In last week’s issue, we wrote about how Good Samaritan laws are being undercut by prosecutors charging suppliers of the drugs that led to overdoses with “drug-induced homicide,” even if those suppliers were loved ones of the user. The result in many jurisdictions is that people are afraid to call 911 in the event of a suspected overdose (see ADAW January 18).

We asked the National District Attorneys Association (NDAA) to comment for the story, but they were not able to by press time. So we sent them last week’s article, which featured comments from Kathie Kane Willis, Ph.D., and Daniel Raymond taking the treatment and harm-reduction side of the argument. For this week’s article, we interviewed Joseph D. Coronato, district attorney for Ocean County in New Jersey, who was speaking on behalf of the NDAA in discussing his view of Good Samaritan laws.

Essentially, he would not arrest anybody for calling 911, unless there were an outstanding warrant for an arrest.

Coronato was appointed and confirmed as district attorney two years ago, and within a relatively short time there were eight overdose deaths within a week in his county. “They were all under the age of 28,” Coronato recalled. “So as a result, we started drilling down on the overdose deaths, and also became very interested in getting these numbers down” by distributing naloxone.

Ocean County was the first county in the state to give naloxone nasal spray kits to all of the police chiefs in the county’s 33 towns, said Coronato. Forfeiture money was used to buy the naloxone. The first rescue by police in the county was in April of 2013; there were more than 100 rescues in 2014, and 272 in 2015. Overdose deaths went down, from 112 in 2013 to 101 in 2014 to 95 in 2015.

The naloxone rescues are closely connected to Coronato’s reading of Good Samaritan laws — people are never charged for calling in the overdose. “Nobody who gets sprayed gets charged with anything, and nobody who makes a call gets charged,” he told ADAW. “I am the chief law enforcement officer for this county, and this is my discretion — not to charge,” he said, adding that he doesn’t know of any other prosecutor in the state who is charging people who call 911. “Generally speaking, we’re all lock-step on this.”

That doesn’t mean, however, that the police won’t check to see if there is an outstanding warrant for an arrest, no matter who is involved. “If we go to a site and there is a warrant for someone’s arrest, we’re going to arrest them,” said Coronato. “The Good Samaritan law says for that incident, they won’t be charged, but that won’t give them an expungement.”

Liability for seller

Coronato looks for “strict liability” in the event of an overdose, he said. “When somebody overdoses and dies, I treat it as a murder case.” His intention is to “hold the ultimate dealer responsible.” Even if the victim doesn’t die, he tries to find out where the drugs came from. “If we go to a house and there are drugs there, I use it as an opportunity to say, ‘This person is dying or on the verge of death, this is the opportunity to do the right thing, where did you get the drugs from?’” The aim is to track down the seller and charge him or her with drug-induced homicide.

When we spoke with Coronato last week, he had more than 19 drug-induced homicide cases, and half had pled guilty to some charge. “It’s all about leverage,” he said. “We charge them not only with the homicide, but with the drug deal.”

Coronato said he goes after dealers well outside his jurisdiction — in the Bronx in New York City, in Philadelphia, in northern New Jersey and in Trenton.

“Drug-induced homicide is declared by the medical examiner,” said Coronato. In some cases, people who overdose also have alcohol in their systems, and in those cases, the medical examiner can’t be sure that it was the drug that caused the overdose, said Coronato.

Linking with treatment

The prosecutor said he has a “partnership” with treatment programs.

The link is the naloxone rescue, or “spray,” as Coronato refers to it. “My orders are that anybody who is sprayed has to go to the emergency room,” he said. “We have recovery people who go to the ER when somebody’s been sprayed and will confront that person and make them agree to go to detox.” He acknowledged that the overdose victim must consent first. “Then they are brought to a detox facility and held there from 24 to 48 hours — with their consent,” he said. If they don’t consent, “the recovery person still contacts them” after discharge from the emergency room, he said. “If they do consent, the detox facility drills down and then we’ll decide with them what treatment program will be good for them — in some instances methadone, in some Suboxone, and in some Vivitrol,” he said.

Coronato was originally in favor of drug-free treatment only, but “the problem is so widespread that we’ll never have enough beds.” So he has come around to supporting medicated treatment, but he prefers Vivitrol to methadone or buprenorphine. “If you really look into it, Vivitrol has the most hope because it’s a total block,” he said. He also said that mental illness needs to be handled. “Which came first, mental health [problems] causing substance abuse or substance abuse causing mental health [problems]?” he asked.

Treatment providers are happy to work with the district attorney, according to Coronato. “They embrace us,” he said. “They understand that we’re not looking to lock up addicts; what we want to do is break the cycle of addiction.”

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