Legislative Priorities

Good Samaritan Laws

In the Gospel of Luke, Jesus tells a story of a man who was robbed, beaten, and left to die on the side of the road. The first two bystanders to see this man do nothing to help. Finally, a Samaritan traveler came along the road, saw the dying man, and had mercy on him. He took care of him and supported him through his recovery. This is the story of the Good Samaritan, and Jesus uses this story to define a neighbor. Iowans are rooted in the midwest values of being a good neighbor. Is it a coincidence that we title policies focused on bystanders showing care for their loved ones as Good Samaritan laws? But Iowa’s current Good Samaritan law needs changes that will reflect the true definition of a neighbor.

“Which of these three, do you think, was a neighbor to the man who fell into the hands of the robbers?” He said, “The one who showed him mercy.” Jesus said to him, “Go and do likewise.”

– Luke 10:36-37

Read the proposed bill language

Under Iowa’s current Good Samaritan Law what happens to Iowans who overdose and those around them are too afraid to call 911?

The Story

These four scenarios show who Iowa’s current Good Samaritan Law protects, and who is left unprotected in the instance of an overdose.

Scenario 1

It’s a Friday night, and Josh and Chris decide to invite some friends to their dorm to hang out before heading to a house party. Mostly they’re drinking beer and a little whiskey, but someone brought some H to share too. Josh takes the first hit, and it’s way stronger than they expected. You can’t always trust the stuff around here. Josh becomes unresponsive, and his lips are turning blue. They’ve all been drinking and nobody’s thinking straight. They’re scared. Chris is on the last leg of his probation from when he got caught drinking last year and is scared he’ll go to jail. He’s only 19, and the only thing he knows about prison is what he’s seen on TV and in movies. Someone has Narcan and starts to administer it. Chris begs his friends not to call the cops. They hope they have enough doses of Narcan on hand to save their friend.

What could happen next?

  1. Chris is on probation, so he will likely go to jail if they call 911 because he has been drinking underage.
  2. Josh may have been brought in for an overdose before. Iowa’s Good Samaritan Law only gives a person who calls immunity once. If his friends call 911, he could go to jail.
  3. They may be too afraid to call 911. If they don’t have enough Narcan on hand, Josh will likely die.

Scenario 2

Jordan lost his job this year after accidently getting his arm caught in one of the machines at the farm equipment factory he worked at. He was prescribed pain meds for about 6 months as he recovers, and got used to feeling “normal” on the medication – no pain in his arm, and he doesn’t have to feel so terrible about being out of work. He loved his job. He loved being able to provide for his family. Eventually, the doctor cut him off his medicine, but Jordan felt like he couldn’t live without it. For a while he was able to buy the same medicine from a friend who wanted to help out, but without his weekly paycheck coming in, he starts buying heroin. It’s much much cheaper. He overdoses for the first time, but fortunately, his wife Ashley was in the house and called 911. As he’s been working on his recovery, their family, friends, and pastor have all been extremely supportive – they know recovery is a process. He’s had a few bumps in the road, but each time, he’s been able to work his way back to abstinence. Jordan still hasn’t been able to find a new job, and they’ve been having a tough time making ends meet. Jordan relapses and overdoses again – he doesn’t realize how low his tolerance has gotten. Luckily, Ashley is home again, but she’s so scared to call 911. She knows that under Iowa’s current Good Samaritan law, both she and her husband have used their one chance at immunity.

What could happen next?

  1. Ashley is desperate to keep her husband alive. Jordan has been working hard on his recovery, and clearly wants the chance to live. Jordan has been brought in for an overdose before. Iowa’s Good Samaritan Law only gives a person who calls immunity once. If Ashley calls 911, he could be arrested.
  2. Ashley has already called 911 for Jordan before. The drugs and supplies Jordan used are in their house. What if they arrest her too?
  3. Ashley may be too scared to call 911. If Jordan doesn’t get naloxone, he will likely die.

