The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
250 Washington Street, Boston, MA 02108-4619
MARYLOU SUDDERS
CHARLES D. BAKER Secretary
Governor
MONICA BHAREL, MD, MPH
KARYN E. POLITO Commissioner
Lieutenant Governor
Tel: 617-624-6000
www.mass.gov/dph
January 13, 2019
Steven T. James
House Clerk
State House Room 145
Boston, MA 02133
Michael D. Hurley
Senate Clerk
State House Room 335
Boston, MA 02133
Dear Mr. Clerk,
Pursuant to Line 4512-0204 of Chapter 154 of the Acts of 2018, please find enclosed a report
from the Department of Public Health entitled “First Responder Naloxone Grants and Overdose
Education and Naloxone Distribution.”
Sincerely,
Monica Bharel, MD, MPH
Commissioner
Department of Public Health
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 Overdose Education and
Naloxone Distribution (OEND)
First Responder Naloxone Grants
January 2020
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Legislative Mandate
The following report is hereby issued pursuant to Line 4512-0204 of Chapter 41 of the Acts of
2019 as follows:
First Responder and Community Bystander Naloxone Programs
4512-0204........ For the purchase, administration and training of first-responder and bystander
naloxone distribution programs; provided, that funds shall be expended to maintain funding for
first responder naloxone grants and bystander distribution in communities with high incidence of
overdose; provided further, that the commissioner of public health may transfer funds between
this item and item 4512-0200 as necessary under an allocation plan which shall detail the
distribution of the funds to be transferred; provided further, that not less than 30 days before any
such transfer, the commissioner shall file the allocation plan with the house and senate
committees on ways and means; provided further, that not later than October 4, 2019, the
department of public health shall submit a report to the house and senate committees on ways
and means on the: (i) the communities included in the program expansion; (ii) the number of
participants for each community; and (iii) the amount of naloxone purchased and distributed,
delineated by community; and provided further, that not less than $20,000 shall be provided for
the county of Barnstable for the purchase of naloxone through the municipal naloxone bulk
purchase program. $1,040,000
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Executive Summary
The Fiscal Year 2020 budget (see Line Item 4512-0204 of Chapter 41 of the Acts of 2019)
allocated $1,020,000 to the First Responder and Community Bystander Naloxone Programs to
support:
• First Responder Naloxone Grants
• Overdose Education and Naloxone Distribution (OEND) at community bystander sites
• $20,000 to Barnstable County for bulk purchasing of naloxone
To support the implementation of this legislatively mandated review and report, staff has
submitted the following report to update the House and Senate Committees on Ways and Means
on the status of these grants and related naloxone programs.
Enclosed in this report you will find a background on the scope of overdose education and
naloxone distribution in the Commonwealth and the status of the First Responder naloxone
grants and community bystander program.
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Introduction
To combat the overdose deaths crisis in Massachusetts, the Department of Public Health (DPH;
the Department) began the Overdose Education and Naloxone Distribution (OEND) program in
November 2007 to train and provide nasal naloxone rescue kits free of charge to potential
bystanders (any person likely to witness an overdose) of an opioid overdose in the community.
In 2010, the Department added the Quincy Police Department and the Revere Fire Department to
the pilot program. By 2014, the pilot included six first responder departments (police and fire):
the Quincy and Gloucester Police Departments, the Revere, Weymouth and Saugus Fire
Departments, and the New Bedford Police and Fire Departments. As of August 2014, there were
five first responder communities participating in the pilot as Gloucester voluntarily opted out and
continued a program on its own.
Over the past decade, many communities experienced a dramatic increase in fatal and non-fatal
opioid overdoses. In response, municipalities expressed an interest in establishing first responder
naloxone programs and approached the Department for technical assistance and/or funding. The
Department was limited in its ability to assist these communities due to funding and regulatory
constraints until a public health emergency was declared in 2014 in response to the opioid crisis.
