DRAFT NOT FOR CIRCULATION EMBARGOED FOR MEDIA RELEASEon 8/11/15ACKNOWLEDGEMENTSThis paper was funded in part by the generous support of the Drug Policy Alliance.MISSIONDRAFT NOT FOR CIRCULATION EMBARGOED FOR MEDIA RELEASEon 8/11/15Diminishing C!"i#$%The Heroin Crisis and IllinoisTreatment in NationalPerspectiveIllinois Consortium on DrugPolicy at oosevelt !niversityAugust "#$%Authored by&'athleen 'ane()illis*iovanni AvilesDavid +arnett,ustyna C-echows.a/cott 0et-geroman ivera+en1amin )aiteDRAFT NOT FOR CIRCULATION EMBARGOED FOR MEDIA RELEASEon 8/11/15The Consortium2s primary ob1ectives are to promote discussion of alternatives to Illinois2 current drug policies and to serve as a forum for the open3 honest3 and thoughtful e4change of ideas. )e aspire to serve both the general public and populations signi5cantly a6ected by drug policies through careful analysis of currentpolicies in the areas of housing3 employment3 education3 social services3 healthcare and economics. )e aim to o6er sensible3 prudent3 1ust and economically viable alternatives to ine6ective policies. The Consortium see.s meaningful change by increasing dialogue3 heightening public awareness3 meeting with legislators3 organi-ing individuals and communities3 and e4panding outreach to other organi-ations that are also impacted by drug policies. The Consortium views individuals and communities that have been directly impacted by drug policies as an integral component for change.DRAFT NOT FOR CIRCULATION EMBARGOED FOR MEDIA RELEASEon 8/11/15DRAFT NOT FOR CIRCULATION EMBARGOED FOR MEDIA RELEASEon 8/11/15T&'( o) Con#(n#s787C!TI97 /!00A:................................................................................................. $National Trends....................................................................................................... $Illinois Trends.......................................................................................................... $Declining Treatment Capacity& Illinois in National Perspective................................"07TH;D;I.A days per monthF.Arrestees from Coo. County reported using heroin in the last three days morethan those from any other region E$%.?IF.The Chicago 0etropolitan area ran.ed 5rst in the country for the total number of mentions for heroin E"C3>"?F nearly double the number for New :or. City. Chicago also reported the highest number of heroin mentions among African American mentions E$C3$?AF3 nearly four times more than New :or. City EC3=>CF and nearly > times higher than Detroit E"3C$$F. Among whites3 only +oston had more 7D mentions for heroin E$#3#=%F3 but Chicago was second E?3#"=F. Chicago ran.ed highest in the number of 7D mentions for both women and men. Ad1usting for population3 Chicago ran.ed "nd highest in the number of mentions overall3 behind +oston.D("'ining T-(#m(n# C!"i#$% I''inois in N#ion' /(-s!("#i0()hile heroin use is increasing in every area of the state3 there has been an alarmingand dramatic decrease in treatment from "##? to "#$". Illinois ran.ed frstin the !/ for the declinein treatment capacity over thisperiod3 a loss of more than half of its treatment episodes3 %"I decrease overthe 5ve year period.2 In "##?3 Illinois ran.ed "Athin state funded treatment capacity3 but in "#$"Illinoisran.ed==th3 or Crdworst inthenationJ onlyTennesseeandTe4asran.ed lower. In "#$"3 Illinois2s state funded treatment rate was E">% per $##'F more than %#I lower than the !/ rate. )hen compared to other 0idwestern states3 Illinois had the lowest rate of state funded treatment. 0innesota2s rate was ".? times Illinois2s rate EBA".$ vs "%>.