Introduction

In 2021, more than 46 million Americans aged 12 and older (17% of the population) had a substance use disorder (SUD), with just 6% receiving SUD treatment.[1] The past two decades have seen a significant increase in U.S. drug overdose deaths involving opioids. Since 2016, overdose deaths have exceeded other causes of accidental death, including motor vehicles and firearms.[2] Since 1999, U.S. authorities recorded almost 1 million overdose deaths with 107,000 overdose deaths in 2021; the majority due to opioids.[3]

Many law enforcement agencies have adopted deflection as a response to SUDs, overdoses, and mental illness, offering another access point to treatment.[4] Police officers often encounter people with behavioral health issues,[5] and may become frustrated by frequent interactions with those with chronic SUDs and having few tools to support recovery and limit arrests.[6] With self-referral deflection programs, individuals voluntarily enter local police stations and request , who are available 24 hours a day, seven days a week, to be referred to treatment referrals without fear of arrest.[7] This program model alleviates common barriers—SUD treatment waiting lists, cost/lack of health insurance, connection to community resources and services, and transportation to treatment.[8] Self-referral programs can operate at a low cost using officers’ time assisting participants.

Lake County Deflection Program: A Way Out

Lake County in Northeastern Illinois has a population of over 700,000.[9] The county started its self-referral deflection program, A Way Out program, in 2016 (Figure 1).[10] A prior study found a majority of A Way Out program participants were White males, aged in their early 30s, had either no insurance or some form of Medicaid/managed care, and were diagnosed with an alcohol or opioid use disorder.[11]

Figure 1

A Way Out by the Numbers

Fig1

Note. As of February 2023. Data source: A. Seidman, personal communication, February 8, 2023. Fifteen police departments and the county sheriff’s office participated in the program. Fifteen police stations and three sheriff’s office locations accepted walk-ins. In addition to the four local treatment providers, the program also used additional local recovery homes and treatment providers outside the county as needed.

The limited literature on deflection programs largely focuses on program description, participant description, and program implementation.[12] The current study adds to the current body of research and can inform federal and state policies, funding decisions, and local jurisdictions. This research brief summarizes information from a report prepared for the National Institutes of Justice and published on the RAND website.[13]

RQ

Methods

The evaluation sought to answer the research question: What is the impact of the program on overdose and crime rates in the county? The evaluation was approved by RAND’s Institutional Review Board. A synthetic control method was used to estimate the impact of program adoption.[14] This method utilizes a weighted set of corresponding variables to compare the observed results to those you would expect if the intervention had not been implemented. In this case, Lake County data was compared to the same variables in other Illinois counties, which were weighted and aggregated. Program effectiveness was estimated by comparing intervention group (Lake County) data to corresponding values of the synthetic control group (other Illinois counties) from 2005 to 2020 (Figure 2). We examined differences post-implementation of A Way Out from 2016 to 2020.

Figure 2

Outcome Data Sources and Sample

Fig2

Standardized mean difference tests assessed the fit of the synthetic control and joint significance tests were used to assess whether the overall effect of the intervention was significant for each outcome over time. We estimated effects using the synth program in STATA version 17.0.

Study Limitations

One limitation of this study was that concurrent deflection programs or other initiatives within or across counties that may have affected outcomes were not considered in the analysis. Concurrent efforts in control counties would have diminished the ability to observe effects, while concurrent efforts in Lake County would confound any observed effects. Since analyses are county-level, our findings cannot indicate whether program participants were more successful than nonparticipants. Moreover, it was unknown whether the control county programs were large enough for county-level effects to be observed. Finally, some quarterly outcomes at the county level, such as fatal overdose, were rare which can skew results when a rare event occurs.

Key Findings

Overall, the findings in Lake County suggest the deflection program improved fatal and non-fatal overdose outcomes, particularly in the category of fatal opioid overdoses, and decreased property arrests from 2016 to 2020 (Figure 3). The reductions of program outcomes varied by year and quarter, but average reductions are provided.

Figure 3

Summary of Lake County’s Deflection Program Outcomes

Fig3

These effects were consistent over time (Figures 4, 5, 6, and 7). Lake County drug arrests decreased, but the estimates were not statistically significant. In addition, DUI arrests and increases in treatment admissions were not statistically significant.

Fig4567

Note. Data sources were Illinois Department of Public Health and Illinois State Police’s Criminal History Record Information. The red vertical line indicates the program start date. The p values in order of figures were p = .053, p = .046, p = .034, and p = .011.

Conclusion

We conducted an outcome evaluation of A Way Out, a Lake County, Illinois deflection program. A synthetic control method was employed to measure the program’s effectiveness of reducing overdose, arrest, and treatment admissions. Findings showed higher reductions in Lake County non-fatal overdoses, fatal drug and opioid overdoses, and property crime arrests following implementation of the A Way Out program compared to those of a control group. Deflection is a relatively new strategy and limited empirical evidence of effectiveness is available; therefore, these findings contribute to the field and guide policy and practice.

The authors would like to thank the Illinois Department of Healthcare and Family Services, Illinois Department of Public Health, Lake County Health Department, Lake County Opioid Initiative, Lake County State’s Attorney’s Office, Lake County Sheriff’s Office, A Way Out police departments, TASC Center for Health and Justice, and members of the research project’s advisory board for their assistance on the project. Finally, we thank the following ICJIA researchers for their contributions: Sharyn Adams, Lily Gleicher, and Karl Gruschow.

