Imagine a scenario where a loved one — your child, sibling or friend — is struggling with an opioid addiction. You’ve done everything in your power to help them get treatment, but because they’re over 18, your options are limited. The frustration, helplessness and fear can feel unbearable. Still, you refuse to give up. You keep naloxone nearby, hoping you’ll never need it but knowing one day you just might.
For my close friend, a nurse, that moment has already come. Despite her best efforts, after administering multiple naloxone to her adult son, it wasn’t enough to save his life. He died on the kitchen floor from the devastating grip of opioid addiction.
Fentanyl, today’s most dangerous and widespread opioid, is 50 times more potent than heroin. Just two milligrams, about the size of a few grains of salt, can be fatal. According to the latest data, 90% of opioid overdose deaths in Massachusetts involve fentanyl.
While the Massachusetts Department of Public Health recently reported a modest decline in overall overdose deaths, the reality is far more complicated. Opioids continue to have a disproportionate impact on Black non-Hispanic men. Overdose deaths have actually increased among this population and in rural communities. We are losing the battle when it comes to our most vulnerable populations. The bottom line is stark: Opioids continue to kill more than 2,000 people in Massachusetts every year.
We must do better.
As a professor of health policy and management and founding director of the Maryland Center for Health Equity, I have spent my career working to eliminate racial and ethnic health disparities. Here’s what I’ve learned:
First, we must meet people where they are. In Black and brown communities, this means partnering with trusted institutions like barbershops and beauty salons, which serve as cultural anchors where honest, judgment-free conversations can flourish.
During the HIV-AIDS pandemic, I helped build the HAIR program, Health Advocates In-Reach and Research, in Pittsburgh, training barbers and stylists as frontline public health educators. This model scaled nationally through the Shots@Shop campaign, where over 1,000 barbers and stylists were certified as COVID-19 vaccine sites. Their trusted voices helped boost vaccine confidence and access in underserved communities. Today, this same hyperlocal, community-driven approach can be leveraged to spread lifesaving knowledge about opioid overdose prevention and treatment.
Second, we need access to every available tool to save lives. Yet, first responders and community health providers in Massachusetts face barriers to using newer, more effective opioid reversal agents that have been developed to combat the evolving overdose crisis.
Why? Because the state’s current standing order, which authorizes pharmacists to dispense opioid reversal medications, excludes some FDA-approved options. At least 20 other states have already expanded their standing orders to include these newer treatments. Massachusetts should do the same.
Scientists and health professionals are constantly looking to improve the responses to these overdoses, and it is important that Massachusetts includes any formulation of any opioid reversal drug approved by the federal Food and Drug Administration in the standing order.
The reality is that many individuals unknowingly ingest fentanyl through tainted products. We call them naïve users. They are often high schoolers and college kids. They think they are taking a Percocet, Xanax or Adderall maybe to help them relax or cram before an exam, only to find out the hard way that the pills were laced with fentanyl. Sometimes they take them simply out a lack of confidence to just say “no.” Peer pressure is a powerful thing.
Shorter-acting reversal agents like naloxone may wear off before fentanyl’s effects subside, increasing the risk of re-overdose. Long-acting reversal agents provide an essential safety net in these cases.
It won’t stop with fentanyl. Already there are other opiates that people are using.
By updating the standing order to include all FDA approved opioid reversal drugs, we will be ready for the introduction of new, more effective, or less expensive medicines that may be approved in the future. As typically the state’s standing order is only updated annually, we do not want to be left in a situation where there is a new, more effective or less costly reversal drug that is not available to the commonwealth’s first responders, health professionals and citizens.
Winning the opioid overdose battle requires a multi-pronged approach. Rather than opposing these medications, we must focus on addressing the gaps in addiction treatment infrastructure and ensuring seamless care from overdose reversal to long-term recovery support. Saving lives and providing opportunities for recovery are objectives we cannot compromise.
State leaders must act now. Whether through updated language in the Department of Public Health’s standing order or legislation, Massachusetts must ensure that all FDA-approved opioid reversal agents are accessible through the state’s emergency response system.
First responders, community advocates and families on the front lines of this crisis deserve access to the full arsenal of tools. Lives depend on it. By expanding access, we can save lives and support recovery, especially in communities that have borne the brunt of this epidemic for far too long.
Stephen B. Thomas is a professor of health policy and management and founding director of the Maryland Center for Health Equity at the University of Maryland School of Public Health. He also served on Maryland’s Health Commission under two governors.
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