Governor Charlie Baker made a forceful case for his controversial opioid legislative package Monday morning amid uncertainty over the fate of a central provision.
Baker, flanked by Boston Mayor Martin J. Walsh and a top aide to Attorney General Maura Healey, acknowledged he faces opposition to key proposals, including one to allow hospitals to hold addicts against their will for 72 hours.
But he argued decisive action is necessary in the face of an epidemic that left more than 1,200 people dead from overdoses last year. "I understand that some of our proposals disrupt the status quo," he said. "They're supposed to."
Senate President Stanley C. Rosenberg and House Speaker Robert A. DeLeo, appearing with Baker after their weekly leadership meeting Monday afternoon, declined to endorse the package. Rosenberg made a delicate reference to concerns he has raised previously about the 72-hour hold.
"I'm still doing my homework on that," Rosenberg said.
Baker's proposal is modeled on existing law for so-called "civil commitments" of the mentally ill. It would allow hospitals to hold addicts who pose a danger to themselves or to others for three days, with the aim of steering them into longer-term care, if appropriate.
Physicians groups, including some that testified about Baker's bill Monday, have questioned the effectiveness of so-called coerced treatment. And they have argued there is no capacity to treat addicts who could flood an already taxed system.
"What will happen with a 72-hour hold is patients will sit in a locked room in the emergency department, or a hallway bed in an already overcrowded emergency department," said Dr. Peter Smulowitz, president of the Massachusetts College of Emergency Physicians. "Those patients will be withdrawing. They will want to leave to get their next fix. We will not give them the proper treatment."
The state, he argued, needs to build a more robust treatment infrastructure before it even considers such a policy.
Administration officials say they are making progress on expanding treatment. Marylou Sudders, Baker's health and human services secretary, listed dozens of new treatment beds of various kinds the state has funded since the administration took office in January.
But she acknowledged there is more to do. And Beacon Hill insiders say concern about the 72-hour hold is shaping up as the biggest hurdle to passage of a legislative package that has emerged as a defining element of the governor's agenda.
Baker, who has taken a nuts-and-bolts approach to problems such as the Massachusetts Bay Transportation Authority's winter breakdown and the Department of Children and Families' failings, is painting in bolder strokes here.
The governor's legislation, in a bid to stop addictions before they start, would also limit practitioners to prescribing a three-day supply of opioids the first time they see a patient.
Dr. Dennis Dimitri, president of the Massachusetts Medical Society, argued in testimony Monday that some patients with a legitimate need for more painkillers will struggle to get back to the doctor's office to obtain extended prescriptions.
"What will they do if they can't get their prescription extended because they're elderly, they're infirm, they're poor, they don't have a caregiver, they don't have transportation to come into a doctor's office, get a paper prescription, bring it to the pharmacy, wait for it to be filled?" he asked.
Dimitri proposed a compromise: a seven-day limit rather than a three-day limit, with a "sunset" provision so that lawmakers could revisit the issue in a few years and decide if the restrictions are still necessary.
Dimitri's offer added to a growing sense on Beacon Hill that an accommodation could be reached on the issue, even as the proposal for 72-hour civil commitments faces a more uncertain fate.
The administration has worked to build a broad coalition of support for the legislative package. In recent weeks, it has highlighted the backing of sheriffs, police chiefs, and the Massachusetts District Attorneys Association.
And at the legislative hearing Monday, the governor leaned heavily on Walsh, a recovering alcoholic who mounted a vigorous defense of the proposed 72-hour hold.
"You might hear people come up to this microphone and say, 'We're not equipped for that,' " the mayor testified, anticipating the critique that would come later that afternoon. "Well, the addicts and the families who are losing loved ones aren't equipped to go to the funeral home to bury their loved ones, either. We can figure it out."
With lawmakers set to go on winter recess this week, they are unlikely to take decisive action on the governor's proposal until January.
Speaking with reporters after his testimony, Baker made it clear he would like the Legislature to move quickly when it reconvenes. "If the clock's still ticking and nothing's happening in February or March," he said, "I'm going to start getting pretty impatient."