Police Use of Discretion in Encounters with People with Opioid Use Disorder: a Study of Illinois Police Officers.

Police frequently encounter people with opioid use disorder (OUD), having a profound effect on their risk environment and health outcomes. Officers retain significant discretionary authority in their response to these encounters. To explore the factors that underlie these decisions, we surveyed a sample of Illinois police officers. We administered an online survey to Illinois police departments using a random sampling strategy, stratified by agency size and the rurality of their service areas. Our final sample was 248 police officers from 27 departments. We surveyed officers' beliefs about (1) influences and control over their decision making; (2) the approval of other actors in making referrals to treatment for addiction, and (3) the potential impacts of medication-assisted treatment (MAT). We analyzed the survey data using descriptive statistics and regression analyses. Most officers were highly influenced by the expectations of their supervisors when responding to subjects who appeared to have an OUD, and about half would take direction from addiction treatment providers. Police in urban departments perceived greater support for MAT and were more likely to believe MAT could reduce the need for future arrests. Our findings suggest ways police officers can be influenced to make discretionary decisions that improve the health outcomes of their encounters with people with OUD: (1) Supervisors should serve as champions to promote referrals to treatment for substance use disorders; (2) collaboration between law enforcement and community addiction treatment providers should be strengthened, and (3) MAT should be supported and expanded in rural areas.

Registering a proposed business reduces police stops of innocent people? Reconsidering the effects of strip clubs on sex crimes found in Ciacci & Sviatschi's study of New York City.

Ciacci & Sviatschi's (2021) 'The Effect of Adult Entertainment Establishments on Sex Crime: Evidence from New York City,' published in The Economic Journal, concluded that opening new adult entertainment businesses reduces sex crimes, with the most compelling finding that '[strip clubs, gentleman's clubs, and escort services] decrease sex crime by 13% per police precinct one week after the opening.' We contend that the study's conclusions speak beyond the data, which cannot support these findings because they do not measure the necessary variables. The study uses the date a business is registered with New York State as a proxy for its opening date, but the actual date of opening comes weeks or months later, after requirements such as inspections, licensure, and community board approval. The study then uses police Stop, Question and Frisk Reports as data about subsequent crimes. As reports created to memorialize forcible police stops based on less than probable cause, 94% of these reports document that the police had an unfounded belief in criminal activity, and the person stopped was innocent of any crime. In effect, what the study has done is measure changes in police encounters with innocent people in the week after an entity has filed the paperwork that will eventually allow it to open as a business. The study lacks construct validity, cannot reject the null hypothesis of its most important finding, and its methods fall short of the rigor necessary to permit replication.

A National Survey of Problem-Solving Court Staff Perceptions of In-Person versus Virtual Hearings.

During the COVID-19 pandemic, problem-solving courts adopted virtual hearings. We conducted an online nationwide survey with a convenience sample of court staff to elicit their perceptions of court participants' attendance, engagement, willingness to talk, and ability to form connection with judges during in-person versus virtual hearings. Sign tests compared ordinal ratings for perceptions of court participant outcomes during in-person versus virtual hearing modalities, and for audiovisual technology versus audio-only technology. The final analysis included 146 staff. Staff felt that during in-person hearings judges could form closer relationships with participants, quality of information exchanged was higher, and participants were more willing to talk. Staff rated attendance as high regardless of the modality. Staff felt participant engagement was higher with audiovisual technology than audio-only technology. Our results suggest that staff have concerns about effects of virtual hearings on court participant engagement and ability to form relationships with judges. Courts should address these potential negative effects of virtual hearings. We are concerned that staff perceived participants more negatively when participants used audio-only versus audiovisual technology, because technology access could be associated with participant demographic characteristics. Further research is needed to examine court participant perceptions and outcomes.

Complexity, Lethality, and the Perverse Imagination: Modelling Nonstate Actors' Means of Attack.

