Law enforcement agencies across the nation are grappling with how to respond to the growing number of opioid overdoses in their communities. Many officers are now carrying naloxone, which saves lives and provides people an opportunity to consider seeking treatment services for their substance use. As more law enforcement agencies become engaged in officer administration of naloxone, many are left asking, “So I saved someone tonight, but now what?” This question has led to involvement in developing overdose follow-up programs that allow agencies to revisit the person and provide them treatment based information. Law enforcement is in a unique situation in which they have overdose victim information (name, location, etc) that can be helpful for harm reduction and behavioral health professionals seeking to engage with these persons. This document is intended to create awareness among law enforcement professionals seeking to develop such a program as to the partnerships and resources required, along with recommendations we’ve created based on our involvement in such programming.
A follow-up visit conducted within days of a naloxone reversal serves as an:
- Opportunity to direct people to harm reduction services for active drug users and treatment/detox services for drug users looking to reduce or stop using
- Opportunity to provide naloxone, overdose prevention training and overdose prevention materials
- Opportunity for stakeholders in the opioid response to work together to reduce overdose mortality
Overdose follow-up programs can serve as a strategic response to the increasing number of opioid overdoses within your community. Visits also provide agencies the potential to refer people into additional services like law enforcement assisted diversion (LEAD). Visit www.nchrc.org/lead/law-enforcement-assisted-diversion for more information on LEAD.
Team creation and operating the overdose follow-up program based on harm reduction is a key component. Involving harm reduction advocates, peer support specialists, or a case manager in your program development and actual response will make all the difference in helping a person decide on whether they are ready to engage in treatment services. In addition, an individual who has been directly impacted and personally experienced drug use or an overdose should be included and consulted with during program development. Programs that are created based on real experiences can be very effective. We recommend you connect with your local harm reduction agency and ask them for their expertise on drug use and overdose. Visit our site for information on our staff locations. (www.nchrc.org)
There are various types of overdose follow-up programs around the state and nation; we encourage development of one that is reflective of your community and your resources. At the core is the involvement of a harm reduction/peer support/case management professional. Some teams (such as in Ohio) even have an EMS representative. One of the most common questions asked is that of the role of law enforcement in these visits. We have found that the most effective programs do not have direct engagement from officers. This is largely due to the mistrust and stigmatized relationship between drug users and law enforcement based on previous experiences. Our experience has found the least effective visits are those in which law enforcement plays an active role on scene and attempts to engage with the person and not allow the harm reduction outreach worker to take the lead role.
We have found the most effective programs are those in which law enforcement shares information with harm reduction outreach worker,but does not attend the follow up visit. This eliminates the visit presenting itself as enforcement action. Other agencies desiring a more active role will have an officer do a warm-hand off on scene to a harm reduction outreach worker. The officer will then leave the scene once the worker indicates they are comfortable staying. The officer can then leave the scene entirely or remain in their car. It is recommended that officers involved in these visits have harm reduction education, are not in uniform, and are not in marked cars. The officer’s presence and/or demeanor can directly affect a person’s willingness to engage in conversation or even answer the door. Remember, at the end of the day, the harm reduction/peer support specialist probably has lived a similar experience and is comfortable and more at ease themselves conducting the visits solo. If they feel law enforcement presence deterred a person from talking, the worker will probably just return later without you.
Visits are a Form of Advocacy
In deciding which route to take, remember that you probably wouldn’t send your toughest officer to talk to a repeat victim of domestic violence. Overdose follow-ups should be treated like you would sensitive crimes; you’d send your victim advocate or most compassionate officer. In the case of overdose follow-ups, let the harm reduction advocate/peer support specialist do the work. Your role should be to make the connection, either by providing information or by doing the quick introduction at the door.
Timing of Visit
Conducting follow-ups is most effective 24–72 hours post overdose. Attempting to discuss treatment services while a person who has recently overdosed is on the gurney will be counter-productive. They are not in a place where they may even comprehend what just happened, let alone consider treatment and they may be in severe withdrawl. Important to understanding addiction and harm reduction is to remember that people may not be ready to discuss changing their drug use behavior today…maybe it will be tomorrow…may it will be next week or next month. Be patient.
A final step in program implementation is to Identify local treatment options that are evidence-based. Make sure these options, in particular medication-assisted treatment, are actually accessible, affordable and available in the area. It is recommended you let the person know if the service you are referring them to takes insurance, how much it costs and the hours of operation. You do not want to refer someone to a $25,000 a month treatment site if they are uninsured, as they may take this as a sign that they can’t afford treatment anywhere. Thus, your team will need to develop material to distribute to the person that provides the service information and how to access it. This is where your behavioral health/substance use partnerships are vital; they are well aware of the local resources and accessibility.
Remember that overdose visits are about providing information on overdose prevention and access to services. Working with your harm reduction/peer support specialist will be important to obtaining these resources:
- Naloxone to provide to those at risk and family/friends
- Overdose prevention literature
- Peer support contact info (who they call when they have questions about accessing service and treatment)
- Syringe exchange information for people who aren’t willing or able to stop using injectable drugs, or people who are very likely to relapse
Overdose follow-ups provide an opportunity to give people the tools they need for when they are ready. Reducing and eliminating risky behaviors take time and are most successful when done on one’s own timeline. Be patient and understanding. Listen and respect the individual’s decisions–even if it means opting out of treatment. The role of law enforcement is very important as they can start the chain of advocacy by partnering with other stakeholders to develop an overdose follow-up team. This strategic response provides the opportunity to reduce overdose deaths in the communities they serve. For more information on developing a team, learn from other agency experiences, and to receive an example policy/procedure contact:
For more information contact:
Melissia Larson, LEAD Coordinator
North Carolina Harm Reduction Coalition