A Public Health Approach to Illicit Drug Use in Travis County...In March 2018, Dr. Tony Fabelo presented findings from his report, Travis County District Attorney: Review of Drug Review

UpdatedAug.2018

Contact:CateGraziani,M.S.S.W/M.P.Aff|GrassrootsLeadership|(512)499-8111|[email protected],M.S.S.W.|TexasCriminalJusticeCoalition|(512)441-8123,ext.102|[email protected]

MarkKinzly|TexasOverdoseNaloxoneInitiative"TONI"|(860)724-5339|[email protected]

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APublicHealthApproachtoIllicitDrugUseinTravisCountyReducingArrests&theCostlyConsequencesofHarmfulDrugUse

“True security is based on people’s welfare – on a thriving economy, on strong public health andeducationprograms,andonfundamentalrespectforourcommonhumanity.”-BamKi-moonReal public safety in our communities can be achieved by addressing the health and welfare of itsmembers.Howacommunityrespondstoillicitdruguseisaremarkableindicatorofitscommitmenttosafety. Communities that respond with harsh criminal consequences are doomed to experience theworstravagesofdruguse,whereasthosethatrespondbyprovidingaccesstotreatmentandcommunitysupportswillseedeclinesindruguseandrelatedcrime.SubstanceUseDisorderHasaDamagingImpactonTravisCountyResidentsandtheLargerCommunityAccordingtoAustin/TravisCountyIntegralCare,whichledagroupofstakeholdersindevelopingaplantoaddress substanceuse inTravisCounty,more than85,000 local youthandadults abusealcoholorillicit drugs each year.1 Of those, more than 40,000 are dependent on drugs or alcohol and requirerecovery supports. The same report indicated that 35 percent of all arrests by the Austin PoliceDepartmentwerealcohol-ordrug-relatedin2015,and60percentofTravisCountyJailresidentsmeetthe criteria for substance use disorder. Substance use disorder is detrimental to the lives of thoseimpacted, harming families and the community. People livingwith untreated substance use disorderaccountforadisproportionateshareofemergencymedicalresponses,hospitalexpenses,policeofficertime,andoverdose-ortraffic-relatedfatalities.Buttherearetwokindsofharmassociatedwithdruguse: theharmcausedby thedrugs themselveswhen theyareabused,and theharmcausedbyourpolicyresponses.TravisCountyFailstoProvideAdequateCommunity-BasedInterventionstoAddressHarmfulDrugUseAccording to the 2010-2012 National Survey on Drug Use and Health, Central Texas has the highestpercentageofpeopleinneedofbutfailingtoreceivesubstanceuseservicesinthestate.2Whenpeopleseekhelp,theytypicallyencounterawaitinglist–themostcommonbarriertoaccessingtreatmentforpeoplewithsubstanceusedisorder.3Further, lackof funding fordetoxificationandrecoverysupportscreatesharmfulgapsinthecontinuumofcare,exacerbatingthecommunityimpactofdruguse.LackofAccesstoTreatmentServicesTravis County lacks adequate detox beds, amajorgap in the continuum of care for people withaddiction toopiates andalcohol.4AustinRecoveryclosed its 14 detox beds in 2014. Cenikor has ahandfulofdetoxbeds,buttheylackthecapacitytoserveallofthoseseekingservices.

GOINGINTHEWRONGDIRECTIONInvestmentsinsubstanceuseservicesinTravisCountydecreasedfrom$1.5millioninFY2012to$1.1millioninFY2015.

TravisCountyPlanforSubstanceUseDisorders

UpdatedAug.2018



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According to the Texas Health and Human Services Commission, low-income youth and adults withsubstanceusedisordermustwaitmorethantwoweeksforintensiveresidentialtreatment,fourweeksforoutpatienttreatment,andalmostfiveweeksformedicationassistedtreatment.5Peopleinneedofco-occurring psychiatric and substance abuse treatmentmustwait almost fourweeks for specializedservices,afactorthatfurtherlimitsaccesstotreatmentforagroupthatisalreadyunderserved.6

