The stigma associated with substance use disorder is so prevalent in this country that it is interfering with writing good overdose legislation. Most states with 911 Good Samaritan Overdose Laws which give immunity to the victim and caller exclude the very individuals that social agencies are trying to reach.The rest of the states simply do not have a law to address calling 911 during an overdose situation and neither is there a Federal 911 Good Samaritan Overdose Law for protection. These individuals are left to fend for themselves and the public looks away. Legislators will proclaim that expanding naloxone for preventing overdose and saving lives is a victory and the recent approval of premeasured naloxone by the Food and Drug Administration (FDA) is a blessing for all those that will get it, but without a wide reaching 911 Good Samaritan Overdose Law, will individuals get naloxone when needed?
When non inclusive 911 Good Samaritan Overdose Laws are written and passed, individuals may still be arrested when calling 911 during an overdose. Therefore those facing a life and death overdose situation chance it; they hesitate, panic and do not call 911. They do not want to bring shame or embarrassment to their family, friends or co-workers and they certainly do not want to be called a criminal. They know what will happen if they get busted; so they leave the "addict" alone and may never make the 911 call.
This callousness is evident in everyday conversations, media reports and online comment sections. Politicians regularly refer to the "addict" as a criminal who needs to be remanded even in the last hours of death. District attorneys convince legislators that they cannot do their jobs if the 911 Good Samaritan Overdose Law is expanded to include everyone as they need to make arrests to get the drugs off the street. The general public agrees. The public is already tired of the headlines and reading about heroin and overdoses. They want the problem to just go away already. Just enact the laws, any laws, make arrests and be done with it.
Overdose and substance use disorder is not going away and neither is it an easy fix. Enacting good legislation is difficult and getting the correct follow up information out to the public takes marketing, communication, education and money. Money and time that we do not want to spend. Allowing naloxone to be readily available will help to reduce the number of overdoses from opiates and heroin but only if it is on hand, a family requests it and it is used. But naloxone is not an instant guarantee, mouth to mouth CPR may need to be done and 911 needs to be called. Many young people and their families have no idea how quickly a crisis can happen. They do not know to administer mouth to mouth CPR and are not familiar with naloxone, why would they be?
Most doctors don't ask patients about substance use and neither do families openly discuss alcohol and drug use. Individuals hide their true substance use from their doctors, schools and employers as well as other family members. High school students and college students go to school every day, head out to sports and work and never tell their parents about the substances they are using. From many parent's perspective, it happened so fast, that there was no way to stop it. Yet not all will develop a problem with alcohol or drugs, only some will. Those are the ones that are blamed.
Young and old alike do not believe that substance use disorder can happen to them and neither does anyone want to be stigmatized as a drug user. Surveyed if a drug clinic or needle distribution center should be built nearby and a petition to prevent it will form. The negative message is everywhere; the news, the internet, parents, teachers and friends. If you use, you are bad. And if you use heroin, you are even worse. Adolescents in particular hide their escalating use from parents and try to help each other instead. But young adults do not have the resources to do it on their own, and the shame makes them shy away from the very people who could help them. Adults are no different, alcohol dependence is masked, actual drug use is minimized and the continued silence is kept. We are conditioned and taught to detach, to make it alone. That strategy has not worked -- we have detached much too long.
There are no widespread public service announcements to call 911 for overdose, no CPR training, no posters or bulletin boards in subway stations, no bus advertisements and no pharmacy ads for naloxone. The schools, which used to try to do their part, are so strapped with other commitments that services for truly informative drug and alcohol education is limited. Community centers do not provide in depth education and health services are hard to find. When services are found, they may be too expensive or have waiting lists so long that families never return. Even with the passage of the Affordable Care Act, insurance may not cover the recommended care. Pediatricians, primary care physicians and even emergency room physicians rather devote their time and effort on other patients. It is easier to leave the drug treatment to the criminal justice system after all what the patient used was against the law. Instead of quality care for substance use disorder, the largest provider of drug rehab has become the court system. But the courts are not medical facilities, judges and lawyers are not doctors and outdated rehab programs mandated by judges have not decreased substance use disorder or overdose deaths. When choosing to care for substance use disorders and mental health issues through the criminal justice system, we must recognize that there is a greater crisis here, a crisis of indifference and disgust.
Families who have lost a child to drug and alcohol use as well as grassroots organizations try to warn others of the dangers of substance use disorders. They attend meetings to spread the word about overdose, shame and compassion but when others secretly believe that somehow these children were criminals, people do not listen. The problem is overwhelming and it is easier to close our eyes and let legislators enact the laws that they want and get the "addicted criminals" off the street. If we look past the criminalization aspect and listen to the health aspects we may begin to make headway in solving substance use disorder and protecting individuals from death. The next victim just may be your friend, your child or grandchild.
Overdose legislation needs support so that naloxone is available to all of those that may need it. 911 Good Samaritan Overdose Legislation needs support so that anyone may call 911 to report an overdose without fear of arrest. It is a fallacy that parents think that it can't happen to their child; they hope that their child is not the next victim. Parents may try to do everything right, but when society continues to treat alcohol and drug use as a crime instead of an openly discussed health issue with legislative support, parents have reason to worry and hide. We all do.
Check where you state falls in enacting naloxone legislation and 911 Overdose Good Samaritan Laws
NY State Limited 911 Overdose Poster - Sample Poster- Available in Spanish as well and NY OASAS brochure