(76) Police Response to Opioid Overdoses: Impact on Future Contacts, Incarceration and Overdose

Introduction: People with untreated opioid use disorder (OUD) tend to have a higher involvement with the criminal justice system. Incarceration has not shown to reduce recidivism. Furthermore, following incarceration, individuals with untreated OUD are at risk of fatal overdose. This study focused on traditional law enforcement approaches to overdose-related events and the subsequent impact on recidivism, incarceration, and fatal overdoses.

Methods: Two groups of adults with a police contact for opioid-related overdose were retrospectively identified using a local Police Department (PD) database: Group 1 (n=52) had an index police contact between September 1, 2015 and August 31, 2016, and Group 2 (n=263) had an index police contact between September 1, 2017 and August 31, 2020. For both groups, data on previous arrests, overdose incidents, and incarceration in the year before the index police contact were obtained, and comparisons between the two groups were made using Mann-Whitney U or Fisher’s exact tests. In addition, similar data were extracted for Group 1 for 12 months after their index police contact; Wilcoxon signed rank or Fisher’s exact tests were used to compare Group 1’s outcomes before and after the index police contact. For Group 1, aggregate data on fatal overdoses, using county-level mortality records, were also obtained for the post-index contact period.

Results: In the year prior to their respective index police contacts, Groups 1 and 2 experienced similar rates of overdose-related events, with Group 1 having a higher incarceration rate (51.9% versus 28.9%; p=0.002) and a longer average incarceration period (16.2 +/- 38.6 days versus 10.2 +/- 31.6 days; p=0.001) compared to Group 2. In the year after their index police contact, Group 1 had an increase in overdose-related police contacts (11.5% versus 28.8%; p=0.049) and in overdose-related police responses (6 versus 18; p=0.024). Group 1 also had an increase in their incarceration rate (51.9% versus 84.6%; p=0.001) and average incarceration duration (16.2 +/- 38.6 days versus 50 +/- 72 days; p< 0.001) after their index police contact. In the 5 years following the index contact, 9.6% of Group 1 members suffered an opioid-related fatal overdose.

Conclusions: Following police contact for an opioid-related overdose, individuals in this project continued their negative trajectory, with increased police contacts and incarceration, and one-in-ten dying due to an overdose. Furthermore, the two groups assessed in this project had similar rates of overdose-related police contacts prior to their respective index police contact, despite the passage of time and interim local and national initiatives aimed at overdose reduction. Overall, our findings corroborate prior ones suggesting that traditional law enforcement approaches are ineffective at improving outcomes among adults with OUD who have police encounters related to overdoses. Alternative law enforcement-led programs focused on treating OUD as opposed to arrest and incarceration may improve outcomes for individuals with OUD and their communities, and help curb the opioid epidemic’s harmful impact.

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