BOSTON — Although Massachusetts’ opioid deaths are still on the rise, with the powerful drug fentanyl adding to the toll, facets of the Legislature’s anti-drug act are beginning to have an impact.

Prescribers have doubled their use of a new online tool to check if patients are getting prescriptions from multiple sources. Schools around the state are instituting programs for students, particularly athletes, to educate them about the dangers of opioids.

“This approach is building a foundation that will serve us well over the long term,” Public Health Commissioner Monica Bharel says nine months after Gov. Charlie Baker signed the Act Relative to Substance Use, Treatment, Education and Prevention.

“This is an epidemic that has building for years, but I am hopeful in the fact that never before has the commonwealth committed so many resources to addressing opioid misuse disorder, and we are going to continue this comprehensive approach no matter how long it takes.” Bharel said.

Sections of the comprehensive law, which Baker signed earlier this year, have been coming on line through the summer and fall. At the same time, opioid deaths continue to rise with 1,005 deaths from prescription and illegal opiates in the first nine months of 2016 along with an estimated 392 to 470 deaths e over the last quarter, according to a recent report from the Massachusetts Department of Public Health.

The nine-month estimate would bring the death toll higher than the 1,197 confirmed deaths for the first three quarters of 2015.

While statistics show the grim tide has yet to ebb, state and local officials say they now have the tools to fight the epidemic, specifically limits on opiate prescriptions, education programs to encourage patients to only partially fill opioid prescriptions and oversight of the Massachusetts Prescription Awareness Tool the state’s new prescription monitoring system.

As of Oct. 15, clinicians were required to go online to check a patient’s prescription history before prescribing Schedule II or III narcotics - painkillers such as Vicodin, OxyContin, and fentanyl. The public health department said the system currently has over 50,000 registered prescribers and their delegates, such as physician assistants.

The online tool has seen a surge of use, rising from 10,000 searches per weekday four days before the requirement kicked in to 24,000 searches per weekday by last week.

“This tool allows prescribers, at their fingertips in a clinical situation, [to] have a tool that helps them in their clinical judgment balance the potential need for pain control and the potential for substance misuse,” Bharel said.

The section of the law that requires schools to screen students for substance abuse, and include opiate education in their curriculum is also moving forward.

Framingham Public Schools Athletic Director Paul Spear oversees the staff educating student-athletes on the dangers of opiates.

“You see a lot of stories about the kids who start out with a sports injury and they are taking some kind of painkiller. Eventually, it leads down the road to addiction, and that’s what we are trying to get people aware of and prevent people from putting themselves in the position where these things become harmful,” Spear said.

Framingham-area schools are using a system similar to the concussion protocol, to monitor student-athletes who are prescribed painkillers as well as educate them on the misuse of the medication.

“[It’s] the same way we do education for concussions with coaches. We have a handout going to coaches and student-athletes. Obviously, it’s something we talk about in our coaches’ meetings, and it’s certainly something we have created an awareness about with our trainer in regard to injuries,” Spear said.

The law has made it easier to communicate with students and families.

“Just that piece of awareness allows our coaches to work with parents, families and players to make sure that students are doing what they supposed to and making healthy choices, which I think is what athletics is all about,” Spear said.

Even with the law coming on line, new proposals are in the works.

The Massachusetts Interscholastic Athletic Association is proposing a subsection to a drug and alcohol rule for the 2017-2019 season that will ban student-athletes under the influence of prescription painkillers from competition or practice.

Judith Styer, director of Health of Wellness of Framingham Public Schools, said the goal of the schools is to increase students’ “social competency,” teaching how to make responsible decisions and positive choices. Even if the issue is not directly hurting students as much as other age groups, teaching children these values can help steer them away from dangerous situations, she said.

“The demographics of opioid abusers is a little bit older than K-12. So, what we’re working on, as a district, is really doing prevention work that is not specifically targeted towards substance abuse,” Styer said.

“A screening tool isn’t prevention, so we’re looking at teaching our kids social and emotional competency… Because those, we believe as the research is coming out, are the places that if we can build competency in kids and community around these competencies, this is going to go a long way for prevention.

The state is also addressing issues surrounding fentanyl, a potent synthetic opiate whose use has increased since 2014.

“Fentanyl is adding to the state’s opioid epidemic more than heroin,” according to data in the state’s recent Chapter 55 report, which found as much as 60 percent of opioid-related deaths with a toxicology report available in 2015 showed a presence of fentanyl, compared to fentanyl being a factor in 40 percent of opioid related deaths in 2014.

Fentanyl is available as a prescribed drug, but according to the U.S. Drug Enforcement Administration, most fentanyl-related deaths are due to stronger dosages on the street rather than in a pharmacy. Black market fentanyl is stronger than its prescribed cousin, and can even be 50 times stronger than heroin.

Bharel acknowledges this next challenge, emphasizing that this crisis is an extremely complex issue that must be tackled from a “multi-faceted approach” that includes teaching clinicians how to effectively use MassPAT, and training EMTs and paramedics how to administer naloxone, which can help save lives in an overdose.

“We have to continue to address it from a cross-sector approach, including areas related to prevention, where we are doing education not only for citizens, but for prescribers and for our core competencies where over 8,000 students are trained in how to look for and treat substance misuse,” said Bharel.

James Mattone is a student writer for the Boston University Statehouse Program.

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