Wanted: New Strategy for Drug War
Get ’em into the system, get ’em clean.
For decades, law enforcement took the same approach to drug use: Arrest the drug addicts. But tough love approach didn’t curb the drug problem. And now, with a new opioid epidemic gripping the nation, people are dying at record rates.
Police officers watched parents burying children again and again, sometimes even their own friends and family.
Desperate to stop the flood of death, an expanding group of police, led by local chiefs, are introducing new tactics and approaches to reinvent how the war on drugs is waged.
TURNING TO ANGELS
For Leonard Campanello, it was logical.
Faced with a spike in overdoses and deaths from opioids last spring that had the small town of Gloucester, Massachusetts, reeling, Campanello, the town’s police chief, created a revolutionary police diversion program for drug-addicted people.
The Gloucester ANGEL Initiative helps funnel people into treatment when they simply ask for help. The person will not be arrested if they bring their drugs and paraphernalia with them. In fact, they’re encouraged to turn them over to police.
“We’re out to be a safe haven for people who are suffering from addiction, who don’t want to do it anymore, who don’t want to engage in criminal activity anymore, who don’t want to suffer anymore. That’s it,” said Campanello, a former narcotics officer on Massachusetts’ North Shore.
Gloucester is America’s oldest seaport and a picturesque vacation spot that’s home to 28,000 full-time residents. It’s a place where salty fishermen rub elbows with yuppies and artists in bars and local shops.
The town has battled the scourge of opioid addiction for decades. Use of the drugs ebbed and flowed, but when five people were claimed by drug overdoses in the first half of 2015, Campanello was ready for a new approach.
He announced the ANGEL Program in a Facebook post in May 2015, and it launched the next month.
Not everyone was sold on the idea. The county’s district attorney wrote Campanello to say he was out of bounds. Some police chiefs around the country called the plan “unrealistic.”
“Come talk to us in two years when you’re overrun with opioids,” he said.
“To do nothing invites more death of viable and worthy people who find themselves with a disease.” — George Hackford
When a drug-addicted person walks into Gloucester Police Department seeking help, a police watch commander immediately starts calling local inpatient treatment centers, looking for a bed, like they’re “buying Bruce Springsteen tickets,” Campanello jokes.
The person suffering from addiction is paired up with a volunteer, an angel, who sits with them during the wait.
“It is quite emotional, but the role of the angel really is to listen,” said George Hackford, the program’s first angel. “The emotions that I see are very often relief. A lot of the people who come in here. It’s a really big step they’ve taken.”
Hackford, a 58-year-old Brit who moved to Gloucester with his wife 14 years ago, sees the angel role as a privilege. He’s helped 27 people since the program’s launch. All have left an impression on him, but one 30-year-old’s woman’s story really stuck with him.
“She was actually born an addict,” he said. “She said something absolutely incredible to me. She said to me, she said, ‘George,’ she said, ‘as a little girl of 5, needles were as normal to me as teddy bears would have been to you at the same age.’”
“She’d lived with this drug addiction, her mother’s addiction and then her own, all her life. That really made me think how good this program is, because what would be the point of criminalizing a person like that?”
At first, it took Gloucester police 15 hours to find a bed at a treatment center. That’s now down to two hours, thanks to a better understanding of the system and more support from treatment facilities.
“To do nothing invites more death of viable and worthy people who find themselves with a disease,” Campanello said. “You can only punch logic in the face so many times.”
There are caveats. A person with outstanding warrants has to clear them up with the court before being admitted. And someone can’t elect to enter the program in lieu of arrest for drug crimes.
The ANGEL Initiative launched on June 1, 2015. By the time we spoke last November, it had helped 306 people. Now, that number has grown to more than 400 as winter weather slowed people coming in. Petty crime, like thefts and burglaries, dropped 31 percent since the program began. And, most important to Campanello, it’s saving lives.
