To understand how overdose death rates and jail incarceration interact at the local level, it is important to examine how state and local policies impact the availability of harm reduction services, substance use disorder treatment, and other supportive services—both in community-based, noncoercive settings, and in jails and other areas of the criminal legal system.^[]Monique Tula, executive director of the National Harm Reduction Coalition, recently shared this analysis of harm reduction as a strategy and as a movement: “When we talk about harm reduction, we often reduce it to a public health framework, [one of] reducing risks. That’s harm reduction with a small ‘h-r’. Harm reduction is meeting people where they are but not leaving them there. But Harm Reduction with a capital ‘H’ and ‘R’—this is the movement, one that shifts resources and power to the people who are most vulnerable to structural violence.” Will Godfrey, “The Harm Reduction Movement: Bigger Than Ever, But Facing Threats,” Filter, October 19, 2018, https://perma.cc/VQM5-HFH2. For more information about harm reduction interventions and supplies, see Jason Tan de Bibiana, Charlotte Miller, Leah Pope, Susan Stellin, Jim Parsons, and David Cloud, Changing Course in the Overdose Crisis: Moving from Punishment to Harm Reduction and Health (New York: Vera Institute of Justice, 2020), https://perma.cc/W4RG-ASX4; National Harm Reduction Coalition (NHRC), “Safer Drug Use,” https://harmreduction.org/issues/safer-drug-use/; NHRC, “What is Crack?” https://perma.cc/ZDT9-985S; and NHRC, “Safer Injection Drug Use,” https://perma.cc/C87K-D4FG.

Vera's case studies from two states—New Mexico and North Carolina—highlight programmatic and policy innovations, as well as ongoing challenges for a diverse set of counties in their efforts to respond to the overdose crisis and address the use of incarceration in their local jurisdictions.

Between March and June 2020, Vera researchers conducted phone and video interviews with local experts in Bernalillo County and Rio Arriba County in New Mexico. Vera chose these sites by considering trends in overdose rates and jail incarceration rates, the presence of clear programmatic or policy innovations, diversity in geographic location, demographic composition of the population, and ability to access key stakeholders. You can read more about the methodology and data sources for overdose deaths and jail incarceration rates here.

State Landscape

Overdose death rates in New Mexico have historically been well above the national average, and from 1999 to 2014, New Mexico remained among the three states with the highest overdose rates. However, in recent years, New Mexico’s prominence has diminished; as overdose rates have increased nationwide, New Mexico has become less of an outlier. In addition to the still-high prevalence of opioid use, the number of overdose deaths attributable to methamphetamine is on the rise in the state, and polysubstance use is prevalent in the state.^[] In 2018, methamphetamines were involved in 36 percent of drug overdose deaths in New Mexico. Of methamphetamine-involved drug overdose deaths from 2014 through 2018, 51 percent were due to methamphetamine combined with opioids and 9 percent were due to methamphetamine with other substances such as alcohol, cocaine, or benzodiazepine. New Mexico Department of Health, New Mexico Substance Use Epidemiology Profile (Santa Fe, NM: New Mexico Department of Health, 2020), https://perma.cc/3DXG-R3ZK.

