Naloxone Distribution: Saving Lives and Restoring Trust in the Police

Law enforcement departments across the country are finally equipping officers with naloxone—a medication that reverses opiate drug overdose—and teaching them to treat overdose as a medical issue before viewing it as a criminal one. 

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By Tessie Castillo

08/27/14

Just a few years ago, no one imagined that police would save lives at the scene of a drug overdose instead of making arrests. But today law enforcement departments across the country are equipping officers with naloxone, a medication that reverses opiate drug overdose, and teaching them to treat overdose as a medical issue before viewing it as a criminal one. To anyone who has ever questioned our nation’s punitive approach to drug use, it’s a welcome change. But not everyone is celebrating.

Though the practice of law officers carrying naloxone is fairly new, the medication itself has been around a long time. Paramedics have used it for decades to reverse respiratory failure in people who overdose on opiates such as pain pills or heroin. The medicine temporarily blocks the opiate effects, allowing a person to breathe again long enough for help to arrive. In 1996 naloxone became available to lay people through a Chicago-based harm reduction program that distributed it to people at risk for opiate overdose and their loved ones. The program has beenimmensely successful at saving lives in the community and is now replicated in 28 states.

As law enforcement naloxone programs increase in popularity, some states have passed legislation limiting distribution only to first responders

Then in 2010 the Quincy Police Department in Massachusetts launched the first program to equip law enforcement with naloxone. Officers often arrive at the scene of an overdose before paramedics and have a unique opportunity to administer the drug before brain damage or death occurs. But there is one problem. As law enforcement naloxone programs increase in popularity, some states have passed legislation limiting distribution only to first responders—and old stereotypes about drug users are resurfacing: they can’t be trusted to handle a medical situation…naloxone would encourage more drug use…drug users don’t care about their own health.

Such rhetoric ignores that fact that naloxone distribution originated among people who use drugs and that they have successfully used it to reverse over 10,000 opiate overdoses over the last two decades. Overdose prevention advocates are disturbed by the new trend in states such as Delaware, Indiana, Louisiana and Missouri. So are some cops.

Chief Ken Ball heads the Holly Springs Police Department, the first department in Georgia to equip all officers with naloxone.

“I think it’s important for people to keep naloxone in the house as soon as they discover a family member is using drugs,” says Chief Ball.

Since their program launched on June 4, 2014, Holly Springs officers have already reversed two overdoses in the community. Chief Ball’s quick action to implement a naloxone program (less than two months after a new Georgia law made such a program possible) was spurred in part by the urgency of the drug overdose situation in Georgia and in part by tragedy within his own department. In August 2013 a Holly Springs police officer, Lieutenant Tanya Smith, lost her 20-year-old daughter to a drug overdose. Lt Smith became the driving force behind efforts to pass the new Georgia law and to equip law enforcement with naloxone. But as a mother who lost a child to drugs, she is also a firm believer in community access to naloxone.

“Giving naloxone to community members provides us with an opportunity to educate people on how to recognize, intervene and prevent overdose deaths,” says Lt Smith. “With the overwhelming number of households with some form of opioid in the cabinets, we cannot rely solely on law enforcement or emergency services personnel to be there in time to reverse an overdose.”

Many paramedics support community access to naloxone as well. Keith Tamayo volunteers for the Wantagh-Levittown Volunteer Ambulance Corps in New York, one of the first paramedic services to dispense naloxone to lay people. The idea for the program developed after Keith and his team responded to an opiate overdose for a 23-year-old man who had received a naloxone kit from a drug treatment program two years prior. Paramedics arrived to find the young man’s mother desperately trying to assemble an intranasal naloxone injector. Keith thought, “Why not start a program where we give naloxone to people in the community and train them continually on how to use it?” They launched the program earlier this summer.

“By giving naloxone to community members who are likely to be present in an overdose situation, we are getting the drug minutes closer to the person who needs it,” he says.

Further south in North Carolina, Guilford County Emergency Services is considering dispensing naloxone to the community as well.

