The outbreak of HIV in Indiana, linked to needle sharing among intravenous drug users, has brought the United States' drug-addiction epidemic back into the spotlight, along with the looming question: What to do about it?
Though Indiana is very publicly and desperately in crisis right now, the addiction issue is a national one. Overdose deaths are the number one cause of injury-related death in the U.S., according to the Centers for Disease Control and Prevention, and deaths from both prescription painkillers and heroin quadrupled between 1999-2000 and 2013. These increases go hand in hand—surveys done by the National Institute on Drug Abuse have found that half of young heroin users report first having abused prescription opioids.
In response to all this, and in the wake of four local deaths linked to drug overdose so far in 2015, the police department of Gloucester, Massachusetts announced a new policy on its Facebook page last week. The post, which now has more than 27,000 likes, reads:
PLEASE READ THIS POST:
On Saturday, May 2, the City held a forum regarding the opiate crisis, and on how Gloucester has many resources for help. We are poised to make revolutionary changes in the way we treat this DISEASE. Your Police Department vowed to take the following measures to assist, beginning June 1, 2015:
- Any addict who walks into the police station with the remainder of their drug equipment (needles, etc) or drugs and asks for help will NOT be charged. Instead we will walk them through the system toward detox and recovery. We will assign them an "angel" who will be their guide through the process. Not in hours or days, but on the spot. Addison Gilbert and Lahey Clinic have committed to helping fast track people that walk into the police department so that they can be assessed quickly and the proper care can be administered quickly.
- Nasal Narcan has just been made available at local pharmacies without a prescription. The police department has entered into an agreement with Conleys and is working on one with CVS that will allow anyone access to the drug at little to no cost regardless of their insurance. The police department will pay the cost of nasal Narcan for those without insurance. We will pay for it with money seized from drug dealers during investigations. We will save lives with the money from the pockets of those who would take them. We recognize that nasal Narcan is not the answer, but it is saving lives and no one in this City will be denied a life-saving drug for this disease just because of a lack of insurance. Conleys has also agreed to assist with insurance requests from those who do not have any.
- I will personally travel to Washington, D.C., with the support of Mayor Theken, the City Council, Sen. Bruce Tarr, and Rep. Ann-Margaret Ferrante, on May 12 and 13. There I will meet with Senators Elizabeth Warren and Ed Markey and Congressman Seth Moulton. I will bring what Gloucester is accomplishing and challenge them to change, at the federal level, how we receive aid, support, and assistance. I will bring the idea of how far Gloucester is willing to go to fight this disease and will ask them to hold federal agencies, insurance companies, and big business accountable for building a support system that can eradicate opiate addiction and provide long-term, sustainable support to reduce recidivism.
I am asking for your help. Like this post, send it to everyone you can think of and ask them to do the same. Speak your comments. Create strength in numbers. I will bring it with me to show how many voters are concerned about this issue. Lives are literally at stake. I have been on both sides of this issue, having spent seven years as a plainclothes narcotics detective. I have arrested or charged many addicts and dealers. I've never arrested a tobacco addict, nor have I ever seen one turned down for help when they develop lung cancer, whether or not they have insurance. The reasons for the difference in care between a tobacco addict and an opiate addict is stigma and money. Petty reasons to lose a life.
Please help us make permanent change here in Gloucester.
This is a radical approach, and stands in stark contrast to the reluctance exhibited by Governor Mike Pence in Indiana, who authorized a temporary needle-exchange program in Scott County, but continued to voice his general opposition to such programs. The response in Facebook comments to Gloucester’s initiative is mostly positive, and the police department has been cordially answering negative comments. In response to one woman who wrote, in part, “You did it to yourself, you knew it was a bad choice before you did it and you chose to anyways. Take responsibility for your own actions,” the GPD Facebook replied, “Thank you for your comment. Please read the research before you call it a choice. I agree that no one forces a pill down your throat, but once you're at the stage of addiction, the brain and body take over … it's not your choice … I did this work for a long time and believed how you do at one point. But I've read the research and I've changed my opinion.”
I spoke with Gloucester police chief Leonard Campanello about the development of this program, how the addiction epidemic has affected his city, and how he thinks police can help. A lightly edited and condensed transcript of our conversation follows.
Julie Beck: How have you seen the opiate crisis affecting Gloucester?
Leonard Campanello: What we see in Gloucester is no different than what we see in a lot of other communities. It's pervasive, there’s not much in the way stopping the supply. Even though my detectives are out there every day intercepting or doing investigations that have to do with dealing, the supply keeps coming and it keeps coming nationally, not just here in the Northeast.
