Police Pathways to Addiction Treatment, Health, and Safety: The Police PATHS Study - Project Summary In the U.S., police officers encounter people who use drugs (PWUD) millions of times per year. Often, these encounters arise from unlawful behavior associated with problematic substance use, resulting in arrests that increase subsequent overdose risk and diminish other health outcomes. As an alternative to arrest on misdemeanor charges, police-assisted diversion (PAD) links PWUD with treatment and services, especially medications for opioid use disorder, offering the potential to reduce overdose, protect health, and address the addiction-related problems that can motivate unlawful behavior. To leverage this potential, police agencies across the nation have implemented PAD, while opioid settlement funds provide the opportunity for PAD’s expansion. Yet, gaps in our knowledge about PAD prevent agencies from maximizing its impact. As there has yet to be a rigorous study of its effect on health outcomes, jurisdictions cannot be sure how its costs compare to arrest as usual, and there is little understanding of how to effectively implement the intervention. This project will investigate those gaps in two large U.S. cities facing especially acute and persistent overdose crises: Philadelphia, where PAD has operated since 2017, and Baltimore, where it faced implementation challenges that made it unsustainable. Employing the Exploration, Preparation, Implementation, Sustainment framework, Aim 1 will use semi-structured interviews of Baltimore and Philadelphia police (n=25 in each city), and Philadelphia PAD clients (n=25) and providers (n=25) to construct retrospective implementation research logic models for each site. The models will array the causal pathways—and expose the causal gaps—that link implementation determinants, de-facto strategies, and mechanisms to outcomes including feasibility, acceptability, appropriateness, fidelity, and sustainability. Aim 2 will evaluate the causal effects of PAD in Philadelphia on access to medications for opioid use disorder and its health outcomes (e.g., overdose, hospitalization for injection-related infections) using a quasi-experimental analysis of linked administrative data from thousands of PWUD who did and did not receive PAD. Aim 3 will assess the cost-effectiveness of PAD compared to criminal justice processing as usual by using data from PAD and non-PAD individuals to parameterize an economic model and estimate the mean incremental cost effectiveness ratio of PAD. The project will yield a comprehensive understanding of PAD, and provide novel data about the decomposition of a public health intervention in Baltimore’s challenging setting. It will improve PAD in Philadelphia and assist Baltimore in an anticipated re-implementation. The Law Enforcement Assisted Diversion National Support Bureau will ensure the project’s findings are used by practitioners to implement and sustain PAD across the U.S., and the project’s logic model will provide the means for police and researchers to conduct PAD implementation in a rigorous and methodical way. Results will also provide the basis for implementation and effectiveness trials of PAD in other settings that test the determinants and strategies observed to have had the greatest impact in the cities here.
