The Block Island Times
http://block-island.villagesoup.com/p/1002266

R.I.’s Good Samaritan Law offers protection — up to a point

Encourages bystanders to report an overdose
By Gloria S. Redlich | May 17, 2013

Since the recent untimely death of a young man on island, community members have come together to find ways to support and protect young people here in the face of the wide-spread availability of lethal substances. Though the death in question has not been legally attributed to an overdose, the family openly stated it was because of a drug overdose.

That incident kicked off a series of public discussions, and among questions raised was what could bystanders do when witnessing an individual using potentially toxic substances.

According to the Network for Public Health Law (NPHL), people often “fail to summon medical assistance for fear of arrest.” In an effort to protect volunteers from assisting people at risk from legal liability themselves, a number of states have passed so-called “Good Samaritan” laws.

In June, 2012 Rhode Island passed such legislation, entitled “The Good Samaritan Overdose Prevention Act.” Sponsored by Rep. Frank Ferri and [then] Senator Rhoda Perry, the law, as described in a press release issued by the Rhode Island General Assembly, “protects people from both civil or criminal liability if they, in good faith,” report an incident of overdosing or if they “administer [opiate antagonists/or antidotes] to a person they believe has overdosed.”

The actual language of the law is unequivocal: “Any person who, in good faith, without malice and in the absence of evidence of an intent to defraud, seeks medical assistance for someone experiencing a drug overdose or other drug-related medical emergency shall not be charged or prosecuted for any crime under RIGL21-28 or 21-28.5, except for a crime involving the manufacture or possession with the intent to manufacture …[or] to deliver a controlled substance, if the evidence for the charge was gained as a result of the seeking of medical assistance.”

In advocating for the law, Ferri said, “Nothing should discourage anyone from trying to protect someone from dying.” Perry added, “Ultimately, saving a life is much more important than an arrest or lawsuit… This bill is about putting human lives first.” Recently reached by phone, Ferri added, “This is very important legislation; more people should know about it.”

New Shoreham Police Chief Vincent Carlone noted he was very supportive of the law, but even without it he had “always acted to protect those individuals who called in to protect someone and save a life,”  which he believes “always comes first.”

However, he was very critical of the over-availability of prescription medications, which he believes contribute to the large number of overdose deaths, a statistic which has overtaken the numbers of fatalities from traffic accidents in the country. Carlone attributed this “epidemic to the drug manufacturers whose pervasive promotions and commercials” have made these medications “household words.” He also faults physicians “for overprescribing these drugs.” He said they may be found in almost every household, and “kids are raiding their parents’ and neighbors medicine cabinets.”

Some of these pills, Carlone said, sell on the street for $30 each. “If you sell 30 of them, you make $900,” he said.

Deaths resulting from overdose have increased more than six-fold over the last three decades and now number over 36,000 a year nationwide, according to the NHPL. Close to half of these result from familiar prescription opioids such as oxycontin and hydrocodone. These, it is said, cause more deaths by overdose “than heroin and cocaine combined,” according to the NPHL.

The NPHL points out a drug overdose is “typically reversible through the timely administration of Naloxone and the provision of emergency care.” The Huffington Post reported last year that while the antidote had been used by medical responders for years, the drug was now being disseminated by public health officials, along with training, to addicts, their families, to police and firefighters.

An antidote to an overdose

In addressing the administration of an opioid antagonist to “someone [believed to be] experiencing a drug overdose,” the Good Samaritan law also protects both medical responders and bystanders who have obtained access to the antidote.

The drug Naloxone (tradename: Narcan) was developed in the 1960s. The NPHL describes it as a “prescription drug [which] is not a controlled substance and has no abuse potential.”

Dr. James McDonald of the Rhode Island Department of Health agreed, in a conversation with The Block Island Times, and noted that Narcan is known to be “completely safe” and has been used successfully to reverse overdoses of both illegal substances and prescription medications. He said that there were no adverse effects from the drug and “even if given to a patient who had not overdosed, the effects of Narcan would be harmless.”

An objection has been raised to making the antidote available: doing so may sanction drug use on some level and could discourage addicts from seeking treatment. McDonald disagreed, and wanted to remind the public that addiction was a “chronic disease.”

“Its victims may exhibit different behaviors — even aberrant behaviors — but what is important is to save lives first, [so the person may] be kept alive long enough to seek treatment,” he said.

He noted that just as individuals with allergies use Epi-pens, easy access to an antidote to a drug overdose was critical to potentially saving lives.

The NPHL identified that obstacles to wider use of the opioid reverser were embedded in “unintended consequences of laws passed for other purposes.” However, with advocacy from the Federal Drug Administration, the United States Conference on Mayors, the American Medical Association and the American Public Health Association, many states, according to the NPHL, are in the process of “removing … legal barriers to the seeking of emergency medical care and the timely administration of Naloxone,” which is delivered by injection or nasal spray.

The NPHL report suggested change might come in two ways: first through “the wider prescription and use of Naloxone,” while ensuring that both “prescribers acting in good faith” and lay administrators might not be prosecuted legally if their express intent was to reverse an overdose. The second change is through encouraging “bystanders to become ‘Good Samaritans’ by summoning emergency responders without fear of arrest or other negative legal consequences.”

As to the administration of Narcan, Chief Carlone said he has not been directly aware of its use on island, though he has observed it in use in other communities in which he’s worked. “Interestingly, when President Clinton visited the island [on August 17, 1997], when a workman here collapsed from an apparent overdose, medical personnel with the President administered Narcan to the man and revived him,” Carlone said.

Pilot project

On May 10, 2013, the Rhode Island Department of Health announced the start of a pilot program making Narcan available at four Walgreens Pharmacies in Warwick in a collaborative arrangement with Miriam Hospital. Recognizing that “addiction and the potential for overdose are serious health threats among Rhode Islanders,” the state Health Department joined with other state agencies in making the public aware of Narcan as “an antidote to opioid abuse that is available without a prescription.”

Rhode Island addicts and family members are encouraged to take advantage of the new program hoping those with substance disorders and those who care about them will seek “the treatment that can save their lives.” Overdose specialists at Miriam Hospital will provide training in the administration of Narcan — whether directly to patients or to their families and friends.

According to island physician Janice Miller, Block Island Health Services has stocked Narcan for years and has administered it “under circumstances that need to be closely evaluated.” She acknowledged that while the Good Samaritan law provides protections, it still leaves practitioners vulnerable in some circumstances.

Rescue Squad Captain Bryan Wilson concurred, pointing out that all decisions on what medications to administer on island ultimately come under the oversight of Miller. He noted that the Good Samaritan Law does not provide “blanket absolution” to medical responders and that his team “still has to work within our own protocols.”

He stressed that all calls received are held in the strictest confidence and that in the case of a potential drug overdose, it was always very important that the medical attendants have as much information as possible in order “to understand the causal factors of a medical emergency.”

To that end, Wilson strongly encouraged bystanders to report a drug overdose — especially to medical responders.

For those seeking treatment options for drug addiction or other related diseases for themselves or others, McDonald shared the following link from the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals: www.bhddh.ri.gov.

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