MEMORANDUM OF SUPPORT OF A2063-B An Act to Limit the Use of Evidence Obtained in Connection with a Person Seeking or Receiving Health

Care for a Drug Overdose

NYAM has been advancing the health of people in cities since 1847. An independent organization, NYAM addresses the health challenges facing the worlds urban populations through interdisciplinary approaches to innovative research, education, community engagement and policy leadership. NYAM has long taken a special interest in substance use and working to improve the health of drug users. In fact, in 1955 The Academy issued a landmark report to the U.S. Senate calling for a public health approach to address addiction.1 Since then, we have continued to contribute to a growing body of work that both documents the tremendous morbidity and mortality associated with addiction and suggests effective public health responses. NYAM strongly supports A2063-B because we believe that it is a critical step in preventing the hundreds of deaths from overdose in New York each year. A2063-B, the Good Samaritan bill, would encourage witnesses and victims of drug related overdose to seek emergency assistance by establishing a policy protecting such individuals from being arrested, charged or prosecuted for drug or drug paraphernalia possession. In doing so, this bill removes one of the major barriers preventing people from seeking critically needed medical assistance. Accidental drug overdose is the fourth leading cause of death among adults in New York. 2 In New York City alone, almost 1,000 people die from drug overdose each year, more than by homicide. Between 1990 and 2000, almost 9,000 people died from drug overdoses in New York City.3 The odds of dying from an overdose are higher among Black and Hispanic males4 and among people who have only recent begun to inject heroin.5 Overall, heroin users face annual mortality rates 6 to 20 times the rate expected among their non-drug using peers, and about half of this excess mortality is attributable to overdose.6 However, heroin alone does not account for the growing problems of overdose deaths. Between 1999 and 2007, the rate of unintentional overdose death in the United States increased by 124%, largely because of increases in prescription opioid overdoses.7 In 2006, 13,800 people died from opioid overdose.8 This loss of life is largely preventable. The administration of naloxone, a medication that displaces opiates and restores breathing and consciousness, has been used for decades with great , success and few complications by medical personnel.9 10,11 Instant death from overdose is uncommon; most deaths occur between one to three hours after injection, suggesting this is a critical time for seeking assistance.12 Despite the high rates of success in treating overdose, a substantial number of people who witness overdose events do not call for help and miss the critical window in which resuscitation is possible. One study found that an estimated 85% of overdose events occur in the company of others, but no ambulance was called in about half of these cases and, in only 14% of cases, was calling an ambulance the first response to a peers overdose .13 Increasingly, research indicates that fear of police and criminal prosecution is a primary reason why help is not sought in cases of overdose.14,15,16 In one study, as many as 32.6% of people reported they would not call for help because they feared police involvement. 17 Penalizing those who seek help in cases of overdose threatens lives and does not stop drug use and abuse. The Good Samaritan bill is a critical step in saving lives and insuring that some of our most vulnerable citizens are linked to the services they need to lead productive lives. We urge you to pass A2063-B and help end the epidemic of overdose deaths.

New York Academy of Medicine, Report on Drug Addiction. Bulletin of The New York Academy of Medicine, 1955. 31(8): p. 592-607. 2 NYC Bureau of Vital Statistics, Summary of Vital Statistics The City of New York 2006. NYC Department of Mental Health & Hygiene, December 2007. 3 Bernstein, K.T., et al., Cocaine- and opiate-related fatal overdose in New York City, 1990-2000. BMC Public Health, 2007. 7(147): p. 31. 4 Galea, S., et al., Racial/ethnic disparities in overdose mortality trends in New York City, 1990-1998. J Urban Health, 2003. 80(2): p. 201-11. 5 Vlahov, S., et al., Mortality risk among recent-onset injection drug users in five U.S. cities. Sub Use & Misuse, 2008, 43(3): 413-28. 6 Worthington, N., et al. Opiate users' knowledge about overdose prevention and naloxone in New York City: a focus group study. Harm Reduction Journal, 2006, 3(19):1-7. 7 Bohnert AS, Valenstein M, Bair MJ, Ganoczy D, McCarthy JF, Ilgen MA, Blow FC. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011 Apr 6;305(13):1315-21. 8 Warner, M., Chen, L.H., and Makuc, D.M. Increase in fatal poisonings involving opioid analgesics in the United States, 19992006. NCHS Data Brief, No. 22. Hyattsville, Maryland: National Center for Health Statistics, 2009. 9 Galea, S., et al., Provision of naloxone to injection drug users as an overdose prevention strategy: early evidence from a pilot study in New York City. Addict Behav, 2006. 31(5): p. 907-12. 10 Chamberlain, J. Klein, B. A comprehensive review of naloxone for the emergency physician. Am J Emergency Med, 1994, 12:650-660. 11 Kim, D., Irwin, K., and Khoshnood, K., Expanded access to Naloxone: options for critical response to the epidemic of opioid overdose moartality. AJPH, 2009. 99(3): p. 402-407. 12 Sporer, K. Strategies for preventing heroin overdose. BMJ, 2003, 326:442-3. 13 Ibid. 14 Worthington, N., et al., 2006. 15 Tracy, M., et al., Circumstances of witnessed drug overdose in New York City: implications for intervention. Drug Alcohol Depend, 2005. 79(2): p. 181-90. 16 Williams, P. & G. Urbas, Heroin overdoses and duty of care. Trends and Issues in Crime & Criminal Justice #188, February 2001, Australian Institute of Criminology, Canberra. 17 Ibid.