Leveraging Body-Worn Camera Footage to Better Understand Opioid Overdoses and the Impact of Police-Administered Naloxone

Michael D. White, PhD; Seth Watts, MS; Carlena Orosco, PhD; Dina Perrone, PhD; Aili Malm, PhD

Disclosures

Am J Public Health. 2022;112(9):1326-1332. 

In This Article

Abstract and Introduction

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. 2022;112(9):1326–1332. https://doi.org/10.2105/AJPH.2022.306918)

Introduction

The opioid overdose crisis emerged 30 years ago, but the last 5 years have been especially deadly.[1] During the COVID-19 pandemic in 2020, the United States experienced more than 93 000 overdose deaths, nearly 70 000 of which involved opioids.[2] The number of overdose deaths increased again from May 2020 to April 2021 to more than 100 000, with synthetic opioids causing 64% of them.[3]

Many jurisdictions have publicly distributed naloxone as a response to the opioid overdose crisis. Naloxone reverses an overdose by binding to receptors in the brain, thereby reducing the chances of brain damage and restoring "normal breathing."[4] (p1202) Naloxone has been available for 25 years; by 2015, more than 27 000 lives had been saved with naloxone.[5]

The police often respond to opioid overdoses, given their availability, rapid response, and duty to protect life.[6] In 2014, the US Department of Justice[7] created the Law Enforcement Naloxone Toolkit to support the adoption of naloxone programs by police. Several studies show that police can safely administer naloxone.[8,9] However, by 2019, only 2500 of the nearly 18 000 US law enforcement agencies had deployed naloxone to their officers.[10]

Diffusion of police-administered naloxone has been slow, in part because of cost[11] and recent efforts to divert overdose calls away from police response.[12] Police have also expressed concerns about naloxone, including negative attitudes about people who use drugs,[13,14] worries about increased civil or criminal liability and administering naloxone improperly,[15,16] fatigue from responding to overdoses,[9] and fears of accidental exposure to opioids and aggression from recovering individuals.[17,18]

Some public health and harm reduction experts and those who use drugs have noted that police involvement will criminalize overdoses through the arrest of survivors, and several studies support this concern.[19,20] One study showed that police response was associated with an increased rate of nonfatal overdoses.[21] These concerns are especially acute in states with no Good Samaritan Laws that provide immunity from arrest for overdose survivors and others on scene.[22] Drug-induced homicide laws raise similar concerns and can lead to reluctance to dial 911.[23] Prior research has not sufficiently investigated concerns over police-administered naloxone.

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