CHAPTER 4

Conclusions and Future Research

This chapter begins with high-level observations and key takeaways and is followed by a discussion of the challenges associated with current program approaches and identified areas of opportunity. The chapter concludes by highlighting knowledge gaps that warrant further study. This chapter has been derived from the study’s literature review and interviews with agency and partner staff and has been shaped by the study team’s interactions with frontline staff, outreach partners, and police officers while shadowing them in the field. By integrating findings from various sources, this chapter provides recommendations and information about areas where additional research is needed to enhance program effectiveness and address emerging issues regarding drug use on transit.

Overall Observations

The following themes encompass transit agency responses to the challenges and opportunities related to addressing drug use on transit:

1. Mission Creep: Transit agencies are increasingly taking on complex responsibilities that traditionally fall within the realm of public health and outreach, which they were not designed or intended to handle. This shift adds layers of complexity, increases operational burdens, and incurs additional costs.
2. Data Collection Challenges: Addressing drug use on transit often lacks clear, safety-specific objectives for both customers and staff. Many agencies have not clearly defined or articulated their goals in tackling this issue. As a result, data remains decentralized, fragmented, and difficult to manage, hindering the development of integrated strategies and the ability to measure outcomes effectively.
3. Harm Reduction vs. Transit Operations and Safety: Harm reduction practices aimed at addressing drug use and addiction can sometimes conflict with the need to ensure the safety and cleanliness of transit systems for employees and customers. Evidence-based measures such as naloxone administration by first responders or outreach workers and clean syringe access and exchange programs are effective responses to the opioid epidemic. Additionally, allowing outreach services to use transit stations as hubs for intervention provides valuable support to vulnerable individuals. However, these practices may present challenges in ensuring a safe and orderly transit environment for all users.

Challenges in Program Approaches

• Before establishing a data program to assess the impact of drug use on transit, agencies must first define clear objectives regarding what they aim to achieve and measure.

To develop a robust data framework, transit agencies must first define the problem and establish clear objectives. Data-informed decisions are guided by a clear understanding of what matters. Objectives are the specific tasks, deliverables, and activities that programs identify to meet their broader goals. Simply put, objectives outline the detailed steps required to achieve success as defined by goal statements—they are what accomplish the goals.

Although many transit agencies have broad objectives to address transit safety, defining specific objectives related to understanding and addressing drug use on transit would be highly beneficial. Specific objectives would help structure the data framework, identify the scope of the issue, determine effective solutions, and track progress. Objectives should be quantifiable, tied to time-based actions, and specific.

Once objectives are established, transit agencies can develop a data program to better understand transit safety issues, measure the effectiveness of initiatives, and refine strategies as needed.

• Information sharing and communications among transit agencies, outreach providers, law enforcement, and referring support organizations can be improved.

Drug use on transit systems is deeply intertwined with issues such as homelessness and mental health complexities, requiring a multidisciplinary approach that includes transit staff, frontline workers, government agencies, and referral organizations. Effective coordination among these partners demands extensive communication and information sharing to align services and support. Although centralized resource guides (e.g., Portland’s “Rose City Resource”) can be beneficial to outreach and enforcement partners who lack a comprehensive centralized information system, the staff of partners rely on informal networks and relationships to share information and make referrals out of necessity—this can be akin to playing a game of chess where complex, shifting variables must be addressed in real time and specific to individual needs. Although some agencies use centralized homeless management information systems for case management, gaps in information sharing remain. For example, the synthesis team observed conflicting information between transit administration staff and frontline outreach workers about the number of available shelter beds at two different transit agencies, highlighting the difficulties in coordinating support services. Enhancing the integration and accuracy of information systems is essential to better support individuals facing drug use issues on transit systems.

• There is a low voluntary uptake of offered support services due to the mismatch between the services provided and individual needs, as well as gaps in the availability of longer-term housing, mental health, and drug treatment programs.

All five participating transit agencies fund various outreach programs designed to connect individuals sheltering on transit with essential services (e.g., food, temporary or long-term housing, social support, medical care, and recovery programs). Despite these efforts, the uptake of services that would remove someone from sheltering or using drugs on transit remains low. This low uptake is largely due to insufficient resources—such as temporary or long-term housing, social support, and recovery programs—as well as barriers to access and concerns about the quality of available services.

