October 27, 2026
NEXT WEEK, Massachusetts voters will decide the future of a law that gives licensed clinicians an important tool to intervene before a crisis becomes a tragedy. For those of us working at the intersection of firearm injury prevention, suicide prevention, and public policy, the stakes extend far beyond the political debate surrounding gun ownership. They concern a fundamental question: What should we do when we recognize that someone is at serious risk of harming themselves or others, but still have an opportunity to prevent it?
In 2024, Massachusetts enacted H.4885, An Act Modernizing Firearm Laws, which made several important updates to the Commonwealth’s firearm safety framework. Among them was an expansion of extreme risk protection orders (ERPOs), allowing licensed health care professionals and certain educational personnel to petition courts for temporary firearm restrictions when an individual poses a significant risk of harm to themselves or others.
This change addressed a critical gap in our approach to firearm injury and suicide prevention. ERPOs, sometimes referred to as red flag laws, are civil court orders that temporarily restrict firearm and ammunition access when evidence indicates an individual presents a danger to themselves or others.
It is important to emphasize that they are not criminal convictions, nor are they permanent firearm prohibitions. Rather, they provide a legal mechanism to intervene during periods of elevated risk, when access to a firearm can turn a temporary crisis into an irreversible outcome. This distinction is extremely important for suicide prevention.
In 2024, 64 percent of firearm deaths in Massachusetts were due to suicide. Suicidal crises can be acute and time-sensitive, and firearms make these crises exceptionally lethal. Creating time and distance between an individual in crisis and a firearm provides a critical opportunity for intervention, treatment, and recovery.
Health care professionals are often among the first to recognize these warning signs. Emergency physicians, psychiatrists, primary care providers, and other licensed clinicians routinely encounter patients experiencing suicidal ideation, psychiatric emergencies, or circumstances involving a heightened risk of violence or harm. Before the 2024 law was passed, these clinicians lacked the legal authority to petition directly for an ERPO, even when their clinical assessment and expertise identified an immediate concern. This critical legislation bridged that gap.
As a firearm injury and suicide prevention researcher working with Boston Medical Center and Boston University, I have studied the implementation of this expansion, including the challenges clinicians face in translating new legal authority into practice. My research has reinforced an important reality: effective prevention requires strong, evidence-based policies that set the stage for training, institutional infrastructure, and meaningful collaboration between health care, legal systems, and community partners.
These systems take time to build. In just one year, more than 480 clinicians across all 14 Massachusetts counties have participated in ERPO training, demonstrating the statewide reach and importance of the expansion this legislation provided. The clinician expansion has been in effect for just over two years, and its long-term impact remains an important subject for evaluation.
Opponents of ERPOs frequently argue that these laws violate constitutional protections and deprive individuals of their property without due process. I agree that constitutional rights and procedural fairness are legitimate concerns that deserve careful examination. But describing ERPOs as firearm confiscation without due process ignores the judicial safeguards that have been carefully written into Massachusetts law.
An ERPO requires court involvement and evidence of risk. Although emergency orders may initially be issued without the respondent present, they are temporary, and a subsequent hearing must occur within a defined period. Individuals have the opportunity to appear, contest the allegations, and present their case. Longer-term orders require judicial findings and are subject to expiration or extension. These safeguards matter. They reflect the principle that protecting public safety and respecting individual rights are not inherently competing objectives. Both must inform how preventative policies are designed and implemented.
Question 9 places this framework before voters. A yes vote would retain Massachusetts’s 2024 gun violence prevention law, including the expanded authority for licensed clinicians and educational personnel to petition for ERPOs. A no vote would repeal the legislation, removing that expansion while leaving the earlier, more limited ERPO framework in place.
This decision is consequential. Repeal would not eliminate ERPOs altogether, but it would significantly shrink who can initiate these potentially lifesaving interventions.
No single law can eliminate firearm violence or suicide. Nor should ERPOs be viewed as substitutes for accessible mental health care, community-based violence prevention, or comprehensive suicide prevention services. ERPOs are one component of a broader public health approach that recognizes the importance of identifying risk early and responding with appropriate, evidence-based interventions.
The question before Massachusetts voters cannot be reduced to whether firearm regulations should be more or less restrictive—it is whether the Commonwealth should preserve an additional pathway for intervention when credible warning signs are present. In public health, we often measure success by the tragedies that never occur: the injury prevented, the crisis resolved, the life that continues, the community that does not have to grieve.
As Massachusetts approaches Election Day, I encourage voters to look beyond political rhetoric, examine what the 2024 legislation actually changed, consider the consequences of preserving or removing these preventive tools, and ultimately vote yes on question 9. The choices we make about firearm policy should be informed by evidence, constitutional safeguards, and a shared commitment to preventing avoidable loss of life. If we knowingly dismantle legislation designed to prevent violence and suicide, we cannot pretend the consequences are out of our control.
Annie Buck, PhD, MS, is a firearm injury and suicide prevention researcher at Boston Medical Center and Boston University.
Courtesy of Commonwealth Beacon
