Reprinted from “The Administration of Naloxone by Law Enforcement Officers: A Statewide Survey of Police Chiefs in Illinois” by Jessica Reichert, Arthur Lurigio, and Lauren Weisner, Law Enforcement Executive Forum, Volume 19, issue 4, Copyright © 2019 by ILETSBEI; all rights reserved.

In the United States, deaths from drug overdoses climbed 94% from 2008 to 2016.[1] A majority of those deaths (70%) were attributable to opioids such as heroin, methadone, oxycodone, and fentanyl. Numerous states have reported steady increases in deaths from opioid overdoses since 2008.[2] For example, from 2015 to 2016, 26 states—including Illinois, which is the site for the current research— reported significant increases in drug overdose deaths, mostly from opioids.[3] In short, the opioid crisis has been devastating communities across America for over a decade.[4]

In 2017, the U.S. Department of Health and Human Services declared the opioid epidemic to be a public health emergency. That year alone, opioids were responsible for nearly 48,000 overdose deaths.[5] Opioid overdose is now a leading cause of accidental death, killing more Americans than motor vehicle and firearm fatalities combined. Each day, an average of 130 Americans die from an opioid overdose.[6] Estimates suggest that one in 96 people born in 2017 will die of an opioid overdose.[7]

Naloxone

Opioids can cause respiratory failure and death within hours or sometimes minutes of ingestion.[8] The prescription drug naloxone has resulted in fewer overdose deaths by stopping potentially fatal opioid-induced respiratory depression.[9] Naloxone is a fast-acting opioid receptor antagonist approved by the U.S. Food and Drug Administration (FDA) as a safe and effective antidote to opioid overdose; it can completely and almost immediately reverse the effects of an opioid overdose when administered before breathing ceases.[10] Naloxone can be dispensed by either nasal spray or auto-injection.[11] The drug has no effect on individuals who have not ingested opioids [12]; however, naloxone can produce acute symptoms of opioid withdrawal when administered to overdose victims (e.g., agitation, hyperventilation, sweating, seizures, irritability, and vomiting). Therefore, those who are revived may require prompt medical attention and be referred to substance use disorder treatment programs.[13]

Two brands of naloxone are available in the U.S.: Narcan® and EVZIO®. In some states, naloxone may be obtained by prescription only. Nonetheless, Illinois and 42 other states have issued standing orders that allow naloxone to be purchased at pharmacies without prescriptions.[14] The FDA has just recently approved the sale of generic naloxone spray, which will decrease the price of the medication and possibly promote its use.[15] Good Samaritan Laws in Illinois and nine other states protect naloxone prescribers and those who administer naloxone on another person from legal liability.[16]

Naloxone is usually supplied in kits of two doses, which are often provided to police departments through public health and human service agencies through local, state, or federal grants.[17] In light of the drug’s potential life-saving effects, demand for the drug has grown from 2006 to 2017, creating a shortage and consequent increase in price, which presently varies from $70 to $150 per dose.[18] Evidence suggests that naloxone saves lives, increases quality-adjusted life years, and is cost effective.[19]

Law Enforcement Officers

Law enforcement officers (LEOs) outnumber other first responders in the U.S. and are typically the first to arrive at the scene of an opioid overdose.[20] Public support for equipping LEOs with naloxone has been rising rapidly since 2010.[21] Indeed, Illinois and several other states have enacted laws that require first responders, including LEOs, to carry naloxone.[22]

Some states mandate training for LEOs and civilians who administer naloxone. The training sessions are usually brief and include instructions on how to detect overdoses and administer the drug properly.[23] More than 2,400 police departments nationwide presently equip their officers with naloxone. The administration of naloxone by LEOs to reverse opioid-related overdoses has reportedly saved thousands of lives.[24] Following non-fatal opioid overdoses, LEOs can provide take-home naloxone kits to opioid users as well as to users’ friends and family members.[25]

