Good Samaritan Laws in the United States

Fatal drug overdose has increased more than six-fold in the past three decades, and now claims the lives of over 47,000 United States citizens every year (in accordance with Rudd, R.A., Aleshire, N., Zibbell, J.E., Gladden, M., 2015. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. Morbidity and Mortality Weekly Report (MMWR) 64, 1-5). Opioids — both prescription painkillers and heroin — are responsible for most of these deaths. (Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, et al. Increases in heroin overdose deaths – 28 States, 2010 to 2012. MMWR Morb Mortal Wkly Rep 2014;63(39):849-54; Hedegaard H, Chen LH, Warner M. Drug-poisoning Deaths Involving Heroin: United States, 2000-2013. NCHS Data Brief 2015(190):1-8).

The death rate from prescription opioid- associated overdose nearly quadrupled from 1999 to 2013, while deaths from heroin more than tripled from 2010 to 2014.

Together, heroin and prescription pain medications take the lives of more than 28,000 Americans per year — over 75 people per day. They also cause hundreds of thousands of non-fatal overdoses and an incalculable amount of emotional suffering and preventable health care expenses.

Opioid overdose is reversible through the timely administration of the medication naloxone and the provision of other emergency care. Opioid overdose is caused by excessive depression of the respiratory and central nervous systems. Naloxone, a κ- and δ, and μ-opioid receptor competitive antagonist, works by displacing opioids from these receptors, thereby reversing their depressant effect.

However, community access to naloxone was historically limited by laws and regulations that pre-date the overdose epidemic. In an attempt to reverse the unprecedented increase in preventable overdose deaths, the majority of states have recently amended those laws to increase access to emergency care and treatment for opiate overdose.

Drug overdoses persist as a major cause of preventable death (see drug overdose deaths). Calling 911 during an overdose can mean the difference between life and death, but witnesses sometimes do not call because they perceive that they may be arrested. Proponents of drug overdose Good Samaritan laws aim to address this concern by providing limited immunity to overdose witnesses and victims. Opponents argue that immunity will provide a “get-out-of-jail-free card” and interfere with the work of police and prosecutors.

Drug overdose Good Samaritan laws are in effect in most of the states and the District of Columbia.

In the U.S. States

From the Robert Wood Johnson Foundation:

By June 22, 2016, all but three states (KS, MT, WY) had passed legislation designed to improve layperson naloxone
access. These states have made it easier for people who might be in a position to assist in an overdose to access the medication, encouraged those individuals to summon emergency responders, or both. (For further background on these laws, please see Davis, C.S., Carr, D., 2015. Legal changes to increase access to naloxone for opioid overdose reversal in the United States. Drug Alcohol Depend 157, 112-120).

In 2001, New Mexico became the first state to amend its laws to make it easier for medical professionals to prescribe and dispense naloxone, and for lay administrators to use it without fear of legal repercussions. The provision of “take home” naloxone to reduce overdose risk was suggested as early as the mid-1990s. See John Strang et al.,Heroin Overdose: The Case for Take-Home Naloxone, 312 BRIT. MED. J. 1435 (1996).

As of June 22, 2015, forty-six other states and the District of Columbia have made similar changes (48 total). For a graphical representation of these laws, please see the relevant LawAtlas map at lawatlas.org/preview?dataset=laws-regulating-administration-of-naloxone. This number includes all states that have passed relevant laws, even if they have a later effective date. Effective dates are listed in the tables.

Largely because of these legal changes, over 150,000 laypeople had received training and naloxone kits as of 2014, and naloxone program participants reported reversing more than 26,000 overdoses (Wheeler E, Jones ST, Gilbert MK, Davidson PJ. Opioid overdose prevention programs providing naloxone to laypersons – United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64(23):631-5). A recent evaluation of one such program in Massachusetts, which trained over 2,900 potential overdose bystanders, reported that opioid overdose death rates were significantly reduced in communities in which the program was implemented compared to those in which it was not (Alex Walley, et al., Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis, 346 BMJ f174 (2013)).

In 2007, New Mexico became the first state to amend its laws to encourage Good Samaritans to summon aid in the event of an overdose. As of June 22, 2016, thirty-five other states and the District of Columbia have followed suit (37 total). For a graphical representation of these laws, please see the relevant LawAtlas map at http://www.lawatlas.org/preview?dataset=good-samaritan-overdose-laws.

Initial evidence from Washington State, which amended its law in 2010, is positive, with 88 percent of drug users surveyed indicating that they would be more likely to summon emergency personnel during an overdose as a result of the legal change (see below).

Development the Case of the Washington State

By Dr. Caleb Banta-Green (in the White House website):

“In 2010, Washington State became the second state to pass a law incorporating a Good Samaritan provision providing immunity from drug possession charges; immunity applies to a person who seeks medical aid during an overdose (e.g., by calling 911 or taking someone to the ER), and to a person having an overdose.

I evaluated the development and implementation of the law and remain involved in spreading awareness of the law, providing overdose education, researching interventions, and encouraging broader availability of the opioid antidote naloxone (Narcan).

To date, there is no indication from police or prosecutors in Washington State that the Good Samaritan law is a serious impediment to the conduct of their work. This may be because arrests at overdose scenes are quite rare. In Seattle, we found that while police, paramedics, and heroin users all agreed police were usually at the scene of an overdose, they also all agreed that arrests were rare. This is in agreement with what we heard from representatives of statewide police/sheriffs and prosecutor associations during and subsequent to passage of the law.

We have not been able to determine if there is a positive impact directly related to the law either on increasing calls to 911 or decreasing overdose deaths. This is not because there is no effect, but rather because passage of the law facilitated the unfolding of a chain of events that was much broader than the simple legal immunity clause. Like other states’ legislation, no funding for implementation was included and no state agency was designated to implement (or evaluate) the law. However, during the course of our public health law research evaluation of the law, we surveyed Seattle police officers and found very low awareness of the law. Only 16 percent had heard of the law, and only 8 percent knew it applied to both overdose witnesses who sought aid and overdose victims. We shared these findings with police command staff, and they developed a training video that was shown to all patrol officers in the city.

The video features the narcotics captain, a county prosecutor, and the medical director for Public Health – Seattle & King County. In my conversations with command staff and patrol officers, it appears that the video has dramatically increased awareness of the law among police in Seattle and has been shared with other Washington law enforcement agencies and at national conferences. The fact that police have been trained about the law has also been shared with those receiving overdose education.”