The drug crisis has left no corner of the United States untouched. It has no regard for race, gender, socioeconomic status, or any other demographic, with overdoses taking the lives of almost 110,000 people in 2022.¹

Law enforcement officers and their colleagues in fire and emergency medical services (EMS) serve on the front lines of addressing this crisis and shoulder the responsibility of responding to scenes involving overdoses daily. They witness the devastating effect of this crisis on its victims and their loved ones, as well as the community-wide effects, including reductions in quality of life, public safety, opportunity, and prosperity.

Since the early 2010s, when fentanyl began causing significant increases in opioid-related overdose fatalities, law enforcement leaders across the United States began to recognize that “we can’t arrest our way out of this problem” and started implementing innovative programs to address the overdose epidemic. These new approaches redirected people with substance use disorders (SUDs) away from the justice system and, instead, connected them to community-based treatment and services. These programs may be known in different jurisdictions as law enforcement or police-assisted diversion, pre-booking diversion, pre-arrest diversion, or deflection programs, but the implementation of these programs by all branches of public safety led to the creation of a new field that the Bureau of Justice Assistance (BJA) recognizes as “First Responder Deflection.”

Through the BJA-funded Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP), the International Chiefs of Police partners with TASC’s Center for Health and Justice (CHJ) to provide training and technical assistance (TTA), resources, and a variety of learning opportunities to state, local, and tribal jurisdictions to implement deflection and pre-arrest diversion programs that provide pathways to treatment for individuals with SUDs.

Deflection and Pre-Arrest Diversion

The terms “deflection” and “pre-arrest diversion” are sometimes used interchangeably because both practices reside at the junction of public safety and public health and require collaboration among first responders, treatment and service providers, recovery support, and different sectors of the community (e.g., faith and business leaders, civic organizations, the recovery community, neighborhood associations). However, it is important to differentiate between them.

Deflection is the practice by which law enforcement or other first responders connect individuals to community-based treatment or services when arrest would not be necessary or in lieu of taking no action when issues of addiction, mental health, or need are present.

Pre-arrest diversion is the practice by which law enforcement officers connect individuals, who otherwise would have been eligible for charges, to community-based treatment and services in lieu of arrest, thereby diverting them from the justice system. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police but sometimes prosecutors or a local government agency), clients are diverted to community-based services.

Both deflection and pre-arrest diversion provide alternatives to traditional enforcement methods of responding to individuals coping with SUDs, mental health disorders, or co-occurring disorders that may necessitate contact with law enforcement or other first responders.

There are six frameworks or pathways of deflection and pre-arrest diversion, each of which addresses specific public health and public safety challenges faced by communities. These six approaches to connecting people to treatment are referred to as “pathways” because when programs in these frameworks are implemented, they allow first responders, including community response teams, to offer access—or pathways—to community-based treatment and resources through proactive outreach and support to individuals in need.

• Self-Referral: An individual voluntarily initiates contact with a first responder agency (law enforcement, fire services, or EMS) for a treatment referral. If the contact is initiated with a law enforcement agency, the individual makes contact without fear of arrest.
• Active Outreach: Specially trained teams, often composed of first responders, clinicians, and peers with lived experience, actively seek out individuals in crisis to engage them or refer them to treatment.
• Naloxone Plus: First responders and program partners (usually a peer with lived experience) conduct outreach to individuals who recently experienced an overdose to link them to treatment and services and provide resources to them and their families.
• First Responder and Officer Referral: During routine activities, such as patrol or response to service calls, a first responder engages and transports or refers at-risk individuals to treatment or to a case manager.
• Officer Intervention: (Exclusive to law enforcement) During routine activities such as patrol or response to a service call during which charges otherwise would be filed, law enforcement officers provide a referral to treatment or to a case manager or issue a noncriminal citation to report to a program. Often, charges are held in abeyance until treatment or a social service plan is successfully completed.
• Community Response: In response to a call for service, a team composed of community-based behavioral health professionals (e.g., crisis workers, clinicians, peer specialists), and/or other credible messengers—individuals with lived experience—sometimes in partnership with medical professionals engages individuals to help de-escalate crises, mediates low-level conflicts, or addresses quality-of-life issues by providing a referral to treatment, services, or to a case manager.

The pathways reflect a proactive and multifaceted approach by law enforcement and first responders to address the complex challenges posed by SUDs and related crises within communities. Programs in the pathways necessitate an enormous degree of collaboration and relationship building among nontraditional allies, including public safety, public health, treatment and service providers, other justice system stakeholders, hospitals, and other community-based partners.

The IACP and CHJ provide state, local, and tribal jurisdictions (both COSSUP grantees and non-grantees) that want to create or enhance these programs with hands-on TTA, mentoring opportunities, and a wide variety of resources to help facilitate their planning and implementation, including the following:

• Hands-on strategic planning using CHJ’s evidence-based Solutions Action Plan
• The Deflection Conversation Framework: A Community Engagement Tool for First Responders: a self-directed, free online course developed to provide police and other first responders with a comprehensive understanding of deflection, including information about the science of addiction, how drug treatment works, and that recovery from drug use is possible, as well as how to engage individuals struggling with SUDs and approaches for building strong community partnerships
• The Pathways to Deflection Case Study Series: publications by the IACP and CHJ about the first five pathways that explain their origins; provide 10 critical elements for planning, implementing, and sustaining programs in each of those pathways; and include case studies on five programs in each pathway
• Opportunities for peer-to-peer learning through the Law Enforcement/First Responder Diversion and Referral Mentoring Initiative, a program that provides communities interested in starting or enhancing a deflection program with the opportunity to learn from established programs in every pathway that have shown success in supporting individuals with substance use disorders in their communities—mentor sites serving as models for individuals and teams interested in starting a program or for established programs interested in learning innovative practices
• The COSSUP First Responder Deflection Resource Library, a repository of materials that provide examples of foundational documents that have been submitted by existing first responder deflection (FRD) programs from across the United States, including documents that may constitute some core elements of FRD programs, organized by category (Deflection Program Documents, Policies and Procedures, etc.)
• A wide range of webinars and articles on deflection, pre-arrest diversion, harm reduction, stigma reduction, gaining officer support for deflection programs, building treatment and service capacity, and public safety and public health partnerships

These resources and more are available on the IACP’s COSSUP project webpage.

For questions about deflection, pre-arrest diversion, or other SUD-related topics, please contact COSSAP@theIACP.org.d

Note:

¹Centers for Disease Control and Prevention, National Vital Statistics System, “Provisional Drug Overdose Death Count.”

Please cite as

Karen Maline and Callie Frye, “Creating Pathways to Treatment,” IACP@Work, Police Chief 91, no. 1 (January 2024): 79–80.