Erick Trickey is a writer in Boston.

PLYMOUTH, Mass. – She watched her sister dying, slumped over her kitchen table, unconscious and gasping. When the police and paramedics came, they turned her sister onto the floor and sprayed naloxone up her nose—once, then a second dose. The anti-opiate did its work in minutes: Her sister woke up.

Three days later, she opened the door to the police again. Derek Back, a police officer in plainclothes, and Tiffany Duggan, an addiction recovery coach, hadn’t come with an arrest warrant but a potential lifeline: a bed in a drug treatment facility.


“I’m praying she comes back,” the 56-year-old woman said of her sister, whom she hadn’t seen since that night. “It’s the only way she’s going to get help.”

The nation’s opioid epidemic, which has raged across New England, killing more than 15,000 since 2014, has come again and again to this small apartment in the region’s oldest town. The woman pointed to a wood plaque on the wall, decorated with a photo of a handsome bearded guy in his 30s, sporting a dark flat cap. “My son,” she said. “He had an overdose, right here on the floor.” She lost him in 2014, and her husband, also to an opioid overdose, months later. “I know he thought it was his fault,” she said of their son’s death.

“This is the highway in,” said Back, a six-year veteran of the 119-officer Plymouth police force.

“I can get her a bed like that,” Duggan said, snapping her finger. She handed the woman her business card.

“If she comes back here, I promise I’ll call you,” the woman said. “I don’t want to lose any more people to this.”

Top: Gloucester, Mass., where police are trying a radical new approach to dealing with the opioid epidemic. (Carlos Osorio/Toronto Star) Bottom left: A woman waits for the commuter rail in Gloucester. (Gabe Souza/Portland Press Herald via Getty Images) Bottom right: The region has been wrestling with an increasing problem of addiction to heroin. A police officer holds a bag of heroin confiscated as evidence. (Photo by John Moore/Getty Images)

In 2015, police in towns across eastern Massachusetts began to embrace a new way to respond to a public health crisis with a rapidly escalating death toll. That spring, the exasperated police chief in the fishing town of Gloucester, Mass., announced that anyone who showed up at the police station and asked for help overcoming an opiate addiction would get it, without fear of arrest, no matter where they lived or whether they had insurance. Police, he said, would get them into treatment.

In the Gloucester program’s first year, 376 people took the chief up on his offer. The New England Journal of Medicine took notice: Almost 95 percent of addicts got a direct referral to treatment—compared to a 63 percent referral rate for a treatment-placement program at Boston Medical Center. “Factors that enabled referrals included the motivation of participants to enter treatment, as evidenced by their coming to the police station,” the researchers wrote, as well as “the fact that officers search for placements 24 hours a day.”

Three years later, the unique approach to combating the opioid epidemic has evolved into a national program called Police-Assisted Addiction and Recovery Initiative, or PAARI, a partnership of 390 police departments that has helped 12,000 people get into drug treatment. Some members, like Gloucester, have opened their police stations as safe spaces for the addicted. Others, like Plymouth, follow a variation created in Arlington, Mass., a Boston suburb, in which officers and addiction counselors reach out to recent overdose victims instead of waiting for addicts to come to them.

Left: John Rosenthal, co-founder of The Police Assisted Addiction and Recovery Initiative based in Newton, Mass., is a key player in the pilot program in Gloucester that is helping keep addicts out of jail and in treatment. Here, he poses for a portrait on the steps of the Gloucester Police Department. (Gabe Souza/Portland Press Herald via Getty Images) Right: Marty Ginivan, an "angel" volunteering with the police department in Gloucester, Mass., helps move drug addicts into recovery as part of its Angel Program. The program gives addicts the chance to turn in all the drugs they have on themselves in exchange for amnesty for any crimes as long as they agree to go into treatment. (Gabe Souza/Portland Press Herald via Getty Images)

While PAARI started in small cities, it is now getting attention from cities with much larger populations and significantly more overdoses. The biggest partner is Macomb County, Michigan, made up of 27 suburbs of Detroit with a combined population of 860,000 and the second-highest rate of opioid overdose deaths in the state—more than twice the national average. Officials there tweaked the Gloucester model, using 250 “angel” volunteers so the police don’t have to arrange the treatment themselves. Phoenix started a program in one of its police stations. Salt Lake City launched a program on the troubled street across from its homeless shelter. Boston just kicked off an effort in which police officers in certain neighborhoods give out cards with the names of treatment advocates PAARI has hired through AmeriCorps.

