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Abstract

Drug users and dealers frequently cycle through the criminal justice system in what is sometimes referred to as a “revolving door.” Arrest, incarceration and prosecution have not deterred this recidivism. Seattle’s Law Enforcement Assisted Diversion (LEAD) program was established to divert these individuals to case management and supportive services instead of jail and prosecution. A nonrandomized controlled evaluation was conducted to examine LEAD effects on criminal recidivism (i.e., arrests, criminal charges). The sample included 318 people suspected of low-level drug and prostitution activity in downtown Seattle: 203 received LEAD, and 115 experienced the system-as-usual control condition. Analyses were conducted using logistic generalized estimating equation models over both the shorter term (i.e., six months prior and subsequent to evaluation entry) and longer term (i.e., two years prior to the LEAD start date through July 2014). Compared to controls, LEAD participants had 60% lower odds of arrest during the six months subsequent to evaluation entry; and both a 58% lower odds of arrest and 39% lower odds of being charged with a felony over the longer term. These statistically significant differences in arrests and felony charges for LEAD versus control participants indicated positive effects of the LEAD program on recidivism.

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... Its primary purpose is to ensure police had a definitive option to contribute to health-orientated approaches to drug use. Based on a model of law enforcement assisted diversion (LEAD) where police support PWUDs connect with the health, social and legal services rather than arresting people or sending them to CTC (Collins, Lonczak, and Clifasefi, 2017). It is a partnership project involving police, government and civil society organisations. ...
... Meanwhile, when reviewing ten years of post-decriminalisation of drug use in the 1999 CCV and assessing the role of police in this process, a retired police officer of MPS commented, This pilot will demonstrate the abilities, duties, and responses of police officers to cooperate and collaborate with multiple civil society and social affairs in harm reduction approach, if their highranking level in the MPS support it then it will be extended other locations in the future (Interviewee #6) Studying productive lessons of Seattle's LEAD program (Collins et al., 2017), the goal of the model is to create conditions for early-stage drug users to participate in drug treatment as well as prevention and treatment of HIV, Tuberculosis and Hepatitis B/C in their respective localities. The project aims to reduce the number of people referred to compulsory detoxification, reduce engagement in crime and improve the quality of life of PWUDs (Hoa, 2019). ...
... The project aims to reduce the number of people referred to compulsory detoxification, reduce engagement in crime and improve the quality of life of PWUDs (Hoa, 2019). Planning No.40 stipulates that local ward police must provide drug users with assistance to access support, counselling, drug dependence treatment and referral to health, social and legal services (Collins et al., 2017). This model will hopefully illustrate that decriminalisation and a health orientated approach to drug use are more effective than sending PWUDs into CTCs for up to two years. ...
Article
In 2009, Vietnam officially decriminalised drug use through amendments to the criminal law. The amendments outlined explicitly that illicit drug use would be seen as an administrative violation, but not a criminal offence. This legal transition has not been without implementation challenges, and police particularly have struggled to find a balance between drug law enforcement and decriminalisation. Despite being a health-orientated drug policy amendment, in practice it allows police to send suspected drug users to compulsory treatment centres without judicial oversight and people who use drugs continue to face challenges in their interface with law enforcement which can negatively impact access to harm reduction and community-based treatment programs. Using policy desk research combined with indepth interviews with 14 key informants from people representing a range of relevant Vietnamese government (n = 10) and non-government agencies (n = 4), this paper explores some insights and considerations into how decriminalisation of drug use in the amended law was implemented. We explore key informant perspectives into how the decriminalisation amendment could be implemented more effectively in order to improve health outcomes for people who use drugs in Vietnam through re-envisioned police protocols and practices. Findings show that while decriminalising drug use in Vietnam was designed as a progressive and health-orientated drug policy, the ongoing disconnect between the health intent of the policy and the police-led oversight of its implementation in the community persists. Part of this disconnect is explained by the lack of training and clear protocols that would enhance the police in their ability to contribute to the health intent of the policy rather than continue to view drug use through a drug law enforcement only lens. The paper calls for further collaboration across policing and the health and community-based organisations delivering services for people who use drugs. We suggest that through developing a deeper understanding of the interplay between policing and the implementation of harm reduction policy and programs, decriminalisation can co-exist within a broader and deeply entrenched drug control strategy in Vietnam.
... Изучение результатов программы свидетельствует о значительном повышении уровня компетентности ее участников. Кроме того, исследование показало, что получение жилья снижает уровень арестов на 17 %, а получение работы -на 33 % [72,73]. ...
... Сиэтл уникален тем, что городской отдел полиции непрерывно внедряет программы по работе с мисдиминорами, такие как пилотная «Программа реагирования на расстройства поведения совместно с психиатрами» [62], «Выведение граждан из системы уголовного правосудия на уровне правоохранительных органов» (LEAD) [72,73], планы работы с местным населением (MCPP) [77], суд для лиц с психическими заболеваниями и программа «Вмешательство закона и сеть помощи» (LINC). Эти меры во многом противоречат принципу «нулевой терпимости». ...
... Необходимы также исследования влияния специальных программ на повышение общественной безопасности, сокращение рецидивизма и возвращение к нормальной жизни лиц, осужденных за незначительные правонарушения, вызванные психическими заболеваниями, употреблением алкоголя и наркотиков. В более ранних работах было показано положительное влияние таких программ на сокращение рецидивизма среди упомянутой категории лиц [11,[88][89][90][91], при этом отмечались многообещающие результаты таких программ, как LEAD в Сиэтле [72,71,73], а также сотрудничества на базе отделов полиции по модели CIT, которые дают много возможностей для решения дел лиц с расстройствами поведения [62]. Кроме того, было показано, что число арестов лиц с психическими заболеваниями сокращается в результате принудительного амбулаторного лечения [92], как и при использовании судов для лиц с психическими заболеваниями [93,94]. ...
... Of the six examined programs, only two specified the goals for the program within the study (Collins et al., 2017(Collins et al., , 2014Roe-Sepowitz et al., 2011). For these two programs, the primary objectives were to reduce recidivism and assist with exiting sex work. ...
... Although individual and group counseling was often a requirement for most programs, the specific type of counseling and recommended dose of counseling tended to be individualized (Collins et al., 2017;Leon, & Shdaimah, 2012), or else the details about the type and length of counseling were not specified in the articles (Miner-Romanoff, 2017;Shdaimah, & Wiechelt, 2012;Wahab, 2005Wahab, , 2006. Five of the programs included life-skills training, with the most common topic being employment training (Collins et al., 2017;Leon, Wahab, 2005Wahab, , 2006. ...
... Although individual and group counseling was often a requirement for most programs, the specific type of counseling and recommended dose of counseling tended to be individualized (Collins et al., 2017;Leon, & Shdaimah, 2012), or else the details about the type and length of counseling were not specified in the articles (Miner-Romanoff, 2017;Shdaimah, & Wiechelt, 2012;Wahab, 2005Wahab, , 2006. Five of the programs included life-skills training, with the most common topic being employment training (Collins et al., 2017;Leon, Wahab, 2005Wahab, , 2006. Four programs also included a component for addiction treatment (Collins et al., 2017;Miner-Romanoff, 2017, 2014Roe-Sepowitz et al., 2011;Shdaimah & Bailey-Kloch, 2014). ...
Article
Objective Court diversion programs offer alternative treatment interventions in lieu of punitive sanctions. Programs have recently been developed for women arrested for prostitution, with a recognition that many of these individuals frequently experience multiple forms of violence and experience multiple barriers to exiting sex work. This review aims to (a) examine programmatic components used across programs, and (b) identify the diversionary programs' impact on participants. Methods Studies were identified by entering key search words into three electronic databases and by conducting a citation search. Results Nine articles were included in the review. Although programs varied in structure, services, and length of time, studies indicated a range of positive outcomes for participants. Conclusions Results help to illuminate future directions for criminal justice practice, policy, and research.
... A shift toward more effective measures to address drug-related harms has also included changes in law enforcement practice. Law enforcement officers (LEOs) are being increasingly called upon to refer people who use drugs to care, to administer naloxone to individuals with suspected opioid overdoses, and to use enforcement discretion to promote public health [14][15][16][17][18][19][20]. Some evidence suggests LEOs' attitudes and behaviors may align with public health goals, particularly in settings that are expanding harm reduction in response to the North American overdose crisis [16,17]. ...
... Additionally, LEOs often regard arrest as an ineffective instrument for addressing drug-related harms, especially in the era of COVID-19 [18,21]. Rather than punitive approaches, police-assisted referrals to drug treatment and other services might be more effective from a public health standpoint [15]. Nevertheless, the traumatic legacy of drug law enforcement, with disproportionate burden on communities of color, raises questions about the acceptability and appropriateness of police-assisted treatment navigation and other health-focused efforts [22]. ...
... While there have been numerous police-assisted referral programs in the United States [14,15,18,19], there is little known about preferences stated by the intended beneficiaries, PWID, or about the alignment between LEO's and PWID's attitudes towards these measures. Successful implementation and adoption of a police referral programs requires careful consideration of the attitudes and intended behaviors of both LEOs and PWID. ...
Article
Full-text available
Background Law enforcement officers (LEOs) come into frequent contact with people who inject drugs (PWID). Through service referrals, LEOs may facilitate PWID engagement in harm reduction, substance use treatment, and other health and supportive services. Little is known about PWID and LEO attitudes and concerns about service referrals, however. The objective of this mixed-methods study was to examine the alignment of service referral preferences and acceptability among PWID and LEOs in Tijuana, Mexico. Methods We assessed service referral preferences and perceived likelihood of participation in health and social services, integrating data from structured questionnaires with 280 PWID and 306 LEOs, contextualized by semi-structured interviews and focus groups with 15 PWID and 17 LEOs enrolled in two parallel longitudinal cohorts in Tijuana, Mexico. Results Among potential service referral options, both PWID (78%) and LEOs (88%) most frequently cited assistance with drug- and alcohol-use disorders. Over half of PWID and LEOs supported including harm reduction services such as syringe service programs, overdose prevention, and HIV testing. The majority of PWID supported LEO referrals to programs that addressed basic structural needs (e.g. personal care [62%], food assistance [61%], housing assistance [58%]). However, the proportion of LEOs (30–45%) who endorsed these service referrals was significantly lower ( p < 0.01). Regarding referral acceptability, 71% of PWID reported they would be very likely or somewhat likely to make use of a referral compared to 94% of LEOs reporting that they thought PWID would always or sometimes utilize them. These results were echoed in the qualitative analysis, although practical barriers to referrals emerged, whereby PWID were less optimistic that they would utilize referrals compared to LEOs. Conclusions We identified strong support for LEO service referrals among both LEO and PWID respondents, with the highest preference for substance use treatment. LEO referral programs offer opportunities to deflect PWID contact with carceral systems while facilitating access to health and social services. However, appropriate investments and political will are needed to develop an evidence-based (integrated) service infrastructure.
