Along with other regions around the world, North America has been battling a historic crisis in addiction and overdose.1 The devastating human and financial toll of this crisis has received well-deserved attention, especially across the United States and Canada; however, the burdens addiction and overdose have placed on the first responder workforce has not been fully recognized.
Police and other law enforcement professionals are the front lines of drug crisis response. Officers are dealing with a mounting volume of overdose scenes and addiction-related crimes. A growing percentage of emergency calls for service are related to drug and alcohol use. Agencies have had to adapt to the spiraling drug-related challenges in their communities.
Many jurisdictions have innovated by tasking officers with naloxone administration, outreach, and a variety of other new roles.2 This problem-solving response in the United States and elsewhere has occurred in real time, often without adequate support or training.3 These shifts have stretched already overburdened departments and personnel. In a 2024 International Association of Chiefs of Police (IACP) survey, U.S. law enforcement agencies reported operating at nearly 10 percent below authorized staffing levels on average.4 Recruiting has become more challenging in recent years, according to 70 percent of respondent agencies.5
This has led to significant challenges, including problems with officer retention and recruitment.6 The emotional toll of this work has contributed to rising stress, burnout, and even suicidal risk among officers.7 Potential physical risks, like needle stick injuries and concerns about fentanyl exposure, have further eroded mental well-being.8 Both privately and publicly, personnel have voiced concerns about “doing too much with too little” and “holding the bag” for society’s failure to address addiction and associated problems.9
To address these challenges, a number of officer support initiatives have emerged. After more than a decade, there is mounting evidence that some strategies are more promising than others. First, deflection and diversion programs offramp individuals cycling through the criminal justice system toward treatment and support, helping them find stability. With funding from the U.S. Bureau of Justice Assistance and several states, the Center for Health and Justice (CHJ) at Treatment Alternatives for Safer Communities, Inc. (TASC) is equipping numerous agencies to stand up effective diversion and deflection programs.
Second, officer education covering occupational health and safety has evolved to meet the needs of frontline personnel. Departmental adoption of new programs like deflection and diversion has further spurred the need for training on how to implement these tools effectively. Focusing on the connection between officer wellness and effectiveness, the SHIELD (Safety and Health Integration in the Enforcement of Laws on Drugs) Training Initiative has customized and delivered curricula for agencies in the United States and across the world. Covering topics like needlestick injury prevention, fentanyl exposure, and burnout management, SHIELD has shown great promise in helping officers improve their occupational health and job satisfaction.
Deflection: Building Systems for Police Task-Shifting
Deflection is a strategy designed to divert individuals with substance use disorders (SUD) away from the criminal justice system and into treatment. By involving multidisciplinary teams—policing, EMS, public health, behavioral health, and treatment and recovery services—deflection programs aim to guide individuals to appropriate services before they are arrested. This reduces the likelihood of criminalization and helps individuals gain access to the care they need.10
Deflection programs emerged as a response to the increasing number of individuals with SUD entering the criminal justice system. They were developed through collaborations between police agencies, health services, and treatment providers, with a focus on early intervention. For example, when he was chief of the Northfield, Minnesota, Police Department, lead author Mark Elliott recognized the broad and evolving nature of this public health emergency. He established partnerships with local community organizations, treatment centers, and health care providers to enable his officers to facilitate quick and effective referrals for individuals seeking help. He championed the development of supportive service programs to provide a broad spectrum of services, including medical care, counseling, and housing support, thus addressing the multifaceted nature of SUD.
“Understanding not only how to deflect but why deflection works and why doing the work of deflection benefits officer wellness, job satisfaction, and public safety is key to effective implementation”
Also known as pre-arrest diversion, deflection initiatives aim to connect individuals to the right services before a crisis occurs or before jail and court involvement. By creating clear pathways to treatment, deflection programs help individuals struggling with SUD avoid jail and instead receive the support they need. Over time, these programs have evolved, with expanded strategies to offer more comprehensive, community-based solutions to drug-related issues.
