Police departments are looking for “angels” — a new job title for unpaid volunteers who assist in taking people who turn themselves into the police to treatment. The “angel” title was coined by the Gloucester, Massachusetts, police department, which started the Police Assisted Addiction and Recovery Initiative (PAARI) under Chief Leonard Campanello a year ago (see ADAW, July 27). The angels are recruited by police departments under the PAARI model, which has been adopted by many police departments across the country.

We talked to a provider in Massachusetts and a provider in New Jersey, where angels are now in hot demand thanks to a recent push by Gov. Chris Christie to connect individuals to treatment via emergency departments and police departments.

Established program in Massachusetts

“I think angels can be critical,” said Patrice M. Muchowski, vice president of clinical services at AdCare Hospital of Worcester, which currently gets about two or three patients a week from police referrals. Angels go to the police department to “sit with” the person who comes in asking for help. It takes time to find an available bed or treatment slot, and during that time, the person may change his or her mind. “If people aren’t feeling great, they may say, ‘Never mind, I’m not interested’ in treatment,” said Muchowski. “That was the original goal of the angel problem — to have someone continue to encourage the individual to get some help.”

Diedre Quealey, AdCare’s director of admissions, explained how the process works. “We get a call from a police department saying someone is seeking treatment,” she told ADAW. “We get basic information from the police department — how old the person is, their drug of choice, date of birth and what insurance coverage they have,” she said. “We register them with the admissions department, and then we complete an intake directly with the patient over the phone.” The police department in Gloucester has a phone “set up for this purpose,” said Quealey. The angel helps the patient through this process. “You can’t have a police officer do this,” she said. AdCare started working with Gloucester and other police departments about 8 months ago. Quealey expects the referrals to grow.

Meanwhile, the lion’s share of PAARI referrals in Massachusetts go to Spectrum, and methadone and buprenorphine providers in the state told ADAW that they are not receiving any referrals.

New Jersey

In New Jersey, there is a push for more police referrals to treatment as well. For example, the West Orange Police Department recently contacted Integrity House, a treatment center with Newark, Secaucus and Jersey City facilities, to treat patients who seek help. The New Jersey police departments are also using angels, but in the case of Integrity House, the treatment programs are training them first.

Robert Budsock, Integrity House president and CEO, told ADAW that the West Orange police chief was modeling his program on the Gloucester program, and partnered with Integrity House in setting it up. The police department has a list of angels who agree to come to the police station when someone presents for help, said Budsock.

The training Integrity House provides to angels is mainly oriented around professional boundaries, said Budsock. “It clearly identifies the angels’ role as holding the person’s hand from the point when they present themselves as needing help until they’re connected with services,” he said.

As with AdCare, nobody is admitted from the police department until a trained professional from Integrity House screens the person over the phone.

Budsock noted that Integrity House is not the only program that gets referrals from the West Orange Police Department, adding that the treatment facility is over capacity 365 days a year.

Finding “angels” and training them takes time. “Once there is a cohort of trained angels available, we’ll launch the program,” said Budsock. The West Orange police are recruiting the angels, focusing on people who live in West Orange so they can get to the police department within 30 minutes of being called. “We are going to put the word out for graduates of Integrity House who live in West Orange,” said Budsock.

In West Orange, prospective angels get a background check and if they have a record, they may not be able to do the work.

In addition to sitting with the person and providing encouragement and comfort at the police station, the angel’s role is to contact the admissions department of Integrity House, which will provide the expert screening, said Budsock. “We are making sure that the angel does not overstep those boundaries,” he said. If they do, “they’ll be eliminated from participating as an angel,” he said.

Angels are also given a special Integrity House phone number to call after hours, said Budsock.

DA buy-in?

As originally planned in Gloucester, “if they have any drugs or paraphernalia on them, the understanding is that it’s going to be a drug turn-in program, and they won’t get arrested if they request treatment,” said Budsock.

Whether district attorneys agree to such an arrangement is still an unanswered question.

In Florida, for example, there are no such programs, according to Jeffrey C. Lynne, a legal expert in addiction treatment programs. In general, the reason the police-treatment link exists is that there is a lack of an integrated comprehensive health care system that includes substance use disorder treatment, he told ADAW. A partner with Beighley, Myrick, Udell & Lynne in Boca Raton, Florida, Lynne said there is not any kind of police-affiliated treatment initiative like PAARI in Florida — where, ironically, police departments in states where there is no excess treatment capacity are sending patients. It’s partly a philosophical divide between law enforcement and health, he said. “People down here who run the jails, they don’t like being a drug treatment provider,” he told ADAW. However, Lynne does not sympathize with those in the health field who criticize police involvement with treatment. “They offer no viable alternative to this situation,” he said.

‘Headhunters’

One of the main concerns is whether angels could be used as “headhunters” by treatment programs eager to fill beds. In West Orange, for example, the medium income is about $90,000, said H. Westley Clark, M.D., a former top federal official and a keen observer of treatment and public health. Because of the higher demographic of this town — where Integrity House does not have a program — the police would be “at greater risk for the headhunter role,” Clark told ADAW.

“There is reason to be concerned from a social justice perspective and from a treatment distortion perspective, especially if local law enforcement is offered something more substantial than a cup of coffee and a doughnut for helping,” Clark told ADAW.