... All program evaluations gathered data from initial program deployment and most included preliminary outcomes ranging over a few months (3 months to 12 months), with only one study including an extensive evaluation period of 5 years (Collins, Lonczak & Clifasefi, 2017). With the exception of the Seattle LEAD program (Collins et al., 2017), the remaining programs reviewed have been deployed within the past 5 years, illustrating that these types of initiatives are still relatively new. ...
... All program evaluations gathered data from initial program deployment and most included preliminary outcomes ranging over a few months (3 months to 12 months), with only one study including an extensive evaluation period of 5 years (Collins, Lonczak & Clifasefi, 2017). With the exception of the Seattle LEAD program (Collins et al., 2017), the remaining programs reviewed have been deployed within the past 5 years, illustrating that these types of initiatives are still relatively new. ...
... The programs were not clustered in one specific part of the country, with programs emerging in Washington (Collins et al., 2017), California (Wagner, Bovet, Haynes, Joshua & Davidson, 2016), Massachusetts ( HYPERLINK \l "bib3" Botieri, Cloud & Smulowitz, 2016 ;Schiff et al., 2017), Michigan (Dahlem et al., 2017) and North Carolina (Paul, 2018). The number of participants introduced to these collaborative programs ranged from sample sizes of 11 participants (Wagner et al., 2016) to 376 participants (Schiff et al., 2017), showing extreme variation in program capacity and responsiveness. ...
Article
Full-text available
Background With the current opioid epidemic impacting well over half of all counties across the United States, initiatives that encourage interagency collaboration between first responder organizations appear necessary to comprehensively address this crisis. Police, fire, and emergency medical services (EMS) are in a unique position to identify substance users and provide necessary resources to initiate treatment, yet there is not sufficient evidence of joint collaborative programs between law enforcement/first responders and healthcare providers. Methods In this scoping review we examine the current state of joint criminal justice and healthcare interventions, specifically, opioid and substance use pre-arrest initiatives via emergency first responders and police officers. We relied on data from the last 10 years across three major databases to assess the extent of criminal justice (CJ) and healthcare collaborations as a response to individuals with opioid use disorder (OUD). We specifically focused on interventional programs between criminal justice first responders (pre-arrest) and healthcare providers where specific outcomes were documented. Results We identified only a small number (6) of studies involving interventions that met this criteria, suggesting very limited study of joint interagency collaboration between law enforcement first responders and healthcare providers. Most had small samples, none were in the southern states, and all but one were initiated within the last 5 years. Conclusions Although studies describing joint efforts of early intercept criminal justice responses and healthcare interventions were few, existing studies suggest that such programs were effective at improving treatment referral and retention outcomes. Greater resources are needed to encourage criminal justice and healthcare collaboration and policies, making it easier to share data, refer patients, and coordinate care for individuals with OUD.
... Beyrer 2012) which has implications for many FSW who also use drugs. Studies have evaluated the effectiveness of police trainings and policy changes (e.g., diversion programmes) aimed at shifting police attitudes and practices, while securing police buy-in through a lens of occupational health and reducing rates of recidivism Silverman et al. 2012;S. E. Collins, Lonczak, and Clifasefi 2017). ...
... In line with ongoing political and policy shifts at a national and state level to introduce pre-booking diversion for low level offences in the U.S., Baltimore City has recently joined the 'LEAD' program(S. E.Collins, Lonczak, and Clifasefi 2017). LEAD introduces diversion to drug and social services at the point of arrest, albeit currently targeted specifically at drug using populations, rather than FSW specifically. ...
Preprint
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Background: Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers. Methods: Drawing on ethnographic methods, 280 hours of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature that aided exploration of the influence of the ecological and structural environment on policing practices. Results: Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which police practices towards sex work operate. Conclusions: A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the needs of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.
... However, in the broader context of the failed 'war on drugs' [32] -a campaign in the United States since the 1970s to combat illegal drug use by large increases in enforcement, penalties, and incarceration for drug offenders -the U.S. is now mainstreaming public health-oriented harm reduction interventions aimed at illicit drug use [27,[33][34][35] which has implications for many FSW who also use drugs. Studies have evaluated the effectiveness of police trainings and policy changes (e.g., diversion programmes) aimed at shifting police attitudes and practices, while securing police buy-in through a lens of occupational health and reducing rates of recidivism [36,37,71]. ...
... Another important dimension of officers' embedded stigmatization towards FSW surrounds their injection drug use. In line with ongoing political and policy shifts at a national and state level to introduce pre-booking diversion for low level offences in the U.S., Baltimore City has recently joined the 'LEAD' program [71]. LEAD introduces diversion to drug and social services at the point of arrest, albeit currently targeted specifically at drug using populations, rather than FSW specifically. ...
Article
Full-text available
Background: Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health and human rights evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape harmful policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers. Methods: Drawing on ethnographic methods, 280 h of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature that aided exploration of the influence of the ecological and structural environment on policing practices. Results: Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health and human rights goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which harmful police practices towards sex work operate. Conclusions: A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the rights and health of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.
... In referring PWID to evidence-based harm reduction services, police have the capacity to reduce drug-related harm. Additionally, as first responders, police may play a role in overdose reversal using naloxone [52]. Ideally, interventions to address drug law enforcement would serve to minimize knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities. ...
... While significant gaps in the literature remain on the topic of harm reduction training for police [53], educational programs targeting the interface between police and PWID have been successfully deployed to address public health harms caused by drug law enforcement. For example, the LEAD (Law Enforcement Assisted Diversion) program in Seattle, Washington, has demonstrated efficacy in diverting people into case management and supportive services in lieu of incarceration [52]. This analysis is rooted in the context of police training with the SHIELD (Safety and Health Integration in the Enforcement of Laws on Drugs) model that was implemented in Tijuana between 2015 and 2018. ...
Article
Full-text available
Background Police constitute a structural determinant of health and HIV risk of people who inject drugs (PWID), and negative encounters with law enforcement present significant barriers to PWID access to harm reduction services. Conversely, police may facilitate access via officer-led referrals, potentiating prevention of HIV, overdose, and drug-related harms. We aimed to identify police characteristics associated with support for officer-led referrals to addiction treatment services and syringe service programs (SSP). We hypothesized that officers who believe harm reduction services are contradictory to policing priorities in terms of safety and crime reduction will be less likely to support police referrals. Methods Between January and June 2018, police officers ( n = 305) in Tijuana, Mexico, completed self-administered surveys about referrals to harm reduction services during the 24-month follow-up visit as part of the SHIELD police training and longitudinal cohort study. Log-binomial regression was used to estimate adjusted prevalence ratios and model policing characteristics and attitudes related to officers’ support for including addiction treatment and SSP in referrals. Results Respondents were primarily male (89%), patrol officers (86%) with a median age of 38 years (IQR 33–43). Overall, 89% endorsed referral to addiction services, whereas 53% endorsed SSP as acceptable targets of referrals. Officers endorsing addiction services were less likely to be assigned to high drug use districts (adjusted prevalence ratio [APR] = 0.50, 95% CI 0.24, 1.08) and more likely to agree that methadone programs reduce crime (APR = 4.66, 95% CI 2.05, 9.18) than officers who did not support addiction services. Officers endorsing SSPs were younger (adjusted prevalence ratio [APR] = 0.96 95% CI 0.93, 0.98), less likely to be assigned to high drug use districts (APR = 0.50, 95% CI 0.29, 0.87), more likely to believe that methadone programs reduce crime (APR = 2.43, 95% CI 1.30, 4.55), and less likely to believe that SSPs increase risk of needlestick injury for police (APR = 0.44, 0.27, 0.71). Conclusions Beliefs related to the occupational impact of harm reduction services in terms of officer safety and crime reduction are associated with support for referral to related harm reduction services. Efforts to deflect PWID from carceral systems toward harm reduction by frontline police should include measures to improve officer knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities. Trial Registration : NCT02444403.
... In addition to CIT, a number of jurisdictions have implemented mental health courts which aim to improve adherence to treatment as a means of avoiding incarceration (Kuehn, 2007); however, these courts are not able to serve all individuals with a mental illness who enter the justice system. More recently, jurisdictions have implemented diversion programs for individuals with mental health (Bailey et al., 2018) conditions or SUD (Collins, Lonczak, & Clifasefi, 2017) who commit low level, non-violent offenses; diversion is a way to link individuals to appropriate services and to medical professionals and has been shown to reduce repeat arrests. Programs like Seattle's Law Enforcement Assisted Diversion, which diverts individuals into supportive case management programs instead of jail, have reduced subsequent arrests by nearly 60% for individuals involved in low-level drug and prostitution activity (Collins et al., 2017). ...
... More recently, jurisdictions have implemented diversion programs for individuals with mental health (Bailey et al., 2018) conditions or SUD (Collins, Lonczak, & Clifasefi, 2017) who commit low level, non-violent offenses; diversion is a way to link individuals to appropriate services and to medical professionals and has been shown to reduce repeat arrests. Programs like Seattle's Law Enforcement Assisted Diversion, which diverts individuals into supportive case management programs instead of jail, have reduced subsequent arrests by nearly 60% for individuals involved in low-level drug and prostitution activity (Collins et al., 2017). ...
Article
Full-text available
Background Individuals with mental illness and co-occurring substance use disorders often rapidly cycle through the justice system with multiple arrests. Therefore, is it imperative to examine the prevalence of mental health and substance use diagnoses among arrestees and repeat arrestees to identify opportunities for intervention. Methods We linked police arrest and clinical care data at the individual level to conduct a retrospective cohort study of all individuals arrested in 2016 in Indianapolis, Indiana. We classified arrestees into three levels: 1 arrest, 2 arrests, or 3 or more arrests. We included data on clinical diagnoses between January 1, 2014 and December 31, 2015 and classified mental health diagnoses and substance use disorder (SUD) based on DSM categories using ICD9/10 diagnoses codes. Results Of those arrested in 2016, 18,236 (79.5%) were arrested once, 3167 (13.8%) were arrested twice, and 1536 (6.7%) were arrested three or more times. In the 2 years before the arrest, nearly one-third (31.3%) of arrestees had a mental health diagnosis, and over a quarter (27.7%) of arrestees had an SUD diagnosis. Most of those with a mental health or SUD diagnosis had both (22.5% of all arrestees). Arrestees with multiple mental health (OR 2.68, 95% CI 2.23, 3.23), SUD diagnoses (OR 1.59, 95% CI 1.38, 1,82), or co-occurring conditions (1.72, 95% CI 1.48, 2.01) in the preceding 2 years had higher odds of repeat arrest. Conclusions Our findings show that linked clinical and criminal justice data systems identify individuals at risk of repeat arrest and inform opportunities for interventions aimed at low-level offenders with behavioral health needs.
