New Good Samaritan protections for people who administer naloxone
On 18 February 2016, the Minister for Health Simon Corbell MLA announced that the Legislative Assembly for the ACT had passed new laws to provide legal protection for people who administer the life-saving overdose reversal medicine naloxone in an emergency situation.
The
Health Legislation Amendment Bill 2015 applies to people administering naloxone, a medicine which temporarily reverses the effects of opioids, which has been used successfully to reverse the effects of an overdose for more than 40 years.
These law changes are another important ACT example of how the community benefits when research, policy and consumers collaborate to solve complex problems. These law changes are in response to evidence and various recommendations, including from the ACT Naloxone Program Evaluation, as such it is a model that others could follow about how to engage in public health and drug law reform.
This information below provides a summary of the rationale for and the work undertaken and acknowledges the work of multiple stakeholders in achieving this important piece of Australian and ACT public health and drug law reform.
Opioid overdose is a significant public health problem in the ACT and Australia*
The need for improved approaches to preventing opioid overdose incidence, morbidity and mortality is confirmed by epidemiological evidence suggesting that the ACT (and Australia) is once again on an upward epidemic curve of opioid overdose incidence.
18 Canberrans died from opioids (e.g. heroin and oxycodone) in 2014 - this was double the road toll, likely to be an underestimate and the equal highest number in a decade.
*Olsen A. McDonald D. Lenton S. & Dietze P. 2015.
Independent evaluation of the 'Implementing Expanded Naloxone Availability in the ACT (I-ENAACT) Program', 2011-2014; final report. Melbourne: Centre for Research Excellence Into Injecting Drug Use.
Naloxone administration is an effective response to opioid overdose
Naloxone is a medicine, the only effect of which is to temporarily reverse the effects of opioids, it has been used successfully in overdose situations for more than 40 years in hospital emergency departments and by ambulance paramedics.
International and Australian experience is that the distribution of naloxone to potential opioid overdose witnesses in the community produces positive public health outcomes through reducing the incidence of opioid overdose deaths and complications, and empowering people who use opioids and their families and peers.
In the ACT naloxone is available to people who use opioids and other potential overdose witnesses who have completed an approved training program and have been assessed as being knowledgeable enough to be prescribed* the drug.
*ATODA notes the recent approval for dual scheduling of naloxone by the Therapeutic Goods Administration as both a schedule 4 (Prescription Only Medicine) and a schedule 3 (Pharmacist Only Medicine) drug. This will provide expanded availability of the medicine naloxone in the Canberra community. However, there are significant implementation issues to overcome, such as supply, consumer information and adapted training protocols.
Opioid overdose witnesses should be encouraged to respond, including administering naloxone, and should have good samaritan protections
The nature of opioid overdose is that the person overdosing is unable to respond and administer naloxone to him/herself in the emergency situation. This means that a third party (an overdose witness) needs to respond, including administering naloxone and calling an ambulance.
A very substantial proportion of opioid overdose witnesses are people who themselves use opioids. This is consistent with a key public health message which is to discourage people from using alone so that if an overdose occurs someone can respond. This means that a proportion of people who would administer lifesaving naloxone are likely to have some degree of intoxication or impairment as a result of recent recreational drug use
The research evidence, including the
evaluation of the
ACT Naloxone Program, found that laypeople are able to administer naloxone safely and effectively.
In the ACT it was identified that some ‘good samaritans’ administering naloxone would not have the same legal protection as other ‘good samaritans’. Opioid overdose witnesses want to, should be encouraged to, and need, legal protection to act.
A public health law barrier: the ACT Civil Law (Wrongs) Act 2002
The
ACT Civil Law (Wrongs) Act 2002 includes Good Samaritan provisions meaning that if a person assists someone else in good faith but adverse consequences occur, the Good Samaritan is protected from certain legal consequences.
However, these provisions do not apply if ‘the good samaritan’s capacity to exercise appropriate care and skill was, at the relevant time, significantly impaired by a recreational drug’ (s. 5 (2) (b)).
A ‘recreational drug’ is defined as ‘a drug consumed voluntarily for non-medicinal purposes, and includes alcohol.’
The legislation reads (our emphases):
“Part 2.1 Good samaritans
5 Protection of good samaritans from liability
(1) A good samaritan does not incur personal civil liability for an act done or omission made honestly and without recklessness in assisting, or giving advice about the assistance to be given to, a person who is apparently—
(a) injured or at risk of being injured; or
(b) in need of emergency medical assistance.
(2) However, the protection does not apply if—
(a) the liability falls within the ambit of a scheme of compulsory
third-party motor vehicle insurance; or
(b) the good samaritan’s capacity to exercise appropriate care and skill was, at the relevant time, significantly impaired by a recreational drug.”
For further details see the ACT Legislation Register:
http://www.legislation.act.gov.au/a/2002-40/default.asp
Outcomes sought from the change in law
People who use recreational drugs should be encouraged to use naloxone in the case of an opioid overdose, and feel confident that they can do so without fear of personal civil liability if they act in good faith but nonetheless something goes wrong. They should feel confident in using naloxone whether or not they have some degree of impairment by drug use at the material time.