Two of the transit agencies interviewed addressed the challenge of insufficient temporary housing spaces or insufficient access. SEPTA’s SCOPE program proactively ensured that outreach workers could reliably connect individuals to temporary housing by purchasing 500 shelter bed stays. This arrangement guaranteed that a few spots at the chosen shelter are reserved for SEPTA’s outreach workers during specific time windows. Similarly, LA Metro funds beds at several strategically located shelters that accept individuals at all hours, which is essential since their outreach workers are deployed 24/7, while most shelters in Los Angeles operate during standard business hours.

The low uptake of referrals to temporary housing services can be attributed to several factors, including the lack of immediate availability of resources, dissatisfaction with the quality of shelter spaces, difficulty adhering to shelter rules (e.g., access hours or sobriety requirements), challenges with storing personal belongings, concerns about safety within shelters, and traumatic previous experiences at shelters. When individuals decline support from outreach services, they often remain on the transit system. On the SEPTA system, if an individual refuses assistance, they are initially asked to leave the property. If they do not comply voluntarily, SEPTA Police are dispatched to escort them off the transit system.

Staff noted that individuals who seek shelter on the system often do so because it is a safer alternative than remaining on the streets, with one staff member interviewed stating that, “What we experience in Metro is a microcosm of what is happening locally,” referring to the ongoing issues of homelessness and drug use occurring throughout the wider region. A Metro employee reported similar feelings when referring to the difficulty in constructing more supportive housing: “‘Let’s say you put in three more agencies to help with the homeless,’ she said. ‘That sounds great, but we’re all still hitting the same barriers. The policy needs to change, not us’” (Peterson 2024).

Concerns also exist that the quality of services that outreach workers are connecting individuals with are insufficient for the needs of people who use drugs. These concerns are evident in Philadelphia’s Kensington neighborhood, where there is a high concentration of short-term service provisions for persons who use drugs, including shelters and mobile recovery units, along with churches and nonprofits that distribute clothing and food (Wight and Ratcliffe 2024). Despite this, many unhoused individuals who have substance use disorders remain on the street. Wight and Ratcliffe, in their interviews with SEPTA police officers, captured this contradiction of the large amount of available services compared with the high number of individuals remaining unhoused: “[Treatment providers] have rules. You got to live by the rules and give a urine sample each week. It takes work. It’s easier to stay on the street. . . . The shelters? Too many rules, and people steal your shit” (Wight and Ratcliffe 2024). The authors hypothesized that the negative environment that shelters may pose to the overall well-being of drug users, along with the short-term nature of available services, do not meet the needs of people who use drugs, preventing them from breaking the cycle of addiction and homelessness.

• Addressing physical and psychological safety impacts on frontline staff and contractors.

Frontline staff play critical roles in reporting and intervening in safety incidents. For example, transit agency ambassador programs act as “additional eyes and ears” on the system. However, being present on trains and engaging with riders comes with the risk of experiencing a traumatic incident, such as a fatality on the tracks. Ambassadors have also experienced assault on the job (Kiszla 2024). Such experiences can lead to burnout or turnover among employees. It is well-documented that mental health strain and burnout can occur among healthcare and frontline outreach workers, especially since the COVID-19 pandemic (Chang 2024, Schoenberger et al. 2024, Unachukwu et al. 2023).

Station staff and personnel are often at risk of exposure to biohazards and confrontations with riders sheltering on transit or engaging in drug use. For example, elevator maintenance staff reported their experiences of being confronted with individuals using elevators as temporary shelter. In this case, maintenance is typically deferred or police and security personnel are called in order for the maintenance to proceed safely.

• Enforcing existing illicit drug laws and codes pertaining to drug use on public transit systems is challenging.

The decriminalization of illicit drugs and the trend toward not prosecuting simple drug possession have significantly affected the enforcement of drug laws on public transit systems. Inconsistencies in enforcement practices reflect the difficulty of defining thresholds for when enforcement

actions should be taken. Many police agencies find it impractical to pursue arrests and detain individuals for misdemeanor illicit drug offenses on public transit. This process is often time-consuming and diverts frontline officers from their primary responsibility of patrolling the transit system, exacerbating enforcement challenges. Additionally, some participating transit agencies operate across multiple counties with varying enforcement thresholds for drug use, further complicating the enforcement landscape and hindering a uniform approach.

Moreover, individuals arrested for drug use issues on transit must receive medical clearance prior to processing, adding complexity to the enforcement process. There are also public sensitivities surrounding enforcement actions for minor offenses, which complicate decision-making. An enforcement-based approach may perpetuate cycles of arrests and detainment, and stigma, without addressing the root causes or providing necessary support to a potentially already vulnerable population.