“From a purely pragmatic perspective, it makes more sense to help these people.” — Sander Schultz
Gloucester Police aren’t the only game in town working to combat the problem. The Gloucester Fire Department is doing advanced data collection for the medical community on overdoses to better understand what led people to use and develop strategies that can have a real effect on care.
Both departments were the first in the state to have officers, medics and firefighters carry nasal naloxone — a much quicker and easier to administer version of the overdose reversal drug commonly known as Narcan.
“There was a lot of resistance to it. There was an idea that we were just enabling a population to use, which is simply not true,” said Sander Schultz, EMS coordinator at the Gloucester Fire Department.
Schultz, a firefighter paramedic and former Coast Guardsman, believes helping people suffering from drug addiction get into treatment is the right thing to do. But he admits that doing so saves money as well.
According to Campanello’s calculations, treating the addiction is much less expensive than arrest and jail. It costs taxpayers $220 to put a person behind bars for a night, but the ANGEL program costs $55 per night, on average.
“The cavalier attitude that people who are addicted are somehow not deserving of care is really wrong-headed thinking,” Schultz said. “From a purely pragmatic perspective, it makes more sense to help these people.
“I think it’s really important to take care of the behavioral health substance abuse population just as we do everybody else.”
The Gloucester Police Department doesn’t pay for the treatment. A combination of state and private insurance, plus treatment donated by facilities, covers the cost of a typical 30-day stay for detox and intensive counseling.
Campanello also uses liquidated assets seized from drug dealers to pay for transportation to take people to treatment centers, to make naloxone widely available for free, and to provide critical after-care to ANGEL program participants who can’t afford it.
“Do we buy another cruiser or do we help out people who are addicted with the money that comes from drug dealers?” he said.
Emboldened by the program’s success, Campanello, along with local businessman and activist John Rosenthal, launched the Police Assisted Addiction and Recovery Initiative, or PAARI. The organization offers guidance to other departments exploring bringing the program to their towns. They’ll soon dole out grants to participants for cover funding lapses for treatment. PAARI is soliciting funding from businesses, foundations and donations from individuals.
“We’ll have grants and we’ll be partnering with treatment providers and we’ll cover co-pays and we’ll cover transportation to get people to treatment,” Rosenthal said. “That will be a great model for the rest of the nation to replicate.”
Nearly 80 police departments across the country have brought the program online in their town. There are dozens more in the process of doing so.
“We don’t pretend that the Gloucester program is going to work in every city,” Campanello said. “The more proactive piece is a shift in thinking.”
“If someone comes to us and says I need help, we will get them the help that they need.” — Fred Harran
Fred Harran has been trying to put a dent in the drug overdose crisis in Bensalem, Pennsylvania, for three years.
The Bucks County town on the northeastern border of Philadelphia has seen a 30 percent jump in drug overdoses over the past three years. Police responses are up 224 percent and officers used naloxone to save 17 people from death.
“We’re trying to control it best we can,” said Harran, Bensalem Police Department’s director of public safety. A blustering verbal brawler who’s not afraid to enlighten you on the trials and tribulations of his department, the 51-year-old rolls out new programs to fight the epidemic regularly.
Last year, the department started sending certified letters to doctors when a patient overdoses or when there’s a suspicion a person in custody is abusing prescription painkillers. Officers also have counted pills in prescription bottles found in cars during traffic stops to make sure the count matches the dosing guidelines. If they don’t, they’re confiscated and the doctor gets a letter.
Each day, department staff sends emails to all doctors in the area notifying them about drug arrests and trends in the township.
Drug testing kits are offered free of charge to residents. The department has refused to provide police reports to people who detectives believe are lying about a home burglary to get a new painkiller prescription.
“They left a flat-screen curved TV, they left my iPad, they left all the friggin’ electronics there, but my God, they went right for my Vicodin and it’s gone. The house wasn’t broken into. That’s a junkie trying to get more pills,” he said.
The epidemic has residual effects on the community as well. Harran estimates as much as 80 percent of the crime committed in Bensalem is tied to drugs in one way or another.
