Abstract
There is little research in the U.S. on the interactions of people who use opioids (PWUO) with criminal justice personnel, from their perspective. This study reports on the experiences with police and criminal justice personnel of 27 men and women in treatment for substance use disorder. In-depth interviews revealed that many respondents had had aversive experiences with the criminal justice system, including both physical and verbal abuse. Very few report receiving information on treatment from police. The evidence suggests that many police officers do not view opioid use disorder as a medical condition, and instead stigmatize PWUO. This study reveals that PWUO, like members of other marginalized groups, are often targets of police maltreatment. Despite the fact that police may play a lifesaving role in cases of opioid overdose, these findings indicate the problematic nature of police response to overdose and opioid-related offenses.
Introduction
Despite slight decreases in overdose deaths in recent years, the U.S. is still in the midst of an opioid epidemic. Overdose is the leading cause of accidental death in the U.S., with over 100,000 fatal overdoses annually (Ahmad et al., 2024). The majority (about 76% in 2022) of these deaths are attributable in whole or in part to the use of opioids (National Center for Health Statistics, 2024). The public health response to the crisis has been multifaceted, including increased distribution of the overdose-reversal drug naloxone, the promotion of safe injection sites, and educational campaigns for drug prevention and harm reduction.
It is standard practice in most states for police to respond to 911 calls related to overdose, in addition to paramedics or EMT’s. Increasingly, police officers are being trained in the use of naloxone, and the U.S. National Opioid Settlement Agreement lists expanding training for first responders in the use of naloxone as the first of its “core strategies” for the use of funds to combat overdose deaths (National Opioid Settlement, 2023). Although there is variation across geographical areas, the police in some areas may be able to respond more quickly to 911 overdose calls than emergency medical personnel, making their response to these calls potentially lifesaving (Lowder et al., 2020; Macmadu et al., 2022). There is some disagreement over the utility of law enforcement involvement in overdose calls and in drug-related offenses in general. Some scholars call for greater police involvement in diversion and deflection efforts that show some promise in reducing recidivism (Blais et al., 2022; Collins et al., 2019; Heslin et al., 2016; Nyland et al., 2024) and substance use (Lindquist-Grantz et al., 2021), although there is a need for more research on these initiatives (Charlier & Reichert, 2020). Others argue that integrating law enforcement with public health initiatives has negative outcomes in that it increases criminalization of what is at root a medical problem (Allen et al., 2021; van der Meulen et al., 2021).
People who use opioids and other illegal drugs are also likely to have encounters with the criminal justice system that may not be directly associated with overdose, especially given that drug use itself can lead to arrest, and that property crime rates also tend to be higher among PWUO (Giles & Malcolm, 2021). A study of 573 people who inject drugs (PWID) in Illinois found that 43% of those who had overdosed in the past six months had been arrested in that time period, but 26% of the sample who had not overdosed during that period had also been arrested, showing a high risk of arrest even among those who had not overdosed (Wagner et al., 2015). Substance use disorders are much more common among incarcerated populations and among those who have been arrested than in the general population, with some estimates as high as 65% of the incarcerated population (NIDA, 2021; Widra, 2024).
Given these data, it is surprising that there have been very few studies focused on the experiences of PWUO with the criminal justice system, from their perspective (Fleiz et al., 2022). There is a body of literature documenting the attitudes of police toward this population, specifically focusing on police and correctional officer stigma toward people with opioid use disorder (OUD), toward medications for opioid use disorder (MOUD; Pfaff et al., 2024), and those who overdose. Much of this literature focuses on correlates of stigmatizing attitudes, and on the ability of education and training to change stigmatizing attitudes. However, the perceptions and experiences of PWUO have been understudied. It is likely that this is a reflection of the relatively easy access by researchers to police and correctional officers versus PWUO.
In this study, I document PWUO’s treatment by police and correctional officers among a convenience sample of men and women being treated for substance use disorder and with a history of opioid use disorder in an inpatient facility in a small city in the northeastern United States. Results show a range of treatment by criminal justice personnel, ranging from respectful to severely physically abusive, with very few respondents indicating that police or correctional officers provided them with information on treatment options. While it is useful to study official police and criminal justice professionals’ attitudes toward PWUO, these studies are limited by their inability to determine how those attitudes may be correlated with actual behavior. To the extent that individuals’ experiences with criminal justice personnel are negative, their likelihood of seeking help from police in overdose or other situations is reduced (Carroll et al., 2020; Dickson-Gomez et al., 2025; Ezell et al., 2021; Footer et al., 2023). This might also reduce an individual’s likelihood of seeking or obtaining treatment through formal channels of any type. If PWUO have had aversive experiences with law enforcement over their life course, increasing or improving police training with regard to overdose response and opioid-related offenses is less likely to be effective for that population.
