Li-Chung Wang

With roughly half of its members present, the Joint Committee on Mental Health and Substance Abuse heard testimony on June 27 from advocates, academics, and persons in recovery on bills addressing a variety of issues. Topics covered ranged from marijuana decriminalization to an alcohol excise tax to increase funding for substance abuse treatment, to the siting of methadone clinics.

SB 1151 (Sen. Shannon, D—2nd Middlesex), the Marijuana Decriminalization Bill, is a proposal to impose only a civil fine for the possession of less than one ounce of marijuana, received a great deal of attention. Attorney Michael D. Cutler testified in support of it, as did Attorney Steven Epstein, although he warned that, under the new legislation, 17-year-olds charged with possession of marijuana could pay the civil fine without their parents ever knowing of the incident.

Dr. Jeffrey A. Miron, an Economics Professor from Harvard University who has researched the impact of U.S. drug policy on government, public safety, and drug abuse, argued in favor of SB 1151. “My work estimates the savings in criminal justice resources that would accrue to Massachusetts state and municipal governments under decriminalization at $24.3 million per year,” he stated. “My work also examines the degree to which marijuana use increases after decriminalization. Experience in other states and countries provides little indication that use increases to any substantial degree.”

Whitney Taylor, Executive Director of the Drug Policy Forum of Massachusetts, stated in her testimony that individuals who are convicted of marijuana possession face the same state and federal restrictions—often severe and long-ranging—that other convicted felons do. They become ineligible for government student loans, many forms of military service, and a majority of government jobs. They are also at risk for losing their right to vote, custody of their children, and professional licenses. Taylor also pointed out that “marijuana has already been decriminalized in eleven other U.S. states.”

Support for SB 1151 also came from Jack A. Cole, Executive Director of Law Enforcement Against Prohibition and a retired detective with fourteen years of experience as an undercover narcotics officer. Cole described the War on Drugs as failed public policy and stated that he personally lamented that nearly a thousand young people, who otherwise would have become productive citizens, went to jail because of his earlier work.

Another bill which received considerable attention in the hearing was SB 1156 (Sen. Walsh, D—Suffolk and Norfolk), the Substance Addiction Treatment Act, which would impose an excise tax on alcohol to fund substance abuse treatment. Testimony supporting the bill described the high rates of alcohol abuse and the lack of detox beds in Massachusetts. For example, the state has the second highest rate in the nation of alcohol use among 14- to 17-year-olds. Furthermore, only 6.5% of the state’s population are responsible for over half of its alcohol consumption; one-third of the state’s population do not even drink.

In testifying for SB 1156, Sana Fadel, Public Policy Coordinator at Rosie’s Place, and Coordinator of the Coalition to Increase Access to Addiction Treatment, commented on the existence of taxes for highway and healthcare funding, and argued that the proposed excise tax is a fair way to increase funding for substance abuse treatment.

Several individuals associated with the coalition wore yellow buttons inscribed with the words "Invest in Addiction Treatment." Other testimony justified the tax increase by observing that the excise tax has not been increased since 1976, that the lack of detox beds has an adverse affect on state healthcare costs, and that continuous funds are needed to support of permanent detox programs.

House Bill 3945 (Rep. Malia, D—11th Suffolk), which proposes the creation of a special commission to investigate the impact of alcohol abuse on the state, received supportive testimony from Ricardo Quiroga, the Executive Director of Casa Esperanza, an organization that provides substance abuse treatment. Michael Cutler, who testified in support of SB 1151, also testified in favor SB 1143 (Sen. Creem, D-1st Middlesex and Norfolk), legislation to create a public service campaign to reduce the use of ecstasy and the abuse of pharmaceutical drugs. During his testimony, he observed that it was unusual for the District Attorney for Middlesex County to co-sponsor this piece of legislation, which advocated for education rather than a tough-on-crime approach. Senate Bill 1145 (Sen. Hart, D-1st Suffolk), legislation to regulate the location of methadone facilities due to fear of their causing increases in crime, met with opposing testimony. Advocates called for the committee to prevent the unnecessary relocation of treatment centers.

Testimonies presented by Dr. Jeffrey Miron, Whitney Taylor, Jack Cole, and Sana Fadel can be found at www.cjpc.org in the 2005 Legislative Action section.

