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Public health officials have declared the widespread use and misuse of prescription opioid medications an epidemic in the United States. The director of the Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden, has stated, “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently” (Frieden & Houry, 2016, p. 1503). The present study was prompted by the concern that there is no empirical data on how law enforcement officers have been affected by the use of opioids. It is the first empirical examination of how the epidemic has impacted police officers' resilience and fitness for duty. The President's Task Force on 21st Century Policing identified officer health, wellness, and fitness for duty as one of the six pillars to support policing in the 21st century. The Task Force also affirmed the long-standing belief that the same character strengths that impel officers to confront danger may also be barriers to their resilience. Recognizing this "double-edged" sword, this mixed-methods study analyzed medical and prescription claims over a four year period (2011 to 2014) to examine the prevalence of opioid use by officers in a large urban police department. Using the qualitative, interview-based methodology of Appreciative Inquiry (AI), it examined individual, organizational and systems-level factors explaining officers’ help-seeking for use of prescription medications, as well as help-seeking for substance abuse in general. The interviews also revealed what is needed to replace the existing cultural and organizational arrangements—which can lead to isolation, depression, pathology, and stigma—with a culture that has the necessary processes and commitment to promote physical, behavioral and mental resiliency. The quantitative analyses revealed that law enforcement officers are not immune from the opioid epidemic. Moreover, there is evidence of specific prescription drug use behaviors that indicate sub-groups of officers at heightened risk for developing an opioid use disorder. Approximately 40% of the officers in the sample filled an opioid prescription. Within this group, 27% of the officers filled a prescription for 90 days or longer and 34% filled prescriptions for benzodiazepines. The data also indicates that approximately 1 out of 7 officers in the sample received medical treatment for a mental illness each year. The qualitative data revealed that officers’ help-seeking behaviors for opioid dependence and abuse were shaped by the psychological process of surrendering and acknowledging their vulnerability. Seeking help, therefore, can run contrary to officers’ training and character traits. Additionally, the social supports of the police subculture and effective supervisory leadership contributed to officers’ recovery and resilience from opioid use disorder. Having access to trustworthy and culturally competent treatment services further enhanced officers’ recovery. The research also illuminates broader health care policies and commitments to wellness that can enhance the capacity of police agencies to hire, develop, and maintain resiliency in their officers. This dissertation extends Bronfenbrenner’s theory of resilience to the field of law enforcement. This theory adopts a social ecological perspective, capturing pathways and protective factors at micro, meso and macro levels that bolster officers’ personal growth and development. From a policy perspective, the findings support an asset-based approach to wellness, which stresses the need to access and enlist resources across the micro-, meso- and macro-level spheres. Future research in this area should extend knowledge into the unique cultural context of police work and its implications for the promotion of wellness and resiliency. / Criminal Justice

Chronic pain has no cure. It is a lifelong condition presenting a growing concern due to its high occurrence and effects on every facet of life. It cost about $635 billion each year in medical treatment and lost productivity (IOM, 2011). The management of chronic pain using prescription painkiller opioids has increased drastically in the last two decades, leading to a consequential increase in deaths from chronic opioid use. This Plan-Do-Study-Act quality improvement project investigates the problem of the prevalence of opioid prescription using agent-based computational modeling method. The simulation models the interaction of 50 patient-agents with pain self-management messages in an episode of 50 patient iterations (visits) for 10 simulated years. This interaction generates health benefit and risk outcomes represented by wellness data obtained when messages are processed. As the simulation runs, data are dynamically captured and visualized using wellness charts, time series plots, and benefit and risk regression plots. The result of the project provides evidence for research and practice on the process of achieving more impact of programs based on administering pain self-management education to patients with chronic non-cancer pain who are currently on opioid therapy and on the process of customizing interventions that might take advantage of the conditions of behavior change driven by pain self-management messages. The tools and the evidences in this project are highly recommended to nurse practitioners primary care providers involve with providing care to the vulnerable groups of patient with chronic non-cancer pain. These evidences might inform the formation of self-management interventions that might lead to a decline in opioid use and prescription and accelerate the acceptance of self-management practices.

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