Weaponizing uncertainty: how responders utilize discretion when responding to potential overdose incidents

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 18. Healthcare Providers & Practice II

Abstract

Overdoses continue to cause a significant number of deaths in the United States each year. In recent years, naloxone, a medication used to reverse the effects of overdose, has become more accessible to professionals and lay people outside clinic rooms. However, there is much research about the politics and accessibility of naloxone, but there is a lack of research that focuses on the precise strategies and decision-making processes of people who respond in overdose incidents. In this article, I draw on over 300 hours of ethnographic fieldwork in Kensington, Philadelphia during a police crackdown in 2024 to demonstrate how police officers, health workers, and lay people make decisions in overdose risk incidents. I show that naloxone becomes a tool of discretionary governance to deal with street-level medical uncertainty regarding overdose risk through three distinct logics: weaponization (police); as a moral imperative (health workers); and through relational negotiation (lay people). This study contributes to the study of urban poverty governance and medical uncertainty, by demonstrating how people use discretion when deciding how to use a particular pharmaceutical technology in street-level overdose response. Included in this paper are policy recommendations surrounding how to implement structural and organizational changes in overdose environments.

Author

• Andrew Chelius, Temple University