Expectant mothers prescribed medication for substance use disorders can seek prenatal care without risk of being reported to the state’s Department of Children and Families, under the omnibus opioid bill signed into law this week.

That key provision was championed by Sen. Jo Comerford, D-Northampton. But the bill signed by Gov. Maura Healey, the product of negotiations and compromise by the Senate and House, did not include safe injection sites, also called overdose prevention centers, despite support from the Senate and an endorsement from Northwestern District Attorney David Sullivan.

With advocacy from hospitals like Boston Children’s and Mass General Brigham, and organizations such as Hampshire HOPE, Comerford said she filed the bill that will benefit pregnant people with histories of substance use. Existing child welfare laws, including mandatory reporting requirements for health care providers, run counter to a harm reduction modality, she said, especially when people avoided prenatal care out of fear of being reported for using methadone.

“This was highly understood, by midwives and doulas, that there were pregnant people who were afraid to come in for care,” Comerford said in a phone interview Friday. “Basically, it’s been putting up barriers to prenatal care and putting kids at risk.”

Comerford said medications such as methadone and buprenorphine are critical to recovery for pregnant women with histories of substance use, and that these individuals should not be punished with the threat of a DCF investigation for taking medication prescribed to them by a doctor.

“We won’t penalize people doing the best for their baby’s health,” Comerford said, adding that the bill supports efforts to strengthen the ability of providers and DCF to protect the welfare of children.

The new law modifies reporting requirements so that a substance-exposed newborn no longer triggers an automatic referral to the DCF. It further directs the Department of Public Health, in collaboration with DCF, the Office of the Child Advocate and others, to instead create new regulations related to care, treatment and reporting of substance-exposed newborns.

State Rep. Mindy Domb, D-Amherst, too, said she appreciates that children won’t be taken away from parents who may be receiving a methadone treatment that shows up on a toxicology screen.

“That can have the effect of pregnant people not going to the hospital or their doctor,” Domb said.

Combating overdoses

The omnibus bill’s overall aim is to limit the toll of addiction and substance use disorder, including with strategies to boost access to overdose reversal drugs. Opioid-related overdose deaths dropped 10% in 2023 compared to 2022, the largest year-over-year decline in two decades, but the crisis still killed more than 2,000 Massachusetts residents for the eighth straight year.

“On the whole it’s a very strong bill, a radical bill,” Comerford said, praising Sen. Brendan Crighton, D-Lynn, for leading the conversation on the complex policies embedded in the legislation.

Prior to her time in the Legislature, Domb served as Health Imperatives’ director of HIV Integration Programs, leading two statewide capacity-building projects for staff working in drug and alcohol treatment programs and homeless shelters.

“It’s a great bill and does so many good things for people in recovery,” Domb said.

Domb said the bill also doesn’t have a cookie-cutter, one-size-fits-all approach, which means it should be more effective in helping people. “Individualizing treatment as best we can,” Domb said.

Aspects of the bill require insurers to cover emergency opioid antagonists used to reverse overdoses, such as naloxone or name-brand Narcan, without cost-sharing or prior authorization. Substance use treatment facilities would need to provide patients with two doses of an overdose-reversal drug upon discharge, as would hospitals who discharge patients with a history of substance use disorder.

It also prohibits life insurance companies from limiting or refusing coverage to a person just because they obtained an opioid antagonist for themselves or for others.

Comerford said the bill commits state officials to develop a plan to end the practice of sending civilly committed men to prison for substance use treatment.

Domb said she’s a big believer in treatment on demand, but that individuals should not necessarily be in jail to get that treatment.

The bill props up recovery coaches and peer-to-peer support mentorships. Domb said licensure of recovery coaches could mean more people can go into that field, and harm reduction workers are better protected from liability. It would also limit legal liability for drug users and harm reduction workers who, while on the premises of a harm reduction facility, deploy drug-testing equipment to check the potency of someone’s personal drug supply. Supporters say that step will protect individuals from inadvertently taking a contaminated, potentially deadly substance that is far more potent than they intend.

Domb is proud of an amendment she filed, included in the final bill, that protects pharmacists and prescribers from risks of unintended overdoses associated with prescription opioid use.

Safe injection sites

Meanwhile, Comerford said she will continue to cosponsor legislation to establish safe injection sites in communities that wish to have them, observing there is significant support in western Massachusetts, which she said is blessed with great advocates for the utility of harm reduction and places where people can get support, including clean needles.

In 2023, Sullivan testified before the Joint Committee on Mental Health, Substance Use and Recovery that legal drug consumption sites would save hundreds of lives by offering “a safe place with a clean syringe and a caring person to supervise.”

The legislation approved by the Senate included a 10-year pilot program through which communities could open such supervised centers. Under the proposal, people with substance use addiction could take pre-obtained drugs at the centers while being supervised by trained staff who could help prevent the spread of infectious diseases like HIV, respond to potential overdoses, provide access to naloxone, and connect participants to treatment or other services.

Domb said a lot more work needs to be done on overdose prevention centers, which are also help centers for drug users, complimenting the work of colleague Rep. Marjorie Decker, D-Cambridge.

“What we know about needle exchanges has demonstrated that they don’t promote drug use or initiate drug use,” Domb said.

Such sites were advocated for by Liz Whynott, director of harm reduction at Tapestry Health in Northampton, who testified that the issue generated concerns similar to those raised by needle exchanges in the 1990s.

Scott Merzbach can be reached at smerzbach@gazettenet.com.