“Who would have thought that the access to treatment for somebody in opiate addiction would be through the lobby of a police station?” says Arlington police chief Frederick Ryan, PAARI’s co-chair. “That really highlights a failure of the health care system. … I hope that at some point we put ourselves out of business, and health care and public health take the ball.”



***

In the spring of 2015, Gloucester’s then-police chief, Leonard Campanello, had gotten fed up. Gloucester, part seaside dream, part industrial port, is a working-to-middle-class city accustomed to dealing with untimely death thanks to its long history as a fishing town. Its defining landmark, a captain at a ship’s wheel, is a memorial to the more than 5,000 men Gloucester has lost at sea since 1623. But a new deadly threat was emerging, and it was shaking the town’s 30,000 residents. Fatal overdoses in Gloucester were climbing: six in 2014, then four in the first 10 weeks of 2015 alone.

Former Gloucester police chief Leonard Campanello speaks from his office on March 22, 2016 in Gloucester. (John Moore/Getty Images)

Campanello had spent seven years as a plainclothes narcotics detective in Boston’s suburbs. But watching his officers respond to more and more overdoses—some they had reversed with the newly available naloxone, some they couldn’t—had left the chief disillusioned with the drug war’s criminalization of addicts. “It was pretty evident that we weren’t arresting our way out of anything,” Campanello recalls. “The punishment of a disease wasn’t working.”

Two days after a packed community forum, Campanello, with permission from the city’s mayor, went on the department’s Facebook page and announced the new policy: detox and recovery on demand for the addicted—“not in hours or days, but on the spot,” he promised. “I’ve never arrested a tobacco addict,” Campanello wrote, “nor have I ever seen one turned down for help when they develop lung cancer.” His post went viral: two million people viewed it.

Three weeks later, Steve Lesnikoski, who was living in his car near San Jose, California, read about Gloucester’s new policy on Reddit. At 30, he’d lost his construction job and apartment because of a heroin habit. Gloucester’s promise of immediate help resonated with him. “I was in a parking lot, waiting for my drug dealer to come meet me,” he recalls, “and I thought, ‘Well, it can’t be any worse than where you are now.’”

On June 1, the first day of Gloucester’s new policy, Lesnikoski flew from San Francisco to Boston, on a ticket paid for by the same Reddit Samaritan who’d posted the link. At 4 a.m. on June 2, Lesnikoski became the first person to take Gloucester up on its offer of help. “All I had was a backpack with an [Alcoholics Anonymous] book in it, two T-shirts, and a pair of socks,” Lesnikoski recalls. “That was all that was left.” He was at a detox facility in nearby Danvers by day’s end.

All that summer, Gloucester’s ’70s-era police station was overwhelmed with people seeking help with heroin and prescription painkiller addictions. About one person a day showed up—people from all over New England and beyond. The police converted their old library—a 10-by-20-foot room with a window overlooking the harbor and a stack of yellow Miranda-warning cards—into a waiting room for addicts seeking treatment. They installed a land line for calls to recovery centers.

Keeping the promise of immediate placement proved the biggest challenge. At first, volunteer “angels” met each addicted person, helped them find an open bed at a treatment center, and navigated the insurance system. But it often took hours for an available volunteer to arrive, so the police took over calling treatment centers themselves. Cost was a hurdle. MassHealth, the state’s Medicaid program, could pay for some treatment, but people like Steve Lesnikoski, who came from other states, posed a bigger challenge. Campanello worked to line up drug-treatment centers willing to take a few patients “on scholarship”—at a discount. “We placed them based on anything we could find available,” Campanello says.