Li-Chung Wang

The July 18th hearing of the Committee on Mental Health and Substance Abuse lasted over two hours, during which time testimony was heard from a number of mental health and substance abuse treatment activists and experts. The two most prominent bills heard were HB 3127 (Rep. Rushing, D-9th Suffolk), the “Treatment on Demand Bill,” and SB 1148 (Sen. Moore, D-Worcester and Norfolk), the “Substance Abuse Parity Bill”.

HB 3127 "Treatment on Demand Bill"

HB 3127 would require the Massachusetts Department of Public Health to provide mental health treatment to patients who are not eligible for assistance under any other program, who lack private health insurance, or who have insurance that does not cover this treatment. It was authored by Rep. Byron Rushing and introduced in the last two legislative sessions. Rushing, now serving as the Second Assistant Majority Leader of the House of Representatives, hopes to use his new leadership position to advance this bill, which would increase access to substance abuse services for those who either lack insurance coverage or are underinsured. A key talking point for the bill identifies the political difficulty in increasing access to treatment:

Although rhetoric that substance abuse is an illness and should be treated as any other physical or public health problem is prevalent within patient, provider and behavioral health communities, it still has a long way to go to become effectuated public policy.

Lisa Lambert, Assistant Director of the Parent/Professional Advocacy League (PPAL), an organization that supports people with mental health needs, listed some of those needs that go unmet in the current system. Lambert cited national data showing that “60-75 percent of youth in juvenile justice settings have mental health needs and more than 80 percent have substance use disorders.” Although many individuals affiliated with PPAL receive mental health treatment, “of those identified with substance use disorders, only 19 percent receive treatment.” Lambert also noted that patterns of drinking often worsen without access to treatment.

In her testimony, Whitney Taylor, Executive Director of the Drug Policy Forum of Massachusetts, emphasized the cost of inadequate addiction treatment. “We believe that the most cost effective and beneficial treatment services are provided in the community before an individual’s addiction causes them to commit crimes beyond their illicit substance use,” said Taylor. “These services will ensure long-term savings — for every $1 invested in addiction treatment there is a $7 savings to the taxpayers, according to the RAND Corporation.”

By mid-August, HB 3127 has been reported out favorably by the Joint Committee on Mental Health and Substance Abuse. The Committee removed language on income eligibility standards of not less than 200% of the federal poverty level. Representative Rushing supported this amendment, because it would make substance abuse treatment available to people regardless of income level. Senate Bill 1148 has not been reported on.

SB 1148 "Substance Abuse Parity Bill"

The Coalition to Increase Access to Addiction Treatment was an active supporter of the “Substance Abuse Parity Bill,” SB 1148. This bill would guarantee that insurance providers recognize substance abuse as a disease and prevent them from discriminating against individuals with substance abuse problems. Sana Fadel, Public Policy Coordinator of Rosie’s Place, testifying on behalf of the Coalition, stated that Massachusetts law does not protect patients from restrictions on addiction treatment imposed by private insurers beyond the minimal mandated substance abuse benefit: 30 days of inpatient treatment and $500 of outpatient treatment per year. She gave several reasons in support of the bill. “This bill acknowledges that addiction is a treatable chronic disease,” she said. “This bill protects patients from arbitrary restrictions by private insurance on appropriate healthcare for their addiction. This bill, while fairly holding private insurers to appropriate standards, will only cost a modest 83¢ per member per month.”

Representative Rushing supported SB 1148, remarking:

When someone is seeking substance abuse treatment, they will be able to obtain it, as conveniently as someone who breaks their arm can get that treated at a hospital. No waiting lists, no addiction treatment refusals by insurance companies.

Lambert, of the PPAL, testified that “there are a great many teens in the Commonwealth who are prevented from receiving the substance abuse treatment they need by restrictions on their insurance benefit.” She urged the Committee to vote favorably on the bill.

The Massachusetts Association of Behavioral Health Systems (MABHS), which represents 44 inpatient mental health and substance abuse facilities, supported the bill as well. David Matteodo, Executive Director of MABHS, testified that he supported SB 1148 “primarily because it would help remove the stigma of substance abuse by treating it like other illnesses under the insurance laws in Massachusetts.” He further argued that current insurance benefit levels for substance abuse—30 days for inpatient care and $500 for outpatient treatment—are outdated, since they were established by the legislature in 1973.

