Faced with a national epidemic of opioid-related overdoses, a cadre of police organizations have adopted a promising new approach focused on addiction as an illness rather than a crime. But just as the ANGEL program—which uses cops to steer addicts to treatment rather than jail—has begun to expand to hundreds of police departments with White House support, advocates worry that it could run into obstacles under the incoming Trump administration.
They fear that President-elect Donald Trump will favor a return to a “war on drugs” model that focuses on prosecution rather than treatment. Although the still-forming administration has yet to announce a drug strategy, early signs—including comments from his nominee for attorney general—indicate a focus first on reducing the supply of illicit drugs crossing the Mexican border. Trump has suggested he might support increased access to treatment programs but a repeal of the Affordable Care Act—a prominent Trump priority—could threaten that access.
“I share that fear” of a loss of support, says John Rosenthal, a co-founder of the Massachusetts-based Police Assisted Addiction and Recovery Initiative, a private, nonprofit group that was set up to take the ANGEL program national.
Begun in June 2015 in Gloucester, Mass., a community of about 30,000 northeast of Boston, the ANGEL program was the brainchild of the local police chief. He had grown frustrated by the failure of traditional punitive criminal justice approaches to drug addiction that often resulted in a revolving door between jail and the street. Rather than arrest addicts, he determined to provide them a safe haven. Drug users not already facing criminal charges or outstanding warrants were told they could turn themselves into police, and instead of jail the department would get them enrolled into a treatment program. Police would arrange for a volunteer to transport them that day to a suitable treatment program with an open bed.
A study in The New England Journal of Medicine in December 2016 found the program in Gloucester had shown notable signs of success. Between June 2015 and May 2016, the program’s first year, 94.5 percent of the 376 individuals seeking help were offered placement into a detox or treatment program and 89.7 percent enrolled—a rate far higher than the 50 to 60 percent for similar, hospital-based initiatives. (The researchers noted that further study is needed to determine how many successfully completed the programs and remain drug free.)
Rosenthal credits the Obama administration—and in particular White House Chief of Staff Denis McDonough, along with Michael Botticelli, director of the White House Office of National Drug Control Policy—with helping to build national support for the initiative. It has now been replicated by more than 200 local law enforcement, police and sheriff departments across the country. “They helped change the conversation from opioid addiction as a crime to a disease—a chronic disease that needs long-term treatment rather than jail,” Rosenthal says.
The ANGEL program relies on charitable contributions for administrative costs as well as to pay treatment costs for those without insurance or Medicaid coverage. In some cases medical facilities agree to foot the bill. The Obama administration has pushed for additional Medicaid funding.
At the end of 2016, Pres. Obama signed the 21st-Century Cures Act, which included $1 billion in new funding for additional addiction treatment facilities needed to handle the opioid epidemic, particularly in rural America.
Davida Schiff, a pediatrician at Boston Medical Center and lead researcher of the 2016 study, says opening more treatment facilities is key for police-led treatment referral programs to be successful. “We need to drastically increase availability to treatment, particularly outside of urban areas. Any policy changes that create another hurdle or barrier for people with substance use disorder to access treatment will mean that more people will overdose and die awaiting placement,” she says.
Senate Democrats have argued this month that the just-approved increase in treatment beds could be completely undercut if Republicans repeal the Affordable Care Act. A provision of the act that allows states to expand their Medicaid programs is now covering an estimated 1.6 million previously uninsured individuals with substance use disorders. Overall, Medicaid pays for about 20 percent of all substance use disorder treatment in the U.S., according to Sen. Ed Markey (D–Mass.). “Pending before the Senate is a Republican budget whose entire premise is to repeal coverage for the exact same vulnerable people who need access to treatment,” Markey said on the Senate floor. “Not only is that nonsensical, it is downright cruel for all those families and individuals who finally felt a sense of hope—the hope that new resources could mean the difference between life and death for their loved ones.”
During the 2016 presidential campaign, Trump delivered one speech on the heroin and opioid crisis that focused mostly on illegal drug suppliers and the need for stronger border security. He did, however, also note the need for expanded access to treatment.
But when Botticelli departs with Obama next week, Rosenthal says an advocacy voice will be lost. And Trump’s attorney general nominee, Sen. Jeff Sessions (R–Ala.), has been critical of the Obama administration’s approach to illicit drugs. In a March 2016 press release, Sessions blamed the “abandonment of the tough-on-crime policies” to directly contributing to the rise in drug use, overdose deaths and violent crimes in major cities. “Making heroin harder to get, more expensive and less potent is an essential step to reduce addiction,” he said.
Given the change in personnel, Rosenthal does not expect the Trump administration to be as enthusiastic as their predecessors but is hopeful the ANGEL program will still be supported. So does Jim O’Toole, city manager of Escanaba, a town of around 12,600 on Michigan’s Upper Peninsula that placed its first participant in its ANGEL program into treatment in March 2016. O’Toole, who has a background in law enforcement, is taking a wait-and-see approach when it comes to how the Trump administration handles the drug crisis. “It is easy to say, ‘eliminate supply and everything else will go away,’ but humans being humans they will find something else. If it isn’t heroin or marijuana it will be meth,” he says. “I’m holding judgment for the first 120 days.”