Subsequently, emergency regulations were adopted allowing municipalities to establish first
responder naloxone programs, and the FY15 state budget included a $1,000,000 appropriation in
line-item 4512-0204 to support expansion of the number of first responder and community
bystander naloxone programs. 4512-0204 has appeared in the state budget since that initial
appropriation. This line item was again included in Chapter 41 of the Acts of 2019 and the
language requires that funds shall be expended “for the purchase, administration, and training of
first-responder and bystander naloxone distribution programs; provided, funds shall be
expended to maintain funding for first responder naloxone grants and bystander distribution in
communities with high incidence of overdose;…”
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First Responder Naloxone Grants
Overview:
The First Responder Naloxone grants allow police and fire departments to train personnel and
purchase naloxone in municipalities. In FY19, municipalities that met the criteria listed below
were invited to apply for this 5-year long grant. In FY19, the Department of Public Health
awarded grants to 33 municipalities. Grant amounts ranged between $5,000 and $50,000 per
department based upon the population of the municipality and expressed budget needs and
requests. The current grantee cohort is under contract through 6/30/2023. All FY19 grantees
renewed their contracts for FY20.
Grant Eligibility Criteria:
Eligibility criteria were established by determining the maximum number of high-need
communities that could be funded by the appropriation. Communities that were eligible to apply
ranked in the top 40 municipal counts for both:
• Fatal Opioid Overdoses in 2015 and 2016
• Non-Fatal Opioid Overdose calls for service in 2015 and 2016
Grantees and Program Costs:
This grant now operates via a Master Service Agreement contract, which is a blanket contract.
This means that there is one account that has the total maximum obligation for this award. That
account is loaded with funds annually pending state appropriations. All first responder grantees
will spend down their individual award amounts from this shared account. This structural
adjustment will allow for more flexibility over the course of the grant years for departments to be
responsive to their local overdose response budgetary needs.
Grant funding is intended to pay for:
• Purchasing naloxone and related naloxone supplies
• Purchasing medical supplies that support the program such as pouches or containers for
the naloxone or other equipment such as bag valve masks.
On a case-by-case basis, a minority of the grant funding may be used for activities such as:
• Costs associated with staff time for training on overdose prevention.
• Costs associated with community events such as overdose vigils and overdose prevention
trainings as well as community engagement strategies such as promotion of the 911 Good
Samaritan Law.
All grantees receive an initial award amount. Grantees submit quarterly reports to MDPH.
MDPH monitors spending and fields requests from municipalities for additional funds. Each
municipality has an award ceiling based on population size and volume of opioid overdoses.
The remaining balance of this appropriation will be used to purchase naloxone for the
community bystander Overdose Education and Naloxone Distribution program.
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 Municipality FY20 Initial Award Amount FY20 Award Ceiling
City of Beverly $10,000.00 $20,000.00
City of Boston Funds not yet requested $50,000.00
City of Brockton $12,000.00 $30,000.00
City of Chelsea $5,000.00 $15,000.00
City of Chicopee $6,000.00 $20,000.00
City of Everett $5,000.00 $15,000.00
City of Fall River $15,000.00 $40,000.00
City of Fitchburg $1,500.00 $20,000.00
City of Framingham $6,500.00 $20,000.00
City of Haverhill $4,000.00 $20,000.00
City of Lawrence $10,375.00 $30,000.00
City of Leominster $6,700.00 $20,000.00
City of Lowell $20,000.00 $50,000.00
City of Lynn $5,000.00 $20,000.00
City of Malden $10,000.00 $20,000.00
City of Medford $15,000.00 $20,000.00
City of New Bedford $2,500.00 $45,000.00
City of Pittsfield $3,750.00 $20,000.00
City of Quincy $5,000.00 $25,000.00
City of Revere $ 21,303.00 $25,000.00
City of Salem $3,600.00 $20,000.00
City of Somerville $18,700.00 $30,000.00
City of Taunton $5,500.00 $25,000.00
City of Waltham $5,000.00 $30,000.00
City of Westfield $2,500.00 $20,000.00
City of Worcester $24,856.00 $40,000.00
Town of Falmouth $9,050.00 $15,000.00
Town of North Attleboro $3,600.00 $15,000.00
Town of Plymouth $2,100.00 $25,000.00
Town of Saugus $5,200.00 $15,000.00
Town of Weymouth $7,250.00 $25,000.00
Town of Winthrop $8,000.00 $15,000.00
Town of Yarmouth $4,000.00 $15,000.00
Barnstable County
In addition to these grantees, Barnstable County received $20,000 per the legislative language
for the purchase of naloxone through the State Office of Pharmacy Services municipal bulk
purchasing program.
