Awareness and knowledge of the Good Samaritan Drug Overdose Act among people at risk of witnessing an overdose in British Columbia, Canada: a multi-methods cross sectional study

Abstract

Introduction Bystanders to drug overdoses often avoid or delay calling 9–1-1 and cite fear of police involvement as a main reason. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted by the Canadian government to provide people present at an overdose with legal protection from charges for simple drug possession, and conditions stemming from simple possession. Few studies have taken a multi-methods approach to evaluating the GSDOA. We used quantitative surveys and qualitative interviews to explore awareness, understanding, and perceptions of the GSDOA in people at risk of witnessing an overdose. Methods Quantitative cross-sectional surveys and qualitative telephone interviews were conducted with adults and youth at risk of witnessing an overdose across British Columbia. Cross-sectional survey participants were recruited at 19 Take Home Naloxone sites and online through Foundry. Multivariable logistic regression models were constructed hierarchically to determine factors associated with GSDOA awareness. Telephone interview participants were recruited by research assistants with lived/living experience of substance use. Deductive and inductive thematic analyses were conducted to identify major themes. Results Overall, 52.7% (n = 296) of the quantitative study sample (N = 453) reported being aware of the GSDOA. In multivariable analysis, cellphone possession (adjusted odds ratio [AOR] = 2.19; 95% confidence interval [CI] 1.36, 3.54) and having recently witnessed an opioid overdose (AOR = 2.34; 95% CI 1.45, 3.80) were positively associated with GSDOA awareness. Young adults (25 – 34 years) were more likely to be aware of the Act (AOR = 2.10; 95% CI 1.11, 3.98) compared to youth (16–24 years). Qualitative interviews (N = 42) revealed that many overestimated the protections offered by the GSDOA. To increase awareness and knowledge of the Act among youth, participants recommended adding the GSDOA to school curricula and using social media. Word of mouth was suggested to reach adults. Conclusion Both awareness and knowledge of the GSDOA remain low in BC, with many overestimating the protections the Act offers. Dissemination efforts should be led by people with lived/living experience and should target those with limited awareness and understanding of the Act as misunderstandings can erode trust in law enforcement and harm reduction policy.

“It’s just a perfect storm”: Exploring the consequences of the COVID-19 pandemic on overdose risk in British Columbia from the perspectives of people who use substances

“…This study consisted of semi-structured, one-on-one interviews conducted by phone or in-person as part of two qualitative studies performed across BC: the Concurrent Use and Transition to Methamphetamine among People at Risk of Overdose (CUT Meth OD) study (n = 27) and the Good Samaritan Drug Overdose Act (GSDOA) evaluation study (n = 35) [28,29]. Qualitative interview guides were developed by the research team -including researchers, people with lived and living experience of substance use, stakeholders from community organizations, health authorities, and young adults.…”

Awareness and knowledge of drug decriminalization among people who use drugs in British Columbia: a multi-method pre-implementation study

“…Concerns for the impact of knowledge disparities has been echoed in other studies where legal protections from drug policies were limited. For instance, the benefits of Canada's Good Samaritan Drug Overdose Act were inflated amongst PWUD who believed that warrants and drug trafficking were covered under the legislation [25,60]. Ample research demonstrates the impact of misunderstanding drug-related good Samaritan laws include ongoing hesitation to calling 9-1-1 in the event of an overdose, and an ongoing fear and distrust towards police, the legal system, and government in general [39,60,66].…”

“…The finding that approximately two-thirds of PWUD in our study were aware of decriminalization is slightly elevated compared with other studies that have examined PWUDs’ awareness of drug policy reforms. A study conducted in BC on awareness of Canada’s Good Samaritan Drug Overdose Act in 2020 found that just over half of PWUD were aware of the reform [ 60 ], while other jurisdictions report lower awareness of local drug-related good Samaritan laws [ 50 , 52 , 61 ]. Awareness of other drug policies among PWUD globally are considerably lower.…”

Using qualitative system dynamics modeling to understand overdose bystander behavior in the context of Connecticut’s Good Samaritan Laws and identify effective policy options

“…One reason why Good Samaritan Laws may not be achieving greater impact is that, in many communities, the protections offered by the laws are not fully understood by potential bystanders. Studies have shown that awareness and correct knowledge of locally applicable Good Samaritan Laws remains low among people who use drugs and potential bystanders [ 15 – 18 ]. Better knowledge of Good Samaritan Laws has generally been associated with an increased frequency of bystanders calling 911 and otherwise seeking medical help when witnessing an overdose [ 16 , 19 – 21 ].However, even when knowledge about the laws is correct, distrust of law enforcement and fear of legal consequences may stand in the way of bystanders seeking help [ 18 , 20 ].…”