The Massachusetts Association of Health Plans (MAHP) submitted the only opposing testimony to SB 1148. “Health plans in Massachusetts already provide comprehensive coverage for substance abuse treatment,” stated the testimony. “Because the mental health parity law applies to most cases of alcohol and chemical dependency, there is no need for a separate substance abuse parity law.” Uncertainties about the effectiveness of treatment were also raised. The testimony argued that mandates enacted by the Massachusetts Legislature contributed significantly to the rising cost of health insurance. The testimony concluded by stating that due to rising costs, “businesses, particularly small businesses, often are left with the difficult choice of either shifting the additional costs to their employees or dropping health insurance altogether, leading to an increase in the number of uninsured individuals.”

Text of the testimony presented by Sana Fadel can be found on www.cjpc.org under 2005 Legislative Action.

Li-Chung Wang

As of mid-August 2005, roughly fifteen of sixty-three bills referred to the Joint Committee on Mental Health and Substance Abuse have been considered in executive session. Eight of them have been reported favorably, with no action yet taken on the others. Six of those reported favorably were referred to the Committee on Health Care Financing, which is charged with determining each bill’s cost. Those bills reported favorably that are relevant to CJPC’s concerns are listed below.

HB 1613 (Rep. Jeffrey Davis Perry), an Act Relative to Mental Health Services, has been referred to the Committee of Health Care Financing. The act amends line item 8910-0003 to include the creation of three regional behavioral evaluation and stabilization units that would provide mental health services for incarcerated persons. To monitor the effect of the three proposed regional mental health units, the bill also requires the Massachusetts Sheriffs’ Association, in conjunction with the Department of Correction, to submit a report on mental health among incarcerated individuals.

HB 1616 (Rep. Kay Khan), an Act Relative to Mental Health Examinations and Services, has been referred to the Committee of Health Care Financing. It will ensure that any person admitted to a county correction facility will have access to mental health care consistent with his or her needs. There is also a provision for an annual review of these services.

HB 3127 (Rep. Byron Rushing), the “Treatment on Demand Bill,” has been referred to the Committee of Health Care Financing. The bill was amended in Committee to provide substance abuse treatment to anyone who lacks insurance coverage. It will require the Massachusetts Department of Public Health to provide mental health treatment to patients who are not eligible for assistance under any other program. See “The Mental Health and Substance Abuse Committee Hears Testimony on Several Bills” (page 3) for a discussion on the testimony offered with regard to this bill.

HB 3945 (Rep. Elizabeth A. Malia), Act Relative to the Establishment of an Alcohol Commission, has been reported favorably by the Committee. The Commission will investigate and study the impact of alcohol abuse in Massachusetts. It will be composed of appointed members, government officials, and advocates.

SB 1140 (Sen. Harriette L. Chandler), an Act to Control the Use of Methamphetamine, has been reported favorably by the Committee. The bill will tighten restrictions on the sale of products containing the main ingredients used to produce methamphetamines.

SB 1143 (Sen. Cynthia S. Creem), an Act to Prevent the Use of Ecstasy and the Abuse of Pharmaceutical Drugs, has been referred to the Committee of Health Care Financing. The bill requires the secretary of the Executive Office of Health and Human services to develop a public service campaign to prevent the growing use of ecstasy and other frequently abused drugs.

Thanks are due to those who prepared testimony for recent hearings. Hearings are an early part of the legislative process, but testimonies can be rich sources of talking points for follow-up advocacy conversations with legislators, letters to the editor, and calls to action.

To make these resources available beyond the hearings, CJPC has begun asking those who testified on issues and bills important to our goals to share their testimony with us for collection on our website. As this newsletter goes to press, twenty-five testimonies, on a wide range of bills, are available in the 2005 Legislative Action section of www.cjpc.org. Please take a look!

Three individuals, plus the seven organizations listed below, are represented in the collection to date. Thanks to them and to future contributors for giving others access to the facts and arguments they used to influence legislators. Please send testimony to be added to this collection to [email protected].

* Coalition to Increase Access to Addiction Treatment (4 testimonies)

* Criminal Justice Policy Coalition (3 testimonies)

* Drug Policy Forum of Massachusetts, Boston (2 testimonies),

* Mental Health and Substance Abuse Corporations of Massachusetts (4 testimonies)

* Massachusetts Law Reform Institute, (3 testimonies)

* National Alliance for the Mentally Ill of Massachusetts, (4 testimonies)

* National Association of Social Workers, Massachusetts Chapter (2 testimonies)