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Carroll JJ, Cummins ER, Formica SW, Green TC, Bagley SM, Beletsky L, Rosenbloom D, Xuan Z, Walley AY. The police paradox: A qualitative study of post-overdose outreach program implementation through public health-public safety partnerships in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104160. [PMID: 37597344 DOI: 10.1016/j.drugpo.2023.104160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/27/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Post-overdose outreach has emerged in the United States as an increasingly common response to non-fatal overdose. This qualitative study investigates the implementation of such programs through public health-public safety partnerships in Massachusetts. METHODS We conducted semi-structured interviews with post-overdose outreach team members, overdose survivors, and family members who received outreach. Interview transcripts were inductively analyzed to identify emergent themes and subsequently organized within the framework of Ecological Systems Theory. RESULTS Forty-nine interviews were conducted, including 15 police officers (80% male, 100% non-Hispanic White); 23 public health partners (48% male, 87% non-Hispanic White); 8 overdose survivors who received outreach services and 3 parents of survivors who received services (collectively 27% male, 64% non-Hispanic White). Implementation factors identified across all levels (macrosystem, exosystem, mesosystem, and microsystem) of Ecological Systems Theory included key program facilitators, such as access to police data and funding (macro), interagency collaboration (exo), shared recognition of community needs (exo), supportive relationships among team members (meso), and program champions (micro). Common barriers included inherent contradictions between policing and public health mandates (macro), poor local treatment and service capacity (exo), divergent staff views of program goals (exo), overdose survivors' prior negative experiences with law enforcement (meso), difficulty locating overdose survivors (meso), and police officers' lack of qualifications or training in providing psycho-social services (micro). CONCLUSIONS Most post-overdose outreach programs in this study were dependent on funding and data-sharing partnerships, which police agencies largely controlled. Yet, police participation, especially during outreach visits presented numerous challenges for engaging overdose survivors and establishing non-coercive linkages with evidence-based services, which may undermine the public health goals of these programs. These findings should inform state and federal efforts to expand the role of law enforcement in behavioral health initiatives.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology & Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC 27605, United States; Department of Medicine, Brown University, 222 Richmond St., Providence, RI 02903, United States.
| | - Emily R Cummins
- Ariadne Labs, Harvard T.H. Chan School of Public Health, 405 Park Drive, Boston, MA 02215, United States
| | - Scott W Formica
- Social Science Research and Evaluation, Inc., 84 Mill St., Lincoln, MA 01773, United States
| | - Traci C Green
- The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, 415 South Street MS 035, Waltham, MA 02453, United States
| | - Sarah M Bagley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and the Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Health in Justice Action Lab, Northeastern University, 416 Huntington Ave, Boston, MA 02115, United States
| | - David Rosenbloom
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Alexander Y Walley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
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Lynch E, Goyal D, Moore DJ. Ready, willing, and able: California college campus law enforcement officers' respond to the opioid overdose attitudes scale. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1676-1679. [PMID: 34516937 DOI: 10.1080/07448481.2021.1948857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/02/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
BackgroundCollege campus police departments are providing law enforcement officers the authority to administer naloxone, the antidote to opioid overdose. This study explored the competence, concerns, and readiness among college campus-based law enforcement officers in Northern California to administer naloxone in case of an opioid overdose on campus. METHODS Using a quantitative, cross sectional design, law enforcement officers from seven Northern California college campus-based police departments were recruited for this study. Participants completed sociodemographic information and the Opioid Overdose Attitudes Scale (OOAS) electronically. RESULTS Forty law enforcement officers completed questionnaires. Findings suggested officers were ready and willing to assist opioid overdose victims, had sufficient naloxone administration training, and were not concerned with consequences of precipitating withdrawal symptoms or harm to a student after administering naloxone. CONCLUSIONS College campus-based law enforcement officers had positive attitudes regarding handling opioid overdose situations and felt mostly comfortable administering naloxone.
