The University of Arizona is partnering with the Tucson Police Department, CODAC Health, Recovery & Wellness, and Pima County as part of a three-year, $1.47 million Substance Abuse and Mental Health Services Administration grant to route people with opioid use disorders toward treatment instead of jail.
The project, called Unified Medication Assisted Treatment Targeted Engagement Response, or U-MATTER, is designed to address opioid use head-on and prevent drug-related deaths.
"This project was created as a collaborative project involving government, law enforcement, treatment providers and us researchers to address the local opioid epidemic - a very significant public health and social issue we have in Pima County - and try to improve community well-being," said Josephine Korchmaros, director of the university's Southwest Institute for Research on Women and U-MATTER lead researcher.
"Opioid abuse devastates families and takes a huge toll on communities in Arizona and across the United States," said University of Arizona President Robert C. Robbins, M.D. "Dr. Korchmaros and her team at SIROW will leverage the university's expertise in a collaborative approach that involves essential stakeholders - police officers and a respected addiction treatment provider - in the fight against opioid addiction. I look forward to seeing the positive impact that can be made when we focus on providing help to people whose lives are at stake."
According to the Arizona Department of Health Services, 790 Arizonans died from opioid overdoses in 2016, and opioid deaths in the state increased 74% in just four years. In response, Arizona Gov. Doug Ducey declared a public health emergency.
Tucson Police Department Assistant Chief Kevin Hall knew the toll that opioids such as heroin and fentanyl were taking on Tucson residents, but he also knew that arresting people with substance use issues, on average, wasn't decreasing their substance abuse. The department needed a new approach.
Hall heard about deflection programs - programs designed to identify individuals with substance use issues and get them connected to appropriate treatment and services. He liked the idea, and partnered with CODAC, a local treatment provider, to implement TPD's first deflection program in July 2018.
To evaluate the effectiveness of the program and recommend ways to improve it, Hall tapped researchers at SIROW. Through their combined effort, TPD is retooling its approach to opioid misuse, treating it as something much more complex and sensitive than a criminal justice matter.
"Before the deflection program, when TPD officers came across people in the community who were using substances or had drug paraphernalia on them, they would be arrested," Korchmaros said.
The new approach is very different. When, in their normal course of duty, TPD officers encounter people using illicit substances, they work to deflect them away from arrest and offer to connect them to treatment and services instead. Additionally, any community member can approach TPD to seek help in getting connected to treatment, and the police must help immediately. Through active outreach efforts, TPD officers partner with peer support outreach specialists from CODAC to encourage community members with substance use issues to get treatment.
"Police probably have the most contact with people who use illicit substances in our community," said Erik Morales, a TPD officer involved in the program. "And having all of this contact means we have the opportunity to prevent the loss of life."
Rather than citations and handcuffs, offering access to treatment- and even a ride to the treatment facility - has made a profound difference in community policing.
In May, Korchmaros prepared a report about the program, detailing some of its outcomes.
Of the 362 individuals identified as having substance use issues, 71 received full clinical intake assessments (the first and most important step toward getting necessary treatment), 40 committed to long-term treatment at CODAC, and 10 were participating in medication-assisted treatment through CODAC.
When people who were offered treatment by field officers said they were unsure or did not want to receive treatment, the officers were able to encourage them to seek help 32% of the time, thanks to crisis response and motivational interviewing trainings paid for by the federal grant.
Individuals who receive medication-assisted treatment can volunteer to share information about their recidivism, mental health and living and vocational situation for the SIROW researchers to include in their evaluation. Korchmaros, SIROW research coordinator Tamara Sargus and SIROW research technician Fedora Preston-Haynes conducted the evaluation.
"We have found that most individuals like that component because they get to share their experience," Korchmaros said. "The program has had a significant impact on people's lives and we need to make sure it's a positive one."
The report, which uses pseudonyms, quotes Tucsonans who received treatment through U-MATTER.
Ann was deflected when she was 30 weeks pregnant. She participated in medication-assisted treatment for her opioid use disorder and was reunited with her parents and son.
"I was able to get off the streets and go home to my parents," she said. "I have been coming to CODAC every day."
Laura was deflected and had been engaged in medication-assisted treatment for her opioid use disorder for a month before the report was published.
"I am going on three weeks clean from heroin. I don't think I could have done this without this program," she said.
SIROW, TPD and CODAC recently received an additional $550,000, three-year grant from Arnold Ventures to support the work. Through the grant, SIROW will be able to do an even more comprehensive and rigorous evaluation of TPD's deflection program in the coming years, including an analysis of the costs, outputs and outcomes of the program.
SIROW and its collaborators are developing a handful of new partnerships, including with Arizona Superior Court Pretrial Services, so that individuals in the court system who have substance use issues can be identified and connected to services. With efforts led by Pima County, the project team hopes to work with the Tucson Fire Department and some local hospital emergency rooms to identify people who are suspected of overdosing on opioids so they can connect sooner to treatment and services, Korchmaros said.
"I've always been focused on social justice issues and creating a world where everybody has a chance to reach their potential," Korchmaros said. "And I think that's what U-MATTER is doing for people with substance use issues, by offering opportunities and decreasing barriers."