Bill to combat opioid crisis rejects 72-hour hold, adds mandate for hospital care

Leaders of the state’s House of Representatives have nixed Governor Charlie Baker’s controversial proposal to give physicians and other clinical professionals the power to involuntarily hold, for 72 hours, drug users who pose a danger to themselves or others.

Instead, the House version of Baker’s wide-ranging legislation, released late Monday, requires hospital emergency departments to offer medications to treat addiction — buprenorphine or methadone — to patients who have overdosed, a mandate that would entail physician training and changes to hospital procedures. Currently, many patients leave the hospital after surviving an overdose with only a referral to a treatment program, and often they overdose again.

The measure is the latest chapter of the state’s effort to tackle the opioid crisis. The full House is expected to amend the bill and pass it this week, while the Senate appears likely to take up some version of it before the formal legislative session ends on July 31.

“The Senate believes there is a strong need for effective opioid legislation, and we look forward to the House sending us their bill,” said Scott Zoback, a spokesman for Senate President Harriette L. Chandler.

The provision requiring emergency room treatment was “the big win,” said Vic DiGravio, president and chief executive of the Association for Behavioral Healthcare, a trade group of Massachusetts treatment providers. “It’s another tool in the arsenal to fight the epidemic on a global level,” he said.

If the mandate becomes law, a likely model for other hospitals will be Massachusetts General Hospital, the first hospital in the state to provide buprenorphine in the emergency department.

“Even three days’ worth of medication as a bridge to ongoing care can be lifeline that increases the likelihood that someone stays in treatment and stays alive,” Dr. Sarah E. Wakeman, medical director of the hospital’s Substance Use Disorders Initiative, said in an e-mail to The Boston Globe praising the proposed measure.

The Massachusetts Health & Hospital Association embraced the requirement in a statement Tuesday.

In a move that disappointed advocates, the House bill takes a small step to address the issue of medication to treat addiction for inmates.

Most jails and prisons in Massachusetts and elsewhere deny inmates access to methadone and buprenorphine, the primary drugs used to treat opioid addiction. The policy puts inmates at high risk of deadly overdose when they are released. A coalition of 26 health care groups had urged the Legislature to require jails and prisons to provide the medications to inmates suffering from opioid addiction.

The House bill calls for a two-year pilot program offering the medications — but only in two prisons and only to inmates who had been taking the medications immediately before incarceration. Such a program would affect few people, as most inmates spend time in jail awaiting a court date and have withdrawn from the medications by the time they get to prison.

In a statement Tuesday, the Massachusetts Medical Society called for doing more than a pilot program, saying all addicted inmates needed access to the medications.

Representative James J. O’Day, a Worcester Democrat, is submitting an amendment to the bill that would make the medications available to all addicted inmates in both jails and prisons.

The program would phase in over four years, starting with inmates who arrived already taking the medication, progressing to offering medications 30 days before release, and finally, in 2022, providing the medications throughout the time behind bars.

Although it killed the 72-hour hold, the bill preserves several other key provisions that Baker had proposed. Among them:

■ Strengthening state oversight authority of addiction recovery and mental health beds, ensuring that when a new license is issued or one is transferred, the provider meets the treatment needs of the state’s patients. That will be defined by state health authorities, perhaps mandating that providers take public health insurance, for instance.

■ Establishing a commission to develop a framework for professional standards for recovery coaches, who help people get back on their feet as they fight addiction.

■ A mandate that prescriptions be electronically submitted to pharmacies by 2020.

■ A statewide standing order for the opioid-overdose reversal drug naloxone, enabling all pharmacies to dispense it to people who don’t have a prescription.

■ Allowing people who partially fill a painkiller prescription — say, getting only 10 of the 30 Vicodins they were prescribed — to go back to the pharmacy and get the rest later. (Under current law, those remaining 20 expire immediately.)

After passing what policy makers framed as a nation-leading effort to fight the scourge of opioid overdoses in 2016, Baker proposed a follow-up bill — the CARE Act — in November 2017. The most controversial part of that legislation was the 72-hour hold.

State law already allows for people suffering from addiction who pose an imminent risk of harm to be involuntarily held with a court order. But the Baker administration — which also proposed a similar measure in 2015 — said the severity of the opioid crisis calls for giving clinical professionals more tools.

The administration said that allowing the holds could help break a cycle of opioid use.

But some lawmakers and civil liberties advocates said the provision was a bad idea, and that the current, court-based system of civil commitment should not be expanded.

Baker aides said the governor will carefully review any legislation that reaches his desk.