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Affiliation(s)
- Emily Lynch
- The Valley Foundation School of Nursing, San José State University, San Jose, California, USA
| | - Deepika Goyal
- The Valley Foundation School of Nursing, San José State University, San Jose, California, USA
| | - Dorothy James Moore
- The Valley Foundation School of Nursing, San José State University, San Jose, California, USA
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Lloyd D, Rowe K, Leung SYJ, Pourtaher E, Gelberg K. "It's just another tool on my toolbelt": New York state law enforcement officer experiences administering naloxone. Harm Reduct J 2023; 20:29. [PMID: 36879248 PMCID: PMC9987370 DOI: 10.1186/s12954-023-00748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/03/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Although naloxone is widely acknowledged as a life-saving intervention and a critical tool for first responders, there remains a need to explore how law enforcement officers have adapted to a shifting scope of work. Past research has focused mainly on officer training, their abilities to administer naloxone, and to a lesser extent on their experiences and interactions working with people who use drugs (PWUD). METHODS A qualitative approach was used to explore officer perspectives and behaviors surrounding responses to incidents of suspected opioid overdose. Between the months of March and September 2017, semi-structured interviews were conducted with 38 officers from 17 counties across New York state (NYS). RESULTS Analysis of in-depth interviews revealed that officers generally considered the additional responsibility of administering naloxone to have become "part of the job". Many officers reported feeling as though they are expected to wear multiple hats, functioning as both law enforcement and medical personnel and at times juggling contradictory roles. Evolving views on drugs and drug use defined many interviews, as well as the recognition that a punitive approach to working with PWUD is not the solution, emphasizing the need for cohesive, community-wide support strategies. Notable differences in attitudes toward PWUD appeared to be influenced by an officer's connection to someone who uses drugs and/or due to a background in emergency medical services. CONCLUSION Law enforcement officers in NYS are emerging as an integral part of the continuum of care for PWUD. Our findings are capturing a time of transition as more traditional approaches to law enforcement appear to be shifting toward those prioritizing prevention and diversion. Widespread adoption of naloxone administration by law enforcement officers in NYS is a powerful example of the successful integration of a public health intervention into police work.
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Affiliation(s)
- Danielle Lloyd
- Office of Program Evaluation and Research, New York State Department of Health, AIDS Institute, Corning Tower, Room 342, Albany, NY, 12237, USA. .,, Vermont, USA.
| | - Kirsten Rowe
- Office of Program Evaluation and Research, New York State Department of Health, AIDS Institute, Corning Tower, Room 342, Albany, NY, 12237, USA
| | - Shu-Yin John Leung
- Office of Program Evaluation and Research, New York State Department of Health, AIDS Institute, Corning Tower, Room 342, Albany, NY, 12237, USA
| | - Elham Pourtaher
- Office of Program Evaluation and Research, New York State Department of Health, AIDS Institute, Corning Tower, Room 342, Albany, NY, 12237, USA
| | - Kitty Gelberg
- Office of Drug User Health, New York State Department of Health, AIDS Institute, Corning Tower, Room 474, Albany, NY, 12237, USA
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Speakman EM, Hillen P, Heyman I, Murray J, Dougall N, Aston EV, McAuley A. 'I'm not going to leave someone to die': carriage of naloxone by police in Scotland within a public health framework: a qualitative study of acceptability and experiences. Harm Reduct J 2023; 20:20. [PMID: 36805681 PMCID: PMC9938955 DOI: 10.1186/s12954-023-00750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/03/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Scotland has one of the highest rates of drug-related deaths (DRDs) per capita in Europe, the majority of which involve opioids. Naloxone is a medication used to reverse opioid-related overdoses. In efforts to tackle escalating DRDs in many countries, naloxone is increasingly being provided to people who are likely first responders in overdose situations. This includes non-healthcare professionals, such as police officers. A pilot exercise to test the carriage and administration of naloxone by police officers was conducted in selected areas of Scotland between March and October 2021. The aim of the study was to explore the acceptability and experiences of naloxone carriage and administration by