... We call it [this model] voluntary treatment in the community supported by relevant medical, social and legal services (Interviewee #10) This pilot will demonstrate the abilities, duties, and responses of police o cers to cooperate and collaborate with multiple civil society and social affairs in harm reduction approach, if their high-ranking level in the MPS support it then it will be extended other locations in the future (Interviewee #6) Based on Seattle's Law Enforcement Assisted Diversion (LEAD) program [30], the goal of the model is to create conditions for early stage drug users to participate in drug treatment as well as prevention and treatment of HIV, Tuberculosis and Hepatitis B/C in their respective localities. The project aims to reduce the number of people referred to compulsory detoxi cation, reduce engagement in crime and improve the quality of life of people who use drugs. ...
... The project aims to reduce the number of people referred to compulsory detoxi cation, reduce engagement in crime and improve the quality of life of people who use drugs. Planning No.40 stipulates that local ward police must provide drug users with assistance to access support, counselling, drug dependence treatment and referral to health, social and legal services [30]. This model will hopefully illustrate that decriminalisation and a health orientated approach to drug use is more effective than sending PWUDs into CTCs for up to two years. ...
Preprint
Full-text available
Background In 2009, Vietnam officially decriminalized drug use through amendments to the criminal law. The amendments specifically outlined that drug use would be seen as an administrative sanction, but not a criminal offence. This legal transition has not been without its implementation challenges and police particularly are have struggled to balance their role between drug law enforcement and decriminalisation. Despite being a health-orientated drug policy amendment, in practice it has meant that police can send suspected drug users to compulsory treatment centres without judicial oversight and people who use drugs continue to face challenges in their interface with law enforcement which can negatively impact access to harm reduction and community-based treatment programs. This paper explores the perspectives of policy makers and law enforcement officials in Vietnam and provides some insights and considerations into how the amended law was implemented and how it could be made more effective in improving both health and safety for all people in Vietnam. Methods To understand government and policing perspective on amended changes to the Criminal Code in 2009 and its subsequent implementation, this mixed methods research combined content analysis of a number of core legislations in terms of drug control policies in Vietnam with perspectives and insights from 14 key informant interviews from people representing a range of relevant Vietnamese Government (n=10) and non-government agencies (n=4). Results While most interviewees recognised that decriminalizing drug use in Vietnam was designed as a a progressive and health-oriented drug policy, many participants acknowledged the ongoing disconnect between the health intent of the policy and the police-led oversight of its implementation in the community. Part of this disconnect was explained by the lack of training and clear protocol that would enhance the police in their ability to contribute to the health intent of the policy rather than continue to view drug use through a drug law enforcement only lens. A current pilot initiative by Hanoi’s People Committee to implement a model of assisted referral for people who use drugs to community-based health, social and legal support may provide an example of how to situate decriminalisation policy within a broader context of harm reduction interventions through the design and trial of clear protocols for how law enforcement agencies can actively engage and support the process of diversion into harm reduction and community-based treatment. Conclusions Since the inception of the amended law there has been very little review and analyses of its implementation progress and its challenges. This is the first study to review and assess the progress of decriminalizing drug use since the policy intervention in 2009 with a specific focus on the perceptions of the policy for Vietnam’s drug control in policing. It discusses insights and considerations from government, law enforcement officials and civil society organisations to develop a deeper understanding of how harm reduction interventions – including decriminalisation – can co-exist within a broader and entrenched drug control strategy in Vietnam.
... This program was found to link participants to short-term detoxification services but was unable to overcome challenges associated with a fragmented treatment system (Schiff et al.,2017). The Law Enforcement Assisted Diversion (LEAD) program, which is designed to divert people from arrest for certain types of low-level crimes (e.g., drug possession, prostitution) into voluntary treatment, is one of the few deflection programs that has been evaluated, but only in Seattle (Collins et al.,2017). The nonrandomized controlled evaluation examined LEAD effects on criminal recidivism (i.e., arrests, criminal charges) and found that Seattle LEAD participants had lower rates of arrests and felony charges compared to controls, indicating positive program impacts on recidivism (Collins et al.,2017). ...
... The Law Enforcement Assisted Diversion (LEAD) program, which is designed to divert people from arrest for certain types of low-level crimes (e.g., drug possession, prostitution) into voluntary treatment, is one of the few deflection programs that has been evaluated, but only in Seattle (Collins et al.,2017). The nonrandomized controlled evaluation examined LEAD effects on criminal recidivism (i.e., arrests, criminal charges) and found that Seattle LEAD participants had lower rates of arrests and felony charges compared to controls, indicating positive program impacts on recidivism (Collins et al.,2017). ...
Article
Full-text available
Background Many law enforcement agencies across the United States equip their officers with the life-saving drug naloxone to reverse the effects of an opioid overdose. Although officers can be effectively trained to administer naloxone, and hundreds of law enforcement agencies carry naloxone to reverse overdoses, little is known about what happens on scene during an overdose call for service from an officer’s perspective, including what officers perceive their duties and responsibilities to be as the incident evolves. Methods The qualitative study examined officers’ experiences with overdose response, their perceived roles, and what happens on scene before, during, and after an overdose incident. In-person interviews were conducted with 17 officers in four diverse law enforcement agencies in the United States between January and May 2020. Results Following an overdose, the officers described that overdose victims are required to go to a hospital or they are taken to jail. Officers also described their duties on scene during and after naloxone administration, including searching the belongings of the person who overdosed and seizing any drug paraphernalia. Conclusion These findings point to a pressing need for rethinking standard operating procedures for law enforcement in these situations so that the intentions of Good Samaritan Laws are upheld and people get the assistance they need without being deterred from asking for future help.
... In contrast, police assistance patrol practices consisted of practices typically aligned with 'community policing,' which has been employed in several U.S. states and countries, including within harm reduction programs aimed at better alignment of law enforcement and public health objectives. [41] The distinction between the harms of routine policing and the positive aspects of community policing in communities that are often both 'over-policed' and 'under-protected' [42] was a strength of this scale. ...
Article
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Policing is an important structural determinant of HIV and other health risks faced by vulnerable populations, including people who sell sex and use drugs, though the role of routine police encounters is not well understood. Given the influence of policing on the risk environment of these groups, methods of measuring the aggregate impact of routine policing practices are urgently required. We developed and validated a novel, brief scale to measure police patrol practices (Police Practices Scale, PPS) among 250 street-based female sex workers (FSW) in Baltimore, Maryland, an urban setting with high levels of illegal drug activity. PPS items were developed from existing theory and ethnography with police and their encounters with FSW, and measured frequency of recent (past 3 months) police encounters. The 6-item scale was developed using exploratory factor analysis after examining the properties of the original 11 items. Confirmatory factor analysis was used to model the factor structure. A 2-factor model emerged, with law enforcement PPS items and police assistance PPS items loading on separate factors. Linear regression models were used to explore the relative distribution of these police encounters among FSW by modeling association with key socio-demographic and behavioral characteristics of the sample. Higher exposure to policing was observed among FSW who were homeless (β = 0.71, p = 0.037), in daily sex work (β = 1.32, p = 0.026), arrested in the past 12 months (β = 1.44, p<0.001) or injecting drugs in the past 3 months (β = 1.04, p<0.001). The PPS provides an important and novel contribution in measuring aggregate exposure to routine policing, though further validation is required. This scale could be used to evaluate the impact of policing on vulnerable populations’ health outcomes, including HIV risk.
... Some literature indicated that recidivism and delinquency begin before 18 years of age (The Measures of . Other literature suggested that the tendency to relapse into criminal behavior was a factor of higher incarceration rates among male and female populations (Collins, Lonczak, & Clifasefi, 2017). ...
... Harm-reduction techniques (policies, programs and practices to minimize the negative health, social and legal impacts associated with drug use, drug policies and drug laws (21)), such as opioid agonist therapy (methadone, buprenorphine (22,23)), needle exchange for the prevention of HIV and hepatitis C transmission (24), and naloxone distribution for the treatment of opioid overdose (25) became increasingly utilized over the ensuing decades. Harm reduction approaches to illicit substance use is perhaps best personified in the U.S. by the LEAD (Law Enforcement Assisted Diversion) program, a public safety program which allows police officers discretionary authority to divert individuals suspected of low level, nonviolent crime to community-based health services instead of arrest, jail and prosecution (26). Other countries have progressed even further: Portugal has decriminalized all drug use (27,28); Europe and Canada have, on a small scale, implemented heroin-assisted treatment (29,30) and supervised injection sites/drug consumption facilities (31). ...
... Beletsky's SHIELD intervention and LEAD are two possible avenues for action (Arredondo et al., 2019). SHIELD is a theoretically guided training for officers designed to "harmonize police practices with overdose crisis response, including lay responder naloxone access, Good Samaritan laws, syringe services, opioid substitution therapy, and other public health measures" (Health in Justice Action Lab, (n.d) p.1). LEAD provides pre-arrest diversion to PWUD, diverting them from jail to case management and supportive services (Collins, Lonczak & Clifasefi, 2017). Notably, the North Carolina Harm Reduction Coalition has implemented rural LEAD programs in North Carolina (North Carolina Harm Reduction Coalition [NCHRC], (n.d)). ...
Article
Background Though overdose rates have been increasing in US rural areas for two decades, little is known about the rural risk environment for overdoses. This qualitative study explored the risk environment for overdoses among young adults in Eastern Kentucky, a rural epicenter of the US opioid epidemic. Methods Participants were recruited via community-based outreach. Eligibility criteria included living in one of five rural Eastern Kentucky counties; being aged 18–35; and using opioids to get high in the past 30 days. Semi-structured interviews explored the rural risk environment, and strategies to prevent overdose and dying from an overdose. Interviews were transcribed verbatim and analyzed using constructivist grounded-theory methods. Results In this sample (N = 19), participants reported using in a range of locations, including homes and outdoor settings; concerns about community stigma and law enforcement shaped the settings where participants used opioids and the strategies they deployed in these settings to prevent an overdose, and to survive an overdose. Almost half of participants reported using opioids in a “trap house” or other dealing locations, often to evade police after buying drugs, and reported that others present pressed them to use more than usual. If an overdose occurred in this setting, however, these same people might refuse to call EMS to protect themselves from arrest. Outdoor settings presented particular vulnerabilities to overdose and dying from an overdose. Most participants reported using opioids outdoors, where they skipped overdose prevention steps to reduce their risk of arrest; they worried that no one would find them if they overdosed, and that cell phone coverage would be too weak to summon EMS. Conclusion Findings suggest that initiatives to reduce overdoses in Eastern Kentucky would be strengthened by de-escalating the War on Drugs and engaging law enforcement in initiatives to protect the health of people who use opioids.
... 15 The traditional approach of arrest, incarceration, and prosecution have neither deterred criminal recidivism nor decreased the cycle of continued opioid use. 17,18 The paradigm of punishment rather than treatment does not facilitate the use of effective and coordinated interventions, and even less provide access to medication treatment for OUD. 14 Evidence suggests that more imprisonment does not reduce state drug problems 19 and incarceration alone is not an effective universal strategy. ...