In the pursuit of security, state actors presume a linear relationship between the lethality and complexity of various means of attack. They deploy resources and research programs to overcome the inherent or "analytic" complexity of increasingly lethal means of their own (think of programs to develop nuclear weapons and other highly lethal munitions), and they impose security, legal and regulatory regimes to increase the imposed or "synthetic" complexity opponents must overcome to appropriate or adopt the means they develop. Nonstate actors such as terrorists overcome the challenges of complexity by imaginatively seeking new ways to operate in an alternative high lethality/low complexity space. The perversity of their imagination allows them to conceive of means of attack beyond the pale for state actors, leaving states initially unprepared to defend against them. Car bombs, vehicle ramming and small arms attacks on dense crowds, and iconic attacks such as 9/11 are examples of nonstate actors successfully operating in the high lethality/low complexity space. Successful attackers will continue to do so in ways that state actors fail to imagine and protect against, especially when the prevention of low-complexity attacks traditionally falls on local governments with fewer resources, and they employ means that do not have especially suspicious signatures. The deployment of weaponized drones against crowds and other soft targets may indicate one of the evolutions of this operational space. State security requires fully understanding the imagination of the nonstate actor, but good governance requires balancing the necessary thinking and preventive measures with the freedoms of a state not burdened by such a perverse outlook.

Overdose Prevention Centers, Crime, and Disorder in New York City.

Importance: The first government-sanctioned overdose prevention centers (OPCs) in the US opened in New York City (NYC) in November 2021 amid concerns that they may increase crime and disorder, representing a significant political challenge to OPCs. Objective: To identify whether opening the first 2 government-sanctioned OPCs in the US was associated with changes in crime and disorder. Design, Setting, and Participants: In this cohort study, difference-in-differences Poisson regression models were used to compare crime, residents' requests for assistance for emergencies and nuisance complaints, and police enforcement in the vicinity of NYC's 2 OPCs with those around 17 other syringe service programs that did not offer overdose prevention services from January 1, 2019, through December 31, 2022. Main Outcomes and Measures: Changes in the volume of crimes reported by the public or observed by police; arrests for drug possession and weapons; 911 calls and 311 calls regarding crime, public nuisances, and medical events; and summonses issued by police for criminal infractions in both the immediate vicinity of the sites (ie, a hexagonal area spanning about 6 city blocks) and their wider neighborhoods (ie, a tesselated 3-hexagon array spanning about 18 city blocks). Results: No significant changes were detected in violent crimes or property crimes recorded by police, 911 calls for crime or medical incidents, or 311 calls regarding drug use or unsanitary conditions observed in the vicinity of the OPCs. There was a significant decline in low-level drug enforcement, as reflected by a reduction in arrests for drug possession near the OPCs of 82.7% (95% CI, -89.9% to -70.4%) and a reduction in their broader neighborhoods of 74.5% (95% CI, -87.0% to -50.0%). Significant declines in criminal court summonses issued in the immediate vicinity by 87.9% (95% CI, -91.9% to -81.9%) and in the neighborhoods around the OPCs by 59.7% (95% CI, -73.8% to -38.0%) were observed. Reductions in enforcement were consistent with the city government's support for the 2 OPCs, which may have resulted in a desire not to deter clients from using the sites by fear of arrest for drug possession. Conclusions and Relevance: In this difference-in-differences cohort study, the first 2 government-sanctioned OPCs in the US were not associated with significant changes in measures of crime or disorder. These observations suggest the expansion of OPCs can be managed without negative crime or disorder outcomes.

Unlocking deflection: The role of supervisor support in police officer willingness to refer people who inject drugs to harm reduction services.

BACKGROUND: Research is needed that investigates the relationship between police behaviors, attitudes, and perceived supervisor support as an implementation strategy of improving drug policy reforms. METHODS: We hypothesized that officers with more positive attitudes and practices would be more likely to report the perceived support of their supervisors. Data includes a sample of 1227 police officers who completed Project ESCUDO, a police education training program in Tijuana, Mexico. A negative binomial distribution was used to estimate associations between police behaviors and attitudes and perceived supervisor support. RESULTS: Officers who reported perceived supervisor support accounted for 29.2% (n=470) of the sample. Officers who referred people to social services were more likely and officers who broke syringes were less likely to report perceived supervisor support compared to officers who did not engage in these practices. Officers who believed: MOUD reduced criminal activity, "referring people who use drugs to social services is part of my job", and "laws that treat addiction as a public health problem make my job easier", were more likely to report perceived supervisor support. Beliefs that drug addiction is a disease, laws that treat addiction as a public health problem make their job easier, and talking to other law enforcement officers about infectious diseases were not significantly associated with perceived supervisor support. CONCLUSIONS: Our research highlights the importance of incorporating police supervisors as key actors in assuring officers' practices reflect current drug law reforms as well as embrace patient-centered approaches to managing encounters people who use opioids and inject drugs.