Similar to training for cardiopulmonary resuscitation (CPR), rescue breathing, and first aid, LEOs can effectively save lives by administering naloxone (Bazazi, Zaller, Fu, & Rich, 2010).[26] LEOs are generally amenable to carrying and administering naloxone (Wagner, Bovet, Haynes, Joshua, & Davidson, 2016).[27] For example, a study of LEOs has shown that they are frustrated by their perceived inability to help community residents with addiction and other problems; nevertheless, they view naloxone as a tool that can make a difference in residents’ lives.[28] In another study, LEOs reported little difficulty in administering naloxone, but they underscored the importance of officer training to ensure its proper use.[29] Some LEOs might object to its use because of their belief that naloxone encourages increased drug use[30]; however, research has found reductions in drug use.[31] The benefits of naloxone administration, with suitable training, can extend beyond its overdose-reversal properties by possibly enhancing LEOs’ personal and job satisfaction, and improving police–community relations.[32]

Current Study

The purpose of the current study was to explore the implementation of naloxone by LEOs in Illinois, where deaths from opioid overdoses increased 54% from 2014 to 2017.[33] The research examined the nature and extent of naloxone implementation; differences in naloxone adoption and training; and variations in perceptions, beliefs, and attitudes toward naloxone administration among law enforcement agencies across the state. The research also investigated sources of support and resistance related to naloxone adoption as well as practices related to the storage and administration of the medication among a sample of Illinois police departments. Finally, the study assessed respondents’ knowledge of state laws pertaining to drug overdoses and the liability surrounding naloxone administration.

Methods

Overview

An online survey was conducted with a sample of police chiefs from Illinois law enforcement agencies. A stratified random sampling strategy was employed on a target population of 439 jurisdictions that had recorded 10 or more opioid overdoses in 2017. The overdose data were obtained from the Illinois Department of Public Health (IDPH). ZIP codes with fewer than 10 annual opioid overdoses were removed from the sampling frame. As a function of time and resources, the number of jurisdictions selected for the sample was set at 100. These jurisdictions were selected using the random number generator in Microsoft Excel. The sample also included two large jurisdictions with exceptionally high numbers of overdoses for a final sample size of 102. These jurisdictions were included to gauge the impact of naloxone administration in areas with the highest volume of opioid overdoses in Illinois. The study was approved by the Illinois Criminal Justice Information Authority’s Institutional Review Board.

Sampling Strata

Sampling strata were based on the number of fatal and nonfatal opioid overdoses in each sampled jurisdiction. The number of overdoses in 2017 ranged from 10 to 794. The cutoffs for the stratum sizes were based on the distribution of overdoses across all jurisdictions with more than 10 overdoses: low-overdose stratum (10 to 261 overdoses), medium-overdose stratum (262 to 523 overdoses), and high-overdose stratum (524 to 794 overdoses). The sample sizes for each of the three strata were determined by the following formula: sample size (N = 100)/ overdose range × 3 (strata). The final sample included 95 jurisdictions in the low-overdose stratum, four in the medium-overdose stratum, and one in the high-overdose stratum. The two jurisdictions with the highest number of overdoses in the state (greater than 794) were analyzed separately. Jurisdictions were randomly selected from each stratum using the random number generator in Microsoft Excel.

Survey Strategy

Up to three e-mails were sent to police chiefs in the selected jurisdictions, providing them with a link to the online survey created using Qualtrics software, which was available from November 2018 to February 2019. Follow-up phone calls were made to non-respondents. As of January 2019, 60 of the sampled jurisdictions/police chiefs had not responded to the survey solicitation and were removed from the sample and returned to their strata. To replace them, 60 new jurisdictions—56 from the high-overdose group, two from the medium-overdose group, and two from the low-overdose group—were randomly selected using a random number generator. The same respondent recruitment strategy was employed for the replacement sample.

Final Sample

A total of 106 responses was received. Of them, 24 were removed for the following reasons: 13 were returned with less than 50% of the survey completed, nine had more than one response for the same police department (removed the less-complete survey or randomly removed one or the other response), and two had no information on the survey regarding the identity of the police department. Thus, the final sample consisted of 82 respondents, yielding an 80% response rate. A total of 76 respondents were from the low-overdose stratum (80%), four were from the medium-overdose stratum (100%), one was from the high-overdose stratum (100%), and one was one of the two jurisdictions with the highest number of overdoses in the state.

