911 Good Samaritan Laws
Note. Data collected from CDC Multiple Cause Mortality. Overdose deaths include X40 – X44 (accidental), X60 – X64 (self-harm), X85 (assault), and Y10 – Y14 (undetermined intent). Deaths are divided into those involving opioids (T40.0 – T40.4 and T40.6) or those involving any substance, including but not limited to opioids.
From the years 2000 to 2020, the drug overdose mortality rate increased fourfold, from 6.2 to 27.9 per 100,000. Opioid-related deaths, specifically, increased skyrocketed from 3.0 to 20.8. In Texas, the opioid mortality rate rose from 1.8 to 7.2 per 100,00 in the same period, with provisional estimates for 2021 reaching 9.4 deaths per 100,000.
911 Good Samaritan Laws (GSLs), also called Overdose Bystander Laws, provide limited criminal immunity to people who report drug overdoses, encouraging them to call 911 even if they may be at risk of criminal consequences for drug use. To date, 99% of the United States population is protected by a GSL.
Some studies associate these laws with a 10% reduction in opioid overdose mortality. Texas adopted a GSL in 2021 called the Jessica Sosa Act, which excludes people with prior criminal history, who have used GSL immunity previously, or who have called 911 in the preceding 18 months to report a separate overdose event. Will Texas see a 10% reduction in opioid overdose mortality?
Comparing 911 Good Samaritan Laws Across States
Comprehensive policy surveillance reveals impactful differences in the provisions of these laws across both states and time. While some states adopt transgressive protections intended to immunize as many people as possible, others constrain immunity to exclude people with chronic substance use. The examples below represent just a few of the ways that states have extended or limited their GSL.
In Alabama, immunity does not extend to opioids. While the GSL inoculates persons from misdemeanor controlled substance offenses, possession of opioids is a felony.
The GSL of Illinois immunizes not only possession, but controlled substance manufacturing and drug-induced homicide.
To receive GSL immunity in Indiana, a person must administer the opioid-reversing drug naloxone to the person experiencing the overdose.
In West Virginia, the person whose overdose is reported must complete substance use disorder treatment in order to maintain immunity.
Read the review article in the International Journal of Drug Policy
Browse the data in the 911 Good Samaritan Law Inventory
Understanding Differences Among 911 Good Samaritan Laws
The chart below employs Multidimensional Scaling to visualize the relative proximity of original GSLs in each state. The closer two states are in the chart, the more provisions their initial laws share. While the chart lacks intrinsic dimensions, we may include theoretical observations in the dataset reflecting a complete law (which contains all protections) and an absent law (which contains no protections) in order to produce a completeness axis. Laws higher on this axis offer more protections. Certain features, indicated by colored regions, are unique to certain zones on the chart.
Note. Nonmetric multidimensional scaling plot of proximity among originally-ratified state 911 Good Samaritan Laws. A hypothetical state with complete protection (all offenses immunized with no burdens or exemptions) is included along with a state offering no protection (no offenses immunized, but including every burden and exemption), then the configuration is rotated so these points delineate the Completeness axis. These theoretical observations are then removed. Colored regions indicate laws sharing a common feature exclusive to that zone. States are clustered banked on ranked proximity using Partition Around Medoids clustering to create GSL groups. Five groups were selected based on average silhouette width and between-clusters sum of squares.
Cluster analysis reveals five different varieties of GSL, distinguished by their common features.
Minimal laws provide little immunity and only apply to limited quantities of opioids. States adopting Minimal laws have notable exemptions, such as Alabama’s exclusion of opioids, or Indiana’s naloxone requirement.
Narrow laws offer notable immunity, such protections from the filing of charges or arrest, but narrowly tailored to possession of controlled substances and few other offenses.
Moderate laws offer middling immunity for a modest breadth of offenses, but have no exceptions and few requirements on the Good Samaritan’s behavior.
Rigorous laws center compliance with criminal justice and law enforcement, providing substantial immunity but only for Good Samaritans who cooperate with first responders, complete burdensome treatment requirements, and who haven’t previously used GSL immunity.
Strong laws offer protection from arrest or other forms of robust immunity, including protection from violations of parole, probation, or restraining orders, with no reporting burdens or exemptions.
Selected GSL Features
Use the slider at the bottom of the chart to explore selected features of state GSLs. Notice that certain features are associated with certain zones in the chart.
Complete data, including changes in state laws across time, are available in the 911 Good Samaritan Law Inventory.
Read the article in Drug and Alcohol Dependence
Evaluating 911 Good Samaritan Laws
States adopt GSLs to encourage people to report overdoses to 911, even if they may fear legal consequences for their controlled substance use. Reporting overdoses early allows first responders to arrive at the scene sooner and potentially resuscitate more people with naloxone. As such, if these laws are effective, we should see decreases in either overdose mortality generally or in opioid overdose mortality specifically.
Note. Charts depict expected overdose mortality per 100,000 person based on GSL group, controlling for logged population, percent of male, white and rural residents, percent of residents over age 25 with a bachelor’s degree or higher education, median income adjusted for inflation, and presence of naloxone access laws. Results are based on a segmented panel Poisson regression to separately model single-state changes and changes in slope over time. Variables do not exhibit nonstationarity or multicollinearity. Statistical significance is measured using robust standard errors clustered by state.
Strong 911 Good Samaritan Laws Save Lives
Indeed, adopting a Strong GSL results in a 0.1 reduction in the logarithm of all overdose mortality and 0.09 reduction in the logarithm of opioid overdose mortality. In human terms, a state losing 15 residents per 100,000 to opioid overdose mortality would expect that number to drop to 12.5 in the following year.
Bad Samaritan Laws May Cause Harm
Except for Strong laws, most GSLs were not associated with any change in overdose mortality. However, when evaluating all overdose mortality (including non-opioids, such as benzodiazepines, sedatives, and cocaine), adopting Rigorous laws was predicted a 0.09 increase in log mortality. These laws demand compliance and emphasize the criminality of substance use, further stigmatizing people who use drugs. This may discourage them from calling 911 in an emergency.
Effects are not conserved over time
After several years, any lifesaving benefit of adopting a GSL is lost. The salience of these laws when they’re newly passed may make them more impactful, as the news media cover their implementation and advocates create new informational materials. However, over time, the novelty may diminish and knowledge of GSL immunity may attenuate.
Evidence-Based Policy Recommendations
Only strong GSLs save lives. The Jessica Sosa Act must be amended to better emulate these effective laws in order to prevent the loss of vulnerable Texans.
Remove exemptions in the Jessica Sosa Act based on the reporter’s or personal history that target the most vulnerable Texans and reinforce stigmatizing attitudes toward people who use drugs.
Strengthen the GSL with protections from arrest or charge so reporters don’t need to leave the scene of the emergency to receive immunity.
Close loopholes in the Jessica Sosa Act by extending protection to include violations of parole, probation, and other temporary supervisory conditions.
Raise awareness of the Jessica Sosa Act by commissioning informational material for distribution at state-sponsored centers providing substance use services.