Advocacy, research translation and evidence-generating activities to support reform
Significant and ongoing advocacy, research translation and evidence-generating activities were undertaken in the ACT to engage multiple stakeholders in discussions about the need for law reform. Examples of these activities included:
The ACT Alcohol Tobacco and Other Drug Strategy Evaluation Group also participated in discussions.
Health Legislation Amendment Bill 2015
The new legislative initiative of the ACT Government is the introduction, to the Legislative Assembly, and the passing on 18 February, of the
Health Legislation Amendment Bill 2015 which provides protection of good samaritans from liability under the
Civil Law (Wrongs) Act 2002. The amendment reads:
“Part 2 Civil Law (Wrongs) Act 2002
4 Protection of good samaritans from liability
New section 5 (2A)
(2A) Despite subsection (2) (b), if a good samaritan administers the drug known as naloxone, honestly and without recklessness, to a person apparently suffering from an overdose of an opioid drug for the purpose of resuscitating the person, the protection under subsection (1) applies even if the good samaritan’s capacity to exercise appropriate care and skill was, at the time of administering the drug, impaired by a recreational drug.
Examples—opioid drugs
- heroin
- methadone
- morphine”
For further details see the ACT Legislation Register:
www.legislation.act.gov.au
Using evidence to inform public health and drug law reform and policy
ATODA commends the ACT Minister for Health and the ACT Government for acting on evidence, particularly the recommendations from the 'Implementing Expanded Naloxone Availability in the ACT (I-ENAACT) Program' evaluation.
The ACT Government has demonstrated its commitment to evidence-informed drug policy including working with stakeholders to meaningfully and openly grapple the complex health, social and legal problems that arise from drugs in our community.
These law changes are another important ACT example of how the community benefits when research, policy and consumers collaborate to solve complex problems. Being based on evidence, it is a model that others could follow about how to do public health and drug law reform.
Statements from Mr Simon Corbell, Minister for Health
“These laws provide appropriate legal protections for situations where a person is experiencing an overdose and a Good Samaritan assists them by taking reasonable steps to save their life,” Mr Corbell said.
“We know in many circumstances, the very people who are in the best position to prevent a death by opioid overdose may themselves be under the influence of drugs. This legislation provides appropriate legal protections for those who, while under the influence of drugs, take appropriate action by administering Naloxone in an attempt to save a persons life.
The legislation follows an independent evaluation of the ACT’s ‘Implementing Expanding Naloxone Availability’ Program 2011-14, which was finalised last year. It was Australia’s first overdose management program, which provided Naloxone on prescription to people at risk of an overdose with over 200 successful participants.
The report into the program documented 57 overdose reversals with no serious adverse events with the practitioners, participants and other stakeholders involved in the program being supportive of the program and its continuation.
“We have seen encouraging results through the ACT Naloxone program that has saved lives by increasing the availability of Naloxone to a high-risk group. By formalising these practices in legislation we will continue to save people’s lives…” Mr Corbell said.
The ACT Government has previously consulted on this legislation with community groups and key stakeholders including the Alcohol Tobacco and Other Drug Association ACT (ATODA), the Canberra Alliance for Harm Minimisation and Advocacy (CAHMA), the Human Rights Commissioner, the Law Society of the ACT, the Health Services Commissioner, the Children and Young People Commissioner and the Secretariat of the LHNC.
For more information: see the
Media Release
Creating enabling environments for health of people who use drugs and their families
Key values underpinning the ACT naloxone program and this law reform are:
- The ACT community values the lives of people who use drugs and is willing to do what it can to enhance their well-being
- People who use drugs care about their health and well-being and the health and well-being of their peers
- People who use drugs will take the necessary action to enhance their health and well-being, particularly if society provides resources and helps to create an enabling environment.
This change is law is a specific example of all three of those values, and specifically highlights an example of how to create an enabling environment in which healthy choices are easy choices.
Acknowledgements
Significant work was undertaken by stakeholders over several years to achieve this important public health and drug law reform in the ACT, including:
- Simon Corbell, Minister for Health
- Katy Gallagher, former Minister for Health and former Chief Minister
- Sione Crawford, CAHMA
- Nicole Wiggins, CAHMA
- David McDonald, Social Research and Evaluation
- Anna Olsen, The Australian National University
- Simon Lenton, National Drug Research Institute
- Paul Dietze, Burnet Institute
- Helene Delany, ACT Health
- Victor Martin, Justice and Community Services Directorate
- Carrie Fowlie, ATODA
- Amanda Bode, ATODA
ACT Media
Legal protections for people saving lives with overdose reversal medication
ACT Government, 18 February 2016
New laws providing legal protections for people who administer the life-saving overdose reversal medicine Naloxone in an emergency situation, have today been passed in the Legislative Assembly, Minister for Health Simon Corbell announced.
For more information: See the
Media Release
Good Samaritan protections for Naloxone
CityNews, 19 February 2016
Simon Corbell says new laws providing legal protections for people who administer the life-saving overdose reversal medicine Naloxone in an emergency situation, have been passed in the Legislative Assembly.
For more information: See the
article
