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Methods

In order to evaluate the implementation and potential impacts of the law, Seattle Police Department (SPD) officers and Seattle Fire Department Medic One paramedics were surveyed. Police officers were surveyed during 2 weeks in the Fall of 2011. The surveys were administered in-person, at “roll calls” (staff meetings at the beginning of work shifts) at each of the five SPD precincts. Two study staff (Banta-Green and Schoeppe) administered the structured surveys. Roll calls take place at 3:00 am, 11:00 am, and 7:00 pm. Study staff attended each shift time once at each of the five precincts; totaling 15 shifts and yielding a representative sample of patrol officers in the SPD. Similar questions were asked of paramedics at a single staff meeting during the Fall of 2011. Note that paramedics are advanced life support trained and certified and respond to the most serious emergencies. Paramedics’ scope of practice includes administering naloxone. Prior to administration of the in-person paper survey, the following information was presented to the participants, verbally and in writing: research project background and overall aims; survey aims; survey instructions; and a description of the voluntary and anonymous nature of survey responses. The survey was distributed by study staff and returned to study staff in an opaque envelope. The self-administered anonymous survey took less than 5 min to complete. A single pilot test of the survey and study procedures was conducted during a police department training with only minor wording changes made as a result. Survey procedures were reviewed by the University of Washington Human Subjects Division and determined to be exempt from human subjects’ regulations. Permission for conducting the survey was obtained from an Assistant Chief of the SPD and the medical director of Medic One.

The survey questions used for the analyses presented here address experience with “serious heroin or opiate medication (e.g., OxyContin, methadone, Vicodin) overdoses” with a description of the symptoms of an overdose provided. We also asked about their knowledge of the law and level of support for and opinions of each provision of the law. A description of the law was included in the survey towards the end, immediately preceding questions inquiring about officers’ opinion and the reasons for their opinions of each of the provisions of the law. Opinions were asked with a five-point Likert scale response: very important, somewhat important, neutral, not very important, and not important at all. For the sake of brevity, we report aggregated responses with the first two categories “important” and the last two categories “unimportant.” Following each of the Likert scale opinion questions was a space for a narrative response about the reason for their opinion. The final question on the police survey asked about intended behavior at future overdoses with multiple response options provided. Open-ended responses were exported into Atlas.ti qualitative data analysis software, where they were analyzed by a research team member for common themes. The general process of developing themes and aggregating data into groups of themes was an iterative cycle whereby all comments were summarized by the content of comments made, as themes emerged subcategories were created and the comments re-read and aggregated. This process was repeated on the entire set of data until a complete (all comments included and all placed into a subcategory), minimal, and meaningful set of subcodes was created. This process is one of data reduction via sequential analysis.19 Other data are presented descriptively; given the exploratory nature of the research, tests of statistical significance were not applied to the data.

Surveys were completed by 97 % (251 of 258) of police officers present at roll calls. The respondents represent 50 % of the patrol officers in the city of Seattle. The median of years of service as a police officer was 10.0, with a mean of 11.3 years. Only 5 % of police respondents knew that lay persons could legally possess and administer naloxone whether they are at risk for having or witnessing an overdose (Table 1). Sixteen percent knew of the existence of the Good Samaritan law, of whom 46 % knew that the law applied to both overdose victims and bystanders. Among the 36 officers who knew of the law, 58 % correctly indicated that the charges the law provided immunity for included possession, but 28 % incorrectly reported it covered other drug charges, and 6 % thought it covered warrants/probation/parole. Among all officers surveyed, 1 % felt they had received clear guidance on the law from the police department.

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