Survey Content

The online survey contained 58 questions divided into six domains: (1) demographics (4 questions); (2) use/administration, including policies, procedures, extent of use, and barriers (40 questions); (3) knowledge (2 questions); (4) training (6 questions); (5) attitudes/beliefs (4 questions); and (6) two “other” questions that asked respondents to offer advice to other departments considering naloxone adoption and to provide additional comments. After completing the survey, respondents were invited to download two factsheets—one on Illinois’s policies concerning naloxone administration and the other on the Overdose Detection Mapping Application Program, a free federally funded information-sharing and response technology for LEOs. Survey data were analyzed using SPSS (Statistical Package for the Social Sciences).

Results

Administration of Naloxone

An overwhelming majority of police chiefs (90%) reported that LEOs in their departments carry naloxone. Nearly three-fourths (74%) reported that all the officers carry the drug, 10% reported that only select officers carry the drug, and 5% reported that individual officers may volunteer to carry the drug. A handful of police chiefs (n = 4, 11%) reported that no officers in their department carried naloxone. The reported reasons for why officers did not carry naloxone were a lack of funding, a pending “backorder” for the drug, and an understanding that local fire fighters were responsible for administering the drug when responding to opioid overdose calls. Half of the departments (two of the four) that did not supply their officers with naloxone indicated that they planned to train and equip them to administer the medication within the next six months. To do so, one of the departments indicated that it had to wait until funds became available to purchase the drug.

The reported number of LEOs who carry naloxone while on duty ranged from 0 to 200, with an average of 29 officers who did so. According to respondents, officers were equipped to carry the pre-filled nasal spray (86%), the pre-filled intramuscular auto-injection device (10%), the intramuscular injection syringe (3%), or both the nasal spray and pre-filled auto-injection device (1%). Most departments (87%) that carry naloxone related that they had enough naloxone kits to meet their current demands for the medication. In all jurisdictions in which police officers carry naloxone, a majority of participants (56%) responded that both fire department and EMS personnel carry naloxone as well, 33% reported that only EMS professionals did, and 10% reported that only fire fighters did.

With regard to administration of naloxone, nearly half (47%) of the police chiefs responded that LEOs are among those most often administering the medication at the scene of an overdose, followed by EMT/EMS personnel (41%) and fire fighters (7%). Nearly 60% of the police chiefs reported that their departments had administered naloxone a total of one to ten times in the past year, and 65% reported a total of one to ten successful overdose reversals in the past year. Slightly over half (52%) of the police chiefs responded that their officers have administered naloxone to the same individual more than once. Police chiefs were also asked to report how naloxone recipients typically reacted after receiving the drug. Of the 30 respondents who described the post-administration reactions of individuals, 77% reported that overdose victims exhibited upset/violent, mixed, or confused states at the scene.

Naloxone Distribution in the Community

Almost all respondents (99%) reported they neither trained on naloxone administration nor distributed naloxone to members of the community. Only one respondent indicated their department trained community residents on naloxone administration. In addition, most respondents (85%) reported that they were not registered by the Illinois Department of Human Services (IDHS) as a Drug Overdose Prevention Program to train others on naloxone administration.

Naloxone Policies and Procedures

The source, costs, and funding for naloxone varied by department. As shown in Table 1, police agencies usually obtained naloxone through their local health departments or other sources such as treatment providers, nonprofits, and EMS and fire departments. The most common source of funding for naloxone were the departments themselves, followed closely by grant money. A majority of police chiefs reported that their departments paid nothing to obtain naloxone for their LEOs to use.

According to participants, naloxone is typically stored in a police vehicle (41%), carried on the officer’s person (33%), or kept in the police station (12%). Similar to the closedended responses regarding naloxone storage, 11 police chiefs (14%) wrote that naloxone was stored in “another” location—specifically, in a first aid kit or “duty bag” (n = 6) or at the station (n = 4) when officers are off-duty and in “the police vehicle or on the officer” (n = 1) when officers are on duty. Nearly all departments (99%) indicated that they check their naloxone kits for an expiration date; only one did not. Most police chiefs (87%) also reported that naloxone is not retained after the drug’s expiration date. If kits are kept following expiration, most (86%) are held between one and nine months beyond the date.

