What Massachusetts can teach us about police-assisted referral programs for substance use disorders
REVIEWED BY: Stacey McKenna, PhD
In 2019, according to the Centers for Disease Control and Prevention, 70,630 people in the United States died of a drug overdose. Estimates suggest that number was even higher in 2020. Research increasingly demonstrates that the illicit nature of many substances and the consequent interactions with law enforcement contribute to drug-related harms, including overdose risk.
In response to this information, communities are seeking alternative approaches. In the United States, one strategy has been to reimagine the role of police when it comes to drug use. Hundreds of police departments from Arizona to Massachusetts have partnered with the nonprofit organization Police Assisted Addiction and Recovery Initiative (PAARI) to implement police-assisted referral programs. While the specifics of these programs differ by city and circumstance—some focus on community and home outreach while others suspend consequences while encouraging individuals to actively seek assistance—the general goal is to “create non-arrest pathways to treatment and recovery,” by connecting individuals with substance use disorder (SUD) services.
Given the growing popularity of these programs and the broader nationwide call for major police reform, it will be important to understand the experiences of those involved with carrying out these programs. To that end, Melissa Davoust and colleagues conducted a qualitative study of five of the ongoing programs in Massachusetts, published in early 2021 in the International Journal of Drug Policy.
The research team worked with PAARI to identify and recruit police departments throughout the state that were currently implementing police-assisted referral programs. They conducted focus groups (six total) and interviews (four total) with 33 individuals—five police chiefs, 12 officers, six outreach workers, four community-based organization directors, two interns, one clinician, one program manager, one religious representative, and one prevention specialist—from five Massachusetts communities. The five communities represented a wide range of demographic compositions, with some relatively homogenous and others quite diverse with regard to race/ethnicity, wealth and population density.
Because the study examined program implementation rather than program outcomes, the researchers designed their questions using three constructs identified by the Promoting Action on Research Implementation in Health Services (PARiHS) framework as key to successful program implementation: evidence, context and facilitation. All focus groups and interviews were professionally transcribed and individual identifying information was removed. Davoust et al. then used the PARiHS framework to develop an initial codebook. They analyzed the data in multiple stages, starting with a “pilot” coding round which incorporated codes that emerged inductively from the transcripts. Throughout the process, coders discussed and resolved inconsistencies and discrepancies in their analyses. In the final analysis, the team identified several themes that emerged across the communities, and within each theme, several important findings.
First, Davoust et al. found that the programs were perpetually evolving in response to community needs and barriers. Programs became more complex, trading single-service models focused either on outreach or walk-ins to hybrid programs that allowed them to increase their reach. As it became apparent that a minority of people would accept treatment referrals, program efforts shifted toward harm-reduction services, such as providing naloxone or fentanyl test strips. In addition, several interviewees explained that program participants who did accept referrals tended to be more successful when they received ongoing engagement with an array of services, including assistance with housing, food, transport and health insurance. As such, a number of programs expanded to directly offer or facilitate access to these types of resources.
The second theme highlighted the importance of partnerships, “moving from ‘siloed’ positions to working together.” Interviewees saw such collaboration between police departments and other community stakeholders as essential in order to build relationships with people in need and offer them the wide array of services that would save lives.
The third theme the researchers identified was the importance of departmental leadership. Davoust et al. found that interviewees often credited police chiefs for their role in building strategic partnerships; setting evidence-based and people-oriented agendas; fostering team cohesion and shaping departmental culture. Conversely, when leaders were unwilling to adapt to community needs or grapple with critical feedback, programs tended to be less sustainable.
Fourth, Davoust and colleagues noted interviewees’ definitions of what made a program successful varied. While all five programs operated toward the ultimate ends of reducing overdose mortality and referring individuals to SUD services, they identified more immediate outcomes according to their particular priorities. For most, success was defined by being able to access the types of services people actually wanted—meeting people “where they are”—and thus looked different with every program participant. Other goals were broader, with interviewees saying they wanted to gain community trust or build relationships. In addition, some programs defined success differently for different team members; for example, police officers might be responsible for making the initial referral while outreach workers were focused on the outcome of that referral.
The fifth and final theme Davoust and colleagues uncovered was that these programs have, in many cases, contributed to changes in police officer beliefs and departmental culture. Interviewees felt that seeing the positive impact of these types of programs over time established “buy-in” from officers that were previously skeptical. Furthermore, as officers increasingly viewed addiction as a health issue rather than a crime they were more likely to consider alternatives to incarceration and to explore new ways for law enforcement to serve communities.
This study fills an important gap in the literature, exploring police-assisted SUD referral programs through the lenses of those responsible for their implementation. Their qualitative methods were ideal for exploring an under-studied topic, but the findings are not technically generalizable. A potential weakness of the study is that the authors did not ask interviewees to describe how they measured success. Nor did Davoust et al. attempt to assess the success of these programs themselves.
Nonetheless, the researchers stressed that the variety of models present even among this limited number of departments indicates that programs can be readily adapted to serve individual communities. In addition, the researchers provide limited guidance—especially regarding flexibility, partnership and leadership—for communities looking to implement their own programs. This exploratory research and the resulting recommendations are especially relevant in the current climate, in which the roles of police officers are increasingly being brought into question, and in which such programs may help departments transition to better serve their communities.