The sheriff of Clermont County in Ohio firmly believes it's a call of duty for his deputies to carry a nasal spray that brings people back from the brink of death by drug overdose. Less than 50 miles away, his counterpart in Butler County is dead set against it, saying it subjects deputies to danger while making no lasting impact on the death toll.
The divide over naloxone, the popular overdose antidote, between nearby sheriffs in two hard-hit counties in one of the hardest-hit states for drug deaths shows just how elusive solutions are on the front lines of the U.S. opioid crisis.
Some police officials cite lack of resources for obtaining, maintaining and tracking supplies and for training in when and how to use it. They worry about taking on new duties they say are better suited for medical workers, divert them from fighting crime and can put them in danger. They get support from some citizens weary of people who overdose repeatedly.
Police who do carry it say that development of a nasal spray called Narcan makes naloxone simple to administer, that the $75 two-dose kits are usually given to them by health departments or community organizations, that it's not a major burden to track and maintain supplies and that it's a natural extension of their mission to serve and protect.
"I just say from my personal experience that it is right thing to do," said Sheriff Steve Leahy, whose Clermont County begins in the eastern Cincinnati suburbs, then rolls across hilly fields into Appalachia. Leahy, part of the early wave of police advocates of naloxone, acknowledges he was more inclined to support it after seeing someone close to him struggle for years with heroin.
"Don't get me wrong," Leahy said. "It doesn't mean that we're going to get out of this by hugging everybody, but ... you know, no matter what their plight is and how they got to where they are, it's not for us as law enforcement to decide whether they live or die."
Butler Sheriff Richard Jones, whose county includes growing northern Cincinnati suburbs, older industrial cities and rural areas, also voices compassion. He lost a brother at a young age to alcoholism and drugs, he said, and he recounts cradling infants twitching from the effects of their mothers' drug use.
U.S. & World
But people using drugs make choices, he said: "Knowing that they can die from it, but they still do it." (Addiction specialists and federal drug authorities say it's more complicated than that; repeated uses of a drug can result in brain changes and the disease of addiction.)
And, Jones said, people who overdose can be combative when they come to, he said; an officer bent over giving naloxone could get "a brick to the head."
"It's not what we're supposed to do," said Jones, known for blunt talk on such issues as illegal immigration and Donald Trump's GOP presidential campaign. "We won't do it. Period."
A recent visit with Jones by Associated Press reporters came the morning after a man in Middletown revived by firefighters came back to consciousness in attack mode. He injured a firefighter and tried to bite and punch others.
Such instances are rare, authorities say. Quincy, Massachusetts, police pioneered naloxone seven years ago and have reversed nearly 800 overdoses without a single officer being injured, said Lt. Patrick Glynn.
And advocates for those battling addiction say it seems like a natural situation for police, whose very jobs call for facing sudden threats.
In a Butler County mobile home park where the sheriff's office has stepped up patrols after complaints of drug activity, Jones' position has strong support from Brandon O'Hair, 21. Snuggling his newborn daughter, he said he and nearly all his neighbors have had cars or homes broken into by people stealing to fund their heroin habits.
"That's not what they're supposed to do; they're supposed to enforce the law," O'Hair said of the sheriff's refusal to stock naloxone. "I think it's tough love. ... The rest of us shouldn't have to pay for it."
An AP survey of Ohio's 88 sheriffs found that at least 68, or a little more than three-fourths, equip deputies with naloxone. Of those, a half-dozen have begun within the past six months, and most others have less than two years' experience.
It's hard to say what effect naloxone is having on overdose death rates.
Accidental overdose deaths in at least 11 Ohio counties where sheriffs have used the antidote for more than two years went up last year. Butler's did, too, and is on track for another record toll this year. In Clermont, where sheriff's deputies carry naloxone, the death toll went down last year. Statewide, the overdose death toll soared 33 percent, to 4,050 people, in 2016.
Naloxone is also widely distributed to families and friends of people with addiction. Its availability to police and sheriffs dates back only a few years. And attempts to gauge its effectiveness are hindered by variables including geographical variation in drug potency.
Amy Parker, a native and resident of Butler County, was saved twice by naloxone. She doesn't know whether it was police or paramedics who administered it when she overdosed on heroin in Indianapolis a few years ago. She eventually ended her drug use and now is a peer drug counselor, leading group meetings for those in rehabilitation.
The talk by the sheriff and residents of her county against police use of naloxone, she said, adds to the stigma of those battling drugs and to their reluctance to seek help. She bristled at the claim by Jones and others that naloxone enables; the saying among advocates, she says, is that the only thing naloxone "enables" is breathing.
"I don't care how many times it takes," Parker said. "As long as that person is alive, there is hope."
Contributing to this report were Associated Press reporters Kantele Franko and Andrew Welsh-Huggins in Columbus, Lisa Cornwell in Cincinnati, and AP news researcher Jennifer Farrar in New York.