Adjudicating medical uncertainty in public settings: How police officers, health workers, and people who use drugs exercise discretion when assessing overdose risk.

Overdose continues to cause a significant number of deaths in the United States each year. In recent years, naloxone, a medication used to reverse the effects of overdose, has become more accessible to professionals and lay people outside formal healthcare institutions. Existing research has demonstrated the life-saving benefits of naloxone, yet less attention has been paid to how responders decide whether and how to administer it. In this article, I draw on over 300 h of ethnographic fieldwork in Kensington, Philadelphia to demonstrate how police officers, health workers, and people who use drugs (PWUD) exercise discretion in overdose risk incidents in response to institutional mandates, organizational pressures, and relationally embedded situational knowledge. I show how responders navigate medical uncertainty surrounding naloxone and other overdose technologies through three dominant, and at times overlapping, orientations: weaponization among police, as a moral imperative to save lives among health workers, and through relational negotiation among PWUD. This study contributes to research on urban poverty governance, medical uncertainty, and science and technology studies by demonstrating how medical technologies are mobilized differently in uncertain, public, high-risk overdose incidents and how discretion is shaped by responders' institutional positions and relationships to PWUD.