Evenwhenpeopleareabletoaccessthewaitlistfortreatmentservices,homelessnesscanincreasethelikelihoodofattritionoffthewaitlist.Thisistrueevenwheretherearerelativelyshortdelaysbetweenassessmentandtreatmentadmission.7Substanceuseisthelargestcauseofhomelessnessamongsingleadults.8 According to the Ending Community Homelessness Coalition, more than 300 of the 1,900homelesspeopleinTravisCountyonanygivendayhavebeendiagnosedwithasubstanceusedisorder.9DrugPossessioninTravisCounty:CriminalJusticePracticesMaketheProblemWorseTravisCounty continues to try towinawarondrugs that most experts agree is contrary topublic health and safety. Since 2012, thenumberofdrugpossessioncasesfiledinTravisCountyincreased90percent,arateofincreasethatfarexceedsfilingratesforanyothertypeofoffense.10During the last 12 months alone, there were2,623 arrests for low-level drug possession, inTravis County.11 Inmost cases, the defendantspossessedlessthanonegram(theequivalentofa sugarpacket).Themajorityof thosearrestedspent time in county jail, state jail, or prison.12Yetthereisnoempiricalevidencethatincarcerationwillpreventfuturesubstanceuse;13infact,mostofthe defendantswho are sentenced to a termof incarceration for drug possessionwill be re-arrested

15381807

2312 2360 2396

2921

500

1000

1500

2000

2500

3000

3500

FY2012 FY2013 FY2014 FY2015 FY2016 FY2017

DrugPossessionCasesFiledinTravisCounty2012-2017

21

20

11

7

18

16

27

10

10

32

28

17

13

15

0 5 10 15 20 25 30 35

OUTPATIENT-YOUTH(CYTWRAP-AROUND)OUTPATIENT-YOUTH

INTENSIVERESIDENTIAL-YOUTH-ROOM/BOARD(MEDICAIDINTENSIVERESIDENTIAL-YOUTH

OUTPATIENT(SPECIALIZEDFEMALE)-ADULTINTENSIVERESIDENTIAL(WOMENANDCHILDREN)-ADULT

CO-OCCURINGPSYCHIATRICANDSUBSTANCEABUSEDISORDERSAMBULATORYDETOXIFICATION-ADULT

RESIDENTIALDETOXIFICATION(SPECIALIZEDFEMALE)-ADULTOPIOIDSUBSTITUTIONTHERAPY(MEDICATIONASSISTEDTHERAPY)

OUTPATIENT-ADULTINTENSIVERESIDENTIAL(SPECIALIZEDFEMALE)-ADULT

RESIDENTIALDETOXIFICATION-ADULTINTENSIVERESIDENTIAL-ADULT

AVGDAYSONWAITLISTFORHHSCFUNDEDSUBSTANCEUSESERVICES

UpdatedAug.2018



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within three years.14 And felony convictions significantly limit housing and employment opportunity,making community reintegration a daunting challenge. In 2017, the fourth leading driver for distinctdays in jail for womenwas possession of a controlled substance less than 1 gram (state jail felony),whichaccountedfor33,939days.Ofthosedays,almost32%wereforBlackwomen.15

A smallerproportionof thedrugpossessioncases inTravisCountyoverthe lastyearwerehandledthroughplacementon probation or in a drug court. But unfortunately,probationandpretrialprogramminginTravisCountyisnotarealistic option for many defendants, who face majorobstacles with respect to substance use, mental healthissues,homelessness,andotherfactors.

Theimpactofoverlypunitivedrugpoliciesisespeciallysignificantforcommunitiesofcolor,withglaringracial disparities associatedwith drug arrests. African Americans comprised 24 percent all arrests forpossessionin2017,16despiterepresentingonly8percentoftheTravisCountypopulation.17Andlimitsonemploymentandhousingonlyservetoexacerbatethesedisparities.Continuingthecycleofarrestandincarcerationforwhatisessentiallyapublichealthissuewillonlymaketheproblemsassociatedwithillegaldruguseworse.

CostlyandIneffectiveCriminalJusticeResponsesDetainingsomeonewithsubstanceusedisorderforanonviolentoffenselikepossessionofacontrolledsubstanceisexpensiveandmassivelyinefficient.AustinPoliceDepartmentspendsbetween$55and$97perpersontoarrestandbooksomeoneintocountyjail,andtheSheriff’sOfficeincursanother$152.99perbookingand$96.71perjailbedday.18Taxpayersfootthebillforthesecosts.In addition to significant fiscal ramifications, holding someone in county jail prior to trial, rather thanpracticing non-arrest or pretrial diversion, increases the likelihood that the individual will receive alongersentence(againat taxpayerexpense),andthattheconsequenceswillbemoresevereforevenmoderate-orlow-riskdefendants.19Asnotedabove,incarcerationcanleadtohighratesofrecidivism–higher than recidivism rates among people on community supervision 20 – leading to costly re-incarceration.Further,thereareeconomiccoststofamiliesandthecommunitythatresultfrompretrialdetention:theindividual isdeprivedof theability to retainemploymentandhousing,which increases the likelihoodthatfamiliesmustrelyoncountyorstateresources.

