The policy problem
When a person stops breathing after taking an opioid, time matters. Naloxone can reverse an opioid overdose, but bystanders may still need emergency medical help because breathing can stop again, other drugs may be involved, or complications may not be visible. Yet the people closest to an overdose may also fear arrest. They may possess drugs, be under a supervision condition, have outstanding legal concerns, or simply distrust what will happen when police and paramedics arrive.
Drug-related Good Samaritan laws attempt to solve that problem by limiting criminal liability for people who seek emergency assistance during an overdose. The laws vary. Some protect the caller and the person experiencing the overdose from prosecution for simple possession; others offer narrower protections, contain exclusions, or limit the evidence police may use. They are therefore not one uniform intervention.
The central question is not whether a law sounds compassionate. It is whether legal protection changes what people do in an emergency. The research gives a careful answer: Good Samaritan laws can remove a real barrier, but their effect depends on whether people know the protection exists, believe it will be honored, and encounter an emergency-response system they consider safe.
This matters as the United States continues to experience a large but uneven overdose crisis. The CDC estimated 80,391 drug-overdose deaths in 2024, down 26.9 percent from 2023, while warning that the decline does not eliminate the need for prevention and response. A national decline also does not tell us whether a person in a specific apartment, car, or street knows whom to call—or trusts that calling will not turn a medical emergency into a criminal-justice encounter.
What the research measures
Good Samaritan laws are often evaluated using outcomes that are several steps removed from the policy mechanism. A statute is supposed to reduce fear; reduced fear should make a bystander more likely to call; a faster call should make medical intervention more likely; and timely intervention may reduce the chance of death. Each link can fail.
Researchers consequently study different outcomes:
- surveys of people who use drugs and whether they know about a law;
- self-reported willingness to call emergency medical services;
- 911 or emergency-department utilization;
- overdose mortality; and
- police or paramedic experiences implementing the law.
These measures should not be treated as interchangeable. A law may increase willingness to call without producing a detectable change in population mortality. Mortality may remain high because the illicit supply becomes more dangerous, because emergency services are delayed for other reasons, or because the law protects too little conduct to change behavior. Conversely, a decline in mortality cannot automatically be attributed to a Good Samaritan statute when naloxone distribution, treatment access, drug-supply changes, and other policies are changing at the same time.
The distinction is especially important in the fentanyl era. Hamilton and colleagues (2021) examined U.S. Good Samaritan laws and overdose mortality in a period when synthetic opioids had transformed the risk environment. Their analysis did not show a simple, universal mortality benefit attributable to every law. That is not evidence that the laws are useless. It is evidence that the statute-to-survival pathway is conditional and that a population-level death rate is a demanding test of a legal intervention designed primarily to encourage emergency calls.
Does immunity change behavior?
The strongest reason to support Good Samaritan protections is behavioral and institutional: people cannot receive emergency care if nobody calls. Research has repeatedly identified fear of police and legal consequences as a barrier to calling 911. A review by Karamouzian and colleagues (2020) found that knowledge of the law and confidence in its protections were central themes in the literature, while also noting that awareness was often incomplete.
The laws can therefore work through a trust mechanism. A person deciding whether to call is not evaluating statutory language in the abstract. They are making a rapid judgment about likely consequences: Will officers search everyone? Does the protection cover the drugs in the room? Will an outstanding warrant matter? Does the law protect the caller, the victim, or both? Will paramedics share information with police? A narrow or poorly explained immunity may leave the perceived risk largely intact.
Evidence from policy evaluations is consistent with that account. McClellan and colleagues (2019) studied Good Samaritan policies and reported reductions in opioid-overdose deaths associated with these laws, but the size and interpretation of effects depend on design and research assumptions. In a different study, Rees and colleagues (2019) found that Good Samaritan laws were associated with lower opioid-related mortality, while emphasizing that the policy operates in a broader environment of treatment, enforcement, and drug-market change.
Other findings are more cautious. Hamilton and colleagues (2021) focused on the fentanyl era and found no uniform reduction in overdose mortality across the laws they examined. A Canadian qualitative study by Xiong and colleagues (2021) found that people who use drugs continued to describe uncertainty about protection and concern about police involvement even after a Good Samaritan law was enacted. The jurisdiction differs from the United States, but the mechanism is relevant: formal protection does not automatically become practical security.
The appropriate conclusion is neither “Good Samaritan laws save lives” nor “Good Samaritan laws do nothing.” The evidence supports a narrower proposition: legal immunity is a plausible and sometimes beneficial component of overdose response, but the effect is mediated by awareness, scope, enforcement practice, and the credibility of the promise being made.
