Brandon del Pozo: Policing, Opioids & Implementation Science

Dr. Brandon del Pozo is a postdoctoral researcher on the consequences of substance use and addiction at Rhode Island's Miriam Hospital and the Warren Alpert Medical School of Brown University. His interests include studying systems-level approaches to delivering substance use treatment services, overcoming the stigmas that obstruct evidence-based responses to the nation's opioid crisis, and confronting our growing stimulant epidemic. Brandon talks with Valerie and Carly about implementing evidence-based strategies to address the opioid crisis as chief of police of Burlington, Vermont. Valerie asks Brandon about how his training in philosophy informs his work, whether academics or police are more hierarchical, and his thoughts on police discretion as a critical point of intervention. 

Read more about Brandon’s work here: https://brandondelpozo.com/

Follow Brandon on Twitter: @BrandondelPozo 

Episode Transcript

Valerie Earnshaw (00:11):
I'm Valerie Earnshaw.

Carly Hill (00:13):
I'm C arly hill.

Valerie Earnshaw (00:14):
and this is sex drugs and science.

Carly Hill (00:17):
Today's conversation is with Dr.
Brandon Del Pozo.
Brandon is a postdoctoralresearcher at Rhode islands,
Miriam hospital, and the WarrenAlpert Medical School at Brown
University.
He studies approaches todelivering substance use
treatment services, ways toconfront the stimulant epidemic
and how to overcome stigma sothat we can better respond to
the nation's opioid crisis.

Valerie Earnshaw (00:37):
Before focusing on stigma, full-time
Brandon spent 23 years inpolicing.
He started with the NYPD andlater became the chief of police
in Burlington, Vermont.
The, we spoke with Brandon abouthis experiences using
science-backed approaches torespond to the opioid crisis
while he was chief of police.
And then we dug into his currentresearch interests.

(00:57):
We hope that you enjoy thisconversation with Dr.
Brandon Del Pozo.
Dr.
Brandon Del Pozo.
Thank you so much for joining uson, uh, Sex, Drugs and Science,

Dr. Brandon Del Pozo (01:12):
Dr.
Earnshaw, Great to be here.

Valerie Earnshaw (01:15):
No one calls me, Dr.
Earnshaw, so I feel very, um...
So I'm so excited to have thisconversation with you because
we've been chatting over thepast couple of months about your
research, about some stigma,scale development and
intervention work that you'reinterested in doing.
And I'm grateful for thisopportunity to kind of like dig
in a little bit more into yourbackground and how it's shaping

(01:38):
the work that you're doing.
So thanks again for making thetime.
We know that you're like you'rein crunch time for grant writing
and paper writing.
So we're grateful for your timetoday.

Dr. Brandon Del Pozo (01:49):
This is going to be a fun break though.
So, so thanks for having me.

Valerie Earnshaw (01:53):
All right.
So if we can start our, uh, slowwalk through your background,
you grew up in Brooklyn, in NewYork.

Dr. Brandon Del Pozo (02:00):
Yeah, no, that's right.
I was, I was born in my monitieshospital in the, in the mid
1970s.
Grew up in Brooklyn.
My father was a Cuban immigrant.
He came over from Havana.
His family worked for the radiostation.
And when, when Castro took overthe radio station, there was no
more ad sales.
There was no more of anything.
So they had to leave.
And my mom was, was this, thisJewish girl from Brooklyn.

(02:23):
So she was dating this like veryrespectable wedding
photographer.
When my dad came on the sceneand convinced her to bring home
to her Jewish grandparents, like, like this guy kind of right
off the plane from Cuba.
And then here I am.

Valerie Earnshaw (02:39):
Oh, wow.
What a great romance story.

Dr. Brandon Del Pozo (02:43):
They're still together.
It's great.
They still, they live two doorsdown from where I was born in
and my mom grew up.
So yes,

Valerie Earnshaw (02:50):
That's really neat.
So I was actually just thinkingabout this.
So if you let us means that youhad some of your formative years
in the eighties and earlynineties in New York, and that
was, that was the time of sortathe, like the cocaine and like
the crack epidemic a little bit.
Is that right?
Like, do you, Was that?

Dr. Brandon Del Pozo (03:08):
Yeah, no, the crack epidemic was a thing.
It was this thing.
If you were like someconscientious student going to a
math and science high school,traveling on the train every day
in the subway, an hour to get toschool, the crack epidemic,
right?
It wasn't this thing I wascontending with, thankfully in
my home, it really wasn't verypresent in my neighborhood, but
you could feel the tension inthe streets.

(03:29):
You could feel the effects of,of the stimulant crisis.
You could feel the, the relatedcrime, the violence, it was a
difficult time to be in NewYork.
Especially if you look at howviolent of a place it was.
And a lot of that was fueled bynot only the crack epidemic, but
by the response to it.

Valerie Earnshaw (03:46):
Okay.
So then we fast forward a littlebit into the nineties and you go
off to Dartmouth and you pursuea bachelor's degree in
philosophy, and I've alreadywarned Carly that I'm like, I'm
really fixated on your degree inphilosophy.
I want to know all about this.
Like why philosophy?
Yeah.
Let's start there.
Why did you, why did you chooseto study philosophy?

Dr. Brandon Del Pozo (04:08):
Yeah, it's so interesting.
So I went to a math and sciencehigh school, and I took eight
years of math while I was stillin high school, meaning like the
regular curriculum plus aresearch class every, every
semester, two years of calculus,by the time I graduated and I
thought that I I'd want to studyscience or be an engineer, but I

(04:28):
started having these philosophyconversations with some kids at
the school.
It was just Stuyvesant, it was apublic school, but these kids
went to like, they took a classon Kant at Harvard in the
summer.
That's just listen that's maybe.

Valerie Earnshaw (04:42):
Yeah.

Dr. Brandon Del Pozo (04:42):
My parents were not sending me to do that
in Cambridge.
I was working at the airportdoing freight my sophomore
summer, but I started havingthese conversations about
philosophy.
And I realized that whatinterested me about math was
really the concepts that the,the just set theory, logic, the
relationships that made certainfields in math possible, like
calculus, you know, this ideathat these two points are

(05:05):
getting infinitely closetogether and you're looking at
their slope.
And then philosophy is just themeta of that.
Right?
It's all the format ofquestions.
So I just became reallyinterested in philosophy.
And not only that, like themetaphysics, but also in terms
of morality, in terms of ethics,like getting to the first
principles.
And by the time I went toDartmouth, I sat down to take

(05:25):
the math placement exam to seeif you could start right at
calculus.
And I knew I could do that, butin the middle of it, I just
said, you know, I'm just goingto be a philosopher.
So listen, in my defense, I didtake like physics for engineers
and a few, a few likereasonably, I had a little bit
of science and math one a fewdays.
But by the time I was incollege, I was just fascinated

(05:46):
with the very basic conceptsthat underlied the structure of
reality and ethics, viralitybecame a philosophy major.

Valerie Earnshaw (05:55):
I love this trajectory, my, my husband's
math teacher and he asked peoplethese like really abstract
questions about like howthinking mathematically has
shaped, how they think aboutother things.
And most people are like, what?
So it's really interesting tohear you talk through that
progression and how it sort ofcame along,

Dr. Brandon Del Pozo (06:15):
And, and as, as you know, you know, your
husband and my wife are bothmath teachers and for my kid--
like one day, they're gonnaappreciate it-- but when they're
a teenager, there's gotta benothing worse than having like a
philosopher and a mathematicianparents.
You don't get away withanything.