Spatiotemporal Analysis Exploring the Effect of Law Enforcement Drug Market Disruptions on Overdose, Indianapolis, Indiana, 2020-2021.

Objectives. To test the hypothesis that law enforcement efforts to disrupt local drug markets by seizing opioids or stimulants are associated with increased spatiotemporal clustering of overdose events in the surrounding geographic area. Methods. We performed a retrospective (January 1, 2020 to December 31, 2021), population-based cohort study using administrative data from Marion County, Indiana. We compared frequency and characteristics of drug (i.e., opioids and stimulants) seizures with changes in fatal overdose, emergency medical services nonfatal overdose calls for service, and naloxone administration in the geographic area and time following the seizures. Results. Within 7, 14, and 21 days, opioid-related law enforcement drug seizures were significantly associated with increased spatiotemporal clustering of overdoses within radii of 100, 250, and 500 meters. For example, the observed number of fatal overdoses was two-fold higher than expected under the null distribution within 7 days and 500 meters following opioid-related seizures. To a lesser extent, stimulant-related drug seizures were associated with increased spatiotemporal clustering overdose. Conclusions. Supply-side enforcement interventions and drug policies should be further explored to determine whether they exacerbate an ongoing overdose epidemic and negatively affect the nation's life expectancy. (Am J Public Health. 2023;113(7):750-758. https://doi.org/10.2105/AJPH.2023.307291).

Police Stigma toward People with Opioid Use Disorder: A Study of Illinois Officers.

BackgroundFatal opioid overdoses continue to break historical records. Stigma toward people with opioid use disorder (OUD) can negatively impact treatment access, retention, and recovery. Attitudes and beliefs of police officers can profoundly shape key discretionary decisions. Therefore, we examined police officer views indicating stigma toward those with OUD.ObjectivesWe administered an online survey to select Illinois police departments using a stratified random sampling strategy with a final sample of 248 officers from 27 police departments. We asked officers questions measuring stigmatizing attitudes toward people with OUD including distrust, blame, shame, and fear. We found officers held somewhat stigmatizing views with a mean score of 4.0 on a scale of 1 (least stigmatic) to 6 (most stigmatic).ResultsRegression results showed certain officer characteristics were associated with more stigmatizing attitudes of blaming and distrust of those with OUD, including gender, education, race, years in policing, and department size.Conclusions/ImportanceSince most officers in the sample held at least some stigmatizing views toward people with OUD, this may impede the feasibility and acceptability of criminal justice interventions meant to improve behavioral health, such as police deflection programs that link people who use drugs to treatment in lieu of arrest. Departments should offer officer training and education on substance use disorders, treatment for addiction, and the potential for a person's recovery. Training should allow officers to hear directly from, or learn about, personal experiences of people who use drugs and have been in recovery, as this type of interaction has been shown to reduce stigma.

Buprenorphine and opioid analgesics: Dispensation and discontinuity among accidental overdose fatalities in the Indianapolis metropolitan area, 2016-2021.

BACKGROUND: This study describes overall trends and sociodemographic disparities in buprenorphine and opioid analgesic uptake and prescribing patterns prior to fatal overdose events. METHODS: We examined toxicology data from all accidental overdose deaths from 2016 to 2021 (N = 2682) in a large metropolitan area. These data were linked at the individual-level with a prescription drug monitoring program (PDMP). RESULTS: Fewer than half of all deaths had any kind of PDMP record (39.9 %, n = 1070). Among those with a buprenorphine prescription, 10.6 % (n = 35) of decedents had a buprenorphine dispensation within 7 days of their death, while the majority (64.7 %, n = 214) were dispensed buprenorphine more than 30 days prior to death. Evidence existed of racial disparities among those with any buprenorphine uptake, whereby Black individuals (7.3 %, n = 24) had significantly fewer any dispensations compared to White individuals (92.7 %, n = 307). Among those with an opioid analgesic prescription, about 12.2 % (n = 90) were dispensed within 7 days of death, with the majority (68.5 %, n = 506) occurring more than 30 days prior to death. Like buprenorphine dispensations, Black individuals were prescribed a significantly smaller proportion of opioid analgesics (21.9 %, n = 162) versus White individuals (77.7 %, n = 574). Buprenorphine was detected in 78.5 % of deaths where fentanyl was present in the toxicology record, significantly greater when compared to opioid analgesics (57.5 %). CONCLUSION: Consistent with prior research, our findings suggest prescription opioid analgesics may protect against fatal overdoses. Access to buprenorphine treatment did not keep pace with the rising lethality of the overdose crisis, and in recent years, a smaller percentage of the people at risk of fatal overdose availed themselves of MOUD preceding their death.

