Research Report: The Wisconsin Deflection Initiative – A Comprehensive Analysis of Early Intervention Strategies for Substance Use Disorders

Many thanks to our sponsor Maggie who helped us prepare this research report.

Abstract

Substance Use Disorders (SUDs) represent a significant public health crisis, demanding innovative and compassionate approaches beyond traditional punitive measures. The Wisconsin Deflection Initiative (WDI), launched in 2024, stands as a pioneering example of such innovation, strategically designed to connect individuals grappling with SUDs to vital treatment and support services proactively, thereby mitigating the escalation to crisis events, overdose fatalities, or entrenched criminal justice involvement. This comprehensive research report undertakes an in-depth examination of the WDI’s multifaceted architecture, meticulously dissecting its operational framework, the intricate collaborative dynamics between law enforcement agencies and healthcare providers, and the rigorous metrics employed to gauge its success in fostering early intervention. Furthermore, the report delves into the WDI’s remarkable adaptability, showcasing its capacity to tailor interventions effectively across the disparate demographic and socio-economic landscapes of Wisconsin’s urban centers, sovereign tribal nations, and geographically dispersed rural communities. By systematically evaluating the WDI’s design, implementation, and anticipated outcomes, this report endeavors to furnish invaluable insights into the profound efficacy and transformative potential of comprehensive deflection models in ameliorating the profound societal burdens imposed by substance use disorders.

Many thanks to our sponsor Maggie who helped us prepare this research report.

1. Introduction

Substance Use Disorders (SUDs) continue to exert an immense and escalating toll on public health, social welfare, and economic stability across the United States. Historically, societal responses to drug use have been predominantly characterized by punitive and enforcement-centric strategies, often resulting in mass incarceration, exacerbated social inequalities, and a fundamental failure to address the complex underlying biopsychosocial factors that perpetuate addiction. This traditional paradigm, rooted in the ‘War on Drugs’ ethos, has demonstrably struggled to curtail the burgeoning rates of SUD prevalence, overdose deaths, and the cyclical nature of criminal justice involvement for individuals whose primary need is healthcare, not incarceration.

In recent decades, a significant paradigm shift has begun to emerge, advocating for a public health-oriented approach to SUDs. This contemporary perspective recognizes addiction as a chronic, relapsing brain disease, necessitating comprehensive, accessible, and evidence-based treatment and recovery support. Within this evolving framework, ‘deflection’ initiatives have gained considerable traction as a proactive and preventative strategy. Deflection, broadly defined, involves diverting individuals experiencing or at risk of SUDs away from the traditional criminal justice pipeline – such as arrest, prosecution, and incarceration – and instead channeling them directly into appropriate community-based treatment, harm reduction services, and social support systems at the earliest possible juncture. The core premise is that early engagement with therapeutic interventions can prevent crisis situations, reduce the burden on emergency services, alleviate pressure on the carceral system, and ultimately foster sustainable recovery and improved community well-being.

The Wisconsin Deflection Initiative (WDI) stands as a salient and timely example of this progressive public health policing strategy. Established to address the pervasive impact of SUDs within the state, particularly in the wake of the devastating opioid crisis, the WDI embodies a collaborative, multi-stakeholder commitment to early intervention. Its overarching goal is to diminish the incidence of critical events such as drug overdoses, emergency room visits, and arrests, by forging robust pathways for individuals with SUDs to access comprehensive care. This report provides an exhaustive analysis of the WDI, scrutinizing its conceptual foundations, detailing its operational components, evaluating its strategic partnerships, assessing its projected outcomes, and exploring its nuanced adaptation across Wisconsin’s diverse communities. By delving into these critical areas, this research aims to contribute significantly to the broader discourse on effective, humane, and sustainable strategies for addressing SUDs on a statewide and potentially national scale.

Many thanks to our sponsor Maggie who helped us prepare this research report.

2. Background and Context

2.1 The Opioid Crisis and Its Impact on Wisconsin

The opioid crisis has cast a long and devastating shadow across the United States for over two decades, evolving through distinct waves that have progressively amplified its tragic consequences. The first wave, beginning in the late 1990s, was primarily driven by the over-prescription of opioid pain relievers. The second wave, starting around 2010, saw a rapid increase in heroin overdose deaths. The most recent and currently ongoing third wave, which commenced around 2013, is characterized by a dramatic surge in synthetic opioid overdose deaths, predominantly involving illicitly manufactured fentanyl (IMF) and its analogues. Fentanyl, a highly potent synthetic opioid, has profoundly intensified the crisis due to its extreme potency – estimated to be 50 to 100 times stronger than morphine – leading to a significant increase in unintentional overdose fatalities even with minute exposures. The clandestine introduction of fentanyl into the illicit drug supply, often unbeknownst to users, has dramatically elevated the risk profile for individuals consuming street drugs, contributing to unprecedented mortality rates.

Wisconsin, mirroring national trends, has been profoundly affected by the relentless trajectory of the opioid epidemic. The state has witnessed a harrowing surge in overdose deaths, placing unprecedented strain on its healthcare infrastructure, emergency services, and law enforcement agencies. Data from the Wisconsin Department of Health Services (DHS) indicates a disturbing upward trend in opioid-related fatalities. For instance, in 2022, while the national figure of drug-involved overdose deaths approached 108,000, Wisconsin tragically reported 1,828 such deaths (wisconsinexaminer.com). This represents a stark increase from previous years and underscores the pervasive nature of the crisis across urban, suburban, and rural locales within the state. The human cost is immeasurable, but the crisis also imposes a substantial economic burden, manifesting in increased healthcare expenditures, lost productivity, rising criminal justice costs, and strain on social support systems. Traditional responses, heavily reliant on arrests and incarceration, have proven insufficient and, at times, counterproductive, as they often disrupt potential pathways to treatment, exacerbate social stigma, and fail to address the fundamental drivers of addiction.