Meanwhile, Campanello fielded calls from police across the country. National reporters had interviewed Campanello about his viral Facebook post, and other police chiefs, desperate for alternatives to arresting addicts, wanted to know more about what Gloucester was doing and how they could do it. “It was completely, utterly overwhelming,” Campanello recalls. “It was bigger than me, bigger than Gloucester.”

Campanello called Boston developer John Rosenthal, a founder of the Boston nonprofits Stop Handgun Violence and Friends of Boston’s Homeless. Together, they started PAARI, a nonprofit alliance of police departments willing to help the addicted get into recovery. Focusing first on New England, PAARI helped expand connections to treatment in smaller cities along Massachusetts’ North and South Shores. That’s taken the load off Gloucester’s police, who now get about one person a week coming to the station for help, rather than more than one a day at the start.

In fall 2016, Campanello announced his retirement amid allegations that he had lied during an investigation of his personal relationships with two women. But thanks to Rosenthal and others, PAARI has scaled up Gloucester’s innovation into a national model. Its 390 members get a list of 350 treatment centers nationwide that are willing to take patients referred by police.

For Rosenthal, the effort is personal. Since he co-founded PAARI in 2015, he has lost a nephew to a fatal overdose. “Families that call treatment centers are generally told, ‘Sorry, there’s no room. Call back tomorrow, a week, two weeks,’” he says. “What we know from the disease of addiction is, we’re got to get people into treatment when they’re ready. That’s when they’re most likely to have success in their recovery.” Treatment centers, says Rosenthal, are more likely to say yes to a police officer than a family.



***

Fred Ryan, the police chief in the Boston suburb of Arlington, was on the phone with Campanello every day during the summer of 2015. Arlington, a town of 50,000, was seeing a fatal overdose a month, plus many non-fatal overdoses. Gloucester’s program was already big local news, and Ryan was looking for answers for his town.

“I was frustrated,” Ryan recalls. “How do we stop this?” Ryan felt Arlington couldn’t adopt the Gloucester model. “We just felt with our close proximity to Boston, we didn’t have the capacity to open up our lobby. We wouldn’t be able to manage the volume.”

Arlington’s eureka moment came at a staff meeting about the epidemic. “One of our crime analysts, a brilliant young lady, put a spreadsheet up on the board. [She said], ‘Chief, I think we know who our next victims of a fatal overdose are going to be. They’re right here on the screen. They’re all the people who have previously overdosed.”

So Ryan hired more help for the police department’s mental health clinician and sent her out with plainclothes police to contact everyone who overdoses in Arlington. They offered free naloxone, also known as Narcan, and a fast track to treatment. When addicts say they’re not ready to quit drugs, the clinician counsels them and their loved ones on how to reduce the risk of death from opiate use. When Arlington police arrest an opiate dealer, the police also reach out to all of the dealer’s former customers, offering them treatment.

Ryan says the Arlington Outreach Initiative is much like the changes that police nationwide made to better help domestic violence victims. “We said, we’re not going to judge you for not leaving this abusive relationship. We’re going to try to figure out how you’re going to survive the next assault.” Likewise, “There are many valid reasons you’re not ready for treatment. We get it. We’re not going to judge you for that. We are going to help you stay alive for when you are ready for treatment.”

To carry out Arlington’s policy, Ryan says, the police often confronted obstacles in the medical system. One week, the police responded to three overdoses by the same woman. After the first two, they transported her to an area hospital. Seven hours after the second incident, Ryan says, she overdosed a third time—this time fatally. “We learned that emergency rooms neither had the desire nor the capacity to treat overdose patients,” Ryan says. “They wanted to get rid of them.”

