Some law enforcement officers’ negative attitudes toward overdose victims are
exacerbated following overdose education training

Background: The devastating impact of the current opioid overdose crisis has led to new involvement of law enforcement officers. Training programs have focused on overdose recognition and response without targeting core attitudinal change by covering addiction or harm reduction principles.
Objectives: This study examined the impact of a comprehensive overdose education and naloxone distribution (OEND) training on officers’ attitudes toward overdose victims, knowledge of and competence to respond to an opioid overdose, and concerns about using naloxone. The training included the common information about overdose recognition and response, with added components covering broader content about addiction and harm reduction principles and philosophies.
Methods: A total of 787 (83% male) officers were administered surveys before and after attending a 2.5–3 hour comprehensive OEND training. Survey items measured overdose-related knowledge and attitudes, including attitudes about people who use drugs and who overdose.
Results: Following the training, participants’ overdose-related knowledge and perceived competence to use naloxone improved. However, there were more nuanced changes in attitudes toward overdose victims: though 55.3% of officers reported more positive post-training attitudes, 31% reported more negative attitudes, and 13.7% reported no attitudinal change. Younger officers were most likely to report worsened attitudes. Improvements in attitudes toward overdose victims were associated with reductions in both naloxone-related concerns and risk compensation beliefs.
Conclusions: Despite a comprehensive OEND training that addressed addiction and harm reduction and directly targeted hypothesized drivers of negative attitudes (e.g., risk compensation beliefs), some officers’ attitudes worsened after the training. Randomized experiments of different training approaches would elucidate the mediators and moderators underlying these unexpected responses.

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Training to reduce emergency responders’
perceived overdose risk from contact with
fentanyl: early evidence of success

Background :Emergency Medical Service personnel and Law Enforcement Officers are called to respond to increasing numbers of opioid overdose events. Media reports of fentanyl intoxication from incidental contact have also increased, despite this being a medical impossibility. Excessive fears about occupational danger from touching fentanyl could contribute to burnout, negative attitudes towards people who use drugs, and delays in responding to overdoses.
Aim :We aimed to decrease participants’ belief they can overdose from touching fentanyl through a brief educational training.
Methods: Law Enforcement Officers and Emergency Medical Service personnel (N = 140) attended overdose education and response trainings, which included a 10-minute segment addressing fentanyl safety and misconceptions about the risks of incidental exposure. Participants were asked to respond with “True” or “False” to this statement on a survey before and after the training: “I can overdose from touching fentanyl.” We conducted Fisher’s Exact Tests to assess differences by profession and pre vs. post training.
Results: Prior to the training, 20.7% of participants correctly responded “False,” to the statement “I can overdose from touching fentanyl.” This differed by profession, with 16.8% of Law Enforcement Officers and 37% (p = .03) of Emergency Medical Service personnel answering correctly. Following the training, 83.6% of participants correctly responded with “False” (a difference of 62.7%, χ2 = 85.10, p < .001). The proportion of correct post-training responses did not differ across professional groups (81.4% of Law Enforcement Officers vs. 92.6% of Emergency Medical Service personnel answered correctly, p = .30).
Conclusions: This is the first study to assess the impact of training on reducing emergency responders’ belief that touching fentanyl could result in overdose. The majority of participants began the training incorrectly believing they could overdose from touching fentanyl, but, following the training, correctly reported this is not possible. Ensuring accurate risk perceptions about emerging public health threats – including fentanyl, COVID-19, and future dangers – is crucial, and should be part of all overdose recognition and response trainings. Alleviating concerns about fentanyl exposure could lead to faster responses to overdose events.

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Concerns that an opioid antidote could “make things worse”: Profiles of risk compensation beliefs using the Naloxone-Related Risk Compensation Beliefs (NaRRC-B) scale

Background and aims: As opioid overdose death rates reach epidemic proportions in the United States, the widespread distribution of naloxone is imperative to save lives. However, concerns that people who use drugs will engage in riskier drug behaviors if they have access to naloxone remain prevalent, and the measurement scales to assess these risk compensation concerns remain under researched. This study aims to examine the validity of the Naloxone-Related Risk Compensation Beliefs (NaRRC-B) scale and to understand the effect of overdose education and naloxone distribution (OEND) training on risk compensation beliefs across demographic and professional populations.
Methods: A total of 1424 participants, 803 police officers, 137 emergency medical services (EMS)/fire personnel, and 484 clinical treatment and social service providers were administered surveys before and after attending an OEND training. Survey items measured the endorsement of opioid overdose knowledge and attitudes, as well as risk compensation beliefs.
Results: Police and EMS/fire personnel expressed greater endorsement of risk compensation beliefs than clinical treatment and social service providers at both pre- and post-OEND training. Although endorsement of risk compensation beliefs was significantly reduced in each of the 3 groups after the training, reductions were greatest among EMS/fire personnel, followed by providers, then police. Moreover, younger, male, and black participants endorsed greater beliefs in risk compensatory behaviors as compared with their older, female, and white counterparts.
Conclusion: This study validated a novel measure of naloxone-related risk compensation beliefs and suggests participating in OEND trainings decreases beliefs in naloxone-related risk compensation behaviors. OEND trainings should consider addressing concerns about naloxone “enabling” drug use, particularly in law enforcement settings, to continue to reduce stigma surrounding naloxone availability.

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