Police carriage of naloxone: process evaluation

Question 1

Executive summary

Accepted Answer

Background

Naloxone is a life-saving drug that reverses the effects of an opioid overdose and can help to prevent overdose deaths. In 2005, legislation enabled naloxone to be administered by anyone in an emergency, improving access for those at risk of opioid-related harm. Amendments to the legislation in 2015 and 2019 enabled naloxone to be supplied by drug services without prescription, widening provision. The 2020 Independent review of drugs by Dame Carol Black highlighted rising opioid misuse and overdose deaths in England and Wales, recommending expanded harm reduction measures, including wider naloxone availability.

Equipping police officers with naloxone has emerged as an important strategy, leveraging their frequent interactions with individuals at risk of overdose. The 2021 10-year drug strategy emphasises this approach. As of December 2024 in the UK:

32 police forces in the UK had some provision of naloxone carriage, either ongoing (24) or piloting (8)
7 have agreed but have yet to implement the provision of naloxone
5 were committed to piloting in the near future
2 forces have no carriage or plans to carry

There have been 1,232 administrations of naloxone in the UK by the police between June 2019 and 30 December 2024.^{[footnote 1]}

Internationally, police naloxone rollouts in the US, Canada and Scotland have demonstrated positive outcomes, reinforcing its potential to save lives.^{[footnote 2]}

Building on this evidence, the Home Office commissioned Ipsos UK to evaluate the implementation of police naloxone carriage in England and Wales. This evaluation aims to inform best practices, enhance monitoring processes, and support nationwide adoption to strengthen overdose prevention measures.

Methodology

This process evaluation examined the implementation and perceived impact of police naloxone carriage through a qualitative approach. The initial scoping phase involved a comprehensive literature review, examining internal Home Office documents (Project ADDER^{[footnote 3]} strategies, National Police Chiefs’ Council (NPCC) guidance, relevant policies), academic publications, grey literature and news articles, benchmarking UK practices against established international police carriage of naloxone (US, Australia). Insights from the literature informed semi-structured interviews with 8 key stakeholders, which explored objectives, perceived benefits and challenges, implementation processes, training, monitoring frameworks, and partnerships. Pilot interviews conducted with South Wales and Cleveland police forces refined the interview approach.

The mainstage fieldwork comprised 68 in-depth interviews, including 8 scoping interviews, 8 national stakeholder interviews, and 52 interviews across 7 purposively selected case study sites, chosen for their diverse geographical locations, policing contexts and implementation stages. Seven to 12 interviews were achieved in each site. The final sample comprised 11 force/drug leads, 4 harm reduction leads, 8 supervisory officers, 17 frontline officers, 3 NHS paramedics, one NHS stakeholder and 8 health partners.

Limitations of the evaluation included a small sample of NHS perspectives and low response rates in one area, necessitating the inclusion of another police force to meet the target sample size.

Key findings

The overall objective of this evaluation was to evaluate the implementation of police naloxone carriage across England and Wales, focusing on overcoming barriers, optimising carriage practices and assessing added value. Key findings of this evaluation include:

perceived value of police naloxone carriage: naloxone is widely regarded as essential life-saving equipment, with significant potential to reduce drug-related deaths and strengthen police-community relations by demonstrating a harm-reduction approach, this is particularly critical with increasing ambulance delays due to demand, handover times and overstretched services.^{[footnote 4]}
decisions about naloxone carriage rollout: these are guided by local assessments of need, based on opioid overdose rates and the number of at-risk individuals; forces typically pilot programmes in high-risk areas before broader implementation - ensuring that resources (for example, officers who carry naloxone) are allocated effectively - as pilots help forces adapt their approach to ensure naloxone reaches areas where it is most needed
encouraging carriage by police officers: efforts to encourage officer uptake of naloxone carriage focus on clear communication and reassurance about the value of naloxone; strategies such as promotional videos and internal bulletins, including from officers, emphasising positive experiences and acting as peer advocates, demonstrate its effectiveness while addressing legal concerns
endorsements from key government bodies: endorsements from bodies like the Independent Office for Police Conduct and NPCC have helped reduce apprehension, though the Police Federation for England and Wales’s (henceforth, the Federation) lack of support remains a significant barrier, contributing to hesitancy among frontline officers

It should be noted that the Police Federation of England and Wales has recently revised its stance on naloxone that is referenced in this evaluation report, and has communicated this update to the members through the 43 local branches. The Police Federation now supports the voluntary carriage of naloxone by officers where an operational need is identified, however, they believe the decision to carry naloxone should remain a personal choice, based on appropriate training and individual circumstances.

provision of standardised training: standard training teaches officers how to recognise symptoms, administer naloxone and provide basic first aid, but the introduction of scenario-based training could better prepare them for other situations, such as managing individuals regaining consciousness in agitated or disoriented states
challenges: there were several key challenges and areas for improvement in the response to overdoses, including:
- regaining consciousness in agitated or disorientated states: people who use drugs often regain consciousness in agitated or disoriented states after an overdose, which complicates the management of their immediate care and safety
- gaps in collaboration: there are notable gaps in collaboration with paramedics during overdose incidents, particularly around handover protocols, which can hinder a smooth transition of care
- safeguarding: following an overdose, safeguarding individuals who refuse care is a critical issue, as current police powers to detain these individuals are limited
- short half-life of naloxone: the short half-life of naloxone can restrict officers’ ability to prevent relapse into overdose before additional medical help can be administered
barriers to successful implementation include:
- inconsistent training quality: variability in training quality is a barrier to successful implementation, which affects the confidence and readiness of officers; consistent and high-quality training programmes are essential for ensuring officers are equipped to administer naloxone effectively
- resistance to increased responsibilities: widespread resistance is linked to concerns about inadequate resources to handle the additional police responsibilities associated with naloxone administration, and overcoming this resistance requires addressing concerns about resource allocation and providing adequate support for officers; additionally, clear communication regarding the role of naloxone and its benefits is essential to ensure officers are fully aware of its value in saving lives and the scope of their responsibilities
- stigma against people who use drugs: this was a barrier to the uptake of naloxone carriage among frontline officers; the evidence highlights the need to shift negative perceptions among those who do not wish to carry naloxone, by creating a culture of understanding towards drug addiction in general and people who use drugs in particular
- training on naloxone and cardiopulmonary resuscitation (CPR): comprehensive training on naloxone administration, legal protections and the complementary role of CPR is critical for successful implementation. This ensures officers understand both the medical and legal aspects of their roles in overdose situations
data and recording practices: establishing consistent data collection and standardised recording procedures are vital steps towards understanding the impact of naloxone carriage and improving its implementation across different regions; having these in place can identify trends like overdose spikes or drug contamination and consequently encourage broader naloxone carriage in areas where there is most need, but there is a reluctance to carry it amongst officers

Best practices

The best practices for enhancing police naloxone carriage focus on strong inter-agency collaboration, innovative use of data, and robust referral pathways to connect individuals with support services. Recognising officers’ efforts and sharing success stories further encourages wider participation. Key elements of these best practices include:

inter-agency collaboration: successful roll outs often involve regular meetings between police, health services and ambulance trusts to share information, co-ordinate responses and address emerging drug threats
innovative use of data: data collected from naloxone administrations and applied to heat maps can be used to identify high-risk areas for targeted enforcement and outreach
established referral pathways: effective referral pathways ensure that individuals receiving naloxone are connected with appropriate support services, often through safeguarding forms, multi-agency support hubs or dedicated overdose co-ordinators
commending officers who administer naloxone: this, plus showcasing success stories, can foster a supportive culture and encourage wider programme participation

Recommendations and conclusions

A successful and sustainable implementation of police naloxone carriage requires a multifaceted approach. In light of the findings of the evaluation, the recommendations are as follows:

Data recording

Standardise data recording practices across all police forces in line with strategic objectives and key performance indicators (the full list of key performance indicators (KPIs) is presented in the ‘Recommendations’ section). This will ensure the comparability of data collected, which can help inform the rollout of police naloxone carriage at a national level. We suggest that the recommendations related to data recording – as outlined in this section – be implemented with the involvement of the College of Policing, the NPCC and the Home Office.

Provide more clarity on obtaining consent from people who use drugs for referrals to treatment. Not all forces have implemented treatment referral pathways; in these areas, there is no established process for gaining consent from people who use drugs. Without consent, police cannot refer people who use drugs to treatment. Forces without clear referral pathways must be signposted to, and learn from, forces with these referral pathways already implemented. It is recommended that regional leaders set up regional naloxone working groups designed to understand how forces with referral pathways obtained consent from people who used drugs. The learnings gathered from these working groups could be disseminated by the NPCC.

Centralised development and funding of naloxone training materials

A standardised training offer would ensure that all officers across England and Wales receive the same high-quality training. Training content should be developed collaboratively between the police, the College of Policing, drug treatment services, and individuals with lived experience of drug use. This will ensure that training is comprehensive and informed by diverse perspectives. It is recommended the co-ordination of training rollout should be led by the College of Policing, utilising a ‘train the trainer’ model.

Clarifying and implementing sustainable funding arrangements

implement a structured, three-strand funding approach to sustain the rollout of police naloxone carriage: (i) initial rollout funding; (ii) ongoing training funding; (iii) monitoring and supply funding, to ensure the uninterrupted availability of naloxone and the consistent training of officers. The funding approach will be supported by monitoring systems to understand how naloxone carriage is funded across all forces in England and Wales to track the spending on naloxone by all police forces to ensure there are sufficient funds available to sustain the rollout. The Home Office and NPCC will need to collaborate on how best to co-ordinate the recommended funding and monitoring approach.

Shift negative perceptions of people who use drugs

Addressing stigma at leadership and frontline levels can shift perceptions of people who use drugs. With ongoing support from the Independent Office for Police Conduct (IOPC) and engagement from federations and unions, this can mitigate objections to carrying naloxone among frontline officers and increase the number of police who carry it over time.

Encouraging uptake of naloxone carriage

Implement a collective communications strategy to encourage the uptake of naloxone carriage. Building on the letter of comfort provided by IOPC, reassurance about the legal repercussions of naloxone administration can be emphasised collectively by the IOPC, NPCC, the Federation and relevant unions.

Together, these measures can ensure that naloxone carriage is embedded as a vital component of policing, equipping officers with the resources, skills and attitudes to save lives, build trust with people who use drugs, and contribute to broader harm reduction efforts.

Question 2

1.  Introduction

Accepted Answer

1.1 Background and context

Naloxone as a medicine

Naloxone is a life-saving medication used to reverse the effects of opioid overdoses. It is classified as a prescription-only medicine under the Human Medicines Regulations 2012. However, legislative amendments over the years have progressively expanded its accessibility to enhance public health and safety.

Initially, amendments in 2015 and 2019 allowed drug treatment services provided by, on behalf of, or under arrangements made by, one of the following bodies to provide naloxone without prescription in emergencies:

an NHS body
a local authority
Public Health England
Public Health Agency (Northern Ireland)

As of December 2024, further amendments to the Human Medicines Regulation have come into effect, broadening the range of individuals and organisations that can supply naloxone without prescription. These amendments aim to enhance accessibility, ensuring that naloxone can be more widely distributed to those at risk of opioid-related harm.

1.2 Aims of naloxone provision and carriage

The independent review of drugs by Dame Carol Black in 2020 revealed an increase in opioid misuse and opioid overdose-related deaths in England and Wales. The report emphasised the need for robust harm-reduction strategies, including naloxone distribution, to better protect vulnerable populations. One proposed strategy for expanding naloxone access involves equipping police officers and police staff members with this medication. Police officers, who frequently encounter individuals at risk of opioid overdose, are well-positioned to administer naloxone swiftly in situations where medical intervention could be delayed, thus potentially saving lives.

In response to these challenges, the 10-year drug strategy launched in 2021 included a comprehensive approach aiming to curb illicit drug use, reduce drug-related deaths, and ensure that quality drug treatment services are accessible to people who use drugs. Part of this strategy involves expanding naloxone availability to mitigate overdose fatalities through ‘take home’ schemes and widening the distribution of naloxone to police and public health stakeholders.

