Police-Led Referrals to Treatment for Substance Use Disorders in Rural Illinois: An Examination of the Safe Passage Initiative

Introduction

The United States is facing an opioid crisis—about 90 Americans die each day from overdose, one every 15 minutes.^[1] Annually, drug overdose deaths kill more people than car accidents and gun violence. About 10 percent of the 20 million Americans and 11 percent of the 1.1 million in U.S. jails and prisons with a substance use disorder receive the treatment they need.^[2] The Centers for Disease Control and Prevention estimate the economic burden from prescription drug misuse at over $78 billion per year of which criminal justice is a large portion. Many addicted to opioids or other drugs commit crimes to obtain drugs as a part of their substance use disorder. Some police officers have become frustrated with making multiple arrests of these individuals and jails and prisons should be the last resort as a treatment mechanism.^[3] Law enforcement program models such as the one implemented in Safe Passage offer treatment without fear of arrest in an attempt to lessen the drug-related criminal justice “revolving door” while helping individuals overcome barriers to treatment.

Current Study

Illinois Criminal Justice Information Authority (ICJIA) researchers conducted a process evaluation of the Safe Passage Initiative, an effort in which individuals get help through the police in accessing substance use disorder treatment with no fear of arrest. Researchers sought to understand how the initiative was developed and operated, as well as gain perspectives of those involved in the initiative—stakeholders, police officers, treatment providers, and clients. Researchers used a multi-method approach—gathering information from administrative intake data, a law enforcement staff survey, interviews with treatment providers and clients, and a focus group with stakeholders.

Key Findings

In Safe Passage, a person voluntarily enters the police department for help and a police officer on duty conducts an intake process to collect basic information, including the individuals’ substance use and criminal histories. Officers reserve the right to refuse those with extensive violent criminal backgrounds. In addition, in cases where the individual has an outstanding arrest warrant for contempt, non-payment, or failure to appear on minor criminal offenses, an officer will contact the state’s attorney to negotiate quashing the warrant or postponing a court date until after treatment participation.

Once eligibility is determined, a police officer contacts a treatment provider with whom Safe Passage services have been pre-arranged. The provider conducts a phone interview with the client to determine appropriate level of care. Trained volunteers, recruited through community agencies, drive program participants to treatment facilities often located an hour away or more. After the client enters treatment, minimal contact is made by the police department or program volunteer. Follow-up by the client with Safe Passage is voluntary.

Safe Passage has operated in the two rural, northwestern Illinois counties of Lee and Whiteside since 2015. Spearheaded by the Dixon police chief, the initiative was developed in response to the region’s opioid crisis, but helps anyone with a substance use disorder. Program developers engaged the community and used media to increase awareness. A majority of interviewed treatment providers and some surveyed police officers indicated enhanced awareness would be beneficial to recruit clients into the program.

Intake forms obtained from the program showed 83 individuals entered Safe Passage and received detoxification and/or treatment services in its first year, from August 2015 to August 2016. Of them, 12 entered Safe Passage more than once. A majority of clients were single, unemployed, high school graduates; 54 percent were male; and the clients’ average age was 33 years. Forty-two percent indicated they suffered from a mental health disorder (n=36). All clients misused opioids. All reported using an opioid on the day of intake: 88 percent used heroin, and of them, 69 percent use it intravenously. Clients reported using opioids for an average of almost five years. Fifty-eight percent of Safe Passage clients reported receiving prior treatment and 55 percent reported previously trying to but failing to access treatment. Most clients—83 percent—had no health insurance at intake. Records indicated 86 percent had a criminal history.

Feedback from stakeholders, police officers, treatment providers, and clients was positive. Eighty-six percent of the 79 police officers surveyed were supportive of Safe Passage and 75 percent told someone with a substance use disorder about the initiative while on duty. Most officers surveyed reported receiving some training on Safe Passage (90 percent), but treatment providers indicated that officers could use more training, particularly on levels of care of substance use treatment. The six treatment providers who were interviewed offered unanimous support of Safe Passage and indicated they had good working relationships with police involved in Safe Passage. The five clients that were interviewed also expressed support for the program and appreciation for assistance.

Implications for Policy and Practice

The following are policy and practice recommendations for Safe Passage and similar initiatives based on data collected and analyzed for this evaluation.

Engage a Service Coordinator

Stakeholders and treatment providers suggested employing a full-time case manager with a clinical background to conduct assessments of clients for placement in the proper level of care and offer aftercare services in order to improve outcomes.

Enhance Police Officer Training

Although 90 percent of officers surveyed reported receiving some training on Safe Passage, more education, or refresher training, on substance use disorders would be beneficial. According to some treatment providers, some police officers presumed all with substance use disorders need detox and inpatient care. In fact, that course of treatment may not be beneficial for all clients, and there are assessments available to determine the appropriate level of treatment. Police officers initiate the call to the treatment provider on behalf of the client and may tend to call only providers offering detox and residential services. In addition to clients, police encounter individuals and families in the community in need of assistance for substance use disorders, so such training can further help people in need.^[4]

Ensure the Public is Aware Assistance is Available to Clients With Any Substance Use Disorder, Not Just an Opioid Use Disorder

Although spurred by the opioid crisis, Safe Passage is equipped to, and has helped, individuals with varying substance use disorders, not just opioid use disorders. The initiative was designed to accept anyone with a substance use disorder and the public needs to know that assistance is not limited solely to opioid users.

Ensure Continuation of Treatment/Aftercare

Continuing care for individuals is an important aspect of recovery and clients should be offered recovery support. Safe Passage reported having minimal contact with clients after intake and few treatment providers offered aftercare services. Funding of recovery support coaches offering case management to clients would be beneficial to support clients’ long-term recovery. Safe Passage is just one component of a larger continuum of services needed to reduce drug misuse and overdoses to promote the safety, recovery, and well-being of residents. Client access to all services and engagement in supportive components is beneficial. Communities considering Safe Passage or similar programs should assess the extent to which treatment and aftercare programs are available.

Gather More Information at Intake

Safe Passage intake forms were designed to collect basic information on the type of opioid used, the date of last opioid use, the date of first substance use, and the first substance used. Safe Passage should modify the intake form to include more detailed questions on substance use to have data that can reflect their clients. The initiative can know who is seeking help and for what drug(s) which over time, may show trends in drug use and availability in the community.

Measure Initiative Outcomes

Safe Passage officers and volunteers had minimal or no contact with clients after they entered treatment. Safe Passage should implement a more formalized follow-up process rather than relying on informal conversations or calls with clients. An aftercare/recovery specialist could assist with follow-up. In addition, the program should undergo a formal outcome evaluation to document long-term impact on client recovery and well-being.

Conclusion

Safe Passage represents a new model for police to help those suffering from substance use disorders which is of great interest to other jurisdictions across the country. While more research is needed, this initiative shows promise in connecting clients to treatment with the support of stakeholders, treatment providers, and police officers.