The IACP has been a leader in exploring deflection initiatives. In fact, in March 2017, the IACP hosted the first National Pre-Arrest Deflection Summit. Since that summit, the field of deflection has grown exponentially. Deflection is growing internationally as well, with countries in Europe and Africa exploring ways to integrate deflection into their criminal justice strategies. Summits where interdisciplinary leaders explore challenges and share successes have been held throughout the world. In October 2024, the first African leaders’ summit was held in Kenya. The CHJ played a key role in leading conversations and breakout sessions on alternatives to incarceration.
Since their inception, deflection programs have shown promise in building pathways to needed services. Initiatives like the Tucson, Arizona, Police Department’s Deflection Program and the Madison, Wisconsin, Addiction Recovery Initiative (MARI) have shown promising outcomes. These programs continue to evolve by refining strategies, including offering first responders clear pathways to connect individuals with treatment services before a crisis situation escalates.
For example, Tucson’s program has demonstrated reductions in criminal justice costs, recidivism, and housing instability by ensuring individuals receive timely treatment and support. It even reduced time demands on officers, with an average of 48.5 minutes spent pursuing deflection versus 73.9 minutes for an arrest.11 Similarly, MARI connects justice-involved individuals to treatment services through a police-led approach. Individuals who successfully complete a six-month, individually tailored program have their charges voided. Early results from MARI indicate improvements in health outcomes, a reduction in future police contact, and better access to treatment for individuals with drug-related offenses.12 These studies also indicated that deflection programs address a critical gap in service provision for individuals who previously had limited access to treatment.
Deflection initiatives offer a sustainable solution for police officers striving to reduce crime and positively impact their communities. These programs help community members and contribute to officer well-being and job satisfaction. By providing resources to support individuals in need, officers are better equipped to manage the complexities of addiction and mental health crises.
Deflection Training and Support for First Responders
Officer training is vital to the success of deflection programs. CHJ at TASC is a leading provider of training and technical assistance for communities seeking to design, implement, and sustain deflection initiatives. This work covers various communities across the United States and around the world—rural, suburban, urban, tribal, and multijurisdictional regions—to help build multidisciplinary teams capable of addressing substance use and mental health disorders.
CHJ efforts begin by bringing together community stakeholders and creating a Deflection Strategic Action Plan. This plan helps local teams identify key partners, establish harm reduction goals, and operationalize deflection pathways. One key component of CHJ’s work is helping communities explore the six recognized pathways to deflection, allowing each team to develop a model tailored to its local needs and resources.
The CHJ collaborates with the Bureau of Justice Assistance Comprehensive Opioid Stimulant Substance Use Program (COSSUP) to offer resources and training for criminal justice agencies and their grant recipients. In partnership with the IACP, CHJ developed a checklist for gaining officer support for deflection initiatives.13 This tool, available on both the IACP and COSSUP websites, offers police agencies valuable guidance on starting and maintaining successful deflection programs.
Limitations and Challenges
While deflection programs have shown success, challenges remain. Scaling these programs can be difficult due to resource limitations and the need for strong, sustainable funding. Current systems often have siloed budgets, and while overall costs can go down in long-term care for individuals who enter recovery, short-term costs can shift from one silo to another.
Many communities lack effective cross-sector connections and service pathways. The siloed approach to service delivery is often difficult for those with substance use disorder to navigate. Around-the-clock police response capabilities are hindered in many communities when other services are limited to traditional office hours availability. Connecting individuals to resources immediately can often be critical to opening the path to recovery.
Additionally, while deflection programs can improve engagement with services and cross-sector collaboration, they may not address broader systemic issues like policy constraints and the availability and accessibility of local treatment resources.
Deflection programs can ask officers to adapt new policies and procedures during substance use–related encounters. This can feel like adding more work to officers’ already heavy loads, which interfere with the effective implementation of deflection initiatives. The CHJ’s existing training curricula focuses on the practical and scientific rationale for deflection—but has not been focused on its benefits to frontline personnel. Fortunately, the SHIELD training model can be deployed to engage officers’ intrinsic motivation to clarify that taking these extra steps can improve their own safety, well-being, and effectiveness.
SHIELD Trainings
During the early stages of the U.S. overdose crisis, researchers discovered that police personnel on the front lines were struggling to stay above water. In interviews, officers expressed anxiety about occupational safety risks. At that time, needlestick injuries and bloodborne pathogens topped the list of physical safety concerns. They also voiced frustration about societal failures to build effective safety nets for individuals struggling with addiction. Being unable to help people break the cycle of addiction left many officers feeling hopeless. Phrases such as “shoveling shit against the tide” emerged from these formative conversations, reflecting stress, burnout, and a sense of futility.14
“The ultimate goal of combining SHIELD and deflection programs is to create a comprehensive, community-centered response to the overdose crisis”
The need for additional training and resources was evident. In 2004, researchers developed a curriculum to better equip police officers for overdose crisis response. Piloted at the Pawtucket, Rhode Island, Police Department, this training focused on preventing accidental needlesticks, debunking myths about HIV transmission, and improving occupational wellness. It also emphasized the win-win scenarios in which enhancing officer safety aligned with effective public health responses to drug use. This short module showed promise in improving officer knowledge, attitudes, and intended practices, leading to the development of SHIELD.15
In 2015, the development of this emerging model got a major boost from the United States federal government. The ESCUDO (SHIELD in Spanish) study was the first of its kind funded by the National Institutes of Drug Abuse. This project delivered the training to more than 1,800 police officers in the Tijuana, Mexico, Police Department. The SHIELD team worked with nearly 800 of those trainees for two years to evaluate impact. Over time, this research found significant reductions in accidental needle stick risk, with a sustained decrease of 17.8 percent through 24 months.16 Knowledge on key issues pertaining to infectious disease, drug policies, and referral to treatment also showed sustained improvement.17
This project helped demonstrate that the SHIELD model also bolstered community health. Among people who use drugs, the implementation of the police training averted 2 percent of new HIV infections and 12 percent of fatal overdoses.18 It also increased officer willingness to make service referrals as a mode of task shifting.19 In this setting, SHIELD proved highly cost-effective, demonstrating great promise as a model with dual benefits for occupational health of first responders and community well-being.20
The ESCUDO study helped put SHIELD on the map in United States and across other countries. In its various forms, the intervention has been deployed in hundreds of communities across North America and Asia. Since 2004, this work has been rigorously evaluated using both quantitative and qualitative research methods. As a result, SHIELD has amassed extensive evidence of more than 30 scientific publications (available at Shieldtraining.org/evidence-base).
“Officers trained through the SHIELD program will be able to navigate these complex situations with greater confidence and competence”
Several unique elements of SHIELD help explain this unique track record, such as its use of evidence-based instructional techniques and its customization process. Delivered by police peers, often working alongside behavioral health professionals with lived experience, SHIELD training uses interactive methods to maximize engagement and knowledge retention. The curriculum includes topics such as safety protocols, managing the emotional toll of drug crisis responses, and understanding the local resources available for task shifting.
The curriculum also includes key information on recovery science. This helps address two challenges seen by Chief Elliott: (1) understanding substance use disorders as medical conditions rather than criminal issues per se, and (2) dispelling feelings of failure among officers when individuals decline help. Understanding that recovery can be a long, bumpy road can help officers to persist in offering help without internalizing rejection.
As the North American addiction crisis has shifted, SHIELD’s scope has expanded over time. The training has evolved to incorporate evidence-based methods for reducing burnout and promoting interfacing between police and public health sectors. The SHIELD model emphasizes local customization to ensure the training aligns with community-specific needs and resources.