All but one police chief (99%) reported keeping records of when naloxone is administered by LEOs. The most ommon method of recordkeeping is in paper form (39%) or in both paper and online forms (37%). Only 17% responded that records are kept in an online form only. A majority of departments (69%) indicated that they report information about naloxone administration to IDHS via the state’s overdose reversal forms.

Table 1

Police Departments: Obtaining and Funding Naloxone

n %
How is naloxone obtained?
Local health department 26 29.9
Local pharmacy 6 6.9
Pharmaceutical company 7 8.0
Local hospital 12 13.8
IDHS/IDPH naloxone standing order 14 16.1
Other 22 25.3
Total 87 100.0
Funding source
Grant money 21 27.2
Private donations 4 5.2
Department funds 22 28.6
Drug seizure/forfeiture funds 2 2.6
IDPH/IDHS funds 13 16.9
Local health department 7 9.1
Other 8 10.4
Total 77 100.0
Cost to department
Free (grant funded, donated, etc.) 28 53.8
$1-$50 8 15.4
$51-$75 12 23.1
$75-$150 4 7.7
Total 52 100.0
Note: Respondents could check all that apply.

Naloxone Implementation: Support and Barriers

Participants were asked about support for naloxone when it was first administered. Results showed that support was highest among local public health agencies (83%), followed by local government agencies (70%), department supervisors and administrators (70%), and line officers (51%). According to police chiefs, when departments first implemented naloxone, addiction-related stigma was a barrier from within (28%) and outside (6%) the department. One police chief shared that both his community and his officers were reluctant to support the administration of naloxone. In the respondent’s words,

Truthfully—I think the overall public in our area does not support it. It is looked at widely like the offender makes a choice and the burden to solve the overdose should not be placed on the police. I think most police officers feel the same way.

Other barriers faced at the onset of naloxone implementation included the costs (42%) and civil liability concerns (44%). Respondents perceived that all but one of the barriers contained in the survey diminished significantly from first implementation to the time of the survey: stigma in the department (28 to 10%), legal liability concerns (44 to 9%), cost (42 to 20%), and staffing (1 to 0%). Two respondents mentioned additional current barriers: officer safety while handling fentanyl, and time for training and program administration.

In an open-ended question, police chiefs were asked to specify how they overcame barriers to naloxone implementation. Of those who responded, 59% reported education or training and 10% indicated funding. Another 10%expressed that "time” helped them overcome barriers as they became more comfortable and experienced with the administration of the drug. For example, one police chief wrote that time was needed for officers “to accept that life-saving, regardless of the circumstances, is part of our duties.” An additional 10% suggested barriers were overcome with government policies such as the “state mandate” that required their officers to carry naloxone. One police chief explained, “Some officers still feel very strongly that we should not administer naloxone and only do so because they are ordered by supervisors and required by policy.” Another simply stated, “We are the police; we do what is required by good conscience and by law.” To overcome curren barriers, 28% reported needing more or continued funding for naloxone and 8% reported needing more naloxone education or training.

Officer Training on Naloxone

Police chiefs reported that 99% of the officers in their departments were trained to administer naloxone: 2,834 officers in 78 departments. Almost all (95%) of the police chiefs reported that formal training on naloxone administration was required for LEOs, and 95% agreed that the training for officers to deal with overdoses was sufficient. The majority of respondents (65%) reported that department staff conducted the training, followed by local health departments (20%), local hospitals (12%), treatment providers (9%), and IDHS (4%). Other trainers included nonprofit agencies, coroner’s offices, fire departments, local ambulance services, and local pharmacists. Training times ranged from 15 to 480 minutes (M = 84, Md = 60, and Mo = 60). Table 2 presents the range of topics included in naloxone training such as recognizing the signs of overdose, evaluating patient responsiveness, and employing rescue breathing. As shown, an overwhelming majority of police chiefs reported that trainings covered the “proper administration of naloxone.” A small percentage of police chiefs (28%) reported that the training covered “resources for community-based programs to treat addiction.”

