SMART Policy Podcast
Podcast by the UT SMART Initiative. Host Jeremy Kourvelas speaks with experts from across the recovery ecosystem - representing healthcare, prevention, law enforcement and more - about local, state and federal drug policy to find out what is and isn't working to make this fight against addiction a little easier.
SMART Policy Podcast
Nashville’s Overdose Co-Response Unit Brings Harm Reduction to Law Enforcement
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You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. As the drug overdose deaths continue to climb, we have heard more and more sheriffs and law enforcement officers across the state say we can't arrest ourselves out of this problem. That the criminal justice system plays an important role, but not the only role. That there are many, many factors in the overdose epidemic.
SPEAKER_01We just have to realize that it's not just a public health crisis. It's not just a public safety problem. It's all of the above. And it's gonna take a response utilizing all of the encompassed resources within those two realms to even start to make a dent.
SPEAKER_00My kids this month is Sergeant Mike Hot of the Metro National Police Department. After a long extent of time as an undercover officer, Sergeant Hot now leads the overdose response unit, which combines law enforcement with mental health care and social work to people who have survived an overdose instead of simply arresting them. Their latest turn is that they're developing is perhaps their most surprising. When appropriate, the team will start the individual on medication-assisted treatment on scene.
SPEAKER_01If a co-response unit were able to be on scene and it was appropriate for them to have cyboxone administered to them, you're literally increasing their chances at life significantly.
SPEAKER_00Sergeant Hunt says that the success of his team is due to their community partners like the Mental Health Co-op, but overall, because the team as a whole is willing and able to do whatever they can for the individual beyond what just a solo officer is capable of.
SPEAKER_01We will try absolutely anything and everything within the law to figure out what the perfect meaning is to build the law enforcement public health and public safety model that we are employing. One of the first things he did was to create an overdose response unit to address all the different facets of drug overdoses, to include both the investigation of as well as the outreach for overdoses, as well as informing the community about the problems that we're facing. I was one of the founding members of that unit, and as a supervisor, I was tasked with building the unit in the best possible way, and we we did our best, and I think we did a really good job, made some mistakes, but did a lot of things right, and we're constantly changing shape and adding focuses and changing focuses. We're proven to be a very effective unit and kind of a model for nationwide overdose response.
SPEAKER_00It makes sense that you'd be changing constantly. The drug trends itself are constantly changing.
SPEAKER_01Yeah, they certainly are. That's one of the banes of our existence. But uh, we're a very flexible department as a whole and as a unit. We're also very flexible. If an emergent need pops up in a certain geographic area, we're built to be able to respond to that. Or if a certain trend is appearing in our city, we're able to respond to that as well. And that's thanks not only to our our police department uh sworn personnel as well as our civilian personnel, but as well as all the people uh outside of the police department that we partner with, which those partnerships are probably the single most crucial factor to our current success.
SPEAKER_00Who who did you turn to? What sectors did you turn to to build the team in the first place?
SPEAKER_01There's almost too many to name, but uh, you know, one of the one of the core pillars of our police department is problem-solving partnerships. So I just looked throughout the community and found anybody with a shared mission is ours. We partner with obviously the University of Tennessee, also CDC Foundation. There's a Nashville specific uh or Middle Tennessee specific group called a regional overdose prevention specialists or ropes. They're the individuals that provide training in overdoses and overdose response, as well as uh naloxone and our cannon free of charge to anybody who's at risk. Pretty much it's a it's an all-hands-on-deck approach where as long as we have a shared mission, you're part of the team.
SPEAKER_00How has this changed the broader metro area?
