Intersections of Health and Justice: A Conversation on LEAD and New York’s Opioid Epidemic

The panelists were Roy L. Austin Jr., Deputy Assistant to President Obama for Urban Affairs, Justice, and Opportunity, White House Domestic Policy Council; Brendan Cox, Chief, Albany Police Department; Alice Green, Executive Director, Center for Law and Justice; The Honorable Michael McMahon, District Attorney, Richmond County, Staten Island; and gabriel sayegh, Co-founder, Katal Center for Health, Equity, and Justice. Brian Byrd, a program officer at NYHealth, moderated the discussion.

According to the Centers for Disease Control and Prevention, the associated health care costs attributed to the current U.S. opioid epidemic has totaled an estimated $25 billion. New York State has the third-highest spending in the nation (more than $1.2 billion), and its opioid overdose death rate has equaled or exceeded the national rate every year since 2006. According to the New York City Department of Health and Mental Hygiene, these types of overdose deaths have increased by 56% since 2010, with Staten Island having the highest rate of heroin-involved overdose deaths.

Speaking on behalf of the White House, Mr. Austin provided background on the rationale for President Obama’s criminal justice reform initiative. Mr. Austin cited that real spending on the criminal justice system, specifically incarceration, has totaled more than $80 billion, or more than $260 per capita. “In 2013,” he said, “eleven states spent more on corrections than on higher education. Sixty-four percent of those incarcerated have mental health issues, and 68% have substance abuse issues.” Current criminal justice policies also generate a number of indirect costs, or collateral consequences, for individuals with criminal records, their families, and their communities. Having a criminal record, for example, makes it more difficult to find employment and housing. In a rare moment of bipartisanship, Democrats and Republicans have both agreed that the current state of the criminal justice system is too costly, the policies in place do not work, and the system is in need of reform. “Changing the current system would free up funds that could be better spent elsewhere. So much so, that the Obama Administration and Koch Industries are working together on criminal justice reform ideas and proposals,” Mr. Austin added.

Michael McMahon, the District Attorney for Staten Island, provided a frontline perspective of the opioid epidemic’s impact on his community. Since January 1, 2016, there have been 70 suspected overdoses on Staten Island. “In the last two weeks, there were 12 overdoses, 10 fatal, and three within a 24-hour period. Seven of the recent overdoses were a mixture of heroin and cocaine,” said Mr. McMahon. He went on to discuss how his office is researching and experimenting with new ways to meet this crisis, including the LEAD program. “We cannot jail our way out of this or lock people out of this problem,” he said. “I’m in crisis mode, and that’s why I’m trying to do something expedited.”

gabriel sayegh, co-founder of the Katal Center for Health and Justice, spoke on how the war on drugs—first launched during the Nixon era in 1971—and the Rockefeller drug laws that provided the war’s policy framework have been a failure. “We’ve been doing this criminal justice approach for 45 to 50 years and we are dealing now with the exact same problem that they were dealing with 45 years ago when they launched this approach,” he said. “What is it that has not worked? LEAD emerges from trying to answer that question.” Mr. sayegh went on to describe LEAD as an evidence-based, harm reduction-oriented program designed to reduce low-level arrests and recidivism, as well as to promote better health outcomes for participants. “LEAD is a process,” he said. “It was the police, the district attorneys, the public defenders, people who actively used drugs, the harm reduction community, service providers, and elected officials who came together and said, as a city, ‘How do we do this differently?’”

Brendan Cox, chief of the Albany Police, spoke to why a police department would want to embark on a program like LEAD, how he needed to change the mindset of officers under his command, and what internal and external pressures the department has to endure—including pressure from the community—when officers don’t make an arrest. “We always thought we were helping folks when we arrested them, but we now know that isn’t the case,” said Chief Cox. Alice Green, the executive director for the Center for Law and Justice, gave a historical overview of the challenges faced by Albany’s low-income population (particularly as it pertained to African Americans), its relationship with the criminal justice system, and how it was able to build a good relationship with the Albany Police Department. “There was great concern on how the police conducted their business,” she said. “We really worked on getting the community to understand what was really going on in the criminal justice system.” Both panelists spoke about their experiences using the LEAD model, as well as its challenges and benefits.

Concluding comments reminded the audience that significant improvements can be achieved but will take time and patience. Addressing the opioid epidemic will require coordinating new and existing efforts, programming, and resources in criminal justice, social services, and public health.

“The only way we’re going to solve this problem,” said Mr. McMahon, “is when law enforcement understands it’s a public health problem, and when people in public health understand it’s a law enforcement problem.”

Read more about our grant to the Drug Policy Alliance to help plan and develop the LEAD program.

Read articles in Crain’s New York and SILive about this event.

Read articles in Politico New York and Huffington Post about the LEAD program in Albany.

Read an article in the New York Daily News about Staten Island’s work in diverting low-level drug offenders.

Watch a video featuring a conversation among a recovering addict, a Seattle cop, and a case manager about the LEAD program.