Massachusetts Lawmaker Pushes to Revive MBTA Naloxone Program After Empty Cabinets Left on Station Walls

Empty naloxone cabinets lining the walls of Boston subway stations — some broken, others covered with trash bags — stand as visible reminders of a harm reduction pilot program that Massachusetts transit officials allowed to lapse despite having funds remaining and mounting evidence of the medication's lifesaving potential.

Now Senator John Keenan of Quincy wants to not only restart but significantly expand public access to the overdose-reversal drug across the MBTA system, introducing legislation that would require accessible cabinets at every stop along the Red, Blue, Green, and Orange lines. The bill, currently before the Legislature's transportation committee with a March 31 deadline, comes after a 2024 pilot program ended prematurely — leaving $40,000 unspent and critical infrastructure dormant.

A Pilot Cut Short

The original effort began with promise. In 2023, Keenan successfully championed a budget amendment allocating $95,000 for naloxone cabinets along the Red Line after Harvard students researched overdose clustering around Cambridge transit stations and proposed making the medication accessible where people actually congregate.

The MBTA rolled out the program in summer 2024 at five stations — Quincy Center, Ashmont, Andrew, South Station, and Harvard — installing 15 cabinets with instructional signage explaining naloxone administration. Over the course of a year, the transit authority supplied more than 500 doses of the medication.

But by summer 2025, the program had ended. Transit officials spent only $55,515 of the appropriated funds and cited resource constraints in a mandated report to the Legislature, stating they lacked "sufficient resources or appropriate personnel needed to manage the day-to-day administration of such a program."

The explanation frustrated Keenan, who points out that MBTA stations already have daily maintenance staff and personnel present during operating hours. "You have people who do maintenance in the stations throughout the system every day," he said. "It shouldn't be that difficult."

The Bureaucratic Disconnect

At the heart of the program's collapse lies a fundamental disagreement about intent and expectations. The MBTA characterized the effort as a three-month pilot that was generously extended to a full year. Keenan's office maintains the $95,000 was meant to fund one year of operations with the expectation that agencies would request continued funding — which never happened.

Transit officials pointed to additional complications: record-keeping requirements under the original law and temperature-control specifications for naloxone storage that stretched their administrative capacity. In their October report, they recommended finding a third-party contractor "whose mission is aligned with such an important program and that has the resources and personnel" to sustain it.

Both the Massachusetts Department of Public Health Bureau of Substance Addiction Services and Cambridge Health Alliance confirmed preliminary discussions with the MBTA around the time of the report, but neither agency has remained involved. An MBTA spokesperson told WBUR that efforts to identify a third-party contractor are ongoing but declined an interview request.

Meanwhile, the empty cabinets remain mounted on subway walls — a peculiar form of infrastructure theater that Dr. Scott Weiner, an emergency and addiction medicine physician at Brigham and Women's Hospital, finds troubling. "The message that we're sending is so negative," Weiner said. "It's a service that we think is important enough to put these boxes up, and then we're just leaving them empty. That's not acceptable."

Evidence and Opportunity

Weiner, an associate professor of emergency medicine at Harvard Medical School who has studied overdose clustering and published research with the Harvard students who originally proposed the subway naloxone initiative, emphasizes that widespread naloxone availability is believed to have contributed to Massachusetts' dramatic decline in overdose deaths in recent years.

State Department of Public Health data shows opioid overdose deaths fell to 1,336 in 2024 — a nearly 37% decline from the previous year. The drop aligns with national trends but reflects particularly aggressive harm reduction strategies in the Commonwealth, where naloxone has become broadly accessible through pharmacies, community distribution programs, and public health initiatives.

"The harm reduction approach says very clearly, we just want you to reduce harm. We don't want you to die," Weiner explained. "No one deserves to die from an overdose."

During the year-long MBTA pilot, transit police reported no documented cases of the cabinet naloxone being used to reverse an overdose on T property, suggesting that members of the public who removed doses carried them offsite. Far from undermining the program's value, Keenan views this as evidence of its broader public health impact.

"If somebody is taking Narcan because they anticipate they will be in a situation where it could be used outside of a train station, on their way walking to a station or home, or in their community, and they save a life with it, then I think the MBTA should say, 'Hey, I'm glad we did that,'" the senator said.

Strategic Expansion vs. Universal Access

While Keenan's current legislation calls for naloxone cabinets at all Red, Blue, Green, and Orange Line stations, Weiner suggests a more targeted evidence-informed approach might gain traction: prioritizing the 20 to 30 stations with the highest likelihood of overdoses based on geographic data about substance use patterns and emergency response frequencies.

This middle path could address the MBTA's stated resource concerns while still achieving meaningful public health impact — a compromise between universal access and administrative feasibility.

The transportation committee faces a March 31 deadline to act on the bill. If it advances, the legislation would test whether Massachusetts lawmakers are willing to mandate harm reduction infrastructure over transit agency objections, and whether the state's impressive overdose death reductions can be accelerated through creative deployment of lifesaving medication in high-traffic public spaces.

Transit systems in other major cities have experimented with similar programs. Philadelphia's SEPTA distributed naloxone kits through station ambassadors. New York's MTA trained subway workers to administer the medication and stocked transit police with doses. But few systems have attempted the public-facing cabinet model that Massachusetts piloted and then abandoned.

The Moral and Legal Calculus

Keenan frames his push as both a practical and ethical imperative. "Somebody in an overdose situation on an MBTA property is certainly foreseeable," he said. "So I think we have a legal obligation and a moral obligation to make sure that there's a proper response to that, to prevent a death."

The bill's two co-sponsors and its progression through committee suggest bipartisan recognition that transit infrastructure intersects with public health crisis response. But the MBTA's resistance — and the conspicuous sight of empty naloxone cabinets still affixed to station walls months after the program ended — illustrates how institutional inertia can stall even relatively low-cost, high-impact interventions.

For now, MBTA Transit Police officers continue to carry naloxone, and Superintendent Richard Sullivan says the majority of officers have doses available. But officer-administered medication represents a fundamentally different model than public access cabinets, which enable bystanders to intervene immediately without waiting for law enforcement response times.

As Massachusetts continues to grapple with the overdose crisis despite recent progress, the fate of subway naloxone cabinets will test whether the state's commitment to harm reduction extends beyond policy statements into the unglamorous work of stocking, monitoring, and maintaining emergency medical supplies in public transit stations.

The empty cabinets, for now, remain a question mark — infrastructure waiting for a second chance.