Dayton, Ohio, is on the front lines of America’s opioid epidemic. According to the public health department, the county’s deaths due to overdose more than quadrupled from 2010 to 2017, with more than 560 overdose deaths in Montgomery County in 2017. We expect these numbers to plateau or even drop off in 2018 for a number of reasons: a decrease in the prevalence of fentanyl and other synthetic opioids; a shift to methamphetamine and cocaine; a decrease in prescribed opioids; increased outreach to at-risk populations; and greater access to treatment. The large magnitude of this problem has had a huge impact on the Dayton community and police department. We’ve learned lessons the hard way — through responding to thousands of overdose incidents and hundreds of deaths.
Learning from years of experience trying to end this tragedy, I believe there are three key areas to consider as departments craft their opioid response strategy. First, law enforcement must recognize the importance of reliable and comprehensive data in understanding the extent of the problem and developing an effective response. Second, we need to engage in strategic partnerships with public health, people in recovery, and other key stakeholders. Third, police departments should use their on-the-ground knowledge to inform and advise policymakers on the importance of effective policies that will provide the legal framework for a successful response.
The Importance of Data
The opioid epidemic caught us all asleep at the wheel, including the health care community, public safety, support organizations and institutions, and citizens. This was in large part due to a lack of shared data to better inform all affected community stakeholders of the true severity of the issue. Our lack of data, poor understanding of the crisis, and fragmented response is stunning when compared to the national mobilization against H1N1 — a strain of the swine flu — in 2009, or our response to Ebola a few years later. Swine flu and Ebola are viruses that affect the physical body and opioid addiction is a disease of the brain, but both can harm us and result in death if not treated.
I mean this only as an observation, not a criticism, but it underscores the importance of data. It also highlights stigma as a barrier for health care systems to respond appropriately to the issue at hand. Why do we have data for H1N1 — which hasn’t caused as many deaths in our community — but not for opiate disorder? Effective and comprehensive data collection is the only way we can recognize, understand, and mobilize against a crisis of this magnitude, and I hope this reality will inform our future data collection efforts.
The limited data that we do have around the opioid crisis is alarming. Nationally, the Department of Health and Human Services estimates that 11.5 million people misused prescription opioids in 2016, with more than 42,200 opioid deaths.[1] The Centers for Disease Control and Prevention estimated that more than 100 Americans died every day from opioid overdose in 2016. [2]
From 2009 to 2011, Montgomery County averaged about 130 overdose deaths per year. In 2016, that rose to about 350. Then in the first six months of 2017, it rose to 378, and we ended up exceeding 560 deaths in 2017. When you have these numbers at your disposal, it’s hard to ignore that there’s a crisis, and that our existing response efforts fall dramatically short.
Police departments need good internal data, access to data from other key stakeholders, and analytics to understand the extent of the problem and what constitutes an effective response. Montgomery County has experienced thousands of overdose deaths since 2010, but only recently has a community task force enacted an integrated and robust set of data to be able to measure the true extent of the crisis. This task force is called the Community Overdose Action Team (COAT). Before COAT, even within public safety, we didn’t have an aggregate, comprehensive data set that combined fire department, police, and other first responder data to reflect the full scale of the opioid crisis.
Reviewing our data, we also noted that overdose calls were not always accurately tagged as such, so existing data did not accurately reflect the true scope of the crisis.
The Importance of Partnerships
Solving the opioid epidemic is well beyond the scope of what law enforcement can do alone. Partnerships are key, both to effectively respond to the crisis and to conduct research to fully understand its scope.
On the response level, law enforcement must be part of an integrated system of treatment delivery that is easily understood and accessed by the public. We learned this the hard way in Dayton. At the beginning of the crisis, our response systems were decentralized, formidable to navigate, and expensive. Treatment resources existed, but individuals weren’t accessing them. This was exacerbated as the number of beds available for substance abuse treatment declined even as the number of overdose deaths spiked dramatically. In retrospect, it’s clear that accessing the available treatment beds was a convoluted process. Although access to treatment has improved, more system integration and coordination is needed.
To address this access issue, in 2014 the police department began partnering with the East End Community Services on an initiative called, “Conversation for Change.” Under this program, we identify individuals in the community struggling with addiction and invite them into a welcoming, supportive community setting to talk about a path to recovery and offer them the services they need. This engagement process uses Motivational Interviewing (MI) during one-on-one conversations regarding recovery. In this way, we are able to follow up with community members who have survived overdose calls, and connect them with resources for recovery.
