Police Assisted Addiction and Recovery Initiative

The Police Assisted Addiction and Recovery Initiative (PAARI) offered a way for police to respond to heroin use by connecting people with treatment rather than treating arrest as the default. In Roanoke, the model became the Hope Initiative, a public-private effort built around trained volunteers, treatment referrals, and continued support. Its ambitions were substantial, but its early experience also showed how much depended on a fragmented care system being able to receive the people the initiative was trying to help.

Origins and purpose

On the eve of his retirement, Roanoke police chief Chris Perkins was looking for a response to the city’s surging heroin problem that could bridge health care and criminal justice agencies. He drew on a model developed in Gloucester, Massachusetts, where police chief Joseph Campanello offered people a route to treatment instead of handcuffs if they turned in their drugs. By early 2017, that model, known as the Police Assisted Addiction and Recovery Initiative, had been adopted by 200 police agencies in 28 states. In Roanoke, the PAARI program took the name Hope Initiative and became Perkins’s final major effort before leaving the force.

The program’s premise was to treat addiction as a disease and make treatment—not the threat of arrest—the incentive for seeking help. That approach contrasted with a cycle in which people who had begun with prescription pills could turn to heroin, sell portions of their supply to finance further purchases, and bring new customers into the same network. The Hope Initiative was designed to interrupt that cycle at the point where a person might accept help, while recognizing that the wish to stop using did not itself remove the physical, psychological, or practical barriers to treatment.

The Roanoke model

The Hope Initiative was conceived as a public-private partnership. Its trained volunteer mentors, called angels, would help people enter treatment and remain alongside them through a difficult process in which relapse was common. The intended role combined the availability of a recovery sponsor with the practical skills of a social worker: angels could help people navigate housing, mental-health care, and employment resources as well as treatment. The program was located at the Bradley Free Clinic, a long-running volunteer-staffed clinic serving working people in Old Southwest, an area emerging as a heroin hot spot.

The local effort brought together people whose connection to the crisis differed. Janine Underwood, the clinic’s executive director, attended the first Hope Initiative meeting in fall 2015 not because she was a physician, but because her son Bobby Baylis was among four people who died that June after using fentanyl-laced heroin. Before his death, Bobby had moved between rehabilitation and jail after becoming addicted to OxyContin prescribed following an ACL injury in a snowboarding accident. During a three-year prison sentence, he had participated in treatment and trained as a journeyman in heating and air-conditioning. After release, he was doing well at work and living in his mother’s basement; three months later, contact with old friends from Hidden Valley preceded his return to heroin and his death. Underwood’s presence connected the program’s institutional work to a family’s experience of both recovery and loss.

Referrals and barriers to care

The initiative’s work was not simply to persuade someone to seek help; it had to connect that willingness to an available place in treatment. Local advocates studied a hospital process in Ontario in which overdose patients were automatically referred from emergency rooms to outpatient medication-assisted treatment and counseling. Psychologist Cheri Hartman, a Hope Initiative coordinator, was helping develop a comparable handoff in Roanoke. The effort encountered bureaucratic, financial, and legal obstacles, including too few providers of medication-assisted treatment and too few detoxification and treatment beds. A grant application offered hope of improving the transition, while hospital social workers meanwhile referred people revived after overdoses to Hope, including a growing number who had passed out while driving.

The treatment pathway could break down at basic steps. People leaving a hospital could need someone else to make a call to a detox center on their behalf; even a referral did not guarantee admission or a continuing place in care. A state effort to fund peer recovery specialists through Carilion and other hospital networks was meant to help patients with opioid-use disorder and mental illness move between emergency care and treatment, but it would not be operational for months. In the meantime, agencies were responding in crisis conditions, with interventions that did not always fit together.

Early reach and limits

In its first month, 22 people came to the Hope Initiative. The angels saw progress among some who repeatedly expressed interest and stayed in contact by text or phone, but none had entered residential treatment, and only a handful had obtained outpatient medication-assisted treatment. The gap between contact and care made clear that volunteer attention alone could not create treatment capacity. Underwood became so exhausted that colleagues called emergency medical services after she passed out at work from stress-related vertigo.

A later case showed how much coordination a successful transfer could demand. When John was due to leave detox, a Hope volunteer working with his father arranged a flight to an out-of-state treatment center, but the transfer still depended on Underwood. She persuaded the detox center to keep him for an extra day and arranged an off-site family intervention because detox managers would not allow the meeting on their premises, even in the parking lot. His father hired a retired police officer who escorted reluctant patients into treatment, and the group brought John to a conference room under the pretext that he was going to outpatient counseling. The episode illustrates both the initiative’s persistence and the precariousness of the opening it was trying to use: arranging a destination was not enough if discharge, family coordination, and admission could not be aligned in time.

The Police Assisted Addiction and Recovery Initiative supplied Roanoke with a different organizing principle: police could become a point of entry to treatment rather than only a mechanism of punishment. The Hope Initiative put that principle into practice through volunteer mentoring and local referrals, but its first-month results and the difficulty of individual handoffs exposed the limits of a referral program operating amid scarce beds, limited medication treatment, and disconnected institutions. Its story is therefore not only one of police innovation, but also of how the promise of help can depend on whether the wider system has somewhere—and a workable route—for people to go.