Since the early 2000s, the rate of drug overdose deaths in the United States has more than doubled. Overdose deaths are currently at record levels, with more than 60 percent of these deaths due to opioid use, primarily prescription pain relievers and heroin. According to the Centers for Disease Control (CDC), the United States is facing the worst drug overdose epidemic in its history.
In an effort to reduce the death toll from the use of opioids, New Mexico passed the first Naloxone Access Law (NAL) in 2001. Under this law, trained responders, such as police and firefighters, were authorized to administer an opioid antagonist (naloxone) if they believed that someone was experiencing a drug overdose. The law also said that private citizens who administer opioid antagonists would not be subject to civil liability or criminal prosecution. Since 2001, 44 additional states and the District of Columbia have adopted NALs, which allow laypersons to administer and distribute naloxone without fear of legal repercussions. New Mexico was also the first state to pass a Good Samaritan Law (GSL). Under this law, individuals who seek medical assistance for someone experiencing a drug-related overdose would not be charged or prosecuted. Since 2007, 33 additional states and the District of Columbia have followed suit, although some GSLs are stronger than others. For instance, in 23 states the law provides immunity from prosecution for possession of drug paraphernalia in addition to immunity from prosecution for possession of a controlled substance.
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Both GSLs and NALs are viewed as important weapons in the fight
against the opioid epidemic. They have received strong bipartisan
support, and prominent groups such as the American Medical
Association, the U.S. Conference of Mayors, and the American Public
Health Association also support the adoption of GSLs and NALs.
However, these laws have their critics. For instance, the governor
of Maine, Paul LePage, recently vetoed naloxone access and Good
Samaritan bills, arguing that they would encourage drug use and
hamper law enforcement efforts.
Our research is the first to examine the effects of GSLs and
NALs on opioid-related mortality. Drawing upon data from the
National Vital Statistics System (NVSS) multiple cause-of-death
mortality files for the period 1999-2014, we estimate standard
difference-in-difference models, which exploit within-state
variation and control flexibly for common shocks caused by, for
instance, the reformulation of OxyContin in 2010.
We find that the adoption of an NAL is associated with a 9 to 11
percent reduction in opioid-related deaths. The relationship
between NALs and opioid-related deaths that do not involve heroin
appears to be stronger than the relationship between NALs and
heroin-related deaths. Moreover, our results suggest that removing
criminal liability for possession of naloxone is an important
feature of these laws. Removing criminal liability for possession
of naloxone is associated with a 13 percent reduction in
opioid-related deaths, while estimates of the effect of NALs
without this provision are considerably smaller and statistically
indistinguishable from zero. The estimated effects of GSLs on
opioid-related deaths are consistently negative, but not
statistically significant at conventional levels. We do, however,
find stronger evidence that GSLs reduce opioid-related deaths
involving alcohol. Finally, contrary to the claims made by some
critics of NALs and GSLs, we find little evidence that these laws
increase the recreational use of prescription painkillers.
This research brief is based on Daniel Rees, Joseph Sabia, Laura
Argys, Joshua Latshaw, and Dhaval Dave, “With a Little Help from My
Friends: The Effects of Naloxone Access and Good Samaritan Laws on
Opioid-Related Deaths,” February 2017,