Reluctant Saviors: Professional ambivalence, cultural imaginaries, and deservingness construction in naloxone provision

Professions compete over jurisdictions by laying claim to specific tasks. Research shows that they enhance their professional status by siphoning off tasks and seizing control of social problems that belong to other professions. Not all tasks are equally desirable, though. Studies find that workers resist helping stigmatized groups or taking on “unsolvable” social problems. This raises a critical question for social scientists: How do professionals respond when opportunities for jurisdictional expansion are contingent on aiding a stigmatized population? Our study draws on research from the sociology of culture, professions, and stigma and empirical evidence about naloxone provision to develop a theory of professional ambivalence that explains how professionals respond to this fundamental tension. In response to rising rates of overdose deaths in the U.S., many cities have adopted naloxone provision programs in which first responders—police, firefighters, and EMTs—carry and administer naloxone, an opioid overdose antidote. For police and firefighters, this task enables them to venture into medical territory, but for all three professionals, it requires working with the stigmatized population of people who use drugs. We use abductive analysis of qualitative interviews (n = 20) conducted in a Midwestern metropolitan area from 2018 to 2019 to explore professionals’ attitudes about naloxone. We find that professionals’ willingness to take on new tasks is largely grounded in how they construct patients as deserving or undeserving of care. Deservingness construction is a constitutive process through which first responders draw on cultural imaginaries about addiction and treatment as well as their own experiences providing naloxone. This results in three mechanisms of deservingness construction—experiential, behavioral, and interactional—that reinforce cultural imaginaries and affect how they think about patients, naloxone, and addiction. Findings contribute to theory of professional ambivalence and offer policy implications to enhance the effectiveness of naloxone provision programs.