A single large dose can cause severe respiratory depression and death. The
commonwealth of Massachusetts has not fully reviewed the Massachusetts Comprehensive
Health Curriculum Framework since its inception in 1999. The legislature needs to add reforms
and overhaul the state’s framework.
Subsidize in Prevention and Treatment
When reviewing the Massachusetts Opioid Abuse Prevention Collaborative, prevention
strategies are listed but there is no policy that is requisite for the MD’s. While they do know their
patients best, there needs to be a maximum amount of pills that can be prescribed. Limiting the
prescriptions for patients not only limits the risk of addiction, but it eliminates the adjunct pills
that can either be sold on the black market or distributed amongst friends or colleagues. The
Massachusetts Medical Society (MMS) has urged limiting the first Opioid prescription to
patients. While they differ on the time table, they agree this is something that is certainly
something that needs to be augmented into the framework. The bill currently has a 3 day limit
already formulated, but the MMS recommends a 7 day limit. It would be easiest to meet in the
middle with the MD’s and place a 5 day limit on first prescriptions. Dr. Peter Smulowitz of Beth
Israel Deaconess Hospital in Plymouth agrees, and has advocated for this new infrastructure. To
decrease addiction throughout the commonwealth, new policies placing limitations must be place
in the state’s health curriculum.
Generate a Protocol for Addicts
After spending several hours on the Massachusetts Health and Human Services Department
website, I was surprised that there was no set protocol on how to handle an addict, or even how
doctors should handle their prescribing of Opioids. There needs to be a written protocol for
Medical Centers to follow in their treatment for addicts. After the detoxification, I recommend

2. immediate therapy. This would be the most vital component at the protocol because it eliminates
the possibility of a relapse. Therapeutic protocol should have a broad range of options, from
cognitive to contingency, motivational to behavioral, and of course, family. Treatments and
therapy must be tailored to the patient’s needs, which is why the protocol would be so extensive.
Medications do not need to be reformed, as there are already approved methods by the US Food
and Drug Administration (FDA). Hospitals also need the power to be able to keep an addict in
treatment, even if that means keeping them against their wishes. Studies show that in order to
adequately pass the need for a fix or to finish withdrawals that there needs to be at least a three
day detainment period. Unfortunately, hospitals currently do not have this power.
Increased Screening Among Students for Potential Substance Abuse
The vast majority of overdose related deaths come from the adolescent stage to early adulthood.
High Schools and Colleges in Massachusetts currently do not have an effective procedure for
screening. If the framework is updated, it is essential that a screening procedure is added to
ameliorate the substance abuse problems in its main demographic. Without new procedures,
substance abuse will go unchecked. While basic security checks should be put in place, another
new method I recommend being put in place is the CRAFFT substance abuse screening test. The
test compares the score on the 6-item CRAFFT test with screening categories determined by a
concurrently administered substance-use problem scale and a structured psychiatric diagnostic
interview. Screening categories were "any problem" (ie, problem use, abuse, or dependence),
"any disorder" (ie, abuse or dependence), and "dependence."