How Chicago Successfully Reversed Opioid Trends

After a century of increasing life expectancy in the United States, 2020 witnessed a decline of 1.5 years. Although primarily attributable to COVID-19, the pandemic only exacerbated the persistent health crises of the “before-times,” further contributing to the decline. In particular, the opioid epidemic, which continues to ravage the country, has become a major contributing factor to decreasing life-expectancy. According to the Centers for Disease Control and Prevention (CDC), in the 12-month period ending in April 2021, there were 100,000 deaths from drug overdoses in the United States. This represents an almost 30% increase from the previous 12 months.

The City of Chicago has notably bucked the national trend in 2021. Comparing the first halves of 2020 and 2021, Chicago’s non-fatal overdoses dropped nearly 25%, and opioid-related overdose deaths decreased 18%. Dr. Wilnise Jasmin, Medical Director of Behavioral Health at the Chicago Department of Public Health (CDPH), attributes this to “reduce[ing] barriers to evidence-based care and adopt[ing] a ‘no wrong door approach.’” In short, the city aims to meet the needs of those affected – however they might need support.

The $1.9 trillion economic stimulus bill passed by Congress in March 2021 included $1.5 billion for the prevention and treatment of substance use disorders. While there is no one size fits all solution, the nation can look to Chicago as an example of how to effectively harness this funding. The city takes a multi-pronged approach to addiction treatment by partnering with on the ground allies and local healthcare organizations, and by leveraging existing programs, outreach initiatives, such as medication assisted therapy and incarceration diversion programs. By providing a diversified suite of mental health, social, and legal services, city health officials aim to break the cycle of addiction once and for all.

Chicago Recovery Alliance (CRA) is one example of an on the ground organization tackling Chicago’s drug-related priority number one: deaths from overdose. CRA has been working with individuals affected by HIV and drug use since 1992, providing “[assistance] in the achievement of any positive change as defined by the individuals with whom [they] engage.” While the organization’s outreach efforts were hampered by the pandemic, CRA is back on the streets in full force.

CRA outreach teams provide a range of immediate services to at risk populations, such as disposing of used illicit supplies, distributing Naloxone, a life-saving opioid overdose reversal drug, and offering overdose training, harm reduction counseling, referrals for treatment, and drug testing kits for identifying Fentanyl-enhanced substances. These approaches have proven successful, 1,987 overdoses were reversed in Chicago in 2018. In short, CRA is proving that abstinence or single treatment programs are not enough. It is more important to provide people with the tools they need, whatever their circumstances may be, to chart a realistic path out of addiction and onto stable ground.

While CRA is a great resource for those able and willing to seek assistance, the opioid crisis continues to leave behind many individuals afflicted with opioid use disorder (OUD). Naturally, individuals suffering from OUD often become entangled in the criminal justice system––a system lacking in robust treatment services and resources. Understanding the troubling reality of the addiction to prison pipeline, the Narcotics Arrest Diversion Program (NADP) was launched in 2018. Initially piloted on the West Side of Chicago, the NADP is a collaboration between the Chicago Police Department (CPD), the community health provider Thresholds, and the University of Chicago Urban Labs. Its primary purpose is to divert drug users away from the criminal justice system and towards treatment solutions.

Early results show that recidivism rates dropped dramatically for those enrolled in NADP, 7.5% compared to 58% for those unenrolled, and between 2019 and July 2021, 700 people went into treatment rather than to jail. According to Thresholds, “Of those who attended treatment at Thresholds, almost half returned for another day of treatment, which is over twice the anticipated rate.” The city plans to expand the program across Chicago by the end of 2021, while also reducing eligibility restrictions currently in place, such as prior convictions for a violent crime or illegal possession of a firearm. NADP works to stop the cycle of substance abuse and stands as a model for how law enforcement and healthcare providers can collaborate to address city wide problems.

One-time emergency interventions may not be enough for people suffering from OUD. Chicago is currently piloting a Recovery Initiation and Management after Overdose (RIMO) intervention, which is administered to patients who have overdosed. This approach combines outreach and linkage interventions for not in treatment individuals at risk for opioid overdose, Recovery Management Checkups that connect individuals who have overdosed to treatment programs, and additional recovery support. In practice, RIMO brings a team of paramedics, law enforcement officers, and peer recovery specialists to an overdose situation. Once the patient has recovered via naloxone administration, they are assigned a Linkage Manager who, among other things, conducts extensive interviews with the individual. Because of RIMO, OUD afflicted individuals were far more likely to receive sustained opioid treatment and were also more likely to be admitted into medication-assisted treatment. With a successful pilot, RIMO could prove to be a significant tool for fighting the opioid epidemic.

Chicago is now returning to 2019 levels in terms of opioid overdoses and related fatalities – levels that are still alarming. However, the various initiatives the city has undertaken in recent years are crucial parts of a major step in the right direction. As more lawsuits are settled and damages are paid out by those convicted of facilitating the opioid epidemic, continued investment in and expansion of the above mentioned programs will remain key to winning this fight. Officials in cities across the country can take heed of the progress in Chicago. There is clearly not a one size fits all approach, but every policy intervention should be geared toward meeting the afflicted on their own terms. Far too many lives have been affected by this deadly disorder, but if the case of Chicago tells us anything, it is that there are effective strategies for saving lives and improving the health of American cities.

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CDC, Office of Communication. “Vital Statistics Rapid Release – Cdc.gov.” Life Expectancy in the U.S. Declined a Year and Half in 2020, July 21, 2021. https://www.cdc.gov/nchs/data/vsrr/vsrr015-508.pdf.

Rabin, Roni Caryn. “Overdose Deaths Reached Record High as the Pandemic Spread.” The New York Times, November 17, 2021. https://www.nytimes.com/2021/11/17/health/drug-overdoses-fentanyl-deaths.html.

Chicago Recovery Alliance. “About Us – Any Positive Change.” CRA Annual Report – 2018. Chicago Recovery Alliance, 2018. https://anypositivechange.org/wp-content/uploads/CRA-Annual-Report_2018-190618.pdf.