A drug-related Good Samaritan Law and calling emergency medical services for drug overdoses in a Canadian setting

Abstract

Background People who use drugs (PWUD) are known to fear calling emergency medical services (EMS) for drug overdoses. In response, drug-related Good Samaritan Laws (GSLs) have been widely adopted in the USA and Canada to encourage bystanders to call emergency medical services (EMS) in the event of a drug overdose. However, the effect of GSLs on EMS-calling behaviours has been understudied. We sought to identify factors associated with EMS-calling, including the enactment of the Canadian GSL in May 2017, among PWUD in Vancouver, Canada, a setting with an ongoing overdose crisis. Methods Data were derived from three prospective cohort studies of PWUD in Vancouver in 2014–2018. Multivariable logistic regression was used to determine factors associated with EMS-calling among PWUD who witnessed an overdose event. An interrupted time series (ITS) analysis was employed to assess the impact of GSL on monthly prevalence of EMS-calling. Results Among 540 eligible participants, 321 (59%) were males and 284 (53%) reported calling EMS. In multivariable analysis, ever having administered naloxone three or more times (adjusted odds ratio [AOR] 2.00; 95% confidence interval [CI] 1.08–3.74) and residence in the Downtown Eastside (DTES) neighbourhood of Vancouver (AOR 1.96; 95% CI 1.23–3.13) were positively associated with EMS-calling, while living in a single occupancy hotel (SRO) was negatively associated with EMS-calling (AOR 0.51; 95% CI 0.30–0.86). The post-GSL enactment period was not associated with EMS-calling (AOR 0.81; 95% CI 0.52–1.25). The ITS found no significant difference in the monthly prevalence of EMS-calling between pre- and post-GSL enactment periods. Conclusion We observed EMS being called about half the time and the GSL did not appear to encourage EMS-calling. We also found that individuals living in SROs were less likely to call EMS, which raises concern given that fatal overdose cases are concentrated in SROs in our setting. The link between many naloxone administrations and EMS-calling could indicate that those with prior experience in responding to overdose events were more willing to call EMS. Increased efforts are warranted to ensure effective emergency responses for drug overdoses among PWUD.

Awareness and knowledge of the Good Samaritan Drug Overdose Act among people at risk of witnessing an overdose in British Columbia, Canada: a multi-methods cross sectional study

“…Even so, GSDOA awareness and understanding alone fail to account for other contextual factors that may impact an individual’s willingness to call 9–1-1 and therefore should not be used as a proxy for GSDOA effectiveness. For example, research shows that one’s willingness to call 9–1-1 for an overdose may also depend on factors such as overdose setting (private vs. public) and previous experiences with EHS [ 24 , 81 , 82 ]. Lastly, there is no conclusive evidence about the effectiveness of Good Samaritan Laws, in part due to ongoing concerns around police presence in spite of these laws [ 34 , 36 , 82 ].…”

“…For example, research shows that one’s willingness to call 9–1-1 for an overdose may also depend on factors such as overdose setting (private vs. public) and previous experiences with EHS [ 24 , 81 , 82 ]. Lastly, there is no conclusive evidence about the effectiveness of Good Samaritan Laws, in part due to ongoing concerns around police presence in spite of these laws [ 34 , 36 , 82 ]. Police discretion and stigma can cause PWUD to be poorly treated by first responders at overdose events [ 34 , 36 ].…”

Intention to seek emergency medical services during community overdose events in British Columbia, Canada: a cross-sectional survey

“…Previous studies have assessed factors associated with calling 9-1-1 at an overdose among samples of people with variable knowledge of drug related Good Samaritan laws, which have been implemented in many states throughout the US [ 15 – 17 , 67 , 68 ]. Although our study included a substantial proportion of youth (aged 16–24), a population that has previously been identified as reticent to call 9-1-1 due to fear of criminalization and mistrust of police [ 6 , 23 , 69 , 70 ], we did not find that intent to call 9-1-1 differed by this age group (Block 1).…”

“…on the street) [ 15 , 16 , 28 ]. Additionally, a recent Vancouver study found lower odds of calling 9-1-1 among persons living in SROs compared to other private residences [ 68 ]. Bystanders to overdose in private residences may be concerned about lacking anonymity or losing housing as a result of drug use being discovered [ 91 , 92 ].…”

“…confirmation bias, recall bias, social desirability bias). Altogether, the level of intent to call 9-1-1 may be overestimated, especially considering that most participants were recruited at THN sites and those with THN training and experience administering naloxone are more likely to call 9-1-1 for an overdose [ 68 ]. Sensitivity analysis was completed using imputed datasets and, while the direction of the main associations of interest remained unchanged, associations of the outcome variable with other covariates differed.…”