Table 2

Topics Covered in Agency’s Naloxone Training (N = 78)

n %
Naloxone administration 75 96.2
Information on naloxone 74 94.9
Recognizing signs of overdose 73 93.6
Recovery position post-naloxone 68 87.2
Side effects 67 85.9
Potential reactions post-administration 67 85.9
Evaluation of patient responsiveness 67 85.9
Support immediately following administration 65 83.3
Evaluation for additional naloxone doses 64 82.1
Opioid education 62 79.5
Rescue breathing post-naloxone 62 79.5
Illinois laws related to opioids/opioid overdose 60 76.9
Community addiction program resources 22 28.2

Knowledge About Opioid Overdose

Police chiefs were asked about familiarity with state laws regarding opioid overdose. High percentages of respondents reported that they (88%) and their officers (82%) were very to moderately familiar with the Good Samaritan Law (officially named the Illinois Emergency Medical Services Access Law), which affordslegal protection to people who provide reasonable assistance to those who are needing or seeking emergency medical care for an overdose. In addition, nearly 60% reported being very to moderately familiar with laws regarding civil liability and naloxone administration. Similarly, 92% were at least slightly to somewhat or more familiar with the naloxone standing order, which allows individuals to purchase naloxone at a pharmacy without a prescription. Furthermore, 90% of the police chiefs were at least slightly to somewhat or more familiar with the Heroin Crisis Act, which among other duties, requires police, fire, and EMS professionals to carry and administer naloxone.

Attitudes and Beliefs Regarding Naloxone

Police chiefs were asked to report the general competency, attitudes, and beliefs of officers regarding naloxone. All but one of the police chiefs (99%) agreed with the statement, “If someone overdoses, officers know what to do to help them.” A very large percentage of respondents (97%) also agreed that “Officers will do whatever [is] necessary to save someone’s life in an overdose situation.” A large percentage of police chiefs (82%) noted that officers likely feel more comfortable responding to overdoses with naloxone on hand than they would in the absence of the medication. More than nine of 10 (94%) reported that family and friends of opioid misusers should be prepared to deal with overdoses. Most respondents (77%) also believed LEOs have a role in responding to opioid overdoses, and 65% reported that to some extent officers have voiced more positive attitudes toward those with opioid use disorders since they began administering naloxone. Half of the police chiefs (53%) reported that to some extent LEOs have voiced discomfort concerning the administration of naloxone. In fact, more than threefourths (78%) of the police chiefs reported that to some extent LEOs believed that naloxone had the potential to promote opioid misuse. Nearly 40% of the police chiefs also reported that their officers have voiced concerns about administering naloxone because of the potential for victims of overdose to become aggressive as a side effect of the medication.

Bivariate Analyses

To search for differences in the attitudes and perceptions of police chiefs serving in different types of departments, locations, and overdose settings, three subgroupings were created. These categorizations were based on size of jurisdiction (small, medium, or large population, drawn from 2017 census [M = 22,610, Md = 12,582]), number of overdoses (low, medium, or high, drawn from the IDPH database [M = 91, Md = 53]), and size of department (small, medium, or large, drawn from the survey data [M = 36, Md = 21]). For the purpose of the bivariate analyses, the small-/medium-sized departments, the small/medium numbers of overdoses, and the small-/medium-sized jurisdictions were collapsed. Both the Fisher’s Exact and Chi- Square Tests were performed and yielded nearly identical results. The results from the former (the more appropriate analysis in light of small cell sizes) are presented in Table 3.

