Physicians' perspectives on Extreme Risk Protection Orders (ERPOs) in the clinical setting: Challenges and opportunities for gun violence prevention

PLoS One. 2022 Sep 13;17(9):e0274489. doi: 10.1371/journal.pone.0274489. eCollection 2022.


Background: Firearm-related injuries remain a heavy public health and clinical burden in the United States. Extreme Risk Protection Order (ERPO) laws, which create a path through a civil court process to temporarily remove firearms from individuals deemed to be at risk of harming themselves or others and are one strategy designed to reduce firearm violence. Maryland was the first state to authorize clinicians as ERPO petitioners.

Objective: We aim to document a sample of Maryland physicians' perspectives about the utility of, any barriers to, and other thoughts on clinicians as ERPO petitioners.

Design: A series of semi-structured interviews with Maryland physicians identified through a combination of purposive and snowball sampling. We coded the transcribed interviews and analyzed the coded transcripts for themes using deductive content analysis.

Setting/participants: 13 Maryland-based physicians interviewed over Zoom in and around Baltimore City, Maryland.

Results: The interviewees had overall positive feedback about ERPO as a gun violence prevention tool in the clinical setting. They identified several barriers to effective implementation such as time spent on paperwork and in court, a lack of awareness among clinicians about ERPO, threats to therapeutic alliance, and a sense of futility in a culture where firearms are easy to obtain. Solutions such as providing clinician education about ERPO laws, allowing for virtual court testimony, and creating a consult service with ERPO specialists to manage ERPO petitions were discussed.

Limitations: This study includes a small sample of Maryland-based physicians.

Conclusions: The physicians we interviewed expressed interest in knowing more about ERPO laws and emphasized education as an important tool for improving implementation. Addressing physicians' concerns about ERPO implementation will improve their ability to be effective and efficient petitioners.

MeSH terms

  • Firearms*
  • Gun Violence* / prevention & control
  • Humans
  • Law Enforcement
  • Physicians*
  • United States
  • Violence

Grants and funding

The author(s) received no specific funding for this work.