Literature on People Who Use Opioids and Criminal Justice Professionals
Police and Correctional Officers’ Attitudes Toward PWUO
There is a developing body of literature focusing on police attitudes toward PWUO. There is fairly clear evidence that in general, police hold stigmatizing attitudes toward this population. A study of 248 police officers from 27 police departments in Illinois found an average score of 4 on an index of stigmatizing attitudes ranging from 1 to 6, with 6 being the most stigmatizing (Reichert, del Pozo, & Taylor, 2023). A study of police officers in Pennsylvania found high levels of stigma toward PWUO with regard to their perceived dangerousness to the community and whether they are to blame for their dependence on opioids (Kruis et al., 2020; Kruis & Merlo, 2021). Ezell et al. (2021: 4) found some of the most “cutting and adversarial” attitudes toward PWUO among police in a small, rural sample in Illinois. In one Polish study, many police officers reported holding negative attitudes toward people who are viewed as “addicted” to drugs, such as that they were not the same as “normal people” or that they presented a risk to officers of HIV infection (Bujalski & Wieczorek, 2015, p. 29). The authors suggest that officers who hold negative attitudes like these may be less likely to recommend treatment to drug offenders as a possible diversion from incarceration.
A number of studies find that attitudes toward people who overdose on opioids are more negative among those who have responded most frequently to overdose calls. Phillips et al. (2024) found that first responders who have administered naloxone more frequently hold more negative attitudes toward PWUO, and that this held for both police and EMS personnel. The authors suggest that risk compensation beliefs, or the idea that the availability of naloxone actually contributes to opioid use, may be affected by the frequency with which personnel administer naloxone (Phillips et al., 2024). Risk compensation beliefs were more common among police than EMS personnel in this study, as well as in a study designed to validate the Naloxone-Related Risk Compensation Beliefs (NaRRC-B) scale (Winograd, Werner, et al., 2020). Murphy and Russell (2020) also found that officers who have responded most frequently to overdose calls held more negative attitudes toward those who use drugs, and found that 83% of officers surveyed believe that the availability of naloxone provides an excuse for people to continue using drugs, or a “get out of jail free” card (Green et al., 2013). Carroll et al. (2020) similarly find that police officers who have more frequently responded to overdose calls held more negative attitudes toward overdose response efforts, and suggest that compassion fatigue plays a role.
There is some evidence that officers’ demographic characteristics such as age, rank, and gender are associated with attitudes toward PWUO. Although some studies fail to find significant demographic differences in officer attitudes (White et al., 2021), there is fairly consistent evidence that older police officers and those of higher rank hold less stigmatizing attitudes toward those who use opioids (Carroll et al., 2020; Kruis et al., 2020; Murphy & Russell, 2021; Winograd et al., 2020; Winograd, Werner, et al., 2020; Winograd, Stringfellow, et al., 2020). Female officers tend to hold less stigmatizing attitudes in some studies (Winograd, Werner, et al., 2020), But data collected from officers in Illinois show that female officers hold more stigmatizing attitudes (Riechert, del Pozo, and Taylor, 2023; Reichert, Martins, et al., 2023).
There is also evidence that correctional officers and other criminal justice personnel hold stigmatizing attitudes toward PWUO. McLean et al. (2025) found both quantitative and qualitative evidence of stigma toward OUD among correctional professionals, especially with regard to the blameworthiness of PWUO. Additional research has found that service providers often hold negative attitudes toward PWUO, such as the idea that people with OUD are often not willing to change (McLean et al., 2024). There is evidence that negative attitudes toward PWUO and MOUD also reduce the likelihood that these effective therapies will be utilized (Moore et al., 2022; Pfaff et al., 2024).
