In this rural area about 35 miles southeast of Belleville and home to about 950 people, ambulance response times can take eight to 14 minutes, says police Chief Jason Schlesinger. “It would have been a lot better” if his officers could have acted right away, he says. “That time lapse can cause death.”
The ambulance arrived in time to save the person’s life. But the incident was enough to convince Schlesinger to train his four officers in the use of naloxone, an antidote of sorts that gives overdose victims time to get to the hospital. He sees it no differently from the defibrillators his officers carry for heart attack victims. “We carry first aid equipment,” Schlesinger says. “Why wouldn’t we carry this?”
Heroin is in small-town Illinois, and in fact, most everywhere else. Google the words “heroin overdose” with the name of just about any county in Illinois, and up will pop a news story about an overdose, a court case, an education effort or a prevention measure related to heroin use. “I’ve been attending hearings around the state and one of the most disconcerting things I found was that heroin has gotten everywhere,” says state Rep. Dennis Reboletti, an Elmhurst Republican who is vice chairman of a newly formed House Bipartisan Task Force on the Heroin Crisis. “I thought heroin was only prevalent in the northern Illinois region. It is devastating communities not in a position to address it.”
Heroin is a national problem as well. Citing an 80 percent increase in heroin use among Americans between 2007 and 2012, the White House’s Office of National Drug Control Policy recently called for police and fire departments to be prepared to treat heroin overdose victims and for more access to drug treatment.
It’s a tough addiction to beat, even with treatment and support. John Roberts’ son Billy was 18 when he overdosed, a little more than a year after using heroin for the first time. Roberts even moved away from his home in suburban Homer Glen with Billy to help him get his life together, away from the bad influences. “It is seductive,” Roberts says. About 23 percent of people who use heroin become dependent on it, according to the National Institute on Drug Abuse.
Whether smoked, snorted or injected, heroin loads quickly into the brain, giving users a high that can make them want to seek out the opiate again, says T. Celeste Napier, director of the Center for Compulsive Behavior and Addiction, and professor, departments of Pharmacology and Psychiatry at Rush University Medical Center. The drug works on parts of the brain controlling pain, motivation and reward. “People can find heroin so incredibly pleasurable that other things that were normally important are no longer relevant. Other natural rewards like tasty food and drinks, exercise and sex feel less good when the brain is hijacked. The only thing that may give you joy is the drug,” she says.
Addiction is sneaky, a process that happens with repeated behavior as brain circuitry changes. Reward pathways in the brain change, and the user becomes obsessed with seeking and obtaining more heroin, Napier says. It works the same with other drugs or vices such as gambling. How long depends on the person. “It’s not voodoo or magic or moral failing. It’s a pathological change in the way the brain functions. Pathology means organic. It is biology. It is a disease,” Napier says. With their impulsive, vulnerable brains that are more attuned to peer pressure and less able to make healthy choices when it comes to long-term consequences, teens are especially vulnerable.
Then, there is dependency. Heroin tolerance can build quickly, requiring a person to take more and more to get high. Once dependent, painful withdrawal symptoms can be felt within 12 hours of taking the drug, according to the National Institutes of Health. Nausea, vomiting, diarrhea and body aches are common. Some addicts have gone to the emergency room, thinking they had a severe case of the flu. “Avoiding withdrawal becomes a very big motivator to keep from experiencing these symptoms again and an easy way to avoid withdrawal is to take more heroin. This creates a vicious cycle,” Napier says.
Addicts can recover. “That is the hallelujah at the end of the song,” Napier says. But it isn’t easy. Relapse is seen as probable, and successful recovery can require years under a doctor’s care. Because the potency of heroin varies, overdose is a threat every time someone tries it. It is more likely after a person hasn’t used in a while because the addict may misjudge how much to take. Besides activating the brain’s reward centers, heroin also acts on regions that control normal breathing. Overdose deaths are caused by respiratory depression and failure. The person just stops breathing. “That’s why it is such a scary drug,” Napier says.
Experts say several things have led to heroin’s widespread use, mostly because it is available, cheap at $5 to $10 in Illinois, and provides an intense high. Also, opiate prescription pain killers have become widely used, providing a gateway for heroin. While not all prescription drug abusers move on to heroin, the Substance Abuse and Mental Health Services Administration found about 80 percent of heroin users previously used prescription pain relievers. Heroin is a cheap substitute.
Getting a precise handle on the scope of the problem is difficult. Deaths specifically caused by heroin aren’t tracked statewide, although a bill is pending in the Illinois legislature to tally drug overdose deaths. Kathie Kane-Willis, director of the Illinois Consortium on Drug Policy at Roosevelt University, looks at heroin-related emergency room visits and publicly funded drug treatment programs to measure heroin use. A 2012 report by the consortium showed the Chicago metropolitan area ranked first in the country for heroin-related emergency room visits in 2010 ahead of Boston, Detroit, New York and Seattle. Heroin was the second most common drug after alcohol for Illinoisans to enter publicly funded treatment in 2009. About a decade earlier, heroin ranked as the fourth most common reason.
