New Approach Urged in Dealing with Opioid Epidemic

Last summer, Arlington, Mass., chief of police Frederick Ryan was briefed on a plan to arrest a major heroin supplier. “I asked some very simple questions,” he recalled. “Do we know the identities of those buying their heroin from this dealer? The answer was yes.

“The follow-up question was, what are we doing to get these people services?” he said. “The answer was: nothing.”

Ryan realized his department was about to create a public health crisis by suddenly leaving a known population of addicted people without their supply. This, he explained, was when he knew his police department needed to try a new approach.

He discussed that shift in thinking at Wednesday’s School of Public Health seminar The Opioid Epidemic: Why Cops Are Sending People with Addiction to Treatment Instead of Jail, the latest in the Dean’s Seminar Series on Contemporary Issues in Public Health.

Ryan joined another Massachusetts police chief, Leonard Campanello (MET’05), of Gloucester, whose department launched the Gloucester Angel Initiative last June. The program approaches addiction as a disease instead of a crime, and has influenced the Arlington police department and dozens of others. As well as garnering national headlines, it was the subject of a CBS 60 Minutes segment in December 2015.

Soon after, Campanello also founded the Police Assisted Addiction and Recovery Initiative to support the Gloucester program and others like it.

With 88 police departments in 22 states now taking similar approaches, Campanello and Ryan “are the leaders of a rapidly growing movement,” said David Rosenbloom, an SPH professor and interim chair of health law, policy, and management, as he introduced the two.

Since the Angel Initiative began, Rosenbloom and colleagues from SPH and the School of Medicine have been working with the Gloucester department, monitoring the program to see if—and how well—it really works.

Rosenbloom began the seminar by handing the microphone off to colleague Davida Schiff (MED’12), a MED instructor and general pediatrics fellow, to present their research findings: from June 1, 2015, to February 15, 2016, 352 people walked into the Gloucester police department asking for treatment. They came from all over the state, and 80 percent had been in treatment before.

The BU researchers have begun following up with past participants in the program, said Schiff, adding that out of the 47 contacted so far, 35 (or 74 percent) are not currently using opioids. “The numbers don’t do it justice,” Schiff cautioned. “The stories of their time through their treatment, the arc of their treatment, with relapse, with struggles to stay clean, is more telling.”

With that in mind, Rosenbloom, Campanello, and Ryan talked about the seminar’s central question: Why would, or should, police departments take on this role in the face of the growing opioid epidemic?

For Campanello, the new approach came from listening to the community he had sworn to serve. “What the community was saying was, ‘We don’t want you arresting people with this disease anymore if you don’t have to.’ Seeing death in large numbers led to this change.”

Social media proved an effective way to communicate the department’s new approach. Campanello shared the plan on Facebook: “Any addict who walks into the police station with the remainder of their drug equipment (needles, etc.) or drugs and asks for help will NOT be charged. Instead we will walk them through the system toward detox and recovery.”

That post soon had 2.5 million hits and was shared 30,000 times in every state and in 61 countries. “When you have Uzbekistan reading the Facebook post of a little North Shore city,” Campanello told the audience, “you get a very, very clear picture of how important this issue is to so many people.”

Soon after, the Arlington police department began outreach to people known to be addicted to opioids. The department had a clinician available to help create treatment plans for them and their families.

The Gloucester and Arlington models are now being adopted around the country.

What makes these approaches different from earlier efforts to get people into treatment within the court system, Campanello said, has to do with stigma. “We’re very anticoercion, anti-incentive, for this disease,” he explained. If even the threat of losing child custody doesn’t work, he said, “how is a charge of possession of an illegal substance going to incentivize someone to give up their disease?”

Stigma is the major challenge here, Ryan concurred, even when it comes to implementing these kinds of programs. He described how for decades police have offered not to charge a drug user if they identified their dealer. “That’s discretion,” he said. “We now apply that very same discretion, ‘You go into treatment and I won’t charge you with a crime,’ and prosecutors are saying, ‘I’m not so sure you have the authority.’”

The other major challenge in dealing with the opioid epidemic, both agreed, is a broader system that is full of holes. “What is so cockamamy,” Rosenbloom asked, “so opaque, about getting help for the disease of addiction that people are flocking to police stations, where they could be arrested?”

Ryan’s answer: “We’re now dispatching a clinician to an overdose in the ER.” His department has seen people brought into the emergency room after overdosing, released, and then fatally overdosing just hours later, he said.

Police, as newcomers to the treatment field, are able to bring a level of optimism and creativity to the problem, Campanello added, along with the clout to help move someone through a complex and confusing system. “We ask very three-year-old-like questions,” he said, “which always begin with, ‘Why?’”

Throughout the event, both police chiefs returned again and again to the idea at the heart of their programs: police should serve their communities. With public opinion of police far less positive in recent years, “it remains the police department’s responsibility to rebuild that trust,” Campanello said.

“There’s no achievement in this whatsoever,” he added. “This is a responsibility. This is what we’re supposed to be doing. We’re supposed to be helping people, especially people with a disease, and if that means thinking outside the box, then that too is a responsibility.”

Michelle Samuels can be reached at msamu@bu.edu.