New Mexico lawmakers have long been supportive of progressive harm reduction approaches. The state was one of the first to introduce a legal framework for syringe services with the passage of the 1997 Harm Reduction Act.^[]“Harm Reduction Act,” N.M. Stat. Ann. § 24-2C, https://perma.cc/4B7Y-H5UJ. It was the first state to introduce a Good Samaritan law for 911 callers reporting overdoses and the first to require all law enforcement officers to carry naloxone.^[]In 2007, New Mexico became the first state to pass a 911 Good Samaritan law protecting from arrest and prosecution people who call for medical help in the event of an overdose from simple drug offenses, including witnesses and the person experiencing the overdose. N.M. Stat. Ann. § 30-31-27.1, https://perma.cc/W2BA-3HW5. While this is important legislation that protects people who call for help after an overdose, drug policy advocates are working to expand protections to people who are on probation or parole, as they are currently not protected under current legislation. Drug Policy Alliance, “Harm Reduction in New Mexico,” https://perma.cc/7FJ5-9ANL. For naloxone requirements, see New Mexico Department of Health, “Governor Martinez Announces Continued Improvement in Drug Overdose Death Rankings,” press release (Santa Fe, NM: New Mexico Department of Health, December 21, 2018), https://perma.cc/DR4N-A3Q4. In 2019, the legislature removed criminal penalties for possession of paraphernalia; New Mexico S.B. 323 (2019), https://perma.cc/62Q8-7Y7E. Additionally, Medicaid is suspended during incarceration rather than terminated, and coverage is automatically reinstated as soon as people are released.^[]Vikki Wachino and Samantha Artiga, “How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic,” Kaiser Family Foundation, June 17, 2019, https://perma.cc/G5XK-64P2. Medicaid may be reinstated during incarceration to cover inpatient procedures. Furthermore, providing Medicaid enrollment assistance to people leaving jails and prisons is a priority across the state.^[]Ibid.

During this period of progressive harm reduction reforms, however, criminal legal system practices moved in a notably more punitive direction, as reflected in jail population rates. Historically, New Mexico’s jail incarceration rate has mirrored the nation’s, but in 1997 the state’s rate broke away and steeply increased, nearly doubling before reaching a high in 2008. As of 2015, most people in jail in New Mexico were being held pretrial, but bail reform legislation that became effective on July 1, 2017, has paved the way for a potential jail population decline.^[]Christian Henrichson, Eital Schattner-Elmaleh, Jacob Kang-Brown et al., Incarceration Trends in New Mexico (New York: Vera Institute of Justice, 2019), https://perma.cc/33ZN-4GAL. For bail reform and pre-trial guidance, see New Mexico Courts, “Court Rules for Pretrial Release and Detention,” https://www.nmcourts.gov/court....

This section provides a case study of two counties in New Mexico: Bernalillo County, which is located in central New Mexico with Albuquerque as its county seat, and Rio Arriba County, a less populous but geographically vast county that lies along the northern border New Mexico shares with Colorado. Both counties have undertaken major initiatives over the last several years to advance harm reduction in their approaches to overdose deaths in lieu of more punitive legal system measures. The counties are different in terms of their respective size, culture, and resources. Yet both have struggled to find appropriate services and supports in the community, coordinate between initiatives, and ensure the sustainability of responses located outside of the criminal legal system. For more on the methods used to select these counties, click here.

Bernalillo County, NM

Bernalillo County, home to Albuquerque, is the most populated county in New Mexico.^[]Bernalillo County Community Health Council (BCCHC), Bernalillo County Community Health Profile, 2019 (Albuquerque, NM: BCCHC, 2019), 3, https://perma.cc/ZJ3E-WTGC. Of its nearly 680,000 residents, 83.9 percent are white and more than half of county residents of any race identify as Hispanic or Latinx. Additionally, 6.3 percent are American Indian or Alaska Native, and 3.6 percent are Black.^[]United States Census Bureau, “QuickFacts: Bernalillo County, New Mexico,” https://perma.cc/8SWJ-MV9N. Historically, use of alcohol and opioids was most prevalent, and, like elsewhere in the state, methamphetamine use has been on the rise.^[]In 2018, the alcohol-related death rate in Bernalillo county was 65.1 per 100,000 people. BCCHC, Community Health Profile, 76.