The escalating severity of the crisis necessitated a fundamental re-evaluation of intervention strategies. Public health experts, advocacy groups, and progressive law enforcement leaders began advocating for a shift towards comprehensive, public health-oriented solutions that prioritize treatment, harm reduction, and prevention over punishment. This growing consensus laid the groundwork for the conceptualization and eventual establishment of initiatives like the WDI, signaling a pivotal move towards a more compassionate and effective approach to SUDs.

2.2 The Establishment of the Wisconsin Deflection Initiative

In direct response to the escalating and multifaceted challenges posed by the opioid and broader substance use crisis, the Wisconsin Department of Justice (DOJ) embarked on a strategic effort to secure federal resources that would enable the implementation of innovative intervention models. This effort culminated in December 2024, when the Wisconsin DOJ was successfully awarded a substantial $7 million grant from the U.S. Department of Justice’s Bureau of Justice Assistance (BJA) through its Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) (doj.state.wi.us).

COSSUP is a nationwide program designed to support states, local governments, and tribal communities in developing, implementing, and expanding comprehensive efforts to address illicit opioid, stimulant, and substance abuse. Its primary objectives include reducing the supply of illicit drugs, enhancing public safety, and improving public health outcomes by increasing access to prevention, treatment, and recovery support services. The competitive nature of the COSSUP grant underscores the national recognition of Wisconsin’s urgent need and its compelling proposal for a proactive deflection model.

This significant federal funding served as the critical catalyst for the official launch and operationalization of the Wisconsin Deflection Initiative (WDI). The WDI was meticulously designed with a clear and ambitious mandate: to forge direct, non-punitive pathways for individuals struggling with SUDs to access critical treatment and comprehensive support services before they experience acute crises such as non-fatal or fatal overdoses, or become entangled within the labyrinthine criminal justice system. The initiative’s foundational philosophy centers on early engagement and diversion, aiming to interrupt the typical progression from substance use to crisis and incarceration.

The conceptualization and development of the WDI involved extensive collaboration among a diverse array of stakeholders. The Wisconsin DOJ took a leadership role, working closely with the Wisconsin Department of Health Services (DHS), local law enforcement agencies, emergency medical services (EMS) providers, community mental health and substance use treatment providers, public health organizations, and advocacy groups. These initial planning phases were crucial in establishing a shared vision, identifying existing service gaps, and designing a framework that could be adapted to Wisconsin’s unique demographic and geographic tapestry. The WDI emphasizes the imperative of collaboration, recognizing that effective intervention in SUDs necessitates a seamlessly coordinated response across traditionally siloed sectors. By fostering robust partnerships between law enforcement, emergency responders, and the healthcare and recovery communities, the WDI seeks to create multiple, accessible entry points for individuals to transition from situations of risk or crisis into a continuum of care, thereby promoting rehabilitation, reducing recidivism, and ultimately saving lives across Wisconsin’s diverse communities.

Many thanks to our sponsor Maggie who helped us prepare this research report.

3. Operational Framework of the Wisconsin Deflection Initiative

The Wisconsin Deflection Initiative (WDI) is underpinned by a robust and multi-pronged operational framework designed to facilitate proactive engagement and seamless transitions into care. This framework is not a single program but rather a coordinated ecosystem of interventions, each tailored to specific points of contact where individuals with SUDs can be identified and offered support. The emphasis is consistently on harm reduction, public health, and long-term recovery, moving decisively away from punitive responses.

3.1 Key Components of the WDI

Self-Referral and Officer Intervention Programs

The WDI incorporates dual pathways for individuals to access services: voluntary self-referral and officer-initiated interventions. Self-referral programs are critical for empowering individuals to seek help proactively without fear of legal repercussions. These typically manifest as ‘Safe Station’ or ‘Drop-in Center’ models, where individuals can walk into designated police stations, fire stations, or community centers during specific hours and request assistance for their SUD. Instead of arrest or charges, they are immediately connected with a peer recovery specialist or a social worker who facilitates a warm handoff to a treatment provider. These programs often operate with an ‘anonymous’ or ‘no questions asked’ policy regarding low-level drug possession, focusing solely on immediate connection to care. Some WDI-supported sites may also establish dedicated phone lines or online portals, allowing individuals or their family members to initiate the referral process remotely, ensuring accessibility for those with transportation barriers or fear of in-person contact.

Concurrently, officer intervention programs are foundational to the WDI’s proactive approach. Law enforcement officers, as first responders and frequent points of contact with individuals in distress, are uniquely positioned to identify signs of SUDs. The WDI mandates comprehensive training for officers, equipping them with the knowledge and skills necessary to recognize opioid overdose symptoms, identify individuals exhibiting signs of chronic substance use, and understand the principles of motivational interviewing and de-escalation techniques. This training goes beyond basic identification, focusing on fostering empathy and understanding addiction as a public health issue. Officers learn to offer treatment as an alternative to arrest for certain low-level drug offenses, or simply to make a referral even without an offense. The process involves identifying an individual, assessing their immediate safety and willingness to accept help, and then facilitating an immediate ‘warm handoff’ to a waiting treatment professional or peer recovery specialist, often on-site or through a rapid transport system. This pre-arrest diversion model significantly reduces entries into the criminal justice system, thereby mitigating the collateral consequences of arrest and promoting a quicker entry into treatment.

Active Outreach to At-Risk Individuals

Beyond reactive responses, the WDI emphasizes proactive engagement with at-risk populations. This involves systematic efforts to identify and approach individuals who may not yet be in crisis but are at high risk of developing or exacerbating an SUD. Outreach strategies are data-driven, leveraging overdose mapping, EMS call data, and community intelligence to pinpoint geographic hotspots or specific demographics with elevated risk. Teams comprising peer recovery specialists, social workers, and sometimes plainclothes law enforcement or community health workers, conduct targeted outreach in these areas. This can involve visiting homeless encampments, engaging with individuals recently discharged from hospitals after a non-fatal overdose, or connecting with individuals known to frequent high-risk areas. The outreach is non-coercive, focusing on building trust, providing information about available resources (including harm reduction supplies like naloxone), and offering direct connections to treatment and support services. The goal is to provide resources and build rapport before an acute crisis occurs, fostering a sense of trust that encourages voluntary engagement.

Enhanced Response to Overdose Incidents

Recognizing overdose events as critical ‘teachable moments,’ the WDI integrates enhanced post-overdose response protocols. While initial emergency medical response focuses on stabilization and reversal (e.g., administering naloxone), the WDI extends this by ensuring a follow-up mechanism. Within 24-72 hours of an overdose, a team typically consisting of an EMS responder, a law enforcement officer, and a peer recovery specialist or social worker, will attempt to contact or visit the overdose survivor. The purpose is not to investigate or prosecute, but to offer immediate support, provide resources, and connect the individual with treatment. This ‘Leave Behind’ naloxone program ensures that survivors and their families have access to overdose reversal medication and training. By treating a non-fatal overdose as an opportunity for intervention rather than merely a medical emergency, the WDI significantly increases the likelihood of individuals entering and sustaining treatment, thereby reducing the risk of subsequent, potentially fatal, overdose events. Data gathered from overdose incidents also informs broader prevention strategies and resource allocation, identifying emerging drug trends or high-risk areas.

Coordination Between Law Enforcement and Treatment Providers

The bedrock of the WDI’s operational success lies in its robust, formalized partnerships between law enforcement agencies and substance use treatment providers. This coordination moves beyond mere informal relationships to established memorandums of understanding (MOUs), shared protocols, and integrated communication channels. Joint training sessions are regularly conducted, ensuring that both law enforcement and treatment professionals understand each other’s roles, terminology, and operational constraints. Dedicated liaison roles are often established, where specific individuals from law enforcement and treatment agencies are responsible for facilitating referrals, troubleshooting issues, and ensuring smooth transitions. Information sharing, while strictly adhering to privacy regulations such as HIPAA and 42 CFR Part 2 (federal regulations governing the confidentiality of substance use disorder patient records), is streamlined through consent forms and secure communication platforms, allowing for appropriate follow-up and tracking of outcomes. This high level of integration fosters mutual trust and creates a seamless, person-centered pathway from initial contact to sustained recovery, avoiding fragmentation of care.

Comprehensive Support Services

The WDI recognizes that successful recovery from SUDs extends far beyond medical detoxification and traditional therapy. It embraces a holistic, ‘wraparound’ approach to care, addressing the myriad social determinants of health that often co-occur with SUDs and can impede long-term recovery. Beyond core substance use treatment modalities like Medication-Assisted Treatment (MAT), individual and group therapy, and cognitive-behavioral interventions, the WDI facilitates access to a broad spectrum of ancillary services. These include, but are not limited to, mental health care for co-occurring disorders (which are highly prevalent among individuals with SUDs), secure and stable housing assistance (critical for maintaining sobriety), employment counseling and job placement services, educational opportunities (such as GED programs or vocational training), transportation assistance to appointments, childcare support, and legal aid for issues that may arise from past criminal justice involvement. Peer recovery support, provided by individuals with lived experience of recovery, is a cornerstone of this comprehensive approach, offering empathy, mentorship, and practical guidance. By addressing these multifaceted needs, the WDI aims to build a stable foundation for individuals to rebuild their lives, achieve sustained recovery, and reintegrate successfully into their communities.

3.2 Implementation Strategies

The WDI’s effectiveness hinges on its strategic implementation, characterized by a deep commitment to community engagement, equitable resource allocation, and profound cultural competency. These strategies are particularly vital given Wisconsin’s diverse geographic and demographic landscape.

Community Engagement

At its core, the WDI operates on a profound understanding that successful interventions are locally driven. It eschews a one-size-fits-all model in favor of a community-based approach. This involves extensive collaboration with local non-profits, faith-based organizations, community leaders, public health departments, and neighborhood associations. Needs assessments are conducted at the local level to identify specific substance use patterns, existing service gaps, and unique community challenges (e.g., prevalence of specific substances, cultural norms around seeking help, availability of transportation). Local advisory boards or steering committees, comprising diverse community stakeholders, are established to guide the planning, implementation, and evaluation of WDI programs within their respective areas. This ensures that interventions are not only relevant but also trusted and embraced by the communities they serve, fostering a sense of collective ownership and efficacy.

Resource Allocation

The $7 million COSSUP grant serves as seed funding for the WDI, strategically distributed to maximize its impact across the state. This typically involves competitive sub-grants awarded to local law enforcement agencies, county health departments, and non-profit treatment providers that propose innovative WDI-aligned programs. The allocation process considers factors such as population density, overdose rates, existing infrastructure, and documented need. Beyond the initial grant, the WDI is committed to developing long-term sustainability plans. This includes exploring diversified funding streams, leveraging existing state and federal resources (e.g., Medicaid expansion for SUD treatment), advocating for sustained state appropriations, and encouraging local matching funds or in-kind contributions. The goal is to build enduring infrastructure for deflection services, ensuring their continued operation beyond the initial grant period and equitable distribution of resources to meet the diverse needs of various populations, from dense urban centers to remote rural areas and sovereign tribal lands.

Cultural Competency

Given Wisconsin’s rich tapestry of diverse populations, particularly the significant presence of sovereign tribal nations, cultural competency is not merely an add-on but an intrinsic and indispensable component of the WDI’s implementation strategy. The initiative mandates comprehensive cultural competency training for all law enforcement officers, healthcare providers, and support staff involved in WDI programs. This training emphasizes understanding historical trauma, particularly its profound and ongoing impact on tribal communities, and recognizing how cultural values, traditional healing practices, and familial structures influence help-seeking behaviors and recovery pathways. For tribal communities, services are developed in direct consultation with tribal elders and health authorities, respecting tribal sovereignty and integrating traditional healing modalities alongside Western medical interventions. This ensures that services are not only accessible but also culturally safe and relevant, leading to greater engagement and more effective outcomes. Furthermore, the WDI actively promotes the recruitment and retention of diverse staff, including individuals from tribal backgrounds and other underserved communities, to enhance relatability and trust.

