Recently released data suggest that, after decreasing in 2018, drug overdose deaths in the United States rose in 2019 and have continued to increase this year as the pandemic has increased isolation and disrupted access to treatment efforts.
To get some insights on what is happening, PERF Executive Director Chuck Wexler interviewed Allie Hunter of the Police Assisted Addiction and Recovery Initiative. PAARI defines its mission as “providing training, strategic guidance, support, and resources to help law enforcement agencies nationwide create non-arrest pathways to treatment and recovery.”
As Executive Director of PAARI, Ms. Hunter works with PAARI’s national network of almost 600 police departments in 34 states on treatment initiatives for persons with opioid use disorder and other drug problems.
PERF also interviewed Lt. Patrick Glynn of the Quincy, Massachusetts Police Department, which last month marked the 10th anniversary of “the Quincy Model — a program in which every Quincy police officer carries Narcan, and has since evolved to include a constellation of services aimed at fighting the opioid epidemic,” as detailed in a local newspaper.
- It takes time to gather national statistical data on opioid overdoses and fatalities, but provisional data and anecdotal estimates suggest that an increase in deaths is occurring in many locations. Data from the Centers for Disease Control and Prevention indicate that there were 73,860 overdose deaths from all types of drugs from April 2019 to March 2020, up from 67,726 in the same period a year earlier.
- Fentanyl and fentanyl analogues are the primary driver of this trend in some locations. In Oregon, for example, the state health authority reported a nearly 70% increase in overdose deaths in April-May 2020 compared to the same time in 2019, and fentanyl accounted for nearly 40% of all the overdose deaths.
- Deaths also are characterized by use of multiple drugs, especially stimulants such as cocaine and methamphetamine.
- Causes of increased drug abuse likely include COVID-related factors such as increased social isolation, depression, stress, and disruption of people’s access to treatment programs. An October 31 report by the American Medical Association expressed concern about increases in opioid and other drug-related overdoses attributed to the pandemic, and called on state and local governments to remove barriers to treatment and to expand harm reduction strategies.
- Police and their public health partners are demonstrating creativity in maintaining programs despite COVID-related restrictions on activities, such as prescribing via telephone of buprenorphine, an FDA-approved medication for treating opioid use disorder.
- The culture of policing has changed in some departments regarding how officers view substance abuse. Greater empathy and understanding are leading to more willingness to help persons with addictions.
- The demographics of opioid overdoses have changed in Quincy, with fewer young people and more people in the 50-60 age bracket. That will be a possible trend to watch for in other agencies.
Allie Hunter, Executive Director
The Police Assisted Addiction and Recovery Initiative (PAARI)
Chuck Wexler: Allie, what are you hearing from police departments about how the COVID pandemic has affected them on the drug issue, and their ability to work with drug treatment centers?
Ms. Hunter: PAARI is connected to 600 police departments across the country that are all seeing this in different ways. We are seeing a rise in poly-substance use, particularly with stimulants. And a lot of people are showing the impact of alcohol use, which can result in a rise in alcohol-related crimes, including domestic violence.
Anecdotally, people are saying they feel more isolated, and they don’t have access to their regular recovery support meetings. For example, you might need a negative COVID test before you’re allowed admittance to an in-patient program. And there’s the impact that unemployment can have on a person’s recovery.
On the flip side, there are good things happening such as supporting people who are being released from incarceration, and connecting them to a Boston Medical Center hotline so they can get quick access by telephone to a prescription for their opioid use disorder.
With our law enforcement partners, we’ve been seeing creativity in modifying their programs so they can still operate safely. For example, many of the police departments that we partner with have programs where they follow up after someone survives an overdose. They go to that person’s home, typically with a recovery coach or clinician, and ask if they can discuss treatment programs and other resources. Because of COVID, now they meet people on their porch or another outdoor location, rather than going into someone’s home. We’ve also seen a lot of nimbleness with law enforcement agencies helping to arrange getting Narcan mailed to someone’s home, or mailing packets of information to people’s homes.