Valerie Earnshaw (06:33):
Oh yeah, no, there's going to be some deep,

Dr. Brandon Del Pozo (06:36):
Well, you don't get to make a statement
without like being on eggshells,like which one of my parents is
going to dissect my statement?

Carly Hill (06:44):
Philosopher let alone like former police
officers.

Dr. Brandon Del Pozo (06:48):
Yeah.

Carly Hill (06:49):
Probably not getting away with a whole lot at all.
Uh,

Valerie Earnshaw (06:53):
Multi positionality household.
Some really fun stuff.
Yeah.
All right.
You do this degree in philosophyand then you return to New York,
right?
You joined the NYPD and maybethis is just a, um, a stereotype
that I hold of police officers.
So please correct me if I'mwrong.
But I just, I have the feelinglike there's not a, there's not

(07:16):
a whole ton of philosophy majorswho are police officers.
So, how did that transitionhappen?

Dr. Brandon Del Pozo (07:24):
But there's a few, and there's a few
that went to Dartmouth.
One of them still, two of themwere still on the forest.
And the NYPD in my oldBurlington.
When I went on to be chief, oneof my best cops was a Princeton
grad, but you're talking aboutphilosophy.
It, you know, it just that I didnot want to be a banker or a
consultant.
And I had okay grades, but theyweren't the grades for, you

(07:45):
know, Yale or Harvard law schoolor something like that, or some,
some top tier school.
But at the same time, New Yorkcity was a really, really
violent place.
When I was in high school.
I alluded to that earlier here,talking about the crack
epidemic.
And at the time, you know, we're, we're in this very tenuous
relationship with betweenAmerica and its police now, but
at the time it wasn't like that,right.
Bill Bratton had just finishedbeing the commissioner of New

(08:08):
York city.
I used to drive to the bars onthe west side, from my house
during break to, you know, topursue love and just taking the
trip, you'd see crack dealersand crack users and prostitutes.
And I got robbed in high school.
My friend was killed on the wayhome from school playing pool,

(08:30):
like a lot of violence, right?
And, and there was a change tothat.
The NYPD was putting cops on thecorners of, of a lot of places.
It did seen a lot of violence.
They were really getting gunsoff the street, arresting folks.
They...
and Murder was going down androbberies.
And I said, you know what?
This is, the change in the citywas palpable.
And not just for wealthy whitepeople, but even in the poorest

(08:50):
neighborhoods of the city, I'vesaid this story before, but one
of my good friends in juniorschool was a kid named Damian
Oliver.
He lived in Flatbush, Brooklyn,which was predominantly black.
I lived in Bensonhurst, which ispredominantly white and our
parents wouldn't let us visiteach other on the weekends
because they were justifiablyafraid of what would happen in
each other's neighborhoodsbecause of racism and because of
violence.

(09:11):
And that was changing in NewYork in the nineties.
And I had paid for college withthe army scholarship.
I was inclined to wear auniform.
I was inclined to do somethingsort of active.
So I said, you know what, let mebe a cop for a few years.
It would be a really interestingway to give back to my city and
to like see things I would neverotherwise see.
And I ended up doing it for, youknow, all in 23 years.

Valerie Earnshaw (09:33):
That's awesome.
Yeah.
That's an impressive go.
Yeah.
You know, you're collectingother degrees.
Your CV is littered withdegrees.
The master's in publicadministration from Harvard got
the criminal justice degree fromJohn Jay.
And I'm curious as to how this,this like perspective from
philosophy and maybe some of theother graduate work that you had

(09:54):
been doing at the time was, wasthat shaping like your, your
view and your experience?

Dr. Brandon Del Pozo (10:00):
Yeah.
I mean, I got this, um, timewill tell, but it's about the
wisdom behind this, but I got atattoo right before I became a
cop it's on my arm.
It's three Chinese charactersand it's one[inaudible] in
Mandarin, which means like pathor way of the scholar warrior or
the philosopher warrior.
So I got it.

(10:20):
I didn't like walk, I got it inSan Fran.
I didn't walk into some tattooparlor and like look through the
book.
And like,"I want those tattoos!"I brought it with me.

Valerie Earnshaw (10:29):
A warrior on the top page.

Dr. Brandon Del Pozo (10:30):
Well, I'm sure they, I mean, there's all
sorts of, you know, Chinesecalligraphy in the tattoo books
these days.
But I was reading thisphilosophy book, Eastern
philosophy back, it was notacademically.
I just bought it at thebookstore.
And it was about this idea thatto be a successful person and to
live a worthwhile life, you hadto have a balance between your
love of art, your love ofintellect, your love of

(10:51):
philosophy, and then yourability to actually exist in the
physical world.
That was the warrior part.
So they would have thesenoblemen in ancient China who
would have these competitionswhere they would do debate and
calligraphy and philosophy, butthey'd also do horsemen,
horseback riding and archery andswordsmanship.
And so I thought that was agreat balance.
And you can kind of see that inmy, my life, it gets a little,

(11:15):
you know,"schizophrenic" attimes, but I never lost track of
my love of philosophy, but Ithought it would be important as
a cop to get an advanced degreein criminal justice policy to
learn about evidence, how toincorporate evidence into
policing, to learn what thetrends in criminal justice were.
Right.
So I took my study design stuff.

(11:36):
I went through this really,really old.
I went to my old papers.
I had to like design a grant at,at John Jay, and it was like, I
had to call myself the principalinvestigator and say, what
percent effort my work would be.
It sent chills down my spine torealize I did that in like the
late nineties and how now I'mlike living that.
But anyway, so that right plus,so that was very, very

(11:58):
vocational in a certain way.
Right.
And then public administrationat the Kennedy school was one
step, less vocational.
It was about the principles ofpublic administration and public
leadership.
And then by the time I'dfinished those degrees, my, my
advisor, the man who helped meget my master's at John Jay was
a philosopher and ethicist.
And he's like, Brandon, you needto, you need to get your PhD in

(12:18):
philosophy.
Like that's, I said, it's goingto take forever.
He said, and I tested hispatience.
It took like, I think 12 years,but I ended up finally bringing
it all back home to a doctoratein political philosophy.

Valerie Earnshaw (12:30):
That's such a great story.
So first when Carly and I werelooking through your CV and your
writing, you're a Renaissanceman.
And so that's really interestingthis connection back to like,
you know, the balance betweenall of these different
components of self.
So that's really cool to, or,you know, interesting to hear
you talk about that and reflectthe thing that we can see just

(12:51):
by looking Through,

Dr. Brandon Del Pozo (12:52):
you know, no, no, thanks.
And it's interesting with phasesin life, like, cause you can't
always, for a while, I was ableto successfully balance like my
studies and some of the moreintellectual things.
And I think that's what helpedme respond to the opioid crisis
was the balance between likeimplementation and practice and
like the underlying theory ofwhat I was dealing with, like

(13:14):
addiction, right?
Addiction science, but then inlife, right?
You can't just always beconstantly walking that line.
And what I'm seeing now is thatcoming to grips with the
transition between a person whoI was a cop, I was a precinct
commander.
I worked in intelligence.
I ran a police department.
Now I'm doing research.
And maybe there's just, not onlyis there this constant balance,
but maybe there's also phases inyour life, right?

(13:35):
Where you transition frompractice to theory or vice
versa.