>F3 ;hio2s rate was twice as high as Illinois3 )isconsin rate was $.A times greater3 and Indiana2s rate3 which was lower than that for any 0idwestern state3 aside from Illinois3 was still =CI higher than Illinois. Illinois /tate funding for addiction treatment decreased signi5cantly& @rom "##? to "#$"3 *eneral evenue @unding decreased by nearly C#I EK$$$0 vs K?B0F3 while 0edicaid funding decreased by =I over this time period. These decreases in funding continue in @: $>3 where the proposed budget represents a >$I decrease in state funded addiction treatmentJ Including 0edicaid increases from @:$C to @:$>3 addiction treatment funding Eincluding 0edicaidF3 still dropped by "AI overall EK$>C0 in "##? to K$$>0 inthe proposed @:$> budgetF"### "##$ "##" "##C "##= "##% "##> "##? "##A "##B "#$# "#$$ "#$"#.#$##.#"##.#C##.#=##.#%##.#>##.#?##.#A##.#To#' I''inois T-(#m(n# E!iso.(s !(- 1112111 34111 5 41146A""o-.ing #o #h( CDC S##(s "n%$ 74pand treatment for those with heroin and opiate use disorder3 especially 0edication Assisted Treatment E0AT3 including methadone and buprenorphineF3 which would lower crime and save ta4payer money&3 7ach dollar spent on methadone maintenance yields a cost saving in terms ofcrime reduction between K= and K?. )hen health care costs are included3 thebene5ts returned are K$" for each K$ investedJ 7nsure that all medication assisted treatment is covered by 0edicaid3 withouttime limits. The bene5ts of providing methadone for 1ust "3%## people could save the /tate about KA".%(K$##0 in reduced crime and health care conseGuences Eincluding the cost of the treatmentF. 74pansion of 0AT could reduce the prison population among class = o6endersalone by appro4imately $3### cases per year." Increase access to and training for administering nalo4one to reduce heroin and other opioid overdose deaths. The /tate of Illinois should invest funding in e4isting nalo4one programs sincenalo4one .its are signi5cantly cheaper than an overdose death about K"%(K=# and KC#3###3 respectively.C 7nsure that state funded drug courts are following evidence based practices as is reGuired with federally funded drug courts3 especially the inclusion of 0AT.= Increase availability of syringes and .nowledge of syringe access laws and harm reduction practices in Illinois.% Address the strongest ris. factor for heroin addiction& addiction to prescription opioid pain.illers.4MET7ODOLOG,This brief report is an update to Heroin Use: National and Illinois Perspectives, 2008 to 20101. This update e4amines public treatment data3 emergency department statistics3 and arrest data using the most recent and complete years available. Data was gathered from the National Household /urvey on Drug !se and Health3 the Treatment 7pisode Data /et3 the Drug Abuse )arning Networ.3 the :outh is. +ehavior /urveillance /ystem3 and the Arrestee Drug Abuse 0onitoring program. The following methodological notes regarding the data sets will provide additional information on the data contained within this report. N#ion' 7o8s(ho'. S8-0($ on D-8g Us( n. 7('#h 3NSDU76 ( The "#$C data set was used for this report to provide information on heroin initiates and use patterns in the !nited /tates. Downloaded ,uly3 "#$%. T-(#m(n# E!iso.( D# S(# 3TEDS6 D The "##? and "#$" data sets were used for this report to provide information on use of public treatment servicesfor heroin problems in the !nited /tates and Illinois. It is important to note that one person can undergo multiple treatment episodes. Data were not reported for Alabama E"##?F3 0ississippi E"#$"F3 Pennsylvania E"#$"F3 and )est 9irginia E"#$"F. Downloaded ,uly3 "#$=. D-8g A&8s( W-ning N(#9o-: 3DAWN6 ( The "#$$ data set was used for this report to provide details on the number and rates of individuals receiving emergency medical services for heroin problems