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Discussion

We found that police officers have limited awareness of the Good Samaritan law in Washington State, that they report attending overdoses primarily to ensure the safety of medical personnel, and that they rarely arrest overdose victims or witnesses, although they do confiscate drugs and related paraphernalia with some frequency. In an informal check of the validity of these findings, we compared the results to parallel surveys conducted with paramedics and found good concordance. Similarly, based on a 2011 survey at Seattle area syringe exchange programs with 355 heroin users, 62 % reported police presence at the most recent witnessed overdose to which paramedics responded; just one person reported to have been arrested.20 The majority of heroin users surveyed (88 %) indicated they were more likely to call 911 during a future overdose after being informed about the law.

While we focused on heroin users for this study, the majority of fatal opioid overdoses actually now involve pharmaceutical opioids (usually with other drugs) with the sources of the drugs, motivations for use, and legality of use often unclear.1,21 Interventions that include opioid overdose education, including local laws, may become even more important as indicators suggest a transition from pharmaceutical opioids to heroin in the research literature and mass media.22–24 Indicator data also point to recent increases in heroin use and among young adults in particular.2,25 These younger users may not have hardened perceptions of law enforcement, so messaging directed at them prior to their first encounter with law enforcement may be valuable.

Most police and paramedics surveyed believed it was important for police to be at the scene of an overdose to help ensure the safety of medical personnel. This finding is important in light of concerns expressed locally and in the research literature about the presence of police at the scene of an overdose. Importantly, just a third of police felt it was important to be at the scene of an overdose to enforce laws. Some may view this as still too high a proportion and raises the point that the immunity provision in Washington State is quite narrow, whereas several states passed legislation in 2013 with broader immunity such as New Jersey which provided protection from revocation of probation or parole. A quarter of police did confiscate drugs or paraphernalia when arrests were not made. The perceptions and motivations of all of the players at overdose scenes would ideally be made transparent in order to promote public health. There is evidence from another major US city that medic response to emergencies is delayed in overdose cases while medics wait for police to arrive, this may not be the case in Seattle which has a dense urban environment and very rapid response times by both police and paramedics. However, this issue is an important one for communities to grapple with in a proactive manner. While fear of police is often cited as a concern during overdoses, anecdote and some research also point to positive experiences between drug users and first responders at overdoses.

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