Wider naloxone availability in England and Wales

Police naloxone carriage is only one part of a much broader strategy to combat opioid-related overdoses. Effective harm reduction requires naloxone in multiple areas where at-risk individuals may encounter emergency situations.^{[footnote 5]} Expanding access to naloxone does not only focus on law enforcement but also on other services and agencies, such as emergency services, public health centres, drug treatment services and community organisations. This expansion ensures that naloxone is available at key points in time, especially in areas where opioid overdoses are more frequent.^{[footnote 6]}

Current provision of naloxone by police forces in England and Wales

As of December 2024, 24 police forces across England and Wales have adopted naloxone carriage amongst frontline officers, with 8 forces piloting its deployment. An additional 7 forces have agreed to provide naloxone but have not yet implemented it, while 5 more pilots are set to commence soon. Across the forces currently carrying naloxone, there have been 1,232 administrations of naloxone in the UK by the police from June 2019 to 30 December 2024.^{[footnote 7]} These include sites within the Project ADDER (Addiction, Diversion, Disruption, Enforcement, and Recovery) pilot programme - Blackpool, Cleveland, Swansea Bay and Bristol - as well as other non-Project ADDER sites like Durham, North Yorkshire and Norfolk. Project ADDER is a government initiative piloting a whole-system response to combat drug misuse in 13 areas across England and Wales.^{[footnote 8]}

These Project ADDER sites were included as case studies within this evaluation to build on the ADDER evaluation findings. The inclusion of non-Project ADDER sites in the current evaluation provides valuable insights into naloxone distribution implemented through locally defined strategies. Table 1 sets out the forces included in the current evaluation.

Table 1: Police force naloxone carriage data from NPCC/Home Office, as of December 2024

Police force area	ADDER/non-ADDER	Extent of provision	Number of police officers trained to carry and administer naloxone as of Dec 2024	Total administrations to 30 Dec 2024 since implementation
Cleveland Police	ADDER - Cleveland	Ongoing	179	37
South Wales Police	ADDER - Swansea Bay	Ongoing	673	112
Avon and Somerset Constabulary	ADDER - Bristol	Ongoing	380	38
Lancashire Constabulary	ADDER - Blackpool	Provision agreed but not implemented	Data not received	Data not received
Durham Constabulary	Non-ADDER	Ongoing	279	92
North Yorkshire Police	Non-ADDER	Ongoing	177	19
Norfolk Constabulary	Non-ADDER	Ongoing	216	16

Notes:

Please note the ADDER numbers below refer to the entire police force area, not just the specific ADDER area.
Through the NPCC/HO police naloxone carriage monitoring, Lancashire indicated that their status was ‘Provision agreed but not implemented’. However, in Blackpool, through Project ADDER, some officers have already started carrying naloxone. For the provision status of all forces please see: Police carriage of naloxone: monitoring report, December 2024.

International context of police naloxone carriage

Police use of naloxone has rapidly expanded across the US and Canada, reflecting a shift towards harm reduction in tackling the high rates of opioid-related overdoses and deaths. In the US, police naloxone carriage programmes began in high-overdose areas like Quincy, Massachusetts, in 2010, and have since become standard practice, with officers trained to administer naloxone during overdose emergencies.^{[footnote 9]} Canada followed a similar path, with early adoption in provinces like British Columbia in response to escalating opioid-related deaths.^{[footnote 10]} Reviewing the successful implementation and best practices from other countries is essential for a comprehensive understanding and enhancement of overdose prevention strategies.

Police naloxone carriage in Scotland

Scotland’s pilot programme, launched in 2021, implemented police naloxone carriage and administration. This was initially targeting areas with high opioid-related harm such as Glasgow, Dundee and Falkirk. The pilot included comprehensive training for officers to recognise overdoses and administer naloxone appropriately. This pilot in Scotland and its findings offer a critical basis for evaluating the feasibility and effectiveness of police-led naloxone carriage in England and Wales. Its findings are discussed and highlighted in the ‘Findings’ and ‘Best practices’ sections of the report.

1.3 Evaluation aims and research questions

The Home Office commissioned Ipsos UK to evaluate the implementation of police naloxone carriage across England and Wales, focusing on overcoming barriers, optimising carriage practices and assessing added value. The evaluation explored different implementation strategies and assessed the perceived impact of police carriage, including challenges encountered. By doing so, this evaluation aims to enhance understanding in this area by addressing 2 core objectives: (i) supporting the implementation of police naloxone in local police forces by identifying best practices through case studies; and (ii) strengthening monitoring and analysis processes associated with naloxone use, to inform nationwide implementation of police naloxone carriage.

Research questions

1: What are the main barriers to naloxone carriage and how can these be addressed?

2a: How is naloxone carried within the forces and do these practices vary between forces?

2b(i): Is naloxone carriage targeted in certain areas within each force? Why/Why not?

2b(ii): In forces targeting naloxone carriage, how are these decisions made and implemented?

2c: What does best practice look like and, in what way, if any does this differ between forces?

3a(i): How does police use of naloxone complement other frontline services?

3a(ii): How does police use of naloxone interact with the responsibilities and process of health services in relation to responding to an overdose incident?

3a(iii): What, if anything, are the perceived impacts of police naloxone carriage on the health sector’s use of naloxone?

3b: What are the processes, if any, that are followed after individuals have received police naloxone administration? Does this differ between forces?

3c: To what extent would it be feasible to introduce an automatic notification system whereby police notify drug treatment services after all non-fatal overdoses?

4a: What unintended (negative) consequences (if any), does police naloxone carriage have on police experiences, roles, or perceptions? Have there been any complaints and if so, how has the force responded?

4b: What is the perceived added value of police carrying naloxone? What is the perceived impact it has had on people who use drugs?

4c: For officers who have used naloxone, what do they think would have happened if they were not able to administer naloxone?

1.4 Methodological approach

This section outlines the methodological framework employed in the evaluation, detailing the scoping and familiarisation phase, mainstage fieldwork, recruitment strategies, sampling approaches and the limitations encountered.

Scoping and familiarisation phase

This initial phase aimed to build on the existing evidence base and enhance understanding by initiating the project with a scoping and familiarisation process. This phase had 3 components: (i) conducting a literature review; (ii) holding scoping consultations with key stakeholders; and (iii) pilot interviews with case study sites.

Semi-structured interviews with 8 key stakeholders (from law enforcement, academia and policy) provided first-hand insights into the objectives, implementation challenges and opportunities associated with police naloxone carriage, ensuring diverse perspectives through purposive sampling. Additionally, pilot interviews in South Wales and Cleveland enabled testing and refining of the interview approach, capturing nuanced information on local implementation processes. This iterative scoping phase informed the refinement of research questions, ensuring the evaluation addressed emerging gaps and remained focused on relevant objectives.

Mainstage fieldwork

The mainstage fieldwork for this process evaluation was twofold: conducting in-depth interviews across 7 case study sites and engaging a broader range of stakeholders through additional in-depth interviews. The fieldwork period was from July to October 2024. A total of 68 interviews were conducted across the case study sites and wider stakeholder groups (a full sample breakdown is provided in the subsection, ‘Sampling and interviews’).

Recruitment

Participants were recruited through a gatekeeper approach; access to each site was negotiated by the Home Office, who provided contact details of a site lead from whom participants could be recruited. A kick-off meeting was held with each site lead before starting recruitment to understand the nature of the workforce, relationships with local health services, and any anticipated challenges in recruiting groups of respondents.

While the approach was successful for force leads and supervisory and frontline officers, the NHS paramedics and stakeholder participants proved particularly difficult to reach. This was due to limited access and knowledge of the appropriate channels to connect with them and obtain their contact information. To overcome this, a snowballing approach was used where interviewees were asked to recommend NHS paramedics or stakeholders who may be interested in engaging with the evaluation (refer to the ‘Limitations’ section for more details). This approach was not wholly successful, as the evaluation achieved fewer NHS paramedics and stakeholder interviews than anticipated.

Sampling and interviews

This evaluation sought to conduct 10 to 12 interviews in each of the 7 case study areas, comprising a variety of staff from the police service as well as the NHS and/or local drug services. The number of interviews achieved across case study areas ranged from 7 to 12. The sampling frame was tailored to each site depending on its size, structure and nature of partnerships with local drug services. While this meant the composition of participants varied between sites, the sampling approach broadly took the following structure: one to 2 senior police officers / drugs leads; 2 to 3 supervisory officers; 4 to 5 frontline officers; and 2 to 3 local stakeholders, such as paramedics or local drug services.

This multi perspective approach within each case study allowed for the exploration of different experiences and perceptions on police naloxone carriage. This facilitated a comprehensive understanding of its implementation and impact. The interview guides were tailored to each stakeholder group, ensuring relevance and depth of exploration whilst maintaining consistency across sites. A total of 68 interviews were conducted as part of this evaluation, including 8 scoping interviews, 8 interviews with the wider stakeholder group, and 52 case study interviews across the 7 sites. Below is a breakdown of the sample for the 52 case study interviews.

Table 2: Breakdown of sample

Participant role	Expected total	Numbers achieved
Force / Drugs lead Harm reduction lead	12	11 4
Supervisory officers	18	8
Frontline officers	30	17
NHS paramedics NHS stakeholders Health partners	18	3 1 8
Total	78	52

Limitations

While this evaluation provides valuable insights into the process of implementing police naloxone carriage, it is important to acknowledge certain limitations that may impact the generalisability and interpretation of the findings.

One key limitation is the limited number of interviews conducted with the NHS paramedics and stakeholders. Despite efforts to recruit a diverse range of participants who work in the NHS, only 4 interviews were completed with this stakeholder group. It is important to acknowledge that the limited sample size is unlikely to fully capture the diversity of opinions and experiences within the NHS. Therefore, findings gathered from NHS participants in this report should be interpreted with caution.

Additionally, representatives from the Police Federation and unions did not participate in the research, so their views were not directly included. It should be noted that the Police Federation of England and Wales has recently revised its stance on naloxone that is referenced in this evaluation report, and has communicated this update to the members through the 43 local branches. The Police Federation now supports the voluntary carriage of naloxone by officers where an operational need is identified, however, they believe the decision to carry naloxone should remain a personal choice, based on appropriate training and individual circumstances.

Not all police forces and health authorities were interviewed as part of this evaluation. Whilst this evaluation has found valuable insights from those interviewed, barriers to uptake of naloxone carriage in other forces have not been identified, so these findings are not fully generalisable to police forces across England and Wales.

The target sample size amongst each group of stakeholders was not met, except for force / drugs leads and harm reduction leads. Although this limits the potential diversity of views captured, saturation point had been reached before the fieldwork period concluded. Therefore, not meeting the target is unlikely to have limited the range and depth of findings gained in this evaluation.

Data collection in one police force area was particularly challenging due to high attrition rates. While initially aiming to conduct 10 to 12 interviews at this site, only 3 interviews were ultimately completed. This response rate was lower than expected, and limits the depth and representativeness of the interviews attained from this location. While the 3 interviews conducted still provide valuable insights, they may not fully reflect the range of experiences and perspectives within this police force and from other stakeholders in the area on naloxone carriage. To ensure the target sample size was met, another police force was used as a backup site to reach the necessary number of interviews.

Question 3

2.  Findings

Accepted Answer

This chapter examines the implementation of police naloxone carriage in England and Wales, focusing on decision-making processes, methods for encouraging uptake, development of guidelines and protocols, officer responses to overdose incidents, and its perceived added value. It also analyses barriers to naloxone uptake, including lack of support, access to supplies and funding, training quality and perceptions of officer roles.

2.1 Process of implementation

This section details the current landscape of police naloxone carriage within forces by examining the decision-making processes underpinning the rollout and the systems that have been put in place to facilitate its implementation. Where relevant, it will draw on stakeholder views and evidence from wider research to contextualise the findings.

It helps to answer the following research questions:

how is naloxone carried within the forces and do these practices vary between forces?
is naloxone carriage targeted in certain areas within each force? Why/why not?
in forces targeting naloxone carriage, how are these decisions made and implemented?
what are the processes, if any, that are followed after individuals have received police naloxone administration? Does this differ between forces?

Decision-making processes

Currently, naloxone is carried voluntarily by frontline officers and police staff members in all forces included in this evaluation across - England and Wales.^{[footnote 11]} There was variation across forces in the decision-making processes of whether forces should roll out police naloxone carriage and how it should be implemented. The dominant approach was a needs-based assessment informed by the levels of opioid overdoses or the number of (known) opioid users at risk of an overdose, which was consistent with stakeholder views that resources should be allocated in line with local risk levels.

Forces that adopted a needs-based approach described piloting the rollout prior to expansion across the force. Police naloxone carriage was first targeted at areas with high levels of drug-related deaths amongst people who use drugs within the community. Results^{[footnote 12]} from the pilot then served as the basis to either increase the availability of naloxone by expanding the rollout of police naloxone carriage to other areas within the force or to continue focusing efforts on problem areas.

In South Wales, for example, the distribution strategy is informed by how often and how quickly officers with naloxone can be dispatched to the scene of an incident. The allocation of naloxone carriers is based on the proximity of available officers to areas with high-risk overdose incidents. If naloxone is required and no officer within the immediate vicinity has it, the bronze inspector (an officer responsible for overseeing operations on the ground and ensuring the right resources are deployed in emergencies) managing the call will actively seek out officers carrying naloxone from a wider area, ensuring a rapid response. Where decisions were made to ensure there were adequate resources deployed in problem areas, the rationale was that officers were likely to encounter individuals at risk of an overdose in areas with high levels of deprivation or with high footfall such as city centres. It was, therefore, important to ensure that officers were equipped to respond to an overdose incident in these areas, if necessary.