  1. Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/reports/rpt39443/2021NSDUHFFRRev010323.pdf ↩︎

  2. Stein, B. D., Kilmer, B., Taylor, J., &. Vaian, M. E. (2023). America’s opioid ecosystem: How leveraging system interactions can help curb addiction, overdose, and other harms. RAND Corporation. ↩︎

  3. Centers for Disease Control and Prevention. (2022). Drug overdose deaths: Death rate maps & graphs. https://www.cdc.gov/drugoverdose/deaths/index.html; Centers for Disease Control and Prevention. (2022, May 11). U.S. overdose deaths in 2021 increased half as much as in 2020—but are still Up 15%. [Press release]. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm ↩︎

  4. Charlier, J., & Reichert, J. (2020). Introduction: Deflection—police-led responses to behavioral health challenges. Journal for Advancing Justice, 3, 1-13. https://icjia.illinois.gov/researchhub/articles/introduction-deflection--police-led-responses-to-behavioral-health-challenges; Schiff, D. M., Drainoni, M., Bair-Merritt, M., & Rosenbloom, D. (2016). A police-led addiction treatment referral program in Massachusetts. New England Journal of Medicine, 375, 25. 2-2503. https://doi.org/10.1016/j.jsat.2017.09.003 ↩︎

  5. Open Society Foundations. (2018). Police and harm reduction: How law enforcement can advance public safety, public health, and public confidence. https://www.opensocietyfoundations.org/publications/police-harm-reduction ↩︎

  6. Green, T. C., Zaller, N., Palacios, W. R., Bowman, S. E., Ray, M., Heimer, R., & Case, P. (2013). Law enforcement attitudes toward overdose prevention and response. Drug Alcohol Dependence, 113(2), 677-684. https://doi.org/10.1016/j.drugalcdep.2013.08.018 ↩︎

  7. Reichert, J. (2017). Fighting the opioid crisis through substance use disorder treatment: A study of a police program model in Illinois. Illinois Criminal Justice Information Authority. https://icjia.illinois.gov/researchhub/articles/fighting-the-opioid-crisis-through-substance-use-disorder-treatment-a-study-of-a-police-program-model-in-illinois; Schiff, D. M., Drainoni, M., Bair-Merritt, M., & Rosenbloom, D. (2016). A police-led addiction treatment referral program in Massachusetts. New England Journal of Medicine, 375, 25.2-2503. https://doi.org/10.1016/j.jsat.2017.09.003; Schiff, D. M., Drainoni, M., Weinstein, Z. M., Chan, L., Bair-Merritt, M., & Rosenbloom, D. (2017). A police-led addiction treatment referral program in Gloucester, MA: Implementation and participants’ experiences. Journal of Substance Abuse Treatment, 82, 41-47. https://doi.org/10.1016/j.jsat.2017.09.003 ↩︎

  8. Appel, P. W., Ellison, A. A., Jansky, H. K., & Oldak, R. (2004). Barriers to enrollment in drug abuse treatment and suggestions for reducing them: Opinions of drug injecting street outreach clients and other system stakeholder. The American Journal of Drug and Alcohol Abuse, 30(1), 129-153. https://doi.org/10.1081/ada-120029870; Open Society Foundations. (2018). Police and harm reduction: how law enforcement can advance public safety, public health, and public confidence. https://www.opensocietyfoundations.org/publications/police-harm-reduction; Pullen, E., & Oser, C. (2014). Barriers to substance abuse treatment in rural and urban communities: Counselor perspectives. Substance Use & Misuse, 49(7), 891-901. https://doi.org/10.3109%2F10826084.2014.891615; Schiff, D. M., Drainoni, M., Weinstein, Z. M., Chan, L., Bair-Merritt, M., & Rosenbloom, D. (2017). A police-led addiction treatment referral program in Gloucester, MA: Implementation and participants’ experiences. Journal of Substance Abuse Treatment, 82, 41-47. https://doi.org/10.1016/j.jsat.2017.09.003 ↩︎

  9. The United States Census Bureau. (n.d.). QuickFacts: Lake County, Illinois. https://www.census.gov/quickfacts/lakecountyillinois ↩︎

  10. A Way Out. (n.d.). Lake County A Way Out Program. https://awayoutlc.org/ ↩︎

  11. Reichert, J., Gleicher, L., & Adams, S. (2021). A preliminary outcome evaluation of Lake County’s police referral to substance use disorder treatment program. Illinois Criminal Justice Information Authority. https://icjia.illinois.gov/researchhub/articles/a-preliminary-outcome-evaluation-of-lake-county-illinois-police-referral-to-substance-use-disorder-treatment-program ↩︎

  12. Blais, E., Brisson, J., Gagnon, F., & Lemay, S. A. (2022). Diverting people who use drugs from the criminal justice system: A systematic review of police-based diversion measures. International Journal of Drug Policy, 105, 103697. https://doi.org/10.1016/j.drugpo.2022.103697; Lindquist-Grantz, R., Mallow, L. Dean, M. Lydenberg, & Chubinski, J. (2021). Diversion programs for individuals who use substances: A review of the literature. Journal of Drug Issues, 51(3), 483-503. https://doi.org/10.1177/00220426211000330 ↩︎

  13. Labriola, M. M., Peterson, S., Taylor, J., Sobol, D., Reichert, R., Ross, R., Charlier, J., & Juarez, S. (2023). A multi-site evaluation of law enforcement deflection in the United States. RAND Corporation. https://www.rand.org/pubs/research_reports/RRA2491-1.html ↩︎

  14. Parast, L., Hunt, P., Griffin, B. A., & Powell, D. (2020). When is a match sufficient? A score-based balance metric for the synthetic control method. Journal of Causal Inference, 8(1), 209-228. https://doi.org/10.1515/jci-2020-0013 ↩︎