Valerie Earnshaw (13:39):
One of the, one of my favorite, it's
actually like a careerdevelopment program and they
talk, they give advice on, youknow, this is mostly for
academics on thinking of yourcareer trajectory and they call
your career a book with manychapters and they encourage you
to think about, okay, so this isthe chapter that I'm on.
Now.
Maybe I'm focused on this typeof research.
Maybe someday I want to engagein more community-based

(14:01):
research, not it'll be the nextyear, or maybe I want to write
books.
That's a future chapter.
So there, so I love that becauseI am someone who has like a
million interests at any onetime.
This like book with manychapters is so useful to me
because I can be like, okay,well in this chapter, no matter
how short I'll have that to be,cause I have like a million
other chapters I want to write,but you know, this is what I'm

(14:22):
going to focus on and, and deepdive on and then, you know, I
have other chapters to take on.
So that, yeah, that's a reallyneat Idea.

Dr. Brandon Del Pozo (14:30):
No, it's interesting.
And sometimes I think you, youanswer questions to your
satisfaction and then you moveon to the next question.

Valerie Earnshaw (14:37):
Yeah.
Yeah.
That's true.
Well, so this is so interestingthat it was an advisor who looks
at you and says"you're a PhD inthere".
So when you got that feedback orwhen that was reflected to you,
were you like, oh, of course I'ma PhD or was that a surprising
thing?
I mean, how did that land foryou?

Dr. Brandon Del Pozo (14:53):
So John Kleinig, who was my advisor and
I still keep in touch with them.
And for the, we just co-authoredsomething in the American
journal of bioethics.
And it was, it was a short paperon, um, decriminalization and
the ethics of public health andpolicing.
But, um, he spent his lifeflushing out the ethics of
criminal justice and policing.

(15:13):
And I think he saw that therewas a lot of, of just honestly
like crappy ethics out there.
And he felt maybe like he waspracticing in a fairly limited
field.
And he saw something in me.
I don't know my thesis on, onthe ethics of small gratuities
and policing like won the awardfor best thesis in my year.
And that was one of the thingswhere he was like, listen,
that's, you've got somethinghere.

(15:35):
Like let's, uh, pursue it.
I wrote him recently and said, Ididn't understand why you wanted
me to get a PhD then.
But I understand now that I haveone and thank you for, like,
waiting 12 years for me to sortall that out.

Valerie Earnshaw (15:49):
Wow.

Dr. Brandon Del Pozo (15:50):
Yeah.

Valerie Earnshaw (15:52):
Well, when you look at your work, it's like so
clear that the universe would bepushing you towards getting a
PhD.
I mean, this, the research thatyou're doing, which we'll get
to, you know, in a few, but Imean the perspective of your
advisor saying, you know,there's just, there's not a big
playground here and we need morethinkers and we need more people
can do this.
I mean, not only do we need morepeople, but sometimes now as an

(16:14):
advisor, when I look over ourclassroom, I'm like, you are,
"you are a PhD in the making".
I don't know if you know this,but it is like my duty to go and
tell you, because either the waythat people think about things
or the way that they arethinking about for me, it's
often, you know, like they'rethinking about scientifically.
I mean, there's just somethingabout sometimes the student
where you, where you can see it.
So it's, it's, it's neat that hesaw it, that he was like, come

(16:37):
to this playground

Dr. Brandon Del Pozo (16:38):
Yeah, no, a part of me, the part that was
...
"the improper motivation", whichI had was like, it would be
great to be a chief of policeand have a PhD so that when I go
to meetings with researchers,they have nothing to say, they
can't lorde anything over me.

Valerie Earnshaw (16:52):
would that have been worth it?

Dr. Brandon Del Pozo (16:53):
No.
I mean, sort of it would havebeen like,"Hmm", like, yeah, it
would have been worth it forlike a day just to like, get
that out of my system.
I remember her saying that tosomeone.
Yeah.
When the researchers come in andthey're like, well, at least at
least we have a PhD and I'mlike, okay, I joined the club,
but no, you could tell, I lovetaking ideas apart and seeing
what's under the hood, I lovegetting to the foundation of

(17:15):
things and seeing, seeing howconcepts interrelate and I love
when arguments come together tomake a point, right?
Whether it's scientifically, asI'm trending towards now or even
just in the very basic sense.
And he saw that and reallyencouraged me.
And he said, it's also a mealticket.
And he didn't mean that in a badway.
He said, no matter how good yourideas are or how much you want

(17:37):
to put forth a concept.
Like if you have the PhD, itgets you entree to the spaces
where you can do that.
More like it gives you aplatform and an entree, and
that's just life.
The best implementationresearcher I found is, is it
Laura?
Damschroder have you studied herwork?
Um, she wrote the consolidatedframework for implementation
research.
She was the first author.

(17:59):
That's her all over the placewith implementation research.
She has a MS.
But I think that's, uh, anexception, right?
I think that when you want toget into the rooms where you're
throwing ideas around, they wantyou to have the doctorate.
So part of it was just that too.

Valerie Earnshaw (18:13):
That's fair.
You know, this is, uh, somethingI was wondering about when I was
looking over your work.
So with, um, because youstraddled these two spaces of
police and academia, one of thethings I feel about academia is
that it's one of the mosthierarchical places I've ever
been, but everyone's pretendingthere's no power difference.
There's no hierarchy.
You know, like we have promotionand tenure, real strong

(18:36):
hierarchies there.
You've got students versusfaculty.
Like, it's just, it's a lot ofhierarchy, but everyone's just
like, pretending that that doesnot exist.
But, and then you have policewhere, and I, it looks to me
like there's a lot of hierarchythere and I'm just curious,
like, are both spaces, similarlyhigher hierarchical is policing
more?

(18:57):
like,

Dr. Brandon Del Pozo (18:58):
That's so interesting.
You asked that because it'strue.
And it's made me really attunedto the hierarchies in academia.
I had somebody write arecommendation for me to get my
postdoc.
And they said, you're getting,this is what they said.
And they're a fan.
Right?
They're writing arecommendation.
But they said, you're getting anassociate professor for the
price of a post-doc.
And now granted, like when wetalked before the show about my

(19:21):
Chronbach's alpha, you're like,no,"I don't know if you're
getting..
I don't, I don't know if that'sassociate professor level", but
the recommender was asserting,you know, something that I was
bringing a lot of background andconcepts.
So in policing, right?
Like the, the supervisors andthe cops don't use the same
lounge.
They don't have the same lockerroom in the NYPD they don't have

(19:42):
the same bathrooms in mostcases.
Everything is done in order ofseniority for when you're
something, when something crappyis going to happen, usually, the
least senior person has to doit, you know, as a Sergeant and
above in the NYPD like I had adriver and the guy or gal doing
it, wasn't like...
they were a subordinate, butwhen you're in the car with them
for hours, you know, you have tohave somebody, you truly respect

(20:02):
and you get along as, ascolleagues.
And if you're doing police work,you're both two human beings
that are doing it.
But very hierarchical.
Academia, I think it's a littlemore insidious because it's
definitely there, but people arein denial that it exists, right?

Valerie Earnshaw (20:16):
Yeah.
Yeah.
They're in denial or they see itand they don't wanna talk about
it.

Dr. Brandon Del Pozo (20:21):
Right.
And just even the assistantpostdoc assistant and associate
professor distinction gets at mebecause my friend's like, oh, it
doesn't make any difference.
If you become an assistantprofessor, you'll be golden.
And I'm like, no, the associateprofessors are still going to be
like,"we're associateprofessors".

Valerie Earnshaw (20:36):
Well, I just say, as like, As a woman in
academia, transitioning frompre-tenure to tenure definitely
has had a feeling, to it, topeople.
And when I talk to men and Isay, you know, how does
assistant to associate feel?
And they're like,"oh, it's thesame".
I do not feel like it's thesame.
I feel much more empowered tospeak up, to say things like,

(20:56):
you know, there were momentsbefore tinier where there were,
you know, conversations that Ifelt like had a, had a maybe, a
gendered lens or things thathappened that I think probably
wouldn't have gone that way if Iwasn't like a junior woman, that
now with tenure, I'd be like,oh, I would love to relive that.

