Davis et al. Respond

We thank Paone et al. for their thoughtful letter. Like them, we are very concerned that the continuing criminalization of and stigma toward people who use drugs often result in those individuals receiving substandard care or, all too often, no care at all. We also agree that public health agencies are perennially underfunded and that substantial investment in public health infrastructure is necessary to address the continuing crisis of overdose-related harm.

In our editorial, we disagree on the specific matter of whether the benefits of what we advocate: “Adding nonfatal overdose to [state] lists of mandatory reportable conditions—and providing the resources for public health leadership to take appropriate, evidence-based actions based on those data”^(p1161) outweigh the potential risks. We believe that they do.

Paone et al. note that in New York City, individuals who have overdosed and present to emergency departments are given the opportunity to provide identifying information after informed consent as part of a program that “deploys peers 24-7 to deliver overdose prevention, harm reduction, and treatment resources.” We strongly support such programs. However, we believe that they should be offered to all individuals who have overdosed—including the unknown but large number who receive care in the prehospital setting and in venues other than the emergency department.

We, too, worry about the real danger of potential misuse of overdose data by law enforcement. Two facts temper our concerns. First, in many jurisdictions, law enforcement officers are routinely dispatched to overdose calls and thus already know the location and identity of the individuals involved.¹ Second, identified data in public health reporting databases are protected by both state and federal law and cannot be provided to law enforcement without legal process. Conversely, when sufficient evidence exists for a judge to order that protected health information be revealed, patient consent is immaterial.

Overdose is an ever-worsening epidemic. We in public health have a moral obligation to offer evidence-based, patient-centered, harm reduction–focused services to every individual at risk and to provide those services to all who want them. Meeting people where they are at requires knowing where they are.² We must redouble efforts to appropriately fund public health initiatives, to treat people who use drugs with dignity and respect, and to take back our rightful role as epidemic first responders. We do not believe this to be a magic bullet, but we do believe it to be superior to the status quo.