CTN Dissemination Library & Northwest ATTC
First responders like police, EMTs, and firefighters frequently interact with people who use drugs (PWUD), and, based on how these interactions go, they can either help or harm. First responders have reported negative views toward PWUD and also misinformation related to ways to help them, such as believing that distributing naloxone leads to riskier drug use behaviors (not true). Identifying ways to improve negative beliefs about PWUD and interventions to support them is key to improving interactions between first responders and these communities, which could in turn help reduce rates of both addiction and overdose.
In this project, funded by SAMHSA -- the Connecting the DOTS (Drug Overdose Trust and Safety) Project -- the authors sought to build on the foundation of a prior training project (MO-HOPE) by partnering with the SHIELD (Safety & Health Integration in the Enforcement of Laws on Drugs) Training Initiative to develop an intervention incorporating components based on participant feedback, guidance from subject matter experts, and the emerging success of an occupational wellness approach to professional training.
The curriculum used three core modules: Responder Resilience (reviewing responder stress, burnout, trauma, and mental health), Responder Safety (reviewing bloodborne diseases, overdose recognition, and naloxone administration, as well as fentanyl contact concerns) and empathic communication strategies when responding to an overdose, and Public Safety, reviewing evidence-based treatments and local support services for people with SUD and how first responders can refer to them.
Importantly, the training was delivering using a co-facilitator model, with one trainer being a peer first responder (paramedic for EMS, police officer for law enforcement) and the other a working behavioral health specialist with lived experience of being revived from an overdose by a first responder. This approach was used to model collaboration across sectors, humanize addiction and overdose rescue, and offer insights on how PWUD experience interactions with first responders.
A pre- and post-training survey was used to evaluate this new approach and see if first responders’ beliefs and attitudes toward PWUD and naloxone changed after they attended the training and, if so, did training-associated changes differ by professional population (law enforcement vs. EMS/firefighters).
There were 1,407 participants from 43 agencies within 36 Missouri counties who attended 151 of the trainings between December 2020 and May 2023 who completed the surveys. 53.9% were law enforcement and 46.1% were EMS/firefighters. Most participants identified as white (87%) and men (83%), with the average age 36.31 years. Participants had been in their current field for an average of 11.99 years.
Though attitudes and beliefs among law enforcement were more negative than among EMS/firefighters both before and after the training, attending the training was associated with improvements in those attitudes and beliefs in both sectors, indicating promise with this new approach. Outside of that, the DOTS/SHIELD training yielded no interaction by profession, with both groups reporting similar improvements. This is likely the result of including profession-specific customization, as well as profession-specific peer trainers.
Including a behavioral health specialist with lived experience helped humanize those on the receiving end of responders’ care and provided a rare glimpse into the positive downstream outcomes of their work.
Using customized training components tailored with local substance use resource information also helped equip first responders with the mechanisms needed to improve survival outcomes, which can not only help the people they serve, but also improve their own attitudes toward PWUD by increasing confidence they would truly be able to help. Connecting people to services can also reduce future overdose events, which can in turn reduce demand on first responders, helping to address compassion fatigue and burnout.
Training components that addressed common misinformation about needlestick injuries and fentanyl exposure also helped officers perceive less risk of threat of potential harm during encounters with PWUD, which in turn could make them more likely to issue referrals to services rather than make arrests.
This study provides great insight into what components make training effective for first responders, and also highlights the value of including both peers and people with lived experience as training facilitators. Tailoring trainings to better inform audiences about resources in their own communities can also increase effectiveness and improve outcomes for attendees. Given the frequency with which first responders encounter people with opioid use disorder or in overdose situations, providing effective training to these groups to reduce stigma and improve interactions with PWUD could make a real difference in the number of overdoses in a given community. Many of the lessons learned by this study may apply to training for other types of service providers as well.