USING SYSTEM DYNAMICS MODELING TO ASSESS THE IMPACT OF CONNECTICUT GOOD SAMARITAN LAWS: A PROTOCOL PAPER

Background We applied a participatory system dynamics (SD) modeling approach to evaluate the effectiveness and impact of Connecticut Good Samaritan Laws (GSLs) that are designed to promote bystander intervention during an opioid overdose event and reduce opioid overdose-related adverse outcomes. Our SD model can be used to predict whether additional revisions of the statutes might make GSLs more effective. SD modeling is a novel approach for assessing the impact of GSLs; and, in this protocol paper, we describe its applicability to our policy question, as well as expected outcomes of this approach. Methods This project began in February 2021 and is expected to conclude by March 2022. During this time, a total of six group model-building (GMB) sessions will have been held with key stakeholders to elicit feedback that will, in turn, contribute to the development of a more robust SD model. Session participants include bystanders who witness an overdose, law enforcement personnel, first responders, pharmacists, physicians, and other health care professionals who work in at least two major metropolitan areas of Connecticut (New Haven and Hartford). Due to the restrictions imposed by the COVID-19 pandemic, the sessions are being held virtually via Zoom. The information obtained during these sessions will be integrated with a draft SD model that has already been developed by the modeling team as part of a previous CDC-funded project. Model calibration and policy simulations will then be performed to assess the impact of the current GSLs and to make recommendations for future public policy changes. Discussion An SD modeling approach enables capture of complex interrelationships among multiple health outcomes to better assess the drivers of the opioid epidemic in Connecticut. The model simulation results are expected not only to align with current real-world data but also to recreate historical trends and infer future trends in a situationally relevant fashion. This will facilitate the work of policy makers who are devising and implementing time-sensitive changes to address opioid overdose-related deaths at the state level. Replicating our approach as described can be applied to make similar improvements in other jurisdictions. CONTRIBUTIONS TO THE LITERATURE - System dynamics (SD) modeling and group model-building (GMB) approaches enable the group to start with a simple concept model and apply the collective knowledge of the group to finish the session with a much more developed model that can produce impressively accurate simulation results. - The model will be used to understand the impact of Connecticut Good Samaritan Laws (GSLs), as well as their limitations, and to deduce factors to further improve public health laws to counter opioid overdose-related deaths. - The approach can be applied to other jurisdictions, taking into account local conditions and existing Good Samaritan legislation. KEYWORDS: System dynamics modeling, group model building, opioid overdose deaths, opioid use disorder, Good Samaritan laws

‘It’s the Same Thing as Giving Them CPR Training’: Rural Emergency Responders Perspectives on Naloxone

Most states in the US have implemented Good Samaritan Laws (GSLs) that provide legal protections for anyone calling law enforcement and first responders trained to administer naloxone and reverse overdoses. Despite these laws, some bystanders are reluctant to call the authorities, prompting requests to increase naloxone access and administration training among lay persons. This study examines the perceptions of emergency first responders in a frontier and remote (FAR) state to understand their job responsibilities and perceptions of layperson naloxone administration training. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, members of community organizations responsible for responding to opioid overdoses. The study finds widespread support for layperson naloxone training and administration throughout Montana due to rural first responders’ inability to meet the needs of residents and an overall lack of resources to address substance use. This study adds to the literature because of it focuses on first responders in a frontier and remote area (FAR) that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area’s overall lack of resources. A harm reduction approach that trains laypeople to administer naloxone might be FAR residents’ best chance for survival after an opioid overdose.

Knowledge of a Drug-Related Good Samaritan Law Among People Who Use Drugs, Vancouver, Canada

Background Across the United States and Canada drug-related Good Samaritan laws (GSLs) have been enacted to encourage observers of acute drug overdose events to contact emergency medical services (EMS) without fear of legal repercussions. However, little is known about the working knowledge of GSLs among people who use illicit drugs (PWUD). We sought to evaluate the prevalence and factors associated with accurate knowledge of a GSL among PWUD in Vancouver, Canada, 1 year after the GSL was enacted. Method We used data from participants in three community-recruited prospective cohort studies of PWUD interviewed between June and November 2018. Multivariable logistic regression was used to identify factors associated with accurate knowledge of the GSL. Results Among 1,258 participants, including 760 males (60%), 358 (28%) had accurate knowledge of the GSL. In multivariable analyses, participants who reported ever having a negative police encounter (defined as being stopped, searched, or detained by the police) were less likely to have accurate knowledge of the GSL (adjusted odds ratio [AOR] = 0.70; 95% CI [0.54, 0.90]), while those involved in drug dealing were more likely to have accurate knowledge of the GSL (AOR = 1.50; 95% CI [1.06, 2.06]). Discussion Despite having been enacted for a full year, approximately three quarters of participants did not have accurate GSL knowledge, warranting urgent educational efforts among PWUD. Additional research is needed to understand whether GSLs can mitigate the fears of legal repercussions among those engaged in drug dealing and with past negative experiences with the police.

