Contrasting perspectives and applications of the Good Samaritan Overdose Prevention Law: insights from people who use and distribute drugs in Rhode Island

BACKGROUND: The overdose crisis in the U.S is complex, with opioid overdoses compounded more recently with rising stimulant-involvement. Individuals who experience or witness overdoses often avoid calling 911 due to fear of criminal-legal system consequences. Many U.S. states have "Good Samaritan Laws" (GSLs) protecting those seeking help for overdoses, but research is lacking on the understanding and role of GSL in overdose response among people who use stimulants (PWUS) and criminal-legal populations. Our mixed-methods analysis focused on PWUS from a community-based sample in a state with GSL protections, Rhode Island, and participants incarcerated at the Rhode Island Department of Corrections (RIDOC) for charges related to drug distribution. We analyzed survey and interview data to discern differences in knowledge and attitudes regarding Rhode Island's GSL in the two samples. RESULTS: Overall awareness of the GSL was widespread among the community sample (61.1%) and the RIDOC sample (63.3%); however, more RIDOC participants (70%) than PWUS in the community (42.9%) could accurately describe the law. Participants in both samples reported deeply rooted fears associated with the consequences of help-seeking and skepticism of protections provided by the GSL, particularly around criminal-legal consequences. While the Rhode Island GSL provides protections for probation or parole violations, many RIDOC participants were fearful that these protections would not apply to them, despite the law being amended to provide these protections. Additionally, participants from both samples reflected on differences in help-seeking behaviors among unexpected opioid and stimulant overdoses, discussing how their interpretation of overdose symptoms influenced decisions to call for help (e.g., call 911) or not. CONCLUSIONS: Varying degrees of understanding of the Rhode Island GSL, along with fears of police involvement in overdose situations, underscore the need for targeted interventions, policy change, and re-education efforts about overdose prevention and the GSL. Findings can inform policy and professional practices associated with GSLs.