Corresponding Author

Kathleen Egan, PhD, MS, Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Telephone: 336-716-9354. Email: klegan@wakehealth.edu.

Author Affiliations

1. Kathleen L. Egan, PhD, MS: Associate Professor (Implementation Science), Department of Implementation Science, Wake Forest University School of Medicine (Winston-Salem NC); E-mail: klegan@wakehealth.edu

2. Kelly K. Gurka, MPH, PhD: Assistant Professor (Epidemiology), Department of Epidemiology, University of Florida (Gainesville FL)

3. Alexandria Macmadu, PhD, ScM: Presidential Postdoctoral Research Associate, Department of Epidemiology, Brown University (Providence RI)

4. Herb I. Linn, MS: Research Associate, Office of Health Affairs, West Virginia University (Morgantown WV)

Author Area of Expertise

Kathleen L. Egan, PhD, MS: Substance use prevention; program evaluation; implementation science

Kelly K. Gurka, MPH, PhD: Substance use epidemiology; maternal and child health

Alexandria Macmadu, PhD, ScM: Substance use epidemiology; harm reduction; health equity

Herbert I. Linn, MS: harm reduction; community engaged research


Introduction: Success of opioid overdose interventions involving first responders is dependent on the comfort level that bystanders have with first responders and their willingness to call for assistance. Positive or negative experiences with first responders following witnessing an overdose may influence a person’s willingness to call a first responder for assistance in the future.

Purpose: The objective of this study was to examine changes in bystanders’ perceptions of first responders following witnessing an overdose attended by emergency medical services or a law enforcement official. It specifically explored perception changes among a sample of individuals residing in Appalachia who use prescription opioids nonmedically.

Methods: Individuals from West Virginia who used prescription opioids nonmedically were interviewed to examine changes in perceptions of first responders following witnessing an overdose. The analytic sample (N = 50) consisted of participants who witnessed an overdose for which 911 was called and stayed until a first responder arrived. Chi-square contingency tables and ANOVA were conducted to assess relationships between individual and contextual characteristics with changes in perceptions.

Results: Findings indicate that the majority (63%) had improved perceptions of first responders, 6% had diminished perceptions, and 24% were unchanged. Changes in perceptions varied by income, presence during substance use, and prior concerns about first responders.

Implications: Individuals who reported experiencing a positive interaction with first a responder after witnessing an overdose may be more likely to call 911 during an overdose and support other interventions by first responders (e.g., referral to syringe service programs or treatment with medications for opioid use disorder).



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Egan KL, Gurka KK, Macmadu A, Linn HI. Changes in perceptions of first responders after witnessing a drug overdose: Individual and contextual variations among people who use opioids in West Virginia. J Appalach Health 2023;5(3):22–37. DOI: https://doi.org/10.13023/jah.0503.03