The case of Stephanie Bongiovi makes the argument for broader Good Samaritan laws and the wider use of the overdose antidote naloxone.
On Nov. 14, a 911 call alerted medics that an unresponsive female student at Hamilton College in upstate New York had apparently overdosed on heroin. The victim turned out to be rocker Jon Bon Jovi’s 19-year-old daughter, and according to New York State law, overdose victims and the people who aid them can’t be prosecuted for possession of small amounts of illegal drugs.
Known as the Good Samaritan law, the legislation was first passed in New Mexico in 2007 and is now law in nine states, including New York, to help overdose victims get medical care as soon as possible without fear of criminal repercussions. Research shows that most overdose deaths are witnessed and occur within one to three hours after the last ingestion or injection, but only 10% to 56% of witnesses call for medical help, primarily because they fear being arrested.
Bongiovi’s overdose (for his band, Bon Jovi changed the spelling of his name) is a case in point. Both Bongiovi and the student who allegedly dialed 911, Ian Grant, were arrested on charges of possession of heroin and marijuana — exactly what the law was supposed to prevent.
Citing the legislation, prosecutors dropped those charges the following day. But the confusion highlights the need for expanded understanding and enforcement of Good Samaritan laws as well as greater access to the antidotes for overdose from heroin or prescription painkillers.
About 16,000 people die annually of opioid overdose. Most of these deaths are preventable, however, if treated quickly with a drug called naloxone (Narcan). Unfortunately, awareness of Good Samaritan laws is still low, and despite recent statements of support from the U.S. drug czar’s office and from the American Medical Association, naloxone is not always available when it is needed. The drug is most effective when used just before the overdose victim has stopped breathing, to prevent oxygen-deprived damage to the brain.
In the current issue of the Journal of the American Medical Association (JAMA), researchers call for wider adoption of Good Samaritan laws and federal action to facilitate the distribution of naloxone to treat victims of heroin or prescription-painkiller overdoses.
As Bongiovi’s case highlights, however, the authors say there are still significant barriers to this strategy. “Right now the message is that if you call for help, you’ll get arrested,” says Dr. Sharon Stancliff, medical director for the Harm Reduction Coalition and a frequent prescriber of naloxone for overdose prevention. “A huge amount of damage has been done simply by arresting them in the first place.”
But it’s not simply the legal ramifications that are thwarting efforts to change overdose treatment. Naloxone’s cost and prescription-only status may also keep it from being used more widely. It is currently a prescription drug that is only approved by the U.S. Food and Drug Administration in its injectable form, and since injectable medications need to be sterile, they are generally more expensive to make and buy. Shortages in these drugs are also a growing problem. “The production process for ‘sterile injectables’ like naloxone is prone to any number of problems — of which the recent meningitis-contamination horror story is an extreme example,” explains Leo Beletsky, lead author of the study and assistant professor of law and health sciences at Northeastern University.
“To deal with quality issues, drugmakers may reduce or discontinue making the specific medication, causing a shortage,” he says. “Predictably, in these situations, the production of generic off-patent medications like naloxone is the last priority because they are the least profitable. This makes such drugs more likely to be in shortage and also jacks up their price.”
About 188 community-based programs currently distribute naloxone in 15 states, and at least 10,000 successful overdose reversals have been reported since the programs began in 1996. But such programs still do not meet the national need — there are 16,000 such deaths every year — in part because most programs cannot afford to buy the expensive drug and its use is not covered by insurance.
Regulatory barriers also contribute to the problem. In April the FDA held a meeting to consider making naloxone available over the counter. An intranasal form of the drug exists and is being used in the U.S. by some of the community-based programs, based on small studies that show that it works. But the makers of the intranasal form have not submitted its version for approval by the FDA, and injectable versions of drugs are typically not sold over the counter.
In the JAMA article Beletsky and his co-authors suggest ways of easing the bottleneck in naloxone distribution. Shortages in manufacturing, for example, might be alleviated if the FDA allowed foreign-made naloxone to be imported into the U.S. “Naloxone is a cheap drug to make, and it is abundantly available in Europe and Asia, as well as elsewhere, at a fraction of the cost,” he says. “Given the U.S. shortage, the exorbitantly high prices and existing production lines, there are foreign drugmakers eager to enter the market.”
Further research to support approval of an over-the-counter product could also help, as will awareness campaigns to educate the public of the dangers of overdose, and the need to seek medical help as soon as possible.
After all, it’s not only rock stars and their daughters who are at risk: it could be your child or sister or brother or partner.