John Allen. The Opioid Crisis. Reference Point Press, 2020.
Huntington, West Virginia, is a city besieged with opioid abuse. But Huntington is trying a new approach to the problem. Each morning a team of responders takes to the streets to contact overdose victims. The team consists of three members: police officer Chris Trembley, paramedic Larrecsa Cox, and Sue Howland, who works for Prestera, a mental health service specializing in addiction treatment. Their first stop on a spring day in 2018 is the home of a twenty-six-year-old woman who overdosed on opioids the week before. Staying with her grandparents, she is depressed, anxious, and still a bit suspicious of the team. This is their third visit since the overdose, and they are gradually gaining her trust. They ask about her appetite and whether her headaches have subsided. They hope to convince her to enter a drug treatment program. The visit lasts only ten minutes, but the team members feel they are making progress. Trembley sees it as a small victory for them and the young woman. “Maybe you just didn’t go use today,” says Trembley. “That’s one day. Maybe you might have used but because folks have talked to you and you were feeling good about things maybe you didn’t go out and shoplift today. OK, that’s still a thing.”
Forming a Quick Response Team
Huntington’s new procedure with overdose cases is called a quick response team (QRT). The idea is currently being tested in several cities across the country. Bob Hansen, who started the program in Huntington, first read about the team approach in an article about the police department in Colerain, Ohio. Hansen set up a training session with the heads of the Colerain program and loved the approach. He applied for and received two federal grants to pay for the experiment. “We’ve been having a lot of overdoses in Huntington and Cabell County and really the big thing that stood out to many of us is what are we doing afterwards?” says Hansen. Too often, the next time the police would see an overdose victim is when the person was lying dead on the bathroom floor with a needle stuck in his or her arm.
Teaming an officer with medical and mental health professionals gets across the message to opioid addicts that the purpose is not punishment but care. Fanning out over the city, the team checks on the health of overdose victims and urges them to get professional help. After only four months, the Huntington team has convinced 40 percent of the addicts it has visited to enroll in a treatment program. Other cities are seeing similar results. Charlie Kilbel, a paramedic with a QRT in Cuyahoga Falls, Ohio, is excited about the chance to bring hope to opioid users. “Our goal is to be at the doorstep of overdose victims within 6 days of their overdose,” says Kilbel, “and we will get the individual to detox and/or treatment as long as they’re ready. If they don’t answer the door or they’re not ready we will continue to go back until they do.” Success has encouraged other towns to adopt the program, not only in West Virginia and Ohio but across the nation.
A Welcome Change
Many experts in health care and law enforcement see programs like Huntington’s QRT as a welcome change in dealing with the opioid crisis. They observe that tougher policing has failed to curb drug epidemics in the past and has had little effect on the current opioid problem. A better approach, they say, is to treat opioid addicts as victims who need help rather than criminals who deserve jail time. Rather than focus strictly on law enforcement solutions, they suggest a comprehensive approach that also includes education, prevention, treatment, and recovery. Nan Whaley, the mayor of Dayton, Ohio, where a QRT program is making inroads against a dire opioid problem, agrees a change is needed:
Locking up people suffering from addiction does nothing. Instead, this reflex toward punishment perpetuates the misuse and overuse of jails that continues to drive over-incarceration at huge cost to taxpayers and untold costs to families and communities…. Treating addiction as a public health problem—not a criminal justice one—is key to this success, as communities across the country are already demonstrating. Outdated thinking won’t work and families suffering through this crisis deserve better.
Despite the growing consensus for change in how the opioid crisis is addressed, the Trump administration has mostly doubled down on old ideas about getting tough on crime. For example, Donald Trump sees border control as a crucial element in the crisis. In his 2019 budget plan, he cited the building of an $18 billion border wall with Mexico as an important way to stop the flow of heroin, fentanyl, and other illicit opioids into the United States. Trump has also stressed his belief in law enforcement as a solution. “My take is you have to get really, really tough, really mean with the drug pushers and the drug dealers,” says Trump. At one point he endorsed the death penalty for drug dealers who sell opioids used in a fatal overdose.
In November 2017 a commission set up by the Trump administration issued a report with more than fifty recommendations on how to deal with the opioid crisis. Health experts agreed with many of the commission’s findings. Among the more useful suggestions was creating block grants to help states get prompt federal funding for opioid abuse programs; requiring health care providers to take special classes on opioids before they can renew their federal licenses to prescribe; and setting up drug courts in all ninety-three judicial districts to help those arrested for possession get treatment instead of a prison sentence.
In October 2018 Congress passed a bill that, among other things, promised a crackdown on illicit mailings of fentanyl and support for new nonaddictive therapies for pain. While such laws are helpful, experts say they do not go far enough. “The data keeps showing us we have more and more people dying,” says Chuck Ingoglia, senior vice president of public policy at the National Council for Behavioral Health, “so what’s the reluctance to actually spend money and actually do something?”
A Lifesaving Drug
One item that police and emergency workers are using in overdose cases has a value far beyond its cost—it frequently saves lives on the brink. Naloxone is a drug that can quickly reverse the effects of an opioid overdose. Marketed under the name Narcan, among others, naloxone offers a second chance to opioid users who otherwise would almost certainly die from an opioid overdose.
