Solving the opioid epidemic requires a community approach
Proven harm-reduction strategies, combined with a touch of compassion and empathy, is proving to be a recipe for success in Pasco County, Florida
Centers for Disease Control (CDC) data on overdose deaths showed roughly 11 people an hour died in 2020, resulting in a record 93,000 deaths for the year. Sadly, 2021 set a new record with over 100,000 deaths. Overdose (OD) deaths have increased steadily since 1999, despite our best efforts and hundreds of billions of dollars to try to reverse this trend.
While each one of these overdose deaths reflects both an individual and societal tragedy, drug users are not always sympathetic victims, typically having alienated family and friends and living on the fringe of society. However, every individual is someone’s son, daughter, father, mother, brother, or sister and their lives and deaths ripple through society and affect their families in profound and tragic ways.
I began my law enforcement career in 2000. At that time, I believed drug use was axiomatically wrong. I was just as happy to see a drug user in possession go to jail as I was a drug dealer. To me, there was no difference. Fast forward 20 years of community service and interaction, and I’ve gained a whole new perspective; the veil has been lifted. I’ve learned there are several intercept points law enforcement and the community have to positively impact addiction and support recovery.
A layered approach to combat substance abuse
Pasco County, Florida (like the majority of counties nationwide) has seen steadily increasing numbers of overdoses over the past five years.
Starting in 2019, the Pasco Sheriff’s Office (PSO) Behavioral Health Intervention Team (BHIT) adopted a layered approach to combat substance use in the community. It includes interventions utilizing community-based resources and distribution of Narcan to people who recently experienced a non-fatal overdose.
BayCare Behavioral Health partnered with PSO to expedite mental health and substance abuse services to individuals who were contacted by the BHIT detectives due to recent or frequent interaction with law enforcement. BHIT detectives attempt contact with every overdose subject within 24-48 hours, try to connect them to community-based rehabilitation services, and leave behind two doses of the potentially life-saving tool Narcan.
PSO’s community partner, BayCare Behavioral Health, created a new treatment model to expedite the process for those who wish to be connected to services. Additionally, BHIT’s case managers are able to complete administrative paperwork and pave the way for medication-assisted treatment using either Suboxone or Vivitrol within 24 hours after first contact.
Medication-assisted treatment (MAT) is primarily used to treat opioid addiction and helps the individual in several different areas. It helps to normalize the brain function for the person recovering from substance abuse without creating a euphoric effect and reduces the cravings an individual may feel while withdrawing from the substance. It also helps to block the effects of an opioid if an individual uses while on the medication.
Suboxone and Vivitrol are used to treat opioid addiction and can be the support the individual needs to get on the road to recovery.
Suboxone can be given to individuals shortly after their last use of the opioid and is administered via an oral pill on a daily basis.
Vivitrol can only be given once the individual has completely detoxed from an opioid but can be given as an injection and lasts for approximately 30 days.
In 2019, the Pasco Sheriff’s Office arrested 1,084 individuals for opioid-related offenses. The majority of those arrested were processed into the county jail facility and then moved to housing. While incarcerated, inmates are screened and, if applicable, can participate in substance use recovery programs. However, 15% percent of those arrested are released within 24 hours, making it difficult for any type of treatment or intervention.
In a Post-Release Opioid-Related Overdose Risk Model, incarceration is considered an underlying factor that affects overall overdose risk. Several studies indicate the first four weeks after release from prison or jail have the highest risk for overdose death. In 2019, 23 people in Pasco County overdosed within a month of being released from the county jail facility. This increased risk of overdose and possible death can be reduced with the Naloxone distribution program.
In addition to the Behavioral Health detectives, the Sheriff’s Office provides Narcan to individuals being released from the jail who self-admit to having a substance use disorder or were arrested for a drug offense.
Since the program began in April 2019, the BHIT detectives have provided over 858 doses of Narcan. Distribution includes individuals who recently overdosed, family and friends of substance abusers, and local places such as hotels that have a disproportionate number of overdoses occurring within their establishment. The program was expanded to the inmate population in November 2019, and 1,098 doses have been distributed through this channel.
Additionally, the team works with community partners to determine overdose spikes and where would be the best location to dispense additional Narcan and other resources. The recovery community conducts outreach by distributing food, hygiene products and Narcan.
People in and out of law enforcement have differing views on the distribution of Narcan to individuals at risk for overdoses. Law enforcement tends to view this as enabling behavior that contributes to the stigma around addiction and even encourages risky behavior. However, the distribution of Narcan is a proven harm reduction strategy to reduce the likelihood individuals die as a result of their addictions. The State of Florida has a program through the Department of Children and Families to provide organizations with free doses of Narcan nasal spray to distribute directly to the community.
The faces behind the data
Jason met his BHIT detective after his first overdose in 2019.
Jason’s early 20s were filled with volatility stemming from his substance use, resulting in numerous contacts with law enforcement. Jason was involved in a variety of assaults and batteries as both the suspect and victim. His substance abuse of 12 years came to a head when he experienced a fentanyl overdose in late 2019. Jason’s case raises the bigger question: as law enforcement officers, how do we reduce the impact drugs have on our communities?
The detective was able to get Jason connected with BayCare who provided him with the support of counseling sessions and the use of MAT. Jason’s road to recovery was not a fast or smooth one. He left BayCare’s treatment program and overdosed again. He tried another organization after his second overdose but eventually came back to BayCare to re-enroll in the MAT program. Over the last year-and-a-half, he has remained sober and engaged with BayCare’s services. The support from his family and community was a driving factor in his recovery. Having resources available when the individual is ready to commit to change is critical.
As a law enforcement officer, 20 years ago I would have shaken my head at Jason’s failed attempts and used that against him during any law enforcement action; justification for why Jason would need to go to jail or not catch a break on a traffic ticket. But today, I realize Jason’s relapse was preparing him for future success. He knows recovery is attainable, and he CAN achieve it. Relapse is a common part of the recovery process. It’s a paradigm shift for law enforcement and a bumpy road for us too. But the faster we understand substance abuse and more importantly, recovery, the faster we can build community frameworks to tackle the issue. PSO’s motto is: We Fight As One. It’s a multi-faceted meaning that applies both within the agency and to the broader community.
A community approach
We can’t arrest our way out of a problem, as locking up those with substance use disorders only treats the symptom without addressing the underlying cause. Law enforcement members are overwhelmingly attracted to the cause of serving others and helping the community, and the central question is how best do we accomplish this?
The revolving door of arrest and release does not fix the underlying problem without consideration and involvement of community-based programs for connection to services. While the time in jail will temporarily sober the individual if there is no assistance upon release, the risk for re-engaging substance abuse is astronomically high.
How law enforcement can work with the community is as unique as the individual who needs the help. Each person struggling with addiction has his or her own set of challenges to tackle. There is no silver bullet to blanket the entire epidemic. What works in Pasco County, Florida may not work in other communities across the nation, but a community approach tailored to the individual and encompassing community stakeholders utilizing proven harm-reduction strategies with a touch of compassion and empathy is a recipe for success.
Pasco County's Department of Health and PSO partnered to created CREDO (Community Resources Expo Delivered Online). This video provides helpful resources for substance use recovery.