Chronic Pain and Addiction Treatment in Massachusetts

How is chronic pain treated when someone also has a substance use disorder?

When someone in Massachusetts has chronic pain alongside a substance use disorder, pain and addiction clinicians usually work from one shared plan, so medication, therapy and safety decisions fit together. The addiction team and the pain prescriber exchange records with the patient’s consent and agree on who writes which prescriptions.

Physical dependence is not the same as a use disorder. A person who has taken opioids as prescribed for years can be physically dependent without having an addiction, and a clinician sorts out which applies. Changes to medication are reviewed by both sides together rather than made by one prescriber alone.

Plans often combine buprenorphine or methadone with non-opioid pain medicines, physical therapy and cognitive behavioral therapy. Buprenorphine also eases pain to some degree, which clinicians may weigh. Cutting a long-term opioid or benzodiazepine prescription sharply on your own can bring withdrawal and a surge in pain, so any taper belongs with the prescriber.

MassHealth, the state Medicaid program, is the main public payer, and people without coverage can ask about funding through the Bureau of Substance Addiction Services. Before starting, ask whether a program treats pain and substance use disorder together, whether it can continue buprenorphine or methadone, and whether it will coordinate with your current pain prescriber.

Medication and therapy options

Medication for opioid use disorder includes buprenorphine and methadone. Buprenorphine also has pain-relieving effects, which some clinicians weigh when a person has both conditions. Methadone for opioid use disorder is dispensed through specialized opioid treatment programs. Many plans also include non-opioid pain medicines, physical therapy, cognitive behavioral therapy and other psychological approaches. The right mix for any one person is a decision for the clinicians and the patient together. Massachusetts listings for Suboxone clinics and methadone clinics show where these medicines are offered. Broader opioid treatment in Massachusetts is listed separately.

Is it safe to stop or reduce pain medication on my own?

Stopping or sharply cutting a long-term opioid or benzodiazepine prescription is not safe without a plan, and any taper should be worked out with the prescriber. Abrupt changes can bring withdrawal and a surge in pain. They can also lower tolerance, which raises the danger if a person later takes a former dose. Benzodiazepines carry their own dependence and withdrawal risks, and taking them with opioids adds to the risk of slowed breathing, so neither should be adjusted alone. Programs that treat both conditions can work with the prescriber on the pace of any change and on support along the way. Massachusetts listings for benzodiazepine treatment cover that side of care.

Can I keep getting pain treatment while in addiction treatment in Massachusetts?

Many people in Massachusetts keep receiving pain care during addiction treatment, provided the program and the pain prescriber agree on one plan. Massachusetts keeps a prescription monitoring program for controlled medicines, and clinicians on both sides may look at the same record. The STEP Act of 2016 set a 7-day limit on first opioid prescriptions for adults, so a new prescriber may write a shorter supply at the start than a long-standing one.

Naloxone, the opioid overdose reversal medicine, is widely available across the Commonwealth. A statewide standing order lets any resident get it at a pharmacy without a prescription, and nasal naloxone is also sold over the counter. The You Can Save a Life website offers free home delivery, and MassHealth members pay no copay. The state’s Good Samaritan law protects both the person who calls for help during an overdose and the person overdosing from possession charges. MassHealth also pays for live video and audio-only visits at the same rate as in-person care, so a telehealth program may suit someone whose pain makes travel hard.

How do I pay for pain and addiction treatment in Massachusetts?

MassHealth, the state Medicaid program, is the main public way to pay. Members of the PCC Plan and Primary Care ACOs get behavioral health care through the Massachusetts Behavioral Health Partnership. Accountable Care Partnership Plan members use their plan’s own network. State law requires MassHealth and state-regulated insurers to cover acute treatment services and clinical stabilization services for substance use disorder without prior authorization. Ask your plan how it covers buprenorphine, methadone, and outpatient or residential levels of care. Listings that take Medicaid are easy to filter.

Private insurance benefits vary by plan. Call the number on your card, ask how the plan covers pain management and addiction treatment, and ask how it applies parity rules to substance use benefits. If you have no coverage, ask about public funding through the Bureau of Substance Addiction Services. You can also browse state-funded programs in Massachusetts and sliding scale options.

What should I ask a Massachusetts program before starting?

Start with three questions:

1. Does the program treat pain and substance use together?
2. Can it continue or start buprenorphine or methadone?
3. Will it coordinate with your current pain prescriber?

After that, ask about levels of care, accepted insurers, accreditation, languages and populations served. Each listing shows what the provider reports on these points. If depression, anxiety or trauma is part of the picture too, see dual diagnosis care in Massachusetts.

Using these listings and free starting points

Most of these Massachusetts listings are near the water: 70 percent sit within 25 miles of the coast. Boston Logan International is the nearest airport for about a third of them, and the median distance to the nearest airport is 10.4 miles, which helps if family is traveling in. You can compare this list with all Massachusetts treatment listings or with pain and addiction programs nationwide.

Free help is available by phone:

Massachusetts Substance Use Helpline: 800-327-5050 (call, or text HOPE)
The national treatment referral line
2-1-1
988, if you are in crisis