FAQs Related to Law Enforcement
In MA, why are police included in Post-Overdose outreach visits?
In many communities, law enforcement have been involved from the outset of post overdose outreach programs. From the Best Practice Guidance Introduction (Page 7):
Many existing post-overdose outreach programs have been initiated by local law enforcement agencies responding to local surges in overdose with access to 911 call data.17,22–28 Funding for post-overdose outreach programs has largely come from state and federal agencies that have recognized these programs as a potential overdose response strategy warranting further exploration.29–31
In many communities, law enforcement agencies have taken the lead in developing post-overdose outreach programs and obtained funding to sustain such programs. These public safety agencies have filled a void in public health capacity and infrastructure for post-overdose outreach. The participation of law enforcement officers in post-overdose outreach efforts often represents a substantial departure from traditional law enforcement work, as officers may engage in community health and behavioral health activities; become familiar with and work collaboratively with health and social service agencies, harm reduction organizations, and treatment programs; and focus on the public health goal of reducing overdose mortality and morbidity. For some agencies, post-overdose outreach was the next step in addressing the overdose crisis after equipping themselves with naloxone and receiving training on overdose recognition and response.23
Post-overdose outreach programs have emerged in the midst of systemic stigmatization and criminalization of people who use drugs, particularly those who are American Indian, Alaskan Native, Black, Hispanic or Latino. In studies of interactions between law enforcement and people who use drugs, many people report disrespectful conduct by police, confiscation of personal property, medications, and other important items, and even violence.32,33 People who identify as American Indian, Alaskan Native, Black, Hispanic and Latino are disproportionately arrested, incarcerated,34,35 and killed by law enforcement,36–42 compared to people who identify as White. The history and current experiences of American Indian, Alaskan Native, Black, Hispanic and Latino people who use drugs43,44 with law enforcement and the courts can challenge the ability of post-overdose outreach programs to engage many people who are at highest risk of overdose.
Most programs utilize teams of both public health and public safety (most often law enforcement) personnel to conduct outreach visits. 14,16,17,20,25,28 The extent and type of collaboration between public health and public safety in these programs takes a range of forms, from public safety only providing 911 call data for outreach by a public health-staffed team17 to public safety agencies conducting the outreach without any public health partner involvement. In order to function, post-overdose outreach programs must receive identifying contact information of overdose survivors. Emergency medical service (EMS) providers must comply with the Health Insurance Portability and Accountability Act’s (HIPAA) Privacy Rule, which constrains their ability to share information about the patients they treat. However, most law enforcement agencies are not subject to HIPAA and therefore do not have the same privacy restrictions on the information they share.46
Some police-centered programs partner with recovery coaches and treatment providers, but not harm reduction providers. Any tips for fostering collaboration?
Often times the agency that receives the funding, holds the data and/or has started the first program determines who they partner with. There are post overdose outreach models with all sorts of team make-up. Here is a link to a paper that describes a public health-harm reduction focused model:
Formica SW, Reilly B, Duska M, Ruiz SC, Lagasse P, Wheeler M, Delaney A, Walley AY. The Massachusetts Department of Public Health Post Overdose Support Team Initiative: A Public Health-Centered Co-Response Model for Post-Overdose Outreach. J Public Health Manag Pract. 2022 Nov-Dec 01;28(Suppl 6):S311-S319.
Many police-centered programs take a “treatment-first” approach where their primary focus is engaging overdose survivors in treatment. However, many overdose survivors are not ready to focus on treatment and would really benefit from harm reduction education, materials and other resources. A tip for harm reduction providers in these settings is: Reach out to police-centered programs, describe the full breadth of services you offer, and (at a minimum) get on the program’s referral list. Even better, make it known to the program that you, the harm reduction provider, are available to visit if the survivor is not ready for treatment but needs harm reduction services. With time and collaboration, you may convince the program that a harm reduction provider should be on the team.
Are there post-overdose programs that use social workers embedded within police department? Is there funding for this model?
Social workers tend to pop-up more in the “co-response” “crisis intervention team (CIT)” and “Mental Health Response Team (MHRT)” literatures – they may be pulled into post-overdose outreach, but their role is often broader to any mental health-related concern or situation needing de-escalation. There is a mix of BJA and state department of mental health funding for this approach – not specific to post-overdose.__
Social workers also come up in the deflection and Sequential Intercept Model space: https://www.ojp.gov/library/publications/report-national-survey-assess-first-responder-deflection-programs-response (Page 46). 29.8% have social workers.
