Opiate Crisis Illinois
Illinois is in the midst of an unprecedented opioid epidemic. In 2016, opioid-related overdoses
claimed the lives of 1,946 Illinoisans, more than one and half times the number of homicides
and nearly twice the number of fatal car accidents.
From 2014 to 2015, the national death rate from these drugs increased by 72.2%, according
to the Centers for Disease Control and Prevention (CDC). In 2016, the Cook County Health &
Hospitals System saw more than 5,000 opioid-related emergency department visits, up from
1,000 visits in 2006.
The US leads the world in consuming opioids. For example, Americans are prescribed about six
times as many opioids per capita as are citizens of Portugal and France.
Official numbers from the Centers for Disease Control and Prevention show that overdoses from
drugs — legally prescribed or otherwise, including opioids, hallucinogens and other narcotics
such as cocaine — killed about 63,600 people nationwide in 2016, a 21 percent increase from
the year before. Of those, over 42,000 — roughly 66 percent of the total — involved some kind
of opioid.
Illinois opioid overdoses have been increasing in recent years. As noted above, there were
1,946 opioid overdose fatalities in 2016, an 82% increase since 2013. Nonfatal opioid
overdoses, as tracked by emergency department visits and hospitalizations, have likewise been
rising dramatically statewide.
Synthetic opioids such as fentanyl and its analogues are disproportionately contributing to the
rise in both fatal and nonfatal overdoses. Over the past three years, deaths due to synthetic
opioids have increased tenfold, from 87 in 2013 to nearly 900 in 2016. The national number
of EMS runs that required two Naloxone administrations increased by over 50 percent from
2013-2015, and the number of runs that require three administrations increased by over 75
percent over this time period. This increase can be attributed to the presence of fentanyl and
other synthetic opioids in the substances being used.
Opioid overdoses are an urban, suburban, and rural problem. While the highest absolute
number of opioid overdoses are in Cook County and the collar counties, many of the highest per
population overdose rates are seen in pockets of rural counties statewide. In fact, there were
18 Illinois counties that had 2016 population rates of opioid overdose deaths that were greater
than that of Cook County.
Opioid prescribing activity has been decreasing. Since 2013, the total number of opioid
prescriptions reported to the Illinois Prescription Monitoring Program has decreased by 9.8%.
This is consistent with an overall national trend toward reduced opioid prescribing in recent
years as compared to peak prescribing in the late 2000s and early 2010s. Nevertheless, opioid
prescribing activity remains significantly higher today as compared to the late 1990s.
The opioid epidemic currently gripping the nation represents the deadliest drug crisis in
United States history. The Centers for Disease Control and Prevention (CDC) estimates that
nearly half a million people in the U.S. died of an opioid-related drug overdose between
2000-2014.
In Illinois, opioid overdoses have led to more than 11,000 fatalities since 2008. Dangerously
potent and poisonous synthetic opioids such as fentanyl are increasingly making their way into
the illicit drug supply, and opioid-related deaths have been rising exponentially in recent years.
Beyond the number of deaths is the broader impact of the opioid crisis on individuals, families,
and communities. An estimated one in three Illinoisans have been affected by the crisis,
either suffering from OUD themselves or knowing someone with OUD or who has overdosed.
IDPH classifies opioid overdose deaths into three categories:
! Overdose deaths involving heroin
! “Opioid analgesics,” which includes drug overdose deaths in which any opioid analgesic was
reported as a contributing cause of death (ICD-10 codes T40.2, T40.3, and T40.4)
o Death certificates do not include information regarding whether opioid analgesics were
obtained legally (i.e., prescribed by a physician) or illicitly, and thus, it is not possible to
definitively categorize a death involving an opioid analgesic as caused by a “legitimate”
prescription.
! “Any opioid,” which includes deaths due to heroin, opioid analgesics, and other and
unspecified narcotics.
In 2016, the City of Chicago and Madison County had the highest rates of opioid overdose
deaths rates in Illinois. The largest rate increase from 2015 to 2016 was seen in Kendall County
where the opioid overdose rate more than tripled.
The age-adjusted opioid overdose death rates for all racial/ethnic groups increased between
2015 and 2016, but the greatest increase was among the non-Hispanic (NH) black population
(12.5 to 24.0 per 100,000 population). NH blacks had the highest rate of opioid overdose
deaths in 2016 in Illinois. The Hispanic population also saw a large increase, from 5.1 to 9.4
opioid overdose deaths per 100,000 population.
The age groups most affected by fatal opioid overdose are the 25-44 and 45-64 groups.
Fatal overdoses in the 65 and over age group have increased steadily but are much lower than
other age groups. Fatal opioid overdoses in those 18 and younger are rare and decreased
between 2015 and 2016.
While fatal opioid overdoses have increased for both men and women between 2013 and 2016,
significantly more men than women die of opioid overdose. In 2016, 2.6 men died of an opioid
overdose for every woman.