Dr. Brandon Del Pozo (21:13):
No, it's interesting because in relation
-- not, not related to gender,but I have a friend who's a
criminal justice professor andhe's, um, I think he's full now,
but he's definitely, well, he'sdefinitely tenured, he's
associate.
And he throws firebombs onlineabout criminal justice.
If he, if he disagrees with you,he will tell you because he's

(21:35):
like, your theory of policing iswrong, or you're failing to
account for the fact that crimeis simply up and this more
violence, whatever.
And he says it because he hastenure.
He's like,"if I didn't havetenure, I wouldn't be talking to
other professors this way".
And to be really honest as aperson at the lowest rung of the
doctoral food chain as a postdoc, like, I'm very, very cautious
about what I say online.
Now.
I agree with a lot of what'sgoing on in the criticism of

(21:57):
policing.
It's true and it's overdue.
Some of it though, I think hasgone overboard, but I kind of
bite my lip until I'm in astronger position to talk back,
to put a very fine point on it,about what, I mean, I have seen
ecological studies that havemade the craziest associations
between policing and badoutcomes that I'm just like,
that just defies everything.

(22:19):
And the only reason you'resaying it is because you have
that one little throwaway at theend of your paper,"This is an
ecological assumption, and thisis an ecological study and be
caution, causal inference".
Right?
They say that, but the headlineis like,"POLICING DOES THIS TO
EVERYONE".
And I'm like, you can't...

Valerie Earnshaw (22:37):
it's communication ethics.

Dr. Brandon Del Pozo (22:38):
Right.
I guess I'm like hedging, likejust coming out and saying it.
Like, this is one, like theparadigm study for me is this
one that shows like one, two orthree incidents of police
killings in the metropolitanstatistical area in one year is
associated with an increase inunprotected sex in that NSA

(22:59):
among people of color the nextyear.
And I'm like, that is just aterrible study.
Like, cause it's like a very low"n" it's like one, two or three
police killings in an MSAmetropolitan statistical area,
one year.
But they're also not looking atwhat the rate of unprotected sex
was during the year of thekillings, to see if it's gone

(23:20):
up.
They're comparing like this manypolice killings in this year,
like associates with STIs withthis transmission with...
Hey, this, and this is thepodcast that...
Sex is in the title of hispodcast.
So I was wondering how we weregoing to work it in here.
Her we are.
So I was worried it would befalse advertising, but it's not.
So get the model, like it'salmost like dilation, like a

(23:42):
certain number.
Like if there's a certain numberof police in the statistical
area in this year, let's sayit's 2015.
Then in 2016 that associateswith, with greater rates of
sexually transmitted infections.
But not that they'd gone up justthat like more corresponds to
more across years in anecological sense.

Valerie Earnshaw (24:03):
right.

Dr. Brandon Del Pozo (24:04):
I'm like, I want to tell the world that
this should never, there is noneed to ever replicate that
study again,

Valerie Earnshaw (24:11):
stop here.

Dr. Brandon Del Pozo (24:14):
I'll say it here in the podcast.
But there are limits to what I'dsay academically, because who
knows when that person is goingto be like reviewing my paper.
And my papers matter, right now.

Valerie Earnshaw (24:22):
Yeah.
Yeah, no, I mean, that's thething, like your paper, your
grants, your, and yourmaterials.
There's lots of ways in which, Iwas just about to say, there's
lots of ways scientists can belike police each other, that can
hold power.
Which is interesting, but allright, well, so you're picking
up this PhD in philosophy and,you know, partway through that,

(24:44):
you mosey up to Burlington andyou become the chief of police
and that was 2015.
And it really, you did.
I mean, just speaking of likethe Scholar Warrior
Renaissance-man, you worked on alot there, a lot of different
initiatives, but sex, drugs andscience would, I'd really like
to focus in on, your work withthe opioid crisis.
So first I'm kind of curiouswhat, what was going on in

(25:07):
Burlington in 2015 in regards tothe Opioid crisis.

Dr. Brandon Del Pozo (25:10):
And I guess it was 20-, it was either
the state of the state addressin 2015.
I believe not 2014, but I think2015, which is before I got
there, governor Shumlin, thegovernor of Vermont spent the
entire state of the stateaddress on the opioid crisis.
And he made national news fordoing that.
Like it took a lot of couragefor him to say,"people are
dying.
No one wants to talk about this.

(25:31):
It's terrible, but I'm going tospend the entire State of the
State talking about the opioidcrisis" that really energized my
mayor, Miro Weinberger who's um,left-leaning Democrat to say,
listen-- And by the way, a leftleaning Democrat in Burlington
is like a troubling swing to theright.
Like this is where BernieSanders lives, s ocialists c
ontrol the city council at thispoint.

(25:52):
So when the democratic mayorgets elected people, t hey're
like having an existentialcrisis because it's a Democrat.
"How much further to the rightcan we get?"

Valerie Earnshaw (26:00):
Uh Huh

Dr. Brandon Del Pozo (26:00):
It's the type of place where like I
arrested Ben of"Ben and Jerry's"like, yeah, yeah.

Valerie Earnshaw (26:06):
For what I have to know?

Dr. Brandon Del Pozo (26:09):
Well because the F-25,F-35?
The F-35, you have 35 fighters.
We're going to be based out ofBurlington, replacing F 16
fighters that were alreadythere, but they were noisier and
Ben and Jerry's don't wantfighters in Vermont.
Fighters and ice cream don'tmix.
And so they put like hugespeakers on the back of a truck
and drove it around towndeliberately like replicating,

(26:31):
like jet engine noise andeverybody's ear to like wake
them up to the problem of theF-35's.
But I got a call from his lawyer, like"Ben wants you to arrest
them for violating the noiseordinance".
It's like, well, he's definitelyviolating the noise ordinances.

Valerie Earnshaw (26:44):
You're like, "Happily!"

Dr. Brandon Del Pozo (26:44):
Yeah, no, no that, yeah, he's doing it.
And so there is like, you know,I, so there, I was like, I
remember I got the call, likearchetypal Vermont.
I get the call that this isgoing to happen, like on a, on a
ski lift.
And I'm like, okay, when I'mdone skiing, I got to go arrest
Ben Cohen.
And I've said like,"my officer'smade the arrest and I was on the

(27:06):
scene." Cause he's not a nobody,like, it's going to make
national news.
And it did.
But also Bill McKibben, who'sanother leading environmental
activist.
I've arrested bill McKibben too.
So.

Valerie Earnshaw (27:17):
He also call you and request an arrest?

Dr. Brandon Del Pozo (27:20):
Yeah.
And he was like,"listen, I'mgoing to--", um, he like shut
down a gas station through civildisobedience.
Like he, I forget how he did it,but he disabled all the pumps at
a gas station and we arrestedhim for that.
But so that's what Burlington islike, like Bernie Sanders lives
there, the socialist control thecity council, the mayor, who's a

(27:40):
Democrat is a troubling swing tothe right.
And you spend your days whenyou're not addressing the opiate
crisis, you're like arrestingBen and Jerry's anyway.
So, but it's that type of placewhere people know each other,
there's an intimacy.
So it seemed like a good city toreally try to do something.
So it could really have aneffect on the opioid crisis in a
scalable way.

