The Opioid Summit

Last week I went to a conference in Statesville, NC, called the Opioid Summit. It was hosted by Partners Training Academy, which is part of Partners Behavioral Health. This is an agency that provides mental health and substance abuse treatment for part of North Carolina.

I did not have extraordinarily high expectations for this conference. I’ve gone to plenty of such conferences around the state. The state-wide meetings are good, and regional meetings are decent, too. But I saw they had Dr. Thomas McLellan as a lunch speaker on the topic of integrating addiction care into mainstream medicine, and I wanted to hear him. Besides, it’s nice to socialize with people in this field I haven’t seen for a while.

My expectations were far exceeded.

We had five breakout groups in session at the same time, and on a whim, I went to the one titled, “Law Enforcement Innovation.” I told my friends I was headed to that one, and they thought it was odd. “Why? You know law enforcement doesn’t like MAT!”

But I knew there had to be a reason he was on the schedule, and I knew the speaker. He and I served on the North Carolina Board of Nursing advisory committee at the same time a few years ago, and I thought he was a pretty good guy, and knowledgeable. He was our state’s SBI Special Agent in Charge of drug diversion crimes back then.

Now he’s retired from the SBI, and is working for NC’s Harm Reduction Coalition, heading their LEAD program in Wilmington, NC. The presentation he made to a room full of social workers, drug addiction counselors, doctors, and policemen and women was excellent.

Mr. Varney explained the Harm Reduction Coalition’s new program in Wilmington, NC, called LEAD, which stands for Law Enforcement Assisted Diversion. This is a pre-arrest program that diverts people caught committing low-level crimes to drug addiction treatment and other services, based on their needs. This shunts them away from incarceration. These people are given a chance to avoid jail time and a criminal record if they want to undergo an evaluation by a case manager. The case manager decides what services are needed, and arranges the referrals. They are directed to drug addiction treatment including MAT, mental health services, housing assistance, food pantries…whatever they need.

Of course, the biggest drug addiction challenging our state and our nation is to opioids. According to Mr. Varney, North Carolina had around thirteen hundred drug overdose deaths last year, and 25% of those were from heroin. He didn’t give a breakdown of how many LEAD participants had opioids as a main drug of use, but it’s likely to be a majority.

Mr. Varney pointed out that it costs taxpayers $65 to incarcerate one person in minimum security for one day. That’s almost $24,000 per year. For comparison, the daily cost of the LEAD program is about $29 per day for the most intensive treatment, but then drops to around $17.50 per day for continuing participation. Most incarcerated people have committed low-level crimes to support drug use and drug addiction. In North Carolina, around eighteen thousand are incarcerated per year.

LEAD differs from drug court because LEAD participation starts before arrest, while drug court monitors people after they plead guilty. Since it’s spear-headed by the Harm Reduction Coalition, the program adheres to harm reduction principles. This program is intended to be non-judgmental and non-coercive, and is intended to offer a way to reduce the harm done to individuals and their community from drug use or drug addiction.

LEAD also differs from other programs because it requires the cooperation, participation, and communication from many organizations. First, law enforcement officers in the field must believe in this program to be willing to talk to the people they encounter in their job. Then, case managers help match each participant with needed resources. Representatives from those resources meet with case managers several times per month to discuss each participant’s progress.

I know what you are thinking…that’s great, but will it allow patients to enter medication-assisted treatment with buprenorphine and methadone? Yes. Mr. Varney specifically identified medication-assisted treatment as a necessary component of this program, particularly since so many of the would-be arrestees have opioid addiction.

Sometimes I hear what I want to hear, and I can’t remember his exact words, but regarding MAT, he said something like, “I’m not here to debate the science of medication-assisted treatment with methadone and buprenorphine but take it from me, it has to be part of this program to help these people.”

It was all I could do to keep from shouting “Hallelujah!”

I was delighted to see a top cop, the ultimate law enforcement officer, endorse treatment with methadone and buprenorphine. I sat in the audience grinning for several minutes.

The program in Wilmington, NC, is just getting started, but similar program in Seattle and Santé Fe have had success with LEAD programs.

Santé Fe had the highest overdose death rate in the nation, and since they started a program similar to LEAD, people who finished a treatment program had markedly less recidivism.

All parties benefit from having LEAD available. The person facing arrest gets an opportunity to get his needs assessed and be connected with needed help, instead of going to jail and getting a criminal record. Police benefit because they turn over an individual to a case manager instead of spending three hours arresting that person. Society benefits because it costs less to treat than incarcerate.

Everyone wins.

Right now, funding is the biggest obstacle to developing programs like LEAD. Hopefully someday, after LEAD has more data to show it works, taxpayer money could be earmarked for similar programs. Right now, funding comes from grants and from the cities that have established these programs.

I am delighted to see such an innovative program start in North Carolina. Since it is operated by the Harm Reduction Coalition, I know it will be well-run. I’m eager to see data from this program after it’s been active a few more years.

And yes, Dr. McLellan’s presentation was excellent, as usual.