At the recent Inaugural Pre-Trial Diversion Conference of Police, Treatment and Community in Florida, I (Al Sharp) was privileged to hear presentations on five forms of diversion for non-violent drug offenders away from the prison industrial complex and into treatment and support programs. Below, we offer descriptions of these programs, excerpted from the presenters at the conference. Statements have been edited for length.
In this model, the individual initiates contact with law enforcement to seek a treatment referral, without fear of arrest. Allie McDade, Executive Director of the Police Assisted Addiction and Recovery Initiative in Gloucester, Massachusetts, presented about the program.
The Gloucester Angel program was started in June 2015 after a series of overdose deaths in that community. Gloucester is a small fishing community about an hour north of Boston, so one overdose death per month was a lot for them. The police departments decided to do something different.
The idea was that they would open the doors of the police station and anybody who wanted to come in, 24 hours a day, could just walk into the station and ask for help and they would figure out how to get you into treatment. It didn’t matter where you lived, whether or not you had insurance, what your drug of choice was. The goal was to prevent overdose deaths. The self-referral pathway, as the name suggests, is for people who are ready for treatment. It’s reaching people outside of the criminal justice system before any violation occurs.
Anybody can walk in and ask for a direct referral. Some of the programs, including Gloucester’s, are going to address the barriers to treatment and create linkages, for example, between detox and a longer-term care and advocate. We also do a lot of reentry support, so once someone returns to the community after treatment, we help them get connected to housing and employment.
This pathway—and all the other pathways really—would not work without collaboration. Obviously, as a department, you need [a program] to refer someone to, and you need to be familiar with all the different recovery support services in your community. So, collaboration and linkages are very, very important to this pathway.
In this approach, law enforcement identifies individuals and hands them off to a treatment provider. John Tharp, Sheriff of Lucas County, Ohio, described the program and its origins.
In 1973, my partner and I responded to a call. When we arrived, there were three people dead from overdose in an apartment. We made out a half-page report and contacted the coroner, who came and got the bodies, and that’s all we did… .We were thinking, “We should be doing more.”
So we decided that when we got calls for an overdose we would take those individuals straight to detox when they were released from the hospital. We called Ohio Attorney General DeWine and explained the situation to him, and he brought us $800,000 to pay for more officers and for detox beds.
Since the inception of the unit, we have responded to over 2,600 overdoses, so we’re averaging right around 79% success of getting people into detox beds and getting people to agree to go to detox beds.
It’s very, very tough to respond and get people to go with us, because first of all, they’re afraid of cops. They just overdosed, and the last person they want to see is law enforcement. So, we talk them into going to detox with us, and they will do so.
We actually deputized park rangers and brought them in. We have certified peace officers who work security in public libraries, and we deputize them. We now have 17 officers who are aggressive and responding.
We know that relapse is part of recovery. They relapse. Once they’ve relapsed, we don’t wash our hands of them. We continue to go back and work with them.
This option involves engagement with treatment as part of a response to an overdose or a severe substance use disorder at acute risk for opioid overdose. Tom Fallon, Commander, Amberley Village Police Department, Hamilton County, Ohio; Dan Meloy, Director of Public Safety, Colerain County, Ohio; and Kelly Firesheets, Coordinator, Interact for Health’s Preventing Opioid Misuse and Safety Network described their communities’ applications of this approach to addiction.’
Meloy: I was talking to people in recovery: “What if we showed up at your door after you overdosed? What would you say?” And the young man happened to be a firefighter. He had fallen off a roof in the line of duty, had surgery, was prescribed Percocet, and addiction followed, then crime; he was facing prison and got probation. He just looked at me and he cried…. “Why would police and fire care? I’ve overdosed so many times. I turned into a criminal. Why would police and fire care about me?”
I sat down with the CEO of the Greater Cincinnati Addiction Services Council and laid out the model: “We have the information; we’re going to go out and proactively find them. What do you think?” The CEO looked at me: “It’s going to work. I’ve been doing street-level social work for over 30 years. You’re breaking down barriers by being there.”
Fallon: You have to locate the victim, which a lot of times is very difficult. These people are nomadic. You knock on the door, you get them, and you turn them over, and you just say, “How can I help you?” Our role is to locate the victim and turn them over to the behavioral health people. They figure out the best place to place them, whether in intense outpatient or detox, or whatever they need.
What we see is a collaboration between first responders, usually police, fire, EMS in some shape, form, or fashion and then public health and treatment. More and more, we’re integrating peer recovery coaches and peer recovery counselors, which is a fantastic addition to the work.
Firesheets: These naloxone-plus interventions literally are the bridges in that huge systems gap between the sidewalk where people are dropping and the treatment facilities. So, we’re building those bridges to get people across the gaps.
Law Enforcement initiatives treatment: charges are held in abeyance or citations issued. Greg Frost, President of the Civil Citation Network of Tallahassee, Florida, described this approach.
Basically, we are casting a very broad net for individuals who’ve never been arrested before. It’s their first contact with law enforcement or one of the first where they are a suspect in committing a certain eligible misdemeanor.
Be honest with yourselves. Look back on your life. How many of you, besides me, have done something in your past for which you could have been arrested? Raise your hand. Okay. Now, look around at who didn’t raise their hand. You’ve got it. You’ve got it. It’s us, folks. It’s us. People make mistakes. It’s you and me on a bad day. It’s the person who is a lawyer, a doctor, a student at Florida State University, and they make a mistake, and they end up breaking the law.
