{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T06:28:29Z","timestamp":1793600909154,"version":"4.5.0"},"reference-count":55,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/100010842","name":"Temple University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010842","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Social Science & Medicine"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1016\/j.socscimed.2026.119849","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:10:33Z","timestamp":1790035833000},"page":"119849","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Adjudicating medical uncertainty in public settings: How police officers, health workers, and people who use drugs exercise discretion when assessing overdose risk"],"prefix":"10.1016","volume":"409","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8774-9826","authenticated-orcid":false,"given":"Andrew","family":"Chelius","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.socscimed.2026.119849_bib1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0341062","article-title":"From law enforcement to public safety: police officer experiences of naloxone administration to reverse opioid overdose in New York city","volume":"21","author":"Allen","year":"2026","journal-title":"PLoS One"},{"key":"10.1016\/j.socscimed.2026.119849_bib2","series-title":"ATLAS.ti","year":"2023"},{"issue":"4","key":"10.1016\/j.socscimed.2026.119849_bib3","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1080\/03007995.2017.1334637","article-title":"Use of naloxone nasal spray 4 mg in the community setting: a survey of use by community organizations","volume":"34","author":"Avetian","year":"2017","journal-title":"Curr. Med. Res. Opin."},{"key":"10.1016\/j.socscimed.2026.119849_bib4","series-title":"The Fibromyalgia Story","author":"Barker","year":"2009"},{"key":"10.1016\/j.socscimed.2026.119849_bib5","series-title":"Forgive and Remember: Managing Medical Failure","author":"Bosk","year":"1979"},{"key":"10.1016\/j.socscimed.2026.119849_bib6","series-title":"Righteous Dopefiend","author":"Bourgois","year":"2009"},{"issue":"2","key":"10.1016\/j.socscimed.2026.119849_bib7","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1056\/NEJMra1202561","article-title":"Management of opioid analgesic overdose","volume":"367","author":"Boyer","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"10.1016\/j.socscimed.2026.119849_bib8","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2019.112446","article-title":"A good \u201cdoctor\u201d is hard to find: assessing uncredentialed expertise in assisted injection","volume":"237","author":"Brothers","year":"2019","journal-title":"Soc. Sci. Med."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119849_bib9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12954-024-01143-2","article-title":"Managing xylazine-involved overdoses in a community harm reduction setting: lessons from Tijuana, Mexico","volume":"22","author":"Bufanda","year":"2025","journal-title":"Harm Reduct. J."},{"key":"10.1016\/j.socscimed.2026.119849_bib10","series-title":"OD","author":"Campbell","year":"2020"},{"key":"10.1016\/j.socscimed.2026.119849_bib11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/02791072.2025.2537039","article-title":"Overdoses with xylazine and fentanyl recorded in Pennsylvania's overdose information network: an analysis of law enforcement\/first responder-reported overdose response","author":"Cano","year":"2025","journal-title":"J. Psychoact. Drugs"},{"key":"10.1016\/j.socscimed.2026.119849_bib12","article-title":"Medetomidine in the U.S. illegal fentanyl supply increasing risk for overdose and severe withdrawal syndrome","year":"2026","journal-title":"Health Alert Network (HAN)"},{"key":"10.1016\/j.socscimed.2026.119849_bib13","series-title":"Constructing Grounded Theory","author":"Charmaz","year":"2014"},{"issue":"2S","key":"10.1016\/j.socscimed.2026.119849_bib14","first-page":"S76","article-title":"A review of the use of naloxone as an opioid overdose reversal agent","volume":"58","author":"Chimbar","year":"2018","journal-title":"J. Am. Pharmaceut. Assoc."},{"issue":"6","key":"10.1016\/j.socscimed.2026.119849_bib45","article-title":"Decline in US drug overdose deaths by region, substance, and demographics","volume":"8","author":"Ciccarone","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"10.1016\/j.socscimed.2026.119849_bib15","series-title":"Life and Words: Violence and the Descent into the Ordinary","author":"Das","year":"2007"},{"key":"10.1016\/j.socscimed.2026.119849_bib16","doi-asserted-by":"crossref","DOI":"10.1016\/j.ypmed.2019.105932","article-title":"Over the counter naloxone needed to save lives in the United States","volume":"130","author":"Davis","year":"2020","journal-title":"Prev. Med."},{"issue":"3","key":"10.1016\/j.socscimed.2026.119849_bib17","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.socscimed.2005.06.018","article-title":"Illnesses you have to fight to get: facts as forces in uncertain, emergent illnesses","volume":"62","author":"Dumit","year":"2006","journal-title":"Soc. Sci. Med."},{"issue":"3","key":"10.1016\/j.socscimed.2026.119849_bib18","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1177\/0091450917723350","article-title":"Assembling the social and political dimensions of take-home naloxone","volume":"44","author":"Farrugia","year":"2017","journal-title":"Contemp. Drug Probl."},{"key":"10.1016\/j.socscimed.2026.119849_bib19","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.socscimed.2017.03.013","article-title":"The social logic of naloxone: peer administration, harm reduction, and the transformation of social policy","volume":"180","author":"Faulkner-Gurstein","year":"2017","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119849_bib20","series-title":"Formations of Violence: the Narrative of the Body and Political Terror in Northern Ireland","author":"Feldman","year":"1991"},{"key":"10.1016\/j.socscimed.2026.119849_bib21","series-title":"The student-physician: Introductory Studies in the Sociology of Medical Education","first-page":"207","article-title":"Training for uncertainty","author":"Fox","year":"1957"},{"issue":"11","key":"10.1016\/j.socscimed.2026.119849_bib22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0225376","article-title":"Structural vulnerability to narcotics-driven firearm violence: an ethnographic and epidemiological study of Philadelphia's Puerto Rican inner-city","volume":"14","author":"Friedman","year":"2019","journal-title":"PLoS One"},{"key":"10.1016\/j.socscimed.2026.119849_bib23","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2022.109380","article-title":"Xylazine spreads across the US: a growing component of the increasingly synthetic and polysubstance overdose crisis","volume":"233","author":"Friedman","year":"2022","journal-title":"Drug Alcohol Depend."},{"key":"10.1016\/j.socscimed.2026.119849_bib24","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugpo.2025.105031","article-title":"Perspectives on prescribed safer supply programs among people who inject drugs in Baltimore, Maryland: a mixed methods study among individuals highly affected by drug toxicity","volume":"146","author":"German","year":"2025","journal-title":"Int. J. Drug Pol."},{"key":"10.1016\/j.socscimed.2026.119849_bib25","series-title":"Hobos, Hustlers, and Backsliders: Homeless in San Francisco","author":"Gowan","year":"2010"},{"issue":"24","key":"10.1016\/j.socscimed.2026.119849_bib26","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1056\/NEJMp2303120","article-title":"Xylazine\u2014medical and public health imperatives","volume":"388","author":"Gupta","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"10.1016\/j.socscimed.2026.119849_bib27","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugpo.2021.103457","article-title":"Increasingly powerful opioid antagonists are not necessary","volume":"99","author":"Hill","year":"2022","journal-title":"Int. J. Drug Pol."},{"issue":"4","key":"10.1016\/j.socscimed.2026.119849_bib28","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1080\/00952990.2025.2497800","article-title":"Early experiences and impacts of a fentanyl powder safer supply program in Vancouver, Canada: a qualitative study","volume":"51","author":"Ivsins","year":"2025","journal-title":"Am. J. Drug Alcohol Abuse"},{"issue":"37","key":"10.1016\/j.socscimed.2026.119849_bib29","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.15585\/mmwr.mm7037a4","article-title":"Notes from the field: xylazine detection and involvement in drug overdose deaths\u2014United states, 2019","volume":"70","author":"Kariisa","year":"2021","journal-title":"MMWR (Morb. Mortal. Wkly. Rep.)"},{"issue":"5","key":"10.1016\/j.socscimed.2026.119849_bib30","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s11904-017-0363-y","article-title":"Public health and public order outcomes associated with supervised drug consumption facilities: a systematic review","volume":"14","author":"Kennedy","year":"2017","journal-title":"Curr. HIV AIDS Rep."},{"issue":"7","key":"10.1016\/j.socscimed.2026.119849_bib31","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1517\/14740338.2015.1037274","article-title":"Reducing the harm of opioid overdose with the safe use of naloxone: a pharmacologic review","volume":"14","author":"Kim","year":"2015","journal-title":"Expert Opin. Drug Saf."},{"issue":"2","key":"10.1016\/j.socscimed.2026.119849_bib32","doi-asserted-by":"crossref","DOI":"10.5811\/westjem.2020.10.48768","article-title":"\u201cNobody wants to be Narcan'd\u201d: a pilot qualitative analysis of drug users' perspectives on naloxone","volume":"22","author":"Lai","year":"2021","journal-title":"West. J. Emerg. Med.: Integrating Emergency Care with Population Health"},{"key":"10.1016\/j.socscimed.2026.119849_bib33","series-title":"Street-Level Bureaucracy: Dilemmas of the Individual in Public Services","author":"Lipsky","year":"1980"},{"issue":"1","key":"10.1016\/j.socscimed.2026.119849_bib34","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1177\/2042098617744161","article-title":"Naloxone dosage for opioid reversal: current evidence and clinical implications","volume":"9","author":"Lynn","year":"2018","journal-title":"Therapeutic Advances in Drug Safety"},{"issue":"1","key":"10.1016\/j.socscimed.2026.119849_bib35","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1215\/08992363-15-1-11","article-title":"Necropolitics","volume":"15","author":"Mbembe","year":"2003","journal-title":"Public Cult."},{"issue":"5","key":"10.1016\/j.socscimed.2026.119849_bib36","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1111\/joms.12009","article-title":"Still blue-collar after all these years? An ethnography of the professionalization of emergency ambulance work","volume":"50","author":"McCann","year":"2013","journal-title":"J. Manag. Stud."},{"key":"10.1016\/j.socscimed.2026.119849_bib37","article-title":"The effectiveness of drug-related good samaritan laws: a review of the literature","volume":"90","author":"Moallef","year":"2020","journal-title":"Int. J. Drug Pol."},{"key":"10.1016\/j.socscimed.2026.119849_bib38","series-title":"The Body Multiple: Ontology in Medical Practice","author":"Mol","year":"2002"},{"issue":"11","key":"10.1016\/j.socscimed.2026.119849_bib39","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1016\/j.socscimed.2007.08.008","article-title":"Informed consent, anticipatory regulation and ethnographic practice","volume":"65","author":"Murphy","year":"2007","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119849_bib40","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s12954-025-01203-1","article-title":"Naloxone dosing by non-medical first-responders at opioid overdoses: findings from a qualitative interview study","volume":"22","author":"Neale","year":"2025","journal-title":"Harm Reduct. J."},{"key":"10.1016\/j.socscimed.2026.119849_bib41","article-title":"(Re)situating expertise in community-based overdose response: insights from an ethnographic study of overdose prevention sites (OPS) in Vancouver, Canada","volume":"118","author":"Olding","year":"2023","journal-title":"Int. J. Drug Pol."},{"issue":"5","key":"10.1016\/j.socscimed.2026.119849_bib42","doi-asserted-by":"crossref","first-page":"110","DOI":"10.15585\/mmwr.mm7305a4","article-title":"Comparison of administration of 8-milligram and 4-milligram intranasal naloxone by law enforcement during response to suspected opioid overdose\u2014New York, march 2022\u2013August 2023","volume":"73","author":"Payne","year":"2024","journal-title":"MMWR (Morb. Mortal. Wkly. Rep.)"},{"key":"10.1016\/j.socscimed.2026.119849_bib43","article-title":"Trapped by the \u201cWalmart of heroin.\u201d","author":"Percy","year":"2018","journal-title":"The New York Times"},{"issue":"1","key":"10.1016\/j.socscimed.2026.119849_bib44","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.annemergmed.2024.01.041","article-title":"National institute on drug abuse clinical trials network meeting report: managing patients exposed to xylazine-adulterated opioids in emergency, hospital and addiction care settings","volume":"84","author":"Perrone","year":"2024","journal-title":"Ann. Emerg. Med."},{"issue":"1","key":"10.1016\/j.socscimed.2026.119849_bib46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/700703","article-title":"With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths","volume":"62","author":"Rees","year":"2019","journal-title":"J. Law Econ."},{"issue":"3","key":"10.1016\/j.socscimed.2026.119849_bib48","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s11524-019-00364-2","article-title":"Overdose prevention site acceptability among residents and businesses surrounding a proposed site in Philadelphia, USA","volume":"96","author":"Roth","year":"2019","journal-title":"J. Urban Health"},{"issue":"3","key":"10.1016\/j.socscimed.2026.119849_bib49","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1086\/204378","article-title":"The primacy of the ethical: propositions for a militant anthropology","volume":"36","author":"Scheper-Hughes","year":"1995","journal-title":"Curr. Anthropol."},{"issue":"3","key":"10.1016\/j.socscimed.2026.119849_bib50","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1177\/0003122417702367","article-title":"The ambulance: toward a labor theory of poverty governance","volume":"82","author":"Seim","year":"2017","journal-title":"Am. Sociol. Rev."},{"issue":"8","key":"10.1016\/j.socscimed.2026.119849_bib51","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1080\/10826084.2025.2491768","article-title":"\u201cAll you can do is what you know to do\u201d: naloxone knowledge and uncertainty among people who use drugs in Maryland amid a volatile drug market","volume":"60","author":"Sisson","year":"2025","journal-title":"Subst. Use Misuse"},{"key":"10.1016\/j.socscimed.2026.119849_bib52","article-title":"Policing harm reduction: a case study of who counts as human","author":"Snyder","year":"2024","journal-title":"Crime Media Cult."},{"key":"10.1016\/j.socscimed.2026.119849_bib53","series-title":"Down, Out, and Under Arrest: Policing and Everyday Life in Skid Row","author":"Stuart","year":"2016"},{"key":"10.1016\/j.socscimed.2026.119849_bib54","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.socscimed.2016.05.027","article-title":"Detached concern?: emotional socialization in twenty-first century medical education","volume":"160","author":"Underman","year":"2016","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119849_bib55","article-title":"Experiences administering naloxone among people in different social roles: people who use opioids and family members and friends","author":"Urmanche","year":"2022","journal-title":"J. Drug Issues"},{"key":"10.1016\/j.socscimed.2026.119849_bib56","article-title":"Responding to medetomidine: clinical and public health needs","volume":"44","author":"Zhu","year":"2025","journal-title":"Lancet Reg. Health, Am."}],"container-title":["Social Science & Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953626009275?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953626009275?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T05:49:28Z","timestamp":1793598568000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0277953626009275"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":55,"alternative-id":["S0277953626009275"],"URL":"https:\/\/doi.org\/10.1016\/j.socscimed.2026.119849","relation":{},"ISSN":["0277-9536"],"issn-type":[{"value":"0277-9536","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Adjudicating medical uncertainty in public settings: How police officers, health workers, and people who use drugs exercise discretion when assessing overdose risk","name":"articletitle","label":"Article Title"},{"value":"Social Science & Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.socscimed.2026.119849","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"119849"}}