Buprenorphine involvement in opioid overdose deaths: A retrospective analysis of postmortem toxicology in Marion County, Indiana, 2015-2021.

Background: Amidst an unprecedented overdose epidemic, the opioid partial agonist buprenorphine is a medication for opioid use disorder associated with reductions in overdose. Despite its efficacy, buprenorphine prescribing remains closely regulated, owing to concerns about misuse, and its possible role in overdoses. Methods: A retrospective analysis of the Marion County, Indiana coroner's postmortem toxicology data for unintentional opioid-involved overdose deaths from 2015 through 2021. The county was chosen as a novel setting whose corner provided comprehensive overdose data. It contains Indianapolis, a large city in the US Midwest The 2,369 opioid-involved overdoses were analyzed for the presence of buprenorphine and its metabolite, as wel as potent substances associated with illicit drug use and overdose. Results: Of the 2,369 postmortem toxicology records analyzed, 55 (2.3%) indicated presence of buprenorphine. Of buprenorphine-involved cases, 51 (92.7%) involved other potent substances such as fentanyl, heroin, cocaine, methadone, and amphetamines; 4 (7.3%) were attributed to buprenorphine and liver failure, diabetic ketoacidosis, or relatively less potent substances. Fentanyl was present in 28 cases (50.9%), benzodiazepines were present in 24 (43.6%). Black opioid decedents were considerably less likely to have buprenorphine in their toxicology than White decedents. Conclusions: Buprenorphine was rarely detected in the postmortem toxicology of unintentional opioid overdoses in a major US city in the Midwest. In nearly all cases it was accompanied by other potent substances that more frequently cause fatal overdoses on their own. This study confirms findings from other geographic settings that the overdose mortality risks associated with buprenorphine are low.

Stakeholder-engaged research is necessary across the criminal-legal spectrum.

People with lived experience of incarceration have higher rates of morbidity and mortality compared to people without history of incarceration. Research conducted unethically in prisons and jails led to increased scrutiny of research to ensure the needs of those studied are protected. One consequence of increased restrictions on research with criminal-legal involved populations is reluctance to engage in research evaluations of healthcare for people who are incarcerated and people who have lived experience of incarceration. Ethical research can be done in partnership with people with lived experience of incarceration and other key stakeholders and should be encouraged. In this article, we describe how stakeholder engagement can be accomplished in this setting, and further, how such engagement leads to impactful research that can be disseminated and implemented across disciplines and communities. The goal is to build trust across the spectrum of people who work, live in, or are impacted by the criminal-legal system, with the purpose of moving toward health equity.

Guiding officers to deflect citizens to treatment: an examination of police department policies in Illinois.

BACKGROUND: The U.S. overdose crisis has motivated police departments to enact policies allowing officers to directly deflect individuals to substance use disorder treatment and other services shown to reduce recidivism and subsequent overdose risk, as well as refer people who voluntarily present at police facilities with a desire for treatment. As a new way of operating, and one that relies on an officer's use of discretion for successful implementation, the practice benefits from guidance through written directives, training, and supervisory support. However, there is little information on the establishment, content, and execution of police department deflection policies, which hampers the implementation and dissemination of this promising practice. We analyzed 16 policies of Illinois police department deflection programs. Using content analysis methodology, we coded the policies for language and terminology, as well as program components and procedures. We aimed to examine how the policies were written, as well as the content intending to guide officers in their work. RESULTS: We found the policies and programs had notable differences in length, detail, terminology, and reading level. Only one policy mentioned the use of any type of addiction treatment medication, many used stigmatizing language (e.g., "abuse" and "addict"), and few mentioned "harm reduction" or training in the practice of deflection. Many policies restricted participation in deflection (i.e., no minors, outstanding warrants, current withdrawal symptoms), and critically, a majority of policies allowed police officers to exclude people from participation based on their own judgment. CONCLUSIONS: We recommend police departments consider the readability of their policies and reduce barriers to deflection program participation to engage a larger pool of citizens in need of substance use disorder treatment. Since there is limited research on police policies generally, and the field of deflection is relatively new, this study offers insight into the content of different department policies and more specifically, how officers are directed to operate deflection programs.

