Good Samaritan drug overdose laws
Good Samaritan drug overdose laws provide immunity from arrest, charges, or prosecution for drug possession or paraphernalia when individuals who are experiencing or witnessing an overdose summon emergency services1, 2, 3. Good Samaritan laws vary by state; some states also provide expansive protections from violations of probation, parole, and restraining orders and other protections from arrest on outstanding minor warrants1, 2. Good Samaritan drug overdose laws often accompany efforts to expand a layperson’s ability to administer naloxone in opioid overdose situations3, 4.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced overdose deaths
What does the research say about effectiveness?
Good Samaritan drug overdose laws are a suggested strategy to reduce drug overdose deaths, especially from opioid overdoses1, 2, 3, 4, 5, 6. Available evidence suggests that fear of arrest is a common barrier to calling 911 during an overdose7, 8; fear of police involvement can lead bystanders to delay or forgo calling 911, increasing risk of overdose death6. A Washington-based survey suggests that as drug users learn about Good Samaritan laws, they become more likely to call 911 during an overdose9, and law enforcement officers in states that have Good Samaritan laws report that these laws have improved citizens’ image of law enforcement10. Good Samaritan law protections generally depend on a variety of factors, such as the amount of the substance involved in the situation, and can include the individual experiencing overdose symptoms as well as the bystander that reports the overdose11. However, additional evidence is needed to confirm whether and to what extent existing Good Samaritan laws change behavior.
Experts suggest that enacting legislation and expanding knowledge of Good Samaritan laws among both bystanders and individuals that may experience overdose symptoms may contribute to reductions in overdose deaths. A New York-based study indicates that individuals with accurate and up to date knowledge of Good Samaritan laws were three times more likely to call 911 compared to individuals with incorrect knowledge of Good Samaritan laws12. Lack of awareness of Good Samaritan laws may prevent individuals from reporting overdose situations13. Good Samaritan laws vary from state to state, which may create confusion and prevent bystanders from reporting overdoses14.
How could this strategy advance health equity? This strategy is rated potential to increase disparities: suggested by expert opinion.
Experts suggest that Good Samaritan laws have the potential to increase disparities among people of color due to distrust of law enforcement and historically negative experiences with the law16.
Black and Hispanic/Latino individuals are disproportionately harmed by the worsening overdose crisis in the U.S. due to many barriers, including structural racism. Limited protections, inconsistent implementation, and competing laws that criminalize individuals who use drugs are among the obstacles faced by Good Samaritan laws. Current drug policies may not reduce drug-related harms, especially among Black and Hispanic/Latino individuals, because policies are not implemented consistently across racialized groups17.
What is the relevant historical background?
U.S. drug policies have been driven by racial prejudice and discrimination for well over a century. One of the earliest policies, the 1875 San Francisco Opium Den Ordinance, targeted Chinese immigrants. The Ordinance made it illegal to keep or visit any business where opium was smoked; this specifically targeted Chinese-owned establishments at which white men and women exclusively smoked opium18, 19. Prejudiced practices in drug policies peaked in the 1970s with the launch of President Richard Nixon’s War on Drugs campaign, which led to the incarceration of approximately two million individuals, primarily for drug related crimes. Black individuals were four times more likely to be arrested than white people for cannabis possession18.
Opioid overdose deaths have been increasing since 199920. The rise in opioid overdose deaths began in the 1990s with a substantial increase in the prescription of both natural and semi-synthetic opioids because they were effective at managing chronic pain and falsely marketed to health care providers as non-addictive21, 22, 23. Prescription opioid sales increased fourfold between 1999 and 200824. Many patients who became addicted to prescribed opioids turned to non-prescribed forms of opioids, such as heroin, which lead to a second wave of opioid overdoses in 2010. In 2013, a third wave began when synthetic opioids, such as fentanyl, that are much more potent than other forms of opioids were combined with other drugs or counterfeit prescription pills, often without the purchaser’s knowledge21. As the prescription opioid epidemic began to ravage communities inconsistent with historical trends – white, suburban communities – policy makers and others in power took action in an attempt to stop the crisis18. In 2013, the U.S. Department of Health and Human Services declared the misuse of prescription opioids an epidemic. Four years later, in 2017 the opioid epidemic was declared a national public health emergency25. Between 2020 and 2021, the opioid overdose death rate increased by more than 15% and the synthetic opioid overdose death rate increased by over 22%21.
Equity Considerations
- Does your state have Good Samaritan laws? How do they differ from neighboring states?
- Are the Good Samaritan laws in your community easy to understand? Are they written and communicated clearly to community members? How can your community be educated about these laws?
- How might current relationships between law enforcement, emergency services, and the community impact the effectiveness of Good Samaritan laws? What steps can be taken to increase trust?
Implementation Examples
Implementation Resources
‡ Resources with a focus on equity.
CDC-Public health considerations‡ - Centers for Disease Control and Prevention (CDC). Overdose prevention. Public health considerations for strategies and partnerships.
Footnotes
* Journal subscription may be required for access.
