Charlie Baker made it clear, as soon as he won election in 2014, that tackling the opioid crisis would be a top priority. He did not delay.
A month after taking office as governor, Baker established a working group that by June 2015 came out with 65 recommendations to address opioid addiction. Moved by the stories of families who had lost loved ones to addiction, he nearly wept when he signed the first of two legislative packages targeting the problem.
On Baker’s watch, the overdose-reversing drug naloxone has become widely available, opioid prescribing has fallen 30 percent, the state has amassed and analyzed a trove of data on the epidemic, and new resources have poured into treatment.
Last year, Massachusetts was one of only eight states where opioid overdose deaths declined, despite the growing prevalence of deadly synthetic fentanyl in the region. But there is no evidence that overdoses in general are down or that fewer people are struggling with addiction. Treatment programs still have waiting lists, especially for people covered by the state’s Medicaid program.
As Baker, a Republican, campaigns for reelection, interviews with more than a dozen providers, advocates, and academics yielded near unanimous praise for the governor’s leadership on the opioid problem.
But even his fans identified shortcomings and continuing challenges in confronting a catastrophe that no one believes is close to ending.
“Governor Baker has been probably the most prominent leader among governors on the opioid epidemic,” said Michael Botticelli, who was the national “drug czar” when Baker took office and now heads Boston Medical Center’s Grayken Center for Addiction. “We have seen sustained efforts over time — to implement strategies, to pass legislation, to identify new resources.”
Bertha K. Madras, a Harvard Medical School psychobiologist who served on the President’s Commission on Combating Drug Addiction and the Opioid Crisis in 2017, agreed that few other states’ responses to the crisis “approach the thoughtfulness and thoroughness of the Baker administration.”
But critics fault the governor for what they see as an overemphasis on opioid prescribing, a failure to provide treatment for inmates, a dearth of recovery services after detox, and a failure to ensure that addiction programs provide treatments that work.
Baker’s harshest critic, not surprisingly, is his Democratic opponent, Jay Gonzalez, who had worked on the opioid problem as CEO of small health insurer, CeltiCare Health Plan.
“This has been a priority of his for four years. There’s not a lot to show for it,” Gonzalez said. “The underlying issue of addiction is only getting worse.”
Gonzalez said the epidemic calls for a “more aggressive” response, including ensuring all addicted inmates have access to medication-assisted treatment, requiring health insurers to cover medical marijuana, and raising Medicaid reimbursements for addiction treatment.
It is difficult to overstate the magnitude of the crisis Baker faced when he took office. More than 1,300 people had died of opioid overdoses in 2014, and that number would soar above 2,000 in just two years.
People struggling with addiction told of fruitless searches for treatment or access only to brief detoxes — the notorious “spin-dry” — that spit them back into their previous lives and near-inevitable relapse.
Dr. Ruth A. Potee, a Greenfield family physician and addiction specialist, said that until recently she had no place to send her addicted patients. Today, Potee is medical director of 64-bed facility that came into existence at the behest of the Baker administration, and all addiction treatment is covered for patients with MassHealth, the state’s Medicaid program.
But still, she said, her patients are often unable to find longer-term housing that helps sustain their sobriety.
Although she gives Baker high marks overall, Potee expressed frustration that he keeps talking about prescribed opioids, which she said may have triggered the epidemic but are not the main problem today. Teenagers don’t start out with stolen pills anymore, Potee said; they go straight to heroin. “Sometimes I feel like we’re having the 2012 conversation,” she said.
Cindy Steinberg, policy chairwoman for the Massachusetts Pain Initiative, an advocacy group for people who live with pain, is also troubled by the continuing focus on prescribing, even though prescription opioids are involved in fewer than a fifth of overdose deaths, while fentanyl was found in 89 percent.
“It’s really easy to blame doctors, and politicians do that constantly, instead of using the data to understand the problem and saying, ‘We need to do a better job at stopping the illicit flow of drugs coming in,’ ” Steinberg said.
In a brief phone interview, Baker said controlling prescribing was part of the prevention component of his opioid plan, and he does not intend to step back from it. He said he still hears of people getting 30 days of opioids for problems that don’t warrant that much painkiller. “We do need to stay vigilant on this one,” he said.
Leo Beletsky, Northeastern University associate professor of law and health sciences, faults Baker for not doing more to improve the quality of addiction treatment and failing to ensure that all addiction treatment programs offer the medications that prevent relapses and overdoses.
Beletsky asserted that Baker tends to take positions that are “not rooted in evidence.”
As examples he mentioned the governor’s proposal to empower clinicians to hold addicted people against their will for 72 hours, which was twice rejected by the Legislature, and Baker’s strong opposition to the idea of a supervised injection site, where people could use drugs safely under the watchful eyes of clinicians.
“It flies in the face of his image as someone who is driven by data and science, which he has very much cultivated,” Beletsky said.
Baker pushed back on that accusation. He said the effectiveness of supervised injection sites varies depending on how the sites are designed, and “some offer virtually no path to treatment.” Legislators created a study group on the issue, and Baker said that in signing the bill he demonstrated a willingness to consider the idea.
He also expressed satisfaction with the Legislature’s alternative to his proposed 72-hour hold — requiring hospital emergency rooms to provide addiction treatment to people who overdose.
“You don’t always know which particular time and place, for most people who are dealing with addiction, is going to be the one that sticks,” Baker said. “In our view, if we give people more places, more opportunities, and more spaces to get into treatment, the likelihood that one will stick is higher.”
Dr. Peter D. Friedmann, president-elect of the Massachusetts Society of Addiction Medicine, believes that Baker “has done a tremendous job,” but wishes he were “more full-throated in his advocacy for medication treatment” and worries the state is putting too much money into detox and treatment beds instead of more effective outpatient services.
Botticelli, of the Grayken Center, said there was one area where Massachusetts had fallen behind a few other states: the treatment of inmates.
Baker has said little publicly about the failure of his Department of Correction to provide medication treatment to addicted inmates — even though his Department of Public Health reported that newly discharged inmates are dying of overdoses at extremely high rates.
The opioid legislation Baker proposed this year made no mention of inmates.
Legislators eventually added a pilot program providing the medications in six houses of correction, as well as new requirements on prisons. Baker signed it into law.
But the governor said he did more than just sign the bill; he helped shape it. “We spent a ton of time with [legislators],” he said.
Vic DiGravio, president and CEO of the Association for Behavioral Healthcare, a Massachusetts trade group of treatment providers, affirmed that the governor’s people played a key role in “getting to yes” on the pilot program for corrections.
It’s an example, he said, of Baker’s effectiveness.
“What has most impressed me about the governor,” DiGravio said, “is that he gets the importance of making state government work.”
Correction: An earlier version of this story incorrectly characterized the legislation concerning addiction treatment in prisons and houses of correction. Only the houses of correction program is a pilot.