The effort comes as preliminary figures published this month by the state Health Department show that in the first quarter of 2017 Vermont averaged nearly 10 fatal opiate overdoses per month.
If that pace continues, there would be roughly 120 accidental opiate deaths this year, surpassing last year’s total of 106.
The numbers are said to be driven in part by the growing availability of cheap synthetic opiates like fentanyl and come despite greatly expanded drug treatment services and the growing availability of the anti-overdose drug naloxone.
Now police and prosecutors, social workers and others are having twice-monthly meetings that include a person-by-person inventory of many of the region’s toughest cases of addiction, crime, poverty and other social dysfunction.
That initiative grew out of larger stakeholder meetings modeled on CompStat — a data-intensive approach to law enforcement developed by the New York Police Department in the 1990s. Burlington Police Chief Brandon del Pozo spent two decades with the NYPD before taking his current job and has promoted using a similar technique to address Vermont’s opiate crisis.
A smaller team within CompStat began meeting regularly with a more narrow focus. It’s called SubStat — for a subset of the CompStat effort — and it takes an approach more geared to improving the quality of individual lives and less on raw data.
The group has been meeting since February, with its members sharing information on drug users and low-level dealers causing problems in the region.
“It kind of took on a life of its own, because we realized it’s valuable not just for picking cases, but for kind of looking at the community as a whole,” del Pozo said.
How a SubStat meeting works
During SubStat meetings, representatives from police, probation and parole, social services and the state’s attorney’s office gathered around a table to discuss a dozen to two dozen cases.
Lt. Michael Cram, a 26-year veteran of the Winooski police, said the meetings foster conversations that weren’t taking place before.
“I get to know the people that I’ve heard the organizations but I’ve never dealt with them, so I just get to meet them face-to-face and work to get people help,” Cram said.
At a recent SubStat meeting in a conference room at the Burlington Police Department a spreadsheet listing cases was projected on a wall screen.
The case narratives are often bleak. A woman who has had her parental rights terminated is overdosing regularly, and those around the table fear that losing her children has left her nothing to live for.
A man struggling with depression told a social worker he’s no longer shooting up to get high, he’s shooting up to kill himself — saying he’s gone as far as filling a syringe with saline in the hopes of giving himself an aneurysm.
A young woman from a wealthy family is spiraling out of control while trying to hide her drug use from her parents. She’s overdosed three times since the year began and would likely have died during the last incident if emergency responders hadn’t intervened.
There was one uplifting report. A woman in equally dire straits just weeks before had secured a spot in drug treatment, found stable housing, and is now working to get her kids back.
As the group rattles through cases, members share how their latest interactions with the person played out, any past experiences with them, and what steps might be taken to intervene going forward.
In some cases, just locating the person is helpful for police. Is the person in jail or at least on supervision? Still living at the same place with the friends who are using drugs?
Winooski police responded to an overdose. The man had already been revived when they showed up, and after letting EMTs check him out, he declined a ride to the hospital where officers, medical staff or peer support workers may have tried to guide him into treatment.
The man has a handful of pending charges and will soon be in court, Cram said. Turning to Chittenden County State’s Attorney Sarah George, he said, “He is not going to respond to us voluntarily getting him into treatment.” Cram urged the prosecutor to use the power of her office to add some pressure and get the man into treatment.
George said she would make a note for the assistant state’s attorney prosecuting the case, and the group moved on.
Experts recently completed a forensic evaluation of a woman in jail. They concluded her addiction is likely to kill her if she doesn’t get treatment in a secure facility.
Del Pozo said she fits the profile of an addict “who would do a stint in jail and get out and die a few days later.” The woman faces 18 to 36 months with credit for time served and will be sentenced in July.
That set off some give-and-take between Jackie Corbally, Burlington’s opioid policy manager, and Debbie Thibault, a regional manager for the Department of Corrections, on how best to use the woman’s jail time.
“If she’s got an 18-month minimum, as much as you want her to stay in there, the doors might open, and she might walk out. So just be aware of that,” Thibault said.
Corbally replied, “I think what the important piece for the (Department of Corrections) to hear is that she’s been sitting in jail for 11 weeks, and we have lost all that time that she could be getting treatment.”
Corbally asked if Corrections Commissioner Lisa Menard is still planning to attend a SubStat meeting. “I think Lisa needs to hear this conversation. … The question is, can we as a state system meet her needs or not.”
Legislation was introduced this year to increase access to drug treatment in Vermont prisons, but it stalled in committee. Currently treatment isn’t available to those who weren’t already in it before being locked up.
Special arrangements in the past have allowed some inmates to participate in out-of-state treatment programs in secure facilities, Corbally said. Could something similar be arranged for this woman?
George, the prosecutor, said that even if the SubStat team goes to great lengths and is able to get a spot for the woman in a secure out-of-state treatment facility, she might refuse to go, preferring instead to complete her sentence.
The chief asked whether the judge would be receptive if George pushed for a 36-month sentence. The prospect of a longer jail term could make treatment a more attractive option, he said.
Criticisms of CompStat
Part of CompStat’s appeal, and that of SubStat, is that they’re low-cost initiatives, requiring largely just the staff hours set aside for participants to be present.
There is the expense to Burlington for Corbally’s position, as well as a data analyst hired by the Chittenden County Opioid Alliance — the umbrella organization behind CompStat — which has sponsors in the United Way and the University of Vermont Medical Center.
SubStat’s value is that it gets people talking who work the same cases from different angles, del Pozo said. “How could that not be better than just us being in our silos?” he asked.
Critics, who asked not to be identified in order to speak candidly about the initiative, said some of those interactions were already taking place, and they fear high expectations could lead to cherry-picking success stories in order to demonstrate results.
Del Pozo brushes off such criticism. “We recognize the power of narratives, but also their limits,” he said. Ultimately, CompStat and SubStat will be judged by the numbers, del Pozo added.
As to concerns that law enforcement data can be fudged, del Pozo said SubStat’s results would be measured by different agencies.
“The medical examiner is not going to alter a death certificate, and the hospital is not going to refuse somebody (who has overdosed) so the data looks better,” he said.
The chief acknowledged it may be difficult to tout results from the program when they could end up merely slowing a worsening trend of opiate abuse.
“That’s the worry, right? That we’re facing a tidal wave. That we’re on a rowboat facing a tidal wave, and we’re rowing as hard as we can, and then if the wave overtakes us we’ll say, ‘Oh, look, you didn’t row hard enough,’ or ‘You didn’t have the right boat,’” del Pozo said.
Correction: The New York Police Department’s CompStat model was implemented in the 1990s, not the 1980s as was stated in an earlier version of this story.