On August 1, 2012, Officer Michael Alfieri of Suffolk County, New York, responded to a 911 call about an unconscious man in an apartment. Arriving at the scene, Alfieri noted the man’s bluish skin, labored breathing and track marks in his arms, all indicative of a heroin overdose. Kneeling beside the victim, Officer Alfieri administered two doses of Narcan, a drug that blocks the effects of opiates to the brain, through an intranasal spray. Minutes later the man woke up, shocked and confused, but grateful to be alive.

Officer Alfieri was the first deputy in his department to administer Narcan under a new pilot program launched only two days prior, which trains and equips police officers to use Narcan when confronted with an opiate overdose. Narcan (generic name naloxone), a drug traditionally administered by EMTs, is making its way into the hands of police officers in some states as part of efforts to reverse the nationwide overdose epidemic. Drug overdose recently surpassed auto fatalities as the leading cause of accidental death in the United States, and according to the CDC,current drug distribution through pharmacies is equal to 700 mg of morphine per person, enough for everyone in the U.S. to take a typical 5mg dose of Vicodin every four hours for three weeks. Law enforcement and Narcan may seem odd bedfellows considering the agency’s traditional hard stance on drugs, but the alliance makes sense in light of the nature of opiate overdose. The most lethal of all drugs, opiates, such as heroin or most prescription painkillers, lull the user into a sleepy euphoria that can lead to respiratory failure. As police officers often respond to 911 calls faster than an ambulance, a growing number of counties are relying on law enforcement to reach victims before they stop breathing.

The first police Narcan program in the United States was launched in 2004 in the districts of Santa Fe and EspaÃ±ola, New Mexico. New Mexico has consistently led the other 49 states in overdose deaths, with 27 in 100,000 fatalities, more than twice the national average. Between 2010-2012, several counties in Massachusetts and New York introduced similar initiatives to combat burgeoning overdose epidemics.

Most Narcan programs develop under the leadership of a high-ranking law enforcement officer in response to a spike in overdose fatalities. In rural Rensselaer county, New York, Sheriff Jack Mahar noticed a sharp increase in the use and abuse of prescription pills during his nine-year tenure, as well as delays for the county’s volunteer ambulance to arrive. Recognizing that lives could be saved if overdose victims were reached earlier, Sheriff Mahar and Dr. Michael Daly, medical director of the Rensselaer EMT program, petitioned the public health department to allow police officers to administer Narcan. In May 2012 they received the green light to launch a pilot program.

A similar process occurred in Quincy, Massachusetts. Between 2008 and 2009 the small town of Quincy lost 42 members to overdose. The victims ranged from habitual drugs users to young teens experimenting with pills and elderly folks who confused their prescription medications. Fed up with the losses, a group of concerned citizens approached the police. Lieutenant Detective Pat Glynn, along with the chief of police and the mayor, requested action from the Massachusetts Department of Public Health and in 2011, a pilot program was implemented to train and equip deputies with nasal Narcan. As of August 2012, Quincy officers have reversed 103 overdoses and the death toll has plummeted to 16 since the program began. Officer Donnelly, a seven-year patrol officer with the Quincy police, has personally reversed seven overdoses in the past year and a half. “It’s really amazing when you give [Narcan] to someone who has overdosed. One minute they’re clinically dead and a few minutes later they pop up, alive.” Training officers to use Narcan is fairly simple, especially as officers in Quincy and Rensselaer county are already certified EMTs. After a short training on how to administer intranasal Narcan, which has no adverse affects and cannot be abused, each officer’s cruiser is equipped with two doses of the drug.

Lieutenant Detective Glynn sees police Narcan programs as a positive step towards changing public perception of law enforcement. “We need people to know that the officer in the cruiser is not a monster, but an avenue to emergency care that will save a life,” says Glynn. “Law enforcement now understands that we are not going to arrest our way through this epidemic. Treatment and inpatient facilities are needed…Quick bandaid approaches like arrests are not going to solve the problem, only mask it and place a larger strain on the criminal justice system.”

Officer Donnelly of the Quincy police department adds, “We [officers] took an oath to keep people safe. Narcan is one more tool for us to save people’s lives.”

Despite many positive effects of police Narcan programs, implementation has not been without challenge. Aside from the difficulty of convincing a public health department to launch a new initiative in the midst of the current fiscal climate, police departments have encountered internal resistance.

Some opponents of police Narcan programs, including deputies themselves, argue that if drug users have easy access to a lifesaving medication, they might increase their drug use under a false sense of security. Additionally, Narcan programs raise delicate questions about law enforcement’s role in public health – and public health’s role in law enforcement. If an officer called to reverse an overdose encounters drugs or paraphernalia at the scene, should they make an arrest? Does the police administration of Narcan indicate a softened stance towards drug use? Lt. Detective Glynn believes that there is a place for law enforcement in public health and that police Narcan programs do not lead to an increase in drug use. “I have yet to speak with a substance abuser or a survivor of a Narcan reversal who said they are using heroin because they know there is Narcan available to save them,” he says. “That’s like saying that since there are so many medications available, people will stop living a healthy lifestyle because there is a pill to save them. I would say that people who believe abusers feel safe [because of Narcan] are misinformed.” The Lieutenant Detective reiterated his message at the 2012 Summit on Law Enforcement Safety and Drug Policy hosted by the North Carolina Harm Reduction Coalition (NCHRC) in Raleigh, North Carolina. Public health groups like NCHRC are pushing to expand police Narcan programs to other states, including those in the South, which suffer from some of the highest overdose rates. These groups and other proponents of Narcan access point out that because Narcan blocks opiate receptors in the brain, thus putting opiate addicts into acute and painful withdrawal, it is unlikely to be viewed as a “backup plan” by drug users. A recent study on the affects of Narcan programs also concluded that greater access to the drug does not increase drug use or create a false sense of security for users. But what about arrests at the scene of an overdose? Studies have shown that a major deterrent to calling 911 for an overdose is fear of prosecution for possession of drugs when police arrive. So while the role of police is to enforce drug laws, doing so when it comes to overdose can lead to unnecessary loss of life. It’s a conundrum that has many state officials scratching their heads as they try to reconcile “tough on drugs” laws with the human cost of these policies.

To address this issue, several states, among them New Mexico, Massachusetts and New York, have passed 911 Good Samaritan laws to grant amnesty to anyone found in the possession of drugs or paraphernalia as a result of a 911 call to save someone’s life. Many prominent law enforcement officers support Good Samaritan laws and do not see them as indicative of a softening stance on drugs, nor at odds with law enforcement’s role in the drug problem. As some officers see it, saving the life of a drug user with Narcan gives them a second chance to get into treatment.

Support for Narcan programs and 911 Good Samaritan laws reflect a growing trend in law enforcement to employ multiple tools in efforts to curb substance abuse. It also indicates a departure from a strictly punitive approach to drug use and a deepening recognition of the complexity of the problem. But most importantly, these developments point towards law enforcement’s willingness to be part of a new solution.