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Cook County Hospital fills more outpatient prescriptions every day than are filled at 26 Walgreen's drug store combined.
In tents and under bridges, a new Cook County sheriff’s office program helps hard-to-reach drug users
Sunday, December 01, 2019 Chicago Tribune by JOHN KEILMAN
A woman emerged from a blanket-draped tent in Chicago’s Austin neighborhood on a brisk November morning to find a half-dozen people from the Cook County sheriff’s office lingering on the sidewalk.
“Am I in trouble?” she asked. “I didn’t do nothing.”
The woman, 37, had been camping beneath a railroad overpass with her boyfriend for a year, and she had every problem in the book: drug addiction, mental issues, poor health, malnutrition and an infant lost to foster care, to say nothing of homelessness.
She had sought assistance many times, she said, but something always seemed to get in the way, whether an indifferent bureaucrat or a lack of bus fare. But there on the sidewalk, among the bulletproof vests and black windbreakers, help had arrived, albeit in an unusual form.
The sheriff’s employees were detailed to a new outreach program that attempts to connect particularly hard-to-reach drug users with treatment. They go to homeless shelters, trailer parks and bus stops to make their pitch, and follow up with people who receive emergency treatment for overdoses.
The program is in keeping with a law enforcement movement to seek treatment for drug users instead of jail time, though it’s more proactive than most. Since it began in June, about 160 people have been convinced to give it a try, and roughly half are still engaged with the program.
“The number of people we’re getting into treatment — that, to me, has been astounding,” said Sheriff Tom Dart. “That is really tricky even in the best of scenarios. I want to see where they are a year from now, but the initial numbers and reactions have been fantastic.”
The leader of the outreach unit is Elli Petacque Montgomery, who has created mental health programs in the jail. She said the idea is to connect with people on street before they end up incarcerated or dead.
To that end, she and her colleagues give out naloxone, the overdose-stopping medication, in areas where drug use is common. But they also spend time tracking down people they think will be receptive to treatment.
One population is people who are hospitalized following an overdose. The 911 call center automatically notifies them when ambulances respond to an overdose, and they follow up both with the patient and the patient’s family.
“We can call and say, ‘This is the social service arm of our department and we have services for you and your family if you’re interested,’ ” Petacque Montgomery said. “People say ‘Sure,’ or ‘Tell me more.’ At that point, we’ll go out and meet the family, arm them with naloxone and get a better idea of how we can help the entire family unit as well as the person suffering from substance use.”
Representatives of the sheriff’s office also visit places where they’re likely to find people in need of help. The Pacific Garden Mission on the Near West Side is one frequent stop, and it’s where special assistant Derek O’Neal met a 26-year-old man who has been using heroin on-and-off for 12 years.
In a phone interview, the man, who asked that his name not be used, said he had just gotten out of jail on a possession charge when O’Neal arrived to give a talk on the outreach service.
“I was really put off and leery of talking to him,” he said. “But over the course of his presentation, he made it clear he was just there to help anyone who is experiencing substance abuse issues or psychological issues. He made it clear he was there to help and for no other reason.”
The man said O’Neal got him into treatment, and today he’s in a sober living home while attending intensive outpatient meetings four days a week.
“I’ve been sober now since Aug. 30, and having Derek on my side has really helped,” he said.
That outcome is about as good as it gets for the outreach unit, though not every encounter yields such results. Of the 161 people who have become clients, 73 are still engaged with the program, and of those, 32 have gotten into treatment with its help.
“We don’t leave until someone tries to avoid us, pretty much,” Petacque Montgomery said.
Dart said the program needs more time to gather data before he can make conclusions about its effectiveness. That’s also true for similar programs elsewhere in the country.
Alexander Walley, director of the Grayken Addiction Medicine Fellowship at Boston Medical Center, is studying the more than 100 towns in Massachusetts where public safety agencies run opioid outreach programs. He said there are many variations, and it’s not clear that one approach is better than the other.
“There hasn’t been any research that shows benefit or harm, for that matter,” he said. “We have an analysis embedded in our project to look at that.”
On the street, though, some benefits seem clear enough. The sheriff’s team, which also includes treatment specialist Meghann Cherie and police investigator Efrain Mata, recently handed out naloxone and did quick trainings at a bus stop and "L" station in the Austin neighborhood, where the sheriff’s office supplements Chicago Police Department patrols.
“I appreciate it,” said a woman waiting for a bus on Chicago Avenue. “I think it’s a good thing. They’re trying to help us, and this community needs the help.”
Then they approached the tent beneath the railroad overpass. While uniformed sheriff’s officers hung back to keep an eye out for trouble, Petacque Montgomery, Cherie and O’Neal listened as the woman described her struggles, which included a lack of food, psychiatric meds that had run out and an empty asthma inhaler.
“I need help with everything,” she said. “God must have heard me crying me last night.”
They took her parents’ phone number, gave her a business card and made plans for her to visit Catholic Charities the next day, where she could be ushered to medical help and drug treatment. One of the officers slipped her a $20 bill for food.
Two days later, she still hadn’t taken the first step, a vacillation that’s not uncommon among the program’s clients. Back at the sheriff’s substation, Petacque Montgomery said she still saw the encounter as a victory.
“I’m hopeful,” she said. “I think there’s so much despair in this work, and the people we work with feel helpless. We’re catching them at a very dark time in their lives … Now we have all these different areas of (the woman’s) life we’re aware of and we’ll be able to pull pieces together.
“I think we walk away feeling, ‘Yeah, high-five. We got someone today who wants help.’”