Since the emergence of harm reduction as a compassionate and pragmatic response to problems posed by substance use, practitioners have argued that chemical dependency (and mental health issues) are best addressed through public health measures rather than the criminal justice system. This principle was articulated by the former director of the Office of National Drug Control Police (ONDCP) Gil Kerlikowske and is embraced by his successor Michael Botticelli. Numerous studies showing that addiction treatment is both more effective and cheaper than routing individuals through the criminal justice system reinforce this argument. Yet for many indigent and disenfranchised individuals, access to effective treatment often comes only after their involvement with the criminal justice system (drug courts being the paradigmatic example).
Implemented on a pilot basis in Seattle, Washington in 2011, Law Enforcement Assisted Diversion (LEAD) was designed to finally truly integrate a public health approach into policing of street level drug use and sales (and concomitant behaviors such as street based sex work). LEAD moves the point of intervention downstream right to the level of interactions between police officers and those subject to arrest for possession or sales of drugs (and, in Seattle at least, for prostitution).
In its original design LEAD is a post-arrest, pre-booking diversion program. That is: the officer has grounds to make an arrest for a LEAD eligible offense, runs a criminal history check to see if the individual has a disqualifying prior offense (prior drug and/or prostitution convictions are not disqualifiers), and, if the officer thinks the person could benefit from LEAD, offers an immediate referral to highly trained and skilled case workers. At the request of officers, we also added a social contact referral route based on officer knowledge of the individual’s involvement with drugs and/or sex work. In these cases, officers do not have to wait until they arrest the person, but can approach them and offer a referral.
The case management strategy employed by LEAD differs from typical case management in significant ways. Rooted in harm reduction, this is not office-based case management. Rather, case managers are expected to go out on the street and meet participants where they’re at -- both literally and metaphorically. LEAD is also robustly resourced and does not focus exclusively on getting the diverted participant into addiction treatment or mental health care. The case managers work intensively with individuals to identify and rank their needs from pressing and urgent to long-term. Many participants identify housing and reliable access to food and hygiene facilities as their most emergent needs.
Unlike most drug court programs, LEAD is not an abstinence-based model and has no fixed definition of success or failure and no arbitrary termination date. Furthermore, this is a multi-disciplinary approach, with integrated health and behavioral health practitioners who share a harm reduction/outreach based philosophy. Our experience demonstrates that by the time many individuals reach the point where they are a source of concern to law enforcement and the community, their range of needs are far greater than access to treatment and care and that the longer individuals are engaged the lower their rates of recidivism.
The case management services for LEAD are delivered by staff of Evergreen Treatment Services’ (ETS) REACH Program. ETS also provides outpatient medication assisted treatment for opioid use disorders at multiple locations in Washington State; David Beck, MD, an ASAM member, ABAM Diplomate and Immediate Past President of ASAM’s Washington state chapter, is the Medical Director for two of those clinics. REACH was selected as the case management provider for LEAD based on its history of delivering street-based case management services to homeless people with addiction in Seattle since 1996. REACH clients also participate in federally-funded research projects examining the effectiveness of extended-release naltrexone, along with harm reduction counseling.
Originally begun in Seattle, LEAD has since been replicated in Santa Fe, New Mexico (in 2014) and as of summer 2015 is set to be replicated in Albany, New York with other cities from Portland, Maine to San Diego, California (and Tijuana, Baja, Mexico) expressing strong interest in also adopting LEAD. LEAD has been independently evaluated by researchers from the University of Washington who found that LEAD yielded significant recidivism reductions among participants (both on a pre/post- participant only analysis and also when compared to a selected group of controls). They also found criminal justice system savings when compared to system as normal controls.
Please see the full evaluation reports at: http://leadkingcounty.org/lead-evaluation/.