Experiences of People Who Use Opioids With Criminal Justice Personnel
There is substantial evidence from studies conducted outside of the United States that people who use drugs, who inject, and who use opioids experience mistreatment by the police, including extortion, physical violence, and sexual violence (Fleiz et al., 2022; Kahn et al., 2021; Kutsa et al., 2016; Landsberg et al., 2016; Lunze et al., 2016; Makarenko et al., 2016; Nelson & Brown, 2020;). However, there has been very little quantitative research in the U.S. exploring the extent of police violence against PWUO, and even less qualitative research on the experiences of the victims of police violence in this population. A recent quantitative study in Baltimore, MD found that 7% of a sample of 570 PWID had experienced police violence in the year prior to the survey, and that 24% knew someone who had (Park et al., 2019). One qualitative study of 20 PWUO, also conducted in Baltimore, notes widespread mistrust of police based in part on police violence, but does not report on the direct experience of violence among their respondents (Footer et al., 2023).
Other qualitative studies not explicitly focusing on mistreatment of PWUO find evidence of these experiences. A study of the effects of a police crackdown on harm reduction among PWID found that fear of arrest and police violence lead to rushed injections and other unsafe practices (Cooper et al., 2005). Similarly, studies in Wisconsin and in Ontario, Canada found that witnesses to overdoses are often reluctant to call police for help due to mistrust based on their prior experience with police, such as poor treatment, discriminatory comments, or police not following Good Samaritan laws (Dickson-Gomez et al., 2025; van der Meulen & Chu, 2022; van der Meulen et al., 2021). Although not focused on PWUO, a study of youth who use drugs in Canada reported similar levels of mistrust of police based on prior experience (Greer et al., 2022). A Massachusetts study of public health and public safety partnerships to extend outreach services to overdose survivors reported evidence of verbal harassment (such as the use of the term “junkie”) by police, and overall negative interactions between survivors and police (Carroll et al., 2020). The authors of this study noted the difficulty in locating and interviewing overdose survivors and were only able to interview eight for their study. That study did not report on respondents’ direct experience with police violence.
Methods
Data and Sample
I conducted in-depth interviews with 27 men and women in inpatient treatment for substance use disorder at a facility in a small northeastern city over a three-month period in the spring of 2021. Because beds at the facility were limited, clients regularly moved in and out of the facility, necessitating the extended period of time to obtain a sufficiently large number of interviews. All clients in residence at the facility during that time frame were asked if they were willing to participate in one-to two-hour interviews over that period of time, and all of them agreed. Participants were compensated for their time with a $30 gift card. All respondents had a history of opioid use disorder, and 25 of them were currently being treated for opioid use disorder. Due to the COVID-19 pandemic, all personnel in the facility were masked while indoors, so interviews were conducted masked. Interviews were conducted in private offices at the facility to maintain confidentiality. Interviews were recorded, and the recordings were professionally transcribed. Errors in the transcriptions were evaluated by the author and an undergraduate research assistant and, when possible, were fixed. 1 The final data set consisted of 754 pages of transcribed interviews.
The final sample consisted of 17 men and 10 women, ranging in age from 25 to 60 years old with an average age of 41. I asked respondents how they identified their race/ethnicity without applying predetermined categories. Most identified as “white” or “Caucasian,” (N = 24), two identified only as “Puerto Rican,” and one as “Cape Verdean.” Four respondents identified as ethnically Portuguese in whole or in part, two identified as ethnically Mexican in whole or in part, and one of the respondents who identified as white also claimed Puerto Rican ethnicity. There was only one Black client at the facility while interviews were being conducted. He had agreed to an interview but transferred to a different facility before the interview could be conducted. I continued to conduct interviews past the point at which it was likely that saturation had been achieved (Hennink & Kaiser, 2022), in part in the hope that my sample might become more diverse as new clients arrived. Interviews concluded when admissions to the facility slowed to the point that it was no longer practical to continue.
Coding Methods
The primary focus of the research was to investigate peer influence and other social processes involved in initiating substance use in general and opioid use in particular. Given this focus, interviews were semi-structured and drew on an interview schedule created a priori. For example, all respondents were asked to describe the circumstances surrounding their first use of any intoxicating substance, including their age, who was there, who provided the substance, what was said, and what the respondent was thinking when they decided to use the substance. Other questions focused on whether the respondents had ever initiated others to substances including opioids, and whether respondents had ever tried to discourage peers from initiating opioids or injection drug use. The interview schedule was amended over the course of the research to add questions about issues that arose during the interview process, including respondents’ experiences with the criminal justice system. The primary coding method was structural coding, which assigns labels to specific content, often related to predetermined topics or categories (Saldana, 2021). I also used open or initial coding (Saldana, 2021) to facilitate discovery of phenomena not anticipated prior to interviews. For example, many spontaneously provided accounts of the causes of their dependence on opioids and other substances, often drawing on their experience of traumatic childhoods or psychological distress (Scott & Lyman, 1968).