throughout the !nited /tates and the Chicago 0etropolitan Area. The research team also analy-ed this data by race3 comparing white and African American individuals who received emergency medical services due to heroin use. Data for 0iami and 0iami D @t. 3 reGuired further analysis. The researchers concluded it might have been a reporting error in the "#$$ data3 but this pattern persisted over time3 into "#$". +ecause of these changes in treatment episodes3 we decided to loo. and compare Illinois to other states in terms of publicly funded treatment episodes and compare them to the rest of the nation.This comparison seemed timely as it has been well established by government agencies and others that the heroin and opioid crisis in Illinois were still growing across the nation.77EROIN USE IN NATIONAL /ERS/ECTI+EThis rise of heroin use has been featured e4tensively in news reports3 community forums3 among law enforcement3 public health oHcials3 and government agencies3 especially over the past % years. According to both the Consortium2s research and the Centers for Disease Control ECDCF3 across the nation3 heroin use has increased among most demographic groups3 genders3 ages and income levels.)hat has garnered perhaps the most attention3 particularly in the media3 is the increase among groups not historically associated with heroin use3 including women3 individuals with insurance and those from higher /7/ households.C Among those aged $A("=3 heroin use doubled over the last ten years=. /urvey data demonstrate that the number of people who use heroin in the !nited /tates has continued to rise since "##". In "#$C3 the number of individuals E>A$3###F reporting past year heroin use was signi5cantly higher than in "##? EC$=3###F3 nearly doubling over that si4 year period.)hile 5rst time use of heroin remained stable over this time period3 with $>B3### new initiates in "#$C. The age of 5rst use or initiation increased slightly from "C years in "#$" to "=.% years in "#$C.%

The rise in heroin use has also been accompanied by a rise in heroin mortality& heroin(related overdoses EpoisoningsF have nearly Guadrupled from "##" to "#$C3 with A3"## individuals dead in "#$C.> 0any of these poisonings involving heroin and other opioids are caused by the use of these drugs in combination with other drugs3 li.e alcohol3 ben-odia-epines3 and cocaine.? However3 heroin(related deaths are li.ely undercounted.Heroin is metaboli-ed in the body as morphine3 and to4icologyscreens often detect the presence of morphine metabolites in tissue samples.AHowever3 there is only a small window of opportunity in which heroin can be identi5ed as contributing to death through the morphine mar.er 6-monoacetylmorphine! 0any medical e4aminers lac. the resources to perform thesevery speci5c tests3 opting instead to screen for morphine and code the death as an opiate death. Heroin overdoses need not be fatal.Heroin and other opiate poisonings can be reversed with nalo4one ENarcanLF and there have been advances in getting the overdose reversal drugs more available to law enforcement and the general public3 so that no one need die from an overdose3 if individuals are trained in overdose prevention and nalo4one is available.$#8ILLINOIS ,OUT7 7EROIN USE RATES Heroin use is also increasing among young people in Illinois according to survey data. The :outh is. /urveillance /ystem3 a survey of Illinois youth3 showed an increase in high school youth reporting heroin use.In "##?3 ".%I of Illinois youth reported using heroin in the past year3 while in "#$C3 that number increased to C.BI3 a more than %# percent increase in 1ust si4 years.The greatest percentage increase occurred among females D a B#I increase over that time period.