While not a universal view among stakeholders, it was suggested that naloxone kits should be included in the first-aid kits of police response cars or, ideally, made available to all frontline and custody officers. Forces that adopted a needs-based approach ensured that naloxone was available to all frontline officers and police community support officers (PSCOs) who wished to carry it and had completed the necessary training. The purpose of this was to ensure enough officers who have naloxone were around, even if that meant deploying officers from other areas if needed. For forces that adopted a different approach - such as limiting naloxone carriage or implementing a phased rollout - decisions were driven either by concerns articulated by the unions, or the senior leadership team’s (SLT) support for all officers to be equipped with naloxone through a phased rollout.

Anecdotally, the union’s concern - which was limited to PSCOs - was that naloxone carriage may subject them to risks of physical altercations or aggressions from people who use drugs. Where this concern underpinned how naloxone carriage was implemented, PCSOs were precluded from carrying naloxone. It is important to note that police officers are not permitted to join trade unions due to the Police Act 1996; they are members of the Federation, which is distinct from the unions to which PCSOs can belong. This is why the concern about risks to officers was specifically raised for PCSOs and not for police officers, as the union’s remit does not extend to the Federation.

Data gathered about PCSOs revealed that they do encounter people who use drugs and other vulnerable groups as part of their day-to-day responsibilities (see also Longstaff and others, 2015). Our evaluation found that PCSOs reported incidents where they had encountered individuals who had overdosed while on foot patrol and had to administer naloxone before calling an ambulance. The evidence shows that PCSOs who carried naloxone felt equipped and confident in responding to an overdose incident and saving the lives of people who use drugs, demonstrating the value of distributing naloxone to frontline officers who wish to carry it, regardless of their roles.

However, force leads and supervisory officers believed it was critical for PCSOs to be equipped with naloxone, particularly when they interact with the public and, in some cases, were working closely with (known) opioid users in the community.

“I understand why because the role of a PCSO is not to be in a confrontational situation. The reality is, the fact that if a PCSO is on foot in town, they are always at risk of becoming involved in a confrontational situation. And a number of the PCSOs are actively engaged in working with our drug users. They’ve already built up that rapport. So, it only seems to make sense for those people, those PCSOs who want to carry it, they should be allowed to carry it. And there are a number in my office who wanted to volunteer for it, but unfortunately, were told no.”

(ID50, Supervisory Officer)

The union’s perception that naloxone carriage was unsuitable for PCSOs, therefore, stood in contrast with force leads and supervisory officers who advocated for all frontline officers and PSCOs to be equipped with naloxone. This concern underpinned the implementation of a phased rollout of naloxone across officer groups. Where this approach was adopted, naloxone was first distributed to custody officers. Force leads believed these officers were more likely to encounter individuals with drug and/or alcohol addiction and were responsible for safeguarding their well-being while in custody. It was then extended to the Road Policing Unit (RPU) - potential first responders at serious road traffic incidents - and eventually to response officers and PCSOs, who might encounter overdose incidents in community settings.

Encouraging uptake of naloxone

The findings gathered from stakeholders revealed that endorsements for police naloxone carriage from government bodies, such as the IOPC and NPCC, were pivotal to a successful rollout. Resistance from the Federation and unions meant there remained a level of apprehension among frontline officers about naloxone carriage (this is further elaborated in the ‘Barriers to uptake of naloxone carriage’ section of the report).

In response, the IOPC issued a letter of comfort reassuring officers that they would not be legally liable if there were an unsuccessful attempt to save the lives of people who use drugs through naloxone. The letter also emphasised that there was no evidence that police-administered naloxone had caused or contributed to the death or injury of people who use drugs. In forces where communications centred around the key messaging of the IOPC’s letter of comfort, force leads and supervisory officers believed that it had, in part, alleviated anxieties about the (purported) legal repercussions among frontline officers.

This trickle-down effect of support from SLTs was also reflected across forces in England and Wales. The evidence shows that there has been a concerted effort within forces to encourage the uptake of naloxone carriage among frontline officers through communications delivered on an ongoing basis.

While not universally applied across the forces, these communications focused on 3 key messages. First, forces that emphasised the importance of naloxone in the context of drug-related harms ensured that frontline officers understood the risks posed by opioids, nitazenes and synthetic drugs to people who use drugs, and the effectiveness of naloxone in counteracting opioid-related overdoses. Frontline officers who had administered and/or carry naloxone articulated that their primary purpose for doing so was to preserve the lives of people who use drugs in critical moments, particularly when they were likely to encounter individuals at risk of an overdose.

Naloxone Delivery Steering Group: Scotland

In Scotland, the successful rollout of police naloxone carriage was attributed to strong support from SLTs. Stakeholders described how the key figures within Police Scotland – such as chief constable, assistant chief constable, chief inspector and sergeants – collaborated to drive organisational change by shifting the (negative) perceptions of naloxone carriage and actively promoting its rollout. This collaborative effort gave rise to a Naloxone Delivery Steering Group which comprised representatives and experts from academia, people with lived experience, and the Scottish Government. The Naloxone Delivery Steering Group aimed to provide accountability, advice, and guidance on how best to drive the agenda forward and encourage uptake of naloxone.

The interviews suggest that the support from SLTs had a positive influence on the uptake of naloxone among frontline officers. Supervisory officers reported that there had been 570 administrations of naloxone to date, and that frontline officers felt reassured in providing intervention in critical moments.

Second, where forces showcased successful naloxone administration, these were delivered either through promotional videos containing information on how naloxone works and testimonials from officers who administered it, or internal bulletins showcasing examples of naloxone use and associated outcomes. Force leads, supervisory and frontline officers felt this form of communication encouraged the uptake of naloxone by (i) raising awareness of its risks and benefits, and (ii) providing ‘case study’ examples of the effectiveness of naloxone in saving lives. The endorsement from members of the SLT and testimonials from colleagues who had administered naloxone meant frontline officers who carry and/or have administered it felt reassured in doing so.

Third, and a less commonly held view, exposure to synthetic drugs or opioids for frontline officers when performing their duties was considered by SLTs and stakeholders as a potential risk that needs to be mitigated. In forces where this was a salient concern, naloxone was promoted as a precautionary tool for officers. Frontline officers who were aware of their risk of exposure to synthetic drugs or opioids ensured that they had a sufficient supply of naloxone kits - for example, 2 doses - on them at all times, ready for use by themselves or colleagues if needed. Here, the findings suggest that promoting naloxone as a life-saving tool for officers enhanced the willingness of frontline officers to carry naloxone and overall support for police naloxone carriage.

“The other thing that has shifted things, I think, is things like the arrival of the synthetic opioids, and the risk to officers themselves. So, if you tell them, ‘You can save a [person who used drugs’] life.’ Maybe they don’t care, but if you say, ‘You can save your colleague’s life.’ Then they think, ‘Maybe I would like to carry this.’ Maybe you could save your own life. If they come across a, kind of, drug-dealing den, if you like, and there’s a risk of accidental exposure to synthetic opioids, then they may well need naloxone to reverse an overdose themselves, and that has definitely shifted some of the thinking in forces to being more pro-carrying.”

(ID65, Stakeholder).

Developing guidelines and protocols

Data gathered from force leads and supervisory officers indicated 3 key areas where guidelines and protocols developed across forces could be enhanced. The first of these was data recording procedures. The consensus among the stakeholders was that data on the number of overdoses reversed by police-administered naloxone and the number of administrations were instrumental in facilitating the national rollout of police naloxone carriage. For the data to be used meaningfully, it has to be recorded consistently across the forces. For example, in Scotland, officers who responded to an overdose incident and administered naloxone were expected to complete a standardised form consisting of the following fields:

the area - for example, division and subdivision - where the officer works
date and time of incident
details of the person who used drugs to whom naloxone had been administered
number of actuations (doses) delivered
whether the person who used drugs was conscious or unconscious
whether there were any drug paraphernalia on scene
whether the Scottish Ambulance Service responded to the incident and, if so, if they provided any further medical care
if the person who used drugs was transported to the hospital, or if they had left the scene before the ambulance arrived

Once completed, the forms were shared with the Substance Harm Prevention team and the officer’s local division. The forms were then uploaded to a centralised database and shared with health and/or service partners accordingly.

In England and Wales, the evidence shows that while forces have developed guidelines and protocols around data recording processes, the types of data recorded varied across forces. This variation in recording practices could be attributed to the operational independence of each police force across England, which gives rise to issues with the comparability of data collected (see the ‘Recommendations’ chapter for more details).

Depending on the data recording protocols within the force, frontline officers were expected to record the details of the (i) person who had experienced an overdose, such as age, gender and physical state when officers arrived on scene; (ii) circumstances around the administration of naloxone; (iii) number of actuations delivered; and (iv) outcome of the individual. The information was recorded in the officer’s pocket notebook or in a safeguarding form which was then transferred to the force’s database (there was variation in how forces used this information, but typically it was kept internally and used for monitoring naloxone use and supply). The inconsistency in data recording processes suggests a need for standardised data recording procedures to ensure accuracy and comparability across forces. Standardising data could provide additional benefit to Local Drug Information Systems (LDIS), by consistently feeding in quality data that can inform the decision-making process around drug alerts.

The findings also suggest that a more comprehensive set of data that provides a holistic view of how officers respond to overdose incidents may be useful. Whether frontline officers administered naloxone in conjunction with CPR was identified as one of the concerns around the quality of training provided (this is discussed in full in the section ‘Barriers to uptake of naloxone carriage’).

A protocol developed by Metrebian and others (2023) to assess the effectiveness of naloxone administration by community members in reversing opioid overdose provides a useful framework in this regard. In addition to mortality data collected through death registers and safety data on the outcomes of naloxone administration by community members, the protocol seeks to collect data on how community members responded to the overdose. Here, the data focuses on whether members of the public executed first-aid techniques (including CPR) in conjunction with naloxone. It includes whether the individual:

tried to wake [the person who used drugs] up verbally
tilted [the person who used drugs] head back
checked for response
checked [the person who used drugs] breathing
put [the person who used drugs] into the recovery position
[did] chest compressions
[administered] rescue breaths / mouth-to-mouth
cleared [the person who used drugs] airways
checked [the person who used drugs] pulse (Metrebian and others, 2023:6)

The ‘Recommendations’ chapter will explore the practicalities of how these data could be integrated into the current data recording procedures in England and Wales. The emphasis here is the potential value that response-focused data add to understanding the efficacy of the training provided to officers (alongside wider benefits covered in the ‘Recommendations’ chapter), particularly when this is not currently collected across all forces.

In addition, NHS paramedics and frontline officers mentioned there were no formal guidelines on how the police should hand over the care of a person who had suffered an overdose beyond a verbal handover, or how the 2 services should work together to safeguard the individual concerned. This meant while the continuity of care was provided by paramedics in instances where the person who used drugs was on scene when the ambulance arrived, the findings did not suggest that officers had any further involvement beyond providing a verbal handover of the individual.

Data from Norfolk indicates an ongoing effort to establish a clear handover process, as there is currently no consistent approach to verbal handovers. This initiative aims to ensure that police officers provide paramedics with critical information needed. While the content of verbal handovers often includes basic information such as the individual’s name, age, circumstances of the incident, any accompanying individuals, dosage administered, officer collar number and the patient’s condition, there is no evidence to suggest that a formal written or digital handover process is preferred. However, it is suggested that incorporating guidelines and training on a consistent verbal handover process as part of training could improve communication and ensure all critical details are conveyed effectively. Therefore, formal guidelines on how police and paramedics should work together while on the scene of an overdose would be beneficial to safeguarding the person who used drugs if they were on scene.

These benefits could extend beyond the scene of the overdose. For example, where an administration of naloxone may indicate the use of synthetic opioids, novel substances or adulterated/contaminated drugs, sharing this information with LDIS could inform public health alerts and responses.

2.2 Responding to overdose incidents

This section explores officers’ roles in responding to overdose incidents, focusing on how naloxone training was applied in practice, the challenges of managing complex scenarios, and safeguarding individuals after naloxone administration. It also examines the impact of ambulance response times on police interventions and highlights stakeholder perspectives on improving outcomes.

This section addresses these research questions:

how does police use of naloxone complement other frontline services?
how does police use of naloxone interact with the responsibilities and process of health services in relation to responding to an overdose incident?
what, if anything, are the perceived impacts of police naloxone carriage on the health sector’s use of naloxone?
what unintended (negative) consequences (if any) does police naloxone carriage have on police experiences, roles or perceptions; have there been any complaints and if so, how has the force responded?