SPEAKER_01Well, you know, I wish I could snap my fingers and have the change be instantaneous. I learned very quickly that we are moving a mountain here, but we're doing it one stone at a time. So when I first started back in 2010, the over-prescription of of opioid pain medicine was still happening. It was starting to wane at that time. But when I was a young police officer, then it would be very, very common to encounter somebody who had diverted prescription opioid pills. You know, they were using, for lack of a better term, recreationally or without a prescription. But then, you know, the the government did a good job of putting some regulations on these prescriptions. And before then, I had never encountered heroin in the streets of Nashville. It was out there, but in very small quantities. But when people stopped having the ability to get those prescriptions filled or being able to purchase those diverted prescriptions is the exact moment when heroin started showing up on scene. And at that time is when I was transitioning from a patrol officer to an undercover detective, and that's where I started to see firsthand the distribution of heroin throughout our city and the vast organizations that are responsible for trafficking these drugs across our city. And right at that time there was also a large trend where Tennessee was a large hotspot for for methamphetamine labs, clandestine meth labs. Right. Um and it it's changed 180 degrees since then. So after heroin and the clandestine methamphetamine labs showed up on scene, then it started to transition. And right around the time that COVID came on, uh is right when we started to see a significant change in current drug trends. We saw clandestine meth labs virtually disappear, they're virtually non-existent, and then the illegal uh importation of not only methamphetamine, but then also fentanyl came on scene. And it really was an extremely noticeable market change around the beginning of COVID, and then it continued throughout. Whereas as far as pricing goes with drugs, at least in Nashville, cocaine was always kind of the gold standard uh of pricing, uh meaning the price of cocaine was relatively stable. It could go up a little bit, down a little bit, and methamphetamine was always right on par with cocaine, where roughly an ounce of it would be about twelve hundred dollars. Right in the beginning of COVID, we saw the price of methamphetamine go from roughly twelve hundred dollars an ounce to where the lowest we saw was $175 an ounce, an 80% drop in the cost of methamphetamine. And that's right when the importation of and distribution of fentanyl really started to take off as well. It was around a little bit before that, but the scale uh of which was never seen at the level that it is.
SPEAKER_00That's staggering, 80%.
SPEAKER_01Yes.
SPEAKER_00So what what did you see on the streets? What was it like?
SPEAKER_01Well, it was kind of the perfect storm uh during COVID and all the lockdowns happened, and undoubtedly there was a negative effect on the mental health of a lot of people across our country and across the world. Um so when you couple the mental health uh problems that occurred during COVID, then the readily available supply of methamphetamine plus an 80% reduction of price in methamphetamine, plus this new uh uh opioid that can take almost any form in fentanyl. Um it was just the perfect storm to see overdose activity in Nashville as well as across the country as a whole, just absolutely skyrocket.
SPEAKER_00We've heard from several of our partners in law enforcement that methamphetamine in Tennessee is driving a significant portion of the demand overall. That there are people who prefer methamphetamine and will sometimes turn to fentanyl when they can't get it, vice versa. Would you agree with that observation? Do you think meth is is one of the biggest It's certainly on par with fentanyl in terms of demand, I'd imagine.
SPEAKER_01Absolutely is. And uh before I was asked to build up an overdose unit with all my teammates and and my co-workers, I didn't really have a healthy understanding about how many fatal and non-fatal overdoses occur due to things other than opioids. Didn't realize how much methamphetamine contributed to overdose deaths as well as non-fatal overdoses. And that also applies to cocaine as well. But I learned very quickly working with my unit and developing our response to this that you couldn't just focus on opioids. It had to be it had to be stimulants as well, as well as anything you can can die from and overdose with.
SPEAKER_00So what what makes your unit special in the way it responds?
SPEAKER_01Because we not only embrace a public safety aspect or a public safety approach to the overdose crisis, but we also couple that with a public health approach. And I think those two approaches are an absolute necessity to any law enforcement agency that's trying to develop a response to the overdose crisis because we just have to realize that it's not just a public health crisis, it's not just a public safety problem. It's all of the above. And it's gonna take a response utilizing all of the encompassed resources within those two realms to even start to make a dent. Treatment and treatment resources are probably the biggest thing that I try and work with as well as harm reduction. We realize as a department and as a unit that we cannot arrest ourselves out of this problem. We have to be able to enable people to seek the treatment that they want at the time that they want it. When we may encounter them, may not be the moment that they're ready to accept treatment. And we accept that. But one of the tools or approaches that I utilize when I'm speaking with somebody suffering from substance use disorder or opioid use disorder is insisting that they pull out their phones and I give them a number for one of our large partners, which is the community overdose response team at the mental health co-op. If the person calls this phone number, they can do an assessment of where they're at in their substance use disorder or OUD as well. And even if they have no money or no insurance or they're underinsured because they're a grant-funded organization, they can give them the appropriate treatment that they need, whether it's medicine-assisted treatment or an intensive inpatient treatment or counseling or somewhere in between, all of those things. Having them save that contact in their phone to have at their disposal on the day that they are ready to receive treatment. I think it's it's it's a powerful tool, but it's just a start.
SPEAKER_00Is this continuity of care occurring at an arrest or in a diversion of an arrest? I mean, uh where where in for law enforcement individuals listening to this, where where would this how would this look?
SPEAKER_01It happens at all of those places. It could happen at an arrest, um, it could happen at just during a citizen contact. We also do uh community outreach events where we utilize different tools to see if there's hot spots of overdose activity in a certain geographic area. If we notice an uptick in that area, we can mobilize not only the police department and the overdose unit, we can also mobilize all of our partners who are willing to participate with us and go to that area and just talk to people in that area. And sometimes that is just uh myself and some of the partners I work with going door to door in a certain apartment complex or in a hotel or motel parking lot. Whatever it takes to put people in touch with treatment resources as well as harm reduction tools, we'll do whatever we can just to help one person.