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Community Bystander Overdose Education and Naloxone Distribution Program
Overview:
In addition to the first responder grant program, the Massachusetts Department of Public Health
has implemented an Overdose Education and Naloxone Distribution (OEND) program in
community-based settings. These programs train individuals likely to witness an overdose
(bystanders) on how to reduce overdose risk, recognize signs of an overdose, access emergency
medical services, and administer intra-nasal naloxone. Potential bystanders are instructed to
deliver naloxone when opioid overdose occurs in addition to taking other actions (e.g. rescue
breathing and contacting the emergency medical system). The rescue kit includes instructions as
well as two naloxone nasal spray devices.
Current Program:
Presently, there are 19 community-based agencies participating in the OEND program. All
Bureau of Infectious Disease and Laboratory Science (BIDLS) Office of HIV/AIDS (OHA)
funded Syringe Services Programs provide OEND services. The majority of the OEND programs
are contracted by the Office of HIV/AIDS to provide integrated HIV/HCV/STI/TB Prevention,
Linkage, and Retention in Care and Treatment services. These programs have demonstrated
access to and competency working with people who use drugs and are at risk of overdose.
In addition to the OHA funded programs, Learn to Cope is an OEND program. Learn to Cope
offers families affected by substance use support groups as well as OEND services. There are
currently 25 Learn to Cope chapters in Massachusetts.
Since the start of the OEND program in 2007, there have been a cumulative total of 92,840
individual participants trained and given a DPH-purchased naloxone kit and 25,064 reported
opioid overdose reversals using DPH bystander naloxone. This data is current as of 11/25/2019.
OEND program sites are currently located in the following communities. In addition, many of
the surrounding communities of these site locations are also served by the OEND program:
• Boston • Holyoke • Northampton
• Brockton • Hyannis • Pittsfield
• Cambridge • Lawrence • Plymouth
• Fall River • Lowell • Provincetown
• Falmouth • Lynn • Quincy
• Framingham • Martha’s Vineyard • Revere
• Gloucester • New Bedford • Springfield
• Greenfield • North Adams • Worcester
In FY20, the balance remaining from 4512-0204 will be used to support the community
bystander program. The exact amount of this transfer, which will be no less than $185,000, will
be determined in April of 2020.
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Conclusions
• As part of the state’s overall efforts to address the rise in opioid overdose deaths in the
Commonwealth, the FY19 GAA included an investment of $1,040,000 to continue the
support of first responder and bystander naloxone programs.
• Per the legislative language, Barnstable County received $20,000 to purchase naloxone
from the State Office of Pharmacy Services municipal bulk purchase program.
• Many local police and fire departments have implemented a naloxone program or have
expressed an interest in equipping police officers and firefighters with naloxone.
However, municipalities often face budget constraints that make implementation
challenging. This grant program, as well as DPH’s State Office of Pharmacy Services
Municipal Naloxone Bulk Purchase Program provides relief for that challenge.
• This funding allows more departments to provide overdose response training and to equip
police officers and firefighters with this life-saving overdose antidote.
• This funding allows continued broad geographic coverage for bystander naloxone access
and opioid overdose education.
• Municipalities purchasing of Naloxone often occurs during the second half of the fiscal
year and therefore reporting the amount of Naloxone purchase data is limited at this
reporting period.
• Opioid-related overdose deaths in Massachusetts continue to decline, falling an estimated
6 percent in the first nine months of 2019 compared to the first nine months of 2018,
according to preliminary data released by the Massachusetts Department of Public
Health (DPH). Continued improvements to naloxone availability statewide are a critical
strategy in Massachusetts to reduce fatalities from opioid overdose.
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