Diversion programs, peer support and quick response teams form opioid strategy

Key Takeaways

In 2018, Ulster County had one of the highest per capita overdose death rates in New York state. Upon my election as sheriff in 2019, one of my first priorities was to develop an effective opioid response strategy that would reduce the loss of life my community was experiencing. As a veteran narcotics investigator, I knew that enforcement plays a critical role in addressing the opioid epidemic, but that more needed to be done to help those with substance use disorder. We needed a bold, systemic shift.

What we’re seeing in Ulster County is not unique. A recent needs assessment conducted by the National Sheriffs’ Association and the Opioid Response Network (ORN) found that 80% of responding sheriffs’ offices felt they lacked the resources needed to effectively address substance use disorders in their communities. Agencies across the country reported challenges related to treatment access, recovery services, training, and technical assistance. Those findings reinforced what many of us already knew: Law enforcement cannot tackle this crisis alone, and communities need practical, collaborative solutions that connect people to recovery.

ORN is a national initiative funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) through the American Academy of Addiction Psychiatry (AAAP). Through a large coalition of national organizations, ORN provides free training, education, and technical assistance in every state and territory to support communities addressing opioid, stimulant, and other substance use disorders.

That is why in 2019, I launched the ORACLE initiative, short for Opioid Response as County Law Enforcement. My vision was simple: Combine the authority of law enforcement with the deep empathy of peer advocates and medical professionals.

From the beginning, we recognized that sustainable recovery requires a coordinated response that includes law enforcement, public health agencies, healthcare providers, behavioral health professionals, and community-based organizations. By October 2020, we partnered with the Ulster County Department of Health to secure a three-year federal Comprehensive Opioid, Stimulant, and Substance Use Program (COSSAP) grant from the Bureau of Justice Assistance, giving us the resources to take this compassionate model countywide.

The power of peers on the front lines

The cornerstone of our expanded response is the High-Risk Mitigation Team (HRMT). When an overdose call comes in, we don’t just send a deputy with handcuffs. We deploy a team consisting of a law enforcement officer and a Certified Recovery Peer Advocate (CRPA).

These peer advocates are the heroes of this operation. Many of them have their own lived experiences with substance use recovery. When a survivor is sitting on a bathroom floor after being brought back to life, they don’t see a badge looking down on them; they see someone who has been exactly where they are and survived. That instant connection builds trust, breaks down defensive barriers, and opens the door to long-term recovery support.

Over the course of this three-year grant, our collaborative infrastructure achieved incredible milestones:

• True county collaboration. We secured buy-in from all 15 local police departments, establishing a dedicated ORACLE liaison officer in every jurisdiction.

• Real treatment pipelines. We referred 449 individuals directly into substance use treatment and connected 807 clients to critical recovery support services.

• Breaking jail cycles. We instituted medications for opioid use disorder (MOUD) induction inside the Ulster County Jail, supported by an ORACLE care manager who handles postrelease intake, housing, food, and probation coordination to help individuals transition back into the community and maintain their recovery.

Cutting through the bureaucracy

In the early days of this initiative, we faced significant logistical hurdles. Communication between local police departments and my office was slow, relying on emailed forms that often delayed our HRMT deployment by days.

We refused to let administrative red tape cost lives. We completely overhauled our overdose alert and data collection system, integrating the IamResponding platform to give our teams real-time dispatch alerts. We bought iPads so our deputies and peers could secure digital client consent signatures on the scene, cutting time-to-service down instantly. When we realized a lack of available county vehicles was stalling our teams, my office dedicated a minivan to transport those with substance use disorder (SUD) to rehab locations anywhere in the state or even the tristate area. We also have a recreational vehicle that we take to community functions to educate the public about SUD.

The reality of the numbers

As sheriff, I believe in absolute transparency with the community I serve. When we look at the data from our final COSSAP report spanning October 2020 to September 2023, we see a complex battleground.

We set out to change police culture, and we did. We partnered with People USA to provide intensive 40-hour Crisis Intervention Team (CIT) training. We trained 90 new officers, bringing our county total to 190 CIT-equipped law enforcement personnel. Furthermore, our logistical upgrades worked: The percentage of overdose responses handled within the critical 24-hour window climbed significantly, from 57% in Year 1 to 64% by Year 3.

Yet, our ultimate goal—to cut overdose incidents—remained difficult to achieve. Nonfatal overdose incidents in Ulster County rose from 154 in Year 1 to 260 in Year 2, and reached 413 by Year 3.

These rising numbers are not a sign that our compassionate model is failing. They are proof of the devastating, unprecedented external forces we are fighting. The timeline of this grant hit the compounding trauma of the COVID-19 pandemic and, more aggressively, a lethal influx of fentanyl, xylazine, and other dangerous synthetic substances into our communities.

The next phase

We continue to seek results. Over these three years, my team hosted 363 community education events, provided the county with life-saving naloxone kits, and established a public naloxone box program to place nasal spray directly into high-risk areas.

The work we’ve done has institutionalized a safety net that never existed before in Ulster County. I am proud to share that we have secured a second three-year federal COSSAP grant.

Moving forward, my office will utilize these funds to strengthen our support systems inside the county jail, expand targeted outreach to our Black, indigenous, and people of color communities, and deploy specialized resources to address the rising crisis of intentional, mental health-driven overdoses.

We will continue to protect our communities with tactical excellence, but we will continue to heal them with empathy.

How the Opioid Response Network can help your community

Substance use disorder impacts individuals, families, first responders, and public safety systems every day. Sheriffs are often on the front lines of this crisis and understand that prevention, treatment, and recovery are essential components of an effective community response.

The National Sheriffs’ Association is proud to partner with the American Academy of Addiction Psychiatry and the Opioid Response Network (ORN) to help connect communities with free training, education, and technical assistance related to opioid, stimulant, and other substance use disorders.

Through this national initiative, law enforcement agencies, community organizations, healthcare providers, and local leaders can access resources designed to reduce stigma, strengthen prevention efforts, support treatment and recovery, and improve community outcomes. ORN has consultants in every state and territory who can provide support across prevention, treatment, recovery, diversion programs, recovery support services, and community collaboration efforts.

If your agency or community could benefit from additional resources, training, or technical assistance, visit OpioidResponseNetwork.org and submit a request. Within one business day, an ORN representative will contact you to discuss your needs and connect you with available resources. —J. Figueroa

Disclaimer

Funding for this initiative was made possible (in part) by grant no. 1H79TI088037 from SAMHSA. The views expressed in this article do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. government.