Scenario 3

Childhood friends Emily, Maddy, Sarah, and Jessica are back in their hometown for Christmas break. Sarah’s parents are at a holiday party, and so the girls rummage through her parents’ medicine cabinet and find an old bottle of Hydrocodone. They’ve been drinking and have heard it can be fun to mix the two. After a little while, Sarah gets groggy and falls asleep. She doesn’t respond when Emily yells her name, and Maddy notices that her skin begins to turn blue. She starts to make quiet gurgling noises. They’ve never seen an overdose and don’t know what it looks like, but Sarah’s never passed out from drinking before, and they want to make the safest choice. They call 911. They all stay to wait for the ambulance, and they cooperate with the police who show up. They each had their roles: Jessica helped Sarah keep her airway open and kept her in the rescue position in case Sarah threw up. Maddy researched Sarah’s symptoms and called the poison hotline. After the police arrive, they learn that technically, Sarah wasn’t overdosing. No one is protected from arrest under the law. They’re scared – what if they get kicked out of school? Jessica is studying pre-med, and Maddy wants to be a history teacher. Emily is on a basketball scholarship. Sarah just transferred to her dream school after doing so well in her Freshman classes.

What could happen next?

  1. None of the girls knew how to recognize an overdose, but wanted to play it safe. Now, because Sarah wasn’t actually overdosing, none of the girls are protected under Iowa’s Good Samaritan law. All of the girls could face criminal charges, including Sarah.
  2. The next time they think someone is overdosing but aren’t sure, they may decide not to take the risk of calling 911. If the person is in fact overdosing on this occasion, and without getting the help they need, the overdose will be fatal.

Scenario 4

Jake is a veteran who never felt the same after his overseas tours. He’s had a tough time finding work, and just can’t seem to connect with civilians. He is in and out of homeless shelters, but mostly camps outside. He has a friend, Steve, who camps nearby and is a veteran too. They didn’t serve together, but they more or less understand each other and help each other out when they can. They’ve both found out that opioids can help them sleep through the night. Jake has been trying to get treatment, but can’t always afford the bus ticket to get to the clinic. Steve never goes to the doctor, and says he’s “strong enough to fight this himself.” One day when they are sharing a supply, Steve falls out and is barely breathing. Jake has an outstanding warrant on his name for failing to appear in court. Living on the street, you run into the cops a lot, and Jake’s been in trouble for all sorts of things – loitering, public intoxication, you name it. Jake doesn’t think he would survive in jail or prison. He doesn’t know what kind of person he’ll become there. He calls 911 and runs away, even though he knows he should stay and give rescue breaths. He’s scared for his friend. He prays 911 will get there in time – before its too late. Going without oxygen for so long will mean that his friend could slip into a coma, suffer permanent brain damage, or die.

What could happen next?

  1. If Jake were to stay and wait for the emergency responders, he would be sent to jail for having a warrant for his arrest. Since he didn’t wait, 911 may have difficulty finding Steve without the help of a 911 caller. They may not get there in time, and Steve could die.
  2. Without a bystander, Steve will not receive rescue breaths until 911 arrives. Rescue breaths in that time could be all the difference in preventing Steve from having permanent brain damage, or even dying.

The Current Narrative

What would happen in these stories if instead of doing drugs, our characters had eaten too much, stressed too much, or smoked too much? A heart attack.

If they continue the behaviors that led to heart disease? Another heart attack.

Say someone is there each time. They’d see their loved one dying and would not hesitate to call 911. First responders will come to stabilize them and take him to the hospital.

  1. Each person would get another chance.
  2. No one will go to jail. That possibility never crosses their minds.
  3. Physicians will warn them to change their behaviors but change is hard. Everybody knows that.

In our stories, our characters used drugs. They overdosed.

If they continue the behaviors that led to overdose? They may overdose again. Does that mean they shouldn’t have another chance to survive?

Unless our bystanders eliminate everyone from their lives who may use drugs, and never go anywhere where there is a possibility someone else may be using drugs, they could witness another overdose. If they do and call 911, they could go to jail.