Article
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Opioid overdoses continue to be a leading cause of death in the US. This public health crisis warrants innovative responses to help prevent fatal overdose. There is continued advocacy for collaborations between public health partners to create joint responses. The high correlation between persons with opioid use disorder who have a history of involvement in the criminal justice system is widely recognized, and allows for treatment intervention opportunities. Law enforcement-led treatment initiatives are still relatively new, with a few sparse early programs emerging almost a decade ago and only gaining popularity in the past few years. A lack of published methodologies creates a gap in the knowledge of applied programs that are effective and can be duplicated. This article seeks to outline an interagency relationship between police and healthcare that illustrates arrest is not the only option that law enforcement may utilize when encountering persons who use illicit substances. Program methods of a joint initiative between law enforcement and healthcare in a large, metropolitan area will be reviewed, supplemented with law enforcement overdose data and statistics on law enforcement treatment referrals.
... Jail diversion programs such as Law Enforcement Assisted Diversion (LEAD), a pilot program in King County, Washington (the Seattle metropolitan area), redirect individuals with low-level drug and prostitution offenses away from the criminal justice system and into community-based services such as treatment for substance use disorder, housing, and mental health care [17,18]. Consistent with LEAD's stated goal "to improve public safety and public order" [19], LEAD has demonstrated effectiveness in decreasing recidivism rates for its clients: An average participant is 58% less likely to be rearrested and saves the county $8,000 in legal fees and processing costs annually [20][21][22]. The substantiated links between incarceration and public health suggest that reducing jail populations and increasing the rate at which drug offenders enter sustained treatment for substance use disorder is likely to generate additional benefits. ...
Article
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Background Cycles of incarceration, drug abuse, and poverty undermine ongoing public health efforts to reduce overdose deaths and the spread of infectious disease in vulnerable populations. Jail diversion programs aim to divert low-level drug offenders toward community care resources, avoiding criminal justice costs and disruptions in treatment for HIV, hepatitis C virus (HCV), and drug abuse. We sought to assess the health benefits and cost-effectiveness of a jail diversion program for low-level drug offenders. Methods and findings We developed a microsimulation model, calibrated to King County, Washington, that captured the spread of HIV and HCV infections and incarceration and treatment systems as well as preexisting interventions such as needle and syringe programs and opiate agonist therapy. We considered an adult population of people who inject drugs (PWID), people who use drugs but do not inject (PWUD), men who have sex with men, and lower-risk heterosexuals. We projected discounted lifetime costs and quality-adjusted life years (QALYs) over a 10-year time horizon with and without a jail diversion program and calculated resulting incremental cost-effectiveness ratios (ICERs) from the health system and societal perspectives. We also tracked HIV and HCV infections, overdose deaths, and jail population size. Over 10 years, the program was estimated to reduce HIV and HCV incidence by 3.4% (95% CI 2.7%–4.0%) and 3.3% (95% CI 3.1%–3.4%), respectively, overdose deaths among PWID by 10.0% (95% CI 9.8%–10.8%), and jail population size by 6.3% (95% CI 5.9%–6.7%). When considering healthcare costs only, the program cost $25,500/QALY gained (95% CI $12,600–$48,600). Including savings from reduced incarceration (societal perspective) improved the ICER to $6,200/QALY gained (95% CI, cost-saving $24,300). Sensitivity analysis indicated that cost-effectiveness depends on diversion program participants accessing community programs such as needle and syringe programs, treatment for substance use disorder, and HIV and HCV treatment, as well as diversion program cost. A limitation of the analysis is data availability, as fewer data are available for diversion programs than for more established interventions aimed at people with substance use disorder. Additionally, like any model of a complex system, our model relies on simplifying assumptions: For example, we simplified pathways in the healthcare and criminal justice systems, modeled an average efficacy for substance use disorder treatment, and did not include costs associated with homelessness, unemployment, and breakdown in family structure. Conclusions We found that diversion programs for low-level drug offenders are likely to be cost-effective, generating savings in the criminal justice system while only moderately increasing healthcare costs. Such programs can reduce incarceration and its associated costs, and also avert overdose deaths and improve quality of life for PWID, PWUD, and the broader population (through reduced HIV and HCV transmission).
... Yet these results suggest the need for a rapid community response following a drug seizures; this response would need to target harm reduction and treatment opportunities to a specific geographical region. This idea aligns more with recent policing efforts that focus on harm reduction [36], arrest diversion programs [13], and police-led treatment initiatives for opioid use disorder [58], compared to traditional place-based deterrence policing methods. A police-public health collaboration following police drug seizures is also an opportunity to link individuals to treatment and lower the rate of overdoses. ...
Article
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Recent research has shown an association between monthly law enforcement drug seizure events and accidental drug overdose deaths using cross-sectional data in a single state, whereby increased seizures correlated with more deaths. In this study, we conduct statistical analysis of street-level data on law enforcement drug seizures, along with street-level data on fatal and non-fatal overdose events, to determine possible micro-level causal associations between opioid-related drug seizures and overdoses. For this purpose, we introduce a novel, modified two-process Knox test that controls for self-excitation to measure clustering of overdoses nearby in space and time following law enforcement seizures. We observe a small, but statistically significant (p < 0.001), effect of 17.7 excess non-fatal overdoses per 1000 law enforcement seizures within three weeks and 250 m of a seizure. We discuss the potential causal mechanism for this association along with policy implications.
... Also in the United States, the Seattle's Law Enforcement Assisted Diversion (LEAD) program is implemented, which involves the provision of suspects of drug and prostitutionrelated crimes with certain types of assistance to prevent recidivism [18,19]. ...
Article
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The state of recidivism indicates that the theoretical, legislative and law enforcement issues of its prevention is still relevant. There are different levels and directions of this warning. When developing and implementing appropriate measures, it is necessary to consider the current situation and existing opportunities in a particular state, the positive experience accumulated in it, the practices implemented in other countries, as well as the prospects for development. This study was conducted to reveal the opinions of convicts and employees of the Federal Penitentiary Service of Russia on certain issues of preventing recidivism, as well as to develop proposals for improving measures aimed at this prevention, with regard to the state of recidivism. The study analyzed and summarized official statistical data, conducted a questionnaire survey of convicts and employees of the Federal Penitentiary Service of Russia, studied the experience of other countries in the sphere of the penitentiary and post-penitentiary impact on convicts, and studied the results of studies conducted by other authors. The work presents the results of the analysis and synthesis of statistical data on recidivism over a long period, as well as the data of the author’s survey, and articulates specific proposals for changing existing and new developing measures to prevent recidivism.
... Given that traditional criminal justice-based policing approaches may not be effective in reducing subsequent crime recidivism or overdoses, new policing initiatives, defined as programs differing from the traditional approach, such as pre-arrest diversion programs or assistance with treatment referrals, have been developed and are being tested to address this problem and to redirect individuals with addiction, especially OUD, from the criminal justice system to SUD treatment [17][18][19]. In recent years, additional overdose prevention initiatives and legislative changes (e.g., a standing order for naloxone in many states) have been implemented throughout the nation to help stem the opioid epidemic-related harms. ...
Article
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Background: Individuals with substance use disorder often encounter law enforcement due to drug use-related criminal activity. Traditional policing approaches may not be effective for reducing recidivism and improving outcomes in this population. Here, we describe the impact of traditional policing approach to drug use-related crime on future recidivism, incarceration, and overdoses. Methods: Using a local Police Department (PD) database, we identified individuals with a police contact with probable cause to arrest for a drug use-related crime ("index contact"), including for an opioid-related overdose, between September 1, 2015, and August 31, 2016 (Group 1, N = 52). Data on police contacts, arrests, and incarceration 12 months before and after the index contact were extracted and compared using Fisher's exact or Wilcoxon signed-rank tests. County-level data on fatal overdoses and estimates of time spent by PD officers in index contact-related responses were also collected. To determine whether crime-related outcomes changed over time, we identified a second group (Group 2, N = 263) whose index contact occurred between September 1, 2017, and August 31, 2020, and extracted data on police contacts, arrests, and incarceration during the 12 months prior to their index contact. Pre-index contact data between Groups 1 and 2 were compared with Fisher's exact or Mann-Whitney U tests. Results: Comparison of data during 12 months before and 12 months after the index contact showed Group 1 increased their total number of overdose-related police contacts (6 versus 18; p = 0.024), incarceration rate (51.9% versus 84.6%; p = 0.001), and average incarceration duration per person (16.2 [SD = 38.6] to 50 days [SD = 72]; p < 0.001). In the six years following the index contact, 9.6% sustained a fatal opioid-related overdose. For Group 1, an average of 4.7 officers were involved, devoting an average total of 7.2 h per index contact. Comparison of pre-index contact data between Groups 1 and 2 showed similar rates of overdose-related police contacts and arrests. Conclusions: The results indicated that the traditional policing approach to drug use-related crime did not reduce arrests or incarceration and was associated with a risk of future overdose fatalities. Alternative law enforcement-led strategies, e.g., pre-arrest diversion-to-treatment programs, are urgently needed.
... 32,33 One promising harm reduction intervention is the law enforcement assisted diversion (LEAD) program that diverts individuals from the criminal legal system to case management programs for a range of support services; LEAD is associated with lower odds of arrest and felony charges and is gaining support across the country since its launch in 2011. 34 However, disagreement within the community regarding the role of police and the effectiveness of criminalization, mandated treatment, and the use of Naloxone makes it difficult for effective community planning and programming, calling for additional analyses around these outcomes. ...
Article
Introduction: Rural communities face barriers to opioid treatment and overdose prevention including concerns about stigma and lack of harm reduction services. Purpose: The aim of this study was to explore community perspectives and understanding of harm reduction approaches to opioid use and overdose in a high-risk Northern Appalachian case community in Pennsylvania. Methods: A small town approximately 10 miles from Pittsburgh was identified as the community with the greatest predicted probabilities of epidemic outbreak using posteriors from spatial models of hospitalizations for opioid use disorders. We interviewed 20 key stakeholders in the case community in using a semi-structured interview guide and analyzed the qualitative data using an inductive grounded theory approach. Results: Our findings illustrate how conflicting perspectives about opioid dependence lay the foundation for the polarizing community perspectives on addressing opioid use and overdose and general disagreement regarding the legitimacy of harm reduction approaches versus abstinence-based recovery plans. Community members shared varying perspectives on multiple aspects of the opioid epidemic, including appropriate strategies, treatment, and overdose prevention methods and how community leaders and organizations should respond. Implications: Opinions, coupled with a general lack of education regarding opioid use and harm reduction options, make it challenging for small communities with limited resources to create comprehensive plans to address the opioid crisis.
