Date of Award

Spring 5-17-2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Sheryl M. Strasser

Second Advisor

Stacie Patrice Kershner

Third Advisor

Ashli Anthony Owen-Smith

Fourth Advisor

Matt Hayat

Abstract

INTRODUCTION: Timely medical attention could decrease mortality following drug or alcohol overdose events, but overdose victims and witnesses often delay or fail to seek professional help because they fear police involvement. Statutes that provide immunity from criminal action may have an important impact on the likelihood of seeking timely treatment. As overdose deaths have increased despite legislative attempts to encourage contacting authorities during overdoses, other measures should be considered. In Georgia, recent legislation should make opioid antagonist products like naloxone more accessible to the public.

METHODS: The first paper systematically analyzes variability in Medical Amnesty Laws (or “Good Samaritan Laws”) across states that are designed to encourage bystanders and others to contact authorities for assistance during overdose emergencies. The second paper examines drug poisoning death rates in states with five years of data available after enactment of Medical Amnesty Laws (MALs) to determine whether drug poisoning death rates have decreased. The third paper utilizes a randomized survey of pharmacies across Georgia to report on barriers that exist for the purchase of naloxone by the public.

RESULTS: Forty-six states plus the District of Columbia have MALs, but provisions differ widely in scope. Some laws may not meet legislative goals because they lack protections, allow broad prosecutorial discretion, or are difficult to research, assimilate, and understand. Of the nine states with five years’ experience with MALs, only Washington’s drug poisoning death rates have not increased. Statistical analyses failed to find an association between MALs and drug poisoning deaths. Among Georgia pharmacies surveyed, only half had naloxone in stock, with prices ranging from $65.00 to $201.00. Approximately one-half of pharmacy representatives misstated that a physician’s prescription was required to purchase naloxone, despite a Standing Order and changes in Georgia law that removed this formerly mandated requirement.

CONCLUSIONS: Overdose immunity laws prove to be complex and may not be easily understood by the general population, making them less effective in reaching statutory goals. In Georgia, certain barriers to the purchase of naloxone persist despite recent legislative changes, making it less likely that those who may need a safe, easily administered form of naloxone will obtain the product. Findings from this research reveal an important opportunity to understand how policy goals can be more strongly aligned with diverse stakeholder groups’ knowledge, needs, and interests - from professionals to the public.

Available for download on Wednesday, April 22, 2020

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