Police Chief Leonard Campanello’s New Fight Against the Heroin Crisis
Two days later, on Sunday, Mike exchanged texts with his dealer, walked to the end of the street, and scored another bag. Then he overdosed in the bathroom while his mother was home. “He was starting to turn blue,” Susan recalls. She called an ambulance, Mike regained consciousness, and off he went to the emergency department. By Tuesday, Mike was on his way to a monthlong “dual diagnosis” treatment center in rural Georgia specializing in addiction and mental health. It started out well, but derailed three weeks in, after Susan received a call from the facility informing her that Mike’s insurance—he had since switched to his father’s private plan—would no longer pay the approximately $260-per-day room-and-board fee, though they would continue paying for his medications, including, she says, a $1,100 shot of Vivitrol, a powerful drug that essentially blocks the brain from craving opioids for a month. With nine days left until Mike completed treatment, Susan’s stomach churned with anxiety as she tried to figure out how to come up with more than two grand. “I told them I don’t have any money,” she said.
Mike, knowing that his mom had already forked over thousands of dollars and was struggling to make her own ends meet, checked out of the facility more than a week earlier than scheduled. He traveled to Palm Beach County, Florida, and bounced among a few sober-living houses, as far as his mom knows. Rarely does he call or answer his phone, opting to communicate almost exclusively through text messages. She wants to believe that he is waging his way to sobriety and making the right decisions, but she sees red flags everywhere. His texts asking for food money have increased in frequency. With every small sum she wires down to him, she worries. “I wait for the day that he comes back and is really healthy,” she says. “Or I wait for the really bad thing. Those are really my only two options. The reality of this horrible disease is you get one or the other, and most people get the second one.”
When Campanello promised to stop arresting Gloucester’s heroin addicts, the hardest part wasn’t bending the law. The chief’s biggest problem was figuring out how he was going to find his addicts a bed in a treatment facility. There is general agreement, from doctors, EMTs, and cops on up to elected officials, that addiction needs to be treated the same way we treat diabetes and asthma: as a chronic disease. Addicts may overdose again and again before finding their way into recovery—or dying. But in practice, addiction treatment is a crapshoot: Our system is a public/private patchwork in which insurance companies can change a patient’s course of care, seemingly on a whim. Maybe there will be a bed when you need one, maybe there won’t.
If you have money and Cadillac health insurance, you won’t have to make 25 phone calls to find a detox bed. But disposable income and PPOs are uncommon among heroin users, and every morning hundreds of people in Massachusetts are told by treatment centers to wait another day to see if a bed opens up and to call again tomorrow. It’s impossible, however, to know precisely how many addicts in the state need detox care. Despite the governor’s task force, which has delivered a list of 65 action items, Massachusetts has no centralized waiting list. There’s not even so much as a statewide database of available treatment services for families to access online (though creating one is an action item for Baker). Campanello knew that he couldn’t just tell a heroin addict to wait a few days and come back: For those working through withdrawal symptoms, frustration can morph into despair as they convince themselves that no treatment center will take them, and that getting help is a fantasy.
As part of a statewide plan, Baker has vowed to add 100 new treatment beds to the state by July 2016. But Campanello insists quantity is not the issue. “There are beds everywhere,” he scowls. “The cries of there are no beds really refer to the lack of support from insurance companies.” The chief knew, from the beginning, that if he was going to place heroin addicts in treatment beds, he couldn’t rely on the state, or the insurance companies. He’d have to find them himself.
On a recent afternoon, Campanello took back-to-back meetings in his office with representatives from two out-of-state rehab centers that have accepted his terms. Within days of announcing his plans on Facebook, Campanello had struck partnerships with 17 treatment centers in 11 states. All had promised him on-demand access to beds, linkages to long-term treatment programs—and, perhaps most important, financial assistance for some of the patients Campanello would be placing with them. In essence, Campanello is performing work that is usually reserved for nonprofits or state agencies: pooling together a group of addicts and streamlining them into care. And his network continues to grow, as more treatment centers look to score some good PR by aligning with a provocative police chief.
First up in Campanello’s office was a cherubic southern man named Brent Clements, who wore khakis, a white Brooks Brothers shirt, and hair scooped neatly to the side. His soft drawl led him to pronounce the town’s name as “Glow Chester.” The chief chuckled and corrected him. Over the course of an hour, Clements told the chief that his company, Addiction Campuses—which has facilities in Tennessee, Mississippi, and Texas—fields roughly 6,000 calls a day. Approximately 80 percent of those calls come from the Northeast. In fact, Clements explained, part of the reason he was visiting New England was to scout potential locations for a new facility.
Campanello has no delusions about the motives at play: The reality is that the epidemic isn’t just a financial boon for heroin dealers. A state that has near-universal healthcare coverage and an abundance of addicts is a potential gold mine for the healthcare industry. But the chief is determined to make this reality work for him—mainly because he has detected a possible end run around the hated insurance companies.