News reports across the state reveal the drug is pervasive and used by young, old, rich and poor. A small sampling of some stories from last year reveal: A former judge who presided over drug cases in St. Clair County pleaded guilty in a federal drug case, admitting he was a heroin addict. A 44-year-old woman was found dead last year in a portable toilet outside a Decatur high school. In November, a 17-year-old from Benson, a town of about 400 people located 30 miles north of Bloomington, died in his home. The Franklin County coroner, in southern Illinois, reported at least two heroin deaths last year after having none the previous year. A 27-year-old Springfield man was indicted for delivering the heroin that caused the death of a 43-year-old man. Meanwhile, Winnebago County, which includes the Rockford metropolitan area, had 51 confirmed heroin deaths, up from 37 in 2005. And in DuPage County, west of Chicago, a record 45 heroin-related deaths were reported. The youngest person was 15 and the oldest 64, while nearly half of the deaths were between the ages of 20 and 29.
Individual stories make the issue personal. Police and prosecutors in some areas of the state adopted a get-tough-on-crime approach to fighting heroin. In 2012, the death of a 17-year-old former cheerleader from Troy was a wakeup call, says Madison County State’s Attorney Tom Gibbons. “This was a nice family and not the image of a heroin user that you would think of: the heroin junkie with a needle stuck in his arm,” Gibbons says. “Our society used to look at overdoses as happening to just another junkie. It was an impersonal problem. But when you talk to family members, moms and dads, you realize there is a human cost to this.” Law enforcement in the area started treating overdose scenes like crime scenes with Steven Wiggington, U.S. attorney for southern Illinois, widely quoted saying, “We are going to treat every overdose as a potential homicide. Heroin is the bullet.” The cheerleader had been a classmate of his daughter.
About 30 people are doing time in state prison for drug-induced homicide, for supplying any amount of an illegal drug to someone who dies of an overdose. Sentences range between six and 30 years.
Besides getting tough on heroin crimes, other efforts are underway around the state to deal with what some describe as an epidemic. Two statewide task forces, the House Bipartisan Task Force on the Heroin Crisis and the Young Adults Heroin Use Task Force, are holding hearings around the state to gather information. Counties are creating task forces to combat heroin locally. Local officials are urging the public to safely dispose of old prescription painkillers.
Meanwhile, state lawmakers are considering a package of bills to track overdoses, raise awareness about the state’s Good Samaritan law, educate prescription holders on the dangers of young people having access to opiate painkillers, and create a “last chance” substance abuse treatment facility in DuPage County. The facility would provide intensive treatment for addicts convicted of drug crimes. Treatment would be cheaper and provide better outcomes than warehousing addicts in prison, Reboletti says. “We have to address that we need to treat the symptoms and not the final outcome all the time.’’
DuPage County Public Defender Jeff York had enough when a client died in the bathroom during treatment last year. “We’ve had a lot of clients die, almost to the point where it doesn’t affect us as much,” he says. After that death, York pulled together a group of people from around DuPage County to talk about what could be done. Grant Eckoff, the county’s Judicial and Public Safety Committee chairman, was surprised. “I expected the solution would be to hire a lot more cops and build a bigger jail,” he says. Instead the county board agreed to allocate $100,000 for education and began hosting information forums. “Heroin was the worst kept secret in the county,” Eckoff says. “It has been eye opening. I didn’t realize it was such a pervasive problem.”
Before the education campaign, Eckoff says public forums weren’t well attended. “Schools didn’t want to have them because they didn’t want to be the heroin school, and parents didn’t want to attend because they didn’t want to have a heroin kid,” he says. The county also created a website with information and links to support groups and treatment.
A task force also formed in Madison County after three people overdosed on heroin in a 24-hour period around Valentine’s Day this year. Each was found at home. Made up of law enforcement officials, educators, health care providers and community leaders, the group is looking for barriers to education and treatment. “We’re looking to see where we are falling down,” Gibbons says. “I think there are some bottlenecks. There are a lot of great treatment options, but some people can’t get into treatment. Some don’t have the ability to get into detox. It’s getting them the help they need.”
Kane-Willis, of the Illinois Consortium on Drug Policy at Roosevelt University, is heartened. “There is a lot more compassion than there used to be and more understanding. Instead of being a reactionary, we’re-going-to-arrest-our-way-out-of-this mentality, there is a roll-up-your-sleeves-and-get-to-work kind of feeling,” she says. But she worries about scaremongering getting in the way of treating heroin like a health problem. “I wish we could look at this more rationally,” she says. Heroin is dramatized and even given life when people describe it as though it is something to slay. “Language is used to scare the bejesus out of people. How it has its own power. How it spreads and infects,” Kane-Willis says.