... In 2015, the Police Assisted Addiction and Recovery Initiative (PAARI) in Gloucester, Massachusetts relied on police officers to assist individuals with a referral to addiction treatment (Schiff et al., 2017). In Seattle, Washington, the Law Enforcement Assisted Diversion (LEAD) program, a community-based, harm-reduction intervention, offered case management, and linkages to supportive services and treatment in lieu of jail and prosecution, leading to reduced recidivism, as compared to the "usual" criminal justice processing (Collins, Lonczak, & Clifasefi, 2017). ...
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Background Despite evidence that treatment reduces addiction-related harms, including crime and overdose, only a minority of addiction-affected individuals receive it. Linking individuals who committed an addiction-related crime to addiction treatment could improve outcomes. Methods The aim of this city-wide, pre-arrest diversion program, Madison Addiction Recovery Initiative (MARI) is to reduce crime and improve health (i.e., reduce the overdose deaths) among adults who committed a minor, non-violent, drug use-related offense by offering them a referral to treatment in lieu of arrest and prosecution of criminal charges. This manuscript outlines the protocol and methods for the MARI program development and implementation. MARI requires its participants to engage in the recommended treatment, without reoffending, during the six-month program, after which the initial criminal charges are “voided” by the law enforcement agency. The project, implemented in a mid-size U.S. city, has involved numerous partners, including law enforcement, criminal justice, public health, and academia. It includes training of the police officer workforce and collaboration with clinical partners for treatment need assessment, treatment placement, and peer support. Program evaluation includes formative, process, outcome (participant-level) and exploratory impact (community-level) assessments. For outcome evaluation, we will compare crime (primary outcome), overdose-related offenses, and incarceration-related data 12 months before and 12 months after the index crime between participants who completed (Group 1), started but not completed (Group 2), and were offered but did not start (Group 3) the program, and adults who would have been eligible should MARI existed (Historical Comparison, Group 4). Clinical characteristics will be compared at baseline between Groups 1–2, and pre-post the program within Group 1. Participant baseline data will be assessed as potential covariates. Surveys of police officers and program completers, and community-level indicators of crime and overdose pre- versus post-program will provide additional data on the program impact. Discussion By offering addiction treatment in lieu of arrest and prosecution of criminal charges, this pre-arrest diversion program has the potential to disrupt the cycle of crime, reduce the likelihood of future offenses, and promote public health and safety.
... There is evidence that law enforcement, when supportive of public health efforts, can facilitate participation by referring PWUD into the program [26]. There are harm reduction policing iniativies being adopted across the USA such as Law Enforcement Assisted Diversion (LEAD) programs in which police officers forgo the normal response of engaging a PWUD in the criminal justice system in favor of referring people into support systems and treatment programs [27]. In Seattle, Washington, this approach has been found to be successful in reducing recidivism and other positive outcomes [28]. ...
Article
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Background Syringe services programs provide sterile injection supplies and a range of health services (e.g., HIV and HEP-C testing, overdose prevention education, provision of naloxone) to a hard-to-reach population, including people who use drugs, aiming to prevent the transmission of infectious diseases. Methods We performed a qualitative needs assessment of existing syringe services programs in the state of Colorado in 2018–2019 to describe—their activities, needs, and barriers. Using a phenomenological approach, we performed semi-structured interviews with key program staff of syringe services programs ( n = 11). All interviews were digitally recorded, transcribed, and validated. A data-driven iterative approach was used by researchers to develop a coding scheme to organize the data into major themes found across interviews. Memos were written to synthesize main themes. Results Nearly all the syringe program staff discussed their relationships with law enforcement at length. All syringe program staff viewed having a positive relationship with law enforcement as critical to the success of their program. Main factors that influence the quality of relationships between syringe services programs and law enforcement included: (1) alignment in agency culture, (2) support from law enforcement leadership, (3) police officers’ participation and compliance with the Law Enforcement Assisted Diversion (LEAD) program, which provides intensive case management for low-level drug offenders, and (4) implementation of the “Needle-Stick Prevention Law” and Drug Paraphernalia Law Exemption. All syringe program staff expressed a strong desire to have positive relationships with law enforcement and described how a collaborative working relationship was critical to the success of their programs. Conclusions Our findings reveal effective strategies to foster relationships between syringe services programs and law enforcement as well as key barriers to address. The need exists for both syringe services programs and law enforcement to devote time and resources to build a strong, positive partnership. Having such positive relationships with law enforcement has positive implications for syringe services program clients, including law enforcement being less likely to ticket persons for having used syringes, and encourage people who use drugs to seek services from syringe services programs, which can then lead them to other resources, such as housing, wound care, and substance use treatment programs.
Article
Background Increased uptake of hepatitis C virus (HCV) treatment among people who inject drugs (PWID) will be critical to achieve HCV elimination goals. There are limited data on HCV treatment uptake among PWID recruited from community‐based settings in the HCV direct‐acting antiviral (DAA) era. Methods We analyzed data from PWID with HCV newly recruited into the Baltimore, Maryland‐based AIDS Linked to the IntraVenous Experience (ALIVE) cohort between 2015 and 2018. We characterized the HCV care continuum and evaluated factors associated with HCV treatment uptake. Results Of the 418 PWID with HCV, the median age was 49 years and most (88%) reported recent injection drug use (IDU). Overall, 23% had ever been evaluated by a provider for HCV treatment, 17% ever initiated DAA treatment, and 13% were cured of HCV infection. Treatment uptake approximately doubled between 2015 and 2018 (13% to 26%, p=0.01). In multivariable analyses, HIV infection (adjusted Odds Ratio [aOR] 2.5 [95% Confidence Interval (CI) 1.3, 4.8]), current employment (aOR 4.1 [CI 1.2, 14.4]), having a primary care provider (aOR 4.3 [CI 1.2, 14.9), and longer duration of IDU (aOR 1.3 [CI 1.1, 1.6]) were positively associated with HCV treatment. PWID with a lower annual income (≤$5,000) were less likely to have initiated HCV treatment (aOR 0.5 [CI 0.3, 0.98]). Conclusions Although HCV treatment uptake among PWID in this community‐based setting in the DAA era remains suboptimal, it is encouraging that treatment uptake has increased in recent years. Innovative strategies are needed to reach all PWID infected with HCV.
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Objective The opioid epidemic continues to escalate, and out‐of‐hospital emergency medical services (EMS) play a vital role in acute overdose reversal, but could serve a broader role post‐incident for follow‐up, outreach, and referrals. Our objective is to identify the scope and prevalence of community‐based, post‐opioid overdose EMS programs across the United States. Methods We used a narrative review of prior studies in PubMed and Scopus for the last 20 years (1999–2020) to identify relevant medical literature and a web search to identify gray literature of EMS interventions involving opioids. Results Out of nearly 22,000 EMS agencies across the United States, we found evidence of only 27 programs published in medical or gray literature involving post‐overdose interventions. They were most commonly found in the north and eastern region of the country. Although most of these programs incorporate harm reduction and education, other more innovative aspects such as linkage to outpatient addiction treatment or peer support services, are much less common. The most comprehensive programs involved combinations of innovative outreach, specialized referrals, integration with police and criminal justice, peer support, and even treatment initiation. Conclusions Out‐of‐hospital emergency care has the potential to provide more comprehensive care after drug overdose, but many programs either do not currently have such an intervention in place, or are not disseminating their practices for other agencies to assimilate. EMS protocols and policies that encourage greater adoption of active community paramedicine practices for opioids should be encouraged.
Article
Research Summary We conducted a retrospective, quasi‐experimental study of a police naloxone program to examine individual outcomes following nonfatal overdose where either police (n = 111) or emergency medical services (n = 1,229) provided a first response and administered naloxone. Individuals who received a police response were more likely to be arrested immediately following initial dispatch and had more instances of repeat nonfatal overdose two years following dispatch; there were no differences in rearrest or death rates. Findings suggest police naloxone programs may increase short‐term incarceration risk, but we found little evidence overall of long‐term adverse effects. Policy Implications Naloxone is a tool to reduce fatal opioid‐involved overdose. Its provision alone does not constitute a comprehensive agency response to the opioid epidemic. Findings support the need for standardized policies and procedures to guide emergency responses to nonfatal overdose events and ensure consistency across agencies.
Article
Pre-arrest diversion programs have the potential to reform the front-end of the criminal justice system and reduce the stigma associated with a low-level arrest, but little evaluation work has been conducted in this area. The current study was designed with two objectives: 1) to examine within-program indicators of completion and post-program arrest between the Adult Civil Citation (ACC) pre-arrest and the Pre-Trial Intervention (PTI) post-booking program in Florida’s second judicial district, and 2) to conduct a matched samples comparison of subsequent arrest between the two programs. A prospective longitudinal evaluation was conducted from 2010–2017 to assess within-program indicators of successful completion in addition to a between-program comparison of follow-up arrest. Propensity score matching was used to compare post-program arrest rates between 7,410 adults who entered the PTI program and 1,279 adults who participated in the ACC program. Demographic background, offense type, and completion status were collected within the respective programs while follow-up arrest data was drawn from statewide records. Successful program completion and post-program arrest were associated with participants’ sex, racial background, and offense type. Although participants in both programs experienced similar post-program arrest rates, further research is needed on additional program features, including qualitative differences between programs.
Article
Background Many studies document high risk of fatal overdose after incarceration. Few explore earlier touchpoints in criminal justice processes, like arrests and court hearings. Understanding these touchpoints is important for several reasons. Arrest and adjudicatory processes are harmful even when not resulting in incarceration. Arrests and criminal hearings also may reflect changes in overdose-related risk factors like transitions in employment and housing stability. Moreover, knowledge about these touchpoints contextualizes debate about the implementation of court-based programs like Drug Treatment Courts. This study described the incidence and accumulation of touchpoints for people who fatally overdosed in Philadelphia in 2016, and depicted how touchpoint incidence and characteristics interface with court-program eligibility. Methods Criminal court documents were obtained for all individuals who fatally overdosed in Philadelphia in 2016 from the Philadelphia Medical Examiner's Office. The characteristics of arrests and court hearings were abstracted to compile lifetime criminal histories. Latent class analysis was performed to identify whether these histories followed observably distinct patterns. Results In 2016, 907 people fatally overdosed in Philadelphia. Of these, 605 had at least one or more of 3,926 arrests and 3,822 hearings over their lifetime. There were 488 arrests and 533 hearings in the two years before death, with public disorder charges especially common closer to death. Less than 20% of these hearings resulted in custodial sentences. Of individuals with touchpoints, only nine participated in Drug Treatment Court, consistent with findings that most individuals were ineligible. Latent class analysis suggested five distinguishable patterns in age, timing, and characteristics of touchpoints. Conclusions The type and frequency of touchpoints preceding fatal overdose reflect a period of complex vulnerability. Few individuals qualified for court-based programming, underscoring the limitations of supporting this population in specialized court settings. Reducing incidence and improving the health impact of criminal justice touchpoints remain important public health priorities.