A typical case unfolded in May 2018 in Enid, Oklahoma. Police sergeant John Robinson and two other officers were responding to a 911 call when they discovered a woman lying on the floor of her living room, in a stupor and barely breathing. Her husband, who had made the emergency call, confirmed she was on opioids. Following a quick check of her pulse and shallow breathing, Robinson administered a dose of the nasal spray Narcan just as he had been trained to do. He kept an eye on his watch as an ambulance crew arrived and began moving the woman into the vehicle. Robinson was taught to spray a second dose of the drug if the victim did not respond within three minutes. However, shortly after being lifted into the ambulance, the woman suddenly woke up, became alert, and began to breathe more normally.
This was the first time the Enid police or fire department had used one of the new rescue kits received from the Oklahoma Department of Mental Health Substance Abuse Services. Each kit contains two doses of naloxone. The officers’ training proved decisive in the emergency call. “Certainly, with the quick thinking on [Robinson’s] part, he saved this woman’s life,” says Lieutenant Eric Holtzclaw. “Minutes count when you’re talking about brain injury.”
A Tool That Makes a Difference
Officers and medical workers across the nation are pleased to have an opioid blocker that is actually making a difference in the crisis. According to the federal agency Emergency Medical Services, naloxone has a 93 percent success rate in reviving victims of opioid overdose. Stories about naloxone’s effectiveness are often in the news. For instance, in July 2018 singer Demi Lovato narrowly avoided a fatal overdose at her Hollywood home when emergency personnel arrived to administer Narcan. Experts on opioid abuse consider naloxone such an important safeguard they recommend that addicts, their spouses, or family members keep the drug on hand in case of an incident. Even opioid users who have kicked the habit are urged to have a rescue kit. In most states naloxone can be purchased over the counter without a prescription at pharmacies and national drugstore chains.
Naloxone dates back to 1971, when it was first approved by the FDA. The drug acts by binding to opioid receptors in the brain. This area of the brain is also in control of respiration, which is why a heavy dose of opioids can slow a user’s breathing and even stop it altogether. When naloxone is administered after an overdose, it serves to block the effects of opioids. This allows normal breathing to be restored, reversing the overdose. According to Dr. Kelly Clark, president of the American Society of Addiction Medicine’s board of directors, “As long as that naloxone is sitting in that receptor, other opioids can’t get in there and activate it.” For years naloxone could only be delivered through a needle injection to a muscle in the victim’s arm, thigh, or buttocks. The nasal spray version has made the drug much easier to administer. Naloxone is also safe to use when emergency personnel are not certain why a person is unresponsive. If the person has overdosed on a non-opioid drug or has passed out due to some other condition, administering naloxone will not revive him or her, but at the same time it does no harm.
In states where naloxone can be obtained without a prescription, police officials are using federal grant money to equip officers with Narcan kits and train them for proper use. Priced at forty dollars for a kit that is usable for only three or four months, Narcan is expensive for money-strapped departments that see lots of overdoses. Nonetheless, medical experts and law enforcement officials say the results justify the cost. Some police and emergency personnel have also voiced another reason for carrying the kits: personal safety. In the chaos of a drug scene, officers face the possibility of a random needle stick or inhalation of airborne opioid powder. Federal agents tell stories of drug busts in which suspects threw powdered opioids in the air so that agents would ingest them. When the opioids could be lethal fentanyl or carfentanil, authorities need naloxone available to protect themselves. Doug Wyllie, an expert on police training and public safety, says officers should take heed: “Naloxone … is as important to your safety and survival as your vest, your handson skills, or your sidearm.”
Community Policing
Police may have new tools and methods to deal with the opioid crisis, but traditional policing still has an important role to play. In fact, many officers today see themselves as part old-fashioned cop on the beat and part social worker. By establishing good relations with neighborhood residents, officers can take steps to get drug dealers off the streets and offer addicts the treatment they need.
Sometimes police can employ old-fashioned investigation plus networking to identify opioid dealers and put them out of business. Police in High Point, North Carolina, have used a community-based approach with success. First, they identified four neighborhoods most prone to drug sales and set up surveillance by undercover officers and informants. This brought to light key dealers in the drug trade. Those who had committed violent felonies were prosecuted, but nonviolent dealers were offered a bargain: If caught selling again, they would immediately be arrested, but if they agreed to enter a community-service program, they could receive housing, employment, a food and clothing allowance, and drug treatment. The approach has been adopted by police departments in several states.
The opioid epidemic has also placed new burdens on police because of all the related consequences they must deal with every day. Besides street sales and frequent overdose, there is violence between gangs, petty crimes by users to support their habit, and child abuse and neglect in drug-riddled families. Because of the dangers associated with the opioid trade, emergency responders often wait for police to arrive before entering a neighborhood thought to be unsafe. Officers can also help users through socalled harm-reduction programs. These include distributing Narcan to addicts and getting them into needle-exchange programs that help prevent hepatitis C and HIV. Police can also distribute test strips so users can detect fentanyl in opioid mixtures. And like QRTs, neighborhood cops can sometimes direct addicts into inpatient or outpatient facilities for special care. “The people who overdose are citizens of the community, deserving of protection and service from the police,” according to Arthur Rizer and Carrie Wade, policy experts for security and crime reduction. “Forsaking them will not reduce drug use. It will simply cost lives.”
Law enforcement experts stress that police cannot arrest their way out of the opioid crisis. Police departments in the hardest-hit areas are adopting new measures, such as rapid response teams, to deal with opioid addiction on a more personal level. Although traditional policing still has its place, these new approaches show great promise in rolling back the opioid epidemic in America.