The opioid epidemic continues to ravage communities, transcending race, gender, disability, socioeconomic status, and geographic location. In 2022, on average, 218 people died every day from an opioid-involved overdose for a year-end total of 79,770 deaths. In Pennsylvania specifically, a resident dies every two hours from an opioid-involved death.
Importantly, individuals on probation and parole are more likely to have opioid use disorder (OUD) and more likely to experience an opioid-involved overdose compared to individuals not on community supervision. Despite the evidence, probation and parole agencies connect relatively few individuals with OUD to the services and support they need.
The Pennsylvania Commission on Crime and Delinquency (PCCD), recognizing the opportunity for local probation and parole agencies to intervene with individuals on community supervision with OUD, launched the Comprehensive Opioid, Stimulant and Substance Use Site-based Program (COSSUP). COSSUP’s goal is to reduce overdose deaths among Pennsylvanians on probation and parole by building the capacity of local communities to support these individuals. PCCD is collaborating with Justice System Partners and CUNY’s Institute on State and Local Governance (ISLG) to lead these efforts.
The Scale of Opioid-Involved Overdose in Pennsylvania
While incarcerated in jails or prisons, individuals’ use of substances and particularly opioid-related substances declines substantially, if not completely. Individuals may remain abstinent for months or years during their incarceration. When they return to the community, referred to as the reentry period, many individuals, now with a criminal conviction, struggle to find stable housing, employment, and must navigate complicated rules of community supervision and challenging interpersonal relationships often fractured from their time incarcerated. To manage these conditions, released individuals may return to drug use to cope. However, when individuals return to drug use after periods of abstinence, they often do not account for their loss of tolerance and return to using the same amount of drugs as before incarceration – a dosage that is often too much for their bodies. Evidence suggests recently released individuals are, as much as, 129 times more likely to experience a fatal overdose within the first two weeks of returning home from incarceration.
These numbers are frightening for the state of Pennsylvania – a leader in incarceration. Pennsylvania incarcerates more than 73,000 people each year across their jails, prisons, juvenile detention centers, and federal prisons. State correctional leaders estimate as much as half of these incarcerated individuals have a substance use disorder (SUD). This means many Pennsylvanians are at risk for leaving state jails and prisons, returning home, and experiencing an overdose.
Importantly, Black and Hispanic individuals disproportionately experience incarceration in Pennsylvania and disproportionately experience opioid-involved overdoses upon their return home. Black Pennsylvanians are nearly twice as likely to experience an overdose compared to white Pennsylvanians. Research suggests structural disadvantage such as lack of access to quality housing, healthcare, economic opportunity, coupled with systemic racism and stigma related to justice-involvement contributes to these overdose rates.
These same features systematically deny access to prevention, harm reduction, and treatment services for individuals with OUD, leading to disproportionate overdose deaths among these minoritized communities.
Recognizing these staggering numbers, particularly among historically disinvested communities, Pennsylvania is reimagining their approach to the fight against opioid-involved overdoses for individuals on probation and parole.
Centering Communities in the Fight Against Opioid-Involved Overdoses
Historically, probation and parole agencies will assess individuals to understand if the individual may meet the criteria for substance use disorder. If the assessment suggests the person may meet the criteria, these agencies refer individuals to community services for clinical assessment and treatment. However, in many communities, especially those experiencing structural disadvantage, there are few if any services specifically for opioid use disorder.
Further, gaining access to these services may require long wait times, the need for private insurance, or out-of-pocket expenses that are far too expensive for individuals on probation and parole to afford. While agencies are doing the best they can with what they have, this leaves individuals on probation and parole without the comprehensive care they need to manage their OUD.
As a result, many individuals are not able to follow the rules or conditions of probation and parole – stay drug free and enroll and engage in treatment. When they do not meet these requirements, probation and parole departments often issue violations or revocations and force the person to return to jail or prison. When released from jail they return, again, to the same disinvested communities where the cycle continues.
To interrupt this cycle, COSSUP takes a fundamentally new approach. COSSUP centers the community and people historically excluded from conversations related to service development. Across five selected Pennsylvania communities, the communities themselves will identify the needed continuum of services, an action plan for meeting those needs, and work together on implementing the plan.
