For many people the image of a heroin user is that of a racial minority, usually male, huddled in an alley, a syringe jammed into his arm, near a dumpster, but that image has changed over the years and many users are now white, suburban and female, with prescription painkillers as their point of entry down the swift path to addiction. This and other news on heroin use and treatment were presented Tuesday by the Illinois Consortium on Drug Policy at Roosevelt University, in Chicago, by Kathleen Kane-Willis, director, and a distinguished panel of clinicians, social workers, and law enforcement officials.
The presentation, and its accompanying paper, bore the title, “Diminishing Capacity: The Heroin Crisis and Illinois Treatment in National Perspective.” Housed in Chicago, the ICDP spent over 10 years gathering data to support its findings, and one of the central positions they discovered is that Illinois is lagging far behind in treatment, and support, for users and also leads the nation for treatment admissions, that “are significantly higher,” the report states.
In fact while national treatment admissions were 16.4 percent of total state funded treatment in 2012, Illinois admissions made up one-quarter of all treatment admissions for the state,” and were 56 percent greater than the country as whole, in 2012, but perhaps most startling, was that for the same year, “the Chicago Metropolitan Area percentage of treatment admissions for here was more than double the national average (35.1 % vs 16.4%).”
Over a 6 year period, heroin was also the “second most common reason for Illinoisans to enter state publicly funded treatment, after alcohol,” and by comparison purposes, it was the fourth most common reason for admission. For young Illinoisans, heroin increasingly has become their drug of choice, in “2007, 2.5% of Illinois youth reported using heroin in the past year, while in 2013, that number increased to 3.8%, a nearly 50 percent increase in just six years.”
There was also a dramatic change in the gender of the user, with “the greatest percentage increase occurred among females – a 90% increase over that same period.”
As with many social programs funding, or lack of funding, has become an issue, and just ahead of the report, the Chicago Tribune reported that, “Illinois’ per capita treatment admissions are among the lowest in the country, ahead of only Texas and Tennessee. The state has slashed treatment spending by nearly 30 percent since 2007, according to the report, and Gov. Bruce Rauner’s proposed budget calls for further cuts.”
Treatment, including harm reduction uses such methods as methadone, but its use and distribution has been compromised by not being on the list of Medicaid approved drugs, a problem, according to Kane-Willis, who says that payment “would be especially helpful because it would allow the state’s Medicaid program to pay for methadone,” a medication used to ward off heroin cravings. The bill comes with a $15 million price tag, though, and the Illinois Department of Human Services has said that it is unaffordable,” reported the Tribune. Increased access of methadone can save $8.25 million dollars, she says, with a corresponding decrease in treatment and prison populations. Most importantly the provision for methadone for just 2,500 people cols save the State of Illinois about $82.5-$100 million in reduced crime and health care consequences.”
The resulting decline in Illinois caused it to be “ranked first in the US for the decline in treatment capacity over this period, a loss of more than half of its treatment episodes, 52% decrease over the five year period,” and also in 2012 (the last year for full data) it ranked 44th, or third worse in the nation for state funded treatment, the report noted.
While addiction has come to the forefront of state social ills, the problem of decreased funding continues, in the proposed state budget which represents a 61% decrease in state funded treatment, including case management, and aftercare, which only exacerbates the problem.
One proven method for use in emergency overdoses, and to prevent death is the use of naloxone, whose use is consistent with evidence based practices, notes Kane-Willis, who also emphasizes that naloxone kits are significantly cheaper that an “overdose death about $25-$40, and $30,000 respectively.”
Naloxone works in overdose scenarios by its direct effect on the central nervous system, which allows the person to resume normal breathing, and can be administered with minimal training, by first responders, but as the panel noted on Tuesday, it might take an ambulance longer to get there than desired; and police can easily administer the life saving drug. Evidence which was recently seen, first hand, when Arlington Heights Deputy Police Chief Nicholas Pecora witnessed a young teenage girl brought back to life by a quick-thinking police officer.
Perhaps unknown to many people is that the strongest risk factor for heroin addiction is addiction to prescription opioid painkillers, and this route, as some of the panel observed, needs increased research.
The perception that heroin is an urban problem has also been altered with increasing stats for usage and addiction in places like Decatur, with a 56 percent increase, and in Champaign Urbana, where there has been an increase of 100 percent, thus closing the perceived gap between the urban core, with rural and downstate areas, where usage increased from 3 percent in 2007, to 17 percent in 2012.
Panel members included Dr. Abdel Fahmy, M.D.who is the CEO of Soft Landing Recovery who emphasized the urgent need for medical school training for students, so that when they became physicians they had an understanding of what addiction was, and how it can be treated, and also revealed that in one day, “five [suburban] kids died on the 4th of July weekend,” from heroin overdoses.
The most startling revelations came from Eric J. Guenther, Chief of Police in the Village of Mundelein, who shocked many of the attendees when he said that abusers could drop off their drug equipment, at his station, not be prosecuted and then referred to treatment. He also emphasized that Lake County used a “multi-angled” approach that included giving Naloxone to officers, “so that, if need be, they can beat the ambulance,” and save an addicts life through that intervention.
Kate Mahoney, LCSW, and Executive Director of PEER Services noted that many people can access care and treatment through the Affordable Care Act, but that high deductibles, often in the thousands are preventing people from using the ACA to pay for treatment.
Much hope is centered on a bill sponsored by State Rep. Lou Lang (D-16th) that has met approval from both the Senate and the House, and needs only the signature of the governor. The bill – HB001 – is also known as the Heroin Crisis Act, and would allow for the inclusion of methadone as an approved drug by Medicaid, but the Illinois Department of Human Services says the $15 million price tag is too high. The National Institute on Drug Abuse, however, states that “the average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per patient, whereas 1 full year of imprisonment costs approximately $24,000 per person.”
In a time of intense partisanship between the governor’s office and the state legislature, it will be difficult to predict if the rise in Illinois heroin abuse can be treated, holistically, or with the increased tools and funds that the ICDP has shown.