Many thanks to our sponsor Maggie who helped us prepare this research report.

4. Partnerships with Law Enforcement and Healthcare Providers

The success of the Wisconsin Deflection Initiative hinges on the seamless integration and mutual commitment of its core partners: law enforcement agencies and healthcare providers. This collaboration represents a fundamental paradigm shift from adversarial relationships to a cooperative model focused on public health and safety.

4.1 Role of Law Enforcement

Law enforcement agencies, traditionally viewed as the primary enforcers of drug laws, play an absolutely pivotal and transformative role within the WDI. Their engagement marks a significant evolution in policing philosophy, shifting from a sole focus on ‘custody and control’ to a more holistic approach of ‘care and connect.’

Identifying At-Risk Individuals and Initiating Referrals

One of the primary functions of law enforcement within the WDI is the proactive identification of individuals at risk of, or actively experiencing, SUDs. This requires specialized training that goes far beyond basic drug recognition. Officers are trained to observe behavioral cues, physical signs, and contextual indicators that may suggest substance use or a need for intervention. This includes understanding the nuances of how SUDs can manifest, such as impaired judgment, erratic behavior, or signs of withdrawal. Furthermore, officers are educated on the impact of historical trauma and systemic issues on vulnerable populations, fostering a more empathetic and understanding approach. The training also incorporates elements of crisis intervention and de-escalation techniques, preparing officers to engage effectively and compassionately with individuals who may be experiencing distress or acute intoxication. Once identified, officers are equipped with clear protocols and immediate resources to initiate referrals to treatment services, rather than resorting to arrest. This could involve providing information about self-referral options, directly transporting individuals to designated treatment centers, or coordinating with a co-responder team (e.g., an officer paired with a mental health professional) on scene.

Facilitating Diversion

The WDI’s cornerstone is the ability of law enforcement to facilitate the diversion of individuals from the criminal justice system. This can occur at multiple stages: pre-arrest, post-arrest, or through citation in lieu of arrest. Pre-arrest diversion allows officers to offer a direct pathway to treatment as an alternative to formal charges for certain non-violent, low-level drug offenses (e.g., possession of small amounts of illicit substances) or for individuals who simply need help but have committed no crime. In these scenarios, officers prioritize connecting the individual with treatment over making an arrest. Post-arrest diversion might involve an agreement between law enforcement, prosecutors, and treatment providers to divert individuals who have already been arrested but whose primary issue is an untreated SUD, often contingent upon their engagement with a treatment program. This proactive diversion reduces incarceration rates, alleviates pressure on overcrowded jails, and significantly mitigates the devastating collateral consequences of a criminal record, such as barriers to employment, housing, and education. By promoting rehabilitation over punishment, law enforcement contributes directly to breaking the cycle of addiction and incarceration, leading to improved public safety outcomes.

Collaborative Efforts and Trust Building

Effective collaboration between law enforcement and healthcare providers is paramount. This involves not only formal agreements but also ongoing communication and relationship building at the operational level. Officers are trained to understand the treatment continuum and the types of services available, enabling them to make appropriate referrals. Conversely, treatment providers gain insight into the realities of policing and the challenges officers face. Joint training sessions, shared protocols for responding to specific situations (e.g., overdose calls, mental health crises involving SUD), and designated liaison personnel foster a culture of mutual respect and understanding. Addressing historical skepticism or resistance from both sides – law enforcement sometimes viewing SUD as a moral failing, and treatment providers sometimes distrusting law enforcement – is an ongoing process that requires consistent effort, clear communication of shared goals (public safety and health), and demonstrable positive outcomes. This collaborative environment ensures a coordinated, comprehensive response to individuals in crisis, maximizing the likelihood of successful intervention and recovery.

4.2 Role of Healthcare Providers

Healthcare providers are the backbone of the WDI, serving as the essential destination for individuals diverted from the criminal justice system. Their role extends beyond merely dispensing medication to providing a full spectrum of person-centered care.

Delivering Comprehensive Treatment Services

Healthcare providers within the WDI network offer a wide array of evidence-based medical and psychological care tailored to the complex and individualized needs of those with SUDs. This includes, but is not limited to: medical detoxification services, which safely manage withdrawal symptoms; Medication-Assisted Treatment (MAT), utilizing FDA-approved medications like buprenorphine, naltrexone, and methadone, which are considered the gold standard for opioid use disorder treatment due to their efficacy in reducing cravings, preventing relapse, and improving patient retention in treatment; individual and group therapy sessions utilizing modalities such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Motivational Interviewing (MI); and family therapy to address the broader systemic impacts of addiction. Treatment is offered across various levels of care, including inpatient residential programs, partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and standard outpatient services, ensuring a continuum of care that matches the severity of the SUD and the individual’s needs. The interdisciplinary team approach, involving physicians, nurses, therapists, social workers, case managers, and peer specialists, ensures that all facets of a person’s health and well-being are addressed.

Providing Holistic Support Services

Beyond direct medical and therapeutic interventions, healthcare providers connected with the WDI are instrumental in facilitating access to a wide range of ancillary support services crucial for sustained recovery. This encompasses vital services such as housing assistance, which provides stable environments conducive to recovery; employment support and vocational training, which offer economic stability and purpose; mental health counseling for highly prevalent co-occurring mental health disorders; and connection to basic needs like food assistance and transportation. These services address the social determinants of health that profoundly influence an individual’s vulnerability to SUDs and their capacity for recovery. Healthcare providers act as navigators, connecting individuals to these resources and often directly providing case management to ensure continuity and accessibility. In some contexts, harm reduction services, such as needle exchange programs or overdose prevention education, may also be integrated, aligning with the WDI’s public health goals.

