Reducing Deaths from Opioid Overdoses: Successful Interventions and Clarifying Epidemiology
The Illinois Department of Human Services (IDHS) estimates that 1,826 people died in 2016 from opioid related overdoses This represents an increase of over 70% compared to 2013. The opioid crisis is a growing problem throughout the state, and across the nation, but the addiction can follow different pathways in different areas.
“Far and away most overdoses and opioid-related overdose deaths in Illinois are now caused by heroin use, often in combination with potent synthetic opioids such as fentanyl and carfentanyl,” says Professor James Swartz of the Jane Addams College of Social Work. “In states such as Tennessee or Ohio it’s been more predominantly a problem of prescription opioids, but looking at the data in Illinois, it appears to be increasingly heroin/fentanyl.”
To combat this growing problem, Swartz has been working with the IDHS Division of Alcoholism and Substance Abuse (DASA) on two aspects of the opioid epidemic in Illinois:
- Reducing the number of deaths from overdoses, and
- Gaining a better understanding of the epidemiology of addiction in Illinois.
Improving Outcomes from Overdose Reversal
Naloxone is a substance that temporarily blocks the effects of opioid drugs and has proven successful in reversing opioid overdoses. For the last year Swartz has been working on a project entitled Illinois Prevent Prescription Drug/Opioid Overdose Deaths (PDO). In six Illinois counties known to have high numbers of opioid-related overdoses – Cook, DuPage, Lake, Madison, St. Clair and Will counties – the project has increased the availability of naloxone reversal kits, as well as training in their use.
Sites within these counties have come up with their own approach to implementing the project. Each PDO site is also implementing unique interventions such as increasing “warm hand-offs” of overdose survivors between the police and other first-responders and health care providers, to encourage increased treatment participation.
Swartz will analyze data collected from each site to determine best practices. “Each site is almost like a unique laboratory, and we’ll be doing a careful examination of the data to see what practices are most effective for reducing overdoses and overdose-related deaths as well as use of opiates,” he says.
To help achieve that goal, Swartz will collaborate with the UIC Center for Clinical & Translational Sciences to create an Internet-based app that can be accessed on computers or mobile devices to capture information about naloxone administration from first responders and bystanders in the field.
The PDO project is being conducted under a five-year federal grant from the Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Prevention, administered in Illinois by DASA.
The Epidemiology of the Opioid Crisis in Illinois
Swartz is also conducting an epidemiological analysis of data from a variety of sources. “I’m trying to collect data from as many sources as I can to help us understand how the State of Illinois can best direct its resources to reduce opioid overdoses and use,” he says. “For example, the state has epidemiological data on the general population, but it has never been examined side-by-side with data from the criminal justice system, for people screened as they enter prison. We’ve also never looked at veterans, and we really don’t have comprehensive data for the LGBTQ community.”
Swartz adds that he would also like to include data collected by the Illinois Youth Survey. “They collect information on high school age youth, and we want to look at that because young people have one of the highest prevalence rates of nonprescription opioid use.”
He goes on to say that we also need to achieve a better understanding of the social factors that lead to opioid addiction. “The social drivers can be very different. What drives it in Chicago communities is different than in DuPage county, for example, where people become addicted to opiates via a different pathway,” Swartz says.
He explains that a person might start by using a friend’s or family member’s prescription opioids and then transition to heroin if those become difficult to obtain. Another person might start by snorting heroin but then proceed to injection use to obtain a better high as tolerance develops. “We don’t at present know the percentages of people who follow these different pathways,” he says, “let alone which pathway is more likely to lead to chronic use, addiction, and high risk for overdose.”
Socioeconomic factors may also affect a person’s propensity for use and addiction. “Many of our poorest neighborhoods in Chicago and in other parts of the state, often disproportionately composed of racial and ethnic minorities, have been especially hard hit by this epidemic,” Swartz says. “And we also know that chronic stress and trauma exposure increase the chance of developing an addiction. But addiction is by no means bounded by socioeconomic status or race. Everyone has some susceptibility to becoming addicted to these potent drugs.”
The dean of Jane Addams College of Social Work, Creasie Finney Hairston, adds, “The lives of so many people are being devastated by the opioid crisis, often in communities where access to health services is very limited. As social workers, it is our responsibility to ensure that communities are made whole and well. Only through community wellbeing and health equity will we achieve social justice.”