Massachusetts is considering multiple proposals that, taken together, would make the landscape of overdose response increasingly hostile toward people who use drugs. In particular, one bill would clear a path for wider use of the unnecessarily risky opioid-overdose antidote nalmefene, while three others would put overdose survivors on a trajectory toward involuntary commitment.
After sitting in the Committee on Mental Health, Substance Use and Recovery since February, a joint hearing for MA H2217 has now been scheduled for November 3. The bill would subtly, but meaningfully, modify the section of state law that covers opioid-overdose reversal agents to increase access to Opvee, a nasal spray device that resembles Narcan but is formulated with nalmefene, rather than the better-known opioid antagonist naloxone. Nalmefene has no proven benefits compared to naloxone. But because it lasts several hours longer, it would in some cases introduce unnecessary pain and risk of overdosing again by triggering a syndrome called precipitated withdrawal.
Currently, section 19B of chapter 94C in Massachusetts state law defines “opioid antagonist” as “naloxone or any other drug” approved for opioid overdose reversal by the Food and Drug Administration. Even though naloxone and nalmefene are already the only two drugs that meet that criterion, the proposed legislation would remove the reference to naloxone, making the definition simply “any drug” approved for reversing opioid overdose. The health department would be required to issue a statewide standing order for pharmacists to dispense “all opioid antagonist,” whereas under the current law it simply has the option of issuing one for “an opioid antagonist.”
Though since 2023 some naloxone products have designated over-the-counter medications, rather than prescription medications, states have long relied on blanket prescriptions called “standing orders” to allow bystanders to administer naloxone to someone overdosing.
In September, Opvee manufacturer Indivior Inc. agreed to a settlement with the New York State attorney general’s office after an investigation revealed it had marketed Opvee in violation of state law. New York’s standing order is specific to naloxone—but Indivior led local law enforcement agencies to believe that it could apply to all opioid antagonists.
Around the same time, the company internally informed stakeholders that it would no longer market Opvee at all. Since then, however, senior representatives have continued to publish misleading research claiming that risk of precipitated withdrawal is low and falsely suggesting that nalmefene has benefits that naloxone does not.
The Massachusetts Department of Public Health has so far declined to make the state’s standing order inclusive of nalmefene or higher-dose naloxone products, stating that “these agents are more likely to precipitate withdrawal, which can increase mistrust and foster avoidance of overdose reversal assistance among people who use drugs.” An investigation by the Shoestring and New England Public Media revealed that the Massachusetts Chiefs of Police Association was pushing out free samples of Opvee and asking public officials to “nudge” the health department into revising its position.
A second nalmefene product, an autoinjector developed by Purdue Pharma, is expected to join the market by the end of 2025.
The state is also considering multiple separate bills that govern what happens after someone is administered an opioid antagonist.
The state is also considering multiple separate bills that govern what happens after someone is administered an opioid antagonist.
Under MA H2420, if a law enforcement officer or other first responder “administers an opioid antagonist, as defined in section 19B of chapter 94C, to a person suffering from an apparent drug overdose, such person shall be transported, with or without the person’s consent, by ambulance to a hospital for monitoring, observation and possible treatment.”
It would authorize law enforcement to restrain the person if they deem it necessary, as well as search the person and “the immediate surroundings” to check for weapons.
Because precipitated withdrawal is a painful and disorienting experience, giving someone an excessive dose of an opioid antagonist risks the person becoming agitated when they regain consciousness. (An appropriate dose of an antagonist, which is easiest to achieve using generic intramuscular naloxone, would simply restore the person’s ability to breathe on their own without even waking them up.)
The state’s “Good Samaritan” overdose law protects overdose victims from possession charges, or parole/probation violations, if law enforcement finds the incriminating evidence while rendering aid. However, that immunity has limits, such as not covering possession of larger quantities.
The bill is currently with the Joint Committee on Public Health.
MA 1042, also currently with the Joint Committee on Health Care Financing, would prohibit any patient “who has suffered an overdose or who required the administration of an opioid antagonist” from being discharged until they meet with a social worker, recovery coach and recovery navigator. The discharge also “shall not be granted unless approved by the judge who issued the order for civil commitment.”
Under MA H2213, after someone is evaluated for substance use disorder, if they’re brought back to an emergency department within the next seven days due to an overdose then “the attending physician may authorize the restraint of such person and apply for the treatment of such person for a three-day period at a facility authorized for such purposes.” That bill is currently with the Joint Committee on Mental Health, Substance Use and Recovery.
Image (cropped) via County of Santa Clara
