Hope Initiative launches a treatment-referral program in Roanoke

The Hope Initiative launches a treatment-referral program in Roanoke as a police-backed effort to connect people with heroin addiction to treatment rather than handcuffs. Built around trained volunteers, local health and social services, and a developing network of treatment providers, the program aimed to guide participants through a difficult route into care. Its first months showed both the value of persistent personal support and the structural limits of a referral system when beds, medication treatment, money, and smooth hospital transfers were scarce.

Origins and Design

As he approached retirement after twenty-four years on the force, Chief Perkins was looking for a way to respond to Roanoke’s growing heroin problem by bringing health-care and criminal-justice agencies into the same effort. He had in mind the Police Assisted Addiction and Recovery Initiative, a program associated with a Massachusetts police department that offered treatment in place of arrest to people who turned in their drugs. The Roanoke version, named the Hope Initiative, was Perkins’s final major project as chief. Its proposed incentive was to treat addiction as an illness and allow people who remained in recovery to avoid further police involvement.

The initiative was designed as a public-private partnership. Trained volunteers, called angels, would help people locate treatment and stay engaged through a process often complicated by relapse. The model envisioned volunteers with the practical support skills of social workers, able to draw on housing, mental-health, and employment resources. The program was based at the Bradley Free Clinic in Old Southwest, an area where heroin use was becoming increasingly visible.

The project’s practical machinery included a five-page spreadsheet listing thirty-six rehabilitation and aftercare providers across the southeastern United States. Volunteers could contact providers according to a participant’s ability to pay and whether a bed was available. People could come to the clinic on the second Monday of each month and, if they had no outstanding warrants, be paired with trained volunteers. Social-service workers were available to help eligible participants apply for Medicaid. Some volunteers also helped arrange outpatient medication-assisted treatment, although they disagreed among themselves about its value, with some objecting to treating addiction with another medication despite evidence supporting the approach.

Families, Volunteers, and Barriers to Care

The initiative’s personal stakes were especially acute for Janine Underwood, executive director of the Bradley Free Clinic. She joined the first Hope Initiative meeting in fall 2015 not as a physician but as the mother of Bobby Baylis, her twenty-eight-year-old son, who had died after using fentanyl-laced heroin. Bobby’s addiction had begun with OxyContin prescribed after surgery for a snowboarding injury. He had cycled through rehabilitation and jail, then spent three years in prison, where he participated in treatment and trained as a heating and air-conditioning journeyman. After release, he was working, living in his mother’s basement, and doing well; a visit with old friends was followed by a return to heroin use and his death.

Underwood threw herself into the project while still grieving. She did not initially believe in harm-reduction strategies or medication-assisted treatment, but tried to remain open-minded. When participants injected drugs in the clinic parking lot, police refrained from intervening because the initiative depended on people continuing to come through the door. Underwood and other volunteers also made themselves reachable on personal phones. Their calls included grieving parents seeking another bereaved parent’s understanding and a young participant named Matthew, who contacted Underwood repeatedly because he was in crisis. He died before the day he had planned to come to the program. The episode left Underwood feeling that the initiative was becoming a crisis center beyond her capacity.

The workload was matched by a mismatch between demand and available services. Twenty-two people came to the initiative in its first month. Some maintained contact and repeatedly expressed interest in help, but not one had entered residential treatment, and only a handful had obtained outpatient medication-assisted treatment. Underwood became so exhausted that colleagues called emergency medical services after she collapsed at work with stress-related vertigo. The spreadsheet had organized possible referrals, but it could not create treatment beds or remove the obstacles that kept people from reaching them.

The First Residential Placement

The initiative’s first residential-treatment placement came only after months of operation and weeks of intensive negotiation. The patient, identified under the pseudonym John, had used heroin for ten years and had been a friend of Bobby. After trying to detox at home, he was taken to a hospital by his parents when his condition worsened. Underwood spent eight hours in the emergency room with the family, supporting him as staff treated him and the family struggled to determine what to do next.

Underwood arranged for John to move directly from the hospital to detox, a rare handoff that avoided a waiting period. The connection to Bobby made her feel that John might listen to her, but she recognized that he could leave treatment. By the third day of detox he was already asking his parents to take him home. His next transition required further improvisation: a Hope volunteer worked with his father to arrange treatment out of state, while Underwood persuaded the detox center to keep John an additional day and organized a meeting between him and his family elsewhere. The transfer depended on many phone calls, sustained personal attention, and substantial expense. The case demonstrated what the initiative could accomplish when people stayed involved, but also how much coordination a single placement demanded.

Limits and Wider Significance

Hope Initiative volunteers applied for a grant to make hospital-to-treatment handoffs smoother, working with psychologist Cheri Hartman and emergency physician Karen Kuehl. Kuehl had been studying protocols in Ontario that automatically referred overdose patients from emergency rooms to outpatient medication-assisted treatment and counseling. In Roanoke, the plan faced bureaucratic, financial, and legal obstacles, as well as too few medication-treatment providers and too few detoxification and treatment beds. The grant application was unsuccessful. Meanwhile, state efforts to train peer-recovery specialists were still months from operation, leaving hospital staff to refer revived overdose patients to the Hope Initiative without a reliable, immediate route into care.

The program’s work unfolded amid other barriers to medication treatment. Tess Henry, for example, had found one of the few Virginia facilities accepting patients on medication-assisted treatment during pregnancy, but continuing care after treatment could be expensive and difficult to secure. At the time, federal rules limited the number of patients a certified medication provider could treat, and waiting lists persisted. These pressures help explain why the Hope Initiative’s volunteers could identify a possible next step without being able to guarantee access to it.

Later efforts pointed toward more direct connections between emergency care and medication treatment. Warren Bickel received a grant for a Virginia Tech Carilion Research Institute pilot designed to streamline emergency-room transfers to outpatient buprenorphine, while Roanoke’s community services board added medication treatment for twenty-one patients on the condition that they first engage in counseling. Carilion still had a three-week wait for outpatient medication treatment. These developments did not erase the initiative’s early constraints; they underscored its central lesson: compassion and referrals mattered, but dependable treatment required capacity and coordinated services beyond what volunteers alone could provide.