I first coded one interview transcript, developing and defining a set of codes using both structural and open coding. To check for the accuracy and comprehensiveness of codes, an undergraduate research assistant then independently coded the same transcript. Discrepancies between the two coders were assessed using Atlas.ti’s inter-coder agreement function. We discussed discrepancies, and refined the codes and their definitions based on those discussions. I coded the remaining transcripts. A total of 147 individual codes were generated, organized into ten major categories. The focus in this study is on the category “police and incarceration experience.” To check for errors or omissions, I conducted searches relevant to particular research questions using Atlas.ti’s “search” function. For example, prior to my analysis of data for this study, I performed a search of the entire data set using any terms related to the police or criminal justice system, such as “cops,” “arrest,” “jail,” “prison,” etc. to minimize coding errors or omissions that could affect the results.
Results
Twenty-six of the 27 respondents were explicitly asked about contact with the police, 2 and 23 of the 27 respondents (85%) had a history of at least one arrest. One of the respondents with no arrest history had contact with police when her children were removed from the household as a result of an opioid overdose. Another of those not arrested had been detained by the police for possession of drugs, but the police called his sister to come and pick him up and was not charged. Another respondent who was asked about police contact volunteered that he knew a lot of police officers in his community because he had attended high school with them, implying that police may have overlooked his illegal behavior. The fourth respondent who had not been arrested was one of only two respondents in the data set with no serious drug use history who reported becoming opioid dependent as the result of prescription for themselves. That was also the only respondent who didn’t report any police contact. Of the 23 respondents who had been arrested, 13 of them confirmed at least one period of incarceration in a jail or prison, with some respondents spending years in prison over the course of their lives.
Neutral or Positive Interactions With Police
Respondents’ experiences with police and correctional officers varied widely, with most (15 of 26 with police contact, or 58%) reporting either neutral or positive interactions with them. One respondent noted that he does not hate the police because: “… they’re just doing their job … you know, they found the drugs, they arrested me … when I’m clean and stuff like that, cops don’t bother me. Because I’m not committing any crimes.” Another thought his appearance as a “tall white kid with blond hair” explained why the police didn’t hassle him. One of the female respondents had been arrested after a romantic rival of hers came to her house and started a fight. The respondent assaulted the woman with a broken beer bottle, resulting in serious injury, but she said that the officers treated her pretty well because they saw her as acting in self-defense given the situation.
Several respondents experienced positive interactions with the police in the context of “getting sectioned” (being involuntarily committed) or otherwise being contacted as a result of their family’s request to police to check on their welfare. One respondent described an incident in which his brother was having him committed to a treatment program: And the cops walked in, they were pretty cool, they were like, ‘J., don’t freak out. We’re going to get you some place safe, and get your shit together and help you out there.’ I’m like, ‘Just do me a fucking favor, do not cuff me in front of my neighbors, dude. I’m not trying to look like a criminal coming out of my house, because that is not me. I’m a fucking addict, that’s it … and, you know, they didn’t and that was cool.’
Another respondent, who had generally very unfavorable attitudes toward the police, noted that they treated him well after they located him as the result of his father calling the police station out of concern for him. He said: I walked out of a convenience store and a police officer stopped me. And I was ready to start running from him, because I thought maybe they figured we were -- well, they probably found out we robbed the pharmacy, or whatever. And he put his hands up, he said, ‘Your father is looking for you.’ And I stopped dead in my tracks, and the first thought that went through my mind is my parents think I’m dead. And he said, ‘Call your father he’s looking for you.’
One respondent, “Mark,” also experienced positive interactions with the police in the context of him trying to get help for his girlfriend, who was alcohol dependent. Mark had been calling 911 nearly every day when his girlfriend would become so intoxicated that she was unable to walk. A police officer told him that they couldn’t keep showing up for those calls on a daily basis, and later approached him and said, ‘Listen, I put a warrant out for her to get sectioned. Don’t tell her because she’ll take off. But next time you got to call 911,’ I was like, probably tomorrow, ‘she’ll get sectioned. Tell ‘em squad eight zero has a warrant out for her.’