police in Scotland. METHODS The study comprised of two stages. Stage 1 involved in-depth one-to-one qualitative interviews with 19 community stakeholders (people with lived experience, family members, support workers). Stage 2 involved a mixture of in-depth one-to-one interviews and focus groups with 41 police officers. Data were analysed thematically, and the findings from the two stages were triangulated to develop overarching themes and subthemes. RESULTS By the end of the pilot, 808 police officers had been trained in the use of intranasal naloxone. Voluntary uptake of naloxone kits among police officers who completed training was 81%. There were 51 naloxone administration incidents recorded by police officers at suspected opioid-related overdose incidents during the pilot. Most officers shared positive experiences of naloxone administration. Naloxone as a first aid tool suited their role as first responders and their duty and desire to preserve life. Perceived barriers included concerns about police undertaking health-related work, potential legal liabilities and stigmatising attitudes. The majority of participants (and all community stakeholders) were supportive of the pilot and for it to be expanded across Scotland. CONCLUSIONS Police carriage of naloxone is an acceptable and potentially valuable harm reduction tool to help tackle the DRDs crisis in Scotland. However, it requires appropriate integration with existing health and social care systems. The intervention lies at the intersection between public health and policing and implies a more explicit public health approach to policing.
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Affiliation(s)
| | - Peter Hillen
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Inga Heyman
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Jennifer Murray
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nadine Dougall
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Elizabeth V. Aston
- grid.20409.3f000000012348339XSchool of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Andrew McAuley
- grid.5214.20000 0001 0669 8188School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Macmadu A, Yolken A, Frueh L, Toussaint JR, Newman R, Jacka BP, Collins AB, Marshall BDL. Characteristics of events in which police responded to overdoses: an examination of incident reports in Rhode Island. Harm Reduct J 2022; 19:116. [PMID: 36258209 PMCID: PMC9578237 DOI: 10.1186/s12954-022-00698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Narrow or non-existent Good Samaritan Law protections and harsh drug selling statutes in the USA have been shown to deter bystanders from seeking medical assistance for overdoses. Additionally, little is known about the actions that police take when responding to overdose events. The objectives of this study were to assess the prevalence and correlates of naloxone administration by police, as well as to examine overdose events where arrests were made and those in which the person who overdosed was described as combative. Methods We analyzed incident reports of police responding to an overdose between September 1, 2019, and August 31, 2020 (i.e., 6 months prior to and during the COVID-19 pandemic), from a city in Rhode Island. We examined characteristics of incidents, as well as individual characteristics of the person who overdosed. Correlates of police naloxone administration were assessed using Wilcoxon rank sum tests and Fisher’s exact tests, and we examined incidents where arrests occurred and incidents in which the person who overdosed was described as combative descriptively. Results Among the 211 incidents in which police responded to an overdose during the study period, we found that police administered naloxone in approximately 10% of incidents. In most incidents, police were the last group of first responders to arrive on scene (59%), and most often, naloxone was administered by others (65%). Police were significantly more likely to administer naloxone when they were the first professionals to arrive, when naloxone had not been administered by others, and when the overdose occurred in public or in a vehicle. Arrests at overdose events were rarely reported (1%), and people who overdosed were rarely (1%) documented in incident reports as being ‘combative.’ Conclusions Considering these findings, ideally, all jurisdictions should have sufficient first responder staffing and resources to ensure a rapid response to overdose events, with police rarely or never dispatched to respond to overdoses. However, until this ideal can be achieved, any available responders should be dispatched concurrently, with police instructed to resume patrol once other professional responders arrive on scene; additionally, warrant searches of persons on scene should be prohibited. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00698-2.
