Narcan at MBTA stations: Here’s how this new program will work, and when it starts (2024)

Health

A Harvard student group proposed placing naloxone kits at Red Line stations. It was then approved in the state budget.

By Katelyn Umholtz

August 24, 2023

As overdoses surge in Massachusetts and across the country, a group of Harvard students are partnering with the MBTA to save lives along the Red Line.

The program plans to set up naloxone kits — better known by the nasal spray brand name, Narcan — at Red Line stations for a year and study the impacts of having this life-saving drug, often used to reverse opioid overdoses, readily available in a public place.

Those involved in the program said setting up Narcan kits was inspired by other public space programs across the country that were set up in response to the opioid crisis.

When can you expect these kits to show up along the Red Line? Here’s what we know about the pilot so far.

What exactly is the program?

Spearheaded by a group of students in Harvard College Overdose Prevention and Education Students (HCOPES), this program aims to put naloxone kits in front of people who need it and where it’s needed most.

Two students in the Harvard group, Sajeev Kohli and Jay Garg, wrote up a proposal to persuade local and state agencies as well as lawmakers to fund such a program. David Velasquez, a Harvard Medical School student, and Dr. Scott Weiner, an emergency physician at Brigham and Women’s Hospital, helped the students with research and tailor the proposal for legislators.

They developed partnerships with the state and Cambridge health departments, the MBTA, Cambridge’s EMS, and local academic researchers to collect information when designing the pilot and propose it to lawmakers.

The MBTA will be in charge of distributing and refilling the naloxone kits. Cambridge’s health department will be responsible for disseminating information on where to find the naloxone and how to use it. EMS, the public health department, and the MBTA will all be tasked with gathering data to provide to researchers.

The “where” for the start of this program was picked because of data. From 2018 to 2020, 10% of Cambridge’s overdose calls came from five T stations on the Red Line.

“It’s generally public access spaces,” said Sajeev Kohli, one of the students involved in HCOPES who helped bring the program to life. He added that public-access bathrooms in public spaces, hospitals, and homeless shelters are also hotspots for overdoses.

The group also looked to other public naloxone programs for inspiration, including one at Boston’s Veteran Administration building that keeps naloxone onsite for potential overdoses.

Kohli said the plan is to set up two to three kits at Red Line stations, preferably at the inbound, outbound, and in public restrooms. Each kit will include easy instructions for how to use the Narcan.

It isn’t immediately clear how many Red Line stations will get naloxone boxes. The students originally proposed to outfit the five stations found to have the most overdose calls — Harvard Square, Kendall Square, Central Square, Porter Square, and Alewife — but additional funding may allow them to provide naloxone at all Red Line stations.

The group also set this up as a pilot program so that it could be an opportunity to gather more helpful data — maybe even data that could help expand the program or convince other public spaces to offer naloxone.

Some questions they hope get answered from collecting data are how much naloxone gets used, how many overdoses were reversed, and how difficult it is to implement such a program, according to Jay Garg, a Harvard economics major who is also an HCOPES member.

“One of the goals is to collect as much comprehensive data as we can,” Garg said. “Any of that information would just be super useful to inform other programs like this that are being considered elsewhere.”

Why now?

Opioid-related overdose deaths are on the rise, particularly due to the rise of fentanyl in drugs.

The state Department of Public Health reported that an estimated 2,357 people died because of opioids last year, an increase of 57 deaths since the previous peak in 2021.

According to state data, fentanyl — a synthetic opioid that can be used to treat severe pain but has more frequently shown up in other drugs purchased illegally — was found in 93% of the state’s opioid-related overdose deaths that were analyzed by a toxicology screen.

The drug is incredibly lethal, especially when paired with other drugs.

Providing free Narcan in public spaces is also part of a bigger push for more harm reduction policies, which aim to help people protect themselves when using drugs. This also includes needle-sharing programs.

Free and publicly-accessible Narcan as well as syringe programs are relatively new but are becoming more accepted methods of treatment in some states amid the opioid crisis. However, harm reduction practices remain controversial in most of the country, especially the pockets that aren’t as politically progressive.

When will it start?

The answer to that question has yet to be confirmed, according to the students who started the program.

Gov. Maura Healy approved the state budget at the beginning of the month, and one of those items in the approved budget was the Narcan pilot program. The state is putting $95,000 toward the program — much higher than what Kohli and Garg initially proposed ($45,000) in their paper from May 2023.

“I’m thrilled — I think we’re all thrilled — that this made it into the budget,” said Jay Garg, a Harvard University student studying economics and an HCOPES member. “It is very, very exciting that we’re in a place and at a time where a proposal like this could get passed and people want to help.”

But now the agencies that were involved in formulating this program with the students can start putting plans into action. That could take a handful of months.

What are the challenges?

Right now, it’s figuring out how and when the boxes will be swapped out for more naloxone. In the paper the students published earlier this year, they point out that these boxes must be checked at least daily in order to “minimize the probability of lacking naloxone in a situation in which it is needed.”

As mentioned above, it’s the transit authority’s responsibility to change out the naloxone, and how often it happens will be part of the data the stakeholders are collecting for research.

When asked about these challenges and how many naloxone boxes MBTA employees would have to monitor, an MBTA spokesperson said they’re waiting on discussions with the public health department “to develop a plan based upon the budget language in the coming months.”

“In the meantime, Transit Police carryNarcan,and they are trained in the proper use of it,” spokesperson Joe Pesaturo added.

Is expanding the program an option?

There is already interest in expanding the program, not just from the student group, but from some lawmakers. One such legislator is State Sen. John Keenan, a Quincy Democrat who told WBUR earlier this month that he would support expanding it beyond the Red Line.

“If successful, this program can serve as a model that will help save lives beyond the Red Line,” Keenan, who also sponsored the bill to fund the program, told the public radio station.

Then there are the nonprofit groups in Massachusetts that have for decades worked to bring more harm reduction practices to the public, like Access Hope, a Cape Cod-based organization that provides people with information and resources to safely use drugs.

Kim Powers, the group’s founder and CEO, said expanding access to naloxone in public spaces “removes a huge barrier” for people who need it.

“To give the community that, it empowers people,” Powers said. “It’s life-saving. To have that available, you know someone isn’t going to die there. It should be everywhere.”

But that’s why gathering the data in this pilot program, which could last up to 18 months, is so important, Kohli said, so that expansion can happen.

“We believe this initiative will be positive, but I think to figure out exactly how best to optimize some of the parameters, it’s important to focus on a subset and to see what actually happens when we implement this kind of initiative — then collect all of the data and take it from there to best inform further expansion,” Kohli said.