Dr. Tameka Williams, Senior Associate at JSP and COSSUP project director reflects, “It’s time everyone, including people who have been historically excluded, have access to the support they need. To do this, we must hear from the communities and people most impacted.”
The Comprehensive Opioid, Stimulant and Substance Use Site-based Program (COSSUP)
Across the five participating Pennsylvania communities: Allegheny County, Chester County, Dauphin County, Franklin County, and York County, each must assemble a community advisory board (CAB) to lead the work in the community. Each CAB includes local leaders from probation and parole agencies, treatment providers, local opioid experts, justice-involved individuals, and individuals with- and in recovery from- SUD and OUD– some of whom have experienced a non-fatal overdose while on community supervision. Importantly, all members of the CAB agree each participant offers a unique perspective, but each are equal experts.
Williams, “It isn’t enough to have a seat at the table. We need to make sure we’re passing the people most impacted the mic more often than not. They are the real experts here. The CAB meetings offer an opportunity to elevate their voice.”
Each community’s CAB leads four phases of work.
- Phase 1: The first phase includes listening sessions with CAB members and the wider community to learn more about the impact of SUD and OUD on their local community.
- Phase 2: Informed by Phase 1 sessions, Phase 2 includes a needs assessment of each local community including identifying assets and gaps to address OUD, especially for individuals on probation and parole.
- Phase 3: With a greater understanding of what communities need, Phase 3 includes the development of a strategic community action plan authored by the CAB and other stakeholders, detailing the approach to addressing the gaps. To assist in the development of these plans, JSP will develop a virtual statewide community of practice connecting sites with each other to improve efforts.
- Phase 4: During Phase 4, each CAB will lead the implementation of this community action plan.
CUNY’s ISLG will monitor implementation of action plans across communities during Phase 4 and will also evaluate how these changes impacted several key outcomes for individuals on probation and parole: referrals to treatment, engagement in treatment, revocation rate of individuals with OUD for drug related violations, and new drug related offenses.
Personalizing the Work
Although the CABs lead decision-making across the four phases of work, JSP staff including Williams, JSP associate Lauren Henderson, and JSP contract-associate Teisha Sanders, from Wellbeing & Equity Innovations, will facilitate listening sessions, interviews, and CAB meetings. The goal of their facilitation approach is to ensure the emotional safety of everyone participating. Williams noted that “Researchers or consultants typically come to communities, ask questions, send the answers to the next group and move on. It’s resource extraction. Our equity approach means we must consider the emotional safety of everyone who participates.” For JSP staff, this includes intentional debriefing with individuals following sometimes tense conversations, showing empathy throughout conversations, and mindfully navigating conversations without stigmatizing language.
Henderson adds, “Many of us on the JSP team have family members with substance use disorder, have family members who were previously and currently justice-involved, or both. When we work with community partners and CAB members, we think about how we’d want our own family members to experience a project like this.”
However, JSP staff also recognize that taking an equity approach to the project must include a goal to understand the unique needs of communities within communities. This includes intentionally understanding the assets and needs within Black communities, Hispanic communities, and other minoritized communities residing across the five project counties.
Williams reflecting on the work completed to date, “We’re starting to learn more about why Black community members specifically are slow to engage in traditional treatment services. We’re starting to think more deeply about how traditional probation and parole rules and policies don’t account for this. We’re on our way to building culturally responsive services across these communities.”
JSP, in collaboration with county CABs, completed Phase 1, listening sessions, in Spring 2023 and completed Phase 2, community needs assessments, in June 2023. From the needs assessment, JSP named six key pillars to guide Phase 3 and Phase 4: collaboration, access, reducing stigma, equity, education, and support – CAREES. Sanders says, “It’s now COSSUP CAREES. These pillars are vital to this project and vital in promoting human potential and saving lives.”
Stay up to date on this project, and other JSP projects, by following JSP on twitter and LinkedIn. You can direct questions about COSSUP project goals and activities to Dr. Tameka Williams, email@example.com.
This project was supported by Grant No. 2020-AR-BX-0042 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice’s Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.
JSP Direct To Your Inbox
Get the latest news and articles from JSP.