Humans in Public Health: To Protect and Serve

Rhode Island will make history later this year when it opens the first state-approved safe injection site in the country. To get ready for this big moment, we spoke to Brandon del Pozo, who’s studied the effects of New York City’s safe injection sites.

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Megan Hall 00:38

Welcome, Brandon. I'm so glad to have you here.

Brandon Del Pozo  00:41

It's great to be here. Thanks.

Megan Hall 00:42

Today Brandon is a researcher at Brown University, but his career has been anything but straightforward. 

After going to Dartmouth for college, he returned home to to work as a New York City police officer. 

Megan Hall  00:53 

How did you go from studying philosophy to deciding you wanted to be a police officer?

Brandon Del Pozo  00:59  

So I was the first person in my family to go to college. And the big plan was just to get a bachelor's degree but New York City had a very, very high crime rate. Just commuting to high school as a young person I witnessed a lot of crime was the victim of a lot of crime. So the opportunity to go to Dartmouth in like the middle of nowhere in New Hampshire was exciting. I thought it would be a respite from the city for four years, never having ever been in an environment like that. I was from Brooklyn.

Megan Hall 01:26

But one day in high school, a friend told Brandon about their college philosophy class. 

Brandon Del Pozo 01:32

and for some reason, that thrilled me and I really decided I want to study philosophy, but then like, what do you do with philosophy? Turns out, you become a New York City police officer 

Megan Hall 01:42

That's not usually what people do though?

Brandon Del Pozo 01:43

No clearly that’s the default option. So New York City at the time, you know, so much of my young adult life was defined by like the crime problem in New York City and a young person just trying to take the subway, trying to be out late at night and wondering about violence, it was a real thing. Crime is going down a lot. And a lot of the tensions that we have around policing now, weren't front and center then. People were excited that crime was going down. And they're excited to have a police force that had a role in that. And that wasn't just your stereotypical, like white communities or wealthy business folks. That was a lot of folks. So I thought, when I graduated from Dartmouth in 1996, with my philosophy degree that I would become a New York City police officer.

Megan Hall  02:26

When did you start thinking about the intersection between law enforcement and public health? When did that start to click?

Brandon Del Pozo  02:32  

As I rose through the ranks, and my work shifted from delivering police services myself to policy, and as my work shifted, Really when I went on to become the chief of police of Burlington, Vermont, and the mayor said, like, I want you to come up with an addiction policy that can't be enforcement related, it can’t be arrest centered. I realized that I needed to understand public health to accomplish that. Like and once you take a step back and start looking at public safety policy, if your eyes are open, you're going to start seeing it as directly intersecting with public health. A lot of chiefs if you interrogate what they're saying, they're saying they want to reduce death and injury at the community level. Like that's, that's public health.

Megan Hall  03:17  

You've said that you realized at some point, that public health is about science and systems. What do you mean by that?

Brandon Del Pozo  03:24  

So when the mayor of Burlington in 2015, said, Hey, I have a new police chief, he's full of ambition and big ideas, he's going to help us address the opioid crisis. I was surprised, that wasn't what I had signed up for. But it was what the city needed. It was this burgeoning crisis, that's now even just worse. But in doing the research, to understand how to respond to addiction, I realized that we already had a lot of the science at our fingertips, we have effective medications like methadone and buprenorphine, we have Naloxone that reverses overdose. We understand for opioids anyway, what effective treatment is.

So we have all of that I was surprised to see, in the midst of this big crisis that we kind of knew what to do at the individual level. The biggest gaps I saw were the systems that deliver those services. And a lot of those are not just healthcare systems, but systems of public administration. And so what I would always say as sort of a catchphrase was, “this isn't a problem of science. This is a problem of systems.” And I think that's one of the biggest tragedies of the opioid crisis is that we're not trying to split the atom. Right? We know how to get the science done. We're, we're just really, unfortunately bad at delivering on the systems.

Megan Hall  04:33  

So what do we need to do with those systems? How can we improve them? And what did you do in Burlington?

