BOSTON — The state House of Representatives signed off on Gov. Charlie's Baker's latest plan to combat opioid addiction on Wednesday but stripped a controversial provision aimed at forcing addicts who recently overdosed into treatment.
Baker's proposal would authorize police, medical professionals and family members to commit someone suspected of opioid abuse to treatment, even against their will, for up to 72 hours. House Speaker Robert DeLeo, D-Winthrop, pulled the provision from the bill, which was approved unanimously late Wednesday.
Lawmakers tacked several amendments onto the bill, including one creating a commission to study the 72-hour proposal and the issue of involuntary commitment.
"We don't need another study," Rep. Jim Lyons, R-Andover, told fellow lawmakers in a fiery speech on the House floor. "If you're a parent and you've got a kid overdosing at 2:30 a.m., quite frankly you're not interested in a study. You want to get them into detox and treatment. Putting them back on the street kills them."
Lyons and other House Republicans filed amendments to restore the 72-hour hold provision but they were rejected by the Democratic majority.
Baker's CARE Act — the acronym stands for an Act Relative to Combating Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention — aims to improve treatment and education to fight opioid addiction, which kills an average of four people per day in the state.
The legislation would establish a commission to study professional credentials for recovery coaches who work with addicts in long-term recovery. It would authorize all pharmacies in the state to dispense the overdose-reversing drug naloxone and set penalties for prescribers who violate a limit on initial opioid prescriptions of more than seven days.
It would also create a new trust fund to finance intervention programs to identify students at risk.
Baker's proposed 72-hour hold was a key provision of the bill that was supported by many substance abuse counselors and first responders.
"Shame on them," fumed Phil Lahey, a former Methuen city councilor who oversees the Merrimack Valley Prevention and Substance Abuse Project and supported Baker's involuntary commitment proposal.
"They had a chance to make a real impact and save lives here but they didn't do anything,” he said. "It's outrageous."
Lahey, whose daughter is in recovery after being committed for opioid abuse under the state's Section 35 law, said the system isn't perfect but works.
"Involuntary commitment isn't a guarantee but it works for many people," he said. "I just can't understand why they won't they take a chance on it."
Two years ago, Baker proposed involuntary commitments for those who pose a danger to themselves or others due to opioid addiction. That raised concerns about civil liberties and the ability of emergency rooms to hold addicts until a treatment bed was available. Lawmakers ultimately rejected it.
Under his new plan, ER personnel could have ordered involuntary transport to a treatment facility for up to 72 hours. After that, police, family, physicians or others could ask a judge to order the person into long-term treatment under the Section 35 law.
Still, the 72-hour hold faced staunch opposition from hospitals and the Massachusetts Medical Society, which represents physicians.
"We believe at current the state’s health care infrastructure is not sufficiently prepared to provide medically appropriate care to those who are involuntary committed," the group said in a statement ahead of the debate Wednesday.
"The likely result of involuntarily committing individuals suffering from substance use disorder is substandard care in overcrowded emergency departments, which would place further strain on already limited and stretched hospital resources," it added.
Likewise, the medical society said there is "no solid research or evidence" that involuntary commitment would save lives.
Rep. Paul Tucker, D-Salem, said he was "disappointed" the 72-hour hold was taken out of the final version of the bill but still supported the overall proposal.
Tucker said a provision added to the bill as a trade-off for removing the 72-hour hold would expand the use of medication-assisted treatment — such as methadone and Suboxone — in emergency rooms. He said that will help more people who recently overdosed get clean and into treatment.
"Overall, there are a lot of good provisions in this bill, so I strongly support it," he said. "We can continue to have conversations about the 72-hour hold."
Rep. Linda Campbell, D-Methuen, called the decision to remove the 72-hour hold an "opportunity missed" but said the trade-off for a medication-assisted treatment provision will save lives.
"We have the data and know medication-assisted treatment works,” she said.
A 2016 law requires ER doctors to offer voluntary substance abuse screening to people treated for opioid overdoses. A majority of those patients refuse the evaluation, according to health officials, who say the lack of participation is preventing addicts from getting into treatment.
Consideration of the opioid addiction bill comes as the latest data show the number of opioid-related overdose deaths trending downward for the first time in 15 years.
A report issued last month by the state Department of Public Health estimated 5 percent fewer opioid-related deaths during the first three months of 2018 compared to the same period a year earlier.
For all of last year, the state reported 2,016 opioid-related deaths — 133 fewer than in 2016.
Under the Section 35 law, alcoholics and heroin addicts also can be sentenced up to 90 days for substance abuse treatment.
Massachusetts trial court judges have seen a sizable increase in requests for those sentences in recent years — from 5,870 in fiscal 2010 to 7,895 during the first nine months of fiscal 2018, according to the Executive Office of the Trial Court.
But Lahey and others said the decades-old commitment law is rife with loopholes that block many addicts from getting adequate treatment.
"They overdose, leave the emergency room and end up back there a few hours later," he said. "It's a cycle that addicts can't break on their own."
The bill now moves to the state Senate before it lands on Gov. Baker's desk for consideration.
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites.