Faculty Evaluate City Efforts Aimed at Treatment Instead of Jail

Nurse Jen Miksch, who is part of the Community Opioid Outreach Program, speaks with a person who is homeless Image by Katharine Webster
Registered nurse Jen Miksch talks with an unhoused woman. Miksch was hired to care for people with substance use disorders under a federal grant to Lowell that includes UML as the city's research partner.

By Katharine Webster

When Gianna Sandelli ’19, ’22 was in her sophomore year of college, studying marine biology at Salem State University, a close friend who was using opioids overdosed and died. 

“He kept saying, ‘I just want to stop, I just want to stop,’ and in my brain, I thought, ‘Then why doesn’t he quit?’” she says.

After her friend’s death, Sandelli wanted answers. She left Salem State and went to Middlesex Community College to become a licensed alcohol and drug counselor. Then she earned a B.A. in psychology and a master’s degree in community social psychology at UMass Lowell while working as an outreach specialist for Lowell House Addiction Treatment and Recovery, a nonprofit.

Sandelli was one of several outreach workers hired under a U.S. Bureau of Justice Assistance grant that faculty and staff at UMass Lowell’s Center for Community Research and Engagement had helped the city to write. That grant established Lowell’s innovative Community Opioid Outreach Program (CO-OP), a partnership among Lowell House, Trinity EMS and the city’s police, fire and health departments.

Gianna Sandelli '19, '22 does a wellness check. Sandelli works at Lowell House Addiction Treatment and Recovery Image by Katharine Webster
Gianna Sandelli '19, '22, assistant director of outreach for Lowell House Addiction Treatment and Recovery, does a wellness check near the Lowell Office of Community Counseling.
The partnership’s goal: Save lives and divert people with opioid use disorder from the criminal justice system by connecting them with services including treatment, health care, housing, jobs and counseling. 

It appears to be working. From 2016 – when fentanyl became widespread – to 2020, fatal overdoses in Lowell fell by 37 percent, and from 2018 to 2020, nonfatal overdoses dropped by 40 percent, even as total overdoses in the state rose, says Robin Toof, the center’s co-director, citing Massachusetts Department of Public Health data. 

Now, the city is expanding its diversion efforts with the assistance of two newer grants supported by the center and UML faculty: one that paid for a Spanish-speaking outreach specialist and a nurse who can provide on-the-spot wound care, and one to pay mental health clinicians to accompany police on calls. 

UMass Lowell receives a portion of each grant to serve as the city’s research and evaluation partner. The university’s share also pays graduate students in criminal justice, psychology or public health to serve as research assistants.

Criminology Assoc. Prof. Wilson Palacios, the lead faculty researcher on the opioid grants, says Lowell is increasingly taking a holistic and preventative approach to the opioid use epidemic. 

“The primary mission in the beginning was to help emergency workers respond after an overdose, an understandably reactive approach,” Palacios says. “Now, the city is able to address factors that are known to increase the likelihood an overdose will occur in the first place, such as homelessness, lack of government ID, food insecurity and the inability to access medical and mental health services.”

Gianna Sandelli '19, '22 speaks with bilingual outreach worker Derek Sampson near the Lowell Office of Community Counseling, which offers services to people with substance use disorders Image by Katharine Webster
Sandelli speaks with outreach specialist Derek Sampson, a certified alcohol and drug counselor who is fluent in Spanish and English.
“You can’t arrest yourself out of these problems,” Toof adds.

Under the first U.S. Bureau of Justice Assistance grant in 2016, the city established a response team that visited every home or other location where someone overdosed to offer services to survivors and children living with them; it paid the salaries of three outreach workers. That grant was renewed in 2019, and a $1.9 million grant awarded by the U.S. Department of Health and Human Services last year expands the outreach team to five people who can assist those using any drug, including alcohol.

“Alcohol plays a major role in the overdoses we’re seeing now,” Palacios says. “People rarely use just one drug; combining alcohol with heroin or fentanyl greatly increases the risk of an overdose.”

The new grant also pays for the outreach specialists and the nurse to attend in-depth trainings so that they can then offer workshops in naloxone administration, mental health first aid and other aspects of opioid use disorder to groups in the community, including police, firefighters and EMTs, businesses and community groups, he says.

Having a nurse on the CO-OP team who can provide immediate wound care for abscesses at injection sites and other health problems is critical, Sandelli says. Xylazine, a veterinary tranquilizer that is starting to show up in injectable opioids, makes abscesses worse and increases the risk of a fatal overdose, according to the National Institute on Drug Abuse.

Robin Toof (right), co-director of UML's Center for Community Research and Engagement, and Criminology Assoc. Prof. Wilson Palacios meet with graduate research assistants Shibani Chakravorty (left) and Taylor Sheldon. Image by Katharine Webster
Robin Toof,  right, co-director of the Center for Community Research and Engagement, discusses opioid grant research with Criminology Assoc. Prof. Wilson Palacios and graduate research assistants Shibani Chakravorty, left, and Taylor Sheldon, second from left.
“We work predominantly with unhoused individuals and the highest-risk population in Lowell,” Sandelli says. “The nurse’s role is to provide care in the community before things get so bad that people end up in the ER.”

There is also a clear need for a bilingual outreach worker, as about one in five Lowell residents is Hispanic, Palacios says.

Taylor Sheldon ’21, a Ph.D. student in applied psychology and prevention science who works as a research assistant in the Center for Community Research and Engagement, says she has interviewed many people served by the CO-OP team.

“They were generally very happy with their services,” she says. “They felt they were not judged by the CO-OP workers; they said they were reliable, honest and just there to help with whatever they needed.”

The mental health grant pays for clinicians to ride along with police officers on calls when there might be a mental health issue so they can de-escalate the situation, reduce the need for police to use force and get the person care instead of putting them in jail, says Criminology Prof. Andrew Harris, the primary faculty researcher on that grant.  

Although the mental health grant is not directly aimed at opioid users, Sabrina Rapisarda, a Ph.D. student in criminology who interviewed police officers as a research assistant during summer 2021, says many 911 calls with a mental health component involve people who also have substance use disorders.

“We rarely see that those things don’t go hand in hand,” Rapisarda says.

Sandelli, now Lowell House’s assistant director for outreach as well as a clinician who goes on calls with the CO-OP team, says her education, her job and UML researchers have answered her questions about her friend – and are helping her to assist others like him.

Although there still aren’t enough treatment beds for people with opioid use disorder, she says, the CO-OP team’s holistic approach of building relationships and removing barriers is making a difference.

“We’re like a travel agency to offer people help with detox, long-term treatment, a primary care doctor, a recovery coach, a counselor – and sometimes it’s just a conversation saying, ‘Hey, you’re worth a healthier lifestyle,’ until they’re ready to let us help them.”