Brandon Del Pozo  04:38  

So I come from a public administration perspective where you have the sprawling systems that are out there to deliver things like public safety, to deliver social services, on their face, they may not have much to do with addiction, and treatment. But when you scratch the surface and look at what's driving these contacts with the public, when you look at the problems that policing, for example, is responding to, like addiction is one of the things it's always just below the surface, it's always right there. And so one of the things I think we need to do is be conscious and deliberate about turning these service delivery systems of policing and EMS into effective ways to identify the people that need the interventions, identify the people at risk, and then link them up– use transportation, we have communication we have like people building their careers out of being cops and getting to anywhere in the city in minutes, leverage that to identify the people that need the public health interventions and get them those interventions.

Megan Hall  05:30 

So instead of building new systems, just use the systems that exist in a different way?

Brandon Del Pozo  05:34 

I mean, listen, we definitely don't just want to continue to expand police budgets and say the police should also become addiction service delivery people. But I also think we don't want to build this separate siloed system as well. You're going to have, for example, police and EMS out there 24/7 responding to crises in the community. Everybody knows where their police station is, everyone knows the number to dial. So build out these other systems, whether it's mental health, for example, and co-response, or even mental health and responding is clinicians in lieu of police. So I don't see the police being the lead in this. I see them as being this, I mean, this deliberately, an inextricable partner in this.

Megan Hall  06:12

So after being the police chief in Burlington, you then left and went into academia. What was that transition like for you? Was it abrupt or you'd been kind of doing academic work this whole time you were racking up degrees.

Brandon Del Pozo  06:25 

So while I was a police officer, I got two separate master's degrees, one in criminal justice and one in public administration. And then a third separate PhD in political philosophy. But I was so excited hanging out with public health researchers and learning about like, I had all these normative ideas in my mind about what what the government ought to do for citizens. That was my doctoral studies. The researchers had those normative ideas as like vague concepts of justice in their mind, but they were acting on those vague concepts, trying to deliver services that make a difference, connect people with help, discharge the duties of government, like that sounds wonky, but it's true. And I said, you know, what, I've always been really action oriented. And my job, I mean, stereotypically policing is pretty action oriented. I said, Wait, there's a type of research I can do that, still has important normative bases. But that also involves like, acting, to get people help to change laws to change policy to get elected officials and chiefs of police thinking about things differently. I want to do that.

Megan Hall  07:23 

So let's talk about some of your research specifically, we're really interested in safe injection sites, because Rhode Island is opening its first site this summer. And we're the first state sponsored safe injection site in the country. But New York City already has some and you've done some research. For Rhode Islanders who are curious about what these safe injection sites are like, do you mind just kind of painting a picture for us about what they're like?

Brandon Del Pozo  07:48

They try to keep a balance between their ability to serve all the clients they can and to, you know, be clinically effective and also welcoming. So they are places where people who use drugs know that they can come, they're not going to be judged, they're not going to be bullied into treatment, they're not going to be told, Well, we'll let you use the drugs this time and reverse the overdose. But this has to stop, they’re told listen, welcome, we're glad you're here, we're going to make sure that you're safe. And then they're not just only given the opportunity to use drugs under supervision. Again, so if they overdose, instead of dying, they get revived. They're also linked with, for example, testing for hepatitis and HIV, they're linked with the opportunity to go to treatment for addiction when they're ready. They're also supplied with Naloxone, if they want it, they're given a stock of sterile syringes to use off site as well to stop the spread of HIV and hepatitis. And they'll also do things like if their clothes are dirty, a lot of these folks are unhoused, they'll say like you can clean off here we will wash your clothes. So it's a place where folks who are constantly judged and constantly like in the shadows, know that they can go and survive a very, very dangerous drug use environment in our community, and also know that they won't be judged. And when they're ready to get treatment, this is a place where they've come to trust and feel seen by the site, right?

Megan Hall 09:03

So what did you learn about what's happening at those sites?

Brandon Del Pozo  09:07 

So one of the things that we focused on in our research was this narrow problem of the public safety effects of opening a safe injection site, an overdose prevention center. You know, there's good evidence that they, for their clients, reduce the risk of overdose, it remains to be seen, because it has been so few of them, like what overall community level effect they'll have on overdose. That's that's something that the NIH has funded Brown and NYU researchers to study. But a lot of the political opposition to safe injection sites comes not from the principles of what's going on behind the doors. But what happens to the community outside? Are they going to become a magnet for disorder or a magnet for crime, are our drug users gonna flock to them, and then all of a sudden, it's an eyesore. And this isn't trivial. Philadelphia has preemptively banned safe injection sites from the city limits, specifically because they worry about the crime and disorder effects. So we have a lot of really good administrative crime and disorder data that New York City just makes public. And my colleagues and I took a deep dive into the effects of the two sites on crime and safety in their neighborhoods.

