Inconsistent state policies complicate response to opioid epidemic

Every day, 115 Americans die from an opioid overdose, with most victims under 35 years of age. And from 2014 to 2015, drug overdose deaths increased by 19 percent among teens. State policymakers can play a unique role in mitigating the harm, with two policy strategies emerging as particularly important in preventing overdose deaths: Good Samaritan laws (which encourage witnesses of drug overdoses to call 911 by offering legal protections to the caller) and laws governing Naloxone prescriptions (a drug that can prevent someone from dying when they overdose on opioids).

Knowledge of a state’s laws in these areas and how they match up with the intensity of that state’s opioid epidemic can bolster public understanding of available protections, and can inform policy design for states that currently lack these laws. Laws that do exist often vary from state to state, and knowledge of this variation can inform the development of more consistent laws that are appropriately tailored to the severity of the opioid epidemic in each state.

Strength of Good Samaritan laws and rates of opioid overdoses at the state level

While emergency medical services are needed immediately when someone overdoses, one study found that emergency services are called in only 10–56 percent of overdose events. Fear of criminal prosecution represents a major barrier to seeking help, especially if the caller is also using illegal substances. Good Samaritan laws provide some legal protections for people who call for help during an overdose event; policymakers hope that such laws will encourage more calls. Emerging evidence suggests that this approach may be effective. After passing a Good Samaritan law, the state of Washington surveyed opiate users and found that 88 percent were more likely than before the law’s passage to call emergency services in an overdose event.

While 40 states and the District of Colombia have Good Samaritan laws, they vary widely in the protections provided and (potentially) in their effectiveness. On one end of the spectrum, a Good Samaritan law will protect a caller against arrest; on the other end, it may merely inform sentencing, meaning that the caller can still be arrested, charged, and prosecuted. The map above shows the opioid overdose death rate for each state in 2016 and the strength of its Good Samaritan laws[1], if any exist. A longer yellow bar indicates a higher death rate, and darker blue means a more protective Good Samaritan law.

The map shows that opioid overdose death rates and Good Samaritan law strength do not pace together. Instead, three patterns emerge:

Prevention: States with protective Good Samaritan laws (dark blue) and a low overdose death rate (short yellow bar). Laws here are poised to prevent an increase in the overdose death rate.

Opportunity: States with high overdose death rates (long yellow bar) and Good Samaritan laws with minimal protection (light blue). These states have an opportunity to improve Good Samaritan laws and decrease their overdose death rate.

Matched: States with high overdose death rates (long yellow bar) and protective Good Samaritan laws (dark blue). These laws seem to be appropriately matched to the severity of the epidemic.

Accessibility of Naloxone and rates of opioid overdoses at the state level

When someone overdoses on opioids, they stop breathing. Naloxone is an overdose prevention drug that restores breathing. Importantly, Naloxone has no abuse potential and is nonaddictive. Historically, access to this drug was limited, and it could only be prescribed by a doctor to the individual abusing opioids. The CDC recommends Naloxone distribution through local community-based organizations and standing orders at pharmacies (meaning that someone could purchase it without a prescription). Early evidence indicates that expanding the availability of Naloxone can prevent deaths. Massachusetts provided Naloxone kits and training to several communities and saw overdose deaths decrease.

Today, all states have Naloxone access laws of some kind, although these laws also vary considerably. On one end of the spectrum, states allow prescriptions to third parties, meaning that a parent could get a Naloxone prescription for their child. On the other end, states remove criminal liability for having Naloxone without a prescription. The map above shows the opioid overdose death rate for each state in 2016 and which laws it has passed (if any) to increase the accessibility of Naloxone[2]. States expand Naloxone access through four laws:

1. Laws that make it possible for third parties (i.e., people who do not use opioids) to receive Naloxone prescriptions
2. Laws that protect laypersons when they administer Naloxone
3. Laws that protect prescribers and dispensers for providing laypersons with Naloxone
4. Laws that protect laypersons from criminal liability for possessing Naloxone without a prescription

When more than one of these laws are present in a state, Naloxone becomes more accessible. On the map, longer yellow bars mean a higher death rate and darker purple means that Naloxone is more accessible. As with Good Samaritan laws, overdose death rates and Naloxone access do not pace together. Instead, the same three patterns emerge:

Prevention: States that support Naloxone access (dark purple) and have a low overdose death rate (short yellow bar). Laws here are poised to prevent an increase in the overdose death rate.

Opportunity: States with high overdose death rates (long yellow bar) and laws limiting Naloxone access (light purple). These states have an opportunity to improve Naloxone access to try and decrease their overdose death rate.

Matched: States with high overdose death rates (long yellow bar) and laws promoting Naloxone access (dark purple). Here too, the laws seem to match the severity of the epidemic.

As state policymakers attempt to navigate the opioid epidemic in their states, the opioid issues team from the National Conference of State Legislatures is available to answer questions and provide additional information. As more lethal opioids—such as fentanyl, for which the overdose death rate doubled from 2015 to 2016—become more prevalent, early evidence suggests that overdose deaths will continue to rise. Our states and their policies must be prepared to meet and counter the growing epidemic.

[1] State policy data are taken from the Prescription Drug Abuse Policy System and are accurate through December 1, 2016.

[2] State policy data are taken from Prescription Drug Abuse Policy System and are accurate through July 1, 2017.