Translating training into practice

Training was a prerequisite for officers who wished to carry naloxone. Stakeholders emphasised that officers need to be trained in recognising the signs and symptoms of an overdose. Training should ensure officers understand how to administer naloxone, know the correct dosage and the process in between dosages. The findings indicate that officers were sufficiently trained to administer naloxone.

When recounting their experiences of responding to overdose incidents, officers were able to describe the process of how they administered naloxone, how they established if additional doses of naloxone were needed and the frequency at which they delivered the additional doses. Officers who had administered naloxone described feeling confident in its use, comparing it to other life-saving interventions, such as defibrillators or EpiPens. They valued the straightforward nature of nasal naloxone, and the clarity of procedural steps outlined during training.

However, the evidence shows that officers were not equipped with the ‘softer’ skills with regard to managing the after-effects of naloxone on people who use drugs, and the (full) understanding of the risks and benefits associated with the antidote. Force leads and supervisory officers described how it was commonplace for the person who used drugs to regain consciousness feeling disoriented and agitated; a state that officers were not unfamiliar with but found hard to respond to effectively. Further, there was evidence to show that officers struggled to identify the appropriate course of action in instances where poly-drug or synthetic opioids were involved.

Stakeholder interviews explained that while naloxone is effective only for opioid-related overdoses, some stakeholders believe officers should administer it even when uncertain about the overdose’s cause. Their rationale was that naloxone is unlikely to cause harm if other drugs are involved and may still be beneficial. Therefore, while not a universal view, stakeholders believed that the training should encourage officers to administer naloxone if they were uncertain about the cause of the overdose, as it would have no impact, nor would it likely cause harm, if other drugs were involved. However, it is important to note that administering naloxone to someone on methadone can trigger withdrawal by disrupting the methadone’s effects. Training should make officers aware of this risk which should be considered in an overdose situation. Following guidelines is crucial to minimising complications.

The findings suggest it was crucial to ensure that officers were sufficiently trained to respond to overdose incidents beyond how naloxone should be administered. These gaps in training may constitute barriers to the uptake of naloxone among frontline officers and are explored in the section ‘Barriers to uptake of naloxone carriage’.

Roles of officers at the scene

The roles of officers at overdose scenes largely depended on their order of arrival and the circumstances under which they encountered the incident. Paramedics in the UK routinely carry naloxone as part of their standard equipment, allowing them to directly intervene in overdose situations. However, when officers were the first to arrive, their primary focus was on immediate intervention to prevent loss of life. This involved administering naloxone and providing basic first aid until paramedics arrived. The findings indicate that police officers often assumed this first responder role due to their rapid response capabilities and a perception of increasing constraints on ambulance resources.

When police encountered an overdose during routine duties, such as welfare checks or patrols, having naloxone readily available enabled prompt intervention. Where PCSOs were precluded from carrying naloxone, they reported being able to directly contact a naloxone-trained officer if they encountered an unresponsive individual experiencing overdose symptoms. This was perceived to have prevented delays caused by waiting for an ambulance service to arrive or by the emergency being misclassified - such as when an overdose was not immediately recognised and appropriately prioritised under standard ambulance dispatch protocols.

When paramedics were already on the scene, police transitioned into a supportive role, focusing on scene management and safety. Paramedics explained that police presence is frequently requested in overdose situations to ensure a secure working environment. In these scenarios, officers were reported to assist with maintaining scene safety, managing crowds, identifying potential hazards and relaying initial incident details to medical personnel.

2.3 Ambulance response times

Stakeholders had anxieties about ambulance wait times when police were first on scene and had administered naloxone. Opioid overdoses in which the casualty has stopped breathing are categorised as Category one calls with a target response time of 7 minutes. However, NHS paramedics noted that calls could be de-prioritised if police were first on the scene, had administered naloxone, and the person who used drugs was responsive and breathing. Police officers were concerned de-prioritisation could delay paramedics’ arrival on the scene. This concern was observed in non-ADDER sites and rural areas, where ambulance resources are more limited and travel distances are greater. There was insufficient data to establish how frequently opioid overdose incidents were de-prioritised if police were first on the scene and had administered naloxone.

The interview data show that ambulances arrived within 10 to 20 minutes after police naloxone administration. However, interviewees provided examples of de-prioritised responses or extended wait times - in some cases, up to 4 hours. Despite these isolated reports, the broader findings suggest that these were isolated occurrences rather than reflective of a broader systemic issue.

Efforts to address concerns

The findings show that efforts have been made at a local level to minimise ambulance response times through memorandums of understanding (MOUs) between a number of police forces and ambulance services. MOUs served as reassurance that calls to the ambulance service would not be downgraded even if the police were on scene.

Persistent officer concerns

Despite efforts, the evidence suggests that officers remain concerned about their calls being downgraded if the ambulance service knew that the person who used drugs was receiving medical intervention from trained officers on scene. They reported feeling vulnerable when waiting for medical backup on these occasions, as they lacked the training and equipment to provide extended care, especially in cases involving poly-drug use or complications. A stakeholder noted that this dynamic could contribute to confusion and lead to multiple calls for assistance if the naloxone wears off before further medical intervention is available.

Lessons from Scotland response times

In Scotland, concerns about ambulance delays were addressed through agreements with the Scottish Ambulance Service to maintain high-priority (red or purple) categorisation for overdose calls involving police-administered naloxone. This ensured ambulances typically arrived promptly, with a reported average response time of under 10 minutes. The shortest reported wait was 2 minutes, and the longest was 24 minutes in a rural area. Protocols requiring officers to notify ambulance services immediately after naloxone use were found to help streamline responses. While variability persists, particularly in rural areas, pilot findings indicated no significant systemic delays linked to police administered naloxone and associated interventions.

Safeguarding the person who used drugs

When officers were first on scene and had administered naloxone, they were responsible for safeguarding the person who used drugs, particularly in situations where the ambulance had yet to arrive. However, the evidence shows that this could be challenging as: (i) the police had limited power to detain the person who used drugs if they refused follow-up care; and (ii) they might not be equipped to manage the risk of the individual returning to an overdose state due to the half-life of naloxone.

Officers reported situations where after administering naloxone, the person who used drugs regained consciousness in a state of agitation and confusion and, in several instances, refusing further medical treatment from paramedics or at the hospital. While paramedics had the authority to enforce hospital treatment, officers were constrained by their lack of legal power to detain individuals who no longer appeared to require life-saving intervention. This left officers in a difficult position where they were unable to ensure that the person who used drugs received necessary follow-up care, especially if they chose to leave the scene.

The short 40-minute half-life of naloxone nasal spray was perceived as an entwined issue. Although not a consistent finding, interviews suggest that while the person who used drugs might respond to initial doses of naloxone, there remains a risk of relapsing into an overdose state. NHS paramedics explained that additional naloxone, often 800mg administered intravenously, is required to manage this risk if the individual refuses to go to the hospital. Police officers equipped with a single nasal naloxone kit of 2 doses were generally unable to administer further doses. This left a potential gap in managing the risk of overdose once naloxone wore off. Supervisory staff suggested other options should be explored for equipping officers with alternative, higher-dose or longer-lasting naloxone products to bridge this gap, though no such products currently exist in the UK.

2.4 Perceived value of police naloxone carriage

This section explores the perceived value of police naloxone carriage articulated by force leads, supervisory and frontline officers and NHS paramedics. It explains how police naloxone carriage has the potential to save lives and explores how it can engender better relationships with people who use drugs and reduce stigma surrounding addiction.

This section addresses the following research questions:

what is the perceived added value of police carrying naloxone?
what are the perceived impacts it has had on people who use drugs?
for officers who have used naloxone, what do they think would have happened if they were not able to administer naloxone?

Life-saving potential of naloxone

A common narrative throughout this evaluation, particularly among force leads, supervisory and frontline officers and NHS paramedics, was the life-saving potential of police naloxone carriage. This capacity to intervene in critical moments and reverse the effects of an opioid overdose is not merely seen as a medical intervention, but to provide individuals struggling with addiction the opportunity to receive the relevant support required. The fundamental rationale, as highlighted by stakeholders, is that increasing police use of naloxone directly translates to more opportunities for its use in situations of need, ultimately resulting in more lives saved.

Frontline officers often drew parallels between naloxone and other life-saving equipment, such as defibrillators and EpiPens, emphasising its importance as a tool for preserving life. The consensus among officers who have administered naloxone is that it enables timely intervention, especially when they are first on the scene, potentially mitigating the risks associated with ambulance wait times. This ability to act decisively and potentially avert a fatal outcome is perceived as a notable benefit, empowering officers to make a tangible difference in the lives of people who use drugs.

“It’s a tool that most people don’t get to have the opportunity to use. It gives us a fighting chance. Obviously, we deal not only the criminal side, we do deal with a lot of health issues, mental health, physical, and we are the ones that are on the street effectively. And we’re always going to be first, majority of the time, first on scene, ambulance delays obviously, with the current climate, and so why would we not take a tool that will help us give a fighting chance to those on the street?”

(ID9, Frontline officer).

The provision of naloxone to police officers was seen as a natural extension of their existing duty to safeguard life. Although not a dominant perspective, certain officers acknowledge that naloxone carriage does not fundamentally alter their core responsibilities. However, they express a sense of reassurance in knowing they are equipped to respond effectively to opioid overdoses. This enhanced capacity to intervene is viewed as a valuable addition to their toolkit, allowing them to address a critical public health issue and potentially prevent tragic outcomes.

Beyond the immediate life-saving benefits, naloxone administration was also perceived to be a potential catalyst for positive change in the lives of people who use drugs. For example, the experience of being revived from an overdose can serve as a ‘wake-up call’ for people who use drugs, prompting them to seek help for their addiction. This potential for naloxone to disrupt the cycle of drug abuse and overdose was seen as a profound benefit, offering the possibility of a healthier future. This perspective was further reinforced by the observation that individuals saved by naloxone have subsequently entered recovery, become engaged with support services, and made positive contributions to their communities.

“What it does, it enables a person who might otherwise have died to have a second chance, or their meaningful life and with full contributions to society. So, it gives people second chances and diverting to treatment, which is really, really important in breaking the cycle often of generational drug use. To prevent younger people getting trapped in a life of addiction and drugs which is no life really.”

(ID74, Stakeholder).

However, it is important to consider the opposing minority opinion. There were instances where frontline officers reported an indifference or a lack of discernible change in attitudes or behaviours among people who use drugs following naloxone administration. Here, the findings suggest that, while naloxone offers a crucial opportunity for intervention, its effectiveness is ultimately contingent on the individual’s readiness to engage with treatment and support services. These perspectives highlight the limitations of naloxone as a standalone solution and reinforce the importance of integrating it within a broader harm reduction framework.

Engendering (better) relationships with people who use drugs

The evaluation highlighted the potential for police naloxone carriage to improve relationships with people who use drugs. Namely, people who use drugs trusting and having more positive perceptions of police. This theme resonated with various stakeholders, including frontline and supervisory officers, NHS paramedics and harm reduction leads. The belief that equipping officers with naloxone could reshape perceptions of the police was prevalent, as it demonstrates a commitment to saving lives. By moving beyond the traditional enforcement model, police naloxone carriage offers a tangible opportunity to foster less adversarial interactions with people who use drugs, emphasising genuine concern for their safety and well-being.

Stakeholders envision this shift, where both the carriage and administration of naloxone can transform relationships, with people who use drugs viewing police as supportive community partners rather than purely authoritative enforcers. Such interventions, particularly in moments of vulnerability, have the potential to disrupt cycles of drug abuse and overdose. Positive interactions may serve as catalysts for further engagement with harm reduction services, leading to long-term benefits for individuals with addiction. Ultimately, police naloxone carriage was seen not only as a life-saving intervention but also as a symbol of compassion, fostering trust and paving the way for more collaborative relationships with people who use drugs.

“If they see that we’re carrying naloxone. So, where those officers are out and about on foot, engaging with opioid users, if they see that we are carrying naloxone, I would like to think that they will see that as a positive, in the sense that, we care. So that they know that if someone, either themselves, or one of their friends, associates, ends up in a difficult situation, they know that they can call upon us, because they know that we’re carrying.”

(ID50, Supervisory officer).

While the potential for positive change is evident, it is essential to understand this is not straightforward to achieve. Although not a widely held view, frontline officers and supervisory officers expressed scepticism about the impact on the less tangible aspects of the relationship, noting no discernible change in perceptions or behaviours amongst people who use drugs.