Data Sharing and Feedback Loops

For the WDI to operate effectively and demonstrate its impact, secure and compliant data sharing between healthcare providers and law enforcement is essential. Healthcare providers contribute vital data on treatment engagement, retention rates, and observed health improvements, while adhering strictly to patient confidentiality regulations (HIPAA and 42 CFR Part 2). This often requires robust consent processes from individuals receiving services. Data is shared through secure electronic health record systems or dedicated shared platforms, allowing law enforcement to track the progress of diverted individuals, assess the effectiveness of their referral pathways, and refine their strategies. Crucially, this creates a feedback loop: law enforcement can see that their referrals lead to actual treatment engagement, reinforcing the value of their deflection efforts. This data also enables the WDI to monitor overall program efficacy, identify areas for improvement, and demonstrate positive outcomes to stakeholders and funders, ensuring transparency and accountability in the initiative’s operations.

Many thanks to our sponsor Maggie who helped us prepare this research report.

5. Success Metrics in Early Intervention

The Wisconsin Deflection Initiative’s efficacy is rigorously measured through a comprehensive set of metrics designed to evaluate its impact across public health, criminal justice, and individual recovery domains. These metrics move beyond anecdotal evidence to provide data-driven insights into the WDI’s success in achieving its stated goals of early intervention and improved outcomes.

5.1 Reduction in Overdose Incidents

One of the paramount indicators of the WDI’s success is its measurable impact on overdose incidents, encompassing both fatal and non-fatal events. By connecting individuals to treatment and harm reduction services proactively, the initiative aims to reduce the overall number of overdoses. This metric is tracked through several key data sources:

• EMS Overdose Response Data: Emergency Medical Services (EMS) agencies record all suspected overdose calls, including the administration of naloxone. A reduction in the frequency of these calls within WDI-impacted areas would indicate successful pre-crisis intervention.
• Hospital Emergency Department (ED) Visits for Overdose: Data from hospital EDs on admissions or visits related to overdose incidents (both fatal and non-fatal) provides another crucial dataset. A sustained decline in ED visits for overdose can signify effective early intervention and diversion to treatment before a medical emergency occurs.
• Coroner/Medical Examiner Data on Fatal Overdoses: This is the most critical and tragic metric. A significant and sustained reduction in drug-involved overdose deaths, particularly those linked to opioids and synthetic opioids like fentanyl, is a primary long-term goal. These data are often lagged due to toxicology testing, but they offer the clearest picture of mortality trends.
• Naloxone Administration Data: While increased naloxone administration might initially seem counterintuitive, it can indicate successful outreach efforts in distributing this life-saving medication, and when paired with follow-up protocols, shows that individuals are surviving overdoses and potentially being linked to care. However, the ultimate goal is a reduction in the need for naloxone due to reduced drug use.

Challenges in measurement include the fluidity of illicit drug markets, which can influence overdose rates independently of intervention efforts, and the inherent lag in official reporting of fatal overdose data. Nonetheless, baseline data established prior to the WDI’s implementation allows for longitudinal comparisons to assess the initiative’s contribution to saving lives and reducing critical medical emergencies.

5.2 Decrease in Criminal Justice Involvement

A central tenet of the WDI is to divert individuals from the criminal justice system, thereby reducing the economic and social burdens associated with arrest, prosecution, and incarceration. Success in this area is measured by:

• Arrest Rates for Drug-Related Offenses: A primary metric is the reduction in arrests for low-level drug possession or other non-violent, drug-related offenses among the target population. This indicates effective pre-arrest diversion by law enforcement.
• Recidivism Rates: For individuals who have engaged with the WDI and received treatment, a lower rate of re-arrest or re-incarceration for any offense, particularly drug-related or petty crimes often linked to substance use, signifies successful intervention and rehabilitation.
• Jail and Prison Admissions: A decrease in the number of individuals admitted to local jails and state prisons for offenses where SUD is identified as a primary contributing factor directly demonstrates the WDI’s impact on reducing incarceration rates. This also translates into substantial cost savings for the criminal justice system.
• Court Docket Reduction: Lower rates of drug-related cases entering the court system can indicate a reduced burden on judicial resources, allowing courts to focus on more serious offenses.

By prioritizing deflection, the WDI aims to break the revolving door of addiction and incarceration, fostering a more effective and humane public safety strategy. The financial benefits of reduced incarceration, court costs, and associated social services are also significant and are often included in a comprehensive cost-benefit analysis.

5.3 Improved Recovery Outcomes

The ultimate measure of the WDI’s success lies in the improved long-term recovery outcomes for individuals who engage with the initiative. These outcomes reflect not just the absence of substance use but a holistic improvement in quality of life:

• Sustained Sobriety/Reduced Substance Use: While ‘sobriety’ can be difficult to definitively prove, metrics include self-reported reductions in substance use, negative drug screens (where appropriate and consented to), and reduced frequency of cravings or relapse episodes. Longitudinal follow-up with participants is crucial here.
• Treatment Engagement and Retention: High rates of individuals entering WDI-referred treatment programs and, critically, remaining engaged in those programs for recommended durations (e.g., 90 days or more) are strong indicators of program effectiveness. Retention in MAT is particularly important.
• Employment and Education Status: Improvements in employment rates, consistent work attendance, and engagement in educational or vocational training programs indicate greater stability and reintegration into society.
• Housing Stability: Reduced rates of homelessness or an increase in stable housing situations are vital markers of recovery, as secure housing is a fundamental pillar of long-term well-being.
• Physical and Mental Health Improvements: Self-reported improvements in overall physical and mental health, reduced visits to emergency rooms for non-overdose health issues, and better management of co-occurring mental health disorders are key indicators. Validated assessment tools, such as the Addiction Severity Index (ASI) or the Recovery Capital Scale, can be used for pre- and post-intervention comparisons.
• Improved Quality of Life and Social Functioning: This encompasses broader measures such as improved family relationships, increased social support networks, reduced criminal activity, and a general sense of purpose and well-being. Qualitative data, gathered through participant interviews and focus groups, provides invaluable insights into these more subjective yet profoundly important aspects of recovery.

