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Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Document Type

Article

Publication Date

2026

Notes/Citation Information

0376-8716/© 2026 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.drugalcdep.2026.113188

Funding Information

We thank the KyOSK and SNAP study staff, study participants, and board members for their valuable contributions to the study. This work was supported by the National Institutes of Health through the National Institute on Drug Abuse, which funds KyOSK (R01DA055872 to AMY as principal investigator) and SNAP (R01DA033862 and R01DA024598 to JRH as principal investigator). Funding from the National Institute of Allergy and Infectious Diseases and National Institute on Drug Abuse also supported this analysis (R61DA060622 to JAC, EP, and LB as principal investigators and T32AI102623 which supported TL). The San Diego Center for AIDS Research provided support for the preparation of this manuscript (to EP; P30AI036214).

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