There is an opportunity to enhance enforcement by (1) working more closely with local law enforcement to share information and intelligence and (2) focusing efforts on individuals involved in drug dealing and trafficking on the transit system and surrounding areas, rather than simple possession. Such efforts should prioritize targeting serious offenses while being mindful of the potential harm that enforcement actions can have on further marginalizing those struggling with drug use and in failing to account for the underlying needs of vulnerable individuals who need support rather than punishment.

Areas of Opportunity

• Developing a universal operational policy for naloxone deployment will save lives.

An opportunity for improvement within transit agencies is the development of a universal operational policy regarding which staff are authorized to carry and deploy naloxone. Practices vary widely due to real and perceived risk concerns associated with frontline personnel, which can lead to confusion and potential gaps in time-critical emergency response. Although many agencies choose to have contract outreach staff carry and deploy naloxone, others also train supervisory staff to carry and deploy naloxone. Additionally, some transit agencies provide naloxone on site in the transit system (e.g., the Toronto subway system station collector booths) or through publicly accessible health machines (e.g., Chicago’s current pilot program at the 95th/Dan Ryan Station). Jurisdictions with Good Samaritan laws that legally protect individuals who intervene during an overdose help mitigate legal risks for transit personnel and the public, potentially encouraging more people to act in an emergency without worry of liability. The State of California is exploring making the provision of naloxone a required product within workplace-provided first aid kits (Legislative Assembly of the State of California 2024). Responding to an overdose is time-critical, so having naloxone readily available and ensuring staff are trained to use it can reduce the severity of overdose incidents and lower fatalities caused by overdose on the transit system. A standard policy would provide clarity, improve emergency response, and enhance the overall safety and effectiveness of overdose interventions across transit agencies.

• Communicating roles in multidisciplinary enforcement and outreach programs can enhance customer awareness of transit agencies’ responses to drug use.

Transit agencies implement various multidisciplinary enforcement and outreach programs to address issues like drug use and safety on public transit. Given the involvement of police officers, security officers, outreach workers, and customer service agents, there is a strong opportunity to communicate each group’s distinct roles and responsibilities to the public clearly. Police officers primarily focus on maintaining law and order, addressing criminal behavior, and ensuring overall safety. Security officers assist with surveillance and immediate response to security incidents

within the transit environment. Outreach workers provide support and connect individuals to essential services like shelter and medical care, addressing underlying issues such as drug abuse and homelessness. Customer service agents handle day-to-day passenger interactions, addressing concerns, and ensuring a positive travel experience. Clearly defining and communicating these roles helps transit agencies improve public understanding of each team’s contribution to a safer, more supportive transit system, while also boosting the overall effectiveness of their collaborative efforts in addressing complex challenges.

Transit agencies like LA Metro and TriMet have launched extensive communication and promotional campaigns to clearly define and publicize the roles of different staff members. These efforts include visible signage and information campaigns at stations and onboard vehicles, designed to help the public understand the distinct functions of police officers, security personnel, outreach workers, and customer service agents (see Figures 28 and 29). They also use uniforms and other branding elements to visually differentiate each role. By adopting similar strategies, other transit agencies can improve public understanding of how these multidisciplinary teams contribute to a safer and more supportive transit system—ultimately enhancing the effectiveness of their efforts in addressing complex issues such as drug use on transit.

• There is value in contracting with outreach organizations employing Certified Peer Specialists.

Transit agencies can enhance their response to complex issues like drug use by contracting with outreach organizations that employ certified peer specialists. These specialists, who often have lived experience with drug use and recovery, bring a unique and valuable perspective to the outreach process. Their firsthand understanding of the challenges faced by individuals struggling with drug use allows them to connect more authentically and lends them greater credibility and understanding in the eyes of those they are trying to help. This credibility fosters trust and encourages individuals to engage more openly with the support being offered.

Transit agencies (e.g., LA Metro, TriMet, and SEPTA) have recognized the value of contracting with outreach organizations that employ individuals with lived experience to support their outreach efforts. However, SEPTA is the only agency among the five case example agencies in this synthesis that employs certified peer specialists, who bring an additional level of training and expertise. These certified specialists are well-versed in navigating and accessing critical services, making these individuals highly effective in guiding others to the appropriate support networks. Moreover, employing peer specialists offers a cost-effective alternative to hiring clinicians, providing meaningful support at a lower cost without sacrificing quality of care. This strategy enables transit agencies to address drug use more effectively while optimizing resource allocation. Although using peer specialists is more cost-effective, assigning complex outreach responsibilities to contract staff who are paid less than staff in public health and social services can cause tension.

• Aligning transit agency codes of conduct with evolving laws on drug use will aid enforcement and safety.