Measuring recovery outcomes often requires long-term follow-up studies and robust data linkage, posing methodological challenges. However, the WDI is committed to collecting these comprehensive data points to demonstrate its impact on individuals’ lives and the broader community, reinforcing the long-term benefits of early intervention and comprehensive support.

Many thanks to our sponsor Maggie who helped us prepare this research report.

6. Addressing the Unique Needs of Urban, Tribal, and Rural Communities

Wisconsin’s diverse geographical and cultural landscape necessitates that the WDI adopt a highly adaptable and nuanced implementation strategy. Acknowledging that the challenges and resources differ significantly across urban, tribal, and rural settings is paramount for the initiative’s widespread success.

6.1 Urban Communities

Urban areas, characterized by high population density, diverse demographics, and often significant socioeconomic disparities, present a unique set of challenges and opportunities for SUD intervention. While they typically have a higher concentration of treatment facilities, access remains a significant barrier for many, exacerbated by issues such as homelessness, co-occurring mental health disorders, and systemic inequalities.

• Specific Challenges: Urban environments often contend with higher rates of homelessness, making stable engagement in treatment difficult. They also frequently face more complex co-occurring mental health disorders, often compounded by a lack of integrated care. High population density can lead to the rapid spread of illicit substances, including fentanyl-adulterated drugs. Furthermore, issues such as gang involvement, violence, and entrenched poverty can create significant barriers to seeking and sustaining recovery.
• WDI Strategies: To address these challenges, the WDI focuses on expanding access to services within urban neighborhoods, not just through traditional clinics but also via outreach programs integrated into existing community hubs, such as homeless shelters, community centers, and public health clinics. Community outreach is intensified, utilizing street outreach teams composed of peer recovery specialists and social workers to build trust with vulnerable populations who may be wary of official institutions. The WDI facilitates rapid rehousing initiatives for individuals experiencing homelessness, recognizing stable housing as a foundational element for recovery. Partnerships with harm reduction organizations are critical, including support for naloxone distribution programs and potentially advocating for or exploring the feasibility of safe consumption sites, where appropriate and legally permissible, to reduce overdose deaths and link individuals to care. Addressing the social determinants of health is central, with efforts to connect individuals to resources for housing stability, employment, and educational opportunities. The initiative also supports the development of specialized street outreach teams that can quickly respond to clusters of overdose events, offering immediate support and connections to treatment.

6.2 Tribal Communities

Wisconsin is home to eleven federally recognized Native American tribal nations, each with distinct cultures, histories, and governmental structures. Interventions within these communities demand profound cultural sensitivity and respect for tribal sovereignty, recognizing the deep impact of historical trauma on current health disparities, including SUD prevalence.

• Specific Challenges: Tribal communities disproportionately bear the burden of historical trauma, including the legacy of forced assimilation, land dispossession, and intergenerational trauma from boarding schools. These historical injustices contribute to elevated rates of SUDs, mental health conditions, and chronic diseases. Furthermore, jurisdictional complexities between tribal and state governments can complicate service delivery, and often, tribal health services are underfunded. Stigma within close-knit communities can also be a barrier to seeking help.
• WDI Strategies: The WDI’s approach to tribal communities is rooted in cultural humility and sovereignty. This means engaging in direct, nation-to-nation consultation with tribal leaders, health departments, and elders from the outset. Services are designed to be culturally sensitive, incorporating traditional healing practices, ceremonies, and spiritual components alongside Western medical and therapeutic interventions. This might involve supporting tribal healing lodges, integrating traditional healers into treatment teams, or developing culturally specific therapeutic narratives. Community involvement is paramount, ensuring that tribal leaders are not just informed but are active partners in the planning, implementation, and oversight of intervention strategies. The WDI explicitly addresses the impact of historical trauma through trauma-informed care models that recognize and respond to the pervasive effects of chronic adversity. Funding is often directed straight to tribal health services, empowering them to develop and deliver culturally appropriate programs. Data collection within tribal communities respects data sovereignty, ensuring that data generated by tribal citizens remains under tribal control and is used in a way that benefits the community without perpetuating harmful stereotypes.

6.3 Rural Communities

Rural areas in Wisconsin face unique logistical and systemic barriers to SUD treatment, primarily due to geographic isolation, limited infrastructure, and a smaller, often more stigmatized, social environment.

• Specific Challenges: Geographic isolation is a major hurdle, with long distances to treatment centers, limited public transportation options, and a scarcity of specialized SUD providers (e.g., MAT prescribers, therapists). Rural areas often have less developed healthcare infrastructure, fewer hospitals, and limited mental health resources. The smaller, close-knit nature of rural communities, while beneficial in some ways, can also exacerbate stigma, leading individuals to avoid seeking help for fear of judgment or loss of privacy. Furthermore, the ‘brain drain’ of healthcare professionals often leaves rural areas underserved.
• WDI Strategies: The WDI actively combats geographic barriers through the strategic expansion of telehealth services, ensuring that remote consultations, therapy sessions, and medication management can be accessed from individuals’ homes or local community centers. Addressing the digital divide by supporting broadband infrastructure development in underserved areas is also critical. Mobile treatment units are deployed, bringing services directly to underserved rural areas, functioning as rolling clinics that offer assessment, brief intervention, and connection to ongoing care. The initiative supports the development of community paramedicine programs, where paramedics, after responding to overdose calls, can conduct follow-up visits and connect individuals to services. The WDI also focuses on building local capacity by training primary care providers, pharmacists, and other local healthcare professionals to recognize SUDs, screen for risk, and, importantly, to prescribe MAT (e.g., buprenorphine waivers). This decentralizes care and leverages existing local resources. Furthermore, the WDI fosters the creation of local peer support networks, which are vital in rural areas where formal services may be scarce, providing community-based support and reducing isolation and stigma. The adoption of ‘hub-and-spoke’ models, where a central treatment hub supports multiple smaller satellite clinics or outreach teams in surrounding rural areas, is also a key strategy.