This scepticism highlights the limitations of naloxone carriage as a standalone intervention and underscores the need for broader, systemic changes to address the complex social and structural factors that contribute to negative perceptions of law enforcement amongst people who use drugs. One stakeholder concurred with this idea, stating naloxone should be seen as one component of a broader, holistic response, including treatment referrals and non-stigmatising care from both the police and treatment providers. While a single act of administering naloxone can be a powerful moment of connection, it may not be sufficient to overcome deeply rooted mistrust and negative experiences accumulated over time.

“So, the last overdose I went to the police were in attendance, he had an issue with the police, so when we brought him round the fact that the police were there escalated the situation quite a lot. So, on the one hand, I talked about, you know, it may be improving relationships because if the community were aware that the police were carrying this, it might be like, ‘Okay well they’re trying to help me.’ But equally, it’s really difficult to get away from the already ingrained view of the police by these individuals because quite typically they don’t have good interactions with the police.”

(ID16, NHS paramedic).

Therefore, due to the complicated realities of people who use drugs coupled with their accumulated experiences with law enforcement, building trust and reducing adversarial interactions with police are not straightforward. While this view is not broadly endorsed, one academic article from research in Canada suggests that police presence at an overdose incident might potentially exacerbate the fear or frustration in the person who used drugs due to the preconceptions of officers as law enforcement (Xavier and others, 2022). In such cases, police presence may be perceived as an additional stressor rather than a supportive intervention. This indicates that simply providing naloxone to police officers is insufficient in cultivating positive relationships with people who use drugs. To achieve meaningful change, there must be a concerted effort to integrate naloxone administration into a broader framework of support that includes education, community engagement, and collaborative practices between law enforcement and harm reduction services.

2.5 Barriers to uptake of naloxone carriage

This section discusses the key barriers to the uptake of naloxone carriage by examining several issues: the perceived influence of the Federation on the (un)willingness to carry naloxone among frontline officers; the issue of access to supply and funding; the quality of training provided; the implications of system-wide resource pressures on the (perceived) responsibilities of frontline officers carrying naloxone; and the resistance against police naloxone carriage among frontline officers due to the underlying stigma against people who use drugs.

This section particularly answers the following research question:

what are the main barriers to naloxone carriage and how can these be addressed?

Lack of support for police naloxone carriage

Stakeholders, force leads, and supervisory officers reported that the main barrier to the implementation of police naloxone carriage was the lack of official endorsement from the Federation.^{[footnote 13]} Despite the letter of comfort issued by the IOPC, force leads reported concerns among frontline officers about potential legal repercussions if they administered naloxone without official Federation endorsement, especially if it resulted in a negative outcome for the person who used drugs. This fear of being held legally liable was symptomatic of officers feeling unsupported by the Federation on the issue of naloxone carriage. The fears were exacerbated by unsubstantiated rumours circulating amongst frontline officers about colleagues facing legal action (including court appearances) for administering naloxone that allegedly resulted in a drug user’s death.

“I heard somebody say, ‘Oh, I heard an officer was ripped apart in a coroner’s court.’ And I’m like, ‘Right, when did that happen?’ And then you keep asking and nobody can give you this case of this deceased person, which coroner’s court it was, what happened.”

(ID2, Supervisory officer).

The implementation of naloxone carriage was also impeded by concerns about officers’ health and safety in one area. It was unclear from the interview findings what the specific concerns were. However, the force leads and supervisory officers from this area reported that they had to stop the implementation due to concerns voiced by the health and safety working group until the issues had been reviewed.

Access to supply and funding

Interview data gathered from stakeholders and force leads suggests that successfully rolling out and implementing police naloxone carriage could be impeded by challenges in securing funding. Where the availability of funding was perceived to be the main facilitator of naloxone carriage, force leads questioned their ability to sustain its rollout without adequate funding.

It was understood through stakeholder interviews that funding for naloxone amongst ADDER forces was provided through 3 main sources: (i) a health and safety budget within the police force; (ii) funds from the Home Office’s ADDER programme; or (iii) Public Health Grants. However, it was unclear how naloxone carriage was funded within non-ADDER forces or how these funds were allocated as this was not a focus area of the current evaluation. For stakeholders, this presents a challenge in understanding sources of funding, and assessing whether forces have sufficient funding to sustain their naloxone rollout and resupply; a challenge that was also observed in Scotland.

While not a commonly held view among stakeholders, naloxone kits were perceived to be relatively cheap to procure. Combined with its long shelf life, naloxone kits should constitute a small cost in the force’s budget. However, findings gathered from force leads revealed that the barriers to uptake extended beyond the costs of naloxone kits, to the force’s ability to provide ongoing training for officers and to monitor the supply levels. For example, where naloxone carriage has yet to be implemented, force leads were still trying to overcome the issue of how training would be financed beyond the initial 2-year funding period they secured. An external provider would deliver the training,^{[footnote 14]} but concerns remained about the ongoing provision of training and the sustainability of outsourcing it, given the costs involved.

“We’re having to get an external provider to do the training. That’s fine initially. What then happens in 2 years’ time when naloxone needs replacing, and more volunteers need training? There is no funding for that. We can’t guarantee that [Organisation X], who are the charity that are doing the training, will still be wanting to do that or we’ll have the funding to commission them to do it again. And, we also, then, have no control over what they’re going to charge for that. So, the rollout is absolutely okay. What is going to be the ongoing funding provision, who’s going to pay for it and where is the training going to come from?”

(ID72, Force lead).

Where forces have had to pause their rollout, this was attributed to supply issues underpinned by challenges in monitoring supply allocation and naloxone use. Force leads described issues with data recording protocols, which meant they were unable to reconcile the number of naloxone kits distributed with those that had been used. As a result, they were unable to accurately assess supply levels at any given time or if officers needed to be re-issued with new naloxone kits. There were reports of officers carrying naloxone kits that had expired, mainly due to the lack of opportunity to administer. However, challenges with monitoring supply meant they were yet to receive replacement kits. To mitigate any further risks to implementation, force leads decided to pause any further distribution of naloxone while the supply monitoring processes were being reviewed.

Quality of training

The view gathered from stakeholder interviews was that naloxone training was an essential part of the first-aid module. When combined, the training would - in theory - equip officers not only with the knowledge of how to administer naloxone but also prepare them to respond effectively in a highly stressful situation. However, the interviews suggest that training approaches varied across forces. These ranged from self-directed online courses or in-person training for naloxone as a standalone module, to programmes integrated with first aid for trauma emergencies.

Implicit in the accounts provided by frontline officers was the sense that they relied heavily on naloxone when responding to an opioid overdose incident at the expense of other first-aid techniques such as CPR. The findings suggest a lack of appreciation among frontline officers of CPR as a viable treatment option in the absence of naloxone. This also applied to forces that have integrated naloxone training with the first-aid module.

The prevailing belief among frontline officers was that they would not have been able to save the life of the person who used drugs if naloxone had been unavailable. However, stakeholders, force leads, and NHS paramedics emphasised the importance of administering CPR and managing the airway of the person who used drugs regardless of whether naloxone was available, to prevent cardiac arrest. Therefore, there is a need for training that reinforces the complementary roles of CPR and naloxone, emphasising how they should be used effectively.

“The concern is that people are not going to be administering CPR because they think that they’ve administered this magic spray which will do everything, rather than doing the 2 in conjunction with each other.”

(ID25, Drug strategy lead).

Frontline officers’ fear of legal repercussions reflected concerns about the (perceived) risks of administering naloxone. These fears were exacerbated by uncertainties on whether naloxone should be used if the cause of overdose was unknown, or how to manage the person who used drugs who might become aggressive when they regain consciousness. In forces where these apprehensions were pronounced, force leads and supervisory officers believed that a lack of awareness or understanding of when to use naloxone could be a contributing factor. Here, the evidence suggests that training needs to ensure that officers understand its legal implications, and its effect on people who use drugs when they regain consciousness.

Perceptions of officers’ roles and responsibilities

Data gathered from force leads and supervisory officers revealed the fear of scope creep was a concern raised by the Federation and unions. This concern was widely shared among force leads and supervisory officers. While largely supportive of police naloxone carriage, force leads and supervisory officers acknowledged how the role of officers had shifted, expanding from primarily tackling crime to managing mental health crises and now, with naloxone, responding to drug overdoses.

The perception of these responsibilities goes beyond what ‘traditional’ policing entailed, which meant they understood the reluctance among frontline officers to assume additional responsibilities traditionally assigned to health services. Similarly, NHS paramedics who had attended an overdose incident where police were present expressed concern that police naloxone carriage might create an expectation for officers to act as first responders or paramedics when responding to overdose incidents. Additionally, staying at the scene after naloxone administration could prevent officers from moving on to respond to other crime incidents (seen as their core role).

These concerns about scope creep and additional responsibilities suggest a disjunction between the (perceived) responsibilities of frontline officers and those set out in the Right Care, Right Person (RCRP) approach. The premise of RCRP is to ensure that people in mental health crisis are provided with support that is compassionate and meets their needs (Home Office, and Department of Health & Social Care, 2024). This approach sets out a threshold to assist the police in making decisions on whether they should respond to mental health-related incidents. The threshold for a police response to such an incident is to: (i) investigate a crime that has occurred or is occurring; or (ii) protect people, when there is a real and immediate risk to the life of a person, or of a person being subject to, or at risk of serious harm.

While opioid overdoses may not constitute a mental health incident, research has shown drug misuse and addiction are often symptomatic of underlying mental issues (Sterling and others, 2011; Compton and others, 2003; Mental Health Foundation, 2024). Additionally, based on the legal guidance provided by the College of Policing in the context of RCRP, the police have a duty of care to protect people who use drugs from the risk of harm, particularly if there is a threat to their lives. The need for police naloxone carriage and for officers to respond to overdose incidents if required, therefore, meets the RCRP threshold.

A less commonly held perception among force leads was that overdoses were a medical issue rather than a criminal one, which meant such incidents should not require further police involvement beyond responding to the incident. However, the RCRP approach emphasised the importance of ensuring that people with mental health needs are not left without support.

This requires joint-working models to be developed through cross-agency partnerships (for example, between the police and local health services), to ensure that people who use drugs have access to the right support. These models are in place in a minority of areas studied, for those that did there were clear processes in place. Where these models are yet to be established, the challenges associated with obtaining the consent of people who use drugs could be addressed through locally developed partnerships or health-led triage models with local health agencies.

In sum, the evidence suggests a need to: (i) ensure that SLTs and frontline officers understand the relationship between drug addiction and mental health; (ii) embed the RCRP framework within the principles of police naloxone carriage. These may, in turn, contribute to a shift in SLT and frontline officers’ perceptions of their roles and responsibilities, particularly with regard to their duty of care towards people who use drugs.

Underlying stigma against people who use drugs

Ensuring that SLTs and frontline officers understand the relationship between drug addiction and mental health is critical. There was evidence that the stigma against people who use drugs was a barrier to uptake of naloxone carriage among frontline officers and this perception was common across all staff levels and forces included in the evaluation. It is important to note that we did not speak to officers who were not carrying naloxone, so did not hear directly about any role that stigma may or may not play in their decisions to not carry naloxone. Perceptions of stigma were heard vicariously, but they illustrate the widespread nature of these stigmatising views.

When considering the objections against naloxone carriage, stakeholders and force leads recounted instances they had heard others describing people who use drugs as criminals who made a lifestyle choice and, therefore, are undeserving of life-saving intervention.

The evidence also shows that people who use drugs were often referred to in derogatory terms. Terms such as ‘junkie’ was used in passing during a stakeholder interview, and a supervisory officer reported that it was commonplace that the term ‘baghead’ was used by officers to refer to individuals using opiates or crack cocaine. This use of derogatory language and the pervasiveness of stigmatising views not only dehumanises people who use drugs, but also perpetuates harmful stereotypes that reinforce the belief that drug addiction is a choice.

Stakeholders, force leads and frontline officers also recounted instances where some colleagues dismissed the necessity of naloxone, assuming people who use drugs would refuse it to maintain their high, or that it would encourage further drug use. These assumptions reflect the lack of appreciation and understanding of the mental health issues that may underpin drug addiction.

“You do hear ‘Oh, why should I bother? They’ll only go and take some more next week or something else’. And you do encounter that from time to time, and a slightly grumpy police officer on a bad day will say ‘Why should I bother? It’s not exactly a loss, is it?”

(ID1, Clinical governance lead).

“[The resistance against naloxone carriage stems from the view that] these people are criminals, that we should be locking them up. [That] it’s not our job to actually help them, it’s our job to lock them up.”

(ID75, Stakeholder).