POLICING IN THE AGE OF THE GUN.

This Article examines how the rapid deregulation and rampant possession of firearms is likely going to impact policing, and the constitutional law that governs it. For the longest time, lawful gun carry, concealed or open, was exceedingly rare. For a police officer to see a gun was both to see danger, and a crime in progress. This link among guns, danger, and unlawful possession has shaped much of the law of policing. But now, this understanding of the world is in its last stages of unraveling. In nearly all states, guns are no longer unlawful to own and carry by default. In many, they are barely regulated. Recent Supreme Court Second Amendment decisions like New York State Rifle & Pistol Association v. Bruen serve only to hasten where state laws already were headed. For police, however, the harm guns can do exists irrespective of what the law has to say about the legality of carrying them. As a result, the nation's gun laws are on a collision course with the practice and law of policing. This Article explores how the constitutional law governing policing is changing and will change in the face of gun legalization. Part I of this Article explains the ubiquitous role guns play in the life of a police officer, and what actions guns lead police to take. Part II is about the legal doctrine of policing, both before and after firearm legalization. It details how the law shaped what police could do in order to protect themselves and others, and how that law is changing to accommodate legalization. Police now must operate in a terrain that increasingly is uncertain as to their lawful authority, and that in many instances may put them or others in jeopardy. Part III examines how the shifting laws of guns and policing might impact police behavior, likely resulting in ad hoc carve-outs for police authority that-if history is any guide-overwhelmingly will be imposed on Black and Brown communities.

Comparing Risks of Firearm-Related Death and Injury Among Young Adult Males in Selected US Cities With Wartime Service in Iraq and Afghanistan.

Importance: In 2020, homicides in the United States saw a record single-year increase, with firearm injuries becoming the leading cause of death for children, adolescents, and young adults. It is critical to understand the magnitude of this crisis to formulate an effective response. Objective: To evaluate whether young adult males living in parts of 4 major US cities faced a firearm-related death and injury risk comparable with risks encountered during recent wartime service in Iraq and Afghanistan. Design, Setting, and Participants: In this cross-sectional study of young adult males aged 18 to 29 years living in the top 10% most violent zip codes in each domestic setting (as measured by fatal shooting rates), fatal and nonfatal shooting data for 2020 and 2021 were aggregated at the zip code level for 4 of the largest US cities (Chicago, Illinois; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania). Wartime mortality and combat injury rates for the conflicts in Iraq and Afghanistan were used to assess relative risk. Main Outcomes and Measures: The relative risk of firearm-related death and nonfatal shootings in each setting as compared with combat death and injury in the comparator setting. Results: Of 129 826 young adult males aged 18 to 29 years living in the top 10% most violent zip codes in the 4 cities studied, 45 725 (35.2%) were Black, 71 005 (54.7%) were Hispanic, and 40 355 (31.1%) were White. Among this population, there were 470 homicides and 1684 firearm-related injuries. Young adult males living in the most violent zip code of Chicago (2585 individuals aged 20-29 y) and Philadelphia (2448 individuals aged 18-29 y) faced a higher risk of firearm-related homicide than US soldiers who were deployed to Afghanistan, with risk ratios of 3.23 (95% CI, 2.47-4.68) and 1.91 (95% CI, 1.32-3.46), respectively. In expanding the analysis to the top 10% of the cities' most violent zip codes, the risks in Chicago likewise exceeded those of combat death faced by military service members, with a risk ratio of 2.10 (95% CI, 1.82-2.46), and the risks in Philadelphia were comparable with those of deployment to war 1.15 (95% CI, 0.98-1.39). Nonfatal shooting risks were comparable with, or exceeded, the injury risk of combat in Iraq, producing a combined annual firearm risk of 5.8% in Chicago and 3.2% in Philadelphia. However, these findings were not observed in the most violent zip codes of Los Angeles and New York City, where young men faced a 70% to 91% lower risk than soldiers in the Afghanistan war across fatal and nonfatal categories (eg, fatal shooting in most violent zip code in Los Angeles: risk ratio, 0.30; 95% CI, 0.26-0.34; nonfatal shooting in top 10% most violent zip codes in New York: risk ratio, 0.09; 95% CI, 0.08-0.10). The risk of violent death and injury observed in the zip codes studied was almost entirely borne by individuals from minoritized racial and ethnic groups: Black and Hispanic males represented 96.2% of those who were fatally shot (452 individuals) and 97.3% of those who experienced nonfatal injury (1636 individuals) across the 4 settings studied. Conclusions and Relevance: In this cross-sectional study, for young adult men in several of the communities studied, firearm violence carried morbidity and mortality risks that exceeded those of war. Health equity requires prioritizing effective responses.