Findings showed that police chiefs from medium-/large-sized jurisdictions (p = .03) and from medium-/large-sized departments (p = .01) were more likely to report that officer stigma toward addiction is a barrier to naloxone administration. In addition, police chiefs from small-sized departments reported that officers were more familiar with the state’s naloxone standing order than those from medium-/large-sized departments (p = .07)

Table 3

Attitudes and City Size, Overdose Numbers, and Department Size

Small City Size (n = 74) Medium/Large City Size (n = 4) p value
At least to some extent . . . % %
Officers voiced naloxone potentially promotes opioid misuse 79.7 75.0 .67
Officers voiced uncomfortable administering naloxone 52.7 50.0 1.0
Officers more positive toward OUD since implementation 67.6 62.5 1.0
Officers concerned about aggression following administration 40.3 16.7 .40
Agree % %
Family and friends should be prepared to deal with ODs 93.1 100.0 1.0
Officers have sufficient training to deal with ODs 94.4 100.0 1.0
At least slightly familiar with . . . % %
Heroin Crisis Act/Lali’s Law 90.5 87.5 .58
Naloxone standing order 94.6 75.0 .10
Ability to serve as DOPP 89.2 100.0 1.0
Civil liability 94.6 100.0 1.0
Officers don’t want to carry naloxone because . . . % %
Do not feel it is their role 16.2 0.0 .60
Uncomfortable administering medication 20.3 37.5 .36
Responsibility of other first responders 1.4 0.0 1.0
Do not feel adequately trained or prepared 39.2 37.5 1.0
Enables opioid use 28.4 37.5 .69
At least to some extent, support from . . . % %
Local government, when implementing 98.6 100.0 1.0
Local public health agencies, when implementing 98.6 100.0 1.0
Barrier the department continues to face . . . % %
Stigma regarding addiction within the department 6.8 37.5 .03
Stigma regarding addiction outside the department 1.4 0.0 1.0
Cost to implement naloxone 20.3 12.5 1.0
Civil liability concerns 8.1 12.5 .53
Low Overdoses (n = 80) Medium/Large City Size (n = 2) p value
At least to some extent . . . % %
Officers voiced naloxone potentially promotes opioid misuse 78.8 100.0 1.0
Officers voiced uncomfortable administering naloxone 51.2 100.0 .50
Officers more positive toward OUD since implementation 67.5 50.0 1.0
Officers concerned about aggression following administration 39.0 0.0 1.0
Agree % %
Family and friends should be prepared to deal with ODs 93.5 100.0 1.0
Officers have sufficient training to deal with ODs 94.8 100.0 1.0
At least slightly familiar with . . . % %
Heroin Crisis Act/Lali’s Law 90.0 100.0 1.0
Naloxone standing order 92.5 100.0 1.0
Ability to serve as DOPP 90.0 100.0 1.0
Civil liability 95.0 100.0 1.0
Officers don’t want to carry naloxone because . . . % %
Do not feel it is their role 15.0 0.0 1.0
Uncomfortable administering medication 21.3 50.0 .40
Responsibility of other first responders 1.3 0.0 1.0
Do not feel adequately trained or prepared 38.8 50.0 1.0
Enables opioid use 28.7 50.0 .50
At least to some extent, support from . . . % %
Local government, when implementing 98.8 100.0 1.0
Local public health agencies, when implementing 98.8 100.0 1.0
Barrier the department continues to face . . . % %
Stigma regarding addiction within the department 8.8 50.0 .19
Stigma regarding addiction outside the department 1.3 0.0 1.0
Cost to implement naloxone 20.0 0.0 1.0
Civil liability concerns 8.8 0.0 1.0
Small Department Size (n = 74) Medium/Large DepartmentSize (n = 4) p value
At least to some extent . . . % %
Officers voiced naloxone potentially promotes opioid misuse 79.2 66.7 .61
Officers voiced uncomfortable administering naloxone 51.4 33.3 .68
Officers more positive toward OUD since implementation 66.7 50.0 .41
Officers concerned about aggression following administration 40.3 16.7 .40
Agree % %
Family and friends should be prepared to deal with ODs 93.1 100.0 1.0
Officers have sufficient training to deal with ODs 94.4 100.0 1.0
At least slightly familiar with . . . % %
Heroin Crisis Act/Lali’s Law 90.3 83.3 .49
Naloxone standing order 94.4 66.7 .07
Ability to serve as DOPP 88.9 100.0 1.0
Civil liability 94.4 100.0 1.0
Officers don’t want to carry naloxone because . . . % %
Do not feel it is their role 16.7 0.0 .58
Uncomfortable administering medication 20.8 50.0 .13
Responsibility of other first responders 1.4 0.0 1.0
Do not feel adequately trained or prepared 40.3 50.0 .69
Enables opioid use 29.2 50.0 .37
At least to some extent, support from . . . % %
Local government, when implementing 98.6 100.0 1.0
Local public health agencies, when implementing 98.6 100.0 1.0
Barrier the department continues to face . . . % %
Stigma regarding addiction within the department 6.9 50.0 .01
Stigma regarding addiction outside the department 1.4 0.0 1.0
Cost to implement naloxone 20.8 16.7 1.0
Civil liability concerns 8.3 16.7 .44

