Presentation slides that provide an overview of strategies law enforcement and first responders can adopt in collaboration with community organizations to create pre-arrest diversion options for individuals with substance use disorder or mental health conditions. Prepared by Jac Charlier of the Police Treatment Community Collaborative and Treatment Alternatives for a Safer Community, the slides briefly describe multiple strategies adopted in communities across the country to reduce arrests, protect public safety, and prioritize treatment for individuals in need. Funding Source: Center for Health & Justice at Treatment Alternatives for a Safer Community

A 12 minute video that explains the Law Enforcement Assisted Diversion (LEAD) program through a conversation with a client, police officer and case management. The LEAD program seeks to provide a pre-diversion program that treats addiction as a public health issue rather than seeking arrest and court involvement.Funding Source: Law Enforcement Assisted Diversion

This 3 minute video features the story of an individual who was assisted by Seattle’s Law Enforcement Assisted Diversion (LEAD) program. It includes interviews with case managers, law enforcement officers, and recipients of service and explains how the program improves outcomes for individuals in the community. Funding Source: Arnold Ventures

An overview of the Ocean County, New Jersey Prosecutor’s Office efforts to work with law enforcement to provide access to treatment and recovery for community members with substance use disorders (SUD). The Blue Heroin Addiction Recovery & Treatment (HART) program began with enhanced naloxone distribution to first responders in 2013, expanded to providing recovery support coaches to patients seen in the emergency department for an opioid overdose, and led to creating treatment intake stations at 6 Ocean County police stations. Part of the Addiction Policy Forum’s Spotlight series which highlights innovative programs to address the opioid crisis. Funding source: Various grants and donations This resource was produced by an individual/organization receiving funding from sources that have a conflict of interest such as a pharmaceutical company, political action committee, or other industry-related sources. Multiple studies indicate that research performed by individuals with relationships to industry and research funded by industry sources are more likely to favor the sponsor’s products. Industry funding of charities and non-profit organizations has also been linked to groups supporting industry-favorable positions. For more information, please visit the CLOUD 101 page.

This document serves as a template for conducting informed consent (also known as PARQs – procedures, alternatives, risks and questions) for patients beginning medication assisted treatment with buprenorphine or naltrexone. This template is used by Oregon Health & Science University’s Improving Addiction Care Team (IMPACT). IMPACT provides addiction medicine consultations to patients treated in the hospital who have a diagnosis of substance use disorder. Funding Source: Oregon Health & Science University

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This document serves as a template for medical notes of the addiction consult provided by Oregon Health & Science University’s Improving Addiction Care Team (IMPACT). IMPACT provides addiction medicine consultations to patients treated in the hospital who have a diagnosis of substance use disorder. Funding Source: Oregon Health & Science University

This resource serves as a guide to speaking with patients who use drugs about harm reduction strategies such as safe injection tips, HIV prevention and prophylaxis, and naloxone to treat opioid overdose. It is one of the protocols and tools developed for Oregon Health & Science University’s Improving Addiction Care Team (IMPACT) program which provides addiction medicine consultations to patients treated in the hospital who have a diagnosis of substance use disorder. Funding Source: Oregon Health & Science University

This resource serves as Project IMPACT’s guide to conducting a patient care conference to consider hospital discharge planning for patients receiving intravenous antibiotic therapy. This guide lists the steps for convening and conducting the conference and includes a meeting guide and note template. Funding Source: Oregon Health & Science University

This template is of a social work assessment for safe discharge of patients using a PICC line to receive medications used by Oregon Health & Science University’s Improving Addiction Care Team (IMPACT). IMPACT provides addiction medicine consultations to patients treated in the hospital who have a diagnosis of substance use disorder. Funding Source: Oregon Health & Science University

This resource captures Oregon Health & Science University’s practice recommendations for the management of pain in patients on buprenorphine undergoing surgery and pregnant women during labor, delivery, and the post-partum period. The guidelines were developed through an evidence review of the harms and benefits of continuing buprenorphine treatment during these clinical episodes. and the clinical expertise and consensus of the guideline committee. The committee issued a strong recommendation for continuing buprenorphine but noted the very low strength of evidence available to guide decisions. This policy was included as one of the protocols and tools for Oregon Health & Science University’s Improving Addiction Care Team (IMPACT) program which provides addiction medicine consultations to patients treated in the hospital who have a diagnosis of substance use disorder. Funding Source: Oregon Health & Science University

This document provides a template for substance use disorder assessment as used by Oregon Health & Science University’s Improving Addiction Care Team (IMPACT). IMPACT provides addiction medicine consultations to patients treated in the hospital who have a diagnosis of substance use disorder. Funding Source: Oregon Health & Science University

