SSDP Submission on the Drug Overdose (Assistance Protection) Legislation Bill:

I – Overview Statement

Students for Sensible Drug Policy New Zealand (SSDP) is a student and youth focused group with the vision of ‘an Aotearoa free from drug related harm’. We are writing to you in response to the Drug Overdose (Assistance Protection) Legislation Bill. We strongly support this bill.

We believe strongly that political and policy-related decisions should be backed by science and evidence.

We believe that as written, this Bill will ensure that people who use drugs will not undergo any further harm through legal means during a time of crisis, and that this bill will not encroach on the ability of police to prosecute parties for more serious criminal activity. This Bill represents what is colloquially referred to as a ‘Good Samaritan Law,’ which provides bystanders to overdose the certainty that they can call emergency services to save a life without fear that the victim, caller, or any bystanders will be prosecuted for low level drug offences such as:

• Possession of drug paraphernalia.

• Possession, procurement, or use of controlled drugs.

• ‘Social sharing’ of substances (i.e., the giving of a small amount to a friend, or splitting drugs between a group).

  
  

These noted low level drug offences cover typical illicit actions of people who use drugs but do not venture into drug supply or organised criminal activities. We note that defining social sharing can be difficult, however, we believe that the definition posited of providing substance to no more than five people, at no more than an amount at which is currently presumed to be for supply, is a reasonable definition. A neat balance may be achieved here for both harm reduction and a retention of anti-distributional efficacy with this definition.

II – Evidenced Positions

While many submissions on this Bill will highlight the human face of drug harm in this country, we thought it pertinent, as a group of students and academics, to highlight the scientific merit and evidence base for this proposed law, with a particular focus on three key points:

The severity of drug harm in New Zealand.

We lose three kiwis every week to accidental overdose. This number is only coronial data and does not include the many other types of non-fatal drug harm that may lead to engagement with emergency services, such as falls while intoxicated, non-fatal overdoses, the appearance of acute adverse effects, and severe psychological distress and mental health problems. We do not have good data on the prevalence of these latter events, but they regularly occur and undoubtedly require prompt response.  

We have also seen a considerable nationwide increase in the use of methamphetamine, cocaine, and other drugs in New Zealand, with a large increase in shipments from producer regions known to be cutting this supply with fentanyl and other highly potent opioids. We have identified the presence of this supply on our shores via drug checking, and we know this increase is going to continue We must act now rather than waiting for more deaths to occur.

There is a clear need for further measures to reduce drug harm in New Zealand, and a real risk that current global developments may lead to a worsening of drug harm that needs to be addressed proactively.

There is strong evidence to suggest that when drug related harm does occur, individuals present are fearful to call for help.

A study from Te Puna Whakaiti Pāmamae Kai Whakapiri, the New Zealand Drug Foundation, found that ~39.6% of respondents would be fearful to call emergency services were someone with them to experience an adverse drug reaction. This finding is unsurprising to SSDP and our members – many of whom have had such experiences themselves or know people who have experienced this firsthand.

Research from overseas has found similar results, with historic injustices and maltreatment towards people who use drugs resulting in a mistrust of police, and a fear of arrest and maltreatment; thus, leading to greater fear and hesitation around reaching out for help (Latimore & Bergstein, 2017). The stigmatisation and criminalisation of people who use drugs has led to mistrust and made many fearful to call for help, exacerbating drug harm. Measures to address this will help rebuild trust and support a health‑based approach to drug harm in New Zealand.

Good Samaritan laws help reduce overdose deaths.

Evidence from the United States and Canada shows that Good Samaritan laws are highly effective at increasing emergency call outs and reducing overdose deaths. Such laws have now been implemented in 41 US states (Latimore & Bergstein, 2017) as well as Canada (van der Meulen & Chu, 2022), where much of the research has focused due to the North American opioid crisis. An evaluation of the Washington Good Samaritan Law found that 88% of people who use opiates surveyed were more likely to call emergency services once made aware of these legal protections (Banta-Green et al., 2011). A longitudinal study in New York State found that when the caller had correct information about, and was aware of their Good Samaritan Law, it led to more than a tripling in their likelihood to call emergency services (Jakubowski et al., 2018).

This increase in calls, unsurprisingly, leads to a reduction in deaths, with a 15% reduction in deaths in the United States due to the implementation of Good Samaritan Laws (McClellan et al., 2018). Notably, the reduction of deaths of African Americans was 26% (McClellan et al., 2018) which likely reflects a history of victimisation by police forces.

Considering that Māori are at significantly greater risk of overdose in New Zealand and typically have a greater fear of police due to past injustices, we may see similarly greater benefits to Māori here, directly addressing our inequity in drug harm. If similar benefits are seen here, this proposed law has the potential to save over 25 lives a year – every fortnight that’s another sister, brother, uncle, or daughter still here with us.

III – Suggestions for the Bill

Considering the above, we strongly support this bill as it identifies and effectively addresses a clear need within our communities. In line with this support, we have two suggestions that may increase its effectiveness:

1)    Clear, full communication to effect public awareness

Much of the research on the effectiveness of good Samaritan laws finds that several factors strongly impact their efficacy. One such factor may be a general mistrust of police by people who use drugs, as well as a lack of awareness of the legislation. To truly maximise the effectiveness of this legislation, we recommend investigating measures to increase public awareness of the legislation and additional polices such as limiting police involvement in drug related call outs unless necessary. We note that this has been successfully implemented in British Colombia, and posit it is worth considering as an additional policy change to boost the effectiveness of this proposed legislation here.

