For this week’s show, we’re sharing an episode of “Humans in Public Health,” a podcast from The Brown School of Public Health. It makes a great follow-up to our episode earlier this month about Rhode Island’s first-in-the-nation legally approved proposal for a safe injection site (also known as an overdose prevention center) and how such programs will hopefully fit into the fight against America’s overdose crisis. 

Host Megan Hall spoke with Brandon del Pozo, an assistant professor of medicine and health services at Brown (and a former police officer), about the relationship between America’s overdose crisis, law enforcement’s drug policies, and the growing interest in safe injection sites around the country. They discuss how safe injection sites in New York City have affected the overdose crisis there and what lessons Rhode Island can learn as the state plans to open its first safe injection site later this year. 

Listen to more from Humans in Public Health

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DAN RICHARDS: From the Watson Institute for International and Public Affairs at Brown University, this is Trending Globally. I'm Dan Richards. A little while back on the show, we took a look at Rhode Island's soon to open overdose prevention center, which will be the first in the country to operate with its state's approval.

Overdose prevention centers, also known as safe injection sites, are places where people can bring illegal drugs and consume them under the supervision of trained health care workers. Many public health experts see these types of sites as potentially powerful tools in curbing America's overdose crisis, which claimed over 112,000 lives in Twenty Twenty-Three.

This week, we're sharing an episode from another podcast that takes a slightly different look at the issue. Humans in Public Health is a podcast from the Brown University School of Public health, hosted by Megan Hall.

On this episode, she spoke with Brandon del Pozo, an assistant professor of medicine and health services at Brown. Brandon also served for almost two decades as a police officer with the New York City Police Department.

Recently, he's conducted research looking into the effects of what right now are the only openly operating safe injection sites in America in New York city, where, to be clear, they operate without the state's legal approval.

On this episode, Megan talked with Brandon about the overdose crisis, the growing interest in safe injection sites, and the relationship between public safety and public health. We hope you enjoy Humans in Public Health.

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MEGAN HALL: Welcome to Humans in Public Health. I'm Megan Hall. In the past few years, the field of Public Health has become more visible than ever before. But it's always played a crucial role in our daily lives. Each month we talk to someone who makes this work possible. Today, Professor Brandon del Pozo.

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, I spoke to Brandon del Pozo, who studied the effects of New York City's safe injection sites. Welcome, Brandon. I'm so glad to have you here.

BRANDON DEL POZO: It's great to be here. Thanks.

MEGAN HALL: 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 work as a New York City police officer. So how did you go from studying philosophy to deciding wanted to be a police officer?

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

BRANDON DEL POZO: And for some reason, it thrilled me. And I really decided I want to study philosophy. But then, like, what do you do with philosophy? It turns out you become a New York City police officer.

MEGAN HALL: That's not usually what people do, though.

BRANDON DEL POZO: No, that's the default option. So New York City at the time, so much of my young adult life was defined by 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 was 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 Nineteen Ninety-Six with my philosophy degree that I would become a New York City police officer.

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

BRANDON DEL POZO: 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, that can't be arrest-centered, I realized that I needed to understand public health to accomplish that.

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, that's public health.

MEGAN HALL: 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: So when the mayor of Burlington in Twenty Fifteen 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.

And I was surprised to see in the midst of this big crisis that we kind of knew what to do with the individual level. The biggest gaps I saw were the systems that delivered those services. And a lot of those are not just health care systems, but systems of public administration.

And so what I would always say is sort of a catch phrase 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 just really, unfortunately, bad at delivering on the systems.

MEGAN HALL: 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: So I come from a public administration perspective. You have these 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 that'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 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: So instead of building new systems, just use the systems that exist in a different way?

BRANDON DEL POZO: 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. Everybody 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 as 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 inextricable partner in this.

MEGAN HALL: 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: 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 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, make a difference, connect people with help, discharge the duties of government. That sounds wonky, but it's true.

And I said, you know what? I've always been really action-oriented in 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 then also involves 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: 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: They try to keep a balance between their ability to serve all the clients they can and to be clinically effective and also welcoming. So there 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'll 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.

MEGAN HALL: So what did you learn about what it's happening at those sites?

BRANDON DEL POZO: 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. There's good evidence that they-- for their clients, reduce the risk of overdose.

It remains to be seen because there's been so few of them, like what overall community level effect they'll have on overdose. 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 drug users going to 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: And what did you learn?

BRANDON DEL POZO: So first, the buried lead 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 setting it up for failure.

And as the first site in the US 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 is 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.

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

BRANDON DEL POZO: 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. 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 nothingburger. And the other one is that you're not going to see overdose plummet overnight from one central. 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 decisive for whether that program should persist or not. It's just going to be another useful tool to save lives.

MEGAN HALL: Just to wrap things up, what are your goals for the next 5, 10 years? What are you hoping to accomplish?

BRANDON DEL POZO: 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 to-- 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. 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: Awesome. Well, Brandon del Pozo, thank you for coming in today.

BRANDON DEL POZO: It's a pleasure. Thank you so much.

MEGAN HALL: Brandon del Pozo is an assistant professor of Medicine at the Warren Alpert Medical School, and an assistant professor of Health Services, Policy, and Practice at the Brown University School of Public Health.

Humans in Public Health is a monthly podcast brought to you by Brown University School of Public Health. This episode was produced by Nat Hardy and recorded at the podcast studio at CIC Providence. I'm Megan Hall. Talk to you next month.

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DAN RICHARDS: If you like this episode, be sure to subscribe to Humans in Public Health wherever you listen to podcasts. And if you haven't subscribed to Trending Globally, please do that too.

If you have any questions or ideas for guests or topics, send us an email at trendingglobally@brown.edu. Again, that's all one word, trendingglobally@brown.edu. We'll be back in two weeks with another episode of Trending Globally. Thanks.

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