The available data shows a largely steady increase in Bernalillo County’s overdose death rate since 2000. Although the county had an overdose death rate of 26.3 deaths per 100,000 residents from 2013 to 2017, lower than several other New Mexico counties’ overdose death rates, Bernalillo is a populous county and thus saw the highest number of total overdose deaths in the state—902—during the same period.^[]New Mexico’s Indicator-Based Information System (NM-IBIS), “Health Indicator Report of Drug Overdose Deaths,” database (Santa Fe, NM: New Mexico Department of Health, Community Health Assessment Program), https://ibis.health.state.nm.us/indicator/view/drugoverdosedth.cnty.html. Meanwhile, starting in 2000, jail incarceration rates in Bernalillo climbed well above the national average, hovering between 500 and 600 people per 100,000 from 2004 until 2015. In recent years, the jail incarceration rate has dropped, reaching 273 per 100,000 in 2018.^[] “Incarceration Trends, Bernalillo County, NM,” database (New York: Vera Institute of Justice), https://trends.vera.org/rates/bernalillo-county-nm. Vera researchers spoke with a local prosecutor, a public health expert, a county behavioral health administrator, and a senior staff member from a health and social services organization to better understand how stakeholders at the county level are interpreting and addressing these trends.

Public health and community responses

Coordinated responses to problematic drug use have existed in Bernalillo County in different formats for quite some time. The Opioid Accountability Initiative, a strategic countywide effort launched in 2012, laid the foundation for many of the responses that currently exist in the county and identified priority areas for action.^[]Bernalillo County Community Health Council, “Bernalillo County Opioid Accountability Initiative,” https://perma.cc/D3W8-UXS8.

With support from voters, in 2015, Bernalillo County imposed a gross receipts tax—a tax applied to businesses based on their total sales—to generate funds earmarked for improving behavioral health services, marking the launch of the county’s more broadly focused Behavioral Health Initiative. The tax has the potential to generate around $22 million per year. Proposals for funds are reviewed by a steering committee of initiative members, and final funding decisions are made by the City of Albuquerque and Bernalillo County Commission joint committee.^[]For more information on the gross receipts tax, see Bernalillo County, “The Bernalillo County Behavioral Health Initiative,” https://perma.cc/GX7W-KCEL. Since the tax’s inception, the county has funded more than 24 programs, including the county’s Law Enforcement Assisted Diversion (LEAD) program, a resource reentry center, mobile crisis teams, a crisis stabilization unit, transitional living and supportive housing, and peer support services, to name a few.^[]For an overview of LEAD and other formal and informal alternatives-to-arrest programs, see Jason Tan de Bibiana, Charlotte Miller, Leah Pope, et al., Changing Course in the Overdose Crisis: Moving from Punishment to Harm Reduction and Health (New York: Vera Institute of Justice, 2020), 10, https://perma.cc/3ES8-URUT; and S. Rebecca Neusteter, Ram Subramanian, Jennifer Trone, et al., Gatekeepers: The Role of Police in Ending Mass Incarceration (New York: Vera Institute of Justice, 2019), https://perma.cc/KMH7-YN2F. Though there are no county-level health departments in New Mexico, Bernalillo County has a Department of Behavioral Health Services tasked with administering and overseeing the deployment of these funds. More recently, the Addiction Treatment Advisory Board was formed in 2017 to make policy recommendations to the county on treatment and harm reduction services.^[]Bernalillo County Government, “Addiction Treatment Advisory Board,” https://perma.cc/X24T-CKQT.

Although many of these efforts have seen success and have been welcomed by the community, a local public health expert expressed concern that, in an effort to put money to use, funds are often deployed in fragmented ways. There is now a need for greater coordination and data linkage between initiatives in order to develop a comprehensive response. The expert continued, “the people we are trying to serve tend to be served by multiple components within the system, and those components don’t necessarily work together. There are parts of the system that are beginning to get it, but at many levels, those systems are not connected.” The expert also mentioned the need for real-time data to help the community develop nimble responses.

In addition to calls for greater coordination and data transparency, interviewees highlighted a need for more case management, outreach, and diversion programs that are further upstream, connecting with people before they become entangled in criminal legal systems. Interviewees also mentioned the need for more housing options and greater diversity in treatment providers who can relate to the people they serve. Asked about community-based responses to substance use for people who come to the attention of police, a local prosecutor told Vera that existing programming wasn’t filling key gaps: “It’s certainly not getting linked up to the people who most need it and have justice system involvement.”

