Law Enforcement-Based Outreach and Treatment Referral as a Response to Opioid Misuse: Assessing Reductions in Overdoses and Costs

• Published date: 01 December 2023
• DOI: http://doi.org/10.1177/10986111221143784
• Author: Ellen A. Donnelly,Daniel J. O’Connell,Madeline Stenger,Jessica Arnold,Adam Gavnik
• Date: 01 December 2023
• Subject Matter: Articles

Article

Police Quarterly

2023, Vol. 26(4) 441–465

© The Author(s) 2022

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DOI: 10.1177/10986111221143784

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Law Enforcement-Based

Outreach and Treatment

Referral as a Response to

Opioid Misuse: Assessing

Reductions in Overdoses and

Costs

Ellen A. Donnelly

1

, Daniel J. O’Connell

1

, Madeline Stenger

1

,

Jessica Arnold

1

, and Adam Gavnik

1

Abstract

To reduce opioid-involved overdoses, law enforcement agencies have taken proactive

steps to connect people to treatment and supportive services. This study evaluates the

impact of a law enforcement-based outreach and treatment referral program known as

Hero Help on the incidence and costs of overdoses occurring in the jurisdiction of

Delaware’s New Castle County Division of Police (NCCPD). It f‌irst compares ob-

served and predicted fatal and nonfatal overdoses between 2013 and 2021. A time

series analysis shows an average decrease of 7.25 nonfatal and 1.85 fatal overdoses per

month since the program’s two expansions of its civilian care team. It then adapts

Centers for Disease Control and Prevention and health care cost data to estimate the

cost reductions of fewer overdoses. These metrics suggest Hero Help saved the

community $21.5 million per month. Police departments can then reduce the incidence

and economic burden of overdoses through outreach and referrals to treatment.

1

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

Newark, DE, USA

Corresponding Author:

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

University of Delaware, 257 E Main St, Newark, DE 19716-5600, USA,

Email: done@udel.edu

Keywords

opioid, overdose, substance use treatment, def‌lection, cost savings

Opioid overdoses in the United States have placed enormous pressure on criminal

justice and public health off‌icials to reduce social harm. Drug overdose deaths topped

over 100,000 in 2021, with opioids contributing to 78% of these fatalities (Centers for

Disease Control and Prevention, 2021). Nonfatal overdoses have steadily grown too,

with emergency departments in f‌ive U.S. regions reporting a 29.7% increase in sus-

pected opioid overdose admissions between 2016 and 2017 (Vivolo-Kantor, 2018). The

federal government estimated that opioid misuse has cost the United States nearly $2.5

trillion in human life between 2015 and 2018 (Council of Economic Advisors, 2019),

representing a greater cost than government expenditures on military, Medicare, and

Medicaid combined (Schwartzbach, 2019).

The opioid crisis challenges law enforcement to act: on the one hand, police off‌icers

are f‌irst responders who encounter active overdoses, and, on the other, are enforcers of

the law to disrupt the possession and sale of illicit substances (Yatsco et al., 2020).

Beyond campaigns to get off‌icers to carry and administer naloxone (Davis et al., 2015;

Green et al., 2013;Rando et al., 2015), law enforcement agencies have introduced

def‌lection programs in response to opioid misuse (Charlier & Reichert, 2020). De-

f‌lection programs rely on f‌ive pathways for engagement: (1) self-referral to treatment,

(2) clinician outreach following an overdose, known as naloxone plus, (3) community

outreach, (4) off‌icer-initiated treatment referral, known as off‌icer prevention, and (5)

off‌icer intervention through treatment in lieu of arrest or formal criminal processing

(Center for Health and Justice at Treatment Alternatives for Safe Communities, 2021;

Goodison et al., 2019;SAFE Project, 2019; for a visualization of these pathways, see

PTACC, 2021). The opioid response landscape is rapidly evolving, as departments

strive to develop programs that effectively prevent overdoses, decrease the societal

costs associated with opioid misuse, and save lives (Formica et al., 2018).

In Delaware, the New Castle County Division of Police (NCCPD) introduced an

outreach and treatment-referral program known as Hero Help. Developed in May 2016,

the program connects people seeking help for a substance use disorder to treatment

following self-presentation, upon recommendation of an off‌icer (i.e., no pending

charges), or in lieu of arrest. Program staff also follow up with people who experienced

an overdose, lead community education events, and re-engage individuals who have

previously undergone detox or treatment after an initial referral. Effectively, the

program utilizes some form of each of the f‌ive def‌lection pathways (PTACC, 2021).

The Hero Help program has rapidly evolved in its 6-year history. It has benef‌ited from

two rounds of programmatic expansions: f‌irst, the hiring of a full-time civilian co-

ordinator in March 2018, and second, the addition of a community health partner team

of case managers, a nurse, a mental health professional, and a child victim advocate in

442 Police Quarterly 26(4)