Racialdisparitiesassociatedwithdrugarrestsareglaring:AfricanAmericanscomprised24percentallarrestsforpossessionin2017,despiterepresentingonly8percentoftheTravisCountypopulation.

“Theconsequencesofharmfulsubstanceusearetoooftenaddressedinthemostcostlysettings,throughthecriminaljusticeoremergencyroomsystems,ratherthanthepublichealthsystem.”

TravisCountyPlanforSubstanceUseDisorders

UpdatedAug.2018



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TravisCountyMustImplementNewStrategiestoPromoteHarmReductionandImprovePublicHealthRecognizing that substance use disorder is a chronic disease that requires a continuum of supportswithin thecommunity,TravisCountymustadopt strategies thatbeginwithharmreduction,aimedatreducingnegativeconsequencesassociatedwithdruguse.TheCountymustcommittoaugmentingtheservicesthatworkwhilesimultaneouslydecreasingtheroleofthecriminaljusticesysteminrespondingtosubstanceuse.Criminaljusticestrategiesarecostlyandoftenineffective,squanderingresourcesthatcouldbeusedonevidence-basedapproaches.Despite theworkof community stakeholders todevelopapublichealth-orientedplantoaddresssubstanceusedisorder inTravisCounty,manyoftherecommendationshavenever been adopted due to the ever-increasing interest in maintaining the criminal justiceinfrastructure. It is time for a reinvestment strategy in Travis County. Rather than allocate tens ofmillionsofdollarstohousepeopleinTravisCountyCorrectionalComplexfordrug-ratedcharges,TravisCountyshouldinvestintheservicesrecommendedbycommunitystakeholders.

In March 2018, Dr. Tony Fabelo presented findings from his report, Travis County District Attorney:ReviewofDrugReviewofDrugPossessionCaseDispositions2016-2017andRecidivismAnalysis2014-2015.Thetoptworecommendationswere:

1. CountyofficialsneedtoreviewlawenforcementpracticestounderstandwhybookingsforSJFdrugpossessionshaveincreasedwhileoverallbookingshavegonedown.

2. County officials need to review community concerns about drug abuse, mental health, andassociated problems and whether sufficient alternatives to arrest exist to address theseconcerns.

Pre-ArrestDiversiontoDivertPeoplefromtheTypicalCriminalJusticeProcessAlready,11citiesacrossthecountryhaveimplementedharm-reductioninterventionsfordruganddrug-related offenses.21 Pre-arrest diversion (PAD) approaches, which offer people community-basedservices rather than jail, are founded on the evidence-based principles of harm reduction, whereparticipants’ needs are addressed in a non-coercive manner. Where these strategies have beenimplemented,communitieshaveseenaremarkabledropinre-arrestrates.Specifically,participants inthese programswere 58 percent less likely to be arrestedafter enrollment compared to thosewhowentthroughthenormalcriminaljusticeprocess–arrest,booking,detention,prosecution,conviction,and incarceration.22 Remarkably, program participants also saw a long-term, decreased likelihood ofbeingchargedwithafelonyoffense.Apublichealth/harm-reductionapproachtoillegaldrugusecanachieve fargreater resultswith respect topublic safetyandhealth than thenormal criminal justiceprocess.InSeptember2018,theTexasOverdoseNaloxoneInitiativeandtheAustinHarmReductionCoalitionplantoopena24-hourwalk-incenter,thefirstofitskindinAustin.Thestart-upcostswillbefundedthroughtheTexasTargetedOpioidResponsefundingstream,whichaimstoreducethenegativeimpactsofopioiduse.WealsoknowthatTravisCo.residentsstrugglewithsubstancesbeyondopioids.Weask

UpdatedAug.2018



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thatTravisCo.makeaninvestmentinthewalk-incentertoensurenooneisturnedawayandtolaythefoundationforpre-arrestdiversion.Componentsoftheprogram:

• 24-hourwalk-incenterwithrecoverycoachesandpublichealthprovidersonstaff• Recoverycoachesconnectwithindividualsateveryinterceptonthesequentialinterceptmodel

includingarrest,booking,pre-trialandrelease• Assessmentandpeersupportcarenavigation• Samedayinductionandlinkagetomedicationassistedtreatment(MAT)• Woundcare,dentalcareandHepatitisCtreatment• Transportationtotreatmentandemploymentservices• Transitionalrecoveryhousingvouchers

