Responding to the Opioids Epidemic


The opioids crisis is continuing to worsen, despite some amazing work over the last few years by police departments, public health agencies, drug treatment programs, hospitals, and many other organizations. The latest numbers from the Centers for Disease Control and Prevention, released in August, indicate that drug overdose deaths totaled 64,070 in 2016 - a 21% increase over 2015. Approximately three-fourths of those deaths involved opioid drugs. It is evident that a stronger response needs to be put in to place to combat the epidemic. 

For more information on the statistics surrounding the opioid crisis: The Opioid Crisis: Data and Demographics

General Prevention information can additionally be found here:


The New York City Model

New York City has launched a wide-range series of programs and protocols in response to the high number of fatal drug overdoses in 2016. In 2013 the NYPD begin a pilot program to have officers carry naloxone. Additionally: 

  • 84 new investigators were hired to investigate all overdose cases -- fatal and non-fatal
  • 50 new technicians to test the heroin that is seized
  • Investigating the expansion of programs that are already in place like the HOPE program
    • The HOPE program is a pre-arraignment effort for people that have been charged with low-level drug offenses

This model is a multi-pronged approach including life-saving, administering aid out in the field, arrests of those manufacturing and distributing these drugs, and education to help people lead positive, healthy, productive lives.

The RxStat program and RxStat Operations Group

In New York City, the RxStat program and RxStat Operations Group have also been implemented to affect the opioid epidemic.

The RxStat Operations Group analyzes overdose incidents and identifies gaps in the cities opioid crisis response.

RxStat is a comprehensive surveillance system that monitors opioids and other drugs and the associated consequences, in real time. 25 agencies, including police, the city and state health departments, homeless services, corrections, probation, parole, DEA, the medical examiner, and others work together to raise issues. After the Operations Group meeting, the key stakeholders for each issue are identified, and then hold smaller meetings to see how those gaps can be filled. 

Some concrete change that was made in response include:

  • More naloxone -- for each officer on patrol will have a naloxone kit, for homeless shelters, and jails
  • Protocol for people that arrive at the hospital with drugs
  • Keeping overdose victims in hospitals longer based on a case study where a patient experienced a non-fatal opioid overdose was released and then experienced a fatal overdose
  • Increased knowledge about the good samaritan law


Sharing information about overdoses

  • It is important to have drugs that are found on the scene are tested to identify if the drug is laced with fentanyl or carfentanil
  • Sharing overdose data in real time across the country can ensure victims and participants are offered treatment resources
  • New rules for police officers and sheriff’s deputies
    • While drugs are often regarded as a medical problem, officers have to operate around a new way of thinking to combat the effects 
  • Monitoring of nonfatal overdose data is also important
    • Generally, people are at the greatest risk for fatal overdoses if they have previously experienced nonfatal overdoses

There are a number of initiatives that are implementing these key findings. 

  • Law enforcement are receiving access to the names of overdose victims, all the information, and the particulars to ensure that they are offered treatment resources.
  • If a non-fatal overdose occurs the police chief is notified and then plainclothes police officers knock on the victim's door and ask if they need resources within 12-24 hours
  • Associated case study: Ohio Police Change Approach on Addiction: People Need Help, Not Jail

Digitial 'Pin Map'
  • In Broward County, the medical examiner maintains a 'pin map' which shows the locations of overdose deaths and the type of drug used
  • The data in the pin map is compared to the locations of drug arrests and search warrants, locations of rehabilitation centers, and overdose deaths and near deaths
  • The 2016 digital map can be found here: Drug Overdose Locations 2016

ODMAP

  • The Washington/Baltimore High Intensity Drug Trafficking Area (HIDTA) has developed a phone app for tracing overdoses
  • ODMAP provides real-time overdose surveillance data across jurisdictions to support public safety and health efforts to mobilize an immediate response to an overdose spike.  It links first responders on scene to a mapping tool to track overdoses to stimulate real-time response and strategic analysis across jurisdictions.
  • There are 2 user interfaces -- level 1 and 2.
    • Level 1 for Fire/EMS which record fatal or non-fatal overdoses and if and how much naloxone administered on scene
    • Level 2 is for public health and public safety officials how can see information regarding overdose spikes and other demographics

Federal Education Initiatives 

National Take-Back Initiative

  • This initiative allows people to bring in unused, unwanted, or expired prescription drugs and dispose of them
  • This is an important initiative because four out of five heroin users started with prescription pills
  • This initiative occurs twice a year
  • National Prescription Drug Take Back Day

DEA-FBI movie - Chasing The Dragon

  • A movie was produced to start the conversation around the opioid problem
  • Designed to be shown in high schools
  • Warning provided that it should be seen first before showing a larger audience
  • This movie can be seen here: https://www.youtube.com/watch?v=lqdmWRExOkQ

Operation prevention

  • Partnered with Discovery Education to build a STEM-based curriculum (Science, Technology, Engineering, and Math) available free of charge to high school and middle-school students around the country
  • For more information: https://www.operationprevention.com/#about

The Police Role in Getting Addicted Persons Into Treatment 

Police agencies are increasingly working to get addicted persons into treatment and should trust the expertise of drug treatment experts. Some initiatives include:

Law Enforcement Assisted Diversion (LEAD) program

  • LEAD gives police officers the discretion, at the time of arrest in certain cases, to make a determination about whether to book and prosecute that person, or whether to divert that person to services.
  • Very focused on harm reduction for each individual person, with treatment being the ultimate goal
  • Meet what their basic needs are at that time with diversion, and then what other needs are complicating their lives.
    • For example, if the issue is housing that’s the first thing then the program helps to get them housing or shelter. If the issue is education, the program gets them back to school. These things are ultimately going to help reduce that drug use, and start to heal these individuals and hopefully get the individuals on the path to recovery. 
  • The lead program has continued to grow across many states.

Project SAVE

  • Project SAVE is a drug abuse prevention and intervention program.
  • Project SAVE provides for a state-certified drug and alcohol counselor to be present in municipal court. The counselor provides judges, prosecutors, defendants, and defendants’ family members with information about available drug treatment programs, in order to provide options that go beyond prosecution and conviction.

Vancouver safe injection sites

  • Vancouver has opened up two safe injection sites which have provided 5,000 medical interventions on site from 2003 to 2016
  • The first injection site is in downtown Vancouver and is called Insite. The second one is located in a hospital.
  • Insite is a gateway to a range of services to promote recovery and support those with mental health issues, housing issues, and other needs.

This article lists some of the initiatives that are being implemented in North America. The CDC and other organization can be referenced for additional resources has reports, fact sheets, and other resources that can be used by police officials and other organizations.

In 2017, the Police Executive Research Forum and New York City Police Department co-hosted an opioid conference where police, public health agencies, and other organizations came together to discuss the unprecedented opioid epidemic. This article will outline key findings and initiatives discussed at this conference.

For more information: Opioid Crisis Management: Foundation Roadmap

We are interested in generating some discussion on this topic in our Opioid Crisis Management Community. Please visit this space to join the conversation.