Bridges to Care – Not Incarcration

Bridges to Care – Not Incarcration

By Dr. Fourkan Ali

Gloucester, Massachusetts Police Chief Leonard Campanello wrote on the department's Facebook page that, in the wake of their "opiate crisis," the police were "poised to make revolutionary changes in the way we treat this DISEASE." The chief promised three critical actions: First, "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." Second, "Nasal Narcan [an immediate antidote to respiratory arrest from narcotic pain pills or heroin] has just been made available at local pharmacies without a prescription." And third, he, with other public officials, would go to Washington, D.C., to meet with congressional leaders, Massachusetts Sens. Elizabeth Warren and Ed Markey and Rep. Seth Moulton, to convey what Gloucester is doing and to urge national change.

Five weeks later, the chief reported, again on Facebook, "10 addicts in, 10 placed. 10 on the way to recovery. No judgment. 20 parents lives changed, countless siblings, friends, loved ones. Only the beginning. 1 life at at a time."

This was not policing the old-fashioned way; in fact, this went further than the community policing philosophy dating back to the early 1980s (though not enacted substantively until a decade later), where educating community members and creating neighborhood watches would complement police patrols; where foot patrol would be increased with a commitment to be more accountable to the citizens they serve; and giving more authority to lower-ranking officers to foster greater initiative among them to engage, for example, in problem-solving at the neighborhood level.

The Gloucester Police were instead offering immunity against any criminal action for possession of illegal substances and offering to be bridges to care, not to incarceration. The adoption of Narcan, as well, meant leaving behind views of people with addiction as so-called junkies who should fend for themselves. The police were intent on being social action agents when nothing else was working.

The police, not just for substance use disorders but mental health, domestic disputes and homelessness as well, have become our country's default responders when communities and families are upended by these problems. The tattered social safety net and the increased prevalence of visible and dangerous behaviors in our homes and neighborhoods has left no one but them (or EMTs in some cases) to respond consistently.

The Gloucester Police Department's radical offer to people with substance use disorders and their families – dubbed the Angel Program – would help to transform the role of police to encompass safety and connection to care. Middleborough Police Chief Joseph Perkins, with whom I spoke, said that traditionally, when it came to drugs and addiction, the police response had been investigation and arrest. That's what they knew how to do. An approach that combined education, treatment and enforcement had yet to be established. Now all three could happen, he told me.

While the local district attorney in Essex County took umbrage at offering "immunity," which is not a police authority, police do have authority to decide whether to charge or not. That wording dust-up did not change what was happening, though: People in considerable distress, in withdrawal or intoxicated on drugs, would come in at any hour, often during the middle of the night, and a desk officer would be the only person there to respond. That was more than should be expected of any officer, even of a trained clinician.

Quickly, solutions emerged. Local substance use agencies formed coalitions and deployed clinicians to the station. These clinicians could assess and provide referrals and shepherd individuals to care. A more neutral site in the community, not the police station, served as the new setting for helping these community members. The police department scheduled so-called "open door, open mind" events. Police and families recruited "angels," people in long-term recovery, who could connect with the person with an addiction, and stay with them as they began the tough road of recovery. Families got involved, especially those with a loved one – often a child – with an addiction or who had died from an overdose, setting up support networks and online resource centers. A movement had begun.

The word spread from Gloucester to other police jurisdictions in Massachusetts. The Arlington Police adopted this approach to the opioid crisis, as did East Bridgewater and very recently Middleborough, which has been hard hit by opioid overdoses and deaths.

Massachusetts, where I lived for 24 years, is a liberal state that is known for its social conscience. But Massachusetts has not always put its money where its mouth is. The recent three-part series by the Boston Globe's Spotlight team has laid bare the failed promises and policies of serving people with mental (and addictive disorders). The final part of the series is unsparing in its criticisms and in delineating the consequent costs in human suffering and public safety. Massachusetts has involuntary hospital commitment for up to 90 days (in statute, though not what happens in practice), called Section 35, for people whose lives and that of others are endangered by people with active substance use disorders. But Massachusetts, unlike 46 other states, does not have involuntary outpatient commitment for people with serious mental disorders, often co-occurring with substance use disorders.

In fact, it seems that access to and ongoing quality care – the hallmark of good treatment for every chronic illness – is terribly limited for people with mental and substance use disorders in this state and virtually every other state in this country. The result is that the vast predominance of those in need go without needed counseling, medication and, at times, hospital-level care. In other words, there are a lot of gaps and a lot more to do.

But efforts like those of these innovative police departments are an essential part of the solutions we need to complex, daunting problems that have eluded our efforts to date. These smart and relentless police chiefs and their officers are heartening examples of leadership and problem-solving that is possible and needed if we are going to change the horrific trajectory of substance use problems in our communities