Distributed Manufacturing of Open Source Medical Hardware for Pandemics

Distributed digital manufacturing offers a solution to medical supply and technology shortages during pandemics. To prepare for the next pandemic, this study reviews the state-of-the-art of open hardware designs needed in a COVID-19-like pandemic. It evaluates the readiness of the top twenty technologies requested by the Government of India. The results show that the majority of the actual medical products have some open source development, however, only 15% of the supporting technologies required to produce them are freely available. The results show there is still considerable research needed to provide open source paths for the development of all the medical hardware needed during pandemics. Five core areas of future research are discussed, which include (i) technical development of a wide-range of open source solutions for all medical supplies and devices, (ii) policies that protect the productivity of laboratories, makerspaces, and fabrication facilities during a pandemic, as well as (iii) streamlining the regulatory process, (iv) developing Good-Samaritan laws to protect makers and designers of open medical hardware, as well as to compel those with knowledge that will save lives to share it, and (v) requiring all citizen-funded research to be released with free and open source licenses.

Knowledge of Good Samaritan Laws and Beliefs About Arrests Among Persons Who Inject Drugs a Year After Policy Change in Baltimore, Maryland

Objectives Delivering and receiving prompt medical care during an overdose are imperative to ensure survival. Good Samaritan laws encourage people to call 911 during an overdose by providing immunity from selected drug arrests (eg, low-level possession). However, it is unclear whether persons who inject drugs (PWID) are aware of and understand these laws and their implications. We examined awareness among PWID of the 2015 Good Samaritan law in Maryland and their beliefs about whether they could be arrested for calling 911 or having an overdose. Methods We surveyed 298 PWID in Baltimore, Maryland. We estimated the proportion who knew what the Good Samaritan law addressed and who believed they could be arrested for calling 911 or overdosing. We used a multivariate model to assess the association between harm-reduction services and knowledge of the Good Samaritan law or beliefs about getting arrested for calling 911 or overdosing. Results Of PWID, 56 of 298 (18.8%) knew what the Good Samaritan law addressed, 43 of 267 (16.1%) believed they could be arrested for calling 911, and 32 of 272 (11.8%) believed they could be arrested for having an overdose. After adjusting for demographic characteristics, accessing the syringe services program was associated with accurate knowledge and the belief that PWID could be arrested for calling 911; however, training in overdose reversal was not associated. Conclusions Most PWID were unaware of the Good Samaritan law; this lack of awareness is a barrier to preventing overdose deaths. Educating PWID about Good Samaritan laws is essential, and such education should include police to ensure that law enforcement is congruent with Good Samaritan laws and does not perpetuate mistrust between police and PWID.

Distributed Manufacturing of Open-Source Medical Hardware for Pandemics

Distributed digital manufacturing offers a solution to medical supply and technology shortages during pandemics. To prepare for the next pandemic, this study reviews the state-of-the-art for open hardware designs needed in a COVID-19-like pandemic. It evaluates the readiness of the top twenty technologies requested by the Government of India. The results show that the majority of the actual medical products have had some open source development, however, only 15% of the supporting technologies that make the open source device possible are freely available. The results show there is still considerable work needed to provide open source paths for the development of all the medical hardware needed during pandemics. Five core areas of future work are discussed that include: i) technical development of a wide-range of open source solutions for all medical supplies and devices, ii) policies that protect the productivity of laboratories, makerspaces and fabrication facilities during a pandemic, as well as iii) streamlining the regulatory process, iv) developing Good-Samaritan laws to protect makers and designers of open medical hardware, as well as to compel those with knowledge that will save lives to share it, and v) requiring all citizen-funded research to be released with free and open source licenses.