Several respondents had positive or neutral interactions with the police when they personally knew one or more officers. As noted above, one respondent mentioned that he had never been arrested and indicated an overall positive attitude toward the police because, “I actually know a lot of police officers in the city I went to school with. That I’m really friendly with. So I’m really, I’m totally, I’m a hundred percent [in favor of police.]” In addition to the positive interaction “Mark” had with police described above, he noted that his personal relationship with one officer probably saved him from arrest. He said: There was another guy, his name is J. This Black guy, he was a cop. I used to take [a class] … and he was one of the instructors. And for years, I would see him. He never arrested me. He would transport me from here to there or whatever. And we’d have a talk, he was cool.
Negative Interactions With Police and Correctional Officers
Overall, eleven of 26 respondents with police contact reported aversive interactions with police or correctional personnel, or 42% of those with police contact. Six respondents reported experiencing physical abuse by police or correctional personnel. Five respondents who had not experienced physical abuse reported being verbally harassed by criminal justice personnel or police, or being denied medical treatment while in custody.
Physical Abuse
Some of the physical abuse reported by respondents was relatively minor. “Ed,” a 58-year-old white male, recounted an incident in which a police officer saw him walk out of a bar with a can of beer. When he saw the officer, he put the beer down on the sidewalk, … and the cop came up, it was a state trooper. He got me for all kinds of things, disturbing peace, disturbing the home, all different things and threw me up against the car. The car was filthy. I looked at myself, I was full of dirt. I ended up taking 60 days for that …
Another respondent reported that police were “ripping [her] pants all the way to my crotch, and I’m like, why do you need to do that?”
In contrast, several respondents were seriously injured by police and required medical treatment. “Paulo,” a 47-year-old man who identifies as Cape Verdean, described two serious incidents of police violence in Massachusetts towns. In one incident after a traffic stop when he was discovered to be driving without a license, a police officer broke Paulo’s arm. He said, What they do is they’ll grab you and you got one guy fighting one way and another guy fighting another way and your body is getting twisted in two different directions and then that’s what it makes it look like you are fighting them. ‘Stop fighting me.’ ‘I am not fighting you. Tell your dude over here to stop fighting with me.’ And they make it look like it so that way they can be a little more aggressive and brutal with you… cops have just so much anger in them as any other human beings. It’s just that they use it when they arrest you.
In another incident, Paulo was punched in the face by an officer while he was handcuffed. In response, he kicked the officer, at which point the officers “tried to break my legs with their baton… I had a private investigator going to take pictures of the floor where they missed because it was a wooden floor and there was indents all over the floor.”
Another respondent, “Carlos,” a 37-year-old man identifying as Portuguese and Puerto Rican, described an incident in which he led police on a vehicle and foot chase after an officer attempted to pull him over when he ran a red light. He had been using crack all night, and when the officer tried to pull him over: I went ‘fuck this’ and I floored it and I said, yeah, I can’t go. I got a warrant for my arrest anyway. I floored it and I had drugs on me. So we were in a high speed chase now. And I eventually exited the vehicle and ran and they couldn’t find me for hours… I was smoking crack, at 3:00 in the morning underneath the parked vehicle like it was no big deal and then the next thing I know, I’m being attacked by a dog… the dog stuck its head under the car and grabbed me and he yanked me out and I just kept telling the cop, hey man, get him off me, my arm, he is tearing my arm apart … and he’s like, you shouldn’t have ran and I’m like, Jesus -- they cuff me up, and I’m like, please officer, I apologize, I’m not mad at the dog, he did his job, and I’m not mad at you guys, and I apologize for running. ‘Why did you run?’ I had a warrant, I’m sorry. I’m high on crack and I’m not thinking right. So I’m like, I need to go to the hospital. I need to go to the hospital. My arm is wide open. ‘There’s nothing wrong with you, there is nothing wrong with you.’ And so he lifts up my arm. He says, ‘you got a little scratch, you are fine.’ I’m like, no dude, I’m telling you, I need stitches, man. So he is like, oh, whatever, we’ll take you to the hospital. They took the cuff off and cuffed me to the bed inside there and the nurse was like holy moly, like I am literally down to the white meat… it took like a year to heal.
“Steve,” a 33-year-old white male, reported that he has, … an open lawsuit against [a correctional facility in a northeastern town], yeah. Because they used excessive force and beat the shit out of me and … one cop urinated on me … it’s all like on camera and I have a huge lawsuit. It’s almost like they discriminate against anybody who’s not Portuguese in that jail … it’s like, they’re all cousins with most of these kids out here, like they’re all related and shit. And I’m just like, I’m not from this area. You know what I mean?