(28:00):
Right.
It wasn't so tiny that youcouldn't scale things, but it
wasn't so big that innovationwould take years.
It was right-sized forinnovation.
And that was one of the thingsthat really appealed to me about
going there

Carly Hill (28:11):
Here in Delaware.
We know a thing or two aboutthat,

Dr. Brandon Del Pozo (28:14):
Actually.
Delaware's definitely one ofthose

Carly Hill (28:16):
But like, so I know here, like we have, I think a
lot of it for us is that we'rethis perfect storm of being like
a port city we're right on the95 corridor, right.
Things, you know, we're inbetween all these major cities,
like it's like an hour toPhilly, maybe different things
like that.
So like, what is it aboutBurlington?
Do you think that the opioidcrisis like hit so hard there?

Dr. Brandon Del Pozo (28:37):
Well, it hit hard throughout Vermont and
it's not the overall volume, butthe death rate was fairly high
in sort of Vermont was at themercy of the distribution hubs
for opioids out of Boston andNew York.
It was like at the vortex ofthat.
So if you literally, the greenmountains run north, south up
the spine of Vermont, the eastside of Vermont was a supplied

(28:58):
by the Boston syndicates.
And the west side of Vermont wassupplied by the syndicates out
of New York.
Um, and it was interesting.
It just so interesting becausefentanyl came to Boston before
it came to New York, justbecause of the difference in the
supply chain.
And it was literally likeColombian dealers versus more

(29:20):
African-American and theirvarious supply chains.
So you saw the death rate risingwith fentanyl related deaths in
the Eastern half of Vermont,especially the Southeastern part
before you saw similar effectsin, in the west.
And it was just sort of-- andit's explainable by who was

(29:42):
supplying whom and what theywere getting back home.

Valerie Earnshaw (29:44):
So fentanyl is a super strong opioid synthetic,
and it's something like theamount of like a penny could
kill a room of people.

Dr. Brandon Del Pozo (29:54):
Yeah.
You're thinking of putting the,you know, there's always, they
put the penny next to the grainsof fence and all that can kill
you.
But so morphine is the originalanalgesic that was taken out of
opium in the early 18 hundreds.
It's 50 to a 100 times morepotent than morphine and
morphine is what ends up if youfollow the, this chain of
pharmaceutical development,morphine ends up morphing into

(30:14):
hydrocodone and oxycodone and,and those analgesic pills that
fentanyl, you know, as an aside-- It's just one of those
interesting things where likeyou have to reign me in as I, as
I nerd out on the, on thepharmacology and the history of
it, but like heroine's anagricultural product that comes
from, from the poppy plant.
Right.
And so there's limits to thepotency and it's the natural

(30:35):
limits, right?
Fentanyl is completelysynthesized in factories.
And so not only does it make somuch more sense because it's so
much more compact and easier tosmuggle and, and more powerful,
but it's also just when youswitch from heroin to fentanyl
all as a cartel, you're cuttingout like the last two thirds of
your supply chain.
So you're not like waiting forpoppy to be grown in Afghanistan

(30:58):
and somehow make it to you.
You're like in a factory rightover the border, getting
precursors from China, justmaking this stuff right there.
And it's easier to smuggle thatthis soda can, for example of
fentanyl can yield the sameprofit as, as a case of soda
cans with the heroin.
So to speak, if you're thinkingabout smuggling.
So it was a perfect storm, itcreated the overdose crisis we

(31:21):
have now

Valerie Earnshaw (31:21):
Just hearing you talk about the deep dives
and like, here's the geographyhere is the, here's the, like
the chemistry of it, like,that's why you need Scholar
Warriors to work on this, or,you know, you just, you need
like all of these kinds of likecombining expertise.

Dr. Brandon Del Pozo (31:37):
It's a translation.
Yeah.
I think I just changed myTwitter bio to"Something is
nothing without translation andimplementation".
Sort of like, that's the, now Ihave to go look it up.
But anyway, yeah.
Good point.
I mean, you could glamorize itas a scholar warrior, or you
could just take like aimplementation science
perspective and say, um, yeah,"successful implementation is

(31:58):
based on accessibletranslation".
That was my, uh, my alliterationon my Twitter bio.

Valerie Earnshaw (32:04):
Like any implementation scientists who
are listening to this now areall going to go out and claim
scholar warrior.

Dr. Brandon Del Pozo (32:11):
Yeah.
Yeah.
When I see it on a grantapplication, I'll believe you.
Yeah, there you go.

Valerie Earnshaw (32:16):
Okay.
So you mentioned thatBurlington's like this great
Petri dish, almost tryingdifferent, different
innovations.
So what were some of the thingsthat you tried out in
Burlington?

Dr. Brandon Del Pozo (32:27):
Well, you know, really quick, the first
thing that to his credit, themayor gave me license to do, is
go look at the science.
And so I remember in the firstmeeting, the state attorney
general, the governor, me, themayor, some folks from the
hospital that were talking aboutVivitrol naltrexone, which is
like, and I just was like, oh, Ihave no idea what the heck that
is.
Now I, like, I dislike it forother reasons, scientific

(32:50):
reasons.
But at the time I had no ideawhat it even was.
And I realized I had to gofigure all that out.
So I started talking toresearchers at Hopkins and
UPenn, and I learned aboutbuprenorphine, Suboxone, and
methadone, like what treatsopioid use disorder.
And I came back to the mayor andI said, there are these like
super effective medicines thatyou could give to people that
when they're on opioids, it'snot going to just cure them

(33:12):
overnight.
They still could relapse.
They're still dependent on themrather than addicted, but they
don't die of overdose.
They can get their familiesback, they can work jobs.
And we just, we've got to dowhat the French did a decade and
a half ago.They would just giveit out to everyone who needs it
and we'll solve this thing.
And the mayor was like, thatcan't be true.
That's just too easy.

Valerie Earnshaw (33:31):
Never heard of these medications?
Like he just,

Dr. Brandon Del Pozo (33:32):
Well, he knew About methadone, of course.
Right, right.
But I mean,

Valerie Earnshaw (33:35):
Bupenorphine and Suboxone,

Dr. Brandon Del Pozo (33:36):
not so much buprenorphine and Suboxone,
but he's like,"Brandon, if thatwas true, we wouldn't have an
opioid crisis because we wouldjust do the right thing and give
out these medicines.
So you've got to have thescience wrong".
So then I went back to thedoctors and they were like,"no,
it's actually true!".
And then I realized that itwasn't the science, it was the
systems, right.
It was, it was the stigma aboutthe medications.

(33:58):
It was the stigma towards peoplewho use drugs.
It was the systemicdisincentives to build up these
systems that deliver thesemedicines.
And so when you're asking mewhat I did in Burlington, like I
made it this very-- only a copcan be this simple minded, like,
just dump the buprenorphine outof helicopters, but not actually
do that.
But you use as many simplesystems as possible.

Valerie Earnshaw (34:20):
to get buprenorphine to people who need
it.

Dr. Brandon Del Pozo (34:22):
So we, I started holding these every four
weeks meetings that I callcommunity staff, but it was
comstat.
It was based on the NYP, thesemanagement principles.
And it's four principles firstis timely and accurate
intelligence and information.
So you gotta know what's goingon out there.
And you gotta know what thedeath rate is.
Who's at risk, what's working.
What's not just standard datacollection.