SPEAKER_00Would you say that this is having an impact on the public's perception of uh Metro PD?
SPEAKER_01I think absolutely. There's no negative to it. We're out there trying to help people. As I said before, we realize that we can't arrest ourselves out of the overdose problem. So, you know, we're largely shying away from small misdemeanor drug arrests. I would much rather put a pamphlet in somebody's hand that has a phone number for treatment resources uh than to give them a citation for simple possession or possession of paraphernalia.
SPEAKER_00It's gotten me thinking in in Oregon, for example, which has decriminalized uh all drugs, there is now a bill that would return to the code a misdemeanor for simple possession. Their criticism was that people weren't taking weren't uh accepting the treatment, they weren't utilizing the services they were connected to. There was a citation mechanism, but it wasn't connected to a crime, it's a fine, and and most of the fines went unpaid, and there's no there's no actual penalty for that. They're now considering reversing that by way of having leverage to put it bluntly force people into treatment. However, that's not what's happened here in Tennessee. It is still a crime, and it's a difference in enforcement. And you're saying you're seeing differences in in the perception. What do you why do you think it's working differently here?
SPEAKER_01I think it's a case-by-case basis. I believe that each individual is gonna respond to different approaches in different ways. There are some people, like if you take the drug court model, there are some people who mentally may need a carrot to go after the treatment that they very much need. But then there's also other individuals who may just respond to empathy and just realizing that this officer shook my hand and and put his hand on my shoulder, he wished me all the best, he left me with two boxes of naloxone as well as information on how to seek treatment for whenever I am ready to receive it. And I think that goodwill in the community does reach a significant number of people. But as with our entire approach, the Metro Nashville Police Department's approach to the overdose crisis, it's uh it's kind of a kitchen sink approach. It's everything and anything. So with each individual, there's gonna be a different assessment. The arrests are never gonna fully disappear. Sometimes arrests are mandated by law or policy, but then sometimes they're not. And uh it it's kind of a case-by-case basis and working within the community, uh, especially you know, the community that's afflicted by substance use disorder, um, I think anybody would develop a pretty good gauge of how best to help an individual.
SPEAKER_00That coincides with a law that did pass last year that uh uh if it's the first time an individual is seeking medical assistance for an overdose, it is it's granted criminal immunity. The second and subsequent are left up to a responding officer. So it's our diversity of tools uh and not just you know, oh let's arrest everybody or like oh let's just do nothing but give referrals or oh let's I don't know. I uh does it it's the diversity of approaches that are that are leading to an increase in success, is what you're saying.
SPEAKER_01Yes. We will try absolutely anything and everything within the law to figure out you know what the perfect medium is of the law enforcement, public health, and public safety model that we are employing. So in Nashville, uh several years ago, we started a program called Partners in Care. Uh it's not specific to overdoses, but it is pairing a licensed clinical social worker with a uniformed officer, and they are dispatched primarily to mental health calls. And they've had a significant uh reduction in uses of force as well as reductions in arrest, as well as safe outcomes, safe and lawful outcomes to you know what was previously a generally lawless event that the before only a police officer would respond to. So our team's approach is I wouldn't say the beginning phase, we're kind of in the middle phase of developing a similar co-response program that is specific to overdoses. We're working out all the details with all of our partners, but essentially what it would look like right now is it would be three people or agencies together in one vehicle, and we would respond in short order to non-fatal overdoses. A sworn police officer, most likely in plain clothes, because plain clothes tend to have a better effect when speaking to people about seeking treatment. And then it would also include a licensed clinical social worker who would have the ability to prescribe MAT and administer it on the spot, and then also a Nashville Fire Department paramedic who would be there to give medical aid if necessary. And I believe those three people co-located in one vehicle responding out to an individual who, if you've just suffered a nonfatal overdose, you are absolutely in a moment of crisis. Um, if you've been revived with naloxone, narcan, clixado, any of that, you are in acute withdrawal at that moment. And there's a significant amount of research that shows if you can administer a dose of Suboxone, their mortality rate within a year significantly decreases.
SPEAKER_00MAT on the spot from emergency personnel. So not even at the emergency room, even before so.
SPEAKER_01Yes.
SPEAKER_00Because that's incredible. And there's already data showing a year out of decrease in mortality.
SPEAKER_01Yes. And it's so in Nashville, if somebody suffers from a non-fatal overdose, the fire department will respond, paramedics will respond, but the person can refuse transport to the hospital.