Given many respondents’ long histories of interaction with police and other criminal justice professionals, many of them had mixed experiences with them. “Sarah,” a 39-year-old white female, provides one example. She said that police killed her husband, shooting him in the back while he was running away from them. With regard to how the police treated her, she said: Most of the time, I was fine … there was one incident… [when she refused to tell the police where her boyfriend was] and they had hit the back of my head and I hit my face on the police car and my nose was bleeding. When we got to the police station, they had cuffed us to the bench and [her boyfriend] was high and they kept telling me to wake him up. So I was trying to kick him to wake him up. And one of the cops ended up tasing him while he was cuffed to the bench … we actually ended up getting off of those charges because we had the lawyer [who] was going to bring in the videotapes from the police station and the pictures of my face.
Verbal Abuse and Refusal of Medical Treatment
In addition to these acts of violent victimization, respondents reported a variety of incidents of other forms of mistreatment by the criminal justice personnel. One respondent, a 47-year-old white female, suffered a minor heart attack while in custody in a local jail and was initially refused treatment. She stated, “I had a slight heart attack there and I didn’t know about my heart disease so obviously, they didn’t know. And … they didn’t care.” Stigmatizing language was noted by several respondents, including “Alan,” a 45-year-old white male who stated that the police are: … really just jerks honestly … you’re a junkie. The CO’s in jail, the same way, like junkie suffer… they’re terrible. They’re like “I want to kill these guys.” I just figured this is how it is I guess.
Similar language was reported by “Jack,” a 37-year-old white male whose interactions with the police had been “terrible… they call you junkie.” He reported a police officer taking his wallet with his identification in it with him to his cruiser, and returning it missing $100 in cash. He also described detoxing in jail: I felt like I was having a heart attack and I needed the nurse… my heart rate was something crazy, because I was going through such bad withdrawals from opiates and drugs. ‘That’s why they call it dope because you guys are a bunch of idiots. You’re a bunch of dopes. They don’t call it Smarty.’
Perceptions of Bias or Corruption
Several respondents perceived that their mistreatment by police was the result of their race or ethnicity. “Diego,” a 25-year-old Puerto Rican man, reported being searched for no reason: I remember getting stopped a couple of times and just getting searched, because they said I was acting weird and moving funny and it would piss me off, because … I am Puerto Rican with tattoos, that’s what I personally felt, because of the way they were acting. The respondent “Paulo” offered an explanation for why some police officers are violent: They mostly come from like being bullied… they’re not like jocks. You are not going to see a jock as a cop because they’ve already got that popularity… these cops haven’t so they go like now, ‘Oh, yeah, well I remember 13, 20 years ago when I was in school, those Black kids beat me up, so now I got a Black guy I’m going to fucking take it out on him’ type stuff. I am not necessarily saying it’s a racist thing but I do believe that they have racism not because of color, just racism as people in general. Just like … they just might not like you because they might not like it because you’re a drug addict…
A number of respondents perceived other types of corruption or incompetence among police, including police officers smuggling drugs into prison, officers perceived to be involved with organized crime networks, or who were shirking their job responsibilities, as described by “Carlos”: [Police in a northeastern city] are the worst. I tried to turn myself in with four warrants for my arrest and they said, ‘Can you come back in a little while? I am kind of on my lunch break right now.’ I’m like you don’t even know what my warrants are for! They could be for murder for all you know and you’re telling me to beat it, like they didn’t care. They did not care.
Offers of Treatment From Police
Only three respondents (11.5% of the sample reporting on police contact) reported being offered any meaningful treatment or pathway to treatment by police or criminal justice personnel. The respondent noted previously whose sister was called rather than him being arrested was one; a second respondent had police officers repeatedly telling him that he should get treatment (but not how or where) because, “’This ain’t you.’ Because they know me.” A third respondent was treated with methadone while being held in a local jail. An additional two respondents mentioned being transported to the hospital by police, but not given any information on obtaining treatment for opioid dependence. One respondent noted that EMT’s and fire fighters had provided him with some information on treatment, but, “The police, they just wanted to slap the cuffs on, and another junkie off the street. And somebody that’s not going to hurt my daughter, or rob me, or mess with my tax dollars…”.
In sum, this study revealed evidence of poor relations between people who use opioids and criminal justice personnel, including police and correctional officers. Some respondents expressed understanding that the police had a job to do and that, as people who frequently engage in illegal behavior, they were subject to social control efforts by police. Several respondents also acknowledged individual variation in police treatment, with many having both positive or neutral experiences as well as negative ones. The overall perspective among these respondents was not favorable toward criminal justice practitioners, with many expressing some degree of mistrust, dislike, or resentment toward them, based on their own and others’ interactions with them over the years.