1 Davis 2013 - Davis C, Webb D, Burris S. Changing law from barrier to facilitator of opioid overdose prevention. Journal of Law, Medicine & Ethics. 2013:33-36.
2 NPHL 2016 - Legal interventions to reduce overdose mortality: Naloxone access laws. Network for Public Health Law (NPHL). 2016.
3 NPHL-Good Samaritan laws - The Network for Public Health Law (NPHL). Legal interventions to reduce overdoes mortality: Overdose Good Samaritan laws.
4 NPHL-Naloxone access laws - The Network for Public Health Law (NPHL). Legal interventions to reduce overdose mortality: Naloxone access laws.
5 Moallef 2021 - Moallef S, Hayashi K. The effectiveness of drug-related Good Samaritan laws: A review of the literature. International Journal of Drug Policy. 2021;90:102773.
6 US Mayors-Overdose 2014 - The U.S. Conference of Mayors. The 82nd Annual Meeting Resolutions: Saving lives through overdose preventions. 2014.
7 Follett 2012 - Follett K. Between life and death: The barriers to calling 9-1-1 during an overdose emergency. Waterloo Region Crime Prevention Council. 2012:1-45.
8 Banta-Green 2013 - Banta-Green C J, Beletsky L, Schoeppe JA, Coffin PO, Kuszler PC. Police officers' and paramedics' experiences with overdose and their knowledge and opinions of Washington State's drug overdose-naloxone-Good Samaritan law. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2013;90(6):1102-1111.
9 Banta-Green 2011 - Banta-Green CJ, Kuszler PC, Coffin PO, Schoeppe JA. Washington's 911 Good Samaritan drug overdose law: Initial evaluation results. Alcohol & Drug Abuse Institute, University of Washington; 2011.
10 Davis 2014c - Davis CS, Ruiz S, Glynn P, Picariello G, Walley AY. Expanded access to naloxone among firefighters, police officers, and emergency medical technicians in Massachusetts. American Journal of Public Health. 2014;104(8):e7-e9.
11 Reader 2022 - Reader SW, Walton GH, Linder SH. Review and inventory of 911 Good Samaritan Law provisions in the United States. International Journal of Drug Policy. 2022;110:103896.
12 Jakubowski 2018 - Jakubowski A, Kunins HV, Huxley-Reicher Z, Siegler A. Knowledge of the 911 Good Samaritan Law and 911-calling behavior of overdose witnesses. Substance Abuse. 2018;39(2):233-238.
13 Schneider 2020a - Schneider KE, Park JN, Allen ST, Weir BW, Sherman SG. Knowledge of Good Samaritan Laws and beliefs about arrests among persons who inject drugs a year after policy change in Baltimore, Maryland. Public Health Reports. 2020;135(3):393-400.
14 Reader 2023 - Reader SW, Breckenridge ED, Chan W, Walton GH, Linder SH. Dimension reduction of 911 Good Samaritan Laws: Drawing inferences from policy surveillance. Drug and Alcohol Dependence. 2023;249:109934.
15 PDAPS-Overdose - Prescription Drug Abuse Policy System (PDAPS). Good Samaritan overdose prevention laws.
16 Pamplin 2023 - Pamplin JR, King C, Cooper C, et al. Pathways to racial disparities in the effects of Good Samaritan Laws: A mixed methods pilot study. Drug and Alcohol Dependence. 2023;249:110823.
17 Pamplin 2023a - Pamplin JR, Rouhani S, Davis CS, King C, Townsend TN. Persistent criminalization and structural racism in U.S. drug policy: The case of overdose Good Samaritan Laws. American Journal of Public Health. 2023;113(Suppl 1):S43-S48.
18 NY Good Samaritan law - Pamplin JR. New York’s Good Samaritan law reveals structural racism in its drug policy. New York: Thirteen PBS.
19 Drug war 100 - Fisher G. The drug war at 100. Stanford Law School Blogs. 2014.
20 Freeman 2018 - Freeman PR, Hankosky ER, Lofwall MR, Talbert JC. The changing landscape of naloxone availability in the United States, 2011 – 2017. Drug and Alcohol Dependence. 2018;191:361-364.
21 CDC-Understanding the epidemic - Centers for Disease Control and Prevention (CDC). Understanding the opioid overdose epidemic.
22 Bennett 2021 - Bennett AS, Elliott L. Naloxone’s role in the national opioid crisis — past struggles, current efforts, and future opportunities. Translational Research. 2021;234:43-57.
23 Haffajee 2020 - Haffajee RL, Cherney S, Smart R. Legal requirements and recommendations to prescribe naloxone. Drug and Alcohol Dependence. 2020;209:107896.
24 Judd 2023 - Judd D, King CR, Galke C. The opioid epidemic: A review of the contributing factors, negative consequences, and best practices. Cureus. 2023;15(7):e41621.
25 Salmond 2019 - Salmond S, Allread V. A population health approach to America’s opioid epidemic. Orthopaedic Nursing. 2019;38(2):95-108.
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