I’ve also seen more openness to partnering with harm reduction agencies. We’ve had a pilot program with 11 law enforcement agencies in Massachusetts that hand out fentanyl test strips, which detect the presence of fentanyl in drugs, to reduce overdoses.
In addition to my work with PAARI, I work closely with a number of police departments in Massachusetts, where I live, so I have some first-hand experience with them that I can speak to.
A lot of what I’ve seen in Boston, which is where I’ve had the most direct experience with ride-alongs and other street-level outreach, is about addressing the basic needs of people experiencing homelessness. We’re trying to help them with their addiction or opioid use disorder, but if we can’t help them obtain housing, it’s going to be really tough for them to get on a healthy pathway. So a lot of what we’re doing with the Boston Police Department’s street outreach team is helping people with basic needs. That also includes things like handing out masks and hand sanitizer.
Wexler: How does this year compare to last year in overdoses?
Ms. Hunter: For departments that share their data with us, most of them are seeing a rise in both fatal and nonfatal overdoses, if they track both.
Lt. Patrick Glynn
Quincy (MA) Police Department
Wexler: Patrick, it’s been 10 years since your department became one of the first in the country to equip officers with naloxone. How has that changed your department and your relationship with the community?
Lieutenant Glynn: In the beginning, it was just about people looking at the police differently. Once police started reversing overdoses, family members saw that the police were actually there to help, rather than to enforce the criminal laws about opioids. We also were able to change our Good Samaritan law, which was helpful in reducing the liability of those who call the police to report an overdose. We were able get Narcan out into the community without requiring a prescription, and we had a number of other changes.
As time went on, Narcan came to be seen as just one tool in our toolbox. It became an everyday occurrence of somebody overdosing, we administer the Narcan, they go to the hospital, and people weren’t afraid to call us anymore.
That opened the floodgates, and our response grew to include post-overdose home visits where we offer help to the person who just survived an overdose. Those visits have become more challenging because of COVID, but we’re all working together with the interdisciplinary approach, with the recovery teams, our overdose teams, and the public.
We also started helping the family members of people with addictions. That was one of the most rewarding things for the officers, to be able to help the family members who were living for years with someone with a substance use issue, but who never knew that they could get help for themselves, as well as for their family member. People were living with someone who was lying and stealing from them all the time, and not getting any help.
I give the officers credit for making all these changes, starting with changing to better terminology. Nobody is ever referred to with derogatory words like “junkie.” We’re talking about people with substance use issues, and these people belong to someone. They’re somebody’s mother, father, son, daughter, brother, sister – and now it’s often grandparents who are overdosing. They’re all someone’s family member.
The reality of addiction also hit the police department when we had some officers lose children to addiction. So our eyes were opened much, much wider than they were in the past.
Wexler: How does 2020 compare to 2019 in terms of drug overdoses?
Lieutenant Glynn: Unlike other places, we’ve seen a significant reduction in overdoses. We’re running right now at about 20% less than we were for all of last year. And our death rate is down about 30%.
However, I believe that with Narcan being readily available, many people are self-reversing or family-reversing at home, and are not reporting through the 9-1-1 system.
Deaths are mostly individuals in the 50 to 60 age bracket. We no longer see people in their late teens and mid-20s. The average age of the overdoses has gone up, and the ages of the fatals have dramatically gone up.
Wexler: Why is that?
Lieutenant Glynn: Everything is mostly about fentanyl now. Heroin is basically a thing of the past.
I think what ended up happening is that their bodies are deteriorating over time to a point that they’re just giving out.
Wexler: In the 10 years since Quincy started carrying Narcan, how many people do you think the police have saved in that time?
Lieutenant Glynn: We’ve reversed almost 1,200 overdoses. I’d say that at least 15 to 20 overdoses per year would have been fatal, so that would be a total of 150 to 200 lives saved over 10 years. That might be a conservative number.
PERF also is grateful to the Howard G. Buffett Foundation for supporting this work.