Can the U.S. Halt the ‘Unprecedented’ Opioid Epidemic?

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Photo by Lauri Rantala via Flickr

Only a concerted nationwide effort involving police, healthcare providers, community leaders and courts can tackle an opioid epidemic that is “unprecedented” in size and scope, according to a report by the Police Executive Research Forum (PERF).

Summarizing the recommendations of a conference held in New York City this spring, attended by dozens of police chiefs, sheriffs and federal officials, the report included calls for stepping up data-sharing on opioid users and dealers among law enforcement agencies, and a greater focus on strategies for preventing opioid overdose deaths.

“There is no more important issue in many cities and towns today than the opioids epidemic,” wrote PERF executive director Chuck Wexler in his introduction to the report—the organization’s third major study of the issue—which was released this week.

“Unfortunately, this epidemic is not yet showing signs of abating. So we must continue to expand the programs that we know are working, while reassessing our strategies and searching for new approaches.”

Table displayed at conference showing the rise of drug overdose deaths in New York City, 2010-2016. Photo courtesy PERF

The report cited the most recent figures provided by the Centers for Disease Control and Prevention showing 64,070 deaths from drug overdoses in 2016—a 21 percent increase over the year before. About three-quarters of the deaths were caused by opioid drugs, and some 20,145 were directly tied to fentanyl or other synthetic opioids.

“We all remember that awful shooting in Orlando at the Pulse nightclub last year, in which 49 people were slaughtered by a madman,” Acting Drug Enforcement Administration chief Chuck Rosenberg told the April 6 conference. “Imagine that happening three times a day, every day, for 365 days in a row.

“That’s roughly what we’re talking about with fatal drug overdoses.”

The conference, hosted by the New York Police Department (NYPD), attracted law enforcement officials from across North America, ranging from south Florida, Baltimore and Burlington VT to Vancouver, British Colombia, Canada.

Participants shared strategies they were using to deal with the growth in opioid-related fatalities in their jurisdictions, and almost all emphasized that success depended on working effectively with other community institutions and data systems not normally available to law enforcement.

Seattle Police Chief Kathleen O’Toole. Photo courtesy PERF

“This isn’t just a police problem; this is a community challenge,” said Seattle Police Chief Kathleen O’Toole, “We will only make progress if we work together on multi-disciplinary approaches.”

Brandon Del Pozo, a former New York City detective who now heads the police force in Burlington VT, says he appointed an “opioid policy coordinator” to provide real-time clinical data and work with local doctors in order to help his cops monitor abusers and intervene when necessary.

“Having an opioids policy person working directly in the police department…gives us better credibility,” he said. “So the public health people, instead of saying, ‘Brandon doesn’t get it; he’s a cop,’ realize I have an expert helping me to understand the issues. That helped us get legitimacy.”

Strategies reported by some of the local police chiefs ranged from diversionary treatment to better information sharing. Examples included:

  • The Real Time Crime Center established by Philadelphia police as a portal for information about overdoes reported by hospital emergency rooms and the Medical examiner’s Office;
  • The Cincinnati Fusion Center, which shares overdose data weekly with police officers in southwestern Ohio;
  • The NYPD’s RxStat program, which has been expanded to include timely information-sharing about drug overdoses among senior officials from 25 agencies, including police, probation, health and drug treatment providers.

A 2017 survey of PERF member chiefs found that 63 percent now employ trained officers to carry and administer naloxone—a medication administered by nasal spray that can reverse the effects of a heroin overdose and has been shown to save lives.

Naloxone poster used in New York City. Illustration courtesy PERF

That was a sharp contrast to a similar survey in 2014 which found that just four percent of agencies were using the medication.

But the report made clear that such street-level responses needed to be part of a much broader strategy. It recommended 10 steps that police departments and local justice systems could take to improve their ability to cope with the epidemic.

The steps included:

  • Improve data collection, including deploying the Compstat system, currently used nationwide by police departments to monitor crime;
  • Divert opioid users into treatment as an alternative to punishment, noting the consensus of many chiefs that “we cannot arrest our way out of the opioids crisis;”
  • Develop “strategic enforcement and prosecution” strategies such as focusing on high-activity dealers who sell to persons near drug treatment facilities;
  • Establish partnerships with public health agencies, social service providers and treatment providers.

Prosecutors said their efforts had been complicated by the fact that heroin was increasingly available through many other channels—even through social media.

“It isn’t as simple as ‘put a cruiser on the corner and arrest people,’” said Middlesex County, MA District Attorney Marian Ryan. “Today’s users are having heroin delivered to their house.”

Many of the participating chiefs observed that simply cracking down on prescription drug “pill mills” only accelerated individuals’ switch to cheaper heroin.

Louisville, KY Assistant Chief Greg Burns. Photo courtesy PERF

“When we interview drug dealers, they say they give away the heroin…and also tell us that the drug cartels will not give them any other drugs unless they also buy heroin,” said Louisville, KY Assistant Chief of Police Greg Burns.

Richard Baum, acting director of the Office of National Drug Control Policy, told the group that the increase in nonmedical use of prescription drugs appears to have leveled off.

“But unfortunately,” he added. “The fatalities haven’t leveled off, because of the very pure heroin, the fentanyl and the carfentanil, that are killing so many people.”

PERF’s Chuck Wexler said he hoped the report would serve as a “wake-up call” for jurisdictions who had not yet experienced the epidemic in any serious form.

“The…epidemic has caused tremendous hardship in many parts of the United States, especially New England and Appalachia,” he wrote. “But upper-Midwest states, including the Dakotas, Minnesota, Nebraska, and Iowa, and the Western states of California and Oregon, have not yet felt the crisis to the same extent.

“Those states would be well-advised to study the patterns of the epidemic in other locations, and prepare so that they can quickly detect any increases.”

For a full copy of the PERF report, please click here.

This summary was prepared by TCR Executive Editor Stephen Handelman. Readers’ comments are welcome.

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