I think what we’re talking about here is a paradigm shift in police thinking, of what we're trying to accomplish. In Gloucester we have a really really good foundation of collaboration between the local treatment centers, hospital groups, health organizations, and the police department, and we want to capitalize on that. Our philosophy is that the problem’s everywhere, it’s been everywhere for quite a while, and we’re just not hiding it in Gloucester. We're going to take care of the problem in Gloucester. That's the difference.
If I could point to one thing, I guess it would be the fact that we had four suspected overdose deaths in the first three months of 2015. So it was a call to action, and this is the result.
No one starts out putting a needle into their arm. Nine times out of 10, it’s a pill form which is misused. The stigma of addicts has to be eliminated, because what we’re seeing is not the guy living under a bridge and coming out just to get his drugs. What we’re seeing is people who may have started in a very legitimate place of pain and had a pain management schedule that included opioids, and because of the way opioids work, became addicted. When they were no longer legally available to them, they turned to illegal means, and when it became too expensive, they turned to a much cheaper and more available opioid, which is heroin. And that’s when it gets deadly.
We see this with groups of people that typically are not the people you’d expect. We see this now with younger people, we see this with veterans who’ve come back from terrible injuries, who've started out with pain management and ended up as users. These are not people who are leeches on society, these are people that are legitimately addicted, no different than nicotine.
Beck: Can you tell me about your background and how you developed your thinking on this? I saw in the Facebook post that you used to be a narcotics detective.
Campanello: I’ve been a police officer for 25 years, I was in another community, Saugus, Massachusetts, and took the chief's job here about three years ago. In [Saugus] I was in a plainclothes narcotics capacity for seven years. We got great results, we took a lot of dealers off the street, but it never impacted the users. Addicts could still get drugs readily. I think the policing community is starting to be aware that there is no such thing as the crime of addiction. The ancillary crimes that go with it, possession of drugs, sometimes desperation to get the drugs leads to theft, burglary, things like that, those obviously are crimes. But addiction itself is not a crime, it's a disease. There’s an expectation among the public and even those who use this drug that the health community is there to help and to treat it as a disease, but the police department is there to treat it as a crime. And when we start seeing lives lost because of it, and we don't see any results from an enforcement standpoint, we have to start looking at it differently.
Beck: What prompted the forum that you held on May 2? Who came, what did people have to say?
Campanello: On March 6, the police department put a Facebook post out, it basically said: “We’ve had four deaths. This is our stance. If you’re not involved in any type of drug activity, please be our eyes and ears out there, stay informed, contact us when you see suspicious activity. If you are involved in drugs and you need help, please come to us. If you are a dealer who is selling solely to profit off the misery of others, then we have no use for you, we're going to find you, and get out of the city.” That got us about 37,000 hits on Facebook, so we knew that there was widespread interest in the topic, and very polarized interest in the topic, and as a result of that, the health department, the city council, the mayor's office, and the police department got a forum together.
During that time frame, between March 6 and May 2 when we had the forum, the police department was challenged to come up with ideas that were out of the box and dealt with the issue. The forum attracted about 200 people. It was a city-council meeting at first, so everybody who could speak about the services that the city offers in terms of health, recovery, and prevention, they all had tables set up. And then the second half was a very frank discussion about what’s going on in Gloucester with the opiate problem.
I announced that the police department had a couple of initiatives. One of those being [encouraging people to bring] drugs to the police station, the second being the nasal Narcan availability, the third being pressing legislators to take a hard look at this issue.
Beck: After the forum, you created the policy that if people bring drugs into the station, you're not going to charge them with possession?
Campanello: Well, that starts on June 1. We needed to see what the response would be like, we needed to see public support for this. We’re closing in on 1.9 million Facebook hits right now, so we know that we’re onto something. The support has been overwhelming from state officials, the attorney general's office, the governors office, and now we go to Washington to press that issue there.
Beck: Is this new program a big leap from the way the police department was approaching the problem before?
Campanello: I think it’s a leap in the thought process. We wanted to create a safe haven so that there was no fear between the police department and those who really needed help. When an addict is ready for help, you don't want to miss that opportunity. If it’s 3 o'clock in the morning and the addict has nowhere to go, we want them to come to us. And we'll provide that service. Historically, law enforcement prosecutes illegal crimes. We’re trying to make a differentiation between the crimes that are committed by the addicts and the addiction itself. I think that’s what polarizes people, is that a typically conservative establishment is taking a relatively unilateral approach.
Beck: Could you walk me through the new program? After June 1, if someone walks in and asks you guys for help at the station, and they bring in the rest of their drug supply, what's going to happen from there?
