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

Published date01 September 2023
AuthorEllen A. Donnelly,Chenesia L. Brown,Allison McBride,Leo Beletsky,Tammy L. Anderson
Date01 September 2023
Subject MatterArticles
Emerging Disparities in
the Placement of Law
Treatment Referral and
Recovery Programs
Ellen A. Donnelly
, Chenesia L. Brown
, Allison McBride
Leo Beletsky
, and Tammy L. Anderson
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 afliation 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 deection programing. This placement of PAARI programs
reects broader inequalities in criminal justice and health. More advantaged, predominantly white
communities benet 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.
police processes, drugs and crime, race and crime/justice, substance use
Department of Sociology and Criminal Justice, Center for Drug and Health Studies, University of Delaware, Newark,
Vital Strategies, New York, NY, USA
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
Criminal Justice Review
2023, Vol. 48(3) 359-376
© 2022 Georgia State University
Article reuse guidelines:
DOI: 10.1177/07340168221117109
Within the last decade, opioid use has redened the roles and responsibilities of U.S. law enforce-
ment (Biehl, 2018; Davis et al., 2015; Green et al., 2013). Often as rst responders to a potential
drug poisoning, police ofcers 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 benet 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 rst responder or clinician,
or in place of criminal sanctions (Formica et al., 2018; Pearlman, 2016; Streisel et al., 2019).
These deection 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 Assistances Comprehensive Opioid,
Stimulant, and Substance Abuse Program (COSSAP, 2020), Law Enforcement Assisted
Diversion (LEAD) programs (Clifaseet 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-afliated)
as of December 2021 and agencies in PAARI-afliated 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 beneting from diversionary options, how these programs reect 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)

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