Because the county jail is the primary detox center by default, we have also established the “Front Door Project,” to provide a 24-7 law enforcement hotline to assist individuals who suffer from opiate addiction in accessing treatment services, to include immediate placement in a sober living facility. During normal business hours, community members can walk in and receive treatment, and the police can also bring individuals for treatment. Addiction is a disease, and treatment and recovery can be a long process. Partnerships with public health and community organizations are key in thinking about how we can best approach the problem.
The most recent innovation to more effectively respond to the opioid epidemic in Dayton is the Getting Recovery Options Working (GROW) program. This initiative engages a multi-disciplinary team (police/fire, peer support, recovery specialist) to follow up on overdoses within 72 hours, in an attempt to get an individual into recovery. What we have learned through GROW is that having a peer with shared, lived experience really changes the conversation when responding to an overdose save. Connecting with a peer that can understand what an individual is going through increases the individual’s motivation to make a change for the better.
GROW team members also respond to in-progress overdose calls and provide onsite naloxone training and resources to community members in need. GROW ultimately seeks to educate and connect individuals with opiate addiction and their family and friends — their social support system — to a medically assisted treatment service provider or other community resources.
In addition to these programs, we started deploying Narcan with our police officers in 2014, which has now become standard across the country. After we began deploying Narcan with officers, we saw more overdose incidents, but fewer fatalities. With assistance from public health, we also supported a local community organization that began a needle exchange program, and have partnered with the fire department to further increase our outreach to recent victims of overdose. The nature of the crisis has changed over time, and our response has evolved accordingly. We do everything we can to build a reliable dataset and engage in strategic partnerships to understand the crisis and respond as effectively as possible.
Beyond partnerships at the response level, law enforcement should also partner with academics and other researchers. In Dayton, we’ve undertaken research projects with the University of Cincinnati and Wright State University. We have an NIJ Law Enforcement Advancing Data and Science (LEADS) Scholar, Major Wendy Stiver, who has conducted research to examine the cumulative effect of stress on officers, including stressful incidents related to the opioid epidemic. These partnerships and projects help departments use data and research to understand the extent of the problem, and what best constitutes an effective response.
Policy Is Key
Even with robust datasets and partnerships, it’s impossible for law enforcement to effectively respond to a large-scale crisis without national-, state-, and local-level policies in place to support an effective response. On the ground in Dayton and across the country, the data clearly show us that merely arresting individuals is not the solution to the opioid epidemic. However, if policies aren’t in place to look at the crisis as the complex problem it is, police departments are limited legally in our response.
The answer doesn’t rest purely within either a criminal justice- or a public health-oriented approach — it has to be a combination. We go through polar swings of “let’s punish people” to “let’s help people,” when the reality is very much more nuanced. We need to rethink our policy approach from the standpoint of pure pragmatism. If policymakers can change their perspective and orientation towards this epidemic, law enforcement can more fully be in the business of saving lives, rather than simply making a lot of arrests. This crisis is unprecedented, and we clearly need to do something differently. That includes reconsidering our on-the-ground response, but it also includes a policy-level reframing of how the issue is addressed.
Just a couple examples of policy-level infrastructure that would help departments more effectively respond to the opioid epidemic include special drug courts, similar to veteran’s courts, and an approach to the crisis that is recovery-based, rather than punishment-based. In Ohio, we have a bill that precludes law enforcement from charging individuals who overdose with any kind of crime if they seek treatment within a month. This in itself comes with its own set of problems, but the premise and intent of the bill is good — to get people into treatment rather than penalizing them for addiction.
In an overdose call, it’s easy to administer Narcan, make an arrest, and call it a day. But the opioid crisis does not have a single or simple solution. We must provide a multifaceted response as complex as the problem itself. As H. L. Mencken once wrote, “There is always an easy solution to every human problem — neat, plausible, and wrong.”
About Notes From the Field
The National Institute of Justice (NIJ) is the research, development, and evaluation arm of the U.S. Department of Justice. NIJ aims to address the critical questions of the criminal justice field, particularly at the state and local levels.
NIJ Director David Muhlhausen developed the “Notes From the Field” series to allow leading voices in the field to share their strategies for responding to the most pressing issues on America’s streets today.
Notes From the Field is not a research-based publication. Instead, it presents lessons learned by law enforcement executives and other on-the-ground leaders, from years of experience and thinking deeply about law enforcement issues.