None of these (including the PRONTO survey) specifically refer to “embedded social workers” – just social workers present on the team.
What determines who collects and owns 911 data?
Collection, management and ownership of 911 data varies by community and states. In Massachusetts, police commonly collect, manage and own. Because the data in the hands of the police is not protected health information and not subject to the same privacy regulations, such as HIPAA, there is more flexibility in sharing overdose survivor data by police.
If an outreach organization receives overdose survivor contact information from public safety, is there any requirement to share data back with the public safety agency?
No, there is no requirement to share data. The Best Practice Guidance Data Use Section 4.3 Data Shared to Conduct Outreach Activities recommends:
- Programs should limit the sharing of identifiable information, such as the survivor’s name, contact information, and information about the overdose event or substance use, to program staff and only transfer that information for the purpose of conducting outreach.
- Programs may share identifiable information with other post-overdose outreach programs in different municipalities when all of the following conditions are met:
- Multiple jurisdictions are implicated in the overdose emergency (e.g., if an overdose occurred in one municipality, but the survivor resides in another);
- The survivor explicitly provides consent to share this information with other post-overdose outreach programs; and
- Data are shared solely for the purpose of conducting outreach.
This data sharing arrangement between agencies should be articulated in a memorandum of understanding that outlines data protections and is made publicly available.
What role should involuntary civil commitment play in post-overdose outreach?
From the Best Practice Guidance Visit Procedures Section 5.5. Involuntary Civil Commitment:
Some states have laws establishing procedures for involuntary civil commitment or compulsory treatment to commit people who are using substances to inpatient treatment programs against their will when they are determined by a judge to be a danger to themselves or others. Depending on the state, commitments can be made at the request or petition of blood relatives, clinicians, court officials, or law enforcement. Because evaluations of the use of involuntary civil commitment have produced mixed results and some indicate that the use of involuntary civil commitment may cause additional harms,48 the use of involuntary civil commitment in post-overdose outreach should be limited, if used at all. More specific guidance is available in the Guidance document.
What does “clear policies” mean in relation to law enforcement vis-a-vis paraphernalia or drug possession?
This question refers to Best Practice Guidance Section 5.4 Considerations for Law Enforcement Personnel Present at the Outreach Visit Part 2:
If law enforcement staff are present during outreach, programs should establish clear, written policies defining how infractions observed during the outreach visit (e.g., observing a small amount of drugs in an apartment for personal use) should be responded to. If law enforcement officers are required to report on or arrest for infractions, they should not be involved in post-overdose outreach visits.
“Clear, written policies” means that the staff conducting the outreach should have worked out with buy-in from all participating partners beforehand how specifically they are going to handle situations where they encounter drug paraphernalia or drug possession. The guidance did not address specifically which circumstances should result in a law enforcement action and which should not. Defining this line is an important need.
For police involvement in post-overdose outreach, Is it possible that variations in policies may work differently in different communities? For example, might there be one community where a uniformed officer doing outreach is a strength, whereas in another community a uniformed officer could undermine the team’s ability to engage?
This question warrants further study. It is likely that tailoring the make-up of the post-overdose outreach team based on the characteristics of the community and the perspectives and participation of community members will result in better programs. The Best Practice Guidance states in the Program Staffing Section 2.1.5:
Programs should involve community members who are at risk of overdose (e.g., community advisory boards) to help determine the composition of post-overdose outreach teams, including which agencies and staff to include.
And Section 2.4.1:
Law enforcement-community relations should be considered when formalizing the role of law enforcement in post-overdose outreach. In communities where people who are at risk for overdose have strained relations with law enforcement, the involvement of law enforcement in the outreach efforts may be detrimental to engaging overdose survivors in harm reduction, treatment, and recovery services, and therefore should be limited. Programs with law enforcement staff should adopt procedures and practices that minimize actual or perceived coercion by law enforcement staff during post-overdose outreach. See examples of procedures and practices in Sections 3, 4.1, 4.2, and 5.4 that promote survivor-directed engagement with community overdose prevention services.