Megan Hall  10:09

And what did you learn? 

Brandon Del Pozo  10:10 

So first, the buried lede is that the New York City Police Department, to its credit, really stopped enforcing drug possession around those sites. And when I interrogate my old colleagues in private, they make more candid admissions that it was deliberate in public, I'll say this in public on a podcast, they're a little more reticent to just say they stopped making drug arrests, but they realized that you can't judge an overdose prevention center, a safe injection site on its merits, without giving it a chance. And if police are going to drive the clients away and make drug arrests in the neighborhood and make people scared to go there, they're just setting it up for failure. And as the first site in the U.S. that's operating out in the open, explicitly sanctioned by the local government, they wanted it to sink or swim on its own merits. So there was like an 85-88% reduction in drug enforcement around those sites, it was a very strong consistent finding, strongest finding of our study. There was a reduction in calls for medical assistance, there was a reduction in calls for homelessness conditions.

We don't have the power yet to rule definitively why but that's encouraging because one of the propositions of a site like this, it'll take public drug use and bring it into private locations and also reduce overdoses. So people aren't calling EMS for the overdoses, right? Crime and disorder wise, no significant changes. It did not change the tenor of those neighborhoods. One caveat, these sites were not cut out of whole cloth. They were needle exchanges, syringe service programs that were running already. So they took a neighborhood that had a high need. They took a neighborhood that had that need served by needle exchanges. And they added safe injection. If you take a neighborhood with no other services like that, and then open the site like, you might get a different result, it might develop a client base that would not otherwise be there. But if you take a neighborhood that's already contending with overdose and addiction, that's already being served by a syringe service program, and you add consumption, you add injection, our study said it didn't really change anything, it just improved things.

Megan Hall  12:10  

So based on your research and your experience, what do you think Rhode Island can expect when it opens its site?

Brandon Del Pozo 12:16  

So I want to say in some ways, Rhode Island can expect a lot of nothing. And I say that in a positive way, because this is not one of the Horsemen of the Apocalypse. But I also urge people to understand that this is not going to solve the overdose problem in Rhode Island, it is just going to be another important way to keep people alive, limit the spread of disease, deliver important services. And fill a gap, right? You're not going to see all of a sudden, like this open air bazaar or people hovering around it, it's going to be people coming and going the way they come and go to Harm Reduction Centers already. That's the one part of the nothing burger. And the other one is it's you're not going to see overdoses plummet overnight from one center, it just won't. It didn't happen in Vancouver, it didn't happen in New York, it didn't happen in Europe, it won't happen here. Don't take either of those markers as as decisive for that whether that program should persist or not like it's, it's just going to be another useful tool to save lives.

Megan Hall  13:14

Just to sort of wrap things up, what are your goals for the next 5-10 years? What are you hoping to accomplish?

Brandon Del Pozo  13:19 

So as a researcher, one of the things that interests me is the way that police can get people in contact with treatment in large numbers, that doesn't mean I want the police to lead the issue or be centered in the response. But it does mean that when police respond and not even drug related things, when they respond to theft, when they respond to trespass, when they respond to domestic violence to homelessness conditions, things that people call the police for and are not going to stop calling the police.

I want law enforcement to understand that we have these very effective responses to opioid addiction, medication assisted treatment, wraparound services, that if they link people to these services, and these treatments will not only reduce addiction and overdose, it will reduce crime. People engage in criminal activity to maintain their drug use, right? And there's a lot of evidence that shows when you link them up with the treatment, the crime goes down as well. So for me, as a researcher in the next several years, I want police officers to understand that it's feasible, and it should be acceptable to take folks into the policing system and link them directly to treatment instead of just charging them with crimes.

Megan Hall  14:26  

Awesome. Well, Brendan del Pozo, thank you for coming in today.

Brandon Del Pozo  14:29  

It's a pleasure. Thank you so much.