The New York 911 Good Samaritan Law and Opioid Overdose Prevention Among People Who Inject Drugs

• Author: Cathy Zadoretzky,Mary Ellen Cala,Don Des Jarlais,Courtney McKnight,Heidi Bramson,Mark Hammer,Maxine Phillips
• Date: 01 September 2017
• Published date: 01 September 2017
• DOI: http://doi.org/10.1002/wmh3.234

The New York 911 Good Samaritan Law and Opioid

Overdose Prevention Among People Who Inject Drugs

Cathy Zadoretzky, Courtney McKnight, Heidi Bramson, Don Des Jarlais,

Maxine Phillips, Mark Hammer, and Mary Ellen Cala

This study examines how people who inject drugs (PWIDs) applied and experienced New York’s

Opioid Overdose Prevention Programs (OOPPs) and 911 Good Samaritan Law. Mixed-methods

interviews were conducted with a community sample of New York syringe exchange participants

(N ¼225) and new admissions to methadone treatment (N ¼75) in 2013 and 2014. Most

participants were unaware of explicit protections provided by New York law to witnesses (85

percent) or overdose victims (83 percent) who called 911 for assistance. However, 75 percent called

911 upon last witnessing an overdose and 85 percent were very likely to call 911 for future victims.

Calling 911 was associated with knowing relatives or friends who died of overdose (AOR ¼2.57;

95%CI: 1.28, 5.19), OOPP training since implementation of the 911 Good Samaritan Law

(AOR ¼1.55; 95%CI: 1.07, 2.24), and perceived importance of calling 911 (AOR ¼2.12; 95%CI:

1.02, 4.40). Thematic patterns in qualitative data revealed that participants fearing criminal

penalties delayed calling 911 or abandoned overdose victims after calling 911, risking victim

morbidity and fatality. Misunderstanding of New York law and fear of criminal penalties

undermined participants’ efforts to save lives, even when 911 was called. Public health outcomes

may benef‌it by investigating how PWIDs misunderstand the 911 Good Samaritan Law.

KEY WORDS: opioid overdose, 911 Good Samaritan Law, overdose prevention

Introduction

Prescription opioid and heroin use is currently driving an epidemic of drug

overdose deaths in the United States (Centers for Disease Control and Prevention

[CDC], 2016; Rudd, Aleshire, Zibbell, & Gladden, 2016). In 2014, drug overdose

deaths in the United States totaled 47,055 and a majority of those deaths

(61 percent) involved prescription opioids or heroin (Rudd et al., 2016). Drug

overdose deaths that involved opioid analgesics increased from 1.5 per 100,000

population in 2000 to 5.1 per 100,000 population in 2013; while deaths that

involved heroin increased from 0.7 per 100,000 population in 2000 to 2.7 per

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doi: 10.1002/wmh3.234

#2017 Policy Studies Organization

100,000 population in 2013 (National Center for Health Statistics/Centers for

Disease Control and Prevention [NCHS/CDC], 2015).

Concurrently, drug overdose deaths in New York State, identif‌ied as

unintentional, increased twofold between 1999 and 2013 from 5.0 (Trust for

America’s Health, 2013) to 10.0 per 100,000 population (Division of Informa-

tion and Statistics/New York State Department of Health [DIS/NYSDH],

2015); involving an increase of opioid-related deaths from 1.8 to 6.2 per

100,000 population between 2004 and 2013 (DIS/NYSDH, 2015). Between 2000

and 2013 in New York City, unintentional drug overdose deaths more often

involved heroin than any other drug (New York City Department of Health

and Mental Hygiene, 2014, 2015).

New York State’s response to the rise in opioid overdose deaths included two

public health strategies to enable people who use drugs (PWUDs) and their

friends and relatives to reduce fatal opioid overdose: opioid overdose prevention

programs (OOPPs) and the 911 Good Samaritan Law.

OOPP and Naloxone

People who use drugs in the company of others are potential f‌irst responders

to aid overdose victims (Darke & Hall, 1997, 2003; Davidson et al., 2003; Lenton &

Hargreaves, 2000; Tracy et al., 2005). However, New York PWUDs have

commonly relied on nonmedical, street-informed methods such as physically

stimulating a victim, applying ice or immersing a victim in cold water, or causing

physical pain to resuscitate victims of overdose with unpredictable results

(Lankenau et al., 2013; Tracy et al., 2005). Therefore, in 2005, following the

successful piloting of medically based overdose prevention training among

participants of syringe exchange (Piper et al., 2007; Worthington, Piper, Galea, &

Rosenthal, 2006), New York State enacted New York Public Health Law §3309 to

train the public to medically reverse opioid overdose with the use of the opioid

antagonist, naloxone hydrochloride. Naloxone hydrochloride (naloxone;

EVZIO

TM

; Narcan) reverses respiratory depression caused by opioid overdose

(Kal

eo, 2015; National Library of Medicine, 2015; Taveira da Silva et al., 1983; U.S.

Department of Health and Human Services, 2015). It has no agonist properties

and, therefore, no potential for abuse. It can be administered by injection or as an

intranasal spray (Darke & Hall, 1997; Heller & Stancliff, 2007).

In 2006, pursuant to this law, OOPPs were implemented whereby medical

providers could legally prescribe naloxone hydrochloride to any person who was

trained by an OOPP for secondary administration to others to prevent or to

reverse opioid-related overdose (Heller & Stancliff, 2007; Piper et al., 2007).

OOPPs train people to recognize drug overdose, call 911, perform cardiopulmo-

nary resuscitation upon overdose victims, and administer naloxone. The New

York State Department of Health registers both agencies and providers to

administer OOPPs and provides supplies free of charge (Harm Reduction

Coalition, 2014). Registered agencies include harm reduction programs, drug

Zadoretzky et al.: The New York 911 Good Samaritan Law 319