Emerging Disparities in the Placement of Law Enforcement-Based Treatment Referral and Recovery Programs

• Published date: 01 September 2023
• DOI: http://doi.org/10.1177/07340168221117109
• Author: Ellen A. Donnelly,Chenesia L. Brown,Allison McBride,Leo Beletsky,Tammy L. Anderson
• Date: 01 September 2023
• Subject Matter: Articles

Emerging Disparities in

the Placement of Law

Enforcement-Based

Treatment Referral and

Recovery Programs

Ellen A. Donnelly

1

, Chenesia L. Brown

1

, Allison McBride

2

,

Leo Beletsky

3

, and Tammy L. Anderson

1

Abstract

Rising rates of opioid use disorder, overdoses, and opioid-related criminal offenses have prompted

U.S. law enforcement agencies to adopt alternatives to arrest and formal criminal processing. Police

departments frequently implement treatment referral programs and claim an aff‌iliation with the

Police Assisted Addiction and Recovery Initiative (PAARI). Although expanding to hundreds of agen-

cies, PAARI efforts may not be equally distributed across communities, raising concerns about

access to non-arrest diversion and increasing disparities in the criminal processing of drug-related

offenses. This study compares the characteristics and geographic placement of law enforcement

agencies with and without PAARI programs in 29 states. Lawenforcement agencies situated in com-

munities with lower rates of poverty and smaller Black populations have lower odds of having a

PAARI program. Agencies based in counties with more overdose deaths and greater unmet treat-

ment needs have increased odds of def‌lection programing. This placement of PAARI programs

ref‌lects broader inequalities in criminal justice and health. More advantaged, predominantly white

communities benef‌it from diversionary programs while fewer alternatives to formal criminal pro-

cessing exist for lower-income areas and communities of color. Additional research should explore

these growing disparities in the deployment of law enforcement-based treatment referral programs

and their consequences on drug law enforcement.

Keywords

police processes, drugs and crime, race and crime/justice, substance use

1

Department of Sociology and Criminal Justice, Center for Drug and Health Studies, University of Delaware, Newark,

DE, USA

2

Vital Strategies, New York, NY, USA

3

Health in Justice Action Lab, School of Law and College of Health Sciences, Northeastern University, Boston, MA, USA

Corresponding Author:

Ellen A. Donnelly, Department of Sociology and Criminal Justice, Center for Drug and Health Studies, University of

Delaware, 257 E. Main Street, Newark, DE 19716, USA.

Email: done@udel.edu

Article

Criminal Justice Review

2023, Vol. 48(3) 359-376

© 2022 Georgia State University

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/07340168221117109

journals.sagepub.com/home/cjr

Within the last decade, opioid use has redef‌ined the roles and responsibilities of U.S. law enforce-

ment (Biehl, 2018; Davis et al., 2015; Green et al., 2013). Often as f‌irst responders to a potential

drug poisoning, police off‌icers have received more training on administering naloxone to reverse

the effects of an overdose (Lowder et al., 2020; Purviance et al., 2017; Rando et al., 2015). Arrest

rates for opioid-related possession and sales offenses have grown in urban and non-urban areas

since the 1990s (Donnelly et al., 2021b). In certain jurisdictions, law enforcement has turned to

Prescription Drug Monitoring Programs (PDMPs) for purposes ranging from detecting prescrip-

tion drug fraud to formulating the substance use histories of individuals who might benef‌it from

diversion (Perez et al., 2017). Other police departments have taken a proactive approach to

support recovery in their communities. Such agencies have developed outreach, referral, and

other non-arrest diversionary programs that provide immediate treatment to people with a sub-

stance use disorder on a voluntary basis, upon recommendation of a f‌irst responder or clinician,

or in place of criminal sanctions (Formica et al., 2018; Pearlman, 2016; Streisel et al., 2019).

These def‌lection programs give new pathways to help individuals presenting with a behavioral

health issue beyond the traditional choices of making an arrest or doing nothing (Charlier &

Reichert, 2020, p. 1).

Police Assisted Addiction and Recovery Initiative (PAARI) programs have become a leading

treatment-oriented response to opioid misuse (Charlier & Reichert, 2020; Samuels, 2016; White

et al., 2021). First implemented by the Gloucester and Arlington, MA Police Departments in

2015, hundreds of new law enforcement agencies have partnered with the national PAARI orga-

nization every year to design, adopt, and improve programs that provide outreach to people

who have substance use disorder symptoms and offer the opportunity to connect these individuals

to care without the fear of possible criminal charges (Gloucester Police Department, 2015; PAARI,

2022b). PAARI operates within the broader context of opioid-related collaborations and programs

among police departments, including the Police, Treatment, and Community Collaborative

(PTACC) (PTACC, 2022), the Bureau of Justice Assistance’s Comprehensive Opioid,

Stimulant, and Substance Abuse Program (COSSAP, 2020), Law Enforcement Assisted

Diversion (LEAD) programs (Clifasef‌iet al., 2017; LEAD National Support Bureau, 2022), and

the Quick Response Team (QRT) efforts (Auerbach, 2019). Yet PAARI is among the most expan-

sive in its scope and allows agencies to publicly join a “community policing movement”(PAARI,

2022a) with the promise of technical assistance and resources from the national organization

(PAARI, 2022b).

While showing promise in terms of improving treatment outcomes (Davoust et al., 2021; Schiff

et al., 2016; Streisel et al., 2019), law enforcement-based treatment referral and recovery programs

often begin in predominantly white, suburban communities (Pearlman, 2016).Amid changing patterns

of drug arrests (Donnelly et al., 2021b) and uneven access to substance use treatment (Acevedo et al.,

2018), PAARI programs may grant opportunities for help and the avoidance of criminal sanctions to

some groups at the exclusionof others. No prior study has systematically examined where PAARI pro-

grams are placed or the community conditions that encourage program development.

This research note explores the placement of a large sample of law enforcement-based treat-

ment referral and recovery programs in the United States. It relies on an original dataset of

police departments who have joined the national PAARI organization (i.e., PAARI-aff‌iliated)

as of December 2021 and agencies in PAARI-aff‌iliated states that lack such programing. It

then distinguishes the agency characteristics and community conditions that make PAARI

program development more probable. The study concludes with lessons learned about which

communities are currently benef‌iting from diversionary options, how these programs ref‌lect exist-

ing inequalities in public health and criminal justice, and how gaps in treatment-oriented alterna-

tives to arrest and incarceration may exacerbate racial and class disparities in the criminal

processing of drug-related offenses.

360 Criminal Justice Review 48(3)