SHIELD’s community planning and customization process ensures that the training remains locally relevant and informed by the latest research. By enhancing the capabilities of first responders, SHIELD fosters better decision-making. It has demonstrated promise to create less stressful interactions between responders and individuals who are struggling with drug use. In some jurisdictions, by helping those individuals find stability and break the cycle of addiction, this model has reduced such interactions altogether.21
To recap, the SHIELD initiative has shown significant benefits to officers and the communities they serve. On the occupational wellness front, it has improved openness to talking about mental health among trainees, improved safety during overdose interventions, and improved knowledge of the actual levels of risk associated with fentanyl exposure.22 With regard to serving communities, SHIELD has been shown to increase awareness of how community-based resources can be useful allies in the effort to reduce addiction and improve public safety, increase first responders’ intention to refer to health care and social services, reduce hepatitis C virus rates in the community, and improve police officers’ understanding of drug and syringe possession laws.23
Limitations and Challenges
While SHIELD has demonstrated significant success, there are inherent limitations to this model. One key limitation is that SHIELD is not designed to stand up agency infrastructure. Another is that the promise of task shifting depends upon the availability and accessibility of local treatment and supportive services for people with SUD.
These limitations underscore the importance of integrating SHIELD with other models, such as deflection initiatives. The SHIELD model’s unique focus on occupational health and wellness of frontline personnel can provide the key rationale for taking on new deflection tasks. This connection is so often missing when officers are asked to adopt new duties, including deflection and diversion activities.
Synergy
While both SHIELD and deflection programs have each proven to be effective in addressing the overdose crisis, their potential for even greater success lies in their integration. Each model offers distinct benefits that, when combined, can create a more comprehensive and sustainable framework for responding to substance use and overdose crises. The synergy between SHIELD and deflection is not just about adding programs together; it’s about weaving together their strengths to create a robust, multifaceted system that better supports both first responders and individuals affected by SUD.
Enhancing Officer Preparedness and Emotional Resilience
At the core of this integrated approach is the enhanced preparation of police officers. SHIELD’s training provides first responders with the tools to safely navigate overdose situations, manage their own emotional responses, and build trust with individuals in crisis. However, SHIELD focuses largely on equipping officers with knowledge and safety protocols, while deflection goes a step further by actively guiding individuals away from the criminal justice system and into treatment.
By integrating deflection principles into SHIELD training, officers are not only trained to respond to the immediate health crisis but also prepared to guide individuals to the appropriate resources and services. For example, an officer who has completed SHIELD training will have a comprehensive understanding of safety protocols for safe searches and overdose scenes as well as local behavioral health resources. In addition, by incorporating deflection pathways into their response, they will know exactly how to refer individuals to treatment or recovery services, preventing unnecessary arrests and promoting long-term health outcomes.
The result is an officer who is better equipped not only to manage the technical aspects of overdose intervention but also to play an active role in reducing the criminalization of individuals with SUD. This approach reduces the emotional strain on officers by providing them with more effective, compassionate tools to handle complex situations. Furthermore, by focusing on treatment rather than arrest, officers can experience increased job satisfaction and a greater sense of purpose in their work.
Strengthening Community Connections
SHIELD and CHJ each emphasize the importance of community-based approaches to addressing substance use. SHIELD training encourages first responders to view individuals in crisis not just as offenders but as people in need of health support. By integrating deflection principles into SHIELD’s training, officers are empowered to connect individuals with community resources that can provide the long-term support necessary for recovery. This could include referring individuals to local treatment centers, mental health services, or housing programs.
On the flip side, deflection programs benefit from SHIELD’s emphasis on officer wellness as a rationale for task shifting efforts. Deflection efforts can be enhanced when officers view them as a way to make their jobs better and their investment of time more effective. SHIELD’s customized approach to first responder training ensures that officers understand the broader public health implications of substance use, making them more effective partners in cross-sector collaborations. This can strengthen the overall network of services available to individuals in crisis.