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Diversion programs allow criminal justice actors to send defendants out of the court system, compelling them instead to attend treatment programs, participate in educational opportunities, and/or perform community service. These programs exist for both adult and juvenile offenders. Although some diversion programs are administered within the court system, prosecutors design and operate a substantial number of these programs themselves. Because the prosecutor does not need to obtain input from judges or other actors in these programs, they carry higher risks of performance problems, such as net widening and unequal application of program criteria. Furthermore, because of the local focus of most prosecutors’ offices in the United States, their diversion programs differ from place to place. The published program evaluations are too often site-specific, offering few general insights about this category of programs. The fragmented literature about prosecutor-led diversion programs should expand the metrics of success for these programs and monitor the effects of the prosecutor-dominated governance structure. Expected final online publication date for the Annual Review of Criminology, Volume 4 is January 13, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Article
In 2016, San Francisco (SF) implemented the Law Enforcement Assisted Diversion (LEAD) program, a harm reduction–based pre-booking diversion system for people who violate drug laws and/or are engaged in sex work. LEAD is set apart from existing diversion programs, as it uses police as point of entry. Prior LEAD studies indicate some success in reducing recidivism and improving life outcomes. However, less is known about program implementation, including barriers and facilitators. Relying on policy documents, interviews, and focus groups, this study describes the LEAD SF’s development, operations, adaptations, and challenges. It also identifies the unique context of LEAD SF that led to implementation barriers and facilitators. Results show that SF experienced success in collaboration, relationship building, and client connections to services but experienced challenges in securing and maintaining police officer buy-in and keeping clear and open lines of communication regarding LEAD goals, objectives, policies, and procedures. This led to the termination of LEAD SF in 2020.
Article
Background: Law enforcement officers (LEOs) often are the first responders to arrive at a scene of an opioid overdose. Thus, equipping LEOs as first responders with naloxone is necessary to prevent overdose deaths and a recommended strategy. However, little is known about how LEOs perceive naloxone training and their feelings after using naloxone to save a life. It is important to understand LEOs' experiences with naloxone so as to develop additional training materials that are relevant to the LEO experience. Methods: A descriptive exploratory study was conducted to explore the perceptions of LEOs about using naloxone in the field and to identify areas that should be included in future naloxone trainings. Interview data were obtained through face-to-face interviews with LEOs (N = 14) and analyzed using manifest content analysis. Results: LEOs changed their attitudes and beliefs toward naloxone after receiving training and experiencing a successful resuscitation. The change in attitudes was enhanced after saving a life. However, misconceptions about naloxone and lack of understanding about disease of addiction persisted even after training. Conclusion: Future naloxone curriculum could benefit from additional lessons on the stigma of addiction, the disease of addiction, misconceptions about the safety of naloxone, strategies for postoverdose responses, and the role naloxone, which might play in a hopeful recovery.
Article
Background. Previous reviews of the effectiveness of measures to divert those who use drugs from the criminal justice system have focused mainly on post-conviction or post-sentence programs and report mixed results. The present systematic review synthesizes evidence on the effectiveness of police-based diversion measures in reducing criminal offenses and other harms related to drug use and then summarizes evidence from qualitative studies to identify facilitators and barriers associated with the implementation of such measures. Methods. Eight databases were searched to find evaluations of police-based diversion measures for drug-related offenders. Twenty-seven studies were identified. The vote-count method and the Maryland Scientific Method Scale were used to assess the impact of police-based diversion measures. Themes related to barriers or conditions facilitating the implementation of these measures were extracted from qualitative studies. Results. Evidence from quantitative studies indicates that in general police-based diversion measures are effective in preventing criminal offending and show promising results for improving participants’ health and diminishing social costs as well as costs associated with processing drug-related offenses. There was insufficient evidence to draw conclusions about the effect of police-based diversion measures on drug use, drug accessibility, or changes in participants’ socioeconomic conditions. Findings from qualitative studies suggest that program acceptance by police officers, constructive intersectoral collaboration, clear eligibility criteria, and timely access to services seem to facilitate the implementation and delivery of police-based diversion measures. Conclusion. Police-based diversion measures can be effective in preventing drug-related criminal offenses and harm. Additional research is needed to evaluate their effect on participants’ socioeconomic conditions and drug use as well as drug accessibility.
Article
In 2017, San Francisco (SF) implemented Law Enforcement Assisted Diversion (LEAD), a program Beckett described as harm reduction policing. Through a process and outcome evaluation of LEAD SF, this paper demonstrates the positive impacts of harm reduction policing, on those who use drugs and/or engage in sex work. When law enforcement officers used their discretion to divert individuals into LEAD rather than arrest, those individuals had significantly fewer felony and misdemeanor arrests and felony cases, in comparison to a propensity score matched group. The focus group and interview data describe that the collaboration, the warm handoff, and LEAD’s harm reduction principles were mechanisms of success. However, obtaining officer buy-in was a key challenge. Despite that obstacle, LEAD SF’s harm reduction policing reduces offending, improves the wellbeing of people who use drugs and engage in sex work, and allows the police to carry out their mandate to protect and serve.
Article
Since the late twentieth century, as part of a broad effort to maximize the profitability of commercial spaces and address the complaints of business interests, cities have increasingly criminalized the presence and behavior of populations perceived as disorderly. The resulting police interactions produce a range of deleterious outcomes, particularly for individuals contending with mental health and substance use disorders, homelessness, and other behavioral health concerns. Against this backdrop, we provide a case study of the Let Everyone Advance with Dignity (LEAD) program, a novel public safety intervention developed in Seattle, Washington. LEAD diverts businesses’ disorder complaints from police and 911 toward program personnel who provide long-term harm reduction services and resources. LEAD's non-punitive approach has demonstrated success in reducing the harms of criminalization, improving individual outcomes, satisfying business grievances, and, more broadly, disrupting the defining logic and practices of neoliberal urbanism. LEAD's successes carry theoretical implications, demonstrating the need for non-police alternatives to reconfigure the organizational field of public safety by intervening into the longstanding coalition between businesses and police. The LEAD model also offers insights about the concrete steps necessary to ensure public safety and community vitality without police involvement. This article is protected by copyright. All rights reserved.
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Recent attention has focused on the growing role of psychostimulants, such as methamphetamine in overdose deaths. Methamphetamine is an addictive and potent stimulant, and its use is associated with a range of physical and mental health harms, overdose, and mortality. Adding to the complexity of this resurgent methamphetamine threat is the reality that the increases in methamphetamine availability and harms are occurring in the midst of and intertwined with the ongoing opioid overdose crisis. Opioid involvement in psychostimulant-involved overdose deaths increased from 34.5% of overdose deaths in 2010 to 53.5% in 2019-an increase of more than 50%. This latest evolution of the nation's overdose epidemic poses novel challenges for prevention, treatment, and harm reduction. This narrative review synthesizes what is known about changing patterns of methamphetamine use with and without opioids in the United States, other characteristics associated with methamphetamine use, the contributions of the changing illicit drug supply to use patterns and overdose risk, motivations for couse of methamphetamine and opioids, and awareness of exposure to opioids via the illicit methamphetamine supply. Finally, the review summarizes illustrative community and health system strategies and research opportunities to advance prevention, treatment, and harm reduction policies, programs, and practices.
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The opioid crisis is the most persistent, long-term public health emergency facing the United States, and available evidence suggests the crisis has worsened during the COVID-19 global pandemic. Naloxone is an effective overdose response that saves lives, but the drug does not address problematic drug use, addiction, or the underlying conditions that lead to overdoses. The opioid crisis is at its core a multidisciplinary, multisystem problem, and an effective response to the crisis requires collaboration across those various systems. This paper describes such a collaborative effort. The Tempe First-Responder Opioid Recovery Project is a multidisciplinary partnership that includes police officers, social workers, substance use peer counselors, public health professionals, police researchers, and drug policy/harm reduction researchers. The project, 10 months underway, trained and equipped Tempe (AZ) police officers to administer Narcan. In addition, a 24/7 in-person “Crisis Outreach Response Team” rapidly responds to any suspected overdose and offers follow-up support, referrals, and services to the individual (and loved ones) for up to 45 days after the overdose. We present preliminary project data including interviews with project managers, counselors, and police officers, descriptions of Narcan administrations in the field, and aggregate data on client service engagement. These data highlight the complexity of the opioid crisis, the collaborative nature of the Tempe project, and the importance of initiating a multidisciplinary, comprehensive response to effectively deal with the opioid problem.
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Diversion is a prevalent alternative to traditional criminal justice processing, especially at the pre-trial stage. More recently, pre-arrest diversion has been implemented to avert the consequences of arrest, pre-trial proceedings, and future incarceration. Pre-booking diversion programs rely on the willingness of officers to use their discretionary authority to divert low-level offenders to community-based treatment programs in lieu of arrest, raising considerations about how law enforcement view offenders. Using data collected from a survey distributed during a Law Enforcement Assisted Diversion (LEAD) training session for officers in one jurisdiction in the Rocky Mountain West (N = 118), the current study examines the impact of officer attitudes toward offenders on their decision to divert individuals. Findings indicate that officers who hold an optimistic view toward offender rehabilitation are more likely to divert offenders. Results and their significance for practical implementation of law enforcement pre-arrest diversion efforts are discussed.
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Survivors of domestic minor sex trafficking (DMST) are failing to be identified and are frequently criminalized. Examining the linkages between DMST and the juvenile legal system is important, as many trafficked youths are only identified after entry into the child welfare or juvenile court system as a result of being arrested or detained on related delinquency charges. Due to legacies of structural violence, marginalized youths are reluctant to approach police officers for help. Therefore, social workers have an opportunity to identify, intervene, and advocate for trafficked youths. In this article, the author provides an overview of existing research related to the demographic profile of DMST, homelessness and survival sex, recruitment and entry, barriers to effective community response, and prevention and intervention strategies. This article represents a call to broaden our view of young people in the sex trade and supports the decriminalization of trafficked youths. Interventions and policies must be designed to fit their complex needs and experiences, resulting in empowerment, opportunity, and new beginnings.
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Background Despite widespread interest in adoption, there has been limited systematic examination of Law Enforcement Assisted Diversion (LEAD) implementation, a model for police-led arrest diversion for those with substance use disorders (SUD). In the fall of 2017, the City of New Haven started a LEAD program. During the first 9 months of the pilot, only 2 clients were successfully diverted from arrest. Therefore, we examined the and barriers and facilitators of LEAD implementation. Methods We conducted semi-structured interviews and field observations of LEAD police officers and health care providers between August 2018 and June 2019. Interviews and field observations were analyzed using directed content analysis and guided by the Integrated Promoting Action on Research Implementation in Health Services framework. Results Lead professionals participated in 19 semi-structured interviews and three field observations. Barriers to arrest diversion implementation included procedural complexity of arrest diversion, concerns about reduced penalties for substance use among officers, stigma of SUDs, and a belief in a punitive role for policing. Facilitators included a positive longitudinal relationship with potential clients and an understanding of SUD as a chronic disease. Conclusion We identified several barriers to LEAD implementation. Our results suggest promotion of SUD as a chronic disease, ongoing training of officers, and positive incentives for entering substance use treatment should be utilized to facilitate implementation.