By carefully tailoring its interventions and resource allocation to the distinct socio-cultural and logistical realities of Wisconsin’s urban, tribal, and rural communities, the WDI aims to maximize its reach and effectiveness, demonstrating a truly comprehensive and equitable approach to substance use disorder deflection.

Many thanks to our sponsor Maggie who helped us prepare this research report.

7. Evaluation and Future Directions

For the Wisconsin Deflection Initiative to realize its full potential and serve as a replicable model, a robust and continuous cycle of evaluation, data-driven adaptation, and proactive policy advocacy is indispensable. This commitment to continuous improvement ensures accountability, optimizes resource allocation, and facilitates broader systemic change.

7.1 Data Collection and Analysis

The WDI employs a rigorous and comprehensive data collection and analysis framework to assess its ongoing effectiveness. This involves collecting a wide array of qualitative and quantitative data from all participating partners:

• Types of Data Collected: This includes, but is not limited to: the number of individuals diverted by law enforcement (disaggregated by demographics, offense type, and community); the specific pathways of diversion (e.g., self-referral, officer-initiated referral, post-overdose outreach); rates of engagement in treatment services (initial contact, intake, enrollment); treatment retention rates over various timeframes (e.g., 30, 90, 180 days); types of services accessed (e.g., MAT, therapy, housing support); rates of non-fatal and fatal overdoses in WDI catchment areas; rates of re-arrest or criminal justice involvement for program participants; and self-reported measures of recovery capital, quality of life, employment status, and housing stability from participants. Qualitative data from participant interviews, focus groups, and stakeholder feedback sessions provides rich contextual understanding and insights into lived experiences.
• Frequency and Responsibility: Data collection is ongoing, with defined reporting frequencies (e.g., monthly, quarterly, annually) by each contributing agency (law enforcement, EMS, treatment providers). A central coordinating body, likely within the Wisconsin DOJ or DHS, is responsible for aggregating, standardizing, and analyzing these diverse datasets.
• Data Security and Interoperability: Strict protocols are in place to ensure data security and compliance with all relevant privacy regulations, notably HIPAA and 42 CFR Part 2. This requires secure data sharing agreements and often the use of integrated data platforms or health information exchanges that allow for de-identified or securely linked data analysis while protecting individual privacy. The challenge of interoperability across different agency systems is a significant technical hurdle that requires ongoing investment.
• Analytical Methodologies: Data analysis involves both descriptive statistics (e.g., trends in overdose rates, number of diversions) and inferential statistics to determine the statistical significance of observed changes. Cost-benefit analyses are crucial to quantify the economic impact of deflection, comparing the costs of WDI interventions with the averted costs of incarceration, emergency medical care, and lost productivity. Qualitative data is analyzed using thematic analysis to identify recurring patterns, challenges, and successes reported by participants and front-line staff.

7.2 Continuous Improvement

The WDI is committed to an adaptive management framework, where data-driven insights directly inform program refinement and enhancement. This is not a static program but a dynamic initiative designed for ongoing evolution:

• Feedback Loops and Stakeholder Engagement: Regular meetings are convened with all key stakeholders, including law enforcement officers, paramedics, treatment providers, peer recovery specialists, community leaders, and program participants. These forums serve as vital feedback loops, allowing for the discussion of successes, identification of challenges, and collaborative problem-solving. Front-line experiences are highly valued and directly influence operational adjustments.
• Data-Driven Adjustments: If data reveals that certain referral pathways are underutilized, or specific populations are not being reached, strategies are immediately revised. For example, if overdose clusters emerge in new areas, outreach efforts are re-prioritized. If specific treatment modalities show higher retention rates, resources might be shifted to expand those services. This iterative process ensures that the WDI remains responsive and effective.
• Pilot Programs and Scaling: The WDI supports pilot programs for new or innovative interventions on a smaller scale. If a pilot demonstrates promising results, it can be scaled up and integrated into the broader initiative. Conversely, less effective components can be modified or discontinued, preventing wasted resources.
• Ongoing Training and Professional Development: As the understanding of SUDs and best practices evolves, continuous training and professional development are provided to all personnel involved. This ensures that law enforcement officers are up-to-date on de-escalation techniques and motivational interviewing, and that treatment providers are implementing the latest evidence-based therapies.

7.3 Policy Implications

The findings and successes of the Wisconsin Deflection Initiative hold significant policy implications, not only for Wisconsin but potentially for other states grappling with similar public health crises:

• Statewide Legislative Support and Expansion: Demonstrated success in reducing overdose deaths, criminal justice involvement, and improving recovery outcomes can provide strong evidence for the Wisconsin Legislature to enact sustained funding for deflection models, transitioning them from grant-dependent initiatives to permanently funded public health and safety strategies. This could involve codifying deflection programs into state law, ensuring their longevity and expansion across all counties.
• Influence on National Drug Policy: As a prominent example of a comprehensive deflection model, the WDI’s evaluation findings can inform federal policy discussions. Its success could advocate for increased federal funding for deflection programs through agencies like the BJA, SAMHSA (Substance Abuse and Mental Health Services Administration), and CDC (Centers for Disease Control and Prevention), encouraging broader adoption of similar strategies nationwide. It reinforces the argument for treating addiction as a public health issue rather than solely a criminal one.
• Integration into Broader Public Health Strategies: The WDI’s collaborative framework exemplifies how siloed systems can effectively merge for a common goal. This can serve as a blueprint for integrating SUD deflection into broader public health strategies, such as mental health crisis response, homelessness initiatives, and primary care. It highlights the importance of a ‘whole-of-government’ and ‘whole-of-community’ approach to complex social issues.
• Addressing Systemic Barriers: The insights gained from the WDI can inform policies that address systemic barriers to recovery, such as legal reforms to expunge or seal criminal records for drug-related offenses, advocating for fair chance hiring practices, and expanding access to affordable, recovery-supportive housing. It can also highlight the need for enhanced healthcare infrastructure, particularly in rural and tribal areas, and improved health insurance coverage for comprehensive SUD treatment, including MAT.
• Ethical and Legal Considerations: Ongoing evaluation also addresses ethical considerations, ensuring that deflection is genuinely voluntary and not perceived as a form of coercive treatment. Policy discussions will continue to refine the balance between public safety and individual autonomy within deflection models, ensuring that programs uphold civil liberties while effectively addressing public health needs.

Through rigorous evaluation and a commitment to continuous improvement, the WDI aims not only to impact Wisconsin positively but also to contribute valuable knowledge that can shape future public health and criminal justice policies across the nation, paving the way for more humane and effective responses to substance use disorders.

Many thanks to our sponsor Maggie who helped us prepare this research report.

8. Conclusion

The Wisconsin Deflection Initiative (WDI), launched in 2024 with substantial federal backing, represents a pivotal and promising paradigm shift in how the state addresses the multifaceted challenges posed by Substance Use Disorders (SUDs). Moving decisively beyond a punitive, incarceration-centric approach, the WDI embodies a proactive, public health-oriented strategy, recognizing that early intervention and comprehensive support are far more effective in mitigating the devastating societal and individual impacts of addiction. By deliberately connecting individuals struggling with SUDs to vital treatment and recovery services before crises escalate, before overdose becomes fatal, and before deep entanglement with the criminal justice system occurs, the WDI is poised to redefine the landscape of addiction intervention in Wisconsin.

This report has meticulously detailed the WDI’s comprehensive operational framework, underscoring its foundational components: the dual pathways of self-referral and officer intervention; the strategic imperative of active outreach to at-risk individuals; the critical enhancement of post-overdose response protocols; the formalized and seamless coordination between law enforcement and healthcare providers; and the provision of truly comprehensive, wraparound support services that address the holistic needs of individuals in recovery. Each component is designed to create accessible, non-coercive entry points into a continuum of care, fostering trust and promoting voluntary engagement.

Crucially, the WDI’s design demonstrates remarkable adaptability, meticulously tailoring its implementation strategies to the unique socio-cultural and logistical realities of Wisconsin’s diverse communities. In urban centers, it tackles high population density and socioeconomic disparities through expanded access and targeted outreach. Within sovereign tribal nations, it operates with profound cultural humility, respecting sovereignty and integrating traditional healing practices. For geographically isolated rural areas, it leverages telehealth, mobile units, and local capacity building to bridge infrastructural gaps and overcome stigma. This adaptability is a testament to the initiative’s commitment to equitable and effective service delivery across the entire state.

The success metrics outlined – encompassing a demonstrable reduction in overdose incidents (both fatal and non-fatal), a significant decrease in criminal justice involvement, and tangible improvements in long-term recovery outcomes such such as sustained sobriety, employment, and overall quality of life – are rigorously tracked through comprehensive data collection and analysis. This data-driven approach not only ensures accountability and transparency but also underpins a continuous improvement model, allowing the WDI to remain responsive, innovative, and evidence-based in its evolution.

In fostering robust collaboration between traditionally disparate sectors – law enforcement, emergency services, and healthcare providers – the WDI exemplifies a truly integrated public health and public safety solution. Its foundational premise, that treatment is more effective than incarceration for individuals with SUDs, is gaining increasing recognition. As the WDI progresses and demonstrates its measurable impact, it holds the profound potential to serve not merely as a local success story but as a replicable model for other states and communities nationwide. It underscores the critical importance of sustained investment, collaborative policy-making, and a compassionate, integrated approach in the broader societal effort to combat the opioid and substance use crisis, ultimately promoting healthier communities, reducing systemic burdens, and restoring hope for countless individuals and families across Wisconsin and beyond.

Many thanks to our sponsor Maggie who helped us prepare this research report.

References

• Wisconsin Department of Justice. (2024). Wisconsin DOJ Receives $7 Million Federal Grant to Expand Substance Use Treatment Access. Retrieved from doj.state.wi.us

• Wisconsin Examiner. (2024). Wisconsin DOJ receives $7M for substance abuse treatment. Retrieved from wisconsinexaminer.com

• White, V. M., & Albert, L. A. (2023). Evaluating diversion and treatment policies for opioid use disorder. arXiv preprint. Retrieved from arxiv.org

• Hamilton, M. (2024). Serving vulnerable populations: Hope emerges in the Wisconsin Deflection Initiative. Police1. Retrieved from police1.com

• National Institute on Drug Abuse (NIDA). (Various Years). Principles of Drug Addiction Treatment: A Research-Based Guide.

• Bureau of Justice Assistance (BJA). (Various Years). Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) Overview.

• Wisconsin Department of Health Services (DHS). (Various Years). Wisconsin Overdose Data.

• Samuels, E. A., et al. (2018). Leave Behind Naloxone Programs: An Approach to Reduce Opioid Overdose Deaths. Journal of Health Care for the Poor and Underserved, 29(1), 164-177.

• Taxman, F. S., & Walters, J. P. (2019). The Future of Criminal Justice: Reforming and Reimagining Justice. Routledge.

• National Academies of Sciences, Engineering, and Medicine. (2019). Medications for Opioid Use Disorder Save Lives. The National Academies Press.