The situation shows that there is still a lot of progress to be made in moving addiction treatment from a criminal to a health matter, Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers (NAATP), told ADAW last week. “It is positive that law enforcement is inclined to help by providing access to care rather than punish by providing incarceration,” he said. “But mechanisms for law enforcement help are not fully developed.”

In the 1980s and 1990s, a headhunter or private treatment center would pay off-duty police to “apprehend, handcuff if needed and deliver insured individuals to treatment centers, recalled Art VanDivier, executive director of La Hacienda in Texas and vice chair of the NAATP board of directors. As a result of these abuses, to this day it is illegal for police to transport a patient to any facility that is not owned by the state, he said.

And Ed Reading, a leader in the state counseling profession in New Jersey, related a story of how “mentors” who are like angels are abusing the system in New Jersey, where funding has recently gone to this work from Gov. Chris Christie. “When the hospital calls after an overdose, as the person is being revived, their job is to sit next to them, talk to the family, tell them they almost died and that they need to go to treatment right away,” said Reading. “There’s a lot to be said for that.” But the problem is that some of them are being paid for this work. And they don’t have any direct access to treatment programs — they have to negotiate a placement.

“There are technical questions about whether they’re brokers,” said Reading of the New Jersey emergency department mentors. “They work with program A that says, ‘We’ll take your people, and for every 10 who have insurance, we’ll give you two freebies.’” Rather than being trained in how to find the right fit for a program, they are “doing it by the seat of their pants,” he said. “They’ll get them into any level. They don’t understand the ASAM [American Society of Addiction Medicine] placement criteria or the insurance business.”

In one counselor training, a hospital staffer who was attending stood up and told the class they were wasting their money getting a degree and certification, said Reading. “With a high school diploma and one of these [mentor] jobs, you can get $60,000,” the hospital worker told the would-be counselors.

Licensing questions

The system can’t function without the angels, but there are questions about how they will function. In particular, licensing boards in New Jersey and neighboring Pennsylvania are concerned about accountability, as Reading described. Problems include lack of screening before transport to treatment, lack of awareness about the continuum of care, minimal if any training, the emergence of co-occurring disorders during transport, and inappropriately providing advice on the type of treatment the patient needs (e.g., anti-methadone, anti-buprenorphine).

Jeffrey Quamme, executive director of the Connecticut Certification Board, which certifies addiction counselors, said it would not make sense to license angels. “From the perspective of someone who runs a credentialing body, I wouldn’t have any interest in doing this,” Quamme told ADAW. “I wouldn’t want to put standards” on the work angels do, he said. What’s more important, he noted, is getting someone into treatment.

And Quamme defended the police angels program as being not only well-intentioned but well-run. Police Chief Campanello of Gloucester, the keynote speaker at the Connecticut Certification Board conference this year, told Quamme that police officers “reach out directly to the emergency rooms and get a professional to guide them through the process,” he said. There was no indication that the police are determining the level of care, said Quamme.

There are no formal police-angel-treatment arrangements in Connecticut, said Quamme, who attributes this to the fact that it’s easier to get into treatment in Connecticut. “One of the nice things here is you don’t see waiting lists,” he said.

Health system failures

Others say the situation underscores a basic problem: the lack of easy access to treatment. “This should be a wake-up call to addiction specialists and a time to truly figure out how to get people who are interested in and willing to receive help, the help they need, wherever and whenever they are,” said Richard Saitz, M.D., professor of medicine and epidemiology at Boston University’s School of Medicine and School of Public Health, who commented on the situation on a licensing listserv last month and gave us permission to use his quotes. “The solution to that will not be certifying and licensing police.” Rather, he said, the solution may be to have certified and licensed professionals where people with addictions show up, to help them get the help they need. “I know it is more complicated than that but I really do think we look rather silly as a field when things are so bad that the police take it over and they are the ones saving lives,” said Saitz.

“It’s great to hear police talking about treatment instead of incarceration,” said Sarah Wakeman, M.D., secretary of the Massachusetts chapter of ASAM. "But the police department is not the right venue for people to be entering into treatment,” she told ADAW. “I’ve heard Chief Campanello speak, and he knows this — he talks about the irony of emergency rooms sending people to him.”

Good intentions

Still, the effort is “wonderfully well-intentioned,” said Wakeman, who is also an assistant professor at Harvard Medical School and medical director of the Massachusetts General Hospital Substance Use Disorder Initiative. She is concerned, however, that methadone and buprenorphine be included as options. “We talk about the stigma of addiction, but the stigma of medication-assisted treatment is huge,” she said. “I think we need to be happy that police and criminal justice are at the table and having these conversations, but the clinical, actual treatment itself, that needs to be within the medical community,” she said. “Medicine needs to step up to the plate.”

The addition of police departments as conduits for treatment is beneficial to patients, AdCare’s Muchowski said. Why not just go to the emergency department or to a treatment program, for that matter, if you need treatment? “You can go to the ER, but because your situation is not as acute as another, you may not be seen for a period of time,” she responded. “Beds are tight, so people can get frustrated” if there’s not an immediate solution, she said. “I would not want to limit the ways that people have to access treatment.”

Most of the police departments involved in the angel program “are just wanting to do good,” agreed Reading. “But wanting to do good is not enough — you have to provide competence, you have to provide some kind of public protection.”

Bottom Line…

Police departments are recruiting unpaid volunteers to facilitate treatment for people who walk in off the street, which improves treatment access but raises questions about accountability.