Improving Public Trust and Reducing Recidivism
One of the major challenges of both deflection and traditional policing is building public trust, especially within communities that may be wary of the police or their involvement in sensitive health issues. SHIELD-enhanced deflection could create an environment where individuals in crisis are more likely to engage with services, finding stability and reducing drug-related offenses. By redirecting people toward treatment and rehabilitation instead of cycling through the criminal justice system, SHIELD-enhanced deflection holds the promise to free up police resources to focus on core public safety measures.
Additionally, the integration of these models creates a more transparent and accountable system of response. As police officers and public health experts work together in a coordinated way, communities can see that their safety and well-being are a shared priority. This transparency builds trust, which is vital for fostering stronger relationships between the police and the communities they serve.
Fostering a More Resilient Overdose Response System
By connecting these two models, police agencies can develop a more cohesive response that not only addresses immediate safety concerns but also considers long-term recovery and treatment pathways. This integration helps to break down silos between the police, public health, and social services, creating a more coordinated response to substance use crises that can be sustained over time.
Moreover, the integrated model can help identify gaps in service delivery and address systemic issues that might limit the effectiveness of both SHIELD and deflection programs. For instance, by pairing SHIELD’s training with deflection strategies, communities can assess the availability and accessibility of treatment resources, ensuring that deflection programs are not only operational but also adequately supported by local infrastructure.
Creating a Comprehensive, Community-Centered Model
The ultimate goal of combining SHIELD and deflection programs is to create a comprehensive, community-centered response to the overdose crisis. This integrated approach acknowledges the complexity of substance use and overdose responses, recognizing that no single solution can address the wide range of needs and challenges individuals face.
By aligning the efforts of law enforcement, public health, behavioral health services, and community organizations, communities can build a unified response that addresses both the immediate needs of individuals in crisis and the long-term support necessary for recovery. Officers trained through the SHIELD program will be able to navigate these complex situations with greater confidence and competence, while deflection programs ensure that individuals are connected with the care they need to avoid future crises.
The synergy between SHIELD and deflection also aligns with the broader evidence-based policing philosophy. This shift toward a more health-centered approach can transform the way overdose responses are managed, making them more compassionate; efficient; and, ultimately, more effective in saving lives.
Conclusion
Drug-related crises in the United States and around the world demand multifaceted solutions. By combining the strengths of deflection programs such as those developed by CHJ with SHIELD training, police agencies can create a more effective, compassionate, and sustainable response to the crisis. Understanding not only how to deflect but why deflection works and why doing the work of deflection benefits officer wellness, job satisfaction, and public safety is key to effective implementation. d
Notes:
1United Nations Office on Drugs and Crime, World Drug Report 2024 (2024); National Institute on Drug Abuse, Substance Use and Addiction (2023).
2Caleb J. Banta-Green et al., “Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law,” Journal of Urban Health 90 (2013): 1102–1111.
3Hope M. Smiley-McDonald et al., “Perspectives from Law Enforcement Officers Who Respond to Overdose Calls for Service and Administer Naloxone,” Health & Justice 10, no. 1 (2022): 9.
4Meret S. Hofer, “’The Light at the End of the Tunnel Has Been Permanently Shut Off’: Work-Role Overload Among US Police,” Criminal Justice and Behavior 49, no. 7 (2022): 1070–1089.
5International Association of Chiefs of Police (IACP), The State of Recruitment & Retention: A Continuing Crisis for Policing—2024 Survey Results (2024).
6IACP, The State of Recruitment & Retention.
7Anna La Manna et al., “,” Drug and Alcohol Dependence 271 (2025): 112590.
8Brandon del Pozo et al., “Can Touch This: Training to Correct Police Officer Beliefs About Overdose from Incidental Contact with Fentanyl,” Health & Justice 9 (2021): 34.
9Leo Beletsky, Grace E. Macalino, and Scott Burris, “Attitudes of Police Officers Towards Syringe Access, Occupational Needle-Sticks, and Drug Use: A Qualitative Study of One City Police Department in the United States,” International Journal of Drug Policy 16, no. 4 (2005): 267–274.
