Knowledge of the 911 Good Samaritan Law and 911-calling behavior of overdose witnesses

Background: Overdose deaths tripled between 1999 and 2014. Most fatal overdoses are witnessed, offering an opportunity for bystanders to call 911. However, fear of arrest may prevent them from calling authorities. Many states have passed 911 Good Samaritan laws that protects the 911 caller and overdose victim from prosecution for drug possession. Little is known, however, about whether the law affects 911-calling behavior of overdose witnesses. We investigated the relationship between knowledge of a 911 Good Samaritan Law (GSL) and 911-calling behavior of study participants trained in opioid overdose rescue. Methods: We enrolled 351 individuals (n = 351) trained in overdose rescue and educated about the New York State GSL in a prospective longitudinal study. Trained researchers conducted baseline, three, six and 12-month follow-up surveys with study participants to assess participant knowledge of the GSL and responses to witnessed overdoses. Results: At the twelve-month follow-up, participants had witnessed 326 overdoses. In the overdose events where the participant had correct knowledge of the GSL at the time of the event, the odds of a bystander calling 911 were over three times greater than when the witness had incorrect knowledge of the GSL [OR] = 3.3, 95% [CI]: 1.4-7.5). This association remained significant after adjusting for age, gender, race of the witness and overdose setting [AOR] = 3.6, 95% CI, 1.4-9.4). Conclusions: To our knowledge, this is the first study to show an association between knowledge of the GSL and 911-calling behavior. Legislation that protects overdose responders along with public awareness of the law may be an effective strategy to increase rates of 911-calling in response to overdose events and decrease overdose-related mortality.