(34:44):
We hired an epidemiologist andall that, dissertation
criminologists to be the dataengine, the analytical engine,
right?
For the first pillar, the secondpillar is effective tactics and
strategies.
So you go to the experts and seewhat would actually work to
produce the end goal of fataloverdose reduction.
We just said, if we can reducefatal overdoses, we're going to

(35:06):
have to do a lot of other thingsthat are really positive, but
let's just get to that end goalof fatal overdose reduction.
What effective tactics andstrategies do that, right?
So we set it to be a low barrierto buprenorphine.
Then rapid deployment ofresources is the third I'm
taking the implementation, speakout of it, but just find out
what these effective tactics andstrategies need in terms of

(35:27):
resources and rapidly deploythem.
Right?
And then the fourth thing isrelentless assessment and follow
up.
Is it working?
Have you done what we said we'ddo?
And they wanted to take out inBurlington, like the word
Relentless, like that's not avery Vermont word, like, like
thorough or, or like meaningfulor conscientious assessment.
I was like, no, heroin isrelentless.

(35:50):
Like everybody in Vermont goesto these like summer camps to
spend the summer on the lake.
Heroin doesn't do that.
It's still there.
It's still getting intopeople...
We've got to be relentless too.
And so they relented and we hadrelentless assessment and
followup.
Those are the four principles.
And then to belabor the point,what we ended up doing every, we
make promises to each other atthis meeting.
And so to continue with the,with the heroin analogy.

(36:12):
So if you heard of the booknaked lunch by, by William
Burroughs,

Valerie Earnshaw (36:16):
I'll put it on the list.

Dr. Brandon Del Pozo (36:18):
It's, William Burroughs was a
contemporary of Jack Kerouac.
He was a beat writer.
He was a, um, a real lifelongperson with opioid use disorder.
He did a lot of heroin aroundthe world and he wrote a book
called naked lunch about hisdescent into addiction and his
partial pull out of it.
But naked lunch in the book, hesays, the naked lunch is, is

(36:38):
it's a classic of, of heroineliterature, uh, naked lunches,
where everybody at the tablesees exactly what's at the end
of everybody's else's fork.
So I said our community and thespirit of William Burroughs and
heroin addiction, our communitystep meetings need to be a naked
lunch where the hospitaladdiction services provider, the
police, the prosecutor, thedefense attorneys, the, um,

(37:01):
sober housing people, the all ofthem, we all see what's on the
end of everybody else's fork.
And we make promises to meeteach other in implementing these
interventions.
And if not next month, we'regoing to, we're not going to be
evasive about the fact thatwe're not meeting our
obligations.
So what we did over the courseof a few years was we worked
with local legislators to pass acomprehensive

(37:23):
medication-assisted treatment inprison.
Bill, our local Charmainlegislator wrote the bill.
We brought up the experts fromRhode Island who were doing it,
got them to write legislation inVermont.
That would do it in Vermont.
We got that passed.
So every prisoner and everyperson in jail could get
methadone, buprenorphine if theywant, and naltroxene which no
one really does, to fightaddiction.

(37:44):
We got low barrier buprenorphineout of the emergency department
at the local hospital.
We have one big hospital intown.
You could walk into the ed foranything.
They screened everybody foraddiction, regardless of what
you come in for appendicitis,you were getting screening for
opioid use disorder.
And if you screen positive, youwill offer buprenorphine right
then and there.

Valerie Earnshaw (38:02):
Wow.

Dr. Brandon Del Pozo (38:03):
Knocked it right into treatment, right
there at the ED for anything youcould come in with a broken arm
and get a buprenorphineprescription.
Then we got buprenorphine lowbarrier at the syringe exchange.
So that's a place that peoplewho use drugs feel comfortable
going, and they trust the peoplethere.
They don't feel judged.
And if they're ready to trybuprenorphine, they're not going

(38:23):
to be told you have to do itthis way.
You have to come in, you have topee in a cup.
You have to take counseling.
Like here's the buprenorphinefrom the people you trust.
And the woman who volunteered todo that was a physician who was
an OBGYN who lost her, um, herson to overdose.
And so she had a lot ofemotional skin in the game and
she volunteered to do that.
We also eliminated the waitinglist for medication assisted

(38:46):
treatment, by working hard withthe state and other providers to
open a second hub, right outsideof Burlington, to treat a lot of
people who wanted the moretraditional hub-and-spoke model
of treatment.
And then my police department,that's like a whole other
podcast, but we were doing, wehad, I hired an addiction social
worker to run a program thatvetted all of our police work
for public health outcomes.

(39:06):
She ran a bi-weekly meeting tolook at who is at greatest risk
of fatal overdose, not just fromgetting arrested or overdosing,
but working with other providersto see who was cresting and
their acute needs to channelthem towards treatment.
We had a policy that we refuseto arrest anybody for, um,
prescribed buprenorphan.
So if you've got buprenorphineoff the street and you didn't
get it from a doctor, you got itfrom your friend.

(39:27):
I was glad you had it.
We wanted you to know we werenot going to arrest you for
that.
We were the first are myprosecutor and we're the first
people in the country to dothat.
When you add it all up a longstory, getting to be long, um,
within 20-, over 2018 and 2019,there was a 50% reduction in
fatal overdoses in our county.
And it went up 20% everywhereelse in Vermont.

Carly Hill (39:49):
That's amazing.

Valerie Earnshaw (39:50):
Yeah.
That's pretty incredible.

Dr. Brandon Del Pozo (39:52):
Thank you for listening to the whole
workup to that.

Carly Hill (39:55):
That's what...
I think about it all the time.
You know, we had a situation, Iwork, I do data collection out
of the methadone clinic o r ourlocal methadone clinic here.
And, you know, we have a newintake days are Tuesdays and you
just have to make it there onTuesday, or you can't get, you
know,"on the clinic", as theysay, and I'll never forget this
guy came in and they, it wasWednesday.
He had just missed it.

(40:15):
And he was withdrawing and hehad made this commitment to try
and get sober.
And they were like, well, seeyou next week.
And he was like,"that's not anoption".
That's not i t.
And that's what he said.
He said, you know,"what you'reasking me to do is go out and
get more and try and stay aliveuntil next Tuesday.
Is that really what you want meto do?" And they were like, our
hands Are tied.

Dr. Brandon Del Pozo (40:33):
There's no reason in the world..

Carly Hill (40:33):
we can't help you.
But how easy is it to walk intoan ER and get an opioid, right?
Like, and it's just like, Ithink about that so much.
And it's, you know, that if theaccess to, you know, whatever
the, the medication might be,whether it be, you know, the
methadone, the Suboxone, like ifthat was easier to get than

(40:55):
opioids, wouldn't that?...
It's so fascinating.

Dr. Brandon Del Pozo (40:58):
It's because it's not entirely
treated as a medical condition.
If you come in with the acutesymptoms of diabetes, they don't
say,"well, Wednesday is theinduction into insulin day" with
the insulin.
Right?
That's the-- it's so troubling.
And so we were able to do that.
The researchers hated what I didbecause I just did-- when I say

(41:18):
"I", I mean, it was an effort,but I led the effort.
Like we, I had plenty of greatcolleagues.
We did seven interventions atonce, basically.
And so they were like,"well,that's not random".
"You could have at least done astep wedge".
I was like, what do you like?...

Valerie Earnshaw (41:34):
What it was that they didn't like what you
were doing because they couldn'tfigure out?
So precisely what exactlyworked.

Dr. Brandon Del Pozo (41:43):
So I've, I have a paper under review called
community stat and interventionto reduce opioid deaths in
Burlington, 2018 to 2020.
And it got rejected from ajournal.
Let's hit another one that says,like, it's just a great
recounting of applying evidenceto practice, but it's, there was
no study.
So what's the study.
And my argument is like, no,this is an essay in
implementation science.