2)    Expand protections to include other instances of harm, not just overdose

While overdose is the key focus of the conversation around this bill, it is important to remember that drug use does not occur in a vacuum. Harms in contexts where individuals take drugs aren’t always narcotics related, and parliament should consider broadening this bill to all emergency call outs where drugs are present at the scene, regardless of whether drugs are involved in the call out itself.

If someone experiences an overdose from alcohol or falls and hits their head at a party or festival where drug use is occurring, it does not appear that this bill would currently give bystanders to those events any certainty of their legal immunity.  This lack of clarity will cause people to continue to fear acting in such circumstances. This should be considered in the development of this legislation, as it will reduce further harm to all New Zealanders, and it will make the application of this law much simpler. Police will not have to work out if the event is drug related or not at the scene, or whether or not the Good Samaritan law is applicable.

IV – Addressing Misunderstandings Around the Legislation

Throughout our process of writing this submission, we have reviewed some of the remarks from members of parliament surrounding their concerns with this Bill. Some of these appear to represent misunderstandings around what this Bill is, how it works, and the evidence base for similar such Bills. We wish to address some of these misunderstandings.

Minister Costello noted that, in her opinion, it is rarely fear of prosecution that prevents call outs, but a lack of awareness of the severity of a patient’s condition. Many other members also noted that they could not understand why someone would worry about criminal prosecution when a life is in danger. Although often it may be, in part, a lack of awareness of the severity of a person’s condition that can make them less likely to call an ambulance, the threat of prosecution exacerbates any inhibition surrounding the decision. The internal monologue for many is not ‘should we risk prosecution to save a life,’ but rather ‘should we risk prosecution if we’re not sure they need an ambulance.’

Often it is more about their concern for any risk to the person experiencing the overdose, rather than to themselves. It is in these cases where uncertainty abounds that this legislation will be most helpful. SSDP agrees that addressing this lack of awareness, as well as implementing further prevention and education efforts stated by other ministers is important. However, such measures should come in addition to this legislation, not in place of – we need to implement as many safety mechanisms as possible.

Notably, members raised that Police already have discretion and that arrests at overdoses are rare. The rarity of arrests at overdoses has also been illustrated overseas (Banta-Green et al., 2011), which we are inclined to support. However, whether these arrests are statistically likely to occur is beside the point for an individual undergoing a stressful and potentially life-threatening situation – it is not arrests themselves that slow down or prevent the calling of 111, it is a fear of being arrested that does. This law signals safety to people acting as heroes in a situation where they may have otherwise hesitated to do so.

And finally, it has been supposed by some that this legislation may result in an increase in drug use by making it safer. However, overseas studies have found that such legislation does not result in any increase in drug use (McClellan et al., 2018). This argument is often made against the implementation of harm reduction measures, but evidence suggests that such measures do not typically result in any increase in usage. We suggest that the public safety implemented by such legislation outweighs the likelihood of an increased public interest.

V – Conclusion:

One thing that seems to be clear in this set of issues, is a disconnect between government policy, what is known and understood by everyday New Zealanders, and what still needs to be done. Citizens still fear or have partial or total lack of access to health and social services for drug harm reduction, such as drug checking or addiction therapies. And the same is true of our laws surrounding Police discretion in the prosecution of drug possession; and of course, regarding this proposed Bill. The intention of this Bill is not to reduce prosecutions in instances where they are justified and necessary, but to remove fear from concerned and brave people who may need to call emergency services for someone experiencing an overdose, or any other type of drug harm. We continue to lose too many kiwis to drug related harm.We at SSDP are thankful to see a pragmatic, sensible, and evidence-based piece of legislation that will undoubtedly save lives in New Zealand.

To all those who have experienced drug harm themselves and those who have lost those close to them, our thoughts are with you.

References:

Banta-Green, C. J., Kuszler, P. C., Coffin, P. O., & Schoeppe, J. A. (2011). Washington’s 911 Good Samaritan drug overdose law-initial evaluation results. Alcohol & Drug Abuse Institute, University of Washington.

Jakubowski, A., Kunins, H. V., Huxley-Reicher, Z., & Siegler, A. (2018). Knowledge of the 911 Good Samaritan Law and 911-calling behavior of overdose witnesses. Substance Abuse, 39(2), 233-238.

Latimore, A. D., & Bergstein, R. S. (2017). “Caught with a body” yet protected by law? Calling 911 for opioid overdose in the context of the Good Samaritan Law. International Journal of Drug Policy, 50, 82-89.

McClellan, C., Lambdin, B. H., Ali, M. M., Mutter, R., Davis, C. S., Wheeler, E., ... & Kral, A. H. (2018). Opioid-overdose laws association with opioid use and overdose mortality. Addictive behaviors, 86, 90-95.

Van der Meulen, E., & Chu, S. K. H. (2022). “The law doesn’t protect me”: examining the effectiveness of good Samaritan drug overdose legislation. Substance Use & Misuse, 57(9), 1392-1399.