The pandemic and North Carolinians battling drug addiction

The pandemic and North Carolinians battling drug addiction

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COVID-19 is making community alternatives to incarceration more important than ever before

Much important attention is focusing on how the COVID-19 pandemic is gravely affecting people who are incarcerated in U.S. jails and prisons, a crisis that is worsening daily. There are also very serious concerns about justice-involved people who are living in the community during the pandemic, and are at particularly high risk. Now more than ever, we need alternatives to arresting people: but we also face new challenges providing those alternatives in the community.

The time has come to more broadly embrace LEAD, or Law Enforcement Assisted Diversion, which debuted in Seattle, Wash., and has spread nationwide. The idea is rather than arrest a person for drug-related and other low-level criminal offenses, a person should instead be connected to a range of treatment and social services in the community. The LEAD model, based on a partnership between law enforcement, judicial officials, case managers and service providers, takes a harm-reduction approach, with strong community outreach to meet people “where they are.”

North Carolina has been an early adopter of the LEAD model, with six programs around the state and several others in early phases of implementation. Both a national program support bureau and an NC-based harm reduction coalition support these efforts. Under normal circumstances, LEAD and similar community-based programs are fragile, with a patchwork of funding, a difficult-to-reach population, and very often, an unstable and under-resourced service system, especially for those who are uninsured. COVID-19 is having real-time impacts on LEAD programs, and is sure to have longer-term consequences for their clients, as well.

People with behavioral health disorders, are, in normal times and now more than ever, especially vulnerable to a range of negative outcomes: arrest and incarceration, being victimized in the community, drug overdoses, and unmet basic needs. A range of programs provide community-based services in particular to justice-involved adults with mental illness and/or substance use disorders.

Those programs and the people they serve are struggling during this pandemic, with major disruption in services and access for clients. Our research team’s law enforcement and service partners with LEAD programs in North Carolina have reported increases in overdose incidents since the pandemic. Why? In normal times, a central harm reduction message is “Don’t use drugs alone!” People are now social distanced and more likely to use drugs alone.

Services may be disrupted, such as syringe exchange services, which have temporarily closed their brick-and-mortar sites and gone to mobile distribution only. Some people face challenges adapting to this new method and consequently lose access, which could increase the risk of death due to overdose, HIV/Hepatitis C transmission risk and associated longer-term illness and mortality.

Treatment providers have switched to teletherapy. For some people, this has led to more engagement. Some strongly prefer the convenience and comfort of engaging by video in their own space rather than visiting a treatment clinic. For clients who are unable to engage in teletherapy, however, they have potentially lost all access to behavioral health treatment. There is a real concern that they will deteriorate and/or not re-engage in treatment again once services return to normal.

There are additional losses of other supportive services, as well. For example, some clinics around North Carolina have a harm reduction staff person in place one day a week to offer clinic clients  services like syringe exchange, naloxone and referrals to a range of social services. These complementary services are suspended due to COVID-19, and cannot translate to the telehealth context.

These and other COVID-related disruptions to programming could have serious and even deadly consequences for LEAD clients and other people with behavioral health disorders who are receiving services from similar community-based programs. Police officers are reportedly making fewer arrests for low-level crimes and drug use, which  benefits people who use drugs in that they’re less likely be arrested and jailed. But there are also not yet understood adverse effects of losing the continuum of opportunities to connect people to services. Without referrals by LEAD-trained officers, people might continue to use drugs, without interruption, in deep isolation, contributing to higher overdose risk. Concerns about increased risk for violent victimization is also a particular concern for people who use drugs, both in the community by unknown perpetrators and also intimate partner violence.

These are surely just some of the real-time effects of COVID-19 that are being felt now by LEAD programs and their clients. The longer-term consequences for community-based diversion programs is not yet known. As communities begin to re-open and treatment services return to pre-COVID-19 access, will there be a cultural shift in how we engage with people with a substance use disorder? Will we have gained positive results from diverting this population from jail and from using alternatives such as telehealth? Will these shifts be recognized and put into practice? Pre-arrest programs like LEAD are examples of how stakeholders can change status quo.

It is crucial to support community outreach and strong communication between law enforcement and treatment program stakeholders when their clients are uniquely vulnerable.

Allison Robertson, PhD, MPH is an Associate Professor in the Services Effectiveness Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, and faculty member with Duke Law Center for Science and Justice. Dr. Robertson is currently researching a series of LEAD programs in North Carolina. Melissia Larson is Law Enforcement Programs Manager for the North Carolina Harm Reduction Coalition (NCHRC).