Implementation and Uptake of the Massachusetts Drug Supply Data Stream: A Statewide Public Health-Public Safety Partnership Drug Checking Program.

CONTEXT: The illicit drug supply is rapidly evolving. Equally important to gathering drug supply data for monitoring is timely sharing of information with people who use drugs, the providers who care for them, law enforcement partners, and public health stakeholders so that efforts to avoid harmful substances, take preventive actions, and better target interventions can occur. PROGRAM: The Massachusetts Drug Supply Data Stream (MADDS) is the country's first statewide community drug checking program. Founded on public health-public safety partnerships, MADDS collects remnant drug packaging and paraphernalia with residue from people who use drugs and noncriminal samples from partnering police departments. MADDS tests samples using simultaneous immunoassay fentanyl test strips, Fourier-transform infrared spectrometry (FTIR), and off-site laboratory testing by gas chromatography-mass spectrometry (GC/MS). Results are accessible to community programs and municipalities, while trend analyses inform public health for cross-site alerts and informational bulletins. IMPLEMENTATION: MADDS was launched statewide in 2020 and rapidly expanded to a multisite program. Program staff approached communities and met with municipal police and community partners to secure written agreements to host drug checking. Community partners designed sample collection consistent with their pandemic era workflows. Consultations with stakeholders gathered feedback on design and deliverables. EVALUATION: The program tests sample donations on-site from community agencies and police departments, incorporates review by a medical toxicologist for health and safety concerns, crafts stakeholder-specific communications, and disseminates English, Spanish, and Portuguese language materials. For 2020, a total of 427 samples were tested, of which 47.1% were positive for fentanyl. By early 2021, MADDS detected shifts in cocaine purity, alerted communities of a new toxic fentanyl analogue and a synthetic cannabinoid contaminant, and confirmed the increase of xylazine (a veterinary sedative) in Massachusetts. DISCUSSION: Community drug checking programs can be collaboratively designed with public health and public safety to generate critical health and safety information for people who use drugs and the communities where they live.

Prevalence and correlates of incarceration following emergency medical services response to overdose.

BACKGROUND: To describe the prevalence of incarceration among survivors of non-fatal overdose addressed through an emergency medical services (EMS) response, and compare incarceration by whether the emergency was for opioid-involved or stimulant-involved overdose. METHODS: Administrative records on 192,113 EMS incidents and 70,409 jail booking events occurring between January 1, 2019 and December 31, 2020 in Indianapolis, Indiana were record-linked at the event level. Incarceration taking place within 6-hours of an EMS incident was associated with that incident. Logistic regression was used to calculate adjusted odds ratios (AOR) of incarceration after an overdose. RESULTS: Among all EMS incidents, 2.6% were followed by incarceration. For overdose EMS incidents, the prevalence of incarceration was 10.0%. Overdose incidents had higher odds than non-overdose incidents of leading to a charge of felony, booked on a warrant, and transferred to another law enforcement agency upon release. Prevalence of incarceration following a stimulant-involved overdose was 21.3%, compared to 9.3% for opioid-involved overdose survivors. Compared to persons from other EMS incidents, overdose survivors had greater odds of incarceration (AOR=3.48, 95% confidence interval (CI)= 3.22, 3.75, p < .001), with opioid-involved overdoses (AOR=3.03, 95% CI=2.76, 3.33, p < .001) and stimulant-involved overdoses (AOR=6.70, 95% CI=5.26, 8.55, p < .001) leading to higher odds of incarceration. CONCLUSION: Incarceration in county jail followed one in ten overdose-involved EMS responses. As illicit drug consumption increasingly involves stimulants, the frequency of incarceration following these events is likely to increase. Policy changes and interventions are needed to reduce incarceration after overdose emergencies.