This resource is Oregon Health & Science University’s pharmacy and therapeutics policy on the use of medications (methadone, buprenorphine, and naltrexone) for opioid withdrawal management or opioid maintenance therapy in patients with opioid use disorder who are hospitalized or seen in the emergency department. The document describes the hospitals procedures for patients who present to the emergency department or labor and delivery for a missed medication dose, patients who are treated in the hospital who are on maintenance medication therapy, on patients seeking treatment of withdrawal or induction to maintenance therapy. This policy was included as one of the protocols and tools for Oregon Health & Science University’s Improving Addiction Care Team (IMPACT) program which provides addiction medicine consultations to patients treated in the hospital who have a diagnosis of substance use disorder. Funding Source: Oregon Health & Science University

This resource serves as a guide to managing opioid or alcohol withdrawal in hospitalized patients with substance use disorder. It is one of the protocols and tools developed for Oregon Health & Science University’s Improving Addiction Care Team (IMPACT) program, which provides addiction medicine consultations to patients treated in the hospital who have a diagnosis of substance use disorder. Funding Source: Oregon Health & Science University

This case study describes the Improving Addiction Care Team (IMPACT) model developed at Oregon Health & Science University to provide addiction medicine consultations during inpatient hospitalization and provide transitions to community based substance use disorder treatment upon discharge.

This 3 minute video describes Project IMPACT (Improving Addiction Care Team) operating at Oregon Health and Science University. The video includes program director Honora Englander, M.D., Melissa Weimer, D.O. and peer-recovery counselor O’Nesha Cochran. Funding Source: Oregon Health & Science University

This collection compiles research and implementation materials from the Improving Addiction Care Team (IMPACT) program from Oregon Health & Science University (OHSU). IMPACT is an interprofessional, hospital-based addictions team that provides addiction medicine consults to patients being treated at OHSU who have a substance use disorder (SUD). Hospitals treat many patients with complications from SUD such as endocarditis (inflammation of the heart lining), soft issue infections, and traumatic injuries, but most do not offer services or resources that address the underlying cause – the SUD itself. With IMPACT, inpatient medical and surgical providers and hospital social workers can refer patients with known or suspected SUD to receive services from the IMPACT team. Services include a comprehensive SUD assessment, a process to help the patient set patient-centered goals for their treatment, induction onto medication assisted treatment, direct connections to community based SUD treatment, and information about harm reduction strategies such as safe injection protocols, information about HIV prevention and prophylaxis, and education about naloxone for overdose referral. This collection includes a summary of the research on IMPACT that has been published in peer-reviewed journals and references to those articles, a brief video explaining the program, a summary of the program from…

A resource guide to help law-enforcement agencies create pre-arrest diversion programs for individuals with substance use disorder from the SAFE Project and the Police, Treatment, and Community Collaborative. The guide describes what pre-arrest diversion consists of, defines 2 types of pre-arrest diversion programs, and provides case studies of 5 programs: a self-referral pathway, an active outreach pathway, a naloxone plus pathway, an officer prevention pathway, and an officer intervention pathway. Funding source: Various grants and donations

Website for the Police Treatment and Community Collaborative (PTACC), an alliance of individuals working in law enforcement, behavioral health, community, advocacy, research and public policy whose mission is to enhance pre-arrest diversion pathways to treatment and social services. The goal is to reduce justice system involvement and the collateral consequences of arrests and convictions while enhancing public safety by providing access to substance use disorder and behavioral health treatment for individuals who need it. Funding Source: Various grants and conference fees

This collection provides information about options to create programs that divert individuals with substance use or mental health conditions from the justice system to treatment. Resources featured in this collection include: An overview of principles from the Police Treatment and Community Collaborative to guide pre-arrest diversion programs A slide-deck presentation from the Center for Health & Justice at Treatment Alternatives for Safe Communities that provides more details on pre-arrest diversion programs A link to the website for the Police Treatment and Community Collaborative A resource guide from the SAFE Project and Police Treatment and Community Collaborative for pre-arrest diversion programs A report reviewing how state policies, laws and regulations affect the ability of law enforcement and community organizations to adopt pre-arrest diversion and crisis response initiatives Model legislation for creating pre-arrest diversion programs In addition, the collection contains resources and links to websites for the following specific pre-diversion programs: Police Assisted Addiction and Recovery Initiatives (PAARI) – With PAARI initiatives, law enforcement agencies create non-arrest pathways to substance use disorder treatment and recovery: A link to the PAARI website; PAARI works with over 400 police departments in 32 states An evaluation of Arizona’s Angel Initiative which was piloted in Maricopa County…

Those with untreated substance use disorder (SUD) are often involved with the criminal justice system during the course of addiction and continue to experience negative outcomes following arrest and incarceration. Law enforcement-led pre-arrest diversion ...

Learn about the pre-arrest diversion program we have developed, using our expertise in policing research, public health, and program design.

Communities across the country have implemented deflection and pre-arrest diversion (DPAD) initiatives to link people who use drugs to evidence-based care and services instead of incarceration.

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.

Connecting individuals to substance use disorder and/or mental health treatment as an alternative to arrest.