NUCPS - The Key - Northwestern University Center for Public Safety

Discussion

Background

The EPD is committed to providing exceptional police services to the community in Evanston, which is a progressive community that is impacted by many of the same problems that plague the Chicagoland area. The significant rise of opioid overdose deaths is a state and national problem, and between 2013 and 2017, Illinois overdose rates nearly doubled. (Hedegaard, 2020) In 2017, according to the CDC, 47,600 overdose deaths involved opioids. (CDC, 2019) While the EPD currently does not have a policy requiring officers be trained and carry Narcan, Evanston paramedics do carry and administer Narcan. Illinois law (20 ILCS 301/5-23) is vaguely worded but does specify that first responders carry and be trained in deploying opioid antagonists such as Naloxone (Narcan).

Officers are often dispatched to check the well-being calls, which involve the belief that a person may be in some form of distress. The cause of the distress is rarely known prior to officers receiving the dispatch call. Often officers will arrive and request that paramedics respond. In the case of an opioid overdose, vital time is wasted diminishing the chance of counteracting the overdose. When an overdose victim is suffering respiratory depression, damage to their brain and other organs can increase the longer the subject is in the overdose state. (Davis, 2015) The faster Narcan is administered, the better the chance of full recovery.

The EPD has a drug unit (NET team), and its job includes narcotics investigations, undercover purchases, and narcotic raids. (EPD, 2019) The possibility of NET detectives experiencing an incidental exposure to fentanyl or an equally dangerous opioid during a raid is increasing. On August 23, 2018, two Hartford officers were exposed to fentanyl during a police narcotics raid, the officers were treated and taken to the hospital. (Lam, 2018) It is also becoming more likely for officers to have an incidental exposure to fentanyl during routine duties, such as traffic stops. On May 8, 2019, two St. Charles County Police officers and a K-9 were exposed to fentanyl during a traffic stop. The K-9 received three doses of Narcan, and one of the officers self-administered Narcan. (Ross, 2019)

Internal Survey

A four-question survey was created and distributed to 30 police supervisors at or above the rank of sergeant in the Northwestern School of Police Staff and Command (SPSC) Class #462. The questions asked:

• Does your department require officers to carry Narcan?
• Did your department receive grant funding for its Narcan program?
• Does your department provide annual training on Narcan?
• Who provided the initial Narcan training for officers at your department?

Of the 30 students in Class #462, 28 students responded to the survey. Only five of the departments represented in SPSC Class #462 do not require officers to carry Narcan; 23 agencies do. Of those 23 departments, only nine received grant money for the funding of the program. The survey indicates that well over half of the departments with Narcan policies pay for training and Narcan canisters out of their budgets. Of the 23 police departments, all but four provide Narcan annual training or recertification. Training for these agencies is performed internally with the help of local fire department personnel or contracted with a separate medical provider.

Benefits

The ever increasing risks associated with addiction, as it relates to the opioid epidemic, creates great risk for law enforcement. Contact with fentanyl and other opioids continues to increase. Officers are constantly in situations where the unknown is reality. A good Narcan policy would allow officers the ability to self-administer or to save a fellow officer who was incidentally exposed to fentanyl. Certainty that officers are provided with the proper tools to complete their job and stay safe is a responsibility of police upper management. Furthermore, options are available to negate or lessen the expense a Narcan policy could have associated with it.

The benefit is not only for officers. The community also would benefit from lives being saved, overdoses being overturned. It is not always the drug abuser that can fall victim to an opioid overdose. “Between 1999 and 2016, deaths from opioids increased among children and adolescents, a 2018 study found, rising from 2.2 to 8.1 per 1 million children, a total of nearly 9,000 deaths in young people up to age 19 over the 17 year period.” (Sohn, 2019) Incidental exposure can affect anyone, not just officers. Narcan counteracts all opioids, such as synthetic street drugs heroin or fentanyl, as well as prescription medications derived from opioids, OxyContin, Vicodin, Codeine, and others. (What does Narcan not reverse, 2019.)

Liability Concerns

There are always liability risks associated with police departments taking on responsibilities that traditionally belong to paramedics and fire services. Training is the key to a successful Narcan policy / program. Officers need to recognize signs of an opioid overdose, how to deploy the Narcan correctly, and when to determine if another canister deployment is necessary. The State of Illinois mandates that all Narcan deployments as they relate to opioid overdose intervention be reported to the State. A sound policy must cover training, storage, identification, reporting replacement, and other matters. The Lincolnwood Police Department, a neighboring jurisdiction to Evanston, has a detailed policy that thoroughly covers all components that help mitigate liability. (Lincolnwood Police Department, Policy 430)

The State of Illinois has taken steps to provide legal protections to first responders as relates to personal liability when providing medical care under State Law 745 ILCS 49/70. Even with safety measures in place to mitigate personal liability, there are vulnerabilities for law enforcement agencies. For instance, if policy determines that officers only carry one canister of Narcan, what if an overdose subject requires multiple deployment? The officer cannot revive the overdose subject because policy only requires they carry one canister. Such a situation can create liability issues and potential legal action. Under the same premise, it is safe to assume a police department with no policy requiring officers carry Narcan could be in legal jeopardy if it were determined that subjects may have been revived by officers had they carried Narcan. In 2015, a comprehensive study was completed and published in the American Journal of Public Health, which concluded that “liability risks related to naloxone administration are similar to or lower than those of other activities in which law enforcement officers commonly engage”. (Davis, 2015)

Alternative Solutions

Alternative #1:

The first alternative is to continue with no policy relating to officers being trained and administering Narcan.