Voluntary Registries: Filling the Critical Information Gap in First Response to Mental Health Crises.

We argue that voluntary mental health registries integrated into the 9-1-1 system, where patients and caregivers can establish a repository of this information, will help fill this information gap by enabling first responders to quickly understand the context of a call for service with a mental health component, and to make better informed decisions. Despite valid concerns about privacy, stigma, and the potential misuse of protected health information, such registries, if carefully designed and administered, can improve the health outcomes of 9-1-1 calls for service involving mental health-related crises.

Barriers to medications for opioid use disorder in the court system: provider availability, provider "trustworthiness," and cost.

BACKGROUND: Medications for opioid use disorder (MOUD) significantly decrease mortality but courts rarely refer participants with opioid use disorder to MOUD providers. Previous qualitative work suggests routine court referrals to MOUD providers are more likely if court team members perceive providers as "trustworthy." Court team members may also be less likely to refer participants to MOUD if they consider MOUD unaffordable, particularly in Florida, which has not expanded Medicaid. Our aims were to explore court team members' 1) perceptions of availability of local trustworthy MOUD providers, 2) characteristics associated with perceptions of availability of local trustworthy MOUD providers, including beliefs about MOUD efficacy, and 3) perceptions of MOUD affordability. METHODS: An online survey was distributed to all criminal problem-solving court and dependency court team members in Florida in 2019 and 2020. Likert scale questions assessed respondent agreement with statements about the availability of any MOUD providers, the availability of trustworthy MOUD providers, and the affordability of MOUD for court participants. An open-ended question explored MOUD barriers. Spearman's rho, Friedman, Kruskal Wallis, and Mann-Whitney U tests were used for analyzing quantitative data and iterative categorization for qualitative data. RESULTS: One hundred fifty-one respondents completed quantitative questions (26% response rate), and 42 completed the qualitative question. Respondents were more likely to agree that local MOUD providers are more available than trustworthy MOUD providers. Perceptions of trustworthy provider availability differed significantly by MOUD type and were associated with MOUD efficacy beliefs. Qualitative results suggest that MOUD providers offering counseling and individualized treatment are more trustworthy. CONCLUSIONS: Court team MOUD beliefs may influence their perceptions of providers, or negative experiences with providers may influence court team MOUD beliefs. Improving court team perceptions of local MOUD providers may be critical for facilitating court participant treatment access.

"ARREST ALL STREET MENDICANTS AND BEGGARS:" HOMELESSNESS, SOCIAL COOPERATION, AND THE COMMITMENTS OF DEMOCRATIC POLICING.

In "Are Police the Key to Public Safety?: The Case of the Unhoused," Barry Friedman argues that one of the problems with policing in the United States is that it encompasses too narrow a view of public safety. In the case of homelessness, this narrow view fails to understand that providing shelter and subsistence to the unhoused is providing them with a basic form of safety as well. By this view, enforcing most laws against the behaviors associated with homelessness is unjust because it penalizes people for seeking a form of personal security that the government should have provided them with. This Essay argues that while this concern should guide police conduct in many cases, it does not mean the police have no legitimate reason to regulate the behavior of homeless people using discretionary enforcement of the criminal law. Police are not only tasked with providing some conception of safety but have a mandate to equitably broker and enforce the cooperative use of a community's public spaces, which is a critical feature of democratic equality for both housed and unhoused people. Enforcing laws against the behaviors associated with homelessness should therefore be a balance between ensuring everyone has access to public spaces for various conceptions of recreation, transportation, expression, and commerce, and an awareness that even the most disruptive and uncooperative uses of public space by homeless people are a product of duress rather than choice. Both the housed and the unhoused have a legitimate claim on the commons, and while one is more urgent than the other, this does not mean the more urgent claim is an unrestricted one. Requirements of social cooperation may still apply to unhoused citizens, and when they do, it is the criminal law that empowers the police to broker and enforce them as necessary.1.