The medicalization of the police
Shifts in the police’s missions are nothing new. These have evolved as societies have changed. Yesterday, Officer Friendly ambled along with his six-shooter and billy club. Today, small police departments rehearse terrorism contingency plans and casually drive military-grade, mine-resistant vehicles in local town parades. Tomorrow, a new brand of police officer might look more like a guardian and less like a warrior.
With respect to the medicalization of American police forces, long before the opioid epidemic police had to come to terms with mentally ill people at large. Until the Reagan Administration, expeditionary hospital emergency room personnel were more likely than police to respond to dangerous or troubled behavior in public. Changes in vernacular language give a hint of the shift: People used to speak of the “men in the white coats coming to take you away”—language no one under 50 uses anymore because reality provides no evidence or prompt for the meme.
The real question, then, is what should we want police to do? Where does law enforcement and medical care blur, and what is the best way to resolve the blurring? We can argue that police have been forced to pick up responsibilities that other institutions either do not or cannot any longer meet. It is inevitable that police will sometimes be first responders in situations in which illness, not criminal intent, shape the contingency. But do we want this to happen so often that police missions change, and hence that police end up being not only first responders but also second responders, and so on?
One is reminded of how institutional weaknesses have led over time to the U.S. military taking on by default the missions of other agencies of government. Should American soldiers be painting schoolhouses in Peru as part of a civil-military training program? Should we think of such things as good ideas in their own right, or as consequences of institutional dysfunction elsewhere? Mission definitions for police and soldiers alike should be made on the basis of sound professional criteria, not forced on them by default because other institutions have decayed or collapsed.
A closer look at how the opioid epidemic has changed policing can perhaps help us navigate such questions. That closer look must begin with an appreciation of how novel the opioid epidemic really is.
Unlike the crack epidemic of the 1980s or the methamphetamine epidemic in the early 2000s, the opioid crisis is not exclusively a big-city ghetto problem; it affects rich and middle-class homes as well as those of the poor. Grandparents and children are overdosing on this type of drug. Often enough, no discernable signs of addiction appear until someone needs to call an ambulance. This frustrates the police mission, which is designed to target problem areas or people before things go badly wrong. Many ordinary people do not appreciate how much police work focuses on prevention rather than on arresting law-breakers after the fact. With opioids, there are no back alleys to monitor, no vagrants to round up, no behavioral symptoms one can spot at a distance.
Not only is the opioid epidemic different, it is mushrooming so fast that all authorities, not just police, are struggling to adapt. Small towns with small police forces are often hit the hardest. Lorain County, Ohio, with a population of about 305,000, averaged roughly 12 overdose deaths per year from 2000 to 2009. In 2016, Lorain suffered 132 deaths from drug overdoses, drug-induced heart attacks, or respiratory failures, meaning the county experienced about a decade’s worth of drug-related fatalities in one year.
The Lorain County coroner said the county was on track to surpass 200 overdose deaths in 2017, which would represent almost 20 times as many deaths experienced in a year during the early 2000s. The crisis is so severe that medical examiners do not have the time or money to spend on the test to determine which drugs caused a given death—often they just assume it to have been opioid-related.
The crisis has changed the nature of policing. Departments are forced to divert time and resources to the range of problems that accompany drug addiction, including violence, property crimes, and child neglect. Officers who joined the force to solve crimes and protect their communities are increasingly becoming de facto nurses, social workers, and temporary guardians, frantically trying to plug a hole in a sinking ship with a naloxone needle.
Tragically, opioids have even claimed the lives of officers trying to fight the overdose problem. The news lately is riddled with stories of officers accidentally overdosing on fentanyl and other opioids during routine police encounters. Police dogs have overdosed, too, after exposure to the deadly drug. At the same time, mental health and addiction services for officers are being slashed, sending morale down to levels not seen since the Vietnam era.
As overdose rates continue to climb, it’s not uncommon for police to carry Narcan, the brand name for naloxone, in nasal spray form. Police officers often function as first responders in emergency scenarios, administering Narcan to those experiencing overdoses, both because time is of the essence in saving lives and because the black-market drug trade breeds violence—paramedics usually prefer to wait for police in volatile and perilous environments.
Some law enforcement leaders have decided that protecting the addicted must have limits. One Ohio sheriff announced that officers in his department will no longer carry Narcan because, in his words, “All we’re doing is reviving them, we’re not curing them.” A city council member in a different Ohio city recently proposed a three-strikes policy under which officers and paramedics would refuse to respond to an overdose call if the individual has had repeated overdoses. The guiding idea behind refusing to revive, or limiting the revival of, opioid-addicted individuals is that the policy will deter drug abuse and compel addicts to clean up their habits.
That is wishful thinking. The nature of addiction renders a rational approach to decision-making improbable; instead of acting as a wake-up call, these kinds of policies will only increase deaths from overdose. Since there are evidence-based practices to combat the rising lethality of drug addiction, we have much better options.
No doubt policies like the three-strikes rule are encouraged by a severe lack of funding for Narcan use. The stuff isn’t cheap, but it works: Between 1996 and 2014, Narcan was able to reverse 26,000 opioid overdoses, even when administered by people without medical training. Maine alone experienced 208 deaths related to overdosing in 2015. But in that same year, police and other first responders saved 829 lives with naloxone. As long as police officers are increasingly responding to these kinds of emergencies, they must have access to lifesaving tools like Narcan.
Obviously, Narcan is just a band-aid, not a solution to the opioid epidemic—and no one should expect solutions to be the responsibility mainly of police departments. But policymakers at different levels of government are unlikely to find solutions anytime soon. Some frankly don’t care what happens to drug addicts, believing for whatever atavistic reasons that they are responsible for their own mistakes. Others simply don’t know what to do, or don’t want to risk their popularity by asking citizens to pay for solutions that will work to manage, if not eliminate, the problem. The short-term thinking of many politicians blinds them to the fact that solutions cost less than metastasizing problems left unattended.
In the meantime, law enforcement and emergency first-responders will play a role in harm-reduction efforts, if only by default. They will do so, for example, by diverting addicts away from jails and toward longer-term remediation programs. Officers will find themselves in a position to save thousands of lives. That’s heartening on one level, but over time, what does the suspension of police departments over the chasm of a larger public policy paralysis lead to?
No great public policy savior is coming to help strapped police departments facing the opioid crisis virtually alone. They will not be inundated with funding to hire more officers anytime soon, so many if not most departments will be forced to consider hiring recruits who care about the new landscape of policing. That could alter the array of personality types who become police, and open the profession to a new gender balance as well. The training for these new officers will have to go beyond instructions on how to administer Narcan, delving deep into how police should interact with communities where addiction is real, silent, and deadly. There will be a premium on emotional intelligence, arguably even beyond current demands, if tomorrow our officers will not only be chasing bad guys, but helping the sick and the troubled.
While new challenges for law enforcement are both complicated and pressing, the medicalization of the police is not necessarily a net-negative for society. High-profile controversies over police violence, racial bias, and militarization have widened the trust gap between police and communities, making officers’ jobs more difficult. It is crucial for law enforcement not to shy away from dealing with the opioid epidemic. The challenge for today’s police could result in newly mended relations now far down the road between the police and those they are sworn to protect and serve.
On the other hand, whether the medicalization of the police is the best way to handle the challenges posed by the opioid epidemic and related mental health issues that bleed over into law enforcement contingencies is another matter. The question is not a police question; it’s a leadership question in the broader political sense. Our hunch is that police chiefs throughout the nation are waiting and hoping for such enlightened leadership to arise. One wonders how long they will have to wait.
Image credit: Seth Michael