Since 2013, Illinois has experienced a substantial increase in overdose deaths from all
categories of opioids. Most striking has been the tenfold increase in deaths due to
synthetic opioids, including fentanyl and fentanyl analogues. Deaths due to natural and
semi-synthetic opioids, including prescription pain relievers such as hydrocodone, oxydocone,
and oxymorphone, doubled, and deaths due to heroin increased by 73 percent.
Cook County has embarked on a number of initiatives to combat the epidemic of opioid
use:
• In 2017, CCHHS received $2.6 million to establish new pilot programs to
fight the county opioid epidemic. Programs will include a second
Community Triage Center, expansion of the system’s medication assisted
treatment options and case management services, and new fentanyl
screening capabilities. Funding in support of these initiatives was awarded
to CCHHS by the Illinois Department of Human Services, Division of
Alcoholism and Substance Abuse (IDHS-DASA). These funds are part of an
Opioid-State Targeted Response (STR) grant award (TI-080231) to IDHS-DASA
from the U.S. Department of Health and Human Services, Substance Abuse and
Mental Health Services Administration as part of the 21st Century Cures Act.
• CCHHS invested $3 million to establish a Community Triage Center (CTC)
in Chicago’s Roseland neighborhood. The CTC provides evaluation, crisis
stabilization and treatment for patients presenting with psychiatric and/or
substance-related crises.
• CCHHS currently offers medication-assisted treatment (MAT) at most of its
community health centers and is actively working to expand access
throughout its clinic network and through partnership with community
treatment providers.
• Stroger Hospital has launched a pilot program to initiate MAT in the
Emergency Department in coordination with addiction medicine providers
to reduce the risk of overdose and attrition between an ED visit and an
outpatient appointment with a substance use specialists.
• Through CCHHS’ Cermak Health Services at the Cook County jail,
detainees with a history of opioid use are offered training and naloxone
upon release to reduce the incidence of post-detox overdose.
• CCHHS partners with three community health centers – Esperanza Health
Centers, PrimeCare Community Health, and Heartland Health Centers – to
offer medication-assisted treatment for opioid use disorder within their
primary care clinics.
• CCHHS and CCDPH are working with medical providers to improve and
develop safe prescribing protocols, including an annual training module.
• CCDPH facilitates a panel of opioid addiction experts to provide awareness
and education training on opioid addiction throughout the community as
well as its own workforce.
The reasons, says Dr. Benedikt Fischer, senior scientist at University of Toronto's Centre for
Addiction and Mental Health, are political as well as cultural. "In North America, in our society,
we treat our ailments primarily through drugs," he says. In European countries, by contrast,
"physicians think a lot more about what are the causes behind certain symptoms and are there
things other than drugs we can apply here."
Fischer also says the aggressive marketing by pharmaceutical companies in the United States
is also a factor. "There are only two countries in the world in which direct-to-consumer
advertising is allowed and that's in the United States and New Zealand." Other countries have
much tighter restrictions on pharmaceutical marketing. The public healthcare systems in other
countries also play a role, Fischer says. "In many countries, you only have certain physicians
allowed to prescribe [opioids]. The regulated dosing or length of prescriptions are different. A lot
of the potent opioids are only used in hospital settings."
At this point, says Fischer, the United States has an acute problem on its hands. It can impose
more regulations on prescription painkillers, but patients will likely turn to illegal substitutes like
heroin or fentanyl. "We're really at a point where we're not exactly sure [if it's] better right
now to further restrict medical opioid supplies or leave them at a certain point until we
can deal with all the people that are dependent on them.”
When asked “What do you see as the national solution to this epidemic?”
John Jay Shannon MD, (CEO of Cook County Hospital) remarked, “It's going to take a lot of
different things. We've got a significant charge to educate both the public and healthcare
professionals about pain. We were taught in medical school if someone has pain and you give
them narcotics, they won't get addicted. That's clearly incorrect. We need to develop safer
treatments for pain. We've got a long way to go. We've got to destigmatize addiction
problems so people come forward for treatment. We have to make sure community based
services are available to people who need them. The relief of pain has to be treated
seriously, but at the same time we could all benefit from different expectations regarding pain
relief. I don't think it's going to be any one thing that brings this health crisis to a close.”
Prescription opioid overdose, abuse, and dependence carry high costs. In 2013, it was
estimated that the total economic burden was $78.5 billion (in 2013 dollars).
Approximately one-third of the costs of the prescription opioid crisis are attributable to health care, and one fourth of costs are borne by the public sector.
The total estimated economic burden for prescription opioid abuse, addiction, and overdose death and heroin addiction would be approximately $111 billion (in 2013 dollars). Many costs are inestimable, including the social impact on opioid-dependent people, and the suffering of family members as witnesses to addiction or to fatal overdose.