“You are affected by this because people don’t necessarily go out to get jobs to support their heroin habits, they steal from you,” he said.
Willing to try anything to alleviate this crisis, Harran will roll out a local version of Gloucester Police’s ANGEL Program in March. His department will be first in the region to officially participate in the program.
Upper Darby in Delaware County, while not taking part in the PAARI initiative, launched its own version of the program, called Change is Possible, on March 9.
The distinction of being one of the first, while exciting, concerns Harran.
Bensalem won’t turn away non-residents. The department could be inundated with people seeking help from surrounding towns and major cities like Philadelphia, Camden and Trenton. A lack of treatment capacity could threaten the department’s ability to fulfill the promise.
“If someone comes to us and says I need help, we will get them the help that they need,” he said.
“Can you imagine if they had a waiting list for cancer or diabetes or heart disease?” — Gene DiGirolomo
Paying for treatment is another worry. Unlike in Massachusetts, all Pennsylvanians are not offered free health insurance if they can’t afford coverage. So Harran, along with township and county officials, is asking for increased funding and more scholarship beds from local facilities. Harran sees state help vital to making programs like these work.
“I abhor Harrisburg,” he said exasperatedly. “You don’t need to have hearings on the problem. It’s a friggin’ problem…We’re just making ourselves feel good. Put the money where the money needs to be put, and let’s get people the help before more lives get destroyed.”
Gene DiGirolomo, Bensalem’s 11-term state representative, has been working with Harran and is looking at ways to increase county funding for treatment. The issue is personal for him. His son, Gene Jr., started treatment for heroin addiction when he was 17. He eventually went to Florida for treatment and has been in recovery for 17 years.
DiGirolomo, who is majority chair of the Pennsylvania House Human Services Committee, helped create the Department of Drug and Alcohol Programs and says officials are looking at expanding capacity restrictions at inpatient facilities. They’re hoping to encourage more facilities to open as well.
“Can you imagine if they had a waiting list for cancer or diabetes or heart disease?” he asked. “People would be just outraged, but yet for this disease we look at it a bit differently.”
Still, paying for care is the biggest hurdle. DiGirolomo, a Republican, applauded Gov. Tom Wolf’s Medicaid expansion, which offered insurance to nearly 700,000 residents. But for those without insurance, getting care is all charity-based.
“Certainly, we need help, whether it’s on a state level or federal level. But until they wind up doing things, we have to do what we need to get this job done,” Harran said.
Dan MacDonald would love to focus more efforts on helping drug-addicted people in Philadelphia, but his priority right now is stopping drug-related violence.
MacDonald is the chief of Philadelphia Police Narcotics Bureau. He’s worked for the better part of 20 years in the city’s drug hub, often referred to as “The Badlands,” a collection of neighborhoods including Kensington and swaths of North Philadelphia where drug dealing is pervasive.
“For us, this war, it’s a quagmire,” he said standing at the corner of Boudinot and D streets in Kensington.
Under MacDonald, the Narcotics Bureau has been focused on targeting major drug peddlers who are linked to violence. Within a week or two of locking a major dealer up, MacDonald can expect violence to explode on the corner that dealer ran.
“If they’re looking at serious time, or they’re not getting out on bail, I’ve created a power vacuum out here,” he said. Other dealers fight for control of that corner.
Caught in the middle are drug-addicted people — 40 percent of whom are not city residents. Heroin dealers, looking to insulate themselves from police, began hiring addicts to sell the drugs. Taking advantage of their dependence, they pay the addicts with heroin.
The chief calls them pawns who wind up with felonies instead of help for their disease. It frustrates him.
While MacDonald recognizes addiction is a disease, he worries that removing all negative stigma surrounding drug use could backfire.
“Yeah, it’s a disease, yeah we have to have a compassionate approach, but we also have to tell you that it’s not OK,” he said. “A little bit of shaming can go a long way to help solving our problem, and when we stop doing that, you’ll see those problems just grow.”
He cites the need to better educate the community, especially young children, about the dangers of opioids, similar to what has been done with cigarettes.
While not as progressive as some of his law enforcement colleagues, MacDonald is open to trying new approaches. He believes that the ANGEL program could be tailored to Philadelphia and is in discussions with the Philadelphia District Attorney’s Office to come up with new diversion programs. But he says the success will come down to correctly focusing resources into those areas.
Otherwise, he said, we’re just reliving prohibition. “We’re following the same stupid model,” he said.
A DRUG FOR GOOD
Camden Metro Police have incorporated a hallmark lifesaving tool in the city’s drug fight: Naloxone, initially marketed as Narcan, a drug that can reverse an overdose as it’s happening.
“It’s literally one of the natural things that we have as a tool to help people,” said Tyrell Bagby, a 24-year-old officer who’s saved 16 people from overdose using the drug since joining the force two years ago.
Camden was one of the first cities in the Philadelphia region to have police officers carry the drug. Since the program’s start in May 2014, more than 178 people have been revived by police officers administering the drug.
Once, Bagby was flagged down by a car passenger while walking his beat. The car’s driver had begun to overdose. The naloxone was locked in Bagby’s police cruiser a few blocks away, so he sprinted to the nearby police headquarters to get a vial. He ran back through traffic to administer the drug.
“Right before EMS jumped out of their vehicles, the individual woke up,” he said. “He was very, very thankful for me saving his life. I felt good.”
Every Camden police officer carries naloxone. Across the river in Philadelphia, only select officers in certain districts have it.
Scott Thomson, chief of the Camden County Police Department, opposed carrying the medicine at first. He was worried his officers would be left open to lawsuits for administering the drug. But that changed with a little education about the laws surrounding the use of the drug.
Selling officers on the benefits of the drug came next.
“We quickly found was we went from having a workforce that did not completely understand the challenges of addiction and not really wanting to be involved in what seemed as a sensitive approach to drug trafficking or drug use, illegal activity, into being more part of the solution than the problem,” he said.
“We’ve got officers now that will go into locations where we know people will go to use the heroin and they get out and they search through abandoned houses and vacant lots.”
Despite their best efforts, not everyone can be saved.
Last year, 41 people died on Camden’s streets from drug overdoses. In all, police and paramedics responded to 600 overdose calls. Eighty percent of the victims did not live in the city of Camden.
Some died because others with them at the time of the overdose were afraid of calling police and risking arrest. Police believe that’s what ultimately led to Sal Marchese’s death. Investigators told Patty DiRenzo they believed another person was in the car with her son when he overdosed in the parking lot of a Camden apartment project.
“That just didn’t sit right with me,” Patty said. “Make the call and run. I don’t care. Save a life. They didn’t..
The pain of Sal’s death still fresh, Patty began to advocate for the passage of a good Samaritan law in New Jersey. Other states had them, but the Garden State didn’t have the safety net.
Two years and a veto later, in 2013, NJ’s good Samaritan law was signed into law as the Overdose Prevention Act. Patty calls the passing of the law bittersweet. Had it been in effect when Sal overdosed, he could still be alive.
Now, she periodically goes into Camden to hand out information cards to educate people that they can call 911 for help without getting in trouble.
“I’m saving lives, and I’m doing it in his memory, and that’s what’s important to me,” she said.
Getting people into treatment is still the biggest challenge. Camden County launched Operation SAL (Save a Life), named after Patty’s son, offering county residents the chance to get into treatment immediately after a drug overdose.
“We’re just hoping that folks will have an epiphany and realize ‘Hey, it’s time for me to get help,’” said Lou Cappelli, the county’s freeholder director.
The county established a treatment center in Pennsauken and put aside $250,000 in funding to offer care.
When a person is brought to the emergency room following an overdose, hospital staff try to talk them into treatment. If they agree, the county transports them to the facility and gets them into programs that can extend up to 60 days.
“It’s called a ‘warm hand-off’ under the professional terms, but it’s a way to link those in need of help with a supplier of help,” he said.