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Objective At a time of unprecedented attention to the public health impact of policing, it is imperative to understand the role of occupational safety in shaping officer behaviours. We assessed the longitudinal impact of police training in a quasi-experimental hybrid type-1 trial to reduce syringe-related occupational risk, while realigning police practices with public health prevention among people who inject drugs (PWID). Setting Tijuana, Mexico. Participants Of 1806 Tijuana municipal police trainees, 771 reporting previous exposure to syringes were randomly selected for follow-up. All participants completed at least one follow-up visit; attrition at 24 months was 8%. Intervention Between 2015 and 2016, officers received a training intervention (Safety and Health Integration in the Enforcement of Laws on Drugs, SHIELD) bundling occupational needle stick injury (NSI) prevention with health promotion among PWID. Outcome measures Longitudinal analysis with generalised linear mixed models to evaluate training impact on occupational NSI risk via NSI incidence and prevalidated Syringe Threat and Injury Correlates (STIC) score. This composite indicator integrates five self-reported risky syringe-handling practices (eg, syringe confiscation, breaking) and was used as a proxy for NSI risk due to reporting bias and concerns about reliability of NSI incidence reports. Results No change in self-reported NSI incidence was observed, but significant reductions in risk (16.2% decrease in STIC score) occurred at 3 months, with a sustained decrease of 17.8% through 24 months, compared with pretraining (p<0.001). Police assignment (patrol vs administration) moderated the training effect (p=0.01). Younger age, male gender, lower rank and previous NSI were independently and significantly associated with higher NSI risk overtime, although all groups demonstrated significant reductions post-training. Conclusions SHIELD is the first intervention to be associated with significant sustained changes in police practices that pose risk for both occupational and the public’s health. Integrating occupational safety and public health education should inform other interventions to mitigate the community health detriments of policing behaviours. Trial registration number NCT02444403 .
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As evidence of a failing war on drugs mounts and a deadly opioid crisis continues, U.S. drug policy is slowly changing to less punitive responses to drug use. Collaborations between treatment programs and law enforcement gained praise from politicians, but concerns regarding the impact of increased surveillance and the rising culture of control call for greater focus on these governing relationships. Framed within an abolitionist perspective, and incorporating insights from successful models of decriminalization in Portugal and deinstitutionalization in Italy, our analysis of in-depth interviews with 117 people who are actively using opioids seeks to understand their perspectives on treatment drawing on lived experiences. Findings reveal a need for a paradigm shift in drug policy as well as treatment practices and increased access to targeted social resources in the community. An application of penal abolition policy requires decriminalizing (or legalizing) drug use and creating commissions composed of community members, peers, and professionals disconnected from the criminal justice system.
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Introduction: Central Appalachia has been disproportionately affected by the opioid epidemic and overdose fatalities. We developed West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS), a program based on peer recovery support, to engage individuals using opioids and link them with a range of services. Methods: Community partners providing services to individuals with opioid use disorder (OUD) were identified and collaborations were formalized using a standardized memorandum of understanding. The program was structured to offer ongoing peer recovery support specialist (PRSS) services, not just a one-time referral. A website and cards describing the WV PEERS program were developed and disseminated via community partners and community education sessions. Results: Overall, 1456 encounters with individuals with OUD (mean= 2 encounters per individual) occurred in a variety of community settings over 8 months. The majority of referrals were from harm reduction programs. Overall, 63.9% (n=931) of individuals served by WV PEERS accessed services for substance use disorders and/or mental health problems. Over half (52.3%; n = 487) of individuals entered substance use and/or mental health treatment, and nearly a third (30.4%; n = 283) remained in treatment over six months. Implications: Using the WV PEERS model, PRSSs effectively engaged and linked individuals with OUD to mental health and substance use treatment in rural central Appalachia. Future research is needed to determine whether these services reduce the risk of overdose mortality.
Article
Drug law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Police-PWID street encounters (e.g. syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review (PROSPERO#CRD42018105967) to evaluate the contribution of policing to HIV risk among PWID. We screened MEDLINE, sociological databases and grey literature for studies from 1981–November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles and included 27 eligible analyses from nine countries (Russia, Mexico, United States, Canada, Ukraine, Thailand, Malaysia, China and India). Heterogeneity in variable and endpoint selection precluded meta-analyses. In six (22%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to police presence, fear of arrest, being arrested for planted drugs, and physical abuse. A total of 16 (59%) studies identified policing practices to be associated with risky injection behaviors (e.g. syringe sharing, shooting gallery utilization). In nine (33%), policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.
Article
Purpose The purpose of this paper is to report on a systematic review that examined police social work and social service collaboration strategies implemented to address social problems. Design/methodology/approach A systematic review was conducted to identify the components of police social work and social service collaboration strategies. A total of 11 databases were searched. The inclusion criteria centered on the social problem, focus population, service providers, collaboration components and geographic location. Any methodological approach was included provided that a collaboration between police and social service providers focused on addressing a social problem was implemented and described. Findings The database searches identified 3,065 hits. After first eliminating duplicate titles, then reviewing and eliminating titles and abstracts that did not met the inclusion criteria, 119 full-text studies were reviewed. Among the 81 studies included in the systematic review, 83 implemented collaborations were found. The most collaborations were implemented in the USA, whereas only one implemented collaboration was found among the majority of the countries. Interpersonal violence was the most frequent social problem addressed by the collaborations followed by mental illness, crime, juvenile delinquency, and alcohol and substance use and abuse. Interventions were predominantly delivered by social workers who provided referrals and collaboration with social service agencies that assisted adults. Practical implications Given that police officers are first responders to a wide range of social problems, investigating and disseminating information about the characteristics of police social service collaboration strategies is an important endeavor. Whereas investigating the effectiveness of collaborations was not the aim of this review, several practical implications can be derived from the findings. These findings show the types of social problems, partners and tasks that comprise the collaborations. The present findings suggest that law enforcement agencies do not have accessible name brand social work and social service collaboration models that can be replicated. The majority of the collaborations found appear to be unique models implemented between law enforcement and social service agencies. More outcome studies are needed that investigate whether the social problem has improved among citizens that received services from the collaboration. Originality/value This paper is the first systematic review focused on police social work and social service collaboration strategies implemented to address social problems.
Technical Report
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The 2013 Legislature directed the Washington State Institute for Public Policy (WSIPP) to (1) develop definitions for “evidence-based” and “research-based” and (2) create an inventory of evidence-based and research-based programs to be used by the Department of Corrections. This report contains WSIPP’s definitions as well as an inventory of evidence-based and research-based programs for adult corrections.
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The societal costs of problematic class A drug use in England and Wales exceed £15B; drug-related crime accounts for almost 90% of costs. Diversion plus treatment and/or aftercare programmes may reduce drug-related crime and costs. To assess the effectiveness and cost-effectiveness of diversion and aftercare for class A drug-using offenders, compared with no diversion. Adult class A drug-using offenders diverted to treatment or an aftercare programme for their drug use. Programmes to identify and divert problematic drug users to treatment (voluntary, court mandated or monitored services) at any point within the criminal justice system (CJS). Aftercare follows diversion and treatment, excluding care following prison or non-diversionary drug treatment. Thirty-three electronic databases and government online resources were searched for studies published between January 1985 and January 2012, including MEDLINE, PsycINFO and ISI Web of Science. Bibliographies of identified studies were screened. The UK Drug Data Warehouse, the UK Drug Treatment Outcomes Research Study and published statistics and reports provided data for the economic evaluation. Included studies evaluated diversion in adult class A drug-using offenders, in contact with the CJS. The main outcomes were drug use and offending behaviour, and these were pooled using meta-analysis. The economic review included full economic evaluations for adult opiate and/or crack, or powder, cocaine users. An economic decision analytic model, estimated incremental costs per unit of outcome gained by diversion and aftercare, over a 12-month time horizon. The perspectives included the CJS, NHS, social care providers and offenders. Probabilistic sensitivity analysis and one-way sensitivity analysis explored variance in parameter estimates, longer time horizons and structural uncertainty. Sixteen studies met the effectiveness review inclusion criteria, characterised by poor methodological quality, with modest sample sizes, high attrition rates, retrospective data collection, limited follow-up, no random allocation and publication bias. Most study samples comprised US methamphetamine users. Limited meta-analysis was possible, indicating a potential small impact of diversion interventions on reducing drug use [odds ratio (OR) 1.68, 95% confidence interval (CI) 1.12 to 2.53 for reduced primary drug use, and OR 2.60, 95% CI 1.70 to 3.98 for reduced use of other drugs]. The cost-effectiveness review did not identify any relevant studies. The economic evaluation indicated high uncertainty because of variance in data estimates and limitations in the model design. The primary analysis was unclear whether or not diversion was cost-effective. The sensitivity analyses indicated some scenarios where diversion may be cost-effective. Nearly all participants (99.6%) in the effectiveness review were American (Californian) methamphetamine users, limiting transfer of conclusions to the UK. Data and methodological limitations mean it is unclear whether or not diversion is effective or cost-effective. High-quality evidence for the effectiveness and cost-effectiveness of diversion schemes is sparse and does not relate to the UK. Importantly this research identified a range of methodological limitations in existing evidence. These highlight the need for research to conceptualise, define and develop models of diversion programmes and identify a core outcome set. A programme of feasibility, pilot and definitive trials, combined with process evaluation and qualitative research is recommended to assess the effectiveness and cost-effectiveness of diversionary interventions in class A drug-using offenders. The National Institute for Health Research Health Technology Assessment programme.
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Eight programs are described representing a variety of approaches to diversion in terms of point of criminal justice intervention (prebooking or postbooking), degree of criminal justice coercion, type of linkages provided to community-based treatment, and approaches to treatment retention. The authors also describe the characteristics of almost 1000 study participants who were diverted into these programs over an 18-month period and examine the extent to which systematic differences are observed between prebooking and postbooking subjects, as well as among sites in each of the diversion types. Results suggest that prebooking and postbooking diversion subjects were similar on most mental health indicators, but differed substantially on measures of social functioning and substance use and criminality, with postbooking subjects scoring worse on social functioning and reporting more serious substance use and criminal histories. Variability among sites was also observed, indicating differences in local preferences for the types of individuals deemed appropriate for diversion.