This stigma extends beyond law enforcement into healthcare, indicating a broader societal bias. The evidence gathered from this evaluation shows that NHS paramedics and representatives from local health services also had vicarious experiences with stigmatising views expressed by some of their colleagues. These findings are consistent with research conducted in the US, which indicated that stigma towards people who use drugs is characterised by the belief among first responders that these individuals are responsible for their overdoses and deserving of the life-threatening outcomes of their actions.^{[footnote 15]}

There is evidence from the evaluation to suggest that engagement events involving neighbourhood police teams and individuals with lived experience of police-administered naloxone have been crucial in promoting understanding and reducing stigma and overcoming any barriers to carriage of naloxone. Peer educators with personal stories of opioid addiction provide officers with insights into addiction and the life-saving impact of naloxone, humanising the issue. Hearing first-hand accounts from individuals revived from overdoses who have turned their lives around challenges stereotypes about people who use drugs, demonstrating their potential for recovery and societal contribution.

Question 4

3.  Best practices

Accepted Answer

This chapter examines the best practices adopted by specific forces across England and Wales. It explores how forces co-ordinated effective cross-service responses; how data gathered about police-administered naloxone was used innovatively; the referral pathways developed by forces to ensure people who use drugs receive follow-up care; and how forces reduced the barriers to uptake of naloxone among frontline officers.

This section helps answer the following research questions:

what does best practice look like; and in what way, if any, does this differ between forces?
to what extent would it be feasible to introduce an automatic notification system whereby police notify drug treatment services after all non-fatal overdoses?

3.1 Co-ordinating effective cross-service responses

While not consistent across all forces, the evidence presented in this evaluation indicates efforts to establish a comprehensive, collaborative approach for responding to, and managing the risks of, opioid overdose incidents. This approach relied on strong partnerships with harm reduction leads or drug treatment services to identify emerging drug threats and co-ordinate effective cross-service responses.

Cross-service responses in Durham

In Durham, cross-service responses were embedded in intelligence sharing between the police force, Public Health and the local drug intelligence service. Intelligence on any emerging drug threats was gathered through regular drug tests conducted on different substances. These drug tests aimed to establish the strength of various drugs, including synthetic opioids, and to understand the potential risks these may pose to people who use drugs. The information was then shared with partner agencies to ensure that appropriate services were available to respond to any upticks in opioid overdose incidents.

This inter-agency effort went beyond identifying emerging drug threats; it focused on co-ordinating effective responses to ensure that people who use drugs had access to the necessary support during critical moments. When implementing a drug dispersal order, the harm reduction lead would collaborate with local drug services to ensure adequate resources – for example, health workers – were deployed to the affected area. This approach aimed to engage people who use drugs who are at risk of overdose but may not previously have access to these services.

In South Wales, relationships between the police, local health services, Ambulance Trust and the NHS health boards had been fostered over years and maintained through bi-monthly meetings with key stakeholders from each organisation. The main purpose of these meetings was to discuss intelligence gathered by the police around organised crime and information captured by local services on any increasing threats from synthetic opioids. This enabled the force to respond rapidly to increases in opioid overdose rates through emergency panels and review if additional resources should be deployed and peer-to-peer arrangements were in place to mitigate these rises.

“It really helped us, for example, last Christmas we had 5 drug-related deaths in Cardiff in the space of just a few days which for us we would regard as quite a significant increase in a short space of time, and within a few hours we were able to get a range of partners together really really quickly to talk about, you know, what is our multi-agency response going to be to that incident. And that was including, ‘Right, let’s just do a quick review, how many officers in Cardiff are carrying naloxone? What are the peer-to-peer arrangements like? Is there anything else we can do to make sure whether there are no further deaths?’ But the speed at which we were able to get partners together quickly was really really important for us going forward.”

These examples of inter-agency collaboration demonstrate how an all-systems approach enhances the ability of police naloxone carriage to mitigate the harms associated with opioid overdoses among people who use drugs. This approach ensures that: (i) individuals receive timely interventions; and (ii) appropriate support is available to protect their well-being at critical moments.

3.2 (Innovative) use of police-administered naloxone data

South Wales provides an early example of how the data collected from police-administered naloxone can be utilised innovatively. Information collected by officers who responded to an overdose incident - that is, date, time, location of the incident and individual’s name - was cross-referenced with police records to determine if the person who used drugs was known to the police.

This information was then used to create a heat map to identify areas with the highest concentration of opioid overdoses and drug-related harms, where enforcement and outreach activities were targeted. The supervisory officer described how heat mapping enabled efforts to: (i) disrupt drug supply through county-line operations; and (ii) raise awareness among local services of the (increased) risks of opioid overdoses within the area.

Heat mapping led to enhanced outreach efforts by identifying areas needing increased services, thereby making more support available to people who use drugs. It also informed commissioning decisions to better address drug- and overdose-related issues in specific areas where risk of overdose was highest.

3.3 Creating referral pathways

The findings gathered from this evaluation did not indicate that forces were using an automatic notification system to inform drug treatment services of non-fatal overdoses, nor did it suggest that implementing such systems was a current consideration. However, the findings reveal that forces have made efforts to ensure referral pathways were available to people who use drugs who received police-administered naloxone. The referral processes were underpinned by the consent of the person who used drugs, and a comprehensive data flow within forces enabling referrals to be made through harm reduction leads or a central multi-agency support hub (MASH).

In Durham, where referrals were made through MASH, officers completed a safeguarding form after administering naloxone to the person who used drugs. Force leads and frontline officers reported that the safeguarding form was submitted to the MASH team responsible for reviewing each incident with the consent of the person who used drugs to determine whether the person who used drugs should be signposted to the relevant health services.

In South Wales, referrals were made through the harm reduction lead. Officers were required to share the details of the overdose incident in which they administered naloxone via email to the relevant contact within their basic command unit (BCU). The data was then entered into NICHE - a police records management platform - which triggered a 72-hour protocol. During this period, the incident was reviewed by the harm reduction lead and case co-ordinator in each area. Screening checks were conducted to ascertain if the person who used drugs was known to any health services. If they were, these services were notified. The information collected through this process was subsequently shared with the Drug Poisoning Taskforce, a multi-agency forum, to ensure that all necessary interventions were in place to provide the person who used drugs with support from appropriate services. This referral process is illustrated in Figure 1 below.

Figure 1: Referral pathway from harm reduction lead in South Wales

In Blackpool, direct referrals to local drug services were made through the ambulance service by a dedicated non-fatal overdose co-ordinator. The referral is made once the police have administered naloxone if they were first on scene, have gained consent from the person who used drugs and have handed the individual over to the paramedics. The findings suggest that this process was facilitated by information entered on the Computer Aided Dispatch by paramedics who attended an overdose incident and administered naloxone. While it was unclear what the specifics of the information provided were, the co-ordinator was responsible for sharing these with the local drug service, which would reach out to the person who used drugs to provide support and intervention.

3.4 Reducing barriers to uptake of naloxone

Police forces actively fostered a culture of recognition for naloxone use. This involved providing reassurance for officers who had administered naloxone. Force leads and supervisors described how each incident of naloxone administration recorded in the system was followed up with a commendation card or congratulatory email sent to the respective officers. Officers receiving these commendations reported increased morale and greater confidence in carrying and administering naloxone.

Additionally, forces showcased the successful usage of naloxone through internal bulletins. There was the perception that these stories were effective in encouraging naloxone uptake among officers who were hesitant to do so. The findings also indicate that designated officer naloxone ‘champions’ who act as ambassadors for its use within their respective forces have played a crucial role as mentors on naloxone carriage, providing reliable advice and information to address concerns about the perceived risks of administration.

Question 5

4.  Recommendations

Accepted Answer

This section sets out the recommendations based on the findings presented in this evaluation. The 6 recommendations are:

standardise data recording practices in line with strategic objectives and key performance indicators
to provide more clarity on obtaining consent of the person who used drugs for referrals to treatment from learnings gathered from regional working groups set up by regional leads
standardise naloxone training across all police forces
clarify and implement sustainable funding arrangements with forces
shift negative perceptions of people who use drugs
implement a collective communications strategy to encourage naloxone carriage

4.1 Standardise data recording practices

The consensus amongst stakeholders was that data on the number of overdoses reversed by police-administered naloxone and the number of administrations were instrumental in facilitating the national rollout of police naloxone carriage. However, data gathered from force leads and supervisory officers shows no standardised recording practice across the forces. This meant the evaluation has been unable to build a clear picture of: how levels of naloxone carriage and use were monitored; the number of overdoses reversed by police-administered naloxone; or how the data collected was used to inform the rollout within each force.

A lack of consistent data recording protocols has implications on: (i) understanding the effectiveness of police naloxone carriage in reducing opioid overdose-related deaths; (ii) whether officers were able to respond to opioid incidents effectively; (iii) monitoring supply levels across forces; and (iv) providing an alert for adulterated or contaminated drugs that pose a risk to others, alongside forensic testing. Therefore, establishing consistent data recording protocols ensures comparability of the data collected, which, in turn, can help inform the rollout of police naloxone carriage at a national level. It can also be used in future research to analyse trends in opioid overdose-related deaths.

At the local level, a standardised data collection process would enable forces to effectively monitor: (i) supply levels of naloxone kits; (ii) officers’ ability to respond effectively to overdose incidents; and (iii) any delays in ambulance response times, particularly when the police are first on scene.

We suggest that the recommendations put forward in this section are implemented with the involvement of the College of Policing, NPCC and the Home Office.

The first part of this recommendation is that data recording protocols will need to be underpinned by clear strategic objectives. The evidence gathered from stakeholders suggests recording protocols need to reflect the purpose of naloxone carriage and provide useful information about how the programme is performing. These protocols should be developed based on 3 key considerations:

1. Purpose alignment

Decisions will need to be made at a local and national level on what the data seek to monitor or measure, and how it can support a successful rollout. This enables stakeholders to make (informed) strategic decisions on the implementation of police naloxone carriage and ensure its effectiveness and sustainability.

2. Key performance indicators (KPIs)

Building on purpose alignment, the data need to be built on KPIs of police naloxone carriage. Based on the evidence gathered in this evaluation, these could include:

amount of available funding: assessing whether forces have sufficient funds to sustain the rollout or if they require additional funding
number of overdoses reversed: monitoring the number of individuals who received police-administered naloxone and survived an overdose incident
frequency of naloxone administration: monitoring how often naloxone is administered by officers, which can indicate the level of need for police naloxone carriage
naloxone supply: assessing forces’ ability to maintain an adequate supply of naloxone kits, including resupply
efficiency of response: understanding if officers combined first-aid techniques with naloxone use
ambulance response time: monitoring ambulance response times to overdose incidents, particularly when police were first on scene
inter-agency collaboration: assessing the level of information sharing between the police, ambulance service, local health services and harm reduction services

3. System ownership

Decisions will need to be made on which organisation(s) will be responsible for collecting, monitoring and storing the data at a national and local level. This will ensure data is accessible and can provide timely information to key stakeholders on the performance of police naloxone carriage.

The second part of this recommendation is that data recorded by officers should align with the relevant KPIs to ensure that it is fit for purpose. Similar to the data recording practices adopted in Scotland, forces in England and Wales could be provided with a standardised form which will ensure consistency in how the data is recorded. Combining the types of data that are currently collected by forces in England and Wales with those that Metrebian and others (2023) seek to collect, the fields within the form could include: (i) personal details of the person who used drugs; (ii) type of substance taken; (iii) whether first-aid techniques were applied in conjunction with naloxone; (iv) ambulance response times; (v) and whether the person who used drugs were seen by paramedics.

(Potential) fields in standardised form

Area where the officer works.
Date and time of incident.
Details of the person who used drugs – this will include, if known, the name, gender and age .
Type of substance taken (if known).
Number of doses delivered.
Type of first aid executed (dichotomous fields, Y/N):
- tried to wake [the person who used drugs] up verbally
- tilted [ the person who used drugs] head back
- checked [the person who used drugs] breathing
- put [the person who used drugs] into the recovery position
- [did] chest compressions
- [administered] rescue breaths/mouth-to-mouth
- cleared [the person who used drugs] airways
- checked [the person who used drugs] pulse

Outcome of the person who used drugs: conscious and responsive, unconscious, and non-responsive.
Ambulance response time (from time of call): in minutes.
Whether person who used drugs was seen by paramedics (dichotomous field): Y/N.
Resupply needed (dichotomous field): Y/N. If yes, number of kits required

To assess the levels of inter-agency collaboration, additional future research could focus on how police and paramedics should work together if both parties are present at an overdose incident, and the types of information that need to be shared between services to ensure that people who use drugs have access to the right support.

It was unclear from the evidence gathered in this evaluation how forces that have implemented referral pathways address the need of consent but in forces where there were no clear referral pathways in place, force leads, supervisory officers, and representatives from local health services mentioned consent of people who use drugs was the main barrier to referring them to drug treatment services. With plans to establish a formal referral process still underway, referrals were being made on an ad hoc basis and were contingent on the person who used drugs consenting to their details being shared with local health services. The challenges associated with sharing personal data and obtaining consent from people who use drugs meant these forces were not always able to provide them with the support they required.

