How Small Cities Can Address Addiction

Too often people suffering with addiction end up entangled in the criminal justice system, as substance misuse and addiction continue to increase across the nation as cities grapple with how to tackle the epidemic.

Small cities can face the daunting challenge of addressing similar rates of addiction with less resources than larger cities.

In November at the National League of Cities’ City Summit in Los Angeles, small cities came together to share how they address this epidemic in their communities.

Two strategies emerged that may prove particularly useful for small cities: allowing people to access treatment through first responder agencies and combining resources to confront the epidemic with a regional approach.

First Responders Can Help Open the Door to Treatment

Several dozen small cities allow individuals to seek treatment at police or fire stations without fear of prosecution.  The first responders connect people to treatment through agreements with service providers in the community.

The Police Assisted Addiction and Recovery Initiative (PAARI) is one example of this early diversion, low cost model at police districts.

In 2017, city leaders in Portage, Indiana, a small city with a population of just over 35,000, launched the PAARI program and continues to find the program as a valuable resource for the community.

Another example includes Safe Stations, originally created by mid-size city Manchester, New Hampshire, where an individual seeks treatment at a fire station.  Both models acknowledge that emergency service personnel most often interact with individuals who experience substance use disorder and frequently want to do more to connect people to treatment.

The pathway to treatment from the police district or fire station to the treatment facility can vary to best fit the needs and services in the community. Examples include: emergency services staff drive the individual to treatment, the service provider picks up the individual, or a certified peer provider can take the individual to treatment.

Why is this an effective model for addressing addiction in small cities?

  • The model is cost-effective. It does not require additional monetary resources to set up a referral system with service providers that already exist in the community.
  • It provides the community with a place to go to request treatment without fear of arrest or further stigmatization.
  • The program is replicable and can be tailored to meet different community needs.

How can elected city officials pave the way to implementation?

  • Coalesce community stakeholders and other elected officials to discuss cost-effective ways to address substance misuse and addiction.
  • Garner buy in from the Chief of Police, Fire Chief and local treatment providers.
  • Research the different ways this model is implemented in different communities.

Take a Regional Approach to Tackle Addiction

A regional approach to addressing addiction is another helpful strategy that smaller communities can take.  Pooling resources and garnering support from nearby metropolitan areas can bolster and expand the reach of efforts.

One example from North Dakota is the Mayors Blue Ribbon Commission on Addiction formed to address the local impact of the opioid epidemic. The commission includes four small cities (Moorhead, West Fargo, Dilworth and Horace) partnered together with mid-size Fargo, North Dakota.  The comprehensive slate of initiatives spearheaded by the commission reduced opioid related deaths by almost one-half between 2016 and 2017.

Initiatives include supporting the Fargo/Moorhead Good Neighbor Project, which is a non-profit harm reduction organization. It provides a variety of services including community outreach, syringe exchange services, a drop-in center, infectious disease testing, support groups, as well as Naloxone training to approximately 600 first responders, shelter staff, schools and families.

Similarly, Newtown, Ohio Police Chief Tom Synan actively convened  key stakeholders from small, nearby cities to assist in the development of the Hamilton County Heroin Coalition.  This multijurisdictional coalition includes several small cities and Cincinnati. The coalition aims to increase and improve access to treatment, increase prevention and public education, and reduce the number of fatal overdoses.  It helps participating cities share resources and serves as a powerful voice to communicate the area’s needs with the local, state and federal community.

Why take a regional approach?

  • Shared resources allow for expanded reach and impact.
  • A shared message can assist in garnering state and federal dollars.

How can elected officials help their city take a regional approach?

  • Make a statement to the community that addressing addiction is a priority.
  • Meet with nearby local elected officials and community members to gain buy in.
  • Make the case for benefits of working together.

For more information, contact Tara Dhanraj, senior associate for Justice Reform, at or Leah Ettman, senior associate for Health and Wellness at

About the authors:
taraTara Dhanraj is a Senior Associate for Justice Reform at the NLC Institute for Youth, Education, and Families.

Leah Ettman Headshot LinkedInLeah Ettman is a Senior Associate for Health and Wellness at the NLC Institute for Youth, Education, and Families.