“We absolutely support the concept of ‘civilian administration’ [of naloxone] as a bridge to treatment,” says Guilford County EMS Director, Jim Albright. “Our agency goal is to treat overdoses as a medical condition, manage the immediacy of the emergency, and get patients into a sustained treatment program.”

Still, Albright and others in the medical and law enforcement community have concerns about giving naloxone directly to drug users. One common concern is that if drug users have the antidote to opiate overdose, they might use more drugs.

Dr. Caleb Banta-Green, a Senior Research Scientist at the Alcohol and Drug Abuse Institute at the University of Washington, has studied overdose interventions, including community naloxone programs, for many years.

“Evaluations done to date show that most people do not use more drugs just because they have naloxone available,” he says. “Are there people that will? Yes, probably a small proportion. But the measure of success of any health intervention isn't that it has the perfect, desired effect for every person, but that on average for most people it has a benefit and that benefit outweighs any potential harm.”

Another concern shared by Albright is that if people are trained on how to respond to an overdose with naloxone, they may delay calling 911 or not call at all. While evidence suggests that this may be true for some people, it may also be the case that people who wouldn’t call paramedics because they have naloxone wouldn’t call paramedics if they didn’t have naloxone either—and would try to revive the victim with a number of common but ineffective methods such as putting the person in a cold shower, placing ice on the groin, or injecting the victim with salt water, milk, or other drugs. While it is difficult to measure how naloxone access would affect 911 calls, delaying or forgoing help from emergency services is certainly a concern. Community groups that distribute naloxone should continue to stress the importance of followup medical care in response to an overdose.

Though there is some debate about which groups to prioritize for naloxone access, there is little doubt as to the benefits of training lay people and law enforcement on overdose response. The shared goal of preventing deaths can help alleviate historic tension between the two groups. Evidence from the Quincy Police Department in Massachusetts, who launched the first law enforcement naloxone program in 2010, shows that offering law enforcement the opportunity to save lives can change how officers view drug users and vice versa. In Quincy, drug users are actively seeking officers for help when a friend overdoses because they have something that rarely exists between drug users and law enforcement—trust. And police are starting to emphasize treatment over incarceration for low level drug offenders.

“Absolutely naloxone programs will improve relationships between law enforcement and drug users,” says Chief Ball of Holly Springs. “They change the mentality of ‘Let’s put everyone in jail’ to one that focuses on saving a life and giving that person another chance to get help.”

Perhaps nothing better illustrates how naloxone is already shifting law enforcement attitude towards drug use than the recent Police Executive Research Forum (PERF) National Summit on Illegal Drugsheld in Washington D.C. in April 2014. During the Summit, more than 200 police executives from across the country joined federal officials and nonprofits such as the North Carolina Harm Reduction Coalition (where I work as the Advocacy and Communications Coordinator) to discuss the issue of opiate drugs and naloxone. Much of the debate centered around law enforcement naloxone programs—and officers were overwhelmingly in favor.

U.S. Capitol Police Chief Kim Dine, remarking on the discussion, said, “This is historic. We are hearing police officials from across the country saying, ‘Heroin is a medical problem.’ That is not the way we have viewed this for the last 40 years…We have put a lot of people in jail, and we have hurt police-community relations in a lot of ways by the way police agencies have historically approached the drug issue.”

As the national discussion on drug policy shifts towards a more health-based approach, overdose prevention and naloxone will likely play key roles. It is vitally important that stakeholder groups such as people affected by drug use, law enforcement, and the medical community avoid territorial issues or the temptation to belittle each other’s contribution towards ending the overdose crisis. There is room for everyone at the table. All that remains is to ensure that everyone feels welcome. 

Tessie Castillo is the Advocacy and Communications Coordinator at the North Carolina Harm Reduction Coalition. She writes a regular column for The Huffington Post on overdose prevention, drugs, sex work, HIV/AIDS, law enforcement safety and health. She last wrote about the rise of naloxone distribution programs and joined The Fix's new Ask An Expert section.