The breadth of influence for opioids goes far beyond the people who use them. The national opioid epidemic is a public health crisis that inflicts unprecedented damage. In 2014, 2.4 million people faced an opioid-related substance abuse problem, generating a wave of less-quantifiable stress placed upon their families. Whether the cost is in terms of lives lost, money spent, or loss of productivity, millions of non-users see and experience the impact of opiates in a different, but no less meaningful, way than those who themselves are addicted.
The same is true for the governments and agencies servicing an affected community, as well as the men and women who work within them. In particular, professional duty and close proximity give first responders a complete view of the crisis. Few see the communitywide impact of a drug epidemic like the people who play a key role in most of the criminal, civil, and health events connected to it. This unique relationship with the epidemic naturally carries a number of responsibilities.
Increasingly, anti-overdose drugs are mandated for police, reflecting a need for convergence in the skills responders bring to emergencies. Since police are often the first to arrive at the scene, the public expects officers to render medical aid in life-threatening injuries and attempt to save lives. At least where the law allows, granting access to an easy-to-administer response to potentially fatal overdoses makes sense.
Optimal naloxone administration requires training
People become addicted to or dependent on opioids in a variety of ways. While some experiment with the drugs for pleasure-seeking purposes and become addicted, others can become addicted to opioids through legal use of prescription medications like Vicodin, OxyContin, and fentanyl. Such addiction certainly played a role in the spike in pain medication between 1991 and 2013, an increase from 76 million to roughly 207 million prescriptions. Unintentional overuse or overprescribing can result in lethal or harmful overdose, and naloxone can overcome this.
Naloxone can stave off a fatal overdose long enough for medical professionals to take appropriate, longer-term steps to address the addiction or dependence. It is easy to administer, allowing police supervisors to provide on-shift training after receiving instruction themselves. This was the route police in Akron took when an awareness-raising exercise in the city’s downtown area prompted their chief to consider—and ultimately approve—officers carrying the drug.
While minimal instruction is generally sufficient for learning how to administer naloxone, first responder organizations must also consider some instruction on how to deal with post-injection events which could include violence an irritability from the person who was treated. There are many topics that are appropriate for a training program on overdose reversal including: drug abuse basics, mechanisms by which opioids can cause overdose and the reversal properties of naloxone, occupational safety considerations, legal considerations, standard operating procedures including how to interface with emergency medical personnel, and overdose education about naloxone distribution resources available to the community including what to expect if a bystander has already administered naloxone. It is also ideal if programs cover how first responders can assist those who have overdosed to access social services that can help them on the road to recovery, as naloxone administration is just the first step on this journey.
Any topic involving drug addiction and police responsibility has the potential to be politically divisive. The vast majority of states allow special concessions for naloxone, with variances in legal access and protections. Some states allow purchase without prescription. Some protect pharmacies from civil and criminal penalty when naloxone is dispensed for an overdose. Nearly all allow first responders to carry and administer naloxone without prescriptive authority.
This shift is due in part to the safety of the drug. Naloxone can cause immediate withdrawal, but generally does not result in other side effects. It does not interact with other medications or illegal drugs a patient may be taking. For example, an individual on opioids could overdose on their prescription while taking other prescribed medications and still receive emergency treatment, with no ill effects from the naloxone itself.
Even with general support from state governments, pricing and subsequent funding remain a large roadblock. Implementing an overdose response program will cost law enforcement agencies in three areas: stocking the naloxone kits; delivering training; and, possible overtime costs dictated by union response to new mandates. Prices vary. The drug’s intramuscular (injected) formulation can run in the mid-hundreds of dollars per dose, for instance, while the widely-used intranasal formulation costs as low as $75 per two-dose pack. Either medication can add up, especially when every officer on patrol carries at least one dose in many naloxone-equipped departments.
Although rising prices have sparked legitimate concern—in some cases outrage—manufacturers of naloxone and other overdose reversing drugs have proven at least some willingness to assist governments in providing their medications. In one first-of-its-kind case, Massachusetts lawmakers negotiated an agreement with naloxone manufacturer Amphastar Pharmaceuticals that required the company pay $325,000 into a trust fund for statewide purchases of the drug. The state also receives the drug at $23.75 per dose. In another case, New York lawmakers negotiated with the same company to receive a percentage discount and “dollar-for-dollar” guarantee against future price hikes.
Context informs both of these deals. Massachusetts is home to a world-class metropolitan area and one of several New England states beset by a tremendous opioid epidemic, even by national standards. New York was one of the first states to equip a large police force with naloxone, a directive that affects their 35,000-strong roster. These situations may have more bargaining power than a smaller states or individual departments.
Direct interaction with manufacturers is not the only way for police departments and other community organizations to receive an affordable rate. Some use funds derived from drug forfeiture, a clever tactic in both method and the unique public relations it generates. Others departments can apply for state grants or to private organizations designed to help first responders acquire overdose-fighting drugs.
Naloxone is only one step in opioid addiction treatment
To some degree, providing anti-overdose drugs to officers is its own benefit. These kits are easy to train, purchased cheaply, and save lives. However, other factors are relevant to an epidemic that is so widespread, especially when providing immediate relief from an overdose is only the first step in the recovery process for many addicted individuals.
Whether stemming from tobacco and alcohol or from illegal drugs, addictions carry collateral costs that may be difficult to accurately measure. It may be simple to track the cost of incarceration after an opioid-related arrest, but these incidents often hide secondary strains on community systems. Homelessness and mental health, for example, play complicated roles in addiction. Research suggests that in terms of cost and reducing criminal behavior addiction, rehabilitation is more effective than incarceration, but the road to recovery is long, and overcoming the damage for both the addicted individual and those around them is often difficult.
Some institutionalized approaches to recovery combine the every-life-counts philosophy with more practical concerns. The best known of these may be the Gloucester (Mass.) Police Department’s ANGEL Initiative. With a promise not to arrest or incarcerate drug addicts who surrender their drugs and paraphernalia, this program the program costs roughly $55 per participant—significantly less than the $220-per-day cost of holding them in jail. Funded through drug seizure money, Gloucester connects volunteers with addicts who lack insurance or the ability to pay. These volunteers assist in finding free or low-cost programs to attend, helping reduce overdose deaths and contributing to a 27 percent drop in drug related crime.
The ANGEL Initiative’s sister program, PAARI, helps other police departments attempt similar measures, by providing funding, guidance, and access to treatment providers willing to help. Over 100 departments in 24 states have joined the initiative.
Addiction epidemic is a challenge, but one worth solving
The current opioid problem is a slow-burner, with addiction and overdose numbers rising each year. The risk is widespread, from an addict living on the street to a grandmother who developed a drug dependency following back surgery. The wide-ranging nature of this epidemic gives opioid addiction an edge over more conventional drug abuse problems, in terms of the care and attention afforded by society at large.
The changes policing has seen thus far only reflect this fact. Not every department will have the resources or support to start their own ANGEL initiative, or the interest to join a program like PAARI. Even though some officers may never carry naloxone, a softened stance on opioid addiction has arrived. That does not have to mean letting drug criminals walk free or even deemphasizing their behavior—but it does mean treating addiction as the complex mental disease and not simply as a moral failing.