In each story, someone is there to witness the overdose. Our characters see their loved ones dying, but struggle with the decision to call 911. For some, there’s hesitation. For some, there’s avoidance. For some, there’s potential regret. They’re pushing what should be done first to the end of the list.

There’s a fairness issue in Iowa. Should the response to one of these scenarios really be this dramatically and tragically different from the other? We want to live in a world where everyone gets a second chance (or a third) at staying alive, and we know that most Iowans want this too.

Changing the Narrative

People who use opioids, either prescription pills or heroin, often use these substances around other people. If they overdose, these are the people who could be calling 911, even if they administer naloxone. However, in our state it’s not a clear decision. There are risks. IHRC conducted a 2019 survey of people who use drugs and who live in Iowa to understand if people are taking advantage of the current Good Samaritan Law when witnessing an overdose. Every person who was asked – 174 people – said they will not call 911 because the risk of arrest is too great.1

These are some of the reasons why:

  • They may have done it once already. In Iowa, you get a pass the first time you call for help. This is called immunity. If it happens again though, law enforcement can arrest you for possession of drugs or paraphernalia.
  • You are required to give your full name and contact information. This is intimidating considering the potential for arrest.
  • You are not covered by the law if you have a warrant for arrest.
  • The person who experienced the overdose is not covered by the law at all and could be arrested.

To save lives, Iowa must embrace the truth that substance use is a disease. Iowa’s Good Samaritan Laws should be about rescuing patients instead of arresting criminals.

In 2017, more than 70,000 people died from drug overdoses, making it a leading cause of injury-related death in the United States. Of those deaths, almost 68% involved a prescription or illicit opioid.2

Here’s another way to say it.

In 2017, hundreds of thousands of Americans lost their loved ones to a disease. A brother, sister, mother, father, son or daughter. A cousin or a friend. For the ones who died in Iowa, people may have been there who could have helped but were scared to. Death was the consequence.

This isn’t a new idea

The majority of states have changed their narrative and thus, the fates of many.

17 states with a Good Samaritan Law protect against arrest for controlled substance possession and drug paraphernalia laws.3

The laws are most effective at encouraging people to call 911 and lead to lives saved when:

    • Immunity is extended to all bystanders on the scene, not only to the individual in crisis and the individual who called 911.
    • Bystanders are protected from parole violations and warrant searches in addition to receiving immunity from criminal charges. Any perceived risk to the freedom or safety of the bystander reduces the probability that 911 will be called.
    • Police officers and other first responders are well informed as to their liabilities and responsibilities when responding to an overdose as outlined in their state’s 911 Good Samaritan Law and other state and local regulations.
    • People who use drugs are well informed about the 911 Good Samaritan Law and have reason to trust that those protections will be consistently afforded to them when they call 911.
    • The hospital experiences of people who use drugs are strengthened and improved.Individuals in crisis will not call for emergency care if they don’t want to be transported to the hospital due to previous maltreatment.4

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Additional Resources

(1) Caldwell, Joe. (2019). Iowa Health Survey: Survey and Focus Group Findings. [PowerPoint Slides]
(2) Davis C, Chang S, Hernandez-Delgado H. Legal interventions to reduce overdose mortality: naloxone access and overdose Good Samaritan Laws. Edina: The Network for Public Health Law; 2017.
(3) Prescription Drug Abuse Policy System (PDAPS). Good Samaritan Overdose Prevention Laws [database]. Retrieved from: http://pdaps.org/datasets/good-samaritan-overdose-laws-1501695153. on December 13, 2019.
(4) Centers for Disease Control and Prevention. Evidence-Based Strategies for Preventing Opioid Overdose: What’s
Working in the United States. National Center for Injury Prevention and Control, Centers for Disease Control
and Prevention, U.S. Department of Health and Human Services, 2018. Accessed [February 1, 2020] from http://www.
cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf.