The Impact of Lived Experience Representative Bureaucracy on the Perceived Humanness and Deservingness of Clients: Analyzing First Responders’ Attitudes Toward People with Opioid Use Disorder

Representative bureaucracy theory has mainly been used to understand how identities related to race, ethnicity, and gender influence how bureaucrats administer public services. Although representation through lived experience has expanded the scope of the theory, this theoretical thread has mostly focused on the perspectives of management. In addition, the literature has generally analyzed the values, beliefs, and actions of minoritized bureaucrats rather than those of the racial and ethnic majority. The purpose of this dissertation is to employ lived experience and traditional representative bureaucracy theories to understand the influence of first responders’ experiences with addiction on their viewpoints regarding the humanness and deservingness of clients with opioid use disorder; examine how white first responders perceive clients of different races; and analyze the effect of lived experience on sentiments regarding clients of color.
In this dissertation, I surveyed county- and municipal-level EMS-providers and law enforcement workers in the United States, utilizing a survey experiment and mediation models for the analysis. Results show that indirect and direct lived experiences—respectively, having a family member or friend who has experienced an addiction and feeling addiction has had a direct impact on respondents’ lives—predicted increases in client deservingness, mediated by ascribed humanness and driven largely by EMS-providers. However, responding to opioid overdoses and administering naloxone— on-the-job lived experiences—were associated with reduced deservingness and ascribed humanness in both law enforcement and EMS organizations. Regarding the race of the client, white police personnel had more positive views of white clients with opioid use disorder relative to Black and unidentified clients, with effects amplified by on-the-job and indirect experiences but blunted by direct experiences.