Making noise about a silent epidemic

Steve Tolman admits he is passionate about the issue. The Brighton state senator says he has seen too many families ravaged by drugs and knows of too many overdoses from which a young person never woke up to be complacent about the problem.

"It's a silent epidemic," he says of the strange hold that OxyContin and heroin have on increasing numbers of young people. OxyContin may have been a godsend to those suffering from debilitating pain when it hit the market in the late 1990s, he says, but it has become a nightmare for those who have become hooked on it and for their families.

A 2006 report from a state commission established by the Legislature found that addiction rates in Massachusetts for OxyContin and other prescription medications soared tenfold over the prior decade. Tolman, who served as the first Senate chairman of the Legislature's Committee on Mental Health and Substance Abuse when the panel was formed in 2005, says OxyContin has brought drug addiction to scores of stable, middle-class homes throughout his district and to thousands across the state.

Because it's a legitimate prescription medicine when used properly, the pain drug doesn't have the stigma attached to it that heroin carries. But its effect can be nearly as devastating, and OxyContin abusers can become heroin addicts in a hurry, says Tolman. With an OxyContin pill going for as much as $80 on the street, Tolman says, young people quickly develop a habit they can't afford. "But once they can't afford OxyContin, there's heroin for $4 a bag," he says. "These people are not going to be junkies because they're from good families," he says, parroting the denial that runs rampant. "They will never put a needle in their arm."

But that's exactly what lots of young people wind up doing, he says. "OxyContin is not a gateway to heroin," says Tolman. "It's a rocket ship."

Tolman has been pushing on all fronts, supporting everything from expansion of state treatment programs to an innovative program underway in Essex County in which substance abusers facing minor criminal charges can opt for treatment in lieu of a court arraignment - and the baggage of a criminal record that it would bring. His latest pitch, however, is likely to generate more controversy.

Tolman has filed legislation that would extend from 30 days to 90 days the maximum period of time a court can order someone held at a secure treatment facility under the state's "civil commitment" statute. Under the law, a substance abuser who is not facing any criminal charges can nonetheless be ordered into a locked treatment facility if a judge concludes that he or she is in imminent danger or poses a danger to others. Tolman says families file civil commitment applications as a last resort, but he argues that opiate addiction frequently requires more than 30 days of initial treatment, a benchmark he says was established with alcoholism treatment in mind.

Michael Bottecelli, director of substance abuse services for the state Department of Public Health, praises Tolman for putting a spotlight on "treatment for a younger, more treatment-resistant population." He's not convinced, however, that longer involuntary commitment is the way to go. There isn't "a lot of research that demonstrates really effective outcomes by mandating longer lengths of stay," says Bottecelli.

With so many addicts relapsing after treatment, Tolman says, allowing longer mandated treatment periods could serve as a pilot program to provide that missing research data. "At some point we have to look at this and say we need to change the way we treat the severely addicted," says Tolman. "The moms and dads don't know which way to turn."

Michael Jonas can be reached at jonas@globe.com.