Addressing this barrier is imperative, as it has a direct impact on people who use drugs accessing support services that can help mitigate the risk of future overdoses and promote recovery. If the police cannot gain consent from those they have administered naloxone to, then these individuals will only access the support they need if they reach out themselves to drug treatment services, which does not always happen after experiencing an overdose.^{[footnote 16]}

To address this major barrier to treatment referrals, forces without clear referral pathways must be signposted to forces who have already implemented them. Learning from others, and how they have overcome the challenge of gaining consent for referral to treatment from people who use drugs, will enable forces experiencing this issue to apply these methods in their local area.

Sharing the learning could be facilitated by working groups, learning workshops or any other methods the police typically use to share best practices and new insights. Durham is part of a regional naloxone working group, where data and learning are shared amongst forces in the North East; if these are not already set up in other parts of England and Wales, it is recommended that they should be. Here, it is recommended that regional leaders set up regional naloxone working groups, and the findings from these working groups could be disseminated by NPCC.

If there are existing guidelines on gaining consent, then these should be reviewed and clarified to provide comprehensive guidance on navigating consent-related challenges with people who use drugs. This could involve developing standardised procedures or utilising health-led triage models in collaboration with local health/drug treatment agencies to create a more seamless referral process. However, it must be noted that different systems are used by devolved nations, such as frameworks used in Scotland, so may not be possible to implement in other parts of the UK. Therefore, this process will need to be adapted for efficient implementation in England and Wales.

This evaluation did not uncover the methods used by forces with a clear referral pathway to gain consent for treatment referral from people who use drugs following the administration of naloxone. The non-fatal overdose co-ordinator role in Blackpool warrants further investigation, as it is likely this position deals with the issue of consent regularly, to share the information of the person who used drugs with the local drug service. It may therefore be beneficial for a deep dive to be conducted into the specifics of the referral process across different forces.

Providing more clarity on obtaining consent of people who use drugs for referrals can aid the consistency and effectiveness of the national rollout of police naloxone carriage. By ensuring all forces have clear guidelines and strategies for obtaining consent, there will be a more unified approach to supporting people who use drugs, which in turn can lead to improved outcomes for those at risk of overdose. Fostering partnerships and developing joint-working models with the public health and substance misuse sectors can also increase the overall efficacy of the response to opioid overdoses.

4.3 Centralised development and funding of naloxone training materials

The findings presented in this evaluation indicate mandatory training for police officers in naloxone administration is crucial. With the right training, officers can feel confident in their ability to handle these situations, similar to other life-saving interventions. However, training approaches varied across forces, from self-directed online courses to in-person training, either as a standalone module or integrated with first-aid training. This lack of standardisation means that officers may not be receiving the quality of training they need to respond effectively to all aspects of overdose situations.

To address these inconsistencies, it is recommended that naloxone training be standardised across all police forces. This process of standardising training could be led by the College of Policing. A standardised training offer would ensure that all officers across England and Wales receive the same high-quality training. Consequently, all officers would be equipped with all the knowledge and skills necessary to respond to an overdose and administer naloxone effectively, further reducing the risk of harm and drug-related death for people who use drugs.

Firstly, naloxone training should be standardised by integrating it with broader first-aid training with the police force. This corresponds with the Scotland naloxone evaluation, which recommends that training should be compulsory. Integrating and mandating the training will emphasise the need to view opioid-related overdoses in the same light as other first-aid emergencies, rather than separately. This would also reinforce the complementary roles of CPR and naloxone, addressing the current lack of awareness of CPR as a viable treatment option in the absence of naloxone. Scenario-based methods should also be used to simulate real-life situations, helping officers practice and prepare for different overdose situations, both before and after naloxone administration.

Training content should be developed collaboratively between police, the College of Policing, drug treatment services, and individuals with lived experience of drug use. This will ensure that training is comprehensive and informed by diverse perspectives. The co-ordination of training rollout should be led by the College of Policing, utilising a ‘train the trainer’ model.

Under this model, an appointed representative from each force, together with people with lived experience from the force’s local health services, would receive training directly from the College of Policing. These individuals would then be responsible for conducting training sessions for all officers within their respective forces. This ensures consistent delivery of nationally developed materials. It is important to note that there may be differences in how forces deliver their training - either through external providers or doing them in-house by senior officers. Therefore, the ‘train the trainer’ model must be adapted accordingly to accommodate these different arrangements.

The box below outlines the content to include based on the findings from this evaluation. However, it must be stressed that this is developed and refined with the aforementioned agencies before being implemented.

Standardised naloxone training content

1. Understanding the underlying causes of addiction.

2. Understanding legal protections if naloxone was administered.

3. New / emerging drug trends and their impact.

4. Risks and benefits of naloxone, including use of naloxone in poly-drug overdoses, and on individuals who are on methadone.

5. How to check the naloxone carried is in date and how to order new kits.

6. Before administering naloxone – such as information to collect, observations to make when arriving at the scene.

7. Administering naloxone – including complementary role of CPR, dosage.

8. After administration – what to do when the person who used drugs regain consciousness, referral processes, protocol for handing them over to ambulance service, data recording process.

Officers should attend refresher naloxone training every 12 months so that they are kept up to date on any changes (such as in drug trends, naloxone developments) and can reinforce their skills and knowledge. This will be especially useful for those in areas where officers do not administer naloxone regularly due to low rates of opioid overdoses.

To ensure consistency and alleviate financial concerns about naloxone administration on an ongoing basis, the training should be funded centrally. This could involve collaboration between NPCC and other national bodies and government departments, to ensure the financial burden does not fall on individual forces. Centralised funding (and monitoring) would also facilitate regular updates to the training curriculum, keeping it aligned with the latest best practices and research findings. Each force contracts different providers to deliver their first-aid training, so training updates must feed into the contracting process to ensure each provider covers them in their training offer.

The effectiveness of training should be measured, to ensure the standardised training offer is fit for purpose. There are a variety of ways in which this could be done, requiring different levels of resource and time. This could range from pre- and post-training assessments of officers’ knowledge and confidence levels to surveys and interviews to gather qualitative feedback on officers’ experiences and perceptions. Conducting longitudinal studies could also help assess changes in officers’ attitudes and effectiveness over time, (which would have the additional benefit of monitoring shifting perceptions, as outlined below), ensuring the training continues to meet the evolving needs of both officers and people who use drugs.

4.4 Clarify and implement sustainable funding arrangements with forces

The evidence shows that there were anxieties across all forces about the sustainability of the naloxone rollout due to uncertainties in securing ongoing funding. While some forces benefit from the Home Office’s ADDER programme or public health grants, it is unclear how non-ADDER sites finance their initiatives. Without understanding funding processes and how forces use their funding - particularly in non-ADDER areas - informed decisions cannot be made about the continuation of funding for the naloxone rollout.

The lack of clarity about future funding, especially beyond an initial 2-year period, poses a considerable challenge to the sustainability of the rollout of police naloxone carriage. Without a stable financial foundation, forces face the risk of pausing or stopping police naloxone carriage, which not only undermines the efforts to combat opioid overdoses but also wastes valuable resources invested in initial rollouts. Moreover, the absence of secured funding could lead to inadequate training provision, affecting officers’ preparedness and ability to administer naloxone. Therefore, understanding and securing funding is essential to maintain momentum and prevent disruption in naloxone carriage.

As sources of funding for police naloxone carriage was not a focus of this evaluation, we suggest that the Home Office explore the following recommendations in further conversations with police forces and local authorities.

The first part of this recommendation is to implement a structured funding approach that is divided into 3 distinct strands:

1. Initial rollout funding

Allocate specific funds to cover the initial costs associated with introducing naloxone carriage in police forces. This includes procuring naloxone kits, initial training and setup of necessary resources and infrastructure.

2. Ongoing training funding

Establish a dedicated fund to ensure continuous training for officers. This fund could be used to pay external training providers or to deliver internal training on naloxone, as part of first-aid training. This would cover costs associated with refresher courses and updates on naloxone administration techniques, preventing a lapse in skills and knowledge over time.

3. Monitoring and supply funding

Develop a fund specifically for monitoring naloxone supply levels and ensuring timely replenishment of kits. This funding would support the establishment of robust data recording protocols and supply chain management systems, mitigating risks associated with expired kits or inadequate stock levels.

In Scotland, the Scottish Government funded the pilot and initial rollout of police naloxone. Following the pilot, the government supports this and other naloxone initiatives through their funding to the Scottish Drugs Forum. This evaluation did not uncover any insights into who should be responsible for ongoing funding of police naloxone carriage. However, based on the Scottish approach, it may be beneficial for the Home Office and NPCC to collaborate on how best to co-ordinate the recommended funding and monitoring approach.

The second part of this recommendation is to implement monitoring systems to understand how naloxone carriage is funded across all forces in England and Wales - breaking down how much funding is allocated and what it is spent on. It is important to ensure ongoing communication between the Home Office, force leads and supervisory officers, as well as key stakeholders around the sources of funding and how they are allocated or spent. Ensuring transparency around funding processes may alleviate anxieties around the sustainability of naloxone carriage.

It was out of the scope of the current evaluation to establish how much forces spend on naloxone carriage and its different elements, so monitoring systems can be used to track the spending of all police forces to ensure there are sufficient funds available to sustain the rollout.

Implementing a structured and monitored funding system can significantly enhance the national rollout of the police naloxone carriage programme. Providing clear guidance and reassurance to non-ADDER sites on securing future funding can help bridge any gaps in financing, ensuring all forces have the resources needed to combat opioid overdoses effectively. By securing initial, ongoing and monitoring funds, forces can ensure the uninterrupted availability of naloxone and the consistent training of officers. This approach promotes uniformity across all forces and fosters confidence among stakeholders in the programme’s sustainability.

4.5 Shift negative perceptions

The evidence from this evaluation shows that force leads, and supervisory officers have had to contend with the stigma against people who use drugs and that this may affect their willingness to carry naloxone. The stigma manifests in derogatory terms used to refer to people who use drugs and the perception that they were criminals who had made a lifestyle choice rather than individuals who may be battling with underlying mental health issues. Combined with the reluctance to assume additional responsibilities traditionally assigned to health services, these perceptions constitute a barrier to the uptake of naloxone among some frontline officers.

Shifting these perceptions in those that hold them is crucial to building a culture of understanding towards drug addiction in general and people who use drugs in particular; a culture that encourages these officers to adopt a more compassionate and supportive approach when interacting with people who use drugs and encourages carriage of naloxone. This, in turn, maximises the potential of naloxone carriage to engender better relationships between people who use drugs and the police, characterised by mutual trust and understanding.

Challenging the underlying stigma of people who use drugs and officers’ perceptions of their roles and responsibilities is not straightforward, and will take time, but a ‘top-down, bottom-up’ approach could be an effective step forward. This approach has been adopted in New Mexico for pharmacy-based naloxone distribution that involves both legislative and community-level intervention to increase access to naloxone (Morton and others, 2017).

Applying this model to police naloxone carriage, the ‘top-down, bottom-up’ approach constitutes a two-pronged strategy to address the barriers associated with the stigma against people who use drugs and frontline officers’ perceptions of their roles and responsibilities. The top-down approach would entail:

Unequivocal support from the Federation and police unions for police naloxone carriage. This support will need to be secured through ongoing engagement, and an evidence base built on robust data collection and monitoring mechanisms, to demonstrate the necessity and effectiveness of police naloxone carriage. In Scotland, ongoing dialogue with the Federation and police unions involved dedicated working groups and steering committees to address concerns and misinformation. This collaborative approach ensured alignment and helped secure the Federation’s support by addressing issues and reinforcing the importance of naloxone carriage.
This needs to be bolstered by ongoing support from the IOPC. Ongoing communications from the IOPC can mitigate these concerns effectively. Both these steps contribute to a collective communications strategy, which is explained in more detail in the subsequent subsection.
Ensuring clarity on how police carriage of naloxone fits into the RCRP framework to demonstrate the interactions between officers’ roles and responsibilities, and those of naloxone administration and/or carriage. This will help reinforce frontline officers’ responsibilities beyond ‘traditional’ policing to their duty of care towards people who use drugs in critical moments.
Sustained resource allocation to ensure ongoing training provision for frontline officers are targeted at understanding the underlying causes of addiction. An evaluation by Hillen and others (2024) in Scotland showed a positive shift in police attitudes following naloxone training, though less than half (42%) supported a more tolerant view of drug dependence. The training could incorporate lived experiences shared by individuals who have navigated addiction, offering first-hand insights into their struggles, and demonstrating the value of police naloxone carriage.
Maintain ongoing engagement with force leads, healthcare representatives, and academics, to ensure that the training remains current and reflective of any legislative or policy changes that may affect the implementation of police naloxone carriage.