People want to believe heroin is the problem, when the real problem is why people are choosing to use it. “That dramatization removes us from understanding the way drug use works,” she says. The drama also makes some feel hopeless about recovery. People think they understand treatment, but most get their information from reality shows.
Offended, Kane-Willis recently scrapped her planned testimony before state lawmakers. Minutes earlier, a prosecutor told the panel that heroin addicts don’t recover. Kane-Willis set them straight by sharing her story. “I consider myself to be a reasonably intelligent person, and it took me by surprise,” she says. Like what happens in most cases, a friend introduced Kane-Willis to heroin and addiction happened over time. A college student, she knew it was a bad drug, but didn’t understand she could become physically dependent.
Kane-Willis went public in 2009 because she says there is a need for people to know addicts can recover and get better. “I have kind of a dual role. I want to be taken seriously. I don’t want to be known as the junkie-researcher,” she says. There is a lot of shame around heroin use. Philip Seymour Hoffman died alone in his bathroom, she points out. “The shame is so high that it makes the behavior more dangerous,” she says. “If he had been with someone, he might be alive.”
Heroin use tends to be social, with users pooling money and taking turns buying the drug. For that reason, Kane-Willis thinks drug court should be available to more people convicted of crimes related to heroin use, giving them treatment options. Also, she is concerned drug-assisted treatment programs like methadone maintenance aren’t accepted by the courts and that Illinois’ Good Samaritan law doesn’t go far enough. The law protects a user from a heroin possession charge if 911 is called for an overdose, but doesn’t offer protection from drug-induced homicide charges. In some cases, addicts who were getting high with friends or loved ones are going to jail. “I worry those charges might result in more people dying, that people won’t call 911,” Kane-Willis says.
Every day during two weeks last year in July, an overdose death was recorded in DuPage County. It was then, the health department decided to offer training and supply naloxone to police departments throughout the county. “All we were concerned about was what we could do to save lives,” says Karen Ayala, executive director of the DuPage Health Department. By summer, more than 1,200 officers will have been trained. The department also will encourage area doctors to prescribe the medication to families of heroin addicts and ask pharmacies to stock it. In other parts of the state, AIDS service organizations like Bethany Place in Belleville and the Chicago Recovery Alliance provide training and supplies of naloxone to police and the public besides offering needle exchange programs for addicts.
Treatment centers across the state work with both adults and teens. Of the clients treated last year at Chestnut Health Systems in Bloomington, 26 percent had an opiate diagnosis. Rosecrance in Rockford is seeing higher numbers and has made heroin a priority by admitting addicts as quickly as possible. Last year, about 12 percent of teens came for opiate addictions with 86 percent of them having a secondary use of marijuana. That compares to 51 percent of adults admitted having an opiate addiction. Break out statistics for young men between the ages of 12 and 18, and 70 percent were there for opiate use. At both facilities, detox and treatment are tailored to patients with some using opioid medications to reduce withdrawal symptoms. But not many use them at Chestnut because of the high cost of about $250 to $300 a month, says Tammy Rodgers, director of adult chemical dependency treatment centers. “Each addiction brings its own issues you have to deal with,” she says, noting it is particularly tough for addicts with chronic pain to stop using opiates when other pain relievers aren’t as effective. Another drug blocks the effects of opioids within the brain but is only used after detox. “Treatment is key to all of this. We need to bring people back to life,” says Mary Ann Abate, vice president of public policy at Rosecrance.
Both treatment groups also support education as a form of prevention. Some programs like Project DrugSmart in Edwardsville and a new program by the Hinsdale-based Robert Crown Center for Health are aimed at teaching middle and high school students about the dangers of heroin and the importance of making healthy choices. “Kids hear you get addicted and you die, when there is a lot that happens in between,” says Kris Adzia, project manager at Robert Crown. If they see a friend at a party using a drug and having a great time, there is a contradiction with what they may have learned in a health class or a public service announcement. The Robert Crown program was based in part on interviews with people in treatment about what they wished they had known about heroin. As a result, the program uses Napier to explain how opiates work in the brain and the process of dependency and addiction. It also uses an interactive, fictional story allowing students via computer to learn about a teen who becomes addicted to the drug.
The grandfather of a heroin overdose victim provided funding to help start the Robert Crown program. In many cases, family members have been working to make a difference. Billy’s father, John Roberts, founded an organization called The HERO Foundation with another Homer Glen dad, Brian Kirk, who also lost his son, Matt, to heroin. As a police chief and a father, Roberts brings a unique perspective. “I had people who probably could have helped me, but the stigma — How will this look? — kept me from being more aggressive,” he says. “If we let that stop us, people die. I’ve paid the worst possible price a parent can pay. Until we get those overdose numbers down, we’re not winning the war.”
Kristy Kennedy is a Naperville-based free-lance writer.
Illinois Issues, May 2014