Frequent police contact and nonfatal overdose among people who use drugs in rural Appalachia.

Abstract

Police contact shapes subsequent health practices and outcomes among people who use drugs (PWUD). However, the relationship between police encounters with overdose remains under-researched. We evaluated how police stop-and-search was associated with nonfatal overdose and identified correlates of frequent police contact among PWUD in rural Kentucky. From May 2023 - April 2024, 774 PWUD were enrolled in the Social Networks of Appalachian People and KyOSK studies. The exposure of interest was self-reported police stop-and-search in the past 6 months (0, 1-3, ≥4 times). The primary outcome was self-reported nonfatal overdose in the past 6 months. We evaluated the association between police stops and nonfatal overdose using multivariable logistic regression, adjusting for sociodemographic, housing, polysubstance use, and mental health covariates. Nearly all participants were non-Hispanic White (99%), 52% were female, and 45% used both opioids and methamphetamine in the past 6 months. Thirty-seven percent reported being stopped and searched; 17% experienced a nonfatal overdose. PWUD who were stopped and searched by police ≥ 4 times in the past six months had more than double the odds of nonfatal overdose (adjusted odds ratio: 3.19, 95% CI: 1.60, 6.32) compared to PWUD with no police contact, controlling for other factors. PWUD reporting frequent police contact were significantly more likely to be unstably housed and less likely to be on medications for opioid use disorder. Police stop-and-search was associated with elevated subsequent overdose risk among PWUD. Efforts to improve PWUD health should recast police encounters as opportunities for harm reduction.