(42:03):
Like in my mind, I would stop.
I would like, there's so muchextramural research that I would
just stop doing right now.
Because we know the science,like we know that buprenorphine
works really well.
We know methadone works reallywell.
We know that they work betterthan Vivitrol.
We know that like low-barrierworks.
We know that opioids very-- thebuprenorphine very rarely if

(42:27):
ever shows up in the toxicologyof people who die of opioid
overdose, we don't want to stopthe research completely, but we
want to focus on implementationat this point.
Right?
So the, the whole other end ofthis is like the heal
initiative, which is like thisthree year randomized
implementation.
And multi-sites across the US ofopioid overdose interventions at
like the national level.

(42:47):
And the thing that's sort of alittle tragic about that is that
the sites getting the resourcesin that third year of the study,
or like the third step in thewedge.
They went two years withoutthose resources, and people
definitely died because of that.

Valerie Earnshaw (43:00):
Yeah.
Right.
Yep.
That's such a, I I'm reallygrateful that you're raising
this.
This is a really criticallyimportant tension.
So some of these, like, youknow, a step wedge design or
these other designs, yeah.
They would have asked you tohold off on an intervention
strategy that you pretty muchknow, like it's going to save
lives.
Like connecting buprenorphine inER, is going to save lives so

(43:23):
that you can measure it.
And I, and post, you know,people say, well,"if we don't
study these different componentsseparately, like we don't know
which one's working, or we don'tknow like what dose of what
intervention to roll out." Butlike, what you did is, uh, it's
amazing, but it's, you can dothat package of intervention,

(43:43):
like that package of things inother places and observe how
it's going.
Like, you don't need to just belike, we only want to give
buprenorphine out in ERs.
We don't want todecriminalize...
You know, like,...

Dr. Brandon Del Pozo (43:54):
And part of the issue.
And I think it's lost onexperimental design is that
like, part of it is creating anenvironment with so many changes
that it re-norms things.
And if you're only doingtreatment in prison, but nowhere
else, then there's this wholeother space that people are in
where the norm isn't access tobuprenorphine or the norm isn't
that it's okay to be onmedication-assisted treatment.

(44:14):
But if everywhere you look inthe community, you're getting
the same message, which is"whenI go to the syringe exchange,
it's okay for me to ask for"Bupe" and be on"bupe" When I go
to the ED, they're willing togive it to me.
When I go to the opioidtreatment program, there's no
waitlist, they'll give it to meany time.
When I go to prison, God forbidI ended up getting the stuff.
And then when I have it in mypocket without a prescription,

(44:35):
the police don't arrest me.
The sum, the whole is greaterthan the sum of the parts.
And I think like incrementalimplementation to measure
interventions, deprives you ofthis ability to try to really
quickly like re-norm the wholeessence of what you're doing

Valerie Earnshaw (44:50):
This is so interesting.
So I think a lot, especiallywith stigma interventions,
there's, these, there's likethis most design, and there's a
near these other designs thatcan tease apart the different
tools that we have orintervention tools that we have
in this case to, like,deconstruct stigma.
But in these other cases, youknow, just to do anything and
then yeah, you can see whatworks on, but that's such an

(45:11):
interesting frame about, yeah,the whole being greater than the
sum of its parts.
And, you know, theoretically,you could test that with these
designs, but when people aregoing to die,

Dr. Brandon Del Pozo (45:20):
I feel strongly about that, I feel like
I'm a lot more sympathetic toresearchers as a person who
needs to write proposals thatlike have rigorous experimental
design.
I'm not blaming them for that,but it is a problem with that.
It does, if there's thisdisconnect between the
action-oriented people and theresearchers it's in this
translation space, like it, it'sunfortunate.

(45:41):
And I think in nascent, like ifyou were developing the
medications to deal withstimulant use disorder like
methamphetamine, you would haveto do a lot of really careful
studies.
We don't know anything about themedicines that work.
We don't have any, like there'slike decades of research behind
agonist replacement betweenopioid replacement therapy.
Like we don't have to be supercautious.
And then I'll say, I'll nerd outa little bit.
Like this is also what likesynthetic controls and

(46:04):
difference in difference.
And propensity score matching isabout like, is coming up with
these quasi-experimental designsto allow public administrators
to do these like multi-prongedinterventions.
And then, some super cleverscientists figures out how to
find another jurisdiction thatdidn't do it, but that otherwise
matches and make that asynthetic control.

Valerie Earnshaw (46:24):
I love that.
So really come on now,scientists up your games.
Yeah.
Use Smarter designs to figure itout.

Dr. Brandon Del Pozo (46:31):
Yeah, I'll say this, like, I was talking to
a scientist, a social scientistabout, I said,"how come this
woman's?" I said, every time Igo to this, woman's talk.
All her, all she does is pointprevalence.
So all she does is like,"after namount after c amount of time,
this many people are taking thedrug and this many dropped out".
Like, that's it like, there'sno...
It's literally a bar chart atmonth six, right?

(46:56):
that's it.
I said,"how come she does that?
And you were doing, and I'mgoing to like Monte Carlo,
bootstrapping latent classanalysis, like Cronbach's alpha
principle component." And shesays,"because she,...
I am dealing with like bigbodies of longitudinal data out
there in the public of peopleliving their lives.

(47:17):
And she is spending monthsdesigning the perfect randomized
controlled trial.
If you perfectly randomize yourtrial and you design it
perfectly at the end of the day,all you need point prevalence."
"This many people are stilldoing it.
And this many aren't", if you'redealing with the world, you need
like all of this complicatedmath.
So when I'm making an argumentfor is like...

(47:38):
but yet that scientist, I justdescribed with that, that point
prevalence, like"this manypeople are still enrolled in
treatment.
And this many aren't" that's itthat's all her math is like 12,
6.

Valerie Earnshaw (47:48):
Yeah.

Dr. Brandon Del Pozo (47:49):
Her stuff hasn't been implemented yet.
But the other scientists dealingwith the complicated stuff, or
they're changing the warninglabels on cigarettes, they're,
they're allocating funding tocertain types of programs.
So the math begets results, butyeah, scientists like do your
fancy math and out there in theworld and let's meet up with
public administration and getthings done.
Yeah.

Valerie Earnshaw (48:08):
Well, Brandon, we've been chatting your ear
off.
There is one more thing I wantto ask you about.
Do we have time for one morequestion.

Dr. Brandon Del Pozo (48:14):
Yeah.
Yeah.
We can talk longer and you canedit if, if I'm just going on
and on about the boring science.

Valerie Earnshaw (48:20):
No, none of this is boring.
It's all gold.
Before we even started this, Iknew I was like, it could be
like, stay up all night on zoom,like sleep over podcast with
Carly and Brandon.
But I just, I can't help myselfand doing the research for this.
I read more about your work onpolice discretion as critical
point of intervention, which issomething that I think you're

(48:40):
heading more into with yourresearch.
So I want to first ask you, canyou just talk about what that
is?
What is police discretion?
Why is it an important point ofintervention?
And then I'm looking forward toclarifying what...
I think I've had a miss- I'vehad like misinterpretation or
misperception conversationsabout it.

Dr. Brandon Del Pozo (49:00):
Everybody has seen or knows of The Wire,
right?
That the multi-season crime showthat took place in Baltimore
created by David Simon.
One of these classics in crimeTV, McNulty is the detective in
there.
And he says to another cop asthey're, they roll up on the
scene of these guys, drinkingmalt liquor on the corner of
Baltimore.
And they throw them off the walland start giving him a hard
time.

(49:20):
And McNulty said,"why are youdoing that to those guys?" Like,
well, we got to give youtickets.
He said, the beat cop is thelast true, despite in....
"The Beat Cop is the last truedictatorship in America".
He goes,"we decide who we givetickets to.
We decide who we arrest.
If we want to drink our lifeaway on the bridge, we can do
that.
If we want to arrest everybodyin town, we can do that.