Pros:

• No additional cost for training all personnel.
• No cost for purchase and storage of Narcan.
• No additional risks as it relates to liability.
• Annual training can focus on other recertifications.

Cons:

• Failure to revive an officer who has incidental exposure to fentanyl.
• Failure to revive a citizen who has overdosed or been exposed.
• Loosing equity with the community because of the above failures.

Costs:

• None

Alternative #2:

The second alternative is to create a policy requiring officers to be trained in administering Narcan only to other officers who have incidental exposure.

Pros:

• Opportunity for officers to enhance their training.
• Officers would have the ability to save one another's lives in the event of exposure.
• Officers would have confidence that if they encountered opioid the encounter would be survivable.

Cons:

• Officers would not be allowed to administer a lifesaving dose to a community member.
• Potential liability for having the means to administer a dose but policy not allowing a lifesaving measure.
• Cost associated with training officers.
• Cost associated with purchase of canisters and storage.

Costs:

• Average cost for Naloxone (Narcan) intranasal kit is $22 to $60. (Law Enforcement Naloxone Tool Kit, 2019)
• Estimate: $40 per canister x 500 canisters = $20,000.
• Training 159 officers in 2-hour blocks of training equals $19,000 in officer time.

Alternative #3:

The third alternative would be to create a policy requiring officers to be trained in administering Narcan to other officers and members of the general public who have overdosed or been exposed.

Pros:

• Opportunity for officers to enhance their training.
• Officers would have the ability to save one another, as well as community members in distress.
• Public perception would be positive.

Cons:

• Potential liability associated with lifesaving policy.
• Costs associated with training 159 officers.
• Costs associated with purchase and storage of Narcan canisters.

Costs:

• Average cost for Naloxone (Narcan) intranasal kit is $22 to $60. (Law Enforcement Naloxone Tool Kit, 2019)
• Estimate: $40 per canister x 500 canisters = $20,000.
• Training 159 officers in 2-hour blocks of training equals $19,000 in officer time.
  
  

Conclusion

Society is currently facing an opioid epidemic, and people are overdosing in record numbers. Synthetic drugs are creating dangerous situations for law enforcement during drug raids and such routine patrol functions as traffic stops when officers are incidentally exposed to deadly substances like fentanyl. These exposures can lead to certain death if not counteracted rapidly.

Naloxone (Narcan) has been in existence for decades and is a method for counteracting an opioid overdose. Paramedics and fire personnel have been using this product for years, and recently many law enforcement agencies have adopted policies requiring officers to carry Narcan and be trained in its deployment to save lives. Officers often respond before fire personnel and are in a better position to administer Narcan to save a person’s life.

Currently, the EPD has no policy requiring officers to be trained in administering Narcan and to carry it while on duty. This study has presented EPD with three alternatives to address this issue. Alternative 1 would be to continue with no policy regarding Narcan. This option would continue to put officers in grave risk of being incidentally exposed to an opioid like fentanyl, with no means to counteract the exposure. This also would leave officers with no means to counteract an overdose situation to which they are the first responders. Alternative 2 would provide a policy that trains officers in administering Narcan and provides Narcan canisters to be utilized while on duty. This policy would not allow officers to save a citizen's life during an overdose or incidental contact, even though they would have the means. Alternative 3 would create a policy that would train all officers and provide Narcan for duty use. Officers would be able to administer Narcan to anyone in distress due to an opioid overdose or incidental contact. This option is the best option as it would allow officers to save lives. There are costs associated with Alternatives 2 and 3 although a number of grants provide free or discounted Narcan to departments. So, although costs associated with Alternatives 2 and 3 seem high, they are inflated based on the fact that so many grants exist.

Recommendation

Sources

• Center for Disease Control and Prevention (CDC). (2018, Dec.). National Drug Overdose Deaths: Multiple Causes of Death 1999-2017. Retrieved from CDC WONDER Online Database.
• Davis, Corey S., D. C. (2015, Aug.). Engaging Law Enforcement in Reversal Initiatives: Authorization and Liability for Naloxone Administration. Retrieved from US National Library of Medicine National Institute of Health: https://www.ncbi.nlm.nih.gov
• Evanston Police Department (EPD). (2018). Annual Report.
• Evanston Police Department (EPD). (2019). Organizational Chart.
• Hedegaard, Holly, MD, et el. (2020, Jan.). Drug Overdose Deaths in the United States, 1999 - 2018. NCHS Data Brief. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db356-h.pdf.
• Lam, K. (2018, Aug. 23). Connecticut police officers exposed to possible fentanyl during drug raid, officials say. Retrieved from Fox News: https://www.foxnews.com
• Law Enforcement Naloxone Tool Kit. (2019). Retrieved from National Training and Technical Assistance Center: https://bjatta.bja.ojp.gov
• Lui, E. (2018, Feb. 1). Cook County, Loyola partner to equip first responders with opioid blocker. Retrieved from Crain's Chicago Business: https://www.chicagobusiness.com
• Overdose Death Rates . (2019, Jan.). Retrieved from National Institute of Drug Abuse: https://www.drugabuse.gov
• Ross, K. (2019, May 8). St. Charles county officers, K-9 recovering after fentanyl exposure. Retrieved from CBS KMOV4: https://www.kmov.com
• Sohn, E. (2019, Apr. 28). A surprising number of children are accidentally poisoned. simple steps can prevent that. Retrieved from The Washington Post: https://www.washingtonpost.com
• What does Narcan not reverse. (2019, May 11). Retrieved from The Recovery Village: https://www.therecoveryvillage.com
• Wilusz, L. (2019, Mar. 12). 35 charges with trafficking heroin, fentanyl in Chicago area. Retrieved from Chicago Sun Times: https.//www.chicago.suntimes.com