10Bureau of Justice Assistance, Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP): Law Enforcement and First Responder Deflection, Pathways to Deflection Case Studies Series (2023).
11Josephine D. Korchmaros et al., Costs, Cost Savings, and Effectiveness of a Police-led Pre-arrest Deflection Program (Tucson, AZ: University of Arizona, Southwest Institute for Research on Women, 2022).
12Alice Zhang et al., “Pre-Arrest Diversion-To-Treatment for Adults with Substance Use Disorder: Health Outcomes and Predictors of Program Completion,” Justice Evaluation Journal (2025): 1–18.
13IACP, “Checklist for Obtaining Officer Support for Deflection or Pre-Arrest.”
14Beletsky, Macalino, and Burris. “Attitudes of Police Officers Towards Syringe Access, Occupational Needle-Sticks, and Drug Use.”
15Leo Beletsky et al., “,” American Journal of Public Health 101, no. 11 (2011): 2012–2015.
16Leo Beletsky et al., “” BMJ Open 11, no. 4 (2021): e041629.
17Rivera Saldana et al., “Estimating the Impact of a Police Education Program on Hepatitis C Virus Transmission and Disease Burden Among People Who Inject Drugs in Tijuana, Mexico: A Dynamic Modeling Analysis,” Addiction 118, no. 9 (2023): 1763–1774; Jaime Arredondo et al., “Measuring Improvement in Knowledge of Drug Policy Reforms Following a Police Education Program in Tijuana, Mexico,” Harm Reduction Journal 14 (2017): 1–10; Javier A. Cepeda et al., “Cost-Effectiveness of a Police Education Program on HIV and Overdose Among People Who Inject Drugs in Tijuana, Mexico,” The Lancet Regional Health–Americas 30 (2024): 100679.
18Cepeda et al., “Cost-Effectiveness of a Police Education Program on HIV and Overdose Among People Who Inject Drugs in Tijuana, Mexico.”
19Phillip L. Marotta et al., “Unlocking Deflection: The Role of Supervisor Support in Police Officer Willingness to Refer People Who Inject Drugs to Harm Reduction Services,” International Journal of Drug Policy 121 (2023): 104188.
20Cepeda et al., “Cost-Effectiveness of a Police Education Program on HIV and Overdose Among People Who Inject Drugs in Tijuana, Mexico.”
21Cepeda et al., “Cost-Effectiveness of a Police Education Program on HIV and Overdose Among People Who Inject Drugs in Tijuana, Mexico.”
22Beletsky et al., “Reducing Police Occupational Needle Stick Injury Risk Following an Interactive Training”; Cepeda et al., “Cost-Effectiveness of a Police Education Program on HIV and Overdose Among People Who Inject Drugs in Tijuana, Mexico”; del Pozo et al., “Can Touch This: Training to Correct Police Officer Beliefs About Overdose from Incidental Contact with Fentanyl.”
23Saad T. Siddiqui et al., “An Evaluation of First Responders’ Intention to Refer to Post-Overdose Services Following SHIELD Training,” Harm Reduction Journal 21, no. 1 (2024): 39; Saldana et al., “Estimating the Impact of a Police Education Program on Hepatitis C Virus Transmission and Disease Burden Among People Who Inject Drugs in Tijuana, Mexico”; Pieter Baker et al., “Impact of SHIELD Police Training on Knowledge of Syringe Possession Laws and Related Arrests in Tijuana, Mexico,” American Journal of Public Health 112, no. 6 (2022): 860–864; Beletsky, Macalino, and Burris, “Attitudes of Police Officers Towards Syringe Access, Occupational Needle-Sticks, and Drug Use.”
Please cite as
Mark Elliott et al., “Safeguarding Officers Amid the Addiction Crisis,” Police Chief Online, July 16, 2025.
