To Honor Hoffman, Focus on Prevention, not the Drug War

Aggressive and mounting application of criminal prosecutions following overdose events totally thwart any positive public health impact of Good Samaritan legislation and other efforts to encourage overdose witnesses to come forward.
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As devastating details about Philip Seymour Hoffman's apparent heroin overdose are beginning to emerge, we are already hearing speculation about police efforts to identify the drug source. If and when the suppliers are found, authorities will likely use the full extent of the law to prosecute them on drug, and even homicide charges. Instead, the focus should be on preventing others from following Hoffman's fate.

To be sure, efforts to identify dealers (or friends or acquaintances) who supply deadly drugs to overdose victims are important. Just last week, officials in New York State and elsewhere in the Northeast linked the current spate of heroin overdose deaths to a deadly batch cut with fentanyl -- the powerful synthetic opioid. Concerted detective work to locate and destroy such lethal batches may ultimately save lives. But, despite enormous efforts by federal, state, and local law enforcement, spikes in overdoses involving fentanyl-laced heroin have popped up all over the U.S. since the 1990s. In the long run, it has proven impossible to control the supply and purity of heroin and other illicit drugs.

In the meantime, public health officials have used several straight-forward messages to avert overdose fatalities. These include: not using drugs alone, testing new batches for potency, buying drugs from a trusted source, and knowing exactly what to do in the event that overdose does occur. Although such "harm reduction" tips have stirred up controversy in some corners, public health researchers have successfully argued that this common-sense approach is the best tool we have to address risk among drug users. Especially when working on high-visibility cases, law enforcement officials can do a lot to increase awareness about these life-saving measures.

Conversely, high-profile prosecutions of people tied to drug overdoses can be counter-productive. Such strategies have been a mainstay of drug law enforcement for decades and appear to be gaining momentum, especially in regions hard-hit by overdose like Oregon and Wisconsin (where their number doubled between 2012 and 2013). Taken directly from a "war on drugs" playbook, these efforts have certainly put numerous drug dealers behind bars. In many jurisdictions, however, it is enough to have simply shared a small amount of your drugs with the deceased to be prosecuted for homicide, and there are certainly instances of such charges.

Research suggests that fear of criminal prosecution is the single most important reason why people who witness overdoses do not seek timely emergency medical help. This is particularly true of events that involve heroin: out of all witnessed overdoses, bystanders report calling 9-1-1 less than half the time. Such delays are especially tragic because appropriate emergency response can quickly and effectively reverse most overdoses with the administration of oxygen and -- in the case of overdoses involving heroin or other opioids -- the antidote naloxone. In other words, the fear of legal repercussions likely costs thousands of Americans' their lives each year. What fuels these deadly fears? High-profile prosecutions tied to overdose events, especially like the one currently dominating the news cycle.

In order to encourage overdose witnesses to seek emergency assistance, 17 states including New York have now passed "911 Good Samaritan laws," shielding overdose witnesses and victims from drug-related charges when help is summoned. These laws hold promise, but their impact is limited by several factors. First, they only apply to a limited set of drug possession violations, typically involving small-scale drug possession (state laws also have no bearing on criminal liability under federal law). Secondly, the vast majority of drug users, the general public, and even many police officers may not be aware of such laws. Finally, aggressive and mounting application of criminal prosecutions following overdose events totally thwart any positive public health impact of Good Samaritan legislation and other efforts to encourage overdose witnesses to come forward.

Widespread adoption and aggressive enforcement of punitive drug laws in this country has done little to reduce drug abuse. Acknowledging this, last Thursday the Senate Judiciary Committee passed the Smart Sentencing Act -- a bill to reduce or remove a number of mandatory minimums for non-violent drug offenses. In its current version, however, this bill does not address provisions used to impose 20-year mandatory minimums for supplying controlled substances that result in death or injury. Even if this specific provision is eliminated on the federal level, this will not affect state laws, nor will this necessarily impact prosecutorial decisions to target people who supply drugs to overdose victims -- sometimes bona fide drug dealers, sometimes friends or partners of the deceased. We need to abandon this approach, focusing instead on raising awareness about risk-reduction, widening the scope of Good Samaritan Legislation and finding other ways to save lives rather than fill our prisons.

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