SPEAKER_00Right. This is their right.
SPEAKER_01It is their right. But if a co-response unit were able to be on scene and it was appropriate for them to have Suboxone administered to them, you're literally increasing their chances at life significantly.
SPEAKER_00Absolutely. No, that that's that's fascinating. So run us through how the prescriber aspect of this works.
SPEAKER_01The licensed clinical social worker that would be with us, they're working under the direction of a doctor, a medical doctor who is able to prescribe. And if that individual meets the requirements that that advising doctor has set forth, then that MAT can be administered on the spot.
SPEAKER_00Aaron Powell So that's already legal? Yes. That's tremendous. I can't imagine that this would be that much more expensive at all than a regular co-response unit. I mean, there's many of these already employed licensed clinical social workers. It sounds like a very, very adaptable strategy.
SPEAKER_01Yes. And we're fortunate that the Partners in Care program has only not been implemented, but it has also proven to be very successful. And the individuals that we would be partnering with, the social workers, uh, would come from the same organization. So we already have that groundwork laid. The memorandums of understanding are there, the legal agreements in between the two entities are already there. They'll just have to be modified slightly to focus more narrowly on the overdose crisis. Law enforcement all across the country are at very low staffing levels. Uh, that's no secret. It's a matter of how you prioritize your personnel. And I'm not a police department administrator, but you have to triage the different crises or problems that your community is facing. And overdoses, specifically within Nashville, are a significant crisis, and our chain of command has prioritized overdose response, and I'm I'm very grateful for that.
SPEAKER_00So there's a lot of talk about xylazine in the fentanyl supply, there's a lot of other things like that, uh contaminants, potentially new types of amphetamines, uh amphetamine analogs, benzodiazepines, designer benzodiazepines, I should clarify. What emerging threats are you seeing uh and and how is that changing the situation on the ground?
SPEAKER_01I think uh xylozine is probably gonna be uh the biggest problem that we're gonna have to encounter in the near future. I knew xylosine was on scene in different parts of the country, in the northeast particularly, but I didn't think it was it was as pervasive as I later found out it was. I did a check with uh our crime lab that can do many things, but one of the things they can do is is drug analysis of drugs that are seized in the field and submitted as evidence. In the testing that they've done in the samples that they've tested, xylosine was showing up at least in trace amounts in 60 to 80 percent of the fentanyl samples that were submitted to the lab. And I had a visceral reaction to that. That may not be enough xylosine in there for someone to have the narcotic effect of the xylosine, but that leads one to ask why is there even trace amounts of xylosine within the fentanyl supply?
SPEAKER_00I'd like to just pick your brain a little bit. There's been an ongoing shortage of prescription stimulants, they've uh covered multiple different uh types of drugs. Uh there's been a sharp rise in people getting prescribed these. Have you seen any situations of people not necessarily turning to meth but potentially but seeking prescription stimulants on the street? Have you seen much of that, a diversion of that?
SPEAKER_01Yes, we have absolutely seen that happen without going into specifics, but uh the one of the focuses that my team has in in Tennessee, if you unlawfully distribute a Schedule I or a Schedule II drug that results in the proximate death of an individual, you can be charged by Tennessee code annotated with second-degree murder. Um that's one of the goals is to hold people accountable for killing people with poison. And one of the cases that we did investigate, the victim uh was looking for Adderall. And they turned to someone they knew and asked them if they had any Adderall. I believe they referenced needing uh hel help to get through studying for a test of some sort. And they it it was clear through our investigation, without going into specifics, that the suspect supplied what the person wanted, uh supplied them with an Adderall, but it turned out there was no Adderall in the person's system uh when they unfortunately passed away a short distance later from an acute fentanyl overdose. It's definitely out there. People are definitely seeking legitimate prescription amphetamines or stimulants for illegitimate uses, and that brings us to the problem with counterfeit prescription pills that are flooding our our our streets right now. It's probably one of the most significant trends that's out there because it is so very simple to manufacture a pill that looks like a legitimate prescription pill. With a very small amount of equipment and material, you can buy the binder material that holds the pill together, and you can buy a stamp and a die that will press a pill into any shape, color, or any kind of design on it that you want. So that makes any pill that's sold on the street indistinguishable from a legitimate one. Um and a troubling statistic that came out last year is uh the DEA and Border Patrol did a study of a sample of some of the pills that were seized at the southern border uh that were being illegally imported into America, uh the counterfeit prescription pills, and they found that 42% of the pills that they sampled contained more than two milligrams of fentanyl in it.