Often there’s not enough help to go around, but since Operation SAL’s launch in October 2015, five people have taken advantage of the program.
County officials say the reason is complex. Naloxone jolts a person back to life, but also throws them into withdrawal. Treatment may be the last thing on a person’s mind at that point. Some people have checked themselves out of the emergency room before a social worker can even speak with them.
The county plans to expand the program’s scope to allow municipal judges to offer people treatment instead of jail for drug possession cases.
TWEAKING THE GAMEPLAN
It’s a wet Tuesday morning in early December, and a handful of Drug Enforcement Administration agents are sitting alongside school administrators in a church basement just off the University of Pittsburgh’s campus.
They’re there to preview “Off’script,” a new play, geared toward junior high and high school students about the dangers of prescription drug abuse. The Saltworks Theater Company is hoping to persuade school districts to book the performance.
For the first time, the DEA could play a role in making that happen, as part of the agency’s new 360 Strategy focused on attacking the opioid and heroin epidemic crushing Pittsburgh and western Pennsylvania.
“We do have a serial killer in our community and it is addiction. It’s killing our neighbors, our co-workers, our brothers or sisters, our sons and our daughters,” said Dr. Neil Capretto, an addiction psychologist who’s practiced in the Pittsburgh area for 34 years.
Overdose deaths in the Pittsburgh area are second in the state only to southeastern Pennsylvania. More than 500 lives were claimed by drug overdoses in 2014 in western Pennsylvania, county coroner reporting showed.
In the pilot program, launched in November, the agency is expanding its focus from just enforcement to include better communication with medical providers and more community education. It’s being rolled out in St. Louis, Milwaukee and West Memphis, Arkansas, this year.
The agency has dedicated an agent to work on community engagement. They’re building partnerships with neighborhood groups and organizations like the Boys and Girls Clubs and Elks. The goal is to help them understand the lasting effects drugs have on their residents.
The hope, officials say, is to provide support before and after they take down drug trafficking organizations to get addicts into treatment and prevent new drug operations from reopening in the same place.
“If we can either prevent somebody from using through education or see somebody get treatment and stop them from using, then that denies potential revenue to the drug trafficking organizations,” Gary Tuggle, who oversees the DEA field office in Pennsylvania, said.
The DEA’s new efforts are being bolstered by support from David Hickton, the U.S. attorney for western Pennsylvania.
Hickton has been on the forefront of this issue since 2012, when he and a local district attorney held one of the first prescription pill summits in the nation. Recently, he’s been co-chairing the Department of Justice’s National Heroin Task Force.
He sees the 360 Strategy as a major component of the task force’s enforcement recommendations and an opportunity to create something new.
That includes educating kids, as young as middle schoolers, and parents about the addictive nature of prescription painkillers.
“I’ve pledged all the positive energy I possess to try and make this successful, but we really don’t know what it’ll be. I think that’s one of the strengths of the program,” he said. “We’re going to try and be creative.”
Enough opioid painkillers were prescribed in 2012 to put a bottle in the hands of every American adult, according to the Centers for Disease Control and Prevention. Prescription opioid sales jumped 300 percent since 2013.
Hickton, the federal prosecutor, cringes when he hears stories of painkillers being doled out without reservation.
Hickton, who has six kids, recalled a story about a child who had suffered a mild concussion. When his parents took him to the doctor, Hickton said, the doctor gave him a prescription of 50 OxyContin. The father turned them back in.
“Come on, we know that doesn’t work. We know that that child is more at risk of getting hurt by taking those pills than the underlying condition,” he said. “These are the things I think we can work with the medical community on.”
Linking the steep rise in overdose deaths and use of heroin with prescription painkiller abuse, the DEA is having frank conversations with doctors and pharmacists about prescribing practices.
The same week as the play scouting trip, Tuggle and his agents in Pittsburgh hosted 196 pharmacists and pharmacy staff at two one-day Pharmacy Diversion Awareness Conferences. He asked the group to be partners in stopping prescription pill abuse.
