Occupational and Personal Challenges During the Opioid Crisis: Understanding First Responders' Experiences and Viewpoints of Clients with Opioid Use Disorder.

OBJECTIVES: This study provides preliminary findings on the experiences of first responders during the opioid crisis and their viewpoints regarding whether clients with opioid use disorder deserve medical rehabilitation. Understanding associations between first responder experiences and viewpoints of client deservedness can help reduce stigma, improve compassionate care, and identify training gaps. METHODS: Analyses were run with data from a nationwide survey of Emergency Medical Services-providers and law enforcement workers collected from August to November 2022 (N = 3836). The study used univariate statistics and ordered logistic regression to understand first responders' experiences and viewpoints on client deservedness, as well as the relationship between the two. RESULTS: Results show a negative correlation between responding to overdose calls and perceiving clients with opioid use disorder as deserving of medical rehabilitation. Law enforcement, males, and conservatives also had negative viewpoints. Conversely, having a friend experience addiction and believing addiction has had a direct impact on respondents' lives predicted increases in client deservedness. CONCLUSIONS: Policy should focus on creating spaces where first responders can have positive interactions with people who use drugs or are in recovery. Better training is needed to help first responders manage on-the-job stressors and understand the complexities of addiction.

Understanding problematic substance use among first responders during the COVID-19 pandemic: A survey of law enforcement, fire, and EMS workers in the United States.

BACKGROUND: First responders have experienced increased levels of stress, anxiety, and depression due to job-related pressures associated with the COVID-19 pandemic. However, little is known about the factors associated with first responder drug and alcohol use during this time. METHODS: We conducted a nationwide survey of first responders (n = 2801) to understand the relationship between work pressures, workplace support strategies, and problematic substance use during the early stages of the COVID-19 pandemic. We employed structural equation modeling to analyze whether burnout mediated these relationships. RESULTS: Descriptive statistics showed that 60.8 % reported no concerns with substance use. While general workplace support strategies were negatively associated with problematic substance use, specific COVID-related strategies, such as providing compensation during quarantine, were positively associated with problematic substance use. Burnout fully mediated relationships between workplace support strategies and problematic substance use. Finally, providing spaces at work to decompress was negatively associated with problematic substance use and burnout. CONCLUSION: Although work pressures increased burnout and problematic substance use among first responders, general workplace support strategies (e.g., decompression spaces) reduced problematic substance use while some COVID-related strategies (e.g. compensation during quarantine) increased problematic substance use. Policy interventions to address problematic substance use should focus on providing spaces for first responders to decompress at work, as well as implementing strategies (e.g., access to mental health services, time off) to reduce burnout. However, organizations should be mindful that not all interventions will have their intended impact and some interventions may unintentionally contribute to negative employee outcomes.

Policy responsiveness and institutions in a federal system: Analyzing variations in state-level data transparency and equity issues during the COVID-19 pandemic.

In the absence of a coherent federal response to COVID-19 in the United States, state governments played a significant role with varying policy responses, including in data collection and reporting. However, while accurate data collection and disaggregation is critically important since it is the basis for mitigation policy measures and to combat health disparities, it has received little scholarly attention. To address this gap, this study employs agency theory to focus on state-level determinants of data transparency practices by examining factors affecting variations in state data collection, reporting, and disaggregation of both overall metrics and race/ethnicity data. Using ordered logistic regression analyses, we find that legislatures, rather than governors, are important institutional actors and that a conservative ideology signal and socio-economic factors help predict data reporting and transparency practices. These results suggest that there is a critical need for standardized data collection protocols, the collection of comprehensive race and ethnicity data, and analyses examining data transparency and reductions in information asymmetries as a pandemic response tool-both in the United States and globally.