The bottom-up approach would entail:

Implementing interactive workshops annually as part of the mandatory training officers have to complete. These workshops would be led by people with lived experience and representatives from local health services who can advocate for addiction and mental health issues. These workshops aim to guide participants through the misconceptions about drug addiction and address the underlying stigma that exists against people who use drugs. By engendering an environment that cultivates empathy and understanding, these workshops have the potential to help shift negative perceptions, foster a more compassionate approach towards working with people who use drugs, and encourage officers who do not want to carry naloxone, to do so.
Embedding the principles of RCRP within the force by showcasing success stories of police-administered naloxone and the subsequent support provided to people who use drugs. This can potentially reinforce the vital role that police naloxone carriage plays in providing: (i) a duty of care through timely intervention; and (ii) access to the right support services for people who use drugs.
Building relationships with people with lived experience and community organisations to encourage opportunities for officers to interact with people who use drugs in non-enforcement settings. These interactions can help humanise people who use drugs where they are recognised as individuals rather than stereotypes while fostering trust and encouraging positive relationships between frontline officers and people who use drugs. This can work in both directions, with these relationships and ongoing interactions helping to foster a more respectful position from people who use drugs towards police.

The diagram below shows the full interaction of this ‘top-down, bottom-up’ approach.

Figure 2: ‘Top-down, bottom-up’ approach to shifting negative perceptions

This evaluation has shown that building relationships with people with lived experience and engagement events can shift attitudes towards people who use drugs and reinforce the statement of intent towards supporting those with substance addiction. Lived experience and sharing first-hand accounts, in particular, can combat stigma by humanising people who use drugs. These activities plus the others highlighted in this ‘top-down, bottom-up’ approach have the potential to shift perceptions of people who use drugs and consequently overcome objections to carrying naloxone, thereby ultimately increasing the number of police who carry it over time.

A ‘top-down, bottom-up’ approach can foster a behavioural shift within police forces, promoting greater understanding, empathy, and support for people who use drugs. By addressing stigma at both leadership and grassroots levels, this approach can enhance frontline officers’ knowledge and attitudes toward the underlying causes of drug addiction. It reinforces the importance of officers’ duty of care to people who use drugs, emphasising their role in safeguarding lives. Additionally, this strategy - sustained through ongoing support from the IOPC and engagement with the Federation and unions - can help build confidence and willingness among officers to carry and administer naloxone which, in turn, supports efforts to reduce overdose-related fatalities and improve community-police relations.

4.6 Implement a collective communications strategy to encourage uptake of naloxone carriage

This evaluation’s findings underscore the importance of a co-ordinated communications strategy to bolster the uptake of naloxone carriage among police officers. This strategy would benefit from the involvement of key entities such as the IOPC, NPCC, the Federation and relevant unions. By also integrating perspectives from public health agencies and the College of Policing, the strategy can achieve a well-rounded approach.

The goal is to ensure that messaging effectively reaches leaders at regional and force levels, leveraging various communication channels that have already proven successful in some regions. These might include bulletins, training sessions, and regional and local meetings. Highlighting success stories of naloxone use will play a crucial role in encouraging buy-in and demonstrating the life-saving potential of naloxone carriage.

The letter of comfort from the IOPC has shown that clear and supportive communication can partially alleviate officers’ anxieties about legal repercussions related to naloxone administration. This kind of reassurance needs to be emphasised in the collective strategy and corroborated by NPCC, the Federation and unions, as well as public health and the College of Policing through training.

Additionally, showcasing testimonials and evidence of successful naloxone interventions can raise awareness and acceptance among officers. The strategy should also address the risks associated with exposure to synthetic drugs, framing naloxone as not only a tool to save the lives of people who use drugs but also a precautionary measure for officers themselves.

The potential impact of this recommendation for the national rollout of police naloxone carriage is significant. By fostering a culture of understanding and support, the strategy can mitigate resistance and apprehension, particularly from frontline officers. As officers become more informed and reassured, the likelihood of widespread adoption increases, leading to enhanced public safety outcomes. Ultimately, this collective communications strategy can reinforce naloxone’s role as a critical component of police work, promoting a more humane and responsive approach to drug-related incidents.

Question 6

5.  Conclusion

Accepted Answer

As of December 2024, there have been 1,232 administrations of naloxone in the UK by the police since June 2019. This evaluation of police naloxone carriage in England and Wales provides an in-depth review of the current landscape, highlighting best practices and ongoing barriers. Police forces recognise the life-saving potential of naloxone, however, approaches to implementation, data collection, and inter-agency collaboration vary widely.

Stakeholders highlight the importance of needs-based assessment in determining naloxone rollout, emphasising the need for pilots in high-risk areas to refine strategies. The phased approach allows forces to adaptively respond to local conditions, ensuring that naloxone is available where it is most needed.

One of the main barriers to implementation found in this evaluation was the resistance from the Federation^{[footnote 17]} and unions, which resulted in reluctance by officers to carry naloxone, due to fears about potential legal repercussions. Endorsements for police naloxone carriage from IOPC and NPCC, as well as clear communication and reassurance about naloxone value at the regional / force level helped to reduce apprehension amongst officers. Best practice approaches such as fostering a culture of recognition for naloxone use, providing reassurance and showcasing the successful use of naloxone can encourage uptake amongst officers who were hesitant to do so. However, resistance to carry naloxone remains across police officers and more work is required to overcome this.

The findings indicate that while frontline officers demonstrated proficiency in naloxone administration, they were not equipped with the ‘softer’ skills to manage the after-effects of naloxone on people who use drugs, and the (full) understanding of the risks and benefits associated with the antidote. Barriers to effective training include inconsistent quality and content. There is a need for more in-depth content on what to do post-administration and the complementary role of CPR. It is recommended that scenario-based approaches are used to prepare officers for complex interactions with people who use drugs.

Therefore, naloxone training should be standardised across all police forces. This would ensure that all officers across England and Wales receive the same high-quality training. Consequently, all officers would be equipped with all the knowledge and skills necessary to respond to an overdose and administer naloxone effectively, further reducing the risk of harm and drug-related death for people who use drugs.

Comparable and standardised recording procedures are instrumental to the national rollout of police naloxone carriage. However, variability in data recording processes highlights the need for consistent protocols to ensure consistent tracking, enable comparisons across forces, and monitor naloxone supplies. It is recommended that data recording protocols are guided by clear strategic objectives and standardised data collection processes. Incorporating data collection processes used in Scotland, as well as recommendations from the literature, can facilitate a successful rollout nationally and optimise the implementation process within forces.

Consistent with the RCRP approach, there were instances where forces had made efforts to ensure referral pathways were available to people who use drugs who received police-administered naloxone. These referrals were made through harm reduction leads or a central MASH. In forces where there were no clear referral pathways, consent of people who use drugs was the main barrier to referring them to drug treatment services. These forces must be signposted to those that have these in place, to learn how they have overcome the challenge of gaining consent for referral to treatment from people who use drugs.

If there are existing guidelines on gaining consent, then these should be reviewed and clarified to provide comprehensive guidance on navigating consent-related challenges with people who use drugs. This could involve developing standardised procedures, utilising health-led triage models in collaboration with local health/drug treatment agencies or drawing from current practices adopted in Scotland. However, it must be noted that different systems are used by devolved nations. Therefore, processes must be adapted in England and Wales for efficient implementation.

Addressing the identified barriers and implementing the recommended measures can ensure that naloxone carriage is embedded as a vital component of policing, equipping officers with the resources, skills, and mindset to save lives, build trust with people who use drugs, and contribute to broader harm reduction efforts.

Question 7

Appendix A: Literature reviewed

Accepted Answer

Open source literature:

Advisory Council on the Misuse of Drugs (2022) ‘ACMD review of the UK naloxone implementation’. [viewed on 17 April 2025]

Association of Ambulance Chief Executives (2024) ‘Latest UK NHS ambulance sector data shows there can be no complacency over hospital handoverdelays as 32,000 people estimated to have come to potential harm in May 2024’. [viewed on 17 April 2025]

College of Policing (2024) ‘Legal overview for RCRP’. [viewed on 17 April 2025]

Compton, W.M., Cottler, L.B., Jacobs, J.L., Ben-Abdallah, A. and Spitznagel, E.L. (2003) ‘The Role of Psychiatric Disorders in Predicting Drug Dependence Treatment Outcomes’. American Journal of Psychiatry, 160, pp. 890 - 895. [viewed on 17 April 2025]

Davis, C.S., Ruiz, S., Glynn, P., Picariello, G. and Walley, A.Y. (2014) ‘Expanded Access to Naloxone Among Firefighters, Police Officers, and Emergency Medical Technicians in Massachusetts’. American Journal of Public Health, 104(8), pp.e7 - e9. [viewed on 17 April 2025]

Department of Health and Social Care (2023) ‘Government response to UK naloxone implementation report’. [viewed on 17 April 2025]

GOV.UK (2024) ‘Proposals to expand access to take-home naloxone supplies’. [viewed on 17 April 2025]

Great Britain. Home Office, and Department of Health & Social Care (2024) ‘National Partnership Agreement: Right Care, Right Person (RCRP)’. [viewed on 17 April 2025]

Hillen, P., Speakman, E., Jamieson, M., Dougall, N., Heyman, I., Murray, J., Aston, E. and McAuley, A. (2024) ‘Police officer knowledge of andattitudes to opioid overdose and naloxone administration: an evaluation of police training in Scotland’. Policing and Society, 35(1), pp. 1 - 16. [viewed on 17 April 2025]

HM Government ‘Project ADDER: About Project ADDER’. [viewed on 17 April 2025]

Home Office (2021) ‘Independent Review of Drugs by Professor Dame Carol Black’. [viewed on 17 April 2025]

Longstaff, A., Willer, J., Chapman, J., Czarnomski, S. and Graham, J. (2015) ‘Neighbourhood policing: Past, Present, and Future. A review of literature’. The Police Foundation. [viewed on 17 April 2025]

Mental Health Foundation (2024) ‘Drugs and Mental Health’. [viewed on 17 April 2025]

Metrebian, N., Carter, B., Eide, D., McDonald, R., Neale, J., Parkin, S., Dascal, T., Mackie, D., Guterstam, J., Horsburgh, K., Kaberg, M., Kelleher, M., Smith, J., Theisen, H. and Strang, J. (2023) ‘A study protocol for a European, mixed methods, prospective, cohort study of the effectiveness of naloxone administration by community members, in reversing opioid overdose: NalPORS’. BMC Public Health, 23(1). [viewed on 17 April 2025]

Morton, K.J., Harrand, B., Floyd, C.C., Schaefer, C., Acosta, J., Logan, B.C. and Clark, K. (2017) ‘Pharmacy-based statewide naloxone distribution: A novel “top-down, bottom-up” approach’. Journal of American Pharmacists Association, 57(2), pp. 99 - 106. [viewed on 17 April 2025]

Pollini, R.A., McCall, L., Mehta, S.H., Vlahov, D. and Strathdee, S.A. (2006) ‘Non-fatal overdose and subsequent drug treatment among injection drug users’. Drug and Alcohol Dependence, 83(2), pp. 104 - 110. [viewed on 17 April 2025]

Royal Pharmaceutical Society (2024) ‘Legislative changes to widen access to naloxone’. [viewed on 17 April 2025]

Speakman, E.M., Hillen, P., Heyman, I., Murray, J., Dougall, N., Aston, E.V. and McAuley, A. (2023) ’‘I’m not going to leave someone to die’: carriage of naloxone by police in Scotland within a public health framework: a qualitative study of acceptability and experiences’. Harm Reduction Journal 20(20). [viewed on 17 April 2025]

Sterling, S., Chi, F. and Hinman, A. (2011) ‘Integrating care for people with co-occurring alcohol and other drug, medical, and mental health conditions’. Alcohol, Research & Health, 33(4), pp. 348 - 349. [viewed on 17 April 2025]

The Toronto Star (2016) ‘RCMP to equip officers with anti-opioid nasal spray to fight fentanyl exposure’. [viewed on 17 April 2025]

UK Government (2024) ‘Proposals to expand access to take-home naloxone supplies: Government response’. [viewed on 17 April 2025]

UK Government (2024) ‘Explanatory Memorandum to The Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024’. [viewed on 17 April 2025]

Xavier, J., Greer, A., Crabtree, A. and Buxton, J. A. (2022) ‘Police officer’s perceptions of their role at overdose events: a qualitative study’. Drugs: Education, Prevention and Policy, 30(4), pp. 361 - 372. [viewed on 17 April 2025]

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