Many participating transit agencies have established codes of conduct for passenger behavior, but few address drug consumption explicitly. From an enforcement perspective, activities often focus on no-smoking provisions, which typically result in fines or, in cases of repeated offenses, temporary exclusions from the transit system. With evolving laws, such as those in the state of Oregon that criminalize drug possession in public spaces including transit, there is an opportunity to align transit agency codes of conduct with local and state regulations. Transit agencies like LA Metro are responding by increasing the visibility of code-of-conduct signage throughout the transit system. These signs inform passengers about acceptable behavior and provide guidance on enforcement actions, helping to clarify expectations and support compliance. Aligning

Source: David Cooper

policies with current laws and enhancing public awareness through signage can improve the effectiveness of enforcement and contribute to a safer transit environment.

• Physical design changes to stations can be effective in deterring drug use.

Transit agencies have implemented various physical design changes to station environments as a strategy to reduce drug use on their systems. These changes typically follow the principles of Crime Prevention Through Environmental Design (CPTED). Key modifications include the following:

• Enhanced Sightlines: Improving visibility within stations to reduce the number of secluded areas where drug use might occur.
• Improved Lighting: Upgrading lighting to ensure all areas are well-lit, making it harder for drug-related activities to go unnoticed.
• Access Control: Strengthening control measures at station entrances and within ancillary spaces to limit unauthorized access, as has been done by LA Metro and SEPTA.
• Elevator Modifications: Adjusting operating procedures for elevators, such as keeping doors open when the elevator is not in use to discourage loitering and misuse, as has been employed by LA Metro and Denver RTD.
• Removing Infrastructure: such as shelters in areas with high rates of vandalism or loitering by individuals using illicit drugs within the shelter structure.

These approaches create a less inviting environment for drug use while enhancing overall safety and security within the transit system. However, transit agencies face a challenge in balancing these measures while maintaining a positive customer experience. For example, while removing benches in areas prone to loitering may deter drug use, it can also affect the comfort and satisfaction of transit passengers. Agencies continue to seek strategies that address both vandalism and maintenance issues related to drug use, while minimizing negative effects on customer experience.

Coordination issues with adjacent municipal and private properties can present challenges when addressing physical changes to the transit environment. Effective management of these challenges requires extensive coordination and cooperation among various stakeholders. Clear

delineation of property boundaries and the roles and responsibilities for maintenance and upkeep of these spaces is crucial to ensuring that all parties are aware of their duties and can work together effectively. Further research is needed to evaluate the effectiveness of CPTED-based improvements after implementation, particularly in assessing changes in customer perceptions of safety and the actual number of person- and property-related incidents.

Knowledge Gaps

• There are significant data challenges in understanding the scale and scope of drug use on transit systems.

Understanding drug use on transit systems is challenging due to inconsistent data collection and reporting across agencies. Although certain data points, like naloxone deployments and employee exposure to drugs, offer valuable insights, much of the data relies on indirect measures such as customer reports through Transit Watch and other apps, track falls, vandalism, and outreach referrals. These proxy indicators do not provide a comprehensive or standardized view of drug use issues. Additionally, data maturity and ownership further complicate the usefulness of these indicators for assessing the scope and scale of drug use on public transit.

The diversity of reporting sources further complicates data integration. Information comes from various channels (e.g., customer apps, transit control centers, police reports, emergency medical services, and outreach documentation), each with differing reporting criteria and standards. This fragmentation makes it difficult to compile an accurate and complete understanding of drug use on transit. Managing this data while addressing privacy concerns and coordinating with multiple stakeholders adds further complexity.

To address these challenges, participating transit agencies have already established an informal working group on transit safety and outreach, which can serve as a platform for sharing resources and ideas to develop a consistent data program. Effective data collection and reporting will require collaboration with public health partners, police services, and outreach organizations. An integrated approach is essential for improving responses from public health, outreach, and enforcement perspectives.

Consistent data can enhance agencies’ ability to address drug use; foster a shared understanding among transit riders, the public, politicians, and the media; and lead to more informed decision-making, better resource allocation, and a coordinated response to transit challenges. The lack of a well-defined data framework is a result of unclear role definitions, insufficient standardization, and a lack of a structured approach to public health outcomes. Each stakeholder has a varied role, and the absence of role clarity and objective definitions makes it difficult to measure effectiveness.

Furthermore, it is difficult to develop standards and SOPs when roles and objectives are not clearly defined. Agencies respond to lagging indicators, and the wide variety of roles used to achieve their goals only exacerbates the issue. Without clear objectives, measuring improvement remains a significant challenge.