“You guys are a major line of defense for us and in a lot of cases you’re the last line of defense in terms of identifying those rogue practitioners and those doctor shoppers out there,” he told the group.
Police in Camden have seen the painkillers filter onto the street.
“We have corridors of our city in where there’s more pills being trafficked than your traditional hardcore street drugs,” said Scott Thomson, chief of the Camden County Police Department.
Thomson spent time as a narcotics officer before rising to lead the department. He’s seen the opioid crisis grow first-hand, despite enforcement work by his officers and federal authorities, with prescription painkillers proving to be the most problematic issue.
He points to over-prescribing and abuse of legal prescriptions.
“That creates a very unique challenge within law enforcement because we’re talking about something that’s quasi-legal,” he said. “You can have these pills in your pocket and if you’ve got this little note from your doctor, everything is fine.”
Thomson believes more needs to be done to treat addiction before his officers are forced to revive a person with naloxone.
“Instead of constantly trying to metaphorically pull people out of the river, what’s better is going upstream and addressing what’s causing people to fall in in the first place,” Thomson said.
“At the end of the day, we’re all trying to prevent parents from burying their children.”
A 2015 study led by a researcher at Boston Medical Center found 91 percent of chronic pain patients who overdosed on opioids were prescribed the drugs again. Despite the overdose being entered into the patient’s medical records, 70 percent of those prescriptions were written by the doctor who prescribed the drugs before the overdose.
Looking to curb overprescribing, some lawmakers are setting limits on the amount of painkillers doctors can prescribe.
In Massachusetts, a patient suffering from acute pain can only be prescribed a seven-day supply of the painkillers for their first prescription under a new law passed in March.
After a second visit, doctors would be free to prescribe the drugs for a longer period. That will only apply to adults, however. Children will only be allowed to get a seven-day supply.
Exceptions will be made for patients suffering from chronic pain.
Members of the medical community and law enforcement agree prescribing practices need to be honed, but express caution about limiting doctors’ freedom.
“Do we buy another cruiser or do we help out people who are addicted with the money that comes from drug dealers?” — Leonard Campanello
“I’m not a big fan of any kind of algorithmic fix to anything or, say, setting arbitrary limits on anything,” said Dr. Brian Work, a hospitalist and public health professor in Philadelphia. Work also chairs the board at Prevention Point Philadelphia.
“We saw it and it didn’t work with three strikes and you’re out in law. Equally, in medicine with complex issues, I don’t think that works very well,” he said.
Leonard Campanello, chief of police in Gloucester, believes there’s another entity that needs to come to the table helping to address this crisis: The pharmaceutical companies.
He’s calling on them to release abuse deterrent formulas to generic drug makers including coatings that make pills hard to crush or dissolve, to support drug monitoring programs, and to have an independent group provide training to police and the medical community.
“It’s like putting the fox in the hen house and teaching them how to go away from the fox. It’s a joke,” he said.
If the manufacturers don’t voluntarily offer help, Campanello believes legal intervention could be necessary.
“If any entity in this epidemic is not going to come to the table voluntarily and altruistically, then I think there’s an opportunity to hold people accountable for the state, their role, the role they play to this epidemic,” he said.
Law enforcement officials who have developed these innovative approaches to attacking the opioid and heroin epidemic see their efforts as a stop gap.
They believe a day will come when the public health sphere renders their work unnecessary.
“We should be a catalyst. We should be an entry point into an established system for people getting better and saving their lives,” said Thomson. He says police have a wide set of responsibilities and cannot be expected to shoulder the burden alone.
“We just want the problem to get fixed,” said Campanello. “That’s why we need all these stakeholders to come in and then law enforcement will step out and say, ‘We’re just a safe haven. We can make one phone call and you guys took care of the rest.’”
Until a comprehensive strategy is put in place to combat every facet of this opioid and heroin epidemic, police will continue to carry out their primary directive: Preserve life.