Criminal legal system responses

Building on lessons learned from programs in Seattle, Santa Fe, and North Carolina, Bernalillo County began a LEAD program in 2019.^[]Ryan Boetel, “Program to Focus on Treatment rather than Jail,” Albuquerque Journal, February 11, 2019, https://www.abqjournal.com/1279269/program-to-focus-on-treatment-rather-than-jail.html. Though it is too early to analyze successes of the program using data, local experts shared positive anecdotes from LEAD clients. Reflecting more generally on the role of police in behavioral health matters, one service provider for people experiencing homelessness was apprehensive about law enforcement being the first responders to an overdose, citing the concerns people who use drugs have when seeking help in times of crisis. “If you say anything about potential overdose or substance use [when calling for help], the police department comes right away,” the expert explained. “If you are a person of color, you are much more distrusting of that system. . . people aren’t going to call, so we have a lot of overdoses that result in death in the Black and brown communities in Bernalillo County.”

Bernalillo is also home to the largest county jail in the state, the Metropolitan Detention Center (MDC), which has historically been over capacity. Under pressure from a federal court order, the county has been working to decarcerate the facility since the early 2010s.^[]A 1995 class action lawsuit settled in 2015 and filed by formerly incarcerated people aimed to improve conditions at the jail. See McClendon v. City of Albuquerque, CIV-95-24 JAP/KBM, D.N.M. 1995, https://www.bernco.gov/metropolitan-detention-center/mcclendon-settlement-information.aspx. In 2013, a federal judge ordered Bernalillo County to reduce its jail population while the lawsuit was still pending. See Dan McKay, “Bernalillo County Jail Population Down To Near Design Capacity,” Albuquerque Journal, August 24, 2013, https://perma.cc/P7NZ-9U7V. By 2019, the county was compliant with 60 percent of reforms outlined in the 2015 settlement. See Ryan Boetel, “Bernalillo County Hopes to Resolve Jail Lawsuit Filed in 1995,” Albuquerque Journal, February 18, 2019, https://www.abqjournal.com/1282013/bernalillo-county-hopes-to-resolve-jail-lawsuit-filed-in-1995.html. The local prosecutor Vera spoke with believes that a case management order—imposed by the New Mexico Supreme Court in 2014 to shorten case processing times—may have also driven reductions in the number of people held in jail.^[]For more on the case management order, see Gordon Griller, Integrative Leadership: Reducing Felony Case Delay and Jail Overcrowding, A Lesson in Collective Action in Bernalillo County, New Mexico (Williamsburg, VA: National Center for State Courts, 2015), https://docplayer.net/955732-Integrative-leadership-reducing-felony-case-delay-and-jail-overcrowding-a-lesson-in-collective-action-in-bernalillo-county-new-mexico.html. In 2017, when incarceration was well below peak levels, the county introduced a risk assessment tool, which coincided with statewide bail reform. There is some debate locally about how these events impacted incarceration and crime.^[]Ryan Boetel, "Courts to Implement New Risk Assessment Tool," Albuquerque Journal, May 31, 2017, https://www.abqjournal.com/101...; and Susan Montoya Bryan, "Court Official: New Mexico's Bail Reforms Are Working," Associated Press, November 25, 2019, https://apnews.com/article/0de.... Although more comprehensive jail incarceration data from the Bureau of Justice Statistics is unavailable following 2018, COVID-19 has brought about a few noteworthy changes in MDC operations. Amid concerns about the spread of COVID-19 behind bars, the jail had released more than 200 people as of November 2020 because they were incarcerated for nonviolent charges and/or were medically vulnerable.^[]Metropolitan Detention Center, Bernalillo County, New Mexico, “MDC COVID-19 FAQS,” https://www.bernco.gov/metropolitan-detention-center/mdc-covid-19-faqs.aspx. Meanwhile, a behavioral health administrator notes that police throughout the county made fewer arrests for low-level offenses in an effort to avoid filling up the jail.

Medication-assisted treatment (MAT) is available to people incarcerated in MDC through a partnership with Recovery Services of New Mexico, a local community provider. Since 2005, people with opioid use disorder have been able to continue methadone treatment while incarcerated. In 2017, MDC expanded its program, allowing people to start methadone treatment while incarcerated.^[]The Associated Press, “Methadone Program for Inmates to Begin at New Mexico Jail,” Seattle Times, November 19, 2017, https://perma.cc/FE5U-XKB2; and Bernalillo County, “Commission Approves Behavioral Health Initiatives that will Leverage and Expand Existing Services,” March 29, 2017, https://perma.cc/CB7S-TEDN. The facility does not currently offer all three approved prescription medications for MAT—methadone, buprenorphine, and naltrexone—but expanding options is a priority of the Addiction Treatment Advisory Board.

Though availability of MAT in jails is important, continuity of care in the community is vital to reduce risk of overdose upon release and ensure the treatment is impactful. The county tries to ensure this through the Resource Re-entry Center (RRC), which opened in 2018 at the site of a former jail. RRC is a voluntary program, but nearly every person who is released from MDC passes through its doors. RRC operates 24 hours a day, seven days a week and offers services including, but not limited to, transportation planning, computer and telephone services, naloxone distribution, and case management to connect people to substance use treatment, SNAP/Medicaid enrollment, and other community-based services.^[]See Bernalillo County Dept. of Behavioral Health Services, Bernalillo County Resource Reentry Center Inaugural Year Review June 2018–July 2019 (Albuquerque, NM: Bernalillo County Dept. of Behavioral Health Services, 2019), https://perma.cc/DG5G-MTTL.

Local experts mentioned that before RRC opened, people were dropped off in front of the old jail in downtown Albuquerque, without the extensive resources the center now provides. And though the center tries to fill an important void, its potential impact on jail incarceration and overdose rates has yet to be formally evaluated. The service provider Vera researchers spoke with cautioned that RRC can be perceived by returning citizens as “an extension of the justice system” because the physical space is a former jail and RRC’s services are currently available only to people dropped off by county jail staff. Returning citizens are unable to access RRC’s resources after their initial contact with the center and are directed to a special phone number if they need further assistance.^[]Metropolitan Detention Center, Bernalillo County, NM, “Resource Re-Entry Center,” https://perma.cc/VR36-CLD3.

Conclusion

Over the last decade, Bernalillo County has introduced several significant initiatives addressing substance use, both in the community and in jail, reflecting increased urgency amid rising overdose deaths. Local funding streams and decision-making bodies have expanded the availability of harm reduction and treatment in the community while the police have launched a LEAD program to divert more people to these resources. Meanwhile, significant reductions in the jail population over the last few years have coincided with enhanced treatment for incarcerated people with opioid use disorders, and the county’s new reentry center underlines a commitment to ensuring continuity of care after incarceration. Still, the county’s efforts to combat overdose deaths are a work in progress, and advocates raise concerns about investing in criminal legal system-based approaches to overdose, which can evoke distrust among formerly incarcerated people and communities of color in particular. There remains ample opportunity to further invest in community-based services and supports that reduce the reliance on police and jails to connect people to treatment.

Rio Arriba County

Rio Arriba is known as “the heroin capital of New Mexico,” according to a drug policy and criminal justice reform advocate born and raised in the county. He added, “Heroin is something that’s embedded in our culture, in a way.… There isn’t a single person in the valley who hasn’t been impacted by it.” Rio Arriba’s population is estimated to be 38,921, and in a county that is predominantly Hispanic or Latinx (71.1 percent of the population) and American Indian (19.4 percent), these communities in particular have shouldered the devastating impact of overdose deaths.^[]United States Census Bureau, “QuickFacts, Rio Arriba County, New Mexico,” https://perma.cc/G4JQ-RJQG. “The cavalry is not coming to help, and that is what is really disturbing because we are really good people,” another advocate told Vera researchers. “You know, culturally in so many ways we are like a dying breed that once it’s extinct, so much is gone.”

For decades, Rio Arriba County has seen an overdose death rate well above the state and national averages, including in recent years, as many communities across the country have experienced spikes that became widely recognized as part of a national crisis. From 2013 to 2017, the county’s average overdose death rate was 89.9 deaths per 100,000 residents.^[]NM-IBIS, “Health Indicator Report of Drug Overdose Deaths,” database (Santa Fe, NM: New Mexico Department of Health, Community Health Assessment Program), https://ibis.health.state.nm.us/indicator/view/drugoverdosedth.cnty.html. Meanwhile, the county’s jail incarceration rate has increased from just over 100 per 100,000 people in 2000 to 564.6 per 100,000 people in 2013, when the rate began to drop, decreasing to 402 per 100,000 people as of 2018.^[]Vera, “Incarceration Trends, Bernalillo County, NM,” database (New York: Vera Institute of Justice), https://trends.vera.org/rates/rio-arriba-county-nm. Vera researchers spoke with a local judge, a police diversion program coordinator, and two advocates to better understand how stakeholders at the county level are interpreting and addressing these trends.

Public health and community responses

In Rio Arriba County, there are various community-based organizations that provide treatment and other supportive services to people with problematic substance use and their families. One such organization is Barrios Unidos, which was established with the recognition that many programs put a Band-Aid on the problem without addressing historical trauma, cultural trauma, and systematic inequities that lead to trauma. Addressing these root causes and creating space for healing are central to the mission of Barrios Unidos, which provides support to grandparents caring for grandchildren, peer support, and other services rooted in the culture of the people of Rio Arriba.

Another such organization is The Mountain Center, which provides extensive harm reduction services for people in rural northern Santa Fe and Rio Arriba Counties. These include syringe services; overdose prevention education; naloxone distribution; and information on, and referrals to, services. The center’s work is conducted from an office in Española via mobile outreach, which is particularly important because the county is so vast.

Increasingly, The Mountain Center has coordinated with partners in the criminal legal system to expand the reach of service delivery and reduce the harm of system-only interventions. The county also recently opened a new treatment facility for people with substance use disorders—called Darrin’s Place—and was set to open its first homeless shelter sometime in 2020. However, one advocate expressed concerns about barriers to accessing Darrin’s Place’s services, including an application process and the requirement that clients enter programming “clean.” The same advocate expressed frustration with repeated delays in the opening of the county’s first homeless shelter. The county has additionally initiated regular health council meetings to bring together community members, providers, and other stakeholders to discuss new approaches and shared barriers. Still, local experts mentioned that much remains to be done to strengthen coordination between systems and address the root causes of overdose deaths.

A potential barrier to meaningful change is the stigmatization of people who use drugs. This is still pervasive in the county, despite the fact that many people there have been impacted by substance use—whether through personal use or that of a loved one. People whom Vera interviewed mentioned that “just stop using drugs,” “pull yourself together,” and tough-on-crime sentiments are widespread.

Criminal Legal system responses

In Rio Arriba County, many children are raised by their grandparents or great-grandparents, often a result of parents struggling with problematic drug use, losing their lives to overdose, and/or being incarcerated.^[]According to a report commissioned by the Con Alma Health Foundation 53 percent of children under the age of six in Rio Arriba County were in the care of their grandparents in 2015. Anne Hays Egan, Grandparents Raising Grandchildren In New Mexico: Understanding the Trend & Stemming the Tide (Santa Fe: NM: Con Alma Health Foundation, 2017), 30, https://perma.cc/9G85-VL6W. An advocate Vera researchers spoke with is the caregiver for the children of her son, who is caught in a spiral of incarceration related to his heroin use—a habit she says he picked up during a period of incarceration for driving while intoxicated. She has gone to great lengths to advocate for her son, telling court personnel, probation officers, and other criminal legal system actors, “My son comes out [of incarceration] and he’s worse.”

People shared concerns about the prevalence of drugs in the jail as well as a lack of supports for people when they leave the facility. People are not connected to resources or given naloxone on their release. One person Vera spoke with shared that two of the times he has experienced overdoses were soon after being released from incarceration at the jail.