(49:42):
But it's up to us, and no onetells us otherwise." And that's
true.
And not because police have beengiven too much power.
Some might argue that they have,but because the laws are written
in ways that explicitly, exceptfor things like rape, murder,
that the big felonies are thingswhere we rightfully expect the
police to take action and bringpeople to the judge and not make

(50:03):
the decisions themselves.
But when it comes to almost allthe little things, misdemeanor
drug possession, misdemeanorsyringe possession, public
urination, drinking a beer,jaywalking, every traffic
violation, speeding, red lights,stop signs.
We can go on and on, disorderlyconduct.
All those things are things thatpolice have discretion as to

(50:24):
whether they enforce or not.
Whether they an arrest issue ora warning, or I hope bring
people to treatment instead ofjail.
And we want it that way becausewe want police to use the power
of the law to solve problems,not just to be like
statute-violation-detectionrobots, right?
These statutes are not statutesthat like the world doesn't
hinge on.
And like you can drink in publicnew Orleans.

(50:47):
And in India, you can urinate inthe side where they literally
have urns where you urinate inthe public.
And no one bats an eye.
They're not like these deepmoral things and the statutes
exist not to enforce the moralcode against urination or the
moral code against running astop sign.
You know, it's about likefostering and enforcing social

(51:07):
cooperation, stopping dangerousbehavior from becoming more
dangerous, and figuring out howto use the law to solve
behavioral problems.
And that's why we have thediscretion.
And the tragedy in policing iswhen it gets misused, when it
gets applied desparately tocertain races and classes, which
it does, that's a tragedy.
But the idea that the police canuse their discretion, is not the

(51:29):
tragedy.
That's the hope.
It's getting the discretion tobe used properly.
That will get us on the righttrack.

Valerie Earnshaw (51:35):
This is exactly what I realized I was
wrong about when I was readingyour work, because we've had
some discussions about thisidea.
And I have been like, okay,well, when there-- what we know
from other fields has been,there is more discretion when
there's more ambiguity in whatpeople are supposed to do or how
they're supposed to respond.
The solution is often toengineer the situation to remove

(51:58):
the discretion or the ambiguityin order to stamp out bias,
because it's these places ofdiscretion, ambiguity, that bias
kind of rear its head.
Right?
And so in some of ourconversations, I've been like,
oh yeah, just, you know, liketighten up! Behavioral design
the bias out.
But this, you know, in hearingyou talk about it and reading
more of your writing about it,the discretion is not maybe the

(52:23):
problem or, or there's good, ormaybe there's a reason to keep
the discretion, but you need to,you need to extract the bias
from...

Dr. Brandon Del Pozo (52:30):
Right.
So there are right and leftlanes to the law, like case law
circumscribes discretion andsort of the way you were talking
about like, you can't just likenoise complaints in different
places have different meanings,like there's case law that says
like in-- uh pick new Orleans,like you can't say someone like
playing a jazz saxophone on acorner of bourbon street is like
violating the noise ordinance.

(52:51):
Cause he was noisy.
Like that will go nowhere.
Right.
And free speech, like profanityis an example of disorderly
conduct that almost every courtin America, local court says you
cannot arrest somebody simplyfor yelling a curse word.
Right.
So we do because laws like thatare used to, you know,"Hey, when
that African-American guy saysthe F word, I'm going to put the
cuffs on him." Like that's,"I'llteach him." Right.

(53:13):
But yet when the kid isscreaming on the football field
in Greenwich, Connecticut aboutlike a referee making a bad
play, like, he doesn't go tojail, like that's all BS.
Right.
So, so there are, there is caselaw that circumscribes
discretion.
Um, there are communityexpectations and values that
circumscribed discretion, andthere are systems like you can
have.
I just said like it wasultimately always a cop's

(53:34):
discretion whether to make abuprenorphine arrest or not.
I just said,"I'm taking thataway.
You may not make one".
Right.
But we still want to have policeofficers who can use discretion
to solve problems because I'dlike to think that it's almost
always going to be bringingsomeone to treatment, but there
are times where a personprobably needs to be brought to
a judge instead.
Right?

(53:55):
Or just simply warned about evennot bringing you to treatment.
I'm just or arresting you.
I'm just saying, don't do thisagain.
I'm bringing you back to yourmom.
And so getting officers to makethe right decisions that way by
right?
I mean, produce better healthoutcomes.
Don't yield disparate, negativeoutcomes and adhere to the broad
values of the community.

(54:15):
Like that's where we need to go.

Valerie Earnshaw (54:18):
Well, that sounds like a full career's
worth of work right there.
And we're so glad that we havethis scholar warrior.
I'm never going to let that goby the way.

Dr. Brandon Del Pozo (54:26):
Yeah

Valerie Earnshaw (54:29):
But no, I mean, one of the, one of the
other piece of advice that I gotrecently, which I think is, you
know, I thought of you likeimmediately was"you need to work
on the problem that you areuniquely suited to fixing" like
you're at the right place.
You're the right person.
You're at the right time.
And what I think is just like sointeresting about your career

(54:50):
trajectory and this problem thatyou're now working on, you know,
like bias police, this like thisarea of discretion and opioid
use is, like, you're the rightperson at the right time with
the right problem.
And so I'm just, I'm superlooking forward to seeing that,

Dr. Brandon Del Pozo (55:05):
oh no.
That's so listen, I'm willing toplace off money for the rest of
my career if I can just get afoothold, if I can get talking
about the academic peckingorder, if I could just get the
assistant professor title beforemy name somewhere, Rather than
...

Valerie Earnshaw (55:17):
it's like a matter of seconds before it

Dr. Brandon Del Pozo (55:19):
For the postdoc.
No, that's, uh, that's so kind.
And, and what I love aboutresearch too, and you and I have
talked about this, is if you'remeeting the specific aims of
your funding, you get to do somany other interesting things as
well.
No, one's saying,"why are youdoing that?" They're like,"is he
or she publishing, are theymeeting their aims?
Are there studies coming outthat you can be doing?" Like all
this other interesting stuff andit's good.

(55:41):
Whereas in policing they'relike, why is the chief of police
doing another like opioidintervention?
Like, you know, so yeah, becauseit's a dirty secret.
I've looked at a millionspecific aims by now.
And, um, I have a theory thatthey, that they don't correspond
to as much effort as you'reclaiming on your grant
application.

Valerie Earnshaw (56:02):
Well, it'll be really fun for you to get this
grant that you're working on.
And then you can come back andreport to us about all of the
amazing additional stuff thatyou did along the way.

Dr. Brandon Del Pozo (56:10):
No, no, We'll see maybe...
But you do have to be fairly--you do have to be focused at
least in your expertise, butalso thank you for the
encouragement, but y ou k now,we'll see how it goes.

Valerie Earnshaw (56:18):
Well, thank you so much for joining us
today, right.
And we really appreciate yourtime.

Dr. Brandon Del Pozo (56:21):
Thanks.
That was great.
I love being here.

Valerie Earnshaw (56:24):
Thanks to the Stigma and Health Inequities lab
at the University of Delawarefor their help with the podcast,
including Sarah Lopez, MollyMarine, James Wallace, and
Ashley Roberts.

Carly Hill (56:34):
Thanks to City Girl for the music.
As always be sure to check usout on Instagram
@sexdrugsscience, and stay up todate on new episodes by clicking
subscribe.

Valerie Earnshaw (56:42):
Thanks to all of you for listening.
[inaudible][inaudible].