In theory, insurance companies are beholden to federal and state “parity laws,” which are supposed to guarantee that a patient’s mental health and substance abuse issues are covered equally with other health conditions. But the insurers still retain tremendous power over patients when it comes to deciding what’s “medically necessary.” A treatment center and clinician may believe that an addict needs 60 days of inpatient care—but the insurance company essentially has free rein to reject such a recommendation on grounds that the full course of treatment is not a medical necessity. Treatment providers can appeal these rejections, but that takes a lot of time. And insurers know that treatment centers have to pick their battles carefully when considering the thousands of other patients who will have similar insurance policies and need treatment in the future.
Campanello’s second meeting was with Thomas Zarnawski, who works for A Road to Recovery, a treatment facility based in Port St. Lucie, Florida. Zarnawski told the chief about his own struggles with addiction, and talked at length about the “crazy” limitations insurance companies place on addiction treatment. They have no problem picking up the tab for a prescription of Roxicodone when a teenager sprains his ankle, Zarnawski said, but if that same kid gets hooked and eventually needs to detox, it’s a whole different ball game. After settling in, Zarnawski admitted that he couldn’t believe he was meeting the man behind the Gloucester initiative. “I was shocked I was able to get you on the phone,” he told Campanello. “I was actually really nervous.”
Throughout these meetings, Campanello was at once compassionate and unquestionably tough. Though brief, the powwows are an important part of his plan; they are his way of making it known that standing behind every single patient who comes from Gloucester is a pissed-off police chief who will not stand for insurance companies dictating the level of care a person receives. “You can’t willpower your way out of this disease,” he grumbled. Of course rehab is a business, Campanello said. “But we are here to help people.”
The first heroin user looking for help arrived at the Gloucester police station around 3:30 a.m. on June 2, approximately 27 hours after Campanello opened the doors. Exactly three months later, 145 people have come to Campanello seeking treatment. Fewer than half are from Gloucester—they have traveled from other towns, other cities, and other states as nearby as New Hampshire and as far away as California. Just as the chief promised, he hasn’t charged any of them with a crime, and has placed every one in treatment.
A 23-year old, whom we’ll call Greg, was among the first to take the chief up on his offer. He started using OxyContin at age 15 before progressing to heroin, and has been in and out of more than a dozen treatment facilities in recent years. He learned about Campanello’s program through friends, saying, “I was just so down and out—I used up all my resources, I had nowhere else to go, I had nothing…. Even if it was a set-up and I was going to jail, it was somewhere to live. If it worked out, it worked out.”
Greg and the 144 other individuals who’ve come to the station house have all gone through a similar process: An on-call volunteer clinician travels to the station house, conducts an initial assessment, and talks with the user about his or her treatment history and what type of recovery program may work best. They are assigned a non-police volunteer, a so-called angel, who provides moral support and helps them overcome the challenges that derail so many. After a bed is secured, Campanello’s officers arrange for transportation. In Greg’s case, that meant a ride to the airport so he could get to a facility in Florida.
“We have yet to be able to find a scenario—with or without insurance, in and out of state, up and down, left and right—that we haven’t been able to place someone,” Campanello boasts. “And I’m not talking, ‘Oh, we’ll have that bed for you tomorrow,’ I’m talking, ‘Wait here. We’ll have a bed for you and we’ll bring you there.’”
It is too early to say whether this brand of police-supported treatment will mitigate overdoses, improve recovery outcomes, reduce readmission rates, or yield other quantifiable points of efficacy that policy wonks cherish. From Campanello’s vantage, 145 people sick with addiction that were perpetually at risk of fatally overdosing are alive today in part because they came to the police. “Chief Campanello brought me out of my comfort zone,” Greg says. “This is the first time in my life that I realize I can’t do this myself. I need to work with this program, and I need to do these steps and do it the right way.”
Another indication of the chief’s success—that he’s started a national conversation and people are listening—is the fact that other police departments, from Methuen to Illinois, are following his lead. The Arlington Police Department, inspired by the Gloucester program, has launched a door-to-door outreach effort in which a police officer and public health worker visit known opioid users and encourage them to seek care. In Illinois, the Lee County sheriff has copied the Gloucester model and started routing addicts to treatment in September, immediately placing six individuals into care.
Though enthusiastic, Campanello doesn’t underestimate how ravenous addiction can be and knows that treatment is an imperfect science. Massachusetts could very well top 1,300 fatal overdoses this year—an average of nearly four deaths a day. Gloucester has recorded one more fatal overdose since June 1, and some of the first people to enroll in Campanello’s experiment have already relapsed.
The chief knows this is part of the recovery process. He’s never claimed to have a cure. That’s why the last thing he tells people before they head to treatment is that if they fail, they should come back. “We’ll help you again,” he says. “Just come back in, and we’ll do it again.”