How much compromise is too much? It's a question that plagues policy advocates when their champion legislation is watered down or stuffed with pork in legislative committees. For advocates who fight for 911 Good Samaritan and naloxone access laws to prevent drug overdose deaths, the decision on what to do with a bad bill can be tricky, as lives literally hang in the balance. If a good bill is altered too drastically during the legislative process, advocates may be forced to hit the kill switch.
In 2010, advocates for a 911 Good Samaritan bill in Illinois faced some tough decisions on compromise. Kathie Kane-Willis, Director of the Illinois Consortium on Drug Policy at Roosevelt University, says that their bill unanimously passed the Senate, but once it got to the House "it was a dog fight."
Some issues of contention were the amounts of drugs covered under the immunity (15 grams of any drug in the original bill) and whether to include language stating that people would only be protected from possession of drugs, not for selling or supplying. Under an existing Illinois law, a person who supplied a drug could be charged with homicide if someone overdosed on that drug and died. some lawmakers insisted on re-iterating that law in the 911 Good Samaritan bill.
"We [advocates] knew where our stopping point was," said Kane-Willis. "If the bill would have mandated drug treatment, we were ready to pull the plug. But we were willing to compromise on the amounts of drugs covered under immunity and also to re-state the existing Illinois law on drug-induced homicide. Now at least we have a law we can build on."
Pennsylvania is facing similar dilemmas as three separate overdose prevention bills navigate the legislature. David Humes, who helped pass overdose prevention laws in Delaware after his son died of an overdose in 2012, supports House Bill 2090. HB 2090 is a bipartisan bill that grants broad immunities to people who seek help for an overdose and also includes provisions to expand access to naloxone, a medication that reverses opiate overdose. But Humes is concerned about other bills, such as SB 1164, a 911 Good Samaritan bill supported by Pennsylvania prosecutors. SB 1164 requires that several conditions be met for a person to receive prosecution immunity for drug possession, including that the person must reasonably believe he or she is the first to call 911, provide full name and location to law enforcement officers, and remain with the victim until help arrives. This bill also does not protect drug users from being arrested or charged with drug possession.
In a letter to the bill sponsor outlining his concerns, Humes writes:
"The primary goal of any 911 Good Samaritan type law should be that the call to 911 be made to save a life... When time is critical to saving a life, [individuals] may not have time to consider whether they meet five conditions to receive immunity. This may discourage them from making the call to 911."
Humes says he would rather pass no bill at all than see SB 1164 become law. "If a bad 911 Good Samaritan bill gets passed, my fear is that it will become history and it won't be amended to make it better," he says.
If SB 1164 dies due to lack of support from the very people who advocate for overdose prevention legislation, it won't be the first. Missouri advocates recently allowed a 911 Good Samaritan bill to die because of problems with its language. Due to powerful lobbyist in law enforcement and legislators who take a hard stance against drug use, it can be difficult to pass policies whose primary focus is to save lives.
"The biggest battle we face [as overdose prevention advocates] is ignorance and stigma about drug use," says Chad Sabora of the Missouri Network for Opiate Reform and Recovery. "We need to take it slow, educate legislators and walk them through concepts like harm reduction. We need to meet them where they are at. Sometimes that means giving a little and taking a little."
Missouri recently passed a naloxone access bill that demonstrated what giving a little and taking a little might look like. The original bill expanded naloxone access to first responders and third parties (lay people who can administer naloxone to friends and family experiencing an overdose), and provided funding for naloxone. But the version that eventually passed was stripped down to include only first responders.
"Next year we'll work on an amendment for third parties," says Sabora. "Then maybe the year after that we'll go for funding. I wouldn't want to put funding on a bill now and kill the whole thing."
Ultimately the decision on whether to compromise and how much should be determined on a case-by-case basis. Each state has a different political climate and bills that might pass easily in one state could face contention in others. That's why it's so important to have strong advocates on the ground to ensure that while 911 Good Samaritan and naloxone access legislation may be compromised, their life-saving purpose will not.