Project Summary The recent convergence of the overdose epidemic and continued racialized police violence has accelerated efforts to mitigate the racially disparate harms of policing toward people who use drugs (PWUD) by aligning law enforcement’s role as first responders with evidence-based public health approaches to drug use rooted in harm reduction. Police departments now commonly equip officers with naloxone, participate in partnerships with healthcare service providers, and have a lead role in celebrated diversion programs targeting PWUD and other marginalized populations. Despite initial evaluations of these approaches showing promise in isolation, widespread and enduring reform across the institution of policing has not materialized. Punitive enforcement of drug offenses remains central to the institution of policing. True harmonization of criminal justice and public health systems requires broad changes to well-established cultural and institutional norms. The proposed R36 application builds on pilot program evaluations and studies examining changes in isolated measures of police enforcement by examining how police officers in Baltimore City, Maryland, negotiate, contest, and make sense of drug policy reforms and guidance from public health authorities in order to understand how the broader cultural shift toward evidence-based approaches to substance use is being translated into policing practices that are ultimately experienced by PWUD. Through in-depth interviews with Baltimore Police Department (BPD) leadership (n=20), observations of BPD public-facing events (n=15), and observational ride-alongs with street-level officers (n=60), this research aims to qualitatively explore, 1) how police leadership integrate harm reduction approaches to drug enforcement into the department’s organizational approach to PWUD, and 2) street-level officers’ beliefs, attitudes, and enforcement practices towards PWUD. Analysis of interview transcripts and observation fieldnotes will be conducted using an abductive approach, drawing on theories and concepts from studies of organizations and organizational change, police culture, risk environments and structural determinants of health. The PI of the proposed R36 application, Bradley Silberzahn, is a doctoral candidate in the Department of Sociology at the University of Texas at Austin (UT Austin). Brad will lead all study procedures, as well as a broader expert panel comprised of faculty from UT Austin, Johns Hopkins Bloomberg School of Public Health, and New York University’s School of Global Public Health. This research will inform ongoing debates over drug policy and the role of law enforcement in harm reduction, as well as identify barriers and avenues for widespread and enduring police reform that facilitates police enforcement practices that are in alignment with, not antithetical to, public health.