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Affiliation(s)
- Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | | | - Lisa Frueh
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Jai'el R Toussaint
- Department of Africana Studies, Brown University Churchill House, 155 Angell Street, Providence, RI, USA
| | - Roxxanne Newman
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Brendan P Jacka
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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White MD, Watts S, Orosco C, Perrone D, Malm A. Leveraging Body-Worn Camera Footage to Better Understand Opioid Overdoses and the Impact of Police-Administered Naloxone. Am J Public Health 2022; 112:1326-1332. [PMID: 35862885 DOI: 10.2105/ajph.2022.306918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate what transpires at opioid overdoses where police administer naloxone and to identify the frequency with which concerns about police-administered naloxone are observed. Methods. We reviewed body-worn camera (BWC) footage of all incidents where a Tempe, Arizona police officer administered naloxone or was present when the Tempe Fire Medical Rescue (TFMR) administered it, from February 3, 2020 to May 7, 2021 (n = 168). We devised a detailed coding instrument and employed univariate and bivariate analysis to examine the frequency of concerns regarding police-administered naloxone. Results. Police arrived on scene before the TFMR in 73.7% of cases. In 88.6% of calls the individual was unconscious when police arrived, but 94.6% survived the overdose. The primary concerns about police-administered naloxone were rarely observed. There were no cases of improper naloxone administration or accidental opioid exposure to an officer. Aggression toward police from an overdose survivor rarely occurred (3.6%), and arrests of survivors (3.6%) and others on scene (1.2%) were infrequent. Conclusions. BWC footage provides a unique window into opioid overdoses. In Tempe, the concerns over police-administered naloxone are overstated. If results are similar elsewhere, those concerns are barriers that must be removed. (Am J Public Health. Published online ahead of print July 21, 2022:e1-e7. https://doi.org/10.2105/AJPH.2022.306918).
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Affiliation(s)
- Michael D White
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
| | - Seth Watts
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
| | - Carlena Orosco
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
| | - Dina Perrone
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
| | - Aili Malm
- Michael D. White, Seth Watts, and Carlena Orosco are with the Center for Violence Prevention and Community Safety, Arizona State University, Phoenix. Dina Perrone and Aili Malm are with the School of Criminology, Criminal Justice, and Emergency Management, California State University, Long Beach
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Xavier J, Greer A, Crabtree A, Buxton JA. Police officers’ perceptions of their role at overdose events: a qualitative study. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2070057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
| | - Alexis Crabtree
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jane A. Buxton
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Slocum S, Ozga JE, Joyce R, Walley AY, Pollini RA. If we build it, will they come? Perspectives on pharmacy-based naloxone among family and friends of people who use opioids: a mixed methods study. BMC Public Health 2022; 22:735. [PMID: 35418048 PMCID: PMC9006069 DOI: 10.1186/s12889-022-13078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose "bystanders" (friends or family of people who use opioids) that may be amenable to intervention. METHODS Eligible bystanders were Massachusetts residents ≥ 18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22) were conducted April-July 2018, to inform the development of a subsequent quantitative survey (N = 260), conducted February-July 2020. RESULTS Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one's drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone. CONCLUSIONS Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma, and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jenny E Ozga
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Rebecca Joyce
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Alexander Y Walley
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA.,Grayken Center for Addiction, Clinical Addiction Research Education Unit, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA. .,Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA.
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Kruis NE, McLean K, Perry P, Nackley MK. First Responders' Views of Naloxone: Does Stigma Matter? Subst Use Misuse 2022; 57:1534-1544. [PMID: 35791871 DOI: 10.1080/10826084.2022.2092150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prior work has suggested that first responders have mixed feelings about harm reduction strategies used to fight the opioid epidemic, such as the use of naloxone to reverse opioid overdose. Researchers have also noted that provider-based stigma of people who use opioids (PWUO) may influence perceptions of appropriate interventions for opioid use disorder (OUD). This study examined first responders' perceptions of naloxone and the relationship between stigma of OUD and perceptions of naloxone. METHODS A web-based survey assessing perceptions of PWUO and naloxone was administered to 282 police officers and students enrolled in EMT and paramedic training courses located in the Northeastern United States. Bivariate and multivariable analyses assessed the relationship between variants of stigma (e.g., perceived dangerousness, blame, social distance, and fatalism) and self-reported perceptions of naloxone. RESULTS Participants, in the aggregate, held slightly negative attitudes toward the use of naloxone. Findings from multivariable modeling suggest that stigma of OUD, living in a rural area, and prior experience administering naloxone, were significantly and inversely related to support for the use of naloxone. Support for the disease model of addiction and associating drug use with low socioeconomic status were positively related to support for the use of naloxone. CONCLUSION Efforts to alleviate perceptions of PWUO as dangerous, blameworthy, or incapable of recovery may increase first responders' support for naloxone. To this end, first responder training programs should include instruction on the disease model of addiction, and more broadly, attempt to foster familiarity between PWUO and the professionals who serve them.
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Affiliation(s)
- Nathan E Kruis
- Department of Criminal Justice, Penn State Altoona, Altoona, PA, USA
| | - Katherine McLean
- Department of Criminal Justice, Penn State Greater Allegheny, McKeesport, PA, USA
| | - Payton Perry
- Department of Criminal Justice, Penn State Altoona, Altoona, PA, USA
| | - Marielle K Nackley
- Department of Education, Slippery Rock University, Slippery Rock, PA, USA
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Del Pozo B, Sightes E, Goulka J, Ray B, Wood CA, Siddiqui S, Beletsky LA. Police discretion in encounters with people who use drugs: operationalizing the theory of planned behavior. Harm Reduct J 2021; 18:132. [PMID: 34915910 PMCID: PMC8675297 DOI: 10.1186/s12954-021-00583-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Policing shapes the health risks of people who use drugs (PWUD), but little is understood about interventions that can align officer practices with PWUD health. This study deploys the Theory of Planned Behavior (TPB) to understand what influences police intentions to make discretionary referrals to treatment and harm reduction resources rather than arrest on less serious charges.
Methods On-line surveys integrating TPB constructs and adapting an instrument measuring police intentions to make mental health treatment referrals were completed by police employees in Indiana, Massachusetts, and Missouri. They also included items about stigma towards PWUD and attitudes and beliefs about opioid addiction, treatment, and recovery. Findings Across the sites, 259 respondents perceived control over their decision to arrest for misdemeanors (69%) and confiscate items such as syringes (56%). Beliefs about others’ approval of referrals to treatment, its ability to reduce future arrests, and to increase trust in police were associated with stated practices of nonarrest for drug and possession and making referrals (p ≤ .001), and nonarrest for syringe possession (p ≤ .05). Stigma a towards PWUD was negatively associated with stated practices of nonarrest (p ≤ .05). Respondents identified supervisors as having the most influence over use of discretion, seriousness of the offense as the most influential value, and attitude of the suspect as the most important situational factor. The 17 Likert scale items analyzed had a Cronbach’s alpha of 0.81. Conclusion The TPB offers untapped potential to better understand and modify police practices. In designing interventions to improve the health outcomes of police encounters with PWUD, further research should validate instruments that measure the relationship between these variables and discretionary intentions, and that measure role-relevant police stigma towards PWUD.
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Affiliation(s)
- Brandon Del Pozo
- The Miriam Hospital/Warren Alpert Medical School of Brown University, 164 Summit Avenue, Providence, RI, 02906, USA.
| | - Emily Sightes
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, USA
| | - Jeremiah Goulka
- Health in Justice Action Lab, Northeastern University, Boston, USA
| | - Brad Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St Louis, St. Louis, USA
| | - Saad Siddiqui
- Missouri Institute of Mental Health, University of Missouri St Louis, St. Louis, USA
| | - Leo A Beletsky
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, USA
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White MD, Perrone D, Watts S, Malm A. Moving Beyond Narcan: A Police, Social Service, and Researcher Collaborative Response to the Opioid Crisis. AMERICAN JOURNAL OF CRIMINAL JUSTICE : AJCJ 2021; 46:626-643. [PMID: 34248322 PMCID: PMC8254616 DOI: 10.1007/s12103-021-09625-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/10/2021] [Indexed: 06/13/2023]
Abstract
The opioid crisis is the most persistent, long-term public health emergency facing the United States, and available evidence suggests the crisis has worsened during the COVID-19 global pandemic. Naloxone is an effective overdose response that saves lives, but the drug does not address problematic drug use, addiction, or the underlying conditions that lead to overdoses. The opioid crisis is at its core a multidisciplinary, multisystem problem, and an effective response to the crisis requires collaboration across those various systems. This paper describes such a collaborative effort. The Tempe First-Responder Opioid Recovery Project is a multidisciplinary partnership that includes police officers, social workers, substance use peer counselors, public health professionals, police researchers, and drug policy/harm reduction researchers. The project, 10 months underway, trained and equipped Tempe (AZ) police officers to administer Narcan. In addition, a 24/7 in-person "Crisis Outreach Response Team" rapidly responds to any suspected overdose and offers follow-up support, referrals, and services to the individual (and loved ones) for up to 45 days after the overdose. We present preliminary project data including interviews with project managers, counselors, and police officers, descriptions of Narcan administrations in the field, and aggregate data on client service engagement. These data highlight the complexity of the opioid crisis, the collaborative nature of the Tempe project, and the importance of initiating a multidisciplinary, comprehensive response to effectively deal with the opioid problem.
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Affiliation(s)
- Michael D. White
- Center for Violence Prevention and Community Safety, Arizona State University, 411 N Central Ave, Phoenix, AZ 85004 USA
| | - Dina Perrone
- School of Criminology, Criminal Justice, and Emergency Management, California State University Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840 USA
| | - Seth Watts
- Center for Violence Prevention and Community Safety, Arizona State University, 411 N Central Ave, Phoenix, AZ 85004 USA
| | - Aili Malm
- School of Criminology, Criminal Justice, and Emergency Management, California State University Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840 USA
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Buchheit BM, Crable EL, Lipson SK, Drainoni ML, Walley AY. "Opening the door to somebody who has a chance." - The experiences and perceptions of public safety personnel towards a public restroom overdose prevention alarm system. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103038. [PMID: 33232885 DOI: 10.1016/j.drugpo.2020.103038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 09/23/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioid overdose deaths have surged due to fentanyl in the illicit opioid supply, which causes overdose more rapidly than other opioids. Public restrooms are venues where fentanyl overdoses commonly occur. In response, some organizations have implemented anti-motion alarm systems as a prevention approach. We aimed to describe the experiences and perceptions of public safety personnel after the installation of an anti-motion alarm system in public restrooms at an urban medical center. METHODS From February to June 2019, we conducted semi-structured qualitative interviews to explore the experiences and perceptions of hospital public safety personnel who responded to overdoses in public restrooms with and without an anti-motion alarm system. We interviewed 11 personnel, with interviews lasting an average of twenty-six minutes. We conducted inductive thematic analysis to synthesize and identify salient themes. RESULTS Ten participants were male; the average age was 40 with an average time employed by the hospital of 12 years. Four themes were identified: Public safety personnel 1) believe responding to overdoses is an appropriate responsibility; 2) focus on their training rather than individual emotions when responding to an overdose; 3) view the anti-motion alarm system as an acceptable tool for preventing overdoses, despite technological challenges; and 4) report concern for potential unintended consequences of the anti-motion alarm system. CONCLUSIONS Overdose response in public restrooms has been incorporated into the daily duties of public safety personnel at an academic medical center. Anti-motion alarm systems are an innovation with potential to improve overdose response and safety, though the technology warrants ongoing development and unintended consequences should be assessed. To optimize restroom safety in the midst of fentanyl use, more research is needed among first responders, people who use drugs in restrooms, and other restroom patrons.
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Affiliation(s)
- Bradley M Buchheit
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code: L475, Portland, OR, 97239, USA; Department of Family Medicine, Oregon Health & Science University, 3303 S Bond Avenue, Mail Code: CH9F, Portland, OR, 97239, USA.
| | - Erika L Crable
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, T2W, Boston, MA, 02118, USA; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Sarah K Lipson
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, T2W, Boston, MA, 02118, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Talbot Building, T2W, Boston, MA, 02118, USA; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
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13
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Nath JM, Scharf B, Stolbach A, Tang N, Jenkins JL, Margolis A, Levy MJ. A Longitudinal Analysis of a Law Enforcement Intranasal Naloxone Training Program. Cureus 2020; 12:e11312. [PMID: 33282588 PMCID: PMC7714746 DOI: 10.7759/cureus.11312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The opioid crisis continues to claim lives at historically unprecedented levels and shows few signs of abating. One means of mitigating the harm from opioid abuse and unintentional overdose is training and equipping police officers to administer intranasal (IN) naloxone as part of a broader public health response. While an increasing number of state and local agencies have implemented law enforcement officer (LEO) naloxone training programs, due to the novelty of these programs, the evidence of program efficacy is limited. This study describes the implementation and evaluation of a LEO training program in opioid overdose recognition, management, and administration of IN naloxone. METHODS This evaluation consisted of a secondary analysis of de-identified administrative quality assurance data. Police officers in Howard County, Maryland (n=281) underwent an IN naloxone training program between June and July 2015. The training program entailed a 30-minute online component, a 45-minute in-service session, and a 15-question post-test (n=228). The success of the training program was evaluated via an opioid overdose knowledge survey administered at 30 days (n=207) and 6 months (n=182) after training. RESULTS The 30-day and 6-month scores for all knowledge outcomes indicated that officers retained the contents of the training program well over time. After six months, 100% of respondents correctly identified the physiological effects of naloxone administration, and 95.6% correctly identified the opioid-containing drugs that may result in overdose. At the six-month mark, 74.59% correctly identified the initial signs of opioid overdose, and 60.99% correctly identified the time required for IN to begin working. CONCLUSION LEOs exhibit the ability to retain the contents of IN training over 30-day and 6-month periods and express confidence in their ability to assist suspected opioid overdose victims. Further research is necessary to determine the degree to which further knowledge decay might occur, the sustained ability to implement this knowledge under real-world conditions, and the subsequent effects on overdose victim survival.
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Affiliation(s)
- Jennifer M Nath
- Emergency Medicine, Upstate University Hospital, Syracuse, USA
| | - Becca Scharf
- Office of the Medical Director, Howard County Department of Fire and Rescue Services, Marriottsville, USA.,Emergency Health Services, University of Maryland, Baltimore County, Baltimore, USA
| | - Andrew Stolbach
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nelson Tang
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - J Lee Jenkins
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.,Emergency Health Services, University of Maryland, Baltimore County, Baltimore, USA
| | - Asa Margolis
- Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Matthew J Levy
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.,Office of the Medical Director, Howard County Department of Fire and Rescue Services, Mariottsville, USA
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Murphy J, Russell B. Police Officers’ Views of Naloxone and Drug Treatment: Does Greater Overdose Response Lead to More Negativity? JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620921363] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Police officers and emergency personnel are on the frontlines of the opioid crisis. This research examines police officer attitudes about naloxone administration, drug treatment, and their role in handling drug-related incidents through an online survey. Although officers view themselves as adequately trained in administering naloxone/Narcan, almost half (43%) believe there should be a limit on how often someone who overdoses receives Narcan and the majority (83%) view naloxone/Narcan as providing an excuse to continue drug use. Officers also view drug treatment as ineffective. Negative attitudes differed as a function of frequency of overdose responses; officers who responded to more overdose calls and administered naloxone more frequently demonstrate more pessimistic attitudes toward drug treatment and the use of naloxone/Narcan. Officers more frequently exposed to drug overdoses need education and training about drug addiction issues to decrease stigma and elicit greater empathy toward people struggling with addiction.
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First Responder knowledge, perception and confidence in administering naloxone: Impact of a pharmacist-provided educational program in rural Mississippi. J Am Pharm Assoc (2003) 2019; 59:S117-S121.e2. [DOI: 10.1016/j.japh.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 11/17/2022]
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