SPEAKER_00Which is more than a fatal overdose.
SPEAKER_01That is a fatal dose to somebody who doesn't have a built-up tolerance. So if somebody, as I'll reference, you know, the victim from earlier, if they're just kind of a one-off seeking a stimulant to help get them through a rough patch or whatever it is, and they don't have a tolerance to opioids, they die. And that's 42% of the pills that are coming across the southern border. It's just one of those things that we've we've had to be able to respond to. Um, and one of the tools at our disposal is that if we realize that there's a certain trend in drug use or abuse in a specific area, we're able to send out a spike alert, which if you subscribe to the spike alert system in Nashville, then a text message will be sent to your phone saying, listen, in this specific geographic area, there's a significant risk if you encounter that blue powder, for example. And it's just one of the many tools that we have, but you have to subscribe to the system. We can't send it to everybody without their permission. So a lot of what I do is is trying to get the word out there to media organizations, and and when I do that, I try and give a plug to the spike alerts as well as our different partners in care.
SPEAKER_00I'll make sure to put that in our show notes then for this episode.
SPEAKER_01Thank you.
SPEAKER_00May I ask what motivates you so personally?
SPEAKER_01There are a lot of things. Even prior to the creation of the overdose unit at at the MNPD, I'd been advocating for a couple years that if they were going to build one, I would love to be a part of it. And then I got what I wished for. And but gratefully so, I'm blessed to be where I am. I would say my first exposure into the international drug trade, I was in the United States Army Infantry from 2002 to 2007 with uh two combat deployments, and my first one was to Afghanistan in 2004. When we we would be inserted into a mission, uh, we'd load up on a helicopter and then go fly across the mountain ranges and be inserted wherever we were needed. And it would be nothing for us to fly over, and without exaggeration, I say hundreds of thousands of acres of bright red flowers in an otherwise arid and desolate desert mountain. That's when it was explained to us that that those were the poppies that the farmers were using to make the beginning stages of black tar heroin. It would be nothing for us to come across basketball-sized chunks of black tar wrapped in in tarps that a farmer was transporting from point A to point B, point B being the regional drug lord or whoever was in charge of that area. And when we would speak to these farmers, they were only being given the equivalent at the time of about $20. And that would be uh it's a quarterly crop, so that would be four times a year, $20 when if you estimate the value of that black tar, you're in the hundreds of millions of dollars. When I got out is really where I probably had the most significant realization when it comes to opioids and addiction. A lot of the people that I served with were significantly injured uh during those deployments. And that was at a time when the over-prescription of opioid pain medicine was very common. And I saw a significant number of my friends become dependent upon these drugs. And then also was the time when the government started regulating their prescriptions. And I wouldn't say a lot of times, but definitely in a certain number of times that I saw, my friends were immediately and rapidly taken off of these prescription pain pills. And a significant number of people with this of people in the small number of people that I served with have since passed away from fatalities that are directly linked to opioid overdose or opioid misuse. I was a team leader in Iraq, which means I had a small group of soldiers that worked for me or with me, and two of those soldiers had problems with opioid addiction. One passed away, unfortunately, but the other one's in recovery. These aren't the people that are commonly associated with drug addiction. These were American heroes that were injured fighting for their country, trying to keep the people in America safe. And they came home through no fault of their own, they were over-prescribed pain medication. Through no fault of their own, they were chemically addicted to this substance. And then when the substance dried up, you know, the the logical course of addiction set in. And uh a significant number of my friends are not here because of that. And that's when I started to become passionate about it. I think a lot of times people put the blinders on and don't want to see the impact of addiction and substance use disorder within their direct circle of family and friends and acquaintances. And I encourage people to take those blinders off and do a deep introspection and see how closely addiction is to everybody in our society. And I think that helps people personalize it. And I think it helps people develop empathy to know that statistically speaking, someone very close to you is suffering from addiction, whether you know it outright or whether you subconsciously know it. And putting a human face to those otherwise faceless overdose statistics is probably the single most effective way for me to get through to people about changing their perspective about addiction and substance use disorder and not looking down upon people for suffering from it, but to help people recover from it, because I can tell you it can happen to anyone with the right circumstances. It can and will happen to anyone. We just have to face it, treat people like people, and offer them resources to cure this disease because that's the only way we're gonna get out of it. Thank you for having me. I really appreciate you bringing attention to this much-deserving topic.
SPEAKER_00For more episodes on in-depth discussions on Tennessee policies related to substance use disorder by a range of local experts. Please subscribe to us wherever you get podcasts and visit our website at smart.tennessee.edu. I'm Jeremy Corvellis. Thank you for listening and see you next month.