By Medscholaria Consulting, Inc.
In an era marked by a relentless opioid epidemic, the failure to include fentanyl in routine emergency room drug screenings has proven fatal. As a nurse leader in Utilization Management (UM), and someone deeply involved in continuing education for registered nurses, I have followed the development of Tyler’s Law with professional urgency and personal conviction. This legislation has the potential to reshape emergency medical protocols nationwide, saving lives that are currently being lost due to a glaring gap in toxicological testing.
The Tragedy That Sparked a Movement
Tyler’s Law is named after 19-year-old Tyler Shamash, who tragically died from a fentanyl overdose in 2018 after an emergency room visit failed to detect the drug. At the time, fentanyl was not part of the standard emergency room toxicology panel—a fatal omission. Five months later, a coroner’s toxicology report revealed the presence of fentanyl, a detail that, if known earlier, might have changed the trajectory of Tyler’s care.
His mother, Juli Shamash, turned her grief into advocacy. With no prior knowledge of legislative processes, she fought to mandate fentanyl testing in emergency departments. California responded. In 2022, the California State Assembly and Senate unanimously passed SB 864, also known as Tyler’s Law, which requires hospitals to include fentanyl in routine urine drug screens for suspected overdoses. Governor Gavin Newsom signed the bill into law that same year (CA Legislature, 2022).
Expanding State-Level Support
The momentum did not stop in California. Maryland enacted the Josh Siems Act, Virginia passed Malcolm’s Law, Florida introduced Gage’s Law, and Pennsylvania followed suit—all spurred by similar tragedies involving fentanyl-laced substances. These laws shared a common goal: to institutionalize the inclusion of fentanyl in ER drug screenings. These efforts have largely passed without controversy and have been praised by families, healthcare professionals, and policymakers alike.
From State to Federal: The Federal Tyler’s Law
In 2023, U.S. Senator Joe Manchin and Representative Ted Lieu introduced Tyler’s Law at the federal level (S.3519), referring it to the Committee on Health, Education, Labor, and Pensions (Congress.gov, 2023). The bill seeks to mandate the Department of Health and Human Services (HHS) to study current ER testing practices and issue national guidance encouraging fentanyl screening. Due to the 10th Amendment, the federal version could not mirror the mandates of the state-level laws but aimed instead to standardize best practices.
The legislation gained strong bipartisan backing. The Emergency Nurses Association (ENA), in their 2024 publication of a Naloxone Education Toolkit, reinforced their frontline role in addressing the opioid crisis, highlighting the importance of arming emergency department staff with tools and guidance to respond to opioid-related emergencies, including those involving fentanyl (ENA, 2024).
Challenges in Congress and Renewed Advocacy
Despite early bipartisan momentum and emotional testimony from grieving families, including Shamash and other bereaved mothers, the federal bill stalled. By April 2024, it failed to be incorporated into the SUPPORT for Patients and Communities Reauthorization Act by a tied 24-24 committee vote. The objection was procedural—not ideological—with Republicans expressing concern over the lack of committee hearings.
Still, the will of the people and healthcare professionals remains undeterred. In March 2025, Rep. Lieu reintroduced the bill in the House, with newly elected Sen. Jim Banks leading in the Senate. Banks had previously authored legislation classifying fentanyl as a chemical weapon—an indication of his commitment to addressing the crisis.
Opposition and Counterpoints
While Tyler’s Law has overwhelming support, it is not without critique. Opponents in Pennsylvania and California expressed concern over costs for underfunded rural hospitals and potential misuse of toxicology results in punitive legal contexts. However, medical experts and advocates, including Dr. Roneet Lev, have offered to train rural hospitals and emphasize that testing is a tool for care, not punishment.
Indeed, concerns about cost and discrimination must be weighed against the measurable lives already saved. In one notable case, California’s mandate led to the discovery of fentanyl in a choking infant, prompting a life-saving intervention for him and his twin brother. Their parents were subsequently treated for addiction, and the family was ultimately reunited—a clear testament to the law’s lifesaving potential.
A Path Forward: Why Tyler’s Law Matters
As a continuing education provider and a Utilization Management nurse, I believe Tyler’s Law highlights the broader intersection between policy, advocacy, and clinical practice. Emergency departments are on the front lines of the opioid epidemic, and without comprehensive drug screening, clinicians are working blind. Including fentanyl in standard toxicology screens should not be optional.
Fentanyl is now the leading cause of drug-related deaths in the U.S. With backing from key healthcare stakeholders and minimal opposition rooted primarily in process rather than substance, Tyler’s Law is a rare example of common-sense, bipartisan legislation that could produce immediate, lifesaving results.
At Medscholaria Consulting, we support legislative actions grounded in clinical evidence and real-world outcomes. The passing of Tyler’s Law at the federal level would not only honor the memory of those lost, like Tyler, Josh, Malcolm, Eli, and Gage, but also empower emergency clinicians with the tools needed to act swiftly, accurately, and effectively in the face of the fentanyl crisis.
Conclusion
Nursing is a profession rooted in advocacy, and advocacy requires action. Tyler’s Law is more than a bill—it is a testament to the power of grief transformed into purpose. As we continue to educate the next generation of nurses and lead reforms in healthcare quality and utilization, we must support initiatives that bridge policy and practice.
Lives are on the line. Routine fentanyl screening should be a national standard. Tyler’s Law must pass.
References
CA Legislative Information. (2022). SB-864 Hospitals: fentanyl testing. https://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml?bill_id=202120220SB864
Congress.gov. (2023). S.3519 – 118th Congress (2023-2024): Tyler’s Law. https://www.congress.gov/bill/118th-congress/senate-bill/3519/all-actions?overview=closed#tabs
Emergency Nurses Association. (2024). New Naloxone Education Toolkit Arms Frontline Emergency Department Staff. https://www.ena.org/news-publications/newsroom/new-naloxone-education-toolkit-arms-frontline-emergency-department-staff
Padilla, Banks Introduce Bipartisan Tyler’s Law to Fight Fentanyl Crisis. (2025, March 11). Senator Alex Padilla. https://www.padilla.senate.gov/newsroom/press-releases/padilla-banks-introduce-bipartisan-tylers-law-to-fight-fentanyl-crisis/
Rifkin, J. (2025, May 7). Tyler’s Law: After losing her 19-year-old son to a fentanyl overdose, Juli Shamash is lobbying for legislation in his name. GovTrack.us. https://www.govtrack.us/posts/499/2025-05-07_tylers-law-after-losing-her-19-year-old-son-to-a-fentanyl-overdose-juli-shamash-is-lobbying-for-legislation-in-his-name
Tsirkin, J. (2025, March 11). Bipartisan senators reintroduce bill to expand fentanyl testing in hospitals. NBC News. https://www.nbcnews.com/politics/congress/bipartisan-senators-bill-expand-fentanyl-testing-hospitals-rcna195615