Discussion

Police chiefs signaled the importance of training by reporting that their departments’ officers were educated on a number of topics that are critical to the successful adoption of naloxone programs for LEOs such as the mechanics of implementing different modalities for administering the medication as a withdrawal-reversing agent. Greater emphasis in training should be placed on disabusing officers of their misperceptions regarding naloxone. For example, nearly eight of 10 LEOs believed that the medication rescues promote continued opioid use; research actually shows they might reduce use.[34]

A further barrier to naloxone administration by officers was due to the stigma of substance use disorders, especially in larger cities and departments. The best remedy against this stigma is education on the causes and symptoms of addiction as a brain disease. Along those lines, training should emphasize the chronic and recalcitrant nature of substance use disorders, which would help allay officers’ frustration about repeated administration of the medication with the same people in their communities.

Continued training should be offered to ensure that officers are kept abreast of the latest advances in naloxone-delivery technologies and the laws that pertain to the availability of the drug and the potential legal liability for those who administer the medication. According to the police chiefs, notable percentages of officers harbor concerns about naloxone-related legal liability, and a small percentage are unaware of the state law that mandates all officers to carry naloxone while on duty (Heroin Crisis Act). Police departments should regard postresuscitation as a “teachable moment” [35] and a time to discuss substance use disorder treatments, including a medication-assisted treatment for opioid use disorders. This study showed that community resources for addiction is an under-addressed topic in naloxone training, which suggests that officers probably know little about how and where to refer individuals to treatment and other services.

Police departments should begin to distribute take-home naloxone in the community and consider becoming a source of information on the administration of the medicationand touting its effectiveness. An overwhelming majority of police chiefs emphasized the importance of family members’ and friends’ involvement in the overdose-reversal process. Nonetheless, only a small percentage of departments indicated that they were participating in a program that would appreciably extend the life-saving reach of LEOs. Such community-based naloxone distribution can further contribute to a significant reduction of opioid overdose deaths.[36]

The opioid epidemic shows no signs of abating. Police departments in Illinois and elsewhere will continue to need naloxone and naloxone training to prevent overdose deaths. The survey demonstrated that current allotments of naloxone are falling short of meeting the demand for the medication. The expense of the drug is also an issue that should be alleviated with funds from the state and federal governments, which can be cost-shared by both entities and prorated based on overdose data. A protocol should be established to ensure that naloxone kits are stored properly and disposed of when no longer effective. Furthermore, future research should examine the reasons for the wide variation in the costs of naloxone.

In closing, naloxone is a proven-effective medication to reduce opioid overdose deaths, and it is becoming very common—often required by law—for LEOs along with other first responders to carry naloxone in the field. Not only is naloxone saving lives, the administration of the drug could improve police–civilian relationships and enhance the quality of life in communities. As police become increasingly more comfortable and supportive in their role in dealing with substance use disorders in a public health manner rather than solely a criminal justice one, there are opportunities for expansion to provide naloxone kits to take home for overdose victims, their friends and family, and the community at large, as well as to offer support and referrals to substance use disorder treatment and other services.

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  2. Centers for Disease Control and Prevention (CDC). Annual surveillance report of drug-related risks and outcomes — United States. Atlanta, GA: CDC, U.S. Department of Health and Human Services. Retrieved from https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf ↩︎

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  6. National Safety Council. (n.d.). Preventable deaths. Retrieved from https://injuryfacts.nsc.org/all-injuries/preventabledeath-overview/odds-of-dying ↩︎

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