So the Arlington police asked the hospital staff to contact the police clinician if they discharged people the police had brought in after overdoses. That way the clinician could meet the patient and create an intervention plan. That set off fears about patient privacy laws.

“The immediate response from some of the staffers at the hospital was, ‘Oh, HIPAA!’” says Ryan. “We said, ‘HIPAA? We brought them in! We know their name and know what at least their initial diagnosis is: opiate disorder! Where’s the violation of HIPAA?’”

Ryan, who has been Arlington’s police chief for 19 years, says making progress against the opioid epidemic requires a “damn the torpedoes” response to over-cautious fears about liability. “If we’re in business of saving lives, that stuff will catch up,” he says.

Arlington has gotten results. Ryan reports one suspected fatal overdose in Arlington in 2017, down from monthly overdoses in late 2015 and early 2016. Arrests for drug possession are now rare in Arlington, the chief says. Instead, police seize drugs and refer addicts to treatment. Prosecutors questioned that policy at first, Ryan says, but Ryan compares it to the discretion police use to get drug dealers to flip on their sources in exchange for not being charged.

“We’re deciding how our community should be policed, with the community,” Ryan said. “That’s what needs to be happening nationwide, because our state government and our federal government are not bringing the necessary sense of urgency to this issue.”



***

Steve Lesnikoski, who poses for a portrait in Swampscott, MA on Jan. 24, 2017, was the first person to walk into the Gloucester Police station to seek help under its pioneering Angel Program that helps opioid users and addicts. Lesnikoski has been clean for nearly 18 months. (John Tlumacki/The Boston Globe via Getty Images)

After Steve Lesnikoski finished the detox program in Danvers, he went on a recovery program in California. By late summer 2015, he had relapsed. But Campanello, the police chief, kept calling to check on him, and finally he returned a call and admitted he needed another chance at treatment. Campanello found him a 12-step-based recovery center in New England that took him for 38 days. He got sober on his second try. After working mental health and municipal-sewer cleaning jobs in Massachusetts, he took a job at PAARI in September 2017.

Now, Lesnikoski works with people who ask for help at two local police stations. He also counsels addicted jail inmates on their recovery and return to the community, including career skills like job-hunting—“basic stuff that I wish people had told me,” he says.

Lesnikoski and other PAARI counselors now refer people to treatment centers across the country. A hundred miles down the Massachusetts coast from Gloucester, Tom Brancaleone, 34, is halfway through a month-long drug treatment program at Cape Cod Recovery in Hyannis, thanks to a PAARI counselor and Gloucester’s police department.

A Gloucester resident who used to work in the Gorton’s fish-processing facility there, Brancaleone says he knew about the program long before he needed it. His knee injuries—

one from high school basketball, one from a drunken accident at a college party—led him to prescription opiates. “I was doing it more and more and more, like Guns ’n’ Roses’ ‘Mr. Brownstone’ – ‘I used to a little, but a little wouldn’t do.’” When dealers in Gloucester ran out of pills last July, Brancaleone turned to fentanyl, a synthetic and extremely powerful opiate. “By the end of summer, sure enough, if I had nothing within 24 hours, I was feeling it.” Now he was addicted, using fentanyl to ward off withdrawal.

Gloucester police arrested him this year when he drove back into town with fentanyl. He turned to PAARI for help, and counselors found him a detox center, then got him into Cape Cod Recovery on a scholarship. It’s an abstinence-based center, which he prefers—no methadone or suboxone to quell cravings for fentanyl, just daily group therapy, weekly individual therapy, and trips to local 12-step programs at night. As long as he successfully completes the recovery program here, his criminal case will be thrown out.

“People don’t have to have fear, especially in Gloucester,” Brancaleone says. “The police, from top to bottom, know pretty much everybody in town. [They’re] friends and family, not just the people who get you in trouble. They actually care. The development of the program shows that even more.

“People don’t have to worry about getting in trouble anymore,” he said. “That’s huge.”