Fernandina Beach Police Department
James T. Hurley, Chief
February 28, 2019 11:00 a.m.
As the Opioid Working Group (OWG) began tackling the complexities of the opioid crisis it was suggested that we utilize the very successful problem-solving model of scanning, analysis, response, and assessment, or SARA, which was developed for police more than thirty years ago. Fundamentally, a problem is defined as two or more incidents that are similar, and have the capability of causing harm, while the public expects a law enforcement agency to do something about it. The current opioid problem easily fits our definition of a major problem for police agencies.
The first step, scanning, requires that we recognize the reoccurrence of an issue and the effect that it has on our community and our citizens. The number of arrests, overdoses, and deaths that we have experienced in jurisdictions across the state demonstrate how prevalent the problem is, while there is typically a great deal of additional history tied to each individual story and is cumulative over time. These historical perspectives help to shape the true scope of the problem, prioritize issues and lead to the development of goals to resolve the many related issues within the larger focus. Additionally, non-traditional sources can greatly help us understand the problem. It is important to understand how educators, physicians, social workers and treatment counselors can have keen insights into the dynamics of drug addiction, while law enforcement has typically tried to “arrest its way out of the problem,” with remarkably poor results.
Clearly a new approach is needed and many new ideas are being tried throughout the United States and Canada, such as the early outreach program in Plymouth, MA where addicts are approached in their own homes within 12 – 24 hours of an overdose, thereby reducing the stigma of drug addiction by not forcing people to come forward to ask for help. Resource packets are delivered to family members and the addict as soon after the overdose experience as possible and the program is believed to be having a very positive impact on the goal of getting families involved and the addict willing to explore treatment options. Early reports suggest that this plan may be a valuable strategy, and it has already been replicated in various forms in Florida and elsewhere. “The best predictor of who will overdose and die is those that have overdosed and lived,” said Sheriff Dennis Lemma, Chair of the Opioid Working Group.
Analyzing a problem is often difficult, as underlying conditions must be examined to determine causation and results. Proper analysis begins with the collection of data relevant to the problem. It is necessary to specify current responses to the problem, available resources, and potential reasons for why the problem is occurring or growing. People don’t wake up and decide to become drug addicts. We know that many people addicted to opioids, as many as 80% or more, were first legally prescribed opioids as pain medication. There is also scientific evidence that demonstrates that children who are born to drug users have a greater tendency to become dependent on prescription narcotics than those that have not had the same level of exposure. In both cases, absent the correction of those underlining conditions, the likelihood of breaking the addiction is minimal.
To make matters worse, once addicted to prescription medications many addicts have moved to heroin because it is now cheaper and easier to acquire. And the relatively recent introduction of fentanyl has led to an increase in the rate of overdose deaths, as well as accidental exposures to police officers and others. By reviewing best practices being implemented elsewhere in isolated trials, the OWG can brainstorm ideas for intervention options that might work on a larger scale by combining plans and objectives and implementing a comprehensive proposal that addresses as many variables as possible.
As the OWG labors through the litany of other possible conditions that may be present in every case it is apparent that these situations deserve comprehensive and complete research by trained professionals. This process should extend well beyond offering a professional hypothesis. These recommendations should be deeply rooted in behavioral science and peer-reviewed to determine their accuracy.
The OWG examined the role of police agencies in actively working toward a holistic approach to problem solving the opioid crisis. In other words, a multi-discipline perspective is needed for convincing addicted persons to get into treatment, increasing the scope and accessibility of treatment, evaluating some known alternative (and controversial) methods such as “safe-injection” sites or needle exchange locations to prevent deaths, the importance of relying on the expertise of drug treatment experts, and the barriers to successful rehabilitation such as the $1B synthetic urine industry which, along with other less sophisticated apparatus, is designed to allow addicts to defeat drug screening procedures.
The group also believes that as public leaders we need to be outspoken about the opioid crisis and work diligently toward finding solutions. We also need to assign significant blame through litigation to the manufacturers and distributors of opioid medications, and to push Doctors to reduce prescribing opioid pills, while actively supplying naloxone to our communities by deploying naloxone with every officer. Some believe that naloxone should be prescribed anytime an opioid is prescribed and with sufficient warning to the patient regarding the dangers of addiction and the possibility of overdosing. Some OWG members believe that mandatory reporting at Emergency Rooms for opioid overdoses would help identify those in need of treatment.
The Opioid Working Group hopes to put a preliminary statewide strategy in place in the near future and then turn the mission over to the new Statewide Task Force on Opioid Drug Abuse. This “response” strategy will be based on a range of recommendations, primarily dependent on political will and available funding sources. Hopefully, we will see a departure from traditional “punitive” measures that have not worked well in the past, such as reducing requirements for “cold-turkey” rehabilitation models, restrictive insurance options, or strict arrest and conviction policies when treatment is an option. Because of the physical and psychological dependency on the drug, arrest has been a poor deterrent for drug users. However, drug offenders may still need to be arrested, while we work to break the cycle of incarceration by improving treatment facilities and judicial options, such as split sentencing, and expanding drug and veteran’s courts.
The assessment phase of this process involves evaluation of our strategy and should be adapted and changed whenever necessary. Our strategy will be deemed successful only if the empirical evidence, (new data), steers us in that direction. We should see significant reductions in the number of opioid addiction cases, opioid overdoses, and opioid overdose deaths, as well as a reduction in the number of opioids prescribed and other measurable outcomes. If not, a new course must be adopted. Sometimes only slight tweaks are needed overall or in sub-groups. The OWG recognizes that the problem of drug addiction, specifically opioids and opioid analogs, is extremely complex. Quick and easy solutions to combat such a widespread problem are very unlikely.