Campanello: This doesn’t apply to being found on the street in a police investigation, but if someone's ready enough to come to the police station, hand over their materials or their drugs and say “I need help,” we’re going to immediately put into motion our angel program, which is a group of volunteers. Some may be members of the community who want to help, some may be recovering addicts, some may be trained as recovery coaches, but all will have the same purpose in mind: to support the addict in the beginning steps of their journey towards recovery, through the mired system of emergency-room intakes and assessments, and the follow-up treatments. We know that when an addict seeks help on their own and they go to the hospital, there are a thousand different things going on that can make them leave that hospital—if the wait is too long, if they meet someone who they feel intimidated by, things like that. So we want that second voice there to reassure them and to motivate them to stay and get the treatment.
Beck: Like a sponsor.
Campanello: Almost like a sponsor, but this is a very simple answer. It’s as if you and I were at the dentist, and you don’t like having your cavities filled, and I was sitting there saying, “You can get through this.” It can be that simple. Or it can be more complicated, which is why we hope as the program progresses, we have recovery coaches who are specially trained in this and can offer even more assistance.
Beck: You're going to have naloxone [brand name Narcan, a drug shown to often reverse the effects of opiate overdose] available at a local CVS. Was that difficult to get set up?
Campanello: We originally had an agreement with a local pharmacy, Conley’s. CVS was involved in the talk about this from the very beginning, but obviously they’re a regional entity and there were a couple of hoops to jump through there, but they have since come on board as well. What we have is a system in which if you have insurance, you’re getting your nasal Narcan for $3 a pop, if you don’t have insurance, you're getting it for $120 a dose. We didn’t think it was a good enough reason to deny someone a life-saving medication due to failure to pay or failure to have insurance. We knew that we could assist, in such an ironic way, by using our seized moneys from drug investigations—[for the money] to go from the hands of the people that put the poison in the addicts' hands, back to saving lives of the addicts.
I do want to make a statement about nasal Narcan, for those people out there who say, “Why should we enable the addict? Why should we give the addict false hope that there’s a drug that will bring them back to life and they'll be fine, they can keep using?” That’s a stigma, that’s incorrect. If we lived in a perfect world, we would never need nasal Narcan. The fact that there's a drug that can save a life is the only thing we should be dealing with right now. The problem exists. The problem is here. If we can save a life and we can have another shot at that person, the reasons for not doing that should have nothing to do with money or insurance, or who's paying the bill.
Beck: So if someone can't pay, they go into Conley's or CVS and they just fill out paperwork, and then you guys cover it?
Campanello: The prescription part is deregulated, so anybody can go in and get it, but they still have to say who they are and attest to that they don’t have insurance. Conley’s has agreed to assist people who don't have insurance with gaining either public insurance through MassHealth, or private insurance. So they'll explore their options while they're there, but no one will be denied Narcan because they don't have insurance or they can't pay for it.
Beck: They'll just bill it to the police department instead?
Campanello: Exactly. And they're able to get one dose every 30 days, so we don't have repeat customers. And we’re not the federal government, we can’t support this program throughout Massachussetts. We need legislators, we need other cities and towns to step up and decide what they want to do with it as well.
Beck: You're going to Washington, D.C. soon, right? To talk with legislators?
Campanello: Yeah, Senators Warren, Markey, and Representative Seth Moulton. And I was just asked to meet with the Office of National Drug-Control Policy director. So it’s gotten a lot of attention and we’re happy about that. Hopefully we push some envelopes there as well.
Beck: What are you going to be asking for?
Campanello: Our agendas are going to be very collaborative. We’re going to applaud the good work the government has done so far and we're going to try to see what more can be done in collaboration with pharmaceutical and insurance companies. We're going to try to talk about federal and state drug seizure and civil-asset seizure, and if more percentages of that money can be distributed among cities and towns and that money earmarked for recovery and addiction services. That doesn’t cost the taxpayer a dime. I honestly don't expect anybody who I'm meeting to be adversarial, I think we're going to look for ways that we can move forward on this.
Beck: What do you think the role of police is in addressing the addiction epidemic?
Campanello: I can only speak for what works in Gloucester. I think that for us, law enforcement needed to take a more active role, a more compassionate role, in exploring the social problem of addiction rather than the criminal problem of addiction. So that's what we did. I think law enforcement in general needs to focus on supply as well, but we need to be doing much more with demand. I think that we’re getting close to really proving that attacking the supply is not working and I think that we need to spend a lot more time on the demand. This initiative is one of the ways that we can be compassionate, progressive, bipartisan, and unilateral, because we're talking about saving lives, and I think the bottom line is it’s the right thing to do. No matter what entity we are, whether we're the police, whether we're responsible for the medical field, mental illness, anything, I think this is the right thing to do.