• The effect of fare enforcement on transit safety and drug use on transit is understudied.

Many transit agency staff and frontline police officers believe that fare enforcement is crucial in preventing safety issues and drug use on transit systems. This perspective was commonly discussed with the participating transit agencies, with many respondents viewing fare enforcement as a key strategy in maintaining a safer environment. Although no comprehensive study has empirically evaluated this relationship, some evidence supports the notion. For example, the “tap out” pilot program at North Hollywood station in Los Angeles has led to a 40% reduction in reported crime and incidents (e.g., physical fights, harassment, drug use, and vandalism),

as tracked by LA Metro’s Transit Watch app. This reduction has been largely attributed to the increased level of fare enforcement during the pilot. Similarly, in recent months, SEPTA Police have observed a decrease in crime coinciding with intensified efforts on fare enforcement. Given these findings, further study on the correlation between increased fare enforcement and its impact on transit safety and drug use is advisable to better understand and validate this approach.

• Assessing Physiological Health in the Transit Workplace

Work-related psychosocial hazards, including mental health impacts, have significant effects on workplace safety. For transit workers, these hazards can stem from factors such as inflexible work schedules, poor managerial support, harassment, bullying, conflicting work demands and addressing complexities in the transit operating environment (e.g., witnessing drug use on transit). Anticipating the effect of these issues, both in the workplace and at home, is essential for understanding the full scope of transit worker well-being.

Exposure to work-related hazards can lead to chronic stress, which can affect both mental and physical health, leading to cognitive, emotional, behavioral, physiological, and later on, economic effects (Schulte et al. 2024). Frontline transit workers face unique challenges, where such exposures may negatively affect their health and well-being. These workers, particularly operators, are subjected to verbal and physical threats and witness or respond to passenger drug use while on the job. Witnessing and responding to these types of incidents can cause stress and trauma for the workers, leading to anxiety, depression, and other conditions such as hypertension and cardiovascular disease.

Observing drug use in transit vehicles can be especially stressful or unpredictable, and this stress may be exacerbated depending on workers’ personal histories with drug use. Workers who have a personal or family history of substance use may experience re-traumatization, which may affect their mental health, coping mechanisms, and ability to perform their jobs effectively. To reduce these risks, future research could explore strategies like implementing additional physical barriers and enforcing consistent policies to address drug use within transit vehicles. Additionally, harm reduction strategies could be considered as part of a comprehensive approach to managing drug use in transit spaces, such as offering training to workers on overdose response and de-escalation techniques.

The cumulative effect of these work-related psychosocial hazards underscores the need for further research. Transit agencies must identify and implement strategies to reduce these hazards, thereby improving mental health, wellness, and resilience for transit workers. Such strategies could include trauma-informed care training, peer support programs, and improved access to mental health services, as well as organizational changes like enhancing managerial support and fostering a workplace culture that prioritizes mental well-being.

Conclusion

Of the many issues that U.S. public transportation agencies must contend with, drug use on transit remains one of the most urgent and complex to resolve. The primary goal of this effort was to synthesize existing knowledge on the topic, document how five major U.S. transit agencies are responding to this issue, and chronicle the effects of drug use on the safety of customers and staff. Addressing the unprecedented rise in drug use on transit will assist in post-pandemic ridership recovery and is vital to creating safer environments for customers, staff, and vulnerable members of society.

Each agency varies in its response to drug use. Chicago’s CTA relies heavily on various city agencies for support, such as when selecting contractors to conduct outreach efforts and when

conducting law enforcement. Conversely, the Denver RTD’s small but growing outreach program has its own in-house transit police department. LA Metro directly funds temporary shelter beds for unhoused individuals, relies on three separate police departments to provide law enforcement on its system, and has an extensive ambassador program that works in conjunction with outreach workers. Philadelphia’s SEPTA has taken a comprehensive approach with its SCOPE program, which aims to connect vulnerable individuals with the support they need while improving cleanliness and safety for customers and staff. Finally, Portland’s TriMet relies on a comprehensive network of different staff for customer service, outreach, and law enforcement.

The findings of this effort indicate that, although numerous challenges and knowledge gaps exist in addressing drug use on transit, many opportunities for improvement also exist. The main findings are that (1) transit agencies are taking on complex social responsibilities that they are not intended to manage, (2) data collection is often sparse and inconsistent, and (3) harm reduction practices may sometimes clash with customer and staff safety. These are difficult issues to solve, so transit agencies should strive to respond to the drug use crisis to the best of their ability while actively engaging with and advocating to all levels of government responsible for tackling the issues.