Stopping an Invisible Epidemic: Legal Issues in the Provision of Naloxone to Prevent Opioid Overdose

Burris, Scott; Beletsky, Leo; Castagna, Carolyn A.; Coyle, Casey; Crowe, Colin; McLaughlin, Jennie Maura

doi:10.2139/ssrn.1434381

Cited by 23 publications

(31 citation statements)

References 20 publications

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“…16 Similarly, research among drug users and other at-risk groups has identified pervasive lack of clarity about the law. [27][28][29][30] Our findings underscore the critical role of policy evaluation to evidence-based tailoring of public health laws in order to guarantee their positive impact.…”

Section: Discussionmentioning

confidence: 69%

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

et al. 2013

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Opioid overdoses are an important public health concern. Concerns about police involvement at overdose events may decrease calls to 911 for emergency medical care thereby increasing the chances than an overdose becomes fatal. To address this concern, Washington State passed a law that provides immunity from drug possession charges and facilitates the availability of take-home-naloxone (the opioid overdose antidote) to bystanders in 2010. To examine the knowledge and opinions regarding opioid overdoses and this new law, police (n=251) and paramedics (n=28) in Seattle, WA were surveyed. The majority of police (64 %) and paramedics (89 %) had been at an opioid overdose in the prior year. Few officers (16 %) or paramedics (7 %) were aware of the new law. While arrests at overdose scenes were rare, drugs or paraphernalia were confiscated at 25 % of the most recent overdoses police responded to. Three quarters of officers felt it was important they were at the scene of an overdose to protect medical personnel, and a minority, 34 %, indicated it was important they were present for the purpose of enforcing laws. Police opinions about the immunity and naloxone provisions of the law were split, and we present a summary of the reasons for their opinions. The results of this survey were utilized in public health efforts by the police department which developed a roll call training video shown to all patrol officers. Knowledge of the law was low, and opinions of it were mixed; however, police were concerned about the issue of opioid overdose and willing to implement agency-wide training.

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Section: Discussionmentioning

confidence: 69%

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

et al. 2013

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“…As demonstrated with bloodborne disease transmission, the criminalization and intensive policing that exemplifies the War on Drugs has created and exacerbated drug-related harm and contradicts public health efforts aimed at reducing drug-related harm (Burris et al, 2004, 2009). Likewise, legislation aimed at preventing overdose deaths may be undermined by more recent policies aimed at controlling America’s burgeoning homeless population.…”

Section: Resultsmentioning

confidence: 99%

“…These have included calls for legislation establishing comprehensive immunity for individuals calling 911 and responding to an overdose (Burris et al, 2009) as well as working with law enforcement to implement guidelines and procedures aimed at protecting PWIDs from police harassment, arrest, and other legal consequences when assisting in an overdose reversal (Beletsky et al, 2011; Burris et al, 2009; Davidson et al, 2002; Davis, Webb & Burris, 2013; Seal et al, 2005; Tracy et al, 2005). Burris et al (2009) recommends reallocating current police functions to agencies that are better able to address health issues, and Follett et al (2014) suggest limiting police attendance at routine overdose calls. Our findings suggest the wisdom of such proposals while also suggesting the need to change the policies that current policing practices enforce.…”

Section: Resultsmentioning

confidence: 99%

Why are some people who have received overdose education and naloxone reticent to call Emergency Medical Services in the event of overdose?

Koester

Mueller

Raville

et al. 2017

International Journal of Drug Policy

125

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Background Overdose Education and Naloxone Distribution (OEND) training for persons who inject drugs (PWID) underlines the importance of summoning emergency medical services (EMS). To encourage PWID to do so, Colorado enacted a Good Samaritan law providing limited immunity from prosecution for possession of a controlled substance and/or drug paraphernalia to the overdose victim and the witnesses who in good faith provide emergency assistance. This paper examines the law’s influence by describing OEND trained PWIDs’ experience reversing overdoses and their decision about calling for EMS support. Methods Findings from two complementary studies, a qualitative study based on semi-structured interviews with OEND trained PWID who had reversed one or more overdoses, and an on-going fieldwork-based project examining PWIDs’ self-identified health concerns were triangulated to describe and explain participants’ decision to call for EMS. Results In most overdose reversals described, no EMS call was made. Participants reported several reasons for not doing so. Most frequent was the fear that despite the Good Samaritan law, a police response would result in arrest of the victim and/or witness for outstanding warrants, or sentence violations. Fears were based on individual and collective experience, and reinforced by the city of Denver’s aggressive approach to managing homelessness through increased enforcement of misdemeanors and the imposition of more recent ordinances, including a camping ban, to control space. The city’s homeless crisis was reflected as well in the concern expressed by housed PWID that an EMS intervention would jeopardize their public housing. Conclusion Results suggest that the immunity provided by the Good Samaritan law does not address PWIDs’ fear that their current legal status as well as the victim’s will result in arrest and incarceration. As currently conceived, the Good Samaritan law does not provide immunity for PWIDs’ already enmeshed in the criminal justice system, or PWID fearful of losing their housing.

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“…In the absence of special legislation or standing orders permitting third party prescribing, providing naloxone to people who are not themselves at risk of overdose, but who may be friends or family of people who use opioids might be outside of the prescriber-patient relationship. 69 …”

Section: Discussionmentioning

confidence: 99%

“…71 States increasingly recognize the importance of bystanders’ responding to overdose and are providing some immunity from arrest and/or prosecution for drug possession crimes and/or liability protection for administering naloxone. 69 Twenty-one states and the District of Columbia have enacted “Good Samaritan” provisions providing some protection from prosecution for people who provide help at the scene of an overdose. 70 …”

Section: Discussionmentioning

confidence: 99%

A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community Programming into Clinical Practice

et al. 2015

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Background As physicians have increased opioid prescribing, overdose deaths from pharmaceutical opioids have substantially increased in the United States. Naloxone hydrochloride (naloxone), an opioid antagonist, is the standard of care for treatment of opioid induced respiratory depression. Since 1996, community-based programs have offered overdose prevention education and distributed naloxone for bystander administration to people who use opioids, particularly heroin. There is growing interest in translating overdose education and naloxone distribution (OEND) into conventional medical settings for patients who are prescribed pharmaceutical opioids. For this review, we summarized and classified existing publications on overdose education and naloxone distribution to identify evidence of effectiveness and opportunities for translation into conventional medical settings. Methods For this review, we searched English language PubMed for articles on naloxone based on primary data collection from humans, including feasibility studies, program evaluations, surveys, qualitative studies and studies comparing the effectiveness of different routes of naloxone administration. We also included cost-effectiveness studies. Results We identified 41 articles that represented 5 categories: evaluations of OEND programs, effects of OEND programs on experiences and attitudes of participants, willingness of medical providers to prescribe naloxone, comparisons of different routes of naloxone administration, and the cost-effectiveness of naloxone. Conclusions Existing research suggests that people who are at risk for overdose and other bystanders are willing and able to be trained to prevent overdoses and administer naloxone. Counseling patients about the risks of opioid overdose and prescribing naloxone is an emerging clinical practice which may reduce fatalities from overdose while enhancing the safe prescribing of opioids.

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Stopping an Invisible Epidemic: Legal Issues in the Provision of Naloxone to Prevent Opioid Overdose

Cited by 23 publications

References 20 publications

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

Why are some people who have received overdose education and naloxone reticent to call Emergency Medical Services in the event of overdose?

A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community Programming into Clinical Practice

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