$$ 0ales were more li.ely to report using heroin D nearly si4 percent in "#$Ci $" ETable "F.T&'( 4% I''inois ,o8#h R(!o-#ing 7(-oin Us( in 411; n. 411 "##? "##A "##B "#$# "#$$ "#$"#I$#I"#IC#I=#I%#I>#I?#IA#IB#I$##I/(-"(n# o) To#' T-(#m(n# E!iso.(s &$ S8&s#n"( 34111 5 41146All ;ther0ethHeroin0ari1uanaCocaineAlcohol117EROIN INCREASES IN RURAL ILLINOIS AND SMALLER METRO AREAS;ne might thin. that heroin use is con5ned mainly to the Chicago 0etropolitan Area3 including the suburbs and collar counties but that is not the case3 particularly in recent years. Nearly all of the smaller 0etro Areas and even rural areas have seen the proportion of treatment episodes for heroin increase. @or e4ample3 in "##?3 treatment episodes for heroin comprised 1ust =I of total publicly funded treatment in 0etro 7ast Illinois3 but by "#$"3 heroin made up $AI of all treatment episodes D a fourfold increase in 1ust % years.Decatur demonstrated a similar rise in "##?3 treatment admissions for heroin comprised 1ust CI of the total3 spi.ing to "CI in "#$"3 representing a >(fold increase.ural Illinois has been similarly impacted E@igures "(CF.$=Fig8-( 4% /(-"(n# o) S##( F8n.(. T-(#m(n# A.missions )o- 7(-oin inS('("#(. I''inois M(#-o n. R8-' A-(s 3411; #o 41146 12#I"##I=##I>##IA##I$###I$"##I$=##I$>##I$A##I5= 11= >= 1.= 157EROIN USE AMONG COOK COUNT, ARRESTEES% NATIONAL /ERS/ECTI+EChicagoland ECoo. CountyF ran.ed 5rst in the nation for heroin use among arresteesin "#$$3 according to multiple indicators. According to the Arrestee Drug !se 0onitoring Program EADA0F3 arrestees from Chicago tested positive for opiates Eincluding heroinF at a rate of $A.>I3 higher than any other city in the nation while Portland ran.ed "nd 3)ashington DC Crd3 and New :or. City ?thETable =F. Arrestees from Coo. County also self(reported using heroin more times per month than those from any other area3 E">.A days per monthF while 0inneapolis ran.ed =th3 and Indianapolis ran.ed last E$%." days per monthF EAppendi4 +3 Table +."F in this respect. @inally3 arrestees from Chicagoland reported using heroin in the last three days more than those from any other city E$%.?IF3 while Indianapolis ran.ed >th andIndianapolis ran.ed Ath.Comparatively3 New :or. City ran.ed ?th in this analysisMC.$I of arrestees reported using heroin in the last three days EAppendi4 +3 Table +.CF.$?T&'( ?% /(-"(n# o) A.8'# M'( A--(s#((s T(s#ing /osi#i0( )o- O!i#(s3in"'8.ing h(-oin6 in U-in( T(s#s &$ Ci#$2 4111 3ADAM616Rn: Ci#$ /(-"(n#$ Chicago $A.>" Portland $=.=C )ashington DC $$.C= Indianapolis $#.C% Denver $#.$> /acramento B.>?New :or. A.$A 0inneapolis ?.?B Atlanta >.>$# Charlotte $.AEMERGENC, DE/ARTMENT MENTIONS FOR 7EROIN IN T7E C7ICAGO METRO/OLITAN AREA% NATIONAL /ERS/ECTI+EAccording to the Drug Abuse )arning Networ.3 the Chicago 0etropolitan Area ran.ed 5rst or second in a number of .ey indicators for heroin among individuals using the emergency room Eemergency department or 7DF in the nation.Chicago ran.ed 5rst in the country for the total number of mentions for heroin E"C3>"?F3 nearly double the number for New :or. City E$"3#$%F ETable %F.Chicago also reported the highest number of heroin mentions among African American mentions E$C3$?AF3 nearly four times more than New :or. City EC3=>CF and nearly > times higher than Detroit E"3C$$F EAppendi4 C3 Table C.CF. Among whites3 only +oston had more 7D mentions for heroin E$#3#=%F than Chicago E?3#"=F EAppendi4 C3 Table C.=F.Chicago ran.ed highest in the number of 7D mentions for both women and men EAppendi4 C3 Tables C.% and C.?F.Ad1usting for population3 Chicago ran.ed "nd highest in the number of mentions overall3 behind +oston EAppendi4 C3 Tables C.> and C.AF.$A T&'( 5%To#' Em(-g(n"$ D(!