Every year in Florida, 65,000 people are arrested for the first time on misdemeanor charge. There are serious consequences to that arrest. There hasn’t been a lot of research done on that first-time, low-level, nonviolent misdemeanor offender, because there’s been kind of a, “Yeah, okay, that’s not a big deal.” Well, it is a big deal. And it’s costing us all a lot of money.
We’ve got three large schools, colleges, in Tallahassee. These kids are losing their federal funding because they were 20 years old and got caught with a can of beer in their hand. They’re losing their student loans, having to drop out of school. Access to some housing programs. Negative impact on child custody.
If you lose your job, what’s the impact on some of the minority communities where you have such a high arrest rate? Entire neighborhoods are being destabilized economically, just because the criminal justice system doesn’t provide law enforcement officers with that curve tool.
Here’s the basic process: You have a misdemeanor and a call for service. An officer responds. Let’s just say it’s two guys in a bar and they’re arguing over the tab and somebody pushes the other guy. There’s probable cause.
Rather than arresting the person, the officer can issue a civil citation. The person doesn’t have to take it. They can say, “No, I have my constitutional right, I want to go stand before a judge.”
If they choose the civil citation, then for the next 72 hours, they report into a behavioral health agency. They have a full biopsychosocial assessment, there’s a drug screening, and then from there, there’s an individualized intervention behavioral health plan put together to address their specific issues.
If the person is successful, then they’ll have counseling, they’ll have additional drug screenings, they will go through some educational modules, they’ll have their community service hours. So once they complete all of those successfully, then there is no arrest record.
I’ve talked to a lot of chiefs and sheriffs who have said, “Wait a minute now, this is soft on crime.” No, it’s not. They’re going to have community service hours, they’re going to pay a fee for their behavioral health services. It’ll be basically the same as if they went through the criminal justice system. So a person is being held accountable, one way or the other.
We’ve got approximately an 84% success rate. Those that go into the program, 84% of them successfully complete the program.
In this approach, law enforcement initiates treatment as part of an enforcement action, and no charges are filed. Kris Nyrop, LEAD National Support Director; Co-founder, first LEAD project, Seattle, and Brendan Cox, Director of Policing Strategies at the LEAD National Support Bureau; and Chief (ret.) Albany, NY Police Department, described this approach.
Nyrop: LEAD grew out of incredibly contentious, over-a-decade-long debate that was played out in court, in civil litigation, over massive racial disparity in black arrests. So in a city [Seattle] where 8% of the population was African-American, about 60% of those who were being arrested for drug possession and sales were black. And it was not in response to opioids; the emphasis here was on crack. This was the motivation behind LEAD.
What we’re seeing in other cities is that the motivation is quite different. But the common theme in all of the places that have adopted LEAD so far, is that the status quo around behavioral health conditions is absolutely broken. Police are routinely coming in contact with individuals with behavioral health conditions, either substance abuse or mental health. Or poverty, in some cases. And the only choice the police have at that moment is to arrest that person. That’s the handcuff that the police are in, that the option they’re given is either to ignore what’s going on or to arrest the individual.
So, LEAD was designed to give officers a third option. LEAD exists in both pre-arrest and post-arrest formats. It can be adapted to local situations. Some areas are doing only pre-arrest diversion, others are doing it only post-arrest. Many areas are doing both.
The range of offenses that are eligible for LEAD also varies by jurisdiction. For example, in Seattle, the driver of racial disparity in drug arrests was really around drug sales. So for us it was absolutely critical that drug sales be a divertible offense.
When we first started, our initial eligibility criterion was possession or sales of up to three grams of drugs. That was a big leap for the Seattle Police Department to make. Since then, after six years of successful operation, they’re willing to include a much wider range of offenses. We’re now up to possession or sales of seven grams. Basically, drug possession arrests have ceased in Seattle as a result of doing LEAD.
Cox: There are people who need to be in jail or in prison. We know that. Somebody kills somebody, somebody hurts somebody, they need to be there. But if somebody’s got a substance use issue or somebody’s mentally ill, or they’re living in poverty and they have to steal to support and make sure their kids are fed, those folks shouldn’t be in jail. We need to start ending mass incarceration and recognizing that there is a huge racial disparity everywhere we go.
With LEAD we have a third pathway. We can divert. If somebody has committed a crime and we’re going to divert them, that crime is only going to be held over their head until they do an assessment. That’s it. They may commit another crime and we’ll deal with that. But at that point, they’re free of that charge.
We recognize that change takes time, lots of time. We don’t have a graduation date [for our program] because we know that people are going to have really high points and people are going to have really low points.
We build a team that really looks after individuals. They work closely together. We’re also about changing culture. One of our goals is to create better relationships between the community and the police. We can build great partnerships between community and police, and we’ll increase trust, we’ll increase legitimacy, we’ll increase the fact that we’re working together on something.
Impact and Results
Several of the speakers offered indicators of success. Allie McDade of PAARI, cited a New England Journal of Medicine article with data showing that the police referral rate to treatment is nearly 95% compared to a hospital rate of about 50%. Chief Tharp, for example, noted that his team has responded to over 2,600 overdoses and is averaging close to 80% in placement in detox beds. Preliminary results for the Civil Citation Network indicate that about 85% of those referred to treatment or counseling complete the program with a 7% re-arrest rate.
Benefits of diversion programs extend beyond the impact on those served directly. Krip Nyop of LEAD, for example, commented on what happened when Seattle created supportive housing for chronic late-stage alcoholics: “the building paid for itself in reduced emergency room admissions. But the more important thing was the public safety benefit that happened from having these people off the street. You could just feel it in downtown Seattle. You could see the difference and you could feel it.”