Imagine that you’re a drug addict. (I know, it’s not a glamorous fantasy, but indulge me for a minute.) You’ve just purchased some heroin and decamped to the basement so that you and your buddy can shoot up in peace. But something goes wrong, and now your friend is overdosing. He needs help—quick—or he might die. If you call 911, you might save his life: Many first responders carry a quick-acting drug called naloxone that can reverse the effects of an opioid overdose. But calling 911 puts you at risk of being arrested for drug possession. What do you do?
This decision shouldn’t be difficult: You make the call and save your friend’s life. The fact that drug users sometimes choose not to do so in these situations doesn’t just reflect poorly on them. Their reluctance is, in part, a function of the tough-on-crime attitudes that have characterized state and federal narcotics policies for decades. In theory, the threat of incarceration is supposed to deter people from using and selling drugs. In practice, it often deters users from seeking treatment or medical assistance for fear of punishment.
These attitudes are starting to change, and lately state and federal agencies have begun to see the merits of a drug-control policy that incorporates public health strategies alongside the usual incarceration and sanctimony. On Monday, for example, the White House announced a new federal, treatment-based initiative: a $2.5 million pilot program that will bring together law enforcement officers and public health professionals to collect and disseminate information on the movement of heroin up and down the East Coast, and to train first responders about when it is appropriate to administer naloxone. “Our approach needs to be broad and inclusive,” a government official told the Washington Post’s Marc Fisher. “Law enforcement is only one part of what really needs to be a comprehensive public health, public safety approach.” No argument here. But the relatively meager budget for and scope of this pilot program—its current funding only allows it to operate for one year in 15 states—show us just how foreign this broad, inclusive approach still seems to a policy apparatus that’s been narrow-minded about drug control for so long. Hopefully these efforts will continue to grow. Meanwhile, one important tool is spreading on the state level—but it needs to spread more, and it needs to actually be funded.
For the past several years, a large number of states have been trying to stem drug-related deaths by helping narcotics users in situations like the one I described above make that fateful call. In 2007, facing an overdose fatality rate among the highest in the nation, New Mexico passed a “Good Samaritan law” that granted limited immunity from prosecution on simple possession chargers for people who dialed 911 to report a drug overdose. As of June 2015, according to the Drug Policy Alliance, 28 states and the District of Columbia had passed laws of this sort. The laws vary in scope and specifics, but they all share a similar logic: It is worth trading the chance for a low-level drug arrest for the opportunity to save a life.
Along the way, not everyone has agreed. In October 2012, for instance, New Jersey Gov. Chris Christie partially vetoed a Good Samaritan law that had been passed by the state Legislature, explaining that he was unwilling to “give people who commit harms on other people a free pass just because they picked up a telephone and called. I’m not going to do that.” No free passes for dangerous addicts has long been a refrain of America’s hard-ass lawmakers, and it’s easy to say that sort of thing if you don’t actually know any addicts. But the demographics of drug abuse are changing, and have been for a while, fueled by doctors’ readiness to prescribe highly addictive prescription painkillers. According to the Centers for Disease Control and Prevention, the number of prescription-painkiller overdose deaths in America quadrupled between 1999 and 2013. Most of the victims were white people between the ages of 25 and 54. As states and doctors have started to make it more difficult to acquire opioids like oxycodone, many pill addicts have turned to heroin, which is cheaper and easier to find.
Today, there are more white people dying of drug overdoses in America than ever before, and, frankly, this demographic shift seems largely responsible for changing politicians’ minds. In 2013, New Jersey passed another, very similar Good Samaritan bill, and this time Christie signed it into law. His reversal, he said, had much to do with a conversation he had with musician Jon Bon Jovi, whose teenage daughter almost died of a heroin overdose in her college dorm room. “We want you to save a life first,” Christie said at the time. “The deal we’ll make is we won’t prosecute or arrest [you]. I would rather you didn’t do it in the first place, but I live in the real world”—a world where the daughters of wealthy rock musicians are now at risk of heroin deaths.
In the end, of course, it doesn’t much matter how or why states pass these laws, as long as they pass them. A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before. “Despite lingering concerns about possible negative consequences of the new law, such as prosecutions being impeded, no evidence of negative consequences has been found to date,” the study concluded. Good Samaritan laws are humane and sensible. There are no compelling reasons to oppose them.
But these laws only work if people are aware of them, and that isn’t always the case. The University of Washington study found a few disturbing things: Not only were most drug users they surveyed unaware that the law existed, but only 16 percent of the cops who were surveyed knew about the law, and only 7 percent of them could say whom the law was meant to protect. One possible reason why so few people knew the Washington law existed is that the state Legislature allocated no money for its implementation and tasked no specific state agency with putting it into practice. As such, the publicity measures for the law consisted of a press conference, a few public service announcements, some earned media attention, and a website, stopoverdose.org, that got a mere 2,601 unique visitors in 16 months. Given all that, the 16 percent penetration rate seems like a triumph.
Most of the states that have Good Samaritan laws like these have only passed them within the past year or so, which means we still have a lot to learn about their efficacy. But the Washington study’s findings point toward a common-sense conclusion, one that seems applicable nationwide: If a prevention measure such as this is to work, then stakeholders must know that it exists. After New York state passed its Good Samaritan law in 2011, for example, the Drug Policy Alliance printed 1 million cards and posters that explained the law and offered basic instructions on how to initially respond to an overdose, and worked with various agencies to help distribute these materials to vulnerable populations. Low-tech solutions like these can be effective, inexpensive ways of spreading the word about the law. But states need to budget for this stuff right at the beginning. If they don’t, then they’re basically setting up their efforts to stumble or fail.
We can’t treat public health policies like magic wishes. If we really want to incorporate public health strategies into how we deal with illegal drugs, then we need to fund these programs and policies to the point where we can actually tell whether they work. There’s no reason anyone should be afraid to make that call.