Why results are mixed
First, statutory design varies. A broad law can protect a caller from simple-possession charges but still leave exposure to other offenses. Some laws have exceptions for evidence of distribution, outstanding warrants, or other conduct. Those exceptions may be legally defensible from a conventional enforcement perspective, yet they can be difficult for a bystander to understand under pressure. If the protection is uncertain, the deterrent effect of criminalization can remain.
Second, implementation is part of the policy. Public education campaigns, training for police and paramedics, and clear agency protocols can determine whether an immunity provision is believed. A statute buried in a code book is not the same intervention as a statute communicated through harm-reduction organizations, emergency departments, schools, and people with lived experience. The latter channels can also reveal where legal language fails to match the situations people actually face.
Third, emergency response can be coercive even when arrest is unlikely. Police presence, searches, questioning, child-welfare concerns, immigration concerns, and the possibility of being identified can discourage calls. This is why the legal question cannot be separated from the sociology of institutional trust. People assess a law through their prior experiences with police and public agencies, not only through official claims about immunity.
Fourth, mortality is shaped by the illicit market. Potency, contamination, polysubstance use, geographic isolation, and the availability of naloxone all affect whether a call results in survival. Good Samaritan laws address one point in that chain: willingness to summon help. They do not make the supply predictable, provide ongoing treatment, or eliminate the need for naloxone at the scene.
Finally, the laws may have heterogeneous effects. A policy may matter more in a jurisdiction where people have access to emergency services but fear possession charges, and less where emergency response is slow or the protection is unknown. Average national estimates can conceal meaningful local effects while also making modest benefits difficult to identify.
A better policy test
Evaluating Good Samaritan laws should begin with the mechanism they are intended to change. Researchers should ask whether people know the law, understand its limits, report greater willingness to call, and experience different police behavior after calling. Emergency-call data and response times should be examined alongside mortality, not replaced by it. Studies should also separate enactment from implementation: a law's effective date, public education, agency training, and later amendments may be distinct events.
Policy design should follow the same logic. Legislatures can make protections broad and plain-language, clarify that they apply to both callers and overdose victims where appropriate, and minimize exclusions that make the promise difficult to trust. Agencies can publish protocols that prioritize medical response, train personnel, and make clear what information will and will not be used for prosecution. Harm-reduction organizations should be involved in evaluating whether the law is credible among the people it is meant to reach.
None of this requires pretending that legal immunity is a complete overdose strategy. It is one layer of a response that also includes naloxone access, medications for opioid use disorder, safer-use education, drug checking where available, and non-punitive contact with emergency services. The policy lesson is practical: a Good Samaritan law should be judged as an implementation system, not merely as a sentence in a statute book.
Conclusion
Good Samaritan laws address a real contradiction in drug policy: the state asks bystanders to save a life while giving them reasons to fear the state. Legal immunity can reduce that contradiction, but only if people know about it, understand its boundaries, and believe emergency responders will honor its purpose. Mixed mortality findings do not resolve the question by themselves. They show why overdose policy must connect legal rules to behavior, institutional trust, emergency practice, and illicit-market conditions.
The most defensible conclusion from current research is modest but important. Good Samaritan laws are a necessary harm-reduction safeguard in a punitive environment, but they are not self-executing. If policymakers want more emergency calls, they must make the protection broad, visible, credible, and operationally real.
References
- Centers for Disease Control and Prevention, National Center for Health Statistics. (2025). U.S. overdose deaths decrease almost 27% in 2024. https://www.cdc.gov/nchs/pressroom/releases/20250514.html
- Hamilton, L., Davis, C. S., Kravitz-Wirtz, N., Ponicki, W., & Cerdá, M. (2021). Good Samaritan laws and overdose mortality in the United States in the fentanyl era. International Journal of Drug Policy, 97, 103294. https://doi.org/10.1016/j.drugpo.2021.103294
- McClellan, C., Lambdin, B. H., Ali, M. M., Mutter, R., Davis, C. S., Wheeler, E., Pemberton, M., & Kral, A. H. (2019). Opioid-overdose laws association with opioid use and overdose mortality. Addictive Behaviors, 86, 90–95. https://doi.org/10.1016/j.addbeh.2018.05.017
- Karamouzian, M., et al. (2020). The effectiveness of drug-related Good Samaritan laws: A review of the literature. International Journal of Drug Policy, 85, 102773. https://doi.org/10.1016/j.drugpo.2020.102773
- Rees, D. I., Sabia, J. J., Argys, L. M., Dave, D., & Latshaw, J. (2019). With a little help from my friends: The effects of Good Samaritan and naloxone access laws on opioid-related deaths. Journal of Law and Economics, 62(1), 1–27. https://doi.org/10.1086/700703
- Xiong, A., et al. (2021). A drug-related Good Samaritan Law and calling emergency medical services for drug overdoses in a Canadian setting. Harm Reduction Journal, 18, 91. https://doi.org/10.1186/s12954-021-00537-w