BOSTON – Aiming to save more Bay Staters from fatal opioid-related overdoses, the Senate passed an addiction and substance use disorder bill Tuesday featuring a controversial policy allowing cities and towns to open safe injection sites.

Senate Democrats pitched the sites – also known as overdose prevention centers where people can use illegal drugs under the supervision of trained health care workers – as a life-saving tool to tamp down on the devastating effects of the opioid crisis, which has been exacerbated by the pervasive presence of fentanyl in the state’s drug supply. People who use the centers could be connected to addiction and mental health care resources, lawmakers and advocates say.

Rather than taking a roll call or a voice vote, the Senate passed the bill (S 2898) on an unrecorded 12-3 standing vote. The House did not incorporate overdose prevention centers into its substance use disorder bill last month, and Speaker Ron Mariano expressed concern Monday about Senate Democrats’ late-session attempt to authorize the facilities with scant time remaining for thorny negotiations.

Lawmakers could attempt to pass a final bill during informal sessions that begin Aug. 1, but risk a single legislator’s vote derailing it during those sessions. The House bill passed 153-0, and since representatives did not vote on overdose prevention centers, including the policy in a compromise bill might doom the overall proposal’s chances of passing in informal sessions.

“It’s keeping people alive”

Sen. John Velis, co-chair of the Committee on Mental Health, Substance Use and Recovery, spoke candidly about his struggle with addiction and substance use disorder on the Senate floor Tuesday afternoon.

“Harm reduction, as far as I’m concerned, is simple. It’s keeping people alive,” Velis said. “I’m not sure if anyone else in this room has had an experience, but what I will tell you I know with absolute certainty is that you can’t treat a human being who is dead. You can’t.”

But acknowledging the policies incorporated into the legislation, the Westfield Democrat added, “There are many provisions in this bill that if you had told me about three to four years ago, I would have laughed at you. I would have said, ‘You want to do what?’”

Former U.S. Attorney Andrew Lelling previously suggested that opening overdose prevention centers in Massachusetts would trigger federal prosecution, which prompted former Gov. Charlie Baker to dismiss the sites as a waste of time. Rep. Adrian Madaro, co-chair of the Mental Health, Substance Use and Recovery Committee, told the News Service last month there’s “more work to be done.”

“There are some legitimate financial and federal legal barriers that need to be overcome. There needs to be more support built among the [legislative] membership and, frankly, more education and more understanding,” Madaro said. “We still have to figure out how to make siting equitable and effective both to ensure people across the commonwealth can access these sites, should they advance, when they need them and to confirm that host communities have the resources and measures in place to guarantee that [overdose prevention site] operators are as effective as possible for visitors, workers and neighbors.”

The Senate bill empowers municipalities to operate a slate of harm reduction initiatives, including overdose prevention centers, needle exchange programs and drug testing services. Cities and towns that favor harm reduction programs with opioid reversal services must gain municipal approval, including through the local Board of Health, followed by the Selectboard or City Council.

Through an unsuccessful amendment (#42), Sen. Nick Collins tried to scrap the overdose prevention center language from the bill, decrying the conditions that colleagues observed outside existing facilities, including in Vancouver, where he said “tents are everywhere.“The South Boston Democrat called his proposal “preventing the perpetuation of human trafficking.”

“The reason the amendment is titled as such is because it perpetuates an underground economy that exists, fueling resources for people to continue to buy heroin, fentanyl, tranquilizers, deadly drugs,” Collins said. “That’s what’s happening here. Poor people – largely women, but also men – being trafficked for money, some of which they get a piece of, to buy drugs, that then keep them in a vicious cycle of addiction, abuse and victimization.”

The amendment was rejected on a voice vote, with no public discussion from other senators.

Some amendments were adopted on the floor to the section of the bill related to safe injection sites, including a Velis provision that municipalities consider how close a site is to schools when picking its location. The Senate also adopted a Sen. Pat Jehlen amendment that if the Department of Public Health (DPH) approves or rejects a proposed site, they do so within three months and provide a written explanation for why.

Sen. Julian Cyr, co-chair of the Public Health Committee, stressed the bill provides legal and professional liability protections for health care workers, volunteers and people who use services at harm reduction facilities. The DPH in December voiced its support for the overdose prevention centers in December, but urged the Legislature to codify liability protections.

“We really see the liability provisions as among the biggest barriers currently for the cities that are seeking to do this,” Cyr said. “So the legal and regulatory framework that’s created within this bill will allow further harm reduction programs to operate, they’ll ensure that providers, that staff, that participants are able to continue with their professional license, to have to do life-saving work without worrying about liability.”

Cyr also clarified the bill does not mandate municipalities to open overdose prevention centers, though he said it does empower interested cities and towns to move forward with their plans to open facilities, including in Somerville, Cambridge, Worcester and Northampton.

Addiction service expansion fails voice vote

Sen. Robyn Kennedy, whose district includes Worcester, noted the city logged the highest number of overdose deaths across Massachusetts last year.

“I cannot think of a more important role we can play in representing our community than by passing legislation that truly has the ability to keep people alive,” Kennedy said. “This bill includes a provision that will allow municipalities to approve the creation of [a] harm reduction center, in consultation with the DPH, to begin the work to allow residents to have access to these key support services.”

The Senate bill, echoing the House, establishes a licensing process for alcohol and drug counselors and recovery coaches through DPH. It also directs DPH to study sober homes, mandates insurance coverage of overdose reversal drugs like naloxone, and mandates hospitals and treatment facilities to dispense the reversal drugs.

One insurance-related amendment to expand the amount of time an individual can get addiction treatment services was rejected on a voice vote. Filed by Sen. John Keenan, the amendment would have increased the required insurance coverage for treatment without prior authorization from 14 days to 30 days.

The first few days after checking themselves in for addiction treatment, most patients undergo detoxification, the Quincy Democrat said. After detox, patients begin clinical stabilization services. Those two steps usually take the full 14 days of insurance-covered addiction treatment.

The following days are essential to get people on a stable path to recovery, Keenan said, and forcing them to leave treatment prior to doing that work often puts people right back into the situation where they were using and had access to drugs or alcohol.

“They call it the rinse cycle,” he said. “Wash and repeat, wash and rinse. You go in, you go through detox, you get [transitional support services], you go back out and you do it all over again... We should also focus on making sure that when somebody raises their hand and says ‘I need help, I’m starting to spiral,’ that they have access to that treatment, and that is covered by insurance.”

Amendments that were added to the bill included a Sen. William Brownsberger effort to create a special commission to study how doctors are prescribing benzodiazepines and other hypnotic drugs.

The nervous system depressants are often used to treat anxiety or insomnia, but abuse of the prescription drugs has recently gained more attention.

The Senate also added a Sen. Patrick O’Connor amendment to improve access to an acupuncture treatment that he said is “highly effective in addressing substance use disorder by lessening the harsh symptoms withdrawal, reducing urges, decreasing medication requests, and lowering dosages of medicated assisted treatment.”

This treatment is implemented in 30 other states, including every New England state, he said.