People in the community mentioned fear of criminalization by law enforcement as a reason not to call for help during or after an overdose and shared concerns around a lack of support from law enforcement for harm reduction efforts. Others noted recent shifts in attitudes of law enforcement officers, sharing that officers have been partnering with The Mountain Center for harm reduction education and that arrests are down for possession of syringes.

Another example that suggests a shift in law enforcement officers’ attitudes in recent years is the implementation of Reroute, the county’s LEAD program, which launched in early 2019.^[]See Memorandum Of Understanding Between The County Of Rio Arriba, The City Of Española, The First Judicial District Attorney's Office, The Law Offices Of The Public Defender, The Mountain Center, And The New Mexico Drug Policy Alliance, For The Rio Arriba County Law Enforcement Assisted Diversion Program, Also Known As “Reroute Program,” dated January 22, 2019, https://perma.cc/H8PL-PW4J. The program’s coordinator explained that before Reroute, arrest and incarceration rates remained high because people were being arrested on low-level charges like shoplifting and drug and paraphernalia possession. But since Reroute, fewer people are arrested for these types of charges, and instead are being connected to services in the community. On the other hand, when asked about Reroute, one of the advocates Vera researchers spoke with said it is a good option to have, provided the program is not “weaponized” by law enforcement. He explained that some community members believe program participants are expected to “snitch” on others, and relationships between community members and criminal legal system actors have been historically marked by distrust.

The leadership of a new judge—Judge Jason Lidyard—drove a further shift away from punitive responses in the county. Multiple interviewees mentioned that Judge Lidyard, district court judge in the First Judicial District of New Mexico, has had a significant impact on the community in the two years that he has been on the bench. One advocate said, “With this new judge, I could say that this county is currently getting less punitive… I mean, for once you have a judge who isn’t criminalizing drug addiction and that’s a major, major step.”

Judge Lidyard told Vera researchers that he tries to limit the use of incarceration, connect people to supports, and mend the negative perception that many people have of the court. Recognizing the collateral consequences of incarceration, Judge Lidyard explained that when somebody is incarcerated, “you have serious effects on that individual, their stability and their home life is shaken, their housing may be lost, their employment may be lost, the treatment program that they were in…their support systems start to break away.“ For cases in which substance use may be the underlying cause of the offense they are charged with, Lidyard does not rely on the use of common pretrial services like drug testing and required check-ins. Judge Lidyard said, “We don’t want [requirements] to be such as that it becomes most likely that a violation is going to result in being taken in to custody.” Rather, Lidyard requires people appearing before him to connect with local peer support workers, obtain doses of naloxone through The Mountain Center, and attend monthly recovery meetings. Additionally, in recognizing that probation violations for substance use propel the revolving door of incarceration, Lidyard is piloting an approach that removes probation officers from supervision in certain cases and puts supervision in the hands of a certified peer support worker instead.

Conclusion

Against the backdrop of particularly high overdose death rates over many years, advocates and public health experts in Rio Arriba have long embraced harm reduction services. Such services have become more available in recent years amid increased coordination between health and social service providers and criminal legal system partners. Additional resources set to become available in the county—such as a new homeless shelter and treatment facility—reflect a growing recognition among community members that a variety of services and supports are needed to reduce overdose deaths and provide a workable pathway toward recovery outside of jail.

However, the enduring presence of stigma underlines the need to create sustainable and well-funded mechanisms that deliver care outside of the criminal legal system. With the data showing Rio Arriba’s incarceration rate decreased from 2013 to 2018, the county is better positioned to focus on developing and strengthening interventions in community settings.^[]Vera, “Incarceration Trends, Rio Arriba County, NM,” database (New York: Vera Institute of Justice), http://trends.vera.org/rates/r.... Continued investment in and coordination among community-based responses has the potential to curb punitive attitudes toward drug use, expand the availability and use of treatment resources, and ultimately shrink the footprint of Rio Arriba’s criminal legal system in a public health crisis the county has come to know better than most.