-#m(n# M(n#ions1@ )o- 7(-oin2 &$ Ci#$ 4111Rn: M(#-o A-( M(n#ions$ Chicago "=3>"?" +oston $=3#%?C New :or.$"3#$%= Detroit >3>=C% /eattle >3"#A> Phoeni4 =3#B"A 0inneapolis C3=BC? Denver $3AB=B /an @rancisco ?C$17DECLINING TREATMENT CA/ACIT,% ILLINOIS IN NATIONAL /ERS/ECTI+E)hile heroin use is increasing in every area of the state3 there has been an alarmingand dramatic decrease in treatment from "##? to "#$".Illinois ran.ed 5rst in the !/ for the percent decline in treatment capacity over this period3 a loss of more than half of its treatment episodesM a %"I decrease ETable >F in 1ust % years. In "##?3 Illinois ran.ed "Ath in state funded treatment capacity.In "#$"3 Illinois fell to == out of => states available for analysisii ran.ing above only Tennessee and Te4as ETables3 ?(AF."#

Illinois2s publicly funded treatment rate3 ad1usted for population3 was well below the national average. In "#$"3 the average national publicly funded treatment rate was %BC per $##3###.Illinois2s rate was 1ust ">% per $##3###3 less than half of the !/ rate."$ As compared to other neighboring or 0idwestern states3 Illinois had the lowest rate of state funded treatment. /outh Da.ota2s treatment rate3 ran.ed 5rst in the nation3was more than >.% times greater than Illinois2s E$?=$.B vs. ">%.>F3 0innesota2s rate was ".? times Illinois2s rate EBA".$ vs ">%.>F3 ;hio2s rate was twice as high as Illinois2s3 and )isconsin2s rate was $.A times greater. Indiana2s rate3 which was lower than that of any 0idwestern state3 aside from Illinois3 was still =CI higher than Illinois ETable BF.@igure = shows the decline in Illinois treatment episodes from "###("#$".""Illinois /tate funding for addiction treatment decreased signi5cantly. @rom "##? to "#$" *eneral evenue @unding decreased by nearly C#I EK$$$0 vs K?B0F3 while 0edicaid funding decreased by =I over this time period."CThese decreases in funding continue in @: $>3 where the proposed budget represents a >$I decrease instate funded addiction treatment Enot including 0edicaidF."=Including the increasesin 0edicaid from @:$C to @:$>3 addiction treatment funding Eincluding 0edicaidF3 still dropped by "AI overall EK$>C0 in "##? to K$$>0 in the proposed @:$> budget E@igure %FF."%ii Several states did not re$ort either in 27 or 212% and were not included in these ta&les" 'hese states include (la&a)a% *ennsylvania% +ississi$$i and ,est -ir.inia" 18T&'( >%S##( F8n.(. T-(#m(n# A.missions 9i#h #h( Rn:(. &$ L-g(s#/(-"(n# D("-(s( 3To! 116 3411;541146Rn: S##( =Chng(1 I''inois 554=" New 0e4ico (=AIC CC.$< New :or. $3%BB."? 0assachusetts $3=$?.$5 ;regon $3=#>.=> 9ermont $3C#B.B; Connecticut $3"??.B8 0aine $3"$C.>@ 0aryland $3"##.#11 hode Island $3#?=.?48 I''inois 554A@NA !/ T;TA< >>A.>1#T&'( 8% 7igh(s# S##( F8n.(. T-(#m(n# A.missions &$ R#(2 in"'8.ingI''inois n. US 341146Rn: S##( R#($/outh Da.ota$3?=$.B"Connecticut$3?">.>CColorado$3>AA.>=New :or.$3%#C.>%9ermont$3=#".B>0assachusetts$3C"#.C?;regon$3$%".?A0aryland$3$#$.=B0aine$3#C?."$#hode Island$3#">.=?? I''inois 4>5A>=%Tennessee"#B.%=>Te4as$>$.> !/ Total%B%.CT&'( @% Mi.9(s#(-n S##( F8n.(. T-(#m(n# A.missions &$ R#( !(- 111K341146Rn: S##( R#($ /outh Da.ota $3?=$.B $$ 0innesota BA".$ $" Nebras.a B=B.$ $C Iowa B#?.B $B 0issouri ?=B.# "# 0ichigan %%C.# "" ;hio %$%.? "= )isconsin =B%.? "? 'ansas =%?.= CC Indiana CA".A 2?? I''inois 4>5A> 21Fig8-( ?% S##( F8n.(. T-(#m(n# A.missions R#( 34111541146"### "##$ "##" "##C "##= "##% "##> "##? "##A "##B "#$# "#$$ "#$"#.#$##.#"##.#C##.#=##.#%##.#>##.#?##.#A##.#To#' I''inois T-(#m(n# E!iso.(s !(- 1112111 34111 5 41146Fig8-( 5% I''inois T-(#m(n# F8n.ing &$ T$!( 3411;5 411>622 K( K"#3###3### K=#3###3### K>#3###3### KA#3###3### K$##3###3### K$"#3###3### B11121452111$42,910,300B5424