When Julia Raposa overdosed on opioids last year, she was rushed to a hospital in Leominster, Mass., where her aunt says she was treated and released within 90 minutes. Days later, Ms. Raposa’s next overdose killed her.

A big challenge in the opioid crisis is getting overdose patients from emergency rooms into treatment. Failed opportunities can be fatal.

In...

When Julia Raposa overdosed on opioids last year, she was rushed to a hospital in Leominster, Mass., where her aunt says she was treated and released within 90 minutes. Days later, Ms. Raposa’s next overdose killed her.

A big challenge in the opioid crisis is getting overdose patients from emergency rooms into treatment. Failed opportunities can be fatal.

In an aggressive, new proposal, Massachusetts authorities want to allow hospital staff to send overdose patients to treatment centers against their will for up to three days. The goal is to buy more time for addicts facing imminent risks to accept longer-term treatment.

Overdose patients revived with the widely used drug naloxone are often eager to flee hospitals, spurred on by withdrawal symptoms, according to physicians. Also, many hospitals in the U.S. have long lacked protocols for handling these patients, state officials say.

“Often people leave the emergency room, right back onto the street to find their next fix,” said Marylou Sudders, the Massachusetts Secretary for Health and Human Services.

Advertisement

Addicts spilling out of hospitals are at high risk. An abstract published in October and led by an emergency physician at Boston’s Brigham and Women’s Hospital found one in 10 Massachusetts patients who initially survived after first responders treated them with naloxone died within a year. Opioid-related deaths in the state are trending lower in 2017, but from record highs reached over several recent years.

“We’re missing that window of opportunity to help hundreds if not thousands of people,” said Dina Favreau, who cared for Ms. Raposa, her 24-year-old niece.

Efforts are growing around the U.S. to bridge this hospital gap, though not with mandatory treatment like what Massachusetts is proposing. Softer approaches are more common, often employing recovery experts, some of whom are former addicts themselves, who meet overdose patients in the hospital and urge treatment.

Such programs are known as warm handoffs, and county officials in Pennsylvania started developing them last year. Rhode Island’s statewide program has an encouraging track record of urging addicts toward help, said Linda Mahoney, a state administrator for behavioral-health program services.

Advertisement

Sherry Green, who until earlier this month was chief executive at the National Alliance for Model State Drug Laws, said she expects other states to closely watch the aggressive Massachusetts approach. The state is “taking the lead and trying to figure out how to deal with this,” she said.

Addiction experts agree on the most effective way to help opioid addicts: Medication-assisted treatment. But most inpatient rehab facilities in the U.S. don’t offer this option. WSJ’s Jason Bellini reports on why the medication option is controversial. Image: Ryno Eksteen and Thomas Williams

Some Massachusetts hospitals also have recovery coaches meet with patients. Also, Gov. Charlie Baker signed a bill last year requiring hospitals to offer overdose patients a substance-abuse evaluation and provide treatment information within 24 hours. But the governor’s office said many patients are turning this offer down.

To help recalcitrant patients, the Republican governor wanted ER staff to hold at-risk overdose victims involuntarily for 72 hours, but his plan failed to make last year’s final opioid bill. Doctors and lawmakers raised worries ranging from civil-liberties infringement to warehousing patients in ill-equipped departments.

Julia Raposa, seen with her daughter, was 24 years old when she died last year of an opioid overdose. Photo: Dina Favreau

Many states have emergency-commitment laws that are often aimed at keeping intoxicated people safe, while Massachusetts is notably targeting the gap between overdoses and treatment, Ms. Green said. Laws allowing longer-term involuntary commitment with a judge’s approval are also common. These involuntary commitment laws are seldom used in most states, according to the Hazelden Betty Ford Foundation, though Massachusetts is an exception.

Advertisement

In a new proposal unveiled last month, Mr. Baker seeks to give clinical staff the power to send patients to a treatment center without court approval. The centers then can hold them up to three days. The bill, forecast to cost up to $152 million over five years, includes other measures aimed at the overdose crisis. The state’s Medicaid program, or other insurance, would cover the cost to transport and care for patients

Several ER doctors, including leaders of the Massachusetts College of Emergency Physicians, expressed cautious support for governor’s revamped plan, but also voiced concerns. They stressed the need for adequate treatment beds and said doctors should explore all voluntary treatment options first.

“Involuntary hold is a feasible tool that can literally save a life,” said Melisa Lai-Becker, emergency-department chief at a Cambridge Health Alliance hospital in Everett, Mass. But the option should only be “the nuclear button,” she said.

Mary DeMarco said her daughter, Alicia, overdosed and landed in Massachusetts emergency rooms more times than she can count. Typically her daughter would “jump up and leave, run out and get high again,” recalled Ms. DeMarco, who lives in Reading, Mass.

Advertisement

Then, in November 2014, her daughter made her final hospital trip after overdosing on the potent opioid fentanyl. The 28-year-old died while eight-and-a-half months pregnant, and her baby girl, Arianna, died after an emergency caesarean procedure.

Ms. DeMarco said she believes doctors need the option to force treatment on patients, like her daughter, who are spiraling out of control.

“They’d have three days of clarity, and maybe you could get one person, two people, somebody, to seek help,” she said. “Why wouldn’t you take a chance on that?”

Write to Jon Kamp at jon.kamp@wsj.com