BudgetRequest

Item Amount Quantity Total/Annual DescriptionContractM.D. $50,000 2 $50,000 Medicationassisted

treatment-M,W9am-1pminductionandon-calltelemedicine

LicensedChemicalDependencyCounselors(LCDC)

$40,000+25%benefits

3FTE $150,000 Assessment,casemanagementandfollowup

RecoveryCoaches $35,000+25%benefits

2.5FTE $109,375 Peersupportservices

Transportation $2,000 12months $24,000 Transportationtotreatmentcentersacrossthestateandtransportationto/fromemploymentservices

Housing $500perperson

20permonth

$120,000 Transitionalrecoveryhousing

Total $453,375

UpdatedAug.2018



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Citations1AustinTravisCountyIntegralCare,TravisCountyPlanforSubstanceUseDisorders,p.5,http://www.integralcare.org/wp-content/uploads/2017/09/150901_sud_report_6.pdf.2AustinTravisCountyIntegralCare,TravisCountyPlanforSubstanceUseDisorders,p.34,http://www.integralcare.org/wp-content/uploads/2017/09/150901_sud_report_6.pdf.3Liebling,Elliott,etal,“AccesstoSubstanceUseTreatmentAmongYoungAdultsWhoUsePrescriptionOpioidsNon-Medically”,SubstanceAbuseTreatment,Prevention,andPolicy(December,2016),p.5.4AustinTravisCountyIntegralCare,TravisCountyPlan,p.39.5TexasHealthandHumanServicesCommission,DataRequest,September,2017.6Priester,MaryAnn,et.al,“TreatmentAccessBarriersandDisparitiesAmongIndividualswithCo-OccurringMentalHealthandSubstanceUseDisorders:AnIntegrativeLiteratureReview,”JournalofSubstanceAbuseTreatment(2016),Vol.61,p.55.7Winn,JaimeL.,etal,“HousingAssistanceandCaseManagement:ImprovingAccesstoSubstanceUseDisorderTreatmentforHomelessVeterans”,PsychologicalServices(2013),Vol.10,No.2,p.238.8NationalCoalitionfortheHomeless,SubstanceAbuseandHomelessness,2009,http://www.nationalhomeless.org/factsheets/addiction.pdf.9AustinTravisCountyIntegralCare,TravisCountyPlan,p.40.10OfficeofCourtAdministration,CourtActivityandDirectorySystem,http://card.txcourts.gov/AdHocSearchNew.aspx.11TexasDepartmentofPublicSafety,DataRequest,December,2017.12OfficeofCourtAdministration,CourtActivityandDirectorySystem.13Kelly,William,CriminalJusticeattheCrossroads:TransformingCrimeandPunishment,2015,ColumbiaUniversityPress,NewYork,ebooklocation5014.14LegislativeBudgetBoard,StatewideCriminalandJuvenileJusticeRecidivismandRevocationRates,January,2017,http://www.lbb.state.tx.us/Documents/Publications/Policy_Report/3138_Stwide_Crim_Just_Recid_Revoc.pdf.15TravisCountySheriff’sOffice.DataRequest,2018.16TexasDepartmentofPublicSafety,DataRequest,December,2017.17U.S.CensusBureau,TravisCountyQuickFacts,https://www.census.gov/quickfacts/fact/table/traviscountytexas/SEX205210.18AustinTravisCountyIntegralCare,TravisCountyPlanforSubstanceUseDisorders,p.6,http://www.integralcare.org/wp-content/uploads/2017/09/150901_sud_report_6.pdf.19Ortiz,N.R.,“CountyJailsataCrossroads:AnExaminationoftheJailPopulationandPretrialRelease.”TheNationalAssociationofCounties,http://www.naco.org/resources/county-jails-crossroads.20LegislativeBudgetBoard,StatewideCriminalandJuvenileJusticeRecidivismandRevocationRates.21LEADNationalSupportBureau,LEAD:AdvancingCriminalJusticeReformin2017,https://www.leadbureau.org/.22Collins,Susan,et.al.,“Seattle’sLawEnforcementAssistedDiversion(LEAD):Programeffectsonrecidivismoutcomes”,EvaluationandProgramPlanning,64(2017),p.49–56,https://docs.wixstatic.com/ugd/6f124f_f4eed992eaff402f88ddb4a649a9f5e6.pdf.