Good Samaritans or Murderers? Incoherent Policy Responses to American Drug Overdose Deaths

Overview: The prevalence of contradictory policy responses to recent exponential increases in drug overdoses is explored focusing on reactionary drug-induced homicide laws and immunity-based statutes incentivizing medical responses. Other proven and promising approaches/policies are also discussed as alternatives to the disjointed and misguided strategies currently employed in multiple states.Proposal text: Background/Rationale

Deaths from drug overdoses in the U.S. topped 100,000 for the first time in the 12-month period from April 2020 to April 2021. This marked nearly a 29% increase from that same time frame during the previous year. The increased prevalence of synthetic opioids is often cited as one of the main drivers of this dramatic increase in drug overdoses. However, opioid users are not the only people who use drugs (PWUD) dying from overdoses. The increase is also due to the adulteration of other illicit drugs with synthetic opioids like fentanyl and the prevalence of unregulated synthetic alternatives to more traditional plant-based drugs like cannabis, opium/heroin, and cocaine. Policy responses to the drug overdose epidemic have ranged from reactionary and punitive approaches to “radical” harm reduction-based approaches, until recently only available (at least legally sanctioned) outside of the U.S. This study assesses the prevalence of two common types of – and largely contradictory – state-level policy responses: Drug-induced homicide laws and policies offering immunity from drug/paraphernalia possession laws while promoting medical responses. The latter includes good Samaritan laws, syringe exchanges, and safe consumption centers. Policy responses' congruence with social work values/ethics is also discussed along with the recent implementation of more “radical” drug overdose prevention strategies in the U.S.

Methods

Using data made available from the Prescription Drug Abuse Policy System, the Health in Justice Action Lab, prior research, and news articles, states with drug-induced homicide statutes and immunity-based statutes were recorded. States with both punitive and immunity-based policy responses were highlighted.

Results

As of January 2022, 47 states and Washington D.C. had good Samaritan laws, 32 had statutes allowing syringe exchange programs (although they were operating in 39 states), and one had sanctioned safe consumption centers (although no specific statutes). Conversely, 24 states and the federal government had specific drug-induced homicide statutes. Of those 24, only Wyoming did not also have a good Samaritan law or a statute legally allowing syringe exchange programs.

Conclusions

The fact that 23 states have conflicting legislation regarding culpability for drug overdoses suggests an incoherent approach in much of the country that is often deadly. These contradicting policies make the decision to call authorities during an overdose confusing at best, as PWUD may fear prosecution, not only for drugs/paraphernalia but also for homicide. This lack of clarity is antithetical to social work values/ethics as it limits the agency of PWUD to make informed decisions and further criminalizes them, while also disregarding their inherent dignity, worth, and value as it can lead to inaction and yet another drug overdose death. As such, social workers should advocate for policies whose main function is to keep PWUD alive, regardless of how “radical” they may seem.