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This investigation examined factors contributing to attrition from correctional treatment and the implication that treatment noncompletion may have for issues concerning risk, recidivism, and responsivity. Participants included 93 violent offenders who had been referred to an intensive treatment program in a maximum security correctional facility. Descriptive information, program participation, and recidivism data were gathered from comprehensive institutional and police records. Treatment noncompleters had less formal education and less employment history in the community. They were more likely to be of aboriginal ancestry and classified to maximum security, scored more poorly on several treatment process variables, and were higher risk offenders. Subsequent analyses demonstrated that very high-risk aboriginal offenders were particularly vulnerable to dropping out of treatment (80%). The findings are discussed with respect to the principles of risk and responsivity.
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Objective: The authors reviewed studies of the effectiveness of criminal justice liaison and diversion (CJLD) services in which outcomes of participants in these services were compared with those of offenders with mental illness who received no intervention or a standard intervention. The authors synthesized existing evidence with respect to changes in mental health status or criminal recidivism. Methods: A comprehensive search (1980-2012) of more than 30 generic and specialist databases identified 6,571 published and unpublished studies. The studies, which varied considerably in methodological approach and overall quality, were systematically appraised according to Campbell-Cochrane guidelines. Ten studies met inclusion criteria. Key outcomes included a reduction in offending and postintervention changes in mental health. Results: Synthesized findings indicated that CJLD services appeared to be effective in identifying offenders with mental disorders and that participation in CJLD services had a positive impact on criminal justice and mental health outcomes. Conclusions: Although the methodologies of existing studies are only moderately rigorous, the overall findings suggest that CJLD services can be beneficial. Their effectiveness depends on the model of service delivery, the availability of community services, and the engagement of offenders with mental disorders in treatment. The successful implementation of CJLD services requires a clearer recognition of the importance of systems-of-care principles.
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The propensity score is the probability of treatment assignment conditional on observed baseline characteristics. The propensity score allows one to design and analyze an observational (nonrandomized) study so that it mimics some of the particular characteristics of a randomized controlled trial. In particular, the propensity score is a balancing score: conditional on the propensity score, the distribution of observed baseline covariates will be similar between treated and untreated subjects. I describe 4 different propensity score methods: matching on the propensity score, stratification on the propensity score, inverse probability of treatment weighting using the propensity score, and covariate adjustment using the propensity score. I describe balance diagnostics for examining whether the propensity score model has been adequately specified. Furthermore, I discuss differences between regression-based methods and propensity score-based methods for the analysis of observational data. I describe different causal average treatment effects and their relationship with propensity score analyses.
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Diversion programs are initiatives in which persons with serious mental illness who are involved with the criminal justice system are redirected from traditional criminal justice pathways to the mental health and substance abuse treatment systems. This article is a review of the research literature conducted to determine whether the current evidence supports the use of diversion initiatives to reduce recidivism and to reduce incarceration among adults with serious mental illness with justice involvement. A structured literature search identified 21 publications or research papers for review that examined the criminal justice outcomes of various diversion models. The review revealed little evidence of the effectiveness of jail diversion in reducing recidivism among persons with serious mental illness. However, evidence was found that jail diversion initiatives can reduce the amount of jail time that persons with mental illness serve. Implications for practice and research are discussed.
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For many years it has been claimed that observational studies find stronger treatment effects than randomized, controlled trials. We compared the results of observational studies with those of randomized, controlled trials. We searched the Abridged Index Medicus and Cochrane data bases to identify observational studies reported between 1985 and 1998 that compared two or more treatments or interventions for the same condition. We then searched the Medline and Cochrane data bases to identify all the randomized, controlled trials and observational studies comparing the same treatments for these conditions. For each treatment, the magnitudes of the effects in the various observational studies were combined by the Mantel-Haenszel or weighted analysis-of-variance procedure and then compared with the combined magnitude of the effects in the randomized, controlled trials that evaluated the same treatment. There were 136 reports about 19 diverse treatments, such as calcium-channel-blocker therapy for coronary artery disease, appendectomy, and interventions for subfertility. In most cases, the estimates of the treatment effects from observational studies and randomized, controlled trials were similar. In only 2 of the 19 analyses of treatment effects did the combined magnitude of the effect in observational studies lie outside the 95 percent confidence interval for the combined magnitude in the randomized, controlled trials. We found little evidence that estimates of treatment effects in observational studies reported after 1984 are either consistently larger than or qualitatively different from those obtained in randomized, controlled trials.
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Causal effect modeling with naturalistic rather than experimental data is challenging. In observational studies participants in different treatment conditions may also differ on pretreatment characteristics that influence outcomes. Propensity score methods can theoretically eliminate these confounds for all observed covariates, but accurate estimation of propensity scores is impeded by large numbers of covariates, uncertain functional forms for their associations with treatment selection, and other problems. This article demonstrates that boosting, a modern statistical technique, can overcome many of these obstacles. The authors illustrate this approach with a study of adolescent probationers in substance abuse treatment programs. Propensity score weights estimated using boosting eliminate most pretreatment group differences and substantially alter the apparent relative effects of adolescent substance abuse treatment.
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Elements of a “pluralized” drug policy have been emerging in the United States that attempt to augment punishment with an emphasis on enhanced public health and therapeutic measures. While much of this reform involves compulsory treatment diversion, a “middle ground” to reform has involved the use of pre-arrest/booking strategies in support of harm reduction policies and noncompulsory treatment diversion. In this examination of the cities of Baltimore and San Francisco, we argue that such strategies have proven problematic because of the contradictions inherent in pluralized drug control models that attempt to reconcile abstinence and prohibitions against drug use with tolerance and outreach. We identify two primary factors contributing to these contradictions. The first is an emphasis on compulsory treatment diversion mechanisms in the United States, and in the obverse, disagreements over the wisdom of harm reduction in drug policy reform. The second are limitations on the policing role in social outreach, or what we call here “reintegrative” community policing, involving both organizational factors on the part of law enforcement and resistance from community activists and public health agencies.
Chapter
Correlated datasets develop when multiple observations are collected from a sampling unit (e.g., repeated measures of a bank over time, or hormone levels in a breast cancer patient over time), or from clustered data where observations are grouped based on a shared characteristic (e.g., observations on different banks grouped by zip code, or on cancer patients from a specific clinic). The generalized linear model framework for independent data is extended to model correlated data via the introduction of second-order variance components directly into the independent data model's estimating equation. This generalization of the estimating equation from the independence model is thus referred to as a Generalized Estimating Equation (GEE). This article discusses the foundation of GEEs as well as how user-specified correlation structures are accommodated in the model-building process. This article also discusses the relationship and similarity to the underlying generalized linear model framework and we point out alternative approaches to GEEs for modeling correlated data such as fixed-effects models and random-effects models. Keywords: working correlation matrix; sandwich estimate of variance; generalized linear models; subject-specific models; population-averaged models
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The progressively rigorous methodological requirements of conducting clinical trials of behavioral treatments has placed a large burden on individual investigators, as treatment manuals, methods of evaluating treatment quality and fidelity, and persuasive evidence of the treatment's promise are now virtual requirements of receiving support for conducting a clinical trial of a new or adapted treatment. A Stage Model of Behavioral Therapies research, by articulating the progressive stages of development and evaluation for behavioral treatments, recognizes the scientific merit and need for support for treatment development and initial evaluation designated as stage I. This article describes the conduct of stage I research, including issues addressed in stage I research, major design decisions confronted by investigators, the close relationship of stage I to stage II research and proposes a time line for stage I research.
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The U.S. correctional system is overburdened with individuals suffering from substance use disorders. These illnesses also exact a heavy toll on individual and public health and well-being. Effective methods for reducing the negative impact of substance use disorders comprise critical concerns for policy makers. Drug treatment court (DTC) programs are present in more than 1800 county, tribal, and territorial jurisdictions in the United States as an alternative to incarceration for offenders with substance use disorders. This review article summarizes the available descriptive information on representative DTC populations and the observational studies of drug court participants, and it specifically reviews the available experimental effectiveness literature on DTCs. The review concludes by examining the limitations of the current literature, challenges to conducting research in drug court samples, and potential future directions for research on DTC interventions. A review of nonexperimental and quasi-experimental literature regarding the impact of DTCs points toward benefit versus traditional adjudication in averting future criminal behavior and in reducing future substance use, at least in the short term. Randomized effectiveness studies of DTCs are scant (3 were identified in the literature on U.S. adult drug courts), and methodological issues develop in combining their findings. These randomized trials failed to demonstrate a consistent effect on rearrest rates for drug-involved offenders participating in DTC versus typical adjudication. The 2 studies examining reconviction and reincarceration, however, demonstrated reductions for the DTC group versus those typically adjudicated.
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Longitudinal data sets are comprised of repeated observations of an outcome and a set of covariates for each of many subjects. One objective of statistical analysis is to describe the marginal expectation of the outcome variable as a function of the covariates while accounting for the correlation among the repeated observations for a given subject. This paper proposes a unifying approach to such analysis for a variety of discrete and continuous outcomes. A class of generalized estimating equations (GEEs) for the regression parameters is proposed. The equations are extensions of those used in quasi-likelihood (Wedderburn, 1974, Biometrika 61, 439-447) methods. The GEEs have solutions which are consistent and asymptotically Gaussian even when the time dependence is misspecified as we often expect. A consistent variance estimate is presented. We illustrate the use of the GEE approach with longitudinal data from a study of the effect of mothers' stress on children's morbidity.
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Background For many years it has been claimed that observational studies find stronger treatment effects than randomized, controlled trials. We compared the results of observational studies with those of randomized, controlled trials. Methods We searched the Abridged Index Medicus and Cochrane data bases to identify observational studies reported between 1985 and 1998 that compared two or more treatments or interventions for the same condition. We then searched the Medline and Cochrane data bases to identify all the randomized, controlled trials and observational studies comparing the same treatments for these conditions. For each treatment, the magnitudes of the effects in the various observational studies were combined by the Mantel–Haenszel or weighted analysis-of-variance procedure and then compared with the combined magnitude of the effects in the randomized, controlled trials that evaluated the same treatment. Results There were 136 reports about 19 diverse treatments, such as calcium-channel–blocke...
Article
A number of policy directives are aimed at enabling people with drug problems to live healthy, crime free lives. Drug-using offenders naturally represent a socially excluded group who may experience problems in relation to their drug use. A number of studies and previous systematic reviews have considered the effectiveness of drug treatment interventions for drug misusers in the general population, mixed populations of offenders and non-offenders, drug treatment in a specific setting or country with limited outcome measures. This review focuses on drug treatment for offenders across a number of different settings. A number of studies have been conducted displaying a wide range of outcome measures with varying methodological quality. Little information is provided on the costs and cost-effectiveness of such interventions. Promising results are shown for therapeutic communities with aftercare.
Closing the revolving door? Substance abuse treatment as an alternative to traditional sentencing for drug-dependent offenders
  • T D Warner
  • J H Kramer
Warner, T. D., & Kramer, J. H. (2009). Closing the revolving door? Substance abuse treatment as an alternative to traditional sentencing for drug-dependent offenders. Criminal Justic and Behavior, 36, 89-109.