Discussion and Policy Implications
Although there is a growing body of research on criminal justice personnel’s attitudes toward people who use opioids, there is relatively little published on criminal justice professionals’ treatment of PWUO from the perspective of those who use opioids. This is an important gap in the literature, as studies of police attitudes cannot address how those attitudes may or may not play out in their behavior toward people who use opioids (Buchman et al., 2018; Reichert, Del Pozo, & Taylor, 2023). Almost all of the respondents in the current study had had some interactions with the police, and most had been arrested. As noted, about 41% of them experienced aversive incidents at some point in their lives. When asked, few respondents reported that the police even suggested treatment, or treated them as one suffering from a disease rather than a moral failing. While police violence against Black people and other people of color has garnered a great deal of public attention and concern, there appears to be no similar public perception of people who use opioids as a group who are at risk of violent victimization by police. The problems associated with police response to mental health crises in general has received a good amount of attention in the popular media and in scholarly literature (e.g., Pifer, 2023). However, despite increasing public awareness of OUD as a medical condition (Recovery Research Institute, 2026), a recent national study found that 81% of people in the U.S. still view people with OUD as largely responsible for their own situation (McGinty et al., 2026). The persistent pervasiveness of these stigmatizing attitudes might affect the degree to which the public are concerned about abuse of PWUO.
Many scholars have noted the structural contradiction between the goals of policing and the goals of a public health approach to the opioid epidemic (Ezell et al., 2021; Fedders, 2019; Green et al., 2013; Murphy & Russell, 2021). The public health approach aims to improve access to treatment and increasingly relies on the medical model of addiction to help users recover and avoid overdose. As this and other research has pointed out, however, the treatment of people who use opioids by police and correctional officers is not typically modeled on an ethic of care, and instead is often extremely stigmatizing and sometimes violent. This can lead to a range of negative outcomes. Fear of arrest or police violence can lead people who use drugs to rush injection, which can result in injection-related injury or infection (Cooper et al., 2005; Footer et al., 2023; Small et al., 2007). Aversive experiences with police can lead to psychological distress, which is a known risk factor for opioid misuse, and experiencing arrest has been associated with an increase in non-fatal overdoses (Lowder et al., 2020). Mistrust of police can also deter people from calling for help during an overdose incident, even when Good Samaritan Laws are in place. This was well-stated by a participant in a study on stigma against people who use opioids in rural Illinois, who said, “More people end up hurt because they don’t wanna call the law. Because they know they’re just gonna fuck with them. They’re just gonna treat them like shit, like drug addicts” (Ezell et al., 2021, p. 5).
As noted previously, it is also unlikely that individuals who have experienced stigmatizing treatment or physical abuse by police over their life course will turn to them for help. Currently, the highest rate of fatal overdose in the U.S. occurs among people aged 35–44 (Spencer et al., 2024), many years after the age at which people typically begin misusing opioids (Lynch et al., 2021). Many participants in the current study first misused opioids at very young ages, often in middle school or high school, and many have had years of involvement with the police and the criminal justice system. This might limit the effectiveness of new approaches to police training to have effects, at least for this population. A study of overdose survivors’ and their families’ reactions to police outreach efforts in Massachusetts illustrates this problem (Carroll et al., 2020). It was often the case that police officers who contacted survivors and their families were the same officers who had conducted drug raids or mistreated these people, leading these families to reject officers’ or others’ attempts to help. As one public health practitioner put it, “they wanted nothing to do with us” (Carroll et al., 2020, p. 8).
The findings presented here as well as other research (Fedders, 2019) cast doubt on the ability of traditional policing to effectively reduce opioid misuse, opioid-related overdose, and crimes resulting from possession and use of opioids. However, initiatives to involve police and other first responders in diversion, deflection, and initiatives such as Oregon’s Crisis Assistance Helping Out on the Streets (CAHOOTS) program show promise. CAHOOTS and similar programs like street triage (Heslin et al., 2016) pair medical professionals with police in responding to emergency calls, which has been shown to reduce the likelihood of arrest or detention (Davis et al., 2025). A recent review of deflection programs in the U.S. found positive effects on police practices, moving away from a law enforcement focus and toward a more supportive approach (Labriola et al., 2023). This study also showed that deflection efforts had positive effects on officer attitudes toward deflection, they they had public support, and that they improved attitudes toward the police. The Law Enforcement Assisted Diversion (LEAD) program has been found to significantly reduce criminal justice contact, including jail bookings, incarceration time, and legal costs (Blais et al., 2022; Collins et al., 2019). Although officer buy-in to diversion and deflection programs can be a challenge (Dickson-Gomez et al., 2025), there is qualitative evidence that these programs also improve relationships between law enforcement and other agencies that serve PWUD, and can help improve views of the police among this population (Perrone et al., 2022). A study based on a convenience sample of law enforcement officers in Delaware showed overall positive attitudes towards their agency’s deflection program, with a majority (59%) believing they they’re effective (Regalado et al., 2025). There is some evidence that deflection and diversion programs that include referral to long-term treatment can reduce overdose deaths (Nyland et al., 2024) and overall mortality rates (Surace, 2026) as well.
It’s promising that diversion and deflection programs may have positive effects not only on recidivism and overdose rates, but also on PWUO toward police, and police attitudes toward PWUO. Despite some researchers’ calls for police to stop responding to overdose calls (e.g., van der Meulen et al., 2021), in some cases police can respond more quickly than EMT’s, and in some parts of the country they are the only option (Dickson-Gomez et al., 2025). Additionally, in areas where police carry and are trained to administer NARCAN, they have clearly saved many lives. In one 10-month period in Tempe, Arizona, police officers arriving on the scene of an overdose before EMT’s saved 81 out of 100 persons suspected of overdose (White et al., 2021). It would seem to be more promising, then, to work toward solutions that improve options available to police officers and that promote more positive relationships between law enforcement and PWUO.
The results of this study have implications for guiding state spending of Opioid Settlement funds, which vary widely by state (National Academy for State Health Policy, 2025). Some states are using Opioid Settlement funds for police and criminal justice purposes that do not have clear relevance for opioid use treatment or harm reduction (Whaley & Sharfstein, 2023). States are required to use at least 70% of these funds for treatment and prevention, but some states have used these funds for new police cruisers, overtime pay, and other criminal justice-related expenses that are not necessarily geared toward treatment or prevention (Hoffman, 2023.) Specialists in addiction medicine have argued for an increased role of academics with expertise in opioid dependence in state organizations guiding funding decisions related to Opioid Settlement funds, noting the need to fund evidence-based strategies for reducing overdose deaths (Whaley et al., 2023). The results of this research suggest that social scientists, including criminologists, might be able to provide recommendations specifically pertaining to relationships between criminal justice professionals and PWUO.
Limitations and Directions for Future Research
As with all small-scale qualitative studies, one limitation of this research is its lack of generalizability – interviews were conducted in one location with twenty-seven respondents, and thus the findings cannot be assumed to be generalizable. The sample also lacked racial diversity, although a number of respondents identified as ethnically Latinx, including Portuguese. Another limitation of this study is that its initial focus was not on law enforcement officers’ treatment of PWUO. Given that, it is likely that some insights were missed that might have been revealed with a study explicitly focused on the experiences of PWUO with the criminal justice system as well as other social service agencies. Another limitation is that the questions about interactions with criminal justice professionals were also phrased in terms of the respondents’ lifetime interactions, which likely overestimate the frequency of negative interactions and may overrepresent incidents that occurred years ago.
It would be beneficial for further research to be conducted with larger samples that are more representative of the population of people who use opioids. It is difficult to select probability samples of people who may be in marginalized statuses, but future research might at least involve samples of people from different parts of the country. It would also be useful to make comparisons across states that have different policies relating to policing opioid use. Moving forward, research comparing outcomes of programs funded by the Opioid Settlement in states with different policies on allocating those funds would also be beneficial.
Footnotes
Acknowledgements
I thank the respondents in this research for their participation, and Olivia Belitsos for her research assistance on this project. I thank Jill Doerner, Megan Parry, and Judy Van Wyk for their helpful comments on earlier versions of this manuscript.
Ethical Considerations
This study was approved by the Institutional Review Board at the University of Rhode Island on 3/2/2021, ID 1701043-3.
Consent to Participate
All participants provided oral informed consent prior to enrollment in the study, and the data were recorded with participants’ identities anonymized.
Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this study was provided by the University of Rhode Island’s Social Science Institute for Research, Education, and Policy.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The data for this project cannot be shared because they contain references to individual police departments and location names that could reveal the identity of participants. No reference to these details is made in this manuscript.