Two‐year outcomes following naloxone administration by police officers or emergency medical services personnel

• Author: Daniel O'Donnell,Spencer G. Lawson,Bradley R. Ray,Evan M. Lowder,Emily Sightes
• Date: 01 August 2020
• Published date: 01 August 2020
• DOI: http://doi.org/10.1111/1745-9133.12509

Received:  January   Revised:  June  Accepted:  June 

DOI: ./- .

SPECIAL ISSUE ARTICLE

CUTTING-EDGE RESEARCH IN POLICE POLICY AND PRACTICE

Two-year outcomes following naloxone

administration by police officers or emergency

medical services personnel

Evan M. Lowder1Spencer G. Lawson2Daniel O’Donnell3

Emily Sightes4Bradley R. Ray4

George Mason University

Michigan State University

Indiana University School of Medicine,

Indianapolis Emergency Medical Services

Wayne State University

Correspondence

EvanM. Lowder, Department of Crimi-

nology,Law and Society,George Mason

University, University Drive, F,

Fairfa x, VA .

Email:elowder@gmu.edu

Research Summary: We conducted a retrospective,

quasi-experimental study of a police naloxone program

to examine individual outcomes following nonfatal over-

dose where either police (n=) or emergency medical

services (n=,) provided a first response and admin-

istered naloxone. Individuals who received a police

response were more likely to be arrested immediately

following initial dispatch and had more instances of

repeat nonfatal overdose two years following dispatch;

there were no differences in rearrestor death rates. Find-

ings suggest police naloxone programs may increase

short-term incarceration risk, but we found little evi-

dence overall of long-term adverse effects.

Policy Implications: Naloxone is a tool to reduce

fatal opioid-involved overdose. Its provision alone does

not constitute a comprehensive agency response to the

opioid epidemic. Findings support the need for stan-

dardized policies and procedures to guide emergency

responses to nonfatal overdose events and ensure con-

sistency across agencies.

KEYWORDS

naloxone, nonfatal overdose, opioid epidemic, police

Criminology & Public Policy. ;:–. ©  American Society of Criminology 1019wileyonlinelibrary.com/journal/capp

1020 LOWDER  .

The overdose epidemic in the United States is now characterizedby a growing number of synthetic

opioid-involved deaths (Scholl, Seth, Kariisa, Wilson, & Baldwin, ). Specifically,the synthetic

opioid fentanyl, which is  times stronger than morphine, has been implicated in the majority

of opioid overdose deaths (Jalal et al., ; Lowder, Ray, Huynh, Ballew, & Watson, ). From

 to , the age-adjusted rate of synthetic opioid overdose deaths increased from . to .

per , U.S. residents (Hedegaard, Miniño, & Warner, ). Since , more people have

died of synthetic opioids than any other class of opioids (Ahmad, Escobedo, Spencer, Warner, &

Sutton, ).

In the face of the growing lethality of opioid use in the United States, naloxone has emerged as

a primary harm reduction tool to reduce fatal overdose events. Naloxone is a medication and opi-

oid antagonist that works to counteract the effects of opioids, particularly respiratory depression,

and can be administered via numerous routes (intravenously, subcutaneously, intramuscularly,

or intranasally). As a harm reduction strategy, naloxone is not intended to reduce drug use or

provide treatment for drug use, but is intended to mitigate the more serious consequence of illicit

opioid use as part of a broader public health strategy (Beletsky, Rich, & Walley, ; Hawk, Vaca,

&D’Onofrio,; Kolodny et al., ; Nelson, Juurlink, & Perrone, ). Naloxone is a life-

saving medication (Chamberlain & Klein, ; He, Jiang, & Li, ), and efforts are underway

nationwide to increase the availability of naloxone beyond medical professionals. For example,

as of , nearly  community-based organizations reported providing naloxonekits to layper-

sons (Wheeler, Jones, Gilbert, & Davidson, ). Naloxone is now distributed to laypersons in

emergency departments (Dwyer et al., ) and local pharmacies (Morton et al., ), and there

is growing interest and support for the distribution of naloxone in jail settings (Davidson,Wagner,

Toka r, & Scho la r, ).

However, in many cases, a one-time naloxone administration by a lay responder may not

be sufficient to revive an individual who is overdosing, necessitating an emergency response.

Indeed, recent trends suggest multiple naloxone administrations in a single overdose encounter

are increasing (Faul et al., ). As a result, in addition to lay responders and medical person-

nel, many jurisdictions are equipping other first responders with naloxone to respond directly to

overdose incidents (Davis, Ruiz, Glynn, Picariello, & Walley, ). These efforts have targeted

police officers specifically, because they are likely to encounter individuals involved in an opi-

oid overdose (Wagner, Bovet, Haynes, Joshua, & Davidson, ) and can often respond to such

encounters more rapidly than emergency medical services, particularly in rural areas(Davis, Carr,

Southwell, & Beletsky, ; Fisher, O’Donnell, Ray, & Rusyniak, ). As of , more than

, law enforcement agencies across  states distributed naloxone as part of their emergency

response practices (Lurigio, Andrus, & Scott, ), representing approximately %–% of law

enforcement agencies nationwide (Banks, Hendrix, Hickman, & Kyckelhahn, ).

At least some preliminary study results show these efforts are promising. For example, one

prior study found that expanded access to naloxone among law enforcement was associated with

a reduction in opioid overdose deaths (Rando, Broering, Olson, Marco, & Evans, ). Another

study examining the effects of police officer naloxone training found that the majority of individ-

uals revived from an overdose via a police officer were not arrested, were cooperative, and volun-

tarily agreed to visit the hospital after revival (Fisher et al., ). Beyond contributing to positive

individual-level outcomes, expanded access to naloxone among police mayhelp to improve public

perception of the police and, accordingly, increase bystanders’ willingness to call  at the scene

of an overdose (Davis et al., ). Indeed, equipping police officers with naloxone in an attempt

to prevent overdose deaths has led to improved community relations between the lay public,

police officers, and other public health/community agencies (Beletsky et al., ). Although the