A Preliminary Assessment of Stigma in Law Enforcement Officers’ Responses to Opioid Overdoses

• DOI: 10.1177/0022042620974076
• Author: Nathan E. Kruis,Alida V. Merlo
• Published date: 01 April 2021
• Date: 01 April 2021
• Subject Matter: Articles

https://doi.org/10.1177/0022042620974076

Journal of Drug Issues

2021, Vol. 51(2) 297 –318

© The Author(s) 2020

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DOI: 10.1177/0022042620974076

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Article

A Preliminary Assessment of

Stigma in Law Enforcement

Officers’ Responses to Opioid

Overdoses

Nathan E. Kruis1 and Alida V. Merlo2

Abstract

Prior work has suggested that provider-based stigma of substance use disorders may be one

barrier to fighting the opioid epidemic. However, to date, provider-based stigma has been

afforded little attention in the context of the criminal justice system. The goal of the current study

was to extend this line of research by examining the impact of provider-based stigma toward

opioid using persons to beliefs about help that should be provided to persons experiencing an

overdose among a sample of 208 police officers working in departments in the Northeastern

Region of the United States. In addition, this study explores the relationship between provider-

based stigma and the anticipated on-duty behavioral responses to opioid overdoses. Results

from multivariable analyses indicate that certain dimensions of social stigma are significantly

related to officers’ perceptions of help in varying directions, along with officers’ experiences

with naloxone administration and departmental policy pertaining to the use of naloxone.

Keywords

stigma and responses to drug users, police perceptions and willingness to help

Introduction

Responding to the opioid crisis has been challenging for law enforcement agencies. According to

recent data from the Federal Bureau of Investigation’s (FBI, 2020) Uniform Crime Report (UCR),

of the over 10 million arrests in 2019, the largest category of arrests was for “drug abuse viola-

tions,” totaling more than 1.5 million arrests. Arrests related to opioids, cocaine, and their deriva-

tives accounted for almost 32% of all “sales/manufacturing” arrests and nearly 23% of all

“possession” arrests within this category. In response to the opioid epidemic, and increased officer

contact with persons who use opioids, many departments have enacted departmental-level harm-

reduction policies, such as equipping officers with naloxone and implementing “Deflection,”

Angel, or Law Enforcement Assisted Diversion (LEAD) programs in which officers serve as

entry points into substance use treatment (Hadley, 2019; National Institute of Justice [NIJ],

1Penn State Altoona, PA, USA

2Indiana University of Pennsylvania, USA

Corresponding Author:

Nathan E. Kruis, Department of Criminal Justice, Penn State Altoona, Cypress Building, Room 101E, 3000 Ivyside

Park, Altoona, PA 16601, USA.

Email: nek132@psu.edu

974076JODXXX10.1177/0022042620974076Journal of Drug IssuesKruis and Merlo

research-article2020

298 Journal of Drug Issues 51(2)

2019). Unfortunately, not all departments have developed such policies, and many officers have

reported negative feelings toward harm-reduction strategies (Beletsky et al., 2005; Burris et al.,

2009; Green et al., 2013; Saunders et al., 2019). Prior research suggests that stigma may be one

barrier to overcome to fully implement harm-reduction policies in the criminal justice system and

to combat the opioid epidemic (Formica et al., 2018; Kruis & Choi, 2020; Kruis et al., 2020;

Murphy & Russell, 2020). However, the available research on provider-based stigma in the sys-

tem is scant, and the NIJ (2019) has suggested that more research needs to be conducted on the

use of law enforcement personnel as entry points into treatment for substance using persons.

Using self-reported data from a sample of 208 law enforcement officers working in departments

located in the Northeastern United States, this study sought to help fill these gaps in the literature

by analyzing the influence of provider-based stigma on beliefs about help that officers think

should be provided to persons who experience an opioid overdose by other on-duty police offi-

cers. Furthermore, this study explores the relationship between provider-based stigma and the

on-duty behavioral responses that officers anticipate themselves providing to those who experi-

ence an opioid overdose.

Literature Review

The Opioid Epidemic

The opioid epidemic was first identified by a sudden rise in overdose deaths for synthetic opioids

in 1999 (Centers for Disease Control and Prevention [CDC], 2020). Then, in 2009, overdose

death rates for heroin started to steadily increase (CDC, 2020). Subsequently, in 2013, overdose

deaths from semi-synthetic opioids, such as fentanyl, signaled a sharp upward trajectory (CDC,

2020). Overall, opioids are responsible for about 70% of all drug-related fatalities, and fentanyl

alone is responsible for more than 40% of all drug-related fatalities in the United States (National

Institute on Drug Abuse, 2018c). On average, 128 people die every day from an opioid overdose

in the United States, and opioids have taken the lives of more than 450,000 Americans since 1999

(CDC, 2020).

The criminal justice system has been forced to respond to this epidemic. In addition to the

arrest data noted, about 26% of prison inmates and 28% of jail inmates have reported lifetime

opioid use (Bureau of Justice Statistics, 2017). Furthermore, about one in six prisoners (16.6%)

and one in five jail inmates (18.9%) was a regular user of heroin or prescription opioids in the

month immediately preceding incarceration (Bureau of Justice Statistics, 2017). Consequently,

many inmates have opioid use disorders that need to be addressed (National Institute on Drug

Abuse, 2020). Thus, many law enforcement agencies, courts, prisons, and community correc-

tional agencies have incorporated evidence-based technologies, practices, and policies for deal-

ing with justice-involved persons who use opioids.

On the front end, one strategy involves requiring police officers and other first responders to

carry the opioid reversal drug, naloxone, more commonly known by the brand name, Narcan. As

an opioid antagonist, naloxone reverses the effects of opioids and prevents respiratory failure

(National Institute on Drug Abuse, 2018a, 2018b). The United States Food and Drug Administration

has approved three formulations of naloxone—injectable, auto-injectable, and prepackaged nasal

spray. Most commonly, it is administered via prepackaged nasal spray, and it is available over-the-

counter in most states (National Institute on Drug Abuse, 2018b). Prior research suggests that

increased access to naloxone has demonstrated effectiveness in reducing community-level fatal

opioid overdose rates (Rees et al., 2017; Walley et al., 2013). Often the first uniformed responders

to arrive on the scene, police officers may be able to administer naloxone to the person who has

experienced